1. Overview: Maternal and Child Health in Underdeveloped Countries (or: The World is NOT Flat) HServ/Epi 544 Winter Term 2007

2. Objectives of session Provide an overview of main health problems of women, newborns, and children in underdeveloped countries, including the underlying inequalities Discuss the chief interventions that address those problems Present some challenges in promoting maternal and newborn health in various settings

3. A look at inequalities in global health Definitions: IMR= Infant mortality rate MMR= Maternal mortality ratio LTR=Lifetime risk of dying (of a pregnancy-related cause) expressed as a ratio of 1:x TFR=Total fertility rate CPR=Contraceptive prevalence rate ANC=Antenatal care SBA=Skilled Birth Attendant PC/GNI=Per capita gross national product

4. Overview of inequalities in MCH IMRMMRLTR 1:x TFRCPRANCSBAPC/GNI In $$ Kenya791000195.0398842460 Timor- Leste 64660307.8106118550 South Africa 542301202.85694843630 Nicar- agua 31230883.2698667790 USA71725002.07699 41,400

5. Maternal Health Problems 180–200 million pregnancies per year 75 million unwanted pregnancies 20 million unsafe abortions ~600,000 maternal deaths (1 per minute) 1 maternal death = 30 maternal morbidities

6. Maternal Deaths per 100,000 Live Births Source: WHO, UNICEF, and UNFPA, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA, 2003.

7. *other direct causes include ectopic pregnancy, embolism, anaesthesia-related ** indirect causes include: anaemia, malaria, heart disease, HIV/AIDS. Source: "Maternal Health Around the World" poster. World Health Organization and World Bank, 1997

8. But WHY Do These Women Die? Three Delays Model 1.Delay in decision to seek care –Lack of understanding of complications –Acceptance of maternal death –Low status of women –Socio-cultural barriers to seeking care 2.Delay in reaching care –Geography (mountains, islands, rivers) –Poor transport & organization 3.Delay in receiving quality care –Shortages of supplies, personnel –Poorly trained personnel with punitive attitude –Finances

9. Current approaches to reducing maternal mortality Antenatal care Skilled birth attendants –Traditional birth attendants (TBAs) –Skilled professional attendant at delivery Emergency Obstetric Care (EmOC) Postpartum care Family planning

10. Coverage of Maternal Health Services Source: "Coverage of Maternal Care: A Listing of Available Information, Fourth Edition". World Health Organization, Geneva, 1997.

11. Skilled Care at Delivery and Maternal Deaths Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America/ Caribbean Central, Eastern Europe/ Baltics/ CIS* * Commonwealth of Independent States (former Soviet Union). Source: UNICEF End of Decade Databases—Delivery Care and Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA, 2004.

12. Child Health Problems

13. Status of child health today Almost 11 million children under 5 died in 2004 –30,000 will die today –equivalent to a tsunami every week More than half of these deaths are preventable and/or treatable

14. Causes of Mortality among Preschool Children, 2002 Deaths associated with malnutrition 50% Other HIV/AIDS Measles Malaria Diarrhea Acute Respiratory Infection Perinatal Source: WHO (2003)

15. How effective are global child health programs? Nearly a quarter of children are not routinely immunized Almost half do not have access to antibiotics to treat pneumonia More than two-thirds do not receive oral rehydration solution to treat diarrhea 98% do not sleep under insecticide- treated nets to prevent malaria

16. Health of Newborns

17. Health risks in the newborn:

18. Causes of newborn deaths SEPSIS (septicemia, pneumonia, meningitis, diarrhea) 52% ASPHYXIA 20% PREMATURITY 15% Other 13% (Bang AT, Lancet 1999;354:1955-61))

19. In summary: Maternal health problems often require relatively sophisticated medical interventions for effective management Most child health problems can be dealt with at the community level, with adequately trained and equipped personnel Newborn health problems require a mixture of the two approaches