Maternal and Child Health

Maternal and Child Health

August 1, 2011

Maternal Child Health

• Different from Women’s Health and Child’s Health– “Maternal”– Health of mothers and

children highly inter-related: pregnancy, nutrition, lactation, primary care provision, health seeking, advocacy for education etc

– Maternal educational status consistent predictor of infant survival

Leading Causes of Under Five M & M in Developing World

• Infectious Diseases leading cause of death among children (about half)

• Undernutrition – Potentiating effects on infectious diseases– Related to poor learning and cognitive function

• Perinatal (extreme prematurity, stillbirth etc)

Infectious Diseases in Under 5’s

• Many vaccine preventable– Expanded Program of Immunization (EPI) established 1974– Has significantly reduced polio, neonatal tetanus, and measles

• Parasitic diseases-treatment available for almost all– Malaria major killer in sub-saharan Africa (1 million per year) and

extensive morbidity extensive ---> severe anemia, undernutrition– Helminth infections ---> anemia, undernutrition, cognitive

• HIV/AIDS• Acute lower respiratory tract infections (number 1)• Diarrheal illnesses - highlight precarious state of children

• The assets of the top 3 billionaires are more than the combined GDP of all of the least developed countries and their 600 million people

• At least 1/5 of the world’s population (1.2 billion people) live in absolute poverty, surviving on US$1 or less a day, and a total of 50%, half of the world’s population, live on US$2 or less a day

• 70% of people living in absolute poverty are women.

• Every minute 20 children under 5 years old die, leading to over 10.6 million deaths a year.

• 53% of childhood deaths are associated with malnutrition, as a direct or indirect cause.

• 66% of child deaths each year are caused by diarrhea, acute respiratory infections, measles, malaria and perinatal illnesses.

Sources: For cause-specific mortality: EIP/WHO. Caulfield LE, de Onis M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr. 2004 Jul.; 80 (1): 193-8

Diarrhoea12%

Other29%

Perinatal22% HIV/AIDS

4%

Measles5%

Malaria8%

Pneumonia20%

Deaths associated

with undernutrition

60%

Major causes of death among children under five, world, 2000

0

20

40

60

80

100

1983 1999 1983 1999

Post-neonatal mortality

Late neonatal mortality

Early neonatal mortality

Developing Regions

Developed Regions

Source: RHR/WHO, 2001

Infant Mortality, what are the factors?

Maternal Mortality

• Risk of dying as result of pregnancy or childbirth

– 1 in 30 000 in Sweden– 1 in 6 in Afghanistan and Sierra Leone

• Maternal mortality ratio (# of maternal deaths/100 000 live births)

– US - 17– Haiti - 680– Malawi - 1800

UNICEF, 2004

0

200

400

600

800

1000

1200

1400

1600

1800

US

Haiti

Malawi

Maternal Mortality

MMR

UNICEF, 2004

More Disparities• Urban vs Rural

– Afghanistan: • MMR 418 in Kabul • MMR 6507 in rural Ragh

• Wealthy vs Impoverished– Peru

• Richest quintile – MMR 130• Poorest – MMR >800

0

2

4

6

8

10

12

14

16

18

20

US Maternal Mortality Ratios

White, non-Hispanic

African-American

Disparities at home

What can be done

26¢Measles vaccine Per dose

Malawi boosted immunization coverage to 90 percent in 2002 from 50 percent in 1980. For the first time ever, no measles deaths were reported in 1999.

What can be done

$1.20Tetanus vaccine 3 doses for mother

Bangladesh increased coverage for mothers to 86 percent in 1998 from 5 percent in 1986; during the same period, the death rate fell to 4 per 1,000 live births from 41.

What can be done

33¢Oral rehydration salts Per dose

In Mexico, since the introduction of oral rehydration therapy in 1984, mortality rates for diarrheal diseases fell by 60 percent in less than a decade.