HEALTH
MOTHER CHILD
SOCIETY
Healthy children need healthy mothers
WHO 2001: Health is a complete physical,
mental and social well-being state and not
only absence of disease or ailment.
This medullar ideas conform the totality in
health, although there are differences between
ages, countries, cultures, classes and gender
that prevent a homogenous consensus.
Indicator also termed as Index or Variable is only
an indication of a given situation or a reflection of
that situation
Health Indicator is a variable, susceptible to direct
measurement, that reflects the state of health of
persons in a community.
Indicators help to measure the extent to which the
objectives and targets of a programme are being
attained.
Health Index is a numerical indication of the health
of a given population derived from a specified
composite formula.
WHO defines Indicators as
“variables which measure change”
Measurement of the health of the community.
Description of the health of the community.
Comparison of the health of different communities.
Identification of health needs and prioritizing
them.
Concurrent evaluation and terminal evaluation of
health services.
Planning and allocation of health resources.
Measurement of health successes.
Valid - They should actually measure
what they are supposed to
measure
Reliable – The answers should be the
same if measured by
different people in similar
circumstances
Sensitive - They should be sensitive to
changes in the situation
concerned
Specific - They should reflect changes
only in the situation concerned
Feasible - They should have the
ability to obtain data needed
Relevant - They should contribute to
the understanding of
the phenomenon of interest
Mortality indicators
Morbidity indicators
Disability rates
Nutritional status indicators
Health care delivery indicators
Utilization rates
Indicators of social and mental health
Environmental indicators
Socio-economic indicators
Health policy indicators
Indicators of quality of life
Other indicators
Most women do not have a good access to the
health care and sexual health education
services.
A woman in sub-Saharan Africa has a 1 in 16
chance of dying in pregnancy or childbirth,
compared to a 1 in 4,000 risk in a developed
country – the largest difference between poor
and rich countries of any health indicator.
At least 20% of the burden of disease in
children below the age of 5 is related to poor
maternal health and nutrition, as well as
quality of care at delivery and during the
newborn period.
Maternal and child health status is assessed
through mortality, morbidity and growth and
development.
Commonly used mortality indicators are :
Maternal mortality rate
Mortality in infancy and childhood:
1) Perinatal mortality rate
2) Neonatal mortality rate
3) Post neonatal mortality rate
4) Infant mortality rate
5) 1-4 mortality rate
6) Under 5 mortality rate
7) Child survival rate
Death of a female while pregnant or with in 42
days of termination of pregnancy, irrespective
of duration and site of pregnancy from any
cause related to or aggravated by pregnancy or
its management but not from accidental or
incidental causes / number of live births
In developed countries MMR has declined
significantly .
Maternal Mortality Rate
• Ratio of number of deaths arising during pregnancy
or puerperal period per 1000 live births
• Accounts for the greatest number of deaths among
women of reproductive age in developing countries
• Current MMR – 276/100000 live births
Direct obstetric causes Indirect obstetric causes
Pregnancy Resulting from
Labor previous existing
Postnatal period
disease
Or disease that
Incorrect treatment
developed during
pregnancy
GLOBAL: 400/100,000 LB
INDIA: 301/100,000 LB
CAUSES :
Hemorrhage 38%
Sepsis 11%
Hypertension 5%
Obstructed labor 5%
Abortions 8%
Anemia is the leading cause of death and also
aggravating factor in sepsis, hemorrhage and
toxemia.
Obstetric causes Non obstetric causes
Toxemia Anemia
Hemorrhage Associated diseases:
Infection
cardiac,
renal,metabolic,
Obstructive labor
infection
Unsafe abortion
Malignancy
accidents
Age at child birth
Parity
Too close pregnancy
Family size
Malnutrition
Poverty
Illiteracy
Ignorance
Delivery by untrained dais
Poor communication and transport facility
Social customs
Poor environmental sanitation
Early registration of pregnancy
At least 3 antenatal checkups
Dietary supplements: iron folic acid
Prevention of infection and hemorrhage during labor
Prevention of complications eg.
Eclampsia,malformation and ruptured uterus
Treatment of medical conditions
Tetanus prophylaxis
Clean delivery practices
Training to local dais
Promotion of institutional delivery
Promotion of family planning
Identification of every maternal death and searching
for its cause
Infant death
Neonatal death Post neonatal death
Early
neonatal
death Late
neonata
l death
Perinatal death
Still birth
28 weeks
birth 7 days 1 year
28 days
Fetal death : death prior to complete expulsion or
extraction from its mother of a product of conception ,
irrespective of duration of pregnancy.
Signs : fetus does not breath , heartbeat or pulsation of
umbilical cord is absent
Still birth rate :death of fetus weighing 1000 gm( which
is equal to 28 weeks of gestation ) or more,occuring
during one year in 1000 total births (live + dead ).
India – 9/1000 total births
Prevention :
a) Detection and treatment of infection
b) High B.P. control
c) RH incompatibility
d) Diabetes
e) Premature rupture of membranes
Infant mortality rate
The ratio of deaths under 1yr of age in a given year
to the total number of live births in the same year,
usually expressed as a rate per 1000 live births
Indicator of health status of not only infants but
also whole population & socioeconomic conditions
Sensitive indicator of availability, utilization
&effectiveness of health care, particularly perinatal
care.
Current IMR – 67/1000live birth (69)
Includes late fetal deaths(28 weeks gestation or
more) and early neonatal deaths(7 days) in one
year / live births.
Babies minimum birth weight should be 1000
gm or body length crown to heal of at least 35
cm.
India – 33/ 1000 births
Risk factors:
Maternal age > 35 or <16
High parity (with short intervals between
pregnancies)
Heavy smoking
Malnutrition – severe anemia
Infections
Number of deaths of children < 28 days of age
in a year/total number of live births in same
year
Causes:
Low birth weight
Birth asphyxia
Atelectasis
Birth injuries
Congenital malformation
Infections ( tetanus , diarrhea)
NMR is more in boys as they are biologically
more fragile than girls
NMR in India – 37 /1000 live births
Number of deaths of children between 28 days
to 1 year of age in a year/total number of live
births in same year.
Exogenous factors are responsible.
Girls die more frequently than boys because of
neglect of female children in terms of nutrition
and health care.
India – 23 /1000 live births
Number of deaths of children < 1 year / total
number of live births.
Indicates :
Health status of community
Level of living
Effectiveness of MCH services
It is given a separate treatment because:
It is largest single age category of mortality
Deaths are due to peculiar set of disease and
conditions
It is affected quickly by special health
programme.
IMR in developed countries -10/1000 LB
Reasons of low IMR in developed countries :
Improved quality of life
Improved perinatal care
Better control of communicable diseases
Advances in chemotherapy
Better nutrition , emphasis on breast feeding
Family planning
IMR in India – 58/1000 LB
Variation in different states,
M P. -79 /1000 LB
Kerala – 12 /1000 LB
Orrisa, MP,Assam, Bihar,UP,Haryana and
Rajasthan have IMR above national level
Mortality patterns:
Age – 60% of total deaths in infants occur in
first month, of these 40% die in first week.
Sex – female die more than males
Neonatal mortality Postneonatal mortality
LBW and prematurity Diarrhea
Birth injury and ARI
difficult labor Malnutrition
Sepsis Congenital anomalies
Congenital anomalies accidents
Hemolytic disease of
newborn
Conditions of
placenta and cord
Diarrhea, ARI,tetanus
Multipronged approach
Prenatal nutrition
Prevention of infection – EPI
Breast feeding
Growth monitoring
Family planning
Sanitation
PHC- high risk approach
Socioeconomic development
education
Number of deaths of children aged 1-4 years in
a year / total number of children aged 1-4
years in the middle of year
It is more refined indicator of social situation of
country than IMR.It reflects environmental
health hazards.
In developing countries – 30
In developed countries - 1
Developing countries Developed countries
Diarrhea Accidents
ARI Congenital anomalies
Malnutrition Malignancies
Infectious diseases Influenza
accidents Pneumonia
Annual number of deaths of children under 5
years expressed as a rate / 1000 LB
UNICEF considers this as best single indicator
of social development and well being as it
reflects income, nutrition, health care and basic
education.
Developed countries – 7 /1000 LB
Developing countries – 90 /1000 LB
India – 93 /1000 LB
7. CHILD SURVIVAL INDEX
1000 – Under 5 mortality rate /10
CSI of India = 1000-93 / 10 = 90.7 %
The number of deaths under 5yrs in a given year,
per 1000 children in that age group at the mid-point
of the year.
Correlates with inadequate MCH services,
malnutrition, low immunization coverage and
environmental factors
Current rate – 86/1000
Other indicators are Perinatal mortality rate,
Neonatal mortality rate, Stillbirth rate, etc.
Correlates with inadequate antenatal care and
perinatal care
Globally, 80 percent of all child deaths to
children under five are due to only a handful
of causes:
pneumonia (19 %),
diarrhea (18 %),
malaria (8 %),
neonatal pneumonia or sepsis (10 %),
pre-term delivery (10 %),
asphyxia at birth (8 %),
measles (4 %),
HIV/AIDS (3 %).
the acceptors of
IUD and sterilization are assumed to be
protected to the pregnancies.
In addition, generally half of the pills and
condom acceptors are assumed to be protected.
Now adding the acceptors from all the above
four methods and dividing by the total eligible
women (married women in reproductive ages)
in percent provides the couple protection rate.
Health is not measured directly but using
indicators
Indicator should be valid, sensitive, specific,
reliable, relevant and feasible
Used in measuring, describing, comparing,
identifying health needs and planning and
evaluation of health services
Maternal & child health. Hollistic approach.
MORTALITY DEATH
Survival
Pluripathologic SEPSIS
condition SHOCK
SHC actions MOF
OBJETO
DISEASES
MORBIDITY
Integral Care HEALTH
ACESS
PHC
ACTIONS
Susceptibility PREVENTION
RISK FACTORS Vulnerability
AGENT
SOCIAL DETERMINANTS
CAUSE
