Islam_Global progress in maternal mortality 1990–2011

8/2/2019 Islam_Global progress in maternal mortality 19902011

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Maternal Morality: 1990-2011Asia and Pacific

Stories of Tremendous Successes

Dr Monir Islam,DirectorHealth System DevelopmentWorld Health Organization

South East Asia Regional Office


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170

130110

56

180

340

1200

690

12011082

46

140

300

970

640

919360

120

290

39

790

470

66110

270

79

34

650

44

350

5694

250

6531

580

38

290

0

200

400

600

800

1000

1200

1400

Cambodia China Laos

Mala

ysia

Mon

golia PNG

Philli

pinesVi

etnam

Baseline 1990 1995 2000 2005 2008

Asia and Pacific: Comparison of MMR Estimates

Source: Trends in Maternal Mortality: 1990 to 2008: Estimates developed by WHO, UNICEF,UNFPA, and The World Bank.


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850

600

500

420

340

190

940

650

420

260

200

570

440390

280

230212

620

440

350

270

229

420

350

411

316

219

870

700

550

440

240

229

0100

200

300

400500

600

700

800900

1000

Bangladesh Bhutan India Indonesia Myanmar Nepal

1990 1995 2000 2005 2008 2010

South East Asia: Comparison of MMR Estimates


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Vulnerable population vs facilitychildbirth

05

101520

2530

35

404550

55606570

75

Nigeria 2003

(MMR 1100)

Pakistan

2006/07 2004(MMR 1500)

Bangladesh

2004 (MMR570)

Chad 2004

(MMR 1500)

Egypt 2005

(MMR 130)

Philippines

2003 (MMR230)

%o

fchildbirthathealthfacilities

Age group of 15-19 year Age group of 40 year and above

Birth interval of less than 24 months Mother with 5 or more children


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Lets talk about Bangladesh!


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Service Utilization: Bangladesh 1999-2007


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Childbirths in Bangladesh


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Childbirths by C-Section


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What About

Cambodia?


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Geographical inequities of Childbirths by SBA


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Geographical inequities of Childbirths by C-Sections


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When, Where and Why

women give their lives for bringing lives


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0

20

40

60

80

100

120

140

160

Durin

gpreg

nanc

yDa

y1

Day2

Day3-7

Day8-42

Day43

-90

Day91

-180

Day18

1-365

Year

2

Deaths

per10

00personyear

Timing of death is critical

Most deaths clusteraround labour or

within 24 hours after

delivery

Matlab, Bangladesh

Time since pregnancy

Source Ronsmans C& Graham W 2006; Lancet (9542):1189-200.

Pl f l d h


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Place of maternal deaths(74% in health facilities)

13%3%

6%

50%

13%

5%10%

Home TBA home Clinic Rural hospital

Provincial hospital Central hospital Traveling

Source: Fawcus S, Mbizvo MT, Lindmark G, Nystrom L. A community based investigation of causes of maternal mortality in rural and urbanZimbabwe. Maternal Mortality Study Group. Cent Afr J Med. 1995 Apr;41(4):105-13.
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Fawcus%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mbizvo%20MT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lindmark%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nystrom%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nystrom%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lindmark%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mbizvo%20MT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Fawcus%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract


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Reason for not going to health facilityDHS data from 26 countries in Africa (N=250000 women)


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Demand or supplies or

its organization of services

or its all about Quality?

My photo

stories


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PNG


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Bangladesh: any other districts


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1. Home 3. Lamb Hospital

CommunityHospital

Integrated

2. Safe Delivery Unit

Obstetric First Aid Comprehensive EOC

Bangladesh: the LAMB facilitiess


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So it is not an impossible task


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Lamb Hospital Deliveries

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

deliveries 492 711 674 740 776 882 1288 1363 1526 1686 2251 2156 2352 2673 3181 3723 3719 3444 3039 3321 3821

0

500

1000

1500

2000

2500

3000

3500

4000

4500

numberofdeliveries

year

LH Deliveries by Year


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Bangladesh: Its Chowgacha - so its possible!!


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Stories of India: Demand side: What about supplies


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Stories of India: Demand side: What about supplies

and quality?


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Stories of India: So, its doable!!!


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Stories of India: So, its doable!!!


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Way Forward

Its about demand side along with

supply side financing

Its about organization of services Its about quality

Its about monitoring

Its all about Health System


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Quality Facility Childbirths: Live saved, stillbirth prevented

0

50

100

150

200

250

0

200

400

600

800

1,000

1,200

2009 2010 2011 2012 2013 2014 2015

Numberofm

aternaldeathsaverted

Thousands

Number

ofnewborndeaths/stillbirthaverted

Thousands

YEAR

Stillbirth averted Newborns deaths averted Maternal deaths averted

Source: WHO Framework for accelerated reduction of maternal and newborn mortality, 2009.

R l hi ill b


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Real partnership will be necessaryto achieve our goals

N ti f l


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No more poor options for poor people

Developing countries are not rich enough

to invest on cheap ideas and strategies

Documents

Islam_Global progress in maternal mortality 1990–2011