The Indian Perspective & Its Relevance to Maternal & Child Health

Transcription

1 We continue to do more! 2 nd International Conference Commonwealth Nurses Federation March 8 th & 9 th, 2014 London, UK The Indian Perspective & Its Relevance to Maternal & Child Health Phalakshi Manjrekar, MSN, RN Director of Nursing P.D. Hinduja National Hospital & Medical Research Centre, Mumbai NIGH World Executive Committee of the Nightingale Initiative for Global Health A teen-age mother with her newborn in Kokata, India ASIT KUMAR GHATAK, Courtesy of Photoshare #

2 Child Mortality in India Approximately two million children under age 5 die in India every year. UNICEF s State of the World s Children Report, 2007 Children in Aizwal, in the Mizoram state of India await health care 2008 Diptendu Dutta, Courtesy of Photoshare #

3 Maternal Mortality in India The Maternal Mortality Ratio (MMR) in India is 254 per 100,000 live births according to Sample Registration System (SRS) Report for This is a decline from the earlier ratio of 301 during Women & children outside a child development center in Madhya Pradesh, India Anil Gulati, Courtesy of Photoshare # UNICEF India Archives

4 Wide disparities exist across states in India. The MMR ranges from 95 in Kerala to 480 in Assam. UNICEF India, Archives Two Indian women Karamcheti Swathi, Courtesy of Photoshare #

5 India continues to endure about a quarter of all global maternal deaths. Population Foundation of India A child in Ahmedabad, India, nurses her mother who is suffering from fever after giving birth 20 days ago Sharvari Raval, Courtesy of Photoshare #

6 Globally, every year, over 280,000 women die of pregnancy related causes & 99 % of these occur in developing countries. Population Foundation of India A pregnant woman waits for delivery outside a maternity centre in Mozambique Arturo Sanabria, Courtesy of Photoshare #

7 which also accounts for almost one-fourth of the world s maternal deaths. Population Foundation of India Women wait for antenatal care (ANC) at a health centre in Nampula, Mozambique Arturo Sanabria, Courtesy of Photoshare #

8 India faces the enormous challenge of reducing infant mortality from 53 / 1000 live births to less than 30. Population Foundation of India In the hills of India s Uttaranchal state, young children take care of babies Shuvi Sharma, Courtesy of Photoshare #

9 The average decline of IMR per year between the years 2004 to 2008 has been about 1 % per year. UNICEF India, Archives Photo Attribution:

10 In 2008, the IMR was 53/1,000 live births. Eight Indian states contribute to 75 % of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat & Assam. UNICEF India, Archives Photo of a young mother of the Bodo Tribe in Assam from Wikimedia Commons, photographer: Rajkumar1220, used with Creative Commons Attribution 2.0 Generic license.

11 Neonatal Mortality Rate Mortality in the newborn period stands at 35/1000 live births & contributes to 65 % of all deaths in the first year of life. UNICEF India Archives Photo Attributions: UNICEF India/2010/Graham Crouch from

12 Between neonatal mortality has decreased only slightly from 37/1000 live births to 35/1000. UNICEF India Archives Photo Attribution:

13 56 % of all newborn deaths occur in five Indian states UP, Rajasthan, Orissa, MP & Andhra Pradesh. UNICEF India Archives Graphic Attrribution:

14 Four major causes contribute to about 60 % of all deaths in the newborn period: pre-maturity low birth weight birth asphyxia infections UNICEF India Archives Photo of a poor woman & her child in India from Wikimedia Commons, photographer Peter van der Sluijs, used with the GNU Free Documentation license.

15 Indian Health Ministry Aims: Maternal mortality to decrease from 254 per 1,00,000 live births to less than 100 by Ministry of Health & Family Welfare, Government of India, January 2013 A mother watches her newborn in a sub-health centre in Madhya Pradesh, India Anil Gulati, Courtesy of Photoshare #

16 MMR Address Three Causes: Medical Socio-economic Health Systems Ministry of Health & Family Welfare Government of India, January 2013 A small girl & her younger brother in Bittal Village, Durg District, Chhattisgarh state, India Pritam Kumar Nanda, Courtesy of Photoshare #

17 Direct Medical Causes Postpartum Hemorrhage 37% Sepsis 11% Unsafe Abortions 8% Hypertensive Disorders 5% Obstructive Labor 5% Ministry of Health & Family Welfare Government of India, January 2013 A displaced pregnant woman in Ahmedabad, Gujarat state, India Sharvari Raval, Courtesy of Photoshare #

18 Indirect Medical Causes Anemia Malaria Ministry of Health & Family Welfare, Government of India, January 2013 Life can be tough for pregnant women in rural India. Photo Attribution: Jane Wakefield, Technology Reporter, BBC, from

19 Child Mortality 0-5 Years Treat the Causes: About 70 % perinatal conditions Respiratory Infections 22% Malnutrition is an underlying cause responsible for about 30% of all deaths in childhood. Ministry of Health & Family Welfare, Government of India, January 2013 A family of children living on a street in Ahmedabad, India Sharvari Raval, Courtesy of Photoshare #

20 Child Mortality 0-5 Years Neonatal Causes 52% Pneumonia 15% Diarrheal Diseases 11% Measles 3% Injuries 4% Other Causes 15% WHO Child Health Epidemiology Reference Group (CHERG) 2012 Indian children filmed by Al Jazeera English, posted on Wikimedia Commons, Creative Commons Attribution-Share Alike 2.0 Generic license.

21 Neonatal Deaths Treat the Causes: Prematurity 18% Infections 16% (pneumonia/sepsis) Asphyxia- 10% Congenital Anomalies 5% Ministry of Health & Family Welfare Government of India, January 2013 Roadside dwellers in Mumbai from Wikimedia Commons & Agência Brasil, a public Brazilian news agency. Licença Creative Commons Atribuição 3.0 Brasil exceto quando.

22 A large number of maternal & child deaths are attributable to the three delays : delay in deciding to seek care delay in reaching the appropriate health facility delay in receiving quality care once inside that facility Ministry of Health & Family Welfare, Government of India, January 2013 Indian rural women & girls from the archives of Al Jazeera English & Wikimedia Commons, Creative Commons Attribution-Share Alike 2.0 Generic license.

23 Bottlenecks to treating the causes: Lmited availability of skilled human resources especially nurses Low coverage of services & of skilled staff postings among marginalized communities Inadequate supportive supervision of front-line service providers Coverage Evaluation Survey 2009, Rural Health Statistics 2011 Concurrent Evaluation of NRHM and NRHM Progress Reports Photo Attribution: AP File Photo from news feature on on long lines for maternal health services in India.

24 Bottlenecks to treating the causes: Low quality of training & skill-building Lack of focus to improve quality services Insufficient information, education & communication on key family practices Coverage Evaluation Survey 2009, Rural Health Statistics 2011 Concurrent Evaluation of NRHM and NRHM Progress Reports Photo Attribution:

25 Health Outcome Goals: Established in the 12th Five-Year Plan for India Reduction in Infant Mortality Ratio (IMR) to 100 per 100,000 live births by Ministry of Health & Family Welfare, Government of India, January 2013 An Auxiliary Nurse Midwife (ANM) helps a mother to learn kangaroo mother care, important for the growth of newborns in Madhya Pradesh, India Anil Gulati, Courtesy of Photoshare #

26 Health Outcome Goals: Established in the 12th Five-Year Plan for India Reduction in Maternal Mortality Ratio (IMR) to 100 per 100,000 live births by Ministry of Health & Family Welfare, Government of India, January 2013 An Indian village health worker checks a patient's blood pressure Pinky Patel, Courtesy of Photoshare#

27 Health Outcome Goals: Established in the 12th Five-Year Plan for India Reduction in Total Fertility Rate (TFR) to 2.1 by Ministry of Health & Family Welfare, Government of India, January 2013 In Birbhum, India, mothers with their infants attend a family planning & baby check-up camp organized by a local group with the help of the West Bengal Government under the National Rural Health Mission Sandipan Majumdar, Courtesy of Photoshare #

28 Coverage targets for key interventions for 2017: Increase facilities equipped for perinatal care designated as delivery points by 100%. Ministry of Health & Family Welfare, Government of India, January 2013 Photo Attribution: UNFPA Website:

29 Coverage targets for key interventions for 2017: Increase proportion of all births in government & accredited private institutions at the annual rate of 5.6 % from the baseline of 61% (SRS 2010). Ministry of Health & Family Welfare, Government of India, January 2013 A nurse weighs a newborn at a health centre in Madhya Pradesh, India Anil Gulati, Courtesy of Photoshare #

30 Only 47 % of women in India likely have an institutional delivery & 53 % have had their baby s births assisted by a skilled birth attendant. Ministry of Health & Family Welfare, Government of India, January 2013 Photo from Wikimedia Commons of a Adivasi mother & child from photographer Koustav 2007, used with GNU Free Documentation license.

31 As many as 49 % of pregnant women still do not have three antenatal visits during pregnancy. Only 46.6 % of mothers receive iron & folic acid for at least 100 days during pregnancy. Ministry of Health & Family Welfare, Government of India, January 2013 Photo Attributions: theglobalmail.org. Photogragpher Mark Ralston/Getty Images

32 Coverage targets for key interventions for 2017: Increase proportion of pregnant women receiving antenatal care at annual rate of 6% from the baseline of 53% (CES 2009). Ministry of Health & Family Welfare, Government of India, January 2013 Women of Anjana Nagar, India, pose for a photograph after attending a women's health workshop where they learned about the benefits of pregnancy & nutrition, breast feeding, birth control & STIs Francey Hart, Courtesy of Photoshare #

33 Coverage targets for key interventions for 2017: Increase proportion of mothers & newborns receiving postnatal care at annual rate of 7.5% from the baseline of 45% (CES 2009). Ministry of Health & Family Welfare, Government of India, January 2013 Mother & newborn at the Gurgaon Hospital outside of New Delhi Monique Jaques, Courtesy of Photoshare #

34 Coverage targets for key interventions for 2017: Increase proportion of deliveries conducted by skilled birth attendants at annual rate of 2% from the baseline of 76% (CES 2009). Ministry of Health & Family Welfare, Government of India, January 2013 A mother with her newborn are attended by skilled nursing at a hygienic health care centre in India Abhijit Dey, Courtesy of Photoshare #

35 Most of the causes of death in the newborn period can be prevented or managed by households, communities & health facilities. But they often are unable to provide the required care Ministry of Health & Family Welfare, Government of India, January 2013 Photo Source: Mother & baby at a nutrition rehab centre in Madhya Pradesh, from Wikimedia Commons & UK DFID, Creative Commonse Attribution 2.0 Generic license.

36 Inappropriate practices such as: delayed initiation of breastfeeding delayed clothing & early bathing Ministry of Health & Family Welfare Government of India, January 2013 A mother gives her 12-day-old infant his first traditional bath in a village near Cuduppah in Andhra Pradesh, India. This tradition involves scrubbing the infant with soap, water & an unhygienic ritual of applying dried cow dung Jeevan Kuruvilla, Courtesy of Photoshare #

37 Inappropriate practices such as: not seeking care when newborns are sick & applying harmful material on cord-stumps increase the risk of newborn deaths. Ministry of Health & Family Welfare Government of India, January 2013 Photo Attributions: NYTimes.com article on infant malnutrition in India Photographer Ruth Fremson.

38 Health facilities are often ill-equipped to provide essential newborn care to all newborns & special newborn care to sick newborns. Ministry of Health & Family Welfare Government of India, January 2013 Photo Attribution: Associated Press & the DailyMail.co.uk news article about Indian children needing hospital care.

39 Maternal & Child Health in India need utilization of local resources to benefit the beneficiaries. Multiple forces jointly hope to achieve the best for all the mothers & children. A mother & newborn benefit from maternal health & family planning in Orissa. Wikimedia Commons & UK DFID, Creative Commons Attribution-Share Alike 2.0 Generic license.