Special health needs of women and children

Transcription

1 Special health needs of women and children Images used in this presentation are from UNICEF State of the World s Children 2009; and from Wikimedia Commons Julie Byles

2 Women s Health is important to all of us Pregnancy and Childhood Adult Old Age build resources for later capacity - maternal nutrition, brain, muscle, bone, blood vessels reduce damage (eg.avoiding smoking), protect against damage (eg.anti-oxidants), prevent loss(eg. exercise). minimise disease, protect against increased demands, compensate for lost capacity. Adapted from Alexandre Kaleche WHO

3 A long way to go... Each year, over 15 million women experience severe pregnancyrelated complications that lead to long-term illness, disability or death. The majority of maternal deaths are avoidable. 99% of maternal deaths occur in Sub-Saharan Africa due to poor health and inadequate care Boama V, Arulkumaran S. Safer childbirth: A rightsbased approach. Int J Gynecol Obstet (2009),

4 Reproductive conditions including maternal deaths, disability arising from pregnancy and childbirth, sexually transmitted infections, and cancers of the reproductive organs account for 5-15% of DALYs worldwide (22% of female DALYs) Almost certainly an under-estimate, as not all things are measured, focus on economic costs rather than social costs Payne and Doyle OTPH 2009

5 A matter of place... Sub-saharan Africa - lifetime risk of a woman dying during or after pregnancy and childbirth is 1 in 16 Western Europe - lifetime risk of a woman dying during or after pregnancy and childbirth is 1 in Boama V, Arulkumaran S. Safer childbirth: A rightsbased approach. Int J Gynecol Obstet (2009),

6 Far reaching consequences Surviving children of a woman who dies as a result of a pregnancy related complication are at risk of dying Each year maternal health complications contribute to the deaths of 1.5 million infants in the first week of life and 1.4 million stillborn babies. Boama V, Arulkumaran S. Safer childbirth: A rights-based approach. Int J Gynecol Obstet (2009), In utero conditions are likely to affect our health throughout life, including risk of diabetes and heart disease, our life expectancy and how we age.

7 Major causes of maternal deaths Worldwide.. obstetric hemorrhage accounts for the overwhelming majority of maternal deaths, followed by complications of infection (15%), unsafe abortion (13%), eclampsia (12%), and obstructed labor (8%). Indirect causes account for approximately 20% of all maternal deaths worldwide

8 Beyond pregnancy Female genital mutilation (FGM) is associated with increased risk of urinary tract infections in pregnancy, anemia, preterm labor, and preterm delivery. Over 13 African countries as well as most high income countries have laws prohibiting female genital mutilation High prevalence (90%) of FGM in countries such as Eritrea, Guinea, Mali, and Egypt.

9 Unsafe abortions unsafe abortions are responsible for over maternal deaths annually, accounting for 13% of total maternal mortality. In Western Europe the incidence rate of unsafe abortion is negligible compared with a rate of 31 per 1000 women in East Africa and 34 per 1000 in South America.

10 RTIs, STDs and HIV/AIDS Endogenous Reproductive Tract Infections are the most common. They result from an overgrowth of organisms normally present in the vagina. They are easily treated and cured. Egs: bacterial vaginosis and candidiasis. Iatrogenic infections are introduced through a medical procedure such as induced abortion, insertion of an IUD or during childbirth. Sexually Transmissible Diseases are caused by viruses, bacteria and parasitic micro organisms transmitted through sexual activity with an infected partner. Some are easily treated, others are not. HIV is the most serious infection as it causes AIDS which eventually leads to death. STIs effect men and women. They can also be transmitted during pregnancy and childbirth. Reference: Population Council Reproductive Tract Infections: an introductory overview UNICEF State of the world s children 2009

11 STDs and HIV/AIDS HIV and AIDS are common causes of complications of pregnancy and delivery. In many Sub-Saharan African countries, as much as 40% of the pregnant women attending prenatal clinics are HIV positive. Decreased immunity due to HIV infection does lead to increased risks such as anemia and delayed wound healing after cesarean delivery. Without antiretroviral therapy, up to 40% of newborns from HIVpositive mothers will be infected.

12 Fertility Rates East West Centre The future of population in Asia

13 Contraception and family planning East West Centre The future of population in Asia

14 East West Centre The future of population in Asia

15 East West Centre The future of population in Asia

16 Cultural and social determinants of SRH Determinants of sexual and reproductive health are a complex interplay of factors operating at different levels in society. Eg. the main determinant of unsafe abortion is legislative restriction. (Mundigo: 2006) The legal and policy framework of a country creates a social environment that supports positive health reforms and outcomes. However, they can also create or maintain societies where health outcomes are poor eg. unsafe abortion is a major cause of maternal mortality in many developing countries. Religious beliefs influence policy and law makers as well as community and individual behaviour and decision making. For example, religious influence can determine the prevalence of contraceptive use which has consequences for unintended pregnancies and STI transmission. Gender influences the control men and women have over their health including access to services and resources and outcomes. The social relations between men and women can result in gender inequalities and reinforce long established gender roles. (Hawkes and Hart: 2000) Women frequently experience health disadvantages at a higher rate than men including higher STI prevalence in developing countries. This is due partly to the limited ability women have to negotiate sexual relationships. (Patel: 2006) Lack of access to education and financial resource also contribute to this gender imbalance and poor health outcomes.

17 International responses Millenium Development Goals: 75% reduction in maternal deaths Safe Motherhood Initiative Global Elimination of Congenital Syphilis Minimum standards for ante-natal care and childbirth Advances in Labour and Risk Management

18 Childrens health What are the key health dangers for children? Nearly 10 million children under the age of five die each year more than 1000 every hour but most could survive threats and thrive with access to simple, affordable interventions. Risk of death is highest in the first month of life. Preterm birth, birth asphyxia and infections cause most newborn deaths. Health risks to newborns are minimized by: quality care during pregnancy; safe delivery by a skilled birth attendant; and strong neonatal care: immediate attention to breathing and warmth, hygienic cord and skin care, and early initiation of exclusive breastfeeding. From one month to five years of age, main causes of death are pneumonia, diarrhoea, malaria, measles and HIV. Malnutrition is estimated to contribute to more than one third of all child deaths. Nearly three-quarters of cases of Pneumonia occur in just 15 countries. Addressing the major risk factors including malnutrition and indoor air pollution is essential to preventing pneumonia, as are vaccination and breastfeeding. Breastfeeding helps prevent diarrhoea among young children. Treatment for sick children with Oral Rehydration Salts (ORS) combined with zinc supplements is safe, cost-effective, and saves lives.

19 Key Health Dangers continued Over 90% of children with HIV are infected through motherto-child transmission, which can be prevented with antiretrovirals, as well as safer delivery and feeding practices. About 20 million children under five worldwide are severely malnourished, which leaves them more vulnerable to illness and early death. One African child dies every 30 seconds from malaria. Insecticide-treated nets prevent transmission and increase child survival. About two-thirds of child deaths are preventable through practical, low-cost interventions. WHO is improving child health by helping countries to deliver integrated, effective care in a continuum - starting with a healthy pregnancy for the mother, through birth and care up to five years of age. Investing in strong health systems is key to prevention and delivery of quality care.

20 Gender differences occur even before birth East West Centre The future of population in Asia

21 Child mortality

22 Child Mortality in Asia (selected countries) East West Centre The future of population in Asia

23 Major causes of death Group I: communicable disease; Group II: non-communicable; Group III: Injuries Lopez and Mathers 2006

24 Leading causes of death in children Lopez and Mathers 2006

25 The better news Worldwide mortality in children younger than 5 years has dropped from 11 9 million deaths in 1990 to 7 7 million deaths in 2010: 3 1 million neonatal deaths, 2 3 million postneonatal deaths, and 2 3 million childhood deaths (deaths in children aged 1 4 years). 33 0% of deaths in children younger than 5 years occur in south Asia and 49 6% occur in sub-saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2 1% per year for neonatal mortality, 2 3% for postneonatal mortality, and 2 2% for childhood mortality. I In 13 regions of the world, including all regions in sub-saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to Within sub-saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia.

26 Decline in mortality Rajaratnam et al. Lancet 2010

27 Education

28 Final thoughts Women s health is important to all of us There is a lot of inequity in maternal health, access to care, and risk of death There is much inequity in child mortality, but mortality is decreasing Inequities between males and females start before birth Education is a cornerstone of health, but is not equally distributed across gender, across socioeconomic groups, across countries