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Averting Maternal Death and Disability AMDD

AMDD Program Orientation. 2. This Presentation Covers:. Causes of Maternal Death and DisabilityEvolution of Understanding of the ProblemCentral Role of Emergency Obstetric Care UN Process Indicators The AMDD Program. AMDD Program Orientation. 3. What Is Maternal Death?. The death of a woman while she is pregnant .

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Averting Maternal Death and Disability AMDD

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    1. Averting Maternal Death and Disability (AMDD)

    2. AMDD Program Orientation 2 This Presentation Covers: Causes of Maternal Death and Disability Evolution of Understanding of the Problem Central Role of Emergency Obstetric Care UN Process Indicators The AMDD Program

    3. AMDD Program Orientation 3 What Is Maternal Death? The death of a woman while she is pregnant

    4. AMDD Program Orientation 4 WHO Estimates 515,000 Maternal Deaths Each Year MORE THAN ONE WOMAN DIES EVERY MINUTE from pregnancy-related causes

    5. AMDD Program Orientation 5 What Is Maternal Disability? Short- or Long-term Illness Caused by Obstetric Complications

    6. AMDD Program Orientation 6 What Do Women Die Of?

    7. AMDD Program Orientation 7 OBSTETRIC COMPLICATIONS Hemorrhage 21% Unsafe Abortion 14% Eclampsia 13% Obstructed Labor 8% Infection 8% Other 11%

    8. AMDD Program Orientation 8 OBSTETRIC COMPLICATIONS Are Due to Pre-existing Conditions, Including Malaria, Anemia and Hepatitis And Increasingly HIV/AIDS

    9. AMDD Program Orientation 9 Most Obstetric Complications Occur Suddenly

    10. AMDD Program Orientation 10 WHERE DO WOMEN DIE TODAY? 99% of Maternal Deaths Today Occur in Africa, Asia and Latin America

    11. AMDD Program Orientation 11 WHAT ABOUT THE REST OF THE WORLD? Maternal Mortality Used to Be Very High in Europe and the US and so Was Infant Mortality.

    12. AMDD Program Orientation 12 WHAT HAPPENED NEXT? Better Living Conditions Reduced Infant Mortality in the US by over 40% Between 1915 and 1933

    13. AMDD Program Orientation 13 BUT MATERNAL MORTALITY “The well known triad of fever, haemorrhage and toxaemia predominated…” (Irvine Loudon)

    14. AMDD Program Orientation 14 …Until the late 1930s There was then a “steep and sustained decline which has continued in most Western countries at much the same rate for over fifty years” (Irvine Loudon)

    15. AMDD Program Orientation 15 What Happened to Reduce Maternal Mortality in the West? Effective treatment for obstetric complications was developed and used, e.g., antibiotics for infection, blood transfusions for hemorrhage

    16. AMDD Program Orientation 16 Most Obstetric Complications Can Neither Be Predicted Nor Prevented… But if Women Receive Effective Treatment in Time,

    17. AMDD Program Orientation 17 How Much Time Do We Have? It is estimated that, if untreated, death occurs on average in: 2 hours from Postpartum Hemorrhage 12 hours from Antepartum Hemorrhage 2 days from Obstructed Labor 6 days from Infection

    18. AMDD Program Orientation 18 To Avert Death and Disability…

    19. AMDD Program Orientation 19 How Can We Improve Access to EmOC?

    20. AMDD Program Orientation 20 EmOC Key Functions Cover These Services: Antibiotics (intravenous or by injection) Oxytocic Drugs (ditto) Anticonvulsants (ditto) Manual Removal of Placenta Removal of Retained Products Assisted Vaginal Delivery Surgery (Cesarean Section) Blood Transfusion

    21. AMDD Program Orientation 21 Basic and Comprehensive EmOC Facilities Antibiotics (intravenous or by injection) Oxytocic Drugs (ditto) Anticonvulsants (ditto) Manual Removal of Placenta Removal of Retained Products Assisted Vaginal Delivery

    22. AMDD Program Orientation 22 Antibiotics (intravenous or by injection) Oxytocic Drugs (ditto) Anticonvulsants (ditto) Manual Removal of Placenta Removal of Retained Products Assisted Vaginal Delivery Basic and Comprehensive EmOC Facilities

    23. AMDD Program Orientation 23 THE GOOD NEWS Not all these functions need hospitals and doctors Well-trained nurses and midwives can perform most functions at Basic EmOC Facilities

    24. AMDD Program Orientation 24 How Can We Tell We Are Making a Difference? If we know we have provided enough EmOC… …and if we know that these services are being used by women suffering obstetric complications…

    25. AMDD Program Orientation 25 How Do We Know Which Women Will Experience Complications?

    26. AMDD Program Orientation 26

    27. AMDD Program Orientation 27 Can We Really Tell if Services Are Functioning? In 1991, United Nations Children’s Fund (UNICEF) and Columbia University developed 6 Process Indicators to do just that.

    28. AMDD Program Orientation 28 In general, process indicators show you the changes in the conditions that lead to an outcome (such as death or disability)

    29. AMDD Program Orientation 29 Access to…

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    43. AMDD Program Orientation 43 The AMDD Program The AMDD Program was established in 1999 at Columbia University’s School of Public Health, Heilbrunn Department of Population and Family Health The AMDD Program is dedicated to improving the availability, quality and utilization of life-saving obstetric services in developing countries AMDD partners projects in close to 50 countries within a framework that links technical know-how with management capacity and human rights AMDD is funded by a generous grant from the Bill and Melinda Gates Foundation

    44. AMDD Program Orientation 44 AMDD Partners Project Partners: UNICEF: projects in Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka UNFPA: projects in India, Morocco, Mozambique and Nicaragua Regional Prevention of Maternal Mortality (RPMM) Network: teams and projects in 19 sub-Saharan African countries CARE: projects in Ethiopia, Rwanda, Tanzania, Peru and Tajikistan Save the Children: projects in Mali and Vietnam Reproductive Health for Refugees (RHR) Consortium: projects in 12 countries

    45. AMDD Program Orientation 45 AMDD Partners Technical Partners: Family Health International John Snow International Indian Institute of Management at Ahmedabad (IIMA) JHPIEGO EngenderHealth (formerly AVSC International)

    46. AMDD Program Orientation 46 References Loudon I. 1991. On maternal and infant mortality 1900–1960. Soc Hist Med 4(1): 29–73. Maine D. 1991. Safe Motherhood Programs: Options and Issues. Columbia University: New York. UNFPA and AMDD. 2002. Reducing Maternal Deaths: Selecting Priorities, Tracking Progress, Distance Learning Courses on Population Issues. Turin: UN System Staff College. UNICEF/WHO/UNFPA. 1997. Guidelines for Monitoring the Availability and Use of Obstetric Services. UNICEF: New York.

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