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Maternal & Newborn Health in the Pacific. Pasifika Medical Association, Tonga September 2013. “ Children have a right to special care and assistance”. No mother should die giving life. PICT commonalities. Relative isolation Resource poor Collectivism Service & obligation

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Maternal newborn health in the pacific

Maternal & Newborn Health in the Pacific

Pasifika Medical Association, Tonga September 2013


Children have a right to

special care and assistance”



Pict commonalities
PICT commonalities

  • Relative isolation

  • Resource poor

  • Collectivism

  • Service & obligation

  • Traditional social structures

  • Scattered populations

  • Geographical isolation

  • Resource poor

  • Cultural diversity

  • Traditional social structure

  • Gender inequity

  • Globalisation

  • Urbanisation

  • Erosion of traditional social structures



Pregnancy and better outcomes
Pregnancy and better outcomes

Pre-pregnancy health

Antenatal care

Health promoting behaviors

Labour & delivery

Postnatal care

Supportive environment

Mortality & Morbidity for mothers

Mortality & morbidity for babies


Mch policy strategy
MCH Policy & Strategy

  • “Regional Child Survival Strategy” 2005

  • “Pacific Policy Framework for Universal access to Reproductive Health” 2008

  • “Achieving MDG 4 & 5 : Scaling up programmes for Women and Childrens Health”. 9th Meeting Pacific MOH’s, 2011.

  • “Global Strategy for Women and Children’s Health” United Nations, 2010

  • “Monitoring maternal newborn and child health: understanding key progress indicators”. UN Health Metrics, 2011



11 global mch indicator pacific data
11 Global MCH indicator Pacific data 2011

Data source: World Bank data Bank 2012, Cook Is Census 2011, World Health Statistics 2012, Division of Statistics FSM 2009, Marshall Is 2007, Nauru DHS 2007, Samoa DHS 2009, Global Aids Progress Reporting 2012



Dhs data complementing moh data tuvalu under 5 yr mortality
DHS data complementing MOH data 2011TUVALU under 5 yr mortality


Maternal newborn health challenges opportunities
Maternal & Newborn health 2011Challenges & opportunities

  • Access to essential interventions

  • New technologies and medication

  • Lack of Investment in Maternal & infant health

  • Unclear policy and strategic direction

  • Not tracking results

  • ?? Accountability


Maternal newborn health challenges opportunities1
Maternal & Newborn health 2011Challenges & opportunities

  • Maternal obesity

  • Maternal smoking

  • Non-communicable diseases

  • Maternal mental health

  • Family Planning access

  • Adolescent Mothers


Adapted from Black et al.2008. 2011Cook I, FSM ,Fiji, Marshal Is, Nauru, Nuie, Palau, PNG, Samoa, Solomon Is, Tonga, Tuvalu, Vanuatu


Children s lives saved if mdg target trajectory increased
Children’s lives saved if 2011MDG target trajectory increased

Adapted from : Asia Pacific MDG Report 2011/12 UNFPA, UNICEF, WHO


Oceania 2011

31%

30%

23%


Country neonatal mortality 2010 per 1000 livebirths
Country Neonatal Mortality, 2010 2011per 1000 livebirths


Newborn survival
Newborn survival 2011

  • Maternal health & perinatal care

  • Neonatal resuscitation

  • Neonatal care – warmth, antibiotics, breastfed

  • Postnatal review <3 days



“Neonatal Resuscitation in Low resource settings. What , who and How to overcome challenges to scale up” Wall et al. 2009


Change in maternal mortality ratio by region 1990 2010 not all on track to achieve mdg 5
Change in Maternal Mortality Ratio by region 1990 – 2010 who and How to overcome challenges to scale up” Not all on track to Achieve MDG 5

WHO 2012 “MM Trends”


Mdg 5 reduce maternal mortality by 75 mmr maternal deaths 100 000 births
MDG 5 – Reduce Maternal mortality by 75% who and How to overcome challenges to scale up” MMR (maternal deaths/100,000 births)

MMR

Source: ESCAP database


Maternal deaths saved if off track countries achieved mdg target
Maternal Deaths saved if “Off track” countries achieved MDG target

Adapted from : Asia Pacific MDG Report 2011/12 UNFPA, UNICEF, WHO


Preventing maternal mortality
Preventing Maternal Mortality MDG target

  • Maternal / women’s health

  • Prevent unintended pregnancies

  • Antenatal care

  • Skilled birth attendant

  • Access to emergency obstetric care

  • Postnatal care


Why women die
Why women die MDG target

Ronsmans et al. Maternal Survival. The Lancet, 2006


Giving birth in the pacific
Giving Birth in the Pacific MDG target

  • Ideal = Delivery in a health facility with skilled birth attendant

  • Most continue to deliver at home with Skilled birth attendant access improving

  • Intervention needs to be “at the right time”

    >50% maternal & newborn deaths during the birth period (labour/delivery/postpartum)



Maternal newborn survival strategies for limited health facility setting
Maternal & Newborn survival MDG targetStrategies for limited health facility setting

Community based care

  • Education, access to Family Planning

  • Community Antenatal visits (nutrition, malaria, STI, birth preparedness)

  • Traditional Birth attendants / Village health workers

  • Delivery kits/hygiene/neonatal resuscitation/oral misoprostol

  • Postnatal care – temperature/hygiene/exclusive breast


Giving birth in the pacific the three delays
Giving Birth in the Pacific - The “three delays” MDG target

  • Delay in decision to seek care

  • Delay in reaching care

  • Delay in receiving adequate care


The 1 st delay barriers strategies
The 1 MDG targetst delay – barriers & strategies

  • Female Education

  • Antenatal education

  • Antenatal care

  • Community promotion of Maternal & newborn care

  • Low status of women

  • Lack of understanding of pregnancy /labour complications

  • Lack of knowledge of interventions

  • Acceptance of maternal death


The 2 nd delay
The “2 MDG targetnd delay”

  • Geography

  • Isolation & distance

  • Transport, roads

  • Seasonal barriers

  • Climate disasters

  • Cost

  • Transport infrastructure

  • Emergency transport

  • Anticipatory transfer

  • “waiting houses”

  • Patient subsidies


Third delay strategies
“third delay” - strategies MDG target

  • Infrastructure

  • Workforce

  • Skilled birth attendants

  • Emergency Obstetric care

  • Technology

  • Equipment & meds

  • Communication



HIV +ve antenatal women MDG target receiving antiretroviral treatmentSource: Global Aids Progress Reporting 2012 for individual countries

Pacific MCH Indicators



Stillbirth weights ttm hospital samoa 2006 2009
“Stillbirth” weights TTM Hospital, MDG targetSamoa, 2006-2009

Source: Pacific CHIP project PATIS & Delivery unit record data, Percival & Stowers 2012


Family planning in the pacific
Family Planning in the Pacific MDG target

  • 1 in 5 Adolescent girls (15-19yrs) already mothers

  • Increased health risk to mother & baby



Improving maternal newborn health
Improving Maternal & newborn Health MDG target

  • Leadership (Country & Region)

  • Prioritize mothers and children

  • Prioritize Health

  • Infrastructure & workforce

  • Health Information, Vital statistics

  • Evidence based policy

  • Upscale “best bets”


Levels of maternal newborn care
Levels of MDG targetMaternal & Newborn care

Essential tools & skills

  • Village level (non-clinical workforce)

  • Core intervention/Rx

  • Expanded care & Rx

  • Comprehensive care & Rx



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