Overview: Maternal and Child Health in Underdeveloped Countries or: The World is Not Flat HSERV/GH 544 Winter Term 2011. Objectives of session. Provide an overview of main health problems of women, newborns, and children in underdeveloped countries, including the underlying inequalities
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IMR= Infant mortality rate (deaths 0-11 months/1000 live births)
MMR= Maternal mortality ratio (pregnancy-related deaths per 100,000 births)
LTR=Lifetime risk of dying of a pregnancy-related cause (expressed as a ratio of 1:x women of childbearing age)
TFR=Total fertility rate (expected pregnancies per woman CBA)
CPR=Contraceptive prevalence rate (proportion of couples in union using a modern contraceptive method)
ANC=Antenatal care (variously defined)
SBA=Skilled Birth Attendant (doctor, nurse or midwife)
PC/GNI=Per capita gross national product
Some inequalities in global health:
MMR LTRPC/GNIItaly 3 26,60032,020
United States 114800 44,970
Thailand 44 900 2990Ecuador 210 170 2840
India 450 70 820Mozambique 520 45 290
Timor-Leste 380 35 840
Nepal 830 31 260
Source: State of the World’s Children 2008, UNICEF
What are the medical causes of maternal deaths?
*other direct causes include ectopic pregnancy, embolism, anaesthesia-related** indirect causes include: anaemia, malaria, heart disease, HIV/AIDS.
(50% of all deaths in 2008 were in only 6 countries: India, Nigeria,
Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo)
Middle East and
Europe/ Baltics/ CIS*
* Commonwealth of Independent States (former Soviet Union).
Source: UNICEF End of Decade Databases—Delivery Care and
Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA, 2004.
From: A global picture of poor-rich differences in the utilisation of delivery care, Anton Kunst and Tanja Houweling, Health Services Organization and Policy, 17, 2001
Source: WHO (2003)
At least a quarter of children are not routinely immunized
Almost half do not have access to antibiotics to treat pneumonia
Nearly two-thirds do not receive oral rehydration solution to treat diarrhea
90% do not sleep under insecticide-treated nets to prevent malaria
But remember -- technology is not the only answer….
Fall in the standardized death rate per 100,000 population for nine common
infectious diseases in relation to specific medical measures for the United States, 1900-1973
(Source: McKinlay , J. B., & McKinlay, S. M. (1977). The questionable contribution of medical
measures to the decline of mortality in the United States in the twentieth century. Milbank Memorial
Fund Quarterly. Health and Society, 55 (3), 405-428.)
SEPSIS (septicemia, pneumonia, meningitis, diarrhea)
(Bang AT, Lancet 1999;354:1955-61))