PERINATAL SITUATION IN KOSOVO FOR YEAR 2003

1. PERINATAL SITUATION IN KOSOVO FOR YEAR 2003 Doc. Dr. Shefqet Lulaj Dr. Agron Gashi

2. OBJECTIVES • Ministry of Health / Kosovo Mother and Child Health Committee / Kosovo Gynecology and Obstetric Association / Kosovo Pediatric Association and UNICEF Kosovo Office • Presentation of data by all maternities in Kosovo and centre for preterm newborns and neonatology in Prishtina. • Evaluation of perinatal situation in Kosovo for year 2003. • Problems identification and compilation of recommendations in order to improve mother and child health situation.

3. METHODOLOGY • Data are collected and reported by maternities of public health institutions. • Data are collected by centre for Preterm newborns and neonatology in Prishtina. • Standardized form of collecting and presenting data by relevant health workers from delivery and neonatal record books. • Data are analyzed based on WHO definitions and indicators. • There were no data collected on home deliveries or deliveries in private clinics. • There were no data collected from Mitrovica North Hospital.

4. WHAT IS REPORTED? • Number and structure of the health workers; • Medical equipment supply; • Reported number and mode of deliveries; • Reported number of deliveries per weight and gestation; • Reported number of newborns per weight and gestation; • Stillbirths rate, Early Neonatal Rate and Perinatal Mortality Rate per weight and gestation; • Reported number of maternal deaths and causality; • Most common causes of Early Neonatal Mortality and • Constrains and difficulties.

5. HUMAN RESOURCES

6. MEDICAL EQUIPMENT

7. NUMBER AND MODE OF DELIVERIES – 2003

8. NUMBER OF DELIVERIES PER WEIGHT - 2003

9. NUMBER OF DELIVERIES PER WEIGHT - 2003

10. NUMBER OF DELIVERIES AND NEWBORNS PER GESTATIONAL AGE - 2003

11. NUMBER OF DELIVERIES AND NEWBORNS PER GESTATIONAL AGE - 2003

12. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER WEIGHT – 2003

13. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER WEIGHT – 2003

14. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER WEIGHT – 2003

15. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE – 2003

16. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER GESTATIONAL AGE - 2003

17. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER GESTATIONAL AGE - 2003

18. STILLBIRTHS RATE, EARLY NEONATAL MORTALITY AND PERINATAL MORTALITY RATE PER GESTATIONAL AGE - 2003

19. MAIN CAUSES OF EARLY NEONATAL MORTALITY RATE IN NEONATAL UNIT – 2003

20. MAIN CAUSES OF EARLY NEONATAL MORTALITY RATE – 2003

21. NUMBER OF DELIVERIES, NEWBORNS, PERINATAL MORTALITY FOR MATERNITIES - 2003

22. MATERNAL MORTALITY - 2003

23. MATERNAL MORTALITY - 2003

24. CONSTRAINS – PROBLEMS • Often non functional equipment – (lack of adequate servicing), particularly CTG and vacuum aspirators. • Inadequate temperature in delivery rooms, operating theatre and in the unit. • Insufficient number of CTG in delivery rooms and non PH-meters. • Lack of cardio – respirator monitoring, intensive incubators, mobile RTG and ultrasounds in neonatology units.

25. CONSTRAINS – PROBLEMS • Problems with lab tests. Uncompleted hospital laboratories with necessary equipment. No functional during 24 hours. • Human resources: • Lack and inadequate delivery of health workers. • Medical equipment: • Lack of adequate equipment and lack of their servicing. • Lack of mother and child health booklet. • Lack of protocols.

26. CONCLUSIONS • Perinatal mortality rate is very high: • including weight > 500 g (27.59 ‰) • including weight > 1000 g (20.57 ‰) • Stillbirths rate is: • including weight > 500 g (15,99 ‰) • including weight > 1000 g (11.12 ‰) • Early Neonatal Mortality Rate is: • including weight > 500 g (11.79 ‰) • including weight > 1000 g (9.55 ‰) • Total are reported 7 maternal deaths (Maternal mortality rate 21.92/100 000).

27. CONCLUSIONS – CONTINUE • High number of pregnant women refereed to GYN/OBS clinic in Prishtina, sometimes not in adequate time. • Newborns refereed in inappropriate conditions to CPN and Neonatology.

28. RECOMMENDATIONS • To compile a strategy for improving mother and child health. • To support fully functionality of Kosovo Mother and Child Health Care Committee. • To compile protocols for managing antenatal, intrapartal and postpartum care and referral of obstetric and neonatal cases. • MoH, KMChCC, KOGA, KPA to establish a group of multidisciplinary experts for evaluating and assessing casual perinatal mortality and maternal mortality based on the clinical and patho-anatomy evidence.

29. RECOMMENDATIONS • To strengthen collaboration between different health care levels, health workers and partners on mother and child health care. • To implement strategies based on the evidence. • To organize annually conference for presenting and evaluating maternal and neonatal activities. • To provide continuing education of the health workers and community. • To improve quality of the antenatal visits.

30. THANK YOU