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1World health organization, UNICEF,UNFPA,The World Bank.trends in mortality:1990-2008.Geneva:WHO Press, World health oragnisation 2010 2.Waterston M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity : case control study, BMJ 2001;322:1089-93.
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1World health organization, UNICEF,UNFPA,The World Bank.trends in mortality:1990-2008.Geneva:WHO Press, World health oragnisation 2010 2.Waterston M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity : case control study, BMJ 2001;322:1089-93
Comparison of 1990 and 2010 maternal mortality ratio (MMR, maternal deaths per 100 000 live births) and number of maternal deaths, by United Nations Millennium Development Goal region
Target for MDG 5 • Reducing MMR by ¾ from 1990 to 2015
Where are we? • Punchab- 207/100,000 • NWFP- 275/100,000 • Sindh- 314/100,000 • Balochistan- 785/100,000 PDHS 2006-2007
The direct medical causes of maternal death are common throughout the world, and most are preventable. Thus it is the indirect and underlying causes that are important factors in determining maternal mortality and lead to significant differences between developed and developing countries • Hemorrhage • Eclampsia • Sepsis/DIC • Obstructed labour /ruptured uterus • Unsafe Abortion Direct causes Indirect causes Underlying causes
Direct vs Indirect causes • Direct--------------86% • Indirect ------------14%
Prerequisites of Accurate estimation of MMR • Complete records of all deaths • Good attribution of causes of death • Knowledge of the pregnancy status of women of reproductive age who die
Accurate estimation of maternal mortality is a challenge in low resource countries because they lack complete and accurate civil registration system with good attribution of causes of death
Five approaches of Reviewing Maternal deaths and ill heath • Facility based death review • Community based maternal death review(Verbal Autopsy) • Confidential inquiry in to maternal deaths • Survey of severe morbidity(Near misses) • Clinical audit
Maternal Morbidity • Any illness or injury caused by or aggravated by or associated with pregnancy or child birth.
well Recovered Near miss survived died
WAY FORWARD • Enhance ,empower and upgrade present health system of primary and secondary health care system • Target interventions should be applied on poor people and rural ares • Referral level facilities need to be upgraded to handle critically ill patients including Basic ICU faclities and obstetric interventions • Timely And effective referral • Health education • Refresher courses of health care providers • Family planning