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Maternal Deaths in Sri Lanka

Maternal Deaths in Sri Lanka. Underestimated?. By How much?. Why?. Civil Registration System Maternal death reviews Reports from DPDHS Hospital JMO s Bed Head Tickets Interviews with Medical personnel Household members. Information Sources.

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Maternal Deaths in Sri Lanka

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  1. Maternal Deaths in Sri Lanka • Underestimated? • By How much? • Why?

  2. Civil Registration System Maternal death reviews Reports from DPDHS Hospital JMO s Bed Head Tickets Interviews with Medical personnel Household members Information Sources

  3. Why are maternal deaths underestimated? • Registration documents not received • Not identified • Cause of death, inadequately described • Cause of death incorrectly coded • No information on cause of death 81 152 34 106 12

  4. Sources

  5. Many factors help to achieve thisLong established & gradually developed health care system. • 1858 Civil Medical system. • 1887 Registration of births & deaths. • 1921 1st antenatal clinic D.M.H. • 1953 Family planning services. • 1968 Family health bureau.

  6. Extensive Field Health structure that reaches the grass root level family • Adequate but not too sophisticated network of health institutions some manned by others specialists others by medical officers. • Commitment of the health care professionals and the .policy makers

  7. Literacy Rates Sri Lanka

  8. In 2002 • 66% of women delivered in Specialist hospitals • 44% in non Specialist hospitals

  9. Delivery Pattern of Sri Lanka • Of the deliveries in specialist hospitals • 22% in Teaching • Other Specialist Hospitals • 8% at Castle Street Hospital

  10. Deliveries in the private sector

  11. Even the picturewith low risk mothers was similar

  12. FindingsPeripheral care Sri Lanka Mean No of visits for Registered Mother 6.23 National Average 5.28

  13. Antenatal care – Need to review

  14. Family Health Worker • Skilled Midwife or the Family Health Worker • Inexpensive • Culturally acceptable • Accessible • Trained in a short time

  15. Free health service • Maternity care including blood transfusions & surgery is available free to any women in any part of the country

  16. Government’s spending money on health • Is it affordable

  17. Different Strategiesat different stages • High M.M.R Low level skilled • Declining M.M.R Medium level skilled • Acceptable M.M.R High level skilled

  18. Different Strategiesat different stages • Establish foundations for • Professionalized midwifery • Monitoring systems • Advocacy • Improving access to rural & marginalized groups • Improvement of utilization of available services by improved quality of care • Client Empowerment

  19. Maternal Mortality Reviews • 1950 Ministry of health inquiries • 1968 Association of Obstetricians submitted a memorandum suggesting a confidential inquiry • 1970 circular issued and process started

  20. Maternal Mortality Reviews • Death to be notified within 72 hrs to the Mo M.C.H(Regional) Director M.C.H.by phone or telegram • MOH to visit the hospital and home • Detailed report to be filed • Inquiry and a meeting at the institution where the death occurred within 2 weeks

  21. Maternal Mortality Reviews • Regional review meeting with all the officers concerned to discuss all deaths and plan remedial measures • National level review of all deaths with the participation of director of maternity health services and representatives of the College obstetricians

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