Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
3. Why Maternal and Child Health (MCH) Important?
• Vulnerable or special group
• Continuum of care
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4. Why Maternal and Child Health (MCH) Important?
• Evaluation of the quality of maternal and new-born care
“No woman should die giving life or endure pregnancy and childbirth, only
to go through the agony of having her child born dead or watching the
baby die minutes after birth”
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5. Civil Registration System, Household surveys, Sisterhood methods,
Reproductive-age mortality studies (RAMOS),Verbal autopsy – RHIME
(Representative, Resampled, Routine Household Interview of Mortality
with Medical Evaluation), Census
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6. Maternal Mortality Ratio
MMR = Total no. of maternal deaths* X 1,00,000
Total no of live births
*Maternal death
Death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and site of
pregnancy, from any cause related to or aggravated by the
pregnancy or its management but not from unintentional or incidental
causes
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7. Maternal Mortality Rate
Total no. of maternal deaths X 1,00,000
Women of reproductive age group
• Risk of mortality & fertility level
• Maternal mortality ratio of some other countries:
Nepal 220, Pakistan 188, Bhutan 183, Ban 173,Thailand 37,Sri Lanka 36,
China 29, USA 19, UK 7, Japan 5,World 211
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8. Trend and Current Status
Source: RGI-SRS 2016-18
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Target
• Sustainable development goal – 70 by 2030 & National Health Policy – 100 by 2020
10. Additional Maternal Indicators
Indicator NFHS3
Data
NFHS4
Data
Mothers who had minimum 4 ANC visits (%) 37.0 51.2
Mothers with full ANC care (%) 11.6 21.0
Mothers who received PNC care (%) 34.6 62.4
Institutional births (%) 38.7 78.9
Skilled birth attendance (%) 46.6 81.4
Births delivered by caesarean section (%) 8.5 17.2
Births in a public health facility delivered by caesarean
section (%)
15.2 11.9
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13. Some Definitions of Child Mortality
1. Abortion – termination of pregnancy before the fetus is viable.
2. Late fetal death – death prior to the complete expulsion or extraction from
its mother of a product of conception at 28 weeks or more of gestation.
3. Stillbirth - baby born with no signs of life at or after 28 weeks' gestation.
i. death during late pregnancy (called intrauterine death).
ii. death during labor or birth (called intrapartum death).
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14. Stillbirth Rate
SBR = Number of babies born with no signs of life after 28 weeks X 1000
Total live births + still births
• Current SBR: 4/1000,WB 5
• Target SBR (National Health Policy 2017): Achieved single digit √
• State yet to achieve: Odisha – 10
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15. Peri-natal mortality rate
• Late fetal deaths and early neonatal deaths
1. Min birth weight of 1000g at birth
2. Gestational period of at least 28 weeks
3. Why important?
Late fetal death + Early neonatal death X 1000
Total live births
Current rate: 22/1000,WB: 17
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16. Neonatal Mortality Rate
• Most vulnerable time for child’s survival | “endogenous factors”
• Focusing on neonatal deaths is critical to reduce under five mortality
NMR = Number of deaths of children <28 days of age in a year X 1000
Total live births
• Current NMR: 23/1000,WB 17
• Target NMR (NHP 2017): 16 by 2025
• Target NMR (SDG): 12/1000 by 2030
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17. 33
32
30
28
27
23
23
22
21
21
20
18
17
13
13
11
5
0 5 10 15 20 25 30 35
MP
ODISHA
UP
BIHAR
RAJASTHAN
INDIA
ANDHRA PRADESH
ASSAM
HARYANA
GUJARAT
TELANGANA
KARNATAKA
WEST BENGAL
PUNJAB
MAHARASHTRA
TAMIL NADU
KERALA
NMR ACROSS STATES
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18. Post-Neonatal Mortality Rate
Number of deaths of children aged 28 days to 1 year in a given year X 1000
Total live births in the same year
Exogenous factors | environmental & social – diarrhea, respiratory infections
& malnutrition
Currently – India: 9/1000,WB 6
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19. Infant Mortality Rate
IMR = Number of infant deaths in a year X 1000
Number of live births
• Largest single age-category of mortality | changes rapidly to
interventions | reflect socio-economic development
• Infant deaths : 10.5% of total deaths in India
• Current IMR: 32/1000,WB 22
• Target IMR (NHP 2017): 28 by 2019
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22. Under-5 Mortality Rate
Child Mortality Rate =
Number of deaths of children <5 years of age in a year X 1000
Number of live births in the same year
• Current U5MR: 37/1000
• Target U5MR (NHP 2017): 23 by 2025
• Target U5MR (SDG): 25 BY 2030
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23. 1-4Year Mortality Rate
Child death rate =
Number of children aged 1-4 years in a year X 1000
Total no. of children aged 1-4 years at the middle of the year
• Excludes infant mortality
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24. Additional Childhood Indicators
Sl No Indicator NFHS 3 NFHS 4
1 Children under 2 years fully
immunized
43.5 62.0
2 Children with diarrhoea
who receivedORS
26.0 50.6
3 Children under 6 months
exclusively breastfed
46.4 54.9
4 Children under 5 years who
are stunted
48 38
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26. Reference
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• National Health Profile 2020. Central Bureau of Health Intelligence, Directorate
General of Health Services, Ministry of Health & Family Welfare. Government of
India, New Delhi 2020.
• Park K. Park's textbook of preventive and social medicine. Jabalpur. Banarasidas
Bhanot. 2020.
• India Fact Sheet National Family Health Survey (NFHS-4) 2015-16. Ministry of
Health & Family Welfare. Government of India.
• Dr Gayathri S. Research Fellow, CMCVellore
Acknowledgment
