整合控烟与发展

1. Integrating tobacco control and
maternal and child health to
achieve the UN Millennium
Development Goals
1| MDGs, Tobacco and MCH | April 26, 2012

2. Presentation Outline
 Connection of tobacco and MDGs
 Impact of tobacco use on maternal health
– Fecundity and fertility, impact of co-morbidities related to tobacco
 Impact of tobacco use on child health
– Preterm, LBW, IUGR, congenital malformations, SIDS, URI, Asthma
 Tobacco use among adults and youth (prevalence)
– Smoking and smokeless
– SHS exposure and gender disparities
 Interventions based around Life cycle approach
 WHO guidelines for management of tobacco use and SHS during
pregnancy
2| MDGs, Tobacco and MCH | April 26, 2012

3. UN Millennium Development Goals
Promote
Eradicate Combat Ensure
Achieve gender
extreme Reduce Improve HIV/AIDS, environ-
universal equality
poverty child maternal malaria mental
primary and
and mortality health and other sustain-
education empower
hunger diseases ability
women
3| MDGs, Tobacco and MCH | April 26, 2012

4. Improve Reduce child
maternal mortality
health
4| MDGs, Tobacco and MCH | April 26, 2012

5. MCH and Tobacco targets
Maternal health: To reduce by three quarters the
maternal mortality ratio between 1990 and 2015
Child mortality: To reduce by two thirds the infant
and under-five mortality between 1990 and 2015
NCD HLM proposed global tobacco target: 40%
relative reduction in current tobacco smoking by
2025
5| MDGs, Tobacco and MCH | April 26, 2012

6. Impact of Tobacco on Maternal and Child
health
Maternal Outcomes Neonatal & Infant outcomes
Smoking in the  Infertility  Preterm birth
preconception period and  Spontaneous abortion  Low birth weight
during pregnancy  Ectopic pregnancy  Congenital malformations
 Placenta previa  Sudden Infant Death
 Placental abruption Syndrome
 Premature rupture of
membranes
Using smokeless tobacco in  Pre-eclampsia  Stillbirth
the preconception and  Preterm birth
during pregnancy  Low birth weight
Exposure to second hand  Respiratory problems  Stillbirth
smoke during the  Lower birth weight
preconception period and
pregnancy
6| MDGs, Tobacco and MCH | April 26, 2012

7. Advertising and Promoting targeting
women and girls
 Tobacco industry spends billions of dollars worldwide
each year on advertising, promotion and sponsorship.
 In the last 2 years, the industry has launched its most
aggressive marketing campaigns aimed at women and
girls in over a decade
7| MDGs, Tobacco and MCH | April 26, 2012

8. October 2008: Purse packs -- small, rectangular cigarette
packs that come in mauve or teal and contain superslim
cigarettes.

9. Designed to look like popular clutch-style purses with pop-up
purse packs inside and coupons for over $5 off.

10. Targeting women of different cultures

11. Targeting young women

12. Prevalence of current cigarette smoking
among 13-15 year olds
Source: Global Youth Tobacco Survey, 2000- 2007
12 | MDGs, Tobacco and MCH | April 26, 2012

13. Prevalence of current use of smokeless and
other tobacco products among 13-15 year olds
Source: Global Youth Tobacco Survey, 2000- 2007
13 | MDGs, Tobacco and MCH | April 26, 2012

14. Prevalence of adult tobacco smoking
Source: Global Adult Tobacco Survey, 2008–2010
14 | MDGs, Tobacco and MCH | April 26, 2012

15. Proportion of non-smoking adults exposed to
secondhand smoke, by WHO region - 2010
15 | MDGs, Tobacco and MCH | April 26, 2012

16. Prevalence of SHS exposure at home and
public places - 13-15 year olds
Source: Global Youth Tobacco Survey, 2000- 2007
16 | MDGs, Tobacco and MCH | April 26, 2012

17. WHO Framework Convention
on Tobacco Control

18. Proposed action by WHO:
Development of guidelines for management
of tobacco use and second hand smoke
during pregnancy

19. Effective interventions and their delivery mechanisms
Tobacco use Health interventions Existing delivery
mechanisms
Tobacco use (smoking  Screening of women and girls for tobacco Primary Health Care (PHC) facilities
and smokeless) by use (smoking and smokeless tobacco) at all and existing health care systems
women clinical visits
 Brief tobacco cessation advice
 Referral to intensive behavioural counseling
services
 Pharmacotherapy including Nicotine
Replacement Therapy (NRT) if available
19 | MDGs, Tobacco and MCH | April 26, 2012

20. Effective interventions and their delivery mechanisms
Exposure to SHS Health interventions Existing delivery
mechanisms
Exposure to second hand  Screening for tobacco use (smoking tobacco) Primary Health Care (PHC) facilities
smoke at all clinical visits, both men and women and existing health care systems
 Provide information of dangers of second
hand smoking and its harmful effects on the
pregnant woman, unborn child and other
family members
 Brief tobacco cessation advice for the
partners/husbands and others who smoke
 Referral to intensive behavioral counseling
services
 Pharmacotherapy including Nicotine
Replacement Therapy (NRT) if available for
the partners/husbands who smoke
20 | MDGs, Tobacco and MCH | April 26, 2012

21. Antenatal Care Coverage – WHO regions
21 | MDGs, Tobacco and MCH | April 26, 2012

22. 100
0
20
40
60
80
Cape Verde
22 |
Botswana
Czech Republic
Democratic People's
Dominican Republic
Jordan
Maldives
Republic of Moldova
Jamaica
Peru
Liberia
Colombia
Turkmenistan
Honduras
Kyrgyzstan
Indonesia
Burundi
Paraguay
Uzbekistan
Brazil
Lebanon
Romania
Congo
Georgia
Thailand
South Africa
Zambia
Nicaragua
Zimbabwe
MDGs, Tobacco and MCH | April 26, 2012
El Salvador
Armenia
Lesotho
Kazakhstan
Philippines
Ghana
Namibia
Sierra Leone
Italy
Myanmar
Gabon
Tunisia
United Republic of
Benin
Bahrain
Cameroon
Egypt
United Arab Emirates
Bolivia
Ecuador
Malawi
Source: WHOSIS, 29 Sep 2009
Haiti
Turkey
Mozambique
Comoros
Kenya
India
Guinea
Nigeria
Uganda
Antenatal care coverage - at least four visits (%).
Togo
Antenatal care coverage - at least four visits (%). Data extracted from WHOSIS, 29 Sep 2009
Cote d'Ivoire
Syrian Arab Republic
Algeria
Eritrea
Central African Republic
Madagascar
Senegal
Equatorial Guinea
Antenatal Care Coverage
Morocco
Mali
Azerbaijan
Timor-Leste
Nepal
Viet Nam
Cambodia
Burkina Faso
Chad
Mauritania
Bangladesh
Niger
Pakistan
Yemen
Rwanda
Ethiopia
Djibouti

23. 23 |
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MDGs, Tobacco and MCH | April 26, 2012
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SHS Exposure among Pregnant Women by one antenatal care visit
or ia
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24. WHO Guidelines
TARGET: health care providers and health systems
stakeholders
AIM: Make evidence-based recommendations for:
– management of tobacco use during pregnancy
– prevention of second hand smoke exposure during pregnancy
TIMEFRAME:
Planned to be completed by end of 2012
24 | MDGs, Tobacco and MCH | April 26, 2012

25. WHO Guidelines
Invitation to a side meeting:
Date: 24 March 2012
Time: 14:00 – 16:00 hours (followed by coffee/tea)
Venue: Pan-Pacific Hotel, Singapore
2nd Floor, Meeting room Ocean 6.
7 Raffles Boulevard, Marina Square, Singapore
25 | MDGs, Tobacco and MCH | April 26, 2012

26. Thank you
26 | MDGs, Tobacco and MCH | April 26, 2012