Lecture 1- Maternal and infant public health Flashcards
broad overview of the three domains of public health
Health protection
Ensuring that the risks to health from communicable diseases and/or environmental hazards are minimised.
Health improvement
Preventing ill health and promoting wellbeing by commissioning and providing services that fit with the needs of our population
Healthcare public health
Making sure we have the right health services in place for the population and that these are effective and accessible to all those who need them
the birth experience
Maternal health is the
health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimensions of
- family planning,
- pre-conception,
- prenatal and
- postnatal care
in order to ensure a positive and fulfilling experience in most cases and reduce maternal morbidity and mortality in other cases. (WHO, Maternal Health)
UNFPA definition‘Good sexual and reproductive health is a state of complete
physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.’
having a baby is an excellent health promotion opportunity
- Many opportunities to screen for health conditions
How do we measure maternal health?
- maternal mortality ratio
- proportion of births attebnded by skilled health personnel
- contraceptive prevalence rate
- adolescent birth rat
- antenatal care coverage
- unmet need for family planning
how long does pregnnacy last
- Pregnancy 280 days/40 weeks (term +- 2 weeks)
trimesters of pregnancy
- 3 trimesters
- First (12 weeks)
- Second (12)
- Third (12)
First trimester
- Pregnancy starts at fertilisation when sperm meets egg
- Embryo implants in the uterus
- Starting of formation of embryo and placenta
- V vulnerable to teratogens at this time
Second trimester
Foetus is growing with a placenta
Third trimester
Baby ready to be born
Labour and birth
- Labour can be spontaneous or induced
- Delivery can be vaginal (normal delivery) or Caesarean section
Postnatal period
6 weeks after delivery
Maternal mortality ratio (MMR) calculated by
maternal mortality ratio (MMR) represents
- Represents the risk associated with each pregnancy (i.e. the risk of dying once pregnancy*
- Worse in lower income countries
Maternal mortality ratio (MMR) pros
- good indicator of general population health plus status of women, health services etc
- advocacy purposes
- there are methods to get around missing data
Maternal mortality ratio (MMR) cons
- does not include all pregnancies in the denominator
- dificult to get data required
- does not detail causes of mortality
International Classification of Diseases (ICD) definition of maternal death
- death of a woman while pregnant or within 42 days of the end of the pregnancy (excluding accidental or incidental causes)
- direct
- indirect
late maternal deaths
indirect or direct causes >42 days but <1 year post pregnancy
leading cause of maternal death
- Thrombosis/thromboembolism remain leading cause of direct death
- Maternal suicide is third largest cause of direct maternal death (most important cause of late maternal death)
inequalities in maternal mortality factors
- ethnic groups
- age
- living in more deprived area
Inequalities in maternal health and care have far reaching consequences
- Even before birth inequalities transmit to diff outcomes throughout life
Health protection in maternal and child health: some examples
- Good infection control: sanitation and hygiene during delivery to prevent infections (in mothers and infants)
- Controlling communicable diseases: prevention of vertical transmission of blood-borne diseases e.g. HIV
- Control of environmental hazards, such as ionising radiation, heavy metals, which can be harmful in pregnancy…
Health improvement in maternal and child health: some examples
- Family planning and contraception
- Screening for foetal abnormalities, e.g. ultrasound scans
- Folic acid for the prevention of neural tube defects
- Behaviour and lifestyle changes: e.g. stopping smoking,
- alcohol and substance misuse, improving physical exercise
- Some measures discussed in childhood:
- Weight management programmes
- Oral health promotion (brush4life)
- Free school meals
Healthcare public health in maternal and child health: some examples
“Preventing diseases or improving health-related outcomes through access and utilisation of effective healthcare interventions or treatment”
- Health needs assessment to improve access to mental health care in vulnerable young people at risk of offending
what can be done about maternal mortality
timely managemnt and treatment can
make the difference between lfie and death for mother and baby
Morbidity examples
-
Birth injury e.g. fistula can lead to disability and stigmatisation
- Caused by obstruction of babbies head causing necrosis of tissue
- Psychological morbidity
Neonatal mortality rate =
number of deaths in first 28 days of life per 1000 live births (no 100,000 like MMR)
- Around half of neonatal deaths occur in the
first 24hr of life
- Safe birth techniques
- Resuscitation training and equipment
- Challenging risky traditional practices
The problem of prematurity
- 1 in 10 babies
- 37 completed weeks
Risk factors for premature delivery
- Infant Intrauterine Growth Restriction (IUGR)- small baby
- Infection in the womb/membranes
- Waters breaking early
- Cervical or uterine abnormalities
- Pre-eclampsia
- Lifestyle factors including smoking, illicit drug use
- Multiple pregnancy
- Diabetes in pregnancy
Cause of death among children under 5 years
neonatal= prematurity
postnatal= penumonia/congenital anomalies
Key players in global maternal health
- UNFPA
- WHO
- UKAID
- USAID
- Unicef
- Royal college of obstetricians and gynaecologists
- Oxfam
Wider issues of maternal health
- Smoking
- Malaria
- HIV
- Socioeconomic status of women and access to healthcare
- Gender-based violence and fgm
- Vulnerable populations
