Lecture 6 - Part 2

Question 1

What is the Greatest global inequality in?

Answer 1

maternal deaths

Question 2

What is the Maternal Mortality Ratio?

Answer 2

deaths during pregnancy and 42 days postpartum
OVER
100,000 live births

Question 3

What is the maternal mortality ratio in developed vs developing countries?

Answer 3

developed: 12/100,000
developing: 205/100,000

Question 4

What is the maternal mortality ratio in Canada?

Answer 4

6/100,000

Question 5

Which country has the highest maternal mortality ratio?

Answer 5

Sierra Leone 1,360/100,000

Question 6

Every day, how many women die from preventable causes related to pregnancy and childbirth?

Answer 6

830

Question 7

What % of all maternal deaths occur in developing countries?

Answer 7

99%

Question 8

Between 1990 and 2018, maternal mortality worldwide dropped by what %?

Answer 8

50%

Question 9

what is the sustainable development goal related to global maternal mortality?

Answer 9

Between 2016 and 2030, the target is to reduce the global maternal mortality ratio to less than 70 per 100000 live births

Question 10

Half of all the gains in maternal mortality can be attributed to?

Answer 10

gains made in india

Question 11

What is the Lifetime risk of maternal mortality in high income countries? low income?

Answer 11

high income: 1/5000
low income: 1/200
*note that this risk is also affected by fertility

Question 12

What could potentially bias estimates of the causes maternal mortality?

Answer 12

the fact that only 30% of women in lower income countries give birth in hospitals and if they die in their home, it’s possible the cause of death will be inaccurate

Question 13

What are the 6 top cause of maternal mortality (in order)

Answer 13

1. Haemorrhage (35%)
2. Hypertension (18%)
3. Indirect (18%)
4. Other direct (12%)
5. Abortion (9%)
6. Sepsis (8%)

Question 14

What is the Mexico City Policy?

Answer 14

Also referred to as the gag rule

it is a US policy that blocks US federal funding for NGOs that provide counselling, referrals, advocate to decriminalize abortion or expand abortion services.

Question 15

What % of women worldwide report sexual violence?

Answer 15

35%

Question 16

What did a south african survey find about attitudes about forced sex?

Answer 16

62% of adolescent boys saw nothing wrong with forced sex

Question 17

Why is Sweden rated so highly in world rankings of sexual violence?

Answer 17

probably because of differences in reporting, rather than it actually being more common (less stigmatized)

Question 18

What % of Sierra Leone’s women face sexual or physical violence during their lifetime?

Answer 18

almost 50%

Question 19

What % of Sierra Leone’s women have been victims of genital cutting?

Answer 19

90%

Question 20

Abortion is still illegal in how many countries?

Answer 20

3

Question 21

How many unsafe abortions occur every year?

how many deaths result?

Answer 21

20 million

70,000

Question 22

What is the second cause of death for 15-19 year-old girls globally?

Answer 22

Complications during pregnancy and childbirth

Question 23

How many girls aged 15-19 give birth every year?

How many under 15?

Answer 23

15-19: 16 million

under 15: 1 million

Question 24

What strategies have been tried to make home deliveries safer?

Answer 24

1. Trained Traditional birth attendants

2. Skilled birth attendants

Question 25

Which methods for improving the safety of deliveries have failed? which have worked?

Answer 25

Trained Traditional birth attendants -> No impact Skilled birth attendants: 3-6 months of paramedic training and then additional training -> still little impact The main thing that improves outcomes in delivering in a hospital or health facility, so now the focus is on encouraging that whenever possible

Question 26

What are the leading causes of under 5 mortality? (top 2)

Answer 26

1. Preterm birth | 2. Pneumonia

Question 27

What % of under 5 deaths are in the neonatal period?

Answer 27

45%

Question 28

Where do over 80% of under 5 deaths occur?

Answer 28

sub saharan africa and south east asia

Question 29

How many deaths each year are averted by vaccination? How many more could be averted if vaccination coverage improved?

Answer 29

2-3 million an additional 1.5 million

Question 30

What is the Integrated Management of Newborn and Childhood Illness?

Answer 30

an integrated approach to child health that focuses on the well-being of the whole child includes both preventive and curative elements that are implemented by families and communities as well as by health facilities

Question 31

What are the components of Integrated Management of Newborn and Childhood Illness?

Answer 31

1. Improving case management skills of health-care staff 2. Improving overall health systems 3. Improving family and community health practices

Question 32

What is the Integrated Management of Newborn and Childhood Illness case management process?

Answer 32

1. Assess a child 2. Classify a child’s illnesses 3. Identify treatments for the child. 4. Treatment instructions 5. Counsel the mother to solve any feeding problems and her own health. 6. When a child is brought back to the clinic give follow-up care and if necessary reassess the child for new problems

Question 33

What are the colour codes used in Integrated Management of Newborn and Childhood Illness case-management and what do they mean?

Answer 33

Red - urgent pre-referral treatments and referral Yellow - specific medical treatment and advice Green - simple advice on home management

Question 34

What are the key family practiced that are promoted by the IMNCI? (12) - not sure if should bother memorizing all

Answer 34

1. Exclusive Breastfeeding 2. Complementary feeding / Weaning 3. Micronutrients supplementation for vitamin A, iron and zinc  4. Hygiene. Dispose of faeces and wash hands. 5. Immunization as per EPI. 6. Preventing Malaria. 7. Promote mental and social development by responding to a child’s needs for care 8. Home care during Illness 9. Give sick children appropriate home treatment for infections. 10. Care Seeking. 11. Compliance with advice 12. Antenatal Care

Question 35

What has the greatest impact on preventing pneumonia in under 5s?

Answer 35

hand washing

Question 36

What are two drawbacks to the IMNCI?

Answer 36

1. Can be overwhelming for health workers | 2. requires a lot of supervision and background support

Question 37

What is Integrated Community Case Management?

Answer 37

Community Health Workers are trained, supplied and supervised to diagnose and treat children for m1alaria, pneumonia and diarrhoea

Question 38

What evidence is there to support Community Case Management?

Answer 38

when newborns suspected to have sepsis were seen my community health workers only 5% died vs. 17% who saw a qualified medical professional

Question 39

What were the 6 “red button” signs indicating need to refer identified by the WHO What was the problem with this and how was it improved?

Answer 39

1. Suddenly not feeding 2. Feeling cold to touch 3. Convulsion 4. Disoriented, difficult to engage 5. Repeated vomiting 6. Difficulty breathing Of those referred only 17% admitted. A prediction equation was created which raised admissions to 52% implications for cost**