LBM 3ANOTHER MORTALITY ? WHAT A SHAME

STEP 1 MDGs: Millenium Development Goals, hasil kesepakatan kepala negara dri 189 dai PBB yg mulai dijlaankn pd September 2000 berupa 8 butir tujuan yg dicapai th 2015 yg targetnya tercapainya kesejahteraan rakyat dan pembangunan pd th 2015 Mortality: hilangnya tanda2 kehidupan scr permanen yg dpt tjd kapanpun stlh kelahiran hidup, WHO: kematian yg mrpkn suatu peristiwa yg menghilangnya tnd2 kehdpn scr permanen MMR: Martenal Mortality Rate, kematian wanita sejak saat hamil/ kematian (42 hari) sjk terminasi kehmilan tanpa memandang lamanya kehamilan / tmpt persalinan/ 100000 kelahiran hidup Demographic: ilmu yg mempelajari penyebaran teritorial komposisi dan perubhn penduduk serta sebab2 yg timbul akbt mortalitas, migrasi dan morbiditas sosisal serta faktor ini berpengaruh untuk berubah dr waktu ke waktu.Demos : rakyat/ penduduk, grafien :menulis, tulisan2 atau karangan ttg rakyat/ penduduk

STEP 21. What are 3 components of demography and explain ?!2. What is the relathionship between demographic processes and population structure ?3. How we get data sources for mortality rate ? 4. What is the relathionship between economic structure with mortality ?5. What are the factors of mortality ? explain the patterns of factor mortality !6. What are the causes of MMR ?7. What are indicators to measure MMR ?8. What are the strategy effort to decrease MMR ?9. How to decrease child mortality under 15 yo based on MDGs 4, expecially to overcome the six conditions ?10. What are the supports of another country/ WHO to reach MDGs goals ?11. What are the doctors skill related to martenal high ?

STEP 31. What are 3 components of demography and explain ?!From journal : 1. Birth 2. Death 3. Marriage 4. Migration 5. Social mobilytyWHO said no 1,2,4 are the components of demographic structureDemographiy : study to sociaty in teritorial.Social mobilty and marriage do not change the number of population2. What is the relathionship between demographic processes and population structure ?If a birth increase so the number of population will be increase to, and then the death is increase and the population will be decrease.Imigration will be increase the population.Emigrasi will be decrease th population.Factors that affect : SDA, environtment, innovationKB can prevent population.

3. How we get data sources for mortality rate ?

Registration : pencatatatn pendduk yg dilakukan sendiri ( misal; kelahiran, kematian)Survey : proccess to collect data Sensus : general proccess from data collection, by : BPS ( badan pusat Statistik)

4. What is the relathionship between economic structure with mortality ?

Development country is number for mortatilty, maybe the income of country is high can help increase income the worker, example : if th workers child get sick, they can bring him the hospital so can decrease mortality.

Education, innovation, science and technology developed country

5. What are the factors of mortality ? explain the patterns of factor mortality !6. What are the causes of MMR ?7. What are indicators to measure MMR ?8. What are the strategy effort to decrease MMR ?9. How to decrease child mortality under 15 yo based on MDGs 4, expecially to overcome the six conditions ?10. What are the supports of another country/ WHO to reach MDGs goals ?11. What are the doctors skill related to martenal high ?

STEP 4

Faktor yg mempegaruhiBirthMortalitymigrationdemographic

MDGs

STEP 5STEP 6STEP 71. What are the factors of mortality ? explain the patterns of factor mortality !

http://www.who.int/mediacentre/factsheets/fs348/en/

2. What are the causes of MMR ?The leading causes of maternal death are classified as direct or indirect.Direct causesare those related to obstetric complications of pregnancy, labor and delivery, and the post-partum periods. Direct causes account for 80% of maternal death.* Indirect causes* are those relating to pre-existing medical conditions that may be aggravated by the physiologic demands of pregnancy. A brief overview of the leading causes of maternal death in the developing world follows.

Direct CausesNote:These cannot be predicted.Hemorrhage (uncontrolled bleeding) Accounts for approximately 25% of maternal deaths and is the single most serious risk to maternal health. Blood loss during pregnancy, labor, or post-partum. Can rapidly lead to death without medical intervention. Can be treated with blood transfusions,oxytocics(drugs which induce uterine contractions to stop bleeding), and/or manual removal of the placenta.Sepsis (infection) Accounts for approximately 15% of maternal deaths. Related to poor hygiene and infection control during delivery or to the presence of untreated sexually transmitted infections during pregnancy. Can be prevented or managed with high standards for infection control, appropriate prenatal testing and treatment of maternal infection, and appropriate use of intravenous or intramuscular antibiotics during labor and post-partum period.Hypertensive Disorders Accounts for approximately 12% of maternal deaths Pre-eclampsia(also know as toxemia of pregnancy) is characterized byhypertension(high blood pressure),proteinurea(protein in the urine, generaledema(swelling), and sudden weight gain. If left untreated, can lead toeclampsia. Eclampsiais characterized by kidney failure, seizures, and coma during pregnancy or post-partum. Can lead to maternal and/or infant death. Pre-eclampsia can be identified in the prenatal period by monitoring blood pressure, screening urine for protein, and through physical assessment. Treatment available during childbirth includes the use of sedative or anti-convulsant drugs.Prolonged or Obstructed Labor Accounts for 8% of maternal deaths. Caused bycephalopelvic disproportion(CPD), a disproportion between the size of the fetal head and the maternal pelvis; or by the position of the fetus at the time of delivery. Increased incidence among women with poor nutritional status Use of assisted vaginal delivery methods such as forceps, vacuum extractor, or performing a Caesarean Section can prevent adverse outcomes. CPD is the leading cause of obstetrical fistulaUnsafe Abortion Accounts for approximately 13% of maternal deaths. In some parts of the world unsafe abortion accounts for 1/3 of maternal deaths. Approximately 67,000 cases of abortion related deaths occur each year. Can be prevented by providing safe abortion, quality family planning services, and competent post-abortion care.Indirect Causes Accounts for approximately 20% of maternal deaths. Pre-existing medical conditions such as anemia, malaria, hepatitis, heart disease, and HIV/AIDS can increase the risk of maternal death. Risk of adverse outcomes can be reduced through prenatal identification and treatment as well as the availability of appropriate basic emergency obstetric care (EmOC) at the time of delivery.SPOTLIGHTS ON HEALTH AND RIGHTSKEY TOPICS IN THE HEILBRUNN DEPARTMENT OF POPULATION AND FAMILY HEALTHReproductive Health. Columbia University Mailman School of Public Health.http://healthandrights.ccnmtl.columbia.edu/reproductive_health/causes_maternal_mortality.html

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy. The major complications that account for nearly 75% of all maternal deaths are:3 severe bleeding (mostly bleeding after childbirth) infections (usually after childbirth) high blood pressure during pregnancy (pre-eclampsia and eclampsia) complications from delivery unsafe abortion.

WORLD HEALTH ORGANIZATIONhttp://www.who.int/mediacentre/factsheets/fs348/en/

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death.

The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour.http://www.who.int/topics/maternal_health/en/

WORLD HEALTH ORGANIZATIONhttp://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-infographic.pdf?ua=1

3. What are indicators to measure MMR ?

4. What are the strategy effort to decrease MMR ?Success factors for reducing maternal and child mortalityGood governanceGood governance, and particularly control of corruption, as measured by the World Banks Worldwide Governance Indicators,23is associated with country progress (Fig.3). Ensuring value for money is also a key feature of enabling governance, as most fast-track countries improved health outcomes despite relatively low levels of investment (Fig.8) resulting in part from low GDP per capita and significant political and economic problems.The Success Factors literature review found decentralized governance to be an enabling factor for accelerated progress.16,17However, the reach, influence and even definition of decentralized governance varies considerably between countries. Rwanda has a highly centralized policy-making approach supported by district-level planning and implementation.24In other countries, such as Nepal, geography and politics necessitated a much more regionalized approach. Caution is therefore needed when interpreting decentralized governance as a success factor.

Womens participation in politics and workforceThe Success Factors studies confirm established evidence on the links between better education and improved maternal and child health (Fig.3 and Fig.4).1418The Success Factors studies further highlight the importance of womens political and socioeconomic participation. Fast-track countries have significantly more women parliamentarians (Fig.3 and Fig.4). In Rwanda, 64% of parliamentarians are women.19,23In Lao People's Democratic Republic, the proportion of women members in the national legislature tripled between 1990 and 2003, with the government explicitly recognizing the importance of gender parity and rights for women, including through the Law on the Development and Protection of Women (2004).18,25Fast-track countries also had a higher average female labour-force participation rate than other Countdown countries in 1990 (64% to 54%) and this rate still remained higher in 2010 (Fig.3). Many fast-track countries (e.g. Bangladesh, Cambodia, China and Viet Nam) developed industries that employ large numbers of women.18The increased wages these workers earn are potentially available for expenditure on their own health, as well as that of their children and families, and further work is needed to understand these links.

Catalytic strategiesWhile fast-track countries deployed unique context-specific strategies, the Success Factors studies identified some shared catalytic strategies that these countries used to optimize the use of resources, accelerate progress and maximize health outcomes.Leadership and partnershipsIn the fast-track countries, actors across society played leadership roles in improving womens and childrens health, sometimes compensating for limited government resources.In Bangladesh, the government partners with nongovernmental organizations, communities and the private sector in the provision of health services. In 2010, over half of the births in health facilities occurred in the private sector.26Nongovernmental organizations such as BRAC and the Grameen Foundation cross-subsidize health services with revenues from their commercial activities. Telemedicine and mobile phones also help increase access to health services, particularly for underserved populations.27Partnerships between communities and service providers in the Casa Materna scheme in Peru enable pregnant women in remote rural areas to await delivery in dedicated maternity centres. Transportation to hospitals is available if they need specialist care. These centres also offer culturally sensitive birthing options to promote utilization. Between 2005 and 2010, this scheme contributed to the halving of maternal mortality in the Ayacucho district.28In Cambodia, multistakeholder partnerships promoted maternal and child health through behaviour-change communication campaigns. In 2004, the BBC World Service Trust launched a mass-media campaign using television series and radio broadcasts to promote maternal and child health themes such as exclusive breastfeeding.29Knowledge and practice improved and national exclusive breastfeeding rates increased from 11% in 2000 to 60% in 2005 and to 74% in 2010.29In Ethiopia, the National Nutrition Programme uses multisector partnerships to tackle undernutrition and includes social protection, food security, community nutrition programmes, micronutrient supplementation, treatment of severe acute malnutrition and a package of free health services. The country is now on track to achieve MDG 1c to reduce hunger. Child stunting rates dropped from 57% in 2000 to 44% in 2010.18,30Decision-making and accountabilityDespite limited resources, fast-track countries have developed capacities to collect, analyse and use robust evidence to inform policy, investment, implementation and accountability.The Success Factors literature review highlights the value of evidence-based tools and health information systems.17Save the Childrens Saving Newborn Lives programme demonstrated the value of decision-support tools, such as the Lives Saved Tool, now included in the United Nations One Health Tool, to support national planning.31In Ethiopia, scorecards are used at all levels of the health system community, regional, and national to monitor progress on womens and childrens health. The government views scorecards as a powerful tool to track progress and identify inequities in health services delivery.32In China, the National Maternal and Child Health Routine Reporting System covers the whole population.33A national system of contracts and agreements for health providers and administrators, monitors quality and service delivery at all levels.18,19In Egypt, quality-of-care indicators (e.g. on patient satisfaction) were added to performance-based financing programmes, resulting in increased use and better quality of family planning services.34Testing innovative, evidence-based approaches to address context-specific needs has also been critical to progress. Nepal, for example, has emphasized testing and scaling up community-based approaches.35Approach to sustain progressFast-track countries achieve rapid progress by adopting a triple planning approach that focuses on: (i)quick wins with targeted or emergency strategies to address immediate, urgent needs; (ii)longer-term gains from building strong, sustainable systems to achieve a long-term vision; and (iii)adaptation to address change and sustain progress.After the genocide, in 1994, Rwanda deployed community health workers and volunteers for urgent health needs. At the same time the country promoted investments in a long-term vision to build its professional health workforce and health facilities with medical colleges, referral hospitals and international academic and professional collaborations.36,37Progress is not always unidirectional and countries need to adapt their strategies to sustain it. The Success Factors literature review identifies cases where progress has plateaued or reversed.17For example, in Namibia, an upper-middle-income country, the maternal mortality ratio increased from to 271 to 449 per 100000 live births between 1991 and 2007. Zere et al.38discuss how this increase was due to unequal access to quality emergency obstetric care between the rural poor and the urban wealthy. In Brazil and Peru, concerted efforts to address similar sub-national inequalities have brought about progress.18,39The Success Factors literature review discusses how countries also adapt strategies based on changing needs and available resources, Malaysia, Sri Lanka and Thailand initially focused on improving primary and community-based health care in rural areas. As their health systems became stronger, the emphasis shifted to quality improvements and then to macro-level health reforms for universal health coverage that all contributed to improved maternal and child health outcomes.17,40,41The progress that accrues over time from strengthening systems and adaptive strategies should not be undervalued by measuring a countrys progress only by the initial rates of decline in mortality.14,17Different ways of measuring a country's rates of mortality reduction result in different pictures of progress, for example, sub-Saharan African countries reduced deaths of children under five years of age on average by 60/1000 live births between 1990 and 2012 making it second only to South Asia (74/1000) in terms of absolute decline in mortality. However, when reported as the annual rate of change, it appears that the least progress has been achieved in this region (for example, the Latin American/Caribbean region reduced under-five mortality by 5%, south Asia by 3.7%, and sub-Saharan Africa by just 2%). By looking at absolute decline in mortality, we get a better idea of overall reduction in numbers of deaths over time.14

Guiding principlesFast-track countries use guiding principles to chart their own pathways to progress. These principles are not a panacea, but they nevertheless shape government strategies, align stakeholder action and orient progress towards agreed results. The principles are continually being defined, tested and reformed.Some fast-track countries explicitly adopted human rights-based principles to guide their health and development strategies. For example, Nepals interim constitution is founded on human rights. The Secretary of the Ministry of Health and Population affirmed that: Many government strategies and policies related to safer motherhood, neonatal health, nutrition and gender are anchored in the principles of human rights.18,42Other fast-track countries used guiding principles aligned with frameworks for effective development, for example the Paris Principles and Accra Agenda for Action.43In these countries, the governments interaction with health and development partners is defined by principles of national ownership of policies and programmes, and alignment of partners with country priorities.Principles based on different political systems and models of economic and social development also steer progress. China has experienced a clear evolution of different political philosophies and systems.18,19Currently it aims to address the challenge of achieving harmonization and balance across five axes of national development: ruralurban, westerneastern regions of the country, nationalinternational, economicsocial, and human developmentnatural development

http://www.who.int/bulletin/volumes/92/7/14-138131/en/

5. How to decrease child mortality under 15 yo based on MDGs 4, expecially to overcome the six conditions ?

6. What are the supports of another country/ WHO to reach MDGs goals ?

7. What are the doctors skill related to martenal high ?Preventing Maternal MortalityPromoting Safe MotherhoodMaternal death is directly correlated with lack of access to quality obstetrical care, family planning services, abortion facilities, and post-abortion care.The International Conference on Population Development (1994), the Fourth World Conference on Women in Beijing (1995), and the Millennium Development Goals recognize the prevention of maternal death as an international public health priority. The reduction of maternal mortality is a leading Millennium Development Goal (MDG), which calls for a 75% reduction in maternal mortality by the year 2015.Since the majority of maternal deaths are directly related to complications of pregnancy, childbirth, and the immediate post-partum period, the most significant strategy is to assure the availability, quality, and utilization of emergency obstetric care (EMOC) and skilled attendants at the time of delivery. In some parts of the world, projects designed to reduce maternal mortality have been successful, however in other parts of the world (particularly Africa and Asia) the numbers have not improved.The components of basic and comprehensive EMOC are outlined below:

SPOTLIGHTS ON HEALTH AND RIGHTS. KEY TOPICS IN THE HEILBRUNN DEPARTMENT OF POPULATION AND FAMILY HEALTHReproductive Health. Columbia University Mailman School of Public Health.http://healthandrights.ccnmtl.columbia.edu/reproductive_health/causes_maternal_mortality.html