MCH Care Indicators

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

1. INDICATORS of MCH CARE Dr Tanveer Rehman Senior Resident Dept of Community Medicine & Family Medicine

2. Important MCH Indicators Maternal mortality ratio Still Birth Rate Perinatal Mortality Rate Neonatal Mortality Rate Post-Neonatal Mortality Rate Infant mortality Rate Child Death Rate Under-five Mortality Rate 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 2

3. Why Maternal and Child Health (MCH) Important? Vulnerable or special group Continuum of care 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 3

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” 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 4

5. Maternal indicators 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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 5

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 6

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 7

8. Trend and Current Status Source: RGI-SRS 2016-18 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 8 Target Sustainable development goal – 70 by 2030 & National Health Policy – 100 by 2020

9. Source: RGI-SRS 2016-18 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K Differences Across States

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 10

11. Child indicators 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 11

12. Infant death Post-neonatal death Neonatal death Late neonatal death Early Perinatal death Stillbirth 28 wk BIRTH 7 days 28 days 1 year

13. Some Definitions of Child Mortality Abortion – termination of pregnancy before the fetus is viable . 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. Stillbirth - baby born with no signs of life at or after 28 weeks' gestation. death during late pregnancy (called intrauterine death). death during labor or birth (called intrapartum death). 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 13

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 14

15. Peri-natal mortality rate Late fetal deaths and early neonatal deaths Min birth weight of 1000g at birth Gestational period of at least 28 weeks Why important? Late fetal death + Early neonatal death X 1000 Total live births Current rate: 22/1000, WB: 17 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 15

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 16

17. 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 17

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 18

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 19

20. Distribution of mortality according to age groups 2/7/2021 20

21. Infant Mortality Trend By Residence 2/7/2021 21

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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 22

23. 1-4 Year 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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 23

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 received ORS 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 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 24

25. EXERCISE 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 25

26. Reference 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 26 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, CMC Vellore Acknowledgment

27. THANK YOU 2/7/2021 DR TANVEER REHMAN, CMFM, AIIMS-K 27