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M.C.H. 

 

VITAL STATISTICS

 

Dr.Sijal Fadhil Farhood Al Joborae

 

F

.I

.

C

.

M

.

S

  

Community Med.

  

 M.Sc. Community Med.

 

 M.B.Ch.B.

 


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Why do we need vital statistics? 

Health is difficult to measure directly, so it is 
done indirectly by measuring its converse, 

i.e. 

disease and death or morbidity and mortality 
rates. 

Absolute numbers are not informative or 
comparable,due to the difference in the total 
population number,so we have to use rates that 
include……. 


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Maternal Mortality

 

• Pregnancy and child birth are wonderful and life 

changing events,they can also bring potential for 
illness, suffering and even death

 WHO  definition:   

• Death of women 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 pregnancy or it’s 
managemant but not from accidental or incidental 
causes.  


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one woman or more dies every minute 

from pregnancy related causes

 

from obstetrical complications of  pregnancy, 

Direct maternal death

labor, or  puerperium, and from interventions ,omissions, incorrect 

treatment ,or  chain of events resulting from the above.

 

: death resulting from previous existing disease or 

Indirect maternal death

a disease that developed during pregnancy, labor, or perperium and 

aggravated by  the maternal physiological adaptation to pregnancy.

 

resulting from accidental or incidental cause in 

 

:death

death

Non maternal 

no way related to pregnancy.

 

death of women from direct or indirect maternal 

 

:the

death

Late maternal 

causes occurring after 42 days of termination of pregnancy 

 

 


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Definitions

 

continued:

 

Pregnancy related death

death of women while pregnant or within 42 days of termination 
of pregnancy, irrespective  of the cause of death. 
 

Maternal disability: 

short or long term illnesses caused by obstetric 
complications(fistula, incontinence). 

 


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CAUSES OF MATERNAL DEATH

 

Direct obstetrical complications:the main killers in 
developing countries( ¾). 

• 1-Haemorrhage(APH,PPH) 
• 2-Sepsis 
• 3-Hypertensive diseases of pregnancy 
• 4-Obstructed labour 
• 5-Unsafe criminal abortion 
• 6-Ectopic pregnancies 
• 7-Unsafe operative procedures 
• 8-Pulminary embolism 


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Indirect obstetrical complications:are due to 

pre-existing conditions,(1/4)of maternal 

deaths in developing countries. 

 

• Malaria, anaemia ,hepatitis ,cardiac and renal 

diseases 

**IN IRAQ: 

The leading causes of maternal deaths according 
to their proportions are ; 

APH and PPH. 

Pulmonary embolism. 

Hypertention and toxaemia. 

Purperial sepsis. 


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But why do these women die 

(THREE DELAYS MODEL) 

• 1-Delay in decision to seek care. 

• Lack of understanding of complications. 
• Acceptance of maternal death. 
• Low status of women. 
• Socio-cultural barriers to seeking care. 
 


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• 2-Delay in reaching care: 

• Mountain ,Islands ,Rivers , Poor organization. 

 

• 3-Delay in receiving care: 

• Supply. 
• Personnel. 
• Poorly trained personnel with punitive attitude. 
• Finances. 


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Measures of maternal mortality: 

 

• The number of maternal deaths in a population is 

essentially  the product of two factors , the risk of 

mortality associated with a single pregnancy or a 

single live birth and the number of pregnancies or 

births that are experienced by women of 

reproductive age. 

Maternal mortality ratio

:is defined as the 

number of maternal deaths in a population 

divided by the number of live births(per 

100000),it is represents the risk associated with 

each pregnancy, it is the 

obstetric risk. 

 
 


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Maternal mortality rate: 

• Is

 defined as 

the

 number of maternal deaths in 

a population divided by the number of women 
of reproductive age(usually 15-49)years per 
100000 

• It measures both the 

obstetric risk

 and the 

frequency

 with which women are exposed to 

this risk as well as the 

level of fertility 

in the 

population  

 

 


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Prevention and reduction of 

maternal deaths 

• 1-Ensure 

access to medical treatment for obstetric 

emergencies

,PPH,APH,infection. 

• 2-Improving emergency treatment for obstetric 

complications in existing referral facilities. 

• 3-Inform the community about the 

danger signs 

during pregnancy and delivery. 

• 4-Work with the community to 

improve access to 

emergency care. 


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5-Reduce exposure to the risk of unwanted 

pregnancy,through accessible and acceptable 

family planning 

services. 

• 6-Improve antenatal care services

,11% of 

maternal deaths can be prevented through 

ANC,5%due to prevention of infection,5%due to 

prevention of  anaemia,3.3%due to prevention of 

hypertention,and 80% due to prevention of 

tetanus. 

• 7-Train traditional birth attendants(TBA) 

to refer 

and treat women with complications.  


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These estimates provide an up-to-date 

indication to the extent of the maternal 

mortality rate globally,they strongly indicate a 

need for both imroved action for maternal 

mortality reduction and increased efforts for 

the generation of robust data to provide 

better estimates in the future, achieving 

decline in maternal mortality requires 

increased attention to improve health care for 

women 

 


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• This leads to development of 

safe motherhood 

programmes, a global effort that aims to reduce 
death and illnesses among women and 
infants,especially in developing counries,aimed at 
reducing maternal mortality. 

• These programmes tackle the clinical causes  of 

maternal deaths through improvements in 
maternal services with special emphasis on 
EMOC 


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How to measure maternal 

mortality(sources of data) 

• 1-Hospital. 
• 2-Vital registration system. 
• 3-Confedential inquiries into maternal 

deaths(CEMD). 

• 4-House hold surveys :pregnancy related 

deaths,large sample size,expensive. 
 


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5-Sisterhood methods: retrospective rather than a 
current maternal mortality estimate(over 10 years 
prior to the survey). 

6-census(every 10 years). 

7-verbal autopsy:use to assign cause of death 
through an interview with the family . 

8-Reproductive age mortality surveys (RAMOS).gold 
standard method ,if properly conducted ,provides 
fairly complete estimation of maternal mortality. 
 
 


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INFANTS

IN 

MORTALITY 

 

 

0                22w

 

               birth

 

                      1w

 

                     4w

 

                     1 y

 

Miscarriage or 

abortion

 

Still birth

 

Early neonatal 

death

 

Late neonatal 

death

 

Post neonatal 

death

 

     Perinatal                  death

 

       Neonatal                 death

 

                       Infant death

 


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Mortality in infancy and childhood 

Infant mortality rate(IMR):is defined as 

the 

ratio of infant deaths registered 
in a given year to the total 
number of live births registered 
in the same year.  


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IMR as an indicator 

• IMR is universally regarded not only 

as a most important indicator of the 
health status of a community but also 
of the level of living of people in 
general and effectiveness of MCH 
services in particular. 


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Demographic importance of IMR

 

• 1- The largest single age-category of mortality. 
• 2- Deaths at this age are due to a peculiar set of 

diseases and conditions to which the adult 
population is less exposed or less vulnerable. 

• 3- It is affected rather quickly and directly by 

specific health programs and hence may change 
more rapidly than the general health rate. 


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CAUSES OF NEONATAL MORTALITY

 

• 1- Low birth weight and prematurity 
• 2-Birth injury and difficult labor 
• 3- Sepsis 
• 4- Congenital anomalies 
• 5- Haemolytic diseases of newborn 
• 6- Conditions of placenta and cord 
• 7- Diarrhoeal diseases 
• 8- Acute respiratory infections 
• 9- Tetanus 


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Causes of post-neonatal mortality

 

1- Diarrheal diseases 
2-Acute respiratory infections 
3-Other communicable diseases 
4-Malnutrition 
5- Congenital anomalies 
6- Accidents 


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1-BIOLOGICAL FACTORS 

A-Birth weight 

• Birth weight is a major determinant of infant 

and perinatal mortality and morbidity .

Babies 

of under 2.5 kilogrammes  especially if under 
1000 g and those exceeding 4 kgs are at a 
special risk.

It has been observed that the 

mother who was adequately  nourished 
during her own growing up years has an 
excellent chance of delivering a normal size 
baby even if she has taken inadequate diet 
during her pregnancy 


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B- age of the mother 

There is a definite relationship between the age 
of the mother and the fate of the child. 
Infant mortality rates is greater when the 
mother is either very young  or very old. 

C-Birth order 

:the highest mortality is found 

among  first born and lowest among those born 
second ,the  risk of infant mortality escalated 
after the third birth. 
 


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D-Birth spacing: 

Repeated pregnancies exert a great influences 
on infant mortality ,they cause malnutrition and 
anaemia  in the mother, predispose to 
LBW,which result in high infant deaths. 

E-Multiple births: 

Infants born in multiple births face a greater risk 
of death than do those in single births due in 
large part to the greater frequency of LBW 
among the former. 

 


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F-Family size: 

Studies show that infant mortality 

increase with 

family size

,the number of episodes of infectious 

diarrhea,prevalance of malnutrition ,and sever 
respiratory infections have been found to 
increase with family size. 
 

G-High fertility: 

Fertility is one of the most important factors that 
influence infant mortality. 
 


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2-ECONOMIC FACTORS 

One of the most important factors 
affecting infant mortality rates,both 
directly and indirectly is socio economic 
status, 

the availability and quality of health 

care and the nature of child environment 
are closely related to the socio economic 
status

 


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3-CULTURAL AND SOCIAL FACTORS: 
A-Breast feeding. 
B-Religion. 
C-Early marriage. 
D-Sex of the child(female). 
E-Maternal education. 
F-Quality of motherhood. 
G-Quality of health care. 
 

 


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H-Broken homes(mother or father has 
died or seperated). 
I-Illegitimacy. 
J-Domestic violence. 
K-Midwives. 
L-Bad environmental sanitation. 

 




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