PHOTO Maternal near-miss morbidity in La Paz, Bolivia 2006 M Rst, - PowerPoint PPT Presentation

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Maternal near-miss morbidity in La Paz, Bolivia 2006 M Rööst, V Conde, J Liljestrand, B Essén

Setting • Four hospitals accounting for 75% of all hospital deliveries • MMR: 345/100.000, 37% of deaths at hospital level (Post-Census Survey 2001) • Free maternal health care since 1996 (SUMI) • Readily available maternal health care with short distances from homes to hospitals

Method: Inclusion criteria for near miss morbidity Diagnostic group Definition Specific criteria -Hysterectomy Haemorrhage Severe bleeding -Hypovolemic shock -Repeated blood transfusion Hypertensive disorders -Eclampsia -Severe preeclampsia -BP > 140/90 and -Vasospastic symptoms and -HELLP -Proteinuria > 1g/24h -Hypo/hyperthermia and Infection Sepsis -BP < 90/60 and -HR > 120 -Surgery findings Obstructed labour -Uterine rupture -Bandl’s ring -Impending rupture -Hb < 6 g/dl at sea level 1 and Anaemia Severe anaemia without -Clinical signs of anaemia signs of haemorrhage 1 Hb < 11g/dl in La Paz and Hb < 11.4 g/dl in El Alto due to altitude differences

Near-miss maternal morbidity ”Life-threatening, pregnancy related complication resolved by chance or medical care” Ronsmans et al, 2004 Near ‐ miss Near ‐ miss upon arrival Near ‐ miss after arrival ‐ Prehospital barriers ‐ Quality of care Filippi et al, 2005

Cross-sectional results (%) Diagnostic Near-miss Maternal Mortality group total deaths index n = 15 N = 401 % Haemorrhage 191 (47%) 2 (13%) 1,0 Hypertensive 184 (46%) 1 ( 7% ) 0,5 disorders Sepsis 11 (3%) 6 (40%) 33 Obstructed 4 (1%) 2 (13%) 35 labour Anaemia 11 (3%) 0 0 Unknown 4 (27%) 0

INTEGRATED MODEL IN INTEGRATED MODEL IN MATERNAL and NEONATAL HEALTH MATERNAL and NEONATAL HEALTH Components: Components: Community Health management in Health municipalities facilities Nets

INTEGRATED MODEL OF MATERNAL AND CHILD HEALTH INTEGRATED MODEL OF MATERNAL AND CHILD HEALTH Health management in Comprehensive CSMS CSMS EmONC municipalities 3rd Delay: Receiving quality of care ALS / CLS ALS / CLS 2nd Delay: Communication CSMS CSMS and transport Systems BASIC 1st Delay: EmONC Maternit Recognition and desition to seek care y waiting homes 3rd Delay: 2nd Delay: Receiving quality of care Communication and transport Systems

MUNICIPIO EL SENA MUNICIPIO EL SENA RED SERVICIOS RED SERVICIOS R I O M A D R E D E D I O S Hospital Hosp. Riberalta 200Km. COBIJA 2 4 0 K m . C.S. 3 Medicos s h o r a 2 PISTA AEREA El Sena P.S. o r 1 Odontólogo s l i z a d D e 1 Aux. Enf. Palma Real 1 Lic. Enf. 6 horas Río Manupare 1 Tec. Malaria Deslizador 4 Aux. Enf. 1 Motor (Com.) Río Manurimi 4 Tec. Malaria Deslizador 1 Radio (Com.) 2 horas 1 Farmacia 1 Ambulancia 2 Motocicletas 1 Aux. Enf. 2 Deslizadores 1 Tec. Malaria 2 Motores 1 Motor (Com.) P.S. P.S. 1 Radio Pequin Remanzo 1 Radio (Com.) Teléfono (Pub) 1 Aux. Tec. 1 Tec. Malaria P.S. Malaria Sta. Rosa

¿What we are doing? What we are doing? ¿ • Consolidate Consolidate EmONC EmONC implementation. implementation. • • Improve quality care Improve quality care – – Continuum of care . • Continuum of care . • Improve Reference and Return System. Improve Reference and Return System. • • Involve Social nets in self Involve Social nets in self- -care and care and • timely seeking for health assist. timely seeking for health assist. • Promote CCC = communication for Promote CCC = communication for • behavioural change. behavioural change.

Thank you very much