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

PHOTO

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 Haemorrhage Severe bleeding

• Hysterectomy
• Hypovolemic shock
• Repeated blood transfusion

Hypertensive disorders

• Eclampsia
• Severe preeclampsia
• BP > 140/90 and
• Vasospastic symptoms and
• HELLP
• Proteinuria > 1g/24h

Infection Sepsis

• Hypo/hyperthermia and
• BP < 90/60 and
• HR > 120

Obstructed labour

• Uterine rupture
• Impending rupture
• Surgery findings
• Bandl’s ring

Anaemia Severe anaemia without signs of haemorrhage

• Hb < 6 g/dl at sea level1 and
• Clinical signs of anaemia

1Hb < 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

‐Prehospital barriers

Near‐miss after arrival

‐Quality of care Filippi et al, 2005

Cross-sectional results (%)

Diagnostic group

Near-miss total N = 401 Maternal deaths n = 15 Mortality index %

Haemorrhage

191 (47%) 2 (13%) 1,0

Hypertensive disorders

184 (46%) 1 ( 7% ) 0,5

Sepsis

11 (3%) 6 (40%) 33

Obstructed labour

4 (1%) 2 (13%) 35

Anaemia

11 (3%)

Unknown

4 (27%)

INTEGRATED MODEL IN INTEGRATED MODEL IN MATERNAL and NEONATAL HEALTH MATERNAL and NEONATAL HEALTH Components: Components:

Health management in municipalities Community Health facilities Nets

2nd Delay: Communication and transport Systems 3rd Delay: Receiving quality of care 2nd Delay: Communication and transport Systems 3rd Delay: Receiving quality of care

BASIC EmONC

INTEGRATED MODEL OF MATERNAL AND CHILD HEALTH INTEGRATED MODEL OF MATERNAL AND CHILD HEALTH

Maternit y waiting homes Comprehensive EmONC

1st Delay: Recognition and desition to seek care

ALS / CLS ALS / CLS

Health management in municipalities

CSMS CSMS CSMS CSMS

Hospital COBIJA

• Hosp. Riberalta

MUNICIPIO EL SENA MUNICIPIO EL SENA RED SERVICIOS RED SERVICIOS

2 h

• r

a s D e s l i z a d

• r

P.S. Palma Real P.S. Pequin P.S. Remanzo 2 horas Deslizador 6 horas Deslizador

2 4 K m . 200Km.

R I O M A D R E D E D I O S Río Manurimi Río Manupare 3 Medicos 1 Odontólogo 1 Lic. Enf. 4 Aux. Enf. 4 Tec. Malaria 1 Farmacia 1 Ambulancia 2 Motocicletas 2 Deslizadores 2 Motores 1 Radio Teléfono (Pub) 1 Aux. Enf. 1 Tec. Malaria 1 Motor (Com.) 1 Radio (Com.) 1 Aux. Enf. 1 Tec. Malaria 1 Motor (Com.) 1 Radio (Com.)

P.S.

• Sta. Rosa

1 Tec. Malaria 1 Aux. Tec. Malaria

PISTA AEREA C.S. El Sena

¿ ¿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