Dr. Reza Nassiri - mame-assn.org Nassiri-GlobalHealthChalleng… · maternal, newborn and...
Transcript of Dr. Reza Nassiri - mame-assn.org Nassiri-GlobalHealthChalleng… · maternal, newborn and...
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Global Health Challenges(Maternal and Childcare)
Dr. Reza NassiriAssociate Dean of Global Health, MSUCOM
Director, Institute of International [email protected]
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Global Health Challenges
Today’s global health challenges are increasingly urgent and complex.
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Urgent Global Health Issues • Maternal and childcare• Diarrheal diseases, respiratory infections • Impact of climate change/global warming• The rise of non-communicable diseases• Crises of food supplies• Crises of water supplies• Vector-born diseases• HIV and TB• Parasites, zoonosis, H. Pylori• Obesity, undernutrition• Mental health
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Millennium Development Goals • Some progress has been made towards achieving
MGDs 4 and 5. However, such progress is insufficient to achieve the goals by 2015 vis-à-vis maternal, newborn and under-five morbidity and mortality.
• Community-based interventions are crucial for the attainment of MGDs 4 and 5.– Such approaches should also include public health
measures and control.
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Maternal and Child Health
HEALTH
MOTHER CHILD
SOCIETY
Healthy children need healthy mothersHealth mothers contribute to healthy society
Social & Economic
Development
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Region Mortality* Share of Global Mortality
Mortality* Share of Global Mortality
Asia and the Pacific
325 44% 59 41%
Africa 900 54% 157 49%
The Americas 99 3% 21 7%
Europe 27 1% 16 3%
Maternal and Child Mortality – The Gap!
* maternal mortality is per 100,000 live births; under-five mortality is per 1,000 live births.
Mothers Children under five
Source: WHO (Investing in Maternal, Newborn and Child Health - The Case for Asia and the Pacific)
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Maternal and Child Care
UNICEF (2011) announced that although considerable progress towards improving the health of mothers and children in certain regions of the world, disparitieswithin these countries persist, making this progress inequitable.
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Why are M, I, and C Health Important?
• Health risks– Hypertension and heart disease– Diabetes– Depression– Genetic conditions– STDs– Tobacco and alcohol use– Inadequate nutrition– Unhealthy weight
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Key Facts• Worldwide, 358,000 women die during pregnancy
and childbirth, annually.
• Estimated 7.6 million children die under the age of five.
• Majority of maternal death occur – During childbirth, or – Immediately after childbirth
Source: Maternal, Newborn and Child Health Summit, May 2013, WHO Philippines, Manila
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Key Facts• Common medical issues for maternal death
include:– Bleeding– Anemia– Hypertensive disorders– Prolonged and obstructed labor– Eclampsia– Infections/sepsis– Unsafe abortions
• A child's risk of dying is highest during the first 28 days of life.
Source: Maternal, Newborn and Child Health Summit, May 2013, WHO Philippines, Manila
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Key Facts• Globally, the main causes of neonatal death are:
– Preterm birth– Severe infections– Asphyxia
• Children in low-income countries are nearly 18 times more likely to die before the age of five than children in high-income countries.
Source: Maternal, Newborn and Child Health Summit, May 2013, WHO Philippines, Manila
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Key Facts
• 70% of global deaths among newborn babies happen in just two WHO regions:
• Africa
• South East Asia
Source: Maternal, Newborn and Child Health Summit, May 2013, WHO Philippines, Manila
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Maternal Health & Developing Countries • A woman in sub-Saharan Africa has a 1 in
16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risk in a developing country– The largest difference between poor and
rich countries of any health indicator.
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Maternal Death Issues• Inadequate medical and midwife support
• Lack of access to emergency & intensive care
• Lack of management capacity in the health system
• No political will and lack of management capacity in the health system
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Maternal Death Issues• Malaria is another risk. It can lead to
anemia, which increases the risk for maternal and infant mortality and developmental problems for babies. – A majority of these deaths and disabilities are
preventable, being mainly due to insufficient care during pregnancy and delivery.
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Anemia: A Global Public Health Problem• Contributes to 20% of death among
pregnant women.• WHO estimates 2 billion people – over
30% of the world’s population – are anemic.
• Nearly half of all pregnant women suffer from anemia– 52% in low-income countries– 23% in high-resource regions
Source: Gangopadhyaya et al, International J of Gynecol/Obstet, 2011
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Short-term Risks of Anemia• Mother
– Antepartum: prone to infections, preterm labor, LV failure
– Intrapartum: Heart failure, postpartum hemorrhage, shock
– Postpartum: Heart failure, sepsis, uterine sub-involution, increased cesarean delivery mortality
• Fetus/child: Increased stillbirth, morbidity and mortality due to intrauterine growth restriction, prematurity, sepsis
Source: Gangopadhyaya et al, International J of Gynecol/Obstet, 2011
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Maternal Death Issues• HIV infection is an increasing threat.
• Mother-to-child transmission of HIV continues to be a major problem, with up to 45 per cent of HIV-infected mothers transmitting infection to their children.
• Further, HIV is becoming a major cause of maternal mortality in highly affected countries in Southern Africa, especially with the TB re-emergency.
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HIV/TB Co-infection in HaitiCoupet/Nassiri study in Haiti
In Collaboration with Albert Schweitzer Hospital
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Effects of Tuberculosis During Pregnancy
Medical(Maternal & Perinatal)
EconomicSocio-cultural
The problem of TB not as a medical problem alone, but to consider it holistically in the context of socioeconomic background.
N. Jana et al., J. Obstet. Gynecol. Res, Vol. 38, No. 9:1125-1136, 2012
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Underlying causes of Child illness and death
• Poverty: more than 250 million children under five live in absolute poverty, on less than $1 per day.
• Under-nutrition and malnutrition: at least 200 million children under five are malnourished.
Source: WHO
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Infant and Neonatal Mortality• Infant mortality rate is made up of two
components:– Neonatal mortality (death in the first 28 days of
life)– Postneonatal mortality (death from the infants’
29th day but within the first year)• The leading causes of neonatal death:
– Birth defects– Disorders related to short gestation– LBW and pregnancy complications
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Under-five Mortality Rate• A result of wide variety of inputs:
– Nutritional status and the health knowledge of mothers
– Level of immunization and oral rehydration therapy
– Lack of maternal and child health services (including prenatal care)
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Under-five Mortality Rate• Income and food availability in the family
• Availability of safe drinking water and basic sanitation
• Safety of the child’s environment
• Is a picture of the health status of the majority of children and of society as a whole
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Children < 5 Years Mortality (WHO: 2010)
• Globally, 80 percent of all child deaths to children under five are due to only a handful of causes:
� Pneumonia (19 %)
� Diarrhea (18 %)
� Malaria (8 %),
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Children < 5 Years Mortality (WHO: 2010)
• Globally, 80 percent of all child deaths to children under five are due to only a handful of causes:� Neonatal pneumonia or sepsis (10 %)� Pre-term delivery (10 %)� Asphyxia at birth (8 %)� Measles (4 %)� HIV/AIDS (3 %).
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Malnutrition34%
Causes of under-five deaths in India: 2010
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Bhutta et alNew Eng J Med369;23, Dec5, 2013
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Emerging and Reemerging Challenges
• HIV/AIDS and TB plus MD-resistant TB• Dengue• Viral hemorragic fever • Cholera outbreaks in Africa, Asia, and Haiti• Avian and swine flu• Conflicts, wars and infrastructure
destruction• Poor governance and ineffective polices
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Maternal and Neonatal Tetanus
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Rape Victim
A nurse dresses the wound of rape victim, 25, while a student nurse assists, on the traumatic fistula ward of the HEAL Africa Hospital in Goma, Democratic
Republic of Congo. Photo by Mary F. Calvert / Zumapress / Newscom.
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Core Interventions to PreventChild Deaths
• Vaccination• Folic acid supplementation• Tetanus toxoid• Syphilis screening and treatment• Pre-eclampsia and eclampsia prevention
(calcium supplementation)• Intermittent presumptive treatment for malaria in
pregnancy
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Core Interventions to PreventChild Deaths
• Antibiotics for premature rupture of membranes
• Detection and management of breech (C-section)
• Labor surveillance
• Clean delivery practices
• Breastfeeding
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Core Interventions to PreventChild Deaths
• Zinc for diarrhea • Hib vaccine• Water, sanitation, hygiene• Vitamin A for respiratory infections• Nevirapine and replacement feeding to prevent
HIV transmission• Measles vaccine• Antimicrobials for dysentery and sepsis
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Prevention of Bilirubin-Induced Neurologic Dysfunction
Need for evidence-basedtechnologies to affordablyscreen for BIND or other conditions such as G6PDdeficiency, especially inresource-limited countries.
Baghdad, Iraq, 2010: Infant with sequeleof acute bilirubin encephalopathy,
At age 8 days.
Source: Bhutani and Stevenson, Seminars in Perinatalogy, 2011.
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Maternal Child Health Services
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Maternal Child Health Services
Misoprostol to Prevent Postpartum Hemorrhage (PPH)
� PPH is a major cause of maternal mortality in the developing world.
� Most resource-limited countries have yet to explore Misoprostol at a public policy level. In the meantime, high rates of maternal mortality due to PPH persist.
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Continuum of Care for Reproductive, Maternal, Newborn and Child Health
Pre-pregnancy
Health Facilities
CommunityHousehold
Pregnancy Postnatal Childhood
RMNCH Dimensions• Time• Place
Lifecycle:
Reproductive Health Interventions Maternal Health Interventions
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Interventions to improve Child Health
Home and Community
First-level facility
Referral Facility
Pregnancy Promote & support antenatal care
Detection & management of complications of pregnancy
Management of severe complications
At birth Promote and support skilled care at birth
Immediate newborn care
Management of obstetric complications
Newbornperiod
Promote and support key newborn care practices
Management of newborn illnesses
Immunization
Management of severe newborn illnesses
Infancy and Childhood
Community case management of diarrhea & ARI
Standard case management during childhood illnesses
Management of severe childhood illnesses
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Public Health
MISSION:
…assuring conditions in which people can be healthy
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Public Health• To promote health
• To prevent diseases
• To prolong the life through organized efforts of the society.
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Public Health – Way Forward!GOVERNMENTAL ROLE:• Assessment• Policy Development• Assurance• Partnership with
– Universities– Public Health sectors– Private sectors– Professional organizations (e.g., IMI)
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Challenges in Resource-limited Countries:• Public Health Statistics - participation in mechanism for
collection, tabulation, analysis and reporting for health jurisdiction served
• Health Education - public and professional information and education with emphasis on prevention
• Nutritional Services - nutrition program including appropriate activities in education and consultation for promotion of positive health , prevention of ill health, and dietary control of disease
• Maternal and Child Health - comprehensive plan for maternal and child health services to include prenatal, childbearing and reproductive care, family planning, child and adolescent health, child abuse, genetic disease control
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Challenges in Resource-limited Countries :• Communicable and Chronic Disease Control-
preventive services including immunization, screening, referral for treatment, prevention and control of vision, hearing, dental problems
• Environmental Services - water, food, air, wastes, vectors, housing, bathing places, safety, noise, toxic hazards, nuisances
• Community Nursing Services - Provision of community nursing
IMPACT: approaches must be integrated, multidisciplinary and evidence-based.
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Syria
� 5.5 M infants and children affected
� Devastating effects on education and health
� Malnutrition and illness have stunted children’s growth
Source: U.N. and UNICEF
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Syria
Ali Shaaban is one day old and weighs 1.75 pounds. He was born prematurely, 28 weeks into his mother's pregnancy. He was brought to the Children's Hospital in Damascus. Doctors are waiting for a free incubator to place Ali in. His lungs are not fully developed and he needs help breathing.
Source: NBC News
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Polio in Syria: An outbreak that threatens the Middle East
A child in eastern Syria with legs paralyzed because of polio.
As summer approaches, health agencies are warning of the risk of polio spreading across the Middle East from Syria - where now more than 100
children show symptoms of the disease.
Source: BBC, March 25, 2014
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Syrian Conflict: A Public Health Disaster Source: NBC News
Before the uprising started, Syria boasted nearly 500 hospitals and healthcare center and 70 licensed pharmaceutical manufacturers that
supplied 90 percent of the nation’s drugs. All that has changed!
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Investment in Global Health
Source: http://www.csrwire.com/press_releases/36820-Survey-2014-Top-Investments-in-Global-Health
Health System Strengthening
Improving Health Service Delivery
Systems
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Opportunities for Medical Professionals Serving Abroad
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Kenya Well Project
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Kenya Well Project
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Kenya Well Project
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Kenya Well Project
Access to clean water
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Amazon Community Medicine Project
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Community Medicine, Brazilian Amazon
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Community Medicine, Brazilian Amazon
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Community Medicine, Brazilian Amazon
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Community Medicine, Brazilian Amazon
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Institute of Tropical Medicine, Belem, Brazil
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Community Health Clinic, outside Belem, Brazil
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Amazon Community Medicine Project
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Community Medicine – Dominican Republic
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La Piedra, Dominican Republic� Donations
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Health Mission Trip Dominican Republic
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Community Health Volunteer and Clinical Shadowing Dominican Republic
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Clinical Exposure Dominican Republic
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International Young Doctors Training
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Hon. Ivonne Ortega, Governor
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Merida, Yucatan, Mexico
MSUCOM clinic under construction
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Merida, Yucatan, Mexico
MSUCOM clinic under construction
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Merida, Yucatan, Mexico
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Merida, Yucatan, Mexico