PREFACE

 

Introduction

Justification for this paper. Objectives, goals, target groups, expected results.

 

Summary (Abstract, Keywords)

 

1. Maternal Death

Definition - complexity of definition

Technical and Policy Paper No. 1. UNFPA

WHO (Maternal Reproductive Health) “Il-health” (cancer colli uteri, sexually transmitted diseases)

 

2. Maternal Mortality

Definition of the impact indicators.

1. Ratios (Rátios)

2. Rates (Taxa, Taux)

3. LTR, Life Time Risk of Death - Rates Limitation of impact indicators

4. Process Indicators / output indicators. Achievement indicators in monitoring programmes.

 

 

3. Measuring Maternal Mortality

Global underregistration and estimations.

Technical and Policy Paper No. 1. UNFPA

Indirect methods. Sisterhood Method (Winnie, Farafenni project, The Gambia, Greenwood etc)

Impact indicators / process indicators - output indicators ( The selection of indicators, appropriate for the specific programme)

Implications for monitoring of programmes.

 

4. Causes of Maternal Mortality

 

Global distribution of causes

Direct / indirect causes. ICD-10. WHO Classification of Diseases

 

5. Determinants leading to Maternal death

 

National health statistics, UN Human Development Index. Civil registration.

Framework of social, economical and health factors determining the outcome. 

RATIONAL APPROACH:
3 points of intervention

a. FP (Family planning - fertility planning),

b. Prenatal (Antenatal screening)

c. EOC (PPM network)

 

6. Interventions to prevent Maternal Mortality

a. Family Planning .

b. Prenatal screening (Winnikoff: Theory of Risk), 7

c. EOC. Emergency Obstetric Care. SARA: Preventing Maternal Mortality through EOC.

The use of process indicators (process / output indicators)

The 3 delays: 1. Delay of decision to seek help. 2. Delay of reaching EOC. 3. Delay of treatment.

(Implications and implementation of intervention programmes in Prevention of Maternal Deaths)

 

7. Sustainability of programmes

(Why are the results so poor?, no real progress during the last decade)

Importance of multidisciplinary, interdisciplinary working groups, including not only medical expertise (specialist obstetricians and midwives), but also representatives of social sciences, epidemiologists, demographers, statiticians, economists..

Participation of decision-makers, Ministry of Health.

 

 

8. Conclusions, Implications and Recommendations

 

 

9 . References and Bibliography

 

 

10. Annexes