Lecture 1- Maternal and infant public health

Question 1

broad overview of the three domains of public health

Answer 1

Health protection

Ensuring that the risks to health from communicable diseases and/or environmental hazards are minimised.

Health improvement

Preventing ill health and promoting wellbeing by commissioning and providing services that fit with the needs of our population

Healthcare public health

Making sure we have the right health services in place for the population and that these are effective and accessible to all those who need them

Question 2

the birth experience

Answer 2

Question 3

Maternal health is the

Answer 3

health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimensions of

• family planning,
• pre-conception,
• prenatal and
• postnatal care

in order to ensure a positive and fulfilling experience in most cases and reduce maternal morbidity and mortality in other cases. (WHO, Maternal Health)

Question 4

UNFPA definition‘Good sexual and reproductive health is a state of complete

Answer 4

physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.’

Question 5

having a baby is an excellent health promotion opportunity

Answer 5

• Many opportunities to screen for health conditions

Question 6

How do we measure maternal health?

Answer 6

• maternal mortality ratio
• proportion of births attebnded by skilled health personnel
• contraceptive prevalence rate
• adolescent birth rat
• antenatal care coverage
• unmet need for family planning

Question 7

how long does pregnnacy last

Answer 7

• Pregnancy 280 days/40 weeks (term +- 2 weeks)

Question 8

trimesters of pregnancy

Answer 8

• 3 trimesters
  
  • First (12 weeks)
  • Second (12)
  • Third (12)

Question 9

First trimester

Answer 9

• Pregnancy starts at fertilisation when sperm meets egg
• Embryo implants in the uterus
• Starting of formation of embryo and placenta
• V vulnerable to teratogens at this time

Question 10

Second trimester

Answer 10

Foetus is growing with a placenta

Question 11

Third trimester

Answer 11

Baby ready to be born

Question 12

Labour and birth

Answer 12

• Labour can be spontaneous or induced
• Delivery can be vaginal (normal delivery) or Caesarean section

Question 13

Postnatal period

Answer 13

6 weeks after delivery

Question 14

Maternal mortality ratio (MMR) calculated by

Answer 14

Question 15

maternal mortality ratio (MMR) represents

Answer 15

• Represents the risk associated with each pregnancy (i.e. the risk of dying once pregnancy*
• Worse in lower income countries

Question 16

Maternal mortality ratio (MMR) pros

Answer 16

• good indicator of general population health plus status of women, health services etc
• advocacy purposes
• there are methods to get around missing data

Question 17

Maternal mortality ratio (MMR) cons

Answer 17

• does not include all pregnancies in the denominator
• dificult to get data required
• does not detail causes of mortality

Question 18

International Classification of Diseases (ICD) definition of maternal death

Answer 18

• death of a woman while pregnant or within 42 days of the end of the pregnancy (excluding accidental or incidental causes)
  
  • direct
  • indirect

Question 19

late maternal deaths

Answer 19

indirect or direct causes >42 days but <1 year post pregnancy

Question 20

leading cause of maternal death

Answer 20

• Thrombosis/thromboembolism remain leading cause of direct death
• Maternal suicide is third largest cause of direct maternal death (most important cause of late maternal death)

Question 21

inequalities in maternal mortality factors

Answer 21

• ethnic groups
• age
• living in more deprived area

Question 22

Inequalities in maternal health and care have far reaching consequences

• Even before birth inequalities transmit to diff outcomes throughout life

Answer 22

Question 24

Health protection in maternal and child health: some examples

Answer 24

1. Good infection control: sanitation and hygiene during delivery to prevent infections (in mothers and infants)
2. Controlling communicable diseases: prevention of vertical transmission of blood-borne diseases e.g. HIV
3. Control of environmental hazards, such as ionising radiation, heavy metals, which can be harmful in pregnancy…

Question 25

Health improvement in maternal and child health: some examples

Answer 25

* Family planning and contraception * Screening for foetal abnormalities, e.g. ultrasound scans * Folic acid for the prevention of neural tube defects * Behaviour and lifestyle changes: e.g. stopping smoking, * alcohol and substance misuse, improving physical exercise * Some measures discussed in childhood: * Weight management programmes * Oral health promotion (brush4life) * Free school meals

Question 26

Healthcare public health in maternal and child health: some examples

Answer 26

“Preventing diseases or improving health-related outcomes through access and utilisation of effective healthcare interventions or treatment” * Health needs assessment to improve access to mental health care in vulnerable young people at risk of offending

Question 27

what can be done about maternal mortality

Answer 27

Question 28

timely managemnt and treatment can

Answer 28

make the difference between lfie and death for mother and baby

Question 29

**Morbidity examples**

Answer 29

* **Birth injury** e.g. fistula can lead to disability and stigmatisation * Caused by obstruction of babbies head causing necrosis of tissue * **Psychological morbidity**

Question 30

Neonatal mortality rate =

Answer 30

number of deaths in first 28 days of life per 1000 live births **(no 100,000 like MMR)**

Question 31

* **Around half of neonatal deaths occur in the**

Answer 31

**first 24hr of life** * Safe birth techniques * Resuscitation training and equipment * Challenging risky traditional practices

Question 32

**The problem of prematurity**

Answer 32

* 1 in 10 babies * 37 completed weeks

Question 33

**Risk factors for premature delivery**

Answer 33

* Infant Intrauterine Growth Restriction (IUGR)- small baby * Infection in the womb/membranes * Waters breaking early * Cervical or uterine abnormalities * Pre-eclampsia * Lifestyle factors including smoking, illicit drug use * Multiple pregnancy * Diabetes in pregnancy

Question 34

**Cause of death among children under 5 years**

Answer 34

neonatal= prematurity postnatal= penumonia/congenital anomalies

Question 35

**Key players in global maternal health**

Answer 35

* UNFPA * WHO * UKAID * USAID * Unicef * Royal college of obstetricians and gynaecologists * Oxfam

Question 36

**Wider issues of maternal health**

Answer 36

* Smoking * Malaria * HIV * Socioeconomic status of women and access to healthcare * Gender-based violence and fgm * Vulnerable populations