challenges of meeting mdg4 and mdg 5 in bangladesh prof. kishwar azad project director dab-perinatal...
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Challenges of meeting MDG4 and MDG 5 in Bangladesh
Prof. Kishwar AzadProject Director
DAB-Perinatal Care Project
•Area Area 147,570 km 147,570 km
• Population Population 142 million 142 million*
TFR 3 TFR 3
•Per capita GDP Per capita GDP $456 $456 **
• Life Expectancy Life Expectancy (2004)(2004) 65.1 years 65.1 years **
• Overall Literacy Rate Overall Literacy Rate (2004)(2004) 50.0% 50.0% ***BDHS 2007, **BBS 2006
MDG 4: Reduce U5MR by two thirds
BANGLADESH Target :
(2005)(1990)
50
78 (2006)
31
Trends in Newborn Infant and Under-5 Mortality Rates by Year, Bangladesh 1993 - 2007
133
116
9488
65
5052
6566
31
87 82
3741424852
0
20
40
60
80
100
120
140
160
180
1993 1997 2001 2004 2007 MDG Target
U-5
MR
per
100
0 L
B
U-5 mortality IMR Newborn mortality
Challenges of meeting MDG4
and MDG5 in Bangladesh
Causes of Under-5 mortality
Challenges of meeting MDG4
and MDG5 in Bangladesh
Tetanus ToxoidSafe and Clean DeliveryProphylactic Eye CareEarly and Exclusive BreastfeedingManagement of infectionsImmunization
Case management in community and facility (IMCI/Community IMCI)ORSZinc
Birth spacingMaternal NutritionMalaria ControlKangaroo Care Warming
Resuscitation
Syphilis Control Folate Supplementation
Interventions to achieve MDG-4
Causes of Neonatal Deaths
Unspecified4%
Possible Serious Infections
34%
Birth Asphyxia21%
LBW/PMB11%
Birth Injury4%
Others2%
Undetermined3%
ARI10%
Diarrhoea1%ARI+Diarr
1%N. Tetanus
4%
Cong. Abnorm5%
BDHS:2004
Infection: 50%
Asphyxia : 21%
LBW/PT : 11%
MDG 5: Reduce by three-fourthsthe Maternal Mortality Ratio
BANGLADESH Targets
(2005)
3.0
(1990)
13.8%
Interventions to achieve MDG-5
Iron supplements,
Intermittent
Treatment of Malaria
Antiretrovirals for HIV
Active Management of the Third Stage of Labor
Management of postpartum Hemorrhage
Tetanus ToxoidClean deliveryTreatment of postpartum infection
MagnesiumSulfateCalcium supplementation
Family Planning and Postabortion Care
Partogram
Active Management of the Third Stage of LaborManagement of postpartum Hemorrhage
Tetanus ToxoidClean deliveryTreatment of postpartum infection
Partogram
Iron supplements,Intermittent Treatment of Malaria
Most life-saving interventions require considerable skill
MagnesiumSulfateCalcium supplementation
Family Planning Postabortion Care
• Maternal Health Strategy (2001)Maternal Health Strategy (2001)
• Comprehensive and emergency obstetrics services Comprehensive and emergency obstetrics services
• Community-based Skilled Birth Attendant (C-SBA) Program
• Demand Side Financing: Maternal Health Voucher Scheme (MHVS)Demand Side Financing: Maternal Health Voucher Scheme (MHVS)
• Improved maternal nutrition in pregnancy and postpartum
• Birth preparedness and complication readiness
• Scaling up evidence-based practices for FP and maternal health
Maternal Health and FP Programmes (existing)
Challenges of meeting MDG4
and MDG5 in Bangladesh
Existing neonatal and child health programmes
• Essential newborn care• Special care for LBW babies• Exclusive and breastfeeding• Management of birth asphyxia and neonatal sepsis in the facility
and community• Immunization• IMNCI/Community-IMNCI • Routine Vitamin-A supplementation • Infant and young child feeding (National Nutrition Programme)• National Neonatal Health Strategy (under development)
Opportunities to overcome challenges-1• STRENGTHEN and EXPAND EXISTING PROGRAMMES
• Political commitment is critical - Strong government commitment present
– Governments, donors, partners, professionals and civil society need to work in concert
• Strategic focus for mother and child– Care during delivery is the priority – All women should ideally be able to deliver in health centres, with skilled
birth attendants/midwives working in teams– Target the women in greatest need: e.g., poor rural women– Breastfeeding, EPI, NNP, IMNCI at facility and community
• Greater financial resources– Protect poorest from catastrophic payments, ensure equitable coverage by demand side financing eg voucher scheme– More investment
• Continued– Investment in family planning and safe menstrual regulation – Strengthening of emergency obstetric care in hospitals
• Additional policies, such as those that bring about expansion of female education, reduction of maternal malnutrition, better financial access for the poor, and poverty reduction, are essential
Opportunities to overcome challenges- 2