Exam Card 22

I. Measures of descriptive statistics: rates, ratios, percentages,

percentiles.
1. Situations we need to use measures of descriptive statistics
in medicine & Public health.

2. Rates: types, calculation, examples.

i) Crude rate = number
population
ii) Specific rate dominates with specific population
iii) Adjusted rate / standardized direct/indirect

3. Ratios: calculation, examples.

= as index of comparison between 2 comparing subjects
eg i) Relative risk / risk ration = probability of developing disability
with RVS
probability of developing disability if no
RVS
ii) Odds ratio = probability of occurrence of event
probability of no occurrence
iii) Number of patients
Number of physicians

4. Percentages: calculation, examples.

= representation of an incidence in 100
eg x X 100 = ?
y

5. Percentiles: upper, lower quartiles (25th percentile), give

examples.
= probability of distribution/ representation of subjects in normal
distribution thats grouped

II. Reproductive health as a component of Public health.

1. Definition of reproductive health. Components of Reproductive
health.
Reproductive health addresses the reproductive processes, functions &
system at all stages of life. Reproductive health, therefore, implies that
people are able to have a responsible, satisfying & safe sex life & that
they have the capability to reproduce & the freedom to decide if, when
and how often to do so. Implicit in this are the right of men & women to
be informed of & to have access to safe, effective, affordable &
acceptable methods of fertility regulation of their choice, & the right of
access to appropriate health care services that will enable to go safely
through pregnancy & childbirth and provide couples with the best chance
of having a healthy infant.
Components of Reproductive health
i) Subjects
ii) Baby
iii) Health services

2. Adolescent pregnancy as a public health problem.

Health indicators in young women.
i) Abortion rate
ii) Abortion ratio
iii) Infertility
iv) Birth rate
v) Maternal mortality
vi) Average early delivery of adolescent (14-18)
vii) Use of contraceptives
viii) % of attendance of professionals
ix) Family

3. Maternal mortality: measures, classification. Compare different

countries.
For every 100 women who become pregnant:
i) 40% - experience some complication
- during pregnancy/delivery or after delivery
ii) 15% - life-threatening complication
- some specific service must be provided
iii) 5% - need surgical intervention
if < 5%, its underused

Analysis by time of maternal death:

i) 50% - 1st 24 hours after delivery
ii) 25% - during pregnancy
iii) 20% - between 2-7 days after delivery
- while discharging
- control possible complications between 2-7th day
 iv) 5% - after this period 2-6th weeks

Most is in India (25% of worldwide maternal deaths)

30% - Indonesia, Pakistani, Bangladesh
Subsahara Africa (Nigeria), Euthopia

If compare by regions, lifetime risk of is different

total life expectancy is related to number of pregnancy shes had

Africa 1 in 16
Asia 1 in 65
Latin America & Caribbean 1 in 140
Europe 1 in 1400
North America 1 in 3700

4. Causes of maternal death. Compare different countries.

Causes of maternal death
i) 25% - haemorrhage
ii) 14% - sepsis & complication related to inflammation
problem
iii) 13% - unsafe abortion ( haemorrhage)
iv) 13% - hypertension
v) 7% - obstructive labour
vi) 8% - other direct causes
vii) 20% - other indirect causes

5. Ways to reduce maternal deaths & improve health status of

women.
Common technique in mx of pregnancy risk approach
- evaluate possible risk of complication by score
- previous hx of reproduction, age, disease (chronic
condition)
Studies that were conducted showed that it was impossible to predict
which will get life-threatening condition. Score is important but
dont show.
90% of identified for risk of obstructed labour didnt experience
any problems but among those who did, 70% didnt have any
marker of this problem.

Successful care is important in reducing maternal deaths:

a) Prenatal care
Every have to be consulted/observed by a doctor during
pregnancy.
But to be more demanding, should have 1st visit in 1st trimester
(<12 weeks)
- to identify different problems chronic diseases, aware infection,
nutrition.
- period to decide on termination
- Mandatory weight, fetal size, US, bp.
Counseling, education & psychological support is important.
Screening -fetoprotein test, test for abnormalities of child
- Infection rubella, toxoplasmosis, CMV, herpes,
hepatitis B
b) Delivery care
Provide assistance of a skilled birth attendant (doctor/midwife)
Developing country lack of ppl (esp rural areas) (1
midwife/15,000 births)
Recommended ratio = 1:5000
Sanitary & hygiene conditions
- even for professional attendant
- even in developed country
high rate of nosocomial infection in maternity wards (>60%)
- Therefore organization is used - who delivered on
different days cant
stay in the same ward.
- More developed country approach by a team of
attendants (4 specialists)
(O & G, midwife/nurse, Paediatrician,
anaesthesiologist)
c) Postnatal care = care after delivery
Interestingly, its only provided for < 30% of
i) Developed country almost all provided
ii) Developing country almost none provided
Components breast-feeding, family planning, contraception,
nutritional supplement (deficiency of Ca, I2, Fe)