Perinatal and neonatal

epidemiology
 Outline presentasi
• Konsep dasar
• Kenapa fokus pada Perinatal dan
Neonatal Death?
• Framework maternal and neonatal
mortality and morbidity
• Key interventions
 Konsep dasar dan Definisi
• Under five mortality
• Infant Mortality
• Neonatal mortality rate
MEASURING PERINATAL MORTALITY

Fetus Nenonatal Infant

22 mg

7 hr 28 hr 1 th
Lahir
Lahir mati

Perinatal atau parilahir merupakan periode yang muncul sekitar pada waktu kelahiran (5
bulan sebelumnya dan satu bulan sesudahnya). Preiode perinatal terjadi pada 22 minggu
setelah periode gestasi lewat dan berakhir tujuh hari setelah kelahiran.
 Untuk dapat lebih memahami kematian ditetapkan beberapa
defenisi sebagai berikut :

• Kelahiran hidup (live birth) : ialah dikeluarkannya hasil konsepsi

secara sempurna dari ibunya yang setelah dipisahkan mempunyai
tanda-tanda kehidupan, tanpa memandang umur kehamilan.
•Kematian janin (fetal death) : ialah kematian hasil konsepsi, sebelum
dikeluarkannya dengan sempurna dari ibunya, tanpa memandang
umur kehamilannya.
Lanjutan……
• Kematian janin dibagi menjadi 4 golongan yaitu :
1. Kematian sebelum umur hamil 20 minggu
2. Kematian janin antara umur hamil 20 – 28 minggu
3. Kematian janin setelah umur hamil 28 minggu atau berat
diatas 1.000 gram
4. Kematian yang tidak dapat digolongkan.
• Kelahiran mati (stillbirth) : yaitu kematian hasil konsepsi
setelah mencapai umur 28 minggu atau berat diatas 1.000
gram.
• Kematian perinatal dini : ialah kematian bayi dalam 7 hari
pertama kehidupannya.
• Kematian perinatal : adalah jumlah lahir mati ditambah
dengan kematian bayi dalam 7 hari pertama kehidupannya.
Global distribution of under-five deaths and neonatal deaths by direct
cause, 2008
Neonatal mortality rate (per 1,000 live births), by region, 2010
 Share of under-five mortality

Neonatal deaths Infant deaths within 7 days of birth 40%

50%
Infant deaths
76%

Infant deaths between

7 days of birth and within 28 days 10%

Infant deaths between 28 days

and within one year of birth 26%

Child deaths between one

year and within five years of birth 24%

Source : SRS 2007

 Neonatal mortality.
• Penyebab kematian neonatal dan harusnya bisa di
cegah adalah lahir prematur dan berat badan lahir
rendah dan berkontribusi sekitar 20% neonatal
deaths.

• Sebagian besar kematian neonatal terjadi 24 jam

pertama setelah lahir, sebanyak ¾ kematian
neonatal terjadi pada satu minggu pertama setelah
lahir.
 Perinatal and fetal mortality.
• Health of infants depends in large part on their
health in utero. A fetus with severe defects or
growth problems may not be delivered alive.

• Because only live births are counted in infant

mortality rates, perinatal and fetal mortality
rates provide a more complete picture of
perinatal health than does the infant mortality
rate alone.
 Perinatal mortality.
• The perinatal mortality rate includes both
deaths of live-born infants through the first 7
days of life and fetal deaths after 28 weeks of
gestation.

• This rate is a useful overall measure of

perinatal health and the quality of health
care provided to pregnant women and
newborns.
Creating a supporting
environment
Menciptakan lingkungan yang mendukung bagi
perempuan & anak
Millennium development Goals
 Promoting a healthy behavior
 Securing a quality education
 Preventing child marriage
 Antenatal care coverage
 Skilled delivery care coverage
 Bagi menjadi 4 Kelompok
• Pra Konsepsi
• Antenatal
• Intrapartum
• Post Natal
Promoting a healthy behavior

• Timing of births • Coughs, colds & more

• Safe motherhood serious illnesses
• Child development • Hygiene
• Breast feeding • Malaria
• Nutrition & growth • HIV and AIDS
• Immunization • Injury prevention
• Diarrhoea • Disasters &
emergencies
 Tingkat Pendididikan Perempuan

• Studies show that educated women;

– Are more likely to delay marriage

– Ensure that their children are immunized
– Are better informed about nutrition
– Undertake improved birth spacing practices
 First 28 Days of life

• Specific factors
– Limited access to skilled care providers
– Home births [Associated with half of newborn deaths]
– Inadequate recognition of newborn illnesses
– Insufficient care seeking
– A limited repertoire of interventions for early neonatal
disorders [ e.g. birth asphyxia, premature births ]
– A lack of consensus on interventions and delivery
strategies
 Essential Services for mothers
newborn & children

• Basic health care • Adequate nutrition

• Quality maternal • Improved water &

care sanitation

• Newborn &child
• Hygiene practices
health care
Critical points for service delivery

• Adolescence, • Infancy,
• Pre-pregnancy, • Childhood
• Pregnancy, • Post-partum,
• Birth • Neonatal
 Supportive environment

• Respect for rights of women • Protection from abuse,

exploitation, violence &
& children
discrimination

• Quality education
• Equal participation in home
community, social & political
• Decent standard of living life

• Greater involvement of men • Women empowerment

 The continuum of care across
time & location-
‘Risks & opportunities’

• Across time-{ Key points} • Across location-{ Key

points}
– Adolescence
– Pre pregnancy – Household level
– Pregnancy – Community level
– Birth – Outreach services
– Post natal – Outpatient services
– Neo natal – Facility based care
 Key actions

• Enhance nutrition of adolescent girls

• Improve quality of reproductive health services

• Ensure adequacy of antenatal care

• Ensure skilled assistance during pregnancy & childbirth

 Key actions

• Provide access to quality Basic and Comprehensive Emergency

Obstetric

• Initiation of breastfeeding within one hour of birth

• Newborn care when required

• Expand post-natal care for mothers & newborns

• Promote safe water & hygiene practices at households and in

facilities
 Strengthening health systems to improve
maternal & newborn health

• Enhancing data collection & analysis

• Enhancing human resources, training & supervision

• Fostering social mobilization

• Ensuring equitable & sustainable financing

 Contd.

• Strengthening infrastructure, transportation, logistics

,supplies & referral process

• Improving the quality of care

• Global health initiatives{Strengthening collaberation

Continuum of care: Coverage of key neonatal survival
interventions in the developing world
KEY interventions

Source: Darmstadt, G. L. et al., ‘Evidence-based, Cost-effective Interventions: How many newborns can we
save?’, The Lancet, vol. 365, no. 9463, 12 March 2005, pp. 977-988.