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Overview of Maternal and Child Health Epidemiology

Understand and apply key metrics in maternal and child health, including MMR, IMR, and BWSMR. Learn to calculate rates, proportions, and ratios for effective epidemiological analysis. Explore the Opportunity Gap concept for mortality reduction strategies.

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Overview of Maternal and Child Health Epidemiology

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  1. Overview of Maternal and Child Health Epidemiology GCC/RH Morelos, January 28, 2013

  2. Objectives • COUNT • 2X2 tables • DIVIDE: Ratios, proportions, rates • Maternal Mortality Ratio (MMR) • Infant Mortality Rate (IMR) • Birth weight specific mortality rate (BWSMR) • Proportionate Mortality • Birth weight proportionate mortality rate (BWPMR) • Intervention package proportionate mortality rate (IPPMR) • COMPARE: Opportunity Gap

  3. Cycle of Epidemiology Divide Count Compare

  4. Counts Definition: The absolute number of cases or events related to a health outcome (maternal deaths, neonatal deaths, total number of patients seen, etc.)

  5. Numerator/ Denominator Numerator Denominator • Both are counts • Choice of denominator primarily determines the meaning of the calculation

  6. 2 X 2 Table Outcome

  7. 2 X 2 Table Outcome=deaths

  8. 3 X 3 TableOutcome=DEATHS

  9. Cycle of Epidemiology Divide Count Compare

  10. Ratios– Proportion and Rates Basic Formula: x/y x 10n Ratio: X and Y can be independent of each other or x may be included in y (male to female ratio, maternal mortality ratio=maternal deaths/live births) Proportion: a type of ratio, x is always included in y (low birth weight proportion) Rate: (often) a type of proportion; the occurrence of an event in a population over time (neonatal mortality rate, infant mortality rate, birth weight specific mortality rate, etc.)

  11. Incidence vs. Prevalence • Both rates • Incidence – number of new cases of a disease in a defined population, during a particular time; rate of “infection” • Prevalence – the total number of cases of a disease in a population at a given time.; total burden of disease

  12. Maternal Mortality Ratio x/y x 10n X = # deaths of women caused by pregnancy related causes Y = # live births during the same time interval N = 5 (10n= 100,000)

  13. Infant Mortality Rate Definition: The proportion of deaths among live born infants during a given time period X = number of infant deaths Y = total number of infants N = 3 (10n = 1,000)

  14. Birth Weight Specific Mortality Rate (BWSMR) Definition: The proportion of infants who died and weighed a given birth weight among all infants of that birth weight X = number of infants who died and weighed a given birth weight Y = total number of infants who weighed a given birth weight N = varies

  15. Birth Weight Specific Mortality Rate YES NO

  16. Proportionate Mortality Rate x/y x 10n X = deaths linked to a particular cause or risk factor Y = deaths related to all causes or risk factors N = varies

  17. Birth Weight Proportionate Mortality Rate (BWPMR) Definition: The proportion of infants of a given birth weight who died among all infants who died X = number of deaths among infants of a given birth weight Y = total number of births N = varies

  18. Birth Weight Proportionate Mortality Rate

  19. Intervention Package Proportionate Mortality Rate (IPPMR) Definition: Proportion of deaths among infants whose birth weight(s) and period(s) of death are associated with a given intervention package X = number of deaths in an intervention package cell grouping Y = total number of births N = varies

  20. Intervention Package Proportionate Mortality Rate

  21. Intervention Package Proportionate Mortality Rate (IPPMR)

  22. Intervention Package Proportionate Mortality Rate

  23. The OpportunityGap

  24. The Opportunity Gap Definition: The potential for reduction in excessive mortality based on a comparison between rates already achieved by one population with those experienced by different population

  25. How to Calculate the Opportunity Gap • Plot raw data for targeted subpopulation into the BABIES matrix

  26. How to Calculate the Opportunity Gap 2. Calculate intervention package proportionate mortality rates

  27. 9 2 How to Calculate the Opportunity Gap 3. Select a standard for comparison 4. Subtract the rate for the targeted subpopulation from standard population - 2 7 = 1,9 4,8 1 1 0,8 1,2 1 3 1 5 3,5 4 6 Moldova Georgia, USA The opportunity gap

  28. Opportunity Gap 7 Pre pregnancy interventions 3 Care During pregnancy interventions 5 Early neonatal care interventions 1 Intrapartum care interventions The opportunity gap

  29. Selecting a Standard

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