in Viet Nam

     Photo: Theresa Shaver
• Magnitude of maternal and newborn
  mortality in Viet Nam

• Human and economic consequences

• Priority interventions

• Economic benefits of action
Human Development Index
    Socio-Economic Indicators

 Per capita income         $377

 Allocation to health       5%

 Access to potable water   52%

 School attendance          91%
Characteristics of the Population

• Total Population       78 million

• Women of
  reproductive Age       21.2 million

• Total Fertility Rate   2.25
Place of Delivery
                       Health Facility

                       49.6% rural

                       90% urban

               Photo: Mary
         Place of Delivery
In certain mountainous and remote areas,
  over 90% of women deliver at home
Maternal mortality is the
  death of a woman:

• while pregnant
• during delivery
• or within 42 days after
  the end of pregnancy
WHO, 1992
Maternal Mortality: Mountainous
      and Remote Areas
      Causes of Maternal Death: Viet Nam

Source: MCH/FP, 2000
   Emergency Obstetric Care
Major causes of maternal mortality cannot
be predicted but can be treated
through emergency obstetric care (EmOC).
                      (J.Smith, Columbia University, 2001)

Accessing these services in a timely manner
is key: the “Three Delays” model.
 The First Delay

                        Lack of information
                        about danger signs of
                        pregnancy and labor
53% delay in decision
to seek care
                        Cultural customs
                        among minorities
                        delay care-seeking

                         Family members,
                          especially men,
                         have an important
                            role to play
The Second Delay

                                        Delays in reaching
                                        health facilities:

                                         Poor roads

                                         Lack money

                                         No access to transport
                Photo: Theresa Shaver

Delay in referral: 60%                   Lack awareness about
                                          danger signs
The Third Delay

                         Delay between
                         arriving and receiving
                         quality care at the
                         health facility:

•   Delay in treatment     63%
•   Wrong treatment        37%
•   Lack equipment         11%
•   Lack health staff      12%
•   Lack medicine          20%    (Source: MOH Survey 2000)
Nutritional factors
  contribute to
maternal mortality
 and disabilities
         Severe Anemia
 47% of maternal deaths in Viet Nam
 are due to hemorrhage

 Severe anemia is an underlying factor,
 making the consequences of
 hemorrhage more serious

Iron and folate help to prevent anemia
   Micronutrient deficiencies

Zinc         Vitamin D     Cobalt
      Iodine       Thiamin   Riboflavin
Vitamin B6     Vitamin E   Magnesium
   Manganese        Iron      Selenium
 Folate     Vitamin B12    Niacin
 Vitamin A Phosphorus Vitamin K
   Vitamin C    Cobalamin    Chromium
   Maternal iodine deficiency will
lower the IQ of infants and children

              45,000 children will
              suffer from cretinism

              135,000 children will
              be severely retarded

              About 1 million children will be
              mildly to moderately affected
Maternal           Newborn
 Care        +       Care

      health and survival
Perinatal and neonatal
                   Death in the First Year of Life
                                 Viet Nam, 2000

                                                  Mortality: 37
                      Mortality: 18

Source: Viet Nam MCH/FP, 2000
                        Perinatal and Neonatal Mortality:
                                              Viet Nam, 2000

                                                        Late neonatal mortality

                                                 12     Early neonatal mortality
                                                          (deaths in first week)
       Perinatal mortality
       30 / 1000 total births
                                                         Stillbirths and late
                                                 18      pregnancy losses

Based on State of the World’s Newborns 2001
                    Causes of Neonatal
                                   Other – 5%

      Congenital anomalies – 10%                  Prematurity – 24%

                                   Birth Weight
       Sepsis, tetanus, other
       infections – 32%

                                                  Birth asphyxia and
                                                  injuries – 29%

Source: WHO, 2001
                       Death rates vary by
                     weight categories at birth

               Birth weight      Incidence Mortality
               < 1500 g          1-3%       50 - 80 %
               1500 - 1999 g     1-8%       20 - 30 %
               2000 - 2499 g     4 - 34 %   5%

                     13% of Vietnamese children
                     are born weighing less than
                               2500 g
Global information
Photo: Theresa Shaver
                        Global Newborn Deaths
                            from Asphyxia

         1 infant dies

         4 infants suffer long-
         term impairment

Source:Sommerf elt,E.
Accounts for approximately 1/3 of neonatal deaths

Infections can be prevented by:

   TT immunization for pregnant women
   use of clean delivery practices & equipment
   clean cord care
   immediate and exclusive breastfeeding
To avert deaths from neonatal infection:

   Families and health workers
   • Early recognition of danger signs

   • Knowledge of where to seek care

   Health workers
   • Prompt and appropriate illness
Timely investments and

                         Photo: Mary Kroeger
REDUCE/ALIVE: Maternal and Newborn
    Health and Survival Models

          Team Analysis

         Newborn and maternal
            health linkages

           Estimated benefits
            of interventions

 Lives        Disabilities         Economic
 saved        prevented         losses reduced
                 Data Sources

• Figures on Social Development, 2000
• Health statistics yearbook, 2000
• MCH/FP report, 2001
• UN World Population Prospects, revised 2000
• Global Burden of Disease, 1996-98 (WHO)
• Human Development Report, 2001
• Studies from research institutions in Viet Nam
Photo: Theresa Shaver
Maternal Deaths over 10 Year Period

     No change in level of

    12,000 maternal deaths
   Maternal Deaths due to
Hemorrhage over 10 Year Period

No change in management of

    5,700 maternal deaths
       Economic losses from
       maternal deaths (2001-2010)

The loss of productivity due to all maternal
deaths will be about $14,000,000
    Economic losses from
    maternal deaths due to
   hemorrhage (2001-2010)
The loss of productivity
due to maternal deaths
caused by hemorrhage
will be about
Maternal Disabilities
        Maternal Disabilities

1 maternal death

20 - 40 maternal
      Maternal Disabilities   (2001-2010)

• Chronic anemia
  (including anemia
  from hemorrhage)
• Stress incontinence
• Fistulae
• Uterine prolapse
• Emotional depression
• Maternal exhaustion
Newborn Deaths
 and Disabilities
  Neonatal Mortality
No change in interventions
      for newborns

300,000 children will die
Newborn Disabilities
• Mental retardation and
  cretinism due to IDD

• Mental retardation due to
  birth asphyxia and injury

• LBW can lead to lower IQ
  and chronic ill health in
     Commitment to Reducing Maternal
         and Newborn Deaths
Viet Nam’s
Goal by 2010:

To reduce:
MMR from 95 to 70 / 100,000 live births
IMR from 37 to 25 / 1,000 live births
PNMR from 30 to 18 / 1,000 total births
LBW from 13% to 6%
                          (Vietnam’s National Strategy on RH Care)
 Economic Gains

$198 million saved or
Moving from Information
       to Action
    Priority Program Interventions
To reduce maternal deaths and
 disabilities from hemorrhage:
• Iron and folate supplementation
•   Presumptive malaria treatment where appropriate
•   Active management of the third stage of labor
•   Access to EmOC including safe blood transfusion
   Priority Program Interventions
            for Newborns
Every infant needs a
skilled attendant who will:
• ensure clean delivery practices
• ensure the baby is
    dried and wrapped
    kept with the mother
    breastfed immediately

                                    Photo: Mary
     Priority Program Interventions
              for Newborns
• appropriate resuscitation
  for asphyxiated babies

• early recognition & prompt
  treatment of sick infants

• extra attention to low birth weight
  babies - “Kangaroo Care”

• iodized salt for mothers in high risk areas
 If we act now…
   2,000 women’s lives saved
 321,000 disabilities averted

  52,000 children’s lives saved
$ 198 million in productivity gains
Photo: Theresa Shaver
             Conditions Needed
•   Strong political commitment to maternal and
    newborn survival
•   Special focus on the newborn within the
    framework of existing safe motherhood program
•   Appropriate investment for these interventions
•   Implementation of
      functional health information system
      clearly defined supervision
      monitoring & evaluation mechanisms
  Vietnamese women and children have
        the right to health and life
They need quality maternal and newborn
            care and services

                                Photo: Mary Kroeger
                 Developed by
  MOH/Viet Nam, Save the Children/Viet Nam,
Saving Newborn Lives, NGO Networks for Health,
        and Collaborating Organizations

            with technical assistance from
      Academy for Educational Development (AED)
                ALIVE/REDUCE team

                     April 2002
The REDUCE / ALIVE Viet Nam Team
  1. Dinh Thuan An MD           MCH/FP - MOH
  2. Duong Hai Ngoc MD          MCH/FP - MOH
  3. Nguyen Thi Thang           Health Strategy and Policy Institute, MOH
  4. Ha Anh Duc MD              Cabinet Office, MOH
  5. Le Ngoc Anh                Hanoi Medical University
  6. Vo Minh Tuan MD MPH        HCMC University of Medicine
  7. Huynh Thanh Hai MD         Tu Du Hospital
  8. Bui Thi Diep               Vietnam Women's Union
  9. Le Minh Thi MD             School of Public Health
  10. Nguyen Quang Phuong       General Statistics Office
  11. Nguyen Ngoc Thang         Research Center for Rural Population and Health
  12. Nguyen Thi Phuc MD        SC/US
  13. Nguyen Thi Huong MD       Health Statistics & Information Division, MOH
  14. Nguyen Duc Tien MD        Department of Treatment, MOH
  15. Vu Ngoc Khanh MD          MCH/FP, MOH
  16. Pham Duc Duc MD MA        Institute of Protection for Mothers & Newborn
  17. Vu Kim Hoa MD             Vietnam CPCC
  18. Dang Kim Khanh Ly         Social Institute
  19. Nguyen Bich Van MD        Institute of Protection Child Health
  20. Nguyen Thi Van            Planning department - MOH
  21. Nguyen Hoang Yen          Path
  22. Tran Hoang Nam MD         Pathfinder
  23.Catharine Pownall          NGO Networks for Health
  24. Judith Moore              SC/US
  25.Vu Thi Thanh MD            MOH
  26.Pham Bich Ha MD, MPH       SC/US
  27.Le Thi Huong MD, MPH       Hanoi Medical University
  28. Dao Xuan Dung MD          Medical Practitioner
  29.Debbie Gachuhi             AED
  30.Dr. Elisabeth Sommerfelt   AED

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