Maternal mortality down in India; still a long way to go

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Anemia among the major causes for death in mothers

New Delhi, 8 June 2018: In India, more women are now delivering babies in hospitals, which has brought down the number of women dying during childbirth in the country. As per recently released data by the office of the Registrar General of India, the maternal mortality rate (MMR) declined to 130 in 2014/16 from 167 in 2011/13.

MMR is defined as the number of maternal deaths per 100,000 live births. The causes range from excessive blood loss (post-partum hemorrhage) to infections, primarily because women do not give birth in a hospital or health centre. The major cause, post-partum hemorrhage is usually defined as the loss of more than 500-1,000 ml of blood within the first 24 hours following childbirth.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Death during childbirth is very common in the absence of accessibility to adequate and qualipty healthcare. This is truer in case of rural women. Immediate medical attention is crucial to saving lives of women and preventing complications in newborns. Anemia in pregnancy in one of the top causes of maternal mortality in India and an issue that needs urgent action.There are three types of anemia that can develop in a pregnant woman: iron-deficiency, folate deficiency, and Vitamin B 12 deficiency anemia. While it is normal to have mild anemia during pregnancy, more serious symptoms can indicate trouble and should be addressed at the earliest.”

Some of the symptoms of pregnancy-related anemia include pale skin, lips, and nails; tiredness or weakness; dizziness; shortness of breath; rapid heartbeat; and trouble in concentrating. Many of these symptoms are also normal in any pregnancy and only a routine blood test will be able to clarify whether one has anemia.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “The Pradhan Mantri SurakshitMatritva Abhiyan (PMSMA) was launched last year with the aim to reduce maternal and infant mortality rates by providing comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month leading to safe pregnancies and safe deliveries.The medical profession has been fully supportive of this initiative of the Health Ministry since it was announced, and all doctors are committed to participating in antenatal care and providing voluntary services on the 9th of every month.”

Some tips from HCFI for expectant mothers.

·Eat iron-rich foods such as meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called heme, is more easily absorbed than the iron in vegetables. If you are anemic and you ordinarily eat meat, increasing the amount of meat you consume is the easiest way to increase the iron your body receives.

·Eat foods high in folic acid, such as dried beans, dark green leafy vegetables, wheat germ and orange juice.

·Eat foods high in vitamin C, such as citrus fruits and fresh, raw vegetables.

·Cook in cast iron pots as this can add up to 80% more iron to your food.

·Take your prenatal multivitamin and mineral pill which contains extra folate.

WHO Priority Diseases: Ebola Virus Disease

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Ebola virus disease, or Ebola hemorrhagic fever, as it was earlier known as, is a severe illness which is often fatal, if left untreated.

The disease was first identified in 1976 when two outbreaks were reported from Nzara, South Sudan, and the other in a village near the Ebola River in Yambuku, Democratic Republic of Congo, from which the disease takes its name.

In May this year, WHO declared a new outbreak of Ebola in the Democratic Republic of Congo (DRC) making it the ninth outbreak of EVD in the country since it was first identified. On June 4, an ethics committee in DRC approved the use of five investigational therapeutics to treat Ebola, under the framework of compassionate use/expanded access. This is the first time such treatments are available in the midst of an Ebola outbreak, says the WHO.

Ebola virus disease is caused by the Ebola virus, which belongs to the Filoviridae family. Five species – Zaire, Bundibugyo, Sudan, Reston and Taï Forest – have been identified in the genus Ebolavirus. Of these, Zaire, Bundibugyo, Sudan and Taï Forest can cause disease in humans, while the Reston virus causes disease in nonhuman primates and pigs and not in humans.
Fruits bats (family Pteropodidae) are natural hosts of the virus.
Transmission to humans occurs via through close contact with the blood, secretions, organs or other bodily fluids of infected animals. Human to human transmission occurs through direct contact with the blood, secretions, organs or other bodily fluids of a person who is sick with or has died due to Ebola or contaminated surfaces. Burying the deceased patient also transmits the virus. Sexual transmission (via semen) may also occur.
The incubation period is 2-21 days.
The illness begins with sudden onset of fever, fatigue, muscle pain, severe headache and sore throat. This is followed by vomiting, diarrhea, rash, abdominal pain and unexplained bleeding manifestations.
History of exposure to the Ebola virus 21 days before the onset of symptoms should raise the suspicion of Ebola virus infection.
Diagnosis is confirmed by automated or semi-automated nucleic acid tests (NAT); if NATs are not available, rapid antigen tests are used to screen for Ebola infection. Specimens for testing include whole blood in EDTA and oral fluid in universal transport medium. The virus can be detected three days after the symptoms appear.
There is no specific treatment for Ebola. The infected person should be isolated. Early supportive care, which includes rehydration, oxygen supplementation, management of symptoms like fever, headache including treatment of infections improves chances of survival.
There is no approved vaccine for Ebola. Practicing infection prevention and control practices along with surveillance and contact tracing, a good laboratory service, prompt and safe burial of the dead may help transmission of infection.
Links to earlier published stories on Ebola Virus Disease in eMedinewS

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA