00000ctm a22000001a 4500 UP-1685523046125372937 Buklod 20230503092606.0 a r |||| u| ta 040727s2004 xx |||| r||||u000 0|eng u (iLib)UPMNL-00000051710 LG 995 2004 E62 T36 Tan, Alvin G. Postpartum hemorrhage its association with inadequate prenatal care and contribution to burden of disease Alvin G. Tan. 254 leaves. Vita. Thesis (MS Public Health, Epidemiology)-- University of the Philippines Manila, 2004 Due to the advancements in obstetrics, the use of mortality data became a less sensitive measure of the success of obstetric interventions. A more appropriate indicator, as advocated by the WHO, is a measure that combines mortality and morbidity information to estimate population health. On the other hand, even though it has been practiced for a long time, very few systematic evaluations have been done to assess the effectiveness of prenatal care services in preventing the occurrence of maternal morbidity, such as postpartum hemorrhage. These are the main reasons for the conduct of the present study. In particular, this study has two objectives: (1) to determine the association between adequate prenatal care and the occurrence of postpartum hemorrhage; and (2) to estimate the burden of disease attributable to postpartum hemorrhage. For the 1st objective, a secondary analysis of 2000 Family Planning and Reproductive Health Survey was done. This was a cross-sectional study of ever-married female respondents from various regions of the Philippines who experienced a live birth two years prior to the interview. For this study, information from 3,592 respondents was deemed complete for analysis. Postpartum hemorrhage was assessed from self-reports as elicited from a face-to-face interview. Inadequate prenatal care was divided into two components: (1) inadequate utilization, as measured by the frequency of visits and the timing of prenatal care utilization; and (2) non-receipt of certain components of prenatal care, health behavior advice in particular. Multiple logistic regression revealed that inadequate prenatal care was associated with postpartum hemorrhage. Specifically, inadequate utilization of prenatal care was found to be associated with postpartum hemorrhage, but in addition to parity, socio-economic status is also an effect modified. This relationship was confounded by maternal age. Though statistical significant, the findings should be treated as exploratory and should be verified in further studies. For the estimation of burden of disease, a review of records was done to obtain certain epidemiologic information on postpartum hemorrhage. The absence of available data on a number of these data points led to the utilization of a Delphi survey, which aimed to acquire a consensus from a group of obstetricians on certain aspects of postpartum hemorrhage. After sensitivity analysis, a decision was made to use the following sources for the DALY computations: (1) vital registration for mortality data; (2) data from the Philippine Obstetrics and Gynecology Society for case fatality ration; (3) the Delphi estimates for the age specific distribution of cases of postpartum hemorrhage; (4) the Delphi estimates for the proportion of cases with postpartum hemorrhage who will develop severe anemia; (5) the Delphi estimates on the average duration of the disability; (6) life expectancies from local life tables and Coale and Demeny life tables; and (7) the disability weights from the Global Burden of Disease Study. Age weighing and discounting was also applied. The ensuing calculations showed that 8,676 DALYs (using Coale and Demeny life expectancies) were due to postpartum hemorrhage. Over 99% of this burden is due to YLL, the mortality component of the DALY. This suggests that improvements in the management of the condition are still needed to further reduce the disease burden from the condition. Furthermore, improving health-seeking behaviors of women in the reproductive age group and accessibility of health care facilities may also facilitate the reduction of disease burden. Postnatal care. Maternity nursing. UPMNL CPH LG 995 2004 E62 T36 Thesis