ABSTRACT
In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks. Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6% /795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.
ABSTRACT
The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapidsurvey methodology that can provide data on the prevalence and main causes of blindness.AimTo assess the prevalence and main causes of avoidable blindness and visual impairment in peopleaged 50 and above in Mongolia.MethodsThe RAAB uses a standard methodology which is documented in the RAAB Instruction Manual (HansLimburg, International Centre for Eye Health, London School of Hygiene and Tropical Medicine).Assuming an estimated prevalence of blindness in persons aged 50+ of 2.14% and a non-complianceof 5%, with a variation to 25% around the estimate of 2.14% at 95% probability, the required samplesize was calculated at 4,040: 101 clusters of size 40. Visual acuity (VA) was measured with a Snellentumbling E chart, using optotype size 18 (60) on one side and size 60 (200) on the other side. Thelens status of all participants was assessed by both torch and distant direct ophthalmoscopy, by anophthalmologist in a shaded or dark environment. The data were analyzed using RAAB Version 4.02(ICEH, London) for pre-defined reports relating to both crude and age and gender adjusted results.ResultsThe survey included 4,040 people aged 50 years and older, of whom 4,029 were actually examined.The coverage was 99.7%. 7 persons (0.2%) were absent and 4 (0.1%) refused to participate in thestudy. The prevalence of bilateral blindness with available correction in the better eye is 2.2 % (95% CI,1.7 - 2.7%); 2.4% in males and 2.2% in females. The prevalence of bilateral severe visual impairment(SVI) is 2.1% and bilateral moderate visual impairment (MVI) is 10.8%. The prevalence of functionallow vision, requiring low vision services, is 4.5%. In people aged 50+, untreated cataract is the mostcommon cause of bilateral blindness with 38.9%, followed by glaucoma (20.0%), non-trachomatouscorneal opacity (13.3%), and other posterior segment disease (7.8%).Conclusion: Untreated cataract and uncorrected refractive errors are the major causes of avoidableblindness and low vision in Mongolia, respectively. Priority should be given to cataract surgery,followed by the development of optical services and PHC and PEC services, as these are the mostcost-effective interventions. These three interventions will address about three thirds (67.8%) of thecauses of blindness and have most impact.
ABSTRACT
In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks.Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6%/795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.