GEMP 1: COMMUNITY DR THEME

CARDIOVASCULAR BLOCK

Public Health Introduction To

Reproductive Disorders

Dr Harsha Somaroo
Department of Community Health
 Objectives
Describe the burden of Reproductive Disorders, globally, regionally,
and nationally

Discuss the determinants of Reproductive Disorders

Identify the preventable causes of Reproductive Disorders

Explain the levels of prevention of Reproductive Disorders

 Reproductive health
• Reproductive health deals with the reproductive processes,
functions and system at all stages of life

• Diseases, disorders and conditions affect functioning of the

male and female reproductive systems

• UN agencies claim that sexual and reproductive health

includes physical and psychological well-being

• Implicit right of men and women to be informed of and to

have access to:
– Safe, effective, affordable and acceptable methods of fertility
regulation of their choice
– Access to appropriate health care services for safe pregnancy
experience
 ICD 11 Diagnosis Codes (1)
• https://icd.who.int/browse11/l-m/en
ICD 10 Diagnosis Codes (2)
16 Diseases of the genitourinary system
Diseases of the female genital system
Diseases of the male genital system
Disorders of the breast
Diseases of the urinary system
Other conditions
Postprocedural disorders of genitourinary system
Diseases of the genitourinary system
17 Conditions related to sexual health
18 Pregnancy, childbirth or the puerperium
Global Burden of Disease- 2015 (WHO)
CDR
Rank Cause Deaths (per 100 000
population)
1 Ischaemic heart disease 8,756 000 119.2
2 Stroke 6,241 000 85.0
3 Lower respiratory infections 3,190 000 43.4

4 Chronic obstructive pulmonary disease 3,170 000 43.2

5 Trachea, bronchus, lung cancers 1,695 000 23.1

6 Diabetes mellitus 1,586 000 21.6
7 Alzheimer disease other and dementias 1,542 000 21.0
8 Diarrhoeal diseases 1,389 000 18.9
9 Tuberculosis 1,373 000 18.7
10 Road injury 1,342 000 18.3
Burden of Disease- Africa Region, 2015 (WHO)
CDR
Pos. Description Deaths (per 100 000
population)

1 Lower respiratory infections 1,007 000 101.8

2 HIV/AIDS 760 000 76.8

3 Diarrhoeal diseases 643 000 65.0
4 Stroke 451 000 45.6

5 Ischaemic heart disease 441 000 44.5

6 Tuberculosis 435 000 44.0

7 Malaria 403 000 40.8
8 Preterm birth complications 344 000 34.7
9 Birth asphyxia and birth trauma 321 000 32.5
10 Road injury 269 000 27.2
Burden of Disease- South Africa, 2015 (StatsSA)

Number
Rank Causes of death (based on ICD-10) %
of Deaths
1 Tuberculosis (A15-A19) 33 063 7,2

2 Diabetes mellitus (E10-E14) 25 070 5,4

3 Cerebrovascular diseases (I60-I69) 22 879 5,0

4 Other forms of heart disease (I30-I52) 22 215 4,8

5 Human immunodeficiency virus [HIV] disease (B20- B24) 21 926 4,8

6 Influenza and pneumonia (J09-J18) 20 570 4,5

7 Hypertensive diseases (I10-I15) 19 443 4,2

8 Other viral diseases (B25-B34) 16 097 3,5

9 Chronic lower respiratory diseases (J40-J47) 12 667 2,8

10 Ischaemic heart diseases (I20-I25) 12 239 2,7

WHO Country Profile- South Africa (1)
 Life Course Perspective

Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.
Matern Child Health J. 2003;7:13-30
Determinants of Reproductive Disorders

Non modifiable Risk

Behavioral Risk Factors
Factors
• Age • Family planning
• Sex • Safe sex
• Race • Diet
• Exercise
• Alcohol
• Smoking
 Levels of prevention of
Reproductive Disorders
Primordial
Primary
Social
Secondary
Legal Susceptible
Tertiary
Other
• Health promotion Asymptomatic
• Family planning
• STIs Screening Symptomatic
• Pap Smears Treatment
Adherence
Rehabilitation
 Maternal Morbidity and Mortality
• An estimated 300,000 women died globally in 2015 as a result of
pregnancy-related conditions [1]
• Global maternal mortality ratio has decreased by 1.3 percent per year
globally since 1990
• Greatest annualized rate of reduction in developed countries (-3.1 percent
versus -1.4 percent in developing countries)
• Reduction in maternal mortality due to:
– reduction in the total fertility rate
– increase in maternal education
– increased access to skilled birth attendants
– promotion of policies to
• reduce anemia and malnutrition
• prevent malaria in pregnancy
• provide calcium and micronutrient supplementation
• encourage delivery in facilities properly resourced for emergency obstetric care
• discourage early motherhood
• reduce unsafe pregnancy termination

1. Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015,
with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016; 387:462.
 Definitions
Maternal death
• The death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy
• from any cause related to or aggravated by the pregnancy or its management, but not
from accidental or incidental causes
• Most (62 percent) maternal deaths occurred in sub-Saharan Africa (179,000 deaths)

Late maternal death

• The death of a woman from direct or indirect obstetrical causes more than 42 days, but
less than one year, after termination of pregnancy

Pregnancy related death

• The death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the cause of death
• These deaths may be from accidental or incidental causes
The confidential enquiry into maternal
deaths in South Africa
• The Confidential Enquiry into Maternal Deaths in South
Africa has been operational since 1998

• Process of notification and independent assessment of

maternal deaths, predominantly in facilities

• In the earlier years of the Enquiry, institutional maternal

mortality ratio increased
– 176.2 per 100 000 live births in the 2008–10 triennium
– 146.7 in the 2011/12 period

• The slow progress was due to the significant contribution of

HIV/AIDs to maternal mortality and challenges in
implementing the recommendations
 The confidential enquiry into maternal
deaths in South Africa

The confidential enquiry into maternal deaths in South Africa: a case study, Volume: 121, Issue: s4, Pages: 53-60, First published: 18 September 2014, DOI: (10.1111/1471-
0528.12869)
The Saving Mothers Report
• The Saving Mothers Reports
provide data on
– the numbers
– common causes
– avoidable factors

• If recommendations from
these reports are
implemented /monitored and
evaluated, we expect a
decline in the rates of
maternal deaths
Saving Mothers Report 2014-2016 (1)
Saving Mothers Report 2014-2016 (2)
Questions