Infant and Maternal Mortality. Life Expectancy.

Life Expectancy: Definition

An estimate of the average number of additional years a person could expect to live - if the age-specific death rates for a given year prevailed for the rest of his/her life. A hypothetical (conditional) indicator.

Infant Mortality Indicators

Infant mortality rate - Number of deaths of infants under age 1 per year per 1000 live births in the same year IMR = No. of deaths of infants in a given year / total live births in that year x 1000

Age Specific Infant Mortality Indicators: Postneonatal mortality

Number of infants died between the 29th day of life and the end of the 1st year / number of live births having survived the first 28 days of life x 1000

Age Specific Infant Mortality Indicators: Late neonatal mortality

Number of infants died between the 7th and the 28th day after birth / number of live births having survived the first 6 days of life x 1000

Age Specific Infant Mortality Indicators: Neonatal mortality

Number of live births died during the first 28th days of life / number of live births x 1000

Age Specific Infant Mortality Indicators: Perinatal mortality

Number of stillbirths + live births died during the first 7 days of life / total number of births (still and live births) x 1000

Maternal Mortality Indicators: Maternal Mortality Rate

Number of women who die as a result of complications of pregnancy or childbearing in a given year per 100 000 women of childbearing age in the population = number of maternal deaths / number of women ages 15 - 49 x 100 000 - represents both the obstetric risk and the frequency with which women are exposed to this risk

Life Expectancy: Global Characteristics and Trends

Big difference in Life Expectancy in men and women, especially in more developed regions: In nearly all countries, women have a higher life expectancy at birth than men, and at the global level, female life expectancy exceeds that of males by 4.5 years. Most developed countries - highest Life expectancy - greater difference between men and women (6 - 7 years higher in women); Least developed countries - lowest Life expectancy - smaller difference between men and women - 2 - 3 years (because of the high maternal mortality);

Infant Mortality Causes differ for the developed and developing countries

Developed countries 1. Perinatal causes and conditions - asphyxia, hypoxia, birth injuries, low birth weight, premature births. 2. Congenital anomalies 3. Acute respiratory system diseases 4. Other causes (e.g. Sudden Infant Death Syndrome) Developing countries 1. Immunizations avoidable communicable diseases (diphtheria, whooping cough (pertussis), tetanus, measles, TB, polio); 2. Diarrhea 3. Acute respiratory infections (pneumonia mainly) 4. Neonatal and perinatal causes (incl. neonatal sepsis) 5. Malnutrition

Life Expectancy at Birth: Global Trends

Gender differences in Life Expectancy By 2005-2010, female life expectancy was higher than male life expectancy in all regions, although the difference between the two was relatively small in South- Central Asia and Africa. According to the 2015 WHO data, women on average live longer than men in all major regions and in all individual countries except for Mali and Swaziland.

Age Specific Infant Mortality Indicators: Early neonatal mortality

number of live births died during the first 7th days of life / number of live briths x 1000

Infant Mortality Characteristics in Bulgaria

• Though decreasing, IMR in Bulgaria still remain much higher than the EU average - 3.7%o for the EU. IMR in the majority of the European countries is below 4%o. Few European countries have IMR higher than that of Bulgaria. These are: Romania, Albania, Moldova, Ukraine, Russia, Macedonia.

Life Expectancy at Birth: Trends in Developing Countries

1950s - rapid decline in mortality (expanded use of antibiotics, vaccines and insecticides); Consequent increase in life expectancy at birth From 41 years in 1950-1955 To 65 years in 2005-2010. Narrowed gap in life expectancy between the developed and the developing world From 25 years in 1950-1955 To 12 years in 2005-2010.

Maternal death: Definition

A maternal death is "the death of a woman from any cause related to or aggravated by pregnancy or its management (regardless of duration or site of pregnancy), but not from accidental or incidental causes." Death resulting from complications of induced abortion is considered a maternal death.

Variation in HLY across the EU

Across the EU Member States, Healthy life years at birth for women was between 54.1 years in Latvia and 74.6 years in Malta (a range of 20.5 years); for men was between 51.8 years in Latvia and 74.0 years in Sweden (a range of 22.2 years). In 2015, a woman born in Portugal could expect to live just less than two thirds (65%) of her life free from any limitation, a share that rose to 88% in Sweden and 89% in Malta. In 2015, men born in Estonia and Austria could expect to live 73% of their lives free from any activity limitation, a share that rose to as high as 91% in Malta and 92% in Sweden.

U5MR by Major Regions, 2007

Africa - 51% of all U5MR; Asia - 41% of all U5MR; The rest of the world - 8% of all U5MR.

Maternal Mortality Ratio: World Levels and Trends

Approximately 540 000 women die from pregnancy-related causes annually; Every minute a woman dies during labor or delivery; Almost all (99%) of these maternal deaths occur in developing nations. Many developing nations lack adequate health care and family planning, and pregnant women have minimal access to skilled labor and emergency care.

Life Expectancy at Birth: Global Characteristics and Trends

At the global world level, Life expectancy at birth has increased markedly since 1950: 1950 - 47 years 2015 - 71.4 years

Birth Weight and Gestational Age

Birth weight is a powerful predictor of infant mortality; Low birth weight infants are more than 20 times more likely to die within the first year of life than normal weight infants; Very low birth weight infants are about 100 times more likely to die than normal-weight infants.

Infant Mortality and Mother's Education

Consistent relationship between higher maternal education and lower levels of mortality among children under 1 and under 5 years of age. This has been observed in countries in Africa, Asia and Latin America. Almost one-third of global health gains as measured by mortality reduction in the period 1960-1990 are attributed to gains in female education. More educated mothers - able to reduce health risks and being better able to access modern health services.

Rise in Life Expectancy

Due to the great drop in mortality rates (1900- 1940) Mostly due to public health measures Example: American life expectancy has increased from 45 to 75 years over the past century. Only 5 of those additional years to life expectancy can be attributed to the medical care system interventions.

Life Expectancy at Birth: Trends in Developed Countries

First half of the 20th century - dramatic increase in Life Expectancy, reflecting mainly the reduction in infectious diseases and adverse conditions of maternity and infancy. Second half of the 20th century - an increase and then a decrease in cardiovascular diseases as a cause of mortality and an increase in cancer and trauma-related deaths, so that life expectancy increased, but at a lower rate than in the earlier period.

Maternal Mortality in Bulgaria

High for the European standards; Unstable levels during the last 15 years - 2-3 times higher than the EU average; Decline after 2000 To the level of 11%ооо for 2005-2010 Substantially higher in the rural areas; The main causes are largely avoidable (postpartum hemorrhage, abortions).

Countries with Highest and Lowest Under 5 Mortality Rate

Highest U5MR (2010 - 2015) Angola - 156.9%o Chad; Angola; Central African Republic; Sierra Leone Mali; Nigeria - around and over 120 %o; Lowest U5MR (2010 - 2015) Luxembourg; Singapore; Iceland; Finland; Norway; Slovenia; Swede; Cyprus; Japan - less than - 3.0%o; Germany - 3.7%o; the UK - 4.2%o.

Countries with the highest Life Expectancy

Hong Kong is a territory with the world's highest life expectancy. The life expectancy reached 84.0 years in 2015 surpassing Japan's 83.7 years.

Infant Mortality: World Characteristics and Trends

In 2015, 4.5 million (75% of all under-five deaths) occurred within the first year of life. Globally, the infant mortality rate has decreased from 63 deaths per 1000 live births in 1990 to 32 deaths per 1000 live births in 2015. Annual infant deaths have declined from 8.9 million in 1990 to 4.5 million in 2015.

Life expectancy at age 65, EU-28, 2015

In 2015, it can be observed that once a man had reached the age of 65, he could, on average, expect to live between another 14 years, as in Bulgaria, and 19.4 years, as in France. The life expectancy of women at age 65 was higher. In 2015 it ranged from 17.6 years in Bulgaria to 23.5 years in France.

Healthy Life Years in EU

In 2015, the number of healthy life years at birth in EU-28 was estimated at: 63.3 years for women (LEB = 83.3 years) 62.6 years for men (LEB = 78.7 years); this represented approximately 76% and 80% of total life expectancy for women and men. The gender gap is considerably smaller (0.7 years) in terms of healthy life years than it was for overall life expectancy (5.4 years) Women are expected to live longer, but smaller part of the expected years of life are expected to be in good health (free of disability) Life expectancy for women in the EU-28 was, on average, 5.4 years longer than that for men in 2015. However, most of these additional years tend to be lived with activity limitations.

Life Expectancy at Birth: Impact of the HIV/AIDS Epidemic

In Southern Africa, the region with the highest prevalence of AIDS, life expectancy has decreased: From 62 years in 1990-1995 To 49 years in 2005-2010 and is not expected to regain the level it had in the early 1990s before 2045.

Changes in Life Expectancy at Birth since 1950s

In the early 1950s, 60% of the world's population lived in countries where life expectancy at birth was below 50 years By 2000-2005, this proportion had fallen to 10%. Meanwhile, the share of world population living in countries with life expectancy of 70 or higher years rose from less than 1% in 1950-1955 to over 50% in 2000-2005.

Infant Mortality in Developing Countries

India, Nigeria, China, Pakistan, the Democratic Republic of Congo, and Ethiopia account for 50% of the all child deaths annually; 2/3 of all child deaths worldwide could be prevented with existing scientific knowledge and medical treatment; Focus on community-based interventions to identify and treat pneumonia or to cope with the avoidable by immunizations communicable diseases.

Other Specific Indicators for Infant Mortality

Infant Mortality by: residence (urban / rural / major regions) gender of the infant (male, female) ethnicity race birth weight socio-economic characteristics (e.g. mother's educational level; mother's age; mother's marital status, parity, wealth, etc.

Infant Mortality: Definition

Infant mortality refers to the death of an infant during the first year of life Calculated as: Number of deaths among infants under one year old per 1,000 live births in a given year and territory.

Life Expectancy: Global Characteristics and Trends

Life expectancy at birth - very much influenced by mass epidemics of communicable and non- communicable diseases. Example: In countries most affected by the AIDS epidemic - Life expectancy is with 20 years lower than it would have been without AIDS;

Life Expectancy at Birth: EU

Life expectancy at birth in the EU-28 averaged 80.6 years in 2015 83.3 years for women 77.9 years for men A woman born in 2015 is expected to live between 78.2 years (in Bulgaria) and 85.8 years (in Spain), a range difference of 7.6 years. A man born in 2015 can be expected to live between 69.2 years (Lithuania) and 80.4 years (Sweden), a range difference of 11.2 years. There are still major differences between countries. In 2015, the differences between the highest and lowest life expectancies among EU Member States amounted to 11.2 years for men and 7.6 for women. For men, the lowest life expectancy was recorded in Lithuania (69.2 years) and the highest in Sweden (80.4 years). For women, the range was from a low of 78.2 years in Bulgaria to a high of 85.8 years in Spain.

Life Expectancy: Types

Life expectancy can be measured at age 0 (at bith) - Life Expectancy at Birth, or any other specific age, representing expected survival time once a person has reached that age; For example, Life expectancy at ages 15, 20, 40, 60, 75 or 80 years is the average number of years that a person at that age can be expected to live, assuming that age-specific mortality levels remain constant.

Infant Mortality: Determinants

Low birth weight and premature birth - main reason for neonatal death; Unfavourable socio-economic conditions; Low culture and education of parents; Medical surveillance of pregnant women and infants; Midwifery and childbirth healthcare and services availability; Surveillance of high risk pregnancies and families mothers younger than 19 or older than 35 years of age; short interval between subsequent births; Incompliance with the child nurture rules and recommendations; Influence of environmental factors (pollution, disasters, etc.

Barriers for decreasing Infant Mortality Rates:

Low coverage with routine immunizations; Children and mothers malnutrition (poverty); Insufficient pregnancies surveillance and low coverage with basic maternity care; Low literacy rates and educational status of women; Poor and inadequate living conditions.

Life Expectancy at Birth in Bulgaria: Characteristics and Trends

Main reasons for LEB unfavourable dynamics: Age-specific Mortality Rates increased for men in active age - increased morbidity and mortality from socially significant non-communicable diseases related to risky life style; Infant Mortality Rates in Bulgaria - still substantially high - 2-3 times higher than the EU average rates.

Maternal Mortality: Measurement / Indicators

Maternal Mortality Rate per 100,000 women of childbearing age Maternal Mortality Ratio per 100,000 live births (or per 1000 live births)

Cause Specific Infant Mortality Rate

Measures the frequency of infant deaths from a particular cause / per 100,000 live births Infant mortality from congenital = anomalies Number of infants died during the 1st year of life from congenital anomalies/ Number of live births x 100 000

Under 5 Mortality Rates (U5MR)

Number of deaths among children under 5 years old per 1000 live births in a given year and territory (in %о) Examples: U5MR Assessment Scale Low Medium High Very high - under 30%о - 30 - 94%о - 95 - 170%о - over 170%о Japan, Finland, Sweden, Iceland, Singapore - less than 3 %о - very low U5MR Sierra Leone, Angola; Chad, Mali, Guinea-Bissau - over 150 %o - high and very high U5MR

Measure of Maternal Mortality: Maternal Mortality Ratio

Number of women who die as a result of complications of pregnancy or childbearing (puerperal causes) in a given year per 100,000 live births in the population. Example: Country /Region, Year - deaths due to puerperal causes: 275; live births: 1,750,000. Maternal mortality ratio: 275 / 1,750,000 x 100,000 = 15.71 maternal deaths per 100,000 live births per year

Infant Mortality: Medico-Social Aspects

One of the most informative public health indicators; A good indicator of the overall health status of a population; Much higher than the mortality rates in the following age groups (beyond 1 year of age); A major determinant of life expectancy at birth Tremendous gains in life expectancy in the first 70 years of the 20th century were almost exclusively the result of a declining infant and childhood mortality. Infant Mortality is very sensitive to levels and changes in socio-economic conditions of a population; one of the best indicators to reveal social inequalities in health; Influenced by many factors (healthcare playing major role).

Maternal mortality: Characteristics and Trends

One of the most informative public health indicators; Important indicator for the assessment of women's health, the quality of ante-natal, obstetric and maternity care; Varies largely across different parts of the world; very sensitive to reveal inequalities in health; Denmark, Sweden, Greece, Italy - 3 per 100000 live births; Sierra Leone - 1360%ооо; Central African Republic; Chad; Nigeria over 800%ооо; Bulgaria - 11%ооо; Germany - 6%ооо; UK - 9%ооо;

Periodization of the 1st year of child's life

Perinatal period (from 'peri' = 'around' and 'natus' = ' birth') From the 28th week of gestation to 7th day after birth. Neonatal This period begins at birth and ends at 28 completed days after birth. It is subdivided into 2 sub-periods: Early neonatal - occurring during the first 7 days of life; Late neonatal - occurring after the 7th day but before the 28th completed days of life. Postneonatal (from 'post' = after and 'neonatal') This period begins with the 29th day after birth and ends up with completion of 1 th year of age.

Proportions: As Measures of Infant Mortality - (in %)

Structure of the Infant Mortality Causes - in % Example: Structure of the Infant mortality causes, Bulgaria, 2008 1. Perinatal causes - 42.5% 2. Congenital anomalies - 17.4% 3. Acute respiratory infections - 14.5% 4. Circulatory system diseases - 7.1% 5. Infectious and parasitic diseases - 4.1% 6. Injuries and poisoning - 4.2% 7. Others

Countries with the lowest Life Expectancy

The countries with the lowest overall life expectancies per the WHO are Sierra Leone, the Central African Republic, the Democratic Republic of the Congo, Guinea-Bissau, Lesotho, Somalia, Swaziland, Angola, Chad, Mali, Burundi, Cameroon, and Mozambique.

The gender gap in Life expectancy in EU varies largely

The gap between male and female life expectancies at birth varied substantially between EU Member States. In 2015, the largest difference between the sexes was found in Lithuania (10.5 years) and the smallest in the Netherlands (3.3 years).

Healthy Life Years at age 65

The indicator Healthy Life Years (HLY) at age 65 measures the number of years that a person at age 65 is still expected to live in a healthy condition. HLY is a health expectancy indicator which combines information on mortality and morbidity. HLY at age 65 for EU-28 = 9.4 years - both for men and women

Causes of Maternal Mortality

The main causes of maternal deaths are: Postpartum hemorrhage (24%); Indirect causes: anemia, malaria, heart disease (20%); Infection (15%); Unsafe abortion (13%); Eclampsia (12%); Obstructed labor (8%); Ectopic pregnancy, embolism, and anesthesia complications (8%)

Life Expectancy at Birth: Trends in Least Developed Countries

The reduction of mortality in the least developed regions has not kept pace with the changes occurring elsewhere in the developing world. Life expectancy increased: From 36 years in 1950-1955 To 53 years in 2005-2010. The difference in life expectancy between least developed regions and less developed regions increased: From 5 years in the early 1950s To 12 years 2005-2010. The main cause for such divergence is that 31 of the 50 least developed countries are highly affected by the HIV/AIDS epidemic.

Life Expectancy at Birth: Global Characteristics and Trends

There are major differences in life expectancy between developed and developing countries. The average difference between developed and developing countries is 10 years (8 years for men and 12 years for women); In developed countries as a whole, life expectancy averages 77 years, compared to 67 years in developing countries. In the least developed countries, life expectancy remains low (56 years on average), lowest in Sub- Saharan Africa - 52 years - (the HIV/AIDS epidemic).

Under 5 Mortality Rate: World Levels and Trends

Under-five mortality rate remains high in less developed regions and particularly in the least developed countries. Under-five mortality in Africa is more strongly affected by HIV/AIDS than is infant mortality, because most children born with the disease survive their first birthday but die before age 5.

The gender gap in Life expectancy in EU is shrinking

With a gender gap of 5.4 years of life in 2015, women generally outlive men in the EU-28.

Under 5 Mortality Rate By Major Regions in the World (2005-2010)

World average - 71 %o More Developed Regions - 8 %o Less Developed Regions - 78 %o Least Developed Regions - 132 %o Sub-Saharan Africa - 148 %o Africa - 136 %o Asia - 58 %o Latin America and the Caribbean - 28 %o North America - 7 %o Europe - 9 %o (Western - 5 %o; Eastern - 14 %o)

Infant Mortality Differs By Major Regions in the World

World average - high Infant Mortality Rate - 47 %o More Developed Regions - 6 %o Less Developed Regions - 52 %o Least Developed Regions - 82 %o Sub-Saharan Africa - 89 %o WHO African Region (55 per 1000 live births), over five times higher than that in the WHO European Region (10 per 1000 live births).

Infant Mortality: World Characteristics and Trends

Worldwide, approximately 7 million children under 5 years of age die each year; among which 4.5 million infants under 1 year of age: More than 90% of these infant deaths occur in the developing world; In poorer countries, 10-20% of all infants die before their first birthday. Infant mortality varies largely across the world (over 50 times difference between the countries in different parts of the world) and is very much influenced by the socio-economic development - a very sensitive indicator for the social inequalities in health.

Healthy Life Years

- Whether extra years of life gained through increased longevity are spent in good or bad health is a crucial question. Since Life expectancy at birth is not able to fully answer this question, indicators of health expectancies, such as Healthy life years (HLY) (also calledDisability-free life expectancy (DFLE) have been developed. Healthy Life Years focuses on the quality of life spent in a healthy state, rather than the quantity of life - as measured by life expectancy.. The indicator Healthy Life Years (HLY) measures the number of years that a person is expected to live in a healthy condition. HLY is a health expectancy indicator which combines information on mortality and morbidity. A healthy condition is defined by "the absence of limitations in functioning/disability". The indicator is calculated separately for males and females.

Decrease in Infant Mortality

- very important goal of WHO strategies Globally, IMR has decreased from 63 deaths per 1000 live births in 1990 to 32 deaths per 1000 live births in 2015. Annual infant deaths have declined from 8.9 million in 1990 to 4.5 million in 2015. Major part of the child deaths (infant and under 5 mortality) could be prevented with existing knowledge and treatment