Transcript Under five mortality of Ethiopian children Damte Shimelis, M.D.

Background
• Ethiopia:
second populous country in Africa, 80 million
- women and children constitute 72%
of the population.
- 49.7% of Ethiopia's’ population are
female
- TFR is estimated 4.8
- Maternal mortality rate is estimated at
673 /100,000 live births.
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Background
• Per capita expenditure on health $ 2.31
compared to India $ 9, S. Africa $ 100,
U.K $ 1780
• Doctor to population ratio 1: 42,700
• Nurse to population ratio 1: 4,200
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Child health
• Under 15 years constitute 44.7% of the
population
• Of which 40% are under five and 8% are
under one year.
• Infant mortality rate is 59/1000 live births
• Under five mortality rate 88/1000 live
births
• Neonatal mortality rate 37/1000 live births
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Child health
• 1/20 born alive die in their first month
of life
• 1/10 die before reaching their 1st birth
day
• 1/6 die before reaching their fifth birthday
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Child health
• More than 70% of these deaths are due to the
five diseases.
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Pneumonia 28.9%
Malaria 21.6%
Diarrhea 12%
Measles 5%
60% of these deaths are associated with malnutrition
Perinatal 22%
HIV/AIDS 11%
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Malaria
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Prevalent in 75% of the country
4-5 million are affected every year
40 million are at risk
Morbidity and mortality is high in children
Only 20% of children under five who
experience malaria visit existing clinics
• The case fatality rate currently ranges
from 17-35%
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diarrhea
• One of the major causes of under five mortality
and morbidity next to lower respiratory infection
and measles
• In a nationwide rural survey 12.5% of children 659 months had diarrhea in the past two weeks.
• There is an estimate of 230,000 under five
deaths each year due to diarrhea.
• The median incidence of diarrhea is estimated to
be 5 episodes/child/year.
• Clean water coverage is about 31%
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HIV/AIDS (2001)
• Prevalence rate 2.1%
• Number of orphans – current report is 4
million
• Prevalence in pregnant women 6%- 23%
• 60,000 newborns infected through MTCT
• 40% of infected children die before 1 yr of
age
• 50-75% die before 5th birthday
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Nutrition
• Ethiopian Ministry of Health document shows
that :
47% of under fives are stunted
8% are wasted
37% are underweight
15% are low birth weight
• Malnutrition, underlying cause of death in >50%
of deaths of under fives
• In Ethiopia more than five out of ten under fives
are chronically malnourished
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Health and health related
indicators –MOH/2011
Indicator
Rate/coverage
Total fertility rate
4.8
Maternal mortality rate
673
Antenatal service coverage
34%
Attended skilled delivery
coverage
Postnatal service coverage
26.4%
15.8%
Family planning service coverage 29.0%
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Basic health indicators, MOH, 2011
INDICATOR
Life expectancy at birth
IMR/1000 live births
Crude birth rate
Total fertility rate
Crude death rate
Access to Basic Health
Service
Contraceptive usage
Population growth rate
CURRENT ESTIMATES
53.4(M), 55.4(F) years
59/1000
44/1000
6.1 children per woman
15/1000
86%
29%
2.9%
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The way forward
• The IMNCI strategy
1. Improve health worker skill
2. Improve the health system
3. Improve family and community health
seeking behavior
• ENA approach
• PMTCT
• Roll back malaria initiative – new drug
introduced
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Essential Nutrition Action, program
objectives
• Additional feeding for pregnant and
lactating mothers
• Exclusive breast feeding for 6 months
• Complementary feeding after 6 months of
age
• Extra feeding for the child during illness
• Micronutrient supplementation
• Immunization
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Prevention of Mother to child
transmission of HIV
• The four prongs:
– Primary prevention
– Prevention of unintended pregnancies in HIV
infected mother
– Prevention of mother to child transmission of
HIV
– Care and support to HIV infected women,
their infants and families
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Roll back malaria initiative
• Systematic data collection
• Vector control
– Insecticide treated nets
– Indoor residual spraying
– Integrated vector management
• Case management
• Support research
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There is still great hope!
• The promised land!
“ Let Ethiopia hasten to stretch out her
hands to God”
Psalm (68:31)
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Thank you
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