Transcript Document

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REDUCING MATERNAL AND NEWBORN DEATHS
Regions and Zones
Ethiopia:
11 Regions
62 Zones
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Demographic Characteristics
Total Population
Population Growth Rate
Population doubling time
Population under 15 years
Life Expectancy at birth
67.2mill
2.7%
23 years
44 %
54 years
Infant Mortality Rate
Under five mortality
113/1,000
187.8/1,000
Maternal Mortality Ratio
871/100,000
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Demographic Characteristics
Population below absolute poverty line 44.2%
Economic Growth Rate
5.8%
Per capita income (GDP)
US $100
Access to potable water
28.4%
Access to sanitation
16.9%
Health service coverage
61.8%
Adult literacy
31.9%
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United Nations Human Development Index,2002
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Socio-Demographic characteristics of women
Total Female Population
Population of Women (15-49)
Median age at first marriage
Total Fertility Rate
Female life expectancy at birth
Maternal Mortality Rate
33.6 million
16 million
16.4 years
5.9
55 years
871/100,000
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High Risk Fertility Behavior
40
35
30
%
25
20
15
10
5
0
Birth Order 4+
Birth interval<24 mth
Mothers aged<18
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Total Fertility Rate by Region
No. of children per woman
7
6
5
4
3
2
1
0
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Low Status of Women
 Limited Access to education
Female literacy
Female primary School Enrollment
Female secondary School enrollment
30.9%
51.2%
13.7%
 Limited representation in Governance 7.7%
 Limited access to employment
 Gender Development Index of
45%
142/162
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Women Waiting at Health Facility
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Population per health facility by region
Population/hospital
Population/health center
1,000,000
800,000
600,000
400,000
200,000
0
O
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Am mi
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ah
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SN ra
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PR
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gr
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di m
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D
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am a
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op
ia
Population per facility
1,200,000
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Health Providers/Population
Physician
1: 58,913
Midwife per expected deliveries
1: 3,756
Nurse
1: 5,236
Health Assistant
1: 8,249
Environmental Health Workers
1: 69,228
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Maternal Health Service Statistics (2002)
Family Planning
17.23%
Antenatal Care
34.11%
Attended Delivery
9.63%
Postnatal Care
7.12%
Expected number of deliveries
2,682,445
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Delivery Attendants
6%
6%
4%
26%
58%
H. Prof.
TTBA
NTTBA
Relative
Self
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Causes of Maternal Death*
Others
15%
Abortion
32%
Haemorrhage
10%
Sepsis
12%
Hypertention
9%
Obstructed
labor
22%
*Facility based, Ethiopia
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Contributing Factors to Maternal Deaths
Adolescent
pregnancy
HIV among
pregnant women
Malaria
Malnutrition
Harmful traditional
practices
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Selected Maternal Mortality Ratios in Africa
Maternal deaths per
100,000 live births
1000
800
600
400
200
0
ut
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S
a
ric
f
hA
Bo
na
a
tsw
we
b
a
b
Zim
ria
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g
Ni
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ia
p
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th
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The First Delay
Delay in deciding to seek care at the household level
 Lack of information
and inadequate
knowledge about
danger signals
during pregnancy
and labour
 Cultural /traditional
practices that
restrict women from
seeking health care
 Lack of money
Male Involvement is Key
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The Second Delay
Inability to access health
facilities:
Out of reach health
facilities
Poor roads and
communication network
Poor community support
mechanisms
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The Third Delay
Delay between arriving and
receiving care at the
health facility:
 Inadequate skilled
attendants
Poorly motivated staff
 Inadequate equipment
and supplies
Weak referral system
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Perinatal, Neonatal & Infant Mortality Rates
Perinatal Mortality Rate
100/1000 Births
Neonatal Mortality Rate
58/1,000 LB
Infant Mortality Rate
113/1,000 LB
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B
i
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er
Et
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op
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NP
R
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Ad
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O
Number of neonatal deaths/1000 live births
Neonatal Mortality Rate by Region
80
60
40
20
0
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Causes of Newborn Death
Others
15%
Infections
32%
Prematurity
24%
Birth
asphyxia
29%
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Estimating Consequences of Poor Maternal and
Newborn Health
Data on Maternal & Newborn Health
REDUCE MODEL
Impact on survival and productivity (2001 - 2015)
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Key assumptions in “REDUCE”
The model assumes two scenarios:
Scenario 1:
Maternal mortality ratio remains
constant from 2001-2015.
Scenario 2:
With appropriate interventions
maternal mortality ratio will decline
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Maternal Mortality 2001-2015
No interventions
415, 000 maternal deaths
9 Million suffer disabilities
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Infant Deaths resulting from Maternal
Death and Disability 2001-2015
No interventions
2,000,000 infants
will die
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Effects of Mothers’ Death
The death of a
woman and
mother is a tragic
loss to the family,
community and
nation as a whole.
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Disability Consequences
2001-2015
Chronic anemia
Fistulae
Chronic pelvic pain
Emotional depression
Maternal exhaustion
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Economic Losses
2001-2015
The loss of productivity due to
maternal deaths will be
US $650,000,000 or
about 5.5 billion Birr
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Commitment to Reducing
Maternal Deaths
GOAL
Reduce current MMR by
75 % by 2015
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1000
750
500
250
20
15
20
13
20
11
20
09
20
07
20
05
20
03
0
20
01
Maternal deaths per 100,000
live births
Reduction in Maternal Deaths 2001-2015
Year
No change in maternal care
Improved maternal care
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Economic Gains2001-2015
US $475 million or
4 billion Birr gain
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Intervention 1
Ensuring implementation of policies,
guidelines and standards related to
maternal and newborn health services.
Allocate at least 15% of total annual budget
for health (Arusha Declaration, 2001) and at
least 25 % of that health budget for
reproductive health services.
Strengthen the National RH programme to
promote multi-sectoral involvement.
Develop appropriate strategies for effective
community involvement and participation.
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Interventions 2
Designate and equip one Hospital per 500,000
population to provide comprehensive essential
obstetric which includes basic obstetric care as well
as surgical procedures particularly caesarian section
and safe blood transfusions;
Ensure that each Woreda has a minimum of one health
center equipped to provide basic essential obstetric and
newborn care for 24 Hours daily offering:
postabortion care
assisted vaginal
deliveries
manual removal of the
basic newborn life
placenta
support
Ensure that malaria, TB, TT, VCT & PMTCT are focused
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on during ANC
intravenous sedatives,
oxytocic drugs and
antibiotics
Interventions 3
For all newborns – born at home or in facility:
Clean delivery and cord care
Keep baby dry and warm
Breastfeeding: immediate and exclusive
Avoid harmful practices
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Interventions 4
All health facilities especially the Health
Centers and Hospitals must have regular
supply of water and electricity;
Maintain two way referral system;
All obstetric emergencies must be treated free
for the first 48 hours.
Abrogate Taxation on Contraceptives
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Interventions 5
Capacity building and improvement of skills:
Train 1,148 midwives to meet Government’s
stipulated midwife requirement based on HSDP-I target.
Review the curriculum to upgrade the skills of junior
midwives
Train more obstetricians
Strengthen the EOC component of pre-service training
Delegate responsibility to GPs, HOs and midwives
with adequate training and supervision to offer EOC.
Upgrade the skills of existing health providers to offer
newborn care and family planning.
Offer incentives for these cadres to attract and retain
them especially for the rural areas
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If we act now,
By 2015…
140,000 women’s lives saved
3,000,000 disabilities averted
700,000 children’s lives saved
$ 475 million US (4 billion Birr)
in productivity gains
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Conditions Needed
Strong commitment to maternal and newborn
survival and health by political leaders and
decision makers at national and local levels
Community involvement, Resource mobilization
and Partnership
Realistic and appropriate investment in women’s
education, health and economic empowerment
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Conditions Needed cont.
Male involvement and participation in
Reproductive Health issues and services
Implementation framework with clearly
defined supervision, monitoring and evaluation
mechanisms.
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Conclusion
To guarantee the RIGHT of Ethiopian
women and newborns to health and life,
they must have access to quality
reproductive health services, including
skilled attendance at birth.
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THANK YOU FOR JOINING THE
“REDUCE” TEAM
MOH/WHO
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