Helping health workers save Ethiopia’s youngest children

By Demissew Bizuwerk

Kejelo, Tiro AFETA, Oromia, 14 June 2018: Inside the small room of Kejelo health post, health extension worker Amelework Getachew carefully monitors her stock of medicines stacked on a small wooden shelf. She checks to make sure that an Oral Rehydration Salt (ORS), a fluid replacement used to prevent and treat diarrhoea, Amoxicillin Dispersible Tablet and Gentamicin injection, antibiotics used to treat children with pneumonia and serious bacterial infections, are available in good quantity. She cross checks the numbers on each bin card and the actual quantities on the shelf. “I can’t afford to run out of these medicines,” says Amelework, pointing towards a stock of sachets of ORS and packs of amoxicillin tablets and gentamicin injections. “They are lifesaving.”

After Amelework is done taking inventory, she collects her essential job-aids for home visits and attends to five-month-old Aziza in her home as part of her routine house-to-house visit. This way, Amelework makes sure that pregnant women and newborn babies get health follow-ups.

When Aziza was only 45 days old, she suffered from pneumonia, the common killer of infants in Ethiopia. “I was so worried when my child was sick,” says Rawda, Aziza’s mother. “She was struggling to breathe and had it not been for ‘doctor’, my child would not have survived.”

“I was so worried when my child was sick. She was struggling to breathe

Amelework, whose name also means “a golden character,” is a committed health worker. Her nine-year journey as a health extension worker started in a remote village of Kereyu Dodo when she was given the daunting task of changing people’s attitudes on a range of health-related misconceptions.  It wasn’t easy for her to convince people to dig toilets or use bed nets to keep them safe from malaria. “They used to call us names like the ‘toilet controllers’ or ‘bed net checkers,” she remembers.

CNBC Jimma, Oromia
Amelework examines five months old Aziza. When Aziza was 45 days old, she suffered from Pneumonia. But now she is growing up healthy. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

But Amelework is now dubbed ‘doctor’, a name bestowed to her out of love and respect by the village women.  She is key to the livelihoods of the community, saving mothers and newborns including little Aziza in the small village of Kejelo.

Although Ethiopia has managed to significantly reduce its under-five child mortality, newborn deaths have declined at a much slower pace.  Twenty-nine newborn babies die out of every 1,000 live births from preventable causes such as complications due to prematurity, birth asphyxia, and infections like sepsis, and pneumonia[1]. Newborn deaths also account for a greater and growing share of all deaths among children under 5; almost 44 per cent.

Supported by UNICEF, the Government of Ethiopia introduced the Community Based Newborn Care (CBNC) strategy in 2012. CBNC aims to empower health extension workers, such as Amelework, with skills to provide maternal and child health services during pregnancy, childbirth and postnatally. Heath extension workers are also trained to identify and treat newborns with severe bacterial infections or sepsis where referral is not possible. They provide treatment for sick children both at the health post and in houses during their regular visits.

“The treatment we are providing is free of charge,” says Amelework. “This is encouraging mothers to bring their children early when they are sick.  It is also helping us to save young children from serious illnesses like pneumonia.”

Amelework is trained to provide CBNC services by JSI Research & Training Institute, Inc/ The Last Ten Kilometers Project (JSI/L10K), which is implementing the programme with technical and financial support from UNICEF.  She also gets constant support and follow-up from the CBNC supervision team who regularly visit her health post to make sure that she is applying the standard operating procedures.

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Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K supports Amelework with regular visits to her health post. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

“We train and support Amelework to deliver her very important work by effectively identifying sick children in the village during her regular immunization outreach work and when she is providing house-to-house postnatal care,” says Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K.  “We also monitor and evaluate her records to ensure key information is recorded and stored in the treatment book.”

Amelework is also provided with guidance and support on supply management. She keeps track of her medical supplies to avoid shortages of crical drugs that she needs for immediate use.

“Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses”

UNICEF is supporting the scaling up of CBNC services with funds from the Margaret A. Cargill Foundation. Working in coordination with the Ministry of Health, it is expected that the positive experiences observed in villages like Kejelo will be expanded to pastoralist areas.

CNBC Jimma, Oromia
Amelework is the indispensable medical person for Kejelo village mothers and children. She is dubbed ‘doctor’ by the local women for saving their children. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

A humble hard worker such as Amelework embodies Ethiopia’s hope to end preventable newborn and child deaths within this generation. “Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses,” she says, “I am a mother myself and I know the feeling.”

Aziza is growing up healthy, her mother’s wish is to see her daughter becoming a ‘doctor’, like Amelework. “She [Amelework] saved my child’s life and I want my daughter to also do the same when she grows up,” says Rawda, with eyes full of hope to see a bright future for her baby daughter.

[1] EDHS 2016

World is failing newborn babies, says UNICEF

Babies from the best places to be born up to 50 times less likely to die in the first month of life

NEW YORK, ADDIS ABABA, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.

“While we have more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old,” said Henrietta H. Fore, UNICEF’s Executive Director. “Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies.”

Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

Unequal shots at life[1]

Highest newborn mortality rates Lowest newborn mortality rates
1. Pakistan: 1 in 22 1. Japan: 1 in 1,111
2. Central African Republic: 1 in 24 2. Iceland: 1 in 1,000
3. Afghanistan: 1 in 25 3. Singapore: 1 in 909
4. Somalia: 1 in 26 4. Finland: 1 in 833
5. Lesotho: 1 in 26 5. Estonia: 1 in 769
6. Guinea-Bissau: 1 in 26 5. Slovenia: 1 in 769
7. South Sudan: 1 in 26 7. Cyprus: 1 in 714
8. Côte d’Ivoire: 1 in 27 8. Belarus: 1 in 667
9. Mali: 1 in 28 8. Luxembourg: 1 in 667
10. Chad: 1 in 28 8. Norway: 1 in 667
  8. Republic of Korea: 1 in 667

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

This month, UNICEF is launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:

  • Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care;
  • Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby;
  • Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life; and
  • Empowering adolescent girls, mothers and families to demand and receive quality care.

“Every year, 2.6 million newborns around the world do not survive their first month of life. One million of them die the day they are born,” said Ms. Fore. “We know we can save the vast majority of these babies with affordable, quality health care solutions for every mother and every newborn. Just a few small steps from all of us can help ensure the first small steps of each of these young lives.”

About Ethiopia

 Ethiopia is the second largest country in Africa with a total population of 94 million, out of which 13 million are under five years of age. Despite making overall progress in child survival, deaths among newborn babies still remain high. At 29 deaths per 1,000 live births, newborn mortality accounts for 44 per cent of all under five deaths. The new UNICEF report indicates that in 2016 alone, 90,000 newborn babies died in Ethiopia, ranking the country among 10 high burden countries globally.

Recognizing the need to accelerate newborn survival, the Government has put newborn survival at the centre of the Health Sector Development Plan. It has developed the Newborn and Child Survival Strategy (2015-2020) to strengthen the capacity of the health system and the skills of health workers to deliver quality health care to every mother and newborn baby. This includes the provision of quality antenatal care, skilled delivery, essential newborn care, postnatal care and neonatal intensive care for sick neonates.

UNICEF’s support to the newborn care programme includes;

  • Antenatal care, delivery, postnatal care, child care;
  • Health posts, health centres, and tertiary level hospitals; and
  • Integrated management of neonatal and childhood illnesses, immunization, community-based neonatal care, newborn care corners, and neonatal intensive care units.

UNICEF will continue to support the Ministry of Health to expand the availability of essential newborn care in the 800 health centers across the country, establish Newborn Intensive Care Units (NICUs) in hospitals, and strengthen the link between community-based and facility-based maternal, newborn, and child health programmes.