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.

CNBC Jimma, Oromia6658
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

WHO, UNICEF and Rotary International urge to sustain the polio-free status of Ethiopia

24 October 2017, Addis Ababa: Today, as the world commemorates World Polio Day, we, the World Health Organization (WHO), UNICEF and Rotary International, reaffirm our commitment to building on the success of our joint polio eradication efforts and sustaining the polio free status of the country.

Today, we are looking back at nearly three decades of concerted global polio eradication efforts. The Global Polio Eradication Initiative was created in 1988 after the World Health Assembly resolved to eradicate poliomyelitis globally and has since made remarkable progress towards reaching the eradication target. As a result, polio cases globally decreased by over 99 per cent from an estimated 350,000 cases in 1988, to only 37 reported cases in 2016. Furthermore, the number of countries with polio endemic decreased from 125 to only three countries – Afghanistan, Nigeria and Pakistan. However, until the polio virus transmission is interrupted in these polio endemic countries, all countries remain at risk of polio importation.

 

Nahom Alemseged gets a mark after receiving a polio vaccination
Nahom Alemseged get his finger marked after receiving a polio vaccination during a national campaign. ©UNICEF Ethiopia/2013/Sewunet

Ethiopia maintained its polio-free status for almost four years (45 months) after the last wild polio case was reported in Somali region in January 2014. We recognize that this achievement is a result of the effective leadership of the Federal Ministry of Health and the great partnership of polio eradication initiative collaborators, donors and partners including: Rotary International; Bill and Melinda Gates Foundation; WHO; UNICEF; USAID; CDC; CORE Group; and many frontline health workers who have played a key role in the successful fight against polio. 

We are committed to building on the recommendations which Ethiopia received from the Africa Regional Certification Commission (ARCC) in June 2017 when Ethiopia’s submission of a national polio free status report was accepted. As such, we will strive to strengthen and maintain routine immunization and surveillance with a particular focus on pastoralist communities, refugees, hard to reach and border areas as well as strengthening outbreak preparedness and coordination, cross-border surveillance with Somalia and others.

The theme for this year’s World Polio Day in Ethiopia is Commending Ethiopia polio free status, sustaining the gain.While we celebrate Ethiopia’s polio eradication success, we remain committed to continuing our joint polio eradication efforts in order to sustain this incredible achievement. In particular, we will build on the lessons learned as we strive to achieve regional certification.

The Polio Eradication and End Game Strategic Plan, developed by the Global Polio Eradication Initiative, envisages a polio free world by 2018. While we have come very close to achieving this goal, much remains to be done. We would like to call on all stakeholders to renew their commitment to a world which is free of polio.

 

In Ethiopia, the most common cause of death for children under five years of age is new-born death

Mother breastfeeding her new born for the first time
A mother breast feeds for the first time her new-born at Shire Clinic, Ethiopia ©UNICEF Ethiopia/2009/Tuschman

New York/Addis Ababa, 22 May 2014 – A ground-breaking series of papers released by The Lancet at UNICEF Headquarters today shows that the majority of the almost 3 million children who die before they turn one month old could be saved if they received quality care around the time of birth – with a particular focus on the most vulnerable and under-served.

New-born deaths account for a staggering 44 per cent of total mortality among children under five, and represent a larger proportion of under-five deaths now than they did in 1990. These deaths tend to be among the poorest and most disadvantaged populations.

“We have seen tremendous progress in saving children under five, but where the world has stumbled is with the very youngest, most vulnerable children,” said Dr Mickey Chopra, head of UNICEF’s global health programmes. “This group of children needs attention and resources. Focusing on the crucial period between labour and the first hours of life can exponentially increase the chances of survival for both mother and child.”

According to UNICEF, 2.9 million babies die each year within their first 28 days. An additional 2.6 million babies are still-born, and 1.2 million of those deaths occur when the baby’s heart stops during labour. The first 24 hours after birth are the most dangerous for both child and mother – almost half of maternal and new-born deaths occur then.

The Lancet’s Every Newborn Series identifies the most effective interventions in saving new-borns, including breastfeeding; new-born resuscitation; ‘kangaroo care’ for premature babies – that is, prolonged skin-to-skin contact with the mother; and preventing and treating infections. More funding and adequate equipment are also vital.

Countries that have made the most progress in saving new-born lives have paid specific attention to this group as part of the overall care extended to mothers and under-fives. Rwanda – alone among sub-Saharan African countries – halved the number of new-born deaths since 2000. Some low and middle-income countries are making remarkable progress by, among other methods, training midwifes and nurses to reach the poorest families with higher quality care at birth, especially for small or ill new-borns.

In Ethiopia, Neonatal Mortality Rate (NMR) has reduced from 54 in 1990 to 29 (per 1000 deaths) in 2012 according to the Inter-agency Group of Child Mortality Estimation 2013.

“Despite progress in child survival, the single most important remaining cause of death among children less than five years of age is new-born deaths – deaths within the first 28 days of life,” said Dr Peter Salama, UNICEF Representative to Ethiopia. “The government of Ethiopia is rapidly expanding access to basic health services to communities to prevent maternal and new-born deaths. With the strong commitment of the government and the sustained support of all our partners, we can speed up the reduction of maternal and newborn death even further.”

New Born baby taken care off by his nurse
A nurse takes care of a newborn baby at Shire Clinic, Ethiopia ©UNICEF Ethiopia/2009/Tuschman

To increase access, the Federal Ministry of Health has committed to the improvement of services based on the Health Sector Development Programme (HSDP) including the construction of 800 district hospitals (one per each woreda (district)). At present, over 120 hospitals are providing comprehensive emergency obstetric and neonatal care (CEmONC) services including caesarean sections, blood transfusions and emergency laparotomy for the entire population of the country.

A survey of 51 countries with the highest burden of new-born deaths found that if the quality of care received by the richest were to become universal, there would be 600,000 fewer deaths per year – an almost 20 per cent reduction.

The highest numbers of new-born deaths per year are in South Asia and sub-Saharan Africa, with India (779,000), Nigeria (267,000) and Pakistan (202,400) leading. For the highest burden countries, every $1 invested in a mother’s or baby’s health gives a nine-fold return on investment in social and economic benefit.

UNICEF and World Health Organization will roll out next month the Every Newborn Action Plan which aims to end preventable maternal and child deaths by 2035.

Lancet’s Every Newborn Series is co-authored by experts from UNICEF, the London School of Hygiene and Tropical Medicine, and the Agha Khan University, Pakistan, among others.

Find the press release here

Materials from the Lancet Every Newborn series launch are available at: http://www.thelancet.com/series/everynewborn