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

No mother should die while giving life

By Demissew Bizuwerk

Tena Esubalew Health Extension Worker comes to  Etenesh Belay's house for counselling on breast feeding practices
Tena Esubalew Health Extension Worker comes to Etenesh Belay’s house for counselling on breast feeding practices Amhara region of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

ADDIS ABABA, 17 April 2014 close to 2 million mothers and new-borns in Ethiopia are to benefit from improved maternal health and new-born care services.  Enhancing Skilled Delivery in Ethiopia (ESDE), a joint initiative between the European Union, Federal Ministry of Health and UNICEF, aims to increase access to and utilisation of quality maternal and new-born health services. ESDE is a 1.1 billion birr (€40 million) project financed by the European Union for a three-year period, from 2014 to 2016. Of this grant, €20 million is allocated to the Millennium Development Goal (MDG) pool fund of the Federal Ministry of Health (FMoH) and the remaining half to UNICEF.

This maternal health initiative represents one of the largest grants to maternal health ever provided to Ethiopia. ESDE will be implemented jointly by the Federal Ministry of Health and UNICEF, with the support of other development partners and health professional societies working in the area of maternal and new-born health.

Left to right: Dr. Peter Salama, Dr. Kesetebirhan Admasu and Ambassador Chantal Hebberecht officially launches ESDE Project.
Launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

ESDE comes at a time when Ethiopia is working hard to achieve the MDG target 5 of reducing maternal mortality, which is not yet on track. Currently, Maternal Mortality Ration (MMR) stands at 676 per 100,000 live births while Ethiopia hopes to bring down the level to 267 per 100,000 live births before the MDG deadline. ESDE project is expected to benefit 625,000 mothers and new-borns annually from improved access to maternal and new-born health services – a quarter of annual national deliveries.

Why maternal health matters in Ethiopia?

  • Only 29.5 per cent women delivered in Health Facilities[1].
  • MMR is 676 per 100,000 live births[2], while the expected MDG 5 target is to bring the level below 267 per 100,000 live births by 2015.
  • In Ethiopia, up to 15 per cent of mothers and new-borns suffer serious complications that warrant referral to facilities providing Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services including caesarean sections, blood transfusions and emergency laparotomy. However, the availability of CEmONC has been limited to only over a hundred hospitals having the capacity to provide the service in the country[3].
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health, makes a welcome remarks at the launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

What are the Government plans?

  • The government sets ambitious targets for 2015 MDG deadline including availability of Basic and Comprehensive Emergency Obstetric and Neonatal Care (BEmONC and CEmONC) at 100 per cent of hospitals and health centres in the country.
  • Increase skilled birth attendance rate to 62 per cent of total deliveries and universal access of mothers and neonates for antenatal and postnatal care[4].
  • The construction of over 800 new primary hospitals [one primary hospital per woreda (district)]. The construction of over 200 hospitals has already been initiated in the various regional states and is expected to be completed soon.
  • The hospitals need to be equipped with basic supplies and equipment to provide maternal and neonatal care including equipment for basic operation facilities and essential neonatal care equipment.

ESDE project will provide:

  • Obstetric and new-born care supplies and equipment for 500 health centres and 50 hospitals.
  • Operation theatre equipment for 30 primary hospitals.
  • Training for 5000 health extension workers in community based new-born sepsis management.
  • Obstetric and new-born care training for 250 doctors and health officers from 100 hospitals.
  • Emergency obstetric and new-born care training and supportive supervision for 1000 midwives and nurses.

 

[1] EFY2006 report of the Federal Ministry of Health

[2] Ethiopia DHS 2011

[3]National EmONC Assessment Report, FEDERAL MINISTRY OF HEALTH, 2008

[4]Health Sector Development Program IV, FEDERAL MINISTRY OF HEALTH (HSDP IV), 2010

In Ethiopia, DFATD support improves community based child and maternal care

By Frehiwot Yilma

Paul Rochon thanks Misa Wondimagen, 25, Health Extension WorkerDERA DISTRICT: AMHARA REGION, 30 October, 2013 – It is early Thursday morning and Gibtsawit Health Post, found in a rural village of Gibtsawit Mariam located 42 kilometres from Bahirdar, is busy with patients. The small room is crowded with mothers who are there to check their babies’ growth; pregnant women having their antenatal care and men and women of the community who are receiving malaria treatment.  Today is a special day, because the health extension workers of the health post are welcoming Mr Paul Rochon, Deputy Minister of International Development, Foreign Affairs, Trade and Development Canada (DFATD) and Dr Peter Salama, UNICEF Representative to Ethiopia.

Misa Wondimagegn, a 25 year old health extension worker, supports the community in Gibtsawit village of Dera district with curative and preventative health and nutrition services.  Misa and her colleagues Meseret and Hagere are supported by the health development army (a network of one volunteer to five Households) attend the 13,366 population of the kebele.

Misa has been working at Gibtsawit Health Post for seven years. “It was just when I finished tenth grade that I had the opportunity to join the training for health extension workers. It was hard convincing people to allow me to monitor the growth of their baby and take my advice about what to feed their children,” she says.  “We travelled long distances to reach as many households in the village as possible.  In each of our visit we tried to improve the health seeking behaviour of the community and eventually encouraged them to go to the health post.”

Growth Monitoring and Promotion is the cornerstone in the Community Based Nutrition Programme.  It creates a platform for the health extension workers to contact the caregivers and check the nutritional status of children, detect growth faltering at early stage and provide counselling on Infant and Young Child Feeding practices (IYCF).

“Now, the situation has changed a lot: we have mothers who bring their children for check-up and pregnant women who come for antenatal care. The support we get from UNICEF and the Canadian Government has increased the variety of treatments we provide for the community. We have outpatient treatment for children diagnosed with severe acute malnutrition and for pregnant women we give antenatal care and supply iron –folate. We promote good Hygiene and sanitation and we also give treatment for common childhood illnesses like pneumonia malaria and diarrhoea for the community,” Misa explains with smile on her face.

Support in Action

Haimanot Andarge, 20, and her daughter Azeb Abraru, 23 month, relax at home in Dera Woreda in Amhara region of Ethiopia

Since 2007, the Canadian Government has been supporting UNICEF Ethiopia’s interventions in Child Survival with Vitamin A and Zinc Supplementation and Integrated Health System Strengthening as well as routine immunization. Dera is one of the 100 UNICEF supported districts implementing the preventive and curative nutrition interventions. It is implementing Community Based Nutrition (CBN), integrated with other Community Maternal New-born and Child Health Interventions (CMNCH) to prevent child malnutrition, focusing on the first 1000 days: the time between conception and when a child turns two years of age.

In August 2013, 1,247 children attended the monthly Growth Monitoring and Promotion session in Dera enabling Misa and the other 78 health extension workers in the district to identify nutritional status of the children, detect early growth faltering, help the caregivers visualize the status and counsel them on appropriate age specific feeding messages using the Family Health Card as a counselling aid and refer children for further care in a timely manner whenever needed.

Haimanot Andarge, a 20 year old mother of baby girl Azeb, is one of the many mothers in the district who got follow ups from Misa and her colleagues during their pregnancy. “Misa used to come to my house regularly ever since she knew I was pregnant. She gave me vaccines and other supplements which was important for my baby. And when my labour began my husband took me to the health post. Misa encouraged me to deliver at Hamusit Health Centre which referred me to Bahirdar Hospital in time as my delivery was complicated. My baby was delivered safely because the health post was in our village to identify my condition,” Haimanot remembered. Her eyes reflect her fear of what might have happened. “ Azeb, is going to be two this year and  Misa still follows up on her  regularly and gives me advice on what to feed her,” adds Haimanot.

Integrating approaches to combat malnutrition

Holding Plumpy'Nut produced in Ethiopia, Misa Wondimagen, 25, Health Extension WorkerOne of the challenges to the health extension workers was what kind of advice to give to families with low income, regarding additional food for their children. “Health Extension Workers usually explain to families to use variety of cereals, animal protein and vegetables. Those who have money would buy and others barter with what they have produced,” explains Ato Worku Endale, Head of the Dera District Health Office. “Recently we have been integrating the health extension programme with the agriculture extension programme to support farmers on what to produce and how they can support their children and family with variety of food items. In addition, the safety net programme that has been implemented in this particular community allows families with low income to be involved in the income generating activities.”

With the integrated multisectoral approach of the government of Ethiopia and the support of UNICEF and partners such as DFATD, the hard work of health extension workers like Misa and colleagues is paying off.

Revolutionizing treatment of Severe Acute Malnutrition (SAM)

The support from UNICEF and the Canada Government that started the preventive nutrition programme of Community Based Nutrition linked with provision of WASH facilities has helped reduce the number of children who are malnourished.  According to Dr. Peter Salama, the collaborative work of all stake holders, the availability of treating health posts within the community have made saving a child easier than ever before.

At the end of the visit the team eagerly waits to hear from Misa and her colleagues on their response to the fundamental question of how many children were lost to malnutrition recently.  “There were 27 children diagnosed with Severe Acute malnutrition in July 2012- August 2013. They were treated with the Out-patient Therapeutic Programme (OTP) and 20 have been cured and seven are still on follow up with good prognosis but we have not lost a single child,” Misa explained boastfully.
Group Photo: Joint visit of UNICEF and DFTAD

“It was not easy to change the attitude of the community. When we started, there was no one before us working with the community reaching every  household door to door. We started from nothing. But with the support of donors like  UNICEF and the Canadian Government, I cannot even remember the last time a child died in the community for the last four years,” Misa reminisces.

“It makes me realise that it was not for nothing that I worked so hard at the beginning. I have brought change in my community.” Misa concludes.