A Day in the Life of a Well-fed Child: Ethiopia

By Frehiwot Yilma

AMHARA REGION, 05 June 2014 – Kossoye Ambaras is a small lush green village within Wogrea woreda in northern Gondar where it is relatively cold. Amarech Ashager, a 28 years old mother of two, is used to the weather as she lived her whole life here. At the top of her daily agenda is making sure that her family, especially her youngest son, Metages Birhanu of 9 months, is well fed.

Like many of the residents, Amerech does not rise out of bed before 7 a.m., as it is too cold to leave the house. She begins her day by breastfeeding Metages and cooking breakfast for the rest of the household. Her husband, Birhanu Tagel, is a businessman and her eldest son, Muluken, 10, is a third grader. After saying ‘good day’ to Birihanu and Muluken, Amarech will cook breakfast for Metages. Since he was introduced to solid food only three months ago, Metages eats exclusively porridge. Preparing highly nutritious porridge for a child is a technique that Amarech has recently learnt. The base of the porridge, the flour, contains various grains and legumes. For breakfast the added ingredient besides the flour is an egg and minced cabbage. As well as cooking the food, feeding the child to achieve best results is also a discipline. Amarech has learnt to feed her child while also playing and talking to him to keep him engaged.

It takes a village to raise a child

Health Extension workers in Amhara region provide preventive and curative health service to the community
Health Extension workers in Amhara region provide preventive and curative health service to the community ©UNICEF Ethiopia/2014

Amarech and other mothers in the village get support from Health Extension Workers (HEWs) on how to properly raise their children. Today, HEWs Habtam Dese and Yeshiwork Tesfahun are weighing the children in the village to monitor their health and development. They too receive assistance from Gebeyaw Alamerew, the woreda Nutrition and Child Health Officer. In a typical session with a HEW, a six-month-old child will receive a vitamin A supplement, while those aged above one year will additionally receive deworming tablets. With the support of UNICEF, this has become a routine service in the woreda.

Out of 18 children weighed by the HEWs , 16 are in the average weight range. Amarech is one of the happy mothers to learn that her son, Metages, weighs 8.6 kilograms, well in the range of a healthy baby’s weight. “I am so happy that he has gained a few more grams since last time,” she says, smiling. After weighing babies in the community, Habtam and Yeshiwork demonstrate how to make a child’s diet balanced and about the importance of using iodised salt. As the child-friendly food preparation simmers over a fire, the two mothers, whose children’s weight was under the average limit, get counselling on how to improve their baby’s weight. Gebeyaw believes the woreda has come a long way. “In previous years, there were up to eight children per month in Kossoye suffering from Severe Acute Malnutrition (SAM), but this year there have been no cases,” he says. “This is because we monitor the children’s growth and give counselling and other packages of support to the mothers at the earliest stage possible, as we did with the two mothers today.” When the food has finished cooking, Habtam and Yeshiwork let the mothers feed the warm nutritious preparation to their children.

Bridging the nutrition gap before sunset

Amarech Ashager breast feeds Metages Birhanu, 9 months old
Amarech Ashager breast feeds Metages Birhanu, 9 months old © UNICEF Ethiopia/2014

The afternoons in Kossye Ambaras are usually foggy this time of the season. Amarech has subsequently decided to do her laundry the following day and so turns to preparing dinner as well as other domestic chores. For Metages, she has a new menu in mind: adding mashed potatoes and carrots to the porridge. She says she will also never forget adding iodised salt to the food. “Habtam has told us that iodised salt is key to a child’s mental growth. She also told us that we have to put in the salt after the food is cooked and out of the oven so that the iodine does not evaporate with the heat,” she says.

Habtam is one of 38,000 government salaried HEWs currently providing nutritional and other support to mothers and children across all regions of Ethiopia. Development partners such as UNICEF are committed to support this initiative. “Nations will face critical bottlenecks to economic growth if a large proportion of their working-age people’s IQ and productivity are limited by under-nutrition,” says Dr Peter Salama, UNICEF representative in Ethiopia.

As the day draws to an end, Amarech’s house becomes lively as the family come together and discuss their experiences. While breastfeeding Metages, Amarech tells her husband about the importance of investing in their children’s diet to ensure their healthy future. “I will feed my children a variety of foods so that they will have a bright mind,” she says with confidence. “And I will be happy if Metages becomes a doctor.”

On the recent Micronutrient Global Conference (June 2-6, 2014), researchers, policy-makers, program implementers, and the private sector has been discussing ways of overcoming micronutrient malnutrition. The forum has been held under the theme of “Building Bridges”, thus emphasising scientific advances and multi-sectoral programming on adequate micronutrient intake. Read more

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

Video makes Community Based New-born Care (CBNC) training more productive

By Hailemariam Legesse

The Community Based New-born Care (CBNC) initiative was launched in March 2013, following the national policy breakthrough of allowing Health Extension Workers (HEWs) to treat new-born sepsis. The programme is supporting four agrarian regions: Amhara, Tigray, Southern Nations Nationalities and Peoples’ Region (SNNPR) and Oromia.

One of the methods and tools used during the four day CBNC training in Ethiopia is a training video produced in English, Amharic and Oromiffa. The video helps to make CBNC training more productive through presentation of communication skills and specific technics and procedures performed by Health Extension Workers in a rural setting of Ethiopia.

Though, first and foremost produced to support the four-day standard training on CBNC, the individual components of the video can be used also to support specific separate skill’s training like; Measuring Temperature; Weighing the Baby; Hand Washing; Essential New-born Care; and Expressing Breastmilk.

The video demonstrates components designed to follow the principles of continuum of care for mothers and new-born.             

  1. Registering women in childbearing age by HEW
  2. Communication skills during antenatal care follow up
  3. Filling the birth preparedness plan
  4. Measuring temperature of the new-born
  5. Weighing the baby
  6. Postnatal care visit (PNC) for the mother and new-born
  7. Hand washing
  8. PNC visit for the sick new-born
  9. Essential new-born care
  10. Ikram case study
  11. Expressing breast milk

Federal Ministry of Health led the production of the video with the financial and technical support from UNICEF and WHO and help of CBNC partners through the National Technical Working Group.6

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

Ethiopia: Ending newborn deaths

This is a re-blog from girlsglobe.org

By Haile Gebrselassie, Save the Children Child Ambassador, two-time Olympic Champion and four-time World Champion.

Credit: Jiro Ose/Save the Children

Credit: Jiro Ose/Save the Children

Ethiopia, my country, is the cradle of humanity. The first stone tools were found here and Lucy, a 3 million year old skeleton and the first Homo sapiens, was found in the village of Hadar, on the southern edge of the Afar triangle.

Our history is ancient and continuous. We are fiercely proud of the fact that we are the only African nation never to have been colonised. But like every nation our history is chequered and we have suffered.

In 1983, when I was ten years old, the first flames of hunger were flickering throughout Ethiopia. It was that year my mother died due to birth related complications. In those days, in my village, this was not very unusual.

My mother died following birth complications. The women of the village tried to help, but when I think back I realise that none of them really knew what they were doing.

In so many ways, we have made progress in saving the lives of mothers and their newborns since then. Today, the number of children dying before their fifth birthday has been halved since 1990.

The number of women who die in childbirth has declined by almost a third – that’s millions of kids who get to grow up with a mother and millions more getting a chance at life.

What we have achieved so far must be celebrated. The actions of our governments over the last fifteen years have brought about the greatest leap in children’s wellbeing survival in history. This change has been brought about by bold political leadership at the highest levels.

But even today, half of all women giving birth in sub-Saharan Africa give birth without any skilled help. Globally, 2 million women also give birth completely alone.  A direct result of this lack of skilled health workers, as Save the Children has shown in a new report today, a million newborn babies die on their first day of life. A single baby’s death is one death too many.

The good news is that we know what needs to change: ensuring every birth is supported by quality trained health care workers who have the expertise to help premature babies survive, deal with birth complications and prevent newborn infections can, with some wider steps, help prevent as many as two-thirds of these newborn deaths.

Every country in the world must ensure that all mothers-to-be have access to a midwife with life-saving medicines and equipment.

Africa is finally a continent on the rise – and children are the key to our continuing success. I want them to grow up to be the doctors, lawyers, teachers and even athletes that they are meant to be. The race for survival is a marathon, not a sprint. We are in this for the long haul. Like long distance running, this will take endurance, commitment and conviction. We have seen the incredible results when we put our minds to it.

The prize for these children is much greater than an Olympic medal. They get a fair chance at life, regardless of how poor their parents are, where they live or whether they are a boy or a girl. This is a race that we can win.