Maternal Newborn and Child Mortality and Midwifery Education in Ethiopia- By Meseret Desta Haileyesus - PowerPoint PPT Presentation

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Maternal Newborn and Child Mortality and Midwifery Education in Ethiopia- By Meseret Desta Haileyesus


Every day, about 800 women die from pregnancy or childbirth-related complications. Almost all of these deaths occur in developing countries. More than half of them occur in sub-Saharan Africa.Too many women are dying strictly because they have poor access to the high-quality care they need. As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? Read my presentation. Hope it gives you some insight on maternal mortality and Midwifery Education in Ethiopia. Thanks for sharing my s. – PowerPoint PPT presentation

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Title: Maternal Newborn and Child Mortality and Midwifery Education in Ethiopia- By Meseret Desta Haileyesus

  • Maternal Health and Midwifery in Ethiopia
  • Meseret Desta Haileyesus
  • (SMW,BsN BA,MPH)
  • Office of Global Health, University of Alberta
  • December 2, 2013

  • To share an overview of the general situation of
    Maternal health and midwifery education in

Presentation outline
  • Introduction
  • Maternal and Newborn health problem
  • Contributing factors for Maternal death
  • Referral system
  • Midwifery Education in Ethiopia
  • Challenges of Midwifery students
  • Challenges of overall Maternal and Child Health
  • Recommendations
  • Conclusion
  • References

  • Ethiopia is Africas oldest independent country.
  • Covering 1,104,300 square kilometers
  • Borders with 6 countries
  • Geographical diversity ranging from 4,550m above
    sea level to 110m below sea level.
  • The predominant climate type is tropical monsoon

  • Total population of 79.8 million
  • 83.6 rural
  • 44 are under 15 years
  • 3 over age of 65 years
  • Total fertility rate (number of children per
    woman) 4.8
  • Annual population growth rate is 2.6.

Women age 1519 who are mothers or currently pregnant 12
Pregnant women who received antenatal care from a skilled provider 34
Births assisted by a skilled provider 10
Births delivered in a health facility 10
Children 1223 months fully vaccinated 24
Postnatal 7
The maternal mortality ratio for Ethiopia is 676 deaths per 100,000 live births.
Neonatal mortality 37/1000 live births
Infant mortality 59 /1000 live births
Under-five mortality 88 /1000 live births
  • Ethiopia is one of the 189 countries that signed
    the Millennium Declaration. The UN Millennium
    Development Goals (MDG 4 and 5) calls for
    Ethiopia to reduce child and Maternal morality by
    a two-third and three-fourth respectively by the
    year 2015.

  • Ethiopia is one of the six countries that
    contribute to about fifty percent of the maternal
    deaths the others being India, Nigeria,
    Pakistan, Afghanistan and the Democratic Republic
    of Congo.

Maternal and Newborn health problems
  • MMR 676/100,000, it is still among the highest in
    the world (2011 EDHS)
  • The major causes of maternal death
  • Obstructed/prolonged labor,
  • Ruptured uterus ,
  • Severe pre-eclampsia/ eclampsia ,
  • Malaria,
  • Complications from abortion
  • The majority of maternal deaths occur in the
    early postpartum period, more than half of which
    take place within a day of delivery.

Newborn Health Status
  • Remarkable reduction in infant and under-5
    mortality rate (1990 - 204/1000)..(2012 -
  • Little change in neonatal mortality 37/1000 (EDHS
  • Half of newborn deaths occur within the first 24
    hours after birth
  • Three-quarters of all deaths occur within the
    first week of life
  • Higher NMR in rural areas
  • Major causes on neonatal mortality
  • Infections (46)
  • Birth asphyxia (25)
  • Complications associated with LBW (17 )

Estimated direct causes of neonatal deaths for
Infection alone contributes to 46 of
neonatal death
( Source Facility based death report, FMOH, 2004)
  • 2005 6 of babies delivered by health
  • 2011 10 delivered by health professionals
  • Urban 51
  • Rural 5

Photo Indrias Getachew
Contributing factors to maternal deaths
  • Adolescent pregnancy
  • HIV among pregnant women
  • Malaria
  • Malnutrition
  • Harmful traditional practices(CARE, 2010).
  • Maternal education, cultural norms.(Mekonnen Y.
    et al, 2003Shiferaw et al, 2013).

Current Ethiopian government priority
strategies on Maternal Health
  • The Ethiopia (HSDP-IV) strategies encompass
  • Empowering women, men, families, and communities
    to recognize pregnancy-related risks, and to take
    responsibility for developing and implementing
    appropriate responses to them
  • Ensuring access to a core package of maternal
    and neonatal health services, especially in rural
    areas where health facilities are limited
  • Creating an environment supportive to safe
    motherhood and newborn health.

The First Delay
Delay in deciding to seek care at the household
  • 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
The Second Delay
  • Inability to access health facilities
  • Poor roads and communication network
  • Poor community support mechanisms

The Third Delay
  • Delay between arriving and receiving care at the
    health facility
  • Inadequate skilled attendants
  • Inadequate equipment and supplies
  • Weak referral system

  • 80 of maternal deaths occur in the home and 50
    were the result of failed transportation to a
    health facility
  • (The University of Addis Ababa determined in 2009)

The death of a woman and mother is a tragic loss
to the family, community and nation as a whole.
Commitment to reducing maternal deaths
Reduce current MMR 267/100,000 by 2015
Referral system
Referral is a two way process and ensures that a
continuum of care is maintained to patients or
clients. It is done from the community to the
primary care health service and to hospitals and
within hospitals and vice versa.
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  • To improve referral systems
  • Staff training ,referral guideline and service
    directory mandatory
  • Transportation challenge need long term solution
    (roads improved, vehicle)
  • The primary health care unit/hospitals periodic
    meeting on how to improve communication and
  • Establishment of feedback mechanism
  • Health post should have portable stretchers that
    weight less and easy to handle-

Midwifery Education in Ethiopia
  • 18 universities that are offering midwifery
    training at BSc level of which 2 are private
  • 27 regional colleges are training at the diploma
  • The instructors, teaching materials and
    infrastructure have not grown proportionately to
    the rapid expansion of training institutions.

  • Most of the tutors do not have additional
    training as midwifery tutors rather they are
    assigned by FMOH and MOE to training
  • 50 of the teachers were new graduates with no
    adequate skills and clinical experience as
    midwives to teach and evaluate/supervise students
  • (2009 assessment of Midwifery Training
    Institutions UNFPA)

  • The tutor/student ratio is very high and the
    classrooms are overcrowded.
  • (120 student in class)
  • The health facilities for the practical area are
    very crowded with large numbers of students while
    the number of women delivering in the health
    facilities is less.

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Challenges of Midwives students(UNFPA 2012,State
of Midwife in Ethiopia)
  • Unable to use computers and Internet
  • Poor financial support
  • Poor Infrastructure and non conducive setting of
    training center
  • Shortage of training material
  • Poor practicum
  • Lesser quality of education

  • Motivation and retention
  • lack of access to further education, low
    salaries, lack of supervision and lack of
    opportunities for career development are the main
    demotivating factors.
  • 35 midwives have salary of (56-84)/month
  • Only 7 of midwives have 200/month
  • (UNFPA,2012 State of Midwifery)

The presence of a midwife at birth can mean the
difference between life and death. (UNFPA
Executive Director 2009)
Challenges on over all Maternal and Child
Health care Services
  • Shortage of skilled midwives(117,989
    population)-WHO recommend 1 midwife for 5000
    population.(UNFPA 2012 ,states of Midwives)
  • Turnover of health workers
  • Inadequate availability of medical equipment
    (Mekonnen Y. et al, 2003 Shiferaw et al, 2013).

Challenges Cont.
  • The maternal health care facilities are poor in
    quality and poorly utilized
  • Weak referral system which includes poor
    transportation and poor communication

  • Women are less informed about their health
    needs(most of the rural women are illiterate)
  • There are inadequate and inaccurate data to
    evaluate maternal health care and no continuous
    maternal health care monitoring system

Existing opportunities for intervention
  • Government Commitment
  • Supportive policy environment
  • The Ethiopian government has created steps to
    lower the rates of maternal death. (30,000 HEW
  • Commitment among HEW and Midwives

  • Reducing maternal mortality requires coordinated
    long-term efforts.
  • Building quality improvement partnerships between
    health workers and communities
  • Educating communities to support women and
    newborns through pregnancies, safe births, and
    postpartum periods, including women living with

Recommendations cont..
  • Strengthen the local health institutions and the
    referral system
  • Increasing the number of Midwife trainers, and
    the quality of their training
  • 30 midwives practicing with out licensure.
  • Ministry of Health and Education offices ensure
    tutors should being assigned to teach have at
    least 2 years clinical experience.

Recommendations cont..
  • Ensure adequate and appropriate equipment,
    medications and supplies
  • Improving women education and household economic
    status(health and nutrition improved)
  • Integrating prevention of mother-to-child
    transmission of HIV services into all aspects of
    MNCH care, from family planning and postpartum
    care to ongoing care of HIV-exposed infants.

Recommendations cont..
  • Operational research needed to examine system
    level factor population access to MNCH services,
    content and quality ,assessing competency and
    preparedness of Health workers and HEW can
    provide use full information for programming.
  • The Cessation section delivery in Addis Ababa
    exceeded to WHO recommendation(20) this can have
    effect on maternal and new born health.
    Investigation need for reason for high rate in
    Public and private facilities in Addis.

Recommendations cont..
  • Monitoring and evaluation of the services should
    be strengthen
  • Address the low skill birth attendant rate by
    expanding ANC,PNC and family planning services
  • At community level, health extension workers will
    be equipped with mobile phones, radios, and
    motor-ambulances, to ensure the referral system
    from community level to facilities.

Can these help the country to improve coverage,
and quality of services?......
  • We are optimistic that goal of reducing child and
    maternal mortality is achievable because we have
    seen Ethiopia achieve a more than 40 percent
    reduction in child mortality among children under
    five in the last five years.
  • We have seen sub-Saharan Africa achieve a 39
    percent reduction.

  • Maternal health problems are often not
    predictable, can be dealt with at the community
  • Most deaths are avoidable, as the health-care
    solutions to prevent or manage complications are
    well known.

  • There is ample opportunity to improve maternal
  • Reduce the likelihood that a women become
  • Reduce the likelihood that pregnant women will
    experience a serious complication of pregnancy
  • Improve the outcome of women with complication

  • Road Map for Accelerating the Reduction of
    Maternal and Newborn Morbidity and Mortality in
    Ethiopia 2012-2015, July 2012, FMOH
  • FMOH et al. National baseline assessment for
    emergency obstetric and newborn care, 2008.
  • Ethiopian Midwives Associations registration
    database for 2011/12
  • Ethiopia Demographic and Health Survey 2011
    MEASURE DHS - ICF Macro.
  • Health Sector Development Program IV. 2010- 2015
    Addis Ababa, 2011.
  • International Federation of Midwives (2010).
    Strengthening midwives globally

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  • Thank you
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