Burden Of Pre-Eclampsia and Eclampsia in Ethiopia

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• Burden Of Pre-Eclampsia and Eclampsia in Ethiopia
• Mengistu
  Hailemariam(MD),FMOH

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Presentation Outline

• Background information
• Maternal mortality in Ethiopia
• Causes of Maternal mortality
• Burden of Pre-eclampsia/Eclampsia
• Interventions

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Background Information, 2011

• Ethiopia
• Nine Administrative Regions
• -Two City Administration
• -817 woredas (districts) gt15,000 Kebeles
• Tot. Pop., 79,221,000
• Annual Expected
• Pregnancies3 million

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Maternal mortality in Ethiopia

• Maternal Mortality Ratio
• MMR 1990 1068 (UN Estimate)
• MMR 2000 871 (EDHS 2000)
• MMR 2005 673 (EDHS 2005)
• MMR2008 470( WHO 2008)
• MDG target MMR 267

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Causes of Maternal Death
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Burden of Preeclampsia/Eclampsia

• Though hypertensive disorders of pregnancy are
  common in daily practice in our set up, there is
  no national study there are only few studies in
  health institutions there is a paucity of
  studies in the area.
• A retrospective review of 6 articles on
  hypertensive disorders of pregnancy were
  identified from 1966 to 2007.

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Summary of the Studies
No Author Title Years of Study Type of study
1 Jackson A Eclampsia in Addis Ababa pattern treatment (PTMH) 1966-1969 Retrospective survey
2 Getachew A Outcome of pregnancies complicated with preeclampsia-eclampsia disorders at SPH TAH 1987 Case- control
3 Mekbib T Pre-eclampsia/eclampsia at Yekatit 12 Hospital, Addis Ababa, Ethiopia 1987-1989) Descriptive study
4 Abate M Eclampsia, a 5 year retrospective review of 216 cases managed in two teaching hospitals, AA(SPH TAH) 1994-99 Descriptive study
5 Teklu S Prevalence clinical correlates of hypertensive disorders of pregnancy at TAH 2003-04 Descriptive study
6 Kebede B Maternal perinatal outcome of severe preeclampsia at the three teaching hospitals, AA.(SPH ,TAH,GMH 2007 Descriptive study
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Distribution of cases by age
Age 1 2 3 4 5 6 Total
15-19 10 13 91 69 12 18 213
20-24 11 42 86 56 47 49 291
25-29 11 41 77 58 68 72 327(29.38)
30-34 2 28 51 20 31 35 167
gt35 1 14 43 13 25 19 115
total 35 138 348 216 183 193 1113
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Distribution of cases by diagnosis
Studies Mild Preeclampsia Severe Preeclampsia Eclampsia Chronic HPN/- superimposition HELLP/partial HELLP Total
1 35 35
2 66 43 5 24 138
3 52 275 21 348
4 216 216
5 34 85 37 27 183
6 104 41 48 193
Total 152 507(45.55) 314(28.21) 92 48 1113
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intervention

TYPE OF STUDY intervention intervention Preterm delivery
TYPE OF STUDY Elective induction Elective C/S Preterm delivery
1 12(35) 0(0) 13(37.5)
2
3
4 86(39.8) 36(16.7) 90(42)
5 107(58.5) 107(58.5) 89(48.6)
6 108(56) 22(11.4) 97(50.4)
Total 313(28.12) 58(5.2) 313(28.12) 58(5.2) 289(25.9)
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Management of eclampsia
TYPE OF STUDY ANTICONVULSANT ANTICONVULSANT CONTROL OF CONVULSION
1 LYTIC COCTAIL (CPZ,Promethasin and pethidin) LYTIC COCTAILTHIOPENT 37
2 DIAZEPAM DIAZEPAM
3 DIAZEPAM DIAZEPAM
4 DIAZEPAM DIAZEPAM 65.7
5 DIAZEPAM DIAZEPAM
6 DIAZEPAM MAGNISIUM SO4(60.6) 73
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CASE FATALITY RATE
STUDIES CFR CFR CFR CFR
STUDIES HDP Preeclampsia Preeclampsia Eclampsia
STUDIES HDP mild severe Eclampsia
1 17
2 ----- -------- ---------- 20
3 23.8
4 13
5 2.7 ------ 4.1 ------ 4.1 8
6 2.6
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PERINATAL MORTALITY
Still births Early Neonatal deaths Total PN deaths PNMR
1 9 3 12 342/00
2 11 10 21 152/00
3 30 29 59 165/00
4 44 25 69 312.2/00
5 40 18 58 300/00
6 27 32 59 306/00
Total 161 117 278
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Maternal morbidity
studies Study population ARF Pulmonary oedema Abruption DIC PPH ICU referral Intracranial haemorrhage
1
2
3
4 eclampsia 5.5 2.8 11.6 6.9
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6 Severe preeclampsia 20.2 17.6 26.9 12.4 15 13
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Interventions to address pre-eclampsia/Eclampsia

• -The nation has identified that PE/E is one of
  the major causes of maternal mortality and
  various endeavors are ongoing
• 1.Capacity Buiding
• -The preservice trainings of all health
  care providers have been made to address the
  issue of PE/E adequately
• -Inservice trainings on the management of
  PE/E using the gold standard Mgso4 are being
  given for health care providers of both the
  public and private health facilities
• -National Obstetrics service guideline has been
  revised to include use of Mgso4.

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Interventions to address pre-eclampsia/Eclampsia

• 2. Logistics
• -All the necessary supplies and equipments are
  being availed to health facilities for management
  of PE/E
• 3. Supportive supervision

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• Thank You