Child Health In Ethiopia

Prof . Bogale Worku Medical Faculty,

DPCHOctober 2009

Objectives of the session

Define Child health indicators of EthiopiaDescribe the major causes of morbidity

and mortality

Illness burden

6-12 episodes of illness per year (<5 yrs)Fever 30%Diarrhoea 25%Cough 23 %Rapid breathing 13%

Child health indicators

Define each of the following

NMR 39/1000 LB

IMR 77/1000 LB

<5 MR 123/1000 LB

The Millennium Development Goal No 4.

Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed - missing from current programmes

050

100

150

Glo

bal

mo

rtal

ity

pe

r 10

00

bir

ths

1960 1980 2000 2020Year

Under-5 mortality rate

Late neonatal mortality

Early neonatal mortality

Target for

MDG-4

Opportunities for Africa’s Newborns, 2006

Meeting MDG 4 in Africa?

New hope for reducing under five deaths!

Over the last year several large African countries have reported reductions of 25% or more in under five deaths

41

164

0

100

200

300

1960 1970 1980 1990 2000 2010

Year

Mor

talit

y pe

r 1,

000

births

. Neonatal Mortality Rate

Under 5 Mortality Rate

Infant Mortality Rate

MDG 4 target for 2015

Opportunities for Africa’s Newborns, 2006.

National progress to MDG 4

32% of child deaths are newborns. MDG 4 cannot be met without addressing neonatal

deaths.

39

123

77 68

0

100

200

300

1960 1970 1980 1990 2000 2010

Year

NMRU5MRIMRMDG Target

5

Other

29%

Diarrhoea

12%

Pneumonia

20%

Malaria

8%

Measles

5%HI V/ AI DS

4%

Perinatal

22%

Deaths associated w ith undernutrition

60%

Major causes of death among children under five, world, 2000

EI P/ W HO; Caulfi eld et al, f or t hcoming

When are children dying

neonate (29%)

1-4 yrs (42%)

1-11 months(29%)

Acute Respiratory Illness

Major cause of mortalityPneumonia is the major cause of death

about 20%/(28%)Number one cause of visit to health facility 6-8 episodes /year/child

Key interventions

PneumoniaExclusive breast feedingAdequate complementary feedingHib vaccinationMeasles vaccinationPMTCTVitamin A supplementationAntibiotic treatment

Diarrhea

A major cause of OPD visit and admissionAbout 6 episodes/child/yearA major cause of death Leads to dehydration and deathVicious cycle of Diarrhea and Malnutrition

Diarrhea: Key interventions

Hygiene/sanitation/ safe waterExclusive breast feedingAdequate complimentary feedingVitamnin A supplementationORSZinc supplementAntibiotic

Malaria

A major cause of death in tropical countries and a major cause of epidemics.

75% of the land in Ethiopia malariousLong lasting insecticide treated bed netsAnti-malarial drugs

Measles

A major VPD causing deathResults in many complications

MalnutritionPneumoniaEncephalitisEtc…

High mortality ratesMay cause epidemics

NutritionEthiopia is one of the countries in the sub Sahara

Africa with the highest rates of malnutrition. Breast-feeding is an important component of

Ethiopian tradition culture. About 90% of the mothers breast feed up to two years. Exclusive breast-feeding reported to be 62.3% up to 6

month.The median age of introduction of complementary

feeding was 7.1 m. Introduction of early feeding associated with an increased

risk of diarrhea due to poor sanitary condition and lower quality of supplements:

Malnutrition

height for age 51.1%weight for age 47.2%wasted weight for height 10.5 %

to poor feeding practice, periodic drought, war and displacement have contributed to the

severe malnutrition status of Ethiopian children

Deaths of Ethiopian infants due to sub-optimal breastfeeding practices

70,000 infants deaths annually70,000 infants deaths annually

Malnutrition interventions

Breast feedingComplementary feedingNutrition advice and supplementationVitamin A supplementationMeasles vaccinationFamily planningManagement of severe acute malnutritionZinc

Vaccination

BCG oral polio 0 at birthPenta1 polio1 6th weekPenta 2 polo2 10th weekPenta3 polio3 14th week Measles 9th month

Childhood HIV/AIDS

Mother to child transmissionIn uteroDeliveryBreast feeding

OthersSexual (adolescents)Blood transfusionHarmful traditional practices

HIV : interventions

VCTPMTCT ARTTreating opportunistic infections

New born health

I have the right to survive and grow healthy like any other new born

Other7%

Infection26%

Tetanus7%

Diarrhoea3%

Preterm27%

Asphyxia23%

Congenital 7%

Infections36%

The estimated distribution of the direct causes of 4 million neonatal deaths for the year 2000 based on vital registration data for 45 countries and modelled estimates for 147 countries

Source: 7

The world atlas with neonatal mortality burden

Preterm, 25%

Asphyxia, 24%

Tetanus, 6%

Diarrhoea, 4%

Congenital, 6%

Other, 7%

Sepsis/ pneumonia,

28%

Infections

39%

Source: Opportunities for Africa’s Newborns, 2006. Based on vital registration for one country and updated modeling using the CHERG neonatal methods for 45 African countries using 2004 birth cohort, deaths and predictor variables.

WHY do African newborns die?

3 causes account for 88% of neonatal deaths

Opportunities for Africa’s Newborns, 2006.

Causes of newborn deaths

Infections and tetanus account for

43% of neonatal deaths in Ethiopia

Tetanus, 7%

Infection, 36%

Asphyxia, 25%

Diarrhoea, 3%

Congenital, 4%

Pretern, 17%

Other, 7%

Low birthweight rate: 15%

Opportunities for Africa’s Newborns, 2006

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4

6

8

10

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0 5 10 15 20 25 30

Day of life

Da

ily r

isk

of

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0 s

urv

ivo

rs

.

When -? 1.16 million newborn deaths in Africa

Up to 50% of neonataldeaths are in the first 24 hours

75% of neonatal deaths are in the first week –

Birth and first week is key: when most babies die yet when coverage of care is lowest for mothers and babies

Antenatal care

(ANC 28%)

Avoiding adolescent pregnancy and spacing births by at least 24 months

(CPR 15%)

Clean and safe childbirth

(SBA 6%)

Simple solutions to save newborn lives

Examples of simple solutions to save newborn lives

Treating newborn infections with antibiotics

Breastfeeding promotion and support

Keeping babies warm, especially preterm babies – Kangaroo Mother Care

Thank you