Category Archives: Birth registry

Can we trust community based birth registries?

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Quality check household survey on community birth registry in Bonke woreda in Gamu Gofa Zone in South-west Ethiopia.

Recently Tadesse Data from Arba Minch finished his Masters’ of public health degree at Addis Continental Institute of Public Health and University of Gondar.

In many developing countries, we lack population based and accurate, reliable and complete population data, including birth registration. Recently, we started to register births, neonatal and maternal deaths using health extension workers in south-west Ethiopia.

In his research, Tadesse Data assessed the quality of birth registries done by health extension workers. Specifically, he assessed if the existing birth registries covered the whole population.

He did a community based cross-sectional household survey in Bonke Woreda in Gamo Gofa Zone in south-west Ethiopia. He randomly selected and surveyed 15 of the 30 kebeles (peasant associations) in the woreda (province). He asked about births that had occurred during the last 12 months, and examined if these births were registered in the birth registries.

The study identified 2724 births among a population of 78782. The crude birth rate was 34.5 per 1000 population, and similar to the expected 35 per 1000 population for Ethiopia. About 71 per cent of the births were registered in kebele birth registry. Most of the non-registered births lived in remote areas, and many did not attended antenatal follow up. Eighteen mothers died, and the maternal mortality rate in Bonke Woreda rate is 661 per 100.000 live births.

The study show that health extension workers can do community based birth registration. However, the health extension workers need regular supervision, and we need to improve the coverage of the antenatal services.

 

Low health care coverage in south-west Ethiopia

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Assessment of availabiltiy and utlization af Emergency Obstetric Care Services In Gamo Gofa Zone, SNNRP, Ethiopia

Recently Meseret Girma Abate from Arba Minch University finished her Master of public health degree at Addis Continental Institute of Public Health and University of Gondar.

This work is a part of the research done for the programme to reduce maternal mortality in south-west Ethiopia. The following is an abstract of her research:

Most maternal deaths take place during labour and within few weeks after delivery. The availability and use of emergency obstetric care facilities is important to reduce maternal deaths. However, there is limited evidence how these institutions perform, and how many people use them in Gamo Gofa zone in south-west Ethiopia.

The objective of the thesis was to assess availability and use of emergency obstetric care services in Gamo Gofa zone in south-west Ethiopia.

For this study we did a cross-sectional survey of all 63 health centres and three hospitals  in Gamo Gofa. We did a retrospective review of obstetric services in Gamo Gofa zone in south-west Ethiopia. The data collectors visited each institution, observed the work, and interviewed the head nurses.

The main results show there were three basic and two comprehensive emergency obstetric care institutions per 1,740,885 population. Only 6.6% of all expected births were done by skilled attendants, and the caesarean section rate was 0.8%. Remote laying health institutions had lower number of births. The maternal mortality rate among births attending health institutions was 1900 per 100,000 live births.

The availability of basic and comprehensive emergency obstetric care facilities in south-west Ethiopia is far below the recommended health care coverage. The proportion of institutional deliveries and caesarean section rate is low.

Stillbirths in Ethiopia

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A stillbirth occurs when a foetus dies in the uterus and when foetal death occurs after 20 weeks gestation or the foetus weighs more than 400 grams. We use the term to distinguish it from live birth or miscarriage. Most stillbirths occur in full term pregnancies.

The Lancet recently presented a series of articles on stillbirths. We can confirm from our studies from south Ethiopia that stillbirths represent a huge problem. About 5% of all hospital births are stillbirths. And, in our birth registry data, about 1.4 per cent of registered births are labelled as stillbirths. Such figures are uncertain, and some neonatal deaths might be misclassified as stillbirths.

Results from our studies in Ethiopia demand that we need to address this issue. What are the causes? Can we do anything to reduce stillbirths in settings such as rural south-west Ethiopia? We now plan to recruit a new PhD student to investigate how stillbirths can be reduced in southwest Ethiopia.

 

Birth registration

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We regard birth registries as a important part of our work to reduce maternal and neonatal deaths.

We started to register all births in some parts of our catchment area in 2010. The health extension workers in the local communities registers all births and maternal and neonatal deaths in their catchment area. Usually one health extension worker covers about 250 families. Our experience so far is that it is possible to do this within the existing community infrastructure.

During the first three months of registration we registered three maternal deaths in two woredas. Although the numbers are too small to calculate maternal mortality rates, they show us something important:

1. The hospitals in the areas were unaware that the deaths had occurred.

2. One of the women who died had been advised by the health extension worker to deliver at the hospital, but she refused. We do not know why she refused to go to the hospital.

If our aim is to significantly reduce maternal deaths, there is a need to strengthen the collaboration between hospitals and their local communities. This is a societal responsibility of all health workers, whether they are health specialists or health extension workers.

During the past years, local health authorities have set up routines for compulsory notification of diseases such as measles or cholera. We are discussing if a similar alert system is needed for maternal deaths. It could be a mechanism for health extension workers to refer more delivery cases to the hospitals, and thus increase the institutional deliveries. And, it would make the health authorities aware of all maternal deaths occurring in their communities.

Research on reducing maternal and neonatal mortality in south-west Ethiopia

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Ethiopia is among the countries in the world with most maternal deaths. As part of our project to reduce maternal deaths, we have started several studies to get the necessary information to follow and improve our intervention. 

Monitoring maternal and neonatal deaths
We aim to set up a simple, cost-effective, and sustainable tool to monitor maternal and newborn deaths in a remote part of south-west Ethiopia. We shall set up a community-based birth and death registry using health extension workers.

Data from this research will help us to monitor the intervention programme to reduce maternal and neonatal deaths. The registry is a model for Ethiopia, and may also help other countries to set up birth registries.

We shall use, and compare several designs such as population based registries, direct demographic models (surveys) and institutional registries to measure maternal and neonatal mortality.
The research is collaboration between Ministry of Health in Ethiopia, Arba Minch Hospital, Gidole Hospital, Arba Minch University and University of Bergen.

Developing training programmes for health officers
Through the programme to reduce maternal and neonatal mortality we train non-clinician physicians (health officers) to carry out comprehensive emergency obstetric care. We regularly evaluate the outcomes of the operations they do.

On a separate web page we have outlined

Later, we shall also write about our experiences in setting up emergency obstetric services, at health centres and small rural hospitals. This will also outline the equipment needed to carry out such work.