Category Archives: Maternal mortality

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.

Some lessons learned

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To be able to reduce maternal mortality, two conditions should be met: Staff should be able to carry out comprehensive emergency obstetric care, and these services should be available to and used by the pregnant women.

About six months ago, we started to do caesarean sections at Saula Hospital in the inner part of Gamu Gofa. About 800.000 people live in these remote mountains.

Saula Hospital is a new hospital, which had not done any surgery before. We trained two operators (four months), two anaesthetist nurses (three months) and two scrub nurses. In addition we equipped the hospital with surgical instruments, an oxygen concentrator, suction machines and resuscitation equipment. Two experiences staff from Arba Minch Hospital taught the hospital staff how to handle and sterilize surgical equipments.

Our experience shows:

  1. It is possible to start emergency obstetric services, including operations such as caesareans sections and repair of uterine ruptures at places such as Saula. Non-specialists did the operations.
  2. The midwives correctly use partographs.
  3. Our review shows the indications to do surgery were correct. I believe the operations have saved many lives of mothers and neonates.
  4. Many women have severe complications already at admission to the hospital. This explains the high CS rate of about 20 %. It underlines that pregnant women in this remote part of Ethiopia come late for treatment.
  5. The number of uterine ruptures is high.
  6. Because of the late treatment, several of the women have developed vesico-vaginal fistulas.
  7. The complication rate for this newly started hospital is higher compared with operations done by non-clinician physicians at well-established hospitals. This underlines the importance in developing good and sound routines to ensure safe surgery.
  8. In our programme we review all operations, and we use a no-blame strategy to discuss complications.

One of the important lessons from Saula Hospital is to extend training the operators and anaesthetist nurses to five months at places where they shall start to do emergency operations. We also believe it is important to support and supervise such institutions for some years.

Now that Saula Hospital has set up the surgical and delivery services, emphasis must be to train midwives and nurses from the remote health centres to refer women to the hospital at an early.

30,000 women have an untreated vesicovaginal fistula

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In Ethiopia about 30,000 women have an untreated vesicovaginal fistula. Most often this is the result of complications of neglected, prolonged or obstructed labour.

At our new Fistula Unit in Arba Minch we collaborate with the Fistula Hospital in Addis Ababa in Ethiopia. This hospital in Addis Ababa is dedicated only to the care of women with obstetric fistulae, and treating other physical and social injuries.

In their experience, this vesicovaginal fistula often results in other injuries. More than half of the patients will be divorced and excluded from religious activities, their home, public transport and health institutions. Patients with fistulas have more than a ‘hole’ between the bladder and vagina, and often have physical, psychological and social problems, stress and urge urinary incontinence, hydronephrosis, renal failure, rectovaginal fistulae, secondary infertility, vaginal scarring and damage to the nerves (foot drop).

You can read a review of the experiences from the Fistula Hospital in Addis Ababa in a paper in by Professor Gordon Williams in The Surgeon (February 2007 Vol 5 No 1).