Category Archives: Stillbirths and neonatal mortality

Avoiding maternal deaths

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A recent report in The New York Times highlight the poor states and failures of hospitals in Uganda. They write about pregnant women arriving at hospitals in time to deliver, but when complications arise, no one is there to help them. The tragic events at Arua Hospital is unfortunately not a unique event.

Such failures are unfortunately not seldom. The New York Times article point to the lack of priority given by the Ugandan Ministry of Health. In my view it also points to a failure over many years by the international donor communities.

Where as much emphasis has been given to HIV work, and immunisations, donors and NGOs have been reluctant to support and strengthen institutions. Hospitals are essential to reduce maternal deaths. Most deaths would be averted if the pregnant women would deliver at hospitals near to their homes, and such a hospital need to have trained staff to do Comprehensive emergency obstetric care (see figure for more information).

Many NGOs and donor government unfortunately believe that providing antenatal coverage is enough to reduce maternal deaths. Unfortunately, such logic is only true to a certain extent. Good antenatal services will reduce maternal deaths if it works jointly with hospitals. Antenatal work in the communities and at peripheral health posts must in time refer women in need of comprehensive emergency obstetric care. Experience from many countries show that antenatal care as stand-alone work will not reduce maternal deaths.

In our project in Ethiopia we try to improve the quality of hospitals, and support the Ministry of Health to upgrade health centres to small hospitals so pregnant women can get use essential services near to their homes. The aim is there should be one well-functioning institution providing comprehensive emergency obstetric care for every 150.000 people.

 

 

Excellent for Centre for International Health

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Recently, The Research Council of  Norway evaluated health research in Norway.

The core research groups at Centre for International Health both received the grade “Excellent” by an international expert panel which evaluated medicine and health research in Norway.

The evaluation panel concludes that “the Centre for International Health is the leading research centre within international and global health in the Nordic countries, and one of the leading centres in Europe”.

CIH combines biomedical and public-health research. Both the Child Health and Nutrition, and the HIV and TB Research group received “excellent” grades. Both research groups address important research questions, and base their research on long-term collaboration with universities in Asia and Africa. The research also addresses  the needs of the population, and translates research findings into improved treatment and better control of diseases.

Read the full evaluation report here.

 

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.

 

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.