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Burden Of Pre-Eclampsia and Eclampsia in Ethiopia.ppt

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									• Burden Of Pre-Eclampsia
  and Eclampsia in Ethiopia

       Mengistu Hailemariam(MD),FMOH
           Presentation Outline
•   Background information
•   Maternal mortality in Ethiopia
•   Causes of Maternal mortality
•   Burden of Pre-eclampsia/Eclampsia
•   Interventions
Background Information, 2011
                 Ethiopia:
                 Nine Administrative
                   Regions
                 -Two City
                   Administration
                 -817 woredas (districts)
                   >15,000 Kebeles
                 Tot. Pop., 79,221,000
                 Annual Expected
                 Pregnancies≈3 million




                                      3
  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
Causes of Maternal Death
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.
                    Summary of the Studies
No Author       Title                                              Years of   Type of study
                                                                   Study
1   Jackson A   Eclampsia in Addis Ababa: pattern & treatment      1966-      Retrospective
                (PTMH)                                             1969       survey
2   Getachew    Outcome of pregnancies complicated with            1987       Case- control
    A           preeclampsia-eclampsia disorders at SPH &TAH

3   Mekbib T    Pre-eclampsia/eclampsia at Yekatit 12 Hospital,    1987-      Descriptive
                Addis Ababa, Ethiopia                              1989)      study

4   Abate M     Eclampsia, a 5 year retrospective review of 216    1994-99    Descriptive
                cases managed in two teaching hospitals,                      study
                AA(SPH &TAH)
5   Teklu S     Prevalence & clinical correlates of hypertensive   2003-04    Descriptive
                disorders of pregnancy at TAH                                 study

6   Kebede B    Maternal & perinatal outcome of severe             2007       Descriptive
                preeclampsia at the three teaching hospitals,                 study
        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

>=35     1    14    43    13    25    19    115

total    35   138   348   216   183   193   1113
    Distribution of cases by diagnosis

Studi Mild           Severe    Eclampsia    Chronic    HELLP/par Total
es    Preeclampsia   Preeclamp              HPN/+-     tial HELLP
                     sia                    superim
                                            position
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
                     %)          )
                     intervention
TYPE OF STUDY   intervention                        Preterm delivery
                Elective induction   Elective C/S




1               12(35%)              0(0%)          13(37.5%)
2
3
4               86(39.8%)            36(16.7%)      90(42%)

5                                                   89(48.6%)
                107(58.5%)
6               108(56%)             22(11.4%)      97(50.4%)

Total           313(28.12%)            58(5.2%)     289(25.9%)
          Management of eclampsia
TYPE OF   ANTICONVULSANT                              CONTROL OF
STUDY                                                 CONVULSION
1         LYTIC COCTAIL      LYTIC COCTAIL+THIOPENT   37%
          (CPZ,Promethasin
          and pethidin)
2         DIAZEPAM

3         DIAZEPAM

4         DIAZEPAM                                    65.7%


5         DIAZEPAM


6         DIAZEPAM           MAGNISIUM SO4(60.6%)     73%
          CASE FATALITY RATE
STUDIES                                  CFR
           HDP                    Preeclampsia                     Eclampsia
                                  mild                severe

1                                                                  17%

2          -----                  --------            ----------   20%

3                                                                  23.8%

4
                                                                   13%
5          2.7%                     ------                 4.1%    8%

6                                                          2.6%


                   7 (3.2%) mothers died before delivery
        PERINATAL MORTALITY

         Still births   Early Neonatal   Total PN   PNMR
                        deaths           deaths
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
                     Maternal morbidity
studies Study        ARF    Pulmonar Abr    DIC   PPH     ICU      Intracranial
        population          y oedema upti                 referral haemorrhag
                                     on                            e



1

2

3

4       eclampsia    5.5%                   2.8   11.6%            6.9%
                                            %
5

6       Severe       20.2% 17.6%     26.9   12.4 15%      13%
        preeclampsia                 %      %
      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.
    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
Thank You

								
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