Maternal & Child Health Programme

Overview

of Maternal & Child Health situations in selected areas for interventions in the first phase

Over the past two decades, Ethiopia has made significant strides in reducing child mortality. Under five years old child mortality has declined from 166 per 1000 live births in 2000 to 67 per 1000 live births in 2016, with a reduction of 60% at national level. Over the same period, infant mortality in Ethiopia has declined from 97 per 1000 live births to 48 per 1000 live births, a decrease of 50%.  Whereas, neonatal mortality declined from 49 per 1000 live births to 29 per 1000 live births, with a reduction of 41% over 16 years at national level.

However, the EDHS 2016 report indicated that there is huge disparity in under five years old child mortality among regions, ranging from 39 per 1000 live births in Addis Ababa, to 59 per 1000 live births in Tigray, 88 per 1000 live births in Gambella and SNNPR, 98 per 1000 live births in Benishangul Gumuz, and 125 per 1000 live births in Afar region. Afar region has the highest under five child mortality – almost twice the national average of 67 per 1000 live births and more than three times the rate of Addis Ababa. There is also a marked difference in infant mortality between regions, ranging from 28 per 1000 live births in Addis Ababa to 43 per 1000 live births in Tigray, 56 per 1000 live births in Gambella, 62 per 1000 live births in Benishangul Gumuz, 65 per 1000 live births in SNNPR and 81 per 1000 live births in Afar (a regional average of SNNPR is taken as a proxy indicator of the situation in South Omo zone & Konta special woreda though the rates are expected to be higher than regional average as these areas are among the remotest in the region).

Maternal & Child Health and Nutrition Programme

A comparative summary and trends in child mortality in Afar, Benishangul Gumuz, Gambella, and SNNPR States.For a comparative summary and trends in child mortality in Afar, Benishangul Gumuz, Gambella, and SNNPR States look into the tables below.

Comparisons & Trends

Comparison of under-five child mortality, infant mortality, and neonatal mortality in the areas selected for intervention in the first phase with best performing areas in the country and national level

Comparison of trends of under-five child mortality in the areas selected for intervention in the first phase with the best performing areas in the country and national level over the past 16 years

Comparison of trends of infant mortality in the areas selected for intervention in the first phase with the best performing areas in the country and national level over the past 16 years

Comparison of trends of neonatal mortality in the areas selected for intervention in the first phase with the best performing areas in the country and national level over the past 16 years

The major causes of deaths in children are acute respiratory infection (ARI), diarrhea, premature birth, low birth weight, and asphyxia. Low care seeking behavior and nutritional disorders are aggravating the situation as 50% of deaths in children are associated with malnutrition. According to the EDHS 2016 report, only 30% of under-five children with ARI, 35% with fever and 44% with diarrhea sought treatment. This report has shown that among the under-five children in Ethiopia, 38% are stunted and 57% are anemic. The same report indicated among under-five children in Afar, 41% are stunted and 75% anemic, in Benishangul Gumuz 42.7% are stunted and 43% are anemic, in SNNPR 39% are stunted and 50% anemic, and in Gambella 24% are stunted and 56% anemic. The proportion of children stunted varied significantly by level of the mothers’ education. Forty two percent of under-five children born to mothers with no education are stunted, compared to only 22% of children born to mothers with secondary education and 17% of children born to mothers with more than secondary education. 

The major causes of deaths in children are Acute Respiratory Infections (ARIs), diarrhea, premature birth, low birth weight, and asphyxia (deprived of oxygen).

On the other hand, the maternal mortality ratio in Ethiopia has dropped from 871 per 100,000 live births in 2000 to 412 per 100,000 live births in 2016, with a reduction of 52%. Major causes of maternal deaths include hemorrhage, pregnancy related hypertension, and sepsis. But only 26.2% of pregnant women in Ethiopia, 14.7% in Afar, 25.7% in Benishangul Gumuz, 25.5% in SNNPR, and 45 % in Gambella have delivered at health facilities. The EDHS 2016 report depicted that 56% of births to mothers who attended four antenatal care (ANC) visits were delivered in a health facility compared to 8% of births to mothers with no ANC visits. The same report indicated that 92% of mothers with more than secondary education and 77% of mothers with secondary education were delivered in a health facility compared with 16% of births to mothers with no education. The above report indicated that 80% of births to urban women had skilled attendance compared with 21% of births to rural women. On the other hand, 70% of births to women in the highest wealth quintile were assisted by skilled providers compared with 11% of births to women in the lowest wealth quintile.

Having postnatal care within two days after birth is crucial for health of mothers and neonates but only 16.5% at national level, 11.6% in Afar, 14.5% in Benishangul Gumuz, 16.9% in Gambella and SNNPR have received these services. Besides these, the percentage of currently married women using modern contraceptives in Afar, Benishangul Gumuz, Gambella and SNNPR are 12%, 28%, 35% and 40% respectively, showing modern contraceptive use by married women in Afar and Benishangul Gumuz is lower than the national average of 35%. On top of these factors, persisting communicable diseases and rising incidence of reproductive organ (cervical & breast) cancers in women are posing a growing burden in these regions and the country as a whole. Gambella region still remains the most affected by the HIV/AIDS epidemic though joint efforts made in the past five years has reduced HIV prevalence in the region from 6.5% to 4.8%. Taking into account the relatively lower access to maternal & child health services in these regions, the maternal mortality in the areas selected for intervention in the first phase is expected to be higher than the national level.

The major obstacles to effective delivery of maternal & child health services are limited access to healthcare, poor quality of services, shortage of supplies, inadequate provider skills, low community awareness, weak coordination, and socio-cultural and economic bottlenecks.

These problems have to be addressed through concerted efforts to bring the required changes in demand and utilization of maternal & child health services while promoting the adoption of healthy lifestyles through strengthening local ownership and leadership, enhancing engagement of the beneficiary communities, building capacities for effective delivery of services and strengthening partnerships at all levels.