Stillbirths in Ethiopia

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

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

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.