• 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

3

Background Information, 2011Ethiopia: Nine Administrative

Regions -Two City

Administration-817 woredas (districts)

>15,000 Kebeles Tot. Pop., 79,221,000Annual ExpectedPregnancies≈3 million

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

unsafe Abortion 13

%

Sepsis, 15%

Hypertension, 12%

Obstructed labor 20 %

Hemorrriage 25 %

Other, 15%

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

Study Type of study

1 Jackson A Eclampsia in Addis Ababa: pattern & treatment (PTMH)

1966-1969

Retrospective survey

2 Getachew A

Outcome of pregnancies complicated with preeclampsia-eclampsia disorders at SPH &TAH

1987 Case- control

3 Mekbib T Pre-eclampsia/eclampsia at Yekatit 12 Hospital, Addis Ababa, Ethiopia

1987-1989)

Descriptive study

4 Abate M Eclampsia, a 5 year retrospective review of 216 cases managed in two teaching hospitals, AA(SPH &TAH)

1994-99 Descriptive study

5 Teklu S Prevalence & clinical correlates of hypertensive disorders of pregnancy at TAH

2003-04 Descriptive study

6 Kebede B Maternal & perinatal outcome of severe preeclampsia at the three teaching hospitals, AA.(SPH ,TAH,&GMH

2007 Descriptive 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

Studies

Mild Preeclampsia

Severe Preeclampsia

Eclampsia Chronic HPN/+- superimposition

HELLP/partial HELLP

Total

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%)

5 107(58.5%)

89(48.6%)

6 108(56%) 22(11.4%) 97(50.4%)

Total 313(28.12%) 58(5.2%) 289(25.9%)

Management of eclampsiaTYPE OF STUDY

ANTICONVULSANT CONTROL OF CONVULSION

1 LYTIC COCTAIL(CPZ,Promethasin and pethidin)

LYTIC COCTAIL+THIOPENT 37%

2 DIAZEPAM

3 DIAZEPAM

4 DIAZEPAM 65.7%

5 DIAZEPAM

6 DIAZEPAM MAGNISIUM SO4(60.6%) 73%

CASE FATALITY RATE

7 (3.2%) mothers died before delivery

STUDIES CFR

HDP Preeclampsia Eclampsia

mild severe

1 17%

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

3 23.8%

413%

5 2.7% ------ 4.1% 8%

6 2.6%

PERINATAL MORTALITY

Still births Early Neonatal deaths

Total PN deaths

PNMR

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 population

ARF Pulmonary oedema

Abruption

DIC PPH ICU referral

Intracranial haemorrhage

1

2

3

4 eclampsia 5.5% 2.8%

11.6% 6.9%

5

6 Severe preeclampsia

20.2% 17.6% 26.9%

12.4%

15% 13%

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