Burden Of Pre-Eclampsia and Eclampsia in Ethiopia
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• Burden Of Pre-Eclampsia and Eclampsia in Ethiopia
Mengistu Hailemariam(MD),FMOH
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Presentation Outline
• Background information• Maternal mortality in Ethiopia• Causes of Maternal mortality • Burden of Pre-eclampsia/Eclampsia• Interventions
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Background Information, 2011Ethiopia: Nine Administrative
Regions -Two City
Administration-817 woredas (districts)
>15,000 Kebeles Tot. Pop., 79,221,000Annual ExpectedPregnancies≈3 million
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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
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Causes of Maternal Death
unsafe Abortion 13
%
Sepsis, 15%
Hypertension, 12%
Obstructed labor 20 %
Hemorrriage 25 %
Other, 15%
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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.
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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
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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
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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
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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%)
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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%
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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%
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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
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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%
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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.
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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
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Thank You