Eritrea Annual Health Service Activity Report of Year 2012
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Transcript of Eritrea Annual Health Service Activity Report of Year 2012
Contents
Acronyms ........................................................................................................................................... 3
Part I. Introduction ............................................................................................................................ 6
Vision of the HMIS ............................................................................................................................ 6
Part II. Resources ............................................................................................................................. 13
II.1. Human Resources ................................................................................................................ 13
II.1.2. Available health personnel in the MOH and their distribution in the country .............. 17
II.2.1. Number of Health Facilities that Report to HMIS ........................................................ 23
VI.2. Number of Health Facilities and their Distribution 2012 ................................................... 23
II.3. Patient Bed ....................................................................................................................... 31
II.4. Selected Health System output indicators ........................................................................ 40
III. Maternal and Child Health ......................................................................................................... 43
III.1. Antenatal care Service ........................................................................................................ 43
III. 2. Delivery Services ............................................................................................................... 48
2.1. Health facilities providing delivery services ........................................................................ 48
III.3. Obstetric Emergencies (OBE) ............................................................................................ 65
III.4. Family Planning Services ................................................................................................... 72
IV. OUTPATIENT AND INPATIENT SERVICES ....................................................................... 88
IV.1. OUTPATIENT SERVICES ............................................................................................... 88
IV.2. Inpatient services ................................................................................................................ 92
IV.3. Number of Surgeries ........................................................................................................... 94
IV.4. Diagnostic Service .............................................................................................................. 97
IV.4.1. Imaging Services ......................................................................................................... 97
IV.4.2. Laboratory Services ..................................................................................................... 98
V. DISEASE BURDEN IN ERITREA.......................................................................................... 100
V. 1. Top Ten Leading Causes of Morbidity and Mortality ...................................................... 101
V.2.Trends and Patterns of Morbidity and Mortality of the Ten Leading Causes .................... 107
V. 3. Situation of Some Selected Leading Causes of Disease Burden ...................................... 111
V.3.1. HIV/AIDS ................................................................................................................... 111
Source: HMIS ........................................................................................................................ 113
V.3.2. Malaria ........................................................................................................................ 114
V. 3.3. Tuberculosis (TB) ...................................................................................................... 117
V.3.4. Diarrhea ....................................................................................................................... 119
V.3.5. Acute Respiratory Tract infections (ARI) ................................................................... 120
V.3.6. Eye Problems .............................................................................................................. 123
V.3.7. Non Communicable Diseases ......................................................................................... 127
V.3.7.1. Injuries ..................................................................................................................... 127
V.3.7.3. Heart Diseases .......................................................................................................... 129
V.3.7.4. Neoplasm ................................................................................................................. 130
V.3.7.5. Diabetes Mellitus ..................................................................................................... 132
V.3.7.6. Mental Health ........................................................................................................... 133
V.3.7.7 Anemia and Malnutrition .......................................................................................... 134
V.3.7.9 BRONCHITIS, EMPHYSEMA and COPD ............................................................ 137
4. Disease Burden at Zoba Level ............................................................................................... 138
V.4.1. Zoba Anseba ............................................................................................................... 140
V.4.2. Zoba Debub ................................................................................................................. 141
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Health Management Information System, Department of NHIS, MoH Annual Health Service Activity report of 2012
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V.4.3. Zoba Debubawi Keyh Bahri ....................................................................................... 143
V.4.4. Zoba Gash Barka ............................................................................................................ 145
V.4.5.Zoba Maakel ................................................................................................................ 146
V.4.6. National Referral Hospitals(NRH) ............................................................................. 147
V.4.7. Zoba Semenawi Keyh Bahri ....................................................................................... 149
VI.7. List of Health Facilities Reporting to HMIS in the 2012 (Jan-Dec) ................................ 151
VI.7.1.Anseba ............................................................................................................................ 151
VI.7.2 Debub. ........................................................................................................................... 152
VI.7.3. DKB ............................................................................................................................... 154
VI.7.4. Gash Barka .................................................................................................................... 155
VI. 7.5. Maakel .......................................................................................................................... 157
VI.7.6. National Referrals .......................................................................................................... 160
VI. 7.7 SKB ............................................................................................................................... 160
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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Acronyms
1. AFP- Acute Flaccid Paralysis
2. ALOS - Average Length of Hospital Stay
3. An/ Ans – Anseba
4. AN – associate Nurse
5. ANC - Antenatal Care
6. BMI – Body Mass Index
7. BOR - Bed Occupancy Rate
8. CCM- Catholic Church Mission
9. CFR - Case Facility Rate
10. Cl – Clinic
11. CHS – College of Health Sciences
12. CNHT – College of Nursing and Health Technology
13. CLS – Clinical Laboratory Scientist
14. CS – Cesarean Section
15. CYP – Couple Year Protection
16. DE/De - Debub
17. DKB - Debubawi Keyh Bahri zone
18. DNA, NA – Data Not Available
19. DPTHB – Diphtheria Pertusis, Tetanus Heptitis B
20. Dr. - Doctor
21. DSS - Decision Support System
22. EDHS - Eritrea Demographic Health Survey
23. EHHSUES – Eritrea Household Health Status Utilization and Expenditure Survey
24. EPI - Extended Program of Immunization
25. EVM – Evangelical Mission
26. F.G.M- Female genital mutilation
27. FRHAE- Family reproductive health association
28. FP – Family Planning
29. GB - Gash Barka zone
30. GP - General Practitioner
31. GM – growth monitoring
32. HC – Health Centre
33. HDI – Health Development Index
34. HIS – Health Information System
35. HP - Health Professional, Health Post
36. HMIS – Health Management Information System
37. HMN – Health Metric Network
38. HO – Hospital
39. HQ – head quarter
40. HR – Human Resources
41. HS – Health Station
42. ICD – International Classification of Diseases
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43. IDSR – Integrated Disease Surveillance and Response
44. IPD - Inpatient department
45. IMCI – Integrated Management of Childhood Illness
46. IND - Industry
47. IUD – Intra Uterine Devices
48. Lab - laboratory
49. LAN – Local Area Network
50. LOS - Length of Stay in hospital or health centre
51. LSS – Life Saving Skill
52. Ma - Maakel
53. MC/ MCH – Maternal and Child Health
54. Mgt - management
55. MH - Mini Hospital
56. MLT – Medical Laboratory Technician
57. MLW – Ministry of Labour and Social Welfare
58. MMR - maternal mortality rate
59. MoD- Ministry of defence
60. MOE – Ministry of Education
61. MOH - Ministry of Health
62. MNRH – Maternity National Referral Hospital
63. NA – not available
64. NGO - Non Government Organization
65. NHMIS – National Health Management Information System
66. NID - National Immunization Day
67. NRH - National Referral Hospitals, that include Orotta Paediatric Hospital, Orotta Maternity
Hospital, Berhan Aynee Ophthalmic Hospital, St Mary Psychiatric Hospital, Orotta Mdical
Surgical Hospital, and Hansenian Hospital
68. NMW – Nurse Midwife
69. NNDR – Neonatal Death Rate
70. OBE – Obstetric Emergency
71. OPD – Outpatient department
72. PHC – Primary Health Care
73. PHT – Public Health Technician
74. PMTCT – prevention of mother to child transmission
75. POL - Police
76. Prv - private
77. Pt. – Patient
78. R and HRD – Research and Human resources Development
79. RN – Registered Nurse
80. SKB – Semenawi Kehy Bahri zone
81. Sp - Specialist
82. STI- Sexually Transmitted Infections
83. ST in- Soft Tissue injury
84. TFR – total fertility rate
85. U5 – Under five
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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86. UOA – University of Asmara
87. VCT – voluntary counselling and testing
88. VPD – Vaccine preventable diseases
89. WAN – Wide Area Network
90. WB – World Bank
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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Part I. Introduction
Vision of the HMIS
“To have an integrated information system that generates meaningful information from different
data sources using available information technology to support informed decisions at all levels of
health management” as illustrated in the diagram below.
Diagram 1. Integrated Health Information System (source: HMN guideline, 2008)
The Ministry of Health developed the Health
Management Information System (HMIS) in
1997 and selected disease and health service
indicators through the participation of health
workers and concerned partners and
stakeholders. In accordance with the selected
indicators, standardized tools for data
collection and reporting were developed to
be used in all health facilities. Data collection
manual was developed and health workers
were trained on how to use the data
collection and reporting tools. At the initial
establishment of the HMIS, the computerized
system was developed on Dose-based access
operating system and the data entry at Zoba
level started in February 1998. The reported
data can be disaggregated by Zoba, Sub-Zoba
and facility levels. The outpatient and
inpatient morbidity and mortality report is
used to be disaggregated by two age
categories (under 5 (U5) and above 5) until
the third category (<1) was included in 2004.
The reports from Zoba to the centre have
been made with floppy disks.
Continuous developments have been made to
the system to improve the quality and
reliability of the collected data and the
capacity of analysing, distributing and using
the available information. Thus, the former
Dose based software was upgraded to
window system to make it user-friendly.
Furthermore, dialling up system of reporting
from the Zoba was also developed to enhance
timely report and three zobas are users of the
Data Warehouse
Common User Interface
Decision Support & Executive Dashboard
Information Services
Extract, transform and load data into warehouse
Census Vital Event Registry
Surveys Admin Records
Service Records
Health & Disease Records
Formerly fragmented data collection methods and tools
Different Users Through different means
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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dial up system. The Local Area Network
(LAN and Wide Area Network (WAN) was
also developed to enhance the capacity of
information sharing.
The Decision Support System (DSS)
software that enhances further analysis and
readily use of the available data was
developed and installed at program
manager’s desk tops. The expansion and
strengthening of the network will facilitate
easy access and sharing of updated
information to be used for different purposes
when the capacity of the health workers to
use the network is improved.
Moreover, continuous assessment of
additional information need of the program
areas has also been on going. Thus, the
required variables are being added to the
system. Updating of DSS considering the
changes made in the data items is also a
continuous on-going process.
To satisfy the information needs of managers
and strengthen the system, assessment was
done in 1999, 2003 and late 2006. The
2006’s assessment was done using the Health
Metrics Network (HMN) health information
system (HIS) framework presented in Figure
1.
HMN GoalIncrease availability, accessibility, quality and
use of health information that are critical for
decision making at country and global levels.
HMN GoalIncrease availability, accessibility, quality and
use of health information that are critical for
decision making at country and global levels.
HMN FrameworkHMN Framework
Roadmap
for implementation
Roadmap
for implementation
Health information system components & standards
Health information system components & standards
Data sourcesData sources
HIS resourcesHIS resources
IndicatorsIndicators
Data managementData management
Dissemination and useDissemination and use
Information productsInformation products
Principles Principles
ProcessProcess
ToolsTools
To enhance evidence based practice and
informed decisions; there by to improve the
quality of health care and health status of the
people, a continuous training of health
workers and program managers at national,
Zoba and facility level on different aspect of
health information system is one of the major
focuses of the unit. Hence in the three years,
total of1790 health professionals in the six
Zobas including National referral hospitals
and head quarter were trained on data
management including using the data for
different purposes. To assess the quality and
effect of the data management training given
supportive supervision in 93 health facilities
was also conduct this year
Ensuring the quality of the data is another
focus of the HMIS. Thus, the quality of
recorded and reported data is checked using
data quality monitoring tool at different
levels. The Zobas are also expected to check
the timeliness, accuracy and completeness
of the reports of the health facility and report
to the national office on monthly bases.
Accuracy in terms of completeness, outliers
and unusual morbidity report is continuously
checked by National HMIS staff and
feedback is provided to the Zoba HMIS
officers. Thus, according to the assessment of
Figure 1
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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health facility result in 2009, the accuracy
from the health facility to Zoba level was
80.6% less than by 1.2% from 2005 that
needs special attention in improving the
accuracy rate.
The timeliness from Zoba to National level
in 2012 was 88.1 % with decreased by of
7.5% compared with 2011, as indicated in
the graph below. The decreased could be
attributed to inconsistency power supply and
assigning only one data entry clerks in some
zobas especially in Zoba Anseba, Debubawi
Keih-Bahri. The due date of Timeliness from
zoba to Head quarter is within 15th 15-20
th
days of each month.
Completeness in terms of the number of
reports received, each month compared to the
expected number is always above 90%
indicating good culture of reporting. In the
last four years the completeness was around
98% as shown in graph 3.
F Figure 3.Completeness Report ( Jan-Dec, 2009-2012)
1 0 0 8 3 . 8 8 3 . 3 1 0 0 1 0 0 1 0 0 1 0 0 9 5 . 25 8 . 3 1 0 0 7 5 8 3 . 3 1 0 0 1 0 0 1 0 0 8 8 . 102 04 06 08 01 0 01 2 0
D K S K A N G B D E M A N R A v e r a g e%
Z o b a
T i m e l i n e s s f r o m Z o b a t o N H M I S J a n - D e c2 0 1 12 0 1 2
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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On December 31, 2011 there were 340 health
facilities reporting to HMIS on monthly
bases for their respective reporting formats.
The existed HMIS data is facility based,
although information like community based
information system (CBIS) birth and death
are very essential to measure important
health indicators like infant, maternal and
adult mortality rate which are not included
into the system requiring the establishment of
vital event registration system. To bridge this
identified gap CBIS developed in
collaboration with different program
managers and stakeholders and is expected to
start this year.
The annual health service activity report
included facility based morbidity, mortality,
and health service activity, available health
personnel by category, and the number and
distribution of health facilities. The available
population survey information generated by
different programs is also incorporated where
appropriate.
Routine data available in the system
includes:
• Population data
• Antenatal
services
• Delivery
services
• Family Planning
services
• PMTCT
services
• VCT services
• Growth
Monitoring and
Promotion
services
• Health
Education
• Immunization
• IDSR diseases
• Outpatient and
Inpatient Services
that includes:
• Morbidity and
mortality data.
from hospital and
health centres
which are
classified by
International
Classification of
Disease tabulation
Code (ICD 10
Code),
• Diagnostic services (laboratory,
radiology),
• surgeries performed
• Health station outpatient morbidity
• Administrative data that includes the
number of health professionals actually
working in each health facility by
category, the number of health facilities
and their distribution by type of health
facility, revenue and expenditure of each
health facility.
Because of different interventions related to
the above mentioned services, the 1995 and
2002 DHS and other population based
surveys indicated remarkable improvement
in different health status indicators as
indicated in Table 1.1.
In computing the occurrence of diseases and
population coverage of health services,
percentages, percentage change and averages
were used. Total number of visits in
outpatient and inpatient, total number of
cases, and deaths and total number of
estimated target population for different
health services are used as denominators to
assess the current morbidity and mortality of
Table I. % of Completeness report (Jan-Dec,
2012-2009)
Zoba 2012 2011 2010 2009
DKB 100 99.9 100 100
SKB 99 99.8 99.5 99
AN 100 100 100 100
GB 99.5 99.3 95 95.5
DE 99.9 100 100 99
MA 100 98.6 98.5 98.8
NR 100 100 100 100
Average 99.8 99.7 99 98.9
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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the diseases and service indicators, on which
monthly data is collected. Projected
population estimates based on the 2000 Local
Government population data is used to
calculate the target population for different
health services. Some of the denominators
used are listed in Table I.2. The morbidity
rate expressed in this text expresses the
percent of new reported cases of the heatlth
problem (e.g. Malaria) compared to total
number of new cases due to all other
reported causes in the health facility.
Similarly, the death/mortality rate indicates
the number of deaths from specific health
problem compared to the total number of
deaths in the health facility. The case fatality
rate on the other hand indicates the number
of deaths of specific health problem from the
total number of inpatient cases of the same
problem. Therefore, it is important to note
that all incidents or rates are based on facility
data that may not be representative to infer
the situation to the larger population since
most of the cases or deaths may occur at
home where data is not available. However,
it can be used by extrapolating the
community based surveys and compare it to
the facility based.
Despite this limitation, the routine data is
helpful for disease surveillance and service
delivery performance monitoring and
evaluation, resources allocation, planning
and other health system management
activities. It also is helpful to identify health
problems. The increase or decrease in the
morbidity and mortality data at health facility
also ignites the need for further community-
based studies or surveys.
Denominators
Availability of population data is essential
for monitoring and evaluating performances
and other purposes. Since we never had
census, we have been using different
population data from different sources that
makes comparison very difficult because of
differences in denominator. However, in year
2000, the Local Government issued estimates
of population residing in Eritrea. For our
purpose, an estimated projected population
data from this source is used. To project
population estimation, 3 % annual population
growth rate was used from 2000 to 2002.
From 2002 to 2007, 2.8% annual population growth rate is used based on the EDHS 2002 annual
growth estimates due to reduction of fertility from 6.8 in 1995 to 4.1 in 2002. Thus, the rates
presented in the previous years’ report were also adjusted to this population denominator. The
population estimates used in 2012 report is 3.95 million. Some of the denominators used in this
report are presented in Table 1.2.
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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Table I.1. Status of Health and Socio-Economic Indicators in Eritrea
Indicators 1990 World
Bank,
UNICEF
1995
EDHS
2002
EDHS
2004, 2005, 2006, 2007 different
sources(WHO, WB, UNICEF, HDI
etc)
Crude birth rate/1000 population 42.37 (HDI) 40 (UNICEF 2007)
Crude death rate 15.96
(UNICEF)
9 (UNICEF 2007)
Annual Population Growth 2.9% 2.5% (UNICEF 2007)
Total fertility rate of child bearing age woman 6.7 6.1 4.8 5.1 (UNICEF 2007)
Neonatal Mortality/1000 live births 25 23.6 21 (UNICEF 2004)
Infant Mortality/1000 Live births 88 (UNICEF) 72 47.7 46 (UNICEF 2007)
Child Mortality/1000 (children 1-4) 68 47.9
Under five mortality/1000 live births 147
(UNICEF)
136 93 70 (UNICEF 2007)
Postnatal Mortality/1000 live births 41 24
MMR/100000 live births 1400 998 450 (UNICEF 2005)
Adult literacy rate total 56.7 % (HDI, 2003 UNDP)
Literacy above 6 years of age male (%) 45.6 59.4
Literacy above 6 years of age female (%) 37.7 43.5
Primary School enrollment rate (6-15 years) 48.4
%
61.2 % 67% (UNICEF 2006)
Access to safe water supply per house hold
%
19 16.4 67.4 60 (UNICEF 2006)
Access to sanitation (toilets)% 19 12.8 25.6
Access to basic health services 10 % 70 %
Stunted Children % 38.4 38
Wasted Children % 16.4
Under weight % 44 43.7
Women < 18.5 BMI 40.6 37.3
Pregnant women with at least one ANC visit (%) 49 71
Pregnant women with 4 or more ANC visits(%) 27 41
Births attended by skilled health workers (%) 21 29.5 %
Met needs for OB emergency (%)without
including abortion
17.6
(HMIS,
2004)
42.9 % HMIS (2012)
Immunization service
coverage (percent)
BCG 61 91 99 % Crude coveragee & 84% by
card (EPI survey 2009 )
DPTHB3 49 83 98% crude coverage & 86% by
card (EPI survey 2009 )
DPT1/OPV1 19 43 100% crude coverage &85% by
card (EPI survey 2009 )
Measles 51 84 99% crude coverage& 75% by card
(EPI survey 2009)
Fully immunized 41 76
Not immunized 38 5
TT2 + for women % 23 35
Contraceptive prevalence rate% 8 8
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Table I.2. Denominators Used in Computing Performances
or Situations by Zone in Year 2012 Zones Age
group
AN DE DKB GB MA NR SKB Total
New OPD
cases in
HO/HC
<1 9507 16109 1658 17747 14967 10381 12089 82458
1-4 29480 32231 4943 38747 41119 23362 25821 195703
>5 120845 163515 17069 144994 219367 173410 106374 945574
Total 159832 211855 23670 201488 275453 207153 144284 1223735
OPD First
visit patients
in
HO/HC/MC
<1 8904 14597 1565 16052 13541 9874 10197 74730
1-4 22496 29311 4688 33487 36745 22662 22046 171435
>5
11747 152739 15374 133184
120853
6 163991 100752 892050
Total 14887
4 196647 21627 182723
25882
2
19652
7
13299
5
1138215
Total
Inpatients
HO/HC/MC
<1 4583 3631 325 2891 652 12478 2111 26671
1-4 3377 3986 318 3182 1083 4480 1847 18273
>5 12513 21295 1547 12687 7303 24329 8302 87976
Total 20473 28912 2190 18760 9038 41287 12260 132920
First visit
patients in
Health
Stations
(HS)
<1 15007 20665 2499 14864 11816 6663 71514
1-4 36243 36617 6070 33297 30934 19457 162078
>5 163203 125910 35058 183535 142638 89794 740138
Total 214453 183192 43627 231696 184848 115914 973730
OPD/IPD
deaths in
HO/HC
<1 110 139 25 134 4 157 124 693
1-4 57 53 10 100 8 44 57 329
>5 155 196 30 235 215 649 108 1588
Total 322 388 65 469 227 850 289 2610
Total HS
deaths
<1 5 1 6 8 2 2 24
1-4 7 0 1 6 1 2 17
>5 19 4 2 14 8 2 49
Total 31 5 9 28 10 6 90
Total number of estimated
Population 636,660 1,052,161 92,397 786,390
750,419
639415
3,957,442
Target Population ANC,
4% 25,466 42,086 3,696 31,456 30,017 25,577 158,298
Target Population /
Delivery 3 % 19100 31565 2772 23592 22513 19182 118723
Target Population/ EPI
under one 3 % 19100 31565 2772 23592 22513 19182 118723
Target Population FP, 20
% 127332 210432 18479 157278 150084 127883 127332
Target Population for
under 5, (15 %) 95,499 157,824 13,860 117,959 112,56
3 95,912 593,616
Target Population for GM
<3 years, 12% 76,399 126,259 11,088 94,367 90,050 76,730 474,893
* Case = Type of illness/diagnosis. The number of cases are more than or equal to the number of patients since a patient
can have more than one type of health problems on the day of visit.
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Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012
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Part II. Resources
One of the Ministry of Health’s goals is to
improve the quality of health services through
enhancing the availability and accessibility of
required human and non-human resources.
Some of the non-human resources considered
in improving the quality of health services
include: drug and supplies, vehicles, especially
ambulance service, other communication
services, power supply, water supply,
equipment, finance etc.
In this report, only available human resources,
number and type of health facilities and
number of hospital and health center beds,
which are reported to the National HMIS,
availability of certain resources in health
facilities are included.
II.1. Human Resources
The health workforce is the backbone of the
public health system and central to its effective
operation as highlighted in The World Health
Report 2006. There is a close correlation
between qualified health workers and key
health outcomes. Without investing on human
resources adequately, it is difficult to improve
quality of health services. It takes a
considerable investment of time and money to
train health workers. Countries need these
skilled work forces so that their professional
expertise can benefit the population. The
Ministry of Health has established and
strengthened its training institutes to address
the health professional shortages in the
country.
The College of Nursing and Health
Technology has been training professionals at
Diploma level. At this time three satellite
Associate Nursing Schools were opened in,
Mendefera Zoba Debub (2003) Barentu, Zoba
Gash_Barka (2005) and Ghindae Zoba
Semenawi Keyh Bahri (2007) to increase the
intake and output of the College. Orotta School
of Medicine was also opened in 2003 to
address the scarcity of medical doctors in the
country. At present, Orotta School of Medicine
and Dentistry, Asmara Collage of health
Sciences and School of Post Graduate program
are under the Eritrean Board of higher
Education.
• Asmara College of Health Sciences
which was established in 1995 under
the University of Asmara and where
the College of Nursing and Health
Technology integrated to. This college
consists of:
o School of Nursing
o School of Allied Health
Professions
o School of Pharmacy
o School of Public Health
The School of Medicine provides under
graduate and graduate degree program in
Medicine, and the College of Health Sciences
provides under graduate degree and diploma in
nursing, pharmacy, clinical laboratory and
public health. Moreover, there is also diploma
program in Dental Therapy, Physiotherapy and
Radiology, laboratory (MLT), and Public
health in School of Allied Health Professions.
In addition to the training provided in these
schools, over sea scholarship and distance
education programs are also part of the human
resources development program in the
Ministry of Health.
Short courses are also provided as in-service or
on the job training programs to improve the
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Health Management Information System, Research and HRD, MoH Annual Health Service Activity Report of 2012
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competency and motivation of health
professionals.
II.1.1. Training
Over the last 20 years, from 1991 to 2012, a total of 9151 health professionals were trained and
graduated at degree, diploma and certificate level from the different training institutes in the country,
internal and over sea scholarship, distance education, and in service training programs. The number
and category of health professionals trained by the Government in years is illustrated in Table II 1.1
3, II.1.1.4, II.1.1.5
Prior to year 2005, nursing course was provided for three years and required one more year training to
be a nurse midwife. However, in 2005 nursing curriculum was revised to include more hours of
midwifery, and all graduated since then were comprehensive nurse midwives.
In year 2012, a total of 660 various categories of health professionals were trained in different
training institutions and assigned to respective zones as summarized in Table II. 1.1.1.
Distance learning, in which the training is taken to the learner, is a cost-effective and increasingly
popular tool for retraining the health workforce in different training institutions and assigned to
respective zobas. The new health professionals’ graduates are summarized in Table II.1.1.1.
Considering the need of training and retraining of health professionals to improve their knowledge
and skill to provide better quality health services, continuing education program through external
and internal scholarship, distance education, in-service and on the job training has been provided
to the different categories of health professionals.
Distance learning, in which the training is taken to the learner, is a cost-effective and in addition
to its cost effectiveness and easy to use, a well-designed distance learning programs are very
effective in transferring skill and knowledge to workers and strengthen the human resources
capacity. The numbers of beneficiaries of continuing education program could be more than
presented in Table II.1.1.3, since the other departments used to send their staff for training without
notifying the department of Research and HRD, it could not be appropriately recorded
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Table: II. 1.1.1 Different health professionals trained and assigned to zobas in 2012
Profession GB AN DB MK SKB DKB NRHs HQ Total
MD (GP) 8 4 6 2 10 2 3 0 35
BSN 8 6 7 3 9 8 10 0 51
Nurse 20 11 12 7 17 14 40 0 121
Gynecologist 1 0 1 0 3 0 1 0 6
Pediatrician 2 0 0 0 0 0 1 0 3
Associate Nurse 32 47 47 20 27 15 36 0 224
OR.technician 4 0 5 0 5 0 14 0 28
Pharmacist 2 2 3 1 2 0 0 1 11
CLS 2 1 4 1 4 3 7 0 22
MLT 5 5 5 3 6 5 16 0 45
Dental tech. 2 4 4 2 4 3 8 0 27
Radiology tech. 1 1 0 2 2 2 6 0 14
Pharmacy tech. 4 3 3 4 5 2 10 0 31
PHO 0 1 3 2 3 3 0 1 13
Optometry 3 3 6 4 4 4 5 0 29
Total 94 88 106 51 101 61 157 2 660
Source: HRM Report 2012
In addition to the above table the following staff were upgraded and reassigned with
new position.
� 23 Former Public Health, malaria technicians and sanitarians upgraded to Public
Health BSc.
� 13 laboratory technicians upgraded in Clinical Laboratory Science
� 5 General Practitioners upgraded in Obstetrics & Gynecology, and 3 in Pediatric.
� 48 Registered Nurses upgraded to the BN program through the Distance Program
� 18 other staff upgraded to BA Professional Development 4
� 4 nurse anesthetists upgraded to the BSc program and are assigned to their
previous work place, while 6 nurses upgraded to the field of anesthesia.
� 3 GPs graduated in Pediatrics
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Enrolled Health Professional
Number health professionals graduated and enrolled in Asmara Health Sciences and Post Graduate
Medicine Education as illustrated in table II.1.4 and , II.1.5In addition, Orotta School of Medicine is
gradating medical doctors ever year as indicated in table II.1.8
II.1.4. Advanced placement ongoing training programs at the college of health science
Type of Program 2011-2012 2012-2013 Graduated in
2012
Proposed plan
2012-2013
Assocaite nurse to RN a a a a a 50 30 100
Bachelor in midwifery 20 14 14
BSc in Nursing Anesthesia 41 4 5
BSc in psychiatric nursing 20 10 10
BSc in ophthalmic nursing 25 12
BSc in clinical Lab science 22 3 12 6
BSc public health 29 23 26 28
Diploma Upgrade to LAB to
MLT
23 23
Upgrading pharmacy to BSC 20 20
TOTAL 207 103 42 218
Source: Continue education Report 2012
Table II.1.5 On Going Residency program in Post Graduate Medical Education Program
2009/2014
S.
N
Program No. of
Students
Year started Expected to Complete
1 Postgraduate program in
Obstetric Gynecology
5 2009 Completed
2 Post Graduate 3 2010 2012
3 Postgraduate program in
Surgery
4 2012 Sep 2014
4 Postgraduate program in
Pediatrics
4 2012 Sep 2014
5 Postgraduate program in
Obstetric Gynecology
4 2012 Sep 2014
6 Postgraduate program in
Pediatrics
4 2012 Sep 2014
Source: 2012 Annual Report of Continuing Education, MOH
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In addition there are 6 fellowships abroad in the field of medical oncology, Radiation therapist and
MSC in physicist two from each field.
II.1.2. Available health personnel in the MOH and their distribution in the country
The number of employees of the
Ministry of Health and their distribution
by zoba as reported by the Human
Resources Planning and Management
division and the number of health
professionals working in government
and non-Government health facilities as
reported in HMIS is presented in this
report.
According to, the Human Resources
Planning and Management division
report 2012, the MOH had a total of
8184 employees at National level out of
which 61.4% were professionals and
38.6% were administrative staff that
showed no difference with 2011 report.
Table II.I.6. Distribution of MOH employees by zoba
Category DKB SKB AN DE MA NR HQ TOTAL %
Professions 226 533 550 793 990 1038 245 5022 61.4
Administrative 104 251 248 552 700 644 306 3162 38.6
Total 330 784 798 1345 1690 1682 551 8184 100
Source: HRM 2012 Report
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Table II.I.7. Distribution of MOH professional Specialists by zoba
Profession GB AN DB MK S/K/B D/K/B NRHs HQ Total
Dentist 1 1 1 1 4
Epidemiologist 1 1
ENT specialist 3 3
Gen. surgeon 1 1 5 4 11
Gyn. Specialist 3 1 2 2 7 15
Internist 2 2
Ophthalmologist 1 6 7
Orthopedist 3 2 5
Pediatrician 3 2 3 10 18
Radiologist 1 4 5
Stomatologist 1 1 2
Dermatologist 1 1
Acupuncturist 2 2
Immunologist 1 1
Entomologist 1 1
Pathologist 1 1
Neuro Surgeon 1 1 2
GP 18 11 23 6 19 6 4 12 100
MPH 1 1 1 5 8
Total 27 14 29 25 23 7 46 18 189
Source: HRM 2012 Report
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Table II.I.8. Distribution of MOH other professional Specialists by zoba
Profession GB A
N
DB MK NR
S
SR
S
NR
H
H
Q
Total
Nurse 120 10
0
17
9
16
3
83 38 26
7
32 982
Bs.N 26 18 21 66 27 16 34 48 256
Associate
nurse
325 30
2
40
4
55
6
31
0
11
4
50
2
24 2537
Anesthetists 5 2 5 10 4 1 14 0 41
Nurse psych. 0 1 1 1 0 0 8 0 11
CLS 14 11 16 15 8 2 34 36 136
MLT 29 19 41 28 15 9 35 23 199
Dental tech. 12 10 11 21 7 6 16 0 83
Opth. Tech. 1 2 1 3 3 1 6 1 18
Optometry 4 3 7 4 4 4 6 0 32
Pharmacist 8 5 7 11 4 1 9 20 65
Pharmacy
tech.
24 15 23 39 20 11 29 9 170
PHO 4 6 5 6 5 4 1 7 38
PHT & others 31 14 23 17 11 7 0 11 114
Physiotherapi
st
3 2 3 2 0 1 7 0 18
Radiology
tech.
5 8 16 21 7 4 18 1 80
Others 9 18 1 2 2 0 6 15 53
Subtotal 620 536 764 965 510 219 992 227 4833
Total Table 7 27 14 29 25 23 7 46 18 189
Grand Total 647 550 793 990 533 226 1038 245 5022
In addition to the health workers
employed by the Ministry, 269 health
professionals in average work for at
least 15 days in a month work out
side of the Ministry of health owned
health facilities as indicated in table
Table II.I.9.
Table II.I.9. selected category of health workers
working in non MOH owned health facilities
Associate
N
M-
wife
Nurse
GP Lab.
Tech
Phar/Pharm. Total
194 35 13 19 8 269
Source: DSS, 2012
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Table: II.1.2.1 Employed Health Workers in
the MOH and their proportion to the total work
force by year (1991-2012)
Yea
r
Tota
l
Emp
loye
es
Health
Professionals
Administrativ
e/management
Staff
Num
ber
% of
the
total
No. % of
the
total
1991 *327 NA NA NA NA
1999 4464 2688 60.2 1776 39.8
2000 4864 2742 56.4 2122 43.6
2001 4862 2743 56.4 2119 43.6
2002 3687 2956 80.2 731 19.8
2003 5959 3368 56.5 2591 43.5
2004 5855 3273 55.9 2582 44.1
2005 6034 3501 58.0 2533 42.0
2006 6315 3657 57.9 2658 42.1
2007 6736 3556 52.8 3180 47.2
2008 6861 3467 50.5 3394 49.5
2009 7238 3962 54.7 3276 45.3
2010 7282 4640 63.7 2642 36.3
2011 8191 5025 61.3 3166 38.7
2012 8184 5022 61.4 3162 38.2
* The health workforce of the combatants was
not included in 1991
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II.1.3. Attrition of Health Professionals
Employees work effectively and efficiently, when their personal goals match with the employee
organization’s goals and objectives. Thus, effective human resources management is required to
match the two goals and objective to keep the attrition rate to its minimum level.
According to the 2012 HRM Unit report, the total attrition of health professionals in 2012 was 154
which is less than by 135 compared with 2011.
The main reason of attrition was as indicated in the table below.
Table III.I.3.1 Reasons of Attrition
Reason of attrition Percentage
Absconders 73.3%
Released due to health, aging and social
problems
19.6%
Due to death 3.1%
Termination of expatriates contract 4.0%
Source: HRM 2012 Report
Table: II.1.3.2. The percentage change of available doctors, nurses and
associate nurses in the Ministry from the previous years (2002-2012)
Year Doctors Nurses Associate Nurse
No. %
chang
e
No. %
change
No. % change
2002 211 29.4 846 5.4 1488 8.4
2003 212 0.5 993 17.4 1576 5.9
2004 214 0.9 954 -3.9 1520 -3.6
2005 217 1.4 1012 6.1 1691 11.3
2006 225 3.7 1184 17.0 1602 -5.3
2007 210 -6.7 994 -16.1 1581 -1.3
2008 213 1.4 1070 7.6 1724 11.5
2009 201 -5.6 1167 9.1 2215 28.5
2010 216 7..5 1262 8.1 2380 7.5
2011 134 -37..9* 1136 -9.9 2373 -0.3
2012 189 41 1253 10.3 2537 7.1
N.B.*
The decrease of doctors could be attributed to decrease in expatriate doctors,
31 medical doctors who are in residence program are not included and
attrition due to different reasons.
Source: HRH planning and mgt division Annual report of 2011/2012
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II.I.4. Health Workers Population Ratio
The availability and composition of human
resources for health is an important indicator
of the strength of the health system.
Although, the optimal number of health
workers population ratio is not known, the
higher levels of density are not necessarily
better. The developing countries have very
low ratio compared to the developed
countries that negatively affects the quality
of health services. The WHO estimated that
there is a need of having at least 2.5 health
workers per 10,000 people to achieve the
MDG. In this regard, Eritrea had 10.2 lower
than considering only those employed by the
Ministry.
The doctors, nurses and associate nurses,
ratio in 2012 was 1:206335, 1:3113, 1:1537
respectively indicating that there were 0.48
doctors per 10,000 people, 3.2 nurses and 6.5
associate nurses per 10,000 people taking
only those employed by the MOH. The
number of doctors, nurses and associate
nurses per 10,000 people is almost the same
compared to 2010 and 2011.
Considering the WHO minimum health
worker requirement per 10, 0000 people, it
will not be long before Eritrea exceeds the
recommended minimum figure for doctor.
An average of 30 doctors will be graduating
yearly starting 2009 that will significantly
reduce the ratio. The minimum requirement
for nurses and associate nurses is already
achieved. The WHO recommended target for
developing countries in the doctor population
and nurse population ratio is 1:10,000 and
1:5,000 respectively.
The trends in the doctor, nurse and associate
nurse population ratio in Eritrea as indicated
in table II.1.2.3, remained almost constant in
the last six years with slight decreased trend
of all categories starting in 2011 and
increased trend in 2012. The health workers
population ratio of different health workers
in 2012 is also presented in Table II.1.4.1
Table II.1.4.1. Health Professional
Population Ratio in 2012
Category Number
of HW
People per
Health Worker
Doctors 189 20635
Nurses 1253 3113
A. Nurse 2537 1537
Radiology tech 80 48750
Ophthalmic
tech+ optometry 50 78000
Pharmacist/
Pharmacy .
techch 235 16596
Lab. Sciences
(MLT+CLS) 335 11642
PHT. 114 34211
Others
(dental+physio.) 101 38614
Source:.HRH annual report 2012
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II.2.1. Number of Health Facilities that Report to HMIS
VI.2. Number of Health Facilities and their Distribution 2012
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In 1991, there were 16 hospitals (HO), 4, health centers (HC), and 106 health stations (HS) and or
clinics (Cl.). Since independence, the Ministry has been constructing, rehabilitating, maintaining
and equipping health facilities to increase accessibility to primary health services.
In December 2012 there were 340 health facilities reporting monthly to NHMIS including
government and non-government health facilities except Military Health Facilities (Table II.2.1.1).
Table II. 2.1.1 Total Number of health facilities by type
and ownership in 2012
OWNER HO HC MC HS CL Total
% of
Total
MOH 27 47 6 160 18 258 75.9
ECS 6 1 23 30 8.8
EVM 3 3 0.9
PRV 1 1 6 8 2.4
IND 1 2 28 31 9.1
MLW 2 2 0.6
MOA 1 1 0.3
MOE 1 1 2 0.6
POL 2 2 0.6
OTHER 3 3 0.9
Total 28 56 7 188 61 340 100.0
8.2 16.5 2.1 55.3 17.9 100.0
ECS= Eritrean Catholic Secretariat, EVM= Evangelical,
IND= Industry, POL= Police, PRV= Private, MLW=
Ministry of labor and welfare.
Table II.2.1.2 Total Number of health facilities by type
and zoba in 2012
ZONECODE HO HC MC HS CL Total
AN 1 9 1 27 3 41
DE 5 12 2 46 3 68
DK 3 11 1 15
GB 3 13 3 51 6 74
MA 4 9 24 44 81
NR 8 2 9
SK 4 11 1 29 4 49
Total 28 56 7 188 61 340
% of Total 8.2 16.5 2.1 55.3 17.9 100.0
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Considering the type of health facilities, the hospitals constitutes 8.2%, health centers 16.5%,
health stations 55.3%, and MCH and other clinics 20%. Clinics include industrial clinics, Free
standing alone VCT sites, Dental clinics and other educational and vocational centers.
Out of the total 28 hospitals, 8 are National referral hospitals and 6 zonal referral hospitals. The
others are Subzoba hospitals.
The health centers include: 1 National Referral Physiotherapy Center, I National Referral Center
for Children in Asmara (IOCCA) that provides surgical service to children referred from all over
the country by International Experts; 2 industry health centers that provide mainly OPD service to
their employees, one health center in Mai Nefhi Institute Technology that provide out patient and
inpatient services to the students and one private geriatric center that provide inpatient service to
aged people. The remaining 50 health centers (44 MOH and 6 Catholic Mission) provide the
regular health center activities that include maternal and child health, OPD and IPD services
(Table II.2.2.)
Ownership of Health Facilities
As indicated in table Table II. 2.1., MOH owns 258 (75.9%), ECS 30(8.9%), Evangelical Church
3(0.9%), private 8(2.4%), Industry 31(9.2%) and the remaining others 9 (2.8%). The number of
health facilities in 2012 by type and ownership is presented in Table II.2.1.2.
There are 13 MOH hospitals working as private in the afternoon shift. The report of these
hospitals is separately compiled and analyzed in the NHMIS database. Even though the private
clinics were closed the services that were rendered in those private clinics is now practiced in
these public health facilities in the afternoon session. These health facilities are mainly giving
service focused on OPD activities and refer different case for further treatment and advice. Out of
the total OPD new cases, first visit patients and repeat visit patient 14.9%, 15.1% and 11.3% were
treated in the private sector respectively this year.
Growth of Health Facilities
Considering the total number of reported health facilities, it grew by about 29.1% in the last
14years (1998-2012), but compared to 1991, it grew by about 167.5% (Figure II.2.1.2.).
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71.1
6.39 9.6
3.1 0.9
75.6
1.9
9.4 9.4
2.8 0.9
75.7
2.4
8.9 9.2
0.9 0.90
10
20
30
40
50
60
70
80Percent
Organizations
Figure II.2.1.1. Proportion of Health Facilities by Ownership (2010- 2012)
2010 2011
2012
The number of health stations grew by about 77.4% (from 106 to 188) since 1991, the hospitals
by 75% (from 16 to 28), and the health centers by 1275% (from 4 to 56
The mentioned above health facilities also provide preventive and curative services; there were
also 249 VCT, 208 PMTCT and 0ART sites in 2012 (Figure II.2.1.4.) out of which 11 VCT sites
are free standing.
Moreover, there are also 307 pharmacies, drug shops and rural drug vendors, which also provide
services although, the service provided by the Pharmacies is not reported to NHMIS. The
distribution of these facilities is shown in Table Table II.2.1.1.4.1. and Figure II.2.1.5.
Except very few para-statal pharmacies, all pharmacies, drug shops and rural drug vendor are
privately owned.
no0
100
200
300
400
Number
Year
Figure II.2.1.2. Total Cumulative Number of Health Facilities by Year (1991 & 1998-2012)
no
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Source: NATCoD 2012, MoH
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5 3 3 3 6 8 3 4 9 746 2 3 4 7 3 3 6 9 5
402 04 06 08 01 0 01 2 0M A S K B D E A N G B D K B
F i g u r e I I . 2 . 1 . 5 C o m p a r i s o n o f o u t l e t s b y z o b a a n d y e a r 2 0 1 0 - 2 0 1 2 2 0 1 02 0 1 12 0 1 2
The drug outlets are run by either pharmacist, pharmacy technicians, nurses or associate nurse
depending on the type of outlet.
MOH, National Medicines & Food Administration Report 2012, indicates that there were 44
functional pharmacies, 36 drug shops and 227 rural drug vendors in the country at the end of
2012. The type and distribution is shown in table II.2.1.1.4.1. According to the policy of the
MOH, a pharmacy should have at least one pharmacist, a drug shop at least a pharmacy
technician or nurse, a rural drug vendor either a nurse or associate nurse.
Table II.2.1.1.4.1 Distribution of Pharmacy,Drug shop and Rural drug vendour in 2012
Zoba Pharmacy Drug shop Rural Drug Vendour Total
MA 34 20 12 66
SKB 2 3 29 34
DE 3 6 63 72
AN 3 2 29 34
GB 2 4 91 97
DKB 0 1 3 4
Total 44 36 227 307
% 14.3 11.7 73.9 100.0 Source: MOH, National Medicines & Food Administration Report 2012
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Table II.2.1.14.2: Access of VCT & PMTCT sites by zoba in 2012
Zoba VCT PMTCT Total
MA 33 21 54
DE 71 64 135
AN 39 34 73
GB 46 39 85
SKB 41 39 80
DKB 16 13 29
NR 8 2 10
TOTAL 254 212 466
% of Total 54.5 45.5 100.0
Source :HIV/AID unit 2012 report
Out of 466 sites 11 are free standing giving only VCT services.
Table II.2.1.1.4 Number of Health Facilities by Type and Year (1998-2012)Compared to 1991
YEAR
Type of HF 1991 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Hospital 16 23 23 23 23 24 24 25 25 25 26 26 26 27 27 28
Health Center
/MCH 4 49 49 52 51 49 49 50 51 52 56 56 56
61 63 3
Health Station 106 149 154 170 179 169 174 177 178 180 182 184 186 187 186 188
*Clinics 0 40 37 29 33 73 85 107 104 113 114 105 101 66 44 61
Total 126 261 263 274 315 315 332 359 358 370 378 371 369 335 320 337
VCT 0 0 0 0 15 22 38 45 84 96 110 130 135 162 237 254
PMTCT 0 0 0 0 0 3 3 7 29 59 67 89 93 131 197 212
ART 0 0 0 0 0 0 0 0 5 9 14 15 17 19 19 20
Pharmacy 32 29 28 28 29
28 29 29 33 34 40 44
Drug Shop 31 28 28 28 28
26 34 29 31 30 35 36
Drug Vendor 187 184 186 203 203
228 221 231 228 226 228 227
Total licensed
Private Clinics 130
82
72 72 62 56
22 6
* Includes MCH clinics, first aid clinics, free standing VCT sites, industrial clinics, and other non MOH owned clinics and private clinics run
by physicians.
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II.3. Patient Bed
A hospital bed is an expensive commodity in healthcare. Hospital administrators need an objective
measures and methods for efficient management of their limited financial resources. Bed
utilization rates can be of immense help in realistic and effective decision making. In the Ministry,
hospitals are the major area of expenditure that requires monitoring of appropriate bed utilization
to reduce cost.
Number of Available Patient Beds
The number of available patient beds and their ratio to patients or people in the catchment area
indicates accessibility to patient bed and quality of care.
The reported number of in patient beds in
2012 were 3932 including beds in MCH clinics which is less than by 43 beds than previous year
that served to (1:992 people) for estimated national population of 3.9 million. Out of the total
number of beds, 70.1% were hospital beds, 29.1% health centre and MCH. The total number of
The overall number of beds remained almost constant for the last eight years with slight decrease in
2088 & 2010 (Figure II.3.1
From 2006-2009, there were 11 beds for
every 10,000 people, but in 2011 it was about
10.1 with a ratio of one bed to about 991
people
.
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Bed Utilization
The bed utilization at different levels also
indicates the quality of the referral system, the
continuity of care and appropriate utilization
of resources. Average length of stay (ALOS),
bed occupancy rate (BOR) and bed turn over
interval (BTI) and bed turn over rate or
patients per bed are some of the indicators for
bed utilization.
a. Patients per bed (BTR)
The number of patients served in a bed is
affected by the average length of stay and bed
turn over interval (BTI). Taking the average
length of stay in 2012 at National level (5.1
days) and 300 working days in a year by
considering lost days in between admissions
(turnover interval (TI)), a bed should have
served 60 patients in 2012 with variation in
the zobas and health facilities.). The average
Table: II.3.2. Number of Beds per 10,000 people (2004-2012)
Health
facility
type
Year
2004 2005 2006 2007
2008 2009 2010 2011 2012
Hospital 2695 2697 2592 *2823 2827 2647 2626 2738 2575
H.
Center
1477 1248 1280
1139
1054 1328 1082 1203 1141
MCH
Beds
NA NA NA
63
63 64 64 34 34
Total
Beds
4172 3945 3872
*4025
3944 4039 3732 3975 3932
Beds
Per
10,000
People
13.1 12.0 11.5 11.3 11.1 11.2 9.9 9.8 10.1
The estimated population is taken as 3.9 for the year 2012
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lost days per bed in a year was about 5.7 days,
almost the same with 2010, 2011(6.3days)
(Table II.3.5.). The actual average bed day in
a year was 359 (365-6.3). Taking this number
into account, a bed should have served in
average 71 (expected number of
inpatients/total beds) patients in a year in
2012.. However, only 34 patients were served
per bed at national level indicating low bed
utilization rate at national which similar with
the last year service. Actually only 132894 patients were served in all beds in the country
while 279263 patients were expected to be served in the available beds. In other
words, only 47% were served from the
expected number of patients. In this case it is
important to reduce the number of patient
beds if they are not utilized properly in order
to reduce unnecessary maintenance and other
bed costs.
A hospital bed served 37 (two less than 2011)
patients in a year and a health centre/MCH
bed 27 patients two more than 2011.)
The following hospitals had the highest
patient per bed in the last three years as
indicated the table below.
Table II.3.1 Hospital patient per bed
Hospital
Name
Year
2009 2010 2011 2012
Orotta Maternity 152 220 206
216
Keren 55 58 65 60
Sembel 48 55 56 44
Barentu 43 48 53 18
Mendefera 43 51 52 31
Orotta Pediatric 52 48 42
43
Refer table II.3.5 for other hospitals
Orotta Maternity hospital had the highest
because it provides mainly delivery services.
The 2010, 2011 and 2012 bed utilization
indicates that 2 patients in health centre/MCH
and about 3.2 patients in hospitals used a bed
per month.
In general, the bed utilization rate was low
and indicates that there were more beds than
required in most health facilities which need
consideration and decision to reduce the
number of beds or shift the beds to were they
are needed.
b. Length of Stay
There could be variations in the length of stay
based on the type of illness and the service
required. The time required to treat a
psychiatric and complicated surgical patient is
longer compared to assisting normal delivery
that affects the turnover rate. If patients stay
in hospitals for long period of time, other
patients could not have opportunity to use the
bed resulting to low accessibility.
The average length of stay in days in different
hospitals varies from 1.4 in Orotta Maternity,
to 11.6 days in Denden disable hospitals
excluding Hansenian and St. Mary
Hospitals), and 6.9 days in health centers/
MCH clinics with a National average of 5.1
days.
Hansenian Hospital the only hospital that
deals with leprosy and St. Mary Psychiatric
Hospital that manages mentally ill patients
had the long hospital days. Thus, it seems
reasonable to have long hospital bed stay until
other health facilities provide services to the
mentioned above patients.
Patients in Orotta Maternity Hospital stay
for about one day in average because most of
the clients get admitted for normal delivery
and discharged within one or two days.
The average length of stay in hospitals by
zoba is presented in Figure II.3.4c.
Among the zobas, a hospital bed in Anseba
Keren Hospital 58 followed by Debub 51 and
Zoba GB48 had served the highest number of
patients in 2010 (table II.3.5.). .
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b. The number of people per bed
The annual number of patients per bed in
hospitals at National level is presented in
Figure II.3.5
The average number of people served per bed
at national level (Hospital+MCH+ HC) in
2012 was 1006 which is almost the same with
last two previous years, 1014 1007
respectively. If only hospital beds are
considered, it was 1:1435 greater by 29
compared with 2011. The trend indicates that
more and more people are sharing a bed
because of the constant number of patient
beds over the years and population growth
(Figure II.3.6). On the other hand, the number
of patients served per hospital or health centre
beds is very low this may indicate that there
was no problem getting hospital bed.
However, it may also mean that people are
not using the available beds especially at
zoba level for different reasons. It is
therefore important to assess why the beds
are not optimally utilized at zoba level. Even though further population adjustment is
needed, a patient bed in all zobas except Zoba
DKB is above the National average (Figure
II.3.7). One of the main contributing factors
for increasing people per bed in zoba Maakel
in 2012 could be Halibet hospital beds are
calculated with national referral hospitals.
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c. Bed Occupancy Rate (BOR)
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The BOR refers to the standard measure of in- patient bed utilization at hospital by
dividing the number of patient days by 365 without considering the lost days between each patient
which was about 5.1 less than 2011 by 1.7 days in average. It indicates the percentage of time the
bed is actually occupied in specific period of time. The total length of stay of patients and total bed
days are used to calculate BOR. The optimal bed occupancy rate is 85% and above. The lost days
are not considered in calculating the BOR.
The average BOR at national level in 2012 was 47.6% same with last year. From the Natioanl
referral hospitals Orotta medical surgical, Orotta MCH and Berhane Aynee had the highest BOR
(101.4, 83.% and 69% respectively).The number of IPD beds in Orotta medical surgical and Berhan
aynee have reduced this year due to the reconstruction of inpatient wards and it could one reason
for high BOR. Other hospitals that were having greater than 40% BOR were:
• Keren Hospital 62.8%,
• Semebel Hospital 54.9.5%,
• Agordat Hospital 46.4%
• Adi-quala 45.4%
• Afabet Hospital 42.3%
The BOR of St. Mary hospital was 52.1% this doesn’t indicate that many patients used the beds for the year only 924 952 patients get bed services which is almost the same compared with 2011.
As indicated in figure II.3.8a the trend of BOR of St. Mary is declining starting 2008; this may be
due to the burden of mental illness diseases is carried out by the family or the number of admitted
cases is decreased. However, it needs further studies in order to know the root cause of declining.
More than 100% BOR indicates either more than one patient shared a bed or patients stay in the bed
for more than a year.
The trend of BOR in National, Zonal hospitals referral and Health centers/ MCH is as indicated in
figure II.3.8. Health Centers/ MCH BOR have shown significant increase this year that indicates
bed utilization is improving that have to be sustained.
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d. Bed Turn over Interval (TI)
The average bed turnover interval (TI) (the time between discharge and another admission) at
national level in 2011 was 5.7 that improved by 1.1 compared with 2011 (6.8 days). According to
the reported information, the time spent between discharging a patient and admitting another on the
same bed was the lowest in Orotta Medical Surgical, Orotta Maternity NR hospital, Keren and
Agordat Hospital that accounted for 0, 0.3,2.2 and 3.3 days respectively. Refer Table II.3.5. for
other hospitals BTI and other hospital performances. The high TI for most of the hospitals could be
attributed due to the admission of chronic TB and malnutrition patients. The patients were admitted
until they finished their treatment
.
Definition of same important indicators in calculating performances Average Length Stay (ALS) = The average number of days that inpatients (exclusive of newborn) remained in the hospital
Table II.3.4 Number and Percent of Patient beds by Zoba in 2012
Zoba Ho HC MCH Total (%)
Anseba 215 251 0 466 11.9
Debub 529 314 0 843 21.4
DKB 136 0 0 136 3.5
Gash Barka 400 271 0 671 17.1
Maakel 247 145 0 292 10.0
NRH 842 0 0 842 21.4
SKB 388 160 34 582 11.9
Total 2757 1141 34 3932 100.0
% of total by
type in 2012 70.1 29.0 0.9 100.0
% of total by
type in 2011 68.9 30.3 0.9 100
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Bed Occupancy Rate (BOR) = The percentage of inpatient beds occupied over a given period. Bed Turn Interval (BTI) = Average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next.
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Table II.3..5. Denominators Used in Computing Performances
or Situations by Zone in Year 2012
Beds
Expected inpatients
patients discharged
IPD per bed TLS ALS BTI
Actual bed days BOR
Keren Hospital 215 20645 12965 60 49282 3.8 2.3 78475 62.8
Total HC 251 27017 7508 30 25460 3.4 8.8 91615 27.8
TOTOAL zoba 466 46590 20473 44 74742 3.7 4.7 170090 43.9
MENDEFERA. HOSP 200 17211 6258 31 26543 4.2 7.4 73000 36.4
ADI-KEIH 120 8670 3047 25 15393 5.1 9.3 43800 35.1
ADI-QUALA 62 6987 3175 51 10284 3.2 3.9 22630 45.4
DEKEMHARE 80 12316 3658 46 8673 2.4 5.6 29200 29.7
SENAFE 67 5697 1266 19 5434 4.3 15.0 24455 22.2
TOTAL Hospital 529 50665 17404 33 66327 3.8 7.3 193085 34.4
Total HC 314 34228 11508 37 38534 3.3 6.6 114610 33.6
TOTAL zoba 843 84837 28912 34 104861 3.6 7.0 307695 34.1
ASSAB . HOSP 83 4227 1007 12 7218 7.2 22.9 30295 23.8
EDI 25 1804 510 20 2579 5.1 12.8 9125 28.3
TIO 28 1803 673 24 3815 5.7 9.5 10220 37.3
Total Zoba 136 7986 2190 16 13612 6.2 16.5 49640 27.4
BARENTU HOSP 175 8121 3077 18 24202 7.9 12.9 63875 37.9
AGORDAT 90 11434 5303 59 15236 2.9 3.3 32850 46.4
TESSENEY 135 13204 5073 38 18932 3.7 6.0 49275 38.4
TOTAL Hospital 400 33650 13453 34 58370 4.3 6.5 146000 40.0
Total HC 271 33854 5307 20 15506 2.9 15.7 98915 15.7
TOTOAL zoba 671 62193 18760 28 73876 3.9 9.1 244915 30.2
DENDEN HOSPITAL 40 1225 227 6 2705 11.9 52.4 14600 18.5
HALIBET 110 6655 2599 24 15680 6.0 9.4 40150 39.1
HAZHAZ HOSP 97 7714 4232 44 19423 4.6 3.8 35405 54.9
SEMBEL HOSP 247 16830 7058 29 37808 5.4 7.4 90155 41.9
TOTAL Hospital 145 17414 1960 14 5957 3.0 24.0 52925 11.3
Total HC 392 29482 9018 23 43765 4.9 11.0 143080 30.6
TOTOAL zoba 78 3305 2288 29 19707 8.6 3.8 28470 69.2
BERHAN AYNE 30 41 14 0 3742 267.3 514.9 10950 34.2
HANSENIAN 95 24639 20550 216 28921 1.4 0.3 34675 83.4
OROTTA OBS_GYN 215 14616 9205 43 49423 5.4 3.2 78475 63.0
OROTTA PEDIATRIC 95 3306 3351 35 35150 10.5 -0.1 34675 101.4
OROTTA Med.Surgical 180 8159 4955 28 39900 8.1 5.2 65700 60.7
ST. MARY 149 1775 924 6 28316 30.6 28.2 54385 52.1
TOTAL Hospital 842 61848 41287 49 205159 5.0 2.5 307330 66.8
GHINDAE REG. REF. 100 8272 2617 26 11548 4.4 9.5 36500 31.6
AFABET 56 4398 1861 33 8650 4.6 6.3 20440 42.3
MASSAWA 150 8482 1637 11 10566 6.5 27.0 54750 19.3
NAKFA 82 6717 1128 14 5026 4.5 22.1 29930 16.8
TOTAL Hospital 388 28660 7243 19 35790 4.9 14.6 141620 25.3
Total HC /MC 194 2705 5011 26 131161 26.2 -12.0 70810 185.2
TOTOAL zoba 582 15592 12254 21 166951 13.6 3.7 212430 78.6
National Hospital
2757 219237 101600 37
466,348 4.6 5.3
1006305 46.3
National HC /MCH
1175 61958 31294 27
216,618 6.9 6.8 428875 50.5
Grand Total
3932 279263
132,894 34
682,966 5.1 5.7
1435180 47.6
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II.4. Selected Health System output indicators
In addition to the availability of health
professionals in different type of health
facilities, availability of health system output
indicators are very crucial in health services
delivery. Some of health systems out indicators
included in this annual report availability of
ambulance, water and power supply which are
very important logistic components in the
medical service department. In 2012, data was
collected from 287 health facilities as illustrated
in table II.4.1.1
From the assessed health facilities (287) 88.4 %
have different type of functional power supply,
46.7% have pipe water 62.7% compound fence.
Functional ambulances are calculated from 110
health facilities and 84.5% have functional
ambulances mainly hospitals, health centers and
some health stations owned by the Eritrean
Catholic Church Secretariat.
For more clarification refer the different tables
presented below
Table II.2.4. Type of health facility by Type of power and zoban
23 5 28
8.0% 1.7% 9.8%
28 20 4 1 53
9.8% 7.0% 1.4% .3% 18.5%
5 1 1 7
1.7% .3% .3% 2.4%
78 88 9 14 189
27.2% 30.7% 3.1% 4.9% 65.9%
8 1 1 10
2.8% .3% .3% 3.5%
142 110 19 16 287
49.5% 38.3% 6.6% 5.6% 100.0%
Hospital
Health Center
MCH
Health Station
Clinic
Type of
health
facility
% from Total
Eletric Solar
Eletric and
Solar None
Type of power
Total
Table II.4.1.1 Distribution of selected resources by zoba
Output
indicators AN DE DK GB MA NR SK
Total %
Function Ambulance
22 28 6 18 7 7 18 106
86.2
Pipe water 35 37 3 28 8 4 12 130 47.7
Power supply
21 37 8 53 13 8 21 161 56.3
Source: data collected from Zonal office, 2012
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Table II.4.3.Type of health facility by Funtional Ambulance
26 2 28
92.9% 7.1% 100.0%
42 11 53
79.2% 20.8% 100.0%
3 4 7
42.9% 57.1% 100.0%
21 21
100.0% 100.0%
1 1
100.0% 100.0%
93 17 110
84.5% 15.5% 100.0%
Hospital
Health Center
MCH
Health Station
Clinic
Total
yes no
Funtional Ambulance
Total
Table II.4.4 Type of health facility by Type of Water supply
21 5 1 1 28
75.0% 17.9% 3.6% 3.6% 100.0%
36 3 4 5 5 53
67.9% 5.7% 7.5% 9.4% 9.4% 100.0%
6 1 7
85.7% 14.3% 100.0%
63 26 10 90 189
33.3% 13.8% 5.3% 47.6% 100.0%
8 2 10
80.0% 20.0% 100.0%
134 29 19 98 7 287
46.7% 10.1% 6.6% 34.1% 2.4% 100.0%
Hospital
Health Center
MCH
Health Station
Clinic
Total
pipe sisterna track other
Sisterna
and pipe
Type of Water supply
Total
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Table II.4.5 Type of health facility by availability of * Compound Fence
27 1 28
96.4% 3.6% 100.0%
39 14 53
73.6% 26.4% 100.0%
6 1 7
85.7% 14.3% 100.0%
101 88 189
53.4% 46.6% 100.0%
7 3 10
70.0% 30.0% 100.0%
180 107 287
62.7% 37.3% 100.0%
Hospital
Health Center
MCH
Health Station
Clinic
Total
yes no
Compound Fence
Total
Table II.4.1.3 Distribution of selected resources by zoba
Output
indicators AN DE DK GB MA NR SK
Total %
Function Ambulance
22 28 6 18 7 7 18 106
86.2
Pipe water 35 37 3 28 8 4 12 130 47.7
Power supply
21 37 8 53 13 8 21 161 56.3
Source: data collected from Zonal office, 2012
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Part III. Facility Based Health Service
Activities
III. Maternal and Child
Health
Despite the fact that maternal and child
health has been declared a priority health
issue by the Ministry of Health, the rates of
maternal and child mortality is still high
although infant and child mortality shows
significant decrease according to the 2002
EDHS and different studies afterwards.
To address the Maternal and Child health
problems, the Ministry in collaboration with
its stakeholders and partners has been
implementing different interventions. Some
of these interventions are|:
• Expansion of the health facilities to the
rural areas;
• Training of skilled health personnel and
deploying them to all levels of health care
services;
• Ensuring availability of essential drugs
and supplies;
• Strengthening the blood transfusion
services;
• Expanding the capacity of emergency
surgery to save pregnant women,
• Developing policies and guidelines;
• Developing communication strategies in
health promotion to increase awareness
and bring behavioural changes and
empowering the communities;
• Establishing maternity waiting homes to
increase accessibility;
• Implementing IMNCI and therapeutic
feeding strategies;
• Expanding VCT and PMTCT centres
• Further strengthening the malaria control
program to elimination level;
• Strengthening the disease surveillance
program and
• Expanding the immunization programs
etc can be mentioned as some of the
successful interventions undergoing to
improve the health of the mother and the
child.
As a result of combined efforts of the
Ministry and its partners and stakeholders,
significant improvements are achieved in
increasing the number of antenatal
attendants, attended deliveries by health
workers, immunized children and women,
and reducing infant and child mortality rates
as indicated in the EDHS, 2002, the routine
information system and different studies.
According to UNICEF, the infant mortality
rate is reduced from 88/1000 in 1990 to 46 in
2007, under five mortality from 147/1000 in
1990 to 70 in 2007, Maternal Mortality from
1400/100000 in 1990 to 450 in 2005.
III.1. Antenatal care Service
The healthy future of a society depends on
the health of the children of today and their
mothers. Antenatal care services are provided
to enhance the health of the mother and the
child through early identification of risk
factors associated with pregnancy, and
providing necessary and timely interventions.
The number of pregnant women registered
for antenatal services, number of total visits
during pregnancy, trimester of first
registration and risk factors identified,
referred antenatal women, provision of Iron
folic for pregnant women, tetanus toxoid
coverage of pregnant women are some of the
important indicators for monitoring and
evaluating the quality of antenatal care
services.
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The target population for antenatal service is
estimated to be 4 % of the total population
based on the 2002 EDHS findings of low
birth rate and under one year age children
immunized for BCG.
Number of Health Facilities providing
ANC Services
All health facilities except the specialized
referral hospitals, health centers and clinics
are supposed to provide antenatal care
services. In 2012, out of the total health
facilities (340) 253 (74.4%) provided ANC
services to pregnant women, which is less
than by about 4% change comparing with
previous year. One of the reasons is the
counting of standalone VCT centres to the
total number of health facilities this year.
Excluding the 57 industry and other clinics,
about 90% of health facilities (hospitals, HC,
MCH clinics and HS) were providing ANC
services in 2012(Table III.1.1.). The total
number of health facilities that provide ANC
service by type of health facility and zoba is
presented in Table III.1.1. and the trend in
Figure III.1.1.
Antenatal service coverage
The target number of pregnant women for
antenatal care service in 2012 was estimated
as 158,298 pregnant women.
Table III.1.1. Number of Health facilities Provided ANC
Service in 2012 by Zoba and Type of HF
AN DE
DK
B GB MA
SK
B
Tota
l
Ho 0 4 3 0 1 3 11
HC 9 10 0 13 7 10 49
HS 27 46 12 50 23 24 182
MCH 1 2 0 3 0 1 6
CL 0 0 0 2 1 1 4
Total 37 62 15 68 32 39 253
% of
total
14.6
2
24.
51
5.9
3
26.8
8
12.
65
15.
42
100.
00
From the estimated target population 85,400
(53.9) had at least one ANC visit in 2012
which was less by about 8% change
compared to 2011. Each health facility
provided ANC service to about 373 pregnant
women although the target was 618 women
per health facility (Figure III.1.3). Taking the
denominator of the NHMIS population, the
coverage of ANC is showing an increasing
trend starting 2000 except in 2009 & 2012 as
indicated below.
Annual trends of ANC coverage (at least
one visit) 1998-2012
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The lowest ANC coverage among the Zobas
was observed in SKB (36.5%) and the
highest was recorded in GB (82.9%) slightly
greater than last year (Figure III.I.4.)
However, the coverage of ANC has to be
considered carefully because of the
underestimation or overestimation of the
target population in general. The antenatal
service coverage in GB has been the highest
since 1998 that could be attributed to the
high number of public health facilities that
provide ANC services and the
underestimation of the target population
(Figure III.1.4).
Concerning where the pregnant women got
the ANC service, above 40% were seen in
health station and between 30% and 32.8% in
Health Center and the rest in other type of
health facilities. The trend indicates that the
contribution of the different type of health
facilities remained almost the same compared
with previous year (Figure III.1.2).
Number of Visits and Trimester at First
ANC Visit
The minimum number of antenatal visit that
a mother should make during her pregnancy
is four, although about 12 visits or more is
recommended. It is also recommended that
pregnant women should be registered for
antenatal care in early trimester. The earlier
the first visit is, and the frequent the visits
are, the better the outcome of the pregnancy
is, because of timely detection of risk factors
and timely interventions. Among the first
antenatal attendees in 2012, 21.2 women
registered for ANC service in their first
trimester, 60.2% in the second trimester, and
18.7% in the third trimester. Although the
number of new registrants (first ANC visits,
(85,400) of pregnant women in 2012
decreased by 8% compared to 2011, the
proportion of trimesters remains almost the
same comparing with 2011, which is a good
Zones
Table III.1.2 Number and
Percent of ANC Service Coverage
by Zoba and Year (2007-2012)
2008 2009 2010 2011 2012
D
K
B
N 1611 1808 2494 2151 2056
% 48.7 53.1 71.3 59.5 55.6
S
K
B
N
911
6
787
4
881
2
101
11
933
0
% 39.8 33.4 36.4 40.2 36.5
A
N
N
1303
7
1153
3
1430
9
1446
4
1299
7
% 57.2 49.2 59.4 58.4 51
G
B
N
2478
3
2369
4
2587
1
2905
4
2607
5
% 88 81.8 86.9 95.0 82.9
D
E
N
2260
7
1951
2
2114
0
2219
6
1977
2
% 60 50.4 53.1 54.2 47
M
A
N
1403
3
1328
4
1442
1
1505
0
1519
0
% 52.2 48.1 50.8 51.5 50.6
T
ot
al
N
8547
1
7770
5
8704
7
92,9
26
8540
0
% 60.3 53.3 58.1 60.3 53.9
Key: DKB= Debubawi Keyh Bahri, SKB =
Semenawi Keyh Bahri , AN = Anseba, GB=
Gash Barka, DE= Debub, MA= Maakel
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Health Management Information System, Department of NHIS, MoH Annual Health Service Activity Report of 2012
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sign to detect risk factors and take timely
interventions. The number of women who
registered for ANC service in the second
trimester has been always the highest while
those who registered in first and last
trimesters is lower that needs intervention in
terms of getting pregnant women to come for
ANC care in their first trimester (Table
III.1.3)
The percentage of drop out in 2011 was
61.2% which greater than previous by about
40%. This could be attributed to the
calculation taken this year only total number
fourth visit was taken, while formerly fourth
and more was taken as the numerator. In
addition to that it could be attributed to late
registration for ANC as indicated by
increased trend of second and third trimester
registration for ANC, long distance to walk
to health facilities during late pregnancy,
transportation problems and others (Table
III.1.3 and Figure III.1.8). The drop out rate
shows the percent of registered pregnant
women who failed to have at least three
repeat ANC visits.
The drop out rate in zoba ranges from 49.6%
in Zoba Maakel to 67.9 in Zoba SKB in
2011. As earlier stated, this year in
calculating drop out rate, the numerator was
taken Fourth Visits because the
Reproductive health program has modified
the data collection formats. The above
mentioned problems like long distance to
walk to health facility, changing to another
health facility without informing the
concerned health facility and shortage of
transportation facilities are some of the
contributing factors to high dropout rate that
needs solution to reduce the dropout rate as
indicated in Figure III.1.9.
Zones
Table III.1.1.3. Yearly Trends of
the Number of visits and ANC
service coverage (%) (2009-2012)
2009 2010 2011 2012
First visit
77,705
87,04
7
92,926
85400
Repeat
Visits
155,65
3
1695,
39
176,12
3
163857
Coverage
rate (%
53.3
58.1
60.3
53.9
Dropout
rate (%)
29.7
43.1
61.2
62.9
Percent of pregnant women
registered for ANC at different
trimester (2009-2012)
First
20.4
20.4
20.9
21.2
Second
58.7
61.3
60.6
60.2
Third
21
18.3
19.0
18.7
ANC
Target
populatio
n by DSS
14571
2
15037
6
15398
6
158298
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48
III. 2. Delivery Services
2.1. Health facilities providing
delivery services
In 2012, from a total of 340 health facilities
(Hospital, HC, HS MCH and other clinics) in the
country only 66.2% of all health facilities were
providing delivery services. Out of the total health
facilities that provided delivery services, 69.8%
and 20.4% were health stations and health centers
respectively; whereas the rest 7.6% and 2.2% were
hospitals and MCH & other clinics respectively.
Thus, out of the total hospitals (28) only 17
(60.7%, are currently providing delivery services.
Moreover, 82.1% of all health centers and 83.5%
of the total health stations have been providing
delivery services. Majority of industrial health
facilities, VCT and specialized clinics which are
included in the total number of health facilities are
not supposed to provide the delivery services
leading to low percentage of assisted deliveries.
Thus, at present only 28.6% and 4.9% of the total
MCH and private or industrial clinics are giving
delivery services respectively. Usually, the health
stations in cities or towns where there is hospital
are not providing the service. Overall the number
of health facilities providing delivery service has
increased from 210 in 2007 to 225 in 2012 which
is a change of 7.1%. See Table III.2.1 and figure
III.2.1.
Figure III.2.1. Number of Health Facilities
that provide delivery services by type and
year (2008 - 2012)
0
50
100
150
200
250
2008 2009 2010 2011 2012Year
Number
Hos HC HS MC/other Total
Table III.2.2 illustrates the number and percent of
deliveries attended by type of health facilities. Out
of the total 38,190 deliveries attended in all health
facilities by health workers in 2012, 60.4% were
carried out in hospitals, 18.1 % in health centers,
18.7% in health stations and 2.8% in MCH and
other clinics.
Table III.2.1 Number of Health Facilities that
Provide Delivery Services by Type of Health facility
and Year
(2007 -2012)
Type of HF 2007 2008 2009 2010 2011 2012
HO 15 17 17 17 18 17
HC 43 43 45 44 44 46
HS 145 152 152 152 154 157
MCH/clinics 7 5 6 5 5 5
Total No of HF 210 217 220 218 221 225
% to
total HF 56.1 58. 5 59. 6 65. 4 69. 1 66.2
N.B. Total health facilities included private and VCT
clinics, specialized and industrial health facilities.
(HO=hospital, HC= health center, HS=Health station,
MCH= Maternal and child health care, CL= Clinic
Table III.2.2 Number and % of deliveries
attended by type of health facilities (2007-2012) Type of HF 2007 2008 2009 2010 2011 2012
HO
No. 19362 19801 19624 21665 22882 23066
% 69 67. 4 66. 9 65. 4
60. 7 60. 4
HC
No. 4229 4534 4689 5300 6813 6909
% 15.1 15. 4 15. 9 16 18. 1 18. 1
HS
No. 3294 3916 4034 5042 6890 7142
% 11. 7 13. 3 13. 7 15. 2 18. 3 18. 7
MCH
&
other
clinics
No. 1177 1131 1000 1115 1084 1073
% 4. 2 3. 8 3. 4 3. 4 2. 9 2. 8
Total
Deliveries 28062 29382 29347 33122 37669 38190
Coverage
rate (%) 27. 1 27. 6 26. 7 29. 5 32. 6 32. 2 N.B. Total health facilities included private and VCT
clinics, specialized and industrial health facilities.
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
49
2.2. Delivery Service Coverage Delivery service coverage is defined as the
proportion of the total assisted deliveries to the
expected number/target of deliveries. According to
NHMIS manual guide line, the target population
for delivery service is 3% of the total population
which is used as denominator for calculating the
delivery coverage rate. Comparing the assisted
deliveries to the yearly targets in 2012, it is almost
one third of the target that deliver in health
facilities and about two third of women deliver
outside the health facility as indicated in figure
III. 2.2.
Figure III.2.2. Number of Assisted Deliveries
Compared to Yearly Targets (2007 - 2012)
0
20000
40000
60000
80000
100000
120000
140000
2007 2008 2009 2010 2011 2012Year
Number
Assisted Expected
Thus, the national coverage rate of assisted
delivery which is greatly affected by the
denominator is 32.2% in 2012 showing an increase
of 5.1% as compared to 2007 but decreased by
0.4% compared to 2011. See figure III.2.3 and
Table III. 2.3
Figure III.2.3. Annual Trend of Delivery Coverage Rate
(1998-2012)
As Table III 2.3 and Figure III.2.4 shows, the
yearly trends of delivery coverage have an
increasing tendency in all zobas except in zoba
MA which is reduced by 4.3%, as compared to
2007. Additionally, the coverage rate of 2012 in
the Zobas (Figure III.2.5) ranged from 8.5% in
MA to 35% in AN in which all zobas have either
slightly reduction or remain the same coverage as
compared to 2011.
Figure III.2. 4. Trend of Delivery Service
Coverage By Zoba (2008-2012)
0
10
20
30
40
DK
SK
AN
GB
DE
MA
Zoba
Percent
2007 2008 2009 2010 2011 2012
In 2012, Orotta Maternity National Referral
Hospital attended 24.1% of all deliveries in the
Table III. 2.3 Yearly Trends of Delivery
Service Coverage (Number and Percent) by
Zoba (2007-2012)
Zoba 2007 2008 2009 2010 2011 2012
DKB 614 671 689 945 831 785
% 25. 4 27 27 36 30. 8 28. 3
SKB 2773 3472 3352 3713 4164 4251
% 16.6 20.2 19 20. 5 22. 3 22. 2
AN 3128 3523 3951 4890 7024 6679
% 18.8 20.6 22.5 27. 1 37. 8 35
GB 4047 4173 4398 4854 6346 6615
% 19.7 19.8 20.3 21. 7 27. 7 28
DE 6692 7562 6990 7795 8607 8737
% 24.3 26.8 24.1 26. 1 28. 0 27. 7
Ma 2512 2208 1530 1709 2036 1913
% 12.8 11 7.4 8 9. 3 8. 5
NRH 8296 7773 8437 9216 8661 9210
Total 28062 29832 29347 33122 37669 38190
Total 27. 1 27. 6 26. 9 29. 5 32. 6 32. 2
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
50
country. Not only this but also 39.9% of all
hospital deliveries were attended in this Referral
Hospital followed by Keren Hospital with 8.8%.
See Table III.2.5. In average, a hospital attended
1357 deliveries, a health center 150, a health
station 45, and an MCH and other clinics 215
deliveries in 2012. In hospitals, the number of
deliveries attended ranged from 33 in Edi Mini
hospital to 9210 in Orotta Maternity NRH as
indicated in Table III.2.5.
35
27.7 28.3 28
8.5
22.2
0
5
10
15
20
25
30
35
Percent
AN
DE
DK
GB
MA
SK
Zoba
Figure III. 2. 5. Delivery Service
Coverage (%) in 2012 by Zoba
The proportion of deliveries of 2012 that were
conducted by hospitals has slightly decreased;
whereas in health station and health center, it
remains almost the same compared to 2011.
Moreover, in MCH and other clinics, it has slightly
declined as revealed in Figure III.2.6 and Table
III.2.2.
010203040506070
%
2007 2009 2011Year
Figure III.2.6. Proportion of Deliveries
attended by Health Worker by Type of Health
Facility and Year (2007 - 2012)
HO MC/OTHER HC HS
The proportion of skilled attended deliveries of
2012 is increased by 3% and 7% in health centers
and health stations correspondingly compared to
2007; whereas in hospitals and MCH clinics it is
reduced by 8.4% and 1.4% respectively as
indicated in Figure III.2.6 and Table III.2.2
which may be co-related to the increased
proportion of health centers and health stations.
This may indicate that the capacity of health
centers and health stations are improving, which is
one of the goals of MOH. In order to maintain this
status, these facilities have to be further
strengthened in necessary skill and resources.
83.5% (157) of the total (188) health stations
assisted 7142 deliveries ranging from 1 to 327 in
2012. As shown in Table III.2.6, majority 49.7%
(78) and only 10.2% of the total health stations that
provide delivery services attended 10-50 and 100–
327 deliveries respectively in 2012.
Table III.2.5. Total Number of Deliveries attended
in each hospital in 2012 Zoba Facility name No. of attended
deliveries
% to
total
NR Maternity NR HO 9210 39. 9
AN Keren HO 2022 8. 8
DE Mendefera HO 1967 8. 5
MA Sembel HO 1337 5. 8
GB Barentu HO 1207 5. 2
DE Dekemhare HO 1147 5. 0
GB Tesseney HO 1006 4. 4
DE Adi-Keih HO 873 3. 8
SK Ghindae HO 819 3. 6
SK Afabet HO 775 3. 4
DE Adi-Quala MH 798 3. 5
GB Agordat HO 732 3. 2
DE Senafe MH 444 1. 9
SK Nakfa HO 308 1. 3
DK Asseb HO 281 1. 2
DK Tio MH 79 0. 3
AN Edi MH 33 0. 1
Total 23066 100
Table III.2.6.The range of attended deliveries in
health stations (HS) in 2012(N =157)
Range of
deliveries
No. of HS that provide
deliveries
% to total
of HS
1-9 33 21. 0
10-50 78 49. 7
51-99 30 19. 1
100-327 16 10. 2
Total 157 100. 0
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
51
Similarly, 82.1% (46) of the total (56) health
centers assisted 6909 deliveries ranging from 1 to
503 in 2012. As shown in Table III.2.7, majority
56.5% (26) and only 17.4% of the total health
centers that provide delivery services attended 100-
199 and 200–503 deliveries respectively in 2012.
According to the health facility assessment result
of 2007 conducted by HMIS, the average distance
between a health station and health center is about
50 km and between a health center and a hospital is
about 62 km.
A pregnant woman, who lives in health station
catchments area, travels for about 100 km in
average to get hospital delivery service. This could
be very difficult to most women and availability of
maternity waiting homes could be the best solution
to this problem. To increase the delivery service
coverage, constructing maternity waiting homes
and strengthening the capacity of health stations
and health centers could be solutions that are
with in 5 to 15 km distance from most villages
compared to hospitals. Not only that, but also
majority of the deliveries attended in hospitals
were normal deliveries that can be managed in
health center and health stations provided that
required facilities to manage the delivery and refer
complicated cases are made available.
In an attempt to improve care during home
deliveries and reduce maternal mortality,
traditional birth attendants (TBA) have been
trained to identify risk factors and refer the women
in labour to health facilities. Presence of a
professional attendant at each birth can lead to a
marked reduction in maternal mortality and
morbidity.
Professional health care during childbirth is one of
the process indicators to assess progress towards
the improvement of maternal health. The Ministry
has been working to increase accessibility of
delivery services to the community by increasing
the number of health facilities, training and
assigning Nurse Midwives and other health
workers.
Furthermore, establishing waiting homes with
community participation for women at term to
support assisted deliveries helps to increase access
and reduce maternal and neonatal death.
In addition to this, health workers who were
received training on Life Saving Skill related to
emergency obstetric care deployed to different
health facilities. Most of the health facilities are
also equipped with emergency obstetric care
facilities. Some physicians were also trained on
Emergency Obstetric surgery.
However, Anseba has a significant increase of
16.2% followed by GB and SK with the increment
of 8.3% and 5.6% respectively as compared to the
year 2007, that could be attributed to the
construction of maternity waiting homes that
empowered the pregnant women to stay near the
health facility until they give birth.
Table III.2.7. The range of attended deliveries
in health centers (HC) in 2012 (N = 46)
Range of
deliveries
No. of HC that
provided
deliveries
% to total of
HC
1-50 6 13. 0
51-99 6 13. 0
100-199 26 56. 5
200-503 8 17. 4
Total 46 100. 0
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
52
So far a total of 38 maternity waiting homes were
constructed in all Zobas as shown in Table III.2.4.
Out of the total constructed maternity waiting
homes, 31.6%, 26.3%, and 18.4% were established
in Anseba, DK and GB respectively; whereas the
remaining constructed maternity waiting homes
were 13.2% in Debub and 10.5% in SK. Thus, the
construction of maternity waiting homes in the
zobas has great contribution to increase the
delivery services coverage resulting to reduce
maternal and newborn deaths. Moreover, the
construction of more maternity waiting homes near
health facilities with problem in transportation and
further strengthening the capacity of health centers
and health stations to provide delivery services
could be feasible solutions to increase the skilled
delivery coverage. In DKB for example, women
have to travel for at least 60 K.M to get a health
facility since they leave scattered over a large area.
With increased number of health workers trained
in life saving skill and increased number of health
facilities, the number of attended deliveries should
be significantly increased. However, the delivery
service coverage still remained very low indicating
that there are other factors confounded to the low
delivery service coverage that needs assessment
and interventions. Some of the reasons could be
over estimated target population or decreased
fertility rate.
2.2.1. Outcome of the attended deliveries Looking at the deliveries attended by health
professionals Table III.2.9, in the last four years
(from 2008 to 2011) more than 87% were normal
deliveries. From the total assisted deliveries
(38190) in 2012, only 9.9% were abnormal, in
which out of the total abnormal deliveries 69.2%
were delivered by cesarean section (C/S) increased
by 1.3%) compared to 2011..
According to Table III.2.10, National Referral
hospital covered the highest percentage (24.1%) of
all normal and abnormal deliveries followed by DE
(22.9%), Anseba (17.5%) and GB (17.3%). Not
only this but also 86% of all abnormal deliveries
attended in NRH were C/S; whereas the remaining
14% were other abnormal method of deliveries
such as breech, vacuum etc.. Furthermore, out of
the total number of abnormal assisted deliveries in
MA, 88% were C/S. However, in the rest of the
zobas, roughly 50% of the abnormal deliveries
were C/S.
2.2.2. Cesarean Section (C/S) The main reason for performing C/S was other
causes of C/S 47.9% and obstructed labor due to
cephalo-pelvic disproportion (CPD) 33.3% as
indicated in Table III.2.11 and Figure III.2.7. Out
of the 17 hospitals that provide delivery services,
76.5% perform C/S in 2012, increased by 4.3% as
Table III.2.8. Number & percent of Maternity
Waiting Homes Established by zoba and Site Zoba Site Total % to
total
AN Habero, Kerkebet, Sela, Geleb,
Kermed, Asmat, , Hadish-Adi,
Melebso, Himbol Hashishay,
Habero-Tsada, Jengeren
12
31. 6 DE Areza, Adi-Quala, Dbarwa
Mai-Mine, Kudo-Buoer,
5
13. 2 DK Abo, Wade, Egroli, Tio,
Afambo, Beylul, Aytus,
Ayumen, Rahayta, Belebuy
10
26. 3 GB Dighe, Molki, Mogolo,
Gogne, Endagaber,
Derabush, Mogorib
7
18.4 SK Buya, Foro, Ghelaelo,
Kamchewa
4
10.5
Total 38 100
Table III.2.9. Number of Deliveries Attended by
Health Workers at National Level and maternal
deaths at facility (2007-2012) Year 2008 2009 2010 2011 2012
Total No. 29832 29347 33122 37669 38190
Normal 26146 26390 29815 33940 34424
Abnormal 3177 3035 3307 3729 3766
% normal 87. 6 89. 9 90 90. 1 90. 1
Total MD* 63 67 74 61 68
Facility based
MMR /100,000 219. 8 236. 5
238. 6 164. 2 185.6
N.B. all the normal deliveries are attended by nurse,
mid-wives and associate nurses, MD* = Maternal
Deaths
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
53
compared to 2011 which was 72.2%. The hospitals
that do not perform C/S are: Nakfa hospital, and
Tio, Edi, Adi-Quala, and Senafe mini hospitals.
In 2012, the number of C/S performed in most
hospitals listed in Table III.2.12 have slightly
decreased or remain the same as in 2011 whereas
in Orotta Maternity Referral hospital, C/S has
increased by 7.3% as compared to 2011. Hence
45.2% of all the C/S performed in hospitals was
done by Orotta Maternity Referral hospital.
05101520253035404550
CPD
Distress
PP/AP
Other
Rapture ut
Figure III.2.7. Proportion of causes
of C/S (2008 -2012)
2008 2009 2010 2011 2012
As Amatere MCH has no operating room, CS was
performed in Massawa HO and transferred to
Amatere MCH. Thus, mothers who had C/S in
Massawa hospital were reported by Amatere MCH
and not by Massawa hospital.
2.2.3. Maternal Death at Health facility
Attendances at antenatal clinics and receipt of
professional delivery care have been associated
with a reduction in maternal deaths. On the other
hand, home deliveries in the absence of skilled
professional attendants have been associated with
adverse infant and maternal outcome.
According to WHO “Maternal Death is defined
as the death of a pregnant woman or within 42
days of termination of pregnancy (delivery,
Table III.2.10. Method of Attended Deliveries and
Number and Percent of C/S by zoba in 2012
Zoba
Total attended Deliveries
Cesarean
Section
Norm
al
Abno
rmal
Total
num
ber
% to
total
Numb
er of
C/S
% to
abnor
mal
AN 6128 551 6679 17. 5 305 55. 4
DE 8171 566 8737 22. 9 331 58. 5
DK 740 45 785 2. 1 17 37. 8
GB 6068 547 6615 17. 3 258 47. 2
MA 1512 401 1913 5. 0 353 88. 0
NRH 7851 1359 9210 24. 1 1177 86. 6
SK 3954 297 4251 11. 1 164 55. 2
Total 34424 3766 38190 100 2605 69. 2
Table III. 2.11. Cause of C/S by year 2010-2011 Cause of C/S 2010 2011 2012
No. % No. % No. % CPD 697 32. 9 930 36. 7 867 33. 3 Fetal distress 302 14. 3 317 12. 5 310 12
Placenta previa 165 7. 8 156 6. 2 134 5. 3
Rapture uterus 48 1. 9 38 1. 5
CS- other 954 45. 0 1082 42. 7 1212 47. 9
Total 2118 100 2533 100 2518 100
Table III. 2. 12. Number and percent of C/S
performed in Hospitals by year (2010 – 2012) Name of
Ho
2010 2011 2012
No. % No. % No. %
Orotta
Maternity
1087 51. 3
959 37. 9
1177 45. 2
Mendefera 219 10. 3 294 11. 6 233 8. 9
Sembel 267 12. 6 347 13. 7 353 13. 6
Keren 271 12. 8 404 15. 9 305 11. 7
Massawa* 70 3. 3 99 3. 9 87 3. 3
Barentu 78 3. 7 157 6. 2 197 7. 6
Adi-Keihi 57 2. 7 87 3. 4 67 2. 6
Ghindae 11 0. 5 28 1. 1 63 2. 4
Dekemhare 0 0. 0 24 0. 9 31 1. 2
Agordat 29 1. 4 42 1. 7 23 0. 9
Assab 22 1. 0 25 1. 0 17 0. 7
Tesseney 7 0. 3 63 2. 5 38 1. 5
Afabet 0 0. 0 4 0. 2 14 0. 5
Total 2118 100 2533 100 2605 100
NB-: The numbers of C/S performed in Massawa HO
were reported by Amatere MCH.
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
54
miscarriage or abortion), irrespective of the site or
duration of the pregnancy, from any cause related
to or aggravated by the pregnancy or its
management, but not from accidental or incidental
causes.” E.g. malaria,
Thus, Maternal and neonatal mortality is a key
indicator of a country's progress in improving
health. Maternal mortality ration is usually
expressed as the maternal deaths per 100,000 live
births. The maternal mortality ratio measures the
risk of dying that a woman faces each time as she
becomes pregnant. The 2002 study by Dr. Mismay
Gebrehiwet shows that population based maternal
mortality ratio in Eritrea was 752 per 100,000 live
births and lifetime risk for maternal mortality is 1
in 28.
In 2012, 68 facility based maternal deaths were
reported from all health facilities. Regarding the
place of death, out of the total maternal deaths
70.6% died in hospitals whereas the remaining
maternal deaths were reported by HC 16.2% & HS
11.8% as Table III.2.13 revealed.
As indicated in Figure III.2.8, the trend of facility
based MMR has been slightly fluctuating trend in
the previous years. Although the annual national
trend of MMR in 2012 (185.6/100,000) has a
decreasing tendency comparing to preceding years,
but it has increased as compared to 2011. Thus,
according to Figure III.2.8, generally the overall
facility based maternal mortality ratio has a
decreasing trend.
Except in zoba Anseba and DK, facility based
MMR has reduced in all zobas in 2012 compared
to 2011 as shown in Table III.2.14. According to
figure III.2.8 and Table III.2.14, DK reported the
highest MMR (788.4/100,000) followed by GB
(404.1/100,000) and Anseba (244.4). Zoba MA did
not report maternal mortality in 2012.
Out of the total facility based maternal deaths (68),
88.2% were reported by hospitals and health
centers whereas the rest 11.8% were reported by
health stations in 2012. The reporting system of
HMIS doesn’t allow health stations to specify the
Table III.2.13 Type of Health facilities that
reported maternal deaths excluding anemia in
pregnancy (2011) Type of facility No. of
HF
Total of
MD
% to total
death
HS 5 8 11. 8
HC 9 11 16. 2
HO 9 48 70. 6
MCH Other CL 1 1 1. 5
Total 24 68 100. 0
NB;- HF = Health Facility, HS = Health Station,
HC = Health Center and HO = Hospital, MD =
Maternal Death
Table III.2.14. Facility Based Number and Maternal
Mortality Ratio (MMR) per 100,000 live births by Zoba
(2008-2011) reported from all HO, HC and HS
Zoba
2009 2010 2011 2012 No Ratio No Ratio No Ratio No Ratio
AN 11 285.5 7 145. 8 13 187. 6 16 244. 4
DE 6 86.6 11 141. 6 9 105. 3 8 92. 5
DK 1 140.4 4 440. 0 3 375. 5 6 788. 4
GB 34* 845.8 36* 780. 7 29 470. 5 30 404. 1
MA 3 189.5 0 0.0 1 49. 6 0 0
NR 5 62.7 11 145. 0 4 46. 5 4 43. 9
SK 7 214.6 5* 136. 9 2 48. 9 4 96. 2
Total 67 236.5 74 238. 6 61 164. 2 68 185. 6
N.B. MD due to anemia was excluded from analysis.
*MD of GB in annual report of 2009 = 41 but in HMIS report = 34
*MD of GB in annual report of 2010 = 32 but in HMIS report = 36
*MD of SK in annual report of 2010 = 8 but in HMIS report = 5
Figure III. 2.8. Trend of Facility Based
Maternal Mortality Ratio by Year
0
50
100
150
200
250
300
350
4001998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Ratio
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
55
cause. Thus, a total of five health stations reported
eight maternal deaths without specifying the cause
of maternal death in which three facilities each
accounted two maternal deaths as shown in Table
III.2. 15. Out of the total eight health stations,
Anseba and GB each accounted 40% and the
remaining 20% were from Zoba DK. Table III.2.15. Health Stations that Reported Maternal
deaths in 2012
Zoba Name HF HF Type
No
of
MD
% to
total
AN Filfle HS 2 25
AN Habero Tsada HS 2 25 DK Afambo HS 1 12. 5 GB Gergef HS 2 25 GB Gernfit HS 1 12. 5 Total 8 100
Out of the total (60) maternal deaths that were
reported by hospitals, MCH and health centers,
73.3% of the maternal deaths were reported with
specific causes of death while the causes of the rest
26.7% of the total deaths were not specified as
table III.2.16 indicated.
However, according to HMIS manual guide line,
all hospitals, MCH and health centers were
supposed to report the specific cause of maternal
deaths using ICD Code 10.
Thus, the delivery report of HMIS reveals only the
number of maternal and neonatal deaths and not
the cause of the death. So the maternal and
neonatal deaths that were reported by hospitals,
MCH and health centers in the monthly delivery
report must be transferred to inpatient services
with appropriate ICD 10 code to identify the exact
cause of mortality in order to take action on time
which is not usually followed. All the hospitals and health centers that reported
without specifying the cause of maternal deaths
were from GB. Tesseney and Barentu hospitals
Mogolo, Guluj, Tokombia Shatera and Ghirmayka
health centers were among the health facilities that
reported the sixteen maternal deaths without
specifying the cause of death. Hence, the 26.7% of
the total maternal deaths that were reported by
hospitals, MCH and health centers in the delivery
services report were supposed to be transferred to
inpatient services with appropriate ICD 10 code to
identify the exact cause of mortality.
Out of the 16 maternal deaths that were reported
without specific causes, Tesseney hospital had
31.3% (5) and Barentu hospital 12.5% (2) in which
both hospitals were from GB. Even the rest five
health centers that reported without specific causes
of maternal deaths were from GB namely Forto
health center 12.5% (2), Mogolo health center
18.8% (3), and Guluj, Tokombia Shatera and
Ghirmayka health centers each reported 6.3% (1).
Moreover, Table III.2.16 shows the proportions of
maternal death that reported by each hospital, HC
and MCH clinic. The Zonal Referral hospitals
namely Keren 16.7%, Barentu 11.7%, Mendefera
10%, Assab 8.3% and National Referral hospital
Table III.2.16 Hospitals and Health Centers that reported
Maternal deaths excluding anemia in pregnancy (2012) Name HF Type
of HF
Cause of maternal
death Total
death %
to
total Specifi
c cause Cause
not
specific
Keren HO 10 0 10 16. 7
Barentu HO 5 2 7 11. 7
Tesseney HO 7 5 12 20. 0
Orotta
Maternity
HO 4 0 4
6. 7
Mendefera HO 6 0 6 10. 0
Assab HO 5 0 5 8. 3
Adi -Keih HO 2 0 2 3. 3
Nakfa HO 1 0 1 1. 7
Massawa HO 1 0 1 1. 7
Forto HC 0 2 2 3. 3
Habero HC 1 0 1 1. 7
Kerkebet HC 1 0 1 1. 7
Mogolo HC 0 3 3 5. 0
Guluj HC 0 1 1 1. 7
Tokombia HC 0 1 1 1. 7
Shatera HC 0 1 1 1. 7
Ghirmayka HC 0 1 1 1. 7
Amatere MCH 1 0 1 1. 7
Total 44 16 60 100
% 73. 3 26. 7
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
56
6.7% reported the highest proportion of maternal
deaths in 2012. Tesseney hospital and Mogolo
health center from GB reported 20% and 5%
respectively of all maternal deaths that were
reported by hospitals, health centers and MCH in
2012.
In 2012, four maternal deaths at home were
reported by TTBA of zoba MA as shown in Table
III.2.17. Not only this but also, the number of
deliveries attended by TTBA in 2012 was reduced
by 18.9% compared to 2011. TTBA in zoba
Anseba have not carried out since 2011. Moreover,
the numbers of deliveries attended by TTBA in all
zobas were decreased from time to time showing
an increase of the number of health facilities. Thus,
due to low skill and lack of available resources for
delivery, the policy of MOH encourages TTBAs’
to refer pregnant mothers to health facility rather
than to carry out delivery at home. Considering the
increased accessibility of health facilities to the
community and ability of health centers and health
stations to refer obstetric complications to hospitals
and the re-enforcement of maternal death audit, we
can comfortably say that more than two third of
the deaths are reported.
In January and May 2012, 11.8% of the total
maternal deaths were reported in each month;
while in March, August, October and November
10.3% of the total maternal deaths were reported in
each month. Comparing the zobas, GB has 44.1%
out of the total maternal deaths followed by
Anseba (23.5%) and Debub 11.8%. See Table
III.2.18.
Table III.2.17. Number of Deliveries attended and
number of maternal deaths reported by TTBA by
Zoba and Year (2010 - 2012)
Zoba Deliveries attended
Reported Maternal
deaths
2010 2011 2012 2010 2011 2012
AN 53 0 0 0 0 0
DE 979 484 596 0 0 0
DK 155 175 107 1 0 0
GB 2358 1961 1522 2 4 0
MA 857 956 672 0 0 4
SK 409 399 354 1 0 0
Total 4811 3975 3224 4 4 4
Table III.2.18 Reported Number of Maternal Deaths from HO, HC and HS by Month
and Zoba in 2012 excluding anemia in pregnancy
Months AN DE DK GB MA NR SK Total %
January 5 1 0 2 0 0 0 8 11. 8
February 0 0 1 0 0 0 0 1 1. 5
March 1 2 0 3 0 1 0 7 10. 3
April 3 0 1 2 0 0 0 6 8. 8
May 2 1 0 3 0 1 1 8 11. 8
June 1 1 0 4 0 0 0 6 8. 8
July 1 1 0 1 0 1 1 5 7. 4
August 2 1 0 3 0 1 0 7 10. 3
September 0 0 1 1 0 0 1 3 4. 4
October 1 0 2 4 0 0 0 7 10. 3
November 0 0 0 6 0 0 1 7 10. 3
December 0 1 1 1 0 0 0 3 4. 4
Total 16 8 6 30 0 4 4 68
100.
0
% 23. 5 11. 8 8. 8 44. 1 0 5. 9 5. 9 100
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Causes of Maternal Deaths at Health
Facility Figure III.2.9 Table III.2. 19 reveals the major
causes of maternal death at hospitals and health
centers which included post-delivery/abortion
sepsis 21.7%, rupture of uterus 11.7%, eclampsia
11.7%, obstructed labor (CPD) 8.3%, other
pregnancy/delivery complications and postpartum
hemorrhage 5% each quantified 5% in 2012.
Not only this but also spontaneous complicated
abortion with infection and pre-eclampsia each
accounted 3.8%, Placenta previa /premature, fetal
distress and other causes of C/S each quantified
1.9% were reported as the causes of maternal
deaths in 2011.
Table III.2 19 shows the total number and causes
of maternal deaths that were reported only by
hospitals, MCH clinics and health centers. Hence
maternal deaths that were reported by health
stations were not included in Table III.2 19 as the
reporting system of HMIS is not allowed to report
by cause. According to the Table III.2 19, GB
reported 45% of all maternal deaths that were
reported by hospitals, MCH clinics and HC
followed by Anseba 20% Debub 13.3% and DK
8.3% whereas Orotta National Referral Maternity
hospital and SKB each reported 6.7% in 2012.
However, zoba MA did not report maternal death
in 2012. The proportion of maternal death without
specifying the cause accounted 26.7% in which all
of them were reported by hospitals and health
centers of GB. It needs great attention to specify
the cause of maternal deaths supporting to take
action timely.
Figure III.2.9 Percent of Causes of Reported Maternal
Death in 2012
Unspecified
cause 26.7%
Other
obstetric/puerper
ium
complications
3.3%
Fetal Distress
1.7%
Post
delivery/abortion
sepsis 21.7%
Placenta praevia
1.7%
Other
preg./delivery
complication 5%
CPD 8.3%
Spontaneous
complicated
abortion with
infection 3.3%Rupture of
Uterus 11.7%
Postpartum
Hemorrhage 5%
Eclampsia 11.7%
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58
2.3 The new born
The new born period is defined as beginning at
birth and lasting through the 28th day following
birth. Out of the total live, fresh and macerated
still births which were reported from all health
facilities in 2012, 97.2% (38533) were live
births and 2.8% (1081) fresh and macerated still
births as shown in Table III.2.3. 1.
A still birth is a birth of dead fetus after the 28th
weeks of gestation that include two indicators
namely fresh and macerated still births. These
indicators are used to measure labour, maternal
and fetal follow up. The highest proportion of
fresh and macerated still births was 3.5%
reported from GB and DK followed by SK
3.2%, Anseba 3% and National Referral 2.7%
as shown in Table III.2.3. 1.
However, the percentage of the total low birth
weight to live births was 7.3% (2811). While
the highest percentage of low birth weight was
10.9% from National Referral Orotta Maternity
hospital followed by SK 9.2%, DK 8.1%
Anseba 6.8% and GB 6.5%. Debub and Maakel
each accounted 4.2%. See Table III.2.3.1.
Low Birth Weight is defined as a term baby
weighing less than 2500 grams. If the baby
weighs exactly 2500 grams, (s) he is not a low
birth weight baby.
Table III.2. 19. Number and Causes of Maternal Death Reported only from Hospitals and Health
Centers by Zobas (2011)
Causes of death
Zoba
Total % AN DE DK GB MA NR SK
Eclampsia 0 0 2 3 0 0 2 7 11. 7
Obstructed labor due to mal
position of fetus (CPD) 0 1
1 3
0 0
0
5 8. 3
Other pregnancy/delivery
complications 2 1
0 0
0 0 0 3 5. 0
Placenta praevia, premature
placenta separation 1 0
0 0
0 0 0 1 1. 7
Post delivery/ abortion sepsis 4 2 0 3 0 3 1 13 21. 7
Postpartum hemorrhage 0 1 1 0 0 0 1 3 5. 0
Rupture of Uterus 4 3 0 0 0 0 0 7 11.7
Spontaneous complicated
Abortion with infection 0 0 0 2
0
0
0 2 3. 3
Fetal distress 0 0 0 0 0 1 0 1 1.7
Other obstetric/puerperium
complications 1 0 1 0
0
0
0 2 3. 3
Cause not specified 0 0 0 16 0 0 0 16 26.7
Total 12 8 5 27 0 4 4 60 100
Percent of the total 20 13. 3 8. 3 45 0 6. 7 6. 7 100
Table III.2.3.1. Situation Of New Born at
Birth by Zoba in Year 2012 Zoba Number of
%
FSB
&MSB
Low birth weight
Live
Births
FSB
&
MSB number
% total
live
births
AN 6547 198 3. 0 447 6. 8
DE 8651 194 2. 2 366 4. 2
DK 761 27 3. 5 62 8. 1
GB 7423 260 3. 5 479 6. 5
MA 1888 29 1. 5 80 4. 2
NR 9106 242 2. 7 995 10. 9
SK 4157 131 3. 2 382 9. 2
Total 38533 1081 2. 8 2811 7. 3
NB:- FSB = Fresh Still Births and
MSB = Macerated Still Births
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59
Neonatal death is defined as a death of new
born who is less than one month old and is
expressed as in 1000 live births.
In 2012, the sum of all neonatal deaths reported
from all facilities was 340 out of which 211
were reported in delivery service. Out of the
total neonatal deaths (211) reported in delivery
service, 69.7% were reported by hospitals and
the remaining 14.7% and 15.6 were from health
centers and health stations respectively as
indicated in Table III.2.3.2 in 2012.
Moreover, Table III.2.3.2 reveals that the
highest proportions of neonatal deaths were
64.9% reported by GB followed by DE 12.3%,
Anseba 10% SK 5.7% and DK 5.2% in
comparing the zobas.
As shown in Table III.2.3.3, a total of 178
neonatal deaths were reported in the delivery
services by health centers, MCH and hospitals
in 2012. Thus out of the total 178 neonatal
deaths reported in delivery service, hospitals
accounted 82.6% whereas health centers
reported 17.4%. Not only this but also the
Table III.2.3.3 shows that GB had the highest
percentage of neonatal deaths (70.2%) followed
by DE 13.5%, SK 5.6%, DK 4.5%, and Anseba
3.9%.
According to health management information
system (HMIS) manual guide line, the 178
neonatal deaths that were reported by hospitals
and health centers in delivery services were
expected to be transferred to inpatient services
by cause using appropriate ICD 10 code to
detect the cause and take necessary action on
time; because only the number of neonatal
deaths were reported in the delivery report.
Table III.2.3.4 Health Centers and Hospitals
that report neonatal deaths (ND) without
specifying the cause in 2012 Zoba Facility name Facility
type
No. of
ND %
DE DEKEMHARE HO 1 0. 9
INGELA HC 1 0. 9
DK ASSAB REG HO 2 1. 8
EDI HO 2 1. 8
GB AGORDAT HO 10 8. 8
HAYCOTA HC 4 3. 5
MEKERKA HC 1 0. 9
MOGOLO HC 1 0. 9
SHATERA HC 1 0. 9
TESSENEY HO 84 74. 3
NR OROTTA
MATERNITY HO 4 3. 5
MAHMIMET HC 2 1. 8
Total 113 100
However, majority 63.5% (113) of the 178
neonatal deaths reported in the delivery service
by HO, MCH clinic and HC were not
transferred to inpatient service to identify the
cause as Table III.2.3.4 reveals. Only 36.5% of
the neonatal deaths reported from hospitals,
health centers and MCH transferred to inpatient
service with appropriate ICD code enabling to
Table III.2.3.2 Total number of Neonatal
deaths at Facility Reported in Delivery Service
by type of health facility and zobas in 2012 Zoba Type of Health facility Tot
al
% to
total
death HS HC MCH HO
AN 14 7 0 0 21 10. 0
DE 2 6 0 18 26 12. 3
DK 3 0 0 8 11 5. 2
GB 12 9 0 116 137 64. 9
MA 0 0 0 0 0 0. 0
NR 0 0 0 4 4 1. 9
SK 2 9 0 1 12 5. 7
Total 33 31 0 147 211 100. 0
% 15. 6 14. 7 0 69. 7 100
Table III.2.3.3 Total number of Neonatal
deaths Reported from HC, MCH and HO in
delivery services by zobas in 2011
Zoba
Type of
Health facility
Total
number % to
total HC MCH HO
AN 7 0 0 7 3. 9
DE 6 0 18 24 13. 5
DK 0 0 8 8 4. 5
GB 9 0 116 125 70. 2
MA 0 0 0 0 0. 0
NR 0 0 4 4 2. 2
SK 9 0 1 10 5. 6
Total 31 0 147 178 100
% 17. 4 0 82. 6 100. 0
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know the exact cause. As Table III.2.3.4
discloses, out of 113 neonatal deaths that were
reported without specifying the cause, Tesseney
HO had the highest percentage (74.3%)
followed Agordat HO 8.8% and Haycota HC
3.5% in which all of them are from zoba GB.
Table III.2.3.5 Number and percent of Neonatal
Deaths reported from HO and HC by Zoba in 2012 Zoba
Causes of Neonatal death Total specified Not specified
AN No 24 0 24
% 100 0 100
DE No 31 2 33
% 93. 9 6. 1 100
DK No 4 4 8
% 50. 0 50. 0 100
GB No 39 101 140
% 27. 9 72. 1 100
MA No 0 0 0
% 0 0 0
NR No 67 4 71
% 94. 4 5. 6 100
SK No 29 2 31
% 93. 5 6. 5 100
Total No 194 113 307
% 63. 2 36. 8 100
In addition, from the total neonatal deaths (307)
that were reported by hospitals and health
centers, 63.2% were reported with specific
causes whereas the rest 36.8% were without
specifying the cause. See Table III.2.3.5.
Looking at the zobas, hospitals and health
centers in Anseba reported a total of 24
neonatal deaths in which all of them were
reported with specific causes indicating the
efficiency of their recording and reporting
system. Conversely, facilities from GB had a
report of 140 neonatal deaths out of which only
27.9% of them were reported with specific
causes and the remaining 72.1% were
accounted without definite causes as shown in
Table III.2.3.5.
Hence special attention and assessment is
required to the effectiveness of the recording
and reporting system of the hospitals and health
centers in GB.
Hospitals and health centers of SK reported 31
neonatal deaths in which 93.5% of them were
reported with specific causes while DE had 33
neonatal deaths with 93.9% of them reported
with specific causes.
Both Orotta Maternity and Pediatric hospitals
reported a total of 71 neonatal deaths in which 4
of them were reported in delivery services by
Orotta Maternity hospital. Thus, none of the 4
neonatal deaths were transferred to inpatient
services using ICD 10 code to identify the cause
of death.
On the other hand DK had a total of 8 neonatal
deaths in which 50% of them were reported
with definite causes in 2012.
Obviously the system of NHMIS doesn’t allow
the health stations to transfer facility based
neonatal deaths to inpatients services using the
ICD 10 code. As a result, all health stations
reported 9.7% out of the whole neonatal deaths
(340).
Facility based neonatal deaths of 2012 that were
reported by hospitals, health centers and MCH
clinics had increased by 30% compared to 2011
Table III.2.3.6. Number of Facility based Neonatal
Deaths by Year and Zoba reported from HO, HC,
and MCH through delivery & IPD service (2007 -
2012)
Zoba Number of Reported Neonatal Deaths
2007 2008 2009 2010 2011 2012
AN 10 13 28 26 52 24
DE 27 35 17 31 23 33
DK 9 4 7 8 7 8
GB 38 28 42 40 48 140
MA 0 1 2 1 3 0
NRH 110 142 57 50 74 71
SK 20 40 25 32 29 31
Total *214 *263 178* 188 236 307
* The number of neonatal deaths reported through
delivery and inpatient services in those years were
added after cleaning for duplication in 2009.
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61
as illustrated in Table III.2.3.6. Considering the
zobas, in 2012 GB reported the highest number
of facility based neonatal deaths which
increased by 65.7% as compared to 2011.
Conversely zoba Maakel had no report of
facility based neonatal deaths and in zoba
Anseba it was declined by 46.1% as compared
in 2011. According to Table III.2.3.6, in the
remaining zobas the number of facility based
neonatal deaths of 2012 was slightly increased
or decreased as compared to 2011.
Apparently the neonatal mortality rate is
expressed as the neonatal deaths per1000 live
births. So the facility based neonatal mortality
rate is calculated by taking the total number of
live births reported from all health facilities as
denominator and the numerator is the total
number of neonatal deaths reported in the
delivery services only. The facility based
neonatal mortality rate was 5.5/1000 live births
in 2012. Thus, considering only those neonatal
deaths reported through delivery services in
2012, the facility based neonatal mortality rate
has increased by 2.1/1000 compared to 2011 as
shown in Figure III.2.3.1.
Figure III.2. 3.1. Facility Based Neonatal
Mortality per 1000 Live Births as Reported
through Delivery Service(2006 -2012)
5.5
4.6
3.44.04
4.74.1
0
1
2
3
4
5
6
2006
2007
2008
2009
2010
2011
2012
Year
Rate
NNMR
Although the facility based neonatal mortality
rate has increased in 2012, generally it has
decreasing trends probably because of
improved access to health services and
improvement in quality of care given. The ICD
code for recording neonatal morbidity and
mortality was introduced in 2004. Before 2004,
only the neonatal deaths in delivery room used
to be reported without specifying the cause of
death.
The major causes of neonatal death in inpatient
service were clinical neonatal sepsis (21.1%),
very low birth weight (18.6%), low birth weight
(15.5%), intrauterine hypoxia/birth asphyxia
(12.9%), extremely low birth weight (7.2%),
neonatal hypothermia (6.7%) and pending
neonatal sepsis (5.7%), as indicated in Table
III.2.3.7 and figure III.2.3.2.
Moreover, Table III 2.3.7 indicates that
comparison of facility based neonatal death
with specific and without specific causes in
Zobas in 2012. Regarding to this, the highest
percentage of overall neonatal death rate (with
and without specific causes) was reported by
GB 45.6% followed by Pediatric National
Orotta Referral hospital (21.8%), DE (10.7),
and SKB (10.1); whereas the remaining Zobas
had the following proportion of neonatal
mortality: Anseba 7.8%, DKB 2.6% and Orotta
Maternity National Referral hospital 1.3%.
However, zoba Maakel had no report of facility
based neonatal death.
According to Table III 2.3.7, a total of 307
neonatal deaths were reported by hospitals,
health centers and MCH clinics in which 194
(63.2%) of them were reported with specific
causes and 113 (36.8%) were reported without
specifying the cause of death. Out of the total
neonatal deaths that were reported without
specifying the cause, zoba GB reported 89.4%
which was the highest percentage of neonatal
deaths without specific cause. On the other
hand, out of the total neonatal deaths that were
reported with specific causes Pediatric National
Orotta Referral hospital possessed 34.5%,
followed by GB 20.1%, DE 16%, SKB 14.9 and
Anseba 12.4%.
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
62
7.2
15.5
18.6
12.9
21.1
5.7
6.7
0 5 10 15 20 25
Proportion (%)
Extremely low birth
Low birth wt.
Very low birth wt
Intrauterine hypoxia/birth asphyxia
Clinical Neonatal Sepsis
Pending Neonatal Sepsis
Neonatal hypothermia
Causes
Figure III. 2.3.2. Major Causes of Neonatal Mortality in Health facilities
(2012)
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63
Table III.2.3.7 Causes of Facility Based Neonatal Deaths by Zoba in 2012
Cause of death by ICD 10 Code
Zoba
Tot
al
% to
specif
ied
cause AN
DE
DK
GB
MA
NRH/
Ped.
NRH/
Mate. SK
Extremely low birth wt <1kg (246.1) 0 0 0 3 0 8 0 3 14 7. 2
Very low birth wt 1- 1. 5 kg (246. 2) 1 8 0 8 0 10 0 9 36 18. 6
Low birth wt 1. 5 - 2. 5 kg (246. 3) 4 5 2 3 0 11 0 5 30 15. 5
Intrauterine hypoxia/birth asphyxia 6 7 2 2 0 6 0 2 25 12. 9
Clinical Neonatal Sepsis 9 7 0 20 0 0 0 5 41 21. 1
Neonatal meconium aspiration syndrome
(248. 2) 1
0 0 0 0 0 0 1 2
1. 0
Other Perinatal period respiratory disorders
(249)
2 1 0 0 0 3 0 0 6
3. 1
Congenital infectious & parasitic disease 1 0 0 0 0 0 0 0 1 0. 5
Spinal bifida (254) 0 1 0 0 0 0 0 1 2 1. 0
Hemolytic disease of fetus and newborn 0 0 0 0 0 4 0 0 4 2. 1
Pending Neonatal Sepsis 0 0 0 3 0 6 0 2 11 5. 7
Neonatal cord bleeding 0 1 0 0 0 0 0 0 1 0. 5
Neonatal hypoglycemia (246.7) 0 0 0 0 0 3 0 0 3 1. 5
Neonatal hypothermia (246. 6) 0 1 0 0 0 12 0 0 13 6. 7
Slow fetal growth, malnu. etc. short gest.
LWB
0
0
0 0 0 1 0 1 2
1. 0
Other nervous system congenital
malformations (255) 0 0 0 0 0 3 0 0 3
1. 5
Total causes specified 24 31 4 39 0 67 0 29 194 100
% of causes specified 12. 4 16. 0 2. 1 20. 1 0. 0 34. 5 0. 0 14. 9 100
Total causes not specified 0 2 4 101 0 0 4 2 113
% of causes not specified 0 1. 8 3. 5 89. 4 0 0 3. 5 1. 8 100
Total deaths ( specified & not specified) 24 33 8 140 0 67 4 31 307
% of Total Deaths 7. 8 10. 7 2. 6 45. 6 0 21. 8 1. 3 10. 1 100
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64
Figure III. 2.3.3 Percent of Neonates
Born in Health Facilities with LBW
by Year (2006-2012)
7.37.3
8.18.577.1
5.9
0
2
4
6
8
10
2006
2007
2008
2009
2010
2011
2012Year
% LBW
Infants weighing less than 2,500g are
approximately 4 times more likely to die in
neonatal period and 2 times more in post
neonatal period than new born with normal
weight (Ashworth, 1998). In accordance to this,
low birth weight as explained above was one of
the major contributing factors for neonatal
death in health facilities in 2012. The reduction
of low birth weight also forms an important
contribution to reduce child mortality. The
proportion of neonates born with low birth
weight in 2012 was 7.3 the same as 2011.
Hence, the level of low birth weight in 2012
remained the same as compared to 2011. See
Figure III.2.3.3.
However, health facilities that follow the
manual guide line of recording and reporting of
NHMIS should be encouraged to continue to
transfer all neonatal deaths and low birth weight
by cause to inpatient services which enable the
concerned managers to take necessary measures
timely.
Perinatal mortality rate is expressed as total
number of all still births and all neonatal deaths
less than seven days of age per total number of
live and still births. Thus, according to Figure
III.2.3.4, the perinatal mortality rate (PNMR) in
2012 was 35.9/1000 of the total births and has
increased by 5.5/1000 as compared to 2011
even though the facility based perinatal death
rate has a declining trend.
Figure III.2.3.4 Facility Based Perinatal Death Rate by Year
(1999-2012)
35.9
34.035.3
44.344.244.748.849.849.1
53.1
47.646.0
50.5
30.4
0
10
20
30
40
50
60
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012Year
Death Rate
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65
III.3. Obstetric Emergencies (OBE)
Any woman can experience complications
during pregnancy that can cause maternal
and neonatal deaths. The major direct
obstetric complications are those that cause
most maternal death. However, the quality of
emergency obstetric care is a key to success.
To minimize maternal and Perinatal
mortality, services must be available 24
hours seven days a week, and have well-
trained and motivated staff, essential supplies
and logistics in place, functioning transport
and communication systems and ongoing
monitoring. Low maternal mortality ratios
are due, in large part, to the fact that
complications are identified early and are
treated. Hence, Strong Obstetric emergency
service is critical to reducing maternal and
perinatal mortality and disability.
Health services related to emergency
obstetric care are categorized as basic and
comprehensive. Basic emergency functions,
performed in health facilities without an
operating theatre which include assisted
vaginal delivery; manual removal of placenta
and retained products to prevent infection;
and administering antibiotics to treat
infection and drugs to prevent or treat
bleeding, convulsions and high blood
pressure. Comprehensive services require an
operating theatre which includes all the
functions of a basic emergency facility, plus
the ability to perform surgery (caesarean
section) to manage obstructed labour and
provide safe blood transfusion to respond to
haemorrhages and are usually provided in
hospitals.
Most of the morbidity and mortality related
to obstetric emergency can be reduced with
appropriate antenatal, delivery and referral
systems. According to the second edition of
the Eritrean National Clinical Protocol on
Safe Motherhood, 2002, and International
Journal of Gynecology and Obstetrics, 2006,
the following were considered as obstetric
emergency situations:
• Pre-Eclampsia/Eclampsia,
• Prolonged labor due to obstruction,
• Antepartum (placenta previa) hemorrhage
• Post partum hemorrhage,
• Puerperal Sepsis,
• Complicated abortions and
• New born distress (intrapartum).
The difficulties in measuring maternal
mortality have led to a shift in emphasis from
indicators of health to indicators of use of
health care services. Furthermore, the
recognition that some women need specialist
obstetric care to prevent maternal death has
led to the search for indicators measuring the
met need for obstetric care. The proportion of
all women with complications who are
treated in the health facilities has been widely
promoted as an indicator of "met need for
essential obstetric care".
Met need for essential obstetric is the
proportion of pregnant women expected to
have complications. This assumes that the
proportion of pregnant women having a
complication requiring life-saving obstetric
care is relatively stable across populations at
15%, enabling need for life-saving obstetric
care to be easily quantified.
According to the International Journal of
Gynecology and Obstetrics 2006, the
indicator “met need for emergency
obstetric care” (EmOC) is the most
important measure of use of EmOC services;
it address the question of whether women
who really need EmOC – those with
complications are receiving it. The indicator
is defined as follows: the numerator is the
number of women with direct obstetric
complications seen in EmOC facilities, and
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66
the denominator is the number of women
expected to develop obstetric complications
in the reference population, which is
estimated as 15% of expected live births in
the population; because the goal is to treat all
obstetric complications in EmOC facilities.
EmOC refers to care provided in health
facilities to treat direct obstetric emergencies
that cause the vast majority of maternal
deaths during pregnancy, at delivery and
during the postpartum period.
Table III.3.1. Number of OPD/IPD Obstetric Emergency cases in Hospitals, MCH and Health
Centers by Zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to
total
Pre-Eclampsia 49 57 2 57 10 142 19 336 4.9 Eclampsia 11 14 4 11 0 1 17 58 0.9 Placenta previa (antepartum) 15 27 6 27 5 43 10 133 2.0 Prolonged/obstructed labour 142 141 9 130 57 409 43 931 13.7 Newborn distress (intrapartum) 33 31 0 0 198 135 18 415 6.1 Rupture of uterus 10 16 2 44 1 4 1 78 1.1 Postpartum hemorrhage 30 96 4 21 0 8 6 165 2.4 Post delivery/abortion sepsis
(Puerperal) 44 98 1 109 0 51 13
316 4.6 Other pregn/deliv complications 140 181 17 238 11 27 80 694 10.2 Other obstetric/puerperium
complications 2 34 5 20 2 88 7
158 2.3 Spontaneous complicated abortion
with infection 200 540 14 282 17 1831 84
2968 43.6 Obstetric Fistula 13 65 0 5 145 321 9 558 8.2 Total OBE cases 689 1300 64 944 446 3060 307 6810 100 % to total OBE cases 10.1 19.1 0.9 13.9 6.5 44.9 4.5 100 15% of target population for
delivery service (expected no. of
OBE cases 2865 4735 416 3539 3377 0 2877 17808
Met need for OPD/IPD OBE
cases 24.0 27.5 15.4 26.7 13.2 0 10.7 38.2
As shown in Table III.3.1, the total actual
numbers of outpatient and inpatient OBE
cases in year 2012 were 6810 in which only
include spontaneous complicated abortion
with infection, bleeding, and retained parts in
hospitals, MCH, and health centers. The
average estimate for total OBE cases
(expected number of OBE cases) in 2012 was
17,809; i.e. 15 % of the target population for
delivery service.
From the total causes of outpatient and
inpatient, pregnancy and labour related
morbidity problems in 2012, spontaneous
complicated abortion with infection (43.6%)
was the leading one as followed by
obstructed labor (13.7%), other pregnancy
and delivery complications (10.2%), obstetric
fistula (8.2%),newborn distress (6.1%), pre-
eclampsia (4.9%) and post delivery/abortion
sepsis, 4.6%. See table III.3.1.
Looking at the Zobas, National Referral
Maternal hospital covered 44.9% followed
by Debub 19.1%, GB13.9%, and Anseba
10.1%, and Maakel and SK accounted 6.5%
and 4.5 respectively of the total number of
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
67
OPD and IPD obstetric emergency cases in
2012 as indicated Table III.3.1. Not only
this but also the highest met need for OPD
and IPD OBE cases in year 2012 was
reported by EmOC facilities of zoba Debub
(27.5%), followed by facilities in GB
(26.7%), Anseba (24%) and DK (15.4%); the
average met need was pointed up in the table
III.3.1 as 38.2%.
Table III.3.2. Number of IPD Obstetric Emergency cases in Hospitals, MCH and Health Centers
by zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to
total
Pre-Eclampsia 28 47 2 26 1 98 7 209 3.9 Eclampsia 11 14 3 11 0 1 17 57 1.1
Placenta previa (antepartum) 15 26 6 26 5 33 10 121 2.3 Prolonged/obstructed labour 142 141 8 130 53 408 86 968 18.2
Newborn distress (intrapartum) 33 31 0 0 51 135 18 268 5.1 Rupture of uterus 10 16 2 40 1 4 1 74 1.4
Postpartum hemorrhage 29 95 4 17 0 0 6 151 2.8
Post delivery /abortion sepsis
(Puerperal) 37 96 1 74 0 51 13
272 5.1
Other pregn/deliv
complications 80 113 9 62 4 1 6
275 5.2
Other obstetric/puerperium
comp. 2 14 4 18 0 40 6
84 1.6
Spontaneous complicated
abortion with infection 199 530 12 259 17 1532 83
2632 49.6
Obstetric fistula 9 48 0 2 33 98 5 195 3.7 Total of IPD OBE cases 595 1171 51 665 165 2401 258 5306 100
Total IPD cases in 5yrs and
above 12513 21295 1547 12687 7303 24329 8302 87976
% of OBE IPD cases to total
IPD cases in 5yrs and above 4.8 5.5 3.3 5.2 2.3 9.9 3.1 6.0
15% of target population for
delivery service (expected no.
of OBE cases 2865 4735 416 3539 3377 0 2877 17808
Met need for IPD OBE cases 20.8 24.7 12.3 18.8 4.9 0 9.0 29.8
Table III.3.4. Number of OPD Obstetric Emergency cases in Hospitals, MCH and Health
Centers by zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to
total
Spontaneous non complicated
abortion 108 1 33 55 404 39 640 39.5
Threatened abortions 48 68 1 105 18 472 18 730 45.1
Other pregnancy with abortive
outcome 2 21 7 11 113 64 19 237 0.7
Medical abortion 11 1 12 14.6
Total
50 197 9 149 186 951 77 1619
% to total 3.1 12.2 0.6 9.2 11.5 58.7 4.8 3.1 100
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68
Cesarean Section rate An estimate of the cesarean section rate may reflect, at least partially, the extent to which pregnant
women access life-saving obstetric care. In settings where access to surgical facilities is very low,
the majority of cesarean sections will be carried out to save the life of the mother although
cesarean section might be differentiated into elective (scheduled) cesareans and emergency
cesareans. On the other hand, a total of 6410 obstetric related risk cases were visited in all health
facilities that provide EmOC services out of which Orota National referral hospitals reported
42.3%, Maakel 22%, Debub 19.3% and GB 14.9 and the remaining in other zobas.
According to Figure III.3.1, the yearly trends of Met Need for direct emergency obstetric cases of
inpatient and outpatient OBE including spontaneous complicated abortion was 42.9% in 2012. It
almost the same with 2011 which was 41.9%. Hence, the overall yearly Met need for direct
emergency obstetric cases of inpatient and outpatient have decreasing and increasing trends as
indicated in Figure III.3.
1.
The caesarean rates may be accurate tracers
of use of essential obstetric care services.
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69
The indicator cesarean section rate as a
proportion of all births in the population
addresses whether this specific life-saving
intervention is performed in sufficient
numbers. The indicator takes its numerator
primarily from operating theater logbooks
and the denominator is the estimate of the
number of expected deliveries in the
population.
According to UNICEF et al, 1997, the
acceptable number of CS from expected
births ranges between 5-15 %. Thus, the
target has been set as a range between 5%
and 15% of all births; i.e. the recommended
level is 5–15% of all births.
The total national figure for the C/S (elective
and emergency cesareans) performed in 2011
was 2609 which is 6.8% of all attended
deliveries and 0nly 2.2% of all expected
number of deliveries. The caesarian section
rate of all expected number of deliveries was
less than 2.3% in the last 15 years as
indicated in table III.3.1. Thus, the over all
trend may indicate improved access to
required C/S, but not necessarily indicate the
progress in reduction of maternal death since
there are countries that have maternal
mortality of 20 to 60 per 100,000 with C/S
rates not exceeding 2%. The cesarean section
rate (2.2%) as a proportion of all expected
deliveries in the population shows progress
in 2011 compared to previous years although
the recommended (required) level is 5–15%
of all births as seen in Figure III.3.3.
Table III.3. 1.. Number of C/S performed and its
proportion to total attended and expected
number of deliveries by Year (1998-2012)
Year No. of C/S
Percent to
total
attended
deliveries
% C/S to
Total
Expected
deliveries
1998 629 3.8 0. 8
1999 792 5.4 1. 0
2000 925 6.2 1. 1
2001 1004 5.7 1. 1
2002 1200 5.5 1. 3
2003 1269 5.3 1. 4
2004 1373 5.5 1. 4
2005 1598 6.2 1. 6
2006 1706 6.6 1.7
2007 1877 6.7 1. 8
2008 1859 6.3 1.7
2009 1889 6.4 1.7
2010 2118 6.4 1. 9
2011 2534 6.7 2. 2
2012 2609 6.8 2.2
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70
Figure III.3.2 trend of CS by year (1998-2012)
5.3 5.5
6.8 6.76.46.46.36.76.66.2
5.55.76.2
5.4
3.8
012345678
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012Year
Percent
Percent
Figure III.3.3. The Percent of C/S Performed compared to the Total
Expected Deliveries by Year (1998-2012)
1.3 1.4 1.41.6 1.7 1.8 1.7 1.7
1.9
2.2 2.2
1.11
0.8
1.1
0
0.5
1
1.5
2
2.5
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Percent
Percent
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71
Moreover, the table III.3.2 indicates a total of 57
maternal deaths due to specific causes obstetric
emergency problems which are equivalent to 3.6%
compared to the total OPD/IPD deaths in five years
and above in 2012.
Not only this but also the table III.3.2 shows the met
need for inpatients and outpatients obstetric
emergency cases including complicated abortions
which was 41.4%; whereas without spontaneous
complicated abortions it was only 23.0%.
Table III.3.2. Yearly Trends of Maternal Morbidity and Mortality in Hospitals, MCH and Health Centers
Due to OBE Situations (2000-2012) Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Number of new OBE
OPD and IPD Cases
10018 10324 6843 9718 11156 10204 10166 7996 7989 8423 7171 6410
% to total OPD/IPD
Morbidity in five
years and above
1. 4 1. 6 1 1. 5 1. 4 1. 4 0. 9 0. 9 0. 9 0. 9 0.7 0.6
Number of OBE
Deaths including all
non-medical abortions
55 57 65 59 76 66 60 34 33 50 59 57
% to total OPD/IPD
death in five years
and above
2. 8 3. 3 4. 4 2. 7 4. 8 4. 5 4 2. 3 2. 1 3. 2 4.1 3.6
% of Met need for
obstetric Care with comp. abortion
40 45.8 34.4 29.4 46.3 45.1 40.7 42.8 37.4 23.6 41. 4
% Met needs for
obstetric care without
abortion
11. 9 17. 1 14. 8 15. 8 28. 9 28.1 19.2 21. 8 22.1 20. 5 23. 0
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
72
III.4. Family Planning
Services Family planning in reproductive health
program has contributed greatly to
fertility decline and reduces unintended pregnancy and thereby improves healthy
reproductive behavior. Both availability
and quality of family planning services
are believed to have contributed to
increasing contraceptive use and declining
fertility rates in developing countries.
Eritrea is one of the developing countries
with high fertility rate that increases the risk
of morbidity and mortality of women and
children. Thus, family planning services are
provided to reduce these risks through
spacing between children and support
couples to have informed decisions on the
number of children they want to have and
the spacing method they want to use by
considering the health of the mother and the
children.
In Family Planning (FP) program, the
general health of the women is assessed and
required treatment and advice, and
counseling on infertility problems are
provided.
Data on FP services is collected from all
health facilities that provide the service,
including Family Reproductive Health
clinics. From the total health facilities
(340) that were reporting in year 2012, 201
(59%) facilities were providing FP services.
Out of which 11 were hospitals, 45 health
centers, 133 health stations, and 6MCH and
other clinics (Table III.4.1.).
The number of health facilities that provide
FP service by year is presented in Figure
III.4.1
Figure III.4.1 number of Health
Facilities providing family planning services
(2002-2012) Table III.4.1 Number of Health Facilities
Providing Family Planning Services by Zoba
and Type of Health Facility (2012)
Zoba HO HC HS MCH CL Total
SKB 3 9 17 1 0 30
MA 0 8 21 0 4 33
GB 1 13 40 3 2 59
DKB 3 0 6 0 0 9
DE 4 9 29 1 0 43
AN 0 6 20 1 0 27
Total 11 45 133 6 6 201
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73
Coverage
The two types of data point to evaluate the
utilization of family planning (FP) service
are the total number of new method
acceptors and any client who received other
family planning services that includes
infertility, counseling etc. The target
population for FP service is estimated as
20% of the total population. The family
planning coverage in 2012 considering all
new clients who visited the health facilities
for family planning counseling and different
contraceptive methods was 3.6% (Table
III.4.4)
The recruitment rate on the other hand
indicates the percent of new FP clients who
use any contraceptive method was 3.6 %.
The highest recruitment rate was observed in
Zoba Maakel 6.5%, while the figure for the
other Zobas ranges from 1.4 (in SKB) to 5.5
% in (GB) (Table III.4.4)
Trends in contraceptive use have
implications for shifts in pregnancy rates and
birth rates and can inform clinical practice of
changes in needs for contraceptive methods
and services. Though condoms were used to
be the most popular method of
contraceptive, the trend of condom users
shows down ward trend from 2005-2007 and
then again from 2010-2012. The reason for
low condom use as contraceptive method
could be due to wide spread condom
distribution in different out lets for the
prevention of HIV and other sexually
transmitted diseases which could also be
used for contraceptive method. This could
also have contributed to the low family
planning coverage rate because many can
use condom for dual purposes without being
registered as family planning client. The
stock out level for pills, injection and
Female condoms for the year 2012 is less
than the preceding years as shown in Table
III.4.3.
FigureIII.4.2
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
74
Couple Year Protection (CYP)
The couple year protection indicates the number of years couples are protected against
unwanted pregnancy among target population. Each contraceptive method has its own
standard protection year. For example, fifteen cycles of pills or 4 injections of Depo provera
can protect couples for one year against unwanted pregnancy. The total CYP and CYP rate in
year 2012 was 16229.8 and 2.1 % respectively (Table III.4.5). Low couple year protection
(CYP) indicates high fertility rate that increases the risk of maternal and child mortality as
explained above. The 2002 EDHS findings indicated that the unmet need for FP service was
about 27%.
Trend of stock out level for pills, injection, condom and IUD is summarized in the Table
III.4.3. The high stock out level could contribute to the low contraceptive method use. The
IUD insertion with the situation of HIV infection seems relatively discouraged thus the stock
out is high. Condom is being distributed by Social Marketing Groups, health facilities and
other outlets.
Figure III.4.3 Family planning Decrement and CYP rate(%)in 2012 by zoba
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75
Table III.4.4 Number of New and Repeat Visits for Different Contraceptive Methods and Information and Counseling by Zoba in 2012
Zoba Family Planning Methods 1st IC Only
Referre
d
Total FP Method Acceptors
FP Acce
pter(
%
Service
Cove
rage rate
Pills Injection IUD F+M Condom Other
Methods
First Repea
t
1st Repeat 1st Re 1st Re 1st Re 1ST
New Re % %
AN 592 1338 1604 4261 11 0 117 56 0 0 96 0 2324 5655 1.8 1.8 DE
1488 3181 3284 8433 2 0 715 381 0 0 294 58 5489 11995 2.6 2.6
DKB 66 153 266 604 0 0 33 1 0 0 0 0 364 758 2.0 2 GB
1649 2549 4056 7402 0 0 2994 1960 0 0 11 0 8703 11912 5.5 5.5 MA
2102 6015 3957 12543 166 85 2097 1122 0 0 1357 39 8322 19765 5.5
5.5
SK 726 891 1101 2750 0 0 48 71 0 0 0 0 1878 3717 1.5 1.5
Total
6623 14127
14268 35993 179 85 6004 3591 0 0 1758 97
27080 53802 3.4 1.8
% 24.4 26.3 52.7 66.9 0.6 1.6 22.8 6.7 0 0
N.B. Service coverage rate includes IC visitors
Table III.4.3. Percent Annual Commodity Stock Out Level at HC and HS in Percent Year Pills Injection Condom IUD
2000 33 50 50 90
2001 40 50 50 90
2002 57 50 60 90
2003 45 50 50 90
2004 33 50 60 90
2005 24 70 60 100
2006 29 30 80 100
2007 27.8 37.4 Male 70 Female 97.1 96.1
2008 30.1 30.92 Male 56 Female 97 94.61
2009 34.5 61.9 Male56.1Female 59.3 94.8
2010 51 51.1 Male 69.5 Female 92.1 97.4
2011 47.3 42.7 Male 75.6 Female 91.5 95.6
2012 46.5 41.9 Male 77.5 Female 98.2 98.1
IUD not done in HS
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Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012
76
Table III.4.5. Number and Type of Contraceptive Units Distributed and Couple Year Protection (CYP) by Zoba in
2012 Zobas PILLS INJECTION IUD Condom (M+F) Others Total CYP
Rate
(%) DEPO Noristerat
UNITS CYP UNITS CYP UNITS CYP UNITS CYP UNITS CYP Units CYP Distributed CYP
AN 2617 174.4 5776 1444 9 1.5 11 38.5 772 6.4 0 0 9185 1664.8 1.3
DE 7647 509.8 11719 2929.8 0 0 0 0 5998 49.9 0 0 25364 3489.5 1.6
DKB 555 37.0 739 184.8 0 0 0 0 158 1.3 0 0 1452 223.1 1.2
GB 12684 845.6 11507 2876.8 27 4.5 0 0 13414 111.7 44 154 37786 3992.6 2.4
MA 11624 774.9 16294 4073.5 90 15.5 243 850.5 5173 43.1 11 43 33467 5800.5 3.8
SK 2388 159.2 3867 966.8 0 0 0 0 980 8.1 0 0 7235 1134.1 0.9
TOTAL 37515 2501 49902 12475.5 126 21 254 889 26495 220.7 55 197 114489 16304.2
% to total 32.5 15.3 43.6 76.5 0.8 0.12 0.8 5.5 23.14 1.3 0.0 1.2
Table III.4.6. Yearly Trends of the Number of New FP Acceptors, Repeat Visits, Counseling and Information Visits,
CYP, and FP Coverage (2001-2012)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New FP method Acceptors
22324 30121 21387 28480 19572 19040 25884 28356 36326 26856 27081 Repeat FP Visits
46429 46035 45240 47740 36107 43438 49360 49827 50353 51673 53802
New Information and Counseling
Visits 645 5859 2383 10560 3,940 5132 4713 4725 3471 2654 1758 Total Visits 75210 82015 69010 86780 59619 67610 79957 82908 90150 81183 82641
Total CYP
13774.6 12937.
6 13842 12787.8 11829.
4 13230.9 13854 18835 14,261 19191.8
16229.
8 New FP Method Acceptors rate
(recruitment rate) (%) 3.6 4.9 3.4 4.4 2.9 2.8 3.7 3.3 4.9 3.5 3.4
Couple Year Protection rate
(CYP) % 2.3 2.1 2.2 2 1.8 1.9 2 2.6 1.9 2.0 2.1
TABLE III.4.7. ANNUAL TRENDS OF NEW FAMILY PLANNING METHOD ACCEPTORS BY ZOBA (RECRUITMENT
RATE ) (2000-2012) ZOB
A
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
AN 1.4 1.6 1.5 1.3 1.8 0.9 1.5 1.8 2.2 1.8 1.1 2.8 1.9 DE 1.6 2.7 2.5 5.1 4.0 2.3 2 2.2 2.9 2.7 1.2 2.6 2.8 DKB 3.2 2.2 1.5 5.5 2.6 2.7 3.2 2.5 2.1 3.3 1.8 3.O 2.0 GB 4.5 3.3 2.8 2.7 3.2 8.4 2.7 2.6 5.8 3.3 2.1 4.8 5.5 MA 5.8 6.3 10.4 13.1 6.1 8.3 6.1 5.4 6.1 6.1 4.8 5.7 6.5 SKB 1.8 2.7 1.2 1.0 1.1 1.8 2.3 1.7 2.8 2.6 0.9 1.5 1.5
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III.5.Immunization Service
The Expand ed Program on Immunization (EPI) is
one of the priority programs of the Ministry of Health
.EPI is considered as one of the most cost effective
health interventions At present, BCG, Measles, Polio,
DPT, Hepatitis B, and Homophiles Influenza types B
vaccines are being provided to children less than one
year. Homophiles Influenza type B vaccine was
introduced in the late 2007.the target population for
child immunization is children under one year old
estimated as 3% of the total estimated population, and
pregnant women are targeted for Tetanus Toxoid
immunization. The reports from all health facilities
show over all increased coverage for various vaccines
this year. Taking the number of children immunized
for BCG (91%) in EHDS2002 as births and inflating in
by 9% gives us about 3%(2.7) of the total population
surveyed .Taking these estimates as base, we estimate
the total children under one year as 3% targeted for
immunization .The EPI unite on the other hand is
using estimated infant survival rate estimate of WHO
which 3.6% of the total population to calculate
immunization coverage for under one year age group.
Despite the differences in denominator, the EPI unite
and NHMIS use the same source of data for the
number of children immunized for different antigens
and estimated National population data. Therefore, the
raw numbers can be taken for campaign increase
coverage.
5.1. Health Facilities providing Immunization Service Immunization service has been providing in 258 (75.88 of all health facilities) in 2012.The number of health facilities
providing immunization services is more than tow health facility compared with 2011.Excluding the private and
industrial clinics, 92.5 % of all hospitals, health centres, health station, MCH and clinics were providing
immunization services while hospitals were providing above. Out of the total health facilities that have been
providing the service, 16 were hospitals, 52 health centres, 179 health stations, and 7 MCH and other 4 clinics (Table
III.5.1.1). The health centres that do not provide immunization services are those specialized for specific health
services like Physiotherapy centres, International Operation for Children Centre Asmara (IOCCA). Mai-dima
ophthalmic centre and 3 industrial centres. Similarly hospitals that do not provide immunization were: Dekemhare,
Adikeyh, Halibet, Hazhaz, Dendan, Orotta Pediatric, NR Orotta Medical Surgical, Hansenian, St.Mary, Berhan
Aynee, and Massawa Hospital. Some of these Hospitals are specialized hospital providing specific services while
others have health centres or MCH clinics or health station near the hospitals that provide immunization services. In
addition to the static health facilities ,immunization has been provided in 335 out reach sites in 2012.The total
number of visits to these out reach sites account to 2,001 which is 16.7%more compared with 2011, further more”
National Immunization Days “for Polio and “Measles Catch Up Campaign” have also been conducted to increase the
immunization coverage. The number of out reach sites since some may be closed and others opened based on the
availability of resource. The Annual the number of static health facilities providing immunization services is
presented Figure III.5.1.1.
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Table III.5.1.1.Number of Health Facilities that Provide Immunization
Services by Type of Health facility and Year(2005-2012)
Type 2005 2006 2007 2008
2009
2010
2011
2012
HO 12 13 14 15 14
14 12
16
HC 46 46 49 49 48 49 49 52
HS 162 165 169 176 178 178 179 179
MCH/CL 13 7 8 8 9 8 10 11
TOTAL 234 231 240 249 248 249 250 258
% 65.4 62.4 63.5 67.10 67.21
74.33 78.12 75.88
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“Information is a tool to support informed decisions at all levels not a vertical program”
5.2. Immunization Coverage Child Immunization In 2012, the DPTHepB3 coverage rate at National level was 71.1 % with zoba variations. The coverage ranges
from 49.2% in SKB to 107.2 % in Gash_Barka which indicates that the estimated target population is much less
than actual population. The HMIS uses the 2000 published population estimation and its projection and does not
consider the returnees from the Sudan who settle in Gash Baraka. Although, there is need of adjusting the
current population in all zobas, we will continue using the available official population estimation until the
adjustment is done by concerned authorities. The immunization coverage of children less than one year is
presented in the Table III.5.2.2.The coverage for all antigens and the number of children full immunized before
their first year of birth has
decreased trends. It has
decreased by 6.5 % 2012
than in 2011 (Figure
III.5.2.1.). The
The dropout rate at national
level for this was 0 with
range 0 to 3.3% among the
zones and it is good
performance compare with
2011 as indicated ( Table
III.5.2.1.)
.
Table III.5.2.1. Percent of dropout by zoba and year (2000-2012)
Year
Total
Zoba
AN DE DKB GB MA SKB
2000 13.1 2.9 15.0 21.4 28.3 2.9 6.6
2001 10.9 3.5 14.4 28.3 12.4 5.8 14.6
2002 8.9 4.2 9.1 26.1 11.7 4.9 12.4
2003 4.5 1.6 3.6 11.9 5.7 1.5 12.4
2004 6.4 1.7 7.5 24.5 5.2 3.4 16.1
2005 7.6 4.5 6.0 25.2 9.3 5.5 11.5
2006 3.7 0.5 2.1 25.3 5.6 0.0 11.5
2007 6.1 4.4 3.6 6.9 103 1.0 13.1
2008 3.7 0 3.4 21.7 7.5 0 0
2009 1.9 2.0 1.1 0 5.5 0 1.4
2010 2.6 0.0 1.5 4.7 3.0 1.9 5.00
2011 5.1 4.9 2.6 6.5 9.1 0 6.4
2012 0.0 0.0 3.3 3.1 1.1 0.0 0
Table III.5.2. 2. Immunization Coverage in % for Children Under One Year of age for
Different Antigen by Zoba in Y2012
Zoba Type of Vaccines Fully
Immuniz
ed.
*Target
population BCG OPVO DPTH
B1
DPTH
B2
DPTH
B3
Measles
AN 68.6 32.9 68.1 71.4 71.0 73.1 68.9 19100
DE 68.1 27.0 71.1 71.2 68.8 66.8 66.8 31565
DKB 52.6 32.8 60.1 56.7 58.2 53.5 50.6 2772
*GB 105.3 28.9 108.7 112.8 107.2 99.5 45.5* 23592
MA 20.3 16.0 54.8 57.9 56.6 56.9 55.4 22513
SKB 40.4 23.0 46.1 49.3 49.7 44.5 33.4 19182
Total 61.7 25.7 70.8 73.1 71.1 68.3 55.0 118724
*Estimated target population could be less than the actual population in the zoba. National Referral Hospital data is
excluded due to not having denominator.45.5*low reporting of full immunized in G ASH-BARKA is
due to unable to save the record data this resulted in lower coverage of full immunization
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Zones
Table III.5.2.3 Number of Children Immunized by Age categories,
Type of Vaccines and Zoba in 2012
BCG OPV0
OPV1 OPV2 OPV3 DPTHB1 DPTHB2 DPTHB3 MEASLES Fully Imm.
<1 >1 <1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1
AN 13095
9 6286
13122 5
13642 29 13565 24 13122 5 13642 29 13565 14 13967
430 13167 162
DE 21505 4 8511 22450 5 22492 8 21711 29 22450 5 22485 8 21713 29 21073 1221 21073 1221
DKB 1459 1 909 1665 12 1571 7 1641 23 1665 4 1571 7 1614 23 1484 889 1402 60
GB 24833 52 6769 25707 27 26524 43 25526 68 25575 18 26634 47 25287 94 23450 700 10724 133
MA 4578 0 3621 12441 0 13119 4 12808 1 12451 0 13127 4 12808 9 12679 2133 12725 121
NRH 8317 0 8317 6 2 6 0 8 0 0 0 6 0 8 0 3 2 0 0
SKB 7759 17 4417 8837 193 9525 217 9517 255 8854 191 9472 217 9535 259 8538 1530 6408 823
TOTAL 81546 83 38830 84228 244 86879 909 84749 400 84123 223 86937 312 84530 428 81194 2446 65346 2520
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0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Percent
Year
Figure III.5. 2.3. Percent of Children Under one who had DPTHB3 by Zoba and Year (2001-2012 )
“Information is a tool to support informed decisions at all levels not a vertical program”
5.3. Tetanus Toxoid Immunization of Women
All pregnant women attending routine health
services should be screened for their tetanus
toxoid (TT) immunization status and be
immunized to prevent tetanus infection
during delivery and neonatal tetanus. A
woman immunized with at least two doses
of tetanus toxoid vaccine (TT+2)develops
protective antibodies against tetanus
protecting the infant against tetanus at birth
for the first two months of its life .coverage
with two doses of tetanus toxoid in 2012 is
16.2 %about 3.1% less than in 2011. The
Percent of pregnant women who had at
least two doses of TT vaccine is showing
decreasing trend starting 2012that needs
attention in order to increase the number of
protected children at birth (Figure
III.5.2.3.).TT vaccine is given to all
reproductive age group although the targets
are pregnant women .Thus once a woman
who is in productive age has 5 doses of
TT; she is not required to be immunized
when pregnant. Only the new entry to the
production age and those who was not
immunized are targeted for the
immunization. Therefore, the coverage may
remain low compared to the estimated
number of pregnant women. However, the
percent of children who had DPTHB1 who
were tetanus protected at birth in 2012 was
91.7 % (Figure III.5.3.1) indicating low
coverage of TT2
Type of
Vaccine
Table III.5.2.4 Number of Under One Children Immunized by Year and Type of vaccines(2002-2012)
Years
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BCG 69249 75636 80957 82594 84193 82488 83438 76286 76938 86000 81546
OPV 0 23354 26039 26186 26029 29141 30059 31398 76286 34513 39324 38830
OPV1 72049 73518 81106 83308 84502 83929 85836 79389 77438 88660 84228
OPV 2 71474 73353 79592 81900 85460 82772 85742
80152
77859
88648
86879
OPV3 65605 70392 75569 76138 81314 78507 82631 77547 74916 84298 84749
DPTHepB1 71956 73580 80899 82695 84549 84033 85747 79111 77227 88639 84123
DPTHepB2 71409 72592 79675 81658 85536 82869 85489 79935 77692 88669 86937
DPTHepB3 65524 70259 75759 76412 81375 78903 82589 77595 75232 84142 84530
Measles 56435 65953 69071 72301 80652 75554 81133 75707 69891 75718 81194 Fully
Immunized 53354 62233 65418 72226 77894 71075 77391 72006 65510 71051 65346
“Information is a tool to support informed decisions at all levels not a vertical program”
+ immunization. The TT2 coverage pregnant women TT immunized per year is illustrated in
Table(III.5.3.1)
III.6. Immunization Preventable Diseases (VPD)
Table III.5. 3.1. Percent of pregnant women who had TT2+ vaccine by Year and
Zoba (1999-2012)
Year
Zoba
Total Anseba Debub DKB GB Ma SKB
1999 41.2 23.4 39.3 53.3 36.0 34.3 37.3
2000 38.1 20.2 23.9 44.5 34.6 24.5 31.9
2001 37.2 41.8 33.9 60.5 37.3 27.8 41.5
2002 35.9 42.6 31.0 64.4 43.6 25.4 43.0
2003 31.1 35.2 32.9 66.5 44.0 24.3 40.6
2004 42.2 37.5 33.1 82.6 47.8 27.2 47.6
2005 37 35.9 26.5 70.5 49 28.9 44.1
2006 25.8 38.7 25.6 53.5 47.3 24.3 38.6
2007 28.6 34.2 56.8 54.0 49.3 27.2 39.9
2008 14.0 21.2 34.0 29.6 31.5 17.4 23.3
2009 16.9 18.8 27.0 31.4 23.9 17.7 22.0
2010 21.7 23.0 41.5 30.9 28.4 21.8 25.7
2011 14.6 13.8 23.8 29.5 17.9 18.6 19.3
2012 13.0 11.0 24.0 23.5 17.2 16.3 16.2
Zoba
Table III.5.3.3.Number of Non-Pregnant Women Immunized Against
Tetanus by Zoba in Y2012
Dose of Vaccines
TT1 TT2 TT3 TT4 TT5 TT2+
AN 4413 4223 3653 2666 1528 12070
DE 6396 6372 6731 4806 3715 21629
DKB 825 991 758 588 460 2797
GB 5414 3924 2823 1411 1041 9199
MA 3311 2606 3107 3058 2073 10840
SKB 1914 1600 1484 945 668 4697
Total 22273 19712 18556 13474 9485 61232
“Information is a tool to support informed decisions at all levels not a vertical program”
Immunization programs have led to eradication of
vaccine preventable disease, and substantial
reductions in the morbidity and mortality attributed
to measles, Pertussis, Polio, Tetanus, Diphtheria and
TB which is very important. However, the
downward trend in morbidity and mortality from
VPDs is maintained and carefully monitored, and
that changes are interpreted in relation to
vaccination coverage. In this report as with the
emergency of HIV/AIDS, the incidence and
prevalence of TB is expected to remain high an
opportunistic disease. Therefore, it is dealt
separately in the burden of disease section.
Morbidity and mortality reports of Vaccine preventable disease
Mortality and Morbidity estimates can be used
priority public health interventions. For VPDs, these
estimates indicate the number of deaths and cases
that could be averted if exiting vaccines were used
to their fullest potential. Immunization program
targets are children less than one year of age.
However, some vaccines such as Hepatitis B and
HiB vaccine were introduced recently as a result the
herd immunity to these diseases is low. Thus, the
cases could be more prevalent than diseases its
vaccines introduced earlier. Moreover, some of the
VPDs are diagnosed clinically due to the absence of
laboratory facilities in the country and samples are
sent aboard for conformation like AFP. Measles
samples were used to be sent aboard, but now the
laboratory facilities are available in the country
There were no confirmed polio and there were measles cases in 2012 but only clinically cases of Diphtheria are
reported. In 2012, out of the total number of new OPD/IPD cases reported in all age group from hospitals and
health centres only 0.088%( 1196) illness were due to VPDs. The figure in 2012was less than 2011 by about
0.082 The numbers of reported deaths in 2012 were Nine and causes was reported as Hepatitis B. The number
of vaccine preventable cases and deaths in hospitals and health stations is presented in III.6.1,III.6.2 Immunization preventable diseases have decreasing trends that could be attributable to the effectives of the
immunization program and increased awareness in utilizing the services. The decrease in morbidity and
mortality of immunizable diseases has impact in reducing infant and child mortality as the EDHS 2002 finding
indicated.
The morbidity rate has been consistently low in the six years with slight peak in year 2006.This consistent low
occurrence indicates higher herd immunity contributing to the
lower possibility of spread of the diseases to cause outbreaks. The trends of immunization coverage and
morbidity of vaccine preventable disease have been inversely in the last 3 years. As the immunization coverage
increases, the percentage of immunization disease morbidity decreases.
Table III.6.1.Number of Cases and Deaths of Immunization Preventable
Diseases in Hospitals and Health Centers by Type of Diseases and
Zoba in Y2012
Zoba
Zoba
A
N
D
E
D
K GB MA NR SK
Total
<5 >5
Measles C 30 21 89 91 9 0 338 76 502
NNT C 0 0 0 0 1 0 0 1 0
Other
Tetanus
C 0 1 0 1 0 2 2 0 6
D 0 0 0 1 0 0 2 0 3
Pertussi C 0 13 0 1 21 76 97 31 177
“Information is a tool to support informed decisions at all levels not a vertical program”
Diphthri C 0 1 0 4 1 2 0 1 7
AFP C 0 0 1 4 6 1 1 5 8
Hep. B C 7 18 3 15 140 177 13 126 247
D 1 0 0 2 2 1 0 1 5
Total cases 37 54 93 116 178 258 451 240 947
Total Deaths 1 0 0 3 2 1 2 1 8
Measles
from HS 75 12 22 57 41 0 19
81 145
TableIII.6.2. Number of Suspected Vaccine
Preventable Diseases in Health Stations in Y2012
Zoba Morbidity Cases Total
AFP Measles NNT
AN 17 75 2 94
DE 0 12 0 12
DKB 0 22 4 26
GB 3 57 3 63
MA 1 41 0 42
SKB 3 19 0 22
Total 24 226 9 259
Cases
Table III.6.4.Yearly Trends of Suspected Vaccine Preventable Disease Cases in Health Station
(2000-2012 )
Year
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012
NNT 2 0 3 1 10 9 10 13 0 1 1 12 8 9
Measles 1022 1115 1076 269 285 326 16 131 147 32 60 129 171 226
AFB 61 130 528 334 438 26 6 97 7 11 13 17 17 24
Total 1085 1245 1607 604 733 361 32 241 154 44 74 158 196 259
% 0.13 0.15 0.20 0.06 0.08 0.02 0.004 0.03 0.02 0.004 0.009 0.019 0.021 0.001
Key C= cases D=death
“Information is a tool to support informed decisions at all levels not a vertical program”
TableIII.6.3.Yearly Trend of Number of Cases and Deaths of Immunization Preventable Diseases in
Hospital & Health Centers in (2000-2012 )
VPD Year
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
NNT C 3 1 1 1 2 1 1 2 1 1 9 12 1
D 0 1 1 0 1 1 0 0 0 0 0 0 0
Other
Tetanus
C 13 7 13 3 11 15 9 9 4 21 7 5 6
D 4 0 1 1 3 4 2 3 0 1 1 0 3
Whooping
Cough
C 168 75 149 56 6 48 65 47 34 71 11 91 208
D 0 0 0 0 0 0 0 0 0 0 0 0 0
Diphtheria C 3 1 3 0 0 0 0 7 3 4 3 4 8
D 0 0 0 0 0 0 0 0 0 0 0 0 0
Measles C 826 29 262 275 29 34 88 11 21 13 47 42 578
D 0
1
0
3 0 0 0 0 0
0 0 0
0
AFB C 0 3 0 33 11 22 16 20 19 28 13 9 13
D 0 0 0 0 0 0 0 0 0 0 0 0 0
Hepatitis B C 187 207 192 142 172 274 103 239 477 210 220 183 373
D 13 1 3 6 0 2 1 6 7 0 1 3 6
Total C 1187
316 635 518 233 394 282 335 559
348 310 346
1196
D 17 3 6 9 4 7 3 9 7 1 2 3 9
Percent morbidity
0.16 0.03 0.07 0.06 0.03 0.03 0.02 0.03 0.05
0.04
0.03
0.03 0.10
Percent mortality 0.6 0.2 0.3 0.45 0.2 0.3 0.1 0.3 0.3 0.00 0.02 0.14 0.34
“Information is a tool to support informed decisions at all levels not a vertical program”
88
IV. OUTPATIENT AND INPATIENT SERVICES
In 2012 the outpatient services in Eritrea is
provided in health stations, health centres,
hospitals, and private for profit clinics with the
Ministry of Health remaining the major service
provider. The inpatient services are provided only
by health centres and hospitals.
Hospitals are divided into three levels. The primary
level hospitals that provide preventive and curative
services which function at the community level
receiving referrals from health centres. Some health
centres also function as community hospitals. The
secondary level hospitals are the zoba referral
hospitals that receive referrals from the primary
level hospitals and provide general outpatient and
inpatient services. The tertiary level hospitals are
the National referral hospitals that provide
specialized outpatient and inpatient services.
IV.1. OUTPATIENT SERVICES
Number of Patients
The outpatient departments in health facilities
provide patient consultation services, diagnostic
services, emergency and physiotherapy services.
In 2012, a total of 2,111,888 patients had first and
311,630 repeat OPD visits for different health
problems without including the repeat visits for
treatments (injections, medications and dressings).
(Table IV.1.1. and IV.1.2.).
From the total OPD first visit patients, about 7 %
were children less than one year old, about 16%
were children 1 to 4 years old and the rest about
77% were 5 years old and above. About 28% of all
patients visited Hospitals, Health centers
about 24%, health stations about 46%
and different clinics about 1% (Table IV.
1.3). This indicates
that most of the patients go to health
stations for outpatient services. The
reason could be that, health stations are
the nearest health facilities to most
households in the country.
Out of the total OPD first visits, only
about 9% visited the National Referral
Hospitals which includes Asmara
Physiotherapy Center and Orotta
International Operation Centre for
Children.
First visits are highest in Maekel,
followed by Gash Barka and Debub. The
repeat visits are highest in National
Referral Hospitals (Table IV.1.1. and
IV.1.2.).
Table IV.1.1. Number of First OPD Visit Patients in Health
Facilities (Ho, HC, HS, Cl ) by Zoba and Age category (2012)
<1 1-4 5 and above Total %
AN
23,911
58,739
280,677
363,327
17.2
DE
35,262
65,928
278,649
379,839
18.0
DKB
4,081
10,829
50,755
65,665
3.1
GB
30,871
66,683
316,397
413,951
19.6
MA
25,357
67,139
351,174
443,670
21.0
NRH
9,874
22,662
163,991
196,527
9.3
SKB
16,860
41,503
190,546
248,909
11.8
Total
146,216
333,483
1,632,189
2,111,888
100.0
%
6.9
15.8
77.3
100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
89
Looking at the trends of the total number of
patients visiting the OPD of hospitals and health
centres, it has increasing trends especially after
2008 (Figure IV.1.2.). However, despite the
increased number of health stations, the number of
OPD first visit patients has almost a constant trend
with a slight increase in 2012 (Figure IV.1.4.). And
the number of patients visiting private clinics had
significantly decreased in 2011 and 2012. It might
be due to irregular reporting and closure of most
private clinics (Figure IV.1.3.).
In hospitals and health centers the number of repeat
visit patients for injection treatment has a
decreasing trend that may be related to infection
prevention implementation through avoiding
injection treatments whenever possible. And repeat
visit for medication has significantly increased in
2011 and 2012 relative to the previous three years
(Figure IV.1.1.).
Figure IV.1.1. Number of Repeat Visit Patients for
Injection and Medication in Hospitals and Health Centers
by Year (1998-2012)
Table IV.1.2. Number of Repeat OPD Visit Patients (Ho ,
HC, HS, Cl)by Zoba and Age category (2012)
<1 1-4
5 and
above Total %
AN
481
874
19,444
20,799
6.7
DE
862
1,578
42,078
44,518
14.3
DKB
375
825
6,256
7,456
2.4
GB
1,247
2,731
17,205
21,183
6.8
MA
1,570
3,590
53,505
58,665
18.8
NRH
1,733
4,976
134,895
141,604
45.4
SKB
893
1,7189
14,793
17,405
5.6
Total
7,161
16,292
288,176
311,630
100
%
2.3
5.2
92.5
100.0
Injection
0
50000
100000
150000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Number
Year
Figure IV.1.3. Number of New OPD Visit patients in Private Clinics by Year
(2003-2012)
HOHC
0
100000
200000
300000
400000
500000
600000
700000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Number
Year
Figure IV.1.2 Number of New OPD Visit Patients in hospital and HC/MCH by Year (2003-2012)
“Information is a tool to support informed decisions at all levels not a vertical program”
90
Number of Referrals
In 2012, a total of 46,394 patients were referred
from different health facilities to the next referral
level for either further investigation or case
management. The referral levels included health
stations to health centres, health centres to
community hospitals and zoba referral hospitals
and zoba referral hospitals to National Referral
Hospitals.
The National referral hospitals may also refer to
other National referral hospitals for special cases
such as Orotta National Medial Surgical Hosptial
may refer a patient to Ophthalmic National referral
hospital for ophthalmic problems or St. Mary
Psychiatric hospital for psychiatric problems. The
National Referral Hospitals may also refer cases to
hospitals outside the country for
complicated cases its treatment is not
available in the country.
From the total referred patients, about
64% were referred from health stations,
above 19% from health centres and about
17% from hospitals (Table IV.1.4.).
Table IV. 1.4. Number of Patients Referred
from One Level to the Other by Type of Health
Facility (2012)
OPD IPD Total %
Ho 6091 1751 7842 16.9
HC 7097 1959 9056 19.5
HS 29496 0 29496 63.6
Total 42684 3710 46394 100.0
% 92.0 8.0 100.0
The annual trend of the percent of
hospital outpatient referrals to other
hospitals is constant in the last three
years which is about 1%. (Figure IV.1.5.)
But the annual trend of the percent of
health center outpatient referrals to other
hospitals has a decreasing trend in the
last three years and the referrals from
health stations to other health facilities
has an overall increasing trend with a
slight increase in this year (Figure IV.1.6
and Figure IV.1.7.). The number of
referred inpatients by age category and
zoba is presented in Tables IV.2.2,
IV.2.3 and IV.2.4.
Looking at the age categories that are
referred about 71% of hospital inpatient
referrals and about 74% of health
centre’s inpatient referrals were five
years old and above. Similarly about
75% of health station’s OPD referrals
were five years old and above. On the
other side about 29% of hospital
inpatient referrals, 26% of health centres
inpatient referrals and similarly about
Table IV.1.3. Proportion of First Visit OPD Patients by
Type of Health Facilities and Age Categories (2012).
Type of HF
Age Categories
<1 1-4 5 and above Total
Ho 22.6 23.3 30.0 28.5
HC 28.5 28.0 23.5 24.5
HS 48.9 48.6 45.3 46.1
CL 0.03 0.1 1.1 0.9
Total 100.0 100.0 100.0 100.0
0
200000
400000
600000
800000
1000000
1200000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Number
Year
Figure IV.1.4. Number of New OPD Visit patients in Health Stations by Year
(2003-2012)
“Information is a tool to support informed decisions at all levels not a vertical program”
91
25% of health stations outpatient referrals were
under five years old.
Relating the referrals to the under five deaths, about
18% of the total under five deaths in health
facilities in 2012, occurred in health centres and
health stations. There could be chance of survival
of some of the children if they could be referred on
time. However, these deaths in health centres and
health stations may occur because of the late arrival
of patients. (Table IV.2.6.)
“Information is a tool to support informed decisions at all levels not a vertical program”
92
Number of Reported Cases
A patient may come to OPD of different health
facilities for different complaints and may have
more than one health problem. Thus, the number of
reported OPD cases is either equal to or more than
the number of patients. In accordance to this, a total
of 1,215,598 new cases were reported in hospitals,
health centers and clinics OPD using ICD 10 code
while another 1,059,569 cases were reported in
health stations OPD using serial number reporting
clinically diagnosed. Most of the cases reported
were from Maaklel as in case of the number of
patients (Table IV.1.5 and Table IV.1.6).
Table IV.1.6. Number of Reported New OPD cases in HS
by Zoba and Age category (2012)
<1 1-4
5 and
above Total %
AN 18052 44668 179680 242400 22.9
DE 24289 43246 135652 203187 19.2
DKB 2716 6533 38496 47745 4.5
GB 17594 39952 158677 216223 20.4
MA 15129 38525 166843 220497 20.8
SKB 7715 22279 99523 129517 12.2
Total 85495 195203 778871 1059569 100.0
% 8.1 18.4 73.5 100.0
About 23% of the total first visit patients
that visited OPD were children under
five. Similarly, about one fourth of the
reported cases (health problems) were of
children under five.
IV.2. Inpatient services Number of Discharged and referred
patients
In year 2012, a total of 122,928 patients
were admitted and discharged from
hospitals and health centers of which
about 28% were children under five
years of age which decreased by about
10% from that of 2011 (31%) (Table
IV.2.1).
Table IV.1.5 Number of Reported New OPD cases in Hospital,
health centre and clinics by Zoba and Age category (2012)
Zoba <1 1-4
5 and
above Total %
AN 9507 23859 120845 154,211
12.7
DE 16109 32181 163515 211,805
17.4
DKB 1658 4943 17068 23,669
1.9
GB 17720 38454 144802 200,976
16.5
MA 14967 40772 218606 274,345
22.6
NRH 10380 23312 172617 206,309
17.0
SKB 12089 25821 106373 144,283
11.9
Total
82,430
189,342
943,826 1,215,598
100
%
6.8
15.6
77.6 100
Table IV.2.2. Total Number of Referred Inpatients to
other Facilities by Zoba and Age category (2012)
Zoba <1 1-4
5 and
above Total %
AN 111 103 423 637 17.2
DE 149 157 1029 1335 36.0
DKB 5 1 22 28 0.8
GB 51 96 695 842 22.7
MA 11 21 177 209 5.6
NRH 217 1 11 229 6.2
SKB 51 38 341 430 11.6
Total 595 417 2698 3710 100.0
% 16.0 11.2 72.7 100.0
Table IV.2. 1. Total Reported Number of Inpatients in Ho
and MC/HC by Zoba and Age category (2012)
Zoba <1 1-4
5 and
above Total %
AN 2811 3377 12513 18701 15.2
DE 3631 3986 21295 28912 23.5
DKB 323 318 1547 2188 1.8
GB 2250 3182 12674 18106 14.7
MA 652 1083 7303 9038 7.4
NRH 4914 4480 24329 33723 27.4
SKB 2111 1847 8302 12260 10.0
Total 16692 18273 87963 122928 100.0
% to
total 13.6 14.9 71.6 100.0
% Ho 75.4 70.8 76.6 75.6
% HC 24.6 29.2 23.4 24.4
“Information is a tool to support informed decisions at all levels not a vertical program”
93
Number of Deaths
Most of the deaths in five and above age
group occur in National Referral
Hospitals (about 33%). NRH is followed
by Gash Barka and Debub with higher
proportion of total reported deaths.
(Table IV.2.5).
The reason for high reported inpatient
deaths in NRH could be that patients
come to health facilities very late when
not much can be done to save them or
there could be some other problems that
need further follow up and assessment.
Table IV.2.3. Number of Inpatients Referred from
Hospitals, Mini Hospitals, MCH clinics to other
Hospitals by Zoba and Age category (2012)
Zoba <1 1-4
5 and
above Total %
AN 33 18 165 216 12.3
DE 65 62 612 739 42.2
DKB 5 1 22 28 1.6
GB 13 23 194 230 13.1
MA 8 7 51 66 3.8
NRH 217 1 11 229 13.1
SKB 29 24 190 243 13.9
Total 370 136 1245 1751 100.0
% 21.1 7.8 71.1 100.0
Table IV.2.4. Number of Inpatients Referred from
Health Centers to Hospitals by Zoba and Age
category (2012)
Zoba <1 1-4
5 and
above Total %
AN 78 85 258 421 21.5
DE 84 95 417 596 30.4
DKB 0 0 0 0 0.0
GB 38 73 501 612 31.2
MA 3 14 126 143 7.3
NRH 0 0 0 0 0.0
SKB 22 14 151 187 9.5
Total 225 281 1453 1959 100.0
% 11.5 14.3 74.2 100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
94
Table IV.2.5. Number of Reported Deaths in OPD and
IPD of Hospitals and Health Centers by ICD code by
Age Category and Zoba (2012)
Zoba
Age Category
5 and
above Total % <1
1-4
yrs
Anseba 110 57 155 322 12.4
Debub 139 53 196 388 14.9
DKB 25 10 30 65 2.5
GB 125 100 234 459 17.7
Maakel 4 8 215 227 8.7
NRH 157 44 649 850 32.7
SKB 124 57 108 289 11.1
Total 684 329 1587 2,600 100.0
% 26.3 12.7 61.0 100.0
IV.3. Number of Surgeries
Minor and major surgeries are performed
in health centres and hospitals. Although,
the type of surgeries performed could be
several, for reporting purposes it is
categorized in anatomical areas.
In 2012, 6,848 minor and 14,121 major,
a total of 20,969 surgeries were
performed. Out of which above 34%
were ophthalmic surgeries (Tables
IV.3.1. and IV.3.3.).
Ophthalmic National Referral Hospital
staff conducts most of the surgeries in
different zobas through their outreach
programs to increase access to the
service.
Orotta International Operation Centre for
Children in Asmara (IOCCA) performed
1.5% of all reported surgeries, 1.5% of
minor and 1.4% of major surgeries. This
centre is running by International
expertise in different surgical specialities
although the major areas are
orthopaedics and cardiac. For example,
about 82% of performed cardiac
surgeries in 2012 were conducted in this
centre. (Tables IV.3.2 and IV.3.3.)
Comparing the zobas, about 56% of all
surgeries were performed in National
Referrals followed by Anseba and
Debub. (Table IV.3.1 and Figure IV.3.1)
Table IV.2.6. Number and Proportion of Reported
Deaths by Type of Health Facility (2012)
Type of
Health
facility
Age Category
Total % <1 1 to 4
5 and
above
Hospital 588 273 1476 2337 86.8
HC 96 56 111 263 9.8
HS 25 16 50 91 3.4
Total 709 345 1637 2691 100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
95
Table IV.3.1. Number of Surgeries Performed by Zoba
and Classification of Surgery (2012)
Zoba
Classification of
Surgery
Total
%
Minor Major
AN 412 1933 2345 11.2
DE 1180 1155 2335 11.1
DKB 17 86 103 0.5
GB 559 1669 2228 10.6
MA 414 1236 1650 7.9
NRH 4050 7722 11772 56.1
SKB 216 320 536 2.6
Total 6848 14121 20969 100.0
% 412 1933 2345 11.2
Table IV.3.2.Number of Surgeries Performed by Orotta International Center for Child
Operation by Category and Classification of Surgery(2012)
Category of Surgery
Classification of Surgery
Total
% Minor Major A n o - r e c t a l3 9 12 3.9 B l a d d e r0 2 2 0.7 C a r d i a c
14 42 56 18.3 C h e s t / L u n g0 2 2 0.7 E y e ( O p h t h a l m i c )5 0 5 1.6 G a l l B l a d d e r2 1 3 1.0 G a s t r i c1 1 2 0.7 H e a d / C r a n i a l4 1 5 1.6 I n t e s t i n e0 7 7 2.3 L o w e r E x t r e m i t i e s
12 21 33 10.8 M o u t h / M a n d i b l e35 56 91 29.7 N e c k / T r a c h e o t o m y
1 0 1 0.3 U p p e r E x t r e m i t i e s16 7 23 7.5 U r e t h r a ( M a l e )
3 1 4 1.3 O t h e r7 53 60 19.6 T o t a l
103 203 306 100
% to total 33.7 66.3 100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
96
Table IV.3.3. Number and Proportion of Surgeries Performed
by Type and Category of Surgeries and Zoba (2012)
Category of Surgery
Zoba
Classification of
Surgery
Total % AN DE DKB GB MA NR SK Total Minor Major A n o - r e c t a l61 10 0 8 55 188 3 159 83 242 325 1.5 B l a d d e r28 54 0 0 30 40 7 68 3 156 159 0.8 C a r d i a c0 0 0 0 0 68 0 151 14 54 68 0.3 C h e s t / L u n g43 0 0 2 6 100 0 7230 46 105 151 0.7 E y e ( O p h t h a l m i c )
1042 613 69 1201 132 4173 0 325 2485 4745 7230 34.5 G a l l B l a d d e r12 8 0 2 188 112 3 46 2 323 325 1.5 G a s t r i c2 8 0 0 17 19 0 158 3 43 46 0.2 G o i t e r15 0 0 1 56 85 1 161 0 158 158 0.8 H e a d / C r a n i a l31 1 0 4 8 117 0 982 43 118 161 0.8 I n t e s t i n e
211 60 3 48 74 575 11 82 18 964 982 4.7 K i d n e y0 0 0 0 30 52 0 3 1 81 82 0.4 L i v e r0 0 0 0 0 3 0 1397 0 3 3 0.0 L o w e r E x t r e m i t i e s
127 14 1 48 137 1069 1 496 168 1229 1397 6.7 M o u t h / M a n d i b l e17 6 0 155 145 173 0 80 87 409 496 2.4 N e c k / T r a c h e o t o m y27 0 0 0 9 44 0 3 18 62 80 0.4 P a n c r e a s0 1 0 0 0 2 0 320 0 3 3 0.0 P r o s t a t e40 5 0 4 104 166 1 1336 0 320 320 1.5 U p p e r E x t r e m i t i e s
140 54 1 44 65 1031 1 770 178 1158 1336 6.4 U r e t h r a ( M a l e )74 338 1 107 37 194 19 2876 526 244 770 3.7 U t e r u s / O v a r y /F a l l o p i a n
430 488 16 249 159 1343 191 3952 148 2728 2876 13.7 O t h e r0 675 12 351 398 2218 298 20969 3014 938 3952 18.8 T o t a l
2345 2335 103 2228 1650 11772 536 13958 6848 14121 20969 100.0
% 16.8 16.7 0.7 16.0 11.8 84.3 3.8 100.0 32.7 67.3 100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
97
IV.4. Diagnostic Service
Laboratory and imaging are considered as
diagnostic services at present in Eritrea.
Hospitals, health centres, clinics and some
health stations provide diagnostic services that
differ in kind and composition depending on the
level of the health facilities. Hospitals provide
more complex services while health centres and
health stations provide only basic services.
Only hospitals provide imaging services while
laboratory services are provided at all levels of
facilities.
In 2012, 24(92.6%) hospitals, 47(78.6%) health
centers, 2 health stations, 3 MCH and 2 private
clinics reported laboratory services (Table
IV.4.2.1). On the other hand, 18 (59.3%)
hospitals, one Health Centre and one MCH
provided imaging services (Table IV.4.1.1).
The hospitals that do not provide the services
use the resources of the nearest hospital, like all
Orotta National Referral Hospitals use the
Orotta Medical Surgical Hospital resources.
IV.4.1. Imaging Services
In 2012, a total of 90,653 patients had the
service, of which about 90% were in outpatient
department. National referral Hospitals (56.9%)
provided most of the imaging services (Table
IV.4.1.2).
The total number of health facilities that
provide imaging services is illustrated in Table
IV.4.1.1. The type of imaging services provided
in different health facilities in 2012 were x-ray,
ultrasound and fluoroscopy.
Table IV.4.1.1. The Number of Health Facilities Reported
Imaging Services by Type and Zoba (2012)
Zoba
Type of Health facilities
HO HC HS MCH CL Total
AN 1 1
DE 5 5
DKB 1 1
GB 3 3
MA 2 1 3
NR 2 2
SKB 4 1 5
Total 18 1 0 1 0 20 % to type
of HF 80.0 10.0 0.0 5.0 5.0 100.0
Table IV.4.1.2 Number of Patients Who Received
Imaging Services by Department and Zoba (2012)
Zoba
Departments
Total % OPD IPD
AN 5527 1954 7481 8.3
DE 11088 1339 12427 13.7
DKB 816 120 936 1.0
GB 1962 933 2895 3.2
MA 10526 841 11367 12.5
NR 48019 3564 51583 56.9
SKB 3368 596 3964 4.4
Total 81306 9347 90653 100.0
% 89.7 10.3 100.0
“Information is a tool to support informed decisions at all levels not a vertical program”
98
In average 1.5 films were used per patient and
similar with last three years outpatient
department consumes about 90% of the films
used. National Referral Hospitals consumed
about 61 % of all the films (Table IV.4.1.3.).
IV.4.2. Laboratory Services
Availability of laboratory services is vital for
appropriate diagnosis and disease surveillance.
Thus, the Ministry is expanding the service to
the lowest level of health facilities. In 2012, a
total of 78 (23.3%) health facilities excluding
National Health Laboratory (NHL), reported
laboratory services (Table IV.4.2.1).
Some specialized health facilities may not need
to provide laboratory services, like the Orotta
Paediatric and Maternity National Referral
Hospitals use the Orotta Medical Surgical NRH
resources since the three of the hospitals are
located in the same vicinity.
The proportion of health facilities that provide
laboratory services in each zoba (except NRH)
compared to the total functional facilities in
all the zobas is around the average (about
23%) (Table IV.4.2.1.).
A total of 1,961,133 laboratory tests were
performed in all health facilities in 2012
excluding NHL. Similar to the imaging
service, the load in laboratory service was
the highest in National referral hospitals
(Table IV.4.2.2.).
Haematology and urinalysis are the most
common laboratory tests performed in most
health facilities in 2012 (Table IV.4.2.3)
The NHL performs more complicated tests
and serves as a referral centre for all health
facilities in the country.
Out of the total tests done, only about 21%
had positive results. Among the type of
laboratory tests, stool tests have the highest
positive rate (35.5%), followed by Malaria
(13.6%) (Table IV.4.2.4 and IV.4.2.5).
Table IV.4.1.3 Number of Films Used by Department and
Zoba (2012)
Zoba
Departments
Total % Film/pt OPD IPD
AN 6045 2197 8242 5.9 1.1
DE 14699 1768 16467 11.8 1.3
DKB 848 130 978 0.7 1.0
GB 3320 1185 4505 3.2 1.6
MA 17649 2713 20362 14.6 1.8
NR 78727 6061 84788 60.8 1.6
SKB 3558 510 4068 2.9 1.0
Total 124846 14564 139410 100.0 1.5
% 89.6 10.4 100.00
Film/pt 1.5 1.6 1.5*
Table IV.4.2.1. The Number of Health Facilities Providing laboratory Services by Type and Zoba (2012)
Zoba
Type of Health facilities
Total
% to
total HFs
Ho HC HS MCH CL
AN 1 9 1 0 0 11 29.7
DE 5 11 1 0 0 17 24.6
DKB 3 0 0 0 0 3 20.0
GB 3 13 0 2 0 18 22.2
MA 4 9 0 0 2 15 18.9
NR 4 0 0 0 0 4 50.0
SKB 4 5 0 1 0 10 20.4
Total 24 47 2 3 2 78 23.3
% to type
of HF 92.6 78.6* 1.1 14.3 4.5 23.1
“Information is a tool to support informed decisions at all levels not a vertical program”
99
Table IV.4.2.2. Number of Inpatients and outpatients who had
laboratory tests by Zoba (2012)
Zoba
Departments
Total
% IPD OPD
AN 6213 53518 59731 10.7
DE 9877 112797 122674 22.0
DKB 482 9011 9493 1.7
GB 8123 74772 82895 14.9
MA 6112 105011 111123 20.0
NR 25042 109047 134089 24.1
SKB 4522 32172 36694 6.6
Total 60371 496328 556699 100.0
Table IV.4.2.3. Number and Type of Laboratory Tests Performed by Zoba(2012)
Type of Laboratory Tests
Zoba
Direct
Microsc
opic
Sensiti
vity
Cultur
e
Haemato
logy
Stool
Parasitol
ogy
Parasit
ology
II
(Blood
Tissue
, Etc.)
Urinalysi
s
Clinical
Chemistr
y
Immuno
serology
Histol
ogy
Cytolog
y Other Total
%
AN 5718 0 31407 13661 5685 36283 19277 8932 0 0 2402 123365 6.3
DE 7946 1387 157320 29312 10592 106844 13311 15177 1960 140 8322 352311 18.0
DKB 1210 10 3629 2131 39 3726 1224 2108 0 26 55 14158 0.7
GB 3613 1854 55756 13184 25300 37624 1491 5875 166 602 1799 147264 7.5
MA 4411 208 375851 31383 7283 255777 9101 19886 2753 1687 7130 715470 36.5
NR 19008 104 86767 18703 7061 109182 153925 49260 1480 216 93436 539142 27.5
SKB 3045 0 19992 9348 4208 25825 0 4242 0 0 2763 69423 3.5
Total 44951 3563 730722 117722 60168 575261 198329 105480 6359 2671 115907 1961133 100.0
% 2.3 0.2 37.3 6.0 3.1 29.3 10.1 5.4 0.3 0.1 5.9 100.0
Table IV.4.2.4. Number of Some selected Laboratory Tests and Their Positive Results by Zoba (2012)
Type of Laboratory Tests and positive results
AFB Gram Stain-Gonococci Gram Stain-meningococci Hepatitis B
Zoba Tests +ve %
+Ve Tests +ve % +Ve Tests +ve % +Ve Tests +ve results % +Ve
AN 6694 242 3.6 64 11 17.2 4 0 0 213 3 1.4
DE 7533 282 3.7 398 22 5.5 5 0 0 810 54 6.7
DKB 1382 48 3.5 0 0 0 8 0 0 173 13 7.5
GB 5854 470 8.0 161 37 23 0 0 0 536 32 6
MA 7074 306 4.3 67 6 9 7 0 0 1928 20 1
NR 7839 255 3.3 1346 24 1.8 437 1 0.2 4209 205 4.9
SKB 3433 280 8.2 67 14 20.9 0 0 0 5 0 0
Total 39809 1883 4.7 2103 114 5.4 461 1 0.2 7874 327 4.2
“Information is a tool to support informed decisions at all levels not a vertical program”
100
V. DISEASE BURDEN IN ERITREA
The burden of diseases provides an indicator
that can be used to evaluate progress over
time within a country and relative
performance across countries and regions.
The disease burden in Eritrea as in case of
any other developing country is attributed to
infectious diseases, malnutrition and
maternal related health problems. These
health problems have negative correlation
with the socio-economic status of the people.
The better the socio-economic status, the less
is the occurrence of these health problems.
Thus, in societies with better socio-economic
status, these health problems have very low
occurrences compared to the poor countries.
This variation is also evident in urban and
rural societies even within the poor countries.
Urban dwellers have relatively better access
to basic social services than rural dwellers
that increases the risk of higher prevalence of
infectious diseases and malnutrition in rural
areas.
Among the diseases, acute respiratory
infection mainly pneumonia, diarrhea,
anemia and malnutrition, skin and eye
infection, malaria and HIV/AIDS have been
among the leading ten causes of morbidity
and mortality in the last 10 years.
The non communicable diseases such as
hypertension, diabetes, ophthalmic problem,
Table IV.4.2.5. Number of Some selected Laboratory Tests and Their Positive
Results by Zoba (2012)
Type of Laboratory Tests and positive results Leishmania Donovani Stool for Intestinal Parasites Malaria
Zoba Tests
+ve
results % +Ve Tests
+ve
results % +Ve Tests
+ve
results % +Ve
AN 1462 1 0.1 14931 8873 59.4 8066 866 10.7
DE 31 4 12.9 23507 7678 32.7 29026 2944 10.1
DKB 0 0 0 1359 410 30.2 30 5 16.7
GB 91 23 25.3 12418 4371 35.2 32932 6316 19.2
MA 440 109 24.8 16651 4640 27.9 4655 690 14.8
NR 8 3 37.5 17995 3443 19.1 6763 535 7.9
SKB 1 0 0 8633 4485 52.0 3389 201 5.9
Total 2033 140 6.9 95494 33900 35.5 84861 11559 13.6
“Information is a tool to support informed decisions at all levels not a vertical program”
101
psychiatric problems, and injuries are also
emerging health problems in Eritrea.
Like the previous years in 2012 the top ten
leading causes of outpatient morbidity alone
constitute above 90% of the total causes of
morbidity in under five age group. And the
top ten leading causes of mortality alone
constitute about 89% of the total causes of
mortality in children under one year old and
about 95% of all causes of mortality in
children aged between 1 to 5 years.
Similarly about 63% of the total outpatient
morbidity, above 43 % of the total inpatient
morbidity and about 64 % of inpatient and
outpatient mortality in five and above age
group is attributed to the top ten leading
causes. This means that, reducing the
morbidity and mortality of the ten leading
causes of morbidity and mortality can
decrease the total outpatient and inpatient
morbidity and mortality significantly. By
preventing only pneumonia and diarrhea, it is
possible to reduce child morbidity by above
46%.
V. 1. Top Ten Leading Causes of Morbidity and Mortality
In 2012, diarrhea, ARI mainly pneumonia,
skin, eye and ear infections, malnutrition,
fever of unknown origin, injury all types and
soft tissue injury are among the top ten leading
causes of outpatient and inpatient morbidity in
under-five years of age. In children under one,
about 27% of the deaths were related to
neonatal problems. Congenital malformations
were also among the top ten leading causes of
deaths in less than one year old.
The top ten leading causes of morbidity and
mortality in children less than one year of age
in hospitals and health centers attributed above
92% of outpatient morbidity and above 90% of
inpatient morbidity and about 89% of
outpatient and inpatient mortality (Table
V.1.1.). About 90% of outpatient and inpatient
morbidity and about 95% mortality in children
1-4 years old is due to those top ten leading
causes of morbidity and mortality. About 63%
of outpatient morbidity, above 43% of
inpatient morbidity and 64% of inpatient
mortality in five years and above age is due to
those top ten leading causes of morbidity and
mortality (Table V.I.2 and Table V.1.3)
This indicates that, by preventing different
infections, we can minimize about 90% of
morbidity and mortality in children under five.
Infectious diseases like Diarrheal Diseases and
Acute Respiratory Infections (ARI) are major
contributors towards the overall morbidity in
under-fives in Eritrea. The 2012 hospital and
health center report indicates that pneumonia
alone contributed to about one fourth (25%) of
all under-five deaths.
In five and above age group, ARI, ORO-dental
infection, gastritis/ulcer, urinary tract infection
and diarrhea all forms were the top five causes
of morbidity in OPD.
From the communicable diseases, HIVAIDS,
Pneumonia and TB accounted heavy toll
(about 23%) for mortality in the five and
above age group. At the same time, the non
communicable diseases, injury all types, heart
diseases, diabetes, anemia all types and
hypertensive related diseases accounted for
29% of the total deaths in this age group
reported in hospitals and health centers (Table
V.1.3.). Injury all types (with out soft tissue
“Information is a tool to support informed decisions at all levels not a vertical program”
102
injury) is the first cause of morbidity in IPD
and sixth cause of morbidity in OPD of the
five and above age group.
The situation of the burden of diseases
indicated in 2012 has similar pattern with 2010
and 2011.
“Information is a tool to support informed decisions at all levels not a vertical program”
103
“Information is a tool to support informed decisions at all levels not a vertical program”
104
Table V.1.1. Ten Leading causes of morbidity and mortality in under One years of age in hospitals and health
centers, (2012)
Morbidity IPD and OPD Deaths % to
total
deaths Rank OPD IPD % to
total
morbidit
y burden
Causes Number % to
total
OPD
burden
Causes No. Causes No.
1 Diarrhea all
forms 21547 26.1
Pneumonia all
types 5826 34.9
Pneumonia
all types 145 21.2
2 Pneumonia
all types 20608 25.0
Diarrhea all
forms 2976 17.8 Septicemia 97 14.2
3 ARI (With
out
pneumonia) 20539 24.9
Low birth
weight 2355 14.1
Malnutrition,
all types 85 12.4
4 Skin
infection &
scabies 3024 3.7
Malnutrition,
all types 1372 8.2
Low birth
weight 82 12.0
5 Infection of
eye including
trachoma 3012 3.7 Neonatal sepis 833 5.0
Diarrhea all
forms 69 10.1
6 Ear infection 2884 3.5
ARI (With out
pneumonia) 788 4.7
Neonatal
sepis 52 7.6
7
Malnutrition,
all types 1436 1.7 Septicemia 411 2.5
Other
perinatal and
neonatal
problem
26 3.8
8 Fever of
unknown
origin 1396 1.7
Other perinatal
and neonatal
problem 240 1.4
Intrauterine
hypoxia/birth
asphyxia 25 3.7
9 Injury all
types 919 1.1
Intrauterine
hypoxia/birth
asphyxia 193 1.2
Congenital
malformation
s 16 2.3
10 Other urinary
tract infection 907 1.1
Injury all
types 144 0.9
Anemia, all
types 13 1.9
Total 10 leading 82430 92.5 Total top 10 16692 90.7 Total top 10 684 89.2
“Information is a tool to support informed decisions at all levels not a vertical program”
105
Table V.1.2. Ten Leading causes of morbidity and mortality in 1-5 years of age in hospitals and health centers, (2012)
Morbidity IPD and OPD Deaths % to
total
deaths Rank OPD IPD % to
total
morbidity
burden
Causes Number % to
total
OPD
burden
Causes No. Causes No.
1 Diarrhea all
forms 49319 26.0
Pneumonia
all types 6851 37.5
Malnutritio
n, all types 138 41.9
2 ARI (With
out
pneumonia)
47025 24.8 Diarrhea all
forms 3691 20.2
Diarrhea all
forms 52 15.8
3 Pneumonia
all types 34870 18.4
Malnutrition,
all types 3242 17.7
Pneumonia
all types 47 14.3
4 Skin
infection &
scabies
9928 5.2 ARI (With out
pneumonia) 1026 5.6 Septicemia 40 12.2
5 Injury all
types 6537 3.5 Injury all types 849 4.6
Anemia, all
types s 13 4.0
6 Ear
infection 6418 3.4 Burns 530 2.9
Injury all
type 7 2.1
7 Infection of
eye
including
trachoma
5756 3.0 Malaria , all
types 422 2.3 Burns 5 1.5
8 Malnutrition
, all types 4805 2.5
Skin infection
& scabies 192 1.1
Malaria , all
types 4 1.2
9 Soft tissue
injury 3542 1.9 Septicemia 183 1.0
Heart
diseases 4 1.2
10 Fever of
unkown
origin
3408 1.8 Asthma 167 0.9 Hepatitis 4 1.2
Total 10 leading 189342 90.6 Total top 10 18273 93.9 Total top 10 329 95.4
“Information is a tool to support informed decisions at all levels not a vertical program”
106
Table V.1.3. Ten Leading Causes of Morbidity and Mortality in Five Years and Above of age in hospitals and health
centers, (2012)
Morbidity IPD and OPD Deaths % to
total
deat
hs Rank OPD IPD % to
total
morbidity
burden
Causes Number % to
total
OPD
burden
Causes No. Causes No.
1 ARI (With
out
pneumonia)
135082 14.3 Injury all
types 6792 7.7
Pneumonia
all types 155 9.8
2 Oro - dental
infection 72988 7.7
Obs
emergencies 5138 5.8
Injury all
types 146 9.2
3 Gastritis /
duodenal
ulcer
67733 7.2 Pneumonia
all types 4938 5.6 Hiv/aids 131 8.3
4 Other
urinary tract
infection
61086 6.5 Malaria , all
types 4288 4.9
Heart
diseases 127 8.0
5 Diarrhea all
forms 60314 6.4
Abortion, all
types 4080 4.6
Other
causes of
death
103 6.5
6
Injury all
types 54390 5.8
Cataracts and
other lens
disorders
3422 3.9
Stroke, not
spec.as
haemmorha
ge/
infarction
92 5.8
7 Skin
infection &
scabies
44962 4.8 Diarrhea all
forms 3336 3.8 Tb, all types 75 4.7
8 Infection of
eye
including
trachoma
35898 3.8
Other urinary
tract
infection
2426 2.8 Diabetes
mellitus 68 4.3
9 Soft tissue
injury 34648 3.7
Gastritis /
duodenal
ulcer
2018 2.3 Anemia, all
types 65 4.1
10 Pneumonia
all types 31718 3.4
Soft tissue
injury 1819 2.1
Hypertensiv
e related
diseases
54 3.4
Total 10 leading 943826 63.4 Total top 10 87963 43.5 Total top 10 1587 64.0
“Information is a tool to support informed decisions at all levels not a vertical program”
107
V.2.Trends and Patterns of Morbidity and Mortality of the Ten Leading
Causes
An important step in understanding the health
status and the factors that improve or harm health
is to document patterns of morbidity and mortality
and rank the causes in order of their frequency
and public health importance.
Acute respiratory infection (ARI including
pneumonia) and diarrhea were consistently the
first two causes of morbidity in outpatient and
inpatient in the last eleven years and they were the
second and fourth causes of mortality respectively
in under-five years of age in 2011 or 2012. About
70% of the disease burden in OPD/IPD of under 5
years old is due to these diseases and are
responsible for about 30% of all deaths in the
same age group in 2012. In the five and above
age group, ARI was also the first cause of
outpatient morbidity, inpatient mortality and the
second cause of inpatient morbidity. In low
resource settings these diseases are mainly
attributed to low nutritional status, poor sanitary
conditions, socio-economic developments,
behavioral and environmental factors.
Communicable diseases are still taking a high
toll in inpatient mortality in the five and
above age group. Among the leading causes
of inpatient mortality in above five age group
are ARI including Pneumonia, HIV/AIDS
and TB, and account for about 23% of all
reported deaths in 2012.
Anemia and Malnutrition combined was the
first cause of death in the last four years
(2009 -2012) and the third cause of admission
for the last eleven years (2002 -2012) for
under-five. It accounts for about 25% of the
total reported deaths in under-five in 2012,
and it is the sixth cause of morbidity in
outpatient departments for the same age
category.
The trends as ranked from one to ten are
illustrated in Tables V.2.1 to V.2.6.
“Information is a tool to support informed decisions at all levels not a vertical program”
108
Table V.2.1. Trends of Top 10 Causes of Outpatient Morbidity in Children Under
Five in Hospitals and health centers (2002-2012) Year
Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
ARI(with Pneumonia) 1 1 1 1 1 1 1 1 1 1 1
Diarrhea 2 2 2 2 2 2 2 2 2 2 2
Skin infection 3 3 3 3 3 3 3 3 3 3 3
Eye Infection 4 5 6 6 6 6 4 4 5 5 5
Ear Infection 5 6 4 4 4 5 6 6 6 4 4
Anemia &Malnutrition 6 4 5 5 5 4 5 5 4 6 6
Soft tissue Injury 8 9 9 9 8 8 8 8 9 9
Fever of Unknown Orgin 9 10 10 8 7 7 7 7 7 8 8
Other UTI 10 10 9 11 11 10 10
Injury all types 7 7
Table V.2.2. Trends of Top 10 Causes of Outpatient Morbidity in 5 Years and Above in Hospitals
and health centers (2002-2012) Year
Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
ARI(with Pneumonia)
1
1
1
1 1
1
1
1 1
1
1
Oro-dental infection
5
5
3
2 2
2
2
3 3
2
2
Skin infection 3 3 2 5 5 3 3 4 4 7 7
Diarrhea 2 2 5 3 3 4 4 2 2 6 5
Gastritis/D. Ulcer
4
4
4
4 4
5
5
6 5
3
3
Other UT diseases
6
6
6
6 6
6
6
5 6
4
4
Eye Infection 7 7 7 7 7 7 7 7 7 8 8
Soft tissue injury 8 8 8 8 8 8 8 8 9 9
Rheumatoid arthritis 10 12 9 9 9 10 10 9 9 10 10
Injury all types 5 6
“Information is a tool to support informed decisions at all levels not a vertical program”
109
Table V.2.3. Trends of Top 10 Causes of Inpatient Morbidity in Under 5 years old, in
Hospitals and Health Centers (2002-2012) Year
Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
ARI(with Pneumonia) 1 1 1 1 1 1 1 1 1 1 1
Diarrhea 2 2 2 2 2 2 2 2 2 2 2
Anemia&Malnutrition 3 3 3 3 3 3 3 3 3 3 3
Septicemia 5 5 4 4 4 4 4 4 4 9 8
Malaria 4 4 5 5 5 5 5 6 5 7 9
Skin infections 6 6 6 9 7 6 6 9 8 10 10
Neonatal Sepsis 8 10 7 8 6
Burns 9 9 8 10 6 7
Low birth Weight 5 4 4 4
Injury all types 5 5
Table V.2.4. Trends of Top 10 Causes of inpatient morbidity in Five Years and Above in
Hospitals and health centers (2002-2012) Year
Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Malaria 1 1 4 1 2 1 5 5 2 4 4
ARI and Pneumonia 3 2 1 2 1 2 3 2 3 2 2
Diarrhea 4 4 5 5 6 5 4 3 5 6 7
Abortion 2 3 3 4 4 3 2 4 4 5 5
Cataract/lens disorder
5
5
6
6 5
4
7
10 10
8
6
Other UT diseases 7 7 7 7 8 6 8 7 7 7 8
OBS Emergencies
6
2
3
3
7
1
1 1
3
3
Gastritis/D. Ulcer 8 8 9 8 7 8 9 8 8 9 9
Soft tissue injury 9 10 10
Injury all types Merging of all types started in 2011 1 1
Table V.2.5. Trends of Top 10 Causes of Inpatient Deaths in Under 5 years old, in
Hospitals and Health Centers (2002-2012)
Year
Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
ARI(with Pneumonia) 1 1 1 1 1 1 1 2 2 2 2
Diarrhea 2 3 2 3 3 3 3 3 3 4 4
Anemia&Malnutriti 3 2 3 2 2 2 2 1 1 1 1
Septicemia 4 4 4 4 4 4 4 4 4 3 3
Heart disease 8 7 6 10 9 11 9 10
Intra uterine
hypoxia/asphexia
7
7 7 8 7 7 8
Neonatal sepsis 10 8 8 6 6 6 6
Low birth weight. 7 6 6 5 5 5 5
Congenital
malformation
10 10 9 9 10 9
Other perinatal and
neonatal problems
10 8 8 7
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110
Table V.2. 6. Trends of Top 10 Leading Causes of Inpatient Deaths in Five Years and
Above in Hospitals and health centers (2002-2012) Year
Causes 2002 2003 20
04
2005 2006 2007 2008 2009 2010 2011 2012
HIV/AIDS 1 1 1 1 1 1 1 1 1 1 2
ARI(with Pneumonia) 3 3 2 2 2 2 3 2 3 2 1
TB 2 2 3 3 3 4 5 4 4 4 6
Hypertension 5 4 4 6 4 6 6 8 7 10 9
Anemia & Malnutrition 9 7 9 8 7 3 4 6 6 9 8
Diabetes Mellitus 8 10 7 7 5 8 8 10 8 7 7
Heart diseases 7 5 5 10 8 5 2 3 2 3 3
Septicemia 10 11 6 9 9 11 13 13 14 10
Stroke 9 9 5 5
Injury all types 6 4
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111
V. 3. Situation of Some Selected Leading Causes of Disease Burden
V.3.1. HIV/AIDS
HIV/AIDS is a fatal infectious disease that
negatively affects the productivity and development
of a country. Thus, it is one of the priorities of the
Ministry of Health of the State of Eritrea.
The first cases of HIV/AIDS in Eritrea were
reported in 1988. From 1998-2012, a total of 26,444
HIV new cases and 3076 deaths were reported in
hospitals and health centers. Since 1998, in average,
about 1762.9 new cases have been reported every
year in hospitals and health centers as indicated in
Figure V.3.1.
Figure V.3.1 Number of HIV/AIDS cases 1998-2010
The reported number of new HIV/AIDS cases in the
health facilities has a decreasing trend since 2006
(Figure V.3.1.), that could be attributed to actual
decrease in the number of new infection as evident
in decreasing trends of HIV positive rate in VCT
and PMTCT attendees (Figure V.3.1.1), blood
donors (Figure V.3.1.2), and Antenatal sentinel site
survey results (Figure V.3.1.4.).
The 2007 and 2011 HIV antenatal sentinel
survey indicated that the prevalence of HIV
in the population was 1.28 % and 0.79%
respectively with variations in different sub
groups and regions.
The over all HIV positivity rate in VCT
clients in 2012 was 1.03%. This is less than
that of 2011 which was 1.77%. (Figure
3.1.1) Similarly, the over all HIV positivity
rate in PMTCT clients in 2012 report was
0.47%. This is slightly greater than that of
2011 (0.45%).
To combat HIV/AIDS, the Ministry of
Health through National AIDS and TB
Control Division (NATCoD) is
implementing a multi-sectoral approach
strategy where each sector implements its
share in preventing and controlling the
infection.
Some of the on going interventions to
combat HIV/AIDS include promoting:
• PMTCT service
• VCT service
• Care & Support
• Clinical care, ART & PEP
• Diagnosing and Treating STI
• BCC
• Capacity building, management skills
• Targeted interventions
• Research, surveillance, M&E
• Infection Prevention Safety of blood &
blood transfusions
As a result of coordinated efforts, significant
achievements are documented in controlling
the infection, enhancing change of behavior
in individuals, families and community, in
providing treatment and care for people
living with HIV/AIDS, rehabilitating the
orphans and families, increasing of the
involvement of the community in combating
the people etc.
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112
The number of voluntary counseling and testing
(VCT) and the prevention of mother to child
(PMTCT) centers have grown from 19 in 2001 to
250 in 2012 and from 3 in 2002 to 208 in 2012
respectively. The number of PMTCT sites has
increased by 5.6% compared with 2011. The
number of clients who used the VCT and PMTCT
centers has also decreased from 77,008 in 2011 to
73,750 in 2012 and from 60,879 in 2011 to 61,874
in 2012 respectively.
The number of people living with HIV/AIDS and
started ARV has also decreased from 7067 in 2011
to 7022 in 2012. According to NATCOD report of
2011, PLWHA put on ART are averaging 1000 per
year. Although ARV is free in Eritrea, it is given to
individuals after legibility assessment.
Table V.3.1.1. Prevalence of HIV in
Antenatal Sentinel Site in 2005 and
2007 by Zoba
Zones Year
2005 2007
Maakel 3.48 1.8
Debub 1.65 0.67
Anseba 1.3 1.12
Gash Barka 2.06 1.22
NRSZ 1.77 1.6
SRSZ 5.9 0.68
Total 2.38 1.28 Source: NATCoD, 2007 report
Reported HIV/AIDS in Health Facilities
HIV/AIDS has been the first leading cause of
inpatient death in five years and above since 1999
and among the top 10 killers of children under five.
The average length of hospital stay of HIV/AIDS
patients have been 11 days since 1998, indicating
increased cost to hospitals.
Although it is becoming one of the leading
cause of inpatient mortality, the over all
outpatient and inpatient morbidity and
mortality of HIV/AIDS in hospitals and
health centers is about 0.1% and 5.2%
respectively (Figure V.3.1.5.).
Source: NATCoD 2012 report
Source: NATCoD 2012 Report
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113
Source: HMIS 2012
Source: NATCOD 2012 report
Source: HMIS 2012
Source: HMIS
Table V.3.1.3. Number of HIV/AIDS and STI cases and
AIDS deaths in Ho. and HC. and the proportion to the
total causes of OPD/IPD morbidity and Mortality by year
(2002-2012)
Year 2005 2006 2007 2008 2009 2010 2011 2012
HIV Cases
3011 2646 1943 2062 1658
1459
1030
1036
(%) to total cases 0.3 0.2 0.17 0.18 0.14
0.12
0.08
0.1
HIV deaths
233 262 260 252 200
184
140
136
(%) to total deaths 9.5 10.7 10.9 10.4 7.6
7.7
6.5
5.2
STI (Ho and
HC) 2599 2,586 3007 3540 2875
2326
2857
2526
(%) to total case 0.2 0.24 0.26 0.31 0.24
0.19
0.22
0.18
STI
syndrome cases (HS) 2938 2611 2919 3090 2450
2018
2565
2728
% to total
HS OPD
0.40 0.35 0.36 0.39 0.30
0.25
0.31
0.28
Table V.3.1.2. Number of Reported AIDS Cases in Hospital and
Health centers by Year and Zoba (1998-2012)
Year AN DE DKB GB MA NRH SKB Total
1998 30 110 77 121 40 640 87 1,105
1999 101 270 92 110 225 942 104 1,844
2000 79 243 49 53 384 548 87 1,443
2001 81 297 58 111 497 502 120 1,666
2002 62 346 53 82 488 467 93 1,591
2003 72 371 48 137 646 451 85 1,810
2004 75 332 104 104 862 567 85 2,129
2005 190 273 61 91 1,589 770 37 3,011
2006 243 223 82 75 1,227 732 64 2,646
2007 233 240 87 84 703 525 71 1,943
2008 283 336 61 112 807 415 48 2,062
2009 190
245
34
150
664
352
23 1658
2010 64 250 19 141 624 330 26 1454
2011 75 186 21 52 467 209 20 1030
2012 88 130 7 60 232 496 23 1036
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114
V.3.2. Malaria Malaria is one of the most devastating global public
health problems. It also contributes to anemia in
children and undermines their growth and
development. It is a primary cause of poverty
slowing economic growth in Africa alone.
In Eritrea, significant improvements are recorded in
decreasing the morbidity and mortality caused by
Malaria.
The 2012 hospital and health center report
indicates that, in comparison to that of 2011, the
number of malaria OPD incidence has decreased by
16.4% in under 5 and increased by 6.4% in five and
above years respectively. Similarly, the inpatient
morbidity in U5 and five and above has decreased
by 12.6% and 9.3% respectively. Moreover, the
mortality in U5 was the highest figure (9 deaths)
since 2007. In five and above age group mortality
has increased by 75% compared to 2011.
Generally speaking malaria morbidity has increased
by 3.5% in OPD and 22.6% in IPD. Malaria
mortality has decreased by 9.7% compared to 2011
situation (Table IV.3.2.1).
In 2012, malaria accounted for only 0.5% of OPD
morbidity, and 1.5% of IPD morbidity and 0.6% of
inpatient deaths in less than five year age. In age
group greater than five it was 1.3% of OPD
morbidity and 4.9% of IPD morbidity and 1.5% of
inpatient deaths in hospitals and health centers
(Table IV.3.24).
It ranked 11th in OPD and 10
th in IPD morbidity in
U5, 14th in OPD and 4
th in inpatient morbidity in
above five age category.
Looking at the regional distribution of the disease
burden for malaria as compared to the other
morbidity cases, still the highest toll was reported in
GB in 2012. It accounted above 61.8% of the total
reported cases in hospital and health centers and
60% of inpatient deaths. In health stations the
highest number of cases reported was in GB
followed by Debub. In hospitals and health centers
the highest malaria burden was reported
from GB (61.8%) and Debub (20.4%).
Some of the contributing factors for the
remarkable reduction according to the
National Malaria Control Program include:
• High ITN coverage, re-impregnation and
utilization.
• Introduction of combination therapy of
CQ+SP as first line drugs.
• Early diagnosis and timely case
management.
• High levels of community awareness and
participation for environmental vector
control.
• Effective and functional partnership of
country and outside RBM partners
• Commitment and dedication of the
Government, MOH, and malaria control
staff and general health workers.
• Technical and financial support received
through RBM initiative.
• Effective planning and implementation of
program activities at central and zonal level.
• Continuous supervision, regular monitoring
and evaluation of program activities at
central and zonal level.
Although, it has been the major cause of
morbidity and mortality in health facilities in
the past few years, its rank has gone down to
the least compared to other disease burdens
at present especially in OPD morbidity and
inpatient deaths. However, it still is one of
the major causes of inpatient morbidity
especially in GB and Debub.
Maakel which most of its areas considered
to be malaria free also reported about 4.6%
of the IPD and OPD cases in hospitals and
health centers. All the sub zobas reported
malaria cases although the highest report
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115
came from Asmara which could probably be
imported cases.
A total of 322 malaria cases in pregnancy were
reported in health stations in 2011. This is 16.6%
decrease from previous year. In Hospitals and
health centers 236 malaria in pregnancy cases were
also reported in 2012. This is 36.6% increase from
that of 2011.
Table IV.3.2.2 illustrates the increase/decrease in
the number of malaria morbidity of all age group in
2012 as compared to 2011. Malaria morbidity at
national level has decreased by 0.2% in 2012
weighing against 2011.
Figures IV.3.2.2.and IV.3.2.3 also indicates the
trends of malaria morbidity in U5 and five and
above as well as malaria deaths in both age groups
respectively. In 2012 the reducing trend of malaria
morbidity has began losing its progress in five and
above years but in under 5 the trend is decreasing
continually..
The case fatality rate in 2012 was 0.2%. Out of the
total deaths 60% were reported from Zoba Gash
Barka.
Figures IV.3.2.4, 3.2.5, 3.2.6, and 3.2.7 indicate the
number of reported malaria cases in Gash Barka
and Debub by sub zoba.
Table V.3.2.2. Total OPD/IPD Malaria Morbidity
Cases and Percent of Increase/ Reduction in Hospital
and Health Centre in 2012 compared to 2011 by Zoba
Zoba Year % increase(+)/
reduction(-) 2011 2012
Anseba 1374 1145 -16.7
Debub 3811 3847 0.9
DKB 2 8 300.0
Gash-Barka 11894 11667 -1.9
Maakel 924 865 -6.4
NRH 648 928 43.2
SKB 269 421 56.5
Total 18922 18881 -0.2
Table V.3.2.1 The percent of reduction or
increase of the number of reported malaria
morbidity and mortality in hospitals and
health centers in 2012 compared to 2011
Age category OPD IPD Deaths
U5 -16.4 -12.6% 900%
5 and above +6.4% 9.3% 75%
Total 3.5% -9.7 150%
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116
Figure IV. 3.2.4 Number of malaria cases in HO and HC in Gash Barka (2012)
Figure IV 3.2.5 Number of Malaria cases in HS Gash Barka (2012)
Figure IV 3.2.6 Number of Malaria cases in HS
Debub (2012)
Table V.3.2.4 Number of New Malaria Cases and Deaths in
Hospitals and Health Centers by Zoba (2012)
Zoba
Number of New Reported Cases % of
total
morbidity
Number of Inpatient Deaths
% of
IPD deaths Outpatient Inpatient
Total
<5 >5 <5 >5 <5 >5 Tot
AN 19 612 30 484 1145 0.7 0 3 3 0.9
DE 171 2209 179 1288 3847 1.6 0 0 0 0.0
DK 0 3 0 5 8 0.0 0 0 0 0.0
GB 1160 8573 278 1656 11667 5.3 8 10 18 3.9
MA 8 424 3 430 865 0.3 0 1 1 0.4
NR 80 709 10 129 928 0.4 1 5 6 0.9
SK 11 100 14 296 421 0.3 0 2 2 0.7
Total 1 4 4 9 1 2 6 3 0 5 1 4 4288 1 8 8 8 1 1.4 9 21 30 1.3 % of total 0.5 1.3 1.5 4.9 0.9 1.5 1.3
Table V.3.2.3. Number of Total Malaria Cases
in Health Stations by Zoba (2012)
<5 >5
*Malaria in
pregnancy Total
% To total
OPD cases
AN 63 1668 11 1742 0.7
DE 435 4359 90 4884 2.4
DK 0 0 0 0 0
GB 2511 16961 210 19682 9.1
MA 11 291 7 309 0.1
SK 19 169 4 192 0.1
Total 3039 23448 322 26809 2.5 % of total
morbidity 1.1 3.0 0.03 2.5
*Included in above 5 age group ** percent to total malaria
cases
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117
V. 3.3. Tuberculosis (TB) TB control program is one of the oldest programs in
the country that deals with the prevention,
detection, treating and controlling TB. However,
TB remained among 10 leading causes of mortality
in adults in Eritrea.
According to World Health Organization (WHO)
estimates, each year, 8 million people worldwide
develop active TB and nearly 2 million die. People
with HIV are particularly vulnerable for developing
active TB.
The prevalence of tuberculosis (TB) in the age
group of 15 and above in Eritrea according to TB
prevalence survey of 2005 was 50/100000 and the
incidence is 25/100000. The TB/HIV co-infection is
11.2%.
According to the National TB Control Program
report, the Ministry expects to identify about 4500
TB cases every year. In 2012, the program notified
781 new sputum positive cases and 3249 total TB
cases.
The cure rate was 82% which is the same as 2010.
There was an increase in success rate from 84% in
2010 to 86% in 2011, according the Treatment
outcome of NSP, 2011 cohort
The 2012 hospital health center report indicated
that a total of 2,266 OPD and 1,016 inpatient
TB cases were recorded of which 2156 (65.7%)
were pulmonary TB. In addition to this, 1,481 suspected TB cases were reported in health
stations. The suspected TB cases have to be
referred for further examination and diagnoses.
The inpatient cases are most of the time OPD
diagnosed cases. Therefore, it is safe to take the OPD cases as incidence of TB reported in
health facilities. In this regard, reported TB
incidence has decreasing trends (Figure
V.3.3.2) considering the improved situation
for diagnosis and expansion of health
facilities. Similar to the incidence, the TB
deaths also have a decreasing trend in 2012
(Figure V.3.3.3). The OPD morbidity has
decreased from 0.9% in 1999 to 0.18% in
2012, and the IPD morbidity from 2.4% in
1999 to 0.8% in 2012 (Table V.3.3.2).
Considering the total number of reported TB
cases in hospital and health center in
different zobas in 2012, the highest toll was
reported in National Referral followed by
Debub. (Table V.3.3.1).
The average length of stay (ALOS) in
hospitals has direct economic impact to the
health facilities in particular and to the
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118
health system in general. It is therefore essential to
minimize the number of TB hospital days through
appropriate health facility and home management of
patients. The average length of stay remained more
than 20 days in the last twelve years with zoba
variations (Table V.3.3.2)
Table V.3.3.1. The Number and percentage of New
Reported TB Cases and Deaths in Hospitals and
Health Centers by Zoba (2012)
Zones
Number of New Cases
%
Death
% to
total
death
IPD
CFR %
ALOS Outpatient Inpatient
Total
< 5 >5 <5 >5 <5 >5
Tot
al
AN 8 120 6 108 242 0.1 0 7 7 1.5 6.1 11.3
DE 2 108 0 249 359 0.1 0 14 14 0.4 5.6 31.3
DKB 1 44 11 53 109 0.4 0 3 3 11.8 4.7 25.8
GB 12 133 6 195 346 0.2 0 18 18 1.2 9.0 13.0
MA 17 206
0 46 269 0.1 0
5 5 1.8
10.9 9.0
NRH 214 1241 17 253 1725 0.7 1 22 23 0.9 8.5 15.8
SKB 4 156 2 70 232 0.1 0 5 5 1.4 6.9 35.6
Total 258 2008 42 974 3282 0.2 1 74 75 0.2 7.4 20.3 % To
total 0.1 0.2 0.1 1.1 0.2 0 5.3 3.1
Figure 3.3.2 Trend of reported number of TB (1998-2012)
Table V. 3.3.2. The Yearly Trends of TB
Morbidity, Mortality, Case Fatality, and Average
Length of Stay in Hospitals and Health Centers
(1999- 2012)
Year OPD
Morbidity
%
IPD
morbidity %
Total
Morbidity %
Deaths
%
Case
Fatality %
ALO
S, days
1999 0.9 2.4 1.0 7.1 1.9 22.6
2000 0.6 2.6 0.8 6.2 1.9 24.1
2001 0.6 2.8 0.8 9.1 2.4 23.3
2002 0.4 2.7 0.6 6.4 2.7 22.4
2003 0.4 1.9 0.4 6.7 8.6 22.0
2004 0.4 1.9 0.5 6.2 8.2 23.0
2005 0.4 1.2 0.5 4.4 8. 0 22.3
2006 0.3 1.2 0.4 4.6 8.5 24.5
2007 0.2 1.0 0.3 3.7 8.4 21.2
2008 0.2 0.9 0.3 3.4 7.9 22.3
2009 0.2 1.0 0.3 4.1 9.1 22.0
2010 0.2 0.9 0.3 3.7 7.3 20.6
2011 0.2 0.9 0.3 4.7 8.3 20.9
2012 0.18 0.8 0.25 3.3 7.4 20.3
Table IV.2.3.3.3. Number of Suspected TB Cases in
Health Stations by Zoba and Year (1999-2012)
YEAR AN DE DKB GB MAel SKB Total
% to total
OPD cases
1999 183 287 96 427 894 350 2237 0.3
2000 163 176 108 328 4145 86 5006 0.7
2001 161 218 157 270 107 169 1082 0.1
2002 121 159 74 255 102 96 807 0.1
2003 130 163 346 164 80 409 1292 0.1
2004 92 172 150 186 77 152 829 0.1
2005 69 171 120 144 78 128 710 0.1
2006 36 236 187 97 118 93 767 0.1
2007 69 247 156 161 139 134 906 0.1
2008 68 247 157 209 274 175 1130 0.1
2009 138 247 178 151 393 111 1218 0.1
2010 237 195 146 151 412 89 1230 0.1
2011 203 200 64 186 479 84 1216 0.1
2012 329 147 117 104 663 121 1481 0.14
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119
Figure 3.3.3 Trends in the number of reported TB
deaths (1998-2011)
V.3.4. Diarrhea Although the overall burden of infectious
diseases has been decreased significantly in
the last ten years, diarrhea is still among the
top ten leading causes of morbidity and
mortality especially in children U5. This
could be attributable to the nutrition status
of children or HIV infection.
For the purpose of evaluating the situation
of diarrhea, shigellosis, amoebiasis, gastro
enteritis and giardiasis are grouped together
under diarrheal diseases.
For the last 10 years, in children under five
years old, it has been the second leading
cause of outpatient and inpatient morbidity
and the third leading cause of inpatient
mortality in hospital and health center. In
2012, it accounted for about 26.1% of OPD
morbidity and 19.1% of inpatient morbidity
and 11.8 % of inpatient mortality in children
U5.
In five and above age group, diarrhea was
ranked the 5th cause of OPD morbidity
responsible for 6.4% of all OPD disease
burden and 3.8% of IPD morbidity and 2.2%
of inpatient deaths. In 2012 diarrhea has
Table V.3.3.3 Number of Reported TB Cases in OPD of Ho and HC
(2004-2012)
Zob 2004 2005 2006 2007 2008 2009 2010 2011
2012
AN 299 332 248 307 345 283 417 111 128
DE 439 293 287 226 138 136 102 95 110
DK 72 110 136 111 113 36 38 21 45
GB 689 757 559 461 407 300 239 199 145
MA 557 1034 746 683 660 705 523 376 223
NR 567 495 453 352 344 469 723 1180 1455
SK 498 488 416 186 173 193 114 114 160
Total 3121 3509 2845 2326 2180 2122 2156 2096 2266
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120
shown increasing trend in age group above 5 years.
In health stations, the burden of diarrhea accounted
for 12.67% of the total outpatient cases in all age
group.
The case fatality rate in inpatients of hospital and
health center in 2012 was 1.5% which is higher than
that of 2011(0.9%). (Table V.3.4.1).
From the total reported deaths of diarrhea 79.1%
were children under five and infants made about
57% of U5 diarrhea deaths and 45.1% of all
diarrhea deaths.
The proportional mortality of diarrhea has increased
by 84.3% in 2012 compared to 2011. (Figure
V.3.4.1. The detail is illustrated in Table V.3.4.2.
Trends
Until 2009 the proportional diarrhea
morbidity remained relatively constant for
the previous years. From 2009 up to 2011
the mortality, morbidity and case fatality
rates have shown decreasing trends. In 2012
diarrhea morbidity and mortality increased
(Figure V.3.4.1.).
0
5
10
15
Percent
Year
Figure V..3.4.1. T h e Y e a r l y T r e n d s o ft h e P r o p o r t i o n a l D i a r r h e a M o r b i d i t y ,M o r t a l i t y a n d I P D C a s e F a t a l i t y ( C F ) ( % ) i nH o s p i t a l s a n d H e a l t h C e n t e r s( 2 0 0 0 - 2 0 1 2 )Morbidity Mortality CFR
V.3.5. Acute Respiratory Tract
infections (ARI)
Acute Respiratory Infections are the most
common infectious diseases. They include
acute pharyngitis/tonsillitis, laryngitis,
influenza, pneumonia, common cold and
other acute respiratory infections. It has
been among the first two leading causes of
morbidity and mortality in all age groups in
health facilities.
In 2012, pneumonia alone accounted for
about 20.4 % of OPD morbidity (the highest
since 1998), about 36.3% of IPD morbidity
and about 18.6% of IPD mortality in U5 in
hospitals and health centers. In the same age
Table V.3.4.1 Number and Proportion of Diarrhea
Cases and Deaths in Hospitals and Health Centers by
Zoba (2012)
Zones
Number of New Cases
%
Death
% To
total
IPD CFR %
Outpatient Inpatient Total
<5 >5 <5 >5 <5 >5 Tota
Anseba 9163 7729 1206 556 18654 10.8 21 5 26 8.2 1.5
Debub 14943 13737 1260
118
3 31123 12.9 11 5
16 4.3 0.7
DKB 1758 973 110 123 2964 11.5 3 0 3 4.6 1.3Gash-Barka
17348 10320 999 600 29267 13.4 28 7 35 7.6 2.2
Maakel 10440 13906 553 309 25208 8.9 4 7 11 4.8 1.3
NRH 6694 6642 1943 196 15475 6.4 19 1 20 3.0 0.9
SKB 10520 7007 596 369
18492 11.8 33 6
39 13.5 4.0
Total 70866 60314
6667
3336
141183 10.5
119 31 150 6.3 1.5
% To
other
causes 26.1 6.4 19.1 3.8 10.6
11.8 2.2 6.3
All age % 10.8 8.1 10.6 6.3
“Information is a tool to support informed decisions at all levels not a vertical program”
121
group the other ARIs accounted for about 24.9% of
OPD and 5.2% of IPD morbidity. There were 2
deaths due to other ARIs in U5 in hospitals and
health centers in 2012.
Similar to the hospital and health center situation,
ARI including pneumonia is also the first leading
causes of out patient morbidity in all age groups in
health station.
Trends of ARI
The proportional morbidity, mortality and the IPD
case fatality rate of ARI remained almost constant
compared to the previous year. (Table V.3.5.3)
Table V.3.5.1 The Number and percentage of OPD and IPD ARI
Cases and IPD Deaths in Hospitals and Health Centers in 2012
Zoba
Number of New Cases
%
Death
%
IPD
CFR %
Outpatient Inpatient Total
< 5 >5 <5 >5 <5 >5 Tot
AN 7140 20725 181 166 28212 16.3 0 0 0 0 0
DE 8721 20119 304 346 29490 12.3 0 1 1 0.3 0
DK 1200 2539 9 24 3772 14.6 0 0 0 0 0
GB 15216 29953 234 267 45670 20.8 2 3 5 1.1 0
MA 16823 30892 188 188 48091 17.0 0 1 1 0.4 0
NR 9075 8948 814 131 18968 7.9 0 1 1 0.1 0
SK 9389 21906 84 122 31501 20.1 0 2 2 0.7 0
Total 67564 135082 1814 1244 205704 15.4 2 8 10 0.4 0
%
24.9 14.3 5.2 1.4 15.4 0.2 0.5
16.8 2.5 0.4
Table V.3.5.2. Trends of ARI with Pneumonia
Burden in Hospitals and Health Centers (1999-
2012) OPD
Morbidity
%
IPD
morbid
ity %
Total
Morbid
ity %
Deaths
%
Case
Fatality
%
Averag
e LOS,
days
1999 20.4 12.4 19.7 12.7 3 4.5
2000 23.3 13.4 22.5 13.5 3 4.3
2001 25.5 14.1 24.6 13 2.5 4.4
2002 27.3 14.9 26.3 13.7 2.5 5.2
2003 26 15.1 17.3 15.2 2.3 4.4
2004 26.1 18.6 25.2 16.2 2.2 4.5
2005 23.04 18.2 22.6 15.6 1.9 3.9
2006 25.8 21.0 25.3 17.0 1.8 3.9
2007 24.8 17.9 24.1 14.1 1.7 3.9
2008 21.7 16 21.2 12.1 1.7 3.7
2009 23.7 15 22.8 12.8 1.9 3.7
2010 23.1 13.3 22.0 12.2 1.5 3.5
2011 23.0 13.4 22 12.3 1.5 3.6
2012 23.8 16.8 23.2 13.7
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122
5.1
3.9
3.7
3
3.4
2.9
2.5
2.1
1.9 1.9
2.1 2.2
1.8 1.8 1.9
0
1
2
3
4
5
6
Percent
Year
Figure V.3.5. 1. Trends of CFR of ARI in IPD of Hospitals and Health Centers (1998-2012)
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123
V.3.6. Eye Problems
Eye infection has been one of the top ten leading
causes of mainly OPD morbidity in almost all age
categories. In this category, trachoma, conjunctivitis
and eye lid inflammation are included. Total eye
problems accounted for 6.3% of all OPD and IPD
morbidity in 2012 (Table V.3.6.1.).
Conjunctivitis accounted 46.6% of all eye
problems in 2012 while Trachoma, which
leads to blindness and can easily be
prevented, caused about 1.2% of eye
problems. Similarly, blindness and low
vision accounted for 1.7%. Cataract and
other lens disorders also accounted for
18.5%, which is the next highest proportion
following conjunctivitis. In 2012 the highest
cases of Conjunctivitis, other conjunctiva,
Keratitis & cornea disorders, and Cataracts
& lens disorders were reported since 1998
(Table V.3.6.1.).
Although, trachoma and strabismus have a
continuous decreasing trends, keratitis, has
an increasing trend.
To reduce or prevent blindness, the
Ministry is implementing Vision 2020
strategy. In 2012, a total of 7,230
ophthalmic surgeries were. Out of the total,
4745 (65.6%) were major surgeries. From
the total surgeries conducted about 57.7%
were in NRH (Table V.3.6.2). From the total
ophthalmic surgeries in 2012, 18.5% was
cataract surgery which is less than the
previous years by 7.3%.
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124
Table V.3.6.2. Number and % of Ophthalmic
Surgeries conducted by Zoba in 2012.
Age categories
Total % Zoba Minor Major
ANSEBA 327 715 1042 14.4
DEBUB 229 384 613 8.5
DKB 2 67 69 1.0
GASH-BARKA 88 1113 1201 16.6
MAAKEL 4 128 132 1.8
NRH 1835 2338 4173 57.7
SKB 0 0 0 0.0
Total 2485 4745 7230 100.0
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125
Table V.3.6.1. Number of New Outpatient and Inpatient Reported Eye Problems in Hospitals and Health Centers by Type of
Problem and Year (2000-2012)
Year
Type of Problem 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2011
2012
% of
2012
Trachoma 2,257 2,735 2,498 2,211 1,940 1,594 1,669 1,781 1,481 1486 1198 1042 1000 1.2
Eyelid inflammation 2,404 3,132 2,996 2,632 2,841 3,917 4,788 5,080 5,606 5308 4851 4419 4438 5.3
Conjunctivitis, other
conjunctiva
24,08
6
28,96
0
30,37
3
29,42
1
29,45
1
30,00
4
32,27
6 35,127 36,668 41242 38249
43577
39343 46.6
Keratitis & cornea disorders 3,306 4,742 4,815 4,622 4,942 5,131 4,668 5,610 5,312 5227 5472 5773 6754 8.0
Cataracts & lens disorders 4,701 9,625
10,19
9
10,07
8
11,48
1
13,92
2
13,18
0 15,370 14,304 15053 13113
16813
15592 18.5
Retinal detachment 240 458 383 371 616 897 701 686 576 585 600 486 536 0.6
Glaucoma 775 1,656 1,754 1,770 2,044 2,403 2,935 2,641 2,469 2877 3028 3000 2773 3.3
Strabismus 171 270 358 185 355 590 726 803 1,005 941 569 517 459 0.5
Refraction/ accommodation
disorders 3,368 6,276 5,391 5,065 6,535 7,850 9,112 10,484 8,971 9800 8688
9657
9588 11.3
Blindness and low vision 1,032 1,190 1,031 710 871 970 1,718 2,083 1,788 1731 1756 1770 1472 1.7
Other eye and adnexa disease 2,002 4,145 5,911 4,674 2,984 3,361 3,843 3,728 3,527 3374 2212 2141 2544 3.0
Total
44,34
2
63,18
9
65,70
9
61,73
9
64,06
0
70,63
9
75,61
6 83,393 81,707 87624 79736
89196
84499 100.0
% to OPD/IPD Morbidity 5.9 6.8 7.0 6.4 6.8 6.7 7.0 7.1 7.1 7.2 6.5 7.0 6.3
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126
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127
V.3.7. Non Communicable
Diseases
Non communicable diseases are also coming
to the picture of the leading causes of
morbidity and mortality although the major
burden is infectious diseases and nutrition
problems. Heart diseases, hypertensive
diseases, diabetes mellitus, gastritis and
duodenal ulcer and injuries are among the 10
leading causes of health facility morbidity and
mortality.
Although the total number of cases and deaths
reported in hospitals and health centers
remained almost constant, the number of non
communicable cases and deaths is increasing
indicating the change in disease burden
pattern in Eritrea.
V.3.7.1. Injuries
Different injuries are also among the leading
causes of OPD and IPD morbidity, mortality
and long hospital stays. A total of 69,631
cases (5.2% of all cases) and 154 deaths
(5.9% of all deaths) due to different injuries
were reported in hospitals and health centers
and 76,099 cases in health stations in 2012.
Injury accounted to 7.2% of all cases in health
stations. The total number of reported injury
cases has increasing trend (Table V.3.7.1.1)
Table V.3.7.1.1.Number and Type of Injury Morbidity
in Hospitals and Health centers
(2006-2012)
Diagnosis 2008 2009 2010 2011
2012
% of
total
injury
Fracture 4794 5448 6344 7225 5902 8.5 Dislocations, sprains, strains 2192 1962 2421 3592
1984 2.8 Eye and orbit injury
& non penetrating 1023 1042 2002 730 1480
2.1
Intracranial injury 59 30 38 57 25 0.0 Other internal organ & blast 16 39 53 30
46 0.1 Amputation due to
external cause 44 235 327 215 257
0.4 Car and other vehicle accident 1141 966 922 942
898 1.3 Physical
violence(rape, beating
etc….) 1831 1085 596 170
285
0.4 Other injuries,
single/multiple sites 10285 9471 8075 9296 10576
15.2 Head injury . No brain protrusion 1059 972 1025 767
1388 2.0
Extremity injury 1120 724 674 444 484 0.7
Maxillo-facial 207 154 132 98 351 0.5
Burns 2110 2232 2135 2422 2195 3.2 Hearing loss due to blast injury 1 3 5 15
6 0.0
Penetrating injury 325 305 343 307 153 0.2
Soft tissue injury 31,183 31812 33289 35743 40670 58.4
Vertebral injury 28 20 39 34 60 0.1
Chest injury 340 201 199 226 135 0.2 Effects of foreign
body entering natural
orifice 582 670 851 837
753
1.1
Poisoning 736 658 715 740 933 1.3
Snake bite 1,172 973 1150 1464 1369 2.0
Rabial dog(other
animal) bite 1,895 2101 1912 2044 2143
3.1
Toxic effects of non-
medicinal substances 91 217 241 164
183 0.3
Maltreatment
syndromes 43 59 189 124
97 0.1 Other and unspecified effects of external
causes 148 175 153 66
48 0.1 Certain early trauma/effects of
medical care 735 806 1018 987
930 1.3
Sequelae of injuries 641 341 204 136
106 0.2
Total Injury Cases 63,801
62,70
1 65,052 68875 69631 100
Proportion to total
OPD/IPD 5.6 5.2 5..3 6.0
5.2
Injuries in HS 75695 73701 70722 70751 76099
Proportion to total other causes in HS 9.6 7..9
7..9 7.6
7.2
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128
V.3.7.2. Hypertension
Hypertension related health problem is among
the leading causes of morbidity and mortality
in adults. It has an increasing trend in
outpatient as well as inpatient morbidity in the
last ten years. Its proportional OPD/IPD
morbidity in hospitals and health centers has
increased from 0.5% in 1998 to 1.3% in 2005
and 0.7% in 2012. In 2012, a total of 9152
hypertension related cases and 54 (2.1%)
deaths were reported as indicated in Table
V.3.7.2.1. However in comparison with 2011
hypertension cases and deaths had decreased
by 12.1% and 12.5% respectively. On the
other hand the case fatality rate has decreasing
trend and has decreased from 15% in 1998 to
7.2 % in 2012 that may indicate improved
quality of case management in health facilities
(Figure V.3.7.2.2). However in 2012 the case
fatality rate has increased by 56.5% when
compared to 2011. The average length of
hospital stay due to hypertension has
decreased from about 8 days in 1998 to 5.0
days in 2012.
In 2012 the proportional morbidity rate is less
than or equal to 1% in all the zobas except in
Maakel with higher rate (1.1%) that may be
related to the life style of the people living in
Maakel. About 34.2% of all reported
hypertension cases in 2012 were reported
from Maakel. (Table V.3.7.2.1.). Taking the
cumulative number of hypertensive cases
reducing the number of deaths every year,
almost 4 in 1000 people in Eritrea visited
health facilities for hypertension problem
treatment in 2011.
Table V.3.7.2.2. The Proportion (%)
of Hypertension Morbidity,
Mortality, Case fatality and ALOS in
Hospitals and Health Centers (1999-
2012)
Year
% of
Morbidity
% of
Mortality ALOS
Case Fatality
Rate
1999 0.7 3.6 7.7 11.8
2000 0.7 4 6.9 12.2
2001 0.9 4.2 7.5 10.1
2002 0.9 5 6.2 11.1
2003 1.1 4.7 7 9.4
2004 1.2 5.2 5.9 9.6
2005 1.3 3 6.2 6.1
2006 1.1 3.6 6.2 8.0
2007 1.1 3.1 6.0 6.9
2008 1.1 2.9 7 6.3
2009 1.0 2.3 5.8 6.3
2010 0.9 3.0 5.5 6.5
2011 0.8 2.2 6.1 4.6
2012 0.7 2.1 5.0 7.2
Table V.3.7.2.1. Number of Hypertensive Diseases Cases
and Deaths in Hospitals and Health Centers in year 2012
Zoba OPD IPD Total *% Deaths *%
AN 449 84 533 0.3 2 0.6
DE 1034 168 1202 0.5 5 1.3
DKB 101 21 122 0.5 2 3.1
GB 1138 134 1272 0.6 9 2.0
MA 2970 160 3130 1.1 15 6.6
NRH 2111 91 2202 0.9 16 1.9
SKB 636 55 691 0.4 5 1.7
Total 8439 713 9152 0.7 54 2.1
% 0.7 0.6 0.7
*The denominator is the total number of cases and deaths
in the respective zobas.
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129
V.3.7.3. Heart Diseases
Heart diseases are managed mainly in
National Referral and zoba referral hospitals.
In 2011, a total of 5106 heart problem cases
and 140 deaths were reported mainly from
Maakel and National referral hospitals. Debub
also reported more cases and deaths of heart
problems along with NRH and Maakel.
Out of the total number of heart disease cases
and deaths, 6.8% and 9.3% were children U5
respectively. Heart disease mortality in
children under 5 has decreased by 51.9%
compared to 2011.
Heart problems accounted for about
0.4% of morbidity cases and 5.4% of all
deaths in hospitals and health centers in
2012. The case fatality rate and Average
length of stay have decreased in 2012
compared to 2011. (Table V.3.7.3.2.).
Considering the reported cumulative
number of heart problem cases after
reducing the annual deaths, about one in
thousand people in Eritrea visited health
facilities for heart problem treatment in
2012.
Table V.3.7.3.1. Number of Heart Disease
Cases and Deaths in Hospitals and Health
Centers by Zoba in Year 2012
Zoba OPD IPD Total *% Deaths *%
Anseba 103 98 201 0.1 5 1.6
Debub 348 195 543 0.2 28 7.2
DKB 18 11 29 0.1 1 1.5
GB 119 105 224 0.1 18 3.9
Maakel 825 198 1023 0.4 19 8.4
NRH 2466 472 2938 1.2 63 7.4
SKB 120 28 148 0.1 6 2.1
Total 3999 1107 5106 0.4 140 5.4
% 0.3 0.9 0.4 5.4
*The denominator is the total number of cases and deaths
in the respective zobas
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130
Table V.3.7.3.2. The Percentage of
Heart Disease Morbidity, Mortality,
Case fatality and ALOS in Hospitals
and Health Centers
(1999-2012)
Year
% of
Morbidity
% of
Mortality ALOS
Case
Fatality
Rate
1999 0.13 2.4 10.6 18.1
2000 0.08 2.7 11 20.8
2001 0.08 3.2 11.7 19.5
2002 0.10 3.8 8.3 21.3
2003 0.10 3.3 8.5 23.3
2004 0.13 2.9 9.3 16.9
2005 0.14 2.3 8.5 15.2
2006 0.11 2.0 9.5 15.2
2007 0.4 3.6 9.4 10.8
2008 0.4 5.9 9.4 14.2
2009 0.4 5.4 10.5 16.2
2010 0.5 6.3 9.8 14.3
2011 0.4 6.6 10.6 12.5
2012 0.4 5.4 9.8 11.8
V.3.7.4. Neoplasm
The number of neoplasm cases shows
significant increase since year 2005 that
may be attributed to improved diagnostic
capacity of the health (Figure V.3.7.4.1).
The proportional morbidity remains
almost constant in the last nine years.
But in 2012 there was a sharp decrease
of number of cases of cancer patients.
Neoplasm of female reproductive organ
has been the leading neoplasm (40.4% of
all neoplasms). In 2012 it’s followed by
neoplasm of the breast, neoplasm of the
skin and neoplasm of digestive system in
that order.
In 2012, apart from skin and internal
organ cancers all other cancer types have
shown a significant reduction in the
number of cases.
Total neoplasm cases accounted for
0.2% of total morbidity and 1.8% of
mortality reported in hospitals and health
centers. Since neoplasm is a chronic
terminal illness, it is possible that most
of the patients die at home. Most of the
cases were reported from Zoba Maakel
and NRH that may be due to availability
of diagnostic facilities, but the highest
number of neoplasm of the urinary
system is reported in Anseba.
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131
Table V.3.7.4.1. Number of Neoplasm (malignant and
Benign) Cases and deaths in Hospitals and Health Centers
by year (2001-2012)
04 05 06 07 08 09 10 11 12
Digestive 224 255 257 314 244 250 263 263 156
Internal Org. 137 143 189 177 157 156 96 99
106
Breast 181 293 210 321 397 312 406 399
379
Female RepS 494 858
102
4 884 943 867 958
111
9
971
Male RepS 14 21 40 39 55 86 58 45 31
Urinary Sy. 143 166 150 107 70 60 83 80
91
Brain &CNS 15 70 62 95 115 104 88 117
59
Respiratory 28 75 54 48 80 139 65 65
62
Skin 172 145 147 190 202 371 417 326
153
Masculosk. 24 30 36 47 44 48 59 51
36
Eye 12 15 44 28 9 5 10 12
4
Hodgkin’s
and non-
Hodgkin’s 25 26 44 63 55 90 82 88
60
Leukomia 12 15 44 28 9 5 10 12
4
Other 459 659 566 460 453 549 588 588
289
Total cases 1940 2771 2867 2801 2833 3042
318
3
326
4
240
1
Proportion % 0.3 0.3 0.3 0.2 0.2 0.3 0.3 0.3
0.2
Total Deaths 41 61 50 72 73 70 44 78
46
Proportion % 1.9 2.5 2 2.8 3.0 2.7 1.8 3.3
1.8
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132
V.3.7.5. Diabetes Mellitus
Diabetes Mellitus is one of the leading causes
of morbidity and mortality mainly in adults in
hospitals and health centers. A total of 78,686
new cases and 926 deaths of Diabetes Mellitus
were reported from hospitals and health
centers since 1998. Moreover, 695
amputations due to diabetes were reported
since 2006 indicating that it is not only
leading cause of morbidity but also a cause of
disability.
Diabetes accounted to 0.4% of morbidity
and 2.7% of total reported deaths in
2012. It was the 7th top leading cause of
mortality in above five years old age
group in 2011. The average length of
stay increased from 6.9 days in 2011 to
7.5 days in 2012. But the case fatality
rate remains the same like 2011(5.4%)
(Table V.3.7.5.2).
Table V.3.7.5.1 illustrates the reported
diabetes cases by Zoba in 2012 and
Table V.7.5.2 shows the annual trends.
Table V.3.7.5.1. Number of Diabetes Mellitus Cases and Deaths in Hospitals and Health
Centers by Zoba in 2012 Zoba OPD IPD Total *% Deaths *%
Anseba 121 197 318 0.2 4 1.2
Debub 284 279 563 0.2 13 3.4
DKB 41 19 60 0.2 4 6.2
GB 355 213 568 0.3 15 3.3
Maakel 2075 208 2283 0.8 8 3.5
NRH 1359 205 1564 0.7 20 2.4
SKB 222 75 297 0.2 5 1.7
Total 4457 1196 5653 0.4 69 2.7
% total 0.4 1.0 0.4 2.7
*The denominator is the total number of cases and deaths in the respective zobas
Table V.3.7.5. 2. Number of Diabetes Mellitus Cases, Deaths and Amputation in Hospital and Health Center
(2002-2012)
year 2003 2004 2005 2006 2007 2008 2009 2010 2011
2012
Cases 4921 7161 6951 5752 6111 5362 5056 6230 6412
5653
% total cases in HF 0.5 0.8 0.7 0.5 0.5 0.5 0.4 0.5 0.5
0.4
Death 67 68 69 76 58 53 50 73 75
69
% to total deaths in
HF 3.1 3.1 2.8 3.1 2.2 2.2 1.9 3.0 3.5
2.7
Average length of stay 9.8 9.6 8.9 7.9 8 7.6 8 6.7 6.9
7.5
Case FR in IPD 5.9 6.2 5.9 6.5 4.9 5.1 4.4 5.2 5.4
5.4
Amputation due to
diabets NA NA NA 48 68 87 88 117 181
104
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133
V.3.7.6. Mental Health
Mental health is one of the priorities of the
Ministry among the non communicable
diseases. It is one of the health problems that
result in too long hospital stay with high cost
of services. Thus, the Ministry has been
training psychiatric nurses and deploys them
to the zobas to decentralize the service to
reduce the load of the only one psychiatric
hospital in the country. Moreover, community
based psychiatric counselors were trained and
deployed. These community based counselors
could facilitate community rehabilitation of
psychiatric patients.
In 2012, a total of 4651 mental health disorder
cases were reported in hospitals and health
centers out of which 20.4% were due to
Neoro-somato form disorder cases, 12.8%
mood disorder cases and 7.8% and
Schizophrenia cases. The total number of
cases has increasing trend compared to 2011
but the proportion to the total OPD and IPD
cases decreased to 0.35% the lowest
ever.(Table IV.3.7.6.1.)
Table IV.3.7.6.1. Number of Mental Health Disorder Cases Reported in Hospitals and Health Centers by Year (2002-2012)
Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2012 %
2012
Dementia 153 74 132 208 149 169 200 211 204 140 195 4.2
Alcohol related MD 34 30 58 84 91 47 39 58 88 36 39 0.8
Mental/behav.disorders,psycho,
Substance abuse 145 126 219 343 307 392 511 583 526 339
361 0.0
Schizophrenia 773 672 760 985 1,032 1051 973 979 1041 772 595 7.8
Mood disorders 641 625 862 988 913 1003 1135 1011 991 835 956 12.8
Neuro. Somatoform 1726 1586 1494 1,854 2,226 2389 2015 1855 1960 1154
947 20.4
Mental retardation 157 148 205 272 234 308 304 291 198 199 218 4.7
Other MD 842 681 888 1,088 1,031 1082 1129 1206 1110 1104 1340 28.8
Total cases 4471 3942 4618 5822 5983 6441 6306 6197 6077 4579 4651 100.0
Proportion(%) 0.48 0.41 0.49 0.55 0.55 0.56 0.55 0.51 0.50
0.36
0.35
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134
V.3.7.7 Anemia and Malnutrition
Anemia and malnutrition are also two of the
top leading causes of morbidity and mortality
both in children U5 and adults. In 2012,
malnutrition ranked 12th cause of OPD
morbidity, 3rd cause of IPD morbidity and the
1st cause of mortality in children U5. A total
of 7,936 OPD and 3297 inpatient malnutrition
cases and 135 deaths were reported in
hospitals and health centers.
Considering anemia, it was ranked 14th cause
of OPD morbidity, again 14th cause of IPD
morbidity and 11th cause of mortality in all
age categories visited to Hospitals and Health
centers. From the total reported anemia cases,
children U5 accounted for 13.8% for
morbidity and 28.6% for deaths.
About 20.9% of anemia deaths were reported
from GashBarka that could be attributed to
repeated infection of malaria. Anseba also
reported 12.1% of anemia deaths.
23.5% of the total anemia and
malnutrition cases were reported from
SKB followed by GashBarka 19.6%,
Maakel 15.4% and Debub 15.1%
(Table V.3.7.1).
The health stations also reported 24,732
anemia (all kinds) and 7,130
malnutrition cases in 2012.
The proportional morbidity rate for
Malnutrition indicates that the OPD and
IPD morbidity remained almost constant
in the last seven years. The proportional
death rate for malnutrition is increasing
since 2010. Proportion mortality of
malnutrition in 2012 is the second
highest record since 1998. (Figure
V.3.7.7.1.
Table V.3.7.7.1. Number of Reported Anemia & Malnutrition cases in Hospitals
and Health Centers by Zoba (2012)
zoba Anemia % Malnutrition % Total %
Anseba 1947 11.5 1623 12.6 3570 12.0
Debub 2075 12.2 2439 19.0 4514 15.1
DKB 458 2.7 279 2.2 737 2.5
GB 3306 19.4 2550 19.8 5856 19.6
Maakel 2887 17.0 1719 13.4 4606 15.4
NRH 1938 11.4 1621 12.6 3559 11.9
SKB 4388 25.8 2626 20.4 7014 23.5
Total 16999 100.0 12857 100.0 29856 100.0
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Health Management Information System, Research and HRD, MOH Annual health service Report of 2012
135
Table V.3.7.7.2. Number of Reported Anemia Deaths in Hospitals and
Health Centers by Zoba and Age Category (2012)
Zoba
Age Categories
Total % to total zoba death
% to Anemia death <1 1 to 4 5 and above
Anseba 1 5 5 11 3.4 12.1
Debub 0 2 2 4 1.0 4.4
DKB 0 2 0 2 3.1 2.2
GB 0 2 17 19 4.1 20.9
Maakel 0 0 7 7 3.1 7.7
NRH 11 2 23 36 4.2 39.6
SKB 1 0 11 12 4.2 13.2
Total 13 13 65 91 3.5 100.0
% 1.9 3.95 4.1 3.5
Table V.3.7.7.3. Number of Reported Malnutrition Deaths in Hospitals and
Health Centers by Zoba and Age Category (2012)
Zoba
Age Categories
Total
% to total zoba
death
% to
malnutrition
death <1 1 to 4
5 and
above
Anseba 4 9 1 14 4.3 6.1
Debub 12 19 1 32 8.2 13.9
DKB 3 3 0 6 9.2 2.6
GB 28 55 1 84 18.3 36.5
Maakel 1 5 1 7 3.1 3.0
NRH 5 14 2 21 2.5 9.1
SKB 32 33 1 66 22.8 28.7
Total 85 138 7 230 8.8 100.0
% 12.4 41.9 0.4 6.2
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V.3.7.8 ASTHMA
Asthma is a chronic, non-communicable
lung condition affecting 300 million people
worldwide. In 1998 there were 9,923
Asthma cases and in 2012 it reached 10,724
cases with an increase of 8.2%.
Since 2010 Asthma is showing a decreasing
trend. In comparison to 2011, overall
asthma cases have reduced by 11%.
Similarly Asthma mortality has reduced by
47.4% compared to 2011.
Maekel, 2500 cases, followed by Debub
has the highest number of Asthma cases.
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Total Asthmatic cases in OPD and IPD by zoba and age group
Cases Deaths
Zoba U5 Above 5 Total U5 Above 5 Total
Anseba 244 1183 1427 0 0 0
Debub 58 1766 1824 0 1 1
Debubawi keyhi bahri 3 184 187 0 2 2
Gash-barka 45 1682 1727 0 1 1
Maakel 100 2425 2525 0 2 2
National referral 204 1561 1765 0 4 4
Semenawi keyhi bahri 152 1117 1269 0 0 0
Total 806 9918 10724 0 10 10
Percent to total opd/ipd cases 0.3 1.0 0.8 0 0.6 0.4
V.3.7.9 BRONCHITIS, EMPHYSEMA and COPD
On average there are around 11,855 annual OPD and IPD cases of Bronchitis Emphysema and
COPD. In 2012 there were 9,659 cases (7.3% lesser than 2011). Almost 98% of bronchitis
cases are OPD patients.
Opd/Ipd Bronchitis Cases
Despite the gradual decrease in the trend of bronchitis cases and deaths over the years, the IPD
cases are steadily increasing since 2010.
Meanwhile, Infant morbidity is consistently increasing and the year 2012 was the highest
record.
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OPD/IPD infant morbidity of Bronchitis
Semenawi Keyih Bahri reported the highest IPD infant bronchitis cases.(10/14 cases).
Zoba Maekel, followed by Debub and Anseba contain the highest number of bronchitis cases.
Bronchitis cases by zoba
4. Disease Burden at Zoba Level
The disease burden at National level is the aggregate result of the situations in the zobas. Thus, the
burden of diseases in the zobas is not different from the situation at the national level although
there could be insignificant variations among the zobas.
Diarrhea, ARI (without pneumonia) and Pneumonia are the first three leading causes of outpatient
morbidity in children under five in almost of all the zobas. Similarly, Injury all types Infections of
the skin, eye and ear, alongside with malnutrition, soft tissue injury and fever of unknown origin
were repeatedly among the leading ten causes of outpatient morbidity under five years in all zobas.
As per the Age group above 5 years, ARI remains predominantly the leading cause of outpatient.
Malaria in Gash_Barka, congenital malformation in NRH and Oro-dental infection in Maekel were
unique top ten causes of outpatient morbidity in children less than five in their respective region.
Pneumonia, diarrhea and malnutrition were the leading causes of hospitalization of children under
five years. In connection with this, Malaria was the major cause of inpatient morbidity in the zobas
of Debub and Gash_Barka. Meanwhile, Neonatal sepsis and Asthma were the unique top ten
causes of hospitalization in National Referral Hospital and Maekel respectively.
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In Zoba Maekel Muskulo-skeletal injury with fracture caused the highest number of inpatient
morbidity in 2011.
Pneumonia, Malnutrition, and Diarrhea are the main causes of death in children under 5 years in
all zobas.
Meanwhile HIV, TB, heart diseases and pneumonia are the principal causes of mortality in the age
group above 5.
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V.4.1. Zoba Anseba
Table V.4.1.1. Ten Leading Causes of OPD
Morbidity in Ho and HC in Anseba in under and
above five in 2012. Under Five 5 and Above
Leading cause No. of
Cases
% Leading
cause
No. of
Cases
%
Diarrhea all
forms 9163
27.5
ARI (With out
pneumonia) 20725
17.2
ARI (With out
pneumonia) 7140
21.4
Injury all
types 9334
7.7
Pneumonia all
types 6816
20.4
Gastritis /
duodenal
ulcer
8678
7.2
Injury all types 1981 5.9
Oro - dental
infection 8482
7.0
Skin infection
& scabies 1611
4.8
Other urinary
tract infection 7792
6.4
Ear infection 1424 4.3
Diarrhea all
forms 7729
6.4
Other digestive
system diseases 1042
3.1
Skin infection
& scabies 5288
4.4
Infection of eye
including
trachoma
986 3.0
Infection of
eye including
trachoma
5053
4.2
Malnutrition,
all types 512
1.5
Pneumonia all
types 4817
4.0
Soft tissue
injury 410
1.2
Rheumathoid
arthritis 3658
3.0
Total top 10 31085 93.2 Total top 10 81556 67.5
Table V.4.1.2 – Ten Leading Causes of Inpatient
Morbidity in Ho and HC in Anseba in under and above
five in 2012. Under Five 5 and Above
Leading
cause
No. of
Cases
% Leading
cause
No.
of
Cases
%
Pneumonia all
types 2803
45.3 Pneumonia all
types 916
7.3 Diarrhea all
forms 1206
19.5 Injury all types 861
6.9 Malnutrition, all
types 783
12.7 Obs
emergencies 644
5.1
Low birth weight 254 4.1
Diarrhea all
forms 556
4.4 ARI (With out
pneumonia) 181
2.9 Malaria , all
types 484
3.9
Neonatal sepis 144 2.3
Abortion, all
types 447
3.6
Injury all types 101 1.6
Other urinary
tract infection 378
3.0
Septicemia 94 1.5
Gastritis /
duodenal ulcer 327
2.6 Intrauterine
hypoxia/birth
asphyxia
74 1.2
Asthma 316 2.5
Other perinatal
and neonatal
problem
56 0.9
Diabetes
mellitus 188
1.5 Total top 10 5696 92.0 Total top 10 5117 40.9
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V.4.2. Zoba Debub
Table V.4.2.1. Ten Leading Causes of OPD Morbidity in Ho and HC in Debub in under and above
five Year in 2012
Under Five 5 and Above
Leading cause
No.
Cases % Leading cause
No.
Cases %
Diarrhea all forms 14943 30.9 ARI (With out pneumonia) 20119 12.3
Pneumonia all types 12384 25.6 Gastritis / duodenal ulcer 15834 9.7
ARI (With out pneumonia) 8721 18.1 Diarrhea all forms 13737 8.4
Skin infection & scabies 2634 5.5 Injury all types 12295 7.5
Infection of eye including
trachoma 2179
4.5 Other urinary tract infection 11676
7.1
Ear infection 1494 3.1 Oro - dental infection 11259 6.9
Injury all types 1387 2.9 Skin infection & scabies 8973 5.5
Malnutrition, all types 995 2.1 Soft tissue injury 7784 4.8
Soft tissue injury 763 1.6
Infection of eye including
trachoma 7214
4.4
Other heliminthiases 414 0.9 Pneumonia all types 6896 4.2
Total top 10 45914 95.1 Total top 10 115787 70.8
Table V.4.1.3 – Ten Leading Causes of Inpatient Deaths in Ho and HC in Anseba in under and above
five in 2012
Under Five 5 and Above
Leading cause No.
Cases
% Leading cause No. of
cases
%
Septicemia 56 34.4 Paralytic ileus/intestinal disease 13 8.4
Diarrhea all forms 21 12.9 Hiv/aids 11 7.1
Pneumonia all types 17 10.4 Obs emergencies 11 7.1
Other perinatal and neonatal
problem 15
9.2 Pneumonia all types 10
6.5
Malnutrition, all types 13 8.0 Injury all types 9 5.8
Neonatal sepis 9 5.5 Septicemia 8 5.2
Anemia, all types 6 3.7 Tb, all types 7 4.5
Intrauterine hypoxia/birth
asphyxia 6
3.7
Stroke, not spec.as haemmorhage/
infarction 6
3.9
Low birth weight 5 3.1 Anemia, all types 5 3.2
Paralytic ileus/intestinal
disease 3
1.8 Vascular diseases 5
3.2
Total top 10 151 92.6 Total top 10 85 55.2
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Table V.4.2.2. Ten Leading Causes of Inpatient
Morbidity in Ho and HC in Debub by Age Group
in 2012
Under Five
Five Years and Above
Leading
Cause No. %
Leading
Cause No. %
Pneumonia all
types 3560
46.7
Pneumonia all
types 1660
7.8
Diarrhea all
forms 1260
16.5 Injury all types 1536
7.2
Malnutrition,
all types 1094
14.4
Malaria , all
types 1288
6.0
Low birth
weight 359
4.7
Diarrhea all
forms 1183
5.6
Ari (with out
pneumonia) 304
4.0
Obs
emergencies 1102
5.2
Septicemia 276 3.6
Other urinary
tract infection 998
4.7
Malaria , all
types 179
2.4
Abortion, all
types 979
4.6
Injury all types 126 1.7
Soft tissue
injury 960
4.5
Skin infection
& scabies 97
1.3
Gastritis /
duodenal ulcer 752
3.5
Soft tissue
injury 58
0.8 Asthma 439
2.1
Total top 10 7313 96.0 Total top 10 10897 51.2
Table V.4.3.1. Ten Leading Causes of OPD
Morbidity in Ho and HC in DKB by Age Group
in 2012
Under Five 5 and Above
Leading
cause No. Cases %
Leading
cause No. Cases %
Pneumonia
all types 1792
27.1
ARI (With
out
pneumonia)
2539
14.9
Diarrhea all
forms 1758
26.6
Infection of
eye
including
trachoma
1342
7.9
ARI (With
out
pneumonia)
1200
18.2
Other
urinary
tract
infection
1176
6.9
Skin
infection &
scabies
455
6.9
Skin
infection &
scabies
1093
6.4
Fever of
unkown
origin
317
4.8
Diarrhea all
forms 973
5.7
Ear infection 279
4.2
Gastritis /
duodenal
ulcer
973
5.7
Infection of
eye including
trachoma
198
3.0
Pneumonia
all types 577
3.4
Malnutrition,
all types 129
2.0
Oro - dental
infection 548
3.2
Injury all
types 93
1.4
Injury all
types 480
2.8
Other
urinary tract
infection
73
1.1
Anemia, all
types 415
2.4
Total top 10 6294 95.3 Total top 10 10116 59.3
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V.4.3. Zoba Debubawi Keyh Bahri
Table V.4.3.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Debubawi Keyh Bahri in
2011
Under Five 5 and Above
Leading cause No. Cases % Leading cause No. Cases %
Pneumonia all types 247 38.5 Diarrhea all forms 123 8.0
Malnutrition, all types 125 19.5 Other urinary tract infection 101 6.5
Diarrhea all forms 110 17.2 Pneumonia all types 101 6.5
Septicemia 25 3.9 Epi preventable diseases 85 5.5
Injury all types 17 2.7 Injury all types 81 5.2
Low birth weight 17 2.7 Tb, all types 53 3.4
Skin infection & scabies 12 1.9 Obs emergencies 51 3.3
Tb, all types 11 1.7 Gastritis / duodenal ulcer 47 3.0
ARI (With out
pneumonia) 9
1.4 Skin infection & scabies 41
2.7
Burns 9 1.4 Abortion, all types 32 2.1
Total top 10 582 90.8 Total top 10 715 46.2
Table V.4.2.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Debub by Age Group in
2012
Under Five Five Years and Above
Leading cause
No. of
Cases % Leading cause
No.of
cases %
Septicemia 52 28.0
Heart diseases 25 13.4
Pneumonia all types 49 26.3
Stroke, not spec.as
haemmorhage/ infarction 22
11.8
Malnutrition, all types 31 16.7 Pneumonia all types 21 11.2
Low birth weight 13 7.0 Hiv/aids 18 9.6
Diarrhea all forms 11 5.9 Septicemia 16 8.6
Intrauterine hypoxia/birth asphyxia 7 3.8 Tb, all types 14 7.5
Neonatal sepis 7 3.8 Diabetes mellitus 12 6.4
Heart diseases 3 1.6 Obs emergencies 8 4.3
Anemia, all types 2 1.1 Diarrhea all forms 5 2.7
Other perinatal and neonatal problem 2 1.1 Hypertensive related diseases 5 2.7
Total of the top 10 177 95.2 Total of the top 10 146 78.1
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Table V.4.2.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Zoba Debubawi Keyih Bahri
by Age Group in 2012
Under Five Five Years and Above
Leading cause No. ofCases % Leading cause
No.of
cases %
Septicemia 9 25
OBS EMERGENCIES 5 16.7
Pneumonia all types 8 22.2 DIABETES MELLITUS 4 13.3
Malnutrition, all types 6 16.7 HIV/AIDS 4 13.3
Diarrhea all forms 3 8.3 SEPTICEMIA 3 10.0
Anemia, all types 2 5.6 TB, ALL TYPES 3 10.0
Burns 2 5.6 ASTHMA 2 6.7
Intrauterine hypoxia/birth asphyxia 2 5.6
HYPERTENSIVE RELATED
DISEASES 2
6.7
Injury all types 2 5.6 OTHER CAUSES OF DEATH 2 6.7
Low birth weight 2 5.6 PNEUMONIA ALL TYPES 1 3.3
Total of the top 10 36 100 Total of the top 10 26 86.7
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V.4.4. Zoba Gash Barka
Table V.4.4.3. Leading Ten Causes of Inpatient Deaths in Ho
and HC. In Gash Barka (2012)
Under Five 5 and Above
Leading cause # % Leading cause # %
Malnutrition,
all types 83
36.9
Pneumonia all
types 32
13.7
Pneumonia all
types 45
20.0 Injury all types 21
9.0
Diarrhea all
forms 28
12.4 Tb, all types 18
7.7
Neonatal sepis 25 11.1
Anemia, all
types 17
7.3
Low birth
weight 14
6.2 Heart diseases 17
7.3
Septicemia 9 4.0
Diabetes
mellitus 15
6.4
Malaria , all
types 8
3.6 Hiv/aids 14
6.0
ARI (With out
pneumonia) 2
0.9
Obs
emergencies 11
4.7
Anemia, all
types 2
0.9
Malaria , all
types 10
4.3
Intrauterine
hypoxia/birth
asphyxia
2
0.9
Hypertensive
related
diseases
9
3.8
Total 218 96.9 Total 164 70.1
Table V.4.4.1. Leading Ten Causes of OPD Morbidity in Ho and HC
in Gash Barka (2012).
Under Five Five Years and Above
Leading cause
No.of
cases % Leading cause
No of
cases %
Diarrhea all
forms
1734
8 30.9
ARI (With out
pneumonia) 29953
20.7
ARI (With out
pneumonia)
1521
6 27.1
Other urinary
tract infection 12638
8.7
Pneumonia all
types
1065
9 19.0
Diarrhea all
forms 10320
7.1
Skin infection &
scabies 1980
3.5
Gastritis /
duodenal ulcer 10100
7.0
Ear infection 1774 3.2
Malaria , all
types 8573
5.9
Injury all types 1295 2.3
Oro - dental
infection 7106
4.9
Malnutrition, all
types 1291
2.3
Pneumonia all
types 5696
3.9
Infection of eye
including
trachoma
1237
2.2
Injury all types 5655
3.9
Malaria , all
types 1160
2.1
Skin infection
& scabies 5072
3.5
Soft tissue injury 1044 1.9
Rheumathoid
arthritis 4446
3.1
Total top 10 5300
4 94.4 Total top 10
99559 68.8
Table V.4.4.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Gash Barka (2012)
Under Five 5 and Above
Leading cause No % Leading cause No.of cases %
Pneumonia all types 2147 39.5 Malaria , all types 1656 13.1
Malnutrition, all types 1051 19.3 Injury all types 1224 9.7
Diarrhea all forms 999 18.4
Cataracts and other lens
disorders 1118
8.8
Malaria , all types 278 5.1 Pneumonia all types 943 7.4
ARI (With out pneumonia) 234 4.3 Obs emergencies 668 5.3
Low birth weight 170 3.1 Diarrhea all forms 600 4.7
Neonatal sepis 123 2.3 Anemia, all types 503 4.0
Septicemia 79 1.5
Abortion, all types 493 3.9
Injury all types 75 1.4 Snake bite 456 3.6
Anemia, all types 64 1.2 Soft tissue injury 396 3.1
Total top 10 5220 96.1 Total top 10 8057 63.6
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V.4.5.Zoba Maakel
Table V.4.5.1. Ten Leading Causes of OPD Morbidity in Ho and HC in Maakel (2012)
Under Five Five Years and Above
Leading cause #of cases % Leading cause No. of cases %
ARI (Without pneumonia) 16823 30.2 Oro - dental infection 30924 14.1
Pneumonia all types 13201
23.7
ARI (Without
pneumonia) 30892
14.1
Diarrhea all forms 10440
18.7
Skin infection &
scabies 15883
7.3
Skin infection & scabies 3444
6.2
Gastritis / duodenal
ulcer 13936
6.4
Infection of eye including
trachoma 1608
2.9 Diarrhea all forms 13906
6.4
Malnutrition, all types 1453
2.6
Other urinary tract
infection 13426
6.1
Ear infection 1344 2.4 Injury all types 7852 3.6
Fever of unkown origin 1224 2.2 Soft tissue injury 6531 3.0
Oro - dental infection 735
1.3
Infection of eye
including trachoma 6426
2.9
Injury all types 591 1.1 Pneumonia all types 5259 2.4
Total top 10 50863 91.3 Total top 10 145035 66.3
Table V.4.5.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Maakel in 2012
Under Five Five and Above
Causes No. % Causes No. %
Pneumonia all types 664 38.3
Cataracts and other lens
disorders 539
7.4
Diarrhea all forms 553 31.9 Pneumonia all types 514 7.0
ARI (With out pneumonia) 188 10.8 Malaria , all types 430 5.9
Malnutrition, all types 151 8.7 Diarrhea all forms 309 4.2
Low birth weight 78 4.5 Gastritis / duodenal ulcer 268 3.7
Fever of unkown origin 16 0.9 Injury all types 242 3.3
Asthma 11 0.6 Cholelithiasis/cholecysitis 239 3.3
Skin infection & scabies 10 0.6 Other urinary tract infection 237 3.2
Congenital malformations 5 0.3 Diabetes mellitus 207 2.8
Other urinary tract infection 5 0.3 Heart diseases 198 2.7
Total 1681 96.9
Total top 10 3183 43.6
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Table V.4.5.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Maakel in 2012 Under Five Five Years and Above
Leading cause No. % Leading cause No %
Malnutrition, all types 6 50 Hiv/aids 37 17.2
Diarrhea all forms 4 33.3 Pneumonia all types 33 15.3
Pneumonia all types 2 16.7 Heart diseases 19 8.8
Other liver disease 18 8.4
Stroke, not spec.as
haemmorhage/ infarction 17
7.9
Hypertensive related
diseases 15
7.0
Gastritis / duodenal ulcer 13 6.0
Diabetes mellitus 8 3.7
Anemia, all types 7 3.3
Diarrhea all forms 7 3.3
Total 12 100 Total top 10 174 80.9
V.4.6. National Referral Hospitals(NRH)
Table V.4.6.1. Ten Leading Causes of Outpatient Morbidit in National Referral Hospitals by Age Group in 2012.
Under Five Five Years and Above
Leading cause
No. of
cases % Leading cause
No. of
cases %
ARI (With out
pneumonia) 9075
26.9 Injury all types 15878
9.2
Diarrhea all forms 6694 19.9 Oro - dental infection 10429 6.0
Pneumonia all types 3029 9.0 Soft tissue injury 10318 6.0
Ear infection 1827 5.4 Gastritis / duodenal ulcer 10032 5.8
Injury all types 1600 4.7
ARI (With out
pneumonia) 8948
5.2
Other urinary tract
infection 1476
4.4
Infection of eye including
trachoma 7492
4.3
Infection of eye
including trachoma 1469
4.4
Other urinary tract
infection 7459
4.3
Skin infection &
scabies 1399
4.2 Diarrhea all forms 6642
3.8
Soft tissue injury 943 2.8 Skin infection & scabies 3988 2.3
Malnutrition, all
types 835
2.5
Refraction and
accomodation disorder 3886
2.3
Total top 10 28347 84.1 Total top 10 85072 49.3
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Table V.4.6.2. 10 Leading Causes of Inpatient Morbidity in National Referral Hospitals by Age
group in 2012
Under Five Five and Above
Leading cause #of cases % Leading cause #of cases %
Diarrhea all forms 1943 20.7 Injury all types 2547 10.5
Pneumonia all types 1506 16.0 Obs emergencies 2211 9.1
Low birth weight 1110 11.8
Cataracts and other lens disorders 1755 7.2
ARI (With out pneumonia) 814 8.7
Abortion, all types 1667 6.9
Malnutrition, all types 654 7.0
Pneumonia all types 399 1.6
Injury all types 644 6.9
Burns 367 1.5
Neonatal sepis 479 5.1 Heart diseases 310 1.3
Burns 463 4.9
Ear infection 306 1.3
Congenital malformations 231 2.5
Congenital malformations 267 1.1
Other perinatal and
neonatal problem 167
1.8 Tb, all types 253
1.0
Total top 10 8011 85.3
Total top 10 10082 41.4
Table V.4.6.3. Ten Leading Causes of Inpatient Mortality in National Referral Hospital by Age
Group in 2012
Under Five Five Years and Above
Leading cause No. of cases % Leading cause
No. of
cases %
Low birth weight 30 14.9
Injury all types 76 16.2
Pneumonia all types 28 13.9 Heart diseases 46 9.8
Diarrhea all forms 19 9.5
Stroke, not spec.as
haemmorhage/ infarction 41
8.7
Malnutrition, all types 19 9.5 Hiv/aids 40 8.5
Congenital
malformations 14
7.0 Pneumonia all types 34
7.2
Anemia, all types 13 6.5 Burns 25 5.3
Heart diseases 8 4.0 Tb, all types 22 4.7
Septicemia 7 3.5 Head injury 21 4.5
Intrauterine
hypoxia/birth asphyxia 6
3.0 Renal failure 18
3.8
Neonatal sepis 6 3.0 Diabetes mellitus 16 3.4
Total top 10 150 74.6 Total top 10 339 72.3
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V.4.7. Zoba Semenawi Keyh Bahri
Table V.4.7.1. Ten Leading Causes of Outpatient Morbidity in Ho and HC in SKB by Age Group in 2012
Under Five Five and Above
Leading cause No. of cases % Leading cause No.of cases %
Diarrhea all forms 10520 27.7 ARI (With out pneumonia) 21906 20.6
ARI (With out pneumonia) 9389 24.8 Gastritis / duodenal ulcer 8180 7.7
Pneumonia all types 7597 20.0 Diarrhea all forms 7007 6.6
Fever of unkown origin 2257 6.0 Other urinary tract infection 6919 6.5
Skin infection & scabies 1429 3.8 Pneumonia all types 6067 5.7
Ear infection 1160 3.1 Skin infection & scabies 4665 4.4
Infection of eye including
trachoma 1091
2.9
Infection of eye including
trachoma 4334
4.1
Malnutrition, all types 1026 2.7 Oro - dental infection 4240 4.0
Injury all types 509 1.3 Anemia, all types 3926 3.7
Oro - dental infection 424 1.1 Injury all types 2896 2.7
Total top 10 35402 93.4 Total top 10 70140 65.9
Table V.4. 7.2 Ten Leading Causes of Inpatient Morbidity in Ho and HC in SKB in 2012
Under Five Five and above
Leading cause No. of cases % Leading cause #cases %
Pneumonia all types 1750 44.2 Abortion, all types 444 5.3
Malnutrition, all types 756 19.1
Pneumonia all types 405 4.9
Diarrhea all forms 596 15.1
Obs emergencies 380 4.6
Low birth weight 379 9.6 Diarrhea all forms 369 4.4
ARI (With out pneumonia) 84 2.1 Injury all types 301 3.6
Neonatal sepis 64 1.6 Malaria , all types 296 3.6
Skin infection & scabies 37 0.9 Epi preventable diseases 275 3.3
Epi preventable diseases 31 0.8
Other urinary tract
infection 182
2.2
Injury all types 27 0.7
Skin infection & scabies 172 2.1
Septicemia 27 0.7 Gastritis / duodenal ulcer 154 1.9
Total top 10 3751 94.8 Total top 10 2978 35.9
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Table V. 4.7.3. Top 10 Causes of Inpatient Mortality in Ho and HC in SKB in 2012
Under Five Five and Above
Causes No. % Causes No. %
Malnutrition, all types 65 35.9 Pneumonia all types 17 15.9
Pneumonia all types 38 21.0 Anemia, all types 11 10.3
Diarrhea all forms 33 18.2 Diarrhea all forms 6 5.6
Low birth weight 18 9.9 Epi preventable diseases 6 5.6
Neonatal sepis 7 3.9 Heart diseases 6 5.6
Other perinatal and
neonatal problem 5
2.8 Hiv/aids 6
5.6
Septicemia 3 1.7 Diabetes mellitus 5 4.7
Intrauterine hypoxia/birth
asphyxia 2
1.1
Hypertensive related
diseases 5
4.7
Anemia, all types 1 0.6 Tb, all types 5 4.7
Burns 1 0.6 Obs emergencies 4 3.7
Total top 10 173 95.6 Total top 10 71 66.4
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VI.7. List of Health Facilities Reporting to HMIS in the 2012 (Jan-Dec)
VI.7.1.Anseba S N F A C N A M E
F A C T Y P E
S U B Z N A M E
O W N E R
B E D1. ADI-TEKELEZAN HC ADI-TEKELEZAN MOH 30
2. ASMAT HC ASMAT MOH
3. EROTA HS ASMAT MOH
4. HURUM HS HS ASMAT MOH
5. ELABERED CL ELABERED MOA
6. ELABERED HC ELABERED MOH
7. HADISH ADI HS ELABERED MOH
8. HALIBMENTEL HS ELABERED CCM
9. SHEB HS ELABERED MOH
10.GELEB HS GELEB MOH
11.MEHLAB HS GELEB MOH
12.AF-EYUN HS HABERO MOH
13.FILFILE HS HABERO MOH
14.HABERO HC HABERO MOH
15.HABERO TSADA HS HABERO MOH
16.ASHERA HS HAGAZ CCM
17.BEGU HS HAGAZ CCM
18.DAROTAI HS HAGAZ MOH
19.GLASS HS HAGAZ CCM
20.HAGAZ HC HAGAZ MOH
21.HASHISHAY HS HAGAZ MOH
22.KERMED HS HAGAZ MOH
23.GEBEY ALEBU HS HALHAL MOH
24.HALHAL HC HALHAL CCM
25.MELEBSO HS HALHAL MOH
26.FREDAREB HC HAMELMALO CCM
27.HAMELMALO AGRI. COLLAGE CL HAMELMALO MOH
28.JENGEREN HS HAMELMALO MOH
29.ST. LUCHA HC HAMELMALO CCM
30.BLOCO KEREN HS KEREN MOH
31.GEZA-MANDA HS KEREN CCM
32.JOKO MCH MC KEREN MOH
33.KEREN REG. REF. HOSP HO KEREN MOH
34.KEREN VCT CL KEREN MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
152
S N F A C N A M E
F A C T Y P E
S U B Z N A M E
O W N E R
B E D35.MEGARIH HS KEREN MOH
36.SHIFSHIFIT HS KEREN MOH
37.HAMISH-DUBA HS KERKEBET MOH
38.HIMBOL HS HS KERKEBET MOH
39.KERKEBET HC KERKEBET MOH
40.LOKAI HS HS KERKEBET MOH
41.SHERIT HS SELA MOH
VI.7.2 Debub.
SN FACNAME FACTYPE SUBZNAME OWNER BED
1 ADI KEIH VCT CL ADI-KEIH MOH
2 ADI-KEIH HS ADI-KEIH MOH
3 ADI-KEIH HOSP. HO ADI-KEIH MOH
4 DEREA HS ADI-KEIH MOH
5 HAWATSU HS ADI-KEIH CCM
6 KOHAYTO HS ADI-KEIH MOH
7 TEKONDAE HS ADI-KEIH CCM
8 ADI-JENU HS ADI-QUALA CCM
9 ADI-QUALA MH ADI-QUALA MOH
10 AWHA HC HC ADI-QUALA MOH
11 ENDAGHERGIS HS ADI-QUALA MOH
12 ADI-GULTI HS AREZA MOH
13 ADI-GUROTO HS AREZA MOH
14 ADI-WUSK HS AREZA MOH
15 AREZA HC AREZA MOH
16 MAY-DIMA HS AREZA MOH
17
MAY-DIMA
OPHTHALMIC HC AREZA MOH
18 UBEL HS AREZA MOH
19 ZEBANDEBRI HS AREZA MOH
20 ADI-BEZAHANIS HS DBARWA MOH
21 ADI-FELESTI HS DBARWA MOH
22 ADI-GEBRAY HS DBARWA MOH
23 DBARWA HC DBARWA MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
153
24 GERTETE HS DBARWA MOH
25 SHIKETI HS DBARWA MOH
26 TERA EMNI HS DBARWA MOH
27 ALLA HS DEKEMHARE MOH
28 DEKEMHARE HS DEKEMHARE CCM
29 DEKEMHARE HOSP. HO DEKEMHARE MOH
30 DEKEMHARE HS1 HS DEKEMHARE MOH
31 DEKEMHARE VCT CL DEKEMHARE MOH
32 FEKEIH HS DEKEMHARE MOH
33 MAY-EDAGA HS DEKEMHARE MOH
34 ANAGER HS EMI-HAILY MOH
35 KUDO-BOUER HC EMI-HAILY MOH
36 SHEKA-IYAMO HS EMI-HAILY MOH
37 KINAFNA HS MAY-AYNEE MOH
38 MAY-AYNEE HC MAY-AYNEE MOH
39 QUATIT HC MAY-AYNEE MOH
40 DABRE HS MAY-MINE MOH
41 MAY-MINE HC MAY-MINE MOH
42 MAY-MINE MCH MC MAY-MINE CCM
43 KUDO-FELASI HS MENDEFERA MOH
44 MENDEFERA HS MENDEFERA CCM
45 MENDEFERA MCH MC MENDEFERA MOH
46
MENDEFERA REG.
REF. HOSP HO MENDEFERA MOH
47 MENDEFERA VCT CL MENDEFERA MOH
48 AKRUR HS SEGHENEYTI CCM
49 DIGSA HC SEGHENEYTI CCM
50 HADIDA HS SEGHENEYTI MOH
51 HEBO HS SEGHENEYTI CCM
52 INGELA HC SEGHENEYTI CCM
53 SEGHENEYTI HC SEGHENEYTI MOH
54 FORTO HS SENAFE MOH
55 GOLO HS SENAFE MOH
56 LAHAYO HS SENAFE MOH
57 MESEREHA HS SENAFE CCM
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
154
58 MONOKSOYTO HS SENAFE CCM
59 SENAFE HS SENAFE CCM
60 SENAFE MH SENAFE MOH
61 SERHA HS SENAFE MOH
62 DEKILEFAY HS TSORENA MOH
63 ENDABA-STIFANOS HS TSORENA MOH
64 GHENZEBO HS TSORENA MOH
65 HADIS-ADI HS TSORENA MOH
66 ONA-ANDOM HS TSORENA MOH
67 TSORENA HC HC TSORENA MOH
68 TSORENA HS HS TSORENA CCM
VI.7.3. DKB
SN FACNAME FACTYPE SUBZNAME OWNER BED
1 AYTUS HS ARETA MOH
2 AYUMEN HS ARETA MOH
3 EGROLI HS ARETA MOH
4 TIO MH ARETA MOH
5 ASSAB REG. REF. HOSP HO ASSAB MOH
6 ASSAB VCT CL ASSAB MOH
7 BAHTI-MESKEREM HS ASSAB MOH
8 ABO HS DEBUB-DENKALIA CCM
9 BEYLUL HS DEBUB-DENKALIA MOH
10 DEBAISIMA HS DEBUB-DENKALIA CCM
11 RAHAITA HS DEBUB-DENKALIA MOH
12 WADE HS DEBUB-DENKALIA MOH
13 AFAMBO HS MAKELAY KEYHI BAHRI MOH
14 BEL-EBUY HS MAKELAY KEYHI BAHRI MOH
15
EDI COMMUNITY
HOSPITAL MH MAKELAY KEYHI BAHRI MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
155
VI.7.4. Gash Barka
SN FACNAME FACTYPE SUBZNAME OWNER BED
1 ADERDE HS AGORDAT EVM
2 ADI-SADINA HS AGORDAT MOH
3 AGORDAT HO AGORDAT MOH
4 AGORDAT MCH MC AGORDAT MOH
5 AGORDAT VCT CL AGORDAT MOH
6 DERET HS AGORDAT MOH
7 ENGERNE HS AGORDAT CCM
8 BARENTU MCH MC BARENTU MOH
9 BARENTU REG. REF. HOSP HO BARENTU MOH
10 BARENTU VCT CL BARENTU MOH
11 DASSIE HS BARENTU MOH
12 KERCASHA HS BARENTU MOH
13 KULUKU HS BARENTU EVM
14 SOSONA HS BARENTU MOH
15 ADI-IBRAHIM HS DIGHE MOH
16 BISHA CL DIGHE MOH
17 DIGHE (GHIRJENAY) HS DIGHE MOH
18 KATRENAY HS DIGHE MOH
19 KERU HS DIGHE MOH
20 SHATERA HC DIGHE MOH
21 TEKRERET HS DIGHE MOH
22 FORTO HC FORTO MOH
23 GHIRMAYKA HC FORTO MOH
24 MOLOVER HS FORTO MOH
25 SAWA(HOMIB) HS FORTO MOH
26 TAMARAT HS FORTO MOH
27 GOGNE HC GOGNE MOH
28 TAKAWDA HS GOGNE MOH
29 ADI-SHEGALA HS GULUJ MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
156
30 ANGULET (Anagulu) CL GULUJ MOH
31 GERGEF HS GULUJ MOH
32 GERSET HS GULUJ MOH
33 GULUJ HC GULUJ MOH
34 KACHERO HS GULUJ MOH
35 OMHAJER HC GULUJ MOH
36 SABUNAIT HS GULUJ MOH
37 SANDASHINA (MENGULA) HS GULUJ MOH
38 TEBELDIA HS GULUJ MOH
39 ALEBU HS HAYCOTA MOH
40 FESCO HS HAYCOTA MOH
41 HADEMDEMIT CL HAYCOTA MOH
42 HAYCOTA HC HAYCOTA MOH
43 ANTORE HS LAELAY GASH MOH
44 AUGARO HS LAELAY GASH MOH
45 GERENFIT HS LAELAY GASH MOH
46 MAY-SHIGLY HS LAELAY GASH MOH
47 SHILALO HS LAELAY GASH MOH
48 TOKOMBIA HC LAELAY GASH MOH
49 ADI-NIAMIN HS LOGO ANSEBA MOH
50 KERENAKUDO HS LOGO ANSEBA MOH
51 LIBAN HS LOGO ANSEBA MOH
52 MEKERKA HC LOGO ANSEBA MOH
53 MELEZANAY HS LOGO ANSEBA MOH
54 DULUK HS MENSURA MOH
55 GERGER HS MENSURA MOH
56 HIRKUK HS MENSURA MOH
57 MENSURA HC MENSURA MOH
58 MIGRAH (TINSHAY) HS MENSURA MOH
59 AREDA (COFERENCO) HS MOGOLO MOH
60 MOGOLO HC MOGOLO CCM
61 TOMBITA HS MOGOLO MOH
62 DERABUSH HS MULKI MOH
63 ENDA-GABR HS MULKI MOH
64 FOLINA HS MULKI MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
157
65 MAI-DOGALE HS MULKI MOH
66 MULKI HC MULKI MOH
67 BINBINA HS SHAMBUKO CCM
68 KOROKON HS SHAMBUKO MOH
69 KOTOBIA HS SHAMBUKO MOH
70 SHAMBUKO HC SHAMBUKO MOH
71 ALIGHIDIR HS TESSENEY MOH
72 FANKO HS TESSENEY MOH
73 TALATA ASHER HS TESSENEY MOH
74 TESSENEY HO TESSENEY MOH
75 TESSENEY MCH MC TESSENEY MOH
76 TESSENEY VCT CL TESSENEY MOH
VI. 7.5. Maakel
1 HAZEGA HS BERIKH EVM BED
2 TSADA CHRISTEAN HC BERIKH MOH
3 TSEAZEGA HS BERIKH MOH
4 ADI-GUEDAD HC GHALA NEFHI MOH
5 ADI-HAUSHA HS GHALA NEFHI MOH
6 ERITREAN INSTITUTE TECH. HC GHALA NEFHI MOE
7 GULIE HS GHALA NEFHI MOH
8 HIMBERTI HS GHALA NEFHI MOH
9 KETEMWWULIE HS GHALA NEFHI MOH
10 MASSAWA VCT CL MASSAWA MOH
11 ACRIA HC NORTH EAST ASMARA MOH
12 ARBATE-ASMARA HS NORTH EAST ASMARA MOH
13 DR. SURUR ALIABDU CL NORTH EAST ASMARA PRV
14 EDAGA HAMUS MH NORTH EAST ASMARA MOH
15 ERITREA ELECTRIC AUTH. CL NORTH EAST ASMARA IND
16 ERITREA TEXTILE CL NORTH EAST ASMARA IND
17 NASANET ENTERPRISE CL NORTH EAST ASMARA IND
18 SABA HS NORTH EAST ASMARA MOH
19 ASMARA PICKLING TANNERY CL NORTH WEST ASMARA IND
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
158
20 COCA-COLA SOFT DRINK CL NORTH WEST ASMARA IND
21 HAZHAZ HS NORTH WEST ASMARA MOH
22 HAZHAZ HOSP HO NORTH WEST ASMARA MOH
23 PRISON SERVICE CL NORTH WEST ASMARA POL
24 RED SEA LEATHER TANNERY CL NORTH WEST ASMARA IND
25 REHABILITATION CENTER CL NORTH WEST ASMARA MOH
26 SEMENAWI ASMARA HC NORTH WEST ASMARA MOH
27 ADI-SHEKA HS SEREJEKA MOH
28 AZIEN HS SEREJEKA MOH
29 BELEZA HS SEREJEKA MOH
30 EMBADERHO HS SEREJEKA MOH
31 GESHNASHIM HS SEREJEKA MOH
32 SEREJEKA HC SEREJEKA MOH
33 WEKI HS SEREJEKA MOH
34 ZAGIR HS SEREJEKA CCM
35 ABRAHA BAHTA SCHOOL CL SOUTH EAST ASMARA MLW
36 ADIS-ALEM HC SOUTH EAST ASMARA MOH
37 ASBECO COMPANY CL SOUTH EAST ASMARA IND
38 ASMARA BEER FACTORY CL SOUTH EAST ASMARA IND
39 AYRAHC (ASMARA YOUTH) CL SOUTH EAST ASMARA OTH
40 BRITISH AMERICAN TOBACCO CL SOUTH EAST ASMARA IND
41 DEARIT DENTAL CLINIC CL SOUTH EAST ASMARA PRV
42 DR. MAHMUED M/OMER CL SOUTH EAST ASMARA PRV
43 DURFO HS SOUTH EAST ASMARA MOH
44 EDAGA VCT CL SOUTH EAST ASMARA MOH
45 FAMILY REPRODUCTIVE CL SOUTH EAST ASMARA MOH
46 LASALE HS SOUTH EAST ASMARA MOH
47 METAL WORKS FACTORY CL SOUTH EAST ASMARA IND
48 NATIONAL INSURANCE CORP. CL SOUTH EAST ASMARA IND
49 POLICE CLINIC CL SOUTH EAST ASMARA POL
50 RED SEA FOOD PRODUCTION CL SOUTH EAST ASMARA IND
51 ST. ANTONIO HS SOUTH EAST ASMARA CCM
52 STAR DENTAL CLINIC CL SOUTH EAST ASMARA PRV
53 TECLE DENTAL CLINIC CL SOUTH EAST ASMARA PRV
54 TELE-CLINIC CL SOUTH EAST ASMARA IND
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
159
55 VCT2 FREE STANDING CL SOUTH EAST ASMARA MOH
56 ZAER (Asmara Textile) CL SOUTH EAST ASMARA IND
57 ASMARA AIR PORT CL SOUTH WEST ASMARA IND
58 ASMARA PALACE HOTEL CL SOUTH WEST ASMARA IND
59 BARAKO CL CL SOUTH WEST ASMARA IND
60 BEDHO GENERAL CONSTRUCTI CL SOUTH WEST ASMARA IND
61 BINI SHOE FACTORY CL SOUTH WEST ASMARA IND
62 DAHLAK SHARE COMPNAY CL SOUTH WEST ASMARA IND
63 DEMBE SEMBEL SCHOOL CL SOUTH WEST ASMARA IND
64 DENDEN HOSPITAL HO SOUTH WEST ASMARA MOH
65 DENDEN HS HS SOUTH WEST ASMARA MOH
66 DR. REZENE DENTAL CLINIC CL SOUTH WEST ASMARA PRV
67 ERITREAN CORWELL DRILL CL SOUTH WEST ASMARA IND
68 FELEGE HIWET HS SOUTH WEST ASMARA MOH
69 FRE-SELAM HS SOUTH WEST ASMARA MOH
70 GERITERIC HC HC SOUTH WEST ASMARA PRV
71 GODAAIF HC SOUTH WEST ASMARA MOH
72 GODAIF HS SOUTH WEST ASMARA MOH
73 ORPAHN CLINIC CL SOUTH WEST ASMARA MLW
74 SABUR P. SERVICE CL SOUTH WEST ASMARA IND
75 SEMBEL HS SOUTH WEST ASMARA MOH
76 SEMBEL HOSP HO SOUTH WEST ASMARA PRV
77
SEMBEL METAL & WOOD
FACT CL SOUTH WEST ASMARA IND
78 SEMEBEL HOUSE HOLD FACT. CL SOUTH WEST ASMARA IND
79 SOAPRAL FACTORY CL SOUTH WEST ASMARA IND
80 SPACE 2001 ERITREA CL SOUTH WEST ASMARA IND
81 UNDP CL SOUTH WEST ASMARA NGO
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
160
VI.7.6. National Referrals
SN FACNAME FACTYPE SUBZNAME OWNER BED
1 ASMARA PHYSIO THERAPY HC NATIONAL REFERRAL MOH
2
BERHAN AYNE
OPHTHALMIC HO NATIONAL REFERRAL MOH
3 HALIBET REFERRAL HO NATIONAL REFERRAL MOH
4 HANSSENIAN HO NATIONAL REFERRAL MOH
5 IOCCA HC NATIONAL REFERRAL MOH
6 MDR HOSPITAL HO NATIONAL REFERRAL MOH
7 MEKANE HIWET OBS_GYN HO NATIONAL REFERRAL MOH
8 MEKANE HIWET PEDIATRIC HO NATIONAL REFERRAL MOH
9 OROTTA HO NATIONAL REFERRAL MOH
10 ST MARY HO NATIONAL REFERRAL MOH
VI. 7.7 SKB
1 ARARIB HS ADOBHA MOH BED
2 ELA-BABU HS ADOBHA MOH
3 HASTA HS ADOBHA MOH
4 HIMBOL HC ADOBHA MOH
5 AFABET HO AFABET MOH
6 FELKET HS AFABET MOH
7 GADM HALIB HS AFABET MOH
8 KAMCHEWA HC AFABET MOH
9 DAHLAK HC DAHLAK MOH
10 DEHILE HS DAHLAK MOH
11 DERBUSHET HS DAHLAK MOH
12 FORO HC FORO MOH
13 IRAFAYLE HC FORO MOH
14 ROBROBIA HS FORO MOH
15 SILIKE HS FORO MOH
16 BADA HC GHELAELO MOH
17 BUYA HS GHELAELO MOH
18 GHELAELO HC GHELAELO MOH
“Information is a tool to support informed decisions at all levels not a vertical program”
Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012
161
19 INGEL HS GHELAELO MOH
20 MENKALELE HS GHELAELO MOH
21 DANKUR HS GHINDAE MOH
22 DEMAS HS GHINDAE MOH
23 EMBATKALA HS GHINDAE MOH
24 GAHTELAY HS GHINDAE MOH
25 GHINDAE HC GHINDAE IND
26 GHINDAE HS GHINDAE CCM
27 GHINDAE REG. REF. HOSP HO GHINDAE MOH
28 MARGERAN CL GHINDAE IND
29 MAYHABAR HS GHINDAE MOH
30 NEFASIT HC GHINDAE MOH
31 SHEBAH HS GHINDAE MOH
32 KARORA HS KARORA MOH
33 MAHMIMET HC KARORA MOH
34 ADIS ALEM DENTAL CL CL MASSAWA MOH
35 AMATERE MC MASSAWA MOH
36 CEMENT FACTORY HS MASSAWA IND
37 ENKULU CL MASSAWA NGO
38 HIRGIGO HS MASSAWA MOH
39 KUTMIA HS MASSAWA MOH
40 MARIN SCIENCE COLLAGE CL MASSAWA MOE
41 MASSAWA HO MASSAWA MOH
42 MASSAWA PORT HS MASSAWA IND
43 TIWALET HS MASSAWA MOH
44 WEKIRO HS MASSAWA MOH
45 AGRAIE HS NAKFA MOH
46 BACKLA HS NAKFA MOH
47 ENDLAL HS NAKFA MOH
48 NAKFA HO NAKFA MOH
49 SHIEB HC SHIEB MOH