Wednesday, 23 September 2015

Infant mortality in Ethiopia

SPHPM’s Mr Berhe Sahle has co-authored an article with researchers from Mekelle University in Ethiopia, seeking to assess the infant mortality rate within Ethiopia as well as explore the current risk factors leading to infant mortality within the country. 

The use of infant mortality rates are a crucial gauge in measuring population health. Regions with high infant mortality rates demonstrate that there are poor economic, social and environmental conditions that impact infants in their formative years. While the World Health Organization’s (WHO) Millennium Development Goal Four sought to reduce the under-five mortality rate by two-thirds by 2015, statistics highlighted that in 2013, infant mortality represented 73 per cent of deaths of children under the age of five.

The development of the Millennium Development Goal Four has seen renewed efforts to make reducing infant mortality as an urgent priority. Globally, there has been significant changes made to better nutrition, sanitation and hygiene, create easier access to health care services and to encourage exclusive breastfeeding. These interventions have seen success in reducing both infant mortality rates and under-five deaths.

Nonetheless, areas that are severely under developed or have disadvantaged communities are still struggling to deal with high infant mortality rates; the global infant mortality rate was approximately 35 per 1000 live births in 2012, in Sub-Saharan Africa the figure was 64 per 1000 live births. Sub-Saharan Africa remains as one of the areas where decline in infant mortality and under five death has been minimal. Ethiopia is also one of the countries to have one of the highest infant mortality rates. In response, Ethiopia made changes to their primary health care and social services, bettering access, significantly within the rural communities. This had a positive impact, with access to primary health care increasing from 57 per cent in 204 to 92 per cent  in 2013. Public healthcare facilities also offer free maternal and child health care services.

As a result, the country has seen a decrease in rates of child and infant mortality, with Ethiopia being one of the select countries who met the Millennium Development Goal Four in 2013. However, due to the lack of a civil registration system, there is a lack of population data identifying the current infant mortality rates within the country. However, similar to other developing countries, it has multiple Health and Demographic Surveillance Systems (HDSS), allowing for the  development of population based health and demographic indicators.

The authors of this study utilised one of these systems, Kilite Awlaleo HDSS (KA-HDSS), to determine the infant mortality rate at a population level, as well as to identify the various risk factors that lead to infant mortality and understand the main causes of infant death. Using the KA-HDSS system, live births to a group of mothers were followed until their first birthday or their death from September 11, 2009 to September 10, 2013. Characteristics of the infants were obtained at both the baseline and during the follow up visits. Following this, multiple-Cox regression was utilised to determine risk factors leading to infant death. Furthermore, causes of death were retrieved through the use of physician review verbal autopsy.

The results indicated that out of the 3684 infants monitored, 174 passed away before their first birthday. The infant mortality rate was therefore 47 per 1000 live births across the four year period. A total of 96 per cent of infants lived up to their first birthday and 56 per cent of deaths happened during the neonatal period. Infants who were born to women aged 15-19 were likely to have a higher risk of death compared to those who were born to mothers aged 25-29. Furthermore, mothers who had a secondary school education or above gave birth to infants who had a 56 per cent reduced risk of death. The leading causes of death were identified as prematurity, asphyxia, sepsis and acute lower respiratory tract infections.

The authors conclude that the infant mortality rate across the four year period was lower than the regional and national estimates. They also discuss and examine the need for better care for newborn children and encouraging teenagers to avoid pregnancies and seek a higher education.

You can read the paper here.

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