Category Archives: Reporting

An Optimistic View of Breastfeeding in Ethiopia

Throughout my travels to health facilities in Ethiopia last week with Save the Children I was heartened to see so many positive messages about breastfeeding on posters and printed materials for mothers to take home.  I also saw several mothers breastfeeding their babies everywhere we went.

In Ethiopia 52% of babies are put to the breast within one hour of being born and 52% of babies are exclusively breastfed through six months according to Save the Children’s State of the World’s Mothers 2012 report. While that number can definitely be improved Ethiopia has been given a “good” rating by Save the Children along with countries such as Rwanda and Eritrea that have percentages for the aforementioned breastfeeding indicators around the 70% range. Only four countries have been given “very good” ratings and they are Malawi, Madagascar, Peru and the Solomon Islands.

Mothers at Health Center, Ethiopia

In Ethiopia, only 51% of  babies are breastfed with complementary foods from 6-9 months, but from 20 – 23 months 82% of all toddlers are still being breastfed. Ethiopia was also given a “good” rating for policy support of the WHO code (International Code of Marketing of Breast-milk Substitutes).

What I did not like seeing at a government-run hospital’s maternity ward was a promotion for Pfizer Nutrition infant formula. That means a pharmaceutical rep came into the maternity ward and influenced health workers to advise mothers to use infant formula. With a child mortality rate that is not on track to reach Millennium Development Goal 4 in 2015, promoting anything other than exclusive breastfeeding is detrimental to the overall health of Ethiopia’s children. In fact, in Africa babies who are breastfed are six times more likely to survive the first few months of life than non-breastfed babies, according to State of the World’s Mothers 2012.

Formula Marketing in Bishoftu Hospital

Ethiopia should take a page out of Kenya‘s book and enact a new law regarding advertising of  infant formula in health settings. Kenya’s new law now forbids kickbacks from pharmaceutical reps to health workers.

Photos: Jennifer James

Mothers in Ethiopia and Newborn Care

No matter where you are babies draw a crowd. It is no different in Ethiopia when we saw babies with their mothers at health posts and centers. One baby (seen below) wore a handmade bracelet her mother told us keeps away hiccups. Despite the mother’s use of cultural practices she still brought her baby into the health center for preventive medicine and a check-up with the nurses.

In Ethiopia the rate of survival for newborns still concerns health officials. 75.29 children under the age of 12 months per 1000 live births will die per Global Health Facts. That is alarming to Save the Children because if the infant mortality number does not decrease the overall number for child mortality will not decrease either. Reducing child mortality for children under the age of five is critical to the health of countries and to the world and is a commitment under the Millennium Development Goals to reduce child mortality by two thirds by 2015.

I am currently in Ethiopia as a guest of Save the Children and its Every Beat Matters campaign to observe frontline health workers and their affect on child survival.

In many areas of Ethiopia where traditional culture still plays a heavy part in child birth and health, especially in Ethiopia’s lowlands and highlands, it is customary for mothers who have just had a child to self-isolate for at least six weeks before being seen by other members of the family and the community. Per traditional culture after the isolation period the baby will be named. Unfortunately many of the health complications for babies occur within the first few days of birth. It is is critical for health extension workers to see the babies and ensure their healthy development. Because health extension workers are trusted community members sometimes they can see a mother’s baby and sometimes they cannot, but they are making considerable progress.

The health extension workers are working diligently to encourage mothers to bring their babies to health posts for regular check-ups or to bring them in when their babies are sick instead of relying on traditional cultural remedies and practices.

This mother in Hawassa brought her daughter to a health post for a check-up. This is promising for the community’s rate of child survival. Photo: Jennifer James

Ethiopia’s Health Care Model, Workers

Ethiopia has its health care flaws and challenges, but what it seems to have captured is an appreciation for simplicity. Ethiopia’s health care system is very easy to understand, even though implementation and results are not easily achievable.

This week I am in Ethiopia with Save the Children and its new campaign Every Beat Matters to observe frontline health workers and the programs that help them achieve the best outcomes with their patients.

Health Extension WorkersOn the community level, health extension workers (HEWs) primarily help expectant and new mothers, newborns, and children. They are trained to diagnose and treat pneumonia, malnutrition, malaria, and diarrhea. They perform antenatal care and prevention and even deliver babies. And they also provide follow-up  care for new mothers.

This video explains how one mother’s baby had a fever and the health extension workers were able to provide immediate care for her.

In addition to health extension workers each community also has a health development army (HDA). These women are a volunteer unit that receives information, help, and health care services from the HEWs and spread the word throughout the community to benefit from the services of the health posts.

Health Development Army

If a patient has an acute illness that the health extension workers cannot treat women and children are referred to health centers where they have a better chance of being helped. And if there is a problem that a health center cannot help, a patient is referred to a district hospital like the Bishoftu hospital highlighted yesterday.

Bishoftu Hospital

Learn more about frontline health workers at Save the Children’s web site Every Beat Matters. Also, read about my first day in Ethiopia in My First Day in Ethiopia: An Army of Women Fight to Save Lives and Day 2: Food by Perscription.

Bishoftu Hospital’s Maternity Ward

In Ethiopia 90% of all expectant mothers deliver their babies at home, but there are some who are referred by frontline health workers with a recommendation to deliver at a hospital. At Bishoftu hospital, a zone hospital that is located about an hour south of Addis Ababa on the sole road towards Djibouti , 200 women annually give birth at its facility.  As an Ethiopian government funded hospital with grants from USAID and implementing partners like Save the Children, all maternity services are free, including C-sections.

For normal deliveries, mothers will remain at Bishoftu for six to 24 hours. For C-sections they will remain at the facility for 2-3 days. In some instances where babies are born prematurely or have heavy complications, the babies must stay in the NICU. Admittedly, Bishoftu’s NICU is small and lacks in high tech tools and equipment. Below are cribs, but in the adjacent room there were attending nurses for the babies and equipment to keep them alive and warm.

NICU

Due to the limits of the NICU, Bishoftu hospital does have a Kangaroo Mother Care room where mothers can use the natural way of keeping their premature baby close in order for her to thrive. When we visited a mother was in the room with her tiny baby sitting snug on her chest.

Kangaroo Mother Care
One of the things about African hospitals is that when women come to deliver their babies they must bring their own bedding. Here is bedding hanging out to dry near the maternity ward.

Maternity ward bedding
As I walked through the sprawling hospital I was heartened to see that Bishoftu has ambulance service. Typically ambulance service in rural Africa are motorbikes, making getting to the hospital a long, hard, potentially life-threatening journey for pregnant women .

Ambulance Service - Bishoftu

Learn more about frontline health workers at Save the Children’s web site Every Beat Matters. Also, read about my first day in Ethiopia in My First Day in Ethiopia: An Army of Women Fight to Save Lives.

I am in Ethiopia as a guest of Save of the Children and their Every Beat Matters campaign to document  frontline health care workers and health programs in Ethiopia.

Photos: Jennifer James

Family Planning in Ethiopia

This week I am a guest of Save the Children on an observational trip in Ethiopia. I, along with three distinguished US nurses, are here to learn about Ethiopia’s frontline health workers, the 38,000 women strong health extension workers. The health extension workers were put into place by the Ethiopian government in 2003 and now through the work of Save the Children and other partners, health extension workers can diagnose and treat malaria, malnutrition, pneumonia, diarrhea and can also administer implantable and injectable contraceptives.

You can learn more about frontline health workers on Save the Children’s new site: Every Beat Matters

In speaking with Dr. Birkety Mengistu, the Maternal Newborn Child Health Advisor at Save the Children’s Addis Ababa’s office, we learned that there is an ample supply of family planning options for any woman who wants it. There are, however, cultural taboos about contraceptives causing many women to forego family planning altogether. 

29% of married women in Ethiopia use family planning services according to Pathfinder. And according to Save the Children 30 – 40% of family planning needs are currently being unmet.

With the vast majority of Ethiopian still living as subsistence farmers and each woman having on average 4.8 children it is essential for women to not only have access to family planning, but also a shift in cultural imperatives that dissuade women from making decisions about their own lives.

To learn more about Save the Children’s work on family planning read: Every woman’s right: How family planning saves children’s lives (pdf).

Photo: United Nations