1. Burden Of Pre-Eclampsia and Eclampsia in Ethiopia Mengistu Hailemariam(MD),FMOH

2. Presentation Outline Background information Maternal mortality in Ethiopia Causes of Maternal mortality Burden of Pre-eclampsia/Eclampsia Interventions

3. 3 Background Information, 2011 Ethiopia: Nine Administrative Regions -Two City Administration -817 woredas (districts) >15,000 Kebeles Tot. Pop., 79,221,000 Annual Expected Pregnancies≈3 million

4. Maternal mortality in Ethiopia   Maternal Mortality Ratio  MMR 1990 1068 (UN Estimate)  MMR 2000 871 (EDHS 2000)  MMR 2005 673 (EDHS 2005)  MMR2008 470( WHO 2008)  MDG target MMR 267

5. Causes of Maternal Death

6. Burden of Preeclampsia/Eclampsia Though hypertensive disorders of pregnancy are common in daily practice in our set up, there is no national study &there are only few studies in health institutions & there is a paucity of studies in the area. A retrospective review of 6 articles on hypertensive disorders of pregnancy were identified from 1966 to 2007.

7. Summary of the Studies NoAuthorTitleYears of Study Type of study 1Jackson AEclampsia in Addis Ababa: pattern & treatment (PTMH) 1966- 1969 Retrospective survey 2Getachew A Outcome of pregnancies complicated with preeclampsia-eclampsia disorders at SPH &TAH 1987Case- control 3Mekbib TPre-eclampsia/eclampsia at Yekatit 12 Hospital, Addis Ababa, Ethiopia 1987- 1989) Descriptive study 4Abate MEclampsia, a 5 year retrospective review of 216 cases managed in two teaching hospitals, AA(SPH &TAH) 1994-99Descriptive study 5Teklu SPrevalence & clinical correlates of hypertensive disorders of pregnancy at TAH 2003-04Descriptive study 6Kebede BMaternal & perinatal outcome of severe preeclampsia at the three teaching hospitals, AA.(SPH,TAH,&GMH 2007Descriptive study

8. Distribution of cases by age Age123456Total 15-19101391691218213 20-24114286564749291 25-29114177586872327(29. 38%) 30-3422851203135167 >=3511443132519115 total351383482161831931113

9. Distribution of cases by diagnosis Studi es Mild Preeclampsia Severe Preeclamp sia EclampsiaChronic HPN/+- superim position HELLP/par tial HELLP Total 135 26643524138 35227521348 4216 534853727183 61044148193 Total152507(45.55 %) 314(28.21% ) 92481113

10. intervention TYPE OF STUDYinterventionPreterm delivery Elective inductionElective C/S 1 12(35%)0(0%)13(37.5%) 2 3 486(39.8%)36(16.7%)90(42%) 5 107(58.5%) 89(48.6%) 6108(56%)22(11.4%)97(50.4%) Total313(28.12%) 58(5.2%)289(25.9%)

11. Management of eclampsia TYPE OF STUDY ANTICONVULSANTCONTROL OF CONVULSION 1LYTIC COCTAIL (CPZ,Promethasin and pethidin) LYTIC COCTAIL+THIOPENT37% 2DIAZEPAM 3 4 65.7% 5DIAZEPAM 6 MAGNISIUM SO4(60.6%)73%

12. CASE FATALITY RATE 7 (3.2%) mothers died before delivery STUDIES CFR HDPPreeclampsiaEclampsia mildsevere 117% 2-----------------------20% 323.8% 4 13% 52.7% ------ 4.1%8% 6 2.6%

13. PERINATAL MORTALITY Still birthsEarly Neonatal deaths Total PN deaths PNMR 19312342/00 2111021152/00 3302959165/00 4442569312.2/00 5401858300/00 6273259306/00 Total161117278

14. Maternal morbidity studiesStudy population ARFPulmonar y oedema Abr upti on DICPPHICU referral Intracranial haemorrhag e 1 2 3 4eclampsia5.5%2.8 % 11.6%6.9% 5 6Severe preeclampsia 20.2%17.6%26.9 % 12.4 % 15%13%

15. Interventions to address pre- eclampsia/Eclampsia -The nation has identified that PE/E is one of the major causes of maternal mortality and various endeavors are ongoing: 1.Capacity Buiding -The preservice trainings of all health care providers have been made to address the issue of PE/E adequately -Inservice trainings on the management of PE/E using the gold standard Mgso4 are being given for health care providers of both the public and private health facilities -National Obstetrics service guideline has been revised to include use of Mgso4.

16. Interventions to address pre- eclampsia/Eclampsia 2. Logistics -All the necessary supplies and equipments are being availed to health facilities for management of PE/E 3. Supportive supervision

17. Thank You