MOAB010 - Amref Health Africa International Conference

Report
Trend of Preeclampsia / Eclampsia, Maternal and Neonatal
Outcomes Among Women Delivering in Government
Hospitals, Addis Ababa, Ethiopia
BY : Maereg Wagnew, Muluken Dessalegn
Amref Health Africa
PLAN OF PRESENTATION
Background
Methodology
Results and
Discussions
Conclusion and
recommandatio
ns
Conclusi
on and
Recomm
andation
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BACKGROUND
Globally(2013) , an estimated 292, 982 maternal deaths
Gravity: Developing countries - 99.4%
•Reason : ≥70% of maternal death are due to five major
complication
Hemorrhage, Infection, Unsafe abortion, hypertensive disorders
of pregnancy including preeclampsia /ecclampsia, Obstructed labor
Prevalence of preeclampsia globally
•Ranges 2% - 10% of pregnancies
•The magnitude is seven times higher in developing countries
•The risk of eclampsia: increasing maternal death by 15%
in developing countries
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cont…
• In Ethiopia maternal mortality is very high (676/100,000)
• Preeclampsia /eclampsiais reported as one of the contributing factor for this
mortality
• No well documented information on preeclampsia /Eclampsia in Ethiopia
• Therefore, this study aim to determine the magnitude and trend of
preeclampsia /ecclampsia, maternal and neonatal outcomes
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METHODOLOGY
• Study Design:– Retrospective cross sectional study
 Reviewing a five years (2009 to 2013) hospital data
• Study Area: Addis Ababa governmental Hospitals(selected)
 Three gov. hospital that offer maternal and delivery service

Tikur Anbesa Specialized hospital, Zewuditu memorial hospital and St.
Paul's Hospital
 Purposively based on the case load and the presence of fully registered data
 All mothers delivered in the three hospital from Jan 2009 to
Dec-2013 were included
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Data collection
 Pretested structured data-extracting tool developed
• Extraction was from
 mothers medical records,
 delivery registry books and HMIS
• Ethical clearance : Approved by MoH
• Ethical clearance obtained from of each hospitals
• Anonymity and confidentiality was maintained
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Analysis
•
Data was entered, coded and cleaned by EPI INFO
•
Analysis by SPSS version 22
•
The analysis was presented in the following steps: (Descriptive Analysis)
 Proportions of PE/E from total deliveries

Proportions of maternal and neonatal complication among PE/E for each
year
 Trends of preeclamsia/eclampsia, maternal and neonatal complication for
each year
 Stratification were done by year (Mantel Hansel chi square used)
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RESULTS AND DISCUSSIONS
Characteristics of PE/E women from 2009-2013
• In five year period (2009-2013)
•
•
•
•
 Total delivery: 42,963
 Preeclampsia/ eclampsia– 1809 cases
Among cases of preeclampsia/ eclampsia
 Mean maternal age: 27(± 5.08),
 Primiparous : 53%
 Mean GA at presentation :36(±3.7) weeks
Diagnosis
 Severe preeclampsia- 1412(78.1%)
 Eclampsia- 313(17.3%)
ANC follow up at least once 1240 (68.6%)
MgSo4 administration 976 (54.1%)
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The proportion of preeclampsia/ eclampsia
• In the five year:

1809 (42,963) :Preeclampsia / eclampsia were registered from
 Average proportion 4.2% [95%CI (4.02%, 4.4%)]
• Consistent with
 Study done in low- and middle-income countries in 2013 (4%).
 Study done at Namibia in 2005 : 3.4%
 Study done at Nigeria in 2011: 3.3%
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Trend of Preeclampsia/Eclampsia
6.00
5.58
5.00
4.95
4.00
Case detection rate due to
special emphasis
% of PE/E among
total delivery
3.95 3.90
Actual increment
3.00
2.00
This increment might be related
with the
Proportion of Preeclampsia
 It needs a further analysis
2.20
1.00
0.00
The percentage increase over the five years was 154%
2009
2010
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2011
Year
1012
2013
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Table 1: Pattern of maternal complications
Variable
Response
Maternal
complication
Yes
652(36.0%)
No
1157(63.96%)
Type
complications
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of HELLP syndrome
Aspiration pneumonia
Pulmonary edema
Abrabtio placenta
Post-partum hemorrhage
Acute Renal failure
Disseminated intravascular coagulopathy
(DIC)
Congestive heart failure (CHF)
Intracranial hemorrhage
Severe anemia
Others
Frequency (%)
257(39.5%)
114 (17.5%)
114(17.5%)
100(15.3%)
56(8.6%)
44(6.8%)
43(6.6%)
41(6.3%)
33(5.1%)
30(4.6%)
6 (0.9%)
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Trend of Maternal complication
45
43
40
35
34
30
32
35
33
25
20
15
10
Proportion of maternal complication
5
0
2009
2010
2011
2012
2013
Fig : the proportion of maternal complication among PE/E from 2009 to 2013
The percentage change of maternal complication over the time was 26.5%.
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Cont…
• This might be related with
 Low administration of MgSO4 and
 low focused ANC follow up
 Delayed (The three Delayed)
 Needs further versification on the intervention of the programs
 This is consistent with a study conducted among the same study group
 In Nigeria (39%) and
 In Namibia (31.8% ).
 In Eastern cape (40.29% )
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Table 3: Pattern of Neonatal complication
Variable
Response
Birth weight(gm)
<1500
1500-2500
>2500
Yes
Neonatal
complication
No
Type of Neonatal Low birth weight
complications
Respiratory
distress
(n=1202)
syndrome
Premature
Frequency (%)
301(16.6)
743(41.1)
765(42.3)
1202(66.4)
607(33.6)
532 (44.2%)
456 (37.9%)
395 (32.8%)
Still birth
363 (30.2%)
Asphyxia
102 (8.5%)
Sepsis
67 (5.6%)
Others
10 (0.8%)
Early Neonatal Alive
outcome(n=144 Dead
6)
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2364.69(±70.7)
1296 (71.64%)
150 (8.29%)
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Trend of neonatal complication
90.0
80.0
70.0
60.0
76.3
67.8
65.5
63.0
66.2
50.0
40.0
X2MH=4.21
P <0.04
% of Neonatal
complication
30.0
20.0
This might be due to
• Special attention given to
the newborn
• Establishing and
strengthen of Neonatal
Intensive Care Unit
(NICU)
10.0
0.0
2009 2010 2011 2012 2013
Year
Fig : the proportion of neonatal complication
The percentage of change of neonatal complication over time was -13.2%.
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LIMITATION OF THE STUDY
• Only hospital based data though the majority of delivery is at
home: 75%
• The trend is limited only five year due to unavailability of data
• The study is simple descriptive study have no any analytical
study
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CONCLUSIONS
• In maternal health, preeclampsia and eclampsia is an important public
health problem as high as 4.2%
• Even though interventions has introduced at country level in the last five
years the proportion of preeclampsia/eclampsia and maternal
complication significantly increased over time in contrary to the
intervention
• The neonatal complication declined significantly overtime
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RECOMMENDATIONS
• Based on the finding of the study, the following
recommendations are forwarded;
 Improve awareness creation to mothers in the community early sign and
symptoms of preeclampsia in order to tackle the ”Three Delays”
 Improving focused ANC services
 Improving the provision of MgSO4 drug by health provider and
ensuring the availability of the MgSO4 at stock
 Putting clear stating on management of Preeclmpsia/eclampsia

The researchers: Encouraged further studies the reason behind this increment
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