Awareness raising, medical training in the field and medical/surgical equipment: focus areas in the initiative by Amref Health Africa and Laboratorios Viñas to improve obstetric health in southern Ethiopia

Ethiopian women have a 1 in 52 chance of dying due to pregnancy-related causes, compared with 1 in 3,700 in developed countries. Obstetric deaths in Ethiopia are estimated as making up approximately 4% of all maternal deaths worldwide (WHO 2013).

The most recent demographic health survey in Ethiopia (EDHS 2011) estimated the maternal mortality rate (MMR) in the country at 676 per 100,000. 85% of maternal deaths in health centres are due to direct obstetric complications. However, it should be kept in mind that the EDHS (2011) showed that just 10% of births take place in a healthcare establishment.

In line with the Emergency Obstetric and Newborn Care (EmONC) Assessment 2008, the top cause of maternal death in healthcare establishments is uterine rupture (18%).

The United Nations Population Fund (UNFPA 2010) estimated that 9,000 Ethiopian women develop an obstetric fistula each year and that up to 100,000 women live with untreated fistulas or uterine prolapse.

An obstetric fistula is an abnormal orifice in the birth canal leading to constant urinary incontinence, health problems, shame and social exclusion. Uterine prolapse occurs when the uterus descends due to rupture or weakness of the pelvic floor.

The causes of these extremely high figures are: the low rate of births in health centres, the lack of qualified midwives, the poor healthcare centre referral system, the lack of Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC), as well as insufficient funding. Similarly, cultural and social mores in rural communities, large distances from health centres and financial barriers constitute significant limitations for the improvement of maternal health.

For all of these reasons, the Ethiopian government prepared a 5-year Strategic Plan (2015 - 2020) containing measures for improvement of childbirth assistance and access to emergency obstetric care. There are 9 fistula repair centres in the country and the Federal Ministry of Health (FMOH) continues to promote campaigns for uterine and vaginal prolapse repair surgery in all hospitals.

Reaching the rural regions of southern Ethiopia

 Aware of this precarious situation, Amref Health Africa and Laboratorios Viñas developed an initiative in southern Ethiopia’s Jinka General Hospital, located in the rural region of South Omo, an area with very low sexual and reproductive health indicators, where, due to its cultural diversity (up to 20 different ethnic groups) and the semi-nomadic way of life, it is essential to raise community awareness to detect cases, even in the most isolated rural communities. Poverty and poor road infrastructure makes access to the formal healthcare system (hospitals and health centres) all the more difficult.

The overall objective of the initiative was to improve obstetric health in the women of Ethiopia’s rural communities. The specific objectives included improving access to specialised obstetric healthcare through campaigns promoting uterine prolapse and obstetric fistula repair surgery and healthcare staff training on prevention, assistance for obstructed labour and prolapse treatment.

To achieve these goals, they engaged in several activities:

• Community-wide awareness raising and information giving, case detection and diagnosis by community healthcare workers.
• Medical/surgical and training campaign for the treatment and repair of uterine prolapse and obstetric fistula.
• Provision of equipment and medicines.

The results have been very positive, and certainly constitute a necessary first step.

• A total of 32 women with uterine prolapse and obstetric fistula were treated with reconstructive surgery and received advice and support.
• 15 healthcare professionals from Jinka Hospital received practical training from volunteer obstetricians and specialist surgeons visiting the country.
• Surgical equipment such as catheters, cannulas, surgical gloves, suture materials and medicines were provided.

Indirectly, the population of women of reproductive age from the municipalities falling within the catchment area of Jinka Hospital will benefit, representing 23.4% of the population or 234,000 women.

During this second year of collaboration, Amref Health Africa and Laboratorios Viñas launched this project after offering training to midwives also in Africa.

Of note, by way of recognition for its work, Amref Health Africa received the 2018 Princess of Asturias Award for International Cooperation.

Since 2007, Laboratorios Viñas has supported humanitarian initiatives to help improve the critical healthcare and nutritional situation of many people in different parts of the world. These actions fall within its Corporate Social Responsibility policy.