Download - Maternal mortality in egypt
Maternal mortality
in Egypt
Prof. Aboubakr Elnashar Benha university Hospital
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Contents
1. Causes
2. Trends
3. MDG 5
4. The Challenges
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1. Causes
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WHO classified MM as either:
1. Direct associated with or resulting from
management of obstetric complications during
pregnancy, labor or puerperium
2. Indirect if associated with a disorder aggravated
by pregnancy (WHO, 2005)
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Ministry of health and population. Maternal mortality bulletin, 3rd
issue, September 2014 ABOUBAKR ELNASHAR
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A sizable portion of MM in Egypt is attributed to
avoidable causes in particular
substandard care
lack of supplies necessary for management of life
threatening pregnancy-related complications (Gipson et al, 2005 ; Campell et al 2005).
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The percentage of reduction in the MMR is still higher in
Upper Egypt (74%) than lower Egypt (61%)
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The highest MMR in Assuit gov (81deaths / 100.000 live births)
followed by Cairo gov (70 deaths/100.000 live births) while the
lowest MMR is in South Sina gov (No deaths at all) followed by
New valley gov (26 deaths / 100.000 live births)
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Private cars and the Taxi had the highest role in
transporting cases (33.2% and 32.9% respectively) while
transportion by ambulance represented only (23.9%). ABOUBAKR ELNASHAR
2. Trends
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Egypt has applied maternal mortality
surveillance system (MMSS) since 2001 on the
national level
1. Identify causes of deaths
2. Adopt the measures to prevent avoidable
factors of MM.
Data analysis of the MMSS can identify what
and where is the problem of maternal deaths
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3. Trends
Significant decline in the past 20 years. From 2007 to 2013, there
is no significant decrease in MMR
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Significant improvement in birth attendance by skilled personnel where the
increase was from 35% in 1990 to 92% in 2014 and the increase in birth
attendance at health facilities was from 23% in 1990 to 87% in 2014.
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The share of the private clinics in births is high where 50.5% of all
births in Egypt occurred in private clinics in 2013. ABOUBAKR ELNASHAR
86% of all deceased women who attended ANC (82.6%) were
received ANC by doctors in private clinics. It may suggest the
substandard ANC
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Malpractice in private health facilities:
delays achieving MDG5
Increases maternal deaths continuously.
The Private Health facilities: A challenge to
achieve MDG5
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It may be thought that 12.5% is not a high figure for the
share of the private facilities in maternal deaths
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36.1% of referred cases were from private clinics so, we
have to add 36.1% to 12.5% so the share of private
facilities is 48.6% of total maternal deaths. This confirms
that private facilities either is the cause of the problem or
refer the problem to other sites.
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The number of maternal deaths in private facilities is increasing
where the percentage of maternal deaths in private facilities was
(22%) in 2011, (22%) in 2012 and (30%) in 2013 of total maternal
deaths ABOUBAKR ELNASHAR
Private health facilities (Clinics - Hospitals)
are the challenges to achieve MDG5:- 1- Health providers do not follow the protocol (e g.
do not use partogram).
2- They manage high risk cases in the facilities
which is not equipped (e.g. CS in private clinic).
3- They anaesthetize cases by themselves.
4- Most of them have refused to be participants in
competency - based training course offered by MOH.
5- In some cases more than one maternal death
occur by the same physician within few months.
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To solve the problem of malpractice in
private clinics:- 1. Cancellation of the license of the physician.
2. Enacting the law of dealing with faulty killing.
3. Develop a law to arrange deliveries outside the
governmental hospitals
4. Review the existing regulations of the private
facilities and issue new ones
5. Reevaluate and relicense the physicians every 3
years
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3. Millennium Development Goal 5
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Improving maternal health: Indicators:
1. MMR:
Reduce by three quarters between 1990 and 2015
2. Proportion of births attended by skilled health
personnel:
universal access to reproductive health by 2015
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2015 targeted MMR:
43.5/100,000
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If Egypt maintains its current rate of
declining MM, it will decline more than the targeted
ratio at the national level with a few regional
exceptions:
Sharkia, Kalyoubia, Beni Suef, and Minya
{inequality in the distribution of medical services}.
Regional and economic disparities remain the main
challenge to accomplishing national goals and the
MDG5.
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The target set for achievement of the MDG5
Egypt is on track to achieve the target of MDG 5 to
reduce MM.
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In response to the initiative of ‘saving lives of mothers and children".
MCH acceleration plan:
speed up the progress towards further reduction of
MM in disadvantaged areas: achieving 43/100 ,000
by 2015.
This will be achieved by:
increasing the implementation
coverage of the MCH packages by additional 27% of
health facilities (1402 health facilities) and 30 communities.
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4. The Challenge
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DR HENK , WHO REPRESENTATIVE , February 2014:
Egypt is a success story in our Region.
There has been a significant decline in MM, but the goal,
although on track, has so far not been achieved.
The key challenge is how to increase coverage of these
interventions and reach the most vulnerable and those who
need them most.
It is important to close the inequity gap between the rich and
the poor, between those living in more developed and less
developed areas in the country.
This is the challenge that the Egypt plan aims to meet.
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Thank you
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The national ratio in Egypt is projected
21.3/100,000
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Egypt is on track to reach MDG 5.
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