I saw an article recently in the British press about the high under five child mortality rate of the UK (www.theguardian.com/society/2014/may/02/uk-child-death-rate-western-europe-health). It caused me to reflect on the differences between child death in the UK and Ethiopia. The UK under five child mortality rate in 2012 was 4.8 per 1000 (30th in the world). This is high compared to other western European countries (Norway’s rate is 2.8 per 1000) and I agree needs to be improved. However for other countries, like Ethiopia, this rate is something to aim for. In 2012 the under five mortality rate in Ethiopia was 68.3 per 1000 (156th in the world). The rate in Ethiopia has fallen dramatically from 204 per 1000 in 1990. A child mortality rate of less than 5 per 1000 is just a dream currently for health professionals working in Ethiopia and other countries round the world.
It is a tragedy when any child dies anywhere in the world. The aim should always be to reduce the number of children dying and examine the causes of deaths so action can be taken. The lower the child mortality rate gets though the more difficult it is to affect it. Ethiopia has taken significant action to try to reduce the under five mortality rate and meet the Millennium Development Goal to reduce the under five mortality by two thirds. It was announced in September last year, not long after I arrived in the country, that the MDG for under five mortality had been achieved. This is fantastic as it makes Ethiopia one of only a handful of countries currently to achieve this MDG.
Behind the headline figures is another story though. Ethiopia is a federation of 9 regions and 2 city administrations. The rate of child mortality varies considerably between each region with some still having an under five mortality rate as high as 169 per 1000 in 2011, while others have a rate as low as 53 per 1000. You also have to look at the age under five of the child when the death occurs. The rate of neonatal deaths is still high. Although child mortality decreased rapidly, neonatal mortality (death in the first month after birth) has not decreased as rapidly. The neonatal mortality rate was 3 per 1000 in the UK in 2012 (34th in the world) compared to 29 per 1000 in Ethiopia (168th in the world). In comparison to the under five mortality rate as a whole the neonatal mortality rate in Ethiopia has decreased by less than half from 54.2 per 1000 in 1990.
Death is more common here but there is always sadness when a child dies. Families mourn their children no matter how old the child is (newborn or older). Just because families often have many children doesn’t meant that life is seen as cheap or not as important because they are only children. It is particularly hard for me when a child dies who I feel that if they had been in the UK I could have done more to save the child’s life.
Events around a death in hospital follow a different pattern here. In the UK resuscitation attempts are prolonged with the family present and kept informed throughout. I found when I arrived that resuscitation was not always attempted for babies and children, although this has improved since my arrival with nurses now attempting resuscitation even if there is no doctor present. The family is often in a different part of the ward and do not always want to be present with the child. After the child dies they are wrapped in white clothes and given to the family for burial. Usually the male relatives will leave the ward with the child and the shovel and pick axe that are kept on the ward. After the child has been buried they return the tools and the family will leave to mourn in private.
There is still plenty to do in Ethiopia that will affect the child mortality rate. Reducing the neonatal mortality rate is a major part of the challenge and one of the reasons that I am working here in Ethiopia is with the aim of establishing a neonatal unit here at Axum St Mary Hospital. The neonatal deaths here occur mainly due to infection or prematurity and low birth weight. Basic care can help a lot of the babies who currently die. Keeping preterm babies warm, making sure they get the right amount of feed to gain weight and supporting their breathing can save a lot of babies who otherwise wouldn’t survive. For infection it is about recognizing a child is sick and starting antibiotics early. Stopping some traditional practices (uvulectomies and use of traditional medicine) that often lead to infection would also help. Education of mothers and families is essential.
Through improving nursing care, giving guidelines for neonatal care, training staff in newborn resuscitation and care, creating a neonatal unit with the equipment needed we hope to help to reduce the neonatal mortality rate here in this small corner of Ethiopia.
Well I arrived in Addis Abba on Sunday very tired after a long flight. Trying to identify all of the other VSO volunteers in the mix of all the passengers was interesting. It was good to meet up with volunteers who I met on the last training weekend I went. This week has been in country orientation at the VSO office in Addis with the entire September intake of volunteers (a mix of British, Canadian and Brazilian). Everyone is lovely and the VSO staff and existing volunteers have been friendly and helpful where possible. Language training has been hard – Amharic is a difficult language which lots of different meanings and also a different alphabet! I do know how to say thank you, hello, ok, how much and some numbers 🙂 This has all come in handy when we were sent off on a scavenger hunt round the city and also shopping in the market for household equipment to take when I head up to Axum. I’ve now seen pictures of the flat where I’m going to live in Axum. It looks great and even has a balcony! Of course no one can tell me when I will be flying up there or if the furniture will have been delivered before I arrive. Luckily the water came back on after two days without it in time for Thursday evening when we were told to ‘dress to impress’ and went off to the British embassy for an evening reception with the ambassador. It was a great evening getting to know existing volunteers and the other new volunteers. Also meeting the ambassador and other people involved in development in Ethiopia. It was especially useful to meet a lady from DFID who is working in the health sector in Ethiopia. Inspiring to hear people talking about the important work volunteers can do. Looking forward to getting up to Axum even more. Special mention should also go to the gin & tonic, beautiful glass of red wine and roast beef & yorkshire pudding canapés! No ferrero rocher though. One of the most exciting piece of news this week is that Ethiopia has met it’s millennium development goal in reducing the under 5 year old mortality!!! There is still more work to be done everyone says but such an amazing achievement to celebrate.