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 1 Background 2Methodology 3 Results and Discussions 4 Conclusion and recommandatio ns Conclusi on and Recomm andation 2 Amref Health Africa

 Globally(2013), an estimated 292, 982 maternal deaths Gravity: Developing countries % 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 BACKGROUND 3 Amref Health Africa

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 4 Amref Health Africa

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 5 Amref Health Africa

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 6 Amref Health Africa

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) 7 Amref Health Africa

RESULTS AND DISCUSSIONS Characteristics of PE/E women from In five year period ( )  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 ( 6 8.6%) MgSo4 administration 976 (54.1%) 8 Amref Health Africa

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% 9 Amref Health Africa

Trend of Preeclampsia/Eclampsia 10  The percentage increase over the five years was 154% This increment might be related with the  Case detection rate due to special emphasis  Actual increment  It needs a further analysis Proportion of Preeclampsia Amref Health Africa

Table 1: Pattern of maternal complications 11 VariableResponseFrequency (%) Maternal complication Yes652(36.0%) No1157(63.96%) Type of complications HELLP syndrome257(39.5%) Aspiration pneumonia114 (17.5%) Pulmonary edema114(17.5%) Abrabtio placenta100(15.3%) Post-partum hemorrhage56(8.6%) Acute Renal failure44(6.8%) Disseminated intravascular coagulopathy (DIC) 43(6.6%) Congestive heart failure (CHF)41(6.3%) Intracranial hemorrhage33(5.1%) Severe anemia30(4.6%) Others6 (0.9%) Amref Health Africa

Trend of Maternal complication 12 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%. Proportion of maternal complication Amref Health Africa

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% ) 13 Amref Health Africa

Table 3: Pattern of Neonatal complication 14 VariableResponseFrequency (%) Birth weight(gm) < (16.6) (±70.7) (41.1) > (42.3) Neonatal complication Yes 1202(66.4) No607(33.6) Type of Neonatal complications (n=1202) Low birth weight532 (44.2%) Respiratory distress syndrome 456 (37.9%) Premature395 (32.8%) Still birth363 (30.2%) Asphyxia102 (8.5%) Sepsis67 (5.6%) Others10 (0.8%) Early Neonatal outcome(n=144 6) Alive1296 (71.64%) Dead150 (8.29%) Amref Health Africa

Trend of neonatal complication 15 Fig : the proportion of neonatal complication  The percentage of change of neonatal complication over time was -13.2%. This might be due to Special attention given to the newborn Establishing and strengthen of Neonatal Intensive Care Unit (NICU) X 2 MH =4.21 P <0.04 Amref Health Africa % of Neonatal complication

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 16 Amref Health Africa

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 17 Amref Health Africa

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 18 Amref Health Africa