Maternal, under five, and Neonatal Mortality during war time at Tigray Region, Northern Ethiopia:
What was the study period? November 2020 to May 2022 –Period of war
When was the data collected? May 2022 through June 2022
Who did the study? The study was conducted with the financial support from UNFPA, UNICEF through Maedot and Moms for Moms, Mekelle University in collaboration with Tigray Regional Health Bureau and Tigray Health Research Institute.
What was studied?
The objective of the study was to assess the Magnitude and causes of Maternal, Under-five, and Neonatal Mortality during war time at Tigray Region. Standard WHO 2022 VA instrument and Inter VA 5.1 was utilized
Which part of Tigray was studied?
Through multistage cluster sampling technique, using urban rural strata and proportional allocation: the study was conducted in 6 of the seven zones of Tigray (Western zone was not included as it is not reachable) and in 121 Tabya of 31 districts.
What were the main findings?
Maternal Mortality
189,087 households were studied. Maternal mortality ratio was at 840/100,000. This level is unacceptably high and is comparable to the level which was 22-29 years back. Maternal mortality ratio has increased by 5 folds as compared to the pre war level.
The commonest causes were obstetric hemorrhage and pregnancy induced hypertension. These are direct causes and could have been easily prevented with intervention. Pregnancy related sepsis and HIV were also notable causes.
Lack of emergency treatment and failed health system contributed to 90% of circumstances of death.
81% of the mothers died outside health facility (home, en route, bush). This is in stark contrast to pre war situation.
Under-five Mortality
What is the magnitude of under-five mortality?
The magnitude of under-five mortality is 59 in 1000 live births. Compared to prewar under -five mortality, this figure shows two fold increment. The Top four commonest causes of under- five mortality were Perinatal asphyxia, Prematurity, Diarrheal Diseases and Pneumonia. Vaccine preventable diseases like diarrheal disease, Pneumonia and Pertusses account for majority of causes for under-five mortality.
When we see the circumstances of death for under-five mortality more than 1/3 rd is attributed to destruction of health system and 1/4 th is attributed to absence of emergency services. More than 2/3 rd of under -five children in Tigray died in their home or on their way to health facility.
Neonatal Mortality
The magnitude of neonatal mortality is 36 in 1000 live births. Compared to the prewar neonatal mortality, this figure shows a four-fold increment. The top three commonest causes for neonatal mortality are perinatal asphyxia, Prematurity and neonatal Infections. When we see the circumstances of death, more than 3/4 th deaths are attributed to destruction of health system and absence of emergency services. And more than 50% of the neonatal deaths happened in their home without any medical intervention.
Recommendations
The most vulnerable of all and yet who have no agency in the fighting, pregnant mothers and children are bearing the brutal consequences of the war.
To avoid further tragic preventable deaths would require commitment
International community
- Cessation of hostilities
- Unfettered access to humanitarian aid including vaccine and medications
- Transportation, Communication
- Rehabilitate and rebuild Tigray Health System
Short term solutions
Partners and non-governmental organizations
- Medical supplies ( Oxytocin, Misoprostol, Magnesium sulphate, Antibiotics, Vaccines, IV fluid)
- Nutritional support for the vulnerable group ( Under five children and pregnant and lactating
mothers) - Interventions that improve emergency clinical care
- Contribute in the rehabilitation of Tigray Health System
- Enhancing the Preventive interventions of infectious diseases
Tigray Regional Health Bureau and partners
- Organize home to home skilled delivery activities
- Maternity waiting homes
Tigray Community
- Organize youths for traditional ambulance
- Participate in blood donation
Trend of Maternal mortality ratio Tigray, Pre and during war
Trend of Neonatal mortality rate in Tigray, Pre and during war
Trend of under five mortality rate in Tigray, Pre and during war