Beyene Lidya William Reichard Eng
02 May 2018
Topic: Infant Mortality in Ethiopia
The high infant mortality rate (IMR) in Ethiopia reflects the presence of unfavorable social, economic, and environmental conditions, and these conditions lead to premature infant death. Infant mortality is the most sensitive indicator of population health in general. IMR in Ethiopia is currently 59 per 1000 births (WHO.int, 2012). This is due to the lack of attention and support from the federal government. In this paper I will explore the dramatically high IMR in Ethiopia and present public health approaches to reallocate funds to better support Ethiopian mothers and their infants. To reduce the risk, the Ethiopian government should develop a program with an extensive network of community-based health extension workers who are trained and deployed in rural health posts to provide health, nutrition, and water and sanitation interventions.
Ethiopia is characterized by a predominantly rural and impoverished population with limited access to safe water, housing, sanitation, food and health care. There is a limited access to the Ethiopian mothers due to improper administration and corruption made by officials.
In Ethiopia, one in every 17 children dies before celebrating their first birthday, and one out of 11 children dies before their fifth birthday. The Ethiopian Demographic and Health Survey (EDHS) conducted during 2000, 2005 and 2011 showed significant reduction trend particularly for under-five. Infant mortality was registered a 39% and under five mortality rates was registered a 47% reduction. This is the biggest of the African regional average (Dadi, 2015).
This indicates that there are many risk factors to consider including premature birth, lack of prenatal care access, sanitation, and lack of political infrastructure. A reasonable political infrastructure would not only resolve these risk factors but would also regulate through periodic standardized evaluations of water, housing, sanitation, food and health care. These risk factors should not only be resolved, but the resolution to this problem should be ensured for future generations.
All of this effects Ethiopian mothers and infants, and efforts should be made by the federal government to reduce infant mortality rate. “Ethiopia has made large-scale healthcare investments to improve child health and survival. However, there is insufficient population level data on the current estimates of infant mortality rate in the country (Ashebir, Y., et al., 2015)”. There is not enough data collected over the current estimates of infant mortality. This is due to ineffectual collection of information. Education for Ethiopian mothers is necessary to provide doctors with health-related information they need. Even though reallocating funds, and building health institutions is an important role, being aware on how to use them is essential. Access to education for Ethiopian mothers should be paramount while working on the rate of infant mortality. The current socio-demography is showing improvements on women’s education and career status which really help the mothers to take a good care of themselves and the newborns to reduce infant mortality.
Even-though the improvement of women’s education and career status is important it is being seen that these women are adapting short birth interval which causes high infant mortality rate. “Infant mortality is highly related to short birth interval, in that the current socio demographic transition in Ethiopia favors the increasing problem of short birth interval. Women spent a long time of their life at school and they are busy of leading their life, so they prefer many kids they desire within short period. This special area needs focus of policy makers so that the problem is not persistent to increase under-one mortality (Dadi, 2015)”. The partnership that the government should work on policy making with public health partners is essential in this case.
Premature birth is a birth that occurs before the usual amount of time an infant need to develop in the womb. Since premature birth requires specialized care, this places an economic burden on Ethiopian families who live in poverty. The specialized care needed is difficult to provide in the rural areas of Ethiopia where the most impoverished reside. This makes premature birth the biggest contributor to IMR in Ethiopia.
Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socio economic factors that may modify and worsen the effect of short intervals (Kozuki et al. 2013).
Kozuki et al. argues that the socio economic factors contribute to inaccessibility of family planning interventions, which prevents premature birth. Therefore, putting in place programs and policies for Ethiopian mothers and infants who live in poverty will decrease IMR for this particular population.
Due to a lack of access to prenatal care, Ethiopian mothers are found to be adopting harmful behaviors such as smoking. Smoking during pregnancy is associated with a modestly increased risk of infant mortality because tobacco contains carcinogens and other harmful chemicals, which can cause health issues for infants. One way the government can help prevent these problem is by providing access to education. In addition, “women with unintended pregnancies were less likely to access or receive adequate antenatal care” (Wado et al. 2013). Antenatal care is the care that pregnant women get from health professionals during pregnancy or before birth. “Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women’s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care” (Wado et al. 2013). Concerning this intervention, government institutions should provide sufficient information available to women by intervention programs on family planning. Society should be made aware of the risks of smoking during pregnancy and provide access to antenatal care. It is unclear how long it would take for antenatal programs and education to lower infant mortality in Ethiopia.
As improving sanitation is largely associated with the prevalence of high infant mortality rates in Ethiopia, access to safe drinking water for Ethiopian mothers and infants could be one way of improving sanitation. According to WHO/UNICEF, poor sanitation and water cause 28% of child deaths, and safe sanitation and water are proven and cost-effective interventions. On the other hand, safe sanitation and water could prevent nine out of ten cases of diarrhea, and simply using a safe toilet can reduce the incidence of diarrhea by nearly 40%. Safe sanitation also significantly reduces other leading causes of child deaths, such as undernutrition and pneumonia. Thus, addressing access to sanitation is key to reducing child mortality by two-thirds (WHO/ UNICEF, 2010). Polluted local water sources and drought are currently the major problems in limiting water availability to the society. Investing on the reduction of pollution of local water sources including policies against industries that dump waste in the local streams and rivers, using natural products to clean the water instead of toxic substances. The government should work on this with public health partners to protect public health by assessing and reduce waterborne exposures and related diseases.
Political infrastructure deals with everything that is mentioned above, and it refers to the interaction between the government and the people within political systems and regulations. To reduce IMR in Ethiopia, public health infrastructure should be accessed by the government which would be possible if there was a stable political infrastructure. In particular, public health infrastructure would oversee services that ensure adequate living conditions for the prevention of IMR in Ethiopia.
All public health services depend on the presence of basic infrastructure. Every public health program—such as immunizations, infectious disease monitoring, cancer and asthma prevention, drinking water quality, injury prevention—requires health professionals who are competent in cross-cutting and technical skills, up-to-date information systems, and public health organizations with the capacity to assess and respond to community health needs. Public health infrastructure has been referred to as the nerve center of the public health system. (Binkin et al. 2011).
The presence of public health professionals will increase the availability of different preventive programs for infant mortality. The availability of public health professionals is dependant upon stable infrastructure. Therefore, the recruitment of public health professionals is determined by a political entity’s ability to offer competitive salaries as a means to attract and retain highly skilled professionals in the medical field.
Access to different facilities and equipment to work on prevention of infant mortality will decrease the risk of death of Ethiopian mothers and infants. “Ethiopia does not have the facilities, equipment and human resource with the essential skills to support a coordinated emergency medical care system and as such lacks the basic infrastructure for delivering health care. (Germa et al. 2013).” This shows that mothers are not getting enough prenatal care in which the government or the officials are not promoting healthy behaviors like promoting food safety, oral health, providing medicines and vitamins that are necessary during pregnancy, consuming environmental risks, giving awareness by ensuring that every mother is getting enough education by professionals. Why Ethiopia doesn’t have the infrastructure is a question that must be answered and dealt with before the problem of IMR rate be resolved.
The dramatically high infant mortality rate in Ethiopia is a major problem that is killing a generation. An effort to better reallocate funds, education, access to healthcare and sanitation will help in reducing the high infant mortality rate. The success or failure of any government in the final analysis is measured by the well-being of citizens, there is nothing more for Ethiopian mothers and infants than public health approaches. If the government works with the people in training women in midwifery and other public health programs like social work then that would not only decrease infant mortality but also provides jobs for women which can contribute a lot to the country’s social, economic, and political development. This leads to a whole generation being lost due to something that is preventable.