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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