Eritrea Annual Health Service Activity Report of Year 2012

Contents

Acronyms ........................................................................................................................................... 3

Part I. Introduction ............................................................................................................................ 6

Vision of the HMIS ............................................................................................................................ 6

Part II. Resources ............................................................................................................................. 13

II.1. Human Resources ................................................................................................................ 13

II.1.2. Available health personnel in the MOH and their distribution in the country .............. 17

II.2.1. Number of Health Facilities that Report to HMIS ........................................................ 23

VI.2. Number of Health Facilities and their Distribution 2012 ................................................... 23

II.3. Patient Bed ....................................................................................................................... 31

II.4. Selected Health System output indicators ........................................................................ 40

III. Maternal and Child Health ......................................................................................................... 43

III.1. Antenatal care Service ........................................................................................................ 43

III. 2. Delivery Services ............................................................................................................... 48

2.1. Health facilities providing delivery services ........................................................................ 48

III.3. Obstetric Emergencies (OBE) ............................................................................................ 65

III.4. Family Planning Services ................................................................................................... 72

IV. OUTPATIENT AND INPATIENT SERVICES ....................................................................... 88

IV.1. OUTPATIENT SERVICES ............................................................................................... 88

IV.2. Inpatient services ................................................................................................................ 92

IV.3. Number of Surgeries ........................................................................................................... 94

IV.4. Diagnostic Service .............................................................................................................. 97

IV.4.1. Imaging Services ......................................................................................................... 97

IV.4.2. Laboratory Services ..................................................................................................... 98

V. DISEASE BURDEN IN ERITREA.......................................................................................... 100

V. 1. Top Ten Leading Causes of Morbidity and Mortality ...................................................... 101

V.2.Trends and Patterns of Morbidity and Mortality of the Ten Leading Causes .................... 107

V. 3. Situation of Some Selected Leading Causes of Disease Burden ...................................... 111

V.3.1. HIV/AIDS ................................................................................................................... 111

Source: HMIS ........................................................................................................................ 113

V.3.2. Malaria ........................................................................................................................ 114

V. 3.3. Tuberculosis (TB) ...................................................................................................... 117

V.3.4. Diarrhea ....................................................................................................................... 119

V.3.5. Acute Respiratory Tract infections (ARI) ................................................................... 120

V.3.6. Eye Problems .............................................................................................................. 123

V.3.7. Non Communicable Diseases ......................................................................................... 127

V.3.7.1. Injuries ..................................................................................................................... 127

V.3.7.3. Heart Diseases .......................................................................................................... 129

V.3.7.4. Neoplasm ................................................................................................................. 130

V.3.7.5. Diabetes Mellitus ..................................................................................................... 132

V.3.7.6. Mental Health ........................................................................................................... 133

V.3.7.7 Anemia and Malnutrition .......................................................................................... 134

V.3.7.9 BRONCHITIS, EMPHYSEMA and COPD ............................................................ 137

4. Disease Burden at Zoba Level ............................................................................................... 138

V.4.1. Zoba Anseba ............................................................................................................... 140

V.4.2. Zoba Debub ................................................................................................................. 141

''Information is tool to support informed decisions at all levels not a vertical program”

Health Management Information System, Department of NHIS, MoH Annual Health Service Activity report of 2012

2

V.4.3. Zoba Debubawi Keyh Bahri ....................................................................................... 143

V.4.4. Zoba Gash Barka ............................................................................................................ 145

V.4.5.Zoba Maakel ................................................................................................................ 146

V.4.6. National Referral Hospitals(NRH) ............................................................................. 147

V.4.7. Zoba Semenawi Keyh Bahri ....................................................................................... 149

VI.7. List of Health Facilities Reporting to HMIS in the 2012 (Jan-Dec) ................................ 151

VI.7.1.Anseba ............................................................................................................................ 151

VI.7.2 Debub. ........................................................................................................................... 152

VI.7.3. DKB ............................................................................................................................... 154

VI.7.4. Gash Barka .................................................................................................................... 155

VI. 7.5. Maakel .......................................................................................................................... 157

VI.7.6. National Referrals .......................................................................................................... 160

VI. 7.7 SKB ............................................................................................................................... 160


Health Management Information System, Department of NHIS , MoH Annual Health Service Activity Report of 2012

3

Acronyms

1. AFP- Acute Flaccid Paralysis

2. ALOS - Average Length of Hospital Stay

3. An/ Ans – Anseba

4. AN – associate Nurse

5. ANC - Antenatal Care

6. BMI – Body Mass Index

7. BOR - Bed Occupancy Rate

8. CCM- Catholic Church Mission

9. CFR - Case Facility Rate

10. Cl – Clinic

11. CHS – College of Health Sciences

12. CNHT – College of Nursing and Health Technology

13. CLS – Clinical Laboratory Scientist

14. CS – Cesarean Section

15. CYP – Couple Year Protection

16. DE/De - Debub

17. DKB - Debubawi Keyh Bahri zone

18. DNA, NA – Data Not Available

19. DPTHB – Diphtheria Pertusis, Tetanus Heptitis B

20. Dr. - Doctor

21. DSS - Decision Support System

22. EDHS - Eritrea Demographic Health Survey

23. EHHSUES – Eritrea Household Health Status Utilization and Expenditure Survey

24. EPI - Extended Program of Immunization

25. EVM – Evangelical Mission

26. F.G.M- Female genital mutilation

27. FRHAE- Family reproductive health association

28. FP – Family Planning

29. GB - Gash Barka zone

30. GP - General Practitioner

31. GM – growth monitoring

32. HC – Health Centre

33. HDI – Health Development Index

34. HIS – Health Information System

35. HP - Health Professional, Health Post

36. HMIS – Health Management Information System

37. HMN – Health Metric Network

38. HO – Hospital

39. HQ – head quarter

40. HR – Human Resources

41. HS – Health Station

42. ICD – International Classification of Diseases



4

43. IDSR – Integrated Disease Surveillance and Response

44. IPD - Inpatient department

45. IMCI – Integrated Management of Childhood Illness

46. IND - Industry

47. IUD – Intra Uterine Devices

48. Lab - laboratory

49. LAN – Local Area Network

50. LOS - Length of Stay in hospital or health centre

51. LSS – Life Saving Skill

52. Ma - Maakel

53. MC/ MCH – Maternal and Child Health

54. Mgt - management

55. MH - Mini Hospital

56. MLT – Medical Laboratory Technician

57. MLW – Ministry of Labour and Social Welfare

58. MMR - maternal mortality rate

59. MoD- Ministry of defence

60. MOE – Ministry of Education

61. MOH - Ministry of Health

62. MNRH – Maternity National Referral Hospital

63. NA – not available

64. NGO - Non Government Organization

65. NHMIS – National Health Management Information System

66. NID - National Immunization Day

67. NRH - National Referral Hospitals, that include Orotta Paediatric Hospital, Orotta Maternity

Hospital, Berhan Aynee Ophthalmic Hospital, St Mary Psychiatric Hospital, Orotta Mdical

Surgical Hospital, and Hansenian Hospital

68. NMW – Nurse Midwife

69. NNDR – Neonatal Death Rate

70. OBE – Obstetric Emergency

71. OPD – Outpatient department

72. PHC – Primary Health Care

73. PHT – Public Health Technician

74. PMTCT – prevention of mother to child transmission

75. POL - Police

76. Prv - private

77. Pt. – Patient

78. R and HRD – Research and Human resources Development

79. RN – Registered Nurse

80. SKB – Semenawi Kehy Bahri zone

81. Sp - Specialist

82. STI- Sexually Transmitted Infections

83. ST in- Soft Tissue injury

84. TFR – total fertility rate

85. U5 – Under five



5

86. UOA – University of Asmara

87. VCT – voluntary counselling and testing

88. VPD – Vaccine preventable diseases

89. WAN – Wide Area Network

90. WB – World Bank



6

Part I. Introduction

Vision of the HMIS

“To have an integrated information system that generates meaningful information from different

data sources using available information technology to support informed decisions at all levels of

health management” as illustrated in the diagram below.

Diagram 1. Integrated Health Information System (source: HMN guideline, 2008)

The Ministry of Health developed the Health

Management Information System (HMIS) in

1997 and selected disease and health service

indicators through the participation of health

workers and concerned partners and

stakeholders. In accordance with the selected

indicators, standardized tools for data

collection and reporting were developed to

be used in all health facilities. Data collection

manual was developed and health workers

were trained on how to use the data

collection and reporting tools. At the initial

establishment of the HMIS, the computerized

system was developed on Dose-based access

operating system and the data entry at Zoba

level started in February 1998. The reported

data can be disaggregated by Zoba, Sub-Zoba

and facility levels. The outpatient and

inpatient morbidity and mortality report is

used to be disaggregated by two age

categories (under 5 (U5) and above 5) until

the third category (<1) was included in 2004.

The reports from Zoba to the centre have

been made with floppy disks.

Continuous developments have been made to

the system to improve the quality and

reliability of the collected data and the

capacity of analysing, distributing and using

the available information. Thus, the former

Dose based software was upgraded to

window system to make it user-friendly.

Furthermore, dialling up system of reporting

from the Zoba was also developed to enhance

timely report and three zobas are users of the

Data Warehouse

Common User Interface

Decision Support & Executive Dashboard

Information Services

Extract, transform and load data into warehouse

Census Vital Event Registry

Surveys Admin Records

Service Records

Health & Disease Records

Formerly fragmented data collection methods and tools

Different Users Through different means



7

dial up system. The Local Area Network

(LAN and Wide Area Network (WAN) was

also developed to enhance the capacity of

information sharing.

The Decision Support System (DSS)

software that enhances further analysis and

readily use of the available data was

developed and installed at program

manager’s desk tops. The expansion and

strengthening of the network will facilitate

easy access and sharing of updated

information to be used for different purposes

when the capacity of the health workers to

use the network is improved.

Moreover, continuous assessment of

additional information need of the program

areas has also been on going. Thus, the

required variables are being added to the

system. Updating of DSS considering the

changes made in the data items is also a

continuous on-going process.

To satisfy the information needs of managers

and strengthen the system, assessment was

done in 1999, 2003 and late 2006. The

2006’s assessment was done using the Health

Metrics Network (HMN) health information

system (HIS) framework presented in Figure

1.

HMN GoalIncrease availability, accessibility, quality and

use of health information that are critical for

decision making at country and global levels.

HMN GoalIncrease availability, accessibility, quality and

use of health information that are critical for

decision making at country and global levels.

HMN FrameworkHMN Framework

Roadmap

for implementation

Roadmap

for implementation

Health information system components & standards

Health information system components & standards

Data sourcesData sources

HIS resourcesHIS resources

IndicatorsIndicators

Data managementData management

Dissemination and useDissemination and use

Information productsInformation products

Principles Principles

ProcessProcess

ToolsTools

To enhance evidence based practice and

informed decisions; there by to improve the

quality of health care and health status of the

people, a continuous training of health

workers and program managers at national,

Zoba and facility level on different aspect of

health information system is one of the major

focuses of the unit. Hence in the three years,

total of1790 health professionals in the six

Zobas including National referral hospitals

and head quarter were trained on data

management including using the data for

different purposes. To assess the quality and

effect of the data management training given

supportive supervision in 93 health facilities

was also conduct this year

Ensuring the quality of the data is another

focus of the HMIS. Thus, the quality of

recorded and reported data is checked using

data quality monitoring tool at different

levels. The Zobas are also expected to check

the timeliness, accuracy and completeness

of the reports of the health facility and report

to the national office on monthly bases.

Accuracy in terms of completeness, outliers

and unusual morbidity report is continuously

checked by National HMIS staff and

feedback is provided to the Zoba HMIS

officers. Thus, according to the assessment of

Figure 1



8

health facility result in 2009, the accuracy

from the health facility to Zoba level was

80.6% less than by 1.2% from 2005 that

needs special attention in improving the

accuracy rate.

The timeliness from Zoba to National level

in 2012 was 88.1 % with decreased by of

7.5% compared with 2011, as indicated in

the graph below. The decreased could be

attributed to inconsistency power supply and

assigning only one data entry clerks in some

zobas especially in Zoba Anseba, Debubawi

Keih-Bahri. The due date of Timeliness from

zoba to Head quarter is within 15th 15-20

th

days of each month.

Completeness in terms of the number of

reports received, each month compared to the

expected number is always above 90%

indicating good culture of reporting. In the

last four years the completeness was around

98% as shown in graph 3.

F Figure 3.Completeness Report ( Jan-Dec, 2009-2012)

1 0 0 8 3 . 8 8 3 . 3 1 0 0 1 0 0 1 0 0 1 0 0 9 5 . 25 8 . 3 1 0 0 7 5 8 3 . 3 1 0 0 1 0 0 1 0 0 8 8 . 102 04 06 08 01 0 01 2 0

D K S K A N G B D E M A N R A v e r a g e%

Z o b a

T i m e l i n e s s f r o m Z o b a t o N H M I S J a n - D e c2 0 1 12 0 1 2



9

On December 31, 2011 there were 340 health

facilities reporting to HMIS on monthly

bases for their respective reporting formats.

The existed HMIS data is facility based,

although information like community based

information system (CBIS) birth and death

are very essential to measure important

health indicators like infant, maternal and

adult mortality rate which are not included

into the system requiring the establishment of

vital event registration system. To bridge this

identified gap CBIS developed in

collaboration with different program

managers and stakeholders and is expected to

start this year.

The annual health service activity report

included facility based morbidity, mortality,

and health service activity, available health

personnel by category, and the number and

distribution of health facilities. The available

population survey information generated by

different programs is also incorporated where

appropriate.

Routine data available in the system

includes:

• Population data

• Antenatal

services

• Delivery

services

• Family Planning

services

• PMTCT

services

• VCT services

• Growth

Monitoring and

Promotion

services

• Health

Education

• Immunization

• IDSR diseases

• Outpatient and

Inpatient Services

that includes:

• Morbidity and

mortality data.

from hospital and

health centres

which are

classified by

International

Classification of

Disease tabulation

Code (ICD 10

Code),

• Diagnostic services (laboratory,

radiology),

• surgeries performed

• Health station outpatient morbidity

• Administrative data that includes the

number of health professionals actually

working in each health facility by

category, the number of health facilities

and their distribution by type of health

facility, revenue and expenditure of each

health facility.

Because of different interventions related to

the above mentioned services, the 1995 and

2002 DHS and other population based

surveys indicated remarkable improvement

in different health status indicators as

indicated in Table 1.1.

In computing the occurrence of diseases and

population coverage of health services,

percentages, percentage change and averages

were used. Total number of visits in

outpatient and inpatient, total number of

cases, and deaths and total number of

estimated target population for different

health services are used as denominators to

assess the current morbidity and mortality of

Table I. % of Completeness report (Jan-Dec,

2012-2009)

Zoba 2012 2011 2010 2009

DKB 100 99.9 100 100

SKB 99 99.8 99.5 99

AN 100 100 100 100

GB 99.5 99.3 95 95.5

DE 99.9 100 100 99

MA 100 98.6 98.5 98.8

NR 100 100 100 100

Average 99.8 99.7 99 98.9



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the diseases and service indicators, on which

monthly data is collected. Projected

population estimates based on the 2000 Local

Government population data is used to

calculate the target population for different

health services. Some of the denominators

used are listed in Table I.2. The morbidity

rate expressed in this text expresses the

percent of new reported cases of the heatlth

problem (e.g. Malaria) compared to total

number of new cases due to all other

reported causes in the health facility.

Similarly, the death/mortality rate indicates

the number of deaths from specific health

problem compared to the total number of

deaths in the health facility. The case fatality

rate on the other hand indicates the number

of deaths of specific health problem from the

total number of inpatient cases of the same

problem. Therefore, it is important to note

that all incidents or rates are based on facility

data that may not be representative to infer

the situation to the larger population since

most of the cases or deaths may occur at

home where data is not available. However,

it can be used by extrapolating the

community based surveys and compare it to

the facility based.

Despite this limitation, the routine data is

helpful for disease surveillance and service

delivery performance monitoring and

evaluation, resources allocation, planning

and other health system management

activities. It also is helpful to identify health

problems. The increase or decrease in the

morbidity and mortality data at health facility

also ignites the need for further community-

based studies or surveys.

Denominators

Availability of population data is essential

for monitoring and evaluating performances

and other purposes. Since we never had

census, we have been using different

population data from different sources that

makes comparison very difficult because of

differences in denominator. However, in year

2000, the Local Government issued estimates

of population residing in Eritrea. For our

purpose, an estimated projected population

data from this source is used. To project

population estimation, 3 % annual population

growth rate was used from 2000 to 2002.

From 2002 to 2007, 2.8% annual population growth rate is used based on the EDHS 2002 annual

growth estimates due to reduction of fertility from 6.8 in 1995 to 4.1 in 2002. Thus, the rates

presented in the previous years’ report were also adjusted to this population denominator. The

population estimates used in 2012 report is 3.95 million. Some of the denominators used in this

report are presented in Table 1.2.



11

Table I.1. Status of Health and Socio-Economic Indicators in Eritrea

Indicators 1990 World

Bank,

UNICEF

1995

EDHS

2002

EDHS

2004, 2005, 2006, 2007 different

sources(WHO, WB, UNICEF, HDI

etc)

Crude birth rate/1000 population 42.37 (HDI) 40 (UNICEF 2007)

Crude death rate 15.96

(UNICEF)

9 (UNICEF 2007)

Annual Population Growth 2.9% 2.5% (UNICEF 2007)

Total fertility rate of child bearing age woman 6.7 6.1 4.8 5.1 (UNICEF 2007)

Neonatal Mortality/1000 live births 25 23.6 21 (UNICEF 2004)

Infant Mortality/1000 Live births 88 (UNICEF) 72 47.7 46 (UNICEF 2007)

Child Mortality/1000 (children 1-4) 68 47.9

Under five mortality/1000 live births 147

(UNICEF)

136 93 70 (UNICEF 2007)

Postnatal Mortality/1000 live births 41 24

MMR/100000 live births 1400 998 450 (UNICEF 2005)

Adult literacy rate total 56.7 % (HDI, 2003 UNDP)

Literacy above 6 years of age male (%) 45.6 59.4

Literacy above 6 years of age female (%) 37.7 43.5

Primary School enrollment rate (6-15 years) 48.4

%

61.2 % 67% (UNICEF 2006)

Access to safe water supply per house hold

%

19 16.4 67.4 60 (UNICEF 2006)

Access to sanitation (toilets)% 19 12.8 25.6

Access to basic health services 10 % 70 %

Stunted Children % 38.4 38

Wasted Children % 16.4

Under weight % 44 43.7

Women < 18.5 BMI 40.6 37.3

Pregnant women with at least one ANC visit (%) 49 71

Pregnant women with 4 or more ANC visits(%) 27 41

Births attended by skilled health workers (%) 21 29.5 %

Met needs for OB emergency (%)without

including abortion

17.6

(HMIS,

2004)

42.9 % HMIS (2012)

Immunization service

coverage (percent)

BCG 61 91 99 % Crude coveragee & 84% by

card (EPI survey 2009 )

DPTHB3 49 83 98% crude coverage & 86% by


DPT1/OPV1 19 43 100% crude coverage &85% by


Measles 51 84 99% crude coverage& 75% by card

(EPI survey 2009)

Fully immunized 41 76

Not immunized 38 5

TT2 + for women % 23 35

Contraceptive prevalence rate% 8 8



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Table I.2. Denominators Used in Computing Performances

or Situations by Zone in Year 2012 Zones Age

group

AN DE DKB GB MA NR SKB Total

New OPD

cases in

HO/HC

<1 9507 16109 1658 17747 14967 10381 12089 82458

1-4 29480 32231 4943 38747 41119 23362 25821 195703

>5 120845 163515 17069 144994 219367 173410 106374 945574

Total 159832 211855 23670 201488 275453 207153 144284 1223735

OPD First

visit patients

in

HO/HC/MC

<1 8904 14597 1565 16052 13541 9874 10197 74730

1-4 22496 29311 4688 33487 36745 22662 22046 171435

>5

11747 152739 15374 133184

120853

6 163991 100752 892050

Total 14887

4 196647 21627 182723

25882

2

19652

7

13299

5

1138215

Total

Inpatients

HO/HC/MC

<1 4583 3631 325 2891 652 12478 2111 26671

1-4 3377 3986 318 3182 1083 4480 1847 18273

>5 12513 21295 1547 12687 7303 24329 8302 87976

Total 20473 28912 2190 18760 9038 41287 12260 132920

First visit

patients in

Health

Stations

(HS)

<1 15007 20665 2499 14864 11816 6663 71514

1-4 36243 36617 6070 33297 30934 19457 162078

>5 163203 125910 35058 183535 142638 89794 740138

Total 214453 183192 43627 231696 184848 115914 973730

OPD/IPD

deaths in

HO/HC

<1 110 139 25 134 4 157 124 693

1-4 57 53 10 100 8 44 57 329

>5 155 196 30 235 215 649 108 1588

Total 322 388 65 469 227 850 289 2610

Total HS

deaths

<1 5 1 6 8 2 2 24

1-4 7 0 1 6 1 2 17

>5 19 4 2 14 8 2 49

Total 31 5 9 28 10 6 90

Total number of estimated

Population 636,660 1,052,161 92,397 786,390

750,419

639415

3,957,442

Target Population ANC,

4% 25,466 42,086 3,696 31,456 30,017 25,577 158,298

Target Population /

Delivery 3 % 19100 31565 2772 23592 22513 19182 118723

Target Population/ EPI

under one 3 % 19100 31565 2772 23592 22513 19182 118723

Target Population FP, 20

% 127332 210432 18479 157278 150084 127883 127332

Target Population for

under 5, (15 %) 95,499 157,824 13,860 117,959 112,56

3 95,912 593,616

Target Population for GM

<3 years, 12% 76,399 126,259 11,088 94,367 90,050 76,730 474,893

* Case = Type of illness/diagnosis. The number of cases are more than or equal to the number of patients since a patient

can have more than one type of health problems on the day of visit.



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Part II. Resources

One of the Ministry of Health’s goals is to

improve the quality of health services through

enhancing the availability and accessibility of

required human and non-human resources.

Some of the non-human resources considered

in improving the quality of health services

include: drug and supplies, vehicles, especially

ambulance service, other communication

services, power supply, water supply,

equipment, finance etc.

In this report, only available human resources,

number and type of health facilities and

number of hospital and health center beds,

which are reported to the National HMIS,

availability of certain resources in health

facilities are included.

II.1. Human Resources

The health workforce is the backbone of the

public health system and central to its effective

operation as highlighted in The World Health

Report 2006. There is a close correlation

between qualified health workers and key

health outcomes. Without investing on human

resources adequately, it is difficult to improve

quality of health services. It takes a

considerable investment of time and money to

train health workers. Countries need these

skilled work forces so that their professional

expertise can benefit the population. The

Ministry of Health has established and

strengthened its training institutes to address

the health professional shortages in the

country.

The College of Nursing and Health

Technology has been training professionals at

Diploma level. At this time three satellite

Associate Nursing Schools were opened in,

Mendefera Zoba Debub (2003) Barentu, Zoba

Gash_Barka (2005) and Ghindae Zoba

Semenawi Keyh Bahri (2007) to increase the

intake and output of the College. Orotta School

of Medicine was also opened in 2003 to

address the scarcity of medical doctors in the

country. At present, Orotta School of Medicine

and Dentistry, Asmara Collage of health

Sciences and School of Post Graduate program

are under the Eritrean Board of higher

Education.

• Asmara College of Health Sciences

which was established in 1995 under

the University of Asmara and where

the College of Nursing and Health

Technology integrated to. This college

consists of:

o School of Nursing

o School of Allied Health

Professions

o School of Pharmacy

o School of Public Health

The School of Medicine provides under

graduate and graduate degree program in

Medicine, and the College of Health Sciences

provides under graduate degree and diploma in

nursing, pharmacy, clinical laboratory and

public health. Moreover, there is also diploma

program in Dental Therapy, Physiotherapy and

Radiology, laboratory (MLT), and Public

health in School of Allied Health Professions.

In addition to the training provided in these

schools, over sea scholarship and distance

education programs are also part of the human

resources development program in the

Ministry of Health.

Short courses are also provided as in-service or

on the job training programs to improve the


Health Management Information System, Research and HRD, MoH Annual Health Service Activity Report of 2012

14

competency and motivation of health

professionals.

II.1.1. Training

Over the last 20 years, from 1991 to 2012, a total of 9151 health professionals were trained and

graduated at degree, diploma and certificate level from the different training institutes in the country,

internal and over sea scholarship, distance education, and in service training programs. The number

and category of health professionals trained by the Government in years is illustrated in Table II 1.1

3, II.1.1.4, II.1.1.5

Prior to year 2005, nursing course was provided for three years and required one more year training to

be a nurse midwife. However, in 2005 nursing curriculum was revised to include more hours of

midwifery, and all graduated since then were comprehensive nurse midwives.

In year 2012, a total of 660 various categories of health professionals were trained in different

training institutions and assigned to respective zones as summarized in Table II. 1.1.1.

Distance learning, in which the training is taken to the learner, is a cost-effective and increasingly

popular tool for retraining the health workforce in different training institutions and assigned to

respective zobas. The new health professionals’ graduates are summarized in Table II.1.1.1.

Considering the need of training and retraining of health professionals to improve their knowledge

and skill to provide better quality health services, continuing education program through external

and internal scholarship, distance education, in-service and on the job training has been provided

to the different categories of health professionals.

Distance learning, in which the training is taken to the learner, is a cost-effective and in addition

to its cost effectiveness and easy to use, a well-designed distance learning programs are very

effective in transferring skill and knowledge to workers and strengthen the human resources

capacity. The numbers of beneficiaries of continuing education program could be more than

presented in Table II.1.1.3, since the other departments used to send their staff for training without

notifying the department of Research and HRD, it could not be appropriately recorded



15

Table: II. 1.1.1 Different health professionals trained and assigned to zobas in 2012

Profession GB AN DB MK SKB DKB NRHs HQ Total

MD (GP) 8 4 6 2 10 2 3 0 35

BSN 8 6 7 3 9 8 10 0 51

Nurse 20 11 12 7 17 14 40 0 121

Gynecologist 1 0 1 0 3 0 1 0 6

Pediatrician 2 0 0 0 0 0 1 0 3

Associate Nurse 32 47 47 20 27 15 36 0 224

OR.technician 4 0 5 0 5 0 14 0 28

Pharmacist 2 2 3 1 2 0 0 1 11

CLS 2 1 4 1 4 3 7 0 22

MLT 5 5 5 3 6 5 16 0 45

Dental tech. 2 4 4 2 4 3 8 0 27

Radiology tech. 1 1 0 2 2 2 6 0 14

Pharmacy tech. 4 3 3 4 5 2 10 0 31

PHO 0 1 3 2 3 3 0 1 13

Optometry 3 3 6 4 4 4 5 0 29

Total 94 88 106 51 101 61 157 2 660

Source: HRM Report 2012

In addition to the above table the following staff were upgraded and reassigned with

new position.

� 23 Former Public Health, malaria technicians and sanitarians upgraded to Public

Health BSc.

� 13 laboratory technicians upgraded in Clinical Laboratory Science

� 5 General Practitioners upgraded in Obstetrics & Gynecology, and 3 in Pediatric.

� 48 Registered Nurses upgraded to the BN program through the Distance Program

� 18 other staff upgraded to BA Professional Development 4

� 4 nurse anesthetists upgraded to the BSc program and are assigned to their

previous work place, while 6 nurses upgraded to the field of anesthesia.

� 3 GPs graduated in Pediatrics



16

Enrolled Health Professional

Number health professionals graduated and enrolled in Asmara Health Sciences and Post Graduate

Medicine Education as illustrated in table II.1.4 and , II.1.5In addition, Orotta School of Medicine is

gradating medical doctors ever year as indicated in table II.1.8

II.1.4. Advanced placement ongoing training programs at the college of health science

Type of Program 2011-2012 2012-2013 Graduated in

2012

Proposed plan

2012-2013

Assocaite nurse to RN a a a a a 50 30 100

Bachelor in midwifery 20 14 14

BSc in Nursing Anesthesia 41 4 5

BSc in psychiatric nursing 20 10 10

BSc in ophthalmic nursing 25 12

BSc in clinical Lab science 22 3 12 6

BSc public health 29 23 26 28

Diploma Upgrade to LAB to

MLT

23 23

Upgrading pharmacy to BSC 20 20

TOTAL 207 103 42 218

Source: Continue education Report 2012

Table II.1.5 On Going Residency program in Post Graduate Medical Education Program

2009/2014

S.

N

Program No. of

Students

Year started Expected to Complete

1 Postgraduate program in

Obstetric Gynecology

5 2009 Completed

2 Post Graduate 3 2010 2012


Surgery

4 2012 Sep 2014


Pediatrics

4 2012 Sep 2014


Obstetric Gynecology

4 2012 Sep 2014


Pediatrics

4 2012 Sep 2014

Source: 2012 Annual Report of Continuing Education, MOH



17

In addition there are 6 fellowships abroad in the field of medical oncology, Radiation therapist and

MSC in physicist two from each field.

II.1.2. Available health personnel in the MOH and their distribution in the country

The number of employees of the

Ministry of Health and their distribution

by zoba as reported by the Human

Resources Planning and Management

division and the number of health

professionals working in government

and non-Government health facilities as

reported in HMIS is presented in this

report.

According to, the Human Resources

Planning and Management division

report 2012, the MOH had a total of

8184 employees at National level out of

which 61.4% were professionals and

38.6% were administrative staff that

showed no difference with 2011 report.

Table II.I.6. Distribution of MOH employees by zoba

Category DKB SKB AN DE MA NR HQ TOTAL %

Professions 226 533 550 793 990 1038 245 5022 61.4

Administrative 104 251 248 552 700 644 306 3162 38.6

Total 330 784 798 1345 1690 1682 551 8184 100

Source: HRM 2012 Report



18

Table II.I.7. Distribution of MOH professional Specialists by zoba

Profession GB AN DB MK S/K/B D/K/B NRHs HQ Total

Dentist 1 1 1 1 4

Epidemiologist 1 1

ENT specialist 3 3

Gen. surgeon 1 1 5 4 11

Gyn. Specialist 3 1 2 2 7 15

Internist 2 2

Ophthalmologist 1 6 7

Orthopedist 3 2 5

Pediatrician 3 2 3 10 18

Radiologist 1 4 5

Stomatologist 1 1 2

Dermatologist 1 1

Acupuncturist 2 2

Immunologist 1 1

Entomologist 1 1

Pathologist 1 1

Neuro Surgeon 1 1 2

GP 18 11 23 6 19 6 4 12 100

MPH 1 1 1 5 8

Total 27 14 29 25 23 7 46 18 189




19

Table II.I.8. Distribution of MOH other professional Specialists by zoba

Profession GB A

N

DB MK NR

S

SR

S

NR

H

H

Q

Total

Nurse 120 10

0

17

9

16

3

83 38 26

7

32 982

Bs.N 26 18 21 66 27 16 34 48 256

Associate

nurse

325 30

2

40

4

55

6

31

0

11

4

50

2

24 2537

Anesthetists 5 2 5 10 4 1 14 0 41

Nurse psych. 0 1 1 1 0 0 8 0 11

CLS 14 11 16 15 8 2 34 36 136

MLT 29 19 41 28 15 9 35 23 199

Dental tech. 12 10 11 21 7 6 16 0 83

Opth. Tech. 1 2 1 3 3 1 6 1 18

Optometry 4 3 7 4 4 4 6 0 32

Pharmacist 8 5 7 11 4 1 9 20 65

Pharmacy

tech.

24 15 23 39 20 11 29 9 170

PHO 4 6 5 6 5 4 1 7 38

PHT & others 31 14 23 17 11 7 0 11 114

Physiotherapi

st

3 2 3 2 0 1 7 0 18

Radiology

tech.

5 8 16 21 7 4 18 1 80

Others 9 18 1 2 2 0 6 15 53

Subtotal 620 536 764 965 510 219 992 227 4833

Total Table 7 27 14 29 25 23 7 46 18 189

Grand Total 647 550 793 990 533 226 1038 245 5022

In addition to the health workers

employed by the Ministry, 269 health

professionals in average work for at

least 15 days in a month work out

side of the Ministry of health owned

health facilities as indicated in table

Table II.I.9.

Table II.I.9. selected category of health workers

working in non MOH owned health facilities

Associate

N

M-

wife

Nurse

GP Lab.

Tech

Phar/Pharm. Total

194 35 13 19 8 269

Source: DSS, 2012



20

Table: II.1.2.1 Employed Health Workers in

the MOH and their proportion to the total work

force by year (1991-2012)

Yea

r

Tota

l

Emp

loye

es

Health

Professionals

Administrativ

e/management

Staff

Num

ber

% of

the

total

No. % of

the

total

1991 *327 NA NA NA NA

1999 4464 2688 60.2 1776 39.8

2000 4864 2742 56.4 2122 43.6

2001 4862 2743 56.4 2119 43.6

2002 3687 2956 80.2 731 19.8

2003 5959 3368 56.5 2591 43.5

2004 5855 3273 55.9 2582 44.1

2005 6034 3501 58.0 2533 42.0

2006 6315 3657 57.9 2658 42.1

2007 6736 3556 52.8 3180 47.2

2008 6861 3467 50.5 3394 49.5

2009 7238 3962 54.7 3276 45.3

2010 7282 4640 63.7 2642 36.3

2011 8191 5025 61.3 3166 38.7

2012 8184 5022 61.4 3162 38.2

* The health workforce of the combatants was

not included in 1991



21

II.1.3. Attrition of Health Professionals

Employees work effectively and efficiently, when their personal goals match with the employee

organization’s goals and objectives. Thus, effective human resources management is required to

match the two goals and objective to keep the attrition rate to its minimum level.

According to the 2012 HRM Unit report, the total attrition of health professionals in 2012 was 154

which is less than by 135 compared with 2011.

The main reason of attrition was as indicated in the table below.

Table III.I.3.1 Reasons of Attrition

Reason of attrition Percentage

Absconders 73.3%

Released due to health, aging and social

problems

19.6%

Due to death 3.1%

Termination of expatriates contract 4.0%


Table: II.1.3.2. The percentage change of available doctors, nurses and

associate nurses in the Ministry from the previous years (2002-2012)

Year Doctors Nurses Associate Nurse

No. %

chang

e

No. %

change

No. % change

2002 211 29.4 846 5.4 1488 8.4

2003 212 0.5 993 17.4 1576 5.9

2004 214 0.9 954 -3.9 1520 -3.6

2005 217 1.4 1012 6.1 1691 11.3

2006 225 3.7 1184 17.0 1602 -5.3

2007 210 -6.7 994 -16.1 1581 -1.3

2008 213 1.4 1070 7.6 1724 11.5

2009 201 -5.6 1167 9.1 2215 28.5

2010 216 7..5 1262 8.1 2380 7.5

2011 134 -37..9* 1136 -9.9 2373 -0.3

2012 189 41 1253 10.3 2537 7.1

N.B.*

The decrease of doctors could be attributed to decrease in expatriate doctors,

31 medical doctors who are in residence program are not included and

attrition due to different reasons.

Source: HRH planning and mgt division Annual report of 2011/2012



22

II.I.4. Health Workers Population Ratio

The availability and composition of human

resources for health is an important indicator

of the strength of the health system.

Although, the optimal number of health

workers population ratio is not known, the

higher levels of density are not necessarily

better. The developing countries have very

low ratio compared to the developed

countries that negatively affects the quality

of health services. The WHO estimated that

there is a need of having at least 2.5 health

workers per 10,000 people to achieve the

MDG. In this regard, Eritrea had 10.2 lower

than considering only those employed by the

Ministry.

The doctors, nurses and associate nurses,

ratio in 2012 was 1:206335, 1:3113, 1:1537

respectively indicating that there were 0.48

doctors per 10,000 people, 3.2 nurses and 6.5

associate nurses per 10,000 people taking

only those employed by the MOH. The

number of doctors, nurses and associate

nurses per 10,000 people is almost the same

compared to 2010 and 2011.

Considering the WHO minimum health

worker requirement per 10, 0000 people, it

will not be long before Eritrea exceeds the

recommended minimum figure for doctor.

An average of 30 doctors will be graduating

yearly starting 2009 that will significantly

reduce the ratio. The minimum requirement

for nurses and associate nurses is already

achieved. The WHO recommended target for

developing countries in the doctor population

and nurse population ratio is 1:10,000 and

1:5,000 respectively.

The trends in the doctor, nurse and associate

nurse population ratio in Eritrea as indicated

in table II.1.2.3, remained almost constant in

the last six years with slight decreased trend

of all categories starting in 2011 and

increased trend in 2012. The health workers

population ratio of different health workers

in 2012 is also presented in Table II.1.4.1

Table II.1.4.1. Health Professional

Population Ratio in 2012

Category Number

of HW

People per

Health Worker

Doctors 189 20635

Nurses 1253 3113

A. Nurse 2537 1537

Radiology tech 80 48750

Ophthalmic

tech+ optometry 50 78000

Pharmacist/

Pharmacy .

techch 235 16596

Lab. Sciences

(MLT+CLS) 335 11642

PHT. 114 34211

Others

(dental+physio.) 101 38614

Source:.HRH annual report 2012



23

II.2.1. Number of Health Facilities that Report to HMIS

VI.2. Number of Health Facilities and their Distribution 2012



24



25

In 1991, there were 16 hospitals (HO), 4, health centers (HC), and 106 health stations (HS) and or

clinics (Cl.). Since independence, the Ministry has been constructing, rehabilitating, maintaining

and equipping health facilities to increase accessibility to primary health services.

In December 2012 there were 340 health facilities reporting monthly to NHMIS including

government and non-government health facilities except Military Health Facilities (Table II.2.1.1).

Table II. 2.1.1 Total Number of health facilities by type

and ownership in 2012

OWNER HO HC MC HS CL Total

% of

Total

MOH 27 47 6 160 18 258 75.9

ECS 6 1 23 30 8.8

EVM 3 3 0.9

PRV 1 1 6 8 2.4

IND 1 2 28 31 9.1

MLW 2 2 0.6

MOA 1 1 0.3

MOE 1 1 2 0.6

POL 2 2 0.6

OTHER 3 3 0.9

Total 28 56 7 188 61 340 100.0

8.2 16.5 2.1 55.3 17.9 100.0

ECS= Eritrean Catholic Secretariat, EVM= Evangelical,

IND= Industry, POL= Police, PRV= Private, MLW=

Ministry of labor and welfare.

Table II.2.1.2 Total Number of health facilities by type

and zoba in 2012

ZONECODE HO HC MC HS CL Total

AN 1 9 1 27 3 41

DE 5 12 2 46 3 68

DK 3 11 1 15

GB 3 13 3 51 6 74

MA 4 9 24 44 81

NR 8 2 9

SK 4 11 1 29 4 49

Total 28 56 7 188 61 340

% of Total 8.2 16.5 2.1 55.3 17.9 100.0



26

Considering the type of health facilities, the hospitals constitutes 8.2%, health centers 16.5%,

health stations 55.3%, and MCH and other clinics 20%. Clinics include industrial clinics, Free

standing alone VCT sites, Dental clinics and other educational and vocational centers.

Out of the total 28 hospitals, 8 are National referral hospitals and 6 zonal referral hospitals. The

others are Subzoba hospitals.

The health centers include: 1 National Referral Physiotherapy Center, I National Referral Center

for Children in Asmara (IOCCA) that provides surgical service to children referred from all over

the country by International Experts; 2 industry health centers that provide mainly OPD service to

their employees, one health center in Mai Nefhi Institute Technology that provide out patient and

inpatient services to the students and one private geriatric center that provide inpatient service to

aged people. The remaining 50 health centers (44 MOH and 6 Catholic Mission) provide the

regular health center activities that include maternal and child health, OPD and IPD services

(Table II.2.2.)

Ownership of Health Facilities

As indicated in table Table II. 2.1., MOH owns 258 (75.9%), ECS 30(8.9%), Evangelical Church

3(0.9%), private 8(2.4%), Industry 31(9.2%) and the remaining others 9 (2.8%). The number of

health facilities in 2012 by type and ownership is presented in Table II.2.1.2.

There are 13 MOH hospitals working as private in the afternoon shift. The report of these

hospitals is separately compiled and analyzed in the NHMIS database. Even though the private

clinics were closed the services that were rendered in those private clinics is now practiced in

these public health facilities in the afternoon session. These health facilities are mainly giving

service focused on OPD activities and refer different case for further treatment and advice. Out of

the total OPD new cases, first visit patients and repeat visit patient 14.9%, 15.1% and 11.3% were

treated in the private sector respectively this year.

Growth of Health Facilities

Considering the total number of reported health facilities, it grew by about 29.1% in the last

14years (1998-2012), but compared to 1991, it grew by about 167.5% (Figure II.2.1.2.).



27

71.1

6.39 9.6

3.1 0.9

75.6

1.9

9.4 9.4

2.8 0.9

75.7

2.4

8.9 9.2

0.9 0.90

10

20

30

40

50

60

70

80Percent

Organizations

Figure II.2.1.1. Proportion of Health Facilities by Ownership (2010- 2012)

2010 2011

2012

The number of health stations grew by about 77.4% (from 106 to 188) since 1991, the hospitals

by 75% (from 16 to 28), and the health centers by 1275% (from 4 to 56

The mentioned above health facilities also provide preventive and curative services; there were

also 249 VCT, 208 PMTCT and 0ART sites in 2012 (Figure II.2.1.4.) out of which 11 VCT sites

are free standing.

Moreover, there are also 307 pharmacies, drug shops and rural drug vendors, which also provide

services although, the service provided by the Pharmacies is not reported to NHMIS. The

distribution of these facilities is shown in Table Table II.2.1.1.4.1. and Figure II.2.1.5.

Except very few para-statal pharmacies, all pharmacies, drug shops and rural drug vendor are

privately owned.

no0

100

200

300

400

Number

Year

Figure II.2.1.2. Total Cumulative Number of Health Facilities by Year (1991 & 1998-2012)

no



28

Source: NATCoD 2012, MoH



29

5 3 3 3 6 8 3 4 9 746 2 3 4 7 3 3 6 9 5

402 04 06 08 01 0 01 2 0M A S K B D E A N G B D K B

F i g u r e I I . 2 . 1 . 5 C o m p a r i s o n o f o u t l e t s b y z o b a a n d y e a r 2 0 1 0 - 2 0 1 2 2 0 1 02 0 1 12 0 1 2

The drug outlets are run by either pharmacist, pharmacy technicians, nurses or associate nurse

depending on the type of outlet.

MOH, National Medicines & Food Administration Report 2012, indicates that there were 44

functional pharmacies, 36 drug shops and 227 rural drug vendors in the country at the end of

2012. The type and distribution is shown in table II.2.1.1.4.1. According to the policy of the

MOH, a pharmacy should have at least one pharmacist, a drug shop at least a pharmacy

technician or nurse, a rural drug vendor either a nurse or associate nurse.

Table II.2.1.1.4.1 Distribution of Pharmacy,Drug shop and Rural drug vendour in 2012

Zoba Pharmacy Drug shop Rural Drug Vendour Total

MA 34 20 12 66

SKB 2 3 29 34

DE 3 6 63 72

AN 3 2 29 34

GB 2 4 91 97

DKB 0 1 3 4

Total 44 36 227 307

% 14.3 11.7 73.9 100.0 Source: MOH, National Medicines & Food Administration Report 2012



30

Table II.2.1.14.2: Access of VCT & PMTCT sites by zoba in 2012

Zoba VCT PMTCT Total

MA 33 21 54

DE 71 64 135

AN 39 34 73

GB 46 39 85

SKB 41 39 80

DKB 16 13 29

NR 8 2 10

TOTAL 254 212 466

% of Total 54.5 45.5 100.0

Source :HIV/AID unit 2012 report

Out of 466 sites 11 are free standing giving only VCT services.

Table II.2.1.1.4 Number of Health Facilities by Type and Year (1998-2012)Compared to 1991

YEAR

Type of HF 1991 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Hospital 16 23 23 23 23 24 24 25 25 25 26 26 26 27 27 28

Health Center

/MCH 4 49 49 52 51 49 49 50 51 52 56 56 56

61 63 3

Health Station 106 149 154 170 179 169 174 177 178 180 182 184 186 187 186 188

*Clinics 0 40 37 29 33 73 85 107 104 113 114 105 101 66 44 61

Total 126 261 263 274 315 315 332 359 358 370 378 371 369 335 320 337

VCT 0 0 0 0 15 22 38 45 84 96 110 130 135 162 237 254

PMTCT 0 0 0 0 0 3 3 7 29 59 67 89 93 131 197 212

ART 0 0 0 0 0 0 0 0 5 9 14 15 17 19 19 20

Pharmacy 32 29 28 28 29

28 29 29 33 34 40 44

Drug Shop 31 28 28 28 28

26 34 29 31 30 35 36

Drug Vendor 187 184 186 203 203

228 221 231 228 226 228 227

Total licensed

Private Clinics 130

82

72 72 62 56

22 6

* Includes MCH clinics, first aid clinics, free standing VCT sites, industrial clinics, and other non MOH owned clinics and private clinics run

by physicians.



31

II.3. Patient Bed

A hospital bed is an expensive commodity in healthcare. Hospital administrators need an objective

measures and methods for efficient management of their limited financial resources. Bed

utilization rates can be of immense help in realistic and effective decision making. In the Ministry,

hospitals are the major area of expenditure that requires monitoring of appropriate bed utilization

to reduce cost.

Number of Available Patient Beds

The number of available patient beds and their ratio to patients or people in the catchment area

indicates accessibility to patient bed and quality of care.

The reported number of in patient beds in

2012 were 3932 including beds in MCH clinics which is less than by 43 beds than previous year

that served to (1:992 people) for estimated national population of 3.9 million. Out of the total

number of beds, 70.1% were hospital beds, 29.1% health centre and MCH. The total number of

The overall number of beds remained almost constant for the last eight years with slight decrease in

2088 & 2010 (Figure II.3.1

From 2006-2009, there were 11 beds for

every 10,000 people, but in 2011 it was about

10.1 with a ratio of one bed to about 991

people

.



32

Bed Utilization

The bed utilization at different levels also

indicates the quality of the referral system, the

continuity of care and appropriate utilization

of resources. Average length of stay (ALOS),

bed occupancy rate (BOR) and bed turn over

interval (BTI) and bed turn over rate or

patients per bed are some of the indicators for

bed utilization.

a. Patients per bed (BTR)

The number of patients served in a bed is

affected by the average length of stay and bed

turn over interval (BTI). Taking the average

length of stay in 2012 at National level (5.1

days) and 300 working days in a year by

considering lost days in between admissions

(turnover interval (TI)), a bed should have

served 60 patients in 2012 with variation in

the zobas and health facilities.). The average

Table: II.3.2. Number of Beds per 10,000 people (2004-2012)

Health

facility

type

Year

2004 2005 2006 2007

2008 2009 2010 2011 2012

Hospital 2695 2697 2592 *2823 2827 2647 2626 2738 2575

H.

Center

1477 1248 1280

1139

1054 1328 1082 1203 1141

MCH

Beds

NA NA NA

63

63 64 64 34 34

Total

Beds

4172 3945 3872

*4025

3944 4039 3732 3975 3932

Beds

Per

10,000

People

13.1 12.0 11.5 11.3 11.1 11.2 9.9 9.8 10.1

The estimated population is taken as 3.9 for the year 2012



33

lost days per bed in a year was about 5.7 days,

almost the same with 2010, 2011(6.3days)

(Table II.3.5.). The actual average bed day in

a year was 359 (365-6.3). Taking this number

into account, a bed should have served in

average 71 (expected number of

inpatients/total beds) patients in a year in

2012.. However, only 34 patients were served

per bed at national level indicating low bed

utilization rate at national which similar with

the last year service. Actually only 132894 patients were served in all beds in the country

while 279263 patients were expected to be served in the available beds. In other

words, only 47% were served from the

expected number of patients. In this case it is

important to reduce the number of patient

beds if they are not utilized properly in order

to reduce unnecessary maintenance and other

bed costs.

A hospital bed served 37 (two less than 2011)

patients in a year and a health centre/MCH

bed 27 patients two more than 2011.)

The following hospitals had the highest

patient per bed in the last three years as

indicated the table below.

Table II.3.1 Hospital patient per bed

Hospital

Name

Year

2009 2010 2011 2012

Orotta Maternity 152 220 206

216

Keren 55 58 65 60

Sembel 48 55 56 44

Barentu 43 48 53 18

Mendefera 43 51 52 31

Orotta Pediatric 52 48 42

43

Refer table II.3.5 for other hospitals

Orotta Maternity hospital had the highest

because it provides mainly delivery services.

The 2010, 2011 and 2012 bed utilization

indicates that 2 patients in health centre/MCH

and about 3.2 patients in hospitals used a bed

per month.

In general, the bed utilization rate was low

and indicates that there were more beds than

required in most health facilities which need

consideration and decision to reduce the

number of beds or shift the beds to were they

are needed.

b. Length of Stay

There could be variations in the length of stay

based on the type of illness and the service

required. The time required to treat a

psychiatric and complicated surgical patient is

longer compared to assisting normal delivery

that affects the turnover rate. If patients stay

in hospitals for long period of time, other

patients could not have opportunity to use the

bed resulting to low accessibility.

The average length of stay in days in different

hospitals varies from 1.4 in Orotta Maternity,

to 11.6 days in Denden disable hospitals

excluding Hansenian and St. Mary

Hospitals), and 6.9 days in health centers/

MCH clinics with a National average of 5.1

days.

Hansenian Hospital the only hospital that

deals with leprosy and St. Mary Psychiatric

Hospital that manages mentally ill patients

had the long hospital days. Thus, it seems

reasonable to have long hospital bed stay until

other health facilities provide services to the

mentioned above patients.

Patients in Orotta Maternity Hospital stay

for about one day in average because most of

the clients get admitted for normal delivery

and discharged within one or two days.

The average length of stay in hospitals by

zoba is presented in Figure II.3.4c.

Among the zobas, a hospital bed in Anseba

Keren Hospital 58 followed by Debub 51 and

Zoba GB48 had served the highest number of

patients in 2010 (table II.3.5.). .



34

b. The number of people per bed

The annual number of patients per bed in

hospitals at National level is presented in

Figure II.3.5

The average number of people served per bed

at national level (Hospital+MCH+ HC) in

2012 was 1006 which is almost the same with

last two previous years, 1014 1007

respectively. If only hospital beds are

considered, it was 1:1435 greater by 29

compared with 2011. The trend indicates that

more and more people are sharing a bed

because of the constant number of patient

beds over the years and population growth

(Figure II.3.6). On the other hand, the number

of patients served per hospital or health centre

beds is very low this may indicate that there

was no problem getting hospital bed.

However, it may also mean that people are

not using the available beds especially at

zoba level for different reasons. It is

therefore important to assess why the beds

are not optimally utilized at zoba level. Even though further population adjustment is

needed, a patient bed in all zobas except Zoba

DKB is above the National average (Figure

II.3.7). One of the main contributing factors

for increasing people per bed in zoba Maakel

in 2012 could be Halibet hospital beds are

calculated with national referral hospitals.



35

c. Bed Occupancy Rate (BOR)



36

The BOR refers to the standard measure of inpatient bed utilization at hospital by

dividing the number of patient days by 365 without considering the lost days between each patient

which was about 5.1 less than 2011 by 1.7 days in average. It indicates the percentage of time the

bed is actually occupied in specific period of time. The total length of stay of patients and total bed

days are used to calculate BOR. The optimal bed occupancy rate is 85% and above. The lost days

are not considered in calculating the BOR.

The average BOR at national level in 2012 was 47.6% same with last year. From the Natioanl

referral hospitals Orotta medical surgical, Orotta MCH and Berhane Aynee had the highest BOR

(101.4, 83.% and 69% respectively).The number of IPD beds in Orotta medical surgical and Berhan

aynee have reduced this year due to the reconstruction of inpatient wards and it could one reason

for high BOR. Other hospitals that were having greater than 40% BOR were:

• Keren Hospital 62.8%,

• Semebel Hospital 54.9.5%,

• Agordat Hospital 46.4%

• Adi-quala 45.4%

• Afabet Hospital 42.3%

The BOR of St. Mary hospital was 52.1% this doesn’t indicate that many patients used the beds for the year only 924 952 patients get bed services which is almost the same compared with 2011.

As indicated in figure II.3.8a the trend of BOR of St. Mary is declining starting 2008; this may be

due to the burden of mental illness diseases is carried out by the family or the number of admitted

cases is decreased. However, it needs further studies in order to know the root cause of declining.

More than 100% BOR indicates either more than one patient shared a bed or patients stay in the bed

for more than a year.

The trend of BOR in National, Zonal hospitals referral and Health centers/ MCH is as indicated in

figure II.3.8. Health Centers/ MCH BOR have shown significant increase this year that indicates

bed utilization is improving that have to be sustained.



37

d. Bed Turn over Interval (TI)

The average bed turnover interval (TI) (the time between discharge and another admission) at

national level in 2011 was 5.7 that improved by 1.1 compared with 2011 (6.8 days). According to

the reported information, the time spent between discharging a patient and admitting another on the

same bed was the lowest in Orotta Medical Surgical, Orotta Maternity NR hospital, Keren and

Agordat Hospital that accounted for 0, 0.3,2.2 and 3.3 days respectively. Refer Table II.3.5. for

other hospitals BTI and other hospital performances. The high TI for most of the hospitals could be

attributed due to the admission of chronic TB and malnutrition patients. The patients were admitted

until they finished their treatment

.

Definition of same important indicators in calculating performances Average Length Stay (ALS) = The average number of days that inpatients (exclusive of newborn) remained in the hospital

Table II.3.4 Number and Percent of Patient beds by Zoba in 2012

Zoba Ho HC MCH Total (%)

Anseba 215 251 0 466 11.9

Debub 529 314 0 843 21.4

DKB 136 0 0 136 3.5

Gash Barka 400 271 0 671 17.1

Maakel 247 145 0 292 10.0

NRH 842 0 0 842 21.4

SKB 388 160 34 582 11.9

Total 2757 1141 34 3932 100.0

% of total by

type in 2012 70.1 29.0 0.9 100.0

% of total by

type in 2011 68.9 30.3 0.9 100



38

Bed Occupancy Rate (BOR) = The percentage of inpatient beds occupied over a given period. Bed Turn Interval (BTI) = Average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next.

“Information is a tool to support informed decisions at all levels not a vertical program”

Health Management Information System, Department of NHIS, MoH Annual Health Service Activity Report of 2012

39

Table II.3..5. Denominators Used in Computing Performances

or Situations by Zone in Year 2012

Beds

Expected inpatients

patients discharged

IPD per bed TLS ALS BTI

Actual bed days BOR

Keren Hospital 215 20645 12965 60 49282 3.8 2.3 78475 62.8

Total HC 251 27017 7508 30 25460 3.4 8.8 91615 27.8

TOTOAL zoba 466 46590 20473 44 74742 3.7 4.7 170090 43.9

MENDEFERA. HOSP 200 17211 6258 31 26543 4.2 7.4 73000 36.4

ADI-KEIH 120 8670 3047 25 15393 5.1 9.3 43800 35.1

ADI-QUALA 62 6987 3175 51 10284 3.2 3.9 22630 45.4

DEKEMHARE 80 12316 3658 46 8673 2.4 5.6 29200 29.7

SENAFE 67 5697 1266 19 5434 4.3 15.0 24455 22.2

TOTAL Hospital 529 50665 17404 33 66327 3.8 7.3 193085 34.4

Total HC 314 34228 11508 37 38534 3.3 6.6 114610 33.6

TOTAL zoba 843 84837 28912 34 104861 3.6 7.0 307695 34.1

ASSAB . HOSP 83 4227 1007 12 7218 7.2 22.9 30295 23.8

EDI 25 1804 510 20 2579 5.1 12.8 9125 28.3

TIO 28 1803 673 24 3815 5.7 9.5 10220 37.3

Total Zoba 136 7986 2190 16 13612 6.2 16.5 49640 27.4

BARENTU HOSP 175 8121 3077 18 24202 7.9 12.9 63875 37.9

AGORDAT 90 11434 5303 59 15236 2.9 3.3 32850 46.4

TESSENEY 135 13204 5073 38 18932 3.7 6.0 49275 38.4

TOTAL Hospital 400 33650 13453 34 58370 4.3 6.5 146000 40.0

Total HC 271 33854 5307 20 15506 2.9 15.7 98915 15.7

TOTOAL zoba 671 62193 18760 28 73876 3.9 9.1 244915 30.2

DENDEN HOSPITAL 40 1225 227 6 2705 11.9 52.4 14600 18.5

HALIBET 110 6655 2599 24 15680 6.0 9.4 40150 39.1

HAZHAZ HOSP 97 7714 4232 44 19423 4.6 3.8 35405 54.9

SEMBEL HOSP 247 16830 7058 29 37808 5.4 7.4 90155 41.9

TOTAL Hospital 145 17414 1960 14 5957 3.0 24.0 52925 11.3

Total HC 392 29482 9018 23 43765 4.9 11.0 143080 30.6

TOTOAL zoba 78 3305 2288 29 19707 8.6 3.8 28470 69.2

BERHAN AYNE 30 41 14 0 3742 267.3 514.9 10950 34.2

HANSENIAN 95 24639 20550 216 28921 1.4 0.3 34675 83.4

OROTTA OBS_GYN 215 14616 9205 43 49423 5.4 3.2 78475 63.0

OROTTA PEDIATRIC 95 3306 3351 35 35150 10.5 -0.1 34675 101.4

OROTTA Med.Surgical 180 8159 4955 28 39900 8.1 5.2 65700 60.7

ST. MARY 149 1775 924 6 28316 30.6 28.2 54385 52.1

TOTAL Hospital 842 61848 41287 49 205159 5.0 2.5 307330 66.8

GHINDAE REG. REF. 100 8272 2617 26 11548 4.4 9.5 36500 31.6

AFABET 56 4398 1861 33 8650 4.6 6.3 20440 42.3

MASSAWA 150 8482 1637 11 10566 6.5 27.0 54750 19.3

NAKFA 82 6717 1128 14 5026 4.5 22.1 29930 16.8

TOTAL Hospital 388 28660 7243 19 35790 4.9 14.6 141620 25.3

Total HC /MC 194 2705 5011 26 131161 26.2 -12.0 70810 185.2

TOTOAL zoba 582 15592 12254 21 166951 13.6 3.7 212430 78.6

National Hospital

2757 219237 101600 37

466,348 4.6 5.3

1006305 46.3

National HC /MCH

1175 61958 31294 27

216,618 6.9 6.8 428875 50.5

Grand Total

3932 279263

132,894 34

682,966 5.1 5.7

1435180 47.6



40

II.4. Selected Health System output indicators

In addition to the availability of health

professionals in different type of health

facilities, availability of health system output

indicators are very crucial in health services

delivery. Some of health systems out indicators

included in this annual report availability of

ambulance, water and power supply which are

very important logistic components in the

medical service department. In 2012, data was

collected from 287 health facilities as illustrated

in table II.4.1.1

From the assessed health facilities (287) 88.4 %

have different type of functional power supply,

46.7% have pipe water 62.7% compound fence.

Functional ambulances are calculated from 110

health facilities and 84.5% have functional

ambulances mainly hospitals, health centers and

some health stations owned by the Eritrean

Catholic Church Secretariat.

For more clarification refer the different tables

presented below

Table II.2.4. Type of health facility by Type of power and zoban

23 5 28

8.0% 1.7% 9.8%

28 20 4 1 53

9.8% 7.0% 1.4% .3% 18.5%

5 1 1 7

1.7% .3% .3% 2.4%

78 88 9 14 189

27.2% 30.7% 3.1% 4.9% 65.9%

8 1 1 10

2.8% .3% .3% 3.5%

142 110 19 16 287

49.5% 38.3% 6.6% 5.6% 100.0%

Hospital

Health Center

MCH

Health Station

Clinic

Type of

health

facility

% from Total

Eletric Solar

Eletric and

Solar None

Type of power

Total

Table II.4.1.1 Distribution of selected resources by zoba

Output

indicators AN DE DK GB MA NR SK

Total %

Function Ambulance

22 28 6 18 7 7 18 106

86.2

Pipe water 35 37 3 28 8 4 12 130 47.7

Power supply

21 37 8 53 13 8 21 161 56.3

Source: data collected from Zonal office, 2012



41

Table II.4.3.Type of health facility by Funtional Ambulance

26 2 28

92.9% 7.1% 100.0%

42 11 53

79.2% 20.8% 100.0%

3 4 7

42.9% 57.1% 100.0%

21 21

100.0% 100.0%

1 1

100.0% 100.0%

93 17 110

84.5% 15.5% 100.0%

Hospital

Health Center

MCH

Health Station

Clinic

Total

yes no

Funtional Ambulance

Total

Table II.4.4 Type of health facility by Type of Water supply

21 5 1 1 28

75.0% 17.9% 3.6% 3.6% 100.0%

36 3 4 5 5 53

67.9% 5.7% 7.5% 9.4% 9.4% 100.0%

6 1 7

85.7% 14.3% 100.0%

63 26 10 90 189

33.3% 13.8% 5.3% 47.6% 100.0%

8 2 10

80.0% 20.0% 100.0%

134 29 19 98 7 287

46.7% 10.1% 6.6% 34.1% 2.4% 100.0%

Hospital

Health Center

MCH

Health Station

Clinic

Total

pipe sisterna track other

Sisterna

and pipe

Type of Water supply

Total



42

Table II.4.5 Type of health facility by availability of * Compound Fence

27 1 28

96.4% 3.6% 100.0%

39 14 53

73.6% 26.4% 100.0%

6 1 7

85.7% 14.3% 100.0%

101 88 189

53.4% 46.6% 100.0%

7 3 10

70.0% 30.0% 100.0%

180 107 287

62.7% 37.3% 100.0%

Hospital

Health Center

MCH

Health Station

Clinic

Total

yes no

Compound Fence

Total

Table II.4.1.3 Distribution of selected resources by zoba

Output

indicators AN DE DK GB MA NR SK

Total %

Function Ambulance

22 28 6 18 7 7 18 106

86.2

Pipe water 35 37 3 28 8 4 12 130 47.7

Power supply

21 37 8 53 13 8 21 161 56.3

Source: data collected from Zonal office, 2012



43

Part III. Facility Based Health Service

Activities

III. Maternal and Child

Health

Despite the fact that maternal and child

health has been declared a priority health

issue by the Ministry of Health, the rates of

maternal and child mortality is still high

although infant and child mortality shows

significant decrease according to the 2002

EDHS and different studies afterwards.

To address the Maternal and Child health

problems, the Ministry in collaboration with

its stakeholders and partners has been

implementing different interventions. Some

of these interventions are|:

• Expansion of the health facilities to the

rural areas;

• Training of skilled health personnel and

deploying them to all levels of health care

services;

• Ensuring availability of essential drugs

and supplies;

• Strengthening the blood transfusion

services;

• Expanding the capacity of emergency

surgery to save pregnant women,

• Developing policies and guidelines;

• Developing communication strategies in

health promotion to increase awareness

and bring behavioural changes and

empowering the communities;

• Establishing maternity waiting homes to

increase accessibility;

• Implementing IMNCI and therapeutic

feeding strategies;

• Expanding VCT and PMTCT centres

• Further strengthening the malaria control

program to elimination level;

• Strengthening the disease surveillance

program and

• Expanding the immunization programs

etc can be mentioned as some of the

successful interventions undergoing to

improve the health of the mother and the

child.

As a result of combined efforts of the

Ministry and its partners and stakeholders,

significant improvements are achieved in

increasing the number of antenatal

attendants, attended deliveries by health

workers, immunized children and women,

and reducing infant and child mortality rates

as indicated in the EDHS, 2002, the routine

information system and different studies.

According to UNICEF, the infant mortality

rate is reduced from 88/1000 in 1990 to 46 in

2007, under five mortality from 147/1000 in

1990 to 70 in 2007, Maternal Mortality from

1400/100000 in 1990 to 450 in 2005.

III.1. Antenatal care Service

The healthy future of a society depends on

the health of the children of today and their

mothers. Antenatal care services are provided

to enhance the health of the mother and the

child through early identification of risk

factors associated with pregnancy, and

providing necessary and timely interventions.

The number of pregnant women registered

for antenatal services, number of total visits

during pregnancy, trimester of first

registration and risk factors identified,

referred antenatal women, provision of Iron

folic for pregnant women, tetanus toxoid

coverage of pregnant women are some of the

important indicators for monitoring and

evaluating the quality of antenatal care

services.



44

The target population for antenatal service is

estimated to be 4 % of the total population

based on the 2002 EDHS findings of low

birth rate and under one year age children

immunized for BCG.

Number of Health Facilities providing

ANC Services

All health facilities except the specialized

referral hospitals, health centers and clinics

are supposed to provide antenatal care

services. In 2012, out of the total health

facilities (340) 253 (74.4%) provided ANC

services to pregnant women, which is less

than by about 4% change comparing with

previous year. One of the reasons is the

counting of standalone VCT centres to the

total number of health facilities this year.

Excluding the 57 industry and other clinics,

about 90% of health facilities (hospitals, HC,

MCH clinics and HS) were providing ANC

services in 2012(Table III.1.1.). The total

number of health facilities that provide ANC

service by type of health facility and zoba is

presented in Table III.1.1. and the trend in

Figure III.1.1.

Antenatal service coverage

The target number of pregnant women for

antenatal care service in 2012 was estimated

as 158,298 pregnant women.

Table III.1.1. Number of Health facilities Provided ANC

Service in 2012 by Zoba and Type of HF

AN DE

DK

B GB MA

SK

B

Tota

l

Ho 0 4 3 0 1 3 11

HC 9 10 0 13 7 10 49

HS 27 46 12 50 23 24 182

MCH 1 2 0 3 0 1 6

CL 0 0 0 2 1 1 4

Total 37 62 15 68 32 39 253

% of

total

14.6

2

24.

51

5.9

3

26.8

8

12.

65

15.

42

100.

00

From the estimated target population 85,400

(53.9) had at least one ANC visit in 2012

which was less by about 8% change

compared to 2011. Each health facility

provided ANC service to about 373 pregnant

women although the target was 618 women

per health facility (Figure III.1.3). Taking the

denominator of the NHMIS population, the

coverage of ANC is showing an increasing

trend starting 2000 except in 2009 & 2012 as

indicated below.

Annual trends of ANC coverage (at least

one visit) 1998-2012



45

The lowest ANC coverage among the Zobas

was observed in SKB (36.5%) and the

highest was recorded in GB (82.9%) slightly

greater than last year (Figure III.I.4.)

However, the coverage of ANC has to be

considered carefully because of the

underestimation or overestimation of the

target population in general. The antenatal

service coverage in GB has been the highest

since 1998 that could be attributed to the

high number of public health facilities that

provide ANC services and the

underestimation of the target population

(Figure III.1.4).

Concerning where the pregnant women got

the ANC service, above 40% were seen in

health station and between 30% and 32.8% in

Health Center and the rest in other type of

health facilities. The trend indicates that the

contribution of the different type of health

facilities remained almost the same compared

with previous year (Figure III.1.2).

Number of Visits and Trimester at First

ANC Visit

The minimum number of antenatal visit that

a mother should make during her pregnancy

is four, although about 12 visits or more is

recommended. It is also recommended that

pregnant women should be registered for

antenatal care in early trimester. The earlier

the first visit is, and the frequent the visits

are, the better the outcome of the pregnancy

is, because of timely detection of risk factors

and timely interventions. Among the first

antenatal attendees in 2012, 21.2 women

registered for ANC service in their first

trimester, 60.2% in the second trimester, and

18.7% in the third trimester. Although the

number of new registrants (first ANC visits,

(85,400) of pregnant women in 2012

decreased by 8% compared to 2011, the

proportion of trimesters remains almost the

same comparing with 2011, which is a good

Zones

Table III.1.2 Number and

Percent of ANC Service Coverage

by Zoba and Year (2007-2012)

2008 2009 2010 2011 2012

D

K

B

N 1611 1808 2494 2151 2056

% 48.7 53.1 71.3 59.5 55.6

S

K

B

N

911

6

787

4

881

2

101

11

933

0

% 39.8 33.4 36.4 40.2 36.5

A

N

N

1303

7

1153

3

1430

9

1446

4

1299

7

% 57.2 49.2 59.4 58.4 51

G

B

N

2478

3

2369

4

2587

1

2905

4

2607

5

% 88 81.8 86.9 95.0 82.9

D

E

N

2260

7

1951

2

2114

0

2219

6

1977

2

% 60 50.4 53.1 54.2 47

M

A

N

1403

3

1328

4

1442

1

1505

0

1519

0

% 52.2 48.1 50.8 51.5 50.6

T

ot

al

N

8547

1

7770

5

8704

7

92,9

26

8540

0

% 60.3 53.3 58.1 60.3 53.9

Key: DKB= Debubawi Keyh Bahri, SKB =

Semenawi Keyh Bahri , AN = Anseba, GB=

Gash Barka, DE= Debub, MA= Maakel



46

sign to detect risk factors and take timely

interventions. The number of women who

registered for ANC service in the second

trimester has been always the highest while

those who registered in first and last

trimesters is lower that needs intervention in

terms of getting pregnant women to come for

ANC care in their first trimester (Table

III.1.3)

The percentage of drop out in 2011 was

61.2% which greater than previous by about

40%. This could be attributed to the

calculation taken this year only total number

fourth visit was taken, while formerly fourth

and more was taken as the numerator. In

addition to that it could be attributed to late

registration for ANC as indicated by

increased trend of second and third trimester

registration for ANC, long distance to walk

to health facilities during late pregnancy,

transportation problems and others (Table

III.1.3 and Figure III.1.8). The drop out rate

shows the percent of registered pregnant

women who failed to have at least three

repeat ANC visits.

The drop out rate in zoba ranges from 49.6%

in Zoba Maakel to 67.9 in Zoba SKB in

2011. As earlier stated, this year in

calculating drop out rate, the numerator was

taken Fourth Visits because the

Reproductive health program has modified

the data collection formats. The above

mentioned problems like long distance to

walk to health facility, changing to another

health facility without informing the

concerned health facility and shortage of

transportation facilities are some of the

contributing factors to high dropout rate that

needs solution to reduce the dropout rate as

indicated in Figure III.1.9.

Zones

Table III.1.1.3. Yearly Trends of

the Number of visits and ANC

service coverage (%) (2009-2012)

2009 2010 2011 2012

First visit

77,705

87,04

7

92,926

85400

Repeat

Visits

155,65

3

1695,

39

176,12

3

163857

Coverage

rate (%

53.3

58.1

60.3

53.9

Dropout

rate (%)

29.7

43.1

61.2

62.9

Percent of pregnant women

registered for ANC at different

trimester (2009-2012)

First

20.4

20.4

20.9

21.2

Second

58.7

61.3

60.6

60.2

Third

21

18.3

19.0

18.7

ANC

Target

populatio

n by DSS

14571

2

15037

6

15398

6

158298



47


Health Management Information System, Department of NHIS, MOH Annual health service Report of 2012

48

III. 2. Delivery Services

2.1. Health facilities providing

delivery services

In 2012, from a total of 340 health facilities

(Hospital, HC, HS MCH and other clinics) in the

country only 66.2% of all health facilities were

providing delivery services. Out of the total health

facilities that provided delivery services, 69.8%

and 20.4% were health stations and health centers

respectively; whereas the rest 7.6% and 2.2% were

hospitals and MCH & other clinics respectively.

Thus, out of the total hospitals (28) only 17

(60.7%, are currently providing delivery services.

Moreover, 82.1% of all health centers and 83.5%

of the total health stations have been providing

delivery services. Majority of industrial health

facilities, VCT and specialized clinics which are

included in the total number of health facilities are

not supposed to provide the delivery services

leading to low percentage of assisted deliveries.

Thus, at present only 28.6% and 4.9% of the total

MCH and private or industrial clinics are giving

delivery services respectively. Usually, the health

stations in cities or towns where there is hospital

are not providing the service. Overall the number

of health facilities providing delivery service has

increased from 210 in 2007 to 225 in 2012 which

is a change of 7.1%. See Table III.2.1 and figure

III.2.1.

Figure III.2.1. Number of Health Facilities

that provide delivery services by type and

year (2008 - 2012)

0

50

100

150

200

250

2008 2009 2010 2011 2012Year

Number

Hos HC HS MC/other Total

Table III.2.2 illustrates the number and percent of

deliveries attended by type of health facilities. Out

of the total 38,190 deliveries attended in all health

facilities by health workers in 2012, 60.4% were

carried out in hospitals, 18.1 % in health centers,

18.7% in health stations and 2.8% in MCH and

other clinics.

Table III.2.1 Number of Health Facilities that

Provide Delivery Services by Type of Health facility

and Year

(2007 -2012)

Type of HF 2007 2008 2009 2010 2011 2012

HO 15 17 17 17 18 17

HC 43 43 45 44 44 46

HS 145 152 152 152 154 157

MCH/clinics 7 5 6 5 5 5

Total No of HF 210 217 220 218 221 225

% to

total HF 56.1 58. 5 59. 6 65. 4 69. 1 66.2

N.B. Total health facilities included private and VCT

clinics, specialized and industrial health facilities.

(HO=hospital, HC= health center, HS=Health station,

MCH= Maternal and child health care, CL= Clinic

Table III.2.2 Number and % of deliveries

attended by type of health facilities (2007-2012) Type of HF 2007 2008 2009 2010 2011 2012

HO

No. 19362 19801 19624 21665 22882 23066

% 69 67. 4 66. 9 65. 4

60. 7 60. 4

HC

No. 4229 4534 4689 5300 6813 6909

% 15.1 15. 4 15. 9 16 18. 1 18. 1

HS

No. 3294 3916 4034 5042 6890 7142

% 11. 7 13. 3 13. 7 15. 2 18. 3 18. 7

MCH

&

other

clinics

No. 1177 1131 1000 1115 1084 1073

% 4. 2 3. 8 3. 4 3. 4 2. 9 2. 8

Total

Deliveries 28062 29382 29347 33122 37669 38190

Coverage

rate (%) 27. 1 27. 6 26. 7 29. 5 32. 6 32. 2 N.B. Total health facilities included private and VCT

clinics, specialized and industrial health facilities.



49

2.2. Delivery Service Coverage Delivery service coverage is defined as the

proportion of the total assisted deliveries to the

expected number/target of deliveries. According to

NHMIS manual guide line, the target population

for delivery service is 3% of the total population

which is used as denominator for calculating the

delivery coverage rate. Comparing the assisted

deliveries to the yearly targets in 2012, it is almost

one third of the target that deliver in health

facilities and about two third of women deliver

outside the health facility as indicated in figure

III. 2.2.

Figure III.2.2. Number of Assisted Deliveries

Compared to Yearly Targets (2007 - 2012)

0

20000

40000

60000

80000

100000

120000

140000

2007 2008 2009 2010 2011 2012Year

Number

Assisted Expected

Thus, the national coverage rate of assisted

delivery which is greatly affected by the

denominator is 32.2% in 2012 showing an increase

of 5.1% as compared to 2007 but decreased by

0.4% compared to 2011. See figure III.2.3 and

Table III. 2.3

Figure III.2.3. Annual Trend of Delivery Coverage Rate

(1998-2012)

As Table III 2.3 and Figure III.2.4 shows, the

yearly trends of delivery coverage have an

increasing tendency in all zobas except in zoba

MA which is reduced by 4.3%, as compared to

2007. Additionally, the coverage rate of 2012 in

the Zobas (Figure III.2.5) ranged from 8.5% in

MA to 35% in AN in which all zobas have either

slightly reduction or remain the same coverage as

compared to 2011.

Figure III.2. 4. Trend of Delivery Service

Coverage By Zoba (2008-2012)

0

10

20

30

40

DK

SK

AN

GB

DE

MA

Zoba

Percent

2007 2008 2009 2010 2011 2012

In 2012, Orotta Maternity National Referral

Hospital attended 24.1% of all deliveries in the

Table III. 2.3 Yearly Trends of Delivery

Service Coverage (Number and Percent) by

Zoba (2007-2012)

Zoba 2007 2008 2009 2010 2011 2012

DKB 614 671 689 945 831 785

% 25. 4 27 27 36 30. 8 28. 3

SKB 2773 3472 3352 3713 4164 4251

% 16.6 20.2 19 20. 5 22. 3 22. 2

AN 3128 3523 3951 4890 7024 6679

% 18.8 20.6 22.5 27. 1 37. 8 35

GB 4047 4173 4398 4854 6346 6615

% 19.7 19.8 20.3 21. 7 27. 7 28

DE 6692 7562 6990 7795 8607 8737

% 24.3 26.8 24.1 26. 1 28. 0 27. 7

Ma 2512 2208 1530 1709 2036 1913

% 12.8 11 7.4 8 9. 3 8. 5

NRH 8296 7773 8437 9216 8661 9210

Total 28062 29832 29347 33122 37669 38190

Total 27. 1 27. 6 26. 9 29. 5 32. 6 32. 2



50

country. Not only this but also 39.9% of all

hospital deliveries were attended in this Referral

Hospital followed by Keren Hospital with 8.8%.

See Table III.2.5. In average, a hospital attended

1357 deliveries, a health center 150, a health

station 45, and an MCH and other clinics 215

deliveries in 2012. In hospitals, the number of

deliveries attended ranged from 33 in Edi Mini

hospital to 9210 in Orotta Maternity NRH as

indicated in Table III.2.5.

35

27.7 28.3 28

8.5

22.2

0

5

10

15

20

25

30

35

Percent

AN

DE

DK

GB

MA

SK

Zoba

Figure III. 2. 5. Delivery Service

Coverage (%) in 2012 by Zoba

The proportion of deliveries of 2012 that were

conducted by hospitals has slightly decreased;

whereas in health station and health center, it

remains almost the same compared to 2011.

Moreover, in MCH and other clinics, it has slightly

declined as revealed in Figure III.2.6 and Table

III.2.2.

010203040506070

%

2007 2009 2011Year

Figure III.2.6. Proportion of Deliveries

attended by Health Worker by Type of Health

Facility and Year (2007 - 2012)

HO MC/OTHER HC HS

The proportion of skilled attended deliveries of

2012 is increased by 3% and 7% in health centers

and health stations correspondingly compared to

2007; whereas in hospitals and MCH clinics it is

reduced by 8.4% and 1.4% respectively as

indicated in Figure III.2.6 and Table III.2.2

which may be co-related to the increased

proportion of health centers and health stations.

This may indicate that the capacity of health

centers and health stations are improving, which is

one of the goals of MOH. In order to maintain this

status, these facilities have to be further

strengthened in necessary skill and resources.

83.5% (157) of the total (188) health stations

assisted 7142 deliveries ranging from 1 to 327 in

2012. As shown in Table III.2.6, majority 49.7%

(78) and only 10.2% of the total health stations that

provide delivery services attended 10-50 and 100–

327 deliveries respectively in 2012.

Table III.2.5. Total Number of Deliveries attended

in each hospital in 2012 Zoba Facility name No. of attended

deliveries

% to

total

NR Maternity NR HO 9210 39. 9

AN Keren HO 2022 8. 8

DE Mendefera HO 1967 8. 5

MA Sembel HO 1337 5. 8

GB Barentu HO 1207 5. 2

DE Dekemhare HO 1147 5. 0

GB Tesseney HO 1006 4. 4

DE Adi-Keih HO 873 3. 8

SK Ghindae HO 819 3. 6

SK Afabet HO 775 3. 4

DE Adi-Quala MH 798 3. 5

GB Agordat HO 732 3. 2

DE Senafe MH 444 1. 9

SK Nakfa HO 308 1. 3

DK Asseb HO 281 1. 2

DK Tio MH 79 0. 3

AN Edi MH 33 0. 1

Total 23066 100

Table III.2.6.The range of attended deliveries in

health stations (HS) in 2012(N =157)

Range of

deliveries

No. of HS that provide

deliveries

% to total

of HS

1-9 33 21. 0

10-50 78 49. 7

51-99 30 19. 1

100-327 16 10. 2

Total 157 100. 0



51

Similarly, 82.1% (46) of the total (56) health

centers assisted 6909 deliveries ranging from 1 to

503 in 2012. As shown in Table III.2.7, majority

56.5% (26) and only 17.4% of the total health

centers that provide delivery services attended 100-

199 and 200–503 deliveries respectively in 2012.

According to the health facility assessment result

of 2007 conducted by HMIS, the average distance

between a health station and health center is about

50 km and between a health center and a hospital is

about 62 km.

A pregnant woman, who lives in health station

catchments area, travels for about 100 km in

average to get hospital delivery service. This could

be very difficult to most women and availability of

maternity waiting homes could be the best solution

to this problem. To increase the delivery service

coverage, constructing maternity waiting homes

and strengthening the capacity of health stations

and health centers could be solutions that are

with in 5 to 15 km distance from most villages

compared to hospitals. Not only that, but also

majority of the deliveries attended in hospitals

were normal deliveries that can be managed in

health center and health stations provided that

required facilities to manage the delivery and refer

complicated cases are made available.

In an attempt to improve care during home

deliveries and reduce maternal mortality,

traditional birth attendants (TBA) have been

trained to identify risk factors and refer the women

in labour to health facilities. Presence of a

professional attendant at each birth can lead to a

marked reduction in maternal mortality and

morbidity.

Professional health care during childbirth is one of

the process indicators to assess progress towards

the improvement of maternal health. The Ministry

has been working to increase accessibility of

delivery services to the community by increasing

the number of health facilities, training and

assigning Nurse Midwives and other health

workers.

Furthermore, establishing waiting homes with

community participation for women at term to

support assisted deliveries helps to increase access

and reduce maternal and neonatal death.

In addition to this, health workers who were

received training on Life Saving Skill related to

emergency obstetric care deployed to different

health facilities. Most of the health facilities are

also equipped with emergency obstetric care

facilities. Some physicians were also trained on

Emergency Obstetric surgery.

However, Anseba has a significant increase of

16.2% followed by GB and SK with the increment

of 8.3% and 5.6% respectively as compared to the

year 2007, that could be attributed to the

construction of maternity waiting homes that

empowered the pregnant women to stay near the

health facility until they give birth.

Table III.2.7. The range of attended deliveries

in health centers (HC) in 2012 (N = 46)

Range of

deliveries

No. of HC that

provided

deliveries

% to total of

HC

1-50 6 13. 0

51-99 6 13. 0

100-199 26 56. 5

200-503 8 17. 4

Total 46 100. 0



52

So far a total of 38 maternity waiting homes were

constructed in all Zobas as shown in Table III.2.4.

Out of the total constructed maternity waiting

homes, 31.6%, 26.3%, and 18.4% were established

in Anseba, DK and GB respectively; whereas the

remaining constructed maternity waiting homes

were 13.2% in Debub and 10.5% in SK. Thus, the

construction of maternity waiting homes in the

zobas has great contribution to increase the

delivery services coverage resulting to reduce

maternal and newborn deaths. Moreover, the

construction of more maternity waiting homes near

health facilities with problem in transportation and

further strengthening the capacity of health centers

and health stations to provide delivery services

could be feasible solutions to increase the skilled

delivery coverage. In DKB for example, women

have to travel for at least 60 K.M to get a health

facility since they leave scattered over a large area.

With increased number of health workers trained

in life saving skill and increased number of health

facilities, the number of attended deliveries should

be significantly increased. However, the delivery

service coverage still remained very low indicating

that there are other factors confounded to the low

delivery service coverage that needs assessment

and interventions. Some of the reasons could be

over estimated target population or decreased

fertility rate.

2.2.1. Outcome of the attended deliveries Looking at the deliveries attended by health

professionals Table III.2.9, in the last four years

(from 2008 to 2011) more than 87% were normal

deliveries. From the total assisted deliveries

(38190) in 2012, only 9.9% were abnormal, in

which out of the total abnormal deliveries 69.2%

were delivered by cesarean section (C/S) increased

by 1.3%) compared to 2011..

According to Table III.2.10, National Referral

hospital covered the highest percentage (24.1%) of

all normal and abnormal deliveries followed by DE

(22.9%), Anseba (17.5%) and GB (17.3%). Not

only this but also 86% of all abnormal deliveries

attended in NRH were C/S; whereas the remaining

14% were other abnormal method of deliveries

such as breech, vacuum etc.. Furthermore, out of

the total number of abnormal assisted deliveries in

MA, 88% were C/S. However, in the rest of the

zobas, roughly 50% of the abnormal deliveries

were C/S.

2.2.2. Cesarean Section (C/S) The main reason for performing C/S was other

causes of C/S 47.9% and obstructed labor due to

cephalo-pelvic disproportion (CPD) 33.3% as

indicated in Table III.2.11 and Figure III.2.7. Out

of the 17 hospitals that provide delivery services,

76.5% perform C/S in 2012, increased by 4.3% as

Table III.2.8. Number & percent of Maternity

Waiting Homes Established by zoba and Site Zoba Site Total % to

total

AN Habero, Kerkebet, Sela, Geleb,

Kermed, Asmat, , Hadish-Adi,

Melebso, Himbol Hashishay,

Habero-Tsada, Jengeren

12

31. 6 DE Areza, Adi-Quala, Dbarwa

Mai-Mine, Kudo-Buoer,

5

13. 2 DK Abo, Wade, Egroli, Tio,

Afambo, Beylul, Aytus,

Ayumen, Rahayta, Belebuy

10

26. 3 GB Dighe, Molki, Mogolo,

Gogne, Endagaber,

Derabush, Mogorib

7

18.4 SK Buya, Foro, Ghelaelo,

Kamchewa

4

10.5

Total 38 100

Table III.2.9. Number of Deliveries Attended by

Health Workers at National Level and maternal

deaths at facility (2007-2012) Year 2008 2009 2010 2011 2012

Total No. 29832 29347 33122 37669 38190

Normal 26146 26390 29815 33940 34424

Abnormal 3177 3035 3307 3729 3766

% normal 87. 6 89. 9 90 90. 1 90. 1

Total MD* 63 67 74 61 68

Facility based

MMR /100,000 219. 8 236. 5

238. 6 164. 2 185.6

N.B. all the normal deliveries are attended by nurse,

mid-wives and associate nurses, MD* = Maternal

Deaths



53

compared to 2011 which was 72.2%. The hospitals

that do not perform C/S are: Nakfa hospital, and

Tio, Edi, Adi-Quala, and Senafe mini hospitals.

In 2012, the number of C/S performed in most

hospitals listed in Table III.2.12 have slightly

decreased or remain the same as in 2011 whereas

in Orotta Maternity Referral hospital, C/S has

increased by 7.3% as compared to 2011. Hence

45.2% of all the C/S performed in hospitals was

done by Orotta Maternity Referral hospital.

05101520253035404550

CPD

Distress

PP/AP

Other

Rapture ut

Figure III.2.7. Proportion of causes

of C/S (2008 -2012)

2008 2009 2010 2011 2012

As Amatere MCH has no operating room, CS was

performed in Massawa HO and transferred to

Amatere MCH. Thus, mothers who had C/S in

Massawa hospital were reported by Amatere MCH

and not by Massawa hospital.

2.2.3. Maternal Death at Health facility

Attendances at antenatal clinics and receipt of

professional delivery care have been associated

with a reduction in maternal deaths. On the other

hand, home deliveries in the absence of skilled

professional attendants have been associated with

adverse infant and maternal outcome.

According to WHO “Maternal Death is defined

as the death of a pregnant woman or within 42

days of termination of pregnancy (delivery,

Table III.2.10. Method of Attended Deliveries and

Number and Percent of C/S by zoba in 2012

Zoba

Total attended Deliveries

Cesarean

Section

Norm

al

Abno

rmal

Total

num

ber

% to

total

Numb

er of

C/S

% to

abnor

mal

AN 6128 551 6679 17. 5 305 55. 4

DE 8171 566 8737 22. 9 331 58. 5

DK 740 45 785 2. 1 17 37. 8

GB 6068 547 6615 17. 3 258 47. 2

MA 1512 401 1913 5. 0 353 88. 0

NRH 7851 1359 9210 24. 1 1177 86. 6

SK 3954 297 4251 11. 1 164 55. 2

Total 34424 3766 38190 100 2605 69. 2

Table III. 2.11. Cause of C/S by year 2010-2011 Cause of C/S 2010 2011 2012

No. % No. % No. % CPD 697 32. 9 930 36. 7 867 33. 3 Fetal distress 302 14. 3 317 12. 5 310 12

Placenta previa 165 7. 8 156 6. 2 134 5. 3

Rapture uterus 48 1. 9 38 1. 5

CS- other 954 45. 0 1082 42. 7 1212 47. 9

Total 2118 100 2533 100 2518 100

Table III. 2. 12. Number and percent of C/S

performed in Hospitals by year (2010 – 2012) Name of

Ho

2010 2011 2012

No. % No. % No. %

Orotta

Maternity

1087 51. 3

959 37. 9

1177 45. 2

Mendefera 219 10. 3 294 11. 6 233 8. 9

Sembel 267 12. 6 347 13. 7 353 13. 6

Keren 271 12. 8 404 15. 9 305 11. 7

Massawa* 70 3. 3 99 3. 9 87 3. 3

Barentu 78 3. 7 157 6. 2 197 7. 6

Adi-Keihi 57 2. 7 87 3. 4 67 2. 6

Ghindae 11 0. 5 28 1. 1 63 2. 4

Dekemhare 0 0. 0 24 0. 9 31 1. 2

Agordat 29 1. 4 42 1. 7 23 0. 9

Assab 22 1. 0 25 1. 0 17 0. 7

Tesseney 7 0. 3 63 2. 5 38 1. 5

Afabet 0 0. 0 4 0. 2 14 0. 5

Total 2118 100 2533 100 2605 100

NB-: The numbers of C/S performed in Massawa HO

were reported by Amatere MCH.



54

miscarriage or abortion), irrespective of the site or

duration of the pregnancy, from any cause related

to or aggravated by the pregnancy or its

management, but not from accidental or incidental

causes.” E.g. malaria,

Thus, Maternal and neonatal mortality is a key

indicator of a country's progress in improving

health. Maternal mortality ration is usually

expressed as the maternal deaths per 100,000 live

births. The maternal mortality ratio measures the

risk of dying that a woman faces each time as she

becomes pregnant. The 2002 study by Dr. Mismay

Gebrehiwet shows that population based maternal

mortality ratio in Eritrea was 752 per 100,000 live

births and lifetime risk for maternal mortality is 1

in 28.

In 2012, 68 facility based maternal deaths were

reported from all health facilities. Regarding the

place of death, out of the total maternal deaths

70.6% died in hospitals whereas the remaining

maternal deaths were reported by HC 16.2% & HS

11.8% as Table III.2.13 revealed.

As indicated in Figure III.2.8, the trend of facility

based MMR has been slightly fluctuating trend in

the previous years. Although the annual national

trend of MMR in 2012 (185.6/100,000) has a

decreasing tendency comparing to preceding years,

but it has increased as compared to 2011. Thus,

according to Figure III.2.8, generally the overall

facility based maternal mortality ratio has a

decreasing trend.

Except in zoba Anseba and DK, facility based

MMR has reduced in all zobas in 2012 compared

to 2011 as shown in Table III.2.14. According to

figure III.2.8 and Table III.2.14, DK reported the

highest MMR (788.4/100,000) followed by GB

(404.1/100,000) and Anseba (244.4). Zoba MA did

not report maternal mortality in 2012.

Out of the total facility based maternal deaths (68),

88.2% were reported by hospitals and health

centers whereas the rest 11.8% were reported by

health stations in 2012. The reporting system of

HMIS doesn’t allow health stations to specify the

Table III.2.13 Type of Health facilities that

reported maternal deaths excluding anemia in

pregnancy (2011) Type of facility No. of

HF

Total of

MD

% to total

death

HS 5 8 11. 8

HC 9 11 16. 2

HO 9 48 70. 6

MCH Other CL 1 1 1. 5

Total 24 68 100. 0

NB;- HF = Health Facility, HS = Health Station,

HC = Health Center and HO = Hospital, MD =

Maternal Death

Table III.2.14. Facility Based Number and Maternal

Mortality Ratio (MMR) per 100,000 live births by Zoba

(2008-2011) reported from all HO, HC and HS

Zoba

2009 2010 2011 2012 No Ratio No Ratio No Ratio No Ratio

AN 11 285.5 7 145. 8 13 187. 6 16 244. 4

DE 6 86.6 11 141. 6 9 105. 3 8 92. 5

DK 1 140.4 4 440. 0 3 375. 5 6 788. 4

GB 34* 845.8 36* 780. 7 29 470. 5 30 404. 1

MA 3 189.5 0 0.0 1 49. 6 0 0

NR 5 62.7 11 145. 0 4 46. 5 4 43. 9

SK 7 214.6 5* 136. 9 2 48. 9 4 96. 2

Total 67 236.5 74 238. 6 61 164. 2 68 185. 6

N.B. MD due to anemia was excluded from analysis.

*MD of GB in annual report of 2009 = 41 but in HMIS report = 34

*MD of GB in annual report of 2010 = 32 but in HMIS report = 36

*MD of SK in annual report of 2010 = 8 but in HMIS report = 5

Figure III. 2.8. Trend of Facility Based

Maternal Mortality Ratio by Year

0

50

100

150

200

250

300

350

4001998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Year

Ratio



55

cause. Thus, a total of five health stations reported

eight maternal deaths without specifying the cause

of maternal death in which three facilities each

accounted two maternal deaths as shown in Table

III.2. 15. Out of the total eight health stations,

Anseba and GB each accounted 40% and the

remaining 20% were from Zoba DK. Table III.2.15. Health Stations that Reported Maternal

deaths in 2012

Zoba Name HF HF Type

No

of

MD

% to

total

AN Filfle HS 2 25

AN Habero Tsada HS 2 25 DK Afambo HS 1 12. 5 GB Gergef HS 2 25 GB Gernfit HS 1 12. 5 Total 8 100

Out of the total (60) maternal deaths that were

reported by hospitals, MCH and health centers,

73.3% of the maternal deaths were reported with

specific causes of death while the causes of the rest

26.7% of the total deaths were not specified as

table III.2.16 indicated.

However, according to HMIS manual guide line,

all hospitals, MCH and health centers were

supposed to report the specific cause of maternal

deaths using ICD Code 10.

Thus, the delivery report of HMIS reveals only the

number of maternal and neonatal deaths and not

the cause of the death. So the maternal and

neonatal deaths that were reported by hospitals,

MCH and health centers in the monthly delivery

report must be transferred to inpatient services

with appropriate ICD 10 code to identify the exact

cause of mortality in order to take action on time

which is not usually followed. All the hospitals and health centers that reported

without specifying the cause of maternal deaths

were from GB. Tesseney and Barentu hospitals

Mogolo, Guluj, Tokombia Shatera and Ghirmayka

health centers were among the health facilities that

reported the sixteen maternal deaths without

specifying the cause of death. Hence, the 26.7% of

the total maternal deaths that were reported by

hospitals, MCH and health centers in the delivery

services report were supposed to be transferred to

inpatient services with appropriate ICD 10 code to

identify the exact cause of mortality.

Out of the 16 maternal deaths that were reported

without specific causes, Tesseney hospital had

31.3% (5) and Barentu hospital 12.5% (2) in which

both hospitals were from GB. Even the rest five

health centers that reported without specific causes

of maternal deaths were from GB namely Forto

health center 12.5% (2), Mogolo health center

18.8% (3), and Guluj, Tokombia Shatera and

Ghirmayka health centers each reported 6.3% (1).

Moreover, Table III.2.16 shows the proportions of

maternal death that reported by each hospital, HC

and MCH clinic. The Zonal Referral hospitals

namely Keren 16.7%, Barentu 11.7%, Mendefera

10%, Assab 8.3% and National Referral hospital

Table III.2.16 Hospitals and Health Centers that reported

Maternal deaths excluding anemia in pregnancy (2012) Name HF Type

of HF

Cause of maternal

death Total

death %

to

total Specifi

c cause Cause

not

specific

Keren HO 10 0 10 16. 7

Barentu HO 5 2 7 11. 7

Tesseney HO 7 5 12 20. 0

Orotta

Maternity

HO 4 0 4

6. 7

Mendefera HO 6 0 6 10. 0

Assab HO 5 0 5 8. 3

Adi -Keih HO 2 0 2 3. 3

Nakfa HO 1 0 1 1. 7

Massawa HO 1 0 1 1. 7

Forto HC 0 2 2 3. 3

Habero HC 1 0 1 1. 7

Kerkebet HC 1 0 1 1. 7

Mogolo HC 0 3 3 5. 0

Guluj HC 0 1 1 1. 7

Tokombia HC 0 1 1 1. 7

Shatera HC 0 1 1 1. 7

Ghirmayka HC 0 1 1 1. 7

Amatere MCH 1 0 1 1. 7

Total 44 16 60 100

% 73. 3 26. 7



56

6.7% reported the highest proportion of maternal

deaths in 2012. Tesseney hospital and Mogolo

health center from GB reported 20% and 5%

respectively of all maternal deaths that were

reported by hospitals, health centers and MCH in

2012.

In 2012, four maternal deaths at home were

reported by TTBA of zoba MA as shown in Table

III.2.17. Not only this but also, the number of

deliveries attended by TTBA in 2012 was reduced

by 18.9% compared to 2011. TTBA in zoba

Anseba have not carried out since 2011. Moreover,

the numbers of deliveries attended by TTBA in all

zobas were decreased from time to time showing

an increase of the number of health facilities. Thus,

due to low skill and lack of available resources for

delivery, the policy of MOH encourages TTBAs’

to refer pregnant mothers to health facility rather

than to carry out delivery at home. Considering the

increased accessibility of health facilities to the

community and ability of health centers and health

stations to refer obstetric complications to hospitals

and the re-enforcement of maternal death audit, we

can comfortably say that more than two third of

the deaths are reported.

In January and May 2012, 11.8% of the total

maternal deaths were reported in each month;

while in March, August, October and November

10.3% of the total maternal deaths were reported in

each month. Comparing the zobas, GB has 44.1%

out of the total maternal deaths followed by

Anseba (23.5%) and Debub 11.8%. See Table

III.2.18.

Table III.2.17. Number of Deliveries attended and

number of maternal deaths reported by TTBA by

Zoba and Year (2010 - 2012)

Zoba Deliveries attended

Reported Maternal

deaths

2010 2011 2012 2010 2011 2012

AN 53 0 0 0 0 0

DE 979 484 596 0 0 0

DK 155 175 107 1 0 0

GB 2358 1961 1522 2 4 0

MA 857 956 672 0 0 4

SK 409 399 354 1 0 0

Total 4811 3975 3224 4 4 4

Table III.2.18 Reported Number of Maternal Deaths from HO, HC and HS by Month

and Zoba in 2012 excluding anemia in pregnancy

Months AN DE DK GB MA NR SK Total %

January 5 1 0 2 0 0 0 8 11. 8

February 0 0 1 0 0 0 0 1 1. 5

March 1 2 0 3 0 1 0 7 10. 3

April 3 0 1 2 0 0 0 6 8. 8

May 2 1 0 3 0 1 1 8 11. 8

June 1 1 0 4 0 0 0 6 8. 8

July 1 1 0 1 0 1 1 5 7. 4

August 2 1 0 3 0 1 0 7 10. 3

September 0 0 1 1 0 0 1 3 4. 4

October 1 0 2 4 0 0 0 7 10. 3

November 0 0 0 6 0 0 1 7 10. 3

December 0 1 1 1 0 0 0 3 4. 4

Total 16 8 6 30 0 4 4 68

100.

0

% 23. 5 11. 8 8. 8 44. 1 0 5. 9 5. 9 100



57

Causes of Maternal Deaths at Health

Facility Figure III.2.9 Table III.2. 19 reveals the major

causes of maternal death at hospitals and health

centers which included post-delivery/abortion

sepsis 21.7%, rupture of uterus 11.7%, eclampsia

11.7%, obstructed labor (CPD) 8.3%, other

pregnancy/delivery complications and postpartum

hemorrhage 5% each quantified 5% in 2012.

Not only this but also spontaneous complicated

abortion with infection and pre-eclampsia each

accounted 3.8%, Placenta previa /premature, fetal

distress and other causes of C/S each quantified

1.9% were reported as the causes of maternal

deaths in 2011.

Table III.2 19 shows the total number and causes

of maternal deaths that were reported only by

hospitals, MCH clinics and health centers. Hence

maternal deaths that were reported by health

stations were not included in Table III.2 19 as the

reporting system of HMIS is not allowed to report

by cause. According to the Table III.2 19, GB

reported 45% of all maternal deaths that were

reported by hospitals, MCH clinics and HC

followed by Anseba 20% Debub 13.3% and DK

8.3% whereas Orotta National Referral Maternity

hospital and SKB each reported 6.7% in 2012.

However, zoba MA did not report maternal death

in 2012. The proportion of maternal death without

specifying the cause accounted 26.7% in which all

of them were reported by hospitals and health

centers of GB. It needs great attention to specify

the cause of maternal deaths supporting to take

action timely.

Figure III.2.9 Percent of Causes of Reported Maternal

Death in 2012

Unspecified

cause 26.7%

Other

obstetric/puerper

ium

complications

3.3%

Fetal Distress

1.7%

Post

delivery/abortion

sepsis 21.7%

Placenta praevia

1.7%

Other

preg./delivery

complication 5%

CPD 8.3%

Spontaneous

complicated

abortion with

infection 3.3%Rupture of

Uterus 11.7%

Postpartum

Hemorrhage 5%

Eclampsia 11.7%



58

2.3 The new born

The new born period is defined as beginning at

birth and lasting through the 28th day following

birth. Out of the total live, fresh and macerated

still births which were reported from all health

facilities in 2012, 97.2% (38533) were live

births and 2.8% (1081) fresh and macerated still

births as shown in Table III.2.3. 1.

A still birth is a birth of dead fetus after the 28th

weeks of gestation that include two indicators

namely fresh and macerated still births. These

indicators are used to measure labour, maternal

and fetal follow up. The highest proportion of

fresh and macerated still births was 3.5%

reported from GB and DK followed by SK

3.2%, Anseba 3% and National Referral 2.7%

as shown in Table III.2.3. 1.

However, the percentage of the total low birth

weight to live births was 7.3% (2811). While

the highest percentage of low birth weight was

10.9% from National Referral Orotta Maternity

hospital followed by SK 9.2%, DK 8.1%

Anseba 6.8% and GB 6.5%. Debub and Maakel

each accounted 4.2%. See Table III.2.3.1.

Low Birth Weight is defined as a term baby

weighing less than 2500 grams. If the baby

weighs exactly 2500 grams, (s) he is not a low

birth weight baby.

Table III.2. 19. Number and Causes of Maternal Death Reported only from Hospitals and Health

Centers by Zobas (2011)

Causes of death

Zoba

Total % AN DE DK GB MA NR SK

Eclampsia 0 0 2 3 0 0 2 7 11. 7

Obstructed labor due to mal

position of fetus (CPD) 0 1

1 3

0 0

0

5 8. 3

Other pregnancy/delivery

complications 2 1

0 0

0 0 0 3 5. 0

Placenta praevia, premature

placenta separation 1 0

0 0

0 0 0 1 1. 7

Post delivery/ abortion sepsis 4 2 0 3 0 3 1 13 21. 7

Postpartum hemorrhage 0 1 1 0 0 0 1 3 5. 0

Rupture of Uterus 4 3 0 0 0 0 0 7 11.7

Spontaneous complicated

Abortion with infection 0 0 0 2

0

0

0 2 3. 3

Fetal distress 0 0 0 0 0 1 0 1 1.7

Other obstetric/puerperium

complications 1 0 1 0

0

0

0 2 3. 3

Cause not specified 0 0 0 16 0 0 0 16 26.7

Total 12 8 5 27 0 4 4 60 100

Percent of the total 20 13. 3 8. 3 45 0 6. 7 6. 7 100

Table III.2.3.1. Situation Of New Born at

Birth by Zoba in Year 2012 Zoba Number of

%

FSB

&MSB

Low birth weight

Live

Births

FSB

&

MSB number

% total

live

births

AN 6547 198 3. 0 447 6. 8

DE 8651 194 2. 2 366 4. 2

DK 761 27 3. 5 62 8. 1

GB 7423 260 3. 5 479 6. 5

MA 1888 29 1. 5 80 4. 2

NR 9106 242 2. 7 995 10. 9

SK 4157 131 3. 2 382 9. 2

Total 38533 1081 2. 8 2811 7. 3

NB:- FSB = Fresh Still Births and

MSB = Macerated Still Births



59

Neonatal death is defined as a death of new

born who is less than one month old and is

expressed as in 1000 live births.

In 2012, the sum of all neonatal deaths reported

from all facilities was 340 out of which 211

were reported in delivery service. Out of the

total neonatal deaths (211) reported in delivery

service, 69.7% were reported by hospitals and

the remaining 14.7% and 15.6 were from health

centers and health stations respectively as

indicated in Table III.2.3.2 in 2012.

Moreover, Table III.2.3.2 reveals that the

highest proportions of neonatal deaths were

64.9% reported by GB followed by DE 12.3%,

Anseba 10% SK 5.7% and DK 5.2% in

comparing the zobas.

As shown in Table III.2.3.3, a total of 178

neonatal deaths were reported in the delivery

services by health centers, MCH and hospitals

in 2012. Thus out of the total 178 neonatal

deaths reported in delivery service, hospitals

accounted 82.6% whereas health centers

reported 17.4%. Not only this but also the

Table III.2.3.3 shows that GB had the highest

percentage of neonatal deaths (70.2%) followed

by DE 13.5%, SK 5.6%, DK 4.5%, and Anseba

3.9%.

According to health management information

system (HMIS) manual guide line, the 178

neonatal deaths that were reported by hospitals

and health centers in delivery services were

expected to be transferred to inpatient services

by cause using appropriate ICD 10 code to

detect the cause and take necessary action on

time; because only the number of neonatal

deaths were reported in the delivery report.

Table III.2.3.4 Health Centers and Hospitals

that report neonatal deaths (ND) without

specifying the cause in 2012 Zoba Facility name Facility

type

No. of

ND %

DE DEKEMHARE HO 1 0. 9

INGELA HC 1 0. 9

DK ASSAB REG HO 2 1. 8

EDI HO 2 1. 8

GB AGORDAT HO 10 8. 8

HAYCOTA HC 4 3. 5

MEKERKA HC 1 0. 9

MOGOLO HC 1 0. 9

SHATERA HC 1 0. 9

TESSENEY HO 84 74. 3

NR OROTTA

MATERNITY HO 4 3. 5

MAHMIMET HC 2 1. 8

Total 113 100

However, majority 63.5% (113) of the 178

neonatal deaths reported in the delivery service

by HO, MCH clinic and HC were not

transferred to inpatient service to identify the

cause as Table III.2.3.4 reveals. Only 36.5% of

the neonatal deaths reported from hospitals,

health centers and MCH transferred to inpatient

service with appropriate ICD code enabling to

Table III.2.3.2 Total number of Neonatal

deaths at Facility Reported in Delivery Service

by type of health facility and zobas in 2012 Zoba Type of Health facility Tot

al

% to

total

death HS HC MCH HO

AN 14 7 0 0 21 10. 0

DE 2 6 0 18 26 12. 3

DK 3 0 0 8 11 5. 2

GB 12 9 0 116 137 64. 9

MA 0 0 0 0 0 0. 0

NR 0 0 0 4 4 1. 9

SK 2 9 0 1 12 5. 7

Total 33 31 0 147 211 100. 0

% 15. 6 14. 7 0 69. 7 100

Table III.2.3.3 Total number of Neonatal

deaths Reported from HC, MCH and HO in

delivery services by zobas in 2011

Zoba

Type of

Health facility

Total

number % to

total HC MCH HO

AN 7 0 0 7 3. 9

DE 6 0 18 24 13. 5

DK 0 0 8 8 4. 5

GB 9 0 116 125 70. 2

MA 0 0 0 0 0. 0

NR 0 0 4 4 2. 2

SK 9 0 1 10 5. 6

Total 31 0 147 178 100

% 17. 4 0 82. 6 100. 0



60

know the exact cause. As Table III.2.3.4

discloses, out of 113 neonatal deaths that were

reported without specifying the cause, Tesseney

HO had the highest percentage (74.3%)

followed Agordat HO 8.8% and Haycota HC

3.5% in which all of them are from zoba GB.

Table III.2.3.5 Number and percent of Neonatal

Deaths reported from HO and HC by Zoba in 2012 Zoba

Causes of Neonatal death Total specified Not specified

AN No 24 0 24

% 100 0 100

DE No 31 2 33

% 93. 9 6. 1 100

DK No 4 4 8

% 50. 0 50. 0 100

GB No 39 101 140

% 27. 9 72. 1 100

MA No 0 0 0

% 0 0 0

NR No 67 4 71

% 94. 4 5. 6 100

SK No 29 2 31

% 93. 5 6. 5 100

Total No 194 113 307

% 63. 2 36. 8 100

In addition, from the total neonatal deaths (307)

that were reported by hospitals and health

centers, 63.2% were reported with specific

causes whereas the rest 36.8% were without

specifying the cause. See Table III.2.3.5.

Looking at the zobas, hospitals and health

centers in Anseba reported a total of 24

neonatal deaths in which all of them were

reported with specific causes indicating the

efficiency of their recording and reporting

system. Conversely, facilities from GB had a

report of 140 neonatal deaths out of which only

27.9% of them were reported with specific

causes and the remaining 72.1% were

accounted without definite causes as shown in

Table III.2.3.5.

Hence special attention and assessment is

required to the effectiveness of the recording

and reporting system of the hospitals and health

centers in GB.

Hospitals and health centers of SK reported 31

neonatal deaths in which 93.5% of them were

reported with specific causes while DE had 33

neonatal deaths with 93.9% of them reported

with specific causes.

Both Orotta Maternity and Pediatric hospitals

reported a total of 71 neonatal deaths in which 4

of them were reported in delivery services by

Orotta Maternity hospital. Thus, none of the 4

neonatal deaths were transferred to inpatient

services using ICD 10 code to identify the cause

of death.

On the other hand DK had a total of 8 neonatal

deaths in which 50% of them were reported

with definite causes in 2012.

Obviously the system of NHMIS doesn’t allow

the health stations to transfer facility based

neonatal deaths to inpatients services using the

ICD 10 code. As a result, all health stations

reported 9.7% out of the whole neonatal deaths

(340).

Facility based neonatal deaths of 2012 that were

reported by hospitals, health centers and MCH

clinics had increased by 30% compared to 2011

Table III.2.3.6. Number of Facility based Neonatal

Deaths by Year and Zoba reported from HO, HC,

and MCH through delivery & IPD service (2007 -

2012)

Zoba Number of Reported Neonatal Deaths

2007 2008 2009 2010 2011 2012

AN 10 13 28 26 52 24

DE 27 35 17 31 23 33

DK 9 4 7 8 7 8

GB 38 28 42 40 48 140

MA 0 1 2 1 3 0

NRH 110 142 57 50 74 71

SK 20 40 25 32 29 31

Total *214 *263 178* 188 236 307

* The number of neonatal deaths reported through

delivery and inpatient services in those years were

added after cleaning for duplication in 2009.



61

as illustrated in Table III.2.3.6. Considering the

zobas, in 2012 GB reported the highest number

of facility based neonatal deaths which

increased by 65.7% as compared to 2011.

Conversely zoba Maakel had no report of

facility based neonatal deaths and in zoba

Anseba it was declined by 46.1% as compared

in 2011. According to Table III.2.3.6, in the

remaining zobas the number of facility based

neonatal deaths of 2012 was slightly increased

or decreased as compared to 2011.

Apparently the neonatal mortality rate is

expressed as the neonatal deaths per1000 live

births. So the facility based neonatal mortality

rate is calculated by taking the total number of

live births reported from all health facilities as

denominator and the numerator is the total

number of neonatal deaths reported in the

delivery services only. The facility based

neonatal mortality rate was 5.5/1000 live births

in 2012. Thus, considering only those neonatal

deaths reported through delivery services in

2012, the facility based neonatal mortality rate

has increased by 2.1/1000 compared to 2011 as

shown in Figure III.2.3.1.

Figure III.2. 3.1. Facility Based Neonatal

Mortality per 1000 Live Births as Reported

through Delivery Service(2006 -2012)

5.5

4.6

3.44.04

4.74.1

0

1

2

3

4

5

6

2006

2007

2008

2009

2010

2011

2012

Year

Rate

NNMR

Although the facility based neonatal mortality

rate has increased in 2012, generally it has

decreasing trends probably because of

improved access to health services and

improvement in quality of care given. The ICD

code for recording neonatal morbidity and

mortality was introduced in 2004. Before 2004,

only the neonatal deaths in delivery room used

to be reported without specifying the cause of

death.

The major causes of neonatal death in inpatient

service were clinical neonatal sepsis (21.1%),

very low birth weight (18.6%), low birth weight

(15.5%), intrauterine hypoxia/birth asphyxia

(12.9%), extremely low birth weight (7.2%),

neonatal hypothermia (6.7%) and pending

neonatal sepsis (5.7%), as indicated in Table

III.2.3.7 and figure III.2.3.2.

Moreover, Table III 2.3.7 indicates that

comparison of facility based neonatal death

with specific and without specific causes in

Zobas in 2012. Regarding to this, the highest

percentage of overall neonatal death rate (with

and without specific causes) was reported by

GB 45.6% followed by Pediatric National

Orotta Referral hospital (21.8%), DE (10.7),

and SKB (10.1); whereas the remaining Zobas

had the following proportion of neonatal

mortality: Anseba 7.8%, DKB 2.6% and Orotta

Maternity National Referral hospital 1.3%.

However, zoba Maakel had no report of facility

based neonatal death.

According to Table III 2.3.7, a total of 307

neonatal deaths were reported by hospitals,

health centers and MCH clinics in which 194

(63.2%) of them were reported with specific

causes and 113 (36.8%) were reported without

specifying the cause of death. Out of the total

neonatal deaths that were reported without

specifying the cause, zoba GB reported 89.4%

which was the highest percentage of neonatal

deaths without specific cause. On the other

hand, out of the total neonatal deaths that were

reported with specific causes Pediatric National

Orotta Referral hospital possessed 34.5%,

followed by GB 20.1%, DE 16%, SKB 14.9 and

Anseba 12.4%.



62

7.2

15.5

18.6

12.9

21.1

5.7

6.7

0 5 10 15 20 25

Proportion (%)

Extremely low birth

Low birth wt.

Very low birth wt

Intrauterine hypoxia/birth asphyxia

Clinical Neonatal Sepsis

Pending Neonatal Sepsis

Neonatal hypothermia

Causes

Figure III. 2.3.2. Major Causes of Neonatal Mortality in Health facilities

(2012)



63

Table III.2.3.7 Causes of Facility Based Neonatal Deaths by Zoba in 2012

Cause of death by ICD 10 Code

Zoba

Tot

al

% to

specif

ied

cause AN

DE

DK

GB

MA

NRH/

Ped.

NRH/

Mate. SK

Extremely low birth wt <1kg (246.1) 0 0 0 3 0 8 0 3 14 7. 2

Very low birth wt 1- 1. 5 kg (246. 2) 1 8 0 8 0 10 0 9 36 18. 6

Low birth wt 1. 5 - 2. 5 kg (246. 3) 4 5 2 3 0 11 0 5 30 15. 5

Intrauterine hypoxia/birth asphyxia 6 7 2 2 0 6 0 2 25 12. 9

Clinical Neonatal Sepsis 9 7 0 20 0 0 0 5 41 21. 1

Neonatal meconium aspiration syndrome

(248. 2) 1

0 0 0 0 0 0 1 2

1. 0

Other Perinatal period respiratory disorders

(249)

2 1 0 0 0 3 0 0 6

3. 1

Congenital infectious & parasitic disease 1 0 0 0 0 0 0 0 1 0. 5

Spinal bifida (254) 0 1 0 0 0 0 0 1 2 1. 0

Hemolytic disease of fetus and newborn 0 0 0 0 0 4 0 0 4 2. 1

Pending Neonatal Sepsis 0 0 0 3 0 6 0 2 11 5. 7

Neonatal cord bleeding 0 1 0 0 0 0 0 0 1 0. 5

Neonatal hypoglycemia (246.7) 0 0 0 0 0 3 0 0 3 1. 5

Neonatal hypothermia (246. 6) 0 1 0 0 0 12 0 0 13 6. 7

Slow fetal growth, malnu. etc. short gest.

LWB

0

0

0 0 0 1 0 1 2

1. 0

Other nervous system congenital

malformations (255) 0 0 0 0 0 3 0 0 3

1. 5

Total causes specified 24 31 4 39 0 67 0 29 194 100

% of causes specified 12. 4 16. 0 2. 1 20. 1 0. 0 34. 5 0. 0 14. 9 100

Total causes not specified 0 2 4 101 0 0 4 2 113

% of causes not specified 0 1. 8 3. 5 89. 4 0 0 3. 5 1. 8 100

Total deaths ( specified & not specified) 24 33 8 140 0 67 4 31 307

% of Total Deaths 7. 8 10. 7 2. 6 45. 6 0 21. 8 1. 3 10. 1 100



64

Figure III. 2.3.3 Percent of Neonates

Born in Health Facilities with LBW

by Year (2006-2012)

7.37.3

8.18.577.1

5.9

0

2

4

6

8

10

2006

2007

2008

2009

2010

2011

2012Year

% LBW

Infants weighing less than 2,500g are

approximately 4 times more likely to die in

neonatal period and 2 times more in post

neonatal period than new born with normal

weight (Ashworth, 1998). In accordance to this,

low birth weight as explained above was one of

the major contributing factors for neonatal

death in health facilities in 2012. The reduction

of low birth weight also forms an important

contribution to reduce child mortality. The

proportion of neonates born with low birth

weight in 2012 was 7.3 the same as 2011.

Hence, the level of low birth weight in 2012

remained the same as compared to 2011. See

Figure III.2.3.3.

However, health facilities that follow the

manual guide line of recording and reporting of

NHMIS should be encouraged to continue to

transfer all neonatal deaths and low birth weight

by cause to inpatient services which enable the

concerned managers to take necessary measures

timely.

Perinatal mortality rate is expressed as total

number of all still births and all neonatal deaths

less than seven days of age per total number of

live and still births. Thus, according to Figure

III.2.3.4, the perinatal mortality rate (PNMR) in

2012 was 35.9/1000 of the total births and has

increased by 5.5/1000 as compared to 2011

even though the facility based perinatal death

rate has a declining trend.

Figure III.2.3.4 Facility Based Perinatal Death Rate by Year

(1999-2012)

35.9

34.035.3

44.344.244.748.849.849.1

53.1

47.646.0

50.5

30.4

0

10

20

30

40

50

60

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012Year

Death Rate



65

III.3. Obstetric Emergencies (OBE)

Any woman can experience complications

during pregnancy that can cause maternal

and neonatal deaths. The major direct

obstetric complications are those that cause

most maternal death. However, the quality of

emergency obstetric care is a key to success.

To minimize maternal and Perinatal

mortality, services must be available 24

hours seven days a week, and have well-

trained and motivated staff, essential supplies

and logistics in place, functioning transport

and communication systems and ongoing

monitoring. Low maternal mortality ratios

are due, in large part, to the fact that

complications are identified early and are

treated. Hence, Strong Obstetric emergency

service is critical to reducing maternal and

perinatal mortality and disability.

Health services related to emergency

obstetric care are categorized as basic and

comprehensive. Basic emergency functions,

performed in health facilities without an

operating theatre which include assisted

vaginal delivery; manual removal of placenta

and retained products to prevent infection;

and administering antibiotics to treat

infection and drugs to prevent or treat

bleeding, convulsions and high blood

pressure. Comprehensive services require an

operating theatre which includes all the

functions of a basic emergency facility, plus

the ability to perform surgery (caesarean

section) to manage obstructed labour and

provide safe blood transfusion to respond to

haemorrhages and are usually provided in

hospitals.

Most of the morbidity and mortality related

to obstetric emergency can be reduced with

appropriate antenatal, delivery and referral

systems. According to the second edition of

the Eritrean National Clinical Protocol on

Safe Motherhood, 2002, and International

Journal of Gynecology and Obstetrics, 2006,

the following were considered as obstetric

emergency situations:

• Pre-Eclampsia/Eclampsia,

• Prolonged labor due to obstruction,

• Antepartum (placenta previa) hemorrhage

• Post partum hemorrhage,

• Puerperal Sepsis,

• Complicated abortions and

• New born distress (intrapartum).

The difficulties in measuring maternal

mortality have led to a shift in emphasis from

indicators of health to indicators of use of

health care services. Furthermore, the

recognition that some women need specialist

obstetric care to prevent maternal death has

led to the search for indicators measuring the

met need for obstetric care. The proportion of

all women with complications who are

treated in the health facilities has been widely

promoted as an indicator of "met need for

essential obstetric care".

Met need for essential obstetric is the

proportion of pregnant women expected to

have complications. This assumes that the

proportion of pregnant women having a

complication requiring life-saving obstetric

care is relatively stable across populations at

15%, enabling need for life-saving obstetric

care to be easily quantified.

According to the International Journal of

Gynecology and Obstetrics 2006, the

indicator “met need for emergency

obstetric care” (EmOC) is the most

important measure of use of EmOC services;

it address the question of whether women

who really need EmOC – those with

complications are receiving it. The indicator

is defined as follows: the numerator is the

number of women with direct obstetric

complications seen in EmOC facilities, and



66

the denominator is the number of women

expected to develop obstetric complications

in the reference population, which is

estimated as 15% of expected live births in

the population; because the goal is to treat all

obstetric complications in EmOC facilities.

EmOC refers to care provided in health

facilities to treat direct obstetric emergencies

that cause the vast majority of maternal

deaths during pregnancy, at delivery and

during the postpartum period.

Table III.3.1. Number of OPD/IPD Obstetric Emergency cases in Hospitals, MCH and Health

Centers by Zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to

total

Pre-Eclampsia 49 57 2 57 10 142 19 336 4.9 Eclampsia 11 14 4 11 0 1 17 58 0.9 Placenta previa (antepartum) 15 27 6 27 5 43 10 133 2.0 Prolonged/obstructed labour 142 141 9 130 57 409 43 931 13.7 Newborn distress (intrapartum) 33 31 0 0 198 135 18 415 6.1 Rupture of uterus 10 16 2 44 1 4 1 78 1.1 Postpartum hemorrhage 30 96 4 21 0 8 6 165 2.4 Post delivery/abortion sepsis

(Puerperal) 44 98 1 109 0 51 13

316 4.6 Other pregn/deliv complications 140 181 17 238 11 27 80 694 10.2 Other obstetric/puerperium

complications 2 34 5 20 2 88 7

158 2.3 Spontaneous complicated abortion

with infection 200 540 14 282 17 1831 84

2968 43.6 Obstetric Fistula 13 65 0 5 145 321 9 558 8.2 Total OBE cases 689 1300 64 944 446 3060 307 6810 100 % to total OBE cases 10.1 19.1 0.9 13.9 6.5 44.9 4.5 100 15% of target population for

delivery service (expected no. of

OBE cases 2865 4735 416 3539 3377 0 2877 17808

Met need for OPD/IPD OBE

cases 24.0 27.5 15.4 26.7 13.2 0 10.7 38.2

As shown in Table III.3.1, the total actual

numbers of outpatient and inpatient OBE

cases in year 2012 were 6810 in which only

include spontaneous complicated abortion

with infection, bleeding, and retained parts in

hospitals, MCH, and health centers. The

average estimate for total OBE cases

(expected number of OBE cases) in 2012 was

17,809; i.e. 15 % of the target population for

delivery service.

From the total causes of outpatient and

inpatient, pregnancy and labour related

morbidity problems in 2012, spontaneous

complicated abortion with infection (43.6%)

was the leading one as followed by

obstructed labor (13.7%), other pregnancy

and delivery complications (10.2%), obstetric

fistula (8.2%),newborn distress (6.1%), pre-

eclampsia (4.9%) and post delivery/abortion

sepsis, 4.6%. See table III.3.1.

Looking at the Zobas, National Referral

Maternal hospital covered 44.9% followed

by Debub 19.1%, GB13.9%, and Anseba

10.1%, and Maakel and SK accounted 6.5%

and 4.5 respectively of the total number of



67

OPD and IPD obstetric emergency cases in

2012 as indicated Table III.3.1. Not only

this but also the highest met need for OPD

and IPD OBE cases in year 2012 was

reported by EmOC facilities of zoba Debub

(27.5%), followed by facilities in GB

(26.7%), Anseba (24%) and DK (15.4%); the

average met need was pointed up in the table

III.3.1 as 38.2%.

Table III.3.2. Number of IPD Obstetric Emergency cases in Hospitals, MCH and Health Centers

by zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to

total

Pre-Eclampsia 28 47 2 26 1 98 7 209 3.9 Eclampsia 11 14 3 11 0 1 17 57 1.1

Placenta previa (antepartum) 15 26 6 26 5 33 10 121 2.3 Prolonged/obstructed labour 142 141 8 130 53 408 86 968 18.2

Newborn distress (intrapartum) 33 31 0 0 51 135 18 268 5.1 Rupture of uterus 10 16 2 40 1 4 1 74 1.4

Postpartum hemorrhage 29 95 4 17 0 0 6 151 2.8

Post delivery /abortion sepsis

(Puerperal) 37 96 1 74 0 51 13

272 5.1

Other pregn/deliv

complications 80 113 9 62 4 1 6

275 5.2

Other obstetric/puerperium

comp. 2 14 4 18 0 40 6

84 1.6

Spontaneous complicated

abortion with infection 199 530 12 259 17 1532 83

2632 49.6

Obstetric fistula 9 48 0 2 33 98 5 195 3.7 Total of IPD OBE cases 595 1171 51 665 165 2401 258 5306 100

Total IPD cases in 5yrs and

above 12513 21295 1547 12687 7303 24329 8302 87976

% of OBE IPD cases to total

IPD cases in 5yrs and above 4.8 5.5 3.3 5.2 2.3 9.9 3.1 6.0

15% of target population for

delivery service (expected no.

of OBE cases 2865 4735 416 3539 3377 0 2877 17808

Met need for IPD OBE cases 20.8 24.7 12.3 18.8 4.9 0 9.0 29.8

Table III.3.4. Number of OPD Obstetric Emergency cases in Hospitals, MCH and Health

Centers by zoba in 2012 OBE cases AN DE DK GB MA NRH SK Total % to

total

Spontaneous non complicated

abortion 108 1 33 55 404 39 640 39.5

Threatened abortions 48 68 1 105 18 472 18 730 45.1

Other pregnancy with abortive

outcome 2 21 7 11 113 64 19 237 0.7

Medical abortion 11 1 12 14.6

Total

50 197 9 149 186 951 77 1619

% to total 3.1 12.2 0.6 9.2 11.5 58.7 4.8 3.1 100



68

Cesarean Section rate An estimate of the cesarean section rate may reflect, at least partially, the extent to which pregnant

women access life-saving obstetric care. In settings where access to surgical facilities is very low,

the majority of cesarean sections will be carried out to save the life of the mother although

cesarean section might be differentiated into elective (scheduled) cesareans and emergency

cesareans. On the other hand, a total of 6410 obstetric related risk cases were visited in all health

facilities that provide EmOC services out of which Orota National referral hospitals reported

42.3%, Maakel 22%, Debub 19.3% and GB 14.9 and the remaining in other zobas.

According to Figure III.3.1, the yearly trends of Met Need for direct emergency obstetric cases of

inpatient and outpatient OBE including spontaneous complicated abortion was 42.9% in 2012. It

almost the same with 2011 which was 41.9%. Hence, the overall yearly Met need for direct

emergency obstetric cases of inpatient and outpatient have decreasing and increasing trends as

indicated in Figure III.3.

1.

The caesarean rates may be accurate tracers

of use of essential obstetric care services.



69

The indicator cesarean section rate as a

proportion of all births in the population

addresses whether this specific life-saving

intervention is performed in sufficient

numbers. The indicator takes its numerator

primarily from operating theater logbooks

and the denominator is the estimate of the

number of expected deliveries in the

population.

According to UNICEF et al, 1997, the

acceptable number of CS from expected

births ranges between 5-15 %. Thus, the

target has been set as a range between 5%

and 15% of all births; i.e. the recommended

level is 5–15% of all births.

The total national figure for the C/S (elective

and emergency cesareans) performed in 2011

was 2609 which is 6.8% of all attended

deliveries and 0nly 2.2% of all expected

number of deliveries. The caesarian section

rate of all expected number of deliveries was

less than 2.3% in the last 15 years as

indicated in table III.3.1. Thus, the over all

trend may indicate improved access to

required C/S, but not necessarily indicate the

progress in reduction of maternal death since

there are countries that have maternal

mortality of 20 to 60 per 100,000 with C/S

rates not exceeding 2%. The cesarean section

rate (2.2%) as a proportion of all expected

deliveries in the population shows progress

in 2011 compared to previous years although

the recommended (required) level is 5–15%

of all births as seen in Figure III.3.3.

Table III.3. 1.. Number of C/S performed and its

proportion to total attended and expected

number of deliveries by Year (1998-2012)

Year No. of C/S

Percent to

total

attended

deliveries

% C/S to

Total

Expected

deliveries

1998 629 3.8 0. 8

1999 792 5.4 1. 0

2000 925 6.2 1. 1

2001 1004 5.7 1. 1

2002 1200 5.5 1. 3

2003 1269 5.3 1. 4

2004 1373 5.5 1. 4

2005 1598 6.2 1. 6

2006 1706 6.6 1.7

2007 1877 6.7 1. 8

2008 1859 6.3 1.7

2009 1889 6.4 1.7

2010 2118 6.4 1. 9

2011 2534 6.7 2. 2

2012 2609 6.8 2.2



70

Figure III.3.2 trend of CS by year (1998-2012)

5.3 5.5

6.8 6.76.46.46.36.76.66.2

5.55.76.2

5.4

3.8

012345678

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012Year

Percent

Percent

Figure III.3.3. The Percent of C/S Performed compared to the Total

Expected Deliveries by Year (1998-2012)

1.3 1.4 1.41.6 1.7 1.8 1.7 1.7

1.9

2.2 2.2

1.11

0.8

1.1

0

0.5

1

1.5

2

2.5

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Year

Percent

Percent



71

Moreover, the table III.3.2 indicates a total of 57

maternal deaths due to specific causes obstetric

emergency problems which are equivalent to 3.6%

compared to the total OPD/IPD deaths in five years

and above in 2012.

Not only this but also the table III.3.2 shows the met

need for inpatients and outpatients obstetric

emergency cases including complicated abortions

which was 41.4%; whereas without spontaneous

complicated abortions it was only 23.0%.

Table III.3.2. Yearly Trends of Maternal Morbidity and Mortality in Hospitals, MCH and Health Centers

Due to OBE Situations (2000-2012) Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Number of new OBE

OPD and IPD Cases

10018 10324 6843 9718 11156 10204 10166 7996 7989 8423 7171 6410

% to total OPD/IPD

Morbidity in five

years and above

1. 4 1. 6 1 1. 5 1. 4 1. 4 0. 9 0. 9 0. 9 0. 9 0.7 0.6

Number of OBE

Deaths including all

non-medical abortions

55 57 65 59 76 66 60 34 33 50 59 57

% to total OPD/IPD

death in five years

and above

2. 8 3. 3 4. 4 2. 7 4. 8 4. 5 4 2. 3 2. 1 3. 2 4.1 3.6

% of Met need for

obstetric Care with comp. abortion

40 45.8 34.4 29.4 46.3 45.1 40.7 42.8 37.4 23.6 41. 4

% Met needs for

obstetric care without

abortion

11. 9 17. 1 14. 8 15. 8 28. 9 28.1 19.2 21. 8 22.1 20. 5 23. 0



72

III.4. Family Planning

Services Family planning in reproductive health

program has contributed greatly to

fertility decline and reduces unintended pregnancy and thereby improves healthy

reproductive behavior. Both availability

and quality of family planning services

are believed to have contributed to

increasing contraceptive use and declining

fertility rates in developing countries.

Eritrea is one of the developing countries

with high fertility rate that increases the risk

of morbidity and mortality of women and

children. Thus, family planning services are

provided to reduce these risks through

spacing between children and support

couples to have informed decisions on the

number of children they want to have and

the spacing method they want to use by

considering the health of the mother and the

children.

In Family Planning (FP) program, the

general health of the women is assessed and

required treatment and advice, and

counseling on infertility problems are

provided.

Data on FP services is collected from all

health facilities that provide the service,

including Family Reproductive Health

clinics. From the total health facilities

(340) that were reporting in year 2012, 201

(59%) facilities were providing FP services.

Out of which 11 were hospitals, 45 health

centers, 133 health stations, and 6MCH and

other clinics (Table III.4.1.).

The number of health facilities that provide

FP service by year is presented in Figure

III.4.1

Figure III.4.1 number of Health

Facilities providing family planning services

(2002-2012) Table III.4.1 Number of Health Facilities

Providing Family Planning Services by Zoba

and Type of Health Facility (2012)

Zoba HO HC HS MCH CL Total

SKB 3 9 17 1 0 30

MA 0 8 21 0 4 33

GB 1 13 40 3 2 59

DKB 3 0 6 0 0 9

DE 4 9 29 1 0 43

AN 0 6 20 1 0 27

Total 11 45 133 6 6 201



73

Coverage

The two types of data point to evaluate the

utilization of family planning (FP) service

are the total number of new method

acceptors and any client who received other

family planning services that includes

infertility, counseling etc. The target

population for FP service is estimated as

20% of the total population. The family

planning coverage in 2012 considering all

new clients who visited the health facilities

for family planning counseling and different

contraceptive methods was 3.6% (Table

III.4.4)

The recruitment rate on the other hand

indicates the percent of new FP clients who

use any contraceptive method was 3.6 %.

The highest recruitment rate was observed in

Zoba Maakel 6.5%, while the figure for the

other Zobas ranges from 1.4 (in SKB) to 5.5

% in (GB) (Table III.4.4)

Trends in contraceptive use have

implications for shifts in pregnancy rates and

birth rates and can inform clinical practice of

changes in needs for contraceptive methods

and services. Though condoms were used to

be the most popular method of

contraceptive, the trend of condom users

shows down ward trend from 2005-2007 and

then again from 2010-2012. The reason for

low condom use as contraceptive method

could be due to wide spread condom

distribution in different out lets for the

prevention of HIV and other sexually

transmitted diseases which could also be

used for contraceptive method. This could

also have contributed to the low family

planning coverage rate because many can

use condom for dual purposes without being

registered as family planning client. The

stock out level for pills, injection and

Female condoms for the year 2012 is less

than the preceding years as shown in Table

III.4.3.

FigureIII.4.2



74

Couple Year Protection (CYP)

The couple year protection indicates the number of years couples are protected against

unwanted pregnancy among target population. Each contraceptive method has its own

standard protection year. For example, fifteen cycles of pills or 4 injections of Depo provera

can protect couples for one year against unwanted pregnancy. The total CYP and CYP rate in

year 2012 was 16229.8 and 2.1 % respectively (Table III.4.5). Low couple year protection

(CYP) indicates high fertility rate that increases the risk of maternal and child mortality as

explained above. The 2002 EDHS findings indicated that the unmet need for FP service was

about 27%.

Trend of stock out level for pills, injection, condom and IUD is summarized in the Table

III.4.3. The high stock out level could contribute to the low contraceptive method use. The

IUD insertion with the situation of HIV infection seems relatively discouraged thus the stock

out is high. Condom is being distributed by Social Marketing Groups, health facilities and

other outlets.

Figure III.4.3 Family planning Decrement and CYP rate(%)in 2012 by zoba



75

Table III.4.4 Number of New and Repeat Visits for Different Contraceptive Methods and Information and Counseling by Zoba in 2012

Zoba Family Planning Methods 1st IC Only

Referre

d

Total FP Method Acceptors

FP Acce

pter(

%

Service

Cove

rage rate

Pills Injection IUD F+M Condom Other

Methods

First Repea

t

1st Repeat 1st Re 1st Re 1st Re 1ST

New Re % %

AN 592 1338 1604 4261 11 0 117 56 0 0 96 0 2324 5655 1.8 1.8 DE

1488 3181 3284 8433 2 0 715 381 0 0 294 58 5489 11995 2.6 2.6

DKB 66 153 266 604 0 0 33 1 0 0 0 0 364 758 2.0 2 GB

1649 2549 4056 7402 0 0 2994 1960 0 0 11 0 8703 11912 5.5 5.5 MA

2102 6015 3957 12543 166 85 2097 1122 0 0 1357 39 8322 19765 5.5

5.5

SK 726 891 1101 2750 0 0 48 71 0 0 0 0 1878 3717 1.5 1.5

Total

6623 14127

14268 35993 179 85 6004 3591 0 0 1758 97

27080 53802 3.4 1.8

% 24.4 26.3 52.7 66.9 0.6 1.6 22.8 6.7 0 0

N.B. Service coverage rate includes IC visitors

Table III.4.3. Percent Annual Commodity Stock Out Level at HC and HS in Percent Year Pills Injection Condom IUD

2000 33 50 50 90

2001 40 50 50 90

2002 57 50 60 90

2003 45 50 50 90

2004 33 50 60 90

2005 24 70 60 100

2006 29 30 80 100

2007 27.8 37.4 Male 70 Female 97.1 96.1

2008 30.1 30.92 Male 56 Female 97 94.61

2009 34.5 61.9 Male56.1Female 59.3 94.8

2010 51 51.1 Male 69.5 Female 92.1 97.4

2011 47.3 42.7 Male 75.6 Female 91.5 95.6

2012 46.5 41.9 Male 77.5 Female 98.2 98.1

IUD not done in HS



76

Table III.4.5. Number and Type of Contraceptive Units Distributed and Couple Year Protection (CYP) by Zoba in

2012 Zobas PILLS INJECTION IUD Condom (M+F) Others Total CYP

Rate

(%) DEPO Noristerat

UNITS CYP UNITS CYP UNITS CYP UNITS CYP UNITS CYP Units CYP Distributed CYP

AN 2617 174.4 5776 1444 9 1.5 11 38.5 772 6.4 0 0 9185 1664.8 1.3

DE 7647 509.8 11719 2929.8 0 0 0 0 5998 49.9 0 0 25364 3489.5 1.6

DKB 555 37.0 739 184.8 0 0 0 0 158 1.3 0 0 1452 223.1 1.2

GB 12684 845.6 11507 2876.8 27 4.5 0 0 13414 111.7 44 154 37786 3992.6 2.4

MA 11624 774.9 16294 4073.5 90 15.5 243 850.5 5173 43.1 11 43 33467 5800.5 3.8

SK 2388 159.2 3867 966.8 0 0 0 0 980 8.1 0 0 7235 1134.1 0.9

TOTAL 37515 2501 49902 12475.5 126 21 254 889 26495 220.7 55 197 114489 16304.2

% to total 32.5 15.3 43.6 76.5 0.8 0.12 0.8 5.5 23.14 1.3 0.0 1.2

Table III.4.6. Yearly Trends of the Number of New FP Acceptors, Repeat Visits, Counseling and Information Visits,

CYP, and FP Coverage (2001-2012)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

New FP method Acceptors

22324 30121 21387 28480 19572 19040 25884 28356 36326 26856 27081 Repeat FP Visits

46429 46035 45240 47740 36107 43438 49360 49827 50353 51673 53802

New Information and Counseling

Visits 645 5859 2383 10560 3,940 5132 4713 4725 3471 2654 1758 Total Visits 75210 82015 69010 86780 59619 67610 79957 82908 90150 81183 82641

Total CYP

13774.6 12937.

6 13842 12787.8 11829.

4 13230.9 13854 18835 14,261 19191.8

16229.

8 New FP Method Acceptors rate

(recruitment rate) (%) 3.6 4.9 3.4 4.4 2.9 2.8 3.7 3.3 4.9 3.5 3.4

Couple Year Protection rate

(CYP) % 2.3 2.1 2.2 2 1.8 1.9 2 2.6 1.9 2.0 2.1

TABLE III.4.7. ANNUAL TRENDS OF NEW FAMILY PLANNING METHOD ACCEPTORS BY ZOBA (RECRUITMENT

RATE ) (2000-2012) ZOB

A

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

AN 1.4 1.6 1.5 1.3 1.8 0.9 1.5 1.8 2.2 1.8 1.1 2.8 1.9 DE 1.6 2.7 2.5 5.1 4.0 2.3 2 2.2 2.9 2.7 1.2 2.6 2.8 DKB 3.2 2.2 1.5 5.5 2.6 2.7 3.2 2.5 2.1 3.3 1.8 3.O 2.0 GB 4.5 3.3 2.8 2.7 3.2 8.4 2.7 2.6 5.8 3.3 2.1 4.8 5.5 MA 5.8 6.3 10.4 13.1 6.1 8.3 6.1 5.4 6.1 6.1 4.8 5.7 6.5 SKB 1.8 2.7 1.2 1.0 1.1 1.8 2.3 1.7 2.8 2.6 0.9 1.5 1.5


III.5.Immunization Service

The Expand ed Program on Immunization (EPI) is

one of the priority programs of the Ministry of Health

.EPI is considered as one of the most cost effective

health interventions At present, BCG, Measles, Polio,

DPT, Hepatitis B, and Homophiles Influenza types B

vaccines are being provided to children less than one

year. Homophiles Influenza type B vaccine was

introduced in the late 2007.the target population for

child immunization is children under one year old

estimated as 3% of the total estimated population, and

pregnant women are targeted for Tetanus Toxoid

immunization. The reports from all health facilities

show over all increased coverage for various vaccines

this year. Taking the number of children immunized

for BCG (91%) in EHDS2002 as births and inflating in

by 9% gives us about 3%(2.7) of the total population

surveyed .Taking these estimates as base, we estimate

the total children under one year as 3% targeted for

immunization .The EPI unite on the other hand is

using estimated infant survival rate estimate of WHO

which 3.6% of the total population to calculate

immunization coverage for under one year age group.

Despite the differences in denominator, the EPI unite

and NHMIS use the same source of data for the

number of children immunized for different antigens

and estimated National population data. Therefore, the

raw numbers can be taken for campaign increase

coverage.

5.1. Health Facilities providing Immunization Service Immunization service has been providing in 258 (75.88 of all health facilities) in 2012.The number of health facilities

providing immunization services is more than tow health facility compared with 2011.Excluding the private and

industrial clinics, 92.5 % of all hospitals, health centres, health station, MCH and clinics were providing

immunization services while hospitals were providing above. Out of the total health facilities that have been

providing the service, 16 were hospitals, 52 health centres, 179 health stations, and 7 MCH and other 4 clinics (Table

III.5.1.1). The health centres that do not provide immunization services are those specialized for specific health

services like Physiotherapy centres, International Operation for Children Centre Asmara (IOCCA). Mai-dima

ophthalmic centre and 3 industrial centres. Similarly hospitals that do not provide immunization were: Dekemhare,

Adikeyh, Halibet, Hazhaz, Dendan, Orotta Pediatric, NR Orotta Medical Surgical, Hansenian, St.Mary, Berhan

Aynee, and Massawa Hospital. Some of these Hospitals are specialized hospital providing specific services while

others have health centres or MCH clinics or health station near the hospitals that provide immunization services. In

addition to the static health facilities ,immunization has been provided in 335 out reach sites in 2012.The total

number of visits to these out reach sites account to 2,001 which is 16.7%more compared with 2011, further more”

National Immunization Days “for Polio and “Measles Catch Up Campaign” have also been conducted to increase the

immunization coverage. The number of out reach sites since some may be closed and others opened based on the

availability of resource. The Annual the number of static health facilities providing immunization services is

presented Figure III.5.1.1.


Table III.5.1.1.Number of Health Facilities that Provide Immunization

Services by Type of Health facility and Year(2005-2012)

Type 2005 2006 2007 2008

2009

2010

2011

2012

HO 12 13 14 15 14

14 12

16

HC 46 46 49 49 48 49 49 52

HS 162 165 169 176 178 178 179 179

MCH/CL 13 7 8 8 9 8 10 11

TOTAL 234 231 240 249 248 249 250 258

% 65.4 62.4 63.5 67.10 67.21

74.33 78.12 75.88


5.2. Immunization Coverage Child Immunization In 2012, the DPTHepB3 coverage rate at National level was 71.1 % with zoba variations. The coverage ranges

from 49.2% in SKB to 107.2 % in Gash_Barka which indicates that the estimated target population is much less

than actual population. The HMIS uses the 2000 published population estimation and its projection and does not

consider the returnees from the Sudan who settle in Gash Baraka. Although, there is need of adjusting the

current population in all zobas, we will continue using the available official population estimation until the

adjustment is done by concerned authorities. The immunization coverage of children less than one year is

presented in the Table III.5.2.2.The coverage for all antigens and the number of children full immunized before

their first year of birth has

decreased trends. It has

decreased by 6.5 % 2012

than in 2011 (Figure

III.5.2.1.). The

The dropout rate at national

level for this was 0 with

range 0 to 3.3% among the

zones and it is good

performance compare with

2011 as indicated ( Table

III.5.2.1.)

.

Table III.5.2.1. Percent of dropout by zoba and year (2000-2012)

Year

Total

Zoba

AN DE DKB GB MA SKB

2000 13.1 2.9 15.0 21.4 28.3 2.9 6.6

2001 10.9 3.5 14.4 28.3 12.4 5.8 14.6

2002 8.9 4.2 9.1 26.1 11.7 4.9 12.4

2003 4.5 1.6 3.6 11.9 5.7 1.5 12.4

2004 6.4 1.7 7.5 24.5 5.2 3.4 16.1

2005 7.6 4.5 6.0 25.2 9.3 5.5 11.5

2006 3.7 0.5 2.1 25.3 5.6 0.0 11.5

2007 6.1 4.4 3.6 6.9 103 1.0 13.1

2008 3.7 0 3.4 21.7 7.5 0 0

2009 1.9 2.0 1.1 0 5.5 0 1.4

2010 2.6 0.0 1.5 4.7 3.0 1.9 5.00

2011 5.1 4.9 2.6 6.5 9.1 0 6.4

2012 0.0 0.0 3.3 3.1 1.1 0.0 0

Table III.5.2. 2. Immunization Coverage in % for Children Under One Year of age for

Different Antigen by Zoba in Y2012

Zoba Type of Vaccines Fully

Immuniz

ed.

*Target

population BCG OPVO DPTH

B1

DPTH

B2

DPTH

B3

Measles

AN 68.6 32.9 68.1 71.4 71.0 73.1 68.9 19100

DE 68.1 27.0 71.1 71.2 68.8 66.8 66.8 31565

DKB 52.6 32.8 60.1 56.7 58.2 53.5 50.6 2772

*GB 105.3 28.9 108.7 112.8 107.2 99.5 45.5* 23592

MA 20.3 16.0 54.8 57.9 56.6 56.9 55.4 22513

SKB 40.4 23.0 46.1 49.3 49.7 44.5 33.4 19182

Total 61.7 25.7 70.8 73.1 71.1 68.3 55.0 118724

*Estimated target population could be less than the actual population in the zoba. National Referral Hospital data is

excluded due to not having denominator.45.5*low reporting of full immunized in G ASH-BARKA is

due to unable to save the record data this resulted in lower coverage of full immunization


Zones

Table III.5.2.3 Number of Children Immunized by Age categories,

Type of Vaccines and Zoba in 2012

BCG OPV0

OPV1 OPV2 OPV3 DPTHB1 DPTHB2 DPTHB3 MEASLES Fully Imm.

<1 >1 <1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1 <1 >1

AN 13095

9 6286

13122 5

13642 29 13565 24 13122 5 13642 29 13565 14 13967

430 13167 162

DE 21505 4 8511 22450 5 22492 8 21711 29 22450 5 22485 8 21713 29 21073 1221 21073 1221

DKB 1459 1 909 1665 12 1571 7 1641 23 1665 4 1571 7 1614 23 1484 889 1402 60

GB 24833 52 6769 25707 27 26524 43 25526 68 25575 18 26634 47 25287 94 23450 700 10724 133

MA 4578 0 3621 12441 0 13119 4 12808 1 12451 0 13127 4 12808 9 12679 2133 12725 121

NRH 8317 0 8317 6 2 6 0 8 0 0 0 6 0 8 0 3 2 0 0

SKB 7759 17 4417 8837 193 9525 217 9517 255 8854 191 9472 217 9535 259 8538 1530 6408 823

TOTAL 81546 83 38830 84228 244 86879 909 84749 400 84123 223 86937 312 84530 428 81194 2446 65346 2520


0

20

40

60

80

100

120

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Percent

Year

Figure III.5. 2.3. Percent of Children Under one who had DPTHB3 by Zoba and Year (2001-2012 )


5.3. Tetanus Toxoid Immunization of Women

All pregnant women attending routine health

services should be screened for their tetanus

toxoid (TT) immunization status and be

immunized to prevent tetanus infection

during delivery and neonatal tetanus. A

woman immunized with at least two doses

of tetanus toxoid vaccine (TT+2)develops

protective antibodies against tetanus

protecting the infant against tetanus at birth

for the first two months of its life .coverage

with two doses of tetanus toxoid in 2012 is

16.2 %about 3.1% less than in 2011. The

Percent of pregnant women who had at

least two doses of TT vaccine is showing

decreasing trend starting 2012that needs

attention in order to increase the number of

protected children at birth (Figure

III.5.2.3.).TT vaccine is given to all

reproductive age group although the targets

are pregnant women .Thus once a woman

who is in productive age has 5 doses of

TT; she is not required to be immunized

when pregnant. Only the new entry to the

production age and those who was not

immunized are targeted for the

immunization. Therefore, the coverage may

remain low compared to the estimated

number of pregnant women. However, the

percent of children who had DPTHB1 who

were tetanus protected at birth in 2012 was

91.7 % (Figure III.5.3.1) indicating low

coverage of TT2

Type of

Vaccine

Table III.5.2.4 Number of Under One Children Immunized by Year and Type of vaccines(2002-2012)

Years

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

BCG 69249 75636 80957 82594 84193 82488 83438 76286 76938 86000 81546

OPV 0 23354 26039 26186 26029 29141 30059 31398 76286 34513 39324 38830

OPV1 72049 73518 81106 83308 84502 83929 85836 79389 77438 88660 84228

OPV 2 71474 73353 79592 81900 85460 82772 85742

80152

77859

88648

86879

OPV3 65605 70392 75569 76138 81314 78507 82631 77547 74916 84298 84749

DPTHepB1 71956 73580 80899 82695 84549 84033 85747 79111 77227 88639 84123

DPTHepB2 71409 72592 79675 81658 85536 82869 85489 79935 77692 88669 86937

DPTHepB3 65524 70259 75759 76412 81375 78903 82589 77595 75232 84142 84530

Measles 56435 65953 69071 72301 80652 75554 81133 75707 69891 75718 81194 Fully

Immunized 53354 62233 65418 72226 77894 71075 77391 72006 65510 71051 65346


+ immunization. The TT2 coverage pregnant women TT immunized per year is illustrated in

Table(III.5.3.1)

III.6. Immunization Preventable Diseases (VPD)

Table III.5. 3.1. Percent of pregnant women who had TT2+ vaccine by Year and

Zoba (1999-2012)

Year

Zoba

Total Anseba Debub DKB GB Ma SKB

1999 41.2 23.4 39.3 53.3 36.0 34.3 37.3

2000 38.1 20.2 23.9 44.5 34.6 24.5 31.9

2001 37.2 41.8 33.9 60.5 37.3 27.8 41.5

2002 35.9 42.6 31.0 64.4 43.6 25.4 43.0

2003 31.1 35.2 32.9 66.5 44.0 24.3 40.6

2004 42.2 37.5 33.1 82.6 47.8 27.2 47.6

2005 37 35.9 26.5 70.5 49 28.9 44.1

2006 25.8 38.7 25.6 53.5 47.3 24.3 38.6

2007 28.6 34.2 56.8 54.0 49.3 27.2 39.9

2008 14.0 21.2 34.0 29.6 31.5 17.4 23.3

2009 16.9 18.8 27.0 31.4 23.9 17.7 22.0

2010 21.7 23.0 41.5 30.9 28.4 21.8 25.7

2011 14.6 13.8 23.8 29.5 17.9 18.6 19.3

2012 13.0 11.0 24.0 23.5 17.2 16.3 16.2

Zoba

Table III.5.3.3.Number of Non-Pregnant Women Immunized Against

Tetanus by Zoba in Y2012

Dose of Vaccines

TT1 TT2 TT3 TT4 TT5 TT2+

AN 4413 4223 3653 2666 1528 12070

DE 6396 6372 6731 4806 3715 21629

DKB 825 991 758 588 460 2797

GB 5414 3924 2823 1411 1041 9199

MA 3311 2606 3107 3058 2073 10840

SKB 1914 1600 1484 945 668 4697

Total 22273 19712 18556 13474 9485 61232


Immunization programs have led to eradication of

vaccine preventable disease, and substantial

reductions in the morbidity and mortality attributed

to measles, Pertussis, Polio, Tetanus, Diphtheria and

TB which is very important. However, the

downward trend in morbidity and mortality from

VPDs is maintained and carefully monitored, and

that changes are interpreted in relation to

vaccination coverage. In this report as with the

emergency of HIV/AIDS, the incidence and

prevalence of TB is expected to remain high an

opportunistic disease. Therefore, it is dealt

separately in the burden of disease section.

Morbidity and mortality reports of Vaccine preventable disease

Mortality and Morbidity estimates can be used

priority public health interventions. For VPDs, these

estimates indicate the number of deaths and cases

that could be averted if exiting vaccines were used

to their fullest potential. Immunization program

targets are children less than one year of age.

However, some vaccines such as Hepatitis B and

HiB vaccine were introduced recently as a result the

herd immunity to these diseases is low. Thus, the

cases could be more prevalent than diseases its

vaccines introduced earlier. Moreover, some of the

VPDs are diagnosed clinically due to the absence of

laboratory facilities in the country and samples are

sent aboard for conformation like AFP. Measles

samples were used to be sent aboard, but now the

laboratory facilities are available in the country

There were no confirmed polio and there were measles cases in 2012 but only clinically cases of Diphtheria are

reported. In 2012, out of the total number of new OPD/IPD cases reported in all age group from hospitals and

health centres only 0.088%( 1196) illness were due to VPDs. The figure in 2012was less than 2011 by about

0.082 The numbers of reported deaths in 2012 were Nine and causes was reported as Hepatitis B. The number

of vaccine preventable cases and deaths in hospitals and health stations is presented in III.6.1,III.6.2 Immunization preventable diseases have decreasing trends that could be attributable to the effectives of the

immunization program and increased awareness in utilizing the services. The decrease in morbidity and

mortality of immunizable diseases has impact in reducing infant and child mortality as the EDHS 2002 finding

indicated.

The morbidity rate has been consistently low in the six years with slight peak in year 2006.This consistent low

occurrence indicates higher herd immunity contributing to the

lower possibility of spread of the diseases to cause outbreaks. The trends of immunization coverage and

morbidity of vaccine preventable disease have been inversely in the last 3 years. As the immunization coverage

increases, the percentage of immunization disease morbidity decreases.

Table III.6.1.Number of Cases and Deaths of Immunization Preventable

Diseases in Hospitals and Health Centers by Type of Diseases and

Zoba in Y2012

Zoba

Zoba

A

N

D

E

D

K GB MA NR SK

Total

<5 >5

Measles C 30 21 89 91 9 0 338 76 502

NNT C 0 0 0 0 1 0 0 1 0

Other

Tetanus

C 0 1 0 1 0 2 2 0 6

D 0 0 0 1 0 0 2 0 3

Pertussi C 0 13 0 1 21 76 97 31 177


Diphthri C 0 1 0 4 1 2 0 1 7

AFP C 0 0 1 4 6 1 1 5 8

Hep. B C 7 18 3 15 140 177 13 126 247

D 1 0 0 2 2 1 0 1 5

Total cases 37 54 93 116 178 258 451 240 947

Total Deaths 1 0 0 3 2 1 2 1 8

Measles

from HS 75 12 22 57 41 0 19

81 145

TableIII.6.2. Number of Suspected Vaccine

Preventable Diseases in Health Stations in Y2012

Zoba Morbidity Cases Total

AFP Measles NNT

AN 17 75 2 94

DE 0 12 0 12

DKB 0 22 4 26

GB 3 57 3 63

MA 1 41 0 42

SKB 3 19 0 22

Total 24 226 9 259

Cases

Table III.6.4.Yearly Trends of Suspected Vaccine Preventable Disease Cases in Health Station

(2000-2012 )

Year

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012

NNT 2 0 3 1 10 9 10 13 0 1 1 12 8 9

Measles 1022 1115 1076 269 285 326 16 131 147 32 60 129 171 226

AFB 61 130 528 334 438 26 6 97 7 11 13 17 17 24

Total 1085 1245 1607 604 733 361 32 241 154 44 74 158 196 259

% 0.13 0.15 0.20 0.06 0.08 0.02 0.004 0.03 0.02 0.004 0.009 0.019 0.021 0.001

Key C= cases D=death


TableIII.6.3.Yearly Trend of Number of Cases and Deaths of Immunization Preventable Diseases in

Hospital & Health Centers in (2000-2012 )

VPD Year

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

NNT C 3 1 1 1 2 1 1 2 1 1 9 12 1

D 0 1 1 0 1 1 0 0 0 0 0 0 0

Other

Tetanus

C 13 7 13 3 11 15 9 9 4 21 7 5 6

D 4 0 1 1 3 4 2 3 0 1 1 0 3

Whooping

Cough

C 168 75 149 56 6 48 65 47 34 71 11 91 208

D 0 0 0 0 0 0 0 0 0 0 0 0 0

Diphtheria C 3 1 3 0 0 0 0 7 3 4 3 4 8

D 0 0 0 0 0 0 0 0 0 0 0 0 0

Measles C 826 29 262 275 29 34 88 11 21 13 47 42 578

D 0

1

0

3 0 0 0 0 0

0 0 0

0

AFB C 0 3 0 33 11 22 16 20 19 28 13 9 13

D 0 0 0 0 0 0 0 0 0 0 0 0 0

Hepatitis B C 187 207 192 142 172 274 103 239 477 210 220 183 373

D 13 1 3 6 0 2 1 6 7 0 1 3 6

Total C 1187

316 635 518 233 394 282 335 559

348 310 346

1196

D 17 3 6 9 4 7 3 9 7 1 2 3 9

Percent morbidity

0.16 0.03 0.07 0.06 0.03 0.03 0.02 0.03 0.05

0.04

0.03

0.03 0.10

Percent mortality 0.6 0.2 0.3 0.45 0.2 0.3 0.1 0.3 0.3 0.00 0.02 0.14 0.34


88

IV. OUTPATIENT AND INPATIENT SERVICES

In 2012 the outpatient services in Eritrea is

provided in health stations, health centres,

hospitals, and private for profit clinics with the

Ministry of Health remaining the major service

provider. The inpatient services are provided only

by health centres and hospitals.

Hospitals are divided into three levels. The primary

level hospitals that provide preventive and curative

services which function at the community level

receiving referrals from health centres. Some health

centres also function as community hospitals. The

secondary level hospitals are the zoba referral

hospitals that receive referrals from the primary

level hospitals and provide general outpatient and

inpatient services. The tertiary level hospitals are

the National referral hospitals that provide

specialized outpatient and inpatient services.

IV.1. OUTPATIENT SERVICES

Number of Patients

The outpatient departments in health facilities

provide patient consultation services, diagnostic

services, emergency and physiotherapy services.

In 2012, a total of 2,111,888 patients had first and

311,630 repeat OPD visits for different health

problems without including the repeat visits for

treatments (injections, medications and dressings).

(Table IV.1.1. and IV.1.2.).

From the total OPD first visit patients, about 7 %

were children less than one year old, about 16%

were children 1 to 4 years old and the rest about

77% were 5 years old and above. About 28% of all

patients visited Hospitals, Health centers

about 24%, health stations about 46%

and different clinics about 1% (Table IV.

1.3). This indicates

that most of the patients go to health

stations for outpatient services. The

reason could be that, health stations are

the nearest health facilities to most

households in the country.

Out of the total OPD first visits, only

about 9% visited the National Referral

Hospitals which includes Asmara

Physiotherapy Center and Orotta

International Operation Centre for

Children.

First visits are highest in Maekel,

followed by Gash Barka and Debub. The

repeat visits are highest in National

Referral Hospitals (Table IV.1.1. and

IV.1.2.).

Table IV.1.1. Number of First OPD Visit Patients in Health

Facilities (Ho, HC, HS, Cl ) by Zoba and Age category (2012)

<1 1-4 5 and above Total %

AN

23,911

58,739

280,677

363,327

17.2

DE

35,262

65,928

278,649

379,839

18.0

DKB

4,081

10,829

50,755

65,665

3.1

GB

30,871

66,683

316,397

413,951

19.6

MA

25,357

67,139

351,174

443,670

21.0

NRH

9,874

22,662

163,991

196,527

9.3

SKB

16,860

41,503

190,546

248,909

11.8

Total

146,216

333,483

1,632,189

2,111,888

100.0

%

6.9

15.8

77.3

100.0


89

Looking at the trends of the total number of

patients visiting the OPD of hospitals and health

centres, it has increasing trends especially after

2008 (Figure IV.1.2.). However, despite the

increased number of health stations, the number of

OPD first visit patients has almost a constant trend

with a slight increase in 2012 (Figure IV.1.4.). And

the number of patients visiting private clinics had

significantly decreased in 2011 and 2012. It might

be due to irregular reporting and closure of most

private clinics (Figure IV.1.3.).

In hospitals and health centers the number of repeat

visit patients for injection treatment has a

decreasing trend that may be related to infection

prevention implementation through avoiding

injection treatments whenever possible. And repeat

visit for medication has significantly increased in

2011 and 2012 relative to the previous three years

(Figure IV.1.1.).

Figure IV.1.1. Number of Repeat Visit Patients for

Injection and Medication in Hospitals and Health Centers

by Year (1998-2012)

Table IV.1.2. Number of Repeat OPD Visit Patients (Ho ,

HC, HS, Cl)by Zoba and Age category (2012)

<1 1-4

5 and

above Total %

AN

481

874

19,444

20,799

6.7

DE

862

1,578

42,078

44,518

14.3

DKB

375

825

6,256

7,456

2.4

GB

1,247

2,731

17,205

21,183

6.8

MA

1,570

3,590

53,505

58,665

18.8

NRH

1,733

4,976

134,895

141,604

45.4

SKB

893

1,7189

14,793

17,405

5.6

Total

7,161

16,292

288,176

311,630

100

%

2.3

5.2

92.5

100.0

Injection

0

50000

100000

150000

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Number

Year

Figure IV.1.3. Number of New OPD Visit patients in Private Clinics by Year

(2003-2012)

HOHC

0

100000

200000

300000

400000

500000

600000

700000

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Number

Year

Figure IV.1.2 Number of New OPD Visit Patients in hospital and HC/MCH by Year (2003-2012)


90

Number of Referrals

In 2012, a total of 46,394 patients were referred

from different health facilities to the next referral

level for either further investigation or case

management. The referral levels included health

stations to health centres, health centres to

community hospitals and zoba referral hospitals

and zoba referral hospitals to National Referral

Hospitals.

The National referral hospitals may also refer to

other National referral hospitals for special cases

such as Orotta National Medial Surgical Hosptial

may refer a patient to Ophthalmic National referral

hospital for ophthalmic problems or St. Mary

Psychiatric hospital for psychiatric problems. The

National Referral Hospitals may also refer cases to

hospitals outside the country for

complicated cases its treatment is not

available in the country.

From the total referred patients, about

64% were referred from health stations,

above 19% from health centres and about

17% from hospitals (Table IV.1.4.).

Table IV. 1.4. Number of Patients Referred

from One Level to the Other by Type of Health

Facility (2012)

OPD IPD Total %

Ho 6091 1751 7842 16.9

HC 7097 1959 9056 19.5

HS 29496 0 29496 63.6

Total 42684 3710 46394 100.0

% 92.0 8.0 100.0

The annual trend of the percent of

hospital outpatient referrals to other

hospitals is constant in the last three

years which is about 1%. (Figure IV.1.5.)

But the annual trend of the percent of

health center outpatient referrals to other

hospitals has a decreasing trend in the

last three years and the referrals from

health stations to other health facilities

has an overall increasing trend with a

slight increase in this year (Figure IV.1.6

and Figure IV.1.7.). The number of

referred inpatients by age category and

zoba is presented in Tables IV.2.2,

IV.2.3 and IV.2.4.

Looking at the age categories that are

referred about 71% of hospital inpatient

referrals and about 74% of health

centre’s inpatient referrals were five

years old and above. Similarly about

75% of health station’s OPD referrals

were five years old and above. On the

other side about 29% of hospital

inpatient referrals, 26% of health centres

inpatient referrals and similarly about

Table IV.1.3. Proportion of First Visit OPD Patients by

Type of Health Facilities and Age Categories (2012).

Type of HF

Age Categories

<1 1-4 5 and above Total

Ho 22.6 23.3 30.0 28.5

HC 28.5 28.0 23.5 24.5

HS 48.9 48.6 45.3 46.1

CL 0.03 0.1 1.1 0.9

Total 100.0 100.0 100.0 100.0

0

200000

400000

600000

800000

1000000

1200000

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Number

Year

Figure IV.1.4. Number of New OPD Visit patients in Health Stations by Year

(2003-2012)


91

25% of health stations outpatient referrals were

under five years old.

Relating the referrals to the under five deaths, about

18% of the total under five deaths in health

facilities in 2012, occurred in health centres and

health stations. There could be chance of survival

of some of the children if they could be referred on

time. However, these deaths in health centres and

health stations may occur because of the late arrival

of patients. (Table IV.2.6.)


92

Number of Reported Cases

A patient may come to OPD of different health

facilities for different complaints and may have

more than one health problem. Thus, the number of

reported OPD cases is either equal to or more than

the number of patients. In accordance to this, a total

of 1,215,598 new cases were reported in hospitals,

health centers and clinics OPD using ICD 10 code

while another 1,059,569 cases were reported in

health stations OPD using serial number reporting

clinically diagnosed. Most of the cases reported

were from Maaklel as in case of the number of

patients (Table IV.1.5 and Table IV.1.6).

Table IV.1.6. Number of Reported New OPD cases in HS

by Zoba and Age category (2012)

<1 1-4

5 and

above Total %

AN 18052 44668 179680 242400 22.9

DE 24289 43246 135652 203187 19.2

DKB 2716 6533 38496 47745 4.5

GB 17594 39952 158677 216223 20.4

MA 15129 38525 166843 220497 20.8

SKB 7715 22279 99523 129517 12.2

Total 85495 195203 778871 1059569 100.0

% 8.1 18.4 73.5 100.0

About 23% of the total first visit patients

that visited OPD were children under

five. Similarly, about one fourth of the

reported cases (health problems) were of

children under five.

IV.2. Inpatient services Number of Discharged and referred

patients

In year 2012, a total of 122,928 patients

were admitted and discharged from

hospitals and health centers of which

about 28% were children under five

years of age which decreased by about

10% from that of 2011 (31%) (Table

IV.2.1).

Table IV.1.5 Number of Reported New OPD cases in Hospital,

health centre and clinics by Zoba and Age category (2012)

Zoba <1 1-4

5 and

above Total %

AN 9507 23859 120845 154,211

12.7

DE 16109 32181 163515 211,805

17.4

DKB 1658 4943 17068 23,669

1.9

GB 17720 38454 144802 200,976

16.5

MA 14967 40772 218606 274,345

22.6

NRH 10380 23312 172617 206,309

17.0

SKB 12089 25821 106373 144,283

11.9

Total

82,430

189,342

943,826 1,215,598

100

%

6.8

15.6

77.6 100

Table IV.2.2. Total Number of Referred Inpatients to

other Facilities by Zoba and Age category (2012)

Zoba <1 1-4

5 and

above Total %

AN 111 103 423 637 17.2

DE 149 157 1029 1335 36.0

DKB 5 1 22 28 0.8

GB 51 96 695 842 22.7

MA 11 21 177 209 5.6

NRH 217 1 11 229 6.2

SKB 51 38 341 430 11.6

Total 595 417 2698 3710 100.0

% 16.0 11.2 72.7 100.0

Table IV.2. 1. Total Reported Number of Inpatients in Ho

and MC/HC by Zoba and Age category (2012)

Zoba <1 1-4

5 and

above Total %

AN 2811 3377 12513 18701 15.2

DE 3631 3986 21295 28912 23.5

DKB 323 318 1547 2188 1.8

GB 2250 3182 12674 18106 14.7

MA 652 1083 7303 9038 7.4

NRH 4914 4480 24329 33723 27.4

SKB 2111 1847 8302 12260 10.0

Total 16692 18273 87963 122928 100.0

% to

total 13.6 14.9 71.6 100.0

% Ho 75.4 70.8 76.6 75.6

% HC 24.6 29.2 23.4 24.4


93

Number of Deaths

Most of the deaths in five and above age

group occur in National Referral

Hospitals (about 33%). NRH is followed

by Gash Barka and Debub with higher

proportion of total reported deaths.

(Table IV.2.5).

The reason for high reported inpatient

deaths in NRH could be that patients

come to health facilities very late when

not much can be done to save them or

there could be some other problems that

need further follow up and assessment.

Table IV.2.3. Number of Inpatients Referred from

Hospitals, Mini Hospitals, MCH clinics to other

Hospitals by Zoba and Age category (2012)

Zoba <1 1-4

5 and

above Total %

AN 33 18 165 216 12.3

DE 65 62 612 739 42.2

DKB 5 1 22 28 1.6

GB 13 23 194 230 13.1

MA 8 7 51 66 3.8

NRH 217 1 11 229 13.1

SKB 29 24 190 243 13.9

Total 370 136 1245 1751 100.0

% 21.1 7.8 71.1 100.0

Table IV.2.4. Number of Inpatients Referred from

Health Centers to Hospitals by Zoba and Age

category (2012)

Zoba <1 1-4

5 and

above Total %

AN 78 85 258 421 21.5

DE 84 95 417 596 30.4

DKB 0 0 0 0 0.0

GB 38 73 501 612 31.2

MA 3 14 126 143 7.3

NRH 0 0 0 0 0.0

SKB 22 14 151 187 9.5

Total 225 281 1453 1959 100.0

% 11.5 14.3 74.2 100.0


94

Table IV.2.5. Number of Reported Deaths in OPD and

IPD of Hospitals and Health Centers by ICD code by

Age Category and Zoba (2012)

Zoba

Age Category

5 and

above Total % <1

1-4

yrs

Anseba 110 57 155 322 12.4

Debub 139 53 196 388 14.9

DKB 25 10 30 65 2.5

GB 125 100 234 459 17.7

Maakel 4 8 215 227 8.7

NRH 157 44 649 850 32.7

SKB 124 57 108 289 11.1

Total 684 329 1587 2,600 100.0

% 26.3 12.7 61.0 100.0

IV.3. Number of Surgeries

Minor and major surgeries are performed

in health centres and hospitals. Although,

the type of surgeries performed could be

several, for reporting purposes it is

categorized in anatomical areas.

In 2012, 6,848 minor and 14,121 major,

a total of 20,969 surgeries were

performed. Out of which above 34%

were ophthalmic surgeries (Tables

IV.3.1. and IV.3.3.).

Ophthalmic National Referral Hospital

staff conducts most of the surgeries in

different zobas through their outreach

programs to increase access to the

service.

Orotta International Operation Centre for

Children in Asmara (IOCCA) performed

1.5% of all reported surgeries, 1.5% of

minor and 1.4% of major surgeries. This

centre is running by International

expertise in different surgical specialities

although the major areas are

orthopaedics and cardiac. For example,

about 82% of performed cardiac

surgeries in 2012 were conducted in this

centre. (Tables IV.3.2 and IV.3.3.)

Comparing the zobas, about 56% of all

surgeries were performed in National

Referrals followed by Anseba and

Debub. (Table IV.3.1 and Figure IV.3.1)

Table IV.2.6. Number and Proportion of Reported

Deaths by Type of Health Facility (2012)

Type of

Health

facility

Age Category

Total % <1 1 to 4

5 and

above

Hospital 588 273 1476 2337 86.8

HC 96 56 111 263 9.8

HS 25 16 50 91 3.4

Total 709 345 1637 2691 100.0


95

Table IV.3.1. Number of Surgeries Performed by Zoba

and Classification of Surgery (2012)

Zoba

Classification of

Surgery

Total

%

Minor Major

AN 412 1933 2345 11.2

DE 1180 1155 2335 11.1

DKB 17 86 103 0.5

GB 559 1669 2228 10.6

MA 414 1236 1650 7.9

NRH 4050 7722 11772 56.1

SKB 216 320 536 2.6

Total 6848 14121 20969 100.0

% 412 1933 2345 11.2

Table IV.3.2.Number of Surgeries Performed by Orotta International Center for Child

Operation by Category and Classification of Surgery(2012)

Category of Surgery

Classification of Surgery

Total

% Minor Major A n o - r e c t a l3 9 12 3.9 B l a d d e r0 2 2 0.7 C a r d i a c

14 42 56 18.3 C h e s t / L u n g0 2 2 0.7 E y e ( O p h t h a l m i c )5 0 5 1.6 G a l l B l a d d e r2 1 3 1.0 G a s t r i c1 1 2 0.7 H e a d / C r a n i a l4 1 5 1.6 I n t e s t i n e0 7 7 2.3 L o w e r E x t r e m i t i e s

12 21 33 10.8 M o u t h / M a n d i b l e35 56 91 29.7 N e c k / T r a c h e o t o m y

1 0 1 0.3 U p p e r E x t r e m i t i e s16 7 23 7.5 U r e t h r a ( M a l e )

3 1 4 1.3 O t h e r7 53 60 19.6 T o t a l

103 203 306 100

% to total 33.7 66.3 100.0


96

Table IV.3.3. Number and Proportion of Surgeries Performed

by Type and Category of Surgeries and Zoba (2012)

Category of Surgery

Zoba

Classification of

Surgery

Total % AN DE DKB GB MA NR SK Total Minor Major A n o - r e c t a l61 10 0 8 55 188 3 159 83 242 325 1.5 B l a d d e r28 54 0 0 30 40 7 68 3 156 159 0.8 C a r d i a c0 0 0 0 0 68 0 151 14 54 68 0.3 C h e s t / L u n g43 0 0 2 6 100 0 7230 46 105 151 0.7 E y e ( O p h t h a l m i c )

1042 613 69 1201 132 4173 0 325 2485 4745 7230 34.5 G a l l B l a d d e r12 8 0 2 188 112 3 46 2 323 325 1.5 G a s t r i c2 8 0 0 17 19 0 158 3 43 46 0.2 G o i t e r15 0 0 1 56 85 1 161 0 158 158 0.8 H e a d / C r a n i a l31 1 0 4 8 117 0 982 43 118 161 0.8 I n t e s t i n e

211 60 3 48 74 575 11 82 18 964 982 4.7 K i d n e y0 0 0 0 30 52 0 3 1 81 82 0.4 L i v e r0 0 0 0 0 3 0 1397 0 3 3 0.0 L o w e r E x t r e m i t i e s

127 14 1 48 137 1069 1 496 168 1229 1397 6.7 M o u t h / M a n d i b l e17 6 0 155 145 173 0 80 87 409 496 2.4 N e c k / T r a c h e o t o m y27 0 0 0 9 44 0 3 18 62 80 0.4 P a n c r e a s0 1 0 0 0 2 0 320 0 3 3 0.0 P r o s t a t e40 5 0 4 104 166 1 1336 0 320 320 1.5 U p p e r E x t r e m i t i e s

140 54 1 44 65 1031 1 770 178 1158 1336 6.4 U r e t h r a ( M a l e )74 338 1 107 37 194 19 2876 526 244 770 3.7 U t e r u s / O v a r y /F a l l o p i a n

430 488 16 249 159 1343 191 3952 148 2728 2876 13.7 O t h e r0 675 12 351 398 2218 298 20969 3014 938 3952 18.8 T o t a l

2345 2335 103 2228 1650 11772 536 13958 6848 14121 20969 100.0

% 16.8 16.7 0.7 16.0 11.8 84.3 3.8 100.0 32.7 67.3 100.0


97

IV.4. Diagnostic Service

Laboratory and imaging are considered as

diagnostic services at present in Eritrea.

Hospitals, health centres, clinics and some

health stations provide diagnostic services that

differ in kind and composition depending on the

level of the health facilities. Hospitals provide

more complex services while health centres and

health stations provide only basic services.

Only hospitals provide imaging services while

laboratory services are provided at all levels of

facilities.

In 2012, 24(92.6%) hospitals, 47(78.6%) health

centers, 2 health stations, 3 MCH and 2 private

clinics reported laboratory services (Table

IV.4.2.1). On the other hand, 18 (59.3%)

hospitals, one Health Centre and one MCH

provided imaging services (Table IV.4.1.1).

The hospitals that do not provide the services

use the resources of the nearest hospital, like all

Orotta National Referral Hospitals use the

Orotta Medical Surgical Hospital resources.

IV.4.1. Imaging Services

In 2012, a total of 90,653 patients had the

service, of which about 90% were in outpatient

department. National referral Hospitals (56.9%)

provided most of the imaging services (Table

IV.4.1.2).

The total number of health facilities that

provide imaging services is illustrated in Table

IV.4.1.1. The type of imaging services provided

in different health facilities in 2012 were x-ray,

ultrasound and fluoroscopy.

Table IV.4.1.1. The Number of Health Facilities Reported

Imaging Services by Type and Zoba (2012)

Zoba

Type of Health facilities

HO HC HS MCH CL Total

AN 1 1

DE 5 5

DKB 1 1

GB 3 3

MA 2 1 3

NR 2 2

SKB 4 1 5

Total 18 1 0 1 0 20 % to type

of HF 80.0 10.0 0.0 5.0 5.0 100.0

Table IV.4.1.2 Number of Patients Who Received

Imaging Services by Department and Zoba (2012)

Zoba

Departments

Total % OPD IPD

AN 5527 1954 7481 8.3

DE 11088 1339 12427 13.7

DKB 816 120 936 1.0

GB 1962 933 2895 3.2

MA 10526 841 11367 12.5

NR 48019 3564 51583 56.9

SKB 3368 596 3964 4.4

Total 81306 9347 90653 100.0

% 89.7 10.3 100.0


98

In average 1.5 films were used per patient and

similar with last three years outpatient

department consumes about 90% of the films

used. National Referral Hospitals consumed

about 61 % of all the films (Table IV.4.1.3.).

IV.4.2. Laboratory Services

Availability of laboratory services is vital for

appropriate diagnosis and disease surveillance.

Thus, the Ministry is expanding the service to

the lowest level of health facilities. In 2012, a

total of 78 (23.3%) health facilities excluding

National Health Laboratory (NHL), reported

laboratory services (Table IV.4.2.1).

Some specialized health facilities may not need

to provide laboratory services, like the Orotta

Paediatric and Maternity National Referral

Hospitals use the Orotta Medical Surgical NRH

resources since the three of the hospitals are

located in the same vicinity.

The proportion of health facilities that provide

laboratory services in each zoba (except NRH)

compared to the total functional facilities in

all the zobas is around the average (about

23%) (Table IV.4.2.1.).

A total of 1,961,133 laboratory tests were

performed in all health facilities in 2012

excluding NHL. Similar to the imaging

service, the load in laboratory service was

the highest in National referral hospitals

(Table IV.4.2.2.).

Haematology and urinalysis are the most

common laboratory tests performed in most

health facilities in 2012 (Table IV.4.2.3)

The NHL performs more complicated tests

and serves as a referral centre for all health

facilities in the country.

Out of the total tests done, only about 21%

had positive results. Among the type of

laboratory tests, stool tests have the highest

positive rate (35.5%), followed by Malaria

(13.6%) (Table IV.4.2.4 and IV.4.2.5).

Table IV.4.1.3 Number of Films Used by Department and

Zoba (2012)

Zoba

Departments

Total % Film/pt OPD IPD

AN 6045 2197 8242 5.9 1.1

DE 14699 1768 16467 11.8 1.3

DKB 848 130 978 0.7 1.0

GB 3320 1185 4505 3.2 1.6

MA 17649 2713 20362 14.6 1.8

NR 78727 6061 84788 60.8 1.6

SKB 3558 510 4068 2.9 1.0

Total 124846 14564 139410 100.0 1.5

% 89.6 10.4 100.00

Film/pt 1.5 1.6 1.5*

Table IV.4.2.1. The Number of Health Facilities Providing laboratory Services by Type and Zoba (2012)

Zoba

Type of Health facilities

Total

% to

total HFs

Ho HC HS MCH CL

AN 1 9 1 0 0 11 29.7

DE 5 11 1 0 0 17 24.6

DKB 3 0 0 0 0 3 20.0

GB 3 13 0 2 0 18 22.2

MA 4 9 0 0 2 15 18.9

NR 4 0 0 0 0 4 50.0

SKB 4 5 0 1 0 10 20.4

Total 24 47 2 3 2 78 23.3

% to type

of HF 92.6 78.6* 1.1 14.3 4.5 23.1


99

Table IV.4.2.2. Number of Inpatients and outpatients who had

laboratory tests by Zoba (2012)

Zoba

Departments

Total

% IPD OPD

AN 6213 53518 59731 10.7

DE 9877 112797 122674 22.0

DKB 482 9011 9493 1.7

GB 8123 74772 82895 14.9

MA 6112 105011 111123 20.0

NR 25042 109047 134089 24.1

SKB 4522 32172 36694 6.6

Total 60371 496328 556699 100.0

Table IV.4.2.3. Number and Type of Laboratory Tests Performed by Zoba(2012)

Type of Laboratory Tests

Zoba

Direct

Microsc

opic

Sensiti

vity

Cultur

e

Haemato

logy

Stool

Parasitol

ogy

Parasit

ology

II

(Blood

Tissue

, Etc.)

Urinalysi

s

Clinical

Chemistr

y

Immuno

serology

Histol

ogy

Cytolog

y Other Total

%

AN 5718 0 31407 13661 5685 36283 19277 8932 0 0 2402 123365 6.3

DE 7946 1387 157320 29312 10592 106844 13311 15177 1960 140 8322 352311 18.0

DKB 1210 10 3629 2131 39 3726 1224 2108 0 26 55 14158 0.7

GB 3613 1854 55756 13184 25300 37624 1491 5875 166 602 1799 147264 7.5

MA 4411 208 375851 31383 7283 255777 9101 19886 2753 1687 7130 715470 36.5

NR 19008 104 86767 18703 7061 109182 153925 49260 1480 216 93436 539142 27.5

SKB 3045 0 19992 9348 4208 25825 0 4242 0 0 2763 69423 3.5

Total 44951 3563 730722 117722 60168 575261 198329 105480 6359 2671 115907 1961133 100.0

% 2.3 0.2 37.3 6.0 3.1 29.3 10.1 5.4 0.3 0.1 5.9 100.0

Table IV.4.2.4. Number of Some selected Laboratory Tests and Their Positive Results by Zoba (2012)

Type of Laboratory Tests and positive results

AFB Gram Stain-Gonococci Gram Stain-meningococci Hepatitis B

Zoba Tests +ve %

+Ve Tests +ve % +Ve Tests +ve % +Ve Tests +ve results % +Ve

AN 6694 242 3.6 64 11 17.2 4 0 0 213 3 1.4

DE 7533 282 3.7 398 22 5.5 5 0 0 810 54 6.7

DKB 1382 48 3.5 0 0 0 8 0 0 173 13 7.5

GB 5854 470 8.0 161 37 23 0 0 0 536 32 6

MA 7074 306 4.3 67 6 9 7 0 0 1928 20 1

NR 7839 255 3.3 1346 24 1.8 437 1 0.2 4209 205 4.9

SKB 3433 280 8.2 67 14 20.9 0 0 0 5 0 0

Total 39809 1883 4.7 2103 114 5.4 461 1 0.2 7874 327 4.2


100

V. DISEASE BURDEN IN ERITREA

The burden of diseases provides an indicator

that can be used to evaluate progress over

time within a country and relative

performance across countries and regions.

The disease burden in Eritrea as in case of

any other developing country is attributed to

infectious diseases, malnutrition and

maternal related health problems. These

health problems have negative correlation

with the socio-economic status of the people.

The better the socio-economic status, the less

is the occurrence of these health problems.

Thus, in societies with better socio-economic

status, these health problems have very low

occurrences compared to the poor countries.

This variation is also evident in urban and

rural societies even within the poor countries.

Urban dwellers have relatively better access

to basic social services than rural dwellers

that increases the risk of higher prevalence of

infectious diseases and malnutrition in rural

areas.

Among the diseases, acute respiratory

infection mainly pneumonia, diarrhea,

anemia and malnutrition, skin and eye

infection, malaria and HIV/AIDS have been

among the leading ten causes of morbidity

and mortality in the last 10 years.

The non communicable diseases such as

hypertension, diabetes, ophthalmic problem,

Table IV.4.2.5. Number of Some selected Laboratory Tests and Their Positive

Results by Zoba (2012)

Type of Laboratory Tests and positive results Leishmania Donovani Stool for Intestinal Parasites Malaria

Zoba Tests

+ve

results % +Ve Tests

+ve

results % +Ve Tests

+ve

results % +Ve

AN 1462 1 0.1 14931 8873 59.4 8066 866 10.7

DE 31 4 12.9 23507 7678 32.7 29026 2944 10.1

DKB 0 0 0 1359 410 30.2 30 5 16.7

GB 91 23 25.3 12418 4371 35.2 32932 6316 19.2

MA 440 109 24.8 16651 4640 27.9 4655 690 14.8

NR 8 3 37.5 17995 3443 19.1 6763 535 7.9

SKB 1 0 0 8633 4485 52.0 3389 201 5.9

Total 2033 140 6.9 95494 33900 35.5 84861 11559 13.6


101

psychiatric problems, and injuries are also

emerging health problems in Eritrea.

Like the previous years in 2012 the top ten

leading causes of outpatient morbidity alone

constitute above 90% of the total causes of

morbidity in under five age group. And the

top ten leading causes of mortality alone

constitute about 89% of the total causes of

mortality in children under one year old and

about 95% of all causes of mortality in

children aged between 1 to 5 years.

Similarly about 63% of the total outpatient

morbidity, above 43 % of the total inpatient

morbidity and about 64 % of inpatient and

outpatient mortality in five and above age

group is attributed to the top ten leading

causes. This means that, reducing the

morbidity and mortality of the ten leading

causes of morbidity and mortality can

decrease the total outpatient and inpatient

morbidity and mortality significantly. By

preventing only pneumonia and diarrhea, it is

possible to reduce child morbidity by above

46%.

V. 1. Top Ten Leading Causes of Morbidity and Mortality

In 2012, diarrhea, ARI mainly pneumonia,

skin, eye and ear infections, malnutrition,

fever of unknown origin, injury all types and

soft tissue injury are among the top ten leading

causes of outpatient and inpatient morbidity in

under-five years of age. In children under one,

about 27% of the deaths were related to

neonatal problems. Congenital malformations

were also among the top ten leading causes of

deaths in less than one year old.

The top ten leading causes of morbidity and

mortality in children less than one year of age

in hospitals and health centers attributed above

92% of outpatient morbidity and above 90% of

inpatient morbidity and about 89% of

outpatient and inpatient mortality (Table

V.1.1.). About 90% of outpatient and inpatient

morbidity and about 95% mortality in children

1-4 years old is due to those top ten leading

causes of morbidity and mortality. About 63%

of outpatient morbidity, above 43% of

inpatient morbidity and 64% of inpatient

mortality in five years and above age is due to

those top ten leading causes of morbidity and

mortality (Table V.I.2 and Table V.1.3)

This indicates that, by preventing different

infections, we can minimize about 90% of

morbidity and mortality in children under five.

Infectious diseases like Diarrheal Diseases and

Acute Respiratory Infections (ARI) are major

contributors towards the overall morbidity in

under-fives in Eritrea. The 2012 hospital and

health center report indicates that pneumonia

alone contributed to about one fourth (25%) of

all under-five deaths.

In five and above age group, ARI, ORO-dental

infection, gastritis/ulcer, urinary tract infection

and diarrhea all forms were the top five causes

of morbidity in OPD.

From the communicable diseases, HIVAIDS,

Pneumonia and TB accounted heavy toll

(about 23%) for mortality in the five and

above age group. At the same time, the non

communicable diseases, injury all types, heart

diseases, diabetes, anemia all types and

hypertensive related diseases accounted for

29% of the total deaths in this age group

reported in hospitals and health centers (Table

V.1.3.). Injury all types (with out soft tissue


102

injury) is the first cause of morbidity in IPD

and sixth cause of morbidity in OPD of the

five and above age group.

The situation of the burden of diseases

indicated in 2012 has similar pattern with 2010

and 2011.


103


104

Table V.1.1. Ten Leading causes of morbidity and mortality in under One years of age in hospitals and health

centers, (2012)

Morbidity IPD and OPD Deaths % to

total

deaths Rank OPD IPD % to

total

morbidit

y burden

Causes Number % to

total

OPD

burden

Causes No. Causes No.

1 Diarrhea all

forms 21547 26.1

Pneumonia all

types 5826 34.9

Pneumonia

all types 145 21.2

2 Pneumonia

all types 20608 25.0

Diarrhea all

forms 2976 17.8 Septicemia 97 14.2

3 ARI (With

out

pneumonia) 20539 24.9

Low birth

weight 2355 14.1

Malnutrition,

all types 85 12.4

4 Skin

infection &

scabies 3024 3.7

Malnutrition,

all types 1372 8.2

Low birth

weight 82 12.0

5 Infection of

eye including

trachoma 3012 3.7 Neonatal sepis 833 5.0

Diarrhea all

forms 69 10.1

6 Ear infection 2884 3.5

ARI (With out

pneumonia) 788 4.7

Neonatal

sepis 52 7.6

7

Malnutrition,

all types 1436 1.7 Septicemia 411 2.5

Other

perinatal and

neonatal

problem

26 3.8

8 Fever of

unknown

origin 1396 1.7

Other perinatal

and neonatal

problem 240 1.4

Intrauterine

hypoxia/birth

asphyxia 25 3.7

9 Injury all

types 919 1.1

Intrauterine

hypoxia/birth

asphyxia 193 1.2

Congenital

malformation

s 16 2.3

10 Other urinary

tract infection 907 1.1

Injury all

types 144 0.9

Anemia, all

types 13 1.9

Total 10 leading 82430 92.5 Total top 10 16692 90.7 Total top 10 684 89.2


105

Table V.1.2. Ten Leading causes of morbidity and mortality in 1-5 years of age in hospitals and health centers, (2012)


total

deaths Rank OPD IPD % to

total

morbidity

burden

Causes Number % to

total

OPD

burden


1 Diarrhea all

forms 49319 26.0

Pneumonia

all types 6851 37.5

Malnutritio

n, all types 138 41.9

2 ARI (With

out

pneumonia)

47025 24.8 Diarrhea all

forms 3691 20.2

Diarrhea all

forms 52 15.8

3 Pneumonia

all types 34870 18.4

Malnutrition,

all types 3242 17.7

Pneumonia

all types 47 14.3

4 Skin

infection &

scabies

9928 5.2 ARI (With out

pneumonia) 1026 5.6 Septicemia 40 12.2

5 Injury all

types 6537 3.5 Injury all types 849 4.6

Anemia, all

types s 13 4.0

6 Ear

infection 6418 3.4 Burns 530 2.9

Injury all

type 7 2.1

7 Infection of

eye

including

trachoma

5756 3.0 Malaria , all

types 422 2.3 Burns 5 1.5

8 Malnutrition

, all types 4805 2.5

Skin infection

& scabies 192 1.1

Malaria , all

types 4 1.2

9 Soft tissue

injury 3542 1.9 Septicemia 183 1.0

Heart

diseases 4 1.2

10 Fever of

unkown

origin

3408 1.8 Asthma 167 0.9 Hepatitis 4 1.2



106

Table V.1.3. Ten Leading Causes of Morbidity and Mortality in Five Years and Above of age in hospitals and health

centers, (2012)


total

deat

hs Rank OPD IPD % to

total

morbidity

burden

Causes Number % to

total

OPD

burden


1 ARI (With

out

pneumonia)

135082 14.3 Injury all

types 6792 7.7

Pneumonia

all types 155 9.8

2 Oro - dental

infection 72988 7.7

Obs

emergencies 5138 5.8

Injury all

types 146 9.2

3 Gastritis /

duodenal

ulcer

67733 7.2 Pneumonia

all types 4938 5.6 Hiv/aids 131 8.3

4 Other

urinary tract

infection

61086 6.5 Malaria , all

types 4288 4.9

Heart

diseases 127 8.0

5 Diarrhea all

forms 60314 6.4

Abortion, all

types 4080 4.6

Other

causes of

death

103 6.5

6

Injury all

types 54390 5.8

Cataracts and

other lens

disorders

3422 3.9

Stroke, not

spec.as

haemmorha

ge/

infarction

92 5.8

7 Skin

infection &

scabies

44962 4.8 Diarrhea all

forms 3336 3.8 Tb, all types 75 4.7

8 Infection of

eye

including

trachoma

35898 3.8

Other urinary

tract

infection

2426 2.8 Diabetes

mellitus 68 4.3

9 Soft tissue

injury 34648 3.7

Gastritis /

duodenal

ulcer

2018 2.3 Anemia, all

types 65 4.1

10 Pneumonia

all types 31718 3.4

Soft tissue

injury 1819 2.1

Hypertensiv

e related

diseases

54 3.4



107

V.2.Trends and Patterns of Morbidity and Mortality of the Ten Leading

Causes

An important step in understanding the health

status and the factors that improve or harm health

is to document patterns of morbidity and mortality

and rank the causes in order of their frequency

and public health importance.

Acute respiratory infection (ARI including

pneumonia) and diarrhea were consistently the

first two causes of morbidity in outpatient and

inpatient in the last eleven years and they were the

second and fourth causes of mortality respectively

in under-five years of age in 2011 or 2012. About

70% of the disease burden in OPD/IPD of under 5

years old is due to these diseases and are

responsible for about 30% of all deaths in the

same age group in 2012. In the five and above

age group, ARI was also the first cause of

outpatient morbidity, inpatient mortality and the

second cause of inpatient morbidity. In low

resource settings these diseases are mainly

attributed to low nutritional status, poor sanitary

conditions, socio-economic developments,

behavioral and environmental factors.

Communicable diseases are still taking a high

toll in inpatient mortality in the five and

above age group. Among the leading causes

of inpatient mortality in above five age group

are ARI including Pneumonia, HIV/AIDS

and TB, and account for about 23% of all

reported deaths in 2012.

Anemia and Malnutrition combined was the

first cause of death in the last four years

(2009 -2012) and the third cause of admission

for the last eleven years (2002 -2012) for

under-five. It accounts for about 25% of the

total reported deaths in under-five in 2012,

and it is the sixth cause of morbidity in

outpatient departments for the same age

category.

The trends as ranked from one to ten are

illustrated in Tables V.2.1 to V.2.6.


108

Table V.2.1. Trends of Top 10 Causes of Outpatient Morbidity in Children Under

Five in Hospitals and health centers (2002-2012) Year

Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

ARI(with Pneumonia) 1 1 1 1 1 1 1 1 1 1 1

Diarrhea 2 2 2 2 2 2 2 2 2 2 2

Skin infection 3 3 3 3 3 3 3 3 3 3 3

Eye Infection 4 5 6 6 6 6 4 4 5 5 5

Ear Infection 5 6 4 4 4 5 6 6 6 4 4

Anemia &Malnutrition 6 4 5 5 5 4 5 5 4 6 6

Soft tissue Injury 8 9 9 9 8 8 8 8 9 9

Fever of Unknown Orgin 9 10 10 8 7 7 7 7 7 8 8

Other UTI 10 10 9 11 11 10 10

Injury all types 7 7

Table V.2.2. Trends of Top 10 Causes of Outpatient Morbidity in 5 Years and Above in Hospitals

and health centers (2002-2012) Year

Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

ARI(with Pneumonia)

1

1

1

1 1

1

1

1 1

1

1

Oro-dental infection

5

5

3

2 2

2

2

3 3

2

2

Skin infection 3 3 2 5 5 3 3 4 4 7 7

Diarrhea 2 2 5 3 3 4 4 2 2 6 5

Gastritis/D. Ulcer

4

4

4

4 4

5

5

6 5

3

3

Other UT diseases

6

6

6

6 6

6

6

5 6

4

4

Eye Infection 7 7 7 7 7 7 7 7 7 8 8

Soft tissue injury 8 8 8 8 8 8 8 8 9 9

Rheumatoid arthritis 10 12 9 9 9 10 10 9 9 10 10



109

Table V.2.3. Trends of Top 10 Causes of Inpatient Morbidity in Under 5 years old, in

Hospitals and Health Centers (2002-2012) Year

Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012


Diarrhea 2 2 2 2 2 2 2 2 2 2 2

Anemia&Malnutrition 3 3 3 3 3 3 3 3 3 3 3

Septicemia 5 5 4 4 4 4 4 4 4 9 8

Malaria 4 4 5 5 5 5 5 6 5 7 9

Skin infections 6 6 6 9 7 6 6 9 8 10 10

Neonatal Sepsis 8 10 7 8 6

Burns 9 9 8 10 6 7

Low birth Weight 5 4 4 4


Table V.2.4. Trends of Top 10 Causes of inpatient morbidity in Five Years and Above in

Hospitals and health centers (2002-2012) Year

Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Malaria 1 1 4 1 2 1 5 5 2 4 4

ARI and Pneumonia 3 2 1 2 1 2 3 2 3 2 2

Diarrhea 4 4 5 5 6 5 4 3 5 6 7

Abortion 2 3 3 4 4 3 2 4 4 5 5

Cataract/lens disorder

5

5

6

6 5

4

7

10 10

8

6

Other UT diseases 7 7 7 7 8 6 8 7 7 7 8

OBS Emergencies

6

2

3

3

7

1

1 1

3

3

Gastritis/D. Ulcer 8 8 9 8 7 8 9 8 8 9 9

Soft tissue injury 9 10 10

Injury all types Merging of all types started in 2011 1 1

Table V.2.5. Trends of Top 10 Causes of Inpatient Deaths in Under 5 years old, in

Hospitals and Health Centers (2002-2012)

Year

Causes 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012


Diarrhea 2 3 2 3 3 3 3 3 3 4 4

Anemia&Malnutriti 3 2 3 2 2 2 2 1 1 1 1

Septicemia 4 4 4 4 4 4 4 4 4 3 3

Heart disease 8 7 6 10 9 11 9 10

Intra uterine

hypoxia/asphexia

7

7 7 8 7 7 8

Neonatal sepsis 10 8 8 6 6 6 6

Low birth weight. 7 6 6 5 5 5 5

Congenital

malformation

10 10 9 9 10 9

Other perinatal and

neonatal problems

10 8 8 7


110

Table V.2. 6. Trends of Top 10 Leading Causes of Inpatient Deaths in Five Years and

Above in Hospitals and health centers (2002-2012) Year

Causes 2002 2003 20

04

2005 2006 2007 2008 2009 2010 2011 2012

HIV/AIDS 1 1 1 1 1 1 1 1 1 1 2


TB 2 2 3 3 3 4 5 4 4 4 6

Hypertension 5 4 4 6 4 6 6 8 7 10 9

Anemia & Malnutrition 9 7 9 8 7 3 4 6 6 9 8

Diabetes Mellitus 8 10 7 7 5 8 8 10 8 7 7

Heart diseases 7 5 5 10 8 5 2 3 2 3 3

Septicemia 10 11 6 9 9 11 13 13 14 10

Stroke 9 9 5 5



111

V. 3. Situation of Some Selected Leading Causes of Disease Burden

V.3.1. HIV/AIDS

HIV/AIDS is a fatal infectious disease that

negatively affects the productivity and development

of a country. Thus, it is one of the priorities of the

Ministry of Health of the State of Eritrea.

The first cases of HIV/AIDS in Eritrea were

reported in 1988. From 1998-2012, a total of 26,444

HIV new cases and 3076 deaths were reported in

hospitals and health centers. Since 1998, in average,

about 1762.9 new cases have been reported every

year in hospitals and health centers as indicated in

Figure V.3.1.

Figure V.3.1 Number of HIV/AIDS cases 1998-2010

The reported number of new HIV/AIDS cases in the

health facilities has a decreasing trend since 2006

(Figure V.3.1.), that could be attributed to actual

decrease in the number of new infection as evident

in decreasing trends of HIV positive rate in VCT

and PMTCT attendees (Figure V.3.1.1), blood

donors (Figure V.3.1.2), and Antenatal sentinel site

survey results (Figure V.3.1.4.).

The 2007 and 2011 HIV antenatal sentinel

survey indicated that the prevalence of HIV

in the population was 1.28 % and 0.79%

respectively with variations in different sub

groups and regions.

The over all HIV positivity rate in VCT

clients in 2012 was 1.03%. This is less than

that of 2011 which was 1.77%. (Figure

3.1.1) Similarly, the over all HIV positivity

rate in PMTCT clients in 2012 report was

0.47%. This is slightly greater than that of

2011 (0.45%).

To combat HIV/AIDS, the Ministry of

Health through National AIDS and TB

Control Division (NATCoD) is

implementing a multi-sectoral approach

strategy where each sector implements its

share in preventing and controlling the

infection.

Some of the on going interventions to

combat HIV/AIDS include promoting:

• PMTCT service

• VCT service

• Care & Support

• Clinical care, ART & PEP

• Diagnosing and Treating STI

• BCC

• Capacity building, management skills

• Targeted interventions

• Research, surveillance, M&E

• Infection Prevention Safety of blood &

blood transfusions

As a result of coordinated efforts, significant

achievements are documented in controlling

the infection, enhancing change of behavior

in individuals, families and community, in

providing treatment and care for people

living with HIV/AIDS, rehabilitating the

orphans and families, increasing of the

involvement of the community in combating

the people etc.


112

The number of voluntary counseling and testing

(VCT) and the prevention of mother to child

(PMTCT) centers have grown from 19 in 2001 to

250 in 2012 and from 3 in 2002 to 208 in 2012

respectively. The number of PMTCT sites has

increased by 5.6% compared with 2011. The

number of clients who used the VCT and PMTCT

centers has also decreased from 77,008 in 2011 to

73,750 in 2012 and from 60,879 in 2011 to 61,874

in 2012 respectively.

The number of people living with HIV/AIDS and

started ARV has also decreased from 7067 in 2011

to 7022 in 2012. According to NATCOD report of

2011, PLWHA put on ART are averaging 1000 per

year. Although ARV is free in Eritrea, it is given to

individuals after legibility assessment.

Table V.3.1.1. Prevalence of HIV in

Antenatal Sentinel Site in 2005 and

2007 by Zoba

Zones Year

2005 2007

Maakel 3.48 1.8

Debub 1.65 0.67

Anseba 1.3 1.12

Gash Barka 2.06 1.22

NRSZ 1.77 1.6

SRSZ 5.9 0.68

Total 2.38 1.28 Source: NATCoD, 2007 report

Reported HIV/AIDS in Health Facilities

HIV/AIDS has been the first leading cause of

inpatient death in five years and above since 1999

and among the top 10 killers of children under five.

The average length of hospital stay of HIV/AIDS

patients have been 11 days since 1998, indicating

increased cost to hospitals.

Although it is becoming one of the leading

cause of inpatient mortality, the over all

outpatient and inpatient morbidity and

mortality of HIV/AIDS in hospitals and

health centers is about 0.1% and 5.2%

respectively (Figure V.3.1.5.).

Source: NATCoD 2012 report

Source: NATCoD 2012 Report


113

Source: HMIS 2012

Source: NATCOD 2012 report

Source: HMIS 2012

Source: HMIS

Table V.3.1.3. Number of HIV/AIDS and STI cases and

AIDS deaths in Ho. and HC. and the proportion to the

total causes of OPD/IPD morbidity and Mortality by year

(2002-2012)

Year 2005 2006 2007 2008 2009 2010 2011 2012

HIV Cases

3011 2646 1943 2062 1658

1459

1030

1036

(%) to total cases 0.3 0.2 0.17 0.18 0.14

0.12

0.08

0.1

HIV deaths

233 262 260 252 200

184

140

136

(%) to total deaths 9.5 10.7 10.9 10.4 7.6

7.7

6.5

5.2

STI (Ho and

HC) 2599 2,586 3007 3540 2875

2326

2857

2526

(%) to total case 0.2 0.24 0.26 0.31 0.24

0.19

0.22

0.18

STI

syndrome cases (HS) 2938 2611 2919 3090 2450

2018

2565

2728

% to total

HS OPD

0.40 0.35 0.36 0.39 0.30

0.25

0.31

0.28

Table V.3.1.2. Number of Reported AIDS Cases in Hospital and

Health centers by Year and Zoba (1998-2012)

Year AN DE DKB GB MA NRH SKB Total

1998 30 110 77 121 40 640 87 1,105

1999 101 270 92 110 225 942 104 1,844

2000 79 243 49 53 384 548 87 1,443

2001 81 297 58 111 497 502 120 1,666

2002 62 346 53 82 488 467 93 1,591

2003 72 371 48 137 646 451 85 1,810

2004 75 332 104 104 862 567 85 2,129

2005 190 273 61 91 1,589 770 37 3,011

2006 243 223 82 75 1,227 732 64 2,646

2007 233 240 87 84 703 525 71 1,943

2008 283 336 61 112 807 415 48 2,062

2009 190

245

34

150

664

352

23 1658

2010 64 250 19 141 624 330 26 1454

2011 75 186 21 52 467 209 20 1030

2012 88 130 7 60 232 496 23 1036


114

V.3.2. Malaria Malaria is one of the most devastating global public

health problems. It also contributes to anemia in

children and undermines their growth and

development. It is a primary cause of poverty

slowing economic growth in Africa alone.

In Eritrea, significant improvements are recorded in

decreasing the morbidity and mortality caused by

Malaria.

The 2012 hospital and health center report

indicates that, in comparison to that of 2011, the

number of malaria OPD incidence has decreased by

16.4% in under 5 and increased by 6.4% in five and

above years respectively. Similarly, the inpatient

morbidity in U5 and five and above has decreased

by 12.6% and 9.3% respectively. Moreover, the

mortality in U5 was the highest figure (9 deaths)

since 2007. In five and above age group mortality

has increased by 75% compared to 2011.

Generally speaking malaria morbidity has increased

by 3.5% in OPD and 22.6% in IPD. Malaria

mortality has decreased by 9.7% compared to 2011

situation (Table IV.3.2.1).

In 2012, malaria accounted for only 0.5% of OPD

morbidity, and 1.5% of IPD morbidity and 0.6% of

inpatient deaths in less than five year age. In age

group greater than five it was 1.3% of OPD

morbidity and 4.9% of IPD morbidity and 1.5% of

inpatient deaths in hospitals and health centers

(Table IV.3.24).

It ranked 11th in OPD and 10

th in IPD morbidity in

U5, 14th in OPD and 4

th in inpatient morbidity in

above five age category.

Looking at the regional distribution of the disease

burden for malaria as compared to the other

morbidity cases, still the highest toll was reported in

GB in 2012. It accounted above 61.8% of the total

reported cases in hospital and health centers and

60% of inpatient deaths. In health stations the

highest number of cases reported was in GB

followed by Debub. In hospitals and health centers

the highest malaria burden was reported

from GB (61.8%) and Debub (20.4%).

Some of the contributing factors for the

remarkable reduction according to the

National Malaria Control Program include:

• High ITN coverage, re-impregnation and

utilization.

• Introduction of combination therapy of

CQ+SP as first line drugs.

• Early diagnosis and timely case

management.

• High levels of community awareness and

participation for environmental vector

control.

• Effective and functional partnership of

country and outside RBM partners

• Commitment and dedication of the

Government, MOH, and malaria control

staff and general health workers.

• Technical and financial support received

through RBM initiative.

• Effective planning and implementation of

program activities at central and zonal level.

• Continuous supervision, regular monitoring

and evaluation of program activities at

central and zonal level.

Although, it has been the major cause of

morbidity and mortality in health facilities in

the past few years, its rank has gone down to

the least compared to other disease burdens

at present especially in OPD morbidity and

inpatient deaths. However, it still is one of

the major causes of inpatient morbidity

especially in GB and Debub.

Maakel which most of its areas considered

to be malaria free also reported about 4.6%

of the IPD and OPD cases in hospitals and

health centers. All the sub zobas reported

malaria cases although the highest report


115

came from Asmara which could probably be

imported cases.

A total of 322 malaria cases in pregnancy were

reported in health stations in 2011. This is 16.6%

decrease from previous year. In Hospitals and

health centers 236 malaria in pregnancy cases were

also reported in 2012. This is 36.6% increase from

that of 2011.

Table IV.3.2.2 illustrates the increase/decrease in

the number of malaria morbidity of all age group in

2012 as compared to 2011. Malaria morbidity at

national level has decreased by 0.2% in 2012

weighing against 2011.

Figures IV.3.2.2.and IV.3.2.3 also indicates the

trends of malaria morbidity in U5 and five and

above as well as malaria deaths in both age groups

respectively. In 2012 the reducing trend of malaria

morbidity has began losing its progress in five and

above years but in under 5 the trend is decreasing

continually..

The case fatality rate in 2012 was 0.2%. Out of the

total deaths 60% were reported from Zoba Gash

Barka.

Figures IV.3.2.4, 3.2.5, 3.2.6, and 3.2.7 indicate the

number of reported malaria cases in Gash Barka

and Debub by sub zoba.

Table V.3.2.2. Total OPD/IPD Malaria Morbidity

Cases and Percent of Increase/ Reduction in Hospital

and Health Centre in 2012 compared to 2011 by Zoba

Zoba Year % increase(+)/

reduction(-) 2011 2012

Anseba 1374 1145 -16.7

Debub 3811 3847 0.9

DKB 2 8 300.0

Gash-Barka 11894 11667 -1.9

Maakel 924 865 -6.4

NRH 648 928 43.2

SKB 269 421 56.5

Total 18922 18881 -0.2

Table V.3.2.1 The percent of reduction or

increase of the number of reported malaria

morbidity and mortality in hospitals and

health centers in 2012 compared to 2011

Age category OPD IPD Deaths

U5 -16.4 -12.6% 900%

5 and above +6.4% 9.3% 75%

Total 3.5% -9.7 150%


116

Figure IV. 3.2.4 Number of malaria cases in HO and HC in Gash Barka (2012)

Figure IV 3.2.5 Number of Malaria cases in HS Gash Barka (2012)

Figure IV 3.2.6 Number of Malaria cases in HS

Debub (2012)

Table V.3.2.4 Number of New Malaria Cases and Deaths in

Hospitals and Health Centers by Zoba (2012)

Zoba

Number of New Reported Cases % of

total

morbidity

Number of Inpatient Deaths

% of

IPD deaths Outpatient Inpatient

Total

<5 >5 <5 >5 <5 >5 Tot

AN 19 612 30 484 1145 0.7 0 3 3 0.9

DE 171 2209 179 1288 3847 1.6 0 0 0 0.0

DK 0 3 0 5 8 0.0 0 0 0 0.0

GB 1160 8573 278 1656 11667 5.3 8 10 18 3.9

MA 8 424 3 430 865 0.3 0 1 1 0.4

NR 80 709 10 129 928 0.4 1 5 6 0.9

SK 11 100 14 296 421 0.3 0 2 2 0.7

Total 1 4 4 9 1 2 6 3 0 5 1 4 4288 1 8 8 8 1 1.4 9 21 30 1.3 % of total 0.5 1.3 1.5 4.9 0.9 1.5 1.3

Table V.3.2.3. Number of Total Malaria Cases

in Health Stations by Zoba (2012)

<5 >5

*Malaria in

pregnancy Total

% To total

OPD cases

AN 63 1668 11 1742 0.7

DE 435 4359 90 4884 2.4

DK 0 0 0 0 0

GB 2511 16961 210 19682 9.1

MA 11 291 7 309 0.1

SK 19 169 4 192 0.1

Total 3039 23448 322 26809 2.5 % of total

morbidity 1.1 3.0 0.03 2.5

*Included in above 5 age group ** percent to total malaria

cases


117

V. 3.3. Tuberculosis (TB) TB control program is one of the oldest programs in

the country that deals with the prevention,

detection, treating and controlling TB. However,

TB remained among 10 leading causes of mortality

in adults in Eritrea.

According to World Health Organization (WHO)

estimates, each year, 8 million people worldwide

develop active TB and nearly 2 million die. People

with HIV are particularly vulnerable for developing

active TB.

The prevalence of tuberculosis (TB) in the age

group of 15 and above in Eritrea according to TB

prevalence survey of 2005 was 50/100000 and the

incidence is 25/100000. The TB/HIV co-infection is

11.2%.

According to the National TB Control Program

report, the Ministry expects to identify about 4500

TB cases every year. In 2012, the program notified

781 new sputum positive cases and 3249 total TB

cases.

The cure rate was 82% which is the same as 2010.

There was an increase in success rate from 84% in

2010 to 86% in 2011, according the Treatment

outcome of NSP, 2011 cohort

The 2012 hospital health center report indicated

that a total of 2,266 OPD and 1,016 inpatient

TB cases were recorded of which 2156 (65.7%)

were pulmonary TB. In addition to this, 1,481 suspected TB cases were reported in health

stations. The suspected TB cases have to be

referred for further examination and diagnoses.

The inpatient cases are most of the time OPD

diagnosed cases. Therefore, it is safe to take the OPD cases as incidence of TB reported in

health facilities. In this regard, reported TB

incidence has decreasing trends (Figure

V.3.3.2) considering the improved situation

for diagnosis and expansion of health

facilities. Similar to the incidence, the TB

deaths also have a decreasing trend in 2012

(Figure V.3.3.3). The OPD morbidity has

decreased from 0.9% in 1999 to 0.18% in

2012, and the IPD morbidity from 2.4% in

1999 to 0.8% in 2012 (Table V.3.3.2).

Considering the total number of reported TB

cases in hospital and health center in

different zobas in 2012, the highest toll was

reported in National Referral followed by

Debub. (Table V.3.3.1).

The average length of stay (ALOS) in

hospitals has direct economic impact to the

health facilities in particular and to the


118

health system in general. It is therefore essential to

minimize the number of TB hospital days through

appropriate health facility and home management of

patients. The average length of stay remained more

than 20 days in the last twelve years with zoba

variations (Table V.3.3.2)

Table V.3.3.1. The Number and percentage of New

Reported TB Cases and Deaths in Hospitals and

Health Centers by Zoba (2012)

Zones

Number of New Cases

%

Death

% to

total

death

IPD

CFR %

ALOS Outpatient Inpatient

Total

< 5 >5 <5 >5 <5 >5

Tot

al

AN 8 120 6 108 242 0.1 0 7 7 1.5 6.1 11.3

DE 2 108 0 249 359 0.1 0 14 14 0.4 5.6 31.3

DKB 1 44 11 53 109 0.4 0 3 3 11.8 4.7 25.8

GB 12 133 6 195 346 0.2 0 18 18 1.2 9.0 13.0

MA 17 206

0 46 269 0.1 0

5 5 1.8

10.9 9.0

NRH 214 1241 17 253 1725 0.7 1 22 23 0.9 8.5 15.8

SKB 4 156 2 70 232 0.1 0 5 5 1.4 6.9 35.6

Total 258 2008 42 974 3282 0.2 1 74 75 0.2 7.4 20.3 % To

total 0.1 0.2 0.1 1.1 0.2 0 5.3 3.1

Figure 3.3.2 Trend of reported number of TB (1998-2012)

Table V. 3.3.2. The Yearly Trends of TB

Morbidity, Mortality, Case Fatality, and Average

Length of Stay in Hospitals and Health Centers

(1999- 2012)

Year OPD

Morbidity

%

IPD

morbidity %

Total

Morbidity %

Deaths

%

Case

Fatality %

ALO

S, days

1999 0.9 2.4 1.0 7.1 1.9 22.6

2000 0.6 2.6 0.8 6.2 1.9 24.1

2001 0.6 2.8 0.8 9.1 2.4 23.3

2002 0.4 2.7 0.6 6.4 2.7 22.4

2003 0.4 1.9 0.4 6.7 8.6 22.0

2004 0.4 1.9 0.5 6.2 8.2 23.0

2005 0.4 1.2 0.5 4.4 8. 0 22.3

2006 0.3 1.2 0.4 4.6 8.5 24.5

2007 0.2 1.0 0.3 3.7 8.4 21.2

2008 0.2 0.9 0.3 3.4 7.9 22.3

2009 0.2 1.0 0.3 4.1 9.1 22.0

2010 0.2 0.9 0.3 3.7 7.3 20.6

2011 0.2 0.9 0.3 4.7 8.3 20.9

2012 0.18 0.8 0.25 3.3 7.4 20.3

Table IV.2.3.3.3. Number of Suspected TB Cases in

Health Stations by Zoba and Year (1999-2012)

YEAR AN DE DKB GB MAel SKB Total

% to total

OPD cases

1999 183 287 96 427 894 350 2237 0.3

2000 163 176 108 328 4145 86 5006 0.7

2001 161 218 157 270 107 169 1082 0.1

2002 121 159 74 255 102 96 807 0.1

2003 130 163 346 164 80 409 1292 0.1

2004 92 172 150 186 77 152 829 0.1

2005 69 171 120 144 78 128 710 0.1

2006 36 236 187 97 118 93 767 0.1

2007 69 247 156 161 139 134 906 0.1

2008 68 247 157 209 274 175 1130 0.1

2009 138 247 178 151 393 111 1218 0.1

2010 237 195 146 151 412 89 1230 0.1

2011 203 200 64 186 479 84 1216 0.1

2012 329 147 117 104 663 121 1481 0.14


119

Figure 3.3.3 Trends in the number of reported TB

deaths (1998-2011)

V.3.4. Diarrhea Although the overall burden of infectious

diseases has been decreased significantly in

the last ten years, diarrhea is still among the

top ten leading causes of morbidity and

mortality especially in children U5. This

could be attributable to the nutrition status

of children or HIV infection.

For the purpose of evaluating the situation

of diarrhea, shigellosis, amoebiasis, gastro

enteritis and giardiasis are grouped together

under diarrheal diseases.

For the last 10 years, in children under five

years old, it has been the second leading

cause of outpatient and inpatient morbidity

and the third leading cause of inpatient

mortality in hospital and health center. In

2012, it accounted for about 26.1% of OPD

morbidity and 19.1% of inpatient morbidity

and 11.8 % of inpatient mortality in children

U5.

In five and above age group, diarrhea was

ranked the 5th cause of OPD morbidity

responsible for 6.4% of all OPD disease

burden and 3.8% of IPD morbidity and 2.2%

of inpatient deaths. In 2012 diarrhea has

Table V.3.3.3 Number of Reported TB Cases in OPD of Ho and HC

(2004-2012)

Zob 2004 2005 2006 2007 2008 2009 2010 2011

2012

AN 299 332 248 307 345 283 417 111 128

DE 439 293 287 226 138 136 102 95 110

DK 72 110 136 111 113 36 38 21 45

GB 689 757 559 461 407 300 239 199 145

MA 557 1034 746 683 660 705 523 376 223

NR 567 495 453 352 344 469 723 1180 1455

SK 498 488 416 186 173 193 114 114 160

Total 3121 3509 2845 2326 2180 2122 2156 2096 2266


120

shown increasing trend in age group above 5 years.

In health stations, the burden of diarrhea accounted

for 12.67% of the total outpatient cases in all age

group.

The case fatality rate in inpatients of hospital and

health center in 2012 was 1.5% which is higher than

that of 2011(0.9%). (Table V.3.4.1).

From the total reported deaths of diarrhea 79.1%

were children under five and infants made about

57% of U5 diarrhea deaths and 45.1% of all

diarrhea deaths.

The proportional mortality of diarrhea has increased

by 84.3% in 2012 compared to 2011. (Figure

V.3.4.1. The detail is illustrated in Table V.3.4.2.

Trends

Until 2009 the proportional diarrhea

morbidity remained relatively constant for

the previous years. From 2009 up to 2011

the mortality, morbidity and case fatality

rates have shown decreasing trends. In 2012

diarrhea morbidity and mortality increased

(Figure V.3.4.1.).

0

5

10

15

Percent

Year

Figure V..3.4.1. T h e Y e a r l y T r e n d s o ft h e P r o p o r t i o n a l D i a r r h e a M o r b i d i t y ,M o r t a l i t y a n d I P D C a s e F a t a l i t y ( C F ) ( % ) i nH o s p i t a l s a n d H e a l t h C e n t e r s( 2 0 0 0 - 2 0 1 2 )Morbidity Mortality CFR

V.3.5. Acute Respiratory Tract

infections (ARI)

Acute Respiratory Infections are the most

common infectious diseases. They include

acute pharyngitis/tonsillitis, laryngitis,

influenza, pneumonia, common cold and

other acute respiratory infections. It has

been among the first two leading causes of

morbidity and mortality in all age groups in

health facilities.

In 2012, pneumonia alone accounted for

about 20.4 % of OPD morbidity (the highest

since 1998), about 36.3% of IPD morbidity

and about 18.6% of IPD mortality in U5 in

hospitals and health centers. In the same age

Table V.3.4.1 Number and Proportion of Diarrhea

Cases and Deaths in Hospitals and Health Centers by

Zoba (2012)

Zones

Number of New Cases

%

Death

% To

total

IPD CFR %

Outpatient Inpatient Total

<5 >5 <5 >5 <5 >5 Tota

Anseba 9163 7729 1206 556 18654 10.8 21 5 26 8.2 1.5

Debub 14943 13737 1260

118

3 31123 12.9 11 5

16 4.3 0.7

DKB 1758 973 110 123 2964 11.5 3 0 3 4.6 1.3Gash-Barka

17348 10320 999 600 29267 13.4 28 7 35 7.6 2.2

Maakel 10440 13906 553 309 25208 8.9 4 7 11 4.8 1.3

NRH 6694 6642 1943 196 15475 6.4 19 1 20 3.0 0.9

SKB 10520 7007 596 369

18492 11.8 33 6

39 13.5 4.0

Total 70866 60314

6667

3336

141183 10.5

119 31 150 6.3 1.5

% To

other

causes 26.1 6.4 19.1 3.8 10.6

11.8 2.2 6.3

All age % 10.8 8.1 10.6 6.3


121

group the other ARIs accounted for about 24.9% of

OPD and 5.2% of IPD morbidity. There were 2

deaths due to other ARIs in U5 in hospitals and

health centers in 2012.

Similar to the hospital and health center situation,

ARI including pneumonia is also the first leading

causes of out patient morbidity in all age groups in

health station.

Trends of ARI

The proportional morbidity, mortality and the IPD

case fatality rate of ARI remained almost constant

compared to the previous year. (Table V.3.5.3)

Table V.3.5.1 The Number and percentage of OPD and IPD ARI

Cases and IPD Deaths in Hospitals and Health Centers in 2012

Zoba

Number of New Cases

%

Death

%

IPD

CFR %

Outpatient Inpatient Total

< 5 >5 <5 >5 <5 >5 Tot

AN 7140 20725 181 166 28212 16.3 0 0 0 0 0

DE 8721 20119 304 346 29490 12.3 0 1 1 0.3 0

DK 1200 2539 9 24 3772 14.6 0 0 0 0 0

GB 15216 29953 234 267 45670 20.8 2 3 5 1.1 0

MA 16823 30892 188 188 48091 17.0 0 1 1 0.4 0

NR 9075 8948 814 131 18968 7.9 0 1 1 0.1 0

SK 9389 21906 84 122 31501 20.1 0 2 2 0.7 0

Total 67564 135082 1814 1244 205704 15.4 2 8 10 0.4 0

%

24.9 14.3 5.2 1.4 15.4 0.2 0.5

16.8 2.5 0.4

Table V.3.5.2. Trends of ARI with Pneumonia

Burden in Hospitals and Health Centers (1999-

2012) OPD

Morbidity

%

IPD

morbid

ity %

Total

Morbid

ity %

Deaths

%

Case

Fatality

%

Averag

e LOS,

days

1999 20.4 12.4 19.7 12.7 3 4.5

2000 23.3 13.4 22.5 13.5 3 4.3

2001 25.5 14.1 24.6 13 2.5 4.4

2002 27.3 14.9 26.3 13.7 2.5 5.2

2003 26 15.1 17.3 15.2 2.3 4.4

2004 26.1 18.6 25.2 16.2 2.2 4.5

2005 23.04 18.2 22.6 15.6 1.9 3.9

2006 25.8 21.0 25.3 17.0 1.8 3.9

2007 24.8 17.9 24.1 14.1 1.7 3.9

2008 21.7 16 21.2 12.1 1.7 3.7

2009 23.7 15 22.8 12.8 1.9 3.7

2010 23.1 13.3 22.0 12.2 1.5 3.5

2011 23.0 13.4 22 12.3 1.5 3.6

2012 23.8 16.8 23.2 13.7


122

5.1

3.9

3.7

3

3.4

2.9

2.5

2.1

1.9 1.9

2.1 2.2

1.8 1.8 1.9

0

1

2

3

4

5

6

Percent

Year

Figure V.3.5. 1. Trends of CFR of ARI in IPD of Hospitals and Health Centers (1998-2012)


123

V.3.6. Eye Problems

Eye infection has been one of the top ten leading

causes of mainly OPD morbidity in almost all age

categories. In this category, trachoma, conjunctivitis

and eye lid inflammation are included. Total eye

problems accounted for 6.3% of all OPD and IPD

morbidity in 2012 (Table V.3.6.1.).

Conjunctivitis accounted 46.6% of all eye

problems in 2012 while Trachoma, which

leads to blindness and can easily be

prevented, caused about 1.2% of eye

problems. Similarly, blindness and low

vision accounted for 1.7%. Cataract and

other lens disorders also accounted for

18.5%, which is the next highest proportion

following conjunctivitis. In 2012 the highest

cases of Conjunctivitis, other conjunctiva,

Keratitis & cornea disorders, and Cataracts

& lens disorders were reported since 1998

(Table V.3.6.1.).

Although, trachoma and strabismus have a

continuous decreasing trends, keratitis, has

an increasing trend.

To reduce or prevent blindness, the

Ministry is implementing Vision 2020

strategy. In 2012, a total of 7,230

ophthalmic surgeries were. Out of the total,

4745 (65.6%) were major surgeries. From

the total surgeries conducted about 57.7%

were in NRH (Table V.3.6.2). From the total

ophthalmic surgeries in 2012, 18.5% was

cataract surgery which is less than the

previous years by 7.3%.


124

Table V.3.6.2. Number and % of Ophthalmic

Surgeries conducted by Zoba in 2012.

Age categories

Total % Zoba Minor Major

ANSEBA 327 715 1042 14.4

DEBUB 229 384 613 8.5

DKB 2 67 69 1.0

GASH-BARKA 88 1113 1201 16.6

MAAKEL 4 128 132 1.8

NRH 1835 2338 4173 57.7

SKB 0 0 0 0.0

Total 2485 4745 7230 100.0


125

Table V.3.6.1. Number of New Outpatient and Inpatient Reported Eye Problems in Hospitals and Health Centers by Type of

Problem and Year (2000-2012)

Year

Type of Problem 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

2011

2012

% of

2012

Trachoma 2,257 2,735 2,498 2,211 1,940 1,594 1,669 1,781 1,481 1486 1198 1042 1000 1.2

Eyelid inflammation 2,404 3,132 2,996 2,632 2,841 3,917 4,788 5,080 5,606 5308 4851 4419 4438 5.3

Conjunctivitis, other

conjunctiva

24,08

6

28,96

0

30,37

3

29,42

1

29,45

1

30,00

4

32,27

6 35,127 36,668 41242 38249

43577

39343 46.6

Keratitis & cornea disorders 3,306 4,742 4,815 4,622 4,942 5,131 4,668 5,610 5,312 5227 5472 5773 6754 8.0

Cataracts & lens disorders 4,701 9,625

10,19

9

10,07

8

11,48

1

13,92

2

13,18

0 15,370 14,304 15053 13113

16813

15592 18.5

Retinal detachment 240 458 383 371 616 897 701 686 576 585 600 486 536 0.6

Glaucoma 775 1,656 1,754 1,770 2,044 2,403 2,935 2,641 2,469 2877 3028 3000 2773 3.3

Strabismus 171 270 358 185 355 590 726 803 1,005 941 569 517 459 0.5

Refraction/ accommodation

disorders 3,368 6,276 5,391 5,065 6,535 7,850 9,112 10,484 8,971 9800 8688

9657

9588 11.3

Blindness and low vision 1,032 1,190 1,031 710 871 970 1,718 2,083 1,788 1731 1756 1770 1472 1.7

Other eye and adnexa disease 2,002 4,145 5,911 4,674 2,984 3,361 3,843 3,728 3,527 3374 2212 2141 2544 3.0

Total

44,34

2

63,18

9

65,70

9

61,73

9

64,06

0

70,63

9

75,61

6 83,393 81,707 87624 79736

89196

84499 100.0

% to OPD/IPD Morbidity 5.9 6.8 7.0 6.4 6.8 6.7 7.0 7.1 7.1 7.2 6.5 7.0 6.3


126


127

V.3.7. Non Communicable

Diseases

Non communicable diseases are also coming

to the picture of the leading causes of

morbidity and mortality although the major

burden is infectious diseases and nutrition

problems. Heart diseases, hypertensive

diseases, diabetes mellitus, gastritis and

duodenal ulcer and injuries are among the 10

leading causes of health facility morbidity and

mortality.

Although the total number of cases and deaths

reported in hospitals and health centers

remained almost constant, the number of non

communicable cases and deaths is increasing

indicating the change in disease burden

pattern in Eritrea.

V.3.7.1. Injuries

Different injuries are also among the leading

causes of OPD and IPD morbidity, mortality

and long hospital stays. A total of 69,631

cases (5.2% of all cases) and 154 deaths

(5.9% of all deaths) due to different injuries

were reported in hospitals and health centers

and 76,099 cases in health stations in 2012.

Injury accounted to 7.2% of all cases in health

stations. The total number of reported injury

cases has increasing trend (Table V.3.7.1.1)

Table V.3.7.1.1.Number and Type of Injury Morbidity

in Hospitals and Health centers

(2006-2012)

Diagnosis 2008 2009 2010 2011

2012

% of

total

injury

Fracture 4794 5448 6344 7225 5902 8.5 Dislocations, sprains, strains 2192 1962 2421 3592

1984 2.8 Eye and orbit injury

& non penetrating 1023 1042 2002 730 1480

2.1

Intracranial injury 59 30 38 57 25 0.0 Other internal organ & blast 16 39 53 30

46 0.1 Amputation due to

external cause 44 235 327 215 257

0.4 Car and other vehicle accident 1141 966 922 942

898 1.3 Physical

violence(rape, beating

etc….) 1831 1085 596 170

285

0.4 Other injuries,

single/multiple sites 10285 9471 8075 9296 10576

15.2 Head injury . No brain protrusion 1059 972 1025 767

1388 2.0

Extremity injury 1120 724 674 444 484 0.7

Maxillo-facial 207 154 132 98 351 0.5

Burns 2110 2232 2135 2422 2195 3.2 Hearing loss due to blast injury 1 3 5 15

6 0.0

Penetrating injury 325 305 343 307 153 0.2

Soft tissue injury 31,183 31812 33289 35743 40670 58.4

Vertebral injury 28 20 39 34 60 0.1

Chest injury 340 201 199 226 135 0.2 Effects of foreign

body entering natural

orifice 582 670 851 837

753

1.1

Poisoning 736 658 715 740 933 1.3

Snake bite 1,172 973 1150 1464 1369 2.0

Rabial dog(other

animal) bite 1,895 2101 1912 2044 2143

3.1

Toxic effects of non-

medicinal substances 91 217 241 164

183 0.3

Maltreatment

syndromes 43 59 189 124

97 0.1 Other and unspecified effects of external

causes 148 175 153 66

48 0.1 Certain early trauma/effects of

medical care 735 806 1018 987

930 1.3

Sequelae of injuries 641 341 204 136

106 0.2

Total Injury Cases 63,801

62,70

1 65,052 68875 69631 100

Proportion to total

OPD/IPD 5.6 5.2 5..3 6.0

5.2

Injuries in HS 75695 73701 70722 70751 76099

Proportion to total other causes in HS 9.6 7..9

7..9 7.6

7.2


128

V.3.7.2. Hypertension

Hypertension related health problem is among

the leading causes of morbidity and mortality

in adults. It has an increasing trend in

outpatient as well as inpatient morbidity in the

last ten years. Its proportional OPD/IPD

morbidity in hospitals and health centers has

increased from 0.5% in 1998 to 1.3% in 2005

and 0.7% in 2012. In 2012, a total of 9152

hypertension related cases and 54 (2.1%)

deaths were reported as indicated in Table

V.3.7.2.1. However in comparison with 2011

hypertension cases and deaths had decreased

by 12.1% and 12.5% respectively. On the

other hand the case fatality rate has decreasing

trend and has decreased from 15% in 1998 to

7.2 % in 2012 that may indicate improved

quality of case management in health facilities

(Figure V.3.7.2.2). However in 2012 the case

fatality rate has increased by 56.5% when

compared to 2011. The average length of

hospital stay due to hypertension has

decreased from about 8 days in 1998 to 5.0

days in 2012.

In 2012 the proportional morbidity rate is less

than or equal to 1% in all the zobas except in

Maakel with higher rate (1.1%) that may be

related to the life style of the people living in

Maakel. About 34.2% of all reported

hypertension cases in 2012 were reported

from Maakel. (Table V.3.7.2.1.). Taking the

cumulative number of hypertensive cases

reducing the number of deaths every year,

almost 4 in 1000 people in Eritrea visited

health facilities for hypertension problem

treatment in 2011.

Table V.3.7.2.2. The Proportion (%)

of Hypertension Morbidity,

Mortality, Case fatality and ALOS in

Hospitals and Health Centers (1999-

2012)

Year

% of

Morbidity

% of

Mortality ALOS

Case Fatality

Rate

1999 0.7 3.6 7.7 11.8

2000 0.7 4 6.9 12.2

2001 0.9 4.2 7.5 10.1

2002 0.9 5 6.2 11.1

2003 1.1 4.7 7 9.4

2004 1.2 5.2 5.9 9.6

2005 1.3 3 6.2 6.1

2006 1.1 3.6 6.2 8.0

2007 1.1 3.1 6.0 6.9

2008 1.1 2.9 7 6.3

2009 1.0 2.3 5.8 6.3

2010 0.9 3.0 5.5 6.5

2011 0.8 2.2 6.1 4.6

2012 0.7 2.1 5.0 7.2

Table V.3.7.2.1. Number of Hypertensive Diseases Cases

and Deaths in Hospitals and Health Centers in year 2012

Zoba OPD IPD Total *% Deaths *%

AN 449 84 533 0.3 2 0.6

DE 1034 168 1202 0.5 5 1.3

DKB 101 21 122 0.5 2 3.1

GB 1138 134 1272 0.6 9 2.0

MA 2970 160 3130 1.1 15 6.6

NRH 2111 91 2202 0.9 16 1.9

SKB 636 55 691 0.4 5 1.7

Total 8439 713 9152 0.7 54 2.1

% 0.7 0.6 0.7

*The denominator is the total number of cases and deaths

in the respective zobas.


129

V.3.7.3. Heart Diseases

Heart diseases are managed mainly in

National Referral and zoba referral hospitals.

In 2011, a total of 5106 heart problem cases

and 140 deaths were reported mainly from

Maakel and National referral hospitals. Debub

also reported more cases and deaths of heart

problems along with NRH and Maakel.

Out of the total number of heart disease cases

and deaths, 6.8% and 9.3% were children U5

respectively. Heart disease mortality in

children under 5 has decreased by 51.9%

compared to 2011.

Heart problems accounted for about

0.4% of morbidity cases and 5.4% of all

deaths in hospitals and health centers in

2012. The case fatality rate and Average

length of stay have decreased in 2012

compared to 2011. (Table V.3.7.3.2.).

Considering the reported cumulative

number of heart problem cases after

reducing the annual deaths, about one in

thousand people in Eritrea visited health

facilities for heart problem treatment in

2012.

Table V.3.7.3.1. Number of Heart Disease

Cases and Deaths in Hospitals and Health

Centers by Zoba in Year 2012

Zoba OPD IPD Total *% Deaths *%

Anseba 103 98 201 0.1 5 1.6

Debub 348 195 543 0.2 28 7.2

DKB 18 11 29 0.1 1 1.5

GB 119 105 224 0.1 18 3.9

Maakel 825 198 1023 0.4 19 8.4

NRH 2466 472 2938 1.2 63 7.4

SKB 120 28 148 0.1 6 2.1

Total 3999 1107 5106 0.4 140 5.4

% 0.3 0.9 0.4 5.4

*The denominator is the total number of cases and deaths

in the respective zobas


130

Table V.3.7.3.2. The Percentage of

Heart Disease Morbidity, Mortality,

Case fatality and ALOS in Hospitals

and Health Centers

(1999-2012)

Year

% of

Morbidity

% of

Mortality ALOS

Case

Fatality

Rate

1999 0.13 2.4 10.6 18.1

2000 0.08 2.7 11 20.8

2001 0.08 3.2 11.7 19.5

2002 0.10 3.8 8.3 21.3

2003 0.10 3.3 8.5 23.3

2004 0.13 2.9 9.3 16.9

2005 0.14 2.3 8.5 15.2

2006 0.11 2.0 9.5 15.2

2007 0.4 3.6 9.4 10.8

2008 0.4 5.9 9.4 14.2

2009 0.4 5.4 10.5 16.2

2010 0.5 6.3 9.8 14.3

2011 0.4 6.6 10.6 12.5

2012 0.4 5.4 9.8 11.8

V.3.7.4. Neoplasm

The number of neoplasm cases shows

significant increase since year 2005 that

may be attributed to improved diagnostic

capacity of the health (Figure V.3.7.4.1).

The proportional morbidity remains

almost constant in the last nine years.

But in 2012 there was a sharp decrease

of number of cases of cancer patients.

Neoplasm of female reproductive organ

has been the leading neoplasm (40.4% of

all neoplasms). In 2012 it’s followed by

neoplasm of the breast, neoplasm of the

skin and neoplasm of digestive system in

that order.

In 2012, apart from skin and internal

organ cancers all other cancer types have

shown a significant reduction in the

number of cases.

Total neoplasm cases accounted for

0.2% of total morbidity and 1.8% of

mortality reported in hospitals and health

centers. Since neoplasm is a chronic

terminal illness, it is possible that most

of the patients die at home. Most of the

cases were reported from Zoba Maakel

and NRH that may be due to availability

of diagnostic facilities, but the highest

number of neoplasm of the urinary

system is reported in Anseba.


131

Table V.3.7.4.1. Number of Neoplasm (malignant and

Benign) Cases and deaths in Hospitals and Health Centers

by year (2001-2012)

04 05 06 07 08 09 10 11 12

Digestive 224 255 257 314 244 250 263 263 156

Internal Org. 137 143 189 177 157 156 96 99

106

Breast 181 293 210 321 397 312 406 399

379

Female RepS 494 858

102

4 884 943 867 958

111

9

971

Male RepS 14 21 40 39 55 86 58 45 31

Urinary Sy. 143 166 150 107 70 60 83 80

91

Brain &CNS 15 70 62 95 115 104 88 117

59

Respiratory 28 75 54 48 80 139 65 65

62

Skin 172 145 147 190 202 371 417 326

153

Masculosk. 24 30 36 47 44 48 59 51

36

Eye 12 15 44 28 9 5 10 12

4

Hodgkin’s

and non-

Hodgkin’s 25 26 44 63 55 90 82 88

60

Leukomia 12 15 44 28 9 5 10 12

4

Other 459 659 566 460 453 549 588 588

289

Total cases 1940 2771 2867 2801 2833 3042

318

3

326

4

240

1

Proportion % 0.3 0.3 0.3 0.2 0.2 0.3 0.3 0.3

0.2

Total Deaths 41 61 50 72 73 70 44 78

46

Proportion % 1.9 2.5 2 2.8 3.0 2.7 1.8 3.3

1.8


132

V.3.7.5. Diabetes Mellitus

Diabetes Mellitus is one of the leading causes

of morbidity and mortality mainly in adults in

hospitals and health centers. A total of 78,686

new cases and 926 deaths of Diabetes Mellitus

were reported from hospitals and health

centers since 1998. Moreover, 695

amputations due to diabetes were reported

since 2006 indicating that it is not only

leading cause of morbidity but also a cause of

disability.

Diabetes accounted to 0.4% of morbidity

and 2.7% of total reported deaths in

2012. It was the 7th top leading cause of

mortality in above five years old age

group in 2011. The average length of

stay increased from 6.9 days in 2011 to

7.5 days in 2012. But the case fatality

rate remains the same like 2011(5.4%)

(Table V.3.7.5.2).

Table V.3.7.5.1 illustrates the reported

diabetes cases by Zoba in 2012 and

Table V.7.5.2 shows the annual trends.

Table V.3.7.5.1. Number of Diabetes Mellitus Cases and Deaths in Hospitals and Health

Centers by Zoba in 2012 Zoba OPD IPD Total *% Deaths *%

Anseba 121 197 318 0.2 4 1.2

Debub 284 279 563 0.2 13 3.4

DKB 41 19 60 0.2 4 6.2

GB 355 213 568 0.3 15 3.3

Maakel 2075 208 2283 0.8 8 3.5

NRH 1359 205 1564 0.7 20 2.4

SKB 222 75 297 0.2 5 1.7

Total 4457 1196 5653 0.4 69 2.7

% total 0.4 1.0 0.4 2.7

*The denominator is the total number of cases and deaths in the respective zobas

Table V.3.7.5. 2. Number of Diabetes Mellitus Cases, Deaths and Amputation in Hospital and Health Center

(2002-2012)

year 2003 2004 2005 2006 2007 2008 2009 2010 2011

2012

Cases 4921 7161 6951 5752 6111 5362 5056 6230 6412

5653

% total cases in HF 0.5 0.8 0.7 0.5 0.5 0.5 0.4 0.5 0.5

0.4

Death 67 68 69 76 58 53 50 73 75

69

% to total deaths in

HF 3.1 3.1 2.8 3.1 2.2 2.2 1.9 3.0 3.5

2.7

Average length of stay 9.8 9.6 8.9 7.9 8 7.6 8 6.7 6.9

7.5

Case FR in IPD 5.9 6.2 5.9 6.5 4.9 5.1 4.4 5.2 5.4

5.4

Amputation due to

diabets NA NA NA 48 68 87 88 117 181

104


133

V.3.7.6. Mental Health

Mental health is one of the priorities of the

Ministry among the non communicable

diseases. It is one of the health problems that

result in too long hospital stay with high cost

of services. Thus, the Ministry has been

training psychiatric nurses and deploys them

to the zobas to decentralize the service to

reduce the load of the only one psychiatric

hospital in the country. Moreover, community

based psychiatric counselors were trained and

deployed. These community based counselors

could facilitate community rehabilitation of

psychiatric patients.

In 2012, a total of 4651 mental health disorder

cases were reported in hospitals and health

centers out of which 20.4% were due to

Neoro-somato form disorder cases, 12.8%

mood disorder cases and 7.8% and

Schizophrenia cases. The total number of

cases has increasing trend compared to 2011

but the proportion to the total OPD and IPD

cases decreased to 0.35% the lowest

ever.(Table IV.3.7.6.1.)

Table IV.3.7.6.1. Number of Mental Health Disorder Cases Reported in Hospitals and Health Centers by Year (2002-2012)

Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

2012 %

2012

Dementia 153 74 132 208 149 169 200 211 204 140 195 4.2

Alcohol related MD 34 30 58 84 91 47 39 58 88 36 39 0.8

Mental/behav.disorders,psycho,

Substance abuse 145 126 219 343 307 392 511 583 526 339

361 0.0

Schizophrenia 773 672 760 985 1,032 1051 973 979 1041 772 595 7.8

Mood disorders 641 625 862 988 913 1003 1135 1011 991 835 956 12.8

Neuro. Somatoform 1726 1586 1494 1,854 2,226 2389 2015 1855 1960 1154

947 20.4

Mental retardation 157 148 205 272 234 308 304 291 198 199 218 4.7

Other MD 842 681 888 1,088 1,031 1082 1129 1206 1110 1104 1340 28.8

Total cases 4471 3942 4618 5822 5983 6441 6306 6197 6077 4579 4651 100.0

Proportion(%) 0.48 0.41 0.49 0.55 0.55 0.56 0.55 0.51 0.50

0.36

0.35


134

V.3.7.7 Anemia and Malnutrition

Anemia and malnutrition are also two of the

top leading causes of morbidity and mortality

both in children U5 and adults. In 2012,

malnutrition ranked 12th cause of OPD

morbidity, 3rd cause of IPD morbidity and the

1st cause of mortality in children U5. A total

of 7,936 OPD and 3297 inpatient malnutrition

cases and 135 deaths were reported in

hospitals and health centers.

Considering anemia, it was ranked 14th cause

of OPD morbidity, again 14th cause of IPD

morbidity and 11th cause of mortality in all

age categories visited to Hospitals and Health

centers. From the total reported anemia cases,

children U5 accounted for 13.8% for

morbidity and 28.6% for deaths.

About 20.9% of anemia deaths were reported

from GashBarka that could be attributed to

repeated infection of malaria. Anseba also

reported 12.1% of anemia deaths.

23.5% of the total anemia and

malnutrition cases were reported from

SKB followed by GashBarka 19.6%,

Maakel 15.4% and Debub 15.1%

(Table V.3.7.1).

The health stations also reported 24,732

anemia (all kinds) and 7,130

malnutrition cases in 2012.

The proportional morbidity rate for

Malnutrition indicates that the OPD and

IPD morbidity remained almost constant

in the last seven years. The proportional

death rate for malnutrition is increasing

since 2010. Proportion mortality of

malnutrition in 2012 is the second

highest record since 1998. (Figure

V.3.7.7.1.

Table V.3.7.7.1. Number of Reported Anemia & Malnutrition cases in Hospitals

and Health Centers by Zoba (2012)

zoba Anemia % Malnutrition % Total %

Anseba 1947 11.5 1623 12.6 3570 12.0

Debub 2075 12.2 2439 19.0 4514 15.1

DKB 458 2.7 279 2.2 737 2.5

GB 3306 19.4 2550 19.8 5856 19.6

Maakel 2887 17.0 1719 13.4 4606 15.4

NRH 1938 11.4 1621 12.6 3559 11.9

SKB 4388 25.8 2626 20.4 7014 23.5

Total 16999 100.0 12857 100.0 29856 100.0


Health Management Information System, Research and HRD, MOH Annual health service Report of 2012

135

Table V.3.7.7.2. Number of Reported Anemia Deaths in Hospitals and

Health Centers by Zoba and Age Category (2012)

Zoba

Age Categories

Total % to total zoba death

% to Anemia death <1 1 to 4 5 and above

Anseba 1 5 5 11 3.4 12.1

Debub 0 2 2 4 1.0 4.4

DKB 0 2 0 2 3.1 2.2

GB 0 2 17 19 4.1 20.9

Maakel 0 0 7 7 3.1 7.7

NRH 11 2 23 36 4.2 39.6

SKB 1 0 11 12 4.2 13.2

Total 13 13 65 91 3.5 100.0

% 1.9 3.95 4.1 3.5

Table V.3.7.7.3. Number of Reported Malnutrition Deaths in Hospitals and

Health Centers by Zoba and Age Category (2012)

Zoba

Age Categories

Total

% to total zoba

death

% to

malnutrition

death <1 1 to 4

5 and

above

Anseba 4 9 1 14 4.3 6.1

Debub 12 19 1 32 8.2 13.9

DKB 3 3 0 6 9.2 2.6

GB 28 55 1 84 18.3 36.5

Maakel 1 5 1 7 3.1 3.0

NRH 5 14 2 21 2.5 9.1

SKB 32 33 1 66 22.8 28.7

Total 85 138 7 230 8.8 100.0

% 12.4 41.9 0.4 6.2



136

V.3.7.8 ASTHMA

Asthma is a chronic, non-communicable

lung condition affecting 300 million people

worldwide. In 1998 there were 9,923

Asthma cases and in 2012 it reached 10,724

cases with an increase of 8.2%.

Since 2010 Asthma is showing a decreasing

trend. In comparison to 2011, overall

asthma cases have reduced by 11%.

Similarly Asthma mortality has reduced by

47.4% compared to 2011.

Maekel, 2500 cases, followed by Debub

has the highest number of Asthma cases.



137

Total Asthmatic cases in OPD and IPD by zoba and age group

Cases Deaths

Zoba U5 Above 5 Total U5 Above 5 Total

Anseba 244 1183 1427 0 0 0

Debub 58 1766 1824 0 1 1

Debubawi keyhi bahri 3 184 187 0 2 2

Gash-barka 45 1682 1727 0 1 1

Maakel 100 2425 2525 0 2 2

National referral 204 1561 1765 0 4 4

Semenawi keyhi bahri 152 1117 1269 0 0 0

Total 806 9918 10724 0 10 10

Percent to total opd/ipd cases 0.3 1.0 0.8 0 0.6 0.4

V.3.7.9 BRONCHITIS, EMPHYSEMA and COPD

On average there are around 11,855 annual OPD and IPD cases of Bronchitis Emphysema and

COPD. In 2012 there were 9,659 cases (7.3% lesser than 2011). Almost 98% of bronchitis

cases are OPD patients.

Opd/Ipd Bronchitis Cases

Despite the gradual decrease in the trend of bronchitis cases and deaths over the years, the IPD

cases are steadily increasing since 2010.

Meanwhile, Infant morbidity is consistently increasing and the year 2012 was the highest

record.



138

OPD/IPD infant morbidity of Bronchitis

Semenawi Keyih Bahri reported the highest IPD infant bronchitis cases.(10/14 cases).

Zoba Maekel, followed by Debub and Anseba contain the highest number of bronchitis cases.

Bronchitis cases by zoba

4. Disease Burden at Zoba Level

The disease burden at National level is the aggregate result of the situations in the zobas. Thus, the

burden of diseases in the zobas is not different from the situation at the national level although

there could be insignificant variations among the zobas.

Diarrhea, ARI (without pneumonia) and Pneumonia are the first three leading causes of outpatient

morbidity in children under five in almost of all the zobas. Similarly, Injury all types Infections of

the skin, eye and ear, alongside with malnutrition, soft tissue injury and fever of unknown origin

were repeatedly among the leading ten causes of outpatient morbidity under five years in all zobas.

As per the Age group above 5 years, ARI remains predominantly the leading cause of outpatient.

Malaria in Gash_Barka, congenital malformation in NRH and Oro-dental infection in Maekel were

unique top ten causes of outpatient morbidity in children less than five in their respective region.

Pneumonia, diarrhea and malnutrition were the leading causes of hospitalization of children under

five years. In connection with this, Malaria was the major cause of inpatient morbidity in the zobas

of Debub and Gash_Barka. Meanwhile, Neonatal sepsis and Asthma were the unique top ten

causes of hospitalization in National Referral Hospital and Maekel respectively.



139

In Zoba Maekel Muskulo-skeletal injury with fracture caused the highest number of inpatient

morbidity in 2011.

Pneumonia, Malnutrition, and Diarrhea are the main causes of death in children under 5 years in

all zobas.

Meanwhile HIV, TB, heart diseases and pneumonia are the principal causes of mortality in the age

group above 5.



140

V.4.1. Zoba Anseba

Table V.4.1.1. Ten Leading Causes of OPD

Morbidity in Ho and HC in Anseba in under and

above five in 2012. Under Five 5 and Above

Leading cause No. of

Cases

% Leading

cause

No. of

Cases

%

Diarrhea all

forms 9163

27.5

ARI (With out

pneumonia) 20725

17.2

ARI (With out

pneumonia) 7140

21.4

Injury all

types 9334

7.7

Pneumonia all

types 6816

20.4

Gastritis /

duodenal

ulcer

8678

7.2

Injury all types 1981 5.9

Oro - dental

infection 8482

7.0

Skin infection

& scabies 1611

4.8

Other urinary

tract infection 7792

6.4

Ear infection 1424 4.3

Diarrhea all

forms 7729

6.4

Other digestive

system diseases 1042

3.1

Skin infection

& scabies 5288

4.4

Infection of eye

including

trachoma

986 3.0

Infection of

eye including

trachoma

5053

4.2

Malnutrition,

all types 512

1.5

Pneumonia all

types 4817

4.0

Soft tissue

injury 410

1.2

Rheumathoid

arthritis 3658

3.0

Total top 10 31085 93.2 Total top 10 81556 67.5

Table V.4.1.2 – Ten Leading Causes of Inpatient

Morbidity in Ho and HC in Anseba in under and above

five in 2012. Under Five 5 and Above

Leading

cause

No. of

Cases

% Leading

cause

No.

of

Cases

%

Pneumonia all

types 2803

45.3 Pneumonia all

types 916

7.3 Diarrhea all

forms 1206

19.5 Injury all types 861

6.9 Malnutrition, all

types 783

12.7 Obs

emergencies 644

5.1

Low birth weight 254 4.1

Diarrhea all

forms 556

4.4 ARI (With out

pneumonia) 181

2.9 Malaria , all

types 484

3.9

Neonatal sepis 144 2.3

Abortion, all

types 447

3.6


Other urinary

tract infection 378

3.0

Septicemia 94 1.5

Gastritis /

duodenal ulcer 327

2.6 Intrauterine

hypoxia/birth

asphyxia

74 1.2

Asthma 316 2.5

Other perinatal

and neonatal

problem

56 0.9

Diabetes

mellitus 188

1.5 Total top 10 5696 92.0 Total top 10 5117 40.9



141

V.4.2. Zoba Debub

Table V.4.2.1. Ten Leading Causes of OPD Morbidity in Ho and HC in Debub in under and above

five Year in 2012

Under Five 5 and Above

Leading cause

No.

Cases % Leading cause

No.

Cases %

Diarrhea all forms 14943 30.9 ARI (With out pneumonia) 20119 12.3

Pneumonia all types 12384 25.6 Gastritis / duodenal ulcer 15834 9.7

ARI (With out pneumonia) 8721 18.1 Diarrhea all forms 13737 8.4

Skin infection & scabies 2634 5.5 Injury all types 12295 7.5

Infection of eye including

trachoma 2179

4.5 Other urinary tract infection 11676

7.1

Ear infection 1494 3.1 Oro - dental infection 11259 6.9

Injury all types 1387 2.9 Skin infection & scabies 8973 5.5

Malnutrition, all types 995 2.1 Soft tissue injury 7784 4.8

Soft tissue injury 763 1.6


trachoma 7214

4.4

Other heliminthiases 414 0.9 Pneumonia all types 6896 4.2


Table V.4.1.3 – Ten Leading Causes of Inpatient Deaths in Ho and HC in Anseba in under and above

five in 2012


Leading cause No.

Cases

% Leading cause No. of

cases

%

Septicemia 56 34.4 Paralytic ileus/intestinal disease 13 8.4

Diarrhea all forms 21 12.9 Hiv/aids 11 7.1

Pneumonia all types 17 10.4 Obs emergencies 11 7.1

Other perinatal and neonatal

problem 15

9.2 Pneumonia all types 10

6.5

Malnutrition, all types 13 8.0 Injury all types 9 5.8

Neonatal sepis 9 5.5 Septicemia 8 5.2

Anemia, all types 6 3.7 Tb, all types 7 4.5

Intrauterine hypoxia/birth

asphyxia 6

3.7

Stroke, not spec.as haemmorhage/

infarction 6

3.9

Low birth weight 5 3.1 Anemia, all types 5 3.2

Paralytic ileus/intestinal

disease 3

1.8 Vascular diseases 5

3.2



Health Management Information System, Department Of NHIS, MOH Annual health service Report of 2012

142

Table V.4.2.2. Ten Leading Causes of Inpatient

Morbidity in Ho and HC in Debub by Age Group

in 2012

Under Five

Five Years and Above

Leading

Cause No. %

Leading

Cause No. %

Pneumonia all

types 3560

46.7

Pneumonia all

types 1660

7.8

Diarrhea all

forms 1260


7.2

Malnutrition,

all types 1094

14.4

Malaria , all

types 1288

6.0

Low birth

weight 359

4.7

Diarrhea all

forms 1183

5.6

Ari (with out

pneumonia) 304

4.0

Obs

emergencies 1102

5.2

Septicemia 276 3.6

Other urinary

tract infection 998

4.7

Malaria , all

types 179

2.4

Abortion, all

types 979

4.6


Soft tissue

injury 960

4.5

Skin infection

& scabies 97

1.3

Gastritis /

duodenal ulcer 752

3.5

Soft tissue

injury 58

0.8 Asthma 439

2.1


Table V.4.3.1. Ten Leading Causes of OPD

Morbidity in Ho and HC in DKB by Age Group

in 2012


Leading

cause No. Cases %

Leading

cause No. Cases %

Pneumonia

all types 1792

27.1

ARI (With

out

pneumonia)

2539

14.9

Diarrhea all

forms 1758

26.6

Infection of

eye

including

trachoma

1342

7.9

ARI (With

out

pneumonia)

1200

18.2

Other

urinary

tract

infection

1176

6.9

Skin

infection &

scabies

455

6.9

Skin

infection &

scabies

1093

6.4

Fever of

unkown

origin

317

4.8

Diarrhea all

forms 973

5.7

Ear infection 279

4.2

Gastritis /

duodenal

ulcer

973

5.7

Infection of

eye including

trachoma

198

3.0

Pneumonia

all types 577

3.4

Malnutrition,

all types 129

2.0

Oro - dental

infection 548

3.2

Injury all

types 93

1.4

Injury all

types 480

2.8

Other

urinary tract

infection

73

1.1

Anemia, all

types 415

2.4




143

V.4.3. Zoba Debubawi Keyh Bahri

Table V.4.3.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Debubawi Keyh Bahri in

2011


Leading cause No. Cases % Leading cause No. Cases %

Pneumonia all types 247 38.5 Diarrhea all forms 123 8.0

Malnutrition, all types 125 19.5 Other urinary tract infection 101 6.5

Diarrhea all forms 110 17.2 Pneumonia all types 101 6.5

Septicemia 25 3.9 Epi preventable diseases 85 5.5

Injury all types 17 2.7 Injury all types 81 5.2

Low birth weight 17 2.7 Tb, all types 53 3.4

Skin infection & scabies 12 1.9 Obs emergencies 51 3.3

Tb, all types 11 1.7 Gastritis / duodenal ulcer 47 3.0

ARI (With out

pneumonia) 9

1.4 Skin infection & scabies 41

2.7

Burns 9 1.4 Abortion, all types 32 2.1


Table V.4.2.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Debub by Age Group in

2012

Under Five Five Years and Above

Leading cause

No. of

Cases % Leading cause

No.of

cases %

Septicemia 52 28.0

Heart diseases 25 13.4

Pneumonia all types 49 26.3

Stroke, not spec.as

haemmorhage/ infarction 22

11.8

Malnutrition, all types 31 16.7 Pneumonia all types 21 11.2

Low birth weight 13 7.0 Hiv/aids 18 9.6

Diarrhea all forms 11 5.9 Septicemia 16 8.6

Intrauterine hypoxia/birth asphyxia 7 3.8 Tb, all types 14 7.5

Neonatal sepis 7 3.8 Diabetes mellitus 12 6.4

Heart diseases 3 1.6 Obs emergencies 8 4.3

Anemia, all types 2 1.1 Diarrhea all forms 5 2.7

Other perinatal and neonatal problem 2 1.1 Hypertensive related diseases 5 2.7

Total of the top 10 177 95.2 Total of the top 10 146 78.1



144

Table V.4.2.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Zoba Debubawi Keyih Bahri

by Age Group in 2012


Leading cause No. ofCases % Leading cause

No.of

cases %

Septicemia 9 25

OBS EMERGENCIES 5 16.7

Pneumonia all types 8 22.2 DIABETES MELLITUS 4 13.3

Malnutrition, all types 6 16.7 HIV/AIDS 4 13.3

Diarrhea all forms 3 8.3 SEPTICEMIA 3 10.0

Anemia, all types 2 5.6 TB, ALL TYPES 3 10.0

Burns 2 5.6 ASTHMA 2 6.7

Intrauterine hypoxia/birth asphyxia 2 5.6

HYPERTENSIVE RELATED

DISEASES 2

6.7

Injury all types 2 5.6 OTHER CAUSES OF DEATH 2 6.7

Low birth weight 2 5.6 PNEUMONIA ALL TYPES 1 3.3

Total of the top 10 36 100 Total of the top 10 26 86.7



145

V.4.4. Zoba Gash Barka

Table V.4.4.3. Leading Ten Causes of Inpatient Deaths in Ho

and HC. In Gash Barka (2012)


Leading cause # % Leading cause # %

Malnutrition,

all types 83

36.9

Pneumonia all

types 32

13.7

Pneumonia all

types 45


9.0

Diarrhea all

forms 28

12.4 Tb, all types 18

7.7

Neonatal sepis 25 11.1

Anemia, all

types 17

7.3

Low birth

weight 14

6.2 Heart diseases 17

7.3

Septicemia 9 4.0

Diabetes

mellitus 15

6.4

Malaria , all

types 8

3.6 Hiv/aids 14

6.0

ARI (With out

pneumonia) 2

0.9

Obs

emergencies 11

4.7

Anemia, all

types 2

0.9

Malaria , all

types 10

4.3

Intrauterine

hypoxia/birth

asphyxia

2

0.9

Hypertensive

related

diseases

9

3.8

Total 218 96.9 Total 164 70.1

Table V.4.4.1. Leading Ten Causes of OPD Morbidity in Ho and HC

in Gash Barka (2012).


Leading cause

No.of

cases % Leading cause

No of

cases %

Diarrhea all

forms

1734

8 30.9

ARI (With out

pneumonia) 29953

20.7

ARI (With out

pneumonia)

1521

6 27.1

Other urinary

tract infection 12638

8.7

Pneumonia all

types

1065

9 19.0

Diarrhea all

forms 10320

7.1

Skin infection &

scabies 1980

3.5

Gastritis /

duodenal ulcer 10100

7.0


Malaria , all

types 8573

5.9


Oro - dental

infection 7106

4.9

Malnutrition, all

types 1291

2.3

Pneumonia all

types 5696

3.9

Infection of eye

including

trachoma

1237

2.2

Injury all types 5655

3.9

Malaria , all

types 1160

2.1

Skin infection

& scabies 5072

3.5

Soft tissue injury 1044 1.9

Rheumathoid

arthritis 4446

3.1

Total top 10 5300

4 94.4 Total top 10

99559 68.8

Table V.4.4.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Gash Barka (2012)


Leading cause No % Leading cause No.of cases %

Pneumonia all types 2147 39.5 Malaria , all types 1656 13.1

Malnutrition, all types 1051 19.3 Injury all types 1224 9.7

Diarrhea all forms 999 18.4

Cataracts and other lens

disorders 1118

8.8

Malaria , all types 278 5.1 Pneumonia all types 943 7.4

ARI (With out pneumonia) 234 4.3 Obs emergencies 668 5.3

Low birth weight 170 3.1 Diarrhea all forms 600 4.7

Neonatal sepis 123 2.3 Anemia, all types 503 4.0

Septicemia 79 1.5

Abortion, all types 493 3.9

Injury all types 75 1.4 Snake bite 456 3.6

Anemia, all types 64 1.2 Soft tissue injury 396 3.1




146

V.4.5.Zoba Maakel

Table V.4.5.1. Ten Leading Causes of OPD Morbidity in Ho and HC in Maakel (2012)


Leading cause #of cases % Leading cause No. of cases %

ARI (Without pneumonia) 16823 30.2 Oro - dental infection 30924 14.1

Pneumonia all types 13201

23.7

ARI (Without

pneumonia) 30892

14.1

Diarrhea all forms 10440

18.7

Skin infection &

scabies 15883

7.3

Skin infection & scabies 3444

6.2

Gastritis / duodenal

ulcer 13936

6.4


trachoma 1608

2.9 Diarrhea all forms 13906

6.4

Malnutrition, all types 1453

2.6

Other urinary tract

infection 13426

6.1

Ear infection 1344 2.4 Injury all types 7852 3.6

Fever of unkown origin 1224 2.2 Soft tissue injury 6531 3.0

Oro - dental infection 735

1.3

Infection of eye

including trachoma 6426

2.9

Injury all types 591 1.1 Pneumonia all types 5259 2.4


Table V.4.5.2. Ten Leading Causes of Inpatient Morbidity in Ho and HC in Maakel in 2012

Under Five Five and Above

Causes No. % Causes No. %


Cataracts and other lens

disorders 539

7.4


ARI (With out pneumonia) 188 10.8 Malaria , all types 430 5.9

Malnutrition, all types 151 8.7 Diarrhea all forms 309 4.2

Low birth weight 78 4.5 Gastritis / duodenal ulcer 268 3.7

Fever of unkown origin 16 0.9 Injury all types 242 3.3

Asthma 11 0.6 Cholelithiasis/cholecysitis 239 3.3

Skin infection & scabies 10 0.6 Other urinary tract infection 237 3.2

Congenital malformations 5 0.3 Diabetes mellitus 207 2.8

Other urinary tract infection 5 0.3 Heart diseases 198 2.7

Total 1681 96.9

Total top 10 3183 43.6



147

Table V.4.5.3. Ten Leading Causes of Inpatient Mortality in Ho and HC in Maakel in 2012 Under Five Five Years and Above

Leading cause No. % Leading cause No %

Malnutrition, all types 6 50 Hiv/aids 37 17.2


Pneumonia all types 2 16.7 Heart diseases 19 8.8

Other liver disease 18 8.4

Stroke, not spec.as


7.9

Hypertensive related

diseases 15

7.0

Gastritis / duodenal ulcer 13 6.0

Diabetes mellitus 8 3.7

Anemia, all types 7 3.3


Total 12 100 Total top 10 174 80.9

V.4.6. National Referral Hospitals(NRH)

Table V.4.6.1. Ten Leading Causes of Outpatient Morbidit in National Referral Hospitals by Age Group in 2012.


Leading cause

No. of

cases % Leading cause

No. of

cases %

ARI (With out

pneumonia) 9075


9.2

Diarrhea all forms 6694 19.9 Oro - dental infection 10429 6.0

Pneumonia all types 3029 9.0 Soft tissue injury 10318 6.0

Ear infection 1827 5.4 Gastritis / duodenal ulcer 10032 5.8


ARI (With out

pneumonia) 8948

5.2

Other urinary tract

infection 1476

4.4


trachoma 7492

4.3

Infection of eye

including trachoma 1469

4.4

Other urinary tract

infection 7459

4.3

Skin infection &

scabies 1399

4.2 Diarrhea all forms 6642

3.8

Soft tissue injury 943 2.8 Skin infection & scabies 3988 2.3

Malnutrition, all

types 835

2.5

Refraction and

accomodation disorder 3886

2.3




148

Table V.4.6.2. 10 Leading Causes of Inpatient Morbidity in National Referral Hospitals by Age

group in 2012


Leading cause #of cases % Leading cause #of cases %

Diarrhea all forms 1943 20.7 Injury all types 2547 10.5

Pneumonia all types 1506 16.0 Obs emergencies 2211 9.1


Cataracts and other lens disorders 1755 7.2

ARI (With out pneumonia) 814 8.7

Abortion, all types 1667 6.9

Malnutrition, all types 654 7.0



Burns 367 1.5

Neonatal sepis 479 5.1 Heart diseases 310 1.3

Burns 463 4.9


Congenital malformations 231 2.5

Congenital malformations 267 1.1

Other perinatal and

neonatal problem 167

1.8 Tb, all types 253

1.0

Total top 10 8011 85.3

Total top 10 10082 41.4

Table V.4.6.3. Ten Leading Causes of Inpatient Mortality in National Referral Hospital by Age

Group in 2012


Leading cause No. of cases % Leading cause

No. of

cases %



Pneumonia all types 28 13.9 Heart diseases 46 9.8


Stroke, not spec.as


8.7

Malnutrition, all types 19 9.5 Hiv/aids 40 8.5

Congenital

malformations 14

7.0 Pneumonia all types 34

7.2

Anemia, all types 13 6.5 Burns 25 5.3

Heart diseases 8 4.0 Tb, all types 22 4.7

Septicemia 7 3.5 Head injury 21 4.5

Intrauterine

hypoxia/birth asphyxia 6

3.0 Renal failure 18

3.8

Neonatal sepis 6 3.0 Diabetes mellitus 16 3.4




149

V.4.7. Zoba Semenawi Keyh Bahri

Table V.4.7.1. Ten Leading Causes of Outpatient Morbidity in Ho and HC in SKB by Age Group in 2012


Leading cause No. of cases % Leading cause No.of cases %

Diarrhea all forms 10520 27.7 ARI (With out pneumonia) 21906 20.6

ARI (With out pneumonia) 9389 24.8 Gastritis / duodenal ulcer 8180 7.7

Pneumonia all types 7597 20.0 Diarrhea all forms 7007 6.6

Fever of unkown origin 2257 6.0 Other urinary tract infection 6919 6.5

Skin infection & scabies 1429 3.8 Pneumonia all types 6067 5.7

Ear infection 1160 3.1 Skin infection & scabies 4665 4.4


trachoma 1091

2.9


trachoma 4334

4.1

Malnutrition, all types 1026 2.7 Oro - dental infection 4240 4.0

Injury all types 509 1.3 Anemia, all types 3926 3.7

Oro - dental infection 424 1.1 Injury all types 2896 2.7


Table V.4. 7.2 Ten Leading Causes of Inpatient Morbidity in Ho and HC in SKB in 2012

Under Five Five and above

Leading cause No. of cases % Leading cause #cases %

Pneumonia all types 1750 44.2 Abortion, all types 444 5.3

Malnutrition, all types 756 19.1



Obs emergencies 380 4.6

Low birth weight 379 9.6 Diarrhea all forms 369 4.4

ARI (With out pneumonia) 84 2.1 Injury all types 301 3.6

Neonatal sepis 64 1.6 Malaria , all types 296 3.6

Skin infection & scabies 37 0.9 Epi preventable diseases 275 3.3

Epi preventable diseases 31 0.8

Other urinary tract

infection 182

2.2


Skin infection & scabies 172 2.1

Septicemia 27 0.7 Gastritis / duodenal ulcer 154 1.9




150

Table V. 4.7.3. Top 10 Causes of Inpatient Mortality in Ho and HC in SKB in 2012


Causes No. % Causes No. %

Malnutrition, all types 65 35.9 Pneumonia all types 17 15.9

Pneumonia all types 38 21.0 Anemia, all types 11 10.3

Diarrhea all forms 33 18.2 Diarrhea all forms 6 5.6

Low birth weight 18 9.9 Epi preventable diseases 6 5.6

Neonatal sepis 7 3.9 Heart diseases 6 5.6

Other perinatal and

neonatal problem 5

2.8 Hiv/aids 6

5.6

Septicemia 3 1.7 Diabetes mellitus 5 4.7

Intrauterine hypoxia/birth

asphyxia 2

1.1

Hypertensive related

diseases 5

4.7

Anemia, all types 1 0.6 Tb, all types 5 4.7

Burns 1 0.6 Obs emergencies 4 3.7




151

VI.7. List of Health Facilities Reporting to HMIS in the 2012 (Jan-Dec)

VI.7.1.Anseba S N F A C N A M E

F A C T Y P E

S U B Z N A M E

O W N E R

B E D1. ADI-TEKELEZAN HC ADI-TEKELEZAN MOH 30

2. ASMAT HC ASMAT MOH

3. EROTA HS ASMAT MOH

4. HURUM HS HS ASMAT MOH

5. ELABERED CL ELABERED MOA

6. ELABERED HC ELABERED MOH

7. HADISH ADI HS ELABERED MOH

8. HALIBMENTEL HS ELABERED CCM

9. SHEB HS ELABERED MOH

10.GELEB HS GELEB MOH

11.MEHLAB HS GELEB MOH

12.AF-EYUN HS HABERO MOH

13.FILFILE HS HABERO MOH

14.HABERO HC HABERO MOH

15.HABERO TSADA HS HABERO MOH

16.ASHERA HS HAGAZ CCM

17.BEGU HS HAGAZ CCM

18.DAROTAI HS HAGAZ MOH

19.GLASS HS HAGAZ CCM

20.HAGAZ HC HAGAZ MOH

21.HASHISHAY HS HAGAZ MOH

22.KERMED HS HAGAZ MOH

23.GEBEY ALEBU HS HALHAL MOH

24.HALHAL HC HALHAL CCM

25.MELEBSO HS HALHAL MOH

26.FREDAREB HC HAMELMALO CCM

27.HAMELMALO AGRI. COLLAGE CL HAMELMALO MOH

28.JENGEREN HS HAMELMALO MOH

29.ST. LUCHA HC HAMELMALO CCM

30.BLOCO KEREN HS KEREN MOH

31.GEZA-MANDA HS KEREN CCM

32.JOKO MCH MC KEREN MOH

33.KEREN REG. REF. HOSP HO KEREN MOH

34.KEREN VCT CL KEREN MOH



152

S N F A C N A M E

F A C T Y P E

S U B Z N A M E

O W N E R

B E D35.MEGARIH HS KEREN MOH

36.SHIFSHIFIT HS KEREN MOH

37.HAMISH-DUBA HS KERKEBET MOH

38.HIMBOL HS HS KERKEBET MOH

39.KERKEBET HC KERKEBET MOH

40.LOKAI HS HS KERKEBET MOH

41.SHERIT HS SELA MOH

VI.7.2 Debub.

SN FACNAME FACTYPE SUBZNAME OWNER BED

1 ADI KEIH VCT CL ADI-KEIH MOH

2 ADI-KEIH HS ADI-KEIH MOH

3 ADI-KEIH HOSP. HO ADI-KEIH MOH

4 DEREA HS ADI-KEIH MOH

5 HAWATSU HS ADI-KEIH CCM

6 KOHAYTO HS ADI-KEIH MOH

7 TEKONDAE HS ADI-KEIH CCM

8 ADI-JENU HS ADI-QUALA CCM

9 ADI-QUALA MH ADI-QUALA MOH

10 AWHA HC HC ADI-QUALA MOH

11 ENDAGHERGIS HS ADI-QUALA MOH

12 ADI-GULTI HS AREZA MOH

13 ADI-GUROTO HS AREZA MOH

14 ADI-WUSK HS AREZA MOH

15 AREZA HC AREZA MOH

16 MAY-DIMA HS AREZA MOH

17

MAY-DIMA

OPHTHALMIC HC AREZA MOH

18 UBEL HS AREZA MOH

19 ZEBANDEBRI HS AREZA MOH

20 ADI-BEZAHANIS HS DBARWA MOH

21 ADI-FELESTI HS DBARWA MOH

22 ADI-GEBRAY HS DBARWA MOH

23 DBARWA HC DBARWA MOH



153

24 GERTETE HS DBARWA MOH

25 SHIKETI HS DBARWA MOH

26 TERA EMNI HS DBARWA MOH

27 ALLA HS DEKEMHARE MOH

28 DEKEMHARE HS DEKEMHARE CCM

29 DEKEMHARE HOSP. HO DEKEMHARE MOH

30 DEKEMHARE HS1 HS DEKEMHARE MOH

31 DEKEMHARE VCT CL DEKEMHARE MOH

32 FEKEIH HS DEKEMHARE MOH

33 MAY-EDAGA HS DEKEMHARE MOH

34 ANAGER HS EMI-HAILY MOH

35 KUDO-BOUER HC EMI-HAILY MOH

36 SHEKA-IYAMO HS EMI-HAILY MOH

37 KINAFNA HS MAY-AYNEE MOH

38 MAY-AYNEE HC MAY-AYNEE MOH

39 QUATIT HC MAY-AYNEE MOH

40 DABRE HS MAY-MINE MOH

41 MAY-MINE HC MAY-MINE MOH

42 MAY-MINE MCH MC MAY-MINE CCM

43 KUDO-FELASI HS MENDEFERA MOH

44 MENDEFERA HS MENDEFERA CCM

45 MENDEFERA MCH MC MENDEFERA MOH

46

MENDEFERA REG.

REF. HOSP HO MENDEFERA MOH

47 MENDEFERA VCT CL MENDEFERA MOH

48 AKRUR HS SEGHENEYTI CCM

49 DIGSA HC SEGHENEYTI CCM

50 HADIDA HS SEGHENEYTI MOH

51 HEBO HS SEGHENEYTI CCM

52 INGELA HC SEGHENEYTI CCM

53 SEGHENEYTI HC SEGHENEYTI MOH

54 FORTO HS SENAFE MOH

55 GOLO HS SENAFE MOH

56 LAHAYO HS SENAFE MOH

57 MESEREHA HS SENAFE CCM



154

58 MONOKSOYTO HS SENAFE CCM

59 SENAFE HS SENAFE CCM

60 SENAFE MH SENAFE MOH

61 SERHA HS SENAFE MOH

62 DEKILEFAY HS TSORENA MOH

63 ENDABA-STIFANOS HS TSORENA MOH

64 GHENZEBO HS TSORENA MOH

65 HADIS-ADI HS TSORENA MOH

66 ONA-ANDOM HS TSORENA MOH

67 TSORENA HC HC TSORENA MOH

68 TSORENA HS HS TSORENA CCM

VI.7.3. DKB


1 AYTUS HS ARETA MOH

2 AYUMEN HS ARETA MOH

3 EGROLI HS ARETA MOH

4 TIO MH ARETA MOH

5 ASSAB REG. REF. HOSP HO ASSAB MOH

6 ASSAB VCT CL ASSAB MOH

7 BAHTI-MESKEREM HS ASSAB MOH

8 ABO HS DEBUB-DENKALIA CCM

9 BEYLUL HS DEBUB-DENKALIA MOH

10 DEBAISIMA HS DEBUB-DENKALIA CCM

11 RAHAITA HS DEBUB-DENKALIA MOH

12 WADE HS DEBUB-DENKALIA MOH

13 AFAMBO HS MAKELAY KEYHI BAHRI MOH

14 BEL-EBUY HS MAKELAY KEYHI BAHRI MOH

15

EDI COMMUNITY

HOSPITAL MH MAKELAY KEYHI BAHRI MOH



155

VI.7.4. Gash Barka


1 ADERDE HS AGORDAT EVM

2 ADI-SADINA HS AGORDAT MOH

3 AGORDAT HO AGORDAT MOH

4 AGORDAT MCH MC AGORDAT MOH

5 AGORDAT VCT CL AGORDAT MOH

6 DERET HS AGORDAT MOH

7 ENGERNE HS AGORDAT CCM

8 BARENTU MCH MC BARENTU MOH

9 BARENTU REG. REF. HOSP HO BARENTU MOH

10 BARENTU VCT CL BARENTU MOH

11 DASSIE HS BARENTU MOH

12 KERCASHA HS BARENTU MOH

13 KULUKU HS BARENTU EVM

14 SOSONA HS BARENTU MOH

15 ADI-IBRAHIM HS DIGHE MOH

16 BISHA CL DIGHE MOH

17 DIGHE (GHIRJENAY) HS DIGHE MOH

18 KATRENAY HS DIGHE MOH

19 KERU HS DIGHE MOH

20 SHATERA HC DIGHE MOH

21 TEKRERET HS DIGHE MOH

22 FORTO HC FORTO MOH

23 GHIRMAYKA HC FORTO MOH

24 MOLOVER HS FORTO MOH

25 SAWA(HOMIB) HS FORTO MOH

26 TAMARAT HS FORTO MOH

27 GOGNE HC GOGNE MOH

28 TAKAWDA HS GOGNE MOH

29 ADI-SHEGALA HS GULUJ MOH



156

30 ANGULET (Anagulu) CL GULUJ MOH

31 GERGEF HS GULUJ MOH

32 GERSET HS GULUJ MOH

33 GULUJ HC GULUJ MOH

34 KACHERO HS GULUJ MOH

35 OMHAJER HC GULUJ MOH

36 SABUNAIT HS GULUJ MOH

37 SANDASHINA (MENGULA) HS GULUJ MOH

38 TEBELDIA HS GULUJ MOH

39 ALEBU HS HAYCOTA MOH

40 FESCO HS HAYCOTA MOH

41 HADEMDEMIT CL HAYCOTA MOH

42 HAYCOTA HC HAYCOTA MOH

43 ANTORE HS LAELAY GASH MOH

44 AUGARO HS LAELAY GASH MOH

45 GERENFIT HS LAELAY GASH MOH

46 MAY-SHIGLY HS LAELAY GASH MOH

47 SHILALO HS LAELAY GASH MOH

48 TOKOMBIA HC LAELAY GASH MOH

49 ADI-NIAMIN HS LOGO ANSEBA MOH

50 KERENAKUDO HS LOGO ANSEBA MOH

51 LIBAN HS LOGO ANSEBA MOH

52 MEKERKA HC LOGO ANSEBA MOH

53 MELEZANAY HS LOGO ANSEBA MOH

54 DULUK HS MENSURA MOH

55 GERGER HS MENSURA MOH

56 HIRKUK HS MENSURA MOH

57 MENSURA HC MENSURA MOH

58 MIGRAH (TINSHAY) HS MENSURA MOH

59 AREDA (COFERENCO) HS MOGOLO MOH

60 MOGOLO HC MOGOLO CCM

61 TOMBITA HS MOGOLO MOH

62 DERABUSH HS MULKI MOH

63 ENDA-GABR HS MULKI MOH

64 FOLINA HS MULKI MOH



157

65 MAI-DOGALE HS MULKI MOH

66 MULKI HC MULKI MOH

67 BINBINA HS SHAMBUKO CCM

68 KOROKON HS SHAMBUKO MOH

69 KOTOBIA HS SHAMBUKO MOH

70 SHAMBUKO HC SHAMBUKO MOH

71 ALIGHIDIR HS TESSENEY MOH

72 FANKO HS TESSENEY MOH

73 TALATA ASHER HS TESSENEY MOH

74 TESSENEY HO TESSENEY MOH

75 TESSENEY MCH MC TESSENEY MOH

76 TESSENEY VCT CL TESSENEY MOH

VI. 7.5. Maakel

1 HAZEGA HS BERIKH EVM BED

2 TSADA CHRISTEAN HC BERIKH MOH

3 TSEAZEGA HS BERIKH MOH

4 ADI-GUEDAD HC GHALA NEFHI MOH

5 ADI-HAUSHA HS GHALA NEFHI MOH

6 ERITREAN INSTITUTE TECH. HC GHALA NEFHI MOE

7 GULIE HS GHALA NEFHI MOH

8 HIMBERTI HS GHALA NEFHI MOH

9 KETEMWWULIE HS GHALA NEFHI MOH

10 MASSAWA VCT CL MASSAWA MOH

11 ACRIA HC NORTH EAST ASMARA MOH

12 ARBATE-ASMARA HS NORTH EAST ASMARA MOH

13 DR. SURUR ALIABDU CL NORTH EAST ASMARA PRV

14 EDAGA HAMUS MH NORTH EAST ASMARA MOH

15 ERITREA ELECTRIC AUTH. CL NORTH EAST ASMARA IND

16 ERITREA TEXTILE CL NORTH EAST ASMARA IND

17 NASANET ENTERPRISE CL NORTH EAST ASMARA IND

18 SABA HS NORTH EAST ASMARA MOH

19 ASMARA PICKLING TANNERY CL NORTH WEST ASMARA IND



158

20 COCA-COLA SOFT DRINK CL NORTH WEST ASMARA IND

21 HAZHAZ HS NORTH WEST ASMARA MOH

22 HAZHAZ HOSP HO NORTH WEST ASMARA MOH

23 PRISON SERVICE CL NORTH WEST ASMARA POL

24 RED SEA LEATHER TANNERY CL NORTH WEST ASMARA IND

25 REHABILITATION CENTER CL NORTH WEST ASMARA MOH

26 SEMENAWI ASMARA HC NORTH WEST ASMARA MOH

27 ADI-SHEKA HS SEREJEKA MOH

28 AZIEN HS SEREJEKA MOH

29 BELEZA HS SEREJEKA MOH

30 EMBADERHO HS SEREJEKA MOH

31 GESHNASHIM HS SEREJEKA MOH

32 SEREJEKA HC SEREJEKA MOH

33 WEKI HS SEREJEKA MOH

34 ZAGIR HS SEREJEKA CCM

35 ABRAHA BAHTA SCHOOL CL SOUTH EAST ASMARA MLW

36 ADIS-ALEM HC SOUTH EAST ASMARA MOH

37 ASBECO COMPANY CL SOUTH EAST ASMARA IND

38 ASMARA BEER FACTORY CL SOUTH EAST ASMARA IND

39 AYRAHC (ASMARA YOUTH) CL SOUTH EAST ASMARA OTH

40 BRITISH AMERICAN TOBACCO CL SOUTH EAST ASMARA IND

41 DEARIT DENTAL CLINIC CL SOUTH EAST ASMARA PRV

42 DR. MAHMUED M/OMER CL SOUTH EAST ASMARA PRV

43 DURFO HS SOUTH EAST ASMARA MOH

44 EDAGA VCT CL SOUTH EAST ASMARA MOH

45 FAMILY REPRODUCTIVE CL SOUTH EAST ASMARA MOH

46 LASALE HS SOUTH EAST ASMARA MOH

47 METAL WORKS FACTORY CL SOUTH EAST ASMARA IND

48 NATIONAL INSURANCE CORP. CL SOUTH EAST ASMARA IND

49 POLICE CLINIC CL SOUTH EAST ASMARA POL

50 RED SEA FOOD PRODUCTION CL SOUTH EAST ASMARA IND

51 ST. ANTONIO HS SOUTH EAST ASMARA CCM

52 STAR DENTAL CLINIC CL SOUTH EAST ASMARA PRV

53 TECLE DENTAL CLINIC CL SOUTH EAST ASMARA PRV

54 TELE-CLINIC CL SOUTH EAST ASMARA IND



159

55 VCT2 FREE STANDING CL SOUTH EAST ASMARA MOH

56 ZAER (Asmara Textile) CL SOUTH EAST ASMARA IND

57 ASMARA AIR PORT CL SOUTH WEST ASMARA IND

58 ASMARA PALACE HOTEL CL SOUTH WEST ASMARA IND

59 BARAKO CL CL SOUTH WEST ASMARA IND

60 BEDHO GENERAL CONSTRUCTI CL SOUTH WEST ASMARA IND

61 BINI SHOE FACTORY CL SOUTH WEST ASMARA IND

62 DAHLAK SHARE COMPNAY CL SOUTH WEST ASMARA IND

63 DEMBE SEMBEL SCHOOL CL SOUTH WEST ASMARA IND

64 DENDEN HOSPITAL HO SOUTH WEST ASMARA MOH

65 DENDEN HS HS SOUTH WEST ASMARA MOH

66 DR. REZENE DENTAL CLINIC CL SOUTH WEST ASMARA PRV

67 ERITREAN CORWELL DRILL CL SOUTH WEST ASMARA IND

68 FELEGE HIWET HS SOUTH WEST ASMARA MOH

69 FRE-SELAM HS SOUTH WEST ASMARA MOH

70 GERITERIC HC HC SOUTH WEST ASMARA PRV

71 GODAAIF HC SOUTH WEST ASMARA MOH

72 GODAIF HS SOUTH WEST ASMARA MOH

73 ORPAHN CLINIC CL SOUTH WEST ASMARA MLW

74 SABUR P. SERVICE CL SOUTH WEST ASMARA IND

75 SEMBEL HS SOUTH WEST ASMARA MOH

76 SEMBEL HOSP HO SOUTH WEST ASMARA PRV

77

SEMBEL METAL & WOOD

FACT CL SOUTH WEST ASMARA IND

78 SEMEBEL HOUSE HOLD FACT. CL SOUTH WEST ASMARA IND

79 SOAPRAL FACTORY CL SOUTH WEST ASMARA IND

80 SPACE 2001 ERITREA CL SOUTH WEST ASMARA IND

81 UNDP CL SOUTH WEST ASMARA NGO



160

VI.7.6. National Referrals


1 ASMARA PHYSIO THERAPY HC NATIONAL REFERRAL MOH

2

BERHAN AYNE

OPHTHALMIC HO NATIONAL REFERRAL MOH

3 HALIBET REFERRAL HO NATIONAL REFERRAL MOH

4 HANSSENIAN HO NATIONAL REFERRAL MOH

5 IOCCA HC NATIONAL REFERRAL MOH

6 MDR HOSPITAL HO NATIONAL REFERRAL MOH

7 MEKANE HIWET OBS_GYN HO NATIONAL REFERRAL MOH

8 MEKANE HIWET PEDIATRIC HO NATIONAL REFERRAL MOH

9 OROTTA HO NATIONAL REFERRAL MOH

10 ST MARY HO NATIONAL REFERRAL MOH

VI. 7.7 SKB

1 ARARIB HS ADOBHA MOH BED

2 ELA-BABU HS ADOBHA MOH

3 HASTA HS ADOBHA MOH

4 HIMBOL HC ADOBHA MOH

5 AFABET HO AFABET MOH

6 FELKET HS AFABET MOH

7 GADM HALIB HS AFABET MOH

8 KAMCHEWA HC AFABET MOH

9 DAHLAK HC DAHLAK MOH

10 DEHILE HS DAHLAK MOH

11 DERBUSHET HS DAHLAK MOH

12 FORO HC FORO MOH

13 IRAFAYLE HC FORO MOH

14 ROBROBIA HS FORO MOH

15 SILIKE HS FORO MOH

16 BADA HC GHELAELO MOH

17 BUYA HS GHELAELO MOH

18 GHELAELO HC GHELAELO MOH



161

19 INGEL HS GHELAELO MOH

20 MENKALELE HS GHELAELO MOH

21 DANKUR HS GHINDAE MOH

22 DEMAS HS GHINDAE MOH

23 EMBATKALA HS GHINDAE MOH

24 GAHTELAY HS GHINDAE MOH

25 GHINDAE HC GHINDAE IND

26 GHINDAE HS GHINDAE CCM

27 GHINDAE REG. REF. HOSP HO GHINDAE MOH

28 MARGERAN CL GHINDAE IND

29 MAYHABAR HS GHINDAE MOH

30 NEFASIT HC GHINDAE MOH

31 SHEBAH HS GHINDAE MOH

32 KARORA HS KARORA MOH

33 MAHMIMET HC KARORA MOH

34 ADIS ALEM DENTAL CL CL MASSAWA MOH

35 AMATERE MC MASSAWA MOH

36 CEMENT FACTORY HS MASSAWA IND

37 ENKULU CL MASSAWA NGO

38 HIRGIGO HS MASSAWA MOH

39 KUTMIA HS MASSAWA MOH

40 MARIN SCIENCE COLLAGE CL MASSAWA MOE

41 MASSAWA HO MASSAWA MOH

42 MASSAWA PORT HS MASSAWA IND

43 TIWALET HS MASSAWA MOH

44 WEKIRO HS MASSAWA MOH

45 AGRAIE HS NAKFA MOH

46 BACKLA HS NAKFA MOH

47 ENDLAL HS NAKFA MOH

48 NAKFA HO NAKFA MOH

49 SHIEB HC SHIEB MOH

Eritrea Annual Health Service Activity Report of Year 2012

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Transcript of Eritrea Annual Health Service Activity Report of Year 2012