Two Ethiopian health care workers
By Project ECHO Communications and Marketing Staff

Ethiopian Hospitals Improve Care for Mothers and Babies with ECHO

Eight hospitals successfully implemented a quality improvement project to standardize delayed cord clamping at birth

In 1990, Ethiopia’s child mortality rate was one of the highest in the world – 205 deaths for every 1,000 babies born.

By 2021, the country’s health system had made significant progress, lowering mortality rates by 84%, but there is still much work to be done in this fast-developing country with persistent public health challenges.

When the Ethiopian Pediatrics Society, together with the American Academy of Pediatrics, decided to address the problem, they turned to Project ECHO.

In 2020, they established the Ethiopian Quality Improvement Initiative ECHO program. The program was implemented in eight hospitals in the Ethiopian capital of Addis Ababa with a goal to increase knowledge around quality improvement (QI) methods and test potential improve newborn care practices in the delivery room. 

For their inaugural QI project in 2021, the hospitals chose to improve the timing of cord clamping, a low-cost intervention with the potential to make a significant impact. “Delayed clamping” means the provider waits one to three minutes after birth to cut or clamp the umbilical cord in non-emergency situations. This delay allows extra time for the blood in the cord and placenta to flow to the baby, decreasing the risk of anemia and boosting neurodevelopment as the baby grows.

Bogale Worku, MD, executive director of the Ethiopian Pediatrics Society, has seen firsthand ECHO’s ability to create meaningful change.

“When we finished with the cord-clamping project, [the hospitals] told us, ‘This is the culture in our unit now. [Cord-clamping knowledge] is no longer a challenge, no longer a gap,’” he says. “I’m so happy we can move the same standards to remote areas where connections are available.”

After 12 ECHO sessions, combining expert lectures and case discussions by hospital-based QI coaches, all eight participating hospitals significantly improved the rate of providers using delayed cord clamping. Nearly all reached their goal of 90% compliance. 

“Delayed core clamping was such a good project for them to pick, because it doesn't require a lot of resources,” says Duke Health neonatologist Sharla Rent, MD, a team leader. “It literally is just a knowledge practice change so they didn't need extra supplies or a lot of extra training and it [lent itself] to quicker implementation.”

This is the culture in our unit now. [Cord-clamping knowledge] is no longer a challenge, no longer a gap,I’m so happy we can move the same standards to remote areas where connections are available
Dr. Bogale Worku, Executive Director of the Ethiopian Pediatrics Society

ECHO’s unique telementoring approach gets life-saving knowledge to underserved communities around the globe, making it a powerful tool in the fight against systemic inequity that makes it difficult for patients to access care when, and where, they need it. For the medical professionals working to alleviate health care inequities in Ethiopia, it was the fastest and most effective way to improve quality of care for mothers and infants.

Project ECHO would like to thank the participants in this story

  • Bogale Worku, MD, Executive Director, Ethiopian Pediatrics Society
  • Shannon Limjuco, MPH, Director of Telehealth and ECHO Initiatives, American Academy of Pediatrics
  • Sharla Rent, MD, FAAP, Neonatologist, Duke Health

About Project ECHO

Since 2003, Project ECHO’s telementoring model has been used to address some of the world’s greatest challenges in health care, education and more. Headquartered at The University of New Mexico Health Sciences Center in Albuquerque, N.M., Project ECHO is empowering local community providers to improve the well-being of people around the world.

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