The Prevalence of Anaemia Among Children Age 6 to 59 Months and Association Factors in Central Highland Region of Ethiopia, Community Based Cross Sectional Design, Initial Assessment for BCC Intervention

Behavioral change communication (BCC) to prevent iron deficiency anaemia had lacked attention in our country. Considerably, children are the most vulnerably group for iron deficiency anaemia (IDA). This study aimed to assess prevalence of anaemia and associated factors among children age 6 to 59 months. Methods: Community based Cross sectional study design was used for initial assessment for BCC intervention in Central Highland of Ethiopia. Multistage sampling method was used to select 8 districts, 16 clustered Kebeles (smallest unit of administration) and 1012 mothers/care givers and their pair children age 6 to 59 months by considering feature BCC intervention. Dietary behaviour, anthropometric measurements and blood samples data were collected. Binary and linear logistic regressions were analysed using IBM SPSS Statistics software version 21. Results: The prevalence of anaemia among study subjects was 184 (18.4 %.), but higher (24.1%) among group of age 6 to <24 months. The mean Hb concentration was 12.55+ 1.73 and stunted growth (411 (40.6%)). Being consuming cow milk as major complementary food (Adjusted Odds Ratio (AOR) =4.54, 95% CI =3.14, 6.56), age 6 to <24 months (AOR=1.4, CI=1.10, 2.94) were considered as independent predictors of risk for having anaemia among children. In linear logistic regression analysis, being increasing age (Bcoefficient ((B) = 0.172, CI=0.01, 0.33) and increasing height (B=0.170, CI=0.14, 0.329) were potentially increase haemoglobin concentration by 0.170 mg/dl. Also, Height for age (HAZ) (B =0.105, CI=0.02, 0.144) change Hb concentration by 0.105mg/dl. Conclusions: The magnitude of anaemia was moderate among young children. Cow milk consumption and young children related to poor dietary intake behaviour increased the risk of anaemia and high proportion of inadequate growth (stunting) among study subjects considerable for BCC intervention to improve iron intake for children growth

Factors associated with women’s autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study

Background Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women’s autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women’s autonomy and identify associated factors in Southeast Ethiopia. Method A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women’s autonomy for health care utilization. Result Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children’s health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women’s autonomy. Conclusion Socio-demographic and maternal factors (knowledge and attitude) were found to influence women’s autonomy. Interventions targeting women’s autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status

Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia : a multilevel cross-sectional analysis

Maternity waiting homes (MWHs) are temporary residential spaces located within or close to health facilities, offering skilled obstetrical care. Data used in this analysis were collected from three districts in Jimma Zone in the southern part of Ethiopia. The survey targeted 3840 women. Qualitative research from this study setting and other areas in Ethiopia highlight the pivotal role of husbands and family support in enabling women’s use of MWHs. Findings have implications for achieving equity in access to maternal healthcare, as poorer women with little social support in the form of companions accompanying them for health facility visits, are among the more vulnerable groups

Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey.

BACKGROUND: Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia. METHODS: Clinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines. RESULTS: Most sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers. CONCLUSION: The Ethiopian health extension workers' clinical assessment, classification and management of sick children did to a large extent not follow the clinical guidelines. This lack of adherence could lead to misdiagnoses and lack of potentially life-saving treatments

Effectiveness of upgraded maternity waiting homes and local leader training in improving institutional births among women in the Jimma zone, Ethiopia : study protocol for a cluster-randomized controlled trial

Geographical and financial barriers are frequently cited as barriers to reaching skilled obstetric care during and after birth. This cluster-randomized trial was designed to evaluate the effects of access to upgraded maternity waiting homes (MWH) on the number of institutional births, relative to usual maternity care and access. Three arms of the study trial are: (1) upgraded MWH along with religious/community leader training; (2) leader training alone; and (3) standard care. The article provides details of the study including trial design, methodology, intervention components, activities and projected outcomes.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Quality of sick child management by health extension workers: role of a complex improvement intervention

BACKGROUND: Despite the expansion of the Integrated Community Case Management services for childhood illness, quality and utilization of services have remained low. To address the problem, the Government of Ethiopia introduced a complex intervention that included community engagement, capacity building of health workers and enhanced district-level ownership of sick child management. We examined whether this complex intervention was associated with improved management of sick children by health extension workers. METHODS: The study was conducted in four Ethiopian regions. A baseline survey was conducted in 26 intervention and 26 comparison districts from December 2016 to February 2017, followed by an end-line survey 24 months later. We observed health extension workers' consultations of sick 2-59 months old children. The analysis has evaluated if children with pneumonia, diarrhoea and malnutrition were assessed, classified and treated according to guidelines, and included difference-in-difference analyses. RESULTS: We observed 1325 consultations of sick children. At baseline, 86% of the sick children with cough in the intervention areas and 85% in comparison areas were assessed according to the guidelines, without any change at end-line associated with the intervention (difference-in-difference = -21%, p = 0.55). Sixty-two percent of children were assessed for dehydration at baseline in intervention and 47% in comparison areas, with no improvement associated with the intervention. Similarly, 87% of sick children in intervention and 91% in comparison areas were assessed for malnutrition, with no change over time associated with the intervention (difference-in-difference = 5%, p = 0.16). Appropriate pneumonia treatment with antibiotics declined and diarrhea treatment increased in both areas. Half of the malnourished children received ready-to-use therapeutic foods without any improvement associated with the intervention. CONCLUSION: The intervention was not associated with improved quality of the health extension workers' management of sick children. The lack of association may be linked to low fidelity in the implementation of the intervention. Our findings suggest that training healthcare providers without continued clinical mentoring and support does not improve the quality of care. Community-based programs can be strengthened by ensuring high coverage and continued clinical mentorships, supportive supervision, and supply of medicines and other essential commodities. TRIAL REGISTRATION NUMBER: ISRCTN12040912, retrospectively registered on 19/12/ 2017

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births : a cluster-randomized controlled trial in Jimma, Ethiopia

The objective of this cluster randomized trial was to evaluate the effectiveness of functional maternity waiting homes (MWH) combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. MWHs are residential spaces for pregnant women located near to obstetric care facilities, which are being used to tackle physical barriers to access. Findings show both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care. Both the combined MWH and leader training, and leader training alone, led to a small but non-significant increase in institutional births.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas.

BACKGROUND: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. METHODS: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. DISCUSSION: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017