The Addis Ababa Declaration on Global Health Equity: A call to action

Background: Health inequalities occur through differences in health status or in the distribution of health determinants between different population groups. Access to basic health services was affirmed as a fundamental human right by the declaration of Alma-Ata in 1978. The reality is that, in 2012, more than 40 years later, many people in resource-poor settings still do not have equitable access to even basic health services. In many places this gap is widening.Rationale: In order to tackle the different global health inequities there is still a need for a concerted effort by different public health experts and institutions. As a multidisciplinary professional association, the World Federation of Public Health Associations (WFPHA) which has a mission of promoting and protecting global public health is one of the institutions which stand for such causes. One of the WFPHA platforms for such kind of initiatives is its triennial World Congress on Public Health, a scientific conference for public health professionals from around the world.The WFPHA Congress: The 13th World Congress on Public Health with the theme of “Moving towards Global Health Equity: Opportunities and Threats”, was held in Addis Ababa, Ethiopia from April 23-27, 2012. The congress brought together over 3000 public health experts from more than 100 countries to discuss different health issues including its major theme global health equity. Participants of the congress touched several public health issues that include: major health threats, health inequity, migration, fair trade, revised MDGs, development aid and health workforce which were used to forward recommendation for action.Call for action: Based on the different interaction, at the conclusion of the 13th World Congress on Public Health, the WFPHA issued the Addis Ababa Declaration, a call to action on Global Health Equity.

Characteristics of maize cultivars in Africa: how modern are they and how many do smallholder farmers grow?

Open Access Journal; Published online: 17 March 2017Maize is the most important cereal and most widely cultivated staple that plays a key role in the food security of sub-Saharan Africa (SSA). Although some countries have achieved significant gains in maize productivity, the SSA average yields are far below what could be obtained with improved cultivars under good crop management. Low cultivar turnover is one among many contributing factors to low maize yields in SSA. At present, there is a critical knowledge gap on the identity, number, and age of maize cultivars currently grown by smallholder farmers on the continent. Results This study revealed that nearly 500 maize cultivars were grown in 13 African countries surveyed in the 2013/2014 main crop season. Sixty-nine percent of the cultivars each occupied 40% and four occupied >30% area. Approximately 32% of all the cultivars were hybrids, 23% were improved open-pollinated varieties (OPVs), and 46% were locals. Eastern Africa (EA) and southern Africa (SA) accounted for about 43 and 38%, respectively, of all the cultivars reported, whereas West Africa’s (WA) share was 19%. The average area planted to modern cultivars in the surveyed areas was estimated at 57%—with EA, SA, and WA estimates of 82, 55, and 36%, respectively; however, increased adoption was not necessarily always related to improved productivity, as the latter depends on many additional factors. Each household planted an average of 1.781 cultivars (range 1–8). The overall weighted average age of the cultivars was 15 years, with hybrids and OPVs being 13 and 18 years, respectively. Conclusions Maize variety turnover in SSA is slower than what is practiced in the USA and other world regions such as Latin America and Asia. The substantial variations among regions and countries in all parameters measured suggest a tailored approach to mitigation interventions. Findings of this current study pave the way for replacing the old cultivars with more recent releases that are tolerant or resistant to multiple stresses and are more resilient

Improving the range of contraceptive choices in rural Ethiopia

Background: Despite the reality of a high unmet need, the utilization of family planning services in Ethiopia could be described as very low. Besides this, the knowledge and practice of family planning is limited merely to the usage of shorter-term contraceptive methods. Therefore, there is a need to expand access to family planning services in rural Ethiopia by making available more choices to family planning clients. Objective: The aim of this study is to examine the pattern of family planning method mix overtime and to assess the impact of combining strategies, such as community and facility based approaches, in improving access to family planning services and choices. Methods: A cross-sectional, descriptive study was conducted in September 2000 in Tehuledere woreda, in South Wollo zone, Amhara Regional State. A census was done on all clients who live in 15 kebeles in the woreda and who used long-term and permanent family planning methods which included IUD, Norplant and male and female sterilization methods and were interviewed. Results: Among the 218 family planning clients interviewed, 11 (5%) were males who had undergone vasectomy. Almost 81% of the clients using long-term and permanent methods were in the age group of 25-44 years. The mean age was 34.2 years with a range of 18-70 years and the mean number of children ever born to the study subjects was 5.6 with a range of 0-14 children. Knowledge of modern family planning methods was found to be over 90%, the majority (73.9%) of the respondents getting information on family planning from the community based reproductive health (CBRH) program. Fifty two percent have undergone voluntary surgical contraception, followed by Norplant (39.0%) and IUD (8.7%). Among the major reasons mentioned for the use of the current family planning methods were limiting family size (45.9%), spacing (27.5%), and side effects of the previous method (12.4%). For most clients (90.8%) the source of information for their current use is the CBRH program. Conclusions: Improving the usage of wide range of contraceptive method mix improves the quality of family planning services rendered to the community and ensures sustainability of the services. A coordinated effort among facility based and community based providers can assist in ensuring client choices and improving the method mix. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 74-7

Genotype x environment interaction and stability analysis for yield and yield related traits of Kabuli-type Chickpea (Cicer arietinum L.) in Ethiopia

Chickpea is the major pulse crop cultivated in Ethiopia. However, its production is constrained due to genotype instability and environmental variability. This research was carried out to examine the magnitude of environmental effect on yield of chickpea genotypes and to investigate the stability and adaptability of genotypes under different agro-ecologies. Seventeen (17) genotypes were evaluated in randomized complete block design (RCBD) with four replications in five locations. Various stability indices were used to assess stability and genotype by environment performances. Combined analysis of variance (ANOVA) for yield and yield components revealed highly significant (P≤0.01) differences for genotypes, environments and their interaction. The significant interaction showed genotypes respond differently across environments. At Akaki, Chefe Donsa, Debre Zeit, Dembia and Haramaya, top performing genotype were DZ-2012-CK-0001 (2933 kg/ha), Arerti (3219 kg/ha), Arerti (3560 kg/ha) DZ-2012-CK-0013 (2675 kg/ha) and Arerti (2019 kg/ha), respectively. The first two PCs explained 74.45% of the variance. Based on ASV value, DZ-2012-CK-0002 were most stable genotypes. As per AMMI biplot, Arerti and DZ-10-4 were most widely adapted genotypes. Dembia and Haramaya were most discriminative environments for genotypes. Debre Zeit and Chefe Donsa were favorable environment for genotype. Genotypes DZ-2012-CK-0004, DZ-2012-CK-0010, DZ-2012-CK-0013, DZ-2012-CK-0007 and DZ-10-4 are recommendable to Akaki, Chefe Donsa, Debre Zeit, Dembia and Haramya, respectively.Keywords: AMMI, ASV, clustering, phenologic traits, Kabuli, univariate statistics.Abbreviation: E, Environments; G, genotypes; RCBD, randomized complete block design.

The status of hygiene and sanitation practice among rural model families of the Health Extension Program (HEP) in Wolayta and Kembata Tembaro Zones of Southern Nations, Nationalities and Peoples’ Region of Ethiopia

Background: Since the Health Extension Program (HEP) started the training and graduation of model families, little is known about the status and maintenance of hygiene and sanitation practice to inform future directions and decisions.Objective: to assess the status and maintenance of hygiene and sanitation practices among rural model families of the Health Extension Program.Method: A cross-sectional comparative study was conducted from Dec.-June 2010/11 in Wolayta and Kembata Tembaro Zones of Southern Nations, Nationalities and Peoples Regional State of Ethiopia. Two types of comparisons were involved in the study; comparison of hygiene and sanitation practices of a randomly selected 690 model families and 686 non-model families, and comparison of similar practices among model families at the time of graduation, assessed in retrospective interview, versus at the time of survey. Quantitative data were collected from the two zones from Dec- Jan. 2010/11. Qualitative data were also collected in June 2011 to complement the findings of the quantitative data from a purposively selected group of women and men among model families in the study areas. Descriptive and analytics statistics were used to analyse the quantitative data using STATA version 10 while the qualitative data were analysed using Open Code version 3.6.2.0Results: The study showed that among model families, 82% of them had pit latrine, 23.1 % had solid and liquid waste disposal pits, 19.0% had shelves for storing utensils and 34.1 % had separate dwelling for people and cattle as compared to 55.6 %, 9.1%, 6% and 18.5 % of similar practices among non-model families respectively (p<0.001). Latrine availability, storage of water in a narrow necked covered container, possession of shelves for storage of utensils and fuel saving stoves declined from 96.6% to 82.3%, 92.7% to 78.6%, 33.6% to 19.1% and from 6.1% to 3%, respectively among model families after graduation (p<0.01). During FGDs and in-depth interviews, socio-economic and cultural reasons were mentioned as factors that hindered the maintenance of the practices.Conclusion: Generally, model families performed better in most of the hygiene and sanitation practices than nonmodel families. The study also indicated a decline in the maintenance of certain practices among some model families

The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

BACKGROUND: There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period. METHODS: A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped. FINDINGS: Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions. CONCLUSIONS: The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.Scopu

Post-harvest management and associated food losses and by-products of cassava in southern Ethiopia

Improved (high yield and disease resistant) cassava varieties were introduced into Ethiopia around the onset of the twenty-first century, as a potential food security crop. At present, limited information is available from the country on post-production aspects of the value chain (VC) and related food losses. The lack of such data prevents policymakers and VC actors from taking steps towards improving VC efficiencies, which can have a significant impact on livelihoods and food security. The focus of this study was to examine the prevailing post-harvest practices in the cassava VC in southern Ethiopia and quantify the extent of food losses and associated by-products in the framework of the recently developed ‘food loss and waste protocol’. The majority of the cassava in the study area was processed into dry chips and milled into a composite flour with teff and maize to prepare the staple bread (injera). ‘Critical loss points’ were during sun-drying (4%) and stockpiling at farm and marketplace (30–50%). Insect pest damage was primarily responsible for food losses at farm and market level. The most important insect species infesting dry cassava were identified during the survey. As far as the by-products were concerned, the ratio of leaf:wood (stem and stump):starchy root on a dry matter basis at harvest was 1:6:10. Further emphasis should be on improving processing and storage technologies to reduce food losses and the better recovery and utilisation of by-products, especially the leaves of cassava, which could be a potential source of protein in human diets