Countdown to 2015: Ethiopia's progress towards reduction in under-five mortality: 2014 country case study

On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for accelerating health improvements and reducing child deaths

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones

Performance of various PFM modalities in Ethiopia: a possibility for harmonization at national scales

Over the past few decades, Participatory Forest Management (PFM) has emerged as a key strategy internationally. Following the recognition that centralized and expert-dependent forest management practices have been unsuccessful in halting deforestation, the government of Ethiopia, with assistance from international donors, has been implementing PFM pioneer projects since the early 1990’s. The experiment is based on the assumption that participation of local communities, which are the major stakeholders using the forest resources, is essential for reversing the de facto open access to forests. The PFM pilot projects have used a diversity of implementation strategies, however, that need to be evaluated before a national PFM strategy can be formulated. The present paper conducts an evaluation of the institutional set up and the outcomes of seven pioneer old PFM sites distributed in Oromia and Southern Nations Nationalities and People Regional states. Outcomes are assessed as forest users’ perceived changes (before and after pioneer projects) in (1) ownership feeling over the resource (2) change in forest condition (3) change in livelihood of members, and (4) stability of the PFM institutions. Qualitative data was collected in focus group discussions, semi-structured and key informants interviews. Our findings indicate that in most sites the forest cover and ownership feelings of the community have improved after introduction of PFM. Post project assessment, however, shows that weak law enforcement, revocation of PFM agreements by the government, high project staff turnover and inequitable forest benefit distribution endangers the sustainability of PFM in Ethiopian pioneer projects. The paper argues that scaling up PFM without consideration for these issues risks multiplying mistakes

Target priority transboundary animal diseases and zoonoses in the IGAD region for control interventions

Prioritization of transboundary animal diseases (TADs) and zoonoses in the IGAD region was conducted by IGAD Member States, namely, Djibouti, Ethiopia, Eritrea, Somalia, South Sudan and Sudan together with support from ICPALD and AU-IBAR. The main aim of the exercise was to develop clear control strategies and policies for focussing disease control efforts and the limited resources on few diseases in order to achieve efficient and effective disease control. The prioritization methodology for transboundary animal diseases and zoonoses according to Phylum was applied, taking into considerations, economic impact, human health importance, societal impact, environmental impact, feasibility of control methods and the ecological impact of the diseases. Overall, Rift Valley fever had the highest rank, followed by Contagious Bovine  Pleuropneumonia, Newcastle Disease, Highly Pathogenic Avian Influenza, Lumpy Skin Disease, Peste des Petits des Ruminants, Rabies,  Brucellosis, Bovine Tuberculosis, Foot-and Mouth Disease and Sheep and Goat Pox. In conclusion, the IGAD region is encouraged to facilitate systematic efforts  towards rolling forth priority diseases through focused national efforts, harmonized regional strategies and streamlined stakeholder investment in the region.Key words: Target, priority, animal diseases, zoonoses, control, interventions, IGAD region Maladies animales transfrontalières et zoonoses prioritaires Ciblées dans la région IGAD pour les interventions de contrôle Les États membres de l’IGAD, à savoir Djibouti, l’Éthiopie, l’Érythrée, la Somalie, le Soudan du Sud et le Soudan, ont procédé à une définition des maladies animales transfrontières et zoonoses prioritaires dans la région IGAD, avec le soutien de l’ICPALD et de l’UA-BIRA. L’objectif principal de cette priorisation était d’élaborer des stratégies et politiques de contrôle claires visant à concentrer les efforts de contrôle des maladies et les rares ressources disponibles sur certaines maladies afin de parvenir à un contrôle efficace et efficient. La méthodologie de priorisation des maladies animales transfrontalières et des zoonoses selon leur phylum a été appliquée, en prenant en considérations l’impact économique, l’importance pour la santé humaine, l’impact sociétal, l’impact environnemental, la faisabilité des  méthodes de contrôle et l’impact écologique des maladies. Dans l’ensemble, la fièvre de la vallée du Rift a été mise en tête des priorités, suivie de la péripneumonie  contagieuse bovine, la maladie de Newcastle, l’influenza aviaire hautement pathogène, la dermatose nodulaire contagieuse, la peste des petits ruminants, la rage, la brucellose, la tuberculose bovine, la fièvre aphteuse et la clavelée du mouton et la variole caprine. En conclusion, la région IGAD est encouragée à faciliter des efforts systématiques visant à contrôler les maladies prioritaires à travers des activités nationales ciblées, des stratégies régionales harmonisées et une rationalisation des investissements des parties prenantes dans la région.Mots-clés : ciblées, prioritaire, maladies animales, zoonoses, contrôle, interventions, région IGA

Usability and acceptability of a multimodal respiratory rate and pulse oximeter device in case management of children with symptoms of pneumonia: A cross-sectional study in Ethiopia

AIM: Pneumonia is the leading infectious cause of death among children under five globally. Many pneumonia deaths result from inappropriate treatment due to misdiagnosis of signs and symptoms. This study aims to identify whether health extension workers (HEWs) in Ethiopia, using an automated multimodal device (Masimo Rad-G), adhere to required guidelines while assessing and classifying under five children with cough or difficulty breathing and to understand device acceptability. METHODS: A cross-sectional study was conducted in three districts of Southern Nations, Nationalities, and Peoples' Region, Ethiopia. Between September and December 2018, 133 HEWs were directly observed using Rad-G while conducting 599 sick child consultations. Usability was measured as adherence to the World Health Organization requirements to assess fast breathing and device manufacturer instructions for use. Acceptability was assessed using semi-structured interviews with HEWs, first-level health facility workers and caregivers. RESULTS: Adherence using the Rad-G routinely for 2 months was 85.3% (95% CI 80.2, 89.3). Health workers and caregivers stated a preference for Rad-G. Users highlighted a number of device design issues. CONCLUSION: While demonstrating high levels of acceptability and usability, the device modifications to consider include better probe fit, improved user interface with exclusive age categories and simplified classification outcomes