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

Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma zone, Ethiopia

The study showed that common reasons for not attending antenatal care (ANC) included women’s lack of awareness of its importance (48%), distance to the health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman’s ability to make healthcare decisions, and pregnancy intendedness. ANC and insecticide-treated net (ITN) uptake during pregnancy in Jimma Zone fall below the respective targets set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma zone, Ethiopia

Re-directing resources to vulnerable sub-groups and locations is necessary to ensure equitable progress in maternal health. Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services. Of major concern are women who are the most vulnerable and in need of healthcare services, being least likely to access them. Mapping of core maternal healthcare service-use indicators can serve as a decision-making tool. This analysis focuses on services across the continuum of maternal healthcare: antenatal care, maternity waiting home use, delivery care at health facilities, and postnatal care, in three rural woredas in Jimma Zone, Ethiopia.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis

Background: Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia. Methods: Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women’s proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality. Results: Significant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women’s decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale. Conclusions: Spatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations

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

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

Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya

Background: Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman’s breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman’s breast health seeking behavior. Methods: This was a mixed method cross-sectional study, conducted between Sept 1st 2015 Sept 30th 2016. We administered surveys to women and male heads of households. Outcomes of interest were analysed in Stata ver 13 and tabulated against gender. We conducted six focus group discussions (FGDs) and 22 key informant interviews (KIIs) with opinion leaders and health care providers, respectively. Elements of the Rapid Assessment Process (RAP) were used to guide analysis of the FGDs and the KIIs. Results: A total of 442 women and 237 male heads of households participated in the survey. Although more than 80% of respondents had heard of breast cancer, fewer than 10% of women and male heads of households had knowledge of 2 or more of its risk factors. More than 85% of both men and women perceived breast cancer as a very serious illness. Over 90% of respondents would visit a health facility for a breast lump. Variable recognition of signs of breast cancer, limited decision- autonomy for women, a preference for traditional healers, lack of trust in the health care system, inadequate access to services, limited early-detection services were the six themes that emerged from the FGDs and the KIIs. There were discrepancies between the qualitative and quantitative data for the perceived role of the male head of household as a barrier to seeking breast health care. Conclusions: Determining level of breast cancer knowledge, the characteristics of breast health seeking behavior and the perceived barriers to accessing breast health are the first steps in establishing locally relevant intervention programs

Quality assessment of health management information system (HMIS) data for maternal and child health in Jimma zone, Ethiopia

Health management information system (HMIS) data underpin attainment of health targets in low- and middle-income countries. However, the quality of HMIS data is often poor. The study appraised the completeness, timeliness, and internal consistency of eight key maternal and child health (MCH) indicators collected for all the primary health care units (PHCUs) located within three districts of Jimma Zone, Ethiopia. Results show that the HMIS may over-report the coverage of key MCH services, namely, antenatal care, skilled birth attendance and postnatal care. The quality of data at the zonal level could be improved to inform MCH research and programmatic efforts.Global Affairs Canada (GAC)Canadian institutes of Health Research (CIHR

Appendix 7 - CCGH 2017 poster

The poster provides a project snapshot. The study examined the relationship between mosquito net ownership and use, and self-reported malaria infection in pregnant women. As well, it clarifies how pregnant women use antenatal care (ANC) that includes mosquito nets. Determining the malaria infection rate in pregnant women is critical for assessing factors that relate to the risk of infections and complications during pregnancy. Data from a cross-sectional survey confirmed that ANC attendance in Jimma Zone is lower than the Federal Ministry of Health’s target of 95% of pregnant women attending four ANC visits (by 2020).Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation