Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016.

BACKGROUND: The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data. METHODS: The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran's, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6. RESULTS: The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran's I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners' educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up. CONCLUSIONS: In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner's education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country

Climate Resilience of town water utilities in Eastern Ethiopia

Climate change threatens the safety of water supplies globally, but small water supplies in rapidly growing and urbanizing towns in low- and middle-income countries are especially at risk. Despite the efforts of the Government of Ethiopia, research shows that that small-town water utilities in Ethiopia are poorly equipped to prioritize developing and maintaining climate-resilient water services. We applied the How tough is WASH framework for climate resilient water supplies to ten town water utilities in Eastern Ethiopia to identify their strengths and weaknesses in preparing for climate change. We found reports of weak institutional support from service authorities and exclusion of climate risk management from trainings, which cascades down to service providers in the form of lack of emergency response, inadequate staffing and financial mismanagement. This is consistent with previous studies on sustainability of town water utilities and highlights the applicability of this tool into existing monitoring frameworks that have been proposed for town water utilities in Ethiopia. We also modified the How tough is WASH framework to capture these findings and better reflect the complexity of a utility-managed piped water supply