Rural poverty in Ethiopia: household case studies from North Shewa

The paper utilizes qualitative data to expand our understanding of the nature and dynamics of rural poverty. It is based on data from key informant interviews, focus group discussions and household case studies collected in two kebele administrations in Tarmaber wereda of North Shewa, one in the woina dega agro-ecological zone and the other in the dega zone. The qualitative approach undertaken in this study goes beyond measurements of incomes and expenditures in assessing poverty to characterize the significance of varying levels of access to key production assets for household economic status, the nature of poverty in a specific context, and the attributes of locally relevant economic categories of households. The process-oriented approach to poverty provides a fuller and more accurate assessment of the factors explaining why households fall into poverty. It also shows how consideration of the 'active' and subjective aspects of various peasant livelihood strategies brings out the potential of and constraints on each of them. Furthermore, it demonstrates that social phenomena such as networks of mutual assistance, resource exchanges, the social development and adaptive changes in the structure of households, which are best studied through qualitative methods, have significant implications for household economic prospects and patterns of rural poverty. Finally, peasant perceptions and experiences of various government development interventions and institutions are considered in assessing their potential and shortcomings in terms of poverty reduction

High-risk birth, fertility intention, and unmet need in Addis Ababa

Abstract: In 1993 a survey was conducted to examine family planning knowledge, attitude and use in Addis Ababa. One of the objectives of the survey was to look at those women who were exposed to high-risk birth (HRB), their contraceptive behaviour and the unmet HRB need for family planning. About 88 % of the women were found to be exposed to at least one bio-demographic risk factor. Most of the women in the high risk category (70.6 %) were exposed to high parity, followed by old age (56.6 %) and closely spaced births (15.2 %). A substantial number of women falling in the too old and too many bio-demographic risk categories expressed a desire to stop childbearing compared to women at no risk. Women in the too frequent category of high-risk birth significantly expressed a desire to space the next birth for at least two years when compared to those women who were not at risk of close birth spacing. The unmet HRB need among married women was 60 % which is 10% higher than the conventional unmet need for family planning. Contraceptive prevalence among high-risk women was found to be 26% with 18% of them in need of a better family planning method. [Ethiop. J. Health Dev. 1998;12(2):103-109

RETROSPECTIVE STUDY OF CERVICAL CARCINOMA:1988-1992

INTRODUCTIONCarcinoma of the cervix is one of the most frequently seen malignant neoplasms in the female genital tract (1).The disease is unknown in virgins, of very low incidence in Jews, intermediate in frequency in Muslims and high among Caucasians and African races. The average age is 48 years, the range being 20-80 years (1).The Pathology Section of NRIH receives biopsy specimens from five hospitals in Addis Ababa and from one or more hospitals of seven administrative regions, namely from three hospitals, in Wollega, one hospital in Arsi, two hospitals in Tigray and one hospital in Eritrea

Estimation of child mortality in Addis Ababa

Abstract: Estimation of mortality level in children below the age of five may have profound impact on a number of demographic parameters. Childhood mortality data are also useful in assessing the impact of child survival programs and identifying child populations that are at risk. In March 1993 a survey was conducted to assess the child mortality rate in Addis Ababa. In the study a sample of 548 ever married women were interviewed regarding the number of children ever born, surviving and dead. A variant of the original Brass estimation procedure (Trussell's method) which is based on data classified by duration of marriage is applied. Accordingly, the under-five mortality rate (q5) is estimated to be 114 per 1000. The results, therefore, suggested that under five mortality rate remains high in Addis Ababa. Integrated maternal and child health intervention programmes have to be strengthened in order to reduce this high level of child mortality rate.[Ethiop. J. Health Dev. 1995;9(3):140-145

Assessment of unmet needs and the demand for family planning in Addis Ababa

A study was conducted to asses Unmet needs for FP in Addis Ababa. The city was categorized, for the Purpose of the study, in to two: inner which is densely Populated and periphery which is relatively sparsely Populated. Five kebeles from each category and hundred households from each kebele were selected randomly. A pretested questionnaire was administered through female enumerators, trained for this purpose. Among the interviewed (1(KX) women) the total number with unmet needs were 56.9% (559 women) of which 52.3% (523 women) Want to limit and 4.6% (46 women) Want to space their birth. The unmet need for limiting is higher at older age than at younger; in the case of spacing it is the vise versa. Unmet need was higher among the illiterate than among those with elementary, high school education and above. More than half of the women (56.9% ) were with Unmet needs, while the proportion of women who are currently using any type of contraceptive (CP) method was found to be 21.6%. This means that if the unmet need was to be satisfied, the prevalence may rise up to 78% -the total demand for family planning. A logistic and log linear analysis (using GLIM and SPSS/PC) was done in order to control confounders. And it was found that age, knowledge about CP and level of' education are the most important factors affecting Unmet need for FP and there was no significant interactive effect

Unmet need and the demand for family planning in Addis Ababa

Abstract: A study was conducted in 1993 to estimate the unmet need for family planning service in Addis Ababa. The city was categorized for the purpose of the study, based on population density. Five kebeles were selected from each category and one hundred households from each kebele and a total of seven hundred fifty women were included. Among the interviewed, the total unmet need was 49% (368), of which 43.7% (328) want to limit and 5.3% (40) want to space. The prevalence of contraceptive use (met need) was 21.6% (162), indicating a great deal of potential users and the need for appropriate method to reach them. It was found that age, knowledge about contraception and level of education of respondents were the most important factors affecting unmet need and there was no significant interactive effect. [Ethiop. J. Health Dev. 1995;9(1):41-45

Early postnatal home visits: a qualitative study of barriers and facilitators to achieving high coverage.

BACKGROUND: Timely interventions in the postnatal period are important for reducing newborn mortality, and early home visits to provide postnatal care are recommended. There has been limited success in achieving timely visits, and a better understanding of the realities of programmes is needed if improvements are to be made. METHODS: We explored barriers and facilitators to timely postnatal visits through 20 qualitative interviews and 16 focus group discussions with families and Health Extension Workers in four Ethiopian sites. RESULTS: All sites reported some inaccessible areas that did not receive visits, but, Health Extension Workers in the sites with more difficult terrain were reported to make more visits that those in the more accessible areas. This suggests that information and work issues can be more important than moderate physical issues. The sites where visits were common had functioning mechanisms for alerting workers to a birth; these were not related to postnatal visits but to families informing Health Extension Workers of labour so they could call an ambulance. In the other sites, families did not know they should alert workers about a delivery, and other alert mechanisms were not functioning well. Competing activities reducing Health Extension Worker availability for visits, but in some areas workers were more organized in their division of their work and this facilitated visits. The main difference between the areas where visits were reported as common or uncommon was the general activity level of the Health Extension Worker. In the sites where workers were active and connected to the community visits occurred more often. CONCLUSIONS: If timely postnatal home visits are to occur, CHWs need realistic catchment areas that reflect their workload. Inaccessible areas may need their own CHW. Good notification systems are essential, families will notify CHWs if they have a clear reasons to do so, and more work is needed on how to ensure notification systems function. Work ethic was a clear influencer on whether home visits occur, studies to date have focused on understanding the motivation of CHWs as a group, more studies on understanding motivation at an individual level are needed

'People have started to deliver in the facility these days': a qualitative exploration of factors affecting facility delivery in Ethiopia.

OBJECTIVES: To understand the recent rise in facility deliveries in Ethiopia. DESIGN: A qualitative study. SETTING: Four rural communities in two regions of Ethiopia. PARTICIPANTS: 12 narrative, 12 in-depth interviews and four focus group discussions with recently delivered women; and four focus group discussions with each of grandmothers, fathers and community health workers. RESULTS: We found that several interwoven factors led to the increase in facility deliveries, and that respondents reported that the importance of these factors varied over time. The initial catalysts were a saturation of messages around facility delivery, improved accessibility of facilities, the prohibition of traditional birth attendants, and elders having less influence on deciding the place of delivery. Once women started to deliver in facilities, the drivers of the behaviour changed as women had positive experiences. As more women began delivering in facilities, families shared positive experiences of the facilities, leading to others deciding to deliver in a facility. CONCLUSION: Our findings highlight the need to employ strategies that act at multiple levels, and that both push and pull families to health facilities

Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria.

Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12-13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change

Appropriateness and timeliness of care-seeking for complications of pregnancy and childbirth in rural Ethiopia: a case study of the Maternal and Newborn Health in Ethiopia Partnership

Background: In 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study. Methods: Methods included secondary analysis of data from MaNHEP\u2019s 2010 baseline and 2012 end line surveys, health program inventory and facility mapping to contextualize care-seeking, and illness narratives to identify factors influencing illness recognition and care-seeking. Analyses used descriptive statistics, bivariate tests, multivariate logistic regression, and thematic content analysis. Results: Maternal illness awareness increased between 2010 and 2012 for major obstetric complications. In 2012, 45% of women who experienced a major complication sought biomedical care. Factors associated with care-seeking were MaNHEP CMNH Family Meetings, health facility birth, birth with a skilled provider, or health extension worker. Between 2012 and 2014, the Ministry of Health introduced nationwide initiatives including performance review, ambulance service, increased posting of midwives, pregnant women\u2019s conferences, user-friendly services, and maternal death surveillance. By 2014, most facilities were able to provide emergency obstetric and newborn care. Yet in 2014, biomedical care-seeking for perceived maternal illness occurred more often compared with care-seeking for newborn illness\u2014a difference notable in cases in which the mother or newborn died. Most families sought care within 1 day of illness recognition. Facilitating factors were health extension worker advice and ability to refer upward, and health facility proximity; impeding factors were time of day, weather, road conditions, distance, poor cell phone connectivity (to call for an ambulance), lack of transportation or money for transport, perceived spiritual or physical vulnerability of the mother and newborn and associated culturally determined postnatal restrictions on the mother or newborn\u2019s movement outside of the home, and preference for traditional care. Some families sought care despite disrespectful, poor quality care. Conclusions: Improvements in illness recognition and care-seeking observed during MaNHEP have been reinforced since that time and appear to be successful. There is still need for a concerted effort focusing on reducing identified barriers, improve quality of care and provider counseling, and contextualize messaging behavior change communications and provider counseling