The role of health extension workers in linking pregnant women with health facilities for delivery in rural and pastoralist areas of Ethiopia

Background: Women’s preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth.Methods: A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People’s Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes.Results: Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women.Conclusion: HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.Keywords: Health extension workers, skilled birth attendance, maternal health service utilization, rural and pastoralist Ethiopi

Factors Affecting Unmet Need for Family Planning in Southern Nations, Nationalities and Peoples Region, Ethiopia

BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations, Nationalities and Peoples Region. In such populations, unmet needs for contraception have a tendency to be high, mainly due to the effect of socio-economic and demographic variables. However, there has not been any study examining the relationship between these variables and unmet need in the region. This study, therefore, identifies the key socio- demographic determinants of unmet need for family planning in the region. METHODS: The study used data from the 2000 and 2005 Ethiopian Demographic and Health Surveys. A total of 2,133 currently married women age 15-49 from the 2000 survey and 1,988 from the 2005 survey were included in the study. Unmet need for spacing, unmet need for limiting and total unmet need were used as dependent variables. Socio- demographic variables (respondent’s age, age at marriage, number of living children, sex composition of living children, child mortality experience, place of residence, respondent’s and partner’s education, religion and work status) were treated as explanatory variables and their relative importance was examined on each of the dependent variables using multinomial and binary logistic regression models. RESULTS: Unmet need for contraception increased from 35.1% in 2000 to 37.4% in 2005. Unmet need for spacing remained constant at about 25%, while unmet need for limiting increased by 20% between 2000 and 2005. Age, age at marriage, number of living children, place of residence, respondent’s education, knowledge of family planning, respondent’s work status, being visited by a family planning worker and survey year emerged as significant factors affecting unmet need. On the other hand, number of living children, education, age and age at marriage were the only explanatory variables affecting unmet need for limiting. Number of living children, place of residence, age and age at marriage were also identified as factors affecting total unmet need for contraception. CONCLUSION: unmet need for spacing is more prevalent than unmet need for limiting. Women with unmet need for both spacing and limiting are more likely to be living in rural areas, have lower level of education, lower level of knowledge about family planning methods, have no work other than household chores, and have never been visited by a family planning worker. In order to address unmet need for family planning in the region, policy should set mechanisms to enforce the law on minimum age for marriage, improve child survival and increase educational access to females. In addition, the policy should promote awareness creation about family planning in rural areas. KEYWORDS: Contraceptive use, Family Planning, Fertility, Unmet Need, spacing, limitin

Determinants of infant and early childhood mortality in a small urban community of Ethiopia: a hazard model analysis

Abstract: By applying Cox's proportional hazard model regression analysis to data collected using a retrospective survey conducted in Sebeta, a town 25 Km west of Addis Ababa, the capital city of Ethiopia, the paper examines the factors impinging on the survival of infants and children between 1 - 3 years of age. It is shown that for higher order births (more than 5), for births to young women (under 20 years of age), and for those to older women (more than 34 years of age), the risk of dying at infancy is higher. The risk of infant mortality is also high for births with short previous birth intervals. In fact, the length of the previous birth interval is found to be the single most important factor affecting the chances of survival during infancy. It is further shown that education of mother, occupation of father, household income, source of drinking water, availability of latrine, and survival status of older sibling have direct effect on infant mortality. Among these, source of water and availability of latrine are identified as having significant effects on infant mortality even after controlling for the effects of other variables. During early childhood, however, the effects of age at maternity, birth order and preceding birth interval becomes trivial. Following birth interval appears to have a strong effect on the chances of survival during early childhood. Household income, religion and survival status of the previous sibling are found to have significant effects on early childhood mortality. The findings provide solid ground to support strategies to broaden MCH/FP services, environmental health and income generating scheme to reduce the risk of death for infants and children. [Ethiop. J. Health Dev. 1997;11(3):189-200

Fertility trends and differentials in central Ethiopia.

Official fertility estimates in Ethiopia show that fertility is high and varies regionally. However, the causes and correlates are not well understood. This thesis investigates the levels, trends and differentials of fertility in two administrative regions, Arsi and Shoa in Central Ethiopia using data from the Population, Health and Nutrition Project baseline survey conducted by the Ministry of Health in 1986. It also provides the socioeconomic and demographic explanations of high fertility in these regions. The thesis examines data limitations and identifies the types and sources of error. Missing, incomplete or inconsistent dates in the birth history are imputed and the validity of the data for fertility studies is assessed. Indirect demographic techniques and period-cohort analysis of birth histories are used for estimating fertility trends, and multivariate analysis is applied for examining fertility differentials. The population is shown to have high and rising fertility. Total fertility increased from about six children per woman around 1970 to about eight children in the early 1980s. Most of this increase occurred between 1977 and 1982. Significant rural-urban, religious and ethnic differentials are also observed. Early and universal marriage, high infant and child mortality, pro-natal cultural and religious values, low levels of infertility and the absence of birth control methods are investigated as possible explanations for the fertility patterns. Change in marital fertility brought about by the decline in the duration and intensity of breastfeeding and increase in exposure to the risk of childbearing through reduced spousal separation are identified as the major causes of the recent rise, while variations in breastfeeding patterns, infant and child mortality and stability of marriage rather than differences in contraceptive use appear to explain most of the observed differentials. The study concludes by identifying methodological problems and needs for future research. The implications of the study are underscored with specific policy recommendations

Demographic Data for Development Decisionmaking: Case Studies From Ethiopia and Uganda

Analyzes the lack of demographic and socioeconomic data, limited access to and use of existing data, and insufficient demand for their application in policy making and resource allocation. Makes recommendations for greater access, demand, and use of data

The uniqueness of the Ethiopian demographic transition within sub-Saharan Africa: multiple responses to population pressure, and preconditions for rural fertility decline and capturing the demographic dividend

The findings of our new book on population and development in the second largest country, Ethiopia, are presented. We highlight its uniqueness in demographic transitions among countries in sub-Saharan African. Ethiopia has the largest rural-urban fertility gap (with below replacement fertility for Addis Ababa), the lowest maternal health service coverage by far, the highest percentage of illiterate mothers, the largest number of food insecure people, and 83% of the population concentrated mainly in densely populated rural areas. We present a new framework for the study of both poverty and development-driven causes and demographic responses to frequent hazards common in the fragile Horn of Africa. Multiple vulnerabilities and responses are rigorously documented, with migration and off-farm labor mobility, female education, delayed marriage, and lower family size norms predisposing a predicted acceleration of the rural fertility decline. We propose numerous policy and research implications to evaluate progress on what may now be reachable 2015 population policy targets in TFR and CPR, and to prepare for a potential demographic dividend

Moving towards universal health coverage for mental disorders in Ethiopia

Background: People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage. Aims: To propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia. Methods: We conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia. Results: Opportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention. Conclusion: Expansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care

Refresher Training Workshop on Feeds and Forage for Dairy Development

Report on Refresher Training Workshop on Feeds and Forage for Dairy Development 27-28 March 2023| Addis Ababa, Ethiopi

Under five causes of death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis

The study worked to identify causes of death for neonatal, post-neonatal, infants and children under five years old in Ethiopia. Causes- targeted obstetric and child healthcare interventions will reduce mortality, and will require improving healthcare units. Major causes of death revealed in this study are bacterial sepsis, birth asphyxia, prematurity, acute lower respiratory infection and diarrheal diseases. Almost all causes are easily preventable and treatable and can be addressed by strengthening health extension services and improved quality of primary health care

Evaluation of radio broadcasts on livestock feed and forage technologies

The International Livestock Research Institute (ILRI) works for better lives through livestock in developing countries. ILRI is co-hosted by Kenya and Ethiopia and has 14 offices across Asia and Africa. The institute is one of the CGIAR research centres, a global research partnership for a food-secure future. CGIAR science is dedicated to reducing poverty, enhancing food and nutrition security, and improving natural resources and ecosystem services. Its research is carried out by 15 CGIAR centres in close collaboration with hundreds of partners, including national and regional research institutes, civil society organizations, academia, development organizations and the private sector. Africa Research in Sustainable Intensification for the Next Generation (Africa RISING) is a program funded by the United States Agency for International Development (USAID) and operates in six African countries (Mali, Ghana, Tanzania, Malawi, Zambia and Ethiopia). The program aims to contribute to Feed the Future goals of reducing hunger, poverty and under-nutrition by delivering high quality research outputs that are relevant to these goals. Through action research and development partnerships, Africa RISING is creating opportunities for smallholder farm households to move out of hunger and poverty through sustainably intensified farming systems that improve food, nutrition and income security, particularly for women and children, and conserve or enhance the natural resource base. In Ethiopia, the main aim of the project is to identify and validate solutions to the problems experienced by smallholder crop–livestock farmers. Some problems arise from the difficulties facing farmers in managing natural resources and achieving efficiencies from managing crops, trees, water and livestock together. These efficiencies are often influenced by other factors such as access to inputs and reliability of markets. To address this complexity, Africa RISING takes an integrated approach to strengthening farming systems. It conducts participatory research that identifies technologies and management practices that work for farmers and takes account of contextual issues like markets for inputs and outputs, community and other institutions and policy environments that influence farm households. The project in Ethiopia facilitates wider scaling of validated crop-livestock-natural resource management technologies to reach and benefit more smallholder farmers. Accelerating the Impact of CGIAR Climate Research for Africa (AICCRA) is a three-year (2021–2023) project that operates in six African countries, including Ethiopia. The project is supported by a grant from the International Development Association (IDA) of the World Bank and will enhance the research and capacity-building activities of CGIAR and its partners. AICCRA in Ethiopia aims to strengthen the capacity of targeted national partners and stakeholders of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) East Africa to access and implement at scale validated climate-smart agriculture technologies, climate information services and climate-informed digital ag-advisories to build the resilience of agri-food systems. The value chains considered for AICCRA’s project in Ethiopia include beans, wheat, small ruminants and livestock feed and forage options. The AICCRA project in Ethiopia has eight research activities, four of which the livestock feed and forage options value chain contributes to. These four are capacity building to support the implementation of climate-smart agriculture (CSA) technology packages; identification of climate, gender and social inclusion-smartness of CSA packages; prioritization and awareness increase of best-bet CSA options and approaches for key value chains; and integration of climate-smart options and tailored climate-smart innovation (CSI) advisory systems for specific value chains. The Sustainable Intensification of Mixed Farming Systems (SIMFS) initiative aims to provide equitable, transformative pathways for improved livelihoods of actors in mixed farming systems through sustainable intensification within target agroecologies and socio-economic settings. Through action research and development partnerships, the initiative will improve smallholder farmers' resilience to weather-induced shocks, provide a more stable income and significant benefits in welfare, and enhance social justice and inclusion for 13 million people by 2030. Activities will be implemented in six focus countries globally, representing diverse mixed farming systems as follows: Ghana (cereal–root crop mixed), Ethiopia (highland mixed), Malawi (maize mixed), Bangladesh (rice mixed), Nepal (highland mixed), and Lao People's Democratic Republic (upland intensive mixed/ highland extensive mixed). Africa RISING, AICCRA projects and SIMFS initiative contracted a consultant to undertake media and communications-related activities. These included media assessment, facilitating media partnership, training radio journalists on livestock feed and forage technologies, and monitoring the radio broadcasts