Abstract
BackgroundImproving newborn survival is essential if Ethiopia is to achieve Millennium Development Goal 4. The national Health Extension Program (HEP) includes community-based newborn survival interventions. We report the effect of these interventions on changes in maternal and newborn health care practices between 2008 and 2010 in 101 districts, comprising 11.6 million people, or 16% of Ethiopia’s population.Methods and FindingsUsing data from cross-sectional surveys in December 2008 and December 2010 from a representative sample of 117 communities (kebeles), we estimated the prevalence of maternal and newborn care practices, and a program intensity score in each community. Women with children aged 0 to 11 months reported care practices for their most recent pregnancy and childbirth. The program intensity score ranged between zero and ten and was derived from four outreach activities of the HEP front-line health workers. Dose-response relationships between changes in program intensity and the changes in maternal and newborn health were investigated using regression methods, controlling for secular trend, respondents’ background characteristics, and community-level factors.Between 2008 and 2010, median program intensity score increased 2.4-fold. For every unit increase in the score, the odds of receiving antenatal care increased by 1.13 times (95% CI 1.03–1.23); the odds of birth preparedness increased by 1.31 times (1.19–1.44); the odds of receiving postnatal care increased by 1.60 times (1.34–1.91); and the odds of initiating breastfeeding immediately after birth increased by 1.10 times (1.02–1.20). Program intensity score was not associated with skilled deliveries, nor with some of the other newborn health care indicators.ConclusionsThe results of our analysis suggest that Ethiopia’s HEP platform has improved maternal and newborn health care practices at scale. However, implementation research will be required to address the maternal and newborn care practices that were not influenced by the HEP outreach activities.
Highlights
Ethiopia is committed to reducing the under-five mortality rate to 68 deaths per 1,000 live births by 2015 in order to achieve Millennium Development Goal four [1]
Implementation research will be required to address the maternal and newborn care practices that were not influenced by the Health Extension Program (HEP) outreach activities
Respondent Characteristics The distribution of women’s age, marital status, education, parity, religion, frequency of radio listenership, household wealth quintile, and the distance to basic emergency obstetric care from the kebele were similar in the two surveys (Table 4)
Summary
Ethiopia is committed to reducing the under-five mortality rate to 68 deaths per 1,000 live births by 2015 in order to achieve Millennium Development Goal four [1]. Simple community-based strategies to improve antenatal, childbirth, and newborn health care practices have been shown to reduce neonatal deaths [5] These community-based strategies include clean delivery practices (clean hands and delivery surface), clean umbilical cord care (cutting the umbilical cord with a sterile instrument, tying it with a sterile thread, and applying nothing to the cut stump of the cord), thermal care (immediate drying and wrapping of the baby after delivery, delay bathing the baby for more than six hours, and skin-to-skin contact with the mother), extra care for low birth weight or preterm birth (additional warmth, cleanliness and nutrition and early recognition of disease), and early and exclusive breastfeeding to minimize the risk factors associated with neonatal mortality in developing countries. We report the effect of these interventions on changes in maternal and newborn health care practices between 2008 and 2010 in 101 districts, comprising 11.6 million people, or 16% of Ethiopia’s population
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