Development Army Research Articles

Awareness on obstetric fistula and associated factors among women health development army, in the South Gondar zone, Amhara region, Ethiopia: A cross sectional study.

Obstetric fistula is a severe birth injury that profoundly impacts women's health, social well-being, economic stability, and psychological state. While it can be prevented with timely emergency obstetric care, a significant barrier in many developing regions, including the study area, is the lack of awareness among women. This study aimed to evaluate the level of awareness about obstetric fistula and the factors influencing it among the Women Health Development Army in the South Gondar zone of the Amhara region, Ethiopia, in 2020. A community-based cross-sectional study was done from July to December 2020, involving 633 women. Participants were selected using a multistage stratified sampling method. Data were collected using a pretested, interviewer-administered structured questionnaire. Data entry was performed using EpiData version 3.1, and analysis was conducted with SPSS version 23.0. Multivariable logistic regression models were employed to identify influencing factors, with a p < 0.05 considered statistically significant. This study found that 55.3% (95% CI, 51.6%-57.2%) of study participants had a good awareness of obstetrics fistula. Significantly associated factors include; no history of ANC (AOR = 0.52: 95% CI, 0.31, 0.86), living >30 min away from a health facility (AOR = 0.43: 95% CI, 0.23, 0.81), no history of abortion (AOR = 0.37: 95% CI, 0.19, 0.72), Injectable and implant users (AOR = 3.60: 95% CI, 1.98, 6.53), having four to six pregnancy (AOR = 1.87: 95% CI, 1.22, 2.87) and lack of communication material in the house (AOR = 0.19: 95% CI, 0.10, 0.37). This study found that 55.3% of women have a good awareness of obstetrics fistula. ANC follow-up history, abortion history, type of family planning, type of communication, number of pregnancies, availability of health facility, and distance of health facility were significantly associated with awareness of obstetric fistula. Hence, local and national efforts should be made to enhance access to information at home and basic maternal health services including antenatal care.

Newborn community health advancements among Ethiopian Orthodox Christian women in North Gondar, Ethiopia: community-based randomised trial protocol

IntroductionDespite significant progress over past decades, neonatal and infant morbidity and mortality remain unacceptably high in Ethiopia. Simple interventions have been shown to improve the health of children and reduce...

A Literature Review of Maternal Mortality in the Countryside. What are the Policies and Prevention?

Maternal mortality in rural areas is still high and is a health problem that is a priority for intervention and policy. Various studies have been conducted to create a prevention model and various policies implemented in several countries have been carried out to deal with maternal mortality in rural areas. This study aims to determine the policies and models or concepts of preventing maternal mortality in rural areas. This study is a literature review using the Scopus database. The strategy in finding articles uses PICOS (Population, Intervention, Comparison, Outcome and Study design). 6 articles that fit the criteria and are relevant to the research objectives. Policy and prevention of maternal mortality in rural areas: (1) Fulfillment of health workers, (2) Fulfillment of health facilities, (3) Maternity waiting homes, (4) Community-based continuous training programmes, (5) HEP (Health Extension Program) and HDA (Health Development Army) policies, (6) Health Insurance. The findings of this study indicate that some of the policies and prevention models implemented were successful in reducing maternal mortality in rural areas, so policies and models for preventing maternal mortality can be applied in rural areas.

Barriers to use of institutional childbirth services: a qualitative study in the rural Jimma Zone, Ethiopia

Background/Aims Institutional birth and skilled birth attendants are two important elements of preventing maternal and newborn deaths. In Ethiopia, despite improved health access, many women give birth without skilled assistance. This study was conducted to identify barriers to institutional childbirth in the Jimma Zone, Ethiopia. Methods An exploratory qualitative case study was conducted, incorporating 16 focus group discussions and 18 in-depth interviews carried out in the Jimma Zone, Ethiopia in 2019. The participants were purposefully recruited and included members of the Women's Development Army, religious leaders, health extension workers, midwifery nurses, primary healthcare unit directors and women of reproductive age. Data were transcribed and translated into English and thematically analysed. Results Five themes emerged from the data: knowledge gaps, beliefs about pregnancy and childbirth, poor access to healthcare services, lack of resources and poor community involvement in institutional childbirth. Conclusions Healthcare services should be aware of local beliefs and cultural norms when encouraging the use of institutional childbirth services. The Ministry of Health must ensure that all services are equipped with adequate resources, both in terms of medical supplies and staff.

Perceived Impact of COVID-19 and Strategies for effective Implementation of Maternal and Child Health Care Services in Ethiopia: A Qualitative Study

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.

Promotion of market-based sanitation in Ethiopia: a case study from Wolaita zone.

Ethiopia increased the availability of latrines notably, but the sanitation facilities rarely meet hygienic standards. Therefore, the market-based sanitation (MBS) programme has been implemented across the country for nearly a decade to expand the market and boost the demand for hygienic sanitation products and services. While it does not seem that the MBS would bring any notable change in sanitation conditions so far, its implementation challenges are not adequately understood. To address this gap, this article delves into the grassroots-level implementation of MBS in the Wolaita zone. The study relies on qualitative data gathered through interviews with various stakeholders, examining both demand- and supply-side challenges. Some issues identified were external to MBS implementation, such as high inflation and an unstable political and security situation in Ethiopia. Additionally, the study reveals that more general deficiencies of the Ethiopian health extension program, including the stress and discouragement of local change agents (health extension workers, health development army members) due to workloads and low remuneration, have adversely impacted MBS delivery. The implementation of MBS has also not effectively addressed the affordability of hygienic sanitation products. On the supply side, economic constraints and organizational inefficiencies have hindered the development of the sanitation market, preventing it from reaching a critical mass. Our research suggests that MBS alone will not suffice to improve sanitation in Ethiopia.

Effect of behavior change communication through the health development army on birth weight of newborns in Ambo district, Ethiopia: a cluster randomized controlled community trial

BackgroundPoor behavior change communication on maternal nutrition and health throughout pregnancy is thought to be to blame for Ethiopia’s high rate of low birthweight babies, and this has implications for neonatal morbidity and mortality. The effect of behavior change communication on birth weight in the study district was not examined. This study was to determine whether improving neonatal birthweight using nutrition and health behavior change communication (NHBCC) interventions was successful.MethodsA cluster randomized controlled trial was conducted in the Ambo district of Ethiopia from May 5, 2018–January 30, 2019. At the beginning of the study, 385 women in the 24 intervention groups and 385 women in the 24 control groups were recruited. In the intervention group, health development armies delivered the NHBCC core message every two weeks for four months by grouping pregnant women in specific clusters. Pregnant women in the control group received the routine treatment offered by the healthcare system during their ANC visits. Within 24 h of birth, the birthweights of 302 and 292 neonates in the intervention and control groups, respectively, were measured at the end point of the study. A binary generalized linear model analysis was employed.ResultThe control group had a larger absolute risk of neonates with low birthweight (0.188 vs. 0.079, p < 0.001) than the intervention group. Pregnant women in the intervention group had an absolute risk difference of 10.9% for low birthweight. Pregnant women who received the intervention were 62% less likely to have low-risk birthweight compared to pregnant women who were in the control group (ARR = 0.381, 95% CI: 0.271–0.737).ConclusionNutrition and health behavior change Communication by health development armies improves birthweight. The findings demonstrated that to improve birthweight, NHBCC must be administered to pregnant women in groups via health development armies in their communities.Trial registration numberPACTR201805003366358.

Motivation and associated factors of health development army in the implementation of health extension packages in Northwest Ethiopia: a cross-sectional study

IntroductionHealth development army is a network of women volunteers organised to promote health and prevent disease through community empowerment and participation.ObjectiveTo assess the level of motivation and associated factors of...

Determinants and knowledge of men on obstetric danger signs: A community-based cross-sectional study in Debretabor, Ethiopia

IntroductionObstetrics danger signs are the major health problems and cause of mortality among women in developing countries including Ethiopia. To make an informed decision man should know the danger signs of pregnancy, childbirth, and postpartum and be able to act when they occur. In this regard, the role of men as decision-makers cannot be overlooked. However, studies regarding knowledge and associated factors of obstetric danger signs were limited in Ethiopia. ObjectivesThis study aimed to assess knowledge and associated factors towards obstetric danger signs among men in Debretabor town North West, Ethiopia. MethodA community-based cross-sectional study was conducted among 609 participants from February 1 -March 30/2021 in Debre Tabor town. A cluster sampling procedure was used. Data were collected through a pretested semi-structured interviewer-administered questionnaire. Data were entered into Epi data version 4.6 and exported into SPSS version 25 for analysis. All variables with a p-value < 0.2 in the Bivariable analysis were entered into multivariable logistic regression analysis. The statistically significant association of variables was determined based on the Adjusted Odds ratio with a 95 % confidence interval and p-value < 0.05. ResultsSix hundred and nine men were interviewed which made a response rate of 96.9 %. Men’s knowledge of obstetrics danger signs was (44.8 %). In logistic regression analysis the wife's previous obstetrics danger sign (AOR = 5.34,95 %CI (3.49–8.16), diploma and above education (AOR = 7.27, 95 %CI (2.13–8.83), wife's antenatal care (AOR = 2.44, 95 % CI (1.29–4.64), wives gave birth at the hospital (AOR = 4.38, 95 %CI 1.69–11.31) and health development army leader (AOR = 3.86, 95 %CI (1.38–10.75) were associated with knowledge level. ConclusionIn this study men’s knowledge of obstetrics danger signs was low. Husband’s education, place of delivery, and antenatal care have a great role in improving men’s knowledge. The government and stakeholders should give due emphasis to creating awareness and health education about obstetrics danger signs in this particular community.

Undoing the development army: a paradigm shift from transfer of technology to agricultural innovation system in Ethiopian extension

Undoing the development army: a paradigm shift from transfer of technology to agricultural innovation system in Ethiopian extension

Antenatal care booked rural residence women have home delivery during the era of COVID-19 pandemic in Gidan District, Ethiopia.

World Health Organization (WHO) recommends that every pregnant woman receive quality care throughout pregnancy, childbirth, and the postnatal period. It is estimated that institutional delivery could reduce 16% to 33% of maternal deaths. Despite the importance of giving birth at a health institution, in Ethiopia, according to the Ethiopian Demographic Health Survey report, nearly half of the ANC-booked mothers gave birth at home. Therefore, this study aimed to determine the prevalence and associated factors of home delivery among antenatal care-booked women in their last pregnancy during the era of COVID-19. A community-based cross-sectional study was conducted from March 30 to April 29, 2021. A simple random technique was employed to select 770 participants among women booked for antenatal care. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted. Adjusted odds ratios with its respective 95% confidence interval were used to declare the associated factors. The prevalence of home delivery was 28.8% (95% CI: 25.7, 32.2). Rural residence (AOR = 2.02, 95% CI: 1.23, 3.34), unmarried women (AOR = 11.16, 95% CI: 4.18, 29.79), husband education (AOR = 2.60, 95% CI: 1.72, 3.91), not being involved in the women's development army (AOR = 1.64, 95% CI: 1.01, 2.65), and fear of COVID-19 infection (AOR = 3.86, 95% CI: 2.31, 6.44) were significantly associated factors of home delivery. Even though the government tried to lower the rate of home delivery by accessing health institutions in remote areas, implementing a women's development army, and introducing maternal waiting home utilization, nearly one in every three pregnant women gave birth at home among ANC booked women in their last pregnancy. Thus, improving the husband's educational status, providing information related to health institution delivery benefits during antenatal care, and strengthening the implementation of the women's development army, particularly among rural and unmarried women, would decrease home childbirth practices.

Exploring dietary perception, beliefs and practices among pregnant adolescents, their husbands and healthcare providers in West Arsi, Central Ethiopia: a phenomenological study

BackgroundThe two most physically active stages of life, pregnancy and adolescence, put the pregnant adolescent under a lot of stress. Adolescence is a crucial era in women’s nutrition that is...

Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia

IntroductionChild mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact...

Gender-based roles, psychosocial variation, and power relations during delivery and postnatal care: a qualitative case study in rural Ethiopia.

The World Health Organization (WHO) strongly encouraged men to support women in receiving maternal healthcare. However, especially in developing countries, maternal healthcare has traditionally been viewed as an issue in women, with men making little or no contribution, even though sexuality and children are shared products. The study aims to understand how gender-based roles, psychosocial variation, and power relations are related to child delivery and postnatal care (PNC) services. The study was conducted in three rural districts of Oromia regional state, Jimma Zone, Ethiopia. An in-depth interview and focus group discussion were held with carefully chosen health professionals, health extension workers, community health development armies, and religious leaders. The data was collected, translated, and transcribed by experienced men and women qualitative researchers. For data analysis, ATLAS.ti version 9 was used. The data were coded and categorized concerning delivery and PNC service utilization. Independent and shared gender-based roles were identified as a means to improve maternal healthcare service delivery. The result obtained three categories, namely, gender-based roles, psychosocial variation, and power relations. Men can persuade pregnant women to use delivery services and PNC. The place of delivery is determined by the levels of gender-based power relations at the household level, but women are usually the last decision-makers. The belief of the community that giving birth in a health facility makes women look clean and neat, as opposed to home delivery, increases their intention to use maternal healthcare services. The study contributes that the role of a man as a husband is crucial in mobilizing others to carry pregnant women to health facilities, contributing to early intervention during labor. The decision-making capacity of women has improved over time, with men accepting their right to make decisions about their health and fetuses. Home delivery and men not being present during delivery are perceived as signs of backwardness, whereas giving birth in health institutes is seen as a sign of modernization and the rights of women.

Understanding Gender-Based Perception During Pregnancy: A Qualitative Study.

Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy. A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category. Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond. This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.

Men’s knowledge, attitudes, and associated factors toward obstetric danger signs: A community-based cross-sectional study in Debre Tabor North West, Ethiopia

Introduction: Maternal mortality remains a public health challenge worldwide, particularly in developing countries. Men should be informed about these danger signs to be better equipped to act if they occur. Studies on the topic have been limited in the area. The study aimed to assess men’s knowledge, attitudes, and related factors about obstetrics danger signs in Debre Tabor, Ethiopia. Materials and Methods: A study was conducted in Debre Tabor Town with 609 participants using a pre-tested questionnaire. The data were analyzed using EpiData version 4.6 and SPSS version 25. Variables with P values ≤0.2 were analyzed with multi-variable logistic regression. A statistically significant association was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a P value &lt;0.05. Results: In this study, 609 men were interviewed, with a response rate of 96.9%. Men’s knowledge of obstetric danger signs was 44.8%, while their attitudes were 35.6%. Wives’ education level (AOR = 7.27, 2.13–8.83), history of obstetric danger signs (AOR = 5.34, 3.49–8.16), receiving antenatal care (AOR = 2.44, 1.29–4.64), giving birth in a hospital (AOR = 4.38, 1.69–11.31), and having a health development army leader (AOR = 3.86, 1.38–10.75) were all associated with knowledge at 95% CI. Having a higher wealth index (AOR = 6.30, 3.44–11.53) and having two or more children (AOR = 2.80, 1.51–5.25) at 95% CI were associated with attitude. Conclusions: Men’s awareness and attitudes concerning obstetric danger signs were low. The husband’s education, place of birth, and prenatal care are all important factors in increasing men’s understanding and attitudes. As a result, the government and stakeholders must prioritize education, attitude reform, and health education for men.

Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia.

Community-based newborn care (CBNC) has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn mortality. However, neonatal mortality rate in Ethiopian is among the highest in the world. Why neonatal mortality remains high in the face of such effective interventions is the issue. As a result, the authors claim that it is unknown whether the planned intervention is carried out effectively or not. The purpose of this study was to investigate the fidelity of community-based newborn care intervention and its implementation drivers. Multicenter community-based mixed method study was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts to evaluate CBNC intervention fidelity. Structured questionnaire and facility audit checklist was used to collect quantitative data. In-depth interview technique was used to explore lived experiences of HEWs on CBNC implementation. CBNC intervention fidelity was computed as a composite index of the product of program coverage, frequency and contents. Multilevel linear regression model with adjusted β-coefficients at P-value of 0.05 and a 95% confidence interval (CI) were used to declare a significant relation between CBNC intervention fidelity and its implementation drivers. Interpretative phenomenological analysis was employed for qualitative data analysis. CBNC intervention fidelity was found to be 4.5% (95% CI: 3.6-5.4) with only two women received the intervention with full fidelity. The overall CBNC intervention coverage was 38.4% (95% CI: 35.2-41.6). Only 8.1% and 1.5% of women received all CBNC interventions with recommended frequency and content, respectively. HEWs knowledge of danger sign was significant facilitator while lack of: health center's feedback, related short-term training, health development army support, health center staff's technical assistance to HEWs and shortage of medical equipment supply were barriers for CBNC intervention fidelity. In conclusion the CBNC intervention fidelity was too low in this study. This indicates that CBNC intervention package was not implemented as envisioned implying an implementation gap. All implementation drivers were poorly implemented to result in improved fidelity and intervention outcomes.

Mothers' health care seeking behavior for neonatal danger sign in southern Ethiopia: Community based cross-sectional study.

Over the previous few decades, significant progress has been made in reducing newborn mortality, but the worldwide scale of the problem remains high. A considerable number of newborn death and difficulties owing to neonatal danger signs could be avoided if mothers sought appropriate health care for common neonatal risk indications, according to a number of studies presently underway in Ethiopia. The aim of this study is to assess health care seeking behavior of mothers' in related to neonatal danger signs. A community-based cross-sectional study was conducted among 410 participants in Wolaita Sodo, From October 1 to October 30, 2019. To collect data, structured interviewer administered questionnaire was used. Data was coded, cleaned, recoded and entered in to epi-data version 3.1 and transported to SPSS window version 21 for analysis. Multivariable logistic regression was carried out and p-value of less than or equal to 0.05 was considered statistically significant. A total of 410 mothers participated in this study, 110 (47.6%) mothers preferred health intuition for their neonate. Husband educational status (AOR = 2.4, 95% CI = 1.1, 5.5), communication media (AOR = 4.3, 95% CI = 2.4, 7.5), place of residence (AOR = 3.5, 95% C.I = 1.9, 6.7), ANC follow up (AOR = 2.8, 95% CI = 1.4, 5.8), and PNC follow (AOR = 1.7, 95% CI = 1.1, 3.1) were all factors that significantly associated with health care seeking practice neonatal dander signs. Overall, there was a low degree of health-seeking practice. The educational status of the mother's husband, communication media, residence, ANC follow-up, and PNC follow-up all predicted the mothers' health-care seeking behavior. The study also identifies the Wolaita Zone and Sodo town health offices, the health development army, one to five local community organizations with and health extension workers as key contributors.

The paradox of externally driven localisation: a case study on how local actors manage the contradictory legitimacy requirements of top-down bottom-up aid

There are ongoing calls in the humanitarian and development sectors to localise aid, make it more participatory and involve communities. A common response to these calls by INGOs and national governments is to work with local actors to jointly deliver local, community-based, participatory aid. However, this setup tends to be hierarchical, with external actors taking the lead on project design and local actors on implementation. As a result, key outcomes envisioned for localisation and participation in aid often do not materialise. This paper explores the role legitimacy work plays in maintaining this unhelpful status quo. To this end, it provides a qualitative case study analysis of an aid project in Ethiopia (2016–2020) that was initiated by two INGOs and built on government structures designed to facilitate mass volunteering at community level: the Women’s Development Army. The paper argues that externally driven localisation is often organised around project models that are shaped by two contradictory paradigms: one centring resilience and one centring surveillance. As a result, local aid workers and civil servants are faced with incompatible legitimacy requirements in their work. This paper uses a paradox perspective as a theoretical lens to explore how these local actors navigate these conflicting needs. It finds that they use impression management, especially visuals and performances, to sidestep the contradictions. This imagery conceals the disconnects between project strategy, implementation and the reality on the ground. As a side effect, it renders the problems with the externally driven approach invisible and legitimises the hierarchical status quo.

Acceptability and feasibility of video-based health education for maternal and infant health in Dirashe District, South Ethiopia: A qualitative study.

Evidence about innovative methods to facilitate nutrition education counseling and promote the intended behavior change at scale is limited. We assessed the acceptability and feasibility of a video-based health education intervention aiming to promote community care for pregnant women, mothers, and infants in the Dirashe District, Ethiopia. Using a phenomenological study design, the experiences of study participants in a trial testing the effectiveness of video-based health education on birth outcomes and nutritional status of mothers and their infants six months postpartum were assessed. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect the data. The study was conducted in the Dirashe District, South Ethiopia. Five FGDs and 41 KII were conducted among video implementers, mothers, nurses, and health extension workers (HEWs) in eight intervention villages. All data were collected with a tape recorder. The tape-recorded data were transcribed and then translated into English. Data were analyzed using thematic content analysis. The videos delivered messages about nine themes on health, nutrition, and hygiene related to mothers and infants. Overall, the video-based health education interventions was acceptable and feasible. Messages delivered were found to be clear, easily understandable, culturally acceptable, and relevant to the needs of the mothers. Feasibility was affected by the nature of the work, lack of help, and overlapping duties of the HEWs. The video-based health education intervention was acceptable and feasible. It was suggested that determining a common location/venue to show the videos, involving husbands, and involving HEWs could improve the intervention. Trial registration: The effectiveness "parent" study was registered as a clinical trial with the U.S. National Institute of Health (www.ClinicalTrials.gov; NCT04414527). The qualitative study included recipients from the same cohort (participating mothers from the intervention group), in addition to video implementers, health extension workers the Health Development Army, and nurses from the intervention communities.