Rural Ethiopia Research Articles

Occupational and environmental pesticide exposure and associated health risks among pesticide applicators and non-applicator residents in rural Ethiopia.

Intensive pesticide use increased concern about the potential acute and chronic health effects of pesticides in general and among applicators in particular. This study aims to explore occupational and environmental pesticide exposure and health risks among pesticide applicators and residents. A community-based cross-sectional study was conducted involving 1,073 individuals. We examined the health effects potentially attributable to pesticide exposure using regression to estimate prevalence ratios (PR). A higher proportion of good knowledge of pesticides [75 vs. 14%; APR = 1.542 (1.358-1.752), p < 0.001] and a higher mean score of perceived health risk of pesticide use [4.21 vs. 3.90; APR = 1.079 (1.004-1.159), p < 0.05] were observed among applicators than residents. A significantly higher proportion of applicators experienced health effects presumably related to pesticide exposure among themselves (36%) than residents (16%), and a higher proportion of them used prescribed drugs in the past 12 months [51 vs. 32%; APR = 1.140 (1.003-1.295), p < 0.05]. Skin irritation, shortness of breath, cough, and dizziness were more likely reported by applicators than residents. Perceived toxicity of currently applied pesticide products, mix pesticides without gloves, regularly maintain and wash sprayer tank after application, occurrence of an incidental splash during mixing and application, and using home-based care after experiencing a symptom presumably due to pesticide exposure were significantly associated with health effects among applicators. Use of face mask and visiting health facility when experiencing a symptom presumably due to pesticide exposure were significantly positively correlated with attending training on the health risks and use of pesticides. A substantial proportion of applicators reported improper use of preventive measures and methods of pesticide waste disposal. These observations point out that applicators can face high health risks of occupational pesticide exposure in Ethiopia. Even trained applicators pursued poor preventive practices; hence, comprehensive practice-oriented in-depth training focusing on safety precautions and proper use of personal protective equipment, and provision of adequate pesticide waste disposal means are crucial interventions.

Combining green energy technologies to electrify rural community of Wollega, Western Ethiopia

Power shortages are a major problem in rural Ethiopia. Only about 45% of people living in around cities have access to the public power grid. The rest of the inhabitants lives in rural regions with limited access to grid-connected energy. To evaluate the potential of a standalone solar-wind hybrid energy system (HES) for a rural off-grid settlement in western Ethiopia, a feasibility study was performed. The electrical demand of a model household, comprising a school and health facility, was calculated. HOMER Pro is a tool for determining the viability of HES. When the software is executed, optimization results are obtained and sorted according to the lowest net present cost (NPC) and cost of Electricity (COE). The results reveal that the Photovoltaic (PV)/battery/converter combination is the most cost-effective, with the lowest NPC and COE. This setup's NPC is $9150, the COE is $0.173/kWh, and the renewable resource contribution is 100%. The study's findings can be used by interested parties, decision makers and investors to show the benefits of increasing renewable energy, modifying components, and reducing electricity bills.

Preserving national values: Reproduction of national identity in a school ofQenie

AbstractSchools pursued multiple ways to cultivate national identity amongst students, but not all approaches are effective. Drawn from ethnographic fieldwork conducted in rural Ethiopia, this study aims at exploring how national identity is reproduced through the knowledge system of the Ethiopian OrthodoxTewahedoChurch (EOTC). By exploring the daily lives of students in the school ofQenie, the findings show detailed practices and how the school system exposes them to a multitude of cultural resources that help in national identity reproduction. The study has important implications for practice and policy to reinforce a healthy approach to nurturing valued aspects of the nation.

Antenatal care utilization and compliance with national and WHO guidelines in rural Ethiopia: a cohort study

BackgroundAntenatal health care utilization has the potential to influence maternal and new-born health. In this study, we assessed compliance of antenatal care utilization with national and World Health Organization (WHO) guidelines. We also examined association of antenatal care utilization with adverse pregnancy outcomes as secondary outcome.MethodsThis was a community-based cross sectional study conducted from July 2016 to November 2017 in rural south-central Ethiopia. We described antenatal care received by pregnant women, whom we followed at three prescheduled visits during pregnancy and collected birth data at time of delivery. Extent of antenatal care content received, timing of antenatal care, place of antenatal care and place and mode of delivery were obtained and computed in accordance with national and WHO guidelines. For adverse pregnancy outcomes, computed as sum of low birth weight, preterm birth, intrauterine foetal death, and stillbirth, the exposure variable used was antenatal care utilization.ResultsSeven hundred and four (704) women participated in the study, and 536 (76.1%) had attended at least one antenatal care visit. Among women who attended antenatal care visit, majority, 421 (79.3%), had done so at health centres and hospitals, while 110 (20.7%) attended at health post. Average number of antenatal care visits was 2.5, which is less than that recommended in national and WHO guidelines. Only 18 (2.6%) women had attended antenatal care in their first trimester, which is low in contrast to the expected 100% specified in the guidelines. Less than half (47%) of the women delivered in a health facility. This is in contrast to the 100% expected health institution deliveries. Low birth weight was 7.9% (n = 48), and preterm birth was 4.9% (n = 31). There were 12 twin pregnancies, three stillbirths, 11 spontaneous abortions, and two intrauterine foetal deaths. We did not find significant association between adverse pregnancy outcomes and antenatal care utilization (COR = 1.07, 95% CI 0.62, 1.86).ConclusionThis study showed that antenatal care service utilization in the study area was markedly low compared to that recommended in national and WHO guidelines. The obtained antenatal health care utilization was not associated with the registered adverse pregnancy outcomes.

Perceived performances of peer learning and education approach on malaria prevention through primary schools communities in rural Ethiopia: Peer educators' perspectives.

Schools are viewed as natural hubs and an effective strategy for promoting community healthy practices such as malaria prevention and control. This study examined the perceived performance of the peer learning and education approach to malaria prevention in rural primary school communities in Ethiopia, which has thus far received little attention. Post-intervention data were collected from 404 randomly selected peer educators between 2 April and June 2020 using a structured questionnaire. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 24.0. Multiple linear regression was used to identify independent predictors of perceived performance of school-based peer learning and educational approach. A statistically significant p-value of < 0.05 was considered statistically significant. Four hundred and one educators (99.2%) completed the interview. The mean score of perceived performance was 44.31 (SD = 6.13) which was above the expected mean level range of 11-55. Feasibility (β = 0.253, 95% CI = [0.313, 0.682]), and appropriateness (β = 0.163, 95% CI = [0.099, 0.442]) were significantly associated with perceived performance. Self-efficacy, malaria risk perception, eagerness to share and learn from each other's experiences, and preference for more than one subject were all significantly associated with perceived performance, with (β = 0.097, CI = [0.017, 0.242]), (β = 0.143, CI = [0.071, 0.233]), (β = 0.207, CI = [0.308, 0.826]) and (β = 0.075, CI = [0.084, 2.511]) at 95% CI, respectively. The peer learning and education approach to malaria prevention and control in schools has a noticeably high level of perceived performance. Thus, it is recommended that when designing and implementing such programs through schools, personal and social (team) factors such as self-efficacy, risk perceptions, and peer education team spirit be considered.

Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24–59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24–59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

Seasonality and predictors of childhood stunting and wasting in drought-prone areas in Ethiopia: a cohort study

Background and objectivesOver centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate...

Children’s school attendance, work, health and rainfall shocks in Ethiopia

ABSTRACT The relationship between rainfall and primary-school-age children’s school attendance, school absence, work and health in rural Ethiopia is investigated. The focus is on how these relationships may differ by children’s gender. An increase in rainfall relative to longer-term average rainfall is associated with increased school attendance by girls and decreased school attendance by boys. An increase in rainfall is associated with increased probability of working by boys and decreased probability of working by girls; no significant change in weekly hours worked by boys and decreased work hours by girls. The implication for boys is that more of them work when there is more rainfall, but those already working work fewer hours. An increase in rainfall frees girls’ time, so they can potentially devote more attention to their schooling. An increase in rainfall is associated with lower school enrolment by boys but fewer hours of work for those already working. In terms of human capital acquisition, these two forces work in opposite ways for boys. An implication of these findings is that policies that offset income shocks arising from reduced rainfall are expected to result in increase in girls’ human capital and potentially reduce future gender economic disparities.

Community and individual level determinants of infant mortality in rural Ethiopia using data from 2016 Ethiopian demographic and health survey

The infant mortality rate remains unacceptably high in sub-Saharan African countries. Ethiopia has one of the highest rates of infant death. This study aimed to identify individual-and community-level factors associated with infant death in the rural part of Ethiopia. The data for the study was obtained from the 2016 Ethiopian Demographic and Health Survey. A total of 8667 newborn children were included in the analysis. The multilevel logistic regression model was considered to identify the individual and community-level factors associated with new born mortality. The random effect model found that 87.68% of the variation in infant mortality was accounted for by individual and community level variables. Multiple births (AOR = 4.35; 95%CI: 2.18, 8.69), small birth size (AOR = 1.29; 95%CI: 1.10, 1.52), unvaccinated infants (AOR = 2.03; 95%CI: 1.75, 2.37), unprotected source of water (AOR = 1.40; 95%CI: 1.09, 1.80), and non-latrine facilities (AOR = 1.62; 95%CI: 1.20) were associated with a higher risk of infant mortality. While delivery in a health facility (AOR = 0.25; 95%CI: 0.19, 0.32), maternal age 35–49 years (AOR = 0.65; 95%CI: 0.49, 0.86), mothers receiving four or more TT injections during pregnancy (AOR = 0.043, 95% CI: 0.026, 0.071), and current breast feeders (AOR = 0.33; 95% CI: 0.26, 0.42) were associated with a lower risk of infant mortality. Furthermore, Infant mortality rates were also higher in Afar, Amhara, Oromia, Somalia, and Harari than in Tigray. Infant mortality in rural Ethiopia is higher than the national average. The government and other concerned bodies should mainly focus on multiple births, unimproved breastfeeding culture, and the spacing between the orders of birth to reduce infant mortality. Furthermore, community-based outreach activities and public health interventions focused on improving the latrine facility and source of drinking water as well as the importance of health facility delivery and received TT injections during the pregnancy.

Does Land Certification Mitigate the Negative Impact of Weather Shocks? Evidence from Rural Ethiopia

This study examines the effects of weather shocks on household consumption and how the land registration and certification program facilitate coping strategies to mitigate the negative income shocks. Using the difference-in-differences (DID) approach and household panel data from Ethiopia, we find that weather shocks negatively affected household consumption expenditure. As expected, households are not able to protect themselves from weather shocks. However, the land certification program facilitated coping strategies (obtaining credit and receiving gifts and assistance from informal sources) to mitigate the negative effect on food consumption against weather shocks. This effect is only found among smaller landowners. Therefore, the program is pro-poor and beneficial for improving the welfare of poorer households and protecting vulnerable households from entering into poverty traps.

Association between sexual and reproductive health education in peer group and comprehensive knowledge of HIV among adolescent girls in rural eastern Ethiopia: a community-based cross-sectional study

ObjectivesThis study examined the association between sexual and reproductive health (SRH) education in peer-group discussion and comprehensive knowledge of HIV among young adolescent girls in rural eastern Ethiopia.DesignThe study analysed...

Thermal efficiency improvement and emission reduction potential by adopting improved biomass cookstoves for sauce-cooking process in rural Ethiopia

Sauce (“Wot”) preparation and Injera baking using an open-fire stove are recurrent cooking activities in rural households in Ethiopia. The low thermal efficiency open-fire stove utilized huge quantities of fuel and caused high particulate matter exposure for cookers. A rocket stove is proposed and fabricated that burns commonly used biomass fuel. The Aprovecho Research Center design guiding principles were followed to develop the prototype. The overall performance of the model was tested using a water boiling test (WBT version 4.2.3) to confirm thermal efficiency improvement and air pollutant reduction compared to the conventional stove. Indoor air pollution (IAP) measuring apparatus was installed to record the carbon monoxide (CO) and fine particulate matter (PM 2.5 ) emission exposure of the cooker during the WBT test. The performance testing result of the model has shown an improved thermal efficiency of 32% compared to the three-stone stove (14%). The stove reduced CO concentration by 42% and PM 2.5 concentration by 99.5% over the three-stone stove. The average concentration exposure for an hour (3.1 μg/m 3 CO) of the new stove satisfies the World Health Organization indoor air quality standard. Furthermore, the stove showed a 43% reduction in specific fuel consumption (roughly 625 kg fuel saving/year/device). The fuel-saving achieved from the model resulted in the reduction of CO 2 gas emissions by 1.3 tCO 2 /year. Therefore, it is assumed that the rocket stove has a considerable improvement over the open-fire stove and its timely development may enhance environmental care. Therefore, shifting the cooking technology from the conventional traditional cooking stove to rocket stoves could mitigate indoor air pollutant emissions and deforestation. • A rocket stove was fabricated and tested in a water boiling test. • The average thermal efficiency of the stove was found to be 32%. • The stove reduced CO concentration by 42% over the three-stone stove. • The stove reduced specific fuel consumption by 43% as compared to open fire stove. • The CO 2 emission saving of the stove was found to be 1.3 tCO 2 /year.

Unravelling the reservoirs for colonisation of infants with Campylobacter spp. in rural Ethiopia: protocol for a longitudinal study during a global pandemic and political tensions

IntroductionUndernutrition is an underlying cause of mortality in children under five (CU5) years of age. Animal-source foods have been shown to decrease malnutrition in CU5. Livestock are important reservoirs for...

Nurturing patriotism and national pride: An ethnographic exploration into the everyday worlds of Yekolo temari in Washera Qenie School

Anchored in an ethnographic fieldwork in rural Ethiopia, involving 66 children (12–18 years old) and 17 church scholars, this article looks at how a traditional school of the Ethiopian Orthodox Church nurtures sentiments of patriotism and national pride in Yekolo temari (children in the school). The findings revealed a multitude of pedagogical approaches that the church school employed. The school system also provided the students with ample cultural resources that enhance their national pride and patriotic feeling. This research has practical implications and contributes to the literature on national identity (re)construction, specifically on ways of cultivating patriotism and national pride among schoolchildren.

Why maternal continuum of care remains low in Northwest Ethiopia? A multilevel logistic regression analysis.

Non-adherence to the maternal continuum of care remains a significant challenge. Though early initiation and continuum of care are recommended for mothers' and newborns' well-being, there is a paucity of evidence that clarify this condition in resource-limited settings. This study aimed to assess the level of women's completion of the maternal continuum of care and factors affecting it in Northwest Ethiopia. A community-based cross-sectional study was conducted from October to November, 2020. Data were collected from 811 women who had a recent history of birth within the past one year. The random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval. The p-value of 0.05 was used to declare significantly associated factors with women's completion of the maternal continuum of care. The study revealed that 6.9% (95%CI: 5.3-8.9%) of women were retained fully on the continuum of maternal care, while 7.89% of women did not receive any care from the existing healthcare system. Attending secondary and above education (AOR = 3.15; 95%CI: 1.25,7.89), membership in the women's development army (AOR = 2.91; 95%CI: 1.56,5.44); being insured (AOR = 2.59; 95%CI: 1.33,5.01); getting health education (AOR = 2.44; 95%CI: 1.33,4.45); short distance to health facility (AOR = 4.81; 95%CI: 1.55,14.95); and mass-media exposure (AOR = 2.39; 95%CI: 1.11,5.15) were significantly associated with maternal continuum of care. The maternal continuum of care is low in rural northwest Ethiopia compared to findings from most resource-limited settings. Therefore, the existing health system should consider multilevel intervention strategies that focus on providing maternal health education, facilitating insurance mechanisms, encouraging women's participation in health clubs, and ensuring physical accessibility to healthcare facilities to be more effective in improving maternal health services.

Crop diversification and child malnutrition in rural Ethiopia: Impacts and Pathways

There is a resurgence of interest in crop diversification as a strategy to deal with a variety of issues including malnutrition in the context of a changing climate and poorly developed markets. However, the empirical evidence base to justify this policy position is thin. This research seeks to contribute to the growing literature and the policy discourse by providing empirical evidence on the impact of crop diversification on child growth using panel survey data combined with historical weather data. The study finds that crop diversification has a positive but small impact on child growth. Results from heterogeneous effects analysis show that the positive effects are more pronounced in areas with limited access to markets. The study demonstrates that the positive child growth effects of crop diversification could be mediated through its positive impacts on household diet diversity, diet quality, and income.

"If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility"-A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services in Northern Ethiopia.

In earlier studies, we have shown that the utilization of maternal health services in rural Ethiopia was distributed in a pro-rich fashion, while the coverage of child immunization was equitably distributed. Hence, this study aimed to explore mothers’ and primary healthcare workers’ perceptions of inequities in maternal, newborn, and child health services in rural Ethiopia, along with the factors that could influence such differentials. A qualitative study was conducted from November to December 2019 in two rural districts in Tigray, Ethiopia. Twenty-two in-depth interviews and three focus group discussions were carried out with mothers who had given birth during the last year before the survey. We also interviewed women’s development group leaders, health extension workers, and health workers. The final sample was determined based on the principle of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Two major themes emerged during the analysis that characterized the distribution of the service utilization and perceived causes of inequity. These were: (1) perceptions of the inequity in the use of maternal and child health services, and (2) perceived causes of inequity in maternal and child health service utilization. The mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service. The inequity in the maternal and child health services was linked to poverty, lack of education, lack of access, and poor-quality services. The poor, the uneducated, and women who were distant from health facilities had a low utilization rate of services. The weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children by improving access and empowering women through poverty alleviation and education.

Perceived barriers and enablers influencing health extension workers toward home-based hypertension screening in rural northwest Ethiopia: interpretive descriptive study

BackgroundHypertension, a major but modifiable risk factor for cardiovascular diseases, is a global health problem including Ethiopia. In a limited infrastructure task sharing of hypertension screening for community health workers is a feasible strategy to improve hypertension management. Recent finding have shown that trained health extension workers (HEWs) can identify high blood pressure, which was effective and feasible. Identifying barriers and enablers for home-based hypertension screening by HEWs is crucial for its implementation. This study aimed to explore barriers and enablers that influence health extension workers’ home-based hypertension screening in the community.MethodsThe interpretive descriptive design was implemented. In-depth interviews were conducted during October, 2020. A total of 26 participants including HEWs, supervisors, and heads of district health office were purposively selected. They were asked to describe their perception toward home-based hypertension screening by the HEWs. The interviews were audio-recorded, transcribed verbatim into Amharic, and translated into English. The transcripts were coded and themes were identified. Thematic approach was used for data analysis.ResultsThe participants identified key perceived barriers and enablers of HEWs home-based hypertension screening. The most common barriers were a lack of hypertension training, blood pressure measuring devices, blood pressure guidelines and manuals, skilled HEWs, financial incentives, and poor community awareness of the disease. The most common enablers were support from community leaders, presence of functional development army and community trust for HEWs, presence of routine campaign on vaccination and community based health insurance, and an integrated health system.ConclusionsOur findings have implications for the HEWs' ongoing implementation of home-based hypertension screening. Successful implementation of this strategy requires scaling up of hypertension training programs for health extension workers and their supervisors, provision of standardized protocols, provision of adequate blood pressure measuring equipment, and regular supportive supervision.

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

BackgroundEvidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia.MethodsWe employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff.ResultsIn the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0).ConclusionUsing a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.

Benefits, barriers and enablers of maternity waiting homes utilization in Ethiopia: an integrative review of national implementation experience to date

BackgroundThough Ethiopia has expanded Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, the utilization rate is low. To maximize the use of MWH, policymakers must be aware of the barriers and benefits of using MWH. This review aimed to describe the evidence on the barriers and benefits to access and use of MWHs in Ethiopia.MethodsData were sourced from PubMed, Google Scholars and Dimensions. Thirty-one studies were identified as the best evidence for inclusion in this review. We adopted an integrative review process based on the five-stage process proposed by Whittemore and Knafl.ResultsThe key themes identified were the benefits, barriers and enablers of MWH utilization with 10 sub-themes. The themes about benefits of MWHs were lower incidence rate of perinatal death and complications, the low incidence rate of maternal complications and death, and good access to maternal health care. The themes associated with barriers to staying at MWH were distance, transportation, financial costs (higher out-of-pocket payments), the physical aspects of MWHs, cultural constraints and lack of awareness regarding MWHs, women’s perceptions of the quality of care at MWHs, and poor provider interaction to women staying at MWH. Enablers to pregnant women to stay at MWHs were availability of MWHs which are attached with obstetric services with quality and compassionate care.ConclusionThis study synthesized research evidence on MWH implementation, aiming to identify benefits, barriers, and enablers for MWH implementation in Ethiopia. Despite the limited and variable evidence, the implementation of the MWH strategy is an appropriate strategy to improve access to skilled birth attendance in rural Ethiopia.