Southern Nations Research Articles

Spatial distribution and determinant factors of unmet need for family planning among all reproductive-age women in Ethiopia: a multi-level logistic regression modelling approach

BackgroundUnmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey.MethodsThis study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data’s hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics.ResultsOverall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country.ConclusionsIn this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority.

Determinants of adoption of climate-smart agricultural technologies and practices in the coffee-based farming system of Ethiopia

ObjectivesThis study explored the adoption status of different Climate Smart Agricultural (CSA) practices and factors that influence their adoption for sustainable soil resource utilization in the changing climate.MethodologyWe used quantitative and qualitative primary data collected from smallholder farmers and other stakeholders from major coffee-growing regions of Ethiopia: Oromia, and Southern Nations, Nationalities, and Peoples (SNNP). We used the multivariate probit (MVP) model to study factors that influence the adoption of climate-smart agricultural technologies, namely, manure application, minimum tillage, intercropping, use of improved forage, and physical soil and water management practices.ResultsThe study result shows that 35% of farmers apply manure on their farm plots. Minimum tillage is also applied to 36% of farms. Intercropping improved forages and physical soil and water management structures are adopted by 45, 19, and 47% of farmers, respectively. The finding of the study indicates the positive and significant effect of education, extension (access to extension services and participation on field days), and ownership of communication devices specifically radio on the adoption of climate-smart agricultural practices.RecommendationsConcerning bodies must pay due attention to problems affecting effective farmers-extension linkage. The positive effect of radio ownership on technology adoption also suggests the need for increased accessibility of FM radio channels to farmers to be aware of climate change and innovative agricultural technologies, practices, and information that mitigate the problem.

Modeling the spatial distribution of Culicoides species (Diptera: Ceratopogonidae) as vectors of animal diseases in Ethiopia

Culicoides biting midges (Diptera: Ceratopogonidae) are the major vectors of bluetongue, Schmallenberg, and African horse sickness viruses. This study was conducted to survey Culicoides species in different parts of Ethiopia and to develop habitat suitability for the major Culicoides species in Ethiopia. Culicoides traps were set in different parts of the country from December 2018 to April 2021 using UV light Onderstepoort traps and the collected Culicoides were sorted to species level. To develop the species distribution model for the two predominant Culicoides species, namely Culicoides imicola and C. kingi, an ensemble modeling technique was used with the Biomod2 package of R software. KAPPA True skill statistics (TSS) and ROC curve were used to evaluate the accuracy of species distribution models. In the ensemble modeling, models which score TSS values greater than 0.8 were considered. Negative binomialregression models were used to evaluate the relationship between C. imicola and C. kingi catch and various environmental and climatic factors. During the study period, a total of 9148 Culicoides were collected from 66 trapping sites. Of the total 9148, 8576 of them belongs to seven species and the remaining 572 Culicoides were unidentified. The predominant species was C. imicola (52.8%), followed by C. kingi (23.6%). The abundance of these two species was highly influenced by the agro-ecological zone of the capture sites and the proximity of the capture sites to livestock farms. Climatic variables such as mean annual minimum and maximum temperature and mean annual rainfall were found to influence the catch of C. imicola at the different study sites. The ensemble model performed very well for both species with KAPPA (0.9), TSS (0.98), and ROC (0.999) for C. imicola and KAPPA (0.889), TSS (0.999), and ROC (0.999) for C. kingi. Culicoides imicola has a larger suitability range compared to C. kingi. The Great Rift Valley in Ethiopia, the southern and eastern parts of the country, and the areas along the Blue Nile and Lake Tana basins in northern Ethiopia were particularly suitable for C. imicola. High suitability for C. kingi was found in central Ethiopia and the Southern Nations, Nationalities and Peoples Region (SNNPR). The habitat suitability model developed here could help researchers better understand where the above vector-borne diseases are likely to occur and target surveillance to high-risk areas.

Effect of spacing on growth performance and leaf biomass yield of Moringa stenopetala tree plantations

Moringa stenopetala is a multipurpose tree distributed naturally in the lowland dry lands of the southern part of Ethiopia. The tree has vital nutritional, industrial, and medicinal applications and is thus good for large scale and/or commercial plantations. However, its cultivation is limited to traditional practices by small holder farmers for food, fodder, shade, windbreak and medicinal value around homesteads and on farmlands. The aim of this study was to determine the effect of plant spacing on plant growth parameters and leaf biomass production of M. stenopetala. The study was conducted in Arbaminch zuria woreda of Southern Nation Nationalities and Peoples Region (SNNPR). Three planting spacings (0.5 × 0.5 m; 1 × 1 m and 2 × 2 m) were arranged in a randomized complete block design (RCBD) and the treatments were replicated three times. Survival%, root-collar diameter (RCD), height and stem diameter of the trees in each plot were recorded at three monthly intervals from the 3rd to 15 months. Data for leaf biomass were collected at the age of 27, 32 and 48 months. The harvested leaves were then oven dried to determine the dry leaf biomass. Individual Moringa trees showed better growth performance at the wider spacing of 2 × 2 m. The mean RCD, plant height and stem diameter were 7.45 ± 0.20 cm, 1.69 ± 0.06 cm and 3.19 + 0.11 cm for the wider spacing, while 3.12 ± 0.16 cm, 1.02 ± 0.07 cm and 2.12 ± 0.14 cm for the narrow spacing at the age of 15 months. The wider spacing produced the largest quantity of dry leaf biomass per individual plant (119.28 ± 9.02, 143.85 ± 10.29 and 249.8 ± 24.220 g/tree, but the least quantity on hectare bases 298.20 ± 22.54, 359.62 ± 25.73 and 624.49± 60.59 kg/ha) while the narrow spacing produced the smallest quantity per individual plant (48.36 ± 5.10, 44.74 ± 3.19 and 88.15 ± 30.28 g/tree), but the largest quantity on hectare bases (1934.40 ± 203.89, 1789.56 ± 127.78 and 3526.01± 1211.2 kg/ha) at the first, second and third harvest, respectively. This indicates that an increase in the plant spacing led to higher dry leaf biomass production per tree due to better plant growth, but the lesser the leaf biomass yields per hectare due to the lower planting density. The performance of M. stenopetala is promising and hence it can be considered for large scale and commercial plantation .

Smallholder farmers’ crop production and input risk analysis in rural Ethiopia

ABSTRACT Different types of risks are inherent in agricultural production. This study examines agricultural input risks faced by smallholder farmers in rural Ethiopia. It uses data from farm household surveys covering the period 1995–2015. The study uses a stochastic production function approach for estimating the mean production and risks of agricultural inputs. The mean production estimation results are consistent with the economic theory of conventional inputs. Land and labour have higher elasticities than the other inputs. The variance or risk estimation results show that fertilizers and labour are risk-decreasing inputs, while land is a risk-increasing input. Crop diversification has a risk-decreasing impact. The more farmers diversify their crops, the less is the yield variability. However, the risk variation effects of farm inputs vary across regions in the country. For example, risk-decreasing effects of fertilizers are high in the Oromia region, moderate in the Southern Nations and Nationalities and low in the Amhara regional state. Variations in regional input risks need to be considered in national agriculture risk management and food security efforts. The risk variation effects of these inputs decreased over time.

Prevalence of symptomatic pelvic organ prolapse and associated factors in Southern Nations, Nationalities, People's Region referral hospitals, Ethiopia.

Pelvic organ prolapse is one of the major causes of morbidity among women that affect their quality of life. Despite the severity of the problem, there is limited information in Ethiopia. Therefore, this study was aimed at assessing the prevalence of symptomatic POP and its associated factors. An institution-based cross-sectional study was carried out in the referral hospitals of Southern Nations, Nationalities, People's Region, Ethiopia. Women were initially interviewed about their prolapse symptoms using validated questionnaires, and if they answered yes to one or more of the questions, they were examined by gynecologists using simplified POP quantification. Pelvic examination results and patient-reported symptoms were used to determine symptomatic POP. A multivariate logistic regression analysis model was used to identify factors associated with symptomatic prolapse. A total of 1,196 respondents were included in this study. The prevalence of symptomatic POP was found to be 20.1%. Age of women ≥55 years (AOR=8.39; 95% CI 3.41-20.62), carrying heavy objects for ≥ 5 h (AOR= 5.18; 95% CI 2.51-10.69), parity ≥4 times (AOR=2.98; 95% CI 1.60-5.53), history of home delivery (AOR= 2.90; 95% CI 1.50-5.61), giving birth through assisted vaginal delivery (AOR=5.01; 95% CI 1.73-14.53), history of chronic constipation (AOR=2.66; 95% CI 1.38-5.15), and a history of a chronic cough (AOR=9.18; 95% CI 4.52-18.61) were associated with symptomatic POP. In this study the prevalence of symptomatic POP is high. Older age, long hours of carrying heavy objects, a high parity, last birth through assisted vaginal delivery, a history of home delivery, a history of chronic constipation, and a history of a chronic cough were found to be associated with symptomatic POP.

Traditional Medicinal Plants Used for the Treatment of Urological and Urogenital Diseases in Ethiopia: A Review

Introduction: Ethiopia is recognized as one of the richest biodiversity in Africa. The present review aimed to compile relevant information on medicinal plants traditionally used to manage urogenital diseases in Ethiopia. Methods: Different literatures published specifically on ethnobotanical use of medicinal plants in scientific journals, books, theses and proceedings were reviewed. Data from literatures were analyzed using statistical package for social sciences (SPSS) Version 20 and an Excel spreadsheet and reported using descriptive statistics, frequency, and percentage. Results: A total of 146 medicinal plants are reported in the reviewed literature. It was distributed in 127 genera and 64 families. Cucurbitaceae (7.51%), Asteriaceae (7.51%), Euphorbaceae (6.20%) and Apiaceae (4.80%) were family’s accounts of high number of species. A higher diversity of medicinal plants was reported from Southern nations and nationalities (44.5%), Oromia (41.1%) and Amhara (27.4%) regional states. The most frequently reported growth form of medicinal plants indicated in the review was herbs (46.8%), followed by shrubs (32.6%). Root (36.2%) and leaves (35.3%) were the most used parts. Decoction (26.1%), concoction (16.5%) and pounding (11.9%) were the most frequently reported remedy preparation methods and were administered orally. Conclusion: The present review indicated that urogenital diseases were managed with different medicinal plants throughout the regions of Ethiopian needed scientifically confirmed in order to produce safe and effective drugs from natural products.

The Prevalence of Work Related Wound and Associated Risk Factors in Working Equines

Across-sectional study was conducted in Hawasssa town, the capital city of Southern Nations and Nationalities People Regional state; to estimate the prevalence of work related wound and associated risk factors in working equines. The study animals were selected randomly. A total of 309 equines were included in the study comprising 164 (53.1%) of donkey, 95(30.74%) of horses, and 50(16.18%) of mules. The risk factors sex, age, body condition scores, purpose of the animals were assessed through questionnaire survey and physical clinical examination of animals. The study shows that an overall prevalence of external injuries in working equines was 84.1%. The prevalence of external injuries by the species was 25.89%, 45.95% and 12.3% for horse, donkey and mule respectively. Statistically significant difference (p&lt;0.05) in the occurrence of external injuries was noted among working equines of different sex groups, different functions, and different causes. Higher prevalence of external injuries was recorded in male animals (79.93%) than female (4.6%). Moreover, the occurrence of external injuries was higher in equines used for cart pool (40.77%) than those used for fetching of water (14.28%). In addition to this the distribution rate of external injuries between animals of different body condition showed that the highest rate was recorded in animals with medium body condition (31.39%) followed by those with good condition (27.18%).The major causes of external injury was inappropriate use of harness materials (33.7%) followed by over load and falling (12.3%). The prevalence of distribution of wounds on various body parts, was (23.46%) on the back which was relatively highest than shoulder, multiple body parts and wither which represent 11.5%, 10.77% and 8.1% respectively. The occurrence of external injuries in horses were 18.75% multiple wounds, 17.5% on the back and 15% on the shoulder while 23.24% on the back, 9.86 on wither and 8.45% multiple wounds, were found in donkeys. The occurrence of 36.86% of external injuries in the back of mule was observed in the study which was higher than other parts of the body. The study showed that working equine owners practice different approaches (70.4%) to manage wounds while 29.6% owners left their animals without any follow up. Hence, greater proportion of the owners (40%) have taken their animals to nearby health centers, while treated with medicine purchased from local markets 11.5% and 9.6% with medical plants. Relatively horse owners seek veterinarian services (43.5%).

The factors associated with antenatal care utilization in Ethiopia

BackgroundAntenatal care (ANC) is the provision of health services to pregnant women by trained health professionals before the birth of their babies to reduce maternal mortality and morbidity. So, the study aimed to identify the factors associated with Antenatal care utilization in Ethiopia. MethodsA Community-based Crossectional study design was used for 8885 women aged 15 to 49. The dependent variable was the utilization of Antenatal care services. Independent variables were Socio-demographic and Socioeconomic factors. The data was from the 2019 Ethiopian Mini demographic and health survey. Bivariate and multilevel binary logistic regression was used. ResultsOut of 8885 of all women considered for this study, 3910(44%) were utilized Antenatal Care (ANC) four or more times. 72.81% of the women were aged 15–34 years. On the other hand, high portions of women were from Amhara, Oromia and Southern Nations Nationalities Regional State with their respective percentages of 10.7%, 11.8% and 11.3%. Women from Somalia Region were 0.285 times less likely to utilize Four or more Antenatal Care (ANC) as Compared to a Women from Tigray Region [AOR = 0.285, 95% CI = 0.109–0.747]. ConclusionThe utilization of the Antenatal Care service was underutilized in Ethiopia. Education status, Ages of mothers, Size of family, Religion and Place of Residence were major Factors of influenced ANC utilization. The concerned government body should also create a better environment for impoverished women to participate in entrepreneurial activities.

Sub-sampling a large physical soil archive for additional analyses to support spatial mapping; a pre-registered experiment in the Southern Nations, Nationalities, and Peoples Region (SNNPR) of Ethiopia

The value of physical archives of soil material from field sampling activities has been widely recognized. If we want to use archive material for new destructive analyses to support a task, such as spatial mapping, then an efficient sub-sampling strategy is needed, both to manage analytical costs and to conserve the archive material. In this paper we present an approach to this problem when the objective is spatial mapping by ordinary kriging. Our objective was to subsample the physical archive from the Ethiopia Soil Information System (EthioSIS) survey of the Southern Nations, Nationalities and Peoples Region (SNNPR) for spatial mapping of two variables, concentrations of particular fractions of selenium and iodine in the soil, which had not been measured there. We used data from cognate parts of surrounding regions of Ethiopia to estimate variograms of these properties, and then computed prediction error variances for maps in SNNPR based on proposed subsets of the archive of different size, selected to optimize a spatial coverage criterion (with some close sample pairs included). On this basis a subsample was selected.This is a preregistered experiment in that we have proposed criteria for evaluating the success of our approach, and are publishing that in advance of receiving analytical data on the subsampled material from the laboratories where they are being processed. A subsequent short report will publish the outcome. The use of preregistered trials is widely recommended and used in areas of science including public health, and we believe that it is a sound strategy to promote reproducible research in soil science.

Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

BackgroundEthiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.MethodsA facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.ResultsOne third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).ConclusionSubstantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

Evaluating eye health care services progress towards VISION 2020 goals in Gurage Zone, Ethiopia

BackgroundEthiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia.ObjectiveTo evaluate Gurage Zone progress towards VISION 2020 targets and process indicators.MethodAn institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources for eye health, infrastructure, and service delivery at the zonal health office and health facilities. At the time of the study, Gurage Zone had a 1.7 million catchment area population. There were a total of five eye care centers, one of which was established by a non-governmental organization. Three of these facilities were secondary eye care centers with an operating theatre and two facilities were primary eye care centers. At the zonal level, there was no survey data available on the prevalence of blindness.ResultThere was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the zonal health office. The human resources for eye health (HReH) in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for HReH. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided emergency and elective pediatric surgery. The cataract surgical rate determined by the study was 1967.ConclusionGurage Zone showed significant improvement in terms of cataract surgical rate. But it had not achieved VISION 2020 goals in terms of critical HReH and service delivery. We recommend that the zonal health office carries out a focused and baseline evaluation of eye health care service achievements.

Spatial variation and determinates of dietary diversity among children aged 6–23 months in Ethiopia: spatial and multilevel analysis using Ethiopian Demography Health Survey (EDHS) 2019

BackgroundMinimum dietary diversity is the consumption of five or more food groups from the eight World Health Organization recommended food groups. Adequately diversified diet, in terms of amount and composition, is critical for optimal growth, development, and long-term health outcomes in the first 2 years. Understanding the regional variation of dietary diversity and the underlying factors is crucial for developing and implementing interventions. However, the use of spatial approaches in dietary studies has not been widely established. Therefore, this study aimed to explore the spatial patterns and determinates of minimum dietary diversity practice among 6–23 months children in Ethiopia.MethodsSecondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 1578 children aged 6–23 months was included for this study. The Global Moran’s I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariable multilevel logistic regression was used for factor analyses. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association.ResultsOverall, 87.4% (95% CI: 85.7 to 88.9%) of children in 2019 had inadequate Minimum dietary diversity. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) notably observed in Somali, Afar, Eastern and western Amhara, western Tigray, Benishangul, and Northeastern and western parts of the southern nations, nationality and peoples’ regions. Inadequate dietary diversity was significantly higher among young children, uneducated mother, married women, younger mother, no postnatal check, community with higher level of poverty and community level uneducated woman.ConclusionAccording to the findings of this study inadequate Minimum dietary diversity for children as measured by World Health Organization dietary assessment shows high. Children's dietary diversity was distributed non-randomly in different districts across Ethiopia's regions. The findings of the study provided critical evidence about dietary diversity and associated factors. Hence, policy should focused on improve education status of Mother, boosting economic status of the community, increased maternal continuum of care and focused on young children nutrition may advance dietary diversity.

Designing a Scalable Nutrition Education Package to Improve Diets of Adolescent Girls Through Primary Schools in Ethiopia

ObjectivesImproving adolescent girls’ nutrition is a high priority for the government of Ethiopia due to its immediate benefits for girls’ education and foundational role in protecting the productive and reproductive lives of women. Alive and Thrive (A&T) aimed to develop and implement an effective nutrition education package for scaling up by government education and health authorities. MethodsWe applied the socio-ecological model of social behavior change to systematically develop and test contextualized nutrition interventions in Southern Nations, Nationalities, and Peoples’ (agrarian) and Somali (pastoralist) regions. Using multiple sources of data and information we identified gaps in dietary practices, barriers, motivations; influential persons; and channels of communication for reaching adolescent girls in primary schools and influential persons, at high coverage and with frequent contacts. Region specific interventions, protocols, tools, and materials were field tested and tailored to fit the contact points and capacity of schools. ResultsThree dietary practices were selected based on evidence of gaps and potential benefits, 1) dietary diversity through promotion of locally available foods and food groups missing from adolescent girls’ diets by region, 2) frequency of meals and 3) reducing the consumption of unhealthy foods. Teachers, parents and peers were found to have the greatest influence on adolescent girls’ dietary practices. Community leaders (including religious leaders in Somali) and health extension workers were influential among parents, and school principals and supervisors were important for motivating teachers. ConclusionsSystematically targeting priority behaviors, engaging key influential persons, achieving high coverage and frequency through existing multiple contact points, and utilizing communication channels available through in-classroom and other activities were critical for developing a feasible and scalable package of school-based nutrition education interventions. Using data to design interventions and streamline implementation strategies facilitated the scale up of an effective intervention package for schools. Funding SourcesBill & Melinda Gates Foundation, through A&T, managed by FHI Solutions.

Professionalism, stigma, and willingness to provide patient-centered safe abortion counseling and care: a mixed methods study of Ethiopian midwives

BackgroundMidwives are a large proportion of Ethiopia’s health care workforce, and their attitudes and practices shape the quality of reproductive health care, including safe abortion care (SAC) services. This study examines how midwives’ conceptions of their professional roles and views on women who have abortions relate to their willingness to provide respectful SAC.MethodsThis study uses a cross-sectional, mixed methods design to conduct a regionally representative survey of midwives in Ethiopia’s five largest regions (Oromia; Amhara; Southern Nations, Nationalities, and Peoples [SNNP]; Tigray; and Addis Ababa) with a multistage, cluster sampling design (n = 944). The study reports survey-weighted population estimates and the results of multivariate logistic regression analyzing factors associated with midwives’ willingness to provide SAC. Survey data were triangulated with results from seven focus group discussions (FGDs) held with midwives in the five study regions. Deductive and inductive codes were used to thematically analyze these data.ResultsThe study surveyed 960 respondents. An estimated half of midwives believed that providing SAC was a professional duty. Slightly more than half were willing to provide SAC. A belief in right of refusal was common: two-thirds of respondents said that midwives should be able to refuse SAC provision on moral or religious grounds. Modifiable factors positively associated with willingness to provide SAC were SAC training (AOR 4.02; 95% CI 2.60, 6.20), agreeing that SAC refusal risked women’s lives (AOR 1.69; 95% CI 1.20, 2.37), and viewing SAC provision as a professional duty (AOR 1.72; 95% CI 1.23, 2.39). In line with survey findings, a substantial number of FGD participants stated they had the right to refuse SAC. Responses to client scenarios revealed “directive counseling” to be common: many midwives indicated that they would actively attempt to persuade clients to act as they (the midwives) thought was best, rather than support clients in making their own decisions.ConclusionFindings suggest a need for new guidelines to clarify procedures surrounding conscientious objection and refusal to provide SAC, as well as initiatives to equip midwives to provide rights-based, patient-centered counseling and avoid directive counseling.

Understanding barriers to men’s support for family planning in rural Ethiopia—findings from the USAID Transform: Primary Health Care Project Gender Analysis

BackgroundEvidence suggests that supportive male engagement in health care services, including family planning, remains low in many countries, despite known benefits for female partners. In 2017–2018, the United States Agency for International Development Transform: Primary Health Care Project conducted a participatory gender analysis, collecting relevant data to better understand Ethiopian men’s lack of support for the uptake of family planning services.MethodsQualitative data were collected through 96 unique participatory group discussions with community members via a semistructured discussion guide and participatory activity; data were disaggregated by sex, age, and marital status. In-depth interviews (91) conducted with service providers, health system managers, and health extension workers used semistructured guides. Discussants and interviewees were selected purposefully, drawn from 16 rural woredas in four project regions: Amhara; Oromia; Tigray; and Southern Nations, Nationalities, and Peoples’ Region. Data collectors took notes and transcribed audio recordings. The research team deductively and inductively coded transcripts to develop preliminary findings later validated by key technical project staff and stakeholders.ResultsFindings reinforce existing knowledge on the dominant role of men in health care–related decision making in rural Ethiopia, although such decision making is not always unilateral in practice. Barriers at the societal level impede men’s support for family planning; these include norms, values, and beliefs around childbearing; religious beliefs rooted in scriptural narratives; and perceived adverse health impacts of family planning. Lack of efforts to engage men in health care facilities, as well as the perception that health care facilities do not meet men’s needs, highlight systems-level barriers to men’s use of family planning services.ConclusionsFindings indicate several opportunities for stakeholders to increase men’s support for family planning in rural Ethiopia, including systems-wide approaches to shape decision making, social and behavior change communication efforts, and additional research and assessment of men’s experiences in accessing health care services.

Signs of a turning tide in social norms and attitudes toward abortion in Ethiopia: Findings from a qualitative study in four regions

BackgroundDespite the 2005 expansion in abortion legal indications in Ethiopia, which provided for abortions in cases of rape, incest, or fetal impairment and other circumstances, nearly half of abortions occurred outside health facilities in 2014. The purpose of this study is to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care, as a means to generate evidence that could be used to improve access to and quality of abortion services.MethodsThirty-two focus group discussions with both men and women were held in four different regions of Ethiopia: Addis Ababa; Amhara; Oromia; and the Southern Nations, Nationalities, and Peoples’ Region. The study team recruited participants (n = 193) aged 18–55 in each region using a purposive sample with snowball recruitment techniques. We conducted discussions in Amharic or Afaan Oromo using a semi-structured guide and transcribed and translated them into English for analysis. We used deductive coding and analysis to categorize findings into emergent themes around stigma, barriers, and the changing nature of attitudes around abortion.ResultsDespite changes in abortion law, findings show that women with unwanted pregnancies and those seeking abortions are still heavily stigmatized and sanctioned in a number of communities across Ethiopia. Abortion was deemed unacceptable in most cases, though respondents were more tolerant in cases of risk to the mother’s life and of rape. We saw promising indications that changes are taking place in Ethiopian society’s view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws and tightly held gender-based social norms, particularly in rural areas. Most participants noted the importance of education and outreach to improve abortion attitudes and norms.ConclusionPolicymakers should create further awareness in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. Such efforts should be based on principles of gender equality, as a means of ensuring enduring changes for women’s reproductive choice throughout the country.

Prevalence of Elevated Blood Pressure and Risk Factors Among Men and Women in Six Regions of Ethiopia

ObjectivesHypertension is a growing problem in Ethiopia; large representative surveys are needed to elucidate the burden of raised blood pressure and regional differences. MethodsA population-based cross-sectional survey including 2,520 women and 1,054 men aged 15–49 years was carried out in six regions of Ethiopia (Addis Ababa, Afar, Amhara, Oromia, Southern Nations Nationalities and Peoples [SNNP], and Tigray). All participants completed a household questionnaire, a food frequency questionnaire (FFQ) and underwent blood pressure and height and weight measurements. Population-weighted prevalences were calculated for prehypertension (defined as systolic blood pressure 120–139 mmHg or diastolic blood pressure 80–89 mmHg) and elevated blood pressure (defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg). Multivariable-adjusted associations of risk factors with systolic blood pressure were estimated using survey-weighted linear regression models. ResultsAcross the six regions, 41% of participants had prehypertension (39% among women and 47% among men) and 17% had elevated blood pressure (17% among women and 16% among men). Regional prevalence of prehypertension was lowest in Tigray (31%) and Afar (30%) and highest in SNNP (44%) and Amhara (43%). Prevalence of elevated blood pressure was lowest in Tigray (9%) and Afar (8%) and highest in SNNP (19%), Oromia (19%), and Addis Ababa (18%). The Global Diet Quality Score Positive Submetric (GDQS+) reflecting higher intake of 16 healthy food groups was inversely associated with systolic blood pressure (Adjusted mean difference [AMD] –0.35 mmHg; 95% Confidence Interval [CI]: –0.64, –0.05). Body Mass Index (BMI) was positively associated with systolic blood pressure (AMD 0.68 mmHg; 95% CI: 0.34, 1.01). Among men, drinking alcohol was associated with higher systolic blood pressure (AMD 3.14 mmHg; 95% CI: 1.25, 5.03). ConclusionsPrevalence of prehypertension and elevated blood pressure among adults aged 15–49 in six regions of Ethiopia is high, with important regional differences. Diet quality, BMI and alcohol use among men are important modifiable risk factors that interventions in Ethiopia could target to lower risk of prehypertension and elevated blood pressure. Funding SourcesThis work was supported by the Bill and Melinda Gates Foundation Grant OPP1179606.

Time to Recovery from Covid-19 and Its Predictors Among Patients Admitted to Treatment Centers of Southern Nations Nationalities and Peoples Region (SNNPR), ETHIOPIA: Multi-Center Retrospective Cohort Study.

BackgroundThe world is currently facing a pandemic of Coronavirus Disease 2019 (Covid-19). It has caused significant morbidity and mortality. So far little is known about recovery time (prolonged hospital stay) from Covid-19 and its determinants in Ethiopia as well as in the study area. Therefore, the aim of this study was to determine time to recovery from Covid-19, and identify predictors of time to recovery among patients admitted to treatment centers of Southern Nations Nationalities and Peoples Region (SNNPR).Methods and MaterialsA facility-based retrospective cohort study was conducted among Covid-19 patients admitted to care centers of SNNPR from May 30, 2020 to October 15, 2021. A sample of 845 patients was included in the study. Summarization of the data was done using mean (standard deviation) and median (inter quartile range). Kaplan–Meier Survival Curve was used to estimate recovery time from Covid-19 and the independent effects of covariates on recovery time was analyzed using multivariable Cox-proportional hazard model.ResultsThe incidence density of recovery was 8.24 per 100 person-days (95% CI: 7.67, 8.85). The overall median recovery time was 10 days (IQR: 8–16 days). Critical stage of Covid-19 (aHR = 0.19, 95% CI: 0.12, 0.29), severe stage of Covid-19 (aHR = 0.40, 95% CI: 0.29, 0.56), mechanical ventilation (aHR = 0.20, 95% CI: 0.073, 0.56) and treatment center (aHR = 0.68, 95% CI: 0.51, 0.90) were significant predictors of recovery rate among Covid-19 patients.ConclusionThe median time to recovery from Covid-19 was relatively short. The incidence density of recovery was 8.24 per 100 person-days. The hazard of recovery was lower for patients at higher levels of Covid-19 severity and for patients in need of mechanical ventilation. Early identification of severity levels of the patients is required at the time of admission. Special attention, critical follow–up and management is warranted for patients at higher levels of Covid-19 severity.

Burden and risk factors of cutaneous leishmaniasis in Ethiopia: a systematic review and meta-analysis.

Cutaneous leishmaniasis (CL) is a major public health problem in Ethiopia. About 30 million people are at risk, and there are 20,000 to 50,000 new cases annually. It is maintained by rock hyraxes and Phlebotomus sand flies. Different studies showed the presence and risk factors of CL. However, there is no study on the pooled prevalence and risk factors. This study aimed to determine the pooled prevalence and risk factors of CL in Ethiopia. We retrieved published articles from different databases. The review was conducted based on PRISMA guidelines. The meta-analysis was done with Stata software version 14. The forest plot with random-effect model and inverse variance index was used to estimate the pooled prevalence with 95% confidence interval and heterogeneity of articles, respectively. A total of 99,226 people from 19 studies were screened. The overall pooled prevalence of CL was 20.4% with 95% CI (15.67-25.13%). The pooled prevalence is a weighted average of results of the included 19 studies. Highest pooled prevalence, 65.39% (95% CI: 61.14-69.47%), was in Southern Nations, Nationalities and Peoples' Region (SNNPR), and the lowest was 1.53% (95% CI: 1.43-1.63%) in Amhara Region. Children were the most affected age group. Living in a home close to farmlands, outdoor sleeping behavior, the presence of gorge, hyrax, cracked walls, animal dung, and other cases in the neighborhood were identified as risk factors for CL. There is high burden of CL in Ethiopia. Larger surveys are required. Health education on the prevention and control strategies shall be implemented.