Women's Development Army Research Articles

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.

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...

Practical contribution of women development army on growth monitoring and promotion service at Dembya and Gondar Zuria districts, Central Gondar Zone, North West Ethiopia: a community based mixed study

BackgroundThe United Nations’ Sustainable Development Goal (SDG)-2 aims to eliminate child hunger or end all forms of child malnutrition by 2030. To achieve this goal the cost-effective method is the implementation of growth monitoring and promotion service with the contribution of Women Development Army (WDA) as community volunteers. However, According to the data, the program’s implementation varies throughout the country and lack of evidence on the practical contribution of the WDA to enhancing child nutritional care outcomes. Therefore this study aimed to determine practical contribution of WDA and associated factors on growth monitoring and promotion service in two rural districts of central Gondar zone, Northwest Ethiopia.MethodsA community based mixed study was conducted from March 6 to April 7, 2022 among 615 Women Development Army. Multistage sampling technique was used to select study participants. A structured questionnaire was used to collect quantitative data and in-depth interview were used to generate qualitative information. Qualitative data were coded and grouped and discussed using identified themes. Binary logistic regression was fitted, odds ratio with 95% confidence interval was estimated to identify factors of practical contribution of WDA and qualitative data was analyzed using thematic analysis.ResultsIn this study practical contribution of WDA on growth monitoring was 31.4% (95% CI: 28.0-35.3%). Having GMP training (AOR = 4.2, 95%CI: 1.63, 10.58), regular community conversation (AOR = 6.0, 95%CI: 3.12, 11.54), good knowledge about GMP (AOR = 2.1, 95%CI: 1.17, 3.83) and not having regular schedule of GMP service in the area (AOR = 0.04, 95%CI: 0.02, 0.09), were statistically significantly associated with practical contribution of growth monitoring. During in-depth interview, lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were mentioned among the problems faced during growth monitoring service.ConclusionIn this study, practical contribution of growth monitoring among WDA was low. GMP training regular community conversation, knowledge about GMP and regular schedule of GMP service in the local area were significantly associated for practical contribution of growth monitoring service. Lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were reasons for did not contribute effectively for GMP service. Therefore, giving training for WDA and improving community conversation at kebeles level are important to improve GM service. .

The Quality of Logistics Management Information System and the Availability of Tracer Drugs at Health Posts in Rural Ethiopia: A Mixed-Method Study.

Proper implementation of the logistics management information system (LMIS) would facilitate access to essential pharmaceutical products. It also prevents wastage at health posts. The aim of this study was to assess the implementation of the LMIS and the availability of tracer drugs at health posts in rural Ethiopia. We employed a cross-sectional descriptive design with a mixed-method approach. The data used for this paper was collected from March to May 2019 as part of the National HEP assessment. The study involved 343 health posts randomly selected from nine regions of Ethiopia. Women's Development Army members and household heads participated in the qualitative study (i.e. in FGD and KII). The quantitative data were exported from Open Data Kit (ODK) to Stata 15.1 for statistical analysis, and the qualitative data were entered into NVivo 12 and analyzed using thematic content analysis. Of the health posts, 59.4% had a space for storing drugs; less than half (41.9%; 95% confidence interval (CI) [36%, 48%]) had a functioning refrigerator. The mean percentage of the availability of selected tracer drugs at health posts was 59.6%, with a 95% CI (58.9%, 60.3%). Bin cards were available at 43% (95% CI [40%, 46%]) of health posts, and among these, only 27.5% of the health posts adequately used the bin cards. The absence and poor use of LMIS tools was observed at health posts. Proper implementation of the LMIS has the potential to improve the availability of essential drugs that, in turn, improve health post level delivery of health services.

The Effect of Behavior Change Communication via the Health Development Army on Pregnant Women’s Nutrition and Health Practices in Ambo District, Ethiopia: A Cluster Randomized Controlled Community Trial

Background: A woman’s nutrition and health at conception and during her pregnancy is crucial factors in defining both her own and her unborn child’s health and well-being at this crucial time in her life. Therefore, the objective of the study was to investigate the effect of Behavior Change and Communication (BCC) through the women development Army on optimal nutrition and health practices of pregnant women. Methods: From April 1, 2018 to October 30, 2019, a cluster-randomized controlled trial was conducted in the Ambo district of Ethiopia. Three hundred eighty-five women in the 24 intervention clusters and 385 women in the 24 control clusters were recruited at the start of the study. In the intervention group, health development armies delivered the BCC’s main messages for three months, from July 2018 to September 2018, and end point data were collected from pregnant women (n = 744, 372 in the intervention group, and 372 in the control group) in October 2018. The control group received the standard care provided by the healthcare system during an ANC visit. The researchers used a binary generalized linear model analysis. A p value of <0.05 is used to indicate statistical significance. Statistical analyses were conducted on a per protocol basis. Result: The overall optimal nutrition and health practice were higher in the intervention group than in the control group (62.6% vs. 38.7%, P<0.001). The control group had a larger absolute risk of suboptimal nutrition and health practice (0.613 vs. 0.374, p<0.001) than the intervention group. Pregnant women in the intervention group had an absolute risk difference of 23.9% for suboptimal nutrition and health. Pregnant women who received intervention were 30.9% less likely to have suboptimal nutrition and health practice compared to pregnant women who were in the control group (ARR=0.691, 95% CI: 0.594-0.804). Conclusions: Behavior change communication (BCC) through the women’s development army is effective in improving optimal nutrition and health practices of pregnant women. Therefore, to improve the optimal nutrition and health practices of pregnant women, BCC through the health development army is recommended.

The Effect of Behavior Change Communication via the Health Development Army on Pregnant Women's Nutrition and Health Practices in Ambo District, Ethiopia: A Cluster Randomized Controlled Community Trial

Background A woman's nutritional and physical health at conception and during her pregnancy is crucial factors in defining both her own and her unborn child's health and well-being at this crucial time in her life. Therefore, the objective of the study was to investigate the effect of Behavior Change and Communication (BCC) through the women development Army on optimal nutrition and health practices of pregnant women. Methods In the Ambo district, 770 pregnant women participated in a two-arm parallel cluster randomized controlled community trial with baseline and end-line measures (385 in control and 385 in intervention groups). Endpoint data from 372 intervention and 372 control groups were gathered, respectively. In the intervention group, health development armies delivered the BCC's main message. The intervention began in July 2018, and end point data were collected from pregnant women (n = 744) in October, 2018. The control group received the typical care provided by the healthcare system during an ANC visit. Descriptive statistics, chi-square test, bivariable and lastly multivariable binary logistic regressions analysis was used to control confounders. Statistical analyses were conducted on intention-to-treat (ITT) basis and p value <0.05 was used to declare statistical significance. Result The overall optimal nutrition and health practice were higher in the intervention group than in the control group (62.6% vs. 39.0%, P<0.001). Pregnant women who received intervention had two times higher odds of optimal nutrition and health practices compared to pregnant women who were in the control group (AOR = 2.051, 95%CI: 1.318-3.192). In a multivariable binary logistic regression analysis (p<0.05), being in the intervention group, educational status, estimated time to reach the health institution, and knowledge about nutrition and health were found to be significantly associated with optimal nutrition and health practices. Conclusions Behavior change communication (BCC) through the women's development army is effective in improving optimal nutrition and health practices of pregnant women. Therefore, to improve the optimal nutrition and health practices of pregnant women, BCC through the health development army is recommended.

Determinants of cervical cancer screening utilization among women in Southern Ethiopia

Cervical cancer has been an important public health problem. Despite the availability of screening services, its utilization in Ethiopia is low. This study therefore, aimed to identify contextual predictors of cervical cancer screening utilization among eligible women. This study employed facility-based unmatched case–control study design. Data were collected from 410 participants using interviewer-administered techniques. The collected data were entered using EpiInfo version 7 and transported to SPSS version 20 for statistical analysis. We performed descriptive analysis and logistic regression to identify predictors of screening utilization. This study demonstrated that urban residence, being in marital union, membership in women development army, knowledge of cervical cancer screening location, use of maternal health care in the previous year and knowledge on cervical cancer and its screening were predictors of screening utilization. Therefore, it is important to improve women’s knowledge on cervical cancer, promote maternal health care use, disseminate health information through women’s groups and consider all positive effects of urban residence among rural women to improve screening utilization.

Determinants of measles vaccination dropout among 12\u2009\u2212\u200923\u2009months aged children in pastoralist community of Afar, Ethiopia

BackgroundMeasles is a viral disease and a leading vaccine-preventable childhood killer. More than 95% of measles deaths occur in countries with low incomes and weak health infrastructures. In response to this, Ethiopia prepared a measles elimination strategic plan to achieve by 2020. However, based on the Mini-Ethiopian demographic health survey 2019 the full coverage of immunization is 43% at the country level and it is lowest (20%) in the Afar region where this study was conducted. Therefore, this study aimed to identify the determinants of the measles vaccine dropout rate in Afar regional state which is one of the pastoralist communities in Ethiopia.MethodsCommunity based unmatched case-control study design was used. The study was conducted in Awash district of Afar regional state, Ethiopia from June 1st -30th 2018. Data were collected from a study unit of 12–23 months old children. For this study, a sample of 166 cases and 331controls were selected by simple random sampling methods and the total sample size was 497. Data were collected using a pretested structured questionnaire by health workers using the local language. Data were entered into Epi-info − 7 and analyzed by SPSS version 20 software and logistic regression was used to assess the determinants measles dropout rate.ResultsA total of 487 children participated in this study with a response rate of 97.9%. More than half of the children were female (53.3%) and 113 (35.2%) children mothers’ were not attended formal education. Mother who had antenatal care ≤ 2 visits [AOR:=5.7(3.2–10.14)], being in the birth order of 1 − 3 [AOR = 4.47(1.63–12.29)], long waiting time > 60 min at nearby health facility for vaccine [AOR = 2.37(1.36–4.15)], households visit by health extension workers [AOR = 2.03(1.12–3.66)], pregnant women not participating with women development army [AOR = 3.5(1.94–6.18)], and poor maternal knowledge on vaccination [AOR = 3.30(1.9–5.73)] were significant determinants with measles vaccination dropout rate.ConclusionsHealth facility and mother characteristics were the determinants of the measles vaccine dropout rate. Therefore, tracing and strict follow up by the health extension works using home visits and women development army at the pastoralist community is necessary to reach them.

Timing and factors associated with early antenatal visits among pregnant women in west Gojjam, northwest Ethiopia

Background Early and appropriate antenatal care practices have the potential to save the lives of mothers and their children, and enable mothers to receive the full range of antenatal care services. However, in developing countries, including Ethiopia, a number of pregnant women do not attend antenatal care in the recommended time period. Therefore, this article assessed the timing and factors associated with early antenatal care visits in west Gojjam, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted among pregnant women attending antenatal care services in west Gojjam. Data on participants' sociodemographic, obostetric and reproductive health information were collected from 820 participants using a structured interviewer-administered pretested questionnaire. Bivariate and multivariate logistic regression analyses were used to identify variables associated with early antenatal care visits. Variables with P<0.05 were considered significant. A visit was considered ‘early’ if a pregnant woman attended their first antenatal care session within the first 12 weeks of gestation. Results Almost a third (31.5%) of mothers started antenatal care early. The mean gestational age at the first visit was 17 weeks (standard deviation±7.7), with a range of 3–36 weeks. In multivariate analysis, it was found that being nulliparous (adjusted odds ratio: 2.3; P=0.013), travel time to the health facility being less than 30 minutes (adjusted odds ratio: 6.1; P<0.001) and living in an urban area (adjusted odds ratio: 2.4; P=0.001) were significantly associated with attending antenatal care early. Conclusions Early first antenatal care attendance was low in the study area. It is important to decentralise the provision of antenatal care services at health posts through an outreach service, by strengthening the mobilisation, screening and early referral system through health extension workers and the women development army. This will allow more women to receive antenatal care from skilled providers.

Effect of complementary feeding behavior change communication delivered through community-level actors on the time of initiation of complementary foods in rural communities of West Gojjam zone, Northwest Ethiopia: a cluster-randomized controlled trial

BackgroundAttaining the recommended level of complementary feeding practices remains a serious challenge in many developing countries. Complementary foods are usually untimely initiated, which has adverse consequences on the growth, development, and survival of infants. The focus of most studies conducted worldwide seemed to be on the effect of behavior change interventions on the adequacy of complementary diets; but not on the timing of initiations. Moreover, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged the family members are scarce. This study aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through women development army leaderson the time of initiation of complementary foods.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia from February 2017 to March 2018. A total of 16 geographic clusters were selected. Trial participants in the intervention group received complementary feeding behavior change intervention for 9 months whereas those in the control group received only the usual health care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimated equation (GEE) regression and survival analyses were used to test differences in time of initiation of complementary food between the study groups.ResultsThe intervention significantly improved the likelihood of timely initiation of complementary food by 22 percentage points [RR: 2.6; 95% CI: 1.78–5.86], and reduced the risk of late initiations by 19 percentage points [RR: 2.8; 95% CI: 1.83–4.37]. The complementary food initiation survival curve for the control group after 6 months was constantly above the curve than for the intervention group. The median age at the introduction of complementary food for infants was 6 months in the intervention group, and 6.7 months in the control group and the difference was statistically significant (P-value < 0.001).ConclusionsComplementary feeding behavior change communication improved the rate of timely initiation of complementary foods and reduced the risk of late initiations.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.

&lt;p&gt;Determinants of Home Delivery Among Women in Rural Pastoralist Community of Hamar District, Southern Ethiopia: A Case–Control Study&lt;/p&gt;

PurposeStudies addressing determinants of home delivery in pastoralist areas are scarce in Ethiopia. In this study, we aimed to assess determinants of home delivery in rural pastoralist communities of Hamar District, Southern Ethiopia.Patients and MethodsIn April 2018, we conducted a community-based case–control study. Of 35 rural kebeles (lowest level of administration) in the district, 8 were randomly selected. Ninety-nine randomly selected cases (mothers who gave birth at home) and 193 controls (mothers who gave birth at health facility) were included in the study. We used structured questionnaires to collect data. Through face-to-face interview, data on place of delivery, socio-demographic characteristics, obstetric history knowledge and attitude of mothers were collected. We used logistic regression model to measure association between variables.ResultsLate initiation of antenatal care (AOR = 4.6, 95% CI = 1.2, 17.1), husbands only decision-making (adjusted odds ratio [AOR] =7.2, 95% CI = 2.1, 24.5), women’s preference for traditional birth attendants (TBAs) (AOR = 3.9, 95% CI = 1.2, 12.5), and not involving in women’s development army (WDA), (AOR = 3.3, 95% CI = 1.0, 10.5) increased the risk of home delivery. Moreover, low maternal knowledge on danger signs of pregnancy (AOR = 6.5, 95% CI = 1.5, 29.0) and negative maternal attitudes towards institutional delivery (AOR = 4.4, 95% CI = 1.4, 14.1) were other factors that increased the risk of home delivery.ConclusionAmong our study participants, a number of factors increased the risk of home delivery. Improving women’s awareness on the importance of institutional delivery, establishing systems for integration between TBAs and health facilities, empowering women and promoting them to participation in WDA were recommended.

Political connections and psychosocial wellbeing among Women's Development Army leaders in rural amhara, Ethiopia: Towards a holistic understanding of community health workers' socioeconomic status.

Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n=74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n=422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.

Effect of complementary feeding behavior change communication delivered through community-level actors on dietary adequacy of infantsin rural communities of West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial.

BackgroundAttaining the recommended level of adequacy of the infant’s diet remains a serious challenge in most developing countries. Complementary foods, particularly in developing countries, are inadequate in quality and quantity that can result in adverse health and nutrition consequences in infants. This could be not only because of lack of food but also associated with caregiver’s poor knowledge, harmful cultural norms and behaviors on infant feeding. The promotion of optimal complementary feeding through behavior change interventions is a global health priority. However, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged other family members are limited worldwide. Moreover, such interventions are scarce in developing countries, including Ethiopia. This trial aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through community-level actors on the dietary adequacy of infants.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia. Trial participants in the intervention clusters received complementary feeding behavior change communication for 9 months whereas those in the control clusters received only the usual care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimating equations regression analyses adjusted for baseline covariates and clustering were used to test the intervention effects.ResultsThe intervention showed positive statistically significant effects on the consumption of dairy products [RR = 1.8; 95% CI: 1.04–3.13], eggs [RR = 3; 95% CI: 1.35–6.56], vitamin A-rich fruits and vegetables [RR = 2.7; 95% CI: 1.17–6.1], other fruits and vegetables [RR = 5; 95% CI: 2.49–10.58] and animal-source foods [RR = 2; 95% CI: 1.39–2.87]. The proportions of infants who achieved minimum dietary diversity [RR = 3; 95% CI: 1.34, 7.39], minimum meal frequency [RR = 2.4; 95% CI: 1.37–4.29], and minimum acceptable diet [RR = 2.7; 95% CI: 1.13–7.23] were significantly higher in the intervention as compared to control groups.ConclusionsComplementary feeding behavior change communication delivered through community-level actors significantly improved the dietary adequacy of infants.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.

Perspectives of the Health Extension Program Enhancing Contraceptive Provision in Southern Ethiopia: A Qualitative Exploration

Aim: To uncover information gap on the health extension program contribution in improving access, the study explored the lived experiences towards creating enabling environments for contraceptive service provision and use in light of the health extension program.&#x0D; Methods: Interpretative phenomenological design was employed for the study. Data were collected using focus group discussions, individual in-depth interviews and key informant interviews. Analysis was done using an interpretive phenomenological analysis framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through the hermeneutic circle.&#x0D; Results: The finding captures the contribution of the health extension program in accelerating/decelerating contraceptive use in the study area. Contraceptive services organization, access and extension in the era of the health extension program were presented. Since the beginning of the program, contraceptive use has alarmingly improved as witnessed by both the service users and providers. The linkage of primary health care with the community organization, a women development army and the one-to-five network are among the major contributed factors for the outcomes.&#x0D; Conclusion and Recommendation: The study concludes that the health extension program has given a special momentum in shaping the principles of PHC. The study revealed that women witnessed encouraging involvements in contraceptive service access and use. Hence, the study recommends that the experiences of women development armies and other networks have to be strengthened. Moreover, the existing community networks should be strengthened through proper evaluation and feedback.

Impact of COVID-19 Pandemic on Sexual and Reproductive Health and Mitigation Measures: The Case of Ethiopia.

Ethiopia has made tremendous progress in sexual and reproductive health (SRH) in the past two decades, especially in reducing maternal mortality and morbidity. Ethiopia's dedication to reducing maternal mortality is exemplary. All maternity services including antenatal care, labor and delivery, postnatal care, family planning, and post abortion care were given free of charge to increase access to service. In 2019, 7,091,000 women were using modern contraceptive methods, which was estimated to avert 2, 755, 000 pregnancies, 607,000 unsafe abortions and 7400 maternal deaths 1 . Women development army (community health workers) works to reduce maternal mortality, especially by increasing awareness of women on institutional delivery. However, the ongoing fear of the COVID-19 pandemics is threatening maternal health services including institutional deliveries 2,3 .

Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia

BackgroundIn the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts. However, there is limited evidence on implementation status of HH contact TB screening by HEWs. The aim of this program assessment was to describe the implementation status and associated factors of HH contact TB screening by HEWs.MethodsThis programme assessment was conducted in three randomly selected districts from March to April 2018. Data was collected by using pre-tested structured questionnaire. Descriptive statistics was carried out using frequency tables. Logistic regression analysis was done to identify factors associated with HH contacts screening by HEWs.ResultsIn this programme assessment a total of HHs of 411 index TB cases were included. One-fifth (21.7%) of index TB cases had at least one HH contact screened for TB by HEWs. Having TB treatment supporter (TTS) during intensive phase of index TB case (AOR = 2.55, 95% CI: 1.06–6.01), health education on TB to HH contacts by HEWs (AOR = 4.28, 95% CI: 2.04–9.00), HH visit by HEWs within 6 months prior to the programme assessment (AOR = 5.84, 95% CI: 2.81–12.17) and discussions about TB activities by HEWs with Women Development Army (WDA) leaders (AOR = 9.51, 95% CI: 1.49–60.75) were significantly associated with household contact TB screening by HEWs.ConclusionsOur finding revealed that the proportion of HH contact TB screened by HEWs was low. Therefore, HEWs should routinely visit HHs of index TB cases and provide regular health education to improve contact screening practice. In addition, it is highly recommended to strengthen HEWs regular discussion about TB activities with WDA leaders and TB TTS.

Psychosocial distress among unpaid community health workers in rural Ethiopia: Comparing leaders in Ethiopia's Women's Development Army to their peers

There is a growing critical social science literature on volunteering in health programs in non-western, low-income countries, yet few have mixed quantitative and qualitative methods to examine the psychological and social wellbeing of unpaid community health workers in such contexts. We address this issue with data from unpaid community health workers (CHWs) and other women who comprise Ethiopia's state-organized Women's Development Army. We draw on qualitative and cross-sectional survey data collected between 2013 and 2016 to test links between various aspects of psychosocial and economic wellbeing and volunteer status in a rural context. We surveyed 422 adult women in Amhara state, 73 of whom were unpaid CHWs in the “Army”. We also conducted interviews and focus group discussions with health officials, salaried Health Extension Workers, volunteer CHWs, and other adult women. Analyses of our qualitative and quantitative datasets show that volunteer CHWs are actually worse off than their peers in various psychosocial and economic respects, and that CHW recruitment processes are the most likely explanation for this difference. Additionally, the unpaid CHW position adds work to already burdened shoulders, and makes women—especially unmarried women—vulnerable to negative gossip and high levels of psychological distress. To a limited extent, the volunteer CHW position also bolsters married women's subjective socioeconomic status and confidence in achieving future gains in status. By showing that unpaid CHWs do not necessarily enjoy psychosocial benefits, and may experience harm as a result of their work, these findings reinforce the recommendation that CHWs in contexts of poverty be paid and better supported.

Effect of breastfeeding education and support intervention (BFESI)\xa0versus routine care on timely initiation and exclusive breastfeeding in Southwest Ethiopia: study protocol for a cluster randomized controlled trial

BackgroundInfant mortality rates are still high in Ethiopia. Breastfeeding is regarded as the simplest and least expensive strategy for reduction of infant mortality rates. Community-based educational and support interventions provided prenatally and postnatally are effective in increasing breastfeeding rates. However, such interventions are not widely implemented in Ethiopia. This study aims to assess the effect of breastfeeding education and support on timely initiation and duration of exclusive breastfeeding.MethodsA cluster-randomized controlled trial at the community level will be conducted to compare the effect of breastfeeding education and support versus routine care. The intervention will be provided by Women Development Army leaders who are already in the country’s health system using a 40-h WHO breastfeeding counseling course, “Infant and Young Child Feeding Counseling: an integrated course” and the “Training of Trainers Manual for Counseling on Maternal, Infant and Young Child Nutrition” in the local language. Culturally appropriate operational packages of information will be developed for them. Using preset criteria at least 432 pregnant women in their third trimester will be recruited from 36 zones. Visits in the intervention arm include two prenatal visits and 8 postnatal visits. Supervisory visits will be conducted monthly to each intervention zone. Data will be entered into Epi-data version 3.1 and analyzed using STATA version 13.0. All analysis will be done by intention to treat analysis. We will fit mixed-effects linear regression models for the continuous outcomes and mixed-effects linear probability models for the binary outcomes with study zone as random intercept to estimate study arm difference (intervention vs. routine education) adjusted for baseline value of the outcome and additional relevant covariates. The protocol was developed in collaboration with the Jimma Zone and Mana district Health office. Ethical clearance was obtained from the Institutional Review Board of University of Oslo and Jimma University. This study is partly funded by NORAD’s NORHED programme.DiscussionWe expect that the trial will generate findings that can inform breastfeeding policies and practices in Ethiopia.Trial registrationClinicalTrials.govNCT 03030651 January 25, 2017 version 3 dated 16 July 2018.

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

BackgroundThe Safe Motherhood Research Project studies the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in Jimma Zone, Ethiopia. This qualitative rapid assessment study was undertaken to explore community perceptions and experiences related to health, health inequality and other MNCH themes.MethodsWe conducted 12 focus group discussions and 24 in-depth interviews with community stakeholder groups (female and male community members, Health Extension Workers, members of the Women Development Army and Male Development Army, and religious leaders) across six rural sites in Jimma Zone. Data were analyzed through thematic coding and the preparation of content summaries by theme.ResultsParticipants described being healthy as being disease free, being able to perform daily activities and being able to pursue broad aspirations. Health inequalities were viewed as community issues, primarily emanating from a lack of knowledge or social exclusion. Poverty was raised as a possible contributor to poor health, however, participants felt this could be overcome through community-level responses. Participants described formal and informal mechanisms for supporting the disadvantaged, which served as a type of safety net, providing information as well as emotional, financial and social support.ConclusionsUnderstanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including MNCH promotion. The findings of this study enable the development of audience-centered MNCH promotion activities that closely align with community priorities and experiences. This research demonstrates the application of rapid qualitative assessment methods to explore the context for MNCH promotion activities.