Save the Children was awarded a five-year Standard USAID/CSHGP Child Survival Project (CS-23) - Innovation for Scale: Enhancing Ethiopia's Health Extension Package in the Southern Nations and Nationalities People's Region (SNNPR) - to address four main ca...
Background Giving birth in a medical institution under the care and supervision of trained health-care providers promotes child survival and reduces the risk of maternal mortality. According to Ethiopian Demographic and Health Survey (EDHS) 2005 and 2011, the proportion of women utilizing safe delivery service in the country in general and in Oromia region in particular is very low. About 30% of the eligible mothers received Ante Natal Care (ANC) service and only 8% of the mothers sought care for delivery in the region. The aim of this study is to determine the prevalence of institutional delivery and understand the factors associated with institutional delivery in Dodota, Woreda, Oromia Region. Methods A community based cross sectional study that employed both quantitative and a supplementary qualitative method was conducted from Jan 10–30, 2011 in Dodota Woreda. Multi stage sampling method was used in selection of study participants and total of 506 women who gave birth in the last two years were interviewed. Qualitative data was collected through focus group discussions (FGDs). Data was entered and analyzed using EPI info 3.5.1 and SPSS version 16.0. Frequencies, binary and multiple logistic regression analysis were done, OR and 95% confidence interval were calculated. Results Only 18.2% of the mothers gave birth to their last baby in health facilities. Urban residence, educational level of mothers, pregnancy related health problems, previous history of prolonged labour, and decision made by husbands or relatives showed significant positive association with utilization of institutional delivery services (P?0.05). While ANC attendance during the index pregnancy did not show any association. Conclusion Institutional Delivery is low. Increasing accessibility of the delivery services and educating husbands not only mothers appear very important factors in improving institutional delivery. Health education on the importance of institutional delivery should also address the general population. The quality and content of the ANC services need to be investigated.
Background Podoconiosis is a neglected tropical disease resulting in progressive bilateral swelling of the lower legs in barefoot individuals exposed to red-clay soil derived from volcanic rocks. It is a considerable public health problem in countries across tropical Africa, Central America and northern India. The present study aimed to assess the prevalence and clinical features of podoconiosis, and patients' experience of disease prevention and treatment, in Bedele Zuria woreda (district), west Ethiopia. Methods The study was conducted during 2011 and involved a house-to-house survey in all 2285 households of five randomly selected rural kebeles (villages). Results The prevalence of podoconiosis was 5.6% (379/6710) (95% CI 5.1–6.2%) and was significantly greater among women than men (6.6% vs 4.7%; p = 0.001). A total of 311 (16.9%) households had at least one member with podoconiosis, and 128 (33.8%) study participants reported having a blood relative with podoconiosis. Two hundred and forty-three (76.4%) podoconiosis patients were in the economically productive age group of 15–64 years. On average, a patient experienced at least six episodes of adenolymphangitis per year resulting in a loss of 25 working days per year. Conclusion This study has revealed a high burden of podoconiosis in west Ethiopia, and suggests that disease prevention and treatment programmes are needed.
Tekola Ayele, Fasil; Alemu, Getahun; Davey, Gail; Ahrens, Christel
The objectives of this study are to examine both the significance of the impact of farmers' perceptions regarding new technology for the adoption decision and how perceptions themselves are influenced by the decision to adopt new technology. The study is based on data from 96 wheat farms in the Moret and Jiru woreda (district) of Ethiopia. The probit approach is
W. Negatu; A. Parikh
Bovine tuberculosis (BTB) is endemic in cattle in the Ethiopian Highlands but no studies have been done so far in pastoralists in South Omo. This study assessed the prevalence of bovine tuberculosis (BTB) at an intensive interface of livestock, wildlife and pastoralists in Hamer Woreda (South Omo), Ethiopia. A cross-sectional survey including a comparative intradermal skin testing (CIDT) was conducted in 499 zebu cattle and 186 goats in 12 settlements. Sputum samples from 26 symptomatic livestock owners were cultured for TB. Fifty-one wildlife samples from 13 different species were also collected in the same area and tested with serological (lateral flow assay) and bacteriological (culture of lymph nodes) techniques. Individual BTB prevalence in cattle was 0.8% (CI: 0.3%–2%) with the >4 mm cut-off and 3.4% (CI: 2.1%–5.4%) with the >2 mm cut-off. Herd prevalence was 33.3% and 83% when using the >4 and the >2 mm cut-off respectively. There was no correlation between age, sex, body condition and positive reactors upon univariate analysis. None of the goats were reactors for BTB. Acid fast bacilli (AFB) were detected in 50% of the wildlife cultures, 79.2% of which were identified as Mycobacterium terrae complex. No M. bovis was detected. Twenty-seven percent of tested wildlife were sero-positive. Four sputum cultures (15.4%) yielded AFB positive colonies among which one was M. tuberculosis and 3 non-tuberculous mycobacteria (NTM). The prevalence of M. avium-complex (MAC) was 4.2% in wildlife, 2.5% in cattle and 0.5% in goats. In conclusion, individual BTB prevalence was low, but herd prevalence high in cattle and BTB was not detected in goats, wildlife and humans despite an intensive contact interface. On the contrary, NTMs were highly prevalent and some Mycobacterium spp were more prevalent in specific species. The role of NTMs in livestock and co-infection with BTB need further research.
Tschopp, Rea; Aseffa, Abraham; Schelling, Esther; Berg, Stefan; Hailu, Elena; Gadisa, Endalamaw; Habtamu, Meseret; Argaw, Kifle; Zinsstag, Jakob
Background Lactating mothers from low-income settings are considered as a nutritionally vulnerable group. Due to the nursing process, mothers are subjected to nutritional stresses. Frequent pregnancies followed by lactation increase the health risk of mothers resulting in a high maternal mortality. Objective To assess the feeding practices, nutritional status and associated factors of lactating women from Samre Woreda, South Eastern Tigray, Ethiopia. Design Community based cross-sectional survey Setting Four kebeles of Samre Woreda (2 urban & 2 rural kebeles) Methods Four hundred lactating mothers were recruited from 400 randomly selected households. Data on socio-demographic characteristics, maternal characteristics, feeding practices, frequency of foods eaten and dietary diversity was collected using a pre-tested and structured questionnaire. Anthropometric measurements were taken from each mother using calibrated equipments and standardized techniques. A one-day weighed food record was also collected from randomly selected sub sample (n=60) of mothers. The nutrient and energy content of foods consumed by the mothers was calculated by using ESHA Food Processor and the Ethiopian Food Composition Tables. To investigate the socio-economic and demographic factors affecting the nutritional status of the women, logistic regression was used. ANOVA and t-test were also used to see if there was a mean difference in nutritional status among the lactating mothers. Results Majority (71.2%) of the participants did not take additional meals during lactation. The median dietary diversity score of the study participants was 5 out of 14 food groups. The prevalence of underweight, chronic energy deficiency and stunting were 31%, 25% and 2.2% respectively. Using logistic regression model, factors significantly associated with the nutritional status of the study participants (as determined by BMI and MUAC) were size of farm land, length of years of marriage, maize cultivation, frequency of antenatal care visit and age of breastfeeding child. Conclusions The feeding practices, dietary intakes and nutritional status of the lactating women were short of the national and international recommendations. Therefore, sustained health and nutrition education is recommended to the women and their families and communities on increased food intake, proper dietary practices and dietary diversification during lactation in order to improve health and nutrition outcomes of lactating women.
Background Since 2002/03, an estimated 4.7 million nets have been distributed in the Southern Nations, Nationalities and Peoples Region (SNNPR) among an at risk population of approximately 10 million people. Evidence from the region suggests that large-scale net ownership rapidly increased over a relatively short period of time. However, little is known about how coverage is being maintained given that the last mass distribution was in 2006/2007. This study sought to determine the status of current net ownership, utilization and rate of long lasting insecticide-treated nets (LLIN) loss in the previous three years in the context of planning for future net distribution to try to achieve sustainable universal coverage. Methods A total of 750 household respondents were interviewed across malarious, rural kebeles of SNNPR. Households were randomly selected following a two-stage cluster sampling design where kebeles were defined as clusters. Kebeles were chosen using proportional population sampling (PPS), and 25 households within 30 kebeles randomly chosen. Results Approximately 67.5% (95%CI: 64.1–70.8) of households currently owned at least one net. An estimated 31.0% (95%CI 27.9–34.4) of all nets owned in the previous three years had been discarded by owners, the majority of whom considered the nets too torn, old or dirty (79.9%: 95%CI 75.8–84.0). Households reported that one-third of nets (33.7%) were less than one year old when they were discarded. The majority (58.8%) of currently owned nets had ‘good’ structural integrity according to a proportionate Hole Index. Nearly two-thirds of households (60.6%) reported using their nets the previous night. The overriding reason for not using nets was that they were too torn (45.7%, 95% CI 39.1–50.7). Yet, few households are making repairs to their nets (3.7%, 95% CI: 2.4–5.1). Conclusions Results suggest that the life span of nets may be shorter than previously thought, with little maintenance by their owners. With the global move towards malaria elimination it makes sense to aim for sustained high coverage of LLINs. However, in the current economic climate, it also makes sense to hark back to simple tools and messages on the importance of careful net maintenance, which could increase their lifespans.
Background Globally, an estimated 287 000 maternal deaths occurred in 2010 annually as a result of complications of pregnancy and childbirth. Sub-Saharan Africa and Southern Asia were accounted for 85% of the global burden (245 000 maternal deaths) including Ethiopia. Obstetric related complications cannot be reliably predicted. Hence, insignificant decline of maternal mortality ratio might be due to the non use of birth preparedness and complication readiness strategies. Therefore, this paper aimed to assess knowledge and practices towards birth preparedness and complication readiness and associated factors among women of reproductive age group (15–49) in Robe Woreda, Arsi Zone, Oromia Region, Ethiopia. Method Community-based cross-sectional study supplemented by qualitative design was conducted in January, 2012. A total of 575 women from 5 kebeles were selected after proportionally allocated to population size and interviewed using structured and semi-structured, pre-tested questionnaires. Univariate and bivariate analysis was performed. Multiple logistic regression analysis was also done to control for possible confounding variables. Results Taking into account place of delivery identification, means of transportation, skilled attendant identification and saving money, about 16.5% of the respondents were prepared for birth and its complications. Preparation for birth and its complication was higher among educated mothers (AOR?=?6.23, 95% CI?=?1.5, 25.87). Monthly income of >716 Ethiopian birr (AOR?=?1.94, 95% CI?=?1.01, 3.87), ANC visit (AOR?=?5.68, 95% CI?=?1.27, 25.4), knowledge of obstetric complications (AOR?=?2.94, 95% CI?=?1.61, 5.37) and those who had given birth at health facility before their last delivery (AOR?=?3.9, 95% CI?=?2.04, 7.46) were also significantly associated with birth preparedness and complication readiness. Conclusion The study identified very low magnitude of birth preparedness and complication readiness in the study area and poor knowledge and practices of preparation for birth and its complication. Community education about preparation for birth and its complication and empowerment of women through expansion of educational opportunities are important steps in improving birth preparedness. In all health facilities during antenatal care emphasis should given to preparation for birth and its complication and provide information and education to all pregnant women.
Background Research was carried out in Konta Special Woreda (District); it is a remote area with lack of infrastructure like road to make any research activities in the area. Therefore, this research was conducted to investigate medicinal plants of the Konta people and to document the local knowledge before environmental and cultural changes deplete the resources. Methods The information was collected between October 2006 and February 2007. Interview-based field study constituted the main data collection method in which the gathering, preparation, use, previous and current status and cultivation practices were systematically investigated. The abundance, taxonomic diversity and distribution of medicinal plants were studied using ecological approach. Results A total of 120 species, grouped within 100 genera and 47 families that are used in traditional medical practices were identified and studied. The Fabaceae and Lamiaceae were the most commonly reported medicinal plants with 16 (13.3%) and 14 (12%) species, respectively. 25.4% of the total medicinal plants are collected from homegardens and the rest (74.6%) are collected from wild habitats. Of the total number of medicinal plants, 108 species (90%) were used to treat human ailments, 6 (5%) for livestock diseases and the remaining 6 (5%) were used to treat both human and livestock health problems. The major threats to medicinal plants reported include harvesting medicinal plants for firewood (24.8%) followed by fire (22.3%) and construction (19%). Of the four plant communities identified in the wild, more medicinal plant species (34) were found in community type-4 (Hyparrhenia cymbaria-Erythrina abyssinica community), which accounted for 61.8%. Conclusion Konta Special Woreda is an important area for medicinal plants and associated local knowledge; the natural vegetation being the most important reservoir for the majority of the medicinal plants. Environmental and cultural changes are in the process of threatening the resources and this signals the need for serious efforts to create public awareness so that measures are taken to conserve the medicinal plants in the natural ecosystems and other suitable environments.
Bekalo, Tesfaye Hailemariam; Woodmatas, Sebsebe Demissew; Woldemariam, Zemede Asfaw
BACKGROUND: Malaria transmission in Ethiopia is unstable and seasonal, with the majority of the country's population living in malaria-prone areas. Results from DHS 2005 indicate that the coverage of key malaria interventions was low. The government of Ethiopia has set the national goal of full population coverage with a mean of 2 long-lasting insecticidal nets (LLINs) per household through distribution
Estifanos B Shargie; Teshome Gebre; Jeremiah Ngondi; Patricia M Graves; Aryc W Mosher; Paul M Emerson; Yeshewamebrat Ejigsemahu; Tekola Endeshaw; Dereje Olana; Asrat WeldeMeskel; Admas Teferra; Zerihun Tadesse; Abate Tilahun; Gedeon Yohannes; Frank O Richards
The experiment was conducted for two consecutive years across four locations using 16 field pea genotypes. The objective of this paper is to determine the magnitude of genotype by environment interactionand performance stability of genotypes. Analysis of variance (ANOVA), regression of genotype on the environmental mean, AMMI analysis, ASV estimation and GGE biplot analysis were carried out following their respective
Agdew Bekele; Yasin Goa
Background The rural populations in Ethiopia have a rich knowledge of wild edible plants and consumption of wild edible plants is still an integral part of the different cultures in the country. In the southern part of the country, wild edible plants are used as dietary supplements and a means of survival during times of food shortage. Therefore, the aim of this study is to document the wild edible plants gathered and consumed by Kara and Kwego people, and to analyze patterns of use between the two people. Methods A cross sectional ethnobotanical study of wild edible plant species was conducted from January 2005 to March 2007. About 10% of each people: 150 Kara and 56 Kwego were randomly selected to serve as informants. Data were collected using semi-structured questionnaire and group discussions. Analysis of variance (? = 0.05) was used to test the similarity of species richness of wild edible plants reported by Kara and Kwego people; Pearson's Chi-square test (? = 0.05) was used to test similarity of growth forms and plant parts of wild edible plants used between the two people. Results Thirty-eight wild plant species were reported as food sources that were gathered and consumed both at times of plenty and scarcity; three were unique to Kara, five to Kwego and 14 had similar local names. The plant species were distributed among 23 families and 33 genera. The species richness: families, genera and species (p > 0.05) were not significantly different between Kara and Kwego. Nineteen (50%) of the reported wild edible plants were trees, 11 (29%) were shrubs, six (16%) were herbs and two (5%) were climbers. Forty plant parts were indicated as edible: 23 (58.97%) fruits, 13 (33.33%) leaves, 3 (7.69%) roots and one (2.56%) seed. There was no difference between wild edible plants growth forms reported (Pearson's Chi-square test (d.f. = 3) = 0.872) and plant parts used (Pearson's Chi-square test (d.f. = 3) = 0.994) by Kara and Kwego people. The majority of wild edible plants were gathered and consumed from 'Duka' (March) to 'Halet' (May) and from 'Meko' (August) to 'Tejo' (November). Sixteen (41%) of the plant parts were used as a substitute for cultivated vegetables during times of scarcity. The vegetables were chopped and boiled to make 'Belesha' (sauce) or as a relish to 'Adano' (porridge). The ripe fruits were gathered and consumed fresh and some were made into juices. The seeds and underground parts were only consumed in times of famine. Thirty-seven percent of the wild edible plants were used as medicine and 23.6% were used for other functions. Conclusions The wild edible plants were used as supplements to the cultivated crops and as famine foods between harvesting seasons. But information on the nutritional values and possible toxic effects of most of the wild edible plants reported by Kara and Kwego, and others in different part of Ethiopia is not available. Therefore, the documented information on the wild edible plants may serve as baseline data for future studies on nutritional values and possible side effects, and to identify plants that may improve nutrition and increase dietary diversity. Some of these wild edible plants may have the potential to be valuable food sources (if cultivated) and could be part of a strategy in tackling food insecurity.
Background Violence against women is one of the most systematic and prevalent human rights abuses in the world. It is a form of discrimination and deeply rooted in power imbalances and structural inequality between women and men. Documenting the extent of the problem and associated factors is essential to develop public health interventions to tackle violence against women. Therefore, the objective of this study was to determine magnitude of domestic violence and identify its predictors among married women in the reproductive age in north western Ethiopia. Methods Community-based cross-sectional study was conducted from February 15 to March 15, 2011 among 682 married women and 46 key informants. Systematic sampling technique was used to select respondents for the quantitative method. Purposive sampling was used to select in-depth interview key informants for and focus group discussants. Data were analyzed using SPSS window version 16.0. Binary logistic regression and multivariable logistic regression analysis were carried out to determine the prevalence and identify independent predictors of domestic violence against women. Statistical association was measured by adjusted odds ratios and 95% confidence intervals. Statistical significance was declared at P?0.05. Result The prevalence of domestic violence was 78.0%. About 73.3%, 58.4% and 49.1% of women reported different forms of psychological, physical and sexual violence, respectively. Alcohol consumption by husband (AOR?=?1.9, 95%CI?=?1.3, 2.8), being pregnant (AOR?=?2.1, 95% CI?=?1.4, 3.4), decision making power (AOR?=?2.3, 95% CI?=?1.5, 3.4) and annual income (AOR?=?1.9, 95% CI?=?1.1, 3.3) were predictors of domestic violence. Conclusion The prevalence of domestic violence was very high as compared to other studies. Women’s husband alcohol consumption, decision making power annual household income and being pregnant are some of the predictors of domestic violence against women.
Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n?=?2), most improved performance (n?=?3), or consistently lower performance (n?=?2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n?=?51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. Conclusions/Significance Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with government offices that oversee front-line providers, and committed community leadership to succeed.
Bradley, Elizabeth H.; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W.; Zerihun, Abraham; Abeb, Yigeremu; Curry, Leslie A.
Background Infections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia. Methods In-depth interviews (IDI) were conducted in a district in each of the four most populous regions in the country: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples Region (SNNPR). In each district, one community was purposively selected; and in each study community, IDIs were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants and 2 Health Extension Workers (HEWs). The two main questions in the interview guide related to cord care were: How was the umbilical cord cut and tied? Was anything applied to the cord stump immediately after cutting/in the first 7 days? Why was it applied/not applied? Results The study elucidates local cord care practices and the rational for these practices. Concepts underlying cord tying practices were how to stem blood flow and facilitate delivery of the placenta. Substances were applied on the cord to moisturize it, facilitate its separation and promote healing. Locally recognized cord problems were delayed healing, bleeding or swelling. Few respondents reported familiarity with redness of the cord - a sign of infection. Grandmothers, TBAs and HEWs were influential regarding cord care. Conclusions This study highlights local rationale for cord practices, concerns about cord related problems and recognition of signs of infection. Behavioral change messages aimed at improving cord care including cleansing with CHX should address these local perspectives. It is suggested that HEWs and health facility staff target mothers, grandmothers, TBAs and other community women with messages and counseling.
Background Podoconiosis is a neglected tropical disease (NTD) that is prevalent in red clay soil-covered highlands of tropical Africa, Central and South America, and northern India. It is estimated that up to one million cases exist in Ethiopia. This study aimed to estimate the prevalence of podoconiosis in East and West Gojam Zones of Amhara Region in northern Ethiopia. Methodology/Principal Findings A cross-sectional household survey was conducted in Debre Eliyas and Dembecha woredas (districts) in East and West Gojam Zones, respectively. The survey covered all 17,553 households in 20 kebeles (administrative subunits) randomly selected from the two woredas. A detailed structured interview was conducted on 1,704 cases of podoconiosis identified in the survey. Results The prevalence of podoconiosis in the population aged 15 years and above was found to be 3.3% (95% CI, 3.2% to 3.6%). 87% of cases were in the economically active age group (15–64 years). On average, patients sought treatment five years after the start of the leg swelling. Most subjects had second (42.7%) or third (36.1%) clinical stage disease, 97.9% had mossy lesions, and 53% had open wounds. On average, patients had five episodes of acute adenolymphangitis (ALA) per year and spent a total of 90 days per year with ALA. The median age of first use of shoes and socks were 22 and 23 years, respectively. More men than women owned more than one pair of shoes (61.1% vs. 50.5%; ?2?=?11.6 p?=?0.001). At the time of interview, 23.6% of the respondents were barefoot, of whom about two-thirds were women. Conclusions This study showed high prevalence of podoconiosis and associated morbidities such as ALA, mossy lesions and open wounds in northern Ethiopia. Predominance of cases at early clinical stage of podoconiosis indicates the potential for reversing the swelling and calls for disease prevention interventions.
Molla, Yordanos B.; Tomczyk, Sara; Amberbir, Tsige; Tamiru, Abreham; Davey, Gail
Background Bovine tuberculosis (BTB) and bovine brucellosis are two important milk-borne zoonoses that have been shown to be prevalent to various degrees in Ethiopian cattle. The study was carried out in four Woredas (districts) around Asella town, Arsi Zone between October 2011 and March 2012 and included 318 small-holders in 13 dairy cooperatives that marketed the delivered milk. The aims of the study were i) to assess the prevalence of the two diseases in cattle in a cross-sectional study, ii) to assess potential risk factors of BTB and brucellosis to humans as well as the knowledge-attitude-practice (KAP) among these farmers towards these diseases. Results BTB testing using the comparative intradermal skin test (CIDT) was done on 584 milking cows, out of which 417 were serologically tested for brucellosis using the Rose Bengal Plate Test and reactors confirmed with an indirect ELISA test (PrioCHECK®). The individual animal prevalence was 0.3% (95% CI 0.1% to 1.3%) for BTB, 1.7% (95% CI 0.8% to 3.5%) for brucellosis and 8.9% (95% CI 6.8% to 11.5%) for MAC (Mycobacterium avium complex). Of the 13 milk cooperatives, two had at least one positive BTB reactor and five had animals positive for brucellosis. Cross-breeds accounted for 100% and 71.4% of the BTB and brucellosis reactors respectively. For both diseases, there were prevalence variations depending on Woreda. No animal was concomitant reactor for BTB and brucellosis. Raw milk was consumed by 55.4% of the respondents. 79.2% of the respondents reported touching the afterbirth with bare hands. The latter was fed to dogs in 83% of the households. One cow among the herds of the 130 interviewees had aborted in the last 12 months. Among the interviewees, 77% stated knowing tuberculosis in general but 42 out of the 130 respondents (32.3%) did not know that BTB was transmitted by livestock. Less than half (47.7%) of the respondents knew about brucellosis. Conclusions Low prevalence of both diseases reflected the potential for the area to compete with the growing milk demand. The authors discussed the possible control strategies for the area.
Background Uptake of health facilities for delivery care in Ethiopia has not been examined in the light of equality. We investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal education. Methods This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was analyzed using logistic regressions to estimate the weighted association between birth in a health facility and study's predictors. Results Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain low (5.4%,2000 and 11.8%,2011). Compared with women from rural places, women from urban areas had independent OR of a health facility delivery of 4.9 (95% CI: 3.4, 7.0), 5.0 (95% CI: 3.6, 6.9), and 4.6 (95% CI: 3.5, 6.0) in 2000, 2005, and 2011, respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively). Women of the upper economic quintile had 3.0–7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile, with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a health facility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and Somali getting relatively worse over time. Conclusions The disparity related to urbanity or education in the use of health facility for birth in Ethiopia is staggering. There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between economic strata except for the richest households.
Yesuf, Elias Ali; Kerie, Mirkuzie Woldie; Calderon-Margalit, Ronit
A cross-sectional study with repeated sampling was conducted to investigate potential risk factors for Newcastle disease (ND) seropositivity and for incidence of ND virus (NDV) exposure in household flocks of backyard chickens in Eastern Shewa zone, Ethiopia. Data were collected from 260 randomly selected households in 52 villages in Adami Tulu Jido Kombolcha and Ada'a woredas (districts) using a structured questionnaire, and serum samples from chickens were tested for NDV antibodies using a blocking enzyme-linked immunosorbent assay (ELISA). Sampling took place during September 2009 and the same households were again sampled in May 2010. Household-level seroprevalence and incidence of NDV exposure were estimated in various ways using serological results from the two samplings, flock dynamics, and farmers' reports of ND in their flocks. The risk factors were assessed using multivariable mixed-effects logistic regression models. Household-level seroprevalence at the two sampling times was 17.4% and 27.4%, respectively, and the estimated incidence of household-level NDV exposure during the intervening period ranged between 19.7% and 25.5%. At the first sampling, reduced frequency of cleaning of poultry waste was associated with increased odds of seropositivity (OR=4.78; 95% CI: 1.42, 16.11; P=0.01) while hatching at home vs. other sources (buying in replacement birds, receiving as gift or buying fertile eggs) was associated with lower odds of seropositivity, both at the first sampling (OR=0.30; 95% CI: 0.11, 0.82; P=0.02) and the second sampling (OR=0.23; 95% CI: 0.10, 0.52; P<0.001). The risk of NDV exposure was shown to be higher with larger flock size at the beginning of the observation period (OR=3.6; 95% CI: 1.25, 10.39; P=0.02). Using an open water source (pond or river) for poultry compared to closed sources (tap or borehole) was associated with increased risk of NDV exposure (OR=3.14; 95% CI: 1.12, 8.8; P=0.03). The use of a grain supplement (OR=0.14; 95% CI: 0.03, 0.69; P=0.03) and hatching at home for flock replacement (OR=0.23; 95% CI: 0.10, 0.52; P=0.005) were associated with a lower risk of NDV exposure. Newcastle disease seroprevalence and incidence of NDV exposure were more heterogeneous between villages than between kebeles (aggregations of villages) and woredas in the study area. Further investigation of village-level risk factors would likely improve our understanding of ND epidemiology in backyard chickens. PMID:23127692
Chaka, Hassen; Goutard, Flavie; Roger, Francois; Bisschop, Shahn P R; Thompson, Peter N
Summary The World Health Organization (WHO) recommends environmental improvements such as latrine construction in the integrated trachoma control strategy, SAFE. We report a cluster-randomized trial assessing the effect of intensive latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass treatment with antibiotics. Twenty-four communities in Goncha Seso Enesie woreda, Amhara Regional State, Ethiopia, were enumerated, and a random selection of 60 children aged 0– 9 years in each was monitored for clinical signs of trachoma and ocular chlamydial infection at baseline, 12 and 24 months. All community members were offered treatment with a single dose of oral azithromycin or topical tetracycline. After treatment, 12 subkebeles were randomized to receive intensive latrine promotion. Mean cluster ocular infection in the latrine and the non-latrine arms were reduced from 45.5% (95% CI 34.1–56.8%) and 43.0% (95% CI 31.1–54.8%) respectively at baseline to 14.6% (95% CI 7.4–21.8%) and 14.8% (95% CI 8.9–20.8%) respectively at 24 months (P=0.93). Clinical signs fell from 72.0% (95% CI 58.2–85.5%) and 61.3% (95% CI 44.0–78.5%) at baseline to 45.8% (36.0–55.6%) and 48.5% (34.0–62.9%) respectively at 24 months (P=0.69). At 24 months, estimated household latrine coverage and use were 80.8% and 61.7% respectively where there had been intensive latrine promotion and 30.0% and 25.0% respectively in the single treatment only arm. We were unable to detect a difference in the prevalence of ocular chlamydial infection in children due to latrine construction.
Stoller, Nicole E; Gebre, Teshome; Ayele, Berhan; Zerihun, Mulat; Assefa, Yared; Habte, Dereje; Zhou, Zhaoxia; Porco, Travis C; Keenan, Jeremy D; House, Jenafir I; Gaynor, Bruce D; Lietman, Thomas M; Emerson, Paul M
The analysis and forecasting of extreme climatic events has become increasingly relevant to planning effective financial and food-related interventions in third-world countries. Natural disasters and climate change, both large and small scale, have a great impact on non-industrialized populations who rely exclusively on activities such as crop production, fishing, and similar livelihood activities. It is important to identify the extent of the areas prone to severe drought conditions in order to study the possible consequences of the drought on annual crop production. In this paper, we aim to identify such areas within the South Tigray zone, Ethiopia, using a transformation of the Normalized Difference Vegetation Index (NDVI) called Absolute Difference NDVI (ADVI). Negative NDVI shifts from the historical average can generally be linked to a reduction in the vigor of local vegetation. Drought is more likely to increase in areas where negative shifts occur more frequently and with high magnitude, making it possible to spot critical situations. We propose a new methodology for the assessment of drought risk in areas where crop production represents a primary source of livelihood for its inhabitants. We estimate ADVI return levels pixel per pixel by fitting extreme value models to independent monthly minima. The study is conducted using SPOT-Vegetation (VGT) ten-day composite (S10) images from April 1998 to March 2009. In all short-term and long-term predictions, we found that central and southern areas of the South Tigray zone are prone to a higher drought risk compared to other areas.; Temporal autocorrelation among monthly minima within the Alamata woreda. (a) ACF-Boxplot and (b) PACF-Boxplot. ; ADVI return level estimates. (a) 10-Month return levels. (b) 100-Month return levels. (c) 1000-Month return levels.
Tonini, F.; Hochmair, H. H.; Jona Lasinio, G.
Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review.
Kebede, Bekana; Gebeyehu, Abebaw; Andargie, Gashaw
Background Floods are the most frequent and devastating type of natural disaster worldwide, causing unprecedented deaths, diseases, and destruction of property and crops. Flooding has a greater impact in developing countries due to lack of sufficient disaster management structures and a lack of economic resources. Objective This study was conducted with the aim of contributing to the knowledge base of development strategies that reduce flood-related health risks in developing countries. The study focused particularly on assessing the flood risks and health-related issues in the Gambella region of Ethiopia; with the intent of producing relevant information to assist with the improvements in the efficacy of the current flood coping strategies in the region. Methods Data were gathered through interviews with 14 officers from different government and non-governmental organizations and a questionnaire survey given to 35 flood victims in Itang woreda. A qualitative approach was applied and the data were analyzed using content analysis. Results It was found that flooding is a common problem in Gambella region. The findings also indicate that the flood frequency and magnitude has increased rapidly during the last decade. The increase in floods was driven mainly by climate change and changes in land use, specifically deforestation. The reported main impacts of flooding on human health in Gambella region were deaths, injuries, and diseases such as malaria and diarrhea. Another notable consequence of flooding was crop destruction and subsequent malnutrition. Conclusions Three weaknesses that were identified in the current coping strategies for flood-related health impacts in Gambella region were a lack of flood-specific policy, absence of risk assessment, and weak institutional capacity. This study recommends new policy approaches that will increase the effectiveness of the current flood coping strategies to sustainably address the impact of flooding on human health.
Wakuma Abaya, Samson; Mandere, Nicodemus; Ewald, Goran
Background Bovine tuberculosis (BTB) is endemic in Ethiopian cattle. The aim of this study was to assess BTB prevalence at an intensive contact interface in Meskan Woreda (district) in cattle, small ruminants and suspected TB-lymphadenitis (TBLN) human patients. Methods The comparative intradermal test (CIDT) was carried out for all animals involved in the cross-sectional study and results interpreted using a > 4 mm and a > 2 mm cut-off. One PPD positive goat was slaughtered and lymph nodes subjected to culture and molecular typing. In the same villages, people with lymphadenitis were subjected to clinical examination. Fine needle aspirates (FNA) were taken from suspected TBLN and analyzed by smear microscopy and molecular typing. Results A total of 1214 cattle and 406 small ruminants were tested for BTB. In cattle, overall individual prevalence (> 2 mm cut-off) was 6.8% (CI: 5.4-8.5%) with 100% herd prevalence. Only three small ruminants (2 sheep and 1 goat) were reactors. The overall individual prevalence in small ruminants (> 2 mm cut-off) was 0.4% (CI: 0.03-5.1%) with 25% herd prevalence. Cattle from owners with PPD positive small ruminants were all PPD negative. 83% of the owners kept their sheep and goats inside their house at night and 5% drank regularly goat milk. FNAs were taken from 33 TBLN suspected cases out of a total of 127 screened individuals with lymph node swellings. Based on cytology results, 12 were confirmed TBLN cases. Nine out of 33 cultures were AFB positive. Culture positive samples were subjected to molecular typing and they all yielded M. tuberculosis. M. tuberculosis was also isolated from the goat that was slaughtered. Conclusions This study highlighted a low BTB prevalence in sheep and goats despite intensive contact with cattle reactors. TBLN in humans was caused entirely by M. tuberculosis, the human pathogen. M. tuberculosis seems to circulate also in livestock but their role at the interface is unknown.
Background Though birth interval has beneficial effects on health status of the mother and their children, it is affected by range of factors some of which are rooted in social and cultural norms and the reproductive behaviors of individual women. However, there was limited data showed the determinants of birth intervals in rural pastoral communities of South Ethiopia. Therefore, the study was aimed to assess the determinants of inter birth interval among women’s of child bearing age in Yaballo Woreda, Borena zone, Oromia Regional State, Ethiopia. Methods A community based unmatched case–control study with multi stage sampling technique was conducted from January to March 2012. Cases were women with two subsequent birth intervals of less than three years and controls were women with two subsequent birth intervals between three and above years. Simple random sampling technique was employed to select six hundred fifty two (326 cases and 326 controls) study subjects. All explanatory variables that were associated with the outcome variable (birth interval) during bivariate analysis were included in the final logistic model. Multivariable backward logistic regression when P values less than or equal to 0.05 and 95% CI were used to determine independent determinants for the outcome of interest. Results The median duration of birth interval was 31 & 40 months among cases and controls respectively. Variables such as number of children (AOR 3.73 95% CI: (1.50, 9.25), use of modern contraceptives (AOR 5.91 95% CI: (4.02, 8.69), mothers’ educational status (AOR 1.89 95% CI: (1.15, 3.37), and sex of the child (AOR 1.72 95% CI: (1.17, 2.52) were significantly associated with birth intervals. Conclusions Concerted efforts to encourage modern contraceptive use, women education, and breastfeeding should be made.
Background Podoconiosis is one of the most neglected tropical diseases, which untreated, causes considerable physical disability and stigma for affected individuals. Little is known about the quality of life (QoL) of patients with podoconiosis. This study aimed to assess the QoL of patients with podoconiosis in comparison with healthy controls in Ethiopia. Methods A comparative cross-sectional study was conducted in May 2012, among 346 clinically confirmed adult patients with podoconiosis, and 349 healthy adult neighbourhood controls in Dembecha woreda (district) in northern Ethiopia. QoL was assessed using the validated Amharic version of the World Health Organisation Quality of Life questionnaire (WHOQoL-BREF) scale; in addition, mental health and stigma were assessed by the Kessler-10 scale and podoconiosis stigma scale respectively. Logistic regression analysis was done to identify factors associated with QoL. Results Patients with podoconiosis had significantly lower mean overall QoL than the controls (52.05 versus 64.39), and this was also true in all four sub domains (physical, psychological, social and environmental). Controls were 7 times more likely to have high (above median) QoL (Odds Ratio = 6.74, 95% Confidence Interval 4.62 to 9.84) than cases. Factors associated with lower QoL were: experiencing high levels of stigma, living in an urban area, being illiterate, having additional co-morbidities, and being unmarried. Mental illness was associated with lower scores in psychological and physical domains. Conclusions Programs targeting podoconiosis interventions should include QoL as an indicator for monitoring progress. Interventions targeting improvement of QoL among patients with podoconiosis should address depression, stigma and other co-morbidities.
Background Podoconiosis is a form of non-filarial elephantiasis that affects barefoot individuals in highland tropical areas. The disease presents with bilateral, asymmetric swelling of the legs, usually confined to below the knee. This study aimed to assess podoconiosis patients’ perceptions of prevention, control, causes and familial clustering of the disease, and to document physical, social and economic impairments associated with the disease, with the ultimate aim of enabling development of tailored interventions in this region. Methods This descriptive study is part of the largest cross-sectional community-based household survey yet conducted on podoconiosis. It was completed in November and December, 2011, in Debre Eliyas and Dembecha Woredas of East and West Gojam Zones, northern Ethiopia, and consisted of a house-to-house census by community health workers followed by interviews of identified patients using a structured questionnaire. Results In the 17,553 households surveyed, 1,319 patients were identified. More male as compared to female patients were married (84.6% vs. 53.6%, ?2?=?157.1, p?0.0001) while more female as compared to male patients were divorced (22.5% vs. 3.6%, ?2?=?102.3, p?0.0001). Less than half of the study subjects believed podoconiosis could be prevented (37.5%) or controlled (40.4%) and many (41.3%) did not know the cause of podoconiosis. Two-fifths of the study subjects had a relative affected with podoconiosis. Approximately 13% of the respondents had experienced one or more forms of social stigmatization. The coping strategies adopted by patients to mitigate the physical impairments caused by podoconiosis were: working only occasionally (44.9%), avoiding physically demanding tasks (32.4%), working fewer hours (21.9%) or completely stopping work (8%). Most study subjects (96.4%) had noticed a decline in their income following the development of podoconiosis, and 78% said they were poorer than their healthy neighbours. Conclusion This study shows that podoconiosis has strong psychosocial, physical and economic impacts on patients in East and West Gojam Zones of northern Ethiopia. Concerns related to familial clustering, poor understanding of the causes and prevention of podoconiosis all add to the physical burden imposed by the disease. Strategies that may ease the impact of podoconiosis include delivery of tailored health education on the causes and prevention of disease, involving patients in intervention activities, and development of alternative income-generating activities for treated patients.
Introduction Ethiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Nevertheless, there are challenges in reducing maternal and neonatal mortality. The aim of this study was to estimate maternal and neonatal mortality and the socio-economic inequalities of these mortalities in rural south-west Ethiopia. Methods We visited and enumerated all households but collected data from those that reported pregnancy and birth outcomes in the last five years in 15 of the 30 rural kebeles in Bonke woreda, Gamo Gofa, south-west Ethiopia. The primary outcomes were maternal and neonatal mortality and a secondary outcome was the rate of institutional delivery. Results We found 11,762 births in 6572 households; 11,536 live and 226 stillbirths. There were 49 maternal deaths; yielding a maternal mortality ratio of 425 per 100,000 live births (95% CI:318–556). The poorest households had greater MMR compared to richest (550 vs 239 per 100,000 live births). However, the socio-economic factors examined did not have statistically significant association with maternal mortality. There were 308 neonatal deaths; resulting in a neonatal mortality ratio of 27 per 1000 live births (95% CI: 24–30). Neonatal mortality was greater in households in the poorest quartile compared to the richest; adjusted OR (AOR): 2.62 (95% CI: 1.65–4.15), headed by illiterates compared to better educated; AOR: 3.54 (95% CI: 1.11–11.30), far from road (?6 km) compared to within 5 km; AOR: 2.40 (95% CI: 1.56–3.69), that had three or more births in five years compared to two or less; AOR: 3.22 (95% CI: 2.45–4.22). Households with maternal mortality had an increased risk of stillbirths; OR: 11.6 (95% CI: 6.00–22.7), and neonatal deaths; OR: 7.2 (95% CI: 3.6–14.3). Institutional delivery was only 3.7%. Conclusion High mortality with socio-economic inequality and low institutional delivery highlight the importance of strengthening obstetric interventions in rural south-west Ethiopia.
Yaya, Yaliso; Eide, Kristiane Tislevoll; Norheim, Ole Frithjof; Lindtj?rn, Bernt
To generate information essential for the implementation of breeding schemes suitable for village poultry producers in Ethiopia, a survey was conducted aimed at defining the socioeconomic characteristics of the production environments in different geographic regions, understanding the important functions of chickens, identifying farmers' choice of chicken breeds and the underlying factors that determine the choice of genetic stock used. The survey included both questionnaire survey and a participatory group discussion. A total of 225 households (45 households from each of five Woredas) were interviewed. The questionnaire was designed to collect data covering general information on village poultry production such as socio-management characteristics, production objectives, population structure, breed choice and trait preferences, market preferences of specific traits, and farmers' selection practices. The participatory farmers' discussions were designed to involve stakeholders in defining the breeding objective "traits" and deriving their relative importance in the production environment based on the different functions of chickens and "traits" identified in the interviews. The results showed that production of eggs for consumption is the principal function of chickens in most regions followed by the use as source of income and meat for home consumption. The production system in all geographic regions studied revealed similar features generally characterized by extensive scavenging management, absence of immunization programs, increased risk of exposure of birds to disease and predators, and reproduction entirely based on uncontrolled natural mating and hatching of eggs using broody hens. Farmers' ratings of indigenous chickens with respect to modern breeds showed the highest significance of the adaptive traits in general, and the superior merits of indigenous chickens to high yielding exotic breeds in particular. Adaptation to the production environment was the most important attribute of chickens in all the study areas. The high significance attributed to reproduction traits indicates the need for maintaining broody behavior and high level of hatchability while breeding for improved productivity of indigenous chickens for village conditions. The market price of chickens is primarily dictated by weight, but farmers rated growth (males) and number of eggs followed by growth (females) as the production traits they would like the most to be improved. Therefore, the ultimate breeding goal should be to develop a dual-purpose breed based on indigenous chicken genetic resources with any of the comb types other than single for all the regions studied having the most preferred white body plumage for farmers in the Amhara region and red body plumage for those in Oromia, Benshangul-Gumuz, and Southern regions. PMID:20512411
Dana, Nigussie; van der Waaij, Liesbeth H; Dessie, Tadelle; van Arendonk, Johan A M