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Mamo A, Abera M, Abebe L, Bergen N, Asfaw S, Bulcha G, Asefa Y, Erko E, Bedru KH, Lakew M, Kurji J, Kulkarni MA, Labonté R, Birhanu Z, Morankar S. Maternal social support and health facility delivery in Southwest Ethiopia. Arch Public Health 2022; 80:135. [PMID: 35546410 PMCID: PMC9092803 DOI: 10.1186/s13690-022-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia. METHODS A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level. RESULT Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. CONCLUSIONS Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.
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Affiliation(s)
- Abebe Mamo
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia.
| | - Muluemebet Abera
- Department of population and family health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Nicole Bergen
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Shifera Asfaw
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | | | - Yisalemush Asefa
- Department of Health Policy & Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Endale Erko
- Maternal and Child Health Directorate, Addis Ababa City Administration Health Bureau, Maternal Health, Family Planning and AYH Advisor, Addis Ababa, Ethiopia
| | | | | | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
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Bergen N, Ruckert A, Abebe L, Asfaw S, Kiros G, Mamo A, Morankar S, Kulkarni MA, Labonté R. Characterizing 'health equity' as a national health sector priority for maternal, newborn, and child health in Ethiopia. Glob Health Action 2021; 14:1853386. [PMID: 33380284 PMCID: PMC7782227 DOI: 10.1080/16549716.2020.1853386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The pursuit of health equity is a priority in Ethiopia, especially with regards to maternal, newborn, and child health (MNCH). To date, there has been little characterization of the ‘problem’ of health inequity, and the normative assumptions implicit in the representation of the problem. Yet, such insights have implications for shaping the framing, incentivization, and implementation of health policies and their wider impact. Objective: In this article, we characterize how health (in)equity is represented as a policy issue, how this representation came about, and the underlying assumptions. Methods: We draw from Bacchi’s ‘what is the problem represented to be’ approach to explore how national-level actors in the health sector constitute the problem. The data for our analysis encompass 23 key informant interviews with national health sector actors working in leadership positions on MNCH in Ethiopia, and six policy documents. Findings were derived from thematic and content analysis. Results: Health inequity is a normalized and inevitable concern that is regarded as actionable (can be altered) but not fully resolvable (can never be fully achieved). Operationally, health equity is viewed as a technocratic matter, reflected in the widespread use of metrics to motivate and measure progress. These representations are shaped by Ethiopia’s rapid expansion of health services into rural areas during the 2000s leading to the positive international attention and funding the country received for improved MNCH indicators. Expanding the coverage and efficiency of health service provision, especially in rural areas, is associated with economic productivity. Conclusion: The metrication of health equity may detract from the fairness, justice, and morality underpinnings of the concept. The findings of this study point to the implications of global pressures in terms of maximizing health investments, and call into question how social, political, and economic determinants of health are addressed through broader development agendas.
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Affiliation(s)
- Nicole Bergen
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa , Ottawa, Canada
| | - Arne Ruckert
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Lakew Abebe
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Shifera Asfaw
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Getachew Kiros
- Faculty of Health Sciences, School of Nursing, University of Ottawa , Ottawa, Canada
| | - Abebe Mamo
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Sudhakar Morankar
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Manisha A Kulkarni
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Ronald Labonté
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
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Kurji J, Gebretsadik LA, Wordofa MA, Morankar S, Bedru KH, Bulcha G, Bergen N, Kiros G, Asefa Y, Asfaw S, Mamo A, Endale E, Thavorn K, Labonte R, Taljaard M, Kulkarni MA. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia. BMC Public Health 2020; 20:1593. [PMID: 33092565 PMCID: PMC7583173 DOI: 10.1186/s12889-020-09692-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Lakew Abebe Gebretsadik
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | | | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Getachew Kiros
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management & Policy, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Shifera Asfaw
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Erko Endale
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute General Campus, University of Ottawa, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute Civic Campus, University of Ottawa, Ottawa, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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Abebe L, Aman M, Asfaw S, Gebreyesus H, Teweldemedhin M, Mamo A. Formula-feeding practice and associated factors among urban and rural mothers with infants 0-6 months of age: a comparative study in Jimma zone Western Ethiopia. BMC Pediatr 2019; 19:408. [PMID: 31684900 PMCID: PMC6827217 DOI: 10.1186/s12887-019-1789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants are in a state of rapid development and maturation; the growth rate is most rapid during the first 4 to 6 months of life. Few studies indicated that in developing countries including Ethiopia the prevalence and duration of breastfeeding is declining and being replaced by formula milk. Therefore, this study aimed to assess the formula-feeding practice and its associated factors among urban and rural mothers with infants 0-6 months of age in the Jimma Zone, Western Ethiopia. METHODS A community-based cross-sectional study was conducted from November 7, 2015, to January 10, 2016, in the Jimma Zone. The quantitative data were collected from a sample of 714 respondents using a multistage sampling technique. Data were collected through a structured questionnaire and the multivariate logistic regression model was used to show predictors of the formula-feeding practice among mothers with infants 0-6 months of age. RESULT The proportion of mothers who feed their baby formula-based was 47.2%, of which 34.5% were living in rural areas and 65.5% were living in urban areas. Among the mothers living in urban areas, the likelihood of formula-feeding was significantly associated with maternal educational status and attitude towards formula-feeding. On the other hand, being attended by relatives/friends and the traditional birth attendant was significantly associated with the formula-feeding practice among mothers who live in rural areas. CONCLUSION Nearly half of the mothers in the study area practice formula-feeding for their infant. Therefore, sustained community based nutritional health education is recommended for pregnant and lactating mothers to reduce the practice of formula-feeding for infants.
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Affiliation(s)
- Lakew Abebe
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Mamusha Aman
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Shifera Asfaw
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, P.O. Box 298, Aksum, Ethiopia
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Science, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Abebe Mamo
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
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Mamo A, Morankar S, Asfaw S, Bergen N, Kulkarni MA, Abebe L, Labonté R, Birhanu Z, Abera M. How do community health actors explain their roles? Exploring the roles of community health actors in promoting maternal health services in rural Ethiopia. BMC Health Serv Res 2019; 19:724. [PMID: 31638983 PMCID: PMC6805355 DOI: 10.1186/s12913-019-4546-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 09/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal and child morbidity and mortality remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through health extension workers in collaboration with other community members is among the key strategies to improve maternal and child health. Little has been studied on the actual roles and contributions of various individuals and groups to date, especially in the rural areas of Ethiopia. In this study, we explored the role played by different actors in promoting ANC, childbirth and early PNC services, and mainly designed to inform a community based Information, Education & Communication intervention in rural Ethiopia. METHODS An exploratory qualitative study was conducted on 24 in-depth interviews with health extension workers, religious leaders, women developmental army leaders, and selected community members; and 12 focus group discussions, six with female and six with male community members. Data was captured using voice recorders and field notes and transcribed verbatim in English, and analyzed using Atlas.ti software. Ethical approval for the fieldwork was obtained from Jimma University and the University of Ottawa. RESULTS Participants described different roles and responsibilities that individuals and groups have in promoting maternal/child health, as well as the perceived roles of family members/husband. Commonly identified roles included promotion of health care services; provision of continuous support during pregnancy, labour and postnatal care; and serving as a link between the community and the health system. Participants also felt unable to fully engage in their identified roles, describing several challenges existing within both the health system and the community. CONCLUSIONS Involvement of different actors based on their areas of focus could contribute to community members receiving health information from people they trust more, which in turn is likely to increase use of services. Therefore, if our IEC interventions focus on overcoming challenges that limit actors' abilities to engage effectively in promoting use of MCH services, it will be feasible and effective in rural settings, and these actors can become an epicenter in providing community based intervention in using ANC, childbirth and early PNC services.
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Affiliation(s)
- Abebe Mamo
- Department of Health, Behavior and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behavior and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
| | - Shifera Asfaw
- Department of Health, Behavior and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Manisha A. Kulkarni
- Schools of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Lakew Abebe
- Department of Health, Behavior and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
| | - Ronald Labonté
- Schools of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
| | - Muluemebet Abera
- Department of population and Family health, Faculty of Public Health, Institutes of Health, Jimma University, Jimma, Ethiopia
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Bergen N, Hudani A, Asfaw S, Mamo A, Kiros G, Kurji J, Morankar S, Abebe L, Kulkarni MA, Labonté R. Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives' perceptions. BMC Health Serv Res 2019; 19:719. [PMID: 31639001 PMCID: PMC6805645 DOI: 10.1186/s12913-019-4596-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes. METHODS We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives' perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach. RESULTS Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives' ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives' working relationships with HEWs. CONCLUSION Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.
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Affiliation(s)
- Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alzahra Hudani
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Shifera Asfaw
- Department of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abebe Mamo
- Department of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Getachew Kiros
- Department of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jaameeta Kurji
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Sudhakar Morankar
- Department of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Manisha A. Kulkarni
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Ronald Labonté
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
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Kurji J, Gebretsadik LA, Wordofa MA, Sudhakar M, Asefa Y, Kiros G, Mamo A, Bergen N, Asfaw S, Bedru KH, Bulcha G, Labonte R, Taljaard M, Kulkarni M. Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2019; 9:e028210. [PMID: 31467047 PMCID: PMC6720516 DOI: 10.1136/bmjopen-2018-028210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia. DESIGN Cross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses. SETTING Twenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia. PARTICIPANTS 3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016. OUTCOME MEASURE The primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman's education, woman's occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births. RESULTS Overall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use. CONCLUSIONS Utilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | | | - Morankar Sudhakar
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Getachew Kiros
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shifera Asfaw
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | | | | | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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Bergen N, Abebe L, Asfaw S, Kiros G, Kulkarni MA, Mamo A, Morankar S, Labonté R. Maternity waiting areas - serving all women? Barriers and enablers of an equity-oriented maternal health intervention in Jimma Zone, Ethiopia. Glob Public Health 2019; 14:1509-1523. [PMID: 30905270 DOI: 10.1080/17441692.2019.1597142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In Ethiopia, maternal waiting areas (MWAs) - residential areas near health facilities where women can stay while waiting to give birth - are community-based, equity-oriented interventions to improve maternal outcomes among rural populations. In this qualitative study we sought to explore the barriers and enablers that Health Extension Workers (HEWs) encounter when engaging with communities about MWAs. We conducted semi-structured interviews with HEWs across rural sites in Jimma Zone, Ethiopia. Drawing from an ecological model of social determinants of maternal and child health, we analysed data using thematic coding methods. HEWs reported a variety of factors that determined MWA use, including the number of children at home, previous childbirth experiences, community support networks, decision making practices within families, the availability and acceptability of health services, geographical access, and health beliefs. HEWs worked to increase the use of MWAs by engaging with husbands and communities, raising awareness in target groups of women, and managing community participation. Policies and practices that support enhanced training for HEWs, increased resources for communities, and greater opportunities for HEWs to liaise with decision makers at various levels of influence are possible ways forward to improve MWA use, specifically, and maternal and neonatal/child health outcomes more generally.
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Affiliation(s)
- Nicole Bergen
- Faculty of Health Sciences, University of Ottawa , Ottawa , Canada
| | - Lakew Abebe
- Department of Health, Behavior and Society, Jimma University , Jimma , Ethiopia
| | - Shifera Asfaw
- Department of Health, Behavior and Society, Jimma University , Jimma , Ethiopia
| | - Getachew Kiros
- Department of Health, Behavior and Society, Jimma University , Jimma , Ethiopia
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa , Ottawa , Canada
| | - Abebe Mamo
- Department of Health, Behavior and Society, Jimma University , Jimma , Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behavior and Society, Jimma University , Jimma , Ethiopia
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa , Ottawa , Canada
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Animut M, Mamo A, Abebe L, Berhe MA, Asfaw S, Birhanu Z. "The sun keeps rising but darkness surrounds us": a qualitative exploration of the lived experiences of women with obstetric fistula in Ethiopia. BMC Womens Health 2019; 19:37. [PMID: 30808352 PMCID: PMC6390300 DOI: 10.1186/s12905-019-0732-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/08/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstetric fistula is a hole between the vagina and bladder, and/or between the vagina and rectum, triggered by prolonged obstructed labor. The World Health Organization has estimated that at least 50,000 to 100,000 cases of obstetric fistula occur every year, and that over two million women with obstetric fistula in developing countries remain untreated. Research on women's lived experiences of obstetric fistula is limited. This study aimed to explore the lived experience of women with obstetric fistula at Bahir Dar Hamlin Fistula Center, Amhara Regional State, Ethiopia. METHODS A qualitative study design, drawing from a phenomenological approach, was employed to explore the lived experience of purposively-selected sample of ten women with obstetric fistula. In-depth interviews were conducted in the local language (Amharic) using an interview guide. Interviews were transcribed and translated into English, and transcripts were entered as primary documents into Atlas.ti 7 software. Thematic categories were identified, and transcripts were coded accordingly. RESULTS Participants perceived that the contributing factors to obstetric fistula were: instrument-assisted delivery; inappropriate physical examination and care; early marriage; and long duration of labour. As a result of obstetric fistula, the patients suffered from uncontrolled dripping of urine and/or faeces (and associated offensive odours), ostracization by their family and community members, and feeling hopeless and isolation from the community. Patients used different coping mechanisms, including frequent washing of clothes and changing of underwear; they also expressed that they preferred to be alone. CONCLUSION Women with obstetric fistula experienced urine incontinence and associated bad odour; social and psychological problems like isolation, divorce and fears were commonly reported. Our findings from perspectives of Ethiopian setting suggest that integrated services for women with obstetric fistula are warranted, including physical therapy, psychological support and social reintegration.
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Affiliation(s)
- Misganaw Animut
- Onchocerchiasis and Lymphatic Filariasis Elimination Project in Awi and Metekel Districts, Carter Center Ethiopia, Bahir Dar, Amhara Regional State, Ethiopia
| | - Abebe Mamo
- Department of Health, Behavior and Society, Institute of Health, Jimma University, PO.Box: 378, Jimma, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior and Society, Institute of Health, Jimma University, PO.Box: 378, Jimma, Ethiopia
| | | | - Shifera Asfaw
- Department of Health, Behavior and Society, Institute of Health, Jimma University, PO.Box: 378, Jimma, Ethiopia.
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Institute of Health, Jimma University, PO.Box: 378, Jimma, Ethiopia
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Asfaw S, Morankar S, Abera M, Mamo A, Abebe L, Bergen N, Kulkarni MA, Labonté R. Talking health: trusted health messengers and effective ways of delivering health messages for rural mothers in Southwest Ethiopia. ACTA ACUST UNITED AC 2019; 77:8. [PMID: 30828451 PMCID: PMC6383212 DOI: 10.1186/s13690-019-0334-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022]
Abstract
Background Access to trusted health information has contribution to improve maternal and child health outcomes. However, limited research to date has explored the perceptions of communities regarding credible messenger and messaging in rural Ethiopia. Therefore, this study aimed to explore sources of trusted maternal health information and preferences for the mode of delivery of health information in Jimma Zone, Ethiopia; to inform safe motherhood implementation research project interventions. Method An exploratory qualitative study was conducted in three districts of Jimma Zone, southwest of Ethiopia, in 2016. Twelve focus group discussions (FGDs) and twenty-four in-depth interviews (IDIs) were conducted among purposively selected study participants. FGDs and IDIs were conducted in the local language, and digital voice recordings were transcribed into English. All transcripts were read comprehensively, and a code book was developed to guide thematic analysis. Data were analyzed using Atlas.7.0.71 software. Result Study Participants identified as Health Extension Workers (HEWs) and Health Development Army (HDA) as trusted health messengers. Regarding communication channels, participants primarily favored face-to-face/interpersonal communication channels, followed by mass media and traditional approaches like community conversation, traditional songs and role play.In particular, the HEW home-to-home outreach program for health communication helped them to build trusting relationships with community members; However, HEWs felt the program was not adequately supported by the government. Conclusion Health knowledge transfer success depends on trusted messengers and adaptable modes. The findings of this study suggest that HEWs are a credible messenger for health messaging in rural Ethiopia, especially when using an interpersonal message delivery approach. Therefore, government initiatives should strengthen the existing health extension packages by providing in-service and refresher training to health extension workers.
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Affiliation(s)
- Shifera Asfaw
- 1Department of Health, Behavior and society, Institute of health, Faculty of Public Health, Jimma University, P O Box: 378, Jimma, Ethiopia
| | - Sudhakar Morankar
- 1Department of Health, Behavior and society, Institute of health, Faculty of Public Health, Jimma University, P O Box: 378, Jimma, Ethiopia
| | - Muluemebet Abera
- 2Department Population and Family health, Institute of health, Faculty of Public Health, Jimma University, P O Box: 378, Jimma, Ethiopia
| | - Abebe Mamo
- 1Department of Health, Behavior and society, Institute of health, Faculty of Public Health, Jimma University, P O Box: 378, Jimma, Ethiopia
| | - Lakew Abebe
- 1Department of Health, Behavior and society, Institute of health, Faculty of Public Health, Jimma University, P O Box: 378, Jimma, Ethiopia
| | - Nicole Bergen
- 3Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Manisha A Kulkarni
- 4Faculty of Medicine, School of Epidemiology and PublicHealth, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Ronald Labonté
- 4Faculty of Medicine, School of Epidemiology and PublicHealth, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
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Bergen N, Mamo A, Asfaw S, Abebe L, Kurji J, Kiros G, Abera M, Bulcha Duguma G, Haji Bedru K, Kulkarni MA, Labonté R, Morankar S. Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment. Int J Equity Health 2018; 17:84. [PMID: 29914493 PMCID: PMC6006566 DOI: 10.1186/s12939-018-0798-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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. METHODS We 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. RESULTS Participants 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. CONCLUSIONS Understanding 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.
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Affiliation(s)
- Nicole Bergen
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Abebe Mamo
- Jimma University, PO Box 378, Jimma, Ethiopia
| | | | - Lakew Abebe
- Jimma University, PO Box 378, Jimma, Ethiopia
| | - Jaameeta Kurji
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | | | | | | | | | - Manisha A Kulkarni
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Ronald Labonté
- University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Mekonnen N, Asfaw S, Mamo A, Mulu Y, Fentahun N. Barriers and facilitators of child-feeding practice in a small sample of individuals from Gozamin District, Northwest of Ethiopia: a qualitative study. BMC Nutr 2018; 4:25. [PMID: 32153887 PMCID: PMC7050846 DOI: 10.1186/s40795-018-0233-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background The first 1000 days is “window of opportunity” for nutrition and vital for physical growth, brain development and the immune system. None of previous studies explored qualitatively child-feeding practices in the developing countries like Ethiopia. The aim of the study was to explore barriers and facilitators of child-feeding practices in Gozamin District, Northwest Ethiopia. Methods A qualitative study was conducted by using 12 in-depth interviews and 4 Focus Group Discussions (n = 32) from Feb. 15/2016 – March 10/ 2016 in eight Kebeles. Purposive sampling technique was used to recruit the participants. The quality of the research findings was checked by using credibility, dependability, transferability and conformability. Data were analyzed using qualitative data analysis software package Atlas ti-7. Results Early initiation of breast-feeding and complementary feeding, exclusive breast-feeding, minimum meal frequency and minimum dietary diversity were the emerged theme in the study. Breastfeeding up to 2 years and above and timely initiation of a complementary feeding were commonly good practice in the area. Dietary diversity, discarding colostrums, pre-lacteal feeding like butter and bottle-feeding were the commonly harmful practices in the area. The most frequently mentioned barriers of child feeding were socio-cultural influences, traditional community practices, workload and poverty. Conclusions Most of the children were suffered from harmful child feeding practices such as pre-lacteal feeding, discarding colostrums and bottle-feeding. Child dietary diversity and complementary food preparation were the major problem in the study area. Therefore, supports on complementary food preparation and diversity food should be given more attention to enhance child-feeding practice in rural Ethiopia.
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Affiliation(s)
- Nakachew Mekonnen
- 1Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Shifera Asfaw
- 2Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Abebe Mamo
- 2Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Yared Mulu
- 3School of Public Health, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Netsanet Fentahun
- 3School of Public Health, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Abstract
BACKGROUND Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is one of the major public health problems throughout the world. Nowadays, antiretroviral treatment (ART) is available in health institutions and HIV-positive individuals who are eligible for ART are taking it. But studies show reinfection of HIV is occurring in them for unknown reasons. PURPOSE This study aimed to assess risky sexual practice and associated factors among HIV-positive ART attendees. METHODS An institution-based cross-sectional study was employed in ten randomly selected health centers in Addis Ababa, between October 05 and November 05, 2013. Simple random sampling technique was employed to select 376 respondents for face-to-face interviews from ART registration book. After the data collection process, data were entered and analyzed using the SPSS version 20 statistical package. Then the effect of each variable was observed by regression analysis to identify the predictors for risky sexual practice at a significant level of P<0.05. RESULTS A total of 376 respondents were included in the study, with 100% response rate. The mean age of the total respondents was 35.28±8.94 (standard deviation). Of the 376 respondents, 30.4% had a history of risky sexual practice, which was inconsistent condom use in the last 3 months prior to the study period. Factors associated with risky sexual practice included alcohol consumption (adjusted odds ratio [AOR] =2.01, 95% CI: 1.07, 3.77), being single (AOR =0.29, 95% CI: 0.15, 0.59) and widowed (AOR =0.32, 95% CI: 0.13, 0.77) respondents, and the gender of the respondents, with an AOR of 1.55 (95% CI: 1.01, 2.33), shows a significant relationship with risky sexual behavior. CONCLUSION Generally, a significant number (30%) of the respondents engaged in risky sexual behavior; so health providers should encourage, support, and allow clients to effectively use condoms during their sexual practice.
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Affiliation(s)
| | - Shifera Asfaw
- Department of Health Education and Behavioral Science, College of Public Health and Medical Sciences, Jimma University, Ethiopia
| | - Lakew Abebe
- Department of Health Education and Behavioral Science, College of Public Health and Medical Sciences, Jimma University, Ethiopia
| | - Getachew Kiros
- Department of Health Education and Behavioral Science, College of Public Health and Medical Sciences, Jimma University, Ethiopia
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Asfaw S, Boley T, Phelps B, Quin J. QS10. Internet Lung Cancer Support Website: Use and Interest. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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