Girum Taye

Malaria remains a major public health challenge in Ethiopia, affecting more than two‑thirds of the population living in endemic regions. Although loc

Introduction Self-report is one of the easiest, cheapest and most widely used methods of collecting data about individuals’ health and risk factor status. Many health studies use self-reported data to assess the prevalence of given risk factors or health behaviors in the community. The objective of this study was to determine the level of perceived morbidity, treatment seeking behavior and associated factors using nationally representative self-reported morbidity data. Methods This study was embedded from a community based, national representative survey which was conducted from September 27 and December 20, 2022 in ten regions and two city administrations. Data collection in the eleventh region, i.e., Tigray region, was carried out separately from December 28, 2023 to February 14, 2024, due to contextual constraints. The survey covered 441 enumeration areas within 11 regional states and two city administrations. A two-stage stratified cluster sampling was employed to select the eligible households and a total of 9,157 household were selected. Data were collected through face-to-face interview with structured questionnaires. Descriptive statistics such as frequency with percentages and mean with standard deviations were employed to describe participants’ characteristics. Bivariate analysis was conducted to assess the association between treatment seeking behavior and independent variables. Mixed effects logistic regression was employed to determine predictors of treatment seeking behavior. Results A total of 2030 (18.02%) household heads experienced at least one perceived morbidity in the past 12 months prior to the survey date. Of these, 776(16.21%) were urban and 1254(18.71%) were rural residents. About 1793(89.4% with 95%CI: 3.76, 3.80) sought treatment to their perceived morbidity. In the multivariable analysis, Afar (AOR=0.47; 95%CI: 0.35, 0.64), Amhara(AOR=0.45; 95%CI: 0.33, 0.61), Oromia(AOR=0.26; 95%CI:0.18, 0.38), Ethiopia Somali(AOR=0.31; 95%CI: 0.21, 0.46), Benishangul-Gumuz (AOR=0.13; 95%CI: 0.09, 0.19), SNNPR(AOR=0.51; 95%CI: 0.37, 0.70), Sidama(AOR=0.59; 95%CI: 0.40, 0.87), South west-Ethiopia(AOR=0.23; 95%CI: 15, 35), Harari(AOR=0.29; 95%CI: 19, 45), and Dire Dawa(AOR=0.80; 95%CI: 0.53, 1.00) were found to be less likely to seek treatment to their perceived morbidity compared to Tigray regional state while Gambela was 2.7 (95%CI:2.07, 3.63) times more likely to seek treatment compared to Tigray regional state. Other factors associated with treatment seeking behavior were being male (AOR, 1.2; 95%CI: 1.00, 1.37), own agricultural land (AOR=1.6; 95%CI: 1.37, 1.80), safety net beneficiaries (AOR=1.5; 95%CI: 1.27, 1.86), self-rated health status (very poor, AOR=2.4; 95%CI: 1.53, 3.90; poor, AOR=5.6; 95%CI: 4.28, 7.44; Neutral, AOR=2.9; 95%CI: 2.21, 3.68; Good, AOR=1.9; 95%CI: 1.55, 2.40) showed statistically significant association. Conclusion This study revealed that majority of the participants sought treatment from health facility for their perceived illness. However, there were significant disparities across the regions and participant characteristics. Thus, the study finding underscores the need for targeted interventions to address inequalities and identified barriers to enhance equitable health care utilization across the regions.

Background: Globally, 2.3 million children died, with an average of 6,300 neonatal deaths every day. Sub-Saharan Africa (SSA) has the world’s highest infant death rate and has made the slowest progress in reducing neonatal mortality. Studies on the impact of antenatal care quality on neonatal mortality in Ethiopia have been limited. Method: This study analyzed five years of Ethiopian demographic and health survey data, examining 51,730 live births from the five years prior to the survey. It assessed the quality of antenatal care through six key components. Utilizing multivariate logistic regression, the study explored the relationship between antenatal care quality scores, ANC visits, service components, and neonatal mortality. Factors with p-values below 0.05 were deemed statistically significant. Results: The quality of prenatal care was 2.69 in 2016, ranging from 2.25 in the Somali region to 6.35 in Addis Ababa, 5.36 in higher education, 4.12 among the wealthiest individuals, and 4.7 in urban subpopulations. Neonatal mortality decreased by 16.3% for each unit increase in prenatal care quality. The reduction in neonatal mortality was associated with AN4+ (AOR=0.46, 95%CI 0.33, 0.64), good quality of antenatal care (AOR=0.56, 95% CI 0.42, 0.74), blood pressure measurements (AOR= 0.42, 95% CI 0.23, 0.75), and counseling about pregnancy complications (AOR= 0.58, 95% CI 0.35, 0.95). Conclusion: The Quality of antenatal care varies across regions, and is more advantageous in the subpopulations. Reducing neonatal mortality is associated with pregnant women receiving quality ANC, attending at least four ANC visits, having blood pressure measurements, and receiving advice on pregnancy-related difficulties.

Introduction: This programme effectiveness study responds to the need for evidence of the effect on birth weight of switching from iron-folic acid supplementation to multiple micronutrient supplementation as part of routine antenatal care in Ethiopia. A 2019 meta-analysis reported a mean increase of 35 g in birth weight among newborns of women who took multiple micronutrient supplements in pregnancy compared with those who took iron-folic acid. Responding to that evidence, the government of Ethiopia decided to implement a 21 district pilot of the use of multiple micronutrient supplementation in routine antenatal care and requested an evaluation of implementation outcomes, including on birth weight. Methods and analysis: A pragmatic, facility-based, randomised trial is being conducted in 42 districts over five regions of Ethiopia between January 2023 and December 2024. Districts have been randomised to one of the two arms, either to retain iron-folic acid supplementation as part of routine antenatal care or switch to multiple micronutrient supplementation. During the study period, the birth weights of all eligible babies born in enrolled health facilities in these 42 districts are continuously recorded alongside data on maternal receipt and use of either multiple micronutrient or iron-folic acid supplementation. We hypothesise that newborns of women resident in the 21 multiple micronutrient supplementation districts will have higher mean birth weight than newborns of women resident in the 21 iron-folic acid supplementation districts. Facility surveys involving pregnant women and healthcare workers at baseline, midline and endline contribute to a process evaluation and cost and cost-effectiveness evaluation. Ethics and dissemination: The study received ethical approval from the review boards at the Ethiopian Public Health Institute (EPHI-IRB-455-2022) and the London School of Hygiene & Tropical Medicine (LSHTM ref 28021). Results from this pragmatic trial will be used by the government of Ethiopia in assessing success of the multiple-micronutrient supplements pilot and for decision making about subsequent scale-up. Dissemination of findings will also inform global decision making, particularly in settings where a transition from iron-folic acid to multiple micronutrient supplementation is being contemplated at scale. Trial registration number: NCT05708183 .

Objectives To assess the geographical equity in Ethiopian infants’ exclusive breastfeeding at 5 months and dietary diversity at 12 months and whether social factors explained the spatial inequities. Design Secondary analysis of a birth cohort study. Setting Analysis of data from the Ethiopian Performance Monitoring for Action panel study conducted from July 2020 to August 2021 in five regions (ie, Oromia, Amhara, Afar and Southern Nations, Nationalities and Peoples regions and the Addis Ababa City administration). We analysed geographical autocorrelation to assess geographical variations in exclusive breastfeeding and dietary diversity. Areas with higher and lower coverage of appropriate infant feeding outcomes were analysed using hotspot analyses. We performed geographically weighted regression to investigate whether sociodemographic factors explained the geographical feeding differences. Participants 1850 infants were prospectively followed from birth to 12 months. Outcome measures Exclusive breastfeeding at 5 months and minimum-level dietary diversity at 12 months. Results Sixty-nine percent (95% CI 67 to 71) of infants were exclusively breastfed at 5 months, while at 12 months, only 16% (95% CI 13 to 19) had complementary feeding from five or more food groups. There were geographical variations in the coverage of exclusive breastfeeding and minimum dietary diversity. Higher proportions of infants were exclusively breastfed at 5 months in northern areas, and more 12-month-old infants in central parts of the country had complementary feeding from at least five food groups. Sociodemographic factors explained a quarter of the geographical variation in dietary diversity. Conclusion Most Ethiopian infants were exclusively breastfed, which was in line with global recommendations but with some geographical differences. There was prominent geographical variation in dietary diversity, partly explained by social factors, but overall, very few 12-month-old infants were fed from at least five food groups. This low dietary quality could impair Ethiopian children’s physical growth, development and health.

Background: Similar to other low and middle-income countries, Ethiopia faces limitations in using local health data for decision-making.We aimed to assess the effect of an intervention, namely the data-informed platform for health, on the culture of data-based decision making as perceived by district health office staff in Ethiopia’s North Shewa Zone. Methods: By designating district health offices as ‘clusters’, a cluster-randomised controlled trial was implemented. Out of a total of 24 districts in the zone, 12 districts were allocated to intervention arm and the other 12 in the control group arms. In the intervention arm district health office teams were supported in four-monthly cycles of data-driven decision-making over 20 months. This support included: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritizing; and (e) a consultative process to develop, commit to, and follow up on action plans. To measure the culture of data use for decision-making in both intervention and control arms, we interviewed 120 health management staff (5 per district office). Using a Likert scale based standard Performance of Routine Information System Management tool, the information is categorized into six domains:- evidence-based decision making, emphasis on data quality, use of information, problem solving, responsibility and motivation. After converting the Likert scale responses into percentiles, difference-in-difference methods were applied to estimate the net effect of the intervention. In intervention districts, analysis of variance was used to summarize variation by staff designation. Results: The overall decision-making culture in health management staff showed a net improvement of 13% points (95% C.I:9, 18) in intervention districts. The net effect of each of the six domains in turn was an 11% point increase (95% C.I:7, 15) on culture of evidence based decision making, a 16% point increase (95% C.I:8, 24) on emphasis on data quality, a 20% point increase (95% C.I:12, 28) on use of information, a 21% point increase (95% C.I:13, 29) on problem solving, and a 10% point increase (95% C.I:4, 16) on responsibility and motivation. In terms of variation by staff designation within intervention districts, statistically significant differences were observed only for problem solving and responsibility. Conclusion: The data-informed platform for health strategy resulted in a measurable improvement in data use and structured decision-making culture by using existing systems, namely the Performance Monitoring Team meetings. The intervention supported district health offices in identifying and solving problems through a structured process. After further research, DIPH intervention could also be applied to other health administration and facility levels. Trial registration: ClinicalTrials.gov ID: NCT05310682, Dated 25/03/ 2022.

Background: The use of contraceptive is key in reducing unsafe abortion from unintended pregnancies, infant mortality, adolescent pregnancies, slowing population growth and helps to prevent HIV/AIDS. However, less than one-third of women within reproductive age in Ethiopia uses modern contraceptive methods. Hence, this study aimed to determine the prevalence of modern contraceptive utilization and to identify potential factors on use of modern contraceptive method. Methods: Data from 2019 Ethiopian Mini Demographic and Health Survey were used in this analysis. A total of 8885 women within the ages of 15–49 years across 305 enumeration areas in nine regions and two city administrations were included in the analysis. Multivariable logistic regression model were applied to examine the association between women’s background characteristics and modern contraceptives utilization. Results: Only 28.1% of all women used modern contraceptives. About 40% of the modern contraceptive users were between age of 25–29 and 30–34 years. There was significant association between women’s age, level of education, region, religion, parity, wealth quintile and marital status on use of modern contraceptives. Women who were married and living with partners were about 20 (AOR = 19.91, 95% CI: 14.27, 27.78) and 24 (AOR = 23.51, 95% CI: 14.66, 37.72) times more likely to use modern contraceptives compared to sexually active unmarried women. Conclusion: The study showed that the use of modern contraceptive method is not adequate and it is also influenced by socio-demographic and economic characteristics of women in Ethiopia. Therefore, increasing the awareness of women to use modern contraceptive methods is vital. We suggest that there is a need to improve the service in women age above 39 years, women in Afar, Somali, Harari and Diredawa regions; and protestant, Muslim and traditional religion followers.

Background: The use of contraceptive is key in reducing unsafe abortion from unintended pregnancies, infant mortality, adolescent pregnancies, slowing population growth and helps to prevent HIV/AIDS. However, less than one-third of women within reproductive age in Ethiopia uses modern contraceptive methods. Hence, this study aims to identify potential factors on use of modern contraceptive method.Methods: Data from 2019 Ethiopian min Demographic and Health Survey were used in this analysis. A total of 8,885 women within the ages of 15–49 years across 305 enumeration areas in nine regions and two city administrations were included in the analysis. Logistic regression model used to examine the association between women’s background characteristics and modern contraceptives use. Results: Only 28.1% of women used modern contraceptives. About 40% of the modern contraceptive users were between age of 25-29 and 30–34 years. There was significant association between women’s age, level of education, region, religion, parity, wealth quintile and marital status on use of modern contraceptives. Women who were married and living with partners were about 20 and 24 times more likely to use modern contraceptives compared to sexually active unmarried women. Conclusion: The study showed that the use of modern contraceptive method is low and influenced by socio-demographic characteristics of women in Ethiopia. Therefore, increasing the awareness of women to use modern contraceptive methods is vital.

Background: Abortion is one of the major direct causes of maternal death, accounting for 7.9% globally. In Africa, 5.5 million women have unsafe abortions annually. Although maternal deaths due to complications of abortion have declined in Ethiopia, women still die from complications. Few studies have focused on providers’ clinical knowledge. This study investigates the level of health workers’ knowledge of comprehensive abortion care and its determinants in Ethiopia. Methods: Data from the national emergency obstetric and newborn care (EmONC) assessment was used. A total of 3804 facilities that provided institutional deliveries in the 12 months before the assessment were included. Provider knowledge was assessed by interviewing a single provider from each facility. Criteria for selection included: having attended the largest number of deliveries in the last one or two months. A summary knowledge score was generated based on the responses to three knowledge questions related to immediate complications of unsafe abortion, how a woman should be clinically managed and what the counselling content should contain. The score was classified into two categories (< 50% and > =50%). Logistic regression was used to determine individual and facility-level factors associated with the summary knowledge score. Result: A total of 3800 providers participated and the majority were midwives, nurses and health officers. On average, providers identified approximately half or fewer of the expected responses. The multivariate model showed that midwives and nurses (compared to health officers), being female, and absence of training or practice of manual vacuum aspiration were associated with lower knowledge levels. Important facility level factors protective against low knowledge levels included employment in Addis Ababa, being male and having internet access in the facility. Conclusion: To increase knowledge levels among providers, pre- and in-service training efforts should be particularly sensitive to female providers who scored lower, ensure that more midlevel providers are capable of performing manual vacuum aspiration as well as provide special attention to providers in the Gambella.