Multi-level analysis of intimate partner violence and its determinants among reproductive age group women in Ethiopia: evidence from Ethiopian Demographic Health Survey, 2016.

BACKGROUND: Intimate partner violence (IPV) is recognized as a main public health challenge, with serious consequences for women's physical, mental, sexual, and reproductive health. Despite its public health importance, most studies of IPV in Ethiopia mainly focused on individual characteristics and didn't identify how factors operating at different levels affect IPV. Thus, there is limited evidence regarding the hierarchical-level factors of IPV and the effect of individual and community-level determinants of IPV. The aim of this study is to assess the individual and community-level factors associated with violence against women among ever-married reproductive-age women in Ethiopia. METHODS: A retrospective analysis of secondary data retrieved from the Ethiopia Demographic and Health Survey was conducted among reproductive age group women (15-49 years of age) who reported ever being married within the available data set for the domestic violence module. STATA 14 was used to conduct the analysis. A two-level mixed-effects logistic regression analysis was used to determine associations between IPV and individual- and community-level factors. IPV variability across the community was assessed using ICC and PCV. The model's fitness was assessed using the Akaike information criterion (AIC), the Bayesian information criterion (BIC), and the likelihood ratio test. RESULT: The life time prevalence of IPV in this study was 33% [95% CI: 30.74, 34.25]. Women's age 20-24 (AOR = 5.85, 95% CI: 201 3.10, 11.04), 25-29 age group (AOR = 6.41, 95% CI; 3.34, 12.32), 30-34 age group (AOR = 9.48, 95% CI: 4.71, 19.06), 35-39 age group (AOR = 9.88, 95% CI: 4.79, 20.39), 40-44 age group (AOR = 11.10, 95% CI: 5.16, 23.89), and 45-49, (AOR = 14.15, 95% CI: 6.01, 32.80), early marriage (AOR = 1.21, 95% CI: 1.08, 1.47), witnessing inter-parental violence during childhood (AOR = 2.80, 95% CI: 2.16, 3.96), having a lot of living children (AOR = 0.45, 95% CI: 0.26, 0.74), having a partner who drank alcohol (AOR = 3.00, 95% CI: 2.42-3.67), decision-making autonomy of the women (AOR = 0.77, 95% CI: 0.62, 0.97), Poor wealth index (AOR = 1.64, 95% CI: 1.23, 2.18), middle wealth index (AOR = 1.86, 95% CI: 1.36, 2.54) and exposure to media (AOR = 1.47, 95% CI: 1.06, 2.00) were all significantly associated with IPV. CONCLUSION AND RECOMMENDATION: This study showed that one-third of the women experienced IPV in their lifetime. The finding suggested that community based interventions and multi-sectorial collaborations are needed to reduce the IPV and its adverse consequences.

COVID-19 Infection Prevention Preparedness, Practices and Case Management in the Primary Health Care Units in Ethiopia.

Background: COVID-19 as pandemic declared by WHO on March 11, 2020 and first case detected in Ethiopia on March 13/2020. The COVID-19 caused a global crisis, including millions of lives lost, public health systems in shock and economic and social disruption. Strategies depend on how an existing health system is organized. Even though public health emergency operation centers of the Ethiopia switched to emergency response, there is no national evidence about infection prevention and control. Therefore, this project aimed to assess the level of infection prevention and control and management of COVID- 19 in Ethiopia, 2021. Methods: The cross-sectional study conducted at four regions and one city (Amhara, Oromia, SNNPR, Sidama Region, and Dire Dawa). Being with zonal health departments and woredas health offices, primary health care units were selected. The data were collected electronically through Kobocollect software from November 08-28/2021. Descriptive analysis like frequency and percentage was conducted by SPSS software version 25 and the results were presented by tables, figures and narration. Results: Data were collected from 16 hospitals, 92 health centers, and 344 health posts. All hospitals have designated COVID-19 focal person. There were significant number of woredas and PHCUs who didn't have IPC guidelines and protocols. About 11 woredas had no any type of diagnostic tests for COVID-19. Conclusions: The study revealed that there were significant gaps on Infection prevention and control practice, shortage of personal protective equipment, isolation and specimen transportation problem, lack of call centers. We recommend concerned bodies to fill the identified gaps.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic.

Background: The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. Methods: Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. Results: The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. Conclusion: This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Maternal social support and health facility delivery in Southwest Ethiopia.

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.

Compliance to antenatal psychosocial assessment practice among midwives: a best practice implementation project.

INTRODUCTION AND AIMS: As directed by the WHO, antenatal care providers have good opportunities to identify and refer mothers who are struggling with psychosocial problems. In Ethiopia, the pooled prevalence of perinatal depression is 25.8%, which is almost two-fold of the pooled global prevalence. Though this is an indication of the need for prompt interventions, there is no assessment targeted to this population. Therefore, the aim of this project was to promote an antenatal psychosocial assessment practice among midwives. METHODS: Using the Joanna Briggs Institute Practical Application of Evidence System, 66 first visit antenatal care assessment opportunities were observed in both baseline and follow-up audit using three audit criteria. Fourteen midwives were interviewed for the first criterion. On the basis of the results, the gaps and barriers were analyzed using Getting Research into Practice strategies. RESULT: The baseline audit result revealed a 0% compliance rate for all evidence-based antenatal psychosocial assessment audit criteria. This scenario disclosed that there had not been psychosocial problem assessment practice at antenatal clinic. However, the postimplementation result showed that an average 91.5% practice of evidence-based antenatal psychosocial assessment was applied as per standards. CONCLUSION: Carrying out discussions on evidence summary with providers, on-the-job training, using local leaders' opinions, and involving relevant stakeholders appeared to be the key methods in improving compliance to best available evidence in antenatal psychosocial assessment.

Discontinuation rate and associated factors among contraceptive implant users in Kersa district, southwestern Ethiopia.

BACKGROUND: Subdermal contraceptive implant is the most widely used method of long-acting reversible contraception among Ethiopian women. Many, however, discontinue use early, which results in unwanted pregnancies and induced abortions and their associated complications. The aim of this study is to determine the rate of and reasons for discontinuation of the contraceptive implant among users in the Kersa district of southwestern Ethiopia. METHODS: A mixed-method study was carried out between March and April 2019 among 475 women who had been using the contraceptive implant between January 2015 and August 2016 in the Kersa district. Systematic random sampling was used for quantitative data collection and purposive sampling was used for qualitative data collection using 8 focus group discussion and 56 In-depth interviews. A binary logistic regression was carried out for bivariate and multivariable analyses. RESULTS: One hundred and ten (23.2 %) contraceptive implant users requested removal before 2.5 years of use. The main reasons for the discontinuation were side effects, followed by a desire for pregnancy or to switch to another contraceptive method and misconceptions. Implant discontinuation was associated with a lack of information prior to insertion on the effectiveness of modern contraception (adjusted odds ratio [OR] 2.0; 95 % confidence interval [CI] 1.13, 3.55), being served by a midwife or nurse (adjusted OR 1.8; 95 % CI 1.04, 3.23), and not being told to return to the health facility if any side effects were experienced (adjusted OR 1.8; 95 % CI 1.01, 3.19) (all p < 0.05). CONCLUSIONS: Almost a quarter of the study participants discontinued use of the contraceptive implant before the due date. Public health interventions should focus on providing adequate awareness for family planning users, trainings for the health care workers on effective counselling services, especially on side effect and misconceptions.

Unmet need for family planning and associated factors among married women attending anti-retroviral treatment clinics in Dire Dawa City, Eastern Ethiopia.

BACKGROUND: Unmet need for family planning is a measure of the gap between women's contraceptive behavior and their fertility desires. It should be measured among different population groups to effectively implement public health interventions. Thus, this study aimed to determine the magnitude of unmet need for family planning and associated factors among HIV- positive women in Dire Dawa city Anti-retroviral treatment (ART) clinics, Eastern Ethiopia. METHODS: We carried out a facility-based cross-sectional study (March-June 2020) among 409 married women aged 15-49 on ART, using systematic random sampling. A face-to-face interview was done using a structured questionnaire. Bivariable and multivariable logistic regression was done to identify factors associated with unmet need for family planning. RESULTS: Overall, 33% [95% confidence interval (CI): 28.9-37.9] of the respondents had unmet need for family planning. Woman's residing in a rural area (adjusted odds ratio (AOR): 2.41 [95% CI: 1.24-4.67]), woman's not attained formal education (AOR: 4.14 [95% CI: 1.73-9.93]) and attaining primary education (AOR: 2.97 [95% CI: 1.54-5.74]), poor knowledge (AOR: 2.87 [95% CI: 1.52-5.40]), and unfavorable attitude towards family planning (AOR: 2.21 [95% CI: 1.12-4.34]), clients not satisfied with family planning service (AOR: 6.34 [95% CI: 3.31-12.15]), the woman not having decision making power on family planning (AOR:3.97 [95% CI: 2.14-7.38]) and not getting family planning counseling in ART clinics (AOR: 2.87 [95% CI: 1.54-5.35]) were positively associated with having unmet need for family planning. CONCLUSION: This study indicates there a high unmet need for family planning among married HIV-positive women. Factors like a place of residence, educational status of women, knowledge and attitude towards family planning, client satisfaction with FP service, women decision-making power, and FP counseling service in ART. Therefore, we recommend that the concerned bodies should collaborate with ART clinics to design interventions that enhance access to family planning programs to combat the high unmet need for family planning among HIV-positive women.

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas.

BACKGROUND: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. METHODS: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. DISCUSSION: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017.

Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma Zone, Ethiopia.

BACKGROUND: In Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia. METHODS: We analyzed data from a community-based cross-sectional survey conducted in 2016 in three rural districts of Jimma Zone, Ethiopia, with 3784 women who had a pregnancy outcome in the year preceding the survey. We used multivariable logistic regression models accounting for clustering to identify the determinants of antenatal care (ANC) attendance and insecticide-treated net (ITN) ownership and use, and the prevalence and predictors of malaria infection among pregnant women. RESULTS: Eighty-four percent of interviewed women reported receiving at least one ANC visit during their last pregnancy, while 47% reported attending four or more ANC visits. Common reasons for not attending ANC included women's lack of awareness of its importance (48%), distance to health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman's ability to make healthcare decisions, and pregnancy intendedness. An estimated 48% of women reported owning an ITN during their last pregnancy. Of these, 55% reported to have always slept under it during their last pregnancy. Analysis revealed that the odds of owning and using ITNs were respectively 2.07 (95% CI: 1.62-2.63) and 1.73 (95% CI: 1.32-2.27) times higher among women who attended at least one ANC visit. The self-reported prevalence of malaria infection during pregnancy was low (1.4%) across the three districts. We found that young, uneducated, and unemployed women presented higher odds of malaria infection during their last pregnancy. CONCLUSION: ANC and ITN uptake during pregnancy in Jimma Zone fall below the respective targets of 95 and 90% set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Reaching ANC non-users and ITN ownership and use as part of ANC services could be emphasized to address these gaps.

How do community health actors explain their roles? Exploring the roles of community health actors in promoting maternal health services in rural Ethiopia.

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.

Talking health: trusted health messengers and effective ways of delivering health messages for rural mothers in Southwest Ethiopia.

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.

A quality assessment of Health Management Information System (HMIS) data for maternal and child health in Jimma Zone, Ethiopia.

Health management information system (HMIS) data are important for guiding the attainment of health targets in low- and middle-income countries. However, the quality of HMIS data is often poor. High-quality information is especially important for populations experiencing high burdens of disease and mortality, such as pregnant women, newborns, and children. The purpose of this study was to assess the quality of maternal and child health (MCH) data collected through the Ethiopian Ministry of Health's HMIS in three districts of Jimma Zone, Oromiya Region, Ethiopia over a 12-month period from July 2014 to June 2015. Considering data quality constructs from the World Health Organization's data quality report card, we appraised the completeness, timeliness, and internal consistency of eight key MCH indicators collected for all the primary health care units (PHCUs) located within three districts of Jimma Zone (Gomma, Kersa and Seka Chekorsa). We further evaluated the agreement between MCH service coverage estimates from the HMIS and estimates obtained from a population-based cross-sectional survey conducted with 3,784 women who were pregnant in the year preceding the survey, using Pearson correlation coefficients, intraclass correlation coefficients (ICC), and Bland-Altman plots. We found that the completeness and timeliness of facility reporting were highest in Gomma (75% and 70%, respectively) and lowest in Kersa (34% and 32%, respectively), and observed very few zero/missing values and moderate/extreme outliers for each MCH indicator. We found that the reporting of MCH indicators improved over time for all PHCUs, however the internal consistency between MCH indicators was low for several PHCUs. We found poor agreement between MCH estimates obtained from the HMIS and the survey, indicating that the HMIS may over-report the coverage of key MCH services, namely, antenatal care, skilled birth attendance and postnatal care. The quality of MCH data within the HMIS at the zonal level in Jimma, Ethiopia, could be improved to inform MCH research and programmatic efforts.

Timely initiation of postpartum contraceptive utilization and associated factors among women of child bearing age in Aroressa District, Southern Ethiopia: a community based cross-sectional study.

BACKGROUND: Globally, more than 90% of women during the first year of postpartum period want to either delay or avoid future pregnancies. The first year postpartum period is more crucial time to use modern contraceptives that enhance maternal and child health, so more attention should be given on time of initiating modern contraceptive utilization after delivery. Therefore, the aim of this study was to assess the magnitude and associated factors of timely initiation of postpartum contraceptive utilization among women of child bearing age in Aroressa district, Southern Ethiopia. METHODS: The study was conducted in Aroressa district from March 15 to April 15, 2017. A community based cross-sectional study design with interviewer administered structured and pretested questionnaire was used. Multistage sampling technique was employed involving a total of 695 women of child bearing age who delivered a child in the past 12 months prior to the study period. Data were cleaned, coded and entered into Epi data version 3.1, then exported to statistical package for social science version 20 for analysis. Descriptive statistics, Bivariate and Multivariate logistic regression analysis were done. p-value < 0.05 was used to consider significant variables. RESULTS: The magnitude of timely initiation of postpartum contraceptive utilization was found to be 31.7% [95% CI (28, 36)]. Antenatal care [AOR = 1.94, 95% CI (1.23, 3.01)], postnatal care [AOR = 1.90, 95%CI (1.23, 2.94)], spousal communication on contraceptive methods [AOR = 1.63, 95% CI (1.09, 2.41)] and resumption of menses after delivery [AOR = 2.6, 95% CI (1.47, 3.81)] were predictors positively associated with timely initiation of postpartum contraceptive utilization. CONCLUSION: The magnitude of timely initiation of postpartum contraceptive utilization was low. Strengthening integration of family planning information with antenatal and postnatal care follow up and encouraging spousal communication by promoting information, education and communication activities is important to enhance contraceptive use on timely manner.

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

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.

Childhood sexual abuse experiences and its associated factors among adolescent female high school students in Arbaminch town, Gammo Goffa zone, Southern Ethiopia: a mixed method study.

BACKGROUND: Childhood sexual abuse is a major social problem in Africa including Ethiopia. Moreover, little has been explored about the pattern of childhood sexual abuse in the context of high school students in Ethiopia in general and in Arbaminch town in particular. Thus, the present study aims to assess the prevalence and associated factors of childhood sexual abuse among adolescent female high school students in Arbaminch town. METHODS: A school- based, cross-sectional study was conducted among adolescent female high school students in Arbaminch town from 3(rd) to 8(th) March 2014. Both quantitative and qualitative methods of data collection were used. For the quantitative data, a simple random sampling technique was used to select 369 female students from grade ten of the six high schools. A pre-tested, self-administered questionnaire was used to collect the data and then analysis was made using SPSS version 20 statistical packages. For the qualitative component, fourteen in-depth interviews were conducted and analysed based on the thematic areas. RESULT: The prevalence of life time rape among adolescent female high school students in Arbaminch town was 11 %. The odds of experiencing life time rape was higher among students who lived alone (AOR = 4.30; 95 % CI: 1.81, 10.24) and among students who lived with their friends (AOR = 3.31; 95 % CI: 1.23, 8.89) than those lived with their parents. The chance of experiencing rape among students who have had no open discussions with their parents about sexuality and reproductive health was higher (AOR = 2.93; 95 % CI: 1.33, 6.45) than those who have had discussions. CONCLUSION: This study revealed high levels of childhood sexual abuse among the adolescent female high school students in Arbaminch town. Ever having a discussion about sexuality and reproductive health with parents, living arrangement of the student, and father's educational status had statistically significant association with childhood sexual abuse. Unwanted pregnancy and abortion were the most common reproductive outcomes of rape. Comprehensive school based reproductive health education, community based awareness creation, open discussions about sexuality and reproductive health matters with students at family level are recommended.

Factors associated with women's autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study.

BACKGROUND: Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women's autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women's autonomy and identify associated factors in Southeast Ethiopia. METHOD: A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women's autonomy for health care utilization. RESULT: Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children's health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women's autonomy. CONCLUSION: Socio-demographic and maternal factors (knowledge and attitude) were found to influence women's autonomy. Interventions targeting women's autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status.