Level of stigma among female sex workers: comparison of two surveys of HIV behavioral data, Ethiopia.

BACKGROUND: HIV and AIDS stigma and discrimination is widespread in Africa. We did a secondary data analysis of HIV and AIDS behavioral surveillance surveys (BSS) on female sex workers residing in three major cities in Ethiopia. OBJECTIVES: To compare level of sigma among sex workers through the analysis of two data sources of BSS conducted in 2002 and 2005 in Ethiopia. METHODS: The BSS used standardized methodology to study the level of stigma among female sex workers. Female sex workers were sampled using two-stage probability sampling methods in each of the three cities. Data from a total of 2,888 female sex workers was analyzed and interpreted. We used Chi square to compare the socio-demographic variables of the two surveys and logistic regression to compare level of stigma between the two surveys. RESULTS: There is a significant difference in the level of stigma between the two surveys. This applies to most of the questions that were included in the surveys. CONCLUSION: The proportion of female sex workers with a stigmatizing attitude is considerably high, posing threats to the HIV prevention program. Strengthening interventions on all aspects of stigma is recommended.

A community survey on maternal and child health services utilization in rural Ethiopia.

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits. Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's diarrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.

PIP: A community survey of 21 villages in rural Ticho district of Arsi region in Ethiopia was conducted in February 1990 to gather data on utilization of maternal and child health (MCH), family planning, and immunization services. 95% of the villages had a traditional birth attendant. 26% of the 419 mothers had used prenatal services when pregnant with their last child. 61% of these women had at least 3 visits. Women who lived within 10 km of the health center in the district capital, Robe, were more likely to use prenatal services than those who lived at a greater distance (41% vs. 23%; p 0.001). Just 29% of mothers had taken their 1st child to the under-5 clinic, but 64% of these took this child to the clinic for at least 3 visits. All but 4 mothers (99%) breast fed their last child; 77% of them were nursing at the time of the interview. Just 4% of all breast feeding mothers discontinued breast feeding before their child reached 1 year. Just 33% of the mothers were familiar with oral rehydration salts (ORS). Most mothers with ORS knowledge (89%) used ORS to treat diarrhea, reflecting a positive attitude towards modern treatment of diarrhea. Only 5% of women 15-49 years old used contraceptives. Contraceptive usage was significantly associated with age (10% for 40 years, 7% for 20 years, and 4% for 21-39 years; p .05). Christians and Muslims used contraceptives at virtually the same rate (6% vs. 5%). Survey results on immunization coverage supports routine reporting data. Attendance at MCH clinics had a positive effect on complete immunization with the diphtheria, pertussis, tetanus vaccine (p 0.001). Such as association was not observed between prenatal care and tetanus toxoid immunization, however. The researchers propose integration of MCH services in upgraded health stations to increase access and coverage of MCH care.

Census in a rural area of Ethiopia: methodology and results.

A census and an ecologic survey were performed in 39 villages of a rural district of Arsi Region, Ethiopia, in difficult field circumstances. Information on age, ethnic group, education and family relationship, as well as data on health facilities and availability of basic services were collected. Supervised students, working in teams, were used as interviewers. Communities were involved through plenary meetings and community health agents participated in the data collection process. A total of 64,714 people in 12,152 households were registered. The repeatability of age assessment was investigated by comparing the results from two villages with data obtained in a pilot study carried out 6 months earlier. The technical error was only 0.80 and 1.67 in the 0-5 and 6-15 age-groups, respectively. Three percent of the total population was under one year, less than previously estimated. This may, in part, be due to the family planning programme in the region. Eighteen percent of the households were headed by females. School attendance was less common among females and in the Oromo ethnic group. The availability of basic services, including safe water and basic sanitation supplies, was very poor in the area.

PIP: A rural demographic surveillance system was established in the Arsi region of Ethiopia with a census, health interview survey, and ecologic data collection in 1989-90. The methodology, data collection, data processing, and survey results of the census and surveys in 39 villages in Ticho District are reported. Ticho was one of 12 districts in Arsi Region in which the population has been resettled in villages since 1985. The area is situated in highlands, which have difficult field circumstances. Students (18) were used as interviewers in the catchment areas of the Robe health center and 5 health stations. Community participation was included prior to the survey. A pilot study was undertaken 6 months prior to the main surveys in April 1989. Community health agents, who were asked to encourage community involvement, and students were trained prior to survey distribution in October-November 1989 and February 1990 during the dry season. Team supervisors monitored data collection and personally collected the ecologic data. Completeness was checked manually, and computer data entries were checked on 10% of all records. THe operation costs amounted to 12,000 Ethiopian birr ($6000), excluding printing of forms and some purchases of materials necessary for fieldwork. Age reliability was checked for 5% of the sample in 2 villages. Technical error was found to increase with age and was lowest in the 0-5 year old group. The census enumerated 64,714 persons in 12,152 households (5.3 persons per household) in the 39 villages. The population increased by single years of age until the age of 8 years. There appeared to be even number digit preference and 0 and 5 digit preference. The Oromo ethnic group comprised 85% of the population; 14% were Amhara. 66% of the Oromo group were Muslim, and the rest were Orthodox. 39% of the Oromo population under 5 years old and 35% of the Amhara group had never attended school. 31% of the population aged 15-19 years had attended primary school and 23% secondary school; only 13.9% of the 15-19 year olds had not attended any school. There were 2217 households headed by females. The nearest health station was an average of 90 minutes away by foot. 23 villages had not or few latrines. Only 3 villages obtained safe drinking water. Access to unprotected water sources took less than 30 minutes for 90% of the villages. 35% (14) of the villages had a primary school. Environmental health needs to be a priority for Primary Health efforts.

Estimation of early childhood mortality using preceding birth technique in a community-based setting.

The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12 month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 x 1000 live-births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.

PIP: The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12-month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 per 1000 live births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between age 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.