Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study.

BACKGROUND: perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. METHODS: An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. RESULTS: A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. CONCLUSION: From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay birth interval also minimize perinatal mortality.

The Effects of a Locally Developed mHealth Intervention on Delivery and Postnatal Care Utilization; A Prospective Controlled Evaluation among Health Centres in Ethiopia.

BACKGROUND: Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. METHODS: A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. FINDINGS: Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53-2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12-3.61)). CONCLUSIONS: Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their clients.

Paving the way for universal family planning coverage in Ethiopia: an analysis of wealth related inequality.

BACKGROUND: Family planning plays a significant role in reducing maternal and child mortality and ultimately in achieving national and international development goals. It also has an important role in reducing new pediatric HIV infections by preventing unwanted pregnancies among HIV positive women. Investing in family planning is one of the smart investments for development as population dynamics have a fundamental influence on the pillars of sustainable development, including that of a sustainable environment. OBJECTIVE: To identify and quantify wealth related differences in family planning use between poor and rich Ethiopian women based on the Demographic and Health Survey asset based wealth quintiles. METHODS: The proportion of women who used contraceptives during implementation of the 2011 and 2005 Ethiopia Demographic and Health Surveys was calculated across wealth quintiles. Data were stratified for place of residence to analyze and determine inequalities in family planning use separately for rural and urban women. Socioeconomic inequalities according to wealth were measured using the slope index of inequality and the relative index of inequality. RESULT: The absolute difference of contraceptive prevalence between poorest and richest women was over 25.3 percentage points (95% CI = 18.9-31.7) in 2011. Contraceptive use was more than twice (RII: 2.6, 95% CI = 2.0 - 3.3) as prevalent among the richest compared with the poorest. CONCLUSION: Despite efforts to provide contraceptives for free at all public health facilities, wealth based inequalities still prevail in Ethiopia. People at lower socioeconomic strata should be empowered more to avoid the root causes of inequality and to achieve national Health Sector Development Program Goals.

Neonatal care practice and factors affecting in Southwest Ethiopia: a mixed methods study.

BACKGROUND: A significant proportion of neonatal mortality can be prevented by the provision of the minimum neonatal care package. However, about 3 million neonates die each year globally because of lack of appropriate care. This situation is the worst in Ethiopia. Thus, the objective of this study was to determine the status of neonatal care and identify factors affecting. METHODS: A mixed methods study involving both quantitative and qualitative methods was conducted from September 2012-December 2013 in Southwest Ethiopia. Randomly selected sample of 3463 mothers were interviewed to collect the quantitative data. Twelve in-depth interviews with purposively selected key informants and six focus-group discussions with purposively selected mothers were conducted for the qualitative data. Mixed-effects multilevel linear regression model was used to identify predictors of neonatal care practice by using STATA 13. Audio recording, transcription and thematic content analysis was done for the qualitative data. RESULTS: The overall status of neonatal care practice was 59.5 % (95 % CI: 57.6 %, 61.3 %). Of the respondents, 53.8 % received tetanus toxoid, 23.8 % planed for birth, 41.9 % received at least one antenatal care and 43.0 % received adequate information during pregnancy. Only, 17.5 % received skilled care at birth and 95.0 % received social support. Of the neonates, 96.5 % received appropriate thermal care, 86.5 % received clean cord care, 64.1 % initiated breast-feeding within one hour, 91.5 % were on exclusive breast-feeding, 56.5 % received appropriate bathing and 8.1 % received vaccination on date of birth. Place of residence, maternal education, husband's occupation, wealth quintiles, birth order and inter-birth interval were identified as predictors of neonatal care practice. CONCLUSIONS: The status of neonatal care practice was low in the study area. Skilled care at birth and receiving vaccination on date of birth were the worst practices. Factors affecting neonatal care existed both at cluster level and at the individual level and included socio demographic, economic and obstetric factors. Appropriate birth spacing, birth limiting and behaviour change communications on the importance of neonatal care are recommended.

Antiretroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review.

BACKGROUND: Despite significant efforts to understand adverse pregnancy outcome in women receiving Antiretroviral Therapy (ART), ART-related adverse birth outcomes are still poorly understood. We systematically review ART-related adverse birth outcomes among HIV-infected pregnant women; we also review the covariates associated with adverse birth outcomes in the aforementioned group. METHODS: The main source for our systematic review was electronic bibliographic databases. Databases such as MEDLINE, PubMed, EMBASE and AIDSLINE were searched. Furthermore, search engines such as Google and Google Scholar were specifically searched for gray literature. Methodological quality of available literature was assessed using the Newcastle - Ottawa Quality Assessment Scale & M. Hewitt guideline. We examined a total of 1,124 papers and reviewed the studies using the PICOT criteria which stands for Patient (population), Intervention (or "Exposure"), Comparison, Outcome and Type of study. Finally, 32 methodologically fit studies were retained and included in our review. RESULTS: Frequently observed adverse birth outcomes included low birth weight (LBW), Preterm Birth (PB), Small for Gestational Age (SGA), while still birth and congenital anomalies were infrequent. Type of regimen such as Protease Inhibitor (PI) based regimens and timing of initiation of ART are some of the factors associated with adverse pregnancy outcomes. Covariates principally included malnutrition and other co-morbidities such as malaria and HIV. CONCLUSIONS AND PUBLIC HEALTH IMPLICATIONS: There is growing evidence in published literature suggesting that ART might be causing adverse birth outcomes among pregnant women in developing countries. There is a need to consider regimen types for HIV-infected pregnant women. There is need to design large cohort studies.

Is Community Conversation Associated with Human Immunodeficiency Virus Voluntary Counseling and Testing Service Uptake in Rural Communities in Ethiopia? A Comparative Cross-sectional Study.

BACKGROUND: Voluntary counseling and testing (VCT) is a cost-effective tool to prevent and control human immunodeficiency virus (HIV)/acquired immodeficiency syndrome. Community conversation (CC) is a community-based strategy meant to enhance the community utilization of VCT. However, the role of CC in VCT service uptake has not yet been evaluated. AIMS: This study was conducted to compare VCT service utilization between rural communities with well CC performance and rural communities with poor CC performance in Shebedino woreda. MATERIALS AND METHODS: A cross-sectional comparative community-based study was conducted in 2010 among 462 selected adults in the age bracket of 15-59 years. VCT service uptake was compared between well CC performing communities and poor CC performing communities using two sample test of proportion. Predictors of VCT service uptake were determined using logistic regression model. RESULTS: Uptake of VCT service and the related VCT knowledge were statistically higher in well CC performing communities than poor CC performing communities; [73.0% vs. 54.1%, P < 0.001) vs. 97.8% vs. 93.8%, P = 0.034]. CC, VCT knowledge, and knowledge on HIV transmission were independent predictors of VCT service utilization. CONCLUSION: Uptake of VCT service is higher in well CC performing communities. Emphasis should be given to strengthen CC performance.

The effects of pregnancy intention on the use of antenatal care services: systematic review and meta-analysis.

BACKGROUND: There has been considerable debate in the reproductive health literature as to whether unintended pregnancy influences use of maternal health services, particularly antenatal care. Despite the wealth of studies examining the association between pregnancy intention and antenatal care, findings remain mixed and inconclusive. The objective of this study is to systematically review and meta-analyse studies on the association between pregnancy intention and antenatal care. METHODS: We reviewed studies reporting on pregnancy intention and antenatal care from PubMed, Popline, CINHAL and Jstor search engines by developing search strategies. Study quality was assessed for biases in selection, definition of exposure and outcome variables, confounder adjustment, and type of analyses. Adjusted odds ratios, standard errors and sample size were extracted from the included studies and meta-analyzed using STATA version 11. Heterogeneity among studies was assessed using Q test statistic. Effect-size was measured by Odds ratio. Pooled odds ratio for the effects of unintended pregnancy on the use of antenatal care services were calculated using the random effects model. RESULTS: Our results indicate increased odds of delayed antenatal care use among women with unintended pregnancies (OR 1.42 with 95% CI, 1.27, 1.59) as compared to women with intended pregnancies. Sub-group analysis for developed (1.50 with 95% CI, 1.34, 1.68) and developing (1. 36 with 95% CI, 1.13, 1.65) countries showed significant associations. Moreover, there is an increased odds of inadequate antenatal care use among women with unintended pregnancies as compared to women with intended pregnancies (OR 1.64, 95% CI: 1.47, 1.82). Subgroup analysis for developed (OR, 1.86; 95% CI: 1.62, 2.14) and developing (OR, 1.54; 95% CI: 1.33, 1.77) countries also showed a statistically significant association. However, there were heterogeneities in the studies included in this analysis. CONCLUSION: Unintended pregnancy is associated with late initiation and inadequate use of antenatal care services. Hence, women who report an unintended pregnancy should be targeted for antenatal care counseling and services to prevent adverse maternal and perinatal outcomes. Moreover, providing information on the importance of planning and healthy timing of pregnancies, and the means to do so, to all women of reproductive ages is essential.

The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural Southwestern Ethiopia.

BACKGROUND: Depression in pregnancy has adverse health outcomes for mothers and children. The magnitude and risk factors of maternal depression during pregnancy is less known in developing countries. This study examines the association between pregnancy intention, social support and depressive symptoms in pregnancy in Ethiopia. METHODS: Data for this study comes from a baseline survey conducted as part of a community- based cohort study that involved 627 pregnant women from a Demographic Surveillance Site (DSS) in Southwestern Ethiopia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during pregnancy. Data on depressive symptoms, pregnancy intention, social support and other explanatory variables were gathered using an interviewer-administered structured questionnaire. The association between independent variables and depressive symptom during pregnancy was assessed using multivariable logistic regression. RESULTS: The prevalence of depressive symptoms during pregnancy was 19.9% (95% CI, 16.8-23.1), using EPDS cut off point of 13 and above. The mean score on the EPDS was 8, ranging from 0 to 25 (SD ±5.4). Women reporting that the pregnancy was unwanted were almost twice as likely to experience depressive symptoms compared with women with a wanted pregnancy. (Adjusted Odds Ratio (AOR) = 1.96, 95% Confidence Interval (CI) 1.04-3.69) Women who reported moderate (AOR = 0.27; 95% CI 0.14-0.53) and high (AOR = 0.23, 95% CI 0.11-0.47) social support during pregnancy were significantly less likely to report depressive symptoms. Women who experienced household food insecurity and intimate partner physical violence during pregnancy were also more likely to report depressive symptoms. CONCLUSION: About one in five pregnant women in the study area reported symptoms of depression. While unwanted pregnancy increases women's risk of depression, increased social support plays a buffering role from depression. Thus, identifying women's pregnancy intention and the extent of social support they receive during antenatal care visits is needed to provide appropriate counseling and improve women's mental health during pregnancy.

The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis.

BACKGROUND: Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality. METHODS: The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I(2) test statistic was used to assess heterogeneity. Funnel plot, Begg's test and Egger's test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. RESULTS: A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87) for health facility delivery as compared to home delivery. CONCLUSION: Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are essential in areas where home delivery is a common practice.

Maternal morbidity in Butajira and Wukro districts, North and South central Ethiopia.

BACKGROUND: Worldwide, for every woman that dies of maternal causes, there are at least 20 more women who suffer from infection, disabilities and injuries relating to pregnancy and childbirth. OBJECTIVE: To determine the magnitude and the role of socio-economic, demographic and reproductive factors on the occurrence of maternal morbidity in the study population. METHODS: During the months of January to February 2012, a community based cross sectional survey was conducted to assess magnitude and factors affecting maternal morbidity in selected kebeles of Wukro and Butajira districts, Tigray and Southern Nation Nationalities and People's (SNNP) regions respectively, Ethiopia. A total of 4949 women who had deliveries in the two years preceding the survey were included. Following description of variables under the study, bivariate and Multivariable statistics were used to see the relationship between different factors and maternal morbidity. RESULTS: A total of 688 (14.2%) women reported that they had at least one form of morbidity. The three most frequent reported maternal morbidity during antenatal period were severe headache 89 (17.2%), lower abdominal pain (15.1%) and excessive vomiting (11.4%). Of the 220 women who reported to have morbidity during labor and delivery, prolonged labor (more than 24 hours) was accounted for 89 (40.5%) followed by hemorrhage and premature rapture of membranes in 74 (33.6%) and 23 (10.5%) of the cases respectively. Lower proportion of maternal morbidity was reported in Wukro than Butajira district [AOR (95% CI) = 0.17 (0.12, 0.25)]. Poorest and poor women were more likely to report to be sick [AOR (95% CI) = 1.79 (1.10, 2.91)] and [AOR (95% CI) = 1.65 (1.10, 2.47)] respectively. Women with parity of 5-6 and > or = 7 children respectively were also more likely to be morbid [AOR (95% CI) = 1.52 (1.11, 2.09)] and [AOR (95% CI) = 2.01 (1.38, 2.91)]. Women who had facility delivery were found more likely to have reported maternal morbidity with [AOR (95% CI) = 3.73 (2.96, 4.71)] CONCLUSION: High parity, wealth status and facility delivery were found to be independent predictors of maternal morbidity. Empowering women through improving their resource generation capacity, and access to family planning services to those with high parity would diminish the likelihood of having maternal morbidity.

Newborn tracking for polio birth dose vaccination in pastoralist and semi-pastoralist CORE Group Polio Project implementation districts (woredas) in Ethiopia.

BACKGROUND: Estimates of immunization coverage rates in Ethiopia varied widely, but were consistent in that polio birth dose coverage is much lower than other antigens, particularly in semi-pastoralist and pastoralist areas. OBJECTIVE: Examine pregnancy and child delivery practices and identify mechanisms for improving polio birth dose coverage in CORE Group Polio Project implementation districts. METHODS: A community based cross sectional study was conducted in March - April 2012 involving 600 women who delivered in the previous one year. Interviews were also conducted with key informants, Traditional Birth Attendants and, Health Extension Workers complemented by Focus Group Discussions (FGDs) with community leaders. RESULTS: Three hundred twelve women (52.0%) had attended antenatal care at least once during the last pregnancy. Five hundred forty nine women (91.5%) delivered their last baby at home. Polio coverage was 29.7%, 19.7%, and 32.7% by history, by card and by history or card respectively. Antenatal care attendance was the main predictor of polio birth does utilization adjusted for other factors. Discussion with FGD participants revealed the prevailing knowledge on polio including misconceptions, and immunization service utilization. CONCLUSIONS: Newborn tracking for improving polio birth dose requires raising awareness among women and the community at large, strengthening mechanisms for identification and follow up of pregnant women at the community level, coordinating and strengthening the activities of front line health workers, and improving accessibility of health service.

Acute flaccid paralysis surveillance status and community awareness in pastoralist and semi-pastoralist communities of Ethiopia.

BACKGROUND: Acute flaccid paralysis (AFP) surveillance is an essential component of the polio eradication strategy. The last laboratory confirmed wild poliovirus in Ethiopia was identified in April 2008. However, the country remains at risk for re-infection because of a number of silent areas and borders with high risk countries. OBJECTIVE: Assess AFP surveillance status and community perception on AFP/Polio in semi pastoralist and pastoralist areas. METHODS: Community and facility based cross-sectional survey was conducted complemented by Focus Group Discussions (FGD) from March - April, 2012. The study populations included District and health center AFP surveillance focal persons, WHO surveillance officers, community and religious leaders and women who delivered in the previous one year in purposively selected districts in Core Group Polio Project Implementation areas of Ethiopia. RESULT: Interviews with health center and district AFP surveillance focal persons revealed deficiencies in training, supervision and feedback. The performance of AFP detection varied in the study districts and knowledge about polio and AFP detection was found to be low in the study communities. CONCLUSION: There is a need to strengthen awareness of communities through targeted information, education and communication (IEC) interventions. Regular need-based training and supportive supervision should be conducted, involving all stakeholders including religious leaders and community leaders at each step of the awareness creation process, case detection and reporting and by giving special emphasis to silent and border districts.

Cross-border wild polio virus transmission in CORE Group Polio Project areas in Ethiopia.

BACKGROUND: Ethiopia interrupted indigenous polio transmission in April 2008. However, it remains at risk of reinfection because of importation of polio virus from bordering countries. OBJECTIVES: Assess polio immunization activities and risk of wild polio virus (WPV) importation in CORE Group Polio Project (CGPP) international border areas of Ethiopia. METHODS: The study employed key informant interviews of community volunteers (CV), health extension workers (HEWs), program coordinators, managers and other stakeholders, as well as focus group discussions (FGDs) with community and religious leaders in six border districts (woredas) located in three regions of the country. It was conducted in March and April 2012. RESULTS: Thirty-three key informant interviews and six FGDs were conducted. Immunization coverage was reported to be low and misconceptions about causes and transmission of polio were abundant. There was extensive cross-border movement of people for various reasons and mechanisms for prevention of cross-border polio transmission was almost non existent. AFP case detection and reporting was generally low. CONCLUSION AND RECOMMENDATIONS: Cross-border transmission of polio can occur from several frontiers. Suggestions to control cross-border polio transmission included establishing and/or strengthening cross-border collaboration with responsible counterparts in neighboring countries by using existing cross-border forums and structures to create community awareness, share information and resources, design and implement strategies for identification of children who are eligible for vaccination or suspected AFP cases. In addition districts should coordinate supplemental immunization activities to coincide with when adjacent districts in neighboring countries are carrying out similar actions.

Factors associated with immunization coverage among children age 12-23 months: the case of Zone 3, Afar Regional State, Ethiopia.

BACKGROUND: Strengthening routine immunization is one of the four pillars of the global polio eradication initiative. OBJECTIVES: To determine the magnitude and factors associated with vaccination coverage among children age 12 -23 months in Zone 4 of Afar Regional State, Ethiopia. METHODS: A community based cross-sectional study using the WHO modified cluster sampling method was carried out in Zone 3 of Afar Regional State between January 01 and May 31, 2009. The calculated sample size was 762 and 740 were included in the analysis of vaccination status. RESULTS: A total of 740 children aged 12-23 months were included in the study. Three hundred forty two (46%) respondents reported that their children were vaccinated at least once. Polio 3 coverage was found to be 35.0% and full immunization coverage was 20.6%. Respondents who could read and write had a higher likelihood of getting their children vaccinated compared to those who could not read or write [AOR = 0.18, 95% CI: 0.08-0.34]. Similarly age of the mother, husband's attitude and joint decision making by husband and wife were significantly associated with child immunization adjusted for other factors. CONCLUSION: The population immunity for polio measured by routine polio vaccine uptake in the study area indicated a high risk for wild polio virus outbreaks following importations, and the emergence and spread of circulating vaccine- derived polio virus. Literacy, positive attitude towards immunization and decision power are important factors to be addressed.

Knowledge and practice of frontline health workers (Health Extension Workers and Community Volunteer Surveillance Focal Persons) towards acute flaccid paralysis (AFP) case detection and reporting in pastoralist and semi-pastoralist areas of Ethiopia.

BACKGROUND: Front line workers in pastoralist and semi pastoralist areas are expected to play a vital role in detecting cases of Acute Flaccid Paralysis. OBJECTIVE: Assess knowledge and practice of Heath Extension Workers (HEWs) and Community Volunteer Surveillance Focal Persons (CVSFPs) on AFP case detection and reporting. METHODS: A cross sectional survey involving 70 Health Extension Workers (HEWs) and 71 Community Volunteer Surveillance Focal Persons (CVSFPs) was conducted in 9 districts in Core Group Polio Project Implementation areas of Ethiopia from March 1-April 30, 2013. Data were entered and analyzed using SPSS version 17. RESULTS: Thirty four HEWs (48.6%) searched for AFP cases by going from house to house, while 27 (38.6%) did not perform any function specific to AFP surveillance. Twenty (28.2%) and 7 (9.9%) of CVSFPs respectively, indicated using a case definition of AFP which included paralysis and acute paralysis. Nine (12.7%) of the CVSPF provided responses that did not include paralysis while 22 CVSFPs (31.0%) did not know the case definition of AFP. Three HEWs and 9 CVSFPs claimed to have detected and reported AFP cases. Thirty-eight (53.5%) CVSFPs had received training on community-based surveillance while 33 (46.5%) had none. Thirty nine (54.9%) of the CVSFPs reported having received supervision during the last six months, 22 (31.0%) of whom reported having received feedback. CONCLUSION: Inadequate pertinent knowledge on AFP and inadequate training and supervision appear to be obstacles for effective AFP detection by front line health workers in the study communities.

Knowledge of mothers on poliomyelitis and other vaccine preventable diseases and vaccination status of children in pastoralist and semi-pastoralist areas of Ethiopia.

BACKGROUND: Awareness and service utilization are key to polio eradication. OBJECTIVE: Assess the knowledge of mothers on polio and other vaccine preventable diseases, and utilization of immunization services in pastoralist and semi-pastoralist areas in Ethiopia. METHODS: A community-based cross sectional study using a multistage cluster sampling method involving women who delivered during the previous one year was conducted. RESULTS: A total of 600 women were interviewed. Three hundred-and-five (50.8%) women said they knew what polio was. The time to initiate polio vaccination was correctly indicated to be at birth or within 2 weeks of birth by 224 (37.4%) women. Four hundred forty five (74.2%) women said they did not know how polio is transmitted Polio birth dose (Polio 0) and Polio 3 vaccine coverage were estimated at 32% and 37% respectively. Adjusting for other factors, knowledge of when polio vaccination starts was significantly associated with having a child vaccinated for Polio 3 (OR 95% CI = 3.45 (2.33- 5.11). CONCLUSION: Knowledge of mothers about polio is low and a little more than one third were aware of when the initial vaccine dose should be administered. Providing detailed information on polio and the recommended vaccination schedule can contribute to improve immunization and hasten polio eradication.

Health facility preparedness for routine immunization services in Gambella region, Ethiopia.

BACKGROUND: Immunization coverage has been consistently low in semi pastoralist regions of Ethiopia, including the Gambella region. OBJECTIVE: Assess facility preparedness for routine immunization services in the region. METHODS: All health centers and randomly selected health posts that were reported to provide immunization services for at least six months earlier to the data collection time were included. The study was conducted in August, 2011. Data were collected through observations and interviewing health facility head or EPI focal person using structured questionnaire. RESULT: Only 7/28 (25%) of health facilities provided routine EPI service regularly while the rest 21/28 (75%) health facilities did not offer routine EPI regularly. The reasons given for not providing EPI services regularly were lack of refrigerator in 9/28 (32.1%) health facilities, shortage of kerosene in 7/28 (33.3%), the refrigerators were dysfunctional in 3/28 (14.3%), had no vaccine in 1/28 (3.6%) health facilities. At times higher coverage were attained when Enhance Routine Immunization Activities (ERIA) were conducted. CONCLUSION: Routine EPI performance in Gambella region is generally low. There seems to be reliance only on ERIAs to increase EPI coverage. Health facilities should be staffed with trained personnel and adequate immunization logistics should be available to run regular static and outreach services.

Parent-young people communication about sexual and reproductive health in E/Wollega zone, West Ethiopia: implications for interventions.

OBJECTIVES: This study aims at examining parent-young people communication about sexual and reproductive health related topics and factors associated with it from both young people's and parents' perspectives. METHODS: A cross-sectional study was conducted among 2,269 young people aged 10-24 years in Nekemte town and semi urban areas, western Ethiopia. Chi-square and multivariate logistic regression analyses were conducted using SPSS for windows version 16. The qualitative data was coded, and categorized in to emerging themes using the open code software version 3.4. RESULT: About a third of young people-32.5% (32.4% of females and 32.7% males) engaged in conversation about sexual and reproductive health topics with their parents/parent figures during the last six months. In logistic regression analyses, young people who were aged 15-19 years were more likely to report parent-communication compared to the other age groups (AOR = 1.57; 95%CI = 1.26-1.97). Female young people are more likely to discuss with their mothers, (AOR = 1.89, 95% CI = 1.13-3.2), sister (AOR = 2.16, 95% CI = 1.19-3.9) and female friends (AOR = 11.7, 95% CI = 7.36-18.7) while males are more likely to discuss with male friends (AOR = 17.3, 95%CI = 10-4-28.6). Educated young people were more likely to parent-communicate(AOR = 1.70, 95%CI = 1.30-2.24). Fear of parent, cultural taboos attached to sex, embarrassments, and parents' lack of knowledge related to sexual and reproductive health were found to be barriers for parent communication. Parent-communication takes place not only infrequently but also in warning, & threatening way. CONCLUSION: Parent-young people communication about sexual health is occurring rarely in the family and bounded by certain barriers. Programmes/policies related to young people's reproductive health should address not only individual or behavioral factors but also cultural and social factors that negatively influence parent-communication about reproductive health.

Maternal intimate partner violence victimization and under-five children mortality in Western Ethiopia: a case-control study.

OBJECTIVE: This study aimed to compare the association between maternal intimate partner violence and under-five mortality. METHODS: Matched case-control study was conducted from May to June 2011. A sample of 286 cases and 572 controls were randomly selected from East Wollega Zone, West Ethiopia. RESULTS: Among cases, 72.7% ever experienced controlling behaviors when compared to 62.4% for controls. All forms of maternal intimate partner violence were experienced by 61.9% of cases and 50.9% of controls. Controlling behavior in marriage and experiences of all forms of intimate partner violence during lifetime were more than four [adjusted odds ratio (AOR) 4.27, 95% confidence interval (CI) 0.97-18.89), and two (AOR = 2.55, 95% CI 1.66-3.92) times as likely to be associated with under-five mortality. CONCLUSION: Maternal intimate partner violence victimization is strongly associated with under-five mortality. Involving men in maternal and child health programs could be one strategy to address the issue of intimate partner violence against women.