Association of Effective Spousal Family Planning Communication with Couples' Modern Contraceptive Use in Harar, Eastern Ethiopia.

BACKGROUND: Spousal family planning communication plays an important role in making better reproductive health decisions and in increasing the use of modern contraceptive methods. The objective of the current study is to examine the association of spousal family planning communication in its broader context with current modern contraceptive use among couples. METHODS: A community based cross-sectional survey was conducted in twelve kebeles of Harar Urban Health and Demographic Surveillance System. A total of 2700 currently married couples of whose wives were in the reproductive age participated in the study. The selection of the study participants was made using simple random sampling and data were collected using an interviewer administered structured questionnaire and analyzed using Stata version 12. RESULTS: The level of current modern contraceptive use was 57.1% (95% CI: 0.53, 3.39). Effective spousal family planning communication was significantly associated with current modern contraceptive use even after controlling for socio-economic and demographic variables. Socio-economic and demographic variables such as religion of couples, number of couples' living children, household monthly income, couples' family planning approval and women's counseling about family planning by health workers were significantly associated with current modern contraceptive use. CONCLUSION: Policies and programs aimed at increasing contraceptive prevalence should properly address the importance of spousal communication about family planning and integrate men into family planning programs to facilitate and enhance couples communication skills.

Injury-related gaining momentum as external causes of deaths in Ethiopian health and demographic surveillance sites: evidence from verbal autopsy study.

BACKGROUND: In Ethiopia, though all kinds of mortality due to external causes are an important component of overall mortality often not counted or documented on an individual basis. OBJECTIVE: The aim of this study was to describe the patterns of mortality from external causes using verbal autopsy (VA) method at the Ethiopian HDSS Network sites. METHODS: All deaths at Ethiopian HDSS sites were routinely registered and followed up with VA interviews. The VA forms comprised deaths up to 28 days, between four weeks and 14 years and 15 years and above. The cause of a death was ascertained based on an interview with next of families or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history and circumstances preceding death after 45 days mourning period. Two physician assigned probable causes of death as underlying, immediate and contributing factors independently using information in VA forms based on the WHO ICD-10 and VA code system. Disagreed cases sent to third physician for independent review and diagnosis. The final cause of death considered when two of the three physicians assigned underlying cause of death; otherwise, labeled as undetermined. RESULTS: In the period from 2009 to 2013, a total of 9719 deaths were registered. Of the total deaths, 623 (6.4%) were from external causes. Of these, accidental drowning and submersion, 136 (21.8%), accidental fall, 113 (18.1%) and transport-related accidents, 112 (18.0%) were the topmost three leading external causes of deaths. About 436 (70.0%) of deaths were from the age group above 15 years old. Drowning and submersion and transport-related accidents were high in age group between 5 and 14 years old. CONCLUSION: In this study, external causes of death are significant public health problems and require attention as one of prior health agenda.

Trend and causes of adult mortality in Kersa health and demographic surveillance system (Kersa HDSS), eastern Ethiopia: verbal autopsy method.

BACKGROUND: The health problems of adults have been neglected in many developing countries, yet many studies in these countries show high rates of premature mortality in adults. Measuring adult mortality and its cause through verbal autopsy (VA) methods is becoming an important process for mortality estimates and is a good indicator of the overall mortality rates in resource-limited settings. The objective of this analysis is to describe the levels, distribution, and trends of adult mortality over time (2008-2013) and causes of adult deaths using VA in Kersa Health and Demographic Surveillance System (Kersa HDSS). METHODS: Kersa HDSS is a demographic and health surveillance and research center established in 2007 in the eastern part of Ethiopia. This is a community-based longitudinal study where VA methods were used to assign probable cause of death. Two or three physicians independently assigned cause of death based on the completed VA forms in accordance with the World Health Organization's International Classification of Diseases. In this analysis, the VA data considered were of all deaths of adults age 15 years and above, over a period of six years (2008-2013). The mortality fractions were determined and the causes of death analyzed. Analysis was done using STATA and graphs were designed using Microsoft Excel. RESULTS: A total of 1535 adult deaths occurred in the surveillance site during the study period and VA was completed for all these deaths. In general, the adult mortality rate over the six-year period was 8.5 per 1000 adult population, higher for males (9.6) and rural residents (8.6) than females (7.5) and urban residents (8.2). There is a general decrease in the mortality rates over the study period from 9.4 in 2008-2009 to 8.1 in 2012-2013. Out of the total deaths, about one-third (32.4%) occurred due to infectious and parasitic causes, and the second leading cause of death was diseases of circulatory system (11.4%), followed by gastrointestinal disorders (9.2%). Tuberculosis (TB) showed an increasing trend over the years and has been the leading cause of death in 2012 and 2013 for all adult age categories (15-49, 50-64, and 65 years and over). Chronic liver disease (CLD) was indicated as leading cause of death among adults in the age group 15-49 years. CONCLUSION: The increasing TB-related mortality in the study years as well as the relative high mortality due to CLD among adults of age 15-49 years should be further investigated and triangulated with health service data to understand the root cause of death.

Neonatal mortality and causes of death in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia, 2008-2013.

BACKGROUND: In the world, Neonatal mortality accounts for 40 % of death of children under the age of 5 years. Majority of neonatal deaths occur in developing countries outside of formal health system, among which death in the first hour of first day of their life constitute the huge bulk. This analysis is intended to estimate neonatal mortality rates and identify the leading causes of death based on the surveillance data over 6 years period in Kersa health and demographic surveillance system (Kersa HDSS) site, Eastern Ethiopia. METHODS: Kersa HDSS is an open dynamic cohort of population established in 2007. The surveillance started after conducting a baseline census followed by population update and events registration on house-to-house visits every 6 months. Data were collected using verbal autopsy (VA) questionnaire from close relatives (usually mothers in this case) and causes of deaths were assigned by 2 to 3 physicians. This analysis was done based on 301 neonatal deaths and 10,934 live births occurred during 2008 to 2013. RESULTS: The overall neonatal death rate during the study period was 27.5 per 1000 live births. Nearly all neonatal deaths (94 %) occurred at home. More than four-fifth (82.4 %) of the deaths was occurred in the first week of life. More than 80 % of the deaths were due to perinatal causes. Bacterial sepsis of the newborn accounted for 31.2 % followed by birth asphyxia and perinatal respiratory disorder (28.2 %), and prematurity (17.3 %). Higher number of death was observed in Tolla and Bereka sub-districts located at the southern parts of the study site which are away from the main road network. CONCLUSION: The overall neonatal mortality over 6 years is the same to the national average (27 per 1000 live births). The leading causes of neonatal death were bacterial sepsis of newborn and birth asphyxia. Community-based skilled health care delivery during birth should be emphasized.

Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia.

BACKGROUND: The global burden of mortality among children is still very huge though its trend has started declining following the improvements in the living standard. It presents serious challenges to the well-being of children in many African countries. Today, Sub-Saharan Africa alone accounts for about 50% of global child mortality. The overall objective of this study was to determine the magnitude and distribution of causes of death among children aged 5 to 14 year olds in the population of Kersa HDSS using verbal autopsy method for the period 2008 to 2013. METHODS: Kersa Health and Demographic Surveillance System(Kersa HDSS) was established in September 2007. The center consists of 10 rural and 2 urban kebeles which were selected randomly from 38 kebeles in the district. Thus this study was conducted in Kersa HDSS and data was taken from Kersa HDSS database. The study population included all children aged 5 to 14 years registered during the period of 2008 to 2013 in Kersa HDSS using age specific VA questionnaires. Data were extracted from SPSS database and analyzed using STATA. RESULTS: A total of 229 deaths were recorded over the period of six years with a crude death rate of 219.6 per 100,000 population of this age group over the study period. This death rate was 217.5 and 221.5 per 100,000 populations for females and males, respectively. 75% of deaths took place at home. The study identified severe malnutrition(33.9%), intestinal infectious diseases(13.8%) and acute lower respiratory infections(9.2%) to be the three most leading causes of death. In broad causes of death classification, injuries have been found to be the second most cause of death next to communicable diseases(56.3%) attributing to 13.1% of the total deaths. CONCLUSION AND RECOMMENDATION: In specific causes of death classification severe malnutrition, intestinal infectious diseases and acute lower respiratory infections were the three leading causes of death where, in broad causes of death communicable diseases and injuries were among the leading causes of death. Hence, concerned bodies should take measures to avert the situation of mortality from these causes of death and further inferential analysis into the prevention and management of infectious diseases should also be taken.

HDSS Profile: The Kersa Health and Demographic Surveillance System.

Kersa HDSS was established in 12 sub-districts of Kersa district, Eastern Hararge, Oromia Region, Ethiopia. The site is principally rural with two small towns (Kersa and Weter). The baseline census was conducted in 2007 and since then has been updated every 6 months, with registration of demographic and health events. Data are entered into the HRS-2 relational database. At baseline a total of 10,085 houses, 10,522 households and 50,830 people were registered. The sex ratio and number of persons per household were 1.0 and 5.1, respectively. At the end of 2013, the population was 60,694. Up to the end of 2013, 12,571 births and 3143 deaths were registered, respectively. Over 85% of births and deaths occurred at home. The annual net population growth ranges from 0.06 to 1.6. The majority of the population in Kersa are not working age group; hence the dependency ratio in most of the years is below 1. The total fertility rate ranges from 4.0 to 5.3. A reduction in neonatal, infant and under-five mortalities was observed. For all deaths, verbal autopsies were done. Tuberculosis is the leading cause of death among adults and malnutrition is the leading cause of death among children aged under 5 years. Kersa HDSS is ready to collaborate with interested researchers on health and demographic issues. For further details please visit: [http://www.haramaya.edu.et/research/projects/kds-hrc/].

The level and patterns of fertility among women in Kersa Demographic Surveillance and Health Research Center (KDS-HRC) Field site, Kersa District, East Ethiopia.

BACKGROUND: Fertility is one of the three principal components of population dynamics. High fertility and rapid population growth exert negative influences on economic and social development. This study was aimed to estimate the level and trends of fertility among (15-49 years) old women in kersa demographic surveillance and health research center, kersa district Eastern Ethiopia. METHODS: The study was conducted at kersa demographic surveillance and health research center in kersa district, Eastern Ethiopia. The study utilized five years follow up data (2008-2012). All women (15 to 49 years old) who have been living at kersa demographic surveillance and health research center in kersa district from 2008 to 2012 were included in the analysis to estimate the level and pattern of fertility. Descriptive statistics was computed to determine level and pattern of fertility. RESULTS: Age specific fertility rate was highest in women of the age group 25-29 years old (233.2 per 1000 women in 2008; 205.8 per 1000 women in 2009; 279.0 per 1000 women in 2010; 186.6 per 1000 women in 2011 and 198.5 per 1000 women in 2012) in five consecutive years from 2008 to 2012. Total fertility rate didn't show any significant decline during the study period, i.e., 4.3, 4.5, 4.9, 3.5, 4.0 live births per woman throughout her reproductive period (15-49) years old in 2008, 2009, 2010, 2011 and 2012, respectively. On the other hand, general fertility rate declined from 110.3 births per 1000 women in 2008 to 95.9 per 1000 women in the reproductive age in 2012. CONCLUSION: The total fertility rate was found to be relatively high. Fertility rate is higher in rural residents and illiterate women than in urban residents and literate women. Strong information, education, communication and behavior change communication on family planning should be designed and implemented to prevent unwanted fertility.