Gender exploitative and gender transformative aspects of employing Health Extension Workers under Ethiopia's Health Extension Program.

OBJECTIVES: To apply a gender lens to Ethiopia's Health Extension Program and the role of Health Extension Workers (HEWs). METHODS: Interviews with 45 HEWs and four focus group discussions with 14 of the same HEWS from three regions in rural Ethiopia: Afar Region; Tigray Region (Adwa Woreda); and two locations in Southern Nations, Nationalities and People's Region (Aleta Wondo Woreda and Kafa Zone). Two focus group discussions were conducted in Afar Region with 17 Women Extension Workers employed by Afar Pastoralist Development Association. RESULTS: Using the Gender Equality Continuum as a gender analysis tool, we found that Ethiopia's Health Extension Program is gender aware by directly linking improved health outcomes for women and their empowerment. However, for HEWs who inhabit a gendered space and place from home to district health centres, there can be unexpected consequences that accommodate existing gender inequalities, are blind to them and perhaps even generate new forms of exploitation. CONCLUSIONS: The Health Extension Program could have more transformative outcomes for HEWs and also for communities if changing gender norms was given more attention and constraints to gender equality were reduced. Community Health Worker (CHW) programs should focus on better understanding on the role of gender for CHWs across health systems.

OBJECTIFS: Appliquer une perspective du genre au programme de vulgarisation de la santé en Ethiopie et au rôle des agents de vulgarisation de la santé (AVS). MÉTHODES: Entretiens avec 45 AVS et quatre discussions de groupe avec 14 des mêmes AVS de trois régions rurales en Ethiopie: Région d'Afar, Région de Tigray (Adwa Woreda), et deux endroits dans les Nations du Sud, La Région des Nationalités et du Peuple (Aleta Wondo Woreda et Kafa Zone). Deux discussions de groupe ont été organisées dans la Région d'Afar avec 17 AVS féminins employés par l'Association de Development Pastoraliste de l'Afar. RÉSULTATS: En utilisant le continuum d'égalité des genres comme outil d'analyse du genre, nous avons constaté que le programme de vulgarisation de la santé en Ethiopie était sensible au genre en reliant directement des résultats améliorés en matière de santé pour les femmes et leur autonomisation. Toutefois, pour les AVS vivant dans un espace et un lieu différenciés par le sexe, du domicile au centre de santé, des conséquences inattendues accommodant les inégalités de genre existantes peuvent être omises et peut-être même générer de nouvelles formes d'exploitation. CONCLUSIONS: Le programme de vulgarisation de la santé pourrait avoir plus de résultats transformateurs pour les AVS et pour les communautés si les normes du genre changeantes étaient davantage prises en compte et les contraintes en matière d'égalité des sexes étaient réduites. Les programmes d'agents de santé communautaires (ASC) devraient être axés sur une meilleure compréhension du rôle des genres pour les AVS dans l'ensemble des systèmes de santé.

Electrolytic synthesis of γ-Al2O3 nanoparticle from aluminum scrap for enhanced methylene blue adsorption: experimental and RSM modeling.

The presence of methylene blue (MB) dye in wastewater has raised concern about human health and environmental ecology due to potential carcinogenic, and mutagenic effects. Therefore, this work aims to remove MB dye from wastewater using γ-Al2O3 nanoparticles synthesized from aluminum scrap via simple electrolytic method. The successful synthesis of the adsorbent was confirmed by a range of spectroscopy and microscopy techniques, including XRD, SEM, FTIR, and BET. The central composite design (CCD) of the response surface methodology (RSM) method was used to optimize the processing parameters such as solution pH, contact time, initial MB concentration, and adsorbent dose. The ANOVA results clearly shows that the quadratic model (p < 0.0001) was sufficient to the best predicting of the removal performance of MB dye (R2 = 0.9862). The optimum condition for the maximum MB dye removal (98.91%) was achieved at solution pH of 8.298, initial MB concentration of 31.657 mg/L, adsorbent dose of 0.387 g/L, and contact time of 46.728 min. Nano-γ-Al2O3 was shown to have a good surface area of 59 mg2/g by BET analysis. The adsorption kinetics follows the pseudo-second-order model (R2 = 0.997). With a maximum adsorption capacity of 137.17 mg/g, the Langmuir isotherm model (R2 = 984) provides the best fit to the adsorption isotherm data, indicating a monolayer adsorption process. Furthermore, thermodynamic analysis demonstrated that the adsorption of MB dye was an endothermic and spontaneous process. The reusability study showed that γ-Al2O3 nano-adsorbent retained 85.08% of its original removal efficiency after five cycles. According to the findings of the study, MB dye molecules were taken up by γ-Al2O3 nano-adsorbent via hydrogen bond formation, Van der Waals interaction, and electrostatic attraction. Therefore, γ-Al2O3 nanoparticles can be used as a potentially eco-friendly and low-cost adsorbent for the removal of MB dye from aqueous solutions.

The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia.

BACKGROUND: Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. METHODS: A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. RESULTS: Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. CONCLUSION: HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.

Factors affecting unmet need for family planning in southern nations, nationalities and peoples region, ethiopia.

BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations, Nationalities and Peoples Region. In such populations, unmet needs for contraception have a tendency to be high, mainly due to the effect of socio-economic and demographic variables. However, there has not been any study examining the relationship between these variables and unmet need in the region. This study, therefore, identifies the key socio- demographic determinants of unmet need for family planning in the region. METHODS: The study used data from the 2000 and 2005 Ethiopian Demographic and Health Surveys. A total of 2,133 currently married women age 15-49 from the 2000 survey and 1,988 from the 2005 survey were included in the study. Unmet need for spacing, unmet need for limiting and total unmet need were used as dependent variables. Socio- demographic variables (respondent's age, age at marriage, number of living children, sex composition of living children, child mortality experience, place of residence, respondent's and partner's education, religion and work status) were treated as explanatory variables and their relative importance was examined on each of the dependent variables using multinomial and binary logistic regression models. RESULTS: Unmet need for contraception increased from 35.1% in 2000 to 37.4% in 2005. Unmet need for spacing remained constant at about 25%, while unmet need for limiting increased by 20% between 2000 and 2005. Age, age at marriage, number of living children, place of residence, respondent's education, knowledge of family planning, respondent's work status, being visited by a family planning worker and survey year emerged as significant factors affecting unmet need. On the other hand, number of living children, education, age and age at marriage were the only explanatory variables affecting unmet need for limiting. Number of living children, place of residence, age and age at marriage were also identified as factors affecting total unmet need for contraception. CONCLUSION: unmet need for spacing is more prevalent than unmet need for limiting. Women with unmet need for both spacing and limiting are more likely to be living in rural areas, have lower level of education, lower level of knowledge about family planning methods, have no work other than household chores, and have never been visited by a family planning worker. In order to address unmet need for family planning in the region, policy should set mechanisms to enforce the law on minimum age for marriage, improve child survival and increase educational access to females. In addition, the policy should promote awareness creation about family planning in rural areas.

SUPPORT FOR THE CONTINUATION OF FEMALE GENITAL MUTILATION AMONG ADOLESCENTS IN JIMMA ZONE, SOUTHWEST ETHIOPIA.

BACKGROUND: Female genital mutilation/cutting is a harmful practice which has effect on female's wellbeing. However, the practice has continued to prevail in many cultures. Research on the social determinants of the practice and its continuation are scarce. The objective of this study was to assess whether attitude towards the continuation of female genital mutilation is predicted by gender role perception among adolescents in Jimma zone. METHODS: This study used data collected in the first round of Jimma Longitudinal Family Survey of Youth. A total of 2084 adolescents were identified from 3700 households and one adolescent were interviewed from each household using structured questionnaire. Data on the socio-demographic characteristics, religiosity, access to electronic media, perception of gender role, attitude towards continuation of Female circumcision was collected. Descriptive and multivariate statistical techniques were used to analyze the data using SPSS for windows version 16.0. Statically tests were performed at the level of significance of 5%. RESULTS: Of the 2084 adolescents, 1146 (55.0%) were aged 12-14 years, 1025 (49.2%) females and 749 (35.9%) from rural areas. The majority, 1289 (61.9%) were Muslims and 1351 (64.8%) Oromo. Five hundred seventy three (28.1%) of the male youth did not agree to the importance of marrying a circumcised girl. However, 149 (13.8%) and 258 (12.7%) agreed that it is very important and important, to marry a circumcised girl, respectively. On multivariate logistic regression analysis, perception of gender role, sex, place of residence, highest education in the household and religion remained to be important predictors of attitude towards the continuation of female genital mutilation after adjustment for age and ethnicity. Adolescents who had low gender role perception were 1.4 times more likely to have a positive attitude towards the continuation of the female genital mutilation (OR: 95%CI, 1.41: 1.02-1.94). Female adolescents were 36% less likely to support (P<0.01) the continuation of FGM compared to their male counter parts (OR: 0.64; 95%CI: 0.49, 0.83). Compared to urban youth, those who live in semi urban and rural areas were 1.46 and 1.52 times more likely to have a positive attitude towards the continuation of the FGM practice, respectively (P<0.05). Similarly the Probability of having positive attitude towards the continuation of the FGM practice decreased steadily as the highest educational level in the household increased. CONCLUSION: One-fifth of the youth support the continuation of the practice. Low gender roles perception, being from the rural areas, household's lower level of education and being Muslim were strong predictors of the attitude towards the continuation of female genital mutilation. Improving perception of adolescents towards gender roles through effective behavior change communication, and involving religious leaders in the campaign against the practice of female genital mutilation is recommended as a useful strategy to ban the practice.