Effect of the Health Extension Program and other Accessibility Factors on Care-Seeking Behaviors for Common Childhood Illnesses in Rural Ethiopian

Background:In January 2011; Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. Objective. To report the effect of HEP; following the introduction of iCCM; and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI]; diarrhea; and fever). Methods. Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care; seeking care from HEP sources; or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey; 2011; were compared with the care-seeking out-comes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Results. Appropriate careseeking for children with acute respiratory infection; ARI; diarrhea; or fever increased two-fold; from 19 at baseline to 38 at follow-up; mainly due to an increase in seeking care for common child-hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Conclusion. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhoodillnesses in rural Ethiopia

Programmatic Correlates of Maternal Healthcare Seeking Behaviors in Ethiopia

Background: Considerable improvement in maternal healthcare use has been observed since the inception of the health extension program (HEP) in Ethiopia in 2003. Objective: This paper evaluates the influence of HEP outreach strategies on maternal healthcare use. Method: Cross-sectional survey of 2;916 women with children 0 to 11 months from Amhara; Oromiya; Southern Nations; Nationalities and People's; and Tigray regions; obtained between December 2008 and January 2009; were analyzed using regression models to assess the impacts of HEP strategies on maternal health outcomes. Result: The analyses found that communities (i.e.; kebeles) with relatively high prevalence of model families; higher rate of household visits by health extension workers; and higher rate of household visits by voluntary community health workers were associated with improved antenatal care use; tetanus toxoid vaccination coverage; and receiving postnatal care visits; but the strategies were not associated with deliveries attended by health professionals. Conclusion: Although the impacts of HEP strategies on maternal healthcare use were statistically significant; they were not optimum to reach the maternal mortality reduction targets of the government of Ethiopia. The HEP needs to review and strengthen its community based strategies in order to reach its goals