Inequalities of Infant Mortality in Ethiopia.

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality is still high, albeit substantial progress has been made in the last few decades. However, there is significant inequalities in infant mortalities in Ethiopia. Understanding the main sources of inequalities in infant mortalities would help identify disadvantaged groups, and develop equity-directed policies. Thus, the purpose of the study was to provide a diagnosis of inequalities of infant mortalities in Ethiopia from four dimensions of inequalities (sex, residence type, mother's education, and household wealth). (2) Methods: Data disaggregated by infant mortalities and infant mortality inequality dimensions (sex, residence type, mother's education, and household wealth) from the WHO Health Equity Monitor Database were used. Data were based on Ethiopia's Demographic and Health Surveys (EDHS) of 2000 (n = 14,072), 2005 (n = 14,500), 2011 (n = 17,817), and 2016 (n = 16,650) households. We used the WHO Health Equity Assessment Toolkit (HEAT) software to find estimates of infant mortalities along with inequality measures. (3) Results: Inequalities related to sex, residence type, mother's education, and household wealth still exist; however, differences in infant mortalities arising from residence type, mother's education, and household wealth were narrowing with the exception of sex-related inequality where male infants were markedly at a disadvantage. (4) Conclusions: Although inequalities of infant mortalities related to social groups still exist, there is a substantial sex related infant mortality inequality with disproportional deaths of male infants. Efforts directed at reducing infant mortality in Ethiopia should focus on improving the survival of male infants.

Inequalities in Childhood Immunisation in South Asia.

Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic and Health Survey (DHS). Descriptive statistics, bivariate association, and logistic regression analyses were employed to identify the prevalence and the factors in each country that affect the likelihood of full childhood immunisation coverage. The complete childhood immunisation coverage varied significantly within each country in South Asia. Afghanistan had the lowest immunisation rates (42.6%), whereas Bangladesh ranked the highest in complete childhood immunisation rates, at 88.2%. Similarly, 77.1% of Indian children, 79.2% of Nepali children, and 62.2% of Pakistani children were completely immunised. Household wealth status strongly correlated with full childhood immunisation in Afghanistan, India, and Pakistan at the bivariate level. The results from the logistic regression showed that a higher maternal educational level had a statistically significant association with complete childhood immunisation in all countries compared to mothers who did not attend any school. In conclusion, the study revealed the inequalities of complete childhood immunisation within South Asia. Governments must be proactive in their endeavours to address universal and equitable vaccine coverage in collaboration with national and international stakeholders and in line with the relevant Sustainable Development Goals.

Perceived Risk Factors for Suicide among Nepalese Migrant Workers in South Korea.

(1) Background: In South Korea, far from their homeland, Nepalese migrant workers often face tremendous challenges. The most severe outcome for migrant workers is death by suicide-a major cause of premature death among migrant workers. Nevertheless, in the literature, key factors associated with suicide among Nepalese migrant workers are not specifically identified. Thus, we aimed to delineate the main suicide risk factors for this group of migrants. (2) Methods: We used qualitative research methodology (sample = 20; male =17, female = 3) and employed nominal group techniques to identify the perceived primary risk factors for suicide. (3) Results: Study participants identified and ranked eight sources of distress and perceived risks for suicide, both from home and in the host country. Perceived risks for suicide include a complex set of socio-cultural, behavioral, occupational, physical, and mental health issues as well as communication barriers. (4) Conclusions: The findings suggest the need to design tailored mental health promotion programs for migrant workers before departure from Nepal as well as after arrival as migrant workers in South Korea.

Oral rehydration salts therapy use among children under five years of age with diarrhea in Ethiopia.

Background: Oral rehydration salts (ORS) therapy for diarrheal diseases is considered an effective therapy that can be applied in many resource-poor settings. Nevertheless, it has been consistently underutilized, and as a result, its potential to reduce child mortality has not been fully exploited. In Ethiopia, the use of ORS therapy for children under five has been inadequate. Like any other health behavior, the provision of ORS therapy to children during diarrheal episodes by caregivers is complex and context dependent. Identifying the factors may help promote wider application. Design and methods: We used data from the 2016 Ethiopia Demographic and Health Survey (EDHS-2016). Samples were selected by a two-stage stratified cluster sampling method. We used data on children under five years of age whose mothers (aged 15-49 years) reported that the child had had diarrhea within two weeks before the survey was conducted (n=1221). The dependent variable was whether these children received ORS therapy. The contextual independent factors were socio-demographic variables (mothers' age, child's age, child's sex, child's place of residence, household wealth, and mother/ husband/partner's education levels and work status), as well as media exposure and healthcare utilization. Results: The prevalence of ORS therapy use among the children was 30%. Mothers who had made at least four prenatal visits during their last pregnancy were 87% more likely to use ORS therapy for their children than those who had fewer prenatal visits (OR=1.874; CI: 1.140-3.082; p=0.013). Conclusions: Integrating efforts for scaling-up ORS use with prenatal health care services may have an extra benefit of promoting children's wellbeing and survival.

Intimate Partner Violence and Help-Seeking Among Ethiopian Women.

Although intimate partner violence (IPV) is a widespread phenomenon in Ethiopia, the relationship between help-seeking sources and IPV is not well understood. Better understanding of this relationship could play a role in preventing IPV. We used data collected in the 2016 Ethiopia Demographic and Health Survey and limited our study to women who have ever been married, aged 15 to 49 years (n = 4469). Overall, the proportions of women who have ever experienced emotional abuse, physical, or sexual violence were 24%, 23.1%, and 10.1%. Women who sought informal help (family) were 2.42 times more likely (OR = 2.42; CI 1.29-4.55) to have ever experienced emotional abuse than women who did not seek family help. Neither formal nor informal help-seeking significantly associated with physical or sexual violence. The results may indicate difficulties women face in seeking help and cultural and social norms that tolerate IPV as an acceptable part of family life in Ethiopia.

Structural correlates of modern contraceptive use among Ethiopian women.

We examined structural determinants of modern contraceptive use among Ethiopian women from the 2011 Ethiopia's Demographic and Health Survey. We selected a representative sample of 7490 non-pregnant and sexually active women between 15 and 49 years of age. Multivariate logistic regressions were fitted and effects of relevant demographic variables controlled. Only one-in-three women were current users of modern contraceptives. Modern contraceptive use enabling and inhibiting (barrier) environments were significant predictors of use. Exposure to family planning information regardless of the delivery method significantly associated with improved use. Women who visited a health clinic in the last 12 months increased their odds of using modern contraceptives by 54%. Distance and transportation constraints were identified as major barriers.

Determinants of child maltreatment in Nepal: Results from the 2014 Nepal multiple indicator cluster survey (the 2014 NMICS).

We examined the prevalence of child maltreatment as measured by the level of physical (moderate to severe) and emotional abuse and child labor, and the associated household level determinants of child maltreatment in Nepal. We used a nationally representative data set from the fifth round of the Nepal Multiple Indicator Cluster Survey (the 2014 NMICS). The main independent variables were household level characteristics. Dependent variables included child experience of moderate to severe physical abuse, emotional abuse, and child labor (domestic work and economic activities). Bivariate analyses and logistic regressions were used to examine the associations between independent and dependent variables. The results showed that nearly half of the children (49.8%) had experienced moderate physical abuse, 21.5% experienced severe physical abuse, and 77.3% experienced emotional abuse. About 27% of the children had engaged in domestic work and 46.7% in various economic activities. At bivariate level, educational level of household's head and household wealth status had shown significant statistical association with child maltreatment (p<0.001). Results from multivariate logistic regressions showed that higher education levels and higher household wealth status protected children from moderate to severe physical abuse, emotional abuse and child labor. In general, child maltreatment is a neglected social issue in Nepal and the high rates of child maltreatment calls for mass awareness programs focusing on parents, and involving all stakeholders including governments, local, and international organizations.

Women's Decision-Making Autonomy and their Attitude towards Wife-Beating: Findings from the 2011 Ethiopia's Demographic and Health Survey.

The study examined the extent of wife-beating acceptance and factors that influence women's attitude towards wife-beating in Ethiopia from a nationally representative sample of 11,658 participants in the 2011 Ethiopian Demographic and Health Survey. Multivariate logistic regressions were fitted to investigate the relationships between women's attitude towards wife-beating and women's decision-making autonomy after controlling for socio-demographic factors. The majority (56%) of women agreed that wife-beating is justified when wife neglects children, 53% when wife burns the food, 50% when wife argues with husband, 48% when wife goes out without telling husband, and nearly 45% when wife refuses to have sex with husband. Overall, 51% of women had shown highly favorable attitude towards wife-beating. Women's place of residence, household wealth quintiles, educational levels, marital status, and husband/partner's employment status have shown significant association with women's attitude towards wife-beating. Women's decision-making autonomy was also a significant predictor of women's attitude towards wife-beating. The odds of having highly favorable attitude towards wife-beating deceased significantly as the level of decision-making autonomy of women improved. Given the widespread acceptance of wife-beating among Ethiopian women, social policies that empower women could serve as a positive force in changing attitudes towards wife-beating and violence against women.

Psychosocial determinants of intention to use condoms among Somali and Ethiopian immigrants in the U.S.

The study examined potential psychosocial determinants of male condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota in two sequential phases: the elicitation (Phase I) and cross-sectional quantitative studies (Phase II). Information from Phase I was used to develop the instrument for Phase II. Study participants who self-identified as Somali and Ethiopian immigrants (n = 205) responded to questions on demographic characteristics, attitudes (affective and instrumental), norms (subject and descriptive), perceived behavioral control, self-efficacy, and intention to use male condoms. Hierarchical regression models were used to assess the relationship between the main independent variables (attitude norms, perceived behavioral control, and self-efficacy, and the dependent variable, the intention to use male condoms. Overall, participants showed low intention and slightly favorable (affective and instrumental) attitudes toward condom use; had experienced weak, but positive social influence as measured by injunctive and descriptive norms. Moreover, study participants had shown slight perceived behavioral control, but had fairly moderate positive self-efficacy. The Theory of Planned Behavior was moderately effective in predicting condom use; however, the Integrated Behavioral Model, explained nearly 40% of the variations in the intention to use male condoms. Among men, self-efficacy had the strongest influence (ß = .44, p < .001) on behavioral intention. Among women, descriptive norms (ß = .22, p < .05) exerted the strongest effect (model 3). Improving self-efficacy, specifically, among older men, and fostering desirable normative influence among women, are suggested as main components of public health interventions to promote condom use among Somali and Ethiopian immigrants.

Attitude as a Mediator between Acculturation and Behavioral Intention.

OBJECTIVE: Immigrants, specifically African-born black persons, are affected by the HIV epidemic in the U.S. The low level of condom use among immigrants is a risk factor for contracting HIV and STIs. Immigrants go through acculturation process in their new adopted countries-a process reported to influence many health risks and protective factors; however, the mechanism through which acculturation influences health behaviors is not well understood. Thus, study examined the mediating role of attitude in the relationship between acculturation and the intention to use male condoms in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. DESIGN AND SAMPLE: The study was a regression analysis and the method of data collection cross-sectional. Participants were (n = 205) Somali and Ethiopian immigrants in Minnesota who volunteered for the study. MEASURES: Study participants responded to questions on attitudes, behavioral intention, and acculturation levels. RESULTS: The indirect effect of acculturation through the mediator, attitude, was not significant, product coefficient (a × b) = 0.04, 95% CI: [0.00, 0.11]; hence attitude did not mediate the relationship between acculturation and the intention to use condoms in the study population. However, there were significant direct and total effects of acculturation (c' = .27, p < .05; c = .31, p < .05), respectively, on intention to use condoms. CONCLUSION: Results of the study may suggest that public health intervention strategies targeting condom use among immigrants should incorporate programs that improve English language training tailored to the cultural practices and values of the immigrants, and consider the effect of acculturation on condom use.

Correlates of Condom Use Among Somali and Ethiopian Immigrants in the U.S.

The study examined correlates of consistent condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. Study participants (n = 205) responded to questions on attitudes, social norms, perceived behavioral control, self-efficacy, behavioral intention, and self-reported male condom use. Participants were neither for, nor against using condoms, and the same was true for social influence and self-efficacy; however, reported moderately favorable attitude toward condom use and little difficulties in using condoms. Self-efficacy emerged as the factor with the strongest direct influence on behavioral intention to use condoms. In turn, behavioral intention was a significant predictor of self-reported condom use. Increasing male condom use self-efficacy among Somali and Ethiopian immigrants is suggested as a main component of public health intervention seeking to curb the spread of HIV and other STIs in Minnesota.