Illness recognition and appropriate care seeking for newborn complications in rural Oromia and Amhara regional states of Ethiopia.

BACKGROUND: Ethiopia has made significant progress in reducing child mortality but newborn mortality has stagnated at around 29 deaths per 1000 births. The Maternal Health in Ethiopia Partnership (MaNHEP) was a 3.5-year implementation project aimed at developing a community-oriented model of maternal and newborn health in rural Ethiopia and to position it for scale up. In 2014, we conducted a case study of the project focusing on recognition of and timely biomedical care seeking for maternal and newborn complications. In this paper, we detail the main findings from one component of the case study - the narrative interviews on newborn complications. METHODS: The study area, comprised of six districts in which MaNHEP had been implemented, was located in the two most populous federal regions of Ethiopia, Oromia and Amhara. The final purposive sample consisted of 16 cases in which the newborn survived to 28 days of life, and 13 cases in which the newborn died within 28 days of life, for a total sample size of 29 cases. Narrative interview were conducted with the main caregiver and several witnesses to the event. Analysis of the data included thematic content analysis and the determination of care seeking pathways and levels and timeliness of biomedical care seeking. RESULTS: Mothers and other witnesses do recognize certain symptoms of newborn illness which they often mentioned in clusters. The majority considered the symptoms to be serious and in some case hopeless. Perceived causes were mostly natural. Forty-one percent of care seekers sought timely biomedical care in the neonatal period. Surprisingly, perceived severity did not necessarily trigger care seeking. Facilitators of biomedical care seeking included accessibility of health facilities and counseling by health workers, whereas barriers included perceived vulnerability of newborns, post-partum restrictions on movements, hopelessness, wait-and-see atttitudes, poor communication and physical inaccessibility of health facilities. CONCLUSIONS: Symptom recognition and care seeking patterns indicate the need to strengthen focused locally relevant health messages which target mothers, fathers and other community members, to further enhance access to health care and to improve referral and quality of care.

Roles and responsibilities in newborn care in four African sites.

OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Listening to youth: teen perspectives on pregnancy prevention.

PURPOSE: To ascertain views of public high school students on preventing teen pregnancy. The authors hypothesized that students at varying risk for pregnancy (e.g., abstinent, consistent contraceptors, inconsistent contraceptors) would have differing views which would have implications for future pregnancy prevention programming. METHODS: A 75-question anonymous survey designed for this study was administered in six Boston high schools. The sample consisted of 49% females and 51% males in 10th and 11th grades from diverse racial and ethnic backgrounds. One thousand surveys were received and analyzed using Chi-square tests to assess statistically significant differences in student responses. RESULTS: Sixty-three percent of the students had had sexual intercourse: 72% of males and 54% of females. Of these, 35% were consistent contraceptors and 65% were inconsistent. Students believed that having more information on pregnancy and birth control (52%), education about relationships (33%), parental communication (32%), improved contraceptive access (31%), and education about parenting realities (30%) would prevent teen pregnancy. Abstinent teens were more likely (58%) to say that information on pregnancy and birth control was important (p<.05), whereas consistently contracepting teens were more likely (40%) to identify greater access to birth control (p <.01). Males were more likely than females to prefer their information on contraception from parents (23% vs. 18%) and health education classes (16% vs. 7.5%), whereas females were more likely than males to prefer the health arena (51% vs. 27%) (p<.001). Teens using contraception were also more likely to be having frequent conversations with parents (49%) (p<.001). When asked why they had not used contraception, inconsistent contraceptors were more likely than others to say that they never thought of it (15%) (p<.001). CONCLUSIONS: Teens report that having more information from parents, school, and health arenas can prevent pregnancy. Abstinent, consistent contraceptors, and inconsistent contraceptors have different preferences regarding strategies. This information has important implications for educational content and policy discussions.

PIP: This survey determined the views of public high school students on teen pregnancy prevention. The authors hypothesized that students at varying risk for pregnancy would have differing views, which would have implications for future pregnancy prevention programming. A 75-question anonymous survey was designed and administered in 6 Boston high schools. A total of 1000 10th- and 11th-grade students from diverse racial and ethnic backgrounds completed the questionnaire. The overall analysis showed that 63% of the students had had sexual intercourse: 72% of males and 54% of females. Among these, 35% were consistent contraceptors and 65% were inconsistent. Teens enumerated the factors that will prevent teen pregnancy. These include having more information on pregnancy and birth control (52%), education about relationships (33%), parental communication (32%), improved contraceptive access (31%), and education about parenting realities (30%). Moreover, abstinent, consistent contraceptors, and inconsistent contraceptors had different preferences regarding strategies. Such findings have important implications for educational content and policy discussions.