Reasons for modern contraceptives choice and long-acting reversible contraceptives early removal in Amhara Region, Northwest Ethiopia; qualitative approach.

BACKGROUND: Women use modern contraceptive methods, mainly either to limit or space pregnancy and both are not identical in their choices. One method may not best fit an individual's need irrespective of the time of spacing. Cognizant of this, the context with which women base in choice of contraceptives, their lived experiences in using, and factors for early removal/ discontinuation of long-acting reversible contraceptives (LARCs) are not much investigated in the study setting and our study aimed to bridge the gap through exploring the underlying reasons. METHOD: A phenomenological study design was used to explore sampled women's reasons and experiences. Reproductive-aged women (15-49 years) who removed long-acting methods in the past 6 months were included. A criterion sampling approach was employed to recruit study participants. Data was collected using an interview guide for in-depth (IDIs) and key informant interviews and were tape-recorded with interviewees' consent. Audio data were transcribed verbatim and translated into English. The data was first saved in plain text format and imported into Atlas.ti 7.0 software to facilitate coding and categorizing. The content analysis method was used to classify, organize data, and interpret the qualitative data according to key categories. RESULTS: Several misconceptions about contraceptives (e.g., implants are not appropriate for daily laborers, women who use contraceptives (such as injectables) can only bear girl-child, etc.) were reported by clients and health providers. These misconceptions might not have scientific merit but they are powerful enough to affect actual behaviors toward contraceptives, including early removal. The awareness, attitude, and use of contraceptives tend to be lower in rural areas. For premature removal of LARCs, side effects, and heavy menstrual bleeding, was the most commonly identified reason. The IUCD is the least preferred method and users said it is not comfortable during sex. CONCLUSION AND RECOMMENDATION: Our study found different reasons and misconceptions for modern contraceptive methods' non-use and discontinuation. Standardized counseling approaches like the REDI (Rapport Building, Exploration, Decision Making, and Implementation) framework should be implemented in the country consistently. Some of the concrete providers' conceptions should be well-studied considering contextual factors to bring scientific evidence.

Hotspots of un-iodized salt availability among Ethiopian households, evidence from the national survey data.

BACKGROUND: Universal salt iodization was started before decades but there are communities using the un-iodized salt till now. More than one-tenth of the Ethiopian community uses un-iodized salt. OBJECTIVE: This study aimed to identify the hotspots and associate factors of un-iodized salt availability in Ethiopia based on Ethiopian national household survey data. METHODS: We conducted an in-depth analysis of the Ethiopian Demographic and Health Survey 2016 data. A total of 15,567 households were included in the final analysis. We cleaned and weighed the data using Stata version 16 software and descriptive outputs were reported in graphs and tables. We computed the weighted prevalence of un-iodized salt and prepared it for spatial analysis. Global-level spatial autocorrelation, hotspot analysis using the Getis-Ord Gi* statistics, and spatial interpolation using empirical Bayesian interpolation were executed using ArcGIS 10.3 to predict the magnitude of un-iodized salt at the national level. The binary logistics regression model was used to identify the contributing factors of un-iodized salt utilization. Model goodness of fit was tested with Hosmer and Lemeshow goodness-of-fit test (P = 0.96). Finally, the adjusted odds ratio (AOR) with 95% CI was reported to identify significant factors. RESULTS: The magnitude of un-iodized salt availability was 14.19% (95% CI: 13.65, 14.75) among Ethiopian households. Un-iodized salt hotspots were found in Afar, Somalia, and Benishangul Gumuz regions. Compared to poorest wealth index: poorer (AOR = 0.55, 95% CI: 0.48, 0.64), middle (AOR = 0.51, 95% CI: 0.44, 0.60), richer (AOR = 0.55, 95% CI: 0.47, 0.64), and richest (AOR = 0.61, 95% CI: 0.50, 0.75); compared to uneducated household head: heads with secondary (AOR = 0.72, 95% CI: 0.60, 0.67) and above secondary (AOR = 0.54, 95% CI: 0.43, 0.67) education reduced the odds of un-iodized salt viability, while households living in highland (AOR = 1.16, 95% CI: 1.05, 1.29) had increased the odds of un-iodized salt availability. CONCLUSION: More than a tenth of the households in Ethiopia uses un-iodized salt. Hotspots of un-iodized salt availability were found in Somali and Afar regions of Ethiopia. Better wealth index and education of the household heads reduces the odds of un-iodized salt availability while living in a high altitude above 2200 m increases the odds of un-iodized salt availability in Ethiopia.

A community survey on maternal and child health services utilization in rural Ethiopia.

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits. Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's diarrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.

PIP: A community survey of 21 villages in rural Ticho district of Arsi region in Ethiopia was conducted in February 1990 to gather data on utilization of maternal and child health (MCH), family planning, and immunization services. 95% of the villages had a traditional birth attendant. 26% of the 419 mothers had used prenatal services when pregnant with their last child. 61% of these women had at least 3 visits. Women who lived within 10 km of the health center in the district capital, Robe, were more likely to use prenatal services than those who lived at a greater distance (41% vs. 23%; p 0.001). Just 29% of mothers had taken their 1st child to the under-5 clinic, but 64% of these took this child to the clinic for at least 3 visits. All but 4 mothers (99%) breast fed their last child; 77% of them were nursing at the time of the interview. Just 4% of all breast feeding mothers discontinued breast feeding before their child reached 1 year. Just 33% of the mothers were familiar with oral rehydration salts (ORS). Most mothers with ORS knowledge (89%) used ORS to treat diarrhea, reflecting a positive attitude towards modern treatment of diarrhea. Only 5% of women 15-49 years old used contraceptives. Contraceptive usage was significantly associated with age (10% for 40 years, 7% for 20 years, and 4% for 21-39 years; p .05). Christians and Muslims used contraceptives at virtually the same rate (6% vs. 5%). Survey results on immunization coverage supports routine reporting data. Attendance at MCH clinics had a positive effect on complete immunization with the diphtheria, pertussis, tetanus vaccine (p 0.001). Such as association was not observed between prenatal care and tetanus toxoid immunization, however. The researchers propose integration of MCH services in upgraded health stations to increase access and coverage of MCH care.

Census in a rural area of Ethiopia: methodology and results.

A census and an ecologic survey were performed in 39 villages of a rural district of Arsi Region, Ethiopia, in difficult field circumstances. Information on age, ethnic group, education and family relationship, as well as data on health facilities and availability of basic services were collected. Supervised students, working in teams, were used as interviewers. Communities were involved through plenary meetings and community health agents participated in the data collection process. A total of 64,714 people in 12,152 households were registered. The repeatability of age assessment was investigated by comparing the results from two villages with data obtained in a pilot study carried out 6 months earlier. The technical error was only 0.80 and 1.67 in the 0-5 and 6-15 age-groups, respectively. Three percent of the total population was under one year, less than previously estimated. This may, in part, be due to the family planning programme in the region. Eighteen percent of the households were headed by females. School attendance was less common among females and in the Oromo ethnic group. The availability of basic services, including safe water and basic sanitation supplies, was very poor in the area.

PIP: A rural demographic surveillance system was established in the Arsi region of Ethiopia with a census, health interview survey, and ecologic data collection in 1989-90. The methodology, data collection, data processing, and survey results of the census and surveys in 39 villages in Ticho District are reported. Ticho was one of 12 districts in Arsi Region in which the population has been resettled in villages since 1985. The area is situated in highlands, which have difficult field circumstances. Students (18) were used as interviewers in the catchment areas of the Robe health center and 5 health stations. Community participation was included prior to the survey. A pilot study was undertaken 6 months prior to the main surveys in April 1989. Community health agents, who were asked to encourage community involvement, and students were trained prior to survey distribution in October-November 1989 and February 1990 during the dry season. Team supervisors monitored data collection and personally collected the ecologic data. Completeness was checked manually, and computer data entries were checked on 10% of all records. THe operation costs amounted to 12,000 Ethiopian birr ($6000), excluding printing of forms and some purchases of materials necessary for fieldwork. Age reliability was checked for 5% of the sample in 2 villages. Technical error was found to increase with age and was lowest in the 0-5 year old group. The census enumerated 64,714 persons in 12,152 households (5.3 persons per household) in the 39 villages. The population increased by single years of age until the age of 8 years. There appeared to be even number digit preference and 0 and 5 digit preference. The Oromo ethnic group comprised 85% of the population; 14% were Amhara. 66% of the Oromo group were Muslim, and the rest were Orthodox. 39% of the Oromo population under 5 years old and 35% of the Amhara group had never attended school. 31% of the population aged 15-19 years had attended primary school and 23% secondary school; only 13.9% of the 15-19 year olds had not attended any school. There were 2217 households headed by females. The nearest health station was an average of 90 minutes away by foot. 23 villages had not or few latrines. Only 3 villages obtained safe drinking water. Access to unprotected water sources took less than 30 minutes for 90% of the villages. 35% (14) of the villages had a primary school. Environmental health needs to be a priority for Primary Health efforts.

Estimation of early childhood mortality using preceding birth technique in a community-based setting.

The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12 month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 x 1000 live-births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.

PIP: The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12-month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 per 1000 live births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between age 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.