Table 2 - uploaded by Luwei Pearson
Content may be subject to copyright.
Source publication
Background. Although under-five mortality in Ethiopia has decreased 67% in the past two decades, many children still die from preventable or treatable conditions, mainly pneumonia, newborn problems, diarrhea, malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care, but access to and use of treatment remains in...
Similar publications
Since 2010, 28,000 female health extension workers (IEWs) received training and support to provide integrated community based case management (iCCM) of childhood pneumonia, diarrhea, malaria, and se- vere malnutrition in Ethiopia.
We conducted a modeling exercise using two scenarios to project the potential reduction of the under five mortality, ri...
Background
Malaria is a public health hazard globally, with Sub-Saharan Africa accounting for more than 90% of malaria deaths, primarily affecting children under the age of five. In Rwanda, malaria interventions include the availability of antimalarial medications, notably Artemisinin-based combination treatments (ACTs) and quick diagnostic test ki...
Background:
The Malian Nutrition Division of the Ministry of Health and Action Against Hunger tested the feasibility of integrating treatment of severe acute malnutrition (SAM) into the existing Integrated Community Case Management package delivered by community health workers (CHWs). This study assessed costs and cost-effectiveness of CHW-deliver...
Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of thi...
Background
Globally, preventable and treatable childhood conditions such as pneumonia, diarrhoea, malaria, malnutrition and newborn conditions still account for 75% of under-five mortality. To reduce the mortality rate from these conditions, Ethiopia launched an ambitious Health Extension Programme (HEP) in 2003. Trained Community Health Workers (C...
Citations
... 29 The mortality associated with such modification is substantial because hypothermia and hyperpyrexia alter the body's metabolic processes and are signs of altered metabolism, sepsis, and severe infections. 33 Pulse rate and the presence of shock were identified as significant ...
Background and Aims
Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition.
Methods
A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analysed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analysed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods.
Results
Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition.
Conclusions
This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished.
... One of the key steps to enhance the clinical case of health extension staff is to encourage better growth and development among under-five children by health extension. Healthy family and neighborhood practices are also encouraged [10,11]. The program also combines immunization, community-based feeding, vitamin A and de-worming with multiple preventive measures [12,13]. ...
... This evaluation showed that most medications, equipment and recording and reporting materials available. This finding was comparable with the standard ICCM treatment guide line [10]. On the other hand trained health care providers, some medications like Zink, Paracetamol and TTC eye ointment, folic acid and syringes were not found in some HPs. ...
Background
Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.
Methods
A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.
Results
The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.
Conclusion and recommendation
The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.
... 25 There are reports of gradual gains in child health in Ethiopia, including reduced morbidity and mortality among children under 5 years old, due to the HEP and the embedded iCCM and community-based newborn care strategies. [41][42][43] However, challenges such as weak infrastructure and poor supply chain systems and geographical and financial barriers remain key bottlenecks to the implementation of these strategies. [44][45][46] The fact that the process and outcome quality components of curative child health services were highest in health centres and health posts, respectively, could be used as an opportunity to focus on strengthening services at the PHC level, as the lion's share (78.7%) of the population lives in rural settings. ...
Objectives
Despite a remarkable decline, childhood morbidity and mortality in Ethiopia remain high and inequitable. Thus, we estimated the effective coverage of curative child health services in Ethiopia.
Design
We conducted a cross-sectional analysis of data from the 2016 Ethiopia Demographic and Health Survey (DHS) and the 2014 Ethiopia Service Provision Assessment Plus (SPA+) survey.
Setting
Nationally representative household and facility surveys.
Participants and outcomes
We included a sample of 2096 children under 5 years old (from DHS) who had symptoms of one or more common childhood illnesses (diarrhoea, fever and acute respiratory infection) and estimated the percentage of sick children who were taken to a health facility (crude coverage). To construct a quality index of child health services, we used the SPA+ survey, which was conducted in 1076 health facilities and included observations of care for 1980 sick children and surveys of 1908 mothers/caregivers and 5328 health providers. We applied the Donabedian quality of care framework to identify 58 quality parameters (structure, 31; process, 16; and outcome, 11) and used the weighted additive method to estimate the overall quality of care index. Finally, we multiplied the crude coverage by the quality of care index to estimate the effective coverage of curative child health services, nationally and by region.
Results
Among the 2096 sick children, only 38.4% (95% CI: 36.5 to 40.4) of them were taken to a health facility. The overall quality of care was 54.4%, weighted from structure (30.0%), process (9.2%) and outcome (15.2%). The effective coverage of curative child health services was estimated at 20.9% (95%CI: 19.9 to 22.0) nationally, ranging from 16.9% in Somali to 34.6% in Dire Dawa regions.
Conclusions
System-wide interventions are required to address both demand-side and supply-side bottlenecks in the provision of child health services if child health-related targets are to be achieved in Ethiopia.
... [8] However, GAPPD implementation showed that Ethiopia is far from reaching the target set by WHO [26]. Ethiopia has made impressive gains in child survival related to ARI through the implementation and scale-up of IMNCI and community case management of ARI [27]. Even though the magnitude of ARIs was decreasing in Ethiopia, the decline in spatial patterns of ARI is uneven. of spatial variations in hospitalization due to pneumonia has been noted among children younger than 5 years hospitalized for severe pneumonia in Brazil [28] and Bhutan [29]. ...
Background
In Ethiopia, acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children under five years. Geographically linked data analysis using nationally representative data is crucial to map spatial patterns of ARIs and identify spatially-varying factors of ARI. Therefore, this study aimed to investigate spatial patterns and spatially-varying factors of ARI in Ethiopia.
Methods
Secondary data from the Ethiopian Demographic Health Survey (EDHS) of 2005, 2011, and 2016 were used. Kuldorff’s spatial scan statistic using the Bernoulli model was used to identify spatial clusters with high or low ARI. Hot spot analysis was conducted using Getis-OrdGi statistics. Eigenvector spatial filtering regression model was carried out to identify spatial predictors of ARI.
Results
Acute respiratory infection spatially clustered in 2011 and 2016 surveys year (Moran’s I:-0.011621–0.334486). The magnitude of ARI decreased from 12.6% (95%, CI: 0.113–0.138) in 2005 to 6.6% (95% CI: 0.055–0.077) in 2016. Across the three surveys, clusters with a high prevalence of ARI were observed in the North part of Ethiopia. The spatial regression analysis revealed that the spatial patterns of ARI was significantly associated with using biomass fuel for cooking and children not initiating breastfeeding within 1-hour of birth. This correlation is strong in the Northern and some areas in the Western part of the country.
Conclusion
Overall there has been a considerable decrease in ARI, but this decline in ARI varied in some regions and districts between surveys. Biomass fuel and early initiation of breastfeeding were independent predictors of ARI. There is a need to prioritize children living in regions and districts with high ARI.
... However, the result is higher than studies conducted in Ethiopia (17,23) and Malawi (24). On the other hand, the current finding is very low compared to other studies performed in Mali (25) and Ethiopia (26). This might be due to the involvement of the health extension workers in a variety of activities. ...
Objectives: To determine the coverage and associated factors of early postnatal home visits (PNHVs) by health extension workers (HEWs) among postpartum women in Gidan district, Northeast Ethiopia.
Methods: A community-based, cross-sectional study was conducted between 30 March and 29 April 2021 in the Gidan district, Northeast Ethiopia. A multistage sampling technique was employed to select 767 postpartum women participants. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted to identify factors associated with early PNHVs by HEWs.
Results: The coverage of early postnatal home visits was 15.13% [95% confidence interval (CI): 12.75, 17.87]. Women’s education, institutional delivery, time to reach health posts, and participation in pregnant women forums were significantly associated with early PNHVs by HEWs.
Conclusion: In the current study, the coverage of early postnatal home visits by HEWs remains low in the study area. The concerned bodies should consider interventions that promote women’s education and institutional delivery, and more efforts should be made to improve community-based participation and links with HEWs.
... e two-thirds reduction in child mortality in Ethiopia since 1990 [12] has been attributed to efforts made at the national level in increasing access to essential child health care services [13] and progressive improvement in evidencebased treatment for child disease conditions [14,15]. However, ICCM implementation and utilization in other limited geographic locations of the country remain low [1,2] when compared to other low-income countries [16]. ...
... 11 The decision to seek care outside the home is influenced by decision-making dynamics within caregivers' lay referral network (especially involving husbands) and the resulting illness labels and perceptions of severity. 12 13 Most caregivers seeking care outside the household have stated they wait for more than 24 hours before leaving home to seek care for their sick child. 12 The most common reasons for delaying seeking care 14 are uncertainty about illness progression, difficulties with access to treatment, apprehensions about presenting to providers and the exigencies of daily life. ...
... 12 13 Most caregivers seeking care outside the household have stated they wait for more than 24 hours before leaving home to seek care for their sick child. 12 The most common reasons for delaying seeking care 14 are uncertainty about illness progression, difficulties with access to treatment, apprehensions about presenting to providers and the exigencies of daily life. 15 Poor health-seeking behaviour is not only due to poor awareness or a poor perceived need for this healthcare option, but is also related to cultural problems, such as caregivers' understanding of an episode of child illness and how the awareness can be transferred to the communities and families. ...
Objectives
To explore the health-seeking behaviour of Ethiopian caregivers when infants are unwell.
Design
A qualitative descriptive approach was employed using in-depth interviews and focus group discussions. Data were collected using semistructured interview guides.
Setting
The study was conducted in East Gojjam zone, Amhara region, northwest Ethiopia.
Participants
Participants were selected using a maximum variation purposive sampling technique across the different study groups: caregivers, community members and healthcare providers. A total of 35 respondents, 27 individuals in the focus group discussions and 8 individuals in the in-depth interviews participated in the study.
Method
In this study, a qualitative descriptive approach was employed to explore the health-seeking behaviour of caregivers. The data were collected from July to September 2019 and conventional content analysis was applied.
Results
The decision to take a sick child to healthcare facilities is part of a complex care-seeking process that involves many people. Some of the critical steps in the process are caregivers recognising that the child is ill, recognising the severity of the illness and deciding to take the child to a health institution based on the recognised symptoms and illness. In Ethiopia, a significant proportion of caregivers do not seek healthcare for childhood illness, and most caregivers do not know where and when to seek care for their child. This study points out that the health-seeking behaviour of caregivers can be influenced by different contextual factors such as caregivers’ disease understanding, access to health services and family pressures to seek care.
Conclusions
Healthcare-seeking practice plays an important role in reducing the impact of childhood illnesses and mortality. In Ethiopia, home-based treatment practice and traditional healing methods are widely accepted. Therefore, contextual understanding of the caregivers’ health-seeking is important to design contextual healthcare interventions in the study area.
... The community-based management of suspected pneumonia using antibiotics, diarrhoea with Oral Rehydration Solution (ORS) and zinc, and malnutrition with ready-touse therapeutic food plays a key role in providing prompt care to reduce mortality in low-resource settings [9][10][11][12][13][14]. Ethiopia established the program for Integrated Community Case Management (iCCM) of childhood illness in 2010, comprising the management of pneumonia, diarrhoea, malaria and acute malnutrition; referral of severe illnesses; and, counselling parents of sick children [15]. These services are provided by health extension workers at health posts as part of the Health Extension Program, which itself was introduced in 2003 [16]. ...
... In Ethiopia, in the early implementation period, studies assessing iCCM indicated that the quality of these services was good [20]. The program had strong leadership and support from the government [15]. Appropriate managerial and clinical support also improved the health extension workers' performance [21]. ...
Background
Despite the expansion of the Integrated Community Case Management services for childhood illness, quality and utilization of services have remained low. To address the problem, the Government of Ethiopia introduced a complex intervention that included community engagement, capacity building of health workers and enhanced district-level ownership of sick child management. We examined whether this complex intervention was associated with improved management of sick children by health extension workers.
Methods
The study was conducted in four Ethiopian regions. A baseline survey was conducted in 26 intervention and 26 comparison districts from December 2016 to February 2017, followed by an end-line survey 24 months later. We observed health extension workers’ consultations of sick 2–59 months old children. The analysis has evaluated if children with pneumonia, diarrhoea and malnutrition were assessed, classified and treated according to guidelines, and included difference-in-difference analyses.
Results
We observed 1325 consultations of sick children. At baseline, 86% of the sick children with cough in the intervention areas and 85% in comparison areas were assessed according to the guidelines, without any change at end-line associated with the intervention (difference-in-difference = -21%, p = 0.55). Sixty-two percent of children were assessed for dehydration at baseline in intervention and 47% in comparison areas, with no improvement associated with the intervention. Similarly, 87% of sick children in intervention and 91% in comparison areas were assessed for malnutrition, with no change over time associated with the intervention (difference-in-difference = 5%, p = 0.16). Appropriate pneumonia treatment with antibiotics declined and diarrhea treatment increased in both areas. Half of the malnourished children received ready-to-use therapeutic foods without any improvement associated with the intervention.
Conclusion
The intervention was not associated with improved quality of the health extension workers’ management of sick children. The lack of association may be linked to low fidelity in the implementation of the intervention. Our findings suggest that training healthcare providers without continued clinical mentoring and support does not improve the quality of care. Community-based programs can be strengthened by ensuring high coverage and continued clinical mentorships, supportive supervision, and supply of medicines and other essential commodities.
Trial registration number
ISRCTN12040912, retrospectively registered on 19/12/ 2017.
... This finding is comparable with a study done in Ethiopia [35,47]. This finding might be due to the launching of the Health Extension Program (HEP), improving access to health care to meet the primary attention of the SDGs agenda and the introduction of integrated community cause management program [48,49]. It would be the increment of private medical facilities, which provide essential maternal health care services to practice delivery child in the health facility. ...
Background
Although an increase in health facility delivery in Ethiopia over time, adolescent women giving birth at health facilities is still low. Health facility delivery is crucial to improving the health of women and their newborns' health by providing safe delivery services. We aimed to examine the trend change and identify factors contributing to health facility delivery in Ethiopia.
Methods
We analyzed the data on adolescent women obtained from three Ethiopian Demographic and Health Surveys. A total of weighted samples were 575 in 2005, 492 in 2011, and 378 in 2016. Data management and further statistical analysis were done using STATA 14. Trends and multivariate decomposition analysis were used to examine the trends in health facility delivery over time and the factors contributing to the change in health facility delivery.
Results
This study showed that the prevalence of health facility delivery among adolescent women in Ethiopia increased significantly from 4.6% (95% CI 3.2–6.7) in 2005 to 38.7% (95% CI 33.9–43.7) in 2016. Decomposition analysis revealed that around 78.4% of the total change in health facility delivery over time was due to the changes in the composition of adolescent women and approximately 21.6% was due to the changes in their behavior. In this study, maternal age, place of residency, wealth index, maternal education, frequency of ANC visits, number of living children, and region were significant factors contributing to an increase in health facility delivery over the study periods.
Conclusion
The prevalence of health facility delivery for adolescent women in Ethiopia has increased significantly over time. Approximately 78.4% increase in health facility delivery was due to adolescent women’s compositional changes. Public health interventions targeting rural residents and uneducated women would help to increase the prevalence of health facility delivery.
... 17,18 Ethiopia has been implementing the iCMNCI strategy since 2010 to treat uncomplicated pneumonia, diarrhea, malaria, malnutrition, and measles by health extension workers (HEWs). 19 In collaboration with local and global development partners, the Ethiopian government has also integrated the iCMNCI guidelines into the national health policy to maintain service quality in the primary care settings. Despite the efforts, low utilization and poor consistency of care persist in rural settings. ...
Ethiopia has adopted the Integrated Community Case Management of Newborn and Child Illness (iCMNCI) strategy to expand access to neonatal and child health services. This study assessed compliance with the iCMNCI case management protocol at the primary care settings. A descriptive cross-sectional assessment was conducted in eight districts of Benishangul-Gumuz Region from April to December 2019, and 1,217 sick children aged 2 to 59 months and 43 sick young infants aged 0 to 2 months who sought clinical consultation at the 236 health posts were selected purposively. Trained supervisors reviewed the medical records of two most recent cases from each illness category to quantify the extent to which health workers correctly assessed, classified, treated, and followed up cases per the iCMNCI guidelines. A total of 32,981 children sought clinical consultation of whom 31,830 (96.5%) were aged 2 to 59 months, and 1,151 (3.5%) were young infants aged 0 to 2 months. Of the 1,217 selected children, 426 (35%) had pneumonia, 287 (23.6%) malaria, 501 (41.2%) diarrhea, and 3 (0.2%) had malnutrition. Nearly two-thirds 306 (72%) of pneumonia cases were correctly classified as having had the disease and 297 (70%) were correctly treated for pneumonia; 213 (74%) were correctly classified as having had malaria and 210 (73%) were correctly treated for malaria; and 393 (78%) were correctly classified as having had diarrhea and 297 (59%) were correctly treated for diarrhea. Generally, the current practices of child illness assessment, classification, and treatment have deviated from iCMNCI guidelines. Future interventions should support frontline health workers to comply strictly with case management protocols through training, mentorship, and supervision.
