Promoting Safe Motherhood in Jimma Zone, Ethiopia (IMCHA)
This project aims to support community-based services that will improve maternal health in Ethiopia, a country with some of the worst health indicators in sub-Saharan Africa. Women's use of maternal and child health services has significant gaps between urban and rural areas.
Healthy mothers, healthy babies
The Government of Ethiopia is committed to improving maternal health. While some key indicators have improved, maternal mortality has not decreased significantly. The Ethiopian Health Department data suggests many of these maternal and neonatal deaths arise from home births in the absence of a skilled and experienced birth attendant. Strengthening community-based services is therefore important to ensure that mothers have access to services that result in safer deliveries.
Technology, communication, skills development
This project will implement interventions such as:
-training traditional birth attendants and equipping them with mobile phones
-developing communication and education strategies for religious leaders and men
-developing healthcare worker skills for safe deliveries
The project team will evaluate the use of improved maternal waiting areas and health extension worker practitioners for their impact on maternal health outcomes. The research will be carried out in close partnership with the Ethiopian Health Department. Researchers will identify interventions that are the most effective at improving maternal and child health services with a view to scale up nationally.
The project team will produce policy and media briefs, articles, and a project website to share information about the project and their findings.
Innovating for Maternal and Child Health in Africa
This project is part of the Innovating for Maternal and Child Health in Africa program, a seven-year $36 million initiative funded by Foreign Affairs, Trade and Development Canada (DFATD), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).
Project ID
108028
Project Status
Completed
End Date
Duration
54 months
IDRC Officer
Sana Naffa
Total Funding
CA$ 980,800.00
Location
Ethiopia
Institution Country
Ethiopia
Project Leader
Lakew Gebretsadik Abebebe
Institution
Jimma University
Institution Website
Institution Country
Canada
Project Leader
Ronald Labonte
Institution
University of Ottawa/Université d'Ottawa
Institution Website
Outputs
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Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia : a multilevel cross-sectional analysis Article
Maternity waiting homes (MWHs) are temporary residential spaces located within or close to health facilities, offering skilled obstetrical care. Data used in this analysis were collected from three districts in Jimma Zone in the southern part of Ethiopia. The survey targeted 3840 women. Qualitative research from this study setting and other areas in Ethiopia highlight the pivotal role of husbands and family support in enabling women’s use of MWHs. Findings have implications for achieving equity in access to maternal healthcare, as poorer women with little social support in the form of companions accompanying them for health facility visits, are among the more vulnerable groups. Author(s): Kurji, Jaameeta, Abebe Gebretsadik, Lakew, Abera Wordofa, Muluemebet, Sudhakar, Morankar, Asefa, Yisalemush Language: English |
Under five causes of death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis Article
The study worked to identify causes of death for neonatal, post-neonatal, infants and children under five years old in Ethiopia. Causes- targeted obstetric and child healthcare interventions will reduce mortality, and will require improving healthcare units. Major causes of death revealed in this study are bacterial sepsis, birth asphyxia, prematurity, acute lower respiratory infection and diarrheal diseases. Almost all causes are easily preventable and treatable and can be addressed by strengthening health extension services and improved quality of primary health care. Author(s): Mekonnen, Wubegzier, Assefa, Nigussie, Asnake, Wubetsh, Sahile, Zekarias, Hailemariam, Damen Language: English |
Causes of maternal death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis Article
The study documented causes of maternal deaths, and risk factors contributing to deaths aggravated by pregnancy and its management in Ethiopia (1990 to 2016), using a systematic review with meta-analysis. The nationwide registration of causes of maternal death should be strengthened to understand the causes in detail, their attributes, as well as the patterns of causes of death. Findings reveal that the main direct causes of maternal death in Ethiopia include obstetric complications such as hemorrhage, obstructed labor/ruptured uterus, pregnancy-induced hypertension, puerperal sepsis, and unsafe abortion. The health sector should sustain its current effort to tackle the diverse causes of maternal death in Ethiopia. Author(s): Mekonnen, Wubegzier, Hailemariam, Damen, Gebremariam, Alem Language: English |
Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma zone, Ethiopia Article
Re-directing resources to vulnerable sub-groups and locations is necessary to ensure equitable progress in maternal health. Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services. Of major concern are women who are the most vulnerable and in need of healthcare services, being least likely to access them. Mapping of core maternal healthcare service-use indicators can serve as a decision-making tool. This analysis focuses on services across the continuum of maternal healthcare: antenatal care, maternity waiting home use, delivery care at health facilities, and postnatal care, in three rural woredas in Jimma Zone, Ethiopia. Author(s): Kurji, Jaameeta, Talbot, Benoit, Bulcha, Gebeyehu, Bedru, Kunuz Haji, Morankar, Sudhakar Language: English |
How do community health actors explain their roles? : exploring the roles of community health actors in promoting maternal health services in rural Ethiopia Article
Participants in this study described different roles and responsibilities of individuals and groups in promoting maternal/child health, as well as the perceived roles of family members/husband. The Health Extension Program (HEP) in Ethiopia depends primarily on Health Extension Workers (HEWs), a female cadre of salaried community health workers (CHWs). The study explored the role played by different actors in promoting antenatal care, childbirth and early postnatal services; it was designed to inform a community- based Information, Education & Communication (IEC) intervention in rural Ethiopia. Author(s): Mamo, Abebe, Morankar, Sudhakar, Asfaw, Shifera, Bergen, Nicole, Kulkarni, Manisha A. Language: English |
Promoting equity in maternal, newborn and child health - how does gender factor in? : perceptions of public servants in the Ethiopian health sector Article
This article explores how government stakeholders understand gender issues in the promotion of maternal, newborn and child health equity in Ethiopia. Participants in the study group have observed/experienced persisting gender-related barriers to health, stemming from traditional gender roles. They also noted an increased inclusion of women in the health workforce since the introduction of the Health Extension Program. Addressing gender inequalities can shift the distribution of power, wealth, and risk within society to the benefit of disadvantaged groups. However, the framing of gender as a women’s health issue, advanced through patriarchal structures, does little to elevate the status of women or contribute to health equity. Author(s): Bergen, Nicole, Zhu, Grace, Yedenekal, Shifera Asfaw, Mamo, Abebe, Gebretsadik, Lakew Abebe Language: English |
MWAs facility based monitoring checklist Training Materials
The document is a facility-based checklist/training material for intake of patients and supplies. For more information about the Safe Motherhood Project, see: [https://www.idrc.ca/en/project/promoting-safe-motherhood-jimma-zone-eth…]. The Safe Motherhood Project is an intervention that supports the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in selected districts of Jimma Zone (Ethiopia). Author(s): Abebe, Lakew Language: English |
IEC activity monitoring checklist Training Materials
The document is a facility-based checklist/training material for intake of patients and supplies. For more information about the Safe Motherhood Project, see: [https://www.idrc.ca/en/project/promoting-safe-motherhood-jimma-zone-eth…]. The Safe Motherhood Project is an intervention that supports the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in selected districts of Jimma Zone (Ethiopia). Author(s): Abebe, Lakew Language: English |
Promoting and delivering antenatal care in rural Jimma zone, Ethiopia : a qualitative analysis of midwives’ perceptions Article
The study shows that enhancing the collaborative interactions between midwives and Health Extension Workers (HEW) is important to increase the reach and impact of Antenatal care (ANC) services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening. Author(s): Bergen, Nicole, Hudani, Alzahra, Asfaw, Shifera, Mamo, Abebe, Kiros, Getachew Language: English |
Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma zone, Ethiopia Article
The study showed that common reasons for not attending antenatal care (ANC) included women’s lack of awareness of its importance (48%), distance to the health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman’s ability to make healthcare decisions, and pregnancy intendedness. ANC and insecticide-treated net (ITN) uptake during pregnancy in Jimma Zone fall below the respective targets set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Author(s): Ouedraogo, Mariame, Kurji, Jaameeta, Abebe, Lakew, Labonté, Ronald, Morankar, Sudhakar Language: English |
Quality assessment of health management information system (HMIS) data for maternal and child health in Jimma zone, Ethiopia Article
Health management information system (HMIS) data underpin attainment of health targets in low- and middle-income countries. However, the quality of HMIS data is often poor. The study appraised the completeness, timeliness, and internal consistency of eight key maternal and child health (MCH) indicators collected for all the primary health care units (PHCUs) located within three districts of Jimma Zone, Ethiopia. Results show that the HMIS may over-report the coverage of key MCH services, namely, antenatal care, skilled birth attendance and postnatal care. The quality of data at the zonal level could be improved to inform MCH research and programmatic efforts. Author(s): Ouedraogo, M., Ouedraogo, Mariame, Kurji, Jaameeta, Abebe, Lakew, Labonté, Ronald, Morankar, Sudhakar, Bedru, Kunuz Haji, Bulcha, Gebeyehu, Potter, Beth K., Roy-Gagnon, Marie-Hélène, KulkarniI, Manisha A. Language: English |
Effectiveness of upgraded maternity waiting homes and local leader training in improving institutional births among women in the Jimma zone, Ethiopia : study protocol for a cluster-randomized controlled trial Article
Geographical and financial barriers are frequently cited as barriers to reaching skilled obstetric care during and after birth. This cluster-randomized trial was designed to evaluate the effects of access to upgraded maternity waiting homes (MWH) on the number of institutional births, relative to usual maternity care and access. Three arms of the study trial are: (1) upgraded MWH along with religious/community leader training; (2) leader training alone; and (3) standard care. The article provides details of the study including trial design, methodology, intervention components, activities and projected outcomes. Author(s): Kurji, Jaameeta, Kulkarni, Manisha A., Gebretsadik, Lakew Abebe, Wordofa, Muluemebet Abera, Morankar, Sudhakar Language: English |
"Everything is perfect, and we have no problems" : detecting and limiting social desirability bias in qualitative research Article
Many qualitative research studies acknowledge the possibility of social desirability bias (a tendency to represent reality in alignment of what is perceived to be socially acceptable) as a limitation that creates complexities in interpreting findings. Drawing on experiences in conducting interviews and focus groups in rural Ethiopia, this article provides an empirical account of how one research team developed and employed strategies to detect and limit social desirability bias. It includes a table regarding “Techniques for Asking Questions in a Manner That Limits Social Desirability Responses, With Examples.” Author(s): Bergen, Nicole, Labonté, Ronald Language: English |
| Ethiopia : social and political issues Book
The complete book of eleven chapters is presented in four sections, respectively covering issues related to governance, health, gender and land. This document encompasses Chapters 1 and 2, which contextualize issues through provision of background history and politics of Ethiopia (Chapter1); and ethnicity, language and education (Chapter2). Author(s): Zerai, Abdissa, Menuta, Fekede, Dejene, Melisew, Cochrane, Logan, Hudson, Derrick K., Roach, Steven C., Bergen, Nicole, Labonté, Ronald, Asfaw, Shifera, Mamo, Abebe, Teshome, Getenesh Berhanu, Whiting, Susan J., Henry, Carol J., Nigussie, Hagos, Drucza, Kristie, Tsegaye, Mulunesh, Rodriguez, Carmen Maria del, Amazan, Rose C., Kassawmar, Tibebu, Zeleke, Gete, Bantider, Amare, Gessesse, Gizaw Desta, Shiferaw, Abebe, Abraha, Lemlem, Tadesse, Matebu, Rahmato, Dessalegn Language: English |
Characterizing 'health equity' as a national health sector priority for maternal, newborn, and child health in Ethiopia Article
The study findings point to global pressures in terms of maximizing health investments, and questions how social, political, and economic determinants of health are addressed through broader development agendas. The article characterizes how health (in)equity is represented as a policy issue. Implications for the framing, incentivization, and implementation of health policies follow representations (and misrepresentations). Health inequity is regarded as actionable (can be altered) but not fully resolvable (can never be fully achieved). Operationally, health equity is viewed as a technocratic matter, reflected in the widespread use of metrics to motivate and measure progress. Author(s): Bergen, Nicole, Ruckert, Arne, Abebe, Lakew, Asfaw, Shifera, Kiros, Getachew Language: English |
Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births : a cluster-randomized controlled trial in Jimma, Ethiopia Article
The objective of this cluster randomized trial was to evaluate the effectiveness of functional maternity waiting homes (MWH) combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. MWHs are residential spaces for pregnant women located near to obstetric care facilities, which are being used to tackle physical barriers to access. Findings show both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care. Both the combined MWH and leader training, and leader training alone, led to a small but non-significant increase in institutional births. Author(s): Kurji, Jaameeta, Gebretsadik, Lakew Abebe, Wordofa, Muluemebet Abera, Morankar, Sudhakar, Bedru, Kunuz Haji Language: English |
Substantial health management and the advancement of health equity : a case study of Ethiopia Article
This study assesses how subnational health managers in Ethiopia understand health equity issues and their role in promoting health equity. It offers insight into how these roles can be harnessed to advance health equity. Findings show that subnational managers perceive geographical factors as a predominant concern in health service delivery inequities, especially as they intersect with poor infrastructure, patriarchal gender norms, unequal support from non-governmental organizations or challenging topography. Health managers’ efforts in promoting health equity are affected by inadequate resource availability, which restricts their ability to enact long-term and sustainable solutions. Author(s): Bergen, Nicole, Ruckert, Arne, Kulkarni, Manisha A., Abebe, Lakew, Morankar, Sudhakar, Labonté, Ronald Language: English |
Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia : a rapid qualitative assessment Article
Understanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including maternal, newborn and child health (MNCH) promotion. The findings of this study enable the development of audience-centered MNCH promotion activities that closely align with community priorities and experiences. The research described in this journal article demonstrates application of rapid qualitative assessment methods to explore the context for MNCH promotion activities. The findings of this research enable development of audience-centered health initiatives, such as MNCH promotion through the Safe Motherhood Project. Author(s): Bergen, Nicole, Mamo, Abebe, Asfaw, Shifera, Abebe, Lakew, Kurji, Jaameeta Language: English |
Narrative depictions of working with language interpreters in cross-language qualitative research Article
Researchers’ views and approaches to working with interpreters evolve across different career stages and adapt to different circumstances. Understanding these aspects can provide new insights in preparing researchers for cross-language research and to strengthen qualitative research. Data were obtained from a semi-structured interview with an experienced cross-language researcher, and drawn from field notes while working with interpreters. Author(s): Bergen, Nicole Language: English |
Talking health : trusted health messengers and effective ways of delivering health messages for rural mothers in Southwest Ethiopia Article
Health knowledge transfer success depends on trusted messengers and adaptable modes of communication. In Jimma Zone (Ethiopia), the study explored sources of trusted maternal health information along with preferences for the mode of information delivery, towards safe and effcient implementation and communication of interventions. Participants identified Health Extension Workers (HEWs) and Health Development Army (HDA) personnel as credible for health messaging in rural Ethiopia, especially when using an interpersonal message delivery approach. Government initiatives should strengthen existing health extension packages by providing in-service and refresher training to health extension workers. Author(s): Asfaw, Shifera Language: English |
Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma Zone, Ethiopia Report
The poster provides a project snapshot. The study examined the relationship between mosquito net ownership and use, and self-reported malaria infection in pregnant women. As well, it clarifies how pregnant women use antenatal care (ANC) that includes mosquito nets. Determining the malaria infection rate in pregnant women is critical for assessing factors that relate to the risk of infections and complications during pregnancy. Data from a cross-sectional survey confirmed that ANC attendance in Jimma Zone is lower than the Federal Ministry of Health’s target of 95% of pregnant women attending four ANC visits (by 2020). Author(s): Abebe, Lakew, Ouedraogo, Mariame, Kurji, Jaameeta, Labonté, Ronald, Morankar, Sudhakar, Haji Bedru, Kunuz, Bulcha, Gebeyehu, Abera, Muluemebet, K. Potter, Beth, Roy-Gagnon, Marie-Helene, Kulkarni, Manisha Language: English |
Appendix 9 : promoting maternal and child health in Ethiopia : how community health actors explain their roles Report
The presentation outlines some initiatives in Ethiopia that address infant mortality and pro-poor programming such as the Health Extension Program (HEP); the Child Survival Strategy; the Ethiopia Hospital Reform Initiative, and others. Tables of results show that infant and maternal mortality rates have been substantially reduced (year 2000 to 2014). The presentation also details the roles of health workers and community leaders and their influence on the health of pregnant women. Author(s): Abebe, Lakew Language: English |
Application of a qualitative rapid assessment approach to inform community-responsive information, education and communication activities Report
The study examined the application of a qualitative rapid assessment approach to explore community perceptions and experiences related to health and health inequality, focusing on maternal and child health (MCH). Participants identified health inequalities within communities and attributed them to lack of knowledge, exclusion from social groups, and poverty. Health Extension Workers (HEWs), religious leaders and “development army” members are well-positioned to disseminate knowledge and influence health behaviours. The study generated a context-specific situational analysis to inform the design and delivery of information, education and communication (IEC) activities in Jimma Zone (Ethiopia). Author(s): Bergen, Nicole, Shifera, Asfaw Language: English |