IntroductionHealth systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.MethodsWe conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.ResultNew family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.ConclusionWe observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies.

Background Despite significant reductions in maternal and child mortality over the past few decades, a disproportionate number of global deaths occur in low and middle-income country settings, such as Ethiopia. To prioritize research questions that would generate policy recommendations for better outcomes, we conducted a scoping review that gathers the current knowledge of maternal, newborn, and child health (MNCH) and illustrates remaining gaps in Ethiopia. Methods We conducted a search strategy from 1946-2018 in PubMed/MEDLINE, EMBASE, and the WHO African Index Medicus. The study team of reviewers independently screened titles, abstracts, and full-texts; abstracted data; and reconciled differences in pairs. Descriptive analyses were conducted. Results We identified 7,829 unique articles of which 2,170 were included. Most MNCH publications in Ethiopia (70.0%) were published in the last decade, 2010-2018. Most studies included children aged one to less than 10 years old (30.5%), women of reproductive age (22.0%), and pregnant women (21.9%); fewer studies included newborns (7.0%), infants (6.6%), and postpartum women (2.9%). Research topics included demographics and social determinants of health (43.4%), nutrition (15.3%), and infectious diseases (13.0%). There were limited studies on violence (1.4%), preterm birth (0.8%), antenatal/postpartum depression (0.7%), stillbirths (0.1%), and accidents (0.1%). Most study designs were cross-sectional (53.6%). A few study designs included prospective cohort studies (5.5%) and randomized control trials (2.3%). Conclusions This is the first scoping review to describe the landscape of MNCH research in Ethiopia. Understanding the depth of existing knowledge will support the prioritization and development of future research questions. Additional studies are needed to focus on the neonatal, infant, and postpartum populations as well as preterm and stillbirth outcomes.

Background Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia. Methods We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities. Results In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs. Conclusions Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.

Background Critical to the improvement of maternal, newborn, and child health (MNCH) in Ethiopia – where 14 000 mothers die from pregnancy-, childbirth-, or postpartum-related complications each year – is high-quality research and its effective translation into policy and practice. While Ethiopia has rapidly expanded the number of institutions that train and conduct MNCH research, the absence of a shared research agenda inhibits a coordinated approach to inform critical MNCH policy needs. The HaSET Maternal and Child Health Research Program (MCHRP) conducted a mixed methods formative assessment and prioritization exercise to guide investments in future MNCH research in Ethiopia. Methods We adapted the Child Health and Nutrition Research Initiative (CHNRI) method, soliciting 56 priority research questions via key informant interviews. Through an online survey, experts scored these on their ability to generate new, actionable evidence that could inform more effective and equitable MNCH programs in Ethiopia. At a workshop in Addis Ababa, experts scored the questions by answerability and ethics, usefulness, disease burden reduction, and impact on equity. Research priority scores were calculated for both the online survey and workshop scoring and averaged to attain a ranked priority list. We validated and contextualized the results by conducting consensus-building discussions with MNCH experts and two community workshops. In total, approximately 100 participants were involved. Results Average research priority scores ranged from 58.4 to 83.7 out of 100.0. The top identified research priorities speak to critical needs in the Ethiopian context: to improve population coverage of proven interventions like integrated community case management (ICCM), family integrated newborn care, and kangaroo mother care (KMC); to better understand the determinants of outcomes like home deliveries, immunization drop-out, and antenatal and postpartum care-seeking; and to strengthen health system and workforce capabilities. Conclusions This exercise expanded on the CHNRI methodology by comparing prioritization across different audiences, formats, and criteria. Agreement between both scoring rounds and consensus-building discussions was strong, demonstrating the reliability of the CHNRI method. By sharing this research priority list broadly among researchers, practitioners, and donors, we aim to improve coordinated MNCH evidence generation and translation into policy in Ethiopia.