Introduction:In Ethiopia, neonatal mortality and stillbirth are high and underreported. This study explored values related to neonatal mortality and stillbirth and the visibility of these deaths in rural Ethiopia among 3 generations of women. Methods:We conducted a qualitative study in 6 rural districts of the Oromiya and Amhara regional states during May 2012. We included 30 focus groups representing grandmothers, married women (mothers), and unmarried girls in randomly selected kebeles (villages). Results:Until the 40th day of life, neonates are considered to be strangers to the community (not human). Their deaths are not talked about; they are buried in the house or in the backyard. Mothers are forbidden to mourn their loss lest they offend God and bring on future neonatal losses. Women who repeatedly lose their neonates may be blamed, mistreated, and dishonored through divorce. Neonatal death and stillbirth are attributed to supernatural powers, although some women and girls associate these deaths with poverty and lack of education. The desire for increased visibility of neonatal death is mixed. Unlike the grandmothers and unmarried girls, most of the married women want death to be visible to draw the attention of policy makers. Women prefer home birth and consider themselves lucky to be able to give birth at home. At present, there is no national vital registration system. Discussion: Neonatal death and stillbirth are hidden and the magnitude is likely underrepresented. The delayed recognition of personhood, attribution of death to supernatural causes, social repercussions for women who experience a pregnancy loss, preference for home birth, and lack of a vital registration system all contribute to the invisibility of perinatal deaths. Increasing the visibility of (and counting) these deaths may require multifaceted behavior-change interventions.

Background: Evidence showed that nutrition education during pregnancy has significant impact on dietary habit of pregnant women and on maternal and birth outcome of pregnancy. The World Health Organization (WHO) recommends that health care providers need to give adequate, specific and acceptable nutrition related advice to pregnant women during every visit of antenatal care (ANC).

BackgroundIn Afar, a pastoralist and remote area of Ethiopia, one in five children suffers from acute malnutrition. Investigation of the prevalence and associated factors of exclusive breastfeeding may provide insight into the current burden and nature of the problem, and offer help on how to direct prevention strategies. The aim of this study was to measure the prevalence and identify associated factors of exclusive breastfeeding (EBF) practice in Afar, Ethiopia.MethodsA community based cross-sectional study was conducted with qualitative inquiry from March to April 2015. Quantitative data were collected from 631 mother-infant pairs residing in Aysaita woreda with a pretested structured questionnaire using the modified expanded program on immunization cluster sampling procedure. Seven clusters were selected using probability proportional to size.The qualitative data were generated through two focus group discussions among purposely selected discussants: one group of eight health professionals and another group of mothers, fathers and traditional birth attendants (n = 10). Bivariate and multivariable analysis was done using binary logistic regression model while thematic framework analysis was employed for the qualitative data.ResultsThe prevalence of EBF under six months of age was 340/618 (55%). Infants whose mothers resided in an urban area [Adjusted Odds Ratio (AOR) 5.7; 95% Confidence Interval (CI) 3.5, 9.2), were knowledgeable about breastfeeding (AOR: 2.3; 95% CI 1.6, 3.5) and delivered at health facilities (AOR: 1.7; 95% CI 1.1, 2.7), were more likely to be exclusively breastfed than the referent group. In addition, mothers had a poor understanding of what constitutes exclusive breastfeeding. Traditional beliefs, myths and misconceptions about EBF and lack of support from husband and family were found to be barriers for proper EBF practice.ConclusionsThe prevalence of EBF did not meet the World Health Organization recommendations. Factors related to infrastructure, service delivery, health education packages and traditional beliefs were associated with EBF practice.

IntroductionIn Ethiopia, even if a significant reduction in child mortality is recorded recently, perinatal mortality rate is still very high. This study assessed the magnitude, determinants and causes of perinatal death in West Gojam zone, Ethiopia.Methods and materialsA nested case control study was conducted on 102 cases (mothers who lost their newborns for perinatal death) and 204 controls (mothers who had live infants in the same year) among a cohort of 4097 pregnant mothers in three districts of the West Gojam zone, from Feb 2011 to Mar 2012. Logistic regression models were used to identify the independent determinant factors for perinatal mortality. The World Health Organization verbal autopsy instrument for neonatal death was used to collect mortality data and cause of death was assigned by a pediatrician and a neonatologist.ResultPerinatal mortality rate was 25.1(95% CI 20.3, 29.9) per 1000 live and stillbirths. Primiparous mothers had a higher risk of losing their newborn babies for perinatal death than mothers who gave birth to five or more children (AOR = 3.15, 95% CI 1.03–9.60). Babies who were born to women who had a previous history of losing their baby to perinatal death during their last pregnancy showed higher odds of perinatal death than their counterparts (AOR = 9.55, 95% CI 4.67–19.54). Preterm newborns were more at risk for perinatal death (AOR = 9.44, 95%CI 1.81–49.22) than term babies. Newborns who were born among a household of more than two had a lesser risk of dying during the perinatal period as compared to those who were born among a member of only two. Paradoxically, home delivery was found to protect against perinatal death (AOR = 0.07 95% CI, 0.02–0.24) in comparison to institutional delivery. Bacterial sepsis, birth asphyxia and obstructed labour were among the leading causes of perinatal death.ConclusionPerinatal mortality rate remains considerably high, but proper maternal and child health care services can significantly decrease the burden.

BackgroundIncreasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation.MethodsThe mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia.ResultsThe system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients’ visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days.ConclusionsIn conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.