Effect of Ethiopia’s Health Extension Program on Maternal and Newborn Health Care Practices in 101 Rural Districts: A Dose-Response Study

Karim, Ali Mehryar; Admassu, Kesetebirhane; Schellenberg, Joanna; Alemu, Hibret; Getachew, Nebiyu; Ameha, Agazi; Tadesse, Luche; Betemariam, Wuleta

doi:10.1371/journal.pone.0065160

Cited by 112 publications

(138 citation statements)

References 19 publications

Supporting

Mentioning

128

Contrasting

Order By: Relevance

“…Despite encouraging reports of positive impact of HEP, 8,[22][23][24][25][26]52 the findings of this study show major deficiency in its overall performance. The scores across all domains were low, which could be due to their interdependence, where the capacity for service provision and financial systems influence the human resource development, the community engagement and service provision process that in turn affect the output and outcome dimension.…”

Section: Discussioncontrasting

confidence: 83%

“…4 BSC has been implemented at the FMOH and federal hospitals levels and remains to be cascaded to all levels of the health system. HEP is one of the core components of HSDP, and although studies have documented the performance of the program on individual indicators, [22][23][24][25][26] there is limited evidence on integrated performance indices and scoring methodologies. 8 We developed a scoring methodology for performance evaluation of HEP based on the BSC approach 14,21 and generated performance indices using data obtained from nationwide HEP evaluation survey.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

Teklehaimanot

Tedella

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. In 2004, Ethiopia introduced a community-based Health Extension Program to deliver basic and essential health services. We developed a comprehensive performance scoring methodology to assess the performance of the program. A balanced scorecard with six domains and 32 indicators was developed. Data collected from 1,014 service providers, 433 health facilities, and 10,068 community members sampled from 298 villages were used to generate weighted national, regional, and agroecological zone scores for each indicator. The national median indicator scores ranged from 37% to 98% with poor performance in commodity availability, workforce motivation, referral linkage, infection prevention, and quality of care. Indicator scores showed significant difference by region (P < 0.001). Regional performance varied across indicators suggesting that each region had specific areas of strength and deficiency, with Tigray and the Southern Nations, Nationalities and Peoples Region being the best performers while the mainly pastoral regions of Gambela, Afar, and Benishangul-Gumuz were the worst. The findings of this study suggest the need for strategies aimed at improving specific elements of the program and its performance in specific regions to achieve quality and equitable health services.

show abstract

Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

Teklehaimanot

Tedella

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…The HEP involves trained and salaried female health extension workers who provide basic primary health care services at the community level. The HEP has improved maternal and newborn health care practices and could contribute to the reduction of under-5 mortality [24, 25]. The contribution of development partners to support high-effect child survival interventions such as immunization and malaria control program could also contribute significantly to reduction of under-5 mortality.…”

Section: Discussionmentioning

confidence: 99%

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

Deribew

Tessema

Deribe

et al. 2016

Popul Health Metrics

View full text Add to dashboard Cite

BackgroundEthiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013.MethodsWe used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.ResultsBetween 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013.Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.ConclusionsLRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

show abstract

“…This survey adds to a small but growing literature on newborn care practices at community level in Sub-Saharan Africa [18,28-32]. In the population served by the health facilities included in this study, the majority of women made one antenatal care visit to a health facility, but less than half made four or more visits.…”

Section: Discussionmentioning

confidence: 99%

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

Callaghan-Koru

Seifu²,

Tholandi³

et al. 2013

BMC Pediatr

View full text Add to dashboard Cite

BackgroundEthiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia.MethodsWe conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection.ResultsThe majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care.ConclusionsImproving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

show abstract

Effect of Ethiopia’s Health Extension Program on Maternal and Newborn Health Care Practices in 101 Rural Districts: A Dose-Response Study

Cited by 112 publications

References 19 publications

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

Contact Info

Product

Resources

About