34 results on '"Gebretsadik A"'
Search Results
2. Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study
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Tenaw, Zelalem, Gari, Taye, and Gebretsadik, Achamyelesh
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- 2023
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3. Inequalities in childhood stunting: evidence from Sudan multiple indicator cluster surveys (2010–2014)
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Wogderes, Bashaw, Shibre, Gebretsadik, and Zegeye, Betregiorgis
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- 2022
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- View/download PDF
4. Magnitude and determinants of animal source food consumption among children aged 6–23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey
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Gebretsadik, Gebretsadkan Gebremedhin, Adhanu, Amaha Kahsay, and Mulugeta, Afework
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- 2022
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5. Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000–2016
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Yaya, Sanni, Ameyaw, Edward Kwabena, Idriss-Wheeler, Dina, Shibre, Gebretsadik, and Zegeye, Betregiorgis
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- 2021
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- View/download PDF
6. Time trends in socio-economic, urban-rural and regional disparities in prevalence of obesity among non-pregnant women in Lesotho: evidence from Lesotho demographic and health surveys (2004–2014)
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Zegeye, Betregiorgis, Shibre, Gebretsadik, and Garedew Woldeamanuel, Gashaw
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- 2021
- Full Text
- View/download PDF
7. Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)
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Shibre, Gebretsadik, Zegeye, Betregiorgis, Idriss-Wheeler, Dina, and Yaya, Sanni
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- 2021
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- View/download PDF
8. Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)
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Shibre, Gebretsadik, Zegeye, Betregiorgis, Ahinkorah, Bright Opoku, Idriss-Wheeler, Dina, Keetile, Mpho, and Yaya, Sanni
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- 2021
- Full Text
- View/download PDF
9. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia
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Kurji, Jaameeta, Gebretsadik, Lakew Abebe, Wordofa, Muluemebet Abera, Morankar, Sudhakar, Bedru, Kunuz Haji, Bulcha, Gebeyehu, Bergen, Nicole, Kiros, Getachew, Asefa, Yisalemush, Asfaw, Shifera, Mamo, Abebe, Endale, Erko, Thavorn, Kednapa, Labonte, Ronald, Taljaard, Monica, and Kulkarni, Manisha A.
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- 2020
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- View/download PDF
10. Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey
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Shibre, Gebretsadik, Zegeye, Betregiorgis, Idriss-Wheeler, Dina, Ahinkorah, Bright Opoku, Oladimeji, Olanrewaju, and Yaya, Sanni
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- 2020
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11. Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study
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Shibre, Gebretsadik, Idriss-Wheeler, Dina, Bishwajit, Ghose, and Yaya, Sanni
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- 2020
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- View/download PDF
12. Milk-borne bacterial health hazards in milk produced for commercial purpose in Tigray, northern Ethiopia
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Berhe, Gebretsadik, Wasihun, Araya Gebreyesus, Kassaye, Enquebaher, and Gebreselasie, Kibrom
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- 2020
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- View/download PDF
13. Risk factors associated with malaria outbreak in Laelay Adyabo district northern Ethiopia, 2017: case-control study design
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Tesfahunegn, Afewerki, Berhe, Gebretsadik, and Gebregziabher, Equbay
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- 2019
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- View/download PDF
14. Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)
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Sanni Yaya, Betregiorgis Zegeye, Gebretsadik Shibre, and Dina Idriss-Wheeler
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Male ,medicine.medical_specialty ,DHS ,Global health ,Economic inequality ,Health facility ,Epidemiology ,medicine ,Humans ,Child ,Children ,Demography ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Pneumonia ,Patient Acceptance of Health Care ,medicine.disease ,Health Surveys ,Health equity ,Cross-Sectional Studies ,Socioeconomic Factors ,Inequality ,Child, Preschool ,Female ,Ethiopia ,Biostatistics ,business ,Care seeking behavior ,Research Article - Abstract
Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).
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- 2021
15. Magnitude and determinants of animal source food consumption among children aged 6–23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey
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Gebretsadkan Gebremedhin Gebretsadik, Amaha Kahsay Adhanu, and Afework Mulugeta
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Family Characteristics ,Livestock ,Malnutrition ,Public Health, Environmental and Occupational Health ,Animals ,Humans ,Ethiopia ,Child Nutrition Disorders ,Diet - Abstract
Background Undernutrition puts children in a physical and cognitive disadvantage. Animal source foods (ASFs) are important components of nutritious diets and play a significant role in increasing dietary diversity and minimizing the risk of undernutrition among children. Ethiopia still suffers from child undernutrition and there’s no adequate information regarding consumption of ASFs. The objective of this study was to determine the magnitude and determinanats of ASF consumption among children 6–23 months of age. Methodology A total weighted sample of 2861 children drawn from the 2016 Ethiopian demographic and health survey was analyzed using “SVY” command of STATA 14.0. Multivariable logistic regression was used to determine the independent determinants of ASF consumption. The strength of the association was measured by odds ratio and 95% confidence interval and p-value Results Nearly half (46.5%) of the children reported consuming any type of ASF. Religion, child age, number of household assets, number of livestock owned by a household, and ownership of land usable for agriculture were significant determinants of the outcome variable. The odds of ASF consumption were six times, twice, and 70% lower in orthodox children compared to other (catholic, traditional, or others), muslim, and protestant children, respectively. Household ownership of assets and livestock led to an increase in consumption of ASF by 19 and 2%, respectively. Children aged 18–23 months were more likely to consume ASF as compared to the younger age group (6–8 months old children). In the contrary, children from households that own land usable for agriculture were 33% less likely to consume ASFs as compared to those from households that do not own. Conclusions In Ethiopia, only nearly half of children aged 6–23 months consume any type of ASF. The findings of this study imply that ASF consumption can be increased through integrated actions that involve community and religious leaders and programs focused on empowering households’ capability of owning other socioeconomic entities including assets and livestock. This study also may contribute to the growing body of research works on the importance of ASF provision in preventing child undernutrition.
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- 2022
16. Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study
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Dina Idriss-Wheeler, Gebretsadik Shibre, Ghose Bishwajit, and Sanni Yaya
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Adult ,DHS ,Inequality ,Adolescent ,Urban Population ,media_common.quotation_subject ,medicine.medical_treatment ,Global health ,030209 endocrinology & metabolism ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,Caesarean section ,030212 general & internal medicine ,Healthcare Disparities ,Socioeconomic status ,media_common ,Demography ,Equity (economics) ,business.industry ,Cesarean Section ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Health equity ,Cross-Sectional Studies ,Socioeconomic Factors ,Demographic economics ,Residence ,Female ,Ethiopia ,Biostatistics ,business ,Research Article - Abstract
BackgroundIn Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies.MethodsThe data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance.ResultsWe found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time.ConclusionsIn all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.
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- 2020
17. Inequalities in childhood stunting: evidence from Sudan multiple indicator cluster surveys (2010-2014)
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Bashaw Wogderes, Gebretsadik Shibre, and Betregiorgis Zegeye
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Sudan ,Socioeconomic Factors ,Public Health, Environmental and Occupational Health ,Prevalence ,Educational Status ,Humans ,Child ,Health Surveys ,Growth Disorders - Abstract
Background Leaving no one behind has been an important marker of the Sustainable Development Goals. Closing the gap in malnutrition between children of different backgrounds aligns well with the tenet of this international agenda. To this end, high-quality evidence of the magnitude and trends of socioeconomic and geographic related existing inequalities in the childhood stunting among Sudanese children emanate from this study help for policy maker and planners to design and implement effective interventions to narrow down inequality. Methods We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) for our analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed the disaggregated analysis of stunting across five equity stratifiers: Wealth, education, residence, sex, and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Slope Index of Inequality (SII), and Relative Index of Inequality (RII). The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. Results In this study, the national average childhood stunting prevalence was increased by 4% from 2010 to 2014. The findings revealed stark inequalities in stunting in all the studied dimensions of inequality. Huge inequality has existed along the wealth quintiles. Simple difference measure for education was increased by four points and simple relative measure decreased by one point for economic status. Conclusions Sex, residence and, geographically related inequalities remain unchanged over time, while economic status and educational inequality had seen a change by some inequality measures over the same time period.
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- 2021
18. Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000–2016
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Dina Idriss-Wheeler, Sanni Yaya, Edward Kwabena Ameyaw, Betregiorgis Zegeye, and Gebretsadik Shibre
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Rural Population ,medicine.medical_specialty ,DHS ,Adolescent ,Total fertility rate ,media_common.quotation_subject ,Population ,Global health ,Fertility ,Adolescent fertility rate ,1117 Public Health and Health Services ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Birth Rate ,Child ,education ,Socioeconomic status ,Reproductive health ,media_common ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Health Surveys ,Health equity ,Socioeconomic Factors ,Inequality ,Educational Status ,Female ,Public Health ,Ethiopia ,Public aspects of medicine ,RA1-1270 ,business ,Research Article ,Demography - Abstract
Background One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. This study assessed the magnitude and trends of socioeconomic and area-based AFR inequalities in Ethiopia. Methods The 2000 and 2016 Ethiopia Demographic and Health surveys (EDHS) was analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. Adolescent fertility rates were disaggregated using three equity stratifiers (economic status, education and residence) and analyzed through four summary measures (Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF)) to assess inequality. To measure statistical significance, point estimates were constructed using a 95% Uncertainty Interval (UI). Results Large socio-economic and urban-rural inequalities were observed within the 16-year period. Adolescents in less well-off socio-economic groups (PAF: -62.9 [95% UI; − 64.3, − 61.4], D: 96.4 [95% UI; 47.7, 145.1]), uneducated (R: 8.5 [95% UI; 4.8, 12.2], PAR: -76.4 [95% UI;-77.7, − 75.0]) and those from rural areas (D: 81.2 [95% UI; 67.9, 94.6], PAF: -74.2 [95% UI, − 75.7, − 72.7]) had a higher chance of pregnancy and more births than their counterparts. Conclusions Socioeconomic (education and economic status) and place of residence determine adolescents’ pregnancy and childbearing. Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities. More emphasis should be placed on subpopulations with disproportionately higher adolescent pregnancy and childbirth.
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- 2021
19. Time trends in socio-economic, urban-rural and regional disparities in prevalence of obesity among non-pregnant women in Lesotho: evidence from Lesotho demographic and health surveys (2004–2014)
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Betregiorgis Zegeye, Gebretsadik Shibre, and Gashaw Garedew Woldeamanuel
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Rural Population ,medicine.medical_specialty ,Population ,Global health ,Developing country ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Prevalence ,Medicine ,Humans ,Women ,030212 general & internal medicine ,Obesity ,education ,Socioeconomic status ,education.field_of_study ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Educational inequality ,Health Surveys ,Health equity ,Lesotho ,Inequality ,Socioeconomic Factors ,Female ,Biostatistics ,Trends ,business ,Research Article - Abstract
Background The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho. Methods Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings. Results We noticed substantial wealth-driven (D = -21.10, 95% CI; − 25.94, − 16.26), subnational region (PAR = -11.82, 95%CI; − 16.09, − 7.55) and urban-rural (− 9.82, 95% CI; − 13.65, − 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity. Conclusions Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.
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- 2021
20. Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011-2015)
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Betregiorgis Zegeye, Sanni Yaya, Bright Opoku Ahinkorah, Dina Idriss-Wheeler, Gebretsadik Shibre, and Mpho Keetile
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Rural Population ,medicine.medical_specialty ,DHS ,Population ,Global health ,Antenatal care ,1117 Public Health and Health Services ,Pregnancy ,Medicine ,Humans ,education ,Socioeconomic status ,Demography ,education.field_of_study ,Multiple Indicator Cluster Surveys ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Mauritania ,Prenatal Care ,Health equity ,Standardized mortality ratio ,Socioeconomic Factors ,Inequality ,Female ,Public Health ,Rural area ,Public aspects of medicine ,RA1-1270 ,business ,Research Article - Abstract
Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.
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- 2020
21. Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey
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Bright Opoku Ahinkorah, Sanni Yaya, Dina Idriss-Wheeler, Betregiorgis Zegeye, Olanrewaju Oladimeji, and Gebretsadik Shibre
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Adult ,Male ,Rural Population ,medicine.medical_specialty ,DHS ,Adolescent ,Urban Population ,Population ,030209 endocrinology & metabolism ,Antenatal care ,1117 Public Health and Health Services ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Global health ,medicine ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,education ,Socioeconomic status ,Demography ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Prenatal Care ,Middle Aged ,Health equity ,Standardized mortality ratio ,Inequality ,Angola ,Socioeconomic Factors ,Attributable risk ,Female ,Public Health ,Biostatistics ,Health disparities ,business ,Research Article - Abstract
Background In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola. Methods We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates. Results The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75). Conclusion The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.
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- 2020
22. Milk-borne bacterial health hazards in milk produced for commercial purpose in Tigray, northern Ethiopia
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Gebretsadik Berhe, Kibrom Gebreselasie, Enquebaher Kassaye, and Araya Gebreyesus Wasihun
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Rural Population ,Veterinary medicine ,Food Safety ,Bacterial growth ,Food Supply ,Foodborne Diseases ,fluids and secretions ,Health-hazards ,Hygiene ,Klebsiella ,Medicine ,media_common ,0303 health sciences ,biology ,Commercial ,lcsh:Public aspects of medicine ,Commerce ,food and beverages ,04 agricultural and veterinary sciences ,Raw milk ,Contamination ,Citrobacter freundii ,Dairying ,Milk ,Milk-borne ,Pasteurization ,Total bacterial count ,Research Article ,Staphylococcus aureus ,Farms ,media_common.quotation_subject ,Cafeteria ,03 medical and health sciences ,Gram-Negative Bacteria ,Escherichia coli ,Animals ,Humans ,Bacteria ,Health professionals ,030306 microbiology ,business.industry ,Tigray ,0402 animal and dairy science ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,biology.organism_classification ,040201 dairy & animal science ,Cross-Sectional Studies ,Food Microbiology ,Ethiopia ,business - Abstract
Background Milk being a suitable medium for bacterial growth, it can serve as a source of bacterial contamination. Pathogenic bacteria in milk pose a serious health threat to humans and constitute about 90% of all dairy-related diseases. However, there are few studies that examined the health hazards of raw milk consumption in Ethiopia. Therefore, the objective of this study was to assess the prevalence of bacterial contamination and associated factors in milk produced for commercial purpose in Tigray region, northern Ethiopia. Methods This study used a cross-sectional study design, selected 315 persons (168 cafeterias, 96 dairy farms, and 51 milk vendors) for interview and collected the same number of bulk raw milk samples using systematic sampling procedure. Data were collected on socio-demographic, farm hygiene and milk handling practices by trained health professionals. Bacterial contamination was defined as total bacterial count (TBC) > 1 × 105, staphylococcus count (SC) > 105, or coliform count (CC) > 102 CFU/ml by culture and the species of bacteria were determined by standard biochemical tests. Results From the 315 milk samples tested, the prevalence of bacterial contamination was 52% (95% CI: 46.5–57.6). The mean counts of contaminated samples of TBC, SC, and CC were 8.94 ± 0.46 Standard Deviation (SD), 8.52 ± 0.6 SD, and 8.78 ± 0.49 SD log CFU/ml, respectively. The proportion of contamination was significantly lower in milk collected from dairy farms (32/96, 33.3, 95% CI: 24.5–43.2) compared to milk from vendors (33/51, 64.7, 95% CI: 51.4–66.2) and cafeterias (99/168, 58.9, 95% CI, 50.9–76.85). The milk samples were culture-positive for Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, K. oxytoca and Citrobacter freundii. Conclusions Over half of the sampled raw milk exhibited bacterial contamination with increasing trend from farmers to points of sale. Thus, milk vendors and cafeteria owners should apply good hygienic and sanitation practices during handling of milk; use appropriate, clean containers, and cold chain during milk transportation; and refrigeration of milk during storage.
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- 2020
23. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia
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Lakew Abebe Gebretsadik, Yisalemush Asefa, Jaameeta Kurji, Nicole Bergen, Ronald Labonté, Erko Endale, Kunuz Haji Bedru, Kednapa Thavorn, Getachew Kiros, Manisha A. Kulkarni, Gebeyehu Bulcha, Muluemebet Abera Wordofa, Abebe Mamo, Monica Taljaard, Sudhakar Morankar, and Shifera Asfaw
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medicine.medical_specialty ,Psychological intervention ,Three-delays model ,Health Services Accessibility ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Complex interventions ,Randomized controlled trial ,RE-AIM framework ,law ,Pregnancy ,Health care ,Medicine ,Humans ,Maternal Health Services ,030212 general & internal medicine ,Cluster randomised controlled trial ,Intervention Duration ,030219 obstetrics & reproductive medicine ,business.industry ,lcsh:Public aspects of medicine ,Institutional birth ,Maternal healthcare ,Community engagement ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Odds ratio ,3. Good health ,Clinical trial ,Cross-Sectional Studies ,Family medicine ,Maternity waiting home ,Female ,Ethiopia ,Health Facilities ,Biostatistics ,business ,Cluster-randomized controlled trial ,Research Article - Abstract
Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.
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- 2020
24. Risk factors associated with malaria outbreak in Laelay Adyabo district northern Ethiopia, 2017: case-control study design
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Afewerki Tesfahunegn, Gebretsadik Berhe, and Equbay Gebregziabher
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Male ,Case control ,Attack rate ,Disease Outbreaks ,0302 clinical medicine ,Protective Clothing ,Risk Factors ,Surveys and Questionnaires ,Epidemiology ,030212 general & internal medicine ,Child ,Health Education ,Rapid diagnostic test ,education.field_of_study ,lcsh:Public aspects of medicine ,Incidence ,Middle Aged ,Laelay-Adyabo District ,Child, Preschool ,Health education ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Population ,030209 endocrinology & metabolism ,Risk Assessment ,03 medical and health sciences ,Young Adult ,Environmental health ,parasitic diseases ,medicine ,Animals ,Humans ,education ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Outbreak ,lcsh:RA1-1270 ,medicine.disease ,Malaria ,Culicidae ,Case-Control Studies ,Ethiopia ,Malaria outbreak ,business - Abstract
Background Globally in 2015 about 214 million malaria cases and 438,000 deaths were reported with 75% were from Sub-Saharan Africa. Malaria transmission in Ethiopia is unstable, and outbreaks are considered public health emergencies. Understanding the trigger for outbreaks in low-transmission areas can help facilitate malaria elimination. On July 8th malaria outbreak was reported from Laelay Adyabo district. The objective was to investigate the magnitude and associated factors with malaria outbreak. Methods We defined a case as confirmed malaria using microscopy or a rapid diagnostic test for Plasmodium parasites in a resident of Laelay-Adyabo District from July 9–28, 2017. We identified cases by reviewing health facility records and conducted a case-control study using randomly-selected cases from a line list, and two neighborhood controls per case. A pretested semi-structured questionnaire adapted from WHO malaria guidelines was used to collect data from case-patients and controls. We calculated crude (COR) and adjusted (AOR) odds ratios to identify factors associated with malaria. Result A total of 145 confirmed malaria cases (57.9% males) were identified with village attack rate (AR) of 12.1/1000. The AR was higher among males than females (14.1 verses 10.1/1000), children aged 5–14 years (12.9/1000), and in Zelazle Kebelle (13.6/1000 population). Wearing protective clothing (AOR = 0.27, 95% CI 0.11–0.66), having good knowledge of malaria transmission (AOR = 0.25, 95% CI 0.08–0.75), having waste collection material at home (AOR = 0.25 95% CI 0.11–0.61), availability of mosquito breeding sites around home (AOR = 9.08, 95% CI 3.6–22.93), and staying outdoor overnight (AOR = 3.7, 95% CI 1.44–9.56) were independently associated with malaria. Conclusion The overall attack rate for malaria during this outbreak was high affecting > 1% of the population. Wearing protective clothing at night, knowing about malaria transmission, having mosquito breeding sites around the home, staying outdoors overnight, and having waste collection material in their house were predictors of the infection. Laelay Adyabo district health office should provide health education on malaria transmission and prevention measures and how to clear mosquito breeding sites. Electronic supplementary material The online version of this article (10.1186/s12889-019-6798-x) contains supplementary material, which is available to authorized users.
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- 2019
25. Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia
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Fikre Enquselassie, Gebretsadik Berhe, and Abraham Aseffa
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Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Smear-positive ,Cross-sectional study ,Logistic regression ,Young Adult ,Internal medicine ,Epidemiology ,medicine ,Humans ,Young adult ,Tuberculosis, Pulmonary ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Medical record ,lcsh:Public aspects of medicine ,Pulmonary tuberculosis ,Public Health, Environmental and Occupational Health ,Sputum ,Tigray ,Retrospective cohort study ,lcsh:RA1-1270 ,Middle Aged ,medicine.disease ,Surgery ,Cross-Sectional Studies ,Treatment Outcome ,Female ,Ethiopia ,Biostatistics ,business ,Research Article - Abstract
Background Monitoring the outcome of tuberculosis treatment and understanding the specific reasons for unsuccessful treatment outcome are important in evaluating the effectiveness of tuberculosis control program. This study investigated tuberculosis treatment outcomes and predictors for unsuccessful treatment outcome in the Tigray region of Ethiopia. Methods Medical records of smear-positive pulmonary tuberculosis (PTB) patients registered from September 2009 to June 2011 in 15 districts of Tigray region, Northern Ethiopia, were reviewed. Additional data were collected using a structured questionnaire administered through house-to-house visits by trained nurses. Tuberculosis treatment outcomes were assessed according to WHO guidelines. The association of unsuccessful treatment outcome with socio-demographic and clinical factors was analyzed using logistic regression model. Results Out of the 407 PTB patients (221 males and 186 females) aged 15 years and above, 89.2% had successful and 10.8% had unsuccessful treatment outcome. In the final multivariate logistic model, the odds of unsuccessful treatment outcome was higher among patients older than 40 years of age (adj. OR = 2.50, 95% CI: 1.12-5.59), family size greater than 5 persons (adj. OR = 3.26, 95% CI: 1.43-7.44), unemployed (adj. OR = 3.10, 95% CI: 1.33-7.24) and among retreatment cases (adj. OR = 2.00, 95% CI: 1.37-2.92) as compared to their respective comparison groups. Conclusions Treatment outcome among smear-positive PTB patients was satisfactory in the Tigray region of Ethiopia. Nonetheless, those patients at high risk of an unfavorable treatment outcome should be identified early and given additional follow-up and social support.
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- 2011
26. Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia
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Berhe, Gebretsadik, primary, Enquselassie, Fikre, additional, and Aseffa, Abraham, additional
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- 2012
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27. Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study
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Zelalem Tenaw, Taye Gari, and Achamyelesh Gebretsadik
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Disability ,Sexual practice ,Lived sexual experience ,Prevalence ,Associated factors ,Ethiopia ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia. Methods A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach. Results In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice. Conclusion Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.
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- 2023
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28. Inequalities in childhood stunting: evidence from Sudan multiple indicator cluster surveys (2010–2014)
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Bashaw Wogderes, Gebretsadik Shibre, and Betregiorgis Zegeye
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Stunting ,Inequality ,Sudan ,MICS ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Leaving no one behind has been an important marker of the Sustainable Development Goals. Closing the gap in malnutrition between children of different backgrounds aligns well with the tenet of this international agenda. To this end, high-quality evidence of the magnitude and trends of socioeconomic and geographic related existing inequalities in the childhood stunting among Sudanese children emanate from this study help for policy maker and planners to design and implement effective interventions to narrow down inequality. Methods We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) for our analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed the disaggregated analysis of stunting across five equity stratifiers: Wealth, education, residence, sex, and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Slope Index of Inequality (SII), and Relative Index of Inequality (RII). The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. Results In this study, the national average childhood stunting prevalence was increased by 4% from 2010 to 2014. The findings revealed stark inequalities in stunting in all the studied dimensions of inequality. Huge inequality has existed along the wealth quintiles. Simple difference measure for education was increased by four points and simple relative measure decreased by one point for economic status. Conclusions Sex, residence and, geographically related inequalities remain unchanged over time, while economic status and educational inequality had seen a change by some inequality measures over the same time period.
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- 2022
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29. Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)
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Gebretsadik Shibre, Betregiorgis Zegeye, Bright Opoku Ahinkorah, Dina Idriss-Wheeler, Mpho Keetile, and Sanni Yaya
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Antenatal care ,Inequality ,Mauritania ,DHS ,Global health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.
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- 2021
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30. Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000–2016
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Sanni Yaya, Edward Kwabena Ameyaw, Dina Idriss-Wheeler, Gebretsadik Shibre, and Betregiorgis Zegeye
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Adolescent fertility rate ,Inequality ,Reproductive health ,Global health ,Ethiopia ,DHS ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. This study assessed the magnitude and trends of socioeconomic and area-based AFR inequalities in Ethiopia. Methods The 2000 and 2016 Ethiopia Demographic and Health surveys (EDHS) was analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. Adolescent fertility rates were disaggregated using three equity stratifiers (economic status, education and residence) and analyzed through four summary measures (Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF)) to assess inequality. To measure statistical significance, point estimates were constructed using a 95% Uncertainty Interval (UI). Results Large socio-economic and urban-rural inequalities were observed within the 16-year period. Adolescents in less well-off socio-economic groups (PAF: -62.9 [95% UI; − 64.3, − 61.4], D: 96.4 [95% UI; 47.7, 145.1]), uneducated (R: 8.5 [95% UI; 4.8, 12.2], PAR: -76.4 [95% UI;-77.7, − 75.0]) and those from rural areas (D: 81.2 [95% UI; 67.9, 94.6], PAF: -74.2 [95% UI, − 75.7, − 72.7]) had a higher chance of pregnancy and more births than their counterparts. Conclusions Socioeconomic (education and economic status) and place of residence determine adolescents’ pregnancy and childbearing. Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities. More emphasis should be placed on subpopulations with disproportionately higher adolescent pregnancy and childbirth.
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- 2021
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31. Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)
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Gebretsadik Shibre, Betregiorgis Zegeye, Dina Idriss-Wheeler, and Sanni Yaya
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Pneumonia ,Inequality ,Care seeking behavior ,Ethiopia ,DHS ,Children ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).
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- 2021
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32. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia
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Jaameeta Kurji, Lakew Abebe Gebretsadik, Muluemebet Abera Wordofa, Sudhakar Morankar, Kunuz Haji Bedru, Gebeyehu Bulcha, Nicole Bergen, Getachew Kiros, Yisalemush Asefa, Shifera Asfaw, Abebe Mamo, Erko Endale, Kednapa Thavorn, Ronald Labonte, Monica Taljaard, and Manisha A. Kulkarni
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Cluster-randomized controlled trial ,Complex interventions ,Maternity waiting home ,Institutional birth ,Ethiopia ,Maternal healthcare ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website ( https://clinicaltrials.gov ) on 3rd October 2017. The trial identifier is NCT03299491 .
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- 2020
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33. Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey
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Gebretsadik Shibre, Betregiorgis Zegeye, Dina Idriss-Wheeler, Bright Opoku Ahinkorah, Olanrewaju Oladimeji, and Sanni Yaya
- Subjects
Antenatal care ,Inequality ,Health disparities ,Global health ,Angola ,DHS ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola. Methods We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates. Results The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75). Conclusion The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.
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- 2020
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34. Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study
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Gebretsadik Shibre, Dina Idriss-Wheeler, Ghose Bishwajit, and Sanni Yaya
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Caesarean section ,Inequality ,Global health ,Ethiopia ,DHS ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies. Methods The data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance. Results We found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time. Conclusions In all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.
- Published
- 2020
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