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Background: Non-communicable diseases (NCDs) are the leading causes of death globally. Available data demonstrate that nearly 80% of NCD deaths occur in low- and middle-income countries. Of these deaths, an estimated 1.5 million, or 4% were due to cancer. In Ethiopia, data on the preparedness of health facilities to cope with the rising epidemic of cancer are insufficient. Therefore, this survey was aimed to assess service availability and readiness for cancer health care in Ethiopia.Methods: The data used in this study is part of the 2014 Ethiopian service provision assessment survey which was conducted from 10 March to 25 July, 2014. There were a total of 873 health facilities included in this particular study. The facility inventory questionnaire collected information on whether the providers in the facility manage patients with cancer. Information about the readiness of facilities to provide good-quality client services on cancer, including the availability of guidelines and trained staff were also collected.Results: Among all health facilities, 23% of health facilities offer services for cancer. Of the facilities that offer service for cancer, 8 % of them had guidelines for diagnosis and management of cancer at the service site during the survey and only 4 % of the facilities had staff reported that he/she or someone else in the facility had received in-service training in cancer diseases during the 24 months preceding the survey.Conclusions and recommendation: The findings indicate that there is a wide gap in service provision for cancer care and must be filled if basic standards are to be met for cancer care by the health care system. The health system strengthening including provision of evidence-based national guidelines, protocols or standards for managing cancer, training of providers and availing essential medicines are urgently needed for cancer service provision in Ethiopia. Key words; Availability, cancer, Ethiopia, health facilities, readiness, service

Background: Physical activity can significantly reduce burden of NCDs. Physical activity is a low-cost and high impact interventions that can be easily implemented among majority of the population throughout the life. Global reports show that physical inactivity has become unique feature. As per the 2014 WHO report, globally, 20 percent of adult men and 27 percent of adult women did not meet the normal- recommendations of physical activity for health most of these being from urban settings.Objective: To assess the magnitude and determinants of physical inactivity among Ethiopian population.Methods: Community-based Cross-sectional study based on the World Health Organization (WHO) NCD Stepwise approach was conducted in Ethiopia from April to June 2015. All men and women age 15-69 years old were the target of this study. A mix of sampling approach namely stratified, three-stage cluster sampling, simple random sampling and Kish method were employed to select the study settings and the study participants. A total of 9801 from 513 enumerations areas were involved with response rate of 95.5%.Result: Among the study participants, 94.2% (95% of male, and 91% of female) of the participants reported physical activity as per WHO recommendations. Based on multivariate analysis, rural residents were 2.5 (AOR=2.46, (95% - CI: 2.12, 2.86) times more likely to engage in physical activity as compared to urbanites. The youngest age group 15-29 were 3.5 (AOR=3.46, (95% - CI: 2.74, 4.36) times more likely to be physically active than the older age group 60-69 years old. Participants who had college and above education were 28 percent (AOR=0.72, (95% - CI: 0.55, 0.96) less likely to do physical activity compared to respondents with no formal education.Conclusion: Considerable proportion of the study population did not meet WHO recommendations on physical activity for health. It showed that, individuals in rural areas were more engaged in physical activity while individuals who had college and above education were less likely to do physical activity. The highest percentage of individuals not meeting the WHO recommendations for physical activity were the older ones in the age group 60–69 years. Key Words: STEPs survey, physical inactivity determinants, Ethiopia

Introduction: No assessment was conducted previously in Ethiopia to monitor, review and evaluate the availability and readiness of health facilities for non-communicable diseases (NCDs). Thus, the present study aims to provide evidence on service availability and readiness for NCDs in Ethiopia.Method: A Service Availability and Readiness Assessment (SARA) was conducted in Ethiopia in 2016. The survey used stratified random sampling design to provide data for 11 regions in Ethiopia for different facility types and managing authorities. A total of 547 public and private health facilities were included in this analysis (210 hospitals, 165 health centres and 172 clinics). Data were collected using CAPI (Computer Assisted Personal Interview) designed using CSPro 6.3 Software. This study uses tracer indicators in data analysis. Tracer indicators aim to provide objective information about whether or not a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity.Result: Overall, among all health facilities offering service for NCDs, the availability of diagnosis and/or management of diabetes, cardiovascular disease, chronic respiratory disease and cervical cancer were 22%, 41%, 45% and 2%, respectively. Cervical cancer diagnosis was the least available; only 2 in 10 facilities offered this diagnosis service. Among all health facilities offering services for NCDs, the availability of trained staff for diabetes, cardiovascular disease, chronic respiratory disease and cervical cancer prevention and control were 10%, 7%, 8% and 61% respectively. Among health facilities that were offering diabetes diagnosis and/or management services, none of them had all thirteen services. On average, 53% of facilities had seven of the thirteen items. Among facilities that provided cardiovascular disease services, only 1% of them had all twelve items. On average, 41% of these facilities had six of the twelve items. Among health facilities that offered diagnosis and/or management of chronic respiratory disease, no facility had all eleven items. On average, approximately three out of ten health facilities had six of the eleven items. From health facilities that were providing diagnosis and/or management of cervical cancer, only five out of ten health facilities had all four items. On average, 72% of facilities had two out of the four items.Conclusion: Overall, service availability and readiness of the health facilities to provide NCDs related health services are suboptimal. The overall level of diabetes diagnosis and/or management by health facilities was unsatisfactory and it varied between urban (34%) and rural (5%) health facilities. In general, cervical cancer diagnosis was rarely provided and no rural health facilities offered this service. We hope that the findings of this study will prompt appropriate national policy response for NCDs towards improved health care service delivery across health facilities. Key words: NCD, availability, readiness, Ethiopia

Background: Ethiopia has made tremendous effort by cutting under five mortality by two third from the 167 in 1999 to 68 in 2012. Nevertheless, nearly 277,186 under five children die each year mostly from diseases which can be prevented or treated. Sound information on the supply and quality of health services is necessary for health systems management, monitoring, and evaluation.Objective: The objectives of this study are to assess the availability of child health services and how often these services are available in Ethiopian health facilities.Method: The assessment is part of the 2014 Ethiopia Service Provision Assessment Plus (ESPA+) Survey which was designed to be a cross-sectional study, which combines MEASURE DHS SPA, World Health Organization’s service Availability and Readiness Assessment (SARA) and the World Bank’s Service Delivery Indicator (SDI). A total of 1,327 health facilities were assessed. All hospitals, selected health centres, private clinics (Higher, Lower, & Medium), and health posts were assessed using a facility inventory questionnaire. .Results: Among all facilities, 62 % of them provide all three basic child health services (out-patient curative care for sick children, routine childhood vaccination services (EPI), and routine growth monitoring services) as a package. Seventy three percent of government facilities provide all three basic child health services. While 68 % of rural facilities provide all the services, in urban settings, 32 % of the facilities provide all the three basic child health services while majority of Health centres (82 %) provide all the services, only 1 % of lower clinics provide all three basic services. Out-patient curative care for sick children is the most commonly provided (95 %) service of all the three basic services. These services are almost universally available across all facility types, except in higher clinics which are less than 80 %. Among all facilities offering outpatient curative care for sick children, majority (78 %) of them offer the service 5 or more days per week at the facility.Conclusion: Majority of facilities provide all three basic child health services (Outpatient Curative Care, Child Vaccination, and Child Growth Monitoring). Out-patient curative care for sick children is the most commonly provided service. Government facilities mostly provide all three basic child health services. Among all facilities offering outpatient curative care for sick children, majority of them offer the service 5 or more days per week at the facility. [Ethiop. J. Health Dev. 2017;31(2):67-74]Keywords: Availability, Child health service, Frequency

Introduction: According to the 2012 national immunization coverage survey report of Ethiopia, EPI coverage by antigen is 79.6% for BCG, 80.0% for DPT-HepB-Hib1 90.1% for OPV1 65.7%; for adjusted DPT-HepB-Hib 3; 65.7 % for OPV3 and 68.2% for Measles. Similarly, the prevalence of full vaccination was 50%. However, the prevalence of valid vaccination dose for all vaccines is 18.6 %. Therefore, the aim of this study is to identify factors that determine the administration of full valid vaccines dose to set effective interventions.Methods: Data was obtained from the 2012 Immunization Coverage survey of Ethiopia, a cross- sectional study administered at the household level. Data were analyzed using SPSS version 20. Binary and multivariate logistic regression with 95% CI was done to assess factors associated with getting full valid vaccination dose. Results: As documented from the 2012 national immunization coverage survey, the coverage of full valid vaccination dose were very low as compared to full immunization coverage that is 18.6% Vs 50%, respectively. Urban residence 2.6 (95% CI: 2.50, 2.68), mothers with age groups of 21-34 and >35 were 1.26 (95% CI: 1.22, 1.29) and 2.4 (95% CI: 2.3, 2.44); children with caretakers with primary, secondary, and higher level of education were 1.6 (95% CI: 1.22, 1.29), 2.8 (95% CI: 2.76, 2.92), and 2.2 (95% CI: 2.13, 2.27) times more likely to get valid vaccination dose.Conclusion: The rich wealth quintile, rural place of residence, living more than 5km proximity to nearest health facility, having more than six sibling, having teenage (

On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for accelerating health improvements and reducing child deaths.

Background: The burden of disease, injury and death associated with excessive alcohol consumption remains high in most countries. Although there were studies done in different parts of Ethiopia that looked at hazardous use and dependence, no national survey was done on excessive alcohol consumption which is an important risk factor for many health and social problems. This study assessed the magnitude and predictors of excessive alcohol use and associated factors in Ethiopia.Methods: A community based cross-sectional survey was conducted using the WHO STEPwise approach to explore risk factors for NCDs including excessive alcohol consumption. A mix of stratified, three-stage cluster and simple random sampling were used to the study setting or clusters and households. The sampling frame was based on the population and housing census conducted in Ethiopia in 2007. A total of 10,260 households were selected from the 513 enumeration areas. Data were collected using WHO STEPS questionnaire. For this report, Heavy Episodic Drinking was taken as a dependent variable. Descriptive statistics including frequency table, mean, median, interquartile range and standard deviations were computed. Logistic regression was used to analyze the predictors of Heavy Episodic Drinking.Results: A total of 9,800 participants were interviewed in the study. The majority59.4% of the study subjects were female, 40.4% were aged 15-29 years. The overall prevalence of lifetime alcohol consumption was 49.3%, and 40.7% of the study participants reported consumption of alcohol in the past 30 days, defined as current drinkers. Heavy episodic drinking was reported by 12.4% of the participants (20.5% males and 2.7% females). In multivariate logistic regression, factors independently associated with heavy episodic drinking, after adjusting for other characteristics, were male sex, rural residence, married, and current tobacco smoking.Conclusion: More than one in five males reported heavy episodic drinking which will predispose them to non-communicable diseases and other risks. Concurrent tobacco smoking is also a major concern. The findings will be helpful to initiate effective public health interventions to reduce heavy episodic drinking and consequently reduce the risks associated with it. It will also serve as a baseline to conduct further studies on this issue in Ethiopia. Key words: Alcohol, Heavy Episodic Drinking, NCD, Ethiopia, WHO STEPS

Background: Chewing of the leaves of the plant khat (Catha edulis Forsk) is a common habit in some countries of East Africa and the Arabian Peninsula. Khat is chewed by an estimated 20 million population every day in the Arabian Peninsula and in Eastern Africa region including Ethiopia. Ethiopia is believed to be the country of origin of khat where millions chew khat on a daily bases. Khat is also one of Ethiopia's biggest export commodities. This particular study assessed the prevalence of khat chewing and its predictors in Ethiopia.Method: We used a community based cross-sectional data collected in 2015 as part of the National STEPs survey on NCD risk factors. .. The target population for this survey was all men and women aged 15-69 years who had been living at their place of residence for at least six months prior to the survey. A mix of stratified, three-stage cluster and simple random sampling were used to the study setting or clusters and households. The sampling frame was based on the population and housing census conducted in Ethiopia in 2007. A total of 10,260 households were selected from the 513 enumeration areas. Data were collected using WHO STEPS questionnaire and a locally constructed structured questionnaire to collect data on life time and current khat chewing and associated factors. Data were analyzed using SPSS Version 20, descriptive statistics as well as association tests were carried out.Result: Nineteen percent of the respondents had ever chewed khat where among these, the majority (83%) were current khat chewers giving an overall prevalence of current khat chewing rate of 15.8% (21.1% of males and 9.4% of females). Khat was significantly higher in Afar [AOR and (95% CI)] [7.23 (2.01-26.01)], Dire Dawa [AOR and (95% CI)] [5.945 (2.116-16.706)], Harari [AOR and (95% CI)] [5.83 (1.49-22.87)] and Somali [AOR and (95% CI)] [4.315 (1.36-13.71)] among others. Similarly, the odds of khat chewing in urban areas [AOR and (95% CI)] [1.726 (1.18-2.53)] and current users of tobacco [AOR and (95% CI)] [2.882 (1.744 to 4.764)] were higher than their counterparts. Those who were in the third and fourth quartile income ranges [AOR and (95% CI)] 0.612 (0.384-0.974)], [AOR and (95% CI)] [0.508(0.309-0.84)] and those in high school education [AOR and (95% CI)] [0.386 (0.213-0.70)] were less likely to use Khat respectively.Conclusion: Almost 1 out of 5 respondents had ever chewed khat and among these, the vast majority, more than 80%, reported to have been current khat chewers. Being educated and in a better economic status were the protective factors for current khat chewing. Current tobacco use was associated with khat chewing increasing the risk to NCDs. Hence, policy measures aiming at prevention of khat chewing are recommended. Further studies aiming at problematic khat chewing and associated psychosocial and physical health problems is recommended. [Ethiop. J. Health Dev. 2017;31(Special Issue):320-230]Key words: Ethiopia, Risk Factors, Khat, NCD, Protective Factors, Tobacco

Background: Non-communicable diseases (NCDs) are the leading causes of death globally. Available data demonstrate that nearly 80% deaths of NCDs occur in low- and middle-income countries. Of these deaths, an estimated 1.5 million, or 4% were due to diabetes. In Ethiopia, data on the preparedness of health facilities to cope with the rising epidemic of diabetes are insufficient.Objective: This survey was aimed to assess service availability and readiness for diabetes health care.Methods: The data used in this study is part of the 2014 Ethiopian service provision assessment survey which was conducted from 10 March to 25 July, 2014. The study employed stratified random sampling designed to provide representative results for Ethiopia. In this study, health facility types managed by different management authorities were included from the eleven administrative regions of the country.There were a total of 873 health facilities included in this particular study. Data were collected using a facility inventory questionnaire that assessed whether the providers in the facility are prepared to provide required services to patients with diabetes. Information about readiness of facilities to provide good-quality client services on diabetes, including the availability of guidelines, trained staff, basic medical equipment, and essential medicines were also collected.Results: Among all health facilities, 59% of health facilities offer services for diabetes. Forty percent of the facilities have diagnostic capacity for blood glucose while 56 % have capacity for urine protein test and 52 % has urine glucose test. Of the facilities that offer service for diabetes, 12 % of them had guidelines for diagnosis and management of diabetes at the service site during the survey. On the other hand, facilities that offer diabetes services were more likely to have basic equipment that support and enhance the provision of services.Conclusions: The findings indicate that availability of treatment services, guidelines for diagnosis and management, trained staff and medicines for diabetes were found to be inadequate. But the availability of the basic medical equipment necessary for the diagnosis and management of diabetes appear to be adequate. Therefore, strengthening health care system towards improved service delivery through availing national guidelines, protocols or standards for managing diabetes, in-service training for providers, and provision of essential medicines are required to improve diabetes service delivery in health facilities. [Ethiop. J. Health Dev. 2017;31(2):110-118]Keywords: Diabetes Mellitus, Disease, Service, Availability, Readiness, Health Facility, Ethiopia

Background: Consuming any form of tobacco is one of the leading causes of preventable morbidity and mortality. Tobacco smoking has been identified as one of the major risk factors for NCDs, including cardiovascular, chronic respiratory diseases, and different cancers. Although there is national information on magnitude of tobacco use, to date there is limited nationally representative data on factors associated with tobacco use. The aim of this study is to assess the distribution and predicators of tobacco use in Ethiopian adult population between 15 -59.Objectives: The main aim of this study was to assess the prevalence of tobacco use and its predictor in Ethiopia.Methods: A cross-sectional population based study design was employed among population age from 15- 69 years. A stratified, three-stage cluster sampling was used to identify the study subjects. Households in each cluster were selected using simple random sampling method. The sampling frame was based on the population and housing census conducted for Ethiopia in 2007. Data was collected using WHO NCD STEPS questionnaire; current tobacco use of any type was taken as the dependent variable. Five hundred thirteen enumeration areas (EAs) as primary sampling units (PSUs) (404 rural and 109 urban) were selected with probability proportionate to size, followed by selection of households as a secondary sampling units (SSUs). A total of 10,260 households were selected from the 513 EAs (20 households per EA). Eligible individuals were selected from households using Kish method (a pre-assigned table of random numbers to find the person to be interviewed). Descriptive statistics using frequency table, mean, median, interquartile range and standard deviations were computed. Step wise logistic regression was used to analyse the predictors of tobacco use. An Estimator of 95% confidence interval was used both for computing descriptive statistics as well testing associations using logistic regression.Results: The prevalence of tobacco use (all tobacco products) was 4.2%. The mean age (± SD) of starting tobacco use was 21(7) years. The mean frequency of tobacco use was 2 times per day. Hierarchical Logistic regression analysis revealed that participants in age groups 30-44 years, and 60-69 years were less likely to use any tobacco type compared to younger age group of15-29 years. Heavy episodic drinking, AOR 2.46 [95% CI= 1.4 – 4.5], and khat chewing, AOR 4.71[95%= 2.26 – 9.8], were independently associated with tobacco use.Conclusion and recommendations: The overall prevalence of tobacco use was relatively higher in males. Factors associated with tobacco use were heavy episodic drinking and khat chewing. Although tobacco use is an important risk factor for different disease on its own, the additional use of these substances exposes individuals to increased risk of NCDs. The findings warrant the need to implement existing anti-tobacco laws in the country, enhance anti-tobacco awareness raising efforts, and implement interventions to help current tobacco users, focusing attention more on regions with high rates of tobacco use and males. Key words: Ethiopia, NCDs, Predictors, Risk factors, Tobacco use, WHO STEPS

Background: Neglected tropical diseases (NTDs) are a group of infections which are especially endemic in low-income populations in developing regions of Africa, Asia, and the Americas. In sub-Saharan Africa, the impact of these diseases as a group is comparable to malaria and tuberculosis. The diseases recognized as neglected tropical diseases by the World Health Organization (WHO) are: Chagas disease, Cysticercosis and taeniasis, Dengue fever, Dracunculiasis, Echinococcosis, Human African trypanosomiasis, Leishmaniasis, Leprosy, Lymphatic filariasis, Onchocerciasis, Rabies, Schistosomiasis, Soil-transmitted helminthiasis, Trachoma, and Yaws. Most of these diseases are either preventable through mass drug administration (MDA) and proper hygiene and sanitation, or treatable through systematic case finding and management. This study was conducted with the aim of assessing the availability of services for neglected tropical diseases management at health facilities in Ethiopia.Method: The assessment is part of the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) Survey. A total of 873 health facilities were assessed for this analysis. All Hospitals, selected health centre, and private clinics were assessed if they provide services for Neglected Tropical Diseases.Result: More than half of all health facilities offer services for both soil transmitted helminthes (64 percent), and services for trachoma (60 percent). About four of every ten health facilities offer services for schistosomiasis. On the other hand, services for onchocerciasis, leishmanianis and lymphatic filariases were available in less than a third of all health facilities (27%, 25% and 24%, respectively).Conclusion and recommendation: Even though, the availability of service for neglected tropical disease in health facilities is relatively good in general, there should be equitable distribution of neglected tropical disease service provision among regions. And private facilities should give emphasis for the provision of these services. Key words: Service Availability, NTDs, SPA+, Ethiopia.