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Background To estimate the cost-effectiveness of an ambulance-based referral system an dedicated to emergency obstetrics and neonatal care (EmONC) in remote sub-Saharan settings. Methods In this prospective study performed in Oromiya Region (Ethiopia), all obstetrical cases referred to the hospital with the ambulance were consecutively evaluated during a three-months period. The health professionals who managed the referred cases were requested to identify those that could be considered as undoubtedly effective. Pre and post-referral costs included those required to run the ambulance service and the additional costs necessary for the assistance in the hospital. Local life expectancy tables were used to calculate the number of year saved. Results A total of 111 ambulance referrals were recorded. The ambulance was undoubtedly effective for 9 women and 4 newborns, corresponding to 336 years saved. The total cost of the intervention was 8299 US dollars. The cost per year life saved was 24.7 US dollars which is below the benchmarks of 150 and 30 US dollars that define attractive and very attractive interventions. Sensitivity analyses on the rate of effective referrals, on the costs of the ambulance and on the discount rate confirmed the robustness of the result. Conclusions An ambulance-based referral system for EmONC in remote sub-Saharan areas appears highly cost-effective.

Gender inequalities in Sub-Saharan Africa are deemed relevant but data to support this view are scanty. Retrospective analysis of a large dataset of 105,025 patients admitted to an Ethiopian rural private, non-for-profit hospital over a 11 years period (2005–2015). Since 2001, the hospital and the local community are involved in a long-term, comprehensive and externally-supported health care intervention. The total number of admissions was higher for females (61.9% of the total) mainly because of the high frequency of admissions for obstetrics conditions. The total male-to-female ratio (M:F) was 0.6. Except for malaria, men had more admissions for the other leading causes, with the highest M:F being found for injuries (2.7) and musculoskeletal diseases (1.7). Overall, excluding admissions for pregnancy-related issues, the M:F was 1.4. The frequency of admissions changed with age and gender. Female admissions prevailed in the reproductive age period (from 15 to 44 years of age) while males admissions prevailed in the younger and older age groups. The case fatality rate was higher for men (M:F = 2.0). The total M:F and the M:F excluding pregnancy-related admissions did not change during the study period. Gender inequalities do exist in rural remote setting but tend to affect women differently during their lifespan. Even if gender inequalities generally favor males, the substantial proportion of admissions for pregnancy-related situations is encouraging.

Students in higher institutions are exposed to many psychosocial problems and risky sexual behaviors as they are away from their parents and possibly due to suboptimal counseling services. The problems may be more apparent in newly established universities. Despite this concern, there is no information regarding the psychosocial health status and risky sexual behaviors of students in higher learning institutions in Ethiopia. The study aimed to assess and compare the magnitude of risky sexual behaviors and psychosocial ill health among students of newly established and old universities. The study employed a comparative cross-sectional survey supplemented with qualitative methods. Cluster sampling technique was used to select the departments after dividing the total sample size proportionally to first year and second year students. A total of 1033 students were included in this study: 518 from DBU and 515 from AAU. Quantitative data were processed in SPSS v.13.00 statistical software. Ethical clearance was obtained from ethical review committee of the school of public health and institutional review board at Medical Faculty of Addis Ababa University. Taped qualitative data were transcribed, translated into English, and manually analyzed by grouping into predetermined thematic areas. The response rate was 97.4%. The results indicate that significantly more students of DBU than AAU [(24.7%) versus 69(13.4%)] were likely to have had sexual intercourse [P