Search

This study investigates that the phenolic compound extracted from the potato peels using ethanol by maceration as a natural preservation agent for cow butter, yielding 10.42 ± 0.03 % phenolic compound. A quantitative and qualitative analysis of potato peels extract (PPE) was conducted to examine the phenolic compounds. The major preliminary phytochemical screenings (Alkaline Reagent Test, Ferric Chloride Test, Chloride Test) were performed to detect the presence of phenols, flavonoids, and tannins. The total phenolic content was measured using the Folin–Ciocalteu method with UV spectrophotometry, which produced 2.9468 ± 0.03 mg GAE/g of dry extract. The total flavonoid content was determined using the aluminum chloride colorimetric method, resulting in 3.6885 ± 0.02 mg equivalent Quercetin/g of dry extract. During 21 days, butter samples treated with PPE at various concentrations (0.2 % and 0.3 %) and storage temperatures (20 °C and 45 °C) were examined for chemical parameters (peroxide value and free fatty acid value) and microbiological parameters (aerobic total bacterial count and yeast mould count). The findings showed that the samples preserved at 20 °C with a concentration of 0.3 % extract had better preservation than samples stored at other temperatures. It also showed lower values of peroxide and free fatty acids, as well as less microbial growth. On the other hand, samples without extract that were kept at 45 °C demonstrated more oxidation and microbial growth. The oxidative stability of cow butter was assessed using the Rancimat method. Results indicate that PPE significantly enhances both oxidative stability and shelf life, offering preservative benefits for up to six months. Specifically, the induction period (IP) at room temperature reached 3960 h (165 days) with PPE, compared to only 120 h (5 days) without it. These findings suggest that the phenolic compounds in the potato peels could serve as natural preservatives for cow butter, particularly when stored at lower temperatures.

Ethiopians traditionally make Nifro, a snack made by boiling wheat and another grain in hot water. Boiling conditions such as boiling time and temperature could have a significant impact on the proximate and sensory properties of boiled foods particularly Nifro. The objective of this study was to optimize boiling time and temperature to obtain quality snack food (Nifro) from two types of wheat (hard and soft wheat). The effects of boiling temperature (70–100 °C) and boiling time (1–3 hr.) on the qualitative attributes of Ethiopia traditional snack food Nifro, including proximate composition (moisture, ash, fat, fiber, protein, and carbohydrate) and sensory properties, were studied using the central composite design test and mathematical models. For both types of wheat, the effect of boiling time and temperature on the quality attributes of the Nifro (moisture, ash, fat, fiber, protein, and carbohydrate) was significant (P

Abstract Background Malaria, transmitted by the bite of infective female Anopheles mosquitoes, remains a global public health problem. The presence of invasive Anopheles stephensi, capable of transmitting Plasmodium vivax and Plasmodium falciparum, was first reported in Ethiopia in 2016. The ecology of this mosquito species differs from that of Anopheles arabiensis, the primary malaria vector in Ethiopia. This study aimed to evaluate the efficacy of selected insecticides, which are used in indoor residual spraying (IRS) and selected long-lasting insecticidal nets (LLINs) for malaria vector control against adult An. stephensi. Methods Anopheles stephensi mosquitoes were collected as larvae and pupae from Awash Subah Kilo Town and Haro Adi village, Ethiopia. Adult female An. stephensi, reared from larvae and pupae collected from the field, aged 3–5 days were exposed to impregnated papers of IRS insecticides (propoxur 0.1%, bendiocarb 0.1%, pirimiphos-methyl 0.25%), and insecticides used in LLINs (alpha-cypermethrin 0.05%, deltamethrin 0.05% and permethrin 0.75%), using diagnostic doses and WHO test tubes in a bio-secure insectary at Aklilu Lemma Institute of Pathobiology, Addis Ababa University. For each test and control tube, batches of 25 female An. stephensi were used to test each insecticide used in IRS. Additionally, cone bioassay tests were conducted to expose An. stephensi from the reared population to four brands of LLINs, MAGNet™ (alpha-cypermethrin), PermaNet® 2.0 (deltamethrin), DuraNet© (alpha-cypermethrin) and SafeNet® (alpha-cypermethrin). A batch of ten sugar-fed female mosquitoes aged 2–5 days was exposed to samples taken from five positions/sides of a net. The data from all replicates were pooled and descriptive statistics were used to describe features of the data. Results All An. stephensi collected from Awash Subah Kilo Town and Haro Adi village (around Metehara) were resistant to all tested insecticides used in both IRS and LLINs. Of the tested LLINs, only MAGNet™ (alpha-cypermethrin active ingredient) caused 100% knockdown and mortality to An. stephensi at 60 min and 24 h post exposure, while all other net brands caused mortality below the WHO cut-off points (

Abstract Background Malaria, transmitted by the bite of infective female Anopheles mosquitoes, remains a global public health problem. The presence of an invasive Anopheles stephensi, capable of transmitting Plasmodium vivax and Plasmodium falciparum parasites was first reported in Ethiopia in 2016. The ecology of An. stephensi is different from that of Anopheles arabiensis, the primary Ethiopian malaria vector, and this suggests that alternative control strategies may be necessary. Larviciding may be an effective alternative strategy, but there is limited information on the susceptibility of Ethiopian An. stephensi to common larvicides. This study aimed to evaluate the efficacy of temephos and Bacillus thuringiensis var. israelensis (Bti) larvicides against larvae of invasive An. stephensi. Methods The diagnostic doses of two larvicides, temephos (0.25 ml/l) and Bti (0.05 mg/l) were tested in the laboratory against the immature stages (late third to early fourth stages larvae) of An. stephensi collected from the field and reared in a bio-secure insectary. Larvae were collected from two sites (Haro Adi and Awash Subuh Kilo). For each site, three hundred larvae were tested against each insecticide (as well as an untreated control), in batches of 25. The data from all replicates were pooled and descriptive statistics prepared. Results The mortality of larvae exposed to temephos was 100% for both sites. Mortality to Bti was 99.7% at Awash and 100% at Haro Adi site. Conclusions Larvae of An. stephensi are susceptible to temephos and Bti larvicides suggesting that larviciding with these insecticides through vector control programmes may be effective against An. stephensi in these localities.

In Ethiopia, malaria incidence has significantly reduced in the past decade through the combined use of conventional vector control approaches and treatment using antimalarial drugs. However, the sustainability of this achievement is threatened by the shift in biting and resting behaviors and emergence of insecticide resistance by the primary malaria vector. Therefore, continuous monitoring of the behaviour of malaria mosquitoes in different sentinel sites is crucial to design effective prevention and control methods in the local context. Entomological investigations were conducted in three sentinel sites for five consecutive months during the major malaria transmission season. The species composition, population dynamics, biting and resting behaviours of malaria vectors were determined using center for disease control and prevention (CDC) light trap, human landing catch (HLC), pyrethrum spray catch (PSC) and Pitfall shelter collection (PFS). Accordingly, 10 households for CDC, 10 households for PSC, 10 households for PFS and 5 households for HLC from each site were randomly enrolled for mosquito collection. A total of 8,297 anopheline mosquitoes were collected from the three sites, out of which 4,525 (54.5 %) were An. gambiae, s.l. 2,028 (24.4 %) were An. pharoensis, 160 (1.9 %) were An. funestus and the rest 1,584 (19 %) were other anophelines (An. coustani, An. cinerus and An. tenebrosus). No significant variation (P = 0.476) was observed between indoor (25.2/trap-night and outdoor collections (20.1/trap-night). Six hundred seventy six (43.3%) of An. gambiae s.l. (primary vector) were collected between 18:00 and 22:00 h. Biting activity declined between 00:00 and 02:00 h. The national malaria control program should pay close attention to the shifting behavior of vector mosquitoes as the observed outdoor feeding tendency of the vector population could pose challenges to the indoor intervention tools IRS and LLINs.

BackgroundIntegrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses.MethodsWe conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017-18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2-59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model.ResultsOver the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (pConclusioniCCM implementation was associated with a meaningful shift in care-seeking to health posts.

Slaughtering methods and practices in Sub-Saharan African countries tend to contribute to the bacterial quality of meat and could be a source of bacterial contamination of meat due to noncompliance with the National Environmental Health Practice Regulations. This study aimed to assess the microbial quality of beef and antimicrobial susceptibility profiles ofisolates from Nsukka and Owerri abattoirs. A completely randomized and a cross-sectional design were adopted. A total of 240 samples from two slaughterhouses (120 meat samples from each slaughterhouse) were collected during 15 visits. The mean aerobic plate and coliform counts of Nsukka meat and Owerri meat abattoirs from the table were significantly (p<0.05) higher than those of Nsukka and Owerri abattoirs from the floor, respectively. Verotoxigenic E. coli and Salmonella spp were isolated from the meat on the floor of both abattoirs. The E. coli and Salmonella isolated from both slaughterhouses (Nsukka and Owerri) were resistant to neomycin (57.15%, 40.00% and 53.06%, 14.29%), gentamicin (14.29%, 20.00% and 6.12%, 0%), amoxycillin (100%, 100% and 100%, 66.6%), tetracycline (42.86%, 40.00% and 83.67%, 66.60%), doxycycline (14.29%, 0% and 61.22%, 0%), nitrofuratoin (42.86%, 40.00% and 22.45%, 42.86%), streptomycin (100%, 100% and 83.67%, 71.43%), amoxicillin-clauvulamic acid (100%, 0% and 93.88%, 7%), ciprofloxacin (28.58%, 20.00% and 38.32%, 28.58%) sulphamethazole/trimethoprin (28.57%, 20% and 46.94%, 14.29%). High microbial loads and pathogenic microorganisms have been found in both abattoirs, indicating unsanitary practices. On the other hand, the slaughtering and processing of animals should be improved, regulated, and enforced by the appropriate authorities. [ABSTRACT FROM AUTHOR]

Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH), Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009-2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%), with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10-14 years (38.8%). Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3%) of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively). Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Polymorphisms in glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) can cause an entire gene deletion. The current methodology can accurately identify GSTM1 and GSTT1 copy number variants (CNVs), which may shed light on the true contribution of each gene copy to the cellular detoxification process and disease risk. Because liver cirrhosis is becoming a critical worldwide health issue, this study determined the CNVs of GSTM1 and GSTT1 and their relationship to the risk of liver cirrhosis.Methods: In this study, we compared 106 patients with liver cirrhosis to 104 healthy controls. Real-time PCR was used to identify the CNVs of GSTM1 and GSTT1. Logistic and linear regression models were used to estimate the relationship between liver cirrhosis and clinical chemistry variables with the CNVs, respectively.Results: In 3.3% of the study participants, > 2 copies of the GSTM1 or GSTT1 genes were detected. GSTT1 carriers had a significantly lower risk of liver cirrhosis (p< 0.05) compared with individuals who had homozygous deletion (adjusted odds ratio (AOR) = 0.47; 95% CI: 0.25, 0.86). This risk reduction was significant (p< 0.05) in patients with a single copy of the GSTT1 gene (AOR = 0.48; 95% CI: 0.25, 0.91). Those with ≥ 2 copies of combined GSTM1 and GSTT1 also had a significantly (p< 0.05) lower risk of developing liver cirrhosis compared with double null genotypes (AOR = 0.38; 95% CI: 0.16, 0.91, p trend < 0.001). Moreover, ≥ 2 copies of combined GSTM1 and GSTT1 genes were associated with a substantial decrease in alanine amino transferase (ALT) and aspartate aminotransferase (AST) levels, respectively.Conclusion: A single copy number of GSTT1, and ≥ 2 copies of combined GSTM1 and GSTT1 genes were associated with a reduced risk of liver cirrhosis in Ethiopians. These findings underscore the importance of gene–environment interactions in the multifactorial development of liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Malaria, transmitted by the bite of infective female Anopheles mosquitoes, remains a global public health problem. The presence of invasive Anopheles stephensi, capable of transmitting Plasmodium vivax and Plasmodium falciparum, was first reported in Ethiopia in 2016. The ecology of this mosquito species differs from that of Anopheles arabiensis, the primary malaria vector in Ethiopia. This study aimed to evaluate the efficacy of selected insecticides, which are used in indoor residual spraying (IRS) and selected long-lasting insecticidal nets (LLINs) for malaria vector control against adult An. stephensi. Methods: Anopheles stephensi mosquitoes were collected as larvae and pupae from Awash Subah Kilo Town and Haro Adi village, Ethiopia. Adult female An. stephensi, reared from larvae and pupae collected from the field, aged 3–5 days were exposed to impregnated papers of IRS insecticides (propoxur 0.1%, bendiocarb 0.1%, pirimiphos-methyl 0.25%), and insecticides used in LLINs (alpha-cypermethrin 0.05%, deltamethrin 0.05% and permethrin 0.75%), using diagnostic doses and WHO test tubes in a bio-secure insectary at Aklilu Lemma Institute of Pathobiology, Addis Ababa University. For each test and control tube, batches of 25 female An. stephensi were used to test each insecticide used in IRS. Additionally, cone bioassay tests were conducted to expose An. stephensi from the reared population to four brands of LLINs, MAGNet™ (alpha-cypermethrin), PermaNet® 2.0 (deltamethrin), DuraNet© (alpha-cypermethrin) and SafeNet® (alpha-cypermethrin). A batch of ten sugar-fed female mosquitoes aged 2–5 days was exposed to samples taken from five positions/sides of a net. The data from all replicates were pooled and descriptive statistics were used to describe features of the data. Results: All An. stephensi collected from Awash Subah Kilo Town and Haro Adi village (around Metehara) were resistant to all tested insecticides used in both IRS and LLINs. Of the tested LLINs, only MAGNet™ (alpha-cypermethrin active ingredient) caused 100% knockdown and mortality to An. stephensi at 60 min and 24 h post exposure, while all other net brands caused mortality below the WHO cut-off points (< 90%). All these nets, except SafeNet®, were collected during LLIN distribution for community members through the National Malaria Programme, in December 2020. Conclusions: Anopheles stephensi is resistant to all tested insecticides used in IRS and in the tested LLIN brands did not cause mosquito mortality as expected, except MAGNet. This suggests that control of this invasive vector using existing adult malaria vector control methods will likely be inadequate and that alternative strategies may be necessary. [ABSTRACT FROM AUTHOR]

Background: Malaria, transmitted by the bite of infective female Anopheles mosquitoes, remains a global public health problem. The presence of an invasive Anopheles stephensi, capable of transmitting Plasmodium vivax and Plasmodium falciparum parasites was first reported in Ethiopia in 2016. The ecology of An. stephensi is different from that of Anopheles arabiensis, the primary Ethiopian malaria vector, and this suggests that alternative control strategies may be necessary. Larviciding may be an effective alternative strategy, but there is limited information on the susceptibility of Ethiopian An. stephensi to common larvicides. This study aimed to evaluate the efficacy of temephos and Bacillus thuringiensis var. israelensis (Bti) larvicides against larvae of invasive An. stephensi. Methods: The diagnostic doses of two larvicides, temephos (0.25 ml/l) and Bti (0.05 mg/l) were tested in the laboratory against the immature stages (late third to early fourth stages larvae) of An. stephensi collected from the field and reared in a bio-secure insectary. Larvae were collected from two sites (Haro Adi and Awash Subuh Kilo). For each site, three hundred larvae were tested against each insecticide (as well as an untreated control), in batches of 25. The data from all replicates were pooled and descriptive statistics prepared. Results: The mortality of larvae exposed to temephos was 100% for both sites. Mortality to Bti was 99.7% at Awash and 100% at Haro Adi site. Conclusions: Larvae of An. stephensi are susceptible to temephos and Bti larvicides suggesting that larviciding with these insecticides through vector control programmes may be effective against An. stephensi in these localities. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led nucleic acid collection and detection became a measure to ensure normal life in China. Considering the huge detection demand, it has emerged that robots replace manual sample collection. However, the cost-effectiveness of nucleic acid collection by robots instead of humans remain unknown. Methods: This study was approved by the Ethics Committee of the Shenzhen Luohu District People's Hospital, number 2021-LHQRMYY-KYLL-031a. All participants signed the written informed consent of this study. 273 volunteers were recruited on December 1st 2021 from Shenzhen and divided into six groups: one group to be sampled by robots and the others to be sampled manually with varying specifications for swab rotation and insertion time. Questionnaires were distributed to the robot group to ask them sampling feeling. The effectiveness and safety of sampling were evaluated through the sampling efficiency, adverse events and sampling feeling of different groups. The economics of the different methods were judged by comparing the sampling cost for each. Results: The sampling efficiency of the robot group was 96.9%, and there was no statistically significant difference between the other five manually sampled groups (p = 0.586). There were no serious adverse events in any of the six groups, but nasal soreness and tearing did occur in all group. Of the volunteers who underwent robotic sampling, 85.94% reported that the experience was either no different or more comfortable than the manual sampling. In economic terms, a single robot used to replace medical staff for sample collection becomes economically advantageous when the working time is ≥ 455 days. If multiple robots are used to replace twice the number of manual collections, it becomes more economical at 137 days and remains so as long as the robot is used. Conclusions: It appears safe and effective for robots to replace manual sampling method. Implementation of robotic sampling is economical and feasible, and can significantly save costs when working over a long term. [ABSTRACT FROM AUTHOR]

Background Childhood malnutrition is well estimated as the major underlying risk factor for morbidity and mortality in children under 5 years. Feeding practices greatly influence the dietary condition of children aged 6-23 months in developing countries. Therefore, this study was performed to determine the association between infant young children feeding (IYCF) practices and the dietary conditions of children aged 6-23 months in Ethiopia. Method A cross-sectional study was conducted based on data on 5638 children aged 6-23 months from three Ethiopia Demographic and Health Surveys (EDHS) (2005, 2011, 2016). Multivariable logistic regression was performed to estimate the odd ratios (ORs) and 95% confidence intervals (CIs) of stunting and anaemia with IYCF practices. Result The prevalence of stunting among children aged 6-23 months in Ethiopia decreased greatly from 49% in 2005 to 32% in 2016. Among the IYCF practices, consumption of iron-rich foods, minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were significant predictors of stunting. In addition, the prevalence of anaemia declined significantly from 26% in 2005 to 16% in 2011, but increased to 29% in 2016. Among the IYCF practices, breastfeeding and minimum meal frequency (MMF) had lower odds of childhood anaemia. Conclusions The present study showed that anaemia and stunting among children aged 6-23 months in Ethiopia is critical public health problems that need urgent attention., Author(s): Aschalew Fikru Hiruy [sup.1] , Anissa Abebe Teshome [sup.1] , Yemane Tadesse Desta [sup.2] , Xuezhi Zuo [sup.3] , Shuiqing He [sup.1] , Eskedar Getachew Assefa [sup.1] , Chenjiang [...]

aimed to study the association of different modern contraceptive methods and anemia on women of childbearing age. Methods: The study was conducted based on secondary data from Ethiopia demographic and health surveys (EDHS) in 2016. The study included 12,981, women of childbearing age. The dependent variable is anemia which was defined based on the level of hemoglobin concentration, and was classified as non-anemic (above 12 g/dL) or anemic (below 12 g/dL). The association between anemia with modern contraceptive method and BMI was analyzed using a logistic regression model. Results: A total of 12,891 non-pregnant women were recruited for this study, 26.3% (95% CI: 25.9 to 27.1) had anemia, and hemoglobin level was 12.9 ± 1.7. The current use of modern contraceptives has substantially reduced the odds of anemia by 50% compared with non-users. Compared to barrier methods, individual modern contraceptive use showed higher odds ratio of, oral contraceptive pills (OCP) 0.6 (95% CI: 0.45 to 1.12), injectables 0.59 (95% CI: 0.24 to 1.79), implant 0.72 (95% CI: 0.60 to 0.86) and significantly reduces the risk of anemia. In addition to the contraceptive method, BMI found to improve anemia and the underweight women showed significant effect on an anemia (OR 2.20 (95% CI 1.58– 2. 62)) P = 0.000. Conclusion: The use of hormonal contraceptive methods reduces anemia among women of childbearing age. Moreover, there is an association between BMI and anemia. [ABSTRACT FROM AUTHOR]

Background: Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses. Methods: We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017–18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2–59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model. Results: Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88–2.86) over the period. Conclusion: iCCM implementation was associated with a meaningful shift in care-seeking to health posts. [ABSTRACT FROM AUTHOR]

Introduction Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based interventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers. Methods Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care-controlling for sociodemographic and health service utilization factors. Results A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P < .001). A positive dose-response relationship existed between the number of meetings attended and greater care completeness ( P < .001). Women with any antenatal care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P < .001). Discussion MaNHEP's family meetings complemented routine antenatal care by engaging women and family caregivers in self-care and care-seeking, resulting in greater completeness of care and more highly skilled birth care. [ABSTRACT FROM AUTHOR]

Introduction The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed 'lead' woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Methods Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Results Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. Discussion MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The multifaceted approach to building capacity was critical for the success in creating lead woredas able to serve as models for other districts. [ABSTRACT FROM AUTHOR]