Assessing Coverage,Equity and Quality Gaps in Maternal and Neonatal Care in Sub-Saharan Africa: An Integrated Approach

BackgroundGaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries.MethodsData were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs) utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC) indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization’s maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care.ResultsAll the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level.ConclusionOur findings confirm the existence of serious issues regarding coverage, equity and quality of health care for mothers and newborns in all study districts. Gaps in one dimension hinder the potential gains in health outcomes deriving from good performances in other dimensions, thus confirm the need for a three-dimensional profiling of health care provision as a basis for data-driven planning.     

Status of Eldana saccharina (Lepidoptera: Pyralidae), its host plants and natural enemies in Ethiopia

Surveys for sugarcane stem borers were undertaken in Ethiopia to determine the prevalence and distribution of these and their natural enemies in crops and indigenous host plants. Eldana saccharina Walker was not recovered from sugarcane, but was present in three indigenous wetland sedges, Cyperus papyrus, C. fastigiatus and C. dives in the southern, central and northern part of the country. The latter indigenous host plant was present in waterways adjacent to sugarcane on the commercial sugar estates. The tachinids Schembria eldanae Barraclough and Actia sp. were common parasitoids of E. saccharina larvae in these indigenous sedges. The braconid Dolichogenidea sp. was recovered from E. saccharina larvae in C. dives. Pathogens comprising Beauveria bassiana, Bacillus thuringiensis and Entomophthora sp., were found to be important mortality factors of E. saccharina larvae in the indigenous sedges. The occurrence of E. saccharina in Ethiopia is reported for the first time, and the host plant preferences of the borer and its indigenous natural enemies found during the surveys are recorded. In addition, its potential threat to sugarcane production in Ethiopia is discussed.     

Paleoanthropology of the Kibish Formation, southern Ethiopia: Introduction

Cranial and skeletal remains of modern humans, Homo sapiens, were discovered in the Kibish Formation in 1967 by a team from the Kenya National Museums directed by Richard Leakey. Omo I, from Kamoya's Hominid Site (KHS), consists of much of a skeleton, including most of the cranial vault, parts of the face and mandible, and many postcranial elements. Omo II, from Paul's Hominid Site (PHS), is a virtually complete calvaria. Only a limited fauna and a few stone artifacts attributed to the Middle Stone Age were recovered in conjunction with the fossil hominids. The available dating techniques suggested a very early age, over 100 ka, for Member I, from which the Omo I and Omo II fossils were recovered. However, in subsequent decades, the reliability of the dates and the provenance of the Kibish hominids were repeatedly questioned. The papers in this volume provide a detailed stratigraphic analysis of the Kibish Formation and a series of new radiometric dates that indicate an age of 196 +/- 2 ka for Member I and 104 +/- 1 for Member III, confirming the antiquity of the lower parts of the Kibish Formation and, in turn, the fossils from Member I. Studies of the postcranial remains of Omo I indicate an overall modern human morphology with a number of primitive features. Studies of an extensive lithic record from Members I and III indicate a Middle Stone Age technology comparable to assemblages of similar age elsewhere in Ethiopia. Studies of the mammalian, avian, and fish faunas indicate overall similarities to those found in the region today, with a few distinctive differences.     

Phenotypic variation in barley (Hordeum vulgare L.) landraces from north Shewa in Ethiopia

An experiment was conducted in a greenhouse to estimate the level of morphological variability within 44 barley landraces (14 farmers' cultivars and 30 accessions) from north Shewa in Ethiopia. Four qualitative traits (spike type, kernel color, caryopsis type and spike density) were recorded. Variation in spike type (two-rowed, irregular or six-rowed) was high in many landraces. Variability in spike type within landraces from Debre Libanose, Kuyu and Girar Jarso was high. The highest mean frequencies of the six-row type were recorded for Ankober-Mezezo (85%) and Kimbibit (80.9%). The two-row types were dominant in Wuchale (53.3%), while they were absent at the Ankober-Mezezo, Debre Libanose and Kimbibit localities. A larger proportion of the irregular types occurred in Debre Libanose (71.3%), followed by Kuyu (62.6%). Diversity for kernel color was generally low except in landraces from Kuyu, but it was very high among landraces. White kernel color was predominant. The mean diversity index pooled over characters ranged from 0.12 ± 0.08 to 0.57 ± 0.11, and 11 landraces had a mean diversity larger than 0.50. Differences among landraces within localities were mostly highly significant for all characters except that of caryopsis type (covered or naked). Landraces from Girar Jarso, Wuchale, and Kuyu in particular differed significantly in spike type and kernel color. Unlike farmers' cultivars, the accessions were found to be more variable in spike type and kernel color. Moreover, the mean diversity indices pooled over characters were relatively higher in the accessions than within farmers' cultivars.     

Knowledge,Attitude, Practice,and Determinants Emergency Contraceptive Use among Women Seeking Abortion Services in Dire Dawa,Ethiopia

Background

Unplanned pregnancy from casual sex, unplanned sexual activity, and sexual violence are increasing. Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in Ethiopia particularly in major cities. Yet the use of EC is very low and abortion rate in cities is high compared to the national average.

Objectives

To assess knowledge, attitude and practice and determinants on the use of emergency contraception among women obtaining abortion service at selected health institutions in Dire Dawa, Eastern Ethiopia.

Methods

A facility based cross-sectional study was conducted on 390 women selected by multi-stage random sampling technique. The samples were generated from government and private for non profit health facilities. Participant’s knowledge and attitude towards emergency contraception were measured using composite index based on 7 and 9 questions, respectively and analyzed using mean score to classify them as knowledgeable or not, and have positive attitude or not. Practice was assessed if the women reported ever use of emergency contraception. Determinants of use of emergency contraception were analyzed using logistic regression.

Result

Out of 390 women interviewed, 162 women (41.5%) heard about EC, only 133 (34.1%) had good knowledge, and 200 (51.3%) of the respondents had positive attitudes towards to EC. Ever use of EC was reported by 38 (9.7%). Age, living arrangement, education, marital status, religion were found to be significantly associated with the use of emergency contraceptives. Women with poor knowledge were less likely to use EC compared to the knowledgeable ones [AOR = 0.027, 95% CI (0.007, 0.105)].

Conclusion

The study identified that most respondents lack adequate knowledge on the method of EC. In addition ever use of EC is very low.

Recommendations

Health professions should give attention in increasing knowledge and uptake of Emergency Contraception.     

Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone,Northwest Ethiopia: a cross-sectional institution based study

Background

Health care workers have a duty to promote and support breastfeeding among their clients. Although their ability to do this may be influenced by their knowledge and personal experience; little is known about breastfeeding practices and the perceived barriers. The objective of this study was to assess the breastfeeding practices and the associated factors among female nurses and midwives in North Gondar Zone; Northwest Ethiopia.

Methods

An institution based cross-sectional study design was conducted in 2013 among 178 nurses and midwives. In this study exclusive breastfeeding refers to breastfeeding exclusively for the first six months of a child’s life. Bivariate and multivariate logistic regressions were performed to identify the presence and strength of association. Odds ratios with 95% confidence interval were computed to determine the level of significance.

Results

Exclusive breastfeeding rate among respondents was found to be 35.9%. Nearly half (49.4%) of the respondents exclusively breastfed for only 3 months or less. The mean duration exclusive breastfeeding was 4.1?±?1.7 months. Older women (AOR?=?2.8; 95% CI 2.16, 3.24), rural residence (AOR?=?3.01; 95% CI 2.65, 3.84), being midwife (AOR?=?2.01; 95% CI 1.83, 2.56), a women who gave birth through vaginal delivery (AOR?=?2.0; 95% CI 1.68, 2.87), multiparous women (AOR?=?2.20; 95% CI 1.74, 2.67) and resumption of work after 3 months (AOR?=?1.61; 95% CI 1.24, 2.35) were independently associated with exclusive breastfeeding.

Conclusion

Though respondents had adequate knowledge on breastfeeding, the practice of exclusive breastfeeding was low. Maternal age, place of residence, profession, mode of delivery, parity and the time before resuming work were factors associated with exclusive breastfeeding. Appropriate education concerning breastfeeding, directed at nurses and midwives is required to enhance exclusive breastfeeding and duration of breastfeeding.

     

Molecular phylogenetics and definition of the Acrapex minima Janse group (Lepidoptera,Noctuidae, Apameini,Sesamiina) with the description of four new species from the Afrotropics

Five morphologically similar species of Acrapex Hampson (Lepidoptera, Noctuidae, Noctuinae, Apameini), from sub-Saharan Africa are reviewed, including four new species that are described: Acrapex mondogeneta Le Ru n. sp., A. mubale Le Ru n. sp., A. robe Le Ru n. sp. and A. rubona Le Ru n. sp. These five species belong to a species complex that we hereby define as the Acrapex minima group. Host plants of three species are recorded; Acrapex minima is recorded for the first time on a host plant, Digitaria natalensis Stent; A. mondogeneta on Hyparrhenia hirta (L.) Stapf and A. rubona on Imperata cylindrica (L.) P. Beauv. We also conducted molecular phylogenetics (using both Bayesian inference and maximum likelihood) and molecular species delimitation analyses (Poisson tree processes) on a six gene multi-marker dataset (four mitochondrial and two nuclear gene fragments; 4582 nucleotides in length) of 42 specimens and 22 species, including 23 specimens from the Acrapex minima group. The results of the corresponding analyses support the monophyly of the group and the species status of the newly described taxa.