Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda,Tigray Region,Ethiopia

Background

The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs’ and mother’s attitudes to maternal health services in Adwa Woreda, Tigray Region.

Methods

In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women’s social status and mobility; and women’s perceptions of skilled birth attendant’s care. All data were analyzed thematically.

Findings

There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women’s Development Groups (WDGs), and referral by ambulance to health facilities either before a woman’s Expected Due Date (EDD) or if labour started at home.

Conclusion

With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women’s groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries.     

CD4 Cell Count Trends after Commencement of Antiretroviral Therapy among HIV-Infected Patients in Tigray,Northern Ethiopia: A Retrospective Cross-Sectional Study

Background

The rate and extent of CD4 cell recovery varies widely among HIV-infected patients with different baseline CD4 cell count strata. The objective of the study was to assess trends in CD4 cell counts in HIV-infected patients after initiation of antiretroviral therapy in Tigray, Northern Ethiopia.

Methods

A retrospective cross-sectional study was conducted by reviewing medical records of HIV patients who received antiretroviral treatment at twenty health centers in Tigray region during 2008–2012. Multi-stage cluster sampling technique was employed to collect data, and the data were analyzed using SPSS version 20.0 software.

Results

The median change from baseline to the most recent CD4 cell count was +292 cells/μl. By 5 years, the overall median (inter-quartile range, IQR) CD4 cell count was 444(263-557) cells/μl while the median (IQR) CD4 cell count was 342(246-580) cells/μl among patients with baseline CD4 cell counts ≤200 cells/μl, 500(241-557) cells/μl among those with baseline CD4 cell counts of 201–350 cells/μl, and 652(537-767) cells/μl among those with baseline CD4 cell counts >350 cells/μl. Higher baseline CD4 cell counts and being male were independently associated with the risk of immunological non-response at 12 months. Furthermore, it was also investigated that these factors were significant predictors of subsequent CD4 cell recovery.

Conclusions

Patients with higher baseline CD4 cell stratum returned to normal CD4 Cell counts though they had an increased risk of immunological non-response at 12 months compared to those with the least baseline CD4 cell stratum. The findings suggest that consideration be given to initiation of HAART at a CD4 cell count >350 cells/μl to achieve better immune recovery, and to HIV-infected male patients to improve their health seeking behavior.     

Spotted hyena (Crocuta crocuta) coexisting at high density with people in Wukro district,northern Ethiopia

We surveyed density and abundance of spotted hyena (Crocuta crocuta) in the highly degraded and prey depleted Wukro district, northern Ethiopia, with a human population density of 98 persons per square kilometer. A total of 117 spotted hyenas responded to callups, giving a hyena density of 52 hyenas per 100 km² or a total population of 535 hyenas in the district. We quantified the economic impact of spotted hyena predation on livestock using semi structured interviews with randomly selected households. Respondents indicated a total loss of 203 domestic animals to hyena depredation over the past five years. Average annual depredation per household was 0.13 livestock worth US$ 6.1. The diet of spotted hyenas was assessed in three sub-districts by scat analysis and showed 99% prey items of domestic origin, only three of 211 scat contained hair of Ethiopian hare (Lepus fagani) and porcupine (Hystrix cristata). We conclude that hyenas in northern Ethiopia live at high density and eat almost exclusively anthropogenic food and are not dependent on conservation areas.     

Partitioning the influence of hydrodynamics-induced physical variables and nutrients on phytoplankton assemblages in a shallow tropical reservoir (Koka,Ethiopia)

Limnology - Ecological processes, population dynamics and species interactions in shallow lakes and reservoirs are affected by seasonal and inter-annual fluctuations in rainfall and runoff. The...     

Elevational changes in vascular plants richness,diversity, and distribution pattern in Abune Yosef mountain range,Northern Ethiopia

The aim of this research is to investigate the patterns of vascular plant species richness,diversity,and distribution along an elevation gradient in the Abune Yosef mountain range,Ethiopia.Preferential systematic sampling was employed to collect vegetation and environmental data along the elevation gradient.We found that plant species richness declines monotonically from low to high elevations.Specifically,vascular plant species richness and diversity were lower in the Afroalpine grassland(high elevation)than in the Dry evergreen Afromontane forest and Ericaceous forest(low elevations).In contrast,endemic vascular plant richness was significantly higher in the Afroalpine grassland than in the Dry evergreen Afromontane forest and Ericaceous forest.Elevation showed a significant impact on the richness,diversity,and endemism of vascular plants.According to Sorensen's coefficient,the similarity between Dry evergreen Afromontane forest and Ericaceous forest vegetation types is higher(32%)than the similarity between Ericaceous forest and Afroalpine grassland(18%).Only 5%similarity was recorded between the Dry evergreen Afromontane forest and Afroalpine grassland.Growth forms showed different elevationai richness patterns.Trees and liana increased monotonically up to 3300 m.Shrub and herb richness patterns followed a hump-shaped and inverted hump-shaped pattern along the elevation gradient.The elevation patterns of vascular plant species richness,diversity,and growth form in the present study may be attributed to differences in management intensity,spatial heterogeneity,microclimatic variations,and anthropogenic disturbances.     

Peri-urban spotted hyena (<Emphasis Type="Italic">Crocuta crocuta</Emphasis>) in Northern Ethiopia: diet,economic impact,and abundance

Global declines of carnivores are related to difficult integration with human land use, in particular conflicts caused by livestock depredation. Spotted hyenas (Crocuta crocuta) live in remarkably close proximity to humans in the degraded and prey-depleted Enderta district, northern Ethiopia. Their diet and interaction with people were investigated in sub-districts close to the regional capital, Mekelle. We interviewed 1,686 randomly selected households from three sub-districts, Debri, Aynalem, and Felege Selam, about livestock management and incidence of depredation from 2005 to 2009. Livestock loss amounted to 492 heads over 5 years; an annual mean of 0.6% worth US$ 7,042. We also performed a survey giving a minimum population estimate of 60 hyenas in the three sub-districts; all but four were found in church forests where they are traditionally tolerated and protected. A total of 1,200 hyena scats were analyzed to determine prey species; the diet contained only domestic species, with sheep being by far the most common prey species. About 5.5% of fecal analysis contained human hairs. We conclude that hyenas depended entirely on domestic prey species, partly through depredation but more importantly through scavenging on (peri-) urban waste. Under the particular local circumstances, continued coexistence appears possible, provided that damage remains tolerable.     

The ecology of large carnivores in the highlands of northern Ethiopia

The degradation and fragmentation of the northern Ethiopian highlands has resulted in frequent encounters of large carnivores with humans and their livestock. We interviewed 500 randomly selected households to estimate economic impact of livestock predation by spotted hyaena (Crocuta crocuta), leopard (Panthera pardus) and jackal (Canis aureus aureus) in the highlands of northern Ethiopia. The annual mean economic loss per household was approximately U.S.$ 20.2, about 7% of the average annual income of households in the area. Households surveyed reported losses of a total of 3122 livestock to hyaena, leopard and jackal predation over the past 5 years. This loss equated to a total financial loss of U.S.$ 50,381 . Livestock predation incidents of spotted hyaena, leopard and jackal demonstrated that spotted hyaena had a preference for dog, donkey, goat and sheep; leopard for goat, dog and sheep; and jackal for goat and sheep. Livestock predation of spotted hyaena and leopard were mainly during the night. We conclude that assessing depredation problems is important to develop actions for management of either livestock practices or wildlife conservation.     

Strong effects of occasional drying on subsequent water clarity and cyanobacterial blooms in cool tropical reservoirs

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Summer Rains and Dry Seasons in the Upper Blue Nile Basin: The Predictability of Half a Century of Past and Future Spatiotemporal Patterns

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