Category Archives: Maternal and neonatal health

Cluster randomized controlled trial to improve maternal and newborn healthcare in Sidama

Pre-print of Research protocol:

This is the pre-print of the protocol for the research group on Neonatal and Maternal Health

Achamyelesh Gebretsadik, Yemisrach Shiferaw, Hirut Gemeda, Yaliso Yaya. Cluster randomized controlled trial to assess the effectiveness of a package of community-based intervention on continuum of maternal and newborn healthcare in Sidama, Ethiopia: The SiMaNeH trial protocol. medRxiv preprint doi: https://doi.org/10.1101/2024.09.01.24312899

Background: Maternal and newborn mortality and morbidity remain high in low- and middle-income countries such as Ethiopia. Limited access and dropouts from essential continuum of care interventions are critical factors. In Ethiopia about one in five complete the continuum of essential care through pregnancy, childbirth, and postnatal period Ethiopia. Evidence is limited on whether a package of interventions involving key community health actors increase the proportion completing essential maternal and newborn healthcare continuum in rural Sidama regional state, Ethiopia.

Objective: This study aims to implement and evaluate the effectiveness of community-based interventions designed to enhance involvement of key community health actors to improve completion rate of continuum of maternal care and utilization of newborn care.

Methods: Twenty rural kebeles (clusters) in Sidama Regional State, Ethiopia, are randomly allocated to intervention and control arms. A total of 2000 pregnant women, 1000 per arm, will be recruited between 20th and 26th week of gestation after intervention. Then they will be followed until six weeks postpartum between June 2024 and February 2025. In the intervention arm, mothers and newborns will receive targeted interventions at home and in their community through a package of interventions designed to improve completion rate of recommended maternal and newborn care. Control clusters will receive normal care from the state public health system. Primary outcomes will be the difference in the completion of continuum of maternal care and essential and emergency newborn care between intervention and control clusters measured by composite indicator constructed from variables. Secondary outcomes include rates of antenatal care completion, facility deliveries with skilled care, completion of at least four postnatal care, essential newborn care, and emergency identification and referrals, mortality measures.

Conclusion: This trial will implement and evaluate community-based intervention package within existing community healthcare infrastructure to produce evidence for informed policy and practice to achieve improved community-based healthcare.

Large regional variations in maternal mortality

Aschenaki Zerihun Kea, from Yirga Alem in southern Ethiopia, is a PhD student in the Joint PhD program at Hawassa University and the University of Bergen (Senuph – I project). He is about to defend his doctoral work.

His research aimed to measure the magnitude and variations in maternal mortality and assess the coverage of skilled birth attendants in the Sidama Region, essential for improving maternal healthcare in Ethiopia.

The study found high maternal mortality in the Sidama Region, with significant district variations. In the past decade, districts of the region have not seen an equal reduction in maternal mortality.

The main impact of this research is to highlight the importance of ensuring equitable emergency obstetric care in all districts of the region. Female education must be
strengthened, and the deployment of midwives has to be improved. All women must be
encouraged to get antenatal care.

His publications on the community surveys of maternal mortality in Sidama include:

Kea AZ, Lindtjorn B, Gebretsadik A, Hinderaker SG.. Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey. PLoS One. 2023 Mar 7;18(3):e0272110. doi: 10.1371/journal.pone.0272110.

Kea AZ, Lindtjorn B, Tekle AG, Hinderaker SG.. Reduction in maternal mortality ratio varies by district in Sidama National Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes. PLoS One. 2023 Oct 12;18(10):e0276144. doi: 10.1371/journal.pone.0276144.

Kea AZ, Lindtjørn B, Tekle AG, Hinderaker SG (2023) Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey. PLOS Glob Public Health 3(12): e0002466. https://doi.org/10.1371/journal.pgph.00024666.

 

New paper: Seasonal variations in household food security and consumption affect women’s nutritional status in rural South Ethiopia

Mezgebe B, Gari T, Belayneh M, Lindtjørn B (2024) Seasonal variations in household food security and consumption affect women’s nutritional status in rural South Ethiopia. PLOS Glob Public Health 4(8): e0003294. https://doi.org/ 10.1371/journal.pgph.0003294

Abstract
Food availability varies seasonally in most rural areas of developing nations, especially in areas affected by drought and climate change, with women being one of the most vulnerable groups. This study aimed to assess the effect of seasonal variation in household food security, adequate dietary diversity, food consumption, and wealth on the nutritional status of women of reproductive age in a rural community in South Ethiopia. Further, the study aimed at identifying associated factors with women’s nutrition status. An open cohort study was conducted from June 2021 to June 2022, with follow-up visits every three months. Anthropometric measurements were carried out along with interviews. Data were analyzed using STATA version 15. Multilevel, multiple linear regressions were employed. Findings revealed that women’s average body mass index (BMI) was 20.4 kg/m2 (95% CI: 20.4–20.5). The highest (20.6 kg/m2, 95% CI: 20.5–20.8) was observed in December, while the lowest (20.2 kg/m2, 95% CI: 20–20.3) occurred in September. During the main postharvest period in December, the household food insecurity score was the lowest (median: 4, Inter quartile range (IQR): 0–9), while the household dietary diversity score (median: 6, IQR: 5–7), and the household food consumption score were the highest (median: 50.5, IQR: 44–70). Factors such as household food security, food consumption, previous season BMI, age, marital status, and membership in safety net programs were identified as determinants of women’s BMI. The study showed the vulnerability of women in drought-prone areas to seasonal undernutrition. We recommend collaborative work among stakeholders to ensure sustainable food access and minimize seasonal food shortages’ effect on women’s nutrition and overall well-being.

For more information about PhD student Bethlehem Mezgebe’s work, visit the link

New PhD at Hawassa University

On April 23, 2024, Zelalem Tenaw defended his PhD thesis at Hawassa University titled “Reproductive Health Service Utilization and Burden of Problems among Women with Disabilities in Sidama Region, Ethiopia”.

His PhD thesis and publications can be downloaded here.

This study aimed to assess the utilization of reproductive health services and the burden of reproductive health problems among women with disabilities in the Sidama Region in Ethiopia. It used a cross-sectional study design of 652 women with disabilities. Two-thirds had recently experienced an unintended pregnancy, and 60% of reproductive-age females with disabilities reported sexual violence experience. Only 27 % were current contraceptive users, and transport accessibility, age, and types of disability determined their contraceptive use. Also, age, residency, income, parity, alcohol use, and sexual information were the risk factors. It is essential to implement strategies for raising contraceptive awareness and incorporating at-home contraceptive provision into the health extension programs.

Zelalem Tenaw earned his BSc in midwifery at Hawassa University and a Master’s in Maternity and reproductive health at Addis Ababa University in 2015. He is an assistant professor at Hawassa University.

Zelalem’s achievement is the first PhD in Public Health at Hawassa University, a testament to his dedication and the university’s commitment to advancing knowledge in this field. This is a significant achievement at the College of Medicine and Health Sciences. Zelalem is the first to enroll and complete his doctoral work as a “pure Hawassa PhD graduate.” Students before him were also attached to other universities.

The Senuph project aims to strengthen the College of Health Sciences to run good PhD programs. In the case of Zelalem Tenaw, both his supervisors are attached to the Senuph project, and the Senuph program has participated in giving PhD courses at the institution. We are now looking forward to more PhD graduates completing their Ph.D.

Strengthening neonatal and maternal health

The maternal and neonatal research team aims to improve the quality of care for mothers and newborns within the community. The team collaborates with community health workers and health development teams, directly influencing the local health system.

The photo illustrates a training session conducted by members of the maternal and neonatal research team and health extension workers for the health development teams residing in the Gala Argiso kebele in the Sidama region of Ethiopia. These health development teams are volunteers dedicated to addressing maternal and newborn health issues at the grassroots level. Additionally, it seeks to educate mothers on self-care practices during pregnancy and postpartum and guide them on when to seek medical attention for health concerns.