Integrated Family Health Program

(IFHP)

A Compendium of Operation
Researches, Technical and
Program Briefs
2008 - 2016
Disclaimer
“This publication is made possible by the generous support of the American people through
the United States Agency for International Development (USAID) with a central field support
mechanism to the Evidence to Action (E2A) project under a cooperative agreement number of AID-
OAA-A-11-00024. The contents are the sole responsibility of IFHP and do not necessarily reflect the
views of USAID or the United States Government.”
© Integrated Family Health Program 2016
Contents
Foreword ...................................................................................................................................... 3
Preamble ...................................................................................................................................... 2
Research and studies
Family Planning
Addressing unmet need for long-acting family planning in Ethiopia: Uptake of single-rod
progestogen contraceptive implants (Implanon) and characteristics of users ..................................... 5
Utilization and determinants of modern family planning among women of reproductive age group
in Ethiopia: results from Integrated Family Health Program ................................................................. 6
Implanon removal experiences of women in Butajira, Ethiopia ........................................................... 7
Identification of Factors Associated with Method Shift from Short-Acting to Long-Acting Methods of
Contraception in Amhara Region of Ethiopia ........................................................................................ 8
Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-
Methods Study ..................................................................................................................................... 9
Maternal and Newborn Health
The Status of Desired Maternal and Child Health Practices and Service Utilizations of Model
Families of the Health Extension Program in SNNPR, Ethiopia ............................................................. 10
Magnitude and Factors that Affect Males’ Involvement in Deciding Partners’ Place of Delivery in
Tiyo District of Oromia Region, Ethiopia................................................................................................ 11
Magnitude and Predictors of Skilled Delivery Service Utilization: A Health Facility-Based, Cross-
Sectional Study in Tigray........................................................................................................................ 12
Determinants of Maternal Health Services Utilization in SNNPR; the Case of Hawassa City
Administration....................................................................................................................................... 13
Birth Preparedness and Complication Readiness among Rural Women of Reproductive Age in
Abeshige Woreda, Gurage Zone, SNNPR, Ethiopia................................................................................. 14
Assessment of Factors Associated With Perinatal Mortality among Public Hospital Deliveries in
Addis Ababa, Ethiopia............................................................................................................................ 15
Child Health
Assessment of health care-seeking behavior of caregivers for common childhood illnesses in
Shashogo Woreda, Southern Ethiopia .................................................................................................. 16
A Descriptive Study of the Changes in Coverage of Preventive and Promotive Interventions Before
and After the Introduction of Integrated Community Case Management (iCCM) in Ethiopia .............. 17
Quality and use of IMNCI services at health center under-five clinics after introduction of integrated
community-based case management (iCCM) in three regions of Ethiopia ........................................... 18
HIV/AIDS/PMTCT
The Effect of Integrating Family Planning with HIV and AIDS Services on Contraceptive Uptake
among HIV Positive Women ................................................................................................................ 19

1
Utilization of Prevention of Mother to Child Transmission (PMTCT) Services and Factors that Affect
Knowledge and Service Uptake among Pregnant Women Attending Antenatal Care in East Hararge
Zone of Oromia Regional State ............................................................................................................ 20
Malaria
Effect of Integrated Community Case Management of Common Childhood Illnesses on the Quality
of Malaria Case Management Provided by Health Extension Workers at Health Posts ........................ 21
Gender Mainstreaming
A Qualitative Analysis of the Experience of Women Supported by the Integrated Family Health
Program to Reach Fistula Repair Services: Their Experience of Repair Services and Re-integration .... 22
Adolescent and Youth Sexual Reproductive Health
Parent-Adolescent Communication and Associated Factors on Sexual and Reproductive Health
Issues among High School Adolescent Students in Sebeta Town, Oromia Region, Central Ethiopia ..... 23
Menstrual Hygiene Management and School Absenteeism among Female Adolescent Students in
Northeast Ethiopia ................................................................................................................................ 24
Others
The status of hygiene and sanitation practice among rural model families of the health extension
program in Wolayta and Kembata Tembaro Zones of Southern Nations, Nationalities and Peoples’
Region of Ethiopia ................................................................................................................................. 25
Program and Technical Briefs
The Technical Advisory Committee: Providing Stewardship to Health Programs in Ethiopia ................ 26
Integrating Family Planning and HIV in Ethiopia: An Analysis of Pathfinder’s Approach and Scale-
Up........................................................................................................................................................... 26
m4Youth: Providing Sexual and Reproductive Health Information to University Students and Peer
Educators ............................................................................................................................................... 27
Prevention and Treatment of Fistula: Pathfinder International’s Experience in Ethiopia and Ghana.... 27
Scale-Up of Task-Shifting for Community-Based Provision of Implanon................................................. 28
Scaling Up Community-Based Service Delivery of Implanon: The Integrated Family Health Program’s
Experience Training Health Extension Workers...................................................................................... 28
Strengthening Health Service Delivery in Ethiopia: The Integrated Family Health Program.................. 29
Strengthening Community and Health Systems for Quality PMTCT: Applications in Kenya, Nigeria,
South Africa, and Ethiopia...................................................................................................................... 29
Strengthening the Continuum of Care for fistula Prevention and repair in Ethiopia ............................. 30
Bringing Youth-Friendly Services to Scale in Ethiopia ............................................................................ 30
Introducing Operations Research to Large-Scale Program Implementation in Ethiopia ....................... 31
EXPANDING CONTRACEPTIVE OPTIONS FOR POSTPARTUM WOMEN IN ETHIOPIA: INTRODUCING
THE POSTPARTUM IUD.......................................................................................................................... 31
Testing a Service-Delivery Model for Offering Long-Acting Reversible Contraceptive Methods to
Youth in Ethiopia (Policy Brief)................................................................................................................ 32

2
Foreword
Writing is the most important means for communicating scientific work. Research and
publication complement teaching and training, clinical care, and public health works.
The most compelling reason for many professionals to start writing is to fulfil specific job
requirements by employers that include promotion to an academic position, professional
accreditation in the form of continuing medical education (CME), and improving
prospect of success in research grant application. Publications can also be regarded as
an asset that enables authors to gain recognition and acknowledgement as experts in a
particular field at national and international levels.
Program learning and documentation were one of the major result areas for the
Integrated Family Health Program (IFHP) which helped the program to use evidence
based planning and decisions throughout its implementation and share results for others
use. This compendium is a compilation of IFHP’s published works including operation
researches, technical briefs, and other studies done by the program over the past eight
and half years. The compendium includes abstracts of over 30 publications, some of
which are already published in peer reviewed journals and others as technical briefs can
be accessed in full version from the links included in each of the papers.
Implementing research and publishing results is crucial for a career in sciences.
Doing research is only half of the picture. If the results of research studies or program
documentations are not published, other researchers cannot appreciate the value of
the evidence generated, they cannot see the evidence or further build on it, and overall
science cannot develop and grow. With this principle, we are sharing this compendium
to contribute to the overall knowledge and evidence in the different technical areas, and
development of science.
I would like to extend my sincere gratitude to all our staffs, consultants, partners, and
beneficiary communities who contributed in one way or the other in the generation
of the different evidences presented in each of the paper. I am also grateful to the
financial and technical support of USAID in producing these evidences as part of the
implementation of IFHP.
I hope readers will benefit from the evidence presented in the different publications
and can contribute their share by interacting with the authors in using the evidence and
generating new ones in the future.

Mengistu Asnake (MD, MPH)

Chief of Party

3
Preamble
Organizations learn from their successes and failures. Learning helps improve program
coverage and quality by building on the successes and avoiding the drawbacks.
Program lessons are acquired in different forms among which include; conducting
operation researches, documenting program experiences and synthesizing model
practices. IFHP underscores the need for decision makers, health professionals,
communities, and program staff to be able to find, use and share lessons based on
experiences of what works and what doesn’t. As a demonstration of its commitment, the
program prioritized systematic program learning as one of its primary objectives. To this
end, a number of formative researches and program assessments have been conducted
and utilized since the program’s inception. The results of the studies were used to
improve program management and service delivery.
Noting the knowledge contained in those studies and assessments, this compendium
has been prepared. The purpose of the compendium is for wider dissemination of our
experiences to a greater audience, and where possible, to provide knowledge base
for implementers of similar programs at home or abroad. We sincerely hope that the
evidences contained in this single report provide a quick summary and references of our
program.
This compendium is a compilation of IFHPs published works including operation
researches, technical briefs, and other studies. It also includes Master’s theses that
the program financed in areas pertinent to family health. Most of the research based
articles are published in peer reviewed journals. The briefs were developed, printed
and distributed during national and international conferences documenting relevant
experiences of IFHP. Electronic copies of the briefs are archived at IFHP website (www.
ifhp.org). Electronic retrieval of the full published research documents is possible
through the hyperlinks provided next to each article. Journal names, volume and issue
number have also been provided for interested readers who want to delve in to details.
It has to be noted that this compendium does not contain all the documentations
produced during the program period. Unpublished research reports that did not undergo
peer review are not included. The compendium is arranged based on subject and hence
the order is neither chronological nor based on relevance.

4
Research and studies
Family Planning
Addressing unmet need for long-acting family planning in Ethiopia: Uptake of
single-rod progestogen contraceptive implants (Implanon) and characteristics of
users
Authors: Mengistu Asnake, Elizabeth G. Henry, Yewondwossen Tilahun, Elizabeth
Oliveras
Journal Name: International Journal of Gynecology and Obstetrics 123 (2013) e29–e32
Full Text Link: http://dx.doi.org/10.1016/j.ijgo.2013.07.003
Introduction: To avail LAFP-Implanon at the community level, the Ministry of Health
(MoH) launched a national Implanon scale-up program in 2009. The program includes
training of Health Extension Workers (HEWs) to insert Implanon at the health post (HP)
level. USAID’s Integrated Family Health Program (IFHP) as a major partner to the MoH,
trained HEWs on Implanon insertions and provided post training and gap filling supply
support to initiate the service at the HP level.
Objective: To describe women who accept single-rod progestogen contraceptive implants
from community health workers in Ethiopia.
Methods: Women who accepted Implanon during training events in 4 regions were asked
about their characteristics and use of family planning. They were compared with implant
users nationally. Differences between groups were tested using 2-sample comparisons of
proportions.
Results: On average, Implanon acceptors were younger and had more years of education
and fewer children than implant users nationally. Almost one-quarter (22.9%) of all
participants had never used contraception before; this was slightly higher among women
who chose Implanon (23.1% vs 16.4%), P = 0.04. Implanon acceptors were also
less likely than non-acceptors (70.8% vs. 77.3%) have used contraception previously
(p=0.05). Women living in urban areas were more likely to be using contraception than
women living in rural areas. Women who accepted Implanon were younger but more
educated than women with unmet need for contraception in the 2005 DHS.
Conclusion: Provision of Implanon at the community level through community health
workers is effective in reaching women with the greatest need for contraception.

5
Utilization and determinants of modern family planning among women of
reproductive age group in Ethiopia: results from Integrated Family Health Program.
Authors: Bekele Belayihun, Girma Kassie, Mengistu Asnake, Habtamu Zerihun, Ismael
Ali
Journal: Ethiop. J. Health Dev. 2016; 30(1):0-00
Full Text Link: http://www.ejhd.org/index.php/ejhd/article/view/481/344
Background: Family planning improves community health and wellbeing by helping
women to space and/or limit the number of children they want until they are physically
and financially prepared.
Objective: The aim of this study was to assess utilization and determinants of modern
family planning among women of reproductive age in Ethiopia.
Methods: The study interviewed 2,404 women of reproductive age using a cross-
sectional household survey. It was conducted in four major regions of Ethiopia (Tigray,
Amhara, Oromia and Southern Nations, Nationalities and Peoples (SNNP)) from April 28
to May 30, 2013. Samples were selected using a two-stage stratified sampling process.
Descriptive and logistic regression methods of analysis were used to analyze utilization
of modern family planning and the factors associated with it.
Result: The mean age of respondents’ was 28.6 years (S.D=8.67). The most commonly
used methods of family planning are injectables. Multivariable analysis showed that
discussion with partner/husband about family planning practice in the last 6 months
(AOR=6.1, 95%CI=4.73-7.81) and respondents who knew health extension workers
providing family planning services (AOR=1.57, 95% CI=1.23-2.01) were significantly
associated with the use of modern family planning methods.
Conclusion: Results of this study revealed that the number of respondents who have
discussed with husband/partner about family planning and respondents who knew the
family planning service providers were high utilizers of modern family planning methods.
Our findings also indicated that current use of modern family planning increases with
women’s education, and creating a conductive environment for women’s education is
critical. Additional efforts are required to promote modern family planning utilization,
partner participation, and couple counselling for join to decision making to improve
modern family planning use.

6
Implanon removal experiences of women in Butajira, Ethiopia
Authors: Habtamu Zerihun, Amanuel Biru, Alehegn Worku, Eyasu Desta, Hailemarialm
Tafesse, Hika Dinssa, Ashenafi Asmelash, Tadelle Hailu, Tekalign Damena, Mirgissa
Kaba, Mitike Molla, Eshetu Girma, Mulugeta Tamire
Journal: Ethiop. J. Health Dev. 2015; 29(3):176-182
Full Text Link: http://www.ejhd.org/index.php/ejhd/article/view/367
Introduction: Over the last decade, a lot of advocacy work has been done to increase
long acting and permanent contraceptive methods (LAPMs) use in Ethiopia. However,
LAPMs uptake is very low compared to short acting ones where eventual disinterest and
subsequent removal of the method is observed.
Objective: This study was carried out to explore reasons behind implanon removal within
unreasonably short time after insertion.
Methods: An exploratory qualitative study was employed to apply class room qualitative
research method training organized by the School of Public Health, Addis Ababa
University. Research participants were purposively selected women in Bido and Diram
kebeles of rural Butajirra, which is a research site of the School of Public Health, Addis
Ababa University’s. Nine women who had recently removed implanon and two health
extension workers (one from each kebele) were interviewed. Data analysis was facilitated
using ATLAS.ti qualitative software and presented using content analysis.
Results: Study participants were aware of the different types of family planning (FP)
services available at the health facilities. However, women did not get two sided
information which explains the benefits and side effects of implanon. Women in this
study reported that the main reasons for early implanon removal were perceived side
effects, desire to get pregnant, partner pressure and at times, religious leaders delay the
burial of a woman who had implanon. After implanon removal, some reported to have
shifted back to short acting FP methods while others reported to have faced unintended
pregnancy. Though implanon insertion is conducted at a community level, removal was
possible only at health centers or Hospitals and this has created discomfort and anxiety
among women.
Conclusion and recommendation: Women’s agency to decide on their reproductive
health, cultural influences, and inadequate information was the main causes for the
untimely removal of implanon. Working with community leaders, access to implanon
removal services at a community level and strengthening the pre-insertion counseling
process to assure informed choice would help to avoid unnecessary removal of implanon
and increase uptake.

7
Identification of Factors Associated with Method Shift from Short-Acting to Long-
Acting Methods of Contraception in Amhara Region of Ethiopia
Authors: Habtu Atnafu, Yigzaw Dires, Amare Yeshambaw, Seid Ali, Wondimu Gebeyehu,
Shewangizaw Bereda, Fikre Enqusilassie, Alemayehu Mekonnen, Adamu Addissie, Seifu
Hagos
Journal: Ethiopian Journal of Health Development, Volume 28, special issue, 2014,
1-43
Full Text Link: http://www2.pathfinder.org/site/DocServer/EJHD_special_issue.
pdf?docID=20241
Background: Family planning can prevent at least 25% of all maternal deaths by
allowing women to delay motherhood, prevent unintended pregnancies, and avoid unsafe
abortions. It also protects women from sexually transmitted infections (STIs), including
HIV, and allows them to stop childbearing when they have reached their reproductive
goals.
Objective: To identify factors associated with method shift from short-acting to long-
acting methods of contraception in Amhara region of Ethiopia.
Methods: A descriptive, cross-sectional, quantitative, facility-based study was carried out
on 986 women of reproductive age who were currently using short-acting family planning
methods in 17 health centers.
Results: Out of the 986 short-acting family planning users interviewed, 18.2% explained
their intention to shift from short-acting to long-acting methods of contraception
of which 95.6 % had preference for implants and the remaining intend to shift to
intrauterine contraceptive device (IUCD).
Prior information about long acting FP methods and the need to delaying pregnancy, fear
of side effects and desire to have more children the reasons mentioned.
Conclusion: Considerable proportion of women had the intention to shift from short-
acting to long-acting methods of contraception. Having information about long-acting
methods of contraception and not planning to have children in the future were found
to be the major factors in intention to shift from short-acting to long-acting methods of
contraception.
Recommendations: We recommend provision of comprehensive family planning
counseling and services by health workers and health extension workers and
strengthening behavioral change interventions to change negative attitudes at the
community level.

8
Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia:
A Mixed-Methods Study
Authors: Yewondwossen Tilahun, Sarah Mehta, Habtamu Zerihun, Candace Lew,
Mohamad I Brooks, Tariku Nigatu, Kidest Lulu Hagos, Mengistu Asnake, Adeba Tasissa,
Seid Ali, Ketsela Desalegn, Girmay Adane
Journal: Glob Health Sci Practice. 2016; 4(1):16-28 .
Full Text Link: http://dx.doi.org/10.9745/GHSP-D-15-00365

Background: In Ethiopia, modern contraceptive prevalence among currently married

women nearly tripled over the last decade, but the method mix remains skewed toward
short-acting methods. Since 2011, the Integrated Family Health Program (IFHP+),
jointly implemented by Pathfinder International and John Snow Inc., has supported the
Federal Ministry of Health to introduce intrauterine devices (IUDs) in more than 800
health centers across 4 regions to improve access to a wider range of methods.
Objective: The objective of the study was to better understand client characteristics and
inform future programming by assessing the impact of IFHP+’s support for the Ethiopian
government’s IUD initiative in program-supported regions.
Method: This study is a cross-sectional survey of 2,943 family planning clients who
accepted the IUD; explore reasons for method discontinuation among 165 clients
seeking IUD removal services; and identify facilitators and barriers to IUD use through
focus group discussions
Result: Introduction of IUDs into the 40 health centers participating in the study
showed statistically significant increase in the contribution of all long-acting reversible
contraceptives (LARCs)—both IUDs and implants—to the method mix, from 6.9%
in 2011 to 20.5% in 2014 (Po.001). The most commonly cited reason for seeking
IUD removal services was a desire to become pregnant (43% of women). Qualitative
data indicated that while acceptability of the method is growing, limited community
awareness, myths and misconceptions about the IUD, and infrastructure deficits
at health centers must be addressed to further expand access to a broad range of
contraceptive methods.
Conclusion and Recommendation: Given that IUDs constitute such a small proportion
of contraceptive use throughout sub Saharan Africa, our study presents relevant
considerations for ensuring that clients’ contraceptive choice is respected and fulfilled
across the region.

9
Maternal and
Newborn Health

The Status of Desired Maternal and Child Health Practices and Service Utilizations
of Model Families of the Health Extension Program in SNNPR, Ethiopia
Author: Mengistu Asnake, Girma Kassie, Tariku Nigatu, Habtamu Zerihun and Kare
Chawecha
Journal: Journal of Community Medicine & Health Education
Full Text Link: http://dx.doi.org/10.4172/2161-0711.1000258
Background: Maternal and Child Health (MCH) is one of the main focus areas of the
Health Extension Program (HEP). Therefore, assessing the status of MCH service
utilization of families benefiting from the HEP is critical to inform progress of the
program and future directions.
Objective: The purpose of this study is to assess the status of desired MCH practices and
service utilization of families benefiting from the HEP in SNNPR state of Ethiopia.
Method: A cross-sectional comparative study was conducted from December 2010 to
June 2011 in Wolayta and Kembata Tembaro Zones of Southern Nations, Nationalities
and Peoples Regional State of Ethiopia. Comparison of selected variables that show
MCH service utilization was made between a randomly selected 690 model families and
686 non-model families. Qualitative data were collected from the two selected zones
to complement the findings of the quantitative data. The qualitative data was collected
from a purposively selected group of women and men among model families. Descriptive
and analytics statistics were used to analyze the quantitative data using STATA version
10 while the qualitative data were analyzed using Open Code version 3.6.2.0.
Results: The study showed that ITN ownership and utilization by model families
was 66.9% and 58.4% as compared to 53.3% and 42.6% by non-model families,
respectively (p<0.01). Similarly, ever and current use of family planning was 45.4%
and 32.3% as compared to 33.6% and 18.6% among model and non-model families,
respectively (p<0.001). Nearly half (47.3%) of the women in model families had ever
tested for HIV while 35.2% of the women in non-model families did the same (P<0.01).
Forty two point three Percent (42.3%) of husbands in model families also tested for HIV
while only 35.8% of their counterparts in non-model families did the same (p<0.01).
Conclusion: Generally, model families performed better than non-model families. The
government’s decision of making all households models through the implementation of
the health development army is a timely decision. Regular follow up of model families
after graduation help further improve outcome and sustain the gains.

10
Magnitude and Factors that Affect Males’ Involvement in Deciding Partners’ Place
of Delivery in Tiyo District of Oromia Region, Ethiopia
Authors: Wassie Lingerh, Bekele Ababeye, Ismael Ali, Tariku Nigatu, Heran Abebe,
Getnet Mitike, Mitike Molla, Seifu Hagos, Adamu Addissie
Journal: Ethiopian Journal of Health Development, Volume 28, special issue, 2014,
1-43
Full Text Link: http://www2.pathfinder.org/site/DocServer/EJHD_special_issue.
pdf?docID=20241
Background: Skilled birth attendants at health facilities reduce the death toll on mothers
and newborns significantly. To the knowledge of the investigators, male involvement in
deciding on the partners’ place of delivery and factors that affect male involvement have
not been studied adequately in the Ethiopian context.
Objective: The study aims to assess male partners’ involvement in deciding on their
spouses’ place of delivery and to identify factors associated with this involvement in the
Tiyo district (woreda) of Arsi zone, Ethiopia.
Methods: A community-based cross-sectional survey was conducted between January
and February 2012 in Tiyo district of Oromia Region. The study involved both
quantitative and qualitative methods. A list of males whose partners gave birth within 12
months prior to the survey was prepared. A total of 999 men were included in the study.
In addition, separate male and female focus group discussions (FGDs) were conducted
to obtain additional information and to triangulate the quantitative findings. Data were
collected using interviewer-administered questionnaires and FGD guide. Descriptive and
analytical statistics were calculated to summarize the data and explore associations.
Results: The majorities of respondents were farmers (93.4%) and had formal education
(84.6). Joint partners’ source of income (OR (95% CI ) =4.25 (1.77- 10.2)),making
joint decision on antenatal care (ANC) service uptake (OR (95% CI) =3.61 (1.52-8.57)),
history of previous institutional delivery (OR( 95% CI) =2.10 (1.15-3.85)) and owning
radio and tape-recorder (OR (95% CI) =1.77 (1.20-2.85)) were significantly associated
with male involvement in deciding their spouses’ place of delivery. Qualitative findings
showed low level of awareness of the benefit of health facility service use for delivery,
low level of knowledge of danger signs related to pregnancy and delivery, and traditional
and cultural influences on perceptions.
Conclusion: Girls and women should be empowered by education and income-generating
activities and male-targeted messages should be deployed through mass media to
motivate male partners to be involved in jointly deciding their spouses’ place of delivery..

11
Magnitude and Predictors of Skilled Delivery Service Utilization: A Health Facility-
Based, Cross-Sectional Study in Tigray
Authors: Tesfaye Gebru, Desta Gebre-Egziabher, Kelali Tsegay, BrhaneHadera, Mesfin
Addissie, WorkuTefera, Seifu Hagos, Adamu Addissie
Journal: Ethiopian Journal of Health Development, Volume 28, special issue, 2014,
1-43
Full Text Link: http://www2.pathfinder.org/site/DocServer/EJHD_special_issue.
pdf?docID=20241
Background: A skilled birth attendant for every pregnant woman during childbirth is
the most crucial intervention for improving maternal and child health. Ethiopia has
a maternal mortality ratio of 676 per 100,000 live births. The majority of births are
delivered at home and the proportion of deliveries assisted by skilled attendants is very
low at 10%.
Objective: To assess utilization of skilled delivery service and associated factors.
Method: A facility-based, cross-sectional survey was conducted in 35 randomly-selected
health centers in March 2012, targeting women who had delivered 12 months prior to
the survey and had come for EPI services for their children under the age of one. A total
of 911 women were interviewed using a pretested and structured questionnaire.
Result: Among the study subjects, 46.8% utilized skilled delivery service, and mothers’
level of education, knowledge on delivery complications, family monthly income,
and distance to health facility were significantly related to the utilization of skilled
delivery service. Women with at least primary education were two times more likely
(AOR (95%CI) =2.19 (1.33-3.61)) to utilize skilled delivery service. Women who had
knowledge of delivery complication were greater than three times more likely to have
used skilled delivery (AOR (95%CI) =3.577 (150-11.12)). Women with monthly family
income greater than birr 500 were two times more likely (AOR (95%CI) =2.438 (1.256-
4730)) to utilize skilled delivery service. Women whose travel to a health facility is less
than an hour are four times more likely to have a skilled birth attendant (AOR (95% CI)
=4.01 (2.30-7.00))
Conclusion and Recommendations: This study revealed a very high proportion of mothers
had attended skilled birth attendants (46.8%). Knowledge about delivery complications,
education level, household income, and distance from health facility were linked to
skilled-delivery attendance of mothers. Increasing availability and accessibility of health
facilities and promotion of antenatal care follow-up with provision of maternal and child
health information particularly on delivery complications or danger signs are vital for the
increased utilization of a skilled-delivery attendant.

12
Determinants of Maternal Health Services Utilization in SNNPR; the Case of
Hawassa City Administration
Author: Kare Chewecha, Nigatu Regassa
Publication: Master’s Thesis
Background: Globally maternal mortality is a serious problem where about half a million
women die every year and about 673 maternal deaths /100,000 live births occur
nationally in Ethiopia. Maternal health services such as antenatal care, delivery services,
postnatal care and family planning services on the other hand are important in improving
maternal and child survival. The aim of this study was to assess the determinants of
maternal health services utilization in Hawassa city, SNNPR, Ethiopia.
Method: A cross sectional survey was conducted during the months of December 2011
to Feb, 2012 among 401 women of childbearing age groups with a response rate of
99.8%. A pretested structured questionnaire consisting of socio demographics and
health services related factors were administered. Data were analyzed using SPSS
software (Version 6) for frequency distribution, bivariate as well as multivariate analysis
Result: The study showed that approximately half (52%) of the women visited ANC
services four or more times during the last pregnancy, while 62% of the women delivered
their last child at health facility level. Among women who have knowledge of family
planning methods (97.5%), currently only 44.2% of them were using contraception and
37.2% of the women reported that the last child got fully immunized
The results of the multivariate analysis showed that frequency of the radio listening,
religion, and respectfulness of health workers’ were found to be associated with
utilization of ANC service uptake. The literacy status of women, the frequency of radio
listening, religion, occupation and household size have shown strong association with
institutional delivery. In general, the study revealed that socio-demographic and service
related factors were the most important predictors which had influenced the use of
maternal health services.
Conclusion and recommendation: Educating women, improving access to information
and behavior and respectfulness of the health workers, creating employment opportunity
for women and improving accessibility of health services for women and children are
important

13
Birth Preparedness and Complication Readiness among Rural Women of
Reproductive Age in Abeshige Woreda, Gurage Zone, SNNPR, Ethiopia
Author: Kebebush Zepre
Advisor: Mirgissa Kaba
Full Text Link: http://etd.aau.edu.et/bitstream/123456789/6567/1/KEBEBUSH%20
ZEPRE.pdf
Publication: Master’s Thesis
Background: Every pregnant woman is at risk of pregnancy complications which are
unpredictable and can lead to maternal and neonatal morbidity or mortality. Birth
preparedness and complication readiness (BPCR) is a tool that promotes utilization of
maternal health services there by improving maternal and neonatal survival.
Method: Community-based cross-sectional study supplemented by qualitative design
was conducted from February to march 2015. A total of 454 women from 8 kebeles
were selected after proportionally allocated to population size and interviewed using
structured and semi-structured, pre-tested questionnaires. Qualitative data also
collected from purposely selected members of the community by using open ended
questionnaires .Quantitative data were analyzed using SPSS and associations were
determined using regression analysis. Qualitative data on the other hand were analyzed
in line of study objective manually.
Results: In This study about 37.2% of the respondents were prepared for birth and its
complications. BPCR was lower among mothers who were farmer (AOR= 0.50, 95% CI:
0.28, 0.91).However, BPCR was higher among Women who live within one hour walk
from health center (AOR =3.51, 95% CI:1.78,36.79),Women who had awareness on
danger signs of pregnancy (AOR=1.72, 95% CI=1.78, 2.94) and on danger signs of
postpartum (AOR=2.32, 95% CI: 1.32, 4.21).Source of information about BPCR from
health extension worker and mother’s one to five network (AOR=2.81, 95% CI:1.34,
6.21) and (AOR=2.52, 95% CI=1.17, 5.54) respectively also had significant association
with BPCR.
Conclusion: This study revealed practice of BPCR was low (37.2%) due to; access
to health facility, awareness on danger signs of obstetric complication, and health
information related factors. Based on this finding; enhancing women awareness about
obstetric danger signs through repeated sensitization, strengthening BPCR information
network at grass root level and better access to health facility help to improve practice of
BPCR.

14
Assessment of Factors Associated With Perinatal Mortality among Public Hospital
Deliveries in Addis Ababa, Ethiopia
Author: Yemisrach Getiye,
Advisor: Mesganaw Fantahun
Full Thesis Link: http://etd.aau.edu.et/bitstream/123456789/6672/1/yemisrach%20
final.pdf
Publication: Master’s Thesis
Background: Perinatal mortality is a death of fetuses weighing at least 1000gm or
28weeks of gestation or more if weight is not available and death of live newborn before
the age of 7 days. It makes three fourth of the deaths of the neonatal period and widely
used as a health indicator for newborn care and reflects prenatal, intra partum and
newborn care.
Methods: An unmatched case control study using secondary data as a source of
information was conducted. A total 1113 samples (376 cases and 737 controls) were
recruited from four public hospitals of Addis Ababa. Cases were still births and early
neonatal deaths and controls were live births and neonates who were discharged alive
from the hospital and did not die before the age of 7 days. The study period was from
January 1st up to February 30/ 2015. Epi-Info version 7.0 and SPSS Version 21 were
used for data entry and analysis respectively. Descriptive statistics using measure of
central tendency and dispersion, frequencies, proportions and diagrams was used to
check its distribution and describe the study population in relation to relevant variables.
Logistic regression model was used to identify the important factors that are associated
with perinatal mortality.
Results: The mean age of the mothers for cases and controls were 26.47+4.87 and
26.95+4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the
first time. Obstetric complication occurred in 64.4% of cases and 43.8% of controls.
Factor that are significantly associated with increased risk of perinatal death were
birth interval less than 2 years (AOR=4.55; 95%CI(1.79-11.54), preterm delivery
(AOR=4.55;95%CI(1.79-11.54)), anemia(AOR= 2.6;95%CI(1.38-4.91) and the others
were congenital anomaly, previous history of early neonatal death and low birth weight).
Use of partograph was another factor that is associated with decreased risk of perinatal
mortality (AOR=0.35; 95%CI (0.18-0.66)).
Conclusion & recommendation: From factors that are associated with perinatal death,
some of them can be prevented with early investigation of pregnant mothers up on
their follow up to identify abnormalities and manage them accordingly. In addition,
appropriate labor follow up and monitoring with regular use of partograph, immediate
newborn care and interventions to delay birth interval should be addressed.

15
Child Health
Assessment of health care-seeking behavior of caregivers for common childhood
illnesses in Shashogo Woreda, Southern Ethiopia
Authors: Bekele Demissie, Berhanu Ejie, Habtamu Zerihun, Zergu Tafese, Getu Gamo,
Tilahun Tafese, Abera Kumie, Jemal Haider, Adamu Addissie ,Seifu Hagos
Journal: Ethiopian Journal of Health Development, Volume 28, special issue, 2014,1-43
Full Text Link: http://www2.pathfinder.org/site/DocServer/EJHD_special_issue.
pdf?docID=20241
Introduction: Improving families’ care-seeking behavior can contribute significantly to
reduction in child mortality. Studying the status of care-seeking behavior and associated
factors help to curve trends in child morbidity and mortality.
Objective: To assess the status of health care-seeking behavior of caregivers for
childhood illnesses and associated factors.
Method: Descriptive cross-sectional study design was employed in Shashogo district
during January 2012. Sample size of 908 was estimated using EPI info 3.5.1. Data was
coded and entered into EPI info, and then exported to SPSS version 20 for analysis.
Logistic regression was used to determine predictors and control confounding variables.
Results: The common symptoms reported were fever (91.0%), cough (66.5%), and
diarrhea (38.5%). Care was sought from public (43.6%) and private (24.9%) facilities.
Considerable proportion of caregivers (31%) did not seek care. Logistic regression
analysis revealed that marriage (AOR (95% CI) =3.16 (1.33-7.51)) and knowledge (AOR
(95% CI) =1.39 (1.04-1.87), sex of child (AOR (95% CI) =1.49 (1.13-1.97), main
symptoms of illness: cough (OR (95% CI) =2.24 (1.65-3.04) and diarrhea (OR (95% CI)
=1.47(1.10-1.96) were found to be predictors of health-seeking behavior.
Conclusion: Considerable proportion of caregivers did not seek care for childhood illness
and most caregivers did not know where and when to seek care. Most often care sought
was delayed after 24 hours of recognition of child’s illness. Basic health care services
at community level should be strengthened. Information, Education, Communication/
Behavior Change Communication (IEC/BCC) strategies should be strengthened to
enhance appropriate and prompt health care-seeking practices.

16
A Descriptive Study of the Changes in Coverage of Preventive and Promotive
Interventions Before and After the Introduction of Integrated Community Case
Management (iCCM) in Ethiopia
Authors: Efrem Teferi, Hibret Alemu, Tesfaye Bulto, Ismael Ali, Dedefo Teno
Journal: Ethiopian Medical Journal , October, 2014 ,Volume 52, Supplement 3:151-5.
Full Text Link: www.jsi.com/JSIInternet/Inc/Common/_download_pub.
cfm?id=15457&lid=3
Background: The effect of integrated community case management (iCCM) of common
childhood illnesses on use of vital preventive services is not known.
Objective: To measure the coverage of maternal and child health preventive and
promotive interventions before and after scaling up iCCM.
Methods: In 2011 and 2013, we conducted cross-sectional, population-based,
household coverage surveys in four IFHP target regions: Amhara, Oromia, SNNP, and
Tigray.
Results: Coverage increased for 10 of 15 indicators, mainly for maternal, immunization,
and nutrition services. In some cases, we observed dramatic increases, i.e., for > 4
antenatal care visits, antenatal iron and folate, and exclusive breastfeeding. Some
increase occurred even when 2011 levels were already high, i.e., for immunization.
Three indicators remained high and unchanged (bed net ownership, children sleeping
under bed nets, and any latrine). Two indicators decreased (tetanus toxoid and
households with > 2 bed nets).
Conclusion: Scale-up of iCCM was consistent with increased coverage of most
preventive and promotive interventions, which may contribute to the life-saving effect of
iCCM.

17
Quality and use of IMNCI services at health center under-five clinics after
introduction of integrated community-based case management (iCCM) in three
regions of Ethiopia
Author: Efrem Teferi, Dedefo Teno, Ismael Ali, Hibret Alemu, Tesfaye Bulto
Journal: Ethiopian Medical Journal, October, 2014, Volume 52, Supplement 3:91-8.
Full Text Link: www.jsi.com/JSIInternet/Inc/Common/_download_pub.
cfm?id=15457&lid=3
Background: The Integrated Management of Newborn and Childhood Illness (IMNCI)
and the related Integrated Community Case Management (iCCM) are evidence-based
strategies to reduce childhood mortality in Ethiopia at health centers and community
health posts, respectively. The effect of introducing iCCM on IMNCI is not known.
Objective: To assess the caseload and quality of IMNCI services in under-five clinics in
health centers after iCCM implementation.
Methods: This cross-sectional study used register review to assess the IMNCI service
use (before and after iCCM, in 2010 and 2012, respectively) and quality throughout
the period in randomly selected health centers in three regions of the Integrated Family
Health Program (Oromia, SNNPR [Southern Nations and Nationalities and Peoples
Region] and Tigray).
Results: Caseload of sick children at 28 health centers increased 16% after iCCM
implementation (21,443 vs. 24,882 children in 2010 and 2012, respectively), but
remained low. The morbidity profile did not change. The quality of IMNCI service was
uneven across case management steps and syndromes.
Conclusion: Caseload increased modestly after iCCM was introduced, but was lower than
expected, even when combined with the HP utilization from other studies. The demand
strategy for sick children needs review. The quality of IMNCI needs improvement even
to bring it to the quality of iCCM at health posts, as measured by the same methods.
Successful quality assurance approaches from iCCM, e.g., the Performance Review and
Clinical Mentoring Meeting, could be adapted for IMNCI.

18
HIV/AIDS/PMTCT

The Effect of Integrating Family Planning with HIV and AIDS Services on
Contraceptive Uptake among HIV Positive Women
Authors: Kidest Lulu, Tariku Nigatu, Girma Kassie, Adugna Tamiru, Alemayehu
Mekonnen, Misganaw Fantahun, Amanuel Kidane and Siefu Hagos
Journal: Women’s Health Care 2014, 3:6
Full Text Link: http://dx.doi.org/10.4172/2167-0420.1000197
Introduction: Integrating Family Planning (FP) into HIV services provides opportunity to
increase access to contraception among clients. However, data on the effectiveness of
FP/HIV integration on FP uptake is limited.
Objective: Determine the effect of FP/HIV services integration, focusing on FP
integration with Antiretroviral Therapy (ART)
Methods: A cross-sectional comparative design was conducted in facilities with and
without FP/ART integration in four major regions of Ethiopia. The study population
included HIV positive women attending ART clinics.
Data were collected using structured questionnaire from 843 and 691 HIV positive
women in intervention and comparison facilities respectively from April 23 to May 2,
2012. Data entry and analysis was done using SPSS version 17.0 and proportions and
relevant associations were computed.
Results: Most of the women (94.7%) received one or more HIV services. In both groups,
736 (48.2%) women used any type of FP method; the majority (97%) used modern FP
and 54.6% used injectables. Over all CPR was 48%; with higher CPR in intervention
than comparison group (52.6 %versus 42.9%) [AOR (95%CI) =1.23, (1.23, 1.92). A
higher proportion of women in intervention than comparison group used dual methods
[AOR (95%CI) =1.50 (1.01, 2.2)]. Total unmet need for FP in the study was 16.2
percent. There was no significant difference in unmet need for FP between intervention
and comparison groups (15.7% vs. 16.9% respectively) [(OR 0.94 95% CI (0.63,
1.39)].
Program Lesson: FP/HIV integration improved CPR and use of dual methods showing
the benefit of FP/HIV integration. However, there was no difference in unmet need for FP
between the two groups calling the need for more research.

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Utilization of Prevention of Mother to Child Transmission (PMTCT) Services
and Factors that Affect Knowledge and Service Uptake among Pregnant Women
Attending Antenatal Care in East Hararge Zone of Oromia Regional State
Authors: Megersa Gobena, Tariku Nigatu ,Belay Yimam, Adeba Tasissa, Daniel Wagaw,
Fufa Birmechu , Daniel Keba, Ahmed Ali, Wubegzier Makonnen, Adamu Addissie ,Seifu
Hagos
Journal: Ethiopian Journal of Health Development , Volume 28, special issue,2014,1-43
Full Text Link: http://www2.pathfinder.org/site/DocServer/EJHD_special_issue.
pdf?docID=20241
Background: Prevention of mother-to-child transmission of HIV (PMTCT) which is
provided as part of antenatal care (ANC) is one of the most effective strategies in HIV
prevention. However, there is a huge descrepancy between levels of ANC attendance and
utilization of PMTCT services in Ethiopia.
Objective: This study aims to assess the utilization of PMTCT services and factors that
affect knowledge and service uptake among women attending ANC in East Herarghe
Zone of Oromia region.
Method: A cross-sectional, facility-based study was conducted in March 2012 among
605 women following ANC in 16 randomly selected health facilities (15 health centers
and 1 district hospital). The sample size was equally divided among the health facilities
and every third pregnant woman was selected for exit interview. Quantitative data was
collected and analyzed statistically. Descriptive statistics including frequencies and
associations were used. Multiple logistic regression technique was used to control for
confounding variables. SPSS version 17 was used for data analysis.
Results : The response rate was 99.5%. Of the total women, 76% and 79% of them
never attended school and were from rural areas, respectivelly. The average duration
of pregnancy (+SD) was 6.32 months (+1.86). Utilization of PMTCT was 72.8%.
Previous ANC visits and prior Information on HIV transmission routes were associated
with knowledge of MTCT and PMTCT. However, reading IEC materials and occupation
of respondents were associated only with knowledge on MTCT while school attendance
was associated only with PMTCT. Utilization of PMTCT was also associated with prior
information on HIV transmission routes and knowledge on MTCT and PMTCT.
Conclusions: Knowledge on MTCT & PMTCT directly or indirectly depended on having
the necessary information. Utilization of PMTCT was also suboptimal compared to the
national direction of providng the service to all ANC attendants

20
Malaria
Effect of Integrated Community Case Management of Common Childhood Illnesses
on the Quality of Malaria Case Management Provided by Health Extension Workers
at Health Posts
Authors: Ajema Wogi, Dedefo Teno, Tesfaye Bulto, Hibret Alemu, Mesfin Nigussie,
Wakgari Deressa,
Journal: Ethiop Medical Journal, 2014,Vol. 52, Supp. 3 ;99-108
Full Text Link: http://jsi.com/JSIInternet/Inc/Common/_download_pub.
cfm?id=15457&lid=3
Introduction: The Integrated Family Health Program supported the government of
Ethiopia to implement the Integrated Community Case Management (iCCM) strategy to
control childhood illness of which malaria is a major cause.
Objective: To assess the effect of iCCM training on quality of malaria case management
at health posts.
Methods: A comparative cross-sectional study was conducted among 170 Health
Extension Workers (HEW) providing either integrated or vertical malaria case
management for children aged less than age five years in 14 woredas of West Hararghe
Zone using a multi-stage sampling procedure. HEWs in seven intervention woredas were
trained in malaria case management and RDT procedures through iCCM, and HEWs in
comparison woredas were trained vertically through the national malaria control program.
Performance was assessed using interview, review of registers, and observation of RDT
procedure.
Results: Intervention HEWs performed better than their counterparts in correct drug
prescription (90.8 vs. 81.0%, p=0.03), treatment duration (97.7 vs. 89.9%, p=0.001),
and treatment schedule (95.4 vs. 75.9%, p=0.000). Intervention HEWs recorded case
management with far more consistency that their counterparts (> 80% consistency
between: classification and treatment [46.5 vs. 6.2%, p=0.000], classification and
treatment [48.8 vs.12.5%, p=0.000], and classification and follow up [48.8 vs. 0.0%,
p=0.000].
Conclusion: ICCM training has a positive effect on the quality of malaria case
management at community level. Thus the program needs to be scaled up to other
areas.

21
Gender
Mainstreaming
A Qualitative Analysis of the Experience of Women Supported by the Integrated
Family Health Program to Reach Fistula Repair Services: Their Experience of
Repair Services and Re-integration
Authors: Kyla Donnelly, Tilahun Yewondwossen, Elizabeth Oliveras, Mehari Belachew
and Mengistu Asnake
Journal: Culture, Health & Sexuality Vol. 17, Iss. 2, 2015;
Full Text Link: http://www.tandfonline.com/doi/full/10.1080/13691058.2014.964320
Background: One of the least discussed—yet most devastating—sources of maternal
morbidity and mortality is obstetric fistula. There has been increasing recognition of the
importance of linking prevention and curative strategies with rehabilitation and social
reintegration programs to holistically address fistula, yet little research and programming
have been done.
Method: To examine the experiences of a cohort of women after they develop fistula,
obtain repair services, and reintegrate them back into their communities Pathfinder
conducted a mixed-methods study in June 2011. Semi-structured interviews were
conducted with a purposive sample of 51 Ethiopian women in Southern Nations,
Nationalities, and Peoples’ Region (SNNPR), Oromia, Amhara, and Tigray. Study
approval was obtained by each of the four regional health bureaus.
Result: Fifty one participants were between 17 and 68 years of age (mean of 35 years),
predominantly uneducated (n=38, 75%) and childless (n=27, 53%), and commonly
suffered from divorce following their fistula (n=18, 35%). Women received repair
services on average 9.8 years after developing the condition, which was completely
repaired for 82% of patients (n=42). In contrast, 18% (n=9) of women continued to
experience urinary incontinence. Women unanimously reported positive experiences
at the fistula repair hospitals, but received highly variable counseling about behaviors
to promote their recovery and rehabilitation. Although the majority of women felt a
dramatic sensation of relief, happiness, and hope following repair, many continued to
feel distress regardless of the success of the procedure.
Conclusion and Recommendation: Pathfinder’s IFHP model of facilitating fistula repair
has had a dramatically positive impact on the lives of underserved Ethiopian women.
In order to promote more holistic recovery, programs should prioritize integrating a
community-based follow-up system to identify women needing further treatment and
sexual, reproductive, and mental health support.

22
Adolescent and Youth Sexual
Reproductive Health
Parent-Adolescent Communication and Associated Factors on Sexual and
Reproductive Health Issues among High School Adolescent Students in Sebeta
Town, Oromia Region, Central Ethiopia
Author: Alemayehu Hunduma
Master’s thesis and unpublished
Background: Many factors affect knowledge, attitudes and sexual behavior of adolescents.
In most cases parents become role models who shape young people’s life styles including
their sexual behaviors. In Ethiopia, few published studies have examined parent -
adolescent communication on sexual and reproductive health issues.
Objective: The aim of this study was to determine the proportion of adolescents who
communicate with their parents about sexual and reproductive health issues and identify
factors associated with these communications.
Method: A school based cross-sectional study using quantitative and qualitative
method was carried out in Sebeta town in April 2014. A total of 361 students were
selected using stratified random sampling technique. The quantitative data was entered
into EPInfo and then cleaned and analyzed using SPSS statistical software version
20.0. Bivariate and multivariate logistic regression analysis was done to determine
the association between the dependent and independent variables. Those variables
found significant at P<0.20 in the bivariate analysis were selected to be included in
multivariate analysis. Qualitative data was taped and transcribed to text then categorized
into themes by using manual coding and the main response was reported in direct
quotation to complement the quantitative findings. Summary tables, charts and graphs
were used to organize and present outputs of the analysis.
Results: There response rate was 99.2%. The proportion of students who had ever
discussed at least two topics on SRH issues with their parent was found to be 25.1%.
The frequently discussed topics between parent and adolescent were body changes
during puberty (57.4%), relationships with the opposite sex (55.6%), and STIs & HIV/
AIDS (53.7%). Attitude of students about SRH issues and perception of students’ about
parents attitude {AOR (95%CI) =2.78 (1.47, 5.24) and AOR (95%CI)=7.57 (3.80,
15.08), respectively, were significant predictors of communication.
Conclusion and recommendation: Parent-adolescent communication on SRH issue
was very low. Adolescents who had positive attitude and perceived their parents are
supportive, frequently communicate with their parents. Therefore, it is important to
design integrated strategy that promote parent-adolescent communication on SRH issues
and improve access to SRH information through various mechanisms

23
Menstrual Hygiene Management and School Absenteeism among Female
Adolescent Students in Northeast Ethiopia
Authors: Teketo Kassaw, Mitike Molla
Master’s thesis and unpublished
Background: Adolescence in girls is associated with misconceptions, malpractices and
challenges among in developing countries. Focusing among school girls, this study has
examined knowledge about menstruation, determinants of menstrual management and
its influence on school-attendance in Northeast Ethiopia.
Methods: A mixed-method research was conducted combining quantitative and
qualitative approaches in northeast Ethiopia. The quantitative study was conducted
among 595 randomly selected adolescent school girls. Nine in-depth interviews; five
school-dropout girls and four female teachers, and four focus group discussions among
school girls were conducted in 2013.
Results: The mean age at menarche was 13.98 (± 1.17) years. About 51% of girls
had knowledge about menstruation and its management. Only a third of the girls used
sanitary napkins as menstrual absorbent during their last menstruation. Girls from urban
areas, those who had mothers of secondary and above education and, families of higher
monthly expenditure had more chance of using sanitary napkins than their counterparts.
More than half of the girls reported to have been absent from school during their
menstruation period. Those who did not use sanitary napkins were more likely to be
absent from school [AOR-95% C.I: 5.37 (3.02 - 9.55)]. Fifty eight percent of girls
reported that their school-performance had declined after they had menarche.
Conclusion: Though there is an effort to increase girls’ school enrollment, lack of basic
needs, like sanitary napkins that facilitate routine activates of girls at early adolescence
are observed to deter girls’ school-attendance in rural Ethiopia. Special support for girl
students, especially when they have their first menstruation and separate functioning
sanitary facilities are necessities that should be in school at all times if gender equality
and girls empowerment is to be achieved.

24
Others

The status of hygiene and sanitation practice among rural model families of the
health extension program in Wolayta and Kembata Tembaro Zones of Southern
Nations, Nationalities and Peoples’ Region of Ethiopia
Authors: Kare Chawicha, Mengistu Asnake, Girma Kassie, Tariku Nigatu, Mehari
Belachew, Habtamu Zerihun
Journal: Ethiopian Journal of health Development (EJHD), Ethiop.J. Health Dev. 2012;26
(2)

Full Text Link: http://www.ejhd.org/index.php/ejhd/article/view/201/108

Background: Since the Health Extension Program (HEP) started the training and
graduation of model families, little is known about the status and maintenance of
hygiene and sanitation practices to inform future directions and decisions.
Objective: To assess the status and maintenance of hygiene and sanitation practices
among rural model families of the Health Extension Program.
Method: A cross-sectional comparative mixed study design was conducted from
Dec.-June 2010/11 in Wolayta and Kembata Tembaro Zones of Southern Nations,
Nationalities and Peoples Regional State of Ethiopia. Two types of comparisons were
involved in the study; comparison of hygiene and sanitation practices of a randomly
selected 690 model and 686 non-model families, and comparison of similar practices
among model families at the time of graduation, assessed in retrospective interview,
versus at the time of survey.
Results: The study showed that among model families, 82% of them had pit latrine,
23.1 % had solid and liquid waste disposal pits, 19.0% had shelves for storing utensils
and 34.1 % had separate dwelling for people and cattle as compared to 55.6 %, 9.1%,
6% and 18.5 % of similar practices among non-model families respectively (p<0.001).
Latrine availability, storage of water in a narrow necked covered container, possession
of shelves for storage of utensils and fuel saving stoves declined from 96.6% to
82.3%, 92.7% to 78.6%, 33.6% to 19.1% and from 6.1% to 3%, respectively among
model families after graduation (p<0.01). During FGDs and in-depth interviews, socio-
economic and cultural reasons were mentioned as factors that hindered the maintenance
of the practices
Conclusion: Generally, model families performed better in most of the hygiene and
sanitation practices than non-model families. The study also indicated a decline in the
maintenance of certain practices among some model families

25
Program and Technical Briefs

The Technical Advisory Committee: Providing Stewardship to Health Programs in

Ethiopia
Contributors: Mengistu Asnake, Tariku Nigatu Minal Rahimtoola
Full Text link: http://www.pathfinder.org/publications/the-technical-advisory-committee-
providing-stewardship-to-health-programs-in-ethiopia/
The Technical Advisory Committee (TAC) was created in response to a need for
coordination among the many new efforts—providing stewardship and oversight of the
implementation of reproductive health programs. Consisting of representatives from the
Ethiopian government, donors, and nongovernmental organizations (NGOs), the TAC
supports the USAID-funded IFHP. TAC members jointly monitor IFHP through quarterly
visits to participating communities and facilities to provide strategic guidance on
program implementation..
Integrating Family Planning and HIV in Ethiopia: An Analysis of Pathfinder’s
Approach and Scale-Up
Contributors: Mengistu Asnake, Alemayehu Ayalew, Alden Nouga
Full Text Link: http://www2.pathfinder.org/site/DocServer/MSI_207427_HIV_
integrations_WEB.pdf?docID=19741
Pathfinder International has supported FP in Ethiopia since the 1960s through
the establishment of the Family Guidance Association of Ethiopia, a pioneer in FP
programming. IFHP has been the mechanism through which Pathfinder has been
pursuing FP/HIV integration scale-up. Given IFHP’s expansive coverage and broad
mandate, it constitutes a valuable foundation on which to improve and expand FP/HIV
integration, particularly because the program is responsible for supporting contraceptive
services (commodities and training) and for developing strategic integration systems.
Moreover, IFHP is able to leverage Pathfinder’s many years of FP/HIV integration
learning. The technical brief describes IFHP’s approach and its evolution and scale-up
over time. It presents the experience in relation to the recommendations of World Health
Organization (WHO) guidelines on FP/HIV integration and also outlines next steps and
recommendations.

26
m4Youth: Providing Sexual and Reproductive Health Information to University
Students and Peer Educators
Contributors: Tariku Nigatu, Marion McNabb, Camille Collins, Worknesh Kereta,
Mengistu Asnake
Full Text Link: http://www.pathfinder.org/wp-content/uploads/2016/09/m4Youth-
Providing-Sexual-and-Reproductive-Health-Information-to-University-Students-and-Peer-
Educators.pdf
Pathfinder International piloted an mHealth project called m4Youth project—a free,
menu-based SMS service provided by IFHP. The project was implemented at Adama
Science and Technology University. The goal of m4Youth was to impact students’
knowledge of sexual and reproductive health, thereby increasing their utilization
of services through provision of need based SRH information to students and peer
educators. Service data of the pilot phase show that during the first nine weeks of
implementation alone, students frequently accessed information about “Sexuality”
(39%) and Contraceptive methods (20%), followed by Sexually transmitted infections/
HIV (15%), This technical brief discusses implementation of the pilot phase and hence
the experiences gained.

Prevention and Treatment of Fistula: Pathfinder International’s Experience in

Ethiopia and Ghana
Full Text Link: http://www2.pathfinder.org/site/DocServer/2009_Fistula_in_Ethiopia_and_
Ghana.pdf
Pathfinder’s family planning and reproductive health programs help prevent fistula
by sensitizing communities about the causes of fistula and increasing access to
contraception In Ethiopia, Pathfinder works to eliminate the harmful traditional practice
of early marriage to prevent future fistula cases. Through these efforts, Pathfinder
has prevented over 18,000 early marriages. Since 2002, Pathfinder/Ethiopia has
helped nearly 900 women receive fistula repair surgery by providing transportation and
accommodations before and after the surgery. In Ghana, Pathfinder trains providers and
improves awareness of the condition and increase access to treatment. The success
of the sensitization efforts was immediate. Women bypassed their local health staff
and went directly to hospital for repair, reporting that they had heard about the repair
services on the radio, or through friends and neighbors. Unfortunately, the demand
created by the sensitization campaign was greater than the project could support

27
Scale-Up of Task-Shifting for Community-Based Provision of Implanon
Contributors: Mengistu Asnake, Claire B. Cole, Elizabeth Oliveras, Yewondwossen
Tilahun
Full Text Link: http://www.pathfinder.org/publications-tools/Scale-Up-of-Task-Shifting-for-
Community-Based-Provision-of-Implanon-Technical-Summary-2009-2011.html
Funded by USAID, IFHP has pursued the scale-up of community-based provision of
Implanon since 2009. Active in four regions of Ethiopia, IFHP’s Implanon scale up
efforts support the government in enabling underserved rural communities to access this
long-acting family planning (LAFP) method at the village level through task-shifting to
Ethiopia’s health extension workers. The scale-up approach was an ongoing process of
real-time assessment and problem solving. Covering 144 of the 264 woredas targeted for
the scale up phase, IFHP’s Implanon scale-up has achieved 55 percent of its targeted
geographic coverage. Through its approach, it has enabled initiation of Implanon service
delivery at health posts responsible for serving 28 percent of all women aged 15–49 in
these four regions and 24 percent of all women aged 15–49 in the national population.

Scaling Up Community-Based Service Delivery of Implanon: The Integrated Family

Health Program’s Experience Training Health Extension Workers
Contributors: Mengistu Asnake, Yewondwossen Tilahun
Full Text Link: http://www.pathfinder.org/publications-tools/pdfs/Scaling-Up-Community-
Based-Service-Delivery-of-Implanon-The-Integrated-Family-Health-Programs-Experience-
Training-Health-Extension-Workers.pdf
The HEP has made great progress in educating women about the benefits of FP. But
despite their safety, efficacy, and low cost, access to long-acting methods of family
planning (LAFP) has remained scarce at the community level. To address this issue,
the MOH invited four organizations to implement pilot programs designed to improve
availability of LAFP.
IFHP was asked to train HEWs in Implanon insertion in eight woredas (districts) of the
Amhara, Oromia, SNNP, and Tigrai regions using a service-delivery based training model
developed by Pathfinder in 2004 for use with nurses, health officers, and physicians.
By training HEWs in Implanon insertion, IFHP provides quality LAFP services at the
community level to thousands of women who previously would not have had access to
these services.

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Strengthening Health Service Delivery in Ethiopia: The Integrated Family Health
Program
Contributors: Mengistu Asnake, Kidest Lulu, Minal Rahimtoola
Full Text Link http://www.pathfinder.org/publications-tools/strengthening-health-service-
delivery-ethiopia-IFHP.html
IFHP supports the government of Ethiopia to implement an integrated service delivery
model to improve family planning and maternal, newborn, and child health in rural
and hard-to-reach communities. IFHP’s geographic coverage encompasses 40 percent
of the population living in the four major regions of Amhara, Oromia, Tigray, and
Southern Nations, Nationalities, and People’s Region (SNNPR), and to a lesser extent in
Beneshangul Gumuz and Somali.
This technical publication shares how IFHP—guided by the government’s vision
for improved service delivery—has mobilized drivers for systems strengthening by
prioritizing community needs and facilitating informed decision making. As a result of
the support, IFHP has improved access, coverage, and quality of health services at the
community and household levels

Strengthening Community and Health Systems for Quality PMTCT: Applications in

Kenya, Nigeria, South Africa, and Ethiopia
Contributors: Claire Cole, Ellen Israel, Sophia Ladha, Kidest Lulu, Rene Mathew,
Dickson Mwakangalu, Alden Nouga
Full Text Link: http://www.pathfinder.org/wp-content/uploads/2016/10/Strengthening-
Systems-for-Quality-PMTCT.pdf
Barriers to implementing programs for prevention of mother-to-child transmission
(PMTCT) of HIV in resource-limited settings fall into common biomedical, behavioral,
and structural categories. In addition to a lack of access to quality PMTCT services at
the clinic level, community-level factors such as stigma; adverse gender dynamics; low
support for HIV testing, antenatal care (ANC), and skilled birth attendance; and poor
linkages between communities and their facilities all pose challenges to improving
PMTCT outcomes. Since 2002, Pathfinder has implemented PMTCT programming in
countries across the globe, gaining insight into the barriers women face in access and
adherence, and using these lessons to inform implementation of our global PMTCT
strategy. This technical brief discusses implementation experience in four African
countries, providing recommendations for future efforts to more holistically advance
improved PMTCT outcomes in resource-limited settings.

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Strengthening the Continuum of Care for fistula Prevention and repair in Ethiopia
Contributors: Heran Abebe, Kidest Lulu, Sarah Mehta, Julia monaghan
Full Text Link: http://www.pathfinder.org/publications/strengthening-the-continuum-of-
care-for-fistula-prevention-and-repair-in-ethiopia/
An estimated 37,500 Ethiopian women are living with untreated obstetric fistula, a
devastating childbirth injury that results in chronic urinary and/or fecal incontinence.
Affected women and adolescents are often abandoned by their partners and families,
ostracized by their communities, relegated to separate living spaces, and subjected
to profound stigma and discrimination. As part of its mandate, the USAID-funded
IFHP, supports regional, zonal, and woreda (district) health offices to build and fortify
a comprehensive continuum of care to address fistula in its four program regions—
Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and People’s Region.
As community sensitization and mobilization efforts began to take root, the program
successfully scaled up, and from 2009 to 2010, the number of cases identified and
referred more than doubled (from 277 to 672). The program saw another 50 percent
increase in the following year (from672 in 2010 to 1,011 in 2011). Since 2011, case
identification has stabilized, averaging 935 cases per year. This technical brief explores
IFHP’s approach, implementation experience, and lessons learned.

Bringing Youth-Friendly Services to Scale in Ethiopia

Contributors: Mengistu Asnake; Claire B. Cole, Gwyn Hainsworth, Jill Hodges, Worknesh
Kereta, Kidest Lulu, Callie Simon
Full Text Link: http://www.pathfinder.org/publications-tools/Bringing-Youth-Friendly-
Services-to-Scale-in-Ethiopia.html
Stigma, service costs, and provider bias pose formidable barriers to Ethiopian young
people’s ability to access sexual and reproductive health (SRH) services. To address
these barriers, in 2005 Pathfinder International and the Ethiopian Federal Ministry
of Health (FMOH) partnered to introduce and scale up youth-friendly services (YFS)
in the Ethiopian public health system. YFS—an evidence-based approach to reducing
barriers to service uptake among young people—lay the foundation for Ethiopia’s
health system to meet the SRH needs and rights of the country’s largely underserved
adolescent and youth population. Ethiopia’s YFS scale-up, horizontal and vertical goals
were complementary and were not made to compete. Beginning from September 2008
through September 2011, IFHP, the FMOH, and local partners successfully expanded
YFS from 20 to 115 sites across six regions of Ethiopia, including ten university
campuses. This technical brief analyzes the scale-up efforts to date

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Introducing Operations Research to Large-Scale Program Implementation in
Ethiopia
Contributors: Mengistu Asnake, Girma Kassie, Tariku Nigatu, Elizabeth Oliveras, Minal
Rahimtool
Full Text Link: http://www.cmamforum.org/Pool/Resources/Introducing-Operations-
Research-to-Large-Scale-Program-Implem-Ethiopia-2013.pdf
Insufficient familiarity with the inquiry methods required to develop evidence-informed
interventions is a challenge to health delivery improvement in low- and middle-income
countries. In 2011, as part of its larger systems strengthening mandate, the Integrated
Family Health Program (IFHP) partnered with Addis Ababa University’s School of Public
Health (AAU-SPH) to begin efforts to build the capacity of health program managers
and implementers to conduct operations research, with the ultimate goal of fostering
local capacity to innovate based on systematic learning. The joint collaborative project
followed a phase based approach to in building the skills of program and public sector
staff in operation research that led to the publication of five papers on a peer reviewed
journal.

EXPANDING CONTRACEPTIVE OPTIONS FOR POSTPARTUM WOMEN IN ETHIOPIA:

INTRODUCING THE POSTPARTUM IUD
Contributors: Mengistu Asnake, Candace Lew, Kidest Lulu, Sarah Mehta, Kathryn
Mimno, Yewondwossen Tilahun
Full Text Link: http://www.e2aproject.org/publications-tools/pdfs/expanding-
contraceptive.pdf
Provision of voluntary contraceptive services during the postpartum period enables
women and couples to avoid unintended pregnancy and yields positive health dividends
for both the mother and newborn. Until recently, the copper-bearing intrauterine
device (IUD) was the only long-acting, reversible contraceptive method recommended
for use by breastfeeding women, making it an important option for postpartum family
planning (PPFP). Yet, in Ethiopia’s public health sector, the postpartum IUD (PPIUD)
has been nearly absent from the contraceptive method mix, inhibiting full and informed
contraceptive access and choice. Since 2013, Pathfinder International has been working
with the government of Ethiopia to introduce and expand access to PPIUD services in
the public sector through the USAID-funded Integrated Family Health Program (IFHP+).
IFHP made efforts to familiarize and introduce PPFP in to the method mix that was
largely absent in Ethiopia. Women have now opportunities to receive PPFP services at
health facilities in the country.

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Testing a Service-Delivery Model for Offering Long-Acting Reversible Contraceptive
Methods to Youth in Ethiopia (Policy Brief)
Full Text Link: http://www.e2aproject.org/publications-tools/testing-a-service-delivery-
model-larcs-for-youth.html?referrer=https://www.google.com/
Young people’s incorrect and/or inconsistent use of short-acting methods (barriers
methods, oral pills, and injectables) contributes to the rampant occurrence of
unintended pregnancies among youth using a contraceptive method.
From June 2014 to April 2015, the Evidence to Action (E2A) Project in collaboration
with the Integrated Family Health Program Plus (IFHP+) conducted a study at 20 youth-
friendly health service sites in Amhara and Tigray regions of Ethiopia to test a model for
offering contraceptive counseling and services to young people that includes LARCs.
The study found out that at baseline, the percentage of new LARCs acceptors among
all new acceptors at intervention sites was lower than at non-intervention sites, while
during the post-intervention phase, the percentage of new LARCs acceptors among all
new acceptors at intervention sites was greater than at non-intervention sites. The study
shows that youth-friendly service providers trained to provide IUDs and implants in a
safe and competent way increases the probability that these long-acting methods will be
adopted by youth.

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Address
Integrated Family Health Program
Tel. +251 11 320 3501
P.O. Box 12655
Nefas Silk Lafto Sub City
Woreda 05, Hadid Building
Around Del Gebeya Area
Addis Ababa, Ethiopia

Prepared by: Tariku Nigatu

Abdusemed Mussa
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Master Print +251 111 557 788