Full immunization coverage and associated factors among children aged 12–23 months in Somali Region, Eastern Ethiopia

Objective Despite those efforts in expanded programs of immunization, nearly one fifth of children in developing countries miss out basic vaccines. Moreover, many children who started vaccination fail to complete immunization.Identifying associated factorswhich is scarce in the study area, is crucial for interventions. This study assessed full-immunization and associated factors among children aged 12–23 months in Somali region, Eastern Ethiopia. Methods A community-based cross-sectional study design was conducted from October 1–30, 2018, in selected rural and urban kebeles in Somali regionamong 612 children. Cluster sampling was employed and data was collected using structured questionnaire. Full-immunization was measured by maternal recall and vaccination card.Data entry and analysis was done by EpiData3.1 and SPSSversion.20 respectively. Binary logistic regression with Bivariate and Multivariable model was usedto identify predictors of full-immunization. Odd ratios were computed and P-value <0.05 was considered as statistically significant. Results Based on maternal recall plus vaccination card 249(41.4%) of children were completed immunization, while vaccination only by card was 87(29.7%). Only 238(39.5%) of participants had good knowledge about vaccination. Not knowing to come back for next visits 197(55.8%) were the major reason for dropout. Residing in urban (AOR = 2.0, 95%CI: 1.0, 3.9),primary educated mothers(AOR = 2.2, 95%CI: 1.0, 5.0), married mothers (AOR = 4.2, 95%CI:1.0, 18), higher average monthly income (AOR = 2.5, 95%CI 1.1, 5.2)and delivered at health facilities (AOR = 3.8, 95%CI 1.9, 7.3)were significantly associated with full-immunization. Conclusion Coverage of full immunization was found to be low compared to the targets set in the Global Vaccine Action Plan(2011–2020).Two-third of the participants has poor knowledge about vaccination. Urban residence, mother education, higher family income, male child and institutional delivery were factors. This study suggests that awareness creation, behaviour change on vaccination and enhancing utilization of maternal health service including delivery service, should be stressed.

Determinants of Place Birth: A Multinomial Logistic Regression and Spatial Analysis of the 2019 Ethiopian Mini Demographic and Health Survey Data

Background: The presence of skilled attendants at birth and institutional delivery with quality serves significantly improves maternal and neonatal health. However, in countries where a practice of home birth is common, maternal and neonatal mortality remained high. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia. Methods: Ethiopian mini-DHS-2019 data was used in this analysis. A survey multinomial logistic regression model was used to analyze determinants of place of birth. An adjusted relative risk ratio and its 95% confidence interval with a p-value of < 0.05 and marginal effect and its 95% confidence interval with a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The magnitude of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth. Result: Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low cluster level coverage of 4+ antenatal visits were predictors of home birth. Homebirth was clustered across enumeration areas and it was over 40% in most parts of the country with >75% in the Somali region. SaTScan analysis detected most likely clusters in the Somali region, eastern and southern zones of Oromia region, central zones of Amhara region, and eastern zones of the South Nations Nationalities and People’s region. Conclusion: Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities through qualified providers with midwifery skills and systems of back-up in place could be supportive.

Effect of Nutrition Education Intervention on Anaemia Among Children aged 6 to 59 Months in Pastoralist and Agro-Pastoralist Community of Somali Region, Eastern Ethiopia: Community Based Case Control Study

Background: Anaemia is one of the major public health problems. It affects over 1.6 billion individuals of all age groups globally. About 273.2 million children below five years of age were affected by anaemia, of which around two-thirds (62.3%) occur in Sub-Saharan Africa. The overall global anaemia prevalence rate reported was 24.8%, of which almost half (47.4%) of it occurs in preschool children. Ethiopia is one of the seriously affected countries. The Ethiopia Demographic and Health Survey (EDHS), 2016 report showed, 56% and 82.6% of preschool children in Ethiopia and the Somali region, respectively, were affected by some degree of anaemia. Hence, this study aims to assess the effect of nutrition education intervention (NEI) on anaemia prevalence in preschool children in the Pastoralist and Agro-pastoralist communities of the Somali Region, Eastern Ethiopia. Methods: A community based case control study was conducted among 404 paired children 6 – 59 months to mothers/caregivers in two phases. Adadle district was used as an NEI group and Gode district as a control group. A face-to-face interview for mothers/caregivers using a semi-structured questionnaire and haemoglobin measurement of the children was done. The same procedure was repeated after eight months of NEI. The blood haemoglobin (Hb) level of the children was measured using Hemocue 301. SPSS version 20 was used, a chi-square test for categorical and t-test (independent and repeated paired) for continuous variables were performed. Results: the overall anaemia prevalence was decreased from 72% at baseline and 51% at post-intervention. The majority of this change had occurred in the intervention group (79.3 - 44.8%). The mean Hb level score difference of the difference (DOD) was significantly improved (-1.163, p<0.001) after NEI. While, the intervention group showed a significantly higher increment of Hb level (9.4g/dl – 10.6g/dl, p<0.001). Conclusion: The NEI has been shown effective and significant improvement in the mean haemoglobin level and decreased the anaemia prevalence in the intervention group. Therefore, behaviour change communication, using religious leaders and other potential people. Advocating the use of locally available, accessible, and affordable nutritious foods, with proper infant and young child feeding and basic health services, are highly effective to tackle the children’s anaemia status.

Prevalence of undernutrition and potential risk factors among children below five years of age in Somali region, Ethiopia: evidence from 2016 Ethiopian demographic and health survey

Background Childhood under-nutrition is far-reaching in low and middle-income nations. Undernutrition is one of the major open wellbeing concerns among newborn children and youthful children in Ethiopia. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Somali Region, Ethiopia. Methods The data for this study was extricated from the Ethiopian Demographic and Health Survey (EDHS) 2016. The data collected from 1339 children born 5 years before was considered within the analysis. A multivariable binary logistic regression analysis was utilized at a 5% level of significance to decide the individual and community-level variables related to childhood malnutrition. Results The prevalence of stunting, underweight and wasting were 27.4, 28.7 and 22.7%, respectively. About 16.1% of children were both stunted and underweight; the extent of both being underweight and wasted was 11.7%, the prevalence of both stunted and wasted children was 5.5%, and all three malnutrition conditions were 4.7% children. Among the variables considered in this study, age of the child in months, type of birth, anemia level, size of child at birth, sex of the child, mothers’ BMI and sources of drinking water were significantly related to stunting, underweight and wasting in Somali Region. Conclusions The prevalence of stunting, underweight and wasting was relatively high. Undernutrition is one of the major open wellbeing concerns among children in Somali region. The impact of these variables ought to be considered to develop strategies for decreasing the lack of healthy sustenance due to undernutrition in the study areas. Hence, intercession should be centered on making strides for the under-nutrition determinant variables of the children to be solid, to improve the child’s wholesome status, and decrease child mortality quickly.

Assessment of linkage between Productive Safety Net Program and Health Services in Somali Region, Ethiopia: Lessons, Challenges and Missed Opportunities

Background: Ethiopia’s Productive Safety Net Programme (PSNP) which has been implemented since 2005 is a large-scale, social protection intervention aimed at improving food security. The fourth phase of the PSNP included a system of integrated health and nutrition service delivery for its categories of beneficiaries especially the creation of a temporary direct support(TDS) category for clients that are pregnant and lactating women (PLW) or caretakers of malnourished children, who are exempted from public work but expected to comply with co-responsibilities which counts towards their public works requirement aimed at improving utilization of health services.Methods: The study was a cross-sectional descriptive survey and used qualitative methods, in-depth interviews and focus group discussions (FGDs), conducted in two woredas( districts) (Gursum and Kebribayah) in Farfan zone of Somali region. The study population were key individuals involved in the linkages of PSNP with health services and the beneficiaries. The study assessed the implementation of the linkage between PSNP4 and health servicesResults: The study observed that the stakeholders have adequate knowledge and understood their roles in the linkages between PSNP and the health services, in addition the beneficiaries also are aware of their rights and the process for exemption from public work. However, the major issues identified included poor coordination among the implementing actors, poor knowledge , monitoring and compliance with the co-responsibilities by the stakeholders and the beneficiaries.Conclusion: Considering the size of the program in the region which is targeted to the poor, the Productive Safety net program being the main tool to help forward Ethiopia’s Social Protection Policy and Strategy, has the potential to improve access and utilization of health and nutrition services if more efforts are put to strengthen integration and linkages with the health sector and monitoring of compliance of co-responsibilities by the beneficiaries of the program.

Determinants of Enrolment for Community Based Health Insurance Scheme among Agro-pastoralist communities of Aw-barre District in Somali region of Ethiopia: Unmatched case control study.

BackgroundEthiopia launched community-based health insurance scheme in 2011 as part of the revised health care financing strategy to ensure universal health coverage and implementation has started in most part of the country since the launching of the scheme. However, the roll out of the scheme started in Somali Region in 2020—much later the rest of the country. The aim of this study was to assess determinants of enrollment of community-based health insurance among households in Awbarre Woreda, Somali Region, EthiopiaMethodsCommunity based unmatched case control study using a mixed approach of quantitative and qualitative methods was conducted between March and April 2021 and the study participants were selected using multi-stage sampling technique. The quantitative method used interviewer administered structured questionnaire among 216 participants (54 enrolled and 162 non-enrolled), while the qualitative method used key informant interview and focus group discussions in two rural and two urban kebeles of the woreda. The quantitative data was analyzed using SPSS version 20 and thematic analysis was used for the qualitative data. Multivariable logistic regression was used to determine the determinants of enrollment for the community-based health insurance and statistical significance was set at p value of <5%. Result Awareness about CBHI scheme AOR = 9.41(1.16,76.19), households income AOR = 2.73(0.77, 9.57); and being a member of community-based solidarity groups AOR = 2.88(1.17, 7.12) were the determinants for CBHI enrollment and reaffirmed by the qualitative findings. ConclusionsThe enrollment for community-based insurance was determined by being well informed about the scheme, household income, and being a member of solidarity groups at community level. Given the early stage of implementation, enhancing sensitization of the community about the scheme using various community platforms, promotion of the existing community based solidarity groups/associations, diligent targeting of the poor households/indigents and ensuring linkage with any existing social protection program would help to increase enrolment for the scheme.