BackgroundDespite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats.ObjectiveThe study aimed to examine effects of individual women and community-level factors of women’s decision on place of delivery in Ethiopia.MethodsData were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics.ResultsIn the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home.ConclusionsNot only individual characteristics of women, but also community-level factors determine women’s decision to deliver at home.

BackgroundEthiopia is a country with low optimal breast feeding practice, and prelacteal feeding is still a norm. Introduction of prelacteal feeding is a known barrier for optimal breast feeding practices. However, knowledge on determinants of introduction of prelacteal feeding is minimal. This study aimed to identify the effects of individual and community-level factors in the introduction of prelacteal feeding in Ethiopia.MethodsData for this study was extracted from the nationally representative 2011 Ethiopia Demographic and Health Survey (EDHS) and focused on a sample from child data, with a sample from 576 clusters of 7692 children who were last-born in the past five years preceding the survey. The data was collected using two-stage cluster design, in which enumeration areas forming the first stage and households making the second stage. A two-level mixed effect multivariable logistic regression model was fitted to determine the individual and community-level factors associated with introduction of prelacteal feeding.ResultsFrom the total sample of children 28.92 % were fed prelacteals. Butter (n = 1143), plain water (n = 395) and milk-other than breast milk (n = 323) were commonly used prelacteals. In multivariable two-level mixed effect model; caesarean mode of delivery (Adjusted odds ratio (AOR) = 1.87; 95 % CI 1.28, 2.73), and late initiation of breastfeeding (AOR = 5.32; 95 % CI 4.65, 6.09) were both positively associated with the odds of giving prelacteals. Higher economic status 28 % (AOR = 0.72; 95 % CI 0.54, 0.98), giving birth at hand of non-health personnel birth assistance (AOR = 0.68; 95 % CI 0.54, 0.87), large birth size of child (AOR = 0.80; 95 % CI 0.68, 0.95) and high community antenatal care use (AOR = 0.58; 95 % CI 0.38, 0.87) were negatively associated with the odds of giving prelacteals. Significant variation in prelacteal feeding practice was also seen among ethnic and religious groups, and across regions.ConclusionsThe prevalence of prelacteal feeding was high that remained a challenge for optimal breastfeeding in Ethiopia. Not only individual-level factors, but also community-level factors contribute to prelacteal feeding practice. Increasing access to health education through increasing maternal health care service coverage and community involvement is crucial.

Background In Ethiopia, pregnancy, and childbearing begin at an early age. Teenage pregnancy has long-term implications for girls, their families, and communities. However, multilevel predictors of teenage pregnancy are not well studied yet. Several studies are focused only on the effects of individual-level characteristics but ignored the community level effect. This, in turn, could result in biased estimation of predictors of teenage pregnancy. Therefore, this study aimed to identify the individual and community level factors that determine teenage pregnancy in Ethiopia. Method The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample from 645 clusters of 2679 (weighted) women aged 20–24 years. The data were collected using a two-stage cluster design that includes selection of enumeration areas as a first stage and selection of households as a second stage. A two-level mixed-effect logistic regression model was fitted to determine the individual and community level factors associated with teenage pregnancy. Result The study revealed that 2134(79.6%) of women aged 20–24 years experienced pregnancy during their adolescent stage. Being sexually active before age 15[AOR = 7.9; 95%CI: 4.5, 13.8]; being married before age 15[AOR = 30; 9%CI: 16.7, 53.9] and being a rural dweller [AOR = 2.2; 95%CI: 1.4, 3.6] were positively associated with teenage pregnancy. A woman living in a community with a lower proportion of contraceptive users [AOR = 2.3; 95%CI: 1.5, 3.5]; had also a statistically significant association with teenage pregnancy. Conclusions and recommendation Various factors at both the individual and community level determined teenage pregnancy. Therefore, the government should work on the prevention of early marriage, early sexual initiation and on improving the utilization of family planning in the community to protect them from pregnancy that occur at early age.

The burden of non-communicable diseases (NCDs) is increasing in Ethiopia. This study aims to describe the prevalence of NCD risk factors of public employees in a regional city in northern Ethiopia. We conducted a cross-sectional epidemiological study targeting men and women aged 25–64 years employed by public offices in Mekelle. The prevalence was age-standardized to the Ethiopian 2007 population. Among the 1380 subjects (823 men and 557 women), 68.7% had less than 1 serving of fruits and vegetables per day, 41.0% were physically inactive, and 57.3% observed religious fast. The age-standardised prevalence of abdominal obesity was 29.3% in men and 58.5% in women, but that of metabolic syndrome was comparable between men (39.2%) and women (39.0%). The prevalence of diabetes was underestimated if only fasting blood glucose (FBG) was used for the diagnosis compared to combination of FBG and glycated haemoglobin (HbA1c) (6.7% in men and 3.8% in women vs. 12.1% in men and 5.6% in women). More than a quarter (26.1%) of men and 8.7% of women had estimated 10-year risk of cardiovascular disease of 10% or more. This study revealed the high prevalence of NCD metabolic risk factors among the urban public employees in the highland of Ethiopia.

IntroductionHypertension is a major risk factor of cardiovascular diseases which are the leading causes of deaths from chronic non-communicable diseases in Ethiopia. However, little is documented in the issue. Therefore, this study aimed to assess the prevalence, associated factors, awareness, treatment and control of hypertension among adults 18 years old or above in Aksum town, Tigray region, North Ethiopia.MethodsA sequential quantitative-qualitative study was conducted among adults aged 18 years and above in Aksum town. A multi stage sampling procedure was used to select the study participants for the quantitative study whilst convenience sampling technique was used for the qualitative part. A pre-tested and structured questionnaire was used to collect quantitative data, and an interview guide was used to collect the qualitative data. The logistic regression model was fitted to identify factors independently associated with hypertension using SPSS Version 20. P-values of < 0.05 were considered statistically significant. For the qualitative data, iterative hearing of the discussions verbatim interpretation was followed by categorizing similar ideas into themes and finally triangulated with the quantitative results.ResultsThe overall prevalence of hypertension was 16.5% (95% CI: 13.4, 20.0). Awareness, treatment and control of hypertension were 43%, 2.1% and 18.2%, respectively. Being unable to read and write [AOR = 4.73, 95% CI:1.11, 20.23], not consuming fruit [AOR = 4.31, 95% CI:1.74, 10.66], being physically inactive [AOR = 20.11, 95% CI:8.75, 6.20], not knowing physical inactivity is a risk factor of hypertension [AOR = 3.57, 95% CI: 1.69, 7.69] and being overweight/obese [AOR = 9.2, 95% CI:4.54, 18.67] were significantly associated with hypertension. Remarkably, all identified hypertensive cases were linked to the nearby hospital for confirmation of diagnosis, care and follow-up and all of them were found to be hypertensive. This suggests that implementing primary health care approach integrated with the urban health extension package may be effective in the prevention and control of hypertension in poor settings.Conclusion and recommendationPrevalence of hypertension among adults was very high, but awareness, treatment and control of hypertension was very low. Being unable to read and write, not consuming fruit, being physically inactive, overweight/obesity and not knowing physical inactivity is a risk factor for hypertension were independently associated with hypertension. Policy makers need to consider integrating prevention and control of hypertension with health extension package. Appropriate information, education and communication strategies should also be designed and implemented to avoid unhealthy lifestyles and promote healthy practices.