ObjectivesKangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.DesignThis study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measuresThe primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.ResultsKey barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).ConclusionsThis study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbersISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.

Background Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. Methods A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. Results Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity’s beliefs and valueswith respect to preterm and LBW babies;health professionals’ acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. Conclusions Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.

BackgroundGlobally, an estimated 289,000 maternal deaths occurred in 2013. Majority of these deaths occurred in sub-Saharan Africa and Southern Asia. Mobility of pastoralists is a well-recognized survival strategy in arid and semi-arid land of sub-Saharan Africa. However governments often encourage settlement as a solution to the difficulty of providing health services for mobile pastoralists. This study aimed to assess utilization of institutional delivery and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji zone, Oromia, Ethiopia.MethodsA Community based cross-sectional survey was conducted among the mobile pastoralist community of the Liban District. Seven hundred ninety-one (791) randomly selected women, who had birth within the last 2 years preceding the survey, were interviewed using a pretested structured questionnaire. Data were entered into Epi-Info version 3.5.4 and analyzed by Statistical Package for Social Science (SPSS) version 16. Bivariate and multivariate analyses were done.ResultsOut of 791 women who gave birth within the last 2 years preceding the survey, only 110 (13.9%) gave birth in health institutions. Majority (74.1%) of the women gave birth at their home. Ninety-one women (11.5%) gave birth at traditional birth attendant’s home; assisted by traditional birth attendants. Multiple logistic regression shows that women who had readily available cash at the onset of labor (aOR 2.79, 95% CI: 1.29–6.25), delivered the birth preceding the most recent birth in a health institution (aOR 6.8, 95% CI: 3.44–13.45) and had birth related complications during the birth preceding the most recent birth (aOR 1.90, 95% CI: 1.08–3.36) were more likely to deliver at health institutions.ConclusionMajority of the pastoral women seek institutional delivery, only when labor related complications are perceived. Mechanisms of alleviating indirect health care costs affecting institutional delivery need to be addressed in future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1325-5) contains supplementary material, which is available to authorized users.

BackgroundThough the burden of malaria is declining, challenges in control continue globally, regionally and nationally as the transmission of malaria is dynamic and determinants differ by place and time, and across populations. The current level of knowledge on malaria prevalence and associated factors in specific communities, such as pastoralist communities of Ethiopia, is lacking.MethodsA community based cross-sectional survey was conducted among pastoralist communities from December 2011 to January 2012. Background information and peripheral blood samples were collected from 461 randomly selected study participants. Multivariate regression analysis was done to explore the risk factors associated to malaria.ResultThe prevalence of malaria among 461 examined study participants was 6.1 % (95 % CI = 4.2, 8.5). The infection rate with Plasmodium falciparum and Plasmodium vivax was 64.3 % (95 % CI = 45.5, 80.2) and 21.4 % (95 % CI = 19.8, 54.5), respectively, while mixed infection was 14.3 % (95 % CI = 4.7, 30.9). The infection rate was higher among lactating (22.2 %, 95 % CI =7.5, 45.3) and pregnant (17.6 %, 95 % CI = 4.7, 40.9) women compared with other community groups like infants (12 %). Mosquito net coverage of the study population was 90.1 % with an average of 1.8 per household. Traditional practices related to malaria prevention and treatment were not significantly associated with malaria infection (p > 0.05). Pregnancy (adjusted Odds Ratio [AOR]: 12.6, 95 % CI = 1.7, 94.7) and saving mosquito net for later use (AOR 9.6: 95 % CI = 2.2, 42.8) were independently associated with prevalent malaria infection.ConclusionIn spite of high coverage of mosquito nets, prevalence of malaria in this pastoralist community was high, affecting pregnant and lactating women at a higher rate. Pregnancy and saving mosquito nets for later use were identified as the associated risk factors. Health education on prevalence of malaria and knowledge on risk factors might be able to change the health behavior in this pastoralist community which consequently can decrease the malaria morbidity and mortality.Trial registrationISRCTN ISRCTN73824458, Registered 28 September 2014.

Background: Hypertension is a serious public health concern which alone is estimated to cause 7.5 million deaths (12.8% of all causes of death) per year and it doubles the risk of many cardiovascular diseases.