BackgroundEthiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia.MethodsWe conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection.ResultsThe majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care.ConclusionsImproving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.
BackgroundThe Standards Based Management and Recognition (SBM-R©) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers’ performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services.MethodsA post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers’ performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups.ResultsThere was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers’ overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother.ConclusionsThe SBM-R quality improvement intervention made a significant positive impact on MNH providers’ performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government’s five-year (2015–2020) health sector transformation plan and health care quality strategies needed to meet the country’s MNH goals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1303-y) contains supplementary material, which is available to authorized users.
Background: African American and Hispanic older adults are reported to have up to a 2-fold higher risk of Alzheimer’s disease and related disorders (ADRD), but the reasons for this increased vulnerability have not been fully explored. The Vulnerability Index (VI) was designed to identify individuals who are at risk of developing cognitive impairment in the future, capturing 12 sociodemographic variables and modifiable medical comorbidities associated with higher ADRD risk. However, a prior limitation of the VI was that the original study cohort had limited diversity. We examined the association of the VI within and between non-Hispanic White, African American, and Hispanic older adults with and without cognitive impairment and different socioeconomic strata enrolled in a community-based dementia screening study. Objective: To explore reasons for reported higher ADRD vulnerability in African Americans and Hispanics. Methods: In a cross-sectional study of 300 non-Hispanic White, African American, and Hispanic older adults with and without cognitive impairment, we studied the association between cognitive status, the VI, and socioeconomic status (SES). Results: When considering race/ethnicity, the presence of more vascular comorbidities drove greater vulnerability. When considering SES, vascular comorbidities played a less prominent role suggesting resources and access to care drives risk. The VI had differential effects on cognitive performance with the greatest effect in the earlier stages of impairment. Conclusion: Findings from this study provide a deeper understanding of the differential risk of ADRD in multicultural older adults captured by the VI and how barriers to healthcare access may increase vulnerability in racial/ethnic minorities.
Background: Alzheimer's disease and related dementias (ADRD) disproportionately affects communities of color with older black Americans performing worse than Whites on cognitive tests and facing higher ADRD risks. 1,2 Contributors to low diagnostic rates include inadequate knowledge, cultural norms, low health literacy, and an unwillingness to discuss early signs of disease. 1,[3][4][5] Older Afro-Caribbeans are a growing subset of the population, particularly in rural South Florida, but best practices to screen for ADRD are unknown. 6 Many instruments, including the Montreal Cognitive Assessment (MoCA) have not been assessed within this population. We report on the use of the MoCA 5-minute test/telephone (Mini-MoCA) as a screening tool in older, rural-dwelling Afro-Caribbeans. 7 Method: We conducted survey interviews with 53 Afro-Caribbean participants. Participants were assessed with the 5-minute Mini-MoCA, which included tests of language fluency, orientation and recall. Linear regression models were used to investigate the association between different components of the Mini-MoCA its effects on age, sex, and education.Result: A total of 53 Afro-Caribbean participants (67.2 +10.8y (Mean ± SD), 68% with 10y or less of education) residing in rural South Florida within the last 20 years were included. Participants were largely from Haiti (66%) with 34% from other Caribbean countries including Cuba, Jamaica, Puerto Rico, and Barbados. About 80% of participants reported not having their memory tested prior to the study. The Mini-MoCA demonstrated good reliability in this sample (α = 0.734). We found that 53% had a total score of 11 or lower on the Mini-MoCA. Linear regression suggested a significant association between Mini-MoCA score and education (p = .001). Conclusion:While the Mini-MoCA showed good reliability in low-educated older Afro-Caribbeans, scores were strongly dependent on years of education. Disparities in educational attainment may contribute to disparities in performance and affect true detection on cognitive impairment in these communities. Social and cultural factors must be considered when interpreting the Mini-MoCA, given the high error rates on items that depend on the ability to read and write. Study results highlight the need to use a language-neutral test to accurately measures cognitive impairment among this specific population.
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