Introduction The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. Methods A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. Results Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). Conclusion This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).

Background: The health system in Ethiopia’s Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services.Aim: This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts).Setting: Somali Region of Ethiopia.Methods: The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region.Results: 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas.Conclusion: With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.

Background: Female genital mutilation (FGM) is a global challenge with estimated over two hundred million girls and women worldwide having undergone the procedure and another three million girls are at risk of being cut yearly. The prevalence of FGM among women and girls aged 15-49 years in Somali region of Ethiopia is 99% compared to the national average of 65%. The study assessed the knowledge, attitude, and practice of health care workers on FGM practices in the region.Methods: The study was a cross-sectional descriptive survey and used quantitative method.Results: 36 (17.8%) of the health workers believed FGM was a mandatory religious practice, while 158 (78.2%) regarded it as a cultural practice. All the respondents knew it caused health problems, 32 (15.8%) believed it was a good practice though 176 (87.1%) of the respondents believed it violated human rights of the girls/women and 99 (49%) wanted the practice to continue. 15 (40.5%) had conducted FGM on a girl before, 5 (13.5%) claimed medicalization made FGM practice safer and 5 (13.5%) of the respondents intended to circumcise their daughters in future.Conclusions: Health care workers still have attitudes and practices that positively promote and could encourage FGM practices in spite of their knowledge of the health consequences and their acceptance as a violation of the rights of women and girls. This attitude has high tendencies of depriving the community members of access to accurate information that will enable them to make informed decision about FGM and efforts to eradicate the practice.

Background: Somali Region of Ethiopia recorded the first confirmed case of SARS-CoV-2 (COVID 19) pandemic on 26 th April 2020. The study aimed to assess the effect of the pandemic on the utilization of maternal newborn, child and nutrition health services. Subjects and Method: This was a retrospective chart review of monthly DHIS database of health facilities in Farfan zone of Somali Region and test of association using t test was used to compare the mean reduction in utilization of maternal and child health services three months before (January -March 2020) and three months during the pandemic (April 2020 to June 2020) at p value set at significant level of 5%. The outcome measure was the utilization of maternal newborn child health and services. Results: The mean reductions in OPD per capita for children under five, children who received first dose of pentavalent vaccines and pregnant women who received first ANC before and during the pandemic was 14.26%, t=1.07; 95% CI= 283.17 to 725.17; p= 0.325); 12.51%, t=0.74; 95% CI= 1439.33 to 2697.31; p= 0.489) and 14.43%, t=0.49; 95% CI= 2363.33 to 3543.41; p= 0.642) respectively, while the mean reduction in skilled birth deliveries conducted at the health facilities was 21.4%, t= 0.97; 95% CI= 319.26 to 736.16 ; p= 0.371). Conclusion:The study provided early effects of COVID 19 on health and nutrition services to health and nutrition services. This study indicated that indirect health service effects are substantial and highlights the importance of maintaining routine essential health and nutrition service delivery and the need to explore innovative ways of delivering both preventive and curative essential services.

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.