Background: A responsive and well-functioning newborn referral system is a cornerstone to the continuum of child health care; however, health system and client-related barriers negatively impact the referral system. Due to the complexity and multifaceted nature of newborn referral processes, studies on newborn referral systems have been limited. The objective of this study was to assess the barriers for effective functioning of the referral system for preterm, low birth weight, and sick newborns across the primary health care units in 3 contrasting regions of Ethiopia. Methods: A qualitative assessment using interviews with mothers of preterm, low birth weight, and sick newborns, interviews with facility leaders, and focus group discussions with health care providers was conducted in selected health facilities. Data were coded using an iteratively developed codebook and synthesized using thematic content analysis. Results: Gaps and barriers in the newborn referral system were identified in 3 areas: transport and referral communication; availability of, and adherence to newborn referral protocols; and family reluctance or refusal of newborn referral. Specifically, the most commonly noted barriers in both urban and rural settings were lack of ambulance, uncoordinated referral and return referral communications between providers and between facilities, unavailability or non-adherence to newborn referral protocols, family fear of the unknown, expectation of infant death despite referral, and patient costs related to referral. Conclusions: As the Ethiopian Federal Ministry of Health focuses on averting early child deaths, government investments in newborn referral systems and standardizing referral and return referral communication are urgently needed. A complimentary approach is to lessen referral overload at higher-level facilities through improvements in the scope and quality of services at lower health system tiers to provide basic and advanced newborn care.

Medical genetics services are needed in Ethiopia. As other countries increase their genetics capacity, the MFHA can provide fundamental genetics services and collect necessary epidemiologic data.

Background: HIV/AIDS is currently a major public health problem in Ethiopia and mother to child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission of HIV from infected mothers to babies could occur during antenatal period, as well as during delivery and breastfeeding (postnatal period). Since breastfeeding is essential for child survival, it is also necessary to assess mothers' knowledge and attitude towards HIV transmission and its prevention during breastfeeding. Objectives: This study attempts to assess mothers' knowledge of MTCT of HIV including breastfeeding, in two government hospitals in Addis Ababa. It also describes mothers' attitudes towards voluntary counseling and testing (VCT) services. Methods: A cross sectional, descriptive study was conducted to assess knowledge and attitude towards MTCT and its' preventive methods on postnatal mothers who delivered at Tikur Anbessa and Zewditu Memorial Hospitals, Addis Ababa, from January to March 2004. A structured, pre-tested questionnaire was used for data collection. Results: A total of 384 mothers were interviewed 78.4% of whom were from Addis Ababa. 87.0% were aged between 16-30 years. Of these mothers 54.9% were primipara, 89.9% were married, and 84.6% were Christians. Amhara (44.5%), Oromo (26.3%), Gurage (17.2%), and Tigre (7.0%) were the major ethnic groups in the study population. All the 384 respondents had heard about HIV/AIDS of which, 82.3 % mentioned the major routes of transmission and 89.8% knew that that HIV could be transmitted from an infected mother to her baby. Most of the respondents (76.8%) knew that MTCT of HIV is preventable, 64.6% knew the protective effect of prophylactic anti-retroviral drugs, 37.1% knew that abstinence from breastfeeding can prevent MTCT, 10.4% knew elective caesarean section (C/S) as a preventive method and 6.9% stated that protection of the mother from HIV is the same as protecting her baby. Those mothers who were from Addis Ababa, and whose educational level was secondary and above were found to be more knowledgeable about MTCT and PMTCT. Three hundred seventeen (82.6%) of the mothers knew what VCT meant and 76.8% of them have positive attitudes to wards VCT. 69.3% of the mother indicated that mothers should be tested before breastfeeding and 67.4% agreed to have VCT before breastfeeding their new babies. 60.2% planned to have VCT before their next pregnancy. Conclusion: This study showed that most mothers in this study knew that HIV could be transmitted from mother to child and that it can be prevented. A majority are of the opinion that VCT can be a preventive strategy and most of them have the intention to have counseling and testing before the next pregnancy. Hence well-organized VCT centers and PMTCT programs should be established to halt the epidemic from affecting the next generation. [Ethiop.J.Health Dev. 2005;19(3):211-218]

This study assesses the quality of care for preterm, low birth weight (LBW), and sick newborns across the public health care system levels in 3 regions of Ethiopia. Qualitative data based on the WHO framework to assess provision and experience of care was collected using in-depth interviews and focus group discussions with women who recently delivered preterm, LBW, and sick newborns, as well as health care providers and health extension workers, and facility administrators associated with study health facilities. This qualitative approach revealed perspectives of patients, health care providers and facility administrators to assess what is actually happening in facilities. Clinical guidelines for the care of preterm, LBW, and sick newborns were not available in many facilities, and even when available, often not followed. Most providers reported little or no communication with parents following hospital discharge. Human resource challenges (shortage of skilled staff, motivation and willingness, lack of supervision, and poor leadership) inhibited quality of care. Participants reported widespread shortages of equipment and supplies, medication, physical space, water, electricity, and infrastructure. Economic insecurity was a critical factor affecting parents’ experience. Acceptance by users was impacted by the perceived benefits and cost. Users reported they were less likely to accept interventions if they perceived that there would be financial costs they couldn’t afford. The quality of care for preterm, LBW, and sick newborns in Ethiopia as reported by recently delivered women, health care providers and facility administrators is compromised. Improving quality of care requires attention to process of care, experience of care, and health system capacity, structure, and resources.

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