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Research

Addis Continental Institute of Public Health collaborates with government and non-governmental organizations to expand the evidence base for public health programs planning and evaluation. The Institute has many senior experts in the field of public health that can help develop research proposals, implement field research, and perform data analysis and report writing. Some recent examples of the research and evidence capturing projects organized by ACIPH and its staff are described below.

 

Impact evaluation of behavior change communication intervention “Alive and Thrive Initiative” on infant and young child feeding (IYCF) practices and on childhood stunting in Ethiopia - 2013


In Ethiopia, nearly half of the under five children are stunted – a chronic malnutrition which is largely irreversible after the age of two years. The Ethiopian Demographic Health Survey 2005 reported few children are properly breastfed and given right amount and right quality of complementary feeding at the right age. Alive &Thrive initiative, funded by Bill and Melinda Gates foundation, with Integrated Family Health Programs (IFHP), has implemented a community based behavior change communication (BCC) intervention along with other strategies through the government’s Health Extension Program (HEP) system to improve infant and young child feeding (IYCF) practice and reduce stunting in children under two years of age. The ongoing evaluation of the BCC helps to estimate the impact of these behavior change communications intervention on creating an enabling household environment for infant and young child feeding (IYCF) and on IYCF practices and childhood stunting. 

Effectiveness of community based management of severe acute malnutrition (CMAM): importance of maternal and health system context in South Ethiopia - 2011-2012


Ethiopia hosts more than 250,000 children under 5 years of age who are found to be severely wasted annually. Evidence-based and cost-effective interventions to reduce childhood malnutrition such as Community based Management of Severe Acute Malnutrition (CMAM) exist and calls have been made to strengthen the scaling up process. The National Nutrition Strategy also includes CMAM as a means to reduce acute malnutrition among vulnerable groups. As the setting or context in which the integration and scale up took place can modify the effect of the large scale nutrition interventions, a study is conducted to examine effectiveness of community based management of severe acute malnutrition in South Ethiopia. This study utilized both qualitative and quantitative designs. Focus group discussions (FGD) and semi structured individual interviews were the methods used to explore the experience of CMAM from mothers’ and health workers’ perspective. A cohort of more than 1000 children with severe acute malnutrition and a population based survey of more than 3,800 household were studied to examine effectiveness of interventions for treating SAM among under five children and determine the contextual factors. 

Ethiopia Community Prevention of Mother-to-Child Transmission Project Assessment of Feeding Practices in HIV-Exposed Children Less than Two Years of Age, “Ethiopia IYCF Study”- 2012


While the prevalence of malnutrition among HIV-exposed Ethiopian children is unknown, these children tend to be more vulnerable due to the economic impact of HIV on families, and the added stresses on mothers that may affect caring practices. Feeding infants less than six months of age with breast milk and other liquids, milk, formula or solid food, called “mixed feeding” in the HIV context, puts the HIV-exposed infant at the increased risk of acquiring HIV from breast milk as well as non HIV-related infections. The assessment used both qualitative and quantitative methods to determine caregivers’ and influential community members’ knowledge, attitudes, and practices (KAP) related to optimal infant and young child feeding (IYCF) practices in the context of HIV/AIDS. In addition, it used consultative research methods to examine what the current practices are, and what changes are feasible and adoptable for mothers to improve their feeding and caring practices for their children less than two years of age which can provide useful inputs to the existing PMTCT and IYCF programs and approaches. 

Community-Based Sub-Component of Ethiopian National Nutrition Program - 2009-2010


Children and women are most vulnerable to malnutrition in developing countries because of low dietary intakes, infectious diseases, lack of appropriate care, and inequitable distribution of food within the household. The Ethiopian Demographic Health Survey conducted in 2005 showed that the level of malnutrition in the country among under five year children; 47% stunted, 11 percent wasted, and 38 percent underweight. To this response the Government of Ethiopia (GOE) developed the National Nutrition Program (NNP) in 2008. As a contribution to the NNP, the GOE-UNICEF Country Program Action Plan 2007 -2011 has initiated the implementation of the CBN sub- component in selected woredas in Amhara, Oromia, SNNP and Tigray regions. 

Community-based Approaches towards Improving Infant Feeding Practices in selected Program Areas of SNNPR and Tigray in Ethiopia-- 2009-2010


IYCF practices are major determinants of the risk of malnutrition in developing countries, including Ethiopia. One of the major platforms for program implementation to shape IYCF demand and practice is through strengthening existing programs which address community-based nutrition in food secure areas. The strategy is to strengthen the government’s community-based Health Extension Program which utilizes HEWs and VCHWs to mobilize their communities, deliver key preventive messages and provide counseling to promote optimal IYCF behaviors. The study utilized a qualitative method and focused on 6 food secure woredas in SNNPR and Tigray. A total of 90 in-depth interviews with mothers of children under two, 42 in-depth interviews with health workers and 18 focus group discussions with grandmothers, fathers and community leaders was conducted to better understand practices and the factors which influence child feeding and best support optimal practices. 

Enhanced Outreach Strategy in Ethiopia - first round 2008 campaign: Post Campaign Evaluation Survey - 2008


The Government of Ethiopia in collaboration mainly with UNICEF and the World Food Program has initiated the delivery of essential preventive package for children aged 6 – 59 months to reduce under-5 mortality and morbidity using the Enhanced Outreach Strategy and target supplementary food (EOS/TSF) since 2004. The key component of the strategy is to reach as many children and women as possible during the campaigns. In order to validate the administrative routinely reported EOS service coverage, the need for an independent post-campaign coverage survey became imperative. Thus, an independent survey was conducted between June and September 2008 following the first round EOS campaigns in 2008. 

Preliminary Results Survey of Non Communicable Diseases among Bank Employees and Teachers in Addis Ababa, Ethiopia - 2010


Chronic non communicable diseases (NCDs), in particular cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases, account for 60% of all deaths globally, more than double the number of deaths caused by infectious diseases, maternal and prenatal conditions, and nutritional deficiencies combined. The global prevalence of NCDs is increasing at an alarming rate, with the majority of cases occurring in developing countries. The change in life style characterized manly by behavioral, dietary and nutritional states are believed to contribute to increased burden of NCDS. 

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Community-Based Sub-Component of Ethiopian National Nutrition Program - 2010


Children and women are most vulnerable to malnutrition in developing countries because of low dietary intakes, infectious diseases, lack of appropriate care, and inequitable distribution of food within the household. The Ethiopian Demographic Health Survey conducted in 2005 showed that the level of malnutrition in the country among under five year children; 47% stunted, 11 percent wasted, and 38 percent underweight. To this response the Government of Ethiopia (GOE) developed the National Nutrition Program (NNP) in 2008. As a contribution to the NNP, the GOE-UNICEF Country Program Action Plan 2007 -2011 has initiated the implementation of the CBN sub- component in selected woredas in Amhara, Oromia, SNNP and Tigray regions. 

Abstract

 

Qualitative Study on Malaria Prevention and Control in Oromia and Amhara Regional States in Ethiopia - 2009


In Ethiopia, malaria is one of the most important public health problems, with more than three-quarters of the landmass of the country and an estimated 68% of the total population is considered at risk of malaria infections. Ethiopia is implementing a range of malaria control interventions that aim to improving access and equity to preventive as well as curative health services, which include prompt and effective malaria treatment, selective vector control using insecticide treated nets (ITNs) and indoor residual spraying (IRS). Effective and timely prevention and control of malaria epidemics is also part of the main strategies. The need for developing comprehensive and high impact communication strategies for malaria control is imperative. 

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Health Systems Strengthening Tracking Study - 2009


The Global Alliance for Vaccines and Immunization (GAVI) was launched in 2000 to increase immunization coverage and reverse widening global disparities in access to vaccines. The partnership includes governments in industrialized and developing countries, the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), World Bank, non-governmental organizations (NGOs), foundations, vaccine manufacturers, and public health and research institutions working together to achieve common immunization goals. Health systems strengthening (HSS) grants are a relatively new addition to GAVI’s funding portfolio. The GAVI Alliance created this new funding window in 2005 based on a multi-country study that identified systemwide barriers to higher immunization coverage. Currently, a total of US $800 million is available from GAVI for HSS to help countries address difficult health systems issues such as management and supervision; health information systems; health financing; infrastructure and transportation; and health workforce numbers, motivation and training.

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Women’s and Girls’ Empowerment Project - Ongoing M&E Final Report - 2009


Women’s and girls’ empowerment project is funded by Packard foundation and implemented by pathfinder international Ethiopia in Amhara, Oromia and Addis Ababa regions from 2007- 2009. Five implementing organization were involved in the implementation of the project. Increasing awareness of reproductive health issues, advocating for the elimination of harmful traditional practices and increasing access and utilization of youth friendly services are among the major strategies of the project.

A baseline survey was conducted in May 2007 and ongoing monitoring and evaluation was performed through out the project period. End project survey is conducted in May 2009 and changes in selected indicators were compared with the results of the baseline study. 

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Assessment of Preparedness to Pandemic Influenza in Ethiopia - 2008


According to Influenza experts, the world is overdue for another flu pandemic. It is therefore helpful to understand the scope of preparedness of the most vulnerable nations. This study was conducted to understand Ethiopia’s past experiences in responding to emergencies, current preparedness for emergencies, and effective channels of communications during emergency situations. It is hoped that by understanding these aspects of emergency preparedness among targeted nations, we can better design pandemic flu preparedness and response programs.

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Formative Assessment for Modeling and Reinforcement to Combat HIV/AIDS (MARCH) Project


This formative assessment was conducted with the aim of understanding the perception of police officers about risks for HIV/AIDS and the services available to prevent, care and treat HIV/AIDS. The study utilized qualitative research approach, mainly Focus Group Discussion and semi-structured interview, to collect relevant data. Data pertaining to risk HIV perception; assessment of the adequacy of the police force structure to support MARCH activities; facilitators and barriers to health services utilization related to HIV/AIDS prevention, treatment and care; and feasibility of implementing serial print drama and peer group discussions for modeling and enforcing behavioral change were collected. Interviews and discussions were audio taped, and then transcribed verbatim. Data were analyzed using the thematic approach assisted by the Open Code computer program. The study concluded that there is a general lack of policy and guidelines for fighting HIV/AIDS in the police force. Available services are not accessed due to fear of stigma and discrimination, lack of information and communication, poor quality of services, and lack of actual and perceived confidentiality. The sample print serial drama was acceptable with modification to reflect on the nature and function of the police force. Useful suggestions about organization, leadership, frequency, and duration of peer group discussion sessions are gathered. The findings suggest that a workplace policy related to HIV/AIDS need to be developed in order to encourage service utilization, reduce stigmatization attitude and improve service quality. Practical manual how to avoid/reduce the risk of HIV acquisition need to be developed and provided to each police force member. Print Serial Drama and peer Group discussion are acceptable and feasible methods of modeling and reinforcing HIV/AIDS prevention activities aimed at behavioral change among Federal and Addis Ababa police force members in Ethiopia. However, policy and implementation guidelines as well as a good implementation plan need to be in place to implement sustainable and effective HIV/AIDS programmme.

 

WHO Treat Study “Health worker access to HIV/TB prevention, treatment and care services in Africa: situational analysis and mapping of routine and current best practices”


‘Treat, Train, Retain’ (TTR), the study is an important component of WHO’s overall effort to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. It is also part of WHO’s effort to promote universal access to HIV/AIDS services. TREAT part of the TTR study is emphasized in this survey. TREAT study is a package of HIV treatment, prevention, care and supports services for health workers who may be infected or affected by HIV and AIDS. The main goal of this project is to facilitate improved prevention, diagnosis, treatment and support of HIV/AIDS and TB and other occupational hazards among health workers and their families by providing a detailed situational analysis to identify current best practices, the strengths and limitations of services in both current best practice and routinely available services, and explore potential strategies for filling gaps, overcoming barriers, and improving timely uptake of services by health workers. The study is conducted in six African countries selected primarily on the basis of their burden of disease, Population size, number of HIV-infected health workers, and geographical spread. These African countries are Zimbabwe, South Africa, Mozambique, Malawi, Kenya, and Ethiopia. Ethiopia is selected on the first phase of this study due to its high burden of HIV, very scarce human resource, High population pressure, and is rapidly scaling up and decentralizing HIV services. Addis Continental Institute of Public Health implemented the project in Ethiopia. The study objectives includes summarizing relevant literature, policy and guidelines; identifying examples of best practice and lessons learnt; identifying the gaps and barriers in routine &best-practices; and exploring perceptions of health workers& policy-makers to solutions.

Alcohol and Khat Consumptions and the association with HIV/AIDS transmission, prevention, care and treatment in Ethiopia


Behaviors associated with substance abuse such as alcohol and Khat are believed to be among the main factors that increase the vulnerability to risky sexual behaviors that facilitate the spread of HIV infection. In Ethiopia both khat and alcohol are consumed widely and HIV prevalence is high in urban areas but their association has not been studied. The Ethiopian Public Health Association and CDC in collaboration with ACIPH initiated the investigation of the magnitude of the exposure and the association to risky sexual behaviors. The study tries to assess alcohol and Khat consumption and its association with HIV/AIDS prevention, care and treatment practices. The study utilizes a mix of qualitative and quantitative designs. The study focused on twelve woredas which are located in eight regions of the country that have high HIV prevalence. The study consisted of three components: household survey, clinic based survey, and qualitative interviews. The total sample size for the household survey was about 10,500, in addition to 1000 PLWHA patients attending ART clinics and 72 in-depth interviews with key informants.

Early Marriage Evaluation Survey in Amhara Regional State, Ethiopia


Early marriage is one of the traditional practices that are widely experienced in most parts of Ethiopia by young girls and boys. The practice is highly rampant in the Northern part of the country particularly in Tigray and Amhara regional states. Mrts have been made by government as well as non government organizations to tany researches indicated that the impact of early marriage is more severe on girls in terms of heath and educational attainment. Thousands of girls had health complications as the result of early marriage. Among others, Fistula is the major and devastating health consequences of early marriage. Effoackle this silent epidemic. Addis Continental Institute of Public Health (ACIPH) in collaboration with Tulane University and MEASURE Evaluation conducts an evaluation survey in sixteen woredas if the Amhara regional state to assess the outcome of the interventions carried out by the USAID implementing partners. Over 5000 randomly selected households and eligible female adolescent between the ages of 10 and 19, male adolescent between the ages of 15 and 24, and one of their parents participate in the study. The survey includes questions about incidence of and attitudes toward early marriage and childbearing, as well as exposure to interventions to delay the age of marriage for girls in both rural and urban areas of Amhara Region.

On Going Monitoring and Evaluation for Women and Girls Empowerment Project


The "Women and Girls Empowerment Project" is a three years project funded by the David and Lucile Packard Foundation. It is implemented through Pathfinder International by its implementing partners. It aimed to improve the status of women and girls using various strategies. In order to assess the change resulting from the interventions and the effectiveness of the various strategies used to improve the status of women and girl’s conducting an on going monitoring and evaluation is crucial. Addis Continental Institute of Public Health is in charge of the on going monitoring and evaluation of the project. The ongoing evaluation provides baseline information for evidence based project implementation and closely monitor and document practices that would enable the project perform in a more efficient and useful way. The monitoring and evaluation methods include formative baseline assessment in selected intervention communities; assessing the comparative advantage of the various program approaches with emphasis on identifying which programmatic approaches worked best for increasing access to RH/FP services (i.e. community education, YFS, peer education and strengthening youth clubs, refurbishment, provider training, etc); identifying which programmatic approaches worked best for advocating for the elimination of HTP and GBV (i.e.: community education, advocacy, community action committees, etc); identifying which programmatic approaches worked best for providing disadvantaged girls with opportunities for education and development of leadership and life skills (i.e.: girls’ scholarships, girls’ clubs, introduction of professional role models, etc); searching and documenting the most significant changes (behavioral/practice) within the project.; providing periodic updates to the program implementers and managers about the findings to improve ongoing programming; and producing a summary evaluation report that triangulates the various sources of evaluation data.