, No 3 (2019): Special Issue November 2019

ntroduction: Ensuring adequate cord care at birth and in the first week of life is crucial to prevent sepsis and cord infections, and to reduce preventable neonatal deaths. WHO recommends application of 7.1% chlorhexidine digluconate daily to the umbilical cord stump during the first week of life for newborns born at home in settings with high neonatal mortality.

Objective: This article describes the introduction of chlorhexidine for cord care in Ethiopia using the Community-Based Newborn Care (CBNC) platform and early lessons.

Methods:  Data related to chlorhexidine introduction inputs and processes from minutes, reports, and related documents from 2013 to 2017 were assessed and described using steps from the three phases to ensure sustainable implementation introduced in a recent guideline from the Global Chlorhexidine Working Group.

Results: Chlorhexidine was included as one of the components in CBNC after consensus building, and it was manufactured locally. Current implementation status in four zones is described. Early lessons include the fact that chlorhexidine for cord care is feasible and acceptable in Ethiopia. Critical gaps in knowledge, practice, and attitude on the service providers’ and mothers’ sides were observed. In addition, product availability was limited outside of facilities. Poor documentation and parallel supply-chain management also require further attention.

Conclusion: Government leadership and integration within the existing platform were key to the introduction of chlorhexidine for cord care in Ethiopia. Issues that require further attention include synchronization, behavior change communication, monitoring, and evaluation, as well as financing for sustainable product availability.

Introductions: Postnatal period is neglected in Ethiopia and receives relatively little attention compared to the other components of the health extension program. Given that a large number of women and their newborns remain at home during and immediately after birth and strengthening postnatal follow up service is a key strategy.

Objective: To assess how postnatal home visits influence the identification of young infants with possible serious bacterial infections in woredas in Southern Zone of Tigray, Ethiopia, an implementation research on community management of possible serious bacterial infections, where referral is not feasible.

Method: We used data from implementation research on the management of sick young infants with PSBIs where referral was not feasible. Infants 0-59 days of age during the implementation period of the larger project were included. Data were collected by health extension workers and checked in the field by cluster supervisors, field coordinators, and research team members. Descriptive data analysis was used to describe the study participants and the postnatal care visits. Data analysis was carried out using Statistical Package for Social Sciences version 20 software.

Key words: Implementation Research, possible serious bacterial infections, Raya Azebo, Raya Alamata, Postnatal Care, Health Extension Workers, Ethiopia.

Introduction: A well-functioning, responsive referral system relies on patient compliance in order to address newborn health problems that cannot be managed by lower level health facilities. Given that early identification and management of young infants with possible serious bacterial infection is fundamental to community-based newborn care.

Objective:Thispaper presents the findings of an assessment ofadherence to referral.

Methods:Usinga cross-sectional design with mixed qualitative and quantitative methods in five zones in two regions this study looked at sick young infants (0-2 months) whose caretakers sought care for them from a health post and who were classified with possible serious bacterial infectionin the 12 months prior to the study. We reviewed clinical records of possible serious bacterial infectioncases at health posts and health centers and conducted interviews with caretakers of referred possible serious bacterial infection cases and health workers.

Introduction: Ethiopia has implemented community-based neonatal sepsis management as one strategy to reduce its persistently high neonatal mortality rate since 2012. The key strategies to maintain the quality of community-based management of neonatal sepsis are training, supportive supervision, and woreda-level performance review.

Objectives: Examine the effects of supervision visits provided to health posts on the consistency of neonatal sepsis management skills of health extension workers in Ethiopia.

Methods: The study domain was limited to 6,416 health posts in 269 woredas of Ethiopia. Longitudinal program monitoring data captured from registers between January 2014 and June 2016 was used for this study. The health post-level repeated measures were accounted for using random effects multiple logistic regression models

Results: All health posts (6,416) received at least one supportive supervision visit, 20% (1,289) received two, and 5% (301) received more than two visits. The consistency of neonatal sepsis management was 71%, 76%, and 84% during the first, second, and third supervision visits, respectively. The effects of supportive supervision that were observed between the first and third rounds of supervisory visits were statistically significant.

Introduction: Neonatal mortality declined by 41% in the past 15 years but remains unacceptability high in Ethiopia (29/100 live births).  Further reductions in neonatal mortality are a major priority and will require improvements in care for mothers and newborns during pregnancy, postnatally, and especially around the time of delivery. These improvements rely on the readiness of facilities to provide high quality services to those who need them.

Objective: To assess the facility readiness for newborn care in Ethiopia.

Methods: The study data is drawn from a cross-sectional national health facility assessment of 175 health centers and 120 hospitals conducted between December 2016 and February 2017. The study focused on the availability and functionality of newborn care corner and related services and newborn intensive care units in the nine regions and two city administrations of Ethiopia.

Results: The study found that 91% of health centers had newborn corners established within labor rooms although wide variations existed between regions. Radiant warmers were assembled in nearly all HCs (82%), however oxygen was used in only 29% of HCs.  Most of the hospitals had received radiant warmers with oxygen cylinders, phototherapy, incubators, and continuous positive airway pressure sets.  Radiant warmers with oxygen cylinders and phototherapy arrived ready to use. However, only 77% of hospitals had assembled and used incubators and only 11% of hospitals had assembled and used continuous positive airway pressure sets.

Introduction: Newborn deaths account for 43% of under-five mortality in Ethiopia, and newborn infection contributes to one third of these deaths. The provision of community-based newborn care services through the Health Extension Program platform is a key strategy to increase the utilization of newborn care services by increasing access near the community. In March 2013, the Ethiopian government launched community based newborn care, through which community health workers are trained, supplied with essential commodities, and supervised on the provision of community based newborn care, including the management of severe newborn infections.

Objective: To assess the effect of CBNC intervention on improving health care-seeking behavior for community newborn and child health services.

Results: The number of sick young infants seen at HPs increased 21-fold after the initiation of community-based newborn care. Managed cases of very severe disease and cases of local bacterial infection increased six-fold and four-fold, respectively. Managed cases of pneumonia and diarrhea showed only slight increases.

Conclusions: Overall, community-based newborn care has improved the health care-seeking behavior of mothers of sick young infants in Ethiopia. However, care-seeking is still low when compared with the numbers of expected cases.

Key words: Sick young infants; sick children; community-based newborn care; care-seeking behavior; pre- and post- community-based newborn care

Introduction:  Successful implementation of Community Based Newborn Care, relies on uninterrupted availability gentamycin and amoxicillin at health posts requiring strong national supply chain System. Ethiopia is implementing a pull system through an integrated pharmaceutical and logistics system but mainly focusing on HIV, tuberculosis, and malaria commodities. Hence a semi-parallel push system was used by the ministry of health with United Nations Children’s Fund support to avail newborn lifesaving commodities at health posts. Moreover, the ministry coordinated the incorporation of the lifesaving commodities in the national essential medicine list, their registration, procurement and distribution.

Objective: This article presents challenges, strategies in availing lifesaving commodities at health posts and recommendations.

Methods: We reviewed different documents and data related to newborn supply chain from March 2013 to December 2016: data from a cross-sectional survey between Quarter-4, 2015 and Quarter-1, 2016, and program monitoring from October 2015 to September 2016 were used. We describe the findings using key components of the supply chain system.

Results: Ethiopia took several measures to overcome supply-chain challenges; cross-sectional survey showed availability of gentamycin and amoxicillin, 72% and 82% of health posts on the day of visit respectively. during routine monitoring visits to 2,500 health posts, gentamycin and amoxicillin dispersible tablets were available in 99.8%and 77.5% on the day of visit respectively.,

Introduction: Ethiopia is scaling up community based newborn care on the platform of the Health Extension Programme after national introduction of integrated community case management of pneumonia, diarrhea, malaria and severe acute malnutrition in the four agrarian regions. Since 2013, 26,600 female health extension workers have been trained and supported to provide community based newborn care, including management of newborn sepsis, at an estimated 14,000 health posts or at home.

Objective: To conduct a modeling exercise to project the potential reduction of the newborn mortality rate due to the community based newborn care program in the four agrarian regions of Ethiopia.

Methods.  We created three projections: (1) baseline projection without community based newborn care using 2013 data; (2) a “realistic” projection using the 2014-2016 data from available survey and routine information systems and (3) a “best case” scenario which scaled up the full package of maternal newborn and child care interventions according to the targets of the Health Sector Transformation Plan of Ethiopia.

Results: If the 2016 coverage achievements of the implementation sites (realistic projection) were applied to the four agrarian regions, we project that the community based newborn care program has contributed 46,180 additional neonatal lives saved between 2013 and 2016. If the Health Sector Transformation Programme targets of maternal newborn and child care are reached, nearly 187,514 additional neonatal lives will be saved between 2017 to 2020, with 233,696 additional neonatal lives saved between 2013 to 2020.

Introduction: Building on lessons learned from integrated community case management of common childhood illnesses, Ethiopia launched community-based newborn care in March 2013 with the goal of reducing newborn and child mortality. The strategies of community-based newborn care included, among others, identification and managing sick newborns at the community level when referral is not possible.

Objective: To assess the strength of the community-based newborn care program implementation in terms of inputs, process, and outputs, and document key lessons learned through the implementation of the first phase of the program in the four agrarian regions of Ethiopia.

Method. Mixed methods were employed; a secondary analysis of quantitative data from routine program databases collected March 2013 through December 2016 and desk review and after-action reviews with stakeholders, in the first phase community-based newborn care program zones.

Results: Trained service providers were available in all health posts(HPs) and 91%(95 CI: 90-92) of health posts had the essential drugs, amoxicillin and gentamycin for community case management of sick newborns on the day of visit. A third (32%) of the expected very severe disease cases sought care at HPs. Nearly three quarters (74%) of these cases were treated at health posts, and 90% of the cases completed their treatment.