Marta Hadush - Academia.edu (original) (raw)

Papers by Marta Hadush

Research paper thumbnail of Maternal mortality during war time in Tigray, Ethiopia: A community‐based study

Maternal mortality during war time in Tigray, Ethiopia: A community‐based study

BJOG: An International Journal of Obstetrics & Gynaecology

ObjectiveThis study seeks to examine the impact of war on maternal mortality following an exacerb... more ObjectiveThis study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict.DesignCommunity‐based cross‐sectional study.SettingTigray region of Northern Ethiopia, between November 2020 and May 2022.PopulationThis study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas.MethodsThe study was conducted in two phases. In the first phase, reproductive‐age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households.Main Outcome MeasuresMaternal mortality ratio level and cause‐specific mortality.ResultsThe results of the study showed that the maternal mortality ratio was 840 (95% CI 739–914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy‐...

Research paper thumbnail of Newborn care practices at home and health facilities in Tigray, Ethiopia: a qualitative assessment

Newborn care practices at home and health facilities in Tigray, Ethiopia: a qualitative assessment

Background: The Most Vulnerable age group for child survival is neonatal period. In 2019, Newborn... more Background: The Most Vulnerable age group for child survival is neonatal period. In 2019, Newborn deaths accounted to nearly half of under-5mortality with 2.4 million deaths Worldwide. (1) The estimated neonatal mortality rate of Ethiopia is 30 deaths per 1000 live births. (3). The aim of this study is to assess the Newborn care practices at home and public health care system in Tigray. Methods: A qualitative study was conducted with two techniques: focused group discussions and in depth interviews. Five zones from Tigray region were included in the study. A total of 16 focused group discussions and 46 in depth interviews were conducted among community representatives and health workers. Collected data was discussed, recorded data was transcribed ATLAS ti software was used for coding themes and experiences. The transcribed data were analyzed using an inductive approach. Before coding, the themes were identified and thoroughly discussed. Results: Community perspective: Despite satisf...

Research paper thumbnail of Practice of Kangaroo Mother Care Among Low-Birth-Weight Infants Discharged from Health Facilities and Its Outcome in Mekelle City, Tigray, Northern Ethiopia

International Journal of General Medicine

Background: Kangaroo mother care is a proven intervention shown to be effective in reducing neona... more Background: Kangaroo mother care is a proven intervention shown to be effective in reducing neonatal mortality among low-birthweight infants. The paucity of evidence regarding the practice at home can be highlighted. This study aimed to assess the practice and outcome of kangaroo mother care at home among mothers having low-birth-weight infants discharged from two hospitals in Mekelle, Tigray, Ethiopia. Methods: A prospective cohort study was conducted among 101 paired mothers and low-birth-weight neonates discharged from Ayder and Mekelle Hospitals. Non-probability purposive sampling was used to select 101 infants. Data were collected from patient charts in both hospitals using interviewer-administered structured questionnaire, anthropometric measurements and were then analyzed using SPSS version 20. Characteristics were analyzed using descriptive statistics. Bivariate analysis was used, and variables with p-value <0.25 were exported to multivariable logistic regression and statistical significance was set at a p-value <0.05. Results: Kangaroo mother care was continued at home in 99% of the infants. Three of the 101 infants died before the age of 4 months with a possible cause of death from respiratory failure. Exclusive breastfeeding was provided for 67% of the infants, and it was higher in infants who started kangaroo mother care within 24 hours of life (AOR 3.8, 95% CI 1.07-13.25). Malnutrition was higher in those with birth weight <1500 grams (AOR 7.3,95% CI 1.63-32.59); small for gestational age (AOR 4.8,95% CI 1.41-16.31) and those provided kangaroo mother care for <8 hours per day (AOR 4.5,95% CI 1.40-16.31). Conclusion: Early initiation and prolonged duration of kangaroo mother care were associated with increased exclusive breastfeeding practice and decreased incidence of malnutrition. Kangaroo mother care should be promoted at the community level.

Research paper thumbnail of Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India

Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India

Acta Paediatrica

Research paper thumbnail of Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research

Pediatric Health, Medicine and Therapeutics

Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mo... more Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC. Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software. Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home. Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Research paper thumbnail of Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale‐up in Tigray Region, Ethiopia

Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale‐up in Tigray Region, Ethiopia

Acta Paediatrica

Research paper thumbnail of Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation

BMJ Open, 2019

Introduction Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-t... more Introduction Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. Methods and analysis This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a su...

Research paper thumbnail of Scaling Up Kangaroo Mother Care in Ethiopia and India: A Multi-Site Implementation Research Study

SSRN Electronic Journal, 2020

Objectives Kangaroo Mother Care (KMC), prolonged skin-toskin care of the low birth weight baby wi... more Objectives Kangaroo Mother Care (KMC), prolonged skin-toskin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%-86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%-65% of infants in all sites, except Oromia (38%) and Karnataka (36%). Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers' conviction that KMC is the standard of care, women's and families' acceptance of KMC, and changes in infrastructure, policy, skills and practice.

Research paper thumbnail of Foot length, chest and head circumference measurements in detection of Low birth weight neonates in Mekelle, Ethiopia: a hospital based cross sectional study

BMC Pediatrics, 2017

Background: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal ... more Background: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal deaths. The early identification of Low birth weight (LBW) neonates is essential for any comprehensive initiative to improve their chance of survival. However, a large proportion of births in developing countries take place at home and birth weight statistics are not available. Therefore, there is a need to develop simple, inexpensive and practical methods to identify low birth weight (LBW) neonates soon after birth. Methods: This is a hospital based cross sectional study. Four hundred twenty two (422) live born neonates were included and anthropometric measurements were carried out within 24 h of birth by three trained nurses. Birth weight was measured by digital scale. Head and chest circumference were measured by using non extendable measuring tape and foot length with hard transparent plastic ruler. Data was entered into SPSS version 20 for analysis. Characteristics of study participants were analyzed using descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for continuous data. Correlation with birth weight using Pearson's correlation coefficient and linear regression were used to identify the association between dependent and independent variables. Receiver operating characteristic (ROC) curve was used to evaluate accuracy of the anthropometric measurements to predict LBW. Results: The prevalence of low birth weight was found to be 27%. All anthropometric measurements had a positive correlation with birth weight, chest circumference attaining the highest correlation with birth weight (r = 0.85) and foot length had the weakest correlation (r = 0.74). Head circumference had the highest predictive value for birth weight (AUC = 0.93) followed by Chest circumference (AUC = 0.91). A cut off point of chest circumference 30.15 cm had 84.2% sensitivity, 85.4% specificity and diagnostic accuracy (P < 0.001). A cut off point of head circumference 33.25 had the highest positive predictive value (77%). Conclusion: Chest circumference and head circumference were found to be better surrogate measurements to identify low birth weight neonates.

Research paper thumbnail of Community Awareness of Sore Throat and Rheumatic Heart Disease in Northern Ethiopia

SSRN Electronic Journal, 2019

Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fe... more Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fever (ARF). In Ethiopian population, knowledge about Rheumatic Heart Disease (RHD) and its prevention strategies is expected to be limited, but few studies have been done. Methods: To determine awareness of RHD prevention in the community in Northern Ethiopia, a descriptive, cross-sectional study was conducted. Using structured questionnaire, adults more than 18 years of age were interviewed. Results: A total of 1298 participants were included, 1004 (77.4%) were from rural areas, 978 (75.3%) were female. Only 34 (2.6%) of the participants responded that the cause of sore throat is due to bacteria/virus and 6.2 % knew the relation between sore throat and heart disease. Of the respondents, 43.3% would take children with sore throat to traditional healers, 71.6% had history of uvulectomy in their children or themselves. Only 7.8% answered that penicillin injection is useful for primary prophylaxis and 8.1% answered that regular penicillin injection is useful as secondary prevention in RHD. Conclusion: We conclude that the community awareness on the cause and the link between bacterial pharyngitis and ARF/RHD is almost non-existent and hence concerted efforts to change this should be made at different levels.

Research paper thumbnail of Maternal mortality during war time in Tigray, Ethiopia: A community‐based study

Maternal mortality during war time in Tigray, Ethiopia: A community‐based study

BJOG: An International Journal of Obstetrics & Gynaecology

ObjectiveThis study seeks to examine the impact of war on maternal mortality following an exacerb... more ObjectiveThis study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict.DesignCommunity‐based cross‐sectional study.SettingTigray region of Northern Ethiopia, between November 2020 and May 2022.PopulationThis study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas.MethodsThe study was conducted in two phases. In the first phase, reproductive‐age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households.Main Outcome MeasuresMaternal mortality ratio level and cause‐specific mortality.ResultsThe results of the study showed that the maternal mortality ratio was 840 (95% CI 739–914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy‐...

Research paper thumbnail of Newborn care practices at home and health facilities in Tigray, Ethiopia: a qualitative assessment

Newborn care practices at home and health facilities in Tigray, Ethiopia: a qualitative assessment

Background: The Most Vulnerable age group for child survival is neonatal period. In 2019, Newborn... more Background: The Most Vulnerable age group for child survival is neonatal period. In 2019, Newborn deaths accounted to nearly half of under-5mortality with 2.4 million deaths Worldwide. (1) The estimated neonatal mortality rate of Ethiopia is 30 deaths per 1000 live births. (3). The aim of this study is to assess the Newborn care practices at home and public health care system in Tigray. Methods: A qualitative study was conducted with two techniques: focused group discussions and in depth interviews. Five zones from Tigray region were included in the study. A total of 16 focused group discussions and 46 in depth interviews were conducted among community representatives and health workers. Collected data was discussed, recorded data was transcribed ATLAS ti software was used for coding themes and experiences. The transcribed data were analyzed using an inductive approach. Before coding, the themes were identified and thoroughly discussed. Results: Community perspective: Despite satisf...

Research paper thumbnail of Practice of Kangaroo Mother Care Among Low-Birth-Weight Infants Discharged from Health Facilities and Its Outcome in Mekelle City, Tigray, Northern Ethiopia

International Journal of General Medicine

Background: Kangaroo mother care is a proven intervention shown to be effective in reducing neona... more Background: Kangaroo mother care is a proven intervention shown to be effective in reducing neonatal mortality among low-birthweight infants. The paucity of evidence regarding the practice at home can be highlighted. This study aimed to assess the practice and outcome of kangaroo mother care at home among mothers having low-birth-weight infants discharged from two hospitals in Mekelle, Tigray, Ethiopia. Methods: A prospective cohort study was conducted among 101 paired mothers and low-birth-weight neonates discharged from Ayder and Mekelle Hospitals. Non-probability purposive sampling was used to select 101 infants. Data were collected from patient charts in both hospitals using interviewer-administered structured questionnaire, anthropometric measurements and were then analyzed using SPSS version 20. Characteristics were analyzed using descriptive statistics. Bivariate analysis was used, and variables with p-value <0.25 were exported to multivariable logistic regression and statistical significance was set at a p-value <0.05. Results: Kangaroo mother care was continued at home in 99% of the infants. Three of the 101 infants died before the age of 4 months with a possible cause of death from respiratory failure. Exclusive breastfeeding was provided for 67% of the infants, and it was higher in infants who started kangaroo mother care within 24 hours of life (AOR 3.8, 95% CI 1.07-13.25). Malnutrition was higher in those with birth weight <1500 grams (AOR 7.3,95% CI 1.63-32.59); small for gestational age (AOR 4.8,95% CI 1.41-16.31) and those provided kangaroo mother care for <8 hours per day (AOR 4.5,95% CI 1.40-16.31). Conclusion: Early initiation and prolonged duration of kangaroo mother care were associated with increased exclusive breastfeeding practice and decreased incidence of malnutrition. Kangaroo mother care should be promoted at the community level.

Research paper thumbnail of Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India

Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India

Acta Paediatrica

Research paper thumbnail of Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research

Pediatric Health, Medicine and Therapeutics

Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mo... more Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC. Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software. Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home. Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Research paper thumbnail of Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale‐up in Tigray Region, Ethiopia

Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale‐up in Tigray Region, Ethiopia

Acta Paediatrica

Research paper thumbnail of Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation

BMJ Open, 2019

Introduction Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-t... more Introduction Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. Methods and analysis This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a su...

Research paper thumbnail of Scaling Up Kangaroo Mother Care in Ethiopia and India: A Multi-Site Implementation Research Study

SSRN Electronic Journal, 2020

Objectives Kangaroo Mother Care (KMC), prolonged skin-toskin care of the low birth weight baby wi... more Objectives Kangaroo Mother Care (KMC), prolonged skin-toskin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%-86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%-65% of infants in all sites, except Oromia (38%) and Karnataka (36%). Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers' conviction that KMC is the standard of care, women's and families' acceptance of KMC, and changes in infrastructure, policy, skills and practice.

Research paper thumbnail of Foot length, chest and head circumference measurements in detection of Low birth weight neonates in Mekelle, Ethiopia: a hospital based cross sectional study

BMC Pediatrics, 2017

Background: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal ... more Background: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal deaths. The early identification of Low birth weight (LBW) neonates is essential for any comprehensive initiative to improve their chance of survival. However, a large proportion of births in developing countries take place at home and birth weight statistics are not available. Therefore, there is a need to develop simple, inexpensive and practical methods to identify low birth weight (LBW) neonates soon after birth. Methods: This is a hospital based cross sectional study. Four hundred twenty two (422) live born neonates were included and anthropometric measurements were carried out within 24 h of birth by three trained nurses. Birth weight was measured by digital scale. Head and chest circumference were measured by using non extendable measuring tape and foot length with hard transparent plastic ruler. Data was entered into SPSS version 20 for analysis. Characteristics of study participants were analyzed using descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for continuous data. Correlation with birth weight using Pearson's correlation coefficient and linear regression were used to identify the association between dependent and independent variables. Receiver operating characteristic (ROC) curve was used to evaluate accuracy of the anthropometric measurements to predict LBW. Results: The prevalence of low birth weight was found to be 27%. All anthropometric measurements had a positive correlation with birth weight, chest circumference attaining the highest correlation with birth weight (r = 0.85) and foot length had the weakest correlation (r = 0.74). Head circumference had the highest predictive value for birth weight (AUC = 0.93) followed by Chest circumference (AUC = 0.91). A cut off point of chest circumference 30.15 cm had 84.2% sensitivity, 85.4% specificity and diagnostic accuracy (P < 0.001). A cut off point of head circumference 33.25 had the highest positive predictive value (77%). Conclusion: Chest circumference and head circumference were found to be better surrogate measurements to identify low birth weight neonates.

Research paper thumbnail of Community Awareness of Sore Throat and Rheumatic Heart Disease in Northern Ethiopia

SSRN Electronic Journal, 2019

Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fe... more Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fever (ARF). In Ethiopian population, knowledge about Rheumatic Heart Disease (RHD) and its prevention strategies is expected to be limited, but few studies have been done. Methods: To determine awareness of RHD prevention in the community in Northern Ethiopia, a descriptive, cross-sectional study was conducted. Using structured questionnaire, adults more than 18 years of age were interviewed. Results: A total of 1298 participants were included, 1004 (77.4%) were from rural areas, 978 (75.3%) were female. Only 34 (2.6%) of the participants responded that the cause of sore throat is due to bacteria/virus and 6.2 % knew the relation between sore throat and heart disease. Of the respondents, 43.3% would take children with sore throat to traditional healers, 71.6% had history of uvulectomy in their children or themselves. Only 7.8% answered that penicillin injection is useful for primary prophylaxis and 8.1% answered that regular penicillin injection is useful as secondary prevention in RHD. Conclusion: We conclude that the community awareness on the cause and the link between bacterial pharyngitis and ARF/RHD is almost non-existent and hence concerted efforts to change this should be made at different levels.