Background Annually 57 million people across the globe require palliative care, 76% are from low- and-middle income countries. Continuity of palliative care contributes to a decline in emergency... Show moreBackground Annually 57 million people across the globe require palliative care, 76% are from low- and-middle income countries. Continuity of palliative care contributes to a decline in emergency room visits., decreased hospital deaths, improved patient satisfaction, better utilization of services, and cost savings. Despite efforts made to develop the palliative care guideline in Ethiopia, the service is not yet organized and linked to primary health care. This study aimed to explore barriers to the continuum of palliative care from facility to household for cancer patients in Addis Ababa. Methods Qualitative exploratory study was conducted with face-to-face interviews with a total of 25 participants. The study population was adult cancer patients, primary caregivers, healthcare providers, volunteers, and nationwide advocates. Data were audio recorded, transcribed verbatim and finally imported to Open code version 4.02 software for coding and analysis. Thematic analysis was guided by Tanahashi’s framework. Results The key barriers to continuity of palliative care included opioid scarcity and turnover and shortage of healthcare workers. A shortfall of diagnostic materials, cost of medications, lack of government backing, and homebased center’s enrollment capacity hampered accessibility. Care providers were instruments of cultural barriers in delivering appropriate end-of-life care, on the other hand, patients’ preference for conventional medicine hindered acceptability. Lack of community volunteers, failure of health extension workers to link patients, and spatial limits fraught utilization. The lack of defined roles and services at several levels and the workload on healthcare professionals affected the effectiveness of the nexus. Conclusion The continuum of palliative care service from health facility to household in Ethiopia is yet in its infancy compromised by factors related to availability, accessibility, acceptability, utilization, and effectiveness. Further research is required to delineate the roles of various actors; th Show less
Why has Africa not been doing so well and what is the way forward? This book starts with the analysis of Vansina and Prah: the old cultural traditions in Africa have been destroyed in colonial... Show moreWhy has Africa not been doing so well and what is the way forward? This book starts with the analysis of Vansina and Prah: the old cultural traditions in Africa have been destroyed in colonial times; new ones are currently taking shape, based in part in African languages. The book uses cross-cultural psychology to show that such new cultural traditions are indeed forming in Africa. However, almost all African countries currently use a former colonial language in secondary and higher education. The book demonstrates that if more and more people get educated, this system will no longer scale. Over the next decade, more and more African countries will have to make a transition towards increased use of African languages. The book proposes a distinction between discerned and designed languages. All over the world, designed languages are made to serve speakers of several discerned languages. This could and should happen in Africa as well. The book contains a number of brief case studies, showing how in fact such a transition is practically possible. In future, African countries will be able to achieve success in their educational systems by using a small number of languages as medium of instruction. Such a transition will also help to form the new cultural traditions that are already taking shape on the continent. Show less
Music beats spoken language in identifying individuals uniquely in two disparate communities. In addition to their given names, which conform to the conventions of their languages, speakers of the... Show moreMusic beats spoken language in identifying individuals uniquely in two disparate communities. In addition to their given names, which conform to the conventions of their languages, speakers of the Oyda (Omotic; SW Ethiopia) and Yopno (Finisterre-Huon; NE Papua New Guinea) languages have “name tunes,” short 1–4 s melodies that can be sung or whistled to hail or to identify for other purposes. Linguistic given names, for both communities, are often non-unique: people may be named after ancestors or contemporaries, or bear given names common to multiple individuals. But for both communities, name tunes are generally non-compositional and unique to individuals. This means that each new generation is likely to bring thousands of new name tunes into existence. In both communities, name tunes are produced in a range of contexts, from quotidian summoning and mid-range communication, to ceremonial occasions. In their use of melodies to directly represent individual people, the Oyda and Yopno name tune systems differ from surrogate speech systems elsewhere that either: (a) mimic linguistic forms, or (b) use music to represent a relatively small set of messages. Also, unlike some other musical surrogate speech traditions, the Oyda and Yopno name tune systems continue to be used productively, despite societal changes that have led to declining use in some domains. Show less
Asemu, Y.M.; Yigzaw, T.; Desta, F.A.; Scheele, F.; Akker, T. van den 2021
Background Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In... Show moreBackground Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists' education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program. Methods A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists' education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students' perceptions of the learning environment. Results The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24-7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = - 5.5, 95% CI = -10.5 to - 0.5, p < 0.05). Initial gender-based performance differences disappeared (66.3% vs. 65.3%, mean score difference = - 1.0, 95% CI = - 6.11-3.9, p > 0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15-6.55, p < 0.05). Conclusion The results suggest that the quality of non-physician anesthetists' education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention. Show less
This study has examined traditional coping systems, emerging adaptation strategies and barriers to the adoption of these strategies. Structured questionnaires on coping and adaptation strategies... Show moreThis study has examined traditional coping systems, emerging adaptation strategies and barriers to the adoption of these strategies. Structured questionnaires on coping and adaptation strategies were conducted among Nyangatom households, expounded by focus group discussions and key informant interviews. Correlations between times series (1987–2016) on rainfall, temperature and the local perceptions on CC were examined. The time series analysis confirmed pastoralists' perception that the frequency of extreme drought has increased since 1987. The Nyangatom responded by temporal migration and herd diversification. Other responses include flood cultivation and enhancing alliance formation with other ethnic groups. Multi-nominal logistic regression analyses indicated that age of household head (−), livestock ownership (+), crop productivity (+), off-farm income (+) and access to climate information (+) proved to be key determinants with a statistically significant (negative or positive) effect on adoption. Other factors that hindered climate change adaption include intermittent conflicts with neighbouring ethnic groups and limited access to alternative livelihood options. Interventions to facilitate transition towards sustainable, adaptation-based communities need to incorporate deliberate, longer-term, risk-reducing strategies, including rangeland management, water harvesting and small scale-irrigation schemes. Improved education access, extension services, and a conducive pastoral policy environment will help to enhance the Nyangatom adaptive capacity. Show less
We use three years of household panel data to analyze the effects of ill-health on household economic outcomes in rural Ethiopia. We examine the immediate effects of various ill-health measures on... Show moreWe use three years of household panel data to analyze the effects of ill-health on household economic outcomes in rural Ethiopia. We examine the immediate effects of various ill-health measures on health expenditure and labor supply, the subsequent coping responses, and finally the effect on income and consumption. We find evidence of substantial economic risk in terms of increased health expenditure and reduced agricultural productivity. Households are able to smooth consumption by resorting to intra-household labor substitution, borrowing and depleting assets. However, maintaining current consumption through borrowing and depletion of assets is unlikely to be sustainable and displays the need for health financing reforms and safety nets that reduce the financial consequences of ill-health. Show less
Sheferaw, E.D.; Bakker, R.; Taddele, T.; Geta, A.; Kim, Y.M.; Akker, T. van den; Stekelenburg, J. 2020
Objective To assess the availability of an institutional-level respectful maternity care (RMC) index, its components, and associated factors.Methods A cross-sectional study design was applied to a... Show moreObjective To assess the availability of an institutional-level respectful maternity care (RMC) index, its components, and associated factors.Methods A cross-sectional study design was applied to a 2016 census of 3804 health facilities in Ethiopia. The availability of an institutional-level RMC index was computed as the availability of all nine items identified as important aspects of institutional-level RMC during childbirth. Logistic regression analysis was used to identify factors associated with availability of the index.Results Three components of the institutional-level RMC index were identified: "RMC policy," "RMC experience," and "facility for provision of RMC." Overall, 28% of facilities (hospitals, 29.9%; health centers, 27.8%) reported availability of the institutional-level RMC index. Facility location urbanization (urban region), percentage of maternal and newborn health workers trained in basic emergency obstetric and newborn care, and availability of maternity waiting homes in health facilities were positively associated with availability of the institutional-level RMC index.Conclusion Only one in three facilities reported availability of the institutional-level RMC index. The Ethiopian government should consider strengthening support mechanisms in different administrative regions (urban, pastoralist, and agrarian), implementing the provision training for health workers that incorporates RMC components, and increasing the availability of maternity waiting homes. Show less
Human trafficking is a persistent global social and economic problem, and part of international organized crime, involving local regional, national, and global agents and networks, and victims... Show moreHuman trafficking is a persistent global social and economic problem, and part of international organized crime, involving local regional, national, and global agents and networks, and victims whose social characteristics traverse age (as they can be children, youths, or adults) and gender (women and men). Ethiopia is not an exception in this regard, and many disadvantaged Ethiopians have fallen victim to human trafficking. This study focuses on the trafficking of Ethiopian women to the Middle East to work as domestic workers. It documents how some of these trafficked women are recruited and transported, and often subjected to severe abuse, including denial of salary, sleep deprivation, passport confiscation, confinement, and physical and sexual assault. It is recognized that some women actively aim for irregular migratjon and try their luck, i.e., not all are by definition trafficked. They thereby aim to stay clear of trafficking agents and dependency but most become entangled in it. Only a few of the trafficked women can escape the above-mentioned abuses, depending on their employers and family or other social networks they may build up or appeal to in the host country. Forms of abuse and inhumane practices, however, predominate against most trafficked Ethiopian women and take place within the ambiguous framework of the kafala system, which is prevalent throughout the Middle Eastern countries.This study was motivated by at least two main concerns, one personal and the other academic. Personally I was intrigued by this tenacious phenomenon causing multiple problems for young women, often marking their lives, and by a concern to see the abusive aspects of the trafficking addressed. Academically, although there is a myriad of studies on the trafficking of Ethiopian women to the Middle East, there are few if any major academic research inquiries undertaken on the Arsi Zone, which is however one of the primary sources of Ethiopian women trafficked to the Middle East. Second, beyond responding to the need to study the root causes of human trafficking, a perplexing question is why human trafficking, in general, and women trafficking, in particular, is still on the increase, despite the proliferation of international, regional and national policy and legal frameworks and institutions established with the central aim of mitigating human trafficking through prevention, protection, and prosecution.Therefore, this study aims to explore the nature, prevalence, root causes, and societal consequences of human trafficking in the two Arsi zones of Arsi and Arsi West of Oromiya National Regional State, so as to inquire why they have persisted. To realize this objective, the data and information used in this study were collected from trafficked women themselves, from185their families, and from middlemen and agents, and relevant government officials, using both qualitative and quantitative methods of data collection in a complementary manner. The study has investigated the trafficking process, i.e., how those trafficked within Ethiopia and to Middle Eastern host countries are recruited and how they travel, are treated, tried to retain agency over their life, and tried to cope. It also sheds light on the role of women returnees from being trafficked, their experiences and tribulations, and (very occasional) successes.Theoretically, this study argues that although trafficking is a transnational phenomenon, its root causes are local, often determined by social and economic factors conducive to poverty, unemployment, gender inequality, and food insecurity, to mention the main ones. Therefore, mitigating women trafficking cannot be treated only as a matter of law and order in the liberal tradition of the individual-civic freedom and emancipation paradigm without giving due recognition to the persistent socio-economic factors which propelled trafficking in the first place. Integrating these two perspectives, which this study advocates, would have critical academic and policy implications for conceiving any credible and practicable interventions to mitigate human trafficking. Show less
Tura, A.K.; Aboul-Ela, Y.; Fage, S.G.; Ahmed, S.S.; Scherjon, S.; Roosmalen, J. van; ... ; Akker, T. van den 2020
With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The... Show moreWith postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated. Show less
In Ethiopia, as elsewhere in Africa, the boundaries of political belonging have always shifted. They continue to do so. Since the 1995 constitution, in a both peculiar and complex manner, ethnicity... Show moreIn Ethiopia, as elsewhere in Africa, the boundaries of political belonging have always shifted. They continue to do so. Since the 1995 constitution, in a both peculiar and complex manner, ethnicity has been included in the apparatus of rights and practices, with often far-reaching consequences for Ethiopian nation-building. Since 1991, citizenship in Ethiopia can hardly be discussed without reference to the post-1991 ethnofederal system, which was the result of the restructuring of domestic politics based on ethnolinguistic criteria. This reformation of the administrative landscape altered interethnic relations, and although justified as an answer to an age-old national question about belonging, and a guarantor for interethnic peace and justice, problems have abounded. In this article, we analyze Ethiopian citizenship in the wider context of global debates on “cultural citizenship.” We examine the bifurcated Ethiopian approach to national and regional citizenship and the language of cultural rights in a historical perspective both as continued subject-making as well as a form of claims-making. Focusing on citizenship and the powers that manifest social boundaries through cultural ascription, we circumvent both the instrumentalist and primordialist gaze on ethnicity and multiculturalism. Ethnicity appears as a reservoir and idiom of political appropriation within an evolving system of state-subject relations that has left the status of citizenship unresolved. Show less
‘Good governance’ has been defined as a necessary condition for (economic) ‘growth’ and ‘development’ not only in in developing world but also in the wealthier, developed nations. This paper seeks... Show more‘Good governance’ has been defined as a necessary condition for (economic) ‘growth’ and ‘development’ not only in in developing world but also in the wealthier, developed nations. This paper seeks to sociologically explore the ‘articulation’ of the ideology of good governance of the post-1991 Ethiopian federal state with versions of legitimate authority, just rule, accountability, economic fairness, etc. with reference to some local ethnic societies in Southern Ethiopia. Similarities and differences will be discussed so as to show that the concept of ‘good governance’ is multi-dimensional and ambivalent, evoking local notions (and expectations) of a just order and the rule of fairness among citizens as well. In the context of Ethiopia, its constant reiteration as a policy aim may thus also have contributed to citizens’ renewed claim-making as well as their rediscovering their own (cultural) notions of just governance. Show less
Sheferaw, E.D.; Kim, Y.M.; Akker, T. van den; Stekelenburg, J. 2019
Background Recent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of... Show moreBackground Recent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors. Methods A two-stage cross sectional sampling design was used to select institutions and women. The study was conducted in hospitals and health centers across four Ethiopian regions. Quantitative data were collected from postpartum women. Mistreatment was measured using four domains: (1) physical abuse, (2) verbal abuse, (3) failure to meet professional standards of care, and (4) poor rapport between women and providers. Percentages of mistreatment and odds ratios for the association between its presence and institutional and socio demographic characteristics of women were calculated using bivariate and multivariable logistic regression modeling. Results A total of 379 women were interviewed, of whom 281 (74%) reported any mistreatment. Physical and verbal abuse were reported by 7 (2%) and 31 (8%) women interviewed respectively. Failure to meet professional standards of care and poor rapport between women and providers were reported by 111 (29%) and 274 (72%) women interviewed respectively. Multivariable logistic regression analysis revealed that the odds of reporting mistreatment were higher among women with four or more previous births (aOR = 3.36 95%CI 1.22,9.23, p = 0.019) compared to women with no previous childbirth, Muslim women (aOR = 3.30 95%CI 1.4,7.77, p = 0.006) and women interviewed in facilities with less than 17 births per MNH staff in a month (aOR = 3.63 95%CI 1.9,6.93, p < 0.001). However, the odds of reporting mistreatment were lower among women aged 35 and older (aOR = 0.22 95%CI 0.06, 0.73, p = 0.014) and among women interviewed between 8 and 42 days after childbirth (aOR = 0.37 95%CI 0.15, 0.9, p = 0.028). Conclusion Mistreatment during childbirth in Ethiopia is commonly reported. Health workers need to consider provision of individualized care for women and monitor their experiences in order to adjust quality of their services. Show less
While the inclusion of extreme poor people is a noble and necessary objective, it is challenging. Attempts to include extreme poor people in development interventìons have often been disappointing.... Show moreWhile the inclusion of extreme poor people is a noble and necessary objective, it is challenging. Attempts to include extreme poor people in development interventìons have often been disappointing. This book addresses the challenge of including the poorest people. lt provides deeper understanding of the mechanisms of in- and exclusion of extreme poor people, the structural causes of extreme poverty and the desirability of a univocal definition of extreme poverty. The book contributes to such an understanding through an analysis of extreme poor and marginalised people and their multiple dimensions of wellbeing. Furthermore, this book sheds light on the discourses and practices applied by development agencies in order to draw lessons about how the extreme poor can be sustainably included in development interventions. This is based on original field research - using a partipatory approach - carried out in Bangladesh, Benin, and (rural and urban) Ethiopia. Show less
Vermeiden, T.; Schiffer, R.; Langhorst, J.; Klappe, N.; Asera, W.; Getnet, G.; ... ; Akker, T. van den 2018
Western donor countries consider a proper functioning multiparty democracy as one of the most import conditions for achieving more legitimate governance and subsequently economic development and... Show moreWestern donor countries consider a proper functioning multiparty democracy as one of the most import conditions for achieving more legitimate governance and subsequently economic development and reduction of poverty in their partner countries. Support to free and fair elections is an integral part of the ‘good governance’ agenda of the traditional donor community. On the basis of the findings of this study, it appears however that it is not so much the acceptance of Western type political institutions or compliance with generally endorsed liberal-democratic standards that determine the possibilities for developing countries to achieve economic transformation and substantial poverty reduction, but rather the nature of the political settlement among the political elites. Show less
