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
This study assesses the impact of a large, state-sponsored sugar plantation scheme on agro-pastoralists’ livelihoods and local land use change in southern Ethiopia, specifically in the lower Omo... Show moreThis study assesses the impact of a large, state-sponsored sugar plantation scheme on agro-pastoralists’ livelihoods and local land use change in southern Ethiopia, specifically in the lower Omo Valley. The study compares the local perceptions on the ongoing Omo-Kuraz sugar project — sugar cane plantations and a cane-crushing factory — and describes how it has affected local communities’ environmental and livelihood strategies vis-à-vis the alleged ‘new development opportunities’. Focus group discussion, key informant interviews, and field observations were applied to get in-depth information about the socio-economic and environmental impacts of large scale land acquisitions. The results show that the implementation of large scale land acquisitions in the lower Omo Valley has put enormous pressure on local land use and land management systems. The Omo-Kuraz I and II projects, started in 2011, neither met the stated economic purposes of the then Ethiopian federal government nor satisfied the pastoral communities’ needs. The LSAI project is still highly contentious among the local community, the project office, and the local government. Our study recommends that shifting the perspective towards the local agropastoralists’ activities, understanding their views and ways of ‘using’ the environment, and creating a broader consultation platform with them may create opportunities for cooperation and synergy to optimize benefits and sustainably adapt the development project to the local context. 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
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
Event number is an important grammatical category in Konso in addition to nominal number. Event number has two main values, singular and plural, which can be expressed by two distinct verbal... Show moreEvent number is an important grammatical category in Konso in addition to nominal number. Event number has two main values, singular and plural, which can be expressed by two distinct verbal morphological processes, punctual and pluractional. The interpretation of a sentence in terms of event number is arrived at through an intricate interplay of lexical meaning, the core meaning of the number marking morphology and the separate system of aspect. Each verb has its intrinsic values for event number associated with its systematic lexical distinctions in terms of event number. Event number includes both event internal and event external situations. The meaning of the markers of singular and plural event number has a primary and a secondary value. There are several situations in which the primary meaning is excluded and the secondary meaning is the only possible interpretation. The pluractional is fully productive while the punctual is not productive and has interesting structural morphological restrictions. Show less
The 2015 elections in Ethiopia had a predictable outcome, showing an entrenched system of one-party dominance that self-referentially enacts the political order created by the Ethiopian People’s... Show moreThe 2015 elections in Ethiopia had a predictable outcome, showing an entrenched system of one-party dominance that self-referentially enacts the political order created by the Ethiopian People’s Revolutionary Democratic Front (EPRDF) since 1991. EPRDF spokespersons continued to defend the party’s hegemony as inevitable, grounded in a logic of technocratic authority and with reference to ‘stability’ and ‘development’. This paper describes the electoral process not in the light of democracy theory but of hegemonic governance theory. Elections seem to have lost relevance in Ethiopia as a means of political expression and are only important as a performance of hegemonic governance and as ‘global impression management’ – showing state skills in securing a smooth electoral process as a major organisational feat in itself. Contradictions that the political process creates between the Ethiopian party-state and domestic constituencies, and between the attitudes/policies of certain donor countries, are downplayed or avoided, but problematic in the long run. Show less
