Direct and indirect effects of distance from health facility on zero-dose children in Ethiopia: a cross-sectional secondary analysis of performance monitoring for action cohort I data, 2025

Objectives

This study aimed to assess the effect of distance from the nearest health facility on zero-dose children in Ethiopia by using a generalised structural equation modelling.

Design

A cross-sectional secondary analysis of longitudinal data.

Setting

Community-based study in five regions of Ethiopia (Tigray, Oromia, Amhara, Southern Nation Nationalities and Peoples (SNNP) regions, and Addis Ababa city).

Participants

The final analysis included a weighted sample of 1973 mother–child pairs.

Primary and secondary outcome measures

The primary outcome was the direct effect of distance to the nearest health facility on zero-dose children. The secondary outcome was the mediating effect of maternal reproductive health service utilisation on this relationship.

Result

The prevalence of zero-dose children was 15.7%, with significant urban (2.2%) and rural (19.7%) disparities. The median distance to the nearest health facility was 1.93 km, with median distances of 2.10 km for rural and 1.26 km for urban residents. Similarly, the mean distance to the nearest public health facility was 2.09 km (SD = ±1.72). Each additional kilometre from the nearest public health facility was associated with 14.2% higher odds of a child being zero-dose (aOR: 1.14 (95% CI 1.02 to 1.28)). This effect was predominantly direct, accounting for 89.4% of the total effect (aOR: 1.13 (95% CI 1.01 to 1.26)), while the indirect effect mediated through maternal reproductive health service utilisation was minimal and not statistically significant (aOR: 1.01 (95% CI 0.97 to 1.05)).

Conclusion

This study suggests that greater distance to the nearest health facility increases the likelihood of children being zero-dose. Therefore, improving physical access to health services through expanded outreach programmes and mobile vaccination services, and strengthening maternal health services, particularly antenatal care and facility delivery, is essential for reducing the burden of zero-dose children.

Birth prevalence and parental stress associated with neural tube defects in Amhara’s public comprehensive specialized hospitals, Ethiopia, 2024

by Hailemariam Gezie, Endalk Birrie Wondifraw, Muluken Amare Wudu, Habtam Gelaye, Fekadeselassie Belege Getaneh

Background

Neural tube defects (NTDs) are severe congenital anomalies resulting from the incomplete closure of the embryonic neural tube, affecting around 300,000 newborns globally each year and leading to significant mortality and disability. While high-income countries have seen a reduction in NTD prevalence, developing nations like Ethiopia continue to face high rates. Families impacted by NTDs often endure emotional challenges, including grief, anxiety, and social isolation. This study aims to investigate the birth prevalence of NTDs and the associated parental stress, emphasizing the wider effects on families.

Methodology

An institution-based cross-sectional study was conducted in Dessie and Deber Berhan comprehensive specialized hospitals from July 24, 2023, to July 24, 2024, to evaluate the birth prevalence of NTDs and the associated parental stress among parents of children aged 1 month to 12 years diagnosed with NTDs. A total of 308 parent-child pairs participated in the study. Data were gathered using a pretested questionnaire and an 18-item Parenting Stress Scale. Statistical analysis was performed using Stata version 17, where linear regression was utilized to identify significant predictors after verifying the necessary assumptions. The findings were presented in multiple formats for clarity and comprehensibility.

Results

The overall birth prevalence of neural tube defects was found to be 0.0052 (95% CI: 0.0038, 0.0067), which translates to 52 cases per 10,000 deliveries. Key factors associated with increased parental stress included being a mother (β = 2.51), older parental age (β = 0.18), the child’s age (β = 0.81), a prior history of having children with NTDs (β = 7.88), and the presence of a ventriculoperitoneal shunt in the child (β = 4.66).

Conclusion

The findings of this study indicate that the birth prevalence of NTDs is becoming a significant public health concern. Additionally, several factors contributing to increased parental stress were identified, including older parental age, the child’s age, a previous history of NTDs in siblings, and the presence of a ventriculoperitoneal shunt. These results highlight the urgent need for targeted support and resources for affected families to help mitigate the psychological impact associated with these conditions.

Knowledge, attitude and risky practices on schistosomiasis in Ethiopia: A scoping review

by Getaneh Alemu, Endalkachew Nibret, Abaineh Munshea, Melaku Anegagrie, Arancha Amor

Background

Despite many years of intervention measures, schistosomiasis (SCH) remains a public health problem in Ethiopia. Health education and promotion enable community involvement and active participation in SCH control and prevention. Therefore, it is considered as one of the key strategies to prevent and control SCH in Ethiopia. However, comprehensive data on the knowledge, attitude and practice (KAP) of vulnerable populations towards the disease are lacking. Therefore, we reviewed the existing KAP studies in Ethiopia.

Methods

Studies conducted in Ethiopia and published between 2006 and 2023 were searched and reviewed from January to April 2024. Electronic literature searches were made in PubMed, Hinari, African Journal Online and Google Scholar using the keywords “Schistosomiasis, Schistosoma, Schistosoma mansoni, Schistosoma haematobium, Knowledge, Attitude, Practice, Perception, Belief, Ethiopia” by combining them with Boolean operators (AND, OR). The review was conducted according to the Arksey and O’Malley Framework for scoping reviews, and studies were selected based on the PRISMA guidelines. Thematic analysis was applied to summarize, synthesize and report results.

Results

Ten studies that recruited 4,763 participants were included in the present review. Knowledge gaps on the source of Schistosoma infection, transmission, morbidity, treatment, and prevention in Ethiopia were identified. Studies have found large differences in attitudes toward SCH in terms of the population at risk, the severity of the disease, and beliefs in the availability and success of its treatment and prevention. Furthermore, in most studies included in this review, the majority of participants had negative attitudes towards SCH. The majority of participants also engaged in risky water-related practices, which facilitated the ongoing transmission of SCH. KAP levels among community members, school-aged children, and mothers/caregivers of preschool-aged children showed no significant differences.

Conclusions

The results of this systematic review showed that the KAP level is inadequate despite health education platforms that have been established and implemented for many years. Therefore, we recommend strengthening the implementation of health education and continuous monitoring of SCH prevention and control activities.