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Essential Services for Health in Ethiopia Is Implemented by John Snow, Inc ?ll^gmbZe M^kob\^l _hk B ^Zema bg ?mabhibZ ?g]+ebg^ B hnl^ahe] Mnko^r L^ihkm ; f aZkZ L^`bhg =hgmkZ\m 441+=+..+.2+..2.1+.. M^im^f [^k 0..6 ; ]]bl ; [Z[Z Essential Services for Health in Ethiopia is implemented by John Snow, Inc. In collaboration with Abt Associates, Academy for Educational Development, and Initiatives, Inc. This report was made possible by the support of the American people through the United States Agency for International Development (USAID) under Contract 663-C-00-00403-00. The contents are the sole responsibility of John Snow, Inc. and do not necessarily reflect the views of USAID or the United States Government. ACKNOWLEDGMENT Essential Services for Health in Ethiopia was able to contribute to long term improvements in child survival in Oromia, Amhara and Southern Nations, Nationalities and Peoples Regional States, thanks to the leadership of the Regional Health Bureaus in mobilizing and coordinating partners in supporting the different woredas and their communities in the three regions. This end line survey could not have been conducted without the collaboration and support of Regional Health Bureaus, Zonal Health Offices and Woreda Health Offices, and this support is greatly appreciated. We also like to express our sincere thanks to the end line survey team members: the principal coordinator of the survey and the assistant coordinator, the technical advisors in the Central Office, the regional project officers and the field supervisors, the interviewers, the data entry clerks, the many drivers who accompanied the teams, the senior advisors in headquarters of JSI and AED respectively, the logistics staff in the project, and program officers who contribute their share to the final production. Without this superb teamwork and continuous dedication, the end line surveys could not have provided the valuable information for evaluation and future planning. In addition, we recognize the efforts that communities, voluntary community health workers, health extension workers and other health workers make on a daily basis in order to improve health of households and communities. The survey results show how much they have accomplished. Finally we like to recognize the different partners with whom ESHE works on a continuous basis in the three regions: projects of multilateral and bilateral cooperation agencies, projects of non- governmental organizations and initiatives of training institutions. The end line surveys measure progress of child survival indicators at regional level and at the level of two strata: project areas and non project areas. Since ESHE is not the only intervention partner in the project areas, some results represent outcomes of direct support, and some results represent effective synergy with other projects. Special thanks also goes to the USAID-Health, Population, AIDS and Nutrition Office team in Addis, for their continuous support to Essential Health Services in Ethiopia. i Table of Contents ACKNOWLEDGMENT ..................................................................................................................................... i ABBREVIATIONS AND ACRONYMS ........................................................................................................ vii EXECUTIVE SUMMARY ...................................................................................................................................1 1. INTRODUCTION .........................................................................................................................................8 1.1. The Context of the Amhara Region ..................................................................................................8 1.2. The Three Pillars of ESHE’s Intervention .........................................................................................8 1.3. The ESHE Community-Based Intervention ......................................................................................9 2. METHODOLOGY ...................................................................................................................................... 10 2.1. Study Design ......................................................................................................................................... 10 2.2. Sample Area .......................................................................................................................................... 11 2.3. Sample Size ............................................................................................................................................ 11 2.4. Survey Questionnaires ....................................................................................................................... 12 2.5. Anthropometry .................................................................................................................................... 13 2.6. Recruitment, Training, and Fieldwork ............................................................................................ 13 2.7. Data Processing and Analysis ........................................................................................................... 13 2.8. Study Limitations ................................................................................................................................. 14 3. INDIVIDUAL AND HOUSEHOLD CHARACTERISTICS ................................................................ 14 3.1. Socio-demographic Characteristics of Respondents .................................................................. 14 3.2. Household Safe Water Supply and Sanitation .............................................................................. 14 3.3. Access to Health Facility ................................................................................................................... 15 3.4. Possession of Insecticide Treated Nets ......................................................................................... 16 4. PROGRAM REACH .................................................................................................................................... 16 4.1. Volunteer Community Health Workers ....................................................................................... 16 4.2. Health Extension Workers and Other Community Health Workers ................................... 17 4.3. Awareness of the Family Health Card ........................................................................................... 18 4.4. Possession of the Family Health Card ............................................................................................ 19 5. IMMUNIZATION ................................................................................................................................... 20 5.1. Vaccination Coverage and Trend .................................................................................................... 20 5.2. Source of Information on Immunization ........................................................................................ 22 5.3. Reason for Never or Incompletely Vaccinated ............................................................................ 23 5.4. Summary and Discussions ................................................................................................................. 24 6. ESSENTIAL NUTRITION ACTIONS ..................................................................................................... 25 Breastfeeding of Children 0-5 Months ................................................................................................... 25 6.2. Complementary Feeding with Breastfeeding (6-23 months) .................................................... 27 6.3. Nutritional Care of the Sick Child .................................................................................................. 32 6.4. Control of Vitamin A Deficiency .................................................................................................. 33 6.6. Control of Anemia ............................................................................................................................. 34 6.7. Children Sleeping under an Insecticide Treated Net (0 to 23 months) ................................. 36 6.8. Women’s Nutrition ............................................................................................................................ 36 6.9. Source of Nutrition Related Information ...................................................................................... 36 6.10. Information to Women During Pregnancy and After Delivery ............................................. 37 6.11. Child Anthropometry ...................................................................................................................... 38 6.12. Summary and Discussion ................................................................................................................. 38 7. CHILD MORBIDITY AND TREATMENT PATTERN ....................................................................... 41 ii 7.1. Incidence and Trend of Child Morbidity ........................................................................................ 41 7.2. Treatment Seeking in Health Facilities for Sick Child ................................................................. 42 7.3. Awareness of the Danger Signs of Childhood Illness ................................................................. 43 7.4. Oral Re-hydration Solution and Recommended Fluid to Children with Diarrhea.............
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