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Alemayehu T.,Save the Children UK | Haider J.,Shool of Public Health
Ethiopian Journal of Health Development | Year: 2010

Background: Worldwide, adolescents suffer from a disproportionate share of reproductive health problem. Throughout the world, over 14 million adolescents aged 15-19 years give birth annually. The purpose of this study was to assess the level and identify proximate and other determinants of adolescent fertility in Ethiopia. Methods: Raw data collected from all part of the country using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 (EDHS-2005) was used. After the data for adolescents aged from 15 to 19 years were extracted from the large data set, Multivariate logistic regression model was applied to identify sociodemographic and economic determinants whereas Bongaarts model was used to determine proximate determinants fertility. Results: Of the 3,266 adolescent women, 443 (13.6%) had given birth at least once prior to the survey and 133 (4.1%) were pregnant. Of the 443 adolescents who had at least given birth, the majority (72.7%) had one child while about a quarter (23.2%) had 2 live births and the rest 1.0% gave four live births with a mean number of child ever born of 1.33±0.6. The major factors associated with adolescent fertility were age, educational status, place of residence, employment, marriage, contraceptive use and postpartum infecundability. The odds for increased adolescent fertility was significantly higher in early adolescents (AOR=7.6; 95% CI=6.0 to 9.9), had lower education (AOR=6.7; 95%CI=4.1 to10.9), among rural teens (AOR=3.6; 95%CI=1.9 to 6.9) and currently not working (AOR=1.7; 95%CI= 1.3 to 2.2) than their counterparts. The observed fertility rate of 0.52 children per woman obtained from Bongaarts model of fertility indicated about 1.98 births per woman were averted due to non-marriage, delayed marriage, contraceptive use and postpartum infecundability. Conclusion: Since adolescent fertility is felt to be a problem, concerted efforts are needed to empower adolescents to fight early marriage, promote education and encourage the utilization of family planning targeting the rural teenagers. Source

For developing countries, adequate domestic water supply is conventionally assessed at international and national levels as the proportion of households that are "covered" by improved water sources. However, this measure has been acknowledged to be insufficient to account for the complex factors, including socio-economic, governance and environmental issues that can limit water use and access in developing countries. Because of this, there is concern that safe water access and use is not being measured accurately, leading to a poor understanding of domestic water and poor water planning and management choices. The Water Poverty Index (WPI) is a holistic tool that aims to address some of these wider issues. The WPI comprises five components that together provide a snapshot of how water poor a household is. This research undertakes concurrent conventional and WPI assessments of domestic water in five rural villages across Cambodia and Viet Nam. It is concluded that conventional measures had a relatively limited connection to how water was used by many respondents and that in the study villages, conventional measures did not predictably determine whether adequate quantities of safe water were used by individual households. It is argued that local, holistic water assessments at selected sites may support and triangulate conventional measurements of domestic water and improve water management planning and policy in rural developing areas. © 2014 United Nations. Source

Brearley L.,Save the Children UK | Eggers R.,World Health Organisation | Steinglass R.,John Snow Inc. | Vandelaer J.,United Nations Childrens Fund
Vaccine | Year: 2013

Addressing inequities in immunisation must be the main priority for the Decade of Vaccines. Children who remain unreached are those who need vaccination - and other health services - most. Reaching these children and other underserved target groups will require a reorientation of current approaches and resource allocation. At the country level, evidence-based and context-specific strategies must be developed to promote equity in ways that strengthen the system that facilitates vaccination, are sustainable and extend benefits across the life cycle. At the global level, more attention must go on ensuring sustainable and affordable supply for low- and middle-income countries to vaccine products that are appropriate for the contexts where needs are greatest. Finally, data must be disaggregated and used at all levels to monitor and guide progress to reach the unreached. © 2012 Elsevier Ltd. Source

Pearson L.,UNICEF | Gandhi M.,Save the Children UK | Admasu K.,Federal Ministry of Health | Keyes E.B.,FHI
International Journal of Gynecology and Obstetrics | Year: 2011

Objectives: To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia. Methods: The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008. Results: Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively. Conclusion: Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under discussion. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Source

Le Masson V.,Brunel University | Nair K.,Save the Children UK
Community, Environment and Disaster Risk Management | Year: 2012

Ladakh is an isolated arid environment in the Western Himalayas whose population relies mainly on glacial melt water. If the predicted adverse impacts of climate change occur, rising temperatures would accelerate the retreat of glaciers and place immense stress on the traditional Ladakhi agriculture and way of life. Very few studies in hydrology and glaciology currently document physical processes happening in Ladakh and only one project has combined climate data based upon measurements of temperature and precipitation, collected by the Indian Air Force in Leh town, and perceptions of local communities in order to explore the potential impacts of climate change in the area. This information constitutes the basis for climate change-related interventions of nongovernmental organizations (NGOs), both local and international, and could help inform any future climate modeling. However, the quality of this data can be questioned on several points, it terms of accuracy, availability and, most importantly, usefulness. Moreover, this chapter discusses the relevance of this kind of data when the focus is placed upon the adaptation of local communities to global environmental changes where climate change may not be the primary cause. For instance, the region is also currently undergoing a rapid transition from subsistence farming to a market-based economy due to the integration of Ladakh into India and the growing influx of tourism. When addressing the broader context of environmental change, reliable, accurate, and available climate data and models could be useful only if used as part of a holistic approach. This approach requires research and interventions to combine scientific information with local knowledge and perceptions about the impacts of climate change to root the physical data in a "real world" context. It must also acknowledge other drivers of environmental changes such as unsustainable development. Copyright © 2012 by Emerald Group Publishing Limited. Source

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