African Journals Online
The Ethiopian Journal of Health Development
(EJHD)

Volume 16, Special Issue 2002
Abstracts

Infant survivorship and occurrence of multiple-births: A longitudinal community-based study, south west Ethiopia
Makonnen Asefa, Fasil Tessema

Abstract: A one year live-birth cohort was studied in 46 urban and 64 rural 'kebeles' in south-west Ethiopia, in 1992-94. In order to recruit all live births in each of the study kebeles, pregnant women were identified in their second trimester and monitored by trained TBAs and enumerators using house to house visit. Each infant-mother pair of the cohort was visited soon after birth followed by regular bimonthly visit to the end of their first year or to an earlier death. Infant mortality was calculated as a life tables estimate using the 'survival' programme in SPSS. There were a total of 8162 births (8050 singletons, 111 twins and one set of triplets) of which 856 died, indicating an infant mortality of 104.8/1000 (estimated probability of surviving to 1 year 0.8952, with s.e. 0.004). The occurrence of multiple-births was 13.6/1000 live births. The infant mortality among them was 446.8/1000 (estimated probability of surviving to 364 days 0.5532, with s.e. 0.0034). This is a matter of serious concern. This study is the first of its kind based on rigorous study design, bigger sample size comprising different population groups and wider areas. The findings could help to formulate policy and health care programmes. [Ethiop. J. Health Dev. 2002;16(Special Issue):5-11]


A birth cohort study in south-west Ethiopia to identify factors associated with infant mortality that are amenable for intervention1
Makonnen Asefa, Robert Drewett, Fasil Tessema

Abstract: A one year live birth cohort of all identified children born in Jimma, Keffa and Illubabor Zones of Southwest Ethiopia, was followed from birth to the end of the first year of life, or to an earlier death, to investigate factors associated with mortality. All identified live-born infants were visited as soon as they were born and then bimonthly to the age of one or early death or lost for follow-up. Information was collected on socio-economic, behavioural, biological, and environmental factors for infants, mothers, and family immediately after birth and in consecutive visits. Overall, infant mortality was 106.2/1000, with estimates of 97.0/1000 and 113.5/1000 for urban and rural areas, respectively. Based on the results of the final Cox Proportional Hazards Model, mortality was associated with mothers' education and with antenatal care follow-up: there was better survival with at least one antenatal care follow-up. It was not associated with the mother's age per se but with marital status. Birth weight was strongly associated with infant mortality, and boys were more likely to die than girls. Twins were much more likely to die than singletons, even after taking their birth weight into account. Once adjustment had been made for these variables, there was no independent effect of the mothers' ethnic group or religion, or of family income. Family size was found to be significantly associated with infant mortality and higher mortality rate to families with the 2-4 persons. The type of water supply to the home was not associated with mortality, but habit of use of soap by the mother in washing her hands was. These results suggest that improvements in survival could be brought about by attempts to improve maternal education, antenatal care attendance, and habit of soap use in washing her hands which are amenable for change with local resources. [Ethiop. J. Health Dev. 2002;16(Special Issue):13-20]


An Ethiopian birth cohort study: the study design1
Makonnen Asefa, Robert Drewett, Jenny Hewison

Abstract: A one-year birth cohort was studied in Jimma town, South West Ethiopia, in 1992-93. We report here on the design and on the methods used in the study and describe the principal health outcomes. Infants were visited bimonthly until their first birthday. Background data on the physical, cultural and economic environment of the home were collected at the first visit, and data on nursing and weaning, on traditional surgical and other practices, and on vaccination at the first visit and at each subsequent visit. Length, weight and mid upper arm circumference were measured, and details of the mother's handling of illness episodes recorded. Of 1563 children born, 86% were successfully followed to the end of their first year or to an earlier death. There were 141 deaths, indicating an infant mortality of 115/1000 (estimated probability of surviving to 1 year 0.8851, with s.e. 0.0101). The mean length and weight of the singleton infants at the end of their first year was -1.41 and -1.52SD below from the median of the NCHS/WHO reference population. Weights throughout the first year were analysed in more detail using a Reed model, fitted as a random coefficient regression model in ML3-E. There were clear differences in growth across the different ethnic groups, with the best growing group weighing on average about 1 kg more at the end of the first year than the groups growing least well. [Ethiop. J. Health Dev. 2002;16(Special Issue):21-36]



Traditional nutritional and surgical practices and their effects on the growth of infants in south-west Ethiopia
Makonnen Asefa , Jenny Hewison, Robert Drewett

Abstract: A 1-year birth cohort of 1563 infants was seen bi-monthly for the first year of life. They comprised all identified infants born in Jimma town, south-west Ethiopia, in the year starting 1 Meskerem 1985 in the Ethiopian calendar (11 September 1992). Growth in infancy is poor in this town, as it is in Ethiopia more generally: mean z-scores for both weight and length were more than 1.5 SD below the median of the NCHS/WHO reference population by 1 year of age, and infant mortality was 115/1000. In this paper we examine the weight gain of singletons in relation to background variables and to traditional nutritional and surgical practices in the families. Confirming work in other areas, sanitation, water supply, the income of the family and the mother's literacy were important determinants of weight gain. Almost all the infants were initially breast fed, and about 80% were still breast fed at 1 year. Many were also given cows' milk from 4 months onwards. Breast-feeding had beneficial effects up to 8 months of age, and cows' milk had beneficial effects after 6 months of age. Supplementary feeds of solids and semi-solids were given at appropriate ages, but had no detectable benefit. Water was given inappropriately early, but did no detectable harm. Episodes of diarrhoea, fever or persistent cough each reduced weight gain. Catch-up in weight then took up to 8 months, probably because of the poor nutritional quality of supplementary feeds. The incidences of local traditional operations in the first year were: circumcision 63% in males and 4% in females, uvulectomy 35% and the extraction of milk teeth 38%. Although circumcision had no detectable adverse effect on weight, uvulectomy and milk teeth extraction both reduced weight gain. [Ethiop.J.Health Dev. 2002;16(Special Issue):37-50]


Mothers' health services utilization and health care seeking behaviour during infant rearing: A longitudinal community based study, south west Ethiopia
Fasil Tessema, Makonnen Asefa, Fekadu Ayele

Abstract: Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and delivery, determine their health seeking behaviour and health care expenditures for infants during the first year of life.

Methods: The study was longitudinal community based study consisted of a cohort of 8273 live births, their mothers and families between September 1992 and October 1994 in rural and urban settings in Jimma, Illubabor and Kefecho Zones, Southwest Ethiopia. Mothers were interviewed for their health care utilization during pregnancy and delivery. Occurrences of any illness for infants and mothers health care utilization during pregnancy and delivery. Occurrence of any illness for infants and mothers health seeking behavior was collected with the bimonthly visit for a period of 12 months.

Results: Mothers' health seeking behaviour for ill babies at the various levels of care showed that 46.5, 42.7, 48.241.6 percent of diarrhea, cough, fever, and other illnesses, respectively, got treatment in health institutions. More than a quarter of ill-infants didn't get any kind of help be it at home, traditional or health institutions. The average health care expenditure in infancy was estimated to be 7.92 birr and it increased with increasing level of education and monthly family income. In all treatment groups about 43 to 58 percent of ill infants claimed to have been cured with highest cure proportion for diarrhea cases after the first treatment was given. 

Conclusion: improved socioeconomic status of families and at least elementary schooling of mothers would change mothers' behaviour in seeking care for infants in health institution and increase the power of the family to spend some of their earnings for better care. Improving and providing at least primary health care services in rural areas needs considerations on the side of planners and health care provider.

Key words: infants, health seeking behaviour, expenditure, level of care. 

[Ethiop. J. Health Dev. 2002;16(Special Issue):51-58]

Assessing the goodness-of-fit of the laird and ware model-an example: The Jimma infant survival differential longitudinal study
Emmanuel Lesaffre, Makonnen Asefa, Geert Verbeke

Abstract: The Jimma Infant Survival Differential Longitudinal Study is an Ethiopian study, set up to establish risk factors affecting infant survival and to investigate socio-economic, maternal and infant-rearing factors that contribute most to the child's early survival. Here, a subgroup of about 1500 children born in Jimma town is examined for their first year's weight gain. Of special interest is the impact of certain cultural practices like uvulectomy, milk teeth extraction and butter swallowing, on child's weight gain; these have never been thoroughly investigated in any study. In this context, the linear mixed model (Laird and Ware) is employed. The purpose of this paper is to illustrate the practical issues when constructing the longitudinal model. Recently developed diagnostics will be used here for. Finally, special attention will be paid to the two-stage interpretation of the linear mixed model. [Ethiop.J.Health Dev. 2002;16(Special Issue):59-76]


Malnutrition and mental development: Is there a sensitive period? A nested case-control study
Robert Drewett, Dieter Wolke, Makonnen Asefa, Mirgissa Kaba, Fasil Tessema

Abstract: To examine the possibility that there is an early sensitive period for the effects of malnutrition on cognitive development, three groups of children (N = 197) were recruited from a birth cohort with known growth characteristics in south-west Ethiopia (N = 1563). All had initial weights;: 2500 g. Early growth falterers dropped in weight below the third centile (z < -1.88) of the NCHS/WHO reference population in the first 4 months. Late growth falterers were children not in the first group whose weights were below the third centile at 10 and 12 months. Controls were a stratified random sample with weights above the third centile throughout the first year. All children were tested blind at 2 years using the Bayley Scales of Infant Development, adapted for use in Ethiopia. Mean (SD) scores on the psychomotor scale were 10.2 (3.7) in the controls, 6.6 (4.2) in the early growth falterers, and 8.5 (4.3) in the late growth falterers. For the mental scale they were 28.9 (5.8), 22.6 (6.2), and 26.6 (6.1) respectively. Both overall differences were statistically significant at p < .001, and planned comparisons between the control and the combined growth faltering groups, and between the early and later growth faltering groups, showed that each difference was statistically significant for both scales. However, early weight faltering was associated with weight at the time of testing (r = .33), which was associated with scores both on the psychomotor (r = .53) and the mental scale (r = .49). After taking weight at the time of testing into account there was no additional effect attributable to the timing of growth faltering. In this population, therefore, early malnutrition does not have specific adverse effect beyond the contribution that it makes to enduring malnutrition over the first 2 years. [Ethiop.J.Health Dev. 2002;16(Special Issue):77-86]