Papers by Assefa Hailemariam
Background: Stigma is significantly impacted by cultural and contextual value systems. People wit... more Background: Stigma is significantly impacted by cultural and contextual value systems. People with mental health conditions frequently have to deal with the condition itself and the associated stigma and discrimination. Contextual understanding is essential to design measures and interventions. Objective: This study aimed to explore the experiences and perceptions of people with mental health conditions, their families and key stakeholders. Method: A qualitative method used to understand mental health-related stigma and its local contexts. Sixteen participants, including service users, caregivers, service providers and health service administrators, were interviewed. Result: People with mental health conditions and their caregivers experienced various forms of stigmatization which is linked to attributions about the causality of the illness, overt manifestations of mental health condition leading to easy identification and functional impairments that adversely affect participation. Social contact, lived experiences sharing and training of service providers are relevant intervention strategy to address stigma. Implication: Stigma and exclusion are prominent in the experiences of people with mental health conditions and their caregivers in this rural Ethiopian setting. Measurement of stigma and the development of interventions should consider how stigma is socially constructed. Antistigma interventions need to be implemented alongside expanded local access to mental healthcare. Impact statement People with mental health conditions (MHCs) face major challenges due to negative stereotypes and prejudice generated by misconceptions about MHCs. While research has gone a long way toward understanding the multiple adverse impacts of MHCs in low-and middle-income countries (LMICs), it is just starting to explain the social construct of mental health-related stigma. Contextualization of stigma measures and development of anti-stigma programs in LMICs are still limited. This study offers a valuable perspective on the experience of stigma and the mechanisms underlying the stigmatization of individuals with mental illnesses and key stakeholders. This enables a thorough investigation of the local context, focusing on the viewpoints and understandings of persons who reside and work in the area. That also looked at the stigma associated with mental health issues more broadly than from the perspective of a particular illness or diagnosis. The present study can be effective in targeting the consequences of stigma and understanding the interpretation of this stigma can aid in the development of context-specific anti-stigma interventions in Ethiopia and provides input into the process of assessing the implications and concept of stigma at a cross-national level. These interventions endorse the use of social contact approaches to reduce stigma, which are acceptable as long as they are combined with measures that foster a supportive environment, such as increased availability of mental health services.
Background: Stigma is significantly impacted by cultural and contextual value systems. People wit... more Background: Stigma is significantly impacted by cultural and contextual value systems. People with mental health conditions frequently have to deal with the condition itself and the associated stigma and discrimination. Contextual understanding is essential to design measures and interventions. Objective: This study aimed to explore the experiences and perceptions of people with mental health conditions, their families and key stakeholders. Method: A qualitative method used to understand mental health-related stigma and its local contexts. Sixteen participants, including service users, caregivers, service providers and health service administrators, were interviewed. Result: People with mental health conditions and their caregivers experienced various forms of stigmatization which is linked to attributions about the causality of the illness, overt manifestations of mental health condition leading to easy identification and functional impairments that adversely affect participation. Social contact, lived experiences sharing and training of service providers are relevant intervention strategy to address stigma. Implication: Stigma and exclusion are prominent in the experiences of people with mental health conditions and their caregivers in this rural Ethiopian setting. Measurement of stigma and the development of interventions should consider how stigma is socially constructed. Antistigma interventions need to be implemented alongside expanded local access to mental healthcare. Impact statement People with mental health conditions (MHCs) face major challenges due to negative stereotypes and prejudice generated by misconceptions about MHCs. While research has gone a long way toward understanding the multiple adverse impacts of MHCs in low-and middle-income countries (LMICs), it is just starting to explain the social construct of mental health-related stigma. Contextualization of stigma measures and development of anti-stigma programs in LMICs are still limited. This study offers a valuable perspective on the experience of stigma and the mechanisms underlying the stigmatization of individuals with mental illnesses and key stakeholders. This enables a thorough investigation of the local context, focusing on the viewpoints and understandings of persons who reside and work in the area. That also looked at the stigma associated with mental health issues more broadly than from the perspective of a particular illness or diagnosis. The present study can be effective in targeting the consequences of stigma and understanding the interpretation of this stigma can aid in the development of context-specific anti-stigma interventions in Ethiopia and provides input into the process of assessing the implications and concept of stigma at a cross-national level. These interventions endorse the use of social contact approaches to reduce stigma, which are acceptable as long as they are combined with measures that foster a supportive environment, such as increased availability of mental health services.
PLOS global public health, May 23, 2024
Background The COVID-19 pandemic is one of the most devastating public health emergencies of inte... more Background The COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia. Methods COVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data
Journal of Biosocial Science, Oct 1, 1991
Levels and trends of fertility in the Arsi and Shoa regions of Central Ethiopia are examined, usi... more Levels and trends of fertility in the Arsi and Shoa regions of Central Ethiopia are examined, using data from the 1986 Population, Health and Nutrition baseline survey of the Ministry of Health of Ethiopia. The population has high fertility. Total fertility of six children per woman in the late 1960s increased to eight children per woman in the early 1980s, then declined to seven children per woman in the mid-1980s. Urban fertility declined by a substantial amount during the 15 years before the survey while rural fertility increased during the same period. The implications of high fertility are considered.
PubMed, Oct 1, 1992
It is argued that some of the determinants of high fertility in Ethiopia are early marriage and c... more It is argued that some of the determinants of high fertility in Ethiopia are early marriage and childbearing, the level of sterility, infant and child mortality, low contraceptive knowledge, the high economic value of children for subsistence agriculture, and the low status of women. The statistical analysis of fertility determinants in Ethiopia is limited by data availability. This study is based on specific fertility rates constructed using the Trussell version of the P/F ratio technique. High levels of reproduction occur during the ages of 20-40 years. Fertility increased from 5.2 children per woman in 1970 to 6.8 children per woman in 1981, 7.5 in 1984, and 7.7 in 1990. Improved data collection techniques over time are not considered a likely explanation for the high and increasing fertility trends. It took 60 years for the population to double in size (1900-1960). Population is expected to double again during 1987-2007 under present conditions. Currently, over 50% of women are married before the age of 20 years. The singulate mean age of marriage is low and varies by region from 15.1 years in Gojam to 18.3 years in Wellega. Among women aged 25 years in 1990, 25% had their first birth before the age of 17 years and 75% had their first birth before the age of 22 years. Divorce and widowhood are common, but remarriage occurs within 3 months to 1 year. Infant and child mortality are still high. Contraceptive knowledge is low, and ever use in urban areas is under 30%. Children are highly valued as supports to parents. Female illiteracy remains high.
Indices for Selected African Countries and for the M.O.H. Data. 3.5. Percentage Distribution of E... more Indices for Selected African Countries and for the M.O.H. Data. 3.5. Percentage Distribution of Ever Married Women by Age at Survey Reporting Date of Marriage. 3.6. Percentage Distribution of Ever Married Women by Five Year Duration Since Marriage. 3.7. Percentage Distribution of Ever Married Women by Age and 5-Year Intervals Before the Survey. 102 3.8. Age at which 10, 25, 50 and 75 per cent of Women Ever Married. 3.9. Percentage Distribution of First Births by Length of Intervals and Age Group of Mothers. 3.10. Percentage Distribution of Ever Married Women According to 1981 Survey. 3.11. Percentage Distribution of Reported Birth Dates by Birth Order. 3.12. Children Ever Born, Children Dead and Sex Ratios by Age Group of Women. Ill 3.13. Sex ratios of Births by 5 Year Period Before the Survey. 3.14. Median Age at First Birth by Age Group, Residence and Literacy. 3.15. Cohort-period Rates, Cumulative Cohort and Period Fertility and P/F Ratios by Age 4.1. Forms of Data Used and Priority. 4.2. Source of Data. 11 4.3. Distribution of Final Logical Ranges. 4.4. Summary of Error Statistics. 4.5. Percentage Distribution of Total Women with Reported, Imputed and Matched Ages by Age Group. 4.6. Percentage Distribution of Deviation Between Reported and Imputed Ages at First Marriage. 4.7. Percentage Distribution of Women by Parity. 4.8. Percentage Difference in Annual Births in the Raw and Imputed Data Sets by Five Year Period Before the Survey. 160 4.9. Period-cohort Rates, Cumulative Cohort and Period Fertility : Imputed Data. 4.10. Ratios of the Rates (imputed to raw data). 4.11. Percentile Values of Birth Intervals by Birth Order 4.12. Correlation Matrix, Coefficients, Standard Error of Coefficients, T Values and their Significance: Raw Data. 4.13. Correlation Matrix, Coefficients, Standard Error of Coefficients, T Values and their Significance: Imputed Data. 5.1. Age Specific Fertility Rates per woman. 5.2. Age Specific Marital Fertility Rates per Woman and Cumulated Marital Fertility Rates. 5.3. Age Specific Marital Fertility Rates Relative to that of the 20-24 Age Group. 5.4. Mean Number of Children Ever Born. 12 5.5. Parity Progression Ratios per Ever Married Woman by Age Groups.
Ethiopia is the second most populous country in Africa. Although it is the fastest-growing econom... more Ethiopia is the second most populous country in Africa. Although it is the fastest-growing economy in Africa, it is also one of the poorest and least urbanized. Recently, the country has been undergoing demographic changes of historic proportions. It has been experiencing rapid declines in fertility, in infant, child, and maternal mortality, and an increase in life expectancy. Currently, the country is going through a demographic transition process. Both the size and the age structure of the population are changing. Understanding these changes is vital as the country plans the pathway for its future development. This contribution uses rigorously generated evidence of Ethiopia’s demographic transition to highlight the changes in population dynamics that have occurred in the country in the last sixty years and to examine the main drivers of these changes and their implications for the country’s future.
Ethiopian journal of health sciences, Aug 26, 2011
BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations, Nation... more BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations, Nationalities and Peoples Region. In such populations, unmet needs for contraception have a tendency to be high, mainly due to the effect of socioeconomic and demographic variables. However, there has not been any study examining the relationship between these variables and unmet need in the region. This study, therefore, identifies the key socio-demographic determinants of unmet need for family planning in the region.
Ethiopian Journal of Health Development, 1997
Abstract: By applying Cox's proportional hazard model regression analysis to data collected u... more Abstract: By applying Cox's proportional hazard model regression analysis to data collected using a retrospective survey conducted in Sebeta, a town 25 Km west of Addis Ababa, the capital city of Ethiopia, the paper examines the factors impinging on the survival of infants and children between 1 - 3 years of age. It is shown that for higher order births (more than 5), for births to young women (under 20 years of age), and for those to older women (more than 34 years of age), the risk of dying at infancy is higher. The risk of infant mortality is also high for births with short previous birth intervals. In fact, the length of the previous birth interval is found to be the single most important factor affecting the chances of survival during infancy. It is further shown that education of mother, occupation of father, household income, source of drinking water, availability of latrine, and survival status of older sibling have direct effect on infant mortality. Among these, source of water and availability of latrine are identified as having significant effects on infant mortality even after controlling for the effects of other variables. During early childhood, however, the effects of age at maternity, birth order and preceding birth interval becomes trivial. Following birth interval appears to have a strong effect on the chances of survival during early childhood. Household income, religion and survival status of the previous sibling are found to have significant effects on early childhood mortality. The findings provide solid ground to support strategies to broaden MCH/FP services, environmental health and income generating scheme to reduce the risk of death for infants and children. [Ethiop. J. Health Dev. 1997;11(3):189-200]
Annals of Medical and Health Sciences Research, 2015
Background: The estimate of the number of people chewing Khat globally ranges from 5 to 10 millio... more Background: The estimate of the number of people chewing Khat globally ranges from 5 to 10 million people. Its use may result in a variety of effects due to the different compounds in it with effects on the gastro-intestinal system and nervous system being the principal ones. Aim: To assess the prevalence, factors, and effects of Khat chewing among students of a college in Gondar town, northwestern Ethiopia. Subjects and Methods: An institution-based cross-sectional study was conducted from 15 th to 20 th of April 2009 on a total sample of 424 students who were selected using stratified random sampling technique. Data were collected by three of the principal investigators using a structured pretested data collection instrument and analyzed by Epi Info version 3.5.2. Results: The lifetime and current prevalence of Khat chewing among the respondents were 42% (168/400) and 32.5% (130/400), respectively. Sex (P < 0.01), religion (P < 0.001), and income (P < 0.01) showed statistically significant variation in Khat chewing. The commonest frequency of Khat chewing was once a day 33.1% (43/130) while alcohol (40.8% [53/130]) and cigarette (40.0% [52/130]) were the mostly used substances with Khat. More than half of the chewers (53.85% [70/130]) reported spending 1-4 h for one Khat chewing ceremony. Financially majority of the chewers reported spending up to 10 Ethiopian Birr (ETB) (1.13 United States Dollar) on Khat (54.6% [71/130]) and other substances (64.6% [84/130]). Nearly two-thirds (62.3% [81/130]) of the chewers mentioned seeking concentration during study as their main reason for chewing. Among chewers, 83.1% (108/130) reported they faced problem associated to sleep disturbance, 82.3% (107/130) loss of appetite, and 80.8% (105/130) constipation. Conclusion: The prevalence of Khat chewing was fairly high among the students and the majority among them used other substances together with Khat. Spending of a significant amount of money and facing health problems were reported to be consequences of the habit. The college should take steps to make students aware of the ills of Khat chewing and associated habits.
Routledge eBooks, Jul 11, 2019
The social and economic problems children and youth face today in Ethiopia are strongly related t... more The social and economic problems children and youth face today in Ethiopia are strongly related to the demographic situation of the country. High fertility combined with moderately declining mortality has contributed to the large number of children and youth in the country while the low level of development has worsened their condition. This paper attempts to review the general demographic and socioeconomic characteristics of Ethiopia. The study is based on data obtained from censuses and surveys conducted in the country during the last several years. Descriptive statistical methods are used in the analysis. Including the introductory section the paper is organized in five sections. Section two presents the demographic profile of the country followed by a description of the socioeconomic situation in section three. Section four attempts to address the implications of the prevailing demographic and socioeconomic situation on children and youth. The last section presents a summary of the main findings and highlights some policy issues.
Population Horizons, Aug 1, 2016
Background: The Ethiopian government promulgated its first ever explicit, comprehensive and multi... more Background: The Ethiopian government promulgated its first ever explicit, comprehensive and multisectoral population policy in 1993. The policy aimed at harmonizing population growth rate with that of the economy and the capacity of the country for sustainable socioeconomic development. As with any population policy, there are important lessons to be learnt from the problems and challenges encountered during its implementation. Objective: The paper assesses the extent to which the population policy objectives have been realized; highlights the successes registered and identifies challenges encountered in its implementation and proposes the way forward. Methodology: Trend analysis using secondary data from censuses, surveys and UN sources were used and policy documents, research findings, development plan and program reports reviewed. Results: Fertility, infant, under-five and maternal mortality have declined significantly. Female participation in education and labour force increased. A range of legal, policy and institutional frameworks have been developed and implemented on environmental security and on gender equity, equality and the empowerment of women. Legislative measures were also taken to remove harmful traditional practices. However, the pace of implementation has been slow and there are areas where not much progress was made. Conclusion: Despite the progress made, there are critical challenges. Failure to establish the National Population Council; weak coordination and institutional arrangement due to absence of legally defined structure for implementation, lack of monitoring and evaluation system, absence of a comprehensive population program and financial constraints, among others are the major barriers. There is need to revise the policy and address these impediments and continuing and evolving challenges.
Springer eBooks, Jan 20, 2010
10 Conclusions and Policy Implications Leslie Lipper, C. Leigh Anderson, Timothy J. Dalton and Al... more 10 Conclusions and Policy Implications Leslie Lipper, C. Leigh Anderson, Timothy J. Dalton and Alder Keleman INTRODUCTION We began this research uncertain ... We follow with policy implications to support improv-ing farmer access to crop genetic resources in local markets ...
PubMed, Oct 1, 1986
This analysis of household size in Ethiopia during 1965-84 indicates that conditions did not have... more This analysis of household size in Ethiopia during 1965-84 indicates that conditions did not have the same effect on rural and urban areas at the regional level. Household size fluctuated during the study period. Analysis of variance of household size in 1964 and 1984 among urban and rural areas indicates that overall variation in household size was explained by type of residence, the Awraja, and the region. There were significant differences between rural and urban areas, between the 75 Awrajas, and between the 12 regions. Over the study period, rural areas had decreases in household size, whereas in urban areas and the regions of Gojam, Gonder, and Keffa, which were least affected by famines, household size increased. It is suggested that rural-to-urban migration during periods of famine accounted for the increased household size and temporal changes. Mortality increase and migration due to famine in rural areas reduced household size. During 1970-80, in rural areas, the relative number of small households decreased from 37.3% to 31.5%. The proportion of large households increased from 15.5% to 20.5%. A comparison of household size in Addis Ababa and rural areas around 1980 indicates that the proportion of large households in the city vs. rural areas was similar. The largest differences were in the proportion of small and medium households. The city had more small households, and rural areas had more medium households. Only in 1965 were the differences in average household size between rural and urban areas statistically significant. It appears that household size over time varied with the size of urban centers. Larger urban centers had a greater proportion of large family sizes. Urban household size was larger in all regions in 1984 compared to 1965. Gains were largest in Shoa and Gojam regions and smallest in Arssi and Illubabor. In 1984 average household size was 5.2 in Addis Ababa and 4.3 for the nation.
PubMed, Jul 1, 1987
The paper studies the emerging patterns of urbanization in Ethiopia. It is noted that, over the 1... more The paper studies the emerging patterns of urbanization in Ethiopia. It is noted that, over the 1967-1984 period, a number of structural changes have occurred which are likely to play a dominant role in the future urban growth in Ethiopia. The paper also provides some data ...
Springer eBooks, Jan 20, 2010
The principle of evidence-based decision-making for development policy and planning is now well a... more The principle of evidence-based decision-making for development policy and planning is now well accepted, and population data are of critical importance. Some ministries (eg., Health) are even including targets for program managers in the “use of reliable data in 75% of their decisions”. In 2008–2009, four African countries were selected for a study to assess the demand for, access to and use of demographic data for development decision making. In the Ethiopia case study presented here, the authors carried out nearly 100 key informant interviews of decision makers, key advisors, planners and media, at Federal and regional levels, plus follow up dialogue with selected and forthcoming policy advisors. The main finding is that demand for demographic data has increased, with the heightened need for monitoring international (eg, poverty, Cairo conference and MDG) targets and national results-based planning, as well as decentralized and locally empowered planning. However, there is still weak demand by international partners for developing strong and transparent national M&E systems. The demand and supply side barriers to effective use include: limited awareness of the value and type of data available; differing sources of information available on the same indicator (eg., contraceptive prevalence, ante-natal care) with contradictory estimates; old, unrepresentative and non-disaggregated data; research and survey findings not communicated well to policymakers, and skepticism and even mistrust of unexpected demographic statistics. Applied research, rigorous evaluation and data generation and analytical capacity in the country are weak, and the lack of demographic media expertise exacerbates the data use gap. The overall recommendation is advocacy for a culture of transparent information in order to rebuild trust and promote strategic use, as well as active involvement of the media to promote awareness of the importance of demographic data for development. Technical and institutional capacity building include the strengthening of key statistical, research and data collection institutions; improving true international partnerships towards increasing local ownership for large scale demographic data collection, research and M&E systems. It is also important to resolving key indicator contradictions between service statistics and household surveys through committed harmonization of sources, improve communications between data analysts, media and policymakers, and the creation of a well-functioning National Population Council. More research is needed on the socio-cultural and historical barriers to enabling a greater culture of reliable data.
Development in Practice, Feb 10, 2016
ABSTRACT This article explores the application of key informant research to examine barriers and ... more ABSTRACT This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.
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Papers by Assefa Hailemariam