Papers by Damen Haile Mariam
Ethiopian Journal of Health Development, Feb 18, 2020
Oxford University Press eBooks, Dec 13, 2007
South Eastern European Journal of Public Health (SEEJPH), Apr 4, 2018
Aims: Development assistance for health is an important part of financing health care in developi... more Aims: Development assistance for health is an important part of financing health care in developing countries. In spite of the increasing volumes in absolute terms in development assistance for health, there are controversies on their effect on health outcomes. Therefore, this study aims to analyze the effect of development assistance for health on health status in Ethiopia. Methods: Using dynamic time series analytic approach for the period 1978-2013, this paper examines whether development assistance for health has contributed for health status change in Ethiopia. While life expectancy at birth was used as a measure of health status, vector error correction model was used for the analysis. Results: Development assistance for health expenditure (lagged one and two years) had a significant positive effect on life expectancy at birth in Ethiopia. Other things being equal, a 1% increase in per capita development assistance for health leads to 0.026 years improvement in life expectancy at birth (P<0.001) in the immediate year following the period of assistance, and 0.008 years (P=0.025) in the immediate two years following the provision of assistance. Conclusion: This study indicates that, seemingly, development assistance for health has significant favourable effect in improving health status in Ethiopia. The policy implication of this finding is development assistance for the health should continue as an interim means to an end.
PubMed, Jul 1, 2002
Setting: Three districts of Oromia Region in Arzi Zone, Ethiopia. Objectives: To determine the ra... more Setting: Three districts of Oromia Region in Arzi Zone, Ethiopia. Objectives: To determine the rate of defaulting from directly observed treatment, short course (DOTS) for tuberculosis and identify associated factors. Design: A case control study. Records of 1367 new tuberculosis patients put on DOTS during a period of 30 months (1 July 1997-31 December 1999) were reviewed to determine the defaulting rate. Cases were defaulters and controls were selected by paired matching of sex and age using the lottery method. All study subjects were actively traced and interviewed by trained interviewers using a pre-tested structured questionnaire. Results: The overall rate of defaulting from DOTS was calculated to be 11.3%, while the rate in sputum smear-positive cases was 11.6%. Defaulting was highest (81%) during the continuation phase of treatment. Medication side effects were significantly associated with defaulting (OR = 4.20, 95% CI 1.51-11.66), while adequate knowledge and family support were found to be possible protective factors (OR = 0.04, 95% CI 0.02-0.1 and OR = 0.19, 95% CI 0.08-0.46, respectively). Conclusions: Major factors contributing to high rates of defaulting were found to be lack of family support, inadequate knowledge about treatment duration and medication side effects. Control programmes that take these factors into consideration should be successful in reducing defaulting.
Advances in Nutrition, 2016
Ethiopian Journal of Health Development, Sep 22, 2011
Background: Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators o... more Background: Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among different groups of populations selected for behavioral surveillance in Ethiopia. Methods: We used HIV/AIDS Behavioural Surveillance Surveys (BSS) data collected from ten target groups in Ethiopia. These were female sex workers, military personnel, police force, pastoralists, long distance truck drivers, intercity bus drivers, road construction workers, teachers, factory workers and ANC catchment populations. Results: Data from 14,524 individuals were analyzed. The majority were male (63.6%). Knowledge of the three preventive methods (abstinence, faithfulness and consistent condom use), misconceptions and comprehensive knowledge was 57%, 75% and 18.5%, respectively. Female sex workers and the defence force showed positive results in using condom during last sexual encounter and did so consistently with non regular sexual partners and paying partners. Women, pastoralists and the illiterate were negatively impacted. Conclusion: Inadequate and incorrect knowledge on HIV/AIDS was observed with special deficiency among the underserved groups such as pastoralists. Women and the older age group were found to be at a disadvantage. The findings indicate the need to expand prevention activities to hard-to-reach groups and such a certain specific population segments. Population groups such as female sex workers and the defense force that were known to be severely affected by the epidemic and are focus of HIV/AIDS interventions showed positive behaviors. Although this is encouraging, considerable proportion of the study groups did not use condom during sex with non regular partners. This underscores the importance of intensifying interventions across all groups and extended to their localities.
Perspectives in Public Health, Sep 1, 2010
Historical accounts of famines in Ethiopia go as far back as the 9th century, however, evidence o... more Historical accounts of famines in Ethiopia go as far back as the 9th century, however, evidence on its impact on health only started to emerge from the 15th century onwards. Unfortunately, famine has been endemic in Ethiopia in the last few decades. The 1973 famine is reported to have claimed over 300,000 lives. In 1985 approximately 10 million people were reported to be starving, with approximately 300,000 already dead and about 1,000 dying daily. In the following years, droughts leading to food shortage have had local and national adverse health effects, in particular in 1999/2000. This paper describes the initial findings of a literature review of evidence on the health impact of droughts leading to famine in Ethiopia and highlights gaps in knowledge. The key finding, thus far, is the marked paucity of health impact data. This review also highlights the fact that adverse health impacts of famines are probably complex and long lasting. Interpretation of any health impact data is difficult as there are few baseline data to compare. Health effects also impact livelihoods. Livelihood disruption following famine does not just affect one generation but also subsequent generations. Surveillance systems are needed so that records of the health impacts of a drought that leads to famine can inform action. With climate change bringing increased likelihood of drought and famine in some parts of the world, the findings of this review could be beneficial not just for Ethiopia but also elsewhere.
Ethiopian Journal of Health Development, Mar 30, 2017
Nations in sub-Saharan Africa have become increasingly unable to finance the provision of health ... more Nations in sub-Saharan Africa have become increasingly unable to finance the provision of health care by public funds due to problems of increasing demand for these services in the face diminishing budget allocation in real terms, decline in international assistance, and problems of managing health services in general. The wave of market oriented economic reform that is occurring in these countries is also further complicating this phenomenon. This article is a glance at the particular situation in Ethiopia with regard to the problem. Furthermore, using models of Organization theory, it is attempted to analyze the trend of health care provision in the country and come up with some suggestions that may be useful for policy related discourse. [Ethiop.
Ethiopian Journal of Health Development, Sep 29, 2016
PubMed, Oct 1, 2001
We describe the design and results of a study conducted to determine the magnitude and healthy ye... more We describe the design and results of a study conducted to determine the magnitude and healthy years of life lost due to morbidity and mortality for major causes in rural Ethiopia. The design included a cross-sectional household survey to determine the magnitude and causes of morbidity and a retrospective longitudinal study to determine the magnitude and causes of mortality. The study was conducted between June 1 and July 12, 1998, within the Butajira Rural Health Project (BRHP) setting. The source population were all people residing in the district and the study population were the sample of households for the BRHP which are the inhabitants of nine rural and one urban Kebeles (villages) in Butajira area, which is located about 130 Kms south of Addis Ababa. The sample was previously selected randomly using probabilities proportional to size, constituting 10% of the total district population (approximately 32,000) and has been under continuous demographic surveillance since 1987. All individuals who were sick two weeks preceding the survey and all those who deceased in the two years prior to the survey were included in the present analysis. The Disability-Adjusted Life Years (DALYs) lost was used as a measure of the burden of disease from the analyzed data. According to the results, prevalence of morbidity within the preceding two weeks was 13.8% (95% CI = 12.8-14.8). In addition, there were 875 deaths during the preceding two years making an annual mortality rate of 13.5 per 1,000 populations (95% CI = 13.13-13.87). The total burden of disease in terms of DALYs lost calculated from these data was 59,125 per 100,000 populations (95% CI = 58,591-59,659). Communicable, maternal, perinatal and nutritional problems contributed to 72% of the total DALYs lost; non-communicable diseases contributed to 24% of the DALYs lost while the proportion of DALYs lost due to injuries was only 4%. The results were similar to previous estimates for countries in Sub-Saharan Africa.
Science Advances
Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian ... more Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media–conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed ...
PLOS ONE, Apr 27, 2023
Background The use of maternal health care services tends to rise with women's empowerment. Howev... more Background The use of maternal health care services tends to rise with women's empowerment. However, disparities in the use of maternal health care services in Ethiopia that are founded on women's empowerment are not sufficiently addressed. In light of women's empowerment equity stratifier, this study seeks to assess inequalities in the uptake of maternal health care services (early antenatal care, four or more antenatal care and postnatal care services). Methods Drawing on data from the four rounds of Ethiopia Demographic and Health Surveys (EDHSs) conducted between 2000 and 2016, we conducted analysis of inequalities in utilization of maternal health care services using women's empowerment as equity stratifier. We utilized concentration index and concentration curve for assessing the inequalities. We used clorenz and conindex Stata modules to compute the index and curve. Decomposition of the Erreygers normalized concentration index was done to explain the inequalities in terms of other variables' percent contributions. Complex aspect of the EDHSs data was considered during analysis to produce findings consistent with the data generating process. All analyses were done using Stata v16. Results Utilization of maternal health care services was inequitably distributed between empowered and poorly empowered women, with women in the highly empowered category taking more of the services. For instance, the Erreygers index for quality ANC are 0.240 (95% CI 0.207, 0.273); 0.20 (95% CI 0.169, 0.231) and 0.122 (95% CI 0.087, 0.157), respectively, for the attitude towards violence, social independence and decision-making domains of women's
medRxiv (Cold Spring Harbor Laboratory), Jan 5, 2023
For the purpose of open access, the author has applied a 'Creative Commons Attribution (CC BY) li... more For the purpose of open access, the author has applied a 'Creative Commons Attribution (CC BY) licence (where permitted by UKRI, 'Open Government Licence' or 'Creative Commons Attribution No-derivatives (CC-BY-ND) licence' may be stated instead) to
BMJ Open
ObjectivesThis study aimed to determine the prevalence of small-for-gestational-age (SGA) and app... more ObjectivesThis study aimed to determine the prevalence of small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA); compare variations in multiple risk factors, and identify factors associated with SGA births among preterm babies born <2000 g.DesignCross-sectional study.SettingThe study was conducted at five public hospitals in Oromia Regional State and Addis Ababa City Administration, Ethiopia.Participants531 singleton preterm babies born <2000 g from March 2017 to February 2019.Outcome measuresBirth size-for-gestational-age was an outcome variable. Birth size-for-gestational-age centiles were produced using Intergrowth-21st data. Newborn birth size-for-gestational-age below the 10th percentile were classified as SGA; those>10th to 90th percentiles were classified as AGA; those >90th percentiles, as large-for-gestational-age, according to sex. SGA and AGA prevalence were determined. Babies were compared for variations in multiple risk factors.ResultsAmo...
31st EPHA Annual Conference, Feb 8, 2020
Ethiopian Journal of Health Development, 2013
Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framew... more Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framework for health systems (1). Human resources for health do consume a significant bulk of the health sector expenditures and also constitute a critical block of health systems as they affect the efficiency and effectiveness with which the other building blocks function. While HRH has remained neglected for years, recent decades have witnessed a wider attention both by the global health community and national governments as a critical ingredient to improving health outcomes. The World Health Report 2006 signifies an important milestone following which several consultations, initiatives and approaches to address HRH have taken effect at global, regional and country levels (2). The establishment of an HRH Secretariat within the WHO, the Global Forums on Human Resources for Health in Kampala and Thailand (3) as well as the ongoing efforts by the WHO African regional office to support ministrie...
Ethiopian Journal of Health Development, 2012
Background : HIV continues to be the major public health challenge in Ethiopia. Despite positive ... more Background : HIV continues to be the major public health challenge in Ethiopia. Despite positive developments in prevention efforts during the last three decades, the pandemic has continued to spread further expanding to remote pastoral communities. Objective : The objective of this study is to determine the current state of awareness on modes of prevention, transmission and ‘misconceptions’ about HIV among the Borana pastoralist community in Ethiopia. Methods : A cross-sectional survey of 502 households, 69 in-depth interviews and nine Focus Group Discussion sessions with 68 participants were carried out to generate data. STATA Version 10 was applied to analyze the survey data while MAXQDA 10 qualitative data analysis software was used to summarize and code qualitative data for further analysis and interpretation. Results : The survey data revealed that only 10% of the respondents identified all modes of HIV prevention. Logistic regression analysis showed that those over 41 years o...
Ethiopian Journal of Health Development, 2016
A number of articles in this issue (1-4) highlight the importance of providing essential basic he... more A number of articles in this issue (1-4) highlight the importance of providing essential basic health services for achieving and maintaining optimal health status within a given population. The Ethiopian health system is also striving to address the need for providing essential health services within the perspective of universal health coverage (UHC) through its health care financing strategy (5) which is a basis for different reforms that include community based health insurance (CBHI) and social health insurance (SHI) schemes for people in the informal and formal sectors respectively as its health insurance strategy (6).
Ethiopian medical journal, 2015
Teenage pregnancy is directly related to high incidence of pregnancy related complications contri... more Teenage pregnancy is directly related to high incidence of pregnancy related complications contributing to maternal morbidity and mortality and social problems. There are no enough data on teenage pregnancy and related complications in Ethiopia and in Benishangul Gumuz region in particular. To investigate the magnitude and factors associated with teenage pregnancy among teenage females visiting Assosa general hospital for health care services. Facility-based quantitative cross-sectional study was carried out among 783 randomly selected teenage females using structured and pre-tested questionnaire from January to April 2014. Teenage pregnancy is estimated at 20.4% in this study. The median age of subjects at first sexual intercourse and at first marriage being 16 and 17 years respectively. High proportion of (46.8%) teenagers had engaged in premarital sex. Among sexually active teenage females, 46.7% experienced their first sexual encounter by coercion. Being young [AOR = 0.21, 95% C...
Developing Country Perspectives on Public Service Delivery, 2015
The highest incidence of maternal deaths occurs in Africa. Recent research has found governance i... more The highest incidence of maternal deaths occurs in Africa. Recent research has found governance in health systems to be a strong determinant of maternal health. Although the role and impact of determinants of governance have been studied individually, how and to what extent these variables influence each other and eventually impact access to maternal health services are questions that remain unanswered. In this study, conducted in two administrative units (districts), i.e. Ambo and Fentale in Ethiopia, we drew upon various indicators for measuring governance and undertook a series of systematic delineation and characterization of the variables that impact the governance of health systems in relation to delivery of reproductive health services. The chapter maps stakeholder perceptions about existing status of the governance variables, determines the influence of governance environments on access and client behaviour and identifies potentially modifiable factors of governance that could expand the accessibility of reproductive and maternal health services in the region and encourage client participation.
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Papers by Damen Haile Mariam