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Children Nutrition in Urban and Rural Areas of Ethiopia

We have recently had accepted and published a research paper entitled “The influence of father’s child feeding knowledge and practices on children’s dietary diversity: a study in urban and rural districts of Northern Ethiopia”  in Maternal & Child Nutrition.

Here is the abstract:

Infant and young child feeding has been recognized as an essential element to improve growth of children, especially in developing countries where malnutrition among children and its dire consequences are very prevalent. However, little attention has been paid on the influence of fathers on child feeding practices although fathers are very important in raising well-adjusted, happy and successful children. Therefore, this study aimed to assess the influence of fathers’ child feeding knowledge and practice on children’s dietary diversity.

A community based comparative cross sectional study was conducted among 850 eligible urban and rural households with children of 6 to 23 months. The father and mother of the child were interviewed on children’s dietary Diversity and fathers’ knowledge and practice of child feeding.

Nearly half (46%) of the children in the rural district did not meet the minimum dietary diversity, and in the urban district the rate was even worse (72%). Dairy products were the common food group given to the children in both districts, whereas vitamin A-rich food and other fruits and vegetables were the least commonly consumed food groups.

Almost all dimensions of fathers’ knowledge and practice were significantly related to children’s minimum dietary diversity; especially fathers’ knowledge of food groups was an important predictor (p value<0.001) in both districts. Interventions that focus on the fathers’ knowledge of child feeding, especially about food groups, is recommended to improbé children’s dietary diversity in the study communities.


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Research Paper on Sexual and Reproductive Health Services Utilization among Adolescents in Ethiopia

Our research paper entitled  “Utilization of Sexual and Reproductive Health Services  in Ethiopia- does it affect sexual activity among high school students?” has recently been accepted and published in Sexual and Reproductive Healthcare.

Here is the abstract:


Universal access to Sexual and Reproductive Health (SRH) services for adolescents was added as a target to the revised Millennium Development Goals framework in 2005. However, the utilization of SRH services among adolescents and their sexual activity is not well explored in Ethiopia, with the result that there is no well-designed and sustainable school based intervention for high school students. We aimed to investigate the utilization of sexual and reproductive health services and sexual activity and, to provide evidence based information and recommendations for possible interventions.

Study design

A cross-sectional survey was conducted among 1031 female and male high school students aged 14–19 years in Mekelle town, Tigray Region, North Ethiopia. A total of 1031 students participated. Self-administered questionnaire was used.

Main outcome measures

Utilization of sexual and reproductive health services and sexual activity were investigated using a self-administered questionnaire.


One out of five students had used the SRH services in the past year. The primary reason for visiting the SRH services was to receive information. The mean age for the first sexual intercourse was 15.7 and one-quarter of the students had multiple sexual partners. Unwanted pregnancies and abortions were reported by female students.


SRH services are known and used by students. However, sexual activity at an early age among high school students and unwanted pregnancies and abortions among female students still call for attention. Therefore, providing accurate SRH information on safe sex and enhancing family–student discussion could be a good approach to reach SRH of adolescents.

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New Research Paper on Mobile Health Data Collection for Primary Health Workers

We have just had a research paper entitled “Mobile health data collection at primary health care in  Ethiopia: a feasible challenge” accepted and published in The Journal of Clinical Epidemiology. The paper describes our experience working with community health workers in Ethiopia using mobile health data collection tools for recording and managing maternal care visits.

Here is the abstract:

Objectives: Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia.

Study Design and Setting: A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones,installed with customized data collection application and electronic maternal health care forms for assessing pregnant women’s health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users’ perception and experience in using the application and forms.

Results: All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers’ acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges.

Conclusion: Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application.




GETHealth Conference in Dublin

At the end of last week, Roman and I were at the GETHealth Summit in Dublin. Roman had a poster presentation accepted (get it here) and I was on the mPowering sponsored breakout session on content adaptation.

I was great to get to meet many people who I’ve only ever spoken to on skype, and with the size of the conference (~200 attendees) it was small enough to get chance to make new contacts with some new faces too.

There was plenty of lively discussion during all the sessions, however now I’ve had a bit of time to reflect on it all there are a few comments and queries that are still outstanding in my mind:

  • Much of the training appears still to be NGO driven, so although this training may well fit with countries health ministries priorities, until this training becomes a core part of health workers career progression and “professionalisation”, the incentives to attend training may still be limited to per-diems.
  • There was little discussion about the quality of the teachers/trainers – for me, the teachers (whether it be via face to face or blended learning) are critical to truly engaging their students in the subject matter, whether or not they have quality content/resources to use. Perhaps this could be a good topic for next years discussions?
  • The dreaded ‘pilotitis’ word appeared a few times, with a suggestion to reterm this as ‘phase 1’. I would prefer to use the word ‘research’. Unfortunately, although there was talk of the number of pilots (30,000 – although no idea how this figure was arrived at, it’s certainly a lot), the systematic review of published research presented by Travis Porter (from Tulane Uni) cited a very limited number of published research articles (~55). So there’s a huge mismatch here between the work that’s being done and what has been properly studied and published. Until more results (good or poor) from these projects are published, we could keep repeating the same mistakes.

One of the highlights for me was to see the “CHN On the Go” mobile app being presented (more info on this project). This is work being done in Ghana, with Concern Worldwide and Grameen Foundation and was presented by Jahera Otieno. What’s great for us is that the app is based on OppiaMobile and has been developed/extended in-country with no support from Digital Campus apart from a short skype call over a year ago. This, to me demonstrates that we have taken the right approach in making the OppiaMobile platform open source, and that it’s in a state where others can expand and adapt to fit their needs.

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Supporting ASHAs in providing Family Planning Advice

ujjwal-training Recently we made a visit to India to support Johns Hopkins Uni CCP in their implementation of OppiaMobile for ASHAs providing family planning advice in their communities in the Bihar region. We’ve been collaborating with the JHU CCP team in India for the last few months, so was great to get the opportunity to actually meet face to face and spend time with the ASHAs and the communities they are supporting.

JHU CCP India have been implementing Project Ujjwal for the last few years (funded by DFID/UKAID) to support improved family planning and reproductive health services in India, focusing on the Bihar and Odissa regions (two of the poorest states in India). One aspect of this project has been to provide health workers with video and media content they can show their clients to help them arrive at the right family planning method for them. So far these videos have been distributed on SD cards on low-end/feature phones, however they also wanted to look at ways in which these videos could be delivered in a more structured way, which is where OppiaMobile comes in.

ujjwal-appWe have created a slightly customised version of the OppiaMobile app, to include the videos resources for use during their client counselling sessions and also a mobile learning component, to give them easy access to more information about how they can use the videos during their counselling sessions and the various family methods they are expected to provide advice on.

The training was split over two days, with the first day initially orientating the health workers in how to use the smartphones (the model used was Lava Iris 406Q) and the app. The health workers then had a day to try the app in their communities during their counselling sessions. The second training day then followed up on their experiences and to gather feedback. Although this was very initial feedback after using for only one day in the field, we’ll be following them up each week for the next few months. Initial feedback was very positive, several ASHAs informed us that just by being able to show the videos to their clients, this had given sufficient information for their clients to attend the local Project Ujjwal family planning clinic. We expect to obtain more substantive and qualified feedback and results over the coming few months.

The Ujjwal app is freely available on the Google Play store at: if you would like to try it out for yourself.

In addition to supporting the initial training, there were several other important aspects to our visit to India:

  1. To build up a better picture of the workflows of frontline health workers, especially with respect to how education and training can be integrated into their day-to-day activities, without creating extra workload burdens.
  2. To begin to build a blueprint of how a locally sustainable end-to-end content production and delivery system could be created to enable the re-use and adaptation of locally relevant content to support frontline health workers’ training needs on mobile platforms, tying in closely with mPowering’s objectives
  3. Meeting with local content production agencies (e.g. filmmakers).
  4. Meeting with local software and technical development organisations, specifically to support the ongoing maintenance and development of the localised OppiaMobile for Ujjwal app.

We’re very grateful to mPowering, JHU CCP and Futures Group, for all their support to enable this work and to the JHU CCP India team who have been very enthusiastic about the possibilities and made us very welcome in India.

Finally, many thanks to the ASHAs, who (despite it being a fasting day during the first day training), were very active during the training sessions and we hope these resources can help the great work they are doing in their communities. For me, it was fantastic to get the chance to spend time with them and learn more about their work, challenges and environment, to continue to improve how they may be supported by these new types of technologies.

Filling the gap: Reflection on the Certificate course on Mobile Phones For Public Health organized by Techchange

by Marijs Carrin at Digital Campus

Recently, I was given the timely opportunity by Digital Campus to participate in a four-week online course on Mobile phones for Public Health, which examined the power of mobile technology and its revolutionary role in improving health outcomes worldwide.

The course focused on health education; service delivery and capacity building for health workers; patient care; diagnostics; as well as supply management and logistics. Throughout that month I gained new insight and reflected upon the benefits and remaining challenges of mobile health (mHealth), as we continuously try to adapt our Oppia mobile – health education and training- application to extend its use among health workers on a more global scale.

My preferred aspects of the course were:

  1. The vast amount of resources (videos, documents, presentations, exercises, links) available on mHealth;
  2. Learning about various mHealth tools and getting hands-on experience using them;
  3. The framework and taxonomy used in classifying mHealth projects (Dr. Alain Labrique, Founding director of the Johns Hopkins University Global mHealth Initiative);
  4. An outline of current evidence and projects.

The presentation by Dr. Labrique, one of the most respected professionals with years of experience in the field, was particularly useful and very inspirational to me. He shared a detailed synopsis of lessons learnt, opportunities and ideas around mHealth today, and allowed me to extend my knowledge regarding the definition, use and future of mHealth.

Dr. Labrique’s words have encouraged me to start thinking more outside the box. Innovation is critical in this field (also for development) and the examples of how it has changed the game are vast. Indeed, he emphasised that the success of mHealth interventions has to go beyond technology. The most important aspect, I learnt, is to create simple, sustainable and efficient solutions to health systems that are dynamic, crosscutting and moreover accessible to all. In a nutshell, mHealth is about people (or beneficiaries), not phones.

Finally, as we move forward in trying to develop, improve and adapt our app, I will keep Dr. Labrique’s words ingrained in my mind: not to ignore that mobile platforms need good design and functionality, but it needs to be equally fun and creative so that the end user (i.e. in our case health workers) “will want to continue to use the system beyond just being part of a routine job description.”

Filling the huge gap between technology and people is a challenge of the digital era. There is a lot of potential for great things to be achieved – and many have been already – but it is, in my opinion, essential that we don’t loose focus of the purpose and feasibility of the whole endeavor.

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