Maternal and child health research program in Ethiopia makes strides

(l to r) Meseret Zelalem, Ministry of Health, Ethiopia; Theodros Getachew, Ethiopian Public Health Institute; Grace Chan, Harvard Chan School; Delayehu Bekele, St. Paul’s Hospital Millennium Medical College

December 11, 2023—The statistics on women and children’s health in Ethiopia are grim: Each year, 173,000 children die from preventable or treatable health conditions and 14,000 women die from preventable or treatable complications in pregnancy or childbirth. Ethiopia is among five nations that account for more than half of the globe’s annual deaths of children younger than five.

The HaSET Maternal and Child Health Research Program—a partnership that includes Harvard T.H. Chan School of Public Health, Saint Paul’s Hospital Millennium Medical College, the Ethiopian Public Health Institute, Boston Children’s Hospital, and Harvard Medical School—aims to uncover the drivers of maternal and child illnesses and death in Ethiopia in order to improve health in that nation and beyond. The program’s goal is evident in its name: In Amharic, Ethiopia’s official language, HaSET means “happiness.” The program’s field site in rural Ethiopia, where research is conducted, is called Birhan, the Amharic word for “light.”

This fall, HaSET’s 140 staff members across Ethiopia and Boston—plus their partners in Ethiopia’s Ministry of Health—celebrated a series of milestones. Among them, the organization published a new research study and graduated the inaugural class of fellows from its postdoctoral program in maternal and child health—the first of its kind in Ethiopia.

The study, published in PLOS Global Public Health in November, aimed to accurately estimate antenatal care coverage in rural Ethiopia, using data collected from Birhan’s ongoing study cohort of more than 2,000 pregnant women. Between December 2018 and April 2020, HaSET researchers tracked the cohort’s antenatal care visits using prospective observations and health facility records. The study found that 92.3% of women attended at least one antenatal care visit; 28.8% attended at least four visits; and none attended eight or more visits. (Eight visits is the World Health Organization’s global target for antenatal care.)

The researchers say the findings provide baseline data for antenatal care in the region that can be used to evaluate future trends as well as the efficacy of interventions designed to help retain women in antenatal care. They noted that such interventions are sorely needed—as is further research to identify the specific barriers keeping women away from clinics after their first visit.

As an additional step, the researchers compared the number of antenatal care visits observed and/or recorded by health facilities to the number women self-reported. They observed around a 50% discrepancy between the two (with self-reports both under- and overestimating the number of antenatal care visits attended compared to facility data). This finding demonstrates the need for investment in electronic medical record systems and other improved data collection systems in low-resource settings, where patients’ self-reports are often the sole source of health data, said the researchers.

New fellowship program

Birhan has been home to many more research studies, conducted in part by HaSET’s first-ever fellowship cohort. Five recent graduates from universities throughout Ethiopia were selected as postdoctoral fellows, and four policymakers from the Ministry of Health, the Ethiopian Public Health Institute, and regional health bureaus participated as implementation fellows. The academic postdoctoral fellows were paired with the policymakers to generate new evidence on maternal and child health from start to finish, from drafting proposals and developing analysis plans to analyzing data and writing manuscripts and policy briefs.

This mentorship and practical experience complemented the classroom curriculum, in which fellows completed nine academic modules taught by HaSET’s Ethiopian and U.S. public health experts.  The modules covered topics such as research methodology, translating evidence into policy, and scientific communication, and also included professional development through field visits, writing workshops, and instruction in data analysis tools STATA and R.

By the end of the fellowships, the nine participants helped produce 15 manuscripts and 11 policy briefs. And they graduated equipped with the necessary knowledge and skills to help strengthen the public health sector and support other young researchers and policymakers within the newest generation of Ethiopian health professionals, according to Grace Chan, HaSET’s principal investigator and an associate professor in the Department of Epidemiology at Harvard Chan School.

On October 26 in Addis Ababa, during the presentation of the fellows’ work, Ethiopian Minister of Health Lia Tadesse said their research “will be used to inform decision-making, expansion, and scale” for health programs throughout the country.

“I am inspired by the work of our fellows and collaborators,” added Chan. “HaSET seeks to bring local voices and evidence to guide policymaking by building world-class research capacity in maternal and child health in Ethiopia. Our work together promises to touch countless lives for years to come.”

– Maya Brownstein

Photo courtesy of the Ethiopian Public Health Institute