Heidi Busse

Creating Change Through Collaboration: A Twinning Partnership to Strengthen Emergency Medicine at Addis Ababa University/Tikur Anbessa Specialized Hospital—A Model for International Medical Education Partnerships

BACKGROUND Morbidity and mortality due to the lack of an organized emergency medical care system are currently high in Ethiopia. Doctors, nurses, and other medical staff often have limited or no formal training on how to handle emergencies. Because of insufficient human and resource capacity needed to assess and treat acutely ill patients, many who are injured may die unnecessarily, at the site of injury, during transport, or at the hospital. OBJECTIVES This article describes the development of a twinning partnership between Addis Ababa University (AAU), the University of Wisconsin-Madison (UW), and the nonprofit organization People to People (P2P), to strengthen emergency care at Tikur Anbessa Specialized Hospital (TASH) and increase the number of trained emergency medical professionals. METHODS The partnership applied the six-phase twinning partnership model, with the overall goal of enhancing and strengthening emergency and trauma care by building institutional and human resource capacity. This was achieved by 1) developing local leaders in emergency medicine (EM), 2) creating training modules adapted to the Ethiopian context, 3) launching an emergency training center, and 4) supporting academic program development. The authors evaluated the programs effectiveness based on our achievements toward these goals. RESULTS Results include: 1) eight Ethiopian faculty completed a condensed EM fellowship in the United States. Now six Ethiopian physicians serve as EM faculty and two as pediatric EM faculty. 2) Nine emergency training modules were adapted to the Ethiopian context. 3) An emergency training center was opened in 2010 and to date has trained over 4,000 Ethiopian medical professionals. 4) Two academic training programs (EM residency and masters nursing programs) were initiated. CONCLUSIONS With many complex factors affecting the burden of emergency care, innovative and interdisciplinary collaborations are needed in Ethiopia to train medical workers, build local leadership capacity, strengthen infrastructure, and inform policies. The short-term achievements of this twinning model could suggest that long-term, institution-to-institution collaborations that are driven by local stakeholders are an effective strategy to create equitable relationships and build sustainable health systems and may serve as a model for other global health partnerships.

Learning from developing countries in strengthening health systems: an evaluation of personal and professional impact among global health volunteers at Addis Ababa University’s Tikur Anbessa Specialized Hospital (Ethiopia)

BackgroundThe positive impact of global health activities by volunteers from the United States in low-and middle-income countries has been recognized. Most existing global health partnerships evaluate what knowledge, ideas, and activities the US institution transferred to the low- or middle-income country. However, what this fails to capture are what kinds of change happen to US-based partners due to engagement in global health partnerships, both at the individual and institutional levels. “Reverse innovation” is the term that is used in global health literature to describe this type of impact. The objectives of this study were to identify what kinds of impact global partnerships have on health volunteers from developed countries, advance this emerging body of knowledge, and improve understanding of methods and indicators for assessing reverse innovation.MethodsThe study population consisted of 80 US, Canada, and South Africa-based health care professionals who volunteered at Tikur Anbessa Specialized Hospital in Ethiopia. Surveys were web-based and included multiple choice and open-ended questions to assess global health competencies. The data were analyzed using IBRM SPSS* version 21 for quantitative analysis; the open-ended responses were coded using constant comparative analysis to identify themes.ResultsOf the 80 volunteers, 63 responded (79 percent response rate). Fifty-two percent of the respondents were male, and over 60 percent were 40 years of age and older. Eighty-three percent reported they accomplished their trip objectives, 95 percent would participate in future activities and 96 percent would recommend participation to other colleagues. Eighty-nine percent reported personal impact and 73 percent reported change on their professional development. Previous global health experience, multiple prior trips, and the desire for career advancement were associated with positive impact on professional development.ConclusionProfessionally and personally meaningful learning happens often during global health outreach. Understanding this impact has important policy, economic, and programmatic implications. With the aid of improved monitoring and evaluation frameworks, the simple act of attempting to measure “reverse innovation” may represent a shift in how global health partnerships are perceived, drawing attention to the two-way learning and benefits that occur and improving effectiveness in global health partnership spending.

Household dietary diversity, vitamin A consumption and food security in rural Tigray, Ethiopia

OBJECTIVE To describe: household dietary diversity across four zones in Ethiopia; the relationship between household dietary diversity and consumption of vitamin A-rich foods; and the relationship between household dietary diversity and food security status. DESIGN This was a cross-sectional survey. Data were collected using structured questionnaires in the local language. Household dietary diversity scores measured types of foods households consumed, and households were classified by food security status using a modified version of the Household Food Insecurity Access Scale. An ordinal logistics regression model was created to assess the relationship between three tiers of dietary diversity (low, medium and high) and food security while controlling for agricultural zone, educational variables and household characteristics. SETTING Rural households in Tigray, Ethiopia. SUBJECTS Three hundred households in Tigray, Ethiopia, were interviewed. RESULTS Of the households, 23, 47 and 30 % had low, medium and high dietary diversity, respectively. Among households with high dietary diversity, eggs and fruit were the most common foods added to the diet. In the fully adjusted model, participants who reported being food secure had 1·8 increased odds of greater dietary diversity (95 % CI 1·0, 3·2) compared with participants who were food insecure. CONCLUSIONS Food security was positively associated with dietary diversity. In order to enhance health, interventions that improve dietary diversity and vitamin A consumption should remain important areas of focus for health leaders in the region.

Family Medicine in Ethiopia: Lessons from a Global Collaboration

Background: Building the capacity of local health systems to provide high-quality, self-sustaining medical education and health care is the central purpose for many global health partnerships (GHPs). Since 2001, our global partner consortium collaborated to establish Family Medicine in Ethiopia; the first Ethiopian family physicians graduated in February 2016. Methods: The authors, representing the primary Ethiopian, Canadian, and American partners in the GHP, identified obstacles, accomplishments, opportunities, errors, and observations from the years preceding residency launch and the first 3 years of the residency. Results: Common themes were identified through personal reflection and presented as lessons to guide future GHPs. LESSON 1: Promote Family Medicine as a distinct specialty. LESSON 2: Avoid gaps, conflict, and redundancy in partner priorities and activities. LESSON 3: Building relationships takes time and shared experiences. LESSON 4: Communicate frequently to create opportunities for success. LESSON 5: Engage local leaders to build sustainable, long-lasting programs from the beginning of the partnership. Conclusions: GHPs can benefit individual participants, their organizations, and their communities served. Engaging with numerous partners may also result in challenges—conflicting expectations, misinterpretations, and duplication or gaps in efforts. The lessons discussed in this article may be used to inform GHP planning and interactions to maximize benefits and minimize mishaps.

Prevalence and predictors of stunting and underweight among children under 5 years in Tigray, Ethiopia: Implications for nutrition-sensitive agricultural interventions

ABSTRACT Understanding local drivers of malnutrition can help improve the design of agricultural interventions intended to reduce child stunting and underweight. This study reports the prevalence of child under-5 stunting and underweight from 10 rural districts in the Tigray region of Ethiopia; analyzes factors associated with child undernutrition; and presents implications for designing and selecting indicators for agricultural programs intended to improve nutrition. Overall prevalence of stunting and underweight was 40.0% and 34.6%, respectively. There was significant variation among the districts in the proportion of children classified as stunted and underweight (p > 0.05). Stunting rates ranged from 26.7% to 66.7%, underweight rates ranged from 13.3% to 63.3%. Geographic location (odd ratio [OR] = 1.99; 95% confidence interval [CI], 0.81–4.87), no maternal history of eye issues (OR = 1.67; 95% CI, 1.01–2.78), and not owning a mobile phone (OR = 1.5; 95% CI, 0.91–2.49) were factors that increased odds of stunting. Geographic location (OR = 1.17; 95% CI, 0.5–2.76) and no maternal history of eye issues (OR = 1.71; 95% CI, 1.01–2.91) increased odds of underweight. The aggregate data masked influential social and behavioral factors affecting nutrition within certain districts and subgroups. Nutrition-specific approaches that target women and children and nutrition-sensitive approaches that strengthen local sources of resilience are needed to accelerate progress toward improved nutrition and reduce health disparities.

Perspectives of female medical faculty in Ethiopia on a leadership fellowship program

Objectives This study aims to evaluate a leadership fellowship program through perspectives of Ethiopian women medical faculty participants. Methods An intensive two-week leadership development fellowship was designed for women faculty from Ethiopian medical schools and conducted from 2011-2015 at the University of Wisconsin-School of Medicine and Public Health in Madison, Wisconsin. Nine Ethiopian women working in early- or mid-level academic positions were selected. Semi-structured interviews were conducted with the fellows. Transcripts were reviewed through qualitative analysis to assess the perceived impact of the training on their careers. Three male academic leaders were interviewed to solicit feedback on the program. Results Eight of 9 fellows were interviewed. Themes describing the benefits of the fellowship included: increased awareness of gender inequities; enhanced motivation for career advancement; increased personal confidence; and improved leadership skills. Fellows provided suggestions for future training and scaling up efforts to promote gender equity. Male leaders described the benefits of men promoting gender equity within academic health centers. Conclusions This paper provides evidence that targeted brief training programs can enhance women’s motivation and skills to become effective leaders in academic medicine in Ethiopia. Promoting gender equity in academic medicine is an important strategy to address health workforce shortages and to provide professional role models for female students in the health professions.

Wealth Matters: Prevalence and Predictive Indicators of Food Insecurity in the Sidama and Wolayta Zones of Southern Ethiopia

Food security is essential for robust economies, political stability, and a resilient environment. Stakeholders from across sectors have a vested interest to ensure that all people at all times have access to sufficient, nutritious food. The objectives of this study were to measure prevalence and severity of food insecurity among households in 2 districts of southern Ethiopia and identify local predictive factors. The study population consisted of 150 households in the Sidama and Wolayta zones in the Southern Nations, Nationalities, and Peoples Region (SNNPR). Data were collected through semistructured questionnaires by trained enumerators in the local language and analyzed using SAS version 9.2. The following factors were found to have association with food insecurity: total livestock, total landholdings, cell phone ownership, educational attainment, radio ownership, and type of roof. Measures of wealth had a positive association with food security. More localized studies such as this may be warranted to help inform the design of programs and policies that work across the sectors of agriculture, nutrition, and health to enhance the livelihoods of individuals, families, and whole communities.