title: Effect of ethiopia's health extension program on maternal and newborn health care practices in 101 rural districts: a dose-response study.
abstract: BACKGROUND
  Improving newborn survival is essential if Ethiopia is to achieve Millennium Development Goal 4. The national Health Extension Program (HEP) includes community-based newborn survival interventions. We report the effect of these interventions on changes in maternal and newborn health care practices between 2008 and 2010 in 101 districts, comprising 11.6 million people, or 16% of Ethiopia's population.
  
  
  RESULTS
  Using data from cross-sectional surveys in December 2008 and December 2010 from a representative sample of 117 communities (kebeles), we estimated the prevalence of maternal and newborn care practices, and a program intensity score in each community. Women with children aged 0 to 11 months reported care practices for their most recent pregnancy and childbirth. The program intensity score ranged between zero and ten and was derived from four outreach activities of the HEP front-line health workers. Dose-response relationships between changes in program intensity and the changes in maternal and newborn health were investigated using regression methods, controlling for secular trend, respondents' background characteristics, and community-level factors. Between 2008 and 2010, median program intensity score increased 2.4-fold. For every unit increase in the score, the odds of receiving antenatal care increased by 1.13 times (95% CI 1.03-1.23); the odds of birth preparedness increased by 1.31 times (1.19-1.44); the odds of receiving postnatal care increased by 1.60 times (1.34-1.91); and the odds of initiating breastfeeding immediately after birth increased by 1.10 times (1.02-1.20). Program intensity score was not associated with skilled deliveries, nor with some of the other newborn health care indicators.
  
  
  CONCLUSIONS
  The results of our analysis suggest that Ethiopia's HEP platform has improved maternal and newborn health care practices at scale. However, implementation research will be required to address the maternal and newborn care practices that were not influenced by the HEP outreach activities.
authors.affiliation: The Last Ten Kilometers Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia. akarim@jsi.com
authors.forename: Ali Mehryar
authors.initials: AM
authors.lastname: Karim
authors.forename: Kesetebirhane
authors.initials: K
authors.lastname: Admassu
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.forename: Hibret
authors.initials: H
authors.lastname: Alemu
authors.forename: Nebiyu
authors.initials: N
authors.lastname: Getachew
authors.forename: Agazi
authors.initials: A
authors.lastname: Ameha
authors.forename: Luche
authors.initials: L
authors.lastname: Tadesse
authors.forename: Wuleta
authors.initials: W
authors.lastname: Betemariam
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult