title: Implementing Routine Head Circumference Measurements in Addis Ababa, Ethiopia: Means and Challenges.
abstract: OBJECTIVE
  A substantial number of infants in Ethiopia suffer from hydrocephalus. Neurosurgical expertise has until recently been virtually nonexistent in the country; however, since 2006, a neurosurgery training program has been established in Addis Ababa, where hydrocephalus surgery now is performed in 3 hospitals. Our experience is that hydrocephalus is diagnosed and treatment is too late to avoid severe brain damage. Introducing routine head circumference (HC) measurements can ease the detection of hydrocephalus and thus lead to earlier diagnosis, thereby reducing the brain damage caused by the condition. The present pilot project had two major aims: to get the process of implementation started and to gain experience with how this implementation best can be achieved.
  
  
  METHODS
  We educated and encouraged the nurse staff members of 12 randomly selected health (mother and child) clinics in Addis Ababa in performing HC measurements, using a recently developed Ethiopian HC chart. Much of the work was related to follow-up. A local Ethiopian healthcare worker was employed to lead the follow-up and to continue the implementation in the remaining 14 clinics.
  
  
  RESULTS
  During our attempted implementation of routine HC measuring, we encountered a line of administrational, cultural, infrastructural, and didactic problems and challenges, which are discussed.
  
  
  CONCLUSIONS
  The experience we have gained during this pilot project will be used in further development and implementation of routine HC measuring throughout Ethiopia. These experiences may be of interest and use to others wanting to introduce similar routines in low-income countries.
authors.affiliation: Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
authors.forename: Arvid A
authors.initials: AA
authors.lastname: Eriksen
authors.affiliation: Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
authors.forename: Joakim S
authors.initials: JS
authors.lastname: Johnsen
authors.affiliation: Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
authors.forename: Anders H
authors.initials: AH
authors.lastname: Tennøe
authors.affiliation: Department of Surgery, Addis Ababa University, College of Health Science, Neurosurgery Unit, Addis Ababa, Ethiopia.
authors.forename: Abenezer
authors.initials: A
authors.lastname: Tirsit
authors.affiliation: Department of Surgery, Addis Ababa University, College of Health Science, Neurosurgery Unit, Addis Ababa, Ethiopia.
authors.forename: Tsegazeab
authors.initials: T
authors.lastname: Laeke
authors.affiliation: Centre for International Health, University of Bergen and Department of Paediatrics, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Ephrem B
authors.initials: EB
authors.lastname: Amare
authors.affiliation: Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. Electronic address: kgwe@helse-bergen.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Wester
mesh_terms: D001071:Appointments and Schedules; D002508:Cephalometry / Q000379:methods*; D003469:Culture; D042241:Early Diagnosis; D005002:Ethiopia; D057238:Growth Charts; D006257:Head / Q000033:anatomy & histology*; D006284:Health Plan Implementation / Q000458:organization & administration; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis*; D065816:Neuroscience Nursing / Q000193:education; D019635:Neurosurgical Procedures / Q000193:education; D010355:Patient Identification Systems / Q000458:organization & administration; D010865:Pilot Projects
keywords: Developing country; Ethiopia; Head circumference; Hydrocephalus; Neurosurgery; Pediatrics; Screening