The Ethiopian Journal of Health Development

Development and Validation of the Ethiopian Women’s Cervical Cancer Awareness and Screening Tool (EWCCaAST)

2025-08-14T01:36:26-04:00

Abstract

Background: There is a lack of a standardized tool for assessing barriers to cervical cancer screening uptake. The validation of the tool helps researchers to identify the barriers and facilitators to improve screening uptake.

Objective: this study aimed to develop and validate a tool that can be used to assess the level of awareness, knowledge, and barriers to cervical cancer and screening among Ethiopian women.

Methods: A Cross-sectional study design involving four steps: refining and developing, expert panel evaluation, translation of the tool into the local language, and internal reliability testing was employed. About 16 experts and 366 randomly selected target-aged women were included in the study. Content validity ratio, content validity index, modified Kappa, and Cronbach`s alpha were used to validate the tool. Internal reliability was assessed using Cronbach's alpha, with a minimum acceptable value of 0.60.

Result: A total of 108 items were categorized into 7 validated domains. The overall content validity ratio (CVR) and item-level content validity index ((I-CVI)) were 0.68 and 0.88, respectively, indicating strong essentiality and relevance of the items. The overall item-level content validity index for simplicity and clarity of the items was 0.88 and 0.82, respectively, indicating that the items are too simple and clear. The lowest modified Kappa was 0.49, indicating moderate agreement, while the highest was 0.94, indicating perfect agreement among the experts. The overall Cronbach's alpha was 0.79, reflecting an acceptable level of reliability for the tool.

Conclusion: The refined and developed tool is essential, relevant, simple, and clear. The overall reliability showed an acceptable value. We recommend that the researchers use this comprehensive validated tool to assess the awareness, knowledge of cervical cancer, and socio-cultural barriers to cervical cancer screening service utilization among women. [Ethiop. J. Health Dev. 2025; 39(2)]

Keywords: Cervical cancer, screening, socio-cultural barriers, Women, Ethiopia

Understanding the Link between Fertility Decline and Child Survival in Ethiopia: Implications from Decomposition and Regression Models

2025-08-21T01:48:00-04:00

Abstract

Background: Despite significant declines over the past two decades, Ethiopia continues to experience high rate of child mortality. While socioeconomic factors and high-risk fertility behaviors are well-established determinants, the independent effect of fertility decline remains underexplored. This study examines the impact of fertility decline- measured by the number of children ever born and the general fertility rate- on child survival in Ethiopia.

Methods: Two data sources and analytic approaches were used: (1) decomposition analysis of United Nations data (2000–2020) to assess the contribution of fertility decline to reductions in under-five deaths and (2) a Probit regression model using the Ethiopian Demographic and Health Survey data to estimate the effect of the number of children ever born on the survival probability of under-five children, adjusted for women’s reproductive and other characteristics. Using complex survey analysis in Stata, the regression is done among 37,780 single and second -or higher- order births of under-five children pooled from five surveys (2000–2019).

Results: Between 2000 and 2020, Ethiopia’s general fertility rate declined from 208.5 to 135.5 per 1,000 women, while under-five mortality dropped from 141 to 45 per 1,000 live births. The decline in the general fertility rate contributed to 16.3% of the nearly 659,000 averted under-five deaths. At the micro level, each additional child was associated with a 1% (marginal effect =0.01, P=0.00) increase in survival probability, and children born to mothers with 2–4 children had approximately 4% (marginal effect = 0.04, P=0.00) higher survival compared to those with eight or more children.

Conclusion: Lower fertility enhances child survival. Beyond reducing early childbearing and short birth intervals, promoting birth limitation and scaling up of the long-acting contraceptives are vital for further reducing child mortality. [Ethiop. J. Health Dev. 2025; 39(2)]

Keywords: child survival, under-five mortality, fertility rate, Ethiopia.

Asbestos Materials Management and Associated Risks: Global and Regional Perspectives with a Focus on Ethiopia

2025-08-26T02:02:57-04:00

Abstract

Background: The yearly worldwide average use of asbestos recently reached 2,000,000 tons. It is also reported that one person dies for every 20 tons of asbestos produced and consumed. With much unrecorded and unreported about asbestos, its management and poor public awareness still demand attention, especially in the developing world. The objective of the current study was to review the current global, regional, and national status of asbestos use and conduct a quantitative survey on local asbestos applications and the associated public and environmental health issues, thereby providing the latest evidence of the magnitude of asbestos-related problems, the use, and implications.

Method: A mixed cross-sectional study consisting of a survey in Ethiopia and a desk review of global and regional data was employed. This study explores asbestos use trends; asbestos-related occupational health concerns and related awareness developments, quantitative and regulatory asbestos contexts, with emphasis on Ethiopia. Data collected in an Excel sheet were analyzed and compared, presented, and discussed.

Results: Though asbestos use is banned in many countries, including four in Africa (Mozambique, South Africa, Egypt, and Gabon), it is still in use by many other nations for various civil work applications, with some 2,030,000 tons being consumed annually. Ethiopia imported around 554 tons of asbestos materials in 2015, and no strong evidence on regulatory and guiding documents exists. In addition to occupational exposure to asbestos-related morbidity and mortality, community exposure appears rather alarming, especially in developing countries like Ethiopia. In this regard, asbestos banning and the standard of practice of its removal are widely unequal between developed and developing nations. In some developing nations, the use of asbestos is still prevalent, particularly in the construction industry. Regulations and enforcement of asbestos bans may be less stringent, leading to higher exposure levels among workers and the general population.

Conclusion: There is a continued use of asbestos by many developing nations, despite limited awareness of its public and environmental health impacts and poor management, especially in Africa. [Ethiop. J. Health Dev. 2025; 39(2)]

Keywords: asbestos; asbestos cement materials; asbestosis; carcinogenic