Fra(m)menti & Share-Net Ethiopia 2022 by Koninklijk Instituut voor de Tropen

FRA(M)MENTI & SHARE-NET ETHIOPIA 2022

from hubs to bubs

linking research policy and practice to critical creativity

ng arch po a rractice ttical creativ

olicy e About: “From Hubs to Bubs: Linking Research, Policy and Practice to Critical Creativity”.

This is a one-issue-only magazine on the 10th Annual Conference by ShareNet on Linking Research, Policy and Practice, an event that traditionally brings together policymakers, practitioners, and researchers working on sexual and reproductive health and rights (SRHR) and gender equality, and women’s empowerment (GEWE) in international development.

The focus lies on the work of young professionals who have recently submitted or are in the process of finishing research as part of a Master’s

program, postgraduate degree, research internship, or research consultancy. The magazine is structured in line with the original conference programme: some young researchers presented on Share-Net country hub contexts (Bangladesh, Ethiopia, Burundi & Burkina Faso, the Netherlands and Colombia) while other international contexts were grouped into three international sessions (Maternal and Menstrual health, SRHR & education and Underexposed perspectives). What we hope to achieve with this magazine is to, first and foremost, highlight the researches and voices of the young researchers who presented their work, but also to transform theory into praxis into what we like to call critical creativity. Academic research and data will be entangled with poetry and illustrations, with photography and prose, with loud slogans and subtle colours liberating the noise and messiness of art whilst maintaining a critical approach to how we can imbue the world with meaning.

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Share-Net International Share-Net International is a knowledge platform for Sexual and Reproductive Health and Rights (SRHR). Share-Net has 7 country hubs in Bangladesh, Burkina Faso, Burundi, Colombia, Ethiopia, Jordan, and the Netherlands, and facilitates training, conferences, and events. They also host the Share-Net International Digital Platform: an extensive e-library of SRHR articles,

research papers, and reports, and continuously publish the latest SRHR knowledge from their country hubs and members. Their mission is realized through strengthening links between research, policy, and practice, through knowledge sharing, generating, translating, and promoting the use of knowledge for the development of better policies and practices in SRHR.

Fra(m)menti Fra(m)menti (from the Italian “fragments”, but also “among minds”), is a transfeminist queer artistic collective based in Milan. We operate both online and offline, organizing cultural and educational events that discuss intersectional feminist topics through the lens of artistic practice,

for we believe that to be a unique site for critical creativity. The collective currently counts 9 people, all invested in creating an accessible, care-oriented, safe(r) space where we value pluralism, celebrate differences, practice mutualism and inclusivity, and suspend all judgment.

A moment to position ourselves We want to take a moment to share that Fra(m)menti collective is made up of a majority of European, white, middle-class, young people. Our gazes hold power and they are inevitably distorted by these privileged positionalities we inhabit. In an ideal world where time and money are not constraints, we would have worked on facilitating rather than actively creating content for those regions of the globe that the researchers focus on and that we have very little knowledge of; we would have collaborated more in-depth with artists and cultural troublemakers from those countries, inviting them to do with this space what they will. For now, we have invited local artists to create illustrations and have remunerated their work to the best of our abilities - you will find their work as covers for the various regional sections, prepare to be blown away by their beauty! We would like to hold space for anybody who would like to comment, share, correct or express any concern and we invite you to contact us at frammenti.m@gmail.com

what does it mean?

AYFHS ANC AOR ASRH CMS CSE DHO EBF ED EMR FP GBV GGR HPV HF HW IPV LLH LMIC MHM MMR MYP OOP OV PNLE PPP RMC SDG SDH SP SRHR STI TASH UHC UNSW WPVH WASH

Analysis of Youth-Friendly Health Services National Antenatal Care Adjusted Odds Ratio Adolescent and Sexual Reproductive Health Critical Menstruation Studies Comprehensive Sexual Education District Health Office Exclusive Breastfeeding Emergency Department East Mediterranean Region Family Planning Gender-Based Violence Global Gag Rule Human Papillomavirus Health Financing Health Workers Intimate Partner Violence Life, Love and Health Low and Middle Income Countries Menstrual Health Management Maternal Mortality Rate Meaningful Youth Participation Out-Of-Pocket (Insurance) Obstetric Violence Plan National de Lutte contre l’Excision Public-Private Partnership Respectful Maternal Care Sustainable Development Goal Social Determinants of Health Service Provider Sexual and Reproductive Health and Rights Sexually Transmissible Infections Tikur Anbessa Specialized Hospital Universal Health Coverage Undocumented Nigerian Sex Worker Workplace Violence in Healthcare Water, Sanitation and Hygiene

00 01 Intro ‡ ‡ ‡

About the Zine Fra(m)menti & Share-Net Glossary

Share-Net Ethiopia

table of contents

topic keys Pregnancy and Birth Covid and SRHR Mental Health Sexual and Menstrual Health Knowledge Gaps and Recommentations Gender and Sexual Orientation Sex Work Artistic Contribution

ETHI -OPIA Moderators: Assefa Seme Deresse and Dr. Terefe Degefa Addis Ababa University Discussant: Dr. Meseret Zelalem Ministry of Health, Ethiopia

Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: a qualitative study

Human papillomavirus in women with precancerous lesion and cervical cancer: the use of urine as an alternative specimen

Knowledge Level and Associated Factors about Sexual and Reproductive Health Rights Among University Of Gondar Students, Gondar Ethiopia

Woinshet Goshu

Tewodros Seyoum (he/him) University of Gondar

01 ETHIOPIA

PROVIDER-PERCEIVED BENEFITS AND CONSTRAINTS OF COMPLETE ADHERENCE TO ANTENATAL CARE GUIDELINE AMONG PUBLIC HEALTH FACILITIES, ETHIOPIA: A QUALITATIVE STUDY

In Ethiopia, health care providers’ level of adherence to the national Antenatal Care (ANC) guidelines is relatively low.

The reasons why they do not follow the guidelines are not well known. Therefore, this study aims to explore the providerperceived benefits and constraints associated with using the guidelines for ANC in public health facilities in Gondar town. 17

METHO -DOLOGY

A qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages.

COMMON FINDINGS Decreasing provider’s workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guidelines. Organizational problems, care providers’ existing knowledge, attitude, skills and availability of training and mentorship were the main identified groups of factors that hinder complete providers’ adherence to ANC guidelines.

RECOMMEN DATIONS Although providers acknowledged the benefits of following ANC guidelines, the guideline is not fully implemented. Refresher training should be given at the start of the updated eightcontact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.

Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.

Ededia Firdawoke (she/her) Addis Ababa University

02 ETHIOPIA

HUMAN PAPILLOMAVIRUS IN WOMEN WITH PRECANCEROUS LESION AND CERVICAL CANCER: THE USE OF URINE AS AN ALTERNATIVE SPECIMEN

In a country where the coverage of cervical cancer screening is low, optimization of the uptake is critical.

The implementation of high precision tests is advocated by WHO. To augment the implementation of human papillomavirus (HPV ) based screening in Ethiopia, we compared the performance of urine HPV DNA test with cervical swab. 21

Of the 103 paired samples, HPV infection prevalence was 83.5% in cervical swabs and 77.7% in urine samples. HPV 16 is the most prevalent in both samples with 56.8% in cervical swabs and 54.6% in urine samples followed by HPV 18 (5.8%) in cervical swabs and HPV 18 and HPV 39 (6.2%) in urine samples. Multiple infection rate (infection of more than one type of HPV ) was 22.4% in urine samples and 32.0% in cervical swabs. The agreement in the detection of HR-HPV between urine and cervical samples was moderate with a kappa value of 0.57 at 95% CI. Using the cervical HPV results as a reference, the analytical sensitivity of urine HPV testing was 88.4% (76/86), specificity of 76.5% (13/17) and ROC area of 0.82 with (0.7-0.9) 95% CI. The Prevo-check HPV16 L1 antibody test has detected antibodies from seven patients that have a low clinical sensitivity but specificity of 100%. Of 93 histology result; 69.9% of the participants were diagnosed with SCC. HR-HPV detected in 76.2% and 79.7% from cervical and urine samples.

Keywords: Human papillomavirus, Urine, Cervical cancer, TASH

The kit simultaneously detects, differentiates, and semi-quantifies 28 HPV genotypes 19 high risk (Hr)HPV types. Pap smear was done by a pathologist and histology results were collected from the chart of the patients and a clinical form was used to collect basic information from the patients by the attending midwife nurses.

COMMON FINDINGS-

METHO -DOLOGY

Paired samples (n=103) of first void urine and cervical swab were collected from patients of the Gynecology Clinic of Tikur Anbessa Specialized Hospital (TASH). After the extraction of DNA using QIAamp DNA Mini Kit (Qiagen) the HPV infection, coinfection and type-specific HPV distribution were determined using the Anyplex HPV28 DNA genotyping kit (Seegene, Seoul, Korea) and CFX96 IVD (In Vitro Diagnostic) Real-Time PCR System.

HPV16 and 18 were the predominant HPV detected from women with CIN2+ and above patients.

RECOMMENDATIONS

In a country with low cervical cancer screening uptake, the collection of urine specimens can be considered as an alternative sample since it is easy to obtain, showed good diagnostic performance and may increase uptake of cervical cancer screening in Ethiopia.

Yohannes Keflie (he/him) University of Gondar College of Medicine and Health Sciences

03 ETHIOPIA

KNOWLEDGE LEVEL AND ASSOCIATED FACTORS ABOUT SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS AMONG UNIVERSITY OF GONDAR STUDENTS, GONDAR ETHIOPIA.

Young peoples’ knowledge on sexual and reproductive health and rights (SRHRs) is essential in exercising these rights. Knowledge about SRHRs helps tackle neglected issues, such as adolescent sexuality, gender-based violence, and unsafe abortions.

But little is known about the level of knowledge and the important predictors in the study area, therefore this study was done to fill this information gap. This study aimed to assess knowledge about sexual and reproductive health and rights and associated factors among undergraduate regular Students in University of Gondar, 2018. 25

A large proportion of students do not have optimal knowledge about SRHRs.

METHO -DOLOGY

Institution-Based Cross-sectional Study conducted from March to April 2018, at University of Gondar, Ethiopia. A multistage random sampling was selected and a structured & pretested questionnaire was administered.

COMMON FINDINGS

A total of 827 students were included making the response rate 98.8%. The overall optimal knowledge level about SRHRs was 57.7%.

FINDINGS

Being muslim, a rural resident, an Information and Education faculty member, or having reduced access to reproductive health services in the campus clinic were statistically significantly associated with not having an optimal knowledge level about SRHRs.

Keywords: sexual and reproductive health rights, University students, Cross-sectional

A large proportion of students do not have optimal knowledge about SRHRs. Factors such as religion, the place where students come from, faculty, and availability of RH services in students’ clinics had statistically significant associations with SRHRs. To bridge this knowledge gap sexual and reproductive right education and RH service shall be available among all faculties, giving emphasis for Muslims and students from rural areas. 27

Francesca Martelli

sexual Youth Youth-led healthcare through centre dance, song in Jimma and poetry

“In this place, we talk easily and are happy to talk.” — Biology student Gebre Haileselassie, volunteer Scan to know more Groups of young people are getting messages about sexual health and contraception out to their peers through dance, song, and poetry. The youth center is run by the Family Guidance Association of Ethiopia (FGAE)

Silvia Bocchero

Researches and base texts by Silke Baas Alis Bambara Doreen Birungi Sterre van Ede Ana Margarita Fernández de Castro Peñaranda Ededia Firdawoke Lambert Hakuziyaremye Femke van Heun Arnaud Iradukunda Tonima Trisa Islam Saskia Jacobs Yohannes Keflie Margherita Magoga Yasser Meneses Zepeda Paola Moreno Molly O’Meara Linda Teresa Orcasita Pineda Tahia Rahman Aminat Salami Elizabeth Salazar Niño Putri Widi Saraswati Tewodros Seyoum Rezwana Shahrin Elena Soldati Hipatia Fernanda Vega Lema

With the support of Share-Net Hubs Share-Net Bangladesh Share-Net Burundi Share-Net Burkina Faso Share-Net Ethiopia Share-Net Colombia Share-Net Netherlands and Share-Net International

Original illustrations by Dani Marie Bordignon Silvia Bocchero Matilde Cesareo Francesca Martelli Nuées Nasheen Jahar Nasir Alejandra Posada Bakita Pietrowicz Shaka Kabushemeye Woinshet Goshu

Moderators, discussants and Share-Net focal points Dr. Khadija Khatun (University of Chittagong) Dr. Sanzida Akhter (University of Dhaka) Kishore Basak (RedOrange) Assefa Seme Deresse (Addis Ababa University) Dr. Terefe Degefa (Addis Ababa University) Dr. Meseret Zelalem (Ministry of Health, Ethiopia) Semenhe Fekadu (CORHA) Olivier Makambira (Jimbere) Zalissa Bande (SOS Jeunesses et defis) Reverien Nshimirimana (University of Burundi) Charlotte van Tuijl (KIT Royal Tropical Institute) Pema Lhaki Gaia Zanaboni (KIT Royal Tropical Institute/CHOICE for Youth & Sexuality) Judith Westeng (Rutgers) Hannah Kabelka (KIT Royal Tropical Institute) Arushi Singh (UNESCO Paris) Laura Cala Vergel (Profamilia) Mónica Godoy (UNFPA) Nicole Moran (KIT Royal Tropical Institute) Olgah Namukuza

Editors Matilde Cesareo, Elena Ascione

Art Direction Silvia Bocchero Fra(m)menti team Dani Marie Bordignon, Francesca Martelli, Matilde Cesareo, Elena Ascione, Silvia Bocchero With contributions by Elle Conant, Tatiana Guerra Contacts frammenti-m.com frammenti.mi@gmail.com @frammenti_m

FRA(M)MENTI & SHARE-NET ETHIOPIA 2022