Implementing Routine Head Circumference Measurements in Addis Ababa, Ethiopia: Means and Challenges

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.