Periodic Reporting for period 1 - ENABLE (Enabling environments for NCD risk reduction in Ethiopia)
Periodo di rendicontazione: 2023-12-01 al 2025-05-31
Non-communicable diseases (NCDs) are a leading cause of preventable illness and death worldwide, with a growing impact in low-resource settings. In Ethiopia, urbanisation led to increased exposure to modifiable risk factors such as unhealthy diets, physical inactivity, and air pollution exposure, also among vulnerable populations like pregnant women. To address the growing threat, a health systems strengthening approach is essential. Existing antenatal care (ANC) services offer this unique opportunity for early-life prevention, but they do not systematically address NCD prevention.
The ENABLE project (Enabling environments for NCD risk reduction in Ethiopia) addresses this gap by co-designing, implementing, and evaluating a complex intervention to reduce NCD risk during pregnancy. ENABLE integrates preventative actions into routine ANC services in urban Ethiopia, and will be testing, through a cluster-randomised controlled trial, whether a contextually adapted, equitable, and integrated intervention can improve maternal and child health by addressing poor nutrition, physical inactivity, and household air pollution exposure during pregnancy. The project leverages digital health tools and environmental monitoring to support service delivery and data-driven decision-making.
ENABLE uses implementation science frameworks to guide design and evaluation and incorporates social sciences to understand user behaviours, cultural norms, and the broader environmental and structural factors that influence health. Equity is a guiding principle throughout the project, ensuring that interventions are responsive to the needs of underserved populations.
ENABLE’s pathway to impact includes: strengthening ANC service delivery and digital health systems, supporting healthier environments for pregnant women and their families, building capacity among Ethiopian researchers and health workers, and engaging policy-makers to inform scale-up and integration into national systems.
ENABLE is implemented by a multidisciplinary consortium of institutions from Europe, the USA, and Africa, jointly coordinated by the Norwegian Institute of Public Health (NIPH) and the Ethiopian Public Health Institute (EPHI).
The ENABLE project (Enabling environments for NCD risk reduction in Ethiopia) addresses this gap by co-designing, implementing, and evaluating a complex intervention to reduce NCD risk during pregnancy. ENABLE integrates preventative actions into routine ANC services in urban Ethiopia, and will be testing, through a cluster-randomised controlled trial, whether a contextually adapted, equitable, and integrated intervention can improve maternal and child health by addressing poor nutrition, physical inactivity, and household air pollution exposure during pregnancy. The project leverages digital health tools and environmental monitoring to support service delivery and data-driven decision-making.
ENABLE uses implementation science frameworks to guide design and evaluation and incorporates social sciences to understand user behaviours, cultural norms, and the broader environmental and structural factors that influence health. Equity is a guiding principle throughout the project, ensuring that interventions are responsive to the needs of underserved populations.
ENABLE’s pathway to impact includes: strengthening ANC service delivery and digital health systems, supporting healthier environments for pregnant women and their families, building capacity among Ethiopian researchers and health workers, and engaging policy-makers to inform scale-up and integration into national systems.
ENABLE is implemented by a multidisciplinary consortium of institutions from Europe, the USA, and Africa, jointly coordinated by the Norwegian Institute of Public Health (NIPH) and the Ethiopian Public Health Institute (EPHI).
During the first 18 months, ENABLE has been laying the foundation for a successful, collaborative, and impactful project. A project kick-off meeting, a collaborative consortium workshop, and the first annual meeting were held during this period. These gatherings not only advanced key technical activities, but also strengthened internal collaboration by building trust, aligning on common goals, and fostering a shared commitment to equity, co-production, and implementation research.
Further, ENABLE has made significant progress in designing, preparing, and initiating the implementation of the ENABLE intervention:
First, a comprehensive formative research was conducted across our study sites, Addis Ababa, Adama, Harar, and Jimma. This phase included health facility observations, interviews with pregnant women, health workers, and key stakeholders, as well as environmental assessments. The findings provided critical insights into existing gaps, behavioural determinants, and the feasibility of integrating NCD prevention into ANC services. Building on these insights, ENABLE co-designed a tailored intervention and implementation package. The content and delivery model were adapted through participatory workshops involving pregnant women, health professionals, and community representatives. According to our plan, we are finalizing the preparations for ENABLE’s transition from needs assessment and adaptation phase to implementation and evaluation phase.
Second, we have made great advancements in developing a digital ANC tool, integrated with local HMIS systems to enable data-driven clinical decision support, delivery and monitoring of the intervention. This system allows ANC providers to register, follow up, and monitor counselling sessions in real time, while also supporting data collection for research and evaluation.
Finally, ENABLE is contributing to local research capacity. All early-career researchers (PhD fellows and postdocs) have been recruited and formally onboarded into their academic programmes. Study protocols for their respective research projects have been developed and submitted for ethics approval. Ongoing training and mentorship are supporting skill development in the project’s scientific areas. The project also collaborates closely with policy-makers and technical partners to promote ownership and integration of project outputs.
Further, ENABLE has made significant progress in designing, preparing, and initiating the implementation of the ENABLE intervention:
First, a comprehensive formative research was conducted across our study sites, Addis Ababa, Adama, Harar, and Jimma. This phase included health facility observations, interviews with pregnant women, health workers, and key stakeholders, as well as environmental assessments. The findings provided critical insights into existing gaps, behavioural determinants, and the feasibility of integrating NCD prevention into ANC services. Building on these insights, ENABLE co-designed a tailored intervention and implementation package. The content and delivery model were adapted through participatory workshops involving pregnant women, health professionals, and community representatives. According to our plan, we are finalizing the preparations for ENABLE’s transition from needs assessment and adaptation phase to implementation and evaluation phase.
Second, we have made great advancements in developing a digital ANC tool, integrated with local HMIS systems to enable data-driven clinical decision support, delivery and monitoring of the intervention. This system allows ANC providers to register, follow up, and monitor counselling sessions in real time, while also supporting data collection for research and evaluation.
Finally, ENABLE is contributing to local research capacity. All early-career researchers (PhD fellows and postdocs) have been recruited and formally onboarded into their academic programmes. Study protocols for their respective research projects have been developed and submitted for ethics approval. Ongoing training and mentorship are supporting skill development in the project’s scientific areas. The project also collaborates closely with policy-makers and technical partners to promote ownership and integration of project outputs.
As ENABLE is still in the early stages of implementation, no scientific results are yet available. However, the project has laid a strong foundation for generating results that go beyond the current state of the art in maternal health and NCD prevention in low-resource urban settings.