Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Background: Data-informed decision making is influenced by organizational, technical, and behavioral factors.Behavioral factors are the major contributing factors for data-informed decision-making practices. This study aimed to explore health workers' perceptions of data-informed decision making at primary health care units in Awi zone. Method: A cross-sectional qualitative study was undertaken to explore health workers' perceptions on the barriers of health data-informed decision-making practices. Eleven healthcare workers were purposively selected from primary hospitals, health centers and health posts. Medical doctors, nurses, midwifes and health extension workers were selected as key informants for the in-depth interview. The selected healthcare workers were asked about their perceptions that affect health data use practices. The data obtained was analyzed through thematic analysis using Open Code software. Analysis was performed using three themes namely, organizational, behavioral, and technical barriers of data-informed decision making. Results: All the health care workers including health extension workers utilized a data-informed decision-making practice at least once during their point of care. Five of the eleven key informants reported their data-informed decision-making practice as reviewing quality of facility data, while none of them reported data-informed decision-making practices for their monthly performance monitoring. Behavioral factors included negligence, workarounds, and skill gaps. Organizational factors included staff turnover and shortage of recording tools. Technical factors included high workloads which lead to data error and paper-based systems were considered major barriers to data-informed decision-making practices. Conclusion: Data-informed decision-making practices were low at primary health care units. Behavioral, organizational, and technical factors contributed to the decreased use of data. [Ethiop. J. Health Dev. 2022;36(2):000-000]

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Maternal mortality in Ethiopia is the highest in the world (412/100,000). Health facility delivery is the cornerstone in reducing maternal mortality. However, health facility delivery is low in Ethiopia, due to poor access and ill-equipped health facilities. Maternity waiting home(MWH)is one of the comprehensive packages of essential obstetric services, enabling women to access well-equipped health facilities. However, there are limited studies on maternal waiting home use in Ethiopia. This study aimedto use the integrated behavioral model, toassess maternal waiting home use and associated factors among mothers in the East Bellessa district, northwest Ethiopia.Method:A community-based cross-sectional study was conducted fromthe1-27 of March 2020. The multistage sampling technique was used to select a total of 624 mothers. Data was collected usingthe face-to-face interview technique. The reliability and validity of the itemswere checked using exploratory factor analysis. Multivariable logistic regressions wereconducted toidentify the factors associated with maternal waiting home use. Findings with a p-value <0.05 with a 95% confidence interval were considered statistically significant in the final model.Result.Overall, 20.5% (95% CI=17.3-23.7) of mothers used maternity waiting homes for the index of childbirth. Husband educational status (AOR=3.78, CI =1.44-9.93), the knowledge on maternitywaiting homes(AOR=3.97, CI=2.27-6.95), between 2 and 3antenatal care follow ups(AOR=0.14 CI=0.06-0.31), experiential attitude (AOR=2.37, CI=1.64-3.44), descriptive norms(AOR=0.66, CI=0.47-0.94), perceived behavioral control (AOR=1.07, CI=1.02-1.13) and behavioral intention (AOR=1.37, CI=1.1-1.71) were associated with maternity waiting home use.Conclusion:Maternity waiting home utilization was low. Husband's education status, antenatal care follow-up, knowledge on maternal waiting homes, experiential attitude, descriptive norms, perceived behavioral control and behavioralintention were positively significantly associated with MWH utilization. Therefore, strengthening the use antenatal care services, husbands'education, and developing a positive attitude towards MWH may improve the use of maternity waitinghomesamong women. [Ethiop. J. Health Dev. 2022; 36(2):000-000]Keyword:Maternity waiting home, mothers,integrated behavioral model, Ethiopia

Clinical Competence and Perception of Medical Students after Early Clinical Exposure through Pre-clerckship Education at an Ethiopian Medical School: A Cross-sectional Study

BACKGROUND: Conventional medical curriculum is the mainstay in the long history of modern medical education. Innovative integrated medical curriculum attracted significant attention in improving conventional curriculum. In the integrated curriculum, basic sciences are incorporated horizontally with each other, and students are exposed early to clinical settings. This is expected to improve students' knowledge and skills in clinical medicine by the time they start their clerkship rotation. METHOD: the study aims to make a baseline assessment on the overall knowledge and skills of medical students towards clinical medicine. An institution-based cross-sectional study was conducted from March to April of 2020 using 91 third year medical students (convenience sampling). A threesection selfadministered survey instrument, short written MCQ exam, and practical (OSCE) students' examination were used for this survey. RESULT: participants tend to exhibit better knowledge on basics of history taking and physical examination with an average score of 79%. Comparatively, the score for average physical examination skill was low (56.3%). Students' perception on ECE showed, over 50% of participants believe ECE increases burden on their overall workload. Even then, the majority (92.3%) still think that ECE has positive impact on their clerkship education. Taken together, it appears more hands-on interventions is needed to further improve skills of medical students in physical examination with particular emphasis on the clinical examination of breast, thyroid, musculoskeletal, and neurologic systems

National guideline for implementation of integrated community-based health services

The National Guideline for Implementation of Integrated Community-Based Health Services has been developed by the Ministry of Health and Wellness­Department of Health Services Management as a technical tool. This guideline is a reflection of the Ministry's commitment to strengthening primary health care and implementation of the Harmonization of Botswana's Community Health Workers Groups: Primary Health Care­Community Health Workers (PHC-CHW) Coordination Strategy launched in 2017. Seeking to promote an integrated approach to community-based health service delivery and standardize a minimum package of community-based health interventions, the guideline also reflects the country's commitment to local and global health sector goals. The specific objectives are to provide technical and programmatic guidance including: • Improving the delivery of integrated community-based health interventions through provision of a standardized minimum package • Strengthening coordination and management of community-based health services through harmonized community health workers groups, leadership and governance • Strengthening CHWs competencies and skill mix for delivery of integrated communitybased health services • Strengthening information management for integrated community-based health services The guideline will benefit various actors and stakeholders including policymakers, managers, Ministries, and CHWs who are responsible for managing and implementing community-based health services. A multidisciplinary team developed the initial concept for the guideline and engaged in an interactive and extended collaborative process of reviewing and refining the scope and content. The guideline is the first publication on community health services and mirrors the primary health care guideline in the way the minimum package is developed. The guideline is intended to be easy to read and user friendly, and will be placed in all facilities for reference. It also includes a curriculum for CHWs in the era of COVID-19.