Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021.

INTRODUCTION: Health care workers are the most affected part of the world population due to the COVID-19 pandemic. Countries prioritize vaccinating health workers against COVID-19 because of their susceptibility to the virus. However, the acceptability of the vaccine varies across populations. Thus, this study aimed to determine the health care worker's intentions to accept the COVID-19 vaccine and its associated factors in southwestern Ethiopia, 2021. METHODS: A facility-based cross-sectional study was conducted among health care workers in public hospitals in southwestern Ethiopia from March 15 to 28, 2021. A simple random sampling method was used to select 405 participants from each hospital. Data were collected using self-administered questionnaires. Descriptive statistics, such as frequency and percentage, were calculated. Multivariable logistic regression was also performed to identify factors associated with health care worker's intention to accept the COVID-19 vaccine. Statistically significant variables were selected based on p-values (<0.05) and the adjusted odds ratio was used to describe the strength of association with 95% confidence intervals. RESULT: Among the respondents, 48.4% [95% CI: 38.6, 58.2] of health care workers intended to accept COVID-19. Intention to accept COVID-19 vaccination was significantly associated with physicians (AOR = 9.27, 95% CI: 1.27-27.32), professionals with a history of chronic illness (AOR = 4.07, 95% CI: 2.02-8.21), perceived degree of risk of COVID-19 infection (AOR = 4.63, 95% CI: 1.26-16.98), positive attitude toward COVID-19 prevention (AOR = 6.08, 95% CI: 3.39-10.91) and good preventive practices (AOR = 2.83, 95% CI: 1.58-5.08). CONCLUSION: In this study, the intention of health care workers to accept the COVID-19 vaccine was low. Professional types, history of chronic illness, perceived degree of risk to COVID-19 infection, attitude toward COVID-19 and preventive practices were found to be factors for intention to accept COVID-19 vaccine in professionals. It is important to consider professional types, history of chronic illness, perceived degree of risk to COVID-19, attitude of professionals and preventive behaviors to improve the intention of professionals' vaccine acceptance.

Knowledge, Attitudes, and Practices Toward Covid-19 and Associated Factors Among University Students in Mizan Tepi University, 2020.

BACKGROUND: A coronavirus pandemic has reached all over the world. It is a highly contagious virus spreading from human to human by respiratory droplet infection and close contact. Applying preventive measures is very important in tackling the spread of the disease since there is no curative antiviral drug. The pandemic of the virus has impacted different institutions including the university. To overcome the impact, students are resuming face to face education by applying preventive measures of Covid-19. This study is undertaken to assess KAP in Mizan Tepi University, 2020. MATERIALS AND METHODS: A cross-sectional study was conducted among 402 randomly selected participants. A structured questionnaire was used to collect the data from December 1-10/2020. Data were entered into Epidata 3.1 and exported to SPSS version 21 for analysis. Bivariate and multivariate logistic regressions were used for analyses. A p-value of less than 0.05 was used to identify significant variables in multivariate logistic regression analysis. RESULTS: In this study, 47%, 54%, and 42.8% of the students had good knowledge, positive attitude, and good practice towards Covid-19, respectively. Being from health sciences (AOR= 2.983, 95% CI (1.869, 4.763)) was significantly associated with good knowledge. Being from health sciences (AOR= 1.86, 95% CI (1.169, 2.970)), female sex (AOR=0.628, 95% CI (0.405, 0.975)), at least one parent having diploma or degree (AOR= 0.455, 95% CI (0.236, 0.878)), and 1000-1500 ETB monthly income (AOR= 0.403, 95% CI (0.189, 0.856)) were significantly associated with students' attitude. Being rural residence (AOR = 1.740, 95% CI (1.136, 2.663)), positive knowledge (AOR=1.893, 95% CI (1.2322.909)), and positive attitude ((AOR=2.676, 95% CI (1.745, 4.105)) were positively associated with the students practice. CONCLUSION: The KAP of the students towards the Covid-19 was low. Being a health sciences student was an explanatory variable for better knowledge. Sex, being a health science college student, parents' educational status, and monthly income were predictors of students' attitude. Residency, knowledge, and attitude were independent predictors of practice. Awareness creation on preventive behaviors among the students is highly recommended.

Adherence and Its Associated Factors Among Adult HIV-Infected Patients on Antiretroviral Therapy in South Western Ethiopia, 2020.

BACKGROUND: Good adherence to antiretroviral therapy (ART) suppresses the viral load, reconstitutes the immune system, and decreases opportunistic infections among HIV-positive patients. However, adherence to ART is still challenging in developing countries such as Ethiopia. The study, therefore, aimed to assess adherence and its associated factors among HIV-positive patients on ART in southern Ethiopia in 2020. MATERIALS AND METHODS: A cross-sectional study was conducted among 329 randomly selected participants. A structured questionnaire was used to collect the data through a face-to-face interview from January 23 to February 23, 2020. Data were entered into Epidata 3.1 and exported to SPSS version 21 for analysis. Bivariate and multivariate logistic regressions were used for analysis. A p-value of less than 0.05 was considered significant in a multivariate logistic regression analysis. RESULTS: In total, 274 patients (83.3%) had good adherence to ART, while 16.7% did not adhere. Age between 39 and 49 years old (AOR=0.068, 95% CI 0.008, 0.578), urban residency (AOR=5.186, 95% CI 1.732, 15.529), an educational status of being unable to read and write (AOR=0.097, 95% CI 0.012, 0.771), an educational status of reading and writing with no formal education (AOR=0.056, 95% CI 0.006, 0.532), comorbidity (AOR=0.042, 95% CI 0.013, 0.139), disclosure (AOR=3.583, 95% CI 1.008, 12.739), WHO clinical stage II (AOR=0.098, 95% CI 0.021, 0.453), and CD4 count ≥500 cells/mm3 (AOR=5.634, 95% CI 1.203, 26.383) were significantly associated with adherence to ART among patients. CONCLUSION: The adherence of patients to ART is relatively low compared to other studies conducted in different regions. Age 39-49 years, educational status, comorbidity, and WHO clinical staging were negatively associated with ART adherence. Residency, disclosure, and current CD4 category greater than or equal to 500 cells/mm3 were positively associated with adherence. Good counseling to patients from rural areas, with low educational status, and with low CD4 counts, and on the importance of disclosure, is recommended and should be given by professionals.

The impact of patient education and shared decision making on hospital readmissions for COPD.

PURPOSE: Education on the self-management of COPD has been shown to improve patients' quality of life and reduce hospital admissions. This study aimed to assess the feasibility of a pilot, pragmatic COPD Chronic Care (CCC) education program led by registered respiratory therapists and determine the CCC's impact on hospital readmissions, patient activation, and health status. PATIENTS AND METHODS: This was a prospective, randomized, pilot study of inpatients with COPD admitted to a US community hospital between August 2014 and February 2016. In total, 308 patients were randomized 1:1 to receive standard care with or without the CCC program. Outcomes included the number of patients completing the program, frequency and time to first all-cause and COPD-related hospital readmissions, and changes in the Patient Activation Measure (PAM) and COPD Assessment Test (CAT). RESULTS: Overall, 37% (n=52) of patients in the CCC group and 29% (n=48) of patients in the control group remained in the study for 6 months and completed all follow-up phone calls. In total, 74% (n=105) of patients in the CCC group and 69% (n=115) of patients in the control group had at least one readmission (P=0.316). The time to first all-cause and COPD-related readmission appeared shorter for patients in the CCC group compared with the control group (mean [standard deviation]: 50.2 [54.5] vs 59.9 [63.1] days and 95.1 [80.2] vs 113.7 [82.4] days, respectively; both P=0.231). Patients experienced significant improvement from baseline in mean PAM (both groups) and CAT (CCC group) scores. CONCLUSION: Utilizing respiratory therapists to lead a chronic care education program for COPD in a community hospital was feasible. Although CCC patients showed improvements in perceived symptom severity, they were readmitted sooner than control group patients. However, the program did not impact the frequency of hospital readmissions. A more comprehensive disease management program may be needed to improve outcomes.

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study.

BACKGROUND: Ethiopia is embarking upon a ground-breaking plan to address the high levels of unmet need for mental health care by scaling up mental health care integrated within primary care. Health system governance is expected to impact critically upon the success or otherwise of this important initiative. The objective of the study was to explore the barriers, facilitators and potential strategies to promote good health system governance in relation to scale-up of mental health care in Ethiopia. METHODS: A qualitative study was conducted using in-depth interviews. Key informants were selected purposively from national and regional level policy-makers, planners and service developers (n = 7) and district health office administrators and facility heads (n = 10) from a district in southern Ethiopia where a demonstration project to integrate mental health into primary care is underway. Topic guide development and analysis of transcripts were guided by an established framework for assessing health system governance, adapted for the Ethiopian context. RESULTS: From the perspective of respondents, particular strengths of health system governance in Ethiopia included the presence of high level government support, the existence of a National Mental Health Strategy and the focus on integration of mental health care into primary care to improve the responsiveness of the health system. However, both national and district level respondents expressed concerns about low baseline awareness about mental health care planning, the presence of stigmatising attitudes, the level of transparency about planning decisions, limited leadership for mental health, lack of co-ordination of mental health planning, unreliable supplies of medication, inadequate health management information system indicators for monitoring implementation, unsustainable models for specialist mental health professional involvement in supervision and mentoring of primary care staff, lack of community mobilisation for mental health and low levels of empowerment and knowledge undermining meaningful involvement of stakeholders in local mental health care planning. CONCLUSIONS: To support scale-up of mental health care in Ethiopia, there is a critical need to strengthen leadership and co-ordination at the national, regional, zonal and district levels, expand indicators for routine monitoring of mental healthcare, promote service user involvement and address widespread stigma and low mental health awareness.

Service user involvement in mental health system strengthening in a rural African setting: qualitative study.

BACKGROUND: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. METHODS: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. RESULTS: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. CONCLUSION: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.

Antimicrobial resistance pattern of Salmonella serotypes isolated from apparently healthy slaughtered camels (Camelus dromedarius) in eastern Ethiopia.

A total of 714 samples consisting of faeces, mesenteric lymph nodes, liver, spleen, abdominal and diaphragmatic muscles (each 119) were collected from November 2001 to April 2002 from apparently healthy slaughtered camels (Camelus dromedarius) in eastern Ethiopia. One hundred sixteen (16.2%) Salmonella strains belonging to 16 different serovars were isolated. All Salmonella strains isolated were examined for antimicrobial resistance to 17 selected antimicrobials. The minimum inhibitory concentration (MIC) values were determined by the microdilution broth test. Fifty-two (44.8%) of the Salmonella isolates were resistant to one or more antimicrobials. Thirty-nine of the 52 (75%) resistant Salmonella serovars exhibited multiple resistance to up to eight different antimicrobials. Among the serovars tested, S. Typhimurium, S. Heidelberg, S. Braenderup and S. Hadar displayed multiple resistance mainly to streptomycin (35.3%), spectinomycin (28.4%), sulfamethoxazole (25.0%), ampicillin (24.1%), trimethoprim (22.4%), trimethoprim/sulfamethoxazole (18.9%), tetracycline (12.9%) and colistin (11.2%). All Salmonella strains tested were susceptible to ciprofloxacin, nalidixic acid, gentamicin, kanamycin and neomycin. The present study showed the importance of camels as a potential source of single and multiple resistant Salmonella strains to different antimicrobials that are also used in the public health sector for the treatment of different bacterial diseases in Ethiopia.