Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model.

OBJECTIVES: The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN: Cross sectional. SETTING: Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS: 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES: The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS: The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR1=aOR2; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR1 = aOR2; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR1= aOR2; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR1 = aOR2; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS: The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.

Adolescent reproductive health and awareness of HIV among rural high school students, North Western Ethiopia.

Ethiopia is faced with an increasing problem from HIV infection, and the vulnerability of adolescents is a key concern. There is little information on the knowledge, attitudes and practices of this age group with respect to HIV, sexually transmitted diseases and preventive measures. We conducted a cross-sectional study among 260 students from two rural high schools in North Western Ethiopia. We found that although the general awareness of HIV was high, correct knowledge of the virus and its modes of transmission was shown in only 44% of adolescent boys and 41% of adolescent girls. Knowledge of HIV and condoms was lower among students whose parents were farmers, significant so among girls (p=0.02). Use of condoms among sexually active single male students (49%) was insufficient but was higher than among adolescents in many other African settings. Knowledge of STDs was generally low: 82% of adolescent males and 37% of adolescent females had some awareness of STDs. Almost 20% of sexually active males in the study had previously experienced an STD, almost all of whom had visited a commercial sex worker. Targeted interventions are warranted among adolescents and sex workers in Ethiopia complemented by STD treatment services.

Prevalence of risk factors for trachoma in a rural locality of north-western Ethiopia.

BACKGROUND: In Ethiopia, the prevalence of blindness has been estimated to be 1.5%. According to a survey done in collaboration with WHO in 1981, the leading cause of blindness in Ethiopia was trachoma (42%) followed by cataract (29%). The problem is mainly seen in the rural areas of the country. OBJECTIVE: To determine the prevalence and associated risk factors of trachoma in a rural locality of north-western Ethiopia. DESIGN: Cross-sectional survey. SUBJECTS: One thousand seven hundred and eighteen individuals participated in the study. MAIN OUTCOME MEASURES: Grades of trachoma--the WHO simplified method of clinical signs was used to determine the various grades of trachoma. RESULTS: The overall prevalence rate of trachoma of the locality was 59.2% while the prevalence rate of active trachoma was found to be 52.4%. Higher frequency of trachoma was observed among females aged 15 years and above than males of the corresponding age group, and this finding was statistically significant (chi2-test, p < 0.001). Child care-taking among women, habits and frequency of face washing, presence of cooking places in living rooms and sharing of same rooms with animals have been found to be highly associated with trachoma (p < 0.001). CONCLUSION: Based on the results of this study, the following recommendations are made, among others: (i) the development of a system aimed at educating and convincing the people to maintain high personal and environmental hygiene and; (ii) the strengthening of the nearby health centres to incorporate activities like correction of lid deformities to prevent further loss of eye vision due to corneal damage are recommended.

Chloroquine resistance of Plasmodium falciparum malaria in Ethiopia and Eritrea.

We report on the first 2 years of operation of a new strategy for treatment for P. falciparum malaria patients who were not cured by a standard course of chloroquine. Any such patient who returned to a malaria treatment and detection post within 2 weeks was treated daily under supervision with chloroquine. Patients whose parasitaemia had not decreased below 25% of the initial level by day 3 or cleared completely by day 7 were given sulphadoxine/pyrimethamine (Fansidar). Of 39824 patients treated initially with chloroquine, 4% returned to the malaria post within 2 weeks of treatment; 87% of these were chloroquine resistant and treated with Fansidar and 28% of the returning patients were RIII resistant. Resistance was associated with geographical area, initial parasite density and age. Earlier studies had shown resistance to be confined to border areas, but we found that it was highest in the centre of the region, notably in the lowlands of the Shewa and Arsi provinces, and lowest in the west. Although imported cases have been held responsible for the development of resistance in border areas, other factors are likely to be important in the middle of the region. The implications of these findings for a treatment policy of P. falciparum malaria in the region are discussed.