A mixed-methods study on health learning materials utilization for COVID-19 risk communication and community engagement among health workers in Arsi Zone, Ethiopia: Implication for response to pandemic.

BACKGROUND: Risk communication and community engagement are among the key strategies used in response to pandemics. Effective risk communication and community engagement can be achieved when assisted by health learning materials. However, their utilization was not known in Ethiopia. Therefore, the present study aimed to assess the utilization of COVID-19 health learning materials (HLMs), and explore barriers and facilitating factors. METHODS: A sequential explanatory mixed-methods study consisting of two phases was carried out. The first phase was a cross-sectional survey to assess the utilization of COVID-19 HLMs and their predictors. In this phase, a multistage sampling technique was used to select 530 health workers. A self-administered structured questionnaire was used for data collection. Epi-data manager version 4.6.0.2 and STATA version 16 were used for data entry and analyses, respectively. Descriptive analyses were carried out as necessary. Ordinal logistic regression analyses were done to identify the predictors of COVID-19 HLMs utilization. Phase two is a qualitative study to explore enablers and barriers to COVID-19 HLMs utilization. A judgmental sampling technique was used and 14 key informants were recruited. The collected data were uploaded into Atlas ti version 7.0.71. An inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. RESULTS: Findings showed that out of the total 530 respondents, 210(39.6%), 117(22.1%), and 203(38.3%) of them never use COVID-19 HLMs, use sometimes, and always, respectively. Health workers' perceived quality of COVID-19 HLMs [AOR = 6.44 (95% CI: 4.18-9.94)], health workers' perceived usefulness of COVID-19 HLMs [AOR = 2.82 (95% CI: 1.88-4.22)], working facility [AOR = 1.83 (95% CI: 1.07-3.14)], educational level of the respondents [AOR = 1.73 (95% CI: 1.11-2.72)] and availability of COVID-19 HLMs [AOR = 1.45(95% CI: 1.01-2.08)] had statistically significant association with the utilization status of COVID-19 HLMs. Findings from the qualitative study showed that materials-related factors, and structure and health workers-related factors had influence on HLMs utilization. CONCLUSIONS: In this study, we found that only a few of the respondents were regularly utilizing COVID-19 HLMs. Perceived quality, usefulness, and availability of HLMs, and health workers' educational status and working facility determined the level of COVID-19 HLMs utilization. There is a need for giving due attention to HLMs, evaluating their quality, availing them to health facilities, and providing training for health workers.

Late initiation of antenatal care and associated factors among pregnant women in Jimma Zone Public Hospitals, Southwest Ethiopia, 2020.

BACKGROUND: Late antenatal care initiation is linked to a higher risk of maternal death. Women who do not start ANC at an early stage may experience the effects of pregnancy-related health difficulties, as well as long-term health issues and pregnancy complications. Therefore, our study aimed to determine the prevalence of late initiation of antenatal care and associated factors among pregnant women in Jimma Zone public Hospitals. METHODS: A facility-based cross-sectional study design was employed in Jimma zone public hospitals from February 1 up to 30 March 2020 and 409 pregnant women were participated in the study by using a systematic random sampling method. Structured questionnaire was used to collect data that contain socio demographic variables, socio cultural variables, pregnancy related factors and predisposing factor related variables. The data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Binary and multivariable logistic regression analysis were performed by using 95%CI and significance was declared at P < 0.05. RESULT: Forty-eight percent of pregnant women were initiated their first ANC late. Primary education (AOR = 0.242; 95% CI, 0.071-0.828) and college diploma and above was (AOR = 0.142; 95% CI, 0.040- 0.511), mothers with an unplanned pregnancy (AOR = 11.290; 95%CI, 4.109-31.023), time taken to arrive the health facility greater than sixty (60) minutes (AOR = 8.285; 95% CI, 2.794-24.564) and inadequate knowledge about ANC service (AOR = 4.181; 95%CI, 1.693-10.348) were associated with late first Antenatal care initiating. CONCLUSION: The prevalence of late initiation of ANC still remains a major public health concern in the study area. Level of education, unplanned pregnancy, distance from house to health facility, and lack of understanding about ANC services were all found to be significant variables in late ANC starting. As a result, healthcare workers can provide ongoing health education on the need of starting antenatal care visits early to avoid unfavorable pregnancy outcomes by considering all identified factors.

Intention Toward Dietary Diversity Among Adult People Living With HIV in Public Hospitals in Southwest Ethiopia Using Theory of Planned Behavior. A Mixed Methods Study.

Dietary diversity is a crucial element of an inclusive care for people living with HIV (PLWHIV), particularly in resource-limited countries where undernutrition, poor intention, and poor attitude toward diversified diets are the common challenges. The aim of this study was to assess the Intention toward dietary diversity behavior among adult PLWHIV in Jimma zone public hospitals, South West Ethiopia. A hospital-based survey was carried out in 5 public institutions among sampled 403 adult PLWHIV. Data were entered into EpiData, and exported to SPSS version 20 for analysis. Relationships among variables were assessed using correlation coefficients. The multivariable linear regression model was fitted to assess predictors of behavioral inclination toward dietary diversity at P-value ≤ .05. The quantitative data was supplemented by qualitative data, which was collected through key informant interviews and analyzed thematically. The significant predictors of intention to use dietary diversity were attitude (ß = .196, P < .01) and subjective norm (ß = .390, P < .01) of adult PLWHIV. The constructs of theory of planned behavior (TPB) independently explained the variance in inclination toward dietary diversity by 25.7%. All the intermediate, proximal, and distal components of TPB explained the final model with 32.2% of variance in the intention to use dietary diversity. The qualitative findings indicated that delivery of HIV care requires a drive for livelihood development and economic improvement, creating a sense of responsibility for sustainable HIV care by creating behavioral change at the individual level. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition.

Response to self-care practice messages among patients with diabetes mellitus visiting Jimma University medical center facility based cross sectional design application of extended parallel process model.

OBJECTIVE: To determine response to self-care practice message among patients with diabetes in Jimma University Medical center based on the Extended Parallel Process Model. DESIGN: A facility-based cross-sectional study was conducted. SETTING: Jimma University Medical Center is found in Jimma town. PARTICIPANTS: A total of 343 patients with diabetes participated in the study; making a response rate of 93.9%. All patients with diabetes who were 18 years and above and who were on follow up and registered were included in the study and those with Gestational DM were excluded. DATA ANALYSIS: Multivariable logistic regression analysis. RESULT: Responsive respondents scored high in self-care practice score as compared to other respondents. educational status, information sources, knowledge, and preferred message appeals were independent predictors of controlling the danger of diabetes. CONCLUSION: There is a significant gap in controlling the danger of diabetes. Variables like the level of education, knowledge of diabetes mellitus, information sources, and message appeals were independent predictors of controlling the danger of diabetes. Designing message having higher efficacy while maintaining the level of threat is the best that fits the existing audience's message processing to bring about desired diabetic self-care Practice.

Why are Youth Engaged in Substance Use? A Qualitative Study Exploring Substance Use and Risk Factors Among the Youth of Jimma Town, Southwest Ethiopia.

INTRODUCTION: Substance use refers to the use of psychoactive substances such as khat, alcohol, cigarettes, and illicit drugs. Young people are more vulnerable to substance use than older people. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health concern among the youth of Ethiopia, mainly in Jimma town. Therefore, this study aimed to explore the substance use and risk factors among the youth of Jimma town in 2019. METHODS: The study was conducted in Jimma town among youth who were engaged in substance use, from March to April 2019. A descriptive qualitative study design was employed and the study participants were acquired using purposive/judgmental sampling techniques. In total, 20 interviews were conducted with young people using in-depth and key informant interview methods. The data were analyzed by using ATLAS.ti version 7. Thematic analyses were performed in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings. RESULTS: The findings of this study were discussed under six themes and 12 categories, which emerged from thematic analysis of the data: substance use setting, time and means of distribution, substance-related factors, social and economic factors, individual factors, psychological factors, and legal and policy factors. CONCLUSION: The study indicated that khat, alcohol, cigarettes and shisha or water pipes were the most commonly used substances. Different factors that drive the youth to engage in substance use were identified; individual factors, social and economic factors, substance-related factors, and legal and policy factors were most common. Generally, to overcome this problem, the community, lawyers, and policemen should participate in the implementation and enforcement of rules and regulations on substance use. Family should monitor their children and need to act as good role models by avoiding substance use.

Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care.

BACKGROUND: Ethiopia has been motivated to achieve a goal of "appointment spacing model approach care." However, little has been documented on the predictor of mortality and challenges of sustainable HIV care. Therefore, the aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS: A retrospective cohort study was conducted on 676 adult people living with HIV who enrolled to ART clinic from September 01, 2012 - August 30, 2016. Multivariable Cox Regression analysis was done where adjusted hazard ratio (AHR)with corresponding 95% confidence interval (CI) at P value ≤ 0.05 cut of point was used to identify predictors of mortality. RESULTS: The total person-time contributed was 28,209 person-months with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). Severe undernourishment and moderate malnutrition at baseline, younger age, female sex, single, divorced, illiterate, lack of disclosure, advanced WHO clinical stage, seeking treatment outside catchment area, rural residence and immunological failure were found to be independent predictors of mortality. CONCLUSIONS: Poor nutritional status at baseline, advanced stage of HIV disease, occurrence of treatment failure, female sex, substance abuse, lack of social support, immunological failure, clinical failure, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of the appointment spacing model care can improve survival of PLWHA.

Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study.

OBJECTIVES: The study aimed to see predictors of undernourished and its implication towards HIV continuum care. STUDY DESIGN: unmatched case-control study was conducted among 678 individuals in Jimma zone, southwest Ethiopia. METHODS: Randomly selected data of 339 PLWHA who had poor nutritional outcomes (cases) and 339 without undernourished (controls) were analyzed. Logistic regression was used to identify forecasters of undernutrition. The quantitative results were supplemented from key informants who work closely on HIV care, then data were coded and analyzed thematically. RESULTS: Rural residence (AOR:1.8; 95% CI: 1.2, 6.4), female (AOR: 2.9; 95% CI: 1.1, 4.3), unstable livelihood (AOR: 5.1; 95% CI: 4.2, 19.6), low meal frequency (AOR: 6.6; 95% CI: 5.2, 21.1), less diversified foods (AOR: 3.5; 95% CI: 1.2, 14.3), and advanced WHO clinical stage (AOR: 4.3; 95% CI: 3.6, 13.7) and were found to be independent predictors of undernourishment. No social support advanced clinical stage, and unstable livelihood adversely affect nutritional status of PLWHA from the qualitative data. CONCLUSIONS: The socio-cultural, economic, and health-system factors inhibit ideal patient nutritional status. Better tracking, enhanced livelihood and social support along with drug therapy, food aid needs to consider for PLWHA.

Predictors of substance use among Jimma University instructors, Southwest Ethiopia.

BACKGROUND: Use of substances such as alcohol, khat leaves (Catha edulis) and tobacco has become one of the rising major public health and socioeconomic problems worldwide and dramatically increased in developing countries. The aim of this study was to assess the predictors of substance use among Jimma University instructors. METHOD: Institutional based cross-sectional study design was conducted in 2018 among Jimma University instructors. A two-stage cluster sampling procedure was employed to select study participants by their departments and data was collected using structured, self-administered questionnaire with severity assessed by the standardized fifth version of a diagnostic statistical manual of mental health criteria for substance use disorder. Multivariate logistic regression was used to identify independent predictors of substance use. Variables with a P-value < 0.05 in the final fitting model were declared to be associated with the outcome variable. RESULTS: A total of 330 instructors were involved in this study, with a response rate of 96.2%. About 225 of the respondents have ever used the substance in life (khat, alcohol, or cigarette or all) making the lifetime prevalence of substance use 68.2%. The lifetime prevalence of khat chewing, alcohol use, and smoking cigarette was 51.6, 81.3, and 17.3% respectively. The prevalence of substance uses disorder among users was 36.9%. Living with family (AOR = 0.220 [2.004-8.536] 95%CI), no family substance use history (AOR = 0.220 [0.098-0.495] 95% CI), friends substance use (AOR = 9.047 [4.645-17.620] 95% CI), Social norm favors substance use, (AOR = 1.123 [1.020-1.238] 95% CI), perceived benefit of substance use (AOR = 1.077 [1.008-1.151] 95% CI) were predictors of substance use. CONCLUSION: Perception toward substance, the influence of family and peer were associated with substance use. Therefore, designing a multifaceted approach directed to an individual, interpersonal and community-level intervention targeted to substance misperception and social norms contributing to substance use.