The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response.

BACKGROUND: The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS: We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O'Malley's methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS: Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS: The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.

Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: A cross-sectional study.

BACKGROUND: Exclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between six months and two years were surveyed using multistage, convenience sampling. Women filled in a paper based validated questionnaire adopted from the Breastfeeding and Employment Study toolkit (BESt). The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariable logistic regression. RESULTS: Four-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF, most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR] = 2.1, 95%, CI 1.2-3.6; P = 0.005), having frequent breaks at work (AOR = 2.6, 95% CI, 1.4-4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR = 1.7, 95% CI, 1.0-3.0; P = 0.033) were statistically associated with an increased chance of EBF. CONCLUSION: Although returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers' support play significant roles in EBF continuation, which in the absence of six-month's maternity leave for employed women in Ethiopia would be of benefit to both mothers and children.

Attitudes and experiences of employed women when combining exclusive breastfeeding and work: A qualitative study among office workers in Northern Ethiopia.

Evidence from different countries shows that the level of support given to mothers who return to paid employment can significantly determine the duration of exclusive breastfeeding (EBF). However, little is known about how returning to work impacts Ethiopian women's EBF practice. The aim of this study was to explore women's attitudes and experiences of EBF when they returned to work. Mothers who had an infant of less than 12 months, working in government institutions in Tigray region, Ethiopia, were invited to participate in this study. Semi-structured, face-to-face interviews were used to explore mothers' perspectives of the factors that influenced EBF when they returned to work. The interview data were transcribed verbatim and thematically analysed. Twenty mothers were interviewed from 10 organizations. Three themes were identified from their accounts: mother's knowledge, attitudes and practice towards breastfeeding; workplace context and employment conditions; and support received at home. Most participants were familiar with the benefits of EBF. Most participants reported that their colleagues had more positive attitudes towards breastfeeding than their managers. In almost all the workplaces, there was no specific designated breastfeeding space. Participants reported that close family members including husbands and mothers were supportive. Mothers' knowledge and attitude towards breastfeeding, workplace and employment conditions and support received at home were found to be the main factors determining the duration of EBF among employed women. Participants reported that the overall support given to breastfeeding women from their employers was insufficient to promote EBF.

Diabetes self-care practice and associated factors among type 2 diabetic patients in public hospitals of Tigray regional state, Ethiopia: A multicenter study.

BACKGROUND: The prevalence of type 2 diabetes is increasing steadily at an alarming rate. Ethiopia is placed fourth among the top five countries of the African region members of the international diabetes federation. This study aimed to determine the level of diabetes self-care practice and associated factors among patients with type 2 diabetes mellitus attending public hospitals of the Tigray region. METHODS: An institution-based, cross-sectional study was conducted in six selected hospitals of Tigray region from January to February 2020. Study participants were recruited using a systematic random sampling method. Diabetes self-care practice was assessed using Summary Diabetes Self-Care Activities (SDSCA) assessment tool. The data were collected by trained nurses via face-to-face interview. Binary and multivariable logistic regression analyses were used to identify factors associated with self-care practices. Statistical significance was declared at p-value < 0.05. RESULTS: A total of 570 patients with type 2 diabetes were included in this study. The mean (SD) age of the participant was 46 (±14.6) years. Less than half (46.7%) of the participants had good diabetes self-care practices. Surprisingly, only 68 (11.9%) of the participants had access to a personal glucometer. Urban residency (AOR = 1.9, 95% CI = 1.20-2.94), age group 48-63 years (AOR = 2.1, 95% CI = 1.19-3.98), not having a formal education (AOR = 2.6, 95% CI = 1.32-5.25), having family support (AOR = 1.9, 95% CI = 1.24-2.85), and having a personal glucometer at home (AOR = 6.1, 95% CI = 2.83-13.0) were the factors associated with good diabetes self-care practices. CONCLUSION: The diabetes self-care practice in the region was found to be poor. Where factors like, being an urban resident, age group between 49-63 years, not having a formal education, and having a personal glucometer at home were associated with good self-care practices. Health care providers might have to consider actions to act on the identified factors and improve the level of self-care practices of the patients.

Work-Related Factors Affecting Exclusive Breastfeeding Among Employed Women in Ethiopia: Managers' Perspective Using a Qualitative Approach.

BACKGROUND: Only 21% of employed mothers in Ethiopia breastfeed exclusively until six months. Evidence from other countries has shown that support from managers encourages mothers to continue breastfeeding. Whereas lack of physical resources, time for breastfeeding and supportive policies adversely impact the continuation of breastfeeding. The aim of this study was to explore the perspective of managers regarding breastfeeding in the Ethiopian context. METHODS: Managers of district level, government institutions were interviewed in the Tigray region of North Ethiopia. Semi-structured, face to face interviews were used to explore managers' perspectives and views about breastfeeding, the level of support they provide to breastfeeding mothers, and the challenges they faced. The data were transcribed verbatim and thematically analysed. RESULTS: Fifteen managers were interviewed from 12 organizations. The data were categorized into three themes. The first theme related to the attitudes and preference of managers and revealed that overall participants had positive views towards breastfeeding. The second theme highlighted managers' concern about the impact of breastfeeding on staffing and workplace productivity. The third theme focused on managers' assertions that, despite improvements, there were still inadequate policies and government strategies to support employed breastfeeding women in North Ethiopia. CONCLUSION: It is promising that managers in North Ethiopia expressed a positive attitude towards supporting breastfeeding mothers. Managers raised concern about the impact of breastfeeding on work performance, as well as the lack of physical facilities and government resources that affects the level of support they can provide.

Enablers and barriers of exclusive breastfeeding among employed women in low and lower middle-income countries.

OBJECTIVE: This systematic review and narrative synthesis aims to explore the specific facilitators and barriers of exclusive breastfeeding (EBF) among employed mothers in low and lower middle-income countries. METHODS: Primary quantitative and qualitative studies undertaken in low and lower middle-income countries published from 2003 to 2019 were included in the review. Two reviewers independently assessed each article for eligibility using standardized critical appraisal instruments from the Joanna Briggs Institute. RESULTS: Seven papers were included in this review. The enabler and barrier factors to EBF are summarized into three categories including maternal factors (such as mode of delivery, number of children, knowledge and attitude on breastfeeding), social factors (such as support from husband, family and child day care), and work-related factors (such as duration of maternal leave, flexibility of work, and availability of physical facilities). CONCLUSION: To increase EBF among employed women, employers should support them by offering flexible working hours, a minimum of six months maternity leave and providing breastfeeding facilities. Support from family and maternal factors were important factors that could positively affect EBF. Identification of modifiable barrier and facilitator factors may contribute to successful EBF in employed women thereby reducing mortality and morbidity in countries with limited resources.

Factors associated with sexual violence among female administrative staff of Mekelle University, North Ethiopia.

OBJECTIVE: To assess factors associated with sexual violence among female administrative staffs of Mekelle University, North Ethiopia. RESULTS: From the total number of participants, 188 (52.8%) had shift work and 110 (30.9%) of these had day and night shift. About half 180 (50.2%) of the participants face sexual violence similarly, 53 (14.9%) of the victims of violence performed by their boss. In multiple logistic regression analysis young age [AOR: 2.319 (1.059-5.075)], educational status of secondary school or less [AOR: 1.981 (1.126-3.485)], office and students related workplace [AOR: 4.143 (1.975-8.687), 2.887 (1.396-5.973)], having night shift [AOR: 2.131 (1.258-3.611)], having multiple partner (AOR: 8.916 (3.052-26.047)] and knowing other female violated in office [AOR: 3.920 (2.326-6.606)] were the factors associated with sexual violence.

Early Implanon discontinuation rate and its associated factors in health institutions of Mekelle City, Tigray, Ethiopia 2016/17.

OBJECTIVE: Contraceptive discontinuation rate is very common in most developing countries, especially removal in the first year of use is common (18-63%), and the majority of these discontinuations are among women who are still in need of contraception. So the objective of this study was assessing early Implanon discontinuation rate and its associated factors in the study area. Institutional based cross sectional study was conducted and systematic random sampling technique was employed to interview the study participants. A binary logistic regression model was used to test association. RESULT: In this study early Implanon discontinuation rate was 38%, 95% CI (32%, 44%). women who attend secondary [AOR: 95% CI 0.35 (0.14, 0.82)] and more than secondary school [AOR: 95% CI 0.23 (0.09, 0.59)] were less likely to remove Implanon early as compared to those illiterate. Mothers who were not counseled [AOR: 95% CI 2.45 (1.05, 5.69)] and those mothers who had a side effect of the method [AOR: 95% CI 2.66 (1.23, 5.72)] discontinue the method early. The study revealed that early Implanon discontinuation rate was high. Women's educational level, presence of side effect and effective counseling were independent predictors of early Implanon removal.

Factors associated with treatment outcome of acute post streptococcal glomerulonephritis among patients less than 18 years in Mekelle City, Public Hospitals, North Ethiopia.

OBJECTIVE: To assess factors associated treatment outcomes of acute post streptococcal glomerular nephritis among patients less than 18 years old in Mekelle City Public Hospitals. RESULTS: About 334 medical records c of children with acute post streptococcal glomerular nephritis were revised during the study period. Of these 244 (73.1%) had a positive outcome. acute post streptococcal glomerular nephritis was found to be statically significant associated with age < 5 years, duration of infection, the source of infection and length of stay in Hospital.