Process Evaluation of Facility Delivery Services in Northwest Ethiopia: In the Case of Public Health Centers.

Background: Even if giving birth at health facility is vital for both the mothers and their newborns, the coverage of institutional delivery in Ethiopia is very low (50%). In that regard, several studies have shown the possible factors of low delivery service uptake from the patients' side, but evidences on delivery services at the health centers are meagre. This study aimed to evaluate the process of delivery services in public health centers of northwest Ethiopia. Methods: A case study evaluation design with an embedded mixed-method was used to evaluate institutional delivery in public health centers of Gondar city. Dimensions from the access (availability, accommodation, and acceptability) and implementation fidelity (compliance) frameworks were used. A total of 363 mothers, 32 document reviews, 32 direct observations, and 17 key informants were included. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall process of institutional delivery services was measured based on pre-determined judgmental criteria. Results: The overall facility delivery process was 75.1%, judged by availability (78.5%), compliance (70.6%), accommodation (68.8%), and acceptability (80.2%) of services. Essential medicines in some of the health centers were stockout, insufficient delivery rooms and inadequate training of health workers on obstetric and newborn care were observed. Using partograph and examining vulval-perineal region for possible laceration during intrapartum period were less practiced. Residence (AOR: 0.13, 95% CI: 0.06-0.30), ANC 1 to 3 visits (AOR: 2.65, 95% CI: 1.05-6.74) and ANC4+ (AOR: 5.57, 95% CI: 2.09, 14.84) were factors affected acceptability of delivery services. Conclusion: Major constraints were in the accommodation of delivery services which needs a holistic effort from all stakeholders. Therefore, implementors with other stakeholders shall improve delivery rooms, facilitate training, and provide parenteral drugs as part of the obstetric and newborn care to improve the facility delivery services in Ethiopia.

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia.

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020.

BACKGROUND: Post-spinal shivering is a common complication after spinal anesthesia with a high incidence among orthopedic patients. Untreated shivering may predispose to exacerbation of wound pain, increased metabolic demand, oxygen consumption, and hemostatic dysfunction. Various studies have been done on the effectiveness of preventing post-spinal shivering using ketamine and other drugs. However, little information on better prophylactic agents in terms of effectiveness and availability. Therefore, this study was intended to compare 0.25 mg/kg of Ketamine (K) versus 0.5 mg/kg of Tramadol (T) for the prevention of post-spinal shivering. METHOD: A prospective cohort study design was employed on 516 patients undergoing orthopedic surgery under spinal anesthesia, and they were selected by a consecutive sampling technique. Patients were divided into two groups based on the anesthetist in charge. Patients who received an intravenous prophylactic dose of Ketamine before spinal anesthesia are called Ketamine groups and patients who received Tramadol are called Tramadol groups (control). The severity and incidence of shivering, blood pressure, heart rate, and axillary body temperature were measured and recorded for one hour at 10-min intervals during the intraoperative period. Descriptive statistics, chi-square, independent t-test, and multivariable logistic regression were used. Significance was declared at a p-value lower than 0.05. RESULTS: The overall incidence of post-spinal shivering was 187 (36.2%), of which it was 74 (28.7%) on ketamine and 113 (43.8%) on tramadol with a p-value of 0.001. The incidence of nausea and vomiting was 157 (60.9%) on tramadol and 8 (3.1%) on ketamine, with a p-value of 0.001. Patients aged 18-35 years (AOR 0.08 (0.02, 0.27), 36-55 years (AOR 0.24, 0.07, 0.81), and those patients with a prolonged duration of surgery (AOR 1.47 (1.37-1.58)) were more likely to experience post-spinal shivering. And Low-dose ketamine has a protective effect against developing post-spinal shivering with an AOR of 0.427 (0.28-0.63). CONCLUSION: Low-dose ketamine is more effective in reducing the incidence and severity of shivering after spinal anesthesia. Therefore, we recommend using low-dose ketamine to be effective as a prophylactic for post-spinal shivering in those patients undergoing orthopedic surgery under spinal anesthesia.

Uptake of postnatal care and its determinants in Ethiopia: a positive deviance approach.

BACKGROUND: Postnatal care (PNC) services are an essential intervention for improving maternal and child health. In Ethiopia, PNC service has been poorly implemented, despite the governments and partners' attempt to improve maternal and child health service utilization. Moreover, many literatures identified that women with no education are significantly underutilized the PNC services. Thus, this study aimed to assess the PNC service uptake among women at high risk for underutilization of PNC services and to identify the individual and community level determinants of PNC services uptake in Ethiopia using the positive deviance approach. METHODS: Data from the Ethiopia Demographic and Health Survey 2016 were used. A total of 2417 deviant women (women with no education) were identified through a two-stage stratified sampling technique and included in this analysis. A multilevel mixed-effect binary logistic regression analysis was computed to identify the individual and community-level determinants of PNC services uptake among deviant women. In the final model, a p-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant determinants of PNC services uptake. RESULTS: In this analysis, the uptake of PNC service among deviant women was 5.8% [95% CI: 4.9-6.8]. Working in the agriculture (AOR = 2.15, 95% CI: 1.13-3.52), being Orthodox religion follower (AOR = 2.56, 95% CI: 1.42-4.57), living in the highest wealth quantile (AOR = 2.22, 95% CI: 1.25-3.91) were the individual level determinants, whereas residing in the city administration (AOR: 3.17, 95% CI: 1.15-8.71), and living closer to health facility (AOR: 1.57, 95% CI: 1.03-2.39) were the community level determinants. CONCLUSION: The study highlighted a better PNC service uptake among deviant women who are working in the agriculture, follows orthodox religion, lives in highest household wealth status, resides in city administration, and living closer to the health facility. The positive deviance approach provides evidences for health policy makers and program implementers to improve health behavior in specific target population, and ultimately to bring better maternal and child health outcomes, despite acknowledged adverse risk profile. Such strategy and knowledge could facilitate targeted efforts aimed at achieving national goals of maternal and newborn mortality reduction in the country.

Evaluation of the outpatient therapeutic program for severe acute malnourished children aged 6-59 months implementation in Dehana District, Northern Ethiopia: a mixed-methods evaluation.

BACKGROUND: In Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia.  METHODS: A facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children's (diagnosed with acute malnutrition) record reviews, nine key informants' interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done. RESULTS: The overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09-0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04-4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01-3.30) were significantly associated with the acceptability of OTP program. CONCLUSION: The overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management.

Micronutrient intake status and associated factors among children aged 6-23 months in the emerging regions of Ethiopia: A multilevel analysis of the 2016 Ethiopia demographic and health survey.

BACKGROUND: Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6-23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6-23 months in the emerging regions of Ethiopia. METHODS: Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6-23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors. RESULTS: In this analysis, 37.3% (95% CI: 34.3-40.3) of children aged 6-23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4-2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3-3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2-2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3-4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0-3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1-0.9) was the community-level factors that decrease micronutrient intake. CONCLUSIONS: Micronutrient intake among children aged 6-23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6-23 months.

Outcome evaluation of capacity building and mentorship partnership (CBMP) program on data quality in the public health facilities of Amhara National Regional State, Ethiopia: a quasi-experimental evaluation.

BACKGROUND: Capacity Building and Mentorship Partnership (CBMP) is a flagship program designed by the Ethiopian Ministry of Health in collaboration with six local universities to strengthen the national health information system and facilitate evidence-informed decision making through various initiatives. The program was initiated in 2018. This evaluation was aimed to assess the outcome of CBMP on health data quality in the public health facilities of Amhara National Regional State, Ethiopia. METHODS: A matched comparison group evaluation design with a sequential explanatory mixed-method was used to evaluate the outcome of CBMP on data quality. A total of 23 health facilities from the intervention group and 17 comparison health facilities from a randomly selected district were used for this evaluation. The Organization for Economic Cooperation and Development (OECD) evaluation framework with relevance, effectiveness, and impact dimensions was used to measure the program's outcome using the judgment parameter. The program's average treatment effect on data quality was estimated using propensity score matching (PSM). RESULTS: The overall outcome of CBMP was found to be 90.75 %. The mean data quality in the intervention health facility was 89.06 % [95 %CI: 84.23, 93.88], which has a significant mean difference with the comparison health facilities (66.5 % [95 % CI: 57.9-75]). In addition, the CBMP increases the data quality of pilot facilities by 27.75 % points [95 %CI: 17.94, 37.58] on the nearest neighboring matching. The qualitative data also noted that there was a data quality problem in the health facility and CBMP improved the data quality gap among the intervention health facilities. CONCLUSIONS: The outcome of the CBMP was highly satisfactory. The program effectively increased the data quality in the health facilities. Therefore, the finding of this evaluation can be used by policymakers, program implementers, and funding organizations to scale the program at large to improve the overall health data quality for health outcome improvement.

A multilevel analysis of determinants of PMTCT service utilisation among women during the antepartum, intrapartum and postpartum period in Ethiopia.

BACKGROUND: Mother-to-child transmission (MTCT) is the largest source of HIV infection in children below the age of 15 years, and more than 90% of pediatric HIV are infected through mother to child transmission. Without treatment, one-half of those infected children will die before the age of 2 years. Despite this, there is limited evidence on PMTCT and its determinants. Therefore, this study aimed to determine the factors affecting the PMTCT service utilisation in Ethiopia. METHODS: A two-stage stratified sampling technique was used to identify 4081 women from 2016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to identify the individual and community level factors associated with PMTCT services utilisation. In the final model, a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant factors with the utilisation. RESULTS: Overall, 21.9% (95% CI, 20.6-23.2) of the women were utilized PMTCT services. Educational status; primary (AOR: 1.65, 95% CI: 1.27-2.13), secondary (AOR: 1.52, 95% CI: 1.03-2.24) and higher school (AOR: 2.48, 95% CI: 1.45-4.22), poorer (AOR: 1.62, 95% CI: 1.12-2.37), middle (AOR: 1.82, 95% CI: 1.10-3.02), richer (AOR: 2.44, 95% CI: 1.42-4.21) and richest (AOR: 4.45, 95% CI: 2.43-8.14) wealth status and orthodox religion follower (AOR: 1.62, 95% CI: 1.22-2.16) were the individual level factors. Moreover, having basic (AOR: 1.66, 95% CI: 1.34-2.06) and comprehensive (AOR: 1.73, 95% CI: 1.38-2.18) knowledge on HIV prevention methods, having knowledge on MTCT of HIV (AOR: 2.69, 95% CI: 2.16-3.36) were also factors at individual level. Whereas, rural residence (AOR: 0.52, 95% CI: 0.32-0.85) was the community level factors that affects the utilization. CONCLUSIONS: Less than one-fourth of the mothers had utilised the PMTCT services in Ethiopia. To increase the utilisation of the services, the health care providers should give emphases on counselling, awareness creation, and strengthen the existing frontline integrated health care services in the country.

Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis.

BACKGROUND: Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis. METHODS: Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger's weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses. RESULT: A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587-9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469-8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761-3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006-2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858-3.101), P = 0.001). CONCLUSION: In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

Health System Responsiveness for HIV/AIDS Treatment and Care Services in Shewarobit, North Shewa Zone, Ethiopia.

PURPOSE: Health System Responsiveness is the key objective of the health system used to fulfil patients' universal legitimate expectations. However, the health system's responsiveness to HIV/AIDS was not assessed in Ethiopia. Therefore, this study aimed at assessing the health system responsiveness of HIV/AIDS treatment and care services and associated factors in the public health facilities of Shewarobit town, Ethiopia. PATIENTS AND METHODS: An institution-based cross-sectional study was employed from 15 February to 15 April 2020 in the public health facilities of Shewarobit town. The data were collected among 416 randomly selected Anti-Retroviral Therapy (ART) users using an interviewer-administered questionnaire. Responsiveness was measured using 27 Likert scale questions across seven responsiveness domains. A binary logistic regression model was fitted. A p-value of less than 0.05 and AOR with a 95% confidence interval (CI) was used to declare the associated factors in the final multivariable logistic regression analysis. RESULTS: The overall health system responsiveness was 55.3% (95% CI: 50.6-59.8). High performance of responsiveness was found on confidentiality, respect, and communication domains, whereas poor responsiveness was achieved in prompt attention and choice domains. Participants aged 50+ years (AOR:2.48, 95% CI, 1.12-5.54), perceived good health (AOR: 3.10, 95% CI: 1.75-5.48), patients' satisfaction with care (AOR: 2.98, 95% CI: 1.35-6.54) and history of visiting traditional healers (AOR: 2.50, 95% CI:1.51-4.17) were factors associated with health system responsiveness of HIV/AIDS treatment and care services in the study area. CONCLUSIONS: Unacceptable responsive performance was found in choice and prompt attention domains. Participants' age, perceived health status, history of visiting traditional healers, and patient satisfaction were factors that affect responsiveness in the study area. Thus, providing training, frequent supportive supervision, improving community awareness, and incorporating traditional healers in the modern health system would enhance the health system responsiveness in Ethiopia.

Feeding Practices and Associated Factors During Diarrheal Disease Among Children Aged Less Than Five Years: Evidence from the Ethiopian Demographic and Health Survey 2016.

PURPOSE: Diarrhea is a common childhood illness and one of the leading causes of death in young children globally. In Ethiopia, a significant number of deaths and hospitalizations in under-five children are related to diarrheal diseases. Inappropriate feeding during diarrhea leads to a double burden of diarrhea recurrence and malnutrition among children. However, empirical evidence is limited in Ethiopia. Thus, this study was aimed to assess feeding practices and associated factors during diarrheal disease among children aged less than five years in Ethiopia. PATIENTS AND METHODS: The study used the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A two-stage stratified sampling technique was applied to identify 917 under five years children. Generalized linear mixed model analyses were computed, and a P value of less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify statistically significant factors with feeding practices. RESULTS: The majority (92.5%) of mothers were married. Out of the participants, (54.1%) of children were male; 55.6% of them were in the age group of 6-23 months. The appropriate feeding practices for children aged less than five years who had diarrhea was 15.4% (95% CI: 13.7%-18.2%). Mothers aged 25-34 years (AOR: 0.6, 95% CI: 0.4-0.9), agricultural occupation of mothers (AOR: 2.2, 95% CI: 1.3-3.6), mothers attended four and more antenatal visit (AOR: 2.3, 95% CI: 1.3-4.32) and mothers who had a postnatal checkup within two months of birth (AOR: 1.9, 95% CI: 1.1-3.2) were factors statistically associated with child feeding practices during diarrhea. CONCLUSION: Less than one-fifth of under-five children practiced appropriate feeding during diarrheal disease. Working in agriculture and attending antenatal care and postnatal checkup within two months were positively influencing feeding practice. Therefore, the government of Ethiopia needs to strengthen the existing maternal and child health services.

Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey.

BACKGROUND: The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. METHODS: In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. RESULTS: Overall, 17.6% (95% CI: 15.6-19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21-0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16-0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21-4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16-0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44-4.82) was the community-level factors associated with the exclusive breastfeeding practices. CONCLUSIONS: Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother's employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

Prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project.

OBJECTIVE: Ethiopia is one of the Africa's signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia. STUDY DESIGN: The study is community-based cross-sectional study. STUDY SETTING: Dabat and Gondar Zuria districts, Northwest Ethiopia. PARTICIPANTS: Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis. METHODS: A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination. OUTCOMES: Incomplete or not at all vaccination. RESULTS: The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25). CONCLUSIONS: In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.

High Hidden Burden of Diabetes Mellitus among Adults Aged 18 Years and Above in Urban Northwest Ethiopia.

BACKGROUND: Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose (FBS) ≥ 126 mg/dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association. RESULT: Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06, 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes. CONCLUSION: The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services.

Improving the Assessment and Classification of Sick Children according to the Integrated Management of Childhood Illness (IMCI) Protocol at Sanja Primary Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

BACKGROUND: A complete and consistent use of integrated management of childhood illness (IMCI) protocol is a strategic implementation that has been used to promote the accurate assessment and classifications of childhood illnesses, ensures appropriate combined treatment, strengthens the counseling of caregiver, and speeds up the referrals to decrease child mortality and morbidity. However, there is limited evidence about the complete and consistent use of IMCI protocol during the assessment and classifications of childhood illness in Ethiopia. Therefore, this intervention was implemented to improve the assessment and classifications of childhood illness according to the IMCI protocol in Sanja primary hospital, northwest Ethiopia. METHODS: A pre-post interventional study was used in Sanja primary hospital from January 01 to May 30, 2019. A total of 762 (381 for pre and 381 for postintervention) children from 2 months up to 5 years of age were involved in the study. Data were collected using a structured questionnaire prepared from the IMCI guideline, and a facility checklist was used. A five-month in-service training, weekly supportive supervision, daily morning session, and availing essential drugs and materials were done. Both the descriptive statistics and independent t-test were done. In the independent t-test, a p value of <0.05 and a mean difference with 95% CI were used to declare the significance of the interventions. RESULTS: The findings revealed that the overall completeness of the assessment was improved from 37.8 to 79.8% (mean difference: 0.17; 95% CI: 0.10-0.22), consistency of assessment with classification from 47.5 to 76.9% (mean difference: 0.34; 95% CI: 0.27-0.39), classification with treatment from 42.3 to 75.4% (mean difference: 0.35; 95% CI: 0.28-0.47), and classification with follow-up from 32.8 to 73.0% (mean difference: 0.36; 95% CI: 0.29-0.42). CONCLUSION: The intervention has a significant improvement in the assessment and classification of childhood illness according to the IMCI protocol. Therefore, steps must be taken to ensure high quality of training, adequate supervision including the observation of health workers managing sick children during supervisory visits, and a constant supply of essential drugs and job aids for successful implementation of IMCI in the hospital and also to other facilities.

Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

INTRODUCTION: Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia. MATERIALS AND METHODS: A pre-post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of <0.05 and a mean difference with 95% CI was used to test the significance of the interventions. RESULTS: The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55-0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline. CONCLUSION: Respectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in-service training of healthcare workers may indorse the practice of respectful maternal care.

Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study.

PURPOSE: Ethiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia. PATIENTS AND METHODS: A community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services. RESULTS: The utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8-63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21-0.63), housewives (AOR=0.36, 95% Cl=0.20-0.64), merchants (AOR=0.08, 95% Cl=0.03-0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73-6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02-2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22-3.18) were factors significantly associated with the utilization of urban health extension services. CONCLUSION: The overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants' perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation.

BACKGROUND: Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system's objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies' employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies' employees in northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies' employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance. RESULTS: Overall, 32% (95% CI: 27.7-36.2) of the government-owned companies' employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69-27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12-2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39-0.92), work experience (AOR: 0.49, 95% CI: 0.26-0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04-0.71) were significantly associated with acceptance of SHI among government-owned companies' employees. CONCLUSIONS: One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.

Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project.

BACKGROUND: The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. METHODS: A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. RESULTS: The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. CONCLUSIONS: The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.

Determinants of postnatal care non-utilization among women in Demba Gofa rural district, southern Ethiopia: a community-based unmatched case-control study.

BACKGROUND: Maternal and neonatal mortality remain a significant problem across much of the developing world, especially in sub-Saharan Africa countries. In Ethiopia, most maternal and neonatal deaths occur during the postpartum period; this is a critical time for monitoring the health of women and newborns, but the most neglected period for care. In rural communities of Ethiopia, the utilization of postnatal care service is very low and evidence on which factors contribute to the non-utilization of postnatal care (PNC) is insufficient. Consequently, this study was designed to identify the determinants of postnatal service non-utilization among women who gave birth in Demba Gofa rural district, Southern Ethiopia. METHODS: A community-based unmatched case-control study was conducted among 186 cases (postnatal care non-utilizers) and 186 controls (postnatal care utilizers) in Demba Gofa rural district from March 1 to April 10, 2019. A previously tested interviewer-administered structured questionnaire was used for data collection. Binary logistic regression analysis was performed. In the final multivariable logistic regression analysis model, a p-value of less than 0.05 and an Adjusted Odd Ratio (AOR) with a 95% confidence interval (CI) was used to determine variables for postnatal care non-utilization. RESULTS: In this study, women who delivered recently were incorporated within 186 cases and 186 controls. Not knowing the availability of PNC services (AOR: 4.33, 95% CI: 1.71-10.99), having a home delivery (AOR: 7.06, 95% CI: 3.71-13.44), ANC non-attendance (AOR: 6.14, 95% CI: 3.01-12.50), unable to make an independent decision (AOR: 9.31, 95% CI: 3.29-26.35), and not participating in the Women's Development Army (WDA) (AOR: 5.09, 95% CI: 2.73-9.53) comprised the determinants which were assessed for non-utilization of postnatal care services. CONCLUSIONS: Encouraging institutional delivery along with integrated health education about postnatal care and postnatal danger signs, empowering women to execute independent decisions, accessing PNC services and strengthening participation in the Model Families will likely improve postnatal care service utilization in the district of Ethiopia.