Baby-friendly workplace initiatives in child feeding practice as predictors of infant and young child anthropometric indices in public health facilities of Southern Ethiopia.

BACKGROUND: Baby-friendly workplace is an effective evidence based initiative developed by the World Health Organization to protect and support maternal knowledge, beliefs, and confidence in infant and young child feeding practices. However, studies that show the effect of the baby-friendly workplace initiative on the nutritional status of infant and young children are not available in Ethiopia. Therefore, this study aimed to assess the nutritional status among baby friendly initiatives service utlizers and non utlizers children age 6-24 months in public health facilities of Southern Ethiopia. METHODS: We conducted a comparative cross-sectional study from 1 to 30 June 2022 among 220 mothers with children aged 6-24 months. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epidata Software version 4.2 and then exported to IBM SPSS version 26 software for analysis. Chi-square and Fisher exact test were used to assess the differences between users and non-users of the baby friendly workplace initiative. Logistic regression model was used to determine the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval was computed. P-values < 0.05 at a 95% confidence level were considered statistically significant. RESULT: The mean (SD) scores of weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) were - 0.38 (1.34),-0.17(2.62) and-0.35 (1.84) respectively. After adjusting for covariates, children aged 6-24 months who did not use baby friendly workplace initiatives were 2.26 times more likely to have stunting compared to the users of baby friendly workplace initiative (AOR 2.26, 95% CI: 1.05, 4.88). However, both wasting (AOR: 0.42; 95% CI:0.13, 1.37) and underweight (AOR: 1.09; 95% CI: 0.45, 2.60) were not significantly associated with the use of baby friendly workplace initiatives. CONCLUSION: The use of baby friendly work place initiatives was successful in improving nutritional status, specifically chronic malnutrition in children. Strengthening and scaling up the baby friendly work place initiative program has the potential to reduce chronic malnutrition in Ethiopia and other similar settings with high burden of malnutrition areas, by implementing it in public facilities.

Epidemiological, clinical and laboratory profile of patients presenting with severe acute respiratory syndrome (SARS-CoV-2) in Ethiopia.

INTRODUCTION: Data regarding patients presenting with severe acute respiratory syndrome (SARS-CoV-2) illness have not adequately been documented which provides distinct insights into low-resource settings like Ethiopia. Thus, the study aimed to compare epidemiological, clinical and laboratory profiles of patients presenting with acute respiratory syndrome illness in Addis Ababa Ethiopia. METHODS: We used a comparative cross-sectional study design among patients with SARS-CoV-2 illness at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia from October 2020 to September 2021. Using a structured questionnaire a consecutive sampling technique was applied to collect socio-demographic data. Additionally, nasal swabs were collected to confirm SARS-CoV-2 infection using a Real-Time Polymerase Chain Reaction. Blood samples were also collected from the participants for laboratory profiles (hematological tests like; white blood cell count, hematocrit, and platelet count; and biochemical and enzymatic tests like; aspartate transaminase (AST), creatinine, etc) analysis. Data were entered and analyzed using SPSS version 23.0 and p-values ≤0.05 were considered as statistically significant. RESULTS: Of the total 413 participants presenting with SARS-CoV-2 illness, 250 (60.5%) participants tested positive for COVID-19 disease. COVID-19 patients were less likely to use an alcohol-based method of hand washing (12.5% vs 87.5%; p = 0.048). The COVID-19 patients had a higher proportion of headache (67.3% vs 32.7%, p = 0.001), sore throat (72.5% vs 27.5%, p = 0.001), and loss of sense of taste (74.4% vs 25.6%, p = 0.002). Patients with COVID-19 have significantly higher neutrophil than their counterparts (68.2% vs 31.8%; p = 0.001). Similarly, creatinine (64.9% vs 35.1%, p = 0.001) from renal function and alkaline phosphatase (66.8% vs 33.2%, p = 0.046) in the liver function tests were significantly higher in the COVID-19 patients. CONCLUSION: Our findings suggest the need to substantially consider headache, sore throat, and loss of taste as potential clinical diagnostic symptoms for early screening and testing. Elevation of neutrophil, creatinine, alkaline phosphatase profiles are also used for potential diagnostic biomarkers in screening and testing suspected patients.

Determinants of pneumonia among under-five children in Oromia region, Ethiopia: unmatched case-control study.

BACKGROUND: Pneumonia is the single largest infectious disease that causes more under-five morbidity and mortality than any other infectious disease in the world, including Ethiopia. The aim of this study is to assess determinants of pneumonia among under-five children in the South West Shewa Zone, Oromia Region, Ethiopia, 2021. METHODS: We used an unmatched case-control study design from March 15 to April 30, 2021, in the South West Shewa Zone, Ethiopia. A sample of 398 (199 cases and 199 controls) participated in the study. Trained data collectors through a pre-tested structured questionnaire collected data. We used Epi Info to enter data and analyzed using SPSS version 23. We described our data using descriptive statistics. We identified predictors of pneumonia using logistic regression analysis. We declared predictors of pneumonia at a P-value of 0.05 or less. RESULTS: Breastfeeding for less than 6 months [AOR:3.51, 95%CI:(1.12,11.00)], lack of Vitamin A supplementation [AOR:3.56,95%CI:(1.58, 8.05)], history of URTI [AOR:9.66, 95%CI:(4.69,19.87)], family child care practices [AOR:6.46, 95%CI, (2.83,14.76)], sleeping with three to five persons in a room [AOR:2.90, 9%CI: (1.23,6.84)], having above five persons in a room [AOR: 3.88, 95%CI: 1.02,14.77), use of wood as a source of fuel [AOR = 3.02 95% CI: 1.41,6.46)] and not opening windows [AOR:2.56 95%CI: (1.21,5.41)] were independent factors of pneumonia among under five children. CONCLUSION: Pneumonia is associated with breastfeeding for less than 6 months, lack of vitamin A supplementation, history of URTI, types of childcare practice, indoor overcrowding, use of wood as a source of fuel, and not opening windows. Therefore, exclusive breastfeeding, improving vitamin A supplementation, early control of respiratory tract infection through promoting good hygiene and ventilation strategies in crowded homes, and promoting how to reduce indoor air pollution through affordable clean stoves will be relevant interventions to reduce under-five pneumonia.

Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia.

BACKGROUND: Long Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia. METHODS: A Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching. RESULTS: Of the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children. CONCLUSION: Discontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Ethiopia has a substantially greater percentage of unintended pregnancy than other developing and developed countries. Long-acting reversible contraception (LARC) has a potential to address a huge and growing unmet need in resource limited countries like Ethiopia, such as reducing unwanted births and abortion rates.As part of this global approach to fertility management, Ethiopia has been implementing various strategies like an on-going task shifting and task sharing with the implanon scale up program, and IUD revitalization program starting from the community health services to higher level healthcare systems to increase access and utilization of long acting reversible family planning methods. However, discontinuing LARCs before the recommended duration use and switching to short-acting contraceptives have proven difficulty in Ethiopia. This may have led to low utilization rate of LARCs in Ethiopian contexts including the study area, when compared to the national target. Very low coverage of use of LARC among unmet need has shown by many studies in various corners of the country. Thus, determining the magnitude and factors of LARC discontinuing and switching is still a pressing need to establish additional strategies used to improve consistent use of LARC for the recommended duration and expand access to LARC for better planning of births.In this study we assessed magnitude and factors of LARC discontinuation and switching from a relatively huge number of records extracted from systematically selected health facilities in Southern Ethiopia. Extracted data from registers of long acting reversible family planning methods were analysed using descriptive statistics and logistic regression. Accordingly, we found significant proportion women discontinued long acting reversible family planning methods before the recommended duration of use as well as switched from long acting reversible family planning methods to other modern short-acting methods due to various reasons. Only a number of children women had is associated with discontinuation and no single factor was associated with method switching in Southern Ethiopia. Family planning services should be re-evaluated with a focus on effective counseling on the side effects of LARCs approaches, and training for family planning providers, particularly community healthcare workers, should be provided.

What do service providers in Southern Ethiopia say about barriers to using youth-friendly sexual and reproductive health services for adolescents?: Qualitative study.

BACKGROUND: In Ethiopia, the utilization coverage of adolescent-friendly health services (AFSRHs) ranged only from 9 to 55% and it was the lowest of all Sub-Saharan African countries in 2016. Little is known why adolescents were not accessing the existing services to the side of healthcare providers. OBJECTIVE: The aim of this study is to explore contextual perceived and actual barriers to accessing AFSRHs by adolescents in Southern Ethiopia. METHODS: Phenomenological study design supplemented with observation was used to explore perceived and actual barriers to accessing AFSRHs in 2020. Criterion sampling was used to select study participants. In-depth interviews with healthcare providers and non-specialist sexual and reproductive healthcare providers were conducted. Transcribed interviews and observations were imported to Open Code 4.02 for coding, categorizing, and creating themes. Finally, barriers to accessing existing services were explained using thematic analysis. RESULTS: The study explores contextual barriers to accessing sexual and reproductive health services in five emergent themes. According to providers' points of view, the barriers include ranging from providers (e.g. poor providers' competency), health facilities (e.g. supply constraints and unsupportive environment), adolescents (e.g. perceived lack of information and attitude towards SRHs), community (e.g. lack of parental and social support), and broader health system (e.g. poor implementation and multi-sectorial engagement). CONCLUSION: As to providers, adolescents face multiple barriers to accessing youth friendly sexual and reproductive health services. Healthcare facilities and all levels of the healthcare system should implement varieties of approaches to increase access to the services for adolescents. Given the lack of progress in utilization of adolescents- youth friendly sexual and reproductive services, the existing strategy should be re-evaluated and new interventions at all levels of the healthcare system are needed. Moreover, implementation research is required at system level factors.

Proximate determinants of fertility in Ethiopia; an application of revised Bongaarts model.

BACKGROUND: World population is growing at about 80 million people each year. Ethiopia is the 12th most populous country in the world. Existing literatures showed that the role of proximate determinants in inhibiting the total fertility has not yet been determined from the DHS data in the country. This study may provide evidence based information regarding the observed changes in total fertility. The objective of this study was assessing proximate determinants of fertility and the role of selected socio-economic variables in influencing fertility in Ethiopia. METHODS: The EDHS data of 2011 and 2016 were used in our study. A total of 16,515 eligible women included in 2011 and 15,683 in 2016 surveys made up the sample for the study. The roles of each of the four proximate determinants in declining fertility have been determined. The background variables selected for the analysis include: region of residence, educational status, wealth index and place of residence. The Bongaart model is used to explain the observed socio-economic differentials in fertility during the two survey years. RESULTS: In 2011, index of marriage inhibited fertility by 37.8%, however in 2016 it inhibited fertility by 34.4%. In 2011, contraceptive use reduced fertility by 28.5% while in 2016 it reduced fertility by 30.7%. The index of postpartum infecundity decreased fertility by 34.7% in 2011 and by 34.5% in 2016. Foetal wastage inhibited fertility by 9.2% in both survey years. The total fertility rate in 2016 was 4.14 whereas the projected total fertility in 2020 will be 3.2 children per woman. CONCLUSION: Among the four proximate determinants of fertility, the contribution of index of marriage was the highest in inhibiting fertility in 2011. On the other hand, the contribution of postpartum infecundability was the highest in inhibiting fertility in 2016. The contribution of the index of contraceptive in inhibiting fertility increased from 28.5% in 2011 to 30.7% in 2016. The index of foetal wastage contributed the least in both 2011 and 2016 survey years. Therefore, strategies have to be designed to promote the contraceptive use and breast feeding practices among the reproductive women.

Adolescent-parent communication on sexual and reproductive health issues and its factors among secondary and preparatory school students in Hadiya Zone, Southern Ethiopia: institution based cross sectional study.

BACKGROUND: Adolescent communication with parents is paramount to reduce sexual health problems. Currently, there is a shortage of information on adolescent-parent communication in Ethiopia in general and study area in particular. Thus, this study is intended to determine adolescent-parent communication on sexual and reproductive health issues and its factors among secondary and preparatory school adolescents in Hadiya Zone, Ethiopia. METHODS: We used institution based cross-sectional study design. We stratified schools into urban and semi-urban settings. Then, a total of 8 schools were randomly selected from the strata. The sample size was allocated for each stratum. Finally, participants were randomly selected from separate sampling frames prepared for each stratum. We developed structured questionnaire from related literatures to collect data on adolescent-parent communication and its factors. We cleaned and entered data using EPI info version 3.5.3 and exported to SPSS version 20 for descriptive and logistic regression analysis. RESULTS: The proportion of adolescents who had communicated with their parents was 144 (35.0%). Multivariate logistic regression analysis indicates that participants' knowledge about availability of adolescent and youth friendly sexual and reproductive health services at health facilities [AOR: 0.40, 95% CI: (0.26, 0.62),P-value = 0.001], utilization of adolescent and youth friendly sexual and reproductive health services [AOR: 0.46, 95% CI: (0.29, 0.72),P-value = 0.001] and respondents' educational status: being grade 9, [AOR: 3.21, (95% CI: ((1.16, 8.89), P-value = 0.025] and grade 11; [AOR: 2.96, (95% CI: (1.06, 8.30),P- value =0.039] were statistically associated factors affecting adolescents for not communicating with parents on sexual and reproductive health issues. CONCLUSION: The findings of our study imply that adolescents were not communicating much with parents about sexual and reproductive health issues even though they were aware of adolescent and youth friendly sexual and reproductive health services. In addition, promotion of service availability may be important to motivate adolescents to communicate with parents. Contextual and age dependent communication barriers should be further identified. Further research is needed in the area to identify barriers particularly from parent side.

Health seeking behavior and its determinants for cervical cancer among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: community based cross sectional study.

BACKGROUND: Cervical cancer is one of the most easily preventable forms of female cancers if early screening and diagnosis is made. Low awareness level about the disease and risk factors, beliefs about the disease, poor access to preventive services, affordability of the service and current health service system can influence decision to seek health care services for cervical cancer. The objective of this study was to determine health seeking behaviour and determinant factors for cervical cancer in Hossana town. METHODS: Our study was carried out in Hossana town using community based cross-sectional study design. The study population was women of childbearing age (15-49 years) who had the chance of being randomly selected from the source population. Five hundred ninety five women of childbearing age were included in the study. Systematic random sampling technique was employed to select the study units. Structured and pretested questionnaire was used to collect the data. The collected data were cleaned and entered by EPI info version 3.5.4 and analysed by SPSS version 16. We considered P-value < 0.05 to decide statistically significant association between the independent and dependent variables. RESULTS: The prevalence of health seeking behaviour for cervical cancer among the study participants was only 14.2%. Respondents' poor knowledge [AOR: 7.25, 95% CI: (1.87, 28.08)], not ever received information [AOR: 52.03, 95% CI: (13.77, 196.52)] and not actively searching information about cervical cancer [AOR: 14.23, (95%CI: (3.49, 57.95)] were significantly associated factors with not seeking health for prevention and control of cervical cancer. CONCLUSION: The prevalence of health seeking behaviour for cervical cancer is low. Respondent' poor knowledge, not ever received information, and not actively searching information about cervical cancer are significantly associated with not seeking health for cervical cancer prevention and control. This study stressed the importance of increasing knowledge, promoting active search of health information and experiences of receiving information from different sources regarding health seeking behaviour.

Magnitude of Malaria and Factors among Febrile Cases in Low Transmission Areas of Hadiya Zone, Ethiopia: A Facility Based Cross Sectional Study.

BACKGROUND: Despite a remarkable decline in morbidity and mortality since the era of malaria roll back strategy, it still poses a huge challenge in Ethiopia in general and in Hadiya Zone in particular. Although, there are data from routine health management information on few indicators, there is scarcity of data showing magnitude of malaria and associated factors including knowledge and practice in the study area. Therefore, the aim of this study was to assess magnitude and factors affecting malaria in low transmission areas among febrile cases attending public health facilities in Hadiya Zone, Ethiopia. METHODS: A facility based cross-sectional study was conducted in Hadiya Zone from May 15 to June 15, 2014. Simple random sampling was used to select the health facility while systematic random sampling technique was used to reach febrile patients attending public health facilities. Data were collected by a pre-tested structured questionnaire containing sections of socio demographic risk factors and knowledge and prevention practices of malaria. Data were entered to Epi-Info software version 3.5.4 and exported to SPSS version 16 for descriptive and logistic regression analysis. RESULTS: One hundred six (25.8%) of participating febrile patients attending at sampled health facilities were found to have malaria by microscopy. Of which, P.vivax, P.falciparum and mixed infection accounted for 76(71. 7%), 27 (25.5%) and 3 (2.8%), respectively. History of travel to malaria endemic area, [AOR: 2.59, 95% CI: (1.24, 5.38)], not using bed net, [AOR: 4.67, 95%CI:, (2.11, 10.37)], poor practice related to malaria prevention and control, [AOR: 2.28, (95%CI: (1.10, 4.74)], poor knowledge about malaria, [AOR: 5.09,95%CI: (2.26,11.50)] and estimated distance of stagnant water near to the residence, [AOR: 3.32, (95%CI: (1.13, 9.76)] were significantly associated factors of malaria positivity in the study. CONCLUSION: The present study revealed that malaria is still a major source of morbidity in the study area among febrile illnesses. Poor level of knowledge, poor prevention practices, not using bed net, travel history to endemic areas and residing near stagnant water were associated factors with malaria positivity in the study area. Therefore, implementers, policy makers and stakeholders should strengthen the services provided by the community health development army, health extension service and health facilities services focusing on increasing malaria intervention coverage and mobilization of information, education and communication to increase knowledge about malaria transmission, prevention and control practices.