Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study.

Background: Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray. Methods: This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05. Results: A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization. Conclusion: The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.

Health extension workers contribution on tuberculosis case notification in Tigray region, Northern Ethiopia: A concurrent mixed method study.

BACKGROUND: Despite the emphasis placed on Community Based Tuberculosis Care (CBTC) implementation by Health Extension Workers (HEWs) within the National Tuberculosis Program (NTP) in Ethiopia, there is little evidence on contribution of HEWs on TB case notification. Therefore, this study aimed to describe the contribution of HEWs on TB case notification and its associated factors in Tigray region, Northern Ethiopia. METHODS: A concurrent mixed method (quantitative and qualitative) cross-sectional study design was conducted in three randomly selected districts in Tigray region, Northern Ethiopia. Quantitative data were collected using a pre-tested semi-structured questionnaire. Qualitative data were collected using Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs) to further describe the community participation and presumptive TB identification and referral system. For the quantitative data, binary logistic regression analysis was done and all variables with P-value of < 0.25 in bivariate analysis were included in the multi-variable model to see predictors of HEWs contribution to TB notification. The qualitative data were thematically analyzed using Atlas.ti version 7. RESULTS: In this study, a total of 68 HEWs were included. From March 1, 2017 to February 28, 2018, a total of 427 TB cases notified in the study areas and one-third (34%) of them were notified by the HEWs referral. Provision of Community Based-Directly Observed Treatment Short course (CB-DOTS) (Adjusted Odds Ratio (AOR) = 3.63, 95% Confidence Interval (CI) = 1.18-11.19) and involvement of community volunteers on CBTC (AOR = 3.31, 95% CI = 1.10-10.09) were significantly associated with the contribution of HEWs on TB case notification. The qualitative findings indicated that high workload of HEWs, inaccessibility of TB diagnostic services at nearby health facilities, and transportation and investigation costs were identified as factors affecting for presumptive TB referral by HEWs. CONCLUSIONS: Provision of CB-DOTS and involvement of community volunteers in CBTC activities should be strengthened to improve the HEWs contribution on TB case notification. Additionally, HEWs should be empowered and further interventions of TB diagnostic services at diagnostic health facilities are needed to improve presumptive TB referral by HEWs.

Knowledge of vaccine handlers and status of cold chain and vaccine management in primary health care facilities of Tigray region, Northern Ethiopia: Institutional based cross-sectional study.

BACKGROUND: Ethiopia federal ministry of health has been working on increasing access to immunization service by deploying solar refrigerators to primary health care facilities. However, there is limited evidence on cold chain and vaccine management status. Therefore, the objective of this study was to assess knowledge of vaccine handlers and status of cold chain and vaccine management and their associated factors in primary health care facilities of Tigray region Northern Ethiopia. METHODS: Institutional based cross-sectional study was conducted in four randomly selected districts of Tigray region, Northern Ethiopia. In each selected district, all primary health care facilities with functional vaccine refrigerators were included in the study. Data were collected using a pre-tested semi-structured questionnaire. The collected data were entered into Epi-data version 3.1 and then exported to Statistical Package for Social Sciences (SPSS) version 21 for analysis. All variables with p-value of < 0.25 in bivariate logistic regression analysis were included in multi-variable model to identify predictors of the dependent variables. RESULTS: In this study, fifty Primary Health Care Facilities (PHCFs) were included with a response rate of 94.4%. The overall level of good knowledge of vaccine handlers and good status of cold chain and vaccine management were 48% (95% CI; 30.7%-62%) and 46% (95%CI; 26.1%-61.3%) respectively. Receiving training on cold chain and vaccine management (AOR = 5.18; 95%CI: 1.48-18.18) was significantly associated with knowledge of vaccine handlers. Furthermore, receiving supportive supervision (AOR = 4.58; 95%CI: 1.04-20.17) and good knowledge of vaccine handlers (AOR = 10.97; 95%CI: 2.67-45.07) were significant associated with cold chain and vaccine management. CONCLUSIONS: This study showed that knowledge of vaccine handlers on cold chain and vaccine management was poor. Similarly, the cold chain and vaccine management status was also poor. Therefore, on-site training should be provided to vaccine handlers to increase their knowledge, so as to improve their practices on cold chain and vaccine management. In addition, Programme based supportive supervision is needed to improve cold chain and vaccine management.

Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey.

INTRODUCTION: Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. METHODS: This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. RESULT: In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1-16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04-2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05-8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40-4.58) and rural residence (AOR = 0.56, 95%CI: 0.36-0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. CONCLUSION: Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.

Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia.

BACKGROUND: In the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts. However, there is limited evidence on implementation status of HH contact TB screening by HEWs. The aim of this program assessment was to describe the implementation status and associated factors of HH contact TB screening by HEWs. METHODS: This programme assessment was conducted in three randomly selected districts from March to April 2018. Data was collected by using pre-tested structured questionnaire. Descriptive statistics was carried out using frequency tables. Logistic regression analysis was done to identify factors associated with HH contacts screening by HEWs. RESULTS: In this programme assessment a total of HHs of 411 index TB cases were included. One-fifth (21.7%) of index TB cases had at least one HH contact screened for TB by HEWs. Having TB treatment supporter (TTS) during intensive phase of index TB case (AOR = 2.55, 95% CI: 1.06-6.01), health education on TB to HH contacts by HEWs (AOR = 4.28, 95% CI: 2.04-9.00), HH visit by HEWs within 6 months prior to the programme assessment (AOR = 5.84, 95% CI: 2.81-12.17) and discussions about TB activities by HEWs with Women Development Army (WDA) leaders (AOR = 9.51, 95% CI: 1.49-60.75) were significantly associated with household contact TB screening by HEWs. CONCLUSIONS: Our finding revealed that the proportion of HH contact TB screened by HEWs was low. Therefore, HEWs should routinely visit HHs of index TB cases and provide regular health education to improve contact screening practice. In addition, it is highly recommended to strengthen HEWs regular discussion about TB activities with WDA leaders and TB TTS.

Magnitude and determinants for place of postnatal care utilization among mothers who delivered at home in Ethiopia: a multinomial analysis from the 2016 Ethiopian demographic health survey.

INTRODUCTION: Above half of mothers in Ethiopia give birth at home. Home based care within the first week after birth as a complementary strategy to facility-based postnatal care service is critical to increase the survival of both mothers and newborns. However, evidence on utilization of postnatal care and location of service among mothers who delivered at home in Ethiopia is insufficiently documented. Therefore, this study assessed the magnitude and determinants for place of postnatal care service utilization among mothers who delivered at home in Ethiopia. METHODS: We used the 2016 Ethiopian Demographic and Health Survey, and extracted data from 4491 mothers who delivered at home during 5 years preceding the survey. A multinomial logistic regression model was applied to examine the determinants of both facility and home -based postnatal care service utilization. Likelihood ratio test was used to see the model fitness and p-value of < 0.05 was used to determine statistical significance at 95% confidence interval. RESULTS: From the total 4491 mothers who delivered at home, only 130(2.9%) and 236(5.3%) of them utilized postnatal service at home and at a health facility respectively. Being from an urban region (AOR = 0.378, 95%CI: 0.193-0.740), ever using the calendar method to delay pregnancy (AOR = 0.528, 95%CI: 0.337-0.826), receiving four and above antenatal care visits (AOR = 0.245, 95%CI: 0.145-0.413) and having a bank account (AOR = 0.479, 95%CI: 0.243-0.943) were the factors associated with utilizing home- based postnatal care. Similarly being a follower of the orthodox religion (AOR = 1.698, 95%CI: 1.137-2.536), being in the rich wealth index (AOR = 0.608, 95%CI: 0.424-0.873), ever using the calendar method to delay pregnancy (AOR = 0.694, 95%CI: 0.499-0.966), wantedness of the pregnancy (AOR = 0.264, 95%CI: 0.352-0.953), receiving four and above antenatal care visits (AOR = 0.264, 95%CI: 0.184-0.380) and listening to radio at least once a week (AOR = 0.652, 95%CI: 0.432-0.984) were the determinants of facility-based postnatal care utilization. CONCLUSION: The coverage of postnatal care service utilization among mothers who delivered at home was very low. Living in urban region, following the Orthodox religion, having higher wealth index, having a bank account, ever using calendar method to delay pregnancy, wantedness of the pregnancy, receiving four and above antenatal care visit and listening to radio at least weakly were associated with postnatal care service utilization. Therefore, targeted measures to improve socio-economic status, strengthen the continuum of care, and increase health literacy communication are critically important to increase postnatal care service utilization among women who deliver at home in Ethiopia.

Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects.

BACKGROUND: Maternal and Perinatal Death Surveillance and Response (MPDSR) was a pilot program introduced in Tigray, Ethiopia to monitor maternal and perinatal death. However; its implementation and operation is not evaluated yet. Therefore, this study aimed to assess the implementation and operational status and determinants of MPDSR using a programmatic data and stakeholders involved in the program. METHODS: Institutional based cross-sectional study was applied in public health facilities (75 health posts, 50 health centers and 16 hospitals) using both qualitative and quantitative methods. Data were entered in to Epi-info and then transferred to SPSS version 21 for analysis. All variables with a p-value of ≤ 0.25 in the bivariate analysis were included in to multivariable logistic regression model to identify the independent predictors. For the qualitative part, manual thematic content analysis was done following data familiarization (reading and re-reading of the transcripts). RESULTS: In this study, only 34 (45.3%) of health posts were practicing early identification and notification of maternal/perinatal death. Furthermore, only 36 (54.5%) and 35(53%) of health facilities were practiced good quality of death review and took proper action respectively following maternal/perinatal deaths. Availability of three to four number of Health Extension Workers (HEWs) (Adjusted Odds Ratio (AOR) = 6.09, 95%CI (Confidence Interval): 1.51-24.49), availability of timely Public Health Emergency Management (PHEM) reports (AOR = 4.39, 95%CI: 1.08-17.80) and participation of steering committee's in death response (AOR = 9.19, 95%CI: 1.31-64.34) were the predictors of early identification and notification of maternal and perinatal death among health posts. Availability of trained nurse (AOR = 3.75, 95%CI: 1.08-12.99) and health facility's head work experience (AOR = 3.70, 95%CI: 1.04-13.22) were also the predictors of quality of death review among health facilities. Furthermore; availability of at least one cluster review meeting (AOR = 4.87, 95%CI: 1.30-18.26) and uninterrupted pregnant mothers registration (AOR = 6.85, 95%CI: 1.22-38.54) were associated with proper response implementation to maternal and perinatal death. Qualitative findings highlighted that perinatal death report was so neglected. Community participation and intersectoral collaboration were among the facilitators for MPDSR implementation while limited human work force capacity and lack of maternity waiting homes were identified as some of the challenges for proper response implementation. CONCLUSION: This study showed that the magnitude of: early death identification and notification, review and response implementation were low. Strengthening active surveillance with active community participation alongside with strengthening capacity building and recruitment of additional HEWs with special focus to improve the quality of health service could enhance the implementation of MPDSR in the region.

Magnitude and Determinant Factors of Surgical Site Infection in Suhul Hospital Tigrai, Northern Ethiopia: A Cross-Sectional Study.

BACKGROUND: Surgical site infections (SSIs) are the most common hospital-acquired infection among surgical patients and remains a major clinical issue. In Ethiopia, despite many studies, the magnitude and associated factors of SSIs are not well documented and differ among regions. The aim of this study was to identify the magnitude and associated factors of SSIs in Suhul Hospital, Northern Ethiopia. METHODS: An institution-based cross-sectional study was conducted from February 2-March 31, 2016, in Shire Suhul Hospital. A total of 280 post-operative patients were included and were selected using simple random sampling. A pre-tested interviewer administrated the questionnaire used to collect relevant information. Data were cleaned, entered, and analyzed using SPSS Version 20. Bivariable and multivariable logistic regression was employed to identify the predictors at p < 0.05. RESULTS: Of the 281 potential study subjects, 280 participated. The mean age of the study subjects was 34.5 years (standard deviation [SD} ±15.6). The prevalence of SSI was 11.1% (95% confidence interval [CI] 7.34-14.67), and in the multivariable logistic regression analysis, four independent determinants emerged as associated with SSI: post-operative hospital stay from 8-14 days (odds ratio [OR] 7.97; 95% CI 1.70-37.38); history of alcohol use (OR 0.04; 95% CI 0.004-0.43); use of local anesthesia (OR 8; CI 1.010-63.398); and dirty incision classification (OR 17; CI 1.249-232.362). CONCLUSION: The magnitude of SSI was high. A hospital stay for more than a week, a history of alcohol consumption, use of local anesthesia, and dirty incision classification were associated independently with a higher risk of SSI. Due attention should be given to infection prevention control methods; and more has to be done to manage dirty and contaminated sites, maintain a strict sterile environment and aseptic surgical techniques, and implement the World Health Organization surgical safety protocol. Efforts should be made to improve appropriate and timely discharge among surgical clients. Prospective longitudinal studies ought to be conducted considering SSI after hospital discharge.