Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis.

Background: Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods: Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results: Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion: The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Pharmacy professionals' perceptions of their professional duties in the Ethiopian health care system: a mixed methods study.

BACKGROUND: Pharmacy professionals are experts in therapeutic knowledge, experience, and skills that are used to ensure desired patient outcomes, utilizing the best available clinical evidence and interventions in collaboration with the health care team. They perceive themselves as a provider of technical, standardized, and individualized advice. The objective of this study was thus to assess the perception of pharmacy professionals towards their current professional roles in the health care system in Dessie, a city in the north-east Ethiopian region. METHODS: A mixed-methods sequential explanatory study was used to assess the perception of pharmacy professionals towards their professional roles in Dessie city administration from December 15-30, 2019. The study participants were all pharmacy professionals working at health facilities in Dessie. Self-administered questionnaires were used to collect quantitative data, and face-to-face key informant interviews were used for qualitative data collection. Data were entered, processed, and analyzed using SPSS 25.0 statistical software, and thematic analysis was used for the qualitative exploration using QDA Miner Lite software (v2.0.7, free edition version). RESULT: The study had a 97.7% response rate. Of the 301 participants, 173 (57.5%) were male. Most of the participants had a positive perception, while 38 (12.6%) had a poor perception of their current professional roles. Lack of physical access, poor initiatives, poor communication skills, and a lack of administrative support for pharmaceutical care were statistically significant at a p value of 0.05 and a 95% confidence interval. From the qualitative data, two major themes emerged: perceived roles and determinants (perceived facilitators and barriers). CONCLUSION: Pharmacy professionals' roles were found to be influenced by a lack of physical access, poor initiatives, poor communication skills, and poor administrator support. Pharmaceutical care requires everyone's involvement in addressing these factors for successful performance and a better outcome and in considering perceived facilitators and barriers.

Corrigendum: Willingness to pay for social health insurance in Ethiopia: a systematic review and meta-analysis.

[This corrects the article DOI: 10.3389/fpubh.2023.1089019.].

Hepatitis B virus infection and associated factors among antenatal care attendees in Dessie City Administration, North-East Ethiopia: a case-control study.

The hepatitis B virus remains a major public health problem due to a variety of risk factors, which we aimed to investigate in Dessie City Administration, Ethiopia. Unmatched case-control study was conducted from February to May 2021 using systematic random sampling. The data were collected using an interviewer-administered questionnaire, then cleaned using EpiData version 4.6.0 and exported to SPSS version 25.0 for analysis. The odds ratio with a 95 percent CI was used to determine the association between the independent and outcome variables. A total of 421 participants (105 cases and 316 controls) were enrolled. A history of having multiple sexual partners (AOR = 4.64; 95 percent CI: 2.64-8.14); a history of abortion (AOR = 3.18; 95 percent CI: 1.78-5.66); the presence of a hepatitis B carrier in the family (AOR = 8.70; 95 percent CI: 4.26-17.77); a history of hospitalization (AOR = 2.98; 95 percent CI: 1.56-5.69); and retroviral seropositivity (AOR = 3.68; 95 percent CI: 1.55-8.74) were independent risk factors for having hepatitis B virus infection. In conclusion, antenatal infection with the virus was found to be determined by the number of sexual partners, abortion and hospitalization, hepatitis B carriers in the family, and retroviral seropositivity, which dictates the need for integrated community-wide intervention.

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study.

Background: The fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme's sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries' satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries' satisfaction and associated factors in Legambo district, North-East Ethiopia. Methods: The study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries' satisfaction. Results: The overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02-3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02-2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04-7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08-11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56-31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71-5.09), presence of referral services (AOR =1.93, 95% CI = 1.33-2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01-2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64-24.20). Conclusion: The beneficiaries' satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).

Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis.

Background: Ethiopia plans to introduce social health insurance with the aim of giving recipients high-quality, long-term universal health care. It was anticipated to be fully operational in 2014. However, due to strong opposition from public employees, the implementation has been delayed multiple times. As a result, more and more studies have been conducted to collect evidence about the issue. However, there is no national pooled evidence regarding the willingness to pay for the scheme. Thus, this review aimed to evaluate the willingness to pay for social health insurance and associated factors in Ethiopia. Methods: On September 1, 2022, database searches were conducted on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Based on this search, 19 studies were included in the review. The risk of bias for the included studies was assessed using Joana Briggs Institute checklists. The data were extracted using Microsoft Excel. RevMan-5 was used to conduct the meta-analysis. The effect estimates assessed were the odds ratios at a p-value <0.05 with a 95% CI using the random effect model. Results: The pooled willingness to pay for social health insurance was 42.25% and was found to be affected by sociodemographic, health and illness status, health service related factors, awareness or knowledge level, perception or attitude toward the scheme, and factors related to the scheme. The pooled result showed that the willingness of participants to pay for the scheme was 16% less likely (OR = 0.84; 95% CI: 0.52-1.36). When the outlier was unchecked, the willingness to pay became 42% less likely (OR = 0.58; 95% CI: 0.37-0.91). The lowest willingness to pay for the scheme was in the Oromia region, while the highest was in Harar. Professionally, teachers were 3.22 times more likely to pay for the scheme (OR = 3.22; 95% CI: 1.80-5.76) than health professionals. Conclusion: The willingness to pay for social health insurance was low, <50%, particularly among health professionals, which urges the Ethiopian health insurance service to deeply look into the issue.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE: We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS: On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS: The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION: Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

Barriers and facilitators to insulin treatment: a phenomenological inquiry.

BACKGROUND: Despite being the most effective treatment for advanced type 2 diabetes, the choice to start and maintain insulin therapy is based on a variety of criteria, including the patients' acceptance and willingness to adhere to it. The patients' beliefs and experiences, on the other hand, could not be revealed without a thorough exploration. OBJECTIVES: This study investigated the barriers and facilitators to insulin treatment from the perspectives of patients with type 2 diabetes following treatment at Dessie Comprehensive Specialized Hospital, North-East Ethiopia. METHODS: A phenomenological study was conducted from July 2019 to January 2020. Twenty-four (11 males and 13 females) participants were recruited purposively. Data were collected through face-to-face in-depth interviews, lasted about 23 to 71 min, until theoretical saturation was reached, and then organized using QDA Miner Lite v2.0.9. The transcripts were thematically analyzed using narrative strategies and the themes that arose were discussed in detail. RESULTS: The most common facilitator of insulin treatment was its relative effectiveness, which was followed by its convenience (fewer gastrointestinal side effects, small needle size and ease of use), the concept of it is life, faith in doctors' decisions, family support, and health insurance membership. The most common impediments, on the other hand, were market failures (expensiveness and supply shortages), followed by its properties and patients' circumstances. CONCLUSIONS: Market failures due to supply shortages and associated costs were identified to be the most significant barriers to insulin treatment, necessitating the availability of an effective pharmaceutical supply management strategy that targets on insulin supply and affordability. It is also strongly recommended that health insurance coverage be increased.

Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study.

BACKGROUND AND AIMS: Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia. METHODS: The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged. RESULTS: The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators. CONCLUSION: Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.

Sufferings of its consequences; patients with Type 2 diabetes mellitus in North-East Ethiopia, A qualitative investigation.

BACKGROUND: The burden of diabetes in Ethiopia is exponentially increasing with more than 68% of people with it being undiagnosed and a death rate of 32%. It is a disease impacting patients with negative somatic, psychological, social, and economic consequences. Patients in Ethiopia have very low awareness about chronic complications, which is very worrying. The study aimed to explore the consequences of their disease experienced by type 2 diabetes patients in North-East Ethiopia. METHODS: The study employed a phenomenological approach informed by the consequences dimension of the Common-Sense Model. It was conducted from July 2019 to January 2020 using purposive sampling with face-to-face in-depth interviews, for about three weeks, until reaching theoretical saturation. The data were collected from twenty-four type 2 diabetes patients, who were selected to include various socio-demographic characteristics. The data were organized by QDA Miner Lite v2.0.8 and analyzed thematically using narrative strategies. RESULTS: Using Common-Sense Model as a framework, the diabetes consequences experienced by the participants were categorized as complications and impacts. While the most common complications were cardiovascular disorders (hypertension, erectile dysfunction, heart and kidney problems, hyperlipidemia, edema, stroke, and fatigue) and ocular problems; the most common impacts were psychosocial (dread in life, suffering, family disruption, hopelessness, dependency, and craving), and economic (incapability and loss of productivity) problems. CONCLUSION: The patients here were bothered by diabetes complications as well as its psycho-social, economic and somatic consequences; being the psycho-social impacts the most common. As a result, the patients have been suffering in the dread of "what can come next?" This dictates that holistic care, based on Common-Sense Model, is needed in providing special emphasis to psycho-social issues.

Practices of anti-malaria pharmaceuticals inventory control system and associated challenges in public health facilities of Oromiya special zone, Amhara region, Ethiopia.

BACKGROUND: Anti-malaria pharmaceuticals inventory control system helps to maintain an appropriate stock level using logistics management information system records and reports. Antimalaria pharmaceuticals are highly influenced by seasonality and demand variation. Thus, to compensate the seasonality, resupply quantities should be adjusted by multiplying the historical consumption with the Look-ahead seasonality indexes (LSI) to minimize stock-outs during the peak transmission season and overstocks (possible expiries) during off-peak seasons The purpose of this study was to assess anti-malaria pharmaceuticals inventory control practice and associated challenges in public health facilities of the Oromiya special zone, Amhara region, Ethiopia. METHODOLOGY: Facility-based cross-sectional study design employing both quantitative and qualitative methods, explanatory sequential mixed method, of data collection and analysis was used in all public health facilities in the Oromia special zone from September 1 to September 30, 2019. The study was conducted in 27 health centers and 2 hospitals, the dispensing units managing anti-malaria pharmaceuticals and data was collected using observation checklists The quantitative data were analyzed by Statistical package for social sciences using linear regression. Purposive sampling was used to select key informants and 12 in-depth interviews were conducted by the principal investigator. Thematic analysis was performed using Nvivo 11 plus and interpretation by narrative strategies. RESULTS: The quantitative finding in this study revealed that none of the health facilities surveyed calculated months of stock and multiplied the historical consumption with look ahead seasonal indices (LSI) to forecast the upcoming year consumptions.. Average months of stock of anti-malaria pharmaceuticals were 5.32 months with the annual wastage rate of 11.32%. The point and periodic availability of anti-malaria pharmaceuticals was 72.38 and 77.03% respectively. The number of stocks out days within the previous 6 months was 41.34 days. The study also reported bin card usage (ß = - 3.5, p = 0.04) and availability of daily dispensing register (ß = - 2.7, p = 0.005) had statistically significant effect on anti-malaria pharmaceuticals inventory control practice. The perceived challenges attributed to the poor anti-malaria pharmaceuticals inventory control practice were lack of integrated pharmaceutical logistics system training, management support, inadequate and near expiry supply from pharmaceuticals supply agency, job dissatisfaction, and staff turnover. CONCLUSION: Inventory control practices for anti-malaria pharmaceuticals was poor as indicated by maximum stock level and none of the health facilities calculated months of stock and the previous consumption was not multiplied by look ahead seasonal indices to compensate the seasonal and demand variation. Efforts should be under-taken by concerned bodies to improve inventory control practice; such as training and regular follow up have to be provided to the health professionals managing anti-malaria pharmaceuticals.

Pharmaceuticals wastage and pharmaceuticals waste management in public health facilities of Dessie town, North East Ethiopia.

BACKGROUND: Pharmaceuticals wastes are drugs and medicines that can no longer be used. The improper disposal of unused medicines is a growing problem throughout the world. This study assessed the pharmaceutical wastage rate and pharmaceutical waste management for the year 2015 to 2017 in the public health facility of Dessie, Ethiopia. METHODOLOGY: A cross-section study design was used to review logistic data retrospectively from health commodity management information systems and manual records in 8 health facilities. Health professionals' (135) pharmaceutical waste management practices were assessed using the world health organization waste management checklist. Descriptive and inferential statistics were made using a statistical package for social sciences version 20. RESULT: Supplies were the leading class of pharmaceuticals with an overall wastage rate of 37.1%. Tablet and injectable constituted the highest class of pharmaceuticals dosage form with the overall wastage rate of 20.78% and 16.49%. The overall pharmaceutical wastage rate was 3.68% amounting to USD 159,762.66 and expiry (92.05%) was the major reason for wastage. The pharmaceutical wastage rate of health centers was nearly twofold higher than hospitals. Pharmaceutical waste management was practiced by 105 (77%; 95% CI; 69.9%, 84.9%) health professionals. Determinants of pharmaceutical waste management were being male (P value = 0.08, AOR = 3.72), receiving training (P value = 0.01, AOR = 4.34), writing label (P value = 0.02, AOR = 5.04), storage of segregated waste in dispensing unit (P value = 0.01, AOR = 0.72) and the presence of disposal plan (P value = 0.002, AOR = 16.93). CONCLUSIONS: Supplies and tablets constituted the highest wastage class of pharmaceuticals and dosage form. The pharmaceutical wastage rate was higher than the standard and increasing in successive years. Pharmaceutical waste management was not fully practiced. Appropriate inventory control and waste management are recommended.

Herbal medicines use and associated factors among pregnant women in Debre Tabor town, north West Ethiopia: a mixed method approach.

BACKGROUND: Use of herbal medicines during pregnancy has been increase in many developing and developed countries. In spite of the studies done on herbal medicine, no study has addressed use of herbal medicine among pregnant women in Debre Tabor Town. Hence, the major aim of this study was to assess the prevalence of herbal medicine use and associated factors. METHODS: A community based explanatory sequential mixed methods was employed. The quantitative method used cross-sectional study design with a sample size of 267 women, also 12 participants in a group for focus group discussion and 6 in-depth interviews from focus group were included for a qualitative part using a purposive sampling technique. The data were coded and entered into Epidata 4.2.0.0 and analysis was done using SPSS version 25, while thematic analysis was used for qualitative data. Bivariate and multivariate logistic analyses were used to assess associations between dependent and independent variables. RESULTS: Ninety-five (36.3%) of pregnant women used herbal medicine during pregnancy. Prior use of herbal medicine (AOR: 3.138; 95% CI: 1.375, 7.162), unable to read & write (AOR: 9.316; 95% CI: 2.339, 37.101), presence of health problems (AOR: 3.263; 95% CI: 1.502, 7.090), drug availability (AOR: 9.872; 95% CI: 4.322, 22.551) and distance to the health facilities (AOR 6.153; 95% CI 2.487, 15.226) were significantly associated with use of herbal medicine. Only 5(5.3%) of herbal medicine users disclosed their herbal medicine use to their healthcare providers. Zingiber officinale, Eucalyptus globulus, Rutachalepensis, Linumusitatissimum, and Moringa stenopetala were the most commonly used herbal medicines by pregnant women. CONCLUSIONS: The use of herbal medicine during pregnancy is a common practice and significantly associated with educational status, prior use of herbal medicine, presence of health problems, drug availability and distance to the health facilities. Since there was high prevalence and low disclosure rate of herbal medicine use, it should be ensured that physicians/midwives establish a good level of communication with pregnant women.

Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration.

OBJECTIVES: Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia. METHODS: The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients' registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies. RESULTS: Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants' recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions. CONCLUSIONS: Patients' main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.

Knowledge, attitude and practice of vaccinators and vaccine handlers on vaccine cold chain management in public health facilities, Ethiopia: Cross-sectional study.

BACKGROUND: Effective management of the vaccine cold chain system at all levels is one of the crucial factors for maintaining vaccine potency. Vaccines require more complex handling and storage requirements due to increased temperature sensitivity and complicated immunization schedules. This urges adequate knowledge, attitude, and practice. This study assessed the knowledge, attitude, and practice of vaccinators and vaccine handlers' in public health facilities. METHODOLOGY: An institutional-based cross-sectional study design was used to assess the knowledge, attitude, and practice of 127 vaccinators and vaccine handlers in public health facilities of Oromia Special Zone, from September 1 to 30, 2019. Data were collected using self-administered questionnaires and a structured observation checklist. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Variables with a p-value <0.05 were taken as statistically significant. RESULT: The response rate was (96.94%). Sixty-eight (53.5%; 95% CI: 46.5%, 61.4%), 58 (45.7%; 95% CI: 37.8%, 53.5%) and 62 (48.8%: 95% CI; 41.7%, 56.7%) vaccinators and vaccine handlers had satisfactory knowledge, positive attitude and good practice respectively. Receiving training on cold chain management had a statistically significant association with the level of knowledge on cold chain management (AOR = 3.04, 95% CI: 1.04-8.88). CONCLUSIONS: More than half of vaccinators and vaccine handlers had satisfactory knowledge, while below half of vaccinators and vaccine handlers had a positive attitude and good practice. The determinants of knowledge in cold chain management were receiving training on cold chain management. Providing regular technical support and on the job training on vaccine cold chain management will improve the knowledge, attitude, and practice of vaccinators and vaccine handlers.

Catastrophic Health Expenditure among Chronic Patients Attending Dessie Referral Hospital, Northeast Ethiopia.

BACKGROUND: Catastrophic health expenditure is health spending that is not covered by a health-care plan. These costs tend to escalate over time, due to chronic illnesses. Catastrophic health expenditure leads to decreased use of health services and poorer treatment outcomes. This study measured the extent of and factors associated with catastrophic health expenditure among chronically ill patients attending Dessie Referral Hospital in northeast Ethiopia. METHODS: An institution-based cross-sectional study design was used to quantify catastrophic health expenditure among 302 chronically ill patients from May 25, 2018 to June 30, 2018. A stratified sampling technique was used to select the study participants. Descriptive and inferential statistics were computed using SPSS 20. RESULTS: Catastrophic health expenditure was found in 194 (64.2%, 95% CI 58.8%-70.5%) of chronic patients. Costly service (151, 50%), transport (104, 34.4%), and pharmaceuticals (189, 62.6%) were the reasons for catastrophic health expenditure among chronic patients. Factors associated with catastrophic health expenditure were age <30 years (AOR 7.74, CI 0.94-63.62; P=0.01), patient monthly income

Influence of pharmaceutical marketing mix strategies on physicians' prescribing behaviors in public and private hospitals, Dessie, Ethiopia: a mixed study design.

BACKGROUND: Prescription drugs constitute the primary source of revenue for the pharmaceutical industry. Most pharmaceutical companies commit a great deal of time and money to market in hopes of convincing physicians about their products. The objective of this study is to assess perceived influence of pharmaceutical marketing mix strategies on physicians' prescribing behaviors in hospitals, Dessie, Ethiopia. METHODS: Mixed methods sequential explanatory design was employed in two public and three private hospitals. A cross-sectional study design was employed by including (136) physicians working in public and private hospitals. Percentage, mean, standard deviation, and multiple linear regressions were computed using Statistical Package for Social Science. In the second phase, the phenomenological design was employed to fully explore in-depth information. Purposive sampling was used to select key informants and 14 in-depth interviews were conducted by the principal investigator. Content analysis was performed using Nvivo 11 plus and interpretation by narrative strategies. RESULTS: The overall perceived influence of pharmaceutical marketing mix strategies in physicians' prescribing behavior was 55.9%. The influence of promotion, product, place and price strategy perceived by physicians in their prescribing behavior was 83 (61%), 71(52.2%), 71 (52.2%), 80 (58.8%) respectively. There was a statistically significant difference among marketing mix strategies (ß = 0.08, p = < 0.001). Determinants on the influence of physicians' prescribing behavior were specialty (p = 0.01) and working areas (p = 0.04). The qualitative design also generates additional insights into the influence of pharmaceutical marketing mix strategies on physician prescribing behavior. CONCLUSIONS: More than half of physicians perceived that pharmaceutical marketing mix strategies influence their prescribing behavior. The qualitative design also revealed that pharmaceutical marketing mix strategies influenced physicians prescribing behavior. Strengthening the regulation and maintaining ethical practice would help to rationalize the physicians' prescribing practice.

Religion, Spirits, Human Agents and Healing: A Conceptual Understanding from a Sociocultural Study of Tehuledere Community, Northeastern Ethiopia.

This paper explores the relationship among religion, spirits and healing in the Tehuledere community in the northeastern part of Ethiopia and focuses on how this knowledge can inform primary healthcare reform. The study employed qualitative ethnographic methods. Participatory observation, over a total of 5 months during the span of 1 year, was supplemented by focus group discussions (96 participants in 10 groups) and in-depth interviews (n = 20) conducted with key informants. Data were analyzed thematically using narrative strategies. The present study revealed that members of the study community perceive health, illness and healing as being given by God. Many of the Tehuledere people attribute illness to the wrath of supernatural forces. Healing is thought to be mitigated by divine assistance obtained through supplication and rituals and through the healing interventions of nature spirit actors. We found that the health, illnesses and healing were inextricably linked to religious and spiritual beliefs. Our findings suggest that religious and spiritual elements should be considered when drafting and implementing primary healthcare strategies for the study communities and similar environments and populations around the globe.