Can performance-based financing improve efficiency of health centers in Ethiopia? A Malmquist Productivity Index analysis.

INTRODUCTION: The Ethiopian government has introduced several healthcare financing reforms intending to improve efficiency. Piloting implementation of performance-based financing is one of these actions. The purpose of this research is to assess the efficiency of healthcare facilities that have implemented performance-based financing compared to those that have not. METHODS: Efficiency was measured using a nonparametric data envelopment analysis and the Malmquist Productivity Index technique. Total factor productivity change, technical change, and technological change are compared across eight sampled healthcare facilities that are implementing performance-based financing and eight that are not in Ethiopia. RESULTS: Health facilities implementing performance-based financing have a mean technical efficiency score of 64%, allowing for a potential 36% reduction in inputs without affecting outputs. Their scale efficiency is 88%, indicating a potential 12% increase in total outputs without expanding facilities. In contrast, facilities not implementing performance-based financing have a mean technical efficiency score of 62%, with a potential for 38% input reduction without affecting outputs. Their scale efficiency is 87%, suggesting a potential 13% increase in total outputs without scaling up facilities. Among the 16 healthcare facilities observed, seven experienced a decline in the mean total productivity, while one remained stagnant. The remaining eight facilities witnessed an increase in productivity. The healthcare facilities implementing performance-based financing showed a 1.3% decrease in mean total productivity during the observed period. Among them, five showed an increase and three showed a decrease in the total factor of productivity. The mean total factor of productivity of all healthcare facilities not implementing performance-based financing remained stagnant over the three-year period (2019-2021), with four showing an increase and four showing a decrease in total productivity. CONCLUSIONS: The study concludes that implementing performance-based financing did not improve productivity levels among healthcare facilities over three years. In fact, productivity decreased among the facilities implementing performance-based financing, while those not implementing it remained stagnant. This shows health facilities that implement performance-based financing tend to utilize more resources for similar outputs, contradicting the anticipated efficiency improvement.

Sociodemographic and health systems determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region of Ghana: A multi-centre study.

Objectives: Optimal adherence to antiretroviral therapy is required for viral load suppression. This study investigated the sociodemographic (age, sex, marital status, level of education, monthly income, settlement type, distance to the antiretroviral therapy-providing site, ethnicity) and health system (antiretroviral therapy-providing site) determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region, Ghana. Methods: A cross-section design was adopted, collecting data from 1729 human immunodeficiency virus patients and analysing them using STATA version 17 at level 0.05. Results: Antiretroviral therapy adherence was poor (51.2%). Being divorced (Adjusted odds ratio (AOR) = 0.65), widow (AOR = 0.58), cohabiting (AOR = 0.22), Ewe (AOR = 3.7), Ga/Dangbe (AOR = 2.27), living in a rural area (AOR = 1.54) and an urban area (AOR = 0.64), having a monthly income of GH₵1000 or less (AOR = 3.21), covering a distance of 51 km and above to the antiretroviral therapy centre (AOR = 1.79), receiving antiretroviral therapy from Ketu South Municipal Hospital (AOR = 0.09), Hohoe Municipal Hospital (AOR = 0.03), Ho Municipal Hospital (AOR = 0.02) and Ho Teaching Hospital (AOR = 0.09) were the determinants of antiretroviral therapy adherence. Conclusion: Antiretroviral therapy adherence was low. Interventions to improve antiretroviral therapy adherence should target these significant determinants.

Mapping factors influencing initiation of antiretroviral treatment among adolescents living with HIV/AIDS in sub-Saharan Africa: A scoping review protocol.

BACKGROUND: Since the Start Free, Stay Free, and AIDS-Free launch, UNAIDS targets intended to promote interventions to prevent HIV transmission and promote access to ART among adolescents and children, of which none were achieved in 2020. In the sub-Saharan African region, the number of adolescents initiated on ART drugs remained consistently low, with approximately100 000 adolescents succumbing to AIDS-related causes in 2022. Although HIV prevalence among adolescents had been reduced, several HIV- positive adolescents died without being initiated on ART drugs. Therefore, this scoping review protocol aims to map factors influencing the initiation of ART drugs among adolescents living with HIV in sub-Saharan Africa. METHODS: The methodological framework for scoping reviews will guide this scoping protocol. A search strategy will be used to search literature in electronic databases, including EBSCOhost (PubMed/MEDLINE), Google Scholar, Science Direct, Scopus, BioMed Central, and the World Health Organization library for citations and literature using keywords and the Medical Subjects Heading (MeSH). The electronic databases will be supplemented by hand-searching references on the included studies. The search will be from Jan 01, 2012, to Dec 31, 2022. Articles will be searched and assessed for eligibility by two screeners uploaded on the Endnote software, and duplicates will be identified and removed before the abstract screening. The two screeners will assess the eligibility of the abstracts and the complete articles of the selected studies using the inclusion and exclusion criteria. A third screener will intervene when there is a lack of consensus between the two screeners. The selection process will be documented by following and using the PRISMA flow diagram (Fig 1). A thematic content analysis will present a narrative account of the extracted data. DISCUSSION: The results of this review will identify and describe factors influencing the initiation of Antiretroviral treatment among adolescents living with HIV in the Sub-Saharan African region. The findings will guide future research and inform tailored interventions and strategies for initiating ART among adolescents. TRIAL REGISTRATION: Open Science Framework. https://doi.org/10.17605/OSF.IO/RNF2T.

Factors inhibiting and enabling performance-based financing in health care delivery across low and middle-income countries: a scoping review

Background: Emerging financing strategies in the health sector have been developed to improve the impact of investments and enhance healthcare outcomes. One promising approach is Results-based Financing, which establishes a connection between financial incentives and pre-established performance targets. This innovative approach holds the potential to strengthenhealthcare delivery and strengthen overall healthcare systems.Aim:The scoping review endeavored to systematically delineate the body of evidence pertaining tofacilitators and barriers to the implementation of performance-based financing within the realm of healthcare provision in low-and middle-income nations.Methods:The review used Preferred Reporting Items for Systematic Reviews and a Meta-Analysis extension for Scoping Reviews checklist to select, appraise, and report the findings. We searched PubMed, Web of Science, and Google Scholar databases and grey literature published between January 2000 and March 2022. We conducted the abstract screening with two independent reviewers. We also performed full-article screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The results were thematically analyzed.Results:Of the 1071 searched studies, 34 met the eligibility criteria. 41% of the studies were descriptive, 26% cross-sectional, 18% trial, and 15% cohort studies. The enabling and inhibiting factors of performance-based financing in healthcaredelivery have been identified. Moreover, the review revealed that performance-based financing's influence on service delivery is context-specific.Conclusion:The facilitators and impediments to the effectiveness of performance-based financing in enhancing service delivery are contingent upon a holistic comprehension of the contextual factors, meticulous design, and efficient execution. Factors such as the level of care facilities, presence of community-based initiatives, stakeholder involvement, and participatory design emerge as key facilitators. Conversely, barriers such as communication obstacles, inadequacies in the PBF models, and deficiencies in the healthcare workforce are recognized as inhibitors. By harnessing the insights derived from a multitude of evidence incorporated in this scrutiny, stakeholders can deftly navigate the intricacies of performance-based financing, while also considering the prospective areas for further exploration and research

Predictors of COVID-19 vaccine uptake among persons aged 18 years and above in Ga North Municipality, Ghana using the Health Belief Model: A community-based cross-sectional study.

BACKGROUND: Although the coronavirus disease 2019 (COVID-19) vaccination rollout has been accepted by the population of the Ga North Municipality, a substantial proportion has developed hesitancy to COVID-19 vaccination uptake. This study determined the predictors of COVID-19 vaccine uptake among persons aged 18 years and above in the Ga North Municipality using the Health Belief Model. METHODS: The study used a cross-sectional study design. Structured questionnaires were used to collect data from a multistage sample of 388 respondents. Multivariable binary logistic regression was used to determine the predictors of COVID-19 vaccination uptake at the level of 0.05 and 95% confidence interval. RESULTS: Vaccination uptake was 72.2%. The odds of COVID-19 vaccination uptake were higher among men than women [AOR = 2.02, 95% Cl: 1.13-3.20] and among singles than the married [AOR = 1.90, 95% Cl: 1.07-3.36], but lower among Muslims than Christians [AOR = 0.33, 95%Cl: 0.18-0.60]. Perceived susceptibility [AOR = 2.43, 95% Cl: 1.36-4.35], perceived barriers [AOR = 0.54, 95%Cl: 0.31-0.95], cues to action [AOR = 2.23, 95% Cl: 1.19-4.21] and self-efficacy [AOR = 3.23 95% Cl: 1.82-5.71] were the significant predictors of COVID-19 vaccination uptake. CONCLUSION: The uptake of the COVID-19 vaccine in GA North Municipality is high. Health promotion interventions should focus on increasing perceived susceptibility to COVID-19, minimising barriers to COVID-19 vaccine uptake, and promoting cues and self-confidence for COVID-19 vaccine uptake. It should also target women, the married, and Muslims.

Effective Coverage of Emergency Obstetric and Newborn Care Services in Africa: A Scoping Review.

Objective: This scoping review aimed to map the evidence of effective coverage (EC) of EmONC (Emergency Obstetric and Neonatal Care) services and associated factors in Africa. Methodology: The review used PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) checklist to select, appraise, and report the findings. We searched four databases (PubMed, Web of Science, Google Scholar, and Scopus) and grey literature published between Jan 01, 2011 - Dec 31, 2020. The search terms included "emergency", "obstetric", "newborn", "effective coverage", and "quality" with Boolean terms, AND and OR. The review was conducted using title, abstract, and full-article screenings. The results were analyzed thematically using NVivo v12 qualitative research data analysis software. Results: Of the 1811 searched studies, 32 met the eligibility criteria for review. The majority of the studies were from East (56.3%) and Western (28.1%) Africa. Most studies were cross-sectional, had targeted health facilities, and combined two or more data collection techniques. The thematic analysis yielded three themes: EmONC service utilization, quality of EmONC service, and factors associated with the quality of EmONC services. The review showed a scarcity of evidence and variations regarding the crude coverage, quality of care, and factors affecting the quality of EmONC services in Africa. Conclusion: The review reported that the utilization of EmONC services was below the WHO-recommended 100% in all studies, though some reported improvements over time. Disparities in EmONC services quality were paramount across studies and contexts. However, the methodological and analytical incongruity across studies brought difficulties in tracing and comparing the progress made in EmONC services utilizations. Registration: This scoping review protocol was first registered on the Open Science Framework (OSF) on Aug 27, 2021 (https://osf.io/khcte/).

Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study.

BACKGROUND: Globally, 11.4 million untreated obstetric complications did not receive Emergency Obstetric and Newborn Care (EmONC) services yearly, with the highest burden in low and middle-income countries. Half of the Ethiopian women with obstetric complications did not receive EmONC services. However, essential aspects of the problem have not been assessed in depth. This study, therefore, explored the various aspects of barriers and enablers to women's EmONC services utilization in southern Ethiopia. METHODOLOGY: A qualitative case study research design was used in nine districts of the Wolaita Zone. A total of 37 study participants were selected using a purposive stratified sampling technique and interviewed till data saturation. Twenty-two key informant interviews were conducted among front-line EmONC service providers, managers, community leaders, and traditional birth attendants (TBAs). Individual in-depth interviews were conducted among 15 women with obstetric complications. The trustworthiness of the research was assured by establishing credibility, transferability, conformability, and dependability. NVivo 12 was used to assist with the thematic data analysis. RESULT: Five themes emerged from the analysis: service users' perception and experience (knowledge, perceived quality, reputation, respectful care, and gender); community-related factors (misconceptions, traditional practices, family and peer influence, and traditional birth attendants' role); access and availability of services (infrastructure and transportation); healthcare financing (drugs and supplies, out-of-pocket expenses, and fee exemption); and health facility-related factors (competency, referral system, waiting time, and leadership). CONCLUSION: Many women and their newborns in the study area suffered severe and life-threatening complications because of the non-utilization or delayed utilization of EmONC services. A key policy priority should be given to enhancing women's awareness, eliminating misconceptions, improving women's autonomy, and ensuring traditional practices' role in EmONC service utilization. Community awareness interventions are required to enhance service uptake. Furthermore, the health systems must emphasize improving the quality of care, inequitable distribution of EmONC facilities, and essential drugs. The financial constraints need to be addressed to motivate women from low socioeconomic status. Furthermore, intersectoral collaboration is required to maintain a legal framework to control and prohibit home deliveries and empower women.

Quality of emergency obstetric and newborn care services in Wolaita Zone, Southern Ethiopia.

BACKGROUND: Globally, nearly 295,000 women die every year during and following pregnancy and childbirth. Emergency obstetric and newborn care (EmONC) can avert 75% of maternal mortality if all mothers get quality healthcare. Improving maternal health needs identification and addressing of barriers that limit access to quality maternal health services. Hence, this study aimed to assess the quality of EmONC service and its predictors in Wolaita Zone, southern Ethiopia. METHODOLOGY: A facility-based cross-sectional study was conducted in 14 health facilities. A facility audit was conducted on 14 health facilities, and 423 women were randomly selected to participate in observation of care and exit interview. The Open Data Kit (ODK) platform and Stata version 17 were used for data entry and analysis, respectively. Frequencies and summary statistics were used to describe the study population. Simple and multiple linear regressions were done to identify candidate and predictor variables of service quality. Coefficients with 95% confidence intervals were used to declare the significance and strength of association. Input, process, and output quality indices were created by calculating the means of standard items available or actions performed by each category and were used to describe the quality of EmONC. RESULT: The mean input, process, and output EmONC services qualities were 74.2, 69.4, and 79.6%, respectively. Of the study participants, 59.2% received below 75% of the standard clinical actions (observed quality) of EmONC services. Women's educational status (B = 5.35, 95% C.I: 0.56, 10.14), and (B = 8.38, 95% C.I: 2.92, 13.85), age (B = 3.86, 95% C.I: 0.39, 7.33), duration of stay at the facility (B = 3.58, 95% C.I: 2.66, 4.9), number of patients in the delivery room (B = - 4.14, 95% C.I: - 6.14, - 2.13), and care provider's experience (B = 1.26, 95% C.I: 0.83, 1.69) were independent predictors of observed service quality. CONCLUSION: The EmONC services quality was suboptimal in Wolaita Zone. Every three-in-five women received less than three-fourths of the standard clinical actions. The health system, care providers, and other stakeholders should emphasize improving the quality of care by availing medical infrastructure, adhering to standard procedures, enhancing human resources for health, and providing standard care regardless of women's characteristics.

Mapping the evidence of intimate partner violence among women living with HIV/AIDS in sub-Saharan Africa: a scoping review.

OBJECTIVES: The present study undertakes a scoping review aimed to map the evidence of intimate partner violence (IPV) against women living with HIV/AIDS in Africa. DESIGN: We used the online database to identify papers published from 1 January 2009 to 1 April 2019, from which we selected 21 articles from Uganda, Nigeria, Kenya, South Africa, Zambia, Ethiopia, Cameroon, Tanzania and Swaziland that used IPV as an outcome variable among women living with HIV/AIDS. DATA SOURCES: PubMed, MEDLINE, EBSCO host, Google Scholar. ELIGIBILITY CRITERIA: We included women who were aged 15 years and above, living with HIV/AIDS in sub-Saharan Africa. DATA EXTRACTION AND SYNTHESIS: We conducted the abstract screening with two independent reviewers. We also performed full-text screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The Mixed Method Appraisal Tool was used to determine the quality of the studies. We used NVIVO software V.12 to undertake a thematic analysis. RESULTS: Of the studies, the majority, 57.1%, reported cross-sectional results. In comparison, 23.8% examined qualitative studies, 9.5% were clinical trials, 4.8% were cohort studies and the remaining 4.8% covered grey literature. This review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, proof of the association of sociodemographic characteristics with IPV and implications for practice. Moreover, the review revealed that following the serostatus disclosure, there is evidence of heightened risk for IPV. CONCLUSIONS: This study found evidence of IPV among women living with HIV/AIDS. The HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Therefore, further research is needed to promote action to reduce IPV among HIV-positive and HIV-negative women and to determine healthcare workers' IPV screening experience.

Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: A scoping review.

BACKGROUND: Knowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people's knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA). METHODS: Systematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O'Malley's framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review's narrative account. RESULTS: A total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19. CONCLUSIONS: Most of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID-19.

Lived experience of intimate partner violence among women using antiretroviral therapy and other outpatient services in Wolaita Zone, Ethiopia: a phenomenological study.

BACKGROUND: Ethiopia is one of the nations which has an enormous burden of intimate partner violence (IPV), and where it is usually difficult to talk about HIV separately from IPV. OBJECTIVES: This research aimed to explore the lived experience of IPV against women using antiretroviral therapy (ART) and other outpatient services in Wolaita Zone, Ethiopia METHODS: We used an Interpretive (hermeneutic) Phenomenological Analysis design among purposively selected adult women aged 18-49 years. A total of 43 women participated in this study, of whom 30 were using ART, and 13 women were using other health services. We used an in-depth interview and focus group discussions until data saturation, while conscious of the need to maintain the scientific rigor, dependability, and credibility. The data were transcribed verbatim and translated into English. We read the transcripts repeatedly to understand the content. We used NVivo 11 software to assist with data organisation, and also, we used the framework analysis method. RESULTS: We identified five themes, namely: "women's terrifying experiences of violence," "the effect of violence on women's health," "support/lack of support /partner's controlling behaviours," "women's feelings about the available services," and "IPV prevention strategies from the perspective of women." Interviewees described their violent experiences which included wife-beating, being stigmatised in front of others, having material thrown at the woman's face, wife's hand and teeth were broken, forced sex, restriction of movement, name-calling, threats to hurt, being insulted, being left alone, and the withdrawal of finances. The negative health impacts reported included abortion, infection with HIV and other sexually transmitted diseases, disability, child's death, and depression. The disclosure of HIV test information resulted in violence. Inappropriate punishment of the perpetrator and the lack of a supportive women's network to avert IPV were perceived as legal limitations. CONCLUSIONS: IPV is a considerable health burden, varying in its presentation and its negative impact on women's health. Improved laws should provide justice for all victims. Establishing a women's network to assist women at risk of violence, should be emphasised. Unwise HIV test result disclosure leads to IPV; hence HIV disclosure should be facilitated through health care providers.

Evidence of sociocultural factors influencing intimate partner violence among young women in sub-Saharan Africa: a scoping review.

OBJECTIVE: This study carried out a scoping review of research on intimate partner violence to determine the extent to which studies on sociocultural factors influencing intimate partner violence among young women (15-24 years) have been conducted, and how different geographical areas are represented. It also considered whether the methodologies used were sufficient to describe the risk factors, prevalence and health outcomes associated with intimate partner violence among young women. STUDY DESIGN: Scoping review. METHODS: Online databases were used to identify studies published between 2008 and 2019. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines by Arksey and O'Malley were used to select studies, and primary studies were assessed using the Mixed Method Appraisal Tool, V.2011. Thematic content analysis was used to summarise the findings of the scoping review. RESULTS: The majority of publications eight (61.5%) reported cross-sectional studies, while four (31.5%) were qualitative studies. One of the studies (7%) collected measured data. Overall, 13 (100%) of the publications examined factors influencing intimate partner violence.Using a customised quality assessment instrument, 12 (92.3%) of studies achieved a 'high'-quality ranking with a score of 100%, and 7.7% of studies achieved an 'average' quality ranking with a score of 75%. CONCLUSIONS: While the quality of the studies is generally high, researches on sociocultural factors influencing intimate partner violence among young women would benefit from a careful selection of methods and reference standards, including direct measures of the violence affecting young women. Prospective cohort studies are required linking early exposure with individual, sociocultural and community factors, and detailing the abuse experienced from childhood, adolescence and youth. PROSPERO REGISTRATION NUMBER: CRD42018116463. SCOPING PROTOCOL PUBLICATION: https://doi.org/10.1186/s13643-019-1234-y.

Risk factors associated with high prevalence of intimate partner violence amongst school-going young women (aged 15-24years) in Maputo, Mozambique.

BACKGROUND: In many countries, there is evidence that intimate partner violence is prevalent among young women. This study aimed to determine the prevalence and the factors associated with intimate partner violence in young women (aged 15-24 years) attending secondary schools in Maputo, Mozambique. METHOD: Using a probability proportional sampling strategy, 431 participants were recruited, and the data were collected using a self-administered questionnaire. Binary and multivariate logistic regression analyses were performed to assess the association between IPV and sociodemographic and sociocultural factors. Odds ratio (OR) and 95% confidence intervals (CI) are reported. RESULTS: Of the 413 participants, 248 (60%) (95% CI: 55.15-64.61) had experienced at least one form of IPV in their lifetime. Then, of the 293 participants who had a partner in the previous 12 months prior to the data collection, 186 (63.4%) (95% CI: 57.68-69.00) reported IPV in the 12 months prior to data collection. The psychological violence was the predominant type of violence, lifetime prevalence 230 (55.7%), and over the previous 12 months 164 (55.9%). The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% CI: 1.009-2.525, p = 0.046) and if the head of the young women's household was unemployed (AOR, 1.642 95% CI: 1.044-2.584, p = 0.032). In the bivariate analysis the odds of being abused remained lower among the younger teenage women (OR, 0.458 95% CI: 0.237-0.888, p = 0.021), and higher, among young women if the partner was employed (OR, 2.247 95% CI: 1.187-4.256, p = 0.013) and among the young women believing that males are superior to females (OR, 2.298 95% CI:1.014-5.210. p = 0.046). CONCLUSION: These findings reveal a high prevalence of IPV among young women. Comprehensive programs should incorporate socioeconomic empowerment strategies to increase women's autonomy. There is a need to address religious beliefs through cultural perspectives, to improve social interactions that promote violence free relationships, gender egalitarian norms, and physical and emotional wellbeing for young women.

Healthcare Worker Experience and the Challenges in Screening for Intimate Partner Violence Among Women Who Use Antiretroviral Therapy and Other Health Services in Wolaita Zone, Ethiopia: A Phenomenological Study.

BACKGROUND: Intimate partner violence is a crime against humanity. This study aimed to explore the experiences and challenges in screening for intimate partner violence among women who use antiretroviral therapy and other health services in Wolaita Zone in Ethiopia. METHODS: A descriptive phenomenological qualitative study design was used, and 16 in-depth interviews were conducted with healthcare workers from 19 health facilities who were providing healthcare services in Wolaita Zone. We selected participants purposively until data saturation was reached. Colaizzi's descriptive phenomenological method was used for the data analysis, and the Open Code software was used to assist with the data coding. We maintained the scientific rigour of credibility, transferability, dependability, and confirmability. RESULTS: Analysis of the study data identified the following five themes: type of IPV identified by HCWs among women, provider-related barriers, healthcare system barriers, patient-level barriers, and providers' recommendations for improvements. Issues that emerged from these findings were a gap in medico-legal report provision, absence of a separate record-keeping for IPV cases, lack of client follow-up, absence of routine assessment of violence for women who have injuries, and lack of specific coordination with an external organisation. Moreover, the absence of staff training, weak referral systems, and a shortage of necessary medical equipment challenged IPV screening. CONCLUSION: This study has shown that there are healthcare provider and health system challenges relating to screening clients for intimate partner violence in Wolaita Zone. Provision of separate record-keeping of intimate partner violence cases in the healthcare facilities, standardising the medico-legal reporting system, improving women's access to education, and executing more gender-equitable policies, are needed. Moreover, the inclusion of intimate partner violence-specific policy frameworks in national legislation is necessary.

Changing youth behaviour in South Africa.

BACKGROUND: Youth behaviour in South Africa continues to be a public health concern. Primary prevention interventions remain a pre-requisite for promotion of improved social and health outcomes. AIM: The aim of the study was to assess the impact of a behavioural youth risk reduction intervention among grade 10 learners. SETTING: The Study was conducted in KwaZulu-Natal high schools, at UMgungundlovu District Municipality. METHODS: We conducted a cluster randomised controlled trial at 16 KwaZulu-Natal high schools where learners completed a self- administered questionnaire assessing youth risk behaviours. Schools were divided into two arms, intervention and a control arms. RESULTS: The intervention reduced learners' reports of carrying of a weapon to school in the past 30 days, but did not significantly reduce other assessed risk behaviours. Although the intervention appeared more likely to reduce learners' risk behaviours when compared to the control group, such as carrying weapons, risky sexual behaviour and alcohol and drug abuse. CONCLUSION: This study was unable to show statistical significance for these outcomes.

Risk factors associated with high prevalence of intimate partner violence amongst school-going young women (aged 15-24years) in Maputo, Mozambique

Background: In many countries, there is evidence that intimate partner violence is prevalent among young women. This study aimed to determine the prevalence and the factors associated with intimate partner violence in young women (aged 15-24 years) attending secondary schools in Maputo, Mozambique. Method: Using a probability proportional sampling strategy, 431 participants were recruited, and the data were collected using a self-administered questionnaire. Binary and multivariate logistic regression analyses were performed to assess the association between IPV and sociodemographic and sociocultural factors. Odds ratio (OR) and 95% confidence intervals (CI) are reported. Results: Of the 413 participants, 248 (60%) (95% CI: 55.15-64.61) had experienced at least one form of IPV in their lifetime. Then, of the 293 participants who had a partner in the previous 12 months prior to the data collection, 186 (63.4%) (95% CI: 57.68-69.00) reported IPV in the 12 months prior to data collection. The psychological violence was the predominant type of violence, lifetime prevalence 230 (55.7%), and over the previous 12 months 164 (55.9%). The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% CI: 1.009-2.525, p = 0.046) and if the head of the young women's household was unemployed (AOR, 1.642 95% CI: 1.044-2.584, p = 0.032). In the bivariate analysis the odds of being abused remained lower among the younger teenage women (OR, 0.458 95% CI: 0.237-0.888, p = 0.021), and higher, among young women if the partner was employed (OR, 2.247 95% CI: 1.187-4.256, p = 0.013) and among the young women believing that males are superior to females (OR, 2.298 95% CI:1.014-5.210. p = 0.046). Conclusion: These findings reveal a high prevalence of IPV among young women. Comprehensive programs should incorporate socioeconomic empowerment strategies to increase women's autonomy. There is a need to address religious beliefs through cultural perspectives, to improve social interactions that promote violence free relationships, gender egalitarian norms, and physical and emotional wellbeing for young women.

Mapping evidence of socio-cultural factors in intimate partner violence among young women: a scoping review protocol.

BACKGROUND: Intimate partner violence among young women continues to be a worldwide concern. Globally, a considerable number of studies reported numerous factors that influence intimate partner violence among the young. The proposed scoping review aims to map available evidence of socio-cultural factors influencing intimate partner violence among young women. METHODS: We will conduct a scoping review to explore, describe and map literature on socio-cultural factors influencing intimate partner violence among young women. The search strategy for this scoping review study will involve electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOHost (PubMed, CINAHL with Full Text, MEDLINE), Google Scholar, BioMed Central and World Health Organization library. Articles will also be searched through the "Cited by" search as well as citations included in the reference lists of included articles. Keyword searches will be used, and two independent reviewers will be screening titles, abstracts and full articles; where there are disputes between the two reviewers, a third reviewer will intervene. Thematic analysis will be employed to present the narrative account of the review. DISCUSSION: Understanding socio-cultural factors influencing intimate partner violence among young women is critical. This will enable researchers to map existing literature, map research gaps and guide future research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42018116463).

Exploring factors influencing integration of traditional and medical male circumcision methods at Ingquza Hill Local Municipality, Eastern Cape: A socio-ecological perspective.

BACKGROUND:  Medical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods. AIM:  This study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels. SETTING:  The study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province. METHODS:  An explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model. RESULTS:  Four main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These included: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices. CONCLUSION:  Male circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods.

Intimate partner violence against women living with and without HIV, and the associated factors in Wolaita Zone, Southern Ethiopia: A comparative cross-sectional study.

OBJECTIVES: This study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia. METHODS: A comparative cross-sectional study design was used to interview the 816 women between 18-49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 4.4.2.0) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented. RESULTS: The lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93-13.42],income [AOR = 3.97; 95% CI:1.81-8.72], bride price payment [AOR = 3.46; 95% CI:1.74-6.87], women's decision to refuse sex [AOR = 2.99; 95% CI: 1.39-6.41],age group of women [AOR = 2.86; 95% CI:1.67-4.90], partner's family choosing wife [AOR = 2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36-4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36-4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05-3.19]. CONCLUSIONS: There is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents.

Mapping the evidence of intimate partner violence among women living with HIV/AIDS in Africa: a scoping review protocol.

INTRODUCTION: Among women living with HIV, intimate partner violence (IPV) is increasingly recognised worldwide as a serious public health concern. The understanding of the link between IPV and HIV is currently inconclusive and information concerning the IPV experiences of HIV-infected women is insufficient. This protocol aims to map evidence of IPV against women living with HIV/AIDS in Africa. METHODS AND ANALYSIS: We will search and review peer-reviewed and review articles. The comprehensive search will include the electronic databases PubMed, MEDLINE with full text via EBSCO host, Google Scholar, Science Direct and Scopus. The advanced search will use MeSH terms. Grey literature will also be included. The titles of the studies from the database searches will be screened, and duplicates will be removed. The abstract screening will be done independently by two reviewers, followed by the full-text screening which will be based on the eligibility criteria. The six methodological stages in this review will be to: identify the research questions; identify relevant studies; select the studies; chart the data; collate, summarise and report the results; and thereafter undertake consultations. The quality of studies included in the review will be determined by the Mixed Methods Appraisal Tool. NVIVO software V.11 will be used to undertake a thematic analysis of each of the studies and to extract the relevant outcomes. DISSEMINATION: The results of this study will be disseminated through publication, and presented at conferences related to IPV. SCOPING REVIEW REGISTRATION: Currently, a scoping review is not eligible for registration on the International Prospective Register of Systematic Reviews.