Factors associated with knowledge of health care workers toward COVID-19 in health facilities West Guji zone, Southern Ethiopia, 2020.

BACKGROUND: Coronavirus pandemic puts healthcare workers (HCWs) at high risk and challenges the abilities of healthcare systems to respond to the crisis. This study aimed to assess the level of knowledge of HCWs and associated factors in West Guji zone public health facilities in southern Ethiopia. MATERIALS AND METHODS: A health facility-based quantitative cross-sectional study was undertaken from June 10 to July 10, 2020. Two hundred and eighty-three HCWs were involved in the study using a systematic sampling method. The instrument was pretested on 5% of the sample in Yabello Hospital. Data were analyzed using bivariate and multivariate logistic regression. RESULTS: The HCW who had good knowledge was 84.7%. HCWs who had degree holders, masters and above holders, work experience of 2-4 years, and >4 years of experiences, had training on Coronavirus, and medical diseases were significantly associated with good knowledge of Coronavirus. CONCLUSIONS: This study indicated that HCWs' knowledge about the Coronavirus was good. Improving the educational status of HCWs and giving updated training on the Coronavirus will improve HCW's knowledge of the Coronavirus.

Effects of maternal education on early initiation and exclusive breastfeeding practices in sub-Saharan Africa: a secondary analysis of Demographic and Health Surveys from 2015 to 2019.

BACKGROUND: Early initiation of breast feeding (EIBF) and exclusive breast feeding (EBF) are the cheapest, feasible and simplest nutritional interventions for infants. Effects of maternal education on EIBF and EBF are not consistent across studies. This study assessed the effects of maternal education on EIBF and EBF. METHODS: A cross-sectional study was done based on data collected for phase 7 Demographic and Health Surveys conducted in 16 sub-Saharan African countries from 2015 to 2019. Data of the last-born children younger than 6 (n=19 103) and 24 (n=75 293) months were analysed to assess associations between maternal education and EIBF and EBF practices, respectively. To assess the associations, X2 test and logistic regression were done. Adjusted ORs (AORs) and their 95% CIs were used to declare statistical significance of the associations. RESULTS: After controlling for all other potentially confounding variables, mothers who completed primary school were 1.29 (95% CI AOR: 1.24 to 1.34) times more likely to initiate breast feeding within the first 1 hour of delivery compared with mothers without education. However, mothers with secondary (AOR: 1.01; 95% CI: 0.96 to 1.06) or higher (AOR: 0.96; 95% CI: 0.87 to 1.05) level of education were not significantly different from mothers without education concerning EIBF. Similarly, mothers educated to primary school were 1.37 (95% CI AOR: 1.27 to 1.48) times more likely to exclusively breast feed compared with mothers without education. However, mothers educated to secondary (AOR: 1.07; 95% CI: 0.98 to 1.17) or higher (AOR: 1.07; 95% CI: 0.89 to 1.27) level of education were not significantly different from uneducated mothers regarding EBF practices. CONCLUSIONS: Effects of maternal education on EIBF and EBF depend on the level of educational attainment. Future studies should look for reasons for the lower rate of EIBF and EBF among mothers with higher educational status.

Assessment of neonatal thermal cares: Practices and beliefs among rural women in West Guji Zone, South Ethiopia: A cross-sectional study.

A newborn has a limited capacity to maintain temperature when exposed to cold environment. Neonatal hypothermia, a common neonatal problem, carries high case fatality rate particularly if concurrently occurs with other neonatal problems. This study assessed neonatal thermal care practices and beliefs among rural women in west Guji Zone, south Ethiopia. A community based cross sectional quantitative study combined with qualitative study was undertaken in rural areas of west Guji Zone, Ethiopia. Randomly selected 388 rural mothers of infants less than 6 months old were participated in the quantitative study. Three focus group discussions were conducted among mothers of infants less than 6 months old. Quantitative data were collected by using structured and pretested Afaan Oromo version questionnaire adapted from relevant literatures. Qualitative data were collected by focus group discussion guide. The quantitative data were cleaned, coded and analyzed by SPSS version 20. Qualitative data were transcribed, translated, coded, and analyzed by thematic analysis approach. In general rural women believe that thermal protection of newborn is important. The findings show that approximately 75% and 85% of newborns were dried and wrapped respectively after delivery. However drying and wrapping of newborn are usually done after the first newborn's bath. Just over 84% of newborns were bathed within the first 6 hours of delivery and majority of them were bathed with warm water. About 69.1% and 57.7% of women put head cover to their newborns immediately after birth, and initiated breast feeding within one hour of delivery respectively. Skin to skin care of newborn is non-existent in the study area and perceived as an odd, frightening and potentially dangerous practice. Studied women practice some of the recommended neonatal thermal cares and believe in their importance in keeping newborn warm. However, practice and beliefs about delayed first bath is against standard recommendation, whereas skin to skin care is non-existent and perceived as an odd practice. Interventions to familiarize skin to skin care and reduce misconceptions surrounding it should be introduced into the study area to improve thermal cares of high risk newborns.

Determinants of health system diagnostic delay of pulmonary tuberculosis in Gurage and Siltie zones, South Ethiopia: a cross-sectional study.

BACKGROUND: Unrecognised transmission of tuberculosis is a main contributor of high epidemic of tuberculosis in low-income countries. Studies done in Ethiopia showed that delay in tuberculosis diagnosis and treatment is one of the major challenges to tuberculosis control programmes in the country. This study assessed factors which predict health system diagnostic delay of new pulmonary tuberculosis in Gurage and Siltie zones, South Ethiopia. METHODS: A health facility-based cross-sectional study was conducted among 204 adult patients with new pulmonary tuberculosis in Gurage and Siltie zones. Consecutive sampling technique was used to recruit participants. Data were collected by using a structured and pretested Amharic questionnaire. Data were entered into Epi-info V.7, processed and analysed by SPSS V.20. Health system diagnostic delay was dichotomised as either long or acceptable delay using median delay. RESULTS: Median (IQR) patient and health system diagnostic delays are almost equal which are 20 (10-34.5) and 20.5 (8.2-56.2) days, respectively. Results from logistic regression show that presence of long patient delays (adjusted OR (AOR)=2.85, 95% CI: 1.44 to 5.62; p=0.003) in seeking care, presence of sputum smear examination (AOR=0.37, 95% CI: 0.19 to 0.75; p=0.005) at the first visit to a health facility and multiple heath facility visit before diagnosis of tuberculosis (AOR=4.95, 95% CI: 1.98 to 12.40; p=0.001) were factors significantly associated with long health system diagnostic delay. CONCLUSIONS: Long patient delay and multiple health facility visits are positively associated with long health system diagnostic delay; whereas sputum smear examination at the first contact with a health facility is negatively associated with long health system tuberculosis diagnostic delay.

Prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in Southern Ethiopia.

OBJECTIVES: Globally, novel coronavirus disease 2019 (COVID-19) has spread rapidly since it was first identified and challenging the provision of essential services for low-resource countries. Healthcare workers involved in providing care are at high risk of developing mental health problems. The aim of this was to determine the prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in the West Guji zone in public health facilities, southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted in public health facilities found in the West Guji zone. A simple random sampling technique was employed to select 283 study subjects. This study was used to assess the prevalence of depression symptoms using Depression, Anxiety and Stress Scale-21, a depression subscale. Descriptive statistics, binary and multiple logistic regressions were used. Adjusted odds ratios (AORs) with 95% confidence interval will be estimated to assess the strength of associations and statistical significance will be declared at a p-value < 0.05. RESULTS: Out of 283 eligible healthcare workers, 275 respondents had participated in this study with a 97.2% response rate. The prevalence of depressive symptoms was 21.5%. The independent predictors associated with depressive symptoms due to COVID-19 were age (adjusted odds ratio = 2.35, 95% confidence interval = 1.126-3.95), family size (adjusted odds ratio = 3.56, 95% confidence interval = 1.09-11.62), alcohol use (adjusted odds ratio = 4.31, 95% confidence interval = 1.76-10.55), medical illness (adjusted odds ratio = 9.56, 95% confidence interval = 3.71-24.59), having training on COVID-19 (adjusted odds ratio = 0.37, 95% confidence interval = 0.17-0.81), and lack of knowledge on COVID-19 (adjusted odds ratio = 15.34, 95% confidence interval = 6.32-37.21). CONCLUSION: The prevalence of depressive symptoms among healthcare workers due to COVID-19 was high. Factors associated with depressive symptoms were age, family size, alcohol use, medical illness, having training on COVID-19, and lack of knowledge on COVID-19.

Effects of Scaling Up Family Planning on Maternal Survival in Ethiopia: Spectrum Modeling.

BACKGROUND: Ethiopia has made great strides on under-five and maternal mortality reduction as demonstrated by achieving the millennium development target of child mortality reduction by the start of 2015. According to a recent demographic and health survey report, Ethiopia has a 67 per 1000 under-five mortality rate and a 412 per 100,000 live births maternal mortality ratio. The current trend of maternal and child mortality reduction is not enough to meet sustainable development goal three (SDG3) of maternal and child mortality reduction target which is set to reduce the maternal mortality ratio to below 70/100,000 live births in all countries. This paper aimed to model the effect of scaling up family planning on pregnancies, live births, stillbirths, abortions and maternal mortality in Ethiopia. METHODS: We used the Spectrum software package to model the impact of family planning on maternal survival and other maternal health metrics. Spectrum has different modules consisting of demproj module (demographic projection), famplan module (family planning), LiST (life saved tool), and AIM (aids impact model). We used Demproj, Famplan and LiST modules for this particular paper. Baseline national data were taken from findings of the Ethiopian demographic and health survey 2016, and World Bank and World Health Organization country specific reports. RESULTS: Total fertility rate will decline to 2.3 children per women by the year 2030 when contraceptive prevalence is scaled up by 2% annually from 2016 to 2030. As a result of continuous scaling up of contraceptive use, around 3.17 million unintended pregnancies can be averted. Unmet need for family planning will significantly decline to 11.7% by 2030. Ninety-four thousand unsafe abortions could be averted and 1233 additional maternal lives could be saved by the end of 2030 in Ethiopia. CONCLUSION: Scaling up family planning has shown a significant effect to meet the SDG3 maternal mortality reduction target. A considerable proportion of unintended pregnancies and unsafe abortions can be averted by scaling up contraceptive prevalence by 2% annually until 2030. Family planning is effective and a less costly intervention to reduce maternal mortality in countries with high fertility; hence, it is highly recommended to rampup all efforts to scale up contraceptive use for improving maternal health status in Ethiopia.

Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study.

BACKGROUND: Maternal mortality and morbidity remain unacceptably high in developing countries. Behind every maternal death, many other women suffered from acute and chronic obstetric complications. Women who survive severe acute maternal morbidities/near miss have many characteristics in common with maternal death events particularly on risk factors. Ethiopia is among countries with high maternal mortality and morbidities in sub-Saharan Africa. However there is scarce evidence on risk factors of severe acute maternal morbidities in Ethiopia. Therefore this study aimed to identify predictors of maternal near miss among women admitted in Gurage zone hospitals, south Ethiopia, 2017. METHODS: Hospital based case control study was conducted to assess predictors of maternal near miss among women admitted in five hospitals of Gurage zone, South Ethiopia. Data of 229 (77 cases and 152 controls) women were included in the analysis. Cases were women admitted due to severe acute maternal morbidity while controls were women admitted for normal labor or women admitted due to mild to moderate obstetric complications. Cases were identified by validated-disease specific criteria. Then, two controls were selected for each verified case using lottery method among eligible women. Data were collected using interviewer administered questionnaire and reviewing patients' records. Data were entered using Epi Info 7 and analyzed by SPSS 21. Multivariable logistic regression analysis was done to identify independent predictors of maternal near miss. RESULT: Majority of cases were admitted due to dystocia (57.1%) and obstetric hemorrhage (26%). The median first delay (delay to seek health care) among cases and controls was six and 4 h respectively. Prior history of cesarean section {AOR 7.68, 95%CI, 3.11-18.96}, first delay {AOR 2.79, 95%CI, 1.42-5.50}, and being referred from other health facilities {AOR 7.47, 95% CI, 2.27-24.51} were independent predictors of maternal near miss. CONCLUSIONS: Prior history of cesarean section, being referred from other health facilities and first delay were factors associated with maternal near miss. Timely health care seeking behavior of women is uncommon in the study area. Therefore primary health care programs need to enhance the existing efforts to improve timely health care seeking behavior of women.

Institutional delivery service utilization and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji Zone, Oromia, Southern Ethiopia: a cross sectional study.

BACKGROUND: Globally, an estimated 289,000 maternal deaths occurred in 2013. Majority of these deaths occurred in sub-Saharan Africa and Southern Asia. Mobility of pastoralists is a well-recognized survival strategy in arid and semi-arid land of sub-Saharan Africa. However governments often encourage settlement as a solution to the difficulty of providing health services for mobile pastoralists. This study aimed to assess utilization of institutional delivery and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji zone, Oromia, Ethiopia. METHODS: A Community based cross-sectional survey was conducted among the mobile pastoralist community of the Liban District. Seven hundred ninety-one (791) randomly selected women, who had birth within the last 2 years preceding the survey, were interviewed using a pretested structured questionnaire. Data were entered into Epi-Info version 3.5.4 and analyzed by Statistical Package for Social Science (SPSS) version 16. Bivariate and multivariate analyses were done. RESULTS: Out of 791 women who gave birth within the last 2 years preceding the survey, only 110 (13.9%) gave birth in health institutions. Majority (74.1%) of the women gave birth at their home. Ninety-one women (11.5%) gave birth at traditional birth attendant's home; assisted by traditional birth attendants. Multiple logistic regression shows that women who had readily available cash at the onset of labor (aOR 2.79, 95% CI: 1.29-6.25), delivered the birth preceding the most recent birth in a health institution (aOR 6.8, 95% CI: 3.44-13.45) and had birth related complications during the birth preceding the most recent birth (aOR 1.90, 95% CI: 1.08-3.36) were more likely to deliver at health institutions. CONCLUSION: Majority of the pastoral women seek institutional delivery, only when labor related complications are perceived. Mechanisms of alleviating indirect health care costs affecting institutional delivery need to be addressed in future studies.

Predictors of exclusive breastfeeding duration among 6-12 month aged children in gurage zone, South Ethiopia: a survival analysis.

BACKGROUND: Exclusive breastfeeding is giving only breast milk to an infant from birth up to six months of age, with the exception of medications and vitamins. For the first six months of life, breast milk alone is the ideal nourishment to meet the nutritional demand of the growing child. Although breastfeeding is a universal practice, in Ethiopia only 52% of children aged less than six months old were exclusively breastfed. The study aimed to investigate the predictors of exclusive breastfeeding duration among women who had children aged between 6-12 months in Gurage zone, South Ethiopia. METHODS: A mixed method cross-sectional study was conducted to assess predictors of exclusive breastfeeding duration in south Ethiopia. Eight hundred and twenty eight study participants were recruited using a multistage sampling technique for the quantitative survey. Interviewer administered close ended questionnaire was used to collect the quantitative data. Data were entered using Epi Data and analyzed using SPSS version 21. The Kaplan-Meier curve with log rank test was used to compare the survival difference due to the selected covariates. A binary and multivariable Cox regression model was used to identify the independent predictors of exclusive breastfeeding duration. Three focus group discussions were conducted to generate the qualitative data. Qualitative data is transcribed and analyzed by thematic approach using open-code software. RESULTS: The median duration of exclusive breastfeeding was six months. About 21.9% of women introduced complementary food before six months of child age. Women with education status of diploma and above (Adjusted Hazard Ratio [AHR]: 2.89, 95% CI: 1.05, 7.97), perceived inadequate breast milk (AHR: 11, 95% CI: 6.7, 18.0) and cesarean section delivery (AHR: 3.8, 95% CI: 2.0, 7.2) were more likely to cease exclusive breastfeeding before six months of child age; while women who had infant feeding counseling during postnatal care (AHR: 5.1, 95% CI: 2.5, 10.23) were less likely to cease exclusive breastfeeding before the child was six months of age. CONCLUSIONS: A significant proportion of women cease exclusive breastfeeding before the recommended six months duration. Maternal education of diploma and above, perceived inadequacy of breast milk, cesarean section delivery, postnatal counseling on child feeding are factors significantly associated with the duration of exclusive breastfeeding. Encouraging behavioral change and improving communication regarding the duration of exclusive breastfeeding, and increasing the utilization of postnatal counseling about exclusive breastfeeding are recommended.