Quality of medical records in public health facilities: A case of Southern Ethiopia, resource limited setting.

Facility based retrospective study was conducted in three regions in southern Ethiopia to assess quality of medical records. A total of 2,145 medical records were reviewed from 73 public health facilities. Minimum standards of medical records were considered to assess completeness and legibility of records. The completeness of medical records were judged systematically according to national HMIS formats. From total of 2,145 medical cards reviewed, only 394 (18.4%) records had all complete and readable data. Gaps observed include 29.0% missed at least one of identification data, 14.3% lack chief compliant, 20.1% lack diagnosis, 12.5% lack medication and 60.3% records had no date and/or signature. Moreover, 9.5% cards had at least one non-readable component. Records at health centers were 56.8% less likely to be quality record as compared to records in hospitals. Even though completeness of every single record is must, only less than one fifth of records met quality of national medical record standard. Ministry of health should consider rules and regulation to maintain data quality and switching to electronic record, and finally progress in data quality should be monitored routinely.

Knowledge and attitude towards COVID-19 and its prevention in selected ten towns of SNNP Region, Ethiopia: Cross-sectional survey.

BACKGROUND: COVID-19 is highly infectious viral disease that can lead to main clinical symptoms like fever, dry cough, fatigue, myalgia, and dyspnea. Since there is no drug to cure the disease, focusing on improving community awareness related to prevention methods is crucial. But there was no regional level study addressing the reach of information, community knowledge and attitude related to COVID-19 and its prevention, and this study was done to inform and assist communication related to the disease responses during early introduction of the disease to the setting. METHODS: Community based cross sectional study was conducted in selected ten towns of SNNPR, Ethiopia. Multi-stage sampling was used to select 1239 participants. Semi-structured questionnaire was designed, pre-tested and uploaded to SurveyCTO data collection system with security patterns. Knowledge was assessed considering awareness about signs and symptoms, confirmatory test (laboratory test), what to do if there is a suspect, availability of drug to cure the disease, mechanisms of transmission, prevention methods and most at risk groups. Attitude was assessed using 11 statements including seriousness of disease, being at risk, possibility of prevention, and benefits of staying at health facilities. Descriptive statistics and binary logistic regression were performed to manage data using SPSS version 25. RESULTS: Almost all respondents (99.8%) heard about the disease. The mean score of knowledge was 52.3% (SD = 18.9) while the mean score attitude was 80.8% (SD = 6.48). Educational status, housing condition and marital status were associated with having good knowledge while occupation, housing condition, age and overall knowledge were associated with having positive attitude. CONCLUSION: Even though almost all respondents had heard about the COVID-19, knowledge and attitude related to COVID-19 and its prevention were low. Awareness creation should be intensified using different local languages to improve community awareness, overcome misconceptions and minimize consequences of the disease.

COVID-19 prevention practices in urban setting during early introduction of the disease: results from community survey in SNNP Region, Ethiopia.

OBJECTIVE: To assess community practices related to COVID-19 prevention and its associated factors during the early introduction of the disease to the study area. SETTING AND PARTICIPANTS: A community-based cross-sectional study was conducted in Southern Nations, Nationalities and People's Region, Ethiopia. Ten zonal towns with high population density and mobility and 1239 participants were included in the study. OUTCOME MEASURE: A semistructured questionnaire was uploaded to SurveyCTO data collection system with security patterns. Mask usage was assessed by observation, while social distancing and handwashing were assessed by interview. Data were collected by health professionals who have Bachelor of Science degree and above and analysed using SPSS V.25. Descriptive statistics and binary logistic regression were performed. RESULTS: From 1239 individuals, about half, 657 (53%), of respondents were women and about two-thirds, 795 (64.2%), were married. Nearly 9 out of 10 (90.3%) and about 8 out of 10 (82.0%) respondents reported that they frequently wash hands with soap and/or use sanitiser and keep social distancing as means to prevent COVID-19, respectively. Less than three-fifths (57.8%) of respondents wore masks during the interview. In summary, about half (48.9%) of respondents were practising the three recommended methods (social distancing, handwashing and wearing masks). Sex, educational status, family size and overall knowledge about COVID-19 were associated with practising COVID-19 prevention measures. CONCLUSION: COVID-19 prevention practice was low as only about half of participants were practising social distancing, handwashing and wearing masks. Although awareness creation has been implemented through different forms of media, it should be strengthened in different local languages. Concerned government bodies should strictly follow using masks in public gatherings.

Exclusive Breast-Feeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia.

INTRODUCTION: Globally, over 90% of HIV infections among children are due to mother-to-child transmission and breastfeeding accounts for 5-20% of the burden. Avoidance of inappropriate feeding practices and practicing exclusive breastfeeding is recommended to reduce mother-to-child HIV transmission, but it is hardly practiced. The aim of this study was to determine the prevalence of exclusive breastfeeding practice and associated factors among HIV-positive mothers attending governmental PMTCT clinics in Southern Ethiopia. METHODS: An institution-based cross-sectional study was conducted from April to May 2019. The participants of the study were 209 HIV-positive mothers at the selected PMTCT sites. The study subjects were drawn from 10 health institutions located at 6 towns in Southern Ethiopia which constituted six hospitals and four health centers. Quantitative data were collected using the pretested structured questionnaire. Logistic regression analysis was used to determine the association between the predictors and outcome variable. RESULTS: Among the 209 participants, 81.6% (95% CI: 75.8-86.5) practiced exclusive breastfeeding and 18.4% (95% CI: 13.5-23.7) practiced mixed feeding. Mothers who had attended the recommended four antenatal visits [AOR: 3.01, 95% CI (1.1-8.28)], who had disclosed their serostatus [AOR: 3.17, 95% CI (1.12-8.99)], who had sufficient knowledge about infant feeding practice [AOR: 3.32, 95% CI (1.15-9.55)], and favorable attitude towards infant feeding practice [AOR: 5.39, 95% CI (1.65-17.6)] were more likely to practice exclusive breastfeeding. CONCLUSION: Exclusive breastfeeding was predominantly practiced. But mixed feeding was also being practice considerably. Improving maternal knowledge and attitude towards appropriate infant feeding practice through appropriate counseling on ANC visits could significantly improve EBF practice. It was also evident that promoting disclose of serostatus could empower the mothers to make an informed decision on how to appropriately feed their newborn.

Decentralizing evidence-based decision-making in resource limited setting: A case of SNNP region, Ethiopia.

BACKGROUND: Access to and the use of accurate, valid, reliable, timely, relevant, legible and complete information is vital for safe and reliable healthcare. Though the study area has been implementing standardized Health Management Information System (HMIS), there was a need for information on how well structures were utilizing information and this study was designed to assess HMIS data utilization. METHODS: Facility based retrospective study was conducted in Southern Nations Nationalities and People's Region (SNNPR) in April, 2017. We included data from 163 sample facilities. Data use was evaluated by reviewing eight items from performance monitoring system that included activities from problem identification to monitoring of proposed action plans. Each item reviewed was recoded to yes or no and summed to judge overall performance. RESULTS: About half (52%) of woredas, 26.2% health centers (HCs), 25% hospitals and 6.2% health posts (HPs) reviewed their performance monthly but only 20% woredas, 6.2% HCs, 1.5% HPs and no hospital prepared action plans after reviewing performance. Summary of 8 items assessed showed that majority of facilities (87.5% hospitals, 81.5% HPs and 70.8% HCs) were poor in data utilization. CONCLUSIONS: Only about half of woredas and below one-fifth of health facilities were utilizing HMIS data and a lot to move to catch-up country's information revolution plan. Lower health care systems should be supported in evidence-based decision-making and progress should be monitored routinely quantitatively and/or qualitatively.

Mismatch between antenatal care attendance and institutional delivery in south Ethiopia: A multilevel analysis.

OBJECTIVES: Uptake of maternal health services remains suboptimal in Ethiopia. Significant proportions of antenatal care attendees give birth at home. This study was conducted to identify the predictors of non-institutional delivery among women who received antenatal care in the Southern Nations Nationalities and Peoples Region, Ethiopia. DESIGN: A community-based cross-sectional survey was conducted among women who delivered in the year preceding the survey and who had at least one antenatal visit. Multistage cluster sampling was deployed to select 2390 women from all administrative zones of the region. A mixed-effects multivariable logistic regression analysis was performed to assess the predictors of non-institutional delivery; adjusted ORs (AOR) with 95% CIs are reported. RESULTS: The proportion of non-institutional deliveries among participants was 62.2% (95% CI 60.2% to 64.2%). Previous experience of short and simple labour (46.9%) and uncomplicated home birth (42.9%), night-time labour (29.7%), absence of pregnancy-related problem (18.8%) and perceived providers poor reception of women (17.8%) were the main reasons to have non-institutional delivery. Attending secondary school and above (AOR=0.51; 95% CI 0.30 to 0.85), being a government employee (AOR=0.27; 95% CI 0.10 to 0.78) and woman's autonomy in healthcare utilisation decision making (AOR=0.51; 95% CI 0.33 to 0.79) were among the independent predictors negatively associated with non-institutional delivery. On the other hand, unplanned pregnancy (AOR=1.67; 95% CI 1.16 to 2.42), not experiencing any health problem during pregnancy (AOR=8.1; 95% CI 3.12 to 24.62), not perceiving the risks associated with home delivery (AOR=6.64; 95% CI 4.35 to 10.14) were the independent predictors positively associated with non-institutional delivery. CONCLUSIONS: There is a missed opportunity among women attending antenatal care in southern Ethiopia. Further health system innovations that help to bridge the gap between antenatal care attendance and institutional delivery are highly recommended.

Understanding performance data: health management information system data accuracy in Southern Nations Nationalities and People's Region, Ethiopia.

BACKGROUND: Health management information system (HMIS) is a system whereby health data are recorded, stored, retrieved and processed to improve decision-making. HMIS data quality should be monitored routinely as production of high quality statistics depends on assessment of data quality and actions taken to improve it. Thus, this study assessed accuracy of the routine HMIS data. METHODS: Facility based cross-sectional study was conducted in Southern Nations Nationalities and People's region in 2017. Document review was done in 163 facilities of different levels. Statistical Package for the Social Sciences (SPSS) for windows version 20 was used to perform data analysis. Data accuracy was presented in terms of mean and standard deviation of data verification factor. RESULTS: Though inaccuracy was noted for all data elements, 96.9 and 84.7% of facilities reported institutional maternal death and skilled birth attendance within acceptable range respectively while confirmed malaria (45.4%), antenatal care fourth visit (46.6%), postnatal care (55.2%), fully immunized (55.8%), severe acute malnutrition (54.6%) and total malaria (50.3%) were reported accurately only by about half of facilities. Antenatal care fourth visit was over reported by 24% while total malaria was under reported by 28%. Reasons for variations included technical, behavioral and organizational factors. CONCLUSIONS: Majority of facilities over reported services while under reporting diseases. Data quality should be monitored routinely against data quality parameters quantitatively and/or qualitatively to catch-up country's information revolution agenda.

Women's perception about contraceptive use benefits towards empowerment: A phenomenological study in Southern Ethiopia.

BACKGROUND: Despite the availability of copious information regarding contraceptive use benefits and the factors that influence the uptake of the services, there is little evidence revealing the lived experiences of rural women. Thus, this study was conducted with the purpose of exploring the lived experiences of women regarding contraceptive use and related benefits towards women's empowerment. METHODS: Interpretative phenomenological qualitative methodology was employed to explore the lived experiences of women. Data were collected through focus group discussions and in-depth individual interviews and analyzed using an interpretive phenomenological framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through hermeneutic circle. RESULT: The reported lived experiences of rural women revealed that their livelihoods greatly improved in different ways after they began to use contraceptives. The benefits included securing more time, energy and social engagements. Contraceptive use helped women postpone unwanted pregnancies and child births and engage in various income generation activities that not only boosted family incomes but also created opportunity to mobilize the resources for different expenses without waiting for the handouts from their husbands. The women's experiences also indicated that contraceptive use improved the educational status of their daughters and they experienced improved self-image, better social standing and improved family relations. The experiences further illustrated that contraceptive use was not only emancipatory and transformative, but also created peace and stability in their lives. CONCLUSION: The study concludes that contraceptive use, which is part of a woman's life experience, created remarkable opportunities and achievements. One of these was that women were able to control their bodies, reproduction and fertility which resulted in a higher degree of empowerment. The control of reproduction and fertility has liberated them from worries and entrapment of unplanned and unwanted pregnancies. Moreover, contraceptive use led to wider opportunities in the community, by improving their status and building a sense of empowerment. Creating awareness around the benefits of contraceptive use has the potential to improve community and national development. Based on the result, the study recommends that systems should be established to capitalize on the lessons learned about the lives of current users and expand the remarkable achievements and experiences to non-user counterparts.

Polysubstance use and its linkage with risky sexual behavior in university students: significance for policy makers and parents.

BACKGROUND: Despite the high prevalence of polysubstance use in low income countries, little has been done to investigate the linkage between polysubstance use and risky sexual behaviors. OBJECTIVE: To assess the association of polysubstance use with risky sexual behaviors, economic, educational and geographic factors. METHODS: A cross-sectional study on aspects of risky behavior towards HIV-infection was conducted on a sample of 1220 university students. Logistic regression analysis was applied to examine the linkage between polysubstance use and risky sexual behavior--having sex with multiple partners, commercial sex workers and failure to use condom. RESULTS: About one fourth of study participants reported to use one or more types of substance (mainly cigarette, alcohol and khat) in one year period. Of these students, more than three-fifths started using the substance before joining university and more than two-fifths were polysubstance users. Students from urban areas were more likely to be polysubstance users and to engage in sexual practice. Logistic regression analysis demonstrated a strong association of polysubstance use with male gender, being born and growing up in urban areas, good income, taught in private school, academically senior and born to more educated parents (P < 0.05 each). The majority (42%) of polysubstance users was also practicing sex with multiple partners and commercial sex workers, had sex without condoms and developed active sexually transmitted infection (STI) symptoms (P < 0.0001 for each). CONCLUSION: This analysis unveils the strong association of polysubstance use with better socioeconomic circumstances, better education and risky sexual behaviors. Primary prevention strategies should target students in elementary and secondary schools, mainly in the urban setting, and preferably by involving their parents.

Prophylactic procurement of university students in Southern Ethiopia: stigma and the value of condom machines on campus.

INTRODUCTION: Risky sexual behavior among Ethiopian university students, especially females, is a major contributor to young adult morbidity and mortality. Ambaw et al. found that female university students in Ethiopia may fear the humiliation associated with procuring condoms. A study in Thailand suggests condom machines may provide comfortable condom procurement, but the relevance to a high-risk African context is unknown. The objective of this study was to examine if the installation of condom machines in Ethiopia predicts changes in student condom uptake and use, as well as changes in procurement related stigma. METHODS: Students at a large urban university in Southern Ethiopia completed self reported surveys in 2010 (N  = 2,155 surveys) and again in 2011 (N =  2,000), six months after the installation of condom machines. Mann-Whitney and Chi-square tests were conducted to evaluate significant changes in student sexual behavior, as well as condom procurement and associated stigma over the subsequent one year period. RESULTS: After installing condom machines, the average number of trips made to procure condoms on-campus significantly increased 101% for sexually active females and significantly decreased 36% for sexually active males. Additionally, reports of condom use during last sexual intercourse showed a non-significant 4.3% increase for females and a significant 9.0% increase for males. During this time, comfort procuring condoms and ability to convince sexual partners to use condoms were significantly higher for sexually active male students. There was no evidence that the condom machines led to an increase in promiscuity. CONCLUSIONS: The results suggest that condom machines may be associated with more condom procurement among vulnerable female students in Ethiopia and could be an important component of a comprehensive university health policy.

Predictors of sexual-risk behaviour and HIV-preventive practices among university students in Ethiopia.

A cross-sectional study design was used to assess sexual-risk behaviour and HIV-preventive practices among students at Hawassa University, Ethiopia, in 2009. Among 1 220 students eligible for the study, approximately 29% reported experience of sex (36.3% of the males and 9.3% of the females). Of the total sexually active respondents, 67.1% had begun sexual activity while still in secondary school. For the previous 12-month period, 42.1% said they did not use condoms during the last sexual encounter, 46.1% of the males claimed having had sex with 'bar ladies,' and 39% said they had an active symptom of a sexually transmitted infection (STI). Logistic regression analysis demonstrated a significant association of higher-risk sexual practices in the previous year with being female and having an income greater than US$30/month. Having multiple sexual partners was strongly associated with being female, having a monthly income greater than US$30, a sexual debut before age 18 and before attending university, ever having had sex for the sake of money, active STI symptoms, and attending nightclubs. Overall, the students reported sexual practices that were considerably unprotected; we surmise that this likely exposed approximately two-fifths to STIs and nearly 10% to unplanned pregnancy. We conclude that to alter university students' sexual-risk behaviour, a great deal of relevant intervention should be carried out during earlier school years, and the observed link between a greater frequency of sexual-risk behaviour and higher income needs to be investigated.

High prevalence of drug-resistance mutations in Plasmodium falciparum and Plasmodium vivax in southern Ethiopia.

BACKGROUND: In Ethiopia, malaria is caused by both Plasmodium falciparum and Plasmodium vivax. Drug resistance of P. falciparum to sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) is frequent and intense in some areas. METHODS: In 100 patients with uncomplicated malaria from Dilla, southern Ethiopia, P. falciparum dhfr and dhps mutations as well as P. vivax dhfr polymorphisms associated with resistance to SP and P. falciparum pfcrt and pfmdr1 mutations conferring CQ resistance were assessed. RESULTS: P. falciparum and P. vivax were observed in 69% and 31% of the patients, respectively. Pfdhfr triple mutations and pfdhfr/pfdhps quintuple mutations occurred in 87% and 86% of P. falciparum isolates, respectively. Pfcrt T76 was seen in all and pfmdr1 Y86 in 81% of P. falciparum. The P. vivax dhfr core mutations N117 and R58 were present in 94% and 74%, respectively. CONCLUSION: These data point to an extraordinarily high frequency of drug-resistance mutations in both P. falciparum and P. vivax in southern Ethiopia, and strongly support that both SP and CQ are inadequate drugs for this region.