A qualitative assessment of challenges to tuberculosis management and prevention in Northern Ethiopia.

OBJECTIVE: To elicit Ethiopian health care providers' understanding of challenges to effectively preventing, diagnosing and treating tuberculosis (TB). DESIGN: Qualitative data were collected via in-depth interviews and focus group discussions with 73 providers, including physicians, nurses, pharmacists and laboratory technicians, in five hospitals in the Northern Ethiopian regions of Amhara and Tigray. There was no intervention. RESULTS: Focus groups and interviews shared a number of prominent common themes. Respondents identified numerous challenges associated with active case identification, infection control practices, diagnostics, including the absence of TB culture and drug susceptibility testing capacity, and the lack of infrastructure for diagnosing and treating multidrug-resistant TB. Pharmacists noted a need for improved procurement practices and pediatric dosages for TB medications. Providers shared concerns regarding isoniazid preventive therapy, health workforce challenges and the risk of contracting TB in the workplace. CONCLUSIONS: Health care providers in the Northern Ethiopian regions of Tigray and Amhara identified many challenges to effectively preventing, diagnosing and treating TB. These challenges are complicated by severe resource constraints and challenges in attracting and retaining providers in government hospitals in centers outside Addis Ababa.

Incidence of neonatal morbidity at Gondar town, Ethiopia.

OBJECTIVE: To determine the incidence and pattern ofneonatal morbidity. DESIGN: For all neonates delivered in the hospital at least one home visit was arranged to collect morbidity data during neonatal period. This collection took place for a period of one year from 1 September 1995 to 31 August 1996. SETTING: Maternity Ward of the Gondar College of Medical Sciences Hospital. PATIENTS: 320 neonates were visited at home and were evaluated for any morbidity. RESULTS: Of the 320 neonates visited at home during the first 24 to 38 days post delivery 83 (25.9%) were found to be sick. URTI (Upper Respiratory Tract Infection), jaundice, pneumonia and neonatal septicimia were diagnosed by physical examination. Non-breastfeeding was associated with neonatal morbidity (p<0.001). CONCLUSIONS: The neonatal morbidity found during the home visit in this study is very high. A concerted effort is needed to improve both antenatal and postnatal care services to prevent neonatal morbidity and to identify sick neonates timely to provide appropriate care in this setting.