Health system delay and its associated factors among tuberculosis patients in Gamo Zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study.

Background: Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. Early diagnosis and initiation of treatment are essential for effective TB control. Objective: The main objective of this study was to assess the magnitude and factors associated with health system delay among tuberculosis patients in Gamo Zone, Southern Ethiopia. Methods: A cross-sectional study was conducted in Gamo Zone, Southern Ethiopia from February to April 2019. Fifteen health facilities in the study area were selected randomly and 255 TB patients who were ≥ 18 years of age were included. Data were collected using a questionnaire through face-to-face interviews and analyzed using SPSS version 20.0. Health system delay was analyzed using the median as a cut-off. Logistic regression analysis was performed to investigate factors of delays. A p-value of ≤ 0.05 at multivariable analysis was considered statistically significant. Results: The median (inter-quartile range) of health system delays was 14(6-30) days. About 54.5% of patients had prolonged health system delays. Patients who had multiple healthcare contacts (AOR: 5.74; 95% CI: 2.47, 13.34) and aged between 25 and 44 years old (AOR: 1.98; 95% CI: 1.02, 3.86) and aged ≥ 45 years (AOR: 3.54; 95% CI: 2.17, 14.27) were significantly associated with longer health system's delay. However, female gender (AOR: 0.46; 95% CI: 0.25, 0.87) and patients presenting symptoms [Hemoptysis (AOR: 0.27; 95%CI: 0.11, 0.65) and Chest pain (AOR: 0.28; 95%CI; 0.14, 0.56)] were significantly associated with reduced health system's delay. Conclusion: In this study, it was observed that a significant proportion of patients experienced more than the acceptable level for health system delay. The number of health care contact, presenting symptoms, age and sex were factors associated with health system delay. Hence, increasing clinician awareness of TB clinical presentation, implementing systems enabling early case detection, and ensuring rapid diagnosis of TB are required to achieve further TB control. Finally, maintenance of a high index of suspicion for tuberculosis in the vulnerable population could reduce long health system delays in the management of TB.

Acceptability and Factors Associated with Immediate Postpartum Intrauterine Contraceptive Device Use Among Women Who Gave Birth at Government Hospitals of Gamo Zone, Southern Ethiopia, 2019.

BACKGROUND: An intrauterine contraceptive device is suitable for women of all reproductive age groups for preventing unwanted pregnancies. Immediate postpartum family planning (PPFP) services need to be emphasized when the woman leaves the hospital. Despite the accepted demand for PPFP, many women do not access the services. Therefore, this study aimed to assess acceptability and factors associated with immediate postpartum intrauterine contraceptive device use among women who gave birth at government hospitals of Gamo Zone, Southern Ethiopia. METHODS: A cross-sectional study was conducted from March 1 to 30, 2019 with 452 participants studied using systematic random sampling technique. Data was collected using a pretested interviewer-administered questionnaire from March 1 to 30, 2019. The data were coded, cleaned and entered into Epi-data manager version 4.2.2.1 and exported to SPSS version 23 for advanced analysis. Binary logistic regression was performed to identify associated factors of immediate PPIUCD acceptability. RESULTS: This study revealed that about 161 (35.6%) in 95% CI (31.0, 39.6) of the study participants accepted immediate PPIUCD. Multiparty (AOR = 2.33, 95% CI, (1.29, 4.20)), completed antenatal follow up (AOR = 3.65, 95% CI, (2.22, 5.99)), counselling (AOR= 8.38, 95% CI, (4.85, 14.48)) and prior discussion (AOR=2.57, 95% CI, (1.51, 4.36)) were statistically significant. CONCLUSION AND RECOMMENDATION: Even though 58% of the mothers were counselled about PPIUCD during the important cascade of pregnancy and 53% of the mothers completed antenatal service, efforts need to improve antenatal care services and integrate counselling services through the whole cascade of pregnancy.

Survival Status and Predictors of Mortality among Newborns Admitted with Neonatal Sepsis at Public Hospitals in Ethiopia.

BACKGROUND: One-fourth of neonatal death is due to neonatal sepsis and nearly 98% of these deaths are occurring at low- and middle-income countries. In Ethiopia, forty percent of under-five mortality occurs during the neonatal period, of which neonatal sepsis accounts for 30-35% of neonatal deaths next to prematurity and its complications. On the other side, among the survived neonates with neonatal sepsis, there exist as vulnerable to short and long-term neurological and developmental morbidity impacting the overall productivity of the child as adult. METHODS: A longitudinal prospective cohort study was conducted among selected 289 neonates with neonatal sepsis who were admitted in the neonatal intensive care unit at public hospitals in Ethiopia from 1st March 2018 to 31st December 2019. Data were entered into Epi data version 3.02 and exported to SPSS V 25 for analysis. The Kaplan-Meier survival curve together with log-rank test was used to estimate the survival time of the neonates. Variables which had p value < 0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant predictors of mortality. RESULTS: The study was conducted with a total of 289 neonates admitted with neonatal sepsis. The cumulative proportion of surviving at the end of the fourth day was 99.5%, and it was 98.2% at the end of the fifth day. In addition, it was 96.6%, 93.5%, and 91.1% at the end of the sixth, seventh, and eighth day, respectively. The incidence of mortality was 8.65 per 100 neonates admitted with neonatal sepsis. Having a history of intrapartum fever (AHR: 14.5; 95% CI: 4.25, 49.5), history of chorioamnionitis (AHR: 5.7; 95% CI: 2.29, 13.98), induced labor (AHR: 7; 95% CI: 2.32, 21.08), and not initiating exclusive breastfeeding within one hour (AHR: 3.4; 95% CI: 1.34, 12.63) were the independent predictors of mortality. CONCLUSION: The survival status of neonates among neonates admitted with neonatal sepsis was high at the early admission days and high cumulative proportion of death as the admission period increased. The risk of mortality was high among the neonates with early onset of neonatal sepsis as compared with late onset of neonatal sepsis and history of intrapartum fever, history of diagnosed chorioamnionitis, onset of labor, and EBF initiation within one hour were the independent predictors of mortality among neonates admitted with neonatal sepsis.