Willingness to pay for social health insurance and its associated factors among public servants in Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: As a means of establishing a sustained and fair health care financing system, Ethiopia has planned and ratified a legal framework to introduce a social health insurance program for employees of the formal sector to protect them against financial and health burdens. However, the implementation has been delayed due to the resistance of public servants to pay the proposed premium. The aim of this study was to estimate the magnitude of willingness to pay the proposed amount of premium set by the government for the social health insurance program and the factors associated with it among public servants in Addis Ababa, Ethiopia. METHODS: An institution-based cross-sectional study design was used to conduct the study. Multistage sampling was employed to select a total of 503 from 12 randomly selected public sectors. Data were collected using pretested, interviewer-administered structured questionnaires. A contingent valuation method with an iterative bidding game was used to elicit willingness to pay. Finally, logistic regression analysis was used to identify independent predictors of willingness to pay. Statistical significance was considered at P < 0.05 with adjusted odds ratios calculated at 95% CIs. RESULTS: Only 35.4% were willing to pay the proposed premium (3% of their monthly salary). Those who had children from 6-18 years old (AOR = 3.252; 95% CI: 1.15, 9.22), had a history of unaffordable health service costs during the last 12 months (AOR = 9.631; 95% CI: 4.12, 22.52), and had prior information about the social health insurance program (AOR = 11.011, 95% CI. 3.735-32.462) were more likely to pay for the proposed social health insurance program compared to their counterparts. CONCLUSION: The willingness to pay the proposed amount premium for social health insurance among public servants in Addis Ababa was very low that implies the implementation will be challenging. Thus, the government of Ethiopia should consider reviewing the amount of premium contributions expected from employees before implementing the social health insurance scheme.

Determinants of pulmonary tuberculosis in public health facilities of Dire Dawa City, Eastern Ethiopia: Unmatched Case-control study.

Background: The Federal Ministry of Health of Ethiopia Annual performance report in 2014-2015 showed that the highest prevalence of tuberculosis (TB) case in Ethiopia was reported from Dire Dawa city which was 400/100,000 population. The aim of this study was to identify the determinants of pulmonary TB (PTB) in public health facilities of Dire Dawa city, Eastern Ethiopia. Methods: A case-control study was conducted from October to December 2017 among 95 cases and 190 controls in Dire Dawa city. Dire Dawa is one of the two chartered cities in Ethiopia like the capital city Addis Ababa. Cases and controls were identified and selected randomly from the health facilities. Data were collected using a pretested and structured questionnaire by trained data collectors. We used logistic regression to model the associations of independent variables with PTB infection. Results: PTB was associated with patients' education (no formal education vs. formal education) (adjusted odds ratio [AQR] [95% confidence interval [CI]: 3.0, [1.3, 7.1]), human immunodeficiency virus (HIV) positive status (AOR [95% CI]: 3.1: [1.1,9.1]), previous contact history with TB patient (AOR [95% CI]: 9.9 [4.3,23.0]), body mass index (BMI) of ≤18 (AOR [95% CI]: 14.9 [6.4,35.1]), and cigarette smoking history (ever vs. never) (AOR [95% CI]: 6.7 [2.3,19.5]). Conclusion: This study showed that patients' educational status, HIV status, cigarette smoking, contact history with PTB patient, and BMI were independently associated with being infected with PTB. To reduce PTB transmission, peoples should be educated on TB prevention and consequences of risky behaviors.

Male Partners' Involvement in the Prevention of Mother-to-Child Transmission of HIV and Associated Factors in Arba Minch Town and Arba Minch Zuria Woreda, Southern Ethiopia.

Background. Male involvement is an important determinant of prevention of mother-to-child transmission of HIV. However, male involvement in prevention of mother-to-child transmission of HIV in Ethiopia is not well known. Objectives. To assess male partners involvement in prevention of mother-to-child transmission of HIV and associated factors in Arba Minch town and Arba Minch Zuria woreda. Methods. Community based study was conducted in Arba Minch town and Arba Minch Zuria district. Multistage sampling technique was used and data were collected using interviewer administered standard questionnaire. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables. Results. The level of male involvement in PMTCT program in Arba Minch town and Zuria district was 53%. Several factors appear to contribute to male involvement in the PMTCT program including age, residence, education level, knowledge on HIV, knowledge on PMTCT, accessibility of health facility, having weak perception for male involvement in PMTCT, having perception of ANC attendance being females' responsibility, ever use of khat, and ever use of cigarette. Conclusion. Geographical accessibility of health facility and male's knowledge on PMTCT should be improved to increase their involvement in PMTCT.