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1
Mekonnen, Tensae, Tinashe Dune, Janette Perz, and Felix Akpojene Ogbo. "Trends and Determinants of Antenatal Care Service Use in Ethiopia between 2000 and 2016." International Journal of Environmental Research and Public Health 16, no. 5 (2019): 748. http://dx.doi.org/10.3390/ijerph16050748.
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: Antenatal care (ANC) services are an essential intervention for improving maternal and child health worldwide. In Ethiopia, however, ANC service use has been suboptimal, and examining the trends and factors associated with ANC service use is needed to inform targeted maternal health care interventions. This study aimed to investigate the trends and determinants of ANC service utilisation in Ethiopia for the period ranging from 2000 to 2016. This study draws on the Ethiopia Demographic and Health Survey data for the years 2000 (n = 7928), 2005 (n = 7276), 2011 (n = 7881) and 2016 (n = 7558) to estimate the trends in ANC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the study factors and ANC service utilisation. Over the sixteen-year period, the proportion of Ethiopian women who received the recommended four or more ANC visits increased from 10.0% (95% confidence interval (95% CI: 8.7–12.5%) in 2000 to 32.0% (95% CI: 29.4–34.3%) in 2016. Similarly, the proportion of women who received one to three ANC visits increased from 27.0% (95% CI: 23.6–30.7%) in 2000 to 62.0% in 2016 (95% CI: 60.4–67.3%). Multivariate analyses showed that higher maternal and paternal education, higher household wealth status, urban residency and previous use of a contraceptive were associated with ANC service use (1–3 and 4+ ANC visits). The study suggests that while Ethiopian pregnant women’s engagement with ANC services improved during the millennium development goal era (2000–2015), recommended ANC use remains suboptimal. Improving the utilisation of ANC services among pregnant women is essential in Ethiopia, and efforts should focus on vulnerable women.
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Mekonnen, Tensae, Tinashe Dune, Janette Perz, and Felix Akpojene Ogbo. "Postnatal Care Service Utilisation in Ethiopia: Reflecting on 20 Years of Demographic and Health Survey Data." International Journal of Environmental Research and Public Health 18, no. 1 (2020): 193. http://dx.doi.org/10.3390/ijerph18010193.
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Background: Most maternal deaths in the world occur during the postpartum period, especially within the first two days following delivery. This makes postnatal care (PNC) critical to improving the chances of maternal and child survival. Over the past 20 years, the proportion of women receiving antenatal care (ANC) in Ethiopia has increased while the proportion of those receiving PNC has remained low. This study aimed to understand the trends, determinants and urban–rural variations of PNC service utilisation. Methods: This study draws on the Ethiopian Demographic and Health Survey (EDHS) data for the years 2000 (n = 4552), 2005 (n = 4467), 2011 (n = 4445) and 2016 (n = 4275) to estimate the trends and determinants of PNC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent factors, the study factors and PNC service utilisation. Results: Over the twenty-year period of the EDHS, the proportion of Ethiopian women who received PNC services increased from 5.6% (95% CI: 4.6–6.9%) in 2000 to 18.5% (95% CI: 16.4–20.7%) in 2016. Similarly, women who received PNC services in urban areas increased from 15.2% (95% CI: 23.6–30.7%) in 2000 to 47% (95% CI: 60.4–67.3%) in 2016. Women who were in the wealthy quintile, had ANC visits, delivered in a health facility, and delivered by caesarean section were most likely to have PNC. The present study also showed that whilst birth spacing was a significant factor among urban women, wealth index, ANC visits, and perception of health facility distance were significant factors among rural women. Conclusions: The study suggests low levels of utilisation of PNC among Ethiopian women from rural districts. Geographically targeted interventions with a focus on low-socioeconomic rural women, and those with no previous contacts with the health system during pregnancy, are needed to improve PNC in Ethiopia.
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Getachew, Theodros, Solomon Mekonnen Abebe, Mezgebu Yitayal, Anna Bergström, Lars-Ake Persson, and Della Berhanu. "Health extension workers’ perceived health system context and health post preparedness to provide services: a cross-sectional study in four Ethiopian regions." BMJ Open 11, no. 6 (2021): e048517. http://dx.doi.org/10.1136/bmjopen-2020-048517.
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ObjectiveThe health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard quality of care. We assessed the health extension workers’ perceived context and the preparedness of health posts to provide services.SettingThis study was part of evaluating a complex intervention in 52 districts of four regions of Ethiopia. This paper used the endline data collected from December 2018 to February 2019.ParticipantsA total of 152 health posts and health extension workers serving selected enumeration areas were included.Outcome measuresWe used the Context Assessment for Community Health (COACH) tool and the Service Availability and Readiness Assessment tool.ResultsInternal reliability of COACH was satisfactory. The dimensions community engagement, work culture, commitment to work and leadership all scored high (mean 3.75–4.01 on a 1–5 scale), while organisational resources, sources of knowledge and informal payments scored low (1.78–2.71). The general service readiness index was 59%. On average, 67% of the health posts had basic amenities to provide services, 81% had basic equipment, 42% had standard precautions for infection prevention, 47% had test capacity for malaria and 58% had essential medicines.ConclusionThe health extension workers had a good relationship with the local community, used data for planning, were highly committed to their work with positive perceptions of their work culture, a relatively positive attitude regarding their leaders, and reported no corruption or informal payments. In contrast, they had insufficient sources of information and a severe lack of resources. The health post preparedness confirmed the low level of resources and preparedness for services. These findings suggest a significant potential contribution by health extension workers to Ethiopia’s primary healthcare, provided that they receive improved support, including new information and essential resources.
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Selamu, Liranso G., and Mohan S. Singhe. "Mental Health Care Service and Mental Problems among Orphan and Vulnerable Children in Addis Ababa Ethiopia." Journal of Health and Allied Sciences NU 07, no. 04 (2017): 003–5. http://dx.doi.org/10.1055/s-0040-1708727.
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AbstractA lot of children in the world suffer from untreated mental health problems. The global burdens of childhood mental disorders are increasing but mental health care services are neglected in most countries. The objective of this critical analysis was to realize the access to mental health service and mental problems among orphan and vulnerable children in Addis Ababa, Ethiopia. To achieve the purpose of the analysis, the method was based on the critical analysis of the recent research literature from Pub-Med, Global Health, Google Scholar, Ethiopian Universities, Psych-Info, and WHO data sources. Thirty-six journals published after 2001 were identified and critically analyzed based on scientific inclusion and exclusion criteria as well as analyzed in a systematic manner. The orphan and vulnerable children face a prospect of a persistent effort for physically continued existence, for fundamental needs, education, love and affection, and protection against exploitation violence and bias. The problem of meeting these desires of the children corresponds to a major new challenge that requires an in-depth research, future interventions, and policy plans in tackling the problem. In light of the problem in Ethiopia, researches regarding the mental health care services of the orphan and vulnerable children in Addis Ababa are extremely inadequate.
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Tessema, Gizachew Assefa, Mohammad Afzal Mahmood, Judith Streak Gomersall, et al. "Structural Quality of Services and Use of Family Planning Services in Primary Health Care Facilities in Ethiopia. How Do Public and Private Facilities Compare?" International Journal of Environmental Research and Public Health 17, no. 12 (2020): 4201. http://dx.doi.org/10.3390/ijerph17124201.
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Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities. Methods: A secondary data analysis of two national surveys, Ethiopia Services Provision Assessment Plus Survey 2014 and Ethiopian Demographic and Health Survey 2016, was conducted. Data from 1094 (139 private, 955 public) health facilities were analysed. In total, 3696 women were included in the comparison of users’ characteristics. Logistic regression was conducted. Facility type (public vs. private) was the key exposure of interest. Results: The private facilities were less likely to have implants (Adjusted Odds Ratio (AOR) = 0.06; 95% Confidence Interval (CI): 0.03, 0.12), trained FP providers (AOR = 0.23; 95% CI: 0.14, 0.41) and FP guidelines/protocols (AOR = 0.33; 95% CI: 0.19, 0.54) than public facilities but were more likely to have functional cell phones (AOR = 8.20; 95% CI: 4.95, 13.59) and water supply (AOR = 3.37; 95% CI: 1.72, 6.59). Conclusion: This study highlights the need for strengthening both private and public facilities for public–private partnerships to contribute to increased FP use and better health outcomes.
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Adulo, Lema Abate, Sali Suleman Hassen, and Asrat Chernet. "Timing of the First Antenatal Care Visit and Associated Risk Factors in Rural Parts of Ethiopia." International Journal of Applied Research on Public Health Management 7, no. 1 (2022): 1–12. http://dx.doi.org/10.4018/ijarphm.20220101.oa1.
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Early antenatal care visit promotes early detection and treatment of complications during pregnancy. The aim of this study was to assess the timing of the first antenatal care visit and associated factors in rural parts of Ethiopia. Only 3065 women from 2016 Ethiopian Demographic and Health Survey in rural area were included in this study. The descriptive and binary logistic regression analysis used to identify the determinants associated with the timing of the first antenatal care visit. This study revealed that 31% of women visited the first antenatal care within the first three months. Our study revealed that women education, maternal age, region, media access, women occupation, distance from health facility, wealth index, pregnancy complication and plan for pregnancy had significant effects on timing of the first antenatal care visit early. To initiate pregnant mothers to attend the first ANC visit timely, community-based services like media coverage, education, transportation and giving awareness about the necessity of having antenatal care service early is mandatory.
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Biresaw, Henok, Henok Mulugeta, Aklilu Endalamaw, Nurhusien Nuru Yesuf, and Yibeltal Alemu. "Patient satisfaction towards health care services provided in Ethiopian health institutions: a systematic review and meta-analysis." Health Services Insights 14 (January 2021): 117863292110406. http://dx.doi.org/10.1177/11786329211040689.
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The level of patient satisfaction is a direct or indirect measure of services delivered in healthcare institutions. Different primary studies in Ethiopia showed the proportion of satisfied patients toward health services. Patient satisfaction reflects a wide gap between the current experience and the expected services and pushes clients to go to farther located health care facilities and even to more expensive private health care facilities to find quality healthcare services. Inconsistent findings regarding the proportion of patients that are satisfied with the healthcare services in Ethiopia make generalizations difficult at the national level. We have accessed previous studies through an electronic web-based search strategy using PubMed, Cochrane Library, Google Scholar, Embase, and CINAHL and a combination of search terms. The quality of each included article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results. Out of 188 records screened, 41 studies with 17 176 participants fulfilled the inclusion criteria and were included for proportion estimation. The pooled proportion of satisfied patients was 63.7%. Attending a health center (AOR = 2.68; 95% CI = 1.79, 2.85), being literate (AOR = 0.46; 95% CI = 0.28-0.64), being younger than 34 years old (AOR = 2.07; 95% CI = 1.28, 2.85), and being divorced (AOR = 0.58; 95% CI = 0.38, 0.88) were factors identified as being associated with patient satisfaction. The proportion of patient satisfaction in Ethiopia was high based on over 50% satisfaction scale. The Ministry of Health should give more emphasis to improve hospital health care services to further improve patient satisfaction.
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Tilahun, Dejene, Abebaw Fekadu, Bethlehem Tekola, et al. "Ethiopian community health workers’ beliefs and attitudes towards children with autism: Impact of a brief training intervention." Autism 23, no. 1 (2017): 39–49. http://dx.doi.org/10.1177/1362361317730298.
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There is a severe shortage of services for children with autism in Ethiopia; access to services is further impeded by negative beliefs and stigmatising attitudes towards affected children and their families. To increase access to services, care provision is decentralised through task-shifted care by community health extension workers. This study aimed to examine the impact of a brief training (Health Education and Training; HEAT) for Ethiopian rural health extension workers and comprised three groups: (1) health extension workers who completed a basic mental health training module (HEAT group, N = 104); (2) health extension workers who received enhanced training, comprising basic HEAT as well as video-based training on developmental disorders and a mental health pocket guide (HEAT+ group, N = 97); and (3) health extension workers untrained in mental health (N = 108). All participants completed a questionnaire assessing beliefs and social distance towards children with autism. Both the HEAT and HEAT+ group showed fewer negative beliefs and decreased social distance towards children with autism compared to the untrained health extension worker group, with the HEAT+ group outperforming the HEAT group. However, HEAT+ trained health extension workers were less likely to have positive expectations about children with autism than untrained health extension workers. These findings have relevance for task-sharing and scale up of autism services in low-resource settings worldwide.
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Wondimu, Abrham, Jurjen van der Schans, Marinus van Hulst, and Maarten J. Postma. "Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis." International Journal of Environmental Research and Public Health 17, no. 8 (2020): 2696. http://dx.doi.org/10.3390/ijerph17082696.
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A previous study in Ethiopia reported significant variation in rotavirus vaccine uptake across socioeconomic strata. This study aims to quantify socioeconomic inequality of rotavirus vaccine uptake in Ethiopia and to identify the contributing factors for the inequality. The concentration curve (CC) and the Erreygers Normalized Concentration Index (ECI) were used to assess the socioeconomic related inequality in rotavirus vaccine uptake using data from the 2016 Ethiopian Demographic and Health Survey. Decomposition analysis was conducted to identify the drivers of inequalities. The CC for rotavirus vaccine uptake lay below the line of equality and the ECI was 0.270 (p < 0.001) indicating that uptake of rotavirus vaccine in Ethiopia was significantly concentrated among children from families with better socioeconomic status. The decomposition analysis showed that underlining inequalities in maternal health care services utilization, including antenatal care use (18.4%) and institutional delivery (8.1%), exposure to media (12.8%), and maternal educational level (9.7%) were responsible for the majority of observed inequalities in the uptake of rotavirus vaccine. The findings suggested that there is significant socioeconomic inequality in rotavirus vaccine uptake in Ethiopia. Multi-sectoral actions are required to reduce the inequalities, inclusive increasing maternal health care services, and educational attainments among economically disadvantaged mothers.
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Bitew Workie, Shimelash, Niguse Mekonen, Mulugeta W. Michael, et al. "Modern Health Service Utilization and Associated Factors among Adults in Southern Ethiopia." Journal of Environmental and Public Health 2021 (January 11, 2021): 1–7. http://dx.doi.org/10.1155/2021/8835780.
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Background. The Ethiopian government is striving to improve the health status of its population through the expansion and strengthening of primary health care services in both rural and urban settings of the country. The study aimed to measure modern health service utilization and associated factors in Wolaita Sodo town, Ethiopia. Method. A cross-sectional study design was implemented from May to June 2019 in Wolaita Sodo town, Ethiopia. All 786 study participants were selected by multistage systematic random sampling. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were collected by an open data kit. Stata window version 15.0 was also employed for statistical analysis. Multiple logistic regression was conducted, and a 95% confidence interval was considered for interpretation. Result. Health service utilization was 77.2% with (95% CI of 74.1%, 80.0%). In terms of health facilities in which they visit, first 50.6% were at the public health center and 25.5% of them were at Teaching and Referral Hospital. Respondents with marital status married and widowed have higher odds of utilizing health services compared to single marital status (AOR: 2.96; 95% CI: 1.7–5.2 and 9.0; 95% CI: 1.69–48.0), respectively. Respondents with middle and highest wealth status have higher odds of health service utilization than poor wealth status with AOR (1.75 95% CI 1.03–2.97 and 1.58 95% CI; 1.01, 2.77). Similarly, respondents who had chronic disease and perceived poor health status have higher odds of health service utilization. Conclusion. Modern health services utilization was found to be unsatisfactory. Being married, wealth status being middle and high, having chronic health conditions, and having poor perceived health status were found to have a statistically significant association with health service utilization.
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Melberg, Andrea, Lidiya Teklemariam, Karen Marie Moland, Henriette Sinding Aasen, and Mitike Molla Sisay. "Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system." Health Policy and Planning 35, no. 8 (2020): 900–905. http://dx.doi.org/10.1093/heapol/czaa043.
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Abstract Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.
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Kitabo, Cheru Atsmegiorgis, and Ehit Tesfu Damtie. "Bayesian Multilevel Analysis of Utilization of Antenatal Care Services in Ethiopia." Computational and Mathematical Methods in Medicine 2020 (July 4, 2020): 1–11. http://dx.doi.org/10.1155/2020/8749753.
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In sub-Saharan Africa, 72% of pregnant women received an antenatal care visit at least once in their pregnancy period. Ethiopia has one of the highest rates of maternal mortality in sub-Saharan African countries. So, this high maternal mortality levels remain a major public health problem. According to EDHS, 2016, the antenatal care (ANC), delivery care (DC), and postnatal care (PNC) were 62%, 73%, and 13%, respectively, indicating that ANC is in a low level. The main objective of this study was to examine the factors that affect the utilization of antenatal care services in Ethiopia using Bayesian multilevel logistic regression models. The data used for this study comes from the 2016 Ethiopian Demographic and Health Survey which was conducted by the Central Statistical Agency (CSA). The statistical method of data analysis used for this study is the Bayesian multilevel binary logistic regression model in general and the Bayesian multilevel logistic regression for the random coefficient model in particular. The convergences of parameters are estimated by using Markov chain Monte-Carlo (MCMC) using SPSS and MLwiN software. The descriptive result revealed that out of the 7171 women who are supposed to use ANC services, 2479 (34.6%) women were not receiving ANC services, while 4692 (65.4%) women were receiving ANC services. Moreover, women in the Somali and Afar regions are the least users of ANC. Using the Bayesian multilevel binary logistic regression of random coefficient model factors, place of residence, religion, educational attainment of women, husband educational level, employment status of husband, beat, household wealth index, and birth order were found to be the significant factors for usage of ANC. Regional variation in the usage of ANC was significant.
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Shipp, M. P.-L., S. A. Francis, K. R. Fluegge, and S. A. Asfaw. "Perceived Health Issues: A perspective from East-African immigrants." Health, Culture and Society 6, no. 1 (2014): 13–32. http://dx.doi.org/10.5195/hcs.2014.113.
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This Study explores Somali and Ethiopian community leaders’ perceptions about health issues in their communities and the barriers to access and utilization of primary health care services. Fourteen in-depth interviews were conducted with community leaders and thematic analysis was used to analyze interviews. Participants identified chronic diseases, the unhealthy behaviors associated with them, and mental health as major health issues. Infectious diseases were secondarily mentioned as important health concerns. Lack of insurance and limited understanding of the health system were viewed as barriers to utilizing health care services. Other identified needs were: better education within immigrant communities about major health issues, enhanced cultural awareness of health care providers, improved health care access, and assistance with the acculturation process. Recommendations to improve the communities’ health status included enhancing providers' cultural competence, educating immigrants about major health issues, and increasing mental health care access.
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Aboma, Daniel, Gudina Egata, and Daniel Ayalew. "Level of Antenatal Care Services Utilization and Associated Factors Among Mothers who have Given Birth in the Past Twelve Months in Gelemso Town, West Hararghe Zone, Oromia National Regional State, East Ethiopia." Journal of Woman's Reproductive Health 2, no. 3 (2020): 11–21. http://dx.doi.org/10.14302/issn.2381-862x.jwrh-20-3444.
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Background In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women. According to the 2011 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Objectives The objective of this study was to determine level and identify factors influencing maternal antenatal care services utilization among mothers who gave birth in the last twelve months in Gelemso town west Hararghe Oromia, Ethiopia. Methods A community-based cross sectional study design was conducted on 347 study participants in Gelemso town west Hararghe Oromia Ethiopia from July 15, 2017 to August 15, 2017 G.C.A probability to proportional to size sampling technique was used to select the study population in two urban Kebeles. Data were collected using a pre tested structured questionairs. Descriptive results were presented using frequencies, and numerical summary measures. Bivariate analysis was carried out to assess the association between outcome variable and each in dependent variables. Odds ratio with 95% confidence level was estimated to identify factors associated with Antenatal Care (ANC) utilization using multivariable logistic regression. The statistical significance was declared at p- value < 0.05. Result The response rate this study was 98%. The prevalence of antenatal care service utilization was 64.6%. About 146 (42.1%) of the pregnant mother started antenatal care visit during the second trimester of pregnancy and a significant proportion 289(83.3%) had less than the recommended four visits. Educational status (AOR;15.19:CI 95%,6.006,38.417), husband attitude (AOR;1.995:CI 95%,1.016,3.916), marital status(AOR:4.587:CI 95%,1.888,11.146), planned pregnancy (AOR:4.938:CI 95%,2.514,9.702) were major factors associated with antenatal care service utilization. Conclusion Though more than half mother used antenatal care service in the study setting, two in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promotion of information, education and communication in the community should be strengthened is to sustain antenatal care service utilization in the community.
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Abdela, Seid Getahun, Johan van Griensven, Fikre Seife, and Wendemagegn Enbiale. "Neglecting the effect of COVID-19 on neglected tropical diseases: the Ethiopian perspective." Transactions of The Royal Society of Tropical Medicine and Hygiene 114, no. 10 (2020): 730–32. http://dx.doi.org/10.1093/trstmh/traa072.
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Abstract Countries around the world are facing an enormous challenge due to the COVID-19 pandemic. The pressure that the pandemic inflicts on health systems could certainly impact on the care, control, and elimination of neglected tropical diseases (NTDs). From mid-January 2020, Ethiopia started to prepare for the prevention and treatment of COVID-19. The Federal Ministry of Health pledged to continue essential healthcare, including NTD care, during this pandemic. However, some hospitals have been closed for other healthcare services and have been turned into isolation and treatment centers for COVID-19. In addition to the healthcare facility measures, all community-based health promotion and disease prevention services have been stopped. The current shift in attention towards COVID-19 is expected to have a negative impact on NTD prevention and care.
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BHARGAVA, ALOK. "DESIRED FAMILY SIZE, FAMILY PLANNING AND FERTILITY IN ETHIOPIA." Journal of Biosocial Science 39, no. 3 (2007): 367–81. http://dx.doi.org/10.1017/s0021932006001593.
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Summary.This paper models the proximate determinants of children born to over 13,000 Ethiopian women and of the women’s stated preferences for additional births using the data from the Ethiopian Demographic and Health Survey 2000. Empirical models for the number of children born to women were estimated using Poisson and ordinal regressions. The results show the importance of variables such as maternal education for smaller family size, and that variables reflecting desired family size are strong predictors of the numbers of children born to women. Secondly, binary logistic models for dichotomous variables for women not wanting more children and if getting pregnant would be a ‘big problem’ showed non-linear effects of the surviving and ‘ideal’ number of children. Moreover, the results indicated a desire on the part of women to limit family size, especially as the number of surviving children increased. Probit models were estimated to address potential endogeneity of certain variables. Overall, the results indicated that counselling couples about small family size and increasing the utilization of health care services can lower fertility in Ethiopia.
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Zigdon, Avi, Gideon Koren, and Liat Korn. "Characteristics Related to Choice of Obstetrician-Gynecologist among Women of Ethiopian Descent in Israel." Healthcare 8, no. 4 (2020): 444. http://dx.doi.org/10.3390/healthcare8040444.
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Background: Patient satisfaction with the quality of health care services is complex with many known factors impacting upon satisfaction, among them the choice of physician. Previous studies examined characteristics of a woman’s choice of gynecologist, but information regarding reasons for these choices among women of Ethiopian descent is lacking. The objective of this study was to identify characteristics related preference of an obstetrician-gynecologist based on gender among women of Ethiopian descent. Method: Analysis of anonymous self-reported questionnaire distributed to 500 women of Ethiopian descent who visited an obstetrician-gynecologist at least once in the past three years (Mean age 29.5; SD = 8.2). Trust in physician was examined using the TPS scale; service quality was checked using the SERVQUAL; and the 5Qs model was used to measure patient’s satisfaction of health care. Results: Very religious (84.1%) and religious (53.6%) women of Ethiopian descent were more likely to prefer a female obstetrician-gynecologist compared to traditional (39.3%) or secular (34.4%) women (p < 0.001). Participants had higher probability to prefer a male gynecologist if they had more employment hours (OR = 3.57, 95% CI = 1.72–7.42, p < 0.001), and the responsiveness of the physician was less important to them (OR = 0.77, 95% CI = 0.60–0.99, p < 0.05). Age of participants, country of birth, years in Israel, family status, being a mother, education or health status were not associated with choosing a female obstetrician-gynecologist. Religious women would prefer to wait longer for a female gynecologist due to modesty imperatives, even at the cost of compromising their health as a result of waiting longer. Conclusions: The findings of this research highlight the importance of accessibility to female obstetrician-gynecologists for women of Ethiopian descent and demonstrate that determinants in the host population rather than immigrant’s past culture, affect the women’s decision. This study demonstrates the importance of the health care system in Israel to enable more female obstetrician-gynecologists to treat women of Ethiopian descent.
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Getachew, Theodros, Solomon Mekonnen Abebe, Mezgebu Yitayal, Lars Åke Persson, and Della Berhanu. "Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia." PLOS ONE 16, no. 3 (2021): e0247474. http://dx.doi.org/10.1371/journal.pone.0247474.
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Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.
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Assebe, Lelisa Fekadu, Wondesen Nigatu Belete, Senait Alemayehu, et al. "Economic evaluation of Health Extension Program packages in Ethiopia." PLOS ONE 16, no. 2 (2021): e0246207. http://dx.doi.org/10.1371/journal.pone.0246207.
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Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3%. Result The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22–$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG. Conclusion The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.
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Miller, Nathan P., Farid Bagheri Ardestani, Hayes Wong, et al. "Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review." Health Policy and Planning 36, no. 7 (2021): 1187–96. http://dx.doi.org/10.1093/heapol/czab047.
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Abstract The Ethiopian Federal Ministry of Health and partners have scaled up integrated community case management (iCCM) and community-based newborn care (CBNC), allowing health extension workers (HEWs) to manage the major causes of child and newborn death at the community level. However, low service uptake remains a key challenge. We conducted a scoping review of peer-reviewed and grey literature to assess barriers to the utilization of HEW services and to explore potential solutions. The review, which was conducted to inform the Optimizing the Health Extension Program project, which aimed to increase the utilization of iCCM and CBNC services, included 24 peer-reviewed articles and 18 grey literature documents. Demand-side barriers to utilization included lack of knowledge about the signs and symptoms of childhood illnesses and danger signs; low awareness of curative services offered by HEWs; preference for home-based care, traditional care, or religious intervention; distance, lack of transportation and cost of care seeking; the need to obtain husband’s permission to seek care and opposition of traditional or religious leaders. Supply-side barriers included health post closures, drug stockouts, disrespectful care and limited skill and confidence of HEWs, particularly with regard to the management of newborn illnesses. Potential solutions included community education and demand generation activities, finding ways to facilitate and subsidize transportation to health facilities, engaging family members and traditional and religious leaders, ensuring consistent availability of services at health posts and strengthening supervision and supply chain management. Both demand generation and improvement of service delivery are necessary to achieve the expected impact of iCCM and CBNC. Key steps for improving utilization would be carrying out multifaceted demand generation activities, ensuring availability of HEWs in health posts and ensuring consistent supplies of essential commodities. The Women’s Development Army has the potential to improving linkages between HEWs and communities, but this strategy needs to be strengthened to be effective.
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Nemera, Bedasa, and Hailu Merga. "Exclusive breastfeeding practice and associated factors among rural mothers with 6–12-month-old children in west Oromia, Ethiopia." African Journal of Midwifery and Women's Health 15, no. 2 (2021): 1–10. http://dx.doi.org/10.12968/ajmw.2020.0021.
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Background/aims Despite the benefits of exclusive breastfeeding for children, the practice is not widespread in low-income countries, including Ethiopia, especially in rural settings. This study aimed to determine exclusive breastfeeding practice and associated factors among mothers with 6–12-month-old children in west Oromia, Ethiopia. Methods This cross-sectional study was conducted among 391 randomly selected mothers with 6–12-month-old children in Amuru, Ethiopia. Data on breastfeeding practice were collected using a structured questionnaire, adapted from the Ethiopian Health and Demographic Survey. Data were analysed using the Statistical Package for Social Sciences version 21. Factors that were significantly associated with exclusive breastfeeding at univariate analysis were then submitted to binary logistic regression, with P<0.05 considered significant. Results Of the 391 respondents, 48.1% of the mothers reported exclusively breastfeeding their children. Factors associated with exclusive breastfeeding were: mother aged 21–25 years old (adjusted odds ratio=5.1, P<0.0001), husband`s educational status (adjusted odds ratio=2.8, P<0.0001), owning a radio (adjusted odds ratio=2.8, P<0.0001), antenatal care attendance (adjusted odds ratio=9.2, P<0.0001), delivery at a health institution (adjusted odds ratio=4.3, P<0.0001) and initiating breastfeeding within an hour of birth (adjusted odds ratio=4.2, P<0.0001). Conclusions The exclusive breastfeeding rate was low among mothers in this study. Health education should be provided to mothers at the community and health facility level. The quality of maternity services provided at health facilities or in the community needs improvement by providing pre-service and in-service training to health workers. Moreover, facility-based birth and respectful care needs promotion.
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Yadeta, Tesfaye Assebe, Bizatu Mengistu, Tesfaye Gobena, and Lemma Demissie Regassa. "Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016." PLOS ONE 15, no. 11 (2020): e0242499. http://dx.doi.org/10.1371/journal.pone.0242499.
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Background The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data. Methods The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran’s, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6. Results The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran’s I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners’ educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up. Conclusions In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner’s education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.
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Tolera, Habtamu, Tegegne Gebre-Egziabher, and Helmut Kloos. "Risk factors for women’s non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia." Therapeutic Advances in Reproductive Health 14 (January 2020): 263349412092834. http://dx.doi.org/10.1177/2633494120928340.
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Objective: Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia. Methods: In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services. Results: Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery. Conclusion: The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.
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Kassie, Ayelign Mengesha, Biruk Beletew Abate, Mesfin Wudu Kassaw, Teshome Gebremeskel Aragie, Bonsa Amsalu Geleta, and Wondimeneh Shibabaw Shiferaw. "Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis." PLOS ONE 15, no. 12 (2020): e0239927. http://dx.doi.org/10.1371/journal.pone.0239927.
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Introduction Cervical cancer is a major public health problem, particularly in resource-limited settings. The use of vaccination and screening tests has reduced the burden of cervical cancer in developed countries. However, the situation is quite the reverse in developing countries, including Ethiopia. Hence, this study aimed to estimate the pooled impact of knowledge and attitude on the prevalence of cervical cancer screening service utilization rates among Ethiopian women. Methods Studies that examined cervical cancer screening service utilization among women in Ethiopia were searched from five international databases. Cochran’s Q chi-square and the I-squared test statistics were used to check the presence of heterogeneity among the included studies. The funnel plot and Egger’s regression tests were also used to assess the presence of publication bias. A weighted DerSimonian and Laird random-effects model was employed. Subgroup analysis was performed by the study population concerning the prevalence of cervical cancer screening service utilization rates. Sensitivity analysis was also conducted to assess the effect of a single study on the pooled estimates. Data analysis was performed using STATA™ Version 14 software. Results A total of 44 studies with 28,186 study participants were included. The estimated pooled prevalence of cervical cancer screening service utilization was 8.11% (95% CI: 7.26, 8.97). After adjustment for publication bias with the trim and fill analysis, the estimated prevalence rate appeared to be 5.47% (95% CI: 4.66, 6.28). The prevalence of cervical cancer screening service utilization was higher among HIV-positive women, 16.85%, and in studies conducted among health care workers, 10.24%, than the general population. The pooled effect of knowledge on the utilization of cervical cancer screening tests among Ethiopian women was statistically significant (AOR = 3.20, 95% CI: 1.63, 6.31). Similarly, the pooled estimated odds of utilizing cervical cancer screening tests were 6.1 times higher (AOR = 6.09, 95% CI: 1.09, 34.36) among women who had a favorable attitude towards the screening tests. Conclusion Knowledge and attitude had a significant impact on the prevalence of cervical cancer screening test utilization rates among women in Ethiopia. However, the prevalence of cervical cancer screening service utilization among Ethiopian women is very low. Hence, large-scale awareness programs and situation-based strategies need to be designed to increase the uptake of cervical cancer screening services in the country.
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Johansson, Kjell Arne, Mieraf Taddesse Tolla, Solomon Tessema Memirie, et al. "Country contextualisation of cost-effectiveness studies: lessons from Ethiopia." BMJ Global Health 4, no. 6 (2019): e001320. http://dx.doi.org/10.1136/bmjgh-2018-001320.
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Emerging demographic, epidemiological and health system changes in low-income countries require revisions of national essential health services packages in accordance with standard healthcare priority setting methods. Policy makers are in need of explicit and user-friendly methods to compare impact of multiple interventions. We provide experiences of country contextualisation of WHO-CHOICE methods and models to a country level. Results from three contextualised cost-effectiveness analyses (CEAs) are presented, and we discuss how this evidence can inform priority setting in Ethiopia. Existing models for a range of interventions in obstetric and neonatal care, psychiatric and neurological treatment and prevention and treatment of cardiovascular diseases are contextualised to the Ethiopian setting. CEAs are defined as contextualised if they include national analysts and use country-specific input for either costs, epidemiology, demography, baseline coverage or effects. Interventions (n=61) are ranked according to incremental cost-effectiveness rates (ICERs), and expected health outcomes (Disability Adjusted Life Years (DALYs) averted) and budget impacts are presented for each intervention. Dominated interventions (n=30) were excluded. A US$2.8 increase per capita in the annual health budget is needed in Ethiopia (currently at US$28 per capita) for increasing coverage by 20%–75% for all the 22 interventions with positive net health benefits. This investment is expected to give a net benefit at around 0.5 million DALYs averted in return in total, with a willingness to pay threshold at US$2000 per DALY averted. In particular, three interventions, neonatal resuscitation, kangaroo mother care and antibiotics for newborn sepsis, stand out as best buys in an Ethiopian setting. Our method of contextualised CEAs provides important information for policy makers. Rank ordering of interventions by ICERs, together with presentations of expected budget impact and net health benefits, is a clear and policy friendly illustration of possible efficient stepwise pathways towards universal health coverage.
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Ousman, Seman K., Jeanette H. Magnus, Johanne Sundby, and Mekdes K. Gebremariam. "Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach." International Journal of Environmental Research and Public Health 17, no. 5 (2020): 1712. http://dx.doi.org/10.3390/ijerph17051712.
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Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner’s education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner’s education, woman’s employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.
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Gidebo, K. D., Thandisizwe Redford Mavundla, and T. E. Masango. "FACTORS INFLUENCING MALARIA TREATMENT AND PATIENT ADHERENCE TO ANTIMALARIAL DRUGS IN SOUTHERN ETHIOPIA." Africa Journal of Nursing and Midwifery 16, no. 2 (2015): 85–97. http://dx.doi.org/10.25159/2520-5293/39.
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In Ethiopia the health system is underdeveloped and much of the rural population has limited access to modern health services. The Ethiopian government introduced the Health Extension Program which is a community-based health care delivery system aimed at accessing essential health services such as malaria treatment through its health extension workers (HEWs). The objective of this study was to evaluate factors influencing malaria treatment practice of health extension workers (HEWs) and patient adherence to antimalarial drugs. A qualitative research design that is explorative and descriptive was used. Data was collected by means of (1) in-depth individual interviews among 20 HEWs, and seven focus group discussions with malaria treated patients. Data was analyzed thematically. Four themes emerged from the data, namely: (1) health facility related factors, (2) HEWs related factors, (3) patient related factors, and (4) community related factors. Improving the availability of essential resources such as rapid diagnostic test kits (RDT) and antimalarial drugs, improving the community’s perception towards antimalarial drug effectiveness and adequately educating patients on how to take antimalarial drugs can improve malaria treatment practice of the HEWs and patient adherence to antimalarial drugs.
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Birhanu, Simon, Melake Demena, Yohannes Baye, Assefa Desalew, Bedru Dawud, and Gudina Egata. "Pregnant women’s satisfaction with antenatal care services and its associated factors at public health facilities in the Harari region, Eastern Ethiopia." SAGE Open Medicine 8 (January 2020): 205031212097348. http://dx.doi.org/10.1177/2050312120973480.
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Background: Antenatal care coverage is very low in low-and middle-income countries, including Ethiopia. Self-reported pregnant women’s satisfaction may be important in identifying the demographic, provider-, and facility-related factors that can be improved to increase antenatal care satisfaction. However, there is a paucity of data on pregnant women’s satisfaction in Ethiopia, particularly in the study setting. Therefore, this study aimed to assess antenatal care service satisfaction and associated factors among pregnant women at public health facilities in the Harari region of eastern Ethiopia. Methods: A health institution–based cross-sectional study was conducted among women who were attending antenatal care clinics in February 2017. All 531 pregnant women were selected using a systematic random sampling method. Data were collected using an interviewer-administered questionnaire, entered into EpiData version 3.1, and analyzed using SPSS version 22.0 software. A logistic regression model was applied to control for confounders. The level of significance was determined at a p-value of less than 0.05. Results: The magnitude of pregnant women’s satisfaction with antenatal care services was 70.3% (95% confidence interval (CI) = 66.4%–74.3%). Receiving antenatal care services from the hospital (adjusted odds ratio (AOR) = 2.44, 95% CI = 1.50–3.98), did not attend formal education (AOR = 2.53, 95% CI = 1.52–4.20) and attended primary education (AOR = 2.17, 95% CI = 1.17–4.04), having a repeated visit to antenatal care (AOR = 4.62, 95% CI = 2.98–7.17), initiating antenatal care services within the first trimester (AOR = 1.74, 95% CI = 1.12–2.71), having no history of stillbirth (AOR = 2.52, 95% CI = 1.37–4.65), and waiting for no more than 30 min in the health facility to get service (AOR = 2.31, 95% CI = 1.28–4.16) were factors associated with pregnant women’s satisfaction with antenatal care services. Conclusion: More than two-thirds of pregnant women were satisfied with the antenatal care service. The type of health facility, education status, number and initiation time of antenatal visit, history of stillbirth, and waiting time to get service were factors associated with pregnant women’s satisfaction with antenatal care services.
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Tiruneh, Gizachew Tadele, Meaza Demissie, Alemayehu Worku, and Yemane Berhane. "Community’s experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study." PLOS ONE 16, no. 8 (2021): e0255404. http://dx.doi.org/10.1371/journal.pone.0255404.
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Background Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. Methods This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. Results We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women’s negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. Conclusion This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.
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Fenta, Esete Habtemariam, Bilal Shikur Endris, Yalemwork Getenet Mengistu, et al. "Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia." PLOS ONE 15, no. 12 (2020): e0243240. http://dx.doi.org/10.1371/journal.pone.0243240.
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Background Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts. Methods This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers. Result We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers. Conclusion We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.
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Abate, Z. M. "Strategies Are Required for Strengthening Integration of Cancer Control Program in Ethiopia Primary Health Care System." Journal of Global Oncology 4, Supplement 2 (2018): 84s. http://dx.doi.org/10.1200/jgo.18.14200.
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Background: Cancer is one of the leading causes of morbidity and mortality worldwide. The number of new cases is expected to rise by about 70% over the next 2 decades. Approximately 70% of deaths from cancer occur in low- and middle-income countries. This growing cancer burden requires innovative approaches to place cancer control and care within existing health systems, while resources should be amalgamated to optimize cost-effective use. Neglect of cancer prevention and care leads to unnecessary death, suffering, and unaffordable treatment. Thus, extension of cancer prevention, diagnosis, and treatment to millions of people with or at risk for cancer is an urgent priority. Integrating cancer prevention and management into primary health care system will tackle cancer-specific priorities while addressing the gaps within the health system, optimizing the use of resources, ensures access to the community and improving coverage. According to World Health Organization regardless of resource level, all countries can implement basic components of cancer control. In the light of the rapidly increasing global cancer burden, it is becoming essential to use the limited resources available in the most effective way. In resource-constrained countries like Ethiopia without specialized services, experience has shown that much can be done to prevent and treat cancer. A strategy to integrated approach thus addresses health problems by providing services in a comprehensive manner. Aim: The purpose of this study is to make a document analysis to assess the requirement of developing strategies for strengthening integration of cancer control program in primary health care system (PHCS). Methods: Document analysis. Results: The Ethiopian National Cancer Control Program unlike most low resource countries planned with necessary implementation cost. The cancer control plan despite its presence usually lack integration in existing health system. There is a variation and significant gaps in the current state of comprehensive cancer control. Conclusion: The country requires strategies to ensure that this plan translated into fully operational interventions. Country specific approaches of integration are required. Integrated framework for cancer prevention is critical to make the most efficient use of its meager resources. This study recommends Ethiopia to develop tailored strategies to strengthen integrated and people-centered cancer control program in its primary health care system.
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Yohannes, Samuel, Yitagesu Habtu, Bereket Abreham, and Menen Ayele. "Utilization of Integrated Community Case Management and Its Factors in Southern Ethiopia: Facility Based-Cross-Sectional Study." Advances in Public Health 2021 (May 31, 2021): 1–8. http://dx.doi.org/10.1155/2021/8835804.
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Background. An integrated community case management (ICCM) program fosters child health care seeking and access to appropriate treatment for illnesses in children at the community level in Ethiopia. There is paucity of evidence to the utilization of ICCM services by mothers/child caregivers in rural Sothern Ethiopia. Hence, the aim of this study was to determine the utilization of integrated community case management (ICCM) and its factors among mothers/child caregivers in rural Southern Ethiopia. Methods. A multistage sampling technique was used to select study participants in health care facilities offering child health care services. An exit interview was conducted on 574 mothers/child caregivers in randomly selected public health centres. Data were entered using Epi Info and transported to SPSS version 20 for analysis. Results. Only less than a quarter of participants visited health posts for ICCM services during the study period. Those study participants who have not heard about ICCM service before the survey were about 6.53 times more likely not to use the services as compared to those who have heard about the service. Participants who were not members of the women’s development team were about 2.23 times more likely not to utilize ICCM services when compared to their counterparts. Conclusion. The study shows low utilization of ICCM service by children less than five years. Prior information about ICCM services and membership in the health development army was significantly associated with ICCM use. Therefore, our finding may suggest the need for advocacy to increase participation in the health development army and information education to increase the level of awareness and formal education efforts.
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Tsegaye, Berhan, Elsabet Shudura, Amanuel Yoseph, and Alemu Tamiso. "Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia." PLOS ONE 16, no. 2 (2021): e0246237. http://dx.doi.org/10.1371/journal.pone.0246237.
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Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.
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Levav, Itzhak, and Alexander Grinshpoon. "Mental health services in Israel." International Psychiatry 1, no. 4 (2004): 10–14. http://dx.doi.org/10.1192/s174936760000672x.
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Israel is a multicultural society in a state of permanent change. The population, of about 6.5 million, comprises the following religious groupings: Jews (77.5%), Muslims (15.3%), Christians (2.1%), Druzes (1.7%) and others (3.4%). The organisation of and the approaches used by the country's health services have been determined by this sociocultural plurality, and also by a continuous influx of immigrants (among whom, 882 600 and 44 200 arrived from countries of the former USSR and Ethiopia, respectively, between 1990 and 2001), as well as by the precarious security situation (the country has seen several wars with its neighbours in addition to the long-standing conflict with the Palestinians). The patterns of care of the population reflect both Western psychiatry and traditional systems. Because of such complexity, the present brief overview is necessarily selective.
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Zeleke, Liknaw Bewket, Asmare Talie Wondie, Melaku Admas Tibebu, et al. "Postnatal care service utilization and its determinants in East Gojjam Zone, Northwest Ethiopia: A mixed-method study." PLOS ONE 16, no. 8 (2021): e0256176. http://dx.doi.org/10.1371/journal.pone.0256176.
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Background The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia. Methods A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively. Results The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25–34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization. Conclusion and recommendation The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.
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Haile Eyasu, Kokeb, Akilew Awoke Adane, Fisseha Zewdu Amdie, Tesfaye Bisenebit Getahun, and Mulunesh Abuhay Biwota. "Adult Patients’ Satisfaction with Inpatient Nursing Care and Associated Factors in an Ethiopian Referral Hospital, Northeast, Ethiopia." Advances in Nursing 2016 (June 7, 2016): 1–7. http://dx.doi.org/10.1155/2016/6308617.
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Introduction. Patient satisfaction with nursing care is considered as an important factor in explaining patients’ perceptions of service quality. Care assessed to be high quality according to clinical, economic, or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Objective. The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in Dessie Referral Hospital, Northeast Ethiopia. Methods. Institution based quantitative cross-sectional study was conducted among patients admitted in medical, surgical, orthopedics, gynecology, and ophthalmology wards of the hospital from March 24 to April 30, 2013. All admitted patients who stayed in the study wards for at least two days during the data collection time were interviewed. Newcastle Satisfaction with Nursing Scale questionnaire was used to collect the data and was analyzed using SPSS version 20. Odds ratios with their 95% confidence intervals and p values in a multiple logistic regression were used to identify factors associated with patient satisfaction with nursing care. Result. The overall patient satisfaction was 52.5%. Respondents’ sex, age, admission ward, self-reported health status, and class of admission were the variables significantly associated with patient satisfaction with nursing care. Conclusion and Recommendation. The rate of patient satisfaction with nursing care was found to be low in this study. Being female, younger age group (18–30 years), good self-reported current health status, being admitted in ophthalmology ward, and first class of admission were significantly associated with better patient satisfaction with nursing care. In-service training programs for nurses, with special emphasis on communication skills, are recommended.
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Addissie, Adamu, Gabriele Braun, Tamiru Demeke, Tariku Wakuma, Claudia Hanson, and Eva Kantelhardt. "Breast Health Global Initiative Recommended Breast Cancer Prevention and Care in Rural Ethiopia." Journal of Global Oncology 4, Supplement 3 (2018): 1s. http://dx.doi.org/10.1200/jgo.18.99800.
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Purpose Breast cancer is the most common cancer among women worldwide and is the leading cause of cancer death among women in low- and middle-income countries, including Ethiopia. Availability of both basic and comprehensive services in all frontline health care facilities is important for cancer control. Whereas women are equally affected in both urban and rural settings, most services are present in urban areas. We assessed health system readiness for breast cancer prevention and treatment in selected hospitals in Western Ethiopia. Methods A total of seven rural hospitals in Western Ethiopia were assessed for availability of comprehensive breast cancer services. A checklist prepared on the basis of breast care prevention and control standards for low-resource settings—recommended by the 2007 Global Summit of Breast Health Global Initiative—was used for the assessment. Data were descriptively analyzed and discussed. Results Whereas cancer incidence and mortality rates are increasing in Ethiopia and other sub-Saharan countries, there is currently no competent health system available that is adequately equipped to meet this challenge. In Ethiopia, the majority of systemic oncologic treatment is administered at the Addis Ababa University Hospital in the capital city, and the majority of patients are referred to this center, which, for the average patient, is more than 500 km away. There are relatively large numbers of health professionals in health facilities in Western Ethiopia, but a critical absence of pathologists and oncologists. Basic diagnostic services, such as ultrasonography and X-ray, were found to be available in most hospitals; however, there were major gaps in cytologic and pathologic services. The nearest referral centers for pathology and additional breast cancer treatment required travelling significant distances; there were no systemic breast cancer treatment and palliative services available in Western Ethiopia. Conclusion Our study revealed that all health facilities lack a comprehensive package of breast cancer diagnosis and treatment services. The lack of implemented comprehensive breast care prevention, diagnosis, treatment, and referral services is representative of most other rural settings in Ethiopia. This calls for a nationally coordinated effort in defining and implementing breast cancer prevention and control standards to realize the national cancer control plan. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Eva Kantelhardt Travel, Accommodations, Expenses: Daiichi Sankyo Oncology Europe
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Defar, Atkure, Yemisrach B. Okwaraji, Zemene Tigabu, Lars Åke Persson, and Kassahun Alemu. "Distance, difference in altitude and socioeconomic determinants of utilisation of maternal and child health services in Ethiopia: a geographic and multilevel modelling analysis." BMJ Open 11, no. 2 (2021): e042095. http://dx.doi.org/10.1136/bmjopen-2020-042095.
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ObjectiveWe assessed whether geographic distance and difference in altitude between home to health facility and household socioeconomic status were associated with utilisation of maternal and child health services in rural Ethiopia.DesignHousehold and health facility surveys were conducted from December 2018 to February 2019.SettingForty-six districts in the Ethiopian regions: Amhara, Oromia, Tigray and Southern Nations, Nationalities, and Peoples.ParticipantsA total of 11 877 women aged 13–49 years and 5786 children aged 2–59 months were included.Outcome measuresThe outcomes were four or more antenatal care visits, facility delivery, full child immunisation and utilisation of health services for sick children. A multilevel analysis was carried out with adjustments for potential confounding factors.ResultsOverall, 39% (95% CI: 35 to 42) women had attended four or more antenatal care visits, and 55% (95% CI: 51 to 58) women delivered at health facilities. One in three (36%, 95% CI: 33 to 39) of children had received full immunisations and 35% (95% CI: 31 to 39) of sick children used health services. A long distance (adjusted OR (AOR)=0.57; 95% CI: 0.34 to 0.96) and larger difference in altitude (AOR=0.34; 95% CI: 0.19 to 0.59) were associated with fewer facility deliveries. Larger difference in altitude was associated with a lower proportion of antenatal care visits (AOR=0.46; 95% CI: 0.29 to 0.74). A higher wealth index was associated with a higher proportion of antenatal care visits (AOR=1.67; 95% CI: 1.02 to 2.75) and health facility deliveries (AOR=2.11; 95% CI: 2.11 to 6.48). There was no association between distance, difference in altitude or wealth index and children being fully immunised or seeking care when they were sick.ConclusionAchieving universal access to maternal and child health services will require not only strategies to increase coverage but also targeted efforts to address the geographic and socioeconomic differentials in care utilisation, especially for maternal health.Trial registration numberISRCTN12040912.
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Arsenault, Catherine, Bereket Yakob, Munir Kassa, Girmaye Dinsa, and Stéphane Verguet. "Using health management information system data: case study and verification of institutional deliveries in Ethiopia." BMJ Global Health 6, no. 8 (2021): e006216. http://dx.doi.org/10.1136/bmjgh-2021-006216.
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Health management information systems (HMIS) are a crucial source of timely health statistics and have the potential to improve reporting in low-income countries. However, concerns about data quality have hampered their widespread adoption in research and policy decisions. This article presents results from a data verification study undertaken to gain insights into the quality of HMIS data in Ethiopia. We also provide recommendations for working with HMIS data for research and policy translation. We linked the HMIS to the 2016 Emergency Obstetric and Newborn Care Assessment, a national census of all health facilities that provided maternal and newborn health services in Ethiopia. We compared the number of visits for deliveries and caesarean sections (C-sections) reported in the HMIS in 2015 (January–December) to those found in source documents (paper-based labour and delivery and operating theatre registers) in 2425 facilities across Ethiopia. We found that two-thirds of facilities had ‘good’ HMIS reporting for deliveries (defined as reporting within 10% of source documents) and half had ‘very good’ reporting (within 5% of source documents). Results were similar for reporting on C-section deliveries. We found that good reporting was more common in urban areas (OR: 1.30, 95% CI 1.06 to 1.59), public facilities (OR: 2.95, 95% CI 1.38 to 6.29) and in hospitals compared with health centres (OR: 1.71, 95% CI 1.13 to 2.61). Facilities in the Somali and Afar regions had the lowest odds of good reporting compared with Addis Ababa and were more likely to over-report deliveries in the HMIS. Further work remains to address remaining discrepancies in the Ethiopian HMIS. Nonetheless, our findings corroborate previous data verification exercises in Ethiopia and support greater use and uptake of HMIS data for research and policy decisions (particularly, greater use of HMIS data elements (eg, absolute number of services provided each month) rather than coverage indicators). Increased use of these data, combined with feedback mechanisms, is necessary to maintain data quality.
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Abrha, Mulugeta Woldu, Tsrity Tadese Asresu, Alemnesh Abraha Araya, and Haftom Gebrehiwot Weldearegay. "Healthcare Professionals’ Knowledge of Neonatal Resuscitation in Ethiopia: Analysis from 2016 National Emergency Obstetric and Newborn Care Survey." International Journal of Pediatrics 2019 (July 16, 2019): 1–7. http://dx.doi.org/10.1155/2019/8571351.
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Background. Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the principal causes of neonatal mortality in Ethiopia. Adequate knowledge of newborn resuscitative procedures plays an important role in early diagnoses and suitable management. However, there are limited data on healthcare professionals’ knowledge about neonatal resuscitation. Thus, this study aimed to determine the knowledge of healthcare professionals about neonatal resuscitation and factors affecting it. Methods. Data from the Ethiopian 2016 national Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternal and newborn health services were analyzed. We have included 3804 healthcare providers, who attended the largest number of deliveries in the last month prior to the survey, and assessed their knowledge of neonatal resuscitation. It was also determined whether certain factors were associated with healthcare providers’ knowledge through linear regression method. Result. The overall knowledge score of the healthcare providers about neonatal resuscitation ranged from 12 to 24 out of 37 items (with mean score of 18.4 (±5.47) and mean score percentage of 49%). The findings showed that providers trained on neonatal resuscitation (β=2.65, 95% CI: 0.65, 4.62; p <0.00), facilities that had guideline of neonatal resuscitation (β=2.50, 95% CI: 0.60, 3.52; p =0.01), and availability of essential equipment (β=0.95, 95% CI: 0.44, 1.45; p =0.02) were significantly associated with sufficient knowledge of neonatal resuscitation in Ethiopia. Conclusion. Overall knowledge of neonatal resuscitation was insufficient. Trained healthcare providers, having guideline on neonatal resuscitation, and availability of essential equipment were significantly associated with knowledge of neonatal resuscitation. Competency and simulation-based in-service training and refresher training complemented by supportive supervision and mentorship are helpful ways to put up providers capability to perform neonatal resuscitation.
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Ayele, Brhane, Mulugeta Woldu, Haftom Gebrehiwot, et al. "Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey." PLOS ONE 16, no. 4 (2021): e0249793. http://dx.doi.org/10.1371/journal.pone.0249793.
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Introduction Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. Methods This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. Result In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. Conclusion Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.
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Tefera, Bekele Belayihun, Mengistu Asnake Kibret, Yordanos B. Molla, et al. "The interaction of healthcare service quality and community-based health insurance in Ethiopia." PLOS ONE 16, no. 8 (2021): e0256132. http://dx.doi.org/10.1371/journal.pone.0256132.
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Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.
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Limenih, Miteku Andualem, Zerfu Mulaw Endale, and Berihun Assefa Dachew. "Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study." International Journal of Reproductive Medicine 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/7095352.
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Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.
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Teshale, Achamyeleh Birhanu, and Getayeneh Antehunegn Tesema. "Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data." PLOS ONE 15, no. 12 (2020): e0243071. http://dx.doi.org/10.1371/journal.pone.0243071.
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Background Even though there is low coverage of maternal health services such as antenatal care and skilled birth attendant delivery as well as poor sanitary practice during delivery in Ethiopia, the proportion of births protected by the tetanus vaccine is low. Thus, this study aimed to investigate the determinants of births protected against neonatal tetanus in Ethiopia. Objective To assess the determinants of births protected against neonatal tetanus in Ethiopia. Method The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A weighted sample of 7590 women who gave birth within five years preceding the survey was used for analysis. We conducted a multilevel analysis, due to the hierarchical nature of the data. Variables with p-value <0.05 in the multivariable analysis were declared to be significantly associated with having births protected against neonatal tetanus. Result In this study, mothers with primary education [adjusted odds ratio (AOR) = 1.23; 95%CI: 1.04, 1.44] and secondary and above education [AOR = 1.36; 95%CI: 1.06, 1.73], media exposure [AOR = 1.35; 95%CI: 1.15, 1.58], not perceiving distance from the health facility as a big problem [AOR = 1.24; 95%CI: 1.08,1.42], one antenatal care (ANC) visit [AOR = 1.56; 95%CI: 2.71, 4.68], two to three ANC visit [AOR = 11.82; 95%CI: 9.94,14.06], and four and more ANC visit [AOR = 15.25; 95%CI: 12.74, 18.26], being in Amhara [AOR = 0.59; 95%CI: 0.38,0.92], Afar [AO = 0.41; 95%CI: 0.25,0.66], and Harari [AOR = 1.88; 95%CI: 1.15,3.07] regions, being in communities with higher level of women education [AOR = 1.25; 95%CI: 1.03,1.52], and higher level of media exposure [AOR = 1.22; 95%CI: 1.01,1.48] were significant predictors of having a protected birth against neonatal tetanus. Conclusion In this study, both individual level and community level factors were associated with having protected birth against neonatal tetanus. Therefore, strengthening maternal health services such as ANC visits and interventions related to increasing media campaigns regarding tetanus could increase the immunization against tetanus among reproductive-age women. In addition, it is also better to give attention to those reproductive age group women from remote areas and also better to distribute maternal services fairly and equally between regions.
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Hailemariam, Shewangizaw, Wubetu Agegnehu, and Misganaw Derese. "Exploring COVID-19 Related Factors Influencing Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Southwest Ethiopia." Journal of Primary Care & Community Health 12 (January 2021): 215013272199689. http://dx.doi.org/10.1177/2150132721996892.
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Introduction: Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia. Methods: A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software. Result: The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone. Conclusion: COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.
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Basha, Garoma Wakjira. "Factors Affecting the Utilization of a Minimum of Four Antenatal Care Services in Ethiopia." Obstetrics and Gynecology International 2019 (August 14, 2019): 1–6. http://dx.doi.org/10.1155/2019/5036783.
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Background. Antenatal care is defined as the routine care of pregnant women provided between conception and the onset of labor. This study is aimed to identify factors affecting the utilization of antenatal care (ANC) services in Ethiopia. Methods. The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 7,167 mothers who gave birth within five years preceding the 2016 EDHS whose complete information was available in the survey were included in this study. Logistic regression statistical analyses were used to identify factors associated with the utilization of a minimum of 4 ANC services in Ethiopia. Results. Among the 7,167 women included in this study, 2,598 (36.6%) had utilized a minimum of 4 ANC services in Ethiopia. This study showed that factors such as place of residence, region, mothers’ education level, household wealth index, desire for pregnancy, frequency of reading newspaper, frequency of listening to radio, and frequency of watching TV were associated with the utilization of a minimum of four ANC services at 5% level of significance in Ethiopia. Conclusion. Strategies to increase the accessibility and availability of healthcare services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with no education are vital to increase their awareness about the importance of antenatal services.
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Desta, Abraham Aregay, Tewolde Wubayehu Woldearegay, Estifanos Gebremeskel, et al. "Impacts of COVID-19 on essential health services in Tigray, Northern Ethiopia: A pre-post study." PLOS ONE 16, no. 8 (2021): e0256330. http://dx.doi.org/10.1371/journal.pone.0256330.
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Background COVID-19 has proved to have an indirect impact on essential health services in several parts of the world which could lead to increased morbidity and mortality and loss of the gains made in the past decades. There were no synthesized scientific evidences which could show the impact of COVID-19 epidemics/pandemic on essential health services in Tigray, Northern Ethiopia. Therefore, this study aimed to assess the impacts of COVID-19 epidemics/pandemic on essential health services provision in Tigray, Northern Ethiopia. Methods A pre-post study design was used to assess the impacts of COVID-19 on essential health services delivery in Tigray, Northern Ethiopia in the second quarter of 2020 (Post COVID-19) compared to similar quarter in 2019 (Pre COVID-19). The study focuses on five categories; namely; maternal, neonatal and child health care; communicable diseases with a focus on HIV and TB-HIV co-infection; prevention of mother to child transmission of HIV; basic emergency, outpatient, inpatient and blood bank services, non-communicable diseases and road traffic accidents (RTAs). Analysis was done using Stata version 14.0 software package. The effects of COVID-19 epidemics/pandemic were calculated taking the differences between post COVID -19 and pre COVID-19 periods and the levels of service disruptions presented using proportions. Wilcoxon sign rank test was done and a significance level of ≤0.05 was considered as having significant difference among the two quarters. Results There were significant increase in institutional delivery, delivery by Caesarian Section (CS), still birth, postnatal care within 7 days of delivery, the number of children who received all vaccine doses before 1st birthday, the number of under 5 children screened and had moderate acute malnutrition, the number of under 5 children screened and had severe acute malnutrition and children with SAM admitted for management. However, there were significant decrease in HIV testing and detection along with enrolment to antiretroviral therapy (ART) care, number of patients with cardiovascular disease (CVD) risk ≥ 30% received treatment, RTAs, total units of blood received from national blood transfusion service (NBTS) and regional blood banks, total number of units of blood transfused and emergency referral. There were no significant changes in outpatient visits and admissions. Conclusion Despite commendable achievements in maintaining several of the essential health services, COVID-19 has led to an increase in under nutrition in under five children, decline in HIV detection and care, CVD, cervical cancer screening and blood bank services. Therefore, governments, local and international agencies need to introduce innovative ways to rapidly expand and deliver services in the context of COVID-19. Moreover, lower income countries have to customize comprehensive and coordinated community-based health care approaches, including outreach and campaigns. In addition, countries should ensure that NCDs are incorporated in their national COVID-19 response plans to provide essential health care services to people living with NCDs and HIV or HIV-TB co-infection during the COVID-19 pandemic period.
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Atnafu, Asmamaw, Adane Kebede, Bisrat Misganaw, et al. "Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project." Journal of Pregnancy 2020 (August 26, 2020): 1–8. http://dx.doi.org/10.1155/2020/4318197.
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Background. The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods. A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results. The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions. The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women’s awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women’s preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.
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Asamrew, Nebsu, Abduilhafiz A. Endris, and Musse Tadesse. "Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia." Journal of Environmental and Public Health 2020 (August 13, 2020): 1–12. http://dx.doi.org/10.1155/2020/2473469.
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Background. The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Level of patients’ satisfaction is an important health outcome, which is regarded as a determinant measure for quality of care. This study was performed with the aim of assessing the level of patient satisfaction with inpatient services and its determinants in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. Methods. A facility-based cross-sectional study was conducted from November 25th to December 20th, 2015, using 398 randomly selected patients. Ethical clearance was obtained from the Jimma University research review board, and verbal consent was also received from the study participants during data collection time. A pretested structured interview questionnaire was used to collect data from study participants. The collected data were handled by using SPSS statistical software. Before analysis, relevant explanatory variables were identified using factor analysis with varimax rotation, and bivariate analysis was carried out using linear regression for every independent variable with the outcome variable independently. Explanatory variables scoring p value <−0.05 were used for the final model after checking the assumption. Study findings are presented by using tables, graphs, and description. Results. A total of 398 patients were participated in the study, yielding a response rate of 100%. A total of 46.2% (95% CI: 41.2%–51.1%) patients were satisfied by the services they received in the hospital. Patient and health care provider interaction and general facility amenity-related domains were found to explain 96.4% of the variability in the net overall satisfaction score. Good quality services provided by hospital physicians, availability of laboratory and radiology services, pain management services, and inpatient pharmacy services of the hospital had positive influences. Besides toilet cleanliness, availability of rooms for accommodation and dietary service had significant relation with level of patient satisfaction. Quality of the inpatient pharmacy service had a great influence on satisfaction; a unit increase in it resulted in 2.3 (95% CI: 2.1–2.5) times increment in patient satisfaction level at p≤0.001. For final predictors, regression estimates for level of satisfaction moved from very dissatisfied to very satisfied when service improves by a unit. Conclusion. Overall patients’ satisfaction is lower than other studies in the nation. A great opportunity is there to improve patient’s satisfaction level if the service quality is improved around the time of patient and health care provider interaction and facility amenity services. Besides, improving the health literacy of service providers and devising a strategy to routinely assess satisfaction level of patients in the facility is critical. On top of this, providing tailored on-the-job training for health care workers in the facility is a crucial step in order to improve their knowledge and skills to render patient-centered quality service to improve their patients’ satisfaction. Using a checklist during service delivery may improve client patient interaction and ensure the standard. Facility design dimension can be considered for future research activities.
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Memirie, Solomon Tessema, Mieraf Taddesse Tolla, Dawit Desalegn, et al. "A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia." Health Policy and Planning 34, no. 4 (2019): 289–97. http://dx.doi.org/10.1093/heapol/czz034.
Full textAbstract:
Abstract Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.