Dissertations / Theses on the topic 'Ethiopian health system'

In the last decade, the reach of New Public Management (NPM) has stretched well beyond its Western origins as modernising African governments and their global health partners have sought to import new approaches. Public health systems in Africa are entirely different to those of the West however, and this sort of application introduces a number of contextually-specific questions that are not considered by the majority of the NPM literature. The few studies that do investigate NPM in Africa are evaluative in content, seeking to understand whether reforms work and to identify barriers to success. Invariably, whether they find in favour of public management reform or not, the same issues are highlighted: lack of capacity, weak institutions, and improper implementation. This thesis will build a theory of NPM reform that is particular to the African context. I develop this theoretical extension through an intensive ethnographic case study of one of the most important on-going public health reform efforts in Africa—the transformation of the entire Ethiopian hospital system to an NPM-style administrative regime. I develop a constructionist theory of African NPM through thick description of the hospitals under reform. I detail the various ways in which the reforms are indigenised as they meet up with local understandings, institutions, and market contexts, and the inevitable unintended consequences as managers seek to ‘make do’ in environments radically different to those of NPM’s origins. I then conduct a detailed consumer analysis to describe the strategies employed by patients seeking care. Patients from different class positions use very different strategies to get health services and I demonstrate that the reform has very different consequences for Ethiopians across classes. Many patients are not recognisable as the ‘customers’ described in the reform documents, and so the hospitals do not organise their reform efforts to serve them.

For many years, the tight bureaucratic and task centered approaches of civil service institutions of Ethiopia led to fragmentation, overlap and duplications of efforts than being responsive, flexible and customer focus. To this end, Business Process Reengineering (BPR) has been considered as a government sector technique to help organizations fundamentally rethink how they do their work in order to dramatically improve customer service, cut operational costs, become responsive, flexible and customer focus. BPR has great potential for increasing productivity through reduced process time and cost, improved quality, and greater customer satisfaction, but it often requires a fundamental organizational change. Despite the numerous advantages of BPR in terms of responsiveness, flexibility and customer focus, its implementation is perceived to be a difficult task and also many unsuccessful experiences have been reported in the literature. In fact, there are very few survey researches that attempt to highlight the kinds of activities that the organizations should pursue to ensure a reasonable transition to the new process; manage the human and technical issues surrounding implementation of the new process; and assess the results of its reengineering efforts. But these researchers saw the issues from private cooperative organizational perspectives and contexts. Besides, most of the discussions and findings were stretched up to showing that successful BPR implementations process are mainly associated with the organizations capability in managing changes. The researches paid no attention to other factors, like the issues of enabler, tools and techniques which can be utilized to build momentum. Hence, the present research investigated the factors associated with successful implementations of BPR projects in the contexts of public institutions. Based on a case study conducted in Ethiopian Ministry of Health and Gambella Regional Health Bureau; this research attempted to provide guidelines and best practices in public service providing institutions that will help them to achieve dramatic performance gains while implementing BPR projects. A cross sectional, qualitative and quantitative study was conducted taking 90 respondents and 20 interviewees as study subjects. Data were collected from June 1 to July 31 2010. A structured questionnaire was filled by 90 respondents where 43.3 % of them from Gambella Peoples’ National Regional State Health Bureau and 56.7% of them were from Ethiopian Federal Ministry of Health. The questionnaire was employed to collect data on change management and factors associated with the attainment of performance goals whereas in-depth interviews were utilized to substantiate the findings of questionnaire and investigate the use of information technology as enabler. The in-depth interviews included planners, core process owners and directors. Cross tabulation results imply that there is significant associations between attainment of performance goals and availability of written comprehensive plan for pilot test, refinement and implementation of change management plan, availability of communication strategy, placement of performance measures, motivation to take new roles and responsibilities, Use of information technology as enabler and pilot testing to evaluate new process. Hence, the findings of this research suggest that reengineering project implementation is complex, involving many factors. To succeed, it is essential that change be managed and that balanced attention be paid to all identified factors, including those that are more contextual (e.g., management support and technological competence), performance management, availability of comprehensive implementation plan, communication strategies, refinement and implementation of change management plan, use of pilot testing to evaluate new process, motivation to take new roles and responsibilities and usage information technology as enabler.<br>+251911436197, Gambella, Ethiopia, P.o.box. 90

The 2015 global adoption of the United Nations 2030 Agenda for Sustainable Development places the achievement of health equity as a global priority for health and development. Due to the normative nature of the concept of health equity and the multi-level, multi-sectoral approaches required to advance it, interdisciplinary investigations are warranted to demonstrate how health equity as a policy objective is understood and operationalized. This dissertation is a case study of health equity in maternal, newborn and child health (MNCH) in Ethiopia, using qualitative methods to explore how health equity is conceptualized and pursued by stakeholders across levels of the health system. Ethiopia, a low-income country in East Africa, reported improvements in MNCH during the Millennium Development Goal period (1990-2015), largely attributed to the expansion of health services into rural areas; however, achievements were not realized across all geographies and population groups. Health equity is a stated policy objective for the country. Through a series of four articles, this dissertation addresses: community members’ perceptions and experiences related to health inequity and MNCH; barriers and enablers encountered by community-level health workers in implementing an equity-oriented MNCH intervention; subnational health managers’ understandings of health equity, and their roles in promoting it; and the characterization of health equity as a policy problem in national-level health discourses. This work deconstructs health equity into three components (health, distribution of health and characterization of the distribution of health) and compares how stakeholders across levels of the health system attribute meaning to each component and imply responsibility and accountability for health equity. The findings detail how diverse experiences related to health equity in MNCH across community, subnational and national contexts are driven by high-level technocratic framings of health equity, which tend to emphasize the delivery of a narrow package of health services to under-served geographical areas. Providing support and recognition for the role of subnational stakeholders in mediating the adaption of national health equity policies to local contexts, and making prominent the social justice underpinnings of health equity in the implementation of national policies are opportunities to strengthen the advancement of health equity in Ethiopia.

Many Low and Middle Income Countries (LAMICs) still lack sufficient health research capacity to build a local evidence-base with which to inform policy and improve population health. Recognising this, The 2013 World Health Report called for all nations to be producers of health research. To achieve this, new strategies that can develop sustainable locally-led capacity are required. Among the health research capacities needed, ability to conduct clinical trials is important. However, there is no evidence-informed guidance on the best ways to develop locally-led trial capacity. This thesis aims to fill this gap. Three cases-studies using qualitative methods to explore the barriers and enablers to locally-led trial conduct were conducted in Ethiopia, Cameroon and Sri Lanka. Current and potential local trial researchers and health research system stakeholders were recruited. A synthesis of the health research capacity development literature was conducted to compare the case-studies’ findings with wider published perspectives. These data permit an examination of the key issues facing the development of locally-led trial capacity in LAMICs. Barriers and enablers to locally-led trial conduct were found at macro, institutional and individual levels. Although different country research systems, and institutions and individuals within them, were variably successful at conducting trials, the key issues and mechanisms influencing successful trial undertaking were largely similar. Agreement among the case-studies and with the diverse literature suggests that many of the findings will be transferable to other LAMICs, and are also of relevance to other health research methods. A conceptual framework explaining the antecedents and consequences of locally-led trial undertaking in LAMICS is presented. This identifies the following factors as important for supporting locally-led trial undertaking: awareness and appreciation for health research and clinical trials; motivation to conduct clinical trials; availability of human resources with trial knowledge and technical skills; research leadership capabilities; ability to form collaborations, effective teams and acquire resources; trial management dedicated to sustainable capacity development and producing useful research; and system-wide prioritisation of health research. The theories of change presented within this framework are used to develop practical recommendations for development of locally-led trial capacity in LAMICs. These recommendations have four inter-related goals: fostering pro-research cultures in stakeholder institutions; developing trial leaders and staff; providing a facilitative operational environment for trials; and ensuring trial research has an impact. However, to create the will to enact change, advocacy from research champions and conducting trials in a way that benefits local institutions and population health is needed.

Research Doctorate - Doctor of Philosophy (PhD)<br>Being a female is difficult in Ethiopia where boys are privileged over girls, girls have less access to school and healthcare, and girls suffer from harmful practices such as early marriage, female genital mutilation, abduction and rape. For those who pass through childhood and reach womanhood, intimate partner relationships are not necessarily safe either—there is a high prevalence of violence against women by their intimate partners. Previous studies have suggested that intimate partner violence (IPV) could be affected by many factors and IPV, in turn, affects the overall health of affected women and their babies. At the time of commencing this thesis, only individual-level determinants of IPV had been investigated within small geographic areas in Ethiopia. There was no study that assessed the hierarchical multilevel predictors of IPV. National-level evidence regarding the adverse impacts of IPV on women’s reproductive health and the survival of their neonates was lacking, and the Ethiopian health system responses to IPV were largely unknown. Therefore, this study investigated the individual, relationship, community, and societal-level determinants of IPV directed against women; it examined the adverse reproductive outcomes (unintended pregnancy, pregnancy loss and neonatal mortality) of IPV in Ethiopia; and explored the perceptions of, and attitudes towards, IPV within the Ethiopian health system. The thesis used a multimethod approach incorporating retrospective analyses of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and qualitative in-depth interviews. In analyses of EDHS data, the determinants and impacts of IPV were invesigated in a subsample of married women of reproductive age (15–49 years) who participated in the domestic violence sub-study of the survey. In addition, a qualitative study was conducted among thirteen purposively selected in-depth interview participants (nine healthcare providers and five health managers) to explore perceptions to IPV. Analyses of EDHS data showed that about one in every three women reported experiencing IPV (a composite measure of physical, sexual and emotional abuse) and three in every five women experienced partner controlling behaviours. Lifetime IPV experience was higher among women who were older, married before the age of 18 years, had witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, experiences of IPV were lower among women who had decision-making autonomy in the household, who had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors including female education and IPV acceptance in the community were also important influences on this major public health issue in Ethiopia. This thesis further revealed that women’s IPV experience, including partner controlling behaviours, were significantly associated with the risk of unintended pregnancy, pregnancy loss and neonatal mortality in Ethiopia, with the impact on unintended pregnancy being partly mediated by women’s autonomy. Qualitative interviews with healthcare providers and health managers in the Ethiopian health sector further suggest that the existing health system responses were insufficient, with several barriers and challenges identified as hindering the health system from providing consolidated IPV services. Taken together, these findings suggest combined interventions at different levels may reduce IPV in Ethiopia. Women’s health and neonatal survival strategies should focus beyond the direct causes and target IPV as an underlying factor in maternal and neonatal ill health and mortality. Reproductive health programs should be sensitive to the relational aspects of fertility control, and the need to improve women’s decision-making power to reduce the negative reproductive health effects of IPV. Overall, there is a clear need to incorporate IPV services into the Ethiopian healthcare setting and should be provided as a key component of maternal reproductive health service. This requires policy frameworks and clear guidelines, training of healthcare workers, community education and sensitization, and sectoral collaborations.

Health Management Information System (HMIS) in developing countries lags seriously behind as compared to the developed countries; and the existing HMIS in many countries is insufficient to support health management functions. The purpose of this study was to describe the implementation of Anti-retroviral Therapy (ART) pharmacy management information system in public health facilities. Quantitative, descriptive research was conducted at 38 public health facilities. The participants of the study were Pharmacists and Druggists those are working at ART Pharmacy. Data collection was done by using structure questionnaire. 76 respondents were recruited to participate in the study. The participants ages ranged from 26-50 years and all had more than 2 years’ work experience. The study indicated that even if there is a system at most health facilities their utilization of information technology (IT) for pharmacy practice were not appreciated. The findings indicated that the need for creating awareness among professionals in giving more skill oriented and also a formal in-service information technology related trainings for the professionals. To achieve better utilization of information technology at health care delivery system particularly pharmacy practice, government and stakeholder should consider capacity building activities through proper training and it should also viewed as a long term socio-cultural and technical development process.<br>Health Studies<br>M.A. (Public Health with specialization in Medical Informatics)

Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)

Introduction: HIV referral and linkage system in many countries in general and in Ethiopia in particular was poorly characterised by low linkage rate. The purpose of this study was to analyses factors associated with poor referral and linkage system and develop strategies to improve the system. Methods: A sequential mixed method approach using exploratory descriptive study design was employed. The study was conducted in Addis Ababa, Ethiopia and it was conducted in two phases. Phase I involved data collection and analysis as evidence for the development of strategies while phase II was the development of strategies. For phase I, data were collected in steps 1 and 2 using individual interviews and focus group discussions respectively. The study participants were programme owners and partners who were supporting facilities during the data collection period in step 1 and health care providers in step 2. A total of 4 individual interviews and 3 FGDs were conducted with purposively selected participants. Data were analysed using computer assisted software called OpenCode version 4.2. Results: The findings revealed five themes namely, issues of referral and linkage practice, ensuring linkage through communication, issues of health care, issues of health care system and issues of partnerships and Health Bureau. Many gaps that affected the referral system were identified and in phase II, nine strategies were developed to strengthen the referral and linkage system. Conclusion:The results of this study highlighted weaknesses in the referral and linkage system of the HIV positive clients from counselling and testing services to chronic care and proposed strategies to strengthen those weaknesses. Measures to operationalise those strategies are also proposed. The successful implementation of the proposed strategies depends on the support of the ministry of health and regional bureau in terms of resources and the readiness of the health care providers to adhere to the proposed measures. Intervention research is needed to test the effectiveness of the proposed strategies.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)

The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation. The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis. The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15, 4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32). The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001). The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001). Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required. Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)

The purpose of the research was to assess the availability of public health services in response to humanitarian crises in Gambella, Ethiopia. This informed the development of a public health service protocol for humanitarian emergency responses in Ethiopia. The objectives of the study were explored and identify current humanitarian health emergency needs and responses, describe the availability of public health services required for humanitarian emergency responses, study and critically analyse different humanitarian responses in respect of health care services and related protocols in other countries, develop a context-specific and needs-based protocol for humanitarian emergency responses in Gambella, Ethiopia, clarify the policy and programme implications of such a protocol. A mixed-method research design was used to conduct the study. Data were collected from 32 health facilities to assess the availability of required resources and public health services. A checklist and in-depth interview guide were used to collect the data. The quantitative data were analysed using simple descriptive statistics using frequency distribution tables and graphs. Thematic analysis was employed to analyse the qualitative data. The study revealed a lack of resources which threatened the availability of public health services in humanitarian emergencies. The ever-increasing number of refugees overstretched the limited resources, leading to stockouts of medicines, other health commodities and equipment. The absence of emergency preparedness, poor coordination of services, coupled with a lack of integration of services exacerbated public health service delivery. The study findings informed the development of a public health service protocol for humanitarian responses in Ethiopia. The study further recommended further research on other factors that might affect humanitarian responses and coordination.<br>Health Studies<br>Ph. D. (Public Health)

Research Doctorate - Doctor of Philosophy (PhD)<br>Background: Refugees from Sub-Saharan Africa, including Ethiopia, Somalia, Sudan and South Sudan, constitute a significant percentage of refugees globally that continue to settle in Australia and other western countries. The dualism of African pluralistic medicine and western scientific biomedicine is no more obvious than when comparing beliefs concerning psychiatric aetiology. Ethno-culture, religion and spirituality are recognised to heavily influence indigenous beliefs concerning mental illness. However, there is minimal research addressing how this dualism and complex interface between phenomenologically constructed African belief systems, and scientifically rationalised conventional western medicine, influence African refugees’ help-seeking behaviour on settlement in a western country. Aim: The aim of this critical ethnographic study was to gain an understanding of how the health beliefs of refugees from Ethiopia, Somalia, Sudan and South Sudan influence attribution of mental illness and help-seeking behaviour on settlement in Australia. Method and analysis: The study used semi-structured interviewing, naturalistic participatory and non-participatory observation. Data were obtained from three sources: 1) African refugees that entered Australia via the offshore humanitarian program; 2) specialist workers in cross-cultural and refugee health; and 3) African diaspora registered health professionals practicing in Australia and native to one the aforementioned African countries. Data saturation was achieved at 35 interviews. Interviews were transcribed verbatim and subjected to a four-step process of thematic analysis using NVivo 10 software. Internal validity was addressed through triangulation of the data and the use of a cultural informants group of community leaders who advised on issues surrounding lexical, contextual and conceptual equivalence. Findings: The study identified four main themes and a number of sub-themes. Each theme constitutes a significant intercultural tension point that acts as a barrier to therapeutic engagement between African refugees and mainstream Australian mental health services. Collectively, the tension points create an impervious barrier to the penetration of western psychoeducation within the Ethiopian, Somali, Sudanese and South Sudanese refugee communities. The four major themes are: 1.Tension between African spiritual explanatory concepts and western theories of mental illness 2.Tension between faith-based and western biopsychosocial models of treatment and recovery 3.Tension between African culture, language and belief systems on the individual’s health literacy and engagement with western mental health services 4.Tension between African cultural collective and western individualistic orientation and effect on health and mental wellbeing. Discussion: The majority of refugees from Ethiopia, Somalia, Sudan and South Sudan were not engaging with mainstream mental health services until they are acutely unwell. Their explanatory models of mental illness were influenced by their traditional animistic and spiritual beliefs, regardless of length of residency in Australia or level of educational attainment. Traditional and faith-based treatment was the preferred option for many repatriated by family, including post-diasporic African/Australian youth, for traditional animistic and faith-based healing. Repatriation commonly resulted in violation of the individual's human rights through involuntary genital mutilation/cutting, forced marriage and other ritualistic practices.

The adoption of eHealth is very slow despite evidences showing its benefits. This research examines the individual, clinical, technical and organizational challenges for eHealth adoption from healthcare provider‟s perspectives. A cross-sectional study design with a quantitative paradigm was used. The study was conducted on 312 doctors and nurses randomly selected from ten hospitals in Addis Ababa, Ethiopia. Most respondents viewed eHealth positively with no significant differences in terms of profession or gender. Computer skill, workload, patient interaction, management support, cost and infrastructure were the main concerns. Privacy and security were not the main concerns. Knowledge of eHealth applications and utilization was low, even for evidence-based medicine and online databases. Specialists and males were better aware of eHealth applications. The study showed that eHealth acceptance was good. Increasing eHealth literacy was recommended as a cost effective means for improving access to updated information to improve the quality of healthcare.<br>Health Studies<br>M.A. Public Health (Medical Informatics)

Text in English with abstracts and keywords in English and Setswana<br>Aim: The purpose of the research was to determine the magnitude and factors associated with gestational diabetes mellitus (GDM), and to explore the experiences of gynaecologists/obstetricians and midwives in the monitoring and prevention of GDM- related adverse maternal outcomes in order to propose best practice guidelines which may be implemented to overcome the problem. Methods: A concurrent mixed methods design was used. Participants for the quantitative study were selected using systematic random sampling, with purposive sampling being used for the qualitative part of the study. A total of 2000 medical records were reviewed using a checklist, in addition to which 7 gynaecologists/obstetricians and 12 midwives were interviewed using an in-depth interview guide. Descriptive and inferential statistics were used for the quantitative part, while Colaizzi’s manual qualitative data analysis method wasused for the qualitative part of the study. Findings: The magnitude of GDM was found to be 2.2%. Age and family history of diabetes mellitus were found to be factors associated with GDM (at p < 0.001). Other factors such as obesity, previous GDM, previous history of fetal macrosomia and multiple gestations were identified by respondents as factors related with GDM. In addition, the study explored the experiences of health professionals (HPs) in the monitoring and prevention of adverse maternal outcomes related to GDM, with the results showing some differences in screening and diagnostic techniques. It was also shown that lifestyle modification (physical exercise, diet management) and medication were utilised for managing women with GDM. In this regard, all the HPs agreed that creating awareness is the best intervention for preventing GDM as well as its adverse maternal outcomes. Conclusions: The magnitude of GDM is increasing, and much needs to be done to draw attention to the burden that GDM places on the health of pregnant women and the public. Since GDM is not considered a public health problem, little is being done to monitor the condition and its adverse maternal outcomes. It is hoped that the best practice guidelines developed from this research study may assist in reducing the adverse maternal outcomes of GDM in Ethiopia<br>Maikaelelo: Lebaka la patlisiso e ne e le go tlhotlhomisa go nna teng le mabaka a a golaganeng le bolwetsi jwa sukiri jwa baimana (GDM), le go tlhotlhomisa maitemogelo a dingaka tsa malwetsi a basadi (gynaeologists/ obstetricians) le babelegisi mo go tlhokomeleng le go thibeleng ditlamorago tse di maswe mo baimaneng tse di amanang le GDM gore go tshitshinngwe dintlhakaelo tse di gaisang tse di ka diragadiwang go fenya bothata. Mekgwa: Go dirisitswe thadiso ya mekgwa e e tlhakantsweng. Banni-le-seabe ba thutopatlisiso e e lebelelang dipalopalo ba ne ba tlhophiwa go diriswa go tlhopha sampole ka go se latele thulaganyo, mme go tlhopha sampole ka maikaelelo go ne ga diriswa mo karolong ya thutopatlisiso e e lebelelang mabaka. Go sekasekilwe palogotlhe ya direkoto tsa kalafi tse 2 000 go diriswa lenanetshekatsheko, mme mo godimo ga moo, go ne ga nna le dipotsolotso le dingaka tsa malwetsi a basadi di le supa le babelegisi ba le 12 go diriswa kaedi ya dipotsolotso tse di tseneletseng. Dipalopalo tse di tlhalosang le tse go sweditsweng ka tsona di ne tsa diriswa mo karolong ya dipalopalo ya thutopatlisiso, fa go dirisitswe mokgwa wa ga Colaizi wa tokololo ya data ya mabaka mo karolong e e lebelelang mabaka. Diphitlhelelo: Go nna teng ga GDM go ne ga fitlhelwa e le 2.2%. Dingwaga le hisetori ya bolwetsi jwa sukiri ya baimana mo lelapeng di fitlhetswe e le dintlha tse di golaganeng le GDM (ka p < 0.001). Dintlha dingwe, jaaka go nona phetelela, GDM mo nakong e e fetileng, go nna teng ga macrosomia ya masea mo nakong e e fetileng le boimana jwa masea a feta bongwe di ne tsa supiwa ke batsibogi jaaka dintlha tse di golaganeng le GDM. Go tlaleletsa foo, thuto e ne ya sekaseka maitemogelo a baporofešenale ba boitekanelo (HPs) mo tlhokomelong le thibelo ya ditlamorago tse di sa siamang mo baimaneng tse di golaganeng le GDM, mme dipholo di bontshitse dipharologano dingwe mo dithekeniking tsa go sekirina le go phekola. Go bonagetse gape gore phetolo ya mokgwa wa botshelo (katiso ya mmele, tsamaiso ya mokgwa wa go ja) le kalafi di ne tsa diriswa go laola bolwetsi jwa basadi ba ba nang le GDM. Mo lebakeng le, baporofešenale botlhe ba boitekanelo ba ne ba dumelana gore go dira temoso ke tsereganyo e e gaisang ya go thibela GDM ga mmogo le ditlamorago tsa yona tse di sa siamang mo baimaneng. Ditshwetso: Go nna teng ga GDM go a oketsega, mme go tshwanetse go dirwa go le gontsi go lemosa ka mokgweleo o bolwetse jono bo o bayang mo boitekanelong jwa baimana le setšhaba. Ka ntlha ya gore GDM ga e kaiwe jaaka bothata jwa boitekanelo jwa setšhaba, ga go dirwe go le kalo go tlhokomela bolwetsi le ditlamorago tsa jona tse di sa siamang mo baimaneng. Go solofelwa gore dintlhakaelo tsa tiriso e e gaisang tse di dirilweng mo thutopatlisisong eno di ka thusa go fokotsa ditlamorago tse di sa siamang tsa GDM mo baimaneng kwa Ethiopia.<br>Health Studies<br>D. Litt. et Phil. (Public Health)