A baseline audit of post-vasectomy follow-up at three Cape Town district health facilities.

BACKGROUND:  Our study focuses on vasectomies, an underutilised contraception method worldwide. Little is known about post-vasectomy semen analysis (PVSA) adherence in our setting, which is an essential step in confirming the procedure's success. We aimed to describe patient adherence to post-vasectomy follow-up and the success of procedures performed by different surgeon categories at three Cape Town district health facilities. METHODS:  We conducted a retrospective descriptive audit. We extracted sociodemographic and procedural information from theatre records and patient folders. The PVSA results were retrieved from Groote Schuur Hospital's Reproductive Medicine Unit. RESULTS:  The records of 270 patients who underwent vasectomies in local district-level facilities from September 2016 to July 2021 were included. Only 122 (45.2%) semen analysis results were retrievable, of which 115 (94.2%) showed that the procedure was successful. Incomplete patient records significantly impacted the study. A data-collection instrument and implementing standardised stationery were developed, which some sites already use. These measures are designed to ensure more comprehensive datasets for future audits. CONCLUSION:  The study's findings have identified flaws in record-keeping practices at the three study sites, a crucial step towards improving post-vasectomy care. Tracking procedural success and patient adherence to post-vasectomy semen analyses using the implemented stationery may assist future research and help drive quality improvement projects.Contribution: This audit strengthens our understanding of improving this underutilised family planning option in the district health services. In partnership with the local teams, a revised clinical care pathway was developed to inform the delivery of an evidence-informed vasectomy service.

Midwives' experiences regarding recordkeeping during intrapartum care in Limpopo Province healthcare facilities.

BACKGROUND:  South Africa has experienced an increase in litigations because of poor recordkeeping. The quality of maternal healthcare necessitates quality recordkeeping. All midwives' interventions should be documented in the maternity case record as an instrument to highlight the quality of intrapartum care offered. OBJECTIVES:  The purpose of the study was to determine and describe the experiences of midwives regarding recordkeeping during intrapartum care in Limpopo province and to make recommendations to improve recordkeeping. METHOD:  A qualitative, explorative and descriptive design was adopted. Midwives were selected purposively to participate in focus group discussions. Data were thematically analysed with the help of the independent transcriptionist and coder. RESULTS:  The findings revealed the themes: perceptions of midwives regarding recordkeeping and the challenges and enablers that influence recordkeeping during intrapartum care. CONCLUSION:  Quality recordkeeping requires timely, detailed, comprehensive and accurate recording. The study recommended the availability of updated guidelines, in-service training, monitoring and evaluation of recordkeeping, peer review, record auditing, proper time management among midwives and appointment of staff in line with the staffing needs of the unit to enhance recordkeeping.Contribution: Quality recordkeeping has a positive impact on the provision of quality healthcare to mothers during intrapartum care and reduces litigations related to maternity cases.

Factors associated with unfavourable treatment outcomes among tuberculosis patients at health facilities of Maseru, Lesotho.

Tuberculosis (TB) treatment success rates (TSR) remain low in Lesotho. The country achieved TSR of 76% in 2020, which is far below the World Health Organization's 95% target set for 2030. This study determined the level of treatment success and factors associated with unfavourable treatment outcomes. This descriptive cross-sectional study used patient records to perform descriptive and logistic regression analyses. Sixty-one per cent of the 336 TB patients were male. Two hundred and eighty-nine had favourable outcomes, of which 10% died in the course of treatment. Patients ≤ 44 years old, and those with supported treatment, had lower odds of unfavourable treatment outcomes, respectively, adjusted odds ration [aOR] = 0.39 (95% CI: 0.19-0.78) and aOR = 0.22 (95% CI: 0.08-0.62), p  0.05.Contribution: The death of patients while on TB treatment needs to be addressed, including heightened advocacy for supported treatment.

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

AIM: This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. BACKGROUND: Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. METHODS: This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. FINDINGS: Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. CONCLUSION: Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria: A national population based cross-sectional study.

BACKGROUND: Globally, about 810 women die daily from pregnancy and childbirth complications, and the burden is highest in Africa. The United Nations sustainable development goal has a maternal mortality ratio (MMR) target of 70 per 100,000 live births by 2030. Nigeria, the largest country in Africa, has an MMR of 512 per 100,000 live births, thus there is need for intensified efforts to reduce maternal deaths in the country. Proper utilisation of maternal health services including health facilities for delivery is crucial to achieving this. This study assesses the regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria. METHODS: This is a weighted secondary analysis of the Nigerian Demographic and Health Survey (NDHS). The sample included women who had a live birth in the preceding 5 years of the NDHS 2008, 2013 and 2018. Bivariate analysis and multilevel logistic regression were carried out to assess the determinants of health facility delivery. Trends analysis was done using bar graphs and spatial analysis showed the distribution of health facility delivery by State. RESULTS: Forty-one percent of women delivered their last child in a health facility. The proportion of women who delivered at a health facility increased from 2008 to 2018 for all regions, with exception of the South-south region. Determinants of facility-based delivery include; ethnicity, level of education, wealth index, exposure to mass media (AOR 1.34; 95% CI 1.20-1.50), number of childbirths, number of antenatal visits (AOR 4.03; 95% CI 3.51-4.62), getting a companion to go the health facility (AOR 0.84; 95% CI 0.72-0.98), community level poverty, community level of female education, community distance to health facility, and geographical region. CONCLUSION: There is an urgent need to deploy appropriate strategies and programme to improve health facility delivery in Nigeria.

Cervical Cancer Screening Services in Nepal: A Descriptive Crosssectional Study.

INTRODUCTION: Cervical cancer, the most prevalent cancer among women, is also the primary cause of cancer-related deaths in reproductive age women in Nepal. The study aims to assess the situation of cervical cancer screening services in Nepal. METHODS: This cross-sectional study used quantitative methods to understand the situation of cervical cancer screening in 572 health facilities of Nepal. The research was conducted to assess screening facilities, the allocation of separate screening rooms, the availability of screening services on a routine basis throughout the week, screening facilities that are free of charge, human resources, and the availability of treatment. It was conducted in October to December 2022. RESULTS: The research was carried out among 572 healthcare facilities, out of which 134 (23.42%) had provision for cervical cancer screening services. Ethical approval was obtained from the Nepal Health Research Council (NHRC) under reference number 397/2022 P. Amongst those 134, 72 (53.73%) healthcare facilities had assigned separate rooms for screening intentions. One hundred and two (76.12%) healthcare facilities provided regular screening services throughout the week, while 112 (83.58 %) had free-of-charge  screening services. Concerning trained personnel, 121 (90.30%) health facilities had personnel trained in visual inspection with Acetic acid, 9 (6.72%) had personnel trained in use of colposcopy, and 5 (3.73%) had personnel trained in use of Loop Electrosurgical Excision Procedure (LEEP). Lastly, 31 (23.13%) healthcare facilities offered treatment choices for cervical cancer. CONCLUSIONS: Most of the health care facilities did not have provision of cervical screening. Amongst those who had the provision, personnel trained in loop electrosurgical excision procedure colposcopy.

Costs and resource distribution of direct services for HIV in Uganda.

OBJECTIVE: In high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country. DESIGN: A cross-sectional study. SETTING: This study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals. PARTICIPANTS: 1119 persons receiving HIV services in 2020. METHODS: We conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time. RESULTS: The mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p<0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p<0.001) and those living in the Western region (US$2.88 higher, p<0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III. CONCLUSIONS: Costs and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities.

Readiness of the health system to provide non-communicable disease services in Nepal: a comparison between the 2015 and 2021 comprehensive health facility surveys.

BACKGROUND: In Nepal, despite the escalating burden of non-communicable diseases (NCDs), there is a gap in the continuum of care for prevention, diagnosis, treatment, and care services for NCDs. The study aimed at assessing the changes in availability and readiness scores of health facilities between two consecutive health facility surveys. METHODS: We compared NCD readiness scores between 2015 and 2021, using data from two nationally representative cross-sectional Nepal Health Facility Surveys (NHFS). Both consecutive surveys used globally validated standard tools of Demographic and Health Surveys (DHS)'s service provision assessment. Both surveys were undertaken using World Health Organization's (WHO) service availability and readiness assessment (SARA) tools. Data were collected using the Census and Survey Processing System on tablets, with validation performed through field check tables. Trained enumerators with a medical background collected data for the surveys, and we analyzed the information from a de-identified dataset downloaded from the DHS website upon request. Both the NHFS protocols were reviewed and approved by the Nepal Health Research Council and the institutional review board of ICF. We calculated the readiness scores based on WHO SARA indicators for diabetes, cardiovascular disease (CVD), and chronic respiratory disease (CRD) using a additive procedure. Multivariate linear regression analysis was undertaken to assess associated factors, with complex sampling design accounting for both surveys. RESULTS: The overall availability of all three services has improved between 2015 and 2021 NHFS. Although the availability of diabetes-related services increased significantly between 2015 and 2021, this does not correspond to the increase in the readiness score. The readiness score increased by 10% points for CVDs related services and 9% points for CRDs. Compared to public hospitals, primary healthcare facilities experienced greater increase in readiness scores (11.5% versus 20.9%). Interestingly, those health facilities without quality assurance systems experienced a lower increase or even decrease in readiness scores than those with quality assurance systems. For the factors associated with readiness scores, health facilities charging additional or separate fees to the patients had a higher readiness score than those not charging any user fee for all three services. Compared to 2015, the readiness scores in 2021 improved for diabetes [ß = 11.01 (95% CI 9.02 to 12.96)], CVD [ß = 10.70 (95% CI 9.61 to 11.80)], and CRD [ß = 8.41 (95% CI 7.20 to 9.62)]. CONCLUSION: The improvement in NCD service availability does not correspond to the proportional increase in readiness scores, which is crucial for delivering quality care. Regular staff meetings and feedback systems are crucial for improving all services including NCD-related service readiness and should be prioritized by local and provincial governments.

Magnitude of anemia and associated factors among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest Ethiopia, 2023.

BACKGROUND: Anemia is a common complication of HIV infected children and it is enabling HIV disease progression, and decreasing survival. In Ethiopia, there is limited evidence on the prevalence of anemia and its associated factors among HIV infected children particularly in the Awi Zone. Therefore, this study aimed to assess the magnitude and associated factors of anemia among HIV infected children on ART aged from 6 months to 15 year-old in ART Clinic, Awi-Zone, Ethiopia. OBJECTIVE: To assess the magnitude and associated factors of anemia among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest, Ethiopia, 2022. METHODS: A facility based cross-sectional study design was conducted from October to December 2022. A simple random sampling method was used to select the study participants. Descriptive statistics, including frequencies and proportions was used to summarize the study variables and data had been entered in to Epi data 4.2 and exported to SPSS version 25. Bivariable logistic regression followed by multivariable logistic regression was performed. Degree of association between dependent and independent variables had been assessed using adjusted odds ratio with 95% CI at p value of ≤ 0.05. RESULT: From 346 participants in the selected sample 339 (97.9%) of them responded. Prevalence of anemia was 13.3% (n = 45) among which, majority (44.4%) of them had mild anemia, while about (42.2%,) had moderate anemia and around 13.3%, of them were severely anemic. Baseline CD4 count (AOR = 6.58, 95% CI: 2.85-15.22), WHO clinical stage III or IV (AOR = 8.42, 95% CI = 3.47, 20.45), hookworm infection (AOR = 5.06, 95% CI = 2.04, 12) and malaria infection (AOR = 4.92, 95% CI (2.19-11.02) were significantly associated with anemia among children on HAART. CONCLUSION: The prevalence of anemia among participants was relatively low in this study. However, a considerable proportion of participants had moderate to severe anemia. Lower CD4 count at enrolment, advanced HIV clinical stage, malaria and hookworm infection were significantly linked with anemia. Thus, it requires regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements.

Associations between prior abortion and hepatitis B virus infection among pregnant women attending health care facilities. Meta-analysis.

BACKGROUND: Different results were found in earlier research on pregnant women with hepatitis B virus infection and past abortions. The current meta-analysis's objective was to investigate the connection between previous abortion and hepatitis B virus infection in pregnant women. METHODS: In January 2023, the following databases were searched: PubMed, Google Scholar, Web of Science, and Cochrane Library. A total of 9 articles that were published in English from 2012 to 2022 were included. Egger's test and the funnel plot's asymmetry were employed to look for publication bias. JBI critical appraisal checklist for analytical cross-sectional studies and case-control studies were used. Using the random effect model; the combined odds ratio and 95% confidence interval were obtained. RESULTS: There were 212 pregnant women with hepatitis B virus infection among the 3582 participants in nine (9) investigations. Comparing pregnant women who had prior abortions to pregnant women who had not had prior abortions, the combined effect size (OR) for hepatitis B virus infection was 3.43 (95% CI 1.66-7.10, p = 0.0009, I2 = 77%). Significant heterogeneity was present (Q = 34.33, I2 = 77%, p 0.00001). There was no evidence of publication bias (Egger's test: p = 0.495; Begg's test: p = 0.532). In all, 3582 (17.39%) pregnant women had previously had abortions, and 5.91% of pregnant women had Hepatitis B virus infection. CONCLUSIONS: Prior abortions elevated a pregnant woman's risk of contracting the hepatitis B virus. However, as a result of this study, we recommend to healthcare professionals to prevent unsafe abortions in order to enhance maternal health by lowering hepatitis B virus infection. Unsafe abortion can be prevented through: good sexuality education; prevention of unintended pregnancy through use of effective contraception, including emergency contraception; and provision of safe, legal abortion. In addition, deaths and disability from unsafe abortion can be reduced through the timely provision of emergency treatment of complications. .

Effect of community - facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda.

BACKGROUND: Improving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the "Communities in which Mothers and Newborns Thrive (COMONETH) project" in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda. METHODS: We used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale. RESULTS: A total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07-1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06-4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20-1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80-1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93-1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06-1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27-1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03-1.14). CONCLUSIONS: The findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

Delayed healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children who visited Yem special woreda public health facilities, Southwest Ethiopia, 2023.

BACKGROUND: For under-five children, receiving timely and appropriate medical attention is crucial in preventing serious and fatal complications. Unfortunately, evidence shows that parents of young children frequently delay seeking care, contributing to the death of many kids before they even get to a medical facility. OBJECTIVES: The study aimed to assess delay in healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children visiting Yem special woreda public health facilities, 2023. METHODS: A facility-based cross-sectional study was conducted among 333 caregivers of under-five children diagnosed with common childhood illnesses visiting Yem special woreda public health facilities. Systematic random sampling was employed, and data was collected using an interviewer-administered questionnaire. Delay was characterized as a long time (typically >24 hours) between disease onset and beginning of treatment. Data was entered into Epi Data version 4.7 and exported to Statistical Package for the Social Sciences version 25.0. Binary logistic regression model was fitted. Bi-variable and multivariable logistic regression analyses were conducted to identify the factors that influence the delayed healthcare seeking. Adjusted odds ratios with a 95% confidence interval were used to determine the associations. Statistically significant variables were identified based on a p-value < 0.05. RESULTS: A total of 326 caregivers participated in the study with a response rate of 98%. The proportion of delayed health care seeking was 74.5%. Caregivers "wait-and-see" approach is the primary reason for the delay followed by traditional home treatments. Child ≥ 12 months (AOR = 1.99, 95% CI: 1.11-3.57), rural residence (AOR = 2.41, 95% CI: 1.35-4.28), no community health insurance (AOR = 1.91, 95% CI: 1.07-3.42), traditional treatment (AOR = 2.98, 95% CI: 1.46-6.10), and initial self-medication at home (AOR = 2.73, 95% CI: 1.32-5.63) and perceiving illness as mild (AOR = 2.64, 95% CI: 1.28-5.42) were factors associated with delayed healthcare seeking. CONCLUSION AND RECOMMENDATION: The study showed delay in health care seeking for common childhood illnesses among caregivers was high. Hence, reducing delays necessitates the implementation of public education campaigns, collaboration with local organizations, and the provision of counseling for caregivers regarding childhood illnesses.

Does organisational myopia mediate the effect of occupational health and safety practices on the risk of occupational accidents in Turkish healthcare institutions?

Occupational health and safety (OHS) policies in healthcare institutions must be well managed, because healthcare practice involves many physical, biological, ergonomic, chemical, and psychosocial hazards that can affect the health of healthcare workers. In addition, their work performance may be affected by the so-called organisational myopia. In this context, the aim of our study was to determine how organisational myopia affects OHS practices in healthcare institutions and whether it increases the risk of occupational accidents. The study population consisted of a convenience sample of 420 healthcare professionals working throughout Turkey who completed a questionnaire addressing these three domains: organisational myopia, OHS practices, and risk of occupational accidents. Their responses were analysed with exploratory factor analysis, reliability analysis, and Spearman's correlation to assess the adequacy of measurement tools and identify relationships between variables, followed by mediation analysis. We found that OHS practices mitigate organisational myopia and the risk of occupational accidents. We also found no significant effect of organisational myopia on the risk of occupational accidents. Our findings underscore the importance of OHS practices in healthcare institutions and that organisational myopia should be evaluated in special contexts such as working time, experience, or routinisation.

Women living in the region under an emergency command post are experiencing delays in reaching health facilities: a multi-center cross-sectional study.

INTRODUCTION: The time between seeking emergency care and receiving the first healthcare service is referred to as delays in reaching health facilities. Delay in reaching health facilities had three main sub-themes in different studies. These include (i). Availability of transportation and infrastructure, (ii). Distance from health facilities and (iii). Lack of finance for transportation. Although there are plenty of findings about maternal delays in reaching health facilities, studies do not address the delay situation of women in conflict zones all over the world. In Ethiopia, specifically, we saw women delayed in healthcare service due to restricted movement and closure of roads, even for ambulances, at night time. METHODS: A multi-center cross-sectional study was conducted among mothers attending public health facilities in the south Gondar zone, Ethiopia from September 01/2023 to April 30/2024. The data was collected by four BSc degree-holder midwives, using structured questionnaires after training was given for a day in each hospital. A pretest using 5% of the sample size was conducted. Descriptive statistics, and multivariable logistic regression analyses were used to identify factors associated with delays in reaching health facilities. Variables having p-value ≤ 0.2 in the bi-variable analysis were fitted into multiple logistic regression models. RESULT: The prevalence of delay in reaching health facilities among women who are living in the region of emergency command post was 54.9% CI (42.04-59.87%). Living in rural areas, non-availability of public transport during the armed conflict, labor onset at nighttime, road closures by the armed forces, and non-availability of ambulances were the factors that contributed to the delay during the emergency command post. CONCLUSION: The magnitude of delay in reaching health facilities among women who are living in the region of emergency command post was high.

Impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia: Implications for future pandemics.

BACKGROUND: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia. METHODS: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level. RESULTS: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (ß: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (ß: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (ß: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (ß: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (ß: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (ß: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia. CONCLUSION: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services.

Assessment of magnitude of medicines wastage and the contributing factors in selected public health facilities of Hadiya Zone, Central Ethiopia Regional State.

BACKGROUND: Medicine wastage occurs when medicines are damaged, obsolete, or expired and become unsafe for use. In Ethiopia, although there are reports that reveal the presence of wasted medicines in the country, there is limited objective evidence on the type and extent of medicine wastage as well as its contributing factors. OBJECTIVE: The study aimed to assess the medicine wastage rate and identify its contributing factors in the sampled public health facilities (HFs) in Hadiya Zone, Central Ethiopia Regional State. METHOD: A facility-based cross-sectional study complemented by a qualitative study was conducted in selected public HFs in Hadiya Zone, Central Ethiopia Regional State, from November 1 to 31, 2022. All the hospitals were selected intentionally, and health centers were selected using simple random sampling techniques. For the qualitative study, the chief clinical officers and pharmacy department heads of HFs were purposefully selected as key informants because they were supposed to be more information-rich than other health professionals. The quantitative data were entered and analyzed using the Statistical Package for Social Sciences version 20. RESULT: The total monetary value of wasted medicines in the assessed HFs in the Ethiopian Fiscal Year (EFY) 2011-2013 was 652,479.45 ETB (5.24%). The three-year trend showed that, in the 2011-2012-2013 EFY, medicine wastage was 7.57%, 6.44%, and 3.1%, respectively. Expiration solely accounted for 97.3% of this total value. The alleged explanations for the waste of such medicines were a lack of accurate data available for medicine quantifications, the presence of overstocked medicines due to improper forecasting, a lack of electronic stock management, an abrupt change in the treatment regimen, and improper use of stock management. Whether the perceived causes had an impact on the medicine wastage was assessed, and the results confirmed that a significant association between medicine wastage and overstock (p-value = 0.006, AOR = 8.57, 95% CI = 1.87-39.26), accurate data (p-value = 0.013, AOR = 5.43, 95% CI = 1.42-20.76), and electronic stock management (p-value = 0.05, AOR = 0.311, 95% CI = 0.094-1.03) was observed. CONCLUSION: The identified medicine wastage rate is significant for a nation that struggles to allocate limited resources fairly. It may negatively affect the initiatives taken by the government to increase public engagement in the healthcare system through insurance contributions. It is a glance for HFs to take immediate corrective action.

Cervical cancer screening service utilisation and related factors among women on antiretroviral therapy in public health facilities of Asella town, Ethiopia, cross-sectional study.

BACKGROUND: Cervical cancer is the predominant form of cancer in Ethiopia, accounting for the majority of malignant cases. Women account for two-thirds of cancer-related deaths in the country. Cervical cancer screening (CCS) can help prevent disease development, but screening rates are unacceptably low. The greatest number of women were in the most vulnerable group, and the availability of wheal data on their use of CCSs was limited. This study aimed to evaluate the use of CCS and the factors that influence its use among HIV-positive women receiving antiretroviral therapy at public health facilities. METHODS: This study used a cross-sectional study design. A total of 396 (97.5%) HIV-positive women participated in this study between March 10 and May 30, 2023. Participants enrolled in public health facilities in Asella town were selected through systematic random sampling, and data were collected through on-site interviews using a pretested, structured questionnaire. The data were analysed using the Statistical Package for Social Science, Version 26. Logistic regression analysis was used to identify the determining factors. RESULTS: The findings from this study indicated that 30.3% of individuals used cervical cancer screening services. Those women who had knowledge about cervical cancer had a 2.54 times greater likelihood of receiving CCS than those who were not informed (adjusted odds ratio [AOR] = (2.54; 95% confidence interval [CI]: 1.42-4.56). Women with a history of sexually transmitted diseases were twice as likely to use CCS as those without such a history (AOR = 2.05, 95% CI = 1.13-3.73). Furthermore, women with a positive attitude towards CCS were found to be significant predictors of utilisation, showing a greater than threefold greater likelihood of using these services (AOR = 3.21; 95% CI: 1.78-5.81). CONCLUSIONS: The proportion of HIV-positive women who underwent cervical cancer screening (CCS) was significantly lower than the recommended guideline of 80%. To enhance the uptake of screening among women with HIV, healthcare professionals should focus on enhancing awareness about cervical cancer, improving attitudes towards CCS, and advancing knowledge about the disease. Healthcare providers' collaboration with both government and nongovernmental stakeholders plays a crucial role in addressing the challenges of accessibility and attendance at screening services.

The nexus between geographical distance and institutional delivery trends in Ethiopia: evidence from nationwide surveys.

Background: Giving birth in a healthcare facility with the guidance of skilled healthcare providers allows access to necessary medical interventions. Ethiopia has implemented several strategies to enhance institutional delivery and decrease maternal mortality; however, the rate of institutional delivery remains low. This study examines the role of distance to healthcare institutions on institutional delivery in Ethiopia, and how this has changed over time. Method: This study used data from two rounds of the Ethiopian Demographic and Health Survey (2011 and 2016), a spatial database detailing the locations of healthcare facilities, and Ethiopian road network data. The sample included 22,881 women who delivered within the 5 years preceding each survey and lived in 1,295 villages. Bivariate and multivariable logistic regression analyses were used to investigate how the distance to health facilities and other potential determinants influenced institutional delivery trends. Results: The rate of institutional deliveries in Ethiopia has increased from 10% in 2011 to 26% in 2016. Likewise, the average transportation distance to health facilities has decreased from 22.4 km in 2011 to 20.2 km in 2016 at the national level. Furthermore, a one-kilometer increase in the distance to the nearest health facility was associated with a 1% decrease in the likelihood of delivering at a health facility in 2016 (odds ratio (OR) = 0.99, 95% CI [0.98-0.99], p < 0.05). Additionally, mothers who are more educated, have completed more antenatal care visits, live in wealthier households in more urban areas, and cohabit with more educated husbands are more likely to deliver at healthcare facilities. These variables showed consistent relevance in both survey rounds, suggesting that key determinants remained largely unchanged throughout the study period. Conclusion: The impact of distance from health facilities on institutional delivery in Ethiopia remains evident, although its influence is relatively modest. The other factors, including education, antenatal care, socioeconomic status, urban residence, and partner education, remained consistent between the two surveys. These determinants have consistently influenced institutional delivery, highlighting the importance of a comprehensive approach that addresses both access to and socioeconomic factors to improve maternal and infant health across the country.

Magnitude of anemia and associated factors among pregnant women attending antenatal care in governmental health facilities of Shashemene Town, Oromia region, Ethiopia.

Introduction: Anemia during pregnancy is a common issue that significantly affects the health of both the mother and her child. Globally, anemia is a major public health concern, affecting both developing and developed countries, with approximately 1.3 billion people affected. Pregnant women are among the most vulnerable to anemia. Objective: To assess the magnitude and risk factors of anemia among pregnant women attending antenatal care in Shashemene Town, Oromia, Ethiopia. Methods: A facility-based cross-sectional study was conducted among 391 pregnant women in Shashemene Town in April 2022. Data were collected using interviewer-administered questionnaires, along with laboratory examinations of blood and stool samples. The data were entered into EpiData 3.1 and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Bivariate logistic regression was performed, and variables with a p-value of <0.25 were included in the multivariate logistic regression analysis to identify factors associated with anemia. Adjusted odds ratio (AOR) with 95% CIs were calculated, and a p-value of < 0.05 was considered statistically significant. Finally, the results are presented using narration, descriptive statistics, such as tables, graphs, and charts. Results: The prevalence of anemia was found to be 30.9% (95% CI: 26.4, 35.4%). Factors significantly associated with a reduced risk of anemia included high dietary diversity (AOR = 0.217, 95% CI: 0.105-0.451), no history of excessive menstrual bleeding (AOR = 0.162, 95% CI 0.076-0.345), age 25-34 years (AOR = 0.391, 95% CI 0.173-0.883), and age ≥ 35 years (AOR = 0.068, 95% CI 0.011-0.444). Conversely, a mild upper arm circumference (MUAC) of <23 cm (AOR = 4.939, 95% CI 2.330-10.469), no use of contraceptives (AOR = 4.935, 95% CI 2.207-11.032), and no iron supplementation use (AOR = 3.588, 95% CI 1.794-7.175) were significantly associated with an increased risk of anemia. Conclusion: According to the WHO classification, anemia in this study was found to be a moderate public health issue. High dietary diversity, no previous excessive menstrual bleeding, and age were significantly associated with a reduced risk of anemia, whereas a MUAC of <23 cm, no contraceptive use, and no iron supplementation were significantly associated with an increased risk of anemia. Therefore, promoting diverse diets among pregnant women, providing counseling on the benefits of family planning and iron-folic acid supplements, and improving women's education and empowerment are essential.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care.

OBJECTIVE: This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia. DESIGN: Secondary data analysis of institution-based cross-sectional national survey data. SETTING: Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia. PARTICIPANTS: This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021-2022 ESPA survey. OUTCOME MEASURES: The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings. RESULTS: Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of 'trained staff and guidelines' and 'diagnostics', but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%. CONCLUSIONS: Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.