Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review.

BACKGROUND: Cervical cancer is the second-leading cause of death among all cancers in Ethiopia. Ethiopia plans to eliminate cervical cancer as a public health problem by 2030, following the World Health Organization's call for action. A scoping review was conducted on the status of the cervical cancer continuum towards elimination in Ethiopia. METHODS: We searched articles in PubMed, Scopus, and Google Scholar. All studies conducted on cervical cancer in Ethiopia, from first date of publication to March 15, 2023, type of article, or language of publication, were included. However, conference abstracts, commentaries, and letters to the editors were excluded. We used EndNote X9 software to merge articles from different databases and automatically remove duplicates. Screening of titles, abstracts, and full texts was performed independently by two co-authors. The cancer care continuum was employed as a framework to guide data synthesis and present the findings. RESULTS: Of the 569 retrieved articles, 159 were included in the review. They found that most of the articles focused on knowledge, attitude, and practice. However, there were few studies on health-seeking behavior, perception and acceptability of cervical cancer services, as well as the availability and readiness of a screening program. The review identified inadequate knowledge, attitude, and perception about cervical cancer, and highlighted that screening for cervical cancer is not widely utilized in Ethiopia. Knowledge, attitude, education status, and income were repeatedly reported as precursors influencing cervical cancer screening. Most studies concluded that there is a high prevalence of precancerous lesions and cervical cancer, as well as high mortality rates or short survival times. The review also identified significant heterogeneity in findings across time and geographic settings within each component of the cancer care continuum. CONCLUSIONS: Overall, there is inadequate knowledge, perception, health-seeking behavior, screening, and treatment services, indicating that the country is falling behind its targets in eliminating cervical cancer, despite the availability of effective interventions and tools. We argue that implementation research is necessary to identify implementation issues, challenges, and strategies to scale up both primary and secondary prevention services. By doing so, Ethiopia can address cervical cancer as a public health problem and work towards its elimination.

Continued adherence to community-based health insurance scheme in two districts of northeast Ethiopia: application of accelerated failure time shared frailty models.

BACKGROUND: The sustainability of a voluntary community-based health insurance scheme depends to a greater extent on its ability to retain members. In low- and middle-income countries, high rate of member dropout has been a great concern for such schemes. Although several studies have investigated the factors influencing dropout decisions, none of these looked into how long and why members adhere to the scheme. The purpose of this study was to determine the factors affecting time to drop out while accounting for the influence of cluster-level variables. METHODS: A community-based cross-sectional study was conducted among 1232 rural households who have ever been enrolled in two community-based health insurance schemes. Data were collected using an interviewer-administered questionnaire via a mobile data collection platform. The Kaplan-Meier estimates were used to compare the time to drop out among subgroups. To identify predictors of time to drop out, a multivariable analysis was done using the accelerated failure time shared frailty models. The degree of association was assessed using the acceleration factor (δ) and statistical significance was determined at 95% confidence interval. RESULTS: Results of the multivariable analysis revealed that marital status of the respondents (δ = 1.610; 95% CI: 1.216, 2.130), household size (δ = 1.168; 95% CI: 1.013, 1.346), presence of chronic illness (δ = 1.424; 95% CI: 1.165, 1.740), hospitalization history (δ = 1.306; 95% CI: 1.118, 1.527), higher perceived quality of care (δ = 1.322; 95% CI: 1.100, 1.587), perceived risk protection (δ = 1.218; 95% CI: 1.027, 1.444), and higher trust in the scheme (δ = 1.731; 95% CI: 1.428, 2.098) were significant predictors of time to drop out. Contrary to the literature, wealth status did not show a significant correlation with the time to drop out. CONCLUSIONS: The fact that larger households and those with chronic illness remained longer in the scheme is suggestive of adverse selection. It is needed to reconsider the premium level in line with household size to attract small size households. Resolving problems related to the quality of health care can be a cross-cutting area of ​​intervention to retain members by building trust in the scheme and enhancing the risk protection ability of the schemes.

Economic costs and Predictors of occupation-related Injuries in Ethiopian sugar industries from the Employer's perspective: top-down approach and friction method.

BACKGROUND: For many industrial workers, occupational injuries are a common health and safety concern. However, sufficient information on the economic costs and predictors of occupation-related injuries from the perspective of employers is lacking in developing countries, including Ethiopia. The objective of this study was to close this gap by quantifying the economic costs and predictors of occupation-related injuries in Ethiopian manufacturing industries from the employer's perspective. METHODS: A cross-sectional study was employed to estimate the employer-side economic cost of occupation-related injuries from December 2021 to March 2022. This study used a top-down approach to compute direct costs, while the friction method was used for indirect cost estimation. Injury data were obtained from the Bureau of Labour and Social Affairs and the industries, while cost data were from workers' compensation records. The insurance company's injury compensation record was triangulated with industries' data. The study collected primary data via an interview-administered, semi-structured questionnaire from 1136 randomly selected injured cases. Statistical analysis was carried out with STATA version 14 software. The study employed a generalized linear model to identify predictors of total cost by considering the non-normal distribution of the total cost. Exponentiate coefficients with a 95% confidence interval were used to express the direction and strength of the association. RESULTS: The survey participation rate was 100%. From the perspective of the employers, the total cost of occupation-related injury was 22,587,635.32 Ethiopian birr (537,800.84 $).Indirect and direct costs accounted for 65.86 and 34.14% of the overall expenses, respectively. Long-term absence from work (exp (b) = 0.85), having a sleeping disorder (exp (b) = 0.90), co-morbidity (exp (b) = 0.85), and severity (type) of injury (exp (b) = 1.11) were predictors significantly associated with the total cost variability in the fully adjusted model. CONCLUSIONS: Employers' toll of occupation-related injuries has severe economic implications. The influential factors that elevated the total cost variation were: long-term absence from work, unsafe acts of the workers, having a sleeping disorder, co-morbidity, and severity (type) of injury. Therefore, the identified modifiable factors are the areas of intervention to reduce the cost of occupation-related injuries.

Financial viability of a community-based health insurance scheme in two districts of northeast Ethiopia: a mixed methods study.

BACKGROUND: Community-based health insurance initiatives in low- and middle-income countries encountered a number of sustainability challenges due to their voluntary nature, small risk pools, and low revenue. In Ethiopia, the schemes' financial viability has not been well investigated so far. This study examined the scheme's financial viability and explored underlying challenges from the perspectives of various key stakeholders. METHODS: This study employed a mixed methods case study in two purposively selected districts of northeast Ethiopia. By reviewing financial reports of health insurance schemes, quantitative data were collected over a seven years period from 2014 to 2020 to examine trends in financial status. Trends for each financial indicator were analyzed descriptively for the period under review. Interviews were conducted face-to-face with nine community members and 19 key informants. We used the maximum variation technique to select the study participants. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was applied with both inductive and deductive coding methods. RESULTS: Both schemes experienced excess claims costs and negative net income in almost all the study period. Even after government subsidies, the scheme's net income remained negative for some reporting periods. The challenges contributing to the observed level of financial performance have been summarized under five main themes, which include adverse selection, moral hazard behaviors, stockout of medicines, delays in claims settlement for service providers, and low insurance premiums. CONCLUSIONS: The health insurance scheme in both districts spent more than it received for claims settlement in almost all the period under the study, and experienced heavy losses in these periods, implying that it is not financially viable for the period in question. The scheme is also unable to fulfill its purpose of protecting members against out-of-pocket expenses at the point of health care. Interventions should target on the highlighted challenges to restore financial balance and enhance the scheme's viability.

Hotspots of female genital mutilation/cutting and associated factors among girls in Ethiopia: a spatial and multilevel analysis.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that violates the human rights of girls and women. It is widely practiced mainly in Africa including Ethiopia. There are a number of studies on the prevalence of FGM/C in Ethiopia. However, little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting FGM/C among girls in Ethiopia. METHODS: A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a total of 6985 girls nested in 603 enumeration areas were included in this analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Kulldorff's spatial scan statistics were used to detect spatial clusters of FGM/C. Multilevel logistic regression models were fitted to identify individual and community level factors affecting FGM/C. RESULTS: Spatial clustering of FGM/C was observed (Moran's I = 0.31, p-value < 0.01), and eight significant clusters of FGM/C (hotspots) were detected. The most likely primary SaTScan cluster was detected in the neighborhood areas of Amhara, Afar, Tigray and Oromia regions (LLR = 279.0, p < 0.01), the secondary cluster in Tigray region (LLR = 67.3, p < 0.01), and the third cluster in Somali region (LLR = 55.5, P < 0.01). In the final best fit model, about 83% variation in the odds of FGM/C was attributed to both individual and community level factors. At individual level, older maternal age, higher number of living children, maternal circumcision, perceived beliefs as FGM/C are required by religion, and supporting the continuation of FGM/C practice were factors to increase the odds of FGM/C, whereas, secondary or higher maternal education, better household wealth, and regular media exposure were factors decreasing the odds of FGM/C. Place of residency, Region and Ethnicity were also among the community level factors associated with FGM/C. CONCLUSIONS: In this study, spatial clustering of FGM/C among girls was observed in Ethiopia, and FGM/C hotspots were detected in Afar, Amhara, Tigray, Benishangul Gumuz, Oromia, SNNPR and Somali regions including Dire Dawa Town. Both individual and community level factors play a significant role in the practice of FGM/C. Hence, FGM/C hotspots require priority interventions, and it is also better if the targeted interventions consider both individual and community level factors.

Maternal satisfaction among vaginal and cesarean section delivery care services in Bahir Dar city health facilities, Northwest Ethiopia: a facility-based comparative cross-sectional study.

BACKGROUND: Mothers' delivery care satisfaction is one of the indicators to monitor the quality of health care provision. However, there is only limited information in this regard in Ethiopia, particularly in the study area. Therefore, the study aimed to determine the level of maternal satisfaction and the determinants among vaginal and cesarean section delivery care in Bahir Dar city health facilities. METHODS: Facility-based comparative cross-sectional study was conducted from April to May 2018. Using systematic random sampling, a total of 896 recently delivered mothers were interviewed. The collected data were entered into the Epi-Data soft and then exported to SPSS Version 20.0 for analysis. Descriptive statistics were computed and Logistic regression model was used to identify the association between explanatory and outcome variables. Adjusted Odds Ratio with 95% CI was used to measure the strength of the association between these variables. The model fitness was checked using Hosmer and Lemeshow goodness of fit (P > 0.05). A p-value < 0.2 at bivariate analysis was considered for variables to be candidates for multivariable logistic regression analysis. Variables with a p-value of < 0.05 at multivariate analysis were considered as statistically significant predictors of mothers' satisfaction. RESULTS: A total of 894 recently delivered mothers participated in the study yielded a response of 99.8%. 448 (50.1%) mothers delivered vaginally whereas 446 (25.8%) via cesarean section. The overall mean age of respondents was 26.60 (± 4.88) years. The total maternal delivery care service satisfaction level was 61.4%. More mothers were satisfied with vaginal delivery care, 65.6% (95% CI: 56.97, 74.22%) than cesarean section, 57.2% (95% CI: 48.19, 66.2%). Maternal education, residence, current delivery care planned, maternal HIV status, the gender of health care provider and gave birth in a private health facility were significantly associated with vaginal delivery care satisfaction. Whereas, maternal education, residence, current delivery care planned, antenatal care attended, gender of health care provider was significantly associated with cesarean section delivery care satisfaction. CONCLUSIONS: The overall maternal delivery care service satisfaction level was low as, per the national standard, and there is a great discrepancy in maternal satisfaction level between vaginal and cesarean section delivery care services.

Contraceptive use and associated factors among women seeking induced abortion in Debre Marko's town, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Contraceptive utilization is a practice that helps individuals or couples to avoid unwanted pregnancy. Even though there is the widespread availability of contraceptives, induced abortion remains an alarming public health problem in Ethiopia. Nationally, more than a third (35%) of women seeking an induced abortion service had a previous history of abortion. Therefore, this study aimed to assess the history of contraceptive use and identify associated factors among women seeking an induced abortion service in Debre Marko's town, Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from March 15 to May 15, 2019. The sample size was 416 and each health institution was proportionally allocated based on the previous 2 months of patient flow. Systematic random sampling was used to select the study participants. A structured questionnaire was used to collect the data. Data were entered by EPI-data and analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were carried out. Model fitness was assured. RESULTS: The proportion of contraceptive use within the last 6 months before pregnancy was 41.3% among women seeking an induced abortion. Women who had good knowledge about contraceptives (AOR = 3.9; 95%CI: 2.36, 6.54), women who had a positive attitude about contraceptives (AOR=; 95%CI: 1.02, 2.56), women who had living children (AOR = 2.1; 95%CI; 1.04, 4.11), women who had frequent sexual practice (AOR = 2.5; 95% CI; 1.53, 4.21) and women discussed with their sexual partners about contraceptives (AOR = 1.9; 95%CI: 1.18, 3.18) were increase the odds of contraceptive use among women seeking an induced abortion. CONCLUSION: Contraceptive use among women seeking an induced abortion was low despite the expected national goal of 55% contraceptive use in 2020. Having good knowledge and having a positive attitude on contraceptives, and having a discussion on contraceptives with sexual partner were increase the odds of contraceptive use. The intervention should focus on abortion seeking women to achieve their contraceptive needs and encourage sexual partner discussion about contraceptives to improve joint partner collective decision-making.

Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis.

BACKGROUND: Stunting reflects a failure to receive adequate nutrition over a long period of time. Stunting is associated with adverse functional consequences including poor cognition, low educational performance, low adult wages, and poor reproductive outcomes. The objective of the study was to investigate spatial variations and factors associated with childhood stunting in Ethiopia. METHODS: This study is a secondary data analysis of the 2011 Ethiopian Demographic and Health Survey (EDHS). A total of 9893 children aged 0-59 months were included in the analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of stunting. A multilevel multivariable logistic regression was used to identify factors associated with stunting. RESULTS: Statistically significant hotspots of stunting were found in northern parts of the country whereas low hotspots where there was less stunting than expected were found in the central, eastern, and western parts of the country. In the final model of multilevel logistic regression analysis, individual and community level factors accounted for 36.6 % of childhood stunting. Short birth interval [AOR = 1.68; 95%CI: (1.46-1.93)], being male [AOR = 1.20; 95%CI: (1.08-1.33)], and being from a male-headed household [AOR = 1.18; 95 % CI: (1.01-1.38)] were the factors that increased the odds of stunting at the individual level. Children in the age group between 24-35 months were more likely to be stunted than children whose age was less than one year [AOR = 6.61; 95 % CI: (5.17-8.44)]. The odds of stunting among children with severe anemia were higher than children with no anemia [AOR = 3.23; 95%CI: (2.35-4.43)]. Children with mothers who had completed higher education had lower odds of being stunted compared to children whose mothers had no formal education [AOR = 0.42; 95%CI: (0.18-0.94)]. The odds of being stunted were lower among children whose fathers completed higher education [AOR = 0.58; 95%CI: (0.38-0.89)] compared to children whose fathers had no formal education. Children whose mothers who had high a Body Mass Index (BMI) (≥25.0 kg/m(2)) were less likely to be stunted compared with children whose mothers had a normal BMI (18.5 kg/m(2)-24.9 kg/m(2))[AOR = 0.69; 95%CI: (0.52-0.90)]. Children from the poorest wealth quintile had higher odds of being stunted compared to children from the richest wealth quintiles [AOR = 1.43; 95 % CI: (1.08-1.88)]. Unavailability of improved latrine facilities and living in the northern parts of the country (Tigray, Affar, Amhara and Benishangul-Gumuzregions) were factors associated with higher odds of stunting from the community-level factors. CONCLUSION: Stunting in children under five years old is not random in Ethiopia, with hotspots of higher stunting in the northern part of Ethiopia. Both individual and community-level factors were significant determinants of childhood stunting. The regions with high hotspots of child stunting should be targeted with additional resources, and the identified factors should be considered for nutritional interventions.

Tuberculosis infection control practices and associated factors among health care workers in health centers of West Gojjam zone, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) remains a major global health problem. The emerging epidemic of multi- and extensively drug-resistant (M/XDR) TB further imperils health workers, patients and public health. Health facilities with inadequate infection control are risky environments for the emergence and transmission of TB. There was no study that presented data on infection control practices of health care workers. This study aimed to assess tuberculosis infection control practices and associated factors among health care workers in West Gojjam Zone, Northwest Ethiopia. METHODS: Institution based quantitative cross-sectional study triangulated with qualitative observation and key informant interview was conducted. Six hundred sixty two health care workers were selected by multistage random sampling method. Self-administered structured questionnaire was used to collect quantitative data. Observation checklists and key informant interview guides were used to collect qualitative data. Quantitative data were entered in to Epi Info version 3.5.3 and analyzed using SPSS version 20. Odds ratio with 95 % confidence interval was used to identify factors associated with TB infection control practice of health care workers. Qualitative data were translated, transcribed, analyzed and triangulated with the quantitative findings. RESULTS: The proportion of proper TB infection control (TBIC) practices was 38 %. Qualitative data showed that administrative, environmental and personal respiratory protection control measures were not practiced well. Knowledge on the presence of TBIC plan [AOR = 4.25, 95 % CI: 2.46 - 7.35], knowledge on the presence of national guideline [AOR = 8.95, 95 % CI: 4.35 - 18.40] and working department of the health care workers were independent predictors of TBIC practices. CONCLUSIONS: The proportion of proper TBIC practices of health care workers was low. TBIC practices were determined by knowing the presence of TBIC plan and national guideline and working department. Hence, supportive supervision and trainings should be given to health care workers who are working other than TB clinics to improve the knowledge of TBIC plan and guidelines. Health centers shall prepare TBIC plans and orient all health care workers.

Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar City Administration, Northwest Ethiopia: a cross sectional study.

BACKGROUND: Hepatitis B infection is a major public health problem in Ethiopia. Health care workers are at increased risk of acquiring hepatitis B infection due to occupational exposure. There is effective and safe vaccine against hepatitis B infection. But many health care workers in developing countries are not vaccinated. There is no study in Ethiopia that describes hepatitis B vaccine knowledge and vaccination status of health care workers. Therefore, this study was done to assess hepatitis B vaccination status and knowledge among health care workers' of Bahir Dar city administration, Northwest Ethiopia. METHODS: Institution based cross sectional study design was employed from April 1 to 30, 2012. All healthcare workers who were working in Health care facilities of Bahir Dar city administration were the study populations. A total of 374 health care workers were included in the study. Simple random sampling technique was used to select eligible study participants from the list of health care workers. Self administered questionnaire was used to collect data. The completeness of questionnaires was checked every day by facilitators and principal investigators. Data were entered and analyzed with statistical package for social sciences version 16.0 software. RESULT: In this study, 64.7% of respondents perceived their risk of acquiring hepatitis B infection very high or high. Only 52% of the respondents were knowledgeable about hepatitis B infection. In this study, only 62% of health care workers were knowledgeable about hepatitis B vaccine. From the total of 370 respondents, only 20(5.4%) reported that they took three or more doses of hepatitis B vaccine. CONCLUSION: Hepatitis B vaccination status of health care workers in the study area was low. Health care workers' knowledge about hepatitis B infection and hepatitis B vaccine was also low as all health care workers should be knowledgeable.

Factors affecting healthcare service utilization of mothers who had children with diarrhea in Ethiopia: evidence from a population based national survey.

INTRODUCTION: Appropriate healthcare-seeking practices of mothers are important to prevent child death. This study aimed to investigate factors associated with mothers' healthcare services utilization for managing childhood diarrhea (CDD) in Ethiopia. METHODS: A secondary data analysis was performed using data from the Ethiopian Demographic and Health Survey 2011. Binary and multivariable logistic regressions were carried out to identify factors associated with mothers' healthcare services utilization for CDD. RESULTS: About 35% (95% confidence interval (CI): 32.67-37.33%) of mothers visited healthcare institutions (HCIs) for CDD. Those mothers with children aged 6-11 months were 2.16 times more likely to use HCIs for CDD (adjusted odds ratio (AOR)=2.16, 95%CI: 1.32-3.53) compared to mothers who had children under 6 months of age. Urban mothers were 1.68 times more likely to use HCIs for CDD compared to rural mothers (AOR=1.68, 95%CI: 1.06-2.67). Those mothers who had information about oral rehydration salts (ORSs) were 2.66 times more likely to use HCIs for CDD compared to those mothers who had no information about ORS (AOR=2.66, 95%CI: 1.93-3.67). Mothers who attended antenatal care were 1.34 times more likely to use HCIs for CDD than mothers who never attended antenatal care (AOR=1.34, 95%CI: 1.04-1.74). Mothers who had postnatal checkups were 1.53 times more likely to use HCIs for CDD compared to mothers who had no postnatal checkups (AOR=1.53, 95%CI: 1.02-2.30). Those mothers who participated in community conversation were 1.67 times more likely to use HCIs for CDD than those mothers who had no information about community conversation (AOR=1.67, 95%CI: 1.15-2.39). CONCLUSIONS: Healthcare services utilization for CDD was found to be poor in Ethiopia. Urban residency, older age of the child, awareness of ORSs, antenatal care attendance, postnatal check and attending community conversation were factors associated with healthcare services utilization for CDD. Interventions to improve mothers' healthcare service utilization for CDD treatment should target rural households. Promotions of appropriate CDD treatment during ANC, postnatal checkup and community conversation are the recommended interventions.

Sex trafficking awareness and associated factors among youth females in Bahir Dar town, North-West Ethiopia: a community based study.

BACKGROUND: Sex trafficking is a contemporary issue in both developed and developing countries. The number of trafficked women and young girls has increased globally. Females aged 18-25 are the most targeted group of trafficking. Although the problem is evident in Ethiopia, there are no studies that explored sex trafficking awareness among females. Therefore, the aim of this study was to assess sex trafficking awareness and associated factors among youth females in Bahir Dar town, North-West Ethiopia. METHODS: A community based cross-sectional study design was employed to collect data from February 1st-30th 2012 from a total of 417 youth females. The participants in the study were selected using systematic random sampling techniques. A structured Amharic questionnaire was used to collect data. Data were entered, cleaned and analyzed using SPSS 16.0. Descriptive statistics were used to describe data. Logistic regression analysis was used to identify factors associated with sex trafficking awareness. RESULT: Two hundred forty-nine (60%) of the participants reported that they had heard or read about sex trafficking. Television (64%), friends (46%) and radio (39%) were the most frequently mentioned sources of information about sex trafficking. About 87% and 74% of the participants mentioned friends and brokers respectively as mediators of sex trafficking. Having TV at home (AOR = 2. 19, 95% CI: 1.31-3.67), completing grade 10 or more (AOR = 2. 22, 95% CI: 1.18-4.17), taking training on gender issues (AOR = 3. 59, 95% CI: 2.11-6.10) and living together with parents (AOR = 3. 65, 95% CI: 1.68-7.93) were factors found associated with sex trafficking awareness. CONCLUSION: In this study, sex trafficking awareness was low among youth females. Having TV at home, living together with someone and being trained on gender issues were predictors of sex trafficking awareness. Therefore, providing education about sex trafficking will help to increase sex trafficking awareness among youth females.

Factors associated with Institutional delivery service utilization among mothers in Bahir Dar City administration, Amhara region: a community based cross sectional study.

BACKGROUND: High maternal mortality is a continued challenge for the achievement of the fifth millennium development goal in Sub-Saharan African countries including Ethiopia. Although institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality, interventions at the community and/or institutions were unsatisfactorily reduced maternal mortality. Institutional delivery service utilization is affected by the interaction of personal, socio-cultural, behavioral and institutional factors. Therefore this study was designed to assess factors associated with institutional delivery service use among mothers in Bahir Dar city administration. METHODS: A community based cross sectional study was conducted in Bahir Dar City administration Northwest of Addis Ababa, Ethiopia. Four hundred eighty four mothers were included in the study. Data were collected by trained female data collectors. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios (OR) with 95% confidence intervals. RESULT: In this study, 78.8% of women gave birth to their current child at health institution. The multivariable logistic regression showed that, attending primary education (AOR = 4.7[95% CI:1.3-16.7], secondary education (AOR = 3.5[95% CI:1.1-10.7]), age at first marriage; first time marriage at 15-19 years (AOR = 5.4[95% CI:2.0-15.0]) and first time marriage at 20-24 years (AOR = 5.0[95% CI:1.5-16.8] and gestational age at first ANC visit (first trimester) (AOR = 5.3[1.3-22.2]) and second trimester (AOR = 2.8[95% CI:0.7-11.]) were independent factors affecting institutional delivery service utilization. CONCLUSION: In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery. This study indicated that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Hence, intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery service utilization.

Electronic maternal and child health application usability, feasibility and acceptability among healthcare providers in Amhara region, Ethiopia.

An innovative electronic Maternal and Child Health (eMCH) application was developed to support operational and clinical decision-making in maternal and child health services. End-user-based evaluation of eHealth application is a critical step to ascertain how successfully users can learn and use it, and improve the technology. Therefore, this study aimed to evaluate the eMCH tool usability, feasibility, and acceptability among healthcare providers (HCPs) in the Amhara region, Ethiopia. A cross-sectional study was conducted among HCPs working in six public healthcare facilities. The usability evaluation was done on 24 HCPs across three professional categories using the ISO 9241-11 usability guideline. One hundred nine HCPs were participated in the feasibility and acceptability study. Data were collected using a standard usability tool, think-aloud protocol, a self-administered approach, and Open Broadcaster Software Studio version 26.1.1 video recorder. Descriptive statistics were used to describe the data. A Kruskal-Wallis test was used to measure the association between mean scores and categories of HCPs. The recorded videos were used for the log file analysis method. None of the HCP categories were able to complete all the tasks without errors. The average number of errors and restarts were 7.5 and 2.8, respectively. The average number of restarts was directly proportional to the average number of errors. The participants successfully completed more than 70% of the tasks without requiring any assistance or guidance. Forty-seven comments or errors were identified from the think-aloud analysis and 22 comments from the usability metrics analysis. Overall, statistically significant performance differences were observed among the three HCP groups across the majority of the usability evaluation metrics. Fifty-seven percent of HCPs scored higher than the mean on the feasibility study. Slightly higher than half, 56 (51.4%), of the HCPs scored higher than the mean score on the acceptability study. The usability evaluation identified vital comments and usability flaws that were essential for the eMCH tool to be upgraded. The tool was feasible and acceptable as reported by end-users. Therefore, the errors and usability flaws of the tool should be fixed before deployment to other healthcare settings.

Gender-based violence in the context of armed conflict in Northern Ethiopia.

BACKGROUND: Gender-based violence (GBV) particularly against women is unfortunately common during armed conflicts. No rigorous and comprehensive empirical work has documented the extent of GBV and its consequences that took place during the two years of devastating armed conflict in Northern Ethiopia. This study aims to assess GBV and its consequences in war-torn areas of northern Ethiopia. METHODS: We used a qualitative method augmented by quantitative method to enroll research participants. We conducted in-depth interviews to characterize the lived experiences of GBV survivors. All interviews were conducted confidentially. The data were collected to the point of data saturation. All interviews were transcribed verbatim into local language, translated into English, and analyzed using a thematic analysis approach. We also used reports from healthcare facilities and conducted a descriptive analysis of the demographic characteristics of study participants. RESULTS: One thousand one hundred seventy-seven persons reported GBV to healthcare providers. The qualitative study identified several forms of violence (sexual, physical, and psychological). Gang rape against women including minors as young as 14 years old girls was reported. Additionally, the perpetrators sexually violated women who were pregnant, and elderly women as old as 65 years, who took refuge in religious institutions. The perpetrators committed direct assaults on the body with items (e.g., burning the body with cigarette fire) or weapons, holding women and girls as captives, and deprivation of sleep and food. GBV survivors reported stigma, prejudice, suicide attempts, nightmares, and hopelessness. GBV survivors dealt with the traumatic stress by outmigration (leaving their residences), seeking care at healthcare facilities, self-isolation, being silent, dropping out of school, and seeking counseling. CONCLUSION: GBV survivors were subjected to multiple and compounding types of violence, with a wide range of adverse health consequences for survivors and their families. GBV survivors require multifaceted interventions including psychological, health, and economic support to rehabilitate them to lead a productive life.

Pesticide use safety practices and associated factors among farmers in Fogera district wetland areas, south Gondar zone, Northwest Ethiopia.

BACKGROUND: Farmers in developing countries, including Ethiopia, are exposed to agricultural pesticides, including pesticides that are restricted or banned in developed countries. There is little information available on pesticide use safety practices and associated factors among Ethiopian farmers, particularly in the study area. OBJECTIVE: To assess pesticide use safety practices and associated factors among farmers in Fogera district wetland area, Amhara region, Northwest Ethiopia. METHODS: A community-based cross-sectional study design that employs quantitative and qualitative methods was used from August 25 to September 30, 2021. Four hundred thirty participants were included by using a stratified random sampling technique. Pre-tested interview questionnaires, observational checklists, and key informant and in-depth interview guides were used to collect data. The quantitative data were collected by face-to-face interviews of farmers, whereas the qualitative data were collected by in-depth interviews of selected farmers and key informant interviews of responsible stalk holders. The data were entered into Epi data version 4.6 and analyzed using SPSS version 21. Bi-variable logistic regression was used to identify factors associated with the dependent variable. A p-value of less than 0.05 was used as a cut-off point to declare a statistically significant association between factors and outcome variables. The odds ratio and 95% CI were calculated to describe the strength of the association between factors and outcome variables. The qualitative study included 35 respondents from various backgrounds and levels of expertise, which were analyzed using thematic analysis by open-code 4.03 version software. RESULT: The proportion of good pesticide use safety practices in the study area was 24.4% (95% CI: 21.4%-29.3%). Educational status (adjusted odds ratio (AOR): 3.19, 95% CI: 1.44-6.71), experience of pesticide spraying (AOR: 6.85. 95% CI: 2.426-9.35), knowledge of pesticide usage (AOR: 3.40, 95% CI: 1.459-7.855), access to safety materials (AOR: 2.06, 95% CI: 1.198-3.536), and ever having received training (AOR: 4.93, 95% CI: 2.88-8.59) were factors associated with good safety practice in pesticide use. Qualitatively, limited material access, lack of government attention, insufficient training opportunities, absence of media coverage, weak enforcement of laws, and limited guideline access barred good safety practices for pesticide use. CONCLUSION: The study revealed that good safety practices were low in the study area. Being educated, having experience with pesticide spraying, having good knowledge of pesticide usage, having access to safety materials, and having received pesticide use training all increased the likelihood of good pesticide use practice. Insufficient training opportunities and material access, weak law enforcement, limited access to guidelines, and a shortage of media coverage were challenges identified qualitatively.

Occupational health and safety practices and associated factors among workers in Ethiopia's Metehara and Wonji sugar industries: a convergent parallel mixed design.

INTRODUCTION: Information regarding workers' practices concerning safety measures in Ethiopia's sugar industries is inadequate. OBJECTIVES: To assess occupational health and safety practices and associated factors among workers in Ethiopia's Metehara and Wonji sugar industries. DESIGN: A convergent parallel mixed design. SETTING: Metehara and Wonji sugar industries in Ethiopia (December 2021 through May 2022). PARTICIPANTS: We used a stratified random sampling method to select 1648 participants for the collection of quantitative data. We employed a purposive sampling method to carry out 20 in-depth interviews in order to gather qualitative data. PRIMARY OUTCOME MEASURES: We computed the extent of occupational health and safety practices using a 21-item questionnaire. Finally, results were graded as 'good' if ≥60% of them were answered correctly and 'poor' if <60% were correctly answered. We created a qualitative data interpretation from the subject's perspective. RESULTS: The percentage of good occupational health and safety practices was 29.6% (95% CI: 27% to 32%). Inappropriate provision of personal protective equipment (adjusted OR (AOR)=1.42, 95% CI: 1.10 to 1.83), a lack of strict safety regulation (AOR=1.64, 95% CI: 1.27 to 2.12), a lack of incentives (AOR=1.31, 95% CI: 1.04 to 1.66) and inadequate management support (AOR=1.19, 95% CI: 1.04 to 1.66) were identified as associated factors. Health service usage defects, inappropriate protective equipment use and failure to follow occupational safety commands were identified as challenges. CONCLUSIONS: Occupational health and safety measures were not used effectively. The qualitative component of this study confirmed that most participants expressed undesirable practices in occupational health and safety measures. Inappropriate protective device provisions, a lack of strict safety regulation, the absence of incentives and inadequate management support were found to be linked with the use of occupational health and safety measures. The contributing factors we identified potentially indicate areas for future intervention.

Bagasse dust exposure and chronic respiratory symptoms among workers in the Metehara and Wonji sugar factories in Ethiopia: a longitudinal study design.

BACKGROUND: Ethiopia's sugar factories are growing by creating job opportunities for thousands of workers with varying educational, professional and socioeconomic backgrounds. These sugar factories are a source of several hazards that severely harm the workers' health. In this context, there is inconclusive evidence on the level of bagasse dust exposure and chronic respiratory health symptoms. This study aimed to assess the degree of bagasse dust exposure and chronic respiratory health symptoms. METHODS: In this longitudinal study, five workstations were selected for dust sampling. A stratified random sampling technique was used to select 1043 participants. We measured the dust intensity using a calibrated handheld real-time dust monitor once a month for 5 months, totalling 50 dust samples. Chronic respiratory symptoms were assessed using the American Thoracic Society's respiratory symptoms questionnaire. RESULTS: A 1 hour time-weighted average of bagasse dust intensity in the boiler, power turbine and evaporation plant was 8.93 mg/m3, 8.88 mg/m3 and 8.68 mg/m3, respectively. This corresponded to an exposure level to bagasse dust of 85.52% (95% CI 83.2% to 87.6%). The level of chronic respiratory health symptoms was 60.6% (95% CI 59.2% to 61.9%). The most common respiratory symptoms were wheezing (96.8%), coughing (89.7%) and breathlessness (80.9%). The identified risk factors were lack of dust control technology (ß= 0.64, 95% CI 0.53 to 0.75), not practising wet spray (ß = 0.27, 95% CI 0.21 to 0.41) and not wearing proper respiratory protection devices (ß = 0.12, 95% CI 0.30 to 0.56). CONCLUSIONS: Bagasse dust exposure and respiratory health abnormalities were worrying concerns. The absence of dust control technologies and no practice of wet spraying elevated the level of exposure. Not wearing proper respiratory protection gear increased the odds of having respiratory abnormalities. Hence, the use of mechanical solutions to stop dust emissions at their sources and the wearing of proper respiratory protection gear are highly advised.

Epidemiological Characteristics of Cancer Patients Attending at Felege Hiwot Referral Hospital, Northwest Ethiopia.

BACKGROUND: Cancer has become a public health problem and a challenge in developing countries, including Ethiopia. There is scanty local data on cancer epidemiology in Amhara region, Ethiopia. Thus, this study aimed to describe epidemiological characteristics of cancer patients attending Felege Hiwot Referral Hospital. METHODS: This study was based on a patient cancer registry that took place in Bahir Dar Felege Hiwot Referral Hospital, Amhara Regional State, Ethiopia. It is the main referral hospital in the Amhara region, and serves more than 5 million people. The hospital has units including oncology for follow-up health care services. All confirmed cancer patients attending oncology units from July 2017 to June 2019 were included in the study. Global Moran's I statistic was employed to assess spatial heterogeneity of cancer cases across districts. Getis-Ord Gi* statistics was performed to identify hot spot districts with high numbers of cancer cases. RESULTS: In a two-year period, a total of 1888 confirmed cancer patients were registered. There was a significant variation of cancer patients between females (60.8% 95%CI 58.5 to 63.0%) and males (39.3% 95%CI 37.0 to 41.5%). The first three most frequent cancer types seen were breast (19.4%) and cervical cancer (12.9%), and lymphoma (15.7%). Breast and cervical cancer and lymphoma were the first three cancers type among women, whereas lymphoma, sarcoma, and lung cancer were the three most common cancer among men. Spatially, cancer cases were non-random in the study area (global Moran's I = 0.25, z-score = 5.6, p-value < 0.001). Bahir Dar city administration (z = 3.93, p < 0.001), Mecha (z = 3.49, p < 0.001), Adet (z = 3.25, p < 0.01), Achefer (z = 3.29, p < 0.001), Dangila (z = 3.32, p < 0.001), Fogera (z = 2.19, p < 0.05), and Dera (z = 2.97, p < 0.01) were spatially clustered as hotspot with high numbers of cluster cases. CONCLUSIONS: We found that there is a variation in the cancer types with sex. This study provides an insight for further exploration of environmental and occupational exposure related factors for cancer to guide future cancer prevention and control programs. The current study also calls for expansion of cancer registry sites, including in rural areas in the region.

The Burdens of Occupational Heat Exposure-related Symptoms and Contributing Factors Among Workers in Sugarcane Factories in Ethiopia: Heat Stress Wet Bulb Globe Temperature Meter.

Background: Heat stress is a harmful physical hazard in many occupational settings. However, consequences of occupational heat exposure among workers in a sugarcane factory in Ethiopia are not well characterized. This study aimed to assess the level of occupational heat exposure-related symptoms and contributing factors. Methods: In this cross-sectional study, five workstations were selected for temperature measurement. Heat stress levels were measured using a wet-bulb globe temperature index meter. A stratified random sampling technique was used to select 1,524 participants. Heat-related symptoms were assessed using validated questionnaires. Results: The level of occupational heat exposure was 72.4% (95% CI: 70.2%-74.8%), while 71.6% (95% CI: 69.3%-74.9%) of participants experienced at least one symptom related to heat stress. The most common heat-related symptoms were swelling of hands and feet (78%), severe thirst (77.8%) and dry mouth (77.4%). The identified risk factors were a lack of reflective shields (AOR: 2.20, 95% CI: 1.53, 3.17), not-enclosed extreme heat sources (AOR: 1.76, 95% CI: 1.23, 2.51), a lack of access to shade (AOR: 9.62, 95% CI: 6.20, 14.92), and inappropriate protective clothing provision (AOR: 1.58, 95% CI: 1.27, 2.71). Conclusions: The burden of occupational heat exposure and heat-induced symptoms was high. Lack of reflective shields, the absence of enclosed extreme heat sources, a lack of access to shade, and inappropriate protective clothing provision were considerable attributes of heat stress. Therefore, the use of mechanical solutions to stop heat emissions at their sources and the key factors identified were areas for future intervention.