Process Evaluation of Community-Based Nutrition Service for Under 2 Years Children in Degadamot District Using Qualitative Approach, Western Ethiopia, 2023.

Malnutrition accounts for 45% of under-5 child morbidities in Ethiopia and is a more common issue in rural communities. In that regard, Ethiopia has implemented a CBN program at the community level to improve the nutrition status of children. Despite this, malnutrition still causes a significant rate of child morbidity and mortality. The implementation status of the CBN program is unknown. Thus, this evaluation aimed to evaluate the children under 2 years in Degadamot district health posts in northwest Ethiopia. A facility-based single-case study design with qualitative-method evaluation was employed from March 28 to April 28, 2023. The evaluation focused on the availability and compliance with multiple data sources. The qualitative data were transcribed, translated, and analyzed using thematic analysis with OPEN CODE version 4.02 software. Finally, the overall program implementation was determined based on predetermined judgmental criteria. According to the predetermined judgment parameter, the overall CBN program implementation level was 62.68%, measured by the availability of resources (71.36%) and compliance of service providers (54.0%). The overall community-based nutrition program implementation in the Degadamot district health post with 2 evaluation dimensions was judged as fair based on the presetting criteria. It is better to improve the service through training HEW and HDA, distributing nutritional supplies, providing regular support, and following up with HEWs for GMP performance in the Degadamot district.

Magnitude of psychological distress and associated factors among war survivor women in Northern, Ethiopia, 2022: a community-based cross-sectional survey.

BACKGROUND: Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. METHODS: A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. RESULT: In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). CONCLUSION: The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.

Intention to leave and associated factors among health professionals working at public hospitals in East Gojjam zone, Northwest Ethiopia, cross-sectional study.

BACKGROUND: The most important element of health systems for meeting the population's healthcare demands is the workforce. The main issue facing the health industry, particularly in emerging nations, has been their shortage and turnover. Thus, the purpose of this study was to assess the intention of leaving and related variables among medical professionals employed at East Gojjam zone public health hospitals. METHODS: An institution based cross-sectional study was conducted among 561 randomly selected health professionals working at public hospitals in East Gojjam Zone from 04 March 2019 to 30 March 2019. Self-administered structured questionnaire was used for data collection. Both bi-variable and multivariable logistic regression analysis were fitted. Variables having P-value less than 0.2 during bi-variable regressional analysis were entered in to multivariable logistic regression analysis and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was used to declare the associated factors with intention to leave. RESULTS: Overall, 61.3% (95% CI: 57.2, 65.4) of health professionals were intended to leave their working organizations. Dissatisfaction with work nature (AOR: 3.01; 95% CI: 2.05, 4.43), work environment (AOR: 1.83, 95% CI: 1.25, 2.68), Remuneration (AOR: 1.89; 95% CI: 1.29, 2.76), having low normative commitment (AOR: 0.55; 95% CI: 0.38, 0.81) and being unmarried (AOR: 1.78; 95% CI: 1.23, 2.58) were satistically significant factors with intention to leave their working organizations. CONCLUSIONS: The health professionals' intention to leave their working organizations was high, three-fifth of the health professionals had intention to leave their organization which might result great service quality compromization and decrease the responsiveness of the health institutions in the study area. Dissatisfaction with remuneration, working environment, work nature, low normative commitment and being unmarried were factors associated with health professional's intention to leave their working organizations. Therefore, hospital administrators, supervisors, and Healthcare policymakers need to emphasize on retention of health workers at their working organization by taking into account the above significant variables. Such as, through creating an attractive working environment and designing better benefit mechanisms.

Process evaluation of the 90-90-90 targets of surge project in Addis Ababa, Ethiopia: a case study evaluation.

BACKGROUND: Human Immunodeficiency Virus (HIV) is a major public health problem that continues to pose an enormous challenge to mankind's survival worldwide. In urban Ethiopia, the HIV prevalence among adults aged 15-49 years is 2.9%, while in Addis Ababa, it is 3.4%. To take the edge off, the Ethiopian government has been implementing the 90-90-90 strategy also known as the surge project, in urban cities. However, the implementation of the program has not been evaluated. Thus, we evaluated the process of the 90-90-90 targets of the surge project in Addis Ababa, Ethiopia. METHODS: We conducted a case study with concurrent mixed-methods evaluation. We used indicator-driven evaluation dimensions -availability and accommodation dimensions from the health services access and compliance and fidelity from implementation fidelity frameworks to test the program process theory with a total of 52 indicators. We interviewed a total of 419 clients and 210 healthcare providers and reviewed 417 clients' cards and 17 registries. We also conducted 30 key informant interviews and resource inventory. A binary logistic regression analysis was done to identify factors associated with clients' satisfaction. We transcribed and translated the qualitative data and analysed thematically. Finally, we judged the overall process of the surge project based on the pre-seated judgmental criteria as; needs urgent improvement, needs improvement and well implemented. RESULTS: We found that 90% of the project process was as per the program process theory measured by the availability of resources (95.8%), compliance (88.0%), fidelity (84.7%), and accommodation of services (89.3%). We found a shortage of human power, test kits, and viral load testing machines. The commitment of health care providers, provider-client interaction, and clients' satisfaction with the service at card rooms were found to be poor. Moreover, being aged 15-24, being married and government government-employed were negatively associated with clients' satisfaction with antiretroviral therapy services. CONCLUSION: The process of the surge project needs improvement. Moreover, the achievements of the first two 90-90 targets were poor. Therefore, implementers need to take intensified action for the availability of resources and to improve the commitment of healthcare providers through refreshment training.

Quality of adolescent and youth-friendly health services in Dehana district public health facilities, northeast Ethiopia: Using the Donabedian quality framework.

INTRODUCTION: Adolescents and youths who need exceptional healthcare are the shapers and leaders of our global future. However, many of them are died prematurely, while others suffer from diseases partly because of the poor quality of health services. Thus, this study aimed to assess the quality of Adolescent and Youth-friendly Health Services (AYFHS) and associated factors in the public health facilities of Dehana district, Northeast Ethiopia. METHODS: A facility-based quantitative cross-sectional study supported with a qualitative component was conducted from February 24 to March 30, 2020. The quality of AYFHS was measured using the Donbidean framework (structure, process and output component). Accordingly, a total of 431 adolescents and youths, five health facilities, twenty-five client-provider interaction observations, and nine key informant interviews were conducted. Binary logistic regression analysis was done, and variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) were used to measure the association. The qualitative data were audio-recorded and transcribed verbatim. Then, Open Code 4.03 software was used to manage and analyze the data. RESULTS: The quality of adolescent and youth-friendly health services was 58.8, 46.4, and 47.2% for structural, process, and output quality dimensions, respectively. The predictor variables for output quality were, being a student (AOR: 2.07, 95%CI: 1.07-3.40), farmers (AOR: 2.59, 95%CI: 1.25-5.39), own income sources (AOR: 1.99, 95%CI: 1.03-3.85), exempted services (AOR: 2.30, 95%CI: 1.43-3.71) and long waiting time (AOR: 3.8495%CI: 1.80-8.23). CONCLUSIONS: The overall quality of adolescent and youth-friendly health services was still lower than the WHO good quality standards. The structural quality dimension was affected by the unavailability of adequate and trained health service providers, poor engagement of adolescents and youths in the facility governance structure, unavailability of guidelines, protocols and procedures. In contrast, the process quality dimension was also compromised due to the provider's poor compliance with the national AYFHS guidelines. Therefore, health facilities need to engage adolescents and youths in the health facility governance structure, and providers should comply with the national guideline.

Low levels of knowledge and practice of occupational hazards among flower farm workers in southwest Shewa zone, Ethiopia: a cross-sectional analysis.

BACKGROUND: Over the last decade, flower farms have been rapidly growing in Ethiopia. Following the advent and development of the sector, various work-related chemical, biological, physical, psychosocial, and ergonomic hazards have been emerging unacceptably, with increased risks of exposures for workers and local communities. However, evidence that describes knowledge and prevention practice of occupational hazards among flower farm workers in the country is little documented. The knowledge and safety practice of occupational hazards among flower farm workers in Ethiopia were explored in the current study. METHODS: A cross-sectional survey of 471 flower farm workers was implemented from March to April 2017. A stratified random sampling technique was used to select the eligible participants. An interviewer-administered questionnaire was used to collect data, and the data were entered in to Epi Info program version 7 and analyzed by SPSS program version 20. Bivariate and multivariate linear regression analyses were performed to evaluate significance of associations at < 0.05 p-values. RESULTS: A total of 451 flower farm workers were interviewed with a response rate of 95.7%. The majority, 72.1% (N = 325) were females. Mean age was 24.1 (SD + 6.5) years. About 39.2% (N = 177) of the participants had good knowledge on occupational hazards. The level of safety practice was 26.6% (N = 120). The level of knowledge on occupational hazards was affected by level of education [AOR: 20.03;95% CI (16.30,23.75)], work experience [AOR: 5.97; 95% CI (4.22,7.72)], and type of employment [AOR: 5.35; 95% CI (2.50,8.19)], whereas the level of safety practice was influenced by regular use of personal protective equipment (PPE) [AOR:17.53;95% CI (13.36,21.71)], level of knowledge [AOR: 7.29; 95% CI (3.87,10.73)], and provision of appropriate PPE [AOR: 4.59; 95% CI (2.34,8.86)]. CONCLUSION: This study revealed the levels of knowledge and safety practice towards occupational hazards were low. The knowledge on occupational hazards was significantly affected by the level of education and duration of employment. Moreover, the use of PPE and level of knowledge considerably influenced safety practice. Therefore, we recommend employers to ensure that workplace health and safety programs account for workers' level of education and work experience. It is also pivotal to provide workers witha suitable PPE and instructions on its use, and to arrange safety communication in the local languages at the relevant workplaces.

Anemia and Associated Factors among Pregnant Women Attending Prenatal Care in Rural Dembia District, North West Ethiopia: A cross-Sectional Study.

Introduction: About 22% of pregnant women are anemic in Ethiopia, but there is a large variation across the country. Hence, the aim of this study identifies the prevalence of anemia and associated factors among pregnant women attending prenatal appointments in Dembia District, northwest Ethiopia.Methods and materials: A facility-based, cross-sectional study was conducted among 713 pregnant women. A multi-stage, stratified sampling technique was used to select the study participants. A structured and pretested questionnaire, laboratory data, and chart review were used to collect data. Bivariate and multivariate logistic regression analyses were used to identify factors associated with anemia in pregnant women.Results: Prevalence of anemia was 32.4% with a majority of these having moderate anemia. Type of health center being rural/urban health center, water sources, days since fasting, 4 weeks of iron supplementation, craving unusual foods, mid-upper arm circumference scores, and decision power were significant predictors of anemia.Conclusion: The present study suggests anemia among pregnant women attending prenatal in Dembia district was high. Working to enhance adherence to iron supplementation and partner involvement for joint decision-making is recommended to avert prenatal anemia. Health-care providers and programmers are advised to pay special attention to rural and fasting pregnant mothers.Abbreviations: AOR: Adjusted Odd Ratio; CMHS: College of medicine and health sciences; CI: Confidence Interval; HFIAS: Household Food Insecurity Access Scale; RCSI: Reduced Coping Strategies Index; Hgb: Hemoglobin; MCMC: Marco Chain Monte Carlo; EPV: Events per variable; BMI: Body Mass Index; PPS: Population proportionate to size sampling; SRS: simple random sampling; DALYS: Disability-adjusted life years; MUAC: Mid-upper-arm-circumference; WHO: World Health Organization; EDHS: Ethiopian Demographic and Health Survey; SPSS: Statistical package for social science; ANC: Ante natal care; PCA: Principal component analysis; MASL: Meter above sea level; g/dl: gram per decilitre HALE: Health Action Leicester Ethiopia; WDDS: Women's Dietary Diversity Scale.

Intentions to leave and associated factors among laboratory professionals working at Amhara National Regional State public hospitals, Ethiopia: an institution-based cross-sectional study.

OBJECTIVE: Laboratory professionals play a vital role in the detection, diagnosis, and treatment of diseases. Knowledge of workplace variables that either motivates staff to keep working or quit their jobs is important for decision making. Thus, this study aimed to assess intentions to leave workplace and associated factors among laboratory professionals working at public hospitals of the Amhara National Regional State, Ethiopia. RESULTS: An institution-based cross-sectional study was conducted from February 16 to March 14, 2016, among 336 randomly selected laboratory professionals. The study revealed that 65.5% (95% CI 60-70) of professionals had intentions to leave their hospitals. Dissatisfaction with the provision of educational opportunities (AOR: 3.59, 95% CI 1.61-7.99), poor pays and benefits (AOR: 3.89, 95% CI 1.53-9.89), lack of recognition (AOR: 2.69, 95% CI 1.35-5.38), poor working environments (AOR: 2.77, 95% CI 1.45-3.30), high workload (AOR: 1.94, 95% CI 1.04-3.63), low affective commitment (AOR: 2.05, 95% CI 1.10-3.82), and being unmarried (AOR: 2.46, 95% CI 1.32-4.58) were factors significantly associated with intentions to leave. Magnitude of laboratory professionals' intention to leave was so high. Healthcare policymakers and hospital managers need to develop and institutionalize evidence-based retention strategies to reduce the intention of laboratory professionals to leave their workplace.

Self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia: a cross-sectional study.

OBJECTIVE: Self-medication practice is the selection and use of medicines by individuals or a member of the individual's family without physician's order to treat self-recognized or self-diagnosed conditions. It is highly prone to inappropriate use and wastage of resources, increase drug resistance pathogens and adverse reactions. Therefore, this study aimed to assess self-medication practices and associated factors among households at Gondar town, Northwest Ethiopia. RESULTS: This community based cross-sectional study was conducted among households at Gondar town from March to June, 2018. The overall prevalence of self-medication practices among households at Gondar town were 50.2%. The odds of self-medication practices among unmarried participants (AOR = 3.12; 95% CI 2.35, 5.34), influenced by peer (AOR = 3.58; 95% CI 2.89, 7.28), poor perceived quality of health care services (AOR = 4.67; 95% CI 2.56, 7.96) and access to pharmacy (AOR = 2.32; 95% CI 1.65, 6.76) were higher compared with their counterparts. In the contrary, the lesser odd was observed among knowledgeable participants about medications (AOR = 0.27; 95% CI 0.16, 0.39) compared with non-knowledgeable. Therefore, improving perception of participants about quality of services, conducting awareness creation and managing negative effects of peer may reduce self-medication practices.

Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia.

OBJECTIVE: To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia. METHODS: Across-sectional study was conducted. A total of 652 households consented to participate in the study (326 insured and 326 uninsured households). Propensity score matching was used to explain possible differences in the baseline variables between enrolled and un-enrolled households. Logistic regression analysis was used to identify factors for healthcare utilization. RESULTS: Healthcare utilization among insured households was 50.5% (95% CI: 44.8%, 56.2%). Whilst among uninsured households, healthcare utilization was 29.3% (95% CI: 24.11, 34.47). In general, the overall healthcare utilization was 39.89% (95% CI: 35.7, 43.8). The overall increase in patient-attendance given illness among insured households was 25.2% higher compared with uninsured (t = 4.94, 95% CI: 0.145, 0.359). Educated (primary and above) (AOR = 1.84; 95% CI: 1.14, 2.98), chronic patient (AOR = 1.86; 95% CI: 1.13, 3.06), first choice was health facilities at the point of illness (AOR = 6.33; 95% CI: 2.97-13.51), rich (AOR = 2.1; 95%CI: 1.29, 3.43), and insured (AOR = 2.16; 95% CI: 1.45, 3.23) were independently associated with increased healthcare utilization. CONCLUSION: Enrolment to mutual health insurance increases healthcare utilization. Presence of illness in the households, household earnings, educational status, first choice of treatment at point of illness, and membership to Mutual Health Insurance scheme should be targeted during escalating of healthcare utilization.

Correlates of early neonatal feeding practice in Dabat HDSS site, northwest Ethiopia.

BACKGROUND: Delaying the start of breastfeeding and giving prelacteal feeding leads to a significant increase in neonatal and infant deaths, particularly in a resource limited countries, like Ethiopia. Therefore, this study aimed to assess early neonatal feeding practice and its determinants in Dabat HDSS site, northwest Ethiopia. METHODS: The census for the reconciliation of the surveillance of the Dabat Health and Demographic Surveillance System (HDSS) site was conducted from October to December 2014. Data were entered into the Household Registration System (HRS) version 2.1 and analyzed using Stata version 14. A total of 6,761 mother-child pairs were included in the study. Sociodemographic factors, maternal health care and early neonatal feeding practices (early initiation of breastfeeding and prelacteal feeding) were collected by interviewing the mothers. The prevalence of early/timely initiation of breastfeeding was computed as the ratio of children put to the breast within one hour of delivery to the total number of children. Prelacteal feeding was defined as giving anything to drink other than breast milk in the first three days following birth. Binary logistic regression models were used to identify variables which were associated with the dependent variable. A multivariable logistic regression analysis was carried out to identify factors associated with early initiation of breastfeeding. RESULTS: The prevalence of early initiation of breastfeeding was 43.9% (95% CI, 41.6, 46.2). More than half (56%) of the mothers gave prelacteal feeds. An urban residence (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval [CI] 1.25. 1.73) and antenatal care (AOR 1.41, 95% CI 1.24, 1.59) were correlated with early initiation of breastfeeding. Similarly, increased odds of timely initiation of breastfeeding were observed among mothers who didn't give prelacteal feeds (AOR 5.72; 95% CI, 5.12, 6.40). CONCLUSION: Delayed initiation of breastfeeding and prelacteal feeding still remain public health concerns in this community. The promotion of improved infant and young child feeding (IYCF) practices and the utilization of antenatal care services should be intensified.