Barriers Towards Obstetric Care Service Utilization in Ethiopia: An Explorative Qualitative Study.

Background: Obstetric care has been at the center of both global and national agendas. More than 50% of pregnant mothers are still preferring to give birth at home with some even after having full antenatal care. However, a few literatures looked at contributing factors for this problem but they are not conclusive and do not consider different sociocultural context of Ethiopia and different health service related barriers. Hence, the aim of this study was to explore barriers to obstetric care service utilization in Ethiopia using the socio-ecological model. Methods: Explorative qualitative study was employed involving key-informant interviews, in-depth interviews, and focus group discussions between October and December 2021; Individual, community, health system, and contextual barriers were explored. Atlas ti. Version 9 was used for analysis. Result: Lack of awareness, unfavorable perception, lack of partner involvement, cultural barrier, shortage of supplies, poor infrastructure, provider-related factors, poor monitoring, and evaluation system, challenging topography, and conflict were the major barriers that hinder mothers from receiving obstetrics service in Ethiopia. Conclusion: Lack of awareness, unfavorable perception, conflict, problems with health system structure and process, and cultural and geographical conditions were major barriers in Ethiopia. Therefore, packages of intervention is important to avail essential equipment, strengthening follow up system, create awareness, and increase access to health facilities is very important for service improvement by the government and non-governmental organizations. Additionally, implementing conflict resolution mechanism is important for addressing better obstetric service.

COVID-19 Infection Prevention Preparedness, Practices and Case Management in the Primary Health Care Units in Ethiopia.

Background: COVID-19 as pandemic declared by WHO on March 11, 2020 and first case detected in Ethiopia on March 13/2020. The COVID-19 caused a global crisis, including millions of lives lost, public health systems in shock and economic and social disruption. Strategies depend on how an existing health system is organized. Even though public health emergency operation centers of the Ethiopia switched to emergency response, there is no national evidence about infection prevention and control. Therefore, this project aimed to assess the level of infection prevention and control and management of COVID- 19 in Ethiopia, 2021. Methods: The cross-sectional study conducted at four regions and one city (Amhara, Oromia, SNNPR, Sidama Region, and Dire Dawa). Being with zonal health departments and woredas health offices, primary health care units were selected. The data were collected electronically through Kobocollect software from November 08-28/2021. Descriptive analysis like frequency and percentage was conducted by SPSS software version 25 and the results were presented by tables, figures and narration. Results: Data were collected from 16 hospitals, 92 health centers, and 344 health posts. All hospitals have designated COVID-19 focal person. There were significant number of woredas and PHCUs who didn't have IPC guidelines and protocols. About 11 woredas had no any type of diagnostic tests for COVID-19. Conclusions: The study revealed that there were significant gaps on Infection prevention and control practice, shortage of personal protective equipment, isolation and specimen transportation problem, lack of call centers. We recommend concerned bodies to fill the identified gaps.

Barriers to Family Planning Service Utilization in Ethiopia: A Qualitative Study.

Background: The unmet need for family planning (FP) is a major impediment to achieving the sustainable development goal The COVID-19 pandemic and other contextual, individual, and hospital-related problems are major barriers that reduce FP service uptake. However, most of the studies are quantitative and give due focus to individual and community-level barriers. Therefore, this study tends to explore barriers to the utilization of FP in Ethiopia including health care and contextual barriers. Methods: A multiple explorative case study design was employed from October to December 2021 and a total of 41 Key-informant interviews, 32 in-depth interviews, and 13 focus group discussions were performed by using the purposive sampling technique. The data were analyzed with a thematic content analysis approach using NVivo software. Result: This study explored barriers to FP in four major teams; individual, community-related, health system, and contextual barriers. It reviled that the community's misconception, fear of side effects, lack of women's decision-making autonomy, existing socio-cultural norms, religious conditions, topography, covid 19 pandemic, and conflict were the major barriers to FP service utilization. Conclusion: Using the four teams mentioned above, this study identified different poor health professional skills, misconceptions, pandemics, functional, and structurally related barriers. As a result, it is recommended that health education for the community and training for health professionals are important. Collaboration between government and non-government organizations is also mandatory for strengthening mentorship and supervision systems and establishing resilient health care that can avoid future pandemics.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic.

Background: The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. Methods: Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. Results: The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. Conclusion: This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Chronic Kidney Disease and Associated Factors among Diabetic Patients at the Diabetic Clinic in a Police Hospital, Addis Ababa.

Background: Diabetes mellitus remains the leading cause of end-stage renal disease in most countries in the world. In Ethiopia, renal complications of diabetes may remain unrecognized due to limited diagnostic resources. As a result, the prevalence of chronic kidney disease among adult diabetics in Ethiopia has not been well described. Hence, this study was aimed at assessing the prevalence of chronic kidney disease and associated factors among diabetic patients who attended the federal police hospital diabetic clinic in Addis Ababa. Methods: A cross-sectional study was conducted among 362 Diabetes Mellitus. Data were collected using face-to-face interviewing questionnaires and analyzed using SPSS version 21.0. Binary logistic regression analyses were performed to identify predictors. Results: The prevalence of chronic kidney disease diagnosed by Cockcroft-Gault equation and Modification of Diet in Renal Disease equation was 14.6% and 7.7% respectively. This finding shows the prevalence of chronic kidney disease among Diabetic patients was low. Age 50-59 years [(AOR= 4.0; 95% CI:(1.2, 13)] by Cockroft-Gault equation (CG), age 60-69 years [(AOR=5.8 95% CI:(1.5,21.0)] by Modification of Diet in Renal Disease (MDRD) and (AOR;22.9 95%CI:7.1,74.2) by CG, age 70 years and above (AOR=4.7; 95 CI: 1.1, 19.7) by MDRD and (AOR= 22.9; 95%CI:7.1,74.2) by CG, BMI (AOR=0.2; 95% CI:0.1,0.4) by CG, and previous kidney disease (AOR=6.2 95%CI:2.0,8.4) by MDRD and (AOR;4.6 95%CI:1.9,10.8) C-G equation have a significant association with chronic kidney disease after an adjustment done. Conclusion: The prevalence of chronic kidney disease among Diabetic patients in this study was lower. Age, BMI, and previous recurrent kidney disease were associated with chronic kidney disease. Preventive measures like giving health education and screening of patients with risk factors should get more attention.

Compliance to antenatal psychosocial assessment practice among midwives: a best practice implementation project.

INTRODUCTION AND AIMS: As directed by the WHO, antenatal care providers have good opportunities to identify and refer mothers who are struggling with psychosocial problems. In Ethiopia, the pooled prevalence of perinatal depression is 25.8%, which is almost two-fold of the pooled global prevalence. Though this is an indication of the need for prompt interventions, there is no assessment targeted to this population. Therefore, the aim of this project was to promote an antenatal psychosocial assessment practice among midwives. METHODS: Using the Joanna Briggs Institute Practical Application of Evidence System, 66 first visit antenatal care assessment opportunities were observed in both baseline and follow-up audit using three audit criteria. Fourteen midwives were interviewed for the first criterion. On the basis of the results, the gaps and barriers were analyzed using Getting Research into Practice strategies. RESULT: The baseline audit result revealed a 0% compliance rate for all evidence-based antenatal psychosocial assessment audit criteria. This scenario disclosed that there had not been psychosocial problem assessment practice at antenatal clinic. However, the postimplementation result showed that an average 91.5% practice of evidence-based antenatal psychosocial assessment was applied as per standards. CONCLUSION: Carrying out discussions on evidence summary with providers, on-the-job training, using local leaders' opinions, and involving relevant stakeholders appeared to be the key methods in improving compliance to best available evidence in antenatal psychosocial assessment.

Anemia among School Adolescents in Haramaya Town, Eastern Ethiopia: Cross-Sectional Study.

BACKGROUND: Anemia is a condition characterized by reduction in the number of red blood cells and/or hemoglobin concentration. It affects 24.8% of the world population. There is little evidence on burden of anemia among adolescents in low income countries like Ethiopia. Thus, this study aimed to assess the magnitude of anemia and factors associated with anemia among school adolescents in eastern Ethiopia. METHODS: School based cross-sectional study was conducted among 493 school adolescents in Haramaya town during February 1 to 28, 2017. Multi stage cluster sampling technique was used. We collected anthropometric data (weight and height) and hemoglobin level of all study participants. The hemoglobin level was adjusted for altitude. Data were entered into EpiData and exported to SPSS version 20 for analysis. Logistic regression model was fitted to identify factors associated with anemia. Level of statistical significance was declared at P < .05. RESULTS: In this study, the prevalence of anemia was 29.4% [95% CI: (25.6, 33.5)]. Being female adolescent (AOR = 2.31, 95 % CI: [1.51, 3.54]), adolescents attending grades 9th to 10th (AOR = 1.66, 95% CI: [1.004, 2.77]), adolescents born to illiterate mothers [AOR = 2.23, 95% CI: (1.02, 4.89)], and low dietary diversity score (AOR = 2.33, 95% CI: [1.12, 4.86]) were factors that increased the likelihood of getting anemia. CONCLUSION: Anemia among school adolescents was a moderate public health problem in the study area. Being female, lower grade levels (9th to 10th), low dietary diversity score and illiterate maternal educational status increased the likelihood of getting anemia. School based Iron/Folic acid supplementation, nutrition education and promotion of diversified foods consumption should be given attention with particular focus on female adolescents.

Women's Decision on Contraceptive Use in Ethiopia: Multinomial Analysis of Evidence From Ethiopian Demographic and Health Survey.

BACKGROUND: Women are left out of the conversation on contraceptive use due to a variety of reasons. One of the reasons women have reported for their nonuse of family planning method is that they do not decide to use or not to use it. This study aimed to assess the women's decision-making on contraceptive use and identify its associated factors. METHODS: Data for this study were extracted from the national representative 2016 Ethiopian Demographic and Health Survey. Data were collected using 2-stage cluster design, in which enumeration areas forming the first stage and households making the second stage. The analysis was done using multinomial logistic regression using STATA software version 14. RESULTS: The study revealed that one-fourth (24.3%) 95% CI (23.7%-25.1%) decision was made by women. The multinomial analysis demonstrated women's decision-making on contraceptive use was influenced by the age of women 15 to 19 years (adjusted odd ratio [AOR] = 0.327, 95% CI: 0.175-0.613), 20 to 24 years (AOR = 0.510, 95% CI: 0.390-0.666), and 25 to 29 (AOR = 0.557 95% CI: 0.460-0.675); place of residence (urban; AOR = 1.637, 95% CI: 1.331-2.015) and region in which the women dwell and husbands education; occupation of both woman and her husband; and number of children ever born were the factors significantly associated with the outcome variable. CONCLUSIONS: Women's decision-making on contraceptive utilization was low. It was influenced by age, place of residence and region, education, occupation, and number of children ever born.

Delay in decision and determinants for safe abortion among women at health facilities in south West Ethiopia: facility based cross sectional study.

BACKGROUND: Delayed safe abortion is the most common cause of gynecologic admission in developing countries. The study, therefore, assessed the delay decision for safe abortion and determinant factors among women at health facilities in South West Ethiopia. METHODS: Facility-based cross-sectional study was conducted among 384 women who were selected from health facilities by using simple random sampling. A pre-tested structured questionnaire was used for data collection. Data were entered into Epidata and exported to SPSS for analysis. Binary Logistic regression was used and Variables with P-value < 0.25 during bivariate analysis were included in the multivariable logistic regression model. Finally, variables with p-value ≤0.05 were judged as a statistically significant association. RESULTS: The magnitude of delay decision for safe abortion services was 70.8% (0.66, 075). Place of residence [AOR 2.44 (95% C.I: (1.39, 4.30)], lack of formal education [AOR: 2.41 (95% C.I:(1.08, 3.59)], level of education [AOR: 2.22 (95% C.I: (1.19, 4.11)], history of previous abortion [AOR: 3.47 (95% C.I: (1.74, 8.6.91)] and late confirmation of pregnancy [AOR: 1.64 (95% C.I: (1.01-2.65)] were the determinant factors for delay in decision for safe abortion. CONCLUSION: This study revealed that the majority of women were delayed for the decision of safe abortion services. Place of residence of the women, lack of formal education, history of previous abortion and late confirmation of pregnancy were the determinant factors for women's decision for safe abortion. Therefore, it is better to work on awareness creation the timing of safe abortion and complication of delay abortion especially for the women from rural area.