What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study.

OBJECTIVE: Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020. SETTING: This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance. RESULTS: A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42). CONCLUSION: Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.

Acceptability of peer learning and education approach on malaria prevention (PLEA-malaria) through primary schools communities in rural Ethiopia: peer educators' perspectives.

BACKGROUND: Evidence on peer educators' experiences of implementing the school-based educational interventions on malaria prevention would be used as inputs for malaria eliminating efforts. This study explored the acceptability of the school-based peer-learning and education approach on malaria prevention (PLEA-malaria) among peer educators in Ethiopia. METHODS: This process evaluation study was aimed to examine the success of the school-based PLEA-malaria that was implemented in 75 primary schools in Jimma from 2017 to 2019. A mixed research method was employed to collect post-intervention data from 404 peer educators and key stakeholders. Data were collected using a structured questionnaire and interview guide. Multivariable linear regression modelling was performed using SPSS software version 26.0. Atlas ti 7.5 for windows was used to analyse the qualitative data. The result was presented by triangulating the findings of the qualitative and quantitative methods. RESULTS: The mean score (M, range = R) of acceptability of PLEA-malaria was (M = 20.20, R = 6-30). The regression modelling showed that age; (ß = 0.264, 95% CI 0.266 to 0.632), GPA; (ß = 0.106, 95% CI 0.008 to 0.074), parental readiness for malaria education; (ß = 0.184, 95% CI 0.711 to 2.130), frequency of peer education; (ß = 0.232, 95% CI 1.087 to 2.514) and team spirit; (ß = 0.141, 95% CI 0.027 to 0.177) were positively associated with the acceptability while this relationship was negative for the number of ITN in the household; (ß = - 0.111, 95% CI - 1.182 to -0.13) and frequency of parent-student communication; (ß = - 0.149, 95% CI - 1.201 to - 0.293). The qualitative study identified facilitators of PLEA-malaria (e.g. team formation process, outcome efficacy, presence of schools' structures, schools priority, and support) and barriers (e.g. low commitments, threat appraisal, response efficacy, and PLEA-malaria implementation gaps). CONCLUSION: The results suggested that the acceptability of the school-based PLEA-malaria was higher implying the strategy is promising in promoting malaria prevention in primary schools. Considering factors related to personal, access to malaria preventive services, school system, and social support in education and behaviour change interventions would be important to improve the acceptability. The relationship about how an improvement in the level of acceptability would in turn influences malaria preventive behaviours among the students should be investigated.

Why are Youth Engaged in Substance Use? A Qualitative Study Exploring Substance Use and Risk Factors Among the Youth of Jimma Town, Southwest Ethiopia.

INTRODUCTION: Substance use refers to the use of psychoactive substances such as khat, alcohol, cigarettes, and illicit drugs. Young people are more vulnerable to substance use than older people. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health concern among the youth of Ethiopia, mainly in Jimma town. Therefore, this study aimed to explore the substance use and risk factors among the youth of Jimma town in 2019. METHODS: The study was conducted in Jimma town among youth who were engaged in substance use, from March to April 2019. A descriptive qualitative study design was employed and the study participants were acquired using purposive/judgmental sampling techniques. In total, 20 interviews were conducted with young people using in-depth and key informant interview methods. The data were analyzed by using ATLAS.ti version 7. Thematic analyses were performed in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings. RESULTS: The findings of this study were discussed under six themes and 12 categories, which emerged from thematic analysis of the data: substance use setting, time and means of distribution, substance-related factors, social and economic factors, individual factors, psychological factors, and legal and policy factors. CONCLUSION: The study indicated that khat, alcohol, cigarettes and shisha or water pipes were the most commonly used substances. Different factors that drive the youth to engage in substance use were identified; individual factors, social and economic factors, substance-related factors, and legal and policy factors were most common. Generally, to overcome this problem, the community, lawyers, and policemen should participate in the implementation and enforcement of rules and regulations on substance use. Family should monitor their children and need to act as good role models by avoiding substance use.

Ethiopian community health workers' beliefs and attitudes towards children with autism: Impact of a brief training intervention.

There is a severe shortage of services for children with autism in Ethiopia; access to services is further impeded by negative beliefs and stigmatising attitudes towards affected children and their families. To increase access to services, care provision is decentralised through task-shifted care by community health extension workers. This study aimed to examine the impact of a brief training (Health Education and Training; HEAT) for Ethiopian rural health extension workers and comprised three groups: (1) health extension workers who completed a basic mental health training module (HEAT group, N = 104); (2) health extension workers who received enhanced training, comprising basic HEAT as well as video-based training on developmental disorders and a mental health pocket guide (HEAT+ group, N = 97); and (3) health extension workers untrained in mental health (N = 108). All participants completed a questionnaire assessing beliefs and social distance towards children with autism. Both the HEAT and HEAT+ group showed fewer negative beliefs and decreased social distance towards children with autism compared to the untrained health extension worker group, with the HEAT+ group outperforming the HEAT group. However, HEAT+ trained health extension workers were less likely to have positive expectations about children with autism than untrained health extension workers. These findings have relevance for task-sharing and scale up of autism services in low-resource settings worldwide.

Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: a mixed methods study.

BACKGROUND: Community health workers can help to address the substantial unmet need for child mental health care in low and middle income countries. However, little is known about their training needs for this potential role. The aim of this study was to examine training needs and perspectives of community health extension workers (HEWs) in relation to providing child mental health care in rural Ethiopia. METHODS: The study was conducted in the Southern Nations, Nationalities and Peoples' Region of Ethiopia. A mixed methods approach was used. A total of 104 HEWs who had received training in child mental health using the Health Education and Training (HEAT) curriculum were interviewed using a structured survey. In-depth interviews were then conducted with 11 HEWs purposively selected on the basis of the administrative zone they had come from. A framework approach was used for qualitative data analysis. RESULTS: Most of the HEWs (88.5%; n = 93/104) reported that they were interested in the training provided and all respondents considered child mental health to be important. The perceived benefits of training included improved knowledge (n = 52), case identification (n = 14) and service provision (n = 22). While most of the participants had their training four months prior to the interview, over a third of them (35.6%; n = 37) had already organized mental health awareness-raising meetings. Participants in the qualitative interviews considered the problem of child mental disorders to be widespread and to cause a large burden to the family and the affected children. They reported that improving their competence and knowledge was important to address the problem and to tackle stigma and discrimination. Participants also listed some barriers for service provision, including lack of competence, stigma and institutional constraints. Opportunities mentioned included staff commitment, high levels of interest and a positive attitude towards providing the service. CONCLUSIONS: Although the HEAT training on child mental health was brief, it appears to have had some impact in improving knowledge and care provision. If the key barriers to service provision are addressed and supported by policy guidance, community health workers may contribute substantially in addressing the treatment gap for children with mental health needs.

Incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital, Ethiopia.

INTRODUCTION: Worldwide approximately 2.7 million are stillborn, more than 98% of these occur in developing countries. To address the problem, incidence and determinants of stillbirth must be understood. Therefore the aim of this study was to assess incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital. METHODS: A cross-sectional study design among 413 mothers who gave birth in Jimma specialized hospital was employed. Study subjects were selected by systematic sampling technique from the list of women who gave birth in hospital in one month study period. Data were collected by using pretested and structured questionnaire. Data were edited, cleaned, coded, entered and analyzed using SPSS-20 statistical software. Univarate and bivariate (logistic regressions) analysis was employed. RESULTS: The incidence rate of stillbirth in the Hospital during a month period was 8% or 80 per 1000 total births. The predictors that showed an independent close association with stillbirth were absence of complication (OR = 0.1, 95% CI (0.04-0.2)), referral from other health facility (OR = 0.3, 95% CI (0.1-0.7)), having antenatal care (OR = 0.3, 95% CI (0.1-0.7)) and normal vaginal delivery (OR = 0.2, 95% CI ( 0.1-0.8)). CONCLUSION: The incidence rate of stillbirths in our setting is high and the identified determinants were related to both ante-partum and intra-partum-period. Therefore, effort should be made to improve antenatal, obstetric services and delivery services in terms awareness, access, timing and referral system to emergency care and specialized service to reduce the number of stillbirths.

Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey.

BACKGROUND: Understanding the perspectives of caregivers of children with developmental disorders living in low-income countries is important to inform intervention programmes. The purpose of this study was to examine the stigma experiences, explanatory models, unmet needs, preferred interventions and coping mechanisms of caregivers of children with developmental disorders in Ethiopia. METHODS: Participants comprised caregivers (n = 102) of children with developmental disorders attending two child mental health clinics in Addis Ababa. The majority (66.7%; n = 68) had a diagnosis of intellectual disability (ID); 34 children (33.3%) had autism spectrum disorder (ASD) as their primary diagnosis. All caregivers were administered a structured questionnaire via a face-to-face interview, which included an adaptation of the Family Interview Schedule, closed questions about socio-demographic characteristics, explanatory models of illness, type of interventions used or desired and coping strategies, and an open ended question regarding the family's unmet needs. RESULTS: Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child's condition and 26.7% made an effort to keep their child's condition secret. Stigma did not depend on the type of developmental disorder, the child's age or gender, or on the age or level of education of the caregiver (all p > 0.05). Reported stigma was significantly higher in caregivers who had sought traditional help (p < 0.01), provided supernatural explanations for their child's condition (p = .02) and in caregivers of Orthodox Christian faith (p = .03). Caregivers gave a mixture of biomedical explanations (e.g. head injury (30.4%) or birth complications (25.5%)) and supernatural explanations (e.g. spirit possession (40.2%) or sinful act (27.5%)) for their child's condition. The biggest reported unmet need was educational provision for their child (74.5%), followed by treatment by a health professional (47.1%), financial support (30.4%) and expert help to support their child's development (27.5%). Most caregivers reported that talking to health professionals (86.3%) and family (85.3%) helped them to cope. Many caregivers also used support from friends (76.5%) and prayer (57.8%) as coping mechanisms. CONCLUSIONS: This study highlights the stigma experienced by families caring for a child with a developmental disorder. Designing interventions appropriate for low-income settings that improve awareness about developmental disorders, decrease stigma, improve access to appropriate education and strengthen caregivers' support are needed.

Effect of community based behavioural change communication intervention to improve neonatal mortality in developing countries: A Systematic Review.

EXECUTIVE SUMMARY: Background A great burden of infant and under-five childhood mortality occurs during the neonatal period, usually within a few days of birth. Community based behavioural change communication (such as interpersonal, group and mass media channels, including participatory methods at community level) intervention trials have been shown to be effective in reducing this mortality. However, to guide policy makers and programme planners, there is a need to systematically appraise and synthesise this evidence.Objective To systematically search, appraise and synthesise the best available evidence on the effect of community based behavioural change communication intervention to improve neonatal mortality in developing countries.Inclusion Criteria This review considered randomised controlled community trials on the effectiveness of community based behavioural change communication interventions aimed at decreasing neonatal mortality that were conducted in developing countries.Search Strategy This review considered English language articles on studies published between December, 2006 to January, 2011 and indexed in PubMed, CINAHL, EMBASE, Mednar, popline, Proquest, or Hinari.Methodological quality Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument by two independent reviewers. Data were analysed using a fixed effects model with RevMan5 software. RESULTS: Community based behavioural change communication interventions were found to be associated with a significant reduction in neonatal mortality of 19% (average OR 0.81; 95%CI 0. to 0.88), early neonatal mortality by 20% (average 0.80; 95%CI 0. to 0.91), late neonatal mortality by 21% (average 0.79; 95%CI 0. to 0.99). In addition, the intervention also resulted in significant improvement of newborn care practice; breast feeding initiation, clean cord cutting and delay in bathing were improved by 185%, 110% and 196% respectively.Conclusions Community-based behavioural change communication interventions such as health education, information education and communication, behavioural change communication, social mobilisation, community mobilisation, community conversation, and home based counselling were found to be associated with a significant reduction in neonatal mortality, early neonatal mortality and post neonatal mortality. The findings of this systematic review call for integration of such interventions into conventional strategies in developing countries.Implications for practice This systematic review has shown that community based behavioural change communication interventions that are implemented through community health volunteers and other community based health workers, targeted at pregnant women and also involving influential people such as mothers-in-law, fathers-in-law and husbands/partners, consistently demonstrated that community based intervention packages significantly reduced early neonatal, late neonatal and neonatal mortality rates and also have a pivotal role in improving household newborn care practice. Thus, this review provides encouraging evidence of the value of integrating newborn care and neonatal mortality reduction strategies into community based approaches.Implications for research The review findings were largely derived from a limited number of community trials from developing regions, particularly the African setting. Thus, there is a clear need for additional research on a larger scale and in more varied settings. There is also a need for more evidence based on higher quality research. The cost effectiveness of these community based interventions may impact on their adoption; however it was outside the scope of this review. Cost-effectiveness of these interventions should become a priority area for future research.

Knowledge, attitude and practice of emergency contraceptives among adama university female students.

BACKGROUND: Unwanted pregnancy followed by unsafe abortion is one of the major worldwide health problems, which has many negative consequences on the health and well-being of women. Information about women's knowledge, attitude and practice of emergency contraceptives plays a major role in the reduction of unwanted pregnancy; however, there are no studies about this issue in the study area. This study assessed Adama University female students' knowledge, attitude and practice of emergency contraceptives. METHOD: A cross-sectional study design was employed from February 1 to 30/2009, on 660 regular undergraduate female students of Adama University. Data were entered and analyzed using SPSS for windows version 16.0. Logistic regression was used to identify the association between variables and emergency contraceptive knowledge, attitude and practice. P-value less than 0.05 at 95% CI was taken for statistical significance. RESULTS: Of the total, 660 respondents, 194(29.4%) were sexually active, 63(9.4%) had history of pregnancy and 49(7.4%) had history of abortion. About 309 (46.8%) of the students had heard about emergency contraceptives and from those who heard emergency contraceptives, 27.2% had good knowledge. Majority, four hundred fifteen (62.9%) of the students had positive attitude towards it. However, only 31(4.7%) had used emergency contraceptive methods. CONCLUSION: This study demonstrated lack of awareness, knowledge and utilization of emergency contraceptives among Adama University female students. Hence behavioral change strategies should be considered by responsible bodies to improve knowledge and bring attitudinal change on use of emergency contraception.

Biting behavior and Plasmodium infection rates of Anopheles arabiensis from Sille, Ethiopia.

The man-biting behavior and Plasmodium infection rates of anopheline mosquitoes were investigated in Sille, a hyperendemic malarious area in southern Ethiopia. Seven Anopheles species were identified from all night landing collections, conducted from 18:00 to 06:00h between October 2001 and August 2002. The predominant species was Anopheles arabiensis (55.8%), followed by Anopheles coustani (31.5%), Anopheles pharoensis (9.5%), Anopheles funestus (2.2%), Anopheles nili (0.5%), Anopheles marshallii (0.4%) and Anopheles demeilloni (0.2%). Dissection of A. arabiensis showed an average parous rate of 73.2%. A large proportion of the parous mosquitoes were caught biting in the latter part of the night. Malaria sporozoite rates were determined by ELISA for A. arabiensis, with 0.5% (4/796) infective with Plasmodium falciparum and 1.76% (14/796) with Plasmodium vivax; there were no mixed infections. From our small sample of sporozoite positives we found no association between biting behavior and sporozoite infection status.