Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

BACKGROUND: In Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: A health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes. RESULTS: In this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20-34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births. CONCLUSION: Adverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.

Implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital, Northwest Ethiopia.

BACKGROUND: Healthcare-Acquired Infections are a major problem in the world and within the healthcare delivery system. An estimated 5-10% and around 25% of hospitalized patients have healthcare-acquired infections in developed and developing countries, respectively. Infection prevention and control programs have proven to be successful in lowering the incidence and spread of infections. Thus, this evaluation aims to evaluate the implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital in Northwest Ethiopia. METHODS: A facility-based cross-sectional design with a concurrent mixed method was used to evaluate the implementation fidelity of infection prevention practices. A total of 36 indicators were used to measure adherence, participant responsiveness, and facilitation strategy dimensions. A total of 423 clients were administered for an interview, an inventory checklist, a document review, 35 non-participatory observations, and 11 key informant interviews were conducted. A multivariable logistic regression analysis was used to identify factors significantly associated with the satisfaction of clients. The findings were presented using descriptions, tables, and graphs. RESULT: The overall implementation fidelity of the infection prevention practices was 61.8%. The dimensions of adherence to infection prevention and control guidelines were 71.4%, participant responsiveness was 60.6%, and facilitation strategy was 48%. In multivariable analysis, ward admission and educational level had a p-value of below 0.05 and were significantly associated with the satisfaction of clients with infection prevention practices at the hospital. The major themes that emerged in qualitative data analysis were healthcare worker-related factors, management-related factors, and patient- and visitor-related factors. CONCLUSION: The evaluation result of this study concluded that the overall implementation fidelity of infection prevention practice was judged to be medium and needed improvement. It included dimensions of adherence and participant responsiveness that were rated as medium, as well as a facilitation strategy that was rated as low. Enablers and barriers were thematized into factors related to healthcare providers, management, institutions, and patient and visitor relations.

Organizational commitment and associated factors among health professionals working in public hospitals of southwestern Oromia, Ethiopia.

INTRODUCTION: Organizational commitment refers to the extent to which employees identify with and are involved with a given organization. It is an important variable for healthcare organizations to consider since it acts as a predictor of job satisfaction, organizational efficiency and effectiveness, health professionals' absenteeism, and turnover. However, there is a knowledge gap in the health sector about workplace factors that are associated with healthcare provider commitment to their organization. Thus, this study aimed to assess organizational commitment and associated factors among health professionals working in public hospitals in the southwestern Oromia region, Ethiopia. METHODS: A facility-based analytical cross-sectional study was conducted from March 30 to April 30, 2021. A multistage sampling technique was employed to select 545 health professionals from public health facilities. Data were collected using a structured self-administered questionnaire. simple and multiple linear regression analyses were employed to assess the association between organizational commitment and explanatory variables after checking the assumptions of factor analysis and linear regression. The statistical significance was declared at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI). RESULTS: Health professionals' organizational commitment percentage mean score was 48.8% (95% CI: 47.39, 50.24). A higher level of organizational commitment was associated to satisfaction with recognition, work climate, supervisor support, and workload. Besides, good practice of transformational and transactional leadership styles and employee empowerment are significantly associated with high organizational commitment. CONCLUSION: The overall level of organizational commitment is a bit low. To improve the organizational commitment of health professionals, hospital managers, and healthcare policy-makers need to develop and institutionalize evidence-based satisfaction strategies, practice good leadership styles and empower healthcare providers on the job.

Maternal satisfaction on quality of childhood vaccination services and its associated factors at public health centers in Addis Ababa, Ethiopia.

BACKGROUND: Vaccination is one of the most important public health interventions to reduce child mortality and morbidity. In Ethiopia, about 472,000 children die each year by vaccine-preventable diseases. A satisfied mother is assumed to use the services and complies with the service provider for better health care outcomes. However, there was no adequate evidence regarding maternal satisfaction with quality of childhood vaccination services. This study aimed to assess maternal satisfaction on quality of childhood vaccination services and its associated factors at public health centers in Addis Ababa, Ethiopia. METHODS: A facility-based cross-sectional study was conducted from 12 July to 12 August 2021 at public health centers in Addis Ababa, Ethiopia. A total of 366 mothers (caretakers) of under one-year-old children participated in the study. A systematic sampling technique with an interviewer-administered questionnaire and inventory checklist were used to collect the data. A binary logistic regression model was fitted. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were used to identify the factors associated with the outcome. RESULTS: Nearly two-thirds (61.2%) of mothers (caretakers) were satisfied with the quality of childhood vaccination services. Service providers' greeting [AOR = 1.60; 95%CI: 1.37-1.99] and information about the types of vaccines [AOR = 1.54; 95%CI: 1.32-1.89] were positively associated with maternal satisfaction. On the contrary, long waiting time of mothers (caretakers) to receive services [AOR = 0.29; 95%CI: 0.14-0.62] was negatively associated with services. CONCLUSION: The overall maternal satisfaction towards the quality of childhood vaccination services in this study was found to be low. Minimizing waiting time at the health facility, enhancing greetings and providing adequate information regarding childhood vaccination for mothers (caretakers) improved their satisfaction with the services.

Work engagement among health professionals in public health facilities of Bench-Sheko zone, southwest Ethiopia.

BACKGROUND: The level of health professional work engagement affects retention, burnout, job satisfaction, patient satisfaction, and outcomes; however, there is a paucity of evidence that benefit health professional work engagement. Therefore, this study aimed to assess work engagement and associated factors among health professionals at public health facilities in the Bench-Sheko zone in southwest Ethiopia. METHODS: Facility-based cross-sectional study was conducted among 605 health professionals from 29 March to 29 April 2021. A simple random sampling technique was used to select the participants. Data were collected using a self-administered questionnaire. Linear regression was fitted and those variables with p-value < 0.2 in simple linear regression were entered into multiple linear regression analysis. Unstandardized ß-coefficient with 95% CI and p-value < 0.05 were used as the cut of points to determine the factors associated with work engagement. RESULTS: Mean score percentage of work engagement was 71.8%. Health center staff (ß = 0.31; 95% CI: 0.22, 0.40), married professionals (ß = 0.10; 95% CI: 0.005, 0.17), co-worker support (ß = 0.06; 95% CI: 0.004, 0.11), role clarity (ß = 0.14; 95% CI: 0.07, 0.21), reward (ß = 0.10; 95% CI: 0.05, 0.15), resilience (ß = 0.14 95%; CI: 0.07, 0.21), self-efficacy (ß = 0.24; 95% CI: 0.16, 0.31) and optimism (ß = 0.20; 95% CI: 0.15, 0.26) were positively associated with work engagement. On the contrary, cognitive demand (ß= -0.06; 95% CI: -0.11, -0.01) was negatively associated with work engagement. CONCLUSION: In this study, health professionals had a moderate level of work engagement. Health facilities shall improve their culture of co-worker support, role clarity, reward, resilience, self-efficacy, and optimism to enhance work engagement. Future researchers shall be done further studies to evaluate the relationship between cognitive demand and work engagement among health professionals.

Comprehensive emergency management of obstetric and newborn care program implementation at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021: an evaluation study.

BACKGROUND: Maternal healthcare service is the care given for the woman during her gestation, delivery and postpartum period. The Maternal Mortality Ratio (MMR) was remains high and a public health problem in Ethiopia. Sub-Saharan African (SSA) countries account two-thirds of the global total maternal deaths. To curb such high burden related with child births, comprehensive emergency obstetric care is designed as one of the strategies for maternal healthcare services. However, its implementation status was not well investigated. This study aims to evaluate the implementation of comprehensive emergency obstetric and new born care program in terms of Availability, compliance and acceptability dimensions at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: A single case study design was employed from 01 to 30 April 2021. A total of 265 mothers who gave birth at University of Gondar Comprehensive Specialized Hospital (UoGCSH) during the data collection period for acceptability, 13 key informant interviews (KIIs), 49 non-participatory observations (25 observations during C/S performance and 24 assisted spontaneous vaginal deliver) and 320 retrospective document review were conducted. Availability, compliance and acceptability dimensions were evaluated using 32 indicators. Binary logistic regression model was fitted to identify factors associated with acceptability of the services. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were also used to identify associated variables with acceptability. The qualitative data were recorded using tape recorder, transcribed in Amharic and translated to English language. Thematic analysis was done to supplement the quantitative findings. RESULTS: The overall implementation of comprehensive emergency obstetric and newborn care (CEmONC) was 81.6%. Moreover, acceptability, availability and care provider's compliance with the guideline accounted 81, 88.9 and 74.8%, respectively. There were stocked-out of some essential drugs, such as methyldopa, nifidipine, gentamycin and vitamin K injection. CEmONC training gaps, inadequate number of autoclaves, shortage of water supply and long-distance delivery ward to laboratory unit were also the barriers for the CEmONC service. Short waiting time of clients (AOR = 2.40; 95%CI: 1.16, 4.90) and maternal educational level (AOR = 5.50, 95%CI: 1.95, 15.60) were positively associated with acceptability of CEmONC services. CONCLUSION: The implementation status of CEmONC program was good as per our judgment parameter. Compliance of healthcare providers with the guideline was fair and needed improvement. Essential emergency drugs, equipment and supplies were stocked-out. The University of Gondar Comprehensive Specialized Hospital was therefore had better to give great emphasis to expand maternity rooms/ units. The hospital had better to avail the resources and provide continuous capacity building for healthcare providers to enhance the program implementation.

Maternal healthcare service is the care given for the woman during her gestation, delivery and postpartum period. The Maternal Mortality Ratio (MMR) was remains high and a public health problem in Ethiopia. Sub-Saharan African (SSA) countries account two-thirds of the total global maternal deaths. To curb such high burden related with child births, comprehensive emergency management obstetric and newborn care is designed as one of the strategies for maternal healthcare services. The implementation status of CEmONC program service at University of Gondar comprehensive specialized hospital was good as per the preset judgment parameter. Unavailability of resources such as delivery couch, operational table, maternity and labor ward beds, glove, gauze, blood, vital sign instruments, and essential drugs including methyldopa, nifidipine, gentamycin, and vitamin K were stocked out and the challenges to provide CEmONC services. Healthcare providers' compliance with the implementation protocol were also fairly affected. Moreover, acceptability CEmONC service was also judged as good as per the judgmental evaluation parameter. Hospital had better to fulfil the necessary equipment and drugs to enhance the implementation status of the hospitals. Capacity building of healthcare providers might also a better strategy to improve the compliance. Strengthening awareness creation for women and their husbands had a paramount importance to enhance the acceptability of the services.

Evaluation of the outpatient therapeutic program for severe acute malnourished children aged 6-59 months implementation in Dehana District, Northern Ethiopia: a mixed-methods evaluation.

BACKGROUND: In Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia.  METHODS: A facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children's (diagnosed with acute malnutrition) record reviews, nine key informants' interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done. RESULTS: The overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09-0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04-4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01-3.30) were significantly associated with the acceptability of OTP program. CONCLUSION: The overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management.

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis.

BACKGROUND: High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia. METHODS: We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing. RESULTS: A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia's health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments. CONCLUSION: Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

Healthcare leadership effectiveness among managers in Public Health institutions of Addis Ababa, Central Ethiopia: a mixed methods study.

BACKGROUND: Leadership is the ability to influence the attitudes, beliefs, and abilities of employees to achieve organisational goals. It is crucial for the successes or failures of organisational performance. Healthcare organizations need effective leadership to manage the health service delivery reforms efficiently and effectively. However, there was no adequate evidence on the current status of the healthcare leaders to make evidence-based decisions. Therefore, this study aims to assess the effectiveness of healthcare leadership and associated factors among managers working at public health institutions in Addis Ababa, Ethiopia. METHODS: Institution-based cross-sectional study triangulated with the qualitative study was employed from 01 April to 01 June 2021. A total sample of 844 healthcare managers were used to assess their leadership effectiveness. Multi-stage sampling followed by a simple random sampling technique was used to select the participants. Binary logistic regression model was fitted to identify the factors associated with healthcare leadership effectiveness. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 during multivariable logistic regression were used to declare the factors associated with the outcome variable. We conducted key informant interviews (KIIs) to explore the views of healthcare managers on their leadership practices, mainly on vision creation, developing followership and implementing vision. We also tape-recorded the KIIs and then transcribed word by word and finally translated it into English. We conducted a thematic analysis to supplement the quantitative findings. RESULTS: In this study, 46.8% (95% CI: 43.4 -50.2) of the participants had effective healthcare leadership practices. Emotional intelligence (AOR = 7.86; 95% CI; 4.56, 13.56), democratic managers (AOR = 4.01, 95% CI; 1.98, 8.14), master or above education (AOR = 5.1; 95% CI; 2.07, 12.61) and work experience (AOR = 3.44, 95% CI; 1.24, 9.55) were positively associated with healthcare effective leadership. The challenges in healthcare leadership were mainly associated with lack of leadership knowledge and skills. In addition, autocratic leaders negatively influenced managers ability to work closely with the staffs and affected employee's motivation. On the contrary, emotionally intelligent managers were effective on employee handling, providing chance to talk, understanding their feelings and needs. CONCLUSION: Healthcare managers had low capacity on vision creation, implementation and developing followership, particularly the ability of vision creation was very low. Lack of leadership knowledge and skills and frequent use of autocratic leadership were the challenges for healthcare leadership effectiveness. This could also negatively influence organisational performances, managers' ability to work closely with the staffs and reduced employee's motivation. Therefore, strengthening emotional intelligence and empowering managers will be very helpful to improve leading health cares.

Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature.

BACKGROUND: The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security. METHODS: We conducted a structured narrative review of studies published through 28 July 2021. We searched the existing literature using three databases: PubMed, Scopus and Web of Science. Search terms included three themes: HSG, UHC and health security. We synthesized the findings using the five core functions of HSG: policy formulation and strategic plans; intelligence; regulation; collaboration and coalition; and accountability. RESULTS: A total of 58 articles were included in the final review. We identified that context-specific health policy and health financing modalities helped to speed up the progress towards UHC and health security. Robust health intelligence, intersectoral collaboration and coalition were also essential to combat the pandemic and ensure the delivery of essential health services. On the contrary, execution of a one-size-fits-all HSG approach, lack of healthcare funding, corruption, inadequate health workforce, and weak regulatory and health government policies were major challenges to achieving UHC and health security. CONCLUSIONS: Countries, individually and collectively, need strong HSG to speed up the progress towards UHC and health security. Decentralization of health services to grass root levels, support of stakeholders, fair contribution and distribution of resources are essential to support the implementation of programmes towards UHC and health security. It is also vital to ensure independent regulatory accreditation of organizations in the health system and to integrate quality- and equity-related health service indicators into the national social protection monitoring and evaluation system; these will speed up the progress towards UHC and health security.

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia.

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

Complete vaccination service utilization inequalities among children aged 12-23 months in Ethiopia: a multivariate decomposition analyses.

BACKGROUND: Although World Health Organization works to make vaccination service available to everyone everywhere by 2030, majority of the world's children have been unvaccinated and unprotected from vaccine-preventable diseases. In fact, evidences on factors contributing to changes in vaccination coverage across residential areas, wealth categories and over time have not been adequate. Therefore, this study aimed at investigating inequalities in vaccination status of children aged 12-23 months owing to variations in wealth status, residential areas and over time. METHODS: Maternal and child health service data were extracted from the 2011 and 2016 Ethiopian Demographic and Health Survey datasets. Then, multivariate decomposition analysis was done to identify the major factors contributing to differences in the rate of vaccination utilization across residences and time variations. Similarly, a concentration index and curve were also done to identify the concentration of child vaccination status across wealth categories. RESULTS: Among children aged 12-23 months, the prevalence of complete childhood vaccination status increased from 20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status was due to differences in respondent characteristics. Of the changes due to the composition of respondent characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status, place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016. CONCLUSION: A significant rural-urban differentials was observed in the probability of a child receiving the required childhood vaccines. Children in urban households were specifically more likely to have completed the required number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for the costs incurred by poor households. Special attention should also be given to rural communities through improving their access to the media. The findings highlight the importance of women empowerment, for example, through education to enhance childhood vaccination services in Ethiopia.

Intentions to use maternity waiting homes and associated factors in Northwest Ethiopia.

BACKGROUND: Maternity Waiting Homes (MWHs) are residential facilities located within hospitals or health centers to accommodate women in their final weeks of pregnancy to bridge the geographical gap in obstetric care. Little is known, however, about women's intentions to use MWHs. Thus, this study aimed to assess pregnant women's intentions to use MWHs and associated factors in East Bellesa district, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted among 525 pregnant women in East Bellesa district from March to May 2018. Study participants were selected using systematic random sampling. Binary logistic regression was used for analysis. Adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI), and p-value < 0.05 were used to identify factors associated with intentions to use MWHs. RESULTS: In the study area, 326/499 (65.3%) pregnant women had the intention to use MWHs. Pregnant women who had good knowledge about maternal healthcare and obstetric complications (aOR 6.40; 95% CI 3.6-11.5), positive subjective norms related to women's perceptions of social pressure (aOR 5.14; 95% CI 2.9-9.2), positive perceived behavioral control of women on the extent to which women feel confident (aOR 4.74; 95% CI 2.7-8.4), rich wealth status (aOR 4.21; 95% CI 2.1-8.4), women who decided by themselves to use maternal services (aOR 2.74; 95% CI 1.2-6.2), attended antenatal care (aOR 2.24; 95% CI 1.2-4.1) and favorable attitudes towards women's overall evaluation of MWHs (aOR 1.86; 95% CI 1.0-3.4) had higher odds of intentions to use MWHs. CONCLUSION: Two thirds (65.3%) of pregnant women had intentions to use MWHs. Factors such as women's knowledge, subjective norms related to women's perceptions of social pressure, perceived behavioral control of women on the extent to which women feel confident to utilize, and wealth status, decision-making power, attending antenatal care and attitude towards women's overall evaluation of MWHs were significantly associated with the intention to use MWHs. Therefore, improving women's awareness by providing continuous health education during antenatal care visits, devising strategies to improve women's wealth status, and strengthening decision-making power may enhance their intention to use MWHs.

Clinical vitamin-A deficiency and associated factors among pregnant and lactating women in Northwest Ethiopia: a community-based cross-sectional study.

BACKGROUND: Vitamin A deficiency is known for its adverse health consequences, such as blindness, growth retardation and death. To curb the problem, Ethiopia has implemented various public health measures although little has been done to examine the deficiency among pregnant and lactating women. As a result, this study assessed the prevalence of Vitamin A deficiency and associated factors among pregnant and lactating women in Lay Armachiho district, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted on pregnant and lactating women in Lay Arimachiho district, northwest Ethiopia, using the multistage systematic sampling technique to select participants. The binary logistic regression model was fitted to test the effect of exposure variables, and the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were computed to identify the significance and the strength of the associations of variables with Vitamin A deficiency. RESULTS: The study revealed that 13.7% of the pregnant and lactating women had night blindness and 0.4% had also Bitot's Spot. Over 35 years of age of mothers (AOR = 2.74; 95%CI: 1.15,7.43), less than USD 22.7 household monthly income (AOR = 8.9; 95%CI: 4.54,21.73), and poor hand washing practices after toilets (AOR = 8.87; 95% CI: 4.43,18.68) were positively associated with VAD, while mothers' access to the media (AOR = 0.20; 95%CI:0.07, 0.59), formal education (AOR = 0.09; 95% CI: 0.03, 0.41), over 18 years of age at first marriage (AOR = 0.19; 95%CI: 0.08,0.36), and no fasting (AOR = 0.14; 95%CI: 0.04,0.46) were negatively associated. CONCLUSIONS: Maternal Vitamin A deficiency was the major public health problem in Lay Armachiho district. Over 35 years of age of mothers, less than USD 22.7 household monthly income and poor hand washing practices after toilets were high risks for VAD, while mothers' access to the media, formal education, over 18 years at first marriage, and no fasting were low risks. Therefore, community awareness about the risk of early marriage, poor hand hygiene practices after toilets, and fasting during pregnancy and lactating period were essential. Organizations working on maternal health need to focus on mothers with low incomes in order to reduce their deficiency in Vitamin A.

Process evaluation of the community-based newborn care program implementation in Geze Gofa district, south Ethiopia: a case study evaluation design.

BACKGROUND: The Community-Based Newborn Care (CBNC) program is a comprehensive strategy designed to improve the health of newborns during pregnancy, childbirth, and the postnatal period through health extension workers at community levels, although the implementation has not been evaluated yet. Therefore, this study aimed to evaluate the process of the CBNC program implementation in Geze Gofa district, south Ethiopia. METHODS: A case study evaluation design with a mixed method was employed from May 1 to 31, 2017. A total of 321 mothers who gave birth from September 01, 2016 to February 29, 2017, were interviewed. Similarly, 27 direct observations, six-month document reviews, and 14 key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 20 for analysis. In the multivariable logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare factors associated with maternal satisfaction. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria. RESULTS: The overall level of the implementation process of the CBNC program was 72.7%, to which maternal satisfaction, availability of resources, and healthcare providers' compliance with the national guideline contributed 75.0, 81.0, and 68.0%, respectively. Essential drugs and medical equipment, like vitamin K, chlorohexidine ointment, neonatal resuscitation bags, and masks used in the program were out of stock. Very severe diseases were not treated according to the national guidelines, and the identification of neonatal sepsis cases was poor. Trading occupation (AOR: 0.16, 95% CI: 0.03-0.97) and low wealth status (AOR: 3.11, 95% CI: 1.16-8.36) were factors associated with maternal satisfaction. CONCLUSION: The process of CBNC program implementation was relatively good, although the compliance of healthcare providers with the national guideline and maternal satisfaction with the services was low. Some essential drugs and medical equipment were out of stock. Merchant and low wealth status affected maternal satisfaction. Therefore, healthcare offices should provide crucial medicines and equipment for better program implementation and improve the wealth status of mothers to enhance maternal satisfaction.

The costs of traumatic head injury and associated factors at University of Gondar Specialized Referral Hospital, Northwest Ethiopia.

BACKGROUND: Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital. METHOD: An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI. RESULTS: The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001). CONCLUSION: Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.

Factors associated with institutional delivery practice among women in pastoral community of Dubti district, Afar region, Northeast Ethiopia: a community-based cross-sectional study.

BACKGROUND: Eighty-five percent of the global burden of maternal mortality was covered by Sub-Saharan Africa. Ethiopia is a major contributor to the death of mothers with a maternal mortality ratio of 676 per 100,000 live births. Only 10% of deliveries in Ethiopia were at health facility with the least (6.4%) in the Afar region. However, there is limited evidence about factors of institutional delivery in the study area. Thus, this study aimed to assess the magnitude and associated factors of institutional delivery practice among women in the pastoral community of Dubti district, Northeast Ethiopia. METHODS: A community based cross-sectional study was conducted from April to May 2016, in the pastoral community of Dubti district. A total of 381 women were selected using systematic sampling technique and interviewed using a standardized structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to declare the factors associated with institutional delivery. RESULTS: This study revealed that 35.2% (95% CI: 30.5-40.1) of women were delivered at the health facility. Women who had travelled less than an hour to reach the nearest health facilities (AOR: 4.90, 95% CI: 2.62-9.18), attending antenatal care (AOR: 2.50, 95% CI:1.48-4.23), previous history of stillbirth (AOR: 4.34, 95% CI: 1.78-10.58), good knowledge (AOR: 2.09, 95% CI:1.23-3.56), and husband involved in decision making on delivery place (AOR: 4.42, 95% CI: 1.98-9.90) were the factors associated with institutional delivery practice. CONCLUSIONS: The overall institutional delivery practices in the study area was low as compared to the national level. This low practice of institutional delivery was contributed by residing far from the facility, does not received antenatal care, and having low awareness about ANC follow up and institutional delivery services. Therefore, strengthening the accessibility of health facility to nearby mothers resided, antenatal care services, and awareness creation provision at the community level for pregnant women in the pastoral community can improve institutional delivery practice.

Building a resilient health system for universal health coverage and health security: a systematic review.

BACKGROUND: Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security. METHODS: A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization's health systems building block framework. RESULTS: A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security. CONCLUSIONS: Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.

Residential and wealth-related disparities of high fertility preferences in Ethiopia: A decomposition analysis.

BACKGROUND: Fertility preference significantly influences contraceptive uptake and impacts population growth, especially in low and middle-income countries. In the previous pieces of literature, variations in fertility preference across residence and wealth categories and its contributors were not assessed in Ethiopia. Therefore, we decomposed high fertility preferences among reproductive-aged women by residence and wealth status in Ethiopia. METHODS: We extracted individual women's record (IR) data from the publicly available 2016 Ethiopian Demographic Health Survey (EDHS) dataset. A total of 13799 women were included in the study. Multivariate decomposition analysis was conducted to identify the factors that contributed to the differences in the percentage of fertility preferences between rural and urban dwellers. Furthermore, we used an Erreygers normalized concentration index and curve to identify the concentration of high fertility preferences across wealth categories. The concentration index was further decomposed to identify the contributing factors for the wealth-related disparities in high fertility preference. Finally, the elasticity of wealth-related disparity for a change in the socioeconomic variable was estimated. RESULTS: The weighted percentage of women with high fertility preference among rural and urban residents was 42.7% and 19%, respectively, reflecting a 23.7 percentage point difference. The variations in fertility preference due to the differences in respondents' characteristics accounted for 40.9%. Being unmarried (8.4%), secondary (14.1%) and higher education (21.9%), having more than four children (18.4%), having media exposure (6.9%), middle (0.4%), richer (0.2%) and richest (0.1%) wealth were the positive and city administration (-30.2%), primary education (-1.3%) were the negative contributing factors for the variations in high fertility preferences due to population composition. Likewise, about 59% of the variations in fertility preference were due to variations in coefficients. City administration (22.4%), primary (7.8%) and secondary (7.4%) education, poorer wealth (0.86%) were the positive and having media exposure (-6.32%) and being unmarried (-5.89%), having more than four children (-2.1%) were the negative factors contributing to the difference in high fertility preferences due to the change in coefficients across residents. On the other hand, there was a pro-poor distribution for high fertility preferences across wealth categories with Erreygers normalized concentration index of ECI = -0.14, SE = 0.012. Having media exposure (17.5%), primary (7.3%), secondary (5.4%), higher (2.4%) education, being unmarried (8%), having more than four children (7.4%), rural residence (3%) and emerging (2.2%) were the positive and city administration (-0.55) was the negative significant contributor to the pro-poor disparity in high fertility preference. CONCLUSION: The variations in high fertility preferences between rural and urban women were mainly attributed to changes in women's behavior. In addition, substantial variations in fertility preference across women's residences were explained by the change in women's population composition. In addition, a pro-poor distribution of high fertility preference was observed among respondents. As such, the pro-poor high fertility preference was elastic for a percent change in socioeconomic variables. The pro-poor high fertility preference was elastic (changeable) for a percent change in each socioeconomic variables. Therefore, women's empowerment through education and access to media will be important in limiting women's desire for more children in Ethiopia. Therefore, policymakers should focus on improving the contributing factors for the residential and wealth-related disparities in high fertility preferences.

Metabolic risk factors of colorectal cancer: Umbrella review.

BACKGROUND AND AIM: The association between metabolic factors and colorectal cancer (CRC) risk is inconclusive. This umbrella review aimed to summarise and describe the association using existing systematic reviews and/or meta-analyses. METHOD: Four databases (Medline, Scopus, Web of Science, and Cochrane Library) were searched for systematic reviews and/or meta-analyses of observational studies. Two independent authors extracted data on the summary estimated effect and heterogeneity of studies using I2 from the individual reviews. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool was used to evaluate the methodological quality. RESULTS: 49 articles were included in this review. Although most included studies were graded with critically low methodological quality (81.6 %), we found a significant positive association between obesity (summary relative risk (SRR) range 1.19-1.49), diabetes mellitus (SRR range 1.20-1.37), hypertension (SRR range 1.07-1.62), metabolic syndrome (SRR range 1.25-1.36), non-alcoholic fatty liver disease (pooled odds ratio (POR) range 1.13-1.56), and risk of CRC. Higher serum high-density lipoprotein cholesterol levels were associated with a lower risk of CRC in 3/6 reviews, while others did not find any association. There was no clear association between high triglyceride levels, total cholesterol levels, low-density lipoprotein cholesterol levels, and risk of CRC. CONCLUSION: This umbrella review identified that most metabolic factors are significantly associated with increased risk of CRC. Thus, people affected by metabolic factors may be benefited from CRC screening and surveillance.