The impact of pastoralist mobility on tuberculosis control in Ethiopia: a systematic review and meta-synthesis.

BACKGROUND: Directly observed treatment, short-course (DOTS) is the current mainstay to control tuberculosis (TB) worldwide. Context-specific adaptations of DOTS have impending implications in the fight against TB. In Ethiopia, there is a national TB control programme with the goal to eliminate TB, but uneven distribution across lifestyle gradients remains a challenge. Notably, the mobile pastoralist communities in the country are disproportionately left uncovered. The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia. MAIN TEXT: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically reviewed articles in seven electronic databases: Excerptra Medical Database, African Journal Online, PubMed, Google Scholar, Centre for Agriculture and Bioscience International Direct, Cochrane Library and Web of Science. The databases were searched from inception to December 31, 2018, with no language restriction. We screened 692 items of which 19 met our inclusion criteria. Using a meta-ethnographic method, we identified six themes: (i) pastoralism in Ethiopia; (ii) pastoralists' livelihood profile; (iii) pastoralists' service utilisation; (iv) pastoralists' knowledge and awareness on TB control services; (v) challenges of TB control in pastoral settings; and (vi) equity disparities affecting pastoralists. Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country. CONCLUSIONS: This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle. Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision. Targeting these two parameters holds promise to enhance effectiveness of an intervention.

Exploring barriers to reproductive, maternal, child and neonatal (RMNCH) health-seeking behaviors in Somali region, Ethiopia.

INTRODUCTION: Health-seeking behaviours are influenced by internal and external contributing factors. Internal factors include attitudes, beliefs and core values, life adaptation skills, psychological disposition whereas external factors include social support, media, socio-cultural, political, economic and biological aspects, health care systems, environmental stressors and societal laws and regulations. This study was meant to explore factors affecting health-seeking behaviors in the Somali regional state of Ethiopia. The study employed a cross-sectional study design using qualitative data collection tools. Data were collected from 50 individual interviews and 17 focused group discussions (FGD) on women of reproductive age and their partners, health extension workers (HEWs), health care providers and health administrators. To ensure representativeness, the region was categorized into three zones based on their settlement characteristics as agrarian, pastoralist and semi-pastoralist. Two districts (one from high and the other from low performance areas) were selected from each category. The data were entered, coded, categorized and analyzed using NVIVO version 11 software. The Socio-ecologic Model (SEM) was used for categorization. RESULTS: Using the social ecological model, the following major barriers for health seeking behaviors were identified. Low socio-demographic and economic status, poor exposure to health information or mass media, detrimental preferences of breast feeding methods and short acting family planning (FP) methods were identified barriers at the individual level; male dominance in decision making, the influence of the husband and society and the role of word of mouth were identified barriers at the interpersonal level and lack of acceptance, fear of modern health practices, unclean health facility environment, lack of well-equipped facilities shortage of trained staffs and barriers relating to distance and transportation were barriers identified at organizational and policy level. CONCLUSION: Overall, factors at various level affected health seeking behaviors of the Somali community. Socio-demographic and economic factors, non-responsive bureaucratic system, shortages or absence of medical supplies and human resources, lack of supportive supervision, a shortage of water and electricity at the health facility and an unclean service delivery environment are significant barriers to health-seeking behaviors for the community.