Exploring health care providers' engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study.

BACKGROUND: Engagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional's engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis. PURPOSE: The purpose of this study was to explore the level of health care providers' engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia. METHODS: Descriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba's parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity. RESULTS: Total of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients' causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis. CONCLUSION: The study explored five emergent themes: patient's underlying causes, seeking support, perceived susceptibility, professionals' incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

Disparities in Postpartum Depression Among Urban and Rural Mothers in Hadiya Zone Shashogo District Southern Ethiopia Community-Based Comparative Cross-Sectional Study.

Introduction: Postpartum depression (PPD) is a nonpsychotic depressive state that begins after childbirth. In Ethiopia, there was limited evidence about the prevalence and factors associated with PPD in terms of residence. Objective: To assess disparities in PPD among urban and rural mothers in the Shashogo district, Hadiya zone southern Ethiopia 2022. Methods: Community-based comparative cross-sectional study design was employed from May 3 to July 3, 2022. A sample size of 556 (185 from urban and 371 from rural) was calculated using a double population proportion approach and mothers in the postpartum period were randomly selected from both urban and rural settings using stratification followed by single stage and the systematic random sampling method. Data were gathered by trained data collectors using an interviewer-administered questionnaire and analyzed using SPSS Version 25. Statistical significance was declared at a P value of < .05. Results: One hundred forty-four (26.6%) mothers in the postpartum period with 95%CI [23-30] were depressed, of which 37 (19.8%) with 95% CI [14-26] in urban and 107 (30%) with 95% CI [25-35] found in a rural setting. Unplanned pregnancy, low maternal social support, assisted delivery, no antenatal care (ANC) follow-up, no postnatal care (PNC) follow-up, and low household income were independent predictors of PPD in rural residence whereas unplanned pregnancy, low maternal social support, assisted delivery, and antenatal depression were independent predictor of PPD in urban. Conclusion: PPD was found to be high in the study area as compared to national/global burden. Unplanned pregnancy, low maternal social support, and assisted delivery were predictors for both urban and rural. Low income, no ANC, and PNC follow-up were associated with PPD in rural settings only whereas antenatal depression is a predictor of PPD in urban settings.