Quality of the delivery services in health facilities in Northern Ethiopia.

BACKGROUND: Substantial improvements have been observed in the coverage of and access to maternal health service, especially in skilled birth attendants, in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study investigated the status of the quality of delivery services in Northern Ethiopia. METHODS: A facility based survey was conducted from December 2014 to February 2015 in Northern Ethiopia. The quality of delivery service was assessed in 32 health facilities using a facility audit checklist, by reviewing delivery, by conducting in-depth interview and observation, and by conducting exit interviews with eligible mothers. Facilities were considered as 'good quality' if they scored positively on 75% of the quality indicators set in the national guidelines for all the three components; input (materials, infrastructure, and human resource), process (adherence to standard care procedures during intrapartum and immediate postpartum periods) and output (the mothers' satisfaction and utilization of lifesaving procedures). RESULTS: Overall 2 of 32 (6.3%) of the study facilities fulfilled all the three quality components; input, process and output. Two of the three components were assessed as good in 11 of the 32 (34.4%) health facilities. The input quality was the better of the other quality components; which was good in 21 out of the 32 (65.6%) health facilities. The process and output quality was good in only 10 of the 32 (31.3%) facilities. CONCLUSIONS: Only 6.3% of the studied health facilities had good quality in all three dimensions of quality measures that was done in accordance to the national delivery service guidelines. The most compromised quality component was the process. Systematic and sustained efforts need to be strengthened to improve all dimensions of quality in order to achieve the desired quality of delivery services and increase the proportion of births occurring in health facilities.

Innovative approach for potential scale-up to jump-start simplified management of sick young infants with possible serious bacterial infection when a referral is not feasible: Findings from implementation research.

BACKGROUND: Neonatal bacterial infections are a common cause of death, which can be managed well with inpatient treatment. Unfortunately, many families in low resource settings do not accept referral to a hospital. The World Health Organization (WHO) developed a guideline for management of young infants up to 2 months of age with possible serious bacterial infection (PSBI) when referral is not feasible. Government of Ethiopia with WHO evaluated the feasibility of implementing this guideline to increase coverage of treatment. OBJECTIVE: The objective of this study was to implement a simplified antibiotic regimen (2 days gentamicin injection and 7 days oral amoxicillin) for management of sick young infants with PSBI in a programme setting when referral was not feasible to identify at least 80% of PSBI cases, achieve an overall adequate treatment coverage of at least 80% and document the challenges and opportunities for implementation at the community level in two districts in Tigray, Ethiopia. METHODS: Using implementation research, we applied the PSBI guideline in a programme setting from January 2016 to August 2017 in Raya Alamata and Raya Azebo Woredas (districts) in Southern Tigray, Ethiopia with a population of 260884. Policy dialogue was held with decision-makers, programme implementers and stakeholders at federal, regional and district levels, and a Technical Support Unit (TSU) was established. Health Extension Workers (HEWs) working at the health posts and supervisors working at the health centres were trained in WHO guideline to manage sick young infants when referral was not feasible. Communities were sensitized towards appropriate home care. RESULTS: We identified 854 young infants with any sign of PSBI in the study population of 7857 live births. The expected live births during the study period were 9821. Assuming 10% of neonates will have any sign of PSBI within the first 2 months of life (n = 982), the coverage of appropriate treatment of PSBI cases in our study area was 87% (854/982). Of the 854 sick young infants, 333 (39%) were taken directly to a hospital and 521 (61%) were identified by HEW at health posts. Of the 521 young infants, 27 (5.2%) had signs of critical illness, 181 (34.7%) had signs of clinical severe infection, whereas 313 (60.1%) young infants 7-59 days of age had only fast breathing pneumonia. All young infants with critical illness accepted referral to a hospital, while 117/181 (64.6%) infants with clinical severe infection accepted referral. Families of 64 (35.3%) infants with clinical severe infection refused referral and were treated at the health post with injectable gentamicin for 2 days plus oral amoxicillin for 7 days. All 64 completed recommended gentamicin doses and 63/64 (98%) completed recommended amoxicillin doses. Of 313 young infants, 7-59 days with pneumonia who were treated by the HEWs without referral with oral amoxicillin for 7 days, 310 (99%) received all 14 doses. No deaths were reported among those treated on an outpatient basis at health posts. But 35/477 (7%) deaths occurred among young infants treated at hospital. CONCLUSIONS: When referral is not feasible, young infants with PSBI can be managed appropriately at health posts by HEWs in the existing health system in Ethiopia with high coverage, low treatment failure and a low case fatality rate. Moreover, fast breathing pneumonia in infants 7-59 days of age can be successfully treated at the health post without referral. Relatively higher mortality in sick young infants at the referral level health facilities warrants further investigation.

Perceived risk of reinfection among individuals treated for sexually transmitted infections in Northern Ethiopia: implication for use in clinical practice.

INTRODUCTION: The prevention of reinfection of sexually transmitted infections (STIs) is highly dependent on the level of risk perception and the subsequent adoption of preventive behaviors. While perceived risk is assumed to be key to adoption of preventive measures, the evidence regarding the predictors of perceived risk to STI reinfection are limited. METHODS: This paper is based on a cross sectional facility based survey conducted in North Ethiopia from January to June; 2015. Patients attending public health facilities for STI care responded to a structured questionnaire at clinic exist. Ordinal logistic regression was employed to identify factors associated with risk perception. RESULTS: Of the 1082 STI patients who participated in the study, 843(77.91%) indicated a high perceived risk of STI reinfection. The major factor associated with low perceived risk of reinfection was willingness to notify partner; the odds of being willing to notify partner was greater among those who perceived low risk (AOR=3.01, 95% CI: 2.13-4.25). In addition, low perceived risk was associated with female index cases (AOR=1.49, 95% CI: 1.07-2.08), those who had high school education and above (AOR=1.68, 95% CI: 1.07-2.65), those aged 25 years and above (AOR=1.52, 95% CI: 1.09-2.12), those who had a single partner (AOR=1.82, 95% CI: 1.20-2.74), and those who had low perceived stigma (AOR=1.42, 95% CI: 1.04-1.95). CONCLUSION: The perceived risk of STI reinfection is high and strongly associated with willing to notify partner. Efforts to prevent STI reinfection need to consider interventions that enhance partner notification.

Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study.

BACKGROUND: Currently 93 million people are estimated as living with diabetic retinopathy worldwide. The prevalence and risk factors of diabetic retinopathy in developed countries have been well documented; but in Ethiopia, data on prevalence and associated factors of diabetic retinopathy is lacking. OBJECTIVE: To determine prevalence and factors associated with development of diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia. METHOD: Cross-sectional study design with record review of 400 diabetic patients was conducted at Arbaminch General Hospital from November to January 2015. Among 400 diabetic patients, 270 patients with baseline information and without history of hypertension at baseline were included in this study. But patients with gestational diabetes and with retinopathy at baseline were excluded from the study. Consecutive sampling technique was applied to select study participants. Data of cohorts was extracted from medical record using pre tested structured extraction check list. Data cleaning, coding, categorizing, merging and analysis carried out by STATA version 12. Descriptive statistics was done and presented accordingly. Bivariate binary logistic regression analysis was done to select potential candidates for the full model at P-value cutoff point ≤ 0.25 and multivariable binary logistic regression analysis was made to estimate the independent effect of predictors on the occurrence of diabetic retinopathy. Model diagnostic tests were done, final model fitness was checked using Hosmer and Lemeshow chi square test. Finally, statistical significance was tested at P-value <0.05. RESULT: Prevalence of diabetic retinopathy among diabetic patients at Arbaminch General Hospital was 13%. Adjusted analysis showed that the odds of diabetic retinopathy were statistically and significantly associated with baseline age (AOR = 6.06: 95%CI; 2.42, 15.21), baseline systolic blood pressure level (AOR = 4.38: 95%CI; 1.64, 11.68), family history of diabetes (AOR = 0.22: 95%CI; 0.08, 0.58) and duration of diabetes (AOR = 8.84: 95%CI; 3.56, 12.89). CONCLUSION AND RECOMMENDATION: In the current study, prevalence of diabetic retinopathy was 13%. Since baseline age ≥60 years, baseline systolic blood pressure level >140 mmhg, duration of diabetes ≥6 years and patients with family history of diabetes were statistically and significantly related with diabetic retinopathy, special care should be given in addition to routine care.

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

BACKGROUND: Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. SUBJECTS AND METHODS: A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). RESULTS: A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. CONCLUSION: Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis.

OBJECTIVES: The loss to follow-up (LTFU) among patients attending care for sexually transmitted infections (STIs) in Sub-Saharan Africa is a major barrier to achieving the goals of the STI prevention and control programme. The objective of this study was to investigate individual- and facility-level factors associated with LTFU among patients treated for STIs in Ethiopia. METHODS: A prospective cohort study was conducted among patients attending care for STIs in selected facilities from January to June 2015 in the Tigray region of Ethiopia. LTFU was ascertained if a patient did not present in person to the same facility within 7 days of the initial contact. Multilevel logistic regression was used to identify factors associated with LTFU. RESULTS: Out of 1082 patients, 59.80% (647) were LTFU. The individual-level factors associated with LTFU included having multiple partners (adjusted OR (AOR) 2.89, 95% CI 1.74 to 4.80), being male (AOR 2.23, 95% CI 1.63 to 3.04), having poor knowledge about the means of STI transmission (AOR 2.08, 95% CI 1.53 to 2.82), having college level education (AOR 0.38, 95% CI 0.22 to 0.65), and low perceived stigma (AOR 0.60, 95% CI 0.43 to 0.82). High patient flow (AOR 3.06, 95% CI 1.30 to 7.18) and medium health index score (AOR 2.80, 95% CI 1.28 to 6.13) were facility-level factors associated with LTFU. CONCLUSIONS: Improving patient retention in STI follow-up care requires focused interventions targeting those who are more likely to be LTFU, particularly patients with multiple partners, male index cases and patients attending facilities with high patient flow.