Exploring community tuberculosis program in the pastoralist setting of Ethiopia: a qualitative study of community health workers' perspectives in Borena Zone, Oromia Region.

BACKGROUND: Pastoralist community accounts for a significant portion of the population in Ethiopia. This community is different from majority of the country's population. Access to TB prevention and control services is uneven in the country. The community TB program is designed to improve the access. Exploring the program performance from the perspectives of its implemters in a pastoral setting remains important. METHOD: We conducted a qualitative study using an interpretive description method in the pastoralist community setting of Ethiopia. Study participants were recruited from geographically dispersed areas. We collected data through in-depth interview using semi-structured interview guides and audio recordings during February 01-30, 2020. The guides were developed in consultation with TB program experts and clinicians treating TB patients in the study area. Notes were taken at the interviews to enrich transcription of the data. Principal investigator conducted the interview. The subsequent interviews were informed by emerging ideas from forgoing interview transcriptions and continued until data saturation was achieved. RESULTS: One hundred and fifty six codes, nine categories and three themes emanated. The first theme was inadequate community TB performance and some of its codes include inadequate presumptive TB case identification and compromised directly observed treatment short course service delivery. The second theme was factors contributing to the program performance. Community factors, lack of physical access to health facilities and indirect non-medical cost were some categories under this theme. The final theme was suggested solutions; and its categories include a need for active community involvement and modification of service delivery approaches. CONCLUSIONS: Community TB performance was inadequate in the pastoralist community. Multifaceted factors contributed to the inadequate program performance. Socioeconomic and access related factors were major contributers. Aligning the program to the context of the pastoralist community setting is required to improve the performance.

Competency in evidence-based medicine and associated factors among medical radiology technologists in Addis Ababa, Ethiopia.

INTRODUCTION: Evidence-based medicine integrates clinical expertise, patient values and best research evidence in clinical decision-making. This study aimed to assess evidence-based medicine knowledge, attitudes, practices and associated factors among medical radiology technologists in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted among 392 medical radiology technologists from May to August 2022 using a self-administered questionnaire. Bivariate and multivariate logistic regression identified factors associated with evidence-based medicine practice. RESULTS: Most medical radiology technologists (57.7%) had moderate evidence-based medicine knowledge and 94.9% had favourable attitudes. However, 64.8% demonstrated poor evidence-based medicine practice. Factors significantly associated with better evidence-based medicine practice were moderate knowledge (AOR 1.949, 95% CI 1.155-3.291), good statistical understanding (AOR 1.824, 95% CI 1.135-2.930), sufficient time for evidence-based medicine (AOR 1.892, 95% CI 1.140-3.141), institutional support (AOR 2.093, 95% CI 1.271-3.440) and evidence-based medicine resource access (AOR 1.653, 95% CI 1.028-2.656). CONCLUSION: Despite moderate knowledge and positive attitudes towards evidence-based medicine, most medical radiology technologists had suboptimal utilisation. Strategies to improve knowledge, ensure dedicated time, provide institutional support and resources could enhance evidence-based radiology practice.

The Promise of the New Educational Strategy for Curriculum Development (SPICES) Model on the Development of Students' Clinical Reasoning Ability. A Comparative Cross-Sectional Study.

INTRODUCTION: Clinical reasoning skills are a core competency that must be taught at all levels of health-care education. In the last decade, several health professional education curricula in Ethiopia have been redesigned with the goal of improving student competence in key health-care delivery skills. Despite the fact that some academic programs followed the conventional educational strategy, a significant number of academic programs adopted a new educational strategy for curriculum development: Student-centered, Problem-based, Integrated, Community-based, Elective, and Systematic (SPICES) model. More empirical evidence, however, is required to determine whether the new curricular approach is effective in improving students' clinical reasoning. The purpose of this study is to determine whether the new educational strategy for curriculum development improves the clinical reasoning ability of midwifery students when compared to a peer institution that follows a traditional curriculum. METHODS: A comparative cross-sectional study was conducted to compare the clinical reasoning skills of midwifery students who completed the new curricular approach versus students who completed a traditional curriculum. A Script Concordance Test (SCT) was used to collect data. The mean SCT score and an independent two-sample t-test were calculated to see if the two groups differed significantly in terms of clinical reasoning skills in managing Post-Partum hemorrhage (PPH). RESULTS: A total of 77 final-year midwifery students participated (38 from the new and 39 from the traditional curriculum approach). Midwifery students who completed the new and conventional curriculum approaches had mean clinical reasoning SCT scores of 0.7 (SD = 0.35) and 0.53 (SD = 0.37), respectively. There was a statistically significant difference in the overall mean SCT score between the two study groups in terms of clinical reasoning skills (p = 0.008). CONCLUSION: Our study found that the new SPICES model curricular approach is promising in fostering the development of clinical reasoning skills of Midwifery students in managing PPH.

Food security status of patients with type 2 diabetes and their adherence to dietary counselling from selected hospitals in Addis Ababa, Ethiopia: A cross-sectional study.

BACKGROUND: Even though adherence to dietary counselling for patients with diabetes is essential for improving health and preventing complications, access to an adequate and quality diet is challenging for patients living in a food-insecure household. The availability of data in this regard is limited in Ethiopia. Thus, this study assessed the food security status of patients with type 2 diabetes, their adherence to dietary counselling, and contributing factors at public hospitals in Addis Ababa, Ethiopia. METHODS: This was a facility-based cross-sectional study among 602 patients with Type 2 diabetes in Addis Ababa, Ethiopia, from July to August 2019. Patients were selected randomly after the total number of samples was proportionally allocated to four public hospitals. Relevant information was collected by trained data collectors using a pre-tested questionnaire. Data were entered into Epi-info version 7 and exported to SPSS version 24 for data analysis. Logistic regression analysis was employed to identify factors associated with adherence to dietary counselling. RESULT: The proportion of nonadherence to dietary counselling among patients with type 2 diabetes was 67.3% (95%CI: 63.5%-71.1%). Nearly half (50.7%) of the respondents were food insecure. Of these, mildly food insecure, moderately food insecure, and severely food insecure were 8.5%, 29.2%, and 13%, respectively. Physical activity (AOR = 1.7; 95%CI: 1.1-2.9); diabetes knowledge (AOR = 1.8; 95%CI: 1.2-2.6); lack of access to information (AOR = 1.6; 95%CI: 1.1-2.6); moderately food insecure (AOR = 2.2; 95%CI: 1.3-3.7); and severely food insecure (AOR = 5.6; 95%CI: 2.1-15.0) were the major significant factors associated with nonadherence to dietary counselling. CONCLUSION: Over two-thirds of patients with diabetes did not adhere to dietary counselling, which appears high. As a result, improving diabetes education, information access, and food security status should be considered to ensure dietary counselling adherence among type 2 diabetes patients.

Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study.

BACKGROUND: Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. METHODS: Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus persons with BMI ≥18.5kg/m2 (normal or overweight) at treatment initiation and after two months of treatment. Treatment was classified as successful in persons who were free of symptoms and had a negative sputum smear for acid-fast bacilli at the end of the 6-month treatment course. We analysed outcomes using univariable and multivariable logistic regression with 95% CI and p value< 0.05. RESULTS: Of enrolled study participants, 184 (40.4%) were underweight and 272 (59.6%) were normal or overweight. Body mass index (BMI ≥18.5kg/m2) at the start and second month of treatment were independent predictors for successful treatment outcome (AOR = 2.15; 95% CI: 1.05, 4.39) and (AOR = 3.55; 95% CI: 1.29, 9.73), respectively. The probability of treatment success among patients with BMI≥18.5kg/m2 at the start and second month of treatment was 92.9% and 97.1%, respectively versus 86.5% and 91.7% in patients with BMI<18.5kg/m2. Bodyweight not adjusted for height and change in the bodyweight after the second and sixth months of treatment were not significantly associated with treatment success. CONCLUSION: In persons treated for TB disease, being underweight at baseline and after two months of treatment was a predictor for unsuccessful treatment outcomes. Nutritional assessment, counselling, and management are important components of TB treatment programs with the potential to improve treatment outcomes.

Prevalence of Vitamin A Deficiency among Preschool Children in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Vitamin A deficiency is a major nutritional concern in lower-income countries. The aim of this systematic review and meta-analysis was to show the magnitude of vitamin A deficiency among preschoolers in Ethiopia. OBJECTIVE: The present study was aimed at synthesizing qualitatively and quantitatively the existing literature on the prevalence of VAD in preschool children in Ethiopia. METHODS: Studies were searched through the search engine of Google Scholar, Hinari, MEDLINE/PubMed, Cochrane Library, and Africa-Wide Information. Searching was made using the keywords/MeSH of vitamin A deficiency, xerophthalmia, night blindness, Bitot's spot, retinol, children, and Ethiopia. Data were analyzed and compared with the WHO threshold criteria to declare a public health problem. Heterogeneity among studies was assessed using a Cochran Q test and I 2 statistics. A random-effects model with 95% confidence interval was used for prevalence estimations. RESULTS: Of the 13 studies included in clinical analysis, 12 of them reported the prevalence of night blindness and/or Bitot's spot among preschool children in Ethiopia which was above WHO cutoff point for the public health problem 1% and 0.5%, respectively. The prevalence of night blindness significantly decreased from moderate public health problem 4.2% (95% CI: 2.8%-5.7%) in a period from 1990 to 2004 to mild public health problem 0.8% (95% CI: 0.6%-1.0%) in a period from 2005 to 2019. Furthermore, statistically insignificant reduction was observed in the prevalence of Bitot's spot in a period from 1990 to 2004, 2.2% (95% CI: 1.3%-3.2%) to 1.8% (95% CI: 1.2%-2.3%) in a period from 2005 to 2019. Among 8 studies on subclinical vitamin A deficiency, 7 of them indicated a severe public health problem (>20%). The prevalence of subclinical vitamin A deficiency decreased from 55.7% (95% CI: 39.8%-71.6%) in a period from 1990 to 2004 to 28.3% (95% CI: 9.8%-46.7%) in a period from 2005 to 2019, but not statistically significant. CONCLUSIONS: Despite the reduced proportion of night blindness and Bitot's spot, still both clinical and subclinical vitamin A deficiencies remain a public health problem in Ethiopia requiring strengthen intervention through the newly initiated health extension program.

Prevalence of anemia among school-age children in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Anemia continued to become a major public health problem in developing nations including Ethiopia. Especially, school children are more vulnerable for anemia and consequences of anemia. Generating accurate epidemiological data on anemia in school children is an important step for health policy maker. There are limited evidences on anemia prevalence in school-age children in Ethiopia. This study aimed to synthesize the pooled prevalence of anemia in school-age children in Ethiopia. METHODS: This systematic review and meta-analysis was followed the PRISMA guidelines. Comprehensive searched was conducted in PubMed/MEDLINE, Cochrane Library, Google Scholar, HINARI, and Ethiopian Journal of Health Development for studies published before 2016, supplemented by manual searches to identify relevant studies. Two review authors independently selected studies, extracted data, and assessed quality of studies. The Cochrane Q test and I2 test statistic were used to test heterogeneity through studies. The overall prevalence was calculated using random-effects model of DerSimonian-Laird method. RESULTS: From 831 obtained studies, 13 articles included in the meta-analysis. The pooled prevalence of anemia among school children in Ethiopia was 23% (95% CI 18-28%). The prevalence of anemia in male and female school-age children was 27% (95% CI 20 and 34%) and 24% (95% CI 18 and 30%), respectively. CONCLUSIONS: This study found that prevalence of anemia was a moderate public health problem in school children. Due to the complications of anemia for school children, preventative planning and control of anemia among school children in Ethiopia is necessary.