Health system responsiveness and its associated factors for intrapartum care in conflict affected areas in Amhara region, Ethiopia: a cross-sectional study.

OBJECTIVE: In Ethiopia, information about health system responsiveness (HSR) in conflict-affected areas is limited. No previous local study was conducted on the assessment of HSR at the community level. Hence, the study assessed HSR for intrapartum care in conflict-affected areas in Amhara region, Ethiopia. DESIGN: Community-based cross-sectional study design. SETTING: Wadila, Gayint and Meket districts, Amhara region, Ethiopia. PARTICIPANTS: The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear. OUTCOME: HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict. METHODS: We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized ß coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR. RESULTS: The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (ß=4.28; 95% CI: 2.06 to 6.50), government employees (ß=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (ß=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (ß=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (ß=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (ß=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (ß=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR. CONCLUSION: In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.

Cross-cultural adaptation of the Amharic version of the Compassionate Care Assessment Tool for application in obstetric services of the Ethiopian context.

Background: There are few studies that have evaluated the provision of compassionate care in Ethiopian contexts. One probable factor could be a lack of validated tools for assessing compassionate care in Ethiopia. Objective: To adapt the Compassionate Care Assessment Tool into the Amharic version and to assess its reliability and validity for application in obstetric services of the Ethiopian context. Method: Four hundred ten mothers who gave birth at the four referral hospitals in North West Amhara participated in this study. Using SPSS version 23.0 and SPSS Amos 26 and by applying principal axial factoring, the Compassionate Care Assessment Tool was assessed for structural reliability and validity. Cronbach's alpha was used to evaluate internal consistency and reliability. Factor loadings, composite reliability, average variance extracted and square root of the average variance extracted were used to test convergent and discriminant validity. Results: Three factors with thirteen items were identified that explained 69.87% of the variation in the Compassionate Care Assessment Tool. Cronbach's alpha was 0.917. In the confirmatory factor analysis, all items had factor loadings more than 0.6, and the average variance extracted was greater than 0.5. Composite reliability values were above 0.7, and the square root of the average variance extracted for each element was greater than the correlation of each factor with other factors in the model. Conclusion: The three factors and the thirteen items of the tool have shown internal consistency in the exploratory factor analysis. The factor loadings and the average variance extracted confirmed the convergent validity of the tool, while composite reliability and the square root of the average variance extracted values confirmed discriminant validity. Thus, the Amharic version of the Compassionate Care Assessment Tool was found to have excellent internal consistency as well as adequate structural, convergent, and discriminant validity among obstetric service users in Ethiopia.

Self-referral practice and associated factors among women who gave birth in South Gondar zone primary hospitals, Northwest Ethiopia: a cross-sectional study design.

Background: Patient self-referral is when patients refer themselves to upper-level health facilities without having to see anyone else first or without being told to refer themselves by another health professional. Self-referral leads to a diminished quality of healthcare services. However, globally, many women who gave birth referred themselves to hospitals without having referral sheets, including in Ethiopia and the study area. Therefore, this study aimed to assess self-referral practice and associated factors among women who gave birth in South Gondar zone primary hospitals in Northwest Ethiopia. Methods: A cross-sectional mixed-method study was conducted among women who gave birth in South Gondar zone primary hospitals between 1 June 2022 and 15 July 2022. Semi-structured questionnaires were used to gather quantitative data from 561 participants who were selected by a systematic random sampling technique. Interview guides were used to collect qualitative data from selected six key informants. Quantitative data were entered into Epi Data version 4.6.0.4 and then exported to the statistical software SPSS version 25 for further analysis. Thematic analysis using open code version 4.02 software was applied for qualitative data analysis. A binary logistic regression analysis was employed. In a bivariable analysis, a p < 0.25 was used to select candidate variables for multivariable analysis. P < 0.05 and a 95% confidence interval were used to determine significant variables on the outcome of interest. Results: The overall magnitude of self-referral was 45.6%, with 95% CI (41.5%, 49.9%). They had no antenatal care (ANC) follow-up (AOR = 3.02, 95% CI: 1.64-5.57) and 1-3 ANC follow-ups (AOR = 1.57, 95% CI: 1.03-2.41), poor knowledge about the referral system (AOR = 4.04, 95% CI: 2.30-7.09), and use of public transportation (AOR = 2.34, 95% CI: 1.43-3.82), which were significantly associated with self-referral practice. Conclusion: This study showed that nearly half of the deliveries were self-referred. ANC follow-up, women's knowledge of the referral system, and mode of transportation were factors significantly associated with the self-referral practice. Therefore, developing awareness-creation strategies and increasing coverage of ANC 4 and above are necessary interventions to reduce the self-referral practice.

Satisfaction with comprehensive emergency obstetric and newborn care services and associated factors among clients in University of Gondar Specialized Hospital, Northwest Ethiopia: A cross-sectional study.

Objective: Emergency obstetric and newborn care services treat 70-80% of maternal deaths. This study aimed to assess satisfaction with comprehensive emergency obstetric and newborn care (CEmONC) services and associated factors among clients in the University of Gondar Specialized Hospital. Methods: Institution-based cross-sectional study was conducted on 404 participants using a systematic random sampling method. The study was conducted from March 5 to May 5, 2020, using interviewer-administered structured questionnaires. Binary logistic regression was used to find the association between independent variables and client satisfaction. The level of statistical significance was declared at a p value less than 0.05. Results: The overall clients' satisfaction with CEmONC services was 65.1% (95% confidence interval (CI): 60.9-69.8). Clients' satisfaction was affected by women who had antenatal care (ANC) of three visits (adjusted odds ratio (AOR): 6.5; 95%, CI: 2.04-20.8), women waited less than 15 min (AOR: 4.15, 95% CI: 1.9-9.06), mothers stayed ⩽1 day (AOR: 0.28, 95% CI: 0.09-0.9) and 2-3 days (AOR: 0.98, 95% CI: 0.1-0.69), obtaining a welcoming environment (AOR: 4.6, 95% CI: 2.15-9.88), and getting providers explanation of examinations (AOR: 3.3, 95% CI: 1.97-5.52). Conclusion: The observed clients' satisfaction with CEmONC services was suboptimal. Having ANC of three visits, waiting less than 15 min, duration of stay, obtaining a welcoming environment, and an explanation of providers' examination were the identified factors of client's satisfaction. Therefore, hospital managers and health professionals should work on the identified factors to increase the client's satisfaction with these services.

Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers' Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa.

Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children's diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children's diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers' consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.

Prevalence and associated factors of undernutrition among adult TB patients attending Amhara National Regional State hospitals, Northwest Ethiopia.

BACKGROUND: TB (tuberculosis) is an infectious disease affecting millions of people worldwide; globally, an estimated 10 million people developed TB disease in the past two years; and there were an estimated 1.4 million TB deaths. In Ethiopia, the burden of TB is ranked third and seventh in Africa and the world, respectively. Hence, studies are limited to solving many of the problems related to undernutrition. Therefore this study aimed to assess the prevalence and associated factors of undernutrition among adult TB patients attending Amhara National Regional State hospitals, Northwest Ethiopia. METHODS: A cross-sectional study was conducted in the TB clinics of Amhara Regional State Referral hospitals from March to April 2020. A total of 405 TB patients participated in the study. Proportional allocation and Systematic random sampling were employed to get representative study participants. The outcome variable, undernutrition, was determined by using Body Mass Index (BMI). Interviewer administered structured questionnaire, anthropometric measurements and patients' document review were done. Bivariable and multivariable logistic regressions were done to identify factors associated with undernutrition. Crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals and P-values < 0.05 were employed to declare the significance and strength of association. RESULTS: The prevalence of under nutrition was 42.2% [95%CI: 32.8, 51.6]. The mean (±SD) BMI was 19.30(±2.83). The odds of undernutrition was higher among TB patients with poor wealth status [AOR = 2.39, 95%CI; 1.19, 4.79], alcohol consumption [AOR = 1.57; 95%CI, 1.01, 2.47], bedridden [AOR = 3.02, 95%CI; 1.21, 7.50] and ambulatory patient [AOR = 2.11, 95%CI; 1.36, 3.26]. Furthermore, being farmer [AOR = 2.59;95%CI,1.08,6.20], housewife [AOR = 2.72;95%CI,1.22,6.06] and unemployed [AOR = 2.46;95%CI,1.18,5.13] were significantly associated with undernutrition. CONCLUSION AND RECOMMENDATIONS: This study illustrated that a considerably high proportion of TB patients were undernourished in Amhara regionals state referral hospitals. Behavioral and socio-economic characteristics were significantly associated with undernutrition. Therefore, nutritional and social support activities are essential for TB patients, particularly those who are socio-economically disadvantaged. Regular nutritional screening and management, as well as behavioral interventions, should be strengthened.

Process Evaluation of Prevention of Mother-to-Child Transmission of HIV Service at Gondar City Administration Governmental Health Facilities, Northwest Ethiopia: A Mixed Approach Case Study Evaluation Design.

INTRODUCTION: Mother-to-child HIV transmission (MTCT), or vertical transmission of HIV, is one mode of HIV transmission from mother to baby during pregnancy, delivery and after childbirth. The continuation of new pediatric HIV infection due to the improper prevention of MTCT is a challenge in developing countries; however, the program is not evaluated yet in Ethiopia. Therefore, this study was aimed to assess the process of PMTCT service implementation status. OBJECTIVE: This evaluation study evaluated the implementation of process levels and identified problems of PMTCT service at Gondar city administration governmental health facilities. METHODS: A case study evaluation design with a mixed method was conducted from March to May 2020. A systematic random sampling technique was used to select participants. Data were collected using an interviewer-administered questionnaire and document review, observation, and key informant interviews. Collected data were entered using EPI data version 7 and analyzed using SPSS version 25. RESULTS: The study found that, generally, the PMTCT program implementation was complying with the Ethiopian national guidelines by 78.32%. All facilities had most of the minimum required resources recommended by the guidelines by 75%. The services required to be provided by the facilities were highly accommodated by 90.18%, acceptable by 77.2%, with 78% compliance. Trained human resources and continuous supply of material are the main gaps. CONCLUSION: The overall level of program implementation was judged to be good. However, there is a need for improvements such as ensuring the privacy of counselling rooms, availability of human, test kits, guidelines, beds, waiting areas, drugs, and refresher training for provider. Also, counsellors should record properly the services provided to clients in their cards, such as counselling sessions.

Respectful Maternity Care and Associated Factors Among Women Who Attended Delivery Services in Referral Hospitals in Northwest Amhara, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Disrespectful and abusive care is a violation of women rights to self-determination, health, life, body integrity, and privacy. Providing respectful maternity care (RMC) during labour and delivery is one of the enhancing factors and targets in the Ethiopian health sector strategic plan to promote facility delivery. However, providing respectful maternity care is still a major challenge in the Ethiopia health-care system. This study aimed to assess respectful maternity care and associated factors among women who attended delivery services in Northwest Amhara, referral hospitals, Ethiopia. METHODS: Health-facility-based cross-sectional study was conducted at Northwest Amhara, referral hospitals from March 1 to April 1, 2020. A systematic random sampling technique was used to identify study participants in the referral hospitals. A total of 410 women who gave birth were enrolled in the study. A pre-tested and structured questionnaire was used for data collection. The data were collected during the exit interview. Data were cleaned and entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Both bi-variable and multi-variable logistic regressions were employed in the analysis. Variables with a p-value of less than 0.05 were used to declare as statistically significantly associated with the dependent variable. RESULTS: The overall magnitude of women who have received respectful maternity care was 56.3%. Four and above antenatal care follow-up adjusted odds ratio (AOR) 3.092 (95% CI: 1.676, 5.725), previous history of facility delivery AOR 2.53 (95% CI: 1.094, 5.867), and delivery time AOR 2.46 (95% CI: 1.349, 4.482) were found significantly associated with respectful maternity care. CONCLUSION: The overall magnitude of respectful maternity care was low as compared to international and national standards. This study showed that respectful maternity care among women who gave birth was influenced by the number of antenatal care visits, previous history of facility delivery, and delivery time.

Prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project.

OBJECTIVE: Ethiopia is one of the Africa's signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia. STUDY DESIGN: The study is community-based cross-sectional study. STUDY SETTING: Dabat and Gondar Zuria districts, Northwest Ethiopia. PARTICIPANTS: Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis. METHODS: A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination. OUTCOMES: Incomplete or not at all vaccination. RESULTS: The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25). CONCLUSIONS: In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.

High Hidden Burden of Diabetes Mellitus among Adults Aged 18 Years and Above in Urban Northwest Ethiopia.

BACKGROUND: Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose (FBS) ≥ 126 mg/dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association. RESULT: Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06, 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes. CONCLUSION: The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services.

Economic Burden and Predictors of Cost Variability Among Adult Cancer Patients at Comprehensive Specialized Hospitals in West Amhara, Northwest Ethiopia, 2019.

BACKGROUND: Cancer is the second leading cause of death in the world and accounts for 5.8% of deaths in Ethiopia. High out-of-pocket payment for the cost of illness of cancer could be linked to the low adherence to cancer treatment. This study aimed to assess the economic burden and predictors of cost variability among adult cancer patients at comprehensive specialized hospitals in West Amhara, Northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from January to February 2019 at the University of Gondar and Felege Hiwot hospitals. The cost of illness of cancer was estimated using a bottom-up micro-costing approach. Direct costs of illness of cancer were measured by calculating out-of-pocket expenditure. The indirect costs were estimated using human capital model approach. Multiple linear regression was used to identify the predictors for the log-transformed data. Unstandardized ß-coefficient with 95% CI and p-value < 0.05 were used to declare factors associated with cost of illness of cancer. RESULTS: The mean cost of cancer illness among adult patients was US$ 1103.7 ±33.2, and median cost was US$ 951.0 with IQR of 822.1. Factors such as urban residents (ß = 0.147; 95% CI: 0.047, 0.246), distance (ß = 0.0007; 95% CI: 0.0002, 0.001), married (ß = 0.125; 95% CI: 0.037, 0.212), higher education (ß = 0.318; 95% CI: 0.202, 0.435), buying drugs at private facilities (ß = 0.134; 95% CI: 0.026, 0.243), richest households (ß = 0.320; 95% CI: 0.143, 0.496) and frequent cycles of chemotherapy (ß = 0.093; 95% CI: 0.061, 0.125) were positively associated with cost, while being female patients (ß = -0.144; 95% CI: - 0.210, - 0.018) were negatively associated. CONCLUSION: The cost of illness of cancer was high. The government, therefore, should expand health insurance and invest an additional budget to safeguard patients from financial catastrophic shock.

Rotavirus Vaccine Coverage and Associated Factors Among a Rural Population: Findings from a Primary Health-Care Project in Two Northwest Ethiopia Districts.

OBJECTIVE: Rotavirus vaccines reduced severe rotavirus disease by more than 60% during the first year of life. In Ethiopia, however, about 28% and 6% of diarrheal disease hospitalizations and deaths among under-five children are associated with rotavirus, respectively. Therefore, this study aimed to investigate rotavirus coverage and associated factors in a rural population of the northwest, Ethiopia. METHODS: A community-based cross-sectional study was conducted from May to June 2019, in Dabat and Gondar Zuria districts, northwest Ethiopia. Data from 603 mothers paired with children aged 12-36 months were collected through house-to-house visits. Variables having a p-value <0.05 were considered to have a significant association with the outcome. Odds ratio (OR) with its 95% confidence interval (CI) was used as a measure of association. RESULTS: The prevalence of rotavirus vaccine coverage among children was 76.60% (95% CI; 69.98, 83.22). The dropout rate for rotavirus vaccine dose 2 out of rotavirus vaccine dose 1 was 1.99%. Mothers with formal education [AOR = 3.04; 95% CI: 1.63, 5.67] and received postnatal care [AOR = 4.37; 95% CI: 2.62, 7.27] had higher odds of rotavirus vaccine completion versus those without formal education and had not received postnatal care, respectively. Similarly, mothers who took <1 hour to reach the vaccination center ([AOR = 2.38; 95% CI: 1.34, 4.2]) were positive predictors of rotavirus vaccine completion. CONCLUSION: Rotavirus vaccine coverage in our study area was lower than the expected WHO target. Formal education, postnatal care, and time taken to reach vaccination centers were predictors to achieving full rotavirus vaccine coverage of children. Health-care services utilization after delivery should be intensified to improved child rotavirus vaccine completion in the districts. The long travel time should be dealt with by strengthening outreach services and increasing the number of new vaccination centers in the districts.

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation.

BACKGROUND: Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system's objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies' employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies' employees in northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies' employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance. RESULTS: Overall, 32% (95% CI: 27.7-36.2) of the government-owned companies' employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69-27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12-2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39-0.92), work experience (AOR: 0.49, 95% CI: 0.26-0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04-0.71) were significantly associated with acceptance of SHI among government-owned companies' employees. CONCLUSIONS: One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.

Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project.

BACKGROUND: The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. METHODS: A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. RESULTS: The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. CONCLUSIONS: The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.

Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia.

PURPOSE: Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia. PATIENTS AND METHODS: An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients' medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables. RESULTS: The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment. CONCLUSION: The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.

Prevalence and determinants of modern contraceptive utilization among rural lactating mothers: findings from the primary health care project in two northwest Ethiopian districts.

BACKGROUND: Contraceptive utilization is a guarantee to avert unwanted pregnancies. In Ethiopia however, more than half of the rural women have shorter birth intervals. Consequently, 17 and 8% of the births have been either mistimed (wanted at later date) or unwanted, respectively. Therefore, this study investigated modern contraceptive utilization and its predictors among rural lactating women. METHODS: A community based-cross-sectional study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, northwest Ethiopia. Data from 603 lactating mother were collected through face to face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were fitted to identify the independent predictors of modern contraceptive utilization. RESULTS: The overall prevalence of modern contraceptive (MC) utilization rate was 45.8% [95% CI: 38.01, 53.59]. The contraceptive method mix was dominated by Depo-Provera (39.8%) followed by implants (4.8%). The odds of utilization of contraceptive were 5.58 times higher among mothers of children with fully immunized [AOR = 5.58, 95% CI: 3.45, 9.01] compared to mothers whose children were vaccinated partially or not at all. Mothers who received antenatal [AOR = 1.74, 95% CI: 1.13, 4.43] and postnatal care [AOR = 2.02, 95%CI: 1.24, 2.91) were 1.74 and 2.02 folds more likely to utilize modern contraceptives than mothers who did not receive such care, respectively. CONCLUSION: The prevalence of modern contraceptive utilization in this study area was lower than the planed national target. In the region, child immunization service is one of the promising platforms for reaching lactating mothers with modern contraceptive utilization. Our findings suggest that antenatal and postnatal care visits are the other key determinants of modern contraceptive utilization. Thus, in low-resource settings like ours, the health system approaches to improved antenatal and, postnatal care and child immunization services should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies.

Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Every year, 808 million people face catastrophic health expenditure (CHE), and 122 million people were pushed into poverty. It aggravates healthcare inequalities, incurs double burden opportunity costs, and pushes households to sit in a deep poverty trap. A few studies have been done so far; however, it is not enough to inform policy decisions. Therefore, this study aimed to assess the catastrophic out-of-pocket health expenditure and associated factors among rural households in Mandura District, Western Ethiopia. METHODS: We conducted a community-based cross-sectional study among the Mandura district's 488 rural households from April to May 2017. We used a multistage systematic sampling technique to select the participants. We fitted a binary logistic regression model to identify the factors associated with catastrophic out-of-pocket health expenditure. We used the adjusted odds ratio (AOR) with 95% CI and the p-value <0.05 to determine the variables associated with catastrophic out-of-pocket health expenditure. RESULTS: Catastrophic health expenditure (CHE) with a 40% capacity to pay (CTP) households in the study area was 22.5%. Female household head (AOR = 2.92; 95% CI: 1.44, 5.93) and household with chronic illnesses (AOR = 3.93; 95% CI: 1.78, 9.14) were positively associated with CHE and, while households who had adult household members (AOR = 0.32; 95% CI: 0.16, 0.63) were negatively associated. CONCLUSION: The overall CHE, with a 40% CTP threshold, was high. Prevention of chronic illness might help to reduce the burden of the expenditure. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help bring healthcare services equity.

Poor child complementary Feeding Practices in northwest Ethiopia: Finding from the Baseline Survey of Nutrition Project, 2016.

BACKGROUND: Improving infant and young child feeding practices is critical to improved nutrition, health, and development of children. Ethiopia adopted the WHO recommendations of child feeding practices and developed the national guideline. In spite of this fact, only few children start and received appropriate complementary feeding based on the recommendation. Therefore, the study aimed to determine dietary diversity score and its associated factors among under five children at Dabat Health and Demographic Surveillance System site (HDSS), northwest Ethiopia. METHODS: A cross-sectional community based study was carried out from February to June 2016. All children aged 6-59 months old who lived in HDSS site were included in the survey. Odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of association. Finally, variables with a P-value of < 0.05 were considered statistically significant.. RESULTS: In this study, a total of 3433 children were included. About 34.87% (95%CI: 33.27, 36.49%) of the children received adequately diversified diet. The odds of receiving adequately diversified diet was higher among children whose mother had secondary and above education (AOR = 6.51; 95%CI: 4.95, 8.56), had antenatal care (AOR = 1.90; 95%CI: 1.60, 2.26) and postnatal care visits (AOR = 1.31; 95%CI: 1.00, 1, 72), and children who feed with their family (AOR = 1.39; 95%CI: 1.17, 1.65). However, a lower dietary diversity score was observed among younger children; 6-11 months old (AOR = 0.59; 95%CI: 0.41, 0.85), and children from food insecure household (AOR = 0.76; 95%CI: 0.63, 0.92). CONCLUSIONS: Diversified diet feeding practice is low in Dabat HDSS site. Age of the child, maternal education, antenatal and postnatal care visits, and household food insecurity were significantly associated with dietary diversity of children. Hence, ensuring household food security and enhancing the coverage of maternal health care utilization are recommended to increase dietary diversity of children.

Exclusive breastfeeding and rotavirus vaccination are associated with decreased diarrheal morbidity among under-five children in Bahir Dar, northwest Ethiopia.

BACKGROUND: More than one in every ten (14%) of under-five child deaths is associated with diarrheal morbidity in Ethiopia. Although Ethiopia has implemented different health interventions like its immunization program, childhood diarrhea morbidity, on which literature is limited, continues as a public health problem. Hence, the aim of this study was to assess the prevalence of diarrheal morbidity and associated factors among under-five children in Bahir Dar, northwest Ethiopia. METHOD: A community based cross-sectional study was carried out from March 05 to April 03/2015 in Bahir Dar in which 553 mother-child pairs participated. A structured questionnaire was adapted from the World Health Organization (WHO) and the Ethiopian Demography and Health Survey (EDHS) to collect the data. Bivariate and multivariate logistic regression analyses were carried out to identify the independent predictors of diarrheal morbidity. RESULT: The overall prevalence of diarrheal morbidity was 9.4% [95% Confidence Interval (CI): 4.8, 14.0%]. No receipt of Rotavirus vaccine dose 2 [AOR = 3.96, 95%CI; 2.13, 7.33], non-exclusive breastfeeding [AOR = 2.69, 95%CI; 1.39, 5.19], unavailability of solid waste disposal system [AOR = 2.62, 95%CI; 1.19, 5.77], employed and private business occupational status of mothers [AOR = 2.10, 95%CI; 1.02, 4.31)], and less than Ethiopia Birr (ETB) 600 household monthly income [AOR = 2.10, 95% CI; 1.2, 7.2] were independently associated with diarrheal morbidity. CONCLUSION: In Bahir Dar, one in every ten of the under-five children surveyed suffered from diarrheal morbidity. Thus, implementing effective rotavirus vaccination programs, encouraging exclusive breastfeeding and emphasizing appropriate solid waste management would reduce childhood diarrheal morbidity in the region. In addition, the finding suggests that improved child care mechanisms, especially for mothers working outside the home, and efforts to increase household income should be intensified to reduce incidence of diarrhea.