Qualitative enquiry on factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia.

Background: The major driver of antibiotic resistance is the huge increase in antibiotic prescribing, especially in low- and middle-income countries. Aim: This study aimed to explore factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia. Methods: The study was part of a three-phased explanatory sequential mixed method design. The study was conducted in five primary healthcare facilities through in-depth interviews of 20 prescribers and 22 key informants using pre-prepared interview guides. The data were analysed through thematic content analysis by applying ATLAS.ti 9 software. Results: The antibiotic prescribing decision of prescribers was shown to be affected by various factors. The factors related to prescribers include not updating oneself on antibiotic use and antibiotic resistance, not reviewing patient history, not considering the concerns related to antibiotic resistance during prescribing, and competency problems. The patient-related factors were low awareness about antibiotics, lack of respect for prescribers, and pressure on prescribers. The shortage of antibiotics and laboratory reagents, a lack of updated antimicrobial resistance information, patient load, inadequate capacity, private sector practice, inadequate follow-up and support, and health insurance membership were the system-related factors. Appropriate interventions should be designed and implemented to address the identified factors and improve the prescribing practice.

Cost of wound dressing: Implication for enrollment into the National Health Insurance scheme, Nigeria.

BACKGROUND:  Enrollment into the National Health Insurance scheme (NHIS) still poses a challenge in Nigeria despite the established Group, Individual and Family Social Health Insurance Programme (GIFSHIP) during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES:  This study examined the direct cost of wound dressing and enrollment into the health insurance scheme among hospitalised patients. METHOD:  A descriptive cross-sectional research design was utilised to investigate the cost of wound dressing and enrollment into health insurance scheme among hospitalised patients in three selected hospitals of South-West Nigeria. The study was conducted from March 2021 to June 2021, and 190 patients were recruited via an interviewer-administered questionnaire. Ethical approvals were obtained from the hospitals while COVID-19 preventive protocols and ethical principles of autonomy, confidentiality and non-maleficence were observed. RESULTS:  Majority of the respondents (91%) were not on any healthcare insurance scheme, only 4.2% were enrolled in NHIS while over 70% could not personally pay for their wound dressing. The minimum average cost of wound dressing materials per week and per acute care episode was ₦10 000.00 (Nigerian naira) and ₦50 000.00, respectively, while the minimum average cost for hospitalisation per week and per acute care episode was ₦18 000.00 and ₦130 000.00, respectively, ($1.00 equaled ₦600.00, June 2022). CONCLUSION:  A lack of health insurance coverage is a precursor of 'out of pocket' payment. A political will is required to scale up enrollment of the indigenous population into the NHIS in Nigeria.Contribution: Many hospitalised patients are not enrolled in the NHIS and they are at a higher risk of catastrophic healthcare expenditure.

Socio-cultural factors perceived to influence sexual behaviours of adolescents in Ethiopia.

BACKGROUND: Adolescence is a period of transition from childhood to adulthood. It is the age of experimentation. They are vulnerable to the undesirable effect of sexual and reproductive health (SRH) problems such as human immunodeficiency virus, sexually transmitted infections and unsafe abortion and childbirth-related risks. AIM: To explore and describe perceived organisational, community and societal level factors that influence sexual behaviours among adolescents in Ethiopia. SETTING: The study was conducted by public health care organisations, youth centres and non-governmental organisations in Addis Ababa, Ethiopia. METHODS: A qualitative descriptive study design was conducted with purposively selected health professionals and adolescents in Addis Ababa from June 2019 to February 2020. The data were collected using in-depth interviews, key informant interviews and focus group discussions. Transcribed interviews were imported to ATLAS. ti 7 for coding, categorising and creating themes using thematic analysis. Lincoln and Guba's model was used to ensure trustworthiness and ethical standards were applied. RESULTS: Poor school involvement, social norms on sexual behaviour and lack of condom acceptability by the general population, financial problems and the gap in law enforcement were found perceived factors influencing sexual behaviour of adolescents. CONCLUSION: Adolescents are engaging in various risky sexual behaviours because of various organisational, community level and societal level factors, which emphasises the need to introduce social and culturally acceptable age-appropriate comprehensive sexuality education for adolescents and other multilevel interventions.Contribution: Provide an in-depth understanding of the influence of sociocultural issues related to adolescent sexual behaviour for health system stakeholders.

Challenges and coping strategies among young adults living with perinatally acquired HIV infection in Botswana. A qualitative study.

BACKGROUND: Due to antiretroviral therapy, many people with perinatally acquired HIV are surviving into young adulthood which is a critical period of human development. Research conducted in various settings globally has shown that young adults living with perinatally acquired HIV (YALPH) face multiple challenges related to HIV infection while also confronting the same challenges of young adulthood faced by other HIV-negative youth. However, there is a paucity of information on YALPH in Botswana and what needs to be done to improve their health and wellbeing. Therefore, this study explores the challenges and coping strategies of YALPH in order to inform health policies and programming in Botswana. METHODS: In-depth interviews were conducted with 45 YALPH (ages 18-27 years) who were enrolled on antiretroviral therapy at the Botswana-Baylor Children's Clinical Centre of Excellence (Botswana-Baylor Clinic). The Botswana-Baylor Clinic is the largest centre for pediatric, adolescent, and young adult HIV treatment and care in Botswana. The maximum variation sampling method was used to select information-rich participants. The questions focused on the challenges YALPH faced and how they coped with HIV. The data was analyzed using content analysis. RESULTS: The results showed that the majority of YALPH had suppressed HIV viral load and perceived themselves to be in good physical health and functioning. They did, however, face numerous challenges, including occasional or longstanding poor antiretroviral therapy adherence, disabilities and impairments, poor school performance and attainment, unemployment, financial stressors, fear of stigma, disclosure worries and concerns, and limited social support. The most vulnerable YALPH included those with disabilities and impairments, those transitioning out of residential care, young parents, the unemployed, and those with maladaptive coping strategies. The YALPH mainly used adaptive coping strategies. The most commonly used maladaptive coping strategies were self-distraction and venting. CONCLUSION: Interventions to prevent, screen for, assess, and manage the challenges identified by this study are critical to improving the health and well-being of YALPH. In addition, diverse interventions that can contribute to the development of adaptive coping mechanisms and reduce the likelihood of maladaptive coping in YALPH should be sought.

Use of home remedies for the treatment and prevention of coronavirus disease: An integrative review.

Background and Aims: Home remedies are understood to mean medications or tonics prepared at home to treat certain ailments without any prescription or professional supervision. Reliance on home remedies increased during coronavirus disease 2019 (COVID-19). The aim of this integrative review was to identify home remedies used to treat and prevent COVID-19 and discuss implications for nursing practice and health related to the safety and efficacy of home remedies. Methods: Cooper's integrative review method guided this study to identify home remedies used to prevent and treat COVID-19. Google Scholar, BMC, EBSCOhost, Medline, Academic Search Ultimate, Web of Science Core Collections, Science Direct and Global Health were used to search for relevant information on the use of COVID-19 home remedies from 2019 to 2022. The Critical Appraisal Skills Program (CASP) checklist was used to select studies that had to be included. The eligibility criteria included studies on home remedies, written in English from 2019 to 2022. Findings of qualitative, quantitative and mixed-methods research were extracted, and narrative thematic data synthesis was applied. Results: Eleven articles which met the inclusion criteria were found in nine countries: Ghana (1), South Africa (1), Tanzania (1), Togo (1) and Zimbabwe (1), Bangladesh (1), Hong Kong (1), India (2), Iran (1), and Pakistan (1). Findings showed that home remedies are used for the prevention of COVID-19 infection, treatment of COVID-19, and boosting immunity. Conclusions: Home remedies have been found to be more pronounced across all sectors and social strata. More research is needed on the use of home remedies for life-threatening outbreaks. Policymakers and healthcare workers are challenged to encourage the use of home remedies in the prevention of other ailments and epidemics that might occur in the future.

Enablers to enhance school-based adolescents with intellectual disabilities' learning: A narrative approach.

Society has always understood individuals with intellectual disabilities from a stance of deficiency, resulting in limited expectations and prospects for school-going adolescents with intellectual disabilities. The study used the social model of disability to explore teachers' perceptions of enablers to enhance school-based adolescents with intellectual disabilities' learning and took cognisance of a wave of policies aimed at including adolescents with intellectual disabilities in mainstream education. A qualitative narrative approach was used for the study. Using a narrative methodological framework, unstructured interview questions were posed to elicit teachers' perceptions of enablers to enhance adolescents with intellectual disabilities' learning. A non-probability purposive sampling method was used to select teachers working with school-based learners with intellectual disabilities. Five themes emerged from the analysis: therapeutic setting; learners' resilience; parental support; teaching strategies; and community involvement as enablers for enhancing learning for adolescents with intellectual disabilities. Policy implications are also provided in the study.

Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana.

Background: Due to the successful antiretroviral therapy (ART) programme in Botswana, large numbers of perinatally HIV-infected adolescents are emerging into young adulthood. Young adulthood is a critical period of human development. However, there is lack of information on the factors affecting the health-related quality of life (HRQOL) of young adults living with perinatally acquired HIV (YALPH) in Botswana. Objectives: The objective of this study was to assess the HRQOL and its determinants among YALPH who were enrolled on ART at Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana. Method: A cross-sectional study assessed the HRQOL of 509 YALPH aged 18-30 years using the WHOQOL-HIV BREF. Data about other variables of interest were abstracted from medical records. Bivariate analyses were performed using t and Chi-square tests to determine the associations between demographic and clinical variables and general HRQOL. The variables that were associated with the general HRQOL at P-value < 0.1 were included in the multivariable analysis using the logistic regression approach. Results: The majority of participants had good general HRQOL (78.4%). The highest mean HRQOL score was in the Physical domain (5.4 [± 2.9]) and the lowest in the Environment domain (13.8 [± 2.7]). The factors that were significantly associated with the general HRQOL included: level of education attained (P = 0.012), employment status (P = 0.069), viral load suppression (P = 0.073) and self-reported illness (P = 0.001). Conclusion: Interventions that effectively increase educational attainment, employment opportunities, ART adherence, and prevention or management of illness are needed to promote good HRQOL among YALPH in Botswana.

Foreign nurse educators' lived experiences of incivility: The case for Botswana.

BACKGROUND: In light of current economic prosperity and subsequent attainment of upper-middle-income country status, Botswana attracted nurse educators from other African countries. Within this cross-cultural environment, anti-immigrant sentiments have catalysed incidents of incivility, affecting the quality of teaching and learning outcomes. OBJECTIVES: The aim of this study was to explore experiences of incivility amongst foreign nurse educators and how it impacts their work and livelihood. METHOD: This study employed a qualitative approach, using interpretive phenomenology. In-depth interviews using a developed guide were conducted with 13 foreign nurse educators working as nurse educators in Botswana. Thematic analysis was conducted in accordance with interpretive phenomenology, where transcriptions were drafted after each interview. RESULTS: Three themes emerged from the study findings: hostile behaviour, discrimination and inequitable application of procedures and processes. Discrimination as a theme has two sub-themes, namely, workplace injustice and individual injustice. CONCLUSION: The study found that foreign nurse educators working in Botswana experience incivility. From the findings, the study strongly recommends application of equitable job opportunities to all employees, including foreign nurse educators who are employed to meet the shortage of nurse educators in Botswana. The researchers are of the opinion that the nurse educator shortage will persist in Botswana, partly because of the nursing profession rendered unattractive by hostile social interactions amongst nurse educators' exclusion of foreign nurses from benefits enjoyed by local nurse educators, workplace injustice targeting foreign nurse educators, as well as inequitable application of policies and processes that affect foreign nurse educators.

Transition of adolescents with intellectual disability from schools for learners with special educational needs: Parents views for the preparedness.

BACKGROUND: Studies on preparedness of parents of adolescents living with intellectual disabilities transitioning from school to adulthood are scarce in sub-Saharan Africa. This study explored views of parents on their preparedness to handle adolescents transitioning from special schools to adulthood. METHODS: Descriptive qualitative method was used to collect views of parents of adolescents with intellectual disability on their preparedness to handle transition of their children from school into community life. Content analysis was used to analyse the data. FINDINGS: Twelve female and two male participants expressed concerns on lack of transition plans, adolescent's future, culture and beliefs and inadequate community support. Views of parents of younger children and those of parents of older children were similar. CONCLUSION: Parents were unprepared for transition of their children from school to community life. Multidisciplinary approach including family involvement and community support is necessary to enhance the transition of adolescents with intellectual disability.

Nurses' perceived role in healthcare transition of adolescents with intellectual disabilities.

BACKGROUND: Nurses' role in the transition of adolescents living with intellectual disabilities (IDs) has always been neglected. The primary role of nurses is to promote health, provide nursing care, alleviate suffering and rehabilitate. Improving the quality of life for individuals with ID when they undergo the healthcare transition process from adolescence to adulthood was previously not considered a priority. OBJECTIVES: To investigate the nurses' perceived role in healthcare transition of adolescents with ID into adulthood. METHOD: A qualitative descriptive design using semi-structured interviews with 18 nurse participants was used. The sample included 25 nurses working in care and rehabilitation centres and non-governmental organisations in Tshwane district, Gauteng province, South Africa. RESULTS: Three main themes that emerged from the analysis were support systems, advocacy and health promotion. CONCLUSION: The findings of this study clearly show the need for a strong healthcare support system to facilitate a successful transition process of adolescents with ID. The study findings support the view that nurses can play a key role in assisting individuals with ID and their families in dealing with the challenges of healthcare transitioning into adulthood.

Reproductive health outcomes: Insights from experts and verbal autopsies.

BACKGROUND: Reproductive health outcomes are a measure of maternal and neonatal health. South Africa's state of maternal health is of particular concern because of the two Millennium Development Goals (MDGs) targets for monitoring maternal health, namely MDG 5a, to reduce the maternal mortality rate by three-quarters, and MDG 5b, to achieve universal access to reproductive health by 2015. Maternal mortality ratio and universal access to reproductive health receive unequal responsiveness from government. Monitoring the maternal mortality ratio has received favourable attention compared to ensuring universal access to reproductive health, hence the limited published research findings on the latter. OBJECTIVES: The purpose of this article is to report on the insights from reproductive health experts and verbal autopsies on the determinants of poor reproductive health outcomes. METHOD: Individual interviews with a purposively selected sample of six reproductive health experts were conducted, augmented by verbal autopsies of 12 next of kin of women and newborn babies who died within the previous 2 years period of the study. Burnard's (1995) approach of content analysis was used to analyse the data. RESULTS: The findings revealed lack of empowerment, inaccessible reproductive health services and separation of patients living with human immune deficiency virus and those patients diagnosed with acquired immune deficiency syndrome. CONCLUSION: To meet the reproductive health needs, especially of the rural population, urgent attention is needed to reduce their vulnerability to the risks of poor reproductive outcomes.

The role of gender in the spread of HIV and AIDS among farmworkers in South Africa.

BACKGROUND:  Gender inequality and men's perceived sexual and economic superiority over women are central to human immunodeficiency virus (HIV) infection. The farming community in which the participants in the study live operates along such patriarchal lines, with the men making the important decisions for their families. AIM:  To explore and describe the role of gender in the spread of HIV and acquired immunodeficiency syndrome (AIDS) among farmworkers in South Africa. SETTING:  The study was conducted in the Levubu farms, Vhembe district, Limpopo Province, South Africa. METHODS:  The researchers adopted a qualitative, explorative and descriptive research design with in-depth semi-structured interviews. Purposive and convenience sampling methods were used to select participants who met the inclusion criteria. Data collected were thematically analysed using Creswell's data analysis method. Lincoln and Guba's model to ensure trustworthiness and ethical standards were applied. RESULTS:  The findings of the study clearly indicated that powerlessness and lack of decision-making by female farmworkers was common as female farmworkers were dependent on their male partners to make decisions in the workplace as well as decisions regarding sexual matters in a relationship. CONCLUSION:  The main conclusion drawn from the findings were that farmworkers are continuously exposed to exploitation and disempowerment in a variety of ways with very little support from their supervisors, which makes them vulnerable to contracting HIV.

The TEAM model for mental health promotion among school-going adolescents.

OBJECTIVE: This paper reports on the process followed in developing the "TEAM" (an acronym for the proposed intervention) model for the promotion of mental health among school-going adolescents. METHODS: A sequential explanatory mixed method combining both quantitative and qualitative approaches was used to gain in-depth understanding of the experiences of adolescents, school health nurses and teachers in dealing with emotional and social problems in high schools. Data collection was conducted in 4 phases from 2012 to 2015 and included a desk review of literature, qualitative interviews with 12 school teachers; qualitative interviews with 10 school health nurses and quantitative interviews with 347 adolescents. The quantitative tool that was used for the study was based on the Social and Emotional Learning Model. RESULTS: Key findings from the study revealed inappropriate handling of emotions by adolescents, leading them to form destructive groups (gangs); involvement in alcohol and substance abuse; disrespect; and adolescent pregnancy. CONCLUSION: A universal team-oriented collaborative model that will assist adolescents to shift negative energy and attitudes to positive and productive lifestyles is required. The TEAM model centres all the activities of a collaborative and focused team on the facilitation of a sense of belonging, ownership and complete engagement of pupils in schools that will contribute positively to social and emotional well-being.

Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda.

BACKGROUND: Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. Several initiatives aimed at reducing sexual and reproductive problems among adolescents have been done. These initiatives include life skill education and abstinence program. Despite these initiatives teen pregnancy, sexually transmitted diseases and abortion are still common among school going adolescents. OBJECTIVES: The purpose of this study was to explore the experiences and perceptions of adolescents and teachers regarding school-based sexuality education in rural primary schools. METHODS: A purposive sample was drawn from primary school-going adolescents aged 12-16 years and teachers aged 28-52 in four rural schools. Eleven audio taped individual interviews and eight focus group discussions were used to collect data. A constant comparison method of data analysis was applied by following the Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. RESULTS: Data analysis revealed that adolescents benefitted from School Based Sexuality Education but the implementation of programmes was undermined by physical and contextual factors such as challenges at national, institutional, community, family and individual levels. CONCLUSION: It is vital to review the teaching and learning resources and to fully integrate sexuality education into the formal school curriculum. A combined effort of major stakeholders including teachers, community leaders, adolescents, healthcare professionals and parents is needed for sexuality education among adolescents to succeed.

Individual determinants associated with utilisation of sexual and reproductive health care services for HIV and AIDS prevention by male adolescents.

BACKGROUND:  Adolescent sexual and reproductive health is one of the essential health care programmes in the world. However, adolescents still face numerous challenges in the area of sexual and reproductive health, which hinder their utilisation of available Sexual and Reproductive HealthCare Services (SRHCS). Male adolescents face further obstacles in accessing and utilising sexual reproductive health services owing to the influence of social constructions of masculinity, which has a bearing on how they view sexual and reproductive health services and their use. OBJECTIVES:  The aim of this study was to investigate individual determinants associated with utilisation of SRHCS for HIV and AIDS prevention by male adolescents. METHOD:  An exploratory, descriptive and contextual qualitative design was used and semi-structured interviews with 20 purposively selected male adolescents aged 18-24 years living in the South African seat of government were conducted. Data were analysed using Tesch's approach of data analysis. RESULTS:  Knowledge of existing services was described as a significant individual determinant of utilisation of SRHCS. This was linked to the quality of SRHCS and violation of human rights of male adolescents. CONCLUSION:  The study recommends the development of a strategy that will enhance and promote the utilisation of SRHCS by male adolescents.

Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients.

BACKGROUND: Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses' experience of a communication skills training intervention. METHODS: A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. RESULTS: Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. CONCLUSION: The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.

Stigma and discrimination within the Ethiopian health care settings: Views of inpatients living with human immunodeficiency virus and acquired immune deficiency syndrome.

BACKGROUND: Stigma and discrimination attached to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. Stigma and discrimination are more devastating when they occur in health care settings where it is least expected. AIM: To explore the factors attributable to stigma and discrimination of people living with HIV in two Ethiopian rural hospitals on what they thought of health care professionals (HCPs) attending to them. METHODS: A qualitative exploratory approach was used. Data collection was by means of audio-taped interview and Tesch's content analysis approach was used. The sample size for this study was determined by saturation of data and consisted of 16 participants who were people living with HIV admitted as inpatients to the two selected hospitals in Amhara region of Ethiopia. RESULTS: Participants' views were grouped into: fear of contact, delay of services, substandard services, denial of care, impoliteness of health care providers, breach of confidentiality and poor patient follow-up for persons infected with HIV. CONCLUSION: The health care settings have been recognised as one of the contexts where HIV and AIDS-related stigmatisation and discrimination can occur. Hospital policies and institutional support should be tailored to embrace people living with HIV as the provision of institutional support is imperative in creating a good working environment and improving the commitment of HCPs so as to enable them to provide holistic care for people living with HIV and AIDS (PLWHA) without discrimination.

HIV and AIDS-related stigma and discrimination in two referral hospitals in Ethiopia.

The aim of the study was to determine the magnitude of HIV and AIDS-related stigma and discrimination (SAD) and its associated factors in healthcare settings. Primary data were collected from June to September 2014 from two referral hospitals located in north-west Ethiopia. The study used pre-test/post-test design with a non-equivalent control group using a quantitative approach. Healthcare professionals were divided into strata and then, using the stratified random sampling technique, the study participants were selected from each stratum. The median age of study respondents in the treatment group was 32.2 years with standard deviation (SD) of 7.74. The regressions of stigma for the pre-tests of the first hospital and second hospital participants' knowledge about SAD-related issues and perceived risk of HIV infection were found to be significantly associated with stigma in the first hospital. In the first hospital, healthcare professionals who felt HIV risk of infection at different contact points with HIV-positive patients were more than 13 times more likely to present stigmatising attitudes towards the patients (OR = 13.46, p = 0.005). In the second hospital, only perceived risk of infection was significantly associated with stigma (p = 0.036). Interventions to lessen HIV and AIDS-related SAD in healthcare settings must focus on improving the knowledge, attitudes and practices of healthcare professionals as well as overcoming the institutional barriers existing in the healthcare settings through staff training and hospital strategy development.

Patterns of caesarean-section delivery in Addis Ababa, Ethiopia.

SETTING: The study was conducted in Addis Ababa, the capital city of Ethiopia. Specifically, it was conducted in all healthcare facilities offering maternity and obstetric services. OBJECTIVE: The objective of the study was to explore the patterns of caesarean-section (CS) delivery in Addis Ababa. METHODS: A cross-sectional survey was carried out between December 2013 and January 2014. The population for the study were women aged between 15 and 19 years of age who had given birth in the last 1-3 years before the date of data collection. The Census and Survey Processing System software was used for data capturing and analysing both descriptive and inferential statistics using Statistical Package for Social Sciences version 20.0. RESULTS: Amongst the 835 women who delivered at health facilities, 19.2% had given birth by CS. The prevalence of CS based on medical indication was 91.3%. However, 6.9% of CS performed had no medical indication. Private health facilities performed more CSs than public health facilities, 41.1% and 11.7% respectfully. CS was high amongst women of higher socioeconomic standing. CONCLUSION: Overall, CS deliveries rate in Ethiopia is above the rate recommended by the World Health Organisation. Because socio-economic factors influence CS delivery, governments should play a key role in regulating performance of CSs in private institutions.

The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia.

BACKGROUND: There are recent efforts made to eliminate inequalities in the utilisation of basic health care services. More emphasis is given for improvement of health in developing countries including maternal and child health. However, disparities for the fast-growing population of urban poor are masked by the urban averages. The aim of this paper is to report on the findings of antenatal care adequacy among slum residents in Addis Ababa, Ethiopia. METHODS: This was a quantitative and cross-sectional community based study design which employed a stratified two-stage cluster sampling technique to determine the sample. Data was collected using structured questionnaire administered to 870 women aged 15-49 years. Weighted 'backward selection' logistic regression models were employed to identify predictors of adequacy of antenatal care. RESULTS: Majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0 % of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively. Educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.7 times more likely to receive overall adequate care compared to those with no formal education. Similarly, clients of private healthcare facilities were 2.2 times respectively more likely to receive overall adequate antenatal care compared to those clients of public healthcare facilities. CONCLUSION: In order to improve ANC adequacy in the study area, the policy-making, planning, and implementation processes should address the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.