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1.
BMC Health Serv Res ; 22(1): 1307, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36324131

RESUMEN

BACKGROUND: In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. METHOD: At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. RESULT: At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. CONCLUSION: The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.


Asunto(s)
Cesárea , Muerte Materna , Recién Nacido , Estados Unidos , Femenino , Embarazo , Humanos , Etiopía/epidemiología , Mortinato , Estudios Transversales , United States Agency for International Development
2.
Reprod Health ; 19(1): 15, 2022 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-35062951

RESUMEN

BACKGROUND: Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia. METHODS: This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP. RESULTS: The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37-0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67-0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67-2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01-1.48) were associated with a higher likelihood of an unmet need for FP. CONCLUSION: The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.


Family planning is a method that couples can use to limit the number of child or space the gap. Unmet need for family planning is defined as the percentage of reproductive age women who wants to space or limit the number of children but not currently using any family planning method. There is a huge proportion of eligible women have an unmet need for family planning in Ethiopia. The health extension program is one of the strategies to reach rural women to improve the health of the community. Although, family planning service is one of the packages in a health extension program and this study aimed to estimate the role of health extension program in reducing unmet need for family planning. About 4991 married women were asked about the family planning use, need and the place where they get the services. During the assessment the role of health extension program was assessed by different question. Some of the major assessment areas were women exposer to service, service availability, awareness and mode of service delivery. One fourth of the women have unmet need for family planning. The family planning utilization is still low. The contribution of the health extension program in family planning service is significant. Women exposed to HEP through level 4 health extension worker and older age are significantly associated with low level of unmet need FP. The unmet need for family planning is high in rural Ethiopia. This will inform the improvement and sustainability of the program.


Asunto(s)
Servicios de Planificación Familiar , Población Rural , Anciano , Niño , Conducta Anticonceptiva , Estudios Transversales , Etiopía , Femenino , Humanos
3.
Trop Anim Health Prod ; 52(6): 3109-3112, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32583205

RESUMEN

As per the report from the OIE in 2005, infectious laryngotracheitis (ILT) has not been yet reported in Ethiopia. Hence, considering the evident clinical signs on-field associated with the disease, it felt that there is a need to identify the disease and to protect the chicken population. The study was, therefore, aimed at identifying the seroprevalence of ILT virus from the samples collected from chickens in backyard system, so as to notify its prevalence and setup recommendations for further research in the future. Consequently, cross-sectional study was conducted in eleven purposefully selected peasant associations (PA) of Ada'a district from January to May 2019 to determine ILT in backyard chickens. A total number of 426 sera sample of backyard chickens were randomly collected from 11 PA and each sera was exposed to an indirect enzyme-linked immunosorbent assay (iELISA), at the National Animal Health Diagnostic and Investigation Center, Ethiopia. Out of 426 samples, 233 (54.7%) samples were found positive for ILT virus-specific antibody. The highest prevalence was recorded in Wajitu (83.3%), whereas the least was in Giche (40.7%) PA. There was a statistically significant difference (p < 0.05) among seroprevalence and study PA. The result of this study revealed that a high prevalence of ILT virus is circulating among backyard chickens in the selected PA of Ada'a district, which could significantly affect the poultry sector. Thus, further studies on the circulating strains and the epidemiology of the disease should be carried using a molecular diagnostic test.


Asunto(s)
Pollos , Enfermedades de las Aves de Corral , Traqueítis/veterinaria , Animales , Estudios Transversales , Etiopía/epidemiología , Enfermedades de las Aves de Corral/epidemiología , Estudios Seroepidemiológicos , Traqueítis/epidemiología
4.
Artículo en Inglés | MEDLINE | ID: mdl-31427293

RESUMEN

Antimicrobial resistance (AMR) is a major public health problem that requires publicly available tools for rapid analysis. To identify AMR genes in whole-genome sequences, the National Center for Biotechnology Information (NCBI) has produced AMRFinder, a tool that identifies AMR genes using a high-quality curated AMR gene reference database. The Bacterial Antimicrobial Resistance Reference Gene Database consists of up-to-date gene nomenclature, a set of hidden Markov models (HMMs), and a curated protein family hierarchy. Currently, it contains 4,579 antimicrobial resistance proteins and more than 560 HMMs. Here, we describe AMRFinder and its associated database. To assess the predictive ability of AMRFinder, we measured the consistency between predicted AMR genotypes from AMRFinder and resistance phenotypes of 6,242 isolates from the National Antimicrobial Resistance Monitoring System (NARMS). This included 5,425 Salmonella enterica, 770 Campylobacter spp., and 47 Escherichia coli isolates phenotypically tested against various antimicrobial agents. Of 87,679 susceptibility tests performed, 98.4% were consistent with predictions. To assess the accuracy of AMRFinder, we compared its gene symbol output with that of a 2017 version of ResFinder, another publicly available resistance gene detection system. Most gene calls were identical, but there were 1,229 gene symbol differences (8.8%) between them, with differences due to both algorithmic differences and database composition. AMRFinder missed 16 loci that ResFinder found, while ResFinder missed 216 loci that AMRFinder identified. Based on these results, AMRFinder appears to be a highly accurate AMR gene detection system.

5.
Antimicrob Agents Chemother ; 60(4): 2567-71, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26856840

RESUMEN

We conducted a retrospective study of 2,149 clinicalSalmonellastrains to help document the historical emergence of antimicrobial resistance. There were significant increases in resistance to older drugs, including ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline, which were most common inSalmonella entericaserotype Typhimurium. An increase in multidrug resistance was observed for each decade since the 1950s. These data help show howSalmonellaevolved over the past 6 decades, after the introduction of new antimicrobial agents.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Salmonella/epidemiología , Salmonella typhimurium/genética , Ampicilina/farmacología , Cloranfenicol/farmacología , Evolución Molecular , Humanos , Pruebas de Sensibilidad Microbiana , Fenotipo , Vigilancia en Salud Pública , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiología , Salmonella typhimurium/clasificación , Salmonella typhimurium/efectos de los fármacos , Salmonella typhimurium/crecimiento & desarrollo , Serogrupo , Estreptomicina/farmacología , Sulfametoxazol/farmacología , Tetraciclina/farmacología , Estados Unidos/epidemiología
7.
J Antimicrob Chemother ; 70(10): 2763-9, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26142410

RESUMEN

OBJECTIVES: The objective of this study was to determine the effectiveness of WGS in identifying resistance genotypes of MDR Escherichia coli and whether these correlate with observed phenotypes. METHODS: Seventy-six E. coli strains were isolated from farm cattle and measured for phenotypic resistance to 15 antimicrobials with the Sensititre(®) system. Isolates with resistance to at least four antimicrobials in three classes were selected for WGS using an Illumina MiSeq. Genotypic analysis was conducted with in-house Perl scripts using BLAST analysis to identify known genes and mutations associated with clinical resistance. RESULTS: Over 30 resistance genes and a number of resistance mutations were identified among the E. coli isolates. Resistance genotypes correlated with 97.8% specificity and 99.6% sensitivity to the identified phenotypes. The majority of discordant results were attributable to the aminoglycoside streptomycin, whereas there was a perfect genotype-phenotype correlation for most antibiotic classes such as tetracyclines, quinolones and phenicols. WGS also revealed information about rare resistance mechanisms, such as structural mutations in chromosomal copies of ampC conferring third-generation cephalosporin resistance. CONCLUSIONS: WGS can provide comprehensive resistance genotypes and is capable of accurately predicting resistance phenotypes, making it a valuable tool for surveillance. Moreover, the data presented here showing the ability to accurately predict resistance suggest that WGS may be used as a screening tool in selecting anti-infective therapy, especially as costs drop and methods improve.


Asunto(s)
Enfermedades de los Bovinos/microbiología , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/veterinaria , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Animales , Antibacterianos/farmacología , Bovinos , Proteínas de Escherichia coli/genética , Orden Génico , Estudios de Asociación Genética , Genoma Bacteriano , Genotipo , Pruebas de Sensibilidad Microbiana , Análisis de Secuencia de ADN
8.
J Med Educ Curric Dev ; 11: 23821205241249378, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38682087

RESUMEN

OBJECTIVE: To explore the challenges of clinical education from the perspective of clinical instructors and clinical staff at Dire Dawa University College of Health Science. METHODS: An institutional-based phenomenological qualitative study was conducted. Clinical instructors and staff provided data through in-depth interviews and key informant discussions, which were facilitated by a semistructured tool and a voice recorder. A total of 17 participants, including 11 in-depth interviews (IDIs) with clinical instructors (including two key informants) and six IDIs with clinical staff were included in this study. A purposive sampling method was used to select study participants, and the data were analyzed thematically using the computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach involves six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing. RESULTS: Clinical instructors and clinical staff noted a number of challenges in clinical education, including insufficient medical equipment, low incentives, clinical site repetition, unfavorable clinical practice sites, lack of communication from instructors, skill attrition, lack of orientation for instructors and students, client/patient unwelcomingness, uncooperative healthcare workers, and poor university cooperation. CONCLUSION: The aforementioned issues contributed to the quality of clinical education and its desired impact, as outlined in this research. A multidisciplinary and collaborative effort is needed to address these challenges.

9.
Heliyon ; 10(5): e26379, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38449644

RESUMEN

The discharge of untreated or partially treated wastewater can have detrimental impacts on the quality of water bodies, posing a significant threat to public health and the environment. In Ecuador, previous research indicates a high prevalence of antimicrobial resistant (AMR) bacteria in surface waters affected by human activities, including irrigation channels. In this study, we analyzed sediment samples collected from an irrigation channel utilized for agricultural purposes in northern Ecuador, using microbiological techniques and whole-genome sequencing (WGS). Our investigation revealed the first documented occurrence of E. kobei in Ecuador and the initial report of environmental E. kobei ST2070. Furthermore, we identified the coexistence of OXA-10-type class D ß-lactamase and KPC-2-type class A ß-lactamase in the E. kobei isolate (UTA41), representing the first report of such a phenomenon in this species. Additionally, we detected various antibiotic resistance genes in the E. kobei UTA41 isolate, including blaCTX-M-12, fosA, aac(6')-lb, sul2, msr(E), and mph(A), as well as virulence genes such as bacterial efflux pump and siderophore biosynthesis genes. We also identified two intact prophage regions (Entero_186 and Klebsi_phiKO2) in the isolate. Our study presents the first evidence of E. kobei isolate containing two carbapenemase-encoding genes in environmental samples from Latin America. This finding indicates the potential spread of critical-priority bacteria in water samples originating from anthropogenic sources, such as urban wastewater discharges and livestock facilities.

10.
Microbiol Resour Announc ; 13(1): e0047723, 2024 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-38032210

RESUMEN

Here, we examine surface waters as a modality to better understand baseline antimicrobial resistance (AMR) across the environment to supplement existing AMR monitoring in pathogens associated with humans, foods, and animals. Data from metagenomic and quasimetagenomic (shotgun sequenced enrichments) are used to describe AMR in Maryland surface waters from high and low human impact classifications.

11.
JAMA Netw Open ; 7(1): e2352856, 2024 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-38265800

RESUMEN

Importance: Although there has been a reduction in stunting (low-height-for-age and low-length-for-age), a proxy of malnutrition, the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to increase awareness and resources to improve the potential for recovery. Objective: To estimate the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months. Design, Setting, and Participants: This population-based cohort study of the Birhan Maternal and Child Health cohort in North Shewa Zone, Amhara, Ethiopia, was conducted between December 2018 and November 2020. Eligible participants included children aged 0 to 24 months who were enrolled during the study period and had their length measured at least once. Data analysis occurred from Month Year to Month Year. Main Outcomes and Measures: The primary outcome of this study was stunting, defined as length-for-age z score (LAZ) at least 2 SDs below the mean. Z scores were also used to determine the prevalence, incidence, and reversal of stunting at each key time point. Growth velocity was determined in centimeters per month between key time points and compared with global World Health Organization (WHO) standards for the same time periods. Heterogeneity was addressed by excluding outliers in sensitivity analyses using modeled growth trajectories for each child. Results: A total of 4354 children were enrolled, out of which 3674 (84.4%; 1786 [48.7%] female) had their length measured at least once and were included in this study. The median population-level length was consistently below WHO growth standards from birth to 2 years of age. The observed prevalence of stunting was highest by 2 years of age at 57.4% (95% CI, 54.8%-9 60.0%). Incidence of stunting increased over time and reached 51.0% (95% CI, 45.3%-56.6%) between ages 12 and 24 months. Reversal was 63.5% (95% CI, 54.8%-71.4%) by age 6 months and 45.2% (95% CI, 36.0%-54.8%) by age 2 years. Growth velocity point estimate differences were slowest compared with WHO standards during the neonatal period (-1.4 cm/month for girls and -1.6 cm/month for boys). There was substantial heterogeneity in anthropometric measurements. Conclusions and Relevance: The evidence from this cohort study highlights a chronically malnourished population with much of the burden associated with growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia, needs to be addressed.


Asunto(s)
Trastornos del Crecimiento , Desnutrición , Masculino , Niño , Recién Nacido , Humanos , Femenino , Preescolar , Etiopía , Incidencia , Estudios de Cohortes , Prevalencia
12.
Front Water ; 62024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38855419

RESUMEN

Antimicrobial resistance (AMR) is a world-wide public health threat that is projected to lead to 10 million annual deaths globally by 2050. The AMR public health issue has led to the development of action plans to combat AMR, including improved antimicrobial stewardship, development of new antimicrobials, and advanced monitoring. The National Antimicrobial Resistance Monitoring System (NARMS) led by the United States (U.S) Food and Drug Administration along with the U.S. Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria in retail meats, humans, and food animals since the mid 1990's. NARMS is currently exploring an integrated One Health monitoring model recognizing that human, animal, plant, and environmental systems are linked to public health. Since 2020, the U.S. Environmental Protection Agency has led an interagency NARMS environmental working group (EWG) to implement a surface water AMR monitoring program (SWAM) at watershed and national scales. The NARMS EWG divided the development of the environmental monitoring effort into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from the SWAM effort will help develop robust surface water monitoring programs with the goal of assessing public health risks associated with AMR pathogens in surface water (e.g., recreational water exposures), provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, and environmental systems.

13.
Foodborne Pathog Dis ; 10(6): 514-9, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23614802

RESUMEN

Swine are the primary reservoir for foodborne illness associated with Yersinia enterocolitica. The use of antimicrobials in animal agriculture has been hypothesized as having a potential role in the increase in prevalence of zoonotic pathogens. The objective of this study was to compare the frequency of Y. enterocolitica fecal shedding in swine reared on farms with conventional antimicrobial use policies to farms that were antimicrobial free (ABF). Swine farms were selected from three regions in the United States. In each region, farms were categorized based on antimicrobial use policy. Fecal samples were collected from pigs on-farm within 48 h of harvest. The overall proportion of Y. enterocolitica and ail-harboring Y. enterocolitica-positive pigs was 10.9% and 4.0%, respectively. There were increased odds (odds ratio [OR] 6.8, 95% confidence interval [CI] 3.46-13.28) for a pig to be Y. enterocolitica positive if it was reared on an ABF farm as compared to a conventional farm. There was no significant association between farm antimicrobial use policy and isolation of an ail-harboring Y. enterocolitica from an individual pig (OR 1.8, 95% CI 0.90-3.61). The association of antimicrobial use policy with Y. enterocolitica shedding in feces should be interpreted cautiously, as antimicrobial use cannot be separated from other management factors (e.g., confinement or outdoor housing), which may be associated with risk of Y. enterocolitica in swine.


Asunto(s)
Crianza de Animales Domésticos/métodos , Antiinfecciosos/administración & dosificación , Sus scrofa/microbiología , Yersinia enterocolitica/crecimiento & desarrollo , Animales , Proteínas de la Membrana Bacteriana Externa/genética , Proteínas de la Membrana Bacteriana Externa/metabolismo , Derrame de Bacterias/efectos de los fármacos , Biomarcadores/metabolismo , Heces/microbiología , Enfermedades Transmitidas por los Alimentos/prevención & control , Humanos , Medio Oeste de Estados Unidos , Tipificación Molecular , North Carolina , Serotipificación , Yersiniosis/prevención & control , Yersinia enterocolitica/clasificación , Yersinia enterocolitica/aislamiento & purificación , Yersinia enterocolitica/metabolismo
14.
Foodborne Pathog Dis ; 10(1): 80-6, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23320426

RESUMEN

Yersinia enterocolitica is an important foodborne pathogen, and pigs are recognized as a major reservoir and potential source of pathogenic strains to humans. A total of 172 Y. enterocolitica recovered from conventional and antimicrobial-free pig production systems from different geographic regions (North Carolina, Ohio, Michigan, Wisconsin, and Iowa) were investigated to determine their pathogenic significance to humans. Phenotypic and genotypic diversity of the isolates was assessed using antibiogram, serogrouping, and amplified fragment length polymorphism (AFLP). Carriage of chromosomal and plasmid-borne virulence genes were investigated using polymerase chain reaction. A total of 12 antimicrobial resistance patterns were identified. More than two-thirds (67.4%) of Y. enterocolitica were pan-susceptible, and 27.9% were resistant against ß-lactams. The most predominant serogroup was O:3 (43%), followed by O:5 (25.6%) and O:9 (4.1%). Twenty-two of 172 (12.8%) isolates were found to carry Yersinia adhesion A (yadA), a virulence gene encoded on the Yersinia virulence plasmid. Sixty-nine (40.1%) isolates were found to carry ail gene. The ystA and ystB genes were detected in 77% and 26.2% of the strains, respectively. AFLP genotyping of isolates showed wide genotypic diversity and were grouped into nine clades with an overall genotypic similarity of 66.8-99.3%. AFLP analysis revealed that isolates from the same production system showed clonal relatedness, while more than one genotype of Y. enterocolitica circulates within a farm.


Asunto(s)
Enfermedades Transmitidas por los Alimentos/microbiología , Variación Genética , Enfermedades de los Porcinos/microbiología , Factores de Virulencia/genética , Yersiniosis/microbiología , Yersinia enterocolitica/genética , Análisis del Polimorfismo de Longitud de Fragmentos Amplificados , Animales , Proteínas Bacterianas/genética , Cromosomas Bacterianos/genética , Análisis por Conglomerados , ADN Bacteriano/genética , Reservorios de Enfermedades , Farmacorresistencia Bacteriana , Heces/microbiología , Genotipo , Humanos , Medio Oeste de Estados Unidos , North Carolina , Fenotipo , Plásmidos/genética , Serotipificación , Porcinos , Yersiniosis/transmisión , Yersinia enterocolitica/aislamiento & purificación , Yersinia enterocolitica/patogenicidad , Zoonosis , beta-Lactamasas/genética
15.
Contracept Reprod Med ; 8(1): 33, 2023 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-37221622

RESUMEN

INTRODUCTION: Improving the quality of care has been a necessary goal for family planning programs worldwide. Even though extensive work has been done, the contraceptive prevalence rate is still low (41% in Ethiopia, 30.5% in Dire Dawa) and the unmet need for contraception is high (26%) in Ethiopia. Moreover, quality of care in family planning services has an important role in increasing coverage of services and program sustainability. Therefore, the objective of this study was to assess quality of family planning services and associated factors among reproductive age women attending family planning unit in public health facilities in Dire Dawa, Eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among reproductive-age women attending a family planning unit in Dire Dawa, Eastern Ethiopia, from September 1-30/2021. A total of 576 clients were selected by systematic random sampling and interviewed using a pre-tested structured questionnaire. SPSS version 24 was used to analyze the data, which included descriptive statistics, bi-variable and multivariable logistic regression analyses. To determine the presence of an association between dependent and independent variables, AOR, P-value 0.05, and 95% CI were used. RESULTS: A total of 576 clients participated in the study and provided a response rate of 99%. The overall satisfaction of clients with FP services was 79%[95% CI:75.2%, 82.9%]. Having primary education (AOR = 2.11, 95% CI(1.11-4.24), convenient facility opening hours (AOR = 3.13, 95% CI (2.12-5.75), maintaining privacy (AOR = 4.1, 95% CI(2.50-8.12), demonstrating how to use F/P method (AOR = 1.98, 95% CI (1.01-5.20), and discussing F/P issues with husbands (AOR = 5.05, 95% CI: 3.33-7.64) were positively significantly associated with client satisfaction. CONCLUSION AND RECOMMENDATION: This study revealed that about four-fifth of the clients was satisfied with the service they received. Clients' education, facility opening hour, maintained privacy, discussion with husband, and demonstration of how to use the methods were associated with client satisfaction. Therefore, health facility heads should improve facility opening hour. Health care providers should maintain client privacy every time, and should consistently utilize information, education, and communication materials during consultation sessions by giving more attention to client who has no education. Partner's discussion on family planning issues should also be encouraged.

16.
BMJ Open Qual ; 12(4)2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37923343

RESUMEN

BACKGROUND: Quality improvement intervention (QI) was implemented from 2018 to 2021 in health facilities of developing regional states of Ethiopia. The main objective of this study was to examine the impact of QI interventions on facility readiness, service availability, quality and usage of health services in these regions. METHODS: We used district health information system data of 56 health facilities (HFs). We also used baseline and endline QI monitoring data from 28 HFs. Data were summarised using descriptive statistics and various tests. Regression analysis was employed to examine the impact of QI interventions on various outcomes. RESULT: The QI intervention improved readiness of HFs, service availability and quality of maternal and child health service delivery. The mean availability of basic amenities increased from 1.89 to 2.89; HF cleanliness score increased from 4.43 to 5.96; family planning method availability increased from 4 to 5.75; score for emergency drugs at labour ward increased from 5.32 to 7.00; and the mean score for basic emergency obstetric and newborn care service availability increased from 5.68 to 6.75; intrauterine contraceptive devices removal service increased from 39.3% to 82.1%; and partograph use increased from 53.6% to 92.9%. HFs that use partograph for labour management increased by 39.3%. The QI intervention increased the quality of antenatal care by 29.3%, correct partograph use by 51.7% and correct active third-stage labour management, a 19.6% improvement from the baseline. The interventions also increased the service uptake of maternal health services, but not significantly associated with improvement in contraceptive service uptake. CONCLUSION: The integrated QI interventions in HFs could have an impact on facility readiness for service delivery, service accessibility and quality of service delivery. The effectiveness of the QI intervention should be evaluated using robust methods, and efforts to enhance contraceptive services through a QI approach requires further study.


Asunto(s)
Servicios de Salud del Niño , Servicios de Salud Materna , Recién Nacido , Niño , Humanos , Embarazo , Femenino , Mejoramiento de la Calidad , Etiopía , Anticonceptivos
17.
Microbiol Spectr ; 11(6): e0148223, 2023 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-37812012

RESUMEN

IMPORTANCE: In developed countries, the human diet is predominated by food commodities, which have been manufactured, processed, and stored in a food production facility. Little is known about the application of metagenomic sequencing approaches for detecting foodborne pathogens, such as L. monocytogenes, and characterizing microbial diversity in food production ecosystems. In this work, we investigated the utility of 16S rRNA amplicon and quasimetagenomic sequencing for the taxonomic and phylogenetic classification of Listeria culture enrichments of environmental swabs collected from dairy and seafood production facilities. We demonstrated that single-nucleotide polymorphism (SNP) analyses of L. monocytogenes metagenome-assembled genomes (MAGs) from quasimetagenomic data sets can achieve similar resolution as culture isolate whole-genome sequencing. To further understand the impact of genome coverage on MAG SNP cluster resolution, an in silico downsampling approach was employed to reduce the percentage of target pathogen sequence reads, providing an initial estimate of required MAG coverage for subtyping resolution of L. monocytogenes.


Asunto(s)
Listeria monocytogenes , Humanos , Listeria monocytogenes/genética , Microbiología de Alimentos , Filogenia , ARN Ribosómico 16S/genética , Ecosistema , Alimentos Marinos
18.
Front Glob Womens Health ; 4: 1131626, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37664420

RESUMEN

Background: Cultural practices are any experiences or beliefs that are socially shared views and behaviors practiced in a certain society at a certain time. Cultural malpractices are defined as socially shared views and traditionally accepted behaviors experienced in a certain society that harm maternal health. Worldwide, the period of pregnancy, labor, and delivery is embedded with different beliefs, customs, and rituals in different societies that contribute a lot to maternal death. They are responsible for the annual deaths of 303,000 mothers and 2.7 million newborns globally. In developing countries, it accounts for approximately 5%-15% of maternal deaths. In Ethiopia, approximately 18% of infant deaths occur due to cultural malpractice, and 52% of pregnant mothers give birth at home following cultural customs in Dire Dawa city. The objective of this study was to assess cultural malpractices during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa City in 2021. Methods: Community-based mixed study was conducted. A total of 624 study participants were selected through a systematic random sampling technique, and a purposive sampling method was used for qualitative data. The study was conducted in the randomly selected Kebeles of Dire Dawa City, Eastern Ethiopia, from November 1 to December 30, 2021. Data were entered into Epi Data version 4.1 and exported to SPSS version 24 for analysis. Bivariate and multivariate analyses were done, and the degree of association was measured by using the odds ratio with 95% CI and significance was declared at a p-value of <0.05. The qualitative data were analyzed thematically using ATLAS-ti version 7. Results: The overall prevalence of cultural malpractice during pregnancy, childbirth, and the postnatal period was 74.6% [95% CI: 70.59%, 77.49%]. Women over the age of 35 were two times more likely [AOR 2.61, 95% CI, 1.45-4.72] to commit cultural malpractice than women aged 15-24 and 25-34. Those with no antenatal care (ANC) follow-up were three times more likely to commit cultural malpractice [AOR 3.57, 95% CI, 1.72-7.40], those who were absent from health education were nearly two times more likely to commit cultural malpractice [AOR 1.83, 95%CI, 1.25-2.67], and women whose culture allows harmful traditional practices were nearly two times more likely to commit cultural malpractices than their counterparts [AOR 1.69, 95%CI, 1.29-2.54]. Conclusion: In this study, nearly three-fourths of participants were involved in cultural malpractices. Therefore, strengthening community education and behavioral change messages on the importance of ANC and avoiding unhealthy care during pregnancy, childbirth, postnatal and neonatal periods, especially with pregnancy at old age (age > 35), may help to reduce cultural malpractices.

19.
Ethiop J Health Sci ; 33(Spec Iss 1): 49-62, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38362476

RESUMEN

Background: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre-service training status and perceived competency in Ethiopia. Methods: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross-sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. Result: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. Conclusions: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs.


Asunto(s)
Servicios de Salud Materna , Humanos , Femenino , Embarazo , Estudios Transversales , Capacitación en Servicio , Curriculum , Etiopía
20.
Ethiop J Health Sci ; 33(Spec Iss 1): 15-24, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38362473

RESUMEN

Background: In Ethiopia, the community health information system (CHIS) is implemented at the health post (hp) level with the aim of improving service delivery and use. We conducted a national level assessment of CHIS utilization and explored the associations of CHIS utilization with use of antenatal care (ANC), postnatal care (PNC), institutional delivery and child immunization in rural Ethiopia. Methods: We conducted a cross-sectional study measuring community-based health service use and HP based CHIS assessment from March to May 2019. Data were collected from 343 HPs and 2,864 women who delivered in the last five years, and multistage sampling was used to select the study subjects. We used descriptive statistics for CHIS implementation and service utilization and multilevel logistic regression to investigate the association of CHIS implementation with maternal and child health care services use. Results: Fifty five percent of the HPs were implementing CHIS. These HPs were using a paper-based household data collection tool called family folder (FF). Of the HPs, one third implemented lot quality assurance sampling (LQAS) based data quality check and 60.4% documented and followed execution of decisions. Overall, among the eligible women, 40% used ANC, close to 50% of currently married women used ANC services; 28% of women that fall in the high wealth index category used PNC within 48 hours after delivery; and 86.1% of women who had at least a high school education delivered at a health facility. Implementation of CHIS and family folder utilization and conducting LQAS based data quality check in the HPs were significantly associated with increased odds of ANC, delivery, and vaccination services use. Conclusion: We found that better implementation of CHIS was associated with better maternal and child health service use which implies that increasing utilization of CHIS at HPs will improve mother and child health service use.


Asunto(s)
Sistemas de Información en Salud , Servicios de Salud Materna , Niño , Femenino , Embarazo , Humanos , Etiopía , Estudios Transversales , Muestreo para la Garantía de la Calidad de Lotes , Utilización de Instalaciones y Servicios , Aceptación de la Atención de Salud , Atención Prenatal , Población Rural , Parto Obstétrico
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