Availability of comprehensive emergency obstetric and neonatal care in developing regions in Ethiopia: lessons learned from the USAID transform health activity.

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.

Hospitalized patients' pain experience before and after the introduction of a nurse-based pain management programme: a separate sample pre and post study.

BACKGROUND: Many patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain management. Hence, a nurse-based pain management programme may influence how hospitalized patients experience pain. In this study we investigated hospitalized patients' experience of pain before and after the introduction of a two-component nurse-based pain management programme. METHODS: A quasi-experimental design with a separate sample pretest-posttest approach was conducted on a convenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four inpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at baseline, before the intervention six weeks after pain management education, and finally immediately after four months of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire. RESULTS: All the samples had similar sociocultural backgrounds. The proportion of patients who reported average moderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to 48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were 53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the physical and emotional function was generally reduced across the surveys after the introduction of the nurse-based pain management programme. These reductions were statistically significant with p < 0.05. CONCLUSIONS: Though the survey findings must be taken with caution, they demonstrate that the nurse-based pain management programme positively influenced patient-reported pain intensity and functional interference at the university medical center. This shows the potential clinical importance of the programme for hospitalized patients.

Persons with Diabetes' Perceptions of Family Burden and Associated Factors.

Background: Families of a person with diabetes play a vital part in diabetes management since their support helps with regimen engagement in self-management behaviors. However, focal information on the family burden of diabetes is lacking. This study is aimed at, therefore, assessing the persons with diabetes' perceptions of family burden and associated factors at a university hospital. Methods and Materials: A facility-based cross-sectional study design was conducted from July 26 to September 26, 2021on 403 persons' with diabetes attending Jimma Medical Center diabetic clinic, the study sample was selected using a simple random sampling method. The data was collected using the Zarit burden questionnaire through face-to-face interviews. Descriptive statistics (mean, standard deviation, frequency, and percentages) were ordered logistic regression, and statistical significance was declared at P value ≤0.05. Results and Discussion. About 36.8% of the patient was in mild to moderate family burden of diabetes. Farmer (AOR 5.419; CI: 1.18, 24.872), living with partners and family (AOR: 0.110, CI: 0.018, 0.659), comorbidity (AOR 5.419; CI: 1.18, 24.872), oral hypoglycemic agent (AOR: 0.380, CI: 0.191, 0.758), and being never hospitalized before because of diabetes (AOR: 0.044, CI: 0.003, 0.571) was statistically associated with a family burden. Conclusion: About one-fourth of diabetic patient-perceived mild to the moderate family burden of diabetes, persons with diabetes who work as farmers and have comorbidities have a higher opinion of family burden, whereas those who live with partners or family members, use oral hypoglycemic medications, and have never been hospitalized for diabetes have a lower view of family burden due to diabetes. The results of this study suggest that strategies for health promotion, intervention, and prevention of diabetes at the family level should consider the interaction between family member burden and the patient's sociodemographic and disease-related factors. A further large-scale study is required to validate these findings.

Patient Satisfaction With a Nurse-Led Pain Management Program: A Quasi-Experimental Study in Ethiopia.

Introduction: Patient satisfaction is one of the important indicators of quality care. Objective: To examine patient ratings of pain management satisfaction before and after introducing a nurse-led management program. Methods: A quasi-experimental design with three cross-sectional surveys between October 1, 2016 and June 15, 2017. A total of 845 patients admitted to the four inpatient departments (medicine, surgery, maternity, and gynecology) of Jimma University Medical Centre were invited to participate in the study. A questionnaire adapted from the American Pain Society Patient Outcome Questionnaire, Pain Treatment Satisfaction Scale, and related literature was used for the survey. Data were analyzed using the chi-square test (categorical variables), t-tests for continuous variables, and robust regression to determine the effect of nurse-led management program on patient satisfaction. For all tests, p-values <.05 were considered statistically significant. Results: Of the 845 patients invited, 782 (92.5%) participated in the surveys-Survey 1: N = 256; Survey 2: N = 259; Survey 3: N = 267. The proportion of patients who perceived that staff responded within 30 min increased from 67.8% in Survey 1 to 71.1% in Survey 2 and 74.2% in Survey 3. On a scale of 1 to 5 (1 = strongly dissatisfied and 5 = strongly satisfied), the overall mean patient satisfaction with pain management was 3.61 (SD 0.80) in Survey 1, 3.81 (SD 0.86) in Survey 2, and 4.10 (SD 0.64) in Survey 3. Moreover, the patients scored significantly higher on all satisfaction items in Survey 2 (B ranged between 0.12 and 0.41) and Survey 3 (B ranged between 0.24 and 0.74) compared to Survey 1. Conclusion: The patients' ratings of their satisfaction and staff nurse responsiveness following the nurse-led pain management program have increased compared to the levels before the intervention. However, further studies, including those with a control group, are warranted to confirm the results.

Awareness of prostate cancer and its associated factors among men 40 years of age and older in Mizan Aman town, Bench Sheko zone, Southern Nations, Nationalities, and Peoples' Region, South West Ethiopia, 2019.

Background: Prostate cancer is a common cause of morbidity and mortality among men aged 40 years and older. Evidence has shown that awareness of prostate cancer plays a greater role in the early detection of prostate cancer. However, there is a paucity of information regarding prostate cancer awareness levels in Ethiopia in general and in Mizan Aman town in particular. Objectives: To assess the awareness of prostate cancer and its associated factors among men aged 40 years and older in Mizan Aman, Bench Sheko zone, Southern Nations, Nationalities, and Peoples' Region, South West Ethiopia, 2019. Methods: A community-based cross-sectional study was conducted from 1 to 30 April 2021 in Mizan Aman town. A total of 322 study subjects were selected from a total population of 1,242 in Mizan Aman town by using the simple random sampling method. Data were collected through a face-to-face interview using a structured questionnaire. Data were entered into EpiData version 3.1 and analyzed by Statistical Package for Social Science version 20. Descriptive statistics were used to summarize sociodemographic characteristics and personal history. Bivariate and multivariate regression analyses were used to explore further variables that were associated with the level of awareness. Significant associations were declared at a p-value of <0.05. The results were presented in text, tables, and charts. Results: The magnitude of prostate cancer awareness was 64%. Participants who were between 40 and 55 years of age (adjusted odd ratio = 6.16, 95% confidence interval = 2.62-14.47), who were government employees (adjusted odd ratio = 4.684, 95% confidence interval = 1.56-13.97), and whose monthly income level is greater than 5,000 birr (adjusted odd ratio = 12.45, 95% confidence interval = 3.2-47.77) were significantly associated with the level of awareness. Conclusion and recommendation: This study revealed that more than half of the men residing in Mizan Aman town had a high level of prostate cancer awareness. First-category age, better economic status, and employment were significantly associated with awareness of prostate cancer. This indicates the need for a collective effort to enhance the awareness of men regarding prostate cancer.

Perceived social supports and associated factors among diabetes mellitus patients.

Purpose: The aim of this study was to assess the Perceived Social Supports and Associated Factors Among Diabetes Mellitus Patients. Methods and materials: A facility-based cross-sectional study on 399 randomly selected adult diabetes patients was conducted at JUMC with data collection between August and September 2021.The data was collected using diabetic social support tool through face-to-face interviews and document review checklist. Logistic regression was used to determine factors associated with perceived social support in diabetes patients. Result: Two hundred nineteen (54.9%) out of 399 diabetes patients reported a good level of perceived social support. Informational support was the most reported (55.4%), followed by emotional support (52.9%), companionship support (52.9%), and instrumental or tangible support (48.8%). Having a family history of diabetes (AOR = 1.90, CI: 1.09, 3.51) and presence of chronic comorbidities (AOR = 2.01; CI: 1.08, 3.75) were positively associated with social support. Whereas unemployment (AOR = 0.09, CI: 0.02, 0.38) was negatively associated with social support. Conclusion and recommendations: One of every two diabetes patients got adequate level of social support. Health care system, along with other stakeholders could strengthen social support in line with diabetes patients' lifestyle.

Ergonomic Risk Factors for Low Back Pain among Three-Wheel Drivers in Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Driving a three-wheel car is an emerging job opportunity in most parts of developing countries. Drivers are at risk for developing low back pain (LBP). However, very little is known about the association between ergonomics factors and LBP among three-wheel drivers. OBJECTIVE: This study was aimed to identify ergonomic risk factors of LBP among three-wheel drivers. METHODS: A community-based cross-sectional study on 396 participants was conducted in the Jimma city on all selected public three-wheel drivers in March, 2020. The data were collected using a standard questionnaire adapted from the Nordic Musculoskeletal questionnaire, anthropometric measurements, and observation checklist. The collected data were entered into Epi Data and exported to SPSS version 21.0. Logistic regression analysis was used for analysis based on the p value less than 0.05, 95% C.I. Results. Among 422 planned respondents, 396 (93.8%) have given the complete response. The mean age of the study population was 27.94 (±5.45). One hundred four (26.26%) out of 396 participants had experienced low back pain in the last 12 months. Driving in sitting upright position OR = 0.32 (95% CI = 0.12-0.86), steer wheel handling OR = 3.02 (95% CI = 1.58-5.77), not holding extra passengers OR = 0.35 (95% CI = 0.21, 0.60), rest breaks, and brand of the three-wheel vehicles were significantly associated with LBP. CONCLUSION: Nearly more than one-fourth of three-wheel drivers in our study had LBP. The finding implies a significant number of three-wheel drivers are at risk of developing reduced well-being. An appropriate health visit, lifestyle modification, and adequate policy should be established in the study area.

Cancer Warning Symptoms Awareness and Associated Factors Among Individuals Living in Assella Town, Ethiopia.

INTRODUCTION: Community awareness about cancer warning symptoms and risk factors in the general population is essential and can be considered as a basis for cancer control programs. Since Patients are rarely aware of the early warning symptoms and cancer risk factors, the burden of disease is increasing everywhere in the world. Evidences has been shown that cancer is highly prevalent in Ethiopia in which the diagnosis is made at later stages of the disease. OBJECTIVE: To assess Cancer Warning Symptoms awareness and associated factors among individuals living in Assella Town, Ethiopia. METHODS: A community-based cross-sectional study was employed in Assella town from May 1st to June 1st, 2020 among 410 adult residents 18 years old and above. A systematic random sampling technique was employed to select the households from which the study subjects randomly identified. Data were collected through face-to-face interview by using pre-tested structured questionnaire and entered into Epi data version 3.1 then exported to SPSS version 25.0 for analysis. Logistic regression analyses were used to identify factors associated with outcome variables. Odds ratio and 95% CI at P-values <0.05 was used to determine the presence of association. RESULTS: The findings of this study revealed that the overall level of awareness of cancer warning symptoms is 214 (52.2% (AOR = 95% CI 47.1, 56.8)). Educational level (AOR = 3.44, 95%CI, 1.50-7.88 (p = 0.003)), awareness of cancer risk factors (AOR = 2.56, 95% CI, 1.67, 3.93, (p < 0.001)) and economic status (AOR = 3.13 (95% CI 1.84, 5.33, p < 0.001)) were identified as factors significantly associated with awareness of cancer warning symptoms among adult populations. CONCLUSION: Almost one-out-of-two adults residing in Assella town has awareness about cancer warning symptoms. Educational level, awareness of cancer risk factors, and economic status among Assella town residents were identified as factors associated with good level of awareness about cancer warning symptoms.