Fathers' involvement in complementary feeding of children in Damot Woyde District, South Ethiopia: a community-based cross-sectional study.

BACKGROUND: In infant and young child feeding practice parents are the primary agents for childcare activities, such as feeding. Mothers' role in infant and young child feeding practice has been the focus of previous research. The involvement of fathers in child-feeding practice has rarely been studied. Thus, this study aimed to assess fathers' involvement in the complementary feeding of children and identify factors associated with it in Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted which included a survey, in-depth interviews, and focus group discussions (FGDs). The survey was conducted with 593 fathers who have at least one child of age 6-23 months. Four FGDs were conducted with fathers, and 21 in-depth interviews were conducted with fathers, mothers, and community health workers. The survey data were entered into Epi data software version 1.4.4.0 and statistical analysis was performed using SPSS software version 20. Bivariate and multivariate logistic regression analyses were performed and statistical significance was considered at p < 0.05. All interviews and FGDs were transcribed, coded, categorized, and analyzed using open code software version 4.0.2. RESULTS: Of the total sample of 593, 50.9% of the fathers in the study were involved in their children's complementary feeding practices. Fathers with better household income (AOR = 1.56; 95% CI: 1.09, 2.22) and good perception of child complementary feeding practice (AOR = 1.79; 95% CI: 1.28, 2.52) were more likely to be involved in their children's complementary feeding practice. The majority of the fathers had better knowledge about the recommended complementary feeding practices. CONCLUSIONS: Income-generating activities and behavioral change communication for fathers should be encouraged to improve their involvement in child feeding. Community-based nutrition programs should also give due attention to increasing the involvement of fathers.

Medical waste management-related factors affecting health and experiences of health risks among medical waste handlers in low and middle-income countries: a systematic review protocol of qualitative studies.

INTRODUCTION: Medical waste management (MWM)-related factors affecting the health of medical waste handlers (MWHs) and their health risks in low and middle-income countries (LMICs) are an important public health concern. Although studies of MWM-related factors and health risks among MWHs in LMICs are available, literature remains undersynthesised and knowledge fragmented. This systematic review will provide a comprehensive synthesis of evidence regarding the individual, system and policy-level MWM-related factors that affect MWHs' health and their experiences of health risks in LMICs. METHODS AND ANALYSIS: All qualitative studies published in peer-reviewed journals between 1 July 2011 and 30 June 2021 with full texts available and accessible will be included in the review. Seven specific electronic databases (eg, Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, ProQuest and PsycINFO) will be searched. Two authors will review the citations and full texts, extract data and complete the quality appraisal independently. A third reviewer will check discrepancies when a consensus cannot be reached on differences between the two reviewers. Data extraction will be conducted using the Joanna Briggs Institute standardised data extraction form for qualitative research. The quality of articles will be assessed using a Critical Appraisal Skills Programme checklist. Results from eligible articles will be synthesised into a set of findings using the thematic framework analysis approach and will be reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. ETHICS AND DISSEMINATION: This review is based on published articles, which does not require ethical approval because there is no collection of primary data. Findings from this review will be published in a peer-reviewed journal and presented at relevant public health conferences. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). PROSPERO REGISTRATION NUMBER: CRD42020226851.

Association of husbands' education status with unintended pregnancy in their wives in southern Ethiopia: A cross-sectional study.

BACKGROUND: Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands' education status and their wives unintended pregnancy in southern Ethiopia. METHODS: The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands' education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy. RESULTS: The proportion of unintended pregnancy in this sample was 20.6%. Husbands' education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]). CONCLUSION: Unintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.

Beliefs and intention of heterosexual couples about undertaking Couple's HIV Testing and Counselling (CHTC) services in Ethiopia.

BACKGROUND: Couples HIV Testing & Counselling (CHTC) service is an approach that may enable more people to be reached and tested for HIV. However, little is known about how couples may use this service and what they think about CHTC as an approach to finding out their HIV status. This study aimed to understand how individuals who had ever been in an ongoing heterosexual relationship for 6 months or more intended to use CHTC in Ethiopia and their beliefs about its benefits and potential harms. METHODS: Qualitative in-depth interviews were conducted in Addis Ababa, the capital city of Ethiopia, in 2017. Semi-structured interviews were undertaken with individuals who had ever been in an ongoing heterosexual relationship (n = 21) and key-informants (n = 11) including religious leaders, health care providers, and case managers. The interviews were transcribed verbatim, and an inductive thematic analysis was conducted. The data were coded to look for concepts and patterns across the interviews and relevant themes identified which captured key aspects related to the individual's views on undertaking HIV testing with a sexual partner. RESULTS: Most participants regarded CHTC as an important HIV testing approach for people who are in an ongoing heterosexual relationship and expressed the view that there was "nothing like testing together". However, many of the individual participants revealed they would prefer first to get tested alone to find out their own HIV status. They feared the consequences if they were HIV-positive, including accusations of infidelity, relationship break-up, and being exposed in the community. Many also reported being pressured to undertake CHTC before marriage by a third party, including religious institutions. Key informant interviews also discussed the requirements for CHTC before marriage. CONCLUSION: The findings of this study suggest that people may be concerned about undertaking couples HIV testing without prior individual HIV testing. The intention of many to first test alone has policy and cost implications and underscores the possible harms of the implementation of CHTC in Ethiopia. Future research should examine whether the views identified in this qualitative study are reflected more broadly among couples in the community.

Better-Educated, Older, or Unmarried Pregnant Women Comply Less with Iron-Folic Acid Supplementation in Southern Ethiopia.

Daily iron supplementation, with or without folic acid, is a proven public health intervention. Although maintaining compliance is crucial for the success of the intervention, inconsistent findings are available on compliance and its predictors in Ethiopia. The aim of this study was to estimate the iron-folic acid (IFA) supplementation compliance rate and its predictors among pregnant women in Wolaita Zone, Southern Ethiopia. A cross-sectional study was conducted in eight randomly selected health centers in Wolaita, Southern Ethiopia. A total of 647 pregnant women were included using multistage sampling procedure. Data were entered into Epi Info (a free statistical analysis software) and exported to SPSS. Bivariate relationship was explored through correlation coefficients. A multiple linear regression model was constructed to estimate the variability coefficient of the compliance rate due to selected factors. Of 647 pregnant women, only 18 (2.8%) pregnant women had received the supplement for 90 days or more. Overall, the compliance rate was 73.2% (95% CI, 70.72 to 75.79). Experiencing heartburn and vomiting significantly reduced the compliance rate. Unintended pregnancy and better education were negatively associated with compliance. By contrast, acceptability of IFA supplement, number of antenatal care (ANC) visits, and being ever married were positive predictors. On average, a pregnant woman did not take more than one-fourth of the daily IFA supplementation. During ANC visits, addressing the issues of side effects, unintended pregnancy, and acceptability of the supplement may improve compliance rate. Overall in Ethiopia, educated, older, and unmarried Ethiopian women need additional attention for successful compliance.

Uptake of couples HIV testing and counselling among heterosexual couples in Sub-Saharan Africa: a systematic review and meta-analysis.

There is a need for further research to inform policy and practice on Couples HIV Testing and Counselling (CHTC) in Sub-Saharan Africa (SSA). The aim of this systematic review and meta-analysis was to estimate and characterise the uptake of CHTC in the SSA. A comprehensive search of published studies was carried out in six electronic databases. Of 30,273 citations, 14 studies with a total of 97,030 study participants were identified. The pooled CHTC uptake was 31.48% (95%CI: 23.55-40.00) with significant heterogeneity between studies (I2 = 99.98%, p < 0.001). However, the sensitivity analysis after omitting two studies showed the pooled estimate for CHTC uptake was 24.05% (95%CI: 16.65-32.34, I2 = 99.86%, p < 0.001). Sub-group analyses indicated that both the study and population characteristics were a source of heterogeneity. The pooled CHTC uptake was higher among pregnant women and their partners (OR = 1.66, 95%CI: 1.58-1.84), and when one person in the dyad first tested individually (OR = 3.16, 95%CI: 2.69-3.72) compared to their counterparts. These findings suggest that people may be cautious of testing together as a couple. Further studies are required to explore how couples intend to use HIV-testing services including CHTC and under what circumstances CHTC may be beneficial to individuals in a relationship.

Sexual experiences and emergency contraceptive use among female university students: a cross-sectional study at Wachamo University, Ethiopia.

BACKGROUND: Although unintended pregnancy rate is declining in both developed and developing countries, it remains higher in developing countries. Ethiopia is one country with a high prevalence of unintended pregnancy. In spite of this fact, very little is known about utilization of emergency contraception (EC) among young women. Therefore, this study aims to assess sexual experiences and emergency contraception use among female students at Wachamo University in Ethiopia. METHODS: A cross-sectional study was conducted from March to April 2013 at Wachamo University in Ethiopia. A pretested self-administered questionnaire was used to assess sexual experiences and emergency contraception use among female students. The study participants (n = 424) were selected using a multistage sampling procedure. A simple random sampling technique was applied to select the study participants from a list obtained in registrar's office. Data was entered into EpiInfo and exported to SPSS for analysis. Bivariate and multivariate logistic regression analyses were used to determine factors associated with emergency contraception use. RESULT: The majority of respondents (62.0%) were 20-24 years old and 31.4% were sexually active. Among sexually active, the mean (standard deviation) age at first sex was 18.22 (SD = 1.69). About one-half participants had high levels of knowledge about EC (49.8%) and positive attitudes towards EC (47.6%). Moreover, 44.4% of sexually active participants used EC at least once after unprotected sexual intercourse. The bivariate logistic regression revealed that age, marital status, religion, previous & current residence, parent's educational status, knowledge about and attitude towards EC has a significant (P < 0.005) association with EC use. Furthermore, the multivariate analysis indicated that female students who have good knowledge, and ever got married were more likely to use EC than their counterparts (P < 0.05). CONCLUSIONS: Emergency Contraception use, knowledge about and attitude on Emergency Contraception were very low among female students. Overall, knowledge on EC and marital status were predictors for EC use. Thus, it is an indication that there is a need for health education and promotion programs in university set-up to improve EC use to prevent unintended pregnancies.

Interpretation of national policy regarding community-based use of misoprostol for postpartum hemorrhage prevention in Ethiopia: a tale of two regions.

INTRODUCTION: Postpartum hemorrhage (PPH) is responsible for a significant proportion of maternal mortality in developing countries. The uterotonic drug misoprostol (Cytotec) is a safe and effective means of preventing PPH. However, ministries of health in some countries are still grappling with policy that addresses the implementation of this targeted intervention in community settings and with communicating this policy throughout the health care system. The purpose of this study was to examine understandings of national policy for community-based use of misoprostol to prevent PPH in 2 regions of Ethiopia: Amhara and Oromiya. METHODS: Qualitative in-depth interviews were conducted with a cohort of purposefully selected health officials (N = 51) representing various administrative levels of the Ministry of Health and influential nongovernmental organizations. Broad topics included national policy for PPH prevention, safety and effectiveness of community-based use of misoprostol, and preferences for misoprostol administration. Interview transcripts were analyzed for key concepts both across and within administrative levels. RESULTS: Among all officials, understandings of national policy for community-based PPH prevention using misoprostol were unclear. Officials in Amhara tended to adopt a strict interpretation that reflected fear of misuse and a deep concern for encouraging home birth (thus deviating from the clear national goal to increase facility-based birth). Conversely, Oromiya officials framed policy in terms of the broader national goal to reduce maternal mortality, which allowed them to adopt multiple means of misoprostol distribution. DISCUSSION: The differences observed in regional practice likely stem from an ambiguously perceived national policy within a climate of decentralization that allowed for flexibility in local implementation. A policy that is clear, specific, evidence-based, and systematically communicated may facilitate common understanding of community-based misoprostol for PPH prevention and, thus, increase women's access to this lifesaving intervention.