Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis.

Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.

Adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Adherence to evidence-based standard treatment guidelines (STGs) enable healthcare providers to deliver consistently appropriate diagnosis and treatment. Irrational use of antimicrobials significantly contributes to antimicrobial resistance in sub-Saharan Africa (SSA).  The best available evidence is needed to guide healthcare providers on adherence to evidence-based implementation of STGs. This systematic review and meta-analysis aimed to determine the pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in SSA. METHODS: The review followed the JBI methodology for systematic reviews of prevalence data. CINAHL, Embase, PubMed, Scopus, and Web of Science databases were searched with no language and publication year limitations. STATA version 17 were used for meta-analysis. The publication bias and heterogeneity were assessed using Egger's test and the I2 statistics. Heterogeneity and publication bias were validated using Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis. The summary prevalence and the corresponding 95% confidence interval (CI) of healthcare professionals' compliance with evidence-based implementation of STG were estimated using random effect model. The review protocol has been registered with PROSPERO code CRD42023389011. The PRISMA flow diagram and checklist were used to report studies included, excluded and their corresponding section in the manuscript. RESULTS: Twenty-two studies with a total of 17,017 study participants from 14 countries in sub-Saharan Africa were included. The pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines in SSA were 45%. The pooled prevalence of the most common clinical indications were respiratory tract (35%) and gastrointestinal infections (18%). Overall prescriptions per wards were inpatients (14,413) and outpatients (12,845). Only 391 prescribers accessed standard treatment guidelines during prescription of antimicrobials. CONCLUSIONS: Healthcare professionals' adherence to evidence-based implementation of STG for antimicrobial treatment were low in SSA. Healthcare systems in SSA must make concerted efforts to enhance prescribers access to STGs through optimization of mobile clinical decision support applications. Innovative, informative, and interactive strategies must be in place by the healthcare systems in SSA to empower healthcare providers to make evidence-based clinical decisions informed by the best available evidence and patient preferences, to ultimately improving patient outcomes and promoting appropriate antimicrobial use.

Sexual and reproductive health experiences, access to services, and sources of information among university students in Ethiopia.

Introduction: Adolescence and youth are times of major growth and change that can place young people at elevated risk of poor sexual and reproductive health (SRH) outcomes, particularly when they are living away from home for the first time. Understanding the barriers that young people face when accessing SRH services and information is imperative for addressing their SRH needs; our study explored this topic among university students in Ethiopia. Specifically, we explore university students' SRH experiences, access to services, and preferred sources of information. Methods: We draw on mixed-methods research conducted in four public universities across Ethiopia in early 2020. A random sample of 822 male and female students completed a cross-sectional survey that explored SRH knowledge, attitudes, experiences, and sources of information. We also conducted 8 focus group discussions with students and 8 key informant interviews across the four universities. Survey data were analyzed using descriptive statistics and we used structural coding and inductive analysis to analyze qualitative data. Results: The survey data demonstrated that condoms and emergency contraceptive pills were the most used contraceptive methods. Nearly 18% of female students had experienced an unwanted pregnancy, and 14% reported having had an abortion. Approximately one-third of students reported encountering gender-based violence in the past 6 months. Most students preferred receiving SRH information from mass media, and male students were more likely than female students to seek information from friends. Our qualitative findings highlight a lack of comprehensive SRH care available on university campuses, and services that are available are often of poor quality; participants described a lack of privacy, confidentiality and respect when accessing SRH care at school. University students also lack regular opportunities to learn about SRH while on campus, and their preferred sources of information varied widely. Discussion: Ethiopian university students have considerable unmet demand for SRH services and often face significant barriers to accessing high-quality information and services on campus. Consistent commitment and investment by universities and the government is vital to meeting the SRH needs of young people during this potentially vulnerable time.

Assessment of Implementation Outcome Measures for Positive Deviance Approach as a New Strategy to Promote Exclusive Breastfeeding: A Psychometric Follow-Up Study.

Background: Implementation outcomes are the effects of deliberate actions while implementing new interventions which explain the process and are preconditions to achieve the desired outcomes. Positive Deviance Approach (PDA) was implemented as a new strategy to mitigate the gaps of exclusive breastfeeding (EBF) practice in Jimma, Ethiopia. However, there was no evidence to what extent intervention participants' perceive/rate these outcomes. In addition, psychometric outcome measures lack conceptual clarity, have unknown reliability and validity to the context. Therefore, we aimed to assess implementation outcomes, determine valid and reliable scales and analyze their correlation and variation explained. Methods: A post-implementation follow-up study was conducted between August 28, 2020 and September 30, 2020 among the intervention participants of an earlier trial. A sample of 384 participants was invited to respond to an interviewer (or self)-administered structured questionnaire. The developed tool was refined through experts' comment, pre-test, and using Exploratory Factor Analysis (EFA) to determine the measurement scales, and Total Variability Explained (TVE). The reliability test was done. The mean scores were determined which indicates the extent of each scale's rate. Pearson's correlation, independent sample t-test/One-way ANOVA were used as needed. The explained variation (interdependency) of scales was checked using coefficient of determination (r2). Level of significance was declared at 95% CI and p-value of <0.05. Results: This study identified nine implementation outcomes of PDA as a new strategy to promote EBF with a TVE 72.1%. 52 valid and reliable items were developed to measure these outcomes. The maximum mean score was for "appropriateness scale" - 27.81 (6.5SD), while the minimum was for "implementation cost scale" - 11.37 (5.2SD). The overall mean score was 164.18 (26.8SD). The emerged scales explained 72.1% of the total variability in implementation outcomes. Majority (6) of outcomes of PDA were highly rated. Implementation fidelity, penetration, organizational readiness, and sustainability scores were positively and significantly correlated with acceptability of the approach. Conclusion: This study identified nine valid, reliable, well explained and correlated implementation outcomes which help to understand the success of PDA as a new strategy to promote EBF. Majority of outcome measures were highly rated by intervention participants, which suggests it is a promising approach in promoting EBF in urban community by PDs.

End-Users Satisfaction with Positive Deviance Approach as an Intervention to Promote Exclusive Breastfeeding in Jimma, Ethiopia: A Multi-Level Analysis.

BACKGROUND: Positive deviance approach (PDA) was implemented as an intervention strategy to address the poor practice of exclusive breastfeeding (EBF) in Jimma town, Ethiopia. Understanding the end-users satisfaction and its drivers is essential to determine whether this approach will be viable in the long run. Therefore, we determined the level of users' satisfaction with the intervention and identified multi-level predictors to explain variability. METHODS: The data for this follow-up study were collected from September 01 to 25, 2020 among the study participants who were living in the intervention clusters of an earlier trial. A sample of 260 participants were invited to respond to an interviewer-administered structured questionnaire that assessed both individual and community-level variables. The developed tool was refined using experts' view (face validity) and using factor analysis (FA) to validate the satisfaction measurement scales (construct validity). The mean scores were standardized using Percentages Scale Mean Score (PSMS) formulae. Two-level mixed-effects linear regression (linear mixed models) were performed to fit individual, community, and mixed-level variables. All assumptions were checked for each analysis as appropriate and ß-estimates at 95% CI and p-value of <0.05 were considered to declare a level of significance. RESULTS: The overall level of end-users' satisfaction (PSMS) with PDA as an intervention to improve EBF was 50.9% with a maximum score of 99% and a minimum of 8%. Of the emerged satisfaction measuring scales, the standardized mean score for the user empowerment scale was the highest (53.7%). Five scales were emerged with 84.2% of the total variability explained in users' satisfaction. The mixed-effect model revealed that age, occupation, experience of breastfeeding (BF), knowledge, attitude, self-efficacy, main source of BF information, previous home visit/support received from HEPs, participation in any social activities, and perceived community support for BF were independent two-level predictors of satisfaction. CONCLUSION: As an intermediate outcome, more than half of the end-users of the PDA intervention were satisfied. End-users' satisfaction with PDA as an intervention to promote EBF was predicted by multi-level factors. If they chose to use PDA as an intervention, Health program managers should be mindful of the two-level factors identified in this study.

Health care manager commitment towards implementation of citizen charter standards and associated factors in public hospitals of Jimma zone, Southwest Ethiopia.

BACKGROUND: Managerial commitment is important for effective design and implementation of citizen charter to assure the quality of health service delivery as per the standards depicted in the document. Hence the objective of this study is to assess the level of managerial commitment towards implementation of the citizen charter standards and associated factor in Jimma zone public hospitals. METHODS: A Facility based cross-sectional study design was employed in Jimma zone public hospitals from March 14 to May 16, 2019 and 422 health managers who were currently working at all levels of management were participated in the study. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P < 0.05. All assumptions of linear regression and principal component analysis were checked. RESULTS: The percentages mean score of managerial commitment for health managers working in jimma zone public hospitals was 58%. Perceived value and care for managers (ß = .329,95% CI,.245,.413, p-value<.001), Interaction between staff and managers' (ß = 0.077,95%CI,.032,.122, p-value< 001),involvement during implementation of citizen charter(ß = 0.061,95%CI,.010,.112,p-value = 018) and positional level(ß = - 122,95%CI,-.242,-.002,p-value = .046) as predictors of managerial commitment towards implementation of citizen charter standards. CONCLUSIONS: In this study, the percentage mean score of managerial commitment for health care managers working in Jimma zone public hospitals was medium. Hence, all levels of managers to consider and maintain factors identified in this study in their management practice to foster a higher level of managerial commitment towards implementation of citizen charter standards in jimma zone public hospitals.

Compliance to kangaroo mother care best practice: an evidence-based implementation project.

BACKGROUND: Worldwide about 13 million babies are born prematurely every year. Kangaroo mother care (KMC) is a proven, acceptable and feasible method to decrease the mortality rate of premature infants. Reviewing current KMC practices, implementing in the context and auditing the compliance would benefit the promotion evidence-based practice (EBP), which was not well known in the study area. OBJECTIVES: The main objective of the study was to increase awareness of EBP for KMC in the neonatal care unit of a public hospital through identifying local barriers and facilitators, and to measure compliance with best practice recommendations. METHODS: The current KMC best practice quality improvement project was conducted between March and May 2018. The project team was established for this implementation project. Six KMC best practice audit criteria were used to evaluate the compliance at baseline and endline using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. All (20) clinical staff who were working in the neonatal care unit were included in the study. Based on the baseline audit result, gaps and barriers were identified and discussed, and implementation strategies specific to the local setting were developed to mitigate the gaps. Baseline results were compared with the final follow-up audit result to measure change in compliance. Again, these data were compared with other studies to identify the sustainability of the project in a clinical setting. RESULTS: A total of 80 cases (baseline 20 and implementation 60) were observed demonstrating KMC procedures. Study found that follow-up compliance rates for all criteria improved compared with baseline audit; for example, criterion 5 (assessment of infant's condition) improved from 20% during baseline to 90% during follow-up and criterion 3 (parent/family received counselling) improved from 30 to 95%. CONCLUSION: The current study demonstrated that EBP training and frequent supportive supervision translated in improved compliance to best available evidence to KMC in a resource-limited setting.

Effectiveness of Positive Deviance Approach to Promote Exclusive Breastfeeding Practice: A Cluster Randomized Controlled Trial.

BACKGROUND: Suboptimal breastfeeding (BF) contributes to a significant number of infant deaths. A positive deviance approach (PDA) was not studied in Ethiopia, whether it improve exclusive breastfeeding (EBF) practice. Therefore, we determined the effectiveness of positive deviant approached intervention in increasing the proportion of EBF practice. METHODS: A cluster-randomized controlled trial was employed in Jimma town from February 01 to September 30, 2018. Six randomly selected clusters (kebeles) were randomized into two arms. Then, 260 mothers who met the eligibility criteria were enrolled in either the intervention or control arm depending on where they lived. Women in the intervention group received counseling and social support in addition to the usual service to promote EBF, from women identified and trained as positive deviants in their community, while those in the control groups received the usual community-based services from urban health extension professionals. Data on primary and secondary outcome variables were collected at three points, and statistical difference was estimated using Chi-X 2 or Fisher exact test. The net effect of the intervention was calculated. The magnitude of the intervention effect was estimated using the relative risk. For all statistical tests, 95% CI with a P-value of <0.05 was used. RESULTS: The overall response rate at the endline was 98.8%. Exclusive BF was significantly different between the groups at mid and end points, while no difference at baseline. A higher proportion of mothers in the intervention group reported EBF compared to the control group at mid and end-line. The rate of EBF increased by 18.5% (P=0.01) in the intervention group while 0.2% in the counterparts, with a net effect of +18.2%. The probability of practicing EBF was significantly higher for the intervention group compared to the control group. At baseline, the relative risk of avoiding EBF (RR:1.112) was similar among the two groups. However, at follow-up, mothers in the intervention group were 2 times more likely to practice EBF (RR: 2.294) compared to those in the control group. CONCLUSION AND RECOMMENDATION: The PD approach is an effective intervention to promote EBF and also positively affected frequency and duration of BF. Therefore, we recommend the promotion and use of positive deviance approach as a strategy to improve EBF practice in urban settings. TRIAL REGISTRATION NUMBER: Clinical trial PACTR201805003379263, 23 May 2018.

Expanding Maternity Waiting Homes as an Approach to Improve Institutional Delivery in Southwest Ethiopia: A Community-Based Case-Control Study.

With the promising efforts in increasing institutional delivery yet, maternal and child mortality is high in Ethiopia. One of the strategies used to minimize this problem was the introduction of Maternity Waiting Homes (MWH). MWHs are residential facilities for pregnant women near a qualified medical facility. The introduction of MWHs has improved institutional delivery in many countries. In Ethiopia however, the contribution of MWHs was rarely studied. To fill this gap, we have conducted a community-based unmatched case-control study from March 1 to April 20, 2016, in Southwestern Ethiopia. Mothers who delivered at a health facility within 1 year were considered as cases while mothers delivered at home were controls. We used simple random sampling to identify study participants from the pool of cases and controls who were identified by census. Data were analyzed using SPSS Version 20. Binary logistic regression was used to identify significant predictors. A total of 140 cases and 273 controls were included in the study. Among the case, 86 (61.4%) used MWHs during their last delivery. Variables like educational status of the mothers [AOR = 2.96, 95% CI: 1.41, 6.23], educational status of the husband [AOR = 5.19, 95% CI: 1.52, 17.76], and having antenatal care follow up [AOR = 3.22, 95% CI: 1.59, 6.54]. This study remarks, accessing MWHs, creating better awareness in utilizing them, and practicing antenatal follow-up have a crucial role in improving institutional delivery. Therefore, strengthening the existing and establishing new MWHs to deliver quality services is a good strategy in reducing home delivery.

Sexual Assault Profile in Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Sexual assault cases are increasingly reported in Ethiopia and worldwide. However, in Ethiopia, sexual assaults' profile was not investigated well, regardless of its social, physical, and psychological impacts on survivors. Hence, this study assessed the survivors' characteristics, circumstances of the victims, and treatment offered with the view of describing the management process, and service responsiveness. METHODS: A descriptive study with 3 years retrospective chart review was conducted in Jimma University Medical Center (JUMC). Samples of 187 charts/medical records were selected using a systematic random sampling technique from the medical unit. The selected survivors' records were reviewed using a structured checklist. Data were analyzed using SPSS Version 21.0. RESULTS: Out of the 187 cases of sexual assaults during the study period, 67.4% were rape cases. Among these, 58.8% were below 14 years, and 85.6% knew their assailants. Above 30% of the victims were assaulted during the daytime, and 51.9% developed perennial laceration. Threat and physical force were mostly used to coerce victims during the violence. All of the survivors were not investigated for vaginal/anal swab (for sperm analysis), and 96.8% of the victims were not tested for HIV screening. Only 8% of the victims received emergency contraception. CONCLUSION AND RECOMMENDATION: Children and adolescents remain the most sexually assaulted group of the population, requiring protection and appropriate medical services to ensure their well-being and reduce their suffering. Appropriate and timely intervention is needed to care for such survivors. The findings have highlighted the need for closer monitoring and better follow-up of the care and support provided in the Medical Center to sexual assault victims.

Practice and Associated Factors of Health Professionals towards Citizens' Charter at Jimma University Medical Center.

BACKGROUND: Citizens' Charter is a public promise between citizens and service providing organizations which visibly specifies expectations and standards in the service delivery. Citizens' charter standard has been implemented in Jimma University Medical Center since 2016/17. However, the practice and associated factor of citizens' charter among health professionals have not been studied yet. Hence, the aim of this study was to assess the practice of citizens' charter and associated factors among health professionals. METHODS: Facility based cross-sectional study was conducted on 389 health care providers, selected through stratified sampling, from April 1 to April 26. Data was collected using a pretested structured self-administered questionnaire. Data were entered into EPI-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, binary and multivariable logistic regression analysis were done. P-values less than 0.05 were used to declare significant association between dependent and independent variables. In the process of multivariable logistic regression analysis, knowledge and attitude variables were not tested due to low number of respondents to those specific variables' measuring items. Hence, it was difficult to declare as a predictor at bivariate analysis. RESULT: For this study, the response rate was 92%. Out of all, 237(60.9%) professionals were properly practicing citizens' charter standard while 152(39.1%) were not properly practicing it. The factors affecting the practice were job satisfaction [AOR =7.4, 95%CI (4.4, 12.5)], perceived workload [AOR =1.8, 95%CI (1.05, 3.0)] and type of profession [AOR=5.4, 95%CI ((1.98, 14.8)]. CONCLUSION: This study revealed that more than half of the respondents properly practiced citizens' charter. However, few health professionals only knew the existence of citizens' charter. Job satisfaction, perceived workload, and type of profession were the factors affecting the practice of citizens' charter.

Quality of Family Planning Services and Associated Factors in Jimma Town Public Hospitals, Southwest Ethiopia.

BACKGROUND: The quality of care is greatly compromised specially in resource limited settings that influence the uptake and continuation of use of family planning services. However, there is paucity of studies in Jimma Town public hospitals. Thus this study aimed to assess the quality of family planning services and associated factors in Jimma Town public hospitals, Southwest Ethiopia. METHODS: A facility-based cross-sectional study design using both qualitative and quantitative methods was employed from March 25 to April 25, 2018. A total of 278 female family planning users (15-49 years old) in Jimma Town public hospitals were included in the study.The sample was calculated using single population proportion formula and consecutive sampling methods was used. Descriptive statistics and multiple logistic regressions were used for analysisis. RESULTS: The mean waiting time of the client before getting service and mean consultation duration were23.5 and 12.5 minutes respectively participant who were unable to read and write were 64% less likely to be satisfied than those who were completed primary and secondary or preparatory schooling (AOR=0.363:CI:0.160,0.822), and clients who were waited for < 30 2minutes at waiting area were 2.7 times more likely to be satisfied than those who waited ≥ 30 minutes (AOR=2.769:CI:1.300,5.898). CONCLUSIONS: In this study, the satisfaction of clients in family planning service was low. Waiting time and received information on what to do in cases of problems and educational level of clients were significant predictors of client satisfaction.

Determinants and Outcome of Safe Second Trimester Medical Abortion at Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester globally. As compared to first trimester, second trimester abortions disproportionately contribute to maternal morbidity and mortality especially in low-income countries where access to safe second trimester abortion is limited. The objective of this study was to identify factors affecting and outcome of induced safe second trimester medical abortion in Jimma University medical center, Southwest Ethiopia. METHODS: Institution based cross-sectional study design was used to conduct a study among women who seek safe second trimester medical abortion services and admitted at gynecology ward. All (201) eligible study subjects included were those who came for safe medical abortion service during data collection period. Data collected using pretested structured questionnaire through exit-interviewing and some clinical data abstracted from their chart. The data was entered into EpData version 3.1 then exported to SPSS version 21.0 for analysis. Variables with P-value less than 0.25 in bivariate analysis were entered into the final predictive model. Multivariable logistic regression was used to identify determinants with 95% CI and P-value < 0.05. Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05. Ethical clearance was obtained and confidentiality kept using codes and patient's chart number. RESULTS: In this study the response rate was 98.1%. Out of 201 women who participated in the study and were addmitted for safe second trimester medical abortion, 154 (76.6%) of them had complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication. Previous experience of abortion [AOR= 6.00, 95% CI= (3.77, 8.88)], gestational age [AOR=0.90, 95% CI= (0.07, 0.99)], parity [AOR=2.38, 95% CI= (1.04, 3.69)], cervical status [AOR=8.00, 95% CI= (5.72, 10.02)], overall waiting time for more than two weeks [AOR=0.53, 95% CI= (0.50, 0.96)], overall waiting time for two weeks [AOR=0.05, 95% CI= (0.01, 0.45)], and moderate anemia -(Hgb:7-10g/dl)-[AOR=0.07,95% CI= (0.01, 0.16)] were independent predictors for outcome of safe second trimester medical abortion. CONCLUSION: This finding implied that proportion of complete abortion without any complication overweighs incomplete abortions with one or more complication through induced safe second trimester medical abortion method. The outcome is strongly determined by gestational age, cervical status, previous experience of abortion, parity, moderate anemia, and overall waiting time. Induced second trimester medical abortion is already known as an effective and safe method. However, much should be done to reduce proportion of incomplete abortions by minimizing overall waiting time through intervening at low gestational age. Therefore, it is recommended that safe second trimester medical abortion services should be continued under a certain legal circumstances so as to reduce maternal morbidity and mortality.

Technical Efficiency of Maternal and Reproductive Health Services in Public Hospitals of Oromia Regional State, Ethiopia.

As the Ethiopian health system faced critical resource constraints, wise use of the available health resources is a priority agenda. Therefore, our study aimed to assess technical efficiency of maternal and reproductive health services in public hospitals of Oromia regional state, Ethiopia. Two-stage data envelopment analysis was performed among 14 hospitals with input orientation and variable returns to scale assumptions. Technical efficiency scores were computed at the first stage, and predictors were determined using Tobit regression at the second stage. The assessment revealed that 12 (85.7%) hospitals were pure technical efficient and 9 (64.29%) hospitals were scale efficient. Level (primary/general) (ß = 1.17, 95% confidence interval [CI] = 0.16-2.18), service years (ß = 0.02, 95% CI = 0.003-0.03), and size of catchment population (ß = 5.58E-07, 95% CI = 2.95E-08 to 1.09E-06) were positively associated with technical efficiency of maternal and reproductive health service, whereas average waiting time for maternal health service (ß = -0.03, 95% CI = -0.05 to -0.01) was negatively associated with efficiency. In conclusion, most of the hospitals were technically efficient and around two-thirds were operating scale efficient. Allocation of more resources to older secondary hospitals with larger catchment population could result in more efficient use of resources for maternal and reproductive health service delivery.

Are we too far from being client centered?

BACKGROUND: Quality of service provision in health facilities is fundamental to ensure effective care. However, women's actual experience of care is often neglected. OBJECTIVE: To assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia. METHOD: Community based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions. RESULTS: Perceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (ß: -0.331, 95% CI: -0.523, -0.140), urban residence (ß: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (ß: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (ß: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (ß: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (ß: -0.689, 95% CI: -0.907,-0.472). Urban residence (ß: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (ß: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure. CONCLUSION: Overall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.

Prevalence and Outcome of Operative Vaginal Delivery among Mothers Who Gave Birth at Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Operative vaginal deliveries (OVD) are vaginal deliveries accomplished with the use of a vacuum device or forceps. If it is technically feasible and can be safely accomplished, termination of second stage labor by operative vaginal delivery is indicated in any condition threatening the mother or fetus that is likely to be relieved by delivery. Hence, the objective of this study is to assess the prevalence, common indication, outcome, and associated factors of operative vaginal delivery among mothers who gave birth in Jimma University Medical Center (JUMC). METHOD: A facility-based cross-sectional study design was used in maternity ward on 242 mothers who gave birth by operative vaginal delivery from December 01, 2016, to May 30, 2017. The clinical data were collected using a check list, recordings of intrapartum fetal and maternal state, and immediate fetomaternal outcomes. The study participants were recruited using consecutive sampling method. Sociodemographics and related data were collected at exit using structured interviewer administered questionnaire which was developed by reviewing different literature and the remaining information abstracted from patient charts. Data were entered to Epidata 3.1 and exported to SPSS version 21 for analysis. Bivariate analysis was done to identify candidate variables using p<0.25. Multivariable logistic regression was used to control the effect of confounding variables and to identify factors affecting the fetomaternal outcome. Statistical significance was declared at P<0.05 using adjusted OR with 95% CI. RESULT: Out of the 2348 pregnant mothers who gave birth in the labor ward of JUMC during the 6 months of the study period, 242 (10.3%) were by operative vaginal delivery (OVD). The commonest indication for operative vaginal delivery is found to be nonreassuring fetal heart rate pattern, 136 (56.2%). Out of all neonates delivered by operative vaginal delivery 210 (86.8%) had favorable outcome. Of all mothers who gave birth by operative vaginal delivery 232 (95.9%) had favorable outcome. Type of instrument used for operative vaginal delivery (AOR=0.228, 95%CI: 0.078, 0.671) and presence of grade two (AOR=0.163, 95%CI: 0.031, 0.858) and grade three (AOR=0.088,95%CI: 0.024,0.327) meconium stained amniotic fluid are factors affecting neonatal outcome while neonatal birth weight (AOR=0.007, 95%CI: 0.000, 0.151) is factor affecting maternal outcome of operative vaginal delivery. CONCLUSION: Prevalence of operative vaginal delivery is found to be 10.3% with the commonest indication of nonreassuring fetal heart rate pattern. Nearly all of mothers and neonates had favorable outcome. Type of instrument applied for operative vaginal delivery is the strongest predictor of neonatal outcome while neonatal birth weight is the only predictor of maternal outcome identified in this study.

Level and Factors Associated with Professional Commitment of Health Professionals Providing Institutional Delivery Services in Public Health Facilities, Southwest Ethiopia.

BACKGROUND: Professional commitment is beyond a commitment for a particular organization and implies the individuals' perspective towards their profession and the motivation that they have to stay in their job with willingness to strive and uphold the values and goals of the profession. In Ethiopia, uptake of institutional delivery services is low. However, the level and factors associated with professional commitment is not known so far. Hence, our objective is to assess the level and factors associated with commitment of health professionals providing institutional delivery services in public health facilities of Jimma Zone, Southwest Ethiopia. METHODS: A facility-based cross-sectional study design was conducted from March 01-20, 2016. A total of 442 eligible health professionals were included from randomly selected 7 districts and 47 respective health facilities. Health professionals were requested to fill self-administered questionnaire. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P<0.05. All assumptions of linear regression and principal component analysis were checked. RESULTS: The percentage mean score of professional commitment was 72.71% (SD21.88). The percentage mean score for perceived maternal health goal scale was 68.37% with the total variance explained being 69.68%. Perceived staff interaction, work-life balance, affective organizational commitment, normative organizational commitment, personal characteristics and perceived maternal health goal were independent predictors of professional commitment. CONCLUSION: The percentages mean score of professional commitment was medium. Hence, Health professionals should foster their level of professional commitment to increase uptake of institutional delivery services.