Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

BACKGROUND: In Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: A health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes. RESULTS: In this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20-34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births. CONCLUSION: Adverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.

Knowledge and practice of nurses with respect to perioperative hypothermia prevention in the Northwest Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study.

OBJECTIVES: It has been reported that maintaining a normal body temperature among surgical patients can reduce the length of hospitalisation by up to 40%, decrease the risk of surgical site infection by 64% and reduce mortality by fourfold. Nurses are primarily responsible for preventing the occurrence of hypothermia among surgical patients. This study assessed nurses' knowledge and practices with respect to perioperative hypothermia prevention in Northwest Ethiopia, and investigated the factors associated with good knowledge and practice. DESIGN: Cross-sectional study. SETTING: Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia, 25 March-20 May 2021. PARTICIPANTS: 413 nurses working in the perioperative units of five referral hospitals. OUTCOME MEASURES: Perioperative hypothermia prevention knowledge and practice among nurses. RESULTS: Nearly three-fifths (59.1%; 95% CI: 54.7% to 63.7%) of respondents had good knowledge and about half (50.4%; 95% CI: 45.5% to 55.0%) had good practice with respect to perioperative hypothermia prevention. Factors associated with nurses' knowledge of prevention of perioperative hypothermia included male sex (adjusted OR (AOR): 1.61, 95% CI: 1.02 to 2.53), having a bachelor's degree (AOR: 2.50, 95% CI: 1.25 to 5.00), having a master's degree (AOR: 4.39, 95% CI: 1.45 to 13.20) and training participation (AOR: 3.68, 95% CI: 2.14 to 6.33). Factors associated with nurses' practice of prevention of perioperative hypothermia included working in recovery (AOR: 2.87, 95% CI: 1.08 to 7.58) and intensive care units (AOR: 2.39, 95% CI: 1.09 to 5.22), training participation (AOR: 2.64, 95% CI: 1.53 to 4.57), being satisfied with their job (AOR: 2.15, 95% CI: 1.34 to 3.43) and having good knowledge (AOR: 2.64, 95% CI: 1.63 to 4.27). CONCLUSION: Nurses' knowledge and practice of the prevention of perioperative hypothermia were inadequate. Hospital managers need to design and strengthen training programmes and work to enhance job satisfaction.

Determinants of Malnutrition and its associated factors among pregnant and lactating women under armed conflict areas in North Gondar Zone, Northwest Ethiopia: a community-based study.

INTRODUCTION: Maternal malnutrition remains a major public health problem, particularly in low and middle-income countries and war-affected areas like Ethiopia. Malnourished pregnant and lactating women with low nutrient stores have babies with poor mental and physical development, increasing the risk of poor birth outcomes. Despite the fact that the majority of Ethiopian mothers are malnourished, there is little evidence in war-affected areas. Therefore, the objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant and lactating mothers in the war affected area of North Gondar Zone, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April 10 to May 25, 2022. A multistage random sampling technique was used to select 1560 pregnant and lactating mothers. MUAC was to ascertain the outcome variable. Data was entered and analyzed by using EPI INFO version 3.5.3 and SPSS version 24, respectively. A multivariable logistic regression analysis was employed to identify the factors associated with acute malnutrition. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association. RESULTS: The prevalence of acute malnutrition among pregnant and lactating women was 34.3% at the 95% CI (31.9-36.8). The age of the mothers (AOR = 0.73; 95% CI: 0.54, 0.99), family size 6-8 (AOR = 1.21; 95% CI: 1.03, 1.82), and greater than or equal to 9 family sizes (AOR = 0.44; 95% CI: 0.19, 0.97), were significantly associated with acute malnutrition. CONCLUSIONS: In the current study, the prevalence of acute malnutrition among pregnant and lactating mothers is high in the study area. Mother's age and family size were factors associated with acute malnutrition in war-affected areas. As a result, mothers with large families will require special assistance to reduce the impact of malnutrition.

Work engagement among health professionals in public health facilities of Bench-Sheko zone, southwest Ethiopia.

BACKGROUND: The level of health professional work engagement affects retention, burnout, job satisfaction, patient satisfaction, and outcomes; however, there is a paucity of evidence that benefit health professional work engagement. Therefore, this study aimed to assess work engagement and associated factors among health professionals at public health facilities in the Bench-Sheko zone in southwest Ethiopia. METHODS: Facility-based cross-sectional study was conducted among 605 health professionals from 29 March to 29 April 2021. A simple random sampling technique was used to select the participants. Data were collected using a self-administered questionnaire. Linear regression was fitted and those variables with p-value < 0.2 in simple linear regression were entered into multiple linear regression analysis. Unstandardized ß-coefficient with 95% CI and p-value < 0.05 were used as the cut of points to determine the factors associated with work engagement. RESULTS: Mean score percentage of work engagement was 71.8%. Health center staff (ß = 0.31; 95% CI: 0.22, 0.40), married professionals (ß = 0.10; 95% CI: 0.005, 0.17), co-worker support (ß = 0.06; 95% CI: 0.004, 0.11), role clarity (ß = 0.14; 95% CI: 0.07, 0.21), reward (ß = 0.10; 95% CI: 0.05, 0.15), resilience (ß = 0.14 95%; CI: 0.07, 0.21), self-efficacy (ß = 0.24; 95% CI: 0.16, 0.31) and optimism (ß = 0.20; 95% CI: 0.15, 0.26) were positively associated with work engagement. On the contrary, cognitive demand (ß= -0.06; 95% CI: -0.11, -0.01) was negatively associated with work engagement. CONCLUSION: In this study, health professionals had a moderate level of work engagement. Health facilities shall improve their culture of co-worker support, role clarity, reward, resilience, self-efficacy, and optimism to enhance work engagement. Future researchers shall be done further studies to evaluate the relationship between cognitive demand and work engagement among health professionals.

Organizational commitment and associated factors among health professionals working in public hospitals of southwestern Oromia, Ethiopia.

INTRODUCTION: Organizational commitment refers to the extent to which employees identify with and are involved with a given organization. It is an important variable for healthcare organizations to consider since it acts as a predictor of job satisfaction, organizational efficiency and effectiveness, health professionals' absenteeism, and turnover. However, there is a knowledge gap in the health sector about workplace factors that are associated with healthcare provider commitment to their organization. Thus, this study aimed to assess organizational commitment and associated factors among health professionals working in public hospitals in the southwestern Oromia region, Ethiopia. METHODS: A facility-based analytical cross-sectional study was conducted from March 30 to April 30, 2021. A multistage sampling technique was employed to select 545 health professionals from public health facilities. Data were collected using a structured self-administered questionnaire. simple and multiple linear regression analyses were employed to assess the association between organizational commitment and explanatory variables after checking the assumptions of factor analysis and linear regression. The statistical significance was declared at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI). RESULTS: Health professionals' organizational commitment percentage mean score was 48.8% (95% CI: 47.39, 50.24). A higher level of organizational commitment was associated to satisfaction with recognition, work climate, supervisor support, and workload. Besides, good practice of transformational and transactional leadership styles and employee empowerment are significantly associated with high organizational commitment. CONCLUSION: The overall level of organizational commitment is a bit low. To improve the organizational commitment of health professionals, hospital managers, and healthcare policy-makers need to develop and institutionalize evidence-based satisfaction strategies, practice good leadership styles and empower healthcare providers on the job.

Evaluation of family planning service delivery in Gondar city public health facilities, Northwest Ethiopia: A cross-sectional study.

INTRODUCTION: Family planning program is low-cost and an effective way to lower maternalmortality by reducing the number of high-risk births. Despite the effectiveness of the program, availability of materials, equipment and trained healthcare providers were some of the challenges in sub-Saharan African countries including Ethiopia. Determining the implementation status and identifying gaps is the aim of this evaluation. METHOD: A facility-based cross-sectional evaluation design with mixed method approach was employed. Quantitative data was collected through the exit interview of 477 clients from March 25-April 25, 2020. The evaluation focused on three dimensions: availability, compliance, and acceptability with multiple data sources. The quantitative data were entered in to Epi-data version 4.6 and exported to SPSS version 25 for analysis. Multivariable logistic regression was done to determine factors associated with client satisfaction. The qualitative data were transcribed, translated and analyzed by using thematic analysis. The evaluation finding was computed and compared with the preset criteria for the final judgment. RESULT: The majority of the health care providers (69.8%) got family planning training in the past two years. Three health facilities (37.5%) had 24hrs electricity with backup generators whereas only 25% of the health facilities had functional piped water inside the service room. Only two (25%) health facilities had a separate room for family planning service and 37.5% of health facilities had national FP guidelines. The overall availability of required resources for family planning service at Gondar city public facilities were 62.1%. Only twenty one (26.3%) of health providers dressed based on dressing code of ethics and none of them had ID during our observation. The overall compliance level of health care providers during providing family planning services were 75.5%. About 53.9% of the clients were satisfied with family planning service provided at Gondar city public health facilities.-and-were significantly associated variables with client satisfaction. CONCLUSION: The overall implementation of family planning service in Gondar city public health facilities with the three evaluation dimensions were judged as fair based on pre-setting judgment matrix. It is better to improve the service through training of healthcare providers, distributed family planning guidelines to health facilities and shortening of waiting time for service.

Evaluation of the outpatient therapeutic program for severe acute malnourished children aged 6-59 months implementation in Dehana District, Northern Ethiopia: a mixed-methods evaluation.

BACKGROUND: In Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia.  METHODS: A facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children's (diagnosed with acute malnutrition) record reviews, nine key informants' interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done. RESULTS: The overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09-0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04-4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01-3.30) were significantly associated with the acceptability of OTP program. CONCLUSION: The overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management.

Trends of Inequalities in Early Initiation of Breastfeeding in Ethiopia: Evidence from Ethiopian Demographic and Health Surveys, 2000-2016.

Background: Early initiation of breastfeeding (EIBF) is a costless practice with numerous neonates' survival benefits. Thus, any disparity results in an unacceptably high neonatal death rate but socioeconomic disparities on EIBF have not been well explored in Ethiopia. Therefore, this study is aimed at assessing the socioeconomic inequalities of EIBF in Ethiopia from 2000 to 2016. Methods: The Ethiopian demographic and health survey data and the World Health Organization's Health Equity Assessment Toolkit were used to investigate the inequalities in EIBF across the wealth quintile, education, residence, and subnational region. Difference, ratio, slope index inequality (SII), relative index inequality (RII), and population attributable risk (PAR) were used as equity summary measures. Results: In Ethiopia, EIBF practice was 47.4% in 2000, 66.2% in 2005, 51.5% in 2011, and 73.3% in 2016. Wealth-related inequality was observed in the 2000, 2005, and 2011 survey years with SII of -7.1%, -8.8%, and 8.7%, respectively, whereas educational-related inequality was observed in 2005 and 2011 with SII of -11.7% and 6.5%, respectively. However, significant change in wealth-, education-, and residence-related inequalities was detected in 2011. Regional inequality on EIBF was observed in all survey years with a difference of 35.7%, 38.0%, 29.1%, and 48.5% in the 2000, 2005, 2011, and 2016 survey years, respectively. But a significant change in regional inequality was noted in 2016 with a PAR of 17.2%. Conclusions: In Ethiopia, the wealth-, residence-, and educational-related inequalities of EIBF increased significantly between the years 2000 and 2011. However, regional inequality persistently increased from 2000 to 2016. Overall, one-sixth of the national level EIBF was decreased due to regional disparity in 2016. The northern regions of Ethiopia (Tigray, Afar, and Amhara) poorly performed compared to the peer regions. Therefore, interventions targeting them would significantly improve the national level of EIBF.

Patient-Centered Care and Associated Factors among Adult Admitted Patients in South Wollo Public Hospitals, Northeast Ethiopia.

BACKGROUND: The US Institute of Medicine's "quality chasm" report defined patient-centered care as care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Services that lack patient-centered care lead to unimproved health status, decreased patient and family satisfaction, and poor patient outcomes. Therefore, this study aimed to assess patient-centered care and associated factors among admitted patients in South Wollo public hospitals in northeast Ethiopia. METHODS: This was a facility-based quantitative cross-sectional study design supplemented with qualitative analysis conducted from February 10 to March 10, 2020 across South Wollo public hospitals. A total of 618 admitted patients were selected using multistage systematic random sampling and interviewed using a structured questionnaire. Five health professionals were selected for in-depth interviews. Binary logistic regression analysis was carried out to identify associated variables, and potential confounders were controlled using a multivariate logistic regression model, and P<0.05 was considered significant. RESULTS: Overall, 60.9% (95% CI 57.1%-64.5%) of patients received patient-centered care. Age 25-35 years (AOR 0.39, 95% CI 0.32-0.64) years, rural residence (AOR 2.61, 95% CI 1.62-4.02), social well-being (AOR 2.34, 95% CI 1.45-3.78), perceived high quality of care (AOR 3.69, 95% CI 2.07-6.04), length of stay (AOR 0.13, 95% CI 0.02-0.79), and routine checkups (AOR 1.92, 95% CI 1.15-3.13) were variables significantly associated with patient-centered care. CONCLUSION: This study revealed that among admitted patients, three in five received patient-centered care. Age, residence, social well-being, length of stay, perceived quality of care, and routine checkups were significantly associated with patient-centered care. Therefore, working on provider improvements in providing consultation and facilitation and decreasing length of stay to improve patient-centered care is needed.

Micronutrient intake status and associated factors among children aged 6-23 months in the emerging regions of Ethiopia: A multilevel analysis of the 2016 Ethiopia demographic and health survey.

BACKGROUND: Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6-23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6-23 months in the emerging regions of Ethiopia. METHODS: Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6-23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors. RESULTS: In this analysis, 37.3% (95% CI: 34.3-40.3) of children aged 6-23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4-2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3-3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2-2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3-4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0-3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1-0.9) was the community-level factors that decrease micronutrient intake. CONCLUSIONS: Micronutrient intake among children aged 6-23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6-23 months.

Quality of adolescent and youth-friendly health services in Dehana district public health facilities, northeast Ethiopia: Using the Donabedian quality framework.

INTRODUCTION: Adolescents and youths who need exceptional healthcare are the shapers and leaders of our global future. However, many of them are died prematurely, while others suffer from diseases partly because of the poor quality of health services. Thus, this study aimed to assess the quality of Adolescent and Youth-friendly Health Services (AYFHS) and associated factors in the public health facilities of Dehana district, Northeast Ethiopia. METHODS: A facility-based quantitative cross-sectional study supported with a qualitative component was conducted from February 24 to March 30, 2020. The quality of AYFHS was measured using the Donbidean framework (structure, process and output component). Accordingly, a total of 431 adolescents and youths, five health facilities, twenty-five client-provider interaction observations, and nine key informant interviews were conducted. Binary logistic regression analysis was done, and variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) were used to measure the association. The qualitative data were audio-recorded and transcribed verbatim. Then, Open Code 4.03 software was used to manage and analyze the data. RESULTS: The quality of adolescent and youth-friendly health services was 58.8, 46.4, and 47.2% for structural, process, and output quality dimensions, respectively. The predictor variables for output quality were, being a student (AOR: 2.07, 95%CI: 1.07-3.40), farmers (AOR: 2.59, 95%CI: 1.25-5.39), own income sources (AOR: 1.99, 95%CI: 1.03-3.85), exempted services (AOR: 2.30, 95%CI: 1.43-3.71) and long waiting time (AOR: 3.8495%CI: 1.80-8.23). CONCLUSIONS: The overall quality of adolescent and youth-friendly health services was still lower than the WHO good quality standards. The structural quality dimension was affected by the unavailability of adequate and trained health service providers, poor engagement of adolescents and youths in the facility governance structure, unavailability of guidelines, protocols and procedures. In contrast, the process quality dimension was also compromised due to the provider's poor compliance with the national AYFHS guidelines. Therefore, health facilities need to engage adolescents and youths in the health facility governance structure, and providers should comply with the national guideline.

Job Satisfaction and Associated Factors among Health Professionals Working at Public and Private Hospitals in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.

INTRODUCTION: Job satisfaction is a pleasurable or positive emotional state resulting from evaluating one's job or job experiences. However, knowledge of workplace factors that either satisfy employees to keep working or dissatisfy them making them leave their jobs or working places is essential for decision-making. Thus, this study is aimed at assessing job satisfaction and associated factors among healthcare professionals working at public and private hospitals in Bahir Dar city, northwest Ethiopia. METHODS: An institution-based comparative cross-sectional study design was conducted from 10 February 2020 to 29 May 2020. A total of 520 health professionals were selected from public and private health facilities using stratified systematic random sampling techniques. Data were collected using structured pretested self-administered questionnaires. A binary logistic regression model with Huber-White robust standard error was fitted to identify job satisfaction and associated factors among healthcare professionals working at public and private hospitals. A less than 0.05 p value and an Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were considered to have a statistically significant association with the outcome variable. RESULTS: The overall magnitude of job satisfaction was 55.2% (95% CI: 51.0, 59.4%). At public and private hospitals, the provider's satisfaction was 29.0% (95% CI: 23.2, 35.1%) and 81.23% (95% CI: 76.6, 85.8%), respectively. Working at private hospital (AOR: 8.89; 95% CI: 5.14, 15.35), pleasant nature of work (AOR: 1.82; 95% CI: 1.05, 3.15), autonomy (AOR: 2.37; 95% CI: 1.29, 4.33), adequate supportive supervision (AOR: 2.42; 95% CI: 1.33, 4.40), good reward and recognition (AOR: 3.04; 95% CI: 1.37, 6.75), and high normative commitment (AOR: 2.57; 95% CI: 1.48, 4.43) were factors affecting the overall job satisfaction of health professionals. CONCLUSIONS: The magnitude of job satisfaction was relatively low in private and public hospital health professionals and severe among health professionals working in public hospitals. Healthcare policy-makers and hospital managers need to develop and institutionalize evidence-based satisfaction strategies considering the predictors of health professional's job satisfaction.

Health System Responsiveness for HIV/AIDS Treatment and Care Services in Shewarobit, North Shewa Zone, Ethiopia.

PURPOSE: Health System Responsiveness is the key objective of the health system used to fulfil patients' universal legitimate expectations. However, the health system's responsiveness to HIV/AIDS was not assessed in Ethiopia. Therefore, this study aimed at assessing the health system responsiveness of HIV/AIDS treatment and care services and associated factors in the public health facilities of Shewarobit town, Ethiopia. PATIENTS AND METHODS: An institution-based cross-sectional study was employed from 15 February to 15 April 2020 in the public health facilities of Shewarobit town. The data were collected among 416 randomly selected Anti-Retroviral Therapy (ART) users using an interviewer-administered questionnaire. Responsiveness was measured using 27 Likert scale questions across seven responsiveness domains. A binary logistic regression model was fitted. A p-value of less than 0.05 and AOR with a 95% confidence interval (CI) was used to declare the associated factors in the final multivariable logistic regression analysis. RESULTS: The overall health system responsiveness was 55.3% (95% CI: 50.6-59.8). High performance of responsiveness was found on confidentiality, respect, and communication domains, whereas poor responsiveness was achieved in prompt attention and choice domains. Participants aged 50+ years (AOR:2.48, 95% CI, 1.12-5.54), perceived good health (AOR: 3.10, 95% CI: 1.75-5.48), patients' satisfaction with care (AOR: 2.98, 95% CI: 1.35-6.54) and history of visiting traditional healers (AOR: 2.50, 95% CI:1.51-4.17) were factors associated with health system responsiveness of HIV/AIDS treatment and care services in the study area. CONCLUSIONS: Unacceptable responsive performance was found in choice and prompt attention domains. Participants' age, perceived health status, history of visiting traditional healers, and patient satisfaction were factors that affect responsiveness in the study area. Thus, providing training, frequent supportive supervision, improving community awareness, and incorporating traditional healers in the modern health system would enhance the health system responsiveness in Ethiopia.

Feeding Practices and Associated Factors During Diarrheal Disease Among Children Aged Less Than Five Years: Evidence from the Ethiopian Demographic and Health Survey 2016.

PURPOSE: Diarrhea is a common childhood illness and one of the leading causes of death in young children globally. In Ethiopia, a significant number of deaths and hospitalizations in under-five children are related to diarrheal diseases. Inappropriate feeding during diarrhea leads to a double burden of diarrhea recurrence and malnutrition among children. However, empirical evidence is limited in Ethiopia. Thus, this study was aimed to assess feeding practices and associated factors during diarrheal disease among children aged less than five years in Ethiopia. PATIENTS AND METHODS: The study used the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A two-stage stratified sampling technique was applied to identify 917 under five years children. Generalized linear mixed model analyses were computed, and a P value of less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify statistically significant factors with feeding practices. RESULTS: The majority (92.5%) of mothers were married. Out of the participants, (54.1%) of children were male; 55.6% of them were in the age group of 6-23 months. The appropriate feeding practices for children aged less than five years who had diarrhea was 15.4% (95% CI: 13.7%-18.2%). Mothers aged 25-34 years (AOR: 0.6, 95% CI: 0.4-0.9), agricultural occupation of mothers (AOR: 2.2, 95% CI: 1.3-3.6), mothers attended four and more antenatal visit (AOR: 2.3, 95% CI: 1.3-4.32) and mothers who had a postnatal checkup within two months of birth (AOR: 1.9, 95% CI: 1.1-3.2) were factors statistically associated with child feeding practices during diarrhea. CONCLUSION: Less than one-fifth of under-five children practiced appropriate feeding during diarrheal disease. Working in agriculture and attending antenatal care and postnatal checkup within two months were positively influencing feeding practice. Therefore, the government of Ethiopia needs to strengthen the existing maternal and child health services.

Prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project.

OBJECTIVE: Ethiopia is one of the Africa's signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia. STUDY DESIGN: The study is community-based cross-sectional study. STUDY SETTING: Dabat and Gondar Zuria districts, Northwest Ethiopia. PARTICIPANTS: Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis. METHODS: A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination. OUTCOMES: Incomplete or not at all vaccination. RESULTS: The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25). CONCLUSIONS: In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.

High Hidden Burden of Diabetes Mellitus among Adults Aged 18 Years and Above in Urban Northwest Ethiopia.

BACKGROUND: Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose (FBS) ≥ 126 mg/dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association. RESULT: Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06, 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes. CONCLUSION: The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services.

Improving the Assessment and Classification of Sick Children according to the Integrated Management of Childhood Illness (IMCI) Protocol at Sanja Primary Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

BACKGROUND: A complete and consistent use of integrated management of childhood illness (IMCI) protocol is a strategic implementation that has been used to promote the accurate assessment and classifications of childhood illnesses, ensures appropriate combined treatment, strengthens the counseling of caregiver, and speeds up the referrals to decrease child mortality and morbidity. However, there is limited evidence about the complete and consistent use of IMCI protocol during the assessment and classifications of childhood illness in Ethiopia. Therefore, this intervention was implemented to improve the assessment and classifications of childhood illness according to the IMCI protocol in Sanja primary hospital, northwest Ethiopia. METHODS: A pre-post interventional study was used in Sanja primary hospital from January 01 to May 30, 2019. A total of 762 (381 for pre and 381 for postintervention) children from 2 months up to 5 years of age were involved in the study. Data were collected using a structured questionnaire prepared from the IMCI guideline, and a facility checklist was used. A five-month in-service training, weekly supportive supervision, daily morning session, and availing essential drugs and materials were done. Both the descriptive statistics and independent t-test were done. In the independent t-test, a p value of <0.05 and a mean difference with 95% CI were used to declare the significance of the interventions. RESULTS: The findings revealed that the overall completeness of the assessment was improved from 37.8 to 79.8% (mean difference: 0.17; 95% CI: 0.10-0.22), consistency of assessment with classification from 47.5 to 76.9% (mean difference: 0.34; 95% CI: 0.27-0.39), classification with treatment from 42.3 to 75.4% (mean difference: 0.35; 95% CI: 0.28-0.47), and classification with follow-up from 32.8 to 73.0% (mean difference: 0.36; 95% CI: 0.29-0.42). CONCLUSION: The intervention has a significant improvement in the assessment and classification of childhood illness according to the IMCI protocol. Therefore, steps must be taken to ensure high quality of training, adequate supervision including the observation of health workers managing sick children during supervisory visits, and a constant supply of essential drugs and job aids for successful implementation of IMCI in the hospital and also to other facilities.

Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre-Post Interventional Study.

INTRODUCTION: Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia. MATERIALS AND METHODS: A pre-post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of <0.05 and a mean difference with 95% CI was used to test the significance of the interventions. RESULTS: The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55-0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline. CONCLUSION: Respectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in-service training of healthcare workers may indorse the practice of respectful maternal care.

Rotavirus Vaccine Coverage and Associated Factors Among a Rural Population: Findings from a Primary Health-Care Project in Two Northwest Ethiopia Districts.

OBJECTIVE: Rotavirus vaccines reduced severe rotavirus disease by more than 60% during the first year of life. In Ethiopia, however, about 28% and 6% of diarrheal disease hospitalizations and deaths among under-five children are associated with rotavirus, respectively. Therefore, this study aimed to investigate rotavirus coverage and associated factors in a rural population of the northwest, Ethiopia. METHODS: A community-based cross-sectional study was conducted from May to June 2019, in Dabat and Gondar Zuria districts, northwest Ethiopia. Data from 603 mothers paired with children aged 12-36 months were collected through house-to-house visits. Variables having a p-value <0.05 were considered to have a significant association with the outcome. Odds ratio (OR) with its 95% confidence interval (CI) was used as a measure of association. RESULTS: The prevalence of rotavirus vaccine coverage among children was 76.60% (95% CI; 69.98, 83.22). The dropout rate for rotavirus vaccine dose 2 out of rotavirus vaccine dose 1 was 1.99%. Mothers with formal education [AOR = 3.04; 95% CI: 1.63, 5.67] and received postnatal care [AOR = 4.37; 95% CI: 2.62, 7.27] had higher odds of rotavirus vaccine completion versus those without formal education and had not received postnatal care, respectively. Similarly, mothers who took <1 hour to reach the vaccination center ([AOR = 2.38; 95% CI: 1.34, 4.2]) were positive predictors of rotavirus vaccine completion. CONCLUSION: Rotavirus vaccine coverage in our study area was lower than the expected WHO target. Formal education, postnatal care, and time taken to reach vaccination centers were predictors to achieving full rotavirus vaccine coverage of children. Health-care services utilization after delivery should be intensified to improved child rotavirus vaccine completion in the districts. The long travel time should be dealt with by strengthening outreach services and increasing the number of new vaccination centers in the districts.