Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia.

Background: Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods: This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen's TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results: In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion: The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women's attitude, subjective norm, and spouse's education associated with intention to undergo CBE.

Training for mental health professionals in responding to experienced and anticipated mental health-related discrimination (READ-MH): protocol for an international multisite feasibility study.

BACKGROUND: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users but can also help reduce the impact of stigma on service users. However, few studies of interventions to equip such professionals to be anti-stigma agents took place in high-income countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across low- and middle-income countries (LMICs). METHODS: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal and Tunisia). OUTCOME MEASURES: knowledge based on course content, attitudes to working to address the impact of stigma on service users and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed upon through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and 3 months post-baseline, followed by qualitative data collection analysed using a combined deductive and inductive approach. Fidelity will be rated during the delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. CONCLUSIONS: The training development used a participatory and contextualised approach. Evaluation design strengths include the diversity of settings, the use of mixed methods, the use of a skills-based measure and the knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.

Effectiveness and quality of risk communication process in Ethiopia: The case of risk communication during cholera outbreak in Addis Ababa, Ethiopia.

BACKGROUND: WHO states risk communication as the conversation of actual information, guidance, and thoughts between specialists and people fronting risks to their well-being, economic or social safety. As risk communication activities are complex and costly usually, evaluation assessment are the best approach to advance risk communication interventions. This study aims to evaluate the effectiveness of risk communication and the quality of health communication materials developed during the 2019 cholera outbreak at Addis Ababa, Ethiopia. METHODS: A community-based parallel mixed design was conducted from May to June 2020 at Addis Ababa. A total of 605 adults were selected randomly from Addis Ketema sub-city and ten purposely selected adults were interviewed for qualitative data. In addition eight health communication materials on cholera were randomly selected for evaluation. The quantitative data were analyzed using SPSS version 25. After audio recorded interviews transcribed verbatim and translated into English the qualitative data were entered into open code version 4.02 for analysis. And then the data were analyzed using thematic analysis. RESULT: Respondents exposed for cholera related messages and outbreak information were 71.8% and 52.7% respectively. Respondents have moderate knowledge for cholera with (M = 14.72 and SD ±4.02) with (0-34) scale range. Both Television and radio spots were found as simple and easy to understand and printed health communication materials score low quality. Poor documentation, lack of data management system and less attention for risk communication activities were identified as a gaps in risk communication in the study settings. CONCLUSION: this study revealed the positive effects of risk communication messages in increasing individuals' knowledge. Even though the risk communication spots were found to be simple and easy to understand, the quality of printed materials was low and less attention was given for the risk-communication activities. Thus, strengthening the quality of risk communication and materials development process is very important to bring desired effects in disease prevention strategies and for effective emergency responses in the future.

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions.

BACKGROUND: People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions. METHODS: This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions. RESULTS: A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care. CONCLUSION: There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis.

Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.

Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study.

Background: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users, but can also help reduce the impact of stigma on service users. However the few studies of interventions to equip such professionals to be anti-stigma agents those took place in High-Income Countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across Low- and Middle-Income Countries (LMICs). Methods: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal, and Tunisia). Outcome measures: knowledge based on course content; attitudes to working to address the impact of stigma on service users; and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and three months post-baseline, followed by qualitative data collection. Fidelity will be rated during delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. Conclusions: The training development used a participatory and contextualized approach. Evaluation design strengths include the diversity of settings; the use of mixed methods; the use of a skills-based measure; and knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care, and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.

"I want to perform and succeed more than those who are HIV-seronegative" Lived experiences of youth who acquired HIV perinetally and attend Zewditu Memorial Hospital ART clinic, Addis Ababa, Ethiopia.

BACKGROUND: In Ethiopian Human Immunodeficiency Virus (HIV) prevention program one of the focusing areas is prevention of mother-to-child transmission and decreasing morbidity and mortality among those who already acquired it. However, the needs and the sexual behavior of children who acquired HIV perinatally was not given due attention. Therefore, we conducted this study with the aim of exploring the lived experiences of youth who acquired HIV perinatally to contribute to HIV prevention and control program. METHODS: We conducted a qualitative study using a phenomenological approach from March to May 2018 among 16 purposively selected youth who were infected with HIV vertically and receive ART services at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. They were recruited based on their willingness after obtaining written informed consent and assent. Data were audio taped, transcribed verbatim in Amharic and later translated to English, and coded using Open Code version 4.02 software. Findings were summarized under four themes by applying interpretative phenomenological analysis. FINDINGS: Seven males and nine females, aged 16 to 22 years have participated in the study. These youth reported as they had support from families and ART clinics, while pill-load, and fear of stigma are some of challenges they have faced, especially majorities don't want to disclose their status because of fear of stigma and discrimination. Half of them have ever had sexual relations usually with a seronegative partner and most of these had their first sex in their17-18 years of age. Unsafe sex was common among them where four girls reported to have had unprotected sex with their seropositive or seronegative sexual partners. Most wish to have purposeful life and love mate of the same serostatus but also fear they may remain alone. CONCLUSION: Youth who had acquired HIV from parents are challenged due to their serostatus and were not sure what type of life they may have in the future. They were also not comfortable in disclosing their serostatus and also engaged in unsafe sexual relation. This calls for an urgent intervention among HIV infected youth and their families; health care providers, and young people in general to halt HIV transmission. Special attention should be given on sexual behavior of all young people (10-24) and in disclosure of HIV status to children and life skills education to cop-up with stigma and discrimination.