Improving immunization capacity in Ethiopia through continuous quality improvement interventions: a prospective quasi-experimental study.

BACKGROUND: Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives. This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement (CQI) interventions to improve national immunization programme performance in Ethiopia. METHODS: The study used a prospective, quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors (556 healthcare facilities, 196 district health offices, and 29 zonal health departments) selected from developing and emerging regions in Ethiopia. Procedures included baseline quality assessment of immunization programme and services using structured checklists; immunization systems strengthening using onsite technical support, training, and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months; and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test. Outcome measures were the coverage of the vaccines pentavalent 3, measles, Bacillus Calmette-Guérin vaccine (BCG), Pneumococcal Conjugate Vaccine (PCV), as well as full vaccination status; while process measures were changes in human resources, planning, service delivery, logistics and supply, documentation, coordination and collaboration, and monitoring and evaluation. Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines. RESULTS: Prior to the interventions, vaccination coverage was low and all seven process indicators had an aggregate score of below 50%, with significant differences in performance at healthcare facility level between developing and emerging regions (P = 0.0001). Following the interventions, vaccination coverage improved significantly from 63.6% at baseline to 79.3% for pentavalent (P = 0.0001), 62.5 to 72.8% for measles (P = 0.009), 62.4 to 73.5% for BCG (P = 0.0001), 65.3 to 81.0% for PCV (P = 0.02), and insignificantly from 56.2 to 74.2% for full vaccination. All seven process indicators scored above 75% in all regions, with no significant differences found in performance between developing and emerging regions. CONCLUSIONS: The CQI interventions improved immunization capacity and vaccination coverage in Ethiopia, where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times. The approach was found to empower zone, district, and facility-level health sectors to exercise accountability and share ownership of immunization outcomes. While universal approaches can improve routine immunization, local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.

DETERMINANT FACTORS OF VISUAL INSPECTION WITH ACETIC ACID (VIA) POSITIVE LESIONS AMONG HIV POSITIVE WOMEN IN MEKELLE HOSPITAL, NORTHERN ETHIOPIA: A CASE CONTROL STUDY.

BACKGROUND: Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women living with HIV/AIDS are at greater risk of developing cervical cancer. The study aimed to identify the determinant factors forsuspected precancerous cervical lesions among HIV- positive women in Mekelle hospital, Ethiopia. METHODS: Anunmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. In Mekelle Hospital, routine screening for lesions of the cervix uteri by visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses. Suspicious findings are treated by cryotherapy or referred to the Gynaecologist. A number of 116 cases, who had suspicious findings on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study The determinant factors for precancerous cervical lesion were analyzed using multiple logistic regression and described as adjusted odds ratio (AOR). RESULTS: HIV positive women who had CD4 cells less than 350/mm3 were two times more likely to have precancerous cervical lesion compared to those with CD4 cells above 350/mm3. Women with two (AOR = 3.6; 95% CI: 1.7, 7.7) and three (AOR = 2.5; 95% CI: 1.2, 5.4) sexual partners were four and three times more likely to have precancerous cervical lesion, respectively, as compared to those who had one sexual partner. Age, History of STI and duration of ART had no influence on presence of VIA positive lesions in HIV positive women. CONCLUSION: CD4 count cells and number of sexual partners were predictors of VIA positive cervical lesion among HIV positive women.

ASSESSMENT OF THE MAGNITUDE OF TEENAGE PREGNANCY AND ITS ASSOCIATED FACTORS AMONG TEENAGE FEMALES VISITING ASSOSA GENERAL HOSPITAL.

BACKGROUND: Teenage pregnancy is directly related to high incidence of pregnancy related complications contributing to maternal morbidity and mortality and social problems. There are no enough data on teenage pregnancy and related complications in Ethiopia and in Benishangul Gumuz region in particular. OBJECTIVE: To investigate the magnitude and factors associated with teenage pregnancy among teenage females visiting Assosa general hospital for health care services. METHODS: Facility-based quantitative cross-sectional study was carried out among 783 randomly selected teenage females using structured and pre-tested questionnaire from January to April 2014. RESULTS: Teenage pregnancy is estimated at 20.4% in this study. The median age of subjects at first sexual intercourse and at first marriage being 16 and 17 years respectively. High proportion of (46.8%) teenagers had engaged in premarital sex. Among sexually active teenage females, 46.7% experienced their first sexual encounter by coercion. Being young [AOR = 0.21, 95% CI = 0.06-0.67], single [AOR = 0.06, 95% CI = 0.03-0.12], housemaid [AOR = 3.93, 95% CI = 1.71-9.04] and use of family planning [AOR = 2.39, 95% CI = 1.20-4.75] have statistically significant association with teenage pregnancy. CONCLUSIONS AND RECOMMENDATIONS: A range offactors including age, marital status, level of education, occupational status, average family income and use of family planning have influence on teenage pregnancy in the study area. Behavioral change communication, strengthening school health program, empowering young women specifically the rural women, and promoting parent-children discussion on sexuality is recommended.

MAGNITUDE OF DISABILITY AND ASSOCIATED FACTORS AMONG PATIENTS IN BORU MEDA HOSPITAL, SOUTH WOLLO ZONE, AMHARA REGION, ETHIOPIA.

BACKGROUND: Leprosy is a chronic infectious disease affecting the skin and peripheral nerves. Early diagnosis and full course treatment are critical for preventing lifelong neuropathy and disability to minimize the occurrence of disability. OBJECTIVE: The objective of this study is to assess the magnitude of disability and associated factors among leprosy patients after treatment in Boru Meda Hospital. METHODS: Facility based cross sectional study was conducted among 128 leprosy patients registered at Boru Meda Hospital from January 1, 2010 to December 31, 2012. Data was collected from charts, entered into a computer, cleaned, edited using EPI Info Version 3.53 for windows and analyzed by SPSS. RESULTS: Five patients (4%) had Grade 2 disability at discharge; the remaining 123 (96%) were discharged with either disability grading 0 or disability grading 1, which are considered to be normal disability grading. Males and rural people were more affected by the diseases: 72% and 92% respectively. Sixty percent of disability occurred due to type one reaction. The mean age of patients and treatment duration were 39.3 years and 60 days respectively. Among the factors type of reaction was significantly associated with disability grading (P = 0.02). CONCLUSION AND RECOMMENDATION: Rural people and males are more affected by leprosy and the prevalence of disability is decreasing. This findings suggest that we need to work on awareness creation on rural people and patients with leprosy to see healthcare providers as early as possible.

PATTERNS OF HYPERTENSIVE DISORDERS OF PREGNANCY AND ASSOCIATED FACTORS AT DEBRE BERHAN REFERRAL HOSPITAL, NORTH SHOA, AMHARA REGION.

BACKGROUND: Hypertensive Disorders of Pregnancy (HDP) represent the most common medical complication in pregnancy associated with significant maternal and perinatal morbidity and mortality worldwide. Identification of common maternal and perinatal morbidities associated with hypertensive disorders of pregnancy is important for policy makers to plan to alleviate the problem. OBJECTIVE: To assess the patterns of hypertensive disorders of pregnancy and associated factors in Debre Berhan Referral Hospital. METHOD: Institution-based retrospective cross sectional study was conducted by reviewing logbooks and patients charts. RESULT: Among 8626 women who got services in the hospital 340 (3.9%)had hypertensive disorders. The proportion of HDP shows an increasing trend from 1.8% in 2011 to 5.7% in 2014. Preeclampsia accounts for 67.4% of all case followed by eclampsia which account for 27.8%. In this study, HDP was associated with 35.4% preterm delivery, 30.8% fetal death, 39.4% low birth weight, 38.4% low APGAR score and 8.5% IUGR. About 15.8% of newborns born from mothers with HDP mothers needed resuscitation and 40.1% ICU admission. Maternal death occurs in 2.5% mothers who had HDP with the case fatality rate for eclampsia being 6.67%. HDP contributed for 35% of all maternal deaths. Of all mothers with HDP, 58% were primi-gravida ladies. CONCLUSION: The prevalence of HDP shows an increasing pattern over the last years. Preeclampsia and eclampsia together take the lion-share of HDP. Primi-gravida women are affected more frequently than multi-gravida women with hypertensive disorders of pregnancy. HDP was associated with major adverse perinatal and maternal outcome.