Client satisfaction on family planning, its myths, and misconceptions among women in Wolaita zone, Southern Ethiopia: A mixed methods design.

Background: Client satisfaction has been recognized as an essential component in evaluating healthcare quality. In Wolaita Zone, there was a lack of research on the myths, misconceptions, and elements linked to client satisfaction with family planning. This study aimed to assess the myths and misconceptions of family planning and the factors associated with women's satisfaction with family planning services. Methods: We used a mixed methods study design (cross-sectional study design with a phenomenological design of the qualitative study). For the survey, 777 women were selected using multistage sampling, while purposive sampling was used to recruit in-depth interview participants. We used STATA version 15 and NVIVO version 12 software. Results: Only two-thirds, 534 (68.7 %) [95 % CI = 65.4%-71 %] clients, were satisfied with the family planning service. Clients who attended secondary education and above (AOR = 1.84; 95 % CI: 1.07, 3.23) and (AOR = 3.04; 95 % CI: 1.37, 6.72) did not wait to get the service (AOR = 5.11; 95 % CI: 1.98, 13.20), attended family planning service in a facility with convenient working hours (AOR = 4.43; 95 % CI: 2.25-8.74) and with posters in the waiting room (AOR = 3.48; 95 % CI: 1.22-9.94), comfortable with the cleanliness of clinic (AOR = 2.08; 95 % CI: 1.20, 3.94), whose Privacy was maintained (AOR = 9.56; 95 % CI: 5.02, 18.20), who were given information on the possible side effects of a method (AOR = 2.77; 95 % CI: 1.75-4.39), and on how the method works (AOR = 2.57; 95 % CI: 1.49-4.43) had higher odds of satisfaction. Also, various myths and misconceptions, such as implants moving to other parts of the body, implants causing paralysis, affecting routine activities, "womb of the woman may not hold the baby", etc., were identified in a qualitative study. Conclusions: Client satisfaction in this study is low. An improved provider approach that suits on-site advocacy and the quality of counselling during the family planning service is needed. There is also a need to improve waiting time, working hours, cleanliness, awareness creation for both couples, and maintaining clients' privacy.

Barriers and enablers to the implementation of immediate postpartum and post-abortion family planning service integration in primary health care units of Wolaita Zone, Southern Ethiopia: A baseline study for implementation research.

INTRODUCTION: Evidence indicates that postpartum and post-abortion women accept family planning at a higher rate when offered timely at appropriate sites. Therefore, this study explored barriers and enablers of postpartum and post-abortion family planning utilization in primary health care units of Wolaita Zone, Southern Ethiopia, from June 20 to July 25, 2022. METHODS: We used a case study strategy of qualitative research using both the Consolidated Framework for Implementation Research (CFIR) and Gender, Youth, and Social Inclusion (GYSI) frameworks was conducted from June to July 2022. We conducted 41 in-depth and key informant interviews and six focus group discussions. We also used Open Code software version 4.02 for coding and further analysis and applied a framework analysis. RESULTS: The analysis of this study identified barriers and enablers of postpartum and post-abortion family planning service uptake in five CFIR domains and four GYSI components. The barriers included misconceptions and sole decision-making by husbands, cultural and religious barriers, and healthcare providers paying less attention to adolescents and husbands, which prevented them from using immediate postpartum and postabortion family planning services. The health facilities were not adequately staffed; there was a shortage and delay of supplies and infrastructure, trained staff turnover, and poor accountability among service providers. The existence of community structure, equal access and legal rights to the service, and having waivered services were enablers for postpartum and post-abortion family planning service uptake. CONCLUSION AND RECOMMENDATION: The current study identified various barriers and enablers to the uptake of postpartum and post-abortion family planning. Therefore, there is a need for high-impact interventions such as targeting male partners and girls, ensuring infrastructure, supplies, and equipment, building staff capacity, and making decisions jointly.

Predictors of Anemia Among HIV-Infected Children on Antiretroviral Therapy in Wolaita Zone, South Ethiopia: A Facility-Based Cross-Sectional Study.

PURPOSE: Anemia is a global public health problem, and the majority of human immunodeficiency virus (HIV)-positive people become anemic at some point in the course of the disease. We lack adequate evidence on the magnitude of anemia among children on highly active antiretroviral therapy in Ethiopia and particularly in South Ethiopia. Thus, this study aimed at determining the proportion and associated factors of anemia among children on highly active antiretroviral therapy in Wolaita zone, South Ethiopia. PATIENTS AND METHODS: A facility-based cross-sectional study was conducted from November to December 2018 on 256 children from 6 months to 14 years of age who were on antiretroviral therapy. Data were collected through an interview with caregivers and review of medical records. CD4+ cell count was analyzed using FACS Calibur, and hemoglobin level was measured with a Hem cue 301 analyzer. Stool samples were examined for the presence of intestinal parasites by direct wet mount technique. Data analyzed with Stata version 14.0 were conveyed in mean and standard deviation of the mean, median and inter-quartile range. Multivariate analysis was carried out to identify independent predictors of the outcome variable. Adjusted odds ratio with 95% confidence interval was reported. RESULTS: The proportion of anemia was found to be 38.8%. Co-trimoxazole prophylaxis (AOR=0.45; 95% CI: 0.21, 0.95), caregivers not receiving nutritional counseling (AOR=0.90; 95% CI: 0.01, 0.98) and presence of intestinal parasites (AOR=3.10; 95% CI: 1.39, 6.88) were associated with anemia. CONCLUSION: The proportion of anemia found in this study is a moderate public health problem. Health education programs in antiretroviral therapy clinics should be targeted at appropriate dietary practice, and appropriate hand washing and other hygienic practices to prevent intestinal parasitic infections. Co-trimoxazole prophylaxis should be given to all eligible children based on the recommendation.

Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia.

BACKGROUND: Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts. METHODS: This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers. RESULT: We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers. CONCLUSION: We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.