Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework.

Introduction: Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State. Methods: A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software. Results: The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents. Conclusion: The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.

Physical activity status among adolescents in Southern Ethiopia: A mixed methods study.

BACKGROUND: Adolescents physical activity is associated with current and future health benefits, reduction of cardio-vascular risk factors, improved bone mineral density, and mental health. The aim of the current study is to assess physical activity status and its factors among adolescents in Arba Minch and Jinka towns, Southern Ethiopia. METHODS: The study was conducted on 1255 randomly selected schools adolescents of Arba Minch and Jinka town by employing a mixed method. The qualitative data was obtained by Focus Group Discussion. Multiple linear regressions were done to identify factors affecting physical activity. Codes, sub-categories, and main categories were derived from the transcripts and presented in narrative ways to describe adolescent student's perception on physical activity, its barriers and facilitators by comparing with quantitative findings. RESULTS: The mean physical activity level was 2.08 (95% CI: 2.04-2.12). A student's self-perception about being physically active, being a member of a sport or fitness team, and engaging in after-school activity to earn money, being older, sex, a self-perception of being healthy, higher levels of vegetable and fruit consumption, having someone who encouraged physical activity, perceiving one's family as being active, self-perception of not being overweight and attending schools that have a sports/playground were factors associated with physical activity. The qualitative finding showed a related finding. Poor awareness on the recommended physical activity, benefits of physical activity, lack of interest, restrictions from family members, peers and the community, uncomfortable environment were barriers to physical activity. CONCLUSION AND RECOMMENDATION: The physical activity level of adolescents was low. Age, sex, a positive self-perception about PA and general health, and perception about one's family PA, healthy eating practice, and the presence of role model were associated factors. Lack of self-motivation, interest and family restrictions were barriers to physical activity. PA promotion should be made by incorporating PA into school health programs and strengthening the existing school curriculum.

Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study.

OBJECTIVE: This analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019. DESIGN: This analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI). STUDY SETTING: The study includes nine region states and two chartered cities of Ethiopia. OUTCOME MEASURES: We calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates. RESULTS: In 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6-8918), 59.4 (95% UI 49.8-71.4) and 2404.5 (95% UI 2059.4-2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions-Benishangul-Gumuz 101.8 (95% UI 84.0-121.7) and Afar 103.7 (95% UI 86.6-122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country. CONCLUSION: In Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.

Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review.

Background: In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap. Methods: This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review. Results: From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents. Conclusion: This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.

Anxiety and its associated factors among inmates in ARBA Minch and JINKA town, southern Ethiopia.

BACKGROUND: The prison populations are more affected by mental illness than the general population but little attention is given to this population. And there is a limitation of study on the magnitude of anxiety and its associated factors. So this study aimed to assess the magnitude of anxiety and its associated factors among prisoners in Arba Minch and Jinka town, Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 650 randomly selected prisoners at Arba Minch and Jinka town. Data was collected by using open data kit then converted to excel and exported to SPSS version 25 for analysis. Descriptive statistics including frequency, means, and proportion were performed. Binary logistic regression was used to identify the associated variables. P < 0.05 was used to declare statistical significance. RESULTS: The proportion of Anxiety among prisoners was 28% [N = 174, (95%CI, 25-32%)]. Age ≥ 48 (AOR = 4.21, 95%CI 1.99-8.93), age 38-47 (3.95, 1.94-8.07), being an urban resident (2.48, 1.56-3.95), not doing physical exercise (2.71, 1.53-4.79), having a chronic disease (1.63, 1.07-2.47), having 1-2 stressful life events (2.92, 1.59-5.35), duration of punishment > 5 years (2.92, 1.59-5.35) and lack of income-generating job in prison (2.54, 1.48-4.35) were significantly associated with anxiety. CONCLUSION: The magnitude of anxiety among prisoners was high. Age ≥ 48 and 38-47, urban residence, not doing physical exercise, having a chronic disease, having 1-2 stressful life events, duration of punishment > 5 years, and lack of income-generating job in prison were significantly associated with anxiety. Giving special attention and being supportive to older age and those who have a chronic disease, facilitating physical exercise, creating job opportunity in the prison, and giving training for prisoners on stress coping mechanism and anxiety is recommended.

Magnitude of Depression and Its Associated Factors Among Prisoners in Arba Minch and Jinka Town, Southern Ethiopia.

Introduction: Globally, there is a rapid increase in the prison population, and one out of nine prisoners suffers from common mental disorders such as depression and anxiety. However, there is a limitation of study on the magnitude of depression and its associated factors among prisoners in low- and middle-income countries including Ethiopia. Purpose: To assess the magnitude of depression and its associated factors among prisoners in Arba Minch and Jinka Town, Southern Ethiopia, 2021. Patients and Methods: A cross-sectional study was conducted among 650 selected prisoners in Arba Minch and Jinka Town. A simple random sampling technique was used to select the study participants. Data was collected using an open data kit and then exported to SPSS version 25 for analysis. Binary logistic regression analysis with a p-value <0.05 with a 95% confidence level was used to declare statistical significance. Results: The magnitude of depression among the prisoners was 445 (72.0%) (95% CI: 68-76%). Age ≥48 years (AOR = 3.09 95% CI 1.16-8.28), being an urban resident (AOR = 2.21 95% CI 1.39-3.49), using smokeless tobacco (AOR = 2.80 95% CI 1.50-5.22), not doing physical exercise (AOR = 2.42 95% CI 1.54-3.81), and lack of income generating job in the prison (AOR = 1.89 95% CI 1.19-3.04) were significantly associated with depression. Conclusion: The magnitude of depression among prisoners was high. Age ≥48, urban residence, using smokeless tobacco, not doing physical exercise, and lack of income-generating job in prison were significantly associated with depression. Giving special attention and being supportive to older age, prohibiting the use of smokeless tobacco; facilitating places and materials for physical exercise and creating income generating opportunities by using prisoner's skills and available resources, giving training for the health professionals working in the prison about diagnosis and treatment of depression, additionally giving training for the prisoners how to cope up with prison life may decrease the magnitude of depression among prisoners.

Determinants of intrauterine contraceptive device utilization at primary health care facilities in Mekelle City, northern Ethiopia.

BACKGROUND: Each year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, approximately 222 million of them have an unmet need for modern contraception. In spite of several advantages and potential effectiveness of Intra Uterine Contraceptive Device, its utilization still too low in Sub Saharan African countries including Ethiopia. OBJECTIVES: To identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city. METHOD: Facility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by structured questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20.0 statistical software. During analysis the variables were defined, categorized and the difference in variables was determined. Odds ratio used to show degree of association between independent variables with Intra Uterine Contraceptive Device. RESULT: Marital status ([AOR (95%CI) =8.59(2.60-28.43)], number of pregnancies (AOR (95%) CI = 5.69(1.020-31.802), number of alive children [AOR (95%CI) =3.5 (1.03-11.9) are variables continued to have statistically significant association with use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about availability of health care provider able to insert Intra Uterine Contraceptive Device. CONCLUSION: This study has identified marital status, Gravidity, number of alive children and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, it is vital at addressing the aforementioned determinants will be vital to improve utilization of Intra Uterine Contraceptive Device. Among long acting reversible modern contraceptive methods, Intra Uterine Contraceptive Devices (IUCDs) are the most reliable and effective as well as with fewer side effects. Despite these advantages and cost effective potential of Intra Uterine Contraceptive Device its utilization is still too low in Sub Saharan countries like Ethiopia. Thus, this study intended to identify the factors that limit the utilization of Intra Uterine Contraceptive Device among women of Ethiopia in Mekele City. The study identify that the utilization of Intra Uterine Contraceptive Device was determined by the marital status of the women, the number of previous pregnancy and recent alive children and the level of awareness about Intra Uterine Contraceptive Device of the women. Therefore, providers training that focus on promoting Intra Uterine Contraceptive Device, centering on increasing awareness and practice about Intra Uterine Contraceptive Device is very important.

Sub-fecundity and associated factors among mothers with natural planned conception attending antenatal care service in Arba Minch Health Facilities.

BACKGROUND: Fecundity is a physiological ability to have children. The inability to get the desired child which was commonly caused by the prolonged time to conceive due to unwanted non-conception period increased from time to time. As a result, many couples are developing psychological, social, and economic problems and unstable life. However, information on fecundity status is limited in Ethiopia context. Therefore, this study aimed to assess the proportion of sub-fecundity and associated factors in Ethiopia context. METHODS: A health institution based cross-sectional study was conducted in Arba Minch health facilities from March 25 to April 25, 2020. By using a systematic sampling method, 539 mothers were selected for the study. Structured questionnaire was used for data collection. A binary logistic regression model was used to identify factors associated with the sub-fecundity. Variables with p-value <0.25 in the bi-variable logistic regression analysis were interred and checked for association in a multivariable logistic regression model. The level of statistical significance was declared at p-value <0.05. RESULT: The proportion of sub-fecundity was 17.8% with 95%CI (14.8%-21.3%). Mothers' age ≥ 30 (AOR = 2.54, 95%CI; 1.18-5.48), partners' age ≥ 35 (AOR = 2.20, 95%CI; 1.01-4.75), coffee consumption of ≥ 4 cups/day (AOR = 2.93, 95%CI; 1.14-7.53), menses irregularity (AOR = 3.79 95%CI; 2.01-7.14) and coital frequency of 1day/week (AOR = 3.65, 95%CI; 1.47-9.05) were significantly associated with the sub-fecundity. CONCLUSION: This study found that a substantial proportion of mothers were sub-fecund. Factors that contributed to the sub-fecundity were pre-pregnancy; mothers' age, partners' age, coffee drinking of ≥ 4 cups/day, coital frequency of 1day/week, and menses irregularity. Thus, efforts to prevent sub-fecundity should focus on awareness creation as to plan to conceive at early age, reducing coffee consumption, increasing days of coital frequency per week, and investigating and treating mothers with irregular menses.

Predictors of Time to First Line Antiretroviral Treatment Failure among Adult Patients Living with HIV in Public Health Facilities of Arba Minch Town, Southern Ethiopia.

BACKGROUND: Antiretroviral therapy is a proven medication given for Human Immunodeficiency Virus positive individuals. However, first-line antiretroviral treatment failure becomes a public health issue and early detection of treatment failure is crucial for timely actions. Therefore, this study aimed to identify the predictors of time to first-line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town. METHODS: Institution-based retrospective cohort study was employed among 396 adult patients that were selected using simple random sampling. The data on relevant variables were extracted from patient medical cards. Bi-variable and multi-variable Cox proportional hazard regression analyses were used to identify predictors. RESULTS: The median survival time was 21 months. Substance use (AHR=2.94, 95% CI=1.62 to 5.32), disclosure status (AHR=1.98, 95% CI=1.03 to 3.79), time since HIV diagnosis (AHR=2.19 95% CI=1.01 to 4.79), WHO clinical stage (AHR=2.02, 95% CI=1.02 to 4.00), opportunistic infection (AHR=2.27, 95% CI=1.23 to 4.19), nutritional status (AHR=3.78, 95% CI=1.99 to 7.17), functional status (AHR=2.71 95% CI=1.33 to 5.51), CD4 count (AHR=1.99, 95% CI=1.05 to 3.75), and adherence level (AHR=1.99, 95% CI=1.05 to 3.76) were independent predictors of time to first line ART treatment failure. CONCLUSION: History of substance use, lack of disclosure status, time since HIV diagnosis, advanced WHO clinical staging, low CD4 counts, opportunistic infection, functional status, poor adherence to ART and under-nutrition affect the time to first-line treatment failure among adult patients living with HIV. Therefore, preventive interventions, and information and counseling focusing on high risk groups of HIV infected adult are very important.

Predictors of time to first line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town, Southern Ethiopia

BACKGROUND: Antiretroviral therapy is a proven medication given for Human Immunodeficiency Virus positive individuals. However, first-line antiretroviral treatment failure becomes a public health issue and early detection of treatment failure is crucial for timely actions. Therefore, this study aimed to identify the predictors of time to first-line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town. METHODS: Institution-based retrospective cohort study was employed among 396 adult patients that were selected using simple random sampling. The data on relevant variables were extracted from patient medical cards. Bi-variable and multi-variable Cox proportional hazard regression analyses were used to identify predictors. RESULTS: The median survival time was 21 months. Substance use (AHR=2.94, 95% CI=1.62 to 5.32), disclosure status (AHR=1.98, 95% CI=1.03 to 3.79), time since HIV diagnosis (AHR=2.19 95% CI=1.01 to 4.79), WHO clinical stage (AHR=2.02, 95% CI=1.02 to 4.00), opportunistic infection (AHR=2.27, 95% CI=1.23 to 4.19), nutritional status (AHR=3.78, 95% CI=1.99 to 7.17), functional status (AHR=2.71 95% CI=1.33 to 5.51), CD4 count (AHR=1.99, 95% CI=1.05 to 3.75), and adherence level (AHR=1.99, 95% CI=1.05 to 3.76) were independent predictors of time to first line ART treatment failure. CONCLUSION: History of substance use, lack of disclosure status, time since HIV diagnosis, advanced WHO clinical staging, low CD4 counts, opportunistic infection, functional status, poor adherence to ART and under-nutrition affect the time to first-line treatment failure among adult patients living with HIV. Therefore, preventive interventions, and information and counseling focusing on high risk groups of HIV infected adult are very important