Mixed-methods approach in evaluating safe abortion care services at public health facilities in North Shewa zone, central Ethiopia: a multicenter institutional cross-sectional study.

Background: Of the 55.7 million abortions that were performed globally, 25.1 million (45.1%) were not safe. Nearly 97% of these took place in developing countries. Approximately 71% of economically developed countries allow safe abortion care (SAC) services, whereas only 16% of developing countries permit it. In sub-Saharan Africa, 92% of mothers live in 43 countries where SAC services are restricted by law. Most Ethiopian women continue to self-terminate unwanted pregnancies in hazardous conditions. The aim of this evaluation was to assess input, care providers' compliance with national guidelines, and clients' satisfaction. Methods: A multicenter cross-sectional study design with a mixed-methods approach was used. Seven public health facilities were randomly selected where 75 health caseworkers were directly observed; 296 clients and 14 key informants were interviewed, respectively. A resource inventory checklist was used to assess all inputs. The overall SAC services evaluation was summarized from 40 indicators: 13 resource availability indicators, 14 healthcare workers' compliance to national guidelines indicators, and 13 clients' satisfaction toward SAC services indicators. A multivariate logistic regression model was fit to determine factors that affect client satisfaction at a p-value <0.005. Results: There were 75 healthcare providers in the maternal and child health departments in the study area. Except for the interruption of water and electricity, maternal waiting area, counseling, and procedural room, all are available making 94% of resources availability. All healthcare workers were compliant in providing anti-pain medication during procedures, identifying clients if they were targeted for an HIV/AIDS test, and providing their test results as per the guideline. Nevertheless, they were poorly compliant in respecting the clients (9, 12%) and taking vital sign (33, 44%). The overall compliance was 62.3%, while only 51% were satisfied with waiting time and privacy of counseling room. The overall client satisfaction was 65%. The overall evaluation of SAC services was 72.9%. Conclusion: Resource availability was excellent, which was in line with national SAC expectations while the healthcare workers' compliance to national guidelines was fair, which deviated from expectations. The clients' satisfaction and the overall evaluation were good, which was below the hypothesized expectation.

Body image dissatisfaction is associated with perceived body weight among secondary school adolescents in Harar Town, eastern Ethiopia.

Purpose: Body image dissatisfaction has emerged as an important determinant of dietary and physical activity, which in turn determine adolescents' nutritional status. Hence, it is important to understand predictors of body image dissatisfaction. Therefore, this study aimed to assess body image dissatisfaction and its associated factors among secondary school adolescents in the study area. Methods: Data collected for other purposes were used to assess body image dissatisfaction among adolescents in Harar town. Body image dissatisfaction was assessed using the Body Part Satisfaction Scale. Data processing and analysis were performed using STATA version 14, and binary logistic regression was used to identify factors associated with body image dissatisfaction. Factors associated with body image dissatisfaction were determined by estimating AOR along with 95% CI and the statistical significance was declared at a p-value less than or equal to 0.05. Result: The prevalence of body image dissatisfaction was 22.06% [95% CI (19.63, 24.70)]. This study also revealed that males were more dissatisfied with their upper torso and face, and females were more dissatisfied with their middle torso, lower torso, height, and weight than males. In this study, body image dissatisfaction was associated with perception of being fat [AOR = 1.89, 95% CI (1.23, 2.91)], anxiety [AOR = 1.59, 95% CI (1.02, 2.48)], and cigarette smoking [AOR = 1.63, 95% CI (1.03, 2.58)]. Conclusion: Almost one in five secondary school adolescents in Harar had body image dissatisfaction, which was significantly associated with perceptions of being fat, anxiety, and smoking. In this study, a significant number of the adolescents experienced body image dissatisfaction. Hence, all concerned bodies have to take action to reduce the burden.

Overweight and obesity and associated factors among public and private secondary school adolescent students in Harar city, Eastern Ethiopia: A comparative cross-sectional study.

Adolescent overweight and obesity are growing public health concerns in developing nations like Ethiopia. They are closely linked to an increased risk of non-communicable diseases, a deterioration in health-related quality of life, subpar academic performance, and a decline in social and emotional well-being. There is, however, little research in this field. Thus, this study aimed to assess overweight and obesity and associated factors among public and private secondary school adolescent students in Harar city, Eastern Ethiopia. A school-based comparative cross-sectional study was conducted among 781 secondary school adolescents in Harar city from February to March 2022. Multi-stage sampling was used to identify 781 study participants (586 in public and 195 in private schools). Anthropometric measures and self-administered structured questionnaires were used to obtain the data. Bivariate and multivariate logistic regression were used to determine the association between independent variables and overweight and obesity. Statistical significance was declared at P < .05. The overall magnitude of overweight and obesity was 9.3% [95% confidence interval (CI) = 7.2-11.4%] with 16.2% in private schools. Being female [adjusted odd ratio (AOR) = 2.04, 95% CI: 1.17-3.55], late adolescent age [AOR = 0.53, 95% CI: 0.31-0.90], bigger family size [AOR = 0.55, 95% CI: 0.31-0.97], high paternal education level [AOR = 2.03, 95% CI: 1.08-3.81], eating meat [AOR = 3.41, 95% CI: 1.27-9.17] and not consuming breakfast daily [AOR = 2.13, 95% CI: 1.24-3.67] were factors associated with overweight and obesity among all secondary school adolescents. A high maternal educational level, not eating breakfast and dinner daily in private secondary school adolescents and having a feminine gender, eating eggs, and not walking or riding a bicycle for at least 10 minutes continuously in public secondary school adolescents were factors associated with overweight and obesity. The extent of overweight and obesity was notably higher in the study area. Communities and educational institutions should work together to promote healthy lifestyle choices among adolescents, with a special emphasis on girls and students enrolled in private schools.

The Magnitude of Hypertension and Its Contributing Factors Among Patients Receiving Antiretroviral Therapy in Public Hospitals in Harar City, Eastern Ethiopia: A Cross-Sectional Study.

Background: Although people living with HIV (PLHIV) are surviving longer due to the development of highly active antiretroviral therapy (HAART), hypertension continues to be a significant obstacle for human immunodeficiency virus (HIV) positive patients. Purpose: This study aims to determine the prevalence of hypertension and its contributing factors among patients receiving HAART in public hospitals in Harar City, Eastern Ethiopia. Patients and Methods: A hospital-based cross-sectional study was conducted among adult PLHIV who receive HAART in public hospitals in Harar City, Eastern Ethiopia, from 20 March to 14 April 2023. A simple random sampling technique was employed to select a total of 406 clients (382 participated in the study). Data were collected through patient interview and chart review using a questionnaire. The binary logistic regression was used for data analysis. The association was declared statistically significant at a p-value less than 0.05. Results: The magnitude/prevalence of hypertension was 23% (95% CI: 19.1, 27.5) in study settings from a total of 382 adults who participated in this study. Factors significantly associated with hypertension in a multivariable binary logistic regression model include residence (rural residence, AOR = 1.95, 95% CI: 1.04, 3.65); body mass index (obese, AOR = 4.35, 95% CI: 1.08, 16.77); cigarette smoking (past cigarette smoking, AOR = 4.7, 95% CI: 1.10, 21.8); and HAART regimen change (AOR = 0.44, 95% CI: 0.20, 0.97). Conclusion: The prevalence of hypertension observed among adult PLHIV in the study settings was high. Adults from rural areas, with a history of past smoking cigarette, and obesity need close attention during their clinic visits for more health education to reduce risk factors. The changed HAART regimen was associated with a reduced risk of hypertension. Generally, hypertensive PLHIV need consideration for their double burden of communicable and non-communicable diseases during disease management and hospital guideline development.

Utilization of preconception care and associated factors among pregnant mothers in Fiche Town, Central Ethiopia: a community-based cross-sectional study 2021.

Introduction: Preconception care is an important preventive intervention for adverse pregnancy outcomes. It is recognized as a strategy to optimize women's health and pregnancy outcomes in Western countries. However, preconception care is underutilized in sub-Saharan Africa, like Ethiopia, where maternal mortality is high. Evidence is scarce in the study area about the prevalence and factors associated with preconception care utilization. Therefore this study aimed to assess the proportion of preconception care utilization and associated factors among pregnant mothers in Fiche town, central Ethiopia, 2021. Method: A community-based cross-sectional study was done from May 10 to June 25, 2021. A systematic random sample technique was used to choose 393 pregnant women for the study. A structured, pre-tested, interviewer-administered questionnaire was used to collect data. The data were entered into Epi Data version 3.1 and then exported into SPSS version 25 for analysis. A Bivariable and multivariable logistic regression analysis was used to check for the association. Odds ratio along with 95% was used to describe the association. Finally, a significant association was declared at a p-value less than 0.05. Results: 388 respondents participated in this study, making the response rate 98.7%. Of total study participants only 84 (21.6%; 95% CI, 18, 25.8) utilized preconception care. The study found that diploma or higher level of education (AOR = 3.47, 95% CI: 1.27, 9.53), psychological and financial support from a partner (AOR = 3.86, 95% CI: 2.1, 7.10), joint discussion and plan with a partner (AOR = 3.32, 95% CI: 1.55, 7.13), history of chronic disease (AOR = 3.47, 95% CI: 1.67, 7.25), and good knowledge about preconception care (AOR = 2.42, 95% CI: 1.34, 4.38) were significantly associated with preconception care utilization. Conclusions: Overall, less than a quarter of the pregnant mothers utilized preconception care, indicating that awareness is very low. Pregnant mothers who have a higher educational level, have good communication and support from their partners, have chronic health problems, and have good knowledge about preconception care were more likely to utilize the service. Preconception care is a better opportunity to intervene and maintain the mother in the continuum of care.

Khat chewing and associated factors among public secondary school students in Harar town, Eastern Ethiopia: a multicenter cross-sectional study.

Background: Khat is a huge, evergreen tree that grows at high altitudes throughout the Arabian Peninsula and in the region stretching from eastern to southern Africa. Cathinone, cathine, and norephedrine are psychoactive ingredients contained in khat. Ethiopian teenagers, especially those in secondary school, frequently use khat. This use of khat may lead to students frequently missing class and experiencing subpar academic performance. However, the study area lacks information regarding the prevalence of khat use and the factors associated with it. Objective: This study's primary goal is to determine the prevalence of khat chewing and related factors among secondary school students in public schools in Harar, Eastern Ethiopia, in 2022. Methods: A multicenter cross-sectional study design was employed from June 01-June 30, 2022, in three public secondary schools in Harar town in a sample of 485 students. Systematic random sampling was used to choose the study sample. Data were gathered using self-administered questionnaires, and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess khat chewing. Epidata version 4.6 was used to enter the data, while STATA version 14 was used to analyze them. To determine the factors related to khat chewing, bivariate and multivariate logistic regression analysis was conducted, and statistical significance was determined at a 95% confidence level with a P-value under 0.05. Results: Out of 485 eligible participants, 455 responded to this survey, giving a response rate of 93.8%. Overall, 33.2% (95% CI: 29.2%-37.6%) of the sample's participants reported currently chewing khat. Age ranged from 20 to 25 years (AOR = 2.04; 95% CI: 1.19-3.48), male students (AOR = 7.03; 95% CI: 4.35-12.57), current alcohol user (AOR 6.48; 95% CI: 2.30-18.28), presence of chewer friends (AOR 3.86; 95% CI: 2.38-6.24), and depression (AOR 1.84, 95%CI: 1.02-3.30), were strongly associated with khat chewing at a p-value of < 0.05. Conclusion: Khat chewing was very common among students in Eastern Ethiopia's public secondary schools. Ages between 20 and 25 years, being a male, being current alcohol users, having chewer buddies, and depression are all significantly linked to khat use. Thus, schools should create and implement audience-specific behavioral change communication to deter and stop students from chewing khat. Additionally, it is important to ban the sale of khat to young adults and adolescents, promote medical care for khat users, and foster peer advocacy for support services.

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study.

Background: Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government's claim of providing free maternal health-care services. Methods: A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association. Results: The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (ß=1.13; 95% CI: 1.00, 1.26), distance from hospital (ß=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (ß=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (ß=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (ß=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (ß=0.86; 95% CI = 0.77-0.97). Conclusion: Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

Implementation Evaluation of HIV/AIDS Voluntary Counseling and Testing (VCT) Service at Public Health Facilities of Akaki Kality Sub-City, Addis Ababa, Ethiopia.

Background: Voluntary Counseling and Testing (VCT) is widely acknowledged globally as an effective method for preventing and treating HIV/AIDS. It allows people to understand their HIV status, make informed choices about getting tested for it, evaluate their personal risk of contracting HIV, and create plans to reduce that risk. The study aimed to evaluate the process of VCT services in public health facilities of Akaki Kality sub-city, Addis Ababa, Ethiopia. Methods and Materials: A case study evaluation design with a mixed method was employed from May 12 to June 12, 2021. A total of 244 clients were interviewed during the study period. Furthermore, 12 direct observations, a review of documents from the past six months to the study period, and 12 key informant interviews were conducted. Quantitative data were entered into Epi data 4.6 and exported to SPSS version 25 for analysis. Univariate analysis was done and presented in tables and texts. Qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall service implementation process was measured on the basis of pre-determined judgmental criteria. Results: The overall level of VCT service implementation was 83.84%, to which the availability of resources (84.8%), compliance of service providers with the national guidelines (85.38%), and client satisfaction (76.93%) contributed. One facility had stock-outs of test kits in the last three months, and all VCT counseling and testing rooms lacked audio-visual privacy. Supportive supervision, the use of IEC materials during counseling, linking all HIV-positive clients to treatment and care services, and sending complete reports were practiced in a way that needs some improvement. Conclusion: Overall, the service implementation was deemed satisfactory, but further action is required to improve resource availability, ensure provider compliance with national guidelines, and enhance the status of the service. In addition, the Woreda Health Office and Addis Abeba Health Bureau should regularly supervise and provide feedback.

Process Evaluation of Health System Responsiveness Level and Associated Factors Among Mothers Gave Birth at Obstetric Ward in a Tertiary Hospital, Southwest of Ethiopia: Mixed Study Methods.

Background: The term responsiveness emerged during the World Health Organization (WHO) report in 2000 as new and essential goals of the health systems to meet the needs of people to their expectations from different services being given in healthcare systems. Obstetric violence and childbirth mistreatment are global problems, but the worst obstetric violence usually occurs in underdeveloped countries. Thus, the main objective of this study was to evaluate the responsiveness of obstetric service at Jimma University Medical Center. Methods: A single-case study design with quantitative and qualitative data collection was employed. Availability with 17 indicators and health system responsiveness with 24 indicators were used. Consecutive sampling technique was used to select the clients and qualitative data were collected from key informants. SPSS version 25 was used for the analysis of quantitative data, whereas thematic analysis was conducted for qualitative data. A multiple linear regression model was fitted after all assumptions were checked and fit to ensure the relation of the dependent variable with independent variables. Results: The overall evaluation was 75.6% and judged good. The resource availability and health system responsiveness were 85.5% and 69.7%, which were judged very good and fair, respectively. A stethoscope and thermometer were not available, while 40% glucose, dexamethasone, and intravenous fluid were the most frequently stocked-out supplies. Dignity (72.1%), confidentiality (71.4%), and prompt attention (70%) were the top three good scores for the health system's responsiveness. Health system responsiveness significantly associated with the following: Not attending formal education, attending college and above, place of delivery (health center), mode of delivery (cesarean section), and being merchant. Conclusion & Recommendation: The health system responsiveness of delivery service in study setting was good. All stakeholders should work for improving the health system's responsiveness in delivery service.

Awareness of prostate cancer and its associated factors among male patients attending care in the urology unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Globally, prostate cancer is the most common cancer among men. It is the second most common cause of cancer-related deaths in men. Symptoms may be non-specific and may not present until the cancer has progressed. Raising awareness, knowing risk factors and symptoms and seeking early medical attention is critical for prevention and detection. The objective of this study is to assess the level of awareness of prostate cancer among male patients attending care in a urology unit in Ethiopia. METHODS: We conducted a cross-sectional study among 241 male patients at Tikur Anbessa Specialized Hospital from February to April 2021. Data were collected using an interviewer-administered questionnaire adapted from published studies and cancer awareness measurement tools. We used EpiData V.4.6.0 and SPSS V.26 for data entry and analysis. Descriptive statistics and linear regressions were used for analyses. Bivariate and multivariate linear regression analysis identified factors associated with prostate cancer awareness. Adjusted odd ratio (AOR) at 95% CI and p value<0.05 were considered statistically significant. RESULTS: A total of 250 patients were approached, and 241 (96.4%) responded. The mean scores for awareness of prostate cancer risk factors, symptoms, screening and prevention were 41.2%, 43.8%, 44.7% and 49.5%, respectively. Families with an average monthly income of more than 8900 ETB (Ethiopian birr), having heard about prostate cancer, having a regular source of care every six months or more, having a history of hospitalisation and having healthcare providers as the main source of information were all significantly associated with awareness of prostate cancer. CONCLUSION: The findings of this study indicate that male patients have a relatively low level of awareness of prostate cancer risk factors, symptoms, screening and prevention. There should be more public awareness initiatives to educate men in Ethiopia on the risk factors, symptoms, screening and prevention of prostate cancer.

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015-2023.

BACKGROUND: One of the most challenging problems in developing countries including Ethiopia is improving maternal health. About 303,000 mothers die globally, and one in every 180 is at risk from maternal causes. Developing regions account for 99% of maternal deaths. Maternal near miss (MNM) resulted in long-term consequences. A systematic review and meta-analysis was performed to assess the prevalence and predictors of maternal near miss in Ethiopia from January 2015 to March 2023. METHODS: A systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Duplicated studies were removed using Endnote X8. The paper quality was also assessed based on the JBI checklist. Finally, 21 studies were included in the study. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Forest plots were used to present the pooled prevalence using the random effect model. Heterogeneity and publication bias was evaluated using Cochran's Q test, (Q) and I squared test (I2). Subgroup analysis based on study region and year of publication was performed. RESULT: From a total of 705 obtained studies, twenty-one studies involving 701,997 pregnant or postpartum mothers were included in the final analysis. The national pooled prevalence of MNM in Ethiopia was 140/1000 [95% CI: 80, 190]. Lack of formal education [AOR = 2.10, 95% CI: 1.09, 3.10], Lack of antenatal care [AOR = 2.18, 95% CI: 1.33, 3.03], history of cesarean section [AOR = 4.07, 95% CI: 2.91, 5.24], anemia [AOR = 4.86, 95% CI: 3.24, 6.47], and having chronic medical disorder [AOR = 2.41, 95% CI: 1.53, 3.29] were among the predictors of maternal near misses from the pooled estimate. CONCLUSION: The national prevalence of maternal near miss was still substantial. Antenatal care is found to be protective against maternal near miss. Emphasizing antenatal care to prevent anemia and modifying other chronic medical conditions is recommended as prevention strategies. Avoiding primary cesarean section is recommended unless a clear indication is present. Finally, the country should place more emphasis on strategies for reducing MNM and its consequences, with the hope of improving women's health.

Teachers' Willingness to Pay for Social Health Insurance and Its Determinant Factors at Harar Region, Ethiopia, 2021.

Background: Most developing nations lag behind in maintaining their populations' health. These nations are characterized by under-financing, low health cost protection mechanisms for the poor, and lack of risk pooling and cost sharing methods. To tackle this challenge, Ethiopia proposed social health insurance in 2010 even though its implementation was delayed. Hence, the purpose of this study was to assess teachers' willingness to pay for the newly proposed social health insurance and its associated factors. Methods: A cross-sectional study was conducted and a stratified sampling technique was used to select government and private schools. After data were collected using a semi-structured self-administered questionnaire, binary and multivariate logistic regressions were done to examine determinants of willingness to pay for social health insurance. Results: Among participants who faced illness six months prior to the study, 85.7% reported that they paid "out of their pocket". About 59.2% and 54% of the teachers had a positive attitude and good knowledge toward health insurance schemes respectively. Of the total study respondents, 89.5% were willing to pay for the suggested insurance scheme. Forty eight percent of participants agreed to pay greater than or equal to 4% of their monthly salary. Willingness to pay was more likely among those who taught in secondary schools, had a positive attitude and good knowledge. Conclusion: Nearly three fourths of the teachers showed willingness to pay for social health insurance. Participants with good knowledge, a positive attitude and from primary schools were more likely to be willing to pay for social health insurance. Equipping all public facilities' employees with necessary knowledge of social health insurance is essential to reduce catastrophic health care costs. Future researchers need to consider qualitative studies to support these findings.