Impairment of health-related quality of life and its determinants among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia: institutional-based cross-sectional study.

OBJECTIVE: This study aimed to assess the impairment of health-related quality of life (HRQoL) and its determinants among patients diagnosed with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia. METHODS: An institutional-based cross-sectional study design was used in the setting of primary healthcare facilities to assess impaired HRQoL among patients with podoconiosis in the East Wollega Zone from 1 March 2023 to 30 April 2023, using the Dermatologic Life Quality Index (DLQI). Data was collected from 494 patients with podoconiosis, and a multistage sampling technique was employed. The data was entered into EpiData V.4.6 and exported to SPSS V.27 for analysis. A linear regression model with a 95% cofidence interval (CI) was used to estimate level of HRQoL and to identify its determinants estimating beta (ß) coefficient declaring the significance level at p<0.05. RESULTS: The quality of life among patients was impaired on average by 9.6±6.1 with the lowest DLQI Score in the domain of treatment (0.8±0.97) and the highest in the domain of daily activity (2.3±1.72). The identified significant determinants of impairment of HRQoL associated with DLQI scores were duration of disease (95% CI, ß=0.11 (0.08 to 0.15)), acute dermato-lymphangio-adenitis (ADLA) (95% CI, ß=0.08 (0.01 to 0.16)), comorbidity (95% CI, ß=1.26 (0.37 to 2.16)), consistently wearing shoes (95% CI, ß=-0.06 (-0.09 to -0.03)), feeling of stigmatised (95% CI, ß=0.21 (0.16 to 0.25)) and psychological distress (95% CI, ß=0.17 (0.14 to 0.21)) and being female (95% CI, ß=1.16 (0.19 to 2.12)). CONCLUSION: Overall, HRQoL among patients with podoconiosis was moderately impaired. The duration of disease, ADLA, comorbidity, stigma, psychological distress and being female in sex significantly impaired HRQoL, whereas consistently wearing shoes significantly improved HRQoL among the patients with podoconiosis. Therefore, healthcare providers and public health experts should work on educating communities and counselling patients to avoid stigma and psychological distress, wearing shoes consistently and treating podoconiosis and other comorbidities among these patients.

What role does community-based health insurance play in the utilisation of health services among households in Ethiopia? A community-based comparative cross-sectional study.

OBJECTIVE: In Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study area was scanty. Therefore, this study aimed to assess health service utilisation and its predictors among insured and non-insured households of community-based health insurance in the East Wallaga Zone, Oromia region, Ethiopia, in 2022. METHODS: A community-based comparative cross-sectional study was employed. Data were collected using semi-structured interviewer-administered pretested questionnaire by face-to-face interviewing of heads of the households or spouse from 1 January 2022 to 30 January 2022, on 900 (450 insured and 450 non-insured). Epi-Data V.3.1 and Statistical Package for Social Science V.26 were used for data entry and analysis, respectively. The association between dependent (health service utilisation) and independent variables was analysed first using binary logistic regression. Multivariable logistic regression was used to identify potential predictor variables at a p<0.05. RESULTS: About 60.5% (95% CI 55.7% to 64.8%) of insured households had used health services compared with 45.9% (95% CI 41.4% to 50.9%) of non-insured households in the last 6 months. Family health status (Adjusted Odd Ratio (AOR) and 95% CI=2.74 (1.37 to 5.45), AOR and 95% CI=1.62 (1.01 to 3.14)); family with chronic disease (AOR and 95% CI=8.33 (5.11 to 13.57), AOR and 95% CI=4.90 (2.48 to 9.67)); perceived availability of drugs (AOR and 95% CI=0.34 (0.15 to 0.79), AOR and 95% CI=3.97 (1.69 to 9.34)); perceived transportation cost (AOR and 95% CI=0.44 (0.21 to 0.90), AOR and 95% CI=1.71 (1.00 to 2.93)); participated in indigenous community insurance (AOR and 95% CI=3.82 (1.96 to 7.45), AOR and 95% CI=0.13 (0.06 to 0.29)) and >10 km travel distance from nearby health facilities (AOR and 95% CI=1.52 (1.02 to 2.60), AOR and 95% CI=8.37 (4.54 to 15.45)) among insured and non-insured households, respectively, were predictors of health service utilisation. CONCLUSION: Insured households were more likely to utilise health services compared with non-insured households. Family health status, family with chronic disease, perceived availability of drugs, perceived transportation cost, participation in indigenous community insurance and >10 km travel were predictors of health service utilisation among insured and non-insured households. Hence, the greatest emphasis should be given to enhancing enrolment in the community-based health insurance scheme to achieve universal health coverage.

Latrine utilization and associated factors among districts implementing and not-implementing community-led total sanitation and hygiene in East Wollega, Western Ethiopia: A comparative cross-sectional study.

INTRODUCTION: Discharge of excreta to the environment lead to surface and groundwater contamination and human exposure to disease-causing micro-organisms. There is limitation of evidences regarding the latrine utilization among community-led total sanitation and hygiene implemented and non-implemented districts of the East Wollega Zone. Hence, this study aimed to determine the magnitude and associated factors of latrine utilization among households in community-led total sanitation and hygiene implemented and non-implemented Districts in East Wollega Zone, Western Ethiopia. METHODS: A cross-sectional study was conducted. A Multi-stage sampling technique was applied to select the 461 households. Data were collected using interviews and observations guided by a pre-structured questionnaire. Data were entered using Epi Data and exported to SPSS software version 25 for data recording, cleaning, and statistical analysis. Bivariable logistic regression was run to identify the candidate variables at p-value <0.25. Variables that had associations with latrine utilization in the bi-variable analysis were entered together into multivariable logistic regression. An Adjusted odds ratio with a 95% confidence interval was calculated and P-value< 0.05 was used to declare a statistically significant association. RESULT: The overall prevalence of latrine utilization was found to be 52.7% (95%CI:48%, 57.3%). Religion (AOR = 0.149;95%CI:0.044,0.506), education (AOR = 3.861;95%CI:1.642,9.077), occupation, absence of children <5 years (AOR = 4.724;95%CI:2.313,9.648), toilet cleaning (AOR = 10.662;95%CI:5.571,20.403), frequency of latrine construction (AOR = 6.441;95%CI:2.203,18.826), maintenance need (AOR = 6.446; 95%CI:3.023,13.744), distance from health institution (AOR = 0.987; 95%CI:0.978, 0.996), distance from kebele office (AOR = 6.478; 95%CI:2.137,19.635), and latrine distance from dwelling (AOR = 11.656; 95%CI:2.108, 64.44) were the factors associated with latrine use. CONCLUSION: The latrine utilization in this study is low as compared to other studies. Religion, education, occupation, absence of children <5 years, toilet cleaning, frequency of latrine construction, maintenance need of the toilet, distance from health institution, distance from kebele, and latrine distance from dwelling are the associated factors of latrine utilization. Both households and health workers have to work together to improve latrine utilization and the safe disposal of children's feces.

Disparities in modern health service utilization across socio-demographic and economic inequalities among households in Gida Ayana district, Oromia Regional state, Ethiopia: a community-based cross-sectional study.

BACKGROUND: Health care disparities (HCD) occur across a broad range of dimensions and achieving equity in health care is a strenuous task. To overcome the disparities, countries worldwide have started implementing varies policies. HCD remains a challenge in the health care system of Ethiopia. Hence, the study aimed to estimate the disparities in health care utilization (HCU) among households. METHODS: A community-based cross-sectional study was conducted from February 01 to April 30, 2022, among households in Gida Ayana District, Ethiopia. A single population proportion formula was used to determine the 393sample size, and participants were selected using systematic sampling. Data was entered into Epi-data 4.6 and exported to SPSS 25 for analysis. Descriptive analysis and binary and multivariable logistic regressions were performed. RESULTS: Of the 356 households that participated in the study, 321 (90.2%) of them reported at least one member of their family perceived morbidity in the last six months. The overall level of HCU determined was 207(64.5%), 95% confidence interval (CI),59.0-69.7%. Urban residents (AOR = 3.68, 95% CI = 1.94-6.97), attending secondary school and above (AOR = 2.79, CI = 1.27-5.98), rich (AOR = 2.47, CI = 1.03-5.92), small families (AOR = 2.83, CI = 1.26-6.55), and insured (AOR = 4.27, CI = 2.36-7.71) significantly contributed to HCD. CONCLUSIONS: Households' overall level of HCU for perceived morbidity was moderate. However, significant disparities were observed in HCU across place of residence, wealth status, level of education, family size, and health insurance. Hence, strengthening the strategy of financial protection by implementing health insurance that focuses on the socio-demographic and economic status of households is recommended to reduce the disparities.

Prevalence and associated factors of stunting and thinness among primary school-aged children in Gudeya Bila district, West Ethiopia: a cross-sectional study.

OBJECTIVES: This study aimed to assess the prevalence and associated factors of stunting and thinness among primary school-age children in the Gudeya Bila district. METHODS AND ANALYSIS: A community-based cross-sectional study was conducted in the Gudeya Bila district which is located in the Western part of Ethiopia. Among the calculated sample size of 561 school-aged children, 551 children were randomly selected by systematic random sampling technique and participated in this study. Critical illness, physical disability and the inability of caregivers to respond were exclusion criteria. Under-nutrition was the primary outcome while factors associated were the second outcome of this study. Semi-structured interviewer-administered questionnaires were used to collect the data while interview and body measurement were used as data collection techniques. Health Extension Workers collected the data. Data were entered into Epi Data V.3.1 and transported into SPSS V.24.0 software for data cleaning and analysis. Both bivariable and multivariable logistic regressions were run to identify the associated factors of under-nutrition. Model fitness was checked by using Hosmer-Lemeshow's test. Variables with p values <0.05 were considered statistically significant in the multivariable logistic regression. RESULTS AND CONCLUSION: The prevalence of stunting and thinness among primary school children was 8.2% (95% CI 5.6% to 10.6%) and 7.1% (95% CI 4.5% to 8.9%), respectively. Being male caregiver (adjusted OR (AOR)=4.26;95% CI 1.256% to 14.464%), family size ≥4 (AOR=4.65; 95% CI 1.8 51% to 11.696%), separated kitchen room (AOR=0.096; 95% CI 0.019 to 0.501) and hand washing after toilet use (AOR=0.152; 95% CI 0.035% to 0.667%) were significantly associated with stunting. Moreover, drinking coffee (AOR=2.25; 95% CI 1.968% to 5.243%) and child dietary diversity score <4 (AOR=2.54; 95% CI 1.721% to 8.939%) were significantly associated with thinness. Under-nutrition in this study was high compared with the global target of eradicating under-nutrition. Community-based nutritional education programmes and implementing health extension programmes are important to reduce the problem of under-nutrition to an undetectable level and to eradicate chronic under-nutrition.

Determinants of community-based health insurance membership renewal decision among rural households in Kellem Wollega zone, Oromia regional state, Ethiopia: a community-based cross-sectional study.

Background: Despite the fact that community-based health insurance (CBHI) is a promising program to achieve the goal of universal health coverage (UHC), it faces challenges that are not only due to low enrollment but also due to membership renewal decision that impact its sustainability. Hence, the study aimed to identify the determinants of CBHI membership renewal decision among rural households in Kellem Wollega zone, Ethiopia. Methods: The study was conducted in Kellem Wollega, Ethiopia, among rural households from March 30-April 30, 2022, using a community-based cross-sectional study design. An interviewer-administered structured questionnaire through face-to-face interviews was used. Using a systematic random sampling method, 551 households were selected making 540 (98%) response rates. The data was entered into EPI Data 3.1 and analyzed using SPSS 25 software. Descriptive statistics, binary, and multiple logistic regressions were performed. Using multiple logistic regressions, a significant association between the CBHI membership renewal decision and independent variables was identified, declaring the statistical significance level using a 95% confidence interval (CI) at p < 0.05. Results: The overall rate of CBHI membership renewal decision among households was estimated to be 365 (67.6%, 95% CI = 63.7-71.5%). The factors that significantly influenced the households' membership renewal decision were family size (AOR = 0.46, 95% CI = 0.25-0.86), low literacy status (AOR = 0.28 95% CI = 0.12-0.64), lower than middle-level of wealth index (AOR = 9.80, 95% CI = 2.75-34.92), premium affordability (AOR = 4.34, 95% CI = 2.08-9.04), unavailability of services (AOR = 0.26, 95% CI = 0.12-0.55), trusting in health facilities (AOR = 5.81, 95% CI = 2.82-11.94), favorable providers' attitude toward members (AOR = 8.23, 95% CI = 3.96-19.64), good quality of service (AOR = 4.47, 95% CI = 2.28-8.85) and health care seeking behavior (AOR =3.25, 95% CI = 1.32-7.98). Conclusion: The overall CBHI membership dropout decision rate among rural households was high, which could affect health service provision and utilization. Therefore, the insurance scheme and contracted health facilities should consider and work on family size and wealth status when membership premiums are calculated, the education level of households when creating awareness about the scheme, building trust in the contracted health facilities by providing all promised benefit packages of health services with good quality, and improving the attitude of health care providers towards the scheme members.

Does community-based health insurance reduce disparities in modern health service utilization among households in Ethiopia? A community-based comparative cross-sectional study.

Background: Community-based health insurance (CBHI) is an emerging and promising concept to access affordable and effective healthcare by substantially pooling risks to improve health service utilization (HSU) and equity. While there have been improvements in healthcare coverage in Ethiopia, disparities in healthcare remain a challenge in the healthcare system. Hence, the study aimed to assess the effects of CBHI on the reduction of disparities in modern health service (MHS) utilization among households. Methods: A community-based comparative cross-sectional study was conducted between 1 February and 30 April 2022 among households in the Gida Ayana district, Ethiopia. The sample size of 356 was determined using the double population proportion formula, and participants were selected using multistage sampling. Data were entered into EpiData 4.6 and exported to SPSS 25 for analysis. Results: Among 356 households, 321 (90.2%) reported that at least one member of their family fell ill in the previous 6 months; 153 (47.7%) and 168 (52.3%) households were among the insured and uninsured, respectively. Only 207 [64.5, 95% confidence interval (CI) = 59.0-69.7%] of them utilized health services. The level of MHS was 122 (79.7, 95% CI = 75.5-85.8%) and 85 (50.6, 95% CI = 42.8-58.4%) among insured and uninsured, respectively. Insured households were four times more likely to utilize MHS compared to uninsured households [adjusted odds ratio (AOR) = 4.27, 95% CI = 2.36-7.71]. Despite the households being insured, significant disparities in MHS utilization were observed across the place of residence (AOR = 14.98, 95% CI = 5.12-43.82) and education level (AOR = 0.20, 95% CI = 0.05-0.83). Conclusion: Overall, the CBHI scheme significantly improved the level of MHS and reduced disparities in utilization across wealth status and family size differences. However, despite households being insured, significant disparities in the odds of MHS utilization were observed across the place of residence and education level. Hence, strengthening the CBHI scheme and focusing on the place of residence and the education level of households are recommended to improve MHS utilization and reduce its disparities.

COVID-19 Vaccine Uptake and Associated Factors Among Health Professionals in Ethiopia.

BACKGROUND: Ethiopia has received 2.2 million doses of COVID-19 vaccine from the COVID-19 Vaccines Global Access (COVAX) facility and planned to vaccinate 20% of its population by the end of 2021. However, evidence on the current uptake of the vaccine in our country is scanty. Therefore, this study aimed to assess COVID-19 vaccine uptake and associated factors among health professionals in Ethiopia. METHODS: A national online cross-sectional E-survey was conducted on COVID-19 vaccine Uptake and associated factors among health professionals in Ethiopia from June 1 to 30, 2021. A semi-structured questionnaire was created on Google forms and disseminated online. The snowball sampling technique through the authors' network with Ethiopian residents on the popular social media like Facebook, telegram, and email was used. Descriptive statistics were performed. Multivariable logistic regression analysis was performed using Statistical Package for Social Sciences version 25, and all variables with P-value <0.05 and adjusted odds ratio at 95% CI were used to declare the predictors of the outcome variable. RESULTS: A total of 522 health professionals participated in the survey, of which about 324 (62.1%) of them were vaccinated with any of the COVID-19 vaccines at least once. The study indicated that COVID-19 vaccine uptake was associated with age range from 35 to 44 years [AOR = 12.97, 95% CI: 2.36-71.21], age beyond 45 years [AOR = 18.95, 95% CI = 2.04-36.29], being male [AOR = 2.91, 95% CI = 1.05,8.09], being only an academician [AOR = 0.23, 95% CI: 0.10-0.49], academicians working in University hospitals [AOR = 0.19, 95% CI: 0.05-0.83], perceiving their family as healthy [AOR = 4.40, 95% CI: 2.21-8.75], no history of receiving other vaccine before as an adult [AOR = 4.07, 95% CI: 2.07-8.01] and no history of contact with confirmed COVID-19 patients or clients [AOR = 0.42, 95% CI: 0.20-0.86]. CONCLUSION: The study found that COVID-19 vaccine uptake among health professionals was low. This was not sufficient to achieve herd immunity as at least nine out of ten health professionals are required for herd immunity. Ages, sex, place of work, perceived family health status, previous experience of receiving a vaccine as an adult and history of contact with COVID-19 clients or patients were the factors that influence the vaccine uptake among health professionals in Ethiopia. Hence, decision makers and health managers should consider instituting mandatory vaccination for health professionals and design strategies for the provision of the vaccine.

Magnitude and Determinants of Dropout from Community-Based Health Insurance Among Households in Manna District, Jimma Zone, Southwest Ethiopia.

BACKGROUND: Community-based health insurance (CBHI) is a prepayment method of financial contributions for healthcare which aims to risk pooling, avoidance of catastrophic and impoverishing health expenditure. However, a high dropout from the scheme remains the biggest challenge to effective and sustainable progress towards universal financial protection in low- and middle-income countries. While large literature had examined initial enrollment and factors associated with it, only a few studies dealt with dropout. So the study aimed to assess the magnitude and determinants of dropout from community-based health insurance among households in Manna district, Jimma zone, Oromia Regional State, Ethiopia. METHODS: A community-based cross-sectional study design was employed to collect data from 634 household heads from March 1 to 30, 2020. A multistage sampling technique was carried out and interviewer-administered questionnaires were used to collect data. Descriptive statistics and multivariable logistic regression analyses were performed, and variables with a P-value<0.05 were considered as having a statistically significant association with the dropout from the CBHI. RESULTS: Magnitude of dropout from CBHI was 31.9% with 95% confidence interval (CI)=28.2-35.8% and relatively older age [adjusted odds ratio (AOR) (95% CI)=0.26 (0.10-0.78)], educational level [AOR (95% CI)=0.16 (0.06-0.41)], family size [AOR (95% CI)=0.36 (0.19-0.66)], poor perceived quality of service [AOR (95% CI)=5.7 (2.8-11.8)], trust in health facility [AOR (95% CI)=0.43 (0.3-0.61)], trust in the scheme [AOR (95% CI)=0.61 (0.45-0.84)], providers' attitude [AOR (95% CI)=10 (4.0-25.4)], and benefit package [AOR (95% CI)=4.9 (2.4-9.9)] were statistically significant determinants associated with dropout. CONCLUSION: Dropout from CBHI in this study area was high. Household heads' age, educational level, family size, perceived quality of service, providers' attitude, a benefits package, trust in the contracted health facility, and the scheme were the significant predictors of dropout. We strongly recommend that greater efforts should be made toward the providers' attitude, promised benefit package, and quality of services.

Cost of treatment among self-referred outpatients in referral hospitals compared to primary health care facilities in East Wollega, western Ethiopia: A comparative cross-sectional study.

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities.