Utilisation of growth monitoring and promotion services and associated factors among mothers of children younger than 2 years in Gondar Zuria District, northwest Ethiopia: a community-based, cross-sectional study.

OBJECTIVE: The study aimed to assess the utilisation of growth monitoring and promotion services and the associated factors among mothers of children under 2 years old in Gondar Zuria District, northwest Ethiopia. DESIGN: Community-based, cross-sectional study. SETTING: The study was conducted in Gondar Zuria District, Central Gondar Zone. Data collection was conducted from 10 March to 5 April 2022. PARTICIPANTS: 576 mother-child pairs, recruited via a multistage, stratified random sampling technique. OUTCOME MEASURES AND ANALYSIS: Utilisation of growth monitoring and promotion services was the outcome of the study. Data were entered into Epi Info V.7 and exported to Statistical Package for the Social Sciences V.24.0 for further analysis. Both bivariable and multivariable logistic regression analyses were used to identify factors associated with utilisation of growth monitoring services. A p value less than 0.05 was considered significant for the outcome variable. RESULTS: The utilisation of growth monitoring and promotion services among children aged 0-23 months was 26.6% (95% CI 22.9, 30.2). Health centre delivery (adjusted OR (AOR)=1.56; 95% CI 1.02, 2.68), postnatal care visits (AOR=3.13; 95% CI 1.99, 4.90), regular growth monitoring and promotion sessions (AOR=6.53; 95% CI 2.43, 9.34), and wealth status (AOR=5.98; 95% CI 3.09, 10.58) were significantly associated with utilisation of growth monitoring and promotion services. CONCLUSION: Less than one in three children aged 0-23 months saw utilisation of growth monitoring and promotion services in the study setting. Birthplace, postnatal care follow-up, regular growth promotion and monitoring sessions, and wealth status were associated with utilisation of growth monitoring and promotion services. Enhancing skilled birth delivery, promoting postnatal care follow-up and expanding the availability of growth monitoring and promotion outreach sites could be useful to improve the utilisation of growth monitoring and promotion services.

Practical contribution of women development army on growth monitoring and promotion service at Dembya and Gondar Zuria districts, Central Gondar Zone, North West Ethiopia: a community based mixed study.

BACKGROUND: The United Nations' Sustainable Development Goal (SDG)-2 aims to eliminate child hunger or end all forms of child malnutrition by 2030. To achieve this goal the cost-effective method is the implementation of growth monitoring and promotion service with the contribution of Women Development Army (WDA) as community volunteers. However, According to the data, the program's implementation varies throughout the country and lack of evidence on the practical contribution of the WDA to enhancing child nutritional care outcomes. Therefore this study aimed to determine practical contribution of WDA and associated factors on growth monitoring and promotion service in two rural districts of central Gondar zone, Northwest Ethiopia. METHODS: A community based mixed study was conducted from March 6 to April 7, 2022 among 615 Women Development Army. Multistage sampling technique was used to select study participants. A structured questionnaire was used to collect quantitative data and in-depth interview were used to generate qualitative information. Qualitative data were coded and grouped and discussed using identified themes. Binary logistic regression was fitted, odds ratio with 95% confidence interval was estimated to identify factors of practical contribution of WDA and qualitative data was analyzed using thematic analysis. RESULTS: In this study practical contribution of WDA on growth monitoring was 31.4% (95% CI: 28.0-35.3%). Having GMP training (AOR = 4.2, 95%CI: 1.63, 10.58), regular community conversation (AOR = 6.0, 95%CI: 3.12, 11.54), good knowledge about GMP (AOR = 2.1, 95%CI: 1.17, 3.83) and not having regular schedule of GMP service in the area (AOR = 0.04, 95%CI: 0.02, 0.09), were statistically significantly associated with practical contribution of growth monitoring. During in-depth interview, lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were mentioned among the problems faced during growth monitoring service. CONCLUSION: In this study, practical contribution of growth monitoring among WDA was low. GMP training regular community conversation, knowledge about GMP and regular schedule of GMP service in the local area were significantly associated for practical contribution of growth monitoring service. Lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were reasons for did not contribute effectively for GMP service. Therefore, giving training for WDA and improving community conversation at kebeles level are important to improve GM service. .

Workload and emerging challenges of community health workers in low- and middle-income countries: A mixed-methods systematic review.

BACKGROUND: Community health workers (CHWs) play an important role in improving access to health services to a broader population; particularly to communities living in remote areas. However, the productivity of CHWs is affected by the workload they have. We aimed to summarize and present CHWs' perceived workload in low-and middle-income countries (LMICs). METHODS: We searched three electronic databases (PubMed, Scopus, and Embase). A search strategy customized for the three electronic databases was developed using the two key terms of the review (CHWs and workload). Primary studies conducted in LMICs that explicitly measured workload of CHWs and published in English were included, without date restrictions. Methodological quality of the articles was assessed by two reviewers independently using mixed-methods appraisal tool. We applied a convergent integrated approach to synthesize the data. This study is registered on PROSPERO, number CRD42021291133. RESULTS: Of 632 unique records, 44 met our inclusion criteria, and 43 (20 qualitative, 13 mixed-methods, and 10 quantitative studies) passed the methodological quality assessment and were included in this review. In 97.7% (n = 42) of the articles, CHWs reported that they have a high workload. Having multiple tasks was the most commonly reported subcomponent of workload, followed by lack of transport; which was reported in 77.6% (n = 33) and 25.6% (n = 11) of the articles respectively. CONCLUSION: CHWs in LMICs reported that they have a high workload; mainly related to having to manage multiple tasks and the lack of transport to access households. Program managers need to make careful consideration when additional tasks are shifted to CHWs and the practicability to be performed in the environment they work in. Further research is also required to make a comprehensive measure of the workload of CHWs in LMICs.

Health system response to COVID-19 among primary health care units in Ethiopia: A qualitative study.

INTRODUCTION: There was limited data on the experiences and roles of sub-national health systems in the response against COVID-19 in Ethiopia. This study explored how sub-national primary health care units and coordinating bodies in Ethiopia responded to COVID-19 during the first 6 months of pandemic. METHODS: We conducted a qualitative study with descriptive phenomenological design using 59 key informants that were purposively selected. The interviews included leaders across Ethiopia's 10 regions and 2 administrative cities. Data were collected using a semi-structured interview guide that was translated into a local language. The interviews were conducted in person or by phone. Coding and categorizing led to the development of themes and subthemes. Data were analyzed using thematic analysis. RESULTS: Local administrators across different levels took the lead in responding to COVID-19 by organizing multisectoral planning and monitoring committees at regional, zonal and woreda (district) levels. Health leaders reacted to the demand for an expanded workforce by reassigning health professionals to COVID-19 surveillance and case management activities, adding COVID-19-related responsibilities to their workloads, temporarily blocking leave, and hiring new staff on contractual basis. Training was prioritized for: rapid response teams, laboratory technicians, healthcare providers assigned to treatment centers where care was provided for patients with COVID-19, and health extension workers. COVID-19 supplies and equipment, particularly personal protective equipment, were difficult to obtain at the beginning of the pandemic. Health officials used a variety of means to equip and protect staff, but the quantity fell short of their needs. Local health structures used broadcast media, print materials, and house-to-house education to raise community awareness about COVID-19. Rapid response teams took the lead in case investigation, contact tracing, and sample collection. The care for mild cases was shifted to home-based isolation as the number of infections increased and space became limited. However, essential health services were neglected at the beginning of the pandemic while the intensity of local multisectoral response (sectoral engagement) declined as the pandemic progressed. CONCLUSIONS: Local government authorities and health systems across Ethiopia waged an early response to the pandemic, drawing on multisectoral support and directing human, material, and financial resources toward the effort. But, the intensity of the multisectoral response waned and essential services began suffering as the pandemic progressed. There is a need to learn from the pandemic and invest in the basics of the health system-health workers, supplies, equipment, and infrastructure-as well as coordination of interventions.

High burden of hypertension amongst adult population in rural districts of Northwest Ethiopia: A call for community based intervention.

BACKGROUND: Hypertension is a serious public health issue in Ethiopia, but there is a paucity of evidence in the country's rural areas. The aim of this study was to determine the prevalence of hypertension and its risk factors among adults in rural districts in northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from June to October 2020. The 1177 study participants were chosen using a multistage sampling procedure. A face-to-face interview was conducted using an adapted version of the WHO STEPwise approach questionnaire. Blood pressure was measured three times using an aneroid sphygmomanometer, and the mean of the last two readings were used for the analysis. Data was entered using Epidata and analyzed using STATA-16. Multivariable logistic regression was used to identify risk factors associated with hypertension. RESULTS: Of the total participants, 218 (18.5%) were found to be hypertensive. The prevalence of hypertension consistently increases with age. Hypertension was positively and significantly associated with female sex ((adjusted odd ratio (AOR) = 2.30, 95% CI: 1.53, 3.45)), age group 45-54 years (AOR = 4.63, 95% CI: 1.01, 21.37), 55-64 years (AOR = 14.40, 95% CI: 3.07, 67.63), ≥65 years (AOR = 19.37, 95% CI: 4.03, 93.09), having history of alcohol consumption (AOR = 3.25, 95% CI: 1.17, 9.02), used much amount of salt (AOR = 2.37, 95% CI: 1.53, 3.60) and too much amount of salt (AOR = 3.78, 95% CI: 1.85, 7.72), sleeping for a short duration (AOR = 2.05, 95%CI: 1.30, 3.24), and having family history of hypertension (AOR = 2.12, 95% CI; 1.32, 3.39). CONCLUSIONS: Hypertension was significantly high among the rural population we studied and is emerging as a public health problem. Female sex, advanced age, ever used alcohol, excessive salt intake, insufficient sleep, and a family history of hypertension were factors that were positively and significantly associated with hypertension. We recommend local health authorities integrate promotion of hypertension health education, lifestyle modification intervention on salt and alcohol reduction, and hypertension detection, particularly for the female and elderly population, at the health post level to avert the problem.

Perceived barriers and enablers influencing health extension workers toward home-based hypertension screening in rural northwest Ethiopia: interpretive descriptive study.

BACKGROUND: Hypertension, a major but modifiable risk factor for cardiovascular diseases, is a global health problem including Ethiopia. In a limited infrastructure task sharing of hypertension screening for community health workers is a feasible strategy to improve hypertension management. Recent finding have shown that trained health extension workers (HEWs) can identify high blood pressure, which was effective and feasible. Identifying barriers and enablers for home-based hypertension screening by HEWs is crucial for its implementation. This study aimed to explore barriers and enablers that influence health extension workers' home-based hypertension screening in the community. METHODS: The interpretive descriptive design was implemented. In-depth interviews were conducted during October, 2020. A total of 26 participants including HEWs, supervisors, and heads of district health office were purposively selected. They were asked to describe their perception toward home-based hypertension screening by the HEWs. The interviews were audio-recorded, transcribed verbatim into Amharic, and translated into English. The transcripts were coded and themes were identified. Thematic approach was used for data analysis. RESULTS: The participants identified key perceived barriers and enablers of HEWs home-based hypertension screening. The most common barriers were a lack of hypertension training, blood pressure measuring devices, blood pressure guidelines and manuals, skilled HEWs, financial incentives, and poor community awareness of the disease. The most common enablers were support from community leaders, presence of functional development army and community trust for HEWs, presence of routine campaign on vaccination and community based health insurance, and an integrated health system. CONCLUSIONS: Our findings have implications for the HEWs' ongoing implementation of home-based hypertension screening. Successful implementation of this strategy requires scaling up of hypertension training programs for health extension workers and their supervisors, provision of standardized protocols, provision of adequate blood pressure measuring equipment, and regular supportive supervision.

Trained health extension workers correctly identify high blood pressure in rural districts of northwest Ethiopia: a diagnostic accuracy study.

BACKGROUND: Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia. METHODS: A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers' ability to identify high blood pressure in comparison to health professionals. RESULTS: The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively. CONCLUSIONS: The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.

Enteric bacterial pathogens and their antibiotic-resistant patterns from the environmental sources in different regions of Ethiopia: A laboratory-based cross-sectional study.

Background and Aim: Antimicrobial resistance (AMR) resulting in the most significant public health and economic threat. Unfortunately, it is one of the missing topics on sustainable development goals (SDGs). Therefore, this laboratory-based study aimed at determining enteric bacterial pathogens and their antibiotic-resistant patterns from the environmental sources in different regions of Ethiopia. Methods: A laboratory-based cross-sectional study was conducted by following the standard microbial culture and the Kirby-Bauer disc diffusion method for identification and AMR patterns of the enteric bacteria using a total of 180 environmental samples from January through June 2020. We employed descriptive statistics to examine the prevalence rate, comparability of results, and summary of AMR patterns of enteric bacteria and a 95% confidence Interval (CI) for considering the statistical significance and give conclusions by using Stata 14.1. Results: The mean prevalence rates (SD) at 95% CI of AMR enteric bacterial pathogens were 53.13 (2.51)% (52.31, 53.95), 45 (1.85)% (44.40, 45.60), 32.5 (3.01)% (31.10, 33.00), and 31.12 (1.95)% (30.80, 31.45) in Wastewaters, leachate from solid waste dumping sites, waste receiving water bodies (Lake Tana at Bahir Dar and Boye Wetland at Jimma), and Soils sequentially. Specifically, Escherichia coli, Shigella, and Salmonella were 90 (3.10)% (89.00, 91.10), 67.5 (2.58)% (66.72, 68.41), and 45(1.58)% (44.48, 45.52), respectively, investigated in wastewater. In addition, solid waste dumping sites were contaminated with E. coli 80 (3.97)% (79.34, 80.66), Shigella 61 (2.87)% (59.06, 60.94), and Salmonella 42 (5.67)% (40.15, 43.85). This study implies that the waste discharges are the main source of contamination for AMR pathogens to the two aquatic water bodies. Conclusion: The finding indicated that wastewater and solid waste dumping sites were important sources for AMR enteric pathogens. The finding might have indicated the tip of the iceberg about the environmental contamination with antimicrobial-resistant enteric pathogens.

Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. METHODS: A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. DISCUSSION: This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. TRIAL REGISTRATION: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.

Review of Policy, Regulatory, and Organizational Frameworks of Environment and Health in Ethiopia.

BACKGROUND: Ethiopia produced its Environmental Health Situational Analysis and Needs Assessment (SANA) report in 2010 as part of the global endeavor to characterize and underscore the importance of connecting health and environment. The assessment methods used in SANA 2010 were updated, replicated and used in this SABNA. with a focus on air pollution, occupational safety and health, and climate change. OBJECTIVES: The purpose of the review was to examine national policies and identify gaps in regulations and organizational arrangements that determine Ethiopia's ability to mitigate and eventually prevent the health impacts of air pollution, occupational hazards, and climate change. METHODS: The national policy and regulatory documents were reviewed. Literature was identified through electronic searches. Hard copies of past reports and policies were reviewed whenever necessary. A semi-structured guideline was used to conduct in-depth interviews aimed at identifying gaps and needs. RESULTS: The Constitution of Ethiopia has policy provisions related to air pollution, occupational safety and health (OSH), and climate change and health. Proclamation No. 300/2002 on Environmental Pollution Control specifies ambient air quality standards and allowable emissions. However, there were no documents that outlined the national or regional strategies that the ministries and agencies could adopt to translate existing policies, legal provisions, or guidelines for air pollution into practical programs. In the same way, a national OSH policy was lacking at the time this review was made on how occupational safety and health should be handled nationally or at lower governing levels as required by the International Occupation Safety and Health and Working Environment Convention No. 155/1981. Ethiopia is a signatory of this Convention. CONCLUSIONS AND RECOMMENDATIONS: The results of the situational analysis indicate that there are cross-cutting gaps in the various sectors. Among these, addressing the critical shortage of skilled personnel is an urgent priority. Most stakeholders face acute shortages of professionals and poor retention mechanisms. It is therefore important to design interventions that focus on capacity building in, for example, aligning curricula with specific needs of ministries, andequip professionals with the necessary technical skills.In addition, the results indicate that policies and regulations exist in theory, but in practice, there are inadequate implementation strategies to encourage adherence and enforcement of the regulations and policies.

Inequalities in child mortality in ten major African cities.

BACKGROUND: The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. METHODS: Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing two measures of relative inequality (the rate ratio and the concentration index) and two measures of absolute inequality (the difference and the Erreyger's index). RESULTS: Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births (95% confidence interval 55 to 166) in Abidjan in 2011-2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. CONCLUSIONS: Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that inequalities are amenable to policy interventions and that it is worth investigating why inequalities are higher in one city than in another. However, larger samples are needed in order to improve the certainty of our results. Currently available data samples from DHS are too small to reliably quantify the level of inequalities within cities.

Prevention of mother-to-child transmission (PMTCT) of HIV services in Adama town, Ethiopia: clients' satisfaction and challenges experienced by service providers.

BACKGROUND: The coverage and uptake of prevention of mother-to-child transmission (PMTCT) of HIV services has remained very low in Ethiopia. One of the pillars of improving quality of health services is measuring and addressing client satisfaction. In Ethiopia, information about the quality of PMTCT services regarding client satisfaction is meager. METHODS: A facility-based cross-sectional study using quantitative methods was conducted in Adama town. We interviewed 423 pregnant women and 31 health providers from eight health facilities. Satisfaction of clients was measured using a standard questionnaire adapted from the UNAIDS best practices collection on HIV/AIDS. Bivariate and multivariate logistic regression analyses were used to identify factors associated with clients' satisfaction. RESULTS: About three-fourth (74.7%) of clients reported that they were satisfied with the PMTCT services provided by the health facilities. However, a much lower proportion (39%) of the total respondents (pregnant women who underwent an ANC follow-up session), said they received and understood the messages related to mother-to-child transmission (MTCT) of HIV and PMTCT. The main challenges reported by service providers were lack of training, lack of feedback on job performance and inadequate pay. Clients' satisfaction with PMTCT service was found to be associated with liking the discussion they had with their counselor, non-preference to a different counselor with regards to sex and/or age and not seeing the same ANC counselor before and after HIV test. CONCLUSION: Although 74.7% of clients were satisfied, the majority did not have a good understanding of the counseling on MTCT and PMTCT. We recommend more efforts to be exerted on improving provider-client communication, devising ways of increasing clients' satisfaction and designing an effective motivation strategy for service providers to enhance the status of PMTCT services.

Provision and awareness for isoniazid preventive therapy among PLHIV in Addis Ababa, Ethiopia.

BACKGROUND: The risk of acquiring tuberculosis by People living with HIV (PLHIV) could significantly be reduced through provision of isoniazid preventive therapy (IPT). In Ethiopia, it is neither practiced well nor researched in depth. Our objective was to assess IPT provision and awareness among PLHIV in Addis Ababa City Administration. METHODS: Between February 2008 and May 2008, a cross sectional facility-based survey was conducted by exit interview of 406 PLHIV from six health facilities. The findings were analyzed and described in this report. RESULTS: The proportion of PLHIV ever had been provided with IPT were 74 of 231 TB free PLHIV (32.0%) and the proportion of having information about IPT among study participants was 29.8%. Females were about two times more informed about the provision of IPT in their health facilities than males [AOR (95%CI): 2.18 (1.31-3.61)]. CONCLUSIONS: We conclude that the practice of provision of IPT for PLHIV is high, but there is room for improvement. Provision of INH for TB free PLHIV has to be strengthened with better diagnostic facilities to certainly rule out active TB cases.

Leadership in strategic information (LSI) building skilled public health capacity in Ethiopia.

BACKGROUND: In many developing countries, including Ethiopia, few have the skills to use data for effective decision making in public health. To address this need, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with two local Ethiopian organizations, developed a year long Leadership in Strategic Information (LSI) course to train government employees working in HIV to use data from strategic information sources. A process evaluation of the LSI course examined the impact of the training on trainees' skills and the strengths and weaknesses of the course. The evaluation consisted of surveys and focus groups. FINDINGS: Trainees' skill sets increased in descriptive and analytic epidemiology, surveillance, and monitoring and evaluation (M and E). Data from the evaluation indicated that the course structure and the M and E module required revision in order to improve outcomes. Additionally, the first cohort had a high attrition rate. Overall, trainees and key stakeholders viewed LSI as important in building skilled capacity in public health in Ethiopia. CONCLUSION: The evaluation provided constructive insight in modifying the course to improve retention and better address trainees' learning needs. Subsequent course attrition rates decreased as a result of changes made based on evaluation findings.

HIV-Related Sexual Behaviors among Migrants and Non-migrants in Rural Ethiopia: Role of Rural to Urban Migration in HIV Transmission.

OBJECTIVE: To compare HIV-related sexual risk behavior among temporary rural to urban migrants and non-migrants and to explore the role of migration in HIV transmission in a rural area of Ethiopia. METHODS: A cross-sectional comparative study was conducted in Bure Woreda, West Gojam, Amhara Region, Ethiopia. A total of 1,310 male subjects (655 rural to urban migrants and 655 non-migrants) were selected randomly and were assessed, analyzed using SPSS version 17 software for their HIV related sexual risk behaviours including the role of migration in HIV transmission in a rural Ethiopia. Two parts of questionnaires were prepared and used for comparing the above groups. The first part of the questionnaires included non-sensitive questions such as demographics and HIV knowledge while the second part comprised sensitive questions related to sexual behaviors. RESULTS: When multiple sexual partners, sex with commercial sex workers, sexual transmitted infections and premarital sex compared between the two groups, the proportions of rural to urban migrants Vs non- migrants who had multiple sexual partners (31.4 % Vs 7.4 %), sex with commercial sex workers (22.3% Vs 13.3%), sexual transmitted infections (11.7% Vs 3.2%) and premarital sex (20.8% Vs 14.2 %) were significantly higher in rural to urban migrants than non-migrants. Among those who had multiple sexual partners, only 12.7 % of, rural to urban migrants and 9.8 % of non-migrants reported consistent condom use with sexual partners other than their spouse. CONCLUSIONS: As both rural to urban migrants and non-migrants are at risk for HIV infection, intervention programmes targeting both groups are recommended. However, in order to contain the bridging effect on HIV transmission from urban to rural areas particular attention should be given for the rural to urban migrant population.

The Ethiopian Field Epidemiology and Laboratory Training Program: strengthening public health systems and building human resource capacity.

The Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) is a comprehensive two-year competency-based training and service program designed to build sustainable public health expertise and capacity. Established in 2009, the program is a partnership between the Ethiopian Federal Ministry of Health, the Ethiopian Health and Nutrition Research Institute, Addis Ababa University School of Public Health, the Ethiopian Public Health Association and the US Centers of Disease Control and Prevention. Residents of the program spend about 25% of their time undergoing didactic training and the 75% in the field working at program field bases established with the MOH and Regional Health Bureaus investigating disease outbreaks, improving disease surveillance, responding to public health emergencies, using health data to make recommendations and undertaking other field Epidemiology related activities on setting health policy. Residents from the first 2 cohorts of the program have conducted more than 42 outbreaks investigations, 27analyses of surveillance data, evaluations of 11 surveillance systems, had28oral and poster presentation abstracts accepted at 10 scientific conferences and submitted 8 manuscripts of which 2are already published. The EFELTP has provided valuable opportunities to improve epidemiology and laboratory capacity building in Ethiopia. While the program is relatively young, positive and significant impacts are assisting the country better detect and respond to epidemics and address diseases of major public health significance.

Screening and case detection for tuberculosis among people living with HIV in Addis Ababa, Ethiopia.

BACKGROUND: The spread of HIV epidemic in Africa has resulted in a fourfold increase in the number of tuberculosis cases. Screening for tuberculosis among people living with HIV would increase case detection. In Ethiopia, it is neither practiced well nor researched in depth. OBJECTIVE: To assess the proportion of Screening and Case Detection for Tuberculosis among People Living with HIV. MATERIALS AND METHODS: Between February 2008 and May 2008, a cross sectional facility-based survey was conducted by exit interview of 406 people living with HIV whether they have been asked by health providers for the presence of cough or unusual lump in their lymph node sites as recommended by National TB/HIV implementation guideline from HIV chronic care. RESULT: Based on our findings, 89.7% of clients reported being screened for tuberculosis at least once during their follow-up visits. The case detection rate while screening was 15.6%. Male respondents were about two times more likely to be diagnosed for tuberculosis than females [AOR (95% CI) 2.18 (1.30-3.66)]. CONCLUSIONS: In general, there was high proportion of screening and case detection for tuberculosis among people living with HIV. The screening has to be well strengthened as many more active cases can be detected.

Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study.

BACKGROUND: Eastern Ethiopia hosts a substantial number of refugees originated from Somalia. Female genital mutilation (FGM) is a common practice in the area, despite the campaigns to eliminate it. METHODS: A cross-sectional study was conducted among 492 respondents sampled from three refugee camps in Somali Regional State, Eastern Ethiopia, to determine the prevalence and associated factors of FGM. Data were collected using pre-tested structured questionnaires. RESULTS: Although the intention of the parents to circumcise their daughters was high (84%), 42.4% of 288 < or = 12 girls were reported being undergone FGM. The prevalence increased with age, and about 52% and 95% were circumcised at the age of 7-8 and 11-12 years, respectively. Almost all operations were performed by traditional circumcisers (81%) and birth attendants (18%). Clitoral cutting (64%) and narrowing of the vaginal opening through stitching (36%) were the two common forms of FGM reported by the respondents. Participation of the parents in anti-FGM interventions is statistically associated with lower practice and intention of the procedures. CONCLUSION: FGM is widely practised among the Somali refugee community in Eastern Ethiopia, and there was a considerable support for the continuation of the practice particularly among women. The findings indicate a reported shift of FGM from its severe form to milder clitoral cutting. More men than women positively viewed anti-FGM interventions, and fewer men than women had the intention to let their daughters undergo FGM, indicating the need to involve men in anti-FGM activities.

Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia.

BACKGROUND: Khat (an evergreen plant with amphetamine-like properties) and alcohol are widely consumed among the youth of Ethiopia. However, their relationship to risky sexual behaviour is not well described. This study was conducted to describe the magnitude of risky sexual behaviour (unprotected sex and early initiation of sexual activity) and its association with Khat and alcohol consumption in Ethiopian youths. METHODS: A probabilistic national sample of 20,434 in-school and out-of-school youths aged between 15 and 24 years of age was selected and interviewed regarding their sexual behavior and substance use. RESULTS: Over 20% of out-of-school youth had unprotected sex during the 12-month period prior to interview compared to 1.4% of in-school youth. Daily Khat intake was also associated with unprotected sex: adjusted OR (95% CI) = 2.26 (1.92, 2.67). There was a significant and linear association between alcohol intake and unprotected sex, with those using alcohol daily having a three fold increased odds compared to those not using it: adj. OR (95% CI) = 3.05 (2.38, 3.91). Use of substances other than Khat was not associated with unprotected sex, but was associated with initiation of sexual activity: adj. OR (95% CI) = 2.54 (1.84, 3.51). CONCLUSION: A substantial proportion of out-of-school youth engage in risky sex. The use of Khat and alcohol and other substances is significantly and independently associated with risky sexual behaviour among Ethiopian youths.

Satisfaction on outpatient services in hospitals of the Amhara Region.

A cross sectional survey was conducted to assess patients' satisfaction on outpatient services in the hospitals of the Amara Region. A total of 898 patients from nine hospitals were interviewed on exit. The majority (95.9%) had come due to illness, and of which, 53.2% had illnesses that lasted for more than 30 days. Among those who were sick, 47.5% were non-paying (free) patients. Long waiting hours during registration, visiting of doctors after registration, laboratory procedures, and revisiting of the doctors for evaluation with laboratory results and obtaining drugs from pharmacies were associated with dissatisfaction. When logistic regression was applied, waiting time for registration, physician consultation/examination, obtaining the prescribed drugs from the pharmacies, and overall time taken to receive prescriptions were associated with dissatisfaction. Among the sociodemographic factors, age was associated with dissatisfaction. More than one-third of the patients did not get the medications prescribed in the hospital pharmacies. Failure to find the prescribed drugs was associated with dissatisfaction. Unnecessary patient delays should be reduced to the minimum by assessing hospitals' processes. Ensuring drug supply with facilitated administrative processes is recommended.