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.

Impact of the COVID-19 pandemic on the cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia: a hospital-based, cross-sectional study.

OBJECTIVE: Globally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct impact of COVID-19 on healthcare provision and utilisation, the impact of the pandemic on the cost of chronic disease treatment and care from a patient perspective was scanty. So, the study aimed to determine the impact of the COVID-19 pandemic on cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia, from 1 August to 31 August 2020. METHODS: An institutional-based cross-sectional study design was used, and the sample size for the study (n=642) was determined using a single population mean formula. Data were collected using interviews and analysed using SPSS V.25. Descriptive statistics were performed, and the cost of follow-up care before and after the pandemic was compared using a related-samples Wilcoxon signed-rank test, declaring the level of significance of the median cost difference at p<0.05. RESULTS: A total of 642 patients were included in the study, of whom 605 (94.2%) responded to the interviews. There was a significant median cost difference (n=593, Z=5.05, p=0.001) between the cost of chronic diseases among follow-up patients during the pandemic and the costs incurred by these patients before the pandemic. CONCLUSION: The cost of follow-up care among chronic disease patients during the COVID-19 pandemic was significantly higher compared with before the pandemic era. Therefore, healthcare providers should arrange special fee waiver mechanisms for chronic disease healthcare costs during such types of pandemics and provide the services at proximal health facilities.

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.

Sociodemographic and institutional determinants of zinc bundled with oral rehydration salt utilisation among under-five children with diarrhoeal diseases in East Wallaga zone, western Ethiopia: a community-based cross-sectional study.

OBJECTIVE: This study aimed to assess the sociodemographic and institutional determinants of zinc bundled with oral rehydration salt (ORS) utilisation among under-five children with diarrhoeal diseases in East Wallaga zone, western Ethiopia, in 2022. METHODS: A community-based cross-sectional study was conducted among 560 randomly selected participants from 1 to 30 April 2022. Data were entered into EpiData V.3.1, then exported to the Statistical Package for Social Science (SPSS) V.25 for analysis. An adjusted OR (AOR) along with a 95% confidence level was estimated to assess the strength of the association, and a p value <0.05 was considered to declare the statistical significance. RESULTS: About 39.6% of the participants had used zinc bundled with ORS for their children with diarrhoea at least once in the last 12 months. Being aged 40-49 years for mothers or caregivers (AOR 3.48, 95% CI 1.41, 8.53); merchant (AOR 4.11, 95% CI 1.73, 8.12); mothers or caregivers able to read and write (AOR 5.77, 95% CI 1.22, 11.67); visited secondary level (AOR 2.82, 95% CI 1.30, 6.10) and tertiary level health facilities (AOR 0.016, 95% CI 0.03, 0.97); degree and above (AOR 0.06, 95% CI 0.03, 0.12) and doctorate (AOR 0.13, 95% CI 0.04, 0.44) holder healthcare professionals were statistically associated with utilisation of zinc bundled with ORS. CONCLUSION: The study found that about two in five of the participants had used zinc bundled with ORS for their under-five children with diarrhoeal diseases. Age, occupation, educational status, level of health facilities visited and level of health professionals provided care were determinants of zinc bundled with ORS utilisation. So, health professionals at different levels of the health system have to enhance the maximisation of its bundled uptake.

Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia.

BACKGROUND: Globally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021. METHODS: Facility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association. RESULT: 116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction. CONCLUSION AND RECOMMENDATION: The favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.

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.

Predictors of Under-Five Caregivers' Utilization of Co-Packaged Zinc and Oral Rehydration Salts for Childhood Diarrhea in East Wollega Zone, Western Ethiopia.

Introduction: Diarrhea morbidity and mortality remain child health and economic burdens in low resource settings. In Ethiopia, diarrheal disease treatment service utilization remains very low. However, evidence on the level of utilization of zinc bundled with ORS among under-five caregivers' was not addressed. Objective: The study aimed to identify predictors of under-five caregivers' utilization of co-packaged zinc and oral rehydration salts for childhood diarrhea in East Wollega Zone, Western Ethiopia, in 2022. Methods: The study design used was a community-based cross-sectional study that was conducted among 540 randomly selected participants from April 1 to 30, 2022. Data were collected using interviewer-administered semi-structured questionnaires. It was entered into Epi-data version 3.1 and analyzed using SPSS version 26. An adjusted odds ratio along with a 95% confidence level was estimated, and a P value <0.05 was considered to declare the statistical significance in the multivariable analysis. Results: About 39.6% of under-five caregivers' had utilized co-packaged zinc and oral rehydration salts for their childhood diarrhea at least once in the last 12 months. Having family size less than 5 [AOR and 95% CI = 5.72 (2.93,11.15)]; heard about the co-pack [AOR and 95% CI = 9.52 (4.95,23.68)]; perceived health status for the recent episode as poor [AOR and 95% CI = 5.90 (2.58, 15.96)] and medium [AOR and 95% CI = 2.20 (1.02, 4.83)]; perceived severity for recent episodes [AOR and 95% CI = 4.48 (1.36, 14.76)] and being community-based health insurance non-member [AOR and 95% CI = 2.28 (1.34, 6.90)] were statistically associated with co-packaged zinc and ORS utilization. Conclusion: The study found that co-packaged zinc and oral rehydration salt utilization was low. Family size, heard about the co-pack, perceived health status, perceived severity, and CBHI membership were predictors of co-packaged utilization of zinc and ORS. Hence, concerned bodies in the health system should have devoted to maximize its uptake.

Efficiency of Medical Equipment Utilization and Its Associated Factors at Public Referral Hospitals in East Wollega Zone, Oromia Regional State, Ethiopia.

Background: The significance of effectively using medical equipment has received widespread public attention. Due to its complex effects on healthcare costs and quality, the relationship between hospital features and medical equipment consumption has drawn increased attention. Therefore, the study aimed to evaluate the efficiency of medical equipment utilization and its associated factors. Methods: The study was conducted at public referral hospitals in East Wollega, Oromia Regional National State, Ethiopia, in 2021. A cross-sectional study design was mixed with observation and document review. The study included approximately 192 pieces of equipment. Descriptive statistics and Pearson Chi-square (χ 2) were used to identify associations between each independent and dependent variable at p<0.05 to declare level of significance. Results: Using 95% confidence interval (CI), the level of utilization coefficient was estimated to be 0.49 (0.44-0.55). As a result, 111 pieces of equipment (57.8%) were used efficiently, while 81 (42.2%) were underutilized. The form in which the hospitals received the equipment (χ 2=7.7.2; P=0.005), regular availability (χ 2=19.30; P=0.00), equipment breakdown (χ 2=11.57; P=0.001), the availability of trained staffs operating the equipment (χ 2=26.14; P=0.00), performing preventive maintenance (χ 2=91.54; P=0.00), the availability of spare parts (χ 2=32.36; P=0.00), and the availability of accessories (χ 2=43.91; P=0.00) were statistically significant factors affecting the medical equipment utilization. Conclusion: On average, the utilization coefficient of medical equipment in the study hospitals was low compared to other study findings, which indicated that 2 out of 5 pieces of medical equipment were under-utilized, which could be significantly affected by the form in which the hospital received the equipment, its regular availability, equipment breakdown, availability of trained staff operating the equipment, performing preventive maintenance, and availability of adequate spare parts and accessories. Every hospital should develop an appropriate strategic framework to manage and utilize the available medical diagnostic equipment based on its level and demand.

Assessment of COVID-19 vaccine take-up and its predictors among healthcare professionals in public hospitals, Addis Ababa, Ethiopia: Facility-based cross-sectional study.

Healthcare professionals (HCPs) are among the highly exposed groups for the COVID-19 pandemic and have been identified as the target population to get vaccination against the spread of the infection. Aimed to assess COVID-19 vaccine take-up and its predictors among HCPs in public hospitals in Addis Ababa, Ethiopia, 2021. A facility-based cross-sectional study was conducted among 403 randomly selected participants from October 1st to November 30, 2021. Data was entered into Epi-info version 7 and analyzed using SPSS version 25. An AOR along with a 95% confidence level was estimated, and a P value <.05 was considered to declare the statistical significance. About 71% of the participants had taken any of the COVID-19 vaccines at least once. Being married (AOR: 10.79; 95% CI: 1.32-18.05); educational status of MSc degree (AOR = 7.7; CI: 2.08-15.1.6), medical doctors/GP (AOR = 5.88; CI: 1.60-15.54), MD with MSc (AOR = 9.63; CI: 2.17-17.76), PHD (AOR = 13.33; CI: 1.23-24.21) and specialist and above 3 (AOR = 3.45; CI: 2.34-42.8) holder HCPs; perceived severity of COVID-19 infection as moderate (AOR = 0.23; CI: 0.08-0.65) and mild (AOR = 0.28; CI: 0.11-0.74) and poor knowledge toward COVID-19 vaccination (AOR = 0.03; CI: 0.01-0.12) were statistically associated. This study showed that COVID-19 vaccine take-up among HCPs was relatively low to achieve herd immunity. Participants' marital status, educational status, perception of the severity of COVID-19 infection, and level of knowledge toward COVID-19 vaccines were the predictors of the COVID-19 vaccine take-up.

Outcomes following COVID-19 vaccination and associated factors among healthcare professionals in Oromia region, Ethiopia.

Vaccines are not free from adverse outcomes. However, the evidence of adverse outcomes following COVID-19 vaccination among health-care professionals (HCPs) in the study setting was scanty. Aimed to assess outcomes following COVID-19 vaccination and associated factors among health-care professionals in Oromia region, Ethiopia. An online cross-sectional survey was conducted from 1 October to 30 October 2021. Data were collected using questionnaire created on Google forms. A snowball sampling technique through the authors' network on the popular social media was used. Data analysis was performed using SPSS version 25. The Adjusted Odd Ratio (AOR) along with the 95% confidence level and variables with a p value <.05 were considered to declare the statistical significance. About 93.9% of the participants had experienced mild-to-moderate adverse outcomes following COVID-19 vaccination. Being married [AOR = 4.19, 95% CI:2.07,8.45] ,family size >5 [AOR = 5.17, 95% CI: 1.74, 15.34], family not tested for COVID-19 [AOR = 0.39, 95% CI: 0.15,0.97], lack of family support to take the vaccine [AOR = 3.58, 95% CI: 1.75, 7.33], heard anything bad about the vaccine [AOR = 4.17, 95% CI: 1.90,9.13] and very concerned as the vaccine could cause Adverse Events Following Immunization (AEFI) [AOR = 6.24, 95% CI: 1.96,19.86] were statistically associated with the outcome. The study showed that over nine out-of-often participants had experienced mild-to-moderate adverse outcomes following COVID-19 vaccination. However, severe adverse outcome experienced was very low, which could not hinder to take the vaccine due to fear of its side effects. Marital status, family size, family tested for COVID-19, lack of family support to take the vaccine, hearing anything bad about the vaccine, and being concerned about as the vaccine could cause adverse events were factors associated with the outcome.

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.

Assessment of Blood Donation Practice and Its Associated Factors Among Wollega University Undergraduate Students, Ethiopia.

Introduction: Blood donation is the process of collecting blood from donors who are at low risk for infection and unlikely to jeopardize their own health. Blood donation addresses maternal and child mortality and contributes to saving millions of lives. But many African countries including Ethiopia are far below the minimum blood collection rate. Furthermore, the blood donation practice is not well studied among young university students in the study area. Hence, this study was done to assess the blood donation practice and associated factors among Wollega University students, Ethiopia. Methods: A cross-sectional study was conducted among 387 students of Wollega University. The students were selected by systematic random sampling. Self-administered questionnaire was used to collect the data. The data were entered into Epidata V.3.1 and exported to SPSSV.25 for analysis. Both bivariate and multivariate logistic regressions were used to identify the associated factors. Adjusted odds ratio with 95% confidence interval and P-value <0.05 were used to declare the statistically significant associations in the multivariable regression. The analyzed result was presented using tables, graphs, and text. Results: Of the 360 respondents, 147 (40.8%; 95% CI: 35.7-46.1%) ever donated blood. Blood donation practice was significantly associated with college of the students (AOR = 3.247; 95% CI: 1.348-7.820), not taking part in blood donation campaigns (AOR = 0.285; 95% CI: 0.161-0.503), knowledge of blood bank location (AOR = 5.297; 95% CI: 3.081-9.110), knowledge about blood donation (AOR = 2.035; 95% CI: 1.123-3.686) and attitude toward blood donation (AOR = 2.266; 95% CI: 1.122-4.577). Conclusion: The magnitude of blood donation in this study was found to be less than the recommended level by the World Health Organization. Absence of the blood donation campaigns, college of study, lack of knowledge, and poor attitude toward blood donation were the factors that influence the blood donation practice. All health and related institutions including the Wollega University must work in coordination to improve the blood donation practice focusing on the regular voluntary blood donors.