High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review.

OBJECTIVE: To present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria. DESIGN: Retrospective medical chart review. SETTING: Facility-based study.ParticipantsChildren aged 6-59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses. RESULTS: Records of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards. CONCLUSIONS: Children with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.

A geospatial analysis of accessibility and availability to implement the primary healthcare roadmap in Ethiopia.

BACKGROUND: Primary healthcare (PHC) is a crucial strategy for achieving universal health coverage. Ethiopia is working to improve its primary healthcare system through the Optimization of Health Extension Program (OHEP), which aims to increase accessibility, availability and performance of health professionals and services. Measuring current accessibility of healthcare facilities and workforce availability is essential for the success of the OHEP and achieving universal health coverage in the country. METHODS: In this study we use an innovative mixed geospatial approach to assess the accessibility and availability of health professionals and services to provide evidence-based recommendations for the implementation of the OHEP. We examined travel times to health facilities, referral times between health posts and health centers, geographical coverage, and the availability and density of health workers relative to the population. RESULTS: Our findings show that the accessibility and availability of health services in Somali region of Ethiopia is generally low, with 65% of the population being unable to reach a health center or a health post within 1 h walking and referral times exceeding 4 h walking on average. The density of the health workforce is low across Somali region, with no health center being adequately staffed as per national guidelines. CONCLUSIONS: Improving accessibility and addressing healthcare worker scarcity are challenges for implementing the primary care roadmap in Ethiopia. Upgrading health posts and centers, providing comprehensive services, and training healthcare workers are crucial. Effective outreach strategies are also needed to bridge the gap and improve accessibility and availability.

Access to primary healthcare, which encompasses essential healthcare services and often the initial point of contact between individuals and the healthcare system, is crucial for addressing the health needs of a population. In Ethiopia, ongoing efforts to reform the primary healthcare system aim to increase geographic access to health services and improve the availability of healthcare workers. This study focuses on the Somali region of Ethiopia and finds that 65% of the population is unable to reach a health center within 1 h of walking, and none of the health centers meet national and international staffing guidelines. These results play an important role in identifying areas where mobile outreach, involving trained service providers traveling to communities with limited access to healthcare facilities, can bridge gaps in healthcare accessibility and availability. Furthermore, the findings inform the implementation of primary healthcare reforms.

Non-financial Incentives for Retention of Health Extension Workers in Somali Region of Ethiopia: A Discrete Choice Experiment.

The study evaluated non-financial incentive packages to retain health extension workers in the Somali Region of Ethiopia using the Discrete Choice Experiment (DCE) technique, conducted among 66 health extension workers in 3 woredas (districts). The study used a mix of qualitative and quantitative methods in sequential order. Mixed logic regression modeling was used to determine the effect of different job attributes on the retention of the health extension workers, while Preference Impact Measure (PIM) was used to determine the combinations of preferred incentive packages to retain the health extension workers in their current workplace. Opportunity for continued education ranked first, 1.009 (0.655, 1.36), P = .000, followed by career advancement/opportunity for promotion, 0.321 (0.107, 0.534), P = .003, then supportive management 0.234 (-0.395, -0.073), P = .004. in terms of impact on retention. The most preferred incentive package for retention using the PIM model was opportunities for continued education after 3 years and always good availability of and access to amenities (running water, electricity, internet), which predicted a 77% retention rate if implemented. The identified proposed retention incentive packages will help in developing evidence-based incentive policies and strategies for the future retention of health extension workers in this region.

Sexual Violence-Related Pregnancy Among Internally Displaced Women in an Internally Displaced Persons Camp in Northeast Nigeria.

Sexual violence is quite common in conflict situations and puts women at risk of unintended pregnancies. In the northeast region of Nigeria with the ongoing insurgency, a substantial number of women are kidnapped and subjected to forced marriages and repeated sexual assaults. This study set out to report on the disclosure and outcomes of sexual violence-related pregnancies (SVRPs) among women liberated from insurgents and relocated to one of largest Internally Displaced Persons (IDP) camps located in Borno State, northeast Nigeria. The clinic records of women with SVRP were reviewed. Forty-seven women with SVRP were identified by the health care providers using a snowball technique to reach as many of the women with SVRP as possible. The mean age of the participants was 15.3 years (SD = 3.4 years), and all the participants had spent 2 years or more in captivity. Most of the women first disclosed the pregnancy to their peers before disclosure to health care providers or family members. All the women initially requested to have the pregnancy terminated; however, abortion services are not offered in the clinic in line with the country's restrictive abortion laws. Following counseling and psychosocial support offered in the clinic, 19 (40%) of the women continued with the pregnancy and were delivered in the camp clinic while the remaining 26 women left the camp shortly after disclosure and pregnancy outcomes are not known. SVRP is not uncommon in humanitarian settings with its associated stigma and unwillingness among the survivors to keep the pregnancy. There is a need for further studies to provide more insight into the extent of this problem and help-seeking for SVRPs especially for women in such difficult circumstances to provide needed empirical information to drive advocacy efforts for more comprehensive services.

Exploring opportunities to enhance effectiveness of mobile health and nutrition strategy for providing health and nutrition services amongst pastoralists in Somali region, Ethiopia.

BACKGROUND: The health system in Ethiopia's Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services. AIM: This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts). SETTING: Somali Region of Ethiopia. METHODS: The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region. RESULTS: 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas. CONCLUSION: With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.

Integrating immunisation services into nutrition sites to improve immunisation status of internally displaced persons' children living in Bentiu protection of civilian site, South Sudan.

INTRODUCTION: The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. METHODS: A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. RESULTS: Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). CONCLUSION: This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).

Application of Call Centre as COVID 19 Alert and Surveillance System in Pastoralist Communities of Somali Region of Ethiopia

Aims:Ethiopia recorded the first confirmed case of COVID 19 pandemic on 13th March 2020 and thesurveillance and alert systemswere immediately activated.In Somali Region, the toll-free call center was used asalert and surveillance system in addition to the routine health facility surveillance system because of poor coverage of health facilities and pastoral lifestylein the region.Study Design:This was a retrospective chart review of COVID 19 alerts and surveillance database. Place and Duration of Study:Somali Region between 13thMarch and 30thJune 2020.Methodology:A retrospective chart review of alert database from the two COVID 19 alert and surveillance systems. The sensitivity for each system was calculated as the proportion of confirmed cases and test of association was done using chi-square testat significant level of 5% Results:414 alerts were reported during the study period, 259( 62.5%) alerts from the toll-free call centre,(49.3%) of which met the criteria as suspected cases and 22(8.5%) confirmed positive for COVID compared to 155( 37.5%) alerts from the health facilities,145(50.7%) of which met the criteria as suspected cases and 43(27.7%) confirmed positive. The positivity rate was statistically significant, p=0.045. However, alerts were received from all the 11 zones in the region through the call centre compared to six zones through the health facilities.Conclusion:The call centre is aneffective system with widecoverage for monitoring alertsand can beexplored as a long-term surveillance system during disease outbreaks and other public health interventions post COVID pandemic

Integrating immunization services into nutrition sites to improve immunization status of internally displaced persons' children living in Bentiu protection of civilian site, South Sudan

Introduction: the protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.Methods: a community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.Results: integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05).Conclusion: this study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV)