Utilization of sexual and reproductive health services among construction worker women in southern Ethiopia.

BACKGROUND: In Ethiopia, the utilization of sexual and reproductive health services (SRH) is alarmingly inadequate, leading to higher rates of maternal and newborn mortality. Disparities in accessing sexual and reproductive health (SRH) services exist among different population groups, with construction worker women at a higher risk of experiencing such issues. We investigated the utilization of sexual and reproductive health services and associated factors among construction worker women in Southern Ethiopia. METHOD: We conducted a cross-sectional study among construction worker women (15-49) in Southern Ethiopia from July 1st to July 30th, 2021. The participants were selected randomly using venue-day-time sampling (VDTS). The data were collected by a pretested structured questionnaire using an open data kit (ODK) and exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Binary logistic regression analysis was conducted to identify factors associated with sexual and reproductive health service utilization. An adjusted odds ratio with 95% CI was used and statistical significance was declared at p-value < 0.05. RESULTS: The study revealed that 54.4% of women of reproductive age had used at least one sexual and reproductive health service in the past year. About 66.7% of women experienced sexual harassment at work, with sex discrimination (86.9%) and sexist hostility (57.9%) being the most common. Aged over 20 years, married women, living with husbands, friends, and boyfriends, within 30 min of health facilities, and having a favorable attitude were significantly associated with SRH service utilization. CONCLUSION: Nearly half of construction workers in southern Ethiopia are not using sexual and reproductive health services, indicating a concerning lack of access to such services. Over two-thirds of women experience sexual harassment in construction site. Therefore, to ensure universal access to SRH services, it is essential to design a new approach including outreach programs specifically tailored to reach such vulnerable groups.

Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis.

INTRODUCTION: Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS: This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT: PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION: PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.

The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers.

BACKGROUND: Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH. METHODS: A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software. RESULT: PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management. CONCLUSION AND RECOMMENDATION: HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis).

BACKGROUND: Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. METHODS: We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. RESULTS: We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. CONCLUSION: To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.

A qualitative study exploring perceptions of people living with HIV using antiretroviral therapy on self-management of healthy nutrition and the related healthcare service in Ethiopia.

In Ethiopia, undernutrition is a quite common health problem among people living with HIV. Unlike in developed countries, nutritional counseling for people living with HIV has not received much attention. This study aimed to explore the perception of people living with HIV on their dietary practice and the existing health care service in Ethiopia. A phenomenological qualitative study was conducted in two hospitals in southern Ethiopia from March to June 2018. A pre-tested interview guide was prepared in English and translated into the Amharic language. The data were collected using key informant interviews, focus group discussions and observations in the ART clinics by six trained nurses. The data were analyzed thematically. Almost all focus group discussion participants mentioned that a healthy diet for ART patients is very important. The majority of the participants mentioned that they were not satisfied with the counseling service given at the ART clinics. Lack of training for health care professionals on nutritional counseling was also reported as a challenge by the nurses themselves. Nutritional counseling given by health care professionals at the ART clinic was poor. Emphasis should be given to the training of healthcare professionals working in ART clinics on nutritional counseling.

Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study.

BACKGROUND: Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia. METHODS: An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities. RESULT: In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity. CONCLUSION: The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs.

Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments.

BACKGROUND: Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement. METHODS: We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended. RESULTS: Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time. CONCLUSIONS: Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research.

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high-impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron-folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability.

Physical activity level and associated factors among adult HIV patients in Ethiopia.

BACKGROUND: People living with HIV, who take antiretroviral therapy (ART), often enjoy long and healthy lives, but this therapy has well known metabolic adverse effects. Physical activity is found to be an important factor in improving these physiological parameters. This study aimed to determine physical activity level and associated factors among HIV patients in Ethiopia. METHODS: An institutional based cross sectional study was conducted from May to June 2019. We selected a total of 422 adult HIV patients, attending antiretroviral therapy clinics in three selected hospitals in Southern Ethiopia. Data were collected at routine care consultations by nine trained nurses using a pre-tested structured questionnaire. The level of physical activity was measured by the international physical activity questionnaire (IPAQ). RESULT: The mean age of participants was 38.7 ± 9.13 years. Of the participants, 68% were physically inactive, with a higher proportion of inactive women (74%) than men (61%) [(AOR = 1.64, 95% CI (1.07, 2.53)]. In addition, urban vs. rural residents [(AOR = 2.57, 95% CI (1.16, 5.72)] and patients who were on ART for ≥ 24 months [(AOR = 1.88, 95% CI (1.15, 3.08)] had higher odds of having a low physical activity level. CONCLUSION: Most people living with HIV and receiving ART have low physical activity levels. Especially female and urban living patients and those with longer treatment duration have low levels of physical activity. More insight is needed on the reasons for physical inactivity among HIV patients and physical activity programs for HIV patients in low-income countries need to be developed.

Understanding the risk perception of visceral leishmaniasis exposure and the acceptability of sandfly protection measures among migrant workers in the lowlands of Northwest Ethiopia: a health belief model perspective.

BACKGROUND: Visceral leishmaniasis (VL) is the leading cause of health concerns among Ethiopian migrant workers. Understanding risk perception and health-protective behavior are significant challenges in the prevention and eradication of the disease. As a result, studies are required to assess these important epidemiological factors, which will provide guidance on how to assist migrant workers in taking preventive measures against VL. METHOD: We conducted qualitative research among migrant workers on seasonal agricultural farms in Northwest Ethiopia between June and November 2019 to assess their perception of the risk of contracting VL and their willingness to use protective measures against the disease. Seventeen focus group discussions and 16 key informant interviews were conducted to study migrant workers' risk perception in relation to sandfly bite exposure and use of sandfly control measures. For analysis, all interviews were recorded, transcribed, and translated. ATLASti was used to perform qualitative content analysis on the data. RESULT: Migrant workers are fearful of VL because of previous exposure and the disease's prevalence in the area. They believe, however, that VL is a minor illness that is easily treated. While Insecticide Treated Nets (ITNs) are widely accepted as a protective measure, there are still reservations about using them due to the seasonality of the transmission, difficulties in hanging them on farm areas, and a preference for alternative traditional practices. Regardless of perceived self-efficacy, the central cues were the message delivered by the health workers and an increase in sandfly bite irritation. Based on the findings, three levels of intervention modalities are suggested: 1) increasing pre-arrival awareness through outdoor media (posters, stickers, billboards), 2) encouraging proper use of protective measures upon arrival at farm camps, and 3) informing departing workers on disease recognition and best practices for health-seeking continuous use of protective measures at home. CONCLUSION: This finding suggests that VL prevention interventions should focus on individuals' perceptions in order to promote consistent use of protective measures. The findings are highly useful in planning effective interventions against VL.

Interrater and intrarater agreement on heart murmurs.

OBJECTIVE: To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting agreement with a reference classification. DESIGN: Intra- and interrater agreement study. SUBJECTS: Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway. MAIN OUTCOME MEASURES: Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification. RESULTS: The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range k = 0.09-0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively.The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29-0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively.Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63-3.58), 2.19 (1.58-3.04), and 2.53 (1.46-4.41), respectively. CONCLUSION: We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement.Key points:Heart auscultation is the main physical examination of the heart, but we lack knowledge of inter- and intrarater agreement on heart sounds.• Physicians identified heart murmurs from heart sound recordings fairly reliably compared with a reference classification, and with fair intrarater agreement.• Both intrarater agreement and agreement with the reference showed considerable variation between doctors• Murmur intensity, more than five years in clinical practice, and cardiology specialty were most strongly linked to agreement with the reference.

Phenotyping the shoulder patient based on ultrasound-detected pathologies: a cross-sectional study in general practice.

BACKGROUND: Shoulder complaints arise from a single pathology or a combination of different underlying pathologies that are hard to differentiate in general practice. Subgroups of pathologies have been identified on the basis of ultrasound imaging that might affect treatment outcomes. OBJECTIVE: Our aim was to validate the existence of different subgroups of patients with shoulder complaints, based on ultrasound-detected pathology, and compare clinical features among them. Profiling shoulder patients into distinct shoulder pathology phenotypes could help designing tailored treatment trials. METHODS: This was a cross-sectional study in general practice. Data were extracted from 840 first visit patient records at a single diagnostic centre in the Netherlands. Exclusion criteria were age <18 years and previous shoulder surgery. Latent class analysis was used to uncover cross-combinations of ultrasound detected pathologies, yielding subgroups of shoulder patients. The uncovered subgroups were compared for demographic and clinical characteristics. RESULTS: We uncovered four distinct subgroups of patients with shoulder complaints: (i) Frozen shoulder group (11%), (ii) Limited pathology group (44%), (iii) Degenerative pathology group (31%) and (iv) Calcifying tendinopathy group (15%). Group comparisons showed significant differences in demographic and clinical characteristics among subgroups, consistent with the literature. CONCLUSION: In a general practice population, we uncovered four different phenotypes of shoulder patients on the basis of ultrasound detected pathology. These phenotypes can be used designing tailored treatment trials in patients with shoulder complaints.

Anaemia and its determinants among young children aged 6-23 months in Ethiopia (2005-2016).

Anaemia in children remains a significant public health threat. Recent numbers from Ethiopia showed that more than two-thirds of children under the age of 2 years were anaemic. This study aimed to investigate the determinants of anaemia throughout Ethiopia over 11 years, making use of the Ethiopian Demographic and Health Survey (EDHS) rounds 2005, 2011 and 2016. The EDHS made it possible to use data on blood tests and detailed questionnaires among infants and young children. Multivariable logistic regression was applied to assess the association of anaemia and different immediate and underlying determinants. A total of 7,324 children aged 6-23 months were included in the analysis, with prevalences of anaemia being 71% in 2005, 61% in 2011 and 72% in 2016. The following determinants were significantly associated with childhood anaemia throughout the entire period: children younger than 1 year, anaemic mothers and those growing up in pastoralist regions. Risk factors such as diet and infections were consistently not significantly associated with anaemia. Given the tremendous adverse health effects of anaemia in young children, urgent action is needed. Hence, this study recommends nationwide multisectoral interventions targeting pastoralist regions, maternal and child health, screening and treatment of risk groups that could reduce the prevalence of anaemia.

Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction.

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

The effect of atmospheric pressure on oxygen saturation and dyspnea: the Tromsø study.

A drop in atmospheric pressure, as observed at high altitudes, leads to decreased oxygen saturation. The effect of regular changes in barometric pressure at sea level has never been studied in a general population. A cohort of adults aged 40 years were examined with pulse oximetry at two separate visits, and the local barometric pressure was available from the local weather station. The study aimed at determining the effect of atmospheric pressure on oxygen saturation also called SpO2, as well as on shortness of breath. Based on spirometry, the participants were divided into two groups, with normal and decreased lung function. Decreased lung function was defined as forced expiratory volume in 1 s (FEV1) below lower limit or normal (LLN) or FEV1/FVC (FVC, forced vital capacity) below LLN, with GLI 2012 reference values. The statistical analysis included uni/multivariable linear and logistic regression. A total of 7439 participants of the Tromsø 7 cohort study were included. There was a significant association between barometric pressure and SpO2 < 96%, and we found that a reduction of 166.67 hPa was needed to get a 1% reduction in SpO2. The change in atmospheric pressure was not significantly associated with shortness of breath, also not in subjects with reduced lung function.

The association between acute malnutrition and water, sanitation, and hygiene among children aged 6-59 months in rural Ethiopia.

The causes of acute malnutrition-or "wasting"-are complex, and a better understanding of the underlying drivers is necessary in order to design effective interventions. Water, sanitation, and hygiene (WASH) practices may play a fundamental role in acute malnutrition, but more research is needed to confirm this relationship. We investigated the association between WASH practices and acute malnutrition among children 6 to 59 months of age in rural Ethiopia, making use of the Ethiopian Demographic and Health Survey. Descriptive statistics were used to assess the WASH status of all rural children. Bivariate logistic regression analyses were performed to assess associations between nutritional status and WASH. Multivariate logistic regression analyses were used to adjust for confounders. A total of 7,209 children were included in the analysis, of which 867 (12.0%) were acutely malnourished. Proper toilet facilities (AOR = 0.63, 95% CI [0.46, 0.86]) and a water source close to home (AOR = 0.71, 95% CI [0.61, 0.83]) were associated with a lower prevalence of wasting. A safe water source for drinking (COR = 1.03, 95% CI [0.89, 1.19]) and a safe disposal of the child's stool (AOR = 0.97, 95% CI [0.84, 1.13]) were not significantly associated with acute malnutrition. These results suggest that WASH practices are related to acute malnutrition. Future studies-in particular intervention studies-should investigate whether improving WASH practices is effective in reducing malnutrition in infants and young children.

Tuberculosis treatment outcome and predictors in northern Ethiopian prisons: a five-year retrospective analysis.

BACKGROUND: The prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons. METHODS: A retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were defined following WHO guidelines. RESULTS: Out of the 496 patients, 11.5% were cured, 68% completed treatment, 2.5% were lost to follow-up, 1.6% were with a treatment failure, 1.4% died, and 15% were transferred out. All transferred out or released prisoners were not appropriately linked to health facilities and might be lost to treatment follow-up. The overall treatment success rate (TSR) of the 5 years was 94% among the patients who were not transferred out. The odds of unsuccessful outcome were 4.68 times greater among re-treatment cases compared to the newly treated cases. The year of treatment was also associated with variations in TSR; those treated during the earlier year were more likely to have unsuccessful outcome. Sputum non-conversion at the second-month check-up was strongly associated with unsuccessful outcome among the smear-positive cases. CONCLUSIONS: The mean TSR of the prisoners in the study prisons was quite satisfactory when gauged against the target level set by the End TB Strategy. However, the lack of appropriate linkage and tracking systems for those prisoners transferred or released before their treatment completion would have a negative implication for the national TB control program as such patients might interrupt their treatment and develop drug-resistant TB. Being in a re-treatment regimen and sputum non-conversion at the second-month check-up were significantly associated with unsuccessful treatment outcome among the all forms of and smear-positive TB cases, respectively.

Designing mHealth for maternity services in primary health facilities in a low-income setting - lessons from a partially successful implementation.

BACKGROUND: Increasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation. METHODS: The mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia. RESULTS: The system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients' visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days. CONCLUSIONS: In conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.

The Perception and Needs of Psychologists Toward Blended Care.

BACKGROUND: Blended care, meaning that online (Internet) components are used in combination with face-to-face contact, in mental health is increasingly encouraged, but research about the needs of psychologists is scarce. METHODS: We assessed the perceptions, design, and barriers toward blended care among members of the Dutch Association of Psychologists through an e-mailed survey. Mean scores (SD) and answer percentages were calculated. Mann-Whitney tests were performed to investigate differences between users and nonusers and primary- and secondary care professionals. RESULTS: Generally, psychologists (63% response rate) had a positive perception toward blended care and they intended to use it in future (M = 3.71, SD = 1.19). Users of blended care and secondary care professionals were more positive toward blended care than nonusers and primary care professionals. Online psychoeducation, diary forms, and exercises for different therapeutic approaches and communication technology configurations were most welcomed. Still, quite some barriers were mentioned before professionals would use blended care. CONCLUSIONS: Psychologists had a positive perception toward blended care, as long as attention is paid to the perceived barriers. Results of this survey could be used in the development of online components that correspond to the needs of professionals. Reviewing the needs of psychologists, e-health components of different therapeutic approaches, apart from cognitive behavioral therapy, are welcomed. Future research is necessary to gain insight in the (cost) effectiveness of blended care for different types of patients (e.g., transdiagnostic interventions) and of different therapeutic approaches.