Membership dropout rates and associated factors in a community-based health insurance scheme in southern Ethiopia: a mixed method study.

Background: Dropout from community-based health insurance (CBHI) membership is a common problem in low-income countries, even if its implementation leads to substantial improvement in the utilization of essential health services. Few studies have addressed the factors contributing to dropout rates in southern Ethiopia. Therefore, the purpose of this study was to determine the rate of CBHI dropout in southern Ethiopia as well as any contributing factors. Methods: This mixed-method cross-sectional study was conducted among 460 randomly selected CBHI-enrolled households at the Arba Minch Health and Demography Surveillance System site from November 1, 2021, to April 30, 2022. The quantitative data were collected by an open data kit (ODK). using an interviewer-based structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Multivariable logistic regression was applied to identify significant variables. The qualitative data were used to support the quantitative findings and were gathered through in-depth interviews (by the CBHI coordinator and three purposively selected health extension workers) and focus group discussions (in two randomly selected villages). The qualitative data were analyzed using thematic analysis. Finally, triangulation was used to present both the quantitative and qualitative findings. Results: This study found that 92 (21.5%) people stopped their community-based health insurance membership. The presence of sick adults [AOR = 0.281, 95% CI (0.136-0.581)], trust of participants in the contracted health facilities [AOR = 0.227, 95% CI (0.121-0.436)], and poor knowledge of the participants [AOR = 5.518, 95% CI (1.526-19.950)] were significant predictors. Conclusion: The magnitude of the dropout rate was high in this study when compared with the national target. The absence of a sick adult, the absence of trust among participants, and the poor knowledge status of the participants were significant predictors. We suggest that the health facility managers, the CBHI coordinating office, and the district health office give priority to implementing a wide range of knowledge improvement activities and a transparent system in public health facilities. Studies with longitudinal research designs are called for at a wide range of national levels to address the limitations of this study.

Incidence of mortality and its predictors among patients with head injury admitted to adult intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia.

Background: Traumatic head injury, referred to as the "silent epidemic", remains a growing public health concern and the leading cause of mortality in young adults, with a disproportionate burden of disability and death occurring in low-income and middle-income countries, including Ethiopia. However, estimates of the traumatic brain injury burden from low and middle-income countries are scarce. The aim of this study was to assess outcome and its associated factors among patients with head injury admitted to the Adult Intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia. Methods: Institution-based retrospective cohort study was conducted at AaBET and ALERT hospitals from February 01, 2019 to January 30, 2020. All head injury patients' records were reviewed. A structured checklist was used to collect data. Binary logistic regression analysis was used to identify factors associated with death among head injury patients. Result: Out of 205 patients, 178 (86.8%) improved, while 27 (13.2%) died. Road traffic accident was the most common cause of head injury (Adjusted odds ratio (AOR) = 46.3%). Patients with pulse rate admission (AOR = 1.49), NA + level (3.48), type of head injury (AOR = 3.67), mechanical ventilation (AOR = 4.70) were significant predictors of death among patients with head injuries. Conclusion: The incidence of death among head injury patients was 13.2% (27). Road traffic accident was the leading cause of head injury. Pulse rate, plasma sodium level, penetrating head injury, being on a mechanical ventilator were predictors of death among traumatic head injury (THI) patients treated for head injuries. Prevention of road traffic accidents and continuous awareness creation about the consequences of a road traffic accident is recommended.

Ultrasonographic Determination of Portal Vein Diameter Among Adults with and without Chronic Liver Disease at Selected Referral Hospitals in Southern Ethiopia.

BACKGROUND: Measuring portal vein diameter (PVD) is a feasible method of detecting portal vein hypertension, which is a primary and fatal complication of chronic liver disease (CLD) and is usually diagnosed very late. However, there is a paucity of morphometric information on portal vein diameter in the Ethiopian population. Hence, it is important to determine the portal vein diameter among adults with and without chronic liver disease. PURPOSE: The study aimed to identify how PVD is affected by age, sex, and anthropometric measurements in patients with and without CLD. METHODS: A cross-sectional study was conducted among 220 participants (110 CLD patients and 110 controls) who have visited the radiology unit at selected Hospitals. Patients with CLD were selected consecutively as they present while controls were selected by a systematic sampling technique. A structured questionnaire was used to collect the data. Correlation and independent t-test were used to assess the relations. A statistically significant association was declared at P-value <0.05. RESULTS: Mean portal vein diameter for CLD patients was 17.03±1.97 mm with a range of 12.8-20.8mm and 10.79±1.27mm with a range of 7.70-13.25mm for the control group. Age, weight, and body mass index had a positive correlation with portal vein diameter in both groups. The mean portal vein diameter increased by 21.34% during deep inspiration in the control group. CONCLUSION: The mean portal vein diameter among patients with CLD was higher than that of the control group. A significant gender-based difference was recorded in the portal vein diameter of the control group only. Ultrasonography is a non-invasive, readily available diagnostic tool for portal vein pathology. RECOMMENDATION: It is recommended for clinicians to take into consideration age, sex and anthropometric measurements while measuring PVD.

Evaluation of Dermatoglyphic Features of Type 2 Diabetic Patients as Compared to Non-Diabetics Attending Hospitals in Southern Ethiopia.

Background: Diabetes mellitus (DM) is a complex metabolic disorder characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 DM has a strong hereditary background. A study of the dermatoglyphic features can help in the early identification of people with a genetic predisposition to develop type 2 DM. Purpose of the Study: The study was aimed to compare the finger and palmar dermatoglyphics features in type 2 diabetic and non-diabetic patients and to evaluate the association with other variables. Patients and Materials: Institution-based cross-sectional study was conducted in one referral hospital and three primary hospitals located in Gedeo Zone. Three hundred ninety study participants (130 type 2 diabetics and 260 non-diabetics) from adult OPD and diabetic clinics were included in the study. The association among different dermatoglyphics variables was analyzed using the chi-square test. An independent t-test was conducted to analyze the mean difference and to test the significance of numerical variables. A statistically significant association was declared at P-value <0.05. Results: In the present study, a total of 3900 digits (1300 from type 2 diabetic and 2600 non-diabetic) were analyzed for distribution of digital dermatoglyphic patterns. Loop pattern is found to be the commonest in both study groups with a prevalence of 65.8% and 60.7% among type 2 diabetics and non-diabetics, respectively. Both the right-left axial tri-radius angle was significantly higher in type 2 diabetes mellitus patients compared to non-diabetic study participants. Total finger ridge counts and absolute finger ridge counts showed no significant difference in both groups. Conclusion: The study revealed Loop pattern was more frequent in type 2 DM compared to non-diabetic study participants. Whorl type was more common than arch type in non-diabetic patients compared to type 2 DM groups. The result also showed tri-radius angle is significantly wider in diabetic groups in both hands.

Placental and Umbilical Cord Indices and Their Association with Fetal Distress in Hadiya Zone Public Hospitals, Southern Ethiopia: A Cross-Sectional Study.

BACKGROUND: The placenta and umbilical cord have been considered as significant contributors to the perinatal outcome and have contributed to some degree to neonatal mortality. The placenta has a very crucial role in normal fetal development. After about four weeks of gestation, the only link of the fetus to the placenta is the umbilical cord. Very little is known about placental and umbilical indices in Ethiopia. This study was aimed to determine placental and umbilical cord indices and their association with fetal distress in Hadiya zone public hospitals, southern Ethiopia. METHODS: This study included 249 placentae with the attached umbilical cord from normal singleton live birth with known gestational age. Bivariable and multivariable logistic regression was used, and variables with p < 0.25 in the bivariable analysis were entered into a multivariable logistic regression to identify the independent factors for the outcome variable. Odds ratios with 95% confidence were computed, and statistical significance was declared at p-value <0.05. RESULTS: Three-fourth (75.9%) of diameter of studied placenta was in normal range and 18.1%, 6.0% below and above normal range, respectively. About one-third (32.9%) of umbilical cords were short, 61.8% normal, and 5.2% long. Newborns with thin placenta [AOR = 3.43; 95% CI: 1.25, 9.40], short cord length [AOR = 3.43; 95% CI: 1.66, 7.09] and long cord length [AOR = 7.55; 95% CI: 2.07, 27.53] were significantly associated with fetal distress. CONCLUSION: In this study, deviation of umbilical cord length from the normal range and placental thickness were significantly associated with fetal distress. In addition, fetal distress was also associated with gestation age and sex of the newborn.

Perceived stress and associated factors among health care professionals working in the context of COVID-19 pandemic in public health institutions of southern Ethiopia 2020.

INTRODUCTION: Health care professionals are at higher risk of developing stress-related problems during outbreaks, due to the overwhelming clinical workload, fear of contagion, and inadequate protective gears. So, in order to monitoring mental health issues and to understand the factors evidence-based interventions is important. Therefore, this study was aimed to assess perceived stress and associated factors among health care professionals working in the context of COVID-19, Southern Ethiopia. METHODS: Institution based cross-sectional study was conducted among 798 health care professionals from the 1st May to 1st June 2020. The study participants were selected using simple random sampling technique after allocating a proportion to each health institute based on the size of health care professionals. A pre-tested and structured interviewer-administered questionnaire using KOBO collect survey tool was used to collect data. A total score of >20 points was considered as the cut off for experiencing perceived stress based on perceived stress scale. Both bivariable and multivariable logistic regression analysis were performed to identify associated factors. The level of statistical significance was set at a p-value of less than 0.05 in multivariable logistic regression. RESULT: Nearly two-thirds 61.8% (95% CI: 58.4%, 65.2%) of HCPs had perceived stress. Not having COVID-19 updated information (AOR = 2.41, 95% CI: 1.31, 4.43), not at all confident on coping with stress (AOR = 9.94, 95% CI:3.74, 26.41), somewhat confident in coping with stress (AOR = 4.69, 95% CI:2.81, 7.84), moderately confident on coping with stress (AOR = 2.36, 95% CI: 1.46, 3.82), and not getting along well with people (AOR = 4.88, 95% CI: 1.42, 16.72) were positively association with perceived stress. However, feeling overwhelmed by the demand of everyday life (AOR = 0.52 95% CI: 0.35, 0.77) and worrying about what other people think about them (AOR = 0.48, 95% CI: 0.24, 0.81) were negatively associated with perceived stress. CONCLUSION: COVID-19 update, confidence in coping with stress, getting along with people, worrying about what other people think about them, and feeling overwhelmed by the demand of everyday life were factors significantly associated with perceived stress. The provision of COVID-19 update to HCPs along with wider strategies to support their psychological wellbeing is vital.