Advancing Antenatal Care in Ethiopia: The Impact of Tele-Ultrasound on Antenatal Ultrasound Access in Rural Ethiopia.

Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.

Determinants of defaulter to full vaccination among children aged 12-23 months in Siraro district, West Arsi zone, Oromia, Ethiopia: a case-control study.

BACKGROUND: Vaccination is one of the most cost-effective global public health interventions to reduce childhood morbidity and mortality. Defaulters to full vaccination can put children at greater risk of acquiring vaccine-preventable disease outbreaks. The reason for not receiving full vaccination is not well explored, and hence, there is limited evidence about defaulters of vaccination in Ethiopia. OBJECTIVES: To identify determinants of defaulter to full vaccination among children aged 12-23 months in Siraro District, West Arsi Zone, Oromia Region, Ethiopia. METHODS: A community-based unmatched case-control study was conducted among children aged 12-23 months from March 20 to April 30, 2022, with a total sample size of 444 (148 cases and 296 controls). Cases were children aged 12-23 months who had missed at least one routine vaccination dose, while controls were children who had received all of the recommended routine vaccinations. Consecutive sampling and simple random sampling techniques were used to select representative cases and controls respectively. Data were collected using a structured questionnaire, entered into Epi-data version 4.6, and exported to Statistical Package for Social Sciences version 26 for analysis. Logistic regression was used to identify determinants of the defaulter to full vaccination and the variables with p-value < 0.25 were recruited for multivariable analysis, and an adjusted odds ratio with a 95% confidence interval and a p-value of ≤ 0.05 was used to declare the statistical significance of the association. RESULT: Of the assessed determinants of the defaulter to full vaccination; inadequate knowledge of mothers/caretakers (AOR = 4.32, 95% CI:2.78-6.70), educational status of a father unable to read and write (AOR = 3.66, 95% CI:1.29-10.39), time to reach health facility ≥ 30 minutes (AOR = 2.45, 95% CI:1.51-3.97), not told about the type of vaccine received (AOR = 2.37, 95% CI;1.27-4.45), no parents discussion on vaccination (AOR = 2.16, 95% CI:1.24-3.79), home delivery (AOR = 2.43, 95% CI:1.39-4.25) and not participated in pregnant mother conference (AOR = 2.47, 95% CI = 1.35-4.49) were the identified determinants of the defaulter to full vaccination. CONCLUSION: Mother's' knowledge, father's education, place of delivery, time to reach a health facility, health workers who told the type of vaccine received, participation in pregnant mother conference, and parents' discussion on vaccination were the determinants of the defaulter to full vaccination status. Thus, the district health office should work on defaulters of vaccination by strengthening immunization service delivery and improving maternal knowledge on vaccination through pregnant mother conference participation.

Metabolic syndrome among people living with HIV in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Human Immuno-deficiency Virus (HIV) infection and antiretroviral therapy (ART) can cause metabolic disorders such as lipodystrophy, dyslipidemia, and insulin resistance, all of which are symptoms of metabolic syndrome (MetS). In Ethiopia, despite the existence of the primary studies, there was no pooled study conducted to summarize the country-level MetS among people living with HIV (PLHIV). Therefore, this study aims to estimate the pooled prevalence of MetS among PLHIV in Ethiopia. METHODS: A systematic search was conducted to retrieve studies on the prevalence of MetS among PLHIV in Ethiopia from PubMed, Google Scholar, Science Direct, Web of Sciences, HINARI, and other relevant sources. A random-effects model was used to estimate the MetS in this study. The overall variation between studies was checked by the heterogeneity test (I2). The Joanna Briggs Institute (JBI) quality appraisal criteria were used to assess the quality of the studies. The summary estimates were presented with forest plots and tables. Publication bias was checked with the funnel plot and Egger's regression test. RESULTS: Overall, 366 articles were identified and evaluated using the PRISMA guidelines, with 10 studies meeting the inclusion criteria included in the final analysis. The pooled prevalence of MetS among PLHIV in Ethiopia was 21.7% (95% CI:19.36-24.04) using National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and 29.91% (95% CI: 21.54-38.28) using International Diabetes Federation (IDF) criteria. The lowest and highest prevalence of MetS were 19.14% (95%CI: 15.63-22.64) and 25.6% (95%CI: 20.18-31.08) at Southern Nation and Nationality People Region (SNNPR) and Addis Ababa, respectively. There was no statistical evidence of publication bias in both NCEP-ATP III and IDF pooled estimates. CONCLUSION: MetS was common among PLHIV in Ethiopia. Therefore, optimizing regular screening for MetS components and promoting a healthy lifestyle is suggested for PLHIV. Furthermore, more study is contributory to identify the barriers to implementing planned interventions and meeting recommended treatment goals. TRIAL REGISTRATION: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023403786.

Exploring barriers of childhood full vaccination among children living in Siraro District, West Arsi Zone, Oromia region, Ethiopia: A qualitative study.

Background: Childhood immunization is one of the most effective global public health interventions to reduce childhood morbidity and mortality. However, some children remain not fully vaccinated in developing countries due to defaulting from full vaccination, which can put them at risk of acquiring vaccine-preventable disease outbreaks. The barriers to full vaccination were well explored in Ethiopia using a qualitative approach. The study aimed to explore barriers to full childhood vaccination in Siraro District, West Arsi Zone, Oromia, Ethiopia. Methods: A qualitative study was conducted in Siraro District through 15 key informant health workers interviews and 6 in-depth interviews with children's mothers from April 20 to May 15, 2022. Data were collected by semi-structured questionnaires and captured using audio tape recorders and field note-taking. A heterogeneous purposive sampling technique was used to select representative study participants. Data transcription and translation were done according to the respondents' verbatim from the local language to English. Data coding and key categories were identified and analyzed using thematic analysis. Finally, data were presented in narrative forms using respondents' own words as an illustration. Result: Twenty-one study participants were interviewed and included in this study. Of the explored barriers to full childhood vaccination, the evidence from the respondents was integrated from subcategories and presented as a whole within each thematic area. Five thematic areas emerged from interviews of the participants through thematic analysis of the data. The identified barriers were forgetting the next vaccination schedule, migration of parents, work overload, lack of knowledge and awareness, rumors, and misinformation. Additionally, vaccination service delivery-related barriers such as vaccine vials not being opened for a few children, fear of vaccine side effects, closed health posts during visits by mothers for vaccination, and absence of health extension workers at health posts were the key barriers to full childhood vaccination. Conclusion: Forgetting vaccination schedule, migration of parents, work overload, rumors, and misinformation, fear of vaccine side effects, vaccine vial not opened for few children, closed health posts during visiting by mothers, absence of health extension workers from health posts were the key barriers to the full vaccination status of children. Thus, the district health office should work on barriers to full vaccination by strengthening vaccination service delivery and improving vaccination awareness through a health extension program.

Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study.

Background: Evidence revealed that there is a statistically significant gender difference in Health-related quality of life (HRQoL) among HIV-positive people on Antiretroviral therapy (ART). Consequently, HIV-positive women have low scores in all HRQoL domains than men. Despite this fact, previous studies in Ethiopia focused on general HIV-positive people and paid less attention to HIV-positive women. Therefore, this study was intended to measure HRQoL and associated factors among HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia. Methods: An institution-based cross-sectional study was conducted from February 01-April 30, 2022. Four hundred twenty-six women on ART were included using a systematic random sampling technique. Face-to-face interviews and medical record reviews were used to collect data. Both bivariable and multiple linear regressions were computed to identify the factors associated with HRQoL. A p-value <0.05 was used to assert statistically significant variables in multiple linear regression analysis. Results: The overall mean (SD) score of the HRQoL was 11.84 (2.44). And, 44.7% [95% CI: 40.3, 49.5] of the women have poor HRQoL. In multiple linear regression analysis, factors like depression (ß = -0.35), Post-Traumatic Stress Disorder (PTSD) (ß = -0.16), age (ß = -0.07), rural residence (ß = -0.52), and bedridden functional status (ß = -1.02) were inversely associated with HRQoL. Oppositely, good treatment adherence (ß = 0.46) was positively associated with overall HRQoL, keeping other factors constant. Conclusion: This study reveals a high magnitude of poor HRQoL among HIV-positive women. Therefore, as HRQoL domains are comprehensive indicators of living status, healthcare service providers should be dedicated to screening and supporting HIV-positive women with poor HRQoL. Additionally, healthcare providers should also pay special attention to routine PTSD screening and management for HIV-positive women due to its detrimental effect on HRQoL.

COVID-19 Case Fatality Rate and Factors Contributing to Mortality in Ethiopia: A Systematic Review of Current Evidence.

Background: The ongoing novel coronavirus disease 2019 (COVID-19) is triggering significant morbidity and mortality due to its contagious nature and absence of definitive management. In Ethiopia, despite a number of primary studies have been conducted to estimate the case fatality rate (CFR) of COVID-19, no review study has attempted to summarize the findings to better understand the nature of pandemics and the virulence of the disease. Objective: To summarize the CFR of COVID-19 and factors contributing to mortality in Ethiopia. Methods: PRISMA guideline was followed. PubMed, Science Direct, CINAHL, SCOPUS, Hinari, and Google Scholar were systematically searched using pre-specified keywords. Observational studies ie, cohort, cross-sectional, and case-control studies were included. The Newcastle-Ottawa scale adapted for observational studies was used to assess the quality of included studies. CFR was defined as the proportion of COVID-19 cases with the outcome of death within a given period. Factors contributing to COVID-19 mortality at p-value <0.05 were described narratively from the eligible articles. Results: A total of 13 observational studies were included in this study. Consequently, this review confirmed the CFR of COVID-19 in Ethiopia ranges between 1-20%. Additionally, comorbid conditions, older age group, male sex, substance use, clinical manifestations (abnormal oxygen saturation level, atypical lymphocyte count, fever, and shortness of breath), disease severity, and history of surgery/trauma increased the likelihood of death from COVID-19 death. Conclusion: This study shows that the range of CFR of COVID-19 in Ethiopia is almost equivalent to other countries, despite the country's low testing capacity and case detection rate in reference to its total population. Comorbid diseases, older age group, male sex, cigarette smoking, alcohol drinking, clinical manifestations and disease severity, and history of surgery/trauma were factors contributing to COVID-19 mortality in Ethiopia. Therefore, given the alarming global situation and rapidly evolving large-scale pandemics, urgent interdisciplinary interventions should be implemented in those vulnerable groups to lessen the risk of mortality. Furthermore, the CFR of COVID-19 should be estimated from all treatment and rehabilitation centers in the country, as underestimation could be linked to a lack of preparedness and mitigation. A large set of prospective studies are also compulsory to better understand the CFR of COVID-19 in Ethiopia.

Time to occurrence, predictors, and patterns of opportunistic infections incidence among HIV-positive patients attending Antiretroviral Therapy Clinic of Salale University Comprehensive Specialized Hospital: A retrospective cohort study.

Opportunistic infections (OIs) in HIV patients are infections that are more common or more severe as a result of HIV-mediated immunosuppression. The advances in the capacity of antiretroviral therapy (ART) have diminished the incidence of OIs. However, even in the ART era, HIV-related OIs continue to be major causes of hospitalization and mortality. Therefore, this study aims to identify time to occurrence, predictors, and patterns of OIs incidence among HIV-positive patients attending ART clinic of Salale University Comprehensive Specialized Hospital, Ethiopia. A retrospective cohort study was conducted between 1st September 2016 and 1st September 2021. All 419 patients diagnosed during the study period were recruited. Data were extracted from both patient medical records and ART logbooks. Stata-16 was used for data analysis. Follow-up time was calculated from the date of HIV diagnosis to the date of OIs occurrence or censoring. Cox proportional hazards regression model was used to identify the predictors of OIs incidence. The total person-time of the follow-up was 8656 person-months of observation. During the follow-up time, 199 (47.49%) of the patients had developed OIs. The incidence rate of OIs was 23 (95%CI: 20, 26) per 1000 person-months of observation. The median OIs free survival time was 36 (95%CI: 31, 40) months. Predictors such as residence, cd4 category, baseline hemoglobin level, ART side effects, isoniazid preventive therapy, and chronic disease comorbidity were significantly predicted OIs incidence. The study area's OIs incidence remained high, requiring prompt action. To reduce the morbidity and mortality associated with OIs, HIV-positive patients with the predictors of rural residence, low CD4 category, low baseline hemoglobin level, ART side effects, not taking IPT, and baseline chronic disease comorbidity necessitate close follow-up and monitoring. Thus, we recommend focused and evidence-informed strategies to address OIs burden and improve outcomes.

Level of Adequate Knowledge of Non-communicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach.

Background: Non-communicable diseases (NCDs) are currently the leading cause of morbidity and mortality, posing significant challenges to global healthcare systems. Particularly, the prevalence of NCDs is rising in Ethiopia, resulting in a triple burden of diseases on the health system that disproportionately affects all age groups. Hence, this study aims to determine the level of adequate knowledge of NCDs and associated factors among adult residents of the North Shewa zone, Oromia region, Ethiopia. Methods: A community-based cross-sectional study with a concurrent mixed-method approach was conducted from April 1, 2021 to May 30, 2021 among 846 residents using the multistage sampling technique. Interviewer administered questionnaire was used to collect quantitative data and a guiding checklist was used to collect qualitative data. Bivariable and multivariable logistic regressions were fitted to compute the association between explanatory variables and knowledge of NCDs. Adjusted odds ratios at 95% confidence interval with a p-value < 0.05 were used to decree statistical significance in multivariable analysis. Also, a thematic framework analysis was used for qualitative data analysis. Results: A total of 823 subjects have participated in this study making a response rate of 97.3%. The level of adequate knowledge was 33.9% (95%CI: 30.67, 37.13). Higher-income, receiving information from health professionals, owning a TV, having a family member with NCD(s), and marital status were factors significantly associated with adequate knowledge of NCDs. Conclusion: This study reveals a high level of inadequate knowledge of NCDs despite its foundational ability in tackling the burden of NCDs. As a result, broadening a wider and more comprehensive health promotion strategy for the prevention of triple burden of NCDs would benefit the population. Additionally, special efforts are needed both at the practice and policy levels targeting the disadvantaged groups, such as low-income people, those who do not receive information from health professionals, those who do not own a television, and those who are widowed/divorced, who were found to have less knowledge of NCDs.

Implementation and evaluation of a pilot antenatal ultrasound imaging programme using tele-ultrasound in Ethiopia.

INTRODUCTION: Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. METHODS: Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. RESULTS: 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. CONCLUSION: Healthcare provider-performed antenatal ultrasound - supported by obstetricians via tele-ultrasound - showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging.

Self-Reported Symptoms of Depression, Anxiety, and Stress Among Healthcare Workers in Ethiopia During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency that has affected many world nations, including Ethiopia. Aside from its implications on the community as a whole, COVID-19 has also been associated with a variety of mental health problems among healthcare workers (HCWs). In this study, we aim to assess the prevalence of self-reported symptoms of depression, anxiety, and stress during the COVID-19 pandemic among HCWs in central Ethiopia. METHODS: An institutional-based cross-sectional study was conducted using an online survey from June 25, 2020, to July 25, 2020, in Ethiopia. Data were collected using a self-reported Depression, Anxiety, and Stress Scale (DASS-21). Data were cleaned, coded, and analysed using SPSS Version 23. A multivariable logistic regression analysis was done to identify the associated factors for mental health outcomes at a p-value of less than 0.05. RESULTS: A total of 816 HCWs completed the self-report questionnaire. The percentage of HCWs who had moderate to extremely severe symptoms of depression, anxiety, and stress were 60.3%, 78%, and 33.8%, respectively. Female participants, HCWs in the Oromiya Special Zone, medical laboratory professionals, and HCWs working in the COVID-19 treatment isolation centers were significantly more likely to have symptoms of depression, anxiety, and stress. CONCLUSION: In this study, HCWs reported a high prevalence of depression, anxiety, and stress symptoms. Female participants, HCWs in the Oromiya Special Zone, medical laboratory professionals, and HCWs working in the COVID-19 treatment isolation centers were significantly more likely to have symptoms of depression, anxiety, and stress. It is imperative that the Ethiopian Federal Ministry of Health should develop psychological interventions to address the specific needs of HCWs who have been impacted by the COVID-19 pandemic.

Occupational Health Safety of Health Professionals and Associated Factors During COVID-19 Pandemics at North Showa Zone, Oromia Regional State, Ethiopia.

BACKGROUND: Coronavirus disease 19 was observed as a pandemic and caused many community health problems that resulted in Global issues. It causes death for many individuals including health professionals. This study aimed to determine the occupational health safety of health professionals and associated factors during COVID-19 pandemic at North Showa. METHODS: Institutions-based Cross-sectional study was conducted using a simple random sampling technique from May 10 to June 15, 2020. Interviewer-administered questioners were used, and data were entered into Epi-data version 3.1 and exported to SPSS 23 for analysis. Bi-variable logistic regression was carried out to select candidate variables with a cutoff point < 0.2. Finally, multivariable logistic regression was conducted to identify significant variables. An adjusted odds ratio with 95% CI at a 5% level of significance was used to measure the strength of association. P-value <0.05 indicated a significant association between variables. RESULTS: A total of 280 health professionals participated with a 92.72% response rate. Of which 57.9% (n=162) were males while 42.1% (n=118) females. Of total 48.9% (n=137) (95% CI: 43.2, 55.0) health professionals had poor occupational health and safety. Availability of soap and bleach (AOR=2.50; 1.439, 4.356), Possibility of isolate COVID-19 suspected clients (AOR=2.525; 1.690, 5.062), Availability of infections prevention and control program standards and policy (AOR=2.329; 1.325, 4.092), Availability of policy and procedure to prevent COVID-19 (AOR= 2.427; 1.389, 4.240) were significantly associated. CONCLUSION: The result suggested that occupational health safety was generally low in the study area. Therefore, a preventive measure such as the use of personal protective equipment and adherence to hand hygiene practice and Infection prevention policy could reduce the spread of COVID-19 and further study should be conducted to generate more evidence on determinants of occupational health safety.

Patient Satisfaction and Associated Factors During COVID-19 Pandemic in North Shoa Health Care Facilities.

BACKGROUND: Patient satisfaction is an indicator of healthcare quality service and involved as an outcome measure. Quality of healthcare service and patient satisfaction has been affected by the current coronavirus disease 2019 (COVID-19) pandemic. It induced uncertainness and shortage of medical supplies due to a limited global movement. Therefore, this study aimed to assess patient satisfaction and associated factors among chronic patients who had a follow-up in North Shoa healthcare facilities. METHODS: An institutional-based cross-sectional study was used to select 410 study participants through a systematic random sampling technique. Data were collected by a structured interviewer-administered questionnaire, entered into Epi Info version 7, and transported to SPSS version 23 for analysis. Bivariable and multivariable logistic regressions were used to identify the factors associated with satisfaction. The odds ratio with a 95% confidence interval was computed, and p-value <0.05 was considered statistical significance in the multivariable model. RESULTS: The overall level of patient satisfaction was 44.6%. The presence of sign and direction indicators (AOR=3.26, 95% CI=1.1, 9.92), obtaining some ordered drugs (AOR=3.7, 95% CI=1.1, 12.54), getting alcohol for hand cleaning (AOR=2.66, 95% CI=1.1,6.65), obtaining sanitizer for hand cleaning (AOR=4.45, 95% CI=1.72,11.52), and maintaining social distancing (AOR=2.63, 95% CI=1.21, 5.70) were factors associated with patient's satisfaction. CONCLUSION: The level of patient satisfaction was very low during a COVID-19 pandemic. The presence of sign and direction indicators, availability of drugs, social distancing, availability of alcohol, and sanitizer were factors associated with patient satisfaction. The intervention targeted at increasing patient satisfaction and improving the quality of service during COVID-19 through maintaining social distancing and availing alcohol or sanitizers is necessary.