Why do women walk away from maternal health services in Southwest Ethiopia? A qualitative study of caregivers' and clients' perspectives.

BACKGROUND: Continuum of care for Maternal Health Care is continuity of care through pregnancy, childbirth, and after birth as a key strategy in reaching mothers and babies at a crucial time. Despite the widespread drop out from the continuum of care, there is limited understanding of perspectives of providers and clients about factors leading to drop out from care among women in Ethiopia. OBJECTIVE: The aim of this study is to explore the underlying reasons for which women walk away from maternal health services in Ethiopia care providers' and clients' perspectives. METHODS: The population for the study were comprised of all purposefully selected district health department deputy heads, MCH coordinators, primary health center unit directors, midwives and nurses in charge of maternity department and who have been rendering maternal health services and chosen women among those attending the MCH clinic for maternal health services in order to identify reasons for dropout from the perspective of the service users based on the established criteria. The final sample size was determined based on the level of information saturation and a total of 20 in-depth interviewees were conducted. The unstructured key informant interview (KII) guide was used to collect data to gain an in-depth understanding of the context in which continuum of care for maternal health care takes place and existing barriers. RESULT: The main themes were identified and compared across all the transcripts to determine similarities and variations in the views of respondents. The major reasons for which women walk away from maternal health services were categorized under three main themes: healthcare system related reasons, community level barriers and individual level barriers. Interpretive analysis was conducted, and elucidations of the results follow the respective themes and verbatim that capture dominant views were considered wherever appropriate to substantiate the findings. CONCLUSION AND RECOMMENDATIONS: Women were walk away from maternal health services because of health system, community level and individual level factors. Hence, implementing initiatives to improve both providers and clients side barriers are essential. Furthermore, we recommend more large-scale studies to digging out more context specific barriers.

Guidelines and best practice recommendations on reproductive health services provision amid COVID-19 pandemic: scoping review.

BACKGROUND: Policymakers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available guidelines, consensus statements, the standard of practice, and practice recommendations on reproductive health service provision during the COVID-19 pandemics. METHODS: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE, and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that's relevant to the review question. The difference between the two authors on data extraction was resolved by discussion. RESULTS: A total of 21 records were included in the review. Identified recommendations were classified into thematic areas. The records addressed approaches to antenatal care, labour and delivery, postnatal care, safe abortion, contraception, gender-based violence, and artificial reproduction. CONCLUSIONS: There were consistent consensus statements and recommendations that there should be access to sexual and reproductive health services like antenatal care (ANC), postnatal care (PNC), contraception service, safe abortion care, and clinical management of rape survivors during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine and community/home-based care or self-care.

Exploration of facilitators of and barriers to the community-based service utilization for newborn possible serious bacterial infection management in Debre Libanos District, Ethiopia: descriptive qualitative study.

BACKGROUND: Globally, possible serious bacterial infection [PSBI] is a cause for about 600,000 newborn deaths per year. To decrease the burden of this infection, a community-based management newborn PSBI when referral to hospital is not possible has been on implementation. Studies showed gaps in the service utilization and this study was aimed at exploring its barriers and facilitators. METHODS: A descriptive qualitative study was conducted from March 11- April 7, 2019, in Debre Libanos District, Ethiopia. Study participants were recruited purposively. Women who gave birth within 2 months before data collection, health extension workers [HEW], health workers, religious leader, kebele chairman, and other community members were involved in the study. Five in-depth interviews, seven key informant interviews, and four focused group discussions were conducted with a total of fifty-two participants. The data were audio-recorded, transcribed verbatim and translated, and inductive thematic analysis was done using Atlas ti.7.1 software. RESULT: The availability of health workers trained on community-based newborn care [CBNC], Integrated Management of Newborn and Childhood Illness guidelines, availability of medical supplies and job aids, and performance review meetings were identified as facilitators. Communities perception that the newborn illness has no medical treatment, newborn illness is not severe and is self-resolution; the belief in healing power of traditional medicines, socio-cultural and religious beliefs, lack of awareness about service availability at the health post, poor supportive supervision or monitoring, shortage of HEW, the residency of HEWs outside the health post, a poor commitment of health workers and HEWs, and non-functionality of health developmental army were explored as barriers. CONCLUSIONS: The findings provided insight into the facilitators of and barriers to community-based service utilization for newborn PSBI management. There is a need to develop strategies to address the barriers. Therefore, health care providers should have to develop strategies, and conduct a behavioral change communication to change the perception of community members towards newborn illnesses, promote the availability of the service at the health post, and the HEWs provide the service staying at the health post.

Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review.

BACKGROUND: Addressing adolescents' sexual and reproductive health and rights (SRHR) requires an understanding of the socio-cultural and spatial settings within which they live. One setting of particular importance is the informal settlements or 'slums' that are gradually dominating the urban space. We undertook a scoping review and synthesis of existing evidence on adolescent SRHR in slums in sub-Saharan Africa (SSA) focusing on the characteristics and nature of existing evidence. METHODS: The scoping review was conducted based on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and using PRISMA reporting guidelines for scoping reviews. A comprehensive search was undertaken in PubMed, POPLINE, African Journals Online (AJOL), Bioline International and Google Scholar. The search was confined to studies published in peer reviewed journals and reports published online between January 2000 and May 2019. Studies were included in the review if they addressed SRHR issues among adolescents living in urban slums in SSA. RESULTS: The review included a total of 54 studies. The majority (79.5%) of studies were quantitative. The bulk of studies (85.2%) were observational studies with only eight intervention studies. While half (27) of the studies focused exclusively on adolescents (10-19 years), 12 studies combined adolescents with other young people (10-24 years). The studies were skewed towards sexual behavior (44%) and HIV/AIDS (43%) with very few studies focusing on other SRHR issues such as contraception, abortion, gender-based violence and sexually transmitted infections (STIs) other than HIV. Most of the studies highlighted the significantly higher risks for poor SRHR outcomes among adolescents in slums as compared to their peers in other settlements. CONCLUSION: Young people growing up in slums face tremendous challenges in relation to their SRHR needs resulting in poor outcomes such as early and unintended pregnancy, STIs, and sexual violence. The results of this review point to several potential target areas for programming, policy, and research aimed at improved adolescent SRHR in slums in SSA.

Complementary feeding practices and associated factors in Damot Weydie District, Welayta zone, South Ethiopia.

BACKGROUND: Each year, more than millions of under-five children die due to under-nutrition, and many of these deaths are associated with inappropriate feeding practices. This study aimed to assess complementary feeding practices in Damot Weydie District, South Ethiopia. METHODS: A community-based cross-sectional study was conducted among four-hundred and one mothers who had children aged 6-23 months in Damot Weydie District. A pretested structured questionnaire was used to collect data using a face-to-face interview. Data were entered into Epi-Data version 3.1 and analysis was done by using Statistical Package for Social Sciences (SPSS) version 20. Multivariable logistic regressions were conducted to determine independent factors associated with complementary feeding practices. RESULTS: More than half (50.6%) of children were given complementary foods at six months of age. Only 8.5% of young children aged 6-23 months were fed with appropriate complementary foods. The proportion of mothers who reported that they know that a baby of 6-23 months old should be fed two or three times was only 75.8%. Government-employed mothers (adjusted odds ratio (AOR) = 0.14(0.04, 0.50) and mothers who attended postnatal care (AOR = 0.19(0.05, 0.70) were less likely to practice inappropriate complementary feeding. Mothers having children with birth intervals less than 35 months were more likely to practice inappropriate complementary feeding when compared to mothers of children with birth intervals greater than 35 months (AOR = 2.67 (1.22, 5.83). CONCLUSIONS: Considerable proportions of infants and young children were not appropriately fed with complementary foods as per WHO recommendations. Being a government employee mother, attending postnatal care and having a child with birth interval greater than 3 years were associated with appropriate complementary feeding. Therefore, it is important to encourage postnatal care utilization and incorporate complementary feeding advice during postnatal visits. It is critical to raise the awareness of the community about optimal complementary feeding practices with special attention to unemployed and less educated mothers. Additionally, inter-sectoral collaboration should be strengthened to increase the variety of food groups available.

Household food insecurity and coping strategies among pensioners in Jimma Town, South West Ethiopia.

BACKGROUND: Ethiopia is currently facing new challenges related to food insecurity among the urban poor. Pensioners are segments of the population with reduced income and working capacity because of advancement of age and other related problems. There is no empirical evidence on Jimma Town pensioner's household food insecurity and coping strategies. METHODS: A cross-sectional study was conducted among households in Jimma Town living on an income obtained from a pension from March 01-28, 2017. Data were collected from 399 randomly selected participants. Data were entered into EPi-Data version 3.1 and analyzed using SPSS Version 20.0. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression model to control for confounding variables. RESULTS: Nearly, 83.5% of households were food insecure. The odds of food insecurity among households with heads attending secondary school and above was 78% lower when compared to that of households with uneducated household heads (AOR = 0.22, 95% CI: 0.97 to 0.49). The odds of food insecurity among households headed by merchants was 91% lower when compared to that of households headed by guards (AOR = 0.09, 95% CI: 0.03, 0.29). Food insecure households were using coping strategies such as changing consumption patterns (44%), eating inexpensive foods (72.4%), reducing meal frequency (62.4%) and selling household assets, such as household food utensils (30.8%). The odds of food insecurity among households having large family size (≥ 7) was 3.74 times higher when compared to that of households with family size less than three (AOR = 3.74(1.27, 10.99). CONCLUSIONS: Household food insecurity was associated with having households headed by uneducated, widowed and guard household heads and having large family size. Food insecure households used both consumption and asset-based coping strategies such as eating less preferred, lower quality or less expensive foods and receiving donation from relatives or friends. Government policies should consider revising the current social protection scheme for pensioners. Special attention should be given to widow pensioners and pensioners with low educational status and with large family sizes.

Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia.

BACKGROUND: Depression is a serious mental illness that affects patients' treatment outcome and caregiver's day to day life. The prevalence of depression among caregivers of patients with severe mental illness is greater than the general population. Little is known about depression among primary caregivers of patients with severe mental illness in Ethiopia. This study is aimed at assessing prevalence of depression and associated factors among primary caregivers of patients with mental illness. METHODS: A cross-sectional study was conducted among primary caregivers of patients with severe mental illness in Jimma University Teaching Hospital. Patient health questionnaire (PHQ-9) was used to assess depression. A multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support; Cut down, Annoyed, Guilty, Eye opener (CAGE) scale was used to assess alcohol use disorder. After conducting descriptive analyses, logistic regression analysis was finally used for bivariate and multivariable analysis. RESULT: The overall prevalence of depression among primary caregivers of patients with mental illness was 12 (19%). Out of those caregivers with depressions, 11.3, 3.5 and 4.2% had moderate, moderately severe and severe types of depression respectively. The prevalence of depression among female primary caregivers was 25% (n = 40). Being single (aOR 2.62, 95% CI = 1.07, 6.41), giving care more than six hours per day (aOR 3.75, 95% CI = 1.51, 9.33) and caring for a patient who had more than once episodes of suicidal attempts (aOR 1.48, 95% CI = 1.07, 3.42) were positively associated with depression among caregivers of patients with mental illness. CONCLUSION: We found that the prevalence of depression among primary caregivers was high. Depression among caregivers was associated with giving care more than six hours per day and caring for a patient who had two or more episodes of suicidal attempts. The prevalence of depression among female caregivers was higher than that of the male caregivers. Therefore, special focus should be given to primary caregivers spending long hours for providing care, those with low perceived social support; caregivers of patients with suicidal ideation and female caregivers.

Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

BACKGROUND: Psychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH). METHODS: Data were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable. RESULTS: The prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31). CONCLUSIONS: The high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

Household dietary diversity and Animal Source Food consumption in Ethiopia: evidence from the 2011 Welfare Monitoring Survey.

BACKGROUND: It is imperative to track dietary quality and progress in nutritional outcomes in a population to develop timely interventions. Dietary diversity is a commonly used proxy to assess dietary quality in low-income countries. This study identified predictors of household dietary diversity in Ethiopia and pattern of consumption of animal source food (ASF) among households. METHODS: Secondary data were analyzed from the 2011 Ethiopian Welfare Monitoring Survey (WMS). This survey used a structured questionnaire to collect socio-demographic and economic data. Dietary data were collected using a dietary diversity questionnaire measuring dietary diversity over the past 1 week. A Household Dietary Diversity Score (HDDS) was constructed according to the Food and Agricultural Organization (FAO) guidelines. Consumption of ASFs is described by its distribution among the regions and by HDDS. Multiple logistic regression analysis was fitted to identify independent predictors for HDDS. RESULTS: A total of 27,995 households were included in the analyses. A little over half of the study households (52.2%) had more than four household members, and 75% of households were male headed. The mean HHDS was five food groups. Cereals were the most commonly (96%) consumed food groups. Fish, egg and fruits, on the other hand, were the least consumed food groups. ASFs were consumed in greater proportion among households with higher HDDS. Being part of the higher and middle socio economic strata (P < 0.001), literacy (P < 0.01), urban residence (P < 0.01), male headed household (P < 0.01), larger family size (P <0.01) and owning livestock (P < 0.01) were positively associated with higher HDDS. CONCLUSIONS: Considering these findings, nutrition sensitive interventions which address the problem through economic and educational empowerment and modern technologies supporting agricultural practices need to be designed to increase both local production and increased consumption.

Khat use in people living with HIV: a facility-based cross-sectional survey from South West Ethiopia.

BACKGROUND: Khat is an evergreen plant with leaves containing the amphetamine-like compounds cathinone and cathine. Many people in the Horn of Africa use khat on a regular basis. Adverse health and social consequences of khat use have been described but little is known about the use of khat in people living with Human Immunodeficiency Virus (PLHIV) in Ethiopia. This study aimed to assess the prevalence of khat use and factors associated with khat use among PLHIV who are in contact with HIV services in a hospital in south-west Ethiopia. METHODS: A cross-sectional study was conducted among 389 PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. A structured questionnaire, translated into the local languages, was used to ask about the frequency of khat use and potential risk factors and consequences of khat use in this patient group. Logistic regression analysis was used for bivariate and multivariable analysis. RESULTS: The overall prevalence of current khat use among people living with HIV was 23.0%. The prevalence was 18.3% in females and 33.6% in males. Christians were less likely to use khat when compared to Muslims (adjusted Odds Ratio (aOR) 0.26, 95% CI = 0.13, 0.55). There was a positive association between khat use and mental distress (aOR 1.84, 95% CI = 1.01, 3.36), smoking cigarettes (aOR 21.21, 95% CI = 7.19, 62.51), alcohol use disorders (aOR 2.16, 95% CI = 1.10, 4.21), CD4 count ≤200 cells/mm(3) (aOR 3.46, 95% CI = 1.60, 7.50) and missing at least one dose of antiretroviral medication in the preceding month (ART) (aOR 4.2, 95% CI = 1.80, 5.75). CONCLUSION: In this study there was a high prevalence of khat use among people living with HIV which was associated with poorer adherence to ART. There is a need to adapt and evaluate feasible and acceptable interventions to reduce khat use in people living with HIV.

Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism.

BACKGROUND: Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. METHODS: We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. RESULTS: In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. CONCLUSION: ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.

Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study.

Background: Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies. Objective: To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia. Methods and Materials: A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index. Results: The overall completion rate was 16.1% (CI, 13.8%-18.5%), with significant dropouts observed between the first and the fourth ANC.Factors associated with the completion of MHC included the women's residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women's occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC. Conclusion and Recommendations: The completion rate of CoC for MHC remains low. Factors influencing completion include women's residence, partners' educational status, women's occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence.

Introduction: Child marriage and teen pregnancy have negative health, social and development consequences. Highest rates of child marriage occur in sub-Saharan Africa (SSA) and 40% of women in Western and Central Africa got married before the age of 18. This systematic review was aimed to fill a gap in evidence of effectiveness to reduce teen pregnancy and child marriage in SSA. Methods: We considered studies conducted in sub-Saharan Africa that reported on the effect of interventions on child marriage and teen pregnancy among adolescent girls for inclusion. We searched major databses and grey literature sources. Results: We included 30 articles in this review. We categorized the interventions reported in the review into five general categories: (a) Interventions aimed to build educational assets, (b) Interventions aimed to build life skills and health assets, (c) Wealth building interventions, and (d) Community dialogue. Only few interventions were consistently effective across the studies included in the review. The provision of scholarship and systematically implemented community dialogues are consistently effective across settings. Conclusion: Program designers aiming to empower adolescent girls should address environmental factors, including financial barriers and community norms. Future researchers should consider designing rigorous effectiveness and cost effectiveness studies to ensure sustainability. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022327397.

Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia.

BACKGROUND: Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. METHODS: A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson's correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. RESULTS: Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors. CONCLUSIONS: Higher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.

Diabetes mellitus self-management education at Jimma University Medical Center: evidence-based implementation project.

BACKGROUND: Low and middle-income countries are currently enduring the heaviest global burden of diabetes and diabetes-related mortalities. Diabetes self-management education (DSME) improves patient clinical outcomes, health status, and quality of life. Lack of awareness about best practice guidelines and recommendations may be associated with increased risk of diabetes morbidity and mortality. OBJECTIVES: The objective of this study was to improve knowledge and skill of healthcare providers and patients with diabetes by enhancing evidence-based practice through self-management education to increase compliance with best practice recommendations. METHODS: JBI's three-phase Practical Application of Clinical Evidence System and Getting Research into Practice audit criteria of diabetes of audit management criteria were used. To understand barriers, 12 audit criteria, patient's medical record handling and educational plan according to set standards were evaluated. To mitigate the barriers, strategies of training and supportive supervision on evidence-based DSME were implemented from 20 April 2018 to 7 June 2018. Sixteen health professionals and 80 patients with diabetes participated in the study conducted in Jimma University Medical Center. Both a baseline and follow-up audit was conducted using the JBI feedback tool. RESULT: The baseline audit results indicate that 3 of the 12 audit criteria recorded zero percent compliance, whereas other compliances were below 40%, representing poor compliance with the current evidence. The post implementation audit reported 100% compliance for criteria on availability of structured education plan, existence of appropriate training for staff, the presence of education regarding nutrition and medications, while for the remaining criteria on competency of staff members for delivering DSME, assessment of prior diabetes knowledge, status of documentation after each session, and the presence of appropriate referrals or booking the compliance rate was improved to 88%. Similarly, criteria on the presence of individualized education plan improved (0-75%), encountering knowledge regarding physical activity (6-75%), self-monitoring of blood glucose (4-60%), and prevention diabetes complications (10-90%). CONCLUSION: There were remarkable changes in both patients and care providers on comparison of pre-intervention and post-intervention, particularly in availability of materials, involvement of staff in self-management education, nutrition, and medication.

Exploration of barriers to postnatal care service utilization in Debre Libanos District, Ethiopia: A descriptive qualitative study.

Background: In Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related barriers to PNC service utilization, but limited evidence was available on the health facilities and health care provider-related barriers. Therefore, the study was aimed at exploring both community and health care provider-related barriers to PNC service utilization. Methods: A descriptive qualitative study was conducted at Debre Libanos District, Ethiopia, from 11 March to 7 April 2019. A purposive sampling technique was used to recruit study participants among recently delivered women (<2 months), health care providers, and community members. A total of five in-depth interviews, 12 key informant interviews, and four FGDs were conducted. Data were audio-recorded, transcribed verbatim, and translated, and inductive thematic analysis was used to analyze the data using the atlas ti.7.1 software. Results: A total of 51 participants were involved in the study. The findings were organized into two major themes: (1) Community/caregiver-related barriers to PNC service utilization: lack of awareness about PNC, its importance, and schedules; lack of awareness about postnatal danger signs, sociocultural and religious beliefs, topographical and transportation problems, non-functionality of the health developmental armies (HDA); (2) health facility and health care provider-related barriers to PNC service utilization: poor supportive supervision and monitoring, lack of health extension workers' (HEW) commitment, lack of an organized system to notify delivery to HEW, shortage of HEWs, the residence of the HEWs, closure of health posts (HP) on working hours, and non-functionality of HPs. Conclusions: The study findings underscore the need to develop different strategies and take actions. Therefore, the health centers and district health offices should have to assign the required number of HEWs at HPs, regularly supervise and monitor HEWs, and develop an organized system to facilitate early notification of delivery to HEWs. The HEWs should have to live near the HP, re-organize HDAs, create awareness of maternal and newborn danger signs, and conduct social and behavioral change communications to increase the health-seeking behavior of community members for utilizing PNC services.

Maternal Healthcare in Low- and Middle-Income Countries: A Scoping Review.

Background: Continuum of care [COC] for maternal health care [MHC] refers to continuity of care that has been considered as a core principle and framework to underpin strategies and programs to save the lives and promote wellbeing of mothers and newborns. However, the status of the continuum of care for maternal health care is not well studied. Thus, the objective of this analysis is to examine the status of the continuum of care for maternal health care and current recommendations in Low- and Middle-Income Countries. Methods: Our review followed the scoping review methods. We searched for relevant studies in the PubMed, and Cochrane Library databases. Additionally, lateral searching was carried out from google scholar, reference lists of the included studies and supplemented by a gray literature search. One reviewer screened the full list, which was randomly split into two halves and independently screened by other 2 reviewers. The 2 reviewers independently extracted the data and discrepancies were resolved through discussion. Results: A total of 1259 records were identified through the databases and others searching strategies. Of these, 13 studies were included in the review and the year of their publication was from 2015 to 2019, more than half (53.8 %) of the included studies were from African countries. As to the source of data 53.8% of them were from countries' Demographic Health Survey [DHS], and all of them were cross sectional study by design. The general picture shows a decline in use of the services as women move along the continuum of care from pregnancy to childbirth and postnatal, and the highest gap was noticed between institutional delivery and postnatal care. The completion status differs from country to country and 60% in Cambodia during the 2010 CDHS but, 5% in Ratanakiri, Cambodia in 2015. Conclusion and recommendations: The status of continuum of care for maternal health care is varies across the countries. Also, there is limited studies on the continuum of maternal health care and more than half of the studies on this area were from countries' Demographic Health Survey and all of them were cross sectional by design. Furthermore, none of the reviewed studies considered status of continuum of care and birth outcomes. Hence, it is decisive to estimate the status of completion of continuum of care, completion, and its effect on birth outcomes in countries like Ethiopia where the burden of maternal and newborn mortality is high. Plain English summary: Continuum of care for maternal health care means the continuity of care during prenatal, delivery and postnatal. It has been considered as core strategies to save the lives of mothers and newborns.We searched for relevant studies in the databases and gray literature. Two reviewers performed data extraction independently. A total of 1259 records were identified through searching. Thirteen studies were included in the review. More than half of the studies included were from African countries. Demographic Health Survey [DHS] reported from these countries formed the main source of data. All of them were cross sectional study by design.The general picture shows a decline in the use of the health services as women move along the continuum of care from ANC to PNC. The completion status varies across countries.

Rapid reviews and the methodological rigor of evidence synthesis: a JBI position statement.

ABSTRACT: The demand for rapid reviews has exploded in recent years. A rapid review is an approach to evidence synthesis that provides timely information to decision-makers (eg, health care planners, providers, policymakers, patients) by simplifying the evidence synthesis process. A rapid review is particularly appealing for urgent decisions. JBI is a world-renowned international collaboration for evidence synthesis and implementation methodologies. The principles for JBI evidence synthesis include comprehensiveness, rigor, transparency, and a focus on applicability to clinical practice. As such, JBI has not yet endorsed a specific approach for rapid reviews. In this paper, we compare rapid reviews versus other types of evidence synthesis, provide a range of rapid evidence products, outline how to appraise the quality of rapid reviews, and present the JBI position on rapid reviews. JBI Collaborating Centers conduct rapid reviews for decision-makers in specific circumstances, such as limited time or funding constraints. A standardized approach is not used for these cases;instead, the evidence synthesis methods are tailored to the needs of the decision-maker. The urgent need to deliver timely evidence to decision-makers poses challenges to JBI's mission to produce high-quality, trustworthy evidence. However, JBI recognizes the value of rapid reviews as part of the evidence synthesis ecosystem. As such, it is recommended that rapid reviews be conducted with the same methodological rigor and transparency expected of JBI reviews. Most importantly, transparency is essential, and the rapid review should clearly report where any simplification in the steps of the evidence synthesis process has been taken.

Vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A scoping review.

INTRODUCTION: The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2. METHODS: We conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers. RESULTS: We identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia. CONCLUSION: Currently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.