Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study.

BACKGROUND: Ethiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face. METHODS: In this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently. RESULTS: This study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers' complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers. CONCLUSION: The level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers' optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers' education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

Social and behavior change communication competency among front-line healthcare system actors in Ethiopia: a cross-sectional study.

INTRODUCTION: Social and Behavior Change Communication (SBCC) plays a critical role in improving behavior and health outcomes across the continuum of healthcare. Failing to implement tailored SBCC strategies continues to pose a risk of ill health, increase disease burden, and impact the quality life of people. In Ethiopia, front-line healthcare system actors' knowledge and skills about SBCC have not been rigorously assessed. Thus, the current study aimed to assess healthcare system actors' competencies in designing, implementing, monitoring, and evaluating SBCC interventions in Ethiopia. METHODS: A cross-sectional study was conducted between 01 August and 31 October, 2020. Five hundred twenty-eight frontline healthcare system actors in SBCC in Ethiopia were included using simple random sampling technique. Data was collected using a self-administered structured questionnaire adopted from Communication for Change; SBCC capacity assessment tool. Descriptive analysis frequencies, percentages, mean, median, standard deviation (SD), interquartile range (IQR) were employed. Besides correlations and linear regression with robust standard errors were carried out. A 95% confidence interval and a p-value of less than 0.05 were used to declare significant statistical association. RESULTS: A total of 488 frontline workers participated in the study, with a response rate of 92.4%. The mean SBCC knowledge score was 13.2 ± standard deviation (SD) 3.99 and 59.2% scored below 60% of the expected maximum score. The standard mean score of overall skill in SBCC intervention was 2.36 (SD ± 0.98) and 52.6% of them scored below mean score. The SBCC knowledge was significantly predicted by the service year and the regional variation. On the other hand, SBCC skills was significantly predicted by sex, service year, profession, regional variation, and SBCC knowledge. The regional variation was the main predictor of both knowledge and skill on SBCC. The regression models explained 23.1% and 50.2% of the variance in knowledge and skill of SBCC, respectively. CONCLUSION: Front-line healthcare system actors in Ethiopia has low knowledge and skills in SBCC. Variations in SBCC knowledge and skill were observed based on demographic and professionals experience related characteristics. Hence, continuous capacity building activities need to be given to frontline healthcare system actors to enhance their knowledge and skill on SBCC program and achieve the intended health results.

Level of Family centered care and associated factors among parents of children with cancer at tertiary level hospital, Ethiopia.

OBJECTIVE: To determining level and factors affecting Family Centered Care (FCC) in pediatric oncology unit of Tikur Anbessa Specialized hospital (TASH), Ethiopia. METHOD: A cross sectional study was conducted from June to December 2022. Three hundred ninety-three parents of children with cancer were consecutively interviewed using Measure of Processes of Care (MPOC-20). Multivariable linear regression was used to identify independent predictors of FCC. RESULT: The total MPOC 20 means was 3.71(SD = 1.04). The mean score for respectful and supportive care, coordinated and comprehensive care, enabling and partnership, providing specific information and providing general information were found to be 4.8, 4.6, 3.7, 2.3 and 2.6, respectively. Family employment (-0.33(95% CI = -0.63, -0.03; P = .029)), low family education (-0.40 (95% CI = -0.70, -0.11; P = .008)), referral cases (-0.37(95% CI = -0.59, -0.14; P = .001)), shorter time spent in hospital (-0.49(95% CI = -0.85, -0.12; P = .010)) and psychological distress (-0.01(95% CI = -0.026, -0.001; P = .028)) were associated with lower mean score of FCC. CONCLUSION: The total FCC mean score was found to be low. From the five FCC components providing general and specific information scored the lowest mean level. PRACTICE IMPLICATIONS: Mechanism to improve information delivery that address parents from different background and referred from other health facility should be in place in order to improve FCC level. In addition, the FCC should be designed to address parents of children with different lengths of stay.

Family-centered care for child cancer treatment in Ethiopia-A qualitative descriptive study.

BACKGROUND: Families are the primary source of support and strength in the care process of children with cancer. Family-centered care (FCC) is a healthcare delivery approach that considers parents as both partners and care recipients, characterized by providing care based on dignity and respect, information sharing, participation, and collaboration or partnership. AIM: This study aimed to describe the delivery of care based on the family-centered care approach at the Tikur Anbessa Specialized Hospital pediatric cancer unit. METHOD: An exploratory, descriptive qualitative study was conducted from March 2023 to August 2023. Eighteen participants (thirteen parents and five health care providers) were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and translated into English. The translated transcripts were used for inductive, data-driven thematic analysis. ATLAS.ti 9 software was used to assist the analysis process. RESULT: Two themes have emerged during the analysis. These are (1) Information sharing, and (2) Enabling and partnership. Under the information sharing theme, we described parents' understanding of child cancer, parents' information-related expectations, the process of obtaining information, adequacy of information received, and factors inhibiting information sharing. Under the enabling and partnership theme, we presented family participation in childcare, discussion among parents, parents' communication with healthcare providers and psychosocial support. CONCLUSION: Suboptimal implementation of family-centered care practice was identified at the pediatric oncology unit. PRACTICE IMPLICATIONS: The findings from this study indicate the need to strengthen the provision of child cancer-related information, improve communication, and strengthen family participation in childcare.

Survival Status and Predictors Among Women with Advanced Stage of Cervical Cancer.

Background: Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum. Objective: To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started. Methods and Materials: A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status. Results: Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785-7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199-11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040). Conclusion: The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.

Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia.

Background: The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia. Objective: This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer. Methods and Materials: A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval. Results: Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021). Conclusion: Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.

Adaptation and validation of the All Aspects of Health Literacy Scale (AAHLS) in healthcare settings of Addis Ababa, Ethiopia.

BACKGROUND: Since health literacy is known to be related to health outcomes, it should be measured to explain how it is associated with the health status of the population. Health literacy tools are designed to measure different dimensions of health literacy of individuals based on their objective. The AAHLS tool is comprehensive and can cover all aspects of health literacy. Overall in Ethiopia, there is no standard health literacy tool that has been developed or/and validated. Therefore, the aim of this study was to adapt and validate the All Aspects of Health Literacy Scale (AAHLS) in healthcare facilities in Addis Ababa city, Ethiopia. METHODS: A mixed-method, facility-based, cross-sectional study was conducted in Addis Ababa city from February 1, 2022, to May 30, 2022. The study was conducted in three phases: forward and backward translation and expert review, cognitive interviews and survey administration. For the cognitive interviews, a total of 16 participants and for the survey administration, 199 participants were involved. Coding and analysis of the qualitative data were performed using OpenCode 4.03 computer software. Then, pretesting (survey administration) was conducted to check the validity and reliability of the tool. CFA was conducted using SPSS version 26 and Stata version 14. RESULTS AND DISCUSSION: The original three response categories were revised to five response categories based on the cognitive interview findings and expert reviews. The survey was administered to 199 participants, 55.8% of whom were males. The Kaiser‒Meyer‒Olkin measure of sampling adequacy was 0.685, with a significant difference according to Bartlett's test of sphericity (p < 0.001). After removing the empowerment factor model fit indices, the internal reliability and convergent and divergent validities improved. Confirmatory factor analysis showed that the model fit indices of the tool were satisfactory. The overall internal consistency, Cronbach's alpha, was 0.71. CONCLUSION: The three response categories of the tool were revised to five response categories. The AAHLS tool was revised to include 10 items. The tool has exhibited adequate model fitness. The validated tool can be used for future health literacy assessments and interventions.

Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review.

Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.

Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study.

Background: Prophylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices. Aim: This study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH). Methods: The observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach. Result: Surgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds. Conclusion: Deeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks.