Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study.

BACKGROUND: Health systems throughout the world, whether in developed or developing countries, are struggling with the challenge of how to manage health-care delivery in conditions of resource constraint. The availability and utilization of various health care equipments at all levels of the health care system has been emphasized for effective and efficient service delivery. In Ethiopia lack of proper management of medical equipment limited the capacity of health institutions to deliver adequate health care. The main objective of this study was to assess availability and utilization of medical devices and identify reported reasons that affect availability and utilization of medical devices among hospitals in Jimma Zone. METHODS: A cross-sectional multiple case-study using mixed quantitative and qualitative methods was used. Three hospitals of Jimma Zone were included in the study. Adapted and pre-tested structured English version checklist for availability and utilization of medical equipment and document review as well as interview guide for in-depth interview were used for data collection. Data were collected by observation of availability of the devices, interviewing selected professionals and document review of health care services using devices in the study hospitals. Data were analyzed using SPSS 16.0 statistical software. Descriptive analysis was made to determine the availability and functional status of medical devices. For qualitative part responses were transcribed, categorized and thematically analyzed. RESULTS: Observation and interview using checklist showed that 299 medical devices were available in the three hospitals among which, 196 (65.6 %) of them were available in Jimma University Specialized Hospital whereas, 57 (19.0 %) and 46 (15.4 %) were available in Limu Genet hospital and Shenen Gibe hospital respectively. Among 196 available medical devices in JUSH, 127 (64.8 %) were functional and the rest; 63 (32.1 %) and 6 (3.1 %) were not functional and not in use respectively. Similarly, 28 (60.9 %) and 30 (52.6 %) of the devices in Shenen Gibe hospital and LGH respectively were functional. CONCLUSION: More than a third of medical devices in the three study hospitals were not functional. Purchasing devices with bids and preference for cheap price, lack of training on how to operate devices, less sense of accountability, power interruption, staff work overload and lack of maintenance experts, and inappropriate referral system were among the reported reasons for influencing availability and utilization of medical devices.

Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia.

BACKGROUND: The reproductive decisions made by PLHIV and their partners have a long-term consequences for the survival and wellbeing of their families and a society at large. Evidence relating to fertility and reproductive intentions among PLHIV is rare, despite the fact that more than 80% of PLHIV are of reproductive age. The aim of the study was to determine fertility desire and associated factors among PLHIV attending ART clinic in Fitche Hospital. METHODS: A facility based cross-sectional study design with both quantitative and qualitative data collection methods was employed from February21-April 20th, 2013. The study participants were selected by using simple random sampling technique. A pre- tested structured questionnaire was used to collect data. Both bivariate and multivariate logistic regressions were used to identify associated factors. RESULT: The prevalence of fertility desire of PLHIV in Fitche Hospital was 133(39.1%) with 95% CI of (34.3% -44.3%). This study identified that factors found to be associated with fertility desire were: - Age from 18-29y [AOR = 3.95, 95% CI: 1.69 - 9.22) and 30-39y (AOR = 3.91, 95% CI: 1.90 -8.19)], marital length ≤4y [AOR = 5.49, 95% CI: 2.08-14.51), within 5-9y (AOR = 4.80, 95% CI: 2.14-10.78) and 10-14y (AOR = 2.82, 95% CI: 1.19 -6.63], had not biological living children [AOR = 11.42, 95% CI: 3.27-39.90) and had more than one child (AOR = 3.67, 95% CI: 1.27-10.62)], community pressure [AOR = 3.67, 95% CI: 1.54-8.70], partner fertility [AOR = 7.18, 95% CI: 3.39-15.22)], duration HIV diagnosis≤1y[AOR = 4.99, 95% CI: 1.91-13.09], disclosed HIV serostatus [AOR = 3.9, 95% CI: 1.37-11.10] and partner sero-difference [AOR = 2.05, 95% CI: 1.01- 4.15] were some of the factors significantly associated with fertility desire. CONCLUSION: The prevalence of fertility desire of PLHIV in the study area was 39.1%. In this study:- age, marital length, biological child, partner, community pressure, duration of HIV-diagnosis, discordant HIV-test and disclosure of HIV-serostatus to partner were demonstrated to have more associations with fertility desire among PLHIV, therefore, these factors should be emphatically considered during PLHIV's reproductive health program development.

Institutional capacity for health systems research in East and Central Africa schools of public health: enhancing capacity to design and implement teaching programs.

BACKGROUND: The role of health systems research (HSR) in informing and guiding national programs and policies has been increasingly recognized. Yet, many universities in sub-Saharan African countries have relatively limited capacity to teach HSR. Seven schools of public health (SPHs) in East and Central Africa undertook an HSR institutional capacity assessment, which included a review of current HSR teaching programs. This study determines the extent to which SPHs are engaged in teaching HSR-relevant courses and assessing their capacities to effectively design and implement HSR curricula whose graduates are equipped to address HSR needs while helping to strengthen public health policy. METHODS: This study used a cross-sectional study design employing both quantitative and qualitative approaches. An organizational profile tool was administered to senior staff across the seven SPHs to assess existing teaching programs. A self-assessment tool included nine questions relevant to teaching capacity for HSR curricula. The analysis triangulates the data, with reflections on the responses from within and across the seven SPHs. Proportions and average of values from the Likert scale are compared to determine strengths and weaknesses, while themes relevant to the objectives are identified and clustered to elicit in-depth interpretation. RESULTS: None of the SPHs offer an HSR-specific degree program; however, all seven offer courses in the Master of Public Health (MPH) degree that are relevant to HSR. The general MPH curricula partially embrace principles of competency-based education. Different strengths in curricula design and staff interest in HSR at each SPH were exhibited but a number of common constraints were identified, including out-of-date curricula, face-to-face delivery approaches, inadequate staff competencies, and limited access to materials. Opportunities to align health system priorities to teaching programs include existing networks. CONCLUSIONS: Each SPH has key strengths that can be leveraged to design and implement HSR teaching curricula. We propose networking for standardizing HSR curricula competencies, institutionalizing sharing of teaching resources, creating an HSR eLearning platform to expand access, regularly reviewing HSR teaching content to infuse competency-based approaches, and strengthening staff capacity to deliver such curricula.

Disclosure of Intimate Partner Violence and Associated Factors among Victimized Women, Ethiopia, 2018: A Community-Based Study.

BACKGROUND: Disclosure is a vital step in the process of finding a lasting solution and breaking the abuse chain in a victim woman by the intimate partner. OBJECTIVES: This study is aimed at assessing the disclosure of intimate partner violence and associated factors among victim women in Dilla town, Gedeo Zone, South Ethiopia, 2018. METHODS: A community-based cross-sectional study design triangulated with the qualitative method was employed. Data were collected from 280 women victims of intimate partner violence using pretested, structured, and interviewer-administered questionnaires. SPSS version 20.0 software was used for analysis. Binary logistic regression and a multivariate logistic regression model were fitted to assess the association between the independent and dependent variables. Qualitative data were collected through in-depth interviews and categorized into themes and triangulated with the quantitative result. RESULTS: Half of the respondents (51%) disclosed intimate partner violence. Partner alcohol use (AOR = 1.99; 95% CI:1.18, 3.34), women experiencing a single type of intimate partner violence (AOR = 0.38, 95% CI: 0.17, 0.79), women having strong social support (AOR = 2.52; 95% CI:1.44, 4.41), and women whose partners' having primary (AOR = 2.04; 95% CI:1.07, 3.9) and secondary education (AOR = 2.16; 95% CI: 1.07, 4.33) were significantly associated with the disclosure of intimate partner violence as the qualitative result shows most of the women prefer their family to disclose and those who kept silent were due to economic dependency, societal norms towards wife beating, arranged marriage, and not getting the chance especially those who went to the hospital. CONCLUSION: Nearly 50% of victims of intimate partner violence women disclose intimate partner violence to others. Thus, it is needed for stakeholders to use their efforts to further increase the disclosure of violence and respect women's rights and equality.

Health Workforce Acquisition, Retention and Turnover in Southwest Ethiopian Health Institutions.

BACKGROUND: Skill mix of health professionals, staff acquisition and turnover rate are among the major challenges for the delivery of quality health care. This study assessed the health workforce acquisition, retention, turnover rate and their intention to leave. METHODS: A cross-sectional survey with quantitative and qualitative data collection methods was conducted in Jimma Zone health institutions. Five years records (September 2009-August 2014) were reviewed to determine the turnover rate. A total of 367 health professionals were included for the quantitative study. For the qualitaive study, all available and relevant health managers and administrative records in the selected health institutions were included. Descriptive and inferential analyses were done for the quantitative study. Thematic analysis was used for the qualitative component. RESULTS: A total of 367 health workers were incorporated for the quantitative study making a response rate of 87%. The overall health workers' satisfaction was neutral (mean 3.3). In five years period, 45.9% staffs had left for a cause; 59.4% health professionals intended to leave. Being male (AOR =1.6, 95%CI: 1.001-2.5), not knowing their overall satisfaction (AOR=0.5, 95%CI: 0.2-0.8), below mean score of institutional satisfaction (AOR =1.7, 95%CI: 1.06-2.7) and below mean score of organizational satisfaction (AOR=1.8, 95%CI: 1.08-2.8) were independent predictors for intention to leave. CONCLUSION: The overall health workers' satisfaction was marginally neutral. A considerable number of staffs had left, and more than half of the current staffs had an intention to leave. Thus, it is recommended that the responsible authorities should design strategies to improve the situation.

Assessment of HIV Post-Exposure Prophylaxis Use Among Health Workers of Governmental Health Institutions in Jimma Zone, Oromiya Region, Southwest Ethiopia.

BACKGROUND: Infection with Human Immunodeficiency Virus is a serious public health problem costing the lives of many people including health workers. Hence, Ethiopia has developed guideline on the prevention of infection in health institutions in July 2004 and also employed the use of post exposure prophylaxis since the implementation of free antiretroviral in January 2005. However in the country, specifically in Jimma zone, published studies showing the clear picture about HIV post exposure prophylaxis in the work place were non-existent. Therefore, this study was conducted to assess the knowledge, practice and factors associated to HIV post-exposure prophylaxis use among health workers of governmental health institutions in the Zone. METHODS: A cross-sectional survey employing quantitative and qualitative methods was conducted from October to December 2008. Two hundred fifty four health workers participated in the quantitative study. Health workers for focus group discussion and key informants for in-depth interviews were identified with the help of administrators/ HIV/AIDs coordinators of the two administrative health bureaus and institutions included in the study. The quantitative data were entered and cleaned using Epi Info version 6.4 and analysed using SPSS for windows version 11.0. Descriptive statistics and chi-square test was employed to assess association among variables. P-value less than 0.05 was considered statistically significant. RESULTS: Among the total 254 participants, 213 (83.9%) had inadequate knowledge about post exposure prophylaxis of HIV and 174 (68.5%) had ever been exposed to HIV risk conditions. Out of 174 health workers exposed to HIV risk, 105 (60.3%) sustained needle prick/cut by sharps, 77 (44.3%) to blood and 68 (39.1%) exposed to patients' body fluid. Perceived causes of exposure were; high workload 77 (44.3%), lack of protective barriers 58 (33.3%) and lack of knowledge on standard precautions 31 (17.8%). One hundred forty two (81.6%) of those exposed did not use post-exposure prophylaxis. Lack of information about the existence of post-exposure prophylaxis service 48 (33.8%), fear of stigma and discrimination 46 (32.4%), lack of understanding the value of reporting 33 (23.2%) and lack of support and encouragement to report 29 (20.4%) were the reasons for not using. Moreover, formal (separate) HIV post-exposure prophylaxis centre with proper guideline was non-existent in the study areas. CONCLUSIONS: In general, findings of the quantitative and qualitative study revealed that the knowledge of health workers about post exposure prophylaxis against HIV is inadequate. Though many of the studied health workers had HIV risk exposure, only few used post-exposure prophylaxis. Therefore, establishing a 24 hours accessible formal post-exposure prophylaxis centre with proper guideline is recommended. Health institutions are also advised to raise awareness of their employees on post exposure prophylaxis.