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Tiruneh GT, Odwe G, K'Oduol K, Gwaro H, Fesseha N, Moraa Z, Haake Kamberos A, Hasan MM, Magge H, Nisar YB, Hirschhorn LR. Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya. BMC Pediatr 2024; 24:599. [PMID: 39304861 DOI: 10.1186/s12887-024-05070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Sepsis is a leading cause of neonatal mortality, despite the availability of effective treatment of possible serious bacterial illness (PSBI), including when referral to a hospital is not feasible. Gaps in access and delivery worsened during COVID-19. We conducted embedded implementation research in Ethiopia and Kenya aimed at mitigating the impact of COVID-19 and addressing various implementation challenges to improve PSBI management. METHODS The implementation research projects were implemented at the subnational level in Ethiopia and Kenya between November 2020-June 2022 (Ethiopia) and December 2020-August 2022 (Kenya). Guided by the implementation research frameworks, both projects conducted mixed formative quantitative and exploratory research from April to May 2021, followed by summative evaluations conducted between June and July 2022. Frameworks encompassed Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), as well as health systems framework that incorporates cascades of care and World Health Organization Health Systems Building Blocks. Results were synthesized across the projects through document review and sharing cross-project measures and strategies through a project community of practice. RESULTS Despite differences in settings across the projects, cross-cutting facilitators included community health worker program and support, and existence of guidelines for PSBI management at primary care levels. Barriers included community attitudes towards seeking care for sick newborns, COVID-19 risks and fear, and lack of health care worker competence. Country-specific contextual barriers included supply chain issues, civil conflict (Ethiopia), and labor strikes (Kenya). Strategies chosen to mitigate barriers and support implementation and sustainability in both settings included leveraging community health workers to address resistance to care-seeking, health workers' training, COVID-19 infection prevention measures, stakeholder engagement, and advocacy to integrate PSBI management into existing programs, policies, and training. Other strategies addressing emerging project-specific barriers, included improving follow-up through a community health desk and PSBI mobile app (Kenya) and supply chain strengthening (Ethiopia). Both projects improved PSBI management coverage, increased adoption and uptake, and informed national policy changes supporting potential for sustainability. CONCLUSIONS Pragmatic embedded implementation research effectively supports the identification of barriers and mapping to strategies designed to increase effective coverage of PSBI management when referral is not feasible during the COVID-19 pandemic. Despite differences in context, cross-cutting strategies identified could inform broader scale-up in the region, including during future health system shocks.
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Affiliation(s)
| | | | | | | | - Nebreed Fesseha
- JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | | | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, USA
| | - Yasir B Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Robert J Havey Center for Global Health, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA.
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Feyisa GT, Marami SN, Dinagde DD, Degefe BD, Abebe ST, Kitil GW, Biratu AK. Comparative study of neonatal hypothermia and associated factors among neonates in rural and urban areas of the Shebadino Woreda, Sidama region, Southern Ethiopia: a community-based comparative cross-sectional study. BMC Public Health 2024; 24:1945. [PMID: 39033283 PMCID: PMC11264896 DOI: 10.1186/s12889-024-19504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Hypothermia is one of the major causes of newborn death, particularly in low-income nations. This was due to poor thermal care in most of the rural communities. Recent studies show that there was a prevalence discrepancy between urban and rural communities where economic, educational, and life standard differences exist. Therefore, this study aimed to assess the prevalence and factors associated with neonatal hypothermia among neonates in rural and urban areas of the Shebadino woreda, Sidama region, Ethiopia. METHOD A comparative community-based cross-sectional study was performed on 682 neonates in the Shebadino Woreda, Sidama Region, southern Ethiopia, in 2023. A multistage sampling technique was used, and the collected data were manually cleaned, coded, and entered into Epi Data version 4.6 before being exported to SPSS version 26 software for analysis. Variables with a p-value < 0.25 in the bivariate logistic regression were further analyzed using multivariable logistic regression. The odds ratio (OR) with 95% CI was used as a measure of association, and variables that had a p-value less than 0.05 in the multivariable logistic regression were considered significantly associated variables. RESULTS The overall prevalence of neonatal hypothermia in this study was 51.8% (95% CI: 47.2%-56.3%). It was greater among rural neonates (55.1%) than among urban neonates (48.6%). Bathing before 24 h. (AOR = 3.64, 95% CI: 1.39, 7.16), Placing a cold object near babies' head (AOR = 2.97, 95% CI: 1.75, 5.03), Neonates who were given traditional medication (Amessa) (AOR = 1.83% CI; 1.04-3.20) and, not separated humans and animals house (AOR = 1.75, 95%, 1.05-2.91) were significantly associated with neonatal hypothermia in rural, while Night time delivery (AOR = 1.81, CI: 1.01-5.62), Neonates who were given traditional medication (Amessa) (AOR = 3.11% CI; 1.85-5.21), and Placing a cold object near babies' head (AOR = 2.40, 95% CI: 1.37, 3.29 were significantly associated with neonatal hypothermia among urban neonates. CONCLUSION The Prevalence of neonatal hypothermia in the study area was relatively greater in rural areas than in urban areas. Cost-effective thermal care such as separating humans from animal houses, teaching not to put cold objects near babies, giving special care to newborns for those delivered from women with medical problems, and giving priority to those delivered at night, is needed.
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Affiliation(s)
- Gizu Tola Feyisa
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia.
| | - Shambel Negese Marami
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Dagne Deresa Dinagde
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Bekem Dibaba Degefe
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | | | - Gemeda Wakgari Kitil
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Andargachew Kassa Biratu
- Department of Midwifery, College of Medicineand,, Health Sciences , Hawassa University, Hawassa, Ethiopia
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Worku S, Dheresa M, Ali T, Lodebo M. Early Postnatal Care Utilization and Associated Factors Among Women Who Give Birth in the Last Six Weeks in Hosanna Town, Southern Ethiopia, 2022. J Pregnancy 2024; 2024:1474213. [PMID: 38726388 PMCID: PMC11081751 DOI: 10.1155/2024/1474213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 05/12/2024] Open
Abstract
Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7-30.0). No formal and primary educational level of husband (AOR = 0.05, 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13, 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (AOR = 0.3, 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08, 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication.
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Affiliation(s)
- Sintayehu Worku
- Department of Public Health, Hosanna Health Sciences College, Hosanna, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mengistu Lodebo
- Department of Midwifery, Hosanna Health Sciences College, Hosanna, Ethiopia
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Tiruneh GT, Fesseha N, Emaway D, Betemariam W, Nigatu TG, Magge H, Hirschhorn LR. Effect of community-based newborn care implementation strategies on access to and effective coverage of possible serious bacterial infection (PSBI) treatment for sick young infants during COVID-19 pandemic. PLoS One 2024; 19:e0300880. [PMID: 38527000 PMCID: PMC10962833 DOI: 10.1371/journal.pone.0300880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In Ethiopia, neonatal mortality is persistently high. The country has been implementing community-based treatment of possible serious bacterial infection (PSBI) in young infants when referral to a hospital is not feasible since 2012. However, access to and quality of PSBI services remained low and were worsened by COVID-19. From November 2020 to June 2022, we conducted implementation research to mitigate the impact of COVID-19 and improve PSBI management implementation uptake and delivery in two woredas in Ethiopia. METHODS In April-May 2021, guided by implementation research frameworks, we conducted formative research to understand the PSBI management implementation challenges, including those due to the COVID-19 pandemic. Through a participatory process engaging stakeholders, we designed adaptive implementation strategies to bridge identified gaps using mechanism mapping to achieve implementation outcomes. Strategies included training and coaching, supportive supervision and mentorship, technical support units, improved supply of essential commodities, and community awareness creation about PSBI and COVID-19. We conducted cross-sectional household surveys in the two woredas before (April 2021) and after the implementation of strategies (June 2022) to measure changes in targeted outcomes. RESULTS We interviewed 4,262 and 4,082 women who gave live birth 2-14 months before data collection and identified 374 and 264 PSBI cases in April 2021 and June 2022, respectively. The prevalence of PSBI significantly decreased (p-value = 0.018) from 8.7% in April 2021 to 6.4% while the mothers' care-seeking behavior from medical care for their sick newborns increased significantly from 56% to 91% (p-value <0.01). Effective coverage of severely ill young infants that took appropriate antibiotics significantly improved from 33% [95% CI: 25.5-40.7] to 62% [95% CI: 51.0-71.6]. Despite improvements in the uptake of PSBI treatment, persisting challenges at the facility and systems levels impeded optimal PSBI service delivery and uptake, including perceived low quality of service, lack of community trust, and shortage of supplies. CONCLUSION The participatory design and implementation of adaptive COVID-19 strategies effectively improved the uptake and delivery of PSBI treatment. Support systems were critical for frontline health workers to deliver PSBI services and create a resilient community health system to provide quality PSBI care during the pandemic. Additional strategies are needed to address persistent gaps, including improvement in client-provider interactions, supply of essential drugs, and increased social mobilization strategies targeting families and communities to further increase uptake.
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Affiliation(s)
| | - Nebreed Fesseha
- JSI Research & Training Institute Inc., Addis Ababa, Ethiopia
| | - Dessalew Emaway
- JSI Research & Training Institute Inc., Addis Ababa, Ethiopia
| | - Wuleta Betemariam
- JSI Research & Training Institute Inc., Washington, DC, United States of America
| | | | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
- Ethiopia and Fenot Project—School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Ruth Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, Illinois, United States of America
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Tiruneh GT, Odwe G, Kamberos AH, K'Oduol K, Fesseha N, Moraa Z, Gwaro H, Emaway D, Magge H, Nisar YB, Hirschhorn LR. Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges. BMC Health Serv Res 2024; 24:280. [PMID: 38443956 PMCID: PMC10916061 DOI: 10.1186/s12913-024-10679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. METHODS From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. RESULTS Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. CONCLUSION Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system's capacity for PSBI treatment.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia.
| | | | - Alexandra Haake Kamberos
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL, USA
| | | | - Nebreed Fesseha
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | | | | | - Dessalew Emaway
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, USA
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Lisa R Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL, USA
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Tiruneh GT, Hirschhorn LR, Fesseha N, Emaway D, Eifler K, Betemariam W. Care-seeking behaviours of mothers and associated factors for possible serious bacterial infection in young infants during COVID-19 pandemic in Ethiopia: mixed-methods formative research. BMJ Open 2023; 13:e073118. [PMID: 37407046 DOI: 10.1136/bmjopen-2023-073118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Implementation research was employed to examine rates and contextual factors associated with mothers' care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access and implementation during the COVID-19 pandemic. DESIGN We conducted formative research involving household survey and programmatic qualitative study. SETTING This formative study was conducted in Dembecha and Lume woredas of Amhara and Oromia regions. PARTICIPANTS Data were captured from 4262 mothers aged 15-49 years who gave live birth 2-14 months before data collection, and interviews with 18 programme managers and 16 service providers in April to May 2021. ANALYSIS A multilevel regression model was employed to identify predictors of maternal care-seeking for PSBI and thematic qualitative analysis to inform strategy development to strengthen PSBI implementation. RESULTS Overall, 12% (95% CI 11.0% to 12.9%) and 8% (95% CI 7.9% to 9.6%) of mothers reported any newborn illness and severe neonatal infection (PSBI), respectively. More than half of mothers sought formal medical care, 56% (95% CI 50.7% to 60.8%) for PSBI. Women who received postnatal care within 6 weeks (adjusted OR (AOR) 2.08; 95% CI 1.12 to 3.87) and complete antenatal care (ie, weight measured, blood pressure taken, urine and blood tested) (AOR 2.04; 95% CI 1.12 to 3.75) had higher odds of care-seeking for PSBI. Conversely, fear of COVID-19 (AOR 0.27; 95% CI 0.15 to 0.47) and residing more than 2 hours of walking distance from the health centre (AOR 0.39; 95% CI 0.16 to 0.93) were negatively associated with care-seeking for severe newborn infection. Multiple pre-existing health system bottlenecks were identified from interviews as barriers to PSBI service delivery and exacerbated by the COVID-19 pandemic. CONCLUSION We found gaps in and factors associated with care-seeking behaviour of mothers for their sick young infants including fear of COVID-19 and pre-existing health system-level barriers. The findings of the study were used to design and implement strategies to mitigate COVID-19 impacts on management of PSBI.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
- Behavioral Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Lisa R Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, Illinois, USA
| | - Nebreed Fesseha
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
| | - Dessalew Emaway
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
| | - Kristin Eifler
- International Division, JSI Research & Training Institute, Boston, Massachusetts, USA
| | - Wuleta Betemariam
- Center for Healthy Women, Children, and Communities, JSI Research & Training Institute, Washington, DC, USA
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Astale T, Abebe T, Mitike G. Workload and emerging challenges of community health workers in low- and middle-income countries: A mixed-methods systematic review. PLoS One 2023; 18:e0282717. [PMID: 36913362 PMCID: PMC10010520 DOI: 10.1371/journal.pone.0282717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Community health workers (CHWs) play an important role in improving access to health services to a broader population; particularly to communities living in remote areas. However, the productivity of CHWs is affected by the workload they have. We aimed to summarize and present CHWs' perceived workload in low-and middle-income countries (LMICs). METHODS We searched three electronic databases (PubMed, Scopus, and Embase). A search strategy customized for the three electronic databases was developed using the two key terms of the review (CHWs and workload). Primary studies conducted in LMICs that explicitly measured workload of CHWs and published in English were included, without date restrictions. Methodological quality of the articles was assessed by two reviewers independently using mixed-methods appraisal tool. We applied a convergent integrated approach to synthesize the data. This study is registered on PROSPERO, number CRD42021291133. RESULTS Of 632 unique records, 44 met our inclusion criteria, and 43 (20 qualitative, 13 mixed-methods, and 10 quantitative studies) passed the methodological quality assessment and were included in this review. In 97.7% (n = 42) of the articles, CHWs reported that they have a high workload. Having multiple tasks was the most commonly reported subcomponent of workload, followed by lack of transport; which was reported in 77.6% (n = 33) and 25.6% (n = 11) of the articles respectively. CONCLUSION CHWs in LMICs reported that they have a high workload; mainly related to having to manage multiple tasks and the lack of transport to access households. Program managers need to make careful consideration when additional tasks are shifted to CHWs and the practicability to be performed in the environment they work in. Further research is also required to make a comprehensive measure of the workload of CHWs in LMICs.
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Affiliation(s)
- Tigist Astale
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Tsegereda Abebe
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Getnet Mitike
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
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Tiruneh GT, Nigatu TG, Magge H, Hirschhorn LR. Using the Implementation Research Logic Model to design and implement community-based management of possible serious bacterial infection during COVID-19 pandemic in Ethiopia. BMC Health Serv Res 2022; 22:1515. [PMID: 36514111 PMCID: PMC9745284 DOI: 10.1186/s12913-022-08945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Community-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia. METHODS This IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation. RESULTS This IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers' care-seeking behavior for their sick young infants. The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings. CONCLUSIONS The use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Tsinuel Girma Nigatu
- Department of Pediatrics and Child Health, Jimma University, Ethiopia and Fenot Project - School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, WA USA
| | - Lisa Ruth Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL USA
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Minuye Birhane B, Alebachew Bayih W, Chanie M, Awoke G, Simegn A, Asnakew S, Mamuye M, Yeshambel A, Muche T, Demis A, Munye T, Endalamaw A, Eshetie Y, Kefale D, Chanie ES, Mengesha Yalew Z, Mesfin Belay D. Home based postpartum care and determinants in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0272489. [PMID: 36007086 PMCID: PMC9409559 DOI: 10.1371/journal.pone.0272489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia. METHODS A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care. CONCLUSION Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother's knowledge about neonatal danger sign.
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Affiliation(s)
| | | | - Muluken Chanie
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Getaneh Awoke
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Amare Simegn
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis
- College of Health Sciences, Woldia University, Ethiopia
| | - Tigabu Munye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- School of Health Sciences, College Medicine and Health Sciences, Bahirdar University, Bahirdar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yeshambew Eshetie
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Zemen Mengesha Yalew
- Department Comprehensive Nursing, College of Health Sciences, Wollo University, Ethiopia
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Self-Reported Work-Related Musculoskeletal Disorders and Associated Factors among Restaurant Workers in Gondar City, Northwest Ethiopia, 2020. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6082506. [PMID: 34211560 PMCID: PMC8205578 DOI: 10.1155/2021/6082506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 02/06/2023]
Abstract
Introduction Globally, work-related musculoskeletal disorders (WMSDs) have resulted in occupational disability and injury. Of these, restaurant workers are among the high-risk professionals usually affected by WMSDs. In Ethiopia, evidence on the burden of musculoskeletal disorder and contributing factors among restaurant workers were very limited. Therefore, this study was aimed at assessing the prevalence of self-reported WMSDs and contributing factors among restaurant workers in Gondar city, northwest Ethiopia, 2020. Methods An institutional-based cross-sectional study was conducted from February 2020 to March 2020 among restaurant workers in Gondar city. A two-stage sampling technique was used to choose 633 study subjects. A structured Nordic questioner was used to collect the data. Data was entered into EpiData version 3.1 and exported to Stata version 14.0 for analysis. Both bivariable and multivariable logistic regression analyses were computed. An adjusted odds ratio with a 95% confidence interval was used to measure the association between WMSDs and independent variables. In the multivariable analysis, a P value of <0.05 was used to declare a statistically significant association. To check the goodness of fit, the Hosmer and Lemeshow test was used. Results The prevalence of WMSDs among restaurant workers in the past 12 months was 81.5% [95% CI (78.18-84.44)]. Attending primary education [AOR: 2.14, 95% CI (1.17-3.90)], attending secondary education [AOR: 1.71 (1.02-2.86)], and job satisfaction [AOR: 1.90, 95%CI (1.13-3.19)] were significantly associated with WMSDs. Conclusion In this study, the prevalence of WMSDs among restaurant workers was high. The upper back, lower back, elbow, and wrist were the most affected body parts. Age above 30 years, educational status being primary and secondary, and being dissatisfied by their job were positively associated with a high prevalence of WMSDs.
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