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Birhanu F, Yitbarek K, Bobo FT, Atlantis E, Woldie M. Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022. Sci Rep 2024; 14:3326. [PMID: 38336795 PMCID: PMC10858243 DOI: 10.1038/s41598-024-53280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: - 0.26, 95% CI - 0.31 to - 0.20], and Cameroon [C: - 0.19, 95% CI - 0.22 to - 0.17], and relatively it was less concentrated among the poor in Liberia [C: - 0.07, 95% CI - 0.11 to - 0.04], and Gambia [C: - 0.07, 95% CI - 0.11 to - 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Amana, Ethiopia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Firew Tekle Bobo
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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Birhanu F, Yitbarek K, Atlantis E, Woldie M, Bobo F. Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005-2016. PLoS One 2024; 19:e0295810. [PMID: 38215079 PMCID: PMC10786372 DOI: 10.1371/journal.pone.0295810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/29/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016. METHOD We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI). RESULT A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P<0.01), 9.5 percentage points for underweight (33.2% to23.7%, P<0.01), and 2.1 percentage points for wasting (12.2% to10.1%, P<0.01). There was persistent and statistically evidence of wealth inequality in stunting, underweight, and wasting (concentration indeces of -0.2 to -0.04, all P values <0.05). Stunting, underweight, and wasting variables were associated with male sex of the child (RR 0.94, 0.95, 0.85, all P-values <0.01) recent diarrhea (RR 1.18, 1.27, 1.37, all P-values <0.01), secondary education status of the mother (RR 0.66, 0.57, 0.61, all P-values < 0.057), increasing wealth index (richest) (RR 0.73, 0.70, 0.50, all P-values < 0.05), and having no toilet facility (RR 1.16, 1.22, 1.18, all P-values < 0.05). CONCLUSION Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Southwest Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Firew Bobo
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. Int J Equity Health 2023; 22:239. [PMID: 37978385 PMCID: PMC10656898 DOI: 10.1186/s12939-023-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ensuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa. METHODS We analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care. RESULTS We included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care. CONCLUSIONS Persistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Health Systems and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Boltena MT, Woldie M, Siraneh Y, Steck V, El-Khatib Z, Morankar S. Adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 16:137. [PMID: 37936215 PMCID: PMC10629154 DOI: 10.1186/s40545-023-00634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Adherence to evidence-based standard treatment guidelines (STGs) enable healthcare providers to deliver consistently appropriate diagnosis and treatment. Irrational use of antimicrobials significantly contributes to antimicrobial resistance in sub-Saharan Africa (SSA). The best available evidence is needed to guide healthcare providers on adherence to evidence-based implementation of STGs. This systematic review and meta-analysis aimed to determine the pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in SSA. METHODS The review followed the JBI methodology for systematic reviews of prevalence data. CINAHL, Embase, PubMed, Scopus, and Web of Science databases were searched with no language and publication year limitations. STATA version 17 were used for meta-analysis. The publication bias and heterogeneity were assessed using Egger's test and the I2 statistics. Heterogeneity and publication bias were validated using Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis. The summary prevalence and the corresponding 95% confidence interval (CI) of healthcare professionals' compliance with evidence-based implementation of STG were estimated using random effect model. The review protocol has been registered with PROSPERO code CRD42023389011. The PRISMA flow diagram and checklist were used to report studies included, excluded and their corresponding section in the manuscript. RESULTS Twenty-two studies with a total of 17,017 study participants from 14 countries in sub-Saharan Africa were included. The pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines in SSA were 45%. The pooled prevalence of the most common clinical indications were respiratory tract (35%) and gastrointestinal infections (18%). Overall prescriptions per wards were inpatients (14,413) and outpatients (12,845). Only 391 prescribers accessed standard treatment guidelines during prescription of antimicrobials. CONCLUSIONS Healthcare professionals' adherence to evidence-based implementation of STG for antimicrobial treatment were low in SSA. Healthcare systems in SSA must make concerted efforts to enhance prescribers access to STGs through optimization of mobile clinical decision support applications. Innovative, informative, and interactive strategies must be in place by the healthcare systems in SSA to empower healthcare providers to make evidence-based clinical decisions informed by the best available evidence and patient preferences, to ultimately improving patient outcomes and promoting appropriate antimicrobial use.
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Affiliation(s)
- Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Knowledge Translation Division, Knowledge Management Directorate, Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- University of Technology Sydney, Sydney, Australia
| | - Yibeltal Siraneh
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Veronica Steck
- Department of Pharmacology and Therapeutics, Faculty of Life Sciences, McGill University, McGill, Montreal, Canada
| | - Ziad El-Khatib
- Global Public Health Department, Karolinska Institute, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Quebec, Canada
| | - Sudhakar Morankar
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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McGrath M, Woldie M, Berhane M, Abera M, Hailu E, Rana R, Lanyero B, Grijalva-Eternod C, Abdissa A, Girma T, Kerac M, Smythe T. Mapping the range of policies relevant to care of small and nutritionally at-risk infants under 6 months and their mothers in Ethiopia: a scoping review protocol. BMJ Open 2023; 13:e069359. [PMID: 37730409 PMCID: PMC10510927 DOI: 10.1136/bmjopen-2022-069359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Evidence gaps limit management of small and/or nutritionally at-risk infants under 6 months and their mothers, who are at higher risk of death, illness, malnutrition and poor growth and development. These infants may be low birth weight, wasted, stunted and/or underweight. An integrated care model to guide their management (MAMI Care Pathway) is being tested in a randomised controlled trial in Ethiopia. Evaluating the extent to which an innovation is consistent with national policies and priorities will aid evidence uptake and plan for scale. METHODS AND ANALYSIS This review will evaluate the extent to which the MAMI Care Pathway is consistent with national policies that relate to the care of at-risk infants under 6 months and their mothers in Ethiopia. The objectives are to describe the range and characteristics, concepts, strategic interventions, coherence and alignment of existing policies and identify opportunities and gaps. It will be conducted in accordance with the JBI methodology for scoping reviews (PRISMA-ScR). Eligible documents include infant and maternal health, nutrition, child development, food and social welfare-related policies publicly available in English and Amharic. The protocol was registered on the Open Science Framework Registry on 20 June 2022 (https://osf.io/m4jt6).Grey literature will be identified through government and agency websites, national and subnational contacts and Google Scholar, and published policies through electronic database searches (MEDLINE, EMBASE and Global and Health Information). The searches will take place between October 2023 and March 2024. A standardised data extraction tool will be used. Descriptive analysis of data will be undertaken. Data will be mapped visually and tabulated. Results will be described in narrative form. National stakeholder discussions will inform conclusions and recommendations. ETHICS AND DISSEMINATION Ethical approval is not required as data consist solely of publicly available material. Findings will be used to evidence national and international policy and practice.
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Affiliation(s)
- Marie McGrath
- Emergency Nutrition Network, Kidlington, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Maternal and Child Health and Nutrition Directorate, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mubarek Abera
- Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Ritu Rana
- Department of Public Health Programmes, Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Betty Lanyero
- Emergency Preparedness and Response Unit, World Health Organization Country Office for Ethiopia, Addis Ababa, Ethiopia
| | - Carlos Grijalva-Eternod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Marko Kerac
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracey Smythe
- Faculty of Epidemiology and Population Health, International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Daka DW, Wordofa MA, Woldie M. Know-do gap for sick child care and drivers of knowledge and practice among health extension workers in four regions of Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e069698. [PMID: 37612100 PMCID: PMC10450039 DOI: 10.1136/bmjopen-2022-069698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Though efforts were made to expand community-based sick child healthcare in Ethiopia, the quality of care provided remained low. Improving quality of care requires understanding providers' knowledge of appropriate care and their actual execution of tasks. This study examined gap between what health extension workers (HEWs) knew and did during the management of sick children in Ethiopia. DESIGN Facility-based cross-sectional study was conducted. SETTING The study was carried out in 52 districts across 4 regions in Ethiopia. PARTICIPANTS We interviewed 274 HEWs and performed observations of consultations done by 150 HEWs supplemented with facility assessment from December 2018 to February 2019. OUTCOME We compared providers' knowledge and performance in the management of childhood pneumonia and diarrhoea. Know-do gap implies the difference in proportion between knowledge and actual practice of HEWs. Logistic regression was used to identify predictors of knowledge and actual practice. RESULTS Providers' correct knowledge ranged from 27.8% to 76.0% for signs and symptoms of pneumonia, and 32.0% to 84% for dehydration signs. Their actual practices ranged from 15.1% to 47.3% for pneumonia and 27.0% to 42.6% for dehydration. The correct knowledge and actual practices for pneumonia and dehydration management were 88.3% vs 15.6% and 93.9% vs 51.3%, respectively. There was significant know-do gap in assessments (16.7%, p=0.002) and management of childhood conditions (68.5%, p<0.0001). Mentorships were associated with providers' knowledge of clinical management, while medicines availability was associated with their actual management practice. CONCLUSIONS While knowledge and actual practice for assessment and management of pneumonia and dehydration ranged from very low to high, what is more concerning is the huge know-do gap among HEWs. Our findings suggest that knowledge-based training is necessary but not sufficient for ensuring correct assessment and management of sick children by HEWs. Continuous support through mentorships and the supply of commodities are critically needed.
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Affiliation(s)
- Dawit Wolde Daka
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | | | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
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Birhanu F, Yitbarek K, Woldie M. Client retention in the continuum of maternal health services in Ethiopia. BMC Health Serv Res 2023; 23:569. [PMID: 37268946 DOI: 10.1186/s12913-023-09602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Even though the global maternal mortality has shown an impressive decline over the last three decades, the problem is still pressing in low-income countries. To bring this to an end, women in a continuum of maternity care should be retained. This study aimed to assess the status of Ethiopian women's retention in the continuum of maternity care with their possible predictors. METHODS We used data from the 2019 Ethiopian Mini-Demographic and Health Survey. The outcome variable in this study was retention in the continuum of maternity care, which consists of at least four ANC contacts, delivery in a health facility, and postnatal check within 48 h of delivery. We analyzed the data using STATA version 14 and a binary logistic regression model was used. In the multiple logistic regression model, variables with a p-value ≤ 0.05 were considered as significantly associated with the outcome variable. A weighted analysis was also done. RESULTS Of the 3917 women included in this study, only 20.8% of women completed all of the recommended services. Besides, the use of maternal health services favors women living in the biggest city administrations, followed by women living in agrarian regions; however, those living in the pastoralist area were disadvantaged. Having four or more ANC was explained by the maternal secondary level of education [AOR: 2.54; 95% CI: 1.42, 4.54], wealth status [AOR: 2.59; 95% CI: 1.45, 4.62], early initiation of ANC [AOR: 3.29; 95% CI: 2.55, 4.24], and being in a union [AOR: 1.95; 95% CI: 1.16,3.29]. After having four ANC, factor-affecting delivery in a health facility was wealth status [AOR: 8.64; 95% CI: 4.07, 18.36]. The overall completion of care was associated with women's higher level of education [AOR: 2.12; 95% CI: 1.08, 4.25], richest wealth status [AOR: 5.16; 95% CI: 2.65, 10.07], timeliness of the first ANC visit [AOR: 2.17; 95% CI: 1.66, 2.85], and third birth order [AOR: 0.58; 95% CI: 0.35, 0.97]. CONCLUSIONS Despite the efforts by the Ethiopian government and other stakeholders, the overall completion of care was quite low. There is also a clear inequality because of women's background characteristics and regional variation. Strategies aiming to empower women through improved educational experience and economic standing have to be implemented in collaboration with other relevant sectors.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, P.O.B. 260, Mizan-Aman, Ethiopia.
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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Daka DW, Wordofa MA, Berhanu D, Persson LÅ, Woldie M. Quality of sick child management by health extension workers: role of a complex improvement intervention. BMC Health Serv Res 2023; 23:165. [PMID: 36797722 PMCID: PMC9933397 DOI: 10.1186/s12913-023-09131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Despite the expansion of the Integrated Community Case Management services for childhood illness, quality and utilization of services have remained low. To address the problem, the Government of Ethiopia introduced a complex intervention that included community engagement, capacity building of health workers and enhanced district-level ownership of sick child management. We examined whether this complex intervention was associated with improved management of sick children by health extension workers. METHODS The study was conducted in four Ethiopian regions. A baseline survey was conducted in 26 intervention and 26 comparison districts from December 2016 to February 2017, followed by an end-line survey 24 months later. We observed health extension workers' consultations of sick 2-59 months old children. The analysis has evaluated if children with pneumonia, diarrhoea and malnutrition were assessed, classified and treated according to guidelines, and included difference-in-difference analyses. RESULTS We observed 1325 consultations of sick children. At baseline, 86% of the sick children with cough in the intervention areas and 85% in comparison areas were assessed according to the guidelines, without any change at end-line associated with the intervention (difference-in-difference = -21%, p = 0.55). Sixty-two percent of children were assessed for dehydration at baseline in intervention and 47% in comparison areas, with no improvement associated with the intervention. Similarly, 87% of sick children in intervention and 91% in comparison areas were assessed for malnutrition, with no change over time associated with the intervention (difference-in-difference = 5%, p = 0.16). Appropriate pneumonia treatment with antibiotics declined and diarrhea treatment increased in both areas. Half of the malnourished children received ready-to-use therapeutic foods without any improvement associated with the intervention. CONCLUSION The intervention was not associated with improved quality of the health extension workers' management of sick children. The lack of association may be linked to low fidelity in the implementation of the intervention. Our findings suggest that training healthcare providers without continued clinical mentoring and support does not improve the quality of care. Community-based programs can be strengthened by ensuring high coverage and continued clinical mentorships, supportive supervision, and supply of medicines and other essential commodities. TRIAL REGISTRATION NUMBER ISRCTN12040912, retrospectively registered on 19/12/ 2017.
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Affiliation(s)
- Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
| | - Muluemebet Abera Wordofa
- grid.411903.e0000 0001 2034 9160Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Della Berhanu
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia ,grid.8991.90000 0004 0425 469XThe London School of Hygiene & Tropical Medicine, London, UK
| | - Lars Åke Persson
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia ,grid.8991.90000 0004 0425 469XThe London School of Hygiene & Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- grid.411903.e0000 0001 2034 9160Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia ,Fenot Project, University of British Columbia, School of Public Health and Population, Addis Ababa, Ethiopia
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Gobena D, Kebede Gudina E, Yilma D, Girma T, Gebre G, Gelanew T, Abdissa A, Mulleta D, Sarbessa T, Asefa H, Woldie M, Shumi G, Kenate B, Kroidl A, Wieser A, Eshetu B, Degfie TT, Mekonnen Z. Escalating spread of SARS-CoV-2 infection after school reopening among students in hotspot districts of Oromia Region in Ethiopia: Longitudinal study. PLoS One 2023; 18:e0280801. [PMID: 36735689 PMCID: PMC9897530 DOI: 10.1371/journal.pone.0280801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 pandemic caused by extended variants of SARS-CoV-2 has infected more than 350 million people, resulting in over 5.5 million deaths globally. However, the actual burden of the pandemic in Africa, particularly among children, remains largely unknown. We aimed to assess the seroepidemiological changes of SARS-CoV-2 infection after school reopening among school children in Oromia, Ethiopia. METHODS A prospective cohort study involving students aged 10 years and older were used. A serological survey was performed twice, at school reopening in December 2020 and four months later in April 2021. Participants were selected from 60 schools located in 15 COVID-19 hotspot districts in Oromia Region. Serology tests were performed by Elecsys anti-SARS-CoV-2 nucleocapsid assay. Data were collected using CSentry CSProData Entry 7.2.1 and exported to STATA version 14.2 for data cleaning and analysis. RESULTS A total of 1884 students were recruited at baseline, and 1271 completed the follow-up. SARS-CoV-2 seroprevalence almost doubled in four months from 25.7% at baseline to 46.3% in the second round, with a corresponding seroincidence of 1910 per 100,000 person-week. Seroincidence was found to be higher among secondary school students (grade 9-12) compared to primary school students (grade 4-8) (RR = 1.6, 95% CI 1.21-2.22) and among those with large family size (> = 5) than those with a family size of <3 (RR = 2.1, 95% CI 1.09-4.17). The increase in SARS-CoV-2 seroprevalence among the students corresponded with Ethiopia's second wave of the COVID-19 outbreak. CONCLUSION SARS-CoV-2 seroprevalence among students in hotspot districts of the Oromia Region was high even at baseline and almost doubled within four months of school recommencement. The high seroincidence coincided with the second wave of the COVID-19 outbreak in Ethiopia, indicating a possible contribution to school opening for the new outbreak wave.
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Affiliation(s)
- Dabesa Gobena
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | | | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Getu Gebre
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Daba Mulleta
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Tarekegn Sarbessa
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Henok Asefa
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Gemechu Shumi
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Birhanu Kenate
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tizta Tilahun Degfie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
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Siraneh Y, Woldie M, Birhanu Z. Assessment of Implementation Outcome Measures for Positive Deviance Approach as a New Strategy to Promote Exclusive Breastfeeding: A Psychometric Follow-Up Study. Int J Womens Health 2022; 14:1579-1601. [DOI: 10.2147/ijwh.s385662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
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11
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Siraneh Y, Woldie M, Birhanu Z. Ignoring Clustering and Nesting in Cluster Randomized Trials Renders Conclusions Unverifiable [Response to Letter]. Risk Manag Healthc Policy 2022; 15:2011-2014. [PMCID: PMC9635539 DOI: 10.2147/rmhp.s392171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia,Correspondence: Yibeltal Siraneh, Email
| | - Mirkuzie Woldie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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12
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Siraneh Y, Woldie M, Birhanu Z. End-Users Satisfaction with Positive Deviance Approach as an Intervention to Promote Exclusive Breastfeeding in Jimma, Ethiopia: A Multi-Level Analysis. Int J Womens Health 2022; 14:179-197. [PMID: 35177939 PMCID: PMC8846610 DOI: 10.2147/ijwh.s349053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Positive deviance approach (PDA) was implemented as an intervention strategy to address the poor practice of exclusive breastfeeding (EBF) in Jimma town, Ethiopia. Understanding the end-users satisfaction and its drivers is essential to determine whether this approach will be viable in the long run. Therefore, we determined the level of users' satisfaction with the intervention and identified multi-level predictors to explain variability. METHODS The data for this follow-up study were collected from September 01 to 25, 2020 among the study participants who were living in the intervention clusters of an earlier trial. A sample of 260 participants were invited to respond to an interviewer-administered structured questionnaire that assessed both individual and community-level variables. The developed tool was refined using experts' view (face validity) and using factor analysis (FA) to validate the satisfaction measurement scales (construct validity). The mean scores were standardized using Percentages Scale Mean Score (PSMS) formulae. Two-level mixed-effects linear regression (linear mixed models) were performed to fit individual, community, and mixed-level variables. All assumptions were checked for each analysis as appropriate and β-estimates at 95% CI and p-value of <0.05 were considered to declare a level of significance. RESULTS The overall level of end-users' satisfaction (PSMS) with PDA as an intervention to improve EBF was 50.9% with a maximum score of 99% and a minimum of 8%. Of the emerged satisfaction measuring scales, the standardized mean score for the user empowerment scale was the highest (53.7%). Five scales were emerged with 84.2% of the total variability explained in users' satisfaction. The mixed-effect model revealed that age, occupation, experience of breastfeeding (BF), knowledge, attitude, self-efficacy, main source of BF information, previous home visit/support received from HEPs, participation in any social activities, and perceived community support for BF were independent two-level predictors of satisfaction. CONCLUSION As an intermediate outcome, more than half of the end-users of the PDA intervention were satisfied. End-users' satisfaction with PDA as an intervention to promote EBF was predicted by multi-level factors. If they chose to use PDA as an intervention, Health program managers should be mindful of the two-level factors identified in this study.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Fenot Project, Department of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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13
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities. Vaccine 2022; 40:141-150. [PMID: 34794824 DOI: 10.1016/j.vaccine.2021.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa. METHODS We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination. RESULTS Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake. CONCLUSIONS Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.
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Affiliation(s)
- Firew Tekle Bobo
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia; Department of Public Health, Institute of Health Sciences, Wollega University, Nekmete, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia; Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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14
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa. BMJ Glob Health 2021; 6:bmjgh-2021-007074. [PMID: 34716145 PMCID: PMC8559094 DOI: 10.1136/bmjgh-2021-007074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
Background Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa. Methods We analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section. Results The rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section. Conclusions There were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia .,School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia.,Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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15
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Siraneh Y, Woldie M, Birhanu Z. Effectiveness of Positive Deviance Approach to Promote Exclusive Breastfeeding Practice: A Cluster Randomized Controlled Trial. Risk Manag Healthc Policy 2021; 14:3483-3503. [PMID: 34466041 PMCID: PMC8403074 DOI: 10.2147/rmhp.s324762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Suboptimal breastfeeding (BF) contributes to a significant number of infant deaths. A positive deviance approach (PDA) was not studied in Ethiopia, whether it improve exclusive breastfeeding (EBF) practice. Therefore, we determined the effectiveness of positive deviant approached intervention in increasing the proportion of EBF practice. Methods A cluster-randomized controlled trial was employed in Jimma town from February 01 to September 30, 2018. Six randomly selected clusters (kebeles) were randomized into two arms. Then, 260 mothers who met the eligibility criteria were enrolled in either the intervention or control arm depending on where they lived. Women in the intervention group received counseling and social support in addition to the usual service to promote EBF, from women identified and trained as positive deviants in their community, while those in the control groups received the usual community-based services from urban health extension professionals. Data on primary and secondary outcome variables were collected at three points, and statistical difference was estimated using Chi-X2 or Fisher exact test. The net effect of the intervention was calculated. The magnitude of the intervention effect was estimated using the relative risk. For all statistical tests, 95% CI with a P-value of <0.05 was used. Results The overall response rate at the endline was 98.8%. Exclusive BF was significantly different between the groups at mid and end points, while no difference at baseline. A higher proportion of mothers in the intervention group reported EBF compared to the control group at mid and end-line. The rate of EBF increased by 18.5% (P=0.01) in the intervention group while 0.2% in the counterparts, with a net effect of +18.2%. The probability of practicing EBF was significantly higher for the intervention group compared to the control group. At baseline, the relative risk of avoiding EBF (RR:1.112) was similar among the two groups. However, at follow-up, mothers in the intervention group were 2 times more likely to practice EBF (RR: 2.294) compared to those in the control group. Conclusion and Recommendation The PD approach is an effective intervention to promote EBF and also positively affected frequency and duration of BF. Therefore, we recommend the promotion and use of positive deviance approach as a strategy to improve EBF practice in urban settings. Trial Registration Number Clinical trial PACTR201805003379263, 23 May 2018.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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16
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Bobo FT, Asante A, Woldie M, Hayen A. Poor coverage and quality for poor women: Inequalities in quality antenatal care in nine East African countries. Health Policy Plan 2021; 36:662-672. [PMID: 33822943 DOI: 10.1093/heapol/czaa192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.,School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.,Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Hailu M, Tafese F, Tsega G, Adamu A, Yitbarek K, Tilahun T, Siraneh Y, Erchafo B, Woldie M. Expanding Maternity Waiting Homes as an Approach to Improve Institutional Delivery in Southwest Ethiopia: A Community-Based Case-Control Study. Inquiry 2021; 58:469580211018294. [PMID: 34027685 PMCID: PMC8142013 DOI: 10.1177/00469580211018294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With the promising efforts in increasing institutional delivery yet, maternal and child mortality is high in Ethiopia. One of the strategies used to minimize this problem was the introduction of Maternity Waiting Homes (MWH). MWHs are residential facilities for pregnant women near a qualified medical facility. The introduction of MWHs has improved institutional delivery in many countries. In Ethiopia however, the contribution of MWHs was rarely studied. To fill this gap, we have conducted a community-based unmatched case-control study from March 1 to April 20, 2016, in Southwestern Ethiopia. Mothers who delivered at a health facility within 1 year were considered as cases while mothers delivered at home were controls. We used simple random sampling to identify study participants from the pool of cases and controls who were identified by census. Data were analyzed using SPSS Version 20. Binary logistic regression was used to identify significant predictors. A total of 140 cases and 273 controls were included in the study. Among the case, 86 (61.4%) used MWHs during their last delivery. Variables like educational status of the mothers [AOR = 2.96, 95% CI: 1.41, 6.23], educational status of the husband [AOR = 5.19, 95% CI: 1.52, 17.76], and having antenatal care follow up [AOR = 3.22, 95% CI: 1.59, 6.54]. This study remarks, accessing MWHs, creating better awareness in utilizing them, and practicing antenatal follow-up have a crucial role in improving institutional delivery. Therefore, strengthening the existing and establishing new MWHs to deliver quality services is a good strategy in reducing home delivery.
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Affiliation(s)
- Meaza Hailu
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | | | | | | | - Tizta Tilahun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Mirkuzie Woldie
- Jimma University, Jimma, Ethiopia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Arsenault C, Yakob B, Tilahun T, Nigatu TG, Dinsa G, Woldie M, Kassa M, Berman P, Kruk ME. Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey. BMC Health Serv Res 2021; 21:485. [PMID: 34022856 PMCID: PMC8140434 DOI: 10.1186/s12913-021-06524-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06524-y.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Bereket Yakob
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Tizta Tilahun
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Tsinuel Girma Nigatu
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Girmaye Dinsa
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.,Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.,Ministry of Health, Addis Ababa, Ethiopia
| | | | - Peter Berman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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Yitbarek K, Hurlburt S, Hagen TP, Berhane M, Abraham G, Adamu A, Tsega G, Woldie M. Inequitable Utilization of Neonatal Health Services in Southwest Ethiopia: The Effects of Socioeconomic Disparities. Inquiry 2021; 58:469580211018290. [PMID: 34027707 PMCID: PMC8142524 DOI: 10.1177/00469580211018290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Low levels of neonatal health services utilization and high neonatal deaths are often concentrated among socially and economically disadvantaged groups, especially in low-income countries. Therefore the aim of this study was to assess inequity in the use of neonatal health services in Southwest Ethiopia. A community-based cross-sectional study was conducted in 8 districts located in Jimma Zone, Southwest Ethiopia from 19 March to 28 April 2018. A total of 835 mothers were included in the study with systematic random sampling. Principal component analysis was conducted to develop wealth quintiles of the households. Equity in neonatal health services was measured using rate-ratio, concentration curve, concentration index, and analyzed by binary logistic regression. Neonates from richer families were 1.25 times more likely to use neonatal health services than the poorer households with a concentration index value of 0.07. Neonates from highly educated mothers have better used the services and the corresponding concentration index value of 0.03. Neonatal service utilization was 1.32 times higher in the highest wealth quintile in rural settings. Similarly, services delivered at health posts and hospitals were used 2.4 and 2 times more by the wealthy, whereas services given at health centers are more utilized by the poorest. Outputs of binary logistic regression analysis indicated that neonates from middle quintile wealth households were found to be better neonatal health service users [AOR_1.72, 95% CI: 1.04, 2.82]. Neonate born from a secondary school attended mother [AOR_3.56, 95% CI: 1.90, 6.69] were more likely to use neonatal health services. Neonatal health service utilization in Southwest Ethiopia is more common among neonates from richer households and more educated mothers. There is a big difference among the wealthy and poorer in a rural setting and among those who used health posts. Working on the social-determinants of health will facilitate eliminating inequity.
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Affiliation(s)
| | - Sarah Hurlburt
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Gelila Abraham
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | | | | | - Mirkuzie Woldie
- Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Tekle Bobo F, Asante A, Woldie M, Hayen A. Erratum to: poor coverage and quality for poor women: inequalities in quality antenatal care in nine East African countries. Health Policy Plan 2021; 36:996. [PMID: 33982748 DOI: 10.1093/heapol/czab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gudina EK, Gobena D, Debela T, Yilma D, Girma T, Mekonnen Z, Woldie M, Abdena D, Shume G, Kenate B, Lemi M, Diriba D, Degfie TT. COVID-19 in Oromia Region of Ethiopia: a review of the first 6 months' surveillance data. BMJ Open 2021; 11:e046764. [PMID: 33782023 PMCID: PMC8008954 DOI: 10.1136/bmjopen-2020-046764] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Despite unrelenting efforts to contain its spread, COVID-19 is still causing unprecedented global crises. Ethiopia reported its first case on 13 March 2020 but has an accelerated case load and geographical distribution recently. In this article, we described the epidemiology of COVID-19 in Oromia Region, the largest and most populous region in Ethiopia, during the early months of the outbreak. METHODS We analysed data from the COVID-19 surveillance database of the Oromia Regional Health Bureau. We included all reverse transcription-PCR-confirmed cases reported from the region between 13 March and 13 September 2020. RESULTS COVID-19 was confirmed in 8955 (5.5%) of 164 206 tested individuals. The test positivity rate increased from an average of 1.0% in the first 3 months to 6.3% in August and September. About 70% (6230) of the cases were men; the mean age was 30.0 years (SD=13.3), and 90.5% were <50 years of age. Only 64 (0.7%) of the cases had symptoms at diagnosis. Cough was the most common among symptomatic cases reported in 48 (75.0%), while fever was the least. Overall, 4346 (48.5%) have recovered from the virus; and a total of 52 deaths were reported with a case fatality rate of 1.2%. However, we should interpret the reported case fatality rate cautiously since in 44 (84.6%) of those reported as COVID-19 death, the virus was detected from dead bodies. CONCLUSION Despite the steady increase in the number of reported COVID-19 cases, Ethiopia has so far avoided the feared catastrophe from the pandemic due to the milder and asymptomatic nature of the disease. However, with the current pattern of widespread community transmission, the danger posed by the pandemic remains real. Thus, the country should focus on averting COVID-19-related humanitarian crisis through strengthening COVID-19 surveillance and targeted testing for the most vulnerable groups.
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Affiliation(s)
- Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Dabesa Gobena
- Public Health Management and Health Research Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Tessema Debela
- Public Health Management and Health Research Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Tsinuel Girma
- Fenot Project, Department of Global Health and Population, Harvard University T H Chan School of Public Health, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, Department of Global Health and Population, Harvard University T H Chan School of Public Health, Addis Ababa, Ethiopia
| | - Dereje Abdena
- Disease Prevention and Health Promotion Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Gemechu Shume
- Public Health Emergency Management and Health Research Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Birhanu Kenate
- Health Research Team Coordinator, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Meles Lemi
- Public Health Management and Health Research Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Dereje Diriba
- Public Health Management and Health Research Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Tizta Tilahun Degfie
- Fenot Project, Department of Global Health and Population, Harvard University T H Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Reproductive Health and Population Studies, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
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Yitbarek K, Abraham G, Berhane M, Hurlburt S, Mann C, Adamu A, Tsega G, Woldie M. Significant inefficiency in running community health systems: The case of health posts in Southwest Ethiopia. PLoS One 2021; 16:e0246559. [PMID: 33606733 PMCID: PMC7895414 DOI: 10.1371/journal.pone.0246559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although much has been documented about the performance of the health extension program, there is a lack of information on how efficiently the program is running. Furthermore, the rising cost of health services and the absence of competition among publicly owned health facilities demands strong follow up of efficiency. Therefore, this study aimed to assess the technical efficiency of the health posts and determinants in Southwestern Ethiopia. Methods and materials We used data for one Ethiopian fiscal year (from July 2016 to June 2017) to estimate the technical efficiency of health posts. A total of 66 health posts were included in the analysis. We employed a two-stage data envelopment analysis to estimate technical efficiency. At the first stage, technical efficiency scores were calculated using data envelopment analysis program version 2.1. Predictors of technical efficiency were then identified at the second stage using Tobit regression, with STATA version 14. Results The findings revealed that 21.2% were technically efficient with a mean technical efficiency score of 0.6 (± 0.3), indicating that health posts could increase their service volume by 36% with no change made to the inputs they received. On the other hand, health posts had an average scale efficiency score of 0.8 (± 0.2) implying that the facilities have the potential to increase service volume by 16% with the existing resources. The regression model has indicated average waiting time for service has negatively affected technical efficiency. Conclusion More than three-quarters of health posts were found inefficient. The technical efficiency score of more than one-third of the health posts is even less than 50%. Community mobilization to enhance the uptake of health services at the health posts coupled with a possible reallocation of resources in less efficient health posts is a possible approach to improve the efficiency of the program.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ayinengida Adamu
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Yesuf EA, Woldie M, Haile-Mariam D, Koller D, Früschl G, Grill E. Identification of relevant performance indicators for district healthcare systems in Ethiopia: a systematic review and expert opinion. Int J Qual Health Care 2021; 32:161-172. [PMID: 32232332 DOI: 10.1093/intqhc/mzaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify potential performance indicators relevant for district healthcare systems of Ethiopia. DATA SOURCES Public Library of Medicine and Agency for Healthcare Research and Quality of the United States of America, Organization for Economic Cooperation and Development Library and Google Scholar were searched. STUDY SELECTION Expert opinions, policy documents, literature reviews, process evaluations and observational studies published between 1990 and 2015 were considered for inclusion. Participants were national- and local-healthcare systems. The phenomenon of interest was the performance of healthcare systems. The Joanna Briggs Institute tools were adapted and used for critical appraisal of records. DATA EXTRACTION Indicators of performance were extracted from included records and summarized in a narrative form. Then, experts rated the relevance of the indicators. Relevance of an indicator is its agreement with priority health objectives at the national and district level in Ethiopia. RESULTS OF DATA SYNTHESIS A total of 11 206 titles were identified. Finally, 22 full text records were qualitatively synthesized. Experts rated 39 out of 152 (25.7%) performance indicators identified from the literature to be relevant for district healthcare systems in Ethiopia. For example, access to primary healthcare, tuberculosis (TB) treatment rate and infant mortality rate were found to be relevant. CONCLUSION Decision-makers in Ethiopia and potentially in other low-income countries can use multiple relevant indicators to measure the performance of district healthcare systems. Further research is needed to test the validity of the indicators.
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Affiliation(s)
- Elias Ali Yesuf
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, D-80336 München, Germany.,Department of Health Policy and Management, Jimma University, Aba Jifar 1 Street, Jimma 378, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Aba Jifar 1 Street, Jimma 378, Ethiopia
| | - Damen Haile-Mariam
- School of Public Health, Addis Ababa University, Zambia street, Addis Ababa 11950, Ethiopia
| | - Daniela Koller
- Institute for Medical Data Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Marchioninistr. 17, D-81377 München, Germany
| | - Gönter Früschl
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, D-80336 München, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Leopoldstr. 7, D-80802 München, Germany
| | - Eva Grill
- Institute for Medical Data Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Marchioninistr. 17, D-81377 München, Germany
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Daka DW, Woldie M, Ergiba MS, Sori BK, Bayisa DA, Amente AB, Bobo FT. Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from "Leaving No One Behind". Clinicoecon Outcomes Res 2020; 12:595-607. [PMID: 33116699 PMCID: PMC7585815 DOI: 10.2147/ceor.s269955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Despite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia. Methods The 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices. Results Overall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099–0.173), 0.106 (95% CI=0.035–0.177), 0.348 (95% CI=0.279–0.418), and 0.348 (95% CI=0.279–0.418), respectively. Maternal age and all of the three socio-demographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services. Conclusion The utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.
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Affiliation(s)
- Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.,Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Meskerem Seboka Ergiba
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Birhanu Kenate Sori
- Policy, Planning, Monitoring and Evaluation Directorate, Oromia Region Health Bureau, Addis Ababa, Ethiopia
| | - Dereje Abdena Bayisa
- Policy, Planning, Monitoring and Evaluation Directorate, Oromia Region Health Bureau, Addis Ababa, Ethiopia
| | - Asfaw Benti Amente
- Policy, Planning, Monitoring and Evaluation Directorate, Oromia Region Health Bureau, Addis Ababa, Ethiopia
| | - Firew Tekle Bobo
- Institute of Health Science, Department of Public Health, Wollega University, Nekemte, Ethiopia.,School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Daka DW, Wordofa MA, Woldie M, Persson LÅ, Berhanu D. Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey. PLoS One 2020; 15:e0239361. [PMID: 32976508 PMCID: PMC7518593 DOI: 10.1371/journal.pone.0239361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia. METHODS Clinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines. RESULTS Most sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers. CONCLUSION The Ethiopian health extension workers' clinical assessment, classification and management of sick children did to a large extent not follow the clinical guidelines. This lack of adherence could lead to misdiagnoses and lack of potentially life-saving treatments.
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Affiliation(s)
- Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Muluemebet Abera Wordofa
- Faculty of Public Health, Population and Family Health Department, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Lars Åke Persson
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Della Berhanu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
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Yitbarek K, Abraham G, Girma T, Tilahun T, Woldie M. The effect of Bacillus Calmette-Guérin (BCG) vaccination in preventing severe infectious respiratory diseases other than TB: Implications for the COVID-19 pandemic. Vaccine 2020; 38:6374-6380. [PMID: 32798142 PMCID: PMC7416741 DOI: 10.1016/j.vaccine.2020.08.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
The rapid spread of the Coronavirus pandemic and its significant health and social impact urges the search for effective and readily available solutions to mitigate the damages. Thus, evaluating the effectiveness of existing vaccines like Bacillus Calmette–Guérin (BCG) has attracted attention. The aim of this review was evidence synthesis on the effect of BCG vaccine in preventing severe infectious respiratory disease including COVD-19, but not tuberculosis. We considered studies conducted on human participants of any study design from any country setting that were published in Enlgish. We did a systematic literature search in MEDLINE, Scopus and Google scholar databases and a free search on Google. The identified studies were appraised and relevant data were extracted using Joanna Briggs Institute tools. The extracted findings were synthesized with tables and narrative summary. Nine studies met the inclusion criteria. The findings indicated that BCG vaccine has a strong protective effect against both upper and lower acute respiratory tract infections. For instance in countries with universal BCG vaccination policy, the incidence of COVID-19 was lower compared to the counterparts. Addtionally, BCG vaccine was found to protect against infections like lethal influenza A virus, pandemic influenza (H1N1), and other acute respiratory tract infections. BCG improved the human body’s immune response involving antigen-specific T cells and memory cells. It also induced adaptive functional reprogramming of mononuclear phagocytes that induce protective effects against different respiratory infections other than tuberculosis. In countries with universal BCG vaccination, the incidence and death from acute respiratory viral infection including COVID – 19 is significantly low. However, there is an urgent need for further evidence from well-designed studies to understand the possible role of BCG vaccination over time and across age groups, its possible benefits in special populations such as health workers and cost-savings related to a policy of universal BCG vaccination.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia; Ethiopian Evidence Based Health Care Centre, Health, Behaviour, and Society Department, Public Health Faculty, Jimma Institute of Health Sciences, Jimma University, Ethiopia
| | - Tsinuel Girma
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Tizta Tilahun
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia; Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia; Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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Garuma M, Woldie M, Kebene FG. Areas of Potential Improvement for Hospitals' Patient-Safety Culture in Western Ethiopia. Drug Healthc Patient Saf 2020; 12:113-123. [PMID: 32848480 PMCID: PMC7425101 DOI: 10.2147/dhps.s254949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/14/2020] [Indexed: 11/23/2022]
Abstract
Background Patient-safety culture is an important component of health-care quality and currentlyan issue of high concern globally. In Ethiopia, little is known about patient-safety culture in hospitals. We assessed the patient-safety culture and associated factors among health-care workers in public hospitals of East Wollega Zone, western Ethiopia. Methods This institution-based cross-sectional study was conducted among 421 health-care workers selected using simple random sampling from March 4 to March 29, 2019. A standardized measuring 12 patient safety–culture components was used for data collection. Data were cleaned and entered into EpiData version 3.1 and analysis done using SPSS version 25 (IBM). Bivariate and multivariate linear regression analyses were performed. Significance was set at 95% CI and p<0.05, and unstandardized β-coefficients were used to measure extent of association. Results This study revealed that the level of patient-safety culture was 49.2% and patient safety culture–component scores ranged from 29.2% for nonpunitive responses to error to 77.9% for teamwork within a hospital unit. Age ≥45 years (β=13.642, CI: 5.324–21.959; p=0.001), 1–5 years’ experience at the current hospital (β=5.559, 95% CI 2.075–9.042; p=0.002), and working in general hospitals (β=11.988, 95% CI 7.233–16.743; p<0.001) and primary hospitals (β=6.408, 95% CI 2.192–10.624; p=0.003) were factors associated with better scores on patient-safety culture. Conclusion Overall scores for patient-safety culture were low. Improving the current state of patient safety in public hospitals would require tailored interventions to address low-scoring components, such as nonpunitive responses to error.
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Affiliation(s)
- Melkamu Garuma
- Nekemte Public Health Research and Referral Laboratory, East Wollega Zone, Oromia Region, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia.,Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Feyera Gebissa Kebene
- Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Mesfin D, Woldie M, Adamu A, Bekele F. Perceived organizational culture and its relationship with job satisfaction in primary hospitals of Jimma zone and Jimma town administration, correlational study. BMC Health Serv Res 2020; 20:438. [PMID: 32429882 PMCID: PMC7236334 DOI: 10.1186/s12913-020-05319-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of Organizational Culture (OC) which refers to the pattern of values, norms, beliefs, attitudes and assumptions may not be articulated through verbal language. However, it shapes the way people behave and the way things get done in an organization. The management of organizational culture is increasingly viewed as necessary part of health system reform. Major cultural transformation of an organization must be secured alongside structural and procedural changes in order to achieve desired quality and performances improvements in health systems. It is therefore essential to understand organizational culture, job satisfaction level of the health workers and the link between them. METHODOLOGY Facility based cross sectional study was conducted in four primary hospitals of Jimma zone and town administration. A self-administered questionnaire was used to collect the data. The collected data were checked for completeness, entered and documented into Epi-data version 3.1 and Exported to SPSS version 21 for analysis. Finally descriptive statistics, Paired t-test and multiple linear regression analysis were used to assess the relationship between organizational culture and job satisfaction and the results were presented using tables and charts. RESULT It was indicated from the finding that, the dominant existing organizational culture typology in the primary hospitals was Hierarchy culture (MS = 22.31, ±2.82).and the preferred organizational culture typology was Innovative culture (MS = 26.09, ±4.72). The health workers had low to medium level of job satisfaction where only (29.40%) of the health workers were very satisfied with their hospital physical working environment. Existing perceived clan culture had positive and significant correlation with health workers' satisfaction in relation to work relation dimension (r = .16, p < 0.002). CONCLUSION while acknowledging all limitation of observational study we reached to the conclusion that an employees of the respective primary hospitals would prefer to work in environment characterized by innovative and clan culture and their satisfaction level is medium so that the managers should undertake major cultural transformation and must work to improve the job satisfaction level of health workers within their respective hospitals.
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Affiliation(s)
- Dereje Mesfin
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Mirkuzie Woldie
- Department of Health Economics, Policy and Management Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Ayinengida Adamu
- Department of Health Economics, Policy and Management Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Fitsum Bekele
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Kasaye HK, Bobo FT, Yilma MT, Woldie M. Poor nutrition for under-five children from poor households in Ethiopia: Evidence from 2016 Demographic and Health Survey. PLoS One 2019; 14:e0225996. [PMID: 31860689 PMCID: PMC6924648 DOI: 10.1371/journal.pone.0225996] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Ethiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly. Methods Ethiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI). Result The prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition. Conclusion The burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target.
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Affiliation(s)
- Habtamu Kebebe Kasaye
- Department of Midwifery, Institute of Health Sciences, Wollega University; ekmete, Ethiopia
- * E-mail:
| | - Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University; Nekmete, Ethiopia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institute of Health Sciences, Wollega University; Nekmete, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University; Jimma, Ethiopia
- Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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Feyissa GT, Balabanova D, Woldie M. How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence. J Multidiscip Healthc 2019; 12:989-1005. [PMID: 31824166 PMCID: PMC6901118 DOI: 10.2147/jmdh.s228951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research Further research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
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Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia.,Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | - Dina Balabanova
- Department of Health Policy and Management, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
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Yitbarek K, Abraham G, Adamu A, Tsega G, Berhane M, Hurlburt S, Mann C, Woldie M. Technical efficiency of neonatal health services in primary health care facilities of Southwest Ethiopia: a two-stage data envelopment analysis. Health Econ Rev 2019; 9:27. [PMID: 31656977 PMCID: PMC6815357 DOI: 10.1186/s13561-019-0245-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Disparity in resource allocation is an issue among various health delivery units in Ethiopia. To sufficiently address this problem decision-makers require evidence on efficient allocation of resources. Therefore, the purpose of this study was to assess the technical efficiency of primary health care units providing neonatal health services in Southwest Ethiopia. METHODS Two-stage data envelopment analysis was conducted based on one-year (2016/17) data from 68 health posts and 23 health centers in Southwest Ethiopia. Primary data were collected from each of the facility, respective district health offices and finance and economic cooperation offices. Technical efficiency scores were calculated using data envelopment analysis software version 2.1. Tobit regression was then applied to identify determinants of technical efficiency. STATA version 14 was used in the regression model and for descriptive statistics. RESULTS By utilizing the best combination of inputs, eight health posts (11.76%) and eight health centers (34.78%) were found to be technically efficient in delivering neonatal health services. Compared with others included in the analysis, inefficient health delivery units were using more human and non-salary recurrent resources. The regression model indicated that there was a positive association between efficiency and the health center head's years of experience and the facility's catchment population. Waiting time at the health posts was found to negatively affect efficiency. CONCLUSIONS Most of health posts and the majority of health centers were found to be technically inefficient in delivering neonatal health services. This indicates issues with the performance of these facilities with regards to the utilization of inputs to produce the current outputs. The existing resources could be used to serve additional neonates in the facilities.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayinengida Adamu
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and child health, Institute of health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Assefa F, Girma W, Woldie M, Getachew B. Birth outcomes of singleton term breech deliveries in Jimma University Medical Center, Southwest Ethiopia. BMC Res Notes 2019; 12:428. [PMID: 31315636 PMCID: PMC6637559 DOI: 10.1186/s13104-019-4442-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/05/2019] [Indexed: 05/30/2023] Open
Abstract
Objective Breech delivery is generally associated with higher perinatal morbidity and mortality than cephalic presentation. Hence describing the outcomes of singleton term breech deliveries in Jimma University Medical Center (JUMC), Southwest Ethiopia addresses in recommendation of improving perinatal outcomes and developing protocols in selecting eligible women. Results The incidence of singleton term breech delivery was 5.3%. Majority, (52.8%) of them had undergone emergency cesarean delivery (C/D), and 38.9% had vaginal breech delivery. There were 14 (13.9%) intrapartum fetal deaths of whom 5.6% were recorded at JUMC. A quarter (25%) of the neonates required admission to the neonatal intensive care unit; 40.7% had perinatal asphyxia, and there were 3 early onset neonatal deaths making up a perinatal mortality rate of 157.4 per 1000 breech births. The incidence of breech delivery was relatively high. Vaginal breech delivery was lower. Significant proportions of adverse perinatal outcomes were recorded. Introduction of a protocol for managing breech deliveries to select eligible women for trial of breech delivery and strengthen training of junior health professionals regularly on how to conduct assisted vaginal breech delivery to improve perinatal outcome is recommended. Further studies to identify determinants of perinatal outcomes is recommended. Electronic supplementary material The online version of this article (10.1186/s13104-019-4442-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fanta Assefa
- Department of Gynecology and Obstetrics, Medical Faculty, Jimma University, P. O. Box 378, Jimma, Ethiopia
| | - Woubishet Girma
- Department of Gynecology and Obstetrics, Medical Faculty, Jimma University, P. O. Box 378, Jimma, Ethiopia.
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, USA
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Tekle Bobo F, Kebebe Kasaye H, Etana B, Woldie M, Feyissa TR. Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate? PLoS One 2019; 14:e0217126. [PMID: 31173588 PMCID: PMC6555589 DOI: 10.1371/journal.pone.0217126] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia. Method A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors. Result Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65). Conclusion Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women’s right to receive health care with dignity.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- * E-mail:
| | | | - Belachew Etana
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University; Jimma, Oromia, Ethiopia
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia
| | - Tesfaye Regassa Feyissa
- Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Abstract
Background Intimate partner violence is a major challenges faced by women especially in developing world. Its consequences range from personal health problems up to countrywide loss of productivity and poverty. There is limited empirical evidence documenting intimate partner violence and underlying reasons in Ethiopia. Therefore, the aim of this study was to assess the magnitude of intimate partner violence and associated factors in Ethiopia. Methods We analyzed the 2016 Ethiopian demographic and health survey data. About 2,750 women aged 15–49 years were included in the survey. Intimate partner violence was measured in three dimensions: physical, emotional and sexual violence. Multiple logistic regression was conducted to identify independent predictors. Variables with p-value less than 0.05 were considered as significantly associated with dimensions of violence. All analysis were adjusted for clusters and sample weights. Results Overall 32.5% of Ethiopian women experienced at least one type of intimate partner violence. Physical and emotional violence were each experienced by 22.5% of the women, while 9.6% of the study participants encountered sexual violence. The age difference between a woman and her intimate partner has a positive effect on emotional and sexual violence while the opposite is true for physical violence. Moreover, physical violence was significantly associated with place of residence, and husband education. Both emotional and sexual violence were predicted by wealth of the household and husband’s employment status. In addition to these, lower educational status of the partner affects emotional violence positively. Conclusion Substantial proportion of women in Ethiopia continue to suffer from intimate partner violence. Physical and emotional violence were much more common than sexual violence. In the light of determinants, we have reported in here, we recommend empowering women in all realm of life by improving their socio-economic status with focus to their educational and economic status.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
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Feyissa GT, Woldie M, Munn Z, Lockwood C. Exploration of facilitators and barriers to the implementation of a guideline to reduce HIV-related stigma and discrimination in the Ethiopian healthcare settings: A descriptive qualitative study. PLoS One 2019; 14:e0216887. [PMID: 31083693 PMCID: PMC6513051 DOI: 10.1371/journal.pone.0216887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/30/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The barriers to uptake of guidelines underscore the importance of going beyound the mere synthesis of evidence to tailoring the synthesized evidence into local contexts and situations. This requires in-depth exploration of local factors. This project aimed to assess contextual barriers and facilitators to the implementation of a guideline developed to reduce HIV-related stigma and discrimination (SAD) in the Ethiopian healthcare setting. METHODS A descriptive qualitative research study was conducted using a semi-structured interview guide informed by the Registered Nurses Association of Ontario (RNAO) framework. The interview was conducted among a purposive sample of seven key informants from Jimma University and Jimma Zone HIV Prevention and Control Office. The interviews were transcribed, coded and analysed using Atlas ti version 7.5 software packages. RESULTS Guideline attributes, provider-related factors and organizational and practice-related were identified as factors that can potentially affect the implementation of the guideline. The presence of expert patients were identified as agents for guideline implementation, whilst regular health education programs in addition to initiatives related to service quality improvement, were identified as suitable platforms to assist with the implementation of this guideline. Study participants recommended that the guideline should be disseminated through multidisciplinary team (MDT) meetings, gate keepers such as opinion leaders and unit heads, one-to-five networks and mentorship programs, as well as training, workshops and posters. The current study also indicated that continuous monitoring, evaluation and mentorship are critical elements in the integration of the guideline into the system of the hospital. CONCLUSIONS This study identified that guideline implementation can make use of existing structures and pathways such as MDT meetings, service quality improvement initiatives, one-to-five networks, training and workshops. Teamwork and partnership with stakeholders should be strengthened to strengthen facilitators and tackle barriers related to the implementation of the guideline. Effective implementation of the guideline also requires establishing an implementation structure. Moreover, indicators developed to track the implementation of stigma reduction guideline should be integrated into mentorship, MDT meetings and evaluation programs of the hospital to improve performance and to assist data collection on implementation experiences.
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Affiliation(s)
- Garumma Tolu Feyissa
- Jimma University, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, South Australia, Australia
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
| | - Zachary Munn
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Lockwood
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, South Australia, Australia
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Yitbarek K, Adamu A, Tsega G, Siraneh Y, Erchafo B, Yewhalaw D, Tekle F, Woldie M. Technical Efficiency of Maternal and Reproductive Health Services in Public Hospitals of Oromia Regional State, Ethiopia. Health Serv Insights 2019; 12:1178632919837630. [PMID: 31007528 PMCID: PMC6458666 DOI: 10.1177/1178632919837630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022] Open
Abstract
As the Ethiopian health system faced critical resource constraints, wise use of the available health resources is a priority agenda. Therefore, our study aimed to assess technical efficiency of maternal and reproductive health services in public hospitals of Oromia regional state, Ethiopia. Two-stage data envelopment analysis was performed among 14 hospitals with input orientation and variable returns to scale assumptions. Technical efficiency scores were computed at the first stage, and predictors were determined using Tobit regression at the second stage. The assessment revealed that 12 (85.7%) hospitals were pure technical efficient and 9 (64.29%) hospitals were scale efficient. Level (primary/general) (β = 1.17, 95% confidence interval [CI] = 0.16-2.18), service years (β = 0.02, 95% CI = 0.003-0.03), and size of catchment population (β = 5.58E–07, 95% CI = 2.95E–08 to 1.09E–06) were positively associated with technical efficiency of maternal and reproductive health service, whereas average waiting time for maternal health service (β = –0.03, 95% CI = –0.05 to −0.01) was negatively associated with efficiency. In conclusion, most of the hospitals were technically efficient and around two-thirds were operating scale efficient. Allocation of more resources to older secondary hospitals with larger catchment population could result in more efficient use of resources for maternal and reproductive health service delivery.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Ayinengida Adamu
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gebeyehu Tsega
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Belay Erchafo
- Department of Public Health, College of Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia.,Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
| | - Firew Tekle
- Department of Public Health, College of Medical and Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence. PLoS One 2019; 14:e0211298. [PMID: 30682131 PMCID: PMC6347272 DOI: 10.1371/journal.pone.0211298] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal of ending the epidemic of HIV by 2030 set by the United Nations Joint Program of HIV/AIDS (UNAIDS) will thus only be achieved if HIV-related stigma and discrimination are reduced. The objective of this review was to locate, appraise and describe international literature reporting on interventions that addressed HIV-related SAD in healthcare settings. Methods The databases searched were: Cumulative Index to Nursing and Allied Health (CINAHL), Excerpta Medica Database from Elsevier (EMBASE), PubMed and Psychological Information (PsycINFO) database. Two individuals independently appraised the quality of the papers using appraisal instruments from the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI. Quality of evidence for major outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results We retained 14 records reporting on eight studies. Five categories of SAD reduction (information-based, skills building, structural, contact-based and biomedical interventions) were identified. Training popular opinion leaders (POLs) resulted in significantly lower mean avoidance intent scores (MD = -1.87 [95% CI -2.05 to -1.69]), mean prejudicial attitude scores (MD = -3.77 [95% CI -5.4 to -2.09]) and significantly higher scores in mean compliance to universal precaution (MD = 1.65 [95% CI 1.41 to 1.89]) when compared to usual care (moderate quality evidence). The Summary of Findings table (SOF) is shown in Table 1. Conclusions Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal precaution. Very low quality evidence indicates that professionally-assisted peer group interventions, modular interactive training, participatory self-guided assessment and intervention, contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma.Further Randomized Controlled Trials (RCTs) are needed. Future trials need to use up-to-date and validated instruments to measure stigma and discrimination.
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Affiliation(s)
- Garumma Tolu Feyissa
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
- * E-mail:
| | - Craig Lockwood
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
| | - Zachary Munn
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
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Woldie M, Feyissa GT, Admasu B, Hassen K, Mitchell K, Mayhew S, McKee M, Balabanova D. Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review. Health Policy Plan 2018; 33:1128-1143. [PMID: 30590543 PMCID: PMC6415721 DOI: 10.1093/heapol/czy094] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 12/21/2022] Open
Abstract
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as 'systematic' if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers.
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Affiliation(s)
- Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, U.S.A
| | | | - Bitiya Admasu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | | | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Erchafo B, Alaro T, Tsega G, Adamu A, Yitbarek K, Siraneh Y, Hailu M, Woldie M. Are we too far from being client centered? PLoS One 2018; 13:e0205681. [PMID: 30321212 PMCID: PMC6188795 DOI: 10.1371/journal.pone.0205681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Quality of service provision in health facilities is fundamental to ensure effective care. However, women’s actual experience of care is often neglected. Objective To assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia. Method Community based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions. Results Perceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (β: -0.331, 95% CI: -0.523, -0.140), urban residence (β: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (β: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (β: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (β: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (β: -0.689, 95% CI: -0.907,-0.472). Urban residence (β: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (β: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure. Conclusion Overall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.
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Affiliation(s)
- Belay Erchafo
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Tesfamichael Alaro
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gebeyehu Tsega
- Department of Health Service Management, College of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Ayinengida Adamu
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Meaza Hailu
- Health Service Quality Division, Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: a systematic review of guidelines, tools, standards of practice, best practices, consensus statements and systematic reviews. J Multidiscip Healthc 2018; 11:405-416. [PMID: 30214222 PMCID: PMC6118284 DOI: 10.2147/jmdh.s170720] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Policy makers and health professionals prefer to use preappraised and summarized evidence. Stigma and discrimination (SAD) reduction activities and programs are needed to improve the quality of care delivered to people living with HIV and the success of HIV-related prevention, care and treatment programs. The objective of this review was to identify and describe systematic reviews, best practices, consensus statements, standards of practice and guidelines that addressed SAD among healthcare workers (HCWs). METHODS All documents in the form of systematic reviews, best practices, consensus statements, standards of practice and guidelines were considered for inclusion. The search strategy aimed to find both published and unpublished studies reported in English with unlimited date range in Excerpta Medica Database from Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL), Psychological Information (PsycINFO) database and Medical Literature Analysis and Retrieval System Online (MEDLINE). Websites of organizations and guideline databases were also searched. Two individuals independently appraised the quality of the documents using the Appraisal of Guidelines for Research and Evaluation (AGREE II) checklist and the Joanna Briggs Institute critical appraisal checklist for systematic reviews. Data extraction was done using a customized tool that was developed to record the key information of the source that is relevant to the review question. RESULTS Twelve records (six guideline-related documents and six systematic reviews) were included in the review. Interventions and recommendations developed to reduce HIV-related SAD were categorized into information-based, structural, biomedical, counseling and support, skills building and contact interventions. CONCLUSION Implications for practice: Interventions that reduce HIV-related SAD are broadly categorized into information-based, structural, biomedical, counseling and support, skills building and contact interventions. Because of limited methodological description of the included documents, it was difficult to draw recommendations for policy and practice. Implications for research: Future studies need to use up-to-date instruments to measure SAD. Further studies of greater methodological quality are needed. Guidelines, tools and best practice documents that aim to reduce HIV-related SAD should be developed with the considerations of research evidence on the specific setting and specific targeted populations.
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Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia,
- Ethiopian Evidence Based Healthcare Centre, JBI Center of Excellence, Jimma University, Jimma, Ethiopia,
- School of Public Health, The Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia,
| | - Craig Lockwood
- School of Public Health, The Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia,
| | - Mirkuzie Woldie
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia,
- Ethiopian Evidence Based Healthcare Centre, JBI Center of Excellence, Jimma University, Jimma, Ethiopia,
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Zachary Munn
- School of Public Health, The Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia,
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Feyissa GT, Lockwood C, Woldie M, Munn Z. Evaluation of a guideline developed to reduce HIV-related stigma and discrimination in healthcare settings and establishing consensus. PLoS One 2018; 13:e0198781. [PMID: 30052634 PMCID: PMC6063398 DOI: 10.1371/journal.pone.0198781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/14/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Developing guidelines and policies is critical to address HIV-related stigma and discrimination (SAD) in healthcare settings. To this end, a multidisciplinary panel developed a guideline to reduce SAD. This project evaluated the appropriateness of implementing the guideline in the Ethiopian context. METHODS A consensus of the expert panel was established through a modified Delphi technique which was followed by a panel meeting. Initial tentative recommendations were distributed to experts through e-mails to be evaluated using the modified guideline implementability appraisal (GLIA) v.2.0 checklist. RESULTS In the first round of the Delphi survey, all (13) panel members evaluated the guideline. The overall score for the general domain of the modified GLIA checklist was 96.56%. The scores for individual recommendations ranged from 68.33% to 92.76%. Maximum and minimum scores were attained for measurability (97.71%) and flexibility (59.77%) domains respectively. Percentages mean score lower than 75% was obtained for flexibility and validity domains. Participants suggested that additional tools and training should be added to the guideline. In the second round of the survey, all the recommendations received endorsement with scores above 75%. Maximum and minimum scores were attained for measurability (100%) and flexibility (86.88%) domains respectively. During the panel meeting, issues of responsibility for implementing the guideline were discussed. CONCLUSION The project evaluated implementability of a guideline developed to reduce HIV-related SAD in healthcare settings. The Delphi survey was followed by a half-day meeting that helped in further clarification of points.
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Affiliation(s)
- Garumma Tolu Feyissa
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Mirkuzie Woldie
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Zachary Munn
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
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Bobo FT, Woldie M, Wordofa MA, Tsega G, Agago TA, Wolde-Michael K, Ibrahim N, Yesuf EA. Technical efficiency of public health centers in three districts in Ethiopia: two-stage data envelopment analysis. BMC Res Notes 2018; 11:465. [PMID: 30001735 PMCID: PMC6044096 DOI: 10.1186/s13104-018-3580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of the study was to measure technical and scale efficiency of public health centers in three districts of Jimma zone, Ethiopia. A two-stage data envelopment analysis was used. First, we estimated technical and scale efficiency of the health centers. In the second stage, institutional and environmental factors were against technical efficiency of the health centers to identify factors associated to efficiency of the health centers. RESULTS Eight out of the 16 health centers in the study were found to be technically efficient, with an average score of 90% (standard deviation = 17%). This indicates that on average they could have reduce their utilization of all inputs by about 10% without reducing output. On the other hand, 8 out of 16 health centers were found to be scale efficient, with an average scale efficiency score of 94% (standard deviation = 9%). The inefficient health centers had an average scale score of 89%; implying there is potential for increasing total outputs by about 11% using the existing capacity/size. Catchment population and number of clinical staff were found to be directly associated with efficiency, while the number of nonclinical staff was found to be inversely associated with efficiency.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project of Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Gebeyehu Tsega
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | | | | | - Nuraddis Ibrahim
- Department of Biomedical Science, Jimma University, Jimma, Ethiopia
| | - Elias Ali Yesuf
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität München, Munich, Germany
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Siraneh Y, Ololo S, Tsega G, Yitbarek K, Adamu A, Erchafo B, Hailu M, Woldie M. Level and Factors Associated with Professional Commitment of Health Professionals Providing Institutional Delivery Services in Public Health Facilities, Southwest Ethiopia. Ethiop J Health Sci 2018; 28:495-504. [PMID: 30607062 PMCID: PMC6308734 DOI: 10.4314/ejhs.v28i4.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Professional commitment is beyond a commitment for a particular organization and implies the individuals' perspective towards their profession and the motivation that they have to stay in their job with willingness to strive and uphold the values and goals of the profession. In Ethiopia, uptake of institutional delivery services is low. However, the level and factors associated with professional commitment is not known so far. Hence, our objective is to assess the level and factors associated with commitment of health professionals providing institutional delivery services in public health facilities of Jimma Zone, Southwest Ethiopia. METHODS A facility-based cross-sectional study design was conducted from March 01-20, 2016. A total of 442 eligible health professionals were included from randomly selected 7 districts and 47 respective health facilities. Health professionals were requested to fill self-administered questionnaire. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P<0.05. All assumptions of linear regression and principal component analysis were checked. RESULTS The percentage mean score of professional commitment was 72.71% (SD21.88). The percentage mean score for perceived maternal health goal scale was 68.37% with the total variance explained being 69.68%. Perceived staff interaction, work-life balance, affective organizational commitment, normative organizational commitment, personal characteristics and perceived maternal health goal were independent predictors of professional commitment. CONCLUSION The percentages mean score of professional commitment was medium. Hence, Health professionals should foster their level of professional commitment to increase uptake of institutional delivery services.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
| | - Shimeles Ololo
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
| | - Gebeyehu Tsega
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
| | - Kiddus Yitbarek
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
| | - Ayinengida Adamu
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
| | - Belay Erchafo
- Department of Public Health, college of Medicine and Health Sciences, Wachemo University, Ethiopia
| | - Meaza Hailu
- Oromia National Regional State, Health Bureau, Primary Healthcare Quality Assurance Expert, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Economics, Management, and Policy, Faculty of public health, Institute of health,Jimma University, Ethiopia
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Abazinab S, Woldie M, Alaro T. Readiness of Health Centers and Primary Hospitals for the Implementation of Proposed Health Insurance Schemes in Southwest Ethiopia. Ethiop J Health Sci 2018; 26:449-456. [PMID: 28446850 PMCID: PMC5389059 DOI: 10.4314/ejhs.v26i5.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In response to the 2005 World Health Assembly, many low income countries developed different healthcare financing mechanisms with risk pooling stategy to ensure universal coverage of health services. Accordingly, service availability and readiness of the health system to bear the responsibility of providing service have critical importance. The objective of this study was to assess service availability and readiness of health centers and primary hospitals to bear the responsibility of providing service for the members of health insurance schemes. Methods and Materials A facility based cross sectional study design with quantitative data collection methods was employed. Of the total 18 districts in Jimma Zone, 6(33.3%) districts were selected randomly. In the selected districts, there were 21 functional public health facilities (health centers and primary hospitals) which were included in the study. Data were collected by interviewer administered questionnaire. Descriptive statistics were calculated by using SPSS version 20.0. Prior to data collection, ethical clearance was obtained. Results Among the total 21 public health facilities surveyed, only 38.1% had all the categories of health professionals as compared to the national standards. The majority, 85.2%, of the facilities fulfilled the criteria for basic equipment, but 47.7% of the facilities did not fulfill the criteria for infection prevention supplies. Moreover, only two facilities fulfilled the criteria for laboratory services, and 95.2% of the facilities had no units/departmenst to coordinate the health insurance schemes. Conclusions More than nine out of ten facilities did not fulfill the criteria for providing healthcare services for insurance beneficiaries and are not ready to provide general services according to the standard. Hence, policy makers and implementers should devise strategies to fill the identified gaps for successful and sustainable implementation of the proposed insurance scheme.
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Affiliation(s)
| | - Mirkuzie Woldie
- Department of Health Economics, Management and Policy, College of Health Sciences, Jimma University
| | - Tesfamichael Alaro
- Department of Health Economics, Management and Policy, College of Health Sciences, Jimma University
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Abstract
Background Clients' needs and their satisfaction are priority issues in studying quality in reproductive health services. However, only 24–37% of Ethiopian women were informed about the available family planning methods and their utilization. High national total fertility rate (4.8) and low contraceptive prevalence rate (29%) might be attributed to these and other reasons. This study assessed the level of client-centeredness of family planning services and their determinants in public health facilities of Bahir Dar Town, Northwest Ethiopia. Methods Exit interviews of 326 consecutively enrolled clients were conducted using structured questionnaire. Thirty consultation sessions were observed using a checklist to record client-provider interaction. The outcome variable was client centeredness as measured by perceived informed choice with perceived client-provider interaction as the intermediate variable. Results The average levels of perceived informed choice and client provider interaction were 70.0% and 67.6%, respectively. Perceived clinical competence of providers, perceived integration and coordination of care, perceived accessibility of services, perceived participation of families and friends in care delivery, perceived physical comfort of the facilities and type of the health facility were the independent predictors of perceived client provider interaction. Perceived degree of client provider interaction, perceived clinical competence of providers, type of health facility and perceived accessibility of services were independent predictors of perceived informed choice (p≤0.01). Conclusion Client-centeredness of family planning services, as measured by clien-provider interaction and informed choice was not sufficiently assured in the study facilities.
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Affiliation(s)
- Ayinengida Walle
- Department of Health Economics, management and Plicy, Jimma University, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Economics, management and Plicy, Jimma University, Ethiopia
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Abstract
BACKGROUND Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. METHOD Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. RESULTS Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. CONCLUSION Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, College of Health sciences; Wollega University, Nekemte, Ethiopia
| | - Elias Ali Yesuf
- Department of Health Economics, Management, and Policy, Faculty of Public Health; Jimma University, Jimma, Ethiopia
- CIH-LMU Center for International Health, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mirkuzie Woldie
- Department of Health Economics, Management, and Policy, Faculty of Public Health; Jimma University, Jimma, Ethiopia
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Weldegebriel Z, Ejigu Y, Weldegebreal F, Woldie M. Motivation of health workers and associated factors in public hospitals of West Amhara, Northwest Ethiopia. Patient Prefer Adherence 2016; 10:159-69. [PMID: 26929608 PMCID: PMC4760664 DOI: 10.2147/ppa.s90323] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health professionals' motivation reflects the interaction between health professionals and their work environment. It can potentially affect the provision of health services; however, this important attribute of the workplace climate in public hospitals is not usually given serious attention to the desired level. For this reason, the authors of this study have assessed the level of motivation of health professionals and associated factors in public hospitals of West Amhara, Northwest Ethiopia. METHODS A facility based cross-sectional study was conducted in eight public hospitals of West Amhara from June 1 to July 30, 2013. A total of 304 health professionals were included in this study. The collected data were analyzed using SPSS software version 20. The reliability of the instrument was assessed through Cronbach's α. Factor scores were generated for the items found to represent the scales (eigenvalue greater than one in varimax rotation) used in the measurement of the variables. The scores were further analyzed using one-way analysis of variance, t-tests, Pearson's correlation, and hierarchical multiple linear regression analyses. The cut-off point for the regression analysis to determine significance was set at β (95% confidence interval, P<0.05). RESULTS Mean motivation scores (as the percentage of maximum scale scores) were 58.6% for the overall motivation score, 71.0% for the conscientiousness scale, 52.8% for the organizational commitment scale, 58.3% for the intrinsic motivation scale, and 64.0% for organizational burnout scale. Professional category, age, type of the hospital, nonfinancial motivators like performance evaluation and management, staffing and work schedule, staff development and promotion, availability of necessary resources, and ease of communication were found to be strong predictors of health worker motivation. Across the hospitals and professional categories, health workers' overall level of motivation with absolute level of compensation was not significantly associated with their overall level of motivation. CONCLUSION The strongest drivers of all motivation dimensions were found to be nonfinancial human resource management tools, so policy makers and health workforce stake holders should focus on these tools to alleviate motivation problems.
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Affiliation(s)
- Zemichael Weldegebriel
- Public Planning Department, Debark Hospital, Debark, North Gondar, Amhara Region, Ethiopia
- Correspondence: Zemichael Weldegebriel, Debark Hospital, Lemalimo Street, Debark, North Gondar, Amhara Region 33, Ethiopia, Tel +251 93 740 8660, Email
| | - Yohannes Ejigu
- Department of Health Services Management, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Fitsum Weldegebreal
- Department of Medical Laboratory Science, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Services Management, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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Agago TA, Woldie M, Ololo S. Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo Town, South Ethiopia. Ethiop J Health Sci 2015; 24:195-202. [PMID: 25183925 PMCID: PMC4141222 DOI: 10.4314/ejhs.v24i3.2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Cost-sharing between beneficiaries and governments is critical to achieve universal health care coverage. To address this, Ethiopia is currently introducing Social Health Insurance. However, there has been limited evidence on willingness to join the newly proposed insurance scheme in the country. The purpose of this study is to assess willingness to join and pay for the scheme among teachers in Wolaita Sodo Town government educational institutions, South Ethiopia. Methods A cross-sectional study was conducted from February 5 to March 10, 2012 on 335 teachers. Stratified simple random sampling technique was used and data were collected using structured interviewer administered questionnaire. Binary and multiple logistic regressions were used to estimate the crude and adjusted odds ratios for willingness to pay. Results Three hundred twenty-eight teachers participated in the study with response rate of 98%. About 55% of the teachers had never heard of any type of health insurance scheme. However, 74.4% of them were willing to pay for the suggested insurance scheme. About 47% of those who were willing to pay agreed to contribute greater than or equal to 4% of their monthly salaries. Willingness to pay was more likely among those who had heard about health insurance, had previous history of inability to pay for medical bills and achieved higher educational status. Conclusion The majority of the teachers were willing to join social health insurance; however, adequate awareness creation and discussion should be made with all employees at various levels for the successful implementation of the scheme.
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Affiliation(s)
| | - Mirkuzie Woldie
- Department of Health Services Management, Jimma University, Ethiopia
| | - Shimeles Ololo
- Department of Health Services Management, Jimma University, Ethiopia
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Affiliation(s)
- Mirkuzie Woldie
- Health Systems Management Specialist, Jimma University, Ethiopia
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Zeleke A, Chanie T, Woldie M. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Int Arch Med 2014; 7:18. [PMID: 24826198 PMCID: PMC4018470 DOI: 10.1186/1755-7682-7-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 04/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. OBJECTIVE To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. METHODS A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). RESULTS Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. CONCLUSIONS Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended.
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Affiliation(s)
- Abebe Zeleke
- Department of Pharmacy, Wollo University, P.O. Box: 1145, Dessie, Ethiopia
| | | | - Mirkuzie Woldie
- Department of Health Services Management, Jimma University, Jimma, Ethiopia
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