Search

Destaw Fetene Teshome,1 Shitaye Alemu Balcha,2 Tadesse Awoke Ayele,1 Asmamaw Atnafu,3 Kassahun Alemu Gelaye1 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Destaw Fetene Teshome Email destaw.fetene@gmail.comBackground: In Ethiopia, the majority of hypertension cases remain undiagnosed, untreated, and uncontrolled. Beliefs about hypertension and its complications play an important role in hypertension management behaviors. Accurate assessment of individuals’ beliefs towards the disease is of paramount importance in the design of hypertension education. This study aimed to develop and validate a hypertension belief assessment tool based on the Health Belief Model for the general population among rural adults in northwest Ethiopia.Methods: The study included item construction, face and content validation, factor analysis, and establishment of reliability and validity of the tool. A total of 308 rural adults participated in the study. Inter-item and item-to-total correlations were used to examine the items assessed with the same content on a scale. Principal component analysis with promax rotation was used to extract the factors. Internal consistency reliability was assessed using Cronbach’s alpha coefficient. Convergent and discriminant validity were assessed using average variance extraction and maximum shared variance.Results: The median age of the participants was 41 (IQR: 31– 55) years. Of the participants, 175 (56.8%) were female and 287 (93.2%) were farmers. Kaiser-Meyer-Olkin test value of 0.84 and significant Bartlett’s test of sphericity (p=0.000) rev

Getachew Asefa,1 Asmamaw Atnafu,2 Endalkachew Dellie,2 Tsegaye Gebremedhin,2 Andualem Yalew Aschalew,2 Chalie Tadie Tsehay2 1Shewarobit Primary Hospital, Shewarobit, North Shewa Zone Administration, Amhara National Regional State, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Chalie Tadie TsehayUniversity of Gondar, P.O. Box: 196, Gondar, EthiopiaEmail chatadie78@gmail.comPurpose: Health System Responsiveness is the key objective of the health system used to fulfil patients’ universal legitimate expectations. However, the health system’s responsiveness to HIV/AIDS was not assessed in Ethiopia. Therefore, this study aimed at assessing the health system responsiveness of HIV/AIDS treatment and care services and associated factors in the public health facilities of Shewarobit town, Ethiopia.Patients and Methods: An institution-based cross-sectional study was employed from 15 February to 15 April 2020 in the public health facilities of Shewarobit town. The data were collected among 416 randomly selected Anti-Retroviral Therapy (ART) users using an interviewer-administered questionnaire. Responsiveness was measured using 27 Likert scale questions across seven responsiveness domains. A binary logistic regression model was fitted. A p-value of less than 0.05 and AOR with a 95% confidence interval (CI) was used to declare the associated factors in the final multivariable logistic regression analysis.Results: The overall health system responsiveness was 55.3% (95% CI: 50.6– 59.8). High performance of responsiveness was found on confidentiality, respect, and communication domains, whereas poor responsiveness was achieved in prompt attention and choice domains. Participants aged 50+ years (AOR:2.48, 95% CI, 1.12– 5.54), perceived good health (AOR: 3.10, 95% CI: 1.75– 5.48), patients’ satisfa

Nahusenay Masresha,1 Esileman Abdela Muche,2 Asmamaw Atnafu,3 Ousman Abdela2 1Hospital Pharmacy, University of Gondar Comprehensive and Specialized Hospital, Gondar, Ethiopia; 2Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Ousman Abdela Tel +251-912-02-3692Fax +251-58-114 1240Email ousmy2009@gmail.comPurpose: To assess the quality of warfarin anticoagulation and its clinical outcomes on patients treated with warfarin at the University of Gondar comprehensive specialized hospital, North-west Ethiopia.Methods: We reviewed medical records of patients treated with warfarin between June 1, 2016, and May 30, 2018, at the University of Gondar comprehensive specialized hospital. The quality of anticoagulation was evaluated using the percentage of time spent in the therapeutic range. Data were entered into Statistical Product and Service Solutions (SPSS), version 20. Descriptive statistics were used to describe the socio-demographic and clinical characteristics of study participants. Multivariable logistic regression analysis was performed to identify independent predictors of quality of anticoagulation. Statistical significance was declared when the p-value was less than 0.05 at 95% confidence interval (CI).Results: From a total of 202 patients’ charts reviewed, women accounted for 134 (67.3%). The mean participants’ age was 44.33 years (± 17.05years SD). The median time spent in the therapeutic range was 37.91 with an IQR of (0.00– 65.86). More than two-third (143, (70.8%)) of participants had poor anticoagulation quality (time spent in the therapeutic range is less than 65%). Twenty-seven patients (13.4%) experienced adverse medication events of bleeding and thromboembolic events. Lo

Getu Debalkie Demissie,1 Asmamaw Atnafu2 1Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Getu Debalkie Demissie Email getud2006@gmail.comBackground: More than 150 million people encounter huge cost of health expenses every year, and most of these treatment seekers face poverty owing to out-of-pocket payments. Community-based health insurance (CBHI) won popularity as a makeshift health financing mechanism for out-of-pocket payments in poor communities. The aim of this study was therefore to explore the facilitators and impediments of enrollment to community-based health insurance in rural parts of the Amhara region, Ethiopia.Methods: Focus Group Discussion (FGD) was the main data collection instrument supplemented by key informant interview (KII). The FGD participants were selected using a purposive sampling technique. The participants were therefore selected based on their membership status of CBHI (members or non-members). Six FGDs and four KIIs were conducted in November 2019 in three districts. Before analyzing the data, all FGDs and KIIs were transcribed and transferred into ATLAS.ti version 7.1 software. An inductive thematic analysis approach was done, that is, on the basis of major themes emerged from the data.Results: Low level of awareness, perception of high amount of premium, poor perception of quality of services and lack of trust are the barriers to join community-based health insurance.Conclusion: There has been low level of awareness and misconception about community-based health insurance. The major reason to decline to join CBHI was low capacity to pay the premium.Keywords: community-based health insurance, enrolment, Ethiopia

Piniel Melkamu,1 Yaregal Animut,2 Amare Minyihun,3 Asmamaw Atnafu,3 Mezgebu Yitayal3 1University of Gondar Specialized Referral Hospital, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Mezgebu YitayalDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, EthiopiaTel +251 947 057683Email mezgebuy@gmail.comBackground: Epilepsy has significant economic implications on health care needs, premature death, and lost work productivity. Therefore, this study aimed to assess the cost of illness of epilepsy and its associated factors in the Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia.Methods: We conducted an institution-based cross-sectional study from March 2018 to April 2018. A total of 442 adult epileptic patients were selected from the chronic follow-up clinic using a systematic sampling technique. We fitted binary logistic regression to identify the associated factors, and significant variables in the multivariable logistic regression analysis were determined using P-value < 0.05 and 95% CI.Results: The study revealed that the mean total cost illness of epilepsy per patient per year was US$ 166± 61.6, and 30.3% of patients incurred high cost. Age (AOR = 1.06; 95% CI: 1.03, 1.09), sex (AOR = 3.66; 95% CI: 1.94, 6.89), educational (AOR = 0.15; 95% CI: 0.005, 0.047), polytherapy (AOR = 4.66; 95% CI: 2.29, 9.46), seizure frequency (AOR = 4.48; 95% CI: 1.56, 12.8), place where AEDs were bought (AOR = 6.23; 95% CI: 2.7, 14.03) and disease duration (AOR = 0.11; 95% CI: 0.05, 0.25) were predictors of the cost of illness of epilepsy.Conclus

Nuhamin Zeru,1 Destaw Fetene,2 Demiss Mulatu Geberu,3 Alemakef Wagnew Melesse,2 Asmamaw Atnafu3 1University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia; 3Department of Health Systems and Policy, University of Gondar, Gondar, EthiopiaCorrespondence: Asmamaw AtnafuUniversity of Gondar, P.O. Box 196, Gondar, EthiopiaTel +251-918776945Email asme2002@gmail.comPurpose: Self-medication is the use of medicines by individuals to treat self-recognized illnesses or symptoms without any medical supervision. Such practices may cause antimicrobial resistance, which causes treatment failure, economic loss, serious health hazards, missed diagnosis, delayed appropriate treatment, drug dependency, and adverse drug effects. However, empirical evidence is limited to the current status of its practices and associated factors among university students. Thus, the aim of this study was to assess the magnitude and associated factors of self-medication practices among medicine and health science students at the University of Gondar.Methods: An institution-based cross-sectional study was employed from February to March 2017. A total of 792 randomly selected students were surveyed with a self-administered structured questionnaire. Epi Info version 7 and SPSS version 20 were used for data entry and analysis, respectively. Binary logistic regression analysis was performed. In multivariable analysis, P-value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to identify associated factors.Results: Self-medication practice was found to be 52.4% (95% CI: (49%, 56%)) among university students. For most students, the major reason for using self-medication was taking the illness as less serious (71.1%). Females (AOR: 1.48; 95% CI: 1.08– 2.01), income category (USD 44.01– 175.87) (AOR: 0.47; 95% CI: 0.29– 0.78), sixth year students

Habtamu Mihret,1 Asmamaw Atnafu,2 Tsegaye Gebremedhin,2 Endalkachew Dellie2 1Injibara General Hospital, Awi Zone administration, Amhara National Regional State, Injibara, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Endalkachew DellieDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar Po. Box 196, University of Gondar, Gondar, EthiopiaEmail endalkd.07@gmail.comIntroduction: Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia.Materials and Methods: A pre–post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of < 0.05 and a mean difference with 95% CI was used to test the significance of the interventions.Results: The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9%

Asmamaw Atnafu,1 Amare Tariku2 1Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Asmamaw AtnafuUniversity of Gondar, PO Box 196, Gondar, EthiopiaTel +251-918776945Email asme2002@gmail.comPurpose: The Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households’ willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia.Patients and Methods: Using a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest.Results: Out of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households’ occupation (AOR=2.26; 95% CI:=1.12– 5.07), perceived good (AOR=2.21; 95% CI:=1.53− 3.21), and medium (AOR=1.44; 95% CI=1.22– 2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08– 2.73) were associated with higher odds of willingness to join the scheme.Conclusion: As The study revealed that level of willingness to jo

Meseret Derbew Molla,1 Haileab Fekadu Wolde,2 Asmamaw Atnafu3,4 1Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Meseret Derbew MollaDepartment of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251 918331617Email messidrm19@gmail.comPurpose: Obesity is becoming one of the most common public health problems worldwide. In particular, central obesity which indicates abnormal fat accumulation in the abdominal regions is highly associated with the risk of getting cardiometabolic diseases and their progression to end stage diseases or death. However, in developing countries, including Ethiopia less attention has been given to analyze the magnitude and associated factors of it. Therefore, we aimed to determine the prevalence of central obesity and its associated factors among adults in urban areas of Northwest Ethiopia.Methods: A cross-sectional study was conducted among 773 adults who lived in urban areas of Northwest Ethiopia from April 1 to May 30, 2019. Central obesity was assessed using both waist to hip ratio and waist circumference of the participants. Data were analyzed using STATA 14.0. The factors associated with central obesity were identified by binary logistic regression analyses using 95% confidence interval and the degree of association of the factors was measured using adjusted odds ratio (AOR). P-value

Terefe Derso,1 Adane Kebede,2 Haileab Fekadu Wolde,3 Asmamaw Atnafu,2,4 Endalkachew Dellie2 1Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Endalkachew Dellie Department of Health Systems and PolicyInstitute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO. Box: 196, Gondar, EthiopiaEmail endalkd.07@gmail.comObjective: Rotavirus vaccines reduced severe rotavirus disease by more than 60% during the first year of life. In Ethiopia, however, about 28% and 6% of diarrheal disease hospitalizations and deaths among under-five children are associated with rotavirus, respectively. Therefore, this study aimed to investigate rotavirus coverage and associated factors in a rural population of the northwest, Ethiopia.Methods: A community-based cross-sectional study was conducted from May to June 2019, in Dabat and Gondar Zuria districts, northwest Ethiopia. Data from 603 mothers paired with children aged 12– 36 months were collected through house-to-house visits. Variables having a p-value < 0.05 were considered to have a significant association with the outcome. Odds ratio (OR) with its 95% confidence interval (CI) was used as a measure of association.Results: The prevalence of rotavirus vaccine coverage among children was 76.60% (95% CI; 69.98, 83.22). The dropout rate for rotavirus vaccine dose 2 out of rotavirus vaccine dose 1 was 1.99%. Mothers w

Asmamaw Atnafu, Tsegaye Gebremedhin Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Asmamaw AtnafuDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box: 196, Gondar, EthiopiaEmail asme2002@gmail.comPurpose: Utilization of primary healthcare services in the rural communities of Ethiopia is very low. The Ethiopian government has introduced community-based health insurance (CBHI) to improve the health service utilization of the rural community. Thus, this study was conducted to examine the association between CBHI enrollment and child health service utilization in northwest Ethiopia.Patients and Methods: A cross-sectional case comparison study among CBHI enrolled and unenrolled households was conducted. A total of 226 sick children from 2008 surveyed households were included in the study. Bivariate-probit regression analysis was employed to account the endogenous nature of insurance enrollment and child health services utilization.Results: The results showed that the overall sick child healthcare visit in the CBHI enrolled group was about 0.44 (44%) point more compared to those unenrolled households. CBHI enrolled households in the poorest wealth group have a higher probability of visiting healthcare facilities for their sick children (coefficient: 0.13, SD: 0.07, 95% CI: − 0.01, 0.27), whereas CBHI enrolled households with older age household head have a lower probability of visiting healthcare facilities for their sick children (coefficient: − 0.16, SD: 0.08, 95% CI: − 0.32, 0.01).Conclusion: A promising positive effect on sick children’s health services utilization among CBHI enrolled was noticed. Moreover, households in the poorest wealth status and older age head affect the use of sick children’s healthcare services a

Elsabet Adane,1 Asmamaw Atnafu,2 Andualem Yalew Aschalew2 1University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Andualem Yalew Aschalew P. O. Box 196, Gondar, EthiopiaTel +251 918151825Email yalewandualem@gmail.comPurpose: Non-communicable diseases impose a significant social, economic and health burden. Hypertension, the leading contributor to the global burden of disease and a growing public health problem worldwide, is one of the most serious non-communicable diseases. In Ethiopia, empirical evidence on the economic burden of hypertension is limited. Therefore, this study aimed to measure the cost of hypertension and associated factors at the University of Gondar comprehensive specialized hospital, northwest Ethiopia.Patients and Methods: An institution-based cross-sectional study was conducted on 442 adult hypertensive patients using a semi-structured questionnaire to estimate the direct and indirect costs of hypertension. The human capital approach was used to calculate indirect costs. A generalized linear model was fitted to identify factors associated with the cost of hypertension at a 95% confidence level and < 0.05 p-value.Results: A total of 442, 56.3% female and 64.3% stage one hypertension patients were included. The total cost of hypertension was ETB 2510.32 ($91.72) ± 2152.80 (78.65) per patient per year; The direct medical and non-medical cost constituted 60.81% and 12.17% of the total cost of hypertension, respectively. Hospitalized (exp(b)=1.87, p< 0.001), using multidrug (exp(b)=1.32, p< 0.000), high socioeconomic status (exp(b)=1.41,p< 0.000), college and above education(exp(b)= 1.35, p< 0.016), government employment (exp(b)= 1.30, p< 0.012), retirement (exp(b)= 0.71, p< 0.001) and co-morbidity (exp(b)= 1