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BackgroundGlobally, a Balanced Scorecard (BSC) is used to measure healthcare institutional performance. Thus, since 2010, Ethiopia has adopted and implemented BSC in all its civil service organizations. Ineffective implementation of this tool has a significant impact on the healthcare performance. The health sector’s healthcare provision, customer satisfaction, customer retention, organizational profit, changes and improvements in the healthcare delivery practice are affected by the implementation of BSC tools. However, no evidence or study indicates the implementation of BSC practice in the Ethiopian context. Thus, this study aimed to assess the magnitude of BSC implementation practice and associated factors among healthcare providers at public primary hospitals in the Central Gondar zone, Northwest Ethiopia.MethodsA mixed methods study was carried out at public primary hospitals from May 25 to June 26, 2022, in Central Gondar zone with 404 study participants. Study participants were selected using a systematic random sampling technique for the quantitative part, and 12 study subjects were chosen purposively for the qualitative part. Bi-variable and multivariable logistic regression analyses were done. The strength of associations was measured using the adjusted odds ratio (AOR) at 95% CI and a p-value of less than 0.05 in the multivariable analysis to declare significant factors. Thematic analysis was applied for the qualitative data using open code 4.03 version software.ResultsThe implementation practice of BSC was found at 48.5% (95% CI: 43.6, 53.4%) with a response rate of 95.28%. Teamwork (AOR: 2.68, 95% CI; 1.53, 4.69), organizational communication (AOR: 3.24, 95% CI: 1.79, 5.89), and availability of infrastructure (AOR: 2.03, 95% CI; 1.14, 3.64) were significantly associated to balanced scorecard implementation practice.ConclusionThe implementation practice of BSC was poor compared to the national standard and the findings of prior studies. Thus, concerned stakeholders need to focus on improving and working on organizational communication channels, teamwork, and infrastructure fulfilment to facilitate the implementation practice of a balanced scorecard.

Abstract Background The fee waiver system is one of the components of the 2004 health care financing reform in Ethiopia. It is a system for granting access to health services to those who are unable to pay. The utilization health services among fee waiver beneficiaries remain low and unevenly distributed. This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dessie City, Northeast Ethiopia. Methods A community-based cross-sectional study design was employed in Dessie City from March 23 to April 23, 2021. The study was conducted among 407 fee waiver beneficiaries. A structured, interviewer-administered questionnaire was used to collect data. Participants were selected using a simple random sampling technique. Both bi-variable and multi-variable binary logistic regressions were performed. Significant factors for the outcome variable were identified at 95% CI with a p-value

Objective: Governance in health care generally means strengthening leadership and governance functions, improving systems, and having both central and local governments jointly take responsibility for overall health system performance. More than half of the world’s population has expressed distrust of state institutions including the health sector. Ethiopia, like other African countries, faces many challenges in the process of good governance building. The aim of this study was to assess the practices health care governance in the South Wollo Zone health sectors, Northeast Ethiopia. Methods: A facility-based cross-sectional study design was conducted in the South Wollo from 15 May to 15 June 2021. A simple random sampling technique was used, and the data were collected using a structured survey. The data were entered into Epi data version 4.6 for cleaning and exported to SPSS v.25 for further analysis. We performed binary and multivariable logistic regression analysis to identify factors of governance practices. Variables with p values less than 0.05 during multivariable logistic regression analysis were declared statistically significant. Results: A 96.75% (387) of the study participants completed the study questionnaires. Out of these, 37.98% (95% confidence interval: 33.1%, 42.9%) have been found practicing good governance in the health sector. Having had training (adjusted odds ratio = 7.92, 95% confidence interval: 4.04, 15.51), having job descriptions (adjusted odds ratio = 2.05, 95% confidence interval: 1.03, 4.09), opportunity to share with peers (adjusted odds ratio = 6.64, 95% confidence interval: 3.02, 14.62), political interference (adjusted odds ratio = 0.40, 95% confidence interval: 0.22, 0.71), and age

Abstract Background There is limited national representative evidence on determinants of women’s acceptance of wife-beating especially; community level factors are not investigated in Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with acceptance of wife beating among reproductive age women in Ethiopia. Methods Secondary data analysis was done on 2016 Ethiopian Demographic and Health Survey data. A total of 15,683 weighted reproductive age group women were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by Stata version 14.0 to identify individual and community-level factors. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at p value less than 0.05 at the final model. Result Individual-level factors significantly associated with acceptance of wife-beating among women were; being Muslim follower [AOR = 1.3, 95% CI = (1.1, 1.5)], Being married [AOR = 1.3, 95% CI = (1.1, 1.6)], attending primary, secondary and higher education [AOR = 0.8, 95% CI = (0.7, 0.9)], [AOR = 0.4, 95% CI = (0.3, 0.5)], [AOR = 0.3, 95% CI (0.2, 0.4)] respectively. From community level factors, living in Somali [AOR = 0.2 95% CI = (0.1, 0.3)], Addis Ababa [AOR = 0.3, 95%CI = (0.2, 0.5)] and Dire Dawa [AOR = 0.5, 95% CI = (0.3, 0.7)] were 80%, 70% and 50% less likely accept wife-beating when compare to women who live in Tigray region, respectively. Live in high proportion of poor community [AOR = 1.2, 95% CI = (1.1, 1.3)], live in low proportion of television exposure communities [AOR = 1.4, 95% CI = (1.2, 2.2)] were significantly associated with acceptance of wife-beating among women in Ethiopia. Conclusion Educational status, religion, marital status, region, community-level wealth, and community level of television exposure had a statistical association with women’s acceptance of wife-beating. Improving educational coverage, community-level of media exposure, community-level wealth status and providing community-friendly interventions are important to reduce the acceptance of wife-beating among women in Ethiopia.

Abstract In the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa.

Abstract Background Worldwide, pneumonia is the third leading cause of death in under 5 years children. Ethiopia is ranked 4th out of 15 countries having the highest burdens of the death rate among under-five children due to pneumonia. Regardless of this fact, efforts to identify determinants of pneumonia have been limited yet in Amhara region. This study was aimed to identify predictors of community-acquired childhood pneumonia among 2–59 months old children in the Amhara region, Ethiopia. Methods Facility-based case–control study was conducted in the Amhara region from June 4 to July 15, 2018, among 28 health centers distributed across the region. The total sample size used was 888 (296 cases and 592 controls) children whose age were 2–59 months. At first, multistage sampling technique was employed. Data were collected on a face-to-face interview. Epi data v. 4.6 for data entry and statistical packages for social sciences version 23 for data analysis were used. Multivariable logistic regression analyses were used to test the associations between the study variables at P-value

Objective: Despite the reproductive health needs of youth having been supported by different organizations, youths continue to fall victim to sexual and reproductive health problems, and utilization of those services remains low. All efforts have not been felt across the Ethiopian learning institutions as is evidenced by persistent reproductive health problems. This study was aimed to determine sexual and reproductive health service needs among preparatory school youths of Debre Tabor town, Ethiopia. Methods: Facility-based cross-sectional study design was conducted in Debre Tabor town from 15 to 30 February 2020. A simple random sampling technique was used to access a total of 850 preparatory school students. The data were collected using pre-tested, structured, and self-administered questionnaires. Data were entered into EpiData v. 4.6 and exported to SPSS version 25 software for analysis. Binary logistics regression was used for analysis. Adjusted odds ratio along with 95% confidence interval was estimated to measure the strength of the association. The level of statistical significance was declared at a p value of 0.05. Results: The overall magnitude of sexual and reproductive health service needs was found 61.5% at 95% confidence interval (58.2%, 64.8 %). Being married (adjusted odds ratio = 2.24; 95% confidence interval: 1.10, 4.55), having information about sexual and reproductive health (adjusted odds ratio = 2.56; 95% confidence interval: 1.85, 3.55), youth discussion with families on sexual and reproductive health (adjusted odds ratio = 1.52, 95% confidence interval: 1.11, 2.10), and having a history of sexual intercourse (adjusted odds ratio = 2.19; 95% confidence interval: 1.53, 3.13) were found significantly associated with sexual and reproductive health service needs of youths. Conclusion: the overall need for sexual and reproductive health services among youths was found high. Therefore, managers and health workers need to prioritize an intervention that can improve youth-friendly service, information dissemination, and counseling, promoting discussion among family members on the sexual and reproductive health needs of the youths.

BackgroundUnder-five mortality (U5M) is one of the most important and sensitive indicators of the health status of the community. Despite there having been a substantial reduction in U5M since 1990, its rate is still high in Sub-Saharan African countries. Thus, this study aimed to assess time to under-five mortality and its predictors in rural Ethiopia.MethodsThis study utilized a secondary analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 9,807 weighted under-five children selected at different stages were included in the analysis. The Kaplan-Meier and Cox's-gamma shared frailty models were used to estimate survival time and to identify predictors of under-five mortality, respectively. An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was used to measure the effect size and direction of the association.ResultsThe study indicated that 6.69% (95% CI: 6.13, 7.30) of children died before celebrating their fifth birthday in rural Ethiopia. Of all the deaths, the median time to death was 27 months. After controlling the effect of cluster and other confounding factors, female sex (AHR = 0.62, 95% CI: 0.52, 0.75), ever born greater than five children (AHR = 1.40, 95% CI: 1.07, 1.83), very large size at birth (AHR = 1.33, 95% CI: 1.03 1.71), very small size at birth (AHR = 1.41, 95% CI: 1.10, 1.82), twin pregnancy (AHR = 3.5, 95% CI: 2.47, 4.88), not ever breastfeeding (AHR = 11.29, 95% CI: 9.03, 14.12), unimproved latrine (AHR = 3.44, 95% CI: 1.91, 6.17), covered by health insurance (AHR = 0.29, 95% CI: 0.12, 0.70) were predictors of under-five mortality.ConclusionsStill under-five mortality was high in rural Ethiopia as compared to the global under-five mortality rate. In the final model, sex of a child, the total number of children ever born, children's size at birth, type of pregnancy, breastfeeding, type of toilet, and being covered by health insurance were significant predictors of under-five mortality. Further emphasis should be given to twin and not breastfeeding children, as well as households' better encouraging membership of community health insurance and utilization of improved latrines.

BackgroundHIV risk behavior among people living with HIV/AIDS (PLWHA) is a major public health concern as it increases HIV transmission. In Ethiopia, findings regarding HIV risk behavior have been inconsistent and inconclusive. Therefore, this meta-analysis aimed to estimate the pooled prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia.MethodsInternational databases, including Google Scholar, Cochrane library, HINARI, Pub Med, CINAHL, and Global Health were systematically searched to identify articles reporting the prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia. The data were analyzed using STATA/SE version-14. The random-effects model was used to estimate the pooled effects. I-squared statistics and Egger's test were used to assess the heterogeneity and publication bias respectively.ResultsA total of 4,137 articles were reviewed and fourteen articles fulfilling the inclusion criteria were included in this meta-analysis. The pooled prevalence of HIV risk behavior in Ethiopia was 34.3%% (95% CI: 28.2, 40.3). Severe heterogeneity was observed between the included research articles (I2 = 96.6, p = 0.000). Alcohol use (OR = 1.9, 95%, CI: [1.6, 2.3]), HIV status non-disclosure (OR = 2.3, 95% CI: [1.3, 4.0]) and perceived stigma (OR = 2.3, 95% CI: [1.3, 4.1]) had a significant association with HIV risk behavior.ConclusionThe prevalence of HIV risk behavior among PLWHA in Ethiopia was high. Alcohol use, HIV status non-disclosure, and perceived stigma had a significant association with HIV risk behavior. In addition to promoting access to Antiretroviral Therapy (ART) treatment and improving medication adherence among PLWHA, various intervention programs focusing on the associated factors have to be implemented to tackle high-risk sexual behavior and go forward toward ending the HIV/AIDS pandemic.

Background Family planning is critical for the health of women and their families and it can accelerate a country’s progress toward reducing poverty and achieving Sustainable Development Goals. Effective use of family planning methods helps couples achieve the desired number of children, contribute to improving maternal and child health which may help women avoid unwanted pregnancy, and reduce the risk factors for maternal and child deaths. Moreover, contraceptive prevalence and unmet need for family planning are key indicators for determining the level of improvements in access to reproductive health. So, this study aimed to identify the prevalence and associated factors of unmet need of modern family planning among reproductive-age women in the south Gondar zone. Methods A community-based cross-sectional study design was conducted in the southern Gondar zone among 528 reproductive-age women. Data were collected with pre-tested, structured, interviewer-administered questionnaires. Data were coded and entered into Epi info version 7 and exported to SPSS version 20. Bivariable and multivariable logistic regression models were applied. A P-value0.05 was considered to declare a result as significant at 95% CI. Result The overall unmet need in this study area was 22.6%, from whom 15.1% of respondents were wanted children later and 7.5% were wanted no more children. For women who had been visited by health care providers within 12 months before the study, women currently on menstrual status, the desired number of children, and induced abortion were found statistically significant. Conclusion The unmet need for FP was found high in the study area as compared to the national and regional prevalence. Women visited by health care providers, currently menstruating, the desired number of children, and history of induced abortion were significantly associated with the unmet need of modern FP. Health care providers and health extension workers need to visit regularly and promote appropriate and active IEC programs that address the provision of accurate information about the availability of the services and various contraceptive options including techniques to reduce and change perceived barriers to service utilization (such as rumors and misconceptions of FP).

Background Patient satisfaction is a key metric for determining how efficient healthcare is delivered. When patients visit health care facilities, they express a clear desire for high-quality services. Inadequately meeting their anticipated needs and expectations may lead to disappointment. This study sought to investigate the level of satisfaction expressed by participants regarding services provided by outpatient departments of selected health facilities in the south Wollo zone of Ethiopia and associated predictors. Methods A facility-based cross-sectional study with a total sample of 540 patients was conducted from May 13 to 25, 2019. A multistage sampling technique was used to select participants. Data were collected an interviewer-administered structured validated questionnaire. Data analysis was conducted with SPSS version 20 to identify predictor variables, applying bivariate and multivariate logistic regression analysis to determine variables that most significantly predicted the outcome variable of the level of patient-satisfaction at 5% level of significance and 95% confidence interval. Results There were 537 participants in the study consisting of males (50.6%) and females (49.4%). An estimated 35.6% of respondents were between the ages of 28 and 37 years. The proportion of respondents high educational attainment was 179 (33.3%), and 155 (28.9%) of respondents reported having receive free health service of charge. Conclusion The study’s results revealed that overall client satisfaction was low. Furthermore, the politeness of health service providers, the convenience of the environment for asking questions, and the availability of all prescription drugs were found to have a significant relationship with level of satisfaction with the health center. Health managers and service providers should come up with creative ways to improve health workers’ caring behavior, protect patients’ privacy, and increase patient satisfaction by making all necessary drugs available.

BackgroundOnly screening a pregnant mother is not satisfactory to prevent mother-to-child transmission of HIV (PMTCT). A male partner's involvement in HIV testing and counseling is also critical for PMTCT, however, it is one of the biggest challenges in Ethiopia. This study aimed to assess a male partner's involvement in HIV testing and counseling and associated factors among partners of pregnant women in the Delanta District, Northern Ethiopia.MethodsA community-based cross-sectional study design was conducted in the Delanta District from March 15 to May 10, 2018. During the study period, 609 male partners were involved. A binary and multiple logistic regression model was used to examine the association between variables.ResultsOut of all, 325 (53.7% at 95% CI: 49.6 to 57.5) of male partners were involved in HIV testing and counseling in the District. Male partners who were living together, ever heard about HIV from health professionals, pregnant women's antenatal care (ANC) visit, partner visited the PMTCT clinic with wife, and partner and wife discussion before HIV testing and counseling were factors associated with male partner involvement.ConclusionThe proportion of male partner involvement was found to be low as compared to the national standards. Local health authorities and health care workers need to develop and conduct interventions that help partners with their wife to live together, improve their awareness about HIV and testing, ANC visit by pregnant women, and encourage having home discussion before HIV testing through counseling, by so doing finally raise the level of male partner involvement in HIV testing and counseling.

BackgroundIntestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps.MethodsA school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children.Main findingsThe overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5-19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother's education (illiterate) (AOR = 3.3; 95% CI: 1.20-9.37), father's education (illiterate) (AOR = 3.9; 95% CI: 1.40-10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25-7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11-4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17-16.70) were statistically associated with presence of intestinal parasitic infections.ConclusionWe concluded that the prevalence of intestinal parasitosis in the study area among Grades 4-8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children's were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students' WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures.

Background Recent studies have indicated that disrespectful/abusive/coercive service by skilled care providers in health facilities that results in actual or perceived poor quality of care is directly and indirectly associated with adverse maternal and newborn outcomes. According to the 2016 Ethiopian Demography and Health Survey, only 26% of births were attended by qualified clinicians, with a maternal mortality rate of 412 per 100,000 live-births. Using seven categories developed by Bowser and Hill (2010), this study looked at disrespect and abuse experienced by women in labor and delivery rooms in health facilities of Borena Ddistrict, South Wollo, Ethiopia. Methods A facility-based cross-sectional study was conducted among 374 immediate postpartum women in Borena District from January 12 to March 12, 2020. Systematic sampling was used to access respondents to participate in a structured, pre-tested face-to-face exit interview. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Finally, bivariable and multivariable logistic regression analysis were performed to declare statistically significant factors related to maternal disrespect and abusive care in Borena District at a p-value of < 0.05 and at 95% CI. Result Almost four out of five (79.4%) women experienced at least one type of disrespect and abuse during facility-based childbirth. The most frequently reported type of disrespect and abuse was non-consented care 63.7%. Wealth index [AOR = 3.27; 95% CI: (1.47, 7.25)], type of health facility [AOR = 1.96; 95% CI: (1.01, 3.78)], presence of companion(s) [AOR = 0.05; 95% CI: (0.02, 0.12)], and presence of complications [AOR = 2.65; 95% CI: (1.17, 5.99)] were factors found to be significantly related to women experiencing disrespect and abuse. Conclusion The results showed that wealth index, type of health facility, presence of companion(s), and birth complications were found to be significant factors. Therefore, health personnel need to develop interventions that integrate provider’s behavior on companionship and prevention of complications across facilities to reduce the impact of disrespectful and abusive care for laboring women.

BackgroundNeedle stick and sharp injuries (NSSIs) are a common problem among healthcare workers (HCWs). Although the factors related to NSSIs for HCWs are well documented by several studies in Ethiopia, no evidence has been reported about the magnitude of and factors related to NSSIs in hospitals in northwestern Ethiopia.MethodsAn institution-based cross-sectional study was carried out from January to March 2019 among 318 HCWs in three randomly-selected hospitals of the eight hospitals found in South Gondar Zone. Sample sizes were proportionally allocated to professional categories. Study participants were selected by systematic random sampling methods using the monthly salary payroll for each profession as the sampling frame. Data were collected using a self-administered questionnaire. The outcome of this study was the presence (injured) or absence of NSSIs during the 12 months prior to data collection. A binary logistic regression model with 95% confidence interval (CI) was used for data analysis. Variables from the bi-variable analysis with a p-value ≤ 0.25 were retained into the multivariable analysis. From the multivariable analysis, variables with a p-value less than 0.05 was declared as factors significantly associated with NSSIs.Main findingsThe prevalence of NSSIs was 29.5% (95% CI: 24.2-35.5%) during the 12 months prior to the survey. Of these, 46.0% reported that their injuries were moderate, superficial (33.3%) or severe (20.7%). About 41.4% of the injuries were caused by a suture needle. Factors significantly associated with NSSIs were occupation as a nurse (adjusted odds ratio [AOR] = 2.65, 95% CI: 1.18-4.26), disposal of sharp materials in places other than in safety boxes (AOR = 3.93, 95% CI: 2.10-5.35), recapping of needles (AOR = 2.27, 95% CI: 1.13-4.56), and feeling sleepy at work (AOR = 2.24, 95% CI: 1.14-4.41).ConclusionThis study showed that almost one-third of HCWs had sustained NSSIs, a proportion that is high. Factors significantly associated with NSSIs were occupation as a nurse, habit of needle recapping, disposal of sharp materials in places other than in safety boxes and feeling sleepy at work. Observing proper and regular universal precautions for nurses during daily clinical activities and providing safety boxes for the disposal of sharp materials, practicing mechanical needle recapping and preventing sleepiness by reducing work overload among HCWs may reduce the incidence of NSSIs.

BackgroundThough institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death.MethodsThe study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects).ResultsThe findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap.ConclusionsThe urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women's income, access to health care facilities to increase the frequency of antenatal care utilization.

BackgroundVaccination is a proven tool in preventing and eradicating childhood infectious diseases. Each year, vaccination averts an estimated 2-3 million deaths from vaccine preventable diseases. Even though immunization coverage is increasing globally, many children in developing countries still dropout vaccination. The objective of this study was to identify determinants of vaccination dropout among children age 12-23 months in North Gondar, North west Ethiopia.MethodsCommunity based unmatched case-control study was conducted in north Gondar from March 1-27, 2019 among 366 children age 12-23 months (92 cases and 274 controls). Multistage sampling was used for reaching to the community. Data were collected from mothers who had 12-23 months age children using a pretested structured face to face interview. Data were entered using Epi info v. 7 and exported to SPSS v. 20 for analysis. On multivariable logistic regression variables with P-value ResultCounseling for mothers about vaccination (AOR = 7.2, 95% CI: (2.93-17.5)); fear of vaccine side effects (AOR = 3.5, 95% CI: (1.56-8.12)); PNC attended (AOR = 3.6, 95% CI: (1.52-8.39)) and mothers not received tetanus toxoid vaccination (AOR = 2.4, 95% CI: (1.03-5.35)) were found risk factors of vaccination dropout.ConclusionCounseling on vaccination, fear of vaccine side effects, PNC attended and mothers' tetanus toxoid vaccination status during ANC visit were found risk factors. Management bodies and health workers need to consider "reaching every community" approach, Counsel every mother at any opportunity, and provide TT vaccination for all pregnant mothers helps to reduce vaccination dropout among children.

Time management contributes to work efficiency, maintaining balance, and job satisfaction by promoting productivity and success. Most people believe they have so much to do and not enough time, and they attribute their unmet expectations, poor results, and low productivity to a lack of time. The aim of this study was to determine the magnitude and associated factors of time management practice among primary hospital employees in North Gondar, Ethiopia.From March 15 to April 28, 2017, a hospital-based cross-sectional mixed methods (both quantitative and qualitative) study design was conducted in North Gondar Zone. For the quantitative part, pre-tested, standardized questionnaires; as well as an interviewer guide for the qualitative part of the study were used for data collection. Using a random sampling technique, 391 employees were completed the questionnaires. A multivariate and bi-variate logistic regression analysis at AOR with a 95% CI and a p-value of < 0.5 were used to identify significant factors of the study. For qualitative data, thematic content analysis was performed. A total of 391 participants (a response rate of 92.6%) took part in the study. The number of participants who practice time management was 56.4% (95% CI: 49.3%, 61.7%). Organizational policies (AOR: 2.16; 95% CI: 1.02, 4.68), performance appraisal systems (AOR: 2.11; 95% CI: 1.32, 4.66), compensation and benefits system (AOR: 4.18; 95% CI: 2.18, 7.99), employee planning experience (AOR: 2.86; 95% CI: 1.42, 5.75), and residence (AOR: 2.08; 95% CI: 1.08, 4.01) were found predictors of time management practice among primary hospital employees. Overall, there was a moderate level of time management practice in the study area. Significant factors found were organizational policies, compensation and benefits packages, performance appraisal systems, planning experience, and residency. Therefore, managers need to develop an intervention to address all the above factors in order to improve time management practice of primary hospital employees at work.

BackgroundTime management practice can facilitate productivity and success, contributing to work effectiveness, maintaining balance and job satisfaction. Thus, this study aimed to assess time management practices and associated factors among employees of primary hospitals in north Gondar.MethodsAn Institutional based cross-sectional study among primary hospital employees in north Gondar was conducted from March to April 2018. A structured and pre-tested questionnaire was used to collect the data. Simple random sampling technique was utilized to select 422 employees. Bivariate and multivariate logistic regression model were done to identify factors associated with time management practice. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was ascertained to show the strength and direction of association.ResultIn this study, the prevalence of time management practice was 56.4% (95%CI: 49.3, 61.7). Being satisfied with organizational policies (AOR = 2.16; 95%CI: 1.02-4.68), performance appraisals (AOR: 2.11; 95%CI: 1.32-4.66), compensation and benefits (AOR: 4.18; 95%CI: 2.18-7.99), and planning (AOR: 2.86; 95% CI: 1.42-5.75) were statistically significant factors associated with time management practice.Conclusion and recommendationThe overall time management practice among the primary hospital employees was low. Planning, organizational policy, compensation and benefit, performance appraisal, and residence were factors significantly associated with hospital employee's time management practice. Thus managers and employees need to carry out interventions on significant factors to improve the employees' time management practice.

BackgroundRecently in Ethiopia, there is an increasing movement to implement community based health insurance scheme as integral part of health care financing and remarkable movements has resulted in the spread of the scheme in different parts of the country. Despite such increasing effort, recent empirical evidence shows enrolment has remained low. To identify determinants of enrollment in community based health insurance among households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019.MethodsA community based unmatched case control study was conducted Tach-Armachiho Woreda from March to May 2019 among 262 participants (88 cases and 174 controls with case control ratio of 1:2). Study subjects were selected using multi-stage sampling technique. Data were collected using a pretested, structured interviewer administered questioner. Data were entered to Epi-info 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression model were used to see the determinants of enrollment in community based health insurance. Adjusted odds ratio with 95% CI at p-value ResultFemale headed households (AOR = 2.79, 95% CI = 1.16, 6.69), Increase in Age (AOR = 1.09, 95% CI = 1.05, 1.13) and negative perception towards community based health insurance (AOR = 0.062, 95% CI = .030, .128) were found to be significant predictors.ConclusionThis study provides evidence that the decision to enroll in the scheme is shaped by age and a combination of household head sex and perception towards community based health insurance. Implementers aimed at enhancing enrolment ought to act on the bases of this findings.