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Background: Evidence-based decision-making is a foundation of health information systems; however, routine health information is not mostly utilized by decision makers in the Amhara region. Therefore, this study aimed to explore the facility and department heads' perceptions towards the demand for and use of routine health information for decision making. Methods: A phenomenological qualitative study was done in eight districts of the Amhara region from June 10/2019 to July 30/2019. We obtained written informed consent and recruited 22 key informants purposively. The research team prepared a codebook, assigned codes to ideas, identified salient patterns, grouped similar ideas, and developed themes from the data. Thus, data were analyzed thematically using OpenCode software. Results: The study revealed that health workers collected many data, but little was demanded and utilized to inform decisions. The majority of respondents perceived that data were collected merely for reporting. Lack of skills in data management, analysis, interpretation, and use were the technical attributes. Individual attributes included low staff motivation, carelessness, and lack of value for data. Poor access to data, low support for Health Information System, limited space for archiving, and inadequate finance were related to organizational attributes. The contextual (social-political) factors also influenced the use of eHealth applications for improved data demand and use among health care providers. Conclusion: In this study, health workers collect routine health data merely for reporting, and they did not demand and use it mostly to inform decisions and solve problems. Technical, individual, organizational, and contextual attributes were contributors to low demand and use of routine health data. Thus, we recommend building the technical capacity of health workers, introducing motivation mechanisms and ensuring accountability systems for better data use. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has been striving to promote institutional delivery through community wide programs. However, home is still the preferred place of delivery for most women encouraged by the community's perception that delivery is a normal process and home is the ideal environment. The proportion of women using institutional delivery service is below the expected level. Therefore, we examined the impact of perception on institutional delivery service use by using the health belief model. Methods: A community-based cross-sectional study was conducted among 1,394 women who gave birth during the past 1 year from September to December 2019. A multistage sampling technique was used to select the study participants. Data were collected by using health belief model constructs, and structured and pretested questionnaire. Binary logistic regression was performed to identify factors associated with the outcome variable at 95% confidence level. Results: Institutional delivery service was used by 58.17% (95% CI: 55.57- 60.77%) of women. The study showed that high perceived susceptibility (AOR = 1.87; 95% CI 1.19–2.92), high cues to action (AOR = 1.57; 95% CI: 1.04–2.36), husbands with primary school education (AOR = 1.43; 95% CI 1.06–1.94), multiparty(5 or more) (AOR = 2.96; 95% CI 1.85–4.72), discussion on institutional delivery at home (AOR = 4.25; 95% CI 2.85–6.35), no close follow-up by health workers (AOR = 0.59;95% CI 0.39–0.88), regular antenatal care follow-up (AOR = 1.77;95% CI 1.23,2.58), health professionals lack of respect to clients (AOR = 2.32; 95% CI 1.45–3.79), and lack of health workers (AOR = 0.43;95% CI 0.29–0.61) were significantly associated with the utilization health behavior of institutional delivery service. Conclusion: The prevalence of institutional delivery in the study area was low. The current study revealed that among the health belief model construct perceived susceptibility and cues to action were significantly associated with the utilization behavior of institutional delivery service. On top of that strong follow-up of the community and home based discussion was a significant factor for the utilization behavior of institutional delivery service. [ABSTRACT FROM AUTHOR]

Aim: We assessed primary care facility preparedness, health workers’ knowledge and their classification and treatment of possible serious bacterial infection and local bacterial infection in young infants aged 0–59 days. Method: A cross-sectional survey was conducted in four regions of Ethiopia, including 169 health posts with 276 health extension workers and 155 health centres with 175 staff. Registers of 1058 sick young infants were reviewed. Result: Antibiotics to treat possible serious bacterial infection were available in 71% of the health centres and 38% of the health posts. Nine of ten health extension workers and eight of ten health centre staff mentioned at least one sign of possible serious bacterial infection and local bacterial infection. Among the registered cases with signs of bacterial infections, the health extension workers classified 49% as having a possible serious bacterial infection and 88% as local bacterial infection. The health centre staff classified 25% as possible serious bacterial infections and 86% as local bacterial infections. One-fourth (26%) of possible serious bacterial infection received the recommended treatment at health posts and 35% at health centres. Conclusion: Many health posts lacked antibiotics. The classification and treatment of possible serious bacterial infection did not follow guidelines. The lack of medicines and poor adherence compromise the quality of care. [ABSTRACT FROM AUTHOR]

Background: Institutional delivery care-seeking behavior is considered a crucial step in preventing maternal and child death. However, the barriers and facilitators related to institutional delivery care-seeking behavior in the study area were not studied very in-depth. Hence, the current study aimed to explore barriers and enablers of institutional delivery care-seeking behavior in Northwest Ethiopia. Methods: A descriptive phenomenological qualitative inquiry was used. The data was collected by using a piloted interview guide. We collected data using in-depth interviews among women and men; and key informant interviews from the Female health development army and health extension workers in November and December 2019. Framework analysis was utilized for the analysis of the data. Results: This study found out the potential factors which hinder and facilitate institutional delivery. The barriers to institutional delivery included the belief that pregnancy and childbirth are normal and business of women's, women's preference of home delivery with traditional attendants, family influence, fear of bad behavior of health care workers, and lack of resources. The facilitators were free maternal services (ambulance services and maternity services), having the experience of safe childbirth at health facilities, and women's health development army linkage with health extension workers. Conclusion: This study provides evidence that low-risk perception of home delivery, socio-cultural influences, service provision modalities, and financial factors were the determinants of institutional delivery service use. Therefore, a stage-matched intervention shall be designed to improve the uptake of institutional delivery service use. Plain language summary: Institutional delivery plays a critical role in the prevention of maternal death and improves newborn health. Although most of maternal health services were free of charge in Ethiopia, institutional delivery is low in the rural Central Gondar zone of Wogera and East Dembiya districts. Low institutional delivery was the major contributors to high maternal deaths in Ethiopia. This low utilization of institutional delivery in the study area could also affect the health status of the newborn. This study was conducted to explore the community perceptions of the socio-cultural and health service factors influencing institutional delivery. Overall, 30 interviews (18 In-depth and 12 Key-informants) were conducted in the selected rural kebeles of Wogera and East Dembiya districts to collect data from women and their husbands for in-depth interview; and key informant interviews from the female health development army and health extension workers. The facilitators of institutional delivery categorized into three themes; namely, free maternal services (ambulance services and maternity services), having the experience of safe childbirth at health facilities, and women's health development army linkage with health extension workers. The socio-cultural factors impeding institutional delivery categorized into five themes; namely, the belief that pregnancy and childbirth are normal and business of women's, women's preference of home delivery with traditional attendants, family influence, fear of bad behavior of health care workers, and lack of resources. Conducting a stage-matched intervention shall be designed to improve the uptake of institutional delivery service use in Wogera and East dembiya districts. [ABSTRACT FROM AUTHOR]

Background: Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients' experiences of taking medications and preferences for ART service provision in Northwest Ethiopia. Methods: A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed. Findings: Participants in this study had reported positive and negative experiences in receiving ART services and also varied preferences toward ART service features. The study identified five themes on experiences for ART service and 15 attributes of ART service characteristics. The identified themes were stigma, time, availability of drugs and providers, costs for clinic visits, and provider-patient interaction. The fifteen attributes were buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, the person providing ART refills, provider's attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics, and total cost of the visit. Conclusions: The results raise awareness for the positive and negative experiences of patients informing us about barriers and supporting factors in ART service provision. They open up the potential for HIV treatment service improvement. The preferences of PLHIVs toward ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients' needs and priorities in Ethiopia. Future research should further assess the reasons for patients' distrust of the community ART delivery models. [ABSTRACT FROM AUTHOR]

Background: The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia.Methods: A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR).Results: A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm.Conclusions: Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

Background: Prenatal alcohol consumption is a serious public health concern that is considered as one of the preventable risk factors for neonatal and childhood morbidity and several adverse pregnancy outcomes. This study aimed to determine the individual- and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia.Methods: A community-based cross-sectional study was conducted among pregnant women in Gondar town from 13 June to 24 August 2019. A cluster random sampling technique was used to select 1237 pregnant women. Data collection was carried out using the AUDIT-C pretested standard questionnaire. Bivariable and multivariable multilevel logistic regression analyses were computed to identify predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05.Results: The prevalence of alcohol consumption during pregnancy was found to be 30.26% (95% CI: 27.74%, 32.91%). The study revealed that pregnant women who have a low knowledge level on harmful effect of alcohol consumption (AOR = 3.2; 95% CI: 1.9, 5.4), positive attitude towards alcohol consumption (AOR = 7.5; 95% 5, 11), history of pre-pregnancy alcohol consumption (AOR = 4.8; 95% CI: 3.4, 6.9), whose partner consume alcohol (AOR = 3.9; 95% CI: 2.5, 6), a perception that alcohol consumption is culturally or socially acceptable (AOR = 3.6; 95% CI: 2.4, 5.3), who were encouraged by their partners to consume alcohol (AOR = 4; 95% CI: 1.9, 8) were significantly associated with pregnancy alcohol consumption. Concerning the community-level characteristics, who had not ever heard/media exposure about the risk of alcohol drinking during pregnancy (AOR = 3; 95% CI: 1.7, 5.5), and who were from low community women's education attainment (AOR = 4; 95% CI: 2.2, 7.7) were statistically significant predictors of alcohol consumption during pregnancy.Conclusions: The study revealed that alcohol consumption during pregnancy is prevalent in Gondar town. Both individual- and community-level predictors were found to be associated with alcohol consumption during pregnancy. Policymakers may take into account these predictors for individual and community-based interventions to which our results appear to point. [ABSTRACT FROM AUTHOR]

Background: 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. Conclusion: The total annual cost of illness of epilepsy was high, taking into account the per capita income of the individuals. The age, sex, and educational status of the patients, and the number of AED, seizure frequency, places where patients buy drugs, and disease duration were factors significantly associated with the cost of illness of epilepsy. Hence, creating an alternative source of income, socio-economic support, and affordable health care service for patients, especially for female and elderly patients, and strengthening and equipping nearby clinics, increasing drug availability in governmental pharmacies. [ABSTRACT FROM AUTHOR]

Purpose: Clinical outcomes have failed to capture the impact of tuberculosis (TB) on patients; consequently, a comprehensive measure is required. This study's objective was to determine the level of quality of life (QOL) and associated factors among patients with TB at the University of Gondar comprehensive specialized hospital, TB clinic. Methods: A cross-sectional study was conducted from April to June 2019. A total of 400 patients were selected. The world health organization quality-of-life (WHOQOL-Bref) questionnaire was used to measure QOL. Linear regression analysis was done to investigate potential predictors, and variables with a P value of <0.05 were considered statistically significant. Results: The participants had a mean age of 38.04 ± 13.53 years; the percentage of patients with pulmonary TB (PTB) was 52.71% and 57.36% were male. The QOL scores for physical, psychological, social and environmental domains were 43.54 ± 10.18, 46.67 ± 7.93, 39.79 ± 15.30 and 41.22 ± 12.90, respectively. PTB was associated with physical, psychological, social, and environmental domains (B = −3.99, P value <0.001), (B = −2.03, P value = 0.027), (B = −4.44, P value = 0.008), and (B = −2.83, P value = 0.029), individually; likewise, drug adherence was associated with physical (B = −10.36), psychological (B = −4.48), social (B = −14.46), and environmental (B = −8.44) domains at a P value <0.001. Education (B = 2.39, P value = 0.018), and co-morbidity (B = −4.28, P value = 0.023) were associated with the psychological domain. Finally, occupation was significantly associated with the environmental domain (B = −4.53, P value = 0.008). Conclusion: This study revealed that the QOL of patients was relatively low compared to that of other studies. Notably, social domains were affected more than other domains. Non-adherence and PTB were negatively associated with all domains. Therefore, health professionals should emphasize patients' drug adherence. [ABSTRACT FROM AUTHOR]

Background: Community-based health insurance (CBHI) schemes have been implemented in developing countries to facilitate modern medical care access. However, studies conducted on the effect of CBHI on healthcare-seeking behavior (HSB) have been limited and revealed inconsistent results. Therefore, this study aimed to assess the effect of CBHI on mothers' HSB for common under-five childhood illnesses. Methods: A community-based comparative cross-sectional study was conducted among 410 rural mothers (205 insured and 205 non-insured), and a multistage random sampling technique was used to select the study participants. Binary logistic regression and propensity score matching were used to identify factors associated with the mothers' HSB, and estimate the effect of CBHI on mothers' HSB, respectively. Results: The overall mother's HSB for childhood illnesses was 48.8% (200/410). From those mothers who visited healthcare, 92.0% were married, 86.0% were unable to read and write, 94.5% were farmers, and 54.5% were from low wealth status, 58.50% had a family size of ≤ 5, 54.0% had children less than 24 months of age. Besides, 63.0% were members of CBHI, 37.0% perceived their child's illness as severe, 78.0% made a shared decision to visit a health facility, and 67.5% lived within less than five Kms from the nearby health facilities. Being a member of CBHI, the child's age, decision to visit a health facility, and perceived disease severity were predictors of HSB. The CBHI had a significant effect on the HSB for childhood illnesses with ATT of 28.7% (t = 3.959). Conclusion: The overall mothers' HSB for common childhood illnesses was low though the CBHI has a significant effect. CBHI should be strengthened to improve the mothers' HSB. It is also crucial to strengthen awareness creation regarding joint decision-making and educate mothers to visit the health facilities regardless of children's age and disease severity. [ABSTRACT FROM AUTHOR]

Background: Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers' ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods: Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results: Health extensions workers' consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers' sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion: This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration: ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912. [ABSTRACT FROM AUTHOR]

Background: Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. Methods: A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. Results: In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. Conclusion: This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community's educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU. [ABSTRACT FROM AUTHOR]

Background: Health Information System is the key to making evidence-based decisions. Ethiopia has been implementing the Health Management Information System (HMIS) since 2008 to collect routine health data and revised it in 2017. However, the evidence is meager on the use of routine health information for decision making among department heads in the health facilities. The study aimed to assess the proportion of routine health information systems utilization for evidence-based decisions and factors associated with it.Method: A cross-sectional study was carried out among 386 department heads from 83 health facilities in ten selected districts in the Amhara region Northwest of Ethiopia from April to May 2019. The single population proportion formula was applied to estimate the sample size taking into account the proportion of data use 0.69, margin of error 0.05, and the critical value 1.96 at the 95% CI. The final sample size was estimated at 394 by considering 1.5 as a design effect and 5% non-response. The study participants were selected using a simple random sampling technique. Descriptive statistics mean and percentage were calculated. The study employed a generalized linear mixed-effect model. Adjusted Odds Ratio (AOR) and the 95% CI were calculated. Variables with p value < 0.05 were considered as predictors of routine health information system use.Result: Proportion of information use among department heads for decision making was estimated at 46%. Displaying demographic (AOR = 12.42, 95% CI [5.52, 27.98]) and performance (AOR = 1.68; 95% CI [1.33, 2.11]) data for monitoring, and providing feedback to HMIS unit (AOR = 2.29; 95% CI [1.05, 5.00]) were individual (level-1) predictors. Maintaining performance monitoring team minute (AOR = 3.53; 95% CI [1.61, 7.75]), receiving senior management directives (AOR = 3.56; 95% CI [1.76, 7.19]), supervision (AOR = 2.84; 95% CI [1.33, 6.07]), using HMIS data for target setting (AOR = 3.43; 95% CI [1.66, 7.09]), and work location (AOR = 0.16; 95% CI [0.07, 0.39]) were organizational (level-2) explanatory variables.Conclusion: The proportion of routine health information utilization for decision making was low. Displaying demographic and performance data, providing feedback to HMIS unit, maintaining performance monitoring team minute, conducting supervision, using HMIS data for target setting, and work location were factors associated with the use of routine health information for decision making. Therefore, strengthening the capacity of department heads on data displaying, supervision, feedback mechanisms, and engagement of senior management are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Knowing how heart failure affects patients' quality of life and its associated factors are crucial for a better patient-centred approach and management. Therefore, this study aims to assess health-related quality of life and its associated factors among adult heart failure patients in southern Ethiopia hospitals. Methods: The facility-based cross-sectional study design was conducted in Wolaita zone governmental hospitals from March to April 2018. The population was all adult heart failure patients in the chronic illness follow-up clinic and inpatient department. All adult heart failure patients on follow-up clinic and inpatient departments who have at least a 6-month follow-up were included in the study. In contrast, patients who had chronic comorbidities were excluded from the study. Minnesota Living with Heart Failure Questionnaire (MLHFQ) tool was used to measure the outcome variable health-related quality of life (HRQoL). Interviews and client medical record reviews also collected socio-demographic, clinical and behavioural characteristics of participants. The data were analyzed using STATA version 14, and multiple linear regression analysis with P-value < 0.05 was used to measure the degree of association between HRQoL and independent variables. Results: A total of 372 patients participated in the study. The HRQoL score for the physical, emotional, and total were 22.2, 7.7, and 46.37, respectively. HRQoL was significantly associated with gender, age, family size, occupation, residency, and recent admission within the past six months, New York Heart Association (NYHA) functional class, department of treatment, salt intake, and health perception. Conclusion: Generally, the HRQoL for patients with heart failure was found to be low. Besides the variables age and gender of participants, family size, occupation, residency, admission history, salt intake, and NYHA class were significant factors for the HRQoL of patients with heart failure. [ABSTRACT FROM AUTHOR]

Background. Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia. Methods. A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose FBS ≥ 126 mg / dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association. Result. Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06 , 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes. Conclusion. The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services. [ABSTRACT FROM AUTHOR]

Background: Cancer is the second leading cause of death in the world and accounts for 5.8% of deaths in Ethiopia. High out-of-pocket payment for the cost of illness of cancer could be linked to the low adherence to cancer treatment. This study aimed to assess the economic burden and predictors of cost variability among adult cancer patients at comprehensive specialized hospitals in West Amhara, Northwest Ethiopia. Methods: An institutional-based cross-sectional study was conducted from January to February 2019 at the University of Gondar and Felege Hiwot hospitals. The cost of illness of cancer was estimated using a bottom-up micro-costing approach. Direct costs of illness of cancer were measured by calculating out-of-pocket expenditure. The indirect costs were estimated using human capital model approach. Multiple linear regression was used to identify the predictors for the log-transformed data. Unstandardized β-coefficient with 95% CI and p-value < 0.05 were used to declare factors associated with cost of illness of cancer. Results: The mean cost of cancer illness among adult patients was US$ 1103.7 ± 33.2, and median cost was US$ 951.0 with IQR of 822.1. Factors such as urban residents (β = 0.147; 95% CI: 0.047, 0.246), distance (β = 0.0007; 95% CI: 0.0002, 0.001), married (β = 0.125; 95% CI: 0.037, 0.212), higher education (β = 0.318; 95% CI: 0.202, 0.435), buying drugs at private facilities (β = 0.134; 95% CI: 0.026, 0.243), richest households (β = 0.320; 95% CI: 0.143, 0.496) and frequent cycles of chemotherapy (β = 0.093; 95% CI: 0.061, 0.125) were positively associated with cost, while being female patients (β = − 0.144; 95% CI: − 0.210, − 0.018) were negatively associated. Conclusion: The cost of illness of cancer was high. The government, therefore, should expand health insurance and invest an additional budget to safeguard patients from financial catastrophic shock. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to assess the health-related quality of life and associated factors among adult human immunodeficiency virus (HIV) mono-infected and tuberculosis (TB) and HIV co-infected patients in the public health facilities of northeast Ethiopia. Methods: A comparative facility-based cross-sectional study was conducted from February 01 to May 30, 2019. A total of 434 HIV mono-infected and 143 TB/ HIV co-infected patients were randomly selected for the study. The data were collected using an interviewer-administered structured questionnaire. The health-related quality of life of patients was measured using the World Health Organization quality of life HIV instrument which contains physical, psychological, social relationships, environmental, level of independence, and spiritual domains. The validated version of the Kessler scale was used to assess depressive symptoms. Linear regression analysis was performed to identify factors associated with the outcome variables, and a p-value < 0.05 with 95% CI was used to measure the degree of association between health-related quality of life and independent variables. Results: The mean scores of health-related quality of life among HIV mono-infected patients in terms of thephysical, psychological, level of independence, social relationships, environmental, and spiritual health domains were 63.9, 65.0, 60.5, 59.0, 56.4, and 63.9, respectively; whereas the mean scores among TB/HIV co-infected patients were 46.6, 48.5, 42.7, 43.5, 39.3, and 51.3, respectively. Among HIV mono-infected patients, being married improved the quality of social relationships by 6.7 compared with unmarried patients (β = 6.7, 95% CI = 3.24, 10.11); whereas among the TB/HIV co-infected patients, being educated increased the quality of social relationships by 10.6 compared with being uneducated (β=10.6, 95% CI=3.70, 17.51). Conclusion: The study revealed that the TB/HIV co-infected patients had poor health-related quality of life in all domains compared with HIV mono-infected patients. Besides, depression and stigma were more prevalent among co-infected patients. Therefore, designing and implementing specific management that focuses on psychiatric centers for TB/HIV co-infected patients will be necessary as their quality of life is lowered. [ABSTRACT FROM AUTHOR]

Background: Quality of care depends on system, facility, provider, and client-level factors. We aimed at examining structural and process quality of services for sick children and its association with client satisfaction at health facilities in Ethiopia.Methods: Data from the Ethiopia Service Provision Assessment Plus (SPA+) survey 2014 were used. Measures of quality were assessed based on the Donabedian framework: structure, process, and outcome. A total of 1908 mothers or caretakers were interviewed and their child consultations were observed. Principal component analysis was used to construct quality of care indices including a structural composite score, a process composite score, and a client satisfaction score. Multilevel mixed linear regression was used to analyze the association between structural and process factors with client satisfaction.Result: Among children diagnosed with suspected pneumonia, respiratory rate was counted in 56% and temperature was checked in 77% of the cases. A majority of children (92%) diagnosed with fever had their temperature taken. Only 3% of children with fever were either referred or admitted, and 60% received antibiotics. Among children diagnosed with malaria, 51% were assessed for all three Integrated Management of Childhood Illnesses (IMCI) main symptoms, and 4% were assessed for all three general danger signs. Providers assessed dehydration in 54% of children with diarrhea with dehydration, 17% of these children were admitted or referred to another facility, and Oral Rehydration Solution was prescribed for 67% while none received intravenous fluids. The number of basic amenities in the facility was negatively associated with the clients' satisfaction. Private facilities, when the providers had got training for care of sick children in the past 2 years, had higher client satisfaction. There was no statistical association between structure, process composite indicators and client satisfaction.Conclusion: The assessment of sick children was of low quality, with many missing procedures when comparing with IMCI guidelines. In spite of this, most clients were satisfied with the services they received. Structural and process composite indicators were not associated with client's satisfaction. These findings highlight the need to assess other dimensions of quality of care besides structure and process that may influence client satisfaction. [ABSTRACT FROM AUTHOR]

Background: Maternity Waiting Homes (MWHs) are residential facilities located within hospitals or health centers to accommodate women in their final weeks of pregnancy to bridge the geographical gap in obstetric care. Little is known, however, about women's intentions to use MWHs. Thus, this study aimed to assess pregnant women's intentions to use MWHs and associated factors in East Bellesa district, northwest Ethiopia.Methods: A community-based cross-sectional study was conducted among 525 pregnant women in East Bellesa district from March to May 2018. Study participants were selected using systematic random sampling. Binary logistic regression was used for analysis. Adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI), and p-value < 0.05 were used to identify factors associated with intentions to use MWHs.Results: In the study area, 326/499 (65.3%) pregnant women had the intention to use MWHs. Pregnant women who had good knowledge about maternal healthcare and obstetric complications (aOR 6.40; 95% CI 3.6-11.5), positive subjective norms related to women's perceptions of social pressure (aOR 5.14; 95% CI 2.9-9.2), positive perceived behavioral control of women on the extent to which women feel confident (aOR 4.74; 95% CI 2.7-8.4), rich wealth status (aOR 4.21; 95% CI 2.1-8.4), women who decided by themselves to use maternal services (aOR 2.74; 95% CI 1.2-6.2), attended antenatal care (aOR 2.24; 95% CI 1.2-4.1) and favorable attitudes towards women's overall evaluation of MWHs (aOR 1.86; 95% CI 1.0-3.4) had higher odds of intentions to use MWHs.Conclusion: Two thirds (65.3%) of pregnant women had intentions to use MWHs. Factors such as women's knowledge, subjective norms related to women's perceptions of social pressure, perceived behavioral control of women on the extent to which women feel confident to utilize, and wealth status, decision-making power, attending antenatal care and attitude towards women's overall evaluation of MWHs were significantly associated with the intention to use MWHs. Therefore, improving women's awareness by providing continuous health education during antenatal care visits, devising strategies to improve women's wealth status, and strengthening decision-making power may enhance their intention to use MWHs. [ABSTRACT FROM AUTHOR]

Background: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities.Methods: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components.Discussion: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond.Trial Registration: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017. [ABSTRACT FROM AUTHOR]

Background: The HEP was established decades ago to address preventive, promotive and selective curative services through Health Extension Workers (HEWs). However, knowledge and practice of HEWs on drug provision for childhood illnesses such as diarrhea, fever, and/or acute respiratory infection have not been well studied. This study aimed to assess the knowledge and practice of HEWs on drug provision for childhood illnesses.Methods: An institutional-based cross-sectional study was conducted among 389 rural HEWs. The districts were selected by using simple random sampling technique, and all the HEWs in the districts were included in the study. Bivariable and multivariable logistic regressions were performed to see the association between knowledge and practice of HEWs on drug provision with the response variables.Results: The study revealed that 57.5 and 66.8% of HEWs had good knowledge and practice on drug provision for childhood illnesses, respectively. Having college diploma (AOR = 5.59; 95% CI: 1.94, 16.11), 7-9 years (AOR = 2.7; 95% CI: 1.3, 5.5) and 10-12 years (AOR = 2.7; 95% CI: 1.4, 5.4) of experiences, being supervised quarterly (AOR = 0.24; 95% CI: 0.13, 0.47) and biannually (AOR = 0.11; 95% CI: 0.04, 0.30), and having national guideline (AOR = 0.22; 95% CI: 0.06, 0.90) were factors significantly associated with good knowledge. In addition, having college diploma (AOR =3.1; 95% CI: 1.1, 8.8), not receiving refreshment training (AOR = 0.31; 95% CI: 0.11, 0.91), being supervised biannually (AOR = 0.32, 95% CI: 0.13, 0.80), and not having national guideline (AOR = 0.16, 95% CI: 0.04, 0.60) were factors significantly associated with good practice.Conclusion: The study indicated that a considerable number of HEWs had poor knowledge and practice on drug provision. Socio-demographic factors such as educational status, and work experience; and health systems and support related factors such as training, supervision, and availability of national guidelines, and training had a significant association with HEWs' knowledge and practice on drug provision. Therefore, designing appropriate strategy and providing refreshment training, and improving supervision and availability of national guidelines for HEWs might improve the knowledge and practice of HEWs on drug provision. [ABSTRACT FROM AUTHOR]

Background: Contraceptive utilization is a guarantee to avert unwanted pregnancies. In Ethiopia however, more than half of the rural women have shorter birth intervals. Consequently, 17 and 8% of the births have been either mistimed (wanted at later date) or unwanted, respectively. Therefore, this study investigated modern contraceptive utilization and its predictors among rural lactating women.Methods: A community based-cross-sectional study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, northwest Ethiopia. Data from 603 lactating mother were collected through face to face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were fitted to identify the independent predictors of modern contraceptive utilization.Results: The overall prevalence of modern contraceptive (MC) utilization rate was 45.8% [95% CI: 38.01, 53.59]. The contraceptive method mix was dominated by Depo-Provera (39.8%) followed by implants (4.8%). The odds of utilization of contraceptive were 5.58 times higher among mothers of children with fully immunized [AOR = 5.58, 95% CI: 3.45, 9.01] compared to mothers whose children were vaccinated partially or not at all. Mothers who received antenatal [AOR = 1.74, 95% CI: 1.13, 4.43] and postnatal care [AOR = 2.02, 95%CI: 1.24, 2.91) were 1.74 and 2.02 folds more likely to utilize modern contraceptives than mothers who did not receive such care, respectively.Conclusion: The prevalence of modern contraceptive utilization in this study area was lower than the planed national target. In the region, child immunization service is one of the promising platforms for reaching lactating mothers with modern contraceptive utilization. Our findings suggest that antenatal and postnatal care visits are the other key determinants of modern contraceptive utilization. Thus, in low-resource settings like ours, the health system approaches to improved antenatal and, postnatal care and child immunization services should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus, which has a wide range of effects on the physical, social and psychological aspects of the well-being of a person, is a common and challenging chronic disease that causes a significant rate of morbidity and mortality. However, studies in our country, by and large, focused on the impact of the disease in terms of mortality and morbidity alone. Therefore, the objective of this study was to assess the health-related quality of life (HRQOL) and associated factors of diabetic patients at the University of Gondar referral hospital, Ethiopia.Methods: A facility-based cross-sectional study was conducted at the University of Gondar referral hospital from April to May 2017. A generic World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to measure the HRQOL. The data were analyzed by Stata version 12. Multiple Linear Regression analysis with P-value 0.05 was used to measure the degree of association between HRQOL and independent variables.Results: A total of 408 patients with Diabetes Mellitus were included in the study. The HRQOL scores for physical, psychological, social and environmental domains were 50.9, 54.5, 55.8 and 47.3, respectively. Diabetes-related complications had a significant association with all except the psychological domain. Higher HRQOL was associated with exercising, following the recommended diet, foot care, sensible drinking and the absence of co-morbidities. However, old age, unemployment and being single and widower had a significant association with lower HRQOL.Conclusion: The environmental and physical domains of HRQOL scores were the lowest compared to the social and psychological domains. Old age and living in rural area had a significant association with a lower HRQOL, whereas the absence of diabetes-related complications, exercising, general diet and foot care had a significant association with better HRQOL of patients. Therefore, strong advice on the recommended lifestyle is important, and old patients and rural dwellers should get due attention. In addition, the prevention of diabetes-related complications is important to improve the patient HRQOL which is an important outcome measurement from the patient's perspective related to the impact of the disease. Therefore, including HRQOL assessment as part of routine management is necessary. [ABSTRACT FROM AUTHOR]

Aim: The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses.Methods: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs' assessment and classification of sick children were followed by child re-examination by a trained health officer.Results: The classification by the HEWs of 620 sick children as compared to the re-examiner had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively.Conclusion: Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. [ABSTRACT FROM AUTHOR]

Background: Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital.Method: An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI.Results: The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001).Conclusion: Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI. [ABSTRACT FROM AUTHOR]

Background: Malaria is the leading cause of disease burden across the world, especially in African countries. Ethiopia has designed a five year (2011-2015) plan to cover 100% of the households in malarious areas with one insecticide treated net (ITN) for every two persons, and to raise consistent ITN utilization to at least 80%. However, evidence on ownership of ITN among malarious rural households in northwest Ethiopia is quite limited. Hence, the present study aimed at assessing ownership of ITN and associated factors among rural households at risk of malaria at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.Methods: A cross sectional re-census was carried out in Dabat Health and Demographic Surveillance System site during peak malaria seasons from October to December, 2014. Data for 15,088 households at Dabat Health and Demographic Surveillance System site were used for the analysis. Descriptive measures and binary logistic regression were carried out.Results: Among those who owned at least one ITN, 53.4% were living at an altitude >2500 m above sea level. However, out of households living at an altitude <2000 m above sea level, 15.8% (95% CI 14.4%, 17.3%) owned ITN at an average of 4.3 ± 2.1 persons per ITN. Of these, 69.5% (95% CI 64.7%, 74.1%) used the ITN. Among utilizing households at malarious areas, 23.7% prioritized pregnant women and 31.4% children to use ITN. The availability of radio receiver/mobile (AOR 1.60, 95%CI 1.08, 2.35) and secondary/above educational status of household member (AOR 1.54, 95%CI 1.19, 2.04) were predictors of ownership of ITN.Conclusion: Rural households at risk of malaria did not own a sufficient number of ITN though the utilization is promising. Moreover, prioritizing children and pregnant women to sleep under ITN remains public health problems. Programmers, partners and implementers should consider tailored intervention strategy stratified by altitude in distributing ITN. ITN distribution should also be accompanied by using exhaustive promotion strategies that consider people without access to any source of information, and educating households to prioritize pregnant and under five children to sleep under ITN. [ABSTRACT FROM AUTHOR]

Background: Despite the high burden of disability in Ethiopia, little is known about it, particularly in the study area. Hence, this study aimed to investigate the prevalence and factors associated with disability at Dabat Health and Demographic Surveillance System (HDSS) site, northwest Ethiopia.Method: A population-based study was conducted from October to December 2014 at Dabat HDSS site. A total of 67,395 people were included in the study. The multivariable binary logistic regression analysis was employed to identify factors associated with disability. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A p-value of <0.05 was used to declare statistical significance.Results: One thousand two hundred twenty-eight individuals were reported to have a disability giving a prevalence rate of 1.82%, of which, about 39% was related to a vision disability. The high odds of disability were observed among the elderly (≥50 years) [AOR: 4.49; 95% CI: 1.95, 10.33], severely food in-secured [AOR: 2.11; 95% CI: 1.59, 2.80], and separated marital status [AOR: 7.52; 95% CI: 1.18, 47.84]. While having a paid job [AOR: 0.46; 95% CI: 0.28, 0.77], being in the richest quintile [AOR: 0.55; 95% CI: 0.41, 0.75], and high engagement in work-related physical activities [AOR: 0.36; 95% CI: 0.27, 0.49] were inversely associated with the disability.Conclusion: Disability is a major public health problem, and the burden is noticeable in the study area. Vision disability is the highest of all disabilities. Thus, efforts must be made on educating the public about disability and injury prevention. Measures that reduce disability should target the elderly, the poorer and the unemployed segment of the population. [ABSTRACT FROM AUTHOR]

Background: Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. Methods: Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. Results: Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. Conclusion: Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important. [ABSTRACT FROM AUTHOR]

Introduction: Despite its proven benefit in reducing child mortality and morbidity, the coverage of exclusive breastfeeding (EBF) remains sub-optimal. In Ethiopia, about 52% of infants under six months of age were exclusively breastfed, implying the need for further identification of the barriers to optimal EBF practice. Therefore, this study aimed to investigate EBF and its determinants in the predominantly rural northwest Ethiopia. Methods: The study was conducted at the Dabat Health and Demographic Surveillance System (HDSS) site, which is located in Dabat District, northwest Ethiopia. A total of 5,227 mothers with children under five years of age were included for analysis. Multivariable binary logistic regression analysis was employed to identify factors associated with EBF. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A P-value of <0.05 was used to declare statistical significance. Results: About 54.5% [95% CI: 51.9, 57.1] of the mothers practiced EBF. Mothers' education [AOR = 2.10; 95% CI: 1.63, 2.71], age (20–35 years) [AOR = 1.39; CI: 1.07, 1.80], urban residence [AOR = 1.28; 95% CI: 1.07, 1.54], at least one ANC visit [AOR = 1.41; 95% CI: 1.23,1.61], initiation of breastfeeding within one hour of birth [AOR = 1.32; 95% CI: 1.15,1.50], richer household [AOR = 1.34; 95% CI: 1.07, 1.65], and withholding prelacteal feeds [AOR = 1.34; 95% CI: 1.17, 1.53] were found important determinants of EBF. Conclusion: In this study area, the prevalence of EBF is lower than the national as well as the global recommendation for universal coverage of EBF. Therefore, strengthening the implementation of Infant and Young Child Feeding strategy (IYCF) and maternal health care utilization are essential for stepping up EBF coverage. Moreover, attention should be given to uneducated, rural resident, and adolescent mothers. [ABSTRACT FROM AUTHOR]

Background: Delaying the start of breastfeeding and giving prelacteal feeding leads to a significant increase in neonatal and infant deaths, particularly in a resource limited countries, like Ethiopia. Therefore, this study aimed to assess early neonatal feeding practice and its determinants in Dabat HDSS site, northwest Ethiopia. Methods: The census for the reconciliation of the surveillance of the Dabat Health and Demographic Surveillance System (HDSS) site was conducted from October to December 2014. Data were entered into the Household Registration System (HRS) version 2.1 and analyzed using Stata version 14. A total of 6,761 mother-child pairs were included in the study. Sociodemographic factors, maternal health care and early neonatal feeding practices (early initiation of breastfeeding and prelacteal feeding) were collected by interviewing the mothers. The prevalence of early/timely initiation of breastfeeding was computed as the ratio of children put to the breast within one hour of delivery to the total number of children. Prelacteal feeding was defined as giving anything to drink other than breast milk in the first three days following birth. Binary logistic regression models were used to identify variables which were associated with the dependent variable. A multivariable logistic regression analysis was carried out to identify factors associated with early initiation of breastfeeding. Results: The prevalence of early initiation of breastfeeding was 43.9% (95% CI, 41.6, 46.2). More than half (56%) of the mothers gave prelacteal feeds. An urban residence (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval [CI] 1.25. 1.73) and antenatal care (AOR 1.41, 95% CI 1.24, 1.59) were correlated with early initiation of breastfeeding. Similarly, increased odds of timely initiation of breastfeeding were observed among mothers who didn't give prelacteal feeds (AOR 5.72; 95% CI, 5.12, 6.40). Conclusion: Delayed initiation of breastfeeding and prelacteal feeding still remain public health concerns in this community. The promotion of improved infant and young child feeding (IYCF) practices and the utilization of antenatal care services should be intensified. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has implemented a nationwide primary health program at grassroots level (known as the Health Extension Program) since 2003 to increase public access to basic health services. This study was conducted to assess whether households that fully implemented the Health Extension Program have improved current contraceptive use. Methods: A cross-sectional community-based survey was conducted to collect data from 1,320 mothers using a structured questionnaire. A multivariate logistic regression was used to identify the predictors of current contraceptive utilization. A propensity score analysis was used to determine the contribution of the Health Extension Program "model households" on current contraceptive utilization. Result: Mothers from households which fully benefited from the Health Extension Program ("model households") were 3.97 (adjusted odds ratio, 3.97; 95% confidence interval, 3.01-5.23) times more likely to use contraceptives compared with mothers from non-model households. Model household status contributed to 29.3% (t=7.08) of the increase in current contraceptive utilization. Conclusion: The Health Extension Program when implemented fully could help to increase the utilization of contraceptives in the rural community and improve family planning. [ABSTRACT FROM AUTHOR]

Background Ethiopia has implemented a nationwide primary health program (the Health Extension Program) at the grass roots level since 2003. The aim of the program is to increase public access to basic health services, mainly by producing model households. These are households which attend at least 75% of the training given by health extension workers and implement at least 75% of the Health Extension Program packages. This study was conducted to assess the extent of the Health Extension Program utilization by the community, and to identify factors associated with it. Methods A community-based cross-sectional study was conducted to assess the utilization of the health extension program. Data were collected from 1320 mothers using a structured questionnaire. Multilevel logistic regression was used to identify factors associated with the utilization of the program. Result Health extension workers conducted frequent visits to 52.7% (95% CI = 50.0 to 55.4%) of the households, and 78.5% (95% CI = 76.2 to 80.7%) mothers visited health posts. Mothers who had frequent household visits by health extension workers were 1.289 more likely to visit the health posts (AOR = 1.289, 95% CI = 1.028 to1.826) than mothers who did not get frequent visits. Mothers from model households (3 years after graduation) were 2.410 times more likely to visit health post (AOR = 2.150, 95% CI = 1.058 to 4.365) compared to mothers from non-model households. Mothers who felt that they understood the Health Extension Program packages were 1.573 times more likely to visit the health posts (AOR = 1.573, 95% CI = 1.056 to 2.343) than mothers who did not feel they understood the program packages. Mothers from higher income families were 2.867 times more likely to visit health posts (AOR = 2.867, 95% CI = 1.630 to 5.040) compared to mothers from lower income families. Conclusions Conducting continuous home visits of non-model households and following up the existing model households, producing more model households by giving model-family training to non-model households, and strengthening the information, education, and communication package are crucial in the implementation of the HEP to increase basic health services utilization. [ABSTRACT FROM AUTHOR]

Background: Contraceptive use including short acting, long acting and permanent methods positively influence the socio-economic development of a nation by allowing families to space and limit their family size to their economic capacity. Demand for LAPMs of contraception as determined by utilization and unmet need for LAPMs of contraception can provide reliable information for providers. Objective: To determine the utilization of long acting and permanent contraception and its associated factors among married women of Goba town, South East Ethiopia. Methods: A cross sectional community based study was conducted among 734 systematically selected married women of reproductive age in Goba town in September/ 2009. A structured and pretested, interview questionnaire was used to collect data on socio-demographic, behavioral factors and data related to demand for LAPMs of contraception. Data were analyzed using EPI INFO and SPSS version 16. Result: The demand for Long Acting and Permanent Methods (LAPMs) of contraception was 18.1%. Utilization of LAPMs of contraception in the town was 64 (8.7%) and the unmet need for LAPMs was 69 (9.4%). Information on LAPMs in the town was 636 (86.6%). Media (radio and television) was the major sources of information 641 (87.3%). The use of LAPMs was significantly associated with ever use AOR[17.43, 95% CI:9.19, 33.03], number of times discussions made on methods AOR[4.6, 95% CI: 1.72,12.17] and main decider of using methods AOR[ 2.2, 95% CI:1.03, 4.65]. It was not associated with socio-demographic variables. Conclusion and recommendation: The utilization of LAPMs in the town was less although higher than the Ethiopian demographic and health survey 2005 result. Moreover, there was a considerable unmet need. Increase the method mix of LAPMs by incorporating varies of implants in order to increase utilization. Proper counseling of client and partners discussion were some of the recommendation forwarded. [ABSTRACT FROM AUTHOR]

Objective: Diabetes, a rising global health problem, requires continuous self-care practice. There are limited studies about self-care practice, and most of the studies conducted in Ethiopia focused on some parts of the recommended self-care practices. Therefore, this study aimed to assess diabetes self-care practice and associated factors among diabetic patients attending at University of Gondar Referral Hospital, Gondar, Northwest Ethiopia. Results: The study revealed that 51.86% (95% CI 46.95–56.72%) of the patients have poor self-care practice. Unable to read and write (AOR = 3.36; 95% CI 1.42–7.90), primary level of education (AOR = 2.62; 95% CI 1.20–5.70), living in rural area (AOR = 3.33; 95% CI 1.61–6.88), having strong social support (AOR = 0.31; 95% CI 0.15–0.62), having diabetes related complication (AOR = 2.20; 95% CI 1.12–4.30), and poor socio-economic status (AOR = 2.16; 95% CI 1.17–3.98) were factors significantly associated with poor self-care practice of patients with diabetes. The study indicates that the prevalence of poor self-care practice was high. Education, residence, socio-economic status, complication and social support were significantly associated with poor self-care practice. Therefore, strategies should be developed to support patients with information, glucometer, and enhance patient's social support. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is a debilitating condition resulted from poorly (un) managed prolonged obstructed labor. It has significant psychosocial and economic consequences on those affected and their families. Data regarding experiences and coping mechanisms of Ethiopian women with fistula is scarce.Methods: Qualitative design was employed with in depth interview technique by using open ended interview guide. Eleven fistula patients waiting for surgical repair at the fistula treatment center of Gondar Specialized Referral Hospital were selected with typical case selection. Thedata were audio-taped, transcribed and translated from Amharic to English. Open code version 4.03was used to organize data and identify themes for analysis.Results: The age of participants of the study ranged between 19 to 43 years. Ten of them were from rural areas. Regarding their educational status eight cannot read and write. Similar number were either separated or divorced. Six of them lived with obstetric fistula without treatment from one to five years. Five women related their condition to their fate. The women faced challenges in role performance, marital and social relationships and economic capability. Frequent bathing, use of stripes of old clothes as a pad, self-isolation and hiding from being observed, wearing extra clothes as cover, increasing water intake and reducing hot drinks and fluids other than water were the ways they have devised to cope with the incontinence.Conclusion: The study participants reported that they experienced deep sense of loss, diminished self-worth and multiple social challenges. They coped with the incontinence in various ways among which some were non effective and might have continuing negative impact on woman's quality of life even after corrective surgery. Developing bridging intervention for early identification and referral could reduce period of women's suffering. [ABSTRACT FROM AUTHOR]

Introduction: the health benefits of institutional delivery with the support of skilled professional are one of the indicators of maternal health status which have an impact on the health of women and new coming generation. Despite these benefits, many pregnant women in Ethiopia are not actively bringing delivery at health facility. This study was aimed at determining the readiness level of community for promoting child birth at health facility. Methods: a population-based crosssectional study was conducted. We interviewed 96 key informants using a semi-structured questionnaire adapted from the community readiness assessment model and translated to Amharic language. The key informants were purposively selected in consultation with the district health office to represent the community. The interviews were transcribed verbatim and survey scores were matched with the readiness stage of 1 of the 9 for the five dimensions using the assessment guidelines. Results: this study placed nine kebeles at stage 3 (vague awareness), which indicates the need for more institutional delivery service strategy programming; efforts of the community were not focused and low leadership concern and one kebele was in stage 2 (denial/resistance). Six kebeles were placed at high level of readiness i.e. in stage 7 (stabilization), indicating actions are sustained by the local managers or opinion leaders. Conclusion: evidence derived from the present study can be used to match intervention tactics for promoting health facility child birth service utilization to communities based on their level of readiness. [ABSTRACT FROM AUTHOR]

Background: Despite the enormous benefits of family planning services, the contraceptive utilization still remains low in Sub-Saharan Africa. There is regional variation in modern contraceptive utilization in Ethiopia. Therefore, this study was aimed to determine the prevalence of modern contraceptive utilization and determinants in Dabat demographic and health surveillance system site, northwest Ethiopia.Methods: A re-census was carried out in Dabat Health and Demographic Surveillance System (HDSS) site from October to December 2014. Data of 8271 married women collected in the re-census was used. The outcome variable was current utilization of any modern contraceptive methods whereas socio demographic and economic variables were the potential determinants considered. Bi-variable and multivariable binary logistic regression along with odds ratio and 95% confidence interval were used to describe the strength of association.Results: Prevalence of modern contraceptive utilization among married women in Dabat DHSS site was found to be 32.5% (95%CI: 31.5, 33.5%). After adjusting for covariates; the odds of using modern contraceptive were 2.35 times, 1.91 times, and 1.39 times higher among women of secondary and above educational level, urban residents, and women having six and above living children, respectively.Conclusion: Modern contraceptive utilization was found to be very low. Effort has to be applied to improve women's educational level that increases their understanding of reproductive health issues. It is also important to give special emphasis for rural residents, those aged 20-40 years, and those with six or more living children while serving for modern contraceptive methods. [ABSTRACT FROM AUTHOR]

Background. The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods. A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results. The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions. The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services. [ABSTRACT FROM AUTHOR]

Background: Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia., Methods: A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant., Result: In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92)., Conclusion: The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality., (© 2024. The Author(s).)

Introduction: even though there are many initiatives to improve institutional delivery, there are low service utilization and community readiness for institutional delivery in Ethiopia. This study assessed the role of community readiness on delivery service use., Methods: a pre-and post-test design with a control group was used for the evaluation of the stage-matched educational intervention following the protocol of the community readiness assessment model. Based on the baseline assessment of community readiness among 15 kebeles where the study was conducted, the overall score of nine kebeles was below stage-5 out of the nine stages, which were targeted for the intervention. The intervention group (n= three kebeles) participated in the stage-matched intervention for 15 months, while the control group (n= three kebeles) were not given the intervention. The data were analyzed using the difference in difference (DiD) method., Results: there were significant improvements in a stage of change for the promotion of institutional delivery (p-value <0.001) and institutional delivery use (p-value <0.001) in the intervention group as compared to the control group. The study revealed that the intervention influenced community resource allocation (at marginally significant levels), improved leader-ship quality of prevention, and community climate to supportive prevention efforts. There was evidence that the intervention (health promotion) also increased service use at a significant level., Conclusion: the community readiness-based intervention (health promotion) can be useful to measure the combined attitude and behavior towards institutional delivery services. The village-based mobilizer approach had a positive effect on institutional delivery use and the level of community readiness on the promotion of institutional delivery., Competing Interests: The authors declare no competing interests., (Copyright: Adane Nigusie et al.)

Background: Discrete choice experiments (DCEs) are used to assess the strength of preferences and value of interventions. However, researchers using this approach have been criticized for not conducting or publishing rigorous studies to select the required attributes and levels. Proper specification of attributes and their levels determines the validity of DCE. Hence, our study aimed to identify and define attributes and levels for the design of a DCE to elicit patients' and providers' preferences for ART service in Northwest Ethiopia., Methods: Four stages were followed to derive the final list of attributes and levels: (1) a literature review to derive conceptual attributes; (2) key informant interviews of 17 providers and in-depth interviews of 15 adult stable patients to identify context-specific attributes and attribute levels; (3) ranking survey among 31 HIV/AIDS program implementers and rating survey among 35 adult stable patients and 42 health workers providing antiretroviral therapy (ART) service to indicate participants' preference of attributes; and (4) an expert opinion to reduce the list of attributes and levels., Results: First, a literature review identified 23 candidate attributes. Second, individual-level analysis of the qualitative transcripts confirmed 15 of these 23 attributes. Third, the ranking and rating surveys put the importance of the 23 ART service attributes in order of preference. Fourth, through discussions with eight experts, 17 attributes were discarded based on multiple criteria. The six retained attributes were: the location of ART refills, the frequency of receiving ART refills, the person providing ART refills, the participants/others seen at the same ART refill visit, medication refill pick-up/delivery times, and the total cost of the visit during antiretroviral (ARV) medication refill. Finally, levels were assigned to these 6 attributes based on data from the literature, transcripts, and knowledge of the Ethiopian context., Conclusions: This detailed description illuminates the attribute development process and provides the reader with a basis for evaluating the rigor of this phase of DCE construction. This paper contributes empirical evidence to the limited methodological literature on attributes and levels of development for DCE, thereby providing further empirical guidance on ART service preference, specifically among patients of low- and middle-income countries., (© 2023. The Author(s).)

Background: Human resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings., Methods: An discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested., Results: A total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively., Conclusion: Rural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition., (© 2023. The Author(s).)

Introduction: Institutional delivery has been considered as one of the important strategies to improve maternal and child health and significantly reduces birth-related complications. However, it is still low in developing countries though there are some improvements. Hence, the aim of this study was to assess the prevalence of institutional delivery and associated factors in the study area., Methods: A community-based cross-sectional study was conducted. A multistage systematic sampling technique was used to select 1,394 study participants. We collected data from 18-48 years old women by using a structured questionnaire. Binary logistic regression was performed to identify factors at 95% confidence level., Results: The mean age of respondents was 30 (±0.15). The wealth status of 33.48% respondents was poor and 33.33% rich. The prevalence of institutional delivery was 58.17% (95% CI: 55.57%, 60.77%). Multivariable logistic regression showed that demographic factors: women age (≥35years) (AOR = 1.43; 95% CI 1.04, 1.96), having a family size of less than five (AOR = 4.61; 95% CI 3.34, 6.34), having family discussion (AOR = 4.05; 95% CI 2.74, 5.97), distance from the nearby clinic (≤30min) (AOR = 2.92; 95% CI 1.53, 5.58) and decision power about place of delivery (AOR = 2.50; 95% CI 1.56, 4.01); socio-economic factors: husband's educational status of primary school (AOR = 1.64; 95% CI 1.19, 2.24), middle level household wealth index (AOR = 1.78; 95% CI 1.25, 2.54) and rich level household wealth index (AOR = 2.01; 95% CI 1.42, 2.86); and programmatic factors: antenatal care visit during their recent pregnancy (AOR = 1.86;95% CI 1.16, 2.97) were affects institutional delivery positively. Whereas bad behavior of health workers (AOR = 0.27; 95% CI 0.19, 0.39) negatively affects institutional delivery., Conclusion: Institutional delivery was low in the study area. This study implies that strengthening family discussion and up taking antenatal care services in regular ways are a few of the suggested recommendations., Competing Interests: The authors have declared that no competing interests exist.

Background: Alcohol use during pregnancy has a potential negative impact on the health of women and children. Binge or hazardous drinking may do greater alcohol-related damage to the developing fetus than drinking a comparable amount spread over several days or weeks. This study aimed to identify determinants of hazardous alcohol use among pregnant women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia., Methods: An unmatched facility-based nested case-control study was carried out to identify the determinants of hazardous alcohol use among pregnant women within a prospective cohort study from 29 October 2019 to 7 May 2020. A two-stage random sampling technique was used to select 455 (113 cases and 342 controls) pregnant women. Data collection was performed using the AUDIT-C standardized and pretested questionnaire. Bivariable and multivariable logistic regression analyses were computed to identify the predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05., Results: Multivariable logistic regression model revealed that no formal education of the husbands [AOR = 2.79; 95%CI: 1.24, 6.29], being housewife[AOR = 2.43; 95%CI: 1.12, 5.26], poor household wealth index[AOR = 2.65; 95%CI: 1.07, 6.54], unplanned pregnancy [AOR = 4.36;95%CI: 2.44, 7.79], poor social support [AOR = 4.9;95%CI: 2.4, 10.04], depression[AOR = 3.84;95%CI: 2.16, 6.82], and not ever heard the risk of alcohol drinking during pregnancy [AOR = 1.97; 95%CI: 1.08, 3.58] were significantly associated with hazardous alcohol use., Conclusions: Routine alcohol screening during ANC visits creates an appropriate referral system for clinical management and provides an opportunity for healthcare workers to offer information on the potential risks associated with alcohol use in pregnancy. Antenatal care providers have a special role to play in assuring that women receive adequate advice about alcohol use and care to manage the problems especially for pregnant women with depression, poor social support, unplanned pregnancy, low socioeconomic status, and for housewives during the antenatal visits. The warning marks on alcoholic beverages including an ongoing message about the risks of alcohol use during pregnancy could be public health good strategies to minimize preventable harms attributed to alcohol consumption during pregnancy., Competing Interests: The authors have declared that no competing interests exist.

Objective: The health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard quality of care. We assessed the health extension workers' perceived context and the preparedness of health posts to provide services., Setting: This study was part of evaluating a complex intervention in 52 districts of four regions of Ethiopia. This paper used the endline data collected from December 2018 to February 2019., Participants: A total of 152 health posts and health extension workers serving selected enumeration areas were included., Outcome Measures: We used the Context Assessment for Community Health (COACH) tool and the Service Availability and Readiness Assessment tool., Results: Internal reliability of COACH was satisfactory. The dimensions community engagement , work culture , commitment to work and leadership all scored high (mean 3.75-4.01 on a 1-5 scale), while organisational resources, sources of knowledge and informal payments scored low (1.78-2.71). The general service readiness index was 59%. On average, 67% of the health posts had basic amenities to provide services, 81% had basic equipment, 42% had standard precautions for infection prevention, 47% had test capacity for malaria and 58% had essential medicines., Conclusion: The health extension workers had a good relationship with the local community, used data for planning, were highly committed to their work with positive perceptions of their work culture, a relatively positive attitude regarding their leaders, and reported no corruption or informal payments. In contrast, they had insufficient sources of information and a severe lack of resources. The health post preparedness confirmed the low level of resources and preparedness for services. These findings suggest a significant potential contribution by health extension workers to Ethiopia's primary healthcare, provided that they receive improved support, including new information and essential resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Objective: Ethiopia is one of the Africa's signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia., Study Design: The study is community-based cross-sectional study., Study Setting: Dabat and Gondar Zuria districts, Northwest Ethiopia., Participants: Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis., Methods: A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination., Outcomes: Incomplete or not at all vaccination., Results: The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25)., Conclusions: In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses., Methods: We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses., Results: There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services., Conclusion: We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period., Trial Registration Number: ISRCTN12040912., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: There is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia., Methods: Studies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger's regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors., Result: Twenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I 2  = 0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR) = 2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR = 3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR = 3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR = 2.91;95% 1.88,4.52) in 5 studies, availability of information source (AOR = 1.80;95% CI 1.16,2.78) in 6 studies, ANC follow-up (AOR = 2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR = 4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR = 3.04;95% CI 1.76,5.24) in 11 studies and place of birth of the elder child (AOR = 8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization., Conclusion: This review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.

Background: Preventing unintended pregnancies among HIV positive women is one component of HIV prevention strategies. However, programs to prevent mother-to-child transmission (PMTCT) of HIV started in antenatal care. The objective of this study was to examine the status of family planning integration to HIV care from client and facility perspectives and identify factors associated with current family planning use., Methods: A facility-based cross-sectional study was conducted from December 2017 to April 2018. Data were coded and double entered into EPI Info version 3.5.4 and exported to STATA version 14 for analysis. Bi-variable and multivariable logistic regression analyses were conducted to assess the association of variables with the current family planning use., Results: A total of 518 HIV-positive women were included in the study. Among HIV-positive women, 35.3% had an unmet need for family planning, and 21.4% responded that their pregnancies were unwanted. About two-thirds (68.1%) of women were using a modern family planning method at the time of the study. Among women who were currently using family planning, 88.8% got the service from a family planning clinic in the same facility, and only 1.1% got the service from the HIV care unit. Women who were not knowledgeable on PMTCT (AOR 0.47, 95% CI = 0.24-0.90), divorced or separated women (AOR 0.19, 95% CI = 0.10-0.37) and women in the age group of 25-34 years (AOR 0.42, 95% CI = 0.20-0.88) and 35-49 years (AOR 0.41, 95% CI = 0.17-0.99) were less likely to use modern family planning methods compared with those women who were knowledgeable, married and women in the age group of 15-24 years. Besides, women with higher income (AOR 2.12, 95% CI = 1.26-3.57) were more likely to use modern family planning methods compared with women with lower incomes., Conclusion: This study indicated that there is a high unmet need for family planning among HIV-positive women and low family planning services integration in the PMTCT/ART clinics. Efforts should be strengthened to tackle the factors which hinder the use of modern family planning and improve family planning service integration.

Background: Hepatitis B virus (HBV) infection is a global public health problem. The burden of the disease is high in low and middle income countries like Ethiopia. However, for highly vulnerable groups such as health professionals, vaccination coverage is a major issue in the developing countries where health professionals are expected to pay for vaccination. Therefore, the objective of this study was to assess health professionals' acceptance and willingness to pay (WTP) and associated factors for vaccination against HBV., Methods: Cross-sectional study was conducted from March to April, 2017 in Gondar city administration governmental health institutions among 423 health professionals. Simple random sampling method was employed to select the study participants. Data were collected using self- administered questionnaire. Tobit model was used to analyze the determinants of WTP and the maximum amount of money the individuals might pay for HBV vaccination. P-value < 0.05 was considered statistically significant., Result: A total of 423 health professionals (physicians, nurses, midwives, laboratory technicians/technologists, and others) participated in the study with a response rate of 100, and 62.4% of them were willing to pay for HBV vaccination. The mean amount of money the participants might pay for HBV vaccination was 325.83 ± 283.46 ETB (US$ 14.39 ± 12.52). The study indicated that the WTP for HBV vaccination of health professionals from health centers was 179.41 ETB less compared to health professionals from hospital. The WTP for HBV vaccination of the participants who had no experience of seeing previous patients with HBV was 157.87 ETB less compared to participants who had experience of seeing previous patients with HBV. As monthly income of the study participants increased by one ETB, the WTP was increased by 0.027 ETB., Conclusion: The study revealed that the mean amount of money the participants might pay for HBV vaccination was much less than the market price for HBV vaccination. Type of workplace and experience of seeing/observing patients with HBV, and income were the predictors of WTP for HBV vaccination. Availing the vaccine with affordable cost in governmental health institutions may increase WTP of health professionals for HBV vaccination.