Addressing the high adverse pregnancy outcomes through the incorporation of preconception care (PCC) in the health system of Ethiopia

Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system.Health StudiesD. Litt. et Phil. (Health Studies

Improving Respectful Maternity Care in Ethiopia

Ethiopia intended to increase access to health care services by considerably expanding the numbers of primary care facilities and preservice education institutions in the past two decades. The utilization of maternity care services, and institutional childbirth, has not increased as anticipated, partly due to the limited promotion of respectful maternity care and widespread mistreatment of women that range from physical and verbal abuse of women to not allowing birth companion of women choice and not allowing preferred birthing position of women. This study assessed the concept of respectful maternity care from the perspective of women and health care providers. The study identified components of respectful maternity care, measured the prevalence of respectful maternity care, identified institutional-level respectful maternity care, and identified factors that are associated with the reported and observed levels of respectful maternity care. One in three women in the study experienced one or more forms of mistreatment during observations of provider-client interaction. Similarly, three out of four women self-reported any form of mistreatment. Less than one in three facilities demonstrated institutional level respectful maternity care index. Implementation of a quality improvement approach and childbirth assisted by midwives (compared to other cadre) were associated with the provision of respectful maternity care. Observing mistreatment performed by supervisors during training, and high stress levels were associated with acceptance of mistreatment. No relationship was found between gender of providers and acceptance of mistreatment of women. Integrating respectful maternity care into quality improvement initiatives and availing midwives in maternity units, and strengthening supervision is recommended

Emerg Infect Dis

Emerging Infectious Diseases is providing access to these abstracts on behalf of the ICEID 2022 program committee (http://www.iceid.org), which performed peer review. ICEID is organized by the Centers for Disease Control and Prevention and Task Force for Global Health, Inc.Emerging Infectious Diseases has not edited or proofread these materials and is not responsible for inaccuracies or omissions. All information is subject to change. Comments and corrections should be brought to the attention of the authors.Suggested citation: Authors. Title [abstract]. International Conference on Emerging Infectious Diseases 2022 poster and oral presentation abstracts. Emerg Infect Dis. 2022 Sep [date cited]. http://www.cdc.gov/EID/pdfs/ICEID2022.pdf2022PMC94238981187

Emerging infectious diseases

Emerging Infectious Diseases is providing access to these abstracts on behalf of the ICEID 2008 program committee, which performed peer review. Emerging Infectious Diseases has not edited or proofread these materials and is not responsible for inaccuracies or omissions. All information is subject to change.Comments and corrections should be brought to the attention of the authors.Slide Sessions -- Foodborne & waterborne diseases I -- Influenza I -- Surveillance: International -- Zoonotic & animal diseases I -- Methicillin-resistant stapylococcal infections -- Vectorborne diseases -- Foodborne & waterborne diseases II -- Influenza II -- Surveillance: Domestic -- Zoonotic & animal diseases II -- Noscomial infections -- Respiratory diseases -- Health communications -- Blood, organ, & tissue safety -- Tropical diseases -- New rapid diagnostics -- Mobile populations & infectious diseases -- Vaccine-preventable diseases -- Tuberculosis -- Sexually transmitted diseases -- -- Poster Abstracts -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Climate changes -- Foodborne & waterborne infections -- Health communication -- Infectious causes of chronic diseases -- Influenza -- New or rapid diagnostics -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Sexually transmitted diseases -- Surveillance: International & new strategies -- Travelers' health & disease importation -- Tropical infections & parasitic diseases -- Vector-borne diseases -- Women, gender, sexual minorities & infectious diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Emerging aspects of HIV -- Foodborne & waterborne infections -- Health communication -- Molecular epidemiology -- Outbreak investigation: Lab & epi response -- Poverty & infectious diseases -- Surveillance: International & new strategies -- Tropical infections & parasitic diseases -- Vector-borne diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Blood, organ, & other tissue safety -- Foodborne & waterborne infections -- Host & microbial genetics -- Influenza -- Molecular epidemiology -- New or rapid diagnostics -- Outbreak investigation: Lab & epi response -- Prevention effectiveness, cost effectiveness, & cost studies -- Surveillance: International & new strategies -- Vector-borne diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Bioterrorism preparedness -- Emerging opportunistic infections -- Foodborne & waterborne infections -- Healthcare worker safety -- Influenza -- Laboratory proficiency testing/quality assurance -- Modeling -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Vector-borne diseases -- Viral hepatitis -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Emerging opportunistic infections -- Foodborne & waterborne infections -- Influenza -- New or rapid diagnostics -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Social determinants of infectious disease disparities -- Surveillance: International & new strategies -- Tuberculosis -- Vector-borne diseases -- Zoonotic & animal diseases -- -- Additional Poster Abstracts.Abstracts published in advance of the conference

Sharing Knowledge, Transforming Societies: The Norhed Programme 2013-2020

publishedVersio

Sharing Knowledge, Transforming Societies

"In June 2016, the Norwegian Programme for Capacity Development in Higher Education and Research for Development (Norhed) hosted a conference on the theme of ‘knowledge for development’ in an attempt to shift the focus of the programme towards its academic content. This book follows up on that event. The conference highlighted the usefulness of presenting the value of Norhed’s different projects to the world, showing how they improve knowledge and expand access to it through co-operation. A wish for more meta-knowledge was also expressed and this gives rise to the following questions: Is this way of co-operating contributing to the growth of independent post-colonial knowledge production in the South, based on analyses of local data and experiences in ways that are relevant to our shared future? Does the growth of academic independence, as well as greater equality, and the ability to develop theories different to those imposed by the better-off parts of the world, give rise to deeper understandings and better explanations? Does it, at least, spread the ability to translate existing methodologies in ways that add meaning to observations of local context and data, and thus enhance the relevance and influence of the academic profession locally and internationally? This book, in its varied contributions, does not provide definite answers to these questions but it does show that Norhed is a step in the right direction. Norhed is an attempt to fund collaboration within and between higher education institutions. We know that both the uniqueness of this programme, and ideas of how to better utilise the learning and experience emerging from it, call for more elaboration and broader dissemination before we can offer further guidance on how to do things better. This book is a first attempt.

Guidelines to improve antibiotic prescribing practice at primary healthcare facilities in Ethiopia

Background Antibiotics are the most frequently used medicines in healthcare facilities. Since their discovery, they have played a pivotal role in combating infectious diseases and maintaining health, especially in developing countries where such diseases still remain as a big challenge. In recent years, however, the benefits derived from antibiotic use are facing great challenges due to the emergence of resistance where many bacteria have become resistant to the most commonly used first-line antibiotics. The major driver of antimicrobial resistance is known to be the huge increase in antibiotic prescribing, especially in low- and middle-income countries. Studies conducted on the rate of antibiotic resistance in Ethiopia have shown that the majority of bacteria that cause infections have developed a considerable degree of resistance to commonly used first-line antibiotics. In this country, antibiotics are prescribed at a far higher rate than the optimal value recommended by the World Health Organization. This exposes the available antibiotics to the risk of resistance. Purpose The purpose of this study was to describe the rate and patterns of antibiotic prescribing, explore the factors that affect the decisions to prescribe antibiotics, and identify interventions that should be implemented with a view to developing evidence- based and theory-informed intervention guidelines to improve antibiotic prescribing at primary healthcare facilities in Ethiopia. Methods Guided by the PRECEDE-PROCEED Model, the study was conducted using an explanatory sequential mixed method approach. In the first phase of the study (quantitative), data was collected from 2 000 prescriptions and patient medical charts sampled from ten randomly selected, public health centres situated in five of the sub cities in Addis Ababa City Administration. The second phase of the study (qualitative) was undertaken through in-depth interview of 20 prescribers from five of the health centres, as well as with 22 key informants from the five health centres, five sub-city health offices and the Health Bureau. The quantitative data was analysed using SPSS version 28. Thematic content analysis supported by ATLAS.ti 9 was used to analyse the qualitative data. Intervention guidelines to improve antibiotic prescribing were then developed by integrating findings of the qualitative and quantitative studies. Results The average number of medicines per prescription was 1.87 ranging from 1.71 to 2.11 among the health centres. The percentage of prescriptions containing one or more antibiotic was 52.5%, with wide variation (41.5% to 61.5%) among the health centres included in the study. The rate of antibiotic prescribing was shown to have a statistically significant correlation with the patient’s age, the qualification of the prescriber and the season of prescribing. Amoxicillin, ciprofloxacin, cloxacillin, doxycycline and cotrimoxazole accounted for nearly 80% of the antibiotics prescribed, with amoxicillin (41.2%), ciprofloxacin (14.1%) and cloxacillin (9.6) being the top three most commonly prescribed. About 56% of the prescribed antibiotics belong to the Penicillins category and majority (92.7%) of the antibiotics were prescribed for oral administration. Nearly 77% belong to the Access category and the remaining 23% to the Watch category of the World Health Organization’s Access, Watch and Reserve Classification of antibiotics. Upper respiratory tract infection (21.7%), urinary tract infections (13.1%) and topical infections – skin, eye and ear (9.7%) were the most common diagnoses for prescribing the antibiotics. About 37.3% of the cases for prescribing of antibiotics were respiratory tract infections, the majority (90.7%) being for upper respiratory tract infections. Of those prescribed for respiratory tract cases, 51.6% were found appropriate and 34.9% inappropriate. The types of inappropriate antibiotic therapy included unnecessary antibiotic use (53%); high dose (16%); need for additional antibiotic (14%); not choosing the right antibiotic (11%); and low dose (6%). Cost wise, antibiotics accounted for 36.2% of the total cost of medicines prescribed, with the majority of that being for amoxicillin (39.8%), cloxacillin (15.7%) and ciprofloxacin (10.3%). Five of them (amoxicillin, cloxacillin, ciprofloxacin, amoxicillin/clavulanic acid and cotrimoxazole) accounted for about 81% of the total cost of antibiotics prescribed. Antibiotics prescribed for all kinds of upper respiratory tract cases accounted for over one-third of the total cost of antibiotics prescribed. There were various kinds of problems with the prescription of antibiotics and their use at health centres, including the repeated use of antibiotics for the same diagnosis; use of antibiotics for minor problems; using high level antibiotics; discontinuing medication; and self-medication with antibiotics. The decision of healthcare providers to prescribe antibiotics is influenced by various predisposing, enabling and reinforcing factors. The factors are related with prescribers, patients and the health system, including gaps in the knowledge of health professionals on the use of antibiotics and resistance, low awareness of patients and the public on antimicrobial resistance, shortage of antibiotics and laboratory reagents, lack of updated information on the national and local antibiotic resistance pattern, patient pressure, patient load, excessive antibiotic prescribing at private health facilities, and the dispensing of antibiotics without prescription at private pharmacies. Though not as such heavily focused on antibiotics and resistance, various initiatives have been implemented at health centres that could contribute to improving the prescription of antibiotics and their use. Various interventions have been identified based on which intervention guidelines are developed to improve antibiotic prescribing at primary healthcare facilities. Challenges that might be faced when implementing these proposed interventions include shortage of personnel; financial constraints; resistance to change from professionals; shortage of medicines and laboratory reagents; inadequate government commitment; and resistance from the private sector because of the profit-motive. Conclusion There is high rate of antibiotic prescribing at health centres that far exceeds the recommended rate for primary healthcare facilities. The majority of antibiotics were prescribed for upper respiratory tract infections which are known to be mostly viral origin. Most of the antibiotics prescribed belong to the Access group of the World Health Organization’s Access, Watch and Reserve Classification. Antibiotics accounted for over one-third of the cost of medicines prescribed. Despite prescribers and key informants being aware of antibiotic resistance, its causes and consequences, there are still various types of antibiotic prescribing problems at health centres. The prescribing decisions of healthcare providers are influenced by several factors that are categorised as predisposing, enabling or reinforcing factors. Intervention guidelines that will be used to improve the prescribing of antibiotics at health centres were developed based on the interventions suggested by the study participants. urther studies on medicine use are required to appropriately understand the rate and patterns of antibiotic prescribing, and prescribers’ adherence to the new Primary Healthcare Clinical guidelines in managing commonly encountered cases such as upper respiratory tract infections at primary healthcare facilities. Research should be undertaken to evaluate the effectiveness of the intervention guidelines developed following PRECEED component (implementation, and monitoring and evaluation phases) of the PRECEDE-PROCEED Model that guided this study. The piloting and implementation of the guidelines requires the active involvement of all stakeholders under the leadership of Ministry of Health and the Health Bureau. The anticipated challenges need to be taken into consideration in implementing the interventions.Health StudiesD.Phil. (Public Health

ABSTRACT BOOK 50th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union)

The International Journal of Tuberculosis and Lung Disease is an official journal of The Union. The Journal’s main aim is the continuing education of physicians and other health personnel, and the dissemination of the most up-to-date infor mation in the field of tuberculosis and lung health. It publishes original articles and commissioned reviews not only on the clinical and biological and epidemiological aspects, but also—and more importantly—on community aspects: fundamental research and the elaboration, implementation and assessment of field projects and action programmes for tuberculosis control and the promo tion of lung health. The Journal welcomes articles submitted on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research