Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

The Relationship between Structural Change and Inequality: A Conceptual Overview with Special Reference to Developing Asia

Structural change has a far-reaching impact on inequality. It exposes the population to challenges and opportunities. Foreign trade and technological progress have been widely put forth as a structural driver of inequality. Broader structural change, such as demographic transition, can also impinge upon inequality. Structural change in developing Asia has been unprecedented in its scale and speed. The heterogeneity of the population implies that the adjustment capacity to these changes varies. The fundamental solution to mitigating the adjustment costs arising from structural change lies in empowering individuals to become more productive, adaptable, and versatile through access to education and employment. Structural change exerts a significant effect on inequality in both advanced and developing countries. The experiences of the advanced economies entail valuable lessons for developing Asia. Extensive structural change is both a cause and consequence of the exceptionally rapid economic growth, which enabled developing Asia to raise living standards and reduce poverty at a historically unprecedented rate. The region has already begun the difficult and complex task of addressing inequality arising from structural change. There is a growing recognition that more sustainable growth supported by broad-based political and social support requires a growth strategy, which provides equality of opportunity, especially in education and employment. The newly developing more inclusive growth philosophy envisions expanded social protection systems and social safety nets to protect the poor and the vulnerable

A study of Correlation Between motor Component of GCS score on Admission and Glasgow Outcome scale Score at Discharge in head injured Patients who underwent Surgical intervention

The aim of this study was to establish a correlation between the motor component of Glasgow Coma Scale (GCS) score on admission and Glasgow outcome scale (GCS) score at discharge (on 10th post-operative day) who underwent surgical intervention in head injured patients. This cross sectional study was carried out at the department of neurosurgery, BSMMU from November; 2005 to May, 2007 on head injured patients who underwent surgical intervention. A total of (35 patients with their age ranged from 5 yrs to 50 yrs who came within 3 days after head injury were included in this study. The patients were examined and the motor component of GCS score on admission and GOS at discharge (on 10th postoperative day) were recorded. Data were collected with the help of a structured questionnaire and face-to-face interview with the attendants of the patients. All relevant data were compiled manually in a master data sheet and then organized by scientific calculator. Best motor response and GOS score exhibit a linear relationship (r = 0.372, p = 0.028) indicating that higher the best motor response on admission higher is the GOS score at discharge (on 10th post-operative day). DOI: http://dx.doi.org/10.3329/bmj.v40i2.18509 Bangladesh Medical Journal 2011 Vol.40(2): 41-46</jats:p