Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

Abstract Background Access to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care. Methods A case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA. Results PLHA who live with their families [OR = 3.29, 95%CI: 1.28-8.45)], lived in a rented house [OR = 2.52, 95%CI: 1.09-5.79], non-pregnant women [OR = 9.3, 95% CI: 1.93-44.82], who perceived ART have many side effects [OR = 6.23, 95%CI:1.63,23.82)], who perceived HIV as stigmatizing disease [OR = 3.1, 95% CI: 1.09-8.76], who tested with sickness/symptoms [OR = 2.62, 95% CI: 1.26-5.44], who did not disclose their HIV status for their partner [OR = 2.78, 95% CI: 1.02-7.56], frequent alcohol users [OR = 3.55, 95% CI: 1.63-7.71] and who spent more than 120 months with partner at HIV diagnosis[OR = 5.86, 95% CI: 1.35-25.41] were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care. Conclusions Efforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.</p

Rural health extension workers’ intention to leave their jobs and associated factors, North Wollo Zone, northeast Ethiopia

Background: The intention to leave primary jobs has risen in importance in the global dialogue on the health workforce. The related concept of staff turnover has also generated debate.&nbsp;This study was conducted to assess health extension workers’ intention to leave their jobs in North Wollo Zone, northeast Ethiopia. Methods: A cross-sectional study was conducted in North Wollo Zone from February to April 2016. Using a multi-stage stratified sampling technique, a total of 383 participants were selected. The data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression analyses were employed to identify significant factors. Odds ratios (ORs), 95% confidence intervals (CI), and p-values were used to measure the strength and presence of statistical associations. Results: The study showed that 64.1% (95% CI: 59.2, 69) of health extension workers had an intention to leave their jobs. Statistically significant factors were: low salary (AOR = 2.23; 95% CI: 1.98, 4.25); high workload (AOR = 2.78; 95% CI: 1.46, 5.31); dissatisfaction with educational opportunities (AOR = 3.74: 95% CI: 1.56, 8.27); dissatisfaction with payments and benefits (AOR = 3.32; 95% CI: 1.87, 6.68); dissatisfaction with the lack of recognition (AOR = 2.15; 95% CI: 1.18, 3.63); and dissatisfaction with working environments (AOR = 1.96; 95% CI: 1.18, 3.52). Conclusions: The proportion of participants who intended to leave their jobs was high. Hence, developing evidence-based retention strategies focusing on payments, educational opportunities, incentives, and work environment could help reduce the intention of health extension workers to leave their jobs.&nbsp;[Ethiop. J. Health Dev. 2020; 34(2):106-113] Keywords: Intention to leave, health extension workers, North Wollo Zone, Ethiopi