Skilled Birth Attendant Competence and Facility Readiness For Managing Obstetric Emergencies in Eritrea

Introduction: Skilled Care Attendance during pregnancy and child birth is crucial for the reduction of maternal and neonatal mortality. Various studies have demonstrated the correlation between increase in skilled care attendance and reduction of maternal mortality globally. Objective: The objective of the study was to asses the impact of life saving skills training in the improvement of knowledge and skills of health workers and the quality of health services provided to mothers and newborns. Methodology: The study was a cross sectional study on 137 Life Saving Skills trained health workers randomly selected out of the total trained staff. The competence study measured knowledge with a 50-question knowledge test that covered the topics of (1) aseptic technique, (2) uncomplicated labor and delivery, (3) immediate newborn care, (4) postpartum hemorrhage, (5) sepsis and (6) pre-eclampsia, and eclampsia. Observation of competency of health workers was used to assess the competency of health workers. Results: The competency test scores appear that nurses and associate nurses are retaining their level of knowledge fairly well. Aseptic technique had the highest average score of any of competency tests. The assessment results showed that most nurses and associate nurses can perform the active management of labor skill relatively well, with an average score of 73% among those assessed. Five zones had average scores above 75%, which indicates the performance is consistently high in most areas. The average score for Manual Removal of placenta was quite high in most zones, with an average score of 66%. Four of the six zones received scores above 70%. The average score for bimanual uterine compression (58%) was slightly lower than the other skills tests related to the prevention and/or treatment of postpartum hemorrhage. After completing LSS training, the providers are expected to be able to recognize the signs and symptoms of an infant who is having difficulty breathing and they should be able to complete the five basic steps of immediate newborn care: DRY, WARM, POSITION, SUCTION (if necessary), and STIMULATE. The scores for the skills of nurses and associate nurses in the five steps identified is an average score of 65%. The study was designed to assess the impact of life saving skills training in the improvement of knowledge and skills of health workers and quality of health services provided to mothers and newborns and represents the first comprehensive assessment of the knowledge and skills of nurses and associate nurses in emergency obstetric care

Self-reported health care seeking behavior in rural Ethiopia: Evidence from clinical vignettes

Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording an 18-fold increase in the number of health posts and a 7-fold increase in the number of health centers. However, annual per capita outpatient utilization has increased only marginally. The extent to which individuals forego necessary health care, especially why and who foregoes care are issues that have received little attention in the context of low-income countries. This paper uses five clinical vignettes covering a range of context-specific child and adult-related diseases to explore the health-seeking behavior of rural Ethiopian households. We find almost universal preference for modern care. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centers, private/NGO clinics as opposed to health posts. Similarly, delays in care-seeking behavior are apparent mainly for adult-related conditions. The differences in care seeking behavior between adult and child related conditions may be attributed to the recent spread of health posts which have focused on raising awareness of maternal and child health. Overall, the analysis suggests that the lack of health-care utilization is not driven by the inability to recognize health problems or due to a low perceived need for modern care but due to other factors

Healthcare-seeking behaviour in rural Ethiopia: Evidence from clinical vignettes

__Abstract__ Objectives: To investigate the determinants of healthcare-seeking behaviour using five contextrelevant clinical vignettes. The analysis deals with three issues: whether and where to seek modern care and when to seek care. Setting: This study is set in 96 villages located in four main regions of Ethiopia. The participants of this study are 1632 rural households comprising 9455 individuals. Primary and secondary outcome measures: Probability of seeking modern care for symptoms related to acute respiratory infections/pneumonia, diarrhoea, malaria, tetanus and tuberculosis. Conditional on choosing modern healthcare, where to seek care (health post, health centre, clinic and hospital). Conditional on choosing modern healthcare, when to seek care (seek care immediately, the next day, after 2 days, between 3 days to 1 week, a week or more). Results: We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non-Government Organization (NGO) clinics as opposed to health posts. Delays in care-seeking behaviour are apparent mainly for adult-related conditions and among poorer households. Conclusions: The analysis suggests that the lack of healthcare utilisation is not driven by the inability to recognise health problems or due to a low perceived need for modern care

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa.

OBJECTIVE: Systematic review and meta-analysis of published studies of alcohol use among young people (age 15-24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. METHODS: Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I(2) statistic (DerSimonian-Laird). RESULTS: We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20-58%], use in the last month 28% (IQR: 17-37%), use in the last year 26% (IQR: 22-32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3-36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79-85%) and female sex workers (66%; 95%CI: 58-74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63-75%). CONCLUSIONS: Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population

Epidemiology of Mycobacterium tuberculosis lineages and strain clustering within urban and peri-urban settings in Ethiopia

BACKGROUND: Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia. METHODS: Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis. RESULTS: From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]. CONCLUSION: Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors

Sub-sampling a large physical soil archive for additional analyses to support spatial mapping; a pre-registered experiment in the Southern Nations, Nationalities, and Peoples Region (SNNPR) of Ethiopia

The value of physical archives of soil material from field sampling activities has been widely recognized. If we want to use archive material for new destructive analyses to support a task, such as spatial mapping, then an efficient sub-sampling strategy is needed, both to manage analytical costs and to conserve the archive material. In this paper we present an approach to this problem when the objective is spatial mapping by ordinary kriging. Our objective was to subsample the physical archive from the Ethiopia Soil Information System (EthioSIS) survey of the Southern Nations, Nationalities and Peoples Region (SNNPR) for spatial mapping of two variables, concentrations of particular fractions of selenium and iodine in the soil, which had not been measured there. We used data from cognate parts of surrounding regions of Ethiopia to estimate variograms of these properties, and then computed prediction error variances for maps in SNNPR based on proposed subsets of the archive of different size, selected to optimize a spatial coverage criterion (with some close sample pairs included). On this basis a subsample was selected. This is a preregistered experiment in that we have proposed criteria for evaluating the success of our approach, and are publishing that in advance of receiving analytical data on the subsampled material from the laboratories where they are being processed. A subsequent short report will publish the outcome. The use of preregistered trials is widely recommended and used in areas of science including public health, and we believe that it is a sound strategy to promote reproducible research in soil science