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

Adherence to Antiretroviral Treatment among Adult People Living with HIV/AIDS Attending Highly Active Antiretroviral Therapy at Adare Hospital, Southern Ethiopia

AbstractBackground: Adherence to antiretroviral therapy (ART) has paramount advantages for programmatic success, including its good treatment outcomes and reduced risk of resistant viral strains transmission to the general population. There is limited evidence on the magnitude and associated factors of adherence to ART among adult PLWHA attending highly active ART (HAART) at Adare General Hospital, Southern Ethiopia.Objective: This study aimed to determine the magnitude and associated factors of adherence to ART among adult PLWHA attending (HAART) at Adare General Hospital, Southern Ethiopia.Methods: A hospital-based cross-sectional study was conducted from January 01/2018 to February 30/2018 at Adare Hospital. The participants were 370 adult people living with HIV/AIDS taking ART and who were selected by systematic random sampling technique. The data were collected by trained health professionals using a pre-tested interviewer-administered structured questionnaire. The data collected was entered into a computer and analysed using SPSS version 19. Descriptive statistics and multiple logistic regressions were applied. The significance level of association was considered at p-value <0.05.Results: The magnitude of retrospectively self-reported combined adherence (measured by dose, schedule and dietary instructions) to ART in the past seven days before the interview was 80.3%. In multivariate analysis, Sidaamu Afoo language (AOR=0.5, 95%CI: 0.21-0.99), monthly income <1,000 Ethiopian Birr (AOR=0.08; 95%CI: 0.03-0.26), not disclosing HIV status to others (AOR=0.18; 95%CI: 0.07-0.50), taking ART pills comfortably while others looking (AOR=6.0; 95%CI: 2.54-13.91) and no utilisation of reminders (AOR=0.08; 95%CI: 0.03-0.21) were factors significantly associated with combined adherence. Forgetfulness and not wanting to take ART while others are looking were major reasons to miss pills.Conclusion: Adherence to ART among adult PLWHA attending HAART at Adare Hospital was suboptimal, but still comparable with that of resource-limited settings. To maximise treatment success, considering emphasised translation to Sidaamu Afoo language, encouraging patients to be involved in any income-generating system and to reveal their HIV status for others is helpful. [Ethiop. J. Health Dev. 2021; 35(2):105-115]Keywords: Adherence, Adults, ART, HIV/AIDS, Sidaama, Ethiopi

Level of Healthcare Providers’ Preconception Care (PCC) Practice and Factors Associated with Non-Implementation of PCC in Hawassa, Ethiopia

BACKGROUND: Healthcare providers (HCPs) are at the forefront of screening and identifying preconception risk factors leading to adverse pregnancy outcomes (APOs). In Ethiopia, there is no published study that assessed the status of the implementation of PCC. This is a study conducted with the aim of determining the level of HCP’s PCC practice and factors associated with non-implementation of PCC.METHODS: This institution based cross-sectional study conducted among HCPs working in public health institutions (PHI) of Hawassa. The data was collected using a validated instrument called ‘Andarg-Ethio PCC-KAPQuestionnaire’. A ltistage sampling was applied to draw a sample of 634 HCPs. The data were analyzed using SPSS software, version 20. Descriptive statistics and binary as well as multiple logistic regression analysis models were used to determine the cruds and adjusted odds ratios.RESULTS: Out of the total study participants, 84.7%(537) were found not totally practising PCC. Those HCPs who do not screen their clients’ reproductive life plan (RPL) had 7 times higher odds of not practising PCC (AOR=7.2 95% C.I. 3.6- 14.5), whereas those HCPs with poor PCC knowledge had 4 times higher odds of not practising PCC (AOR= 4.4, 95% C.I. 2.5-7.6).CONCLUSION: The findings of this study demonstrated the absence of standardized and consistent PCC practice which indicates that PCC is not well introduced to the area. Developing of PCC policy and guidelines plus training of HCPs are recommended.

Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study

Background - Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia. Methods - An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities. Result - In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity. Conclusion - The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs

Providing safe maternity care under challenging conditions in rural Ethiopia : a qualitative study

Background: Women’s health and the reduction in the global maternal mortality rate is a research priority worldwide. The aim of this study was to investigate the structural conditions that influence the maternity care provided for women in rural Ethiopia. Methods: A qualitative descriptive study was conducted, composed of 28 individual in-depth interviews with midwives and women who had given birth during the past 8 months, and observations of maternity care at health centres and a primary hospital. A thematic analysis was conducted. Results: The midwives do their utmost to save the lives of mothers and prioritise saving lives over providing compassionate care. Inadequate resources, such as equipment, medicine and water, affect the quality of care they provide for the birthing women. This creates a conflict between the midwives’ ideals and what conditions allow them to do. Families and the women’s network play important roles in providing care and support to the women who give birth in health facilities. Conclusions: Structural conditions make it difficult for Ethiopian midwives in rural areas to provide optimal maternity care. In addition to the availability of professional midwifery care, the expectant mothers’ families and networks also tend to provide important support and care. Further studies on how to improve the quality of maternity care from the women’s perspective are needed. Keywords: Maternity care, Childbirth, Structural conditions, Qualitative method, Rural area, Ethiopia.publishedVersio

Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia.

Background: Khat use is a well-established public health problem in Yemen, Arabian Peninsula, and Ethiopia. Along with its large scale production, the magnitude of khat use is increasing among students. Objective: This study was intended to assess the prevalence, determinants, and effect of khat use on academic performance of high school students in Sidama Ethiopia. Methodology: A cross-sectional study was conducted from April to June 2015. We used a stratified sampling technique to draw a total of 1,577students. The data was collected using self-administered questionnaires and analyzed using SPSS version 20. Descriptive statistics and logistic regression models were used to determine the prevalence, effects, and predictors of khat use. Result: The life time and current prevalence of khat use were 14.6% and 13%, respectively. Smoking cigarette (AOR=5.1, 95% C.I: 2.3-14.3), drinking alcohol (AOR=3.0, 95% C.I: 1.4-6.3), having a family growing khat (AOR=2.0, 95% C.I: 1.1-2.5), having friend chewing khat (AOR=3. 95% C.I: 2.0-4.6), were some of factors that increased the odds of students\u2019 khat use. Student\u2019s khat use increased the odds of student\u2019s poor academic performance (AOR=2.1, 95% C.I: 1.1-3.9). Conclusion: The prevalence of khat use in high khat producing districts of Sidama and its contribution to poor academic performance demand prompt intervention

Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia

Background] Khat use is a well-established public health problem in Yemen, Arabian Peninsula, and Ethiopia. Along with its large scale production, the magnitude of khat use is increasing among students. Objective This study was intended to assess the prevalence, determinants, and effect of khat use on academic performance of high school students in Sidama Ethiopia. Methodology A cross-sectional study was conducted from April to June 2015. We used a stratified sampling technique to draw a total of 1,577 students. The data was collected using self-administered questionnaires and analyzed using SPSS version 20. Descriptive statistics and logistic regression models were used to determine the prevalence, effects, and predictors of khat use.ResultThe life time and current prevalence of khat use were 14.6% and 13%, respectively. Smoking cigarette (AOR=5.1, 95% C.I: 2.3-14.3), drinking alcohol (AOR=3.0, 95% C.I: 1.4-6.3), having a family growing khat (AOR=2.0, 95% C.I: 1.1-2.5), having friend chewing khat (AOR=3. 95% C.I: 2.0-4.6), were some of factors that increased the odds of students' khat use. Student's khat use increased the odds of student's poor academic performance (AOR=2.1, 95% C.I: 1.1-3.9). Conclusion The prevalence of khat use in high khat producing districts of Sidama and its contribution to poor academic performance demand prompt intervention

Determinants of alcohol use and khat chewing among Hawassa University students, Ethiopia: a cross sectional study.

Background: Students\u2019 alcohol and khat use have been associated with various health related problems. However, its magnitude and associated factors among Ethiopian students are not yet well documented. Objective: The study aimed to assess the prevalence of alcohol use, khat chewing and its associated factors among Hawassa University students. Methods: A cross-sectional study was conducted from June to July 2011. Multistage stratified sampling technique was employed to select 590 students. Self administered questionnaires were used to collect data. Data was entered and analysed by SPSS version 20.0. Logistic regression analyses were used to identify the association of different variables. Results: The current prevalence of student\u2019s alcohol and khat use were 29.5% (95% CI: 25.8-33.3) and 16.3% (95% CI: 13.7- 20.0) respectively. Being male (AOR 1.8; 95% CI 1.1-3.0) and living alone (AOR 20.1; 95% CI 2.5-166.7) had a higher odds of alcohol use. Similarly, family substance use history (AOR 4.8; 95% CI 2.5-9.3) and peer influence (AOR 4.6; 95% CI 2.3-9.0) had also higher odds of khat use. Conclusion and recommendation: The proportion of student\u2019s khat chewing and alcohol use was significant. Hence, higher education in collaboration with other stakeholders should work on convincing students about the ill effects of these substances

Towards a Global Interdisciplinary Evidence-Informed Practice: Intimate Partner Violence in the Ethiopian Context

Background. Intimate partner violence is a global health issue and is associated with a range of health problems for women. Nurses, as the largest health workforce globally, are well positioned to provide care for abused women. Objectives. This nursing-led interdisciplinary project was conducted to understand the current state of knowledge about intimate partner violence in Ethiopia and make recommendations for country-specific activities to improve response to intimate partner violence through practice changes, education, and research. Methods. The project involved two phases: review of relevant literature and an interdisciplinary stakeholder forum and a meeting with nurse educators. Findings. The literature review identified the pervasiveness and complexity of intimate partner violence and its sociocultural determinants in the Ethiopian context. Two significant themes emerged from the forum and the meeting: the value of bringing multiple disciplines together to address the complex issue of intimate partner violence and the need for health care professionals to better understand their roles and responsibilities in actively addressing intimate partner violence. Conclusions. Further research on the topic is needed, including studies of prevention and resilience and “best practices” for education and intervention. Interdisciplinary and international research networks can support local efforts to address and prevent intimate partner violence