An assessment of the free health care provision system in Jimma town, Southwest Ethiopia

Background: Despite the fact that equity is the underlying principle of all major global health policies, difficulties have emerged in providing proper care for the poor with the introduction of user fees for health services. However, the criteria used to determine eligibility for free health services at public health facilities are either unclear or nonexistent in most sub-Saharan African countries.Objective: To assess the free health care delivery system and the extent to which strict criteria are followed in granting free health care services in Jimma town, southwest Ethiopia.Methods: A cross-sectional, exploratory study, employing both quantitative and qualitative study designs, was conducted from December 22–27, 2003.Results: Fifty-eight percent of the respondents were found to be patients exempted from fees on the day of interview. There exist no clearly stated criteria in the free health care provision system of Jimma town. The presence of leakage and under-coverage were 36.9% and 43.6% respectively. The occupation and income category of the respondents showed a statistically significant association with their service category at the public health facilities (p=0.000). Conclusion: The absence of clearly defined criteria for waiving user fees at public health facilities has made the free health care provision system difficult for both the providers and users. The system is also prone to the possibility of leakage and under-coverage. These findings imply the importance of a strict reconsideration of the exemption policy of the locality and the country with focus on efforts to produce clear criteria and guidelines in granting free health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 188-19

CLIENTS’ SATISFACTION WITH ANTI RETROVIRAL THERAPY SERVICES AT JIMMA UNIVERSITY SPECIALIZED HOSPITAL

No abstract - Available on PD

MOTHERS’ HEALTH CARE SEEKING BEHAVIOR FOR CHILDHOOD ILLNESSES IN DERRA DISTRICT, NORTHSHOA ZONE, OROMIA REGIONAL STATE, ETHIOPIA

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Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites

<p>Abstract</p> <p>Background</p> <p>The community case management of malaria (CCMm) is now an established route for distribution of artemisinin-based combination therapy (ACT) in rural areas, but the feasibility and acceptability of the approach through community medicine distributors (CMD) in urban areas has not been explored. It is estimated that in 15 years time 50% of the African population will live in urban areas and transmission of the malaria parasite occurs in these densely populated areas.</p> <p>Methods</p> <p>Pre- and post-implementation studies were conducted in five African cities: Ghana, Burkina Faso, Ethiopia and Malawi. CMDs were trained to educate caregivers, diagnose and treat malaria cases in < 5-year olds with ACT. Household surveys, focus group discussions and in-depth interviews were used to evaluate impact.</p> <p>Results</p> <p>Qualitative findings: In all sites, interviews revealed that caregivers' knowledge of malaria signs and symptoms improved after the intervention. Preference for CMDs as preferred providers for malaria increased in all sites.</p> <p>Quantitative findings: 9001 children with an episode of fever were treated by 199 CMDs in the five study sites. Results from the CHWs registers show that of these, 6974 were treated with an ACT and 6933 (99%) were prescribed the correct dose for their age. Fifty-four percent of the 3,025 children for which information about the promptness of treatment was available were treated within 24 hours from the onset of symptoms.</p> <p>From the household survey 3700 children were identified who had an episode of fever during the preceding two weeks. 1480 (40%) of them sought treatment from a CMD and 1213 of them (82%) had received an ACT. Of these, 1123 (92.6%) were administered the ACT for the correct number of doses and days; 773 of the 1118 (69.1%) children for which information about the promptness of treatment was available were treated within 24 hours from onset of symptoms, and 768 (68.7%) were treated promptly and correctly.</p> <p>Conclusions</p> <p>The concept of CCMm in an urban environment was positive, and caregivers were generally satisfied with the services. Quality of services delivered by CMDs and adherence by caregivers are similar to those seen in rural CCMm settings. The proportion of cases seen by CMDs, however, tended to be lower than was generally seen in rural CCMm. Urban CCMm is feasible, but it struggles against other sources of established healthcare providers. Innovation is required by everyone to make it viable.</p

Effect of training on the use of long-lasting insecticide-treated bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results of a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the utilization of long-lasting insecticide-treated bed nets (LLITN) is hampered by behavioural factors such as low awareness and negative attitude of the community. The aim of this study was to present the design and baseline results of a cluster randomized trial on the effect of training of household heads on the use of LLITN.</p> <p>Methods</p> <p>This baseline survey was undertaken from February to March, 2009 as part of a randomized cluster trial. A total of 11 intervention and 11 control <it>Gots </it>(villages) were included in the Gilgel Gibe Field Research Centre, south-west Ethiopia. House to house visit was done in 4135 households to collect information about the use of LLITN and socio-demographic variables. For the diagnosis of malaria and anaemia, blood samples were collected from 2410 under-five children and 242 pregnant women.</p> <p>Results</p> <p>One fourth of the households in the intervention and control <it>Gots </it>had functional LLITN. Only 30% of the observed LLITN in the intervention and 28% in the control <it>Gots </it>were hanged properly. Adults were more likely to utilize LLITN than under-five children in the control and intervention <it>Gots</it>. The prevalence of malaria in under-five children in the intervention and control <it>Gots </it>was 10.5% and 8.3% respectively. The intervention and control <it>Gots </it>had no significant difference concerning the prevalence of malaria in under-five children, [OR = 1.28, (95%CI: 0.97, 1.69)]. Eight (6.1%) pregnant women in the intervention and eight (7.2%) in the control <it>Gots </it>were positive for malaria (P = 0.9). Children in the intervention <it>Gots </it>were less likely to have anaemia than children in the control <it>Gots</it>, [OR = 0.75, (95%CI: 0.62, 0.85)].</p> <p>Conclusion</p> <p>The availability and utilization of LLITN was low in the study area. The prevalence of malaria and anaemia was high. Intervention strategies of malaria should focus on high risk population and vulnerable groups.</p

Delays in Tuberculosis Treatment and Associated Factors in Jimma Zone, Southwest Ethiopia

No abstract - Available on PD

Ownership and use of Treated Bed Nets in Urban Communities of Assosa Zone. Western Ethiopia

No abstract - Available on PD

Maternal and paternal anxiety-mood disorders and children’s social, motor, and cognitive development in Sub-Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58606/1/hadley_parental symptoms_2008.PD

Depressive symptoms and posttraumatic stress disorder as determinants of preference weights for attributes of obstetric care among Ethiopian women.

BACKGROUND: Mental health, specifically mood/anxiety disorders, may be associated with value for health care attributes, but the association remains unclear. Examining the relation between mental health and attributes in a context where quality of care is low and exposure to suboptimal health conditions is increased, such as in Sub Saharan Africa (SSA), may elucidate the association. METHODOLOGY/PRINCIPAL FINDINGS: We assessed whether preference weights for obstetric care attributes varied by mental health among 1006 women from Jimma Zone, Ethiopia, using estimates obtained through a discrete choice experiment (DCE), a method used to elicit preferences. Facilities were described by several attributes including provider attitude and performance and drug/equipment availability. Mental health measures included depressive symptoms and posttraumatic stress disorder (PTSD). We used Bayesian models to estimate preference weights for attributes and linear models to investigate whether these weights were associated with mental health. We found that women with high depressive symptoms valued a positive provider attitude [β = -0.43 (95% CI: -0.66, -0.21)] and drug/equipment availability [β = -0.43 (95% CI: -0.78, -0.07)] less compared to women without high depressive symptoms. Similar results were obtained for PTSD. Upon adjusting for both conditions, value for drug/equipment availability was lower only among women with both conditions [β = -0.89 (95% CI -1.4, -0.42)]. CONCLUSIONS/SIGNIFICANCE: We found that women with psychopathology had lower preference weights for positive provider attitude and drug/equipment availability. Further work investigating why value for obstetric care attributes might vary by psychopathology in SSA is needed

Food insecurity, stressful life events, poverty, and the risk of common mental disorders in East Africa: Evidence from the Gilgel Gibe Growth and Development Study.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61171/1/hadley_food insecurity_2008.pd