Age at Menarche Among In-School Adolescents in Sawla Town, South Ethiopia

Background: Although a declining trend in age at menarche has been observed in developed countries over decades commonly attributed to childhood excessive weight gain and sedentary life, little is known about this case in the developing countries.Methods: A cross-sectional study design and multistage sampling was used to include 660 school adolescents for analysis. Data collection included weight and height measurements. Multinomial logistic regression analyses were done for early and late age of menarche, in reference to average age at menarche, to measure the association of age at menarche with some socio-demographic variables and body habits.Results: The mean age at menarche was 13.9±1.2 years (95%CI, 13.8-14.0). The menarche ages ranged between 10 and 12 years for 10.5%, 13 and 14 years for 54.5%, and 15+ years for 35%. Low menarche age was independently associated with high calorie consumption, high protein diet, more coffee intake, low physical activity and parents’ low educational background. Low body mass index, low parents' income, exercise, and Amhara ethnic background were associated with late menarche age.Conclusion: The mean menarche age found in this study was higher than the report from developed countries. But, the proportion of adolescents with low menarche age was comparable with reports from developed countries. Inactive adolescents were more likely to see menarche earlier than average age. Healthy eating habits, regular exercise and nutrition education need to be promoted among school children.Keywords: adolescent, cross sectional, menarche age, Ethiopi

The Ethiopian Health Information System: Where are we? And where are we going?

Health Information System (HIS) is a system that integrates data collection, management, and interpretation, including the use of the information to improve the quality of service and care through better management at all levels of health services (1). Early on, efforts to restructuring HIS to systematically collect, analyze, and report data for improved management in developing countries were undertaken by national program managers of vertically structured programs. In recent years, however, HIS in developing countries, including Ethiopia, has gained more and more attention as more effort by governments, international agencies, non-governmental organizations, donors, and other development partners seek to improve health care to reverse disease trends in these countries. The expansion of the health system, diagnostic capacity with the rapid transition of diseases epidemiology, and information technology played a crucial role in the increment of health data demand and information use in the health sector over the years (2). HIS encompasses a number of issues: data use, data quality, quality of care, e-Health and other relevant topics. This editorial provides a highlight of each of these topics and associated challenges. Because these entities are very much linked, it is not possible to expect successful progression in the use and quality of health information systems unless they are treated holistically

Improving the Quality of Clinical Coding through Mapping of National Classification of Diseases (NCoD) and International Classification of Disease (ICD-10).

AbstractIntroduction: Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. Utilization of international disease classification provides higher-quality information for measuring healthcare service quality, safety, and efficacy. The Ethiopian National classification of disease (NCoD) was developed as part of Health Management information System (HMIS) reform with consideration of accommodating code in International Classification of disease (ICD-10). There is limited resource about the utilization status and related determinants of NCoD by health care professionals at tertiary level hospitals. This study is designed to assess the utilization status of NCoD and improve the quality of clinical coding through mapping of NCoD and ICD-10. Methods: Quasi-experimental study considering “Mapping” as an intervention was employed in this study. Retrospective medical record reviews were carried out to assess the utilization of NCoD and its challenges at Tikur Anebsa Specialized Hospital (TASH) for a period of one year (2018/2019). Qualitative approach used to get expert insight on NCoD implementation challenges and design of mapping exercises as an intervention. Seven thousand five hundred forty-seven (20%) of the medical records from the total of 37,734 medical records were selected randomly for review. A data abstraction checklist was developed to collect relevant information on individual patient charts, patient electronic records specific on a confirmed diagnosis. The reference mapping approach was employed for the mapping output between ICD-10 and NCoD. Both ICD-10 and NCoD were mapped side by side using percentage comparison and absolute difference. Result: Data for document review was taken from the electronic medical record database. Out of the total, 3021 (40%) of records were miss-classified based on the national classification of disease. From the miss-coded record, 1749 (58%) of them used ICD code to classify the diagnosis. Reasons provided for poor utilization of NCoD among physicians include, perception of having a limited list of diagnosis in the NCoD, not being familiarized, inadequate capacity building about NCoD use, and absence of enforcing mechanism on the use of standard diagnostic coding among professionals. Utilization of disease classification coding provides higher-quality information for measuring healthcare service quality, safety, and efficacy. This will in turn provide better data for quality measurement and medical error reduction (patient safety), outcomes measurement, operational planning, and healthcare delivery systems design and reporting. Conclusion: Extended NCoD categories were mapped from ICD-10. Standard ways of coding disease diagnosis and coding of new cases into the existing category was established. This study recommends that due emphasis should be given in monitoring and evaluation of medical coding knowledge and adherence of health professionals, and it should be supported with appropriate technologies to improve the accessibility and quality of health information. [Ethiop. J. Health Dev. 2021; 35(SI-1):59-65] Keywords: Mapping, NCoD, ICD, Clinical Coding, Diagnosis, Health Information Syste

Quality of Primary Health Care during COVID-19 Pandemic in Addis Ababa Ethiopia: Patients-side and facility level assessment

Abstract Background: Quality is increasingly becoming an important aspect of health care that is given a priority nowadays. The assessment and assurance of quality depends on reliable evidence. It is evident that there is no comprehensive study related to quality of health care in public primary health care facilities during COVID-19 pandemic in Ethiopia. Even if the formulation and launching of health facility standards nationally has been made in 2013 and quality has been taken as one pillar for the past two decades, quality of health services has been poor. Unfortunately, the occurrence of COVID 19 pandemic poses another threat to the already existing poor quality of health service. Therefore, this assessment of selected quality dimensions of primary health care in Addis Ababa could be used for future monitoring and evaluation of quality improvement in the country as well as prepare the primary health facilities against possible future pandemics. Objective: The objective of the study is to assess the selected dimension of health care quality at the time of COVID 19 in the selected primary health care facilities in Addis Ababa, Ethiopia Methods: A facility-based cross-sectional study design was used. The study was done in six health facilities in Addis Ababa, Ethiopia. Patients, health service providers and health facilities were the study participants. An observation checklist and interviewer administered questionnaire were used to assess the routine service provision. Data cleaning, management and analysis was done using SPSS version 23 statistical software. Both descriptive and analytical results were used to present the findings. Result: The overall patient satisfaction was 77.9 %. From the quality dimension, the grand mean satisfaction score for health service accessibility, patient centeredness, equitability, and timeliness were54.7%, 67.9%, 72.1%, 63.4% respectively. From the facility level analysis only two facilities indicated employees receive ongoing Continuing Professional Development (CPD). All the facilities maintain employment record of each staff; however, with regard to the content only two facilities contain credential information, health examination record, in-service education /training and copies of annual evaluation. In half of the facilities lack of procedure room and hand washing room was observed. Toilets were not clean. Poor continuity of care was also identified and only two facilities indicated they had feedback providing mechanism in the referral system. Conclusion: Most of the respondents were satisfied with the quality of primary health care service. Gaps, however, were identified in the human resource management, infrastructure, referral system and continuity of care from the facilities’ perspective. Incomplete recording of most of the content of employee was identified as well. Thus, it is recommended to improve the identified challenges through provision of a system (guideline), continuous supervision, mentorship, and training. [Ethiop. J. Health Dev. 2021; 35(SI-1):98-107] Keyword: quality of service, patient satisfaction, continuing professional developmen

Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study

IntroductionA stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021.MethodsFrom 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals.ResultsA total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3–43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6–47.5) than among unemployed mothers (36.7%) (95% CI: 32.0–41.7). Maternal age [AOR = 2.8, 95% CI: 1.26–6.34] and wealth status [AOR = 0.32, 95% CI: 0.18–0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95–17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12–3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06–0.26] were associated with stunting of preschool children among employed mothers.ConclusionStunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers

Performance of Local Light Microscopy and the ParaScreen Pan/Pf Rapid Diagnostic Test to Detect Malaria in Health Centers in Northwest Ethiopia

Background: Diagnostic tests are recommended for suspected malaria cases before treatment, but comparative performance of microscopy and rapid diagnostic tests (RDTs) at rural health centers has rarely been studied compared to independent expert microscopy. Methods: Participants (N = 1997) with presumptive malaria were recruited from ten health centers with a range of transmission intensities in Amhara Regional State, Northwest Ethiopia during October to December 2007. Microscopy and ParaScreen Pan/PfH RDT were done immediately by health center technicians. Blood slides were re-examined later at a central laboratory by independent expert microscopists. Results: Of 1,997 febrile patients, 475 (23.8%) were positive by expert microscopists, with 57.7 % P.falciparum, 24.6 % P.vivax and 17.7 % mixed infections. Sensitivity of health center microscopists for any malaria species was.90 % in five health centers (four of which had the highest prevalence),.70 % in nine centers and 44 % in one site with lowest prevalence. Specificity for health center microscopy was very good (.95%) in all centers. For ParaScreen RDT, sensitivity was $90$70 % in six and,60 % in four centers. Specificity was $90 % in all centers except one where it was 85%. Conclusions: Health center microscopists performed well in nine of the ten health centers; while for ParaScreen RDT they performed well in only six centers. Overall the accuracy of local microscopy exceeded that of RDT for all outcomes. Thi

Reliability of Measurements Performed by Community-Drawn Anthropometrists from Rural Ethiopia

Undernutrition is an important risk factor for childhood mortality, and remains a major problem facing many developing countries. Millennium Development Goal 1 calls for a reduction in underweight children, implemented through a variety of interventions. To adequately judge the impact of these interventions, it is important to know the reproducibility of the main indicators for undernutrition. In this study, we trained individuals from rural communities in Ethiopia in anthropometry techniques and measured intra- and inter-observer reliability.We trained 6 individuals without prior anthropometry experience to perform weight, height, and middle upper arm circumference (MUAC) measurements. Two anthropometry teams were dispatched to 18 communities in rural Ethiopia and measurements performed on all consenting pre-school children. Anthropometry teams performed a second independent measurement on a convenience sample of children in order to assess intra-anthropometrist reliability. Both teams measured the same children in 2 villages to assess inter-anthropometrist reliability. We calculated several metrics of measurement reproducibility, including the technical error of measurement (TEM) and relative TEM. In total, anthropometry teams performed measurements on 606 pre-school children, 84 of which had repeat measurements performed by the same team, and 89 of which had measurements performed by both teams. Intra-anthropometrist TEM (and relative TEM) were 0.35 cm (0.35%) for height, 0.05 kg (0.39%) for weight, and 0.18 cm (1.27%) for MUAC. Corresponding values for inter-anthropometrist reliability were 0.67 cm (0.75%) for height, 0.09 kg (0.79%) for weight, and 0.22 kg (1.53%) for MUAC. Inter-anthropometrist measurement error was greater for smaller children than for larger children.Measurements of height and weight were more reproducible than measurements of MUAC and measurements of larger children were more reliable than those for smaller children. Community-drawn anthropometrists can provide reliable measurements that could be used to assess the impact of interventions for childhood undernutrition

Evaluation of light microscopy and rapid diagnostic test for the detection of malaria under operational field conditions: a household survey in Ethiopia.

BACKGROUND: In most resource-poor settings, malaria is usually diagnosed based on clinical signs and symptoms and not by detection of parasites in the blood using microscopy or rapid diagnostic tests (RDT). In population-based malaria surveys, accurate diagnosis is important: microscopy provides the gold standard, whilst RDTs allow immediate findings and treatment. The concordance between RDTs and microscopy in low or unstable transmission areas has not been evaluated. OBJECTIVES: This study aimed to estimate the prevalence of malaria parasites in randomly selected malarious areas of Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia, using microscopy and RDT, and to investigate the agreement between microscopy and RDT under field conditions. METHODS: A population-based survey was conducted in 224 randomly selected clusters of 25 households each in Amhara, Oromia and SNNP regions, between December 2006 and February 2007. Fingerpick blood samples from all persons living in even-numbered households were tested using two methods: light microscopy of Giemsa-stained blood slides; and RDT (ParaScreen device for Pan/Pf). RESULTS: A total of 13,960 people were eligible for malaria parasite testing of whom 11,504 (82%) were included in the analysis. Overall slide positivity rate was 4.1% (95% confidence interval [CI] 3.4-5.0%) while ParaScreen RDT was positive in 3.3% (95% CI 2.6-4.1%) of those tested. Considering microscopy as the gold standard, ParaScreen RDT exhibited high specificity (98.5%; 95% CI 98.3-98.7) and moderate sensitivity (47.5%; 95% CI 42.8-52.2) with a positive predictive value of 56.8% (95% CI 51.7-61.9) and negative predictive value of 97.6% (95% CI 97.6-98.1%) under field conditions. CONCLUSION: Blood slide microscopy remains the preferred option for population-based prevalence surveys of malaria parasitaemia. The level of agreement between microscopy and RDT warrants further investigation in different transmission settings and in the clinical situation

Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions

Trachoma, which is the leading infectious cause of blindness worldwide, is caused by repeated ocular infection with Chlamydia trachomatis. Treatment for trachoma includes mass azithromycin treatments to the entire community. The World Health Organization recommends at least 3 rounds of annual mass antibiotic distributions in areas with trachoma, with further mass treatments based on the prevalence of trachoma. However, there are other options for communities that have received several rounds of treatment. For example, programs could continue antibiotic treatments only in those households most likely to have infected individuals. In this study, we performed trachoma monitoring on children from 12 Ethiopian communities one year after a third mass azithromycin treatment, and conducted a household survey at the same time. We found that children were more likely to be infected with ocular chlamydia if they had ocular inflammatory signs or ocular discharge, or if they had missed the preceding antibiotic treatment, had an infected sibling, or came from a larger community. These risk factors suggest that after mass azithromycin treatments, trachoma programs could consider continuing antibiotic distributions to households that have missed prior antibiotic distributions, in households with children who have the clinical signs of trachoma, and in larger communities

Antibiotic Selection Pressure and Macrolide Resistance in Nasopharyngeal Streptococcus pneumoniae: A Cluster-Randomized Clinical Trial

Jeremy Keenan and colleagues report that during a cluster-randomized clinical trial in Ethiopia, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to receive azithromycin compared with untreated control communities