Health Services Utilization and Associated Factors in Jimma Zone, South West Ethiopia

BACKGROUND: In Ethiopia, utilization of health services remains low and unevenly distributed. To ensure appropriate health care use, we need to understand factors affecting health care use, and the reasons for low levels of utilization among our community. The objective of the study was to assess utilization of health services and associated factors in Jimma zone, south west Ethiopia.METHODS: A cross sectional data was collected from January 15 to February 08, 2007 in Jimma zone. First, four districts were selected by lottery method. Then 2 ‘kebeles’ from each district were selected randomly and households were selected by systematic sampling. A total of 836 households were studied. The data were cleaned, coded and entered into computer and analyzed using SPSS for windows version 12.0. Bivariate analysis and logistic regression were conducted and a significance level of 5% was considered for interpretation.RESULTS: The health services utilization rate was found to be 45.6%. After controlling confounders using logistic regression; sex (OR=0.23), marital status (OR=8.1), household income (OR=0.70), socioeconomic status (OR=3.5), presence of disabling health problem (OR=3.3), presence of an illness episode (OR=28.3), perceived transport cost (OR=3.6), perceived treatment cost (OR=0.15) and distance to the nearest health center or hospital (OR=2.9) were found to be predictors of utilization of healthcare. CONCLUSIONS: It has been shown that utilization level was not satisfactory. Thus, we recommend that the level of health service utilization should be improved by improving predictors of health care use like physical accessibility.KEY WORDS: Health services utilization, accessibility, health statu

Genomic tools for exploiting germplasm resources to improve grain attributes in sorghum: A case of Ethiopian sorghum germplasm collection

Doctor of PhilosophyDepartment of AgronomyTesfaye TessoSorghum is a primary source of diet for millions of people living in the semi-arid regions of Sub-Saharan Africa and Asia. Due to its immense resilience, sorghum stands as the crop of choice in the face of climate change that has already been causing widespread crop failures. However, the low nutritional quality of sorghum has negatively impacted its use and marketability relative to other cereals. Given the vast untapped germplasm resources for the species, opportunities exist to exploit beneficial alleles that may be of value to tackle challenges related to sorghum production and utilization. The current work is focused on exploring germplasm resources from one of the most significant sources of diversity, Ethiopia, to lay the scientific basis for genetic improvement of sorghum nutritional traits with emphasis on protein and the role of grain physicochemical attributes on adaptation behavior of the species. The work is presented in four chapters. The first chapter deals with a review of background information on the nutritional attributes of cereals emphasizing on challenges and opportunities for improving protein content; the second part investigates the pattern of adaptation of sorghum across Ethiopia’s diverse agroecology in view of bioclimatic factors vis-a-vis grain physicochemical attributes and genomic profile; the third chapter explores the power of genomics for mining germplasm resources in gene banks; the last chapter focuses on the impact of grain pre-treatment on bio-availability of proteins from a fermented sorghum food product. In the second chapter, after the background review, the hypothesis that environmental factors shape sorghum grain attributes was tested using more than 1500 Ethiopian landraces. We utilized phenotype-environment and genome-environment associations to support the thesis. The phenotype-environment association supports the hypothesis that tannin presence, grain weight, kernel hardness, and panicle compactness are all associated with historic precipitation gradient. The correlation pattern revealed by principal component analysis fits the expectation that grain attributes that favor grain-related diseases, such as compact panicles, were mainly concentrated in drier areas. In contrast, traits like tannin presence and loose panicle dominate high precipitation areas. Moreover, landraces from low rainfall regions were susceptible to grain mold suggesting the need to incorporate resistance when materials from dry regions are used as breeding parent for developing varieties for high precipitation areas. Genome-environment association also revealed the importance of polyphenols for the adaptation of sorghum. Moreover, the genomic loci attributed to historical population structure were correlated with precipitation and temperature gradients. The study suggests that sorghum improvement endeavors targeting grain attributes should also consider the climatic condition of the target environments. Likewise, germplasm originating from high precipitation areas may be utilized as donors of resistance genes to various grain diseases The third section investigates the potential of genomic selection (GS) in germplasm improvement. The study utilized grain-related and phenological data from Ethiopian sorghum core collection. Low to moderate prediction and validation accuracies were observed for the traits and increasing training size increased prediction accuracy. The focused identification of germplasm sampling (FIGS) approach, which had been proved successful in increasing the success rate in identifying rare alleles from large germplasm collections, was also evaluated for its complementarity with GS. Grain weight was utilized as a proxy for assessing the approach. Sampling using the FIGS-based approach changed population parameters relative to the base population. Genomic prediction on a reference population sampled using FIGS based approach had smaller validation accuracy and selection differential than randomly reconstituted reference populations. Modifying the FIGS sampling strategy by incorporating a few individuals from the opposite end of the FIGS predicted environment improved the overall performance of the system. The last chapter investigated the importance of pre-processing method to improve protein digestibility, a critical constraint in sorghum. This was conducted using four preprocessing methods on four selected varieties of sorghum varying in grain quality attributes. The result showed significant pre-processing and variety interaction effects in protein digestibility of fermented and cooked sorghum food samples, implying that varietal selection should target a specific pre-processing method. Sprouting, one of the pre-treatment methods studied, improved overall grain protein digestibility. Genotypes with inherently improved protein content and in-vitro protein digestibility when subjected to appropriate milling and pre-processing treatment can significantly enhance protein availability from fermented sorghum foods. In conclusion, understanding the adaptation history and the target end-user application is crucial for improving sorghum grain quality and nutritional traits. The information generated on the grain attributes and the genomic selection pipeline for the FIGS approach has promising potential to accelerate the development of nutritionally improved and locally adapted varieties

Assessment of Effective Coverage of HIV Prevention of Pregnant Mother to Child Transimission Services in Jimma Zone, South West Ethiopia

BACKGROUND: Coverage assessment of prevention of Pregnant Mother to Child Transmission (PMTCT) of HIV service is useful to measure the health system effort or performance of health service delivery function and to influence decisions. The objective of this study was to assess effective coverage level for prevention of Pregnant Mother to Child Transmission services in Jimma University Hospital.METHODS: Health institution based cross-sectional quantitative and qualitative study was conducted on prevention of Pregnant Mother to Child Transmission of HIV services.RESULTS: Out of total 1904 pregnant women who received at least one antenatal care service, 1472 (77.3%) were covered with PMTCT service in 2005 in Jimma University Hospital. The overall PMTCT service coverage for the target group in the Jimma Zone was 1.1 %. The prevalence of positive HIV blood test among pre counseled women was 101 (6.9%). Of all HIV positive pregnant women 62(61.3%) were taking Neverapine at home.CONCLUSION: From the data obtained, it was observed that PMTCT service coverage was low. Thus, we recommended that the services to be strengthened, for a better achievement and optimizing coverageKEY WORDS: Effective coverage, availability, utilization, continuity, quality, PMTCT, service

Assessment of Effective Coverage of Voluntary Counseling and Testing Services in Major Health Facilities of Jimma Zone, South Ethiopia

BACKGROUND: Coverage assessment of Voluntary Counseling and Testing (VCT) service is useful to measures the health system effort or performance of health service delivery function and to influence decisions. The objective of this study was to assess effective coverage level for Voluntary Counseling and testing services in major health facilities of Jimma Zone.METHODS: Health institution based cross-sectional quantitative and qualitative study on health facilities that provide voluntary Counseling and testing services.RESULTS: The over all HIV/AIDS service package indicators availability coverage were 45.5% across the zone. The over all coverage for target population were 1.3%. The primary health care centers served only 18% of total registered Voluntary Counseling and Testing service users. Out of total positive serostatus clients, only 5% received condom. The coverage for post result counseling was 98.7% for all tested clients. Seventy-four (1.3%) of clients who were tested for HIV did not returned to know their results. CONCLUSION: This study demonstrated that effective coverage of Voluntary Counseling and Testing service was very low based on the providers view and records available. Thus we recommended that the services has to be strengthened, supervised and monitored to have a better achievement and improving the coverage status in addition to scaling up the services in the Zone.KEYWORDS: Effective coverage, availability, utilization, quality, VCT service

Indigenous Community Insurance (Iddirs) as an Alternative Health Care Financing in Jimma City, Southwest Ethiopia

No abstract - Available on PD

The prevalence of pulmonary tuberculosis among miners from the Karonga, Rumphi, Kasungu and Lilongwe Districts of Malawi in 2019

Introduction Miners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess the burden of TB among these miners. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and health-seeking behaviour (HSB) in a population of miners in Malawi, and a range of associated factors. Our goal was to develop a method to identify missing cases of TB. MethodsWe conducted a cross-sectional study in the Karonga, Rumphi, Kasungu and Lilongwe districts of Malawi in 2019. We calculated frequencies, proportions, odds ratios (ORs) and their 95% confidence intervals (95% CIs), and used the chi-square test in STATA version15.1 to investigate the burden and magnitude of PTB in the mining sector. Bivariate and multivariate logistic regression models were also fitted for PTB and HSB. ResultsOf the 2400 miners approached, we were able to interview 2013 (84%). Of these, 1435 (71%) were males, 1438 (71%) had known HIV status and 272 (14%) had PTB. Multivariate analysis showed that the miners performing informal mining were 50% more likely to develop PTB compared with those in formal mining (adjusted odds ratio [AOR]=1.50, 95% CI: 1.10–2.05, P=0.01). A total of 459 (23% of 2013) miners had presumptive TB. Of these, 120 (26%) sought health care; 80% sought health care at health facilities. Multivariate analysis also showed that miners who experienced night sweats were less likely to seek health care compared with those without night sweats (AOR=0.52, 95% CI: 0.30–0.90, P=0.02).ConclusionThe prevalence of PTB was higher among miners than in the general population. Consequently, targeted TB screening programmes for miners may represent a suitable strategy to adopt if we are to end TB by 2030. Poor health-seeking behaviours among miners is worrisome and further qualitative research is necessary to understand the barriers to accessing health care in these settings. &nbsp

Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia

BACKGROUND: The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV) drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia. METHODS: The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0) and third month (M3) follow up visits. RESULTS: A total of 400 and 383 patients at baseline (M0) and at follow up visit (M3) respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food) was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21). Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81). However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55) and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51) were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases. CONCLUSION: The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot reliably be predicted by a few patient characteristics that are assumed to vary with time. Adherence is a process, not a single event, and adherence support should be integrated into regular clinical follow up