Assessment of HIV Post-Exposure Prophylaxis Use Among Health Workers of Governmental Health Institutions in Jimma Zone, Oromiya Region, Southwest Ethiopia

Background: Infection with Human Immunodeficiency Virus is a serious public health problem costing the lives of many people including health workers. Hence, Ethiopia has developed guideline on the prevention of infection in health institutions in July 2004 and also employed the use of post exposure prophylaxis since the implementation of free antiretroviral in January 2005. However in the country, specifically in Jimma zone, published studies showing the clear picture about HIV post exposure prophylaxis in the work place were non-existent. Therefore, this study was conducted to assess the knowledge, practice and factors associated to HIV post-exposure prophy-laxis use among health workers of governmental health institutions in the Zone. Methods: A cross-sectional survey employing quantitative and qualitative methods was conducted from October to December 2008. Two hundred fifty four health workers participated in the quantitative study. Health workers for focus group discussion and key informants for in-depth interviews were identified with the help of administrators/HIV/AIDs coordinators of the two administrative health bureaus and institutions included in the study. The quanti-tative data were entered and cleaned using Epi Info version 6.4 and analysed using SPSS for windows version 11.0. Descriptive statistics and chi-square test was employed to assess association among variables. P-value less than 0.05 was considered statistically significant. Results: Among the total 254 participants, 213 (83.9%) had inadequate knowledge about post exposure prophy-laxis of HIV and 174 (68.5%) had ever been exposed to HIV risk conditions. Out of 174 health workers exposed to HIV risk, 105 (60.3%) sustained needle prick/cut by sharps, 77 (44.3%) to blood and 68 (39.1%) exposed to pa-tients’ body fluid. Perceived causes of exposure were; high workload 77 (44.3%), lack of protective barriers 58 (33.3%) and lack of knowledge on standard precautions 31 (17.8%). One hundred forty two (81.6%) of those ex-posed did not use post-exposure prophylaxis. Lack of information about the existence of post-exposure prophylaxis service 48 (33.8%), fear of stigma and discrimination 46 (32.4%), lack of understanding the value of reporting 33 (23.2%) and lack of support and encouragement to report 29 (20.4%) were the reasons for not using. Moreover, formal (separate) HIV post-exposure prophylaxis centre with proper guideline was non-existent in the study areas. Conclusions: In general, findings of the quantitative and qualitative study revealed that the knowledge of health workers about post exposure prophylaxis against HIV is inadequate. Though many of the studied health workers had HIV risk exposure, only few used post-exposure prophylaxis. Therefore, establishing a 24 hours accessible formal post-exposure prophylaxis centre with proper guideline is recommended. Health institutions are also ad-vised to raise awareness of their employees on post exposure prophylaxis

Health workforce acquisition, retention and turnover in southwest Ethiopian health institutions

Background: Skill mix of health professionals, staff acquisition and turnover rate are among the major challenges for the delivery of quality health care. This study  assessed the health workforce acquisition, retention, turnover rate and their  intention to leave.Methods: A cross-sectional survey with quantitative and qualitative data collection methods was conducted in Jimma Zone health institutions. Five years records (September 2009-August 2014) were reviewed to determine the turnover rate. A total of 367 health professionals were included for the quantitative study. For the qualitaive study, all available and relevant health managers and administrative records in the selected health institutions were included. Descriptive and inferential analyses were done for the quantitative study. Thematic analysis was used for the qualitative component.Results: A total of 367 health workers were incorporated for the quantitative study making a response rate of 87%. The overall health workers’ satisfaction was neutral (mean 3.3). In five years period, 45.9% staffs had left for a cause; 59.4% health professionals intended to leave. Being male (AOR =1.6, 95%CI: 1.001-2.5), not knowing their overall satisfaction (AOR=0.5, 95%CI: 0.2-0.8), below mean score of institutional satisfaction (AOR =1.7, 95%CI: 1.06-2.7) and below mean score of organizational satisfaction (AOR=1.8, 95%CI: 1.08-2.8) were independent predictors for intention to leave.Conclusions: The overall health workers’ satisfaction was marginally neutral. A considerable number of staffs had left, and more than half of the current staffs had an intention to leave. Thus, it is recommended that the responsible authorities should design strategies to improve the situation.Keywords: Health workforce, acquisition, retention, turnover, Ethiopi

Institutional capacity for health systems research in East and Central Africa schools of public health: enhancing capacity to design and implement teaching programs

BACKGROUND: The role of health systems research (HSR) in informing and guiding national programs and policies has been increasingly recognized. Yet, many universities in sub-Saharan African countries have relatively limited capacity to teach HSR. Seven schools of public health (SPHs) in East and Central Africa undertook an HSR institutional capacity assessment, which included a review of current HSR teaching programs. This study determines the extent to which SPHs are engaged in teaching HSR-relevant courses and assessing their capacities to effectively design and implement HSR curricula whose graduates are equipped to address HSR needs while helping to strengthen public health policy. METHODS: This study used a cross-sectional study design employing both quantitative and qualitative approaches. An organizational profile tool was administered to senior staff across the seven SPHs to assess existing teaching programs. A self-assessment tool included nine questions relevant to teaching capacity for HSR curricula. The analysis triangulates the data, with reflections on the responses from within and across the seven SPHs. Proportions and average of values from the Likert scale are compared to determine strengths and weaknesses, while themes relevant to the objectives are identified and clustered to elicit in-depth interpretation. RESULTS: None of the SPHs offer an HSR-specific degree program; however, all seven offer courses in the Master of Public Health (MPH) degree that are relevant to HSR. The general MPH curricula partially embrace principles of competency-based education. Different strengths in curricula design and staff interest in HSR at each SPH were exhibited but a number of common constraints were identified, including out-of-date curricula, face-to-face delivery approaches, inadequate staff competencies, and limited access to materials. Opportunities to align health system priorities to teaching programs include existing networks. CONCLUSIONS: Each SPH has key strengths that can be leveraged to design and implement HSR teaching curricula. We propose networking for standardizing HSR curricula competencies, institutionalizing sharing of teaching resources, creating an HSR eLearning platform to expand access, regularly reviewing HSR teaching content to infuse competency-based approaches, and strengthening staff capacity to deliver such curricula.DFI

Intimate Partner Violence in Pregnancy in Ethiopia

Intimate partner violence (IPV) during pregnancy imposes a substantial effect on the health of the woman and her fetus. However, studies on the extent of the problem, contributing factors, and how the communities’ different institutions perceive and respond to IPV in pregnancy, are limited in Ethiopia. This thesis is aimed to investigate the prevalence and factors contributing to IPV during pregnancy, its influence on the initiation of antenatal care, the perceptions and responses of community institutions and health care workers (HCWs) on IPV, using quantitative and qualitative methods. The quantitative data were collected from 720 pregnant women at antenatal care (ANC) clinics. The interviews data were obtained from HCWs and individuals representing different community institutions. The results show that IPV in pregnancy is prevalent (35.6 %) in Ethiopia and multi-factorial. Late entry into ANC is also very common (52%), especially among multiparous women reporting IPV. We also identified socio-cultural, structural and economic factors, acting as barriers for victims to receive adequate assistance. The HCWs as well as the community informants expressed limited awareness of the adverse impacts IPV has on pregnant women and fetal health, disclosed the absence of support to IPV victims or any networks aimed at IPV mitigation among relevant institutions. Additionally, despite regular contact with pregnant IPV victims, HCWs mainly focusing on treating apparent obstetric complications and/or visible trauma. This thesis adds knowledge to the Ethiopian society of the complex social ecologic risk factors of IPV in pregnancy and how IPV directly impacts the use of ANC during pregnancy. It also highlights the perceptions and attitude of HCWs and different community stakeholders towards IPV in pregnancy. Together these four papers provide invaluable information when planning a cross-sectoral community intervention mitigating IPV and its impact on women and children

Disclosure of Intimate Partner Violence and Associated Factors among Victimized Women, Ethiopia, 2018: A Community-Based Study

Background. Disclosure is a vital step in the process of finding a lasting solution and breaking the abuse chain in a victim woman by the intimate partner. Objectives. This study is aimed at assessing the disclosure of intimate partner violence and associated factors among victim women in Dilla town, Gedeo Zone, South Ethiopia, 2018. Methods. A community-based cross-sectional study design triangulated with the qualitative method was employed. Data were collected from 280 women victims of intimate partner violence using pretested, structured, and interviewer-administered questionnaires. SPSS version 20.0 software was used for analysis. Binary logistic regression and a multivariate logistic regression model were fitted to assess the association between the independent and dependent variables. Qualitative data were collected through in-depth interviews and categorized into themes and triangulated with the quantitative result. Results. Half of the respondents (51%) disclosed intimate partner violence. Partner alcohol use (AOR=1.99; 95% CI:1.18, 3.34), women experiencing a single type of intimate partner violence (AOR=0.38, 95% CI: 0.17, 0.79), women having strong social support (AOR=2.52; 95% CI:1.44, 4.41), and women whose partners’ having primary (AOR=2.04; 95% CI:1.07, 3.9) and secondary education (AOR=2.16; 95% CI: 1.07, 4.33) were significantly associated with the disclosure of intimate partner violence as the qualitative result shows most of the women prefer their family to disclose and those who kept silent were due to economic dependency, societal norms towards wife beating, arranged marriage, and not getting the chance especially those who went to the hospital. Conclusion. Nearly 50% of victims of intimate partner violence women disclose intimate partner violence to others. Thus, it is needed for stakeholders to use their efforts to further increase the disclosure of violence and respect women’s rights and equality

Additional file 1: of Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study

Adapted study tools(questionnaire,interview guide and checklist). (DOCX 52 kb

Community Stakeholders’ Perspectives on Intimate Partner Violence during Pregnancy—A Qualitative Study from Ethiopia

Intimate partner violence (IPV) in pregnancy adversely affects the health of women and unborn children. To prevent this, the community responses, societal systems, and structures to support victims of IPV in pregnancy are vital. Objectives: to explore community stakeholders’ perspectives related to IPV in pregnancy in Jimma, Ethiopia, and if needed, create the knowledge base for interventions. Methods: using an exploratory design, this qualitative study had a maximum-variation (multiple spectrum sources) sampling strategy with 16 semi-structured interviews of purposively selected key informants representing different community institutions. Guided by Connell’s theory of gender and power, a content analysis of the translated interviews was conducted using Atlas.ti 7 software. Results: reconciliation between IPV victims and their abusers was the solution promoted by almost all the respondents. There was limited awareness of the adverse impacts IPV in pregnancy has on the health of the woman and the foetus. Despite regular encounters with victims, there is no organized or structured operational response to support IPV victims between the participating institutions. Conclusion: the potential danger of IPV for the mother or the unborn child was not well understood by the members of the studied Ethiopian community. Neither coordinated efforts to support IPV victims nor links among relevant agencies existed. The study demonstrated the dire need of coordinated practical action, changes in current socio-cultural norms, formal training and capacity building, awareness creation, clear intervention guidelines, and facilitation of support networks among relevant institutions in Ethiopian communities

Community Stakeholders’ Perspectives on Intimate Partner Violence during Pregnancy—A Qualitative Study from Ethiopia

Abstract:Intimate partner violence (IPV) in pregnancy adversely affects the health of womenand unborn children. To prevent this, the community responses, societal systems, and structuresto support victims of IPV in pregnancy are vital. Objectives: to explore community stakeholders’perspectives related to IPV in pregnancy in Jimma, Ethiopia, and if needed, create the knowledgebase for interventions.Methods: using an exploratory design, this qualitative study hada maximum-variation (multiple spectrum sources) sampling strategy with 16 semi-structuredinterviews of purposively selected key informants representing different community institutions.Guided by Connell’s theory of gender and power, a content analysis of the translated interviewswas conducted using Atlas.ti 7 software. Results: reconciliation between IPV victims and theirabusers was the solution promoted by almost all the respondents. There was limited awareness ofthe adverse impacts IPV in pregnancy has on the health of the woman and the foetus. Despite regularencounters with victims, there is no organized or structured operational response to supportIPV victims between the participating institutions. Conclusion: the potential danger of IPV forthe mother or the unborn child was not well understood by the members of the studied Ethiopiancommunity. Neither coordinated efforts to support IPV victims nor links among relevant agenciesexisted. The study demonstrated the dire need of coordinated practical action, changes in currentsocio-cultural norms, formal training and capacity building, awareness creation, clear interventionguidelines, and facilitation of support networks among relevant institutions in Ethiopian communitie

Ethiopian Health Care Workers’ Insights into and Responses to Intimate Partner Violence in Pregnancy—A Qualitative Study

Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy

Social ecological factors and intimate partner violence in pregnancy

<div><p>Background</p><p>Intimate partner violence (IPV) during pregnancy increases adverse pregnancy outcomes. Knowledge of societal, community, family and individual related factors associated with IPV in pregnancy is limited in Ethiopia. Our study examined these factors in an Ethiopian context.</p><p>Materials and methods</p><p>A cross sectional study was conducted among pregnant women attending antenatal care at governmental health institutions, using a consecutive probability sampling strategy. A total of 720 pregnant women were interviewed by five trained nurses or midwives, using a standardized and /pretested survey questionnaire. Bivariate and multivariate logistic regression analyses were applied to assess factors contributing to IPV. We used Akaike’s information criteria, to identify the model that best describes the factors influencing IPV in pregnancy.</p><p>Results</p><p>Among the women interviewed, physical IPV was reported by 35.6%, and lifetime emotional or physical abuse by 81.0%. Perceiving violence as a means to settle interpersonal conflicts, presence of supportive attitudes of wife beating in the society, regarding violence as an expression of masculinity, and presence of strict gender role differences in the society, were all positively associated to IPV in pregnancy. The presence of groups legitimizing men’s violence in the community, feeling isolated, having no social support for victims, and presence of high unemployment, were the perceived community related factors positively associated with IPV in pregnancy.</p><p>Conclusion</p><p>IPV in pregnancy is very prevalent in Ethiopia and is associated with multiple social ecologic factors. Reduction of IPV in pregnancy calls for cross sectorial efforts from stakeholders at different levels.</p></div