Levels, Trends and Determinants of Under-Five Mortality in Amhara Region, Ethiopia Using EDHS (2000 -2011)

Children are the human resource bank of every nation. Above all, the first five years of life are the most crucial to the physical and intellectual development of children and can determine their potential to learn and thrive for a life time. Under-five mortality is a key indicator of social and economic development and has received attention as a part of United Nations Millennium Development Goals. This is due to more than any other age group of a population, children survival depends on the socio-economic condition. In Amhara region under-five mortality remains one of the public health problems. Although the region has made remarkable progress in reducing under-five mortality over decades it still remains high. The objective of this study is thus to assess the levels, trends and determinants of under-five mortality in Amhara Regional State, Ethiopia. The source of data comes from the three nationally representative Ethiopian Demographic and Health Surveys conducted in 2000, 2005 and 2011. A total of 8,479 children included in this study. Of these children 3,202, 2,621 and 2,656 were from 2000, 2005 and 2011 surveys, respectively. The analysis tools used include both descriptive and inferential statistics. The finding of the descriptive statistics indicates that under-five mortality was declining over the period 2000 to 2011. Moreover, the result of multivariable analysis revealed that the hazards of under-five mortality were found to be significant for male, children born from illiterate and primary school mothers, children born outside marital union, mothers who do not use contraceptive and household without access to improved water. Thus, the result suggests that support system geared towards improving access and choices to women secondary educational training, integrating family planning with child survival programmes and improving sources of drinking water can reduce the existing high under-five mortality rate in the region. Keywords: Amhara Region; Under-five Mortality; Hazard, Hazard Model; Determinants; Surviva

Treatment Outcomes of Tuberculosis Patients at Debre Berhan Hospital, Amhara Region, Northern Ethiopia

BACKGROUND: Directly observed treatment remains one of the most widely-accepted global health interventions for tuberculosis. Tuberculosis treatment outcome is one of the performance indicators of the programme set by World Health Organization. Therefore, evaluating the treatment success rate ofDebreBerhanHospital was mandatory to show the achievement and to indicate where the hospital is against the World Health Organization target.METHODS: A register based cross sectional study covering the period of January 2009 to December 2013 was employed. All clients with complete records of the treatment outcome were included in the study. A checklist was prepared to extract data from patient charts. Data were entered into Epi-info version 3.2.2andanalyzed using SPSS version 16 for windows.RESULT: Between January 2009 and December 2013, a total of 1280 tuberculosis cases that had  complete records on treatment outcome were included in the analysis. Four in five (79.4%) of the patients had favorable treatment outcome; 15.8% were cured and 63.5%completed their treatment.  There was a continuous increment of treatment success rate from 2010 to 2013 in the area and the treatment success rate in the year 2013 was 84.4%.CONCLUSION: Despite the recent improvements in treatment success rate, treatment completed and defaulting rate, further efforts should be made by responsible bodies to identify and improve possible  promoting factors for successful tuberculosis treatment outcome.KEYWORDS: Tuberculosis, Treatment outcome, Success rate, DOTs, DebreBerha

Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study

Background: In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations. Methods: A ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS. Results: The most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%),and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 - 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 - 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS. Conclusions: Patients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency

Measuring the spatial heterogeneity on the reduction of vaginal fistula burden in Ethiopia between 2005 and 2016

Vaginal fistula is a shattering maternal complication characterized by an anomalous opening between the bladder and/or rectum and vagina resulting in continuous leakage of urine or stool. Although prevalent in Ethiopia, its magnitude and distribution is not well studied. We used statistical mapping models using 2005 and 2016 Ethiopia Demographic Health Surveys data combined with a suite of potential risk factors to estimate the burden of vaginal fistula among women of childbearing age. The estimated number of women of childbearing age with lifetime and untreated vaginal fistula in 2016 were 72,533 (95% CI 38,235–124,103) and 31,961 (95% CI 11,596–70,309) respectively. These figures show reduction from the 2005 estimates: 98,098 (95% CI 49,819–170,737) lifetime and 59,114 (95% CI 26,580–118,158) untreated cases of vaginal fistula. The number of districts having more than 200 untreated cases declined drastically from 54 in 2005 to 6 in 2016. Our results show a significant subnational variation in the burden of vaginal fistula. Overall, between 2005 and 2016 there was substantial reduction in the prevalence of vaginal fistula in Ethiopia. Our results help guide local level tracking, planning, spatial targeting of resources and implementation of interventions against vaginal fistula

Health system capacity for Tuberculosis Care in Ethiopia: evidence from national representative survey

Objective The objective of this study was to evaluate the TB health system capacity and its variations by location and types of health facilities in Ethiopia. Settings The study included 873 public and private health facilities all over Ethiopia. Design We used the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all hospitals and randomly selected health centers and private facilities in all regions of Ethiopia. We assessed structural, process and overall health system capacity based on the Donabedian quality of care model. Multiple linear regression and spatial analysis were done to assess TB capacity score variation across regions. Results A total of 873 health facilities were included in the analysis. The overall TB care capacity score was 76.7%, 55.9% and 37.8% in public hospitals, health centers and private facilities respectively. The health system capacity score for TB was higher in the urban (60.4%) facilities compared to that of the rural (50.0%) facilities (β=8.0, 95%CI: 4.4, 11.6). Health centers (β= 16.2, 95%CI: -20.0, -12.3) and private health facilities (β= -38.3, 95%CI: -42.4, -35.1) had lower TB care capacity score than hospitals. Overall TB care capacity score were lower in Western and Southern western Ethiopia and in Benishangul Gumz and Gambella regions. Conclusions The health system capacity score for TB care in Ethiopia varied across regions. Health system capacity improvement interventions should focus on the private sectors and health facilities in the rural and remote areas to ensure equity and improve quality of care

The burden of HIV/AIDS in Ethiopia from 1990 to 2016: evidence from the Global Burden of Diseases 2016 Study

BACKGROUND: The burden of HIV/AIDS in Ethiopia has not been comprehensively assessed over the last two decades. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk factors (GBD) data to analyze the incidence, prevalence, mortality and Disability-adjusted Life Years Lost (DALY) rates of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) in Ethiopia over the last 26 years. METHODS: The GBD 2016 used a wide range of data source for Ethiopia such as verbal autopsy (VA), surveys, reports of the Federal Ministry of Health and the United Nations (UN) and published scientific articles. The modified United Nations Programme on HIV/AIDS (UNAIDS) Spectrum model was used to estimate the incidence and mortality rates for HIV/AIDS. RESULTS: In 2016, an estimated 36,990 new HIV infections (95% uncertainty interval [UI]: 8775-80262), 670,906 prevalent HIV cases (95% UI: 568,268-798,970) and 19,999 HIV deaths (95% UI: 16426-24412) occurred in Ethiopia. The HIV/AIDS incidence rate peaked in 1995 and declined by 6.3% annually for both sexes with a total reduction of 77% between 1990 and 2016. The annualized HIV/AIDS mortality rate reduction during 1990 to 2016 for both sexes was 0.4%

Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.</p> <p>Methods</p> <p>The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.</p> <p>Results</p> <p>A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.</p> <p>Conclusion</p> <p>Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.</p> <p>Trail registration</p> <p>Australian New Zealand Clinical Trials Registry (ACTR number: <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a>).</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