Inequalities in the Utilization of Maternal Health Services by Key Indicators in Ethiopia

Introduction: Inequalities in health are a major challenge for health policy, because most of them can be considered unfair or unreasonable. The aim of this study was to examine inequality in maternal health service indicators based on selected inequalities dimension. Methods: The Demographic and Health Survey datasets of Ethiopia (2000, 2005 and 2011) were used. Five maternal health service indicators such as four or more antenatal care visits from a skilled professional, at least one antenatal care visit, delivery assistance from a skilled birth attendant, modern contraceptive use by married women and demand family planning satisfied were included in the study. Each of these maternal health services were stratified by economic, education and place of residence. We calculated the ratio and concentration index inequality measure using World Health Organization health equity assessment toolkit (HEAT) software version 1.0.Results: Improvement in maternal health service utilization observed across each survey year by economic, education and place of residence but utilization was uneven. The maternal health services utilization are concentrated in advantage groups (richest quintile, urban and educated secondary & above).  The least equality related to economics, educational levels and residence is observed in the utilization of skilled birth attendants and four or more antenatal care visits. Conclusion: Maternal health services use inequality related to economic, education and residence are observed in all indicators and the utilization are concentrated in advantaged groups. Health inequality related to maternal health service use in terms of wealth quintiles, educational levels and residence need due emphasis to narrow the gap between advantaged and disadvantaged population distribution. Keywords: Maternal; Health Service; Inequality; Ethiopi

In-vitro Acaricidal efficacy evaluation trial of Ixodid ticks at Borana, Ethiopia.

The study was conducted from September 2011 to May 2012 in Borana pastoral community with the objectives of determining the efficacy of Amitraz 12.5% and Diazinon 60% Emulsion Concentrate (EC) against Rhipicephalus pulchellus and Amblyoma gemma using modified Adult Immersion Test (AIT) and to assess the pastoralist communities’ perceptions on acaricide (usage, delivery and methods of tick control practice). Acaricide treatment is the only method for tick control in the community, where Amitraz was the most widely used followed by Diazinon. Manual spraying and hand dressing of each acaricide relaying on frequent applications of often inadequate acaricide concentrations without alternation of acaricidal products was the common practice. The result of AIT on engorged female ticks revealed that, Amitraz 12.5% produced significantly higher (P<0.05) level of oviposition inhibition (Percent control = 95.5%) in A. gemma and Rh. pulchellus than Diazinon 60% EC (Percent control = 80.9 %). Both acaricides however are relatively less efficient against R. pulchellus and A. gemma. Furthermore, Amitraz and Diazinon are the two mostly used acaricides by the community. Under laboratory condition, Amitraz seems to provide more oviposition inhibition effect against Rh. pulchellus and A. gemma than Diazinon 60% EC. Therefore, in vivo trial to assess the residual effect of these acaricides is suggested.Key words: Acaricide, Cattle, Efficacy, Ethiopia, In-vitro evaluation, Ixodidae tick

Utilization and Determinants of Postnatal Care Services in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND: Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This reviewaimed to determine the utilization and determinants of postnatal care use in Ethiopia.METHODS: PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effectsmodel.RESULTS: Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use.CONCLUSION: Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The review was registered on PROSPEROCRD42017060266

The Clerkship Pediatric Rotation: Does Setting Matter?

ABSTRACTBackground: Medical student rotations in community practice settings are increasingly common within pediatric clerkship curricula yet little evidence exists to support the quality of the educational exposure. Purpose: To assess the impact of clerkship site (community setting vs. exposure to an Academic Health Sciences Center) on the following educational outcomes: 1. Clinical Performance; 2. Examination Performance; 3. Written Assignment Performance; and 4. Successful Matching to a Canadian Pediatric Residency Program.Methods: 340 medical students from the graduating classes of 2007 and 2008 at the University of Toronto, Canada were studied. Rotation performance (clinical assessment, examination mark, and written assignment mark) and acceptance into a Canadian pediatric residency program were assessed in relation to clerkship rotation site. These outcomes were assessed while controlling for the following potential confounders: 1) Pre-clerkship career preference and 2) Pre-rotation site preference as expressed by each medical student. Results: 172 medical students completed rotations that included exposure to an academic health sciences center, while 168 medical students had exclusive exposure to the community setting. Students who completed exclusively community-based pediatric rotations received slightly higher clinical evaluations (p=0.006), but not exam marks (p=0.812) nor written assignment marks (p=0.086). Students who had expressed an interest in paediatrics as a career prior to beginning their clerkship performed better during paediatric clerkship regardless of site (p= .0003) and were more likely to choose a clerkship setting that included exposure to an Academic Health Sciences Center (p=.052). Clerkship setting was not found to impact on successful matching to a Canadian pediatric residency program (p=0.171).Discussion: These results help support the decision of curriculum committees to incorporate the use of community practice settings and inform students and faculty as to the validity of distributed medical education within the field of pediatric medical education

Knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital, southwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>In Ethiopia maternal mortality rate is very high more than one in five women die from pregnancy or pregnancy related causes. The use of contraceptives to prevent unwanted pregnancies and unsafe abortion is an important strategy to minimize maternal mortality rate. Among various forms of contraception, emergency contraceptives are the only one that can be used after sexual intercourse offering chance to prevent unwanted pregnancy. The aim of this study was to assess the knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital (JUSH).</p> <p>Methods</p> <p>Institution base cross-sectional study on knowledge, attitude and practice of emergency contraceptive was conducted at JUSH from April to June, 2011Data was collected using structured questionnaire and analyzed using SPSS version 17.0.</p> <p>Results</p> <p>In this study 89 women were interviewed. More than half of them (48) were from urban area and 41 were from rural area.46 (51.7%) of them were single. Of all the respondents only nine women had awareness about emergency contraceptive. Seven of the women mentioned pills as emergency contraception and only two of them mentioned both pills and injectable as emergency contraception. All of them have positive attitude towards emergency contraception but none of them have ever used emergency contraceptives.</p> <p>Conclusion and recommendation</p> <p>The finding revealed pregnancy among women of 15-19 years was very common. The knowledge and practice of emergency contraception is very low. But there is high positive attitude towards emergency contraceptives. Since there is much deficit on knowledge of women on emergency contraceptives, in addition to making them accessible; programs targeted at promotion and education of emergency contraceptives is helpful to prevent unwanted pregnancy.</p

Genomics of Ocular Chlamydia trachomatis After 5 Years of SAFE Interventions for Trachoma in Amhara, Ethiopia.

BACKGROUND: To eliminate trachoma as a public health problem, the World Health Organization recommends the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy. As part of the SAFE strategy in the Amhara Region, Ethiopia, the Trachoma Control Program distributed >124 million doses of antibiotics between 2007 and 2015. Despite this, trachoma remained hyperendemic in many districts and a considerable level of Chlamydia trachomatis (Ct) infection was evident. METHODS: We utilized residual material from Abbott m2000 Ct diagnostic tests to sequence 99 ocular Ct samples from Amhara and investigated the role of Ct genomic variation in continued transmission of Ct. RESULTS: Sequences were typical of ocular Ct at the whole-genome level and in tissue tropism-associated genes. There was no evidence of macrolide resistance in this population. Polymorphism around the ompA gene was associated with village-level trachomatous inflammation-follicular prevalence. Greater ompA diversity at the district level was associated with increased Ct infection prevalence. CONCLUSIONS: We found no evidence for Ct genomic variation contributing to continued transmission of Ct after treatment, adding to evidence that azithromycin does not drive acquisition of macrolide resistance in Ct. Increased Ct infection in areas with more ompA variants requires longitudinal investigation to understand what impact this may have on treatment success and host immunity

Active trachoma and community use of sanitation, Ethiopia.

OBJECTIVE: To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. METHODS: Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. FINDINGS: In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). CONCLUSION: In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level

Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia.

This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies