Developing and validating a multi-dimensional instrument for measuring the performance of district health systems in a national region in Ethiopia

Background: Despite being the main vehicles of primary healthcare provision in Ethiopia, district health systems lack comprehensive set of valid performance indicators that are both process and outcome oriented. Therefore, we aimed to develop and validate a set of performance indicators for district health systems of Oromia Region, Ethiopia. Methods: We used a sequential mixed-methods design. During development stage, we employed a qualitative interview study in Oromia Region, Ethiopia. We transcribed, did in vivo coding and inductive analysis of the interviews. Moreover, we conducted a narrative systematic review. Records on performance of health systems were appraised and synthesized. Then, during the validation stage, we supplied the indicators generated from the previous two studies to experts in the field of health systems as part of a Delphi study. In the Delphi study, experts voted on the inclusion- or exclusion-of indicators in three stages. Results: Eleven functions of district health systems emerged from the interviews including: creating capacity of health centers for the provision of health care; and provision of comprehensive health care for communicable diseases and maternal health conditions, among others. Furthermore, 59 out of 238 indicators generated by the interviews and the systematic review were found to be valid by experts. Among these, 40 were found to be able to be drawn from the information systems in the districts. The indicators addressed multiple dimensions of performance of district health systems, such as capacity, quality, and outcomes. Among valid and feasible indicators were rate of utilization of family planning methods, and tuberculosis cases per 1000 people. Conclusion: Policy makers can use the valid indicators to monitor national policy priority areas like the expansion of family planning services. Moreover, the indicators can be used in the districts for local decision making, for example, to identify poorly performing functions and take corrective action

Developing and validating a multi-dimensional instrument for measuring the performance of district health systems in a national region in Ethiopia

Background: Despite being the main vehicles of primary healthcare provision in Ethiopia, district health systems lack comprehensive set of valid performance indicators that are both process and outcome oriented. Therefore, we aimed to develop and validate a set of performance indicators for district health systems of Oromia Region, Ethiopia. Methods: We used a sequential mixed-methods design. During development stage, we employed a qualitative interview study in Oromia Region, Ethiopia. We transcribed, did in vivo coding and inductive analysis of the interviews. Moreover, we conducted a narrative systematic review. Records on performance of health systems were appraised and synthesized. Then, during the validation stage, we supplied the indicators generated from the previous two studies to experts in the field of health systems as part of a Delphi study. In the Delphi study, experts voted on the inclusion- or exclusion-of indicators in three stages. Results: Eleven functions of district health systems emerged from the interviews including: creating capacity of health centers for the provision of health care; and provision of comprehensive health care for communicable diseases and maternal health conditions, among others. Furthermore, 59 out of 238 indicators generated by the interviews and the systematic review were found to be valid by experts. Among these, 40 were found to be able to be drawn from the information systems in the districts. The indicators addressed multiple dimensions of performance of district health systems, such as capacity, quality, and outcomes. Among valid and feasible indicators were rate of utilization of family planning methods, and tuberculosis cases per 1000 people. Conclusion: Policy makers can use the valid indicators to monitor national policy priority areas like the expansion of family planning services. Moreover, the indicators can be used in the districts for local decision making, for example, to identify poorly performing functions and take corrective action

Impact of soil conservation on crop production in the Northern Ethiopian Highlands:

"Land degradation, in the form of soil erosion and nutrient depletion, threatens food security and the sustainability of agricultural production in many developing countries. Governments and development agencies have invested substantial resources in promoting soil conservation practices, in an effort to improve environmental conditions and reduce poverty. However, very limited rigorous empirical work has examined the economics of adopting soil conservation technology. This paper investigates the impact of stone bunds on crop production value per hectare in low and high rainfall areas of the Ethiopian highlands using cross-sectional data from more than 900 households having multiple plots per household. We use modified random effects models, stochastic dominance analysis (SDA) and matching methods to ensure robustness. The parametric regression and SDA estimates are based on matched observations obtained from nearest neighbor matching using propensity score estimates. This is important because conventional regression and SDA estimates are obtained without ensuring the existence of comparable conserved and non-conserved plots within the distribution of covariates. Here, we use matching methods, random effects and Mundlak's approach to control for selection and endogeneity biases that may arise due to correlation of unobserved heterogeneity and observed explanatory variables. The three methods used herein consistently show that plots with stone bunds are more productive than those without such technologies in semi-arid areas but not in higher rainfall areas, apparently because the moisture-conserving benefits of this technology are more beneficial in drier areas. This implies that the performance of stone bunds varies by agro-ecological type, suggesting a need for the design and implementation of appropriate site-specific technologies." from Authors' AbstractSoil conservation, Crop production, Agro-ecology, Matching method, Stochastic dominance, Modified random effects model, Land management,

Group B Streptococcus Recto-Vaginal Colonization in Near-Term Pregnant Women, Southwest Ethiopia

BACKGROUND: Group B Streptococcus (GBS) is recognized as an important cause of maternal and neonatal morbidity and mortality. Maternal vaginal carriage of GBS (Streptococcus agalactiae) can lead to vertical transmission to the neonate at the time of delivery. However, little is known about its prevalence, predictors and antibiotic susceptibility pattern in Jimma, Ethiopia. This study assessed the prevalence, antimicrobial susceptibility pattern and determinants of GBS recto-vaginal colonization among near-term pregnant women.METHODS: A cross-sectional study was conducted from May to August 2015 at Jimma University Medical Centre in Southwest Ethiopia. Data through questionnaire and GBS isolates from vaginal and rectal swabs were collected. Antimicrobial susceptibility testing was performed.RESULTS: The overall prevalence of GBS colonization among near term pregnant women (35-37 weeks) was 16.3% (22/135). The majority of GBS isolates were sensitive to Ampicillin and Penicillin G with 95.5% and 90.1%, respectively. Erythromycin and clindamycin were resisted by 50% and 40.9% of the isolates, respectively, whereas gentamicin was resisted by all isolates. GBS colonization was significantly associated with a history of preterm delivery (PTD) (AOR: 6.3, 95% CI: 1.42, 28.3) and history of urinary tract infection (UTI) during current pregnancy (AOR: 6.4, 95% CI, 1.95, 21.1).CONCLUSION: Our study indicated that one among six near-term pregnant women had recto-vaginal GBS colonization. In places where universal screening is not feasible, selective screening for factors particularly history of PTD and UTI during current pregnancy may be a reasonable option. Antibiotic susceptibility testing should be performed while using Erythromycin, Clindamycin or Gentamicin.&nbsp

Inequities in utilization of reproductive and maternal health services in Ethiopia

Background: Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Method: Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used;equity gaps, rate-ratios, concertation curve and concentration index. Results: Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Conclusion: Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably

Practice and Associated Factors of Health Professionals towards Citizens’ Charter at Jimma University Medical Center

BACKGROUND: Citizens’ Charter is a public promise between citizens and service providing organizations which visibly specifies expectations and standards in the service delivery. Citizens’ charter standard has been implemented in Jimma University Medical Center since 2016/17. However, the practice and associated factor of citizens’ charter among health professionals have not been studied yet. Hence, the aim of this study was to assess the practice of citizens’ charter and associated factors among health professionals.METHODS: Facility based cross-sectional study was conducted on 389 health care providers, selected through stratified sampling, from April 1 to April 26. Data was collected using a pretested structured self-administered questionnaire. Data were entered into EPI-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, binary and multivariable logistic regression analysis were done. P-values less than 0.05 were used to declare significant association between dependent and independent variables. In the process of multivariable logistic regression analysis, knowledge and attitude variables were not tested due to low number of respondents to those specific variables’ measuring items. Hence, it was difficult to declare as a predictor at bivariate analysis.RESULT: For this study, the response rate was 92%. Out of all, 237(60.9%) professionals were properly practicing citizens’ charter standard while 152(39.1%) were not properly practicing it. The factors affecting the practice were job satisfaction [AOR =7.4, 95%CI (4.4, 12.5)], perceived workload [AOR =1.8, 95%CI (1.05, 3.0)] and type of profession [AOR=5.4, 95%CI ((1.98, 14.8)].CONCLUSION: This study revealed that more than half of the respondents properly practiced citizens’ charter. However, few health professionals only knew the existence of citizens’ charter. Job satisfaction, perceived workload, and type of profession were the factors affecting the practice of citizens’ charter.

Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based Cross-Sectional Study

BACKGROUND: Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home.  METHODS: A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness.  RESULTS: Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation. CONCLUSIONS: The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections

COVID-19 Vaccines Safety Tracking (CoVaST): Protocol of a Multi-Center Prospective Cohort Study for Active Surveillance of COVID-19 Vaccines' Side Effects.

Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses' side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869. CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines.This study protocol preparation was funded by Masaryk University, grant numbers MUNI/IGA/1543/2020 and MUNI/A/1608/2020.S

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding: Bill & Melinda Gates Foundation