Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study

Background Despite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People’s Region (SNNPR) of Ethiopia. Methods A community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI. Results From a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness. Conclusion Low LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country’s malaria elimination goal.publishedVersio

Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples' Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. METHODS: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. RESULTS: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age- and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level age-adjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude 15°C, and the use of open defecation by household members. CONCLUSION: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement)

Ideal family size decision and its associated factors among women of reproductive age: community survey in southern Ethiopia

Background Understanding fertility preferences is important for population studies and planning programs. The ideal family size, which is the number of children wanted in one’s lifetime, is one of variables used to measure fertility preferences. However, there was limited information on ideal family size decision in Southern Ethiopia. Therefore, this study was designed to assess ideal family size decision and its associated factors among women of reproductive age in Southern Ethiopia. Methods A community based cross-sectional study was conducted in 2015 in Southern Ethiopia. Multi-stage stratified cluster sampling was used to select 3,205 study subjects. Data on socio-demographic characteristics, reproductive history, deciding ideal number of children, knowledge and utilization of contraceptives were considered. Descriptive statistics and binary logistic regression were done to describe and assess factors associated with deciding ideal family size. The association between variables was presented using odds ratios with 95% confidence intervals. Results We included 3,205 women of reproductive age from which 37.5% respondents could not read and write and 56.5% were housewives. About half of the respondents, 47.1%, did not decide ideal numeric family size or failed to report numeric preferences while 21.6% desire to have five or more children. The mean ideal number of children preferred was 4.5 ± 1.62. Educational status (P &lt; 0.001), overall knowledge about contraceptives (P &lt; 0.001), current contraceptive use (P &lt; 0.001), place of residence (P &lt; 0.001), age (P &lt; 0.004), marital status (P &lt; 0.003) and number of living children (P &lt; 0.003) were factors associated with deciding ideal family size. Conclusion Only about half of respondents decided ideal family size from which one fifth prefer high fertility. The mean ideal number of children was comparable with that of Sub-Saharan estimate. Counselling that can empower women to decide family size should be strengthened to empower less empowered women. </jats:sec

Sustaining women’s empowerment for development in resource-limited settings: an exploratory qualitative approach

BackgroundWomen's empowerment is one of the fundamental issues for attaining sustainable development goals crossing multiple dimensions. In Ethiopia, Women’s Development Network (WDN), a network of women, was established in 2010 with development aims. Ensuring women’s empowerment critically needs collective efforts of platforms such as WDN. However, there was a paucity of information about the patterns of WDN functionalities, its contribution, and factors affecting its functionality in rural areas of Southern Ethiopia. Hence, this study aimed to explore WDN status and factors affecting their functionality in Southern Ethiopia.MethodologyThe study employed an exploratory qualitative design. Data were collected from purposively selected zones using focus group discussions and key informant interviews. Audio-taped materials were transcribed verbatim and analyzed using a thematic approach. Initially, data were coded (open coding) and after several reviews, themes were developed and interpreted in line with the study objectives.ResultWDN has passed several steps from its establishment up to now. It was seen skeptically at its early inception, very good level of acceptance in the middle, and staggering currently. However, WDN has contributed to improvements in household welfare resulting from increased ability to afford food, clothing, health, and education. Specific to health, WDN has contributed to general awareness creation, maternal and child health utilization, and environmental sanitation. On the other hand, the volunteer nature of the job put pressure on WDN and revealed socioeconomic stresses. Moreover, inconsistent support from stakeholders especially health extension workers, inadequate men’s engagement, and sidelining of WDN by some educated women remain challenges for the sustainable functionality.ConclusionWDN has contributed to multidimensional development goals, especially health services uptake and environmental sanitation. However, over time, it became flaccid and lost adequate emphasis from most of its stakeholders and supportive structures. Therefore, considering such vital inputs from community participation in resource-limited settings, stakeholders should offer adequate attention to WDN in terms of selection, training, orientation, follow-up, and acquainting with the community they serve. Moreover, efforts are needed to retain women voluntarily serving and build positive images across all stakeholders and fellow women receiving the services

Factors associated with positive attitude towards hypertension control in Hawassa city administration: Community based cross‐sectional study

Abstract Background and Aims In low‐income countries where there is shortage of appropriate medical care to manage hypertension (HTN), understanding dynamics of communities' knowledge and attitude to prevent through lifestyle is crucial. Despite this fact, there was limited information on levels of awareness and attitude towards HTN and its prevention in the study setting. So, this study was conducted to assess level and factors associated with positive attitude in Hawassa city, Southern Ethiopia. Methods A community level study using cross‐sectional design was done in Hawassa city administration in 2017. Six hundred and twelve respondents were selected using a multi‐stage sampling technique. Knowledge and attitude were assessed using multiple questions and responses were categorized considering mean as cutoff points. Descriptive statistics and binary logistic regression analysis at 95% confidence interval (CI) were performed. Results The level of mean score of knowledge was 62.7% (SD = 22.2) [95% CI: 60.9–64.4] while that of attitude was 68.1% (SD = 8.8) [95% CI: 67.4–68.8]. Divorced/widowed respondents were 73% less likely to have positive attitude as compared to married respondents (adjusted odds ratio [AOR] 95% CI: 0.27 [0.14–0.51], p‐<0.001). Respondents who attended primary, secondary and higher education were 2.84 times (AOR 95% CI: [1.48–5.42], p 0.002), 5.59 times (AOR 95% CI: [2.87–10.89], p‐<0.001) and 9.28 times (AOR 95% CI: [4.39–19.65], p‐<0.001) more likely to have positive attitude as compared to those who cannot read and write. Moreover, respondents who have good knowledge were 2.24 times (AOR 95% CI: [1.49–3.37], p‐<0.001) more likely to have positive attitude as compared with those who have poor knowledge. Conclusion The overall levels of knowledge and attitude related to HTN and its prevention were moderate but not adequate to bring lifestyle modifications required to prevent and control HTN. Health promotion activities should be strengthened to improve awareness and attitude that are pillars to bring lifestyle modification practices

Missed opportunities in family planning: process evaluation of family planning program in Omo Nada district, Oromia region, Ethiopia

Abstract Background Family planning (FP) program is a key program to avert unbalanced human population growth, maternal mortality, unintended pregnancy, unsafe abortion, sexually transmitted diseases and malnutrition. To address these aims, all services that clients receive must be of consistently high quality. So, services that clients receive should be monitored and evaluated. Methods Case study was carried out in January, 2011, in Omo Nada district, Oromia region. Data were collected using different data collection methods. Process of FP program was evaluated using Judith Bruce model. Geographical accessibility, availability of resources for service provision and technical compliance were assessed. Level of program implementation was measured using stakeholders’ agreed indicators and judgment matrix. Results Though overall program implementation level was good and clients were satisfied, notable gaps observed were absence of crucial materials, poor provision of information in relation to method given, poor technical performance in following aseptic procedure, and poor integration of services. Conclusion Service provision should be monitored to maintain quality of service by integrating available services in resource limited setting

Ideal family size decision and its associated factors among women of reproductive age: community survey in southern Ethiopia

Background Understanding fertility preferences is important for population studies and planning programs. The ideal family size, which is the number of children wanted in one’s lifetime, is one of variables used to measure fertility preferences. However, there was limited information on ideal family size decision in Southern Ethiopia. Therefore, this study was designed to assess ideal family size decision and its associated factors among women of reproductive age in Southern Ethiopia. Methods A community based cross-sectional study was conducted in 2015 in Southern Ethiopia. Multi-stage stratified cluster sampling was used to select 3,205 study subjects. Data on socio-demographic characteristics, reproductive history, deciding ideal number of children, knowledge and utilization of contraceptives were considered. Descriptive statistics and binary logistic regression were done to describe and assess factors associated with deciding ideal family size. The association between variables was presented using odds ratios with 95% confidence intervals. Results We included 3,205 women of reproductive age from which 37.5% respondents could not read and write and 56.5% were housewives. About half of the respondents, 47.1%, did not decide ideal numeric family size or failed to report numeric preferences while 21.6% desire to have five or more children. The mean ideal number of children preferred was 4.5 ± 1.62. Educational status (P < 0.001), overall knowledge about contraceptives (P < 0.001), current contraceptive use (P < 0.001), place of residence (P < 0.001), age (P < 0.004), marital status (P < 0.003) and number of living children (P < 0.003) were factors associated with deciding ideal family size. Conclusion Only about half of respondents decided ideal family size from which one fifth prefer high fertility. The mean ideal number of children was comparable with that of Sub-Saharan estimate. Counselling that can empower women to decide family size should be strengthened to empower less empowered women

Prevalence of hypertension and its associated factors in Hawassa city administration, Southern Ethiopia: Community based cross-sectional study

Background In association with the epidemiological, nutritional and demographic transition, many research findings showed that the number of risk factors that leads to increased prevalence of hypertension in low and middle income countries like Ethiopia is increasing. Several urban specific studies conducted in Ethiopia showed varying prevalence of hypertension. The aim of this study was to determine prevalence of hypertension and to identify factors associated with hypertension in Hawassa city administration, Southern Ethiopia. Methods A community-based cross sectional study was carried out in Hawassa city administration in 2017. A multi-stage sampling technique was used to select 612 study participants. Descriptive statistics was used to describe socio-demographic, behavioral and anthropometric variables. The economic status of household, ‘wealth index’, was constructed by running principal component analysis. Binary logistic regression analysis was performed to assess factors associated with hypertension at 95%CI. Results The overall prevalence of hypertension was 21.2% (95% CI: 18.1–24.7), (24.5% for urban and 14.7% for peri-urban). About two fifths of hypertension cases (42.3%) were newly diagnosed with elevated blood pressure during data collection. Age, occupation, wealth status, consuming vegetables and animal fat, usual mode of transport, body mass index (BMI), family history of hypertension and existence of diabetes were associated with presence of hypertension at 95%CI. The average diastolic blood pressure for urban was 2.18mmHg higher than that of peri-urban groups (p-0.01). Conclusion More than one fifth of study participants had hypertension and about two fifths of hypertension cases were newly diagnosed. Health communication should be strengthened focusing on identified risk factors and attention should be given to early detect and tackle the effects of hypertension in resource limited setting. </jats:sec

COVID-19 prevention practices in urban setting during early introduction of the disease: results from community survey in SNNP Region, Ethiopia

ObjectiveTo assess community practices related to COVID-19 prevention and its associated factors during the early introduction of the disease to the study area.Setting and participantsA community-based cross-sectional study was conducted in Southern Nations, Nationalities and People’s Region, Ethiopia. Ten zonal towns with high population density and mobility and 1239 participants were included in the study.Outcome measureA semistructured questionnaire was uploaded to SurveyCTO data collection system with security patterns. Mask usage was assessed by observation, while social distancing and handwashing were assessed by interview. Data were collected by health professionals who have Bachelor of Science degree and above and analysed using SPSS V.25. Descriptive statistics and binary logistic regression were performed.ResultsFrom 1239 individuals, about half, 657 (53%), of respondents were women and about two-thirds, 795 (64.2%), were married. Nearly 9 out of 10 (90.3%) and about 8 out of 10 (82.0%) respondents reported that they frequently wash hands with soap and/or use sanitiser and keep social distancing as means to prevent COVID-19, respectively. Less than three-fifths (57.8%) of respondents wore masks during the interview. In summary, about half (48.9%) of respondents were practising the three recommended methods (social distancing, handwashing and wearing masks). Sex, educational status, family size and overall knowledge about COVID-19 were associated with practising COVID-19 prevention measures.ConclusionCOVID-19 prevention practice was low as only about half of participants were practising social distancing, handwashing and wearing masks. Although awareness creation has been implemented through different forms of media, it should be strengthened in different local languages. Concerned government bodies should strictly follow using masks in public gatherings.</jats:sec