Assessment of client satisfaction on emergency department services in Hawassa University Referral Hospital, Hawassa, Southern Ethiopia.

BACKGROUND: Satisfaction refers to a state of pleasure or contentment with an action, event or service, especially one that was previously desired. Regarding to client, satisfaction is the level of happiness that clients experience having used a service. It therefore reflects the gap between the expected service and the experience of the service, from the client's point of view. Information was unavailable regarding the level of satisfaction of patients towards emergency health care servicesat Hawassa University Referral Hospital thatserve a huge catchment area; and this study addressed this gap. METHOD: Cross-sectional study was conducted from March 13 to May 15/2014. Systematic sampling method was used to enroll study participants. The data was collected by trained data collectors using pre-structured questionnaire. RESULTS: A total 407 clients were enrolled under this study with respondent rate of 96.9%. Nearly two third of study participants were male, 270 (66.3%). 86.7% of study participants were satisfied by services provided in Emergency Out Patient Department (OPD). The percentage of study satisfaction with physical examination by Doctor, nursing, laboratory and pharmacy services were 95.6%, 89.9%, 84.7% and 67.6%, respectively. Only 31.9% were satisfied with availability of drugs in the pharmacy. Regarding to staff courtesy, 91.7% of study participants were satisfied by the manner shown by the staffs working in Emergency OPD. The vast majority of the participants (97%) were satisfied with the courtesy of Medical laboratory personnel and the least satisfaction (79.4%) was recorded for security guards. CONCLUSION: This study showed low level of patient satisfaction in pharmacy services specifically due to unavailability of drugs due to lack of sustained supply of drugs

Variation in Malaria Transmission in Southern Ethiopia. The impact of prevention strategies and a need for targeted intervention

In Ethiopia, 60 per cent of the population is at risk of malaria. The transmission of the disease is unstable, and hence, the possibility of epidemics demanded continuous vigilance and preparedness of the health system. Meanwhile, the complexity of the transmission of the disease has become an impediment to retain the effectiveness of prevention and control strategies. Understanding factors that play role in disease transmission at different locations, the pattern of disease transmission, the impact of prevention and control strategies and challenges in control efforts were deemed crucial for the way forward. This thesis analysed the local variations in the link between potential determinants of transmission – meteorological factors and malaria incidence. For this, we used datasets from 35 locations found in the Southern Nations and Nationalities People’s Region and registered within the period 1998 to 2007. The findings implied that the variability in the models to be principally attributed to regional differences, and a single model that fits all locations was not found. Although there is a biological link between meteorological factors and malaria transmission, the link is affected by local conditions and non-meteorological factors. With the understanding of a need to incorporate non-meteorological factors, in an attempt to predict disease incidence, a detailed investigation was carried out in Chano Mille Kebele – one of the malarious Kebeles of Arba Minch Zuria district, Gamo Gofa zone, south Ethiopia. A prospective cohort study was conducted for two years with a weekly visit to each of 1,388 households. The findings showed that rainfall increased and indoor residual spraying with Deltamethrin reduced falciparum malaria incidence. Higher disease incidence was observed among males, children 5–14 years old, insecticide-treated net non-users, the poor, and people who lived closer to vector breeding site. Meanwhile, we identified spatio-temporal clusters of high disease rates within a 2.4 sq.km area of the Kebele. Mass distribution of insecticide-treated nets neither showed community-wide benefit nor influenced the spatio-temporal clustering of malaria, though proved to be protective at the individual level. Further analysis on insecticide-treated nets showed that the proportion of insecticide-treated net use reached a maximum of 69 per cent despite a near universal coverage (98.4 per cent) was achieved. Sleeping under the insecticide-treated nets was influenced by gender, age and proximity to the vector breeding site. Factor compromising the usable life of insecticide-treated nets and a lack of convenient space to hang more than one net were reported. The local variations in meteorology-malaria link, the heterogeneous risk carried by different population segments and the observed effect of prevention strategies may help to revisit the approaches towards malaria – for which I forwarded specific recommendations

Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study.

BACKGROUND: Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in the body. During pregnancy; iron deficiency is associated with multiple adverse outcomes for both mother and infant. Most of the studies conducted in Ethiopia on anemia during pregnancy were conducted at institution level and associated factors are not well studied and documented. Independent factors like, food security status, dietary diversity and intestinal parasites infection were considered by only a few of them. Hence, the aim of this study was to determine the prevalence of anemia and associated factors among pregnant women in Lemo District, Southern Ethiopia. METHODS: Community based cross- sectional study was conducted from May-June 2015. Multistage sampling was used to include 507 study participants. Anaemia was diagnosed using HemoCue HB 301 and haemoglobin concentration <11 g/dl was classified as anaemic. Stool examinations were also done. Structured questionnaire was used as a tool to collect sociodemographic characteristics, individual dietary diversity and level of household food security data. Multivariate logistic regression model was employed to determine the effect of explanatory variables like level of education, level of household food security, dietary diversity, trimester of pregnancy, family planning before pregnancy, deworming, gravidity, iron intake in current pregnancy and soil transmitted helminthes on dependent variable anemia. RESULTS: The prevalence of anemia was 23.2% (95% CI: 19.5%-26.9%). Factors associated with anemia were: low socio-economic status (AOR = 2.03, 95% CI: 1.11-3.69), trimester second (AOR = 3.09, 95%CI: 1.41-6.79) and third (AOR = 3.68, 95% CI: 1.67-8.08), gravidity three to five (AOR = 1.78, 95% CI: 1.03-3.07) and six and above (AOR = 2.59, 95%CI: 1.37-4.92), not supplemented with iron (AOR = 1.72, 95% CI: 1.02-2.91), low dietary diversity score (AOR = 3.18, 95% CI: 1.37-7.37) and hookworm infection (AOR = 2.69, 95%CI: 1.34-5.39). CONCLUSION: Anemia has moderate public health significance in the area. Community-based interventions should be enhanced considering the identified associated factors

Potentially inappropriate medication prescribing patterns in geriatric patients in a health facility in Addis Ababa, Ethiopia

Purpose: To assess potentially inappropriate medication (PIMs) prescribing pattern in geriatric patients attending the outpatient department (OPD) of the General Hospital in Addis Ababa, Ethiopia.Methods: The study was conducted retrospectively for geriatric patients sixty years of age and above, who visited an Outpatient Department of Tirunesh Beijing General Hospital. Data were gathered for a duration of one month from prescriptions/encounters at the Outpatient Pharmacy, and analysis was carried out using SPSS (Statistical Packages for Social Sciences) version 20, while and drug prescribing indicators, and potentially inappropriate medications were calculated based on WHO prescribed indicators and Beer’s criteria.Results: Of the 400 encounters assessed, 218 (55 %) were male and 182 (45 %) were female. Four hundred prescriptions contained 1,003 drugs. Out of the mean drug per prescription of 2.51, drugs prescribed by generic names were 91.62 %, those prescribed from NLEM (national list of essential medicine) were 91.53 %; prescriptions with an antibiotic injection were 27.75 % and 16.25% respectively, and more than 5 drugs were prescribed only for 10.8 % of geriatrics patients. Cardiovascular drugs constituted about a quarter of the&nbsp; prescribed medications with 271 (27.02 %); others were analgesics, anti-inflammatory, anti-infective, endocrine drugs, gastrointestinal drugs, and other drugs, accounting for 116 (11.6%), 112 (11.2%), 96 (9.6%), 94 (9.4%) and 187 (18.6%), respectively. Potentially inappropriate drugs occurred in 46.9 % of the cases.Conclusion: Potentially inappropriate medication (PIMs) prescribing in geriatric is highest in percentage. Proper interventions are needed from all concerned bodies to avoid drug-related complications

The Current Status and Factors Associated With Implanon Service Provision by the Health Extension Workers at the Health Post Level, Wolaita Zone, Southern Ethiopia: A Cross-Sectional Study.

Objective: Family Planning is often taken as one of the "Magic Bullet" interventions owing to its high impact and wide reaching nature in achieving multiple goals. This study aimed to assess the current status and the factors associated with health post level Implanon service provision through trained health extension workers in Wolaita zone, southern Ethiopia. Materials and methods: A cross sectional study was conducted among trained health extension workers in Wolaita zone in February 2013. A simple random sampling technique was used to identify a total of 285 trained HEWs. First bivariate, then multivariate logistic regression model along with 95% confidence interval was used to see the independent effect of factors associated with current Implanon service provision by the health extension workers. Results: Currently, the number of Implaon providing trained health extension workers in Wolaita was 264(45.8%). Distance of health post from district health offices and health center, turnover of trained health extension workers in the health post, interest of trained health extension workers in providing Implanon and their job satisfaction to serve as a health extension workers and availability of service delivery guidelines and teaching aids were associated with the current provision of Implanon by health extension workers. Conclusion: Implanon provision among trained health extension workers was affected by different factors. Hence, improving the working conditions of trained health extension workers, regular and periodic facilitative supervision, availing service delivery guidelines and improvement of health management information system are recommended

Adherence to Antiretroviral Treatment among Adult People Living with HIV/AIDS Attending Highly Active Antiretroviral Therapy at Adare Hospital, Southern Ethiopia

AbstractBackground: Adherence to antiretroviral therapy (ART) has paramount advantages for programmatic success, including its good treatment outcomes and reduced risk of resistant viral strains transmission to the general population. There is limited evidence on the magnitude and associated factors of adherence to ART among adult PLWHA attending highly active ART (HAART) at Adare General Hospital, Southern Ethiopia.Objective: This study aimed to determine the magnitude and associated factors of adherence to ART among adult PLWHA attending (HAART) at Adare General Hospital, Southern Ethiopia.Methods: A hospital-based cross-sectional study was conducted from January 01/2018 to February 30/2018 at Adare Hospital. The participants were 370 adult people living with HIV/AIDS taking ART and who were selected by systematic random sampling technique. The data were collected by trained health professionals using a pre-tested interviewer-administered structured questionnaire. The data collected was entered into a computer and analysed using SPSS version 19. Descriptive statistics and multiple logistic regressions were applied. The significance level of association was considered at p-value &lt;0.05.Results: The magnitude of retrospectively self-reported combined adherence (measured by dose, schedule and dietary instructions) to ART in the past seven days before the interview was 80.3%. In multivariate analysis, Sidaamu Afoo language (AOR=0.5, 95%CI: 0.21-0.99), monthly income &lt;1,000 Ethiopian Birr (AOR=0.08; 95%CI: 0.03-0.26), not disclosing HIV status to others (AOR=0.18; 95%CI: 0.07-0.50), taking ART pills comfortably while others looking (AOR=6.0; 95%CI: 2.54-13.91) and no utilisation of reminders (AOR=0.08; 95%CI: 0.03-0.21) were factors significantly associated with combined adherence. Forgetfulness and not wanting to take ART while others are looking were major reasons to miss pills.Conclusion: Adherence to ART among adult PLWHA attending HAART at Adare Hospital was suboptimal, but still comparable with that of resource-limited settings. To maximise treatment success, considering emphasised translation to Sidaamu Afoo language, encouraging patients to be involved in any income-generating system and to reveal their HIV status for others is helpful. [Ethiop. J. Health Dev. 2021; 35(2):105-115]Keywords: Adherence, Adults, ART, HIV/AIDS, Sidaama, Ethiopi

Modifiable cardiovascular disease risk factors among adults in southern Ethiopia: a community-based cross-sectional study

Objective To assess the prevalence, magnitude and factors associated with the number of major modifiable cardiovascular disease (CVD) risk factors. Design Community-based cross-sectional study. Setting General population in urban and rural Wolaita, southern Ethiopia. Participants A total of 2483 adults aged 25–64 years were selected using the three-stage random sampling. Outcome measures Prevalence of major modifiable CVD risk factors, co-occurrences and the number of modifiable CVD risk factors. Results The major modifiable CVD risk factors documented in the Wolaita area were smoking with a weighted prevalence of 0.8%, hypercholesterolaemia 5.0%, hypertriglyceridaemia 15.5%, low high-density lipoprotein cholesterol (HDL-C) 31.3%, high systolic blood pressure 22.2%, high diastolic blood pressure 22.4%, physical inactivity 44.1%, obesity 2.8% and hyperglycaemia 3.7%. The numbers of participants having ≥1, ≥2 and ≥3 major modifiable CVD risk factors in the study area were 2013, 1201 and 576 with a weighted prevalence of 75.8%, 42.3% and 19.4%, respectively. In general, there were 28 different combinations of major modifiable CVD risk factor co-occurrences. The combination of physical inactivity with low HDL-C was found in 19.7% of the study participants, followed by physical inactivity with hypertension of 17.8%. Urban residence, male gender, sugar-sweetened food consumption and older age had a positive association with the number of major modifiable CVD risk factors, while being a farmer had a negative association. Conclusions The prevalence and magnitude of major modifiable CVD risk factors in the study area were high. The components of the most prevalent combinations of major modifiable CVD risk factors should be targeted. Therefore, public health measures against major modifiable CVD risk factors such as promotion of physical exercise and reduction of sugar-sweetened food consumption have to be taken, targeting the vulnerable groups such as urban residents and older age.publishedVersio

Proximity to vector breeding site and risk of Plasmodium vivax infection: a prospective cohort study in rural Ethiopia.

BACKGROUND: Despite falling incidence and mortality since the turn of the century, malaria remains an important global health challenge. In the future fight against malaria, greater emphasis will have to be placed on understanding and addressing malaria caused by the Plasmodium vivax parasite. Unfortunately, due to years of neglect and underfunding, there are currently many gaps in knowledge of P. vivax malaria. The aims of the present study were to explore the association between distance to vector breeding site and P. vivax infection in rural Ethiopia, and, secondarily, to test whether this association varies with age. METHODS: A prospective, cohort study of all residents in the Chano Mille Kebele in southern Ethiopia from April 2009 to March 2011 (n = 8121). Weekly household follow up visits included screening for febrile cases (active surveillance). Participants were also asked to contact the local health centre if they experienced subjective fever between visits (passive surveillance). Plasmodium vivax infection was confirmed using microscopy by two independent readers. Information was collected on demographics and household characteristics including GPS-determined distance to vector breeding site. Data was analysed using Cox regression modelling. RESULTS: Overall the P. vivax infection rate was 12.3/1000 person-years (95% CI 10.5-14.5). Mean household distance to breeding site was 2449 m (range 1646-3717 m). Fully adjusted results showed very strong evidence of an association between proximity to breeding site and P. vivax infection: rate ratio = 3.47 (95% CI 2.15-5.60; P  2700 m; n = 2460). There was no evidence that age was an effect modifier in the association. CONCLUSION: Results showed strong evidence that household proximity to vector breeding site is positively associated with P. vivax infection in rural Ethiopia, and that this association is constant across age groups. The findings might influence how net-distribution and indoor residual spraying campaigns are planned, help guide strategies on water resource development by highlighting potential health effects of man-made dams near human habitats, and add to current educational information given to people living close to breeding sites

Trend of Malaria Cases in Hana and Keyafer Health Centers, South Omo Zone, Southern Ethiopia.

BACKGROUND: Data registered in health facilities about malaria are vital source of information regarding the trend and pattern of the disease. Moreover the data also used to evaluate the impact of the intervention methods and to plan malaria control accordingly. The aim of this study was to assess the number of malaria cases in the service providing health institutions of South Omo Zone, SNNPR, over a period of seven years, 2008-2014. METHODS: A retrospective review of routinely collected and recorded data on malaria was conducted at Hana and Keyafer health centers located in South OmoZone, during December-March/2014. RESULT: This retrospective study examined records of 54,160 presumptive and confirmed malaria cases registered over seven years (January 2008-December 2014). Among the registered, a total of 22,494 laboratory confirmed malaria cases were reported. The mean annual prevalence of malaria was 3213, with total slide positivity rate (SPR) of 41.53%. The seven years' overall trend of malaria occurrence in the study sites showed a fluctuating trend from 2008 to 20114. P. falciparum was the predominant species with no trend shift in seven years period. Plasmodium falciparum accounted for 61.03% and Plasmodium vivax for 32.44%. Most of the confirmed cases were males (63.26%) and most were above 15 years old (70.7%). Rainfall at lag of one month was significantly predicting number of cases at Hana Health center (P< 0.001), though it was found to be not significant in case of Keyafer Health Center. CONCLUSION: The finding of the retrospective study revealed that malaria still remains as a public health problem in the study areas. The deadly species P. falciparium was most predominant, and the age group above 15 was more infected. Hence, malaria intervention methods should be scaled up in the study sites

Incidence of postpartum and neonatal illnesses and utilization of healthcare services in rural communities in southern Ethiopia: A prospective cohort study

Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson’s total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level.publishedVersio