Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data

Background: Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia.Methods: The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression).Results: The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women’s education, age and birth order were identified as key predictors of service utilization.Conclusion: The findings highlight the need for coordinated effort from government and stakeholders to improve women’s education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.Key words: antenatal care, differentials, skill birth attendance, delivery servic

A descriptive analysis of admissions to Amanuel Psychiatric Hospital in Ethiopia

Background: The care of patients with severe mental disorder in Ethiopia remains centralized in the capital city. Objective: To assess pattern of psychiatric admission and its implication for service provision. Methods: A descriptive analysis of one-year admission data was undertaken from the only psychiatric hospital in Ethiopia. Results: The annual age-sex standardized admission rate was 4 per 100 000 (n=1564). Two-thirds of the patients came from Addis Ababa and the immediate surrounding areas. Nearly three-quarters were men, and aged 30 years or younger. Schizophrenia and bipolar disorder were the top two discharge diagnoses. The median length of hospital stay (LOS) was 63 days. Diagnosis of schizophrenia and place of residence, i.e. living outside of Addis Ababa independently predicted LOS above the median. Conclusion: Admission data demonstrated a huge mental health unmet need in Ethiopia. Providing adequate resources for modernization and well-supervised decentralization may be vital steps in the quest for accessible and equitable psychiatric care.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 173-17

Nurses’ knowledge of the management of diabetic patients at Juba Teaching Hospital

Introduction: Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia and is a major health problem. The International Diabetes Federation (IDF) estimated that there were 425 million people with diabetes in the world in 2017 with the number rising most rapidly in middle- and low-income countries. The prevalence of DM in Juba City in 2017 was reported to be 11.8%.Objective: To assess nurses’ knowledge of the management of diabetic patients and factors associated with it in Juba Teaching Hospital - the only referral hospital in South Sudan.Method: This was descriptive cross-sectional study, carried out in March 2018, in which 40 nurses were randomly selected. Data were collected using a pre-tested questionnaire and analysed using SPSS version 20 for Windows software.Results: Of the 40 participants 31(77.5%) were females. The mean age was 35.6±10.7 years and median work experience was 9 years and 10 months; overall 57.6% of the participants correctly answered the questions on diabetic care. The factors cited for poor management of diabetic patients included lack of hospital guidelines (47.5%), insufficient salary to motivate staff (77.5%), inadequate nurse to patient ratio for good patient care (60.0%), and no resources for special training (57.5%).Conclusion: Many nurses in JTH have inadequate knowledge for diabetic management and most are interested in receiving more training.Keywords: Nurse, knowledge, management of diabetes, South Suda

Preparation and sorption property study of Fe3O4/Al2O3/ZrO2 composite for the removal of cadmium, lead and chromium ions from aqueous solutions

Fe-Al-Zr ternary mixed oxides composite was synthesized via co-precipitation method for the removal Pb(II), Cd(II) and Cr(VI) ions from aqueous solutions. The as-synthesized materials were characterized by X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET), scanning electron microscope hyphenated with energy dispersive X-ray diffraction (SEM-EDX) and Fourier transform infrared (FTIR) techniques. The pH at the point of zero charge (pHpzc) of the sorbent and effect of ionic strength on sorption were also determined. The batch tests were conducted to optimize the various sorption parameters such as pH, adsorbent dose, contact time, speed of agitation and initial metal concentration. The experimental results showed that the adsorbed amounts of Pb(II), Cd(II) and Cr(VI) tend to decrease with increase in pH. Freundlich isotherm model fits better the equilibrium data for the adsorbent. Kinetic data correlated better with both pseudo first order and pseudo second order kinetic models. The spontaneous nature of the adsorption process was also confirmed from thermodynamic grounds. The nanosized adsorbent exhibited an adsorption efficiency of 96.65%, 96.55% and 97.2% for Cd(II), Cr(VI) and Pb(II), respectively, at optimum condition. Experimental results showed that the nanocomposite was effective for the removal of the title heavy metals from aqueous solution.   Bull. Chem. Soc. Ethiop. 2020, 34(1), 105-121. DOI: https://dx.doi.org/10.4314/bcse.v34i1.1

Problematic khat use as a possible risk factor for harmful use of other psychoactive substances: a mixed method study in Ethiopia

Background: Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. Harmful alcohol use, is a known contributor for many harms (accidents, suicide, violence, and complication of other psychiatric and medical disorders). In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risky behavior for other illicit drugs such as cocaine and heroin. Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. But there is a knowledge gap regarding the position of khat use or problematic khat use in sequential progression of different psychoactive substances. Therefore, we aimed to understand and investigate the relationship of problematic khat use and other psychoactive substances in Ethiopia. Methods: Exploratory mixed methods study was employed. Quantitative cross sectional survey was done among 102 khat users, and 4 focus group discussions and 11 in-depth interviews were conducted to understand the pathways between khat use and other psychoactive substances use in 2014. Non random sampling (purposive and snowballing) was employed for both quantitative and qualitative studies. Khat users from khat cafeterias, shops, and from other open markets of khat in Addis Ababa were invited to participate. Result: Currently significant majorities of khat users (86.3%) used at least one other psychoactive substance after they started khat use. The prevalence of harmful drinking was 53.9% among khat users. Problematic khat use was a significant predictor of harmful drinking (p<0.05). About one from ten respondents engaged to risky sexual behavior pushed by the effect of khat after chewing. Conclusion: The proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population. In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor. A rigorous methodology which could test gateway hypothesis

Photometry of the Globular Cluster NGC 5466: Red Giants and Blue Stragglers

We present wide-field BVI photometry for about 11,500 stars in the low-metallicity cluster NGC 5466. We have detected the red giant branch bump for the first time, although it is at least 0.2 mag fainter than expected relative to the turnoff. The number of red giants (relative to main sequence turnoff stars) is in excellent agreement with stellar models from the Yonsei-Yale and Teramo groups, and slightly high compared to Victoria-Regina models. This adds to evidence that an abnormally large ratio of red giant to main-sequence stars is not correlated with cluster metallicity. We discuss theoretical predictions from different research groups and find that the inclusion or exclusion of helium diffusion and strong limit Coulomb interactions may be partly responsible. We also examine indicators of dynamical history: the mass function exponent and the blue straggler frequency. NGC 5466 has a very shallow mass function, consistent with large mass loss and recently-discovered tidal tails. The blue straggler sample is significantly more centrally concentrated than the HB or RGB stars. We see no evidence of an upturn in the blue straggler frequency at large distances from the center. Dynamical friction timescales indicate that the stragglers should be more concentrated if the cluster's present density structure has existed for most of its history. NGC 5466 also has an unusually low central density compared to clusters of similar luminosity. In spite of this, the specific frequency of blue stragglers that puts it right on the frequency -- cluster M_V relation observed for other clusters.Comment: 51 pages, 21 figures, 1 electronic table, accepted to Ap

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa.

OBJECTIVE: Systematic review and meta-analysis of published studies of alcohol use among young people (age 15-24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. METHODS: Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I(2) statistic (DerSimonian-Laird). RESULTS: We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20-58%], use in the last month 28% (IQR: 17-37%), use in the last year 26% (IQR: 22-32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3-36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79-85%) and female sex workers (66%; 95%CI: 58-74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63-75%). CONCLUSIONS: Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population

Co-morbid mental health conditions in people with epilepsy and association with quality of life in low- and middle-income countries:a systematic review and meta-analysis

Background: Comorbid mental health conditions are common in people with epilepsy and have a significant negative impact on important epilepsy outcomes, although the evidence is mostly from high-income countries. This systematic review aimed to synthesise evidence on the association between comorbid mental health conditions and quality of life and functioning among people with epilepsy living in low- and middle income countries (LMICs). Methods: We searched PubMed, EMBASE, CINAHL, Global Index medicus (GID) and PsycINFO databases from their dates of inception to January 2022. Only quantiative observational studies were included. Meta-analysis was conducted for studies that reported the same kind of quality of life and functioning outcome. Cohen’s d was calculated from the mean difference in quality-of-life score between people with epilepsy who did and did not have a comorbid depression or anxiety condition. The protocol was registered with PROSPERO: CRD42020161487. Results: The search strategy identified a total of 2,101 articles, from which 33 full text articles were included. Depression was the most common comorbid mental health condition (33 studies), followed by anxiety (16 studies). Meta-analysis was conducted on 19 studies reporting quality of life measured with the same instrument. A large standardized mean effect size (ES) in quality of life score was found (pooled ES = −1.16, 95% confidence interval (CI) − 1.70, − 0.63) between those participants with comorbid depression compared to non-depressed participants. There was significant heterogeneity between studies (I 2 = 97.6%, p &lt; 0.001). The median ES (IQR) was − 1.20 (− 1.40, (− 0.64)). An intermediate standard effect size for anxiety on quality of life was also observed (pooled ES = −0.64, 95% CI − 1.14, − 0.13). There was only one study reporting on functioning in relation to comorbid mental health conditions. Conclusion: Comorbid depression in people with epilepsy in LMICs is associated with poor quality of life although this evidence is based on highly heterogeneous studies. These findings support calls to integrate mental health care into services for people with epilepsy in LMICs. Future studies should use prospective designs in which the change in quality of life in relation to mental health or public health interventions across time can be measured

Economic evaluation of Health Extension Program packages in Ethiopia

Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3 Result The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22–$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG. Conclusion The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.publishedVersio