The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia

Introduction and Objections: Low back pain (LBP) is a highly prevalent and disabling public health problem globally. However, little is known about factors affecting health care utilisation for optimal management of the pain, and there is no validated instrument to derive epidemiological data for a better understanding of these factors. The aim of this study was to develop and validate an instrument used to measure determinants of health care utilisation for LBP in Ethiopia.Methods: The relevant domains of potential determinants of health care utilisation for LBP were identified following a comprehensive review of the literature. Items relating to each domain were then generated by considering the context of Ethiopia, and where necessary, existing items were adapted. The instrument was then translated, and an expert panel reviewed the instrument for content validity, clarity and any other suggestions. Using the data collected from 1303 adults with LBP, factorial validity was assessed by conducting principal component and parallel analyses. Internal consistency reliability was also assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate temporal stability of the instrument.Results: Parallel analysis showed that there were six components with Eigenvalues (obtained from principal component analysis) exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00.Conclusions: This study demonstrated that the newly developed instrument has an overall good level of content and factorial validity, internal consistency reliability, and temporal stability. In this way, this instrument is appropriate for measuring determinants of health care utilisation among people with LBP in Ethiopia

Determinants of healthcare utilisation for low back pain: a population-based study in Ethiopia

Low back pain (LBP) remains one of the major public health problems worldwide. However, in low-income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population-based cross-sectional study was conducted in South-West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log-binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9-38.1, while the annual prevalence rate was 30%, 95% CI: 27.9-32.2. Of those with a 1-year history of healthcare utilisation, while 7.4%, 95% CI: 4.9-10.3 rural and 36.6%, 95% CI: 29.5-44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3-2.7 rural and 6.8%, 95% CI: 3.1-10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP

Condom utilization among female sex workers in Northwest Ethiopia: A cross-sectional study

Introduction: sexually transmitted infections are among the most important public health problems in the world. People who indulge in unsafe sex, such as female sex workers are the most at risk population groups due to multiple sexual partners and inconsistent condom use. The aim of this study was to assess condom utilization and associated factors among female sex workers in Gondar town, Northwest Ethiopia. Methods: a quantitative cross-sectional study triangulated with qualitative method was conducted from March 20 - April 10, 2014 in Gondar town. The quantitative data were collected through interviewing 488 female sex workers while in-depth interview was administered to collect qualitative data from 10 female. The collected data were entered into EPI-INFO version 3.5.3 and exported to SPSS version 20.0 software for analysis. Logistic regression analysis was done to determine the association between condom utilization and independent variables. Results: this study revealed that less than half (47.7%) of the respondents utilized condom with any type of client. Secondary education or above, perceiving themselves at risk of HIV/AIDS infection, having awareness that STI could increase HIV infection, being tested for HIV/AIDS in the last 12 months, and having lower number of clients in a month were positively associated with condom utilization. Conclusion: this finding depicted that condom utilization was low among female sex workers. Thus, developing and implementing target oriented behavioral change and communication strategies are needed to prevent the risk of acquiring HIV/AIDS and other sexually transmitted infections in female sex workers

Hospital admission and associated factors among individuals presenting to healthcare facilities for low back pain in Ethiopia

Aim: The aim of this paper is to analyze hospital admission and associated factors following presentation to healthcare facilities for low back pain (LBP) in Ethiopia.Methods: A population-based cross-sectional study was conducted between June and November 2018 in South-west Shewa zone of Oromia regional state. Data were collected by face-to-face interviews of adults (≥18 years) with self-reported LBP using a newly developed and validated instrument. All the statistical analyses of (n = 543) individuals with a 1-year history of presentation to healthcare facilities for LBP were performed using R version 3.5.1. The log-binomial regression model was fitted and prevalence ratios with 95% confidence intervals (CIs) were calculated to identify factors associated with hospitalization and the significance level was considered at the P value of ≤ .05.Results: The proportion of hospital admissions following presentation to healthcare facilities for LBP was 14.4%, 95% CI 11.4-17.3, with an average length of stay (LOS) 7.4 days, 95% CI 6.4-8.8. The admission rate was 18.5%, 95% CI 13.4-23.3 in females and 11.4%, 95% CI 8.0-15.1 in males. Multiple factors, such as gender, age, living conditions, residential environment, alcohol consumption status, intensity of pain, and presence of additional spinal pain, were found to be independently associated with hospitalization for LBP.Conclusions: The burden on the individuals and the Ethiopian healthcare system as a result of LBP is evident by the rate of hospital admissions. Further evidence on LBP case referral procedures is needed to allow health policy makers to develop appropriate management strategies capable of dealing with the increasing epidemiology of LBP