Comprehensive abortion care: evidence of improvements in hospital-level indicators in Tigray, Ethiopia.

ObjectiveApproximately 18% of maternal deaths in East Africa is attributable to unsafe abortion. Availability of comprehensive abortion care (CAC) services at all levels of the healthcare system, including medical abortion, has the potential to increase access to safe abortion thereby reducing the burden of unsafe abortion. This study sought to assess trends in abortion-related morbidity indicators in referral hospitals.DesignResearchers conducted a secondary data analysis on retrospectively collected data.MethodsData analysed were collected from four hospitals in the Tigray region of Ethiopia that took part in a CAC pilot project. Providers were trained in mid-2009 to provide abortion services using all available technologies. Data records from hospitals were collected in 2012 for the years 2006 through 2012; 2006/2007 data were too sparse to include in the analyses.ResultsTrends in abortion-related services show a significant decrease in treatment of incomplete abortion, inverting the relationship between safe terminations and treatment of incompletes as a percentage of total abortions. Medication abortion was nearly non-existent in 2008, but increased steadily, representing 80% of total procedures in 2012. The inclusion of medication abortion and availability of CAC also contributed to a decline in inpatient procedures and prevalence of complications.ConclusionsThe trends observed in the data demonstrate how increased availability of CAC services at all levels of the healthcare system, among other factors, can contribute to reductions in the burden of unsafe abortion at referral hospitals

Potential for cost recovery: women's willingness to pay for injectable contraceptives in Tigray, Ethiopia.

ObjectiveTo investigate factors associated with a woman's willingness to pay (WTP) for injectable contraceptives in Tigray, Ethiopia.MethodsWe used a multistage random sampling design to generate a representative sample of reproductive age women from the Central Zone of Tigray, Ethiopia to participate in a survey (N = 1490). Respondents who had ever used injectable contraceptives or who were interested in using them were asked whether they would be willing to pay, and if so, how much. Logistic regression odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were used to assess which factors were associated with WTP in our final model.FindingsOn average, respondents were willing to pay 11 birr ($0.65 USD) per injection. Being married, completing any amount of education, having given birth, and having visited a health facility in the last 12 months (whether received family planning information or not) were associated with statistically significantly increased odds of WTP. Having initiated sexual activity and having 1-2 children (compared to 0 children) were associated with statistically significantly decreased odds of WTP. We also detected two significant interactions. Among women who prefer injectable contraceptives, their odds of WTP for injectable contraceptives vary across length of time they have used them. And among women who work for pay, their odds of WTP for injectable contraceptives vary by whether they agree with their husband/partner about the ideal number of children.ConclusionIn a sector that continually struggles with funding, cost recovery for contraceptive services may offer a means of improved financial sustainability while increasing rural access to injectable contraceptives. Results indicate there are opportunities for cost recovery in rural Tigray, Ethiopia and highlight factors that could be leveraged to increase WTP for injectable contraceptives

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia.

Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region

Meeting rural demand: a case for combining community-based distribution and social marketing of injectable contraceptives in Tigray, Ethiopia.

BackgroundIn Sub-Saharan Africa, policy changes have begun to pave the way for community distribution of injectable contraceptives but sustaining such efforts remains challenging. Combining social marketing with community-based distribution provides an opportunity to recover some program costs and compensate workers with proceeds from contraceptive sales. This paper proposes a model for increasing access to injectable contraceptives in rural settings by using community-based distributers as social marketing agents and incorporating financing systems to improve sustainability.MethodsThis intervention was implemented in three districts of the Central Zone of Tigray, Ethiopia and program data has been collected from November 2011 through October 2012. A total of 137 Community Based Reproductive Health Agents (CBRHAs) were trained to provide injectable contraceptives and were provided with a loan of 25 injectable contraceptives from a drug revolving fund, created with project funds. The price of a single dose credited to a CBRHA was 3 birr ($0.17) and they provide injections to women for 5 birr ($0.29), determined with willingness-to-pay data. Social marketing was used to create awareness and generate demand. Both quantitative and qualitative methods were used to examine important feasibility aspects of the intervention.ResultsForty-four percent of CBRHAs were providing family planning methods at the time of the training and 96% believed providing injectable contraceptives would improve their services. By October 2012, 137 CBRHAs had successfully completed training and provided 2541 injections. Of total injections, 47% were provided to new users of injectable contraceptives. Approximately 31% of injections were given for free to the poorest women, including adolescents.ConclusionsInsights gained from the first year of implementation of the model provide a framework for further expansion in Tigray, Ethiopia. Our experience highlights how program planners can tailor interventions to match family planning preferences and create more sustainable contraceptive service provision with greater impact

Abortion and Unwanted Pregnancy in Adigrat Zonal Hospital, Tigray, North Ethiopia

Unwanted pregnancy is associated with increased risk of maternal mortality and morbidity. This study was done to determine the causes of unwanted pregnancy and its impact on maternal health. A cross sectional study (February 1, 2002-January 31, 2004) was conducted on 907 patients with diagnosis of abortion and admitted to the gynecological ward of Adigrat zonal hospital, Tigray Region, Ethiopia. This accounts to 12.6% of all hospital and 60.6% of gynecolo-gical admissions. The majority of these women (69.8%) had unwanted pregnancy. Modern contraception methods were not in use in 76.2% of unwanted and 57.7% of wanted pregnancies (P = 0.008). Interference was reported in 81.4% of unwanted pregnancy. High incidence of complication was reported in patients with unwanted pregnancy. In this study it is found that unwanted pregnancy is associated with increased risk of maternal morbidity and mortality. The development and prompt implementation of a strategy that enables women to safely manage unwanted pregnancy is recommended (Afr. J. Reprod. Health 2010; 14[3]: 183-188).Key words: unwanted pregnancy, unsafe abortion, modern methods of contraception

Feasibility of Malaria Elimination in Ethiopia

BACKGROUND: The problem of malaria is very severe in Ethiopia where it has been the major cause of illness and death for many years. The purpose of this review article is to assess the feasibility of malaria elimination in Ethiopia.METHOD: To compile this review article, different relevant research articles related to the topic from open access journals were searched using different searching engines such as Google scholar, Science direct, and Pub Med using different key words and phrases.RESULT: Based on review of the literature, Ethiopia has been trying to control and eliminate malaria for more than 60 years. To assess feasibility of malaria elimination, the WHO assessment tools/recommendations for elimination of malaria were used. Based on WHO parameters, the country has achieved remarkable progress on the fight against malaria during the most recent decades. Malaria morbidity and mortality have been reduced dramatically with intensive use of insecticide residual spray, long lasting insecticide treated nets, chemotherapies, improved diagnosis and case management, improved quality of laboratories, continued support from malaria partners, and political commitment of the Ethiopian government towards malaria prevention and control. Hence, the past achievements and current activities, have led to consider the possibility of malaria elimination in Ethiopia at least by 2030 or beyond.CONCLUSION: Considering the triumphs achieved so far and the current undertaking efforts, malaria could possibly be eliminated from Ethiopia once and for all

The Prevalence of Malaria in Tselemti Wereda, North Ethiopia: A Retrospective Study

BACKGROUND: A significant segment of the world’s population is at risk of contracting malaria infection at any one time. In Ethiopia, sustained control efforts have been made in the past decade to fight malaria. Yet, it remains as the major cause of morbidity, mortality and socioeconomic problems in the country. The intensified control of malaria can further be augmented by analyzing health facility based malaria data. Hence, the aim of this study was to determine the magnitude of malaria infection in Northwest Ethiopia.METHODS: A retrospective record review was conducted in Northwest Ethiopia from February-April 2016. All blood film results reported between January 2013 and December 2015 in the seven health centers were extracted and analyzed.RESULTS: A total of 41,773 patients with chief malaria complaint were screened for malaria in the three years period. The overall prevalence of microscopically confirmed malaria was 28.1%. Males (29.5%) were more affected by malaria than females (26.5%). Malaria was also higher in the age group >15 years (32.6%) followed by 5-15 years (29.3%) and under-five children (20.5%). Plasmodium falciparum, Plasmodium vivax and mixed infectionsaccounted for 58.2%, 35.5% and 6.3%, respectively. The highest prevalence of confirmed malaria cases was observed during spring (35.6%) and summer (25.1%). Higher prevalence of slide positive malaria was recorded in Dima (46.1%), Cherecher (45.3%) andFyel wuha (35.3%) health centers.CONCLUSION: Malaria specific outpatient cases were high in the study area. Both plasmodia species were of public health significance in the area with predominance of Plasmodiumfalciparum

Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV

Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study

Background: Intestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying the main associated factors for transmission of protozoan parasitic infections help for effective control measures of protozoan infections. Hence, the current study was aimed at determining the prevalence of foodborne intestinal protozoa infections and associated factors among diarrheic patients in North Ethiopia. Methods: A health facility based cross-sectional study was conducted among 223 patients with watery diarrhea in four selected government health facilities in North Ethiopia from November 2016\u2013June 2017. A structured questionnaire was used to collect data on socio-demography of study participants and factors associated with foodborne protozoa infections. The diarrheic stool samples were collected, transported, and processed using direct wet mount, formal-ether concentration and modified ZiehlNeelson staining methods. The data were analyzed using SPSS version 21 and descriptive statistics, bi-variate, and multivariate logistic regressions were computed. P-value < 0.05 at 95% confidence interval was considered statistically significant. Results: The overall prevalence of foodborne protozoa infection was 101 (45.3%). The predominant protozoa species identified was Entamoeba histolytica/dispar 55 (24.7%), followed by Giardia intestinalis 25 (11.2%) and Cryptosporidium species 5 (2.2%). The highest proportion of protozoa infection was observed among males (23.3%) and the age group 15\u201324 years (13.5%). Statistically significant associations were observed between foodborne protozoan infection and not using any type of recipe to decontaminate salads and fruits (AOR = 2.64, 95 CI: 1.34\u20135.19, P = 0.005) and using vinegar as a decontaminant (AOR = 2.83, 95 CI: 1.24\u20136.48, P = 0.014). Eating out (meals at a restaurant) on the other hand was found to be protective for foodborne protozoan infection (AOR = 0.43, 95 CI: 0.23\u20130.78, P = 0.006). Conclusion: Our study revealed that foodborne protozoa infections are of public health significance in the study area. Vinegar, which is frequently used as a recipe for decontaminating salads and fruits, is inversely related to foodborne protozoa parasite infection