Vaccine safety practices and its implementation barriers in Northwest Ethiopia: A qualitative study

AbstractIntroduction: Even if immunization coverage increases over time, it is imperative to ascertain the safety and efficient coverage of immunization services. However, evidence on the safety practices of vaccines is limited. Assessing the implementation status of vaccine safety practices and its implementation barriers is crucial for program monitoring, interventions, and improvements. Therefore, this study aimed to assess vaccine safety practices and its implementation barriers in the public health facilities of Northwest Ethiopia.Aim: The objective of this study was to assess the safety practices of vaccines and to explore its implementation barriers.Methods: A qualitative research approach was adopted for this study. Face-to-face in-depth interviews with key-informants and immunization session-observations were the main data collection methods used in this study. Study participants were purposively selected based on their experience and knowledge about the subject matter and framework analysis was performed.Result: The study's findings revealed that the safety practices of vaccines from the cold chain system, vaccine administration and waste disposal and management perspective was suboptimal. Many barriers influencing vaccine safety practices were also explored. They are 1) vaccine storage and handling, 2). vaccine administration/delivery, 3) waste disposal and management, 4) communication, 5) monitoring and evaluation and 6) and resource.Conclusion: Efforts to promote the safety of vaccines and vaccination practices is a complex phenomenon and demands multidisciplinary action. Based on our findings, improved vaccine storage and handling, proper administration of vaccines based on guidelines, proper disposal and management of waste, and effective communication, and monitoring can contribute to the safe delivery of vaccination practices. Furthermore, improving the financial freedom of the facilities could increase the availability of essential resources and equipment that can safely store vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3): 111-117]Keywords: Immunization safety practice, Qualitative study, Framework analysis, Northwest Ethiopi

Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia

BackgroundPremenstrual dysphoric disorder (PMDD) is the most prevalent but neglected psychiatric disorder, with somatic symptoms that are severe enough to markedly affect usual daily activities and have a negative impact on mental health and quality of life by affecting female patients’ behavior and cognition. Studies regarding premenstrual dysphoric disorder and associated factors among high school students in low- and middle-income countries are limited. Therefore, the aim of this study was to assess the prevalence and associated factors of PMDD among high school students, and this is pivotal in further investigation.MethodsA school-based cross-sectional study was conducted from March 25 to April 17, 2023 using a simple random-sampling technique to select a sample of 564 participants. Premenstrual dysphoric disorder was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Self-administered standardized questionnaires were used to collect data.ResultA total of 548 study participants participated, with a 97.2% response rate. The prevalence of premenstrual dysphoric disorder among high school students was found to be 33.03% (95%CI: 29.20–37.09). In a multivariable analysis, irregular menstruation cycle (AOR = 4.242, 95%CI = 2.182–8.246), depression (AOR = 5.272, 95%CI = 2.779–10.002), having greater than 4 days of menstruation bleeding duration (AOR = 2.138, 95%CI = 1.105–4.138), and high perceived stress (AOR = 3.468, 95%CL = 1.217–9.880) were the factors significantly associated with premenstrual dysphoric disorder.ConclusionThe overall prevalence of PMDD which was one-third among high school students was high. Moreover, long duration of menstruation bleeding, depressive symptoms, irregular menstruation cycle, and high perceived stress were significant factors in PMDD. Therefore, it needs early screening and intervention in primary healthcare settings, especially for those who have high perceived stress, having depression, having a long duration of menstruation bleeding, and having an irregular menstruation cycle, so as to have good academic achievement and psychological wellbeing

Prevalence of diarrheal disease and associated factors among under-five children in flood-prone settlements of Northwest Ethiopia: A cross-sectional community-based study

BackgroundDiarrheal illnesses are a long-standing public health problem in developing countries due to numerous sanitation issues and a lack of safe drinking water. Floods exacerbate public health issues by spreading water-borne infectious diseases such as diarrhea through the destruction of sanitation facilities and contamination of drinking water. There has been a shortage of studies regarding the magnitude of diarrheal disease in flood-prone areas. Therefore, this research aimed to evaluate the prevalence of diarrheal disease and its predictors among under-five children living in flood-prone localities in the south Gondar zone of Northwest Ethiopia.MethodA community-based cross-sectional research was carried out in flood-prone villages of the Fogera and Libokemkem districts from March 17 to March 30, 2021. Purposive and systematic sampling techniques were used to select six kebeles and 717 study units, respectively. Structured and pretested questionnaires were used to collect the data. A multivariable analysis was performed to determine the predictors of diarrheal disease, with P-value <0.05 used as the cut-off point to declare the association.ResultThe prevalence of a diarrheal disease among under-five children was 29.0%. The regular cleaning of the compound [AOR: 2.13; 95% CI (1.25, 3.62)], source of drinking water [AOR: 2.36; 95% CI: (1.26, 4.41)], animal access to water storage site [AOR: 3.04; 95% CI: (1.76, 5.24)], vector around food storage sites [AOR: 9.13; 95% CI: (4.06, 20.52)], use of leftover food [AOR: 4.31; 95% CI: (2.64, 7.04)], and fecal contamination of water [AOR: 12.56; 95% CI: (6.83, 23.20)] remained to have a significant association with diarrheal diseases.ConclusionThe present study found that the prevalence of the diarrheal disease among under-five children was high. Routine compound cleaning, the source of drinking water, animal access to a water storage site, vectors near food storage sites, consumption of leftover food, and fecal contamination of water were significant predictors of diarrheal disease. Therefore, it is advised to provide improved water sources, encourage routine cleaning of the living area, and offer health education about water, hygiene, and sanitation

The Effect of Process Parameters on Electro-coagulation Treatment of Paint Industrial Effluent

Number of electrodes, processing time and power supply were used as process parameters. The study conducted by preparing three electro-coagulation cells each having a volume of 1,800.0 mL, 6, 12, 18 aluminum electrodes (anode and cathode) with a respective dimensions of 8.0 cm, 9.0 cm and 2.0 mm of width, height and thickness, power supply of 5.0, 7.5, 10.0 V and 20.0, 40.0, 60.0 minutes of processing time. The distance between each plate of the anode and cathode electrodes were uniform for the three electro-coagulation cells. Between 20 and 60 minutes of processing time and increased supply of power from 5 to 12.5 V found to have a removal of 78.9% to 99.5% of white paint pigment Titanium Dioxide (TiO2); the anode and the power consumptions increased from 1.54 g/m to 4.32 g/m3 and 3.07 to 21.61 Wh/m3 respectively. The result obtained from response surface model was observed that the processing time, the power supply and their combined effect were significant on the removal percentage of white paint pigment TiO2; on the other hand the number of electrodes did not have significant effect. Based on the combined effect of treatment time and power consumptions, 99.44% of white paint pigment TiO2 removal was recorded at a lower power and anode consumption of 3.25 Wh/m3 and 1.63 g/m3 respectively, and with optimized parameters of 12 aluminum electrodes, power supply of 5 V and 60 minutes of processing time. Beside the successful removal efficiency of the white color pigment TiO2, COD, BOD5 and TSS were 98.01%, 96.97% and 95.68 % respectively; hence these values were below the permissible limit of Federal Environmental Protection Authority (FEPA).

Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.

IntroductionIn Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.MethodsA cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants' maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of ResultsThe study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04).ConclusionsParticipants' willingness to pay for cataract surgery in outreach Sites is much lower than the surgery's actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility

Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study

BACKGROUND: Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. METHODS: A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. RESULTS: In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. CONCLUSION: This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community’s educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU

Determinants of household dropout from community-based health insurance program in northwest Ethiopia; A community-based case-control study.

BackgroundCommunity-Based Health Insurance (CBHI) is an evolving program for delivering financial protection against the cost of illness and enhancing access to quality health services for low-income informal households.ObjectiveThe study aimed to identify determinants of household dropout from a CBHI program in Mecha district, North West Ethiopia, 2019.MethodsA community-based case-control study was conducted in the Mecha district from March 10 to June 10, 2018. The final sample was 634 (317 cases and 317 controls) determined by the two-population proportion formula, and these samples were selected using a multi-stage sampling technique. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value ResultsPoor perceived quality of care (AOR = 3.66; 95%CI: 2.35, 5.69), low knowledge of community-based health insurance (AOR = 6.02; 95%CI: 2.97, 12.26), no active community communication (AOR = 5.41; 95%CI: 3.29, 8.90) no chronic illness (AOR = 10.82; 95%CI: 5.52, 21.21) premium fee is not affordable (AOR = 2.35; 95%CI: 1.47, 3.77), and out of pocket money not reimbursed (AOR = 9.37; 95%CI: 4.44, 19.77) were the determinants for the dropout from CBHI.ConclusionsPoor perceived quality of care, low knowledge of CBHI, no active community participation, no chronic illness, premium fees are not affordable, and out-of-pocket money not reimbursed were the determinants for the dropout from CBHI

Downscaling and validating SMAP soil moisture using a machine learning algorithm over the Awash River basin, Ethiopia.

Microwave remote sensing instrument like Soil Moisture Active Passive ranging from 1 cm to 1 m has provided spatial soil moisture information over the entire globe. However, Soil Moisture Active Passive satellite soil moisture products have a coarse spatial resolution (36km x 36km), limiting its application at the basin scale. This research, subsequently plans to; (1) Evaluate the capability of SAR for the retrieval of surface roughness variables in the Awash River basin; (2) Measure the performance of Random Forest (RF) regression model to downscale SMAP satellite soil moisture over the Awash River basin; (3) validate downscaled soil moisture data with In-situ measurements in the river basin. Random Forest (RF) based downscaling approach was applied to downscale satellite-based soil moisture product (36km x 36km) to fine resolution (1km x 1km). Fine spatial resolution (1km) soil moisture data for the Awash River basin was generated. The downscaled soil moisture product also has a strong spatial correlation with the original one, allowing it to deliver more soil moisture information than the original one. In-situ soil moisture and downscaled soil moisture had a 0.69 Pearson correlation value, compared to a 0.53 correlation between the original and In-situ soil moisture. In-situ soil moisture measurements were obtained from the Middle and Upper Awash sub-basins for validation purposes. In the case of Upper Awash, downscaled soil moisture shows a variation of 0.07 cm3 /cm3, -0.036 cm3 /cm3, and 0.112 cm3 /cm3 with Root Mean Square Error, Bias error, and Unbiased Root Mean Square Error respectively. Following that, the accuracy of downscaled soil moisture against the Middle Awash Sub-basin reveals a variance of 0.1320 cm3 /cm3, -0.033 cm3 /cm3, and 0.148 cm3 /cm3 with Root Mean Square Error, Bias error, and Unbiased Root Mean Square Error respectively. Future studies should take into account the temporal domain of Soil Moisture Active Passive satellite soil moisture product downscaling over the study region

Determinants of household dropout from community-based health insurance program in northwest Ethiopia; A community-based case-control study

Background Community-Based Health Insurance (CBHI) is an evolving program for delivering financial protection against the cost of illness and enhancing access to quality health services for low-income informal households. Objective The study aimed to identify determinants of household dropout from a CBHI program in Mecha district, North West Ethiopia, 2019. Methods A community-based case-control study was conducted in the Mecha district from March 10 to June 10, 2018. The final sample was 634 (317 cases and 317 controls) determined by the two-population proportion formula, and these samples were selected using a multi-stage sampling technique. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value Results Poor perceived quality of care (AOR = 3.66; 95%CI: 2.35, 5.69), low knowledge of community-based health insurance (AOR = 6.02; 95%CI: 2.97, 12.26), no active community communication (AOR = 5.41; 95%CI: 3.29, 8.90) no chronic illness (AOR = 10.82; 95%CI: 5.52, 21.21) premium fee is not affordable (AOR = 2.35; 95%CI: 1.47, 3.77), and out of pocket money not reimbursed (AOR = 9.37; 95%CI: 4.44, 19.77) were the determinants for the dropout from CBHI. Conclusions Poor perceived quality of care, low knowledge of CBHI, no active community participation, no chronic illness, premium fees are not affordable, and out-of-pocket money not reimbursed were the determinants for the dropout from CBHI

Individual- and Community-Level Determinants for Complete Vaccination among Children Aged 12-23 Months in Ethiopia: A Multilevel Analysis

Background. Childhood vaccination continues to increase dramatically. In spite of the success of immunization programs to date, millions of children continued to die each year, and sub-Saharan Africa (SSA) accounted for the world’s highest neonatal deaths. Childhood vaccination was designed as one of the most effective ways to reduce child mortalities from fatal vaccine-preventable diseases. Therefore, this study is aimed at investigating the individual- and community-level determinants of childhood complete vaccination in Ethiopia. Methods. A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 1,984 children aged 12-23 months was included for analysis. Considering the hierarchical nature of EDHS data, a two-level multilevel analysis for assessing individual- and community-level determinants of childhood complete vaccination was done. The intraclass correlation coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p value < 0.2 in the bivariable multilevel analysis were considered for the multivariable multilevel analysis. In the multivariable multilevel logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to declare significant determinants of complete childhood vaccination. Results. Overall complete vaccination status among children aged 12-23 months was 39% (95% CI: 36.8, 41.2). In the multilevel analysis, secondary or above educated mothers (AOR=2.48; 95% CI: 1.41, 4.36), richest wealth status (AOR=2.24; 95% CI: 1.16, 4.32), ≥four ANC visits (AOR=2.77; 95% CI: 1.90-4.02), employed mothers (AOR=1.66; 95% CI: 1.26, 2.18), urban residence (AOR=1.84; 95% CI: 1.00, 3.51), and children in city administration (AOR=2.66; 9% CI: 1.53, 4.62) were positively associated with vaccination status. On the other hand, children with a female household head (AOR=0.68; 95% CI: 0.48, 0.96) were negatively associated. Conclusion. Overall, childhood full vaccination status was low compared with the WHO targets. Maternal education, wealth status, ANC visit, maternal occupation, residence, region, and sex of household head were significant predictors of childhood complete vaccination. As a result, it is better to design a compensation mechanism to the costs associated with childhood vaccination for the poor households and strengthen awareness creation for rural residents to improve the access, utilization, and continuum of vaccination service