Membership dropout rates and associated factors in a community-based health insurance scheme in southern Ethiopia: a mixed method study

BackgroundDropout from community-based health insurance (CBHI) membership is a common problem in low-income countries, even if its implementation leads to substantial improvement in the utilization of essential health services. Few studies have addressed the factors contributing to dropout rates in southern Ethiopia. Therefore, the purpose of this study was to determine the rate of CBHI dropout in southern Ethiopia as well as any contributing factors.MethodsThis mixed-method cross-sectional study was conducted among 460 randomly selected CBHI-enrolled households at the Arba Minch Health and Demography Surveillance System site from November 1, 2021, to April 30, 2022. The quantitative data were collected by an open data kit (ODK). using an interviewer-based structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Multivariable logistic regression was applied to identify significant variables. The qualitative data were used to support the quantitative findings and were gathered through in-depth interviews (by the CBHI coordinator and three purposively selected health extension workers) and focus group discussions (in two randomly selected villages). The qualitative data were analyzed using thematic analysis. Finally, triangulation was used to present both the quantitative and qualitative findings.ResultsThis study found that 92 (21.5%) people stopped their community-based health insurance membership. The presence of sick adults [AOR = 0.281, 95% CI (0.136–0.581)], trust of participants in the contracted health facilities [AOR = 0.227, 95% CI (0.121–0.436)], and poor knowledge of the participants [AOR = 5.518, 95% CI (1.526–19.950)] were significant predictors.ConclusionThe magnitude of the dropout rate was high in this study when compared with the national target. The absence of a sick adult, the absence of trust among participants, and the poor knowledge status of the participants were significant predictors. We suggest that the health facility managers, the CBHI coordinating office, and the district health office give priority to implementing a wide range of knowledge improvement activities and a transparent system in public health facilities. Studies with longitudinal research designs are called for at a wide range of national levels to address the limitations of this study

Assessment of Educational Quality and Associated Factors: The Case of Arba Minch College of Health Sciences in 2017, South Ethiopia

Introduction. Over the decades, improving the quality of education has been pronounced frequently in many studies. It became a political argument in different media across the globe and the theme of courtesy among scientists. The concern about education is not something you ignore or consider later, so the attempts to improve are increasing with the quality matter going longer and continuing to date. Thus, the primary aim of this work was to assess the quality of education and its associated factors for the future improvement in the study site. Methods. An institution-based cross-sectional study was conducted in Arba Minch College of Health Sciences (AMCHS) students and staff from all departments. Ethical clearance was received and verbal consent was secured beforehand. After processing, data was entered into Epi Info and then transferred and analyzed in SPSS 25.0. Result and Discussion. The overall quality of education in the college was 2.87 ± 1.12. Administrative services, reading places, and resources took a larger share of poor quality. Accessibility, friendliness of staffs to each other and students, availability of clear guideline of conduct, presence of effective, accurate, and promotive services, high standard administrative buildings, availability of standard catering service, availability of standard laboratories, communication, and exchanges with similar level colleges in the region, weekly time table, weekly load, distance, etc. and some sociodemographic factors were associated with poor quality of education. Thus, the college inquired to welcome the aforementioned shortcomings improvement and to provide enough solutions

Determinants of abortion among youth 15-24 in Ethiopia: A multilevel analysis based on EDHS 2016.

IntroductionDeterminants of the magnitude of abortion among women of diverse social and economic status, particularly in Africa poorly understood because of the missing information in most countries. In this study, we addressed abortion and its determinants among youth women of 15-24 ages to provide clear direction for policymaking in Ethiopia.MethodsWe examined the 2016 Ethiopian demographic health survey data downloaded from the EDHS website after obtaining permission on abortion among 15-24 age women. We applied bivariate and multilevel binary logistic regression. Community and Individual level abortion predictors passed through a three-level binary logistic regression analysis where we used p-value ResultThe abortion among the youth population in this study was 2.5%. Factors associated with pregnancy were age group 20-24 2.5(1.6-3.8), youth with one birth 0.65(0.44-0.96), youth with 2-5 births 0.31(0.18-0.55), age ≥18 0.50(0.33-0.76), married 38(17-84), divorced 20(7-55), birth in the last five years 0.65(0.44-0.96), middle wealth youth 1.7(1.0.4-2.8), being in Amhara0.31(0.11-0.85), and 0.30(0.12-0.77).ConclusionLess abortion occurred in economically poor youths. It is a noble finding; however, the access problem might lead to the result. We observed more abortions in age <18years; those have not given birth until the data collection date. It portrays forth clear policy direction for politicians and all other stakeholders to intervene in the problem. The analysis also showed abortion increased with age. It shows that as age increased, youths disclose abortion which is rare at an early age, and again given an essential clue for the next interventions. The fact in this study is both age and marriage affected abortion similarly. It might be because of various culture-related perceptions where it is not appropriate for an unmarried woman to appear with any pregnancy outcome as the reason behind the decreased number of abortions at a younger age. Thus, more attention is required during implementation for unmarried and lower age youth regardless of the magnitude of the abortion

Predictors of maternal health services uptake in West African region: a multilevel multinomial regression analysis of demographic health survey reports

Abstract Background Pursuant to studies, receiving the three key maternal health services (Antenatal Care, Skilled Delivery Service, and Postnatal Care) in a continuum could prevent 71% of global maternal deaths. Despite the Western African region being known for its high maternal death and poor access to maternal health services, there is a dearth of studies that delve into the spectrum of maternal health services uptake. Hence, this study aimed to assess the level and predictors of partial and adequate utilization of health services in a single analytical model using the most recent Demographic and Health Survey (DHS) data (2013–2021). Methods This study was based on the appended women's (IR) file of twelve West African countries. STATA software version 16 was used to analyze a weighted sample of 89,504 women aged 15–49 years. A composite index of maternal health service utilization has been created by combining three key health services and categorizing them into ‘no’, ‘partial’, or ‘adequate’ use. A multilevel multivariable multinomial logistic regression analysis was carried out to examine the effects of each predictor on the level of service utilization. The degree of association was reported using the adjusted relative risk ratio (aRRR) with a corresponding 95% confidence interval, and statistical significance was declared at p < 0.05. Results 66.4% (95% CI: 64.9, 67.7) and 23.8% (95% CI: 23.3, 24.2) of women used maternal health services partially and adequately, respectively. Togo has the highest proportion of women getting adequate health care in the region, at 56.7%, while Nigeria has the lowest proportion, at 11%. Maternal education, residence, wealth index, parity, media exposure (to radio and television), enrolment in health insurance schemes, attitude towards wife beating, and autonomy in decision-making were identified as significant predictors of partial and adequate maternal health service uptake. Conclusion The uptake of adequate maternal health services in the region was found to be low. Stakeholders should plan for and implement interventions that increase women's autonomy. Program planners and healthcare providers should give due emphasis to those women with no formal education and from low-income families. The government and the private sectors need to collaborate to improve media access and increase public enrolment in health insurance schemes

Determinants of childhood vaccination among children aged 12–23 months in Ethiopia: a community-based cross-sectional study

Objective Childhood vaccination is a cost-effective, essential service to reach a larger population globally. Due to unclear reasons, new emergence and resurgence of vaccine-preventable diseases increase. Thus, the aim of this study is to identify prevalence and determinants of childhood vaccination in Ethiopia.Design Community-based cross-sectional study.Setting We used data from 2019 Ethiopia Mini Demographic and Health Survey. The survey included all the nine regional states and two city administrations of Ethiopia.Participants A weighted sample of 1008 children 12–23 months of age was included in the analysis.Main outcome measures A multilevel proportional odds model was fitted to identify determinants of childhood vaccination status. In the final model, variables with a p value of less than 5% and an adjusted OR (AOR) with a 95% CI were reported.Result The full childhood vaccination coverage of Ethiopia was 39.09% (95% CI: 36.06%–42.28%). Mothers who attended primary (AOR=2.16; 95% CI: 1.43–3.26), secondary (AOR=2.02; 95% CI: 1.07–3.79) and higher education (AOR=2.67; 95% CI: 1.25–5.71); being in union (AOR=2.21; 95% CI: 1.06–4.58); kept vaccination cards (AOR=26.18; 95% CI: 15.75–43.53); children receiving vitamin A1 (AOR=4.14; 95% CI: 2.9–5.9); living in Afar (AOR=0.14; 95% CI: 0.04–0.45), Somali (AOR=0.19; 95% CI: 0.06–0.60), Gambela (AOR=0.22; 95% CI: 0.06–0.77), Harari (AOR=0.14; 95% CI: 0.04–0.52) and Dire Dawa (AOR=0.23; 95% CI: 0.06–0.79) regions; and rural residents (AOR=0.53; 95% CI: 0.30–0.93) were factors significantly associated with childhood vaccination.Conclusion The full childhood vaccination coverage in Ethiopia was low and remained unchanged since 2016. The study identified that both the individual-level and community-level factors affected the vaccination status. Accordingly, public health interventions targeted to these identified factors can increase childhood full vaccination status

Tracking progress in anthropometric failure among under-five children in Ethiopia: a geospatial and multilevel analysis

Abstract Background Undernutrition is a major public health concern among under-five children in many developing countries. This work evaluated the overall prevalence of under-nutrition by using a composite index of anthropometric failure (CIAF), which helps in the detection of children with multiple anthropometric failures. This research also includes the Spatio-temporal distribution of childhood anthropometric failures across time. Methods Secondary data was obtained from the Ethiopian Demographic and Health Survey for the survey 2005, 2011, and 2016 years. Data included 23,864 samples of children between the ages of 0–59 months, which is a nationally representative sample in Ethiopia. Other than descriptive statistics, the multivariate multilevel logistic regression was used to identify associated factors, and Getis-Ord spatial statistical tools were employed to identify high and low hotspots areas of anthropometric failures. Result The prevalence obtained with CIAF in 2005, 2011, and 2016 was, 53.5 %, 51 %, and 46.2 % of children were suffering from under-nutrition respectively. The spatial analysis revealed areas that are at a higher risk of anthropometric failures consistently were found in northern parts of the country, largely in the Amhara, Tigray, and Afar regions. Multilevel logistic regression analysis showed that the risk of anthropometric failure was higher among older children, had low birth weight, had a mother with low BMI, was in a rural area, had mothers and fathers without formal education. Conclusions In addition to identifying wasted, stunted, and underweight children, CIAF also identified children with multiple conditions, which are often overlooked in nutritional surveys. As revealed by this composite index, the prevalence of anthropometric failure remains considerably high and its spatial distribution also significantly varied across the regions in the country. The established socio-demographic characteristics and districts with a higher risk of anthropometric failure can be used to develop localized intervention and prevention strategies to improve Ethiopian children’s nutritional status and healthcare

Using geographically weighted regression analysis to assess predictors of home birth hot spots in Ethiopia

Background Annually, 30 million women in Africa become pregnant, with the majority of deliveries taking place at home without the assistance of skilled healthcare personnel. In Ethiopia the proportion of home birth is high with regional disparity. Also limited evidence on spatial regression and deriving predictors. Therefore, this study aimed to assess the predictors of home birth hot spots using geographically weighted regression in Ethiopia. Methods This study used secondary data from the 2019 Ethiopian Mini Demographic and Health Survey. First, Moran’s I and Getis-OrdGi* statistics were used to examine the geographic variation in home births. Further, spatial regression was analyzed using ordinary least squares regression and geographically weighted regression to predict hotspot area of home delivery. Result According to this result, Somalia, Afar, and the SNNPR region were shown to be high risk locations for home births. Women from rural residence, women having no-education, poorest wealth index, Muslim religion follower, and women with no-ANC visit were predictors of home delivery hotspot locations. Conclusion The spatial regression revealed women from rural resident, women having no-education, women being in the household with a poorest wealth index, women with Muslim religion follower, and women having no-ANC visit were predictors of home delivery hotspot regions. Therefore, governmental and other stakeholders should remain the effort to decrease home childbirth through access to healthcare services especially for rural resident, strengthen the women for antenatal care visits

Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria

Abstract Background Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria. Methods This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15–49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample. Results The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48–0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30–2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45–0.97)] compared to women with lower socioeconomic status. Conclusions This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general

Attitude towards tele rehabilitation-based therapy services and its associated factors among health professional working in specialized teaching hospitals in Amhara region, Northwest Ethiopia

Background: Tele-rehabilitation is part of Tele-health (TH) which provides a rehabilitation service at a distance through using telecommunication technology. The lack of skilled staff, accessibility concerns, high transportation costs, lengthy waiting times, and mobility issues make face-to-face rehabilitation treatment difficult. Therefore, this study aimed to assess attitudes and its associated factors of health professionals towards TR services. Method: An institutional-based cross-sectional study design was conducted among 408 health professionals from March to April 2021. A simple random sampling technique was applied to select study participants. Epi-data 3.1 versions software was used for data entry, and SPSS version 20 was used for the analysis. A bi-variable and multivariable logistic regression was used to determine factors associated with the attitude of health professionals towards tele-rehabilitation. Result: A total of 408 participants enrolled in the study, with a response rate of 95.5%. The majority 285(69.9%) of health professionals had good attitude towards tele rehabilitation-based treatment services. Good knowledge of tele rehabilitation [AOR = 1.76, 95%, CI: 1.078, 2.879], digitally literate [AOR = 1.74, 95%, CI: 1.028, 2.954], perception on security and privacy [AOR = 0.56, 95%,CI: 0.333, 0.944], and owns smart mobile phone [AOR = 1.9,95%,CI: 1.007, 3.781] were significantly associated with attitude towards tele rehabilitation service. Conclusion: In this study the majority of the respondents had a good attitude towards tele rehabilitation services. Having own mobile, knowledge towards tele rehabilitation, digital literacy, perception on security and privacy to rehabilitation were found to be factors associated with attitude towards tele rehabilitation service. Therefore, the government and other responsible entities should consider enacting systems and strategies to encourage the use of mobile technologies for the management of disability, chronic diseases and for rural patients

Spatial distribution and associated factors of measles vaccination among children aged 12–23 months in Ethiopia. A spatial and multilevel analysis

Introduction In Ethiopia, measles continues to be the cause of a significant number of vaccine-preventable infant morbidity and mortality due to the low vaccination rate. However, understanding the geographical distribution of the measles-containing vaccine first dose (MCV1) and identifying associated factors is crucial to setting up appropriate interventions. This study aimed to explore the spatial distribution and associated factors of MCV1 coverage among children aged 12–23 months in Ethiopia using national representative data. Methods A cross-sectional study design using a two-stage stratified sampling technique was used. The analysis was performed using STATA 14.2, ArcGIS 10.8, and SaTScan version 9.6 software. To find significant related factors with measles vaccination, researchers used multilevel logistic regression. Results The prevalence of MCV1 in Ethiopia was 58.5%. A spatial variation of MCV1 coverage was observed across the study area. The most likely significant primary clusters with low MCV1 coverage were observed in Liben, Afder, Shebelle, Korahe, and Nogob zones of the Somali region; Bale and Guji zones of the Oromia region, and Gedeo and Sidama zones of the SNNPR. Rural areas, maternal primary education, secondary and above school education, Orthodox religion, Muslim religion, health facility delivery, and Afar region were significantly associated with MCV1 vaccination. Conclusion The overall MCV1 coverage in Ethiopia was low. Aside from the inadequate coverage, there was a geographical variation across the country. Low MCV1 coverage areas should be prioritized to improve vaccination efforts to control measles across the country