Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study

Introduction: Although Ethiopia is one of the least urbanized countries in the world, the pace at which urbanization increases is unprecedented. During the last twenty years, urbanization has expanded rapidly and is estimated to be at 38% in 2050 from the current proportion of 19%. Despite the fact that urbanization is associated with relatively, better access to social services including health, residents in urban setting are believed to suffer from health disparities in health indicators such as use of Antenatal care (ANC), institutional delivery and postpartum care (PNC). This study aims to identify reasons why urban women fail to use available maternal health services in selected urban settings in Ethiopia.Methods: A qualitative study using focus group discussions and in-depth interview was conducted in six purposively selected urban settings such as Adama, Dire Dawa, Hawassa, Debre Berhan, Gondar, and Mekelle. A total of 11 Focus Group Discussions and 40 in-depth-interviews were completed with residents of these urban settings who were living in the section of urban setting characterized as slum. The data collected were categorized in to themes and analyzed using thematic method.Results: Study participants anonymously argued that there are positive changes in maternal health service utilization in all study settings over the years. However, students, daily laborers, widows, divorced and separated women, commercial sex workers, house maids, and migrants were found to be reluctant in using maternal health services such ANC follow-up, institutional delivery and PNC. Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community level in connection with pregnancy, delivery and postpartum.Conclusion: Although service utilization in urban setting is believed to have been relatively better over the years, still women in urban settings do not use available maternal health services. Especially women living in slum areas tend to neglect use of available health services. This study suggests that blanket programmatic approach should give way to intervention that target specific section of population. Furthermore, programs are expected to be tailored to addresses individual, institutional and socio-cultural factors in tandem to improve maternal health service utilization in urban setting. [Ethiop. J. Health Dev. 2017;31(2):96-102]Keywords: Maternal Health Services, Urban Health, Social Determinant of Health, Ethiopi

A qualitative study of vulnerability to HIV infection: Places and persons in urban settings of Ethiopia

Background: HIV continues to differentially affect specific population group and geographic locations in the world. Often individual risk behaviors are associated with vulnerability to HIV infection. However, such notion often overlooks the broader context of social determinants of the infection. Such determinant is broader than personal attributes and includes diverse social factors that contribute to vulnerability to as well as prevention of HIV infection. This study explores the social determinants for HIV infection in urban settings of Ethiopia.Methods: A qualitative study employing Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs) was conducted in six purposively selected cities of Ethiopia. FGDs and IDIs were tape recorded and fully transcribed. Transcripts were coded, categorized and analyzed using thematic analysis.Results: Findings show that it is not only people who are vulnerable, but specific places in urban settings where they reside. Vulnerability of places are linked to overcrowding, being hub of in-migrants and transistors, and with limited availability of services and infrastructure for its residents Majority of residents in such places were daily laborers, female sex workers, students who are living away from family, widows, separated and divorced women, those who work in restaurants and engaged in petty trade were found to be relatively more vulnerable group of population. They were also found to have weakened social controls and restraints that facilitate vulnerability.Conclusion: Every city has settings that are relatively more vulnerable as compared to others and there are population groups that are particularly vulnerable to HIV infection. Mitigating the spread of HIV infection requires mapping vulnerable section of the city and targeting vulnerable group of population makes interventions effective. Moreover, HIV intervention in urban settings calls for a multi-sectoral response. [Ethiop. J. Health Dev. 2016;30(3):105-111]Keywords: HIV, social determinant of health, place, person, JS

Caregivers’ perception of malaria and treatment-seeking behaviour for under five children in Mandura District, West Ethiopia: a cross-sectional study

Abstract Background Early diagnosis and prompt malaria treatment is essential to reduce progression of the illness to severe disease and, therefore, decrease mortality particularly among children under 5 years of age. This study assessed perception of malaria and treatment-seeking behaviour for children under five with fever in the last 2 weeks in Mandura District, West Ethiopia. Methods A community based cross-sectional study was conducted among 491 caregivers of children under five in Mandura District, West Ethiopia in December 2014. Data were collected using interviewer-administered questionnaires. Data were entered into Epi Info version 7 and analysed using SPSS version 20. Multiple logistic regression analyses were conducted to identify the determinants of caregivers’ treatment-seeking behaviour. Results Overall, 94.1% of the respondents perceived that fever is the most common symptom and 70% associated mosquito bite with the occurrence of malaria. Of 197 caregivers with under five children with fever in the last 2 weeks preceding the study 87.8% sought treatment. However, only 38.7% received treatment within 24 h of onset of fever. Determinants of treatment-seeking include place of residence (rural/urban) (AOR 2.80, 95% CI 1.01–7.70), caregivers age (AOR 3.40, 95% CI 1.27–9.10), knowledge of malaria (AOR 4.65, 95% CI 1.38–15.64), perceived susceptibility to malaria (AOR 3.63, 95% CI 1.21–10.88), and perceived barrier to seek treatment (AOR 0.18, 95% CI 0.06–0.52). Conclusions Majority of the respondents of this study sought treatment for their under five children. However, a considerable number of caregivers first consulted traditional healers and tried home treatment, thus, sought treatment late. Living in rural village, caregivers’ age, malaria knowledge, perceived susceptibility to malaria and perceived barrier to seek treatment were important factors in seeking health care. There is a need to focus on targeted interventions, promote awareness and prevention, and address misconceptions about childhood febrile illness

Knowledge about Cervical Cancer and Associated Factors among 15-49 Year Old Women in Dessie Town, Northeast Ethiopia

<div><p>Background</p><p>Cervical cancer is one of the leading causes of morbidity and mortality amongst female cancer worldwide, especially in developing countries, including Ethiopia. The level of women’s knowledge about cervical cancer is not well documented in Ethiopia. The current study sought to assess women’s knowledge about cervical cancer and associated factors.</p><p>Methods</p><p>A community based cross-sectional survey was conducted with a sample of 620 women aged 15–49 years residing in Dessie town, Northeast Ethiopia. Respondents were selected using a multistage sampling technique. The women were interviewed at home by trained data collectors using a structured questionnaire on cervical cancer knowledge. Knowledge about cervical cancer was measured using an eight item instrument. The maximum possible score was 8; those scoring 5 or more were categorized as having “sufficient” knowledge. Binary and multiple logistic regressions were employed to determine factors associated with knowledge about cervical cancer.</p><p>Results</p><p>A total of 51% of the participants had sufficient knowledge about cervical cancer. After adjusting for covariates, having sufficient knowledge about cervical cancer was positively associated with better educational level and income. Women with primary education (Adjusted Odds Ratio (AOR): 3.4; 95% CI: 2.2–5.1) and those who had secondary and above education (AOR: 8.7; 95% CI: 5.5–13.7) were more likely to have sufficient knowledge about cervical cancer compared to those who had no formal education. Furthermore, women earning an average household monthly income above 1500 Ethiopian birr (ETB) (~75 U.S. dollars) were more likely to have sufficient knowledge (AOR: 2.3; 95% CI: 1.3–3.9) than women with an average household monthly income less than 500 ETB (~25 U.S. dollars).</p><p>Conclusion</p><p>This study shows a suboptimal knowledge about cervical cancer regarding its risk factors, signs and symptoms, prevention and treatment among women in the study site. The level of education and economic status were found to be important determinants for knowledge about cervical cancer. Prevention programs should focus cervical cancer educational resources on women with less education and women with lower economic status groups.</p></div

Factors associated with knowledge about cervical cancer among women aged 15–49 years in Dessie town, Ethiopia, January 2015.

<p>Factors associated with knowledge about cervical cancer among women aged 15–49 years in Dessie town, Ethiopia, January 2015.</p

Knowledge of women about risk factors, presenting symptoms, prevention measures and treatment options of cervical cancer, Dessie town, Ethiopia, January 2015.

<p>Knowledge of women about risk factors, presenting symptoms, prevention measures and treatment options of cervical cancer, Dessie town, Ethiopia, January 2015.</p

Socio-demographic characteristics of respondents, Dessie town, Ethiopia, 2015.

<p>Socio-demographic characteristics of respondents, Dessie town, Ethiopia, 2015.</p

Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study

Introduction: Ethiopia has recently adopted lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women (Option B+ strategy), regardless of CD4 count or clinical stage. However, the exact timing and predictors of loss to follow-up (LFU) are unknown. Thus, we examined the levels and determinants of LFU under Option B+ among pregnant and breastfeeding women initiated on lifelong ART for prevention of mother-to-child transmission (PMTCT) in Ethiopia. Methods: We conducted a retrospective cohort study among 346 pregnant and breastfeeding women who started ART at 14 public health facilities in northeast Ethiopia from March 2013 to April 2015. We defined LFU as 90 days since the last clinic visit among those not known to have died or transferred out. We used Kaplan-Meier and Cox proportional hazards regression to estimate cumulative LFU and identify the predictors of LFU, respectively. Results: Of the 346 women included, 88.4% were pregnant and the median follow-up was 13.7 months. Overall, 57 (16.5%) women were LFU. The cumulative proportions of LFU at 6, 12 and 24 months were 11.9, 15.7 and 22.6%, respectively. The risk of LFU was higher in younger women (adjusted hazard ratio (aHR) 18 to 24 years/30 to 40 years: 2.3; 95% confidence interval (CI): 1.2 to 4.5), in those attending hospitals compared to those attending health centres (aHR: 1.8; 95% CI: 1.1 to 3.2), in patients starting ART on the same day of diagnosis (aHR: 1.85; 95% CI: 1.1 to 3.2) and missing CD4 cell counts at ART initiation (aHR: 2.3; 95% CI: 1.2 to 4.4). Conclusions: The level of LFU we found in this study is comparable with previous findings from other resource-limited settings. However, high early LFU shortly after ART initiation is still a major problem. LFU was high among younger women, those initiating ART on the day of HIV diagnosis, those missing baseline CD4 count and those attending hospitals. Thus, targeted HIV care and treatment programmes for these patients should be part of future interventions to improve retention in care under the Option B+ PMTCT programme