The prevalence and drivers of early marriage across three generations in three districts from Amhara, Oromia and Southern Nations, Nationalities and Peoples regions of Ethiopia

Early marriage is a harmful traditional practice which affects millions of children worldwide. In the developing world, one in three will marry by the age of 18 and one in nine will marry by the age of 15. This article presents the findings of a study which established the prevalence and drivers of early marriage in Alefa, Diksis and Gorche districts of the Amhara, Oromia and Southern Nations, Nationalities and Peoples (SNNP) regions, respectively. A cross-sectional survey research design was employed.  A total of 1199 women participated in a quantitative survey and data were analysed using descriptive and inferential statistics. The prevalence of early marriage among respondents was found to be 69.9%.  The overall mean age at first marriage of respondents was found to be 14.8. An overall declining trend in the prevalence of early marriage and increasing trend in mean age at first marriage were noted. Respondents attendance of formal school, whether or not fathers ever attended formal school and size of land of natal family were  found to be the variables significantly associated with respondents’ age at first marriage. The drivers of early marriage were categorized into gendered social norms, economic contexts, and institutional factors. Some conclusions are drawn based on the research findings

Revisiting money and labor for valuing environmental goods and services in developing countries

Many Stated Preference studies conducted in developing countries provide a low willingness to pay (WTP) for a wide range of goods and services. However, recent studies in these countries indicate that this may partly be a result of the choice of payment vehicle, not the preference for the good. Thus, low WTP may not indicate a low welfare effect for public projects in developing countries. We argue that in a setting where 1) there is imperfect substitutability between money and other measures of wealth (e.g. labor), and 2) institutions are perceived to be corrupt, including payment vehicles that are currently available to the individual and less pron to corruption may be needed to obtain valid welfare estimates. Otherwise, we risk underestimating the welfare benefit of projects. We demonstrate this through a rural household contingent valuation (CV) survey designed to elicit the value of access to reliable irrigation water in Ethiopia. Of the total average annual WTP for access to reliable irrigation service, cash contribution comprises only 24.41 %. The implication is that socially desirable projects might be rejected based on cost-benefit analysis as a result of welfare gain underestimation due to mismatch of payment vehicles choice in valuation study.Comment: There is no difference between the previous version and the current version. This version is to link with the published version DO

Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross‑sectional study

Background: There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. Methods: A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. Results: No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09). Conclusion: In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention

Biomedical waste disposal systems of health facilities in Ethiopia

Background: Biomedical waste generated from health and health-related activities can be grouped as general waste and hazardous waste. This remains true if and only if there is proper on-site handling, such as the segregation and separation of waste based on the type and nature of the source. Methods: A stratified random sampling design was used to provide representative results for Ethiopia, for various types of facility and management authorities, and for each of the 11 regions. Totally, 1327 health facilities were assessed using the World Health Organization (WHO) inventory tools. Results: Nationally, medical waste in 32.6% of the studied health facilities was stored in covered containers, and in about 27% of them it was stored in another protected environment. About 40% of health facilities stored their medical waste in unprotected areas. Twenty-eight (2.6%) and 420 (39.3%) health facilities used 2-chamber industrial incinerators and 1-chamber drum incinerators, respectively. About 58% of health facilities used unsafe waste treatment methods. The proportion of using safe medical waste disposal method was high in referral hospitals (87.9%). This shows the utilization of safe medical waste disposal methods is in decreasing order from higher to lower levels of organization in health facilities. Conclusion: The present study showed a preliminary finding on the waste disposal systems of health facilities at the national level. Dumping biomedical waste outside the health facility is common, and access to common waste facilities is limited. Therefore, a holistic approach to safe medical waste management practices, including the collection process (handling, sorting, and segregation), storage, treatment and final disposal is crucial in all types of health facilities, regardless of the level of organization, ownership, or geographic distribution. Keywords: Health Facility, Biomedical Waste, Disposal, Incinerator, Ethiopi

Neglected Tropical Diseases (NTD) service availability at health facilities in Ethiopia: Evidence from 2014 Ethiopian service provision assessment

Background: Neglected tropical diseases (NTDs) are a group of infections which are especially endemic in low-income populations in developing regions of Africa, Asia, and the Americas. In sub-Saharan Africa, the impact of these diseases as a group is comparable to malaria and tuberculosis. The diseases recognized as neglected tropical diseases by the World Health Organization (WHO) are: Chagas disease, Cysticercosis and taeniasis, Dengue fever, Dracunculiasis, Echinococcosis, Human African trypanosomiasis, Leishmaniasis, Leprosy, Lymphatic filariasis, Onchocerciasis, Rabies, Schistosomiasis, Soil-transmitted helminthiasis, Trachoma, and Yaws. Most of these diseases are either preventable through mass drug administration (MDA) and proper hygiene and sanitation, or treatable through systematic case finding and management. This study was conducted with the aim of assessing the availability of services for neglected tropical diseases management at health facilities in Ethiopia.Method: The assessment is part of the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) Survey. A total of 873 health facilities were assessed for this analysis. All Hospitals, selected health centre, and private clinics were assessed if they provide services for Neglected Tropical Diseases.Result: More than half of all health facilities offer services for both soil transmitted helminthes (64 percent), and services for trachoma (60 percent). About four of every ten health facilities offer services for schistosomiasis. On the other hand, services for onchocerciasis, leishmanianis and lymphatic filariases were available in less than a third of all health facilities (27%, 25% and 24%, respectively).Conclusion and recommendation: Even though, the availability of service for neglected tropical disease in health facilities is relatively good in general, there should be equitable distribution of neglected tropical disease service provision among regions. And private facilities should give emphasis for the provision of these services. Key words: Service Availability, NTDs, SPA+, Ethiopia

Efficacy of Bilateral Transversus Abdominis Plane and Ilioinguinal-Iliohypogastric Nerve Blocks for Postcaesarean Delivery Pain Relief under Spinal Anesthesia

Background. Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus abdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel incision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery have been conducted in our setup. Method. An institutional-based prospective observational cohort study was conducted to compare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity of pain measured using a numeric rating scale. Result. Twenty-four hours after surgery, the NRS score at rest was (0.90 ± 0.80) versus (0.67 ± 0.58) and at movement (1.2 ± 1.07) versus (0.88 ± 0.76) for the TAP and II-IH groups, respectively. Twenty-four hours after surgery, the mean tramadol consumption was (55.45 ± 30.51) versus (37.27 ± 27.09) mg in TAP and II-IH groups, respectively (p = 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and Recommendations. There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain score, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request than TAP. Thus, we recommend the II-IH nerve block

COVID 19 Epidemic Trajectory Modeling Results for Ethiopia

AbstractBackground: An outbreak of “pneumonia of unknown etiology" later renamed as Novel Corona Virus (COVID 19) was first reported from Hubei Province, China on 31 December 2019. The cases have increased exponentially; the pandemic has reached all countries in the world with 81.2 million confirmed cases and over 1.8 million by December 28, 2020. Ethiopia reported its first case on March 13, 2020, and as of December 28, 2020, the country had 122864 confirmed COVID-19 cases and 1909 deaths. Being a new pandemic its epidemiologic trajectories across regions and populations remains unknown. Mathematical models are widely used to understand and predict the possible courses of an outbreak, given a set of underlying assumptions. Objective: This study intends to model COVID 19 epidemic trajectory under different assumptions and to predict the likely timing of peak of the epidemic in Ethiopia. Methods: Standard Susceptible Exposed, Infected and Recovery (SEIR) compartmental epidemiological deterministic model was employed to estimate and predict COVID 19 in progression in Ethiopia and Addis Ababa at different points of time. Exhaustive literature reviews were carried out to contextualize COVID 19 pandemic epidemiological. Efficacy and coverage of face mask and social distancing were considered in the best and worst situation to run the model and estimate the number of infections after sustained local transmissions. Result. Without any intervention, the COVID 19 viruses spread will peak at 150 days from the first report, infecting 8.01million people given local/community transmission. As the compliance with face mask coverage increases by 25%, 50%, and 75%, the infection will be reduced by about 20%, 40%, and 60% respectively social distancing compliance by le 25% of the population alone will reduce above 60% of infections. Compliance of 40% face mask use and social distance combined effect will reduce 97% of the estimated number of cases. Conclusion: This predication indicated that compliance with combination of non-pharmaceutical intervention such as use of face mask use with physical distance averted significant number of COVID infection. For a county like Ethiopia with poor health systems resilience, mitigating the pandemic at an early stage through strong preventive measures is necessary. [Ethiop. J. Health Dev. 2021; 35(SI-1):25-32] Key word: COVID 19, Modelling, Non-Pharmaceutica intervention, Ethiopi

Determinants of full valid vaccine dose administration among 12-32 months children in Ethiopia: Evidence from the Ethiopian 2012 national immunization coverage survey

Introduction: According to the 2012 national immunization coverage survey report of Ethiopia, EPI coverage by antigen is 79.6% for BCG, 80.0% for DPT-HepB-Hib1 90.1% for OPV1 65.7%; for adjusted DPT-HepB-Hib 3; 65.7 % for OPV3 and 68.2% for Measles. Similarly, the prevalence of full vaccination was 50%. However, the prevalence of valid vaccination dose for all vaccines is 18.6 %. Therefore, the aim of this study is to identify factors that determine the administration of full valid vaccines dose to set effective interventions.Methods: Data was obtained from the 2012 Immunization Coverage survey of Ethiopia, a cross- sectional study administered at the household level. Data were analyzed using SPSS version 20. Binary and multivariate logistic regression with 95% CI was done to assess factors associated with getting full valid vaccination dose. Results: As documented from the 2012 national immunization coverage survey, the coverage of full valid vaccination dose were very low as compared to full immunization coverage that is 18.6% Vs 50%, respectively. Urban residence 2.6 (95% CI: 2.50, 2.68), mothers with age groups of 21-34 and &gt;35 were 1.26 (95% CI: 1.22, 1.29) and 2.4 (95% CI: 2.3, 2.44); children with caretakers with primary, secondary, and higher level of education were 1.6 (95% CI: 1.22, 1.29), 2.8 (95% CI: 2.76, 2.92), and 2.2 (95% CI: 2.13, 2.27) times more likely to get valid vaccination dose.Conclusion: The rich wealth quintile, rural place of residence, living more than 5km proximity to nearest health facility, having more than six sibling, having teenage (&lt;20years old) mother, having mother with no formal education, having mother/ care giver with no card or family folder which state children vaccination status sources, and having mother who did not heard a message about importance of vaccine were found to be the independent determinants of low valid dose immunization. The efforts at all level to increase full valid vaccination coverage by targeting activities to socio-economic, socio-demographic, organizational, and related determinants. [Ethiop. J. Health Dev. 2016;30(3):135-141]Keywords: Valid dose, vaccination, Ethiopi

Tuberculosis Service Provision in Ethiopia: Health Facility Assessment

The major objective of the survey is to assess the availability and preparedness of health facilities in Ethiopia to provide quality Tuberculosis services. The survey was part of the 2014 Ethiopia Service Provision Assessment Plus Survey. A total of 1,327 health facilities were assessed. The results shows that more than two out of three (69%) facilities excluding health posts in Ethiopia offer any TB diagnostic, treatment or/and treatment follow up services. Among all health posts, 29% of them offer any TB diagnostic services and any treatment and/or treatment follow up services. Six in ten (59%) of facilities excluding health posts use sputum smear only to diagnose TB. Of those facilities offering any TB services more than half (60%) have trained staff. Among facilities excluding health posts offering any TB services, 44% have guidelines for diagnosis and treatment of TB, 18% have guideline for diagnosis and treatment of MDR-TB, and 9% have guideline for management of HIV and TB co-infection.As a conclusion we can say that any TB diagnostic, treatment or/and treatment follow up services is available in more than half of the facilities in Ethiopia excluding health post. Half of the health facilities in Ethiopia excluding health post have guidelines for diagnosis and treatment of TB

Pattern and Trend of Medical Admissions of Patients of Chronic Non-Communicable Diseases in Selected Hospitals in Addis Ababa, Ethiopia

Although chronic non-communicable diseases (NCDs) have been of major importance in developed countries for several decades, currently it is becoming recognized as a major public health threats in the developing world too.The increasing NCDs burden is compounded by failure in provision of clear and up-to-date evidence on the burden for key decision makers. The present study is designed to collect retrospective secondary data from selected Government and Private Hospitals in Addis Ababa that offer services to out-patients of NCDs through special referral clinics. The Objective of this research is to depict the patterns and trends of common NCDs in Government and Private Hospitals in Adds Ababa, and provide decision makers with  information on the burden of NCDs at  health facility level.In order to collect retrospective data, four Governments and five Private owned Hospitals in Addis Ababa that offer referral clinic for NCD were selected. Data of NCD out-patients from 2007 to 2011 were considered for present study. Records of cardiovascular diseases, diabetes mellitus, cancer, chronic kidney diseases and chronic pulmonary obstructive diseases including asthma were collected. The data were collected from Hospital registration and patient records anonymously by respective Hospital staff members assigned in the referral clinics.Records of 46,565 patients were collected and more than 60% data were obtained from TikurAnbessa Specialized Teaching Hospital and International cardiac center. Majority of the clients (77 %) were from urban areas while 23% from rural areas. With regard to gender, 56% of the patients are females and 44% males.  As age increases the proportion of patients with NCDs increased and there was a decline after 54 years. Among the patients who were attending outpatient clinics, the vast majority about 40% were patients were with cardiovascular diseases while diabetes and cancer each independently accounts 20% of the proportion. Patients with chronic pulmonary obstructive diseases including asthma, and chronic kidney diseases were 6% and 5%, respectively. Information regarding the status of patients while making follow-up was also collected. It resulted in about 56% of all NCDs out-patients were actively following their health condition by making   frequent visit to their respective out-patient referral clinics, about 2% were deceased and 1% referred to other hospitals, about 41.2% of all NCDs patients were found to be drop-out for unknown reasons. This research reveals that NCDs are becoming public health problems in Addis Ababa. Therefore, there is a need for population-based representative survey to quantify the burden with risk factors for policy formulation and interventions against this emerging epidemic. Moreover, further study is recommended to investigate the reasons of patients why they discontinue care &amp; treatment offered at facility level