A Mediation Analysis of Determinants of New-born Care Practices in Four Regions of Ethiopia

Background: Despite a substantial decline in under-five mortality in Ethiopia, neonatal mortality declined steadily and the contribution of the insignificant decline of neonatal mortality to under-five mortality grew from 29.5% in 2000 to 43.3% in 2016. The slow fall of neonatal mortality implies the need for an approach that addresses the main causes of new-born deaths. The World Health Organization recommends essential new-born care practices to save new-borns from morbidity and mortality. The aim of this study was to assess determinants of new-born care practice in the four regions of Ethiopia.Method: The study is part of an intervention project that attempts to investigate the impact of Optimising Health Extension Project on health service utilisation of mothers and children below the age of five years. Data for 590 births that occurred in the twelve months preceding the survey was extracted from the main study data and utilized for the present study. The outcome variable of our study is the number of new-born care practices performed by women that delivered recently. Thus, Poisson regression analysis was used, and a goodness of fit test showed that the model fits the data well. Maternal healthcare utilisation is considered as a mediating variable and a difference approach was used to test whether the effects of socio-economic and demographic variables were mediated. STATA 14 was used for data management and analysis and 5% level of significance was used to declare statistical significance.Results: Clothing (88.1%) and drying (75.2%) are the most frequently accomplished thermal care practices. Cutting the cord with a clean and sharp material was practiced for 83.0% of the births. For more than two third of the births (68.5%), timely initiation of breastfeeding was performed as a new-born care practice. Immunization of the new-born for polio 0 was the least performed new-born care practice for 25.8% of the births. Maternal healthcare utilisation beyond ANC was observed to be beneficial to new-born care practice. The total effect of birth preparedness and complication readiness (0.15 (0.08, 0.22)) was split to direct and indirect effect. Both the direct (0.08 (95% CI (0.01, 0.15))) and indirect (0.07 (95% CI (0.02, 0.12))) effects were statistically significant. The predictive power of birth preparedness and complication readiness through its influence on maternal healthcare utilization accounted for 45.3% (95% CI (15.6, 75.0)) of its total effect.Conclusion: New-born care practice is inadequate in general. However, birth preparedness and complication readiness have dual benefit of enhancing both maternal healthcare utilization and new-born care practices. Therefore, women shall be provided with information on benefits of facility delivery and getting professional assistance during delivery to improve new-born care practices.[Ethiop. J. Health Dev. 2021; 35(2):000-000

Knowledge, Attitude, Practice, and Associated Factors of Breast Cancer Self-Examination among Urban Health Extension Workers in Addis Ababa, Central Ethiopia

Background & aim: Breast cancer is one of the leading cancer types among women. In Ethiopia, the knowledge, attitude and practice among health extension workers (HEWs) towards breast cancer self-examination are not well understood. Therefore, this study assessed knowledge, attitude, and practice (KAP) of breast cancer self-examination (BCSE) and associated factors among HEWs. Methods: This cross-sectional study was conducted from October to November 2017 among female HEWs in Addis Ababa, using self-administered questionnaire. Multivariate logistic regression was used to assess factors associated with KAP of the BCSE. Adjusted odds ratio (AOR) with 95% confidence interval (95% CI) was used to assess statistical significance. Results: A total of 453(89.2%) HEWs participated in this study. Close to two-third (64.0%) of the respondents had adequate knowledge on breast cancer signs, symptoms, and practice of BCSE. However, only 146(40.0%) of the respondents practiced BCSE on a monthly basis. The majority (81.0%) of the respondents had a positive attitude towards BCSE. Work experience ranging from one to four years (AOR: 2.8; 95%CI: 1.2, 6.4)and ≥five years(AOR: 2.4; 95%CI: 1.1, 5.7), familiarity with people who had history of breast cancer (AOR: 1.7; 95%CI: 1.1, 2.6),perceived susceptibility (AOR: 1.8; 95 %CI: 1.2, 3.0), and knowledge of BCSE(AOR: 2.3; 95 %CI: 1.4, 3.7) were significant predictors of BCSE. Conclusion: More than half of HEWs had adequate knowledge and attitude towards BCSE; however, only a few put them into practice. With regard to in-service training focusing on severity, consequences and detection methods of breast cancer may enhance the BCSE practices of the HEWs

Effect of empathy training on the empathy level of healthcare providers in Ethiopia: a cluster randomized controlled trial

ObjectiveEmpathy has deteriorated throughout clinical training and medical practice, and little is known about the effect of empathy training on the empathy level of healthcare providers. To address this gap, we assessed the effect of empathy training on the empathy level of healthcare providers in Ethiopia.DesignA cluster randomized controlled trial study design was conducted from 20 December 2021 to 20 March 2022. The empathy training intervention was conducted for three consecutive days.SettingThe study was conducted in five fistula treatment centers in Ethiopia.ParticipantsThe participants were all randomly selected healthcare providers.Main outcome measuresTotal mean score, percentage changes, and Cohen’s effect size were computed. A linear mixed effects model and independent t-test were used for data analysis.ResultsA majority of the study participants were nurses in the profession, married, and first-degree holders. There was no statistically significant difference in the baseline empathy score of the intervention arm across their socio-demographic features. At the baseline, the mean empathy scores of the control and intervention arms were 102.10 ± 15.38 and 101.13 ± 17.67, respectively. The effect of empathy training on the total mean score changes of empathy of the intervention arm compared to the control arm at each follow-up time had a statistically significant difference. After a week, a month, and three months of post-intervention, the total mean empathy scores between the intervention and control arms were as follows: (intervention 112.65 ± 18.99, control 102.85 ± 15.65, d = 0.55, p = 0.03); (intervention 109.01 ± 17.79, control 100.52 ± 12.57, d = 0.53, p = 0.034); and (intervention 106.28 ± 16.24, control 96.58 ± 14.69, d = 0.60, p = 0.016) with the overall percentage changes of 11, 8, and 5% from the baseline scores, respectively.ConclusionIn this trial, the empathy training intervention was found to have more than a medium effect size. However, over the follow-up intervals, there was a decreasing trend in the total mean empathy scores of healthcare providers; suggesting that there should be continued empathy training and integration of it into educational and training curriculums to enhance and sustain the empathy of healthcare providers.Clinical Trial Registration: Pan African Clinical Trial Registry: http://www.edctp.org/panafrican-clinical-trials-registry or https://pactr.samrc.ac.za, PACTR202112564898934

Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care

BACKGROUND፡ Ethiopia has been motivated to achieve a goal of “appointment spacing model approach care.” However, little has been documented on the predictor of mortality and challenges of sustainable HIV care. Therefore, the aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART).METHODS: A retrospective cohort study was conducted on 676 adult people living with HIV who enrolled to ART clinic from September 01, 2012 - August 30, 2016. Multivariable Cox Regression analysis was done where adjusted hazard ratio (AHR)with corresponding 95% confidence interval (CI) at P value ≤ 0.05 cut of point was used to identify predictors of mortality.RESULTS: The total person-time contributed was 28,209 personmonths with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). Severe undernourishment and moderate malnutrition at baseline, younger age, female sex, single, divorced, illiterate, lack of disclosure, advanced WHO clinical stage, seeking treatment outside catchment area, rural residence and immunological failure were found to be independent predictors of mortality.CONCLUSIONS: Poor nutritional status at baseline, advanced stage of HIV disease, occurrence of treatment failure, female sex, substance abuse, lack of social support, immunological failure, clinical failure, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of the appointment spacing model care can improve survival of PLWHA

Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based Cross-Sectional Study

BACKGROUND: Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home.  METHODS: A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness.  RESULTS: Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation. CONCLUSIONS: The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections

The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.</p> <p>Methods</p> <p>The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.</p> <p>Results</p> <p>A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.</p> <p>Conclusion</p> <p>Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.</p> <p>Trail registration</p> <p>Australian New Zealand Clinical Trials Registry (ACTR number: <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a>).</p

Malaria and Under-Nutrition: A Community Based Study Among Under-Five Children at Risk of Malaria, South-West Ethiopia

BACKGROUND: The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia. METHODS: This cross-sectional study was undertaken during March-February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden). RESULTS: Significant proportion (40.4%) of under-five children were stunted (height-for-age<-2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1-2.0)]. CONCLUSION: In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia

Effect of training on the use of long-lasting insecticide-treated bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results of a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the utilization of long-lasting insecticide-treated bed nets (LLITN) is hampered by behavioural factors such as low awareness and negative attitude of the community. The aim of this study was to present the design and baseline results of a cluster randomized trial on the effect of training of household heads on the use of LLITN.</p> <p>Methods</p> <p>This baseline survey was undertaken from February to March, 2009 as part of a randomized cluster trial. A total of 11 intervention and 11 control <it>Gots </it>(villages) were included in the Gilgel Gibe Field Research Centre, south-west Ethiopia. House to house visit was done in 4135 households to collect information about the use of LLITN and socio-demographic variables. For the diagnosis of malaria and anaemia, blood samples were collected from 2410 under-five children and 242 pregnant women.</p> <p>Results</p> <p>One fourth of the households in the intervention and control <it>Gots </it>had functional LLITN. Only 30% of the observed LLITN in the intervention and 28% in the control <it>Gots </it>were hanged properly. Adults were more likely to utilize LLITN than under-five children in the control and intervention <it>Gots</it>. The prevalence of malaria in under-five children in the intervention and control <it>Gots </it>was 10.5% and 8.3% respectively. The intervention and control <it>Gots </it>had no significant difference concerning the prevalence of malaria in under-five children, [OR = 1.28, (95%CI: 0.97, 1.69)]. Eight (6.1%) pregnant women in the intervention and eight (7.2%) in the control <it>Gots </it>were positive for malaria (P = 0.9). Children in the intervention <it>Gots </it>were less likely to have anaemia than children in the control <it>Gots</it>, [OR = 0.75, (95%CI: 0.62, 0.85)].</p> <p>Conclusion</p> <p>The availability and utilization of LLITN was low in the study area. The prevalence of malaria and anaemia was high. Intervention strategies of malaria should focus on high risk population and vulnerable groups.</p

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.</p> <p>Methods</p> <p>A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.</p> <p>Results</p> <p>A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.</p> <p>Conclusion</p> <p>Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12610000035022.aspx">ACTRN12610000035022</a></p

Pattern and Trend of Severe and Malaria Morbidity Over Five Years in JImma Zone, Southwest Ethiopia

No abstract - Available on PD