Patient Satisfaction and Associated Factors with Services Provided at Outpatient Departments

Asking patients what they think how they feel about the health service they have received is an important step towards improving the quality of care and, ensuring that local health services are meeting clients needs and expectations. Facility- based cross-sectional study was conducted from April 1-7, 2019 in randomly selected primary hospitals found in Guraghe zone. There were 266 randomly selected patients who attended the primary hospitals were participated in the study. Data was collected using a interviewer-administered structured questionnaire and analyzed using SPSS version 21. Multiple logistic regression analysis used to identify predictors of patient satisfaction. The overall of patient satisfaction level with the health service provided at the outpatient departments of the primary hospitals was 66.5% (95% C.I. 60.8%-72.2%). waiting time (AOR 3.65), informing patients about cause of illness (AOR, 2.46) and waiting area cleanliness (AOR 2.33) were among the significant predictors of patients satisfaction. Acknowledging the limitation of the cross-sectional study design findings of this study indicate that waiting time, telling the cause of illness, cleanliness of the waiting area are important predictors of patient satisfaction

Evaluating usability of cross-platform smartphone applications

The computing power of smartphones is increasing as time goes. However, the proliferation of multiple different types of operating platforms affected interoperable smartphone applications development. Thus, the cross-platform development tools are coined. Literature showed that smartphone applications developed with the native platforms have better user experience than the cross-platform counterparts. However, comparative evaluation of usability of cross-platform applications on the deployment platforms is not studied yet. In this work, we evaluated usability of a crossword puzzle developed with PhoneGap on Android, Windows Phone, and BlackBerry. The evaluation was conducted focusing on the developer's adaptation effort to native platforms and the end users. Thus, we observed that usability of the cross-platform crossword puzzle is unaffected on the respective native platforms and the SDKs require only minimal configuration effort. In addition, we observed the prospect of HTML5 and related web technologies as our future work towards evaluating and enhancing usability in composing REST-based services for smartphone applications

Factors Affecting Family Planning Information Utilization by Rural Households: The Case of Dugda Woreda, East Shewa, Ethiopia

High fertility and rapid population growth have an impact on the overall socio-economic development of a country in general and maternal and child health in particular. Ethiopia is among the developing countries where the rate of population growth is one of the highest and contraceptive prevalence rate is the lowest. The practice of family planning and its possible determinants have hardly been explored in rural parts of the country. Thus, the objectives of the study were to assess the level of family planning information utilization by the rural households in the study area and to identify factors that determine the utilization of family planning information (FPI). The study was conducted in Dugda Woreda, East Shewa Zone of Central Ethiopia where the population growth rate (2.8) is more than the national average (2.6). Dugda Woreda was purposively selected and a total of 120 sample couples were randomly selected from 4 kebeles, and interview schedule was used to collect primary data. Focus groups’ discussions were held to support the survey data. Data were analyzed by using descriptive statistics and binary logit model. From the total sampled couples, 46.6% were users of family planning at the time of the survey while the remaining 53.3% were non users. The result of binary logistic regression model analysis showed that among the 17 explanatory variables entered into the model, nine of them were found to be significant at less than 10% probability level. Targeting the identified factors, and making policy and development interventions can promote the level of utilization of family planning among rural women in the study area. Therefore, policy makers and family planning service providers should give attention to factors that significantly influence family planning information utilization through emphasizing women education, health counseling, making suitable timing and duration of mass media programs. Keywords: family planning, determinants, Dugda woreda, rural household

PERCEIVED EFFECTIVENESS OF THE LEADERSHIP STYLES OF DEANS IN ETHIOPIAN GOVERNMENTAL TECHNICAL AND VOCATIONAL EDUCATION AND TRAINING (TVET) COLLEGES

The Industrial Development Strategy of 2003 has shown that considerable human resource deficits in Ethiopia are the major reason for the low rate of industrial development. This strategy confirms in its statement: “...education and a training system that is capable of producing the manpower that is both professionally and ethically capable of carrying and sustaining the responsibility of seeing to it that our industrial development program will have achieved its goals” (MOFED, 2003). Therefore, it called for efforts towards quality improvement of the workforce, to reverse the marginalisation of the industrial professions in the TVET system, and to build a culture of entrepreneurship and self-employment (MOFED, 2010). In 2009, the Southern Nations, Nationalities People’s Region (SNNPR) Centre of Competence (COC) conducted standard exams for those who graduated from TVETs. The results were disappointing, as only 12.2% of the TVET graduates and 34.9% of the TVET instructors passed the examinations (SNNPR TVET, 2010). Hence, to solve this chronic problem, high calibre deans should be appointed. In line with this idea, in the year 2003, the World Bank designed a training project to produce and assign skilled leaders in higher education in Ethiopia (World Bank, 2003). Although it failed, it was also the plan of the Ethiopian government that the percentage of TVET leaders trained in leadership would reach 100% in the year 2014 (MOFED, 2010). The TVET sector has particular significance for the reduction of poverty and for the promotion of gender equity because it stresses certain dimensions such as opportunities, skills, human resources development and empowerment. However, in Ethiopia, the Ministry of Finance and Economic Development (MOFED) has introduced an emphasis on developing TVET skills only since the turn of the 21st century. As a result, the MOE has required TVET practitioners not only to link up their knowledge and skills with the past in order to understand the present situation, but also to prompt them to look beyond the present to cope with this dynamic world (MOFED, 2006). The present study assumes importance in finding out perceived effectiveness of the leadership styles of deans in Ethiopian governmental technical and vocational education and training (TVET) colleges.  Article visualizations

LEADERSHIP STYLES OF THE DEANS IN ETHIOPIAN GOVERNMENTAL TECHNICAL AND VOCATIONAL EDUCATION AND TRAINING (TVET) COLLEGES

Technological advancements have driven the development of dynamic work environments leading to a need for dynamic and visionary leaders who possess leadership skills and are capable of meeting the challenges and opportunities that exist in the modern workplace that is intent on promoting the change necessary for developing and maintaining the competitive edge (Burke, Stagl, Klein, Goodwin, Salas, Halpin & Winer, 2006). Again, it is even more critical that leaders of the highest calibre are identified, developed, and sharpened within educational institutions. Avolio and Bass (1991) who in their research identified three leadership styles, namely: transformational, transactional, and laissez-faire. They state that these three leadership styles can be used to identify the predictive roles of this range of leader attributes as well as the three outcomes of leadership, namely: extra effort, effectiveness and satisfaction. The FRL is regarded as a contemporary model that has the potential to explain leadership and its multidimensional nature and to measure behaviours empirically that can be used to predict leadership outcomes (Antonakis, Avolio & Sivasubramaniam, 2003; Avolio, 2010). According to Dew (1995) and Northouse (2012), leaders make an attempt to lift up motivation and morale when a transformational leadership style is put into effect. Similarly, Curtin (2004) and Conger and Kanungo (1990) propose that organisations require leadership that stimulates leaders and followers as a result of which observable change can come to the fore. For Avolio (2010), college deans should use the transformational leadership style to be the most successful. The findings of Morgenson, DeRue and Karam (2009), and Ross and Offerman (1991) have suggested that it is advantageous for organisations if they are led by lenient, more nurturing leaders. In his work, Nahavandi (2003) has tried to describe the characteristics of transformational leaders as follows: they work hard to promote self-reliance and optimism about goals and followers' ability, provide a vivid vision, initiate innovation through empowerment and rewards for followers, inspire high expectations by creating a conducive environment and, finally, form and strengthen personal relationships with followers. For Nahavandi (2003), these five characteristics of a transformational leader are of vital importance and the absence of one of these characteristics would make such a leader either ineffective or less effective in terms of his/her leadership. The present study assumes importance in finding out to what extent do the leadership styles adopted by deans have an effect on the government TVET Colleges’ perceived effectiveness as evaluated by deans, teachers, and students.  Article visualizations

Global Monthly Water Scarcity: Blue Water Footprints versus Blue Water Availability

Freshwater scarcity is a growing concern, placing considerable importance on the accuracy of indicators used to characterize and map water scarcity worldwide. We improve upon past efforts by using estimates of blue water footprints (consumptive use of ground- and surface water flows) rather than water withdrawals, accounting for the flows needed to sustain critical ecological functions and by considering monthly rather than annual values. We analyzed 405 river basins for the period 1996–2005. In 201 basins with 2.67 billion inhabitants there was severe water scarcity during at least one month of the year. The ecological and economic consequences of increasing degrees of water scarcity – as evidenced by the Rio Grande (Rio Bravo), Indus, and Murray-Darling River Basins – can include complete desiccation during dry seasons, decimation of aquatic biodiversity, and substantial economic disruption

Crop residue allocation to livestock feed, soil improvement and other uses along a productivity gradient in Eastern Africa

Crop residues are a key livelihood resource in smallholder mixed crop-livestock systems in Sub-Saharan Africa. With expansion of arable land and resultant decline in grazing resources, crop residues are becoming an increasingly important component of livestock feeds. This demand for livestock feeds has implications for the long-term sustainability of such systems since failure to return biomass to soils has implications for soil quality and the capacity of soils to support long-term productivity. Biomass allocation patterns are likely to vary with overall level of productivity and hence availability. In this study we used a household survey to quantify crop residue allocation patterns across a gradient of productivity in Eastern Africa focusing on two sites in Ethiopia and one in Kenya. We assessed the underlying determinants of crop residue allocation patterns with a view to understanding how productivity increases through intensification will influence biomass allocation in Eastern Africa and how livelihood and natural resource management objectives could be optimized. Results showed that farmers strongly favour allocation of residues to livestock feeding but that allocation to soil increases along the productivity gradient. This reduced feeding to livestock and increased allocation to soil fertility is associated with smaller farm sizes leading to reduced animal traction needs for tillage, increased overall livestock productivity, increased use of inputs and a reduced reliance on farm-based activities in overall livelihood strategies. The implications of these trends are that productivity increases in smallholder systems are likely to reduce pressure on biomass in the long term and that measures that enhance the prospects for farmers to intensify their production systems are likely to increase soil health and sustainability objectives in general. A key conclusion of the work is that intensification of livestock production could reduce crop residue allocation to soils with long term implications for soil productivity

Polio Outbreak Response in Ethiopia

Background: Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. Objectives: This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. Design: A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. Subjects: All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. Results: Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. Conclusion: Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a oneyear period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security. East African Medical Journla Vol. 85 (5) 2008: pp. 222-23

Ontogeny of Recognition Specificity and Functionality for the Broadly Neutralizing Anti-HIV Antibody 4E10

The process of antibody ontogeny typically improves affinity, on-rate, and thermostability, narrows polyspecificity, and rigidifies the combining site to the conformer optimal for binding from the broader ensemble accessible to the precursor. However, many broadly-neutralizing anti-HIV antibodies incorporate unusual structural elements and recognition specificities or properties that often lead to autoreactivity. The ontogeny of 4E10, an autoreactive antibody with unexpected combining site flexibility, was delineated through structural and biophysical comparisons of the mature antibody with multiple potential precursors. 4E10 gained affinity primarily by off-rate enhancement through a small number of mutations to a highly conserved recognition surface. Controverting the conventional paradigm, the combining site gained flexibility and autoreactivity during ontogeny, while losing thermostability, though polyspecificity was unaffected. Details of the recognition mechanism, including inferred global effects due to 4E10 binding, suggest that neutralization by 4E10 may involve mechanisms beyond simply binding, also requiring the ability of the antibody to induce conformational changes distant from its binding site. 4E10 is, therefore, unlikely to be re-elicited by conventional vaccination strategies

Cost implications of delays to tuberculosis diagnosis among pulmonary tuberculosis patients in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Delays seeking care worsen the burden of tuberculosis and cost of care for patients, families and the public health system. This study investigates costs of tuberculosis diagnosis incurred by patients, escorts and the public health system in 10 districts of Ethiopia.</p> <p>Methods</p> <p>New pulmonary tuberculosis patients ≥ 15 years old were interviewed regarding their health care seeking behaviour at the time of diagnosis. Using a structured questionnaire patients were interviewed about the duration of delay at alternative care providers and the public health system prior to diagnosis. Costs incurred by patients, escorts and the public health system were quantified through patient interview and review of medical records.</p> <p>Results</p> <p>Interviews were held with 537 (58%) smear positive patients and 387 (42%) smear negative pulmonary patients. Of these, 413 (45%) were female; 451 (49%) were rural residents; and the median age was 34 years. The mean (median) days elapsed for consultation at alternative care providers and public health facilities prior to tuberculosis diagnosis was 5 days (0 days) and 3 (3 days) respectively. The total median cost incurred from first consultation to diagnosis was $27 per patient (mean =$59). The median costs per patient incurred by patient, escort and the public health system were $16 (mean =$29), $3 (mean =$23) and $3 (mean =$7) respectively. The total cost per patient diagnosed was higher for women, rural residents; those who received government food for work support, patients with smear negative pulmonary tuberculosis and patients who were not screened for TB in at least one district diagnostic centers.</p> <p>Conclusions</p> <p>The costs of tuberculosis diagnosis incurred by patients and escorts represent a significant portion of their monthly income. The costs arising from time lost in seeking care comprised a major portion of the total cost of diagnosis, and may worsen the economic position of patients and their families. Getting treatment from alternative sources and low index of suspicion public health providers were key problems contributing to increased cost of tuberculosis diagnosis. Thus, the institution of effective systems of referral, ensuring screening of suspects across the district public health system and the involvement of alternative care providers in district tuberculosis control can reduce delays and the financial burden to patients and escorts.</p