Logistics performances of health care system using queue analysis

As there is a very high demand for health service that exceeds the available capacity, the public healthcare centers are overwhelmed with the long queues or they are delivering the service with relatively very low consultation time. In the existing conditions, patients go as early as they can to the healthcare facilities, waiting in queue, even before the opening and had to wait long time for examination, consultation and diagnosis. However, due to high number of patients at the outpatient departments relative to the number of physicians, it results in an increased workload on the physicians and it shortens the patient consultation time, which has an impact on the patients’ health. The main objective of this research was to study the logistic performances of the healthcare system using queuing analysis. This research used three key performance indicators namely, patient queue length, patient waiting time and consultation time length. The performance evaluation was conducted based on data from patients who visited 69 clinical, surgical and diagnosis departments at the outpatient clinics of the hospital. Queue analysis was performed to determine the operational characteristics using a queue scenario with Poisson arrival, exponential service, infinite population, First Comes First Served (FCFS) discipline and multiple server arrangement. The study showed that the patients’ arrival rate highly exceeded the service rate, in each respective clinical department. The outpatient clinics at the SPHMMC achieved an average total waiting time of 92 minutes to get consultation and nearly 70% of the patients waited for more than 95 minutes. The consultation time was as low as 5.71 minute at the Medical clinic and 6.16 minute at the Ophthalmology clinic and around 60% of the patients saw the doctor for a time less than 10 minutes. Therefore, this research recommends addressing the gaps in human resources and logistical supplies, to implement and enforce a staggered patient scheduling and appointment system and to have serious intervention and control on the dual practice, to ensure a smooth clinic process and to reduce waiting times

Essays on Welfare, Demand and Resilience to Food Insecurity in Rural Ethiopia

I prezzi dei generi alimentari sono cresciuti in modo considerevole in Etiopia a partire dal 2004. Questa tesi esamina a fondo gli effetti distributivi degli alti prezzi dei generi alimentari nelle zone rurali dell’Etiopia. Utilizzando il Rapporto di Beneficio Netto non parametrico ed il Sistema Quadratico di Domanda Quasi Ideale nonché stimando la Variazione Compensata, dimostra come gli alti prezzi dei generi alimentari possano avere effetti positivi sul benessere sociale delle famiglie rurali a livello aggregato. Tuttavia, i guadagni non sono distribuiti uniformemente tra le famiglie; una significativa percentuale di esse sono compratrici nette di cereali e potrebbero essere sfavorite da un aumento dei prezzi dei cereali qualora non beneficiassero di un aumento del reddito associato ad attività diverse dall’agricoltura. Teoreticamente, le famiglie rurali dovrebbero beneficiare di un aumento del prezzo dei generi alimentari poiché sono sia produttori sia consumatori dei prodotti. Un aumento della produttività agricola, attraverso l’intensificazione e la diversificazione delle produzioni, è un’importante strumento di politica economica che può limitare gli effetti negativi, di breve e di lungo periodo, sugli acquirenti netti rurali di generi alimentari derivanti da un aumento del loro prezzo. La tesi esamina anche la resilienza alla mancanza di cibo, la stagionalità nel consumo del cibo e la partecipazione nel mercato così come il ruolo dei trasferimenti monetari e delle preferenze dei beneficiari degli stessi.Food prices in Ethiopia considerably rose since 2004. This thesis thoroughly examines the distributional impacts of high food prices in rural Ethiopia. Using the non-parametric Net Benefit Ratio analysis as well as Quadratic Almost Ideal Demand System and estimating Compensated Variation, it shows high food prices have positive impact on the welfare of rural households at aggregate levels. The gains, however, are not evenly distributed among households; large proportion of them are net cereal buyers (major staples) and could be adversely affected by rising cereal prices unless compensated by increase in income from off-farm activities. Theoretically, rural households should benefit from rising food prices as they are both consumers and producers of the products. Promoting agricultural productivity, through intensification and diversification, is an important policy tool to overcome short and long-run negative impacts of high food prices on rural net buyers. It also examines resilience to food insecurity, food consumption seasonality and market participation as well as cash transfers and beneficiaries preferences

Building sustainable resilience for food security and livelihood dynamics: The case of rural farming households in Ethiopia

Building sustainable resilience for food security and livelihood dynamics is explored using the Ethiopia Rural Household Survey panel data. Household resilience scores are derived from measures taken to protect against shocks. The impact of several demographic and socio-economic factors on resilience dynamics is then tested. The result shows that the experience of resilience in the past leads to a subsequent higher chance of continuing to be resilient (‘true state-dependence’). It also demonstrates that measures that promote asset creation, diversified enterprises and access to improved technologies are positively and significantly correlated with dynamics of building resilience for food security.JRC.D.5-Food Securit

Climate Variability and Farmers' Perception in Southern Ethiopia

The study aims to analyze climate variability and farmers' perception in Southern Ethiopia. Gridded annual temperature and precipitation data were obtained from the National Meteorological Agency (NMA) of Ethiopia for the period between 1983 and 2014. Using a multistage sampling technique, 403 farm households were surveyed to substantiate farmers' perceptions about climate variability and change. The study applied a nonparametric Sen's slope estimator and Mann–Kendall's trend tests to detect the magnitude and statistical significance of climate variability and binary logit regression model to find factors influencing farm households' perceptions about climate variability over three agroecological zones (AEZs). The trend analysis reveals that positive trends were observed in the annual maximum temperature, 0.02°C/year (p<0.01) in the lowland and 0.04°C/year (p<0.01) in the highland AEZs. The positive trend in annual minimum temperature was consistent in all AEZs and significant (p<0.01). An upward trend in the annual total rainfall (10 mm/year) (p<0.05) was recorded in the midland AEZ. Over 60% of farmers have perceived increasing temperature and decreasing rainfall in all AEZs. However, farmers' perception about rainfall in the midland AEZ contradicts with meteorological analysis. Results from the binary logit model inform that farmers' climate change perceptions are significantly influenced by their access to climate and market information, agroecology, education, agricultural input, and village market distance. Based on these results, it is recommended to enhance farm households' capacity by providing timely weather and climate information along with institutional actions such as agricultural extension services

"Trends in Extreme Climate Events over Three Agroecological Zones of Southern Ethiopia,"

The study aims to assess trends in extremes of surface temperature and precipitation through the application of the World Meteorological Organization's (WMO) Expert Team on Climate Change Detection and Indices (ETCCDI) on datasets representing three agroecological zones in Southern Ethiopia. The indices are applied to daily temperature and precipitation data. Nonparametric Sen's slope estimator and Mann–Kendall's trend tests are used to detect the magnitude and statistical significance of changes in extreme climate, respectively. All agroecological zones (AEZs) have experienced both positive and negative trends of change in temperature extremes. Over three decades, warmest days, warmest nights, and coldest nights have shown significantly increasing trends except in the midland AEZ where warmest days decreased by 0.017°C/year (p<0.05). Temperature extreme's magnitude of change is higher in the highland AEZ and lower in the midland AEZ. The trend in the daily temperature range shows statistically significant decrease across AEZs (p<0.05). A decreasing trend in the cold spell duration indicator was observed in all AEZs, and the magnitude of change is 0.667 days/year in lowland (p<0.001), 2.259 days/year in midland, and 1 day/year in highland (p<0.05). On the contrary, the number of very wet days revealed a positive trend both in the midland and highland AEZs (p<0.05). Overall, it is observed that warm extremes are increasing while cold extremes are decreasing, suggesting considerable changes in the AEZs

Household food insecurity and its association with school absenteeism among primary school adolescents in Jimma zone, Ethiopia

Abstract Background Household food insecurity and lack of education are two of the most remarkable deprivations which developing countries are currently experiencing. Evidences from different studies showed that health and nutrition problems are major barriers to educational access and achievement in low-income countries which poses a serious challenge on effort towards the achieving Sustainable Development Goals. Evidence on the link between food security and school attendance is very important to address this challenge. This study aimed to assess to what extent food insecurity affects school absenteeism among primary school adolescents. Methods A school based cross-sectional study was conducted among primary school adolescents in Jimma zone from October-November, 2013. Structured questionnaire was used to collect data on the household food security and socio-demographic variables. Data were analyzed using SPSS for windows version 16.0 after checking for missing values and outliers. Multivariable logistic regression analyses were used to determine the association of school absenteeism and food insecurity with independent variables using odds ratio and 95 % of confidence intervals. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression analysis to control for associations among the independent variables. Results The frequency of adolescent school absenteeism was significantly high (50.20 %) among food insecure households (P < 0.001) compared to their peers whose households were food secure (37.89 %). Findings of multivariable logistic regression analysis also showed that household food insecurity [AOR = 2.81 (1.70, 4.76)] was positively associated with poor school attendance while female-headed household [AOR = 0.23 (0.07, 0.72)], urban residence [AOR = 0.52 (0.36, 0.81)] and male-gender [AOR = 0.64 (0.54, 0.74)] were inversely associated with school absenteeism. Household food insecurity was positively associated with lack of maternal education [AOR = 2.26 (0.57, 8.93)] and poor household economic status [AOR = 1.39 (1.18, 2.83)]. However, livestock ownership [AOR = 0.17 (0.06, 0.51)] was negatively associated with household food insecurity. Conclusions Findings of this study showed that household food insecurity has strong linkage with adolescent school absenteeism. Maternal education and household economic status were significantly associated with household food security status. Therefore, national policies and programs need to stress on how to improve family income earning capacity and socioeconomic status to handle household food insecurity which is a key contributor of adolescent school absenteeism

Enhancing personal hygiene behavior and competency of elementary school adolescents through peer-led approach and school-friendly: a quasi-experimental study

Background: Recent studies showed that poor personal hygiene practices play a major role in the increment of communicable disease burden in developing countries. In Ethiopia, 60% of the disease burden is related to poor sanitation practices. This school based study was aimed to assess the effectiveness of school-friendly and peer-led approach in improving personal hygiene practices of school adolescents in Jimma Zone, Southwest of Ethiopia.Methods: A total of 1000 students from 10 to 19 years were included into the study. The intervention was done using peer-led approach, health clubs and linking the school events with parents. Data were collected at baseline, midline and end-line using structured questionnaires. Repeated measurement analysis was done and statistical significance was considered at alpha 0.05.Results: The findings of this study indicated that there was a significant difference in personal hygiene practices and knowledge between the intervention and control groups (P&lt;0.001). A significant difference was also observed with the duration of time in the intervention schools (P&lt;0.05). The proportion of adolescents who reported illness before the baseline survey was significantly high among the intervention schools (P&lt;0.01). However, at midline of the survey, the proportion of self-reported illness was significantly high among the control group(P&lt;0.001).Conclusion: The findings of this study showed that there was a significant improvement in personal hygiene knowledge and practice of students in the intervention schools. Therefore, there is a need for proper health education intervention through the framework of schools for the students to improve their personal hygiene knowledge and practices.Keywords: Hygiene, School, Knowledge, Attitude, Jimm

Global analysis of food and nutrition security situation in food crisis hotspots

This report provides a global overview of food insecurity due to different crises and natural disasters to support programming of the Pro-resilience Actions (PRO-ACT) funding mechanism, a component of the Global Public Goods and Challenges (GPGC) thematic programme of the European Union. The analysis covers the period January 2015-January 2016 that has been marked by food crises in several countries because of extreme weather events due the El Niño phenomenon but also because of conflicts and political crises. In a number of countries, in particular in West Africa, food insecurity remains a major concern because of chronic vulnerability despite good crop production in 2015.JRC.H.4-Monitoring Agricultural Resource

Assessing the use of acute malnutrition indicators for nutrition surveillance: Results from 682 283 child observations in 27 low- and middle-income countries

Surveillance with anthropometric indicators is crucial to detect any deterioration in the nutritional status of a population as it provides information on trends to monitor progress and effectiveness of interventions and facilitates geographical and contextual situation analysis which informs prioritization of actions and allocation of resources. For this purposes it is essential that the indicators used to monitor the situation yield comparable results. However, the two indicators most widely used to identify children´s acute malnutrition (AM), the weight-for-height/length Z-score (WHZ) and the absolute value of mid-upper arm circumference (MUAC) provide discrepant results when applied to the same populations. The aim of this report is to shed light on the relationships between WHZ and MUAC in identifying possible population level patterns of acute malnutrition, and explore how they relate to individual characteristics such as sex, age or stunting status, in order to guide their interpretation and use to inform nutrition interventions. The MUAC for age (MUACZ) is also assessed to explore further possibilities of using this indicator as part of population based surveillance taking into account the age bias that exists when assessing children for acute malnutrition using absolute MUAC measurement only. The JRC-UNICEF collaboration was set up to collate, harmonise and analyse a large dataset composed of surveys from 19 West and 7 East African countries and Yemen. In total, 135 national and subnational representative surveys containing 682,283 child observations from 27countries (2011-2018) were collated. We use descriptive statistics and regression analyses to analyse these data. The findings show that WHZ and MUAC measurements identify different manifestations of acute malnutrition and are thus complementary and additive, rather than alternative or exchangeable. Overall and in most of the countries the global acute malnutrition prevalence was lower when using MUAC as compared to WHZ or MUACZ. However, results at country and regional level differed from findings described in other multi-country studies, suggesting that the relationship between the indicators doesn´t follow a geographical pattern (no regional or country pattern can be identified), but rather depend on the sample characteristics of the population surveyed. Importantly, sex, age, and stunting status were confirmed to impact how children are diagnosed as acutely malnourished by the different indicators. Whereas absolute MUAC consistently identifies more acutely malnourished children in younger age groups (below 2 years), MUAC for age (MUACZ) identifies more acute malnutrition in older children. And in relation to the sex of the child, depending on the indicator, the prevalence of acute malnutrition is higher among girls (MUAC) or among boys (WHZ and MUACZ). Conversely, acute malnutrition was consistently higher among stunted children (compared to non-stunted children) across the three indicators, although MUACZ invariably identified the highest number of AM children within the stunted children, as compared to MUAC and WHZ. Finally, these discrepancies can result in discordant situation analysis if the same severity thresholds are applied to all AM population estimates, independently of the indicator used. At the time being, the only global thresholds prescribed to categorize the severity of AM within populations are the ones defined by WHO for wasting based on WHZ. In conclusion, the recommendation is to always specify the indicator used to diagnose acute malnutrition when reporting nutrition outcomes, as well as to disaggregate results by sex, age (below and at/above 24 months) and stunting status for better interpretation. The use of MUAC for age showed potential to improve estimation of acute malnutrition for surveillance but requires additional research. Also, further investigations are needed to define global thresholds to describe severity of acute malnutrition at population level when using the different indicators. Alternatively, to reconsider the age targeting of surveys to 0-23 months, in line with 1000 days programming, and to develop population threholds specific of this age group. Meanwhile, the WHO population based thresholds to interpret the severity of global acute malnutrition for children under five years should be used exclusively for WHZ, and for the acute malnutrition derived from absolute MUAC we recommend to use alternative methods such as the one developed by the Integrated Food Security Phase Classification initiative.S

Cereals Availability Study in Ethiopia, 2008

Unusual changes in grain markets have been the source of major concerns for the Government of Ethiopia and its development partners. Increase in cereal price presented serious challenges to the implementation of country’s food security programs. Local procurement of food by the WFP declined also in the recent years. Being one of the largest donors of local procurement of food, the European Union was particularly concerned about these developments. Thus, as a General Directorate in charge of supporting EU policies, the Joint Research Centre (JRC) of the EU developed the technical specification of a project to extend the scope of the usual Cereal Availability Study (CAS) in order to account for the developments in the Ethiopian cereal markets. International Food Policy Research Institute (IFPRI) consortium with the Ethiopian Development Research Institute (EDRI) and the Ethiopian Institute of Agricultural Research (EIAR) was selected to carry out the study. A number of preliminary analyses, undertaken by the World Bank and IFPRI had put forward a number of hypotheses to explain unusual high cereal prices. While the different hypotheses were widely debated in the country, there is limited primary information to validate or refute them. It is in this context that the current study was undertaken. The focus has been mainly on achieving the following objectives: • To gather information regarding recent changes in cereal production, storage, and marketing patterns in order to test the hypotheses that have been proposed to explain the high price of cereals in Ethiopian markets. • To improve the general methodology of the past cereal availability studies. • To estimate the quantity of maize, sorghum, and wheat that can be procured from domestic markets in the 2008 for relief purposes without disturbing the local market. Implementation of the study was carried out in three broad stages. The first stage involved an overview of cereal availability methods and a consultation for determining the survey / sampling methods. Three surveys were conducted in the second stage, namely, a household survey, a traders’ survey, and a rapid assessment of cross border trade. At third stage, results from the surveys, and some secondary data, have been used to develop a spatial equilibrium multi-market model (ESGMM) to analyze policy impacts of various policy interventions. The results were presented in a final workshop held in the United Nations’ Economic Commission for Africa in Addis Ababa on December 5, 2008.JRC.H.4-Monitoring Agricultural Resource