Factors Associated with Client Satisfaction with Institutional Delivery Care at Public Health Facilities in South Ethiopia

Background: Ethiopia has one of the world’s highest maternal death rates. Client satisfaction is a dynamic indicator of quality of delivery care services. However, little is known about the factors that contribute to client satisfaction in this setting. Objective: To assess client satisfaction with institutional delivery in women attending for delivery at public health facilities in South EthiopiaMethods: A quantitative and qualitative cross-sectional study was conducted. Sixteen health facilities (one hospital and 15 health centers) were included in the study: a total of 380 mothers were interviewed when discharged. Consecutive sampling was employed to obtain the required sample size. Trained nurses collected the quantitative data, and the principal investigator collected qualitative data from focus groups. Data were coded, entered, cleaned, and analyzed using binary logistic and multivariable logistic regression analyses to identify predictors of client satisfaction. Qualitative data were analyzed according to themes and triangulated with the quantitative data. Result: Overall, 67.9% of clients were satisfied with delivery care in public health facilities in the study zone. Satisfaction varied from 23.4% in the technical dimension to 76.1% in outcomes of care. Predictors of satisfaction were: the presence of an attendant throughout delivery (AOR=2.18; 95% CIs 1.23-3.85), being informed about the baby following neonatal examination (3.22; 1.85-5.62), being prepared for labor and delivery (3.53 1.81-6.89), and care taken to assure privacy (3.07; 1.70-5.52). Qualitative data revealed a range of client satisfaction from perceiving warm, courteous, and respectful care to expressing grievances about being insulted, embarrassed, and even beaten by care providers. Conclusion and recommendations: Physical, interpersonal, and technical aspects of care influence client satisfaction with delivery care services. Healthcare providers should address problems related to physical, technical, and intrapersonal aspects of care and develop friendly and courteous relationships with clients and cleaner environments to escalate satisfaction, and hence utilization, of services by clients. Keywords: Client satisfaction, delivery services, South Ethiopi

Global, regional, and national mortality due to unintentional carbon monoxide poisoning, 2000–2021: results from the Global Burden of Disease Study 2021

Background Unintentional carbon monoxide poisoning is a largely preventable cause of death that has received insufficient attention. We aimed to conduct a comprehensive global analysis of the demographic, temporal, and geographical patterns of fatal unintentional carbon monoxide poisoning from 2000 to 2021. Methods As part of the latest Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), unintentional carbon monoxide poisoning mortality was quantified using the GBD cause of death ensemble modelling strategy. Vital registration data and covariates with an epidemiological link to unintentional carbon monoxide poisoning informed the estimates of death counts and mortality rates for all locations, sexes, ages, and years included in the GBD. Years of life lost (YLLs) were estimated by multiplying deaths by remaining standard life expectancy at age of death. Population attributable fractions (PAFs) for unintentional carbon monoxide poisoning deaths due to occupational injuries and high alcohol use were estimated. Findings In 2021, the global mortality rate due to unintentional carbon monoxide poisoning was 0·366 per 100 000 (95% uncertainty interval 0·276–0·415), with 28 900 deaths (21 700–32 800) and 1·18 million YLLs (0·886–1·35) across all ages. Nearly 70% of deaths occurred in males (20 100 [15 800–24 000]), and the 50–54-year age group had the largest number of deaths (2210 [1660–2590]). The highest mortality rate was in those aged 85 years or older with 1·96 deaths (1·38–2·32) per 100 000. Eastern Europe had the highest age-standardised mortality rate at 2·12 deaths (1·98–2·30) per 100 000. Globally, there was a 53·5% (46·2–63·7) decrease in the age-standardised mortality rate from 2000 to 2021, although this decline was not uniform across regions. The overall PAFs for occupational injuries and high alcohol use were 13·6% (11·9–16·0) and 3·5% (1·4–6·2), respectively. Interpretation Improvements in unintentional carbon monoxide poisoning mortality rates have been inconsistent across regions and over time since 2000. Given that unintentional carbon monoxide poisoning is almost entirely preventable, policy-level interventions that lower the risk of carbon monoxide poisoning events should be prioritised, such as those that increase access to improved heating and cooking devices, reduce carbon monoxide emissions from generators, and mandate use of carbon monoxide alarms.publishedVersio

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg

Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background. Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area. Objectives. The aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods. A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014–September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. The collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data. Results. A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD = 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6–10 postoperative days. The majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation. Conclusion. The current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate

Determinants of birth asphyxia among neonates admitted to neonatal intensive care units in hospitals of the Wolaita zone, Southern Ethiopia: A case-control study

Background: Birth asphyxia, according to the World Health Organization (WHO), is the inability of breathing to start and continue automatically at birth. Blood-gas exchange is impaired, which results in increased hypoxia, hyperapnea, and substantial metabolic acidosis. The aim of this study was to determine the factors contributing to birth asphyxia in infants admitted to neonatal intensive care units in hospitals in the Wolaita Zone. Methods: An institution-based, unmatched case-control study among neonates admitted to neonatal intensive care units in Wolaita Zone hospitals was conducted from March 1 to April 15, 2021. With 148 cases and 294 controls and a case-to- control ratio of 1:2, a sample size of 442 was determined. The pre-tested and structured Open Data Kit collect mobile application (v1.26.1) was used to collect the data, and SPSS version 25 was used for analysis. Using adjusted odd ratios and their corresponding 95 % confidence intervals, bivariate and multivariable logistic regression analyzes were performed. Results: A total of 143 cases and 286 controls were included making. the response rate 97 %. Meconium or blood-stained amniotic fluid (AOR = 5.43, 95%CI:3.10–9.50), mothers who experienced any of dangerous symptom during pregnancy (AOR = 3.71, 95%CI: 1.56–8.65), premature rupture of membrane (AOR = 3.12, 95%CI: 1.42–6.83), hypothermic newborn (AOR = 4.57, 95CI: 1.77–11.81), labor not supported by Basic Emergency Obstetric and Neonatal Care (BEMONC) trained health professional (AOR = 3.23, 95%CI: 1.83–5.71), birth weight of less than 2500 gm (AOR = 2.68, 95%CI: 1.04-6.92), sub-standard filling of partograph (AOR = 4.03, 95%CI: 2.19–7.41), not filling on partograph during follow-up (AOR = 8.16, 95%CI: 2.24-29.66) and assisted vaginal delivery (AOR = 1.87, 95%CI:1.03–3.39) were identified as determinants of birth asphyxia. Conclusion: In this study, fetal conditions such as hypothermia and low birth weight, changes in the color of amniotic fluid, dangerous pregnancy symptoms, membrane rupture, standard filling of the partograph, and BEMONC training were factors that predicted birth asphyxia. Therefore, prompt and effective management of fetal and maternal problems and as well as the development of health professionals' BEMONC competence are crucial

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones.A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively.Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery.The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization

Client satisfaction with antiretroviral treatment services in South Ethiopian public health facilities: an institution-based cross-sectional survey

Background HIV/AIDS remains the leading cause of morbidity and mortality worldwide. Moreover, sub-Saharan countries, including Ethiopia, are highly affected by HIV/AIDS pandemic. Ethiopia’s government has been working on a comprehensive HIV care and treatment programme, including antiretroviral therapy. However, evaluating client satisfaction with antiretroviral treatment services is not well studied. Objectives This study aimed to assess client satisfaction and associated factors with antiretroviral treatment services provided at public health facilities of Wolaita zone, South Ethiopia. Methods A facility-based cross-sectional study involved 605 randomly selected clients using ART services from six public health facilities in Southern Ethiopia. A multivariate regression model was used to see an association between independent variables and the outcome variable. The odds ratio with 95% CI was computed to determine the presence and strength of the association. Results Four hundred twenty-eight (70.7%) clients were satisfied with an overall antiretroviral treatment service, which included significant variations ranging from 21.1% to 90.0% among health facilities. Sex [AOR = 1.91; 95% CI = 1.10–3.29], employment [AOR = 13.04; 95% CI = 4.34–39.22], clients’ perception of the availability of prescribed laboratory services [AOR = 2.56; 95% CI = 1.42–4.63], availability of prescribed drugs [AOR = 6.26; 95% CI = 3.40–11.52] and cleanliness of toilet in the facility [AOR = 2.83; 95% CI = 1.56–5.14] were factors associated with client satisfaction with antiretroviral treatment services. Conclusion The overall client satisfaction with antiretroviral treatment service was lower than the national target of 85%, with a marked difference among facilities. Sex, occupational status, availability of comprehensive laboratory services, standard drugs, and cleanliness toilets in the facility were factors associated with client satisfaction with antiretroviral treatment services. Sex-sensitive services needed to address and sustained availability of laboratory services and medicine recommended

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

Abstract Background Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. Methods We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles’ quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. Results We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants’ homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. Conclusion To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements

Health service utilization of study participants, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.

<p>Health service utilization of study participants, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.</p