Improving health care services through enhanced Health Information System: Human capacity development Model

AbstractBackground: Quality of health care depends on how the health system is able to reduce errors through evidence-based decisions. Demand for data on patient care has increased over the years to improve the health care system, including planning and policy issues in several countries across the globe. However, there are challenges and opportunities in the process of recording, managing, analyzing, interpreting, and reporting data and/or information. Accordingly, several studies showed that an appropriate capacity development program is expected to improve data recording, data quality and use by professionals, planners, policymakers, and stakeholders.Objective: This project aims to assess existing capacity-building efforts and formulate a new and better capacity-building model for the lower-level health facility staff of Addis ababa City administration, 2018-2020.Methods: PRISM and SWOT analysis method were employed to assess existing HIS gaps and opportunities. The assessment was carried out in the health centers located in selected three sub-cities of Addis Ababa City Administration. We employed phase to phase approach to design an innovative human capacity development model, namely, desk review, data collection, data synthesis, design, and validation.Results: The project designed interventions that were implemented simultaneously and one supporting the other. The capacity-building model includes a renewed approach to training; structured mentorship approach; practically oriented supportive supervision; ‘experience sharing program’ for helping those in a poor environment gain experience through experience sharing; quality improvement initiatives; and implementation science studies to tackle problems that may not be solved with activities listed earlier.Conclusion and recommendation: The new capacity-building approach helped to improve individual knowledge, interpersonal relationship, strategic thinking, system management, and accountability, all of which lead to sustained and improved HIS. Improvement in HIS is often a collective effort of several forces, but the human element plays a decisive role. [Ethiop. J. Health Dev. 2021; 35(SI-1):42-49]Keywords: Human Capacity Development Model, Health Information Systems, Quality of health care, data quality, Information us

Estimation of stature by anatomical anthropometric parameters in first-year regular undergraduate students at Debre Markos University, North West Ethiopia

Introduction: The stature of an individual is an inherent characteristic and is considered as an important parameter of personal identification. Estimating stature from the measurement of various body parts is of particular interest to forensic scientists, anatomists and medical researchers in order to complete biological profiles after death or when measuring standing height is impossible. However, establishing the identity of an individual from mutilated, decomposed and amputated body fragments is a challenging task in medico-legal cases, and a necessity when measuring standing height is difficult.Objectives of the study: To assess the relationship between anatomical anthropometric measurements and stature in undergraduate students at Debre Markos University (DMU), Ethiopia.Materials and Methods: An institutional-based, cross-sectional, prospective study was conducted among first-year undergraduate students at DMU. The sample size was 572 and data were collected from April to June 2018. Height, weight, head circumference, head length, inter-acromial length, humeral length, ulnar length, hand length and breadth, tibial length, and foot length and breadth were measured in both sexes. The data were analyzed using SPSS version 25 statistical software. The level of significance was set at p<0.05.Results: The mean age of study participants was 21.27±1.74 years for males and 20.41±1.58 years for females. The mean height of study participants was 168.36±5.89cm for males and 165.24±4.01cm for females. The correlation coefficients (R) of anatomical anthropometric measurements with height were: head circumference (males R = 0.404, females R = 0.127), head length (males R = 0.422, females R = 0.168), inter-acromial length (males R = 0.530, females R = 0.140), right humeral length (males R = 0.539, females R = 0.163), left humeral length (males R = 0.535, females R = 0.159), right ulnar length (males R = 0.496, females R = 0.147), left ulnar length (males R = 0.498, females R = 0.144), right hand length (males R = 0.276, females R = 0.125), left hand length (males R = 0.243, females R = 0.122), right hand breadth (males R = 0.349, females R = 0.129), left hand breadth (males R = 0.331, females R = 0.124), right tibial length (males R = 0.634, females R = 0.259), left tibial length (males R = 0.632, females R = 0.258), right foot length (males R = 0.579, females R = 0.185), left foot length (males R = 0.581, females R = 0.186), right foot breadth (males R = 0.311), left foot breadth (males R = 0.306). The highest correlation was found in the right tibial length in both males and females. Conclusions: All anatomical anthropometric parameters were significantly (p<0.05) correlated with height in both sexes, except foot breadth in females. Therefore, all anatomical anthropometric parameters, including head circumference, head length, inter-acromial length, humeral length, ulnar length, hand length, hand breadth, tibial length, foot length and foot breadth, can estimate stature in both sexes, except foot breadth in females. Ethiop. J. Health Dev. 2019; 33(3):188-197]Key words: Estimation of stature, anthropometry, anatomical anthropometric parameter

Cell mean versus best linear unbiased predictors in Biplot analysis of genotype × environment interaction in Barley

In multi-environment trials, accurate estimation of yields in individual environments and astute choice of models to extract and display gronomically relevant signals enhance genotype evaluation and accelerate breeding progress. The objective of this study is to (i) compare patterns of genotype × environment interaction (GE) using additive main effect and multiplicative interaction (AMMI) biplots arising from cell means versus best linear unbiased predictors (BLUPs), and (ii) examine some features of the genotype main effect plus GE interaction (GGE) in relation to AMMI in comprehending the GE patterns. A data set generated from 39 barley genotypes grown in 18 environments (three sowing dates and two crop protection treatments over three years) in the central highlands of Ethiopia was used. AMMI analysis of variance based on cell means depicted the first five principal components (PCs) to be significant. However, only the first two PCs were significant when BLUPs were used. Partitioning of the original GE sum of squares into signal and noise confirmed that only the first two AMMI PCs contained signals required to explain the real GE pattern. AMMI PC1 contained 76.5% and AMMI PC2 15.9% of the total GE variance. AMMI biplot based on BLUPs depicted patterns that were more in tandem with agronomic interpretations than biplot based on cell mean data. PC1 of GGE contained 66.9%, PC2 11.2% and PC3 14.5% of the total GE variance. AMMI2 explained as much GE variance as PC1, PC2 and PC3 of GGE put together. AMMI2 biplot depicted a GE pattern that was not obvious from GGE2. AMMI2 biplot was more similar to GGE PC1 versus PC3 biplot than GGE2 biplot. AMMI2 was more efficient than GGE2 for displaying patterns of GE interaction in this data set. However, GGE2 was quite elegant and simple for presenting G and GE combined in a biplot graph including the which-wonwhere pattern. BLUPs might improve yield estimation and pattern recognition, and that attempting both AMMI and GGE analysis might provide important insights on genotype performance and GE

Investigating the nature of GxE interaction under different management systems and yield levels using linear-bilinear models: The case of CIMMYT maize hybrids trials in Eastern Africa

The International Center for Maize and Wheat Improvement(CIMMYT) conducts selection of stress-tolerant genotypes under managed stress conditions. Data sets for this study were from Intermediate to Late Hybrid Trials (ILHT) conducted in five Eastern and Central Africa (ECA) countries from 2008 to 2011. Several trials, which were categorized into four management systems and two yield levels were used for this study. Variance Components, broad sense heritability (H), Site Regression (SREG), Genotypic Regression (GREG) and Factor Analytic (FA) models were fitted. We argue that it is preferable to first fit the fixed effect models before proceeding to the mixed effect model, as the former shows the level of complexity of the GE component and the number of axes required to explain it. The fixed effect model, SREG2, is preferable for trials targeting comparison of hybrids with checks. From the GGE biplots it was noted that the first two principale components (PC) did not account for sufficient percentage of variation for all years. Nevertheless, since PC1 accounted for large percentage of variation than PC2, the plot gives some idea of which hybrids won where. Most importantly, location of genotypes along PC1 can serve for judging yielding potential of the genotypes to guide in selection decision. Equivalence between Finlay - Wilkinson and GREG was established. The few environmental covariables obtained for 2009 were used to fit Partial Least Square (PLS) regression. The result indicated complexity in the GE component, as PLS latent factors accounted for small percentage of variation. It was recommended to use information from SREG2, GREG2 and FA(1) models in order to identify stable genotypes.Keywords: AMMI, Biplot, Factor Analytic Model, GREG, Mixed Effect Model, SREG, Stability

Reducing Nitrate Pollution By Redirecting Farm Runoff Into The Subsurface Of An Herbaceous Riparian Buffer Zone.

In areas dominated by agricultural land use, excess nitrate is one of the leading contributors to water pollution. Tile drains, installed to drain crop root zones for maximum yield, fast track the introduction of nitrate-laden water into a nearby stream. Due to the risks elevated levels of nitrate pose to an ecosystem and its inhabitants, the following project explores a method of reducing nitrate pollution. One that can do it as close to the source of the pollution as possible. A tile draining a 60acre farm in central Illinois was redirected to discharge its contents through subsurface flow into an herbaceous riparian buffer zone (RBZ) located immediately below the farm. A transect of nested observation wells were installed across the riparian buffer intersecting the redirected subsurface tiles. A study on the groundwater and soils was performed to determine the ability the RBZ has for nitrate reduction/removal. Prior to redirecting tile water into the RBZ, chemical analysis of the RBZ water showed low concentrations of NO3-–N (≤5mg/L). The conditions necessary for the reduction/removal of nitrate, such as low levels of dissolved oxygen, dissolved organic carbon, and organic matter in the soils, and groundwater temperature were also investigated. A statistical comparison of the concentration of NO3-–N at the wells (effluent) vs the diversion box (influent) shows that the waters are significantly different (p\u3c0.0001). Concentrations measured in the diversion box leading to the riparian buffer averaged 13.6 mg/L. Once this water had entered the riparian buffer however, the average concentration registered was lower than 1mg/L; a 94%reduction in the RBZ. The factors responsible for this reduction/removal such as dilution and denitrification are explored as well as any seasonal trends in nitrate removal

The Effects of leadership style on Organizational Commitment: The Mediating Role of Job Satisfaction, In Case of Oromia Forest and Wild Life Enterprise

The purpose of the present study was to investigate effects of Leadership style on Organizational commitment with the mediated role of satisfaction .Data was gathered by closed ended questionnaires distributed to five OFWEL’s in oromia. The scales used were the Multifactor Leadership Questionnaire, MLQ, the Job Satisfaction Survey, JSS and the Organizational Commitment Questionnaire, OCQ. The study population consisted permanent employees of OFWE’s and 315 employees were selected by simple random sample. After processing and modifying the data, only 309 respondents used as the main resources analyzed by using Structural Equation Model (SEM). Confirmatory factor analysis using structural equation modeling (SEM) has been employed as a statistical tool to validate these interdependence relationships. Confirmatory Factor Analysis (CFA) would be used to estimate the adequacy of the measurement model for each construct. Some of the results were according to the expectation after theory examination, but others were surprisingly contradictive. Transformational leadership had a direct and indirect effect on organizational commitment. Leadership style had positive indirect effects on organizational commitment. Based on the result of this research it is recommended that transformational leadership style should be practiced in OFWEs to gain satisfied and committed employees. The findings of the study are expected to provide a source of information for policy makers, researchers and human resources professionals to understand link between organizational cultures, leadership style on organizational commitment, with mediating role of job satisfaction in OFWEL’s &nbsp

A monitoring and evaluation framework to assess the performance of innovation platforms in the context of livestock value chains

Growing local and informal markets in Asia and Africa provide both challenges and opportunities for small holders. In developing countries, market failures often lead to suboptimal performance of the value chains and limited and inequitable participation of the poor. In recent years, innovation platforms have been promoted as mechanisms to stimulate and support multistakeholder collaboration in the context of research for development. They are recognized as having the potential to link value chain actors, and enhance communication and collaboration to overcome market failures. Despite the increased use of innovation platforms in research for development projects and programs, a monitoring and evaluation framework that encompasses the dynamic nature of innovation systems and value chains is not available. In this paper, the authors aim to develop a monitoring and evaluation framework for understanding and assessing the performance of innovation platforms in the context of pro-poor value chains, based on a discussion of various approaches

Perceived barriers to health care for residents in vulnerable urban centers of Ethiopia

Background: Slums in urban settings are fast expanding and unprecedented proportions of urbanites are now living in slums, with the compromised provision of health services. Slum-dwellers in urban settings often face multifaceted barriers to accessing available health services. There is a paucity of evidence on identifying barriers in vulnerable urban centers of Ethiopia. This study aims to explore the barriers to the use of health services in slum urban settings of Ethiopia. Methodology: A qualitative study using in-depth and key informant interviews were conducted in 13 selected John Snow, Inc. (JSI) program operational urban areas of Ethiopia. Data were collected from community members, community opinion leaders, Urban Health Extension Professionals, and urban area health office representatives. The interviews were transcribed by data collectors and analyzed using a thematic content analysis approach. Accordingly, individuals, community- and health facility-level barriers were key themes under which findings were categorized. Results: Findings revealed that barriers to health service use at the individual level include limited awareness about health problems, competing priorities and limited capacity to pay for services when referred. Institutional-level barriers include limited medical supplies, and a lack of passion, respect, and positive attitudes on the part of health service providers. Barriers at the community level include a lack of shared understanding of the problems, services, and the community’s established values in relation to the problems and services. Conclusions: The provision of (maternal) health services in slums in Ethiopia’s urban settings is affected by different barriers that work in tandem. The improvement of health service provision in slum settings requires multiple interventions, including strengthening the health system’s responsiveness to health care demand. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):04-11] Keywords: Barriers, slum sections of urban centers, community, service provider

Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study

Introduction: Although Ethiopia is one of the least urbanized countries in the world, the pace at which urbanization increases is unprecedented. During the last twenty years, urbanization has expanded rapidly and is estimated to be at 38% in 2050 from the current proportion of 19%. Despite the fact that urbanization is associated with relatively, better access to social services including health, residents in urban setting are believed to suffer from health disparities in health indicators such as use of Antenatal care (ANC), institutional delivery and postpartum care (PNC). This study aims to identify reasons why urban women fail to use available maternal health services in selected urban settings in Ethiopia.Methods: A qualitative study using focus group discussions and in-depth interview was conducted in six purposively selected urban settings such as Adama, Dire Dawa, Hawassa, Debre Berhan, Gondar, and Mekelle. A total of 11 Focus Group Discussions and 40 in-depth-interviews were completed with residents of these urban settings who were living in the section of urban setting characterized as slum. The data collected were categorized in to themes and analyzed using thematic method.Results: Study participants anonymously argued that there are positive changes in maternal health service utilization in all study settings over the years. However, students, daily laborers, widows, divorced and separated women, commercial sex workers, house maids, and migrants were found to be reluctant in using maternal health services such ANC follow-up, institutional delivery and PNC. Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community level in connection with pregnancy, delivery and postpartum.Conclusion: Although service utilization in urban setting is believed to have been relatively better over the years, still women in urban settings do not use available maternal health services. Especially women living in slum areas tend to neglect use of available health services. This study suggests that blanket programmatic approach should give way to intervention that target specific section of population. Furthermore, programs are expected to be tailored to addresses individual, institutional and socio-cultural factors in tandem to improve maternal health service utilization in urban setting. [Ethiop. J. Health Dev. 2017;31(2):96-102]Keywords: Maternal Health Services, Urban Health, Social Determinant of Health, Ethiopi

Health service access, utilization and prevailing health problems in the urban vulnerable sections of Ethiopia

Background: Currently, one-third of urban residents in Africa and Asia reside in slum settings with a compromised state of health, and this proportion is increasing at an alarming rate. In Ethiopia, it is estimated that 70-80% of the urban population lives in settings that are believed to be slums and most of the urban population has no access to improved sanitation. Though there is still a limitation on proper urban health profile data, there is evidence of vulnerability to a wide range of health-related problems in the country, including HIV. Hence, this study aimed to generate evidence on access to and utilization of health services, particularly by mothers and children, and the prevailing health problems of vulnerable sections of the urban population. Methods: A total of 115 urban vulnerable sections were identified in 46 towns in five regions (Amhara; Oromia; Tigray; Southern Nations, Nationalities, and Peoples’ (SNNP); and Harari) and two city administrations (Addis Ababa and Dire Dawa) where John Snow Inc. (JSI) urban centers are located. A cross-sectional household survey design was conducted among identified urban vulnerable sections of the population on 10–20 May 2017. A total of 1,220 households were included, based on a two-stage stratified sampling method. The analysis used mainly descriptive statistics and SPSS version 21 software was used for the analysis. Results: The mean age of the respondents was 43.2 (SD=14.8) years, and females accounted for 75% of all participants. The average time (SD) from the households to the health facility is 18 (±11) minutes. One month prior to the study, 32.6% of the household members reported having had some form of illness and 44% of them visited a health center and 36% a hospital. More than two thirds (68.6%) of women gave birth at a health facility and most (70.1%) births were assisted by a skilled provider. Nearly two thirds (63.4%) of women received a postnatal check-up. In 7.6% of the households, diarrhea occurred among children under 5 in the past two weeks, and 88% sought advice or further treatment. Non-communicable diseases (NCDs) account for the largest share of causes of morbidity among adults (29%) and death was observed in 8.4% of the households in the last three-year period prior to the survey. The most perceived causes of death in households were kidney disease, hypertension, heart disease, and other NCDs (65%). Conclusions: Health facilities are located near households. However, a significant proportion of mothers are still giving birth at home and more than a third of the births are attended by non-skilled attendants. Postnatal care utilization remained a challenge. NCDs were found to be the most prevailing problem among adults in the households and most of the deaths were also related to NCDs. Social changing interventions are recommended so that women have trust to deliver at facilities and postnatal visits are increased. Targeted preventive interventions are also essential to avert the growing burden of NCDs and others in the urban vulnerable sections. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):12-23] Keywords: Health service, access, health problem, vulnerable sections, Ethiopi