Human resources for public health supply chain management in Ethiopia: Competency mapping and training needs

Background: A health care system is judged to be functioning well, among others, when seen in light of the access it provides to affordable and quality medicines and supplies. This largely depends on the availability of competent health supply workforce.Health supply workers can become competent if and when they get the education and training needed to develop the skills required to work effectively in health supply chain in the country.Objective: The objective of this needs assessment was to identify the need for health supply chain management trainingand map competencies of personnel working at different levels of the health supply chain in Ethiopia.Methods: Initially, national sensitization and consensus building workshop on human resources for public health supply chain management was held in Addis Ababa.At the workshop, gaps were identified and required competencies suggested. This was followed by qualitative and quantitative surveys.Findings: The sensitive nature ofpublic health supply seems to be increasingly recognized by policy makers and other stakeholders. This is encouraging. However, the situation of the supply chain in the countryis not as effective as desired. Issues related to human resourcewereamong themajor factors that have contributed tothe problem of the supply chain. Scarcity and lack of expertise in supply chain management were noted in the finding as the challenges often talked about. In addition, there are issues related to poor commitment and lack of motivationon the part of the personnel currently involved in the management of the supply chain.Overall, shortages in some aspects and gaps in others characterize the supply chain management. Evidence of emergency purchases has also been observed.Largely, participants had either entry level or midlevel competencies in the five major supply chain domains. The majority (i.e., 89.5%) of the participants of the study showed interest to advance their career in health supply chain management. MSc level training was one way they said this could be achieved.Conclusion: Despite various efforts made to implement initiatives that increase the supply chain efficiencyover the past years, marked inadequacies still characterize the system. For example, stocks are observed to run out of essential medicines and supplies. Lack of timelinessin delivery of itemsis also reported. Multiple factors were identified to be held responsible for the reported deficiencies of theperformances of the supply chain system. Human resources related challenges are identified as key contributing factors to the problems.Examples reported include workers’ lack of competencies required for the work. One reason claimed to have underlined this lack of competencies is the inadequate level of the training given to the workers. Ethiop. J. Health Dev. 2017; 31(4):266-275]Keywords: Human resources for health supply chain, training need, competency, Ethiopi

Health seeking behavior and use of medicinal plants among the Hamer ethnic group, South Omo zone, southwestern Ethiopia

Appendix I Glossary of local names of illnesses and some traditional medical practices and their equivalent meanings in English. Appendix II Questionnaire to be used to collect ethnopharmacological information at house hold level among Hamer ethnic group, Hamer Woreda, South Omo Zone, SNNPR. Appendix III Questionnaire to be used to collect ethnopharmacological information for key informants among Hamer ethnic group, Hamer Woreda, South Omo Zone, SNNPR. Appendix IV Questions for Focused Group Discussions. (DOCX 24 kb

Popular Healing and Primary Health Care: A Socio-Cultural Study in Rural North-Eastern Ethiopia

Introduction: Studies have shown that popular healing practices at home could play a major role in solving the problem of overcrowding in primary care services. This study explored the indigenous popular healing practices used by communities in North Eastern Ethiopia.Methodology: A qualitative ethnographic method was used for this study. Using Kleinman’s Cultural Systems Model, we conducted participatory observation (5 months during the span of one year) supplemented by ten focus group discussions (n=96) and 20 key informant interviews with purposefully selected knowledgeable community members. The focus group and key informant interviews included questions about the popular healing as a health care option and popular modes of healing practices. The process of analysis and interpretation was informed by thematically and the analysis of narratives strategies.Findings: The study found that home remedies are applied for both prevention and remedial purposes. Common ailments that are managed at home include Nedad (malaria) and Mich (acute febrile illness). Home remedies are prepared in the household by the patient, his/her parent or a family member. However, in cases where home remedies and/or home-based treatment did not cure a patient, other alternatives are looked for such as visiting a bio-medical care facility following a similar model developed by Kleinman in early 1980’s.Conclusion: Since people in the study communities believe that popular healing is a health care option among multiple health-care resources, successful rural primary health care strategy would give due attention to such local resources. This will help to ensure the optimal utilization of Ethiopia’s limited resources. ]Key Words: Popular healing, home remedies, ailments, primary health care, Ethiopi

Use of medicinal plants among Ethiopian patients with diabetes: A qualitative exploration

Background: Most studies on the use of medicinal plants reported from Africa (including Ethiopia) have focused on the clinical actions of medicinal plants with little attention given to patient experiences in using these plants and factors impacting patients’ decisions about using them.Objectives: The main objective of this study is to explore the experiences of patients with diabetes attending treatment in the biomedical setting regarding their use of medicinal plants.Methods: Qualitative interviews were held with 39 purposively selected participants attending their treatment in 3 public hospitals in urban centers of central Ethiopia. Interviews continued until key themes were saturated.Results: Medicinal plants were used alongside prescribed medicines with a range of factors impacting study participants decisions to trying out and continuing to use medicinal plants and also in recommending against their use or discontinuing them. Some of the main factors that encouraged use of medicinal plants include perceptions that bitter things were thought to be good for diabetes, their claimed and experienced benefits as well as the influence of others and the media while those that discouraged the use of medicinal plants primarily include safety concerns in relation to using the plants.Conclusions: The findings highlight the use of medicinal plants by patients with diabetes in the context of limited information. This is suggestive of the need for the healthcare practitioners in the conventional healthcare system to give more attention to patients’ interest in medicinal plants and for providing more evidence-based information about the plants used by these patients so as to improve health outcomes. Key words: medicinal plants, type 2 diabetes, Ethiopia, qualitative researc

Ethnomedicinal uses of plants among the Somali ethnic group, Jigjiga Woreda, Somali Regional State, Eastern Ethiopia

Introduction: In Ethiopia, most people are dependent on traditional medicine (TM), mainly of plant origin for human and animal health problems. The practice of herbal medicine varies widely, in keeping with the societal and cultural heritage of different countries. The heritage has not been well documented in the developing countries including Ethiopia and this is even more so in the emerging regions of the country. The objective of this study was to document medicinal plant knowledge of the people and identifying factors determining the use of medicinal plants in Jigjiga Woreda, Somali Regional State, eastern Ethiopia.Methods: A cross-sectional study was conducted in five kebeles from where ethno-medicinal information was collected using semi-structured questionnaire. The questionnaire was administered to 800 heads of households. Data were entered and analyzed using Statistical Packages for Social Sciences version 20. Multivariable logistic regression was performed to show possible associations between the dependent and independent variable and statistical significance was set at p < 0.05.Results: The study documented an overall prevalence of 40% to use of herbal medicine during one month recall period. A total of 45 medicinal plant species were collected and botanically identified. The study found that leaves are the most frequently utilized plant part (30.5%), followed by roots (23.0%). The reasons for preference of herbal drugs were related to lower price, efficacy and geographic accessibility as compared to modern medicine. Age, gender, educational status and occupation were identified as important determinants for the use of herbal medicine.Conclusion: This ethno-medicinal study showed that community in Jigjiga Woreda relies on traditional medicinal plant species to treat a wide spectrum of human ailments. It is therefore suggested that more in depth studies be condicted to explore the potential of traditional medicine in the region to preserve this indigenous knowledge. [Ethiop. J. Health Dev. 2017;31(3):188-199]Keywords: Ethnomedicine, Jigjiga Woreda, Medicinal plants, Somali ethnic grou

Concomitant use of medicinal plants and conventional medicines among hypertensive patients in five hospitals in Ethiopia

Background: Even if the use of medicinal plants has a long tradition in Ethiopia, little is known about which medicinal plants are concomitantly used with which conventional medicines, since patients’ disclosure to their treating physicians is low. The concomitant use of medicinal plants and conventional medicines may increase the risk of unwanted interactions, unexpected toxicities and possible under-treatment. The aim of this study was to identify plants concomitantly used with conventional medicines by hypertensive patients. Methods: A total of 365 patients and 17 healers were surveyed to identify medicinal plants commonly used by hypertensive patients. In addition, patients’ charts were reviewed to identify if they had any co-morbid conditions or history of taking medicinal plants. Descriptive statistics were used for the analysis. Results: Of 365 hypertensive patients, 171(46.8%) reported having co-morbidities, mainly hypercholesterolemia(28, 7.7%), diabetes mellitus(38, 4.9%) and asthma (12, 3.3%). While the majority (319, 87.4%) of patients preferred modern medicines for the management of their hypertension, some preferred taking holy water (24, 6.69%) and using medicinal plants (20,5.5%). The concomitant use of medicinal plants and conventional medicines was practiced by just under half of the patients (171, 46.8%). Hydrochlorothiazide, enalapril, nifedipine, amlodipine, atenolol and aspirin were the most commonly used conventional medicines. Moringa (Moringa stenopetala), damakase (OcimumlamiifoliumHochst.), haregresa (ZehneriascabraSond.) and thyme(Thymus serrulatus)were the most commonly used plants. However, none of these medicinal plants were standardized in terms of the dose, frequency, duration or method of preparation. Conclusions: Conventional medicine was the initial primary treatment choice for hypertensive patients. However, a high tendency of using medicinal plants concomitantly was observed due to the side-effects of conventional medicines, patients’ curiosity to try medicinal plants and the desire to achieve better blood pressure control. [Ethiop. J. Health Dev. 2019; 33(4):239-249] Key words: Hypertension, herb-drug interaction, medicinal plants, conventional medicine, Ethiopi

Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: A comparative study

<p>Abstract</p> <p>Background</p> <p>Fresh leaves and buds of the Khat plant (<it>Catha edulis</it>) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults.</p> <p>Methods</p> <p>We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height.</p> <p>Results</p> <p>The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups.</p> <p>Conclusion</p> <p>Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.</p

Coverage of azithromycin mass treatment for trachoma elimination in Northwestern Ethiopia: a community based cross-sectional study

Abstract Background Mass drug administration with antibiotics predominantly with azithromycin is one of the four arms of the SAFE strategy. The elimination of ocular chlamydial infection is only achieved as long as the azithromycin mass treatments (AMT) are given frequently enough and at a high enough coverage. This study was conducted to assess the coverage of azithromycin mass treatment and its determinants in Awi Zone, Northwestern Ethiopia. Methods House to house survey using a structured questionnaire was done between July 7 to July 25, 2013. Coverage is defined as the proportion of individuals in the eligible population who actually ingested the Azithromycin during the Campaign. Results A total of 1267 households were enrolled in the survey in which 5826 eligible members were living in these households. Almost half (54.6%) of the community members who were eligible for all six campaigns had participated in more than three campaigns of azithromycin mass treatment. The overall average self-reported coverage of the azithromycin mass treatment (AMT) in all six campaigns was 62.8% (64% in rural vs. 61.6% urban). On average, each eligible person had taken the drug 3.77 times. The rural residents were significantly more likely to have received treatment during the last round of AMT in 2012 {AOR = 2.35; 95% CI [1.80–3.06]}. Azithromycin uptake status of female household heads was less than the corresponding male household heads {AOR = 0.41; 95% CI [0.24–0.72]}. Household heads’ awareness about trachoma (AOR = 2.55; 95% CI [1.19–5.44]) and AMT {AOR = 7.19; 95% CI [3.27–15.82]} had positive association with acceptability. Conclusion The overall average AMT coverage was found to be low. There was low coverage of the treatment in the urban community as compared to the rural residents. Misconceptions of household heads about trachoma and azithromycin have negatively affected the coverage. Further work on why female household heads are associated with higher risk of non-participation in AMT is warranted. Strengthening awareness creation and consideration of additional campaigns is essential

Assessment of ceftriaxone utilization in different wards of the Federal Police Referral Hospital in Ethiopia: a retrospective study

The unreasonable use of certain antimicrobials is one of the threatening issues worldwide leading to evolving antimicrobial resistant bacteria species. The problem becomes twofold when it occurs in low income countries like Ethiopia. The objective of this study was to assess the utilization of ceftriaxone in different wards of the Federal Police Referral Hospital (FPRH), Addis Ababa, Ethiopia. An institution based retrospective cross sectional study design was used to evaluate the use of ceftriaxone. The assessment was done by reviewing medication records of patients who received ceftriaxone during hospitalization in the different wards of FPRH from 01May, 2013 to 30 April, 2014. A systematic random sampling technique was used to select the samples from all the inpatient prescriptions containing ceftriaxone. Data was collected by using a structured format and evaluated against the standard treatment guideline of Ethiopia as well as the Infectious Disease Society of America and American Society of Health-System Pharmacists’ guidelines. Out of the 682 patient medication records sampled, 571 were found to be complete and subsequently evaluated against the guidelines. Ceftriaxone was prescribed for 2048 (44.3%) of the 4423 admissions in the respective wards. Overall evaluation of ceftriaxone therapy for indication, dose, frequency and duration revealed that 346 (60.6%) of the patient medication records were compliant to recommendations set in the guidelines. Among the co-prescribed medications; warfarin, heparin and doxycycline with potential drug-drug interaction with ceftriaxone were found to be concomitantly used. Days of hospital stay, type/payment scheme of medical service and type of ward patients who had been admitted in were the factors associated with compliant ceftriaxone use in FPRH. The compliance of ceftriaxone utilization in FPRH to the guidelines, is moderate. All concerned bodies and the hospital should develop an antimicrobial use guideline and provide ongoing trainings to promote rational use of antimicrobials including ceftriaxone.Keywords: ceftriaxone utilization, retrospective study, random sampling, Federal Police Referral Hospital, Ethiopi

Herbalists in Addis Ababa and Butajira, Central Ethiopia: Mode of service delivery and traditional pharmaceutical practice

Objective: To assess herbalists mode of service delivery and describe their traditional pharmaceutical practices. Methods: In-depth interviews of herbalists were conducted in Addis Ababa and Butajira, using a semi-structured questionnaire. Results: The mean age of the healers was 53.7 and most of the healers practised traditional medicine on part-time basis. The average number of patients seen per week by the healers was 7. Most of the healers do not have fixed payment rate for their services. The analysis of traditional prescriptions revealed that the predominant dosage forms were liquid preparations and the average number of plants per prescription was 1.16. Conclusions: Healers treat a wide range of health problems using medicinal plants in various dosage forms. In the process of evaluation and standardisation of these dosage forms, formulations tested should be made in accordance with the method used traditionally. [Ethiop.J.Health Dev. 2002;16(2):191-197