Readiness to treat and factors associatedwith survival of newborns with breathingdifficulties in Ethiopia

Background Ethiopia is one of five countries that account for half of the world’s 2.6 million newborn deaths. A quarter of neonatal deaths in Ethiopia are caused by birth asphyxia. Understanding different dimensions of the quality of care for newborns with breathing difficulties can lead to improving service provision environments and practice. We describe facility readiness to treat newborns with breathing difficulties, the extent to which newborn resuscitation is provided, and by modeling the survival of newborns with difficulties breathing, we identify key factors that suggest how mortality from asphyxia can be reduced. Methods We carried out a secondary analysis of the 2016 Ethiopia Emergency Obstetric and Newborn Care Assessment that included 3804 facilities providing childbirth services and 2433 chart reviews of babies born with difficulties breathing. We used descriptive statistics to assess health facilities’ readiness to treat these newborns and a binary logistic regression to identify factors associated with survival. Results Over one-quarter of facilities did not have small-sized masks (size 0 or 1) to complete the resuscitation kits. Among the 2190 cases with known survival status, 49% died before discharge, and among 1035 cases with better data quality, 29% died. The odds of surviving birth asphyxia after resuscitation increased eightfold compared to newborns not resuscitated. Other predictors for survival were the availability of a newborn corner, born at term or post-term, normal birth weight (≥2500 g) and delivered by cesarean or assisted vaginal delivery. Conclusion The survival status of newborns with birth asphyxia was low, particularly in the primary care facilities that lacked the required resuscitation pack. Newborns born in a facility with better data quality were more likely to survive than those born in facilities with poor data quality. Equipping health centers/clinics with resuscitation packs and reducing the incidence of preterm and low birth weight babies should improve survival rates.publishedVersio

Biomedical waste disposal systems of health facilities in Ethiopia

Background: Biomedical waste generated from health and health-related activities can be grouped as general waste and hazardous waste. This remains true if and only if there is proper on-site handling, such as the segregation and separation of waste based on the type and nature of the source. Methods: A stratified random sampling design was used to provide representative results for Ethiopia, for various types of facility and management authorities, and for each of the 11 regions. Totally, 1327 health facilities were assessed using the World Health Organization (WHO) inventory tools. Results: Nationally, medical waste in 32.6% of the studied health facilities was stored in covered containers, and in about 27% of them it was stored in another protected environment. About 40% of health facilities stored their medical waste in unprotected areas. Twenty-eight (2.6%) and 420 (39.3%) health facilities used 2-chamber industrial incinerators and 1-chamber drum incinerators, respectively. About 58% of health facilities used unsafe waste treatment methods. The proportion of using safe medical waste disposal method was high in referral hospitals (87.9%). This shows the utilization of safe medical waste disposal methods is in decreasing order from higher to lower levels of organization in health facilities. Conclusion: The present study showed a preliminary finding on the waste disposal systems of health facilities at the national level. Dumping biomedical waste outside the health facility is common, and access to common waste facilities is limited. Therefore, a holistic approach to safe medical waste management practices, including the collection process (handling, sorting, and segregation), storage, treatment and final disposal is crucial in all types of health facilities, regardless of the level of organization, ownership, or geographic distribution. Keywords: Health Facility, Biomedical Waste, Disposal, Incinerator, Ethiopi

Estimation of Ethiopia's immunization coverage - 20 years of discrepancies.

Background Coverage with the third dose of diphtheria-pertussis-tetanus-containing vaccine (DPT3) is a widely used measure of the performance of routine immunization systems. Since 2015, data reported by Ethiopia's health facilities have suggested DPT3 coverage to be greater than 95%. Yet, Demographic and Health Surveys in 2016 and 2019 found DPT3 coverage to be 53 and 61% respectively for years during this period. This case study reviews the last 20 years of administrative (based on facility data), survey and United Nations (UN) estimates of Ethiopia's nationwide immunization coverage to document long-standing discrepancies in these statistics. Methods Published estimates were compiled of Ethiopia's nationwide DPT3 coverage from 1999 to 2018. These estimates come from the Joint Reporting Form submitted annually to WHO and UNICEF, a series of 8 population-based surveys and the annual reports of the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC). Possible reasons for variation in survey findings were explored through secondary analysis of data from the 2012 immunization coverage survey. In addition, selected health officials involved with management of the immunization program were interviewed to obtain their perspectives on the reliability of various methods for estimation of immunization coverage. Findings Comparison of Ethiopia's estimates for the same year from different sources shows major and persistent discrepancies between administrative, survey and WUENIC estimates. Moreover, the estimates from each of these sources have repeatedly shown erratic year-to-year fluctuations. Those who were interviewed expressed scepticism of Demographic and Health Survey (DHS) statistics. Officials of the national immunization programme have repeatedly shown a tendency to overlook all survey statistics when reporting on programme performance.ConclusionsThe present case study raises important questions, not only about the estimation methods of national and UN agencies, but about the reliability and comparability of widely trusted coverage surveys. Ethiopia provides an important example of a country where no data source provides a truly robust "gold standard" for estimation of immunization coverage. It is essential to identify and address the reasons for these discrepancies and arrive at a consensus on how to improve the reliability and acceptability of each data source and how best to "triangulate" between them

Neglected Tropical Diseases (NTD) service availability at health facilities in Ethiopia: Evidence from 2014 Ethiopian service provision assessment

Background: Neglected tropical diseases (NTDs) are a group of infections which are especially endemic in low-income populations in developing regions of Africa, Asia, and the Americas. In sub-Saharan Africa, the impact of these diseases as a group is comparable to malaria and tuberculosis. The diseases recognized as neglected tropical diseases by the World Health Organization (WHO) are: Chagas disease, Cysticercosis and taeniasis, Dengue fever, Dracunculiasis, Echinococcosis, Human African trypanosomiasis, Leishmaniasis, Leprosy, Lymphatic filariasis, Onchocerciasis, Rabies, Schistosomiasis, Soil-transmitted helminthiasis, Trachoma, and Yaws. Most of these diseases are either preventable through mass drug administration (MDA) and proper hygiene and sanitation, or treatable through systematic case finding and management. This study was conducted with the aim of assessing the availability of services for neglected tropical diseases management at health facilities in Ethiopia.Method: The assessment is part of the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) Survey. A total of 873 health facilities were assessed for this analysis. All Hospitals, selected health centre, and private clinics were assessed if they provide services for Neglected Tropical Diseases.Result: More than half of all health facilities offer services for both soil transmitted helminthes (64 percent), and services for trachoma (60 percent). About four of every ten health facilities offer services for schistosomiasis. On the other hand, services for onchocerciasis, leishmanianis and lymphatic filariases were available in less than a third of all health facilities (27%, 25% and 24%, respectively).Conclusion and recommendation: Even though, the availability of service for neglected tropical disease in health facilities is relatively good in general, there should be equitable distribution of neglected tropical disease service provision among regions. And private facilities should give emphasis for the provision of these services. Key words: Service Availability, NTDs, SPA+, Ethiopia

Determinants of full valid vaccine dose administration among 12-32 months children in Ethiopia: Evidence from the Ethiopian 2012 national immunization coverage survey

Introduction: According to the 2012 national immunization coverage survey report of Ethiopia, EPI coverage by antigen is 79.6% for BCG, 80.0% for DPT-HepB-Hib1 90.1% for OPV1 65.7%; for adjusted DPT-HepB-Hib 3; 65.7 % for OPV3 and 68.2% for Measles. Similarly, the prevalence of full vaccination was 50%. However, the prevalence of valid vaccination dose for all vaccines is 18.6 %. Therefore, the aim of this study is to identify factors that determine the administration of full valid vaccines dose to set effective interventions.Methods: Data was obtained from the 2012 Immunization Coverage survey of Ethiopia, a cross- sectional study administered at the household level. Data were analyzed using SPSS version 20. Binary and multivariate logistic regression with 95% CI was done to assess factors associated with getting full valid vaccination dose. Results: As documented from the 2012 national immunization coverage survey, the coverage of full valid vaccination dose were very low as compared to full immunization coverage that is 18.6% Vs 50%, respectively. Urban residence 2.6 (95% CI: 2.50, 2.68), mothers with age groups of 21-34 and >35 were 1.26 (95% CI: 1.22, 1.29) and 2.4 (95% CI: 2.3, 2.44); children with caretakers with primary, secondary, and higher level of education were 1.6 (95% CI: 1.22, 1.29), 2.8 (95% CI: 2.76, 2.92), and 2.2 (95% CI: 2.13, 2.27) times more likely to get valid vaccination dose.Conclusion: The rich wealth quintile, rural place of residence, living more than 5km proximity to nearest health facility, having more than six sibling, having teenage (<20years old) mother, having mother with no formal education, having mother/ care giver with no card or family folder which state children vaccination status sources, and having mother who did not heard a message about importance of vaccine were found to be the independent determinants of low valid dose immunization. The efforts at all level to increase full valid vaccination coverage by targeting activities to socio-economic, socio-demographic, organizational, and related determinants. [Ethiop. J. Health Dev. 2016;30(3):135-141]Keywords: Valid dose, vaccination, Ethiopi

Tuberculosis Service Provision in Ethiopia: Health Facility Assessment

The major objective of the survey is to assess the availability and preparedness of health facilities in Ethiopia to provide quality Tuberculosis services. The survey was part of the 2014 Ethiopia Service Provision Assessment Plus Survey. A total of 1,327 health facilities were assessed. The results shows that more than two out of three (69%) facilities excluding health posts in Ethiopia offer any TB diagnostic, treatment or/and treatment follow up services. Among all health posts, 29% of them offer any TB diagnostic services and any treatment and/or treatment follow up services. Six in ten (59%) of facilities excluding health posts use sputum smear only to diagnose TB. Of those facilities offering any TB services more than half (60%) have trained staff. Among facilities excluding health posts offering any TB services, 44% have guidelines for diagnosis and treatment of TB, 18% have guideline for diagnosis and treatment of MDR-TB, and 9% have guideline for management of HIV and TB co-infection.As a conclusion we can say that any TB diagnostic, treatment or/and treatment follow up services is available in more than half of the facilities in Ethiopia excluding health post. Half of the health facilities in Ethiopia excluding health post have guidelines for diagnosis and treatment of TB

Pattern and Trend of Medical Admissions of Patients of Chronic Non-Communicable Diseases in Selected Hospitals in Addis Ababa, Ethiopia

Although chronic non-communicable diseases (NCDs) have been of major importance in developed countries for several decades, currently it is becoming recognized as a major public health threats in the developing world too.The increasing NCDs burden is compounded by failure in provision of clear and up-to-date evidence on the burden for key decision makers. The present study is designed to collect retrospective secondary data from selected Government and Private Hospitals in Addis Ababa that offer services to out-patients of NCDs through special referral clinics. The Objective of this research is to depict the patterns and trends of common NCDs in Government and Private Hospitals in Adds Ababa, and provide decision makers with  information on the burden of NCDs at  health facility level.In order to collect retrospective data, four Governments and five Private owned Hospitals in Addis Ababa that offer referral clinic for NCD were selected. Data of NCD out-patients from 2007 to 2011 were considered for present study. Records of cardiovascular diseases, diabetes mellitus, cancer, chronic kidney diseases and chronic pulmonary obstructive diseases including asthma were collected. The data were collected from Hospital registration and patient records anonymously by respective Hospital staff members assigned in the referral clinics.Records of 46,565 patients were collected and more than 60% data were obtained from TikurAnbessa Specialized Teaching Hospital and International cardiac center. Majority of the clients (77 %) were from urban areas while 23% from rural areas. With regard to gender, 56% of the patients are females and 44% males.  As age increases the proportion of patients with NCDs increased and there was a decline after 54 years. Among the patients who were attending outpatient clinics, the vast majority about 40% were patients were with cardiovascular diseases while diabetes and cancer each independently accounts 20% of the proportion. Patients with chronic pulmonary obstructive diseases including asthma, and chronic kidney diseases were 6% and 5%, respectively. Information regarding the status of patients while making follow-up was also collected. It resulted in about 56% of all NCDs out-patients were actively following their health condition by making   frequent visit to their respective out-patient referral clinics, about 2% were deceased and 1% referred to other hospitals, about 41.2% of all NCDs patients were found to be drop-out for unknown reasons. This research reveals that NCDs are becoming public health problems in Addis Ababa. Therefore, there is a need for population-based representative survey to quantify the burden with risk factors for policy formulation and interventions against this emerging epidemic. Moreover, further study is recommended to investigate the reasons of patients why they discontinue care & treatment offered at facility level

Service availability and readiness for major non-communicable diseases at health facilities in Ethiopia

Introduction: No assessment was conducted previously in Ethiopia to monitor, review and evaluate the availability and readiness of health facilities for non-communicable diseases (NCDs). Thus, the present study aims to provide evidence on service availability and readiness for NCDs in Ethiopia

Non-communicable diseases in Ethiopia: policy and strategy gaps in the reduction of behavioral risk factors

Introduction: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Over 80% of NCD deaths occur in developing countries. Four modifiable behaviors, namely tobacco use, consumption of unhealthy diet, physical inactivity, and the harmful use of alcohol, contribute to 80% of the NCD burden. Studies show that the vast majority of NCDs can be prevented through behavioral risk-reduction interventions. Properly executed, the interventions could lead to a decrease in the burden of NCDs, ranging from a 30% drop in the prevalence of cancer to a 75% reduction in cardiovascular diseases. This study examined the policy and strategy gaps in the reduction of the modifiable NCD behavioral risk factors in Ethiopia to inform and guide policy-makers and other stakeholders. Methodology: This study used a data triangulation methodology with a sequential, explanatory, mixed-method design conducted in two stages. The authors carried out quantitative analysis on the prevalence and distribution of behavioral risk factors from the Ethiopia NCD STEPwise approach to surveillance (STEPS) survey. Qualitative data on national policies and strategies complemented the analysis of the progress made so far and the existing gaps. Results and Discussion: Ethiopia has made substantial progress in responding to the NCD epidemic by developing a health sector NCD strategic action plan, generating evidence, and setting time-bound national targets on NCD behavioral risk factors. Activities mainly aimed at reducing tobacco use, such as implementation of the ratified WHO Framework Convention on Tobacco Control (FCTC), using evidence of the Global Adult Tobacco Survey (GATS), and the articulation of legislative measures are ongoing. On this paper our analysis reveals policy and strategy gaps, status in law enforcement, social mobilization, and awareness creation to reduce the major behavioral risk factors. Conclusions: NCDs share common risk factors and risk reduction strategies creates an opportunity for an effective response. However, the national response still needs more effort to have a sufficient impact on the prevention of NCDs in Ethiopia. Thus, there is an urgent need for the country to develop and implement targeted strategies for each behavioral risk factor and design functional, multisectoral coordination. There is also a need for establishing sustainable financial mechanisms, such as increasing program budgets and levying ‘sin taxes,’ to support the NCD prevention and control program. Ethiop. J. Health Dev. 2019; 33(4):259-268] Key words: NCDs, behavioral risk factors, policy, strategy, multisectoral coordination, Ethiopi

Non-communicable Diseases in Ethiopia: Disease burden, gaps in health care delivery and strategic directions.

Abstract Introduction: In Ethiopia, non-communicable diseases (NCDs) cause 42% of deaths, of which 27% are premature deaths before 70 years of age. The Disability Adjusted Life Years (DALYs) increased from below 20% in 1990 to 69% in 2015. With no action, Ethiopia will be the first among the most populous nations in Africa to experience dramatic burden of premature deaths and disability from NCDs by 2040. However, the national response to NCDs remains fragmented with the total health spending per capita for NCDs still insignificant. The focus of this paper is highlighting the burden of NCDs in Ethiopia and analyzing one of the two major WHO recommended policy issues; the status of integrated management of NCDs, in Ethiopia. NCDs are complex conditions influenced by a range of individual, social and economic factors, including our perceptions and behavior. Also, NCDs tend to be easily overlooked by individuals and policy makers due to their silent nature. Thus, effectively addressing NCDs requires a fresher look into a range of health system issues, including how health services are organized and delivered.Methods: A mixed method approach with quantitative and qualitative data was used. Quantitative data was obtained through analysis of the global burden of diseases study, WHO-STEPs survey, Ethiopian SARA study and the national essential NCD drug survey. This was supplemented by qualitative data through review of a range of documents, including the national NCD policies and strategies and global and regional commitments.Results and discussion: In 2015, NCDs were the leading causes of age-standardized death rate (causing 711 deaths per 100,000 people (95% UI: 468.8–1036.2) and DALYs. The national estimates of the prevalence of NCD metabolic risk factors showed high rates of raised blood pressure (16%), hyperglycemia (5.9%), hypercholesterolemia (5.6%), overweight (5.2%) and Obesity (1.2%). Prevalence of 3-5 risk factors constituting a metabolic syndrome was 4.4%. Data availability on NCD morbidity and mortality is limited. While there are encouraging actions on NCDs in terms of political commitment, lot of gaps as shown by limited availability of resources for NCDs, NCD prevention and treatment services at the primary health care (PHC) level. Shortage of essential NCD drugs and diagnostic facilities and lack of treatment guidelines are major challenges. There is a need to re-orient the national health system to ensure recognition of the NCD burden and sustain political commitment, allocate sufficient funding and improve organization and delivery of NCD services at PHC level. [Ethiop. J. Health Dev. 2018;32 (3):00-000]Key words: Non-communicable diseases, health-system re-orientation, NCD burden, metabolic risk factors, Service delivery, Primary Health Car