A hierarchical modelling approach to identify factors associated with the uptake of HIV counselling and testing, maternal health services, and prevention of mother to child HIV transmission programme services among post-partum women in Ethiopia

Philosophiae Doctor - PhDThe HIV/AIDS epidemic remains an unbeaten challenge that affects all parts of the global population. Since the identification of the epidemic in the early 1980s, nearly 58 million people have become infected with the virus and 25 million people have died of HIV-related complications. This study aimed to elucidate individual and community level factors associated with the uptake of antenatal care (ANC), health facility delivery, HIV Counselling and Testing (HCT), and Prevention of Mother-to-Child Transmission of HIV (PMTCT) services by implementing a hierarchical (multilevel) methodological approach. This study used a cross-sectional, multistage sampling design in which health facilities were first selected (stage 1), followed by recruitment of post-partum women who came for child immunization from each health facility (stage 2), in Tigray region. Structured interview guides were developed for interviews. Four-fifths (80.0%) of mothers used antenatal services at least once during their most recent pregnancy and of these 74.6% of women accessed HCT. Sixty nine percent of women had delivered at a health facility, 79% of mothers and 55.7% of their children had received PMTCT services. Place of residence was significantly associated with ANC attendance and place of delivery, with women living in urban areas almost 2 times (OR=1.75, 95% CI 1.06, 2.92) more likely to deliver at a health facility. With the addition of one health facility per 25000 people, the likelihood of delivering at a health facility increased by 2.45 fold (OR=2.45, 95% CI 1.04, 5.78). Attending ANC (OR=4.54; 95%CI 2.82,7.33) and getting support from husband (OR=1.97; 95%CI 1.25,3.10) were significantly associated with HCT, at the individual level. At the community-level, for the addition iii of one health facility and HCT site for every 25000 people increase the likelihood of HCT utilization by 2.1 and 2.4 fold respectively. Mothers who delivered at a health facility were 18 times (OR=18.21; 95%CI 4.37,75.91) and children born at a health facility were 5 times (OR=4.77; 95%CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. With the addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (OR=7.22; 95% CI 1.02,51.26). Community-level random-effects were also significant and there was confirmation of nesting at the community-level even after controlling for individual and communitylevel variables. Findings also showed that HCT utilization was nested according to district of residence, contributing 11.3% of the variance. In addition, the variation of mothers getting PMTCT services between districts was only 0.6%, but was 27.2% for children. Conclusion: Factors influencing utilization of maternal health services work at different levels, individual and community. Hierarchical models reveal these differences in ways that single-level (individual or community) models do not. Interventions are needed to increase spouse involvement in ANC utilization, and explore effective ways of increasing health facility delivery among poor women with little formal education in rural areas and increasing the number of health facility per people are important. The government should focus on increasing ANC access, educating couples on the importance of health services utilization, increasing the number of health facilities and HCT sites per population to improve HCT utilization. In addition to these, programmes should focus on increasing health facility delivery, training traditional birth attendants to understand the need for PMTCT and increasing iv HCT coverage to advance getting PMTCT services for mothers at the individual level and for children at both individual and community level. Permission to conduct the study was granted from the Ethics Committee of the University of the Western Cape and from Tigray Region Health Bureau. Verbal informed consent was obtained from each participant in the health facility based interview

Upaya Peningkatan Pemahaman Siswa Terhadap Prinsip Kerja Pneumatik Berbantuan Perangkat Lunak Multimedia Interaktif

Penelitian ini bertujuan untuk meningkatkan pemahaman siswa pada pembelajaran prinsip kerja komponen pneumatik berbantuan multimedia interaktif. Penelitian dilakukan menggunakan metode deskriptif dan evaluatif dengan pendekatan research and development. Tahapan penelitian sampai pada uji coba terbatas. Subyek penelitian merupakan kelas XI Kompetensi Keahlian Mekatronika di SMK Negeri 2 Cimahi dengan jumlah sampel 30 siswa. Pengumpulan data dilakukan dengan pemberian angket, observasi dan tes berupa pretest dan posttest. Hasil penelitian menunjukkan bahwa penggunaan media pembelajaran berbantuan multimedia interaktif efektif digunakan pada materi prinsip kerja komponen pneumatik. Berdasarkan hasil angket, terdapat pengaruh yang positif pada peningkatan minat siswa terhadap pembelajaran sistem pneumatik. Media pembelajaran berbantuan multimedia interaktif ini memiliki pengaruh yang positif pada peningkatan minat siswa terhadap pembelajaran sistem Pneumatik. Berdasarkan hasil pretest dan posttest media pembelajaran berbantuan multimedia interaktif dapat meningkatkan pemahaman siswa terhadap prinsip kerja komponen pneumatik

Incidence and factors associated with diabetic retinopathy among diabetic patients at arbaminch general hospital, gamo gofa Zone (longitudinal follow up data analysis)

Background: Currently, 93 million people are estimated as living with diabetic retinopathy (DR) worldwide. The incidence, retinopathy-free survival time and associated factors of DR in developed countries have been well documented; but in Ethiopia, national data on incidence and associated factors of DR are lacking. Objective: The objective of this study is to determine incidence and factors associated with the development of DR among diabetic patients at Arbaminch General Hospital, Ethiopia. Materials and Methods: Longitudinal follow-up data analysis with record review of 400 diabetic patients was conducted at Arbaminch General Hospital. Among 400 diabetic patients, 270 diabetic patients with baseline information and without a history of hypertension at baseline were included in this study. Whereas, pregnancy induced diabetes and patients with retinopathy at baseline were excluded from this study. Consecutive sampling technique was applied to select study participants. Data of cohorts were extracted from medical record using pre-tested structured extraction checklist. Data cleaning, coding, categorising, merging and analysis carried out by STATA version 12. Descriptive statistics was done and summarised accordingly. Bivariate Cox proportional hazard regression analysis was done to select potential candidates for the full model atP ≤ 0.25 and multivariable Cox proportional hazard regression analysis was made to estimate the independent effect of predictors on the incidence of DR. Model diagnostic tests were performed and final model fitness was checked by Cox and Snell residuals; finally, statistical significance was tested atP 12 years. Adjusted analysis showed that the hazard of developing DR was statistically and positively associated with baseline age, baseline systolic blood pressure (SBP) level and fasting blood glucose (FBG) level. Conclusion: In the current study, the incidence of DR was high. Since baseline age, baseline SBP level and high FBG level were statistically and positively related with the development of DR; special care should be given in addition to routine care

Level of data quality from Health Management Information Systems in a resources limited setting and its associated factors, eastern Ethiopia

Background: A Health Information System (HIS) is a system that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. Despite the credible use of HIS for evidence-based decision-making, countries with the highest burden of ill health and the most in need of accurate and timely data have the weakest HIS in the vast majority of world’s poorest countries. Although a Health Management Information System (HMIS) forms a backbone for strong health systems, most developing countries still face a challenge in strengthening routine HIS. The main focus of this study was to assess the current HIS performance and identify factors affecting data quality in a resource-limited setting, such as Ethiopian health facilities. Methods: A cross-sectional study was conducted by using structured questionnaires in Dire Dawa Administration health facilities. All unit and/or department heads from all government health facilities were selected. The data was analysed using STATA version 11. Frequency and percentages were computed to present the descriptive findings. Association between variables was computed using binary logistic regression. Results: Over all data quality was found to be 75.3% in unit and/or departments. Trained staff to fill format, decision based on supervisor directives and department heads seek feedback were significantly associated with data quality and their magnitudes were (AOR = 2.253, 95% CI [1.082, 4.692]), (AOR = 2.131, 95% CI [1.073, 4.233]) and (AOR = 2.481, 95% CI [1.262, 4.876]), respectively. Conclusion: Overall data quality was found to be below the national expectation level. Low data quality was found at health posts compared to health centres and hospitals. There was also a shortage of assigned HIS personnel, separate HIS offices, and assigned budgets for HIS across all units and/or departments

Perceived risk of reinfection among individuals treated for sexually transmitted infections in Northern Ethiopia: implication for use in clinical practice

Introduction: The prevention of reinfection of sexually transmitted infections (STIs) is highly dependent on the level of risk perception and the subsequent adoption of preventive behaviors. While perceived risk is assumed to be key to adoption of preventive measures, the evidence regarding the predictors of perceived risk to STI reinfection are limited.Methods: This paper is based on a cross sectional facility based survey conducted in North Ethiopia from January to June; 2015. Patients attending public health facilities for STI care responded to a structured questionnaire at clinic exist. Ordinal logistic regression was employed to identify factors associated with risk perception.Results: Of the 1082 STI patients who participated in the study, 843(77.91%) indicated a high perceived risk of STI reinfection. The major factor associated with low perceived risk of reinfection was willingness to notify partner; the odds of being willing to notify partner was greater among those who perceived low risk (AOR=3.01, 95% CI: 2.13-4.25). In addition, low perceived risk was associated with female index cases (AOR=1.49, 95% CI: 1.07-2.08), those who had high school education and above (AOR=1.68, 95% CI: 1.07-2.65), those aged 25 years and above (AOR=1.52, 95% CI: 1.09-2.12), those who had a single partner (AOR=1.82, 95% CI: 1.20-2.74), and those who had low perceived stigma (AOR=1.42, 95% CI: 1.04-1.95).Conclusion: The perceived risk of STI reinfection is high and strongly associated with willing to notify partner. Efforts to prevent STI reinfection need to consider interventions that enhance partner notification.Keywords: Ordinal regression, risk perception, STI reinfectio

Antibacterial efficacy of local plants and their contribution to public health in rural Ethiopia

Abstract Background Proper hand hygiene with soap and detergents prevents the transmission of many infectious diseases. However, commercial detergents are less likely to be accessible or affordable to poor people in remote rural areas. These people traditionally use some plant parts as a detergent even though their antibacterial activity has not been yet investigated. Therefore, this study aims to determine the antibacterial activities of some of the plants against bacteria isolated from humans. Methods Plants selected for this study are Phytolacca dodecandra fruits, Rumex nepalensis leaves, Grewia ferruginea bark and leaves. The samples of these plants were collected from rural areas of Jimma town based on their ethno-botanical survey and information on their local use. Acetone was used as a solvent to extract the bioactive constituents of the plants. The antibacterial activities of the plants were evaluated against reference strains and bacteria isolated from humans using disc diffusion and macro dilution methods. Results The plant extracts have shown varying antimicrobial activities against the bacterial species tested. Susceptibility testing shows zones of inhibition ranging from 8.0 ± 1.0 mm to 20.7 ± 5.5 mm. The MIC and MBC of the plants against the bacterial species tested were 3.13 and 12.5 mg/ml respectively. These variations are attributed to different concentrations of the bioactive constituents of the extracts like saponins, tannins, flavonoids and terpenoids. Conclusion The studied plants can contribute to achieve better personal hygiene since they are effective against different bacterial agents and are freely available in rural areas