Reasons and Outcomes of Admissions to the Medical Wards of Jimma University Specialized Hospital, Southwest Ethiopia

BACKGROUND: Non-communicable diseases are the main reasons for admission to the medical wards in high-income countries. While in low and middle income countries communicable diseases are the main reasons for admission to the medical wards. However, in some low and middle income countries the reasons for admission are changing from communicable diseases to non-communicable diseases. But, data on reasons for admission to the medical wards of low income countries is scarce. Therefore, this study takes one year data from a low income country referral hospital aiming at describing the recent reasons and outcomes of medical admissions to see whether there is a change in reasons for admission and the outcome. METHODS: A retrospective study examined patient case notes and ward registration books of medical admissions at Jimma University Specialized Hospital from January 1, 2008 to December 31, 2008. Socio-demographic variables, reasons and outcomes of admission were some of the variables recorded during the data collection. The International Statistical Classification of Disease was used for sorting and categorizing the diagnosis. The data was then analyzed using SPSS windows version 13.0. RESULT: A total of 610 patient case notes were reviewed. The mean age of the patients was 36 years (SD + 15.75). The highest number of admissions 218 (35.7%) was among the age groups 21 to 30 years. Communicable diseases; namely severe community acquired pneumonia 139(22.8%), all infectious and parasitic diseases category 100 (16.4%), and pyogenic as well as chronic meningitis 80(13.1%) were the most common reasons for admission. The death rate among patients admitted to the medical wards was 12.6%. CONCLUSIONS: Communicable diseases were still the common reasons for medical admissions at Jimma University Specialized Hospital. The outcome of medical admissions has not changed over sixteen years

Client-Centeredness of Family Planning Services in a Resource Limited Setting

BACKGROUND: Clients’ needs and their satisfaction are priority issues in studying quality in reproductive health services. However, only 24-37% of Ethiopian women were informed about the available family planning methods and their utilization. High national total fertility rate (4.8) and low contraceptive prevalence rate (29%) might be attributed to these and other reasons. This study assessed the level of client-centeredness of family planning services and their determinants in public health facilities of Bahir Dar Town, Northwest Ethiopia.METHODS: Exit interviews of 326 consecutively enrolled clients were conducted using structured questionnaire. Thirty consultation sessions were observed using a checklist to record client-provider interaction. The outcome variable was client centeredness as measured by perceived informed choice with perceived client-provider interaction as the intermediate variable.RESULTS: The average levels of perceived informed choice and client provider interaction were 70.0% and 67.6%, respectively. Perceived clinical competence of providers, perceived integration and coordination of care, perceived accessibility of services, perceived participation of families and friends in care delivery, perceived physical comfort of the facilities and type of the health facility were the independent predictors of perceived client provider interaction. Perceived degree of client provider interaction, perceived clinical competence of providers, type of health facility and perceived accessibility of services were independent predictors of perceived informed choice (p≤0.01).CONCLUSION: Client-centeredness of family planning services, as measured by clien- provider interaction and informed choice was not sufficiently assured in the study facilities.KEYWORDS: Perceived informed choice, perceived client provider interaction, client centerednes

Investigations of Latrine Coverage and Associated Factors Among Debretabor Town, Amhara Region North West Ethiopia

Studies in a number of countries have shown that wherever inappropraite waste disposal morbidity and mortality rates are high. Although latrine coverage is an important indicator for measuring success of the health service program; data on latrine coverage scarce in the study area. Objective: To investigate latrine coverage and associated factors in among households of Debretabor town, Amhara region, Ethiopia. Methods: A community based cross sectional study was conducted in Debretabor town from September 1-30, 2013. A total of 422 households were included in the study using systematic sampling technique. Data were collected using structured questionnaire and analyzed using SPSS version 16.0. Degree of association between independent and dependent variables was assessed with a 95% confidence level and p-value less than 0.05 was used to detect statistical significance. Result: In this study. Ninety three point five percent of households have latrine. Graduated as model family was predictor for availability of latrine (AOR= 3.18,). Income and house ownership were also found to be predictors for availability of latrine (AOR=3.70), (AOR=8.46), respectively. Educational status of respondents was found to be predictors for availability of latrine (AOR= 2.65). Conclusion: latrine coverage was relatively lower from the national target of 100%, still there are households that use open defication. Educational status, house owner shipe, income and graduated as model family were main factors affecting latrine availability. Improving socio economic status of households, provision of continuous advice and technical support at household level on the availability of latrine are recommended

Feeding styles of caregivers of children 6-23 months of age in Derashe special district, Southern Ethiopia

<p>Abstract</p> <p>Background</p> <p>Apart from basic determinants, appropriate child care practices are important in prevention of growth faltering and undernutrition. Providing safe and appropriate quality complementary foods is crucial to child growth and development. However, some children in low-income communities grow normally mainly due to proper caregiver feeding behaviors. Hence, the objective of this study was to determine caregivers' feeding styles as well as to indentify predictors in Derashe special district, Southern Ethiopia.</p> <p>Methods</p> <p>A community based cross-sectional study design was employed in the seven randomly selected Kebeles (smallest administrative unit) of Derashe special district. A total of 826 caregivers provided data pertaining to socio-demographic variables. However, 764 caregivers had complete data for the outcome variable (caregiver feeding style). A multistage stratified sampling technique was used to identify study subjects. An adapted Caregiver's Feeding Styles Questionnaire (CFSQ) was used to gather information about caregivers' feeding styles. Multivariate multinomial logistic regression was employed to identify predictors of caregivers' feeding style.</p> <p>Results</p> <p>The majority (80.6%) of caregivers were biological mothers. Nearly seventy-six percent of the caregivers practiced a responsive feeding style. Caregivers other than the biological mother favoured a laissez-faire feeding style, while caregivers residing in rural Kebeles were more responsive. Caregivers with a breastfeeding frequency of more than eight times predicted both laissez-faire (RRR = 1.88; 95% CI = 1.03-3.41) and controlling (RRR = 1.7; 95% CI = 1.02-2.85) feeding styles as compared to responsive feeding.</p> <p>Conclusion</p> <p>Responsive feeding was the commonest style practiced by the caregivers. Many of the caregivers who were rural residents and birth parents have been responsive in child feeding. The instruments needed to be validated in the Ethiopian context and an additional prospective study based on direct observation of caregiver-child interactions is recommended.</p

Readiness of health centers and primary hospitals for the implementation of proposed health insurance schemes in Southwest Ethiopia

Background: In response to the 2005 World Health Assembly, many low income countries developed different healthcare financing mechanisms with risk pooling stategy to ensure universal coverage of health services. Accordingly, service availability and readiness of the health system to bear the responsibility of providing service have critical importance. The objective of this study was to assess service availability and readiness of health centers and primary hospitals to bear the responsibility of providing service for the members of health insurance schemes.Methods and materials: A facility based cross sectional study design with quantitative data collection methods was employed. Of the total 18 districts in Jimma Zone, 6(33.3%) districts were selected randomly. In the selected districts, there were 21 functional public health facilities (health centers and primary hospitals) which were included in the study. Data were collected by interviewer administered questionnaire. Descriptive statistics were calculated by using SPSS version 20.0. Prior to data collection, ethical clearance was obtained.Results: Among the total 21 public health facilities surveyed, only 38.1% had all the categories of health professionals as compared to the national standards. The majority, 85.2%, of the facilities fulfilled the criteria for basic equipment, but 47.7% of the facilities did not fulfill the criteria for infection prevention supplies. Moreover, only two facilities fulfilled the criteria for laboratory services, and 95.2% of the facilities had no units/departmenst to coordinate the health insurance schemes.Conclusions: More than nine out of ten facilities did not fulfill the criteria for providing healthcare services for insurance beneficiaries and are not ready to provide general services according to the standard. Hence, policy makers and implementers should devise strategies to fill the identified gaps for successful and sustainable implementation of the proposed insurance scheme.Keywords: - Health Insurance,Public Health Facilities, Readines

Hypertensive Disorders of Pregnancy in Jimma University Specialized Hospital

Background: Hypertensive disorders represent the most common medical complications of pregnancy with a reported incidence between 5 and 10%. The disorders are major causes of maternal and perinatal morbidities and mortalities. This study was conducted to determine the pattern and outcomes of pregnancies complicated by hypertensive disorders.Methods: Hospital based cross-sectional study was conducted on all mothers who gave birth in the labor ward of Jimma University Specialized Hospital from April 1, 2009 to March 31, 2010. Data was collected by interviewing the mothers and review of their medical records using structured questionnaire and checklist, respectively. Data analysis was performed using SPSS for windows version 16.0. Result: Majority (52.5%) of the mothers were in the age group of 25 - 34 years. The overall prevalence of hypertensive disorders of pregnancy was 8.5%. Severe preeclampsia accounted for 51.9% of the cases followed by eclampsia (23.4%). Residential area of the mothers (urban/rural) was found to have statistically significant association with severity of the disorder. Most (66.5% and 74.7%) of the mothers were nulliparous and had antenatal care follow-up during the index pregnancy, respectively. Antenatal care follow-up and parity had no statistically significant association with severity of the disease. The case fatality rate of hypertensive disorders of pregnancy was 1.3% with perinatal mortality of 317.1/1000 births.Conclusion: Pregnancies complicated by hypertensive disorders have poor maternal and perinatal outcomes and rural women were more affected. Quality antenatal care services with good obstetric and neonatal care at delivery are essential for early recognition and management of hypertensive disorders of pregnancy.Keywords: Hypertensive disorders, Hypertension, Pregnancy, EclampsiaEthiop J Health Sci. Vol. 21, No. 3 November 201

How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence.

INTRODUCTION: Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. METHODS: This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. RESULTS: We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. IMPLICATION FOR PRACTICE: Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. IMPLICATIONS FOR RESEARCH: Further research-experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness-is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required

An assessment of the free health care provision system in Jimma town, Southwest Ethiopia

Background: Despite the fact that equity is the underlying principle of all major global health policies, difficulties have emerged in providing proper care for the poor with the introduction of user fees for health services. However, the criteria used to determine eligibility for free health services at public health facilities are either unclear or nonexistent in most sub-Saharan African countries.Objective: To assess the free health care delivery system and the extent to which strict criteria are followed in granting free health care services in Jimma town, southwest Ethiopia.Methods: A cross-sectional, exploratory study, employing both quantitative and qualitative study designs, was conducted from December 22–27, 2003.Results: Fifty-eight percent of the respondents were found to be patients exempted from fees on the day of interview. There exist no clearly stated criteria in the free health care provision system of Jimma town. The presence of leakage and under-coverage were 36.9% and 43.6% respectively. The occupation and income category of the respondents showed a statistically significant association with their service category at the public health facilities (p=0.000). Conclusion: The absence of clearly defined criteria for waiving user fees at public health facilities has made the free health care provision system difficult for both the providers and users. The system is also prone to the possibility of leakage and under-coverage. These findings imply the importance of a strict reconsideration of the exemption policy of the locality and the country with focus on efforts to produce clear criteria and guidelines in granting free health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 188-19