Sanitary chemical analysis of protected springs in Jimma zone, Southwestern Ethiopia

Abstract: Sanitary chemical analysis is one of the methods used to evaluate the safety of water. Water samples were collected from sixteen protected springs located in and around Jimma, Agaro, Shebe, and Asendabo towns from April to May 1997. After making three determinations in three samples taken from each protected spring, average analytical data of sanitary chemicals, namely, chloride (Cl-), ammonia (NH3+), nitrite (NO2-), and nitrate (NO3-), were compiled. Although concentrations of ammonia and nitrite were low, nitrate concentration which exceeded the safe level (50 mg/l) was recorded at three sites in Agaro and in one in Shebe area. The four springs with the highest nitrate concentrations were also noted to have the highest chloride concentration. This finding indicates the presence of organic pollution and, therefore, the microbiological safety of the protected springs is questionable. Moreover, the presence of excess nitrate in drinking water supply may present a potential health hazard as it is known to cause methemoglobinemia, especially in young infants. [Ethiop. J. Health Dev. 1999;13(1):45-48

Prevalence and associated factors of undernutrition among adult tuberculosis patients in some selected public health facilities of Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND: The prevalence of undernutrition among adult tuberculosis patients is high in developing countries. However it has not been well explored in Ethiopian situation. Therefore the aim of this study was to determine the prevalence of undernutrition and its associated factors among adult TB patients in some selected public health facilities of Addis Ababa. METHODS: An institution based cross-sectional study was conducted. The total sample size of the study was 360. The sample size was allocated to the selected health facilities proportional to their size and study subjects were consecutively enrolled to the study during the study period. Data were collected using a pretested structured questionnaire. The data were entered and cleaned by using EPI info version 3.6.1 and transferred to SPSS version 20 for analysis. Bivariate and multivariate logistic regression analyses were done to identify factors that are associated with undernutrition. RESULTS: The prevalence of undernutrition was 39.7 % (23.6 % mild, 8.6 % moderate and 7.2 % severe undernutrition). Functional status of the patients (AOR = 2.57; 95 % CI = 1.42, 4.68) and dietary counselling (AOR = 1.79; 95 % CI = 1.03, 3.12) were factors independently associated with undernutrition among adult TB patients. CONCLUSION: The prevalence of undernutrition was found to be very high. Regular nutritional assessment and dietary counselling should be part of the routine care of adult TB patients

Pattern and treatment outcome of patients with achalasia cardia after Modified Heller’s Myotomy: experience from Ethiopia

Background: Although achalasia condition occurs in males and females with equal frequency, there are studies reporting that there is a male predominance even in Ethiopia. There appears to be striking international variations with significant differences between countries with respect to prevalence, occurrence in different sex and age groups and clinical features. The main objective of this study was to determine the pattern of clinical presentation and demographic characteristics and to assess the surgical treatment outcome of patients with achalasia. Methods: This was a 5-year retrospective review of medical records and theatre operation register notes of patients operated for achalasia of cardia at Tikur Anbessa Specialized Hospital, Addis Ababa. Selected socio- demographic variables, clinical presentations, radiologic imaging, post-operative course and final outcome were recorded on a structured format. Data was entered, cleaned and edited using EPI info version 3.5.1 for windows and analyzed using SPSS version 15 for windows. Frequencies, percentages, Mann-Whitney U test and Chi-square test were applied to describe and compare the difference between sex, age and dysphagia scores. Wilcoxon Signed Ranks test was used to evaluate the surgical treatment outcome after patients underwent Modified Heller’s Myotomy (MHM). Results: A total of 46 patients’ records that were operated for achalasia were reviewed, of whom 56.5% were males, 52.2% were of younger age (52.2%) with a mean of 26.4 years (Range: 14 – 65 years). Thirty eight (82.6%) patients suffered from grade 3-4 dysphagia. Higher dysphagia score, with no significant statistical difference, was predominantly seen among the young (87.5%) and female (95%) patients. Severity of symptoms of dysphagia was significantly reduced after Modified Heller’s Myotomy (P<0.0001). Conclusion: Slight predominance of male sex and younger age group was found among patients operated for achalasia. Modified Heller’s Myotomy was found to be effective in alleviating symptoms of achalasia

Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting

Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75–82). Women attending health centres were more likely satisfied than women attending hospitals (χ2=83.7, df=12, P<0.001). The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ2=27.4, df=1, P<0.001). The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75–14.1) and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44–9.06). Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09–81). Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals

Knowledge, attitude and practice towards cervical cancer among women in Finote Selam city administration, West Gojjam Zone, Amhara Region, North West Ethiopia, 2017

Introduction: Cancer of the cervix is the leading cause of cancer-related death among women, especially in developing countries affecting women at a time of life when they are critical to social and economic stability.Method: The study was conducted at Finote Selam City Administration from February 01 to March 01, 2017 using a community-based cross-sectional study design. The representative sample size was selected using multistage sampling technique. The data were collected using an interviewer-administered questionnaire adapted from the previous study. Data were entered using EpiData Version 3.1 statistical software and analyzed using SPSS version 20 statistical package.Result: One hundred seventy (23.1%) were knowledgeable about cervical cancer whereas 63% of participants had a negative attitude and only 7.3% had ever screened for the disease. Logistic regression analysis showed that age, marital status, religion, experienced sexual intercourse and age at 1st sexual intercourse were found to be significantly associated with the knowledge of cancer of the cervix.Conclusion: Ministry of health in collaboration with other concerned bodies should design a strategy to give education about cervical cancer including information on risk factors, signs and symptoms; and availability of screening should be provided for women and as well as for the public.Keywords: Cervical cancer, screening, Finote Selam, North West Ethiopia

Practice analysis to validate Master of Public Health core competencies and identify education gaps in Ethiopia: a national cross-sectional study

Introduction: Competency-based education has the potential to transform education and health outcomes. The taskforce for strengthening public health education drafted core competencies for Master of Public Health (MPH) education in Ethiopia. This study aims to validate the draft MPH core competencies and identify education gaps. Methods: A national cross-sectional survey was conducted in 2015 with public health professionals who hold an MPH degree. The required sample size was calculated using a single population proportion formula. Study participants were selected from the different regions using a convenience sampling technique. They were asked to make judgments about the 127 draft competencies organized in 11 domains. For each competency statement, respondents answered four basic questions: 1) How important is the accurate and timely performance of the competency on population health outcomes? 2) How often do you perform the task? 3) How comfortable are you in performing the task? 4) When and where were you trained to perform the task? We collected data using a self-administered questionnaire. Data analysis involved calculating proportions for each competency, followed by generating an average percentage for each competency domain. Results: A total of 350 public health professionals from academia and practice participated in the study. Over 90% of respondents said that the draft public health core competencies were important for improving population health outcomes. More than one-third of the respondents indicated they performed the public health competencies rarely. A further 8.3% to 27.6% said they had never performed the public health competencies in their career. Although most respondents said they were competent, one-sixth to one quarter admitted a lack of capability in the domains of financial planning and management, cultural competence, policy and program, leadership and systems thinking, and education and training. Pre-service education was the most frequent setting for learning public health competencies. However, between one quarter and one third did not have any opportunity to learn some competencies, especially in the domains of cultural competence, financial planning and management, leadership and systems thinking, policy and program, communication skills, and education and training. Public health competency domains with high ‘not trained’ responses also drew high ‘not capable’ and high ‘never performed’ responses. Conclusions: The draft MPH core competencies are applicable to Ethiopia. The substantial education gaps found in our study warrant re-designing the MPH curriculum. [Ethiop. J. Health Dev. 2020; 34(Special issue 1):16-24] Keywords: Master of Public Health (MPH); essential competencies; postgraduate education; public health; competence gap

Gaps in public health training in Ethiopia: Insights from a qualitative study

Background: The challenges public health encounters in the 21st century in relation to social, economic, political and climatic dynamism are widely documented. Endeavors are under way at different levels to contain the challenges and ensure healthy living. However, the extent to which public health training is aligned with the demands of the century remains unclear. This study aims to explore efforts made by public health training institutions in Ethiopia to equip public health professionals with competencies that meet contemporary expectations, gaps and suggestions. Methods: Sixteen public health experts who hold advisory and decision-making positions in the public health sector, local and international development partners and public health training institutions of higher learning were purposively selected to participate in the study. A key informant interview technique was employed to collect data on what are perceived to be the gaps in public health graduates’ competencies, and suggested improvements. A topic guide was developed to elicit the competences of graduates, identify gaps in their competences, and extract suggestions on how to fill those gaps so as to contribute to the development of public health endeavours. Interviews were held at a time and place of convenience for the experts. Data collected were categorized under key themes: training, research, and future directions. Under each of these themes, knowledge and skills on leadership and management, community practice, design and conduct of problem-solving research were specified to compile and interpret the data. Efforts were made to faithfully represent the opinion of participants, and verbatim quotes of dominant opinions were collected without identifiers. Findings: There were four participants from training institutions, seven from public sector organizations, and five from development partners. The findings reveal the limitations of graduates to be able to take up public health functions. It was unanimously agreed that irrespective of the level of training, graduates need time to acquaint themselves with what is expected of them as a professional. It was found that public health graduates at master’s and PhD level failed to fit into the existing system fast enough to take on leadership responsibilities. Participants unanimously argued that public health training encounters major challenges in empowering students with the necessary knowledge and skills to meet contemporary public health challenges. The problem of a curriculum that does not change in line with changing public health needs, the lack of competence of teaching staff, lack of contemporary references, and lack of time and money to engage students in community practice, were identified as major drawbacks in training. The fact that the curricula of the different schools of public health were adapted from the same sources and has not been revised to fit the demands of the day was particularly emphasized by participants from universities. Students’ skill in planning and conducting problem-solving research, and skills to mobilize and engage the community to recognize and solve their own problems, were reported as limited, irrespective of the level of training and management. Conclusions: Public health training in Ethiopia is perceived to have major limitations, particularly where graduates, irrespective of their level of training, fail to contribute to public health functions. Curricula are not revised to meet current demands. This calls for concerted action by the education and health sectors and like-minded stakeholders to improve the curricula for the different levels of training in public health education. [Ethiop.J. Health Dev. 2020; 34(Special issue 1):4-10] Keywords: Public health training, public health competencies, community practice, problem-solving researc

Developing core competencies for the public health workforce in Ethiopia: The way forward

Background: Preparing the public health workforce for the 21st century is a formidable task as public health professionals are expected to address the myriad of political and economic development challenges in the context of limited resources. In spite of achieving most MDGs, the Ethiopian ‘health system’ continues to face complex and daunting tasks. Method: Available studies that outlined requirements for competent, motivated and empowered workforce in a rapidly evolving global order were reviewed and synthesized without following a formal review procedure. Result: Although it is not easy, in view of the available evidence, this synthesis provided the Way Forward to ascertain competencies of the public workforce in Ethiopia. Specific details on adopting and sharing competencies; promoting the development of a philosophy and definition of public health; promoting the development of a public health workforce taxonomy; promoting research to inform the design and implementation of reforms; curriculum development; learning materials development; strengthening continuing professional development (CPD); monitoring and evaluation; and setting up a follow-up mechanism for the long-term were defined. Conclusion: This synthesis has suggested clear guidance on how and who may have to track, adapt, share, and updates public health core competencies in Ethiopia. [Ethiop.J. Health Dev. 2020;34(Special issue 1):25-33

Issues in the definition and philosophy of public health in relation to core competencies

Introduction There are various definitions of ‘public health’, as it operates under different and sometimes conflicting skill sets, finance models, professional paradigms, legal authorities, and political environments. Official documents in Ethiopia do not attempt to give a formal definition of the term. A collective deliberation and position on these issues are therefore required. Method A rapid review of documents was undertaken to define ‘public health’, in order to help guide the preparation of core competencies for public health training in Ethiopia. Philosophical, theoretical, and programmatic materials were also reviewed. Findings and conclusions: The review reveals that various definitions of ‘public health’ persist and the situation is even worse in the neglected and even more controversial field of the philosophy of public health, whose complexity almost implies addressing the philosophy of everything. This is compounded by the quasi-absence of units/departments of public health philosophy and public health journals. The impact of this in the development of more impactful human resources for public health should not be underestimated. Even though public health will always be judged by what happens in practice, the better-developed schools of public health in Ethiopia are called upon to develop mechanisms to articulate a philosophy of public health for the country. [Ethiop. J. Health Dev. 2020;34(Special issue 1):34-38

Prevalence and Determinants of Low Birth Weight in Ethiopia: A Systematic Review and Meta-Analysis

Introduction: Low birth weight was defined as weight at birth less than 2500 grams. This had numerous negative outcomes such as fetal and&nbsp; neonatal mortality and morbidity. It was estimated that between year 2000 to 2018, twenty million (15% to 20%) of all births worldwide had low birth weight yearly. Data analyzed from the Swedish Childhood Diabetes Register (SCDR) indicated that, low birth weight infants. were 24% higher odds of developing type-1 diabetes, hypertension, obesity and dyslipidemia in future compared to normal birth weight infants. In Ethiopia, the proportion of births weighing less than 2.5 kg at birth in the past three DHS surveys was 14% in 2005, 11% in 2011, and 13% in 2016. That differed with WHO 2025 goal of achieving 30% reduction in the number of infants born with weight lower than 2500g. Objectives: This systematic review study was aimed to explicitly assess and determine the contributing factors of low birth weight in Ethiopia for intervention. Methodology: Cross-sectional, case-control and cohort studies were conducted in English language. A search of studies in the main databases; PubMed, EMBASE, CINAHL, Web of Science, Scopus, and other gray literature sources was conducted. In respect to eligibility criteria, the&nbsp; investigators included observational studies that had been conducted at a facility setting in different parts of Ethiopia on the prevalence and factors associated with low birth weight, published and accessible from 2000 - 2018 then written in English. Articles with irretrievable full text records with unrelated outcome measures with missing or insufficient outcomes, reviews, commentaries, editorial, case series/reports, and patient stories were excluded. Meta-analyses with random effects, subgroup analyses, and meta-regression were performed. Publication bias was measured using the Egger regression test and visual funnel plot inspection. Pooled odds ratio was done by using RevMan 5.3 software. 16 studies fulfilled the eligibility criteria. Result: The underlying causes were multi-factorial. Antenatal Care(ANC) and pregnancy complication increased the risk of low birth weight of&nbsp; infants in Ethiopia. Maternal harmful substance exposure(pesticide, noise, radiation and alcohol consumption), undernutrition, infections, poor socioeconomic status, history of chronic diseases, hepatitis B carriers, intrauterine growth restrictions (IUGR) were reported. The pooled prevalence of low birth weight was 18% (95% CI: 13.9%, 22.2%). Gestational age less than 37weeks was (AOR,7.8; 95% CI: 4.7, 12.95), no antenatal care (AOR,3.39; 95% CI: 1.65, 6.98), rural residence (AOR,2.44; 95% CI: 1.94, 3.08) and women with medical illness during pregnancy (AOR,4.36; 95% CI: 2.55, 7.44) that was significantly associated with low birth weight in Ethiopia. Conclusion: The pooled prevalence of low birth weight was high in Ethiopia. Most rural mothers were unable to follow antenatal care and maternal medical illnesses during pregnancy were significantly contributing factors. The meta-regression confirmed that the sample size and the&nbsp; methodological quality could partially explain the statistical heterogeneity. Recommandations: Almost all these factors can be prevented by scaling up Antenatal Care (ANC) with the help of Community Health Workers/ Volunteers(CHW/Vs), quality health facilities and improve on the socioeconomic status of the population. Policy makers to assimilate and take action&nbsp; to the multiple abnormalities found by formulating a management plan for patients with multiple organ disease in the maternity mortality reports. Keywords: low birth weight; prematurity; Ethiopia; systematic review; meta-analysi