Full Immunization Coverage and Associated Factors among Children Aged 12-23 Months in a Hard-to-Reach Areas of Ethiopia.

INTRODUCTION: Childhood immunization averts 2.5 million annual child deaths globally. However, poor monitoring, possibly due to a lack of locally available data on immunization, might affect full protection of vaccines from Vaccine Preventable Diseases. This study was aimed at bringing data about immunization service coverage and its associated factors from Sekota Zuria district, which is one of the hard-to-reach areas in Amhara Region, Ethiopia. METHODS: A community-based cross-sectional study was conducted from September 20 to October 28, 2017, among 620 children aged 12-23 months in seven randomly selected rural kebeles of Sekota Zuria district. Socio-demographic child conditions and vaccine-related data were collected using a pretested interviewer-administered questionnaire. Multivariable logistic regression analysis was carried out to identify factors associated with immunization coverage at a p-value ≤ 0.05. Crude and Adjusted Odds Ratio (AOR) with their confidence interval were reported. RESULTS: 77.4% (95%CI: 74.0%-80.6%) of children aged 12-23 months were fully immunized. Having antenatal care visit (AOR=2.75, 95%CI: 1.52-5.0), higher level of maternal education (AOR=2.39, 95%CI: 1.06-5.36), mothers' good knowledge on immunization (AOR=3.70, 95%CI: 2.37-5.79), short distance to health facility (AOR=2.65, 95%CI: 1.61-4.36), and being born in health institutions (AOR=2.58, 95%CI: 1.66-3.99) had increased the odds of full immunization coverage while having five and more family size reduced the odds of children's vaccine uptake (AOR=0.62, 95%CI: 0.38-0.99). CONCLUSION: Full immunization coverage of the district was lower than the target set by the World Health Organization. Improving mother's health seeking behavior toward pregnancy follow-up and enhancing mothers' knowledge on child immunization, strengthening outreach services, community engagement, and actively working with local community-based health agents are recommended to increase number of children to be vaccinated.Peer Reviewe

Knowledge of Pregnant Women on Mother-to-Child Transmission of HIV in Meket District, Northeast Ethiopia

Knowledge of pregnant women on the three periods of mother-to-child transmission (MTCT) of HIV has implication for child HIV acquisition. This study aims to assess the knowledge of pregnant women on mother-to-child transmission of HIV and to identify associated factors in Meket district, northeast Ethiopia. Logistic regression models were fitted to identify associated factors. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the presence and strength of association. About onefifth (19%) of women were knowledgeable on mother-to-child transmission of HIV (95% CI: 15.5%, 22.4%). Being urban resident (AOR: 2.69, 95% CI: 1.48, 4.87), having primary education (AOR: 2.41, 95% CI: 1.03, 5.60), reporting receiving information on HIV from health care providers (AOR: 3.24, 95% CI: 1.53, 6.83), having discussion with partner about mother-to-child transmission of HIV (AOR: 2.64, 95% CI: 1.59, 4.39), and attending antenatal care (AOR: 5.80, 95% CI: 2.63, 12.77) were positively associated with increased maternal knowledge of mother-to-child transmission of HIV. Knowledge of mother-to-child transmission of HIV among pregnant women was low. Providing information, especially for rural women and their partners, is highly recommended. Background Vertical transmission of Human Immunodeficiency Virus (HIV) is still a major challenge in the world, especially in developing countries Without any intervention, the risk of a baby getting HIV infection from an infected mother ranges from 15% to 25% in the developed nations and from 25% to 35% in developing countries. HIV transmission rate and timing are estimated to be 5% to 10% during pregnancy, 10% to 15% during delivery and 5% to 20% through breast-feeding. In general mother to child transmission contributes 15-45% of HIV acquisition for children The national adult HIV prevalence in Ethiopia is 1.2% It is estimated that 138, 906 children less than 15 years are living with HIV in 2014. There are an estimated 3,886 new infections each year due to mother-to-child transmission According to Ethiopian Demographic and Health Survey (EDHS) report, about three-quarters of reproductive aged women know that HIV can be transmitted to a baby through breastfeeding Maternal knowledge on MTCT is a corner stone of effective implementation of the World Health Organization (WHO) recommendation of the four-pronged approach to reduce mother-to-child transmission of HIV Despite the large challenge of vertical transmission of HIV, there were also limited community-based studies on women knowledge on mother-to-child transmission of HIV. Hence, this study attempts to fill the gap through assessing the level of knowledge of MTCT of HIV and its associated factors at Meket district, Northeast Ethiopia. Methods Study Design, Population, and Setting. A communitybased cross-sectional study design was conducted in Meket district, northeast Ethiopia, from March 8 to 21, 2014. Meket district is located 665 km north of Addis Ababa, the Ethiopian capital city. The district has an estimated population size of 254,520 of which 59,939 are reproductive aged women, and an estimated 8,246 were pregnant women. Those pregnant women are living in Meket district were constituted our study population. Sample Size and Sampling Procedure. Sample size was determined using single population proportion formula with the assumptions of 95% level of confidence, 12% proportion of knowledgeable women on MTCT of HIV Operational Definitions. In the present study, pregnant woman was regarded as being knowledgeable on MTCT if she correctly identified the three different modes/periods of MTCT of HIV; otherwise she was classified as nonknowledgeable. Comprehensive knowledge of HIV was also measured if a pregnant woman correctly identified three modes of transmission of HIV (unsafe sexual practice, blood transfusion, and MTCT) and recognized two common misconceptions. Comprehensive knowledge about HIV/AIDS was measured after posing the following questions: (1) knowing that condom use and limiting sex partners to one uninfected partner are HIV prevention methods, (2) being aware that a healthy-looking person can have HIV, and (3) rejecting the two most common local misconceptions, that is, HIV/AIDS can be transmitted through mosquito bites and by supernatural means in Ethiopia Data Collection Procedures. Data were collected using pretested, structured, and interviewer administered questionnaire. The questionnaire was prepared after reviewing relevant literatures. Five female nurses supervised by two BSc health professionals collected the data. For eligible women who were not at home during our first attempt, the interviewers revisited the participant's home at least two times before excluding the participant. Training was given to the data collectors about informed consent, techniques of interviewing, data collection procedures, and different sections of the questionnaire. Supervisors and principal investigators checked the questionnaire on its completeness and consistency on the daily basis. Data Processing and Analysis. The data were entered into EPI info version 3.5.3 statistical software and then sorted, cleaned, and analyzed by using SPSS version 20 statistical package. Descriptive statistics were done to describe the study participants in relation to relevant variables. Both bivariate and multiple logistic regression analyses were carried out to see the effect of sociodemographic factors, maternal condition factors, and other factors on the knowledge of MTCT of HIV and to control cofounding. Odds ratios with 95% CI were computed to identify factors associated with mothers' MTCT knowledge. Ethical Consideration. Ethical clearance was obtained from the Research and Ethical Review Committee (REC) at the Institute of Public Health, College of Medicine and Health Science of University of Gondar. Permission letter was secured from Meket District Health Office. Written informed consent was taken from each study participant after reading the consent form. The purpose and benefit of the study and their right to withdraw at any time were also delivered to each participant prior to the interview. Confidentiality of the information was maintained throughout by using anonymity identifiers, keeping their privacy by interviewing them individually. Results Sociodemographic Characteristics of Pregnant Women. Five hundred forty-two pregnant women participated in the study (97.5% response rate). The majority (85.4%) were rural dwellers. The mean age of the study participants was 29.45 years (SD = 5.4). Four hundred and sixty (84.9%) were married, 196 (36.2%) were able to read and write, and nearly four-fifths (80.1%) were homemaker ( Journal of Pregnancy 3 Knowledge of Pregnant Women on MTCT. One hundred three (19%) (95% CI: 15.5%, 22.4%) were knowledgeable on MTCT of HIV. Most (84.5%) heard about mother to child transmission of HIV. Among those who heard MTCT, more than two-thirds (70.7%) mentioned labor/delivery as a time of HIV transition from mother to child. 225 (41.5%) pregnant women identified at least two periods of motherto-child transmission of HIV. Nearly two-thirds (63.8%) had comprehensive knowledge on HIV/AIDS, and another equivalent proportion of women heard about PITC Factors Associated with Knowledge of Pregnant Women on MTCT of HIV. In multivariable analysis, higher levels of maternal education status, having received information about HIV from health professionals, and reported discussion of MTCT and ANC with their partners were positively associated with knowledge of mother-to-child transmission of HIV. Those women who live in the urban settings were about three more like to be knowledgeable than their rural counterparts (AOR: 2.69, CI (1.48, 4.87)). Those literate mothers were about three times more likely to be knowledgeable than who did not read and write (AOR: 3.25, CI (1.55, 6.78)). Likewise, a woman was 2.41 times more likely to be knowledgeable if she had completed primary school as compared to those who did not read and write (AOR: 2.41, CI (1.04, 5.60)). Pregnant women who received information on HIV from health care providers were about three times more likely to be knowledgeable than women who had not received information (AOR: 3.24, CI (1.54, 6.83)). Women who had discussions with their partner were more likely to be knowledgeable than those who had not (AOR: 5.80, CI (2.63, 12.78)). Correspondingly, mothers who discussed MTCT with their partners were more likely to be knowledgeable than those who had not (AOR: 2.64, CI (1.59, 4.39)) Discussion Being knowledgeable on MTCT of HIV and the fact that the risk of transmission can be reduced by using antiretroviral drugs are critical in reducing MTCT of HIV. This can contribute greatly towards the achievement of the Millennium Development Goals related to HIV. This study revealed that 19% (95% CI: 15.5%, 22.4%) of respondents were knowledgeable on MTCT of HIV. This result is in line with a cross-sectional study conducted at Temeke District Hospital, Dar Es Salaam (15.7%) In the present study, nearly two-thirds of pregnant women had comprehensive knowledge on HIV/AIDS which is higher than studies in Yaoundé (23%) Knowledge of pregnant women on MTCT of HIV among pregnant women was significantly varied based on their place of residence. Those pregnant women residing in urban areas were more likely to be knowledgeable when compared to the rural residents. This finding is in line with studies conducted at Gondar and Hawassa towns in Ethiopia In this study, pregnant women who discussed and received information about HIV/AIDS from health care providers were more knowledgeable. They were found to be three times more likely to be knowledgeable than those who had not. Spouse discussion on antenatal care follow-up was also positively associated with knowledge of MTCT. Those pregnant women who had discussions with their partners were six times more likely to be knowledgeable than those who had not discussed the issue. This is similar to reports from other studies Pregnant women may receive information from a variety of sources about health services. Spouses having delivered information and participated in discussions about MTCT of HIV with their wives (40.6%) were associated with good knowledge of the subject. Accordingly, pregnant women who had discussion with their partners were more than two times more likely to have good knowledge of MTCT. This might be because partner discussion in this regard could enhance their knowledge. This study tried to assess pregnant women who did not attend health care facilities for ANC and HIV concerning their knowledge about MTCT of HIV. However, because of financial and time constraints, this study did not include the knowledge part of prevention of mother-to-child transmission of HIV. Conclusions Despite many efforts, the knowledge of pregnant women on mother-to-child transmission of HIV is low. If pregnant woman resides in urban environment, she attends school, if she receives information on HIV from health care providers, and if she attends antenatal care, she is more likely to be knowledgeable on MTCT of HIV. Strengthening women education and by reaching previously inaccessible parts of the community, integration of HIV, prevention of MTCT, and ANC service, is highly recommended. Moreover, strengthening discussion of MTCT with spouses is important

Knowledge of Health Professionals on Cold Chain Management and Associated Factors in Ezha District, Gurage Zone, Ethiopia

Copyright © 2019 Zeyneba Jemal Yassin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background. Maintaining quality of vaccines has been one of the main challenges of immunization programs in Africa including Ethiopia, and this could mainly be explained by health professional’s knowledge about cold chain management. There are limited studies done in Ethiopia linking the knowledge of health professionals on cold chain management, and that is why we needed to conduct this study. Methodology. Institution-based cross-sectional study was conducted among all available health professionals in selected health facilities (232 health professionals). Face-to-face interview using a semistructured questionnaire was conducted to collect required information from September to October 2016. Observational checklist was used to spot availability and functionality of refrigerators. Data entry and cleaning was done using Epi Info and exported to SPSS for analysis. A multivariable logistic regression model was fitted to identify factors associated with health professional’s knowledge about cold chain management. Result. The response rate was 92.43%, and 119 (51.3%; 95% CI; 44.9%, 57.6%) health professionals had a satisfactory knowledge about cold chain management. Being trained on immunization program (AOR = 5.1; 95% CI: 2.68, 10.13), having a work experience above six years (AOR = 2.1; 95% CI: 1.8, 4.15), using EPI guidelines (AOR = 2.58; 95% CI: 1.47, 5.57), and being a BSc nurse/health officer (AOR = 2.4; 95% CI: 1.47, 14.4) had got better knowledge on cold chain management. Conclusion. Health professionals working in the health centers and health posts had low knowledge on cold chain management. Longer work experience, in-service training, and using EPI guideline at work were factors that improved health professionals’ knowledge about a cold chain management, which needs to be maintained.Peer Reviewe

The COVID-19 pandemic and healthcare systems in Africa:A scoping review of preparedness, impact and response

BACKGROUND: The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS: We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS: Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS: The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised

The COVID-19 pandemic and healthcare systems in Africa : a scoping review of preparedness, impact and response

Funding Information: Funding GAT was supported with funding from the Australia National Health and Medical Research Council (NHMRC) Investigator Grant #1195716.Peer reviewedPublisher PD

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.info:eu-repo/semantics/publishedVersio

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation