Perceived barriers to health care for residents in vulnerable urban centers of Ethiopia

Background: Slums in urban settings are fast expanding and unprecedented proportions of urbanites are now living in slums, with the compromised provision of health services. Slum-dwellers in urban settings often face multifaceted barriers to accessing available health services. There is a paucity of evidence on identifying barriers in vulnerable urban centers of Ethiopia. This study aims to explore the barriers to the use of health services in slum urban settings of Ethiopia. Methodology: A qualitative study using in-depth and key informant interviews were conducted in 13 selected John Snow, Inc. (JSI) program operational urban areas of Ethiopia. Data were collected from community members, community opinion leaders, Urban Health Extension Professionals, and urban area health office representatives. The interviews were transcribed by data collectors and analyzed using a thematic content analysis approach. Accordingly, individuals, community- and health facility-level barriers were key themes under which findings were categorized. Results: Findings revealed that barriers to health service use at the individual level include limited awareness about health problems, competing priorities and limited capacity to pay for services when referred. Institutional-level barriers include limited medical supplies, and a lack of passion, respect, and positive attitudes on the part of health service providers. Barriers at the community level include a lack of shared understanding of the problems, services, and the community’s established values in relation to the problems and services. Conclusions: The provision of (maternal) health services in slums in Ethiopia’s urban settings is affected by different barriers that work in tandem. The improvement of health service provision in slum settings requires multiple interventions, including strengthening the health system’s responsiveness to health care demand. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):04-11] Keywords: Barriers, slum sections of urban centers, community, service provider

Community members’ views on Addis Ababa University’s rural community health training program: A qualitative study

AbstractBackground: Community-Based Education (CBE) is an educational process aiming to ensure educational relevance to community needs, thereby contributing to improved community health needs. Addis Ababa University runs a six-week long Rural Community Health Training Program at Adami Tulu District, East Shoa Zone. In the program, the final year medical students are attached to the community to apply their theoretical training and address the community’s health problems. This study explored views of the local community about the program.Methods: A descriptive qualitative study was carried out in Adami Tulu District of East Shoa Zone – the district is the site of the training program. Data was collected from community members, local administrators, health extension workers, school principals and opinion leaders selected from three kebeles within the attachment area. A total of five FGDs and six key informant interviews were conducted using a semi-structured interview guide. The audio-taped data was later transcribed verbatim and translated into English. Themes were developed guided by the objective of the study with the application of Open Code Version 4.02.Results: The finding of the study revealed that the local community, beyond recognizing the participants as some kind of medical professionals from Addis Ababa University, knew very little about the program and its objectives. For example, the only benefit all the participants rightly mentioned in common, as evidence of their knowledge the program is free treatment for sick children by the students. Lack of communication between the university and local administration; absence of community involvement in the planning, execution and evaluation of the program; and problems related to language were identified as key areas for improvement.Conclusion: The Rural Community Health Training Program (RCHTP) is an important resource for both the university and the local community. It is therefore important that the university take proactive measures and optimize the involvement of local leaders and community members to enhance their sense of ownership of the program. [Ethiop. J. Health Dev. 2018;32(1):10-17

Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study

Introduction: Although Ethiopia is one of the least urbanized countries in the world, the pace at which urbanization increases is unprecedented. During the last twenty years, urbanization has expanded rapidly and is estimated to be at 38% in 2050 from the current proportion of 19%. Despite the fact that urbanization is associated with relatively, better access to social services including health, residents in urban setting are believed to suffer from health disparities in health indicators such as use of Antenatal care (ANC), institutional delivery and postpartum care (PNC). This study aims to identify reasons why urban women fail to use available maternal health services in selected urban settings in Ethiopia.Methods: A qualitative study using focus group discussions and in-depth interview was conducted in six purposively selected urban settings such as Adama, Dire Dawa, Hawassa, Debre Berhan, Gondar, and Mekelle. A total of 11 Focus Group Discussions and 40 in-depth-interviews were completed with residents of these urban settings who were living in the section of urban setting characterized as slum. The data collected were categorized in to themes and analyzed using thematic method.Results: Study participants anonymously argued that there are positive changes in maternal health service utilization in all study settings over the years. However, students, daily laborers, widows, divorced and separated women, commercial sex workers, house maids, and migrants were found to be reluctant in using maternal health services such ANC follow-up, institutional delivery and PNC. Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community level in connection with pregnancy, delivery and postpartum.Conclusion: Although service utilization in urban setting is believed to have been relatively better over the years, still women in urban settings do not use available maternal health services. Especially women living in slum areas tend to neglect use of available health services. This study suggests that blanket programmatic approach should give way to intervention that target specific section of population. Furthermore, programs are expected to be tailored to addresses individual, institutional and socio-cultural factors in tandem to improve maternal health service utilization in urban setting. [Ethiop. J. Health Dev. 2017;31(2):96-102]Keywords: Maternal Health Services, Urban Health, Social Determinant of Health, Ethiopi

Health service access, utilization and prevailing health problems in the urban vulnerable sections of Ethiopia

Background: Currently, one-third of urban residents in Africa and Asia reside in slum settings with a compromised state of health, and this proportion is increasing at an alarming rate. In Ethiopia, it is estimated that 70-80% of the urban population lives in settings that are believed to be slums and most of the urban population has no access to improved sanitation. Though there is still a limitation on proper urban health profile data, there is evidence of vulnerability to a wide range of health-related problems in the country, including HIV. Hence, this study aimed to generate evidence on access to and utilization of health services, particularly by mothers and children, and the prevailing health problems of vulnerable sections of the urban population. Methods: A total of 115 urban vulnerable sections were identified in 46 towns in five regions (Amhara; Oromia; Tigray; Southern Nations, Nationalities, and Peoples’ (SNNP); and Harari) and two city administrations (Addis Ababa and Dire Dawa) where John Snow Inc. (JSI) urban centers are located. A cross-sectional household survey design was conducted among identified urban vulnerable sections of the population on 10–20 May 2017. A total of 1,220 households were included, based on a two-stage stratified sampling method. The analysis used mainly descriptive statistics and SPSS version 21 software was used for the analysis. Results: The mean age of the respondents was 43.2 (SD=14.8) years, and females accounted for 75% of all participants. The average time (SD) from the households to the health facility is 18 (±11) minutes. One month prior to the study, 32.6% of the household members reported having had some form of illness and 44% of them visited a health center and 36% a hospital. More than two thirds (68.6%) of women gave birth at a health facility and most (70.1%) births were assisted by a skilled provider. Nearly two thirds (63.4%) of women received a postnatal check-up. In 7.6% of the households, diarrhea occurred among children under 5 in the past two weeks, and 88% sought advice or further treatment. Non-communicable diseases (NCDs) account for the largest share of causes of morbidity among adults (29%) and death was observed in 8.4% of the households in the last three-year period prior to the survey. The most perceived causes of death in households were kidney disease, hypertension, heart disease, and other NCDs (65%). Conclusions: Health facilities are located near households. However, a significant proportion of mothers are still giving birth at home and more than a third of the births are attended by non-skilled attendants. Postnatal care utilization remained a challenge. NCDs were found to be the most prevailing problem among adults in the households and most of the deaths were also related to NCDs. Social changing interventions are recommended so that women have trust to deliver at facilities and postnatal visits are increased. Targeted preventive interventions are also essential to avert the growing burden of NCDs and others in the urban vulnerable sections. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):12-23] Keywords: Health service, access, health problem, vulnerable sections, Ethiopi

A qualitative study of vulnerability to HIV infection: Places and persons in urban settings of Ethiopia

Background: HIV continues to differentially affect specific population group and geographic locations in the world. Often individual risk behaviors are associated with vulnerability to HIV infection. However, such notion often overlooks the broader context of social determinants of the infection. Such determinant is broader than personal attributes and includes diverse social factors that contribute to vulnerability to as well as prevention of HIV infection. This study explores the social determinants for HIV infection in urban settings of Ethiopia.Methods: A qualitative study employing Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs) was conducted in six purposively selected cities of Ethiopia. FGDs and IDIs were tape recorded and fully transcribed. Transcripts were coded, categorized and analyzed using thematic analysis.Results: Findings show that it is not only people who are vulnerable, but specific places in urban settings where they reside. Vulnerability of places are linked to overcrowding, being hub of in-migrants and transistors, and with limited availability of services and infrastructure for its residents Majority of residents in such places were daily laborers, female sex workers, students who are living away from family, widows, separated and divorced women, those who work in restaurants and engaged in petty trade were found to be relatively more vulnerable group of population. They were also found to have weakened social controls and restraints that facilitate vulnerability.Conclusion: Every city has settings that are relatively more vulnerable as compared to others and there are population groups that are particularly vulnerable to HIV infection. Mitigating the spread of HIV infection requires mapping vulnerable section of the city and targeting vulnerable group of population makes interventions effective. Moreover, HIV intervention in urban settings calls for a multi-sectoral response. [Ethiop. J. Health Dev. 2016;30(3):105-111]Keywords: HIV, social determinant of health, place, person, JS

Selling my sheep to pay for medicines – household priorities and coping strategies in a setting without universal health coverage

Background: The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families’ opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities. Methods: A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants. Results: In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns. Conclusions: While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting concerns to newborn health and family welfare. We argue that families should not be left in situations where they have to choose between survival of the newborn and economic ruin. Protection against out-of-pocket spending is key as Ethiopia moves towards universal health coverage. A necessary step is to provide prioritized newborn health care services free of charge.publishedVersio

Cervicovaginal Microbiota Profiles in Precancerous Lesions and Cervical Cancer among Ethiopian Women

Although high-risk human papillomavirus infection is a well-established risk factor for cervical cancer, other co-factors within the local microenvironment may play an important role in the development of cervical cancer. The current study aimed to characterize the cervicovaginal microbiota in women with premalignant dysplasia or invasive cervical cancer compared with that of healthy women. The study comprised 120 Ethiopian women (60 cervical cancer patients who had not received any treatment, 25 patients with premalignant dysplasia, and 35 healthy women). Cervicovaginal specimens were collected using either an Isohelix DNA buccal swab or an Evalyn brush, and ribosomal RNA sequencing was used to characterize the cervicovaginal microbiota. Shannon and Simpson diversity indices were used to evaluate alpha diversity. Beta diversity was examined using principal coordinate analysis of weighted UniFrac distances. Alpha diversity was significantly higher in patients with cervical cancer than in patients with dysplasia and in healthy women

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination : A systematic review and meta-analysis

Research Funding National Health and Medical Research Council. Grant Number: APP1194679 World Health Organization Article Funding Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.Peer reviewedPublisher PD

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination:A systematic review and meta-analysis

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.</p

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe