Magnitude and Pattern of Injury in Jimma University Specialized Hospital, South West Ethiopia

BACKGROUND: Injury statistics in Ethiopia provides little knowledge about its magnitude and related information needed for prevention. This study, therefore, aims to determine the magnitude and pattern of injury in Jimma University Specialized Hospital (JUSH).METHODS: A retrospective review of records of all injured patients seen at surgical outpatient department from April 09, 2010 to January 07, 2011; was conducted in January 2011. Data were collected using a structured checklist that was developed by adapting the World Health Organization instrument. Five degree holder nurses collected the data while investigators closely supervised. Socio demographic characteristics of the patients and injury related information were collected. Data were analyzed using SPSS for windows version 16.0. RESULTS: Of 13500 patients who visited surgical outpatient department of JUSH during the study period, 1102(8.2%) were injury cases. The commonest mechanism of injury was blunt assault, 341(30.9%), followed by road traffic accident, 334(30.3). Fracture was the leading outcome of injury, 454(41.2%), followed by bruise or skin laceration, 404(36.7%). Significantly more males had cut, (AOR=2.0; 95% CI=1.2, 3.3) and stab, (AOR=3.0; 95% CI=1.6, 5.7), injuries compared to females. Conversely, significantly fewer males had burn, (AOR=0.4, 95% CI=0.2, 0.8) and road traffic accident, (AOR=0.7, 95% CI=0.5, 0.9), than females. Most, 715(95.8%), patients were presented to the hospital within one week. The commonest functional limitations were; difficulty to use hands, 312(28.3%) and difficulty to use legs, 217(19.7%). Eighty three, (7.5%) of the patients died and road traffic accident alone accounted for almost half, 179 (49.7%), of the severe injuries.CONCLUSION: The magnitude of injury in the hospital was considerably high. Age and sex were predictors of injury. Appropriate prevention strategies should be designed and implemented against assault, road traffic accident and cut by sharp tool. KEYWORDS: Injury, Magnitude, Pattern, Case records, Jimma University Specialized HospitalEthiop J Health Sci. Vol. 21, No. 3 November 201

Quality of birthing care in low income settings: the case of Ethiopia

Background: Maternal mortality is a common event for women in the poorer parts of the world. The maternal mortality ratio in Ethiopia is 412 per 100,000 live births. Most high burden countries including Ethiopia have strategies to provide skilled maternity care yet very few are making progress, due at least in part to not ensuring quality facility childbirth care. In Ethiopia, there are no studies on woreda (district) level factors associated with skilled birth attendance (SBA) rates, and evidence on quality of Labour and Delivery (L&D) care is generally scarce. Therefore, this project aimed at closing this gap. Methods: Two quantitative studies were conducted. The first study described variation in woreda SBA rates (N=839) and determinants of higher rates using a cross-sectional ecologic study design. The second study examined quality of birthing care in government hospitals (n=20) of Southern Nations and Nationalities Region (SNNPR) by collecting primary data, using a cross-sectional study design. Key findings: The first study showed that the mean woreda-level SBA rate in Ethiopia was low at an ecologic level, but with substantial variations. Women’s families, the wider community, availability of health resources, and proportion of four or more antenatal care significantly increased the SBA rate. The second study revealed gaps in the structural, process and outcome aspects of quality of L&D care in the hospitals. About two thirds of the required inputs were fulfilled, and only two hospitals fulfilled almost all the standards. Laboratory services and safe blood, essential drugs, supplies and equipment were the areas with the largest gaps. In terms of process quality, about two thirds of the standards were met overall for each woman for which she was eligible. The highest scores were achieved with immediate and essential newborn care practices, and care during the second and third stages of labour. History of a danger sign in the current pregnancy had a positive effect on the process quality at the level of each woman. At hospital level, teaching status and structural quality index score had significant positive effects, whilst annual L&D service volume had a significant negative effect on the process quality index score. Perceived quality of L&D care provided was also suboptimal. Being illiterate, absence of a complication after birth, perceived high quality of interpersonal communication and emotional support, responsiveness, health education and physical environment; all positively influenced women’s overall experience. Furthermore, teaching status and primary or general level of hospitals, staff training, and high quality of L&D care process index also positively affected the experience. Recommendations: It is essential to increase the coverage of four or more ANC visits and strengthen the current community-based approaches to meaningfully increase the SBA rate. There is a need to ensure that all hospitals meet the required structure to enable the provision of quality routine L&D care, with particular emphasis on laboratory services and safe blood for emergency transfusion, and availability of essential drugs, supplies and equipment. It is also important to focus efforts on the factors that showed a significant effect on the process quality of routine L&D care process and the women’s experience with the care received

Knowledge, experiences and training needs of health professionals about disaster preparedness and response in southwest Ethiopia: a cross sectional study

Background: Over the past decade, the magnitude and intensity of disasters have been vividly rising globally due to the forces of nature or man. This study aimed at assessing the perceived knowledge, experiences and training needs of health professionals regarding disasters, their prevention and management in Jimma Zone, Southwest Ethiopia. Methods: An institution based cross-sectional survey was conducted on 377 health professionals taken from 9 randomly selected districts out of 18. All health professionals working at health offices, hospitals and health centers were included. Data were collected using a structured questionnaire which was developed by the investigators after reviewing the relevant literature in the field. Data were coded and entered into SPSS 20 software for cleaning and analysis. Descriptive and logistic regression analyses were done.Results: The majority (85.1%) of the participants were able to define the concept of disaster from various perspectives; 9.7% did not know about it at all and 5.2% could describe the concept partially or misconceived it. The majority (84.3%) agreed that disaster has direct public health consequences on humans. The main public health consequence of disaster the participants mentioned was environmental pollution (65.8%). Malaria, measles and diarrhoeal diseases accounted for 35.5%, 33.1% and 10.5% of the epidemics, respectively. Only 20.6% of the respondents were trained on disaster related topics in the last two years.The majority felt that they had poor knowledge on early warning indicators of drought (48.0%) and flood (48.0%). Simialry, 50.8%, 47.7%, 51.1% and 42.6% of the participants had poor knowledge on preparedness to drought, preparedness to flood, response to drought, response to flood. On composite scale, they generally perceived to have adequate (29.4%), moderate (32.4%) and poor (38.2%) knowledge about early warning information bout, preparedness for and response to common disasters. A vast majority (92.8%) reported that they need training on disaster preparedness, management and response.Conclusion: A considerable number of professionals had limited understanding about the concept of disaster and response to certain specific disasters. They also had limited opportunities for training,despite their felt needs. Therefore, training should be provided focusing on the specific gaps identified.Keywords: training needs, disaster, knowledge, experience, health professionals, Jimma, Ethiopi

Prevalence of household food insecurity and associated factors in drought-prone pastoralist communities in Borana, Oromia, Ethiopia

AbstractBackground: Food security is a central component of the development agenda in pastoralist communities, especially among those who reside in drought-prone areas.Objective: This study measured the prevalence of household food insecurity and associated factors among pastoralist communities of Borana, Ethiopia. Methods and materials: A community-based cross-sectional study was conducted between July and August 2015 in two pastoralist communities in Borana Zone, Oromia, Ethiopia. Data were collected from 1,058 randomly sampled households through an interviewer-administered structured questionnaire. The data were analysed using SPSS version 21.0. Results: The mean household food insecurity score was 18.21 (value range: 0.00-27.00). Overall, 82.33% of the households were severely food insecure, with 14.56% moderately food insecure. Ownership of private farming land, reliance on crop farming as the main economic activity (β=1.47, p=0.016), and one-way walk time to water sources (β=0.01, p=0.001) were significantly associated with household food insecurity (p<0.05). Likewise, increased family size (β=0.49, p=0.001) and lack of education (β=1.41, p=0.025) were significantly associated with food insecurity. In contrast, dependence on small business (petty trade and shop) as the main economic activity (β=5.14, p=0.001); ownership of milking cow (β=-0.25, p=0.001), bull/heifer (β=-0.16, p=0.002), goat (β=-0.14, p=0.001) or pullet (β=-1.17, p=0.001); ownership of various assets, such as forage (β=-2.50, p=0.009); and participation in village-level saving schemes (β=-1.41, p=0.044) were all significantly associated with reduced household food insecurity. Conclusions: Household food insecurity was widespread in the pastoralist communities of Borana, Ethiopia, affecting a high number of households in all domains: food anxiety, food quality, and quantity of food at the household level. As there were factors that were linked to food insecurity in the study pastoralists, evidence-based innovative interventions via a combination of measures in a medium-to-long-term development plan are vital for sustained household food security. [Ethiop. J. Health Dev. 2021; 35(1):38-49] Keywords: Pastoralist, resilience, food resiliency, food insecurity, Borana, Ethiopi

Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy

Background: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. Scope and findings: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. Conclusions: Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes

Endemic goiter in School Children in Southwestern Ethiopia

No Abstract Available Ethiop.J.Health Dev. Vol.18(3) 2004: 175-17

Understanding Resilience Dimensions and Adaptive Strategies to the Impact of Recurrent Droughts in Borana Zone, Oromia Region, Ethiopia: A Grounded Theory Approach

Recurrent shocks and stresses are increasingly deteriorating pastoralist communities’ resilience capacities in many aspects. A context specific resilience framework is essential to strengthen pastoralist community’s resilience capacity towards the impact of recurrent drought. Hence, the present study was aimed to develop a context specific and data driven resilience building framework towards impacts of recurrent droughts in the case of Borana pastoralists in Ethiopia. Qualitative grounded theory approach was employed to guide the study process. The data were collected through focus group discussions and in-depth interviews in two drought affected districts of Borana Zone during October 2013. The analysis was assisted by ATLAS. ti 7.1.4. The analysis provided a context specific resilience building conceptual tool, which consists of, closely interconnected, eight dimensions operating at multiple capacities and levels: environment (underlying vulnerability factor); livestock, infrastructures/social services, and wealth (immediate causes and effects); community network/social capital, as well as governance, peace and security (support and enabling factors oriented), psychosocial, and human capital (as eventual outcomes and impacts). The resilience capacities of these pastoralist communities have been eroded, leaving them without sufficient and effective adaptive strategies. The emergent resilience framework can serve as a useful guidance to design context-specific interventions that makes the people and the system resilient to the impacts of recurrent droughts

Intervention pathways towards improving the resilience of pastoralists: A study from Borana communities, southern Ethiopia

Building resilient communities towards recurrent droughts is increasingly becoming an important element in development endeavours, particularly among communities vulnerable to shocks and stresses. Despite decades of remarkable efforts made by governmental and non-governmental organization, the resilience capacity of pastoralists in Ethiopia remains poor. The aim of this study is to test the statistical relationships among the resilience dimensions that emerged through community consultations, and to identify the intervention pathways for effective resilience building efforts. Data were collected from 1058 randomly sampled households in Arero and Dhas districts of Borana Zone, Southern Ethiopia. The data were collected through interviewer administered structured questionnaire and observational checklist. Principal component analyses were done to develop composite scores of the different resilience dimensions. Structural equation model (SEM) verified the theoretical model. The SEM also revealed that resilience towards impact of recurrent droughts was multi-dimensional and showed statistically significant (p < 0.05) relationships. Consequently, household food insecurity manifested as ultimate outcome of poor resilience. Infrastructure and social services (β = −0.24), livestock dimension (β = −0.21), human capital (β = −0.12), psychosocial distress (β = −0.1) dimensions significantly (p < 0.05) affected the status of household food insecurity. Furthermore, livestock and wealth (β = 0.16), wealth and infrastructure (β = 0.06), infrastructure and human capital (β = 0.18), livestock and psychosocial distress (β = −0.09) dimensions have structural relationships and significantly influence each other. Environment, and peace and security are found to be major underlying resilience factors and significantly associated with pastoralists’ resilience which affect other resilience dimensions. The intervention pathway indicated that intervention on the livestock and infrastructure dimensions could help to improve the resilience of these communities