DSpace Collection: Thesis - Public Health

Assessment of Quality of Adult Antiretroviral Treatment Services in public hospitals of Addis Ababa

Fri, 18 May 2012 13:33:18 GMT

Title: Assessment of Quality of Adult Antiretroviral Treatment Services in public hospitals of Addis Ababa

Authors: Daniel, Dejene

Abstract: Background: Antiretroviral therapy (ART) is a breakthrough intervention in care, support & prevention of HIV/AIDS. This program has been scaled up and decentralized in our country recently. Multiple works should be done to assess the quality of the service in Addis Ababa. Objective: The study tried to assess the quality of ART services in public hospitals of A.A. with emphasis on client satisfaction, providers’ views, functional & structural status of the ART service. Methodology: Quantitative & qualitative designs were used. 420 clients were considered for exit interview about their satisfaction using structured questionnaire. To assess the structural & functional aspects in ART sites, self-administer questionnaire for ART coordinators and observation check list were used. In-depth interview of providers was conducted for their views on services. Descriptive statistics was used for most variables. SPSS version 15 was used for data entry, cleaning and analyses. Result and Discussion: Nearly half clients had consultations time less than 10 minutes. Critical information of procedures, ongoing counseling was not given for many clients. All ordered laboratory tests & all prescribed drugs were not available for 21.8% and 14.4%of clients respectively which is not in accordance with recommendations( national & WHO’s) for ART implementation. Linkage of clients to care and support functions were a major gap (84.0% were not linked despite having the need). It hampers the comprehensiveness of ART care in this study area. The overall none satisfaction rate was 44.4%. it is large figure which negatively effect prime objectives of the program; like good adherence, safe & effective drugs, expansion of the service. The major determinants for none satisfaction were availability of OI drugs; care & support functions, waiting & consultation time. The determinants were similar to different studies for clients satisfaction. Poor motivational schemes & workload were big gaps. Conclusion: The overall none satisfaction rate was too large. Most sites had the minimum recommended packages for implementation of ART. However, there was significant work load; long waiting time, and short consultations time. Shortage OI drugs and poor care and support interventions were a big challenge. Recommendation: Strengthen programs on care and support through resource mobilization, community involvements through health education need to be done. Attention should be given by all stakeholders for continuous availability of OI drugs. Offering services in extra time, decentralization &task shifting should be encouraged. Hospitals should Increase responsiveness to preferences of clients using suggestion boxes, during meeting and decisions. Build the capacity of hospitals to address the problems of telephone, laboratory services, and motivational aspects.

EXAMINATION OF THE LEVELS AND DETERMINANT FACTORS OF FERTILITY AND CONTRACEPTIVE USE IN NORTHWEST ETHIOPIA

Thu, 17 May 2012 14:53:39 GMT

Title: EXAMINATION OF THE LEVELS AND DETERMINANT FACTORS OF FERTILITY AND CONTRACEPTIVE USE IN NORTHWEST ETHIOPIA

Authors: Getu, Degu

Abstract: Background: Nearly two million people are added to the population of Ethiopia each year. It is the second most populous country in Africa (next to Nigeria) and usually quoted as one of the demographic giants on the African continent. It has now become clear that uncontrolled fertility has adversely influenced the socio-economic, demographic and environmental situations of Ethiopia. Rapid population growth has hampered its development making the eradication of extreme poverty and hunger difficult. The country has experienced many man made and natural disasters. This undesirable situation is further aggravated by rapid population growth. In spite of the rapid population growth in Ethiopia in General and in the Amhara region (especially in the two Gondar Zones) in particular the contraceptive prevalence rates are reported to be low. Objectives: A number of distinct objectives that addressed several issues which ultimately led to the examination of fertility and the use of family planning methods were employed. Efforts were made to estimate the fertility rates and quantify the contribution of each of the proximate determinants of fertility that bring fertility below its biological maximum in North and South Gondar Zones of Northwest Ethiopia. It was also aimed at identifying the factors influencing fertility and investigating the perception of the study subjects towards rapid population growth. Moreover, efforts were made to closely explore the current practices and future intentions of the study subjects towards contraception. Methods: The study had two components. The first one was a quantitative study which involved 3512 women aged 15 to 49 years. The second component was a qualitative study which consisted of five focus group discussions and ten key informant interviews. iv I) Quantitative study: A multi-stage cluster sampling technique was applied to select the required study units from the urban and rural areas of the study zones. Ten Weredas (eight rural and two urban Weredas) were included in the present study. A total of 2756 women were drawn from the randomly selected rural Woredas while the remaining 756 were taken from the two big towns of Gondar and Debre Tabour. These towns have the status of Woreda administrations. Because the present study had a number of different outcome variables it was necessary to calculate the respective sample sizes separately. Among the various sample sizes computed on the bases of different assumptions, the one with the greatest value was taken as the final sample size. A structured questionnaire with closed and open ended questions was used to collect the quantitative data. A questionnaire which encompassed 7 different sections was first prepared in English and then translated into the local language, Amharic. Among others, the questionnaire included questions relating to the socio-economic and demographic characteristics, population pressure, history of marriage, contraception, pregnancy and fertility preferences of the women. The whole questionnaire was tested prior to collecting the actual data in order to standardize the flow and content of the questions. Accordingly, amendments were made depending on the results of the pre-test that was conducted in the nearby similar areas. Data collection was carried out by twenty health professionals (health officers, nurses and environmental health technicians) who were given a three-day intensive training with practical exercises. Five health officers/sanitarians were assigned to supervise the data collection process. The various statistical and demographic techniques such as, multivariate logistic regression (unconditional) and the Bongaarts model were applied to analyze the given data and to estimate the required fertility rates and proximate determinants of fertility depending on the specific nature of the variables under consideration. v II) Qualitative study: This part of the study was aimed at substantiating and complementing the main quantitative study. The selection of participants and the formation of the focus group discussions were facilitated by the community leaders of the respective kebeles (Woredas) under consideration. Three Woredas, Dembia and Dabat in North Gondar and Fogera in South Gondar were identified for the conduct of the five focus group discussions. Some of the key informant interviews were also undertaken in these Woredas. Results: The overall total fertility rate of the two Gondar zones was computed as 5.3. Among the three major proximate determinants in reducing fertility in the two zones, postpartum infecundability (Ci=0.55) stood first followed by contraceptive use (Cc=0.75) and non-marriage (Cm=0.83). On the other hand, the analysis made on the examination of the association of different variables with the fertility level came up with some interesting findings. In this regard, among the 25 variables considered in this study, only 9 of them were found significantly and independently associated with the level of fertility. Women with at least secondary education were at a lower risk of high fertility with OR=0.37 (95% C.I., 0.21 to 0.64) compared to those with no formal education. However, women with primary education did not show any significant difference when compared with the same baseline group. Age at first marriage was inversely associated with the number of children ever born alive. Place of residence, household expenditure, number of children who have died, attitude towards using contraceptives, women's knowledge on the safe period, and current marital status were the other variables that showed significant associations with the level of fertility. Over 90% of the women who participated in the quantitative study and nearly all of the focus group discussants and interviewees felt that something should be done to keep the population from growing too fast. Surprisingly the overwhelming majority of the participants showed their approval of the government passing a law regarding the maximum number of children that couples should have in their lifetimes. vi The contraceptive prevalence rates among all women and currently married women were 22% and 27.3%, respectively. The unmet need for family planning was 38% among currently married women. Educational status of the women, discussion with partner about family planning and possession of functional radios were amongst the factors that showed significant associations with the practice of contraception. All married men and the majority of religious leaders who participated in the qualitative study were in favor of the use of contraceptives. Conclusion: The fertility-inhibiting effect of postpartum infecundability resulting from prolonged breastfeeding is by far the most important proximate determinant in the entire study areas. A substantial role on fertility decline (particularly in urban areas) is played by contraceptive use. The promotion of breastfeeding should continue by all concerned bodies and the region should give much emphasis to make the majority of the rural population (both women and men) users of modern contraceptive methods. Female education beyond the primary level, reduced infant and child mortality, delayed marriage and correct knowledge on the safe period during the menstrual cycle were amongst the main factors that had a bearing on high fertility. Both the quantitative and qualitative components of the study showed encouragingly positive attitudes of women, married men and religious leaders towards contraception. However, the unmet need for family planning is still very high necessitating rigorous promotional and counseling activities besides making the method of choice available and accessible to the clients. Overall, the present study has shown the very fact that things on the ground are changing and it is timely for the responsible bodies to exert maximum effort and commitment in responding to the emerging attitudes of the people by making the population problem a priority.

Assessment of sexual risk behaviours of in-school youth: effect of living arrangement of students; West Gojam zone, Amhara regional state, Ethiopia.

Thu, 17 May 2012 14:45:30 GMT

Title: Assessment of sexual risk behaviours of in-school youth: effect of living arrangement of students; West Gojam zone, Amhara regional state, Ethiopia.

Authors: Anemaw, Asrat

Abstract: Background: Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, to the investigator's best knowledge, there have been only one previous study of possible differential vulnerabilities of in-school adolescents to risky sex in reference to parental influences and living arrangements in Ethiopia. Objective: To assess and compare sexual risk behaviours of preparatory students in West Gojam zone, in reference to their living arrangements Methodology: A comparative cross-sectional study was done in ten preparatory schools; West Gojam zone, Amhara National Regional State, Ethiopia. The study participants were selected based on probability proportional to size. A total of 314 students [104 living permanently in the corresponding towns and 210 not], were included in the study. Result: Seventy three (23.2%) respondents had ever had sexual intercourse with an individual of the opposite sex. Disaggregated by sex, 55 (25.0%) of males had had sex compared to 18 (19.4%) of females. Twenty two students (33.3%) reported having had two or more sexual partners in their lifetime (range 1-7, average1.56). In the logistic regression analyses, controlling for observed covariates, age more than 20 years [OR= 2.85; 95%CI= 1.07 to 7.59], having peer pressure to have sex [OR= 4.43; 95%CI= 2.02 to 9.69] and perceived family connectedness [OR= 0.96; 95%CI= 0.92 to 0.99] continued to be significantly and independently associated with sexual activity Conclusion: A greater sense of connectedness to parents decreases the likelihood of sexual activity regardless of living arrangement, Parental monitoring, gender, khat and alcohol consumption, and parental education. Students with peer pressure to have sex are more likely to initiate sexual intercourse.

ASSESSMENT OF ECONOMIC COST OF MALARIA IN KERSA DISTRICT, JIMMA ZONE, SOUTHWEST ETHIOPIA

Thu, 17 May 2012 12:58:32 GMT

Title: ASSESSMENT OF ECONOMIC COST OF MALARIA IN KERSA DISTRICT, JIMMA ZONE, SOUTHWEST ETHIOPIA

Authors: Lelisa Sena

Abstract: Background: Malaria is among the top public heath problem, especially Sub-saran Africa countries, including Ethiopia, are highly affected by the disease. Due to resistance development of both the vector (to insecticides) and the parasite (to drugs) coupled with shortage of resources; the eradication program was not completely successful. Consequently, malaria continued to be major obstacle of health and economic development. It is understood to be both a disease of poverty and a cause of poverty. Data on malaria expenditures of both households and health services are scarce although they are important for advocacy, planning (priority setting) purposes and as baseline for detailed studies. Objective: To assess the direct economic costs at household and primary health care levels as well as indirect (lost workdays) costs of malaria at household level. Methods: The study was conducted from Dec.2004 to Jan. 2005 at households of four rural kebeles and three primary health services of Kersa district, Jimma Zone. The four kebeles were purposively selected on the basis of accessibility to health services. Three hundred households of these rural kebeles were systematically selected from malaria case registration books that had been done by community health workers of the respective kebeles. At the same time sample health services were assessed to capture both recurrent and capital costs of malaria. Results: Out of the 1712 members of studied households 1185 (69.2%) reported to have malaria for an average of 19.34 days in the year. Only 5.2% of the lost workdays were compensated. The 7 direct household expenditure was Birr 67.10 and the estimated indirect cost (lost workdays) was Birr 347.85 per household. The unit cost of malaria (average of the three health services) was Birr 11.53 (19.00, 10.32, 4.29 at health center, clinic and health post respectively). Conclusions and Recommendations: The disease has imposed heavy burden on the community both in terms of morbidity and economic loss. Therefore, strengthening preventive measures, advocacy workshops with concerned bodies to mobilize reasonable resource for malaria control (and prevention) program, private sector involvement where and prospective longitudinal studies were recommended.