Browsing by Author "Adugnaw Berhane"

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    Global Health Diplomacy in the Context of COVID-19 Vaccine Acquisition: A Case Study of Ethiopia
    (Addis Ababa University, 2024-05) Hawi Getnet; Meseret Molla; Adugnaw Berhane; Birhan Tassew
    The COVID 19 pandemic has enlighten the world of its existing inequality and vulnerability on global health infrastructure. With various geopolitical, logistical, and economic challenges during pandemics, GHD serves as a strategic tool for countries to achieve health goals through diplomatic efforts fostering negotiations and collaborations in ensuring equitable access to health care and vaccine access. While those richer countries secured vaccine stocks, many developing countries like Ethiopia, relied on global health diplomacy and international Aid to access the vaccine. By focusing on Ethiopia's GHD efforts during the COVID-19 pandemic within the dimensions of global health diplomacy, this research successfully uncovered the role, strategies, opportunities, challenges, and puts forward areas of improvement for future health emergencies. In doing so, the study provides insights that could be valuable not just for Ethiopia but for other countries understanding the complex landscape of health diplomacy during global health crises. This qualitative research used purposive snow balling sampling technique to identify the right participants. In-dept and KI interview was conducted both face to face and virtual, with 10 participants who had a direct involvement on the GHD efforts during the time. The data is analyzed using Atlasti.9. An inductive thematic analysis is done using the dimensions as thematic area. The results are presented under each dimension of GHD. The WHO, WB, UNICEF, GF and GAVI has been the major actors involved with major contribution to the MOH. The most frequent opportunity mentioned for the success of the efforts was the existing partnership the MOH had with partners. The government’s commitment with allocating a huge amount of money for the pandemic response, the domestic resource mobilization and the diaspora contribution had a significant impact in the response and vaccine acquisition success. Having no proactive budget for health emergencies, the cold chain infrastructure and the global resource nationalism were the challenges MOH faced. Unlike most other research, the results are able to provide broader and visible understanding on the efforts Ethiopia played during within the 7 dimensions of the GHD. This research outcomes can be used by decision and policy makers as a lesson learned for future pandemics to efficiently use opportunities and address challenges.
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    Hypertension Screening Practice and its Predictors among Employees of Commercial Bank of Ethiopia in Addis Ababa, Ethiopia Using the Health Belief Model.
    (Addis Abeba University, 2020-12) Bosona Tilahun; Adugnaw Berhane; Bezawit Ketema
    Background: Hypertension is a chronic medical state and important public health problem worldwide. In Africa more than one-third of adults are hypertensive. Therefore, assessing practice and perception towards hypertension screening is important for the disease primary prevention and reducing long lasting health complication. Decreased physical activities are important contributors of hypertension, which commonly seen amongst employees of the profession where working is mostly sedentary like bank employees. That is why the present cross-sectional study will be carried out. Objectives: The purpose of this study is to assess hypertension screening practice and its predictors among employees of Commercial Bank of Ethiopia in Addis Ababa, Ethiopia using the health belief model. Methods: An institutional based cross-sectional study was conducted among 620employees of Commercial Bank of Ethiopia in Addis Ababa and self administered questionnaire were administered to collect data. Independent sample t-test was used to determine whether mean differences existed between perceptions of employees who had ever screened and never screened for hypertension. Crude odds ratios were considered to measure associations for each variable with the hypertension screening practice and multivariable logistic regression was run to identify predictors of hypertension screening practice. Result: In this study hypertension screening practice among employees of Commercial Bank of Ethiopia was 29.19%.There was a mean score difference between the ever and never screened employees, which those who screened had higher perceived susceptibility, perceived severity, perceived benefit, perceived threat, self-efficacy, Net-benefit and cues to action at P<0.05.Perceived self-efficacy and Net-benefit were the predictors of hypertension screening practice with (P<0.001,AOR 1.106,95% CI 1.051,1.163) and (P<0.001,AOR 1.082,95% CI,1.041,1.125) respectively. Conclusion and Recommendation: This study high lights employees’ perceptions towards hypertension screening influenced the uptake of HTN screening uptake. Therefore, educational interventions given to increase employees perception towards self-efficacy and Net benefit improve the hypertension screening practice.
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    Intention to Khat Chewing Among Youths in Raya Azebo District , Southern Tigray, Ethiopia.
    (Addis Abeba University, 2019-10) Abadihailay Atsbaha; Adugnaw Berhane; Bezawit Ketema
    Background: Recently, Khat chewing has become a common practice worldwide. It causes and predisposes a significant physical and mental health, and social-economic crisis. However, behavioral intention to khat chewing is not well studied yet in Ethiopia. Objectives: To assess intention to khat chewing among youths in Raya-Azebo district, Southern Tigray, Ethiopia, 2019. Methods: A community-based cross-sectional quantitative study among randomly selected 627 youths in Raya Azebo district, Northern Ethiopia was conducted in 2019. Data were collected using a pre-tested structured interviewer-administered questionnaire. Epi Data version 4.4.2 was used for data entry then exported to SPSS version 25 for data analysis. A multivariable linear regression model was used to predict the contribution of independent variables and identify variables strongly associated with intention to khat chewing among youths. The goodness of fit model was checked and P-value ≤ 0.05 was used to declare statistical significance. Results: The response rate of the study was 97.82%. A considerable proportion, 192 (30.62%) of youths had an intention to chew khat in the next 6 months. The direct components of theory of planned behavior (TPB) were predicted by their respective indirect components. The component of TPB independently explained the variance in intention to khat chewing by 83.0%. TPB constructs and Socio-demographic, Knowledge, and past behavioral experience variables explained the variance in intention to khat chewing by 83.20%. The strongest predictors of intention to khat chewing were attitude (β= 0.350, P<0.001), subjective norm (β= 0.297, P<0.001), and perceived behavioral control (PBC) (β= 0.150, P= 0.01). Conclusions: Behavioral intention to khat chewing was a function of attitude, subjective norm and perceived behavioral control towards khat chewing. The behavioral intention was primarily under attitudinal influences. Conducting prospective study and construct validity of the tool is better. Strategies to empower youths to change a positive attitude of khat chewing, programs targeted on resisting social pressures and increasing self-efficacy to combat chewing are needed.
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    Parents’ and Teachers’ Perspective Towards Inclusive Education for Children with Autism in Pre-Primary and Primary Schools of Addis Ababa: A Qualitative Study.
    (Addis Ababa University, 2024-06) Hana Habtu; Adugnaw Berhane; Kalkidan Solomon
    Background: Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. Despite the Salamanca Statement's advocacy for inclusive education as a human right, the reality in Ethiopia shows a stark contrast, with only a small fraction of schools equipped with inclusive education. Objective: To explore the perspective of parents’ and teachers’ towards inclusive education for children with autism in pre-primary and primary schools of Addis Ababa, Ethiopia. Methods: The study was conducted in Akaki Kality and Arada sub city pre-primary and primary schools, government and private schools. A qualitative content analysis study approach using mixed sampling method was used to select participants. Content analysis was carried out using Atlas Ti software. Result: The study indicated that the concept of inclusive education is not widely recognized by most parents of typical children, it is well-understood and supported by nearly all parents of children with autism. While most typical child parents and teachers support inclusion and recognize its benefits for autistic children, concerns are raised about academic value and disruptions of learning process; some typical child parents and teachers preferring segregated learning. Barriers to IE are multifaceted and categorized as child with autism behavior related factor, parent and teacher related factor, systemic and institutional factor. Among the factors that facilitate IE are typical students and teachers support, parents' positive beliefs on their child with autism, awareness creation programs in schools, and collaboration with different organizations. Conclusion and recommendation: parents’ and teachers' perspective towards inclusive education have mixed views most supporting and highlight the social skill benefit children with autism get. However both participants are concerned about the implementation of IE due to many existing barriers. Therefore, for a better inclusion of children with autism, strategies that best fit our country and laws that mandate schools to implement IE should be settled. In addition capacity building for teachers, human and material resources, special need teachers, and categorizing autistic children according to their level and supping them as per their need is required.
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    Understanding Patient Satisfaction: Preferences, Expectations and Patient Rights of Practice in Public Hospital Settings of Amhara Regional State, Ethiopia.
    (Addis Abeba Universty, 2016-06) Adugnaw Berhane; Fikre Enquselassie
    Background: Patient satisfaction has become an indicator and a standard part of evaluation ofthe health care system, despite its complex nature and multiple determinants of patientsatisfaction. Health care now a day is a major service area for the people, thus it should satisfy itscustomers. There have been different mechanisms to enhance patient satisfaction. Adhere toservices on patients’ preferences, meeting expectations and health care practice based onpatients’ rights were among others. Making health care service more congruent with patients’preferences, expectations and patients’ rights practice can be achieved through measurement andfeedback of patients’ satisfaction and interventions that address patient concerns. Even countrieshave guaranteed patients' rights to process for resolving dissatisfactions with health careproviders. The implementation of patients’ rights can increase patient satisfaction, as well asachieve equal distribution of responsibility between the patients, and health service providers.Thus research is needed to move forward with the structural changes regarding patients’ value judgments in the health care service. Studies on patients’ preference to use health care, patient expectation and patient rights practice as an important factor for patient satisfaction carer endered at health care facilities in the developing country context like Ethiopia are often neglected in health service researches and rarely subjected to scientific inquiry. Objectives: The study aimed to examine patients’ preference, expectations, and the lived experience of patients on patient rights practice as a factor of patient satisfaction at public hospitals in Amhara Region, northern Ethiopia. Methods: The study was carried out in nine public hospitals of Amhara Region of Ethiopia. It was designed as a mixed method study in which both quantitative and qualitative data collection and analyses were employed. About 1005 participants in the out and in patient departments of general, medical and surgical departments were involved in the preference study which used Discrete Choice Experiment method. A stated-preference discrete choice experiment survey was performed among patients who visited the hospitals. Six attributes namely waiting time, physician communication, nursing communication, drug availability, continuity of care, and diagnostic facilities were selected based on a literature review of the most important characteristics of hospital health care service. These attributes were reviewed and validated with inputs from patients and researchers in the field. Data were entered in SPSS Version 17 andanalyzed using STATA version 12. A random-effects probit model was used to perform the analysis. Regarding the quantitative Pre-and-Post consultation study of patient expectation, 776participants were involved in the study. Data were collected on two occasions; about the expectations before consultation, and how their expectations were met and their satisfaction afterthe consultation. Data were entered and analyzed using SPSS Version 17. Means were computedfor the overall and the sub categories of expectation items. Paired t-test and logistic regressionanalysis techniques were also employed. For the qualitative study, data were collected using semi-structured interview from 22 patients who have had experience of health care service utilization in the hospital setting. The participants were selected purposively using maximum variation sampling technique based on criteria like age 18 and above years, both sexes, considering residence, educational status, and experience in the outpatient and inpatient departments. The interview (data) were tape-recorded,transcribed, translated, reviewed, and analyzed using an iterative content approach of phenomenographic researches. Open code software version 4.02 was used for data management.Main categories and sub categories were described. The outcome space was constructed based onmain categories of patients’ conceptions and ways of understanding the phenomenon of patientrights practice. Results: The attributes included in the preference study; waiting time, physician communication,nursing communication, drug availability in the hospital pharmacy, continuity of care anddiagnostic facilities had significant impact on participants’ decisions in the choice of hospitals.The waiting time coefficient showed a negative value in the main effects model (β=-0.773,P=0.026) indicated a higher probability of choosing a hospital with less waiting time for aconsultation. Patients were willing to wait up to 3.3 (MRS, 3.263 95%, CI: 1.387-5.139) hoursand 2.7 (MRS, 2.66 95%, CI: 1.769-3.556) hours to get full drugs in the hospital and goodnursing communication, respectively.Preferences differ with sex occupation and type of hospitals. Farmers preferred a hospital withgood nursing communication (=0.089, P<0.05), and partial drug availability (=0.101, P<0.05). Participants with no jobs preferred a hospital with partial drug availability (=0.150, P<0.05) and those patients who were from referral hospitals preferred a hospital that has continuity of care (=0.081, P<0.05). Patients expressed preferences in a decreasing order of all the significant attribute levels: a lot of diagnostic facilities, full drug availability, presence of continuity of care, good nursing communication, partial drug availability, good physician communication, and shorter waitingtime for the consultation. A hospital with lots of diagnostic facilities was ranked at the top, whichaccounted for 65.9% of the log-likelihood. This was followed by full drug availability in thehospital, continuity of care, and good nursing communication collectively accounting for 23.5%.According to Degner Scale to measure the preference in making decisions about medical care,412(53.1% of participants expressed a desire for sharing responsibility for which treatment isbest for them. This indicates patients prefer collaboration on medical decision. Of the 776patients included in the study, 594 (76.5%) were satisfied with the global measure of patientsatisfaction. Significant mean difference was reported in overall expectation between preconsultationand post-consultation ( x 1 =39.62±10.27) to ( x 2= 47.34±14.45) with (t = -12.95,P<0.001).The Multivariable logistic regression analysis showed that the probability of patient satisfactionis contingent on post consultation expectation score level. Higher score of post consultation metexpectation scores, less likely satisfied. Participants with excellent to good self-perceived health status groups were 3.5 times (OR, 3.53, 95% CI; 2.27-5.49) more likely satisfied than fair to very poor self-perceived health status groups. Similarly, the odds of satisfaction were higher amongparticipants who had a lot of perceived control on health compared with their counter parts. Theodds of satisfaction were significantly lower among patients who were disappointed with theconsultation (OR, 0.32, 95% CI; 0.22-0.47) compared to patients who were not disappointed.Similarly, the odds of satisfaction were lower among participants who had previous experiencein health care service compared with their counter parts. Compared with patients that felt a lot ofinfluence on the consultation, the odds of satisfaction was significantly lower (OR, 0.58, 95% CI;0.37-0.91) to patients who do not felt a lot of influence on the consultation. The association with pre consultation expectation scores and age were not significant in the multivariable regression analysis. The qualitative findings indicated patients described four qualitatively different main categoriesof patient rights practice. The main categories of description include: patient centered practice, being secured, respecting dignity and getting referral. Patient rights practice was understood from comprehensive to the lowest level hierarchically in the following order: patient centered practice, getting referral, respect dignity, and being secured. Conclusion: Patient satisfaction can be understood from the perspective of patient preference, expectations and patient rights of practice. Changes to the diagnostic facilities of a hospital are likely to have the greatest impact on patients’ preferences for hospital health care. Patient satisfaction had no relationship with pre-consultation expectations. But, it had relationship with post consultation met expectations. Based on the qualitative study, patient centered practice was a comprehensive way of illustrating patient rights practice in the hospital setting. Recommendations: Health service providers and managers should focus on patient experience and work on their preferences to enhance patient satisfaction. Providers should also acknowledge patient rights practice in the health care continuum. Policy makers should draft a frame work which incorporates patients have the right to choose to consult a health service, and which one to consult. The health care should incorporate patient centered care in health care based on the values and standards established by the patient and the health profession. Health care ethics training both in the pre-service and in-service as well as ethical reasons in daily activities should get due attention. Furthermore, health care providers should also take part to identify situations that violates patients’ rights and focused on to practice with their best effort. Future research on the preferences for health care in a specific hospital’s department/ward may be important to elicit disease-specific preferences for hospital health care. Other studies which incorporate health service providers should be conducted to address the complete picture of patient satisfaction and the match in expectation and patient rights practice between patients and health service providers.