Browsing by Author "Alemayehu Desalegne"

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    Cost and Cost-Effectiveness of Facility, Standalone and Mobile Based VCT in Addis Ababa, Ethiopia
    (Addis Ababa Universty, 2018-10) Amanuel Lulu; Alemayehu Desalegne
    Background: Early diagnosis of HIV virus is a determinant for effective treatment of the disease with less costs than a late treatment. Mobile based VCT as part of community HIV testing and counselling service is suited to highly populated settings. Recently the world has agreement on UNAIDS 90-90-90 goals to achieve 90% of people living with HIV to know their HIV status by 2020 and end the AIDS epidemic by 2030. Despite the agreement, HIV testing and counselling continues to be undertaken predominantly in health facilities, even if there is strong evidence on clients’ preference to test in the community. Hence, empirically studied cost-effective HIV testing and counselling model is desirable to achieve the goal. Objective: The objective of this study is to describe the cost and compare the cost-effectiveness of Facility, Standalone and Mobile based VCT in Addis Ababa, Ethiopia. Methods: Ingredients costing method and reciprocal cost allocation approach based on a provider perspective in view of economic costs was performed from July 2016 to June 2017 (2009 EFY). Effectiveness is measured by HIV-seropositive individual identified. A cross sectional study design using Decision tree modelling on TreeAge 2018 software was performed. One way and Probabilistic sensitivity analysis were conducted on HIV prevalence, costs, and probabilities. Result: The mean cost per client tested for HIV in Facility, Standalone and Mobile based VCT are USD 4.9, 6.6 and 3.7 respectively. The mean cost per HIV seropositive client identified for the corresponding models are USD 153.6, 154.1 and 138.8 respectively. From the three models, Standalone based VCT is extendedly dominated. The incremental cost of Mobile based VCT is USD 192.1 for every additional HIV positive clients identified when compared to Facility based VCT. Conclusion: More resources should be allocated to HIV prevention through mobile testing to eliminate HIV transmission and start ART early in the disease progression as Mobile based VCT is effective in diagnosing higher number of HIV positive individuals than Facility based VCT with higher costs. As the HIV prevalence in Ethiopia is becoming more concentrated in urban areas, more effort should be made for the provision of HIV counseling and testing service by implementing testing through Mobile based VCT to reach the 90-90-90 goal set by UNAIDS.
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    Cost-Effectiveness Analysis of Gene Xpert Test Compared to Smear Microscopy Test for Diagnosis of Suspected Tuberculosis Patients at Health Facilities in Arsi Zone, Ethiopia.
    (Addis Abeba University, 2019-10) Abdene Kaso; Alemayehu Desalegne
    Background: Tuberculosis remains a global public health problem. It mainly affects the poor and vulnerable populations. Therefore, there is a substantial global and country level effort to detect and treat tuberculosis cases. Early diagnosis of tuberculosis is one of the pillars of the tuberculosis control strategy. Smear microscopy testing is a routine test for the diagnosis of pulmonary tuberculosis in resource-constrained countries. However, the use of rapid molecular tests like Gene Xpert is increasing, and many countries are scaling up the use of Gene Xpert without a clear evaluation of the cost and cost-effectiveness of the technique. Objective: To evaluate the cost-effectiveness of Gene Xpert test compared to smear microscopy test for diagnosis of tuberculosis patients at health facilities in Arsi zone. Methods: We developed a decision-analytic model to evaluate the cost-effectiveness of Gene Xpert algorithms compared to smear microscopy for the diagnosis of tuberculosis. Costs were estimated from the health provider perspective in a one-year time frame. We applied an ingredients-based costing approach to identify, measure, and value the cost of the smear microscopy and Xpert algorithm. Effectiveness was measured as the proportion of cases detected for each of the diagnostic strategies. The cost-effectiveness ratio was calculated by dividing the change in cost and change in effectiveness. One-way and probabilistic sensitivity analysis was done by varying different inputs parameters. Result: The unit cost of Gene Xpert and smear microscopy methods was $12.92 and $3.1 per test respectively. The unit costs of Xpert and smear microscopy were mostly influenced by the cost of cartridge $10.67 (82.58%) and supplies $1.28 (41.29%). The mean cost of smear microscopy and Gene Xpert site was 3.3$ ($2.4-$4.96) and 12.96$ ($12.69-$13.22) respectively. The cost-effectiveness of the Gene Xpert method was $729.82 per proportion of TB cases detected. During one-way sensitivity analysis, TB prevalence was the most influential parameter on ICER (530.56 to 1401.13 per proportion of TB cases detected). Conclusion: The unit cost of Gene Xpert is high compared to smear microscopy diagnostic method. Our study found that using the Gene Xpert as a routine test is cost-effective compared to one or three times GDP per capita of Ethiopia and can be part of the routine diagnostic testing strategy. TB prevalence was the most influential parameter of the cost effectiveness of the Gene Xpert method.
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    Girl’s Preference for Human Papilloma Virus Vaccination in Secondary Schools in Addis Ababa, Ethiopia, 2017: Discrete Choice Experiment.
    (Addis Abeba Universty, 2017) Rahel Assefa; Alemayehu Desalegne
    Background: There are three HPV vaccines that are safe and effective for protecting HPV infection. These are: bivalent which protect from HPV type 16 and 18, quadrivalent for HPV type 6, 11, 16 and 18, and non avalent for HPV type 6, 11, 16, 18, 31, 33, 45, 52 and 58. About 7,000 new cervical cancer cases are diagnosed annually in Ethiopia. It is the second cause of cancer related death in women aged 15 to 44 year. Even thouge Ethiopia undergo a pilot for HPV vaccine implementation at two sites in Oromia Region, Jimma zone, Gomma woreda and Tigray Region Ahiferom Woreda with support of GAVI, there is no data that show a finding regarding the current status of receiver’s attitude, acceptance, and mainly girls’ preference for HPV vaccine. Objective: The aims of this study was to rank the contribution of the attributes for HPV vaccination; and to measure the willingness-to-pay, the trade-offs, and choices of girls between risk and benefits of the vaccination. Methods: The study was done by using discrete choice experiment (DCE). The data was collected from February to March 2017 among 4 different secondary schools in Addis Ababa. A total of 336 girls aged 15-18 year were included in the study. The vaccination program attributes considered in the choice experiment were: degree of protection against cervical cancer, duration of protection, age at vaccination, number of doses, risk of developing serious side effects, price of vaccine, and way of delivery. Each choice set of all determined options were put in to mixed logit model to determine the sign of the coefficient of each attributes. Trade-offs and WTP also determined. Results: From all participants, only six of them had been vaccinated for HPV. Doctors recommendation (34.9 %), mass-media campaign (81%) and positive family's’ opinion (80 %) were factors encouraging respondents to get the vaccination. Girls were willing to trade-off 5 % of protection against cervical cancer in order to get HPV vaccination which had protective duration of 25 years instead of 8 years. On average the respondents were willing to pay 153 ETB for an improvement in protection against cervical cancer from 70 % to 98 %. Conclusion: There was significant variation of preference among girls for all HPV vaccine attributes. Degree of protection, number doses, and the risk of serious side effect were the three most important attributes which guide the choice of girls, while cost of the vaccine had been the least important factor. We found high level of tradd-offs level of protection against number of doses, seriouse side effects and place of delivery
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    Improving the Implementation Status of Nursing and Midwifery Care Standard Practice at Medical, Surgical and Gynecology Wards in Dilchora Hospital, Dire Dawa, Ethiopia.
    (Addis Ababa Universty, 2018-06) Mulatu Takele; Alemayehu Desalegne
    Background: The nursing/midwifery care standard practice is the levels of safe and competent practice but, its implementation status is poor & inconsistent, particularly in developing countries. Similarly, the baseline assessment in this study at Dil chora hospital was poor. Thus, it was critically important to improve the implementation of the Nursing/midwifery care standard practice in Dil chora Hospital. Objectives: To improve the implementation status of Nursing /midwifery Care Standards from 48.2% to 73% in Medical, surgical & Gynecology wards of Dil chora Hospital, by the end of May 2018. Method: A facility based pre- post interventional study was conducted from March to May 2018 in Dil chora Hospital, Dire Dawa, Ethiopia. The interventions include training of ward nurses; delegation of internal supportive supervision, strengthening nursing audit committee & facilitate to change the present nursing/midwifery process format with the new one. The same numbers of nurse/midwife participants (50 before & 50 after) and 80 medical cards (40 before & 40 after) were conducted by Simple random sampling method to compare the findings before & after interventions. The data were analyzed by using nursing/midwifery standard checklists. Result: Among the total 50 the same respondents (50 before & 50 after), mean age was 31.20 years (SD=5.338) and the implementation status of nursing/midwifery care standards was 25 (50.5%) in baseline 38 (76%) after-intervention. This change was statistically significant at (df =7, P ). Of the total of 80 medical card review documentation (before 40 & after 40) the implementation status of the standards in nursing/midwifery process & Medication administration record was 19 (47.5%) in baseline, 31 (77.5%) after-intervention. Conclusion and recommendation: The implementation status of the nursing /midwifery care standard practice is still below the expected criteria and it needs further intervention to increase its utilization. Knowledge, recognition & motivation are possible contributing factors for the improving of nursing/midwifery care standard practice those who are working at medical, surgical, & gynecology wards.
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    Magnitude and Determinants of Out of Pocket Medical Expenditure among Outpatients Visiting Public Hospitals in East Shoa Zone of Oromia Region
    (Addis Abeba University, 2019-10) Deraro Bedado; Alemayehu Desalegne
    Background: Out of pocket expenditure at the point of health service delivery increases the likelihood of catastrophic financial expenditures for health service users. In Ethiopia, around 33.7% of total health expenditure comes from the household out-of-pocket expenditure. Such significant out of -pocket payment creates financial barriers to access to health services and puts people at risk of poverty. Therefore, this finding offers new evidence on the magnitude and determinants of out of pocket expenditure on out-patient care. Objectives: To investigate the magnitude and determinants of Out-of-Pocket medical expenditure among outpatients visiting Hospitals in East Shoa Zone, Oromia, Ethiopia. Methods: An institution based cross-sectional study was conducted on 422 participants visited public hospitals in East Shoa zone from February 18 to Murch 9, 2019. Data collection took place through interviews with patients coming to the outpatient pharmacy after finishing their visits at the different outpatient departments in the hospitals. Data were collected via structured questioner, then it was cleaned, coded, entered into EPI info 7 and exported to SPSS version 23 statistical package for analysis. Descriptive statistics and both bivariate and multivariable logistic regression were used to identify determinants of OOP. The existence of association was measured using odds ratio with 95% confidence intervals. Results: From the 378 interviews included in the final analysis, the proportion of participants paid out-of-pocket medical expenditure was 332(87.8%) and the mean out-of-pocket medical expenditure was 351.48 ETB (12.55USD) per visit, while the direct medical cost was 132.86 ETB. In addition, the study identifies some significant determinants for the out-of-pocket medical expenses of OPD services namely, residence, education of the household head and sex of the households. Conclusion: Most of the study participants were pay OOPME with the high average for OPD service received which is high when compared with the mean monthly household per capita income and OOPME found to determine by residence, educational level of household head and sex of the household. Health managers should focus on the implementation of CBHI and start SHI in order to protect society from financial risk that occurred at the service delivery.