Browsing by Author "Hailemariam, Damen(PhD)"

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    Assessment of Household Strategies to Cope with Costs of Illness in Rural Communities, Jimma Zone
    (Addis Ababa University, 2000-12) Bogale, Tadele; Hailemariam, Damen(PhD)
    Health calamities are one of the conU1lOn causes of impoverishment at the household level; and different households find different mechanisms for adapting to the same calamitous circumstance. Nowadays, in many developing countries, affordability of health care is a growing concern both for policy makers and households, as people are expected to contribute more from their own pockets in getting health care due to health sector financing reforms and privatization. This cross-sectional study, which has used both quantitative and qualitative methods of data collection, was conducted from February to October 2000 in 630 randomly selected ruml households living in a predominantly coffee growing district of southwest Etlliopia. The main objective of the study was to assess the strategies used by households to cope with the financial and time costs of illness. The average cost of visiting a health care provider for one illness episode was found to be 32.87 Birr (about 4 US$), of which expenditures for drugs, transpOlt and lodging away from home while seeking health care were considerable. In an attempt to quantify the economic implications of morbidity at the household level, days lost due to illness were determined. Accordingly, adults who have repOlted illness in the one-month recall period have lost 9.23 working days, which corresponds to a loss of about 138.45 Birr (about 17 US$) in one month . About 42% of the studied households with sick family members in the recall period of sixmonths were found not purchase outside health care for reasons associated with out of pocket 11 expenditure of health care costs. Main mechani sms use to cope with the financial costs of illnesses were looking for exemption paper (16.8%), sale of household assets (13.3%), use of household saving (\3.1 %), and going into debt ( 12.7%). In addition, about 64% of tJle housebolds did nothing to cope the potential time lost due to illness. Using multiple logistic regressIOn, socio-demographic and economic factors at the household le ve l, which have significant association with the choice of mechanisms for coping, were identifi ed. Based on the results of the study, altemative strategies of financing the local health services incorporating indigenous social networks like "eder" were di scussed and reconullendations forwarded
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    Assessment of the Magnitude of Attrition and Exploring factors Related to it among health Extension workers Deployed in Oromia Region.
    (Addis Abeba Universty, 2011-06) Feyissa, Aberra; Hailemariam, Damen(PhD)
    Background: - The lowest health tier system of Ethiopia is Primary level health care, with one Primary Hospital, 5 health centers and twenty-five health posts at rural level, that one health post serves 3000-5,000 population. Two Health Extension Workers (HEWs) are trained and deployed in each health post at the village/kebele level to improve access and equity to basic health services, targeting households particularly women/mothers focusing on sustained preventive health actions and increased health awareness. Objective: - To assess the magnitude of attrition, explore the whereabouts of the HEWs who have left their jobs and the possible factors related to those among Health Extension Workers deployed in Oromia Regional State. Methods: - It is an exploratory cross sectional study done in Oromia Regional State. Data for the number of HEWs graduated, by the years of graduations from TVETs commission, number of HEWs who have left their jobs, and the whereabouts of HEWs who have left their jobs since 1997 EFY until 2001 EFY assessed and collected from all eighteen Zones of Oromia. Three Zones (Guji, West Harerge and Nannewa Finfinne) from the Region and again three Woredas/Districts from each Zone were selected by the highest number of HEWs left their jobs/services, for the assessment of factors /reasons associated with attrition among HEWs deployed in Oromia Regional State. Systematic random sampling method used to select Health Extension Workers in each Woreda/District, using the payroll list of HEWs in each District/Woreda Heath Offices as a sample frame. The total sample size of 118 respondents were selected from each Zone/District, based on proportion to size of the current number of Health Extension Workers or key informants in each Zone/District. Results: - There were multiple reasons associated with the attrition of HEWs in the region, of which 87.4% of key informants mentioned low salary payment. One hundred ninety (20.7%) and 141 (15.3%) of HEWs that have left their jobs changed their jobs to other non-health category & left because of marriage respectively. Conclusion: - In general, 12,766 HEWs were trained and deployed that fulfilled 99.2% of the need during the five years (1997 to 2001 EFY) period in Oromia Region, and the finding of this study showed that attrition rate of HEWs was 7.2% which is not high
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    Economic Burden of Schizophrenia and Bipolar Disorders in Ethiopia
    (Addis Ababa University, 2008-07-22) Zergaw, Ababi; Hailemariam, Damen(PhD)
    In Ethiopia, economic burden of schizophrenia and bipolar disorders was a virgin area of research untapped for the last many decades. On the other hand sporadic epidemiological studies indicate that mental health problems are major public health concern in the country. However, despite high magnitude of the problems, the extent and the longitudinal time change of family and caregiver burden due to schizophrenia and bipolar disorders is unknown. Therefore, this dissertation has tried to give answers to the following research questions: What is the extent of economic burden of schizophrenia and bipolar disorders in Ethiopia? How does burden change overtime in families of patients with schizophrenia and bipolar disorders? Are families with a member with schizophrenia and bipolar disorder face different disease burden compared to families with physical disorders? To answer these research questions one year longitudinal prospective study with economic and family caregiver burden measurements on families of 249 schizophrenia, 190 bipolar, 55 diabetes, hypertension and asthma patients and 659 families who are with other sickness in the community was carried out. Population average generalized estimating equation and time series generalized least squares analyses were used to estimate the extent and the change over time of burden in the families of patients with schizophrenia and bipolar disorders.Using the prevalence based and the human capital approach, economic burden estimations at societal level were also made. As a result in the analysis of six waves of data, families of patients with schizophrenia were found to experience persistent burden for about eighty-three percent of the year. The change in family burden due to time was statistically significant with a mean family burden score of 3.10 (z = -20.86, P>|z|= 0.001). In terms of caregiver characteristics, female caregivers, caregivers in farming occupation, whose monthly living expenses were very little, who had paid more out-ofpocket for mental health services, who were angry at the patient, who were worried about the patient, who were over involved in controlling the patient, and who had lost more days of work were found to be more burdened. Overall in 2005, the total burden of schizophrenia to families in Ethiopia ranged approximately between $2.12 million to $9.97 million. As observed in families of patients with schizophrenia, in a comparative analysis, bipolar patient family caregivers were also found to be more burdened for about 8 to 10 months of the year than family caregivers of patients with diabetes, hypertension and asthma and sick controls in the community. The average difference in family caregiver burden score between bipolar and diabetes, hypertension and asthma patient family caregivers was 4.36 (z = -8.75, P>|z|= 0.001); while the difference due to time between the two groups was 3.42 (z= -4.27, P>|z|= 0.001). Similarly, the average difference in family caregiver burden score between family caregivers of bipolar patient and sick controls in the community was 3.7 (z= -4.88, P>|z| 0.001). In terms of longitudinal caregiver burden difference, bipolar patients family caregivers were found to be more burdened than family caregivers of sick controls in the community with a burden score difference of 2.97 (z= -5.17, P>|z|= 0.001). Over the year, patients with bipolar disorder lost a mean of 93.52 cumulative days of work. Consequently, in the year 2005, bipolar disorder patents living in a community under clinical follow-up lost 112.8 million days of work. In sum the total economic burden of schizophrenia and bipolar disorders in Ethiopia ranged approximately $378.62 to $469.47 million. Out of this total economic burden the direct cost was found to be 1.25 percent to 3.66 percent of the country’s public health expenditure in the year 2005. This amount of burden is very huge for poor countries like Ethiopia. It is a hidden economic loss. Generally the figure shows that the country’s health care system should try to reduce the high level of hidden sufferings of families and caregivers so as to keep the level of burden low. Future studies need to focus more on how to devise feasible intervention strategies to lessen economic and family burden due to schizophrenia and bipolar disorders Key words: schizophrenia; bipolar disorder; caregiver burden; family burden; economic burden; panel data; population average generalized estimating equation; time-series generalized least squares, Ethiopia
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    Economic Costs of Podoconiosis in Wolaita Zone, Southern Ethiopia
    (Addis Abeba Universty, 2005-07) Tekola, Fasil; Hailemariam, Damen(PhD)
    Podoconiosis is endemic non-filarial elephantiasis mostly affecting barefootedrural farmers in countries of tropical Africa, Central and South America, North India, Cameroon and Sri Lanka. In Ethiopia the condition is more prevalent than any other African country. In areas of red clay soil the disease is common mainly in the economically active age group. Even so, little attention has been given to it and there have not been any studies on the economic burden of podoconiosis. The overall objective of this study was to estimate podoconiosis-related direct and productivity costs in Wolaitta zone, SNNPR, Ethiopia. The study was undertaken in Wolaitta zone, SNNPR, using quantitative matched comparative cross-sectional study complemented by qualitative key informants' interview on 702 study subjects. Cost estimation was based on the societal perspective for cost analysis, the human capital approach to estimate productivity losses and the prevalence-based model as a time frame. Data were entered into EPI-INFO V.6 and exported to SPSS V.11 for matched pair analysis. The opportunity cost of time lost by patients and care-takers accounted for the major component (72.1%) of patient-side cost. The average patient-side cost was 97.6 Birr (US$ 11.35) per patient. The actual out-of-pocket expenses over the three months period form 6% of the overall quarterly expenditure of households ix of the studied patients per annum. When projected over one year, the total direct costs amount to 1233.40 Birr (US$ 143.42) per patient. It was also found that most patients did not completely stop work, but spent only 3.56 ± 2.87 hours per day on economic activity compared to 6.52±2.53 hours worked by controls (p<0.001). Female patients spent 3.45 hours less on domestic activity compared to their matched controls (p<0.001). The total productivity cost comes to 538.86 Birr (US$ 62.658) per patient per year. Regression analyses revealed that total absenteeism and total working hours spent on economic activity were significantly influenced by the presence of the disease and by sex. The presence of the disease and household expenditure significantly influenced total absenteeism from domestic work. In addition, the presence of disease, marital status and 'kebele' type significantly determined the number of hours spent on domestic work. Based on the results, some recommendations were forwarded.
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    Exploring Partnerships with Civil Society Organizations in Health Development: The Case of Iddirs in Addis Ababa
    (Addis Abeba Universty, 2007-05) Kena, Garoma; Hailemariam, Damen(PhD)
    Background: Health being the major development input, it was given due considerations in the millennium development goals to be achieved by 2015 by developing countries including Ethiopia. The health service coverage, utilization and quality in Ethiopia are poor and have not shown significant gains over time. The sector has been dominated by the public sector with limited involvement by other actors. The government could not handle the problem alone. Cognizant of these facts, the need to diversify actors in the health sector was given priority in the health policy as well as other policy documents. The Iddir is one of civil society organizations in Ethiopia that has recently gained some attention as potential partner in development, both by the government and non governmental organizations. Objectives To explore partnership potentials between Iddirs, the government, and nongovernmental organizations in the health sector. Methods: Cross-sectional exploratory study was conducted from January to March, 2007 using both qualitative and quantitative methods of data collection. For the quantitative survey, a sample of 422 Iddir leaders were randomly selected from the Iddirs currently registered with the ten Sub Cities of Addis Ababa for interview. For the qualitative part, four focus group discussions were organized with Iddir leaders and Iddir members to explore their views on the importance and willingness of establishing partnerships between Iddirs and the government and non governmental organizations. Eleven in-depth interviews were also conducted with key informants drawn from non-governmental organizations working in partnerships with Iddirs vi and relevant government agencies to explore their views on the significance and possibilities of establishing partnerships with Iddirs in health development. Result: Out of the 422 Iddirs surveyed, 228 (54.0%) are currently engaged in health related activities in one way or another. The majority, 216 (51.2%), are involved in HIV/AIDS prevention, care and support activities. One hundred thirteen (26.8%) are offering some form of health care financing services to their members. Ninety-seven of them (22.9%) are also involved in environmental health activities. In the qualitative study, the need to establish partnerships with Iddirs has been emphasized by participants from governmental and non governmental organizations. Iddirs have also expressed their willingness to go in to such partnerships, although some are still suspicious in partnering with the government. Participants also expressed the need to build the capacity of Iddirs to be active development partners and improve their working environment. Conclusion: In general, a number of opportunities and entry points exist to establish partnerships with Iddirs in public health efforts. The study has found that Iddirs, which were once providing only funeral services, are coming out as development actors and partners. Moreover, they are modifying their by-laws to include issues pertaining to pressing public health problems such as HIV/AIDS. There is also increasing recognition on the role of Iddirs in development by both the government and NGOs. The public health activities the Iddirs are currently engaged in can serve as potential entry points into partnerships with them for all concerned. However, a number of important contextual factors have been identified that need to be considered in initiating partnership working arrangements with Iddirs. Such initiative must accommodate their fears, concerns and suspicions if it has to prove effective.
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    Knowledge, Attitude, Risk Behavior on HIV/Aids And Willingness to Participate in an HIV Vaccine Trial among High School Teachers in Addis Ababa City, Ethiopia
    (Addis Abeba Universty, 2002-04) Kidane, Fesehatsion; Hailemariam, Damen(PhD)
    There is an ongoing study on sexual behavior in Akaki factory workers and many KABP studies. A cross-sectional study on high risk behavior and knowledge on vaccines and their willingness to participate in HIV vaccine trial among randomly selected high school teachers was conducted from January 10 to 30, 2002 in Addis Ababa city. Mean age at first marriage for high school teachers was 26.7 years. Of the 621 high school teachers (26.4%) had engaged in commercial sex and 249 (40.1%) had non-regular noncommercial sexual contacts in the last 12 months prior to the survey. Mean age at first sexual intercourse was 18.7 years. Ever use of condoms by the high school teachers was 65.1%. Knowledge on HIV prevention was very low. However, knowledge on vaccines and their willingness to participate in HIV vaccine trial was very high and modestly high, respectively. Although it is recognized that the specific educational needs will vary in different contexts, our data support the need for incorporate vaccine trial’s education into the design and implementation of future HIV vaccine trials. Serial surveillance surveys are necessary to see the trend of change in behavior of the study population. HIV preventive messages should be repeatedly directed to high school teachers. There is a need to increase HIV awareness in high school teachers.
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    Retrospective Record Assessment of Visceral Leishmaniasis (VL) Patients in Kahsaye-Abera Hospital and Knowledge, Attitude and Practice Pertaining to Visceral Leishmaniasis Among the Indigenous People and Migrant Workers in Kafta- Humera District
    (Addis Ababa University, 2005-04) Fesseha, Tadesse; Hailemariam, Damen(PhD); Ali, Ahmed(PhD)
    According to a substantial body of evidence, leishmaniasis is posing burden on people of all ages living in different parts of the world at varying degrees of morbidity and mortality. Visceral leishmaniasis (VL) is endemic in the south, southwest, north, North West and north east peripheral low lands of Ethiopia. K/Humera, in Tigray Region is VL endemic. Its proximity to the Sudan, economic attraction and a venue for several migrant workers further complicates the problem. With the objective of describing the magnitude of visceral leishmaniasis at Kahsaye-Abera Hospital, a study was conducted using a pre-tested questionnaire and a retrospective clinical records review. The knowledge and practice of both migrant workers and indigenous people was found to be 56.1%, 77.2% and 6.9%, 68% respectively. Out of the 931 migrant workers, 69% were familiar with the work kala azar compared to 85.8% of the indigenous population. A bit higher than 40% of both cohorts accessed the information from health facilities with only 4% of the labor migrant force and 14.7% of the local inhabitants from the media. A wide gap of behavioral practice was evidenced between the labor migrants and local residents, where 93.1% migrant workers and 29% indigenous people exhibited poor practice towards visceral leishmaniasis. Of the 882 retrospectively reviewed patients’ records, only 174 (19.7%) had no any inter-current infections whereas majority of the group 80.2% had atleast one concurrent infection with the highest rate of respiratory infections, 48.4% and the HIV/leishmania co-infection was as high as 25%. HIV co-infected VL cases were seven times more likely to relapse compared to HIV negative VL cases. Respondents were less familiar with the sandflies as the major players in the transmission of VL (kala azar) and had unsatisfactory perception and poor practice towards kala azar. Moreover, mortality and HIV/VL co-infection rate was among the highest. Health workers and other stake holders should join hands to adequately disseminate information to the community to actively participate in the sphere of prevention
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    Social Stigma Attached to HIV/AIDS and its Determinants in Dire Dawa Town
    (Addis Ababa University, 2001-10) Kifle, Yared; Ismael, Shabbir(PhD); Hailemariam, Damen(PhD)
    A cross sectional study was carried out from April to June 2001 among residents of Diredawa town aged 18 year and above to assess the magnitude and determinants of stigma related to HIV/AIDS and PLWHA. A multistage sampling procedure was used to select 845 study subjects. Both qualitative and quantitative data collection methods were utilized. Although majority of respondents were well aware about HIV/AIDS, there is still misconceptions about its casual transmission. Most respondents manifest at least some form of stigma towards PLWHA. Majority 527(68.7%) of the respondents agreed that PLWHA should not have child and 463(60.4%) of them to keep the HIV positive status of their family member secrete. Three hundred ninety six (51.6%) of the respondents said that PLWHA should never be trusted and 363(47.3%) respondents believed that PLWHA deserve the disease. More than a quarter of them 275(35.9%) also had an attitude of separating PLWHA from others to safeguard the public and 269(35.1%) reported their unwillingness to let their children learn in a school where one of the students is known to be HIV positive. Significant (P<0.05) negative correlation between stigmatizing attitude and knowledge of HIV/AIDS, belief about its casual transmission and income was established. On multivariate analysis, level of education, income, knowledge of HIV/AIDS, and belief about casual transmission of HIV were found to be significant (P< 0.05) negative predictors of stigmatizing attitude towards HIV and PLWHA. Addressing the issues of stigma in all activities that advocate disclosure of HIV status, encouraging PLWHA to disclose their HIV status, IEC regarding casual transmission of HIV and further studies to enrich knowledge about stigma surrounding HIV/AIDS and PLWHA are recommended