Browsing by Author "Hailemariam, Damen (PhD)"
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Item Assessment of Quality of Health Care in Private Health Institutions in Addis Ababa Ethiopia(Addis Ababa University, 2000-12) Afework, Senait; Hailemariam, Damen (PhD)Involvement of the private sector in provision of health services has progressively increased in many developing countries including Ethiopia. Promotion of the private sector involvement is also one of the health care financing strategy in Ethiopia. A cross sectional descriptive study was done on Quality of Care in private clinics in Addis Ababa in April, 2000. Different levels of clinics were randomly selected and assessments were done on structural aspects, performance of health workers in polyclinic outpatient department and patients satisfaction with the different aspects of care given. It was found that most clinics fulfill the structural requirements of the MOH with regard to sta ffing, equipment and medications. Neverthless few clinics were found not to fulfill the minimum requirements put in the guideline. With regard to performance, various aspects of malperformance were observed where the highest problem was concerning treatments given to patients. Thirty seven percent of treatments given to patients were rated to be unacceptable. Over prescription of antibiotics and injections was also found specially in small clinics. Patients were generally satisfied in all aspects of medical care where highest satisfaction was in relation to courtesy of providers and relatively lower satisfaction with cost. Findings are discussed in comparision with findings in public and private health facilities in Ethiopia and other countries. It is recol1Ullended that regulation be strengthened. Inclusion of the assessment of process of care in quality control measures is also recommended.Item Cost Analysis of Abortion in Addis Ababa Public Hospitals(Addis Abeba Universty, 2000-04) Negash, Selamawit; Hailemariam, Damen (PhD)This is an institution based cross-sectional study conducted in four public hospitals in Addis Ababa, Ethiopia, with the objective of analyzing the cost of treating patients with abortion complications and provision of safe abortion services. The data on unsafe cases were collected for three months and patients with abortion complications who attended these hospitals during the study period were interviewed (n=401). Four hundred twenty four medical records were reviewed and observation was done in ten percent of the cases (n=42) and administrative records were reviewed, to obtain data on direct, indirect and opportunity cost in treating abortions complications. The cost in provision of safe abortion service was estimated and the average unit cost ranges from 40.97 to 65.32 birr while the actual average unit cost in treating a patient with abortion complication was 131.7 birr with out including the patient side cost. Moreover the sensitivity analysis showed that the cost of treating complication of abortion could rise up to 323.23 birr. Thus, the health care system is spending a lot of resources for treating complications of abortion, which could be possible to prevent it through provision of safe abortion services. The average patient side cost which includes medical, non-medical and opportunity cost was found to be 535.5 birr. If the existing law were liberalized to allow provision of early and safe abortion services with feasible promotion of family planning, in addition to cost reduction 8 in the health system and individual patients, it could save life and minimize suffering of a lot of women who undergo unsafe abortion.Item Defaulting From Dots and its Determinants in Three Districts of Arsi Zone, Oromia Regional State, Ethiopia(Addis Ababa University, 2000-12) Tekle, Betru; Hailemariam, Damen (PhD)A case-control study, on defaulting from DOTS was performed in three districts of Arsi Zone, Oramia Regional State, among patients registered during the period of July 1, 1997 to December 3 1, 1999 to determine the rate of defaulting and to identify factors assoc iated with it. A health record review of 1367 new tuberculosis patients put on DOTS during a period of 30 months (July 1997 to December 1999) was carried out in order to determine the rate of defaulting. All the study subjects were registered and put on DOTS after June 30, 1997 and completed treatment or declared cured before January 1,2000. The cases and controls were traced actively and interviewed by trained interviewers using a pre-tested structured questionnaire. The two groups were compared by social, demographic and health services variables. The overal l defaulter rate and specific rate by 1I10nth of defaulting, health in stitutions, di stricts and di stance from hea lth institutions were calculated. All defaulters and the non-defaulters were selected by paired matching of sex and age using the lottery method. Two controls were matched individually to each case. One hundred fifty five cases and one hundred sixty controls were included in the study. The overall defaulting rate from DOTS was calculated to be 11.3%. The rate of defaulting in case of sputum smear positive pulmonary tuberculosis was found to be 1 J .6%. The rate of defaulting was higher in Etheya clinic and Hitosa District. Highest (80%) rate of defaulting occurred during the continuation phase. Medication side effect was found to be signi fica ntly associated with defaulting from DOTS (OR= 4.20 with 95% CI 1.51 to I 1.66). Adequate knowledge and fa mily suppot1 were found to be impot1ant possible protective factors for defa ulting (OR=0.04 with 95% CI 0.02 to 0.10 and OR=0.J9 with 95% Cl 0.08 to 0.46 respectively). Distance from health units and drug intolerance were the major reasons mentioned for defaulting. However, there is no significant difference between cases and controls regarding distance, employment statu s, attitude to treatment center, level of education and average monthly income. The rate is slightly higher than the critical level of J 0% set by WHO. The major factors contributing to high rate of defaulting were lack offamily SUpp0l1, inadequate knowledge about duration of treatment and presence of medication side effects. Health prograt11l11e that are intended to enhance family suppOt1 and knowledge about duration of DOTS treatment and Drug tolerance should be strengthened.Item Exploring Partnerships with Civil Society Organizations in Health Development: The Case of Iddirs in Addis Ababa(Addis Abeba University, 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.Item Health and Life-Related Burden of Motor Vehicle Injuries in Addis Ababa(Addis Abeba Universty, 2010-07) Gebremichael, Mussie; Hailemariam, Damen (PhD)Ethiopia has a relatively high number of fatalities due to road traffic injuries per number of vehicles as compared to many countries in the world, with a death rate of 80 per 10,000 vehicles. Based on reports from Federal Police Commission, more than 94% of road traffic injuries in Ethiopia occur due to motor vehicle crashes and 60% of road traffic crashes in the country are reported from Addis Ababa. This study aimed to estimate the health and life related burden of motor vehicle injuries that occurred in Addis Ababa, Ethiopia during the year 2001 EFY. The study was conducted from February to June 2010 in six hospitals of the metropolis. It was designed as prevalence based cost -of- illness study from a societal perspective. A retrospective descriptive study was conducted to capture costs incurred by motor vehicle injuries in Addis Ababa in 2001 EFY. Multi-stage cluster sampling technique was used to select 364 study subjects. The total health and life-related cost of motor vehicle injuries in Addis Ababa was estimated to be 31,692,892 birr. Out of this, the indirect and direct costs were 20, 608, 801 and 11,084,091 birr respectively. In conclusion, the enormous health and life related burden caused by motor vehicle injuries implies that such injuries are health problems of economic importance demanding more attention from health planners and policy makers. The health sector should collaborate with other agencies in the prevention of motor vehicle injuries so as to reduce the immense economic burden it inflicts on health services.Item Health Seeking Behaviour for STDs Among Soldiers in Core One Hundred Eighth of the Ethiopian Army(Addis Abeba Universty, 2003-07) Teshome, Sintayehu; Hailemariam, Damen (PhD)A community based descriptive cross-sectional survey was conducted to describe the healthseeking behaviour for STDs and determine the factors associated with the health-seeking behaviour of soldiers in Core One Hundred Eighth of the Ethiopian army. The study was conducted in Tigray Regional State from December 2002 to February 2003. A sample proportionate to population size was drawn from each units of the Core and subjects were selected using a systematic random sampling technique. Data were collected from 384 subjects that reported having had one or more STD related genital symptoms during the one year recall period using a structured questionnaire. Among the sample, while awareness about gonorrhoea, syphilis, chancroid, and lymphogranuloma venerum was found to be fairly high, knowledge about the other STDs was low. A substantial number of respondents were found to have misconceptions and/or erroneous knowledge about the risk factors and preventive methods of STDs. Among study subjects, more urethral discharge, genital ulcer, genital blister, and painful micturation were found to be associated with STDs than the other genital symptoms (OR = 9.87 (5.29 – 19.27). Peers were found to be the most important sources of information for STD related genital symptoms. The rate of treatment-seeking was 72.1%. Thought of having some kind of illness during having the symptom, severity of symptoms, perceived source of most effective treatment for the symptom and working assignment units were found to be significantly associated with treatment receipt (P < 0.05). Geographic proximity to units, marital status, and age were found to be significant determinants of choice of treatment sources (between those under Ministry of Defence and outside Ministry of Defence) (P < 0.05). Geographic proximity to units, association of genital symptoms with STDs, severity of symptoms, and working assignment units were found to be significantly associated with time of attendance to treatment sources (P < 0.05). In addition, attendance to IX treatment sources at earlier symptomatic stages was found to correlate with longer military service (P < 0.05). Health education interventions should be strengthened and expanded to include the second generation STDs. Health education interventions should emphasise the risk factors, and preventive methods of STDs, and on the creation of demand and positive attitude towards modern services. The Ministry of Defence needs to look for a way to allow soldiers with STD related genital symptoms to receive care at any of the Ministry’s treatment centres nearby their locations at times when they are away from their units. Studies concerning quality of treatment sources under Ministry of Defence should be carried-out to improve social accessibility of the treatment sources.Item The Impact of Globalization on Health Status in Sub-Saharan Africa(Addis Abeba Universty, 2006-05) Gutema, Keneni; Hailemariam, Damen (PhD)Globalization (GLB), one of the characteristics that define the beginning of 21st century has received considerable attention in the past two decades. Its effects are suggested to impact on most aspects of economic, political and social life including that of public health. Despite being current national and global concern with such many potential impacts, yet limited attention so far has been given to its effect on health, particularly in developing countries. Therefore, this empirical study aimed to examine the relationship between GLB and health status outcome in Sub- Saharan Africa (SSA) to contribute to policy making dialogue that can exploits the possible benefits and mitigate GLB’s detrimental effects. The study was confined to the period of 1960-2000 for cross-section of twenty-six SSA. Two latest decades of contemporary GLB were measured with preceding two decades for comparison. A Balanced panel data (time series- Cross section) analytic method was used for its advantage over pure time series and pure cross-section study. Measures of GLB and the traditionally recognized determinant of health were used as an independent variable while Infant Mortality Rate (IMR) was used as a dependent measure of health. The analysis was made using LIMDEP econometric analysis software for its reach varieties of panel data analytic procedures. A 0.05 alpha level was used to report the significant values. The result revealed the existence of correlations between the presumed determinant of health and measure of health status. Among the determinant factors, export of goods and services (p=0.018), Primary school enrollment of females (p=0.030) and emigration (p=0.020) were found to have significant, inverse relationship with IMR. On the other hand, import of goods and services (p=0.042), tourism (p=0.012), and surprisingly, urbanization (p=0.038) were found to have a positive, significant association. Whilst possible recommendations were suggested from these findings, the effect of separate dimensions of GLB on health and the other integral features like cultural dimensions of GLBs’ influence on health are recommended for further research in the region.Item Process Evaluation on Child Survival Interventions in SNNPR: Special Focus on Community Health Promotion Initiatives.(Addis Abeba Universty, 2006-06) Chaka, Mezgebu; Hailemariam, Damen (PhD)Current trends in the field of health promotion emphasize community-based programs employing multiple interventions as the main strategies for achieving population-level change in risk behaviors and health. It may be difficult to find the individual who would be friendly concerned about the welfare of the other, uninterested in money, and hard working respecting and willing to visit any who ask her/him. The purpose of this study was to evaluate child survival program interventions with special focus on community health promotion initiatives and to assess determinants of community health promoters’ functionality in SNNRP, two Woredas of Gamogofa Zone and Alaba Special Woreda A comparative cross-sectional study was used to compare functioning CHP with nonfunctional CHP in study areas. The study was a census survey, thus the study population were all the CHPs trained in the study area in 2003 (n=443). In addition, 2 focus group discussions were held in each study woreda and in-depth interviews were made with key informants in the study areas. Epi-Info and SPSS software were used for data entry and analysis to reveal the finding. The finding revealed that 88.3% of interviewed community health promoters were performing 50% or more of the activities mentioned in their job description. Eleven point seven percent of the community health promoters were found to be performing no activities at the time of interview .i.e a point prevalence attrition rate of 11.7% over 2 years in the study areas. According to the community response, community health promoters were very good health teachers,” Increased ITN utilization, toilet use, hand wash practice after toilet, and improved household hygiene, were the major appreciable change observed following the introduction of CHPs”. The finding could help the health planners who are interested to improve community based health interventions as to address the primary health care services through community involvement and responsibility for health.Item Quality Assessment of Directly Observed Treatment Short-Course of Tuberculosis in Afar National Regional State(Addis Abeba University, 2007-07) Girma, Anteneh; Hailemariam, Damen (PhD)Introduction: despite availability of reliable diagnostic approaches and effective drugs for over decades, Tb remained a major public health problem, where there have been limited impacts in reducing its global burden despite the growing adherence to the recommendations of WHO on the use of DOTS and other interventions in many countries. Objective: to assess the quality of Tuberculosis treatment in Afar National Regional State. Methodology: cross sectional health institution based survey was conducted between 5th February and 10th March in six health institutions, where records were reviewed for 270 Patients’, exit interview were made among 209 patients, six providers were interviewed and observations were made for 49 patients. Data were entered and analyzed using SPSS 11.0 for windows statistical software and findings at 95% confidence interval and p value of 0.05 were reported as statistically significant. Result: the results of the study showed that staffing qualities were poor and patterns of supervision were weak but delivery supplies for Tb control activities were good. A relatively higher proportion of patients were dissatisfied with the appropriateness and adequacy of working hours and waiting time. Statistically significant correlation was observed between process quality and output quality (clients’ satisfaction). Conclusion And Recommendations: it was concluded that the quality of Tb treatment in Afar National Regional State was poor where; both the quantity and the quality of staffing were not satisfactory, the issue of refreshment training seems to be absent, the pattern of supervision was weak and was also unplanned, inconsistent and lack feedback whenever it had been effected, which is totally against the national guideline where it is strongly recommended as part of program communication. Hence, mechanisms to improve the different aspects of the program and sticking to the national TLCP manual were strongly recommended. 2Item Quality of Health Care in Private Clinics in Addis Ababa(Addis Abeba Universty, 2000-12) Afework, Senait; Hailemariam, Damen (PhD)Involvement of the private sector in provision of health services has progressively increased in many developing countries including Ethiopia. Promotion of the private sector involvement is also one of the health care financing strategy in Ethiopia. A cross sectional descriptive study was done on Quality of Care in private clinics in Addis Ababa in April, 2000. Different levels of clinics were randomly selected and assessments were done on structural aspects, performance of health workers in polyclinic outpatient department and patients satisfaction with the different aspects of care given. It was found that most clinics fulfill the structural requirements of the MOH with regard to staffing, equipment and medications. Neverthless few clinics were found not to fulfill the minimum requirements put in the guideline. With regard to performance, various aspects of mal performance were observed where the highest problem was concerning treatments given to patients.Thirty seven percent of treatments given to patients were rated to be unacceptable. Over prescription of antibiotics and injections was also found specially in small clinics. Patients were generally satisfied in all aspects of medical care where highest satisfaction was in relation to courtesy of providers and relatively lower satisfaction with cost. Findings are discussed in comparision with findings in public and private health facilities in Ethiopia and other countries. It is recommended that regulation be strengthened. Inclusion of the assessment of process of care in quality control measures is also recommended.