Browsing by Author "Mekonnen, Wubegzier(PhD)"

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    Age at first Sexual Debut and Condom Use among in School youth in Debre Markos Town, Amhara Region, Ethiopia
    (Addis Abeba Universty, 2013-01) Dagne, Behailu; Mekonnen, Wubegzier(PhD)
    Background: Early initiation of sexual activity has been escalating among young people.and it leads to risky sexual behaviors. This might lead to health and health related burden among youth. In order to prevent this problem as well as to implement youth reproductive health (RH) programs effectively conducting different reasearches is necessary. Objective: To assess the age of first sexual debut and condom use among in school youth in Debre Markos town Method: A cross sectional study was employed in Debre Markos town from December, 2013 to December, 2014. The study populations were secondary school students in the town. Seven hundred students were selected from three secondary schools. Self administered structured questionnaire and in depth interview was a method used to collect data. Data entered into EPI-info software and analyzed using the SPSS statistical package. Descriptive statistics, Chi square test, bivariate and multivariate logistic regressions were used. Result: About a fifth (22.3%) of study participants started sexual intercourse at the time of the study. The median age at first sexual intercourse was 16. Socio-demographic factors such as being grade nine (AOR =5.5: 95%CI (1.2, 25.6), living with renting alone AOR=1.7:95%CI (1.2, 17.6) and getting less than 100 birr/month pocket money AOR=5.1:95%CI(1.1,26.0)were significantly associated with early sexual activity. Similarly, students who did not hear about the negative effect of early sexual activity AOR=3. 5:95%CI (1.1, 11.2) and who did not agree with the idea of their parental connection and supervision might postpone sex AOR=3.5:95% CI (1.1, 10.7) significantly associated with early sexual debut. Majority 109 (69.9%) did not use any family planning method including condom at the time of their first sexual intercourse. Those who planned their first sexual intercourse (36.5%) and who had willingness to get condom themselves (36.8%) used condom more than their counterparts. Those who got more than 200 Birr per month pocket money (AOR=5.7: 95%CI (1.1, 29.9) were used condom more at last sexual intercourse. Among student’s community norms, lack of comprehensive knowledge and misconception about condom is a reason not using condom during sex Conclusion: Age of sexul debut among high school students was low in the town. Students’ knowledge about early sexual activity influence to start sex at earlier age. Parental connection and supervision has a role to start sex at earliy age.Use of condom or other family planning method at first sexual intercourse among student was low. Students who are not willing to get condom themselves used condom lower than others. Recommendation: In order to decrease early sexual activity, equip students with comprehensive sexual health knowledge is a crucial work. This could be done by the collaboration of family, governmental and non governmental organizations. Condom use at sex might be increased by improving their willingness to get condom themselves. Awareness creation in the community and avoiding misconception could be a a strategy.
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    Assessment of Effect of Access to Free Health Care on Early Childhood Mortality, Controlled Quasi Experimental Study of Butajira Birth Cohorts from 2002-2008, South Central Ethiopia
    (Addis Abeba university, 2014-06) Abay, Mebrahtu; Mekonnen, Wubegzier(PhD)
    Background: Mortality in African children is unacceptably high. Providing free health care to young children has been hypothesized to improve access to health care and lead to better health outcomes. However, there have been only few methodologically robust studies testing this hypothesis. This study examined the impact of free healthcare provided to a birth cohort of children born from March, 2005 to June, 2006 in Butajira DSA (Demographic Surveillance Area) through the C-MaMiE project (Child outcomes in relation to Maternal Mental health in Ethiopia), in comparison to three cohorts of user fee children (children born within 2.5 years before and after the intervention and parallel with the intervention). Objective: The aim of this study was to assess the impact of making health care services free at the point of use upon under-fives mortality. Methods: This controlled quasi-experimental study compared intervention cohort, children born in Butajira from March, 2005 to June, 2006 and received free health care provided by the C-MaMiE project, from pre-birth (pregnancy) to 12 months, and from 24 to 60 months, and three comparison cohorts of children born in the same geographical area (2.5 years before, during and after the intervention). The crude and adjusted under-five mortality in the intervention cohort versus the comparison cohorts was evaluated using Cox regression model. Result: Incidence of under-five mortality was 15.7 (12.3-20.0), 98.7 (88.3-110.3), 41.2 (35.2- 48.2) and 39.3 (33.5-46.1) per 1000 person-years of observation children provided free, user fee before intervention, user fee during intervention and user fee after intervention health care services, respectively. The risk of under-five mortality among user fee children (before, during and after the intervention) were 5.87 (4.47-7.72), 2.45 (1.84-3.28), and 2.72 (2.03-3.66) times higher than those provided freely, respectively. Maternal death (AHR=2.10; 95% CI; 1.36- 3.23), rural residence (AHR=0.56; 95% CI; 0.44-0.72) and death of elder child (AHR=1.28; 95% CI; 1.01-1.61) were also found to be independent predictors of under-five mortality. Conclusion and recommendation: There was a slow decrement of early childhood mortality in the study area and was relatively high among user fee children, even compared to the after arm comparison cohort whereby lower mortality is expected, and health policy makers should give more emphasis on abolition of user fee health care services as it is one of the methods which significantly reduce under five mortality
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    Assessment of Factors Affecting Adherence and Utilization of Isoniazid Preventive Therapy among HIV Patients Yekatit 12 Hospital, Addis Ababa
    (Addis Ababa University, 2014-02) Getachew, Yitagesu; Mekonnen, Wubegzier(PhD)
    Background: Isoniazid (INH) is given to individuals with latent infection of tuberculosis in order to prevent progression to active disease. It is important to understand factors associated with non-adherence so that high adherence can be maintained or low adherence improved since adherence to effective treatment improves health outcomes. Objective: To assess factors affecting adherence and utilization of IPT in HIV patients and to explore the opinions of patients and health care providers about factors affecting adherence and use of INH Methods: Participants eligible for the study 403 individuals who were HIV positives taking INH on follow up at yekatit 12 hospital randomly selected and Adherence measured by self-report of INH tablets taken for past 3, 7 and 30 days and in depth interview for recruited patients, adherence counselor and health professionals at ART clinic was done. Results: Adherence to INH was 94% by self-report for last 7 days .The odds of adherence to INH was 7.7 [95% CI (2.6, 22.9)]times higher among those with no skin rash compared to patients with skin rash. Conclusion: The prevalence of adherence to INH among people living with HIV in yekatit 12 hospital has a better rate of adherence than other local and African studies and the reasons for poor adherence was strongly associated with occurrence of jaundice, skin rash and seizure and rate of utilization is perceived to be low because of interrupted drug supply. Recommendation: Availability of comprehensive care and support such as nutritional support and appointment per demand adequate time for counseling, follow up, sustainable drug supply, evaluation and treatment of side effects
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    Assessment of knowledge, attitude and practice of breast self-examination among women aged 20-49 years in Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2017-06) Chimdi, Chala; Mekonnen, Wubegzier(PhD)
    Introduction: Breast cancer is the most prevalent cancer among women globally and the second commonest cancer overall. In Africa, breast cancer was also the most commonly diagnosed cancer and the second leading cause of death among women in 2008. In Ethiopia it is also an emerging public health problem and top leading causes of cancer mortality and morbidity among women of reproductive age group. However, only few researches were done regarding knowledge, attitude and practice of breast cancer self-examination. Objective: To assess the knowledge, attitude and practice of breast self-examination among women aged 20-49 years in Addis Ababa, Ethiopia, 2017. Methodology: A community based cross- sectional study was conducted with a sample of 630 women aged 20-49 years in Addis Ababa. A multi-stage sampling technique was applied to select the study participants. Four out of ten sub-cities were selected randomly. One woreda was randomly selected in each sub-cities and systematic random sampling technique was used to select households in each selected Woreda .If there are more than one woman in the selected household one of them were randomly selected. A pretested structured questionnaire was used to collect data. Likert’s scale was applied to measure attitude and bloom cut classification score for knowledge score. Data was entered in to epidata and analyzed by (SPSS) software version 20. A Cross-tabulation was used to know the overall association of explanatory variables with breast self-examination. Bivariable and multi-variable binary logistic regression were also fitted to identify factors associated with breast self-examination practice. Result A total of 608 respondents participated in the study, of these only 155 (25.6%) of them had good knowledge and 53.4% had positive attitude towards breast self examination. Only 241 (39.6%) of the respondents had practiced BSE, from these study subjects only 96 (39.8%) of them practiced monthly. Occupational status and good knowledge of BSE were found to be significant association with the practice of breast self examination. Women of reproductive age group who are government employee were about 2 times more likely to practice breast self examination than those non-governmental employee [AOR=2.13, 95%, CI (1.19,3.84 ),p=0.011].Women who had good knowledge towards of breast self examination were 6 times more likely to practice BSE than those who had poor knowledge [AOR=5.99, 95%CI (4.1, 8.9), p=0.000] vii Conclusion and recommendation: knowledge and practice of breast self examination was low, even if majority of them had positive attitude. I suggest that the ministry of health and other concerned bodies should have to promote awareness creation for the community about breast cancer and BSE
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    Hypertensive disorders of pregnancy and its effect on birth outcomes among mothers in public hospitals of Tigray, North Ethiopia.
    (Addis Abeba University, 2019-05) Kahsay, Hailemariam Berhe (PhD); Enqusellasie, Fikre(PhD); Mekonnen, Wubegzier(PhD)
    Background: over half a million women die each year from pregnancy related causes signifying that complications of pregnancy and childbirth are the leading cause of death amongst women of reproductive ages. Hypertensive disorders of pregnancy are the second direct cause of maternal death only next to hemorrhage which accounts 14% of all maternal mortality globally and 16 % in subSaharan African countries. In Ethiopia 11% of all maternal deaths and 16% of direct maternal deaths are due to this obstetric complication. There is paucity of study looking into the pattern and distribution, the risk factors and the maternal and perinatal outcomes of hypertensive disorders of pregnancy. Moreover, little is known why hypertensive disorders of pregnancy are not early detected and managed to prevent the serious consequences of the disorders. Objective: the aim of this study was to assess hypertensive disorders of pregnancy and its effect on birth outcomes Methods: The study was conducted in public hospitals of Tigray, Ethiopia. Cross-sectional, matched case control, cohort and descriptive qualitative designs were applied for objectives one, two, three and four respectively. For the retrospective record review, all records of women diagnosed with hypotensive disorders of pregnancy from September 2012 to August 2017 (with calculated sample size of 746) were considered while for the case control study a total of 330 (cases=110 and controls=220) matched by parity were included. In addition, a total of 374 (exposed/with hypertensive disorders=187, non-exposed/without hypertensive disorders=187) were included in the follow up study. In the qualitative study, for documenting barriers, health professionals, health care leaders and women with a history of hypertensive disorder of pregnancy were included. Cases were pregnant women attending maternal health services with a diagnosis of hypertensive disorders of pregnancy by an obstetrician while controls were pregnant women attending maternal health services without hypertensive disorders of pregnancy. In the cohort study, exposed group were women diagnosed with any of the hypertensive disorders of pregnancy after 20 weeks of gestation by an obstetrician while non-exposed group were women free from any of the hypertensive disorders of pregnancy. Case-control incidence density sampling was used to identify cases and controls. For the cohort study, women diagnosed with hypertensive disorders of pregnancy with their nonhypertensive pairs were enrolled after 20 weeks of gestation and followed until the first 7 days postpartum. In both designs (case-control and cohort) the sample size was distributed to each selected hospitals according to the case load. For the qualitative study, a total of 22 in-depth interviews were conducted and the sample size was guided by the level of information saturation Data entry for the quantitative study was done into Epi-Info software and it was analysed using STATA 14 software. Descriptive statistics was computed and data were summarized in frequencies, proportions and means. Binary logistic regression was used to calibrate the association of different variables with the dependent variable for the quantitative study. For the case control study conditional logistic regression model was applied and Odds ratio was generated. Besides, relative risk was generated from a binary logistric regression for the cohort study. P-value less than 0.05 were considered significant in all analysis. For the qualitative study, recorded data were transcribed verbatim and translated to English. The transcript was exported to Atlas ti.7 software for qualitative data analysis which was followed by developing a categorization scheme to reduce the data and make it more manageable. Transcripts were read for several times and the primary codes were extracted. Then, the related codes were put in one group/category. Finally, based on similarity and content, the subcategories were used to make the main categories or themes. Thus, thematic content analysis was used to generate the main themes of the study. The overall findings were presented using figures, tables and texts. Ethical clearance was obtained from Institutional Review Board (IRB) of Addis Ababa University College of Health Sciences. Cooperation letter was written from the Regional Health Bureau and permission was requested from study facilities. Individual written informed consent was also sought from respondents at the time of data collection. Results: A total of 45,329 mothers were admitted to deliver in the selected public hospitals of Tigray during the five years study period (September 2012 to August 2017). Out of the total deliveries, 1347 (3%) women were diagnosed for one of the hypertensive disorders of pregnancy. The overall magnitude showed an increasing trend over the review period ranging from 1. 4% in 2013 to 4% in 2017 which gives average percentage increase of 31% per annum.The change over the five years period was checked for its significance using chi-square trend analysis and it was found to be significant (X 2 = 153, p≤0.001). Multivariable analysis on the relationship between hypertensive disorders of pregnancy and different covariates revealed that rural residence (AOR = 3.7, 95% CI; 1.9, 7.1), less amount of fruits consumption (OR =5.1, 95% CI;2.4, 11.15), being overweight (pre-pregnancy BMI>25 Kg/m2) (AOR= 5.5 95% CI; 1.12, 27.6), gestational diabetes mellitus (AOR = 5.4, 95%CI; 1.1, 27.0) and multiple pregnancy (AOR= 4.2 95%CI; 1.3, 13.3) were independent predictors of hypertensive disorders of pregnancy. Moreover, the study showed higher risk of having pregnancies complicated by maternal and perinatal adverse outcomes. Thirty six (20.2%) of hypertensive women and 19(10.7%) of normotensive women undergone cesarean section delivery. Preterm birth (RR=1.8; 95%CI, 1.5, 2.2), stillbirth (RR=1.6; 95%CI, 1.3, 2.02), low birth weight (RR=1.9; 95%CI, 1.6, 2.3), early neonatal death (RR=1.7; 95%CI, 1.3, 2.3), perinatal death (aRR=2.6, 95%CI; 1.2, 5.7) and cesarean section delivery(RR=1.7; 95%CI, 1.02, 2.9) were significantly higher among women with hypertensive disorders of pregnancy Furthermore, the qualitative study showed that knowledge deficit and traditional believes towards hypertensive disorders of pregnancy, delayed referral and provision of incomplete pre-referral treatments in the lower level health care facilities, failure to implement antenatal follow up as per the recommendation; scarcity and interruption in the supply of resources; and lack of mentorship programs to make professionals competent were claimed for the late detection and management of hypertensive disorders of pregnancy. Conclusion: Hypertensive disorder of pregnancy in Tigray is found to be 3% and it showed an increasing trend. Rural residence, less fruit consumption, multiple pregnancy, presence of gestational diabetes mellitus and pre-pregnancy overweight were identified as independent risk factors in the current study. Besides, women with hypertensive disorders in pregnancy were at significantly higher risk of having pregnancies complicated by maternal and perinatal adverse outcomes. A significant risk of cesarean section delivery, preterm birth, perinatal death, stillbirth and low birth weight delivery were reported among women with hypertensive disorders of pregnancy. Moreover, poor awareness of mothers and community misconceptions towards hypertensive disorders of pregnancy, multiple referrals before reaching the final functional health care facility, less focus on the quality of antenatal care, scarcity of resources and limited capacity building programs were reported as barriers for early detection and management of hypertensive disorders of pregnancy. Therefore, health care managers and administrators at different level of the health care system should give due emphasis to hypertensive disorders of pregnancy as it is one of the top causes of maternal and perinatal mortality and its magnitude is increasing from time to time. Health institutions should have strong strategies of screening, counselling, follow-up and referral linkage of mothers in the antenatal clinic and maternity wards by availing necessary materials and designing strong supportive supervision/ mentorship programs.
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    Levels and Determinants of Fertility among Refugees in Ethiopia
    (Addis Abeba Universty, 2014-02) Haile, Gashawbeza; Mekonnen, Wubegzier(PhD)
    Background: Refugees are believed to be highly vulnerable, marginalized and underserved population groups and at high risks of different physical, psychosocial, sexual and mental health threats. The short and/or long term partner separation and other fertility inhibiting factors due to conflict and forced migration result in changing refugee fertility behavior. The refugees maternal and child health conditions are more affected by the forced migration and uncontrolled births. In the current study refugee population little is known about their fertility determinants. Objective: This study was an attempt to examine refugees’ current and desired fertility levels and to assess the relative contribution of intermediate (proximate) fertility determinant variables and distal fertility determinant among refugee inhabiting in Ethiopia. Method: Refugee community based cross-sectional study design was employed. Using the standard and structured questionnaires 2041 sampled women refugee in the childbearing age and dwell in camps and urban settings interviewed mainly on their socio-demographic and reproductive characteristics. Bongaart’s model was used to measure the relative contribution of the proximate determinants of fertility and negative binomial regression model was employed to identify distal fertility determinants. Data were entered in Epi info 7 and exported to SPSS version 20.0 and Stata 11 software for cleaning and analysis. Results: The observed total fertility rate and the total marital fertility rate were found to be 4.6 and 5.9 children per woman respectively. There was a big disparity of total fertility rate among urban vs. camp refugees with 3.0 and 5.8 children per woman respectively. The mean children ever born were 3.40 children per woman. The mean desired fertility rate was estimated at 8.72 children per woman and the mean children ever born to women in the age group 45-49 were 7.90 children per woman. However, 83% of the respondents attributed that only God/Allah will decide on the number of children refugees can have. On the other hand, non-marriage and postpartum amenorrhea contributed the highest (35% and 34%) fertility inhibition effect of its possible biological maximum respectively. Meanwhile, the inhibitory effect of contraception from its natural level was only 16% among refugees. Similarly, from the selected socio-demographic and reproductive variables, religion (fertility level among women refugee in the Muslim religious congregation were, 1.42: 95% CI (1.19, 1.70) times higher compared to Christianity followers). age at migration (fertility was 1.22: 95% CI (1.05,1.43), 1.66: 95% CI: (1.37,2.01) and 1.92: 95% CI (1.51,2.44) times higher among women refugee moved out from their usual place of abode 11-20, 21-30 and 31or more years ago respectively compared to those who migrated within the past 10 years). Similarly, age, monthly income, polygamous marital forms, history of abortion, age at first birth, partner's attitude on contraceptive use and marital duration were the significant predictors of refugee fertility. Conclusion: The refugees’ current and desired fertility is among the highest, with significantly high disparities between current and desired fertility level. Women’s religious belief has a greater effect on the desired fertility level. Non-marriage, postpartum amenorrhea and contraception significantly reduced fertility from its natural level. Refugee women’s age, monthly income, marital forms, history of abortion, age at first birth, age at migration, religion, partner's attitude on contraceptive use and marital duration are the significant predictors of fertility. Hence, strengthening refugee women and girls' schooling help to empower women refugee and able claim and exercise their reproductive rights as appropriate. Religious leaders and male partners’ involvement in the woman's fertility decision is highly recommended. The refugees’ current and desired high fertility level entail the need for refugees based and friendly reproductive health program design with due emphasis on the identified predictor variables along with encouraging refugees’ best practices of non-marriage, postpartum amenorrhea and contraceptives uses. Key words: Refugee women, desired and current fertility level, Proximate and distal determinants of fertility, Children ever born, socialization, disruptive, adaptation
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    Pre-post Intervention Study on Overcrowding and Waiting time at Outpatient Department in Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2013-11) Yalew, Tamiru; Mekonnen, Wubegzier(PhD); J. Cherlin, Emily (PhD)
    Overcrowding is one of the major problems that impede quality of services at Amanuel Mental Specialized Hospital, especially at outpatient department. Overcrowding at outpatient department deters easy movement of both staff and patient which hinders appropriate use of available space in the hospital. Outpatient overcrowding influences quality and efficiency of service provision. The objective of this intervention research was to assess impediments of overcrowding to improve patient flow and ease service provision at outpatient department in Amanuel Mental Specialized Hospital by end of October 30, 2013. An intervention study comparing the status of overcrowding before and after the appropriate procedures to ease free movement and quality service was placed in the Outpatient Department of Amanuel Mental Health Specialized Hospital. All possible factors that cause overcrowding at outpatient department in Amanuel Mental Specialized Hospital were explored at the baseline (at pretest). These factors would be related to the characteristics of patients, care takers, providers and the physical and logistics setup in the department. Appropriate interventions were developed by the principal investigator in collaboration with the hospital leadership. Ultimately changes brought about by the proposed intervention was measured and documented. From a total of 250 health care professionals, 41 health care providers were serving in regular outpatient department of Amanuel Mental Specialized Hospital. All health care providers who are working at OPD are selected by purposive sampling method. A total of 8,791 clients visit Amanuel mental specialized hospital per month. Three hundred eight four clients were selected by simple random sampling technique for survey. Pre-intervention- Intervention–Post-Intervention study was conducted. In each phase, analysis was performed using SPSS software version 20 and Excel spreadsheet. Two sample proportion test (pre and post) statistical tests was used to test factors contributing to overcrowding for clients, staff and two mean comparison test (T-test) was used for waiting time study. This project work was done from December 2012 to August 2013. The total cost required to conduct and implement the project was 12,240 Ethiopian Birr. After the implementation of appropriate interventions, overcrowding in most outpatient department units was significantly reduced, quality of services was enhanced, and there was low waiting time to get outpatient services. After implementing selected strategies (Appropriate appointment system and recruiting adequate staff) the proportion of outpatient load among treatment session was significantly reduced from 76.82% at morning session to 57.49% and increased from 23.18% at afternoon to 42.51% with p=0.0001 which is significant proportion difference between the two tests. And similarly the overall time taken to complete all the services were 112 minutes (SD+58) in pre- and post intervention the result was 54.53 minutes (SD+9.86) with p=0.0001 which is significant mean difference between the two test means.