Browsing by Author "Shiferaw, Solomon (PhD)"
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Item Assessment of Client-Health Care Provider Communication at Antenatal Care Clinics in Addis Ababa, Ethiopia(Addis Ababa University, 2012-06) Tadesse, Worku; Shiferaw, Solomon (PhD); Lamnew, Worksheet (PhD)Background Health care provider-client communication during Antenatal care is an effective strategy to improve maternal health care seeking behavior and satisfaction with health services. However, the presence of miscommunication, lack of communication, or unsatisfactory communication between health care providers and clients pose a significant challenge in the health care service utilization. Objective The aim of this study was to assess the client-health care provider communication including client satisfaction in public hospitals at antenatal care clinics, in Addis Ababa, Ethiopia. Method: A cross-sectional study design using both quantitative and qualitative methods was employed from October to June 2012. 425 consecutive clients of antenatal care took part in the study. Additionally, in-depth interview was conducted among 15 purposively selected antenatal clients, 17 conveniently selected health care providers using interview guides. Results: The mean (SD) age of antenatal clients was 27.6±4.7 years; majority having secondary (33.4%) and tertiary education (34.4%); and Only 161(37.9%) antenatal clients were satisfied by health care providers‟ quality of communication. Getting care by one provider at different visits (AOR=0.55;95%CI:0.32,0.96), longer duration of time for discussion(AOR=0.29;95%CI:0.11,0.77), clients‟ feeling of privacy(AOR=0.47;95%CI:0.22,0.99),health care providers‟ empathy (AOR=0.41; 95%CI:0.22,0.77) and information provision (AOR=0.09; 95% CI: 0.05, 0.17) were significantly associated with better client satisfaction. Time constraint due to heavy clients‟ load (88.0%), multiple clinical task (71.0%), and lack of dedicated space for communication (58.8%) were the most common barriers of optimal communication reported by health care providers. Conclusion and Recommendation: more than 3 out of 5 of antenatal clients were not satisfied by the providers‟ quality of communication. Insufficient discussion time, suboptimal health care providers‟ empathy and information provision, lack of feeling of privacy and lack of continuity of care by same health care providers were the main factors that contributed to the low antenatal client satisfaction on health care provider‟s quality of communication. Better demonstration of empathy, information provision, longer discussion time, continuity of care with one provider and providing sufficient feeling of privacy should be encouraged to improve antenatal clients‟ satisfaction on health care providers‟ quality of communication. Attempt should be made to free health care providers at ANC from multiple clinical tasks with more attention given to ensuring dedicated space to improve optimal provider-client communication.Item Assessment of Knowledge and Utilization of Growth Monitoring and Promotion for under two children in Butajira, Ethiopia 2017(Addis Abeba Universty, 2017-05) Desalegne, Luwam; Shiferaw, Solomon (PhD)Background: United Nations International Children Emergency Fund (UNICEF) defines Growth Monitoring and Promotion (GMP) is a prevention activity comprised of growth monitoring linked with promotion (usually counseling) that increases awareness about child growth; improves caring practices; increases demand for other services, as needed; and serves as the core activity in an integrated child health and nutrition program, when appropriate. This would help parents keep their young children healthy and well nourished. GMP has been implemented in Ethiopia since 2008 as nutrition specific intervention to prevent malnutrition. Objective: To assess knowledge and utilization of growth monitoring and promotion and identify factor associated with knowledge and utilization of GMP for children under two years in Butajira, SNNPR, Ethiopia. Method: Community based cross sectional study was conducted from April-May 2017. A total of 548 child mother pair less than 2 years old who resides in Butajira were selected by simple random sampling method. Qualitative study (in depth interview and observation) were also conducted to supplement the quantitative study and to assess the skill and knowledge of health extension workers working in selected heath post. The data was entered using Epidata version 3.1 and analyzed using STATA version 14 software. Multivariable logistic regression model was fitted to predict the association between knowledge and utilization of GMP and their determinants. All statistical analysis was set at 5% level of significance (i.e. p < 0.05. The results were reported as Odds Ratio and 95% CI). Appropriate tables and diagram were used to present findings. Result: Among 507 mother-child pair participates utilization of GMP was fifty five 11% [95%CI=8.4%-13.8%] while three hundred twenty five 64% [95%CI= 60%-68%] of the mothers had adequate child feeding and growth chart knowledge. The result showed that mothers gave birth in the health facility were 1.60 times more likely to be knowledgeable about child feeding and growth chart than those mother gave birth at home [AOR=1.60; (95% CI=1.06, 2.44)]. Whereas those child-mother pair traveled less than one hour to reach to the nearest health facility from their house were 2.06 times more likely to be knowledgeable about child feeding and growth chart than those mother travel more than an hour to reach to their nearest health facility [AOR= 2.06; (95%CI=1.35, 3.13)]. Mothers with elementary educational level were 3.31 time xii more likely utilize GMP [AOR=3.31(95%CI=1.50, 6.02)] while mothers with secondary and above education level were 3.33 times more likely utilize GMP than illiterate mothers [AOR=3.33(95%CI=1.30,8.50)]. Regarding occupation of the mother, framers were 4.03 times more likely utilize GMP than house wives [AOR=4.03(95%CI=1.32, 8.50)]. Mothers with child feeding and growth monitoring adequate knowledge were about 5 times more likely utilize GMP than those mother with inadequate knowledge [AOR=4.87(95%CI=1.80,13.16)]. Qualitatively, irregularity of GMP session due to health extension work load, not recording the age and weight of the child accurately, mother wrong belief and skill gap of heath extension workers were challenges of GMP utilization. Conclusion: growth monitoring and promotion is not implemented as it was supposed to be. More than half of the respondents had adequate child feeding and growth chart knowledge and utilization of GMP is very low in rural kebeles of Butajira. Monitoring implementation of growth monitoring and promotion should be needed throughout different weredas and kebeles that are expected to implement growth monitoring and promotion program.Item Assessment of the prevalence and associated factors of exclusive breastfeeding practice in Afar. A community based cross sectional survey, Aysaita wereda, Afar, Ethiopia(Addis Abeba Universty, 2015-06) Tsegaye, Medhin; Shiferaw, Solomon (PhD)Background: Breastfeeding is an important public health strategy for improving child and maternal health conditions. However, the prevalence of exclusive breastfeeding is very low in many developing countries including Ethiopia. Therefore, this study was conducted to determine the prevalence of exclusive breastfeeding and associated factors among infants aged six months in Asaita wereda, Afar Ethiopia. Objective: To measure the prevalence and identify determinant factors of exclusive breastfeeding practice in Afar. Materials and methods: A community based cross-sectional study was conducted with qualitative inquiry from March to April 2015. Quantitative data were collected from 631 mother infant-pairs residing in Aysaita wereda with pretested structured questionnaire using the modified EPI cluster sampling procedure. Seven clusters were selected using the PPS (probability proportional to size) after selecting the clusters, households were divided and distributed equally for each enumeration areas. Dividing 1958 HHs (estimated HHs to be visited) equal to the 7 EAs, 280 households in each selected clusters or enumeration areas were visited. The qualitative data were generated through focus group discussions among purposely selected discussants. Odds ratio with 95% confidence interval was estimated using bivariate and multivariable analysis with binary logistic regression model to identify independent predictors of exclusive breastfeeding while thematic framework analysis was employed for the qualitative data Results: The majority (97.9%) of the mothers have ever breastfed their infants. The prevalence of exclusive breastfeeding was 55% with a median duration of 0.5 months. Residing in Urban AOR: 5.7, 95%CI(3.5-9.2), having good knowledge on exclusive breastfeeding AOR: 2.3, 95%CI (1.6-3.5), lower parity (1 & 2-4) AOR: 2.2 95%CI(1.2,4.2) & AOR: 1.9, 95%CI(1.1,3.5) respectively, delivering at health facility AOR: 1.7, 95%CI (1.1,2.7) unemployment AOR: 1.8, 95%CI(1.1,2.9) and primary education AOR: 0.6, 95%CI (0.4,0.9) were found to be a predictor of exclusive breast feeding. Conclusion: The prevalence and median duration of exclusive breastfeeding was found to be low compared to the WHO recommendation. In the current study, however half of the mothers had good knowledge on exclusive breastfeeding, knowledge of mothers about the right time to initiate breastfeeding after birth, and knowledge on foods/liquids recommended to infants less than 6 months was far lower from many studies done in developing countries. Most of the study population had positive/favorable attitudes towards exclusive breastfeeding practice during the first six months. Urban residence, being unemployed, being knowledgeable on EBF practices, low parity and delivering at health facilities were the independent predictors of exclusive breastfeeding practice in the studied community. Thus Strengthening efforts on availability of basic services and promoting education on the cultural malpractices on rural areas, promoting knowledge on exclusive breast feeding using accessible means such as medias and public meetings, revising policies on maternity leaves and creating a baby friendly working environment, encouraging the mothers to deliver at health facilities and promoting its importance and encouraging further researches on the topic of area are recommendedItem Assessment on food security, nutritional status and their association with HAART adherence among adult PLWHA in public hospitals of Addis Ababa, Ethiopia(Addis Abeba Universty, 2011-05) Tezera, Solen; Shiferaw, Solomon (PhD)Background: Morbidity and mortality related to HIV/AIDS remain unacceptably high in developing countries, despite major advance in HIV therapy and increased international funding on HIV/AIDS. Individual’s ability to obtain, consume and utilize food is compromised by HIV/AIDS. It causes morbidity and mortality as a result of poor nutritional status and weight loss. Interactions between antiretroviral therapy (ART) and nutrition can affect medication efficacy, nutritional status, and adherence to drug regimens. The concept of enhancing access to food among PLWHA and managing the interactions between ART and food and nutrition is critical remains critical. Objective: To assess food security, nutritional status and their association with adherence of HAART among adult People living with HIV/AIDS. Methods: A hospital based cross-sectional survey was conducted between December 2010 and February 2011 among adult (≥18 years) PLWHA on HAART with a complementary qualitative interview among HAART adherence supporters at selected public hospitals of Addis Ababa, Ethiopia. A total of 394 adult PLWHA systematically selected and participated in the study having a 100% response rate. Semi structured and structured questionnaires, adopted from FANTA were used to collect data on food security. BMI measurements were taken to assess nutritional status. Univariate, bivariate and multivariate logistic regression analysis was done using SPSS version 16. Qualitative content analysis was done after importing the transcribed text onto the Open code program. Result: Majority 252 (65%) of the study participants were females, 305 (77%) in the age group 25-44 years. Overall 293(74.4%) PLWHA were food insecure with 95% CI: (70.09, 78.71). And the rate of self reported adherence based on the combined indicator of the dose and time adherence measurement was 321(81.5%) with 95% CI: (77.67, 85.33). Only 61(16.5%) with 95% CI: (12.83, 20.17) were underweight. Household’s monthly income (≤500 ETB) predicted food insecurity (AOR, 6.37; 95% CI, 2.98-13.63). And there was no statistical significant association between food security and self reported HAART adherence. II food security, nutritional status & their association with HAART adherence Conclusions & recommendations: Large number of adult PLWHA was food insecure. Wide ranges of coping strategies were taken to cope with food insecurity. Self reported HAART adherence was high. Medium to long term intervention aiming at generating and diversifying income to improve self reliance of PLWHA would help mitigate the food insecurity problem.Item Effect of maternal characteristics during pregnancy on birth weight of neonates in private and public health facilities of Addis Ababa: a crossectional study(Addis Abeba Universty, 2016-06) Sebsibe, Samrawit; Shiferaw, Solomon (PhD)Background: Birth weight is a good indicator of the newborn‟s chances for survival, long-term health, growth, and psychosocial development. Low birth weight increases the risk for certain adulthood chronic disorders which may increase risk of morbidity and mortality. The present study was intended to determine the effect of maternal characteristics during pregnancy on birth weight of neonates in health facilities. Objective: to determine the effect of maternal characteristics during pregnancy on birth weight of neonates and occurrence of LBW in private and public health facilities of Addis Ababa. Methods: A facility based cross sectional study was conducted on a total of 881women coming to health facility seeking delivery service. The study was performed in selected public and private health facilities of the city from February to march 2016. Data was collected using a structured questionnaire in a face to face interview. Data concerning condition of the mother during time of pregnancy were also collected by reviewing antenatal care (ANC) chart. Epi-Info version 7.0 and stata version 12 was used for data entry and analysis .Univarate analysis was used to measure the magnitude of LBW, Bivariate analysis was used to assess the strength of an association between low birth weight and list of independent variables and test significance of the association. Multivariate logistic regression model was used to identify the important determinants by controlling for possible confounding variables and statistical significance was considered at p-value <0.05. Result The proportion of low birth weight was 14.7%[95% CI:(12.2,17) and among maternal determinants place of antenatal care visits, level of hemoglobin, gestational age, previous history of low birth weight, pregnancy induced hypertension and weight at third trimester were significantly associated with low birth weight. Conclusion and Recommendation: The proportion of low birth weight was high and most of them were associated with maternal obstetric and medical condition which can be prevented by improvement public health intervention on ANC follow up, and giving more attention for mothers history of past adverse outcome and with medical illnessItem Knowledge, Attitude, and Practice of Women towards Exclusive Breastfeeding and Mixed Feeding In Gubalafto Woreda, Amhara Regional State, Ethiopia(Addis Abeba Universty, 2014-04) Gellaw, Mitiku; Shiferaw, Solomon (PhD)Background World health organization (WHO) and United Nations Children’s fund (UNICEF) recommends breastfeeding children exclusively the first six months, and continuing breast-feeding along with complementary foods up to 2 years or beyond is important. Despite the recommendations, national exclusive breastfeeding prevalence in many countries remained very law which ranges from 30%-67% only. This study was intended to provide relevant information for government and nongovernmental organizations’ (NGOs) officials on magnitudes and gaps on breastfeeding, exclusive breastfeeding in particular. This will help for appropriate and relevant interventions. Objective To assess knowledge, attitude, and practices of mothers on exclusive breast-feeding and mixed feeding and indicate areas of interventions for relevant stakeholders. Methodology This study was designed as an institution based cross-sectional study supplemented with qualitative method. A structured and semi structured questionnaires were used for quantitative and qualitative data collection respectively. Results Proportion of women with good knowledge and good exclusive breastfeeding practice was 259(65.1%) and 311(78.1%) respectively. Prevalence of mixed feeding practice was 73(18.3%). In the hierarchical analysis; their spouse being educated, maternal age >35 years, married mothers, being a housewife remained significant predictors of EBF knowledge. Mothers who were formally educated and being a housewife were significant predictors of good EBF practice. Conclusions and Recommendations Even though mothers who visit health clinics are expected to have better knowledge status, their knowledge status regarding EBF recommendations remained very low. Their EBF practice level was still unsatisfactory. Their spouse being educated, mothers being married, being a housewife and mothers’ illiteracy negatively affected their knowledge and practice status on EBF. A ii support from family, health care providers, health policy makers and health project implementers is imperative to improve appropriate breastfeeding practice among breastfeeding mothers.Item M obile based emergency reporting system for infectious disease surveillance(Addis Ababa University, 2015-06) Ahmed, Harif; Bekele, Rahel (PhD); Shiferaw, Solomon (PhD)Quick detection and response to emergency infectious disease is crucial. However, manual paper based reporting and response system has many shortcomings such as inability to report emergency infectious disease on time and the possibility of errors that can be committed during data entry. The research project therefore, aimed to design Mobile based emergence reporting for infectious disease surveillance support system for Oromia Regional Health Bureau, in order to improve the use of mobile based reporting for infectious disease surveillance for making sound decision and alert response to prevent and to control communicable diseases. A phased development, Object Oriented Analysis and Design (OOAD) methodology and iterative approach is applied to the study of the design system. Interview and document analysis were used as a main tool to capture the business system requirement along with observation. Unified modeling language (UML) development techniques, applied in the process of requirements capture, model organization business system and design. Argo UML and Visio Software were employed in analysis and design models diagramming. Overall a Mobile based emergency reporting for infectious disease surveillance support system is developed that can be used for Oromia regional health office, in case of emergence of infectious disease outbreak to give response, feedback and alert early warning in a timely manner. The researcher recommends the implementation of the design by the Oromia Regional Health Bureau or any concerned body including laboratory case reports, case based reporting, eventbased surveillance such as events related to occurrence of disease in human and events related to potential risks for humans health that are not included under current design to realize the benefit of Mobile based Reporting and Response system. Keywords: surveillance response system, mobile based, outbreak, emergency infection disease, Oromia Regional Health Bureau, UMLItem Nutritional Recovery among Moderately Malnourished Adults Living with HIV in Clinical Nutritional Care in Addis Ababa(Addis Abeba Universty, 2015-06) Hibist, Selam; Shiferaw, Solomon (PhD)Background: Infection with HIV is one of the greatest challenges to global health. HIV infected person needs extra calorie than non-infected of the same age group. Malnutrition and HIV/AIDS exacerbate one another. PLWHIV are prone to develop malnutrition and malnourished PLWHIV have rapid disease progression and increase risk of mortality. National Clinical Nutritional Care Program provides therapeutic and supplementary food along with nutritional assessment and counseling to malnourished HIV positive individuals. However, to the investigators’ best knowledge no published research that examined the recovery rate of moderately malnourished adults living with HIV on nutritional care program and its determinants. Objective: This study aimed to evaluate the nutritional outcomes and associated factors among moderately malnourished adults living with HIV who were in the treatment care plan of nutritional care program. Method: A retrospective before after study design (without a control group) was employed. For this purpose, we used medical records (FBP registration book) from 41 health facilities in Addis Ababa. Individuals' weight, height and clinical signs measured at baseline data and at the end of the 3 month follow up was analyzed and compared. In addition, we interviewed 15 health care providers' to get their insight about the program and understand the possible reasons for recovery/failure of the nutritional supplementation program. Result: A total of 383 classified and treated as moderately malnourished clients data were reviewed from 41 health facilities (30 health centers and 11 hospitals). More than half of the study population, 223(58.2%) were females with a median age of 36.6 years. Overall the majority 284(74.2%) gained weight, while 13.8% lost their weight and 46(12%) discharged with the same weight of admission. The analysis showed there was significant improvement in the mean BMI score from 17.4kg/m2 during admission and to discharge at 18.2kg/m2 (P-value <0.01) With 133 (34.7%) getting out of malnutrition (reaching a BMI ≥18.5kg/m2), of those who recovered from under-nutrition 67.6% were treated in health centers while 32.3% were treated in hospitals (with recovery rate of 33% & 39.1% in health center and hospital respectively). Sharing of the product within the household, selling and patient dislike of the product was explained as a main reason for failure. Conclusion: There was significant change in weight but reaching the intended BMI still questionable only a minority of patients achieved stated programmatic goals. Further study should include duration of treatment, exit criteria and associated factor. The findings revealed clients who were admitted to nutritional care program in hospitals & with symptomatic disease were more likely to recover at discharge compared to their counterparts who were admitted to health center and without symptomatic disease. More in-depth study is recommended to understand the reasons and replicate the positive experience of hospitals in health centers. Product quality especially the taste takes a part in nutritional failure so further research is also needed to evaluate and design a better product which is preferred by adults.