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Magnitude of Mental and Behavioral Disorders in Children and Adolescents in Butajira, Southern Ethiopia
(Addis Ababa University, 1998-12) Ashenaffi, Yihalem; Kebede, Derege (PhD)
In order to explore the magnitude of specific mental and behavioural disorders and their socio-demographic corre lates in children, a study was cond ucted in Butajira, Southern Ethiopia, using the Amharic vers ion of the Diagnostic In strument for Children and Ado[escents (D[CA). A total of [477 children were assessed; 3.5 % of the study subjects had at least one or more mental or behav ioura l disorders. The most frequent diagnoses were anx iety disorder ( 1.6%), Attention Deficit Hyperactiv ity Disorder (ADHD) ( [ .5%); and disruptive behav ioura l disorder (1.5%). Mood d isorders ( [ %) and elim ination disorders (0.8%) were re lative ly less common. Res idence in urban area was associated with ADHD:OR(95 % CI) = 3.03 (1.11-8.04).ADHD was also associated with increasing age, having a s ingle parent, or a chronica ll y s ick family member: OR (95 % CI) = 3.32 ( 1. 15-10.33), 4.63( 1.25-1 7.3 1), 5.5 6(2. [6-14. [6), respectively. Disruptive behavioural disorders were sign ificantly associated with increasing age, parents not living together, severe financial problem and with the presence of chrunically sick family member OR (95 % C[) =4.4 1 ( 1.40- 15.45),4.63( 1.05- 17.3 1 ),2.77( 1.05,7. 12), and 8.15 (3.23 ,20.56), respectively. Livi ng in a house with more than one room was a lso sign ificant ly but inversely, associated with anxiety disorder: OR(95%CI)=0.39 (0.16,0.95). Mood disorders were assoc iated with the presence of parents not li ving together, fi nancial problem and chronically sick fami ly member: OR (95 % CI ) = 4.44 ( 1.00, [8 .57),5.57 ( 1.82,17.20), and 12. [2(3.89,38.84), respective ly. Enuresis was found to have no stat istically signi ficant association with any of the variables mentioned. Specific mental and behav ioura l disorders in chil dren were fo und s igni fica nt public health problems.[n order to explore the magnitude of specific mental and behavioural disorders and their socio-demographic corre lates in children, a study was cond ucted in Butajira, Southern Ethiopia, using the Amharic vers ion of the Diagnostic In strument for Children and Ado[escents (D[CA). A total of [477 children were assessed; 3.5 % of the study subjects had at least one or more mental or behav ioura l disorders. The most frequent diagnoses were anx iety disorder ( 1.6%), Attention Deficit Hyperactiv ity Disorder (ADHD) ( [ .5%); and disruptive behav ioura l disorder (1.5%). Mood d isorders ( [ %) and elim ination disorders (0.8%) were re lative ly less common. Res idence in urban area was associated with ADHD:OR(95 % CI) = 3.03 (1.11-8.04).ADHD was also associated with increasing age, having a s ingle parent, or a chronica ll y s ick family member: OR (95 % CI) = 3.32 ( 1. 15-10.33), 4.63( 1.25-1 7.3 1), 5.5 6(2. [6-14. [6), respectively. Disruptive behavioural disorders were sign ificantly associated with increasing age, parents not living together, severe financial problem and with the presence of chrunically sick family member OR (95 % C[) =4.4 1 ( 1.40- 15.45),4.63( 1.05- 17.3 1 ),2.77( 1.05,7. 12), and 8.15 (3.23 ,20.56), respectively. Livi ng in a house with more than one room was a lso sign ificant ly but inversely, associated with anxiety disorder: OR(95%CI)=0.39 (0.16,0.95). Mood disorders were assoc iated with the presence of parents not li ving together, fi nancial problem and chronically sick fami ly member: OR (95 % CI ) = 4.44 ( 1.00, [8 .57),5.57 ( 1.82,17.20), and 12. [2(3.89,38.84), respective ly. Enuresis was found to have no stat istically signi ficant association with any of the variables mentioned. Specific mental and behav ioura l disorders in chil dren were fo und s igni fica nt public health problems.
The Effect of Violence on Adverse Reproductive Health Outcomes among ANC Clients in Woliso Town, Southwest Shewa Zone Oromia Regional State, Ethiopia.
(Addis Ababa University, 2011) Genet, Seralem; Deyesa, Negussie (MD, MPH, PHD)
Back ground: It is globally acknowledged that violence against females is least considered sever problem due to different hindrances like cultural, economical, social and deep rooted male dominancy throughout the world. Besides this in the study area health institutions there are no researches conducted on the effect of violence against females on adverse reproductive health outcomes. Objective: The study was intended to assess and compare the effect of violence on adverse reproductive health outcomes and or sexually transmitted infections among antenatal care visitor clients. Methods: A case control study was conducted among antenatal care visitors of St.Lukes Catholic hospital and woliso health center which are found in Woliso town, South West Shewa administrative zone. Mothers who have at least one adverse reproductive health outcome or sexually transmitted infections were considered as cases and those who have no as controls in which the total sample size, were 198 cases and 202 controls included. The X 2-test and OR with 95 % CI was applied for data analysis. A binary logistic regression analysis method has been used to assess the effect of independent variables. Result: Women experiencing sexual violence were about 4 times higher at risk among cases when compared to controls [OR =3.74, 95% CI (2.17-6.45)]. Similarly the chance of experiencing psychological violence was more than 2 times higher among cases compared to the controls [OR=2.14, 95%CI (1.36-3.36)]. The likely hood of experiencing any form of violence during pregnancy was more than 3 times higher among cases than controls [OR=3.27, 95%CI(1.35-7.88)]. However there was not significant association in experiencing physical violence among cases and controls. Conclusion and Recommendation: The study revealed that risk of sexual and psychological violence among cases was higher than controls. Therefore when,women come with any form of adverse reproductive health outcome assessing their experience of violence is necessary, and those exposed to the problem should get appropriate health care management.
Perinatal Mortality among Cohorts of Pregnant Women in three Districts of North Shewa (Degem,Kuyu and Wore Jarso)Oromia Region: Magnitude, Causes and Determinants.
(Addis Ababa University, 2013-01) Merdassa, Elias; Molla, Mitike(MPH, PhD)
Background: Improving perinatal health is key in decreasing child and infant mortality rates but information on perinatal deaths is highly susceptible to omission and misreporting. Hence community based data can provide more representative and reliable information. Objective: this Study is intended to assess the magnitude, determinants and main cause of perinatal mortality among babies born from cohorts of pregnant women in three selected districts of North Shewa zone Oromia Regional State namely Degem, Kuyu and Warajarso. Methods: A cohort of 5,784 pregnant women were followed through delivery by the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) from March 2011 to February 2012 in three districts of North Shewa zone of Oromia Regional State where MaNHEP is providing maternal and neonatal health intervention. At the beginning of the study, pregnancy outcomes of 3,916 women were identified by house to house visit using the initial records of MaNHEP in each kebele. Using this cohort we conducted community based nested case-control design among 67 cases and 134 controls. All perinatal deaths reported between March 2011 to February 2012 were included in the study and two live birth controls born from mothers in the cohort were included for each perinatal death after a random selection from the same Gote with the cases. A standard verbal autopsy instrument was used as a main data collection tool after adapting to the local situation. Data were entered using Epi Info version 3.5.1 for windows and exported to SPSS version 20.0 for analysis.Logistic regression model was employed with Crude and Adjusted Odds Ratio at 95 CI, p-value 0.05 taken as level of statistical significance.The probable causes of deaths were assigned by two pediatricians using ICD 10. Principal component analysis was used to construct household socio-economic status of the study participants. Result: Data were collected from 67 cases and 134 controls. Twenty four (30.38 %) of the cases were still births while 43(54.43%) were early neonatal deaths. The overall perinatal mortality rate in the study area was 19.5 per 1000 live births and still birth. Maternal age greater than 30 years [AOR 2.665, (95% CI:1.0266.922)], having previous history of neonatal mortality [AOR 6.833, (95% CI:2.782-16.782)], preterm births [AOR 6.929,( 95% CI:1.779-26.994)], male sex [AOR 4.049,(95% CI:1.836-8.926)] and home delivery [AOR 3.704,(95% CI:1.192-11.506)] were significantly associated with perinatal mortality in the final model. Birth asphyxia (31%), sepsis (25%), chorioamnionitis (11%), antepartum hemorrhage (9%) were the four leading causes of perinatal death. Conclusion: The study reported lower perinatal mortality rate than other studies conducted in the country.Majority of the deaths occurred in the first twenty four hours suggesting that interventions should focus on this critical time of vulnerability to save lives of newborn.Potential determinants and causes of perinatal mortality identified in this study were related with maternal factors implies that still there is a need to focus on these major causes of deaths for further intervention.
Assessing Satellite-Based Ambient PM in Relation to Under-Five Children Mortality in Ethiopia.
(Addis Ababa University, 2022-05) Bereded, Ashenafie; Kumie, Abera (PhD); Tefera, Worku (PhD. Candidate)
Background: Particulate matter below 2.5 µm diameter (PM ) is a part of air pollution that has adverse effects on health. Data on exposure to ambient PM 2.5 is not well monitored in sub-Saharan Africa due to limited resources and skilled manpower.The effect of PM 2.5 on health is least explored in Ethiopia. Objectives: The study has assessed the relationship between satellite-based ambient PM 2.5 pollution and under-five mortality in Ethiopia. Methods: The study used the data from Ethiopian Demographic Health Surveys conducted in 2016, collected between January 18 and June 27. Under-five children with the child mortality information and coordinates of geographical location were included. Satellite-based ambient PM 2.5 concentration was extracted from the Atmospheric Composition Analysis Group website at Washington and Dalhousie University, in the United States and Canada, respectively. Datasets were downloaded from their respective websites. Annual pollution level and mortality datasets were matched by children’s geographical location, birth, death, and interview dates.The relationship between satellite-based ambient PM and under-five mortality was determined by multilevel multivariable logistic regression. The statistical analyses were two-sided at 95% confidence interval. Results: The study addressed 10452 children with the proportion of under-five mortality being 5.4% (95% CI 5.0% - 6.8%). The estimated lifetime mean annual exposure of ambient PM 2.5 was 20.1 ± 3.3 µgm-3. Significant clustering of mean annual PM concentration and under-five mortality proportion were varied by region. A ten-unit increase in lifetime mean annual ambient PM 2.5 2.5 was associated with 2.40 [95% CI 1.51, 3.80] times more odds of under-five mortality after adjusting for other variables. In addition, children with food cooked inside a house but with no separate room, mothers without formal education, very large birth size, twins, born at home, and stunting prevalence were significantly positively. Conclusions: Clustered spatial distribution of ambient PM concentration and under-five mortality has existed. Satellite-based PM 2.5 2.5 is significantly associated with under-five mortality adjusted for other variables. Validating satellite-based PM data with ground-based measurements is advised. Additional ground-based PM monitoring devices, particularly in Afar where PM 2.5 2.5 and under-five mortality were higher, is suggested.
Assessment of the Major Factors for Health Workers’ Motivation for Staying at Peripheral Level of the Health System in Government Health Service Delivery Institutions in Oromia Region.
(Addis Ababa University, 2011-06) Debela, Girma; H/Mariam, Damen(MD, MPH, PhD)
Background: It’s important to note that human factors, socioeconomic strata, labor market demand and supply, policies and procedures play role in human resource management.The challenges of human resource management have many dimensions stretching from recruitment to separation.One of this is the prediction of human motivation factors. Human resources for health are always the center point of health care. The quality of care depends on the number, knowledge, skills and commitment without forgetting the importance of other resources by which to serve. Low health workers density is very detrimental to health outcomes.That is why supply and retention strategies are being issues of critical importance. Objective: To assess the major factors for health workers’ motivation for staying at peripheral level of the health system in government health service delivery institutions in Oromia region. Methods: cross-sectional descriptive study using quantitative approach supplemented with qualitative research. Structured questionnaire, focus group discussion/key informants’ interview and record review were used. Results: Age, marital status, location of the health facility and compulsory service year, were factors having strong association with the length of stay in peripheral health facilities. Other pull and push factors were also identified. Discussion, conclusion and recommendation: As assessed by this study, those aged above 30 years, married couples, and those with longer service years motivated to stay longer than the younger, singleton and junior counterparts respectively. Proprietorship, achieved education, expected sponsorship and /or family responsibility could be the cause of settlement.Those who dispelled early might left intentionally to arrange for further studies, to search for better pays and to head marital plans. Frustrations from extended service years ahead and discomforts from lack of facilitated conditions for standard could be a cause of exit from posting for senior professionals as do in other African countries. Human resource policies, guidelines and procedures should pay special consideration to these center pieces of the health system in development and application of sensible interventions to remove bottlenecks of HRH management thereby monitoring and evaluation of the outcomes.
Assessment of Parental Influence on Pediatrics highly Active Antiretroviral therapy (HAART) Adherence in Addis Ababa, Ethiopia, May, 2010.
(Addis Ababa University, 2010-05) Hailu, Frie; Betre, Mulugeta(Dr.)
ABSTRACT Back ground: Ensuring good adherence is critical to the success of highly active anti-retroviral therapy (HAART). Failure to adhere very closely to the regimens results in continued viral replication, treatment failure and the emergence of drug resistant strains of human immune deficiency virus (HIV). Although parents and caregivers may have primary responsibility for their children©s medication-taking, there is no single study that examined parents influence on pediatrics highly active anti-retroviral therapy (HAART) adherence in our set up.The result of the study is expected to help device intervention strategies to improving children’s adherence on highly active anti-retroviral therapy (HAART). Objectives: To assess the status, determinants of adherence and identify parental factors influencing pediatrics highly active anti retroviral therapy (HAART) adherence in Addis Ababa. Methods: An observational: descriptive, cross sectional study was conducted in 9 Health institutions: public, private and Non Governmental Organizations (NGOs) in Addis Ababa. Multi-stage sampling procedure was used to select a total of 586 children: age 0 - 14 years,Human Immune Deficiency Virus (HIV) infected and started anti-retroviral therapy (ART) 12 weeks ago.Primary care givers of the children were enrolled after the nature of the study was explained that allowed informed decision to be made and written consent obtained. Data was collected from February 8- May 10, 2010 on socio demographic, parent factors, clinical markers,care givers to provider relationship and regimen variables. Structured questionnaire and focus group discussion were used. Univariate, bivariate and multivariate analysis was carried out. Result: The parental factors were strongly associated with non adherence; children who had non biological parents [OR=9.805(95%CI= 2.198, 43.736)], parents who didn’t communicate about HIV and ART adherence to their children [OR=3.915 (95%CI= 1.273, 12.036)], and parents who hadn’t good relationship with health care providers [OR=29.592(95%CI= 1.326, 660.333)] were more likely non adherent. Children who had more than four siblings [OR= 5.676 (95% CI=2.100, 15.339)] were also significantly associated with non adherence. Conclusion: The parental factors were strongly associated with non adherence.The need for providers to have smooth relation ship with the care givers of the HIV infected children on antiretroviral therapy, support caregivers to communicate with their children about the disease and antiretroviral therapy adherence is critical. Further research is recommended to explore the validation of self report adherence using longitudinal study designs.
Effect of Community based Health Insurance on Catastrophic Health Expenditure among Chronic Patients in Asella Referral Hospital, South East Ethiopia
(Addis Abeba University, 2022-06) Bekele, Mosisa; Derseh, Anagaw
Background: Chronic Disease-Related Catastrophic Health Spending is Frequent in Ethiopia, Affecting Between 27% and 64.2 % of households, depending on the chosen catastrophe threshold. CBHI has been in place in Ethiopia since 2011, with the purpose of enhancing financial access to health care services, but there is little evidence of how well it protects chronic patients financially. Objective: The objective of the study was to assess level of catastrophic expenditure and evaluate the effect of community-based health insurance on catastrophic health expenditure among patient attending chronic follow up departments in Asella referral hospital, Southeast Ethiopia. Method: A health facility-based comparative cross-sectional study was conducted in Asella referral hospital from March 2022 to May 2022. Systematic random sampling was used to select 325 chronic patients. Data was collected by ODK collect app and then imported to STATA version 17 for analysis. Principal component analysis (PCA) has been used to construct a wealth index, and propensity score matching was used to identify the effect of community-based health insurance on catastrophic health expenditure. Result: The study enrolled a total of 325 chronic patients (157 CBHI members and 168 non-members). Indirect costs were the major source of health care costs for insured patients, whereas direct costs were for uninsured patients. The incidence of catastrophic health expenditure was found in 39% of the total sample, while it was found in 31% and 47% of insured and uninsured patients, respectively, when the 15% non-food threshold is employed. Overshoot and mean positive overshoot were 10% and 33% for CBHI members, respectively, and 18% and 39% for non-members. Community-based health insurance contributes to a 19% (t = -2.97) reduction in catastrophic health expenditure among chronic patients. Conclusion: Chronic patients, particularly uninsured households, had a high incidence and intensity of catastrophic health expenditure. Community-based health insurance has a substantial effect on lowering chronic patients' catastrophic expenditures. As a result, the government and all concerned bodies must expand community-based health insurance to provide financial protection for people suffered from chronic conditions.
Catastrophic out of Pocket Expenditure for Cancer Care among Hospitalizaed Cancer Patients in Addis Abeba, Ethiopia
(Addis Abeba University, 2022-06) Yihun, Girum; Derseh, Anagaw
Background: Out of pocket (OOP) expenditure for cancer care exposes households to unanticipated expenditure. When the available health service is mainly dependent on out of pocket expenditure, then the household will face catastrophic health expenditure. Accordingly, this study aimed to estimate the incidence and intensity of catastrophic out of pocket expenditure for hospitalized cancer patients and to identify coping strategies and associated factors. Method: Hospital based cross-sectional study was conducted in Addis Ababa city. Two public and three private hospitals were included in the study. Hospitals were selected based on their cancer case annual report and the sample size was proportionally allocated based on their patient load. The study participants were inpatient cancer cases who were on treatment follow up for the last one year preceding the interview date. The data was collected through face-to-face interview using structured questionnaire. All direct medical and non-medical and indirect expenditures were calculated. Indirect expenditure was calculated by using human capital model. The data were interred to Epi data3.1 and exported to STATA 16 for analysis. Multivariable logistic regression was applied to assess the relationship of CHE and the independent variables. For this study, household that spent ≥40% of nonfood expenditure for cancer care considered as catastrophic. Sensitivity analysis at different thresholds (20%, 25%, 30%) was done. Result; The incidence and intensity (mean positive overshoot) of CHE at 40% threshold of households’ non food expenditure (capacity to pay) was 77.7% and 78.3%, respectively. CHE for cancer care was significantly associated with the type of facility, patient residence, cycle of chemotherapy, insurance enrolment and income quintiles. Saving and selling assets were identified as the main coping mechanisms. Conclusion; The incidence and intensity of catastrophic out of pocket expenditure among cancer inpatients is very high. Improve quality and coverage of health insurance and decentralizing cancer care to regions at similar standard with Addis Ababa will save households from incurring CHE.
Household Satisfactionof Health Care: With Nsuredand Non-Insured under Community based Health Insurances in Mahal Sayent District South Wollo, Ethiopia
(Addis Abeba University, 2021-02) Gashaw, Kalkidan; Molla, Meseret(Phd)
Background: Community-based health insurance is recognized as a promising tool for health system improvement and financial protection for low-income individuals that improves the health status of enrollees and enhances productivity and labor supply. The program is implemented in several districts, however, studies focusing on clients’ satisfaction provided by the health insurance scheme are still limited. The aim of this study was, therefore, to assess individuals’ satisfaction of utilizing health care service with insured and non-insured under community-based health insurance in Mahal Sayent district, South Wollo. Methods: Community-based comparative cross-sectional study was conducted among 346 households who are both enrolled and non-insured to the community-based health insurance in south Wollo, Mahal Sayent district from December 1 to April 20, 2021. The data was collected using a structured questionnaire and checked for completeness, entered, edited, cleaned by Epi-data version 3.1 and analyzed by SPSS version 20. Descriptive statistics were used to present the variables. Multivariable logistic regression was fitted to examine the relationship between outcome variable and independent variables. Finding was reported using adjusted odds ratios with 95% confidence interval and statistical difference was declared at P-value <0.05. Result: From the total of 346 respondents took part in this study, only 125 (36.1%) of the participants were insured under CBHI. Overall satisfaction of CBHI members 77.6% while for non-CBHI members were 42.1%. Moreover, insurance status (AOR = 4.23; 95% CI: 2.32–87.70), educational status (AOR = 3.12; 95% CI: 1.35–7.22), satisfaction with waiting time (AOR = 3.41; 95% CI: 1.27–9.18) and appropriateness of the time to diagnosis a problem (AOR = 41.61; 95% CI: 12.34–140.38) were found to be significantly associated with overall patient satisfaction. Conclusion and Recommendation: The study showed that insured patients have a higher level of overall satisfaction score. The key determinants of overall satisfaction were educational status, insurance status, waiting time and appropriateness of the time to diagnose a problem. To improve patient satisfaction and in turn to increase the quality of health care; CBHI program should be promoted and encouraged by the government. Moreover, policy makers, health system managers, and health professionals should work to minimize the waiting time of service provision.
Practices and Beliefs During Pregnancy and Child Birth in Adamitulu Woreda, Oromiya Regional State, Ethiopia
(Addis Ababa University, 1997-12) Kebede, Yigzaw; Eshetu, Fisseha (PhD)
This community-based cross sectional study was carried out from MayAugust 1997 in Adamitulu Woreda, East Shewa Zone, Oromiya Regional State. The objective was to asses practices and beliefs during pregnancy and child birth, with special emphasis to traditional practices, and to identify factors related with them. Survey and focus group discussions were the techniques used to collect data. A total of 1023 women, 328 in Zeway town and 695 in the surrounding peasant associations, were interviewed. The major harmful traditional practices during pregnancy were restriction of certain food items, and taking "kosso" (Hagenia abyssinica) for the treatment of Tape Worm infestation and for other purposes. During child birth, the major harmful traditional practices identified were abdominal massage, and lubrication of birth canal with butter, using unboiled materials to cut the umbilical cord, leaving the umbilical stump untied, application of materials (mud, soil, cow dung, butter) on the umbilical stump, and giving butter to the new born. The major harmful traditional practices after delivery were delayed commencement of breast feeding, discarding colostrum, confining the child from sun light, and application of hot metal to the child when he/she has abdominal cramp. The effects of sex during pregnancy, "Metaten" during pregnancy, and drinking goat or sheep blood during delivery is not well studied that it is difficult to label them as useful, harmful or neutral. In general, harmful traditional practices are highly prevalent in the area and - the effects of some of the traditional practices are not well known. Extensive health education towards the eradication of the identified harmful traditional practices, further studies on the effects of traditional practices whose effect is not well known, and similar studies in other areas is therefore recommended.
Determinants of HIV Mother-to-Child Transmission (HIV MTCT): A Case Control Study in Assela, Adama and Bishoftu Hospitals, Oromia Region, Ethiopia.
(Addis Ababa University, 2010-06) Burusie, Abay; Deyessa, Nigussie(MD,MPH,PHD-Student)
Determinants of Mental Illness in A Rural Ethiopia Adult Population
(Addis Ababa University, 1999-05) Tafari, Solomon; Aboud, Frances (PhD)
2000 subjects from two woredas of a rural sect i on of Ethiopia were interviewed to determine how many were suffering from mental disorder and what determinants are related to the disorder. A WHO Self-Reporting Questionnaire was used to assess mental illness. The questionnaire has been used before in Ethiopia and measures neurotic, psychotic, and psychosomatic illness in terms of s ymptoms. 344 cases were found, indicating an overall frequency of 17.2%. The great majority of cases were suffering from neurotic and psychosomatic illnesses. Psychiatric morbidity was higher in women, in divorced/separated/widowed groups, and in the age group 35 - 44. However, the level of social stress experienced in the past year was most predictive of mental illness; the higher a person 's stress level, the higher the mental symptom score. Family history of mental illness was the second best predictor.
A Community Based Study of Health-Related Problems among Adolescents in Awassa Zuria Woreda, Southern Ethiopia
(Addis Ababa University, 1995-05) Mengiste, Solomon; Berhane, Yemane (PhD)
The prevalence and determinants of substance use (alcohol, khat, cigarette), mental illness, suicidal attempt, STDs and teenage pregnancy among adolescents aged 10-24 years have not been well documented in the country. A community based cross-sectional study was conducted in Awassa Zuria Woreda, southern Ethiopia from November to December 1994 G.C. A total of 1953 adolescents were included in the study. Data were collected using questionnaire by trained interviewers. The likelihood of substance (alcohol, Khat, Cigarette) use on average was at leas t two times higher (p<0.05) among adolescents who reported history of run away from their family and police arrest. Mental illness, suicidal attempt, STDs and teenage pregnancy were found to be more likely to occur among adolescents who use one or more of the substances than others.The older adolescents in general were found to be more likely to be exposed to all of the health related problems studied. Risk factors identified for substance use and association of substance use with the health related problems among adolescents were observed in this study. The levels and the interactions observed between the adolescent risk behaviors and health related problems indicate the need to set an immediate intervention programmers .
Unmet Palliative Care Needs of People Living with HIV and AIDS in Hawassa, Ethiopia
(Addis Ababa University, 2012-05) Nane, Selamawit; Mitike, Getnet (MD, MPH, PhD)
Background: The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with threatening illnesses. Assessing the palliative care needs of people living with HIV and AIDS (PLHIV) and providing them with adequate care and support has a special significance in combating the AIDS epidemic. Objective: The main objective of this study is to assess unmet palliative care needs of people living with HIV and AIDS in Hawassa town. Methods: A descriptive cross-sectional study design was conducted to assess palliative care needs of PLHIV and qualitative method was applied to triangulate the findings. Adult PLHIV on ART for at least 6 months were randomly selected for quantitative data. The reason for this is that, palliative care team visit and gives support for PLHIV every 3 months. So PLHIV who have been on ART at least for 6 months have more knowledge about palliative care and have a chance to be visited by palliative care team. For qualitative data health care providers and the PLHIV were purposely selected and a total of 6 in-depth individual interviews and four focus group discussions were conducted. Quantitative data was entered in to SPSS for analysis and qualitative data is analyzed using thematic analysis. Findings of the quantitative data supplemented with qualitative results using the process of triangulation. Result: A total of 390 (121 males and 269 females) PLHIV and 17 (7 males and 10 females)health workers included in this study. The mean age of study participants was 32.9 ± 9.6 years. As the result of this study the most common unmet palliative care needs are financial assistance (59%), pain relief (48.7%), free treatment for OI (47.9%), nutritional support (38.7%), shelter(28.7%) and home based care (21.3%). Multiple regression analysis showed that all the identified unmet needs for palliative care were more among unemployed PLHIV than employed (p<0.05). The health care providers indicated that shortage of staff, lack of funding, lack of equipment and lack of strong policy on palliative care program were the main barrier to meet the need of palliative care among PLHIV. Conclusion and recommendation: In conclusion the identified palliative needs in this study include financial assistance, nutritional support, treatment for opportunistic infections, shelter. Home based care and pain relief. These findings could be used as base for the development of a comprehensive palliative care policy and programmes for PLHIV in Hawassa. So the government and other donor agencies should give emphasis to access and availability of palliative care services.
Assessment of Birth Preparedness and Complication Readiness in Robe Woreda, Oromia Region, Central Ethiopia
(Addis Ababa University, 2012-06) Kaso, Muhammedawel; Addissie, Mesfin(Dr.)
Background: Globally more than half a million women die annually as a result of complications of pregnancy and childbirth. Ninety-nine percent of these deaths occur in most developing countries like Ethiopia. Obstetric related complications cannot be reliably predicted and it is necessary to use birth preparedness and complication readiness strategies to overcome those problems when they arise. Objective: To assess the knowledge and practices towards birth preparedness and complication readiness and factors associated among women of reproductive age (15-49) in Robe Woreda,Oromia Region, Ethiopia. Method: A cross-sectional community-based study supplemented by qualitative design was conducted in January, 2012. A total of 575 women from 5 kebeles were selected using proportionally allocated to population size and interviewed using structured and semi-structured, pre-tested questionnaires. Univariate and bivariate analysis was performed.Multivariate analysis was also done to control for possible confounding variables. Results: Data were obtained from 575 mothers, yielding a response rate of 98.97%. Taking into account place of delivery identification, means of transportation, skilled attendant identification and saving money, about 16.5% of the respondents were prepared for birth and its complications. In multivariate analysis, preparation for birth and its complication was higher among educated mothers (AOR= 6.23, 95% CI= 1.5, 25.87), monthly income >716 ETBr (AOR= 1.94, 95% CI=1.01, 3.87), ANC visit (AOR= 5.68, 95% CI= 1.27, 25.4), knowledge of obstetric complications (AOR= 2.94, 95% CI= 1.61, 5.37) and those who had given birth at health facility before their last delivery (AOR= 3.9, 95% CI= 2.04, 7.46). Conclusion: The study identified poor knowledge and practices of preparation for birth and its complication. Community education about preparation for birth and its complication and empowerment of women through expansion of educational opportunities are important steps in improving birth preparedness. In all health facilities during antenatal care emphasis should given to preparation for birth and its complication and provide information and education to all pregnant women.
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.
Determinants of Utilization of CHAs in Rural Communities.
(Addis Ababa University, 1989-05) Mohammed, Seid; E. Aboud, Frances (PhD)
A study of the determinants of utilization of community health agents among rural communities was conducted in the district (Awraja) of Buno-Bedelle, south western part of Ethiopia.The main objectives of the study were to determine the prevalence of utilization of CHAs and to see the relation between utilization of CHAs and knowledge , attitude and participation of the community. There were a total of 311 CHAs trained in the Awraja, up to May 1988. Only 221 were found during a survey conducted in May 1988. 80 PAs were randomly selected from those where a CHA had been found regardless of functionality. A structured questionnaire was administered to a systematic sampling of 2400 heads of households. It was found that 83.6% of the study population used at least one service of the CHA in the past year.The most used services were preventive and promotive activities, particularly, health education and home visits (59.7% and 58.0% respectively).The least used services were treatment activities, death and birth registration. Utilizers of CHA services had better access to safe water supply and sanitary facilities. People who are members of PPCAs, literate, have knowledge about CHAs and their services, have a positive attitude towards CHAs and their services, and participated ln the selectionof their CHAs and related matters are more likely to be utilizers of CHAs. It was also found that a positive attitude towards CHAs and their services was the best predictor of utilization of CHAs.
Unhealthy Weight Control Practice and Related Factors among Postpartum Women in Addis Abeba, Ethiopia
(2021-06) Assefa, Hana; Samson, Gebremedhin
Background: Women in the postpartum period are more concerned about their weight status and frequently practice unhealthy weight control methods. However, little is known about the practice of unhealthy weight control among postpartum women in Ethiopia. Objectives: To investigate the prevalence of unhealthy weight control practices and related facors with postpartum weight status and body image dissatisfaction among postpartum women in Addis Ababa, Ethiopia. Methods: A health facility-based cross-sectional study was conducted among 640 postpartum women from 6 months to 9 months postpartum period from randomly selected public health centers and private maternal and child medical centers. Unhealthy weight control practices were assessed by using the 12 item self-reporting tool with the reference period of 30 days. Body image dissatisfaction was measured by using 8 items Evan & Dolan Body Shape Questionnaire. Bivariable and multivariable logistic models were fitted to identify predictors of unhealthy weight control practice while controlling for possible confounders. The results are presented using adjusted odds ratio (aOR) with the respective 95% confidence interval (CI). Results: The prevalence of unhealthy weight control practice among postpartum women in the past 30 days was 38.3% (95%CI: 34.4-42.2). Factors that were associated with unhealthy weight control practices were Perceived overweight (aOR = 7.68; 95%CI: 2.01-29.38), being overweight (aOR=6.48; 95%CI:1.86-22.53), having only one child (aOR = 2.98; 95%CI: 1.63-5.45), being a single mother (aOR=5.94; 95%CI: 2.13-16.55 and having body image dissatisfaction (aOR=1.16; 95%CI: 1.11-1.21). Further reported peer (aOR = 2.96; 95%CI: 1.56-5.62), husband/dating partner (aOR = 2.63; 95%CI: 1.44-4.82) and social media (aOR = 4.79; 95%CI: 2.22-10.33) influences were associated practice of unhealthy weight control practices. Conclusion: Unhealthy weight control practice are commonly among post-partum women in Addis Ababa. To address the problem, programmatic and severe provision related attentions should be given attention.
Exclusive Breastfeeding Practice and Work- Related Factors among Health Care Workers in Addis Ababa, Ethiopia
(Addis Ababa University, 2021-06) Petros, Rita; Shiferaw, Solomon
Background. Breastfeeding is one of the most powerful practices for promoting child survival and well-being. Healthcare workers have a responsibility to promote and support breastfeeding among their clients, even though their ability to do this may be influenced by their workplace environment and personal experience. However, little is known about exclusive breastfeeding practices and the perceived barriers among health workers. Objective: To assess the exclusive breastfeeding practices and work-related factors among healthcare workers with children between the ages of 4-6 months in government and private hospitals of Addis Ababa, Ethiopia. Method: Institution based cross-sectional study was conducted among 369 health care worker mothers with children between the ages of 4-6 months from January to February, 2021. Exclusive breastfeeding was assessed based on infant feeding practice in the 24 hours preceding the survey. A structured questionnaire was used for data collection and EPI data version 4.6.0 to enter, clean and Stata version 16.0 was used to analyze data. Bivariable and multivariable logistic regressions were fitted to identify the presence and strength of association. Odds ratios with 95% confidence interval were computed to determine the level of significance. Result: The magnitude of exclusive breastfeeding among healthcare workers with infants between the age of 4-6 months was 26.6% (95 % CI: 22, 31) in the 24 hours preceding the survey. Being employee of a government hospital (AOR = 3.09; 95% CI: 1.44, 6.63), giving birth through spontaneous vaginal delivery (AOR=3.71; 95% CI: 1.48, 9.26), being a part time employee (AOR=2.2; 95% CI: 1.19, 4.06) and resumption of work at 5 months (AOR = 3.69; 95% CI: 2.1, 6.46) were found to be significantly associated with higher exclusive breastfeeding practice. Conclusion: A small proportion of infants are exclusively breastfed during the first 6 months, despite what is recommended in the national and global infant and young child feeding guidelines.The type of organization, mode of delivery, working status and time of return to work were factors associated with exclusive breastfeeding practice. Employers should make workplaces more breastfeeding friendly to enhance exclusive breastfeeding.
Assessment of the Effect of Focused Antenatal Care on Utilization of Skilled Delivery Attendant at Birth among Mothers in Gomma Woreda and Agaro Town.
(Addis Ababa University, 2013-06) Belete, Shambel; Worku, Alemayehu(PhD, Ass.Prof.)
Background: There should be a link between use of antenatal care and delivery assisted by a professional health care provider. Ethiopia is ranked among the nations with the highest maternal mortality ratios in the world. The effect of packaged health care services in Focused Antenatal Care that a mother receives during pregnancy, at the time of delivery and soon after delivery is important for the survival and well-being of both the mother and the new born. Objectives: To assess the effect of Focused Antenatal Care on Skilled Delivery service Utilization at birth among women who have attended FANC in Health centers and deliver in the one year preceding the survey in Gomma Woreda and Agaro Town,Jimma Zone, Oromia National Regional state, south west Ethiopia. Methods: a community based comparative cross sectional survey was conducted among mothers who have attended 1-3(none exposed) and ≥4(exposed) FANC at Health centers and delivered one year preceding to the study period in Gomma woreda and Agaro Town. A total number of 369 mothers that attended FANC were selected with systematic random sampling technique from Health centers’ ANC registration book based on the number of FANC .Then selected mothers were traced and interviewed. The association of FANC visits and other factors with outcomes(skilled delivery attendant utilization) was assessed using Chi-square (χ2)-statistics and multivariate logistic regression models and to control confounders. Place of delivery was divided into home delivery or facility delivery. Results: The study results showed that the magnitude of skilled birth attendant service utilization at birth among FANC visitors was 53.1% in the study area. Utilization of SDA among ≥4 FANC attendants was 68.5% and 48.0% among 1-3 FANC visit attendants. Maternal education,religion, living in a distance of 30 minutes’ walk to nearest health facility with SDA, preference of husbands’ as place of delivery for their wives and birth preparedness and complication readiness plan implementation was significantly associated with utilization of SDA at birth among FANC attending mothers. Conclusions: The magnitude of deliveries attended by skilled birth attendant was relatively high among ≥4 FANC attendant mothers but there was no statistical difference between 1-3 and ≥4 FANC attendants in utilization of skilled delivery attendant care at birth. So, enable pregnant mothers to attend their ANC followup with skilled providers. Recommendations: To make FANC service effective in getting back mothers to utilize skilled delivery attendant during delivery, emphasize on individualized service provided to pregnant mothers attending FANC not on number of visits she should attend, implement all packages of FANC services, birth preparedness and complication readiness should have to get equal attention as other packages, involve husbands/partners at least once during FANC visit, provide free-cost emergency transportation for distant mothers during labor, enable women to attend formal education at least up to secondary education, community mobilization and involving religion leaders in Skilled birth attendant service utilization promotion activities were recommended.

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