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    Assessment of patient flow, areas of inefficiency for improvement in Tikur Anbessa Specialized Hospital: A mixed explanatory study
    (Addis Ababa University, 2024-03) Kedru, Yemisrach; Haile Mariam,Damen (Prof.); Deneke,Andualem(Prof.); Molla,Meseret(Dr.); Tassew, Birhan
    Introduction: In Ethiopia, hospitals face many challenges like high waiting times, inefficiency, and negative patient experiences. Tikur Anbessa Specialized Hospital (TASH) is a tertiary level hospital located in Addis Ababa. There is little study done on patient flow, areas of inefficiency, and patient experiences. Understanding these areas will help in making improvement in the health service provision that are given in Tikur Anbessa Specialized Hospital in an efficient manner. Objective: This study aims to assess the patient flow and identify bottleneck areas of inefficiency for improvement in Tikur Anbessa Specialized Hospital. Methods: A facility based cross sectional design, employing time motion survey and Data Envelopment Analysis (DEA) to assess the patient flow and measure technical efficiency respectively. And a qualitative phenomenological design is used to explore the patient experience identify the bottleneck area at TASH. For the time motion study, descriptive analysis is performed using mean and standard deviation to characterize health worker contacts time at services areas at the hospital by using STATA version 12. For the patient experience interview, the transcript is read repeatedly to have an overview and coded. The codes with similar meaning were categorized which were then further classified into themes that reflects the central idea. The data are analyzed using Atlas.ti version 9 software. A DEA was used to calculate the efficiency of each department taking them as decision making units (DMUs). As an input, the number of health workers are taken; and as an output the number patients treated/visited at that department were included. The data were analyzed using MaxDEA software. Result: The identified bottlenecks in operating the routine activities include communication barrier between the health care providers themselves, and between the health care providers and patients and caretakers. In addition to these issues, lack of fulltime doctors at outpatient departments (OPDs) and poor appointment system were found to be challenges resulting in long patient queues at different services areas. In addition, issues of inconsistent availability of drugs and supplies, services like MRI and CT scan have resulted in the clogging the patient flow in the routine operations of the Hospital. Out of the ten OPDs with the highest patient visits, only two were technically efficient. Conclusion: Therefore, these bottlenecks contributed for the OPDs not functioning efficiently. Furthermore, the results from the DEA indicated that the technical efficiency of OPDs needs better operational improvement.
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    Assessment of antenatal care utilization and associated factors among internally displaced reproductive age Amhara women (15-49 years) in North-Shewa camps of Amhara region, 2023
    (Addis Ababa University, 2023-12) Meseret, Hana; Mekonnen, Wubegzier (Associate Professor); Seme, Assefa(Associate Professor)
    Background: Ethnic induced conflict has displaced over 1.8 million people in Tigray, more than 1 million people in Amhara, and 334,196 in Afar regions. There is paucity of information on the utilization of maternal and child health services among internally displaced persons (IDPs). Objective: The aim of this study was to assess the magnitude of antenatal care (ANC) service utilization and its associated factors among internally displaced reproductive-age Amhara women in the North-Shewa camps of Amhara region. Methods: A facility based cross-sectional study was conducted from February to March, 2023 among internally displaced women in Semen Shewa zone Amhara region. Thus a total of 512 women were included in the study with simple random sampling. The bi-variable and multi-variable logistic regression model were employed to identify factors significantly associated with ANC utilization. Adjusted odds ratio (AOR) with 95% CI was estimated to show the strength of association. Finally p-value 0.05 in multivariable logistic regression analysis was used to identify factors associated with ANC service utilization. Finally, key findings of the study are portrayed using tables and graphs with adequate textual descriptions. Result: Overall 51% of mothers received at least one Antenatal care service during pregnancy and 5.2% of women had the recommended four and above visits. Women whose husbands attained primary and above level of education [AOR: 2.6, 95% CI: (1.24-5.27)], pregnancy complications [AOR: 4.1, 95% CI: (2.07-8.07)], good knowledge on ANC services [AOR: 5.67, 95% CI: (2.93-10.99)], wanted pregnancy [AOR: 8.1, 95% CI: (3.97- 16.55)] and distance to health facility[AOR: 4.45, 95% CI:(2.07-9.45)] were significantly associated with ANC service utilization. Using Poisson regression, empowered women (AIRR=1.3: 95% CI (1.07-1.59), those with good knowledge about ANC (AIRR=1.29: 95% CI (1.09-1.53), living in a camp where health facilities are available (AIRR=1.72: 95% CI (1.32-2.35) and women whose pregnancies are both wanted and desired (AIRR=1.27: 95% CI (1.09-1.48) had association with frequency of ANC visits. Conclusion and Recommendations: Close to half of women didn’t utilize ANC services during their pregnancy and only about 5% of them had four plus ANC visits. Availing health facilities in the camps, and enhancing education and awareness creation about ANC service could help women utilize ANC service.
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    Trend and Inequalities in the Current Family PlanningUse Among Currently Married Reproductive Aged Women and the Family Planning Service Readiness in Addis Ababa Ethiopia.
    (Addis Ababa University, 2023-11) Berhanu, Hewan; Mekonnen, Wubegzier(PhD); Shibre, Gebretsadik(MPH, PhD candidate)
    Background: Family planning use among reproductive aged women in Addis Ababa is declining from 56.9% to 49.9% according to Ethiopian Demographic and Health Survey (EDHS) data during 2005 and 2019. Urban health facilities had lesser availability of family planning services compared to rural facilities (87% Vs. 95%) according to Service Readiness Assessment 2016. Evidence on the trend, inequalities and service readiness in family planning services in Ethiopia is scarce and yet such evidence is important to contribute to the effort towards increasing family planning use. Objective: The objectives of this study is to assess the trend, and inequality in terms of age group, religion, parity, women empowerment, education of women and husband, employment and media exposure in family planning use among re productive aged women and health facilities that give family planning services in Addis Ababa, and, to assess the family planning service readiness of health facilities in Addis Ababa. Methods: The four Demographic and Health Surveys, the 8 Performance Monitoring for Action (PMA) was used to assess the trend and inequality among married women in Addis Ababa and Service Availability and Readiness Assessment (SARA) data set to assess the health facilities family planning service readiness. we used STATA software for the analysis. We used descriptive analysis to show socio demographic statuses and service readiness. We used logistic regression to show the trend. Concentration index was used for the ordinal equity stratifiers, regression based predictive probability and odds ratio was used for others such as age, religion, employment and parity. And finally, regression-based decomposition analysis was used to identify contribution of socio-economic and demographic factors to inequality in FP use. Result: The overall trend of FP use is slightly increasing from 45% in 2000 (EDHS) to 60% in 2021(PMA). Primary and higher educational level of women and husband, 20-24 age group, having more than 1 child, being Christian and being employed were found to be significantly associated with high FP use. The largest contributors to education-based inequality are secondary and higher educational level of women (-0.63) in PMA 2019 and having 1 child (2.13) in PMA 2021. Among assessed health facilities, 2.1% provide 13 of the tracer items in 2016 and 1.3% provide all the 14 items in 2018. Conclusion: Trend in FP use showed a slight increase and was not uniform among the selected equity stratifiers. Furthermore, estimates of absolute and relative inequalities show significant inequalities. FP service readiness of health facilities in Addis Ababa were low. It is recommended to maintain improvements in FP services and scaling up the interventions that directly act on leading determinants of FP inequality by targeting the disadvantaged group.
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    Assessment of Catastrophic Health Expenditure and Coping strategies of Multi Drug ResistantTuberculosis (MDR-TB Patients in Addis Ababa, Ethiopia.
    (Addis Ababa University, 2023-06) Asmerom, Hiwot; Worku, Alemayehu (Prof.); Tassew, Berhan
    Introduction: The World Health Assembly (WHA) in 2014 adopted the World Health Organization’s (WHO) END TB strategy containing three pillars among which TB affected families’ catastrophic costs to be zero percent by 2030. Tuberculosis (TB), which mostly affects the poorest of the poor, is an example of a disease that can substantially contribute to the disease poverty trap. Even though most countries have aimed to provide the diagnosis and treatment of TB free of charge, a number of studies have found out that patients are still subject to direct and indirect cost due to TB illness and care-seeking, hampering access and putting people at risk of financial ruin or further impoverishment. A number of health care financing schemes have been designed and implemented in Ethiopia. However, the status of catastrophic cost for TB in general and MDR- TB have not been established for the country. Objective: The objective of this study is to assess catastrophic health expenditure and coping strategies of MDR-TB patients in Addis Ababa. Methods: Facility based cross-sectional survey to assess catastrophic health expeditures and coping strategies of patients with MDR-TB was employed at two hospitals in Addis Ababa, the leading of which are known TB care and research. All MDR-TB patients being cared for the disease at the time of the survey were identified from the national TB registry for inclusion. For accurate estimation of costs and other associated factors such as coping strategies all MDR-TB patients being treated in two hospitals known for initiating treatment and follow-up for MDR-TB fulfilling the inclusion criteria were part of the survey. Result: In this survey about 54.3 % of households experienced catastrophic health expenditure more than 20% of their annual household income. To cope with the costs associated with TB care, patients underwent variety of coping mechanisms including about 61 (33%) patients borrowing an estimated average of 5739 birr (108 USD); about 26 (14%) patients selling house properties (mainly household items, land and livestokcs) with the estimated mean market value of the property sold being 21375 birr (403 USD); and about 21 (11.4%) patients undergoing dissavings including withdrawal of money from banks the amoung standing at an average of 55000 ETB (1037 USD). Conclusion: The catastrophic cost of MDR-TB service Addis Ababa cannot be overlooked, despite the free policy. This study has revealed the incidence of catastrophic health expenditure among households affected by MDR-TB is about 54.3%..
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    Assessment of Patient Satisfaction and Associated Factors in Telemedicine Service Providing Organizations in Addis Ababa, Ethiopia.
    (Addis Ababa University, 2023-06) Mitiku, Kenean; Addise, Mesfin(MD, MPH); Nega, Adiam (BSc, MPH)
    Background: Telemedicine is the provision of health care services, clinical information, and education in all specialties over different sort of technologies including the Internet, mobile phones and electronic medical records. Assessing the level of patient satisfaction in Telemedicine program, allows continual improvement in the design, alternative, or choice of equipment, and program administration and management for the health service provider. Hence, this study is intended to fill this gap in evidence in the study area assessing patient satisfaction so that interventions can be taken to improve of Telemedicine service quality in Ethiopia. Objective: To assess level of patient satisfaction and associated factors among service users of Telemedicine service providing organizations in Addis Ababa, Ethiopia. Methods: Facility based, cross-sectional study design was conducted from April to May 2023 in Addis Ababa. A total of 410 patients were selected by non-probability voluntary sampling method from five service providing organizations that were selected randomly. Data was collected based on an online self-administered Telemedicine satisfaction questionnaire using pre tested structured questioner. For the analysis, SPSS version 25 was used. Ethical approval for this study was obtained from the Research Ethical Committee of SPH, AAU, Permission letter was written for the selected telemedicine organizations, during data collection informed consent was obtained from the participants, after the necessary explanation was given. Based on the mean value among the factors related questions asked. Bivariate and Multivariate logistic regression was done to identify factors that were associated with diabetic self -care practice. The odds ratio with 95% CI was used to determine the association. A statistical significance was declared at p value <0.05. Result: Among 373 respondents about 205(54.7%) were satisfied. Age ranging from 35- 44(AOR=0.341, 95%CI; 0.127-0.919), male gender(AOR=0.233, 95%CI; 0.128-0.425), hotline type of telemedicine(AOR = 0.607,95%CI;0.369-0.999), patients with no previous experience(AOR=0.287, 95%CI; 0.161-.513),patients who thought the service was inexpensive(AOR =0.422, 95% CI; 0.247-0.719) were significantly associated with overall telemedicine patient satisfaction. Conclusion: The study demonstrated more than half of the patients 57.4% were satisfied but still substantial amount (42.7%) of respondent were dissatisfied. Telemedicine patient satisfaction was found to be associated with age, gender, previous experience and cost perception.
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    Traditional Medicine Usage for Cutaneous Leishmaniasis in Kallu District, South Wollo, Ethiopia
    (Addis Ababa University, 2023-01) Tadesse,Massame; Tamire,Mulugeta(Ass.Prof.); Kaba,Mirgissa(Ass.Prof.); Tadesse,Yordanos (MPH); Gadisa,Endalamaw (Phd)
    Background: Cutaneous leishmaniasis is neglected tropical disease that is endemic in many parts of the world, including Ethiopia. In Ethiopia, diagnostic and treatment facilities for cutaneous leishmaniasis are limited. As a result, traditional healthcare is a locally available resource that patients turn to. However, there is limited evidence on the use of traditional medicine and resources in Kallu district of the Amhara region. Objective: The aim of this study was to explore traditional medicine use and sources for treatment of cutaneous leishmaniasis in Kallu district, South Wollo, Ethiopia. Methods: A qualitative study using phenomenological study approach was conducted in Kallu district, Ethiopia. The data collection was through in-depth interviews, key informant interviews and participatory observation. Purposive sampling using maximum variation was used to recruit participants for in-depth interview with cutaneous leishmaniasis patients, snowball sampling for key-informant interviews with traditional healers and criterion sampling for community leaders. The data was analyzed thematically using MAXQDA 2022 software. Results: Participants reported using local treatment options first, usually from traditional healers, to treat cutaneous leishmaniasis. Plant-based medicines are the main source of traditional medicine. Several reasons led participants to use local treatments, including limited access to and duration of modern treatment, lack of awareness, high cost of modern healthcare, belief in traditional healers' expertise and traditional medicine, and recommendations from their social circle. Conclusion: The findings of this study indicated the use of traditional medicines, which are primarily derived from plant sources, as a first treatment option for cutaneous leishmaniasis. This choice is primarily driven by factors such as awareness, accessibility, affordability, personal beliefs, and recommendations from trusted individuals. To promote the adoption of modern healthcare, efforts should focus on enhancing awareness, improving accessibility, and reducing costs. Collaboration with community leaders, former patients, and local healers is also crucial.
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    Assessment of Occupational Noise Exposure,Temporary Hearing Loss,and Associated Factors Among Secondary Aliminum Production Factory Workers in Debre Berhan Town,Ethiopia.
    (Addis Ababa University, 2023-12) Nigussie,Meseret; Wakuma,Samson(PhD); Tefera,Yifokire(PhD)
    Introduction: Occupational noise is a widespread risk factor with a strong evidence base linking it to an important health outcome (hearing loss).Beside the fact that hearing loss brought on by industrialization is currently a significant public health issue in sub-Saharan Africa, including Ethiopia, Objective: To assess occupational noise exposure, temporary hearing loss, and associated factors among secondary aluminum production factory workers in DebreBerhan Town. Ethiopia Methods: An institutional-based cross-sectional study design was employed from April 1, 2023, to June 30, 2023. The data collection methods were observational checklists, face-to-face interviews, aerial and personal noise level measurements. Trained data collectors participated in the data collection. A total of 458 production workers from the six departments were directly interviewed for the questionnaires, and again, 30 individuals from those production workers, five from each six departments, were selected randomly based on the similar exposure group (SEG) technique for personal noise dosimeter measurements. The data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Bivariate and multivariable logistic analyses were used to identify the associated factors. Statistical significance was declared using a 95% confidence interval and a p-value of < 0.05. Results: A total of 458 workers participated in this study, making the response rate 100%. Among the participants, 276 (60.1%) were males, with a mean age of 25.3 (+3.64) years. The prevalence of temporary hearing loss among workers was 69%, 95% (CI, 64.5-73.2%).Working departments and working hours were significantly associated with temporary hearing loss. The maximum average noise exposure levels for an 8 hours working day were recorded in the cold rolling mill (96.2 ± 0.82 dB (A)) and sizing (94.6+ 2.88 dB (A)) work sections. Conclusion: - This study indicated that workers in a secondary aluminum production factory are exposed to a very high noise level with a high prevalence of hearing loss. Working departments and duration of exposure (length of working hours) were the determinant factors to hearing loss. Recommendation: - The factory should implement noise control methods, such as engineering or administration with providing hearing protective devices to reduce the noise exposure of workers.
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    Assessment of Computer Vision Syndrome and Associated Factors Among Employees of Ethio Telecom in Addis Ababa, Ethiopia.
    (Addis Ababa University, 2023-11) Gizachew,Natnael; Abegaz,Teferi(MPH, PHD); Nega,Ansha (PHD Candidate)
    Background: Computer Vision Syndrome is a range of eye and vison related problems which may result from extended use of digital devices such as computers. It is a public health problem, affecting more than 70% of all computer users. In developing countries like Ethiopia, there is a scarcity of studies on computer vision syndrome, particularly in the telecom industry for evidence-based practice. Hence, the study aims to identify the determinants and the prevalence of computer vision syndrome among Ethio telecom workers in Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted among Ethio telecom employees in Addis Ababa, Ethiopia from march to June 2023. A total of 497 individuals participated in the study. Data was collected using an interview- administered questionnaire, observational checklist and an illuminance measuring instrument. Data were collected using Kobo toolbox and transferred to Statistical Package for the Social Sciences (SPSS) version 26 for analysis. Multivariable logistic regression was performed to assess the association and control for potential confounders. Results: the prevalence of computer vision syndrome in the last 12 months among the total study participants of 497 was 68.8% [95% CI (64.5, 72.9)]. In Multivariate logistic regression factors that showed significant association were viewing distance, AOR (2.32(1.24-4.33)) and task illumination AOR: (1.78(1.09-2.91)). And Habit of taking break AOR: (0.439(0.281-0.686)) and adjustment of brightness and contrast AOR: (0.39(0.22-0.68)) were also found significantly associated factors of Computer Vision Syndrome. Conclusion: More than half of employees of Ethio telecom in Addis Ababa are affected by computer vision syndrome. Viewing distance, task illumination, habits of taking breaks, and adjustment of brightness and contrast were associated significantly. Results suggest a need for remedial actions to improve conditions of work environment.
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    Assessment of occupational skin diseases and associated factors among construction industry workers in Adama town, Oromia region, Ethiopia.
    (Addis Ababa University, 2023-11) Sultan,Radiya; Wakuma,Samson(PhD); Kumie,Abera(Prof.)
    Background: - Occupational skin diseases are an occupational dermatosis that is caused by exposure to hazards at work, or skin contact with substances used at work activities. The activities are practiced in construction work, such as masonry, painting, plastering, sand, and cement mixing. These may finally lead to exposures that can issue the workers with risks of developing occupational skin diseases. Objective: The main objective of this study was to assess the prevalence of occupational skin disease and associated factors among building construction industry workers in Adama Town, Oromia region, Ethiopia. Methods and Materials: - Institutional based cross-sectional study design was conducted from March 15, 2023 to April 15, 2023, in Adama Town, Ethiopia. A total of 420 randomly selected workers from eleven construction industries participated in the study. NOSQ version 2002 for assessment of skin disease was used through interview and observation checklist to collect primary data. Data were entered into EPi info version 7.2 and cleaned and transferred to SPSS version 26 windows for analyses. Bivariate and multivariate logistic regression analyses were performed to determine factors associated with the occurrence of skin diseases. Result:-The prevalence of occupational skin disease among construction workers was 58.6 % in the preceding 12 months. The factors that were significantly associated with the occurrence of skin disease included illiterate [AOR= 3.97, 95% CI (1.09 - 14.41)], assistant mason workers [AOR= 2.18, 95% CI (1.02 - 4.66)], working hours per day: >8 hours [AOR= 1.80, 95% CI (1.09 - 2.98)], permanent [AOR= 6.84, 95% CI (3.49 - 13.38)], not provided hand washing facilities [AOR= 2.19, 95% CI (1.24 - 3.864)], unavailability of PPE [AOR= 2.86, 95% CI (1.61 - 5.11)], not implemented of rules [AOR= 2.86, 95% CI (1.61 - 5.11)], and didn’t use PPE [AOR= 2.24, 95% CI (1.22 - 4.10)], were influenced the prevalence of occupational skin diseases. Conclusion: It can be concluded that the prevalence of occupational skin diseases is high in these construction workers. The determinant factors; educational status, job category, working hours per day, employment condition, provided with hand washing facilities, unavailability of PPE, not using personal protective equipment and enforcement of OSH-related rules had shown a significant association with an increased prevalence of skin disease. Key Words: Contact dermatitis, Personal protective equipment, Occupational skin disease, Preventive Measures, Construction workers.
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    Sexual Assault and Psychosocial Support among Survivors at Gandhi Memorial Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2023-11) Mengistu,Selamawit; Girma,Eshetu (MPH, PhD, Ass.Prof.); Tamire,Mulugeta (MPH, PhD, Ass.Prof.)
    Background: In Ethiopia, the pooled prevalence of lifetime sexual violence was found to be 39.33% in 2018. Sexual assault survivors face medical and psychological problems after the assault. Relevant and reliable data on sexual assault is critical to inform the knowledge we have about the burden, risk factors, circumstances and consequences surrounding sexual assault. Objectives: This study aims to assess the sexual assault experiences and psychosocial support of sexual assault survivors at Gandhi hospital Addis Ababa, Ethiopia. Methods: The study used a mixed method approach including a facility based cross-sectional design and case study design. The study was conducted at Gandhi memorial hospital one-stop center in Addis Ababa, Ethiopia. A total of 176 survivors and 6 key informants were recruited. Quantitative data was analyzed using SPSS version 25 and qualitative data was coded using open code version 4.03 and analyzed using thematic analysis. Results: A total of one hundred seventy-six (176) women sexual assault survivors participated in this study. From the 176 women, majority 76.7% of the women were between the ages of 14 to 19. Majority 91.5% of survivors reported vaginal rape. The perpetrator was a stranger in 55.1% of the cases and 44.9% of assaults were committed in the perpetrator’s home. Among the respondents 98.3% disclosed the assault to at least one person. Majority 70.5% of the survivors received positive social reaction while 94.3% received some kind of support after the sexual assault. With respect to the consequences suffered by survivors after the assault, 9.7% had unwanted pregnancy, 45.5% had depression, 63.8% had anxiety and 63.1% had post-traumatic stress disorder. Regarding predictors of mental health consequences, social reaction was found to be a significant predictor of PTSD with (p < 0.05), for every unit increase in social reaction there is 0.442 times decrease in PTSD diagnosis with (P < 0.05, OR 0.442, 95% CI 0.222, 0.880). Service providers at the one- stop center mentioned that they provide medical, psychological, and legal services for survivors in their center. The service providers also stated that the reaction the survivors receive from their social groups is mostly negative. Some of the service providers mentioned that survivors not coming to hospital early is a challenge. Another challenge pointed out was the lack of timely training and short working period within the center. For this reason, service providers recommended that the length of time they work in the center be extended to gain more experience and that training should be provided to professionals before they start working in the center. Conclusions: Most survivors in this study were aged between 14 and 19 implying that adolescent aged girls are most vulnerable for sexual assault. Majority of the survivors reported receiving positive social reaction and psychosocial support after the sexual assault. Survivors also reported consequences like unwanted pregnancy, depression, anxiety, and post-traumatic stress disorder. Social reaction was found to be a significant predictor of PTSD with every unit increase in social reaction having 0.442 times decrease in PTSD diagnosis. Thus, these findings can be used as input for future prevention strategies, health education programs and for improving service provision for sexual assault survivors.
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    Facilitators and Barriers of Healthcare Seeking Behavior for Cutaneous Leishmaniasis and Leprosy in Kallu District of South Wollo, Amhara Region, Ethiopia
    (Addis Ababa University, 2023-11) Tafese,Wagari; Girma,Eshetu (PhD, Ass. Prof.); Tadesse,Yordanos (MPH); Kaba,Mirgissa(PhD, Ass. Prof.); Gadissa,Endalamaw(PhD)
    Background: Leprosy and cutaneous leishmaniasis (CL) are preventable and treatable neglected tropical diseases (NTDs) that disproportionately affect impoverished populations in Ethiopia. Despite the availability of treatments, delays in healthcare seeking remain a challenge, hindering timely diagnosis and treatment and contributing to the persistence of these NTDs. Understanding the facilitators and barriers to healthcare-seeking behaviour is crucial for designing effective interventions to improve disease management and control. Objective: This study aims to assess the facilitators and barriers to healthcare seeking behavior for cutaneous leishmaniasis and leprosy among community members in Kallu district, South Wollo, Amhara region, Ethiopia. Method: This study employed an exploratory mixed-methods design. A quantitative study involving 602 participants was conducted using structured interviewer-administered questionnaires among community members, who were selected using multicluster sampling. Additionally, a qualitative study was carried out with 17 participants, including leprosy patients, cutaneous leishmaniasis patients, and key informant health professionals, who were recruited via criterion- purposive sampling. The quantitative data was collected electronically and analyzed using SPSS version 26 statistical software. Descriptive statistics, including frequencies, mean, and standard deviation, were employed to summarize the quantitative data. For the qualitative data, thematic analysis was conducted using MAXQDA 2022 Results The study found that about543 (90%) and518 (86%) of participants had heard or seen leprosy and cutaneous leishmaniasis (CL), respectively. In the past six months, 33 (6%) and45 (8.5%) of households experienced leprosy and CL, respectively. Eventhough they diagnosed late afer disabilities occurs, among those who experienced leprosy, 31(94%) sought treatment from health facilities, compared to only 6(13%) of those who experienced CL. The qualitative analysis explored several facilitators, such as the perceived severity of leprosy and CL, the societal emphasis on skin aesthetics, as well as family and social support, Additionally, access to free drug and services, community education initiatives, and a pathway through health extension workers (HEW) were identified as facilitators, Conversely, barriers to healthcare seeking in the community included limited knowledge, financial constraints, reliance on traditional treatments, geographical and logistical challenges, drug shortages, and prolonged waiting times. Conclusion: To minimize delays in healthcare seeking for leprosy and cutaneous leishmaniasis, it is crucial to tackle the barriers identified at the individual, community, and health facility levels in this study. These barriers include lack of awareness, financial constraints, and unavailability of drugs and services. Moreover, it is essential to leverage the facilitators of healthcare seeking, such as community education iniiattives, free drug and service and social and family support.
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    Catastrophic and impoverishing out-of-pocket health expenditure in Ethiopia: Evidence from the Ethiopia Socioeconomic Survey
    (Addis Ababa University, 2023-06) Bereket,Yamlak; Molla,Meseret(Dr.); Derseh, Anagaw(Dr.)
    Background: Out of pocket payment remains one of the ways to finance health care in Ethiopia accounting for 31%. These out of pocket health expense leads citizens’ face catastrophic and impoverishing expenditure. The most recent survey-based study of catastrophic and impoverishing health expenditure was done from the 2015/16 consumption and expenditure survey with finding of 2.1% and 1% respectively. Objective: To assess catastrophic and impoverishing out of pocket health expenditure and the determinant factors of catastrophic health expenditure in Ethiopia, 2023 from the 2018/19 socioeconomic survey. Methodology: A secondary data from Ethiopian socioeconomic survey 2018/19 conducted by Ethiopia’s Central Statistical Agency and World Bank was used to assess the catastrophic and impoverishing health expenditure at the national and subnational level by the Wagstaff and van Doorslaer and Xu. Et.al Methodology. Then binary logistic regression was computed by the STATA (ver.12) software to assess the determinant factors of catastrophic health expenditure. Result: From 6770 households 1.49% and 0.89% of them in Ethiopia faced catastrophic and impoverishing health expenditure respectively at 10% threshold level and households having a member with more facility visit had increased likelihood of facing catastrophic health expenditure (AOR=2.45, 95%CI; 1.6- 3.8) and also having member being hospitalized in the household had increased odds of facing catastrophic health expenditure (AOR=1.9, 95%CI; 1.19- 3.16). On the contrary, there is a decreased likelihood of facing catastrophic health expenditure among those who were insured for health (AOR= 0.58, 95%CI; 0.35- 0.97) and was in the richest consumption quintile group (AOR=0.6, 95%CI; 0.47- 0.65). Conclusion and recommendation; The finding indicate that there are still notable households facing catastrophic and impoverishing out of pocket health expenditure in Ethiopia especially in the lower consumption quintiles indicating inequity. In addition it is found that those with health insurance coverage, lower hospitalization and health service utilization had lower chance of facing catastrophic health payment. So it is suggested that activities that reduce hospitalization rate, increase insurance coverage and addressing the poor must be in place so that the catastrophic health cost incurred can be lowered at national level.
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    Acute Respiratory Tract Infections and Infant and Young Child Feeding Practices among 6 TO 23 Months Old Children In Addis Ababa, Ethiopia, 2023
    (Addis Ababa University, 2024-01) Minwyelet,Selamawit; Ali, Jemal Haida (MD, MSc, PHN, CRM, CME, HD); Yirgu,Robel (PhD, MPH, Bsc)
    Background: Suboptimal child feeding practice may lead to malnutrition which in turn is associated with an increased risk of morbidity and mortality from respiratory tract infections among under two children. In Ethiopia, an encouraging progress in the reduction of ARI was observed until 2010; however, since then the national prevalence is unchanged. Therefore, the need to uncover the role of infant and young child feeding practice is to provide information for interventions aiming to reduce under-five children morbidity and mortality due to childhood infections. Objective: The aim of this study is to determine the association between acute respiratory tract infections and infant and young child feeding practices among 6 to 23 months old children attending public health centers in Addis Ababa, Ethiopia, 2023. Methods: Facility based analytical cross-sectional design was conducted from August to September, 2023 among 342 children aged 6- to 23-months paired with their mothers in public health centers located in Addis Ababa. Multistage sampling technique was used to recruit the study participants. Data was collected from mothers of the infants and children using electronic method. Data was entered and analyzed using the statistical package for social sciences (SPSS) version 26. The association between IYCF practices and ARI were investigated using Chi-square test and binary logistic regression model. Result: The overall proportion of infants and children with acute respiratory tract infection was 31%. Early initiation of breastfeeding (AOR 0.57; 95% CI: 0.39, 0.82) and Exclusively Breastfed for the first two days after birth (AOR 0.64; 95% CI: 0.45, 0.91) were associated with lower risk of ARI. Infants and children who were frequently fed (AOR 0.54; 95% CI: 0.38, 0.76) and who consumed fruits and vegetables (AOR 0.37; 95% CI: 0.23, 0.61) were also less likely to experience ARI compared to their counterparts. Conclusion: The findings of the study indicate that the magnitude of acute respiratory tract infection is high among under two years children as upper respiratory tract infection being commonest cause and the recommended IYCF practices to reduce the occurrence of ARI in infants and children are early initiation of breastfeeding, exclusive breastfeeding in the first two days after delivery, consumption of vegetables or fruits and frequent feeding of infants and children.
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    Assessing safety and ethical issues among participants in a herbal medicine phase І clinical trial: conducted in Addis Ababa Ethiopia: A Mixed Methods Research
    (Addis Ababa University, 2024-06) Gebremedhin,Melat; Addissie,Adamu (MD, MPH, MA ,PhD); Abay, Solomon M(BPharm, MSc, PhD); Teferi,Mekonen(D.V.M, MSc)
    Background: Ethics in the conduct of clinical research is mandatory to protect research participants. The goal of phase І clinical trial is to determine the maximum dose of the new medication that may be administered without the risk of serious side effects. Participants in most of phase І clinical trial have no direct benefit in participating in the trial but the amount of money provided for compensation can cause the participants to participate without being concerned to the risks the new drug may bring. Objective: To investigate the safety and ethical issues among healthy volunteers in phases І clinical Study in Addis Ababa, Ethiopia in 2024. Methods: An institutional-based cross-sectional study design mixed with a qualitative description approach was employed. The study was conducted at Armauer Hansen Research Institute; semi-structured interviews were conducted face-to-face. Data was entered into the Kobo toolbox and exported to SPSS version 24; a descriptive analysis was done; and the socio- demographic characteristics of the study participants were described. For qualitative method, twelve interviewees were purposefully selected and interviewed. An open-ended question was developed to facilitate in-depth interviews with respondents. Interviews were audio-recorded with consent. Transcriptions were entered into ATLAS.ti and coded. The data was analyzed using a thematic analysis approach. Result: The major motivation of participants (54.4%) was financial benefit. The majority of the participants (52.6%) had a low monthly income of less than 2000 birr per month, followed by (42.1%) agreed to the need to help in the development of new drugs. When deciding to join a trial, the majority of them (40.4%), strongly agreed with giving consideration to the type of drug under investigation and the level of risk that can be caused. Altruism and medical care provided by the trial site were also the other major decision factors mentioned. Conclusion: The findings of this study indicate that the motivations and enrollment decisions of healthy participants to engage in a phase І clinical trial are diverse, extending beyond financial incentives. By taking these factors into account, researchers can develop more effective approaches to engage and protect the healthy volunteers in the trial.
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    Perspective and Experiences of Researchers regarding Informed Consent for Biorepositories in Ethiopia: A Qualitative Study
    (Addis Ababa University, 2024-07) Abdella,Siham Mohammed; Belachew,Ayele(Ass.Prof.); Minwuyelet,Lealem(MSc); Solomon,Kalkidan(Ass.Prof.)
    Background: Informed consent in biorepository-based research is a highly debated issue in the scientific community. Unlike one-time consent for a specific study, broad consent is required for future use of biospecimens. However, providing sufficient information about future research poses ethical challenges, making informed consent complex. Additionally, the use of complex procedures and terminology can make it difficult for individuals to fully comprehend the scope of their consent. As a result, the question of whether informed consent can be considered valid is a contentious and multifaceted issue. Given the significant increase in genomics and biorepository-based studies in Ethiopia, it is crucial to gain insight into the perspectives and experiences of researchers, sample donors, ethics committees, and other stakeholders involved in biorepositories. Objective: This study aims to explore and understand the perspective and experiences of researchers concerning informed consent for biorepository-based studies in Ethiopia. Methods: A qualitative study was conducted among 15 participants recruited using purposive intensity sampling. Face-to-face and virtual in-depth interviews were conducted with the study participants are well-experienced in biomedical research that involved collecting and storing human biospecimens from Addis Ababa University, College of Health Sciences, Ethiopian Public Health Institute, and Armauer Hansen Research Institute. Data were organized using NVivo version 20 and analyzed thematically. Results: The study reveals that while information is clearly stated on the information sheet, the informed consent process is not flawless, due to complexity of the study, lack of scientific knowledge, traditional beliefs, and communication flaws during information delivery. Moreover, the absence of a standardized informed consent model specifically tailored to genetics and other biorepository-based research emerged as another primary challenge. Conclusion: Overall, the researchers viewed the informed consent paper positively, yet the consent process was perceived negatively due to participants' poor comprehension. This informs the need for testing comprehension levels before obtaining consent. Future multi-site studies shall be conducted to generate evidence on the opinions and experiences of ethics committees, study participants, and other key stakeholders on informed consent for biorepositories.
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    Economic Burden of Diabetesmellitus on Patients and Their Families Attending Hospitals in Addis Ababa, Ethiopia.
    (Addis Ababa University, 2024-09-15) Kilil Kebron; Workneh Sale
    Diabetes is a chronic disease that imposes a substantial economic burden on countries, health systems, patients, and their families. The cost of treating and caring for diabetes puts a significant strain on household budgets exposing household for catastrophic expenditure.
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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.
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    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.
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    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.
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    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.