Leadership Commitment and the Quality of Adolescent-Friendly Sexual Reproductive Health Services in Public Health Facilities Among Pastoral Districts of Guji Zone, Ethiopia

Background

Accessible and high-quality sexual and reproductive health services are essential for adolescents. However, there is a need for more knowledge about the role of leadership and the quality of these services in Ethiopia, where a significant proportion of the population consists of adolescents. Inadequate quality of friendly health services may lead to underutilization and higher rates of unintended pregnancies and sexually transmitted infections. This study aimed to evaluate the leadership role and quality of friendly health services in the pastoral community of East Guji Zone, Ethiopia.

Methods

We implemented in-depth interviews and focus group discussions with eight key informants and fifty participants. Study design: We used a programmatic qualitative research design. Data were collected using 22 semi-structured questions and analyzed using ATLAS.ti7.

Results

The findings indicate significantly less commitment to health sector leadership and substandard quality of adolescent-friendly sexual and reproductive health services. Inadequate achievement of the quality of care frameworks, including accessibility, equitability, availability, acceptability, and appropriateness, contributed to the insufficient quality of friendly health services.

Conclusions and Recommendations

Poor commitment of health facility leaders influenced the quality of adolescent-friendly sexual and reproductive health services in the pastoral community of the East Guji Zone, according to the study. We recommend enhancing organizational and provider readiness, ensuring equitability, and redesigning services through improving leadership commitment, which is crucial to improving the quality of adolescent-friendly health services. The Ministry of Health Ethiopia and relevant stakeholders should consider these recommendations to improve the quality of friendly health services for adolescents in Ethiopia.

Effect of a school-linked life skills intervention on adolescents' sexual and reproductive health skills in Guji zone, Ethiopia (CRT)-A generalized linear model

Background

Although appropriate life skills are recognized as a fundamental right for adolescents and a critical component of health policy, they are often overlooked and rarely researched in pastoral communities. Life skills encompass the ability to adopt positive behaviors, which enable individuals to effectively deal with the demands and challenges of everyday life. This study aimed to evaluate the effectiveness of a school-linked life skills intervention program on adolescents' sexual and reproductive health skills in the pastoral community of Guji zone.

Methods

A two-arm cluster randomized control trial with a pretest-posttest experimental design was conducted, involving the intervention group (N = 375) and the control group (N = 384). This study assessed the effect of a school-linked adolescent-friendly life skills intervention in comparison to the usual RH curriculum, used as a control arm. Pretest-posttest and posttest-posttest scores of the control group and trial groups were compared, and the data were collected using 27 self-administered questions. The collected data were analyzed using paired-sample independent t-tests and a generalized linear model to examine the relationship between the dependent and independent variables.

Results

Data were collected from 759 adolescents in 15 intervention and 15 control clusters. The findings have shown that the proportion of mean life skills score was significantly higher in the intervention clusters than controls [(375) 70.49% vs. (384) 62.25%, P < 0.001 95% CI (0.06 and 0.1)]. Adolescents who were trained in school-linked life skills (β = 1.915, 95% CI: 1.411-2.418), were confident to make safe and informed decisions (β = 1.999, 95% CI: 1.562-2.436), and had life skills to deal with SRH issues (β = 1.66, 95% CI: 1.233-2.087) were significantly correlated with predicting the relevant life skills. The proportion of adolescents with SRH life skills increased from 384 (52%) at baseline to 375 (70%) at end line in the intervention group compared to 384 (60.31%) at baseline to 384 (62.31%) in control arms, respectively.

Conclusions

The implementation of a school-linked life skills intervention program proved to have a significant effect on SRH life skills development. Furthermore, individual-level and behavioral-level variables were significant in explaining variability in life skills development within the pastoral community. Therefore, we recommend scaling up this intervention in all high schools.

Trial registration

Trial registration PACTR202107905622610, registered on 16 July 2021.

Relationship Between Unintended Pregnancy and Antenatal Care Use During Pregnancy in Hadiya Zone, Southern Ethiopia

BACKGROUND

Unintended pregnancy has direct relation with poor utilization of maternal health care services and also associated with unhealthy behaviors during pregnancy. Few studies have examined the association between unintended pregnancy and maternal health behaviors during pregnancy in developing countries including Ethiopia. The purpose of the study was to determine the association of unintended pregnancy with use of antenatal care during pregnancy among pregnant women in Hadiya zone, southern Ethiopia.

METHODS

Community based cross sectional study design was employed in Hadiya zone, southern Ethiopia in 2017. 748 pregnant mothers were included using single population proportion. Study participants were selected by simple random sampling technique. A structured interviewer administered questionnaire was used to collect data. Descriptive, bivariate and multivariate logistic regression was employed to identify the independent effect of unintended pregnancy on the outcomes of interest. The level of significance was confirmed if p-value was less than 0.05.

RESULTS

More than one third (36.2%) of women reported unintended pregnancy. Unintended pregnancy was significantly associated with use of antenatal care. Women with unintended pregnancy were 69% less likely to receive ANC (AOR=0.31, 95% CI; 0.21-0.46) and were four times more likely to have late ANC initiation (AOR=4.40, 95% CI; 1.70-11.40) during pregnancy as compared to counterparts.

CONCLUSION

This study finding showed an association between unintended pregnancy and ANC use during pregnancy. Women with unintended pregnancy were less likely to use antenatal care and more likely to delay initiation of antenatal care. Longitudinal studies are recommended on relationship between unintended pregnancy and ANC use.

Udder health problems and major bacterial causes of camel mastitis in Jijiga, Eastern Ethiopia: implication for impacting food security

One hundred and forty-five traditionally kept lactating camels (Camelus dromederius) were examined for mastitis by combination of clinical, mastitis card test and subsequent bacteriological isolation. Clinical and sub-clinical mastitis were prevalent in 8.3% (95%CI = 4.6, 14.4) and 20.7% (95%CI = 14.6, 28.4) of the studied animals, respectively. This gives an overall mastitis prevalence of 29.0% (95%CI = 21.9, 37.2) at animal and 17.9% (95%CI = 14.9, 21.3) at quarter levels. High proportion (33.8%) of lactating camels had blind teats and 5.5% had lesions on udder or teat. Taking clinical mastitis and blocked teats into account, the study revealed that only 57.9% of the camels have four teats for milk production. Out of the 505 quarter milk samples examined, 80 (15.8 %) quarters were positive for indicator paper. Upon subsequent culturing, 68.8% (55 out of 80) of the quarter milk samples yielded bacteria. Staphylococcus, Streptococcus, E. coli and Bacillus species were the major isolates. Mastitis prevalence was significantly (p<0.05) affected by tick infestations, udder lesions, and increased age and parity of the animals. In conclusion, mastitis is a major problem in traditionally managed camels and deserves further attention owning to its potential impact on milk production affecting food security.