Malaria epidemics in the highlands of Ethiopia

OBJECTIVE

To confirm the occurrence and describe the patterns of the 2003 malaria epidemics reported in the highlands of Ethiopia.

DESIGN

A retrospective descriptive study.

SETTINGS

Fifty epidemic affected districts between altitude ranges of 1500 and 2500 m in three regions in Ethiopia.

RESULTS

Exaggerated seasonal transmission was observed in 25 districts, 16 in Oromia region and 9 in SNNPR. A sustained upward trend with 3-4 consecutive abnormal seasonal transmissions, which has started since 2002, has been identified in 22 districts. True explosive epidemic malaria was recorded at exceptionally high altitude (around 2500m) in at least one of the health facilities in seven districts. The incidence of malaria in 2003 epidemic has showed a six fold increase on average (range 2-20) from the threshold level.

CONCLUSION

Occurrence of a malaria epidemic was confirmed in all studied districts showing that the level of malaria endemicity and magnitude of the problem is increasing. The findings suggest the strategic importance of taking well-timed and appropriately targeted preventive and control interventions.

The use of real-time PCR to identify Entamoeba histolytica and E. dispar infections in prisoners and primary-school children in Ethiopia

In Ethiopia, it is generally unknown what proportion of the amoebic infections commonly found, by microscopy, in humans are caused by non-invasive Entamoeba dispar rather than the potentially invasive E. histolytica. Faecal samples were therefore collected from 363 primary-school students and 409 prisoners from various regions of Ethiopia. Each of these samples was checked for Entamoeba infection by the microscopical examination of formol-ether concentrates. DNA was then extracted from the 213 samples (27.6%) found Entamoeba-positive, and run in a real-time PCR with primers, based on the SSU-rRNA gene sequences of E. histolytica and E. dispar, that allow DNA from the two species to be distinguished. Although E. dispar DNA was identified in 195 (91.5%) of the 213 samples checked by PCR, no E. histolytica DNA was detected. This finding is consistent with the conclusion of a previous, smaller investigation: that many amoebic infections in Ethiopia are incorrectly attributed to E. histolytica and then treated, unnecessarily, with amoebicidal drugs.

Efficacy of sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in Ethiopia

OBJECTIVE

To assess the status of the therapeutic efficacy of sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria to enable evidence based policy decisions.

DESIGN

The study used the new WHO (2003) protocol for the assessment of the therapeutic efficacy of anti-malarial drugs.

SETTING

Eleven health facilities located in malarious areas with seasonal transmission.

SUBJECTS

Patients aged six months and above who presented to the health facilities for febrile illness and for whom consent was obtained to participate in the study after fulfilling the inclusion criteria were enrolled in the study.

MAIN OUTCOME MEASURES

Proportion of treatment failures.

RESULTS

In eleven (90.9%) of the sites, where adequate sample was collected, a total of 598 subjects were enrolled and 487 (81.4%) completed the follow-up. A mean treatment failure rate of 35.9% (95% confidence interval [CI] 31.8, 40.3) on the 14 days follow-up and 71.7% (95% CI 67.5, 75.9) on the 28-days follow-up was recorded (not PCR corrected). The mean clinical failure on the 14-days follow-up was 20.9% (95% CI 17.5, 24.7) and 70% (n=10) sites had aggregated clinical failure rates higher than 15%, while in 80% (n=10) sites the total treatment failure exceeded 25%. There was no significant difference in treatment failure rates in areas with malaria transmission duration of six months and above as compared to areas with below six months of transmission (odds ratio [OR] = 0.9, 95% CI 0.43,1.83 p = 0.75). The difference in mean treatment failure between the <5 and > or =15 years of age was not significant (OR 0.8, 95% CI 0.39,1.67 P = 0.54).

CONCLUSION

The level of treatment failure detected is much higher than the WHO recommended tolerable levels. The findings, therefore, strongly indicate the need for an immediate review of the existing national anti-malarial treatment guideline.

Size-polymorphism of mini-exon gene-bearing chromosomes among natural populations of Leishmania, subgenus Viannia

In order to explore genomic plasticity at the level of the mini-exon gene-bearing chromosome in natural populations of Leishmania, the molecular karyotype of 84 Leishmania stocks belonging to subgenus Viannia, originating mostly from Peru and Bolivia, and differing according to eco-geographical and clinical parameters, was resolved and hybridised with a mini-exon probe. The results suggest that size variation of the mini-exon gene-bearing chromosome is frequent and important (up to 245-kb size-difference), and partially involves variation (up to 50%) in copy number of mini-exon genes. There is no significant size-difference between mini-exon-bearing chromosomes of Peruvian and Bolivian populations of cutaneous and mucosal isolates of Leishmania (Viannia) braziliensis, but there is between eco-geographical populations of Leishmania (Viannia) peruviana. Leishmania (V.) peruviana presented a significantly smaller mini-exon-bearing chromosome than the other species of subgenus Viannia. The contrast between the general chromosome size heterogeneity and the homogeneity observed in some Peruvian Andean areas is discussed in terms of selective pressure.

Genotyping and molecular detection of multidrug-resistant Mycobacterium tuberculosis among tuberculosis lymphadenitis cases in Addis Ababa, Ethiopia

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major public health problem. Drug-resistance surveillance data show that 3.9% of new and 21% of previously treated TB cases were estimated to have had rifampicin/ multidrug-resistant tuberculosis (MDR/RR-TB) in 2015. This implies that the MDR-TB is increasing alarmingly. Hence, a better understanding of drug resistance mechanisms and genotypes associated with multidrug resistance in M. tuberculosis is crucial for improving diagnostic and therapeutic methods to treat individuals with MDR-TB. The aim of this study was to analyze molecular drug resistance mutations of MDR-TB isolates from the cases of TB-lymphadenitis in relation to its genetic lineages.

A cross-sectional study was conducted on culture positive cases from July to October, 2014 in Addis Ababa, Ethiopia. Sixty isolates were included to analyze drug resistance mutated gene responsible for MDR-TB in relation to its molecular genotyping. Mycobacterial culture, GenoTypeMTBDR plus and Spoligotyping were used to undertake the study.

Of 60 TBLN isolates, 8.3% were identified MDR-TB cases and one isolate was isoniazid mono-resistant. Eleven isolates in T3-ETH genetic sub lineage were sensitive to both RMP and INH, while only 2 isolates were MDR-TB. Most of the RMP- resistant isolates showed mutation in codon S531L and all isolates mutated in the katG gene conferring INH resistant strains had mutations in codon of S315T1.

Screening for the rpoB and katG gene mutation of tuberculosis lymphadenitis is useful in Ethiopia for an early detection and treatment of MDR-TB. Besides, there is a drug resistance variation among different lineages of Tuberculosis lymphadenitis which has important consequences for the development of efficient control strategies.

Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia

Purpose

Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia.

Patients and Methods

An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables.

Results

The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment.

Conclusion

The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.

Safety and efficacy of artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in Ethiopia

OBJECTIVE

To document baseline data on the efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in Ethiopia.

DESIGN

Patients diagnosed for P. falciparum, who were treated with six doses of artemether-lumefantrine over three days, were followed for 28 days and treatment outcomes classified based on the WHO (2003) protocol.

SETTING

Four health facilities located in malarious areas in two regions: Alamata and Humera hospitals in Tigray region and Assendabo and Nazareth in Oromia region.

SUBJECTS

Patients with body weight of more than 10 kgs, excluding pregnant women, who or their guardians consented to participate in the study after fulfilling the inclusion criteria were enrolled in the study for a follow-up period of 28 days.

MAIN OUTCOME MEASURES

Proportion of treatment success and adverse drug effects that required discontinuation of treatment and/or follow-up.

RESULTS

A total of 213 patients who fulfilled the enrolment criteria completed the 28 days follow-up after treatment with artemether-lumefantrine. A treatment success rate of 99.1% (95% confidence interval [CI] 96.9, 99.8) and no adverse effects or complaints related to the drug that required discontinuation of treatment or withdrawal from follow-up was reported. Treatment success was not achieved in 213 (0.9%) subjects for whom fever and peripheral parasitaemia was demonstrated on day 21 and 28. The day 21 and day 28 blood samples of the treatment failure cases were not PCR corrected.

CONCLUSION

The artemisinin based combination drug artemether-lumefantrine has shown very high (99.1%) clinical and parasitological cure for the treatment of uncomplicated falciparum malaria with no reports of adverse reaction that required withdrawal of treatment or discontinuation of follow-up. In the presence of the low efficacy of sulfadoxine-pyrimethamine, chloroquine and amodiaquine, the use of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria is the best choice for Ethiopia.

The Ethiopia applied nutrition project

The British projects conducted in Ethiopia under the auspices of the I. B. P. have collected a vast amount of information concerning the peoples in Begemedir province, a highland area. This background served well as baseline data to establish the value of an applied nutrition project covering a broad range of activities. In the project township, Debarek, a polyclinic was introduced. Special attention was given to nutrition education for the under-fives by using several approaches. Other activities included nutrition education in the school and polyclinic, investigations into treatment of goitre and vitamin A deficiency, market garden schemes and improvements in poultry keeping. The only input in the control town Adi Arkai was a polyclinic set up by the Ethiopian Ministry of Health. Information about Debarek (the target community) and Adi Arkai (control) was also obtained from government statistics and surveys carried out by the Gondar Public Health College in 1968. The Project carried out censuses in 1970 and again in 1972. The evidence collected in the two communities over this period, while insufficient to establish any long-term trend, showed clearly a similar population structure. The most marked characteristics were the imbalance in the sex-ratio (67 males per 100 females Debarek, 86/100 in Adi Arkai) which reflected mobility, and the employment of about 80 % of the labour force in the tertiary or service sector, which reflected the economic function of the towns. On the other hand, religious groupings appeared to be remarkably stable and were an important aspect of the pattern of authority in the community. The monitoring of births and deaths during the Project gave accurate data for the first time. Crude birth rates in Debarek and Adi Arkai were 42 and 50 per thousand, crude death rates 19 and 35 per thousand, and infant mortality rates 229 and 198 per thousand live births respectively. A number of indicators of nutritional status were employed. Within a stratified sample of families three-day individual food intakes were measured on six occasions during 1969 and again at the conclusion of the Project in 1972. Energy intakes were consistently low, being about 70 % of the 1973 F. A. O./W. H. O. recommendations. Measurements made on these families, and on schoolchildren, of height, mass, skinfold thickness and arm circumference demonstrated that the people are small and underweight, with very little body fat. Clinical examinations revealed few overt signs of nutritional deficiencies, except for vitamin A and goitre. Evaluation was achieved by comparing anthropometric, mortality, and morbidity data from the Project and control towns. The most significant changes observed in the Project town were a 38 % reduction in the infant mortality rate, an improvement in the mass for age data for under-fives, and a reduction in the prevalence of vitamin A deficiency and goitre. Assessment of nutritional knowledge, its application, and effectiveness was attempted on selected groups. The achievements and failures of applied nutrition programmes are discussed in relation to the underlying economic basis of malnutrition, i.e. poverty.

Respectful Maternity Care and Associated Factors Among Women Who Attended Delivery Services in Referral Hospitals in Northwest Amhara, Ethiopia: A Cross-Sectional Study

Background

Disrespectful and abusive care is a violation of women rights to self-determination, health, life, body integrity, and privacy. Providing respectful maternity care (RMC) during labour and delivery is one of the enhancing factors and targets in the Ethiopian health sector strategic plan to promote facility delivery. However, providing respectful maternity care is still a major challenge in the Ethiopia health-care system. This study aimed to assess respectful maternity care and associated factors among women who attended delivery services in Northwest Amhara, referral hospitals, Ethiopia.

Methods

Health-facility-based cross-sectional study was conducted at Northwest Amhara, referral hospitals from March 1 to April 1, 2020. A systematic random sampling technique was used to identify study participants in the referral hospitals. A total of 410 women who gave birth were enrolled in the study. A pre-tested and structured questionnaire was used for data collection. The data were collected during the exit interview. Data were cleaned and entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Both bi-variable and multi-variable logistic regressions were employed in the analysis. Variables with a p-value of less than 0.05 were used to declare as statistically significantly associated with the dependent variable.

Results

The overall magnitude of women who have received respectful maternity care was 56.3%. Four and above antenatal care follow-up adjusted odds ratio (AOR) 3.092 (95% CI: 1.676, 5.725), previous history of facility delivery AOR 2.53 (95% CI: 1.094, 5.867), and delivery time AOR 2.46 (95% CI: 1.349, 4.482) were found significantly associated with respectful maternity care.

Conclusion

The overall magnitude of respectful maternity care was low as compared to international and national standards. This study showed that respectful maternity care among women who gave birth was influenced by the number of antenatal care visits, previous history of facility delivery, and delivery time.

High Hidden Burden of Diabetes Mellitus among Adults Aged 18 Years and Above in Urban Northwest Ethiopia

BACKGROUND

Ethiopia is one of the sub-Saharan African countries with a rapidly increasing burden of diabetes mellitus (DM). There is limited updated information about the community-based burden of the disease and its associated factors in Ethiopia which is very crucial to plan effective prevention and control measures against the disease. This study is aimed at determining the burden of DM and its associated factors in urban northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from April to May 2019 among residents aged ≥ 18 years in Gondar town and urban kebeles (lowest administrative units of the country) of Health and Demographic Surveillance System site (HDSS) in Dabat district. A multistage sampling technique was used to select 773 participants. World Health Organization (WHO) stepwise approach for noncommunicable disease surveillance was used to collect the data. Fasting blood glucose (FBS) ≥ 126 mg/dl was used to diagnose DM. Descriptive statistics were done to describe the variables of the study. Prevalence with its 95% confidence interval (CI) was estimated. Binary logistic regression model was fitted, variables with p value < 0.05 were considered to have a significant association with the outcome, and odds ratio (OR) was used to measure the strength of association.

RESULT

Of the total participants, 6.34% (95% CI; 4.82, 8.29) were found to be diabetic. Of these, 40 (81.6%) were newly diagnosed. Besides, the prevalence of prediabetes was 9.31% (95% CI: 7.45, 11.58). Increased age (AOR = 1.06, 95% CI; 1.04, 1.09) and eating vegetables one to three days per week (AOR =0.29, 95% CI; 0.13, 0.65) were significantly associated with diabetes.

CONCLUSION

The overall prevalence of DM is a bit higher than the national estimate, while the proportion of undiagnosed DM which can easily progress to disabling and life-threatening complications was alarmingly high. Age and frequency of eating vegetables per week were associated with diabetes. In light of this finding, future prevention and control measures against the diseases should consider the identified factors. There should also be improved access to screening services.

Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study

Background

Every year, 808 million people face catastrophic health expenditure (CHE), and 122 million people were pushed into poverty. It aggravates healthcare inequalities, incurs double burden opportunity costs, and pushes households to sit in a deep poverty trap. A few studies have been done so far; however, it is not enough to inform policy decisions. Therefore, this study aimed to assess the catastrophic out-of-pocket health expenditure and associated factors among rural households in Mandura District, Western Ethiopia.

Methods

We conducted a community-based cross-sectional study among the Mandura district’s 488 rural households from April to May 2017. We used a multistage systematic sampling technique to select the participants. We fitted a binary logistic regression model to identify the factors associated with catastrophic out-of-pocket health expenditure. We used the adjusted odds ratio (AOR) with 95% CI and the p-value <0.05 to determine the variables associated with catastrophic out-of-pocket health expenditure.

Results

Catastrophic health expenditure (CHE) with a 40% capacity to pay (CTP) households in the study area was 22.5%. Female household head (AOR = 2.92; 95% CI: 1.44, 5.93) and household with chronic illnesses (AOR = 3.93; 95% CI: 1.78, 9.14) were positively associated with CHE and, while households who had adult household members (AOR = 0.32; 95% CI: 0.16, 0.63) were negatively associated.

Conclusion

The overall CHE, with a 40% CTP threshold, was high. Prevention of chronic illness might help to reduce the burden of the expenditure. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help bring healthcare services equity.

The health consequences of intrauterine growth retardation in southwestern Ethiopia

Although over 90% of low birth weight deliveries occur in the developing world, knowledge of its occurrence and consequences are largely based on studies in developed populations. The aim of this investigation was to determine the health consequences of intrauterine growth retardation (IUGR) among an historical cohort of children delivered in a regional hospital located in southwestern Ethiopia. Following a census of all births over a three year period 116 full-term, IUGR and normal birth weight (NBW) matched pairs between 3 and 40 months of age were identified. IUGR children were found to be at elevated risk for moderate to severe malnutrition [relative risk (RR) = 2.26 (1.15,4.43)], frequent illnesses (RR = 1.29 (1.13, 1.46)), and current illness (RR 1.52 (1.10, 2.09)). Catch-up growth among IUGR children did not occur. A steady decline in the growth of NBW children resulted in similar anthropometric outcomes by 2 years of age between the two groups.

Exclusive breastfeeding and rotavirus vaccination are associated with decreased diarrheal morbidity among under-five children in Bahir Dar, northwest Ethiopia

BACKGROUND

More than one in every ten (14%) of under-five child deaths is associated with diarrheal morbidity in Ethiopia. Although Ethiopia has implemented different health interventions like its immunization program, childhood diarrhea morbidity, on which literature is limited, continues as a public health problem. Hence, the aim of this study was to assess the prevalence of diarrheal morbidity and associated factors among under-five children in Bahir Dar, northwest Ethiopia.

METHOD

A community based cross-sectional study was carried out from March 05 to April 03/2015 in Bahir Dar in which 553 mother-child pairs participated. A structured questionnaire was adapted from the World Health Organization (WHO) and the Ethiopian Demography and Health Survey (EDHS) to collect the data. Bivariate and multivariate logistic regression analyses were carried out to identify the independent predictors of diarrheal morbidity.

RESULT

The overall prevalence of diarrheal morbidity was 9.4% [95% Confidence Interval (CI): 4.8, 14.0%]. No receipt of Rotavirus vaccine dose 2 [AOR = 3.96, 95%CI; 2.13, 7.33], non-exclusive breastfeeding [AOR = 2.69, 95%CI; 1.39, 5.19], unavailability of solid waste disposal system [AOR = 2.62, 95%CI; 1.19, 5.77], employed and private business occupational status of mothers [AOR = 2.10, 95%CI; 1.02, 4.31)], and less than Ethiopia Birr (ETB) 600 household monthly income [AOR = 2.10, 95% CI; 1.2, 7.2] were independently associated with diarrheal morbidity.

CONCLUSION

In Bahir Dar, one in every ten of the under-five children surveyed suffered from diarrheal morbidity. Thus, implementing effective rotavirus vaccination programs, encouraging exclusive breastfeeding and emphasizing appropriate solid waste management would reduce childhood diarrheal morbidity in the region. In addition, the finding suggests that improved child care mechanisms, especially for mothers working outside the home, and efforts to increase household income should be intensified to reduce incidence of diarrhea.

Rotavirus Vaccine Coverage and Associated Factors Among a Rural Population: Findings from a Primary Health-Care Project in Two Northwest Ethiopia Districts

Objective

Rotavirus vaccines reduced severe rotavirus disease by more than 60% during the first year of life. In Ethiopia, however, about 28% and 6% of diarrheal disease hospitalizations and deaths among under-five children are associated with rotavirus, respectively. Therefore, this study aimed to investigate rotavirus coverage and associated factors in a rural population of the northwest, Ethiopia.

Methods

A community-based cross-sectional study was conducted from May to June 2019, in Dabat and Gondar Zuria districts, northwest Ethiopia. Data from 603 mothers paired with children aged 12–36 months were collected through house-to-house visits. Variables having a p-value <0.05 were considered to have a significant association with the outcome. Odds ratio (OR) with its 95% confidence interval (CI) was used as a measure of association.

Results

The prevalence of rotavirus vaccine coverage among children was 76.60% (95% CI; 69.98, 83.22). The dropout rate for rotavirus vaccine dose 2 out of rotavirus vaccine dose 1 was 1.99%. Mothers with formal education [AOR = 3.04; 95% CI: 1.63, 5.67] and received postnatal care [AOR = 4.37; 95% CI: 2.62, 7.27] had higher odds of rotavirus vaccine completion versus those without formal education and had not received postnatal care, respectively. Similarly, mothers who took <1 hour to reach the vaccination center ([AOR = 2.38; 95% CI: 1.34, 4.2]) were positive predictors of rotavirus vaccine completion.

Conclusion

Rotavirus vaccine coverage in our study area was lower than the expected WHO target. Formal education, postnatal care, and time taken to reach vaccination centers were predictors to achieving full rotavirus vaccine coverage of children. Health-care services utilization after delivery should be intensified to improved child rotavirus vaccine completion in the districts. The long travel time should be dealt with by strengthening outreach services and increasing the number of new vaccination centers in the districts.

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation

BACKGROUND

Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system's objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies' employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies' employees in northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies' employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance.

RESULTS

Overall, 32% (95% CI: 27.7-36.2) of the government-owned companies' employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69-27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12-2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39-0.92), work experience (AOR: 0.49, 95% CI: 0.26-0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04-0.71) were significantly associated with acceptance of SHI among government-owned companies' employees.

CONCLUSIONS

One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.

Prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project

OBJECTIVE

Ethiopia is one of the Africa's signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia.

STUDY DESIGN

The study is community-based cross-sectional study.

STUDY SETTING

Dabat and Gondar Zuria districts, Northwest Ethiopia.

PARTICIPANTS

Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis.

METHODS

A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination.

OUTCOMES

Incomplete or not at all vaccination.

RESULTS

The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25).

CONCLUSIONS

In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.

Prevalence and determinants of modern contraceptive utilization among rural lactating mothers: findings from the primary health care project in two northwest Ethiopian districts

Background

Contraceptive utilization is a guarantee to avert unwanted pregnancies. In Ethiopia however, more than half of the rural women have shorter birth intervals. Consequently, 17 and 8% of the births have been either mistimed (wanted at later date) or unwanted, respectively. Therefore, this study investigated modern contraceptive utilization and its predictors among rural lactating women.

Methods

A community based-cross-sectional study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, northwest Ethiopia. Data from 603 lactating mother were collected through face to face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were fitted to identify the independent predictors of modern contraceptive utilization.

Results

The overall prevalence of modern contraceptive (MC) utilization rate was 45.8% [95% CI: 38.01, 53.59]. The contraceptive method mix was dominated by Depo-Provera (39.8%) followed by implants (4.8%). The odds of utilization of contraceptive were 5.58 times higher among mothers of children with fully immunized [AOR = 5.58, 95% CI: 3.45, 9.01] compared to mothers whose children were vaccinated partially or not at all. Mothers who received antenatal [AOR = 1.74, 95% CI: 1.13, 4.43] and postnatal care [AOR = 2.02, 95%CI: 1.24, 2.91) were 1.74 and 2.02 folds more likely to utilize modern contraceptives than mothers who did not receive such care, respectively.

Conclusion

The prevalence of modern contraceptive utilization in this study area was lower than the planed national target. In the region, child immunization service is one of the promising platforms for reaching lactating mothers with modern contraceptive utilization. Our findings suggest that antenatal and postnatal care visits are the other key determinants of modern contraceptive utilization. Thus, in low-resource settings like ours, the health system approaches to improved antenatal and, postnatal care and child immunization services should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies.

Economic Burden and Predictors of Cost Variability Among Adult Cancer Patients at Comprehensive Specialized Hospitals in West Amhara, Northwest Ethiopia, 2019

Background

Cancer is the second leading cause of death in the world and accounts for 5.8% of deaths in Ethiopia. High out-of-pocket payment for the cost of illness of cancer could be linked to the low adherence to cancer treatment. This study aimed to assess the economic burden and predictors of cost variability among adult cancer patients at comprehensive specialized hospitals in West Amhara, Northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from January to February 2019 at the University of Gondar and Felege Hiwot hospitals. The cost of illness of cancer was estimated using a bottom-up micro-costing approach. Direct costs of illness of cancer were measured by calculating out-of-pocket expenditure. The indirect costs were estimated using human capital model approach. Multiple linear regression was used to identify the predictors for the log-transformed data. Unstandardized β-coefficient with 95% CI and p-value < 0.05 were used to declare factors associated with cost of illness of cancer.

Results

The mean cost of cancer illness among adult patients was US$ 1103.7 ±33.2, and median cost was US$ 951.0 with IQR of 822.1. Factors such as urban residents (β = 0.147; 95% CI: 0.047, 0.246), distance (β = 0.0007; 95% CI: 0.0002, 0.001), married (β = 0.125; 95% CI: 0.037, 0.212), higher education (β = 0.318; 95% CI: 0.202, 0.435), buying drugs at private facilities (β = 0.134; 95% CI: 0.026, 0.243), richest households (β = 0.320; 95% CI: 0.143, 0.496) and frequent cycles of chemotherapy (β = 0.093; 95% CI: 0.061, 0.125) were positively associated with cost, while being female patients (β = −0.144; 95% CI: − 0.210, − 0.018) were negatively associated.

Conclusion

The cost of illness of cancer was high. The government, therefore, should expand health insurance and invest an additional budget to safeguard patients from financial catastrophic shock.

Poor child complementary Feeding Practices in northwest Ethiopia: Finding from the Baseline Survey of Nutrition Project, 2016

Background

Improving infant and young child feeding practices is critical to improved nutrition, health, and development of children. Ethiopia adopted the WHO recommendations of child feeding practices and developed the national guideline. In spite of this fact, only few children start and received appropriate complementary feeding based on the recommendation. Therefore, the study aimed to determine dietary diversity score and its associated factors among under five children at Dabat Health and Demographic Surveillance System site (HDSS), northwest Ethiopia.

Methods

A cross-sectional community based study was carried out from February to June 2016. All children aged 6–59 months old who lived in HDSS site were included in the survey. Odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of association. Finally, variables with a P-value of < 0.05 were considered statistically significant..

Results

In this study, a total of 3433 children were included. About 34.87% (95%CI: 33.27, 36.49%) of the children received adequately diversified diet. The odds of receiving adequately diversified diet was higher among children whose mother had secondary and above education (AOR = 6.51; 95%CI: 4.95, 8.56), had antenatal care (AOR = 1.90; 95%CI: 1.60, 2.26) and postnatal care visits (AOR = 1.31; 95%CI: 1.00, 1, 72), and children who feed with their family (AOR = 1.39; 95%CI: 1.17, 1.65). However, a lower dietary diversity score was observed among younger children; 6–11 months old (AOR = 0.59; 95%CI: 0.41, 0.85), and children from food insecure household (AOR = 0.76; 95%CI: 0.63, 0.92).

Conclusions

Diversified diet feeding practice is low in Dabat HDSS site. Age of the child, maternal education, antenatal and postnatal care visits, and household food insecurity were significantly associated with dietary diversity of children. Hence, ensuring household food security and enhancing the coverage of maternal health care utilization are recommended to increase dietary diversity of children.