In Ethiopia's Kutaber district, does community-based health insurance protect households from catastrophic health-care costs? A community- based comparative cross-sectional study

OBJECTIVE

Every health system needs to take action to shield households from the expense of medical costs. The Ethiopian government implemented community-based health insurance (CBHI) to protect households from catastrophic health care expenditure (CHE) and enhance the utilization of health care services. The impact of CBHI on CHE with total household expenditure and non-food expenditure measures hadn't been studied, so the study aimed to evaluate the impact of CBHI on CHE among households in Kutaber district, Ethiopia.

METHODS

A total of 472 households (225 insured and 247 uninsured) were selected by multistage sampling techniques. Households total out-of-pocket (OOP) health payments ≥10% threshold of total household expenditure or ≥40% threshold of household non-food expenditure categorized as CHE. The co-variants for participation in the CBHI scheme were estimated by using a probit regression model. A propensity score matching analysis was used to determine the impact of CBHI on CHE. A Chi-square (χ2) test was computed to compare CHE between insured and uninsured households.

RESULTS

The magnitude of CHE was 39.1% with total household expenditure and 1.8% with non-food expenditure measures among insured households. Insured households were 46.3% protected from CHE when compared to uninsured households with total household expenditure measures and 24.2% to 25% with non-food expenditure measures.

CONCLUSION

The magnitude of CHE was lower among CBHI-enrolled households. CBHI is an effective means of financial protection benefits for households as a share of total household expenditure and non-food expenditure measures. Therefore, increasing the upper limits of benefit packages, minimizing exclusions, and CBHI scale-up to uninsured households is essential.

Prevalence and Associated Factors of Intimate Partner Violence Among Married Women During COVID-19 Pandemic Restrictions: A Community-Based Study

Ethiopia has taken unprecedented preventive measures, such as confinement to home and closure of schools and offices to halt the spread of Corona virus pandemic in the country. Unfortunately, such orders may have been associated with intimate partner violence (IPV) against women but there is no study conducted to assess the magnitude of IPV during the lock-downs in the country. Thus, this study intended to investigate the prevalence and associated factors of IPV against women during the COVID-19 pandemic restrictions. A community-based cross-sectional study was conducted on sample of 617 married or cohabited women. A systematic random sampling technique was employed to identify and enroll women who are married. A logistic regression analysis was used to identify the predictors of IPV among women and all statistical analyses were carried out using STATA 14.2. In this study, amongst the 589 married women who were included in the analysis, 22.4% [95% CI: 19.1%, 25.9%] were experienced at least one form of IPV. Additionally, 11.0%, 20.0%, and 13.8% of women also experienced physical, psychological, and sexual IPVs respectively. After adjusting for covariate; being illiterate [AOR=2.37: 95% CI 1.29, 4.35], having illiterate husband [AOR=2.67: 95% CI 1.36, 5.21], having substance user husband (alcohol, chat or cigarettes) [AOR=2.75: 95% CI 1.42, 5.34], and community tolerant attitude to violence [AOR=2.97: 95% CI 1.17, 7.61] were the independent predictors of IPV amongst married women. In conclusion, the prevalence of IPV among married women was comparable to the national pre-COVID figure of IPV. Therefore, national and regional governments should work toward enhancing gender equality, coupled with addressing risk factors at multiple levels, using community- and institution-based approaches to prevent IPV and to specifically achieve SDG5 of eliminating violence against women by 2030.

Psychological problems and the associated factors related to the COVID-19 pandemic lockdown among college students in Amhara Region, Ethiopia: a cross-sectional study

OBJECTIVE

The central aim of this study was to assess the level of psychological problems among college students during school closure due to the emerging COVID-19 pandemic.

DESIGN

Institution-based, cross-sectional study.

SETTING

Colleges in the Amhara regional state of Ethiopia.

PARTICIPANTS

Participants were college students (N=422, >18 years) who were actively enrolled in the selected colleges preceding the survey.

METHODS

Data entry was done using Epi Info V.7.02 and data analysis was done using SPSS V.24.0. Variables with a p value less than 0.25 in the bivariate analysis were entered into the multivariable logistic regression model. Model fitness was checked using the Hosmer-Lemeshow model fitness test. Statistically significant level was declared at p<0.05.

OUTCOME

Level of psychological problem.

RESULTS

This study involved 408 students, with a response rate of 96.6%. In this study, 77.2%, 71.8% and 48.5% of students experienced depression, anxiety and stress-related psychological problems during the lockdown, respectively. The multivariable logistic regression model showed that being female (adjusted OR (AOR)=1.68, 95% CI 1.09 to 2.91), inadequate practice of prevention measures (AOR=1.74, 95% CI 1.01 to 3.02) and living in an urban residency (AOR=0.76, 95% CI 0.48 to 0.94) were independent predictors of psychological problems among students.

CONCLUSIONS

The study revealed that the level of anxiety, stress and depression disorders is optimally high among college students. Therefore, local governments should develop effective psychological interventions for students. Moreover, it is important to consider the educational enrolment type and the academic year of students.

Level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in Amhara Regional State, Ethiopia

BACKGROUND

In Ethiopia, nearly one-third of people living with human immunodeficiency viruses do not adhere to antiretroviral therapy. Moreover, information regarding non-adherence and its associated factors among adults on first-line antiretroviral therapy in Northeast Ethiopia is limited. Therefore, this study aimed to assess the level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in North Shewa Zone, Amhara Regional State, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted on 326 participants selected by systematic random sampling technique from the five randomly selected public health facilities. Data were collected using the questionnaire adapted from the studies conducted previously and the collected data were entered into Epi data version 3.1 and exported to Stata version 14 for further analysis. Multivariable logistic regression analysis was done and an adjusted odds ratio with its corresponding 95% confidence interval was used to declare a statistical significance.

RESULTS

The overall prevalence of non-adherence was 17.4% [95% CI: (12.8%, 21.2%)]. Patients with no formal education [AOR (95% CI) = 5.57 (1.97, 15.88)], those who did not use memory aids to take their medications [AOR (95% CI) = 3.01 (1.27, 7.11)], travel more than 10 kilometers to visit the nearby antiretroviral therapy clinics [AOR (95% CI) = 2.42 (1.22, 25.86)], those who used substance [AOR (95% CI) = 3.57 (1.86, 28.69)], and patients whose medication time interfered with their daily routine activities [AOR (95% CI) = 15.46 (4.41, 54.28) had higher odds of having non-adherence to first-line antiretroviral therapy compared to their counter groups.

CONCLUSION

The level of non-adherence to first-line antiretroviral therapy was 17.4%, higher compared to WHO's recommendation. Hence, patients counseling focused on avoiding substance use, use memory aids, and adjusting working time with medication schedule are very crucial. Furthermore, the ministry of health and the regional health bureau with other stakeholders should expand antiretroviral therapy service delivery at health facilities that are close to the community to address distance barriers.

Level of Perceived Attitude and Practice and Associated Factors Towards the Prevention of the COVID-19 Epidemic Among Residents of Dessie and Kombolcha Town Administrations: A Population-Based Survey

PURPOSE

COVID-19 has been declared a pandemic by the World Health Organization. The unprecedented global health crisis we are facing is affecting all parts of society and changing lives and livelihoods. International efforts have been applied to prevent the spread of the virus through personal hygiene, masks and social distancing as prevention measures. The aim of this study is to assess the level of perceived attitude and practice and associated factors among Dessie and Kombolcha Town administrations, north-east Ethiopia.

PATIENTS AND METHODS

A cross-sectional population-based survey was conducted using a structured interview-administered questionnaire from June 7 to 14, 2020, among Dessie and Kombolcha town residents. The data were entered to Epi Info-7.1 and exported to SPSS-23. Bivariable logistic regression was done, and variables with p < 0.25 were entered a multivariable logistic regression analysis model. Statistically significant level was declared at 95% CI and a p-value <0.05.

RESULTS

A total of 828 participants were involved with a response rate of 98%. Of the total participants, 29.35% (95% CI: 26.3, 32.5) had poor attitude and 41.79% (95% CI: 38.5, 45.3) had poor practice towards COVID-19 prevention. Multivariable regression results showed a significant association with being male, unable to read and write, and mass media with attitude and rural residence, being widowed, a merchant, family size 4-6, spring water source and information heard from social media with practice.

CONCLUSION

Our findings revealed that there are inappropriate practices and poor attitudes towards COVID-19 prevention among Dessie and Kombolcha residents.

Knowledge level and factors influencing prevention of COVID-19 pandemic among residents of Dessie and Kombolcha City administrations, North-East Ethiopia: a population-based cross-sectional study

OBJECTIVE

In Ethiopia, community-level knowledge about the current COVID-19 pandemic has not been well studied. This study is aimed to assess knowledge level and factors influencing the prevention of the COVID-19 pandemic among residents of Dessie and Kombolcha city administrations, Ethiopia.

DESIGN

Community-based cross-sectional study.

SETTINGS

Dessie and Kombolcha city administrations.

PARTICIPANTS

Participants were household heads or members (n=828, >18 years) who have lived in the study area for at least 2 months preceding the survey.

METHODS

Binary logistic regression was used for a single outcome and multiple response variables. In the multivariable regression model, a value of p<0.05 and adjusted OR (AOR) with 95% CI were used to identify factors associated with knowledge level of the community. Epi Info V.7.2 and SPSS V.20 software were used for data entry and analysis, respectively.

OUTCOME

Knowledge level.

RESULTS

A total of 828 participants was involved with a response rate of 98%. Women were 61.7%. Participants' mean (±SD) age was 39 (±14) years. Of the total participants 54.11% (95% CI 50.6% to 57.6%) had inadequate knowledge about COVID-19 prevention. Significant associations were reported among women (AOR=1.41; 95% CI 1.03 to 1.92); age ≥65 years (AOR=2.72; 95% CI 1.45 to 5.11); rural residence (AOR=2.69; 95% CI 1.78 to 4.07); unable to read and write (AOR=1.60; 95% CI 1.02 to 2.51); information not heard from healthcare workers, mass media and social media (AOR=1.95; 95% CI 1.35 to 2.82), (AOR=2.5; 95% CI 1.58 to 4.19) and (AOR=2.13; 95% CI 1.33 to 3.42), respectively, with inadequate knowledge.

CONCLUSION

These findings revealed that more than 50% of participants had inadequate knowledge about COVID-19. It highlights the need for widespread awareness campaigns about COVID-19 through mass media, healthcare professionals and social media as sources of information. House-to-house awareness creation is recommended to address older adults who are more vulnerable to the pandemic.

Academic Achievements in National Competence Assessment Among Health Extension Students in Regional Health Science Colleges, Amhara Region, Ethiopia

BACKGROUND

The national competency assessment (NCA) is a strategy with the objective of creating a competent, motivated, adaptable and innovative workforce in Ethiopia. However, of all the students that had taken the NCA, below average students had passed the assessment in the study settings. Therefore, this study aimed to assess the level of academic achievements of health extension students (HESs) and identify the influencing factors that contribute to the failure of HESs on NCA in the study settings.

METHODS

An institution-based cross-sectional study complemented with qualitative methods was conducted from 18th to 27th January 2019 of a sample of 186 level III health extension students in Regional Health Science Colleges. A self-administered structured questionnaire and focus group discussion guiding tool were used to collect the data. The data were checked for completeness, coded and entered into EPI info version 7.1.0 and exported to SPSS version 20 for analysis. Bivariate logistic regression analysis was done to assess the association between each independent variable and the outcome variable with p<0.25. Multivariable analysis was done to control the influence of potential confounding variables and to identify influencing factors. The significant level was declared at p<0.05.

RESULTS

A total of 186 study subjects were involved in the study with a response rate of 100%. Of the total participants, only 31.7% of students passed the national competency assessment. After adjusting for covariates, fathers' education level, fathers' occupation, and students' English language understanding were significantly associated with the passing of the NCA.

CONCLUSION

Students' competency in the NCA is below average. Therefore, the health science colleges should give due attention to the inclusion of the English language as a unit of competency. The regional government and stakeholders should give priority to paternal awareness about the health extension program. Follow-up studies are recommended exploring other influencing factors related to the NCA.

Determinants of Neural Tube Defects among Newborns in Amhara Region, Ethiopia: A Case-Control Study

BACKGROUND

Worldwide, an estimated 300,000 neonates are born with neural tube defects (NTDs) each year. However, NTDs are underreported in Ethiopia though it causes substantial mortality, morbidity, disability, and psychological and economic cost in the country. Moreover, the factors attributed to NTDs were not addressed. Hence, this study intended to identify the determinants of neural tube defects in Amhara Region, Ethiopia.

METHODS

A case-control study design was conducted among 400 newborns (133 cases and 267 controls) who were born at randomly selected public hospitals. Cases were identified using the physician diagnosis of confirmed NTDs, and the two consecutive controls were selected using a simple random sampling technique. The data analysis was done using Stata 14.0. Variables with p value < 0.25 in the bivariate analysis were entered into the multivariable logistic regression model, and a corresponding 95% confidence interval was used to identify the predictors of NTDs.

RESULTS

In this study, fifty percent (48%) of the cases were contributed by anencephaly. After controlling the covariates, living in rural areas (AOR = 1.78: 95% CI 1.02, 3.11), being illiterate (AOR = 1.81: 95% CI 1.07, 4.61), being female newborn (AOR = 1.95: 95% CI 1.09, 3.50), having no ANC follow-up (AOR = 1.93: 95% CI 1.17, 5.04), and having a previous history of NTDs (AOR = 4.39: 95% CI 2.42, 7.96) were the risk factors for NTDs. However, being supplemented with folic acid or multivitamins before or during pregnancy (AOR = 0.37: 95% CI 0.21, 0.65), never having taken any substance during pregnancy (AOR = 0.42: 95% CI 0.21, 0.88), and being free from medical illnesses during pregnancy (AOR = 0.27: 95% CI 0.11, 0.69) were the protective factors of NTDs.

CONCLUSION

The study revealed different factors associated with NTDs among newborns in the region. Therefore, comprehensive preventive strategies focused on identified risk factors are needed at regional and national levels.