Traditional Medicine Practice in the Context of COVID-19 Pandemic: Community Claim in Jimma Zone, Oromia, Ethiopia

Purpose

To assess traditional medicine practice claims by the community for the prevention and treatment of COVID-19.

Methods

A community-based cross-sectional study design was conducted among 422 households of Jimma Zone, and the data were collected by interviewing individuals from the selected households. The medicinal plants were recorded on Microsoft excel 2010 with their parts used, dosage form, route of administration and source of plants and tabulated in the table. Descriptive statistics were used to describe and organize the data. The Relative Frequency of Citation (RFC) was calculated for each traditional medicine to identify the top 10 medicinal products.

Results

Around 46% of participants used traditional medicines for the prevention and treatment of COVID-19. The study recorded 32 herbal and non-herbal medicinal products. Garlic (RFC: 0.166), ginger (RFC: 0.133), lemon (RFC: 0.133), garden cress (RFC: 0.069) and “Damakase” (RFC: 0.031) were the frequently used herbal medicines. Seeds (47.22%) and leaves (30.56%) were the most used parts of medicinal plants. Most preparation of medicinal plants (90.63%) was administered through the oral route. The majority of medicinal plants were from home gardens.

Conclusions and Recommendations

Around half of the participants practiced traditional medicines for COVID-19. Garlic, ginger, lemon, garden cress and “Damakase” were the frequently used herbal products. Seeds and leaves were regularly used parts. The oral route is the most used route of administration. The majority of medicinal plants were from home gardens. This quantity of traditional medicine practice is probably challenging to control the pandemic. However, it might open possibilities for pharmaceutical industries and researchers to look into the effectiveness and safety of claimed medicinal products. Therefore, all responsible bodies are advocated to behave accordingly.

Patients' healthcare, education, engagement, and empowerment rights' framework: Patients', caretakers' and health care workers' perspectives from Oromia, Ethiopia

BACKGROUND

Successful health care and clinical services essentially depend on patients' realization of ones' rights, and health workers' and facilities' fulfillments and protections of these rights. However, little is documented about how patients and health workers perceive patients' rights during care-seeking practices.

METHODS

A qualitative study was conducted in four hospitals in Ethiopia through 8 focus group discussions with patients and 14 individual interviews with diverse groups of patients, caretakers, and 14 interviews with health workers. Participants were recruited through a purposive sampling method to meet the saturation of ideas about patients' rights. The sampled patients, caretakers, and professionals were enlisted from various departments in the hospitals. The data analysis was assisted by ATLAS.ti 7.1.4.

RESULTS

The study identified three major categories of healthcare rights (clinical, socio-cultural, and organizational), incorporating supporting elements of education, engagement, and empowerment. Study participants reported detailed rights the patients would have during hospital visits which included the right to timely access to care and treatment, adequate medications) with full respect, dignity, and without any discrimination. Patients widely perceived that they had the right to tell their illness history and know their illness in the language they can understand. It was also widely agreed that patients have the right to be educated and guided to make informed choices of services, procedures, and medications. Additionally, patients reported that they had the right to be accompanied by caretakers together with the right to use facilities and resources and get instructions on how to utilize these resources, the right to be protected from exposure to infections and unsafe conditions in hospitals, right to get a diet of their preference, and right to referral for further care. Nevertheless, there was a common concern among patients and caretakers that these rights were mostly non-existent in practice which were due to barriers related to patients (fear of consequence; a sense of dependency, feeling of powerlessness, perceptions of low medical literacy), health workers (negligence, lack of awareness and recognition of patient rights, undermining patients), and facilities' readiness and support, including lack of guiding framework.

CONCLUSIONS

Perceived patients' rights in the context of hospital visits were profoundly numerous, ranging from the right to access clinical and non-clinical services that are humanely respectful, fulfilling socio-cultural contexts, and in a manner that is organizationally coordinated. Nonetheless, the rights were not largely realized and fulfilled. Engaging, educating, and empowering patients, caretakers, and health care providers supported with policy framework could help to move towards patient-centered and right-based healthcare whereby patients' rights are protected and fulfilled in such resource-limited settings.

Development of constructs to measure client satisfaction with pharmacy services in resource-limited settings. A multicenter cross-sectional study

BACKGROUND

Satisfaction with pharmacy services has many implications, including the degree of interaction with health care providers, the type and quality of service provided, and the extent to which needs and desires are met. This study aimed to identify the dimensions of pharmacy services and quantify client satisfaction with them.

METHODS

A quantitative cross-sectional study was employed to guide this study. Data were entered into Epi Data, exported to SPSS 26.0, and analyzed using exploratory factor analysis to identify the underlying dimensions of pharmacy service. The study was conducted between 14th August 2020 and 28th December 2020. For standardization and comparison purposes, items loaded onto each dimension were computed and rescaled, and descriptive statistics were used to summarize the results. Stepwise linear regression was performed to quantify the contribution of each dimension to overall satisfaction and to identify determinant variables for overall satisfaction. A 95% CI, and a P-value of < 0.05 were used for the declaration of statistical significance.

RESULTS

The mean overall satisfaction with pharmacy service was found to be (21.62±6.74)/30. There were eight dimensions of pharmacy service identified, and poor customer satisfaction was recorded for the premises and supply dimensions, with mean satisfaction of (12.08±8.49)/30 and (13.66±10.06)/30, respectively. The highest mean satisfaction was recorded with waiting time (24.24±6.54). Of the emergent dimensions, only four (supply, compassion and care, privacy, and premises) were predictors of overall satisfaction (P<0.05). The supply component was the strongest predictor of overall satisfaction, accounting for 20% of the variance in overall satisfaction. The number of prescribed and dispensed pharmaceuticals, marital status, and gender of participants also predicted overall satisfaction (P<0.05).

CONCLUSION

The survey uncovered eight underlying aspects of pharmacy services that influence client satisfaction. A significant gap was recorded with premises and supply chain-related components. These dimensions' contributions to total satisfaction were substantial in terms of practical relevance. As a result, improving the availability of pharmaceuticals and the infrastructure surrounding pharmacy services may enhance consumer satisfaction considerably. Stakeholders must work on addressing supply related and premises difficulties to increase client satisfaction.

Health commodity management information system (Dagu-2 Software) implementation status in public health facilities of South-western Oromia, Ethiopia: a mixed method study

BACKGROUND

To ensure the complete traceability of healthcare commodities, robust end-to-end data management protocols are needed for the supply chain. In Ethiopia, digital tools like Dagu-2 are used in the lower levels of the healthcare supply chain. However, there is a lack of information regarding the implementation status, factors, and challenges of Dagu-2, as it is a recent upgrade from the offline Dagu-1 application. Thus, this study aimed to assess the implementation status of Dagu-2 in public health facilities in Southwestern Oromia, Ethiopia.

METHODS

The study employed a sequential explanatory mixed method design to investigate the implementation status of the Dagu2 program in 33 public health facilities in the Southwestern Oromia region of Ethiopia. Study participants were selected using a two-step approach. Firstly, public hospitals and health centers that had implemented Dagu-2 were identified. Secondly, 65 logistic practitioners, including store managers and pharmacy heads, who met the eligibility criteria were selected for the quantitative study. Quantitative data were collected using validated and reliable self-administered questionnaires and analysed using SPSS version 23. We run both descriptive and inferential statistical analyses. Fisher's exact test was used to discern the relationship between dependent and independent variables at p < 0.05. The qualitative data were gathered through in-depth interviews and underwent manual thematic analysis.

RESULTS

Out of 65 questionnaires, 61 were completed (93.8% response rate). About 77.0% reported using Dagu-2 for operational and strategic decisions, and 80.3% used it for logistics performance monitoring. Roughly 78.7% of the participants indicated a positive implementation status for Dagu-2. Antivirus usage (p = 0.018) and administrative support (p = 0.002) significantly associated with the implementation. External support and user-friendliness facilitated the implementation, while infrastructure constraints, connectivity absence, weak management support, and project handover gaps were major obstacles.

CONCLUSION

Overall, the study revealed a promising implementation process and service quality improvements. However, challenges such as lack of management support, limited ICT infrastructure, absence of connectivity, weak management support, and project handover gaps became obstacles for successful implementation. To ensure an effective healthcare system, leveraging technology tools and securing stakeholder support through training are essential.

Assessment of COVID-19 prevention practice and associated factors in Jimma town, Ethiopia: A mixed study

Background

COVID-19 has affected the mental and physical wellbeing, social structure, countries' economy as well as individuals and community resilience, trust, and inequalities among societies. However, now almost all of the activities have been returned to the pre-corona era, despite the emergence of new strains and the spread of the disease. Hence, this study was conducted to assess COVID-19 prevention practice and the associated factors.

Materials and methods

A community-based cross-sectional study triangulated with the qualitative findings was conducted in Jimma town, Oromia, Ethiopia. A total of 422 sample households were involved in the quantitative study. The quantitative data were collected using a structured questionnaire and 12 key informants were also interviewed for the qualitative part. The quantitative data were processed and entered into the Epi Data version 4.6 (software) and analyzed using SPSS 26.0. Similarly, the qualitative data were analyzed using ATLASti.7.1.04 software package. Descriptive statistics and binary logistics regression (p < 0.25) were conducted to identify the candidate variable for multivariable logistics regression analysis (p < 0.05) and a 95% confidence interval was used to establish the level of significance of the variables with the practice.

Results

Interviews were conducted with a total of 422 participants, yielding a response rate of 100%. Good preventive practices were found to be adopted by 13.3% of the respondents. People aged ≥ 50 years, [AOR = 2.85, 95%, CI = 1.246-0.53] who recovered from COVID-19, [AOR = 2.41, 95%, CI = 1.184-0.92], had chronic diseases [AOR = 3.70, 95%, CI = 1.887-0.25], and living with COVID-19 high risk [AOR = 2.96, 95%, CI = 1.475-0.991 were independently associated with good preventive practices.

Conclusion

In this study, it was understood that there were poor COVID-19 preventive practices among the study participants. There was a disparity in adherence to the preventive practices in relation to (i.e., 50 and above years) the experience of contracting COVID-19 and people aged above 65 years old living with the high-risk group. In addition, the community had different misconceptions or risk perceptions related to COVID-19 infection and preventive practices. This highlights the need to design health education programs and implement risk and/or social and behavior change communication interventions to change perceptions or misconceptions of people or community members to bring about the desired behavioral change and prevent the spread of COVID-19.

Effectiveness of Integrated Social and Behavior Change Communication Interventions in Mass Drug Administration Campaigns in Enhancing Knowledge, Perceptions, and Preventive Practices for Neglected Tropical Diseases in Jimma

Background

Despite control efforts, including mass drug administration (MDA), neglected tropical diseases (NTDs) continue to pose a significant public health threat, particularly in rural Ethiopia. Integrating social and behavior change communication (SBCC) into MDA is essential for success. This study aimed to evaluate the effectiveness of tailored SBCC integrated into MDA campaigns to enhance community knowledge, perception, and preventive behaviors regarding targeted NTDs in the Jimma, Ethiopia.

Methods

A community-based study was conducted using a pre-test post-test design. A multistage sampling technique was employed for surveys, while for qualitative insights, purposive sampling was employed. SBCC interventions tailored to local needs were implemented. Changes in knowledge, perception, and practices were evaluated using Cohen's d. Additionally, a score for key outcome variables comparisons were made to examine variations based on socio-demographic factors, employing suitable statistical tests. Qualitative data were analyzed thematically using Atlas.ti 7.1.5.

Results

The prevalence of SBCC exposure was 88.8%. The intervention had a more significant impact on improving knowledge and preventive practices related to Onchocerciasis (OC) compared to Soil-transmitted helminthes (STH). Specifically, most OC outcomes showed moderate to large effect sizes. In contrast, the effect on STH was more limited, with only knowledge of consequences improving moderately and preventive practices showing a small effect size. The mean score for OC preventive practices varied by educational level and sex, while the median score for STH perception varied among educational level and marital status. Additionally, score variation was observed across districts for all key outcome variables.

Conclusion

The majority of the population was exposed to SBCC resulting in improvements in knowledge, perception, and preventive behaviors regarding OC and knowledge of consequences of STH and its prevention behavior. This highlights the importance of incorporating well-designed SBCC activities in to MDA campaigns to optimize the control and eventual elimination of targeted NTDs.

Communities' knowledge, perceptions and preventive practices on soil-transmitted helminthes in Jimma, Oromia, Ethiopia: Formative mixed study

BACKGROUND

Soil-transmitted helminthes (STH) infections are one of the most common neglected tropical diseases. It has become one of a significant public health problem programmatically aimed for prevention and control in Ethiopia. Limited evidence is available on communities' knowledge, perceptions, and practices regarding STH particularly in rural settings of Jimma, Ethiopia.

METHODS

A community-based cross-sectional study triangulated with the qualitative method was conducted. The survey included 732 sampled rural households. Linear regression was used to assess association between predictors of knowledge and preventive practices of STH; likewise logistic regression was used to identify the predictors of hand washing practice at critical times. Kruskal-Wallis and Mann-Whitney tests were done to test differences in median risk perception score by socio-demographic factors. Qualitative data were collected through 7 key informant interviews, 6 focus group discussions and 7 expert group discussions then transcribed verbatim. Then, the data were coded, categorized and thematized using the Atlas ti.7.1.4 software package.

RESULTS

Almost all of the respondents (99.6%) had heard of STH. The prevalence of comprehensive knowledge, risk perception and preventive practices towards STH were 46.7%:(95%CI:43.2, 50.4), 55.2%: (95%CI:51.2,59) and 44.4%:(95%CI:40.8, 48.2) respectively. Likewise, the magnitude of knowledge and practice of hand washing at critical times were 42.5%: (95%CI: 38.7,45.9) and 43.9%: (95%CI: 40, 47.5) respectively. Risk perception and comprehensive knowledge towards STH varied significantly across districts and by respondents' educational status. Ownership of improved latrine was associated to comprehensive knowledge of STH. The STH preventive practice that varied across districts was predicted by the overall and knowledge specific to washing hands at critical times. The practice of washing hands at critical times was significantly associated to knowledge of hand washing, owning improved latrine, and age from 15 to 34 year compared to >45 year. Moreover, qualitative findings were supportive of the findings.

CONCLUSION

Despite reported exposures to STH communication opportunities, the study found modest levels of knowledge, perceptions, and preventive practices related to STH among rural communities where the burden of STH was the programmatic concern. These levels of knowledge, perceptions, and practices varied across the districts. Educational and latrine status predicted overall knowledge, whereas knowledge specific to hand washing and overall knowledge were predictors of STH preventive practice. Furthermore, washing hands during critical times was moderately improved among the young-aged, ownership of improved latrine and knowledgeable on hand washing. This study underscores the need for locally tailored and contextualized community behavioral change interventions needs to be strengthened toward improved STH preventive practices.

Households willingness to join and pay for community-based health insurance: implications for designing community-based health insurance based on economic Status in Ethiopia

BACKGROUND

Despite the encouraging results achieved by community-based health insurance in Ethiopia, the program faces significant challenges. Among these challenges is the current practice where premium contributions to Community Based Health Insurance are either a flat rate or based solely on family size, rather than considering households' socio-economic status The overall aim of this study was to assess households' willingness to join and pay for Community Based Health Insurance in reference to socio-economic status to design sliding scale-based Community Based Health Insurance contributions in Ethiopia.

METHODS

A community based cross-sectional study was conducted in districts from two different contexts: urban areas and agrarian areas in two major regions in Ethiopia, namely Oromia, and Amhara. A double-bounded dichotomous contingent valuation method was used to determine households' willingness to pay. Descriptive statistics were used to summarize the data. A chi-square test was used to assess background factors associated with willingness to join and pay for Community Based Health Insurance, and tobit regression analyses were conducted to identify factors that determine the amount of willingness to pay for Community Based Health Insurance. The statistical significance of all results was interpreted using an adjusted two-sided Type I error rate of 0.05.

RESULT

A total of 786 households participated in this study. Overall, 532 (67.7%) study households have ever participated in the Community Based Health Insurance scheme. The reason for never participating was unaffordability of payment (30.3%), and they stated that the service was unsatisfactory (21.7%). Generally, 647 (82.3%) of the households were willing to join Community Based Health Insurance or renew their scheme membership in the future, with higher willingness among rural and urban residents and households with food insecurity (p < 0.05. The average amount households were willing to pay was 538.2 Ethiopian Birr with mode (570.0 Ethiopian Birr). In contrast with the existing premium contribution policy, the vast majority of households preferred premium contributions that considered households' economic status (81.2%). Increased household size, better household food security, and being rural residents, increased satisfaction with the scheme; and rural households' economic status significantly predicted the value of money households are willing to contribute to Community Based Health Insurance (p < 0.05).

CONCLUSION

This study revealed a strong willingness among community members to participate in or renew their membership in the Community Based Health Insurance scheme, with a clear preference for a socio-economic-based sliding scale approach over current flat rate or family size-dependent premium systems. This preference highlights the potential for transforming towards more equitable citizen contributions. Policymakers should therefore consider household economic status, alongside factors like household food security and family size, in determining Community Based Health Insurance membership fees. Furthermore, enhancing the quality of healthcare services is essential to boosting Community Based Health Insurance member satisfaction and ensuring the program's long-term sustainability. This comprehensive approach not only improves health outcomes but also strengthens community trust and support for the Community Based Health Insurance initiative.

An analysis of COVID-19 information sources

Background

The COVID-19 pandemic has brought new situations that require the effective delivery of health information across the world and it’s important to offer clear, consistent, and credible information on the pandemic to mitigate and control the outbreak.

Aim

To assess COVID-19 information source, need and trust among the rural community of southwest Ethiopia.

Methods

A community-based cross-sectional study design was conducted among 634 rural communities of southwest Ethiopia. The data were collected by interviewing individuals from selected households and analyzed by SPSS version 26. A multivariable logistic regression model was used to assess factors affecting information needs.

Results

Radio 484 (76.3%) was mostly used as a source of information for COVID-19, and government 404 (63.7%) and health professionals 345 (57.7%) were trusted. However, only 10 (1.6%) of the participants acquired information from health professionals. Around 395 (62.3%) of the participants needed additional information on COVID-19. Around 230 (58.2%) and 186 (47.1%) of the participants required additional information on cause and sign and symptoms, respectively. Age of < 45 years old (AOR: 2.11, 95% CI: 1.43, 3.12, P < 0.001), and absence of formal education (AOR: 2.00, 95% CI: 1.35, 2.95, P: 0.001) were factors positively affecting the information needs of the participants on COVID-19. Church goers (AOR: 3.24; 95% CI: 2.03, 5.19; P < 0.001), television (AOR: 2.39; 95% CI: 1.63, 3.49; P < 0.001) and social media users (AOR: 4.52; 95% CI: 2.26, 9.04; P < 0.001) as source of information required additional information on COVID-19, and the participants that trusted social media (AOR: 2.52; 95% CI: 1.64, 3.87; P < 0.001) and friends/relatives (AOR: 2.95: 95% CI: 1.51, 5.76; P < 0.001) were also required additional information on COVID-19.

Conclusions

The popular sources of COVID-19-related information were radio and television. The participants trusted the government and health professionals on COVID-19. However, less than 2% of the participants had information from health professionals. The majority of the participants wanted to learn more about COVID-19. The areas the participants required additional information include cause and signs and symptoms. Age, educational status, trust in social media, trust in friends, using the church, television and social media as a source were factors associated with information needs.

Exploring the role of ICT in pharmaceutical supply chain practices and operational performance in Ethiopia: a structural equation modeling approach

BACKGROUND

A well-coordinated supply chain ensures the sustainable availability of life-saving medicines that improve public health outcomes. Information Communication Technology (ICT) is one of the strategies for optimizing supply chain coordination. However, there is a paucity of data on how it affects supply chain practice and performance at the Ethiopian Pharmaceutical Supply Agency (EPSA).

OBJECTIVE

This study aimed to explore the relationships between information and communication technology, supply chain practice, and pharmaceutical supply chain operational performance using a structural equation modeling approach.

METHODS

We conducted an analytical cross-sectional study between April and June 2021. Three hundred twenty EPSA employees participated in the survey. We used a pretested, self-administered five-point Likert scale questionnaire to collect the intended data. A structural equation modeling confirmed the relationship between the constructs (information communication technology, supply chain practices, and performance). Thus, the measurement models were first validated using exploratory and confirmatory factor analysis in SPSS/AMOS software. A p-value of less than 5% indicated statistical significance.

RESULTS

Of the 320 questionnaires distributed, 300 participants (202 males and 98 females) duly responded. In this survey, supply chain practices (mainly customer relationship management and information sharing) and ICT had significant positive direct effects on operational performance with standardized regression weights (β) of 0.65 (p < .001) and 0.29 (p < .001), respectively. On the other hand, 73% of the variations in operational performance were explained by ICT and supply chain practices, wherein ICT played moderate mediation effects between supply chain practice and performance (VAF = 0.24, p < .001). Despite the significant positive influence of ICT, the agency still faced data visibility problems with customers and other supply chain partners.

CONCLUSION

The findings revealed that supply chain practices and ICT implementation impacted the agency's supply chain performance positively and significantly. The ICT implementation practice in the agency posited a significant positive partial mediating role between supply chain practice and operational performance. Thus, if the agency focuses on the automation and integration of customer relationship management and the practice of information exchange, the essential supply chain practices, it can further improve operational performance.

Community's knowledge, perceptions and preventive practices on Onchocerciasis in Jimma zone, Ethiopia, formative mixed study

BACKGROUND

In Ethiopia, Onchocerciasis is a prevalent neglected tropical disease, currently targeted for elimination with mass drug administration and community behavioral changes towards sustained control and eventual elimination. This study aimed to elucidate the awareness, perceptions and practices of endemic communities in Jimma Zone, Ethiopia.

METHODS AND MATERIALS

Community-based cross-sectional study triangulated with qualitative method was conducted from October-November, 2021. A multistage sampling was employed and data were collected using a pre-tested interviewer-administered structured questionnaire. Logistic regression was used to identify the predictors of comprehensive knowledge and preventive practice. Adjusted odds ratios were calculated at 95% confidence interval (CI) and considered significant with a p-value of <0.05. Kruskal-Whallis and Mann-whitney tests were used to compare median risk perception score by socio-demographic factors. Qualitative data were collected through focus group discussions and key informant interviews and transcribed verbatim. Then the data were coded, categorized, and themes were developed.

RESULT

The overall prevalence of adequate comprehensive knowledge was 48.8% (95% CI: 44.9, 52.3), high risk perception was 18.7% (95%CI15.9, 21.4) and preventive practice was 46.9%(95%CI:(43.3,50.4). High risk perception[AOR = 1.95 95%CI: (1.32, 2.89] was statistically significant with comprehensive knowledge, likewise knowledge of mode of transmission [AOR = 2.64 95% CI: (1.44, 4.85)], knowledge of consequences [AOR = 2.12 95%CI: (1.21, 3.72)] and knowledge of preventive measures [AOR = 15.65,95%CI:(10.1, 24.2)] were statistically significant with preventive practice. The median risk perception was varied significantly between the groups by educational status, study district and age category. Qualitative evidence showed that there were great community knowledge gap about the disease.

CONCLUSION

Community knowledge, perceptions, and practices are unacceptably low. Risk perception was significantly associated with comprehensive knowledge, likewise knowledge of mode of transmission, consequences and preventive measures were significantly associated with preventive practice. This implies knowledge is a key component of effective prevention strategies as it is a necessary condition for the behavior change.