Abebaw Gebeyehu

Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study.

BackgroundReducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors.MethodsA community-based cross-sectional survey was conducted from April 1–20, 2011, among mothers who gave birth 12 months before the study began in Munesa Woreda, Arsi Zone, Oromia Region, Southeast Ethiopia. A stratified cluster sampling was used to select a sample of 855 participants.ResultsOut of all deliveries, only 12.3% took place at health facilities. Women who were urban residents (AOR = 2.27, 95%CI: 1.17, 4.40), women of age at interview less than 20 years (AOR = 6.06, 95%CI: 1.54, 23.78), women with first pregnancy (AOR = 2.41, 95%CI: 1.17, 4.97) and, women who had ANC visit during the last pregnancy (AOR = 4.18, 95%CI: 2.54, 6.89) were more likely to deliver at health institutions. Secondary and above level of mother`s and husband`s education had also a significant effect on health institution delivery with AOR = 4.31 (95%CI: 1.62, 11.46) and AOR = 2.77 (95%CI: 1.07, 7.19) respectively.ConclusionInstitutional delivery service utilization was found to be low in the study area. Secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery. Increasing the awareness of mothers and their partners about the benefits of institutional delivery services are recommended.

Prevalence and Factors Associated with Anxiety among Patients withHypertension on Follow Up at Menelik-II Referral Hospital, Addis AbabaEthiopia

Background: Anxiety disorders are common among people living hypertension. The co-existence of these disorders are associated with barriers to treatment and worsening medical outcomes, including treatment resistance, increased risk for suicide, greater chance for recurrence and utilization of medical resources and/or increase morbidity and mortality. Therefore, assessing depression and anxiety among hypertensive patients has a pivotal role for further interventions. Methods: Institution based cross sectional study was used by face to face interview using standardized questioner, Amharic Version of Hospital Anxiety & Depression Scale (HADS), which has scores for classifying the participants having anxiety symptoms, was applied in systematic random sampling of 417 adult participants. Data entry was performed by using EPI info 3.5.3 and SPPSS version 20. Binary logistic regression analysis (multivariate analysis) was used to identify associated factors. Result: The study revealed that the prevalence of anxiety was 28.5%. Stressful life events (AOR 1.69, 95%CI (1.03, 2.79), being female (AOR 2.57, 95% CI (1.42, 4.56), co-morbid diabetes illness (AOR 2.98, 95%CI (1.61, 5.53), unable to read and write (AOR 2.72, 95% CI (1.33, 5.58) and poor social support (AOR 6.98, 95% CI (3.48, 13.96) had statistically significant association with anxiety with p-value <0.05. Conclusion and Recommendation: Prevalence of anxiety was high. Co-morbid diabetes mellitus, low social support, being female sex, having stressful life events and unable to read and write educational status were associated with anxiety. Clinicians who provide service for patients with hypertension should focus on patients who have co-morbid of other illness such as, diabetes mellitus, and who have stressful life events in the last six months to assess the presence of anxiety. In additions ministry of health should give training on how to screen anxiety hypertensive patients and should develop guidelines to screen and treat among hypertensive patients.

Use of previous maternal health services has a limited role in reattendance for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia

Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review.

Implications of baseline study findings from rural and deep rural clinics in Ethiopia, Kenya, Malawi and South Africa for the co-design of mHealth4Afrika

mHealth4Afrika is a collaborative research and innovation project, co-funded under Horizon 2020, that is evaluating the potential impact of co-designing an open source, multilingual mHealth platform on the quality of maternal and newborn healthcare delivery in rural and deep rural clinics. This paper presents results from a comprehensive baseline study carried out with 40 informants from the leadership of 19 healthcare clinics in Northern Ethiopia, Western Kenya, Southern Malawi and Eastern Cape, South Africa during November — December 2015, using focus groups and semi-structured interviews. These findings identified human resource capacity, environmental, practical and technical challenges, and equipment and infrastructure deficits. Training requirements of healthcare workers were also identified. Constraints identified include the need for: intuitive, easy-to-use user interfaces to reduce the need for extensive training; use of flexible data protocols to facilitate cost effective bandwidth and effective data exchange; cost effective; low power consumption technologies to reduce cost of replication and scaling; solar charging units to increase availability; support for sensors and telemedicine due to a deficit of healthcare professionals in rural and deep rural clinics; and the need for easy configuration and adaptation to facilitate wider adoption. This insight will be used to inform co-design of the mHealth4Afrika platform during 2016–2018, based on user-centered design principles, leveraging current state-of-the-art in terms of electronic patient record systems and medical sensors. It will also inform the minimum ICT infrastructure required in each clinic. The expected outcome is a multi-region proof of concept that can make a significant contribution in accelerating exploitation of mHealth across Africa.

The prevalence of non-communicable diseases in northwest Ethiopia: survey of Dabat Health and Demographic Surveillance System

Objective The main objective of this study was to investigate the magnitude and associated factors of non-communicable chronic diseases (NCDs) at the Dabat Health and Demographic Surveillance System (DHDSS) site in the northwestern part of Ethiopia. Design A population-based cross-sectional study was conducted from October to December 2014. Setting HDSS site, Ethiopia. Participants A total population of 67 397 living in 16 053 households was included in the study. Measures Structured interviewer-administered questionnaire was used to collect data. Self-reported morbidity was used to ascertain NCD. A binary logistic regression model was employed to identify the determinants of NCDs. Result One thousand one hundred sixty (1.7%) (95% CI 1.62 to 1.82) participants were found with at least one type of NCD. Heart disease and hypertension which accounted for 404 (32.2%) and 401 (31.9%), of the burden, respectively, were the most commonly reported NCDs, followed by 347 (27.7%) asthma, 62 (4.9%) diabetes mellitus and 40 (3.2%) cancer cases. Advanced age (≥65 year) (adjusted OR (AOR)=19.6; 95% CI 5.83 65.70), urban residence (AOR=2.20; 95% CI 1.83 to 2.65), household food insecurity (AOR=1.71; 95% CI 1.37 to 2.12) and high income (AOR=1.28; 95% CI 1.02 to 1.59) were significantly associated with the reported history of NCDs, whereas low (AOR=0.36; 95% CI 0.31 to 0.42) and moderate (AOR=0.33; 95% CI 0.22 to 0.48) alcohol consumption, farming occupation (AOR=0.72; 95% CI 0.57 to 0.91), and work-related physical activities (AOR=0.66; 95% CI 0.50 to 0.88) were inversely associated with NCDs. Conclusion There is a high burden of NCDs at the Dabat HDSS site. Promotion of regular physical exercise and reducing alcohol consumption are essential to mitigate the burden of NCDs. In addition, preventive interventions of NCDs should be strengthened among urban dwellers, older age people and people of higher economic status.

Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007–2013

BackgroundReliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.MethodsCauses of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose.ResultsCommunicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death.ConclusionTuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.BACKGROUND Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. METHODS Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. RESULTS Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. CONCLUSION Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.