Bereket Yakob

High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia

The impact of public health interventions for tropical diseases is limited by lack of understanding of the sociocultural context into which these interventions are delivered. Podoconiosis (endemic non-filarial elephantiasis) is a considerable public health problem in Ethiopia, yet little is known about community understanding of it. This study aimed to assess the knowledge, attitudes and practices of community members towards podoconiosis in a highly endemic area in southern Ethiopia. A cross-sectional study was conducted in January 2007 among 438 study participants selected by multistage probability sampling. Most respondents (93.5%) had seen a patient with podoconiosis and 91.6% had heard of the local terms for podoconiosis. The proportion of respondents holding at least one misconception about causation was 93.4% (95% CI 91.1-95.7%). More than one-half (55.8%) showed stigmatising attitudes towards social interactions with podoconiosis patients and 63.8% had unfavourable attitudes towards the condition. Just over one-half (55.2%) of respondents were wearing shoes during the interview, but shoe wearing was inconsistent and inadequate to prevent podoconiosis. In this highly endemic area, the community held significant misconceptions about causation, care, treatment and prevention of podoconiosis. Community interventions for podoconiosis must include education components aimed at dispelling misconceptions and stigma.

Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users

There are inconsistent findings about the relation between gender and HIV status disclosure. We conducted a facility-based cross-sectional study, using qualitative and quantitative data collection methods, to explore gender differences in HIV-positive status disclosure among service users in south-west Ethiopia. Among 705 participants, an equal number of men and women (94.6% men v. 94.3%, women) indicated that they had disclosed their result to someone, and the majority (90.9% men v. 90.7% women) to their current main partner. ‘It is customary to tell my partner everything’ was the most frequently cited reason for disclosing (62.5% men v. 68.5% women). Reasons for non-disclosure varied by gender: men were concerned about their partners worry and exposure of their own unfaithfulness. Women feared physical violence, and social and economic pressure in raising their children. Factors that influenced disclosure also indicated gender variation. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partners HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partners HIV status, advanced disease stage, having no more than primary education, being married, and perceiving the current relationship as long-lasting. There was no significant difference in the proportion of HIV status disclosure among men and women. However, the contextual barriers and motivators of disclosure varied by gender. Therefore it is important that clinicians, counsellors, and health educators underscore the importance of gender-specific interventions in efforts to dispel barriers to HIV status disclosure.

Health professionals' attitudes and misconceptions regarding podoconiosis: potential impact on integration of care in southern Ethiopia.

Offering long-term community care for patients with podoconiosis (endemic non-filarial elephantiasis) is challenging, and requires co-operation between patients and their families, the community and health care professionals. Health professionals who harbour misconceptions about podoconiosis or stigmatize patients are likely to deliver substandard services and propagate such attitudes within the community. In January 2007, we used a structured self-administered questionnaire to assess knowledge of and attitudes towards podoconiosis among 275 health professionals in public and private health institutions in southern Ethiopia. Nearly all (97.8%) health professionals held at least one significant misconception about the cause of podoconiosis, and 97.1% responded incorrectly to one or more questions about signs and symptoms of podoconiosis. Around half (53.9%) incorrectly considered podoconiosis to be an infectious disease and were afraid of acquiring podoconiosis while providing care. All (100%) held one or more stigmatizing attitudes towards people with podoconiosis. These high levels of misconceptions and stigmatizing attitudes suggest negative effects of health professionals, seriously undermining integration between themselves, patients and community partners. We recommend pre- and in-service training of health professionals to overcome these misconceptions, to diminish stigma and to improve integration among those offering community care of patients with podoconiosis.

Risky sexual behaviors among female youth in Tiss Abay, a semi-urban area of the Amhara Region, Ethiopia.

Background Little is known about sexual risks and associated factors about female youths in semi-urban areas of Ethiopia. This study aimed to describe the nature and magnitude of risky sexual behaviors, and the socio-demographic and behavioral determinants among female youths in Tiss Abay, a semi-urban area on the outskirts of Bahir Dar City of the Amhara Region in northern Ethiopia. Methods A cross-sectional census type study was conducted among female youths who were unmarried and aged 15–29 years in September 2011. Results 711 female youths participated in the study, with the mean age of initiation of sex of 78.6% being16.73±2.53 years. Only 52(9.3%) used condom during the first sex. Within the last 12 months, 509(71.6%) had sexual intercourse and 278(54.6%) had two or more sex partners, and 316(62.1%) did not use condom during their last sex. Sex under the influence of substances was reported by 350(68.8%), and a third of the recent sexes were against the will of participants. One or more risky sexual practices were reported by 503(70.3%) participants, including: multiple sexual partnerships, inconsistently using or not using condoms, sex under the influence of alcohol and/or sex immediately after watching pornography. Age group, current marital status, drinking homemade alcohol, chewing ‘khat’, watching pornography and using any form of stimulant substances were the predictors of risky sexual behavior. Watching pornography before sex and sex for transaction were the predicators of not using condom during most recent sex. Conclusions Risky sexual behaviors were very common among the female youths in Tiss Abay. Initiation of context-based interventions, such as raising awareness about the risks, safer sex practices, condom promotion and integration of gender issues in the programs are recommended.

Perceived quality of HIV treatment and care services in Wolaita Zone of southern Ethiopia: a cross-sectional study.

Objective To investigate the levels and factors affecting the perceived quality of HIV/AIDS treatment and care services. Design A cross-sectional study. Setting The study was conducted in Wolaita Zone of southern Ethiopia in one hospital and five health centres providing antiretroviral therapy (ART) and pre-ART. Participants 481 persons infected with HIV on outpatient care, 408 (83.8%) on ART and 73 (16.2%) on pre-ART care. Results 324 (71.4%) of the participants perceived the quality of HIV care as ‘good’, while 130 (28.6%) stated that it was ‘not good’; 219 (46.2%) and 255 (53.8%) were satisfied and not satisfied with the services, respectively. In the multivariate analysis, a unit increase in the doctors subscale of multidimensional health locus of control-form c score resulted in a 1.27 (1.04 to 1.55) increase in the odds of perceived good quality of care (p<0.05). Similarly, a unit increase in the responsiveness, perceived financial fairness, and perceived transportation convenience scores was associated with a 1.03 (1.01 to 1.05) (p<0.05), 1.08 (1.05 to 1.15) (p<0.01), and 1.07 (1.05 to 1.18) (p<0.05) increase in the odds of perceived good quality of HIV care, respectively. In terms of client satisfaction with services, a 1 km increase in the distance from health facilities, and unemployment were associated with a 4.64 (2.61 to 8.25) (p<0.001), 1.02 (1.01 to 1.04) (p<0.05) and 2.23 (1.30 to 4.54) (p<0.01) times, respectively, increase in the perceived quality of HIV treatment and care services. Conclusions The majority of the participants reported perceptions of good quality HIV care and satisfaction with the services. Satisfaction with services; responsiveness; health locus of control; perceived financial fairness; perceived transportation convenience; employment status; and distance from the health facility were predictors of the perceived quality of HIV care. Thus, improving quality of HIV treatment services may require addressing the above factors.

Client satisfaction: correlates and implications for improving HIV/AIDS treatment and care services in southern Ethiopia

INTRODUCTION Satisfaction with services is a qualitative but important measure of the fit between clients and care providers and is also a measure of the outcome of treatment. This study investigated the level and correlates of client satisfaction with HIV care. METHODS A cross-sectional questionnaire-based study was conducted on 485 people using HIV/AIDS treatment and care services in six health facilities in Wolaita Zone of Ethiopia from November 2014 to March 2015. RESULTS A total of 222 (45.8%) and 263 (54.2%) of the participants attended care at the health centers and hospital, respectively; 192 (39.6%) visited traditional medical practitioners. Seventy-five (15.5%) of the participants suffered probable mild to major mental depression. In total, 342 (70.7%) said that the quality of care was good and 224 (46.4%) were satisfied with the services. In multivariate analysis, probable mental depression, health system responsiveness, perceived quality of care and type of health facility were independently associated with satisfaction with HIV care (p<0.05). CONCLUSIONS Healthcare systems need to improve the responsiveness and quality of HIV care, and integrate a mental health care component to achieve higher client satisfaction. Further studies on the types of health facilities (between health centers and hospitals) in relation to satisfaction with services are recommended.

Measuring health system responsiveness at facility level in Ethiopia: performance, correlates and implications

BackgroundHealth system responsiveness measures (HSR) the non-health aspect of care relating to the environment and the way healthcare is provided to clients. The study measured the HSR performance and correlates of HIV/AIDS treatment and care services in the Wolaita Zone of Ethiopia.MethodsA cross-sectional survey across seven responsiveness domains (attention, autonomy, amenities of care, choice, communication, confidentiality and respect) was conducted on 492 people using pre-ART and ART care. The Likert scale categories were allocated percentages for analysis, being classified as unacceptable (Fail) and acceptable (Good and Very Good) performance.ResultsOf the 452 (91.9%) participants, 205 (45.4%) and 247 (54.6%) were from health centers and a hospital respectively. 375 (83.0%) and 77 (17.0%) were on ART and pre-ART care respectively. A range of response classifications was reported for each domain, with Fail performance being higher for choice (48.4%), attention (45.5%) and autonomy (22.7%) domains. Communication (64.2%), amenities (61.4%), attention (51.4%) and confidentiality (50.1%) domains had higher scores in the ‘Good’ performance category. On the other hand, ‘only respect (54.0%) domain had higher score in the ‘Very Good’ performance category while attention (3.1%), amenities (4.7%) and choice (12.4%) domains had very low scores. Respect (5.1%), confidentiality (7.6%) and communication (14.7%) showed low proportion in the Fail performance. 10.4 and 6.9% of the responsiveness percent score (RPS) were in ‘Fail’ and Very Good categories respectively while the rest (82.7%) were in Good performance category. In the multivariate analysis, a unit increase in the perceived quality of care, satisfaction with the services and financial fairness scores respectively resulted in 0.27% (p < 0.001), 0.48% (p < 0.001) and 0.48% (p < 0.001) increase in the RPS. On the contrary, visiting traditional medicine practitioner before formal HIV care was associated with 2.1% decrease in the RPS.ConclusionThe health facilities performed low on the autonomy, choice, attention and amenities domains while the overall RPS masked the weaknesses and strengths and showed an overall good performance. The domain specific responsiveness scores are better ways of measuring responsiveness. Improving quality of care, client satisfaction and financial fairness will be important interventions to improve responsiveness performance.

Correlates of Strengthening Lessons from HIV/AIDS Treatment and Care Services in Ethiopia Perceived Access and Implications for Health System.

Background Access to healthcare is an important public health concept and has been traditionally measured by using population level parameters, such as availability, distribution and proximity of the health facilities in relation to the population. However, client based factors such as their expectations, experiences and perceptions which impact their evaluations of health care access were not well studied and integrated into health policy frameworks and implementation programs. Objective This study aimed to investigate factors associated with perceived access to HIV/AIDS Treatment and care services in Wolaita Zone, Ethiopia. Methods A cross-sectional survey was conducted on 492 people living with HIV, with 411 using ART and 81 using pre-ART services accessed at six public sector health facilities from November 2014 to March 2015. Data were analyzed using the ologit function of STATA. The variables explored consisted of socio-demographic and health characteristics, type of health facility, type of care, distance, waiting time, healthcare responsiveness, transportation convenience, satisfaction with service, quality of care, financial fairness, out of pocket expenses and HIV disclosure. Results Of the 492 participants, 294 (59.8%) were females and 198 (40.2%) were males, with a mean age of 38.8 years. 23.0% and 12.2% believed they had ‘good’ or ‘very good’ access respectively, and 64.8% indicated lower ratings. In the multivariate analysis, distance from the health facility, type of care, HIV clinical stage, out of pocket expenses, employment status, type of care, HIV disclosure and perceived transportation score were not associated with the perceived access (PA). With a unit increment in satisfaction, perceived quality of care, health system responsiveness, transportation convenience and perceived financial fairness scores, the odds of providing higher rating of PA increased by 29.0% (p<0.001), 6.0%(p<0.01), 100.0% (p<0.001), 9.0% (p<0.05) and 6.0% (p<0.05) respectively. Conclusion Perceived quality of care, health system responsiveness, perceived financial fairness, transportation convenience and satisfaction with services were correlates of perceived access and affected healthcare performance. Interventions targeted at improving access to HIV/AIDS treatment and care services should address these factors. Further studies may be needed to confirm the findings.