Zewdie Birhanu

Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia.

Background The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia. Methods This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden). Results Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)]. Conclusion In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study.

BackgroundIn primary health care, provider-patient interaction is fundamental platform and critically affects service delivery. Nevertheless, it is often ignored in medical research and practice and it is infrequently subjected to scientific inquiry, particularly in Ethiopia. This study aimed to assess patient satisfaction with health care provider interactions and its influencing factors among out-patients at health centers in West Shoa, Central Ethiopia.MethodsA cross sectional facility based study was conducted on 768 out-patients of six health centers in West Shoa Zone, Central Ethiopia. The total sample size was allocated to each of the six health centers based on patient flow during the ten days prior to the start of data collection. Pre-tested instruments were used for data collection and the data were analyzed using SPSS version 16.0 statistical software. Factor score was computed for the items identified to represent the satisfaction scale by varimax rotation method. Using this regression factor score, multivariate linear regression analysis was performed and the effect of independent variables on the regression factor score was quantified.ResultsSeventy three percent of the respondents perceived that providers empathy was good and 35% complained that providers were not technically competent enough. In addition, 82% of the respondents rated non-verbal communication by the providers to be good, very good or excellent on a five-point ordinal scale. Regardless of the process, only 34.1% of the patients implied that the consultations made a difference in understanding their illness and coping with it. Generally speaking, 62.6% of the patients reported that they have been satisfied with their visit. Perceived empathy, perceived technical competency, non-verbal communication, patient enablement, being told the name of once illness, type and frequency of visit, knowing the providers and educational status were main independent predictors of patient satisfaction in this study. Furthermore, very good empathy (Beta = -4.323), fair non-verbal communication (Beta = -0.188), fewer expectations met (Beta = -0.169) and disagreement to technical competency (Beta = -0.156) had greater negative influence on patient satisfaction. On the other hand, excellent non-verbal communication (Beta = 0.114) and being told the name of once illness (0.109) had pronounced positive influence on patient satisfaction.ConclusionThe present study showed that interpersonal processes including perceived empathy, perceived technical competency, non-verbal communication and patient enablement significantly influence patient satisfaction. Therefore, health care providers should work towards improving the communication skill of their professionals along with having technically competent workers which could possibly affect the perception of the patient about all of the variables identified as independent predictors of patient satisfaction in this study.

Health seeking behavior for cervical cancer in Ethiopia: a qualitative study.

BackgroundAlthough cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease.MethodsFocus group discussions were conducted with men, women, and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Data were captured using voice recorders, and field notes were transcribed verbatim from the local languages into English language. Key categories and thematic frameworks were identified using the health belief model as a framework, and presented in narratives using the respondents own words as an illustration.ResultsParticipants had very low awareness of cervical cancer. However, once the symptoms were explained, participants had a high perception of the severity of the disease. The etiology of cervical cancer was thought to be due to breaching social taboos or undertaking unacceptable behaviors. As a result, the perceived benefits of modern treatment were very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behavior and alternated between traditional remedies and modern treatment methods.ConclusionLack of awareness and health seeking behavior for cervical cancer was common due to misconceptions about the cause of the disease. Profound social consequences and exclusion were common. Access to services for diagnosis and treatment were poor for a variety of psycho-social, and health system reasons. Prior to the introduction or scale up of cervical cancer prevention programs, socio-cultural barriers and health service related factors that influence health seeking behavior must be addressed through appropriate community level behavior change communications.

The effect of household heads training on long- lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.MethodsThe study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.ResultsA total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.ConclusionHousehold level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.Trail registrationAustralian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).

Mothers’ experiences and satisfactions with health extension program in Jimma zone, Ethiopia: a cross sectional study

BackgroundAlthough mothers are the fundamental unit of interventions in Health Extension Program in Ethiopia, their experiences and satisfactions with the service remain unstudied. Therefore, this study was aimed to assess mothers’ experiences and satisfaction with health extension service.MethodsA community based cross sectional study was conducted in Jimma Zone, Oromiya, Ethiopia. Three hundred Seventy-nine mothers were participated in the study. The study was conducted in four randomly selected rural villages. Systematic sampling technique was used to identify respondents. As part of the data collection process, four focus group discussions were conducted with mothers. SPSS 17.0 and ATLASti.4.1. Softwares were used for data analysis.ResultsOne hundred Sixty nine (51.7%) of the respondents had an experience of interactions with health extension workers during one year prior to the survey, while 271 (71.5%) of them reported that they received visits from health extension workers during the same period. 298 (78.6%) of the respondents received information at least on one of the Health extension packages. In fact, they had better exposure to personal hygiene and environmental sanitation packages. Even though health extension program is being run by female workers alone, it was believed that the involvement of men is vital to the success of the program. Mothers thought that men are more courageous and professionally competent to deal with complex matters. They also tended to criticize health extension program for lacking curative services and health extension workers are less competent. The greater emphasis laid on outreach services was not supported. 286 (75.5%) of the respondents rated their relationship with health extension workers as positive. Similarly, higher satisfaction was reported though the program has problems. Age, perceived skill to diagnose community problems, perceived respect, involvement of husband and being recognized as a model family were significantly predicted satisfactions with health extension services.ConclusionsMost mothers had good relationship, were satisfied with and had positive attitude towards health extension program though the program was criticized for not including curative services and the less attention given to static services at health post. Stakeholders are required to reconsider these issues.

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.MethodsA cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.ResultsA total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.ConclusionTraining of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022

Self-care practice and glycaemic control amongst adults with diabetes at the Jimma University Specialized Hospital in south-west Ethiopia: A cross-sectional study

Abstract Background The main goal in diabetes care is to improve the patients quality of life, to maintain satisfactory metabolic control and to retain minimal complications caused by diabetes mellitus (DM). Thus, this study has assessed self-care practice and glycaemic control amongst adults with diabetes mellitus. Setting A facility-based study amongst the diabetic follow-up clinic at Jimma University Specialized Hospital in Ethiopia. Methods A cross-sectional study was conducted from 01 April to 30 April 30 2010. A total of 343 diabetic patients were selected using a systematic sampling method. The data were collected by structured questionnaires and a medical card review; anthropometric measurement was done by trained nurses. Results The study showed that 53% of the respondents had diabetes related knowledge. The study also found that 64% of the respondents were physically less active, and 17% of the respondents were walking on foot for less than 30 minutes per a day. Only 18.1% of the respondents were able to control their Fasting Blood Sugar (FBS) to level below 126 mg/dL. Conclusion The present study illustrates that the level of knowledge about diabetes and self-care practices amongst diabetic patients were meager. In addition, it showed that respondents’ level of physical activity, their educational status, and the dose of oral hypoglycaemic agents taken by the respondents significantly affected glycaemic control.

Predictors of perceived empathy among patients visiting primary health-care centers in central Ethiopia

BACKGROUND Empathy is crucial to the achievement of patient centeredness consultations. However, it has not been frequently studied particularly in resource-limited settings. OBJECTIVE To identify predictors of patient reports indicating greater empathy among providers during patient visit to primary health-care facilities. PARTICIPANTS A cross-sectional study was conducted to assess the level of satisfaction among 768 out-patients, who consecutively visited six health centers in central Ethiopia. Patients were recruited from health centers under study based on proportional to size allocation. Multiple linear regression was used to assess the relationship between empathy scores and other patient factors. RESULTS The mean perceived empathy score was 31.34 ± 8.37 (range of possible values: 10-50). Patient-related factors that were negatively associated with perceived empathy were Tigre and Guraghe ethnicity [β = -4.45; 95% confidence interval (CI) = -6.86 to -2.03], Wakefena religion (β = -2.09; 95% CI = -3.82 to -0.35), lack of privacy during consultation (β = -1.62; 95% CI = -2.57 to -0.68), involvement of family in consultation (β = -1.45; 95% CI = -2.17 to -0.12) and not revealing ones own private issues (β = -1.25; 95% CI = -2.17 to -0.33). Positive associations with provider empathy scores were found for those who reported knowing their provider (β = 2.42; 95 CI = 1.70 to 4.13), non-verbal communication (β = 0.88; 95% CI = 0.80 to 0.96) and perceived technical competency (β = 0.12; 95% CI = 0.05 to 0.19). CONCLUSIONS Perceived empathy in this study was lower than the findings reported in earlier studies. Health-care providers committed to the delivery of patient-centered care should take note of the determinants of better empathy as perceived by their clients.

Are people controlling the danger or fear for condom use as HIV/AIDS preventive message? An evaluative type of study based on extended parallel process model.

Background: There almost three decade years after the first clinical cases of AIDS were reported; it has become the most devastating disease of world particplarly in developing world. Despite massive resources and intensified interventions were made in promoting condom use as prevention methods, desired decline has not been achieved. This study was aimed to evaluate how people controlling the Danger or Fear for condom use as HIV/AIDS preventive message among youths exposed to messages and the response they experience on messages. Methods: Cross-sectional study design was conducted using quantitative and qualitative methods of data collection. Pre-tested self administered questionnaires were used to collect data. Study participants were selected using stratified random sampling from hosanna public college students. Quantitative data were analyzed using SPSS version 16.0. Thematic analysis was use for qualitative data. Results: Hundred ninty one (48.1%) of the respodents were found in danger control responses, whereas 206 (51.9%) were found in fear control responses. Perceived susceptibility to and severity of HIV/AIDS was relatively high; however, perceived self efficacy and response efficacy to HIV prevention messages had lower scores. Perceived susceptibility [β (95%CI)=1.07 (1.21 to 7.10)] and severity of [β (95%CI=1.65 (1.25 to 21.81)] HIV/AIDS were positively associated factors for fear control responses. Self efficacy [β (95%CI)=-0.96 (0.16 to 0.92)] and response efficacy [β (95%CI)=-1.21 (0.11 to 0.83)] were negatively associated factors. Totally, 66.3% of the variance in the response of condom use message as HIV prevention could be explained by EPPM model. Conclusion: Despite higher numbers of students were in fear control psychological responses, there were gaps between discriminative scores and most of the current behavior. Perceived susceptiblity, severity, self efficacy and response efficacy were independent predictors of students’ perceptions to use recommended responses. Due attention should given to fill the gap of perception of both susceptibility and severity.

Determinants of patient enablement at primary health care centres in central Ethiopia: a cross-sectional study

Abstract Background Patient enablement is associated with behaviours like treatment adherence and self-care and is becoming a well-accepted indicator of quality of care. However, the concept of patient enablement has never been subjected to scientific inquiry in Ethiopia. Objectives The aim of this study was to determine the degree of patient enablement and its predictors after consultation at primary health care centres in central Ethiopia. Method Data were collected from 768 outpatients from six primary health care centres in central Ethiopia during a cross-sectional study designed to assess patient satisfaction. Consecutive patients, 15 years or older, were selected for the study from each health centre. Multinomial logistic regression was performed to identify predictors of patient enablement using SPSS (version 16.0). Results The study showed that 48.4% of patients expressed an intermediate level of enablement, while 25.4% and 26.2% of the patients expressed low and high levels of patient enablement, respectively. Four models were developed to identify predictors of patient enablement. The first model included socio-demographic variables, showing that residence, educational status and occupational status were significantly associated with patient enablement (p < 0.05). This model explained only 20.5% of the variation. The second and third models included institutional aspects, and perceived doctor–patient interaction and information sharing about illness, respectively. They explained 31.1% and 64.9% of the variation. The fourth model included variables that were significantly associated with patient enablement in the first, second and third models and explained 72% of the variation. In this model, perceived empathy and technical competency, non-verbal communication, familiarity with the provider, information sharing about illness and arrangement for follow-up visits were strong predictors of patient enablement (p < 0.05). Conclusion The present study revealed specific predictors of patient enablement, which health care providers should consider in their practice to enhance patient enablement after consultation.