Minding the Immunization Gap: Family Characteristics Associated with Completion Rates in Rural Ethiopia

To examine risk factors for lack of immunization, we tested the impact of maternal, paternal, and household variables on child immunization status in children ≥1 year in a rural area of Ethiopia. Data collected by face-to-face interview on maternal, paternal, household and child variables from cross-sectional random sample community-based study on health and well-being in rural Ethiopia was used to test hypotheses on immunization status of children (n = 924). Bivariate and multivariate logistic regression models were used for two immunization outcomes: record of at least one vaccination, and record of DPT3, indicating completion of the DPT series. Complete data were available for 924 children ≥1 year of which 79% had at least one vaccination. Of those, 64% had DPT3/Polio3; below recommended coverage level. Children were more likely to be vaccinated if the mother reported antenatal care (ANC), and less likely to be vaccinated if the mother had a history of stillbirth, and no opinion of health center. Children were more likely to have DPT3 if: mother had ≥1 year of education, mother reported ANC, or older paternal age. Children were less likely to have DPT3 in households with food insecurity and no maternal opinion of health center. The study had three findings with implications for immunization programming: (1) Mothers completing the recommended ANC visits is strongly associated with receiving at least one vaccination and with completing a vaccination series; (2) Maternal education is associated with a completed vaccination series; (3) Paternal characteristics may affect vaccination series completion.     

Partograph utilization and associated factors among obstetric care providers in North Shoa Zone,Central Ethiopia: a cross sectional study

Background

Globally, prolonged and obstructed labor contributed to 8% of maternal deaths which can be reduced by proper utilization of partograph during labor.

Methods

An Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care providers. A pre-tested and structured questionnaire was used to collect data. Data was entered to EpiInfo version 3.5.1 statistical package and exported to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables.

Results

Out of 403 obstetric care providers, 40.2% utilized partograph during labor.Those who were midwives by profession were about 8 times more likely to have a consistent utilization of the partograph than general practitioners (AOR=8. 13, 95% CI: 2.67, 24.78). Similarly, getting on job training (AOR=2. 86, 95% CI: 1.69, 4.86), being knowledgeable on partograph (AOR=3. 79, 95% CI: 2.05, 7.03) and having favorable attitude towards partograph (AOR=2. 35, 95% CI: 1.14, 4.87) were positively associated with partograph utilization.

Conclusion

Partograph utilization in labor monitoring was found to be low. Being a midwife by profession, on job training, knowledge and attitude of obstetric care providers were factors affecting partograph utilization. Providing on job training for providers would improve partograph utilization.     

Households willingness to pay for long-lasting insecticide treated nets in three urban communities of Assosa Zone, western Ethiopia

BACKGROUND: Achieving the target coverage of insecticide treated nets (ITNs) has to be preceded by understanding their demands, willingness to pay (WTP) and determinants of WTP for those who could not get free of charge. OBJECTIVE: To assess WTP for long lasting ITN using contingent valuation method and determinants of maximum WTP for long lasting ITN among households in Assosa Zone, Western Ethiopia. METHODS: The contingent valuation method was used to assess WTP for long-lasting ITN among households selected from the three urban communities. univariate and multivariate regression analyses were carried out. The adjusted effect (beta), F-ratios, adjusted odds ratios (AOR) and 95% CI were used to interpret results. The criterion for statistical significance was set at 0.05. RESULTS: Ninety six percent of the respondents reported that long-lasting ITN are important for their family fbr prevention of malaria and demanded for long lasting ITN. Sixty seven percent of the respondents were willing to pay for long-lasting ITN at the starting bid amount of 25 Birr. The mean, maximum WTP amount was 27.84 Birr. The mean WTP amount varied with the respondents' wealth status, which was 19.09 and 35.26 Birr foir poorest and well-off wealth quintiles respectively. Wealth status and knowledge of the respondents about its preventive effects against boring insects were significantly associated with their WTP (adjusted beta = +3.76, 95% CI: 2.3, 4.6 and adjusted beta = 10.15, 95% CI: 2.7, 17.6 respectively). CONCLUSION: The poor have shown their WTP for reduced cost of ITN, thus the regional health bureau should develop a price discrimination mechanism for those economically vulnerable groups.     

Knowledge, attitude and practice of home-based care for HIV/AIDS patients by their family/ caregivers at Jimma Town

BACKGROUND: About 1.5 million people are currently living with HIV/AIDS in Ethiopia-one of the largest HIV infected populations in the world. The current prevalence rate of infection is estimated at 4.4% nationally. Hospital bed occupancy rate due to AIDS has reached over 50% in urban hospitals creating a severe burden to the health service system in the country, or else US $3.4 million is needed in order to increase their bed capacity. Here arises the need to look for a better way of caring for people living with HIV/AIDS. Home care would thus offer the only feasible option for this need as it can mobilize the considerable reservoir of caring and sympathy that exists within a community beyond that of cost cutting. The study was conducted to determine the knowledge, attitude and practice of family/caregivers regarding home-based care for people living with HIV/AIDS. METHODS: This was a cross-sectional community-based study conducted among 274 family/caregivers who were giving care for people living with HIV/AIDS in urban setting of Jimma town from June - August 2005. A structured and pre-tested questionnaire was used to collect data on socio-demographic characteristics, knowledge and attitude towards home based care practice. Data collection was done by interviewing family/caregivers at their respective houses and analyzed using SPSS for windows version 11.0. RESULTS: Over three fourth of the studied subjects (91.6%) were knowledgeable about home based care and 88.7% showed favorable attitude. Ninety two point eight percent agreed that home is a better place for the care of PLWHA than hospital. Single caregivers were about four times more likely to be knowledgeable about home care as compared to their counterparts (OR = 3.98 (95% CI: 0.50, 88.08), but the finding was not statistically significant (p > 0.05). Neighbors and friends were two times more likely to have favorable attitude towards HBC as compared to family members, OR = 1.96 (95% CI: 0.74, 5.21) but, the finding is not statistically significant (p > 0.05). CONCLUSION: The study highlighted that the majority of family members/caregivers have good knowledge and favorable attitude towards HBC and over half favored this care. Therefore, appropriate use of the above promising findings and experience of innovative approaches of HBC from other countries is recommended for further, more organized and effective home-based care practice.     

Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

Background  

In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.     

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection

To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150 min and the estimated blood losses were 150, 400, and 130 mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9 mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.     

Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross - sectional study

Background  

Adequate antiretroviral drug potency is essential for obtaining therapeutic benefit, however, the behavioral aspects of proper adherence and readiness to medication, often determine therapeutic outcome. Therefore, this study aimed to assess the level and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy (HAART) among people living with HIV/AIDS (PLWHA) at Gondar University Teaching Hospital and Felege Hiwot Hospital in Northwest Ethiopia.     

Effect of complementary feeding behaviour change communication delivered through community‐level actors on infant growth and morbidity in rural communities of West Gojjam Zone,Northwest Ethiopia: A cluster‐randomized controlled trial

Attaining the recommended level of adequacy of the infants'' diet remains a serious challenge in developing countries. On the other hand, the incidence of growth faltering and morbidity increases significantly at 6 months of age when complementary foods are being introduced. This trial aimed to evaluate the effect of complementary feeding behaviour change communication delivered through community‐level actors on infant growth and morbidity. We conducted a cluster‐randomized controlled trial in rural communities of Ethiopia. Trial participants in the intervention clusters (eight clusters) received complementary feeding behaviour change communication for 9 months, whereas those in the control clusters (eight clusters) received only the usual care. A pre‐tested, structured interviewer‐administered questionnaire was used for data collection. Generalized estimating equations regression analyses adjusted for baseline covariates and clustering were used to test the effects of the intervention on infant growth and morbidity. Infants in the intervention group had significantly higher weight gain (MD: 0.46 kg; 95% CI: 0.36–0.56) and length gain (MD: 0.96 cm; 95% CI: 0.56–1.36) as compared with those in the control group. The intervention also significantly reduced the rate of infant stunting by 7.5 percentage points (26.5% vs. 34%, RR = 0.68; 95% CI: 0.47–0.98) and underweight by 8.2 percentage points (17% vs. 25.2%; RR = 0.55; 95% CI: 0.35–0.87). Complementary feeding behaviour change communication delivered through community‐level actors significantly improved infant weight and length gains and reduced the rate of stunting and underweight.