Background: Adequate knowledge is key for immunization service provision and related practices, such as providing the right vaccine at the right time, keeping vaccines potent, and to prevent vaccine failures. This study was conducted to assess the knowledge, attitude and practices of immunization service providers in primary health care units in pastoral and semi-pastoral areas of Ethiopia. Methods: A facility-based cross-sectional study was conducted of 1,280 health workers drawn from health centers (233) and health posts (632) in five regions of Ethiopia: Somali, Gambella, Benishangul-Gumuz, Oromiya and SNNPR. Data were collected using a self-administered questionnaire prepared in English and translated into three local languages, and analyzed using STATA version 13.0. Descriptive statistics and binary logistic regression analysis were carried out to determine the magnitude of, and identify associated factors for, knowledge, attitude and practice. A p-value of less than 0.05 was used to declare statistical significance. Results: Of all health center respondents, 389 (61.3%) had a good knowledge of the vaccination schedule; 403 (63.5%) had poor practices relating to vaccine placement in refrigerators; and 321(54%) had poor attitudes in relation to vaccines and vaccination. With respect to the vaccination schedule, midwives and Health officers/Medical Doctors were 0.28(95% CI: 0.08-0.95) times less knowledgeable than nurses; and health workers with more than five years’ work experience were 2.78 (95% CI: 1.54-5.01) times more knowledgeable than health workers who had three years’ work experience. Conclusions and recommendations: In this study, gaps were observed in health service providers’ knowledge, attitudes and practices in relation to immunization. Support to address these gaps – through training, supervision, monitoring and other mechanisms should focus on HEWs whose education is less than or equal to grade 12 at health post level, and on midwives and Health Officers (HOs)/MDs at the health center level. Similarly, attention should be given to enhance the vaccine and vaccination knowledge of semi-pastoral health facility service providers. The government, immunization working partners and other responsible bodies should give attention and take corrective measures to use maximum vaccine preventive potency.[Ethiop.J. Health Dev. 2019;33(Special issue):10-15] Key words: Immunization, Knowledge, Attitude, Practice, Health Worker

Background: Intravenous balanced anesthesia (IVA) is desirable during the evacuation of retained products of conception (ERPC) to avoid the use of inhalational anesthetics agents that may cause uterus relaxation, the possibility of bleeding, and the risk of uterus perforation. Objectives: The aim of this study was to compare the efficacy and safety of ketofol (a mixture of propofol and ketamine) versus fentafol (a mixture of propofol and fentanyl) during the ERPC. Methods: A double-blind, randomized comparative study was conducted among a total of 60 women of childbearing age categorized as grades I and II according to the American Society of Anesthesiologist (ASA), presented for ERPC. The patients were selected and randomized blindly into two groups (K group and F group), with 30 patients in each group. The K group was given ketofol (1ml containing 5mg of propofol and 5mg of ketamine) and F group was given fentafol (1ml containing 5mg propofol and 5mcg fentanyl). An intravenous loading dose of ketofol or fentafol was given slowly, with doses ranging from 1ml to 2ml/10kg, to reach level 5 or 6 of the Ramsay Scale of Sedation (RSS), followed by small incremental doses which were given when RSS dropped to 4. Hemodynamic parameters, success, and side effects were assessed throughout the procedures. Results: K group demonstrated a significant increase in heart rate (HR) and blood pressure (BP), compared to significant decreases in the F group. Decreases in oxygen saturation (SpO 2 ) and respiratory rate (RR) were observed more in the F group. However, no patients developed hypertension, hypotension, apnea, hypoxemia or serious adverse effects. Ketofol showed less propofol consumption and a short recovery time. Conclusions: Both ketofol and fentafol offer optimum conditions for ERPC. Ketofol is characterized by more stable hemodynamic parameters, a smaller dosage and faster recovery. [ Ethiop.J. Health Dev. 2019; 33(2):88-93] Key words: Propofol, ketamine, fentanyl, retained products of conception (RPC), ketofol, fentafol

Introduction: The stature of an individual is an inherent characteristic and is considered as an important parameter of personal identification. Estimating stature from the measurement of various body parts is of particular interest to forensic scientists, anatomists and medical researchers in order to complete biological profiles after death or when measuring standing height is impossible. However, establishing the identity of an individual from mutilated, decomposed and amputated body fragments is a challenging task in medico-legal cases, and a necessity when measuring standing height is difficult. Objectives of the study: To assess the relationship between anatomical anthropometric measurements and stature in undergraduate students at Debre Markos University (DMU), Ethiopia. Materials and Methods: An institutional-based, cross-sectional, prospective study was conducted among first-year undergraduate students at DMU. The sample size was 572 and data were collected from April to June 2018. Height, weight, head circumference, head length, inter-acromial length, humeral length, ulnar length, hand length and breadth, tibial length, and foot length and breadth were measured in both sexes. The data were analyzed using SPSS version 25 statistical software. The level of significance was set at p<0.05. Results: The mean age of study participants was 21.27±1.74 years for males and 20.41±1.58 years for females. The mean height of study participants was 168.36±5.89cm for males and 165.24±4.01cm for females. The correlation coefficients (R) of anatomical anthropometric measurements with height were: head circumference (males R = 0.404, females R = 0.127), head length (males R = 0.422, females R = 0.168), inter-acromial length (males R = 0.530, females R = 0.140), right humeral length (males R = 0.539, females R = 0.163), left humeral length (males R = 0.535, females R = 0.159), right ulnar length (males R = 0.496, females R = 0.147), left ulnar length (males R = 0.498, females R = 0.144), right hand length (males R = 0.276, females R = 0.125), left hand length (males R = 0.243, females R = 0.122), right hand breadth (males R = 0.349, females R = 0.129), left hand breadth (males R = 0.331, females R = 0.124), right tibial length (males R = 0.634, females R = 0.259), left tibial length (males R = 0.632, females R = 0.258), right foot length (males R = 0.579, females R = 0.185), left foot length (males R = 0.581, females R = 0.186), right foot breadth (males R = 0.311), left foot breadth (males R = 0.306). The highest correlation was found in the right tibial length in both males and females. Conclusions: All anatomical anthropometric parameters were significantly (p<0.05) correlated with height in both sexes, except foot breadth in females. Therefore, all anatomical anthropometric parameters, including head circumference, head length, inter-acromial length, humeral length, ulnar length, hand length, hand breadth, tibial length, foot length and foot breadth, can estimate stature in both sexes, except foot breadth in females. Ethiop. J. Health Dev. 2019; 33(3):188-197] Key words: Estimation of stature, anthropometry, anatomical anthropometric parameters

Background: The quantity and distribution of the health workforce is one of the most important aspects of a health care system. Inequality in the distribution of the health workforce is common in China and in many developing countries. This paper aimed to evaluate and discuss inequality in the distribution of the health workforce in Beijing, China, and explain the sources of the inequality.Methods: The study described and measured inequality in the distribution of the health workforce in Beijing using data from the Beijing Regional Statistical Yearbook 2017. The 16 districts of Beijing are divided into four divisions and the paper used methods from the economics literature, including the Lorenz curve, Gini coefficient and Theil L index, to measure inequality in the distribution of the health workforce at sub-provincial level in Beijing for three categories of health workers: doctors, nurses and all health workers.Results: There are inequalities in the densities of health workers at the district and division levels. In terms of the densities of all health workers, doctors and nurses, the Capital Core Functional Division is 3.95 times, 3.82 times and 4.13 times, respectively, higher than the Urban Development New Division. All the Gini coefficients are between than 0.2 to 0.3, which means that the health worker distribution is rather equitable. The Theil L index shows that the inequalities mainly come from the differences between the four divisions, and that nurses are more unequally distributed between divisions (0.28 for Gini coefficient and 0.380 for the Theil L index).Conclusions and recommendations: According to the study findings, the inequalities in health workforce distribution in Beijing could be addressed by increasing investment in the numbers and quality of nurses, as well as by establishing additional policies to attract more health workers to work in remote areas. Chinese governments need to think more carefully about the current distribution of health workers at the sub-provincial level. [Ethiop.J. Health Dev. 2019; 33(1):22-27]Key words: Health workforce distribution, equality, Beijing, health resources

Abstract Background : The low levels of education associated with low use of contraceptive methods are the major factors for high fertility rate in many developing countries including Ethiopia. Ample research works indicated that nearly two million people are added to the population of Ethiopia each year. The implication is that uncontrolled fertility rate affects the socio-economic, demographic and environmental situations of the country. The general objective of the study was to identify demographic and socio-economic determinants of fertility among reproductive-age women in Gonji-Kollela district of the Amhara Region. Methods : The study employed survey research design of a quantitative approach. Multi-stage sampling techniques were employed to select the required sample for the study. The data were collected using structured questionnaire and presented with the help of frequencies, percentages, and tables. SPSS version 20 was employed for data analysis. Multiple linear regression model was applied to identify determinant factors affecting the number of children ever born in the study area. Results : The total fertility rate (TFR) in the study area was 5.3 children per woman, which is higher than the TFR of the country (4.1 children per woman).The study pointed out that the total fertility rate of women with no education was 7.0 against 3.6 with secondary educational level. This means that respondents with no education have a large number of children ever born (CEB) than those who have some formal education. The marital status of the respondents revealed that 47% and 22.4% established marriage less than 15 years and 15-17 years of age, respectively. The study noted that fertility was the lowest among mothers who do not worry about sex preference. The results of the linear regression model also evidenced that sex preference, age at first birth, low educational levels of mothers and age at first sexual intercourse were the determinant factors for a high number of children ever born in the study area. Conclusions : The study found out that early marriage, low level of formal and informal education, parents motive to have a large number of children and inaccessible in the use of contraceptive methods were the major factors for high fertility rate in the study area. Hence, continuous awareness creation about the negative consequences of early marriage has to be promoted by the district health offices, Region’s bureau of women affairs and other stakeholders. [ Ethiop. J. Health Dev. 2018;32(3):000-000] Keywords: Fertility determinants, contraceptive use, children ever born, sex preference, reproductive age, total fertility rate, Amhara Region

Background : Providing health care for patients with hypertension has been difficult in rural areas of sub-Saharan Africa because of lack of medical staff and facilities. The use of non-physician healthcare workers offers a possible solution, but little is known about the feasibility and clinical response to treatment. Methods : We carried out a descriptive, retrospective review of the records of a sequential sample of 249 hypertensive patients aged 52.3 (SD 12.7) years from eight health centres in a rural area of southern Ethiopia where nurses and health officers had been previously trained to diagnose, treat and manage non-communicable diseases including hypertension. The study evaluated the changes in systolic and diastolic blood pressures following treatment over a 30 month period. Results : The mean systolic blood pressure on admission was 156.1(SD 21.1) mm Hg and the mean diastolic pressure 95.7(SD 12.7) mm Hg. Of the 249 subjects, 105(42.1%) defaulted from clinic follow-up during the period of the study. More than half (53.8%) were controlled on monotherapy with a thiazide diuretic, the remainder required combination therapy. Significant declines in systolic and diastolic blood pressure were achieved in each blood pressure group with the exception of the lowest pressure groups. Conclusion : Our study demonstrates that nurses and heath officers working in remote rural health centres can obtain worthwhile reductions in blood pressure in patients with hypertension. Moreover, this could often be achieved with a single, inexpensive diuretic, hydrochlorthiazide, although combination therapy was sometimes required. [Ethiop. J. Health Dev. 2018; 32(2):104-109] Key words : Hypertension, blood pressure, task-shifting, delivery of health care, nurses, Ethiopia.

Abstract Background: Community-Based Education (CBE) is an educational process aiming to ensure educational relevance to community needs, thereby contributing to improved community health needs. Addis Ababa University runs a six-week long Rural Community Health Training Program at Adami Tulu District, East Shoa Zone. In the program, the final year medical students are attached to the community to apply their theoretical training and address the community’s health problems. This study explored views of the local community about the program. Methods: A descriptive qualitative study was carried out in Adami Tulu District of East Shoa Zone – the district is the site of the training program. Data was collected from community members, local administrators, health extension workers, school principals and opinion leaders selected from three kebeles within the attachment area. A total of five FGDs and six key informant interviews were conducted using a semi-structured interview guide. The audio-taped data was later transcribed verbatim and translated into English. Themes were developed guided by the objective of the study with the application of Open Code Version 4.02. Results: The finding of the study revealed that the local community, beyond recognizing the participants as some kind of medical professionals from Addis Ababa University, knew very little about the program and its objectives. For example, the only benefit all the participants rightly mentioned in common, as evidence of their knowledge the program is free treatment for sick children by the students. Lack of communication between the university and local administration; absence of community involvement in the planning, execution and evaluation of the program; and problems related to language were identified as key areas for improvement. Conclusion: The Rural Community Health Training Program (RCHTP) is an important resource for both the university and the local community. It is therefore important that the university take proactive measures and optimize the involvement of local leaders and community members to enhance their sense of ownership of the program. [Ethiop. J. Health Dev. 2018;32(1):66-73] Key words: Community health, Rural attachment, RCHTP, Ziway

Abstract Background: Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes mellitus, cancers and chronic respiratory diseases, have remained the major burden and threat of the world with quite alarming rise in the developing nations. Eating a diet high in fruits and vegetables is associated with a decreased risk of many chronic diseases. Methods: Community-based cross-sectional survey based on the World Health Organization (WHO) NCD Stepwise approach was done. The survey was conducted in the 9 regions and two city administrations (Addis Ababa and Dire Dawa) in Ethiopia. The target population for this survey included all men and women age 15-69 years old who consider Ethiopia to be their primary place of residence. A single population-proportion formula was used to determine the sample size: design effect coefficient of 1.5, Z-score of1.96, proportion of 35.2%and marginal error of 0.04. A total of 513 EAs were covered nationwide. Thus, 10,260 study participants were included in the study. A mix of sampling approach namely stratified, three-stage cluster sampling, simple random sampling and Kish method were employed to select the study settings and the study participants. Descriptive weighted analysis was done along with complex sample analysis, and bivariate and multivariate analysis was conducted for fruit and/or vegetable intake. Result: The prevalence of fruit and/or vegetable consumption in Ethiopia was found to be (1.5%). More female than male ate fruit and vegetable in Ethiopia. When adjusted for included demographic and residence confounders (age, sex, location, income, education), those in rural area of residence ate ≥5 servings of fruits and vegetable [OR and (95% CI) [2.77 (1.60, 4.80)] than their counterparts. Conclusion and recommendation: Fruits and/or vegetables intake was generally extremely low. As the general level of risk factors rises, more people are put at risk. Preventive interventions to address these behaviours are implemented at individual, group, and community levels and include education, access to fruits and vegetables should therefore aim at reducing risk throughout the population. [Ethiop. J. Health Dev. 2017;31(Special Issue):355-361] Key Words: STEPs survey, fruit, vegetables, Ethiopia

Background: In Ethiopia, only 28% of all births occur at health facilities. Disrespect and abuse of women by health providers during pregnancy, labour and immediate postpartum is one of the main reasons that affect health care seeking from health facilities. This study explored disrespect and abuse of women using seven categories (Bowser D. and Hill K) including physical abuse, non-dignified care, non-consented care, non-confidential care, discrimination, abandonment care and detention at health facilities. Methods: We conducted a qualitative research in four health centres of Amhara and Southern Nations Nationalities and Peoples’ regional states between March and April 2014. Data were generated using in-depth interviews involving four midwives, 42 women (22 who delivered at the health facilities and another 20 who delivered at home) and eight focus group discussions involving 63 family members who accompanied labouring women to the health centres in the past three months before the study. The interview guides explored potentially abusive and disrespectful care and the perspectives of the participants towards such occurrences. Key themes were identified using phenomenological approach. Results: This study found that most women faced disrespectful care while few were abused during labour, delivery and immediate postpartum. Women who faced disrespect and abusive care during antenatal care reported to have avoided giving birth at health facilities. However, most women and their accompanying family members were found to have normalized non-dignified care (disrespect) and abuse as indicated by a participant " It is ok if a woman is mistreated, insulted, her consent is not asked or her privacy is violated as far as it is for the wellbeing of the delivering women and the newborn ". Conclusion: These findings showed that disrespect and abuse at health facilities have negatively affected women’s care-seeking from health facilities for delivery. Normalization of disrespect and abuse by labouring women could be one reason for the continuation of the practice by providers. Facilitating community dialogue on respectful and compassionate care, improving client-professional relationships and ensuring functional grievance handling systems in health facilities should be given high priority to change the situation. [ Ethiop. J. Health Dev . 2017; 31(3):129-137] Keywords: Disrespect and abuse, maternal health, pregnancy, labour, delivery, normalization, women and Ethiopia