Health Facilities In Ethiopia Research Articles

Knowledge and attitude toward cervical cancer screening among women aged 30–49 years attending selected health facilities in Ethiopia: Using structural equation model

BackgroundAccording to estimates, there were 570,000 new cases of cervical cancer in 2018, making it the fourth most common malignancy among women worldwide. Almost all 342,000 deaths from cervical cancer take place in low- and middle-income countries, accounting for 90 % of deaths. Few studies use structural equation modeling to comprehensively analyze the predictors of cervical cancer screening. ObjectiveThe purpose of this study was to assess knowledge and attitude towards cervical cancer screening and its associated factors among women aged 30–49 years in Ethiopia. MethodsA facility-based cross-sectional study was conducted among eligible women attending health centers in Oromia and the southern nationality People regions. A systematic random sampling method was used to select 916 respondents. The data was collected using a structured interviewer-administered questionnaire. Structural equation modelling was employed to assess the direct and indirect relationship between knowledge and attitude toward cervical cancer screening. ResultsThe overall proportion of knowledge and attitude towards cervical cancer detection among women 30–49 years of age were 28 % and 57 %, respectively., income (adjusted β= 0.075, 95 % CI: 0.042, 0.091), being urban (adjusted β= 0.088, 95 % CI: 0.062, 0.093), being employee (adjusted β= 0.119, 95 % CI: 0.113, 0.342), the number of parity (adjusted β= 0.014, 95 % CI: 0.012, 0.021), usage of contraceptive (adjusted β= 0.719, 95 % CI: 0.057, 0.082) and family history of cervical cancer (adjusted β= 0.211, 95 % CI: 0.18, 0.302) were statistically significant associated factors with knowledge and Being smoker (adjusted β=-0.157, 95 % CI: 0.265, −0.141). Having multiple sexual partnership (adjusted β= 0.169, 95 % CI: 0.148, 0.349), having formal education (adjusted β= 0.118, 95 % CI: 0.052, 0.294), live in urban area (adjusted β= 0.116, 95 % CI: 0.023, 0.347), knowledge (adjusted β= 0.42, 95 % CI: 0.301, 0.567) were statistically significant associated factors with the attitude of women toward cervical cancer screening. Conclusionsand recommendation: The study highlights a lack of awareness of cervical cancer screening, highlighting the need for improved routine practices, education campaigns, and treatment provision.

Prevalence and associated factors of anemia among postpartum mothers in public health facilities in Ethiopia, 2024: a systematic review and meta-analysis

BackgroundPostpartum anemia, characterized by hematocrit or hemoglobin levels below the defined cutoff point (< 11gm/dl or hematocrit < 33%), is a prevalent global issue. It serves as an indirect contributor to maternal mortality and morbidity. Mothers in the postpartum period experience diminished quality of life, impaired cognitive function, emotional instability, and an increased risk of postpartum depression due to anemia. Additionally, infants of affected mothers may face challenges such as insufficient breast milk supply and a lack of proper care. Examining the combined prevalence and factors associated with postpartum anemia is crucial for addressing maternal health risks and complications during the postnatal phase attributed to anemia.ObjectiveThe study aimed to synthesize the existing literature on the prevalence and associated factors of postpartum anemia in public health facilities of Ethiopia, in 2024.MethodsThe study was conducted by searching through the Google Scholar, PubMed, and Cochrane Library search engines. The search utilized keywords and MeSH terms such as anemia, low hemoglobin, postpartum, postnatal women, and Ethiopia. The collected data underwent analysis and comparison with the WHO criteria to determine if it met the threshold for declaring a public health concern. Heterogeneity was evaluated through the Cochran Q test and I2 statistics. Prevalence and odds ratio estimations were performed using a random-effects model with a 95% confidence interval.ResultFour studies were included in this systematic review and meta-analysis. The overall pooled prevalence of anemia among postpartum women in Ethiopia was 69% (95% CI: 60- 77%).Lack of formal education(OR = 3.5;CI:2.639,4.408),Low Pre-delivery hemoglobin (OR = 4.2;CI: 1.768–6.668), Postpartum women < 4 ANC visit (OR = 2.72; 95% CI:2.14,3.3 ),history of post partum hemorrhage (OR = 2.49; CI: 1.075–3.978),history of Forceps/vacuum delivery(OR = 3.96; CI:2.986–4.947), Poor iron and folic acid adherence (OR = 2.8;95% CI:2.311,3.297), C/S (OR = 4.04; 95% CI: 3.426,4.671),lower dietary diversity (OR = 4.295% CI:1.768,6.668) were significantly associated postpartum anemia.ConclusionPostpartum women in Ethiopia continue to face a considerable public health challenge in the form of anemia. Consequently, there is a pressing need for the government to formulate comprehensive, multi-sectorial policies and strategies. These initiatives should be designed to address the substantial regional disparities influenced by interconnected factors, with the aim of reducing the prevalence of anemia among postpartum women in Ethiopia.

Diagnostic error during antenatal care visit in selected health facilities of Ethiopia: a survey

Diagnostic error in antenatal care is a critical concern within the broader challenge of diagnostic errors in healthcare. Antenatal care plays a crucial role in ensuring the well-being of both the mother and the developing fetus during pregnancy. As a result, missed or delayed antenatal care visits or diagnosis errors of maternity complications affect both the mother and the baby. Diagnostic errors in this context refer to mistakes or inaccuracies in identifying and interpreting medical conditions, risks, or abnormalities related to the pregnancy. Several factors contribute to diagnostic errors in antenatal care, and understanding these challenges is essential for improving the overall quality of maternal and fetal healthcare. Delivering an improved approach to underrating diagnostic error requires the combined usage of non-technological and technological solutions. Identifying the factors contributing to diagnostic errors among healthcare professionals can lead to targeted interventions, training programs, and system level changes to prevent or minimize such errors. In this study, the prevalence of DE among health care professionals, pregnant women, and their relatives, and the frequency of occurrence of DE among health workers in selected health facilities in Ethiopia has been assessed. The data was collected using a questionnaire. The assessment results show that the major causes of diagnostic errors (mainly incorrect diagnosis) are identified as loss of patient records (36.4%), lack of proper laboratory (22.7%), and an insufficient number of health care professionals (13.6%). The leading effects of diagnostic error recognized are disease aggravation (58.3%) and permanent disability (25.0%). The research shows that providing an accurate diagnosis is crucial for avoiding risky obstetric outcomes and, as a result, reducing morbidity and mortality due to complications of pregnancy.

Surgical System Efficiency and Operative Productivity in Public and Private Health Facilities in Ethiopia: A Cross-Sectional Evaluation.

Global and local health organizations track surgical system efficiency to improve surgical system performance using various efficiency metrics, such as operating room (OR) output, surgical incision start time (SIST), turnover time (TOT), cancellation rate among elective surgeries, and in-hospital surgery wait time. We evaluated the surgical system efficiency and factors affecting the efficiency in health facilities across Ethiopia. A cross-sectional study design with retrospective record review was used to evaluate the surgical system efficiency in 163 public and private health facilities in Ethiopia from December 2020 to June 2021. Experienced, trained surgical clinicians abstracted efficiency data from service registers and patient charts using a pretested tool. A bivariable and multivariable regression analysis was conducted. In the study facilities, 84.11% of the operating tables were functional, and 68,596 major surgeries were performed. The aggregate OR output in both public and private health facilities was 2 surgeries per day per OR table. Operating productivity was shown to be affected by first-case SIST (P=.004). However, of the total 881 surgery incision times audited, 19.86% of the first-of-the-day elective surgeries started after 10:01 am. The SIST was strongly associated with an in-hospital wait time for surgery (P=.016). The elective surgery cancellation rate was 5.2%, and aggregate mean TOT was 50.25 minutes. The mean in-hospital surgery wait time was 45.40 hours, longer than the national cutoff for wait time. In a bivariable analysis, the independent variables that demonstrated association operating room productivity were then inputted into a multivariable regression analysis model. However, none of the predictor/independent variables showed significance in the multivariable regression analysis model. The volume of surgery and overall OR productivity in Ethiopia is low. This calls for concerted action to optimize OR efficiency and improve access to timely and safe surgical care in Ethiopia and other LMICs.

Use of Electronic Quality Monitoring Tool and Central Dashboard to Improve Clinical and Programmatic Decisions.

The HIV service quality improvement tool is deployed in 123 health facilities in Ethiopia. The tool uses a central dashboard for visualization and decision making at the health facility and higher levels of the health systems. The dashboard is developed on excel with analytics about HIV testing, case finding, treatment linkage and quality indicators. The dashboard was developed based on the requirements requested during discussions with HIV clinicians and the program team.

Incidence and Predictors of Preterm Mortality in Ethiopia: A Systematic Review and Meta-analysis

Introduction Preterm birth complication is the first leading cause of neonatal mortality in Ethiopia. In this study, the pooled prevalence and predictors of preterm mortality in Ethiopia were assessed. Methods The research protocol was registered to PROSPERO under the CRD42023415334 registration number. PubMed, Google Scholar, Cochrane Library, and Hinari databases were searched for studies up to April 10, 2023. Cohort studies on the incidence of preterm mortality and its predictors in Ethiopia were included in this review. This review was reported using the preferred reporting items for systematic reviews and meta-analyses checklist. We extracted data from the selected papers and exported to R 4.2.3 and STATA version 15.0 for estimating pooled incidence proportion, density rate, and adjusted hazard ratio (AHR). By looking at the funnel plot and using Egger’s test, the publication bias was assessed. This study didn’t receive funds from any organization. Results From 152 identified studies, 16 studies were selected for final analysis. The pooled incidence proportion and incidence density of preterm mortality were 30% (95% CI: 27%–32%) and 40 (95% CI: 30–40) per 1,000-person days, respectively. Being a male (AHR = 1.43, 95% CI: 1.09, 1.78), gestational age (0.83, 95% CI: 0.80, 0.87), born before 32 weeks (AHR = 2.15, 95% CI: 1.15, 3.84), antepartum hemorrhage (AHR = 2.46, 95% CI: 1.07, 3.84), the fifth minute Apgar rating less than seven (AHR = 1.84, 95% CI: 1.43, 2.25), birth asphyxia (AHR = 1.87, 95% CI; 1.59, 2.14), birth weight 1,000–1,499 g (AHR = 3.63, 95% CI: 1.69, 5.57), respiratory distress syndrome (AHR = 1.80, 95% CI: 1.59, 2.02), jaundice (AHR = 2.39, 95% CI: 1.16, 3.61), neonatal sepsis (AHR = 1.54, 95% CI: 1.25, 1.83), and not using kangaroo mother care (AHR =1.92, 95% CI: 1.11, 2.72) were predictors of time to death of preterm. Conclusions Almost one third of preterm neonates treated at different health facilities in Ethiopia failed to survive to the first four weeks of life. Because every study that was included was an institution-based cohort study, the results may not generalized to preterm newborns who were not hospitalized at medical facilities.

Factors determining knowledge and preventive practices within the COVID-19 pandemic among pregnant women at public health facilities in Ethiopia: a multicentre cross-sectional study

Factors determining knowledge and preventive practices within the COVID-19 pandemic among pregnant women at public health facilities in Ethiopia: a multicentre cross-sectional study

Mean difference in timing of first antenatal checks across regions and associated factors among pregnant women attending health facilities in Ethiopia: evidence from Ethiopian demographic health survey, 2019

IntroductionEarly initiation of antenatal care visits is an essential component of services to improve maternal health. Conducting a detailed study about the mean difference in timing at first antenatal checks across regions and factors associated with timing at first antenatal checks among women attending antenatal in Ethiopia is essential to ensure maternal and newborn health. Therefore, this study aimed to describe the mean difference in timing at first antenatal visits and associated factors among pregnant women attending different health facilities across regions in Ethiopia.MethodThe Ethiopian Demographic and Health Survey (EDHS) conducted a community-based cross-sectional study in 2019. In this study, data about the timing of the first antenatal check-ups were requested from the Demographic Health Survey in February 2023, and the required variables were downloaded in SAS and SPSS formats from the data set. A total of 2935 women from nine regional states and two city administrations with an age range of 15 to 49 years were included in the study. The mean difference in timing at first antenatal check-ups, its correlation and various factors were estimated using multiple linear regressions to identify factors.ResultThe majority of the 2034 (69.3%) of pregnant women who participated in the study were rural residents. The mean (± SD) age of the pregnant women was 29 (± 6.5) years. Approximately 32.5% of pregnant women visited their first antenatal check after 4 months of pregnancy. The results showed that counselling by health workers during a previous pregnancy (p < 0.01) significantly predicts timing at first antenatal checks in months holding previous delivery, previous antenatal care at both government and private facilities, ever attended school, and highest educational level. Timing at the first antenatal check-in months is expected to decrease by 0.99 months for every counselling session at each pregnancy. The results of the analysis suggested that the regression model significantly predicted timing at the first antenatal check (p = 0.001).ConclusionThe mean difference in timing at the first antenatal check in months among Ethiopian pregnant women relatively significantly varies in two regions. Previous pregnancy counselling by health workers positively influences the timing of first antenatal check-ups for subsequent antenatal check follow-ups in Ethiopia.

Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project

BackgroundIn 2009, the WHO introduced the surgical safety checklist (SSC) as one of the interventions for improving patient safety. The systematic use of structured checklists during surgery has been shown...

A clustered randomized control trial to assess feasibility, acceptability, and impact of implementing the birth companion intervention package in Ethiopia, Kenya, and Nigeria: study protocol

BackgroundA birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions.MethodsThis two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang’a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country.DiscussionAmple evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings.Trial registrationTrial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic.

The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Availability and Utilization of Psychosocial Services for Breast Cancer Patients in Addis Ababa, Ethiopia: A Mixed Method Study

The provision of psychosocial services has a substantial impact on cancer care by reducing emotional distress and improving both the quality of life and survival of patients, but the availability and utilization of such services have not been well studied in developing countries, particularly, Ethiopia. Therefore, we explored the types of psychosocial services available for breast cancer patients in Addis Ababa, Ethiopia. A mixed method study was conducted using a cross-sectional survey involving 428 breast cancer patients, followed by a qualitative study. A total of nine in-depth interviews (IDIs) were conducted with four breast cancer patients and five key informants using two separate interview guides. In addition to descriptive statistics, logistic regression was performed to identify factors associated with the provision of psychosocial services. Thematic analysis was used for the qualitative data, using NVivo 12 plus software. Only 47 (11.1%) patients received psychosocial services in the form of counselling, emotional support, or information provision. Health professionals reportedly provided such services along with their routine activities, and patients predominantly received social/emotional support from family members, friends, and colleagues. There were no well-structured counselling services, emotional support, or group discussion sessions for breast cancer patients in these health facilities. The main reasons for not providing these services were high patient flow/workload, inadequate space, lack of training, and not having qualified professionals to organise and deliver psychosocial services in these hospitals. Only one in ten breast cancer patients received psychosocial services from health professionals, and the services were not delivered in a structured way. Therefore, psychosocial services should be integrated in both private and government health facilities in Ethiopia.

Characteristics of Women Seeking Cervical Cancer Cytology Screening in a Private Health Facility.

Background and Objectives: Over 80% of cervical cancer cases in sub-Saharan Africa are detected at late stages, predominantly due to the lack or inaccessibility of prevention services. Public health facilities in Ethiopia offer free cervical cancer screening for eligible women. Besides the public health facilities, private providers also offer a variety of screening services at the patients' expense. As the overall cervical cancer screening uptake in Ethiopia is still far below the 90% WHO target, coordination between all actors of the health system is key. This includes a close cooperation between the public and private sectors to combine the advantages of both to the benefit of all patients as well as media campaigns and community involvement to promote the self-initiation of screening. Materials and Methods: To gain insights into the utilization of cervical cancer screening in the private health sector, we conducted an institution-based cross-sectional study at Arsho medical laboratories in Addis Ababa. Every woman who came there for cervical cancer screening between 1 May and 30 June 2020 was asked to participate in a questionnaire-based, face-to-face interview about their socio-demographic background, cervical cancer screening experience and self-initiation of screening. A total of 274 women participated in the interviews. We further assessed the reproductive status of the patients, their risk factors for cervical cancer, source of information about the screening and barriers to cervical cancer screening. Results: The ages of the participants ranged between 20-49 years. The majority (over 70%) were married. A total of 37.6% reported self-initiating the screening. More than three-quarters of all interviewed women reported mostly using the private health care sector for all kinds of health services. Conclusions: While the Ethiopian government efforts on scaling up cervical cancer screening focus mainly on public health facilities, the private sector often does not get as much attention from policy makers. Efforts should be made to extend the government's interest in cervical cancer screening and implementation research to the private healthcare sector.

Cost analysis of the WHO-HEARTS program for hypertension control and CVD prevention in primary health facilities in Ethiopia

BackgroundIn 2020, Ethiopia launched the Ethiopia Hypertension Control Initiative (EHCI) program to improve hypertension care using the approach described in the WHO HEARTS technical package. ObjectiveTo estimate the costs of implementing the HEARTS program for hypertension control and cardiovascular disease (CVD) prevention in the primary care setting in Ethiopia for adult primary care users in the catchment area of five examined facilities. Study designThis study entails a program cost analysis using cross-sectional primary and secondary data. MethodsMicro-costing facility surveys were used to assess activity costs related to training, counselling, screening, lab diagnosis, medications, monitoring, and start-up costs at five selected health facilities. Cost data were obtained from primary and secondary sources, and expert opinion. Annual costs from the health system perspective were estimated using the Excel-based HEARTS costing tool under two intervention scenarios – hypertension-only control and a CVD risk management program, which addresses diabetes and hypercholesterolemia in addition to hypertension. ResultsThe estimated cost per adult primary care user was USD 5.3 for hypertension control and USD 19.3 for integrated CVD risk management. The estimated medication cost per person treated for hypertension was USD 9.0, whereas treating diabetes and high cholesterol would cost USD 15.4 and USD 15.3 per person treated, respectively. Medications were the major cost driver, accounting for 37% of the total cost in the hypertension control program. In the CVD risk management scenario, the proportions of medication and lab diagnostics of total costs were 18% and 64%, respectively. ConclusionsThe results from this study can inform planning and budgeting for HEARTS scale-up to prevent CVD across Ethiopia.

Readiness, access, and use of facility childbirth care in Ethiopia: results from nationally representative linked household and health facility surveys

Background Facility readiness is an important prerequisite for providing safe, effective childbirth care. This study assesses the readiness of health facilities in Ethiopia to provide childbirth services, describes variations in geographic access to service-ready facilities, and evaluates how facility readiness relates to childbirth service usage with a lens on equity. Methods The study used cross-sectional data from a nationally representative sample of households in Ethiopia linked with data from health facilities serving the same areas. We explored variation in childbirth service readiness across facilities and classified facilities as “service-ready” if they had a readiness score of 0.75 or higher on a 0-1 scale. We used logistic regression modeling to examine the odds of residing within 10 kilometers of a service-ready facility by socioeconomic and geographic characteristics, and the odds of a facility delivery given the readiness of nearby facilities. Results Childbirth service readiness was generally high for hospitals (median score: 0.92) with minimal variation (interquartile range, IQR: 0.88 to 0.96). Health centers and clinics displayed lower and more variable readiness (median: 0.75, IQR: 0.66 to 0.84). In both crude and adjusted regression analyses, odds of residing within 10 kilometers of a service-ready facility were significantly greater for women with higher education levels, greater wealth, and urban residence. We found the adjusted odds of using facility childbirth services were 1.23 (95% CI: 1.03, 1.48) times greater for each 0.10-unit increase in the readiness level of nearby facilities. Conclusions Access to childbirth care is not equal for Ethiopian women. Those living in rural areas and the poor must travel farther to reach facility childbirth services, and the nearest facilities serving these women were less prepared to provide quality care. This may contribute to lower service utilization by such disadvantaged groups of women.

Comparison of Xpert MTB/RIF Ultra Results of Stool and Sputum in Children with Presumptive Tuberculosis in Southern Ethiopia.

The introduction of stool as a readily obtainable sample and the recently developed simple one-step (SOS) stool processing method on Xpert MTB/RIF Ultra (Xpert Ultra) offer an opportunity for TB diagnosis in children. We conducted this study in secondary health facilities in Ethiopia, which are the first-level referral facilities for childhood TB diagnosis and treatment, with the aim to determine if stool-based TB diagnosis can be performed with a reasonable level of concordance with sputum tests using Xpert MTB/RIF Ultra. Eligible children 0-14 years old with presumptive pulmonary TB were asked to provide stools in addition to routinely requested sputum samples. We determined the level of agreement between the stool and sputum test results. Of the 373 children included in the study, 61% were <5 years of age and 56% were male. Thirty-six children (9.7%) were diagnosed with TB, and all started treatment. The rate of concordance between stool and sputum was high, with a kappa value of 0.83 (p < 0.001). There were more Xpert Ultra positive results on stool (n = 27 (7.2%)) than on sputum/NGA (n = 23 (6.2%)). Laboratories in secondary hospitals can perform stool-based TB diagnosis in children, with high concordance between stool and sputum test results reaffirming the applicability of the SOS stool method.

Clonal diversity of Staphylococcus aureus isolates in clinical specimens from selected health facilities in Ethiopia

Staphylococcus aureus is among the top three causative agents of nosocomial infection in Ethiopia. The majority of studies in Ethiopia have focused on the epidemiology of S. aureus in hospital settings, with limited molecular genotyping results. Molecular characterization of S. aureus is essential for identification of strains, and contributes to the control and prevention of S. aureus infection. The aim of the current study was to determine the molecular epidemiology of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) isolates recovered from clinical specimens in Ethiopia. A total of 161 MSSA and 9 MRSA isolates were characterized using pulsed-field gel electrophoresis (PFGE) and staphylococcal protein A (spa) typing. Based on the PFGE analysis, MSSA isolates were grouped into eight pulso-types groups (from A to I), while MRSA isolates clustered into three (A, B and C) pulso-types with more than 80% similarity. The spa typing analysis showed diversity of S. aureus with 56 distinct spa types. Spa type t355 was most prevalent (56/170, 32.9%), while eleven new spa types were detected including t20038, t20039, and t20042. The identified spa types were clustered into 15 spa-clonal complexes (spa-CCs) using BURP analysis; novel/unknown spa types were further subjected to MLST analysis. The majority of isolates belonged to spa-CC 152 (62/170, 36.4%), followed by spa-CC 121 (19/170, 11.2%), and spa-CC 005 (18 /170, 10.6%). Of the nine MRSA isolates, 2 (22.2%) were spa-CC 239 with staphylococcal cassette chromosome (SCC)mec III. These findings highlight the diversity of S. aureus strains in Ethiopia, as well as the presence of potentially epidemic strains circulating in the country necessitating further characterization of S. aureus for antimicrobial resistance detection and infection prevention purposes.

Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study

BackgroundTuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms. MethodsWe consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth’s multivariate-penalized logistic regression model. ResultsWe enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20–57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25–12.29]) were associated with bacteriologically-confirmed TB cases. ConclusionsWe found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.

Patients' experience of undergoing maintenance hemodialysis. An interview study from Ethiopia.

People with kidney failure require renal replacement therapy in the form of dialysis or a kidney transplant for survival. Many facets of their life, both within and outside the dialysis unit, are impacted by the management of this disease. It is important to comprehend the experiences of people undergoing hemodialysis in order to improve the care provided to them. Therefore, this study aimed to explore the experiences of patients undergoing maintenance hemodialysis in Ethiopia. A qualitative descriptive study was conducted at two healthcare facilities in Ethiopia. Individual interviews with 15 participants (men and women aged 19-63), undergoing hemodialysis in Ethiopia, were analyzed using reflexive thematic analysis. The analysis resulted in five themes: Feeling grateful, Facing a restricted life, a Supportive environment, Dreaming of a transplant, and Leading a hassled life. The subthemes include Trust in treatment, Faith in God, Challenging fluid and dietary restrictions, Being too fatigued to socialize, Being stigmatized, Family and social support, Supportive healthcare, Lacking a donor and sponsor, COVID-19 as a barrier, Financial constraints, Inaccessibility to care and transport and Access line implantation. Despite being dependent on a machine and having to deal with food and fluid restrictions as well as financial challenges, participants were hopeful and dreamed of a transplant. From the study's participants, it was discovered that the experiences of people with kidney failure undergoing hemodialysis were generally, considerably negative narratives. Based on the results we recommend development of multidisciplinary teams to better meet patients' physical, emotional, and social needs while undergoing hemodialysis. Such a team should also involve the patient's family members when caring for patients on hemodialysis.

Data for local decision-making, not a mere reporting requirement: development of an index to measure facility-level use of HMIS data

Background Well-functioning health management information systems (HMIS) enable decision-making at all health system levels. This study develops an index to measure the use of HMIS data at the facility level. Methods We used two rounds of cross-sectional data collected from 305 health facilities in Ethiopia in 2019 (pre-COVID-19) and 2020 (post-COVID-19). We constructed a summative, 10-item index using exploratory factor analysis and 2019 index development data; and used Cronbach’s alpha to assess reliability. To examine content validity, we mapped items against a previously published conceptual framework and consulted Ethiopian experts. We then employed one-way ANOVA and t-tests comparing the mean index scores overall and by key facility characteristics between 2019 and 2020. Results The 10-item index loaded on one factor (Cronbach’s alpha=0.74), and the index scores did not differ significantly by facility characteristics in 2019. The mean index score increased from 7.2 in 2019 to 7.9 in 2020 (P&lt;0.01). During this period, more facilities received feedback on HMIS reports from facility leadership (19.3% difference); received actionable recommendations on performance targets and resource allocation (7.5% and 12.3% difference, respectively); and reviewed maternal deaths (15.1% difference); conversely, the proportion of facilities that held participatory performance review meetings monthly or more often decreased by 13.8% (all P &lt;0.05). Conclusions We propose a facility-level HMIS data use index and document an upward trend in HMIS data use in Ethiopia immediately after the COVID-19 pandemic was declared. Future research should further evaluate and refine the proposed index to support the measurement of HMIS data quality and utilization in Ethiopia and like settings.