Health Posts Research Articles

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia.

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

Assessment of Implementation of CB-IMNCI Program at Primary Health Care Centers and Health Posts.

Community-based integrated management of neonatal and childhood illness (CB-IMNCI) is a government-run priority one program aimed to decrease neonatal and childhood morbidity and mortality. The objective of our study was to identify the CB-IMNCI implementation gap in terms of health care providers' training status, availability of medicines, follow-up visits and clinical outcome at Primary Health Care Centers and Health Posts of Morang district of Nepal. We conducted a community based cross-sectional study in Morang district of Nepal from 25 Oct 2021 to 25 Jan 2022. Ethical approval was taken from ethical review board of the Nepal Health Research Council. We enrolled 9 (53%) out of 17 local governments of Morang district of Nepal by simple random sampling. The collected data was entered in MS Excel and analyzed by SPSS version 23. The majority of healthcare workers were in their early age of 26-35 years (57.2%), male (85.7%) and Auxiliary Health Workers (78.6%). The mean duration of practice was 15.1 years. Only 46.5% of healthcare providers were trained for the CB-IMNCI program. The availability of medicine as per CB-IMNCI guideline was 52.9%. There was no record available for total number of required follow up, total number of actual follow up and clinical outcome in last 6 months. About half of the human resources were trained with the availability of only half of the required medicines. We also found a lack of adequate record-keeping of follow up of patients and their clinical outcomes.

The Effect of Solar Direct Derive Cold Chain Equipment on the Performance of Immunization Services in Health Facilities of Ethiopia

The effect of solar direct derive (SDD) from cold chain equipment on the quality and equity of health facilities’ immunization services is assessed using descriptive and explanatory research design by collecting data using a structured questionnaire from health workers in health centres and health posts of 56 purposely selected health facilities in Ethiopia. Quantitative data were collected from the EPI registry for the year 2014 as a baseline, and a follow-up review was made for the year 2018 performances. It was found that the new cold chain equipment, SDD refrigerators have a positive and significant effect on improving equity (Penta 3 coverage) and quality (Penta 1 -Measles dropout rate) of the immunization service. This helps to reduce the number of zero dose children.

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia:A consolidated framework for implementation research.

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high-impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron-folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care unitsrequires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervisionand accountability.

Choline, DHA, and Diarrheal Disease Associated with Growth Faltering in a Case-Control Study

ABSTRACTBackgroundChildren with recurrent infectious diarrhea are susceptible to growth faltering. DHA and choline may play a role in this relationship due to their involvement in lipid metabolism, gut immunity, and inflammatory pathways.ObjectivesThis study aimed to characterize the contributions made by DHA and choline status and enteric damage in young children in the association between diarrheal illness and child growth.MethodsA longitudinal case-control study was conducted among children aged 6–36 mo (N = 195) in Cap-Haitien, Haiti. Mother-child dyads were recruited from community health posts and outpatient clinics. Cases were defined as children experiencing acute diarrhea within the last 3 d and matched to healthy controls. Child anthropometry, dietary intake, and blood and stool samples were collected at baseline and follow-up. Plasma DHA, choline, and betaine were determined by LC-MS/MS methods (n = 49) and intestinal fatty acid–binding protein (I-FABP) by ELISA (n = 183). Multivariate regression models were applied with mediation analyses to examine associations and adjust for confounding factors.ResultsAt baseline, mean plasma DHA concentrations (1.03 µg/mL; 95% CI: 0.91, 1.15) were not significantly different between cases and controls, nor was there a difference in mean plasma choline concentrations (4.5 µg/mL; 95% CI: 3.8, 5.1). Mean plasma I-FABP concentrations were significantly higher at follow-up in cases (3.34; 95% CI: 3.28, 3.40) than controls (3.20; 95% CI: 3.13, 3.27; P = 0.002). In adjusted multilinear regression models, higher plasma DHA concentrations at follow-up were associated with a negative change in weight-age z score (P = 0.016), and follow-up I-FABP was inversely associated with height-age z score (P = 0.035). No interaction or mediation effects were found.ConclusionsI-FABP concentrations were significantly higher in cases as compared with controls at follow-up, suggesting ongoing enteric damage and increased risk for malnutrition. Plasma DHA and I-FABP may have a role in childhood growth outcomes.

Impact of preventive and early treatment of childhood pneumonia and diarrhea in Ethiopia, analysis from Health Management Information System (HMIS) report 2010 -2016

Background: In Ethiopia mortality in children younger than five years it has dropped from 202 in 1990 to 55 in 2019 (EDHS 2019). Pneumonia and diarrhea are the two leading causes of under-five mortality. They have overlapping risk factors, such as poverty, undernutrition, and poor hygiene. Ethiopia introduced Integrated Community Case management (ICCM) is strategy to treat sick children in communities. Pneumococcal Conjugate vaccine was introduced in 2010, and Rotavirus vaccine was in 2013.This research was conducted to assess the changes in morbidity and mortality in children due to pneumonia and diarrhea based on HMIS data. Methodology: Diarrhea and pneumonia morbidity, admission, and mortality data of under five children were extracted from 2002/09 EFY to 2008/16 GC, annual Federal Ministry of Health and Health related indicators bulletin. Proportion of morbidity, admission, mortality, and change in percentage analyzed and compared using significant test. Results: Morbidity due to pneumonia to total under five morbidity increased from 2.6% to 8.7%, and that of diarrhea from 2.3% to 11.8% in six years (2010 to 2016) p-0.000. Admission due to pneumonia decreased from 5% to 4.5%, (10% reduction), p-0.009 and that of diarrhea 3.4%, to 1.3%, (63% reduction), p-0.000. Mortality due pneumonia decreased from 2.7%, to 1.4 %, (48% reduction), p-0.113, that of diarrhea decreased from 1.9% to 0.9%, (53% reduction), p-0.42. The change in morbidity and admission were significant, but that of mortality was not significant. Conclusion: The increase in morbidity of pneumonia and diarrhea might be due to increase in health service utilization. The decline in admission and mortality of both diseases showed that introduction of new vaccines of, Rota, and early treatment in health posts using ICCM algorisms, have significant contribution. Standard quality treatment, prevention by improving immunization quality and coverage, maximum utilization of health service, is necessary to further decrease, admission and mortality.

Point prevalence mapping of malaria infection in Rivers State, Nigeria

Background: Variations in the risk of malaria across locations exist but are poorly understood though identifying hotspots of malaria transmission will create opportunities for targeted interventions. Point prevalence of malaria in Rivers State was studied using Primary Healthcare Centres (PHCs) as survey points.&#x0D; Methods: The PHCs in Rivers State were geo-referenced using a handheld Global Positioning System (GPS) and 74 were selected across 21 local government areas using systematic grid point sampling. Blood samples were obtained from 2340 persons who consented and questionnaires were administered to obtain their demographic data. Malaria parasites in blood films were detected using the Giemsa staining technique. Data generated were analysed using SPSS 22.0 and presented using descriptive statistics. The level of relationship amongst the parameters was obtained using Chi-square. Co-ordinates of PHCs sampled and their prevalence data for malaria were entered into Microsoft Excel 2007 spreadsheet and transmitted to ArcGIS 10.8. This platform was then used to produce point prevalence infection maps of the State using geographic information systems (GIS). Survey points with malaria point prevalence values of 75% and above and cumulative prevalence of 1.97% and above were categorised as malaria transmission hot spots in the various LGAs.&#x0D; Results: The study recorded an overall prevalence of 56.3%, with P.falciparum as the only identified malaria parasite. Data revealed that Oyoro Model Primary Health Centre (MPHC), Arukwo Primary Health Centre, Ele Health Post (HP) and Emago HP recorded very high prevalence of 96.7%, 96%, 95.2% and 94.4% respectively, whereas MPHC Iriebe had the least prevalence. Twelve hotspots with point prevalence above 75% were identified and eight hotspots likewise with cumulative prevalence above 1.97%.&#x0D; Conclusion: Malaria infection remains endemic in Rivers State. This study provides malaria point prevalence maps of Rivers State which will serve as a reference to policymakers for strategic interventions in the State

Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia.

Studies in Ethiopia show an increasing trend in maternal health service use, such as having at least 4 visits of antenatal care (ANC4+) and skilled birth attendance (SBA). Improving the health information system (HIS) is an intervention that can improve service uptake and quality. We conducted a baseline study to measure current maternal service coverage, HIS performance status, and their relationship. We conducted a linked health facility-level and population-based survey from September 2020 to October 2020. The study covers all regions of Ethiopia. For the population-based survey, 3,016 mothers were included. Overall, 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. A two-stage sampling procedure was applied to select target households. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Multilevel logistic regression was employed to account for clustering and control for likely confounders. Maternal service indicators, ANC4+ visits (54.0%), SBA (75.8%), postnatal care (70.6%), and cesarean delivery (9%) showed good service uptake. All data quality and use indicators showed lower performance compared to the national target of 90%. Maternal education and higher levels of wealth index were significantly and positively associated with all selected maternal service indicators. Longer distance from health facilities was significantly and negatively associated with SBA and the maternal care composite indicator. Among HIS-related indicators, availability of electronic HIS tools was significantly associated with maternal care composite indicator and ANC4+. Maternal service indicators showed promising performance. However, current HIS performance is suboptimal. Both service user and HIS-related factors were associated with maternal service uptake. Conducting similar research outside of the project sites will be helpful to have a wider understanding and better coverage.

Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study

ObjectiveLittle is known about the extent to which Health Extension Programme (HEP) has played its role to increase service uptake among young girls. This study aims to estimate the status...

Cognitive testing of questions about antenatal care and nutrition interventions in southern Nepal

Large scale surveys such as the Demographic and Health Surveys (DHS) are used to measure the coverage and quality of antenatal care (ANC)-related services. Studies have increasingly validated questions from these surveys, though few have explored respondent comprehension or associated thought processes. This study aimed to use cognitive testing and validation approaches to understand how survey respondents understand questions related to ANC-related nutrition services. The study was nested within a larger validation study in southern Nepal. Pregnant women's receipt of ANC related services was directly observed at five health posts followed by a recall interview at 6 months postpartum. A week later, a survey module was re-administered to 30 women containing 15 questions about receipt of ANC care and specifically nutrition-related services. Detailed probing was used to identify cognitive challenges related to comprehension, retrieval, judgement, and response. Respondents accurately recalled the four specific ANC visits recommended by the government of Nepal but those with more visits struggled to estimate the total number of ANC visits they had made. A number of terms including “antenatal care, “nutrition” and “breastfeeding” were challenging for many respondents to understand. Visits to private providers including for ultrasounds were inconsistently included in ANC visit counts suggesting that question wording could better specify the type of care. Many respondents over-estimated the number of iron folic acid (IFA) supplements taken during pregnancy, and recall was challenging. Calculations were based on estimating the number of months between first ANC visit to delivery, and only sometimes factored in missed tablets. Opportunities exist to improve questions to facilitate better comprehension by respondents through a combination of using local terms and explanations, reordering some questions, and adapting questions to better match respondents' approaches to estimating numeric responses.

Exploration of barriers to postnatal care service utilization in Debre Libanos District, Ethiopia: A descriptive qualitative study.

BackgroundIn Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related barriers to PNC service utilization, but limited evidence was available on the health facilities and health care provider-related barriers. Therefore, the study was aimed at exploring both community and health care provider-related barriers to PNC service utilization.MethodsA descriptive qualitative study was conducted at Debre Libanos District, Ethiopia, from 11 March to 7 April 2019. A purposive sampling technique was used to recruit study participants among recently delivered women (<2 months), health care providers, and community members. A total of five in-depth interviews, 12 key informant interviews, and four FGDs were conducted. Data were audio-recorded, transcribed verbatim, and translated, and inductive thematic analysis was used to analyze the data using the atlas ti.7.1 software.ResultsA total of 51 participants were involved in the study. The findings were organized into two major themes: (1) Community/caregiver-related barriers to PNC service utilization: lack of awareness about PNC, its importance, and schedules; lack of awareness about postnatal danger signs, sociocultural and religious beliefs, topographical and transportation problems, non-functionality of the health developmental armies (HDA); (2) health facility and health care provider-related barriers to PNC service utilization: poor supportive supervision and monitoring, lack of health extension workers' (HEW) commitment, lack of an organized system to notify delivery to HEW, shortage of HEWs, the residence of the HEWs, closure of health posts (HP) on working hours, and non-functionality of HPs.ConclusionsThe study findings underscore the need to develop different strategies and take actions. Therefore, the health centers and district health offices should have to assign the required number of HEWs at HPs, regularly supervise and monitor HEWs, and develop an organized system to facilitate early notification of delivery to HEWs. The HEWs should have to live near the HP, re-organize HDAs, create awareness of maternal and newborn danger signs, and conduct social and behavioral change communications to increase the health-seeking behavior of community members for utilizing PNC services.

Analysis of the Perinatal Care System in a Remote and Mountainous District of Nepal.

Despite significant improvements in recent years, maternal and neonatal health outcomes remain poor in many regions of the world. One such area is in the remote mountainous regions of Nepal. The purpose of this study is to describe the current antenatal care practices and delivery support in a mountainous district of Nepal. This study took place in Solukhumbu District between December 2015 and February 2018. A household survey was created using evidence-based maternal and neonatal care indicators. Women who had delivered within the previous two years were surveyed regarding antenatal and delivery care they received. A standardized health facility survey was used to evaluate the operational status of health facilities. The study was approved by the Nepal Ministry of Health and the University of Utah IRB. A total of 487 households and 19 facilities were surveyed. 35.7% (174/487) of deliveries occurred in a health facility (hospital, primary health care center or birthing center). 35.2% (171/486) of deliveries were attended by a skilled birth attendant. 52.8% (47/89) of women who did not deliver in a facility noted that transportation issues and not having sufficient time to travel during labor prevented them from delivering in a facility. No health posts had staff trained in obstetric and neonatal emergencies. The majority of women in Solukhumbu District do not receive high quality antenatal and delivery care. An intervention that would make antenatal care and delivery support more accessible could improve maternal and infant outcomes in this district and other similar regions.

A problem of self-isolation in Japan: The relationship between self-isolation and COVID-19 community case.

Background: The Japanese government advised mild or asymptomatic coronavirus disease-2019 (COVID-19) cases to self-isolate at home, while more severe individuals were treated at health posts. Poor compliance with self-isolation could be a potential reason for the new outbreak. Our study aimed to find out the correlation between the rising new cases of COVID-19 and home-based patients in Japan. Methods: A secondary data analysis study was conducted with the data from COVID-19- involved databases collected from Johns Hopkins University, Japanese Ministry of Health, Labour and Welfare, and Community Mobility Reports of Google. New community cases, stringency index, number of tests, and active cases were analyzed. Using a linear regression model, an independent variable was utilized for a given date to predict the future number of community cases. Results: Research results show that outpatient cases, the stringency, and Google Mobility Trend were all significantly associated with the number of COVID-19 community cases from the sixth day to the ninth day. The model predicting community cases on the eighth day (R2=0.8906) was the most appropriate showing outpatients, residential index, grocery and pharmacy index, retail and recreation index, and workplaces index were positively related (β1=24.2, 95% CI: 20.3– 26.3, P<0.0001; β2=277.7, 95% CI: 171.8–408.2, P<0.0001; β3=112.4, 95% CI: 79.8–158.3, P<0.0001; β4=73.1, 95% CI: 53- 04.4, P<0.0001; β5=57.2, 95% CI: 25.2–96.8, P=0.001, respectively). In contrast, inpatients, park index, and adjusted stringency index were negatively related to the number of community cases (β6=-2.8, 95% CI: -3.9 – -1.6, P<0.0001; β7=-33, 95% CI: -43.6 – -27, P<0.0001; β8=-14.4, 95% CI: -20.1– -12, P<0.0001, respectively). Conclusion: Outpatient cases and indexes of Community Mobility Reports were associated with COVID-19 community cases.

Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana.

IntroductionRural health clinics in low-resource settings worldwide are usually staffed with health care workers with limited knowledge and skills in managing acute emergencies. The Emergency Centre (EC) at the district hospital or primary hospital serves as an entry point for patients with diverse medical needs from health posts and community clinics. The study described the socio-demographic characteristics, primary diagnosis, and disposition of patients transferred from the clinics and health posts to the district hospital in the Kweneng district.MethodThis study is a chart audit of the triage sheets and admitting medical records (Botswana Integrated Patient Management System, IPMS) conducted for the period June through to December 2020. Descriptive statistics were used to analyze the quantitative data. Frequencies, percentages, and measures of central tendency were calculated using the software, SPSS version 27.ResultsA total of 1565 charts were reviewed; 56% (n = 877) were females and 43.5% (n = 681) were males. Half of the patients presenting to the EC ranged from ages 21 to 50, with a mean age of 36.49. The most frequently reported reason for referral was “trauma,” (23.5%, n = 368) whereas the second common reason for referral was abortion-related complications (14.2%, n = 222). The highest admissions were from abortion-related complications (20.2%, n = 169). Most patients’ transfers were from clinics and health posts outside Molepolole (59.4%, n = 930). More than half of the patients (64.2%, n = 537) transferred from outside Molepolole were admitted than discharged from the EC.DiscussionOur study has shown significant transfers to a higher facility for emergency care. The higher number of transfers are trauma-related cases, whereas most patients were admitted for abortion-related complications indicating the need for skill-building in trauma care and management of abortions.

Determinants of place birth: a multinomial logistic regression and spatial analysis of the Ethiopian mini demographic and health survey data, 2019

BackgroundMaternal and neonatal health significantly improves when birth is attended at health institutions where there are quality services and skilled attendants. In contrary, home birth results in high rates of maternal and neonatal mortality. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia based on the recent national survey.MethodsEthiopian mini-DHS-2019 data was used in this analysis. A weighted sample of 5423 mothers were included. While health facility was a reference, home and health post were used as comparison categories to identify determinants of place of birth in a survey multinomial logistic regression model. An adjusted relative risk ratio, marginal effect, and a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The prevalence of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth.ResultPrevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low coverage of cluster level 4 + antenatal visits were predictors of home birth. Also, home birth was clustered across enumeration areas and it was over 40% in most parts of the country with > 75% in the Somali region. SaTScan analysis detected most likely primary clusters in the Somali region and secondary clusters in the rest five regions of the country.ConclusionHome birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally, implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities by qualified providers and back-up systems in place could be supportive.

Assessing essential new born care practice and associated factors in mothers who gave birth within the last 6 months in east badewacho woreda, hadiyya zone, Ethiopia

Background: Every year, more than 2.7 million new-borns die before reaching neonatal age in the world, with the majority of these deaths occurring at home. Surprisingly, half of these occur within the first 24 hours of delivery, and 75% occur in the early neonatal period. One low-cost approach to improving new-born baby health outcomes is to promote essential new-born care practices. Objective: Thus, the purpose of this study was to evaluate essential new-born care practices and associated factors among mothers who gave birth within the last 6 months in East Badewacho woreda, Hadiyya zone. Methods: From March 1 to April 30, 2018, a community-based cross-sectional study was designed. The sampled population consisted of 399 mothers who had live births within the previous six months, as determined by a multistage random sampling technique. The data was collected using a semi-structured questionnaire and entered into Epi-data version 3.1 before being exported to SPSS version 21 for analysis. A binary logistic regression analysis with a 95% confidence interval was performed. Results: Less than half of the mothers (34.1 %) practice essential new-born care. The husband's educational status [AOR=0.24, CI (0.089, 0.64)] and [AOR=0.314, CI (0.126, 0.78)], place of delivery [AOR=0.024, CI (0.009, 0.068)] and knowledge of essential new-born care [AOR=2.03, CI (1.223,3.371)] were significant predictors of essential new-born care practice. Conclusion: The study's findings revealed that essential new-born care was not widely practiced in East Badewacho Woreda. As a result, strengthen the link between health centers and health posts in order to increase ANC, institutional delivery, and PNC service utilization.

Intrapartum care intervention fidelity and factors associated with it in South Wollo Administrative Zone, Northeast Ethiopia.

Abstract Background: Implementation of recommended intrapartum care intervention varies across places due to contextual socio-cultural and behavioral determinants. Previous research has utilized several operationalizations to measure intrapartum intervention content and has failed to analyze provider and facility-related factors that influence intrapartum intervention content. So yet, no study has used intervention fidelity metrics to assess intrapartum care. Therefore, this study aimed at assessing institutional intrapartum care intervention fidelity &amp; factors associated with it. Methods: On randomly selected keabeles (study sites), a cross-sectional study design was used. All health posts and health extension workers within the specified area were included, as were 898 postnatal mothers within six months of delivery. Data was collected via an interview, self-administered questionnaires, and an observation checklist. To calculate the institutional delivery coverage and intrapartum care intervention fidelity, descriptive statistics were used. The weighted sum of all intrapartum care components and institutional delivery coverage were used to calculate intrapartum care intervention fidelity. The researchers utilized a multilevel linear regression analysis model to find characteristics linked to intrapartum care intervention fidelity. Results: In this study, institutional delivery coverage was 60.9% (95% CI: 57.7 – 64.1) with intrapartum care intervention fidelity of 35.6% (95% CI: 31.3-35.9). Moreover, only 21 (2.3%) of mothers received all of the contents of intrapartum care intervention. Health posts’ distance from mothers’ home, unskilled birth attendant, poor relationship between HEWs and HC staffs and low HEWs knowledge of danger signs were statistically significant barriers while HEWs as birth attendant were facilitators for Intrapartum care intervention fidelity. Conclusion: This study investigated that intrapartum care intervention fidelity was low. This finding indicated that distance from health institution inhibit mothers to receive skilled intrapartum care interventions as recommended.

Evaluation of the outpatient therapeutic program for severe acute malnourished children aged 6–59 months implementation in Dehana District, Northern Ethiopia: a mixed-methods evaluation

BackgroundIn Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia. MethodsA facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children’s (diagnosed with acute malnutrition) record reviews, nine key informants’ interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done.ResultsThe overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09–0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04–4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01–3.30) were significantly associated with the acceptability of OTP program.ConclusionThe overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management.

Knowledge, attitudes, and practices of health care waste management among Zambian health care workers.

Poor management of health care waste poses a serious threat to the health of health care workers, patients and communities. In developing countries, adequate health care waste management (HCWM) is often a challenge. To address this, the Zambian Health Services Improvement Project with HCWM as a component, was implemented in five Zambian provinces (Luapula, Muchinga, Northern, North-Western and Western Provinces), under which this cross-sectional study was conducted to identify the knowledge, attitudes, and practices of health care workers on HCWM. Fifty government hospitals and health posts from five provinces in Zambia were included in the study. Data was collected using a mixed-methods approach, which included surveys with health care workers (n = 394), in-depth interviews (n = 47) with health officials at the provincial, district, and facility levels, and observational checklists (n = 86). Overall, knowledge of proper waste segregation was average (mean knowledge score 4.7/ 7). HCWM knowledge varied significantly by job position (p = 0.02) and not by facility level, years of service, nor prior training. Only 37.3% of respondents recalled having received any sort of HCWM training. Poor waste segregation practice was found as only 56.9% of the facilities used an infectious waste bag (yellow, red or orange bin liner) and a black bag for general waste. This study revealed that only 43% of facilities had a functional incinerator on site for infectious waste treatment. Needle sticks were alarmingly high with 31.3% of all respondents reporting a prior needle stick. The system of HCWM remains below national and international standards in health facilities in Zambia. It is imperative that all health care workers undergo comprehensive HCWM training and sufficient health care waste commodities are supplied to all health facility levels in Zambia.

Malaria-associated risk factors among adolescents living in areas with persistent transmission in Senegal: a case–control study

BackgroundIn Senegal, malaria morbidity has sharply decreased over these past years. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal.MethodsA case–control study was conducted from November to December 2020 in four health posts located in the Saraya district. Cases were defined as adolescents (10–19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Factors associated with clinical malaria were assessed using stepwise logistic regression analysis.ResultsIn total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65; 95% CI 1.58–4.45), non-use of other preventive measures (aOR = 2.51; 95% CI 1.53–4.11) and indoor sleeping (aOR = 3.22; 95% CI 1.66–6.23). Protective factors included 15–19 years of age (aOR = 0.38; 95% CI 0.23–0.62), absence of stagnant water around the house (aOR = 0.27; 95% CI 0.16–0.44), having a female as head of household (aOR = 0.47; 95% CI 0.25–0.90), occupation such as apprentice (OR = 0.24; 95% CI 0.11–0.52).ConclusionsThe study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups.