Urban Health Extension Program Research Articles

Assessment of Urban Health Extension Package Utilization and Healthcare Seeking Behavior Among Model and Non-model Households in Addis Ababa, Ethiopia: A Comparative Community Based Study

BACKGROUND: Ethiopia has been implementing the Urban Health Extension Program (UHEP) at the community level since 2009. The program was a pro-poor and cost-effective approach that aimed to enhance the utilization of urban health extension program packages and empower community healthcare-seeking behavior. This study was conducted to compare the utilization and healthcare-seeking behaviors of urban health extension program packages and the healthcare-seeking behaviors of model and non-model households. METHODS: A community-based comparative cross-sectional study was conducted among 594 female household heads (297 models and 297 non-models) using a structured face-to-face interview. A bivariate and multivariable logistic regression analysis was employed to identify associated factors. A p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval were carried out to identify significant factors. RESULTS: Urban health extension program package utilization was 78% among model and 64.2% among non-model female households. A total of 75.5% of model and 65.2% of non-model female household heads had appropriate healthcare-seeking behavior. Moreover, having information about UHEPs (AOR = 2.35, 95% CI = 1.08 - 3.42), the frequency of home visits by UHEWs (AOR = 2.12, 95% CI = 1.01 - 3.13), knowledge about UHEPs (AOR = 3.14, 95% CI = 2.43 - 4.47), and household graduation status (AOR = 3.052, 95% CI = 2.024 to 5.113) were significantly associated with urban health extension program package utilization and healthcare-seeking behaviors. CONCLUSION: In terms of utilization, the overall urban health extension package favors model female household heads over the non-model female household heads. As a result, raising awareness, frequent home visits, and focusing more on disease prevention and control packages will boost the adoption of urban health extension packages.

Implementation, experience, and challenges of urban health extension program in Addis Ababa: a case study from Ethiopia

BackgroundEven though the urban health extension program (HEP) has been implemented since 2009, little was known about its implementation, experience and challenges. Therefore, this study was aimed at exploring the implementation, experience, and challenges of the urban HEP.MethodsA qualitative case study was conducted in Addis Ababa from November 15 to December 29, 2017. The study participants were recruited purposefully. The parent populations were health extension professionals (HEPs). However, health post supervisors, health development army leaders (HDAs), Addis Ababa city HEP administrators, and other community members were also involved in the study. Four focus group discussions and 31 in-depth and key informant interviews were conducted. Data were transcribed verbatim, translated into the English, and analyzed by an inductive thematic analysis approach using Atlas ti7.1 software.ResultThe study found that there were 15 health service packages of the urban HEP delivered to the community based on the need of the households. The strategies for the program implementation were provision of trainings, home visitation, creation of model households, strengthening of HDAs, supervision and reporting, referral and feedback, and social and community mobilization. However, program implementation was challenged by the health system related challenges (health service package and delivery, workload of HEPs, shortage of trained HEPs, lack of regular supervision or monitoring, lack of logistical or motivational support, poor supply chain management, dissatisfaction of HEPs, assigning of more than expected households for HEPs, etc.), multisectoral related and community related challenges (HDAs need of incentives, and lack of graduating model households as per the plan, etc.).ConclusionsAlthough the program had a significant contribution to the health of community, it was affected by different challenges that underscore the need to develop different strategies and taking of actions. Therefore, the district health office, health centers and stakeholders from different sectors should have to support and motivate the HEPs and HDAs, and work together with them for successful implementation of the program.

Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study.

PurposeEthiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia.Patients and MethodsA community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services.ResultsThe utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8–63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21–0.63), housewives (AOR=0.36, 95% Cl=0.20–0.64), merchants (AOR=0.08, 95% Cl=0.03–0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73–6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02–2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22–3.18) were factors significantly associated with the utilization of urban health extension services.ConclusionThe overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants’ perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.

Modern Contraceptive Utilization and Its Associated Factors Among Women Beggars in Bahir Dar Town, North West Ethiopia

In Ethiopia the health extension packages as Ethiopia’s Health Extension Programs primarily targets to address maternal and child health problems specifically in addressing family planning services at household level. However women living on street, around churches and mosques living by begging cannot be addressed by health extension packages, only those beggars who have rented houses can be addressed by health extension packages, though modern contraceptive use among women beggars is scarce and not well known in the study area. This study aims to assess modern contraceptive utilization and associated factors among women beggars in Bahir Dar town, North Western Ethiopia. A quantitative cross-sectional study was conducted in March 2019 from Bahir Dar town, Northwestern Ethiopia on 238 women beggars using consecutive sampling technique with an interviewer administered structured questionnaire. Data was entered in to Epi-Info version 7 then, exported to SPSS version 23 for cleaning and analysis. Binary logistic regression analysis was used to determine the association between different factors and modern contraceptive service utilization. Those variables which had significant association with modern contraceptive service utilization were entered to multivariable logistic regression analysis. Finally odds ratio with 95% confidence intervals were used to identify the independent predictors of modern contraceptive utilization by women beggars. One hundred fifteen (48.9%) have ever used and seventy three (31.1%) with (95%CI=25.1-37.4%) were currently using modern contraceptives, 44 (60.3%) use injectable followed by implant 11 (15.1%). Being married (AOR=4.850 & 95%CI 2.285-6.971), being educated (AOR=5.771 & 95%CI 3.173-6.564), currently living in a rented house (AOR=2.155 & 95%CI 1.523-3.623), having a history of sexual assault/rape (AOR=3.846 & 95%CI 2.133-5.448) and having discussion with a HEW (AOR=3.173 95%CI 2.154-3.889) were more likely to be modern contraception users than their counter parts. The current contraceptive use among women beggars in Bahir Dar town Northwestern Ethiopia is lower considering the natures of their life styles and living conditions though working by including them in urban health extension program by targeting the identified factors is more helpful.

Factors associated with the early termination of exclusive breastfeeding among mother-infant dyads in Samara-Logia, Northeastern Ethiopia

BackgroundThe World Health Organization recommends that mothers should exclusively breastfeed their infants until 6 months of age due to the benefits for the mother and the child. There is documented evidence on exclusive breastfeeding from Ethiopia, but not specifically from Samara-Logia city administration. This study aimed to assess the factors associated with early termination of exclusive breastfeeding among mother-infant dyads in Samara-Logia, Ethiopia.MethodsA cross-sectional study was conducted in March 2018. Data were collected on 484 randomly selected mother-infant dyads. The Kaplan Meier curve with the log-rank test was used to compare the survival difference. Cox regression models were used to identify the predictors of early termination of exclusive breastfeeding.ResultsThe cumulative proportion of survival probability of exclusive breastfeeding to 6 months was 64.5%, with the median duration of 6 months. Mothers having partners with formal education [Adjusted hazard ratio (AHR): 0.58; 95% confidence interval (CI): 0.39, 0.85], receiving counseling on exclusive breastfeeding at antenatal check-up [AHR: 0.62; 95% CI: 0.43, 0.91], giving birth in a health institution [AHR: 0.50; 95% CI: 0.28, 0.88], initiating breastfeeding within the first hour [AHR: 0.41; 95% CI: 0.24, 0.68], and perceiving breast milk adequate for the first 6 months [AHR: 0.17; 95% CI: 0.12, 0.25] were associated with lower hazard of discontinuing exclusive breastfeeding before 6 months.ConclusionThis study showed that the cumulative proportion of survival probability on exclusive breastfeeding was low in Samara-Logia city administration. Educating husbands to support their partners, strengthening infant feeding counseling, promoting institutional delivery, educating women about the benefit of early initiation of breastfeeding, and expanding urban health extension program are important to improve the duration of exclusive breastfeeding in Ethiopia.

Family Planning Utilization Among Model and Non Model Family Women Enrolled in Urban Health Extension Program in Addis Ababa, Ethiopia, 2015

Background : In 2003, the Ethiopian Federal Ministry of Health (FMOH) launched a new health care plan, the “Accelerated Expansion of Primary Health Care Coverage,” through a comprehensive Health Extension Program (HEP).Recognizing the huge gap between need and health care services available, the FMOH has focused on “providing quality promotive, preventive, and selected curative health care services in an accessible and equitable manner to reach all segments of the population, with special attention to mothers and children. Objective: To assess on family planning service utilization among model and non-model family women enrolled in urban health extension program of kirkos sub-city administration. Method: A cross sectional study design using a quantitative method was used .A total of 424 (212 model families and 212 non-model families) participated the study. Adjusted ORs that controls the confounding effects of other covariates were calculated using the multiple logistic regression models of SPSS version 16 statistical programs. Statistical significance was considered at P-value less than 0.05. Result: Large proportion study population 210(81.08%) [109(78.4%)) and 101 (84.1%),) model and non-model respectively] were they prefer to be informed by health professional and followed by other (like friend husband...) were 27(10.42%) [18(12.9%) and 9(7.5%) for model and non-model families respectively], media (radio and TV) were 15(5.79%) [5(3.59) and10 (8.33%) for model and non-model families respectively] with X2 =4.21, p value =0.000021. Conclusion : By this measurement the UHEP programs lacks the aspects expected to be done. FMOH should see the implementation strategies of UHEP on providing and upgrading family planning service. Keywords: Family planning, Urban Health Extension Program (UHEP), Model /Non-model Family DOI : 10.7176/JMPB/59-04 Publication date :September 30 th 2019

Urban health extension service utilization and associated factors in the community of Gullele sub-city administration, Addis Ababa, Ethiopia

Background: In Addis Ababa, the capital of Ethiopia, the urban health extension program was started in 2009. Its approach is based on the assumption that access to and quality of primary health care in urban communities can be improved through transfer of health knowledge and skills to households. The study was conducted to assess the status of urban health extension service utilization and associated factors.Methods: A community based cross–sectional study was conducted to collect data from 628 participants. Sample size was determined by using a single population proportion formula. Binary logistic regression was used for data analysis.Results: The proportion of community utilization of the urban health extension program was found to be 86%. Respondents’ odds of utilizing urban health extension services among those who participated in the planning of urban health extension program activities were 2.8 (AOR=2.8; 95% CI: 1.43-3.70) times the odds of those who did not participate. The household respondents who utilized toilet with hand washing facilities had odds of utilizing urban health extension services that are higher by 2.62 (AOR=2.62 with 95% CI: 1.70-9.77) compared to those not utilizing toilet with hand washing facilities.Conclusions: The study provided important information regarding to the status of community utilization of urban health extension services. Respondents who utilized toilet with hand washing facilities were higher among the respondents who utilized and implemented the urban health extension packages. Respondents who participated in the planning of urban health extension program activities were those who significantly utilized and implemented the urban health extension program.

Urban health extension program model housing and household visits improved the utilization of health Services in Urban Ethiopia: a community-based cross-sectional study

BackgroundThe government of Ethiopia launched an innovative program called Urban Health Extension Program (UHEP) in 2009, aims to produce better health outcomes to the urban populations using urban health extension professionals (UHE-ps) by enabling households to implement most health intervention packages designed by the government, which is referred to as model households (practice and implement at least 75% of the training provided by UHE-ps on UHEP packages). The objective of this study was to assess health service use and its associated factors.MethodsA community-based cross-sectional study was conducted to assess the health service use in Addis Ababa. Structured questionnaires were filled out by 1086 women, and a binary logistic regression was performed.ResultsUrban health extension professionals performed home visits to 57.1% (95% CI (confidence interval) =54.2 to 59.8%) of the households. Mothers who had heard of the program (had information about UHEP) were 2.13 times more likely to visit the health center (HC) (AOR (adjusted odds ratio) =2.13, 95% CI = 1.36 to 3.32) than mothers who had not heard of the program. Mothers from model households were 2.12 times more likely to visit the HC (AOR = 2.12, 95% CI = 1.16 to 3.88) than mothers from non-model households. Mothers whose households were visited by the UHE-ps were 1.89 times more likely to visit the HC (AOR = 1.89, 95% CI = 1.22 to 2.94) than mothers whose households were not visited. Similarly, mothers who were in the reproductive age group (18 to 49 years) were 1.74 times more likely to visit the HC (AOR = 1.74, 95%CI = 1.12 to 2.71) than mothers above 49 years old.ConclusionsModel households and mothers in the reproductive age group exhibited significant associations with health service use. Sustaining the practices of graduated and certified model households is essential to maximize the benefits of the UHEP’s activities regarding health service use. Regular home visits to both model and non-model households are essential to scale up health service use and design re-graduation or other sustainable options for already graduated households.

The Ethiopian Health Extension Program and Variation in Health Systems Performance: What Matters?

BackgroundPrimary health care services are fundamental to improving health and health equity, particularly in the context of low and middle-income settings where resources are scarce. During the past decade, Ethiopia undertook an ambitious investment in primary health care known as the Ethiopian Health Extension Program that recorded impressive gains in several health outcomes. Despite this progress, substantial disparities in health outcomes persist across the country. The objective of this study was to understand how variation in the implementation of the primary health care efforts may explain differences in key health outcomes.Methods and FindingsWe conducted a qualitative study of higher-performing and lower-performing woredas using site visits and in-depth interviews undertaken in 7 woredas. We classified woredas as higher-performing or lower-performing based on data on 5 indicators. We conducted a total of 94 open-ended interviews; 12–15 from each woreda. The data were analyzed using the constant comparative method of qualitative data analysis. Substantial contrasts were apparent between higher-performing and lower-performing woredas in use of data for problem solving and performance improvement; collaboration and respectful relationships among health extension workers, community members, and health center staff; and coordination between the woreda health office and higher-level regulatory and financing bodies at the zonal and regional levels. We found similarities in what was reported to motivate or demotivate health extension workers and other staff. Additionally, higher-performing and lower-performing woredas shared concerns about hospitals being isolated from health centers and health posts. Participants from both woredas also highlighted a mismatch between the urban health extension program design and the urban-dwelling communities’ expectations for primary health care.ConclusionsData-informed problem solving, respectful and supportive relationships with the community, and strong support from zonal and regional health bureaus contributed to woreda performance, suggesting avenues for achieving higher performance in primary health care.

Community satisfaction with the urban health extension service in South Ethiopia and associated factors.

BackgroundThe urban health extension program (UHEP) is an innovative government plan to ensure health equity by creating demand for essential health services through the provision of appropriate health information at a household level. It aims to improve the overall health of a community through active participation and utilization of services, which depends on satisfaction and acceptance of the program. However, there is no study on community satisfaction with the services provided by the UHEP in Ethiopia. This study was aimed to assess the level of community satisfaction with the UHEP in Hadiya Zone, South Ethiopia, and the associated factors with it.MethodsA community based cross-sectional study, using quantitative and qualitative methods of data collection, was employed. Quantitative data were collected from 407 respondents using a structured questionnaire. Descriptive statistics, bivariate and multiple regression analyses were performed. P-value less than 0.05 and 95% confidence intervals were used to determine an association between independent and dependent variables. Qualitative data were collected through focus group discussions with village health committee members and model families in Hadiya Zone.ResultsThe majority (67.4%) of respondents were satisfied with the services provided by the UHEP. The communities’ perceptions of technical competency (ß = 0.425; 95% CIs 0.084, 0.34), interpersonal relationships (ß = 0.506; 95% CIs 0.216, 0.797), and perceived accessibility of services (ß = 0.752; 95% CIs 0.064, 0.86) were independent predictors of satisfaction (P < 0.05). In addition, the marital status, knowledge, and attitudes of the respondents were associated with community satisfaction.ConclusionA community’s satisfaction with UHEP has supposed to have a significant influence on the community’s utilization of the services and implementation of the program. The present study have clearly shown that majority of the respondents were satisfied with the services provided by urban health extension program.

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study.

BackgroundUnintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia.MethodsA community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05.ResultsThe magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn’t. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn’t use. Sex workers who had 60–96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]).ConclusionsHigh level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1366-5) contains supplementary material, which is available to authorized users.

Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: a cross-sectional study.

BackgroundExclusive breastfeeding is the most widely known and effective intervention for preventing early-childhood deaths. Optimum breastfeeding practices can prevent 1.4 million deaths worldwide among children under five every year. The aim of this study was to assess the prevalence of exclusive breastfeeding and associated factors among mothers who have an infant less than six months old in Debre Markos, Northwest Ethiopia.MethodsA community based cross-sectional study was conducted from April 1 to 30, 2013. A simple random sampling technique was used from a list of all mothers who had an infant less than six months old obtained from the health extension workers (HEWs) registration book in all kebeles (neighbourhoods) of the city. A total of 423 mothers with infants less than six months old were included in this study. Data were collected using questionnaires administered at interview. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with exclusive breastfeeding.ResultsThe prevalence of exclusive breastfeeding during the seven days before the survey was 60.8% (95% CI: 55.8%, 65.8%). Those mothers who were unemployed [AOR = 1.98 (1.21, 3.22)], received breastfeeding counseling during antenatal care (ANC) [AOR = 2.44 (1.53, 3.91)], received infant feeding counseling during postnatal care (PNC) [AOR = 5.03 (3.04, 8.31)], didn’t give prelacteal feeding [AOR = 3.44 (1.88, 6.33)] and had adequate knowledge about breastfeeding [AOR = 2.57 (1.57, 4.19)] were more likely to practice EBF than their counterparts.ConclusionsAlthough the prevalence of exclusive breastfeeding was lower in the study area than international recommendations, rates were higher than found in other studies. Recommendations for improving exclusive breastfeeding include better support for working mothers through extending maternal leave and establishing work-site day care centers for infants, expanding the urban health extension program so that more pregnant women and mothers can be taught about appropriate infant and young child feeding practices and how to express their milk, thereby increasing their breastfeeding knowledge.

Factors Associated with Men’s Awareness of Danger Signs of Obstetric Complications and Its Effect on Men’s Involvement in Birth Preparedness Practice in Southern Ethiopia, 2014

Background. Compared to average maternal mortality ratio of 8 per 100,000 live births in industrialized countries, Ethiopia has an estimated maternal mortality ratio of 676 per 100,000 live births. Maternal deaths can be prevented partially through increasing awareness of danger signs of obstetric complications and involving husbands (male) in birth preparedness practice.Methods. Community based cross-sectional study was done. All adult males with a wife or partner who lives in the selected kebeles were our study population. Data was collected by pretested and structured questionnaires and two-stage cluster sampling procedure was used in order to collect study samples. Data was cleaned and entered into Epi Info 7 and exported to SPSS (IBM-21) for further analysis. Ordinary and hierarchical logistic regression model were used and AOR with 95% CI were used to show factors and the effect of men’s awareness of danger sign on men’s involvement in birth preparedness practice.Results. Total numbers of men interviewed were 836 making a response rate of 98.9%. 42% of men had awareness of danger sign and 9.4% (95% CI: (7.42, 11.4) of men were involved in birth preparedness practice. Respondents who live in the rural area [(AOR: 8.41; (95% CI: (4.99, 14.2)], governments employee [(AOR: 3.75; (95% CI: (1.38, 10.2)], those who belong to the highest wealth quintile [(AOR: 3.09; (95% CI: (1.51, 6.34)], and husbands whose wives gave birth in the hospital [(AOR: 2.09; (95% CI: (1.29, 3.37)], health center [(AOR: 1.99; (95% CI: (1.21, 3.28)], and health post [(AOR: 2.2; (95% CI: 2.16 (1.06, 404)] were positively associated and those who had no role in the health development army [(AOR: 0.43; (95% CI: (0.26, 0.72)] were negatively associated with men’s awareness of danger signs of obstetric complications.Conclusion. The prevalence of men awareness of danger sign was low and male involvement in birth preparedness practice was very low. Since there is a low level of awareness (17.1%) particularly in the urban area and men act as gatekeepers to women’s health, the respective organization needs to review urban health extension program and give due emphasis to husband education in order that they are able to recognize danger signs of obstetric complications in a way to increase their involvement in birth preparedness practice.

Utilization of Environmental Health Services of Urban Health Extension Program and Associated Factors in Debretabor Town, North West Ethiopia: Cross Sectional Study

Back ground: Studies in a number of countries have shown that wherever indiscriminate waste disposal is high, infant and child mortality rates are high. Although utilization of environmental health services is an important indicator for measuring success of the health extension program; data on environmental health services of urban health extension program are scarce in the study area and elsewhere in Ethiopia. Objective: To assess utilization of environmental health services of urban health extension program and associated factors in Debretabor town, Amhara region, Ethiopia. Methods: A community based cross sectional study was conducted in Debretabor town from September 1-30, 2013. A total of 422 households were included in the study using systematic sampling technique. Data were collected using structured questionnaire and analyzed using SPSS version 16.0. Degree of association between independent and dependent variables was assessed with a 95% confidence level and p-value less than 0.05 was used to detect statistical significance. The findings of quantitative data were triangulated with the qualitative one. Result: In this study 69.8% and 65.5% of households practiced proper solid and liquid waste management mechanisms respectively. Income was found to be predictors for liquid waste management (AOR=1.82) Educational status of respondents was found to be predictors for liquid waste management (AOR=1.83). Conclusion: Solid and liquid waste management practices were lower than the minimum 75% expectation of the national health extension program package and, Educational status, house ownership, income and graduated as model family were main factors affecting environmental health services. Improving socio economic status of households, provision of continuous advice and technical support at household level on the utilization of environmental health service are recommended.