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1دورية أكاديمية
المصدر: BMC Health Services Research, Vol 24, Iss 1, Pp 1-14 (2024)
مصطلحات موضوعية: Accessibility barriers, Inequity, Healthcare utilization, Under-five children, Ethiopia, Public aspects of medicine, RA1-1270
الوصف: Abstract Background Disparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia. Methods Data were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization. Results This study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level. Conclusion This study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/1472-6963Test
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2دورية أكاديمية
المصدر: BMJ Open, Vol 14, Iss 3 (2024)
مصطلحات موضوعية: Medicine
الوصف: Introduction Despite Ethiopia’s policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists.Objective This study examined inequity and trends in polio immunisation and determinant factors among children aged 12–23 months in Ethiopia between 2000 and 2019.Methods Cross-sectional data from 2000, 2005, 2011, 2016 and 2019 Ethiopian demographic and health surveys were analysed with the updated version of the WHO’s Health Equity Assessment Toolkit software. Six standard equity measures: equity gaps, equity ratios, population attributable risk, population attributable fraction, slope index of inequality and relative index of inequality were used. Datasets were analysed and disaggregated by the five equality stratifiers: economic status, education, place of residence, sex of the child and regions. Multilevel logistic regression analysis was used to identify determinant factors.Results Polio immunisation coverage was increased from 34.5% (2000) to 60.0% (2019). The wealth index-related inequity, in coverage of polio immunisation between quintiles 5 and 1, was 20 percentage points for most surveys. The population attributable risk and population attributable fraction measure in 2011 indicate that the national polio immunisation coverage in that year could have been improved by nearly 36 and 81 percentage points, respectively, if absolute and relative wealth-driven inequity, respectively, had been avoided. The absolute difference between Addis Ababa and Afar Region was 74 percentage points in 2000 and 60 percentage points in 2019. In multilevel analysis result, individual-level factors like wealth index, maternal education antenatal care and place of delivery showed statistical significance.Conclusion Although polio immunisation coverage gradually increased over time, in the 20-year survey periods, still 40% of children remained unvaccinated. Inequities in coverage by wealth, educational status, urban–rural residence and administrative regions persisted. Increasing service coverage and improving equitable access to immunisations services may narrow the existing inequity gaps.
وصف الملف: electronic resource
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3دورية أكاديمية
المؤلفون: Yalemwork G. Mengistu, Damen Hailemariam, Meselech A. Roro, Bilal S. Endris, Kokeb Tesfamariam, Seifu H. Gebreyesus
المصدر: BMC Pediatrics, Vol 23, Iss 1, Pp 1-10 (2023)
مصطلحات موضوعية: Intrauterine growth, Fetal growth, Growth pattern, BUNMAP, Longitudinal study, Ultrasound, Pediatrics, RJ1-570
الوصف: Abstract Background Abnormal fetal growth pattern during pregnancy including excessive fetal size and intrauterine growth restrictions are the major determinants for perinatal outcomes and postnatal growth. Ultrasonography is a useful tool in monitoring fetal growth for appropriate care and interventions. However, there are few longitudinal studies using serial ultrasonography in low and middle-income countries. Moreover, the reference charts used for fetal growth monitoring in low-income countries comes from high income countries with distinct population features. Therefore, the purpose of this study was to evaluate the intrauterine growth pattern of the fetus using serial ultrasonography. Methods We conducted a prospective community-based cohort study from March 2018 to December 2019. Pregnant women with gestational age of 24 weeks or below living in the Butajira HDSS were enrolled. We followed the pregnant women until delivery. Serial ultrasound measurements were taken, and fetal weight was estimated using the Hadlock algorithm based on biparietal diameter, head circumference, abdominal circumference, and femur length. The z-scores and percentiles of biometric measurements were calculated and compared to the INTERGROWTH-21st International Standards for Fetal Growth. Results We reviewed a total of 2055 ultrasound scans and 746 women who fulfill the inclusion criteria were involved”. We found similar distribution patterns of biometric measurements and estimated fetal weight compared to the previous study done in Ethiopia, the WHO and INTERGROWTH-21st references. In our study, the 5th,50th and 95th percentiles of estimated fetal weight distribution have a similar pattern to the WHO and INTERGROWTH-21st charts. The 50th and 95th percentile had also a similar distribution pattern with the previous study conducted in Ethiopia. We found that 10% of the fetus were small for gestational age (below the 10th percentile) based on the Z-score of estimated fetal weight. Conclusion Our study evaluated the fetal growth patterns in rural community of Ethiopia using serial ultrasound biometric measurements. We found similar IUG patterns to the WHO and INTERGROWTH-21st reference standards as well as the previous study conducted in Ethiopia.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/1471-2431Test
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4دورية أكاديمية
المؤلفون: Tamiru Demeke, Damen Hailemariam, Pablo Santos, Edom Seife, Adamu Addissie, Eric Sven Kroeber, Rafael Mikolajczyk, Birgit Silbersack, Eva Johanna Kantelhardt, Susanne Unverzagt
المصدر: PLoS ONE, Vol 19, Iss 3, p e0300631 (2024)
الوصف: IntroductionBreast cancer (BC) is the most common malignant neoplasm among women in Addis Ababa, Ethiopia. The willingness and ability to pay (WATP) for treatment is a contributing factor in the utilization of health care services. The World Health Organization Breast Cancer Initiative calls for 80% of patients to complete multimodality treatment and indicates payment as central factor to improve BC outcome. The objectives of this study are to identify how much female BC patients paid in Addis Ababa for BC treatment, their WATP for BC treatment, and the factors that affect WATP.MethodsThe researchers collected data from 204 randomly selected BC patients who were treated in one of four different health facilities (one public and three private) between September 2018 and May 2019. A structured questionnaire was used to assess their WATP for BC treatment and multivariable regression to investigate factors associated with patients' WATP.ResultsOf interviewed patients, 146 (72%) were at reproductive age. Patients' median expenditure for all BC treatment services was 336 US dollars (USD) in a public cancer center and 926 USD in privately owned health facilities. These amounts are in contrast with a reported WATP of 50 USD and 149 USD. WATP increased with increasing expenditure (OR 1.43; 95% CI 1.09 to 1.89 per 100 US), educational level (OR 1.37; 95% CI 1.02 to 1.85) and service quality (OR 1.34; 95% CI 1.04 to 1.72). In contrast, a monthly income increase by 100 USD corresponds to a 17% decrease of WATP (OR 0.83; 95% CI 0.70 to 0.99).ConclusionsWe demonstrated that BC treatment was very expensive for patients, and the cost was much higher than their WATP. Thus, we suggest that BC should be included in both social and community-based health insurance plans and treatment fees should consider patients' WATP.
وصف الملف: electronic resource
العلاقة: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0300631&type=printableTest; https://doaj.org/toc/1932-6203Test
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5دورية أكاديمية
المصدر: PLoS ONE, Vol 19, Iss 1 (2024)
وصف الملف: electronic resource
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6دورية أكاديمية
المؤلفون: Kevin Croke, PhD, Mosa Moshabela, MMed PhD, Neena R Kapoor, MSc, Svetlana V Doubova, MD DSc, Ezequiel Garcia-Elorrio, MD PhD, Damen HaileMariam, ProfMD PhD, Todd P Lewis, PhD, Gloria N Mfeka-Nkabinde, MD, Sailesh Mohan, ProfMD PhD, Peter Mugo, PhD, Jacinta Nzinga, PhD, Dorairaj Prabhakaran, ProfMD DM, Ashenif Tadele, MSc, Katherine D Wright, DrPH, Margaret E Kruk, ProfMD
المصدر: The Lancet Global Health, Vol 12, Iss 1, Pp e134-e144 (2024)
مصطلحات موضوعية: Public aspects of medicine, RA1-1270
الوصف: Summary: Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.
وصف الملف: electronic resource
العلاقة: http://www.sciencedirect.com/science/article/pii/S2214109X23005132Test; https://doaj.org/toc/2214-109XTest
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7دورية أكاديمية
المؤلفون: Tsegahun Manyazewal, Mohammed K. Ali, Tedla Kebede, Matthew J. Magee, Tewodros Getinet, Shivani A. Patel, Damen Hailemariam, Cam Escoffery, Yimtubezinash Woldeamanuel, Nardos Makonnen, Samrawit Solomon, Wondwossen Amogne, Vincent C. Marconi, Abebaw Fekadu
المصدر: npj Digital Medicine, Vol 6, Iss 1, Pp 1-12 (2023)
مصطلحات موضوعية: Computer applications to medicine. Medical informatics, R858-859.7
الوصف: Abstract Investments in digital health technologies such as artificial intelligence, wearable devices, and telemedicine may support Africa achieve United Nations (UN) Sustainable Development Goal for Health by 2030. We aimed to characterize and map digital health ecosystems of all 54 countries in Africa in the context of endemic infectious and non-communicable diseases (ID and NCD). We performed a cross-national ecological analysis of digital health ecosystems using 20-year data from the World Bank, UN Economic Commission for Africa, World Health Organization, and Joint UN Programme on HIV/AIDS. Spearman’s rank correlation coefficients were used to characterize ecological correlations between exposure (technology characteristics) and outcome (IDs and NCDs incidence/mortality) variables. Weighted linear combination model was used as the decision rule, combining disease burden, technology access, and economy, to explain, rank, and map digital health ecosystems of a given country. The perspective of our analysis was to support government decision-making. The 20-year trend showed that technology characteristics have been steadily growing in Africa, including internet access, mobile cellular and fixed broadband subscriptions, high-technology manufacturing, GDP per capita, and adult literacy, while many countries have been overwhelmed by a double burden of IDs and NCDs. Inverse correlations exist between technology characteristics and ID burdens, such as fixed broadband subscription and incidence of tuberculosis and malaria, or GDP per capita and incidence of tuberculosis and malaria. Based on our models, countries that should prioritize digital health investments were South Africa, Nigeria, and Tanzania for HIV; Nigeria, South Africa, and Democratic Republic of the Congo (DROC) for tuberculosis; DROC, Nigeria, and Uganda for malaria; and Egypt, Nigeria, and Ethiopia for endemic NCDs including diabetes, cardiovascular disease, respiratory diseases, and malignancies. Countries such as Kenya, Ethiopia, Zambia, Zimbabwe, Angola, and Mozambique were also highly affected by endemic IDs. By mapping digital health ecosystems in Africa, this study provides strategic guidance about where governments should prioritize digital health technology investments that require preliminary analysis of country-specific contexts to bring about sustainable health and economic returns. Building digital infrastructure should be a key part of economic development programs in countries with high disease burdens to ensure more equitable health outcomes. Though infrastructure developments alongside digital health technologies are the responsibility of governments, global health initiatives can cultivate digital health interventions substantially by bridging knowledge and investment gaps, both through technology transfer for local production and negotiation of prices for large-scale deployment of the most impactful digital health technologies.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/2398-6352Test
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8دورية أكاديمية
المؤلفون: Fikru Abebe Gebremariam, Ephrem Mannekulih Habtewold, Dereje Tegene Degife, Habte Bekele Geneti, Damen Hailemariam Gebrekiros
المصدر: Reproductive Health, Vol 20, Iss 1, Pp 1-18 (2023)
مصطلحات موضوعية: Comprehensive abortion care, Ethiopia, Oromia, Readiness, Satisfaction, Shawa, Gynecology and obstetrics, RG1-991
الوصف: Abstract Background In Ethiopia only 53% of induced abortions were performed in a health facility. Even though efforts have been made to improve comprehensive abortion care (CAC), still several health facilities fail to provide the services. Even in facilities where such care is provided, significant numbers of clients report their dissatisfaction with the service. Hence, this study sought to assess availability and readiness to meet the need for CAC, client satisfaction with the service and associated factors in public health facilities of East Shawa Zone, from March 1 to July 31, 2020. Method Cross-sectional study was conducted taking a random sample of 30 health facilities and 900 women who received CAC and providers who delivered the services. Data were collected using interviewer-administered questionnaire and observational checklist. The analysis was performed using Stata-13. Descriptive summaries were used to characterize study participants, to determine service availability and readiness of facilities. The levels of satisfaction were estimated using proportion with a 95% confidence interval (CI). Multilevel ordinal logistic regression analysis was performed to identify factors associated with service satisfaction. The magnitude of association was estimated by adjusted odds ratios (AOR) with a 95% CI, and a p-value
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/1742-4755Test
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9دورية أكاديمية
المؤلفون: Amanuel Yigezu, Senait Alemayehu, Shallo Daba Hamusse, Getachew Teshome Ergeta, Damen Hailemariam, Alemayehu Hailu
المصدر: Cost Effectiveness and Resource Allocation, Vol 18, Iss 1, Pp 1-12 (2020)
مصطلحات موضوعية: Ingredients costing, Decision tree modeling, Reciprocal cost allocation, Cost-effectiveness analysis, VCT models, Medicine (General), R5-920
الوصف: Abstract Background Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.
وصف الملف: electronic resource
العلاقة: http://link.springer.com/article/10.1186/s12962-020-00231-xTest; https://doaj.org/toc/1478-7547Test
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10دورية أكاديمية
المؤلفون: Anayda Portela, Rajiv Bahl, Sarmila Mazumder, Nita Bhandari, Jose Martines, Lynn M Sibley, Ramesh Agarwal, Gary L Darmstadt, Khalid Aziz, Thomas Brune, Araya Abrha Medhanyie, Selemawit Asfaw Beyene, John N Cranmer, Dereje Duguma, Addisalem Fikre, Abebe Gebremariam Gobezayehu, H L Mohan, Arin Kar, Raghav Krishna, Aarti Kumar, Vishwajeet Kumar, Mulusew Lijalem Belew, Prem K Mony, Abiy Seifu Estifanos, Henok Tadele, Abraham Tariku, Birkneh Tilahun Tadesse, Marta Yemane Hadush, Grace J Chan, Krishnamurthy Jayanna, Tarun Kumar, Pankaj Kumar, Sonia Trikha, Damen HaileMariam, Alok Kumar, Arun Singh Jadaun, Fitsum W/Gebriel, Lamesgin Alamineh, Maryann Washington, Dejene Hailu Kassa, Hajira Amin Mohammed, Tedros Hailu Abay, Fisseha Ashebir Gebregizabher, Selamawit Mengesha Bilal, Mesfin Kote Debere, Suresh Kumar Dalpath, Samson Yohannes Amare, Arti Sahu, Prabhu Deva Gowda, Pramod Kumar Singh, Dawit Seyoum Gebremariam, Harsh Vardhan Jaiswal, Suman Rao PN
المصدر: BMJ Global Health, Vol 6, Iss 9 (2021)
مصطلحات موضوعية: Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
الوصف: Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.
وصف الملف: electronic resource
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