Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Introduction: While the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them. Methods: In this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630). Results: According to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers. Conclusion: Our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components

Clinical decision making approaches and associated factors among nurses working in a tertiary teaching hospital

Introduction: The clinical decision-making approach is an ongoing process in the nursing clinical setting and has an impact on the survival of the patient under their care. Objective: To assess clinical decision-making approaches among hospital nurses. Methods and materials: An institutional-based cross-sectional study was conducted from March 20 to April 4, 2018. A single population proportion formula for sample size determination and stratified sampling technique was used to select the study participants. The data was gathered using a pretested, structured, self-administered questionnaire and trained data collectors. The data was analyzed using SPSS version 20. To explain the study variables, frequency tables, figures, and percentages were used. Bivariable and multivariable logistic regressions were used to see the association between independent and dependent variables. Results: Among the total participants, 44.3% had intuitive and 55.7% had analytical decision-making approaches. Being at a higher educational level (aOR = 3.49, 95 % CI (1.45, 13.16)), having 10 years experience, having a high workload (aOR = 0.54, 95 % CI (0.37,0.42)) and having training (aOR = 3.11, 95 % CI (1.83, 5.28)) were significantly associated with intuitive clinical decision making. Conclusion: The intuitive decision-making approach was lower as compared to most of the previous studies. Variables such as higher experience, the high workload in the working unit, and talking training in clinical decision-making were significantly associated with the intuitive decision-making approach. Therefore, policymakers ought to implement the standard nurse-to-patient ratio and design training on how to handle the patient in different situations to achieve a good decision-making approach

Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of public hospitals in Addis Ababa, Ethiopia

Abstract Background Neonatal hypothermia is a worldwide problem and an important contributing factor for Neonatal morbidity and mortality especially in developing countries. High prevalence of hypothermia has been reported from countries with the highest burden of Neonatal mortality. So the aim of this study was to assess the prevalence of Neonatal hypothermia and associated factors among newborn admitted to Neonatal Intensive Care Unit of Public Hospitals in Addis Ababa. Methods An institutional based cross-sectional study was conducted from March 30 to April 30, 2016, in Public Hospitals in Addis Ababa and based on admission rate a total of 356 Neonates with their mother paired were enrolled for the study. Axillary temperate of the newborn was measured by a digital thermometer at the point of admission. Multivariate binary logistic regression, with 95% confidence interval and a p-value < 0.05 was used to identify variables which had a significant association. Results The prevalence of Neonatal hypothermia in the study area was 64%. Preterm delivery (AOR = 4.81, 95% CI: 2.67, 8.64), age of Neonate ≤24 h old (AOR = 2.26, 95% CI: 1.27, 4.03), no skin to skin contact with their mother immediately after delivery (AOR = 4.39, 95% CI: 2.38, 8.11), delayed initiation of breastfeeding (AOR = 3.72, 95% CI: 2.07, 6.65) and resuscitation at birth (AOR = 3.65, 95%CI: 1.52, 8.78) were significantly associated with hypothermia. Conclusions The prevalence of Neonatal hypothermia in the study area was high. Preterm delivery, age ≤ 24 h old, no skin to skin contact immediately after delivery, delayed initiation of breastfeeding and resuscitation at birth were independent predictors of Neonatal hypothermia. Therefore attention is needed for thermal care of preterm newborn and use of low-cost thermal protection principles of warm chain especially on early initiation of breastfeeding, skin to skin contact immediately after delivery and warm resuscitation

Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia

Abstract Background Globally 3.1 million children die each year in their neonatal period (first 28 days of life) according to World Health Organization (WHO) 2011 report. Half of these surprisingly occur within the first 24 h of delivery and 75% occur in the early neonatal period. Methods A community based cross-sectional study design was carried out from March 2016 to April, 2016 in Damot Pulasa district, Wolaita zone, Southern Ethiopia to assess selected essential newborn care practices and associated factors among home delivered mothers in Damot pulasa district. Data were entered into Epi Info version 3.5.1 and exported to SPSS version 20 software for analysis. Multiple logistic analyses were done to control possible confounding variable. A P-value less than 0.05 was taken as a significant association. Result The study showed that the prevalence of essential newborn care practice was 24%. Multivariate logistic regression analysis revealed that variables like ANC visit (AOR =0.213,P = 0.015,CI = 0.102–0.446),PNC visit (AOR = 0.209, P = 0.00,CI = 0.110–0.399), advice about essential newborn care practice (AOR =0.114,P = 0.0001, CI = 0.058–0.221),urban areas women (AOR =2,P = 0.042, CI = 1.024–3.693), planned pregnancy (AOR = 7, P = 0.00, CI =3.732–11.813), and knowledge about newborn danger signs (AOR = 0.277, P = 0.006, CI = 0.110–0.697) were the independent predictors of ENBC practices. Conclusion Generally, coverage of essential newborn care practices was low. ANC visit, advice about ENBC, PNC visit, residence, planned pregnancy and knowledge about newborn danger signs were predictors of essential newborn care practice in the study area. Therefore, Health facilities should enhance linkage with health posts to increase ANC and PNC service utilization. Health extension workers should also promote and give health education about pre-lacteal feeding, early bathing, planned pregnancy, newborn danger signs and application of materials on the newborn stump

Referral Service Barriers in Ethiopia: experiences and perceptions of actors.

AbstractBackground: Globally, about 2.8 million neonates and 295,000 mothers die annually. Almost two-third of these deaths are reported from Africa and Asia. The causes have been attributed to sepsis, asphyxia, prematurity, hemorrhage, obstructed labor, and hypertension. To save the lives of women and babies, the Ethiopian Ministry of Health developed and implemented a referral system which comprises a network of primary health care facilities, a guiding document, and established tracking mechanisms. However, there is limited information on barriers to effective patient referrals. This study aims to assess referral barriers at primary healthcare entities in four regional states of Ethiopia.Methods: The study employed a cross-sectional study design with mixed qualitative and quantitative methods. It was conducted in September 2019 in four purposively selected districts with high referral rates in Ethiopia. The quantitative data were collected for a one-month period from all 1,139 referral service beneficiaries or adult care takers in targeted health facilities using exit interviews. In addition, qualitative data was collected from 52 key informants using in-depth interviews. The quantitative data was analyzed using SPSS v20 and is presented using, tables, and figures. Qualitative data were transcribed verbatim were read and reread. Categories and themes that emerged and corresponding codes were labeled using open code software.Results: Out of 1,139 formally referred patients, 95% reported that no pre-referral communication occurred between referring and receiving facilities. On the qualitative data analysis, five themes emerged as follows: (1) Lack of provider communication skills, (2) lack of governing documents, (3) shortage of human resource, and (4) Lack of essential equipment in ambulance services, and (5) Lack of infrastructure.Conclusion: This study explored and described several referral service barriers in four regional states of Ethiopia. The referral service barriers were influenced by both individuals and health systems related factors. The investigators recommend implementing performance and quality improvement interventions to strengthen the referral systems. In addition, to address the barriers of referral system, improving the communication skills of health care providers was recommended. Furthermore, providing governing documents including referral protocol, referral service directory, and guidelines can solve some of the referral services barriers. Equipping ambulances with trained providers and lifesaving equipment, enhancing telephone lines and office facilities are recommended. [Ethiop. J. Health Dev. 2021;35(SI-5):55-62]Keywords: referral, barrier, primary healthcare, experience, Ethiopi

Biosynthesis and characterization of copper oxide nanoparticles from Plumbago zeylanica leaf extract for antibacterial and antioxidant activities

Abstract In recent years, green synthesis has become a prevalent method for producing metallic oxide nanoparticles, preferred over traditional physical and chemical processes because of its low toxicity, cost-effectiveness, and environmental friendliness. Therefore, this study aimed to synthesize and characterize CuO NPs using P. zeylanica leaf extract, as well as to assess their total phytochemical content, in vitro antibacterial properties, and antioxidant activity. The synthesized CuO NPs were analyzed using UV–visible spectrophotometry, XRD, SEM, FTIR, and TGA/DTA. UV–visible spectroscopy revealed SPR peaks at 376 nm, confirming the formation of CuONPs, with a band gap energy of 3.22 eV indicating their semiconductor nature. FTIR analysis reveals the presence of Cu–O bonds around 528cm−1. XRD analysis further confirmed the monoclinic phase of CuO NPs, with an average crystallite size of 25.15 nm. The spherical shapes of the synthesized CuO NPs were determined using SEM analysis. TGA/DTA analysis revealed a weight loss of 19.3% within the temperature range of 21–600 °C. Along with this study, the antibacterial activity of the biosynthesized CuONPs was evaluated using an agar well diffusion assay against three gram-negative and two gram-positive. The results demonstrate that CuO NPs were more effective against gram-negative bacteria, showing inhibition zones of 19.33 mm, 20.30 mm, and 16.50 mm against Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumonia, respectively. The antioxidant activity was evaluated, and IC50 values for DPPH assays of the synthesized CuO NPs, P. zeylanica leaf extract, and ascorbic acid were determined to be 123.77 ± 1.96, 97.28 ± 1.85, and 27.08 ± 0.15 μg/mL, respectively. These results indicate significant antioxidant and antibacterial activity for CuO NPs

Bacterial profile, drug resistance pattern, clinical and laboratory predictors of ascites infection in cirrhosis patients

Abstract Ascites is a pathological collection of free fluid in the peritoneal cavity, which is a common complication in patients with cirrhosis, an advanced liver disease. Bacterial infection increases the mortality rate of hospitalized patients with cirrhosis, irrespective of the severity of the liver disease. Around 60% of patients with compensated cirrhosis developed ascites within 10 years during the course of their disease. The in-hospital mortality rate due to spontaneous bacterial peritonitis (SBP) could exceed 90%, but with early diagnosis and prompt antibiotic therapy, this rate has been shown to decrease to 20%. Here, we enrolled adult (age ≥ 18) patients with liver disease with evidence of cirrhosis who developed ascites and assessed the presence of spontaneous ascites fluid infection (SAFI) in these patients. Of the total 218 patients, 22.9% (50/218) develop ascites infection. The liver organ function tests like alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin were found to be significantly (P < 0.05) higher in patients with ascites fluid infection compared to patients with non-ascites fluid infection. Of the gram-negative bacteria, K. pneumonia and E. coli were isolated and found to be 100% resistant to amoxicillin and clavulanate. From the gram-positive bacterial isolates, S. aureus was only resistant to penicillin, whereas Str. viridans was resistant to ceftriaxone, cefotaxime, cefepime, and penicillin. On the other hand, clinical features such as a history of jaundice, low arterial blood pressure, and ultrasound results such as a shrunken liver and enlarged spleen were also independent predictors of spontaneous bacterial peritonitis. In conclusion, given the high probability of death following SAFI, early detection, and treatment, as well as knowledge of the microbial agent, resistance profile, and predictive markers in various contexts, are essential for the timely diagnosis and management of SAFI in these patients

Treatment of chronic hepatitis B in Ethiopia: 1-year results from a real-life, multicentre, prospective cohort study.

BackgroundIn the global efforts to combat chronic hepatitis B virus (HBV) infection, the African continent is falling behind. Simplified treatment guidelines are recommended by WHO in low-income and middle-income countries, but it is unclear how this approach works in real life. We aimed to address this knowledge gap using a simplified treatment programme in Ethiopia.MethodsWe did a prospective cohort study in four public hospitals in Ethiopia. We enrolled HIV-negative adults (age ≥18 years) with chronic HBV infection and applied simplified treatment criteria on the basis of clinical assessment, aspartate aminotransferase-to-platelet ratio index (APRI), alanine aminotransferase, and point-of-care HBV DNA. The primary endpoint was 1-year treatment outcome (active in care, dead, or lost to follow-up), and secondary endpoints were virological and biochemical treatment response. We used Cox proportional hazards regression models to identify predictors of death and logistic regression models to explore associating factors with decompensated cirrhosis. This study is registered with ClinicalTrials.gov, NCT02344498.FindingsBetween Dec 8, 2021, and Dec 31, 2023, we enrolled 6010 participants (2953 [49·1%] female and 3057 [50·9%] male; median age 30 years [IQR 25-38]), of whom 1672 (27·8%) were eligible for treatment. 1138 (18·9%) started tenofovir disoproxil fumarate treatment before July 1, 2023, and were included in the 1-year analysis. 532 (46·7%) participants were active in care after 1 year, 58 (5·1%) died, and 508 (44·6%) were lost to follow-up. Of the participants active in care after 1 year, 321 (78·3%) of 410 had virological suppression (HBV DNA ≤10 IU/mL) and 289 (67·5%) of 428 had normal ALT (≤40 U/L). Independent predictors of death were decompensated cirrhosis (adjusted hazard ratio [HR] 8·74 [95% CI 5·01-15·27]) and age (per 1-year increment; adjusted HR 1·03 [1·01-1·05]). Decompensated cirrhosis was associated with male sex (adjusted odds ratio [OR] 1·68 [95% CI 1·17-2·40]), increasing age (per 1-year increment; adjusted OR 1·02 [1·01-1·03]), regular khat use (adjusted OR 1·54 [1·11-2·12]), and HBV DNA concentration greater than 200 000 IU/mL (adjusted OR 1·52 [1·10-2·11]).InterpretationAbout half of the participants who initiated HBV treatment were still active in care after 1 year, and most of whom had virological and biochemical response to treatment. However, the high proportion lost to follow-up underscores the need for better strategies and tools to improve retention in HBV care.FundingThe South-Eastern Norway Regional Health Authority and the John C Martin Foundation