Institutional delivery service utilization and associated factors in Banja District, Awie Zone, Amhara Regional Sate, Ethiopia

Introduction: Many women lose their lives in the process of giving life. Maternal mortality remains high in the developing world. This study was conducted to assess institutional delivery service utilization and associated factors in Banja District, Amhara region, Ethiopia, 2013. Methods: A community-based cross-sectional study was conducted among mothers who gave birth in the last two years prior to the study in Banja District from June to July 2013. Multistage sampling technique was used to select the total of 394 study participants. Data were collected by means of a pretested standardized questionnaire. Analysis was carried out by using SPSS version 16. Crude and adjusted odds ratio with 95% confidence interval was calculated by using binary logistic regression. p-value less than 0.05 was considered as statistically significant. Results: The study indicated that only 15.7% of the respondents delivered in health institution. Age of mothers 15-24 years, educational status of the mothers with secondary and above, the existence of educated family members, mothers with previous experience with institutional delivery and mothers’ Knowledge on the danger signs of labor were significantly associated with institutional delivery service utilization at p-value less than 0.05. Conclusions: Institutional delivery service utilization in the study area was low (15.7%). Therefore, policy makers, health planers and programmers should recognize determinants of institutional delivery service utilization. More efforts should be given to educate mothers and families. Previous experience sharing and knowledge transfer will be crucial to bring expected institutional delivery utilization.

Competency Assessment and Factors Associated with It among Health Professionals at Debre Birhan Health Science College

Background: Competency assessment has a key role in the assurance of quality professionals in every discipline. Competency assessment is a method by which we can verify that our employees are competent to perform tasks timely. To derive the greatest benefit from the application of competency assessment in the health professionals, we must be sure that we are addressing areas where our efforts are utilized to optimize the patient care. There is no research done on the competency assessment so far except the report send by Technical Vocational and Educational Training. Objectives: To assess knowledge, attitude and practice of health professionals towards competency assessment and factors were associated with competencies at Debre Birhan Health Science College, 2013. Methods: A facility based cross sectional study was conducted using interview technique. Study participants were all students taking competency assessment in all departments at Debre Berhan Health Science College in two rounds. The percentage of participants who were competent was computed. Factors associated with competency were assessed using bivariate and multivariable logistic regression. Results: Among the total participants (n = 287), (57.8 percent) were female. Among the (n = 287) study participants, 226 (78.7%) were competent. Of these, 88.5% of the candidates were learned at governmental institution. Predictors of competency were department of the respondent AOR [95%];0.05 [0.01, 0.45], expectation of the results [AOR (95% CI) = 0.13 (0.02, 0.85)], number of competency taken [AOR (95% CI) = 0.11 (0.01, 0.88)] and candidates’ knowledge of their right and obligations AOR [95%];3.7 [1.3, 10.3]. Conclusions: Significant numbers of candidates were not yet competent due to various factors at different level. Therefore, comprehensive work should be done on the instructors, students and the center to make the candidates competent.

Prevalence of HIV and Associated Factors among Infants Born to HIV Positive Women in Amhara Region, Ethiopia

Background: An estimated 1.2 percent of pregnant women are living with HIV in Ethiopia and sadly, one of every 3 children born to these women is infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of pregnant women living with HIV have yet received the medication needed to prevent MTCT of HIV in Amhara region, Ethiopia. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers might be high. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV. Methods: All eligible records of HIV-exposed infants enrolled between January and December 2012 were reviewed from 17 health facilities which were providing PMTCT services. The study included 434 HIV-exposed infants having HIV DNA/PCR test result. Data were collected using structured data extraction formats. Data were then entered into EPI INFO Version 3.5.1 and analyzed by SPSS Version 16.0. Both bivariate and multivariate analyses were carried out to calculate odds ratios and to control for the effect of confounding. Result: The prevalence of HIV among exposed infants was 10.1%. Delay in HIV diagnosis (AOR = 1.3), mixed infant feeding (AOR = 8.8), failure to receive antiretroviral therapy during pregnancy or breast feeding (AOR = 21.6), failure to attend skilled delivery service (AOR = 6.1) and shorter duration of HIV treatment (AOR = 12) were the factors that increase the risk of mother-to-child transmission of HIV in this study. Conclusion: The prevalence of HIV among infants born to HIV positive women in the region is close to the national estimate of 10.9%. Delayed HIV diagnosis, inadequate use of antiretroviral therapy and lack of skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Having such a significant figure in the era of the world’s pledge to eliminate MTCT of HIV is unbearable. Ensuring access and use of integrated PMTCT services should be the top priorities of the national PMTCT program.

Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44;95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68;95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.

Diabetes mellitus is associated with increased mortality during tuberculosis treatment:a prospective cohort study among tuberculosis patients in SouthEastern Amahra Region,Ethiopia

Background:There is growing evidence suggesting that diabetes mellitus(DM)affects disease presentation and treatment outcome in tuberculosis(TB)patients.This study aimed at investigating the role of DM on clinical presentations and treatment outcomes among newly diagnosed TB patients.Methods:A prospective cohort study was conducted in South-Eastern Amhara Region,Ethiopia from September 2013 till March 2015.Study subjects were consecutively recruited from 44 randomly selected health facilities in the study area.Participants were categorized into two patient groups,namely,patients with TB and DM(TBDM)and TB patients without DM(TBNDM).Findings on clinical presentations and treatment outcomes were compared between the two patient groups.Cox proportional hazard regression analysis was applied to identify factors associated with death.Results:Out of 1314 TB patients enrolled in the study,109(8.3%)had coexisting DM.TBDM comorbidity[adjusted hazard ratio(AHR)3.96;95%confidence interval(C.I.)(1.76–8.89)],and TB coinfection with human immunodeficiency virus(HIV)[AHR 2.59;95%C.I.(1.21–5.59)]were associated with increased death.TBDM and TBNDM patients did not show significant difference in clinical symptoms at baseline and during anti-TB treatment period.However,at the 2nd month of treatment,TBDM patients were more symptomatic compared to patients in the TBNDM group.Conclusions:The study showed that DM is associated with increased death during TB treatment.DM has no association with clinical presentation of TB except at the end of the intensive phase treatment.Routine screening of TB patients for DM is recommended for early diagnosis and treatment of patients with TBDM comorbidity.

Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

Background:Measuring the size of the infectious pool of tuberculosis(TB)is essential to understand the burden and monitor trends of TB control program performance.This study applied the concept of TB management time to estimate and compare the size of the TB infectious pool between 2009 and 2014 in West Gojjam Zone of Amhara Region,Ethiopia.Methods:New sputum smear-positive and smear-negative pulmonary TB(PTB)and retreatment cases who attended 30 randomly selected public health facilities in West Gojjam Zone from October 2013 to October 2014 were consecutively enrolled in the study.In order to determine the infectious period,the TB management time(number of days from the onset of cough until start of anti-TB treatment)was computed for each patient category.The number of undiagnosed TB cases was estimated and hence the TB management time for the undiagnosed category was calculated.The total size of the TB infectious pool during the study period for the study zone was estimated as the annual number of infectious person days.Results:New smear-positive and smear-negative PTB cases contributed 25,050 and 12,931 infectious person days per year to the TB infectious pool,respectively.The retreatment and presently undiagnosed cases contributed 8840 and 34,310 infectious person days per year,respectively.The total size of the TB infectious pool in West Gojjam Zone during the study period was estimated at 81,131 infectious person days per year or 3405 infectious person days per 100,000 population per year.Compared to a similar study done in 2009 in the study area,the current study showed reduction of the TB infectious pool by 244,279 infectious person days.Conclusions:TB management time is a simple and practical tool that may help to estimate and compare the changes in the size of the TB infectious pool at local level.It may also be used as an indicator to monitor the changes in TB control program performance.