Mirkuzie Woldie

ABSTRACT ABSTRACT Review question/objective The objective of this review is to identify the best available evidence regarding the association between perceived HIV-related stigma and presentation for HIV/AIDS care in developing countries. Inclusion criteria Types of participants This review will consider studies that include HIV-positive participants aged 15 years and older in developing countries; defined as those countries listed as “low human development” on the 2013 WHO human development index rankings. Patients receiving prior HIV/AIDS care will be excluded from this review. Types of exposure(s) This review will consider studies that evaluate HIV-related stigma. HIV-related stigma may be measured using any validated tool, either by self-administered questionnaire or interviewing method for people living with HIV, health workers, or the general population. Types of outcomes This review will consider studies that include the following outcomes: Time at presentation for HIV care, measured by immune status or stage of HIV infection. Early presentation for HIV care is defined as WHO stage I or II and CD4>=200 cells/µL. Late presentation for HIV care is defined as WHO stage III or IV or CD4<200 cells/µL. KEYWORDS Protocol; Presentation of HIV care; Developing countries; Adult population

Background: Despite unrelenting global efforts to contain its spread, Coronavirus disease 2019 (COVID-19) is still causing unprecedented crises globally with no proven vaccine or cure so far. Ethiopia reported its first case on 13 March 2020 but has an accelerated increase in caseload and geographic distribution since recently. We now describe the epidemiology of COVID-19 in Oromia Regional State, the largest and most populous region in Ethiopia, during the early months of the outbreak.Methods: We analyzed data from the COVID-19 surveillance database of the Oromia Regional Health Bureau. We included RT-PCR confirmed COVID-19 cases diagnosed at healthcare facilities across the region during the period of 13 March to 13 September 2020.Findings: COVID-19 was confirmed in 8955 (5·5%) of 164206 individuals tested during the surveillance period. The test positivity rate increased from an average of 1·0% in the first three months to 6·3% in August and September. About 70% (6230) of the cases were male;the mean age was 30·0 years (SD=13·3) and 87·8% were between 10 and 49 years of age. Only 64 (0·7%) of the cases had symptoms at diagnosis. Among symptomatic cases, cough was the most common, reported in 48 (75·0%) and fever the least common, reported in 11 (17·2%) of cases. Moreover, only 6 (0·1%) cases presented with severe disease. Overall, 4346 (48·5%) have recovered from the virus and a total of 52 deaths were reported with a case fatality rate of 1·2%. However, the reported case fatality rate should be interpreted cautiously since in 44 (84·6%) of those reported as COVID-19 death, the virus was detected from a dead body.Interpretation: The COVID-19 infection rate in the Oromia Region of Ethiopia is surging six months after the onset of the pandemic in the country. So far, the proportion of symptomatic cases and severe diseases besides the fatality rate are lower than reports from most other developing and developed countries. This epidemiologic profile might have prevented the anticipated health system crisis to date, but it can hinder efforts to contain the outbreak.Funding: NoneDeclaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The authors have obtained authorization to use the surveillance data from Oromia Regional Health Bureau Public Health Emergency Management and Health Research Directorate

BACKGROUND: Professional commitment is beyond a commitment for a particular organization and implies the individuals’ perspective towards their profession and the motivation that they have to stay in their job with willingness to strive and uphold the values and goals of the profession. InEthiopia, uptake of institutional delivery services is low. However, the level and factors associated with professional commitment is not known so far. Hence, our objective is to assess the level and factors associated with commitment of health professionals providing institutional delivery services in public health facilities of  Jimma Zone, Southwest Ethiopia.METHODS: A facility-based cross-sectional study design was conducted from March 01-20, 2016. A total of 442 eligible health professionals were included from randomly selected 7 districts and 47 respective health facilities. Health professionals were requested to fill self-administered questionnaire. After checking its completeness, the data ...

BackgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.MethodsWe analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.ResultsThe rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant ...

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...

Review question/objective The objective of this review is to determine the effectiveness of home‐based HIV counselling and testing in reducing HIV related stigma and risky sexual behavior among adults and adolescents. As a secondary outcome, the review will also determine the effect of home‐based HIV counselling and testing on clinical outcomes. Background Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is one of the leading causes of mortality and morbidity worldwide.1 In a 2010 analysis of disease burden, it was ranked first among leading causes of disability adjusted life years (DALYs) in Southern Sub‐Saharan Africa and Eastern Sub‐Saharan Africa and the fifth leading cause of DALYs globally.1 In the same year, HIV/AIDS was the main cause of DALYs for young adults globally.1 According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) report, at the end of 2013, there were 35 million people living with HIV worldwide.2 Of these, 24.7 million were living in Sub‐Saharan Africa, where nearly one in every 25 adults (4.4%) were living with the virus.2 Since 2001, new HIV infections have increased by 31% in the Middle East and North Africa, where trends in rising new infections are causes for concern.2 In Western Europe and North America, new HIV infections had increased by 6% at the end of 2013 from where it was in 2001.2 Specific groups that have behaviors that do not conform to social norms and groups that are legally criminalized in some countries, such as people who inject drugs, men who have sex with men and sex workers and sex workers are highly affected by HIV.2 The UNAIDS report indicated that worldwide the HIV prevalence among sex workers is 12 times greater than that among the general population.2 This report also indicates that, there are an estimated 12.7 million people who inject drugs worldwide, and 13% of them are living with HIV.2 There are three aspects to the HIV/AIDS epidemic: the epidemic of HIV, the epidemic of AIDS, and the epidemic of stigma, discrimination, and denial. The third aspect is the epidemic of social, cultural, economic and political responses to AIDS.3 Stigma is typically a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgment about a person or a group.4 HIV/AIDS‐related stigma builds upon and reinforces earlier negative thoughts.5,6 People living with HIV/AIDS (PLHIV) may be considered to have deserved becoming infected with the virus by doing something wrong. Often these "wrongdoings" are linked to sex or to illegal or socially "frowned upon" activities, such as injecting drug use. Men who become infected may be seen as homosexual, bisexual or as having had sex with prostitutes.5 HIV‐related stigma may be manifested in the form of anticipated stigma (expectation of social rejection, violence or discrimination by PLHIV), enacted stigma (actual experience of social rejection, violence or discrimination by PLHIV) and self/felt/internalized stigma (feelings and beliefs of PLHIV that they are disgusting and immoral).7 Researchers have validated scales for the measurement of stigma and discrimination. Genberg and colleagues use three dimensions of stigma: negative attitude (shame, blame, and social isolation), discrimination; and equity.8 The first component (negative attitude) encompasses items regarding the shame of PLHIV, items related to labelling, devaluing and isolation of PLHIV.8 It also includes blame for the responsibility for HIV infection on the HIV positive person, feelings about PLHIV and attitudes regarding the proper treatment of PLHIV and their families.8 The second component is discrimination (enacted stigma).8 The third component (equity) focuses on the endorsement of views that PLHIV should be considered equal members of the society as those who are HIV‐free.8 Visser and colleagues have also developed the parallel stigma scale that enables comparison both within groups and across different populations.9 They developed three parallel scales (personal stigma, attributed stigma, and internalized stigma) that use the same items.9 Personal stigma refers to stigmatizing attitude held by individuals within a group or community.9 Attributed stigma measures the level of stigma that individuals attribute to others in their group or community.9 Internalized stigma assesses the extent to which an HIV infected individual feels stigmatized because of the disease.9 Therefore, these validated scales measure stigma from the perspective of the victims (PLHIV), from the perspective of the community about their own perceptions about PLHIV and from the perspective the community about their perceptions of how others think/act about PLHIV. Stigma and discrimination related to HIV act as barriers to the uptake of testing and treatment services. Stigma and discrimination also affect economic, social…

Benefits and Experiences of Establishing Knowledge Centers: A Case Study from Two Public Hospitals in Ethiopia In 2010, the Federal Ministry of Health (FMOH) of Ethiopia, in collaboration with the Global Health Workforce Alliance(the Alliance) and the World Health Organization (WHO), agreed to establish three pilot knowledge centers (KCs). Two of KCs have been functional for two years. This assessment was meant to explore the benefits and experiences gained since the two KCs.

Supplemental material, sj-pdf-1-inq-10.1177_00469580211018290 for Inequitable Utilization of Neonatal Health Services in Southwest Ethiopia: The Effects of Socioeconomic Disparities by Kiddus Yitbarek, Sarah Hurlburt, Terje P. Hagen, Melkamu Berhane, Gelila Abraham, Ayinengida Adamu, Gebeyehu Tsega and Mirkuzie Woldie in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental material, sj-pdf-1-inq-10.1177_00469580211018294 for Expanding Maternity Waiting Homes as an Approach to Improve Institutional Delivery in Southwest Ethiopia: A Community-Based Case-Control Study by Meaza Hailu, Fikru Tafese, Gebeyehu Tsega, Ayinengida Adamu, Kiddus Yitbarek, Tizta Tilahun, Yibeltal Siraneh, Belay Erchafo and Mirkuzie Woldie in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Low levels of neonatal health services utilization and high neonatal deaths are often concentrated among socially and economically disadvantaged groups, especially in low-income countries. Therefore the aim of this study was to assess inequity in the use of neonatal health services in Southwest Ethiopia. A community-based cross-sectional study was conducted in 8 districts located in Jimma Zone, Southwest Ethiopia from 19 March to 28 April 2018. A total of 835 mothers were included in the study with systematic random sampling. Principal component analysis was conducted to develop wealth quintiles of the households. Equity in neonatal health services was measured using rate-ratio, concentration curve, concentration index, and analyzed by binary logistic regression. Neonates from richer families were 1.25 times more likely to use neonatal health services than the poorer households with a concentration index value of 0.07. Neonates from highly educated mothers have better used the servi...

Establishing maternity waiting homes is a key strategy to address the geographic barrier to obstetric care access among women living in rural areas. In Ethiopia, maternity waiting homes have been in use for several years, with a sharp increase in the number of such facilities recently. However, there is little empirical evidence detailing the experiences and challenges faced by women during the implementation of this initiative in Ethiopia. This study used a multiple case study design with qualitative data collection methods, and was conducted from October to November 2016. Data were collected using focus group discussions, in-depth interviews and direct observation of each maternity waiting home. All interviews and focus group discussions were recorded using a digital voice recorder. Data were transcribed and translated into English. The coding process and formation of thematic structure was assisted by Atlas ti7.5 computer software. The participants reported that they were satisfi...

Background: Apart from basic determinants, appropriate child care practices are important in prevention of growth faltering and undernutrition. Providing safe and appropriate quality complementary foods is crucial to child growth and development. However, some children in low-income communities grow normally mainly due to proper caregiver feeding behaviors. Hence, the objective of this study was to determine caregivers ’ feeding styles as well as to indentify predictors in Derashe special district, Southern Ethiopia. Methods: A community based cross-sectional study design was employed in the seven randomly selected Kebeles (smallest administrative unit) of Derashe special district. A total of 826 caregivers provided data pertaining to sociodemographic variables. However, 764 caregivers had complete data for the outcome variable (caregiver feeding style). A multistage stratified sampling technique was used to identify study subjects. An adapted Caregiver’s Feeding Styles Questionnair...

Background: Women are more liable to die during or following delivery than during pregnancy but use of both delivery services and post-partum care is low. Objective: To find out the prevalence and predictors of institutional delivery in Wolaita Sodo (Sodo) town, southern Ethiopia. Methods: A cross-sectional study was used to look at 844 women who had given birth in the previous five years in Sodo town. The study employed a multistage-sampling scheme. Codes were given for all identified women in selected kebeles (neighbourhoods) and a simple random-sampling technique was used after generating random numbers using the Statistical Package for Social Sciences (SPSS). SPSS was then used to carry out binary- and multiple logistic regressions. A 95 % CI for the odds ratio was applied to judge the presence of relationships between variables. Results: The prevalence of institutional delivery-service utilisation in Sodo town was 62.2%. Husband educational status, parity, number of antenatal c...

The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or mor...

Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated...