Alem Desta - Academia.edu (original) (raw)

Papers by Alem Desta

Research Square (Research Square), Jan 8, 2020

Back ground: Substantial improvements have been observed in the coverage and access to maternal h... more Back ground: Substantial improvements have been observed in the coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of this study was to assess quality of Option B + PMTCT service provision. Methods : Facility based cross-sectional study was conducted in 12 public health facilities from February to April 2016. It employed both quantitative and qualitative method. Donabedian input-process-output quality assessment model was used to evaluate the service. Data collection techniques carried out were facility inventory, non-participatory observation, record and chart review to assess input, process and

Additional file 1. Excel files showing the detail scores for the three quality components.

BMJ Open, 2020

IntroductionEthiopia successfully reduced mortality in children below 5 years of age during the p... more IntroductionEthiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses.MethodsWe included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.ResultsThere were 31 intervention activities; many were one-off and implemented late. In eig...

Ethiopian Journal of public health and nutrition, Nov 12, 2020

BMC Public Health, 2015

Background: Ethiopia has been providing free Antiretroviral Treatment (ART) since 2005 for HIV/AI... more Background: Ethiopia has been providing free Antiretroviral Treatment (ART) since 2005 for HIV/AIDS patients. ART improves survival time and quality of life of HIV patients but ART treatment outcomes might be affected by several factors. However, factors affecting treatment outcomes are poorly understood in Ethiopia. Hence, this study assesses treatment outcomes and its determinants for HIV patients on ART in selected health facilities of Kembata and Hadiya zones. Methods: A retrospective cohort study was conducted on 730 adult HIV/AIDS patients who enrolled antiretroviral therapy from 2007 to 2011 in four selected health facilities of Kembata and Hadiya zones of Southern Ethiopia. Study subjects were sampled from the health facilities based on population proportion to size. Data was abstracted using data extraction format from medical records. Kaplan-Meier survival function was used to estimate survival probability. Cox proportional hazards regression model was used to identify factors associated with time to death. Result: Median age of patients was 32.4 years with Inter Quartile Range (IQR) [15, 65]. The female to male ratio of the study participants' was 1.4:1. Median CD4 count significantly increased during the last four consecutive years of follow up. A total of 92 (12.6 %) patients died, 106(14.5 %) were lost to follow-up, and 109(15 %) were transferred out. Sixty three (68 %) deaths occurred in the first 6 months of treatment. The median survival time was 25 months with IQR [9, 43]. After adjustment for confounders, WHO clinical stage IV [HR 2.42; 95 % CI, 1.19, 5.86], baseline CD4 lymphocyte counts of 201 cell/mm 3 and 350 cell/mm 3 [HR 0.20; 95 % CI; 0.09−0.43], poor regimen adherence [HR 2.70 95 % CI: 1.4096, 5.20], baseline hemoglobin level of 10gm/dl and above [HR 0.23; 95 % CI: 0.14, 0.37] and baseline functional status of bedridden [HR 3.40; 95 % CI: 1.61, 7.21] were associated with five year survival of HIV patients on ART. Conclusion: All people living with HIV/AIDS should initiate ART as early as possible. Initiation of ART at the early stages of the disease, before deterioration of the functional status of the patients and before the reduction of CD4 counts and hemoglobin levels with an intensified health education on adherence to ART regimen is recommended.

Tropical Medicine & International Health, 2010

To assess the impact and feasibility of artemether-lumefantrine deployment at community level, co... more To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia. Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year. At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013). Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.

BMJ Open, 2020

Introduction Ethiopia successfully reduced mortality in children below 5 years of age during the ... more Introduction Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses. Methods We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses. Results There were 31 intervention activities; many were one-off and implemented late. I...

Introduction: students are becoming aware of the availability and seeking of safe abortion servic... more Introduction: students are becoming aware of the availability and seeking of safe abortion services in their communities. However, unsafe abortion still remains globally major health problem especially in developing countries like Ethiopia. It is becoming one of the leading direct obstetric causes of maternal morbidity and mortality. In many low income countries lack of knowledge about the consequences of unsafe abortion and having negative attitude towards abortion service resulted in unsafe abortion practices. This study is important to identify area for improvement and encourage better communication with student clients who need safe abortion services. Objective: The aim of this study is to assess knowledge, attitude and factors associated with safe abortion among first year students in Mekelle University, Tigray, Ethiopia. Methods: Institution based-cross-sectional study design involving both quantitative and qualitative methods was employed. The sample size was 772 and the samp...

Background: Domestic violence against women is the most pervasive yet underestimated social and h... more Background: Domestic violence against women is the most pervasive yet underestimated social and health problem that occur in pandemic proportions. Globally, six out of ten women experience domestic violence. The problem is not well studied in the developing country, thus the objective of this study was to determine the magnitude and factors associated with physical violence among women in the rural part of Northern Ethiopia. Methods: A cross sectional study was conducted in rural Hawzen District from March 1- 14, 2013 to collect data from 660 ever married women using a systematic random sampling technique. Descriptive and multiple logistic regression analyses were performed using STATA version 11 to estimate indicators and effect sizes of the violence among ever married women. Multiple logistic regression analysis was used to identify independent predictors of physical violence. Result: In the current study the magnitude of physical violence in the last 12 month was 38.6%. Among the...

BMC Pregnancy and Childbirth

Background This study aimed to identify the utilization and factors associated with antenatal car... more Background This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. Methods A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May–June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. Results Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic med...

BMC Health Services Research

Background Substantial improvements have been observed in coverage and access to maternal health ... more Background Substantial improvements have been observed in coverage and access to maternal health services in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study aimed to assess the level of quality of Option B+ PMTCT in Northern Ethiopia. Methods A facility based survey was conducted from February to April 2016 in Northern Ethiopia. Twelve health facilities were enrolled in the study. Mixed method approach was used in line with Donabedian (Input- Process-Output) service quality assessment model. Data of 168 HIV positive mothers & their infant were abstracted from registers, and follow up charts. During the Option B+ service consultation, a total of 60 sessions were involved for direct observation. Of which, 30 clients and 12 service providers were subjected for exit and in-depth interview respectively. Facilities were categorized rendering good service quality based on predetermined quality judgment criteria. Reasons of good and bad service quality ...

Background Substantial improvements have been observed in coverage and access to maternal health ... more Background Substantial improvements have been observed in coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of the study was to assess quality of OptionB + in Mekelle Zone, Northern Ethiopia.Methods Facility based cross-sectional study involving both quantitative and qualitative methods was conducted from December 2016- January 2017. The quality of service delivery was assessed in 11 public health facilities in Mekelle. Data collection was conducted using facility audit, observation, and client exit interview check list to assess (Input-Process–Output) quality components. Similarly in-depth interview guide was used to gather qualitative data. Data were analyzed using SPSS version 21 software. Descriptive statistics were computed to summarize the study findings and triangulation was made with qualitative findings.Results Overall, 2 (16.7%) of study health facilities full filled all the three quality compo...

BMC Women's Health, 2015

Background: In the latest report of Ethiopian Demographic and Health Survey (EDHS) 2011, the mate... more Background: In the latest report of Ethiopian Demographic and Health Survey (EDHS) 2011, the maternal mortality ratio (MMR) was estimated at 676/100,000 live births, with total fertility rate at 4.8 and contraceptive prevalence rate at 29 %. Knowledge and utilization of long acting contraceptive in the Tigray region are low. This study aims at comparing and identifying factors related to the utilization of long acting contraceptive in urban versus rural settings of Ethiopia. Methods: A comparative community-based cross-sectional study, comprised of quantitative and qualitative methods, was conducted among 1035 married women in Wukro (urban area) and Kilteawlaelo district (rural area) in March, 2013. Stratified sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple logistic regression analysis was used to identify the respective effect of independent predictors on utilization of long acting contraceptive. Results: The proportion of long acting contraceptive use among the respondents was 19.9 % in the town of Wukro and 37.8 % in the district of Kilteawlaelo. Implanon was the most common type of contraceptive used in both districts, urban (75 %) and rural (94 %). The odds of using the long acting contraceptive method were three times higher among married women in the rural areas as compared with the urban women [AOR = 3. 30; 95 %, CI:2.17, 5.04]. No or limited support from male partners was an obstacle to using long acting contraceptive method [AOR = 0. 24, 95 of CI: 0.13, 0.44]. Moreover, married women whose partner did not permit them to use long acting contraceptive [AOR = 0. 47, 95 % of CI: 0.24, 0.92] and women who attended primary education [AOR = 0.24, 95 %, CI: 0.13, 0.44] were significantly associated with long acting contraceptive use. Conclusion: Overall, the proportion of long acting contraceptive use has found to be low. Rural women were more likely to use long acting contraceptives as compared to urban women. Moreover, educational status and the partner's permission to use contraception could influence the utilization of long acting contraceptives.

Journal of AIDS & Clinical Research, 2014

In addition, the scarcity of data on survival of children receiving ART beyond 2 years of follow ... more In addition, the scarcity of data on survival of children receiving ART beyond 2 years of follow up was another reason why this study

BMC Women's Health

Background: Menstruation is a universal aspect of human female reproductive life. Management of m... more Background: Menstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews. Methods: A detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray. Results: Recurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public. Conclusions: Changes in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.

Research Square (Research Square), Jan 8, 2020

Additional file 1. Excel files showing the detail scores for the three quality components.

BMJ Open, 2020

Ethiopian Journal of public health and nutrition, Nov 12, 2020

BMC Public Health, 2015

Tropical Medicine & International Health, 2010

BMJ Open, 2020

BMC Pregnancy and Childbirth

BMC Health Services Research

Background Substantial improvements have been observed in coverage and access to maternal health ... more Background Substantial improvements have been observed in coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of the study was to assess quality of OptionB + in Mekelle Zone, Northern Ethiopia.Methods Facility based cross-sectional study involving both quantitative and qualitative methods was conducted from December 2016- January 2017. The quality of service delivery was assessed in 11 public health facilities in Mekelle. Data collection was conducted using facility audit, observation, and client exit interview check list to assess (Input-Process–Output) quality components. Similarly in-depth interview guide was used to gather qualitative data. Data were analyzed using SPSS version 21 software. Descriptive statistics were computed to summarize the study findings and triangulation was made with qualitative findings.Results Overall, 2 (16.7%) of study health facilities full filled all the three quality compo...

BMC Women's Health, 2015

Journal of AIDS & Clinical Research, 2014

BMC Women's Health