Publications by authors named "Firew Tekle Bobo"

12 Publications

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Poor coverage and quality for poor women: Inequalities in quality antenatal care in nine East African countries.

Health Policy Plan 2021 Jun;36(5):662-672

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

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 more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.
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http://dx.doi.org/10.1093/heapol/czaa192DOI Listing
June 2021

Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from "Leaving No One Behind".

Clinicoecon Outcomes Res 2020 20;12:595-607. Epub 2020 Oct 20.

Institute of Health Science, Department of Public Health, Wollega University, Nekemte, Ethiopia.

Background: Despite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia.

Methods: The 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices.

Results: Overall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099-0.173), 0.106 (95% CI=0.035-0.177), 0.348 (95% CI=0.279-0.418), and 0.348 (95% CI=0.279-0.418), respectively. Maternal age and all of the three socio-demographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services.

Conclusion: The utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.
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http://dx.doi.org/10.2147/CEOR.S269955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585815PMC
October 2020

Decomposition of socioeconomic inequalities in child vaccination in Ethiopia: results from the 2011 and 2016 demographic and health surveys.

BMJ Open 2020 10 20;10(10):e039617. Epub 2020 Oct 20.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.

Objectives: Monitoring and addressing unnecessary and avoidable differences in child vaccination is a critical global concern. This study aimed to assess socioeconomic inequalities in basic vaccination coverage among children aged 12-23 months in Ethiopia.

Design, Setting And Participants: Secondary analyses of cross-sectional data from the two most recent (2011 and 2016) Ethiopia Demographic and Health Surveys were performed. This analysis included 1930 mother-child pairs in 2011 and 2004 mother-child pairs in 2016.

Outcome Measures: Completion of basic vaccinations was defined based on whether a child received a single dose of Bacille Calmette-Guerin (BCG), three doses of diphtheria, tetanus toxoids and pertussis (DTP), three doses of oral polio vaccine and one dose of measles vaccine.

Methods: The concentration Curve and Concentration Indices (CCIs) were used to estimate wealth related to inequalities. The concentration indices were also decomposed to examine the contributing factors to socioeconomic inequalities in childhood vaccination.

Results: From 2011 to 2016, the proportion of children who received basic vaccination increased from 24.6% (95% CI 21.4% to 28.0%) to 38.6% (95% CI 34.6% to 42.9%). While coverage of BCG, DTP and polio immunisation increased during the study period, the uptake of measles vaccine decreased. The positive concentration index shows that basic vaccination coverage was pro-rich (CCI=0.212 in 2011 and CCI=0.172 in 2016). The decomposition analysis shows that use of maternal health services such as family planning and antenatal care, socioeconomic status, exposure to media, urban-rural residence and maternal education explain inequalities in basic vaccination coverage in Ethiopia.

Conclusions: Childhood vaccination coverage was low in Ethiopia. Vaccination was less likely in poorer than in richer households. Addressing wealth inequalities, enhancing education and improving maternal health service coverage will reduce socioeconomic inequalities in basic vaccination uptake in Ethiopia.
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http://dx.doi.org/10.1136/bmjopen-2020-039617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577064PMC
October 2020

Predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia.

PLoS One 2020 1;15(5):e0232524. Epub 2020 May 1.

Department of Public Health, Wollega University, Nekemte, Oromia, Ethiopia.

Background: Diabetes Mellitus recognized as one of the emerging public health problems in developing countries. Self-monitoring needs to be individualized and should assist people with diabetes. This study aimed to assess the predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia.

Methods: A facility-based cross-sectional study was conducted from November 2017 to February 2018 in hospitals located in western Oromia, Ethiopia. An interview was made with a total of 400 diabetic patients attending the diabetes center and admitted to ward in the study hospitals. The data were entered into Epi Info software version 3.5.4. Data analysis was made using a statistical package for the social sciences (SPSS) version 20. Odds ratio (OR) was used to show the association. The statistical significance was considered at P<0.05, and potential confounding variables were controlled using logistic regression. The analyzed data were presented in texts and tables.

Results: From a total of 398 interviewed patients, 129 (32.4%) practiced diabetes self-management. About 63.6% of the study participants' self-management practice was good. Most 103 (79.84%) of those who practiced self-management were presented with one of diabetes mellitus-related complications. Logistic regression analysis results showed that merchants were about six times higher in self-management practice [AOR of 5.945 (1.177-30.027 at 95% CI)] and those having family support in diabetes practiced self-management 2.87 times than others [AOR of 2.835 (1.386-5.801 at 95% CI)].

Conclusions: Compared to the findings of previous studies, diabetes self-management practices of the participants was good. The study participants regular physical activity, food intake, medication adherence, and foot self-examination were moderate. Two variables, being a merchant and having family support were found to be the predictors of self-management practices. Predictors of self-management should be considered to boost self-management practice.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232524PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194359PMC
July 2020

Poor nutrition for under-five children from poor households in Ethiopia: Evidence from 2016 Demographic and Health Survey.

PLoS One 2019 20;14(12):e0225996. Epub 2019 Dec 20.

Department of Health Policy and Management, Jimma University; Jimma, Ethiopia.

Background: Ethiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly.

Methods: Ethiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI).

Result: The prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition.

Conclusion: The burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225996PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924648PMC
March 2020

Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate?

PLoS One 2019 7;14(6):e0217126. Epub 2019 Jun 7.

Department of Public Health, Wollega University; Nekemte, Oromia, Ethiopia.

Background: Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia.

Method: A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors.

Result: Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65).

Conclusion: Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women's right to receive health care with dignity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217126PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555589PMC
February 2020

Intimate partner violence and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis.

Reprod Health 2018 Dec 4;15(1):196. Epub 2018 Dec 4.

College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Intimate Partner Violence (IPV) during pregnancy is a serious public health concern globally. Within Sub-Saharan Africa nearly 40% of women reported abuse by their intimate partners. In Ethiopia, study findings regarding prevalence and associated factors of IPV among pregnant women have been inconsistently reported and highly variable. Thus, this systematic review and meta-analysis estimates the pooled prevalence of IPV and associated factors among pregnant women in Ethiopia.

Methods: International databases (i.e., PubMed, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library) were systematically searched during the period of January 1 to February 13, 2018. All identified observational studies reporting the prevalence of IPV and associated factors among pregnant women in Ethiopia were considered. Two authors (AA and CT) independently extracted all necessary data using a standardized data extraction format. Extracted quantitative data were analyzed using STATA Version 13. Heterogeneity among the included studies was assessed through the Cochrane Q test statistics and I test. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of IPV. Associations between factors and IPV were also examined using a random effects model.

Results: After reviewing 605 studies, eight studies involving 2691 pregnant women fulfilled the inclusion criteria and were included in this meta-analysis. The findings of these eight studies revealed that a 26.1% (95% CI: 20, 32.3) overall prevalence of IPV among pregnant women in Ethiopia. The subgroup analysis of this study further revealed the highest observed prevalence was in Oromia region (35%), followed by Amhara region (29%). Mothers'educational status (OR: 2.1, 95% CI: 1.1, 3.7), intimate partners' educational status (OR: 3.5, 95%CI: 1.4, 8.5), and intimate partners' alcohol use (OR: 11.4, 95%CI: 2.3, 56.6) were significantly associated with IPV among pregnant women.

Conclusion: This study found that the prevalence of IPV among pregnant women in Ethiopia was quite common; with slightly more than 1 in 4, pregnant women experienced IPV during pregnancy. Mothers' educational status, intimate partners' educational status, and intimate partners' alcohol use were factors significantly associated with IPV among pregnant women.
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http://dx.doi.org/10.1186/s12978-018-0637-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278116PMC
December 2018

Susceptibility to cigarette smoking and associated factors among high school students in western Ethiopia.

BMC Res Notes 2018 Aug 30;11(1):626. Epub 2018 Aug 30.

Department of Nursing, Debre Markos University, Debre Markos, Ethiopia.

Objective: Tobacco smoking is one of the leading causes of preventable premature death worldwide. Adolescence is a common period at which most of the established smokers start experimenting and smoking. The aim of the study was to determine the prevalence of susceptibility to cigarette smoking and associated factors among high school students in western Ethiopia.

Result: The prevalence of susceptibility to cigarette smoking among the study participants was 16.9%. Two-third (65.9%, 95% CI; 62.77, 68.87) of the students reported that they are exposed to second hand smoking in public areas. Students, whose father smoked (OR 2.76, 95% CI [1.26, 6.09]), whose friends smoked (OR 3.73 95% CI [1.57, 8.90]). Adolescents who have the perception that boys who smoke are attractive (OR 2.26, 95% CI [1.24, 4.09]) and smoking cigarettes makes young people look cool (OR 1.47, 95% CI; [1.01, 2.17]) were more likely to be susceptible to smoking. Having the knowledge that tobacco smoking is harmful (OR .43, CI 95% [.28, .67]) to health was found to be a protective factor against susceptibility to smoking cigarette.
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http://dx.doi.org/10.1186/s13104-018-3734-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117939PMC
August 2018

Role of antenatal and postnatal care in contraceptive use during postpartum period in western Ethiopia: a cross sectional study.

BMC Res Notes 2018 Aug 13;11(1):581. Epub 2018 Aug 13.

Department of Public Health, College of Medical and Health sciences, Wollega University, Po BOX 395, Nekemte, Ethiopia.

Objective: Little has been known about the magnitude and predictors of contraceptive use in extended postpartum period in Ethiopia. Thus, this study aims to assess the magnitude and determinants of contraception utilization in extended postpartum period. A community based cross-sectional survey was conducted in Gida Ayana district, Oromia regional state, Ethiopia in February 2015. Six hundred and three postpartum women were included using a multistage sampling technique. Descriptive statistics were used to summarize the data and logistic regressions were used to assess the predictors of modern family planning use at 95% confidence interval.

Results: The proportion of women using any of the modern family planning in extended postpartum period was 45.4%. Women who had four and more antenatal care visits (AOR = 2.93; 95% CI 1.08-7.94), mothers who received post-natal care (AOR = 4.34; 95% CI 2.37-7.94), and those desiring less number of children (AOR = 5; 95% CI 2.19-11.41) were more likely to use modern family planning methods during the extended postpartum period. Therefore, health care providers should work to improve quality of health services provided during antenatal care and postnatal care to enhance family planning utilization among post-partum women.
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http://dx.doi.org/10.1186/s13104-018-3698-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090703PMC
August 2018

Technical efficiency of public health centers in three districts in Ethiopia: two-stage data envelopment analysis.

BMC Res Notes 2018 Jul 13;11(1):465. Epub 2018 Jul 13.

Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.

Objective: The aim of the study was to measure technical and scale efficiency of public health centers in three districts of Jimma zone, Ethiopia. A two-stage data envelopment analysis was used. First, we estimated technical and scale efficiency of the health centers. In the second stage, institutional and environmental factors were against technical efficiency of the health centers to identify factors associated to efficiency of the health centers.

Results: Eight out of the 16 health centers in the study were found to be technically efficient, with an average score of 90% (standard deviation = 17%). This indicates that on average they could have reduce their utilization of all inputs by about 10% without reducing output. On the other hand, 8 out of 16 health centers were found to be scale efficient, with an average scale efficiency score of 94% (standard deviation = 9%). The inefficient health centers had an average scale score of 89%; implying there is potential for increasing total outputs by about 11% using the existing capacity/size. Catchment population and number of clinical staff were found to be directly associated with efficiency, while the number of nonclinical staff was found to be inversely associated with efficiency.
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http://dx.doi.org/10.1186/s13104-018-3580-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044096PMC
July 2018

Inequities in utilization of reproductive and maternal health services in Ethiopia.

Int J Equity Health 2017 06 19;16(1):105. Epub 2017 Jun 19.

Department of Health Economics, Management, and Policy, Faculty of Public Health; Jimma University, Jimma, Ethiopia.

Background: Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia.

Method: Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index.

Results: Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy.

Conclusion: Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.
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http://dx.doi.org/10.1186/s12939-017-0602-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477250PMC
June 2017
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