Papers by Prof. Mezgebu Yitayal
Ethiopian Journal of Health Development, 1990
Ethiopian Journal of Health Development, 1990
BMC Medical Education, Mar 13, 2023
Background Human resource is one of the health system's building blocks, which ultimately leads t... more Background Human resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings. Methods An discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested. Results A total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively. Conclusion Rural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition.
PLOS ONE, Apr 30, 2019
Introduction Cervical cancer is a major public health problem in developing countries like Ethiop... more Introduction Cervical cancer is a major public health problem in developing countries like Ethiopia. Cervical cancer screening service has been offered to high-risk groups in Ethiopia since 2013. However, there is no evidence on the willingness to pay for the screening. Therefore, we conducted this study to assess the female health professionals' willingness to pay for cervical cancer screening at the
BMC women's health, Jun 20, 2024
Background Civilian war and internal conflicts increase the incidences of mental health condition... more Background Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. Methods A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. Result In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.
Women & Health, Sep 7, 2020
The physical problems associated with fistula result in psychological alteration. This study was ... more The physical problems associated with fistula result in psychological alteration. This study was aimed to assess whether psychological wellbeing of women with fistula after surgical treatment differ from that of before treatment. Institution-based pre-post follow-up design was conducted. Selfreported incontinence and psychological wellbeing score were assessed. Data were analyzed using Stata 12. Paired t-test and multiple linear regressions were fitted to identify variables correlate with the score difference. In this study, 117 women were interviewed giving response rate of 98.3 percent. Their mean (±sd) age was 27.13 ± 5.37 years. On admission, all women had urinary or fecal incontinence and their mean psychological score was 31.1 (95 percent CI; 30.5-31.6). After treatment, however, 89.7 percent (n = 105) of women reported that they regained continence. Similarly, the mean psychological score has dropped to 18.05 (95 percent CI; 16.4-21.6, p < .001). Pretreatment score, normal body weight, regaining continence, and getting counseling service were correlates of score difference. Psychological wellbeing of women with genital fistula was improved drastically after treatment. Establishing a system for early identification and treatment of cases could reduce prolonged psychological alteration.
Health and Quality of Life Outcomes, Mar 10, 2020
Background: Diabetes mellitus, which has a wide range of effects on the physical, social and psyc... more Background: Diabetes mellitus, which has a wide range of effects on the physical, social and psychological aspects of the well-being of a person, is a common and challenging chronic disease that causes a significant rate of morbidity and mortality. However, studies in our country, by and large, focused on the impact of the disease in terms of mortality and morbidity alone. Therefore, the objective of this study was to assess the health-related quality of life (HRQOL) and associated factors of diabetic patients at the University of Gondar referral hospital, Ethiopia. Methods: A facility-based cross-sectional study was conducted at the University of Gondar referral hospital from April to May 2017. A generic World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to measure the HRQOL. The data were analyzed by Stata version 12. Multiple Linear Regression analysis with P-value 0.05 was used to measure the degree of association between HRQOL and independent variables. Results: A total of 408 patients with Diabetes Mellitus were included in the study. The HRQOL scores for physical, psychological, social and environmental domains were 50.9, 54.5, 55.8 and 47.3, respectively. Diabetes-related complications had a significant association with all except the psychological domain. Higher HRQOL was associated with exercising, following the recommended diet, foot care, sensible drinking and the absence of co-morbidities. However, old age, unemployment and being single and widower had a significant association with lower HRQOL. Conclusion: The environmental and physical domains of HRQOL scores were the lowest compared to the social and psychological domains. Old age and living in rural area had a significant association with a lower HRQOL, whereas the absence of diabetes-related complications, exercising, general diet and foot care had a significant association with better HRQOL of patients. Therefore, strong advice on the recommended lifestyle is important, and old patients and rural dwellers should get due attention. In addition, the prevention of diabetes-related complications is important to improve the patient HRQOL which is an important outcome measurement from the patient's perspective related to the impact of the disease. Therefore, including HRQOL assessment as part of routine management is necessary.
Research Square (Research Square), Jul 13, 2021
Background In Ethiopia, previous studies have explored the role of the proximate determinants for... more Background In Ethiopia, previous studies have explored the role of the proximate determinants for recent fertility decline at national and regional levels. However, none of these studies have examined the role of socioeconomic factors on the observed fertility decline through these proximate variables. This study aimed to estimate the effects of proximate determinants of fertility and the contribution of distal variables in recent fertility in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. Methods A community based cross-sectional survey was carried out in 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. Generalized structural equation model was employed for the mediation analysis to estimate the relationships among distal and mediating variables with outcome variable, children ever born, simultaneously. A difference approach was used to test whether the effects of predictor variables were mediated. Results The Total Fertility Rate (TFR) for the three years preceding the survey was estimated at 3.4 children per woman. The Age Speci c Fertility Rate (ASFR) in the study area reached its peak in the age group of 25-29 with 191 children per 1000 women. Among the proximate determinants, only marriage was a signi cant proximate determinant of recent fertility. The probability of having birth was more than vefold higher among currently married women (IRR = 5.6 with a P-value = 0.000) than their unmarried counterparts. Age of women, occupation of women, household wealth status, ideal number of children, and experiencing child death had a signi cant total effect on recent fertility that were decomposed to direct and indirect or mediated effects of variables. Conclusion Marriage was the only proximate determinant that stood out as a signi cant mediated variable through which the distal variables affected fertility. Findings also clearly indicated that female participation in nonagricultural occupation affected the recent fertility. Hence, women's level of employment should be raised to increase their economic independence that will reduce the desirability of early marriage which in turn lower the number of children. In addition, the prevailing strategies on family planning programs should be improved to enhance the prevalence of contraceptive use among married women that will accelerate the current fertility transition.
BMC Pregnancy and Childbirth, Jun 15, 2020
Background: There is wide variation in the utilization of institutional delivery service in Ethio... more Background: There is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia. Methods: Studies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger's regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors. Result: Twenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I 2 = 0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR) = 2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR = 3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR = 3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR = 2.91; 95% 1.88,4.52) in 5 studies, availability of information source (AOR = 1.80;95% CI 1.16,2.78) in 6 studies, ANC followup (AOR = 2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR = 4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR = 3.04;95% CI 1.76, 5.24) in 11 studies and place of birth of the elder child (AOR = 8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization. Conclusion: This review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.
Research Square (Research Square), Mar 8, 2022
Background Understanding the experiences, needs, preferences, and behaviors of people living with... more Background Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited research evidence in Ethiopia on the views of PLHIV regarding their positive and negative experiences on current antiretroviral therapy (ART) service and their preferred models of HIV treatment. Hence, this study aimed to explore patients' experiences of taking medications and preferences for ART service provision characteristics in Northwest Ethiopia. Methods This study with a phenomenological approach was conducted as part of the larger discrete choice experiment study. Purposive selection of stable and 18 years old and above PLHIVs using ART service at health facilities implementing four differentiated service delivery (DSD) models in East Gojjam, West Gojjam, Awi, and Bahir Dar special zones was done. Data were collected between July and September 2021. About 15 in-depth interviews with differentiated ART eligible patients were conducted. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed. Findings Participants in this study had reported both positive and negative experiences in receiving ART. Five themes: stigma, time, availability of drug and provider, costs per clinic visit, provider-patient interaction were identi ed. Participants also reported varied preferences towards ART service features. Fifteen attributes: buddy system, ART re ll (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, person providing ART re lls, provider's attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics and total cost of visit were identi ed. Conclusions Participants provided both positive and negative experiences with the aspects of current ART service. The preferences of PLHIVs towards ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients' needs and priorities in Ethiopia. Future research should also focus on understanding the satisfaction of patients enrolled among the four DSD models now under implementation in the country to get insights for optimizing each model implementation and to ensuring the strong quality of ART service provision for stable PLHIV. Background Page 3/33 Global progress is being made towards achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 HIV targets: 95% of people with HIV diagnosed, 95% of those diagnosed on treatment, and 95% of those on treatment virally suppressed [1]. Since 2015, the World Health Organization (WHO) has endorsed a differentiated service delivery(DSD) approach to providing HIV services to support reaching the UNAIDS targets by 2030 [2]. Differentiated service delivery-a "patient-centered approach that simpli es and adapts HIV services across the cascade to serve the needs of people living with HIV (PLHIV) better and reduce unnecessary burdens on the health system [3] "-has emerged as a core principle of HIV programs in resource-limited settings [2, 4, 5]. DSD is operationalized by adjusting the four building blocks: the frequency of visits, the location of service delivery, the type of health care workers, and the package of services according to the needs of different groups of PLHIV [6]. DSD models are broadly categorized as individual or group models, with service delivery at a facility or in the community [7]. DSD models for antiretroviral treatment (ART) for HIV are being scaled up throughout sub-Saharan Africa in the expectation that they will better meet the needs of patients, improve the quality and e ciency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes [8]. Ethiopia has also adopted various DSD models since 2017 for stable PLHIV taking ART. Appointment spacing is being implemented in full scale. The health extension worker-managed community-based ART re ll model has been piloted in Addis Ababa and Gambella since the end of 2018 and is being scaled up at six regions: Addis Ababa, Oromia, Amhara, Southern Nations, Nationalities and People, Sidama, and Gambella. Fast track ART re ll and peer lead community ART re ll models started in 2020 [9]. A successful client-centered HIV program aims to get antiretroviral medications into the hands of clients in a timely and e cient manner and to provide services that are convenient and welcoming. This starts with gathering insights to understand each client's experiences, needs, preferences, and behaviors, and then designing programs that reach them where they are and deliver services in ways that meet their needs which in turn support patients in adhering to ART as well as remain in the program for the long term [10, 11]. A previous systematic review found forgetting, lack of access to adequate food, stigma and discrimination, side effects, and being outside the house or traveling were barriers whereas social support, reminders, feeling better or healthier after taking ART, disclosing HIV status, and having a good relationship with a health provider were facilitators for patients' adherence to ART[12]. The previous metasynthesis also identi ed stigma and discrimination, fear of HIV status disclosure, task shifting to lay health workers, human resource and institutional challenges, mobile Health (mHealth), family and friend support, intensive case management, and, relationships with caregivers as facilitators or barriers for retention in HIV care[13]. A recent systematic review also found that patients preferred facility-based ART service over community service, shorter travel distance, reduced waiting time, less frequent clinic visits, good providers' attitude, having shared decision making, individualized models, and effective drugs with
Aids Research and Therapy, Jun 4, 2023
Background Discrete choice experiments (DCEs) are used to assess the strength of preferences and ... more Background Discrete choice experiments (DCEs) are used to assess the strength of preferences and value of interventions. However, researchers using this approach have been criticized for not conducting or publishing rigorous studies to select the required attributes and levels. Proper specification of attributes and their levels determines the validity of DCE. Hence, our study aimed to identify and define attributes and levels for the design of a DCE to elicit patients' and providers' preferences for ART service in Northwest Ethiopia. Methods Four stages were followed to derive the final list of attributes and levels: (1) a literature review to derive conceptual attributes; (2) key informant interviews of 17 providers and in-depth interviews of 15 adult stable patients to identify context-specific attributes and attribute levels; (3) ranking survey among 31 HIV/AIDS program implementers and rating survey among 35 adult stable patients and 42 health workers providing antiretroviral therapy (ART) service to indicate participants' preference of attributes; and (4) an expert opinion to reduce the list of attributes and levels. Results First, a literature review identified 23 candidate attributes. Second, individual-level analysis of the qualitative transcripts confirmed 15 of these 23 attributes. Third, the ranking and rating surveys put the importance of the 23 ART service attributes in order of preference. Fourth, through discussions with eight experts, 17 attributes were discarded based on multiple criteria. The six retained attributes were: the location of ART refills, the frequency of receiving ART refills, the person providing ART refills, the participants/others seen at the same ART refill visit, medication refill pick-up/delivery times, and the total cost of the visit during antiretroviral (ARV) medication refill. Finally, levels were assigned to these 6 attributes based on data from the literature, transcripts, and knowledge of the Ethiopian context. Conclusions This detailed description illuminates the attribute development process and provides the reader with a basis for evaluating the rigor of this phase of DCE construction. This paper contributes empirical evidence to the limited methodological literature on attributes and levels of development for DCE, thereby providing further empirical guidance on ART service preference, specifically among patients of low-and middle-income countries.
AIDS Research and Therapy
Background Understanding the experiences, needs, preferences, and behaviors of people living with... more Background Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients’ experiences of taking medications and preferences for ART service provision in Northwest Ethiopia. Methods A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated tra...
JMIR Medical Informatics
Background Weak health information systems (HISs) hobble countries’ abilities to effectively mana... more Background Weak health information systems (HISs) hobble countries’ abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. Objective This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. Methods The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was...
Background In Ethiopia, previous studies have explored the role of the proximate determinants for... more Background In Ethiopia, previous studies have explored the role of the proximate determinants for recent fertility decline at national and regional levels. However, none of these studies have examined the role of socioeconomic factors on the observed fertility decline through these proximate variables. This study aimed to estimate the effects of proximate determinants of fertility and the contribution of distal variables in recent fertility in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. Methods A community based cross-sectional survey was carried out in 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. Generalized structural equation model was employed for the mediation analysis to estimate the relationships among distal and mediating variables with outcome variable, children ever born, simultaneously. A difference approach was used to test whether the effects of predictor variabl...
Background: Alcohol consumption during pregnancy can lead to multiple health, social and, behavio... more Background: Alcohol consumption during pregnancy can lead to multiple health, social and, behavioral problems for both the mother and the offspring. Anemia is one of the major public health concerns and causes of morbidity and mortality among pregnant women with poor maternal and fetal outcomes in developing countries. This study aimed to identify the link between prenatal alcohol consumption and anemia among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia.Methods: A facility-based retrospective cohort study was conducted among pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include study participants in the cohort. Data were collected using a standardized interviewer-administered questionnaire. Multivariable analysis was performed to examine the association between reported prena...
Ethiopian Journal of Health Development, 1990
Ethiopian Journal of Health Development, 1990
BMC Women's Health, Jun 20, 2018
Background: Women with fistula live in a state of distress and in fear of their future life. An o... more Background: Women with fistula live in a state of distress and in fear of their future life. An obstetric fistula has a devastating impact on affected women and their families. The objective of this systematic review was to synthesize the evidence from published articles on the consequences of obstetric fistula on women who endure the condition. Methods: The consequences were systematically reviewed from purely qualitative and mixed method primary studies. The literatures were searched through the search engines Google, Google scholar, Hinari using Pub Med data bases, and citation tracking. Relevant source of publications were searched for primary qualitative studies by formulating search protocol using related search terms. Time (articles published between January first of 2007 and 30th September 2016), participants (women who experienced obstetric fistula due to obstructed labor complications), types of study (purely qualitative and mixed method primary articles), findings (reporting consequences/impacts of obstetric fistula) were used as inclusion criteria. The quality appraisal tool for qualitative studies and the critical appraisal skills program were used to appraise the quality of the studies. The findings of sixteen studies were included in the review. The data were collected and then a thematic framework approach was applied for analysis. Results: The thematic categories shared across most studies were related to the physical challenges of losing body control, women's social and family relationships, and the challenges of losing income. Obstetric fistula has far reaching consequences on women's physical well being, social and marital relationships, mental health and economic capacity. Fistula also challenged women coping abilities. Conclusion: The consequences of obstetric fistula are far more than the visible medical condition. Little evidence is available on mental health, child and fertility issues, and coping mechanisms. Therefore, further researches shall be aimed at addressing the understudied area and suitable interventions shall be offered to improve women's overall quality of life.
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Papers by Prof. Mezgebu Yitayal