Process Evaluation of Auditable Pharmaceutical Transaction Service in Seka primary Hospital, Jimma Zone, South West Ethiopia

Background A well-functioning drug supply management is the corner stone for any meaningful health service. However, Pharmaceutical supply systems in many developing countries have severe problems, including inefficient selection, procurement and use of drugs. The magnitude and extent of the problem is huge and chronic in the Ethiopian health care system for a long time. Objective To evaluate auditable pharmaceutical transaction service process in Seka primary hospital, Jimma zone south west Ethiopia. Evaluation Methodology Case study design involving both quantitative and qualitative methods was conducted in Seka primary hospital. The focus of this evaluation was on the process of Auditable pharmaceutical transaction service. The evaluation was focused on process part of the program with dimensions; availability, compliance and client satisfaction in the dimension of accommodation. Resource inventory, document review; key informant interviews and observations were conducted. Client satisfaction was assessed through exit interview; with sample size of 326. The qualitative data was analyzed manually using thematic analysis and quantitative data were analyzed by using SPSS version 23 software. Results In Seka primary hospital, percentage availability of the 32 selected Key medicinewas 10.7(82.0%) and there were no expired drugs found on their shelves. The availability of 17 of the required 20(85%) professionals was adequate according the Auditable pharmaceutical transaction service. The average lead time was found to be less than five days. The average counselling and dispensing time were 5:43 minutes and 1:17 minutes, respectively. The average number of drugs per prescription was 2.0. The 1154(97.9%) of drugs prescribed by generic name and 1175(99.7%) of prescribed drugs on Essential Drug List indicates prescribers ‘adherence to facility specific List. Conclusion This evaluation revealed that (based on the pre-set judgment criteria) the achievement of the Auditable pharmaceutical transaction service in Seka primary Hospital was GOOD 82.6 % (achieved 355.2 of 430 weight given), i.e. even though it is Good achievement ,there are areas that needs improvement. Areas for improvement identified were: Pre- and in-service training for all health workers involved in store room and dispensary to improve on the medium counselling time, poor record keeping and the extremely poor labelingof drugs which this all improve the overall client satisfaction.

Community Based Study of Rural, Tribal Women Seeking Induced Abortions in a Extremely Low Resource Region

Background Induced abortions are globally sought, whether permitted, or not permitted. Community based information about abortion seeking by rural tribal women is scarce. Objectives Community based study was carried out to know the magnitude, profile, reasons, places, persons performing IA for rural tribal women. Material Methods Study was conducted in 118 villages to get the study subjects . Women from every fourth house were interviewed for desired information. Results and Conclusion Of all abortions, 2.17% in Melghat and 24.38 %in Sewagram were IA. Most women who had IA were young and 19% in Melghat region, 2.6% in Sewagram region were illiterate. Majority of Sewagram region, were housewives of low middle class, in Melghat unskilled workers of low economic class. In Melghat region all women reported seeking IA at health facilities,63% Private hospitals (PH), 18.5% Sub centres (SC), 7.4% Medical College (MC), 7.4% District hospital(DH), 3.7% Primary Health Centres (PHCs) and In Sewagram region 58% PH, 23% MC, 6.7% PHCs, 3.9% DH, 3.9% SCs and 3.9% at home. Most women said they had IA for spacing with no contraceptive use or contraceptive failure, poor health, poverty, IA were done medically in 76.2%, surgically 23%. No sex–selective IA were reported and there was no evidence Many women lacked awareness and had misconceptions, more so in Melghat region. In focus group discussions, common reasons for disfavoring IA were personal beliefs (34%), practice restrictions (19%). There was extreme poverty, still PH were used. Lot of awareness is required.

Level of Antenatal Care Services Utilization and Associated Factors Among Mothers who have Given Birth in the Past Twelve Months in Gelemso Town, West Hararghe Zone, Oromia National Regional State, East Ethiopia

Background In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women. According to the 2011 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Objectives The objective of this study was to determine level and identify factors influencing maternal antenatal care services utilization among mothers who gave birth in the last twelve months in Gelemso town west Hararghe Oromia, Ethiopia. Methods A community-based cross sectional study design was conducted on 347 study participants in Gelemso town west Hararghe Oromia Ethiopia from July 15, 2017 to August 15, 2017 G.C.A probability to proportional to size sampling technique was used to select the study population in two urban Kebeles. Data were collected using a pre tested structured questionairs. Descriptive results were presented using frequencies, and numerical summary measures. Bivariate analysis was carried out to assess the association between outcome variable and each in dependent variables. Odds ratio with 95% confidence level was estimated to identify factors associated with Antenatal Care (ANC) utilization using multivariable logistic regression. The statistical significance was declared at p- value < 0.05. Result The response rate this study was 98%. The prevalence of antenatal care service utilization was 64.6%. About 146 (42.1%) of the pregnant mother started antenatal care visit during the second trimester of pregnancy and a significant proportion 289(83.3%) had less than the recommended four visits. Educational status (AOR;15.19:CI 95%,6.006,38.417), husband attitude (AOR;1.995:CI 95%,1.016,3.916), marital status(AOR:4.587:CI 95%,1.888,11.146), planned pregnancy (AOR:4.938:CI 95%,2.514,9.702) were major factors associated with antenatal care service utilization. Conclusion Though more than half mother used antenatal care service in the study setting, two in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promotion of information, education and communication in the community should be strengthened is to sustain antenatal care service utilization in the community.

Rate, Maternal and Fetal Outcome of Cesarean Delivery Performed by IESO at Shenen Gibe General Hospital, Jimma South West Ethiopia: A Descriptive Retrospective Data

Background Pregnancy and parturition are events of considerable significance in the life cycle of women. Though it is supposed that the quality of care during labor, birth, and postpartum period plays a great role for adverse outcomes of birth, various reports claimed that cesarean delivery carries a higher maternal and fetal morbidity and mortality compared to vaginal delivery. Therefore, this study assessed the Rate, Maternal and Fetal Outcome of Cesarean delivery performed by IESO at Shenen Gibe General Hospital, Jimma south west Ethiopia. Integrated Emergency surgical officer is a health professional qualified and authorized to perform emergency obstetrical-gynecological and emergency general surgical procedures. The training has started in 2010 in 3 universities and 10 affiliated sites with intake of 43 students. The MSc program in integrated emergency surgery is intended to achieve one of the millennium development goals (MDG): reducing the overwhelming maternal mortality ratio and perinatal mortality rate at the local and national level. (1) Methods Hospital based two-year retrospective descriptive cross-sectional study design was employed and data collected from November to December 2019 in shenen Gibe General Hospital ,Jimma south west Ethiopia. A total of 185 mothers who delivered by cesarean delivery from December 2017 to December 2018 and complete data were included in the study. Data were extracted using structured data collection format and cleaned, and entered into Epi data software version 3.1 and exported into SPSS version 26 for further descriptive analysis. Result Among 2115 deliveries in the two years of retrospective data, a total of 186 mothers were delivered by cesarean section, giving cesarean delivery rate 8.8 %. The leading indication for cesarean delivery was fetal distress (24.2%). Among the total cesarean delivery, 22 neonates were died, giving the proportion of neonate mortality rate 16.8%. One mothers were died following cesarean delivery, giving maternal mortality rate following cesarean delivery 12 per 1000 live births. The leading cause for maternal mortality was hemorrhagic shock Conclusion However, cesarean delivery rate in this study was within the WHO recommended range, the health outcome of mothers and neonates’ following cesarean delivery was not acceptable. The neonatal and maternal mortality following cesarean delivery was 16.8% and12 per 1000 live births respectively. The main cause of neonatal death was birth asphyxia.

pH-Sensitive Nanomedicine for Treating Gynaecological Cancers

Emergence of various nanoscale drug carrier platforms as Drug Delivery Systems (DDS) has revolutionized the field of medicine.Nonetheless, theside-effects due to non-specific distribution of anticancer therapeutics in normal, healthy tissues remain to be a prime pitfall in curing cancers. Therefore, to achieve a better therapeutic efficacy, the use of a target-specific delivery, combined with a stimuli-responsive nanocarrier system, particularly pH-sensitive nanosystems offer an attractive strategy. Targeted drug delivery through pH-sensitive nanosystems offer the potential to enhance the therapeutic index of anticancer agents, either by increasing the drug concentration in tumor cells and/or by decreasing the exposure in normal host tissues. Therefore, nanoscale-based drug delivery through pH-sensitive nanosystems seem to be a boon for treating gynaecological cancers (as well as other cancers) without side-effects or with least harm to normal healthy tissues.

A Feasibility Study of A Home-Based Program to Promote Perceived Adequate Milk

Objective The purpose of this study was to evaluate the feasibility of a home-based educational skill building program to support exclusive breastfeeding for mothers in the early postpartum period. Specific aims were to: (1) evaluate the effectiveness of the study’s recruitment strategy, comparing the use of an intermediary with a direct approach, (2) examine intervention fidelity, (3) examine program adherence, and (4) assess the acceptability of the intervention to participants. Design and Sample A mixed methods within-group, three-occasion descriptive design, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. Intervention The program was implemented during three, 60-90 minute educational training sessions in the home, delivered at 6, 13, and 27 days postpartum. Results Mothers who adhered to the intervention protocol correctly attributed their infant’s crying behavior to factors other than the adequacy of the mother’s milk supply. All participants were recruited through direct approach. The program was delivered as planned with high fidelity, a high retention rate, and with a high rate of acceptability. Conclusions A fully scripted, at-home, nurse-delivered educational skill building program can be delivered with efficiency to breastfeeding mothers with full-term singleton infants; intervention fidelity, retention, and acceptability were high.

Coping with Pregnancy in Academic Environment: Experiences of Pregnant Students in A Public University in Ghana

Background: The Ghanaian culture expects women of reproductive age to reproduce. This makes pregnancy an acceptable occurrence in most tertiary institutions in Ghana. Although Ghanaian Universities allow pregnancy in school, challenges associated with pregnancies do not exempt pregnant students from following the academic requirements of the universities. This study therefore explores students’ experiences of copying with pregnancy in an academic environment in Ghana. Methods: This was a case study, quantitative and qualitative design using structured questionnaires and semi-structured interview guides respectively for data collection. Respondents comprised twenty (30) pregnant full time and part time female students from campuses of University of Education, Winneba. Data collection was between October 2016 and May 2017. Quantitative data were analysed using statistical package for social sciences (SPSS) version 23. The qualitative data was transcribed and manually analysed thematically. Results: The study found that majority of participants were adults between ages 26 and 30 years. More than half of them (66.7%) had no child and this was their first pregnancy which they felt was mistimed as it occurred during schooling, posing some physiological, financial and academic challenges which compelled students to devise various coping strategies to combine academic work and pregnancy amidst limited University provisions for pregnant students. Conclusions: The study results have policy and programme implications for meeting women’s needs for pursuing academic and reproductive goals concurrently. The study recommends that public universities in Ghana should institutionalise programmes on preconception counselling and coping with pregnancy in academic environment to enable female students make informed decisions on exercising their reproductive rights in whilst in the university to ensure positive maternal health outcomes.

Prevalence of Non-Fistulous Urinary Incontinence among Nonparturient Women in A Tertiary Hospital

Objective: To determine the prevalence and risk factors of non-fistulous urinary incontinence (UI) among non-parturient women at University College Hospital, Ibadan, Nigeria. Methods: A hospital based cross sectional study of 500 non-parturient women presenting with non- fistulous gynaecological symptoms at the University College Hospital, Ibadan. An interviewer administered questionnaire was used to obtain information. Data were analyzed using SPSS version 20. Data analysis involved descriptive statistics, bivariate and multivariate analysis to determine the risk factors of urinary incontinence. Results: Mean age was 36.61 (SD=10.1) years and almost all (83.2%) were married. Prevalence of urinary incontinence is 21.4%. Majority (40.6%) had symptoms of stress urinary incontinence and 8.0% had urge urinary incontinence. Only 19.6% of those who leaked urine in the last one month sought medical attention despite visiting the hospital for other ailment(s), while of those that had ever leaked urine, 13.1% of them ever sought medical attention. Risk factors for UI were age at first delivery (OR=21.21, 95%CI=2.179-206.478), marital status (OR=0.142, 95%CI=0.044-0.454), chronic illness (OR=3.987, 95%CI=2.147-7.405) and history of prolonged labour (OR=3.111, 95%CI=1.584-6.110). Conclusion: UI is not uncommon in Nigeria. The identified predisposing factors were low age at first delivery, history of prolonged labour and chronic illness. There is need to sensitize women of the symptoms and complications associated with urinary incontinence as well as its prevention and need to seek medical care if they have the symptoms.

Ordeals of Sexually Violated Women and Access to Comprehensive Healthcare: A Case Study of Victims of Sexual Violence in North Kivu, Eastern Congo

Background: The impact of sexual violence in any community is extremely devastating and women in the Eastern part of the Congo are no exception. Sexual violence not only affects the health of women, but it impacts their social life within the community too. Objective: The study aims to investigate the experiences of female victims of sexual violence in accessing medical care in North Kivu. Design: An interpretive, phenomenological approach was used for this inductive and qualitative study. In-depth informant interviews were the main data collection tool. Open-ended questions were used during the interviews in order to garner more information from the interviewees. Heidegger’s approach was utilized in analyzing the collected data. Results: The analyzed and interpreted results of the data indicated that survivors of sexual violence are engaged in an ongoing struggle. The victims demonstrated immense resilience despite the lack of comprehensive medical care and have continued to reassemble their broken lives. In order to present the outcomes of the research in a succinct and coherent manner, the outcomes are categorized into five sub-themes: managing worries and shame; regaining happiness; healing and restoration; the need for professional assistance and struggles in daily life. Conclusion: The study provides an understanding of the recovery processes of survivors of sexual violence in North Kivu, with important insights into dimensions that rehabilitation programs should take into consideration.