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Getasew Amare, Mezgebu Yitayal, Amare Minyihun, Ayal Debie Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Getasew AmareDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, EthiopiaEmail getasewa23@gmail.comBackground: Around $3.5 trillion globally and up to $2.78 billion in Ethiopia, losses are reported annually due to malnutrition. Even if in Ethiopia nutrition services are delivered free of charge, specific public health programs may start to charge users of services that include maternal and child health services. Therefore, this study was aimed to assess mothers’ willingness to pay an out-of-pocket payment for maternal and child nutritional services and associated factors in Northwest Ethiopia.Methods: A community-based cross-sectional study design was conducted at Yilmana Densa district from March to May 2017. The sample size was 569, and a systematic random sampling technique was used. Bi-variate, multivariable logistic regression, and Tobit econometric analysis models were done. Adjusted odds ratio (AOR) and B-coefficient with 95% confidence interval (CI) and p-value were used.Results: A total of 545 (response rate of 95.8%) study participants were included in the study. The finding indicates that 88.8% of households were willing to pay for maternal and child nutrition services. The average amount of money to pay per visit was 19.6 ETB (CI = 18.8, 20.4) (0.84 USD). Mothers with good knowledge, good perceived family health status, medium and high perceived quality of services, and satisfaction with maternal and child nutritional services were significant variables to accept an out-of-pocket payment. In addition, the Tobit econometric model analysis reveals that knowledge, mothers’ age, pregnancy status, mothers’ educational status, wealth status, and self-reported satisfaction were identified as significant factors.Conclusion: The majority of mothers were willing to accept out-of-pocket payments for maternal and child nutritional services with an average of 19.6 ETB. Therefore, strengthening awareness and improving the quality of nutritional services and maternal satisfaction may increase mothers’ willingness to pay an out-of-pocket payment.Keywords: willingness to pay, Tobit model, maternal and child nutritional services, northwest Ethiopia

Debelo Shikuro,1 Mezgebu Yitayal,2 Adane Kebede,2 Ayal Debie2 1Benshangul-Gumuz National Regional State Health Bureau, Assossa, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Mezgebu YitayalDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, EthiopiaTel +251 947057683Email mezgebuy@gmail.comBackground: Every year, 808 million people face catastrophic health expenditure (CHE), and 122 million people were pushed into poverty. It aggravates healthcare inequalities, incurs double burden opportunity costs, and pushes households to sit in a deep poverty trap. A few studies have been done so far; however, it is not enough to inform policy decisions. Therefore, this study aimed to assess the catastrophic out-of-pocket health expenditure and associated factors among rural households in Mandura District, Western Ethiopia.Methods: We conducted a community-based cross-sectional study among the Mandura district’s 488 rural households from April to May 2017. We used a multistage systematic sampling technique to select the participants. We fitted a binary logistic regression model to identify the factors associated with catastrophic out-of-pocket health expenditure. We used the adjusted odds ratio (AOR) with 95% CI and the p-value < 0.05 to determine the variables associated with catastrophic out-of-pocket health expenditure.Results: Catastrophic health expenditure (CHE) with a 40% capacity to pay (CTP) households in the study area was 22.5%. Female household head (AOR = 2.92; 95% CI: 1.44, 5.93) and household with chronic illnesses (AOR = 3.93; 95% CI: 1.78, 9.14) were positively associated with CHE and, while households who had adult household members (AOR = 0.32; 95% CI: 0.16, 0.63) were negatively associated.Conclusion: The overall CHE, with a 40% CTP threshold, was high. Prevention of chronic illness might help to reduce the burden of the expenditure. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help bring healthcare services equity.Keywords: catastrophic out-of-pocket health expenditure, semi-pastoral community, Ethiopia

Tilahun Hailu,1 Mezgebu Yitayal,2 Lake Yazachew2 1Department of Health System, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Lake YazachewUniversity of Gondar, P. O. Box: 196, Gondar, EthiopiaEmail lyazachew07@gmail.comPurpose: This study was conducted to assess the health-related quality of life and associated factors among adult human immunodeficiency virus (HIV) mono-infected and tuberculosis (TB) and HIV co-infected patients in the public health facilities of northeast Ethiopia.Methods: A comparative facility-based cross-sectional study was conducted from February 01 to May 30, 2019. A total of 434 HIV mono-infected and 143 TB/ HIV co-infected patients were randomly selected for the study. The data were collected using an interviewer-administered structured questionnaire. The health-related quality of life of patients was measured using the World Health Organization quality of life HIV instrument which contains physical, psychological, social relationships, environmental, level of independence, and spiritual domains. The validated version of the Kessler scale was used to assess depressive symptoms. Linear regression analysis was performed to identify factors associated with the outcome variables, and a p-value < 0.05 with 95% CI was used to measure the degree of association between health-related quality of life and independent variables.Results: The mean scores of health-related quality of life among HIV mono-infected patients in terms of thephysical, psychological, level of independence, social relationships, environmental, and spiritual health domains were 63.9, 65.0, 60.5, 59.0, 56.4, and 63.9, respectively; whereas the mean scores among TB/HIV co-infected patients were 46.6, 48.5, 42.7, 43.5, 39.3, and 51.3, respectively. Among HIV mono-infected patients, being married improved the quality of social relationships by 6.7 compared with unmarried patients (β = 6.7, 95% CI = 3.24, 10.11); whereas among the TB/HIV co-infected patients, being educated increased the quality of social relationships by 10.6 compared with being uneducated (β=10.6, 95% CI=3.70, 17.51).Conclusion: The study revealed that the TB/HIV co-infected patients had poor health-related quality of life in all domains compared with HIV mono-infected patients. Besides, depression and stigma were more prevalent among co-infected patients. Therefore, designing and implementing specific management that focuses on psychiatric centers for TB/HIV co-infected patients will be necessary as their quality of life is lowered.Keywords: health-related quality of life, HIV, tuberculosis, TB/HIV co-infection, Ethiopia

Mezgebu Yitayal,1 Yemane Berhane,2 Alemayehu Worku,3 Yigzaw Kebede11University of Gondar, Gondar, Ethiopia; 2Addis Continental Institute of Public Health, Addis Ababa, Ethiopia; 3Addis Ababa University, Addis Ababa, EthiopiaBackground: Ethiopia has implemented a nationwide primary health program at grassroots level (known as the Health Extension Program) since 2003 to increase public access to basic health services. This study was conducted to assess whether households that fully implemented the Health Extension Program have improved current contraceptive use.Methods: A cross-sectional community-based survey was conducted to collect data from 1,320 mothers using a structured questionnaire. A multivariate logistic regression was used to identify the predictors of current contraceptive utilization. A propensity score analysis was used to determine the contribution of the Health Extension Program “model households” on current contraceptive utilization.Result: Mothers from households which fully benefited from the Health Extension Program (“model households”) were 3.97 (adjusted odds ratio, 3.97; 95% confidence interval, 3.01–5.23) times more likely to use contraceptives compared with mothers from non-model households. Model household status contributed to 29.3% (t=7.08) of the increase in current contraceptive utilization.Conclusion: The Health Extension Program when implemented fully could help to increase the utilization of contraceptives in the rural community and improve family planning.Keywords: Health Extension Program, current contraceptive utilization

Molla Fentanew, Melisew Mekie Yitayal, Kalkidan Nigussie Chala, Tesfa Kassa Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, Gondar, EthiopiaCorrespondence: Tesfa KassaUniversity of Gondar, P.O. Box: 196, Gondar, EthiopiaEmail tesfaphysio2001@gmail.comIntroduction: Community-based rehabilitation service (CBR) is a community development strategy set for persons with disabilities and their families. Measuring caregivers’ satisfaction is a recommended approach to know the overall satisfaction of rehabilitation service. Therefore, this study aimed to assess the magnitude of satisfaction and associated factors among caregivers of children with disabilities towards community-based rehabilitation in Central and North Gondar zone, North West Ethiopia.Methods: A community-based cross-sectional study was conducted from March to September 2020. The data were collected by socio-demographic variables, types of services, types of disabilities, and Client Satisfaction Questionnaire (CSQ-8). Data analysis was done by SPSS Version-20 statistical software. Descriptive statistics, bi-variable, and multivariable logistic regression analysis were computed. The multivariable logistic regression analysis model a P-value < 0.05 was used to identify the associated factors with caregivers’ satisfaction.Results: The study showed that the overall caregivers’ satisfaction with community-based rehabilitation service among caregivers of children with disabilities was 60.9% (95% CI; 55– 66%). Female gender (AOR: 0.19, 95% CI: 0.05– 0.68), older age (AOR: 0.160, 95% CI: 0.03– 0.85), being farmer (AOR: 0.14, 95% CI: 0.05– 0.42), North Gondar zone residence (AOR: 7.02, 95% CI: 6.78– 8.59), high monthly income (AOR: 2.48, 95% CI: 1.09– 5.61), got two or more type of service (AOR: 3.65, 95% CI: 2.64– 12.39), service duration 8– 14 years (AOR: 4.36, 95% CI: 1.44– 7.04) and service frequency 5– 8 times per month (AOR: 3.91, 95% CI 2.18– 7.01) were factors associated with the caregivers’ satisfaction on community based-rehabilitation service.Conclusion and Recommendation: The magnitude of caregivers’ satisfaction with community-based rehabilitation services in the study area was more than half. Female gender, older age, being farmer, high monthly income, North Gondar zone residence, the high number of services, duration of services started and frequency of follow-up were factors significantly associated with caregiver’s satisfaction.Keywords: caregivers’ satisfaction, children with disability, community-based rehabilitation, Central and North Gondar zone, Ethiopia