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Introduction: The health insurance system has been proven to offer effective and efficient health care for the community, particularly community-based health insurance is expected to ensure health care access for people with low economic status and vulnerable groups. Despite the significance of evidence-based systems and implementation, there is a limited report about the magnitude of CBHI utilization. Therefore, this study was done to assess factors associated with community-based health insurance utilization in Basona Worena District, North Shewa Zone, Ethiopia., Method: A community-based cross-sectional study was employed. We have included 530 households from 6 randomly selected kebeles. The data was entered using Epi-Data V 3.1 and exported to SPSS version 20.0 for statistical analysis. Bi-variable and multivariable logistic regression analyses were computed to determine factors associated with community-based health insurance utilization., Result: The study finding shows that 58.6% of the respondents were members of community-based health insurance. Respondents who had primary and secondary education levels were 2 times more likely to be members than those who had no formal education. As compared to those who had awareness, respondents who had no awareness about CBHI were 0.27 times less likely to be insured. Respondents who did not experience illness were 0.27 times less likely to be members than respondents who experienced illness., Conclusion: Educational status, awareness about CBHI, perception of CBHI scheme and illness experience of family influence CBHI utilization. There is a need to strengthen awareness creation to improve the CBHI utilization., (© 2022. The Author(s).)

Objectives: This cross-sectional study was conducted on 399 patients at Hawassa University Comprehensive Specialized Hospital from February 15 to March 30/2018 to assess the length of stay (LOS) and its associated factors in emergency departments (EDs)., Result: About 91.5% patients were stayed in the EDs for greater than 24 h in different reasons. Inadequacy of beds in inpatient wards, overcrowding, absence of different laboratory test profiles and delay in radiological services were showed a significant differences in LOS greater than 24 h when compared to LOS ≤ 24 h in EDs (p < 0.05 for all). In addition, admission beds [adjusted odds ratio: 8.7 (95% CI 3.2-23.2)]; overcrowding [adjusted odds ratio: 3.6 (95% CI 1.6-8.3)]; laboratory test profiles [adjusted odds ratio: 5.1 (95% CI 1.9-14.1)], and radiology services [adjusted odds ratio: 3.7 (95% CI 1.5-9.2)] were significantly and positively associated with LOS greater than 24 h in EDs. Further, a significant proportion of patients were stayed for unnecessary extended length of time in EDs due to different factors. Therefore, the commitment of organization is crucial to provide sufficient number of admission beds, to scale-up laboratory test profiles and to decrease radiology service turn-around time in order to improve LOS in EDs.

Objective: The irreversibly crippling disease neurolathyrism is caused by prolonged over-consumption of Lathyrus sativus seed. The molecular mechanism of toxicity is unclear and more biochemical information is needed., Methods: The urinary amino acids from 5 recent patients and 9 healthy subjects in Ethiopia were analysed by HPLC after PITC (phenyl isothiocyanate) derivatisation. The trace elements Cu, Zn and Mn of urine and seeds were determined by atomic absorption spectroscopy., Results: The free amino acids aspartic acid, glycine, beta-aminoisobutyric acid, arginine, alpha-aminoadipic acid and phenylalanine were statistically higher (p<0.05) in urine from patients than in urine from control subjects. The trace element Cu was also statistically higher (p<0.05) in patient urine., Conclusion: The amino acid metabolism of the neurolathyrism patients is disturbed by over-consumption of grass pea seeds. The high concentrations of Cu found in the patient urine might indicate the involvement of trace elements in the aetiology of neurolathyrism.

Objective: To study an array of household individual and dietary risk factors for neurolathyrism., Method: Case-control study using recent cases in a district highly affected by the recent neurolathyrism epidemic in Ethiopia: 108 households with cases and 104 households with no cases; 170 neurolathyrism cases, 370 intra-family controls and 170 community controls frequency matched for age and sex., Results: A history of acute illness was associated with a two- and threefold increased risk of paralysis in community and intra-family controls, respectively. Soaking grass pea in water before cooking roughly halved the risk of neurolathyrism but cooking in clay utensils more than quadrupled it. Consumption of grass pea in the green unripe and boiled forms increased the risk 10 times or more. Mixing the food with gravy that contains condiments with antioxidant activity reduced it by a factor of 4. The consumption of grass pea mixed with cereals rich in sulphur amino acids was also highly protective, but the magnitude of the effect depended on the grass pea preparation consumed., Conclusion: Consumption of pure grass pea, especially in the green unripe and boiled forms, should be avoided. Communities at risk of neurolathyrism during famine crises should be encouraged to combine and use grass pea with cereals before the household cereal stock is fully depleted. Breeding programmes, alongside traditional attempts to reduce the toxin content, should enhance the content of sulphur amino acids and antioxidants in grass pea.

Neurolathyrism is a spastic paraparesis that can be caused by excessive consumption of the drought-resistant grass pea (Lathyrus sativus). Devastating neurolathyrism epidemics have occurred during major famine crises in various parts of the world. We investigated in a case-control study the effects of food aid on risk of paralysis. Risk increased with consumption of boiled grass pea (adjusted odds ratio 2.78, 95% CI 1.09-7.13 with cereals; 5.22, 2.01-13.55 without cereal) and raw unripe green grass pea (1.96, 1.16-3.31; p=0.011), but not with the fermented pancake, unleavened bread, and gravy preparations. In a correlational study there was an inverse relation between the number of new cases and the amount of food-aid cereals distributed per person. During famine, cereals and nutritional information should reach people before they have grass pea as the only food.

Non-compliance is a major problem in the treatment of tuberculosis (TB). This paper assesses the effectiveness of "TB clubs" in improving compliance with TB treatment and their impact in improving societal attitudes associated with TB. The study utilised both quantitative (cohort study) and qualitative (focus group discussion and an in-depth interview) methods. The cohort study was conducted in two rural districts of Northern Ethiopia. A total of 128 sputum positive pulmonary patients were enrolled and followed, 64 in the TB club and 64 in the comparison groups, to determine treatment outcome of anti-TB therapy. The impact of the TB clubs in changing societal attitudes and behaviour associated with TB was assessed using qualitative methods. The treatment completion rate was significantly better (X2=5.41, P<0.02) in the TB club group, 44 out of 64 patients (68.7%) completed treatment in TB club while only 30 of the 64 (46.8%) completed treatment in the comparison group. The defaulter rate was also significantly lower (X2=11.57, P<0.001) in the TB club group 8/64 (12.5%) compared to 26/64 (40.6%) in the comparison group. The qualitative part of the study also demonstrated remarkable changes in patients' understanding of TB, patients' initial reaction to a TB diagnosis, misconceptions as to the cause and treatment of TB, the social isolation and compliance and belief in the modern health care in the TB club area. The complementary results obtained from the quantitative and qualitative components of the study indicate that the TB club approach has a significant impact in improving patients' compliance to anti-TB treatment and in building positive attitudes and practice in the community regarding TB. This study, thus, provides convincing evidences that the TB club approach is useful in delivering TB treatment successfully in rural populations. Further large-scale studies are needed to find out whether this approach is applicable on a national scale and to other developing countries.

An exploratory study was conducted in the rural Estie district of Ethiopia in 1997 to identify the role of ABO blood group, rhesus factor, and type of grass pea (Lathyrus sativus) diet in the susceptibility to neurolathyrism. Five-hundred study subjects (250 cases and 250 controls) were examined and interviewed, and had their ABO and rhesus blood groups determined. The majority (86%) of the cases were males. Blood group O was the most common in the patients and controls followed by groups A, B, and AB. The vast majority of the study subjects were rhesus-positive. The gravy (Shiro) grass pea preparation was consumed by 91.6% of the study population, boiled (Nifiro) by 86%, and roasted (Kollo) by 56.4%. Almost half (48%) of the cases had consumed grass pea for > 4 months compared to 8% of controls (P < 0.001). There was a significant association between the risk for neurolathyrism and the consumption of boiled (adjusted odds ratio [AOR] = 98.4) and roasted (AOR = 55.62) forms of grass pea. There was no risk of paralysis associated with consumption of the gravy form of grass pea (AOR = 0.40, 95% confidence interval 0.1-2.0). Blood group O remained significantly associated with the disease after adjusting for age, type of grass pea preparation consumed, and duration of consumption (AOR = 2.90).

Five Hundred and Thirty Nine articles published between January 1984 and December 2000 in the Ethiopian Medical Journal were analysed to assess the research pattern and the citations of published articles. Hand-in-hand search of the journals and the Science Citation Index database were used. Majority (69%) of the articles were original articles. The median number of authors per article was 2 with a range of 9 (Maximum 10 and Minimum 1). Majority of first authors were affiliated to teaching institutions (69.6%). Foreign nationals were first authors in 19.9% and co-authors in 26.7% of the articles. Multiple authored articles [OR (95% CI) = 1.17 (1.03-1.33)], original articles [OR (95% CI) = 12.0 (4.43-32.48) and articles dealing with intestinal parasites [OR (95% CI) = 3.88 (1.24-12.08)] were more likely to be cited. Although, encouraging efforts were seen in addressing issues of public health importance in the last five years (1996-2000) of the study period, the findings of the study suggest that there is still a need to address them in a more vigorous way. It was also recommended efforts should be initiated to improve the citation of articles published by the Ethiopian Medical Journal and enhance the publication of editorials and brief communications.

A cross sectional community based study was done in the Amhara Regional State of Ethiopia in 1999-2000 to assess and compare knowledge and attitude towards neurolathyrism among health workers and the rural community. A sample of 217 health workers selected by probability proportional to size and randomly selected 589 heads of household from a rural district were interviewed using pre-tested questionnaires. Neurolathyrism was widely known among the health workers and the community. More than half of community respondents associated the disorder with walking or lying on the straw and the stalks of grass pea. In a multivariate analysis. poor neurolathyrism knowledge among the community was associated with illiteracy and with presence of a neurolathyrism patient at home. Among health workers, contact with vapour or steam of grass pea foods was the commonest cause cited. In a multivariate analysis nurses had the poorest knowledge among the health workers. Depending on the subject, health workers and community respondents had more or less knowledge than the other. The prevailing recurrent adverse climatic conditions might promote grass pea as a 'friendly' crop to the poor peasants in marginal areas who otherwise rely on it only during times of food shortages and could increase the incidence of neurolathyrism. The poor knowledge among health workers and the community and the general neglect of neurolathyrism requires urgent intervention. Appropriate strategies for the dissemination of information education, and communication (IEC) are needed.

Objectives: To describe the neurolathyrism epidemic in Ethiopia and to identify associated household factors., Methods: We interviewed 589 randomly selected heads of household in Debre Sina district of Ethiopia, the area afflicted by the recent neurolathyrism epidemic. Disease information was obtained for 2987 family members., Results: Neurolathyrism patients were detected in 56 (9.5%) households (prevalence rate 2.38%). The mean number of affected family members per household was 1.27 (SD 0.65, range 1-3). Most (77.5%) patients developed the disability during the epidemic (1995-1999). The median age at onset of paralysis was 11 years with a range of 41 (range 3-44). Younger people were more affected during the epidemic than during the non-epidemic period (P=0.01). The presence of a neurolathyrism patient in the family was associated with illiteracy [adjusted OR (95% CI)=2.23 (1.07-5.10)] of the head of household, with owning a grass pea farm [adjusted OR (95% CI)=2.01 (1.04-3.88)] and with the exclusive cooking of grass pea foods using handmade traditional clay pots [adjusted OR (95% CI=2.06 (1.08-3.90)]., Conclusion: Males aged 10-14 years were most affected by neurolathyrism. Increased household risk was associated with illiteracy of the head of the household and exclusive cooking of grass pea foods with handmade traditional clay pots.

A community based cross sectional study was conducted in April 1997 to assess the perspective of the rural community towards Tuberculosis (TB) and TB patients and identify prevailing misconceptions and other problems related with TB in the south Gonder administrative zone of the Amhara region. A total of 1000 heads of household were interviewed and disease information was obtained for 5078 family members. The prevalence of productive cough lasting more than 3 weeks was 4.6% (233/5078) and cervical, axillary or inguinal swelling with or with out a sinus tract that lasted more than 12 months was 1.0% (52/5078). TB treatment defaulters were found in 10% of the rural households. Apparent clinical improvement after the intensive phase was the commonest reason for defaulting (45%) followed by far distance of the health institution (25.3%). Evil spirit and sexual intercourse were incriminated as a cause for TB in 19.9% and 4.7% of respondents respectively. TB was believed as curable disease by 66.7% of the respondents. The rural community exhibited a great deal of ostracism towards TB patients. Majority (76.2%) of the respondents have heard about HIV/AIDS out of whom 19.4% disclosed that there could be an association between HIV/AIDS and TB. It was demonstrated that misconceptions about TB, its treatment, patients and families were prevalent among the communities in South Gonder. Community based awareness creating strategies should be designed and dissemination of TB information and education are strongly recommended.

A community based cross sectional study was conducted in a rural district of North West Ethiopia between February and April 1997 to determine the magnitude of marriage through abduction ('Telefa') and identify problems associated with it. Randomly selected and currently married 1,168 women were interviewed. The prevalence of marriage through abduction was 6.2% (72/1168). All the abductions reported were only once in lifetime during the first marriage. The median age at first marriage of abducted women was 13 years with a range of 13 (Minimum = 7 and Maximum 20). About two third (66.7%) of abducted women had been married more than once in their life time. Following a multivariate analysis in a logistic regression model abducted women were likely to be victims of abortion [Adjusted OR (95% CI) = 1.71 (1.10-3.05)], marital instability [Adjusted OR (95% CI) = 1.87 (1.10-3.18)], rape [Adjusted OR (95% CI) = 7.77 (3.78-15.95)] and domestic violence [Adjusted OR (95% CI) = 1.69 (1.11-2.81)]. The recognition of the magnitude and the associated health problems of marriage through abduction (Telefa) is important. Appropriate strategies that address the health needs of abducted women must be designed. Enforcing the judiciary system to discourage this harmful practice and empowerment of young girls and rural women is needed.

Setting: A rural district (Estie) in South Gonder, Ethiopia., Objective: To describe the contribution of 'TB clubs' (small support groups of patients based on where they live) to the performance of the tuberculosis control programme in Estie District., Design: A descriptive study of the formation of 'TB clubs', their contribution to case-finding and the treatment outcomes before and after formation of the 'TB clubs'., Results: The proportion of actual among expected attendances of tuberculosis patients for follow-up during treatment at health facilities significantly increased (P < 0.001) after the introduction of the TB clubs. Community elders, community health agents and local health workers helped TB clubs to refer tuberculosis suspects, promote treatment adherence and trace defaulters as an integral part of a district tuberculosis programme. The TB clubs referred 181 tuberculosis suspects in the community for investigation, of whom 65% subsequently had a diagnosis of tuberculosis. TB clubs identified 69% of all patients and 76% of new sputum smear-positive pulmonary patients diagnosed in the district. Treatment success rates in new sputum smear-positive, smear-negative and extra-pulmonary tuberculosis patients were 83%, 79% and 81%, respectively., Conclusion: The formation of TB clubs contributed to the effective implementation of a district tuberculosis programme. Further evaluation is needed to assess the sustainability and applicability of the approach in other settings.

An institution based cross sectional study was conducted in June 1996 at a rural health centre in South Gonder Administrative Zone of Northern Ethiopia. Interview and respective review of medical records of patients were done. A total of 211 tuberculosis (TB) patients were included in the study, 133 (63%) males and 78 (37%) females. Majority (79.6%) of patients had pulmonary disease. Clinical observation based on symptoms and signs suggestive of tuberculosis was used as a sole criteria to prescribe anti-tuberculosis treatment in 54.1% (114/211) of all the patients. Acid fast staining of sputum was done for 51.2% (86/168) of the pulmonary patients out of whom only 31.4% were smear positive. Social ostracism was observed to have been affecting tuberculosis patients and their families to a great extent. Divorce rate due to tuberculosis among patients was 29.1% (37/127). Patients have reported loss or threat to lose their job. Dietary misconceptions were rampant. The TB control activities were ineffective and poorly organised. Starting anti-tuberculosis treatment without proper diagnosis was observed to have negative consequences on the patients and the control programme. Appropriate counselling service along with the medical treatment was provided to patients with eventual family reunions. Patients were also organised into local 'TB clubs' by their residential locations so as to improve treatment adherence and the level of TB awareness among the patients and the community. It is strongly recommended that the political system and health authorities of Ethiopia should have to give much more attention and commitment to the TB control activities in Ethiopia.

Three hundred and thirty three patients in the lathyrism endemic rural Estie district of Northern Ethiopia were interviewed and examined to assess the psychosocial impacts of neurolathyrism. The majority of the affected were in the age group of 11-20 years (43%) followed by 21-30 years (29%). Males were more affected than females (4.8:1). Peak occurrences of neurolathyrism was observed at time of mobilization of the population in villagization and land diversification schemes. Females were affected to lesser extent and at an earlier age than males. Neurolathyrism affected matrimony among the rural farming population where marriage is considered as the most significant social achievement of any young member of the society. Divorce rate due to paralysis was 28%. It also influenced the choice of occupation among the afflicted rural people. Many males went into ecclesiastical professions. A significant number of males also took up occupations which traditionally were considered to be exclusively for women like basketry and embroidery. More females, not withstanding their age, were engaged in cattle-keeping. During the study, the rural communities were made aware of the association of neurolathyrism and consumptions of grass pea seed. It is believed that this step will enable communities to use home-based detoxifying methods and resort to alternate crops during times of food shortage.