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Tafesse Gizaw,1 Mekonnen Bogale,2 Dejene Melese3 1Quantification and Market Shaping Office, Ethiopian Pharmaceuticals Supply Agency, Jimma, Ethiopia; 2College of Business and Economics, Jimma University, Jimma, Ethiopia; 3Department of Health Management and Policy, Faculty of Public Health, Jimma University, Jimma, EthiopiaCorrespondence: Tafesse GizawQuantification and Market Shaping Office, Ethiopian Pharmaceuticals Supply Agency, PO Box 359, Jimma, EthiopiaEmail tafessegizaw@gmail.comPurpose: The pharmaceutical logistics service is concerned with meeting the needs of customers in a public healthcare setting. When customers’ needs are addressed, they will be satisfied. As a result, the objective of this research was to identify major logistics factors that influence customer satisfaction in the Ethiopian pharmaceutical supply agency hubs, as well as to evaluate their satisfaction with the pharmaceutical logistics delivery process.Methods: We conducted a cross-sectional study with 262 randomly selected pharmacy unit employees from healthcare facilities. The information was acquired using a pre-tested self-administered questionnaire, then analyzed using SPSS statistical software. We performed an exploratory factor analysis to determine relationships (between observed variables and factors) and used the results in the subsequent analysis. To identify the explanatory variables that can significantly predict the outcome variable, a multiple linear regression model is used. A confidence interval (CI) that did not include zero and a p-value of less than 5% were considered statistically significant.Results: In terms of customer satisfaction, approximately 68% of respondents were satisfied with the pharmaceutical logistics services. Most pharmaceutical logistics service attributes, such as ordering procedure [β=0.075, 95% CI (0.005, 0.150)], personal contact quality [β=0.189, 95% CI (0.087, 0.240)], product availability [β=0.206, 95% CI (0.123, 0.303)], timeliness (β=0.192, 95% CI (0.099, 0.225)], order accuracy [β=0.190, 95% CI (0.097, 0.236)], order discrepancy handling [β=0.225, 95% CI (0.137, 0.287)], and complaint handling [β=0.177, 95% CI (0.089, 0.257)] had significant positive effects on satisfaction, explaining 72% of variations.Conclusion: The study revealed that a notable proportion of customers feel dissatisfied with the pharmaceutical services they receive. To further satisfy pharmaceutical customers and maintain service competitiveness, proactive measures to improve pharmaceutical logistics service attributes should be implemented, and logistics managers at all levels should strive for operational excellence in light of ever-changing customer expectations.Keywords: pharmaceutical logistics service, customer satisfaction, health facility, exploratory factor analysis, Ethiopian pharmaceutical supply agency

Wondimu Biressaw,1 Habtamu Tilaye,2 Dessie Melese2 1Benishangul-Gumuz, Wombera Sineor Secondary and Preparatory School, Benishangul, Ethiopia; 2University of Gondar, College of Natural and Computational Science, Departmentof Statistics, Gondar, EthiopiaCorrespondence: Dessie MeleseDepartment of Statistics, College Natural and Computational Science, University of Gondar, P.O. Box 196, Gondar, EthiopiaEmail dessie.melese1@uog.edu.etBackground: Among the many worldwide health problems, HIV/AIDS has caused severe health problems in several countries. The problem is also widely seen in Ethiopia. The general objective of the study is to cluster HIV patients and to find out the factors that mostly affect the prevalence of HIV within a group (cluster) and between groups (clusters) of HIV patients.Methods: The study is made based on the 2016 Ethiopian Demographic Health Survey (EDHS) which was collected by the Central Statistical Agency (CSA) of Ethiopia, and the survey collected a total of 26,753 samples, of which 14,785 were women and 11,968 were men and the age group was between 15 and 49 years for both. Binary logistic regression, principal component analysis, cluster analysis, and ANOVA were applied to analyze the data.Results: The result from binary logistic regression reveals that 15 factors such as ever heard of AIDS, region, water not available for at least a day in the last 2 weeks, has a radio, family members wash their hands, location of the source of water, everything completed to water to make it harmless to drink, food cooked in the house/separate house/outside, has a mobile telephone, has a table, type of place of residence, highest education level attained, current marital status, sex of household members, and age of household members are all significant factors that affect HIV status.Conclusion: Using these significant variables, 12 principal components are identified which describe 78% of the variation in the data. The result of HIV patients are clustered into 3 clusters and determine the status of HIV levels. Mainly, cluster 2 accounts for 50% of HIV patients whereas cluster 3 and 1 accounts for 40% and 10%, respectively.Keywords: Ethiopian Demographic Health Survey; EDHS, cluster analysis, principal component analysis, HIV patients

Daniel Molla Melese,1 Wondyefraw Mekonen,2 Abebaye Aragaw,2 Adisu Asefa,1 Abebe Muche Belete1 1Department of Biomedical Science, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia; 2Department of Physiology, College of Health Science, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Daniel Molla Melese, Department of Biomedical Science, Asrat Woldeyes Health Science Campus, Debre Berhan University, PO Box 445, Debre Berhan, Ethiopia, Tel +251 912204363, Email danielmolla54@gmail.comBackground: RDW is critical to the clinical diagnosis and progression of ESRD. There is currently little data on the relationship between RDW and ESRD in sub-Saharan Africa. Because of this, the present study evaluates RDW in patients with ESRD and associated factors in Addis Ababa, Ethiopia.Methods: The hospital-based cross-sectional study design was conducted on a total of 83 patients. RDW, MCV, SCR, BUN, GFR, FBS and serum albumin were determined. Blood pressure (mmHg), weight (kg), height (m), MUAC (cm) and BMI (kg/m2) were also measured. Data entry was via Epi-data version 3.4 and analyzed with SPSS version 26.0. A multivariate logistic regression analysis with a p-value < 0.05 at a 95% confidence interval was used to identify the associated factors of RDW.Results: A total of 83 ESRD patients participated, with a response rate of 95.4%. RDW ranged from 15.5% to 23.6% with a mean of 17.40% + 1.46%. Anisocytosis was present in 98.8% of patients. Of 83 patients, 66.3% were hypertensive, 20.5% had diabetes, and the remaining 13.3% had other conditions (glomerulonephritis and peripheral vascular disease). The mean GFR value was 5.20 mL/min/1.73 + 1.58. RDW showed a significant association with GFR (AOR: 4.6, 95% CI [1.27, 20.74], P = 0.047), alcohol consumption (AOR: 13.4, P = 0.012, 95% CI [1.97, 22.62]), recurrent kidney disease (AOR=25.6, P=0.016, 95% CI [1.85, 53.71]) and use of medication (AOR=00.2, P=0.044), 95% CI [0.03, 0.95]).Conclusion: RDW showed a significant association with GFR, recurrent kidney disease, alcohol consumption, and medication use in hemodialysis-dependent ESRD patients. The mechanisms of RDW disruption in ESRD patients need further investigation.Keywords: red cell distribution width, end stage renal disease, glomerular filtration rate, serum creatinine, mean corpuscular volume, body mass index, blood urea nitrogen, mid-upper arm circumference

There are various challenges that limit crop productivity in developing countries like Ethiopia. Lack of accessible plant nutrients in proper quantity as well as form to plants is an important determinant of reducing agricultural productivity. In this regard, a trial was conducted at Shela Borkoshe on the land owned by the farmer in Sodo Zuriya District, Wolaita Zone, Southern Ethiopia over the planting seasons of 2019 to 2020 with the aim of identifying the appropriate rates of blended nitrogen, phosphorus, sulfur, boron (NPSB), and potassium (K) fertilizer in maize production. The treatments, which were assessed using a factorial randomized complete block design with three replications, comprised of four rates of blended NPSB (0, 50, 100, and 150 kilograms/hectare) and four rates of K (0, 30, 60, and 90 kilograms/hectare K2O). Agronomic traits leaf area, LAI, ear length, seeds per row, seeds per ear, TSW, biomass as well as grain produce have been significantly varied due to NPSB by K fertilizer rates interactions. The highest leaf area (9886.20 ± 343.95 cm2), LAI (7.78 ± 0.26), ear length (32.58 ± 1.46 cm), TSW (160.67 ± 4.85 g), biomass (14941 ± 200.92 kilograms/ha), and grain output (7544 ± 119.49 kilograms/ha) have been attained by combining 150 kilograms/ha NPSB and 90 kilograms/ha K fertilizer rate. Following this, maximum quantity of seeds per row (44.88 ± 1.67) and seeds per ear (705.87 ± 25.61) have been attained from combination of 150 kilograms/ha NPSB and 60 kilograms/ha K fertilizer rates. Economic analysis revealed that maximum net profit (1491 Dollar/ha) and marginal rate of return (MRR) 1196.67% have been achieved from combining 150 kilograms/ha NPSB and 60 kilograms/ha K fertilizer rates. This investigation revealed that the combination of the NPSB fertilizer level of 150 kilograms/ha and 60 kilograms/ha K fertilizer showed superior performance with higher grain yield and economic return over other treatments. Therefore, a combined application of 150 kilograms/ha NPSB with 60 kilograms/ha K fertilizer rates could be recommended for maize production in the study area and similar agro-ecologies.

Introduction: Although wastewater-based epidemiology (WBE) successfully functioned as a tool for monitoring the coronavirus disease 2019 (COVID-19) pandemic globally, relatively little is known about its utility in low-income countries. This study aimed to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater, estimate the number of infected individuals in the catchment areas, and correlate the results with the clinically reported COVID-19 cases in Addis Ababa, Ethiopia., Methods: A total of 323 influent and 33 effluent wastewater samples were collected from three Wastewater Treatment Plants (WWTPs) using a 24-h composite Moore swab sampling method from February to November 2023. The virus was captured using Ceres Nanotrap® Enhancement Reagent 2 and Nanotrap® Microbiome A Particles, and then nucleic acids were extracted using the Qiagen QIAamp Viral RNA Mini Kit. The ThermoFisher TaqPath™ COVID-19 kit was applied to perform real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to quantify the SARS-CoV-2 RNA. Wastewater viral concentrations were normalized using flow rate and number of people served. In the sampling period, spearman correlation was used to compare the SARS-CoV-2 target gene concentration to the reported COVID-19 cases. The numbers of infected individuals under each treatment plant were calculated considering the target genes' concentration, the flow rate of treatment plants, a gram of feces per person-day, and RNA copies per gram of feces., Results: SARS-CoV-2 was detected in 94% of untreated wastewater samples. All effluent wastewater samples ( n  = 22) from the upflow anaerobic sludge blanket (UASB) reactor and membrane bioreactor (MBR) technology were SARS-COV-2 RNA negative. In contrast, two out of 11 effluents from Waste Stabilization Pond were found positive. Positive correlations were observed between the weekly average SARS-CoV-2 concentration and the cumulative weekly reported COVID-19 cases in Addis Ababa. The estimated number of infected people in the Kality Treatment catchment area was 330 times the number of COVID-19 cases reported during the study period in Addis Ababa., Discussion: This study revealed that SARS-CoV-2 was circulating in the community and confirmed previous reports of more asymptomatic COVID-19 cases in Ethiopia. Additionally, this study provides further evidence of the importance of wastewater-based surveillance in general to monitor infectious diseases in low-income settings., Conclusion: Wastewater-based surveillance of SARS-CoV-2 can be a useful method for tracking the increment of COVID-19 cases before it spreads widely throughout the community., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abera Dinssa, Gebremicael, Mengistu, Hull, Chalchisa, Berhanu, Gebreegziabxier, Norberg, Snyder, Wright, Gobena, Abera, Belay, Chala, Gizaw, Getachew, Tesfaye, Tefera, Belachew, Mulu, Ali, Kebede, Melese, Abdella, Rinke de Wit, Kebede, Hailu, Wolday, Tessema and Tollera.)

Background: Natural infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or vaccination triggers antibody production against key viral antigens. However, there is limited evidence on the levels of antibodies produced in naturally infected individuals compared to those vaccinated in Ethiopia. Therefore, we aimed to detect and compare SARS-CoV-2 antibodies produced by naturally infected and vaccinated individuals., Materials and Methods: We conducted a multicenter cross-sectional study among a total of 355 naturally infected and 355 vaccinated individuals from November 2022 to April 2023 at 10 selected health facilities in Addis Ababa, Ethiopia. We enrolled the participants consecutively upon their arrival at health facilities until the required sample size was achieved. We used a structured questionnaire to collect data on the demographic and clinical characteristics of the participants. We also collected 3-5 ml of blood samples from all participants and tested for anti-Spike (anti-S) and anti-nucleocapsid (anti-N) antibodies using Cobas 6000. We utilized frequency, mean, or median to describe the data, the Mann-Whitney U test to compare groups, and a generalized linear regression model to assess factors associated with anti-S antibody concentration. We analyzed the data with SPSS version 26, and the level of significance was set at P-value < 0.05., Results: Of the naturally infected participants, 352 (99.5%) had anti-S antibodies and all (100%) had anti-N antibodies, whereas among vaccinated participants, all (100%) had anti-S antibodies, while 323 (91.6%) had anti-N antibodies. Anti-S antibodies produced by vaccinated individuals were significantly (P < 0.001) higher than those produced as a result of natural infection. Being young (P = 0.004), having hypertension (P < 0.001), and having diabetes (P < 0.001) were significantly associated with lower anti-S antibody levels, while being recently vaccinated and having a higher number of vaccine doses were significantly associated with higher anti-S antibody concentrations in vaccinated participants. Having diabetes (P < 0.001) were significantly associated with lower anti-S concentrations in participants who were naturally infected., Conclusion: There is a high seropositivity rate in both naturally infected and vaccinated individuals. However, vaccinated individuals had higher levels of SARS-CoV-2 antibodies than those who were naturally infected, which highlights the significant contribution of vaccination in increasing the protection of COVID-19 in Ethiopia., (© 2024. The Author(s).)

Respiratory viruses contribute to high morbidity and mortality in Africa. In 2020, the Ohio State University's Global One Health Initiative, in collaboration with the Ethiopian Public Health Institute and the US Centers for Disease Control and Prevention, took action to strengthen Ethiopia's existing respiratory virus surveillance system through decentralization of laboratory testing and scale-up of national and regional capacity for detecting respiratory viruses. In August 2022, four regional laboratories were established, thereby raising the number of reference laboratories conducting respiratory virus surveillance to five. This article highlights lessons learned during implementation and outlines processes undertaken for laboratory scale-up and decentralization., (Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene 2024.)

Background: The overall time refers to the amount of time a patient spends in a health care facility, from the time he or she enters to the time he or she leaves. As a result of the imbalance between supply and demand, waiting times occur. Ethiopian hospitals are being reformed to improve the quality of care they provide. The time a patient spends in the hospital is one of the most important indicators of quality of care, as it provides insight into customer satisfaction and provider success. However, the overall time patients spend in hospitals was not studied., Objective: The study aimed to assess the overall time spent by clients from entry to exit and associated factors in the outpatient departments of Jimma zone hospitals., Methods: An institution-based cross-sectional study was conducted. Patients from outpatient units at Jimma zone public hospitals participated in the study from March 15 to May 17, 2018. Data were collected using a time and motion tool coupled with an interviewer-administered structured questionnaire on 249 samples. Participants in the study were selected using the consecutive sampling method. Overall time, in terms of waiting and service times at each section unit, and the relationship of socio-demographic and clinical factors with overall time was the main outcome variables. Data were analyzed using descriptive and linear regression analysis. Simple linear regression analysis was used to determine the relationship between the dependent and explanatory variables. Variables were considered significantly associated with the overall time if they had a p-value of less than 0.05 at the 95% confidence interval (CI)., Result: The overall response rate was 94.8%. Overall, patients spent a median time of 342.5 minutes. Patients spent 12.7% of the total time as service time and 86% of the time waiting for care. The longest overall times were spent in the laboratory (170 minutes), imaging (95 minutes), other diagnostic units (84 minutes) and examination (83 minutes). The average overall time was increased by 52.03 minutes (95%CI 21.65, 82.412), 4.65 minutes (95%CI 3.983, 5.324), and 96.43 minutes (95%CI 52.076, 140.787) when the patient was referred, the number of patients at the queue was increased by one unit, and patients who had other diagnostic tests performed respectively with P <0.005 &adjusted R2 = 0.522., Conclusion and Recommendations: The majority of patients stayed for a longer period. Most time was spent waiting for services, particularly in the examination, laboratory, and imaging units. This is strongly related to high patient load, an absence of some services, being referred patients, and patients who had other diagnostic tests. To reduce the number of patients in the queues, hospitals should work hand in hand with the Ministry of Health to enforce policies that are understood and adopted by all workers in the lower healthcare facilities. And hospital administrators are working to strengthen the triaging system to screen patients with minor illnesses. This is because most patients with minor illnesses queue with those with more complicated illnesses. Finally, we recommend that researchers conduct further research on service quality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Walle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Aims: Chronic obstructive pulmonary disease (COPD) causes airflow obstruction and respiratory problems. Thus, the main objective of this study was to determine the risk factors for the progression of COPD using longitudinally measured forced vital capacity with time to onset of polycythemia outpatients follow-up., Methods: A retrospective study design was used to gather the related data on longitudinal change of forced vital capacity and time to onset of polycythemia from the medical charts. The joint model consists of a longitudinal submodel for the change of forced vital capacity and a survival submodel for the time to onset of polycythemia of chronic obstructive pulmonary patients., Results: From the total of 266 patient's estimated value of forced vital capacity of chronic obstructive pulmonary patients was 74.45 years with a standard deviation of 8.59. The estimated value of the association parameter was -0.006, which indicates that the lower value for a forced vital capacity measure was associated with the higher risk of polycythemia and vice versa "Based on the joint model analysis found that the predictor smoking, comorbidities, marital status, weight, and HIV" jointly affected the two responses, which are change of forced vital capacity and time to onset of polycythemia among chronic obstructive pulmonary patients., Conclusion: The overall performance of separate and joint models, joint modeling of longitudinal measures with the time-to-event outcome was the best model due to smaller standard errors and statistical significance of both the association parameters., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background and Aims: Chronic kidney disease (CKD) is a major health problem worldwide. The general objective of this study is to identify the joint factors of serum creatinine (SCr) and time to end stage of renal disease (ESRD) for CKD patients under treatment at University of Gondar Referral Hospital (UOGRH)., Methods: A retrospective cohort study was conducted. The collected information was secondary data type obtained from 311 CKD patient's medical charts in the UOGRH from September 2019 to January 2022 G.C. Joint modeling analysis contained a linear mixed model for SCr and the Cox-PH model for time to ESRD of CKD patients under treatment was used., Result: From the total of 311 patients, 104 (33.4%) patients were developed the ESRD, while the other 207 (66.6%) were censored patients. In the longitudinal submodel, the variable sex, age, electrolyte, visit time, anemia, diabetes mellitus, chronic heart disease, hypertension, and hepatitis have a significant effect on the variable SCr. In survival process, anemia (HR = 2.53, p  = < 0.001), diabetes mellitus (HR = 2.206, p  = < 0.0047), chronic heart disease (HR = 2.83, p  = < 0.0011), HIV (HR = 2.778, p  = < 0.0045), hypertension (HR = 2.616, p  = < 0.001), and hepatitis (HR = 4.4, p  = < 0.0074) have a significant effect on the variable ESRD. On the basis of the result of the joint model, the variable anemia, diabetes mellitus, chronic heart disease, hypertension, and hepatitis were common significant factors., Conclusion: The majority of patients 207 (66.6%) of CKD patients were censored. On the basis of the smaller information criteria value and the significance association value, the joint model better fits the data. In the joint model, the variable anemia, diabetes mellitus, chronic heart disease, hypertension, and hepatitis were common factors of two responses, and also concluded that the rate of progression of longitudinal measure SCr decreased over time., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: As the Human Immunodeficiency Virus (HIV) rapid testing services expanded to reach the global target that 95% of people living with the virus will know their status by 2030, ensuring the quality of those services becomes critical. This study was conducted to assess the performance of HIV Rapid testing at sites in health facilities that were enrolled in the Rapid Test Quality Improvement Initiative (RTQII) in Ethiopia., Methods: Characterized HIV proficiency testing (PT) panels of Dried Tube Specimen (DTS) were prepared, verified, and distributed to testing sites from August to December 2019. In addition on-site evaluation of HIV testing sites (HTSs) was conducted using a checklist to assess testing conditions. For proficiency testing, the study included 159 HIV testing sites (HTSs) in 41 Health facilities (HFs) in five administrative regions and two city administrations. The collected data was analyzed by SPSS version 20 and chi-square test was applied to identify the association between acceptable performance and contributing factors. Testing sites with 100% PT score as well as conducting the test with adherence to the National HIV Testing Algorithm were considered acceptable., Results: The overall acceptable performance (100% PT score with the correct algorithm followed) was found to be 62% while 12% scored 80% and 11% scored between 20 and 60%. The rest 15% were not considered as acceptable due to failure to adhere to the National HIV Testing Algorithm. Testing sites that participated in External Quality Assessment/Proficiency Testing schemes have shown better performance than those that did not participate with 70% and 56% performance respectively (p = 0.057)., (© 2023. The Author(s).)

Background and Aims: Hepatitis is an inflammation of the liver that can reason a variety of health problems and can be fatal. According to the most recent estimates of the Global Burden of Disease study and WHO, viral hepatitis is accountable for around 1.34 million deaths yearly, which is comparable to the yearly number of deaths from HIV/AIDS (1.3 million), malaria (0.9 million), and tuberculosis (1.3 million). This study aimed to assess the prevalence of the Hepatitis B virus and associated risk factors among adults patients at Dessie Referral and Kemise General Hospitals., Methods: The source for the data on Hepatitis B virus (HBV) was all adults aged≥18 years that were admitted and tested for HBV from September 2020 to February 2021 were included in the study. A total of 1283 adults were admitted out of which, 1080 adults have completed measurements and had been taken into consideration for this examination, and others had been excluded from the examination because of exclusion criteria. To meet our objective descriptive statistics, the χ 2 test and multiple logistic regression statistical models were used for data analysis., Results: In this study, a total of 1080 adults were included out of which 631 (58.4%) female and 449 (41.6%) were male with a mean age of 34(SD ± ±  12.56) years. The overall prevalence of HBV among adults was 27.4% (95% confidence interval [CI];24.8-30.2). The results of this study showed that age 25-34(odds ratio [OR] = 3.6, p -value = 0.005), 35-44 (OR = 6.67, p -value <0.001), ≥45 (OR = 3.85, p -value = 0.005), male (OR = 4.36, p -value < 0.001), history of hospitalization (OR = 0.644, p -value = 0.04), family history of HBV (OR = 1.96, p -value = 0.005), and jaundice (OR = 2.50, p -value = 0.005) were significant risk factors of HBV., Conclusion: The prevalence of HBV in this study is 27.4%. The results of this study showed that age, male, history of hospitalization, family history of HBV, and jaundice were significant risk factors for Hepatitis B virus., Competing Interests: The authors declare no conflicts of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Managerial commitment is important for effective design and implementation of citizen charter to assure the quality of health service delivery as per the standards depicted in the document. Hence the objective of this study is to assess the level of managerial commitment towards implementation of the citizen charter standards and associated factor in Jimma zone public hospitals., Methods: A Facility based cross-sectional study design was employed in Jimma zone public hospitals from March 14 to May 16, 2019 and 422 health managers who were currently working at all levels of management were participated in the study. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P < 0.05. All assumptions of linear regression and principal component analysis were checked., Results: The percentages mean score of managerial commitment for health managers working in jimma zone public hospitals was 58%. Perceived value and care for managers (β = .329,95% CI,.245,.413, p-value<.001), Interaction between staff and managers' (β = 0.077,95%CI,.032,.122, p-value< 001),involvement during implementation of citizen charter(β = 0.061,95%CI,.010,.112,p-value = 018) and positional level(β = - 122,95%CI,-.242,-.002,p-value = .046) as predictors of managerial commitment towards implementation of citizen charter standards., Conclusions: In this study, the percentage mean score of managerial commitment for health care managers working in Jimma zone public hospitals was medium. Hence, all levels of managers to consider and maintain factors identified in this study in their management practice to foster a higher level of managerial commitment towards implementation of citizen charter standards in jimma zone public hospitals., (© 2021. The Author(s).)

Background: Coronavirus disease (COVID-19) is a highly transmittable virus that continues to disrupt livelihoods, particularly those of low-income segments of society, around the world. In Ethiopia, more specifically in the capital city of Addis Ababa, a sudden increase in the number of confirmed positive cases in high-risk groups of the community has been observed over the last few weeks of the first case. Therefore, this study aims to assess knowledge, practice and associated factors that can contribute to the prevention of COVID-19 among high-risk groups in Addis Ababa., Methods: A cross-sectional in person survey (n = 6007) was conducted from 14-30 April, 2020 following a prioritization within high-risk groups in Addis Ababa. The study area targeted bus stations, public transport drivers, air transport infrastructure, health facilities, public and private pharmacies, hotels, government-owned and private banks, telecom centers, trade centers, orphanages, elderly centers, prison, prisons and selected slum areas where the people live in a crowded areas. A questionnaire comprised of four sections (demographics, knowledge, practice and reported symptoms) was used for data collection. The outcomes (knowledge on the transmission and prevention of COVID-19 and practice) were measured using four items. A multi variable logistic regression was applied with adjustment for potential confounding., Results: About half (48%, 95% CI: 46-49) of the study participants had poor knowledge on the transmission mode of COVID-19 whereas six out of ten (60%, 95% CI: 58-61) had good knowledge on prevention methods for COVID-19. The practice of preventive measures towards COVID-19 was found to be low (49%, 95% CI: 48-50). Factors that influence knowledge on COVID-19 transmission mechanisms were female gender, older age, occupation (health care and grocery worker), lower income and the use of the 8335 free call centre. Older age, occupation (being a health worker), middle income, experience of respiratory illness and religion were significantly associated with being knowledgeable about the prevention methods for COVID-19. The study found that occupation, religion, income, knowledge on the transmission and prevention of COVID-19 were associated with the practice of precautionary measures towards COVID-19., Conclusion: The study highlighted that there was moderate knowledge about transmission modes and prevention mechanisms. Similarly, there was moderate practice of measures that contribute towards the prevention of COVID-19 among these priority and high-risk communities of Addis Ababa. There is an urgent need to fill the knowledge gap in terms of transmission mode and prevention methods of COVID-19 to improve prevention practices and control the spread of COVID-19. Use of female public figures and religious leaders could support the effort towards the increase in awareness., Competing Interests: The authors have declared that no competing interests exist.

In this paper, we present and analyze a spatio-temporal eco-epidemiological model of a prey predator system where prey population is infected with a disease. The prey population is divided into two categories, susceptible and infected. The susceptible prey is assumed to grow logistically in the absence of disease and predation. The predator population follows the modified Leslie-Gower dynamics and predates both the susceptible and infected prey population with Beddington-DeAngelis and Holling type II functional responses, respectively. The boundedness of solutions, existence and stability conditions of the biologically feasible equilibrium points of the system both in the absence and presence of diffusion are discussed. It is found that the disease can be eradicated if the rate of transmission of the disease is less than the death rate of the infected prey. The system undergoes a transcritical and pitchfork bifurcation at the Disease Free Equilibrium Point when the prey infection rate crosses a certain threshold value. Hopf bifurcation analysis is also carried out in the absence of diffusion, which shows the existence of periodic solution of the system around the Disease Free Equilibrium Point and the Endemic Equilibrium Point when the ratio of the rate of intrinsic growth rate of predator to prey crosses a certain threshold value. The system remains locally asymptotically stable in the presence of diffusion around the disease free equilibrium point once it is locally asymptotically stable in the absence of diffusion. The Analytical results show that the effect of diffusion can be managed by appropriately choosing conditions on the parameters of the local interaction of the system. Numerical simulations are carried out to validate our analytical findings., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors.)

Efforts towards slowing down coronavirus (COVID-19) transmission and reducing mortality have focused on timely case detection, isolation and treatment. Availability of laboratory COVID-19 testing capacity using reverse-transcriptase polymerase chain reaction (RT-PCR) was essential for case detection. Hence, it was critical to establish and expand this capacity to test for COVID-19 in Ethiopia. To this end, using a three-phrased approach, potential public and private laboratories with RT-PCR technology were assessed, capacitated with trained human resource and equipped as required. These laboratories were verified to conduct COVID-19 testing with quality assurance checks regularly conducted. Within a 10-month period, COVID-19 testing laboratories increased from zero to 65 in all Regional States with the capacity to conduct 18,454 tests per day. The success of this rapid countrywide expansion of laboratory testing capacity for COVID-19 depended on some key operational implications: the strong laboratory coordination network within the country, the use of non-virologic laboratories, investment in capacity building, digitalization of the data for better information management and establishing quality assurance checks. A weak supply chain for laboratory reagents and consumables, differences in the brands of COVID-19 test kits, frequent breakdowns of the PCR machines and inadequate number of laboratory personnel following the adaption of a 24/7 work schedule were some of the challenges experienced during the process of laboratory expansion. Overall, we learn that multisectoral involvement of laboratories from non-health sectors, an effective supply chain system with an insight into the promotion of local production of laboratory supplies were critical during the laboratory expansion for COVID-19 testing. The consistent support from WHO and other implementing partners to Member States is needed in building the capacity of laboratories across different diagnostic capabilities in line with International Health Regulations. This will enable efficient adaptation to respond to future public health emergencies., Competing Interests: The authors declare no competing interests., (Copyright: Adisu Kebede et al.)

Background: The utilization of routine health information is an essential factor of the structural capacity of health departments and public health performance depends on the effectiveness of information use for routine and programed decisions. Considerable research has been conducted in health data collection and ways to improve data quality, but little is known about utilization of routine health information among health workers in Ethiopia in general and in the study area in particular., Objectives: The aim of this study was to assess level of utilization of routine health information and associated factors among health workers in Hadiya zone, Southern Ethiopia, 2019., Methods and Materials: Facility-based cross-sectional study design with both quantitative and qualitative data collection methods was employed at the Hadiya zone from March 10-25, 2019. A total of 480 health workers were included in the study and systematic random sampling was employed to select the health care workers in the study. The results were analyzed and presented in tables and graphs. Finally, the binary logistic regression was used to examine independent predictors., Result: Good level of utilization of routine health information was reported by 301 (62.7%, 95% CI: 58.5%-66.9%) of the health workers. Training [AOR = 8.12; 95% CI: (4.33-15.23)], supportive supervision [AOR = 2.34; 95% CI:(1.40-3.92)], good perceived culture of health information [AOR = 5.05; 95% CI: (2.99-8.50], having a standard set of indicators (AOR = 2.05 95%; CI: (1.23-3.41) and competence on routine health information tasks [AOR = 5.85; 95% CI: (3.41-10.02)] were independent predictors., Conclusion: Good level of utilization of routine health information was noted in less than two-third of the study participants. Further training, supportive supervision, perceived culture of health information, having standard set of indicators and competence on routine health information task were factors that improve routine health information utilization., Competing Interests: No authors have competing interests.

Introduction: Physician is a central figure in the client list of clinical laboratory. Monitoring physicians' satisfaction with laboratory service is an important indicator of the quality management system and required by international laboratory standards. However, there is no national data on physician satisfaction with laboratory services in Ethiopia. Therefore, the aim of this national survey was to assess satisfaction level of physicians with laboratory services at public hospitals in Ethiopia., Methods: Institutional based cross-sectional study design was employed from November 1-30/2017. A total of 327 physicians were randomly selected from 60 public hospitals from all regions of Ethiopia. Data was collected using pre-tested self-administered questionnaire and analyzed with SPSS version 23 software. Logistic regression model was fitted to identify predictors of physician satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant., Results: Overall, 55% of physicians were satisfied with the clinical laboratory services. More than half of the physicians were satisfied with the existing laboratory request form (69%), legibility and completeness of laboratory report (61%), notification of new test (78%) and test interruption (70%). On the other hand, many physicians were dissatisfied with the absence of laboratory hand book (87.5%), the existing test menu (68%), lab-physician interface (62%), availability of referral and/or back up service (62%), notification of Turn Around Time (TAT) (54%), timely notification of panic result (55%), long TAT (33.1%), provision of urgent service (67%), and timely advisory service (57%). Most of the physicians perceived that consistent quality of service was not delivered at all working shifts (71%). At 5% level of significance, we did not find enough evidence to conclude that sex, age, marital status, education level, and experience were statistically associated with physician satisfaction (p-values > 0.05)., Conclusion: This national survey revealed nearly half of the physicians were unsatisfied with laboratory service at public hospitals in Ethiopia, which mainly related to lack of adequate test menu, laboratory hand book, on time notification of panic result, provision of urgent service, timely advisory service, delivery of quality services in all working shifts and weak lab-physician interface. Therefore, hospital management should address the gaps and improve the needs of physicians for better patient health care. In addition, laboratories should evaluate and monitor physician satisfaction level at regular interval., Competing Interests: ADL is employed by and receives salary from IBEX Biotech Ltd. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Knowing customers' level of satisfaction is relevant to improve and provide quality health care services. In the clinical laboratory, monitoring customers' satisfaction is an important indicator of the quality management system and required by international laboratory standards. However, in Ethiopia, there has not been baseline data about the satisfaction level of patients' with laboratory services at the national level. The aim of this national level survey was to assess patients' satisfaction level with laboratory services at public hospitals in Ethiopia., Methods: A national survey was conducted using an institutional based cross-sectional study design was employed from 01 to 30 November 2017. A total of 2399 patients were selected randomly from 60 public hospitals. Data was collected using structured questionnaire, entered in Epi Info and analyzed with SPSS software. Multiple logistic regression model was fitted to identify predictors of patients' satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant., Result: Overall, 78.6% of the patients were satisfied with the clinical laboratory services. Patients were dissatisfied with cleanness of latrine (47%), long waiting time (30%), clear and understandable advisory service during specimen collection (26%), adequacy of waiting area (25%), easy accessibility of laboratory (19%) and latrine location (20%), availability of requested service (18%), unfair payment of service (17%) and missing of result (12%). The educational status (P = 0.032), and distance (P = 0.000) were significantly associated with client overall satisfaction level., Conclusion: Most laboratory patients' were satisfied with the service provided by public hospital laboratories in public hospitals in Ethiopia. However, patients' were dissatisfied with the accessibility of sites, adequacy of waiting area, cleanness of latrine, long TAT, communication, missing of results, availability of requested service and cost of service. Therefore, responsible bodies in each level should act on the identified gaps and improve the need of patients in each hospital laboratory. In addition, all hospital laboratories should conduct a satisfaction survey and meet the needs of laboratory patients.