This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M. Public Health

Background - Khat is a mild stimulant plant chewed by a limited segment of the population mainly in the eastern parts of Ethiopia for social facilitation and religious purposes. In recent decades, the use of khat has spread to all parts of the country and its social, economic and political impact has increased significantly at national level. In cities like Addis Ababa, the traditional purposes are superseded and it is now chewed mainly for recreational purposes. Following this development, many people have raised concerns on the potentially adverse socioeconomic and psychological effects of khat on the current generation, particularly the youth. The main issues raised are the misuse of income, the waste of productive time on chewing khat, and the adverse consequences on family cohesion and health. Those who argue in favor of khat cite its positive impact on increasing productivity, high economic returns and traditional values. These arguments on khat are not based on substantiated evidence and this research attempted to answer this question by assessing the ‘positive’ and ‘negative’ socioeconomic and psychological effects of khat on the chewers living in Addis Ababa. Drug control policies intersect with much of the 2030 Agenda for Sustainable Development and Ethiopia has not yet developed a policy on khat. This research intends to make its contribution to the development of the policy by highlighting the socioeconomic and psychological effects on the chewers. Objective –To assess the effects of khat on the income; use of time/time management/; productivity, and psychological well-being of chewers in the city of Addis Ababa. The study is related to policies of Ethiopia in relation to the production, marketing and consumption of khat. It makes policy recommendations based on the assessed costs and benefits. Methodology - The study, using snowball sampling, was conducted in 2018 with 84 khat users. The data collection methods employed were structured questionnaire focus group discussions, narrations of life stories and interviews with key informants. An extensive literature review was also conducted. Result – Respondents reported the diversion of financial resources to purchase khat compromising other personal and family needs and a waste of working hours on chewing khat. There were mixed results found on its effects on productivity. Users also reported that khat made them vulnerable to other addictions such as alcohol, cigarettes and hard drugs and to a number of social and psychological problems. Conclusion - Khat has a significant adverse impact on income and the efficient use of time of chewers. The findings on the effect on productivity are inconclusive. The reported physical and psychological effects on productivity need to be scientifically proven. Chronic use of khat is detrimental to mental health and leads to other serious health consequences. It distorts social and family relationships and inhibits the ability of the chewer to significantly execute his/her social responsibilities. It hurts the self-esteem of the chewers and makes them lose a sense of purpose in their lives. Thus, there is an urgent need to develop a national policy on khat. However, a comprehensive study should be conducted to exploit the potential benefits of khat (mood lifting and medicinal values) by using khat in a modest and controlled way. The social and economic interest of the suppliers; its religious and cultural significance, and environmental impacts should also be considered. / Development Studies / M.A. (Development Studies)

This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M.A. (Public Health)

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC).The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. In the study, 79.8% and 248 (71.5%) of the women who delivered within 12 months prior to this study received ANC and skilled birth attendance respectively from SBA. Fifty five (15.8%) mothers and 131 (38%) babies received Postnatal care from SBA with in 45 days after delivery. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health- ervice utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework. / Health Studies / D. Litt. et Phil. (Health Studies)

Cervical cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death among women in less developed countries. Screening for cervical cancer is the most accepted and successful strategy for cervical cancer control. The purpose of the study was to investigate factors that determine cervical cancer screening practice among women in Addis Ababa, Ethiopia and develop guidelines to improve the utilisation of cervical cancer screening services. The researcher used the health belief model (HMB) as the theoretical foundation of the study and a convergent parallel mixed methods design. Quantitative data was obtained from screened and not screened women attending maternal health services at selected public health centres. Statistical Package for Social Sciences (SPSS) Version 23 was used for entry and analysis of data Qualitative data was obtained in key informant interviews from health service professionals on their perceptions of women‟s cervical cancer screening uptake at the health centres. The study found that higher age >35 years category (X2 =33.618 and p-value <0.001), contraceptive use (X2 value=20.7 and p-value <0.001), having two or more children, and knowledge of cervical cancer and screening (chi-value X2 =51.649, p-value=0.001) were strongly associated with screening practice. In addition, women‟s perception of susceptibility (t-test=3.42 and 3.432, p-value=0.001) was a predictor of screening. Lack of awareness was a serious barrier to cervical cancer screening and health service providers‟ information was a strong promoter of screening. The study recommends promoting and facilitating health education on cervical cancer at all health facilities; organising awareness campaigns, education programmes, and community mobilisation to raise awareness of cervical cancer screening; integrating cervical cancer screening with other reproductive health services, and capacitating the health professionals in order to increase utilisation of cervical cancer screening services. Consequently, the researcher used the findings of the study to develop guidelines to improve the uptake and quality of cervical cancer screening services. / Health Studies / D. Litt. et Phil. (Public Health)

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

This qualitative research investigated the implementation problems of apprenticeship training program in the Addis Ababa TVET colleges and enterprises. The research looked into the training program conducted by TVET Colleges and enterprises. Relevant literature on the nature of apprenticeship training and the factors that could affect its implementation were also reviewed. The research applied the theoretical statement of Bandura’s (1977) theory of observation /imitation/, Vygotsky’s theory of ZPD, contextual or the situated learning (Lave and Wenger, 1991), the constructivist view of learning and career theory as the main theoretical frameworks to describe the apprenticeship training process. The theories, however, do not mention the factors that can hamper the implementation of apprenticeship training in a specific social context. The theory of observation was preferred since it can describe the apprentice’s effort to master the skill of an occupation by observing the craftsman at the enterprises. The situated learning was preferred as it gives value to practice as a condition for the effectiveness of learning. Similarly, the research considered Vygotsky’s theory of the ZPD. The application of ZPD indicates the difference between what the apprentice can accomplish independently and what he/she can do with the close assistance of supervisor on a given task. Holland’s career theory (as cited in De lary, Duncan & Swarth, 2006) is also considered to describe the apprenticeship training in relation with an occupation. The current research has enabled to consider context specific conditions by focusing on the investigation of the causes of the implementation challenges of the apprenticeship training. The researcher collected data from Addis Ababa TVET Agency experts, deans of one private and another public TVET Colleges, college apprenticeship training coordinators, trainers, trainees, supervisors and enterprises by employing unstructured and structured interviews, observation and Focus Group Discussion tools. The analysis was made by making the data pass through three successive steps: data reduction, data display and interpretation, and conclusion. The findings showed that the implementation of the apprenticeship training program had challenges that could be shared among its actors; Trade Unions had no involvement in the implementation of the apprenticeship training program; the selected colleges and enterprises addressed their challenges by using limited strategies and without regular and systematic way; the presence of some less motivating factors for the participation of the apprentices in the apprenticeship training was reported; the presence of conditions that could adversely affect the apprentices’ acquisition of occupational skills was reported; the provision of apprenticeship training at the enterprises lack, either facilities or training services, in order to arrange the apprenticeship training program for TVET college trainees; and there were some indications for the presence of some weak professional qualities of supervisors that have implications for the apprentices’ training. Eventually, it was concluded that the implementation of apprenticeship training program in the Addis Ababa TVET Colleges and enterprises had challenges that require the consideration of both institutional and human conditions. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)