59 research outputs found
Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey
No full textBackground: Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at signifcant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. Methods: A national cross-sectional survey, based on the World Health Organization’s NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defned as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifcally diabetes and high blood pressure. Results: Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors. Conclusion: In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals’ lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.Yalemzewod Assefa Gelaw, Digsu N. Koye, Kefyalew Addis Alene, Kedir Y. Ahmed, Yibeltal Assefa, Daniel Asfaw Erku, Henok Getachew Tegegn, Azeb Gebresilassie Tesema, Berihun Megabiaw Zeleke, and Yohannes Adama Melak
Reorienting and rebuilding the health system in war-torn Tigray, Ethiopia
No full textArmed conflict and war, directly and indirectly, affect health and health systems.1 2 Globally, conflict was responsible for over 63000 deaths and over 2.7million years of lives lost due to disability in 2019.3 The war in the Tigray region of Ethiopia, which started in November 2020, has already caused a considerable number of casualties, massive internal displacement and over 70000 refugees in neighbouring Sudan.4 A recent report by World Food Program suggests that 91% of the region’s six million people require immediate emergency humanitarian assistance, and 400000 people had crossed the ‘threshold into famine’.5 6 Evidence also revealed that women and girls were subjected to sexual abuse and gender-based violence in this war. 6 In addition, the destruction, vandalisation and looting of health facilities have left millions of people without access to essential healthcare.
Improving the prevention and management of non-communicable diseases through primary health care in Ethiopia
No full textMortality from non-communicable diseases (NCDs) in Africa will overtake combined mortality from communicable, maternal, neonatal and nutritional diseases by 2030. Despite global declarations on the need for comprehensive primary health care (PHC) to address NCDs, the policy responses of African nations have been limited. In this thesis, I conduct a mixed methods study to assess the capacity of PHC systems to improve the prevention and management of NCDs in Africa, with a focus on Ethiopia.
Section 1 summarises the NCD burden in Africa and provides an overview of the Ethiopian health system. Section 2 comprises Chapters 1 and 2. Chapter 1 maps progress against World Health Organization (WHO) targets for NCD care in the 47 countries of the WHO African Region. No country has met all recommended targets, and seven have met no targets. In Chapter 2, I propose priority areas to address these gaps, including (i) enhanced political commitment; (ii) service redesign; (iii) workforce capacity strengthening; (iv) improved treatment protocols; (v) comprehensive resource gap analysis; (vi) large-scale implementation; and (vii) support from multilateral institutions.
In Section 3, which comprises Chapters 3–5, I focus on Ethiopia. Chapter 3 presents an in-depth qualitative study that corroborates the Chapter 1 findings, highlighting health system governance challenges to strengthening PHC (limited political commitment, inter-sectoral coordination and funding) combined with operational constraints (an insufficiently skilled and supported PHC workforce, fragmented information systems, and inadequate equipment and medicines). Chapter 4 presents a multi-level analysis of the National Ethiopia Health Extension Program (HEP) Survey. The analysis showed that provision of essential non-NCD HEP services was both positively and negatively associated with NCD service provision. In Chapter 5, I assess NCD training, supervision and performance appraisal for health extension workers (HEWs). I found variable quality in NCD training for HEWs and supervisors; inconsistent and somewhat punitive supervision practices; and non-transparent performance appraisal, which has led to HEW de-motivation.
In Section 4, I synthesise all study findings and discuss the policy implications for Ethiopia and Africa more broadly. I also appraise the opportunities to strengthen NCD service delivery in the context of the COVID-19 coronavirus disease pandemic and the ongoing civil war in Ethiopia. I conclude with recommendations for future research and policy to increase Ethiopia’s capacity to provide comprehensive PHC that includes NCD care
Voilà, an orientation shift marker in modern French discourse: a conversation analytic perspective
No full textUsing Conversation analysis as a methodology, this study investigates the use and functions of the discourse marker voilà in French interaction. As my literature review will show (chapter 2), prior studies on voilà focused mainly on morphosyntactic aspects of voilà (e.g., Moignet, 1969; Morin, 1985, Hug, 1995). Despite being one of the most frequently used words in everyday French conversation the discourse marker voilà has yet to be systematically studied from a conversation analytic perspective. This oversight is reflected in beginning French textbooks, in which the treatment of voilà is in most cases restrictive and somewhat misleading.
The present study is the first comprehensive study of voilà which takes into account the sequential position of the discourse marker in talk-in-interaction in order to identify the multiple functions that it performs. My data come from two different speech exchange systems: four hours of ordinary phone and Skype conversations among native speakers of French, and over twenty hours of institutional talk in the form of radio and TV talk shows from France. All the functions of voilà described in this dissertation occur in both speech exchange systems, except for delicate talk which contained no instances of voilà.
In my analytical chapters I examine the use of voilà in sequence closings (chapter 3), the use of voilà in openings (chapter 4), and the use of voila in word search activities (chapter 5). In chapter 3 I show that voilà is used in second pair parts (SPPs) of adjacency pairs to claim higher epistemic authority over co-participants and in sequence closing thirds (Schegloff, 2007). In addition, voilà can close a turn before its syntactic/pragmatic ending. This usually occurs in delicate interactions, or when recipients are presumed to know the rest of the talk. In chapter 4, I investigate how speakers use voilà to present upshots of their prior talk, and to introduce hypothetical direct quotes. In chapter 5 I explore the use of voilà in word search activities. My analyses show that speakers deploy voilà to preface the newly found word, and to mark the finding of the sought-for word. Speakers may also use voilà as a semantic place holder until the sought-for word is found. The occurrence of voilà in these various positions indicates that voilà is a rather prevalent device. Finally, in my conclusion chapter (chapter 6) I highlight the main findings, I point out the pedagogical implications of my findings, the limitations of the current study, and the avenues for future studies.
Throughout my analyses and discussion sections, I explore the question as to why voilà among any other possible linguistic elements is used by co-participants to perform its various actions. My analyses demonstrate that when voilà closes an action and indicates a speaker’s readiness to start the next action, it looks backward and forward at the same time. Likewise when voilà presents the newly found word, presents upshots of prior talk, projects the yet-to be found word in the projection space or presents the hypothetical direct quote in the imaginary and fictitious world, it clearly looks forward. All of these observations thus establish the fact that voilà in discourse is directly linked to its central semantic meaning, which is spatial-deictic (Bergen & Plauché, 2001, 2005). It is specifically voilà’s ability to look backward and forward at the same time that differentiates it from voici.
When voilà is used in combination with other discourse markers (e.g., enfin voilà), the actions are mainly performed by the additional discourse markers and not necessarily by voilà. Hence, when used by itself, the actions performed by voilà are first and foremost accomplished by virtue of its position in the ongoing talk. All of these observations lead to the conclusion that voilà’s is defined by its ability to shift orientation and thereby orient co-participants’ attention to specific parts of utterances. Therefore I argue that if from a morphosyntactic perspective voilà is a subjectless or an existential verb (Moignet, 1969; Morin, 1985, Hug, 1995), then from a conversation analytic perspective voilà is primarily an orientation shift marker.Submission published under a 24 month embargo labeled 'U of I only', the embargo will last until 2017-08-01The student, Azeb Haileselassie, accepted the attached license on 2015-07-01 at 10:11.The student, Azeb Haileselassie, submitted this Dissertation for approval on 2015-07-01 at 11:04.This Dissertation was approved for publication on 2015-07-08 at 08:28.DSpace SAF Submission Ingestion Package generated from Vireo submission #8328 on 2015-09-29 at 14:59:01Made available in DSpace on 2015-09-29T20:49:40Z (GMT). No. of bitstreams: 2
HAILESELASSIE-DISSERTATION-2015.pdf: 3526956 bytes, checksum: a090a3b3995450f613d7cfd6738e9d22 (MD5)
LICENSE.txt: 4215 bytes, checksum: 477687f2748d78baca7adcce60d982df (MD5)
Previous issue date: 2015-07-08Embargo set by: Seth Robbins for item 89435
Lift date: 2017-09-29T20:50:34Z
Reason: Author requested U of Illinois access only (OA after 2yrs) in Vireo ETD systemU of I Only Restriction Lifted for Item 89435 on 2017-09-30T09:15:27Z
Additional file 1: of A qualitative study of drivers of psychoactive substance use among Mekelle University students, Northern Ethiopia
No full textCodes-quotations list. (DOCX 237 kb
A qualitative study of drivers of psychoactive substance use among Mekelle University students, Northern Ethiopia
No full textAbstract Background Psychoactive substance (PS) use is a public health concern among University students. Understanding the factors underlay the use helps to underpin effective preventive interventions. However, there is dearth of exploratory studies on the drivers of psychoactive substance use in Ethiopian universities. Here, we aimed to explore the drivers for psychoactive substance use among Mekelle University undergraduate students. Methods Exploratory qualitative study was conducted from April 1 to May 30, 2017. We conducted five focus group discussions (FGDs) and eleven in-depth interviews (IDIs) with students, proctors and bar owners. We also conducted three round interviews within two weeks interval with each of four key-informant researchers (KIR). Participants were selected purposively and the investigators conducted the discussions and the interviews using semi-structured guides. Data were audio-recorded, transcribed verbatim and imported into qualitative data analysis software for coding and analysis. An inductive approach was applied to crystalize non-repetitive emerging themes overarching the drivers for psychoactive substance use among university students. Results The following themes emerged as drivers for psychoactive substance use among University students; (1)feeling helpless following detachment from family, (2) prior experience with substances, (3) socialization reasons, (4) low academic performance, (5) physical environment (explained by easy access to substance and limited recreational alternatives), and (6) sub-optimal organizational support. Conclusions Multiple drivers that range from individual to structural levels are involved in university student’s use of psychoactive substances, with socialization process at the center of the factors. Thus, the study appeals for a range of multifaceted interventions directed to the individual, interpersonal and organizational level factors
‘First of all, I need training’: a qualitative study evaluating the Fiji community health worker training program
No full textAbstract Background Fiji faces a growing burden of diseases and a significant emigration of health workers, heightening the role of community health workers (CHWs) in healthcare delivery. Effective training is crucial for CHWs to enhance their capacity and service quality. This study evaluates CHW training in Fiji, aiming to identify areas for improvement. Methods A qualitative study was conducted, encompassing a review of national policies on CHW training, six focus group discussions, and interviews with CHWs and their supervisors across Fijian subdivisions. This study was collaboratively designed with Fiji's Ministry of Health and Medical Services (MOHMS). Data was transcribed, coded, and thematically analysed using the Community Health Workers Assessment and Improvement Matrix (CHW-AIM). Findings While CHW training policies in Fiji are well-established, discrepancies exist between the policy and its implementation. Challenges include inconsistent training for new recruits, limited resources, and variability in training content and frequency of training across divisions, especially concerning noncommunicable disease (NCD) training. Interpretation To enhance the CHW training program in Fiji, a restructuring and standardisation of both pre-service and in-service training is necessary, tailored to the needs of each division. Investment in ongoing capacity building, alongside the development and revision of training guidelines, particularly for managing NCD complications in the community, is crucial. Implementing these changes will enable CHWs in Fiji to be better equipped for providing essential community-based care
Childhood obesity and associated problems
No full textThe purpose of this Bachelor’s Thesis was to find out the current situation regarding childhood obesity and associated problems. Basically the topic has two parts: childhood obesity and the problems associated with childhood obesity. It will also answer basic questions regarding childhood obesity. The aim of this Bachelor’s Thesis was to create awareness among children and parents about childhood obesity and associated health problems. Additionally, it would be used as a guide in Terveysnetti for families as an educational material.
Method: For this literature review, the author used recent studies from databases such as PubMed, CINHAL and EBSCOhost as main sources to search different review from 2012 to present. Studies were searched using search terms “childhood obesity” and “associated problems”. Ten of the most relevant studies summarized that met the inclusion criteria were included.
Results: The prevalence of childhood obesity is increasing in children. There are many factors that lead to childhood obesity such as: genetic, behavioral, and environmental. Moreover, overweight and obesity, as well as their related non-communicable diseases, are preventable. Exercise programs/outdoor activities with a dietary modification are effective for children to maintain normal weight.
Conclusion: Educating parents and children about the healthy life style and the consequences of the health issues can reduce childhood obesity.Tämän opinnäytetyön tarkoituksena oli selvittää lapsuusiän lihavuutta ja siihen yhteydessä olevia tekijöitä. Kirjallisuuskatsauksessa on kaksi osaa: lapsuusiän lihavuus ja siihen yhteydessä olevat tekijät. Se vastaa myös peruskysymyksiin, jotka koskevat lasten lihavuutta. Tämän opinnäytetyön tavoitteena oli lisätä lapsen ja vanhempien tietoisuutta lapsuusiän lihavuudesta ja siihen yhteydessä olevia tekijöitä. Lisäksi siitä valmistui opas Terveysnettiin.
Menetelmä: Opinnäytetyö toteutettiin kirjallisuuskatsauksena. Siinä käytettiin tuoreita tutkimuksia seuraavista tietokannoista, kuten PubMed, CINHAL sekä EBSCOhost, pääasiallisina lähteinä etsimään erilaisia tarkasteluja vuodesta 2012 eteenpäin. Tutkimuksia haettiin käyttämällä hakutermejä "lapsuusiän lihavuus" ja "liittyvät ongelmat". Kymmenen tärkeimpiä tutkimuksia tiivistettiin, jotka täyttivät osallisuutta koskevat kriteerit.
Tulokset: Lasten lihavuuden esiintyvyys kasvaa lapsilla. On monia tekijöitä, jotka johtavat lapsuuden lihavuuteen, kuten: geneetti syyteen, käyttäytymiseen ja ympäristöön liittyvät tekijät. Lisäksi, ylipaino ja lihavuus sekä niihin liittyvät tarttumattomat taudit ovat estettävissä. Harjoitusohjelmat ja ulkoilu, joihin yhdistetään ruokavalion muutos, ovat tehokkaita lapsille normaalin painon säilyttämiseksi.
Tästä kirjallisuuskatsauksesta voidaan päätellä, että vanhempien ja lasten kouluttaminen terveistä elämäntavoista ja terveysongelmien seurauksista voi vähentää lapsuusiän lihavuutt
Readiness for non-communicable disease service delivery in Ethiopia: an empirical analysis
No full textAbstract Background Ethiopia’s health system is overwhelmed by the growing burden of non-communicable diseases (NCDs). In this study, we assessed the availability of and readiness for NCD services and the interaction of NCD services with other essential and non-NCD services. Methods The analysis focused on four main NCD services: diabetes mellitus, cardiovascular diseases, chronic respiratory diseases, and cancer screening. We used data from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. As defined by the World Health Organization, readiness, both general and service-specific, was measured based on the mean percentage availability of the tracer indicators, such as trained staff and guidelines, equipment, diagnostic capacity, and essential medicines and commodities needed for delivering essential health services and NCD-specific services, respectively. The survey comprised 632 nationally representative healthcare facilities, and we applied mixed-effects linear and ordered logit models to identify factors affecting NCD service availability and readiness. Results Only 8% of facilities provided all four NCD services. Availability varied for specific services, with cervical cancer screening being the least available service in the country: less than 10% of facilities, primarily higher-level hospitals, provided cervical cancer screening. General service readiness was a strong predictor of NCD service availability. Differences in NCD service availability and readiness between regions and facility types were significant. Increased readiness for specific NCD services was significantly associated with increased readiness for communicable disease services and interacted with the readiness for other NCD services. Conclusion NCD service availability has considerable regional variation and is positively associated with general and communicable disease services readiness. Readiness for specific NCD services interacted with one another. The findings suggest an integrated approach to service delivery, focussing holistically on all disease services, is needed. There also needs to be increased attention to reducing resource allocation variation between facility types and locations
Health system capacity and readiness for delivery of integrated non-communicable disease services in primary health care: A qualitative analysis of the Ethiopian experience.
No full textBackgroundNon-communicable diseases (NCDs) now account for about 71% and 32% of all the deaths globally and in Ethiopia. Primary health care (PHC) is a vital instrument to address the ever-increasing burden of NCDs and is the best strategy for delivering integrated and equitable NCD care. We explored the capacity and readiness of Ethiopia's PHC system to deliver integrated, people-centred NCD services.MethodsA qualitative study was conducted in two regions and Federal Ministry of Health, Addis Ababa, Ethiopia. We carried out twenty-two key informant interviews with national and regional policymakers, officials from a partner organisation, woreda/district health office managers and coordinators, and PHC workers. Data were coded and thematically analysed using the World Health Organization (WHO) Operational Framework for PHC.ResultsAlthough the rising NCD burden is well recognised in Ethiopia, and the country has NCD-specific strategies and some interventions in place, we identified critical gaps in several levers of the WHO Operational Framework. Many compared the under-investment in NCDs contrasted with Ethiopia's successful PHC models established for maternal and child health and communicable disease programs. Insufficient political commitment and leadership required to integrate NCD services at the PHC level and weaknesses in governance structures, inter-sectoral coordination, and funding for NCDs were identified as significant barriers to strengthening PHC capacity to address NCDs. Among the operational-focussed levers, fragmented information management systems and inadequate equipment and medicines were identified as critical bottlenecks. The PHC workforce was also considered insufficiently skilled and supported to provide NCD services in PHC facilities.ConclusionStrengthening NCD prevention and control through PHC in Ethiopia requires greater political commitment and investment at all health system levels. Prior success strategies with other PHC programs could be adapted and applied to NCD policies and practice, giving due consideration for the unique nature of the NCD program
- …
