Theses and Dissertations (Health Studies)

Loss to follow-up on antiretroviral therapy amongst HIV patients on CCMDD program at Makhado Municipality, Limpopo Province, South Africa

Sun, 01 Feb 2026 00:00:00 GMT

Loss to follow-up on antiretroviral therapy amongst HIV patients on CCMDD program at Makhado Municipality, Limpopo Province, South Africa Moradi, Rofhiwa Faith Background: Loss to Follow-Up among HIV patients receiving Antiretroviral Therapy (ART) remains a significant barrier to achieving optimal HIV care outcomes in South Africa. The Central Chronic Medicine Dispensing and Distribution (CCMDD) Programme was introduced to improve access to treatment; however, retention challenges persist. Purpose: The study aimed to explore factors contributing to high rates of LTFU among HIV patients enrolled in the CCMDD Programme in the Makhado Local Municipality in the Limpopo Province, South Africa. Study setting: The study was conducted in three purposively selected clinics that implemented the CCMDD Programme in the Makhado Local Municipality, in the Limpopo Province. Method: An exploratory, descriptive qualitative research design was employed. A purpose sample of 34 HIV positive patients, aged 18 years and older, who had defaulted ART within the past twelve months but subsequently returned to care, participated in semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Trustworthiness was ensured through researcher-led data collection and strategies to enhance credibility and dependability. Results: Five major themes emerged from the data: (1) positive factors of the CCMDD Programme; (2) individual factors; (3) interpersonal factors; (4) community factors; and (5) health system-related factors. The positive aspects of the CCMDD Programme included improved patient adherence to treatment and reduced facility congestion. Contributing barriers included a shortage of medication, long waiting periods, poor data recording, communication breakdowns,Limited understanding of the Programme, distance and travel time, challenges with script renewal, side effects, stigma, nondisclosure, and a lack of social support. Conclusion: The findings of the study highlighted that the key drivers contributing to LTFU include stigma, non-disclosure of HIV status, long travel distances to collection points, lack of social support, and limited knowledge of the CCMDD Programme. Strengthening patient education, improving communication systems, and implementing early tracing strategies may enhance retention and adherence among patients enrolled in the CCMDD Programme.

Community based health insurance uptake and utilisation of healthcare in Ethiopia

Fri, 09 Jan 2026 00:00:00 GMT

Community based health insurance uptake and utilisation of healthcare in Ethiopia Adane Kebede Gutema Background: Community-Based Health Insurance (CBHI) is widely recognized as a key strategy for improving healthcare access and financial protection among lowincome populations. In Ethiopia, despite sustained efforts to expand CBHI coverage, enrolment remains below the national target of 80%. By 2020, only 49% of eligible households enrolled in Shaggar City, Oromia Region, Ethiopia. This limited coverage continues to expose many households to out-of-pocket healthcare costs, delays in seeking care, and poor health outcomes, thereby constraining broader socioeconomic development. Purpose: This study aimed to investigate the factors influencing CBHI uptake and healthcare utilization and to develop sustainable, evidence-based intervention strategies to enhance enrolment, renewal, and effective service use. Methods: A convergent mixed-methods design, guided by the Socio-Ecological Model (SEM), was employed across six sub-cities of Shaggar City, Oromia Region. The quantitative component involved a cross-sectional survey of 406 households, analyzed using SPSS (version 26) through descriptive statistics and multivariable logistic regression. The qualitative component comprised in-depth interviews with health leaders, CBHI officials, experts, healthcare providers, and community representatives, and was analyzed thematically. Findings from both strands were integrated and further refined using the APEASE framework (Affordability, Practicability, Effectiveness, Acceptability, Safety, and Equity). Results: CBHI enrolment showed a substantial improvement over time. While national and earlier evidence indicated that only 49% of eligible households were enrolled by 2020, the findings of this study revealed that enrolment had increased to 98% among eligible households in the study area by 2025. Despite this significant progress in coverage, both CBHI uptake and healthcare utilization were influenced by interconnected factors operating at multiple levels. Key determinants included individual awareness, perceived quality of healthcare services, household economic status, community trust, and institutional capacity. Qualitative insights further enriched these findings by highlighting persistent challenges related to service quality, limited access to reliable information, and gaps in system responsiveness. Drawing on the integrated evidence, the study developed the Comprehensive Integrated CBHI Uptake and Utilization (CICU) strategy, which focuses on strengthening awareness, improving service delivery, and enhancing sustained community engagement. Conclusion: This study makes a meaningful contribution to the field of health financing by offering an empirically grounded and theoretically informed framework for strengthening the implementation of Community-Based Health Insurance. The proposed Comprehensive Integrated CBHI Uptake and Utilization (CICU) strategy provides practical and context-sensitive guidance for policymakers and practitioners to enhance enrolment, improve service utilization, and address system-level challenges. By promoting more equitable and sustained access to quality healthcare, the study also supports Ethiopia’s ongoing efforts toward achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG 3). Keywords: Community-Based Health Insurance, CBHI uptake, healthcare utilization, socio-ecological model, health financing, Shaggar City, Oromia Region, Ethiopia

Radiation protection and safety practices among medical imaging professionals in Addis Ababa, Ethiopia

Fri, 13 Feb 2026 00:00:00 GMT

Radiation protection and safety practices among medical imaging professionals in Addis Ababa, Ethiopia Selam Fasil Ketema Background: Radiation exposure in medical imaging poses a potential health risk when safety protocols are inadequately practised. Despite awareness of radiation hazards, compliance with radiation protection measures among medical imaging professionals remains inconsistent across many healthcare settings. Purpose: The study aimed to assess radiation protection and safety practices among medical imaging professionals in Addis Ababa, Ethiopia, and to identify gaps in their knowledge, attitudes, perceptions, adherence and enabling environmental factors influencing these practices. Study setting: The study was conducted in four selected healthcare facilities in Addis Ababa, Ethiopia, among radiological technologists and radiographers. Method: A quantitative, descriptive cross-sectional research design was employed. Data were collected through an electronic questionnaire completed by 82 respondents. Descriptive and inferential statistical analyses, including a Pearson correlation analysis, were conducted. Results: The study population consisted mainly of Radiologic Technologists (RTs) (91.50%), of whom 64.6% were male, and 86.6% held a bachelor’s degree. Knowledge of core radiation protection principles was high (74-85%, p < 0.001), but gaps persisted in operational, regulatory and equipment-related knowledge domains. Attitude was generally positive; however, prioritising efficiency over safety practices (47.8%) was reported among respondents. Self-reported practices were inconsistent, with low adherence to shielding use, dose monitoring, and standardised radiation safety protocols. High workload (90%), limited resources (76.8%), inadequate training (72%), and insufficient regulatory guidance (54.9) were key barriers. Practice demonstrated a moderate correlation with attitude (r = 0.472, p < 0.01), perception (r = 0.514, p < 0.01) and enabling environment (r = 0.515, p < 0.01) but not with knowledge (r = 0.119, p = 0.287). Discussion: Generally, respondents demonstrated adequate knowledge and positive attitudes. However, deficiencies were observed in safety practices, including inconsistent adherence to shielding equipment, limited implementation of ALARA principles, and inadequate strategies to reduce repeat exposures. Although most respondents perceived their work as hazardous, this perception did not consistently translate into protective practices. High workload, limited resources, and insufficient training emerged as major barriers. Correlation analysis further revealed that attitude, perception and environmental factors had a stronger influence than knowledge alone. Conclusion: Although awareness and attitude were favourable, the translation into consistent safety practices remains limited. Furthermore, environmental constraints and behavioural factors significantly influenced radiation protection practices, highlighting the need for stronger institutional support, regular training, and improved radiation safety culture.

Strategies to enhance the implementation of the Ethiopian national guidelines for cervical cancer screening among women in Ethiopia

Thu, 01 Jan 2026 00:00:00 GMT

Strategies to enhance the implementation of the Ethiopian national guidelines for cervical cancer screening among women in Ethiopia Roman, Negewo Desta Background: An estimated 80% of cancer patients in developing countries present with advanced stage of cancer at their first visit to health care facilities. According to, WHO in 2022, an estimated 660 000 women were diagnosed with cervical cancer worldwide and about 350 000 women died from the disease. Effective primary which is HPV vaccination, awareness of cervical cancer and secondary prevention approaches; screening for, and treating precancerous lesions will prevent most cervical cancer cases (WHO 2020:8). When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. With a comprehensive approach including implementing the national cervical cancer screening guideline throughout all health facilities to follow the primary, secondary and tertiary prevention for, cervical cancer prevention, screen and treat cervical malignancy can be eliminated as a public health problem within a generation. Cervical cancer affects an estimated 22 million women over the age of 15 worldwide, accounting for 25.8% to 32% of all female cancers. Each year, 6294 women are diagnosed with cervical cancer, with 4884 dying as a result (Bruni et al 2019: 9). Cervical cancer is the most common cancer in Ethiopia, accounting for 13.4% of all malignancies, and women account for around two-thirds of all cancer deaths. Only 0.6% of Ethiopian women aged 18 to 69 were screened for cervical cancer (FMOH:2020:12). This indicated that in Ethiopia cervical cancer screening uptake is very low and majority of the women don’t have an access or lack information about the disease in furthermore, most of the prevention methods primary, secondary and tertiary prevention were not implemented as recommended by the national guideline throughout the health facilities.Therefore, the purpose of this research was to develop strategies to enhance the implementation of the Ethiopian National Cervical Cancer Screening Guidelines among women in Ethiopia. Methods and material: Mixed method approach with sequential explanatory design was employed. Fourteen cervical cancer screening health facilities were identified with simple random sampling method from the two regions of the country the study has three phases. Phase one quantitative data was obtained through a validated checklist adapted from the National Cervical Cancer Screening Guidelines to obtain data from fourteen managers of selected health centres furthermore; observation was made on cervical cancer screening logbook, health education registry and VIA result registration books to collect cervical cancer screening service statistics data. Descriptive statistics was employed to analyse quantitative data. Phase two qualitative study phenomenological qualitative design was employed, fourteen focus group discussions with health workers and twenty-eight in-depth interview were conducted with women. Semi structured open ended focus group and in-depth interview guide was developed to collect qualitative data. Thematic analysis was utilized for data analysis. Phase three strategies development five experts were selected with purposive sampling methods who had better knowledge and experience in the field of area self-administered structured data collection method was employed. The questioner contents nine interim strategies. Data was analysed manually by using simple calculator to assess the level of acceptance, experts rated each strategy using a four point Likert scale ranging from “Strongly disagree” to “Strongly agree‟. Each strategy was scored out of 40, with a mean score of 30 (75%) considered the threshold for acceptability. After data analysis quantitative and qualitative findings were triangulated. Finally, strategies were developed after an extensive review and validation by experts. Results: Overall, findings of this study revealed that majority of cervical cancer screening procedures and activities were not fully implemented based on the national cervical cancer screening guideline of the country resulting in an adverse impact on the uptake of cervical cancer screening. The quantitative findings revealed that, majority of health facilities have a challenge to address screening and treatment. The main problem was unavailability of room for screening, lack of skilled manpower including limited training, and shortage of important instruments cryotherapy machine to perform cryotherapy treatment to treat premalignant lesions for VIA positive women. There was no well-established referral and information system, no tracing mechanism to clients who are lost from follow up. The qualitative finding identifies that, a significant portion of women lack knowledge about the disease and its screening process and did not know where services are available. Misconception, cultural influence and unavailability of preventive HPV vaccine for girls, were reasons for late presentation with advanced stages of the disease and a factor for high prevalence and full-blown cervical cancer in the country. Although the guideline clearly outlines what health professionals should do such as primary prevention through awareness raising, secondary prevention through timely identification and treatment, provision of information about available services, and implementation of screening procedures most health workers were not consistently carrying out these recommended activities. These shortcomings collectively contributed to adverse impacts on the uptake of cervical cancer screening. Conclusion: In conclusion, it is imperative for the Federal Ministry of Health (FMOH) to prioritise women’s health, particularly strengthened cervical cancer screening programmes through implementing cervical cancer screening procedures and activities fully implemented in accordance with the national cervical cancer screening and prevention guideline. The government must take proactive measures to raise awareness of the importance of screening and ensure services are readily available and accessible across all communities. Expanding public healthcare facilities nationwide will enhance the provision of cervical cancer screening, ultimately improving health outcomes for women and reducing the burden of disease. Recommendation: The findings of this study served as a foundation for developing practical strategies aimed at improving the implementation of the national cervical cancer screening guideline and increasing screening uptake among women. The evidence generated has important implications for stakeholders at multiple levels, including policymakers, programme planners, program implementers, regional health bureaus, MOH, woreda health office administrators, and healthcare service providers by highlighting the challenges and identifying potential solutions, the study contributes to bridging existing gaps and advancing knowledge on cervical cancer screening services, and further research is recommended such as Involvement of male partners or husbands, family members and community leader, exploration of the experiences of survivors regarding cervical cancer screening. Text in English with abstract in English and Amharic