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Background Ethiopia’s Community-based health insurance (CBHI) is currently providing financial protection to more than 54 million beneficiaries (64% of the target population). Beneficiaries’ satisfaction with health service provision is among the important factors that influence the decision to enroll and renew. Despite the importance of satisfaction in influencing such important decisions, there is limited evidence on systematic studies conducted at a national level on CBHI beneficiaries’ satisfaction with health care service provision. Hence, this study aimed to measure the level of CBHI beneficiaries’ satisfaction with health service provision and identify its determinants in Ethiopia. Methods This study employed a health facility-based cross-sectional study design. A total of 1,836 patients who made OPD visits were sampled, yielding a 99.9% response rate. The mean value of a composite variable derived from satisfaction items, was used to measure the level of satisfaction. Factors determining patient satisfaction were measured using binary logistic regression model, and variables with p-values < 0.05 were considered the final predictors of satisfaction. Results Overall, 58% [(95% CI: 55.8, 60.4)] of the patients were satisfied with the health service they received. Factors associated with higher satisfaction include fully receiving prescribed medicines [AOR = 5.31, 95% CI; 3.74, 8.12], partially receiving prescribed medicines [AOR = 1.92, 95% CI; 1.27, 2.9], being informed about health problem [AOR = 1.84, 95% CI; 1.47, 2.31], being informed about recovery methods [AOR = 1.61, 95% CI; 1.28, 2.03], patient’s perception about conformity of service with benefit package [AOR = 1.4, 95% CI; 1.12, 1.73], visiting urban health facility [AOR = 1.34, 95% CI; 1.07, 1.67], and being in older age group. The study revealed a lower satisfaction at hospitals (53%) compared with health centers (61%). Conclusion Notably, a substantial proportion of patients (42%) were not satisfied, a rate higher than reported in comparable studies. Dissatisfaction was predominantly associated with shortages of prescribed medicines, inadequate laboratory services, and exposure to out-of-pocket payments. These findings highlight the need for coordinated efforts among health authorities and service providers to ensure uninterrupted availability of prescribed medicines and diagnostic services in alignment with the CBHI benefit package. Addressing these gaps is critical to fostering trust and improving satisfaction among CBHI beneficiaries.

ObjectiveA routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data.DesignThis was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework.SettingThis study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts.ParticipantsWe visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment.Outcome measuresWe assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions.ResultsThere was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting.ConclusionWe identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.

Background Malaria is a major public health concern in Ethiopia, and its incidence could worsen with the spread of the invasive mosquito species Anopheles stephensi in the country. This study aimed to provide updates on the distribution of An. stephensi and likely household exposure in Ethiopia. Methods Entomological surveillance was performed in 26 urban settings in Ethiopia from 2021 to 2023. A kilometer-by-kilometer quadrant was established per town, and approximately 20 structures per quadrant were surveyed every 3 months. Additional extensive sampling was conducted in 50 randomly selected structures in four urban centers in 2022 and 2023 to assess households’ exposure to An. stephensi . Prokopack aspirators and CDC light traps were used to collect adult mosquitoes, and standard dippers were used to collect immature stages. The collected mosquitoes were identified to species level by morphological keys and molecular methods. PCR assays were used to assess Plasmodium infection and mosquito blood meal source. Results Catches of adult An. stephensi were generally low (mean: 0.15 per trap), with eight positive sites among the 26 surveyed. This mosquito species was reported for the first time in Assosa, western Ethiopia. Anopheles stephensi was the predominant species in four of the eight positive sites, accounting for 75–100% relative abundance of the adult Anopheles catches. Household-level exposure, defined as the percentage of households with a peridomestic presence of An. stephensi , ranged from 18% in Metehara to 30% in Danan. Anopheles arabiensis was the predominant species in 20 of the 26 sites, accounting for 42.9–100% of the Anopheles catches. Bovine blood index, ovine blood index and human blood index values were 69.2%, 32.3% and 24.6%, respectively, for An. stephensi , and 65.4%, 46.7% and 35.8%, respectively, for An. arabiensis . None of the 197 An. stephensi mosquitoes assayed tested positive for Plasmodium sporozoite, while of the 1434 An. arabiensis mosquitoes assayed, 62 were positive for Plasmodium (10 for P. falciparum and 52 for P. vivax ). Conclusions This study shows that the geographical range of An. stephensi has expanded to western Ethiopia. Strongly zoophagic behavior coupled with low adult catches might explain the absence of Plasmodium infection. The level of household exposure to An. stephensi in this study varied across positive sites. Further research is needed to better understand the bionomics and contribution of An. stephensi to malaria transmission. Graphical Abstract

Background: Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective: To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods: We analysed national Health Management Information System data on 19 indicators of maternal health, neonatal survival, immunization, child nutrition, malaria, and tuberculosis over the 2012-2018 time period. The analyses were conducted by 38 analysts from the Ministry of Health, Ethiopia, and two government agencies who participated in the Operational Research and Coaching for Analysts (ORCA) project between June 2018 and June 2020. Using a World Health Organization Data Quality Review toolkit, we assessed indicator definitions, completeness, internal consistency over time and between related indicators, and external consistency compared with other data sources. Results: Several services reported coverage of above 100%. For many indicators, denominators were based on poor-quality population data estimates. Data on individual vaccinations had relatively good internal consistency. In contrast, there was low external consistency for data on fully vaccinated children, with the routine Health Management Information System showing 89% coverage but the Demographic and Health Survey estimate at 39%. Maternal health indicators displayed increasing coverage over time. Indicators on child nutrition, malaria, and tuberculosis were less consistent. Data on neonatal mortality were incomplete and operationalised as mortality on day 0-6. Our comparisons with survey and population projections indicated that one in eight early neonatal deaths were reported in the routine Health Management Information System. Data quality varied between regions. Conclusions: The quality of routine data gathered in the health system needs further attention. We suggest regular triangulation with data from other sources. We recommend addressing the denominator issues, reducing the complexity of indicators, and aligning indicators to international definitions.

Introduction Tuberculous lymphadenitis (TBLN) is an infection of the lymph node caused by Mycobacterium tuberculosis . Histological diagnoses of presumptive patients are often accompanied by cytomorphological features. However, the sensitivities of these features are often precluded by the variable degrees of narrative similarities compared to other diagnostic modalities. Objective The aim of this study was to investigate and compare the cytomorphological and clinical features of presumptive TBLN patients with bacteriological detection methods. Methods A similar cohort of TBLN patients from our previous study who were enrolled prospectively from the ALERT Specialized Hospital, Addis Ababa, Ethiopia, was considered for this analysis. SPSS version 26 was used for data analysis. Descriptive analysis was conducted to characterize the study population using the independent variable and presented with frequency tables. The chi-square test was used to measure the association. A P-value of < 0.05 was considered statistically significant. Results Using FNAC, 60/126 (47.6%) of the participants were reported to have features consistent with TB. Of the total FNAC-positive cases, many (30/60 and 27/60) showed pattern B (caseous necrosis only) and pattern C (epithelioid granuloma with caseous necrosis), respectively. Strong concordance was observed in Pattern A (abundant caseous necrosis with few epithelioid macrophages) followed by patterns B and C with GeneXpert and MGIT culture (P value < 0.001). Night sweats and alcohol intake were shown to correlate with positive cases as reported by FNAC (P value = 0.008 respectively), GeneXpert (P value = 0.02 & 0.001), and culture methods (P-value = < 0.001 & 0.002). Conclusion Cytomorphological features, particularly patterns A, B, and C, could be considered in the diagnosis of TBLN given their comparable outcomes with bacteriological detection methods. On another note, we recommend that due care and attention be given when treating TBLN patients based solely on clinical presentation, as these diagnostics may be prone to false results, leading to inappropriate administration of anti-TB drugs and other consequences.

Background The human immunodeficiency virus (HIV) is still a significant global public health concern. Mortality among people living with HIV remains high, predominantly in resource-limited settings. Despite significant progress in HIV care and treatment services, there is limited evidence on mortality among people living with HIV in Ethiopia. Therefore, this study aimed to assess the magnitude of mortality and its associated factors among people living with HIV admitted to selected hospitals in Ethiopia. Method A facility-based retrospective cross-sectional study was conducted among 10,077 PLHIV admitted to thirty-seven selected hospitals in Ethiopia. Data were collected from patient charts and registration books for the follow-up period between January 2016 and December 2023; cleaned and analyzed by STATA version 17. Descriptive, bivariate and multivariable logistic regression analysis were conducted. The association was measured by adjusted odds ratio (AOR) with 95% CI and p-value less than 0.05 was considered statistically significant. Results A total of 10,077 PLHIV were included in this study. The mean age (± SD) was 36.9 ± 13.9 years and 60.28% were females. The magnitude of mortality among PLHIV was 13.2% (95% CI:12.5%–13.9%). Being male (AOR = 1.29; 95% CI:1.14–1.45), aged 45–54 years (AOR = 1.23; 95% CI:1.01–1.52), aged 55 years or older (AOR = 1.40; 95% CI: 1.11–1.77), presence of opportunistic infections (OIs) at admission (AOR = 2.25; 95% CI:1.99–2.56), presence of non-communicable diseases (NCDs) and other comorbidities at admission (AOR = 1.59; 95% CI:1.40–1.81), and inactive ART status at admission (AOR = 1.27; 95% CI:1.12–1.45) were predictors of mortality in this study. Conclusion One in nearly eight admitted PLHIV die during hospitalization which is driven by male gender, older age, the presence of OIs, NCDs and inactive ART status at admission. Strengthening the health system with gender-specific interventions and routine screening for co-morbidities and OIs is essential. Moreover, further studies using prospective design are recommended. Clinical trial number Not applicable.