Summary Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast,...

OBJECTIVESDisrespect and abuse are an often-unacknowledged cause of maternal mortality and morbidity globally. The objective of this study was to assess the prevalence and associated factors of disrespect and abuse of women during childbirth at a health facility in the town of Bahir Dar, Ethiopia.METHODSIn this community-based cross-sectional study, 422 mothers were interviewed from March 1 to 30, 2017 using a systematic random sampling technique with the kth value of 23 calculated based on the number of households in each sub-city and the expected sample size from sub-cities. Data were collected using a structured face-to-face interview questionnaire. EpiData version 3.1 was used to code and enter data, which were analyzed using SPSS version 22. Descriptive statistics were calculated for each variable, and binary logistic regression analysis with 95% confidence intervals (CIs) was carried out to determine the associations between predictor variables and outcome variables.RESULTSA total of 410 women participated in the study, with a response rate of 97.2%. The overall prevalence of disrespect and abuse was 67.1% (95% CI, 63.0 to 72.0). Disrespect and abuse were more prevalent in women with a monthly income less than 2,000 Ethiopian birr (adjusted odds ratio [aOR], 1.74; 95% CI, 1.08 to 2.80), mothers who stayed in a health facility after delivery (aOR, 5.14; 95% CI, 2.23 to 11.82), those who received care at a governmental hospital (aOR, 2.49; 95% CI, 1.15 to 5.40), and those who attended fewer than 4 antenatal care visits (aOR, 1.97; 95% CI, 1.15 to 3.40).CONCLUSIONSThe prevalence of disrespect and abuse was high in this study setting. To decrease the prevalence of this phenomenon, appropriate interventions should be designed, focusing on increasing the number of antenatal care visits, increasing the incomes of mothers, and improving the relationship between health workers and mothers during mothers’ stay at health facilities.

BackgroundEffective menstrual hygiene has direct and indirect effect on achieving millennium development goals two (universal education), three (gender equality and women empowerment) and, five (improving maternal health). However, in Ethiopiait is an issue which is insufficiently acknowledged in the reproductive health sector. The objective of this study therefore, is to assess the age of menarche and knowledge of adolescents about menstrual hygiene management in Amhara province.MethodSchool based cross sectional study was conducted from November 2012 to June 2013. Multistage stage sampling technique was used. The school was first clustered in to grades & sections and thenparticipants were selected by lottery method. A pretested &structured questionnaire was used. Data were entered, cleaned and analyzed using SPSS version 16.0. Finally, multivariate analysis was used to assess independent effect of predictors.FindingsIn this study, 492 students were included, making a response rate of 100%. Mean age at menarche was 14.1±1.4 years. The main sources of information about menstrual hygiene management were teachers for 212 (43.1%). Four hundred forty six (90.7%) respondents had high level knowledge about menstrual hygiene management. Most of the respondents 457 (92.9%) and 475 (96.5%) had access for water and toilet facility respectively. Place of residence (AOR = 1.8, 95%CI: [1.42–1.52]) and educational status of their mothers’ (AOR = 95%CI: [1.15–13.95]) were independent predictors of knowledge about menstrual hygiene management.ConclusionKnowledge of respondents about menstrual hygiene management was very high. School teachers were the primary source of information. Place of residence and their mother’s educational status were independent predictors of menstrual hygiene management. Thus, the government of Ethiopia in collaboration with its stalk holders should develop and disseminatereproductive health programmes on menstrual hygiene management targeting both parents and their adolescents. Moreover, parents should be made aware about the need to support their children with appropriate sanitary materials.

Introduction: Menstrual hygiene management has not received adequate attention in the reproductive health sectors in developing countries. In Africa the practice of menstrual hygiene management is still poor and the issue is under estimated. Due to poor menstrual hygiene management the adolescent girls are exposed for reproductive tract infection, school absenteeism and increase school dropout rate. Objectives: To assess the practice of menstrual hygiene and associated factors among female Mehalmeda high school students in Amhara regional state, Ethiopia. Methods: Institution based cross sectional study design conducted from April 01 to 30/2013 using multistage sampling technique. Four hundred ninety two study participants were selected and structured pretested questionnaire was used to collect information from the participants. The data was analyzed using SPSS version 16 Crude odds ratio (COR) and Adjusted odds ratio (AOR) was used to identify the association with p value <0.05 as significant. Result: Majority of the participants (90.9%) practiced good menstrual hygiene and had high level of menstrual hygiene knowledge. After bivariate analysis, the significant factors of menstrual hygiene were entered in to the multivariate model. It revealed that good menstrual hygiene was practiced among those participants who had high level of knowledge about menstrual hygiene (OR 5.78: 95% CI, 2.15-15.51), teachers as source of information (OR 7.64: 95% CI, 2.16-27.03) and access for water (OR 6.5: 95% CI, 2.08-20.32) and urban place of residence (OR 2.38: 95% CI, 1.137, 3.05). Conclusion: Majority of the participants had high level of menstrual hygiene knowledge practiced good menstrual hygiene. Different factors affect the practice of menstrual hygiene such as source of information, access of water and knowledge about menstrual hygiene.

BackgroundDisclosure of human immune deficiency virus (HIV) positive status has a key role in the prevention and control of HIV/AIDS. The failure of people infected with HIV to disclose their positive status can expose their sexual partners to the virus. Identifying the factors associated with status disclosure is a priority issue as high proportion of people living with HIV do not discloses their status and to design appropriate strategy to deal with the issues this involves. The aim of this study was to assess the disclosure and its associated factors of HIV positive status to sexual partners among patients attending antiretroviral therapy (ART) clinic follow up at Mekelle Hospital, Tigray, Ethiopia.MethodsAn institution based cross sectional study was conducted at Mekelle hospital. Samples of 324 individuals were selected by using systematic random sampling techniques from July 1st until the 30th July 2012. The data was collected by trained data collectors through pretested semi structured questionnaire. The collected data was cleaned, coded, entered and then analysed using SPSS version 16.0 windows program. Descriptive statistics, binary and multivariable regression analysis with 95% confidence interval was carried out and p value less than 0.05 used to determine the significant association.ResultsA total of 324 people on ART care follow up were interviewed with 100% response rate. The overall HIV status disclosure to sexual partner was 57.4%. Among those who disclosed their HIV status 58.0% of them told their partner after one month of initial diagnosis. The study showed that there is significant association between knowing HIV status of sexual partner [AOR = 16.69, 95% CI (5.4, 51.65)], duration of HIV related care follow up [AOR = 5.48, 95% CI (2.17, 13.80)] and discussion before HIV testing [AOR = 4.33, 95% CI (1.43, 13.08)] with HIV positive status disclosure to sexual partner.ConclusionsA HIV positive status disclosure to a sexual partner in this study was lower than what was reported in other studies in Ethiopia. The duration of HIV related care follow up, knowing partners HIV status and prior discussion were the main factors which affect the practice of HIV positive status disclosure to their sexual partners.