Drug promotion by medical representatives is one of the factors that influence physicians’ prescribing decisions and choice of drugs. To assess the influence of medical representatives on prescribing practice of physicians in health facilities, Mekelle, Northern Ethiopia. Facility-based cross-sectional study was conducted enrolling all physicians working in public and private health facilities. All public and private health facilities were included and similarly, all physicians rendering services in these facilities were sampled in the study. The data were collected from February to March, 2015. Data were then entered into Epidata Version 3.1 and transferred to STATA version 12 for analysis. Both bivariable and multivariable logistic regressions were used to determine predictors. Of the ninety physicians approached in this study, 40 (48.2%) of the physicians believed that their prescribing decisions were influenced by visits of medical representatives (MRs). The odds of physicians who received gifts from MRs being influenced to prescribe their respective products was six times higher than those who reported not accepting any gifts [AOR = 6.56, 95% CI: 2.25, 19.13]. Stationery materials 23(35.4%) and drug samples 20(54.2%) were the commonest kinds of gifts given to physicians and face to face talking 45(54.2%) was the most frequent promotional methods. The finding of this study showed that around thirty-nine percent of MRs have had negative attitude toward competitors’ product. Moreover, working in private health facility was also another predictor of influence of prescribing decision in the study area [AOR = 12.78, 95% CI: 1.31, 124.56]. Nearly half of the physicians working in Mekelle reported that their prescribing decisions were influenced by MRs in the last 12 months. Accepting gifts and working in private health facilities were predictors of influencing prescribing decisions. However, most MRs fails to provide adequate and accurate information regarding their products and they had a negative attitude towards the competitors’ product(s).

Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1–3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively). The magnitude of non-prescribed antimicrobial use was high. Familiarizing with health care utilization and delayed waiting time in health care facilities were the very important factors independently associated with non-prescribed antimicrobial use. Emphasis should be given to community education through involvement of the private health sector and health care providers. Regulation and policy enforcement are also necessary to promote the rational use of antimicrobial.

Background: Use of herbal medicines during pregnancy has been increase in many developing and developed countries. In spite of the studies done on herbal medicine, no study has addressed use of herbal medicine among pregnant women in Debre Tabor Town. Hence, the major aim of this study was to assess the prevalence of herbal medicine use and associated factors. Methods: A community based explanatory sequential mixed methods was employed. The quantitative method used cross-sectional study design with a sample size of 267 women, also 12 participants in a group for focus group discussion and 6 in-depth interviews from focus group were included for a qualitative part using a purposive sampling technique. The data were coded and entered into Epidata 4.2.0.0 and analysis was done using SPSS version 25, while thematic analysis was used for qualitative data. Bivariate and multivariate logistic analyses were used to assess associations between dependent and independent variables. Results: Ninety-five (36.3%) of pregnant women used herbal medicine during pregnancy. Prior use of herbal medicine (AOR: 3.138; 95% CI: 1.375, 7.162), unable to read & write (AOR: 9.316; 95% CI: 2.339, 37.101), presence of health problems (AOR: 3.263; 95% CI: 1.502, 7.090), drug availability (AOR: 9.872; 95% CI: 4.322, 22.551) and distance to the health facilities (AOR 6.153; 95% CI 2.487, 15.226) were significantly associated with use of herbal medicine. Only 5(5.3%) of herbal medicine users disclosed their herbal medicine use to their healthcare providers. Zingiber officinale, Eucalyptus globulus, Rutachalepensis, Linumusitatissimum, and Moringa stenopetala were the most commonly used herbal medicines by pregnant women. Conclusions: The use of herbal medicine during pregnancy is a common practice and significantly associated with educational status, prior use of herbal medicine, presence of health problems, drug availability and distance to the health facilities. Since there was high prevalence and low disclosure rate of herbal medicine use, it should be ensured that physicians/midwives establish a good level of communication with pregnant women.

Background: The goal of health care financing in Ethiopia has been to achieve universal health care coverage by minimizing the catastrophic out of pocket health service expenditure. Even though the performance was not as planned, the promising strategy to achieve universal health care coverage in the informal sector was community based health insurance which was expected to cover more than 83 % of the population. So, we systematically reviewed determinants of community based health insurance utilization in Ethiopia. Methods: We searched DOAJ, EconBiz, ERIC, Google Scholar, Oxford Journals, PubMed, SpringerLink, Europe PMC, Microsoft Academic Search, OAIster and AJ including various relevant websites by March 9 to 10, 2019. We included articles regardless of their publication status with both quantitative and qualitative approaches. Results: The factors determining community based health insurance utilization in Ethiopia were found to be associated with supply side, health facility, demographic and socioeconomic predictors. Among demographic and socio-economic factors, the report of the studies regarding to gender and age was not consistent. However income, education, community participation, marriage, occupation and family size were found to be significant predictors and were positively related with the scheme’s utilization. With respect to health status and health service related factors; illness experience, benefit package, awareness level, previous out of pocket expenditure for health care service and health service status (quality, adequacy, efficiency and coverage) were significantly and positively related but premium amount, self-rated health status and bureaucratic complexity were found to be negative predictors. Conclusion: To achieve universal health care coverage through community based health insurance, it is advisable that special attention should be given to income level, education, community participation, marriage, family size, benefit package, awareness level and health service quality, premium amount and bureaucratic or governance issue.

Background: Anti-malaria pharmaceuticals inventory control system helps to maintain an appropriate stock level using logistics management information system records and reports. Antimalaria pharmaceuticals are highly influenced by seasonality and demand variation. Thus, to compensate the seasonality, resupply quantities should be adjusted by multiplying the historical consumption with the Look-ahead seasonality indexes (LSI) to minimize stock-outs during the peak transmission season and overstocks (possible expiries) during off-peak seasons The purpose of this study was to assess anti-malaria pharmaceuticals inventory control practice and associated challenges in public health facilities of the Oromiya special zone, Amhara region, Ethiopia. Methodology: Facility-based cross-sectional study design employing both quantitative and qualitative methods, explanatory sequential mixed method, of data collection and analysis was used in all public health facilities in the Oromia special zone from September 1 to September 30, 2019. The study was conducted in 27 health centers and 2 hospitals, the dispensing units managing anti-malaria pharmaceuticals and data was collected using observation checklists The quantitative data were analyzed by Statistical package for social sciences using linear regression. Purposive sampling was used to select key informants and 12 in-depth interviews were conducted by the principal investigator. Thematic analysis was performed using Nvivo 11 plus and interpretation by narrative strategies. Results: The quantitative finding in this study revealed that none of the health facilities surveyed calculated months of stock and multiplied the historical consumption with look ahead seasonal indices (LSI) to forecast the upcoming year consumptions.. Average months of stock of anti-malaria pharmaceuticals were 5.32 months with the annual wastage rate of 11.32%. The point and periodic availability of anti-malaria pharmaceuticals was 72.38 and 77.03% respectively. The number of stocks out days within the previous 6 months was 41.34 days. The study also reported bin card usage (β = − 3.5, p = 0.04) and availability of daily dispensing register (β = − 2.7, p = 0.005) had statistically significant effect on anti-malaria pharmaceuticals inventory control practice. The perceived challenges attributed to the poor anti-malaria pharmaceuticals inventory control practice were lack of integrated pharmaceutical logistics system training, management support, inadequate and near expiry supply from pharmaceuticals supply agency, job dissatisfaction, and staff turnover. Conclusion: Inventory control practices for anti-malaria pharmaceuticals was poor as indicated by maximum stock level and none of the health facilities calculated months of stock and the previous consumption was not multiplied by look ahead seasonal indices to compensate the seasonal and demand variation. Efforts should be under-taken by concerned bodies to improve inventory control practice; such as training and regular follow up have to be provided to the health professionals managing anti-malaria pharmaceuticals.

Background: Despite increased global immunization, many children in developing countries remain unvaccinated. Effective communication with parents is crucial to overcoming barriers and improving vaccination coverage. Objective: To examine caregivers’ perception towards child vaccination and identify factors associated with incomplete vaccination status (as an indicator of vaccine hesitancy) among children 12–36 months of age in Tehuledere Woreda, South Wollo Zone, North East Ethiopia. Methods and materials: An explanatory sequential mixed method was used. A community-based cross-sectional study was conducted from September 1 to November 30, 2019 with a sampling technique. A total of eight hundred twenty-four mothers/caregivers of children aged 12–36 months were systematically selected and interviewed using a structured questionnaire. Data were analyzed using SPSS version 20. Logistic regression and content analysis were performed. Results: A total of 596 (72.3%) of the children were completely vaccinated. Widowed mothers (AOR = 7.3, 95% CI = 2.2,24), home delivery practice (AOR = 4.6, 95% CI = 1.8,10), long walking time to health facility (AOR = 9.5, 95% CI = 3.2,27), use of community as vaccine information source (AOR = 4.2, 95% CI = 1.7,9.6), occurrence of child death in the family (AOR = 2.6, 95% CI = 1.2,6.8) and mothers’ health seeking behavior (AOR = 2.5, 95% CI = 1.1,5.4) were found to be associated with incomplete vaccination. Conclusion and recommendations: Acceptance and refusal of child vaccination reflected factors including perceived benefits of vaccine and social environment. Encouraging mothers to attend proper antenatal care and to utilize family planning programs is recommended to improve vaccination status of children in the rural communities. Community awareness programs also should be scaled up by incentivizing community health workers.