Process evaluation of pediatrics antiretroviral treatment service in selected health facilities of Addis Ababa, Ethiopia A Case of ZMH and WWO-AHF

Abstract

Background: The pediatrics ART program was being implemented in Addis Ababa since 2005. However the service had been limited to nine health facilities until 2007. These health facilities were Governmental Hospitals (ZMH, Yekatit 12, Tikur Anbessa, Saint Peter, and ALERT), NGOs (SOS, WWO-AHF, and Missionary of charity) and private Hospital (Bethezata). This evaluation is planned to assess process of pediatrics antiretroviral treatment service of two health facilities (ZMH and WWO-AHF). Objective of the Evaluation: to evaluate the implementation level and identify gaps of pediatrics ART services in selected health facilities in Addis Ababa, Ethiopia. Methods: A cross-sectional institutional based study design which involved both (qualitative and quantitative data). The data were collected from December15, 2008 to January 30, 2009. Two supervisors and four data collectors were selected and trained for both (ZMH and WWO-AHF) health facilities. The data were cleaned edited and entered in a computer and analyzed using SPSS for windows version 16. For evaluation decision making purpose, the variables were summarized into indicator level, which can fit the basis for judgment. Summaries of findings were compared with the preset criteria-standards to judge the pediatric ART service. Results: A total of 376 of parents/ caretakers responded to exit interview questionnaires out of 392 parents/caretakers of children who attended the clinic. The mean age of parent’s or caretakers was 27.5 years (SD±12.7). Female respondents predominantly constitute 271(72.1%), 176 (46.8%) were orthodox Christians, and married 206(54.8%). Based on three indicators of accommodation dimension, 134 (87.9 %) of WWO-AHF s and 190(84.7 %) of ZMH Parent’s/ caretakers were highly satisfied. Almost all human and material resource required for both HFs were available according to national pediatric ART guideline. However the proportion of pediatric ART trained health professionals found was 60.1 % in WWO-AHF and 61.1 % in ZMH. ART eligibility criteria, CPT eligibility criteria and continuous CD4 monitoring were compared against the pediatrics ART guideline. Sixty five children (26.4%), who visited ZMH pediatric ART facility, were not monitored for CD4 count/percentage in every six month. Out of 150 eligible children, 113 children (75.2%) were on ART. Out of 115 eligibleProcess evaluation of Pediatric ART service in selected health facilities of Addis Ababa, Ethiopia By Befekadu E. January 2014 iii children for CPT, 91 children (79.1%) were actually receiving it. Similarly, 6 children (4.7%) of children who visited the WWO-AHF pediatric ART clinic were not monitored for CD4 count/percentage every six months. Out of 107 eligible children, 97 children (90.3%) were on ART. Out of 61 eligible children for CPT, those who actually received the treatment were 50 children (81.6%). Conclusion This study suggests that HAART to children in ZMH and WWO-AHF pediatrics ART program was judged very good based on the agreed criteria. This practice should be encouraged to be continued. However, adequate number of trained physicians on ART, and supervision are required. An emphasis on the compliance to the national ART guideline should be a key element for the successful provision of pediatrics ART service in both health facilities