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Prevalence of Occupational Injury and Knowledge of Post-Exposure Prophylaxis Accessibility among healthcare workers in Mogadishu, Somalia

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Occupational Diseases and Environmental Medicine 2024年第3期12卷 172-198页

作者： Yonis Abdullahi Ahmed Anshur Abdishakur Mohamud Sheik Miski Abdullahi Roble Abdullahi Mohamed Yasin Abdullahi Ali Mohamed Fardowso Ali Mohamud Abdimalik Dahir Abdi Ikran Abdullahi Isse Warda Adan Ibrahim Mohamed Jimale Adan Ugbad Ahmed Daud Ahmed Aweis Abdullahi Mohamed Hassan Fujeyra College of Medicine and Health Science Abrar University Mogadishu Somalia Directorate of Health-Banadir Regional Administration Mogadishu Somalia Mogadishu Somali Trkiye Training and Research Hospital Mogadishu Somalia Department Faculty of Medicine and Surgery Zamzam University of Science and Technology Mogadishu Somalia Banadir Maternity and Childhood Hospital Mogadishu Somalia Department Faculty of Medicine and Surgery Banadir University Mogadishu Somalia Faculty of Medicine & Surgery Somali National University Mogadishu Somalia

Introduction: healthcare workers in Mogadishu, Somalia face significant occupational injury risks, particularly needle stick injuries, with 61.1% reporting incidents. This poses a serious threat to their health, leading to infections such as hepatitis B, hepatitis C, and HIV. Despite the high prevalence of injuries, awareness of Post-Exposure Prophylaxis (PEP) accessibility is relatively high, with 84.0% of respondents aware of it. However, there are gaps in knowledge and implementation, as evidenced by variations in availability of PEP. Improving workplace safety measures, providing comprehensive training on injury prevention and PEP protocols, and ensuring consistent availability of PEP in healthcare facilities are crucial steps to safeguard the well-being of healthcare workers in Mogadishu, Somalia. Methods: A cross-sectional study was conducted among hospital workers in Mogadishu, Somalia, focusing on professionals from various healthcare facilities. The study targeted nurses, doctors, laboratory personnel, and pharmacists. Purposive sampling was employed, resulting in a sample size of 383 calculated using Fisher’s sample size formula. Data were collected using coded questionnaires entered into Microsoft Excel 2019 and analyzed with SPSS software to generate frequencies and proportions, presented through frequency tables and pie figures. Results: The study in Mogadishu, Somalia, examined the prevalence of occupational injuries and knowledge of Post-Exposure Prophylaxis (PEP) accessibility among healthcare workers. Findings indicate a high prevalence of injuries, with 61.1% reporting incidents, predominantly needle stick injuries (60.6%). Despite the majority seeking prompt medical attention (72.0%), work-related illnesses affected 53.2% of respondents, notably work-related stress (59.5%). While most received training on injury and illness prevention (68.9%), gaps exist in PEP awareness, with 16.0% unaware of it. Nonetheless, 84.0% were aware, predominantly throu

关键词： Prevalence of Occupational Injury Post-Exposure Prophylaxis (PEP) Accessibility healthcare workers Needle Stick Injuries Infections (Hepatitis B Hepatitis C HIV) Awareness Knowledge Workplace Safety PEP Availability Blood-Borne Diseases Personal Protective Equipment (PPE) HIV PEP (Post-Exposure Prophylaxis)

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Violence study of healthcare workers and systems in the Caribbean:ViSHWaS-Caribbean study

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World Journal of Methodology 2024年第3期14卷 106-118页

作者： Reshon Hadmon Daniella Myriam Pierre Akshat Banga Jacques W Clerville Hans Mautong Precious Akinsanya Rajat Das Gupta Sama Soliman Tolupe M Hunjah Bamidele A Hunjah Hafeez Hamza Ruman Khurshid Qasba Faisal A Nawaz Salim Surani Rahul Kashyap Department of Medicine St.George University School of MedicineGrenada FZ818West Indies Department of Research Global Remote Research Scholar ProgramSt PaulMN 55101United States Department of Public Health Cuny Graduate School of Public Health and Health PolicyNew YorkNY 10027United States Department of Internal Medicine Sawai Man Singh Medical CollegeJaipur 302004India School of Public Health Georgia State UniversityAtlantaGA 30302United States Department of Sociology and Demography School of HealthUniversidad de Especialidades Espiritu SantoSamborondon 092301Ecuador Department of Medicine Holy Name Medical CenterTeaneckNJ 07666United States Department of Epidemiology and Biostatistics University of South CarolinaColumbiaSC 29208United States Department of Medicine Pavlov First State Medical University of St PetersburgSankt-Peterburg 197022Russia Department of Medicine University of SuffolkIpswich IP41QJUnited Kingdom Department of Medicine Unicaf University of ZambiaLusaka 20842Zambia Department of Pharmacy School of PharmacyGirne 99428Cyprus Department of Medicine Sher-i-KashmirInstitute of Medical ScienceSrinagar 190011India Department of Psychiatry Al Amal Psychiatric HospitalEmirates Health ServicesDubaiUnited Arab Emirates Department of Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Anesthesiology and Critical Care Mayo ClinicRochesterMN 55905United States Department of Research Wellspan HealthYorkPA 17403United States

BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains *** aim is to determine the cause,traits,and consequences of violence on HCWs in the *** To determine the cause,traits,and consequences of violence on HCWs in the *** This research adopted an online cross-sectional survey approach,spanning over eight weeks(between June 6th and August 9th,2022).The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails,social media,text messages,*** regression analysis was performed to evaluate the variables that influence violence,including gender,age,years of experience,institution type,and night shift *** The survey was completed by 225 *** comprised 61%.Over 51%of respondents belonged to the 21 to 35 age ***(n=61),Haiti(n=50),and Grenada(n=31)had the most *** HCWs(49%)worked for government academic institutions,followed by community hospitals(23%).Medical students(32%),followed by attending physicians(22%),and others(16%)comprised the most common cadre of *** 39%of the participants reported experiencing violence themselves,and 18%reported violence against colleague(s).Verbal violence(48%),emotional abuse(24%),and physical misconduct(14%)were the most common types of *** 63%of respondents identified patients or their relatives as the most frequent *** logistic regression analyses demonstrated that female gender(OR=2.08;95%CI:1.16-3.76,P=0.014)and higher frequency of night shifts(OR=2.22;95%CI:1.08-4.58,P=0.030)were associated with significantly higher odds of experiencing *** than 50%of HCWs felt less motivated and had decreased job satisfaction post-violent *** A large proportion of HCWS in the Caribbean are exposed to violence,yet the phenomenon remains *** a result,HCWs’job s

关键词： ViSHWaS healthcare workers Violence Survey Workplace violence Caribbean Cross-sectional study

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Assessment of Knowledge, Attitude and Practices among healthcare workers in a Tertiary Care Hospital on Needle Stick Injury

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Advances in Infectious Diseases 2024年第2期14卷 487-495页

作者： Komal Kanani Sangita Rajdev Summaiya Mullan Department of Microbiology Government Medical College & New Civil Hospital Surat India

Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers sustain Needle stick injuries each year. This study was conducted to assess healthcare workers’ knowledge, attitude and practices regarding needle stick injury. Materials & Methods: A cross-sectional study was conducted in a Tertiary Care Hospital over the period of 3 months. The study population consisted of Intern Doctors, Post Graduate resident Doctors, Staff Nurses, laboratory technicians of Government Medical College and New Civil Hospital, Surat (n = 300). The data were collected using a self-administered questionnaire via the means of Google Forms. Questionnaire was made with prior review literature. The data obtained were entered and analysed in Microsoft Excel. Results: The prevalence of NSI in our study was 46%, with a higher prevalence among the PG residents (72%). Overall scores regarding knowledge and attitude were better in PG residents (knowledge score > 7 in 71% and Attitude Score > 7 in 68% of PG Residents). Even though the PG residents scored highest in the knowledge category, the majority of them suffered needle stick injuries as a result of poor practice scores. Among those who had NSI (n = 139/300), 70% of study participants had superficial injuries, only 9% reported the incident, 18% got medical attention within 2 hours of the incident, and 7% followed up to recheck their viral markers status. Most incidents of NSI were due to hypodermic needles while recapping needles. Conclusion: Exposure to needle stick injuries and their underreporting remains a common problem. It is imperative that healthcare workers receive regular training on the proper handling of sharp objects. We can also draw the conclusion that preventing NSIs requires putting knowledge into practice.

关键词： Needle Stick Injury Knowledge Attitude Practice healthcare workers

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Prevalence and Factors Associated with Low Back Pain among healthcare workers in Two Hospitals in Yaoundé-Cameroon: A Cross-Sectional Study

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Open Journal of Rheumatology and Autoimmune Diseases 2024年第3期14卷 89-107页

作者： Brian Gweha Ahmadou Musa Jingi Baudelaire Fojo Talongong Claude Tayou Madeleine Singwé-Ngandeu Department of Clinical Sciences Faculty of Health Sciences The University of Bamenda Bamenda Cameroon Faculty of Medicine and Biomedical Sciences The University of Yaound Yaound Cameroon The Rheumatology Unit The Yaound Central Hospital Yaound Cameroon The Hematology Laboratory The Yaound University Teaching Hospital Yaound Cameroon

Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this hi

关键词： Prevalence Associated Factors Low Back Pain healthcare workers Yaoundé

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Analysis of Hand Hygiene Knowledge,Compliance,and Influencing Factors Among Psychiatric healthcare workers

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Journal of Clinical and Nursing Research 2024年第7期8卷 134-139页

作者： Weidong Liu Li Xiang Guangzhou Municipal Civil Affairs Bureau Psychiatric Hospital Guangzhou 510430Guangdong ProvinceChina

Objective:To evaluate the knowledge,compliance,and influencing factors of hand hygiene among psychiatric healthcare ***:68 healthcare workers who worked in the Department of Psychiatry between September 2023 and May 2024 were selected to assess their knowledge of hand hygiene and compliance by questionnaire as well as to analyze their influencing ***:Knowledge of hand hygiene among healthcare workers was less than 90%,and doctors’knowledge was lower than that of nurses(Phealthcare workers’compliance with hand hygiene was lower than 80%,and the adherence of doctors was lower than that of nurses(Phealthcare workers’compliance with hand hygiene,with Phealthcare workers’knowledge of hand hygiene as well as compliance with it is low,and there are various factors affecting it,so targeted training is required to strengthen their hand hygiene implementation.

关键词： Psychiatry healthcare workers Hand hygiene Knowledge Compliance

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Influence of the continuing COVID-19 epidemic on sleep quality and psychological status of healthcare workers in private institutions

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World Journal of Psychiatry 2024年第10期14卷 1495-1505页

作者： Man-In Ho Zhe-Hao Wu Yu-Ying Chen Weng-Io Leong Jue Wang Hua Zhou Zi-Tuo Wu Ying-Qi Mao Jia-An Du Yi Zheng Yi Yu Paulo Do Lago Comandante Li-Li Yu Qi-Biao Wu Faculty of Chinese Medicine Medical Sciences DivisionMacao University of Science and TechnologyMacao 999078China Department of Child Rehabilitation Children Health CareJieyang Women Infant Health Care HospitalJieyang 522000Guangdong ProvinceChina Macao Association for Analytical Psychology Macao 999078China The State Key Laboratory of Quality Research in Chinese Medicine Macao University of Science and TechnologyMacao 999078China State Key Laboratory of Dampness Syndrome of Chinese Medicine The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510006Guangdong ProvinceChina Guangdong Provincial Hospital of Chinese Medicine Guangdong Provincial Academy of Chinese Medical SciencesGuangzhou 511400Guangdong ProvinceChina Chinese Medicine Guangdong Laboratory(Hengqin Laboratory) Guangdong-Macao In-Depth Cooperation Zone in HengqinHengqin 519000Guangdong ProvinceChina University Hospital Macao University of Science and TechnologyMacao 999078China Department of Rehabilitation The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine)Hangzhou 310006Zhejiang ProvinceChina Department of Clinical Nutrition The Second Affiliated Hospital of Zhejiang Chinese Medical UniversityXinhua Hospital of Zhejiang ProvinceHangzhou 310000Zhejiang ProvinceChina Associação dos Investigadores Praticantes e Promotores da Medicina Chinesa de MacaoMacao 999078China Zhuhai MUST Science and Technology Research Institute Macao University of Science and TechnologyZhuhai 519099Guangdong ProvinceChina Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health Guangdong University of TechnologyGuangzhou 510000Guangdong ProvinceChina

BACKGROUND On January 22,2020,Macao reported its first case of coronavirus disease 2019(COVID-19)*** August 2021,the situation had escalated into a crisis of community *** response,the government launched a recruitment campaign seeking assistance and services of healthcare workers(HCWs)from the private sector throughout *** participants faced concerns about their own health and that of their families,as well as the responsibility of maintaining public health and *** study aims to determine whether the ongoing epidemic has caused them physical and psychological *** To examine the influence of COVID-19 on the sleep quality and psychological status of HCWs in private institutions in Macao during the *** Data were collected from December 2020 to January *** consecutive surveys were *** Pittsburgh Sleep Quality Index(PSQI)scale,Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were employed as investigation *** In the first-stage survey,32%of HCWs experienced a sleep disorder,compared to 28.45%in the second-stage survey.A total of 31.25%of HCWs in the first-stage survey and 28.03%in the second had varying degrees of anxiety.A total of 50.00%of HCWs in the first-stage survey and 50.63%in the second experienced varying degrees of *** difference in PSQI scores,SAS scores,or SDS scores were observed between the two surveys,indicating that the COVID-19 epidemic influenced the sleep quality and psychological status of *** negative influence persisted over both periods but did not increase remarkably for more than a ***,a positive correlation was observed between the PSQI,SAS,and SDS scores(r=0.428-0.775,P<0.01),indicating that when one of these states deteriorated,the other two tended to deteriorate as *** The sleep quality,anxiety,and depression of HCWs in private institution in Macao were affected by the COVID-19 *** these fac

关键词： COVID-19 healthcare workers Sleep quality Anxiety Depression Psychological status

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Knowledge and awareness of human mpox infection among healthcare workers:A cross-sectional study in southwestern Nigeria

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Asian Pacific Journal of Tropical Medicine 2023年第6期16卷 245-252,I0001页

作者： Paul Oladapo Ajayi Deborah Tolulope Esan Tope Michael Ipinnimo Moronkeji Temitope Olanrewaju Oluremi Olayinka Solomon Olajumoke Oyewumi Atanda-Owoeye Department of Community Medicine Faculty of Clinical SciencesEkiti State UniversityAdo-EkitiEkiti StateNigeria Department of Nursing Science College of Health SciencesBOWEN UniversityIwoOsun StateNigeria Department of Community Medicine Federal Teaching HospitalIdo-EkitiEkiti StateNigeria Department of Family Medicine Federal Teaching HospitalIdo-EkitiEkiti StateNigeria Department of Community Medicine Ekiti State University Teaching HospitalAdo-EkitiEkiti StateNigeria

Objective:To identify the knowledge and awareness level of human mpox viral infection among healthcare workers in southwestern ***:A cross-sectional study was conducted in Ekiti State,southwest Nigeria among 316 healthcare workers that were selected through a systematic random *** were collected with the aid of a semi-structured,self-administered *** Chi-square test and binary logistic regression were used to find the association between the independent and dependent *** significance level was set at P-valuehealthcare workers,there still exists a huge knowledge *** is recommended that targeted intervention could be directed towards continuous medical education and simulation exercises on re-emerging infectious diseases like mpox to improve the knowledge of the healthcare workers.

关键词： Awareness Knowledge Human mpox viral infection healthcare workers Nigeria

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Prevalence of and risk factors for tuberculosis among healthcare workers in Chinese tuberculosis facilities

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Infectious Diseases of Poverty 2018年第1期7卷 264-274页

作者： Xiao-Ning Wang Tian-Lun He Meng-Jie Geng Yu-Dan Song Ji-Chun Wang Min Liu Sarah Jayne Hoosdally Ana Luíza Gibertoni Cruz Fei Zhao Yu Pang Yan-Lin Zhao Guang-Xue He Department of Science and Technology Chinese Center for Disease Control and Prevention(China CDC)BeijingChina Chaoyang District Center for Disease Control and Prevention BeijingChina School of Economics and Management Beijing University of TechnologyBeijingChina Department of Infectious Disease Control and Prevention China CDCBeijingChina National Center for Chronic Disease Control and Prevention China CDCBeijingChina Nuffield Department of Medicine University of OxfordJohn Radcliffe HospitalOxfordUK National Center for Tuberculosis Control and Prevention China CDCBeijingChina

Background:China is one of 22 countries with a high tuberculosis(TB)burden in the *** workers(HCWs)have a high risk of contracting Mycobacterium tuberculosis infection due to insufficient infection control *** conducted a cross-sectional study to explore the prevalence of TB and its associated risk factors among HCWs in Chinese TB ***:Two hundred and forty-one TB facilities employing a total of 9663 HCWs were selected from 12 provinces in China to represent healthcare settings at the provincial,prefectural,and county *** questionnaires were used to collect information on TB infection control practices and HCWs in those *** was double entered into EpiData 3.1;TB prevalence and associated risk factors were analyzed using SPSS 21.0 with bivariate and multivariate regression ***:The results showed that 71 HCWs had been diagnosed with TB,accounting for a prevalence of 760/*** multivariate analysis showed that associated risk factors included belonging to the age group of 51 years and above(aOR:6.17,95%CI:1.35-28.28),being a nurse(aOR=3.09,95%CI:1.15-8.32),implementation of 0-9 items of management measures(aOR=2.57,95%CI:1.37-4.80),and implementation of 0-1 items of ventilation measures(aOR=2.42,95%CI:1.31-4.47).Conclusion:This was the first national large sampling survey on TB prevalence among HCWs in *** was found that the implementation of TB infection control practices in some facilities was *** TB prevalence in HCWs was higher than that in the general ***,TB infection control practices in Chinese medical facilities should be strengthened.

关键词： Tuberculosis Prevalence Risk factors healthcare workers China

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COVID-19 vaccination intention among healthcare workers in Vietnam

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Asian Pacific Journal of Tropical Medicine 2021年第4期14卷 159-164页

作者： Giao Huynh Thien Thuan Tran Han Thi Ngoc Nguyen Le An Pham Faculty of Public Health University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam Infection Control Department University Medical Center Ho Chi Minh CityHo Chi Minh CityVietnam Family Medicine Training Center University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam

Objective:To assess the acceptance of coronavirus disease(COVID-19)vaccine among healthcare workers at two general hospitals in Vietnam when it is ***:A cross-sectional study was conducted using a convenience sampling from January to February 2021 among 410 healthcare workers at two general hospitals in Vietnam via a selfadministered questionnaire.A multivariable regression analysis was performed to determine predictors of vaccine acceptance including the demographic factors,COVID-19 knowledge,and vaccine beliefs based on the domains of Health Belief ***:Among 410 healthcare workers,76.10%showed vaccination *** of acceptance were determined that the group reporting as“vaccine acceptance”was more likely to be positive towards the perceived susceptibility and severity of COVID-19(OR 2.45;95%CI 1.48-4.06,P<0.05),perceived benefits of vaccination,and cues to action(OR 4.36;95%CI 2.35-8.09,and OR 5.49;95%CI 2.84-10.61,respectively,all P<0.001),but less likely to have the perceived barriers to vaccination(OR 0.19;95%CI 0.09-0.38;P<0.001)compared with the no acceptance ***,people who had a good knowledge regarding the severity of illness were 3.37 times more likely to have identified as vaccine acceptance(OR 3.37;95%CI 1.04-10.86,P<0.05).The demographic factors were also associated with willingness to receive the vaccine,with participants who were staff and received COVID-19 information from relatives were less likely to accept the vaccine over those who were doctors and not receiving information from relatives(OR 0.36;95%CI 0.13-0.96,and OR 0.37;95%CI 0.17-0.78,respectively,all P<0.05).Conclusions:A rate of willingness to get vaccinated against COVID-19 was relatively high with discrepancies between occupation,receiving information from relatives,knowledge toward the severity of illness,and the elements of Health Belief *** findings will provide information for the management authorities to develop relevant interv

关键词： Acceptance COVID-19 healthcare workers Intention SARS-CoV-2 Vaccination

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Knowledge and associated factors of healthcare workers on measles vaccine and cold chain management at health institutions in Gondar,Ethiopia

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Asian Pacific Journal of Tropical Medicine 2023年第1期16卷 26-32页

作者： Aschalew Gelaw Yeshambel Belyhun Yitayih Wondimeneh Mehretie Kokeb Mulat Dagnew Azanaw Amare Mesert Mulu Martha Alemayehu Baye Gelaw Department of Medical Microbiology School of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia Department of Molecular Biology and Immunology School of Biomedical and Laboratory SciencesCollege of Medicine and Health Sciences University of GondarGondarEthiopia Department of Pediatrics and Child Health School of MedicineCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia

Objective:To assess the knowledge of healthcare workers on the measles vaccine and its cold chain ***:An institutional-based cross-sectional study was conducted from February 1 to March 30,2022 in Gondar City Administration public health institutions among 165 healthcare *** were collected using a structured *** addition,an on-spot observation checklist was used to assess the availability,status and management of the cold chain.A logistic regression model was used to assess the relationship between the outcome and predictor *** and adjusted odds ratios were calculated with 95%confidence ***:Overall,87(52.7%;95%CI 44.8%-60.5%)of the healthcare workers had unsatisfactory knowledge regarding the measles vaccine and its cold chain *** hundred thirty-six(82.4%)healthcare workers correctly mentioned the recommended range of temperature(2-8℃)for measles vaccine *** workers aged 18-29 years(P=0.001)and 30-44 years(P=0.014)were observed as determinants of unsatisfactory knowledge on the measles vaccine and its cold chain *** hundred and five(63.6%)of the healthcare workers did not correctly mention the type of measles vaccine used in routine *** than one-third(36.4%)of the healthcare workers perceived that the measles vaccine is not safe and could cause ***:More than half of the healthcare workers in the study area had unsatisfactory knowledge on the measles vaccine and its cold chain *** is necessary to provide technical support and in-service training for healthcare workers to ensure optimal immunization effectiveness.

关键词： Measles vaccine healthcare workers Cold chain Gondar

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