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Examining critical factors affecting graduate retention from an emergency training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives.

ABSTRACT: Background:In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system. Methods:One post-graduate trainee and one program manager from the AAU and the University of Toronto (UT) partnership conducted qualitative interviews with current AAU EM residents and stakeholders in Ethiopian EM. Qualitative inductive thematic analysis was performed. Results:Resident and stakeholder participants identified critical factors in three domains: the individual condition, the occupational environment, and the national context. Within each domain, priority themes emerged from the responses, including the importance of career satisfaction over the career continuum (individual condition), the opportunity to be involved in the developing EM program and challenges associated with resource, economic, and employment constraints (occupational environment), and perceptions regarding the state of awareness of EM and the capacity for change at the societal level (national context). Conclusion:This work underscores the need to continue to address multiple systemic and cultural issues within the Ethiopian health care landscape in order to address EM graduate retention. It also highlights the potential success of a retention strategy focused on the career ambitions of keen EM doctors.

SUBMITTER: Kuipers M

PROVIDER: S-EPMC5669294 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Examining critical factors affecting graduate retention from an emergency training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives.

Kuipers Meredith M Eapen Amira A Lockwood Joel J Berman Sara S Vaillancourt Samuel S Maskalyk James J Azazh Aklilu A Landes Megan M

Canadian medical education journal 20170420 2

<h4>Background</h4>In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system.<h4>Methods</h4>One post-graduate trainee and one program ...[more]

PMID: 29114347

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Project description:ObjectiveTo assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.DesignThe study was a facility-based, cross-sectional study.SettingTwo public and tertiary hospitals in Addis Ababa.ParticipantsAll pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals.Primary and secondary outcome measuresThe primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model.ResultsA total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays.Conclusion and recommendationThis study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals' set-up and readiness to manage obstetric emergencies.

Project description:BACKGROUND:Rubella is a vaccine-preventable contagious disease causing an estimated 100,000 children to be born with congenital rubella syndrome each year globally. Studies documented that 18 rubella outbreaks were occurred each year in Ethiopia. Yeka sub-city woreda 13 public health emergency management office reported two measles suspected cases on 8 February, 2018. We investigated this outbreak to identify its etiology, describe the outbreak and implement control measures. METHODS:We described the outbreak using descriptive epidemiology. The study population was defined as students learning in the school where the outbreak occurred. Suspected rubella case was defined as student with generalized rash whereas confirmed case was suspected case tested positive for rubella IgM. Questionnaires, checklists and students record review were used to collect data. We searched for new cases in classes daily and excluded them from classes. The school environment was assessed and the outbreak was described in person and time. RESULTS:We identified 58 cases (median age: 4.6 years; IQR: 4-5 years) with six of them rubella IgM positive and 52 epidemiologically linked. The outbreak began on 8 February 2018 having multiple intermittent peaks during its course reaching its highest peak at 2 April, 2018 and ended on 20 April, 2018. Index cases were reported from two classes; however, cases were occurred in 13/15(86.67%) of the classes during the entire outbreak. Fifty five percent (32/58) and 45/58(77.59%) of the cases were females and 3-5 years children, respectively. Overall attack rate was 58/531(4.05%). Attack rate was higher in females 32/252 (12.7%) than in males 26/279 (9.32%), and higher 45/275(16.36%) in 3-5 years than those in 5-8 years 13/256(5.08%) children. Case fatality ratio was zero. All cases were vaccinated against measles but unvaccinated against rubella. CONCLUSIONS:Attack rate was higher in females than in males and higher in 3-5 years than 5-8 years children. We recommended establishing rubella surveillance system, conducting sero-prevalence of rubella among child bearing age females and establishing CRS surveillance among young infants to provide evidence-based information for RCV introduction. It was also recommended to develop a national rubella surveillance guideline which aid to exclude rubella cases from schools during outbreak.

Project description:IntroductionAdherence to lifestyle modification in addition to medication adherence is very important in preventing complications. Nevertheless, lifestyle modification guidelines are not widely followed by patients with hypertension. The objective of the study was to explore the predictors of compliance with lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019.MethodA descriptive cross-sectional study design was used. A total of 384 patients with hypertension were included in this study. A systematic sampling method was used to select study participants. The data were collected through an interview method by using a structured questionnaire. The data were entered and analyzed using SPSS. Each variable was summarized using summary statistics. To measure the association between lifestyle modification and its predictors, a bivariate and multivariate logistic regression model was used. P-value < 0.05, odds ratio (OR), and 95% confidence interval (CI) were used to determine statistical significance, direction, and strength of association.ResultsTwo hundred six (53.6%) patients with hypertension had poor adherence to the recommended lifestyle modification. Male patients with hypertension were more adherent to lifestyle modification compared with female patients (adjusted OR (AOR) = 0.60, 95% CI: 0.39-0.92). The rate of poor adherence was 1.86 times higher among patients with hypertension diagnosis of <5 years compared with patients with hypertension diagnosis of ⩾5 years(AOR = 1.86, 95% CI: 1.19-2.89). Patients who were adherent to their medication were 2.13 times to have poor adherence to lifestyle modification compared with medication non-adherent patients (AOR = 2.13, 95% CI: 1.38-3.27).ConclusionHigh proportions of patients with hypertension were non-adherent to lifestyle modification. Sex, age, duration of the disease, and medication adherence were significantly associated with lifestyle modification adherence. Close follow-up of female patients, the elderly, and patients with a short duration of hypertension is recommended.

Project description:BackgroundTrihalomethanes (THMs) are the most dominant fraction of all the byproducts formed during chlorination of water. Disinfection by product (DBP) formation in water is a function of numerous factors, including pH, temperature, residual chlorine, source water characteristics, and organic matter. No study has determined the THM level in the drinking water supply of Addis Ababa, Ethiopia.MethodsA cross-sectional design was conducted to collect water samples in the water supply distribution networks of Addis Ababa, Ethiopia. Twenty-one (21) sampling stations yielded a total of one hundred twenty (120) samples of drinking water. The sample handling and collection procedures were carried out in accordance with USEPA guidelines. A DB-5 capillary column was used to separate the THMs, which were detected using GC-ECD (gas chromatography-electron capture detector). Spectrophotometric and in situ methods were used for physicochemical parameters. Redundancy analysis (RDA) was used for data analysis of trihalomethanes and environmental variables using CANOCO 4.5.ResultsThe mean concentration of total trihalomethanes in drinking water in Addis Ababa was 76.3 μg/L. The concentration of chloroform in the drinking water supply in Addis Ababa, Ethiopia, ranged between 4.03 and 79.4 μg/L. The mean total THMs in the Legedadi and Gefersa water supply systems were 77.4 μg/L and 69.66 μg/L, respectively. The residual chlorine, phosphates, UV absorbance at 254 nm, and combined chlorine had positive correlations with THM formation. However, electron conductivity had a negative correlation with THM formation.ConclusionsChloroform contributed the most to TTHMs in nearly all samples. The residual chlorine, UV absorbance, phosphate and hardness as calcium, and electron conductivity were found to be the main predictors determining the abundance and distribution of trihalomethanes. The monitoring and regulation of the THMs is required on a regular basis to analyse trends and guide the water treatment and distribution system.

Project description:BackgroundThere has been a paradigm shift in understanding homelessness. The shift is from the belief that homelessness results from lack of secure housing towards the view which explains homelessness in terms of the complex interactions of factors which determine the pathways into and out of homelessness. The evidence base for women's homelessness is less robust than men's homelessness. The effect of gender and its relationship with homelessness has been neglected. Addis Ababa, the capital city of Ethiopia, is estimated to be home for around 50,000 homeless people. This study aims to explore pathways through homelessness in women who were sheltered in a facility for the homeless in Addis Ababa.MethodsIn-depth interviews were conducted in 2019 with 14 women who were 'roofless', and were gathered for support in a temporary shelter in Addis Ababa, Ethiopia. The shelter was one of the eight such facilities established in Addis Ababa few months earlier than the study. For data analysis the QDA Miner 5.0.30 software was used and data was analyzed using thematic analysis approach.ResultsThe analysis revealed that determinant factors for pathways into homelessness among women occurred on the background of predisposing factors, such as poverty, being raised by caregivers other than biological parents, child marriage, unstable employment history. On top of the predisposing factors listed above the occurrence of precipitating factors such as problems with marriage, migration, death of parents, deception, became the immediate cause of homelessness. Despite mentions of positive experiences of homelessness such as mutual support and good social life within network of homeless people, the net effect of the interaction between negative and positive experiences of the homeless life, together with the effectiveness of coping strategies by the participants resulted in the participants' decision of whether homelessness is tolerable. Finally, the presence of perpetuating factors such as lack of affordable house, feeling of shame to go back home, and unfavorable situation at home discouraged participants from exiting the homeless situation.ConclusionFrom the findings of the study we conclude that the predisposing factors and the precipitating factors resulted in the occurrence of onset of homelessness among the participants. Once homeless, the experiences of life as homeless, and the availability of the means to exit from it determined whether the participants would stay homeless or exit from it.

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Examining critical factors affecting graduate retention from an emergency training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives.

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Examining critical factors affecting graduate retention from an emergency training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives.

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