Dataset Information

Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.

ABSTRACT: OBJECTIVE:To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model. DESIGN:The study was a facility-based, cross-sectional study. SETTING:Two public and tertiary hospitals in Addis Ababa. PARTICIPANTS:All 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 MEASURES:The 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. RESULTS:A 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 RECOMMENDATION:This 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.

SUBMITTER: Assefa EM

PROVIDER: S-EPMC7312330 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.

Assefa Endalkachew Mekonnen EM Berhane Yemane Y

BMJ open 20200623 6

<h4>Objective</h4>To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.<h4>Design</h4>The study was a facility-based, cross-sectional study.<h4>Setting</h4>Two public and tertiary hospitals in Addis Ababa.<h4>Participants</h4>All 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 Hospital ...[more]

PMID: 32580981

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Project description:OBJECTIVES:To assess the provision of basic emergency obstetric and newborn care (BEmONC), knowledge of high-risk pregnancies and referral capacity at health centres in Southern Ethiopia. DESIGN:A facility-based survey, using an abbreviated version of the Averting Maternal Death and Disability needs assessment tool for emergency obstetric and newborn care. Modules included infrastructure, staffing, number of deliveries, maternal and perinatal mortality, BEmONC signal functions, referral capacity and knowledge of risk factors in pregnancy. SETTING:Primary healthcare centres providing delivery services in the Eastern Gurage Zone, a predominantly rural area in Southern Ethiopia. PARTICIPANTS:All 20 health centres in the study area were selected for the assessment. One was excluded, as no delivery services had been provided in the 12 months prior to the study. RESULTS:Three out of 19 health centres met the government's staffing norm. In the 12 months prior to the survey, 10?004 ([Formula: see text]) deliveries were attended to at the health centres, but none had provided all seven BEmONC signal functions in the three?months prior to the survey ([Formula: see text]). Eight maternal and 32 perinatal deaths occurred. Most health centres had performed administration of parenteral uterotonics (17/89.5%), manual removal of placenta (17/89.5%) and neonatal resuscitation (17/89.5%), while few had performed assisted vaginal delivery (3/15.8%) or administration of parenteral anticonvulsants (1/5.3%). Reasons mentioned for non-performance were lack of patients with appropriate indications, lack of training and supply problems. Health workers mentioned on average 3.9±1.4 of 11 risk factors for adverse pregnancy outcomes. Five ambulances were available in the zone. CONCLUSION:BEmONC provision is not guaranteed to women giving birth in health centres in Southern Ethiopia. Since the government aims to increase facility deliveries, investments in capacity at health centres are urgently needed.

Project description:BackgroundTurnover intention is a probability of an employee to leave the current institution within a certain period due to various factors. It is the strongest predictor of actual turnover expected to increase as the intention increases. Emergency Department (ED) nurses are especially vulnerable to high turnover because of their increased risk of developing burnout and compassion fatigue associated with the work environment. This study is aimed to assess nurses' intention to leave emergency departments and associated factors at selected governmental hospitals in Addis Ababa, Ethiopia.MethodsInstitutional based cross-sectional study was conducted on 102 nurses in three selected governmental hospitals, Addis Ababa from February 19 to March 31, 2018, using a structured pre-tested self-administered questionnaire. The logistic regression model was used and an adjusted odds ratio with a 95% confidence interval was calculated to identify associated factors.ResultA total of 102 respondents were involved with a response rate of 91.1%. Among them, 79 (77.5%) respondents had the intention to leave the current working unit of the emergency department or hospital. Significant predictive factors of nurses' intention to leave their institutions are educational status (adjusted odds ratio (OR) =4.700, 95% confidence interval (CI) = 1.033-50.772; p < 0.048), monthly income of less than 3145 Birr (adjusted OR = 6.05, 95% CI = 1.056-34.641; p < 0.043) and professional autonomy (adjusted OR = 0.191, 95% CI = 0.040-0.908; p < 0.037).ConclusionMore than 77% of the respondents have the intention to leave their current working place of the emergency unit. Educational status, monthly income, and autonomy were significantly associated with emergency nurses' turnover intention in three governmental hospitals. Emergency leaders and hospital managers should have made efforts to enhance nurses' decision making for patient care activities and shared decision overwork or unit related activities.

Project description:IntroductionAutism is a neurodevelopmental disorder that occurs in the early childhood period and is characterized by altered social interaction, communication problems, repetitive, and stereotyped behavior. Genetic, environmental, or physical risk factors are associated with prenatal, natal, or postnatal complications, leading to the development of autism spectrum disorders. Prompt diagnosis and management should be an integral component of the care provision in countries like Ethiopia.ObjectiveThis study aimed to assess knowledge of childhood autism among nurses working in governmental hospitals in Addis Ababa, Ethiopia.MethodsInstitutional based cross-sectional study design was used. The sample size was calculated using the single population proportion formula, and the final sample size was 360. Final study subjects were selected by using the simple random sampling method. Data were collected using structured self-administered questionnaires and were then coded and entered into Epi-data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics were utilized to show frequencies and percentages, and analysis of variance was carried out to compute the association between the dependent and independent variables. Independent t-test was also done to see the association between dependent variables and independent variables with two means. A p-value of less than 0.05 was considered statistically significant.ResultsThe mean score for knowledge-related items was 8.79 ± 0.4. In this study, out of 331 nurses, 180 (54.35%) had good knowledge. Significant mean score difference was observed among age distribution (F-Ratio = 2.8, p-value = 0.04), level of education (F-ratio = 13.97, p < 0.001) and work experience (F-Ratio = 3.07 p-value = 0.017).ConclusionA significant gap was observed in the overall knowledge of childhood autism among nurses employed in the governmental hospitals of Addis Ababa. The respondents' knowledge level was significantly different among age group distributions, education levels, and work experience.

Project description:ObjectiveThis study was conducted to assess the magnitude and contributing factors of medication administration errors among nurses in federal hospitals in Addis Ababa, Ethiopia.DesignA hospital-based cross-sectional study design was employed. Data on medication administration and associated factors were collected using a structured self-administered questionnaire. Multivariable binary logistic regression analysis was done to identify factors associated with medication administration errors on the basis of adjusted OR with 95% CI and a p value less than 0.05.SettingThis study was conducted in federal hospitals in Addis Ababa, Ethiopia.ParticipantsFour hundred and twenty-three randomly selected nurses participated.Outcome measuresThe primary outcome variable is medication administration error, which was ascertained using the following errors: wrong medication, wrong dose, wrong time, wrong route, wrong patient, wrong drug preparation, wrong advice, wrong assessment and wrong documentations.ResultsA total of 59.9% (95% CI: 55.0% to 64.8%) of the nurses in the federal hospitals in Addis Ababa committed one or more medication administration errors in the last 12 months prior to the survey. The most commonly reported medication errors were wrong time (56.8%), wrong documentation (33.3%), wrong advice (27.8%) and wrong dose (20.1%). Medication administration errors among nurses were significantly associated with short work experience (adjusted OR (AOR): 6.48, 95% CI: 1.32 to 31.78), night shift work (AOR: 5.0, 95% CI: 1.82 to 13.78), absence of on-the-job training (AOR: 3.16, 95% CI: 1.67 to 6.00), unavailability of medication administration guidelines in wards (AOR: 2.07, 95% CI: 1.06 to 4.06) and interruptions during medication administration (AOR: 2.42, 95% CI: 1.30 to 4.49).ConclusionIt was found that a high proportion of nurses in federal hospitals committed medication administration errors. Short work experience, night shift work, absence of on-the-job training, unavailability of medication administration guidelines and interruptions during medication administration explained the high magnitude of medication administration errors.

Project description:BACKGROUND:Seeking healthcare in children is unique since parents decide upon the type and frequency of healthcare services accessed. Mothers/caregivers lower healthcare seeking behavior is one of the major reason for increased morbidity and mortality from childhood illness in developing countries. Hence, this study aimed to assess healthcare seeking behavior of mothers/caregivers towards childhood illnesses in selected health centers of Addis Ababa, Ethiopia. METHODS:A facility-based cross-sectional survey was conducted on 422 sampled mothers/caregivers of children age 0-59?months, from April 18 to May 11, 2016. Ten health centers were selected using simple random sampling technique and proportionate number of participants were included from each health centers. A pre-tested, semi-structured questionnaire was used to collect data. Data were analyzed using SPSS version 20.0. Descriptive statistics was used to summarize socio-demographic characteristics and multivariable logistic regression was employed to identify factors associated with of healthcare seeking behavior. RESULT:In case of illnesses, 26.5% of mothers/caregivers sought healthcare for their children. Among the common childhood illnesses, acute respiratory tract infection and diarrhea accounted for 47.6 and 31%, respectively. Mothers/caregivers healthcare seeking behavior towards common childhood illnesses were influenced by child's age (AOR?=?1.78, 95% CI:1.02, 3.13), education of mothers/caregivers (AOR?=?4.24, 95% CI:1.32, 13.63), family size (AOR?=?3.83, 95% CI:1.06, 13.78), perception of severity of illnesses (AOR?=?2.00, 95% CI:1.05, 3.84), previous experience of similar illnesses (AOR?=?3.67, 95% CI:1.36, 9.86) and previous history of under-five child death (AOR?=?13.31, 95% CI:5.13, 34.53). CONCLUSIONS:The common under-five childhood illnesses were acute respiratory tract infection and diarrhea. The study also revealed that there was a delay in seeking healthcare and this was significantly associated with age of the child; mothers/caregivers level of education; family size; perception of illness severity; previous experience of similar illnesses and under-five child death.

Project description:BackgroundChild mortality remains a global public health problem, particularly in Sub-Saharan Africa. After initiating ART, the mortality rate among HIV-infected children in Ethiopia was 12-17 deaths per 1000 child-year.ObjectiveTo determine the time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia, from April 12, 2017, to May 12, 2022.MethodAn institution-based retrospective follow-up study was conducted among 415 HIV-infected children at selected public hospitals of the Addis Ababa town administration. Computer generated simple random sampling technique was used to select each sampling unit. Data was extracted using a structured data extraction checklist. Data were entered into EPI data 4.2 and analyzed using STATA 14. The child mortality rate was calculated. The Cox proportional hazards regression model was fitted to identify predictor factors. The result of the study was presented using text, tables, graphs, and charts. An adjusted hazard ratio with a 95% confidence interval and a p-value less than 0.05 was used to declare the level of significance.ResultA total of 415 (97.42%) of the 426 children on ART were included for analysis. Of these, 41(9.88%) children were died during the following period. The study participants were followed for a total of 8237 person- months of risk time. The overall mortality rate was 4.98 (95% CI: 3.67-6.77) per 1000 child-months. The estimated survival after starting ART was 61.42% at 56 months of follow-up. Severe underweight (AHR = 3.19; 95% CI: 1.32-7.71), tuberculosis (AHR = 3.86; CI: 1.76-8.47), low hemoglobin level (AHR = 2.51; CI: 1.02-6.20), and advanced WHO clinical stages at enrolment (AHR = 3.38; CI: 1.08-10.58) were predictors of death among HIV-infected under-five children on ART.ConclusionThe incidence of mortality was 4.98 per 1000 child-months. Severe underweight, tuberculosis infection, low hemoglobin level, and advanced WHO clinical stages at enrolment were predictors of death among under-five children on ART.

Dataset Information

Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.

Publications

Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.

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