24 research outputs found
Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study
No full textAbstract Background Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting. We aimed to identify barriers and facilitators to utilization of EBCAs in the TASH-ED, to identify priority targets for development of EBCAs tailored for the TASH-ED context and to understand the process of care in the TASH-ED to inform implementation planning. Methods We employed a multi-component qualitative design including: semi-structured interviews with TASH-ED clinical, administrative and support services staff, and Toronto EM physicians who had worked in the TASH-ED; direct observation of the process of care in TASH-ED; document review. Results Although most TASH-ED participants reported an awareness of EBCAs, they noted little or no experience using them, primarily due to the poor fit of many EBCAs to their practice setting. All participants felt that context-appropriate EBCAs were needed to ensure standardized and evidence-based care and improve patient outcomes for common ED presentations. Trauma, sepsis, acute cardiac conditions, hypertensive emergencies, and diabetic keto-acidosis were most commonly identified as priorities for EBCA development. Lack of medication, equipment and human resources were identified as the primary barriers to use of EBCAs in the TASH-ED. Support from leadership and engagement of stakeholders outside the ED where EBCAs were believed to be less well accepted were identified as essential facilitators to implementation of EBCAs in the TASH-ED. Conclusions This study found a perceived need for EBCAs tailored to the TASH-ED setting to support uptake of evidence-based care into routine practice for common clinical presentations. Barriers and facilitators provide information essential to development of both context-appropriate EBCAs and plans for their implementation in the TASH-ED
Quality of basic emergency obstetric and newborn care services from patients' perspective in selected public health centers in Addis Ababa, Ethiopia 2022: A cross-sectional study.
No full textBackgroundThe majority of maternal and neonatal deaths occur within the first 24 hours of birth. To minimize maternal as well as neonatal morbidity and mortality, it is important to supply quality Basic Emergency Obstetric and Newborn Care. Basic emergency obstetric and newborn care services prevent immediate obstetric problems. There have been studies in Ethiopia that have looked at the availability of EmONC services. However, from the clients' perspective and experience, there is insufficient knowledge of quality BEmONC services.ObjectiveTo assess the quality of basic emergency obstetric and newborn care (BEmONC) services and associated factors from the perspective of mothers in selected public health centers in Addis Ababa, Ethiopia, 2022.MethodsA facility-based cross-sectional study was used among mothers receiving at least one of the signal functions of BEmONC services. A total of 377 mothers were enrolled. Eleven public health centers, one from each of the 11 sub-cities, were selected by simple random sampling. Respondents were chosen by a systematic random sampling method. A structured questionnaire from Open Data Kit version 2022.1.2 was used. Finally, it was exported to SPSS version 26 for analysis. Bivariate analysis at a P-value of 0.25 and multivariable analysis at a P-value of 0.05 were applied.ResultsThe overall quality of BEmONC services from the mothers' perspective was 56.9%. Mothers who paid for services had lower odds of rating the quality as good compared to those who received services for free (AOR = 0.564; 95% CI: 0.327-0.971). Additionally, mothers aged 20 to 24 years had a lower likelihood of viewing the quality as good compared to those older than 35 years (AOR = 0.362; 95% CI: 0.157-0.837). However, mothers who were accompanied by relatives had significantly higher odds of rating the quality as good than those who were alone (AOR = 18.557; 95% CI: 3.844-89.588). Regarding monthly income, respondents with an average monthly income of less than 1,500 ETB had higher odds of rating the quality as good compared to those earning more than 6,000 ETB (AOR = 2.429; 95% CI: 1.026-5.753).Conclusion and recommendationThe total quality of BEmONC services from the perspective of mothers was suboptimal. It was predicted by age, monthly income, presence of a companion, and payment. This study strongly recommends that more should be done to ensure that the services given are more client-centered
Epidemiology of stroke patients in Tikur Anbessa Specialized Hospital: Emphasizing clinical characteristics of Hemorrhagic Stroke Patients
No full textBackground: Stroke is one of the leading causes of death and adult disability. Unlike the developed world, hemorrhagic stroke has been reported to be more prevalent in sub-Saharan Africa. Risk factors and determinants of stroke are not well identified in Ethiopia.Methods: A retrospective chart review of all stroke patients who presented from December 2010 to December 2014 was conducted. Demographic characteristics, risk factors and stroke types and their hospital outcome were reviewed, emphasizing on hemorrhagic stroke patients.Result: During the study period, 301 patients were seen for stroke, of which a total of 139(46.1%) were hemorrhagic stroke patients. From the hemorrhagic stroke patients, 88 (63.3%) of them were male and 51 patients (36.7%) were female. From those hemorrhagic stroke patients, 103 patients (74.1%) of them had hypertension. Majority, 65(63.1%), of hypertensive hemorrhagic stroke patients were not adherent to their antihypertensive medication. From hemorrhagic stroke patients with HTN, 28(27%) of them were diagnosed to have HTN after stroke already occurred. From the study participants, 58(19.2%) of the patients died in the hospital and 35 (60.3%) of them were hemorrhagic stroke.Conclusion: The proportion of hemorrhagic stroke is higher compared with other developed countries. Untreated hypertension may be the contributing factor. Early detection of hypertension and strict control, early health seeking, and good comprehensive stroke care will potentially decrease the mortality and morbidity of stroke.Key words: Stroke, Hemorrhagic, Hypertension, non-complianc
Child labor, agricultural shocks and labor sharing in rural Ethiopia
No full textThe author studies the effect of an agricultural shock and a labor sharing arrangement (informal social network) on child labor. Albeit bad parental preference to child labor (as the strand of literature claims), poor households face compelling situations to send their child to work. This is, especially, true when they are hit by an income shock and face a binding adult labor constraint.The author used panel data from the ERHS and employed a fixed effects model to pin down causal relation between shocks, membership in a labor sharing arrangement and child labor. It was found that child labor is, indeed, a buffer stock. Though a labor sharing arrangement doesnÂ’t affect child labor at normal times, it helps households to lessen the pressure to rely on it when hit by idiosyncratic shocks. While almost the whole effect of these shocks is offset by participation in a labor sharing arrangement, the covariate shock is not. Even if this may well affect a childÂ’s academic performance, school attendance doesnÂ’t decrease. This differential effect of shocks on child labor in participant households might be because of the extra adult labor made available or due to mutual support that comes with these social networks.This paper is indicative of the importance of considering social networks in smoothing out consumption. Further, it highlights the difficulty to cope up with covariate shocks and hence, calls for development interventions that are particularly meant to address their impact.social networks;Ethiopia;shocks;child labor;labor sharing
Additional file 1: of Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study
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Epidemiology of stroke patients in Tikur Anbessa Specialized Hospital: Emphasizing clinical characteristics of Hemorrhagic Stroke Patients
No full textAbstract
Background: Stroke is one of the leading causes of death and adult disability. Unlike the developed world, hemorrhagic stroke has been reported to be more prevalent in sub-Saharan Africa. Risk factors and determinants of stroke are not well identified in Ethiopia.
Methods: A retrospective chart review of all stroke patients who presented from December 2010 to December 2014 was conducted. Demographic characteristics, risk factors and stroke types and their hospital outcome were reviewed, emphasizing on hemorrhagic stroke patients.
Result: During the study period, 301 patients were seen for stroke, of which a total of 139(46.1%) were hemorrhagic stroke patients. From the hemorrhagic stroke patients, 88 (63.3%) of them were male and 51 patients (36.7%) were female. From those hemorrhagic stroke patients, 103 patients (74.1%) of them had hypertension. Majority, 65(63.1%), of hypertensive hemorrhagic stroke patients were not adherent to their antihypertensive medication. From hemorrhagic stroke patients with HTN, 28(27%) of them were diagnosed to have HTN after stroke already occurred. From the study participants, 58(19.2%) of the patients died in the hospital and 35 (60.3%) of them were hemorrhagic stroke.
Conclusion: The proportion of hemorrhagic stroke is higher compared with other developed countries. Untreated hypertension may be the contributing factor. Early detection of hypertension and strict control, early health seeking, and good comprehensive stroke care will potentially decrease the mortality and morbidity of stroke. [Ethiop. J. Health Dev. 2017;31(1):13-17]
Key words: Stroke, Hemorrhagic, Hypertension, non-complianc
A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks
No full textIntroduction: Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management.
Methods: This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa.
Results: A standardised survey was conducted with 64 participants working in emergency medicine [30/64 (46.9%)] and orthopaedics [34/64 (53.1%)]. Twenty-three of 64 (35.9%) respondents had received formal training. Knowledge was acquired from didactic/workshop format for 15/23 (65.2%), followed by peer training 6/23 (39.1%). The majority, 62/64 (96.9%), believed that knowledge of general anatomy and nerve blocks are very important. Thirty-one of 64 (48%) of the respondents did not routinely perform peripheral nerve blocks. A majority, 27/31 (87.1%) stated they lacked the required skills. Ultrasound guidance of the femoral nerve 16/33 (48.5%) was the most commonly performed peripheral nerve block, followed by ankle block using anatomic landmarks 15/33 (45.5%). Almost all (15/16) ultrasound-guided nerve blocks were done by emergency medicine providers, while all anatomic land mark guided blocks were done by orthopaedic teams. A majority of the respondents (93.8%) (n = 60) were optimistic that their practice on peripheral nerve blocks would increase in future. A highly significant association was found between previous training on peripheral nerve blocks and the number of peripheral nerve blocks performed in a month; p value – 0.006.
Discussion: This study indicates peripheral nerve blocks are likely underutilised due to lack of training. There was a positive attitude towards peripheral nerve blocks but gaps on knowledge and practice
The burden on emergency centres to provide care for critically ill patients in Addis Ababa, Ethiopia
No full textIntroduction: Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia. Methods: This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa. Structured questionnaires were completed by six emergency and critical care nurses. EC patients were included if they met the Society for Critical Care Medicine (SCCM) intensive care unit (ICU) admission criteria and stayed in the EC for more than 6 h. We collected initial demographic and clinical information, data about the patients’ clinical course in the EC, and data regarding the patients’ disposition. We used descriptive statistics for analysis. Results: A total of 291 patients, over the course of three months, had an EC stay that exceeded six hours. The median length of stay for these patients was 48 h (interquartile range: 25–72 h). The most common categories of illness were neurological disease in 87 patients (30%) and cardiovascular disease in 61 patients (21%). The most frequent aetiologies of critical illness were severe head trauma and severe sepsis with multi-organ failure (26 patients, 9% each). A total of 94 patients (32%) died in the EC, while 86 (30%) were discharged directly from the EC without hospital admission. Discussion: ECs in Addis Ababa face a heavy burden in caring for a large number of critically ill patients over a long period of time, with relatively high mortality rates. These findings should promote supporting emergency centres to strengthen and expand ICU capacity to provide appropriate critical care services. Keywords: Emergency medicine, Critical care, Overcrowding, Ethiopi
Reversal of Burden of Proof in Case of the Crime of Illicit Enrichment: A Case Study
No full textThis thesis aims at addressing questions such as what is reversal of onus of proof; is there a
reversal of onus of proof in case of the crime of illicit enrichment; if any, its constitutionality. It
answers the constitutionality question of the onus imposed on those who are accused of the crime
of illicit enrichment under Ethiopian laws. The constitutionality test is made in view of the
fundamental rights of accused persons that are guaranteed under the FDRE Constitution. To this
end, this thesis embarks on by determining the existence or otherwise of reversal of onus of
proof in case of the crime of illicit enrichment. Apart from theoretical explications, the
discussion is backed up by examination of illustrative practical cases. Moreover, in addition to a
discussion on the legal frameworks that govern the crime of illicit enrichment, the thesis
examines the elements of and rationales behind criminalisation of illicit enrichment.
After discussing all the above issues, the author argues that, in Ethiopia, in case of the crime of
illicit enrichment, there is a reversal of onus of proof, and it infringes the constitutionally
guaranteed rights of accused persons, unambiguously, the PoI and protection against selfincrimination. However, contrary to Article 9(1) of the FDRE Constitution, the author
recommends not to nullify the proclamation‟s provision on the crime of illicit enrichment but to
amend some constitutional provisions; particularly, the provision on the PoI and the protection
against self-incrimination
Child labor, agricultural shocks and labor sharing in rural Ethiopia
No full textThe author studies the effect of an agricultural shock and a labor sharing arrangement (informal social network) on child labor. Albeit bad parental preference to child labor (as the strand of literature claims), poor households face compelling situations to send their child to work. This is, especially, true when they are hit by an income shock and face a binding adult labor constraint.
The author used panel data from the ERHS and employed a fixed effects model to pin down causal relation between shocks, membership in a labor sharing arrangement and child labor. It was found that child labor is, indeed, a buffer stock. Though a labor sharing arrangement doesn't affect child labor at normal times, it helps households to lessen the pressure to rely on it when hit by idiosyncratic shocks. While almost the whole effect of these shocks is offset by participation in a labor sharing arrangement, the covariate shock is not. Even if this may well affect a child's academic performance, school attendance doesn't decrease. This differential effect of shocks on child labor in participant households might be because of the extra adult labor made available or due to mutual support that comes with these social networks.
This paper is indicative of the importance of considering social networks in smoothing out consumption. Further, it highlights the difficulty to cope up with covariate shocks and hence, calls for development interventions that are particularly meant to address their impact
