Comparing the Effect of Spinal and General Anaesthesia for Pre- Eclamptic Mothers Who Underwent Caesarean Delivery in A Tertiary, Addis Ababa, Ethiopia

BACKGROUND: Opinions are controversial regarding the use of general and spinal anesthesia in pre-eclamptic mothers undergoing Caesarean section. Some studies recommended avoiding spinal anesthesia in pre-eclamptic patients because of concern for suddensevere hypotension, while other studies support the use of spinal anesthesia as first choice reasoning less post-operative morbidity and mortality. This study aims to compare maternal outcome among pre-eclamptic women undergone caesarian delivery under general and spinal anesthesia.METHODS AND PATIENTS: A retrospective comparative crosssectional study was conducted to compare maternal outcome. Allpre-eclamptic mothers who underwent Caesarian section in Black Lion Specialized Hospital from October 2014 to October 2016 were included in the study. Data entry and analysis were conducted using SPSS version 20. Student’s T-test was used to compare the outcome in both groups and p value < 0.05 was set as cut off point for statistical significance.RESULTS: A total of 170 client documents were reviewed. The mean age of the study subjects was 28.18 + 4.66 years, with median age 28 years (IQR: 25-30). Our study shows that both general and spinal anesthesia have no difference in terms of maternal survival status, days of hospital stay, post-operative admission to ICU, and post-operative complications. However, this study found a statistically significant higher post-operative blood pressure and pulse rate among general anesthesia groups compared with spinal anesthesia group.CONCLUSION፡ Spinal anesthesia is safer than general anesthesia in terms of stable vital signs among pre-eclamptic women undergoing Cesarean section.KEYWORDS: Spinal, General, Anesthesia, Pre-eclampsia, Maternal outcom

Job Satisfaction and Associated Factors Among Anesthetists at Government Hospitals of Addis Ababa, Ethiopia

Background: Anesthetic practice is always at high risk in medical profession. Job satisfaction level of Anesthetist can be affected by different factors. An investigation to retain anesthetists in the profession to meet the increasing demands of the healthcare system has a great importance. This study was aimed to determine the level of job satisfaction and associated factors among anesthetists working in government hospitals of Addis Ababa. Methods: A cross-sectional study conducted on sampled 101 anesthetists. Simple random sampling method was used to obtain the study participants. Data were collected using a structured questionnaire, comprised two main parts; demography and job satisfaction. Respondent rated 18 factors related to job satisfaction using six point Likert scale. A descriptive analysis using Proportion and frequency were used. A‘chi square’ test were used to assess statistical significance of association and P-values less than 0.05 were considered as statistically significant. Results: Among 101 anesthetists respondent, 57% were male, the majority of respondents were below the age of 30 years 58.4% and 59.4% of the respondents were single. A 53% of the respondents were satisfied and the highest dissatisfaction rate was in the age group of below thirty.  Satisfaction in helping others, responsibilities and freedom to choose method of working were significantly associated with job satisfaction. The major reasons reported for their dissatisfaction were inadequate salary, lack of public awareness about the role of anesthetists and professional hazard. Conclusion: There is a low level of job satisfaction among anesthetists who are working in government hospitals of Addis Ababa. Therefore, improving satisfaction level of anesthetist by solving major reasons of dissatisfaction is strongly recommended. Keywords: Anesthetists , satisfaction , dissatisfaction , government hospitals DOI: 10.7176/JHMN/94-05 Publication date:October 31st 2021

Education, Practice, and Competency Gaps of Anesthetists in Ethiopia:Task Analysis

Purpose: This study assessed the needs and gaps in the education, practice and competencies of anesthetists in Ethiopia. Design: A cross-sectional study design was used. Methods: A questionnaire consisting of 74 tasks was completed by 137 anesthetists who had been practicing for 6 months to 5 years. Findings: Over half of the respondents rated 72.9% of the tasks as being highly critical to patient outcomes, and reported that they performed 70.2% of all tasks at a high frequency. More than a quarter of respondents reported that they performed 15 of the tasks at a low frequency. Nine of the tasks rated as being highly critical were not learned during pre-service education by more than one-quarter of study participants, and over 10% of respondents reported that they were unable to perform five of the highly critical tasks. Conclusions: Anesthetists rated themselves as being adequately prepared to perform a majority of the tasks in their scope of practice

Impact of anesthetist licensing examination on quality of education in Ethiopia: a qualitative study of faculty and student perceptions

Abstract Background Ethiopia drastically increased the anesthesia workforce density by training ‘associate clinician anesthetists’ as a task-shifting and sharing strategy. However, there were growing concerns about educational quality and patient safety. Accordingly, the Ministry of Health introduced the anesthetist national licensing examination (NLE) to assure the quality of education. However, empirical evidence is scarce to support or refute the overall impact of NLEs, which are relatively costly for low- and middle-income settings. Therefore, this study aimed to explore the impact of introducing NLE on anesthetists’ education in Ethiopia. Methods We conducted a qualitative study using a constructivist grounded theory approach. Data were prospectively collected from ten anesthetist teaching institutions. Fifteen in-depth interviews were conducted with instructors and academic leaders, and six focus groups were held with students and recently tested anesthetists. Additional data were gathered by analyzing relevant documents, including versions of curricula, academic committee minutes, program quality review reports, and faculty appraisal reports. Interviews and group discussions were audiotaped, transcribed verbatim and analyzed using Atlas.ti 9 software. Results Both faculty and students demonstrated positive attitudes toward the NLE. Student motivation, faculty performance, and curriculum strengthening were the three primary changes that emerged, resulting in three subsequent spin-offs on assessment, learning, and quality management practices. Academic leaders’ dedication to evaluating examination data and turning these into action led to changes that improved education quality. Increased accountability, engagement, and collaboration were the predominant factors facilitating change. Conclusion Our study indicates that the Ethiopian NLE has prompted anesthesia teaching institutions to improve their teaching, learning, and assessment practices. However, more work is required to improve exam acceptability among stakeholders and drive broader changes

Preparing the health workforce in Ethiopia: A Cross-sectional study of competence of anesthesia graduating students

BACKGROUND: Efforts to address shortages of health workers in low-resource settings have focused on rapidly increasing the number of higher education programs for health workers. This study examines selected competencies achieved by graduating Bachelor of Science and nurse anesthetist students in Ethiopia, a country facing a critical shortage of anesthesia professionals. METHODS: The study, conducted in June and July 2013, assessed skills and knowledge of 122 students graduating from anesthetist training programs at six public universities and colleges in Ethiopia; these students comprise 80% of graduates from these institutions in the 2013 academic year. Data was collected from direct observations of student performance, using an objective structured clinical examination approach, and from structured interviews regarding the adequacy of the learning environment. RESULTS: Student performance varied, with mean percentage scores highest for spinal anesthesia (80%), neonatal resuscitation (74%), endotracheal intubation (73%), and laryngeal mask airway insertion check (71%). Average scores were lowest for routine anesthesia machine check (37%) and preoperative screening assessment (48%). Male graduates outscored female graduates (63.2% versus 56.9%, P = 0.014), and university graduates outscored regional health science college graduates (64.5% versus 55.5%, P = 0.023). Multivariate linear regression found that competence was associated with being male and attending a university training program. Less than 10% of the students believed that skills labs had adequate staff and resources, and only 57.4% had performed at least 200 endotracheal intubations at clinical practicum sites, as required by national standards. DISCUSSION: Ethiopia has successfully expanded higher education for anesthetists, but a focus on quality of training and assessment of learners is required to ensure that graduates have mastered basic skills and are able to offer safe services