The Status of Facility Based Emergency Care in Public Hospitals of Ethiopia Using WHO Assessment Tool

BACKGROUND: The availability of emergency care contributes to half of the total mortality burden in a low and middle income countries. The significant proportion of emergency departments in LMICs are understaffed and poorly equipped. The purpose of this study is to examine the status of emergency units and to describe the facilitators and barriers to the provision of facility-based emergency care at selected Ethiopian public hospitals. METHODS: A mixed-methods explanatory design was used. Ten hospitals were purposively selected due to their high number of patients and referral service. A WHO facility assessment tool was used to quantitatively assess the facilities, and an in-depth interview with hospital and emergency room leadership was conducted. The quantitative results were descriptively analyzed, and the qualitative data was thematically analyzed. RESULT: This survey included a total of ten hospitals. Three of the facilities were general hospitals, and seven were tertiary level hospitals. They all were equipped with an emergency room. All of the studied hospitals serve a population of over one million people. In terms of infrastructure, only 3/10 (30%) have adequate water supply, and alf (5/10) have telephone access in their ED. The qualitative resultshowedthat the most common barriers to emergency care delivery were prolonged patient stays in the emergency room, inadequate equipment, and a shortage of trained professionals. CONCLUSION: The status of emergency care in Ethiopia is still developing, and hospital care as a whole should improve to alleviate the high burden of care in emergency rooms and reduce morbidity and mortality

Injury severity levels and associated factors among road traffic collision victims referred to emergency departments of selected public hospitals in Addis Ababa, Ethiopia: the study based on the Haddon matrix

Abstract Background Globally, about 1.25 million people die annually from road trafficcollisions. Evidence from global safety report shows a decreasing trend of road traffic injury indeveloped countries while there is an increasing trend in many developing countriesincluding Ethiopia. This study is aimed at assessing factors affecting injury severity levels of road traffic collision victims referred to selected public hospitals in Addis Ababa based on the Haddon Matrix. Methods Ahospital-based cross-sectional study designwas implemented to randomly select a total of 363 road traffic collision victims. The collected data was cleaned andentered into Epidata version 3.1 and exported to SPSS Version 21 for analysis. Bivariate and multivariate logisticregression models were used to examine the association between explanatory and outcome variables. Results A total of 363 individual sustained road traffic injuries were included to the study. Theprevalence of severe injury among road traffic accident victims was 36.4%. The following variables were significantly associated with increased injury severity: motorbike rider or motorbike passenger without helmet, adjusted odds ratio (AOR) 4.7(95% CI: 1.04–21.09); driving under the influence of alcohol, crude odds ratio (COR) 2.64(95% CI;1.23–5.64); victim with multiple injuries, AOR 3.88(95% CI: 2.26–6.65); vehicle size, AOR 2.14(95% CI: 1.01–4.52); collision in dark lighting condition, AOR 1.93(95% CI: 1.01–3.65); collision in cross city/rural, AOR 1.95(95% CI: 1.18–3.24) and vehicle occupant travelling unrestrained on the back of a truck, AOR3.9 (95% CI: 1.18–12.080). On the other hand, victims extricated at the scene by health care professional, AOR 0.33(95% CI: 0.13–0.83); victims extricated at the scene by police AOR 0.47(95% CI: 0.24–0.94); strict traffic police control at the scene of the collision, AOR 0.49(95% CI: 0.27–0.88) were significantly associated with less severe injuries. Conclusions Findings reported in this paper suggest the need forimmediate and pragmatic steps to be taken to curb the unnecessary loss of livesoccurring on the roads. In particular, there is urgent need to introduce road safety interventions

The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors.

BackgroundCOVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors.MethodsA total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals.ResultsThe overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients.ConclusionsThere were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care

Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study

Abstract Background Childhood mortality remains high in resource-limited third world countries. Most childhood deaths in hospital often occur within the first 24 h of admission. Many of these deaths are from preventable causes. This study aims to describe the patterns of mortality in children presenting to the pediatric emergency department. Methods This was a five-year chart review of deaths in pediatric patients aged 7 days to 13 years presenting to the Tikur Anbessa Specialized Tertiary Hospital (TASTH) from January 2012 to December 2016. Data were collected using a pretested, structured checklist, and analyzed using the SPSS Version 20. Multivariate analysis by logistic regression was carried out to estimate any measures of association between variables of interest and the primary outcome of death. Results The proportion of pediatric emergency department (PED) deaths was 4.1% (499 patients) out of 12,240 PED presentations. This translates to a mortality rate of 8.2 deaths per 1000 patients per year. The three top causes of deaths were pneumonia, congestive heart failure (CHF) and sepsis. Thirty two percent of the deaths occurred within 24 h of presentation with 6.5% of the deaths being neonates and the most common co-morbid illness was malnutrition (41.1%). Multivariate analysis revealed that shortness of breath [AOR=2.45, 95% CI (1.22-4.91)], late onset of signs and symptoms [AOR=3.22, 95% CI (1.34-7.73)], fever [AOR=3.17, 95% CI (1.28-7.86)], and diarrhea [AOR=3.36, 95% CI (1.69-6.67)] had significant association with early mortality. Conclusion The incidence of pediatric emergency mortality was high in our study. A delay in presentation of more than 48 hours, diarrheal diseases and shortness of breath were significantly associated with early pediatric mortality. Early identification and intervention are required to reduce pediatric emergency mortality

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes

Treatment seeking behaviours and associated factors among patients experiencing acute coronary syndrome using health belief model in Addis Ababa, Ethiopia

BACKGROUND: Acute coronary syndrome (ACS) is a lifethreatening condition. The mortality rate will be reduced if immediate treatment is provided. Patients' awareness of ACS is limited, so they do not seek help as quite often as they should. The level of treatment seeking behavior and associated factors among ACS patients admitted to three hospitals in Addis Ababa, Ethiopia, were assessed using a health belief model.METHODS: A cross-sectional study was conducted among 330 ACS patients from November 2019 to December 2020. Sociodemographic and clinical variables data were extracted using pre-tested checklist. The outcome and other variables data were collected using the checklist and structured questionnaire. The data were entered into Epi-data 3.1 and exported to STATA 17.1 for analysis. Descriptive statistics relevant to the variable wasperformed. A multivariable logistic regression was used to identify factors associated with treatment seeking behavior.RESULTS: This study revealed that the mean time from symptom onset to arrival at the emergency unit (EU) was 24 ± 19.5 hours, slightly < half of the participants (n=149, 45.1 %) had adequate treatment seeking behavior. Perceived threat (AOR=1.03,95% CI:1.01-1.06, p=0.002), perceived benefits (AOR=1.09, 95%CI: 1.02-1.0, p≤0.001), self-efficacy (AOR=1.16, 95% CI :1.01- 1.22, p≤ 0.001), education (AOR=2.2,95%CI:1.31-3.9, p≤0.01) selfautonomy (AOR=3.1,95%CI:1.82-5.4, p<.001) and no depression (AOR=1.9,95%CI:1.1-3.3, p≤0.05) were found to have significantly association with adequate treatment seeking behavior.CONCLUSION: This study indicates, less than half of ACS patients had adequate treatment seeking behavior. Thus, contextspecific behavioral interventions, along with public awareness campaigns about ACS, should be implemented

Assessment of Knowledge and Practices of Standard Precaution against Blood Borne Pathogens among Doctors and Nurses at Adult Emergency Room in Addis Ababa, Ethiopia

Background. Standard precautions are infection control techniques against pathogenic microorganisms that are present in human blood and can cause disease in humans. Objective. This study aims to assess knowledge and practice of standard precautions against blood borne pathogens among doctors and nurses in adult emergency room, Addis Ababa, Ethiopia. Methods. Institutional based cross sectional study was conducted from February to March 2018. A total of 128 study participants selected from four public hospitals were enrolled in this study. Data were collected using standardized pretested questionnaire and thencoded, entered, checked for completeness, and analyzed using SPSS version-23 statisticalsoftware. Chi-square test was used to measure the association between variables. P values <0.05 were taken as statistically significant. Result. The mean knowledge score of standard precaution measures was 10.3 out of 14 knowledge items. Out of 32 doctors, 93.8% (n=30) have good knowledge and out of 91 nurses, 86.8% (n=79) have good knowledge. The mean practice level of the study subjects was 8.5 out of 12 practice items. Majority (73.6%) of nurses have good practice level than doctors (21.8%). Knowledge level was significantly associated with the presence of infection control officer, infection control guideline, and washing hands before touching patients. Profession, training, and the presence of infection control guideline in emergency room were significantly associated with practice level of respondents (P<0.05). Conclusion. Both nurses and doctors have good knowledge of standard precaution measures. However, nurses have better practice level than doctors. Orientation during employment and continuous training programs should be provided for the newly employed health workers. In addition sustainable supply systems should be available in each hospital management

Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia

Introduction: Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia. Methods: A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05. Results: The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54–3.27), working time (AOR: 2.23; 95 % CI: 1.52–3.26), length of stay (AOR: 2.40; 95 % CI: 1.27–4.54), saturation level (AOR: 2.35; 95 % CI: 1.31–4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37–3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06–2.16). Conclusion: The study revealed that ED were overcrowded approximately two-thirds of the time

Description of socio-demographic (predisposing) characteristics by prehospital care utilization among severe and critical COVID-19 patients, Addis Ababa, Ethiopia, May to July 2021.

Description of socio-demographic (predisposing) characteristics by prehospital care utilization among severe and critical COVID-19 patients, Addis Ababa, Ethiopia, May to July 2021.</p

Bivariate and multivariate logistic regression analysis of factors associated with prehospital care utilization among severe and critical COVID-19 patients treated in centers in Addis Ababa, Ethiopia, from May to July 2021.

Bivariate and multivariate logistic regression analysis of factors associated with prehospital care utilization among severe and critical COVID-19 patients treated in centers in Addis Ababa, Ethiopia, from May to July 2021.</p