Assessment of routine health information utilization and its associated factors among Health Professionals in Public Health Centers of Addis Ababa, Ethiopia

AbstractBackground: - A Routine Health Information System (RHIS) is referred to as the interaction between people, processes, and technology to support operations management in delivering information to improve healthcare services. Routine health information is likely to allow public health facility providers to document analyze and use the information to improve coverage, continuity, and quality of health care services. In Ethiopia, information use remains weak among health professionals. Besides, more have to be done on the utilization of routine health information among health professionals to strengthen and improve the health of the community at large. This study aimed to assess the level of routine health information use and identified determinants that affect health information use among health professionals. Method: Facility-based cross-sectional study design was used from March to April 2020 among 408 health professionals within 22 public health centers using a multi-stage sampling technique. Data was collected using a Semi-structure questionnaire and an observational checklist. The data collected were entered into EpiData version 3.1 and transferred into SPSS version 20 for further statistical analysis. Stepwise regression was used to select the variable. Variables with a p-value of less than 0.05 for multiple logistic regression analysis were considered statistically significant factors for the utilization of RHIS. Result: In this study, Routine health information utilization rate among health professionals was 37.3% (95% CI: 32.6%, 42.1%). The findings also showed a significant positive association between routine health information utilization and health professionals who use of Both manual and computer-based files (AOR = 1.474, 95 % CI =1.043-2.082); Organizational rules, values, and practices (AOR = 1.734, 95 % CI =1.212-2.481); Human resource (AOR = 1.494, 95 % CI = 1.056-2.114); Had problem solving skill on HIS tasks (AOR = 2.091, 95 % CI = 1.343-3.256); Professional who believe that routine health information use is important (AOR = .665, 95 % CI = .501- .883); Planning and monitoring practice (AOR = 1.464 95% CI (1.006-2.131)) and Knowing duties and responsibilities (AOR = 1.525, 95 % CI = 1.121-2.073) Conclusion and Recommendations: Good health information utilization status of health professionals in Addis Ababa was low. Use of recording information; Organizational rules, values, and practices; Inadequate Human resource; Problem-solving skill of health professionals on HIS tasks; Professional who believe that routine health information use is important; the Collected information used for planning, monitoring, and evaluation of facility performance; and Staff know their duties and responsibilities in their workplace were found significantly associated with routine health information use. Thus, major improvements must be done in equipping health professionals to utilize the information they have by improving the above key findings/factors in the health care system. And, health professionals have to use routine health information for evidence-based decision-making in health facilities for a better quality of health care system implementation. [Ethiop. J. Health Dev. 2021; 35(SI-1):05-14] Keywords: Routine Health information Utilization, Health centers, Health professionals, Information Use, healthcare dat

A mixed-methods assessment of Routine Health Information System (RHIS) Data Quality and Factors Affecting it, Addis Ababa City Administration, Ethiopia, 2020

AbstractBackground: Effective and efficient health care services need evidence-based decisions, and these decisions should rely on information from high-quality data. However, despite a lot of efforts, routine health data is still claimed to be not at the required level of quality. Previous studies have primarily focused on organization-related factors while little emphasis was given for perception and knowledge of service providers' gaps. Therefore, this study aims to evaluate the quality of data generated from routine health information systems and factors contributing to data quality from diverse aspects. Objective: This study aims in assessing the quality of routine health information system data generated from health facilities in Addis Ababa city administration, providing the level of data quality of routine health information system, and factors affecting it. Method: A cross-sectional study was conducted on 568 health professionals from 33 health centers selected randomly using a two-stage sampling method. A qualitative study was also conducted using 12 key informants. Result: The overall regional data quality level was 76.22%. Health professionals' motivation towards routine health care data have shown a strong association with data quality, (r (31) =.71, p<.001). Lack of adequate Health information system task competence, non-functional PMT, and lack of supervision was also commonly reported reasons for poor data quality. Conclusion: This review has documented the data quality of routine health information systems from health centers under Addis Ababa city. Overall data quality (76.22%) was found to be below the national expectation level, which is 90%. The study emphasized the role of behavioral factors in improving the quality of routine health care data. [Ethiop. J. Health Dev. 2021; 35(SI-1): 15-24 ] Keywords: RHIS, Accuracy, completeness, timeliness, consistency, Addis Abab

Data quality and it’s correlation with Routine health information system structure and input at public health centers in Addis Ababa, Ethiopia.

AbstractBackground: The Government of Ethiopia, together with its partners, has made significant progress over the years in the standardization and implementation of health information system (HIS). The sector continues to be challenged by its lack of accurate, timely and thorough data, which therefore has affected the quality of care, planning and management systems in the country. This study assessed HIS for managing health care data and data quality in the Addis Abeba City Administration in Ethiopia. Methods: A cross-sectional study was conducted to determine the quality of the data. The study was conducted in 25 health centers in Addis Ababa City. Connected woreda assessment tools have been used. Composite analysis was carried out to determine the implementation of routine health information system structure and input. Univariate and multiple linear regression are used to identify predictors of overall data quality,reporting findings using a regression coefficient and 95 % confidence interval. Result: The overall |implementation of RHIS structure and input was 63.9% at health facilities. The mean score of RHIS structure and input was 19.2/30 + 4.7. The overall data quality was found to be 57.9% with a 95 Confidence interval of (95%CI (51.0-64.9%). Overall data accuracy, completeness, and timeliness in all assessed health facilities was 69.6% (95 IC 59.8-79.3%), 49.5% (95 CI 38.3-60.7%), and 56% (95 CI, 48.8_63.2), respectively. Supportive supervision and mentorship found to be associated to data quality, as supervision mean score increase by one-unit data quality increases by 1.42 with 95% CI (0.10-2.76) given another variable held constant. Conclusion and recommendation: Overall data quality was much lower than the national acceptable level of less than 90%. Supportive supervision and mentorship has a significant correlation with data quality. A considerable number of health facilities have not yet fulfilled all the input required to strengthen the HIS. Strengthen support supervision and mentorship is an opportunity to improve data quality at the level of health facilities. [Ethiop. J. Health Dev. 2021; 35(SI-1):33 - 41] Keywords: Data quality, RHIS structure and input, healthcare dat

Patterns of essential health services utilization and routine health information management during Covid-19 pandemic at primary health service delivery point Addis Ababa, Ethiopia.

AbstractBackground: Health information system refers to any system that captures, stores, manages, and transmit information related to health of individuals. The essential health service includes Antenatal care, skilled birth attendant, emergency, outpatient, Inpatient, Pneumonia, and Immunization. The current pandemic of coronavirus disease (COVID-19) has proved devastating in low-income countries, which were already suffering from low access for basic health service utilization. The pandemic might generate disruptive collateral damage to ongoing healthcare services through diverting available healthcare resources to the fight against the pandemics in these countries. This study aimed to assess the pattern of essential health services utilization, data accuracy checking, and information use performance review practice at selected public health center in Addis Ababa Ethiopia. Methods: We employed cross-sectional study and retrospectively reviewed health records to assess the pattern of selected essential health service utilization, data quality, and performance review practice before and during the COVID-19 pandemic. Out of twenty-seven health centers, nine health centers were randomly selected from three sub-cities to review key indicators using a guiding checklist. Data were extracted using record verification protocol. Data was entered, cleaned, and analyzed using STATA version 14. We used average change in proportions to describe the pattern of service utilization, data quality and performance review practice before and during COVID 19. The mean difference before and during COVID 19 was compared using paired T-test statistics. Result: Essential health services utilization has been partially or completely disrupted in the selected health centers. Pneumonia (70%), Upper respiratory diseases (65%), PICT (54%), Out-patient (42%), and 39% for data quality and performance review practice (39%) showed significant reduction during COVID 19 cases reported in the country. ANC1, ANC4, Penta1, and Penta4 service show almost in a similar trend from month to month before and during COVID-19. Conclusion: Service utilization like emergency, out-of-patient, and VCT cases significantly reduced during COVID-19 pandemic. During the COVID-19 pandemic, routine data accuracy checks, and RHIS performance reviews practice were also significantly reduced. [Ethiop. J. Health Dev. 2021; 35(SI-1):90-97] Key words: Data quality, data use, health service utilizatio

Improving the Quality of Clinical Coding through Mapping of National Classification of Diseases (NCoD) and International Classification of Disease (ICD-10).

AbstractIntroduction: Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. Utilization of international disease classification provides higher-quality information for measuring healthcare service quality, safety, and efficacy. The Ethiopian National classification of disease (NCoD) was developed as part of Health Management information System (HMIS) reform with consideration of accommodating code in International Classification of disease (ICD-10). There is limited resource about the utilization status and related determinants of NCoD by health care professionals at tertiary level hospitals. This study is designed to assess the utilization status of NCoD and improve the quality of clinical coding through mapping of NCoD and ICD-10. Methods: Quasi-experimental study considering “Mapping” as an intervention was employed in this study. Retrospective medical record reviews were carried out to assess the utilization of NCoD and its challenges at Tikur Anebsa Specialized Hospital (TASH) for a period of one year (2018/2019). Qualitative approach used to get expert insight on NCoD implementation challenges and design of mapping exercises as an intervention. Seven thousand five hundred forty-seven (20%) of the medical records from the total of 37,734 medical records were selected randomly for review. A data abstraction checklist was developed to collect relevant information on individual patient charts, patient electronic records specific on a confirmed diagnosis. The reference mapping approach was employed for the mapping output between ICD-10 and NCoD. Both ICD-10 and NCoD were mapped side by side using percentage comparison and absolute difference. Result: Data for document review was taken from the electronic medical record database. Out of the total, 3021 (40%) of records were miss-classified based on the national classification of disease. From the miss-coded record, 1749 (58%) of them used ICD code to classify the diagnosis. Reasons provided for poor utilization of NCoD among physicians include, perception of having a limited list of diagnosis in the NCoD, not being familiarized, inadequate capacity building about NCoD use, and absence of enforcing mechanism on the use of standard diagnostic coding among professionals. Utilization of disease classification coding provides higher-quality information for measuring healthcare service quality, safety, and efficacy. This will in turn provide better data for quality measurement and medical error reduction (patient safety), outcomes measurement, operational planning, and healthcare delivery systems design and reporting. Conclusion: Extended NCoD categories were mapped from ICD-10. Standard ways of coding disease diagnosis and coding of new cases into the existing category was established. This study recommends that due emphasis should be given in monitoring and evaluation of medical coding knowledge and adherence of health professionals, and it should be supported with appropriate technologies to improve the accessibility and quality of health information. [Ethiop. J. Health Dev. 2021; 35(SI-1):59-65] Keywords: Mapping, NCoD, ICD, Clinical Coding, Diagnosis, Health Information Syste

Quality of Primary Health Care during COVID-19 Pandemic in Addis Ababa Ethiopia: Patients-side and facility level assessment

Abstract Background: Quality is increasingly becoming an important aspect of health care that is given a priority nowadays. The assessment and assurance of quality depends on reliable evidence. It is evident that there is no comprehensive study related to quality of health care in public primary health care facilities during COVID-19 pandemic in Ethiopia. Even if the formulation and launching of health facility standards nationally has been made in 2013 and quality has been taken as one pillar for the past two decades, quality of health services has been poor. Unfortunately, the occurrence of COVID 19 pandemic poses another threat to the already existing poor quality of health service. Therefore, this assessment of selected quality dimensions of primary health care in Addis Ababa could be used for future monitoring and evaluation of quality improvement in the country as well as prepare the primary health facilities against possible future pandemics. Objective: The objective of the study is to assess the selected dimension of health care quality at the time of COVID 19 in the selected primary health care facilities in Addis Ababa, Ethiopia Methods: A facility-based cross-sectional study design was used. The study was done in six health facilities in Addis Ababa, Ethiopia. Patients, health service providers and health facilities were the study participants. An observation checklist and interviewer administered questionnaire were used to assess the routine service provision. Data cleaning, management and analysis was done using SPSS version 23 statistical software. Both descriptive and analytical results were used to present the findings. Result: The overall patient satisfaction was 77.9 %. From the quality dimension, the grand mean satisfaction score for health service accessibility, patient centeredness, equitability, and timeliness were54.7%, 67.9%, 72.1%, 63.4% respectively. From the facility level analysis only two facilities indicated employees receive ongoing Continuing Professional Development (CPD). All the facilities maintain employment record of each staff; however, with regard to the content only two facilities contain credential information, health examination record, in-service education /training and copies of annual evaluation. In half of the facilities lack of procedure room and hand washing room was observed. Toilets were not clean. Poor continuity of care was also identified and only two facilities indicated they had feedback providing mechanism in the referral system. Conclusion: Most of the respondents were satisfied with the quality of primary health care service. Gaps, however, were identified in the human resource management, infrastructure, referral system and continuity of care from the facilities’ perspective. Incomplete recording of most of the content of employee was identified as well. Thus, it is recommended to improve the identified challenges through provision of a system (guideline), continuous supervision, mentorship, and training. [Ethiop. J. Health Dev. 2021; 35(SI-1):98-107] Keyword: quality of service, patient satisfaction, continuing professional developmen

COVID 19 Epidemic Trajectory Modeling Results for Ethiopia

AbstractBackground: An outbreak of “pneumonia of unknown etiology" later renamed as Novel Corona Virus (COVID 19) was first reported from Hubei Province, China on 31 December 2019. The cases have increased exponentially; the pandemic has reached all countries in the world with 81.2 million confirmed cases and over 1.8 million by December 28, 2020. Ethiopia reported its first case on March 13, 2020, and as of December 28, 2020, the country had 122864 confirmed COVID-19 cases and 1909 deaths. Being a new pandemic its epidemiologic trajectories across regions and populations remains unknown. Mathematical models are widely used to understand and predict the possible courses of an outbreak, given a set of underlying assumptions. Objective: This study intends to model COVID 19 epidemic trajectory under different assumptions and to predict the likely timing of peak of the epidemic in Ethiopia. Methods: Standard Susceptible Exposed, Infected and Recovery (SEIR) compartmental epidemiological deterministic model was employed to estimate and predict COVID 19 in progression in Ethiopia and Addis Ababa at different points of time. Exhaustive literature reviews were carried out to contextualize COVID 19 pandemic epidemiological. Efficacy and coverage of face mask and social distancing were considered in the best and worst situation to run the model and estimate the number of infections after sustained local transmissions. Result. Without any intervention, the COVID 19 viruses spread will peak at 150 days from the first report, infecting 8.01million people given local/community transmission. As the compliance with face mask coverage increases by 25%, 50%, and 75%, the infection will be reduced by about 20%, 40%, and 60% respectively social distancing compliance by le 25% of the population alone will reduce above 60% of infections. Compliance of 40% face mask use and social distance combined effect will reduce 97% of the estimated number of cases. Conclusion: This predication indicated that compliance with combination of non-pharmaceutical intervention such as use of face mask use with physical distance averted significant number of COVID infection. For a county like Ethiopia with poor health systems resilience, mitigating the pandemic at an early stage through strong preventive measures is necessary. [Ethiop. J. Health Dev. 2021; 35(SI-1):25-32] Key word: COVID 19, Modelling, Non-Pharmaceutica intervention, Ethiopi

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia.

INTRODUCTION: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses. METHODS: We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses. RESULTS: There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services. CONCLUSION: We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period. TRIAL REGISTRATION NUMBER: ISRCTN12040912

Tobacco use and its predictors among Ethiopian adults: A further analysis of Ethiopian NCD STEPS survey-2015

Background: Consuming any form of tobacco is one of the leading causes of preventable morbidity and mortality. Tobacco smoking has been identified as one of the major risk factors for NCDs, including cardiovascular, chronic respiratory diseases, and different cancers. Although there is national information on magnitude of tobacco use, to date there is limited nationally representative data on factors associated with tobacco use. The aim of this study is to assess the distribution and predicators of tobacco use in Ethiopian adult population between 15 -59.Objectives: The main aim of this study was to assess the prevalence of tobacco use and its predictor in Ethiopia.Methods: A cross-sectional population based study design was employed among population age from 15- 69 years. A stratified, three-stage cluster sampling was used to identify the study subjects. Households in each cluster were selected using simple random sampling method. The sampling frame was based on the population and housing census conducted for Ethiopia in 2007. Data was collected using WHO NCD STEPS questionnaire; current tobacco use of any type was taken as the dependent variable. Five hundred thirteen enumeration areas (EAs) as primary sampling units (PSUs) (404 rural and 109 urban) were selected with probability proportionate to size, followed by selection of households as a secondary sampling units (SSUs). A total of 10,260 households were selected from the 513 EAs (20 households per EA). Eligible individuals were selected from households using Kish method (a pre-assigned table of random numbers to find the person to be interviewed). Descriptive statistics using frequency table, mean, median, interquartile range and standard deviations were computed. Step wise logistic regression was used to analyse the predictors of tobacco use. An Estimator of 95% confidence interval was used both for computing descriptive statistics as well testing associations using logistic regression.Results: The prevalence of tobacco use (all tobacco products) was 4.2%. The mean age (± SD) of starting tobacco use was 21(7) years. The mean frequency of tobacco use was 2 times per day. Hierarchical Logistic regression analysis revealed that participants in age groups 30-44 years, and 60-69 years were less likely to use any tobacco type compared to younger age group of15-29 years. Heavy episodic drinking, AOR 2.46 [95% CI= 1.4 – 4.5], and khat chewing, AOR 4.71[95%= 2.26 – 9.8], were independently associated with tobacco use.Conclusion and recommendations: The overall prevalence of tobacco use was relatively higher in males. Factors associated with tobacco use were heavy episodic drinking and khat chewing. Although tobacco use is an important risk factor for different disease on its own, the additional use of these substances exposes individuals to increased risk of NCDs. The findings warrant the need to implement existing anti-tobacco laws in the country, enhance anti-tobacco awareness raising efforts, and implement interventions to help current tobacco users, focusing attention more on regions with high rates of tobacco use and males. Key words: Ethiopia, NCDs, Predictors, Risk factors, Tobacco use, WHO STEP

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries