Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

Background: Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective: The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods: A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results: Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions: Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock

A bilobed Gallbladder (Vesica Fellea Divisa) in Cattle Slaughtered at Jimma Municipal Abattoir, West Oromiya, Ethiopia

Gallbladder abnormalities occur rarely. The recognized abnormalities recorded so far comprised duplication, septation, abnormal position and total absence of the gallbladder. The bilobed gallbladder of the cross bred oxen slaughtered at Jimma municipality abattoir constituted two lobes separated by a deep cleft. However, the two lobes were joined at the neck and drained by one duct. Both the lobes were of equal size and filled with bile.Key words: Bilobed, Cattle, gallbladder, Jimma, Muncipal abattoi

Study on the acaricidal effects of Azadirachta indica and Phytolacca dodecandra on Amblyomma ticks in Ethiopia

A study was carried out to investigate the acaricidal effect of extracts of Azadirachta indica (neem) and Phytolacca dodecandra (locally known endod in Ethiopia) on Amblyomma cohaerens and Amblyomma variegatum. An adult stage of A. cohaerens was collected from east Wollega zone of the Oromia region of Ethiopia and the larval stage of A. variegatum was obtained from tick rearing unit of the National Animal Health Diagnostic and Investigation Centre (NAHDIC), Sebeta, Ethiopia. Neem seed was  collected from Awash town of the Afar region. Berries of endod from Aklilu Lemma Institute of  Pathobiology and commercial neem oil were obtained from India. The water extract of the two plants at doses of 18,750 ppm, 37,500ppm, 75,000 ppm, 150,000 ppm and 300,000 ppm were tested on Petri dish and using the immersion method. The result showed that, neem seed water extract produced mortality rate of 16.6% on adult stage of A. cohaerens at a dose of 300,000 ppm. The LD50 indicated a dose of 370,854.7 ppm and no statistically significant (p>0.05) difference was observed among the two methods of applications. The same extract in both methods of application produced a mortality rates of 8.3%, 16.6% and 41.6 % at doses of 75,000ppm, 150,000ppm and 300,000ppm  respectively on A.variegatum and the probit analysis indicated LD50 of 366,64ppm. Endod extract did not produce any mortality at all doses tested on both species of ticks. Neem oil was also evaluatedat a concentration of 20%, 40%, 60%, 80% and 100%. At 100% concentration, the oil caused 50% mortality on adult of A. cohaerens whereas 20% concentration resulted  in 8.3% mortality rate. Likewise, 100%, 100% and 75% mortality rate on A. variegtum was observed at 100%, 80% and 20% concentrations of the oil respectively. Probit analysis indicated LD50 value of 11.7%  concentration. The water extracts of both plants did not  produce 100% efficacy while promising results were obtained by neem oil on larva of A. variegatum at high concentrations.Keywords: Acaricidal effect, Amblyomma variegatum, Amblyomma cohaerens, Azadirachta indica (neem), Phytolacca dodecandra (endod)

Predictors of early neonatal mortality at a neonatal intensive care unit of a specialized referral teaching hospital in Ethiopia

Background: The larger fraction of infant mortality is that of neonatal; and early neonatal death is the most significant contributor of neonatal mortality as a whole. There are various factors which may be associated with early neonatal mortality and they have been the reasons for the wide variation in mortality rates among the health facilities reporting.Objective: This study was made to assess the independent predictors of early neonatal mortality.Methods: From 2001 through 2005, a total of 3789 live born neonates, who were admitted to the neonatal intensive care unit of Tikur Anbessa Hospital, were included in this study. Variables were classified into two: Socio economic/reproductive factors and maternal/newborn factors. Predictors were assessed using a multivariable binary logistic regression. Variables with a p-value of <0.05 were entered into a multivariable logistic model.Results: From the socio-economic/reproductive variables: age less than one day (AOR=2.53 95% CI= (1.66, 3.85)), having three or more siblings (AOR=2.04, 95% CI= (1.15, 3.64) ), second birth order (AOR=1.79, 95% CI= (1.28, 2.51)), absence of antenatal care (AOR=1.70, 95% CI= (1.28,2.26)), and being unmarried (AOR=1.55 95%CI= (1.20,2.00)) were independent predictors of increased mortality. On the other hand, singleton pregnancy was found to be protective by 30% against early neonatal mortality with an odds of 0.70, 95% CI of (0.54, 0.90). From the neonatal/ maternal variables: gestational age of <32 weeks (AOR= 10.46, 95% CI= (5.39, 20.31)), first minute APGAR of three or less (AOR=2.12, 95% CI= (1.39, 2.23)), presence of any congenital anomaly ( AOR=2.02, 95% CI=(1.33,2.51)), presence of peri-natal asphyxia (AOR=1.82, 95% CI=(1.32,2.51)), any oxygen treatment (AOR=2.65, 95% CI=(1.89,3.72)), birth weight less than 1500 (AOR=9.64, 95%CI=(3.32,27.97)) were independent predictors of neonatal mortality. A normal weight at admission was protective of early neonatal mortality.Conclusion: There are many factors that could have influenced neonatal mortality in the current study. Antenatal care follow up is the key point of contact for planning and managing labor and delivery; it should be improved to control most other variables. The care provided to these high risk babies should also be maximized to reduce mortality in these risk groups

Investigating the Moderating Impact of National Culture in Information Systems Security Policy Violation: The Case of Italy and Ethiopia

Information systems security (ISS) has become one of the top agendas of companies located in the developed world. Despite this fact, there is an increasing trend in the types and frequency of ISS breaches. Most of the time researchers and practitioners focus on threat that are caused by external agents while most of the threats are originated from insiders. In addition to this, the majority of the investments and researches around ISS are limited to technically oriented solutions. It is now realized that the technical approach alone couldn’t bring the required level of ISS, and this led ISS researchers to embark on socio-technical approaches. One of the critical social factors that has been given little emphasis is culture. Thus, this research investigates the impact of national culture on employees’ ISS behaviour. Specifically, it answers the question “what is the moderating impact of national culture on the influence of ISS countermeasures on employees’ intention to violate ISS policies?” We will develop and test an empirical ISS compliance model, using rational choice theory and national culture constructs. Survey will be used to collect data from Italy and Ethiopia

Mineral contents of barley grains and its processed foods (kolo, porridge, bread and injera) consumed in Ethiopia

ABSTRACT. Barley (Hordeum vulgare L.) is one of the most widely cultivated stable food crops in the world. Barley grain samples were collected from four selected areas (Bahir Dar, Bure, Finote Selam and Debre Markos) of Ethiopia and four types of processed food (kolo, porridge, bread and injera) were prepared from it. The levels of essential and non-essential metals in barley grains and its processed food were determined by microwave plasma-atomic emission spectrometry after wet digestion with a mixture of HNO3 and HClO4 (5:1, v/v). The concentration (mg/kg dry weight) in the barley grains were in the ranges K (5482-6516), Mg (546-643), Ca (445-684), Mn (7.31-9.80), Fe (127-439), Cu (0.88-1.86), Zn (42.8-56.8), Pb (0.39-2.73), Cd (3.01-4.66). The concentrations of all the metals in the four types of processed barley foods showed variation among each other. The results indicate that Ethiopian barley grains and its processed foods are good source of essential metals.                     KEY WORDS: Barley, Hordeum vulgare L., Processed foods, Macro-minerals, Micro-minerals, Toxic metals   Bull. Chem. Soc. Ethiop. 2021, 35(3), 471-484. DOI: https://dx.doi.org/10.4314/bcse.v35i3.

Effect of processing method on the Proximate composition, mineral content and antinutritional factors of Taro (Colocasia esculenta, L.) growth in Ethiopia

Although taro is widely grown in Ethiopia, it is an underutilized crop and little is known about its proximate and micro-element composition and the antinutritional factors of the raw, boiled and fermented products. Boiling and fermentation processing techniques are widely used in the country, especially within the rural community of the Southern region where the crop grows widely. A cultivar of taro grown in the country was analyzed for proximate and mineral composition and antinutritional factors. An investigation was also made on the effects of boiling and fermentation on the nutritional contents. Protein, fat, fiber, total ash and utilizable carbohydrates, respectively were found to be 6.43, 0.47, 2.63, 4.82 and 85.65%, while the Gross Energy was 372.55 Kcal/100g. The contents of the micronutrients namely: Fe, Zn, Mg, Ca, Na, P and Mn were 5.86, 43.08, 7.24, 45.23, 13.81, 7.77 and 3.61 mg/100g, respectively. Phytate for the raw product was 115.43 while oxalate and tannin were 243.06 and 47.69 mg/100g, respectively. Cyanide was not detected in all the samples. There was a significant difference (p < 0.05) in the contents of the proximate and mineral composition and antinutritional factors during boiling and fermentation. The protein content was lower by 9.37% and 8.46%, respectively, in the boiled and fermented products, under the sampling and processing conditions used in the study. The crude fat content was significantly different (p < 0.05) from the crude fat content of the boiled product which was 0.87%. On the other hand, analysis of variance conducted showed that the fiber content of raw sample was significantly different from the fermented samples. Fermentation resulted in a lower level of fiber which was 6.44% and phytates of about 84.75%. Boiling of taro resulted in a higher value of oxalate (70.9%). The data presented in this paper provide an evidence of the potential of Boloso I (which is one variety of taro) to serve as a nutrient dense product for the Ethiopian population provided that the techniques of its processing are optimized.Keywords: Ethiopia, Taro, Oxalates, PhytatesAfrican Journal of Food, Agriculture, Nutrition and Development, Volume 13 No. 2 April 201

Proximate composition, mineral content and antinutritional factors of some capsicum (Capsicum annum) varieties grown in Ethiopia

This study was conducted to generate baseline information on the nutritional composition, mineral content and antinutritional factors of three capsicum varieties (Marako fana, Bako local and Oda haro) grown in Ethiopia. In relation to proximate composition, Marako fana, Bako local and Oda haro contained 9.2, 9.0 and 8.8% moisture; 11.9, 8.8 and 9.2% crude protein; 27.3, 26.0 and 28.6% crude fiber and 11.2, 9.5 and 9.2% fat (oleoresin) on wet weight basis. They also contained 1.7, 1.6 and 1.8 mg/100 g potassium; 27.2, 38.2 and 54.6 mg/100 g calcium and 7.2, 6.9 and 9.6 mg/100 g iron on wet weight basis. Tannin was found to be 0.142, 0.164 and 0.148 mg/100 g, respectively, while phytate was not detected in any of the samples. Analysis of variance and LSD (least significant difference) test revealed that protein and oleoresin of Marako fana were significantly higher (p less than 0.05) than Bako local and Oda haro. Potassium, calcium and iron contents of Oda haro were significantly higher (p less than 0.05). Based on these results Marako fana is preferable for large scale production of oleoresin, while Oda haro is nutritionally preferable because it contains high amounts of potassium, calcium and iron.KEY WORDS: Capsicum, Ethiopia, Composition, Mineral, Antinutrients Bull. Chem. Soc. Ethiop. 2011, 25(3), 451-454

Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities

This review explores the limitations of self-reported race, ethnicity, and genetic ancestry in biomedical research. Various terminologies are used to classify human differences in genomic research including race, ethnicity, and ancestry. Although race and ethnicity are related, race refers to a person’s physical appearance, such as skin color and eye color. Ethnicity, on the other hand, refers to communality in cultural heritage, language, social practice, traditions, and geopolitical factors. Genetic ancestry inferred using ancestry informative markers (AIMs) is based on genetic/genomic data. Phenotype-based race/ethnicity information and data computed using AIMs often disagree. For example, self-reporting African Americans can have drastically different levels of African or European ancestry. Genetic analysis of individual ancestry shows that some self-identified African Americans have up to 99% of European ancestry, whereas some self-identified European Americans have substantial admixture from African ancestry. Similarly, African ancestry in the Latino population varies between 3% in Mexican Americans to 16% in Puerto Ricans. The implication of this is that, in African American or Latino populations, self-reported ancestry may not be as accurate as direct assessment of individual genomic information in predicting treatment outcomes. To better understand human genetic variation in the context of health disparities, we suggest using “ancestry” (or biogeographical ancestry) to describe actual genetic variation, “race” to describe health disparity in societies characterized by racial categories, and “ethnicity” to describe traditions, lifestyle, diet, and values. We also suggest using ancestry informative markers for precise characterization of individuals’ biological ancestry. Understanding the sources of human genetic variation and the causes of health disparities could lead to interventions that would improve the health of all individuals

Challenges and opportunities to improve autism services in low-income countries: lessons from a situational analysis in Ethiopia

Background. Little has been reported about service provision for children with autism in low-income countries. This study explored the current service provision for children with autism and their families in Ethiopia, the existing challenges and urgent needs, and stakeholders’ views on the best approaches to further develop services. Methods. A situational analysis was conducted based on i) qualitative interviews with existing service providers; ii) consultation with a wider group of stakeholders through two stakeholder workshops; and iii) information available in the public domain. Findings were triangulated where possible. Results. Existing diagnostic and educational services for children with autism are scarce and largely confined to Ethiopia’s capital city, with little provision in rural areas. Families of children with autism experience practical and psychosocial challenges, including severe stigma. Informants further raised the lack of culturally and contextually appropriate autism instruments as an important problem to be addressed. The study informants and local stakeholders provided several approaches for future service provision expansion, including service decentralisation, mental health training and awareness raising initiatives. Conclusions. Services for children with autism in Ethiopia are extremely limited; appropriate care for these children is further impeded by stigma and lack of awareness. Ethiopia’s plans to scale up mental healthcare integrated in primary healthcare provides an opportunity to expand services for children with autism and other developmental disorders. These plans and additional strategies outlined in this paper can help to address the current service provision gaps and may also inform service enhancement approaches in other low-income countries