Hospitalization, Recovery, Death, incubation period and Severity of COVID-19: A Systematic Review

AbstractBackground: The novel coronavirus SARS-CoV-2 disease, named “COVID-19" by the WHO, was declared Public Health Emergency Concern globally January 2020. As of 01 February, 2021, the virus already visited more than 200 countries across the globe, with a total of over 103 million confirmed cases, over 2 million deaths and over 76 million recoveries.COVID-19 first appeared in the African continent on 15th February 2020 in Egypt. Back in April 2020, only a few African countries reported 1, 2 or 3 confirmed cases with no death; but as of 07 June the virus visited over 45 African countries already with a total of 183,474 confirmed cases, 81,367 recovered and 5,041 deaths. Moreover, country context evidence is important at least to reduce the impact of COVID 19 in Africa region. Objective: The objective is to get cohesive understanding on hospitalization, recovery, death, incubation period and severity of COVID-19. Methods: Systematic Review was carried out to synthesis cohesive information on hospitalization, recovery, death, incubation period and severity of the disease. This review includes a systematic literature search of PubMed and other sources like Google Scholar and Research Gate. Results: Hospitalization rate for young is as low as 1%, while it ranged from 20.7% to 31.4% for older people. Hospitalization rate was high among patients with obesity (Body Mass Index>40), and heart failure. Recovery rate ranged from 30% in China to over 70% in South Korea. Overall case fatality rate from different studies ranged from 0.1% to 6%. But this value increases to as much as over 45% for those over 75 years old. The median incubation period ranged from 4 days to 5.1 days but showed increment for the older ages. Proportion of critically ill patients ranged from 0.026% to 23%. More severe cases were seen among males than females. Conclusion: This systematic review in-sight the variation in hospitalization, recovery, death, incubation period and severity of COVID-19 pertaining to patients’ characteristics. [Ethiop. J. Health Dev. 2021; 35(SI-1):76-81] Key words: Hospitalization, Recovery, Death, incubation period severity, COVID-19, systematic revie

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

The Ethiopian Health Information System: Where are we? And where are we going?

Health Information System (HIS) is a system that integrates data collection, management, and interpretation, including the use of the information to improve the quality of service and care through better management at all levels of health services (1). Early on, efforts to restructuring HIS to systematically collect, analyze, and report data for improved management in developing countries were undertaken by national program managers of vertically structured programs. In recent years, however, HIS in developing countries, including Ethiopia, has gained more and more attention as more effort by governments, international agencies, non-governmental organizations, donors, and other development partners seek to improve health care to reverse disease trends in these countries. The expansion of the health system, diagnostic capacity with the rapid transition of diseases epidemiology, and information technology played a crucial role in the increment of health data demand and information use in the health sector over the years (2). HIS encompasses a number of issues: data use, data quality, quality of care, e-Health and other relevant topics. This editorial provides a highlight of each of these topics and associated challenges. Because these entities are very much linked, it is not possible to expect successful progression in the use and quality of health information systems unless they are treated holistically

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

Precancerous Cervical Lesion Among Adult Women With Human Immune Deficiency Virus on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia: A Hospital-Based Cross-Sectional Study

BackgroundCervical cancer is the fourth most frequent cancer in women representing 6.6% of all female cancers occurring in low and middle-income countries, where resources for cancer prevention programs are often scarce. So this study aimed to assess the prevalence of precancerous cervical lesion and associated factors among adult women with human immune deficiency virus (HIV) on Anti Retroviral Therapy (ART) at Saint Peter Specialized Hospital, Addis Ababa, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from November 06 to July 20, 2020 among 267 adult women with HIV on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia. Data were collected using face-to-face interview, patient chart review, and the examination of the squamo-columnar junction by the visual inspection with the acetic acid method. The collected data were entered into Epi-data version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 24.0 for analysis. Bivariate and multivariable binary logistic regression analysis were used to identify factors associated with the precancerous cervical lesion. Statistical significance was considered at a P-valve less than 0.05.ResultA total of 267 women who were on ART were included in the study and the prevalence of precancerous cervical lesion was 7.5% with 95% CI =4.10%-10.50%. Modern family planning (AOR = 4.14, 95% CI = 1.23-13.87), history of sexual transmission infection (STI) (AOR=5.39, 95% CI= 1.56-18.70) and viral load (AOR=20.85, 95% CI = 6.19-70.25) had significant association with precancerous cervical lesionConclusionIn this study, the prevalence of precancerous cervical lesion is relatively low compared to studies in low and middle-income countries. Modern family planning, history of sexual transmitted infection, and viral load had a significant association with a precancerous cervical lesion. Hence, encouraging modern family planning, and routine screening of women for pre-cancerous cervical lesions for those with high viral load have enormous contributions to decreasing cervical cancer disease among Women with Human Immune Deficiency Virus through Anti Retroviral Therapy