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Sultan M, Waganew W, Kassaye M, Beza L, Waleligh M, Azazh A, Yifru S, Redae B, Ataro D, Fisseha A, Ashagre A, Baru A. Facilitators and Barriers to National COVID 19 Guideline Adherence among Healthcare Providers in Ethiopia. Ethiop J Health Sci 2023; 33:183-192. [PMID: 37484189 PMCID: PMC10358374 DOI: 10.4314/ejhs.v33i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 07/25/2023] Open
Abstract
Background Evidence-base practice needs to be supported by guidelines and decision-making protocols. This study aimed to look into the barriers and facilitators of adherence to national protocols in Ethiopia. Methods Exploratory qualitative method was implemented to explore adherence to protocol. The national COVID-19 case management guideline was used as this study's prototype reference. A total of five FGDS were conducted among 26 healthcare providers. A total of 14 physicians and 12 nurses participated in the FGDs. Semi-structured focus group discussions guides were used to facilitate the discussion among healthcare workers involved in COVID-19 case management. The FGDs were audio recorded, transcribed and analyzed thematically. Results Three broad themes have emerged from the content analysis. These include individual factors, environmental factors and system factors. System factors barriers to utilization include unclear guidelines, discordant guidelines and a lack of live national guidelines, while the main facilitator was supportive management. The environmental factors that were barriers to adherence included limited infrastructure and shortages of drugs suggested in the protocols. Conclusion Outdated and discordant guidelines and a shortage of suggested managements were barriers. Future similar works should consider the identified barriers and need regular updates to facilitate effective implementation.
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Affiliation(s)
| | | | | | | | | | | | - Sisay Yifru
- Saint Paul's hospital millennium medical college
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Sultan M, Waganew W, Beza L, GebreMedihin Y, Kidane M. The Status of Facility Based Emergency Care in Public Hospitals of Ethiopia Using WHO Assessment Tool. Ethiop J Health Sci 2022; 32:1093-1100. [PMID: 36475266 PMCID: PMC9692150 DOI: 10.4314/ejhs.v32i6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Menbeu Sultan
- Saint Paul's Hospital Millennium Medical College, Department of Emergency and Critical Care, Addis Ababa, Ethiopia
| | - Woldesenbet Waganew
- Saint Paul's Hospital Millennium Medical College, Department of Emergency and Critical Care, Addis Ababa, Ethiopia
| | - Lemlem Beza
- Addis Ababa Univercity department of emergency medicine
| | - Yemene GebreMedihin
- Saint Paul's Hospital Millennium Medical College, Department of Emergency and Critical Care, Addis Ababa, Ethiopia
| | - Mulu Kidane
- Saint Paul's Hospital Millennium Medical College, Department of Emergency and Critical Care, Addis Ababa, Ethiopia
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Abdella S, Tessema M, Tasew G, Defar A, Deressa A, Regasa F, Teka F, Tigabu E, Nigussie D, Belachew T, Molla M, Deribew A, Abebe W, Yigzaw T, Nigatu T, Mitike G, Haile T, Taame H, Ahmed M, Nigatu F, Tolesa T, Wolka E, Amogne W, Laillou A, Amare M, Fufa Y, Argaw A, Waganew W, Azazh A, Worku A, Redae B, Sultan M, Walelegn M, Tefera M, Yifru S, Argaw R, Brehau N, Teklu S, Demoz G, Seman Y, Salasibew M, Ejeta E, Whiting SJ, Wolday D, Tollera G, Abate E, Duguma D. Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol. BMC Infect Dis 2021; 21:956. [PMID: 34530744 PMCID: PMC8443913 DOI: 10.1186/s12879-021-06652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. Methods A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. Discussion This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. Trial Registration: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.
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Affiliation(s)
- Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Asefa Deressa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feyisa Regasa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Frehiwot Teka
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Eyasu Tigabu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Tsinuel Nigatu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Getnet Mitike
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | | | | | - Muhammed Ahmed
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Tola Tolesa
- Saint Paul's Hospital, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | | | | | - Misker Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yaregal Fufa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Sisay Yifru
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Rahel Argaw
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Natinael Brehau
- COVID-19 Isolation and Treatment Center, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Sisay Teklu
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Getachew Demoz
- COVID-19 Isolation and Treatment Center, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Yakob Seman
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | | | - Eshetu Ejeta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Sultan M, Kene D, Waganew W, Worku A, Azazh A, Girma B, Seman Y, Tessema N, Yifru S, Teklu S, Argaw R, Tefera M, Walelegn M, Redae B. Clinical Characteristics of COVID-19 Related Deaths in Ethiopia. Ethiop J Health Sci 2021; 31:223-228. [PMID: 34158772 PMCID: PMC8188069 DOI: 10.4314/ejhs.v31i2.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Since the occurrence of COVID-19 in the world, it has claimed nearly 1.39 million human lives in the world and more than 1500 lives in Ethiopia. The number of deaths is increasing with variable distribution in the world. Despite its increasing fatality, the clinical characteristics of the deceased patients are not yet fully known. Analyzing the clinical characteristics of deceased patients will help to improve the outcome of infected patients. Hence, this study aimed to determine the clinical characteristics of patients who died due to COVID-19 in Ethiopia. Methods Hospital based multi-center cross-sectional study was conducted using chart review of deceased patients. Since the number of COVID-19 related deaths was limited, all consecutive COVID-19 related hospital deaths were analyzed. The data was entered into and analyzed using SPSS version 25.0. Descriptive statistics was used to explain the data collected from the survey. Result A total of 92 deceased patient charts were analyzed. Of these patients, 65(71%) were males. Age ranged from 17 to 92 years (mean age being 59 years). On arrival vital signs, 60.5% of them had hypoxia, 49% had tachycardia and only 32% of patients had fever. Three fourth of the patients 64/85 had at least one comorbidity. Diabetes mellitus (DM) was the commonest comorbidity accounting for 445.9%, followed by hypertension, 23/85(27%), and HIV/ AIDS, 15/85 (17.5%). Conclusion The results of this study showed that COVID-19 deceased patients presented with respiratory failure and hypoxia. However, less than a third of these patients had fever. In addition, the presence of comorbid illnesses and non-COVID-19 diseases like AIDS defining illness in significant amount needs further study to identify their level of contribution to the increasing burden of COVID-19 deaths in Ethiopia.
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Affiliation(s)
- Menbeu Sultan
- St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia
| | - Desalegn Kene
- St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia
| | | | - Aschalew Worku
- Addis Ababa University College of health science. Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Addis Ababa University College of health science. Addis Ababa, Ethiopia
| | - Beza Girma
- Federal ministry of health Ethiopia, Addis Ababa, Ethiopia
| | - Yakob Seman
- Federal ministry of health Ethiopia, Addis Ababa, Ethiopia
| | | | - Sisay Yifru
- University of Gondar, college of medicine and health sciences, Gondar Ethiopia
| | - Sisay Teklu
- Addis Ababa University College of health science. Addis Ababa, Ethiopia
| | - Rahel Argaw
- Addis Ababa University College of health science. Addis Ababa, Ethiopia
| | - Muluwork Tefera
- Addis Ababa University College of health science. Addis Ababa, Ethiopia
| | - Miraf Walelegn
- Federal ministry of health Ethiopia, Addis Ababa, Ethiopia
| | - Berhane Redae
- University of Gondar, college of medicine and health sciences, Gondar Ethiopia
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Teklu S, Sultan M, Azazh A, Worku A, Redae B, Walelegn M, Tefera M, Argaw R, Waganew W, Yifru S, Amogne W, Tssema N, Bekele A, Gebregziabher Y, Araya H, Birhanu A, Demoz G, Tadesse B, Seman Y, Abayneh A. Clinical and Socio-demographic Profile of the First 33 COVID-19 Cases Treated at Dedicated Treatment Center in Ethiopia. Ethiop J Health Sci 2021; 30:645-652. [PMID: 33911824 PMCID: PMC8047264 DOI: 10.4314/ejhs.v30i5.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Severe respiratory tract infection caused by family of Corona viruses has become world pandemic. The purpose of this study was to describe the first few COVID 19 cases in Ethiopia. Method Descriptive study was conducted on the first 33 consecutive RT-PCR confirmed COVID 19 cases diagnosed and managed at Ekka-Kotebe COVID Treatment Center in Addis Ababa, Ethiopia. Result The median age of the cases was 36 years. Cough, headache and fever were the most frequent symptoms. Diarrhea, sore throats, loss of taste and/or smell sensation were among the rare symptoms. Most (84.8%) had mild to moderate disease, and 15.2%(n=5) were critical at the time of admission. Among the five ICU admissions, four patients required invasive mechanical ventilation. Thirty cases were discharged after two pairs of nasopharyngeal and oropharyngeal samples turned negative for SARS CoV2. Three cases from the ICU died while on mechanical ventilator. The age of the two deaths was 65 years, and one was 60 years. With the exception of three, all cases were either imported from abroad or had contact with confirmed cases. Conclusion Most of our patients were in the younger age group with male predominance and few with comorbidities. Cough was the commonest symptom followed by headache and fever. As it was in the early stage of the pandemic, observation of more cases in the future will reveal further clinical and demographic profiles of COVID-19 cases in Ethiopia.
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Affiliation(s)
- Sisay Teklu
- Addis Ababa University, College of Health Sciences
| | | | - Aklilu Azazh
- Addis Ababa University, College of Health Sciences
| | | | | | | | | | - Rahel Argaw
- Addis Ababa University, College of Health Sciences
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