Facilitators and Barriers to National COVID 19 Guideline Adherence among Healthcare Providers in Ethiopia

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Outdated and discordant guidelines and a shortage of suggested managements were barriers.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.

The magnitude of khat use and its association with health, nutrition and socio-economic status

Although the literature on khat (Catha edulis Forsk) is fairly extensive, and several authors have stated the potential adverse effects of habitual use of khat on mental, physical and social well-being, very few population based studies exist to substantiate those statements in Ethiopia. A house-to-house survey of a representative sample of 1200 adults from a rural Ethiopian community was conducted from January to September of 1997 to determine the prevalence of khat use and its association with health, nutritional status, mental distress, substance use, family and social functioning and economic well-being. The current prevalence of khat chewing was found to be 31.7%. Muslims more than Christians, males more than females, those between the ages 15 and 34 years more than other age groups were habitual users. The following factors were found to be significantly associated with khat use: physical illness, (OR = 1.52, 95% CI = 1.14-2.02); injuries (OR = 2.31, 95% CI = 1.42-3.79), undernutrition (OR = 1.76, 95% CI = 1.24-2.48), mental distress (OR = 8.30, 95% CI = 5.20-13.31). Family functioning among current khat users was significantly higher than non users (OR = 1.56, 95%-CI = 1.04-2.28). Social functioning and economic well-being were not significantly associated with khat use. It is concluded that a fairly large proportion of the population consumes khat and that this is related to physical and mental ill-health, although family and social functioning, and economic well-being seem to be unrelated to khat use.

Prevalence and outcomes of sexual violence among high school students

A cross sectional, school-based survey using self administered anonymous questionnaire was conducted in Addis Ababa and Western Shoa among high school students to determine the prevalence, and reported outcomes of sexual violence. A total of 1401 female students were involved in the study. The prevalence of completed rape and attempted rape among female students was 5% and 10% respectively. The age range of completed rape was between 12-23 years and 61/72 (85%) of the rape victims were under 18 years of age. No significant linear trend was observed among the different age intervals (Chi Square for linear trend = 1.18; p-value = 0.27). Of the total respondents 78%, believed that rape was a major problem. Sexual harassment was reported in 74% of female students. Among the seventy two girls who reported to be raped 17(24%) had vaginal discharge and 12(17%) became pregnant. Social isolation, fear and phobia, hopelessness and suicide attempt were reported in 33%, 19%, 22%, 6% of rape victims, respectively. It is concluded that the prevalence of sexual violence among high school students is a serious problem and concern. Awareness creation to adolescents and the family need to be introduced and schools should also devise appropriate sex education regarding damaging effect of rape and educate youth on sexuality and responsible sexual decision making.

Magnitude, type and outcomes of physical violence against married women in Butajira, southern Ethiopia

The seriousness in magnitude of physical violence globally, and lack of information on the dimensions and context of the problem in Ethiopia is very visible. A cross-sectional survey was conducted in Meskanena Mareko Woreda, Southern Ethiopia, from November 1 to 30, 1995 to assess the magnitude, type and outcomes of physical violence against married women. A total of 673 married women were included in the study. The study found out the overall prevalence of physical violence against married women to be 45% and 10% in their lifetime and last three months, respectively. Two hundred and twenty nine (76%) and 39 (60%) of the lifetime and three month's physically abused women respectively, were slapped with fist. Four (1%) of the lifetime physically abused women have been abused using a knife or a gun. Among the 303 physically abused women, 161 (53%) reported minor and serious somatic injuries in their lifetime. One hundred and nine (46%) of them had acquired minor lacerations or scars; 22 (7%) had reported to have fracture or dislocation; and 5 (2%) had lost their vision. It is concluded that physical violence among married women is quite high and a serious problem. We recommended that policy makers need to urgently explore for appropriate strategies to curtail the problem of physical violence against married women.

Modifiable risk factors for coronary heart disease among young people in Addis Ababa

We report results of a cross-sectional survey of modifiable risk factors for coronary heart disease among young people (15-24 years of age) in Addis Ababa, conducted in 1994/95. A city-wide random sample of 1,436 (851 females and 585 males) young people participated in the study. Interviews using structured questionnaires, weight, height and blood pressure measurements were conducted using trained and supervised field workers. Current smoking was 11.8% for males and 1.1% for females. About 34% of the respondents consumed alcoholic beverages regularly, but 7.0% of these took more than 100 grams of alcohol per week. High fat intake and sedentary life-styles were registered in 4.5 and 8.4% of the respondents, respectively. About 6.0% of the females and 0.7% of the males were obese. The prevalence of elevated blood pressure (diastolic BP > 90 mmHG) was 7.1%. The prevalence of modifiable risk factors among young people in Addis Ababa indicates that there is need for initiation of primary preventive activities as soon as possible.

A randomized community trial of prepackaged and homemade oral rehydration therapies

OBJECTIVE

To compare the effectiveness of prepackaged oral rehydration solutions with homemade cereal-based oral rehydration therapy in the treatment of acute childhood diarrhea in children younger than 5 years.

BACKGROUND

In Ethiopia, approximately 40% of all mortality in children younger than 5 years, or over 200,000 annual deaths, is attributable to acute childhood diarrhea. Less than 15% of the episodes of acute childhood diarrhea are treated with oral rehydration solutions.

SUBJECTS

Two hundred ninety-one children younger than 5 years with acute childhood diarrhea.

METHODS

A randomized field trial comparing the effectiveness of an entirely homemade cereal-based oral rehydration therapy (HC-ORT, n = 103) with two alternative prepackaged salt solutions, a glucose-based oral rehydration solution (G-ORS, n = 98) and a cereal-based oral rehydration solution (C-ORS, n = 90), in the treatment of mild to moderate acute childhood diarrhea in children younger than 5 years.

RESULTS

Subjects in the HC-ORT group demonstrated equivalent or better weight gain than those in the C-ORS or G-ORS groups at 24, 48, 72, and 96 hours following the onset of treatment. The beneficial weight-gain effect of HC-ORT was most pronounced in infants younger than 12 months, following adjustment for demographic and baseline clinical characteristics. Compliance with ORT use through 96 hours was significantly better among caretakers of children receiving HC-ORT. Minor errors in the preparation of these oral rehydration regimens occurred more frequently among caretakers preparing either of the cereal-based ones.

CONCLUSIONS

That HC-ORT is an effective, culturally more acceptable alternative to G-ORS or C-ORS. The implementation of well-monitored, community-based HC-ORT programs in less developed countries is recommended.