Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia.

BACKGROUND: In low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. METHODS: A facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital's four NCD clinics using systematic random sampling. Patients' direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study's findings, while logistic regression was used to examine the associations between variables. RESULTS: A study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41-16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold. CONCLUSION AND RECOMMENDATION: This study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.

The mediating role of perceived social support between work-family conflict and presenteeism among ICU nurses working shift work in Chinese public hospitals: A cross-sectional investigation.

OBJECTIVE: Relative to explicit absenteeism, nurses' presenteeism has a more lasting impact and is more harmful and costly. This study aimed to explore the relationship between work-family conflict, perceived social support, and presenteeism and whether perceived social support mediates the relationship between work-family conflict and presenteeism among ICU nurses working on shifts in Chinese public hospitals. MATERIALS AND METHODS: A cross-sectional research design was conducted from January to April 2023 in Sichuan Province, China. A total of 609 valid questionnaires were collected. The questionnaires contained information on demographic characteristics, the Work-Family Conflict (WFC) scale, the Perceived Social Support Scale (PSSS), and Stanford Presenteeism Scale-6 (SPS-6). Multiple stratified regression was used to explore the mediating role of perceived social support between work-family conflict and presenteeism. The mediating effect of perceived social support in work-family conflict and presenteeism was tested by Model 4 in the PROCESS 4.1 macro program in SPSS. RESULTS: A total of 609 nurses were included in this study, and the mean presenteeism score for ICU nurses working on shifts was 16.01 ± 4.293 (Mean ± SD), with high presenteeism accounting for 58.46%. After controlling for sociodemographic characteristic variables, work-family conflict was positively associated with presenteeism, explaining 7.7% of the variance. High perceived social support was related to low presenteeism, explaining 11.5% of the variance. Perceived social support mediated the association between work-family conflict and presenteeism among ICU nurses working on shifts. CONCLUSIONS: Chinese shift-work ICU nurses' high presenteeism scores deserve managers' attention. Work-family conflict is a significant predictor of nurses' presenteeism. Perceived social support is essential in improving nurses' work-family conflict and mediates the relationship between work-family conflict and presenteeism. Improving social support can reduce the impact of work-family conflict on presenteeism among nurses working shifts.

Inpatient opioid prescribing patterns and their effect on rehospitalisations: a nested case-control study using data from a Swiss public acute hospital.

AIMS OF THE STUDY: Opioid prescriptions have increased in Switzerland, even though current guidelines warn of their harms. If opioids for postoperative analgesia are not tapered before hospital discharge, patients are at risk of adverse events such as constipation, drowsiness, dependence, tolerance and withdrawal. The aim of this study was to investigate and quantify the potential association between opioids prescribed at discharge from hospital and rehospitalisation. METHODS: We conducted a nested case-control study using routinely collected electronic health records from a Swiss public acute hospital. Cases were patients aged 65 years or older admitted between November 2014 and December 2018, with documented opioid administration on the day of discharge and rehospitalisation within 18 or 30 days after discharge. Each case was matched to five controls for age, sex, year of hospitalisation and Charlson Comorbidity Index. We calculated odds ratios for 18-day and 30-day rehospitalisation based on exposure to opioids using a conditional logistic regression adjusted for potential confounders. Secondary analyses included stratifications into morphine-equivalent doses of <50 mg, 50-89 mg and ≥90 mg, and co-prescriptions of gabapentinoids and benzodiazepines. RESULTS: Of 22,471 included patients, 3144 rehospitalisations were identified, of which 1698 were 18-day rehospitalisations and 1446 were 30-day rehospitalisations. Documented opioid administration on the day of discharge was associated with 30-day rehospitalisation after adjustment for confounders (adjusted odds ratio 1.48; 95% CI 1.25-1.75, p <0.001), while no difference was observed in the likelihood of 18-day rehospitalisation. The combined prescription of opioids with benzodiazepines or gabapentinoids and morphine-equivalent doses >50 mg were rare. CONCLUSIONS: Patients receiving opioids on the day of discharge were 48% more likely to be readmitted to hospital within 30 days. Clinicians should aim to discontinue opioids started in hospital before discharge if possible. Patients receiving an opioid prescription should be educated and monitored as part of opioid stewardship programmes.

Self-management practice and associated factors among asthmatic patients on follow-up care at public tertiary hospitals, south west, Ethiopia, 2022.

INTRODUCTION: Bronchial asthma is a major public health issue that affects patients, families, and communities worldwide. Despite the growing importance of self-management and its clear link to better health outcomes, the uptake and use of self-management among asthmatic patients is not well understood. Thus, the study aimed to determine the level of self-management practice and associated factors among asthmatic patients on follow-up care at public tertiary hospitals found in south-west Ethiopia. METHOD: An institutional-based cross-sectional study design was employed from August 1 to September 30, 2022. The study included all asthmatic patients on follow-up care at public tertiary hospitals found in south west Ethiopia, among whom 274 were interviewed. All asthmatic patients who were registered at the chronic follow-up unit of each hospital and fulfilled inclusion criteria were included and interviewed consecutively. The data were collected using a structured interviewer-administered questionnaire adapted from previous studies, entered into EpiData version 4.6, and exported to SPSS version 25 for analysis. Descriptive statistics were used to summarize the participant's characteristics. Linear regression was used to identify variables associated with asthma self-management practice, and variables with a p-value of 0.05 were considered statistically significant. Finally, tables, graphs, and text were used to present the data. RESULT: Out of 274 interviewed asthmatic patients, 45.26% 95% CI (39, 51) had good asthma self-management practices. Advancing in age (ß = -0.009, P = 0.043), being a smoker (ß = -0.346, 95%, P = 0.03, being alcohol drinker (ß = -0.217, P = 0.001), having depression (ß = -0.038, P = 0.005), having anxiety (ß = -0.029, P = 0.02) and having social support (ß = 0.022, P<0.001) were identified as factors affecting asthma self-management practice. CONCLUSION: The finding revealed that four of every nine asthmatic patients had good asthma self-management practices. Age, alcohol consumption, smoking, anxiety, depression, and social support were significantly associated with asthma self-management practice. Ongoing self-management support and collaborative target interventions aimed at improving asthma self-management practices and identified factors are very crucial.

The effect of lifestyle factors on chronic complications of diabetes at public health hospitals in Southwest Ethiopia.

Ethiopia faces a significant challenge with increasing non-communicable diseases like diabetes, ranking among the top four in sub-Saharan Africa. However, there is a lack of research on how lifestyle affects chronic complications of diabetes in Ethiopia, highlighting the need for urgent exploration to develop better intervention strategies. This study aimed to evaluate the link between lifestyle factors and chronic complications of diabetes in public health hospitals in Southwest Ethiopia. A cross-sectional study involving 389 diabetes patients from Mizan-Tepi University Teaching Hospital (MTUTH) and Gebretsadik Shawo General Hospital (GSGH) in Southwest Ethiopia was conducted. Data collection methods included interviewer-administered questionnaires, patient medical record reviews, physical examination, and serum analysis. SPSS version 25 was used for data analysis, including descriptive statistics and bivariate and multivariate logistic regression analyses. Statistical significance was determined at a p-value < 0.05. The study revealed a 32.1% prevalence of chronic complications of diabetes, with 13.4% having chronic kidney disease, 8.0% experiencing visual disturbances, and 16.7% suffering from peripheral sensory pain. After adjusting for confounding variables, age (41-60 years [AOR = 1.77; 95% CI 1.01, 3.15] and > 60 years [AOR = 2.18; 95% CI 1.20, 4.33]), duration of diabetes mellitus (> 6 years [AOR = 2.90; 95% CI 1.74, 4.85]), alcohol consumption [AOR = 2.30; 95% CI 1.33, 3.98], physical inactivity [AOR = 2.43; 95% CI 1.38, 4.27], and body mass index (underweight [AOR = 7.66; 95% CI 1.68, 34.8] and obese [AOR = 3.53; 95% CI 1.84, 10.5]) were significantly associated with chronic complications of diabetes. Chronic complications of diabetes are a major problem in the study area. Lifestyle factors strongly influence chronic diabetes complications, highlighting the importance of preventive measures. Implementing health education and prevention programs focusing on modifiable lifestyle factors is crucial.

Parents' satisfaction with physiotherapy services for neuropediatric outpatients in government and private hospitals in the United Arab Emirates: a cross-sectional study.

Background: Healthcare, like other industries, emphasizes performance, quality, and consumer experience while also attempting to reduce costs. However, high-quality healthcare remains paramount for vulnerable and ill patients. This study aimed to investigate parents' and caregivers' level of satisfaction with physiotherapy services provided to neuropediatric outpatients on the United Arab Emirates (UAE). Methods: This descriptive cross-sectional study included 103 parents/caregivers of children with neurological disabilities that were randomly selected from different Emirates Health Services Hospitals in the UAE. Data was collected using the long-form Patient Satisfaction Questionnaire (PSQ-III). Results: The overall mean satisfaction was 159±7.73 (out of 250 points). Communication (20.36/25), interpersonal factors (20.17/35), and doctor-patient time (20.17/35) had the highest mean satisfaction scores (8.06/10). The lowest mean satisfaction scores were for access/availability/convenience (34.60/60), technical quality (33.17/50), and economic elements (23.83/40). Conclusion: Despite participants' overall satisfaction scores being positive, some service domains require improvement to improve satisfaction, specifically the access/availability/convenience, technical quality, and economic elements. These areas should be prioritized by service providers and managers to improve patients' experiences and clinical outcomes.

Challenges related to the organizational climate of the nursing team in a public hospital - nurses' perception. / Desafios relacionados ao clima organizacional da equipe de enfermagem de um hospital público - percepção dos enfermeiros.

The organizational climate is related to the degree of motivation of its employees. This perception is essentially felt, it is neither seen nor touched, but it is real. This study aims to identify difficulties and potentialities related to the organizational climate of the nursing staff at a public hospital in the Federal District. Methodologically, a descriptive and exploratory study was carried out characterized by a qualitative approach. The thematic content analysis led to three interpretative dimensions: environment and working conditions; communication, interpersonal relationship and work flows; motivation to improve the work environment. The results indicate a deficit of human resources, scarcity of material resources, supplies, precarious physical structure, in addition to interpersonal relationship problems, such as the (de)valuation of professional nurses and nursing. The challenges posed to managers go beyond the technical and structural dimension, the technological complexity of equipment without maintenance, as it unfolds through the human dimension, feelings and unmet needs (of appreciation) of nursing, which needs to be cared for, valued, heard and seen in their care process.

O ambiente organizacional está relacionado com o grau de motivação de seus colaboradores. Essa percepção é essencialmente sentida, não se vê e nem se toca, mas tem uma existência real. Este estudo objetiva identificar as dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público do Distrito Federal. Metodologicamente foi realizado um estudo descritivo e exploratório caracterizado por uma abordagem qualitativa. A análise de conteúdo temática conduziu a três dimensões interpretativas: ambiente e condições de trabalho; comunicação, relacionamento interpessoal e fluxos de trabalho; e motivação para a melhoria do ambiente de trabalho. Os resultados apontam para um déficit de recursos humanos, escassez de recursos materiais, insumos, estrutura física precária, além de problemas de relacionamento interpessoal, como a (des)valorização do profissional enfermeiro e da enfermagem. Os desafios postos para os gestores estão para além da dimensão técnica e estrutural, da complexidade tecnológica dos equipamentos sem manutenção, desdobra-se pela dimensão humana, pelos sentimentos e pelas necessidades não atendidas (de valorização) da enfermagem, que precisa ser cuidada, valorizada, ouvida e vista no seu processo de cuidar.

Women's experiences in institutional childbirth care in times of the first and second waves of COVID in Mexico. / Experiencias de mujeres en la atención del parto institucional en tiempos de la primera y segunda ola de COVID en México.

This is a qualitative study that explores the perspectives and experiences of a group of Mexican women who experienced institutionalized childbirth care in the first and second waves of the COVID-19 pandemic. Through a semi-structured script, nine women who experienced childbirth care were interviewed between March and October 2020 in public and private hospitals in the city of San Luis Potosí, Mexico. Under the Grounded Theory analysis proposal, it was identified that the health strategies implemented during the pandemic brought with them a setback in the guarantee of humanized childbirth. Women described themselves as distrustful of the protocols that personnel followed to attend to their births in public sector hospitals and very confident in those implemented in the private sector. The intervention of cesarean sections without a clear justification emerged as a constant, as did early dyad separation. Healthcare personnel's and institutions' willingness and conviction to guarantee, protect and defend the right of women to experience childbirth free of violence remain fragile. Resistance persists to rethink childbirth care from a non-biomedicalizing paradigm.

Estudio de tipo cualitativo que explora las perspectivas y experiencias de un grupo de mujeres mexicanas que vivieron la atención institucionalizada del parto en la primera y segunda ola de la pandemia por COVID-19. A través de un guión semiestructurado se entrevistó a nueve mujeres que vivieron la experiencia de la atención del parto entre marzo y octubre de 2020, en hospitales públicos y privados de la ciudad de San Luis Potosí, en México. Bajo la propuesta de análisis de la teoría fundamentada, se identificó que las estrategias sanitarias implementadas en el marco de la pandemia, trajeron consigo un retroceso en la garantía del parto humanizado, las mujeres se narraron desconfiadas en los protocolos que siguió el personal para la atención de sus partos en los hospitales del sector público y muy confiadas en los que se implementaron en el sector privado. La realización de cesáreas sin una justificación clara emergió como una constante, igual que la separación temprana de los binomios. Continúa frágil la disposición y el convencimiento del personal sanitario y las instituciones para garantizar, proteger y defender el derecho de las mujeres a vivir el parto libre de violencia. Persisten resistencias para repensar la atención del parto desde un paradigma no biomédicalizante.

Preconception care use and associated factors among HIV positive reproductive age women attending ART clinics at public hospitals in the Hadiya zone, southern Ethiopia: a mixed method approach.

BACKGROUND: Globally, the HIV pandemic makes preconception care even more crucial due to the additional risks for sexual and vertical transmission of HIV. However, there is limited evidence on the utilization of preconception care among high-risk women in Ethiopia. The purpose of this research is to assess preconception care utilization and associated factors among HIV-positive women of reproductive age who attend ART clinics in public hospitals in the Hadiya zone of Southern Ethiopia in 2023. METHODS: A cross-sectional study design employing a mixed methods approach was used among 297 study participants from July 1-Semptember 1, 2022. Data were collected by pretested structured questionnaires. The data were analyzed by SPSS statistical software version 25. Logistic regression, Adjusted Odds Ratio (AOR) with a 95% confidence interval was computed, and variables with a p-value < 0.05 were considered statistically significant. Qualitative data were analyzed using open code version 4.03. RESULTS: This study revealed that 19.9% (95%Cl: 15.4, 24.2) of study participants use preconception care. Women's autonomy (AOR = 3.65; 95% CI: 1.14, 11.68;P = 0.03), knowledge of PCC (AOR = 3.05; 95% CI: 1.13, 8.22; P = 0.001), getting family/husband support (AOR = 4.06; 95% CI: 1.56, 10.53;P = 0.022), discussions with healthcare providers (AOR = 5.60; 95% CI: 2.26, 13.90;P = 0.002), availability of room for PCC (AOR = 3.77; 95% CI: 1.38, 10.31;P = 0.009), getting all laboratory services (AOR = 4.19; 95% CI: 1.61, 10.94; P = 0.002), and history of medical problems (AOR = 2.94; 95% CI: 11.01, 8.62;P = 0.036) were significantly associated with PCC use. CONCLUSION: The level of PCC use in the current study area is low. Women's autonomy, knowledge of PCC, obtaining support from family or husband, engaging in discussions with healthcare providers, having access to a PCC room, access to all laboratory services, and having a history of medical problems are significantly associated with PCC use. Our findings suggest integrating PCC into routine HIV care, boosting women's autonomy, and integrating family support with healthcare providers.

Survival status and predictors of mortality among severely acute malnourished under-5 children admitted to stabilisation centers in selected government hospitals in Addis Ababa, Ethiopia, 2022: a retrospective cohort study.

OBJECTIVE: This study aims to assess the survival status and predictors of mortality among under-5 children with severe acute malnutrition in Addis Ababa, Ethiopia. DESIGN: A retrospective cohort study was employed on randomly selected 422 medical records of children under the age of 5 admitted to stabilisation centres in Addis Ababa, Ethiopia. Survival analysis and Cox regression analysis were conducted to determine time spent before the outcome and predictors of desired outcome. SETTINGS: The stabilisation centres in four governmental hospitals in Addis Ababa, Ethiopia: Tikur Anbessa Specialised Hospital, Zewditu Memorial Hospital, Yekatit 12 Hospital and Tirunesh Beijing Hospital PARTICIPANTS: Of 435 severely malnourished children under the age of 5 admitted to four governmental hospitals in Addis Ababa, Ethiopia, from January 2020 to December 2022, we were able to trace 422 complete records. The remaining 13 medical records were found to be incomplete due to missing medical history information for those children. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the survival status of under-5 children with severe acute malnutrition after admission to the stabilisation centres. The secondary outcome is predictors of survival among these children. RESULTS: Of 422 children, 44 (10.4%) died, with an incidence rate of 10.3 per 1000 person-days. The median hospital stay was 8 days. Full vaccination (adjusted HR (AHR) 0.2, 95% CI 0.088 to 0.583, p<0.05), feeding practices (F-75) (AHR 0.2, 95% CI 0.062 to 0.651, p<0.01), intravenous fluid administration (AHR 3.7, 95% CI 1.525 to 8.743, p<0.01), presence of HIV (AHR 2.2, 95% CI 1.001 to 4.650, p<0.05), pneumonia (AHR 2.2, 95% CI 1.001 to 4.650, p<0.01) and occurrence of shock (AHR3.5, 95% CI 1.451 to 8.321, p<0.01) were identified as significant predictors of mortality. CONCLUSION: The study identified a survival rate slightly higher than the acceptable range set by the social and public health economics study group. Factors like vaccination status, HIV, pneumonia, shock, intravenous fluid and the absence of feeding F-75 predicted mortality.

Work-related stress among nurses: a comparative cross-sectional study of two government hospitals in Ghana.

BACKGROUND: Occupational stress is increasing globally and affecting all workplaces and countries' health professionals. Despite its significant impact on healthcare delivery, limited studies have actually compared the prevalence, causes, effects, and coping strategies of stress among nurses working in hospitals with variation in capacity and function in Ghana. We, therefore, examined and compared the prevalence, causes, effects and coping strategies of occupational stress among nurses working in a secondary care and tertiary hospital in Ghana. METHODS: We conducted a health facility-based cross-sectional study among 248 nurses from two hospitals (Volta Regional Hospital [VRH] and Ho Teaching Hospital [HTH]). The Perceived Stress Scale (PSS) and Weiman Occupational Stress Scale (WOSS) were used to measure the nurses' stress levels and causes of occupational stress respectively. A self-reported checklist was used to measure both the effects of stress and strategies. Descriptive analyses and t-tests were performed, and statistical significance was measured at the 0.05 level. RESULTS: The majority of nurses 77.8% experienced a moderate level of perceived stress. The total individual mean scores of the nurses from the two hospitals (VRH = 3.02 and HTH = 3.09) were 34% and 37% respectively higher than the established WOSS individual average of 2.25. Nursing difficult patients (t=-1.1196, p = 0.037), Unfriendly relationships with superiors, colleagues, and subordinates (t=-2.3333, p = 0.020), working with incompetent staff (t=-1.3129, p = 0.037) were the statistically significant stressors among nurses in the HTH. Whereas, long work hours (t = 2.0841, p = 0.038) and needle-stick injuries (t = 2.6669, p = 0.008) were the statistically significant stressors among nurses from the VRH. Headache (VRH = 73.8% and HTH = 97.9%), Fatigue (VRH = 68.9% and HTH = 83.5%), Frustration VRH = 50.5% and HTH = 68.3%) and Lack of Concentration (VRH = 81.6% and HTH = 80.0%) were most common effects of occupational stress reported. CONCLUSION: The majority of nurses reported moderate levels of stress, with the two institutions' stressors differing. Key causes of stress were needle stick injuries, long hours, dealing with challenging patients and strained interpersonal relationships. Common side effects were headaches, exhaustion, irritability, and trouble focusing. To accelerate progress towards achieving the sustainable development goal (SDG) 3.4 of promoting mental health and well-being by 2030, the 2012 Mental Health Act of Ghana and the Occupational Health and Safety Regulations, should fully and effectively be implemented in health facilities across the country.

Antibiotic use in public hospitals in Vietnam between 2018 and 2022: a retrospective study.

OBJECTIVE: To assess the patterns of antibiotic consumption and expenditure in Vietnam. DESIGN: This was a cross-sectional study. SETTING: This study used data of antibiotic procurement that was publicly announced from 2018 to 2022 as a proxy for antibiotic consumption. PARTICIPANTS: This study included winning bids from 390 procurement units in 63 provinces in Vietnam for 5 years with a total expenditure of US$ 12.8 billions that represented for approximately 20-30% of the national funds spend on medicines. INTERVENTIONS: Antibiotics were classified by WHO AWaRe (Access, Watch and Reserve) classification. OUTCOME MEASURES: The primary outcomes were the proportions of antibiotic consumptions in number of defined daily doses (DDD) and expenditures. RESULTS: There was a total of 2.54 million DDDs of systemic antibiotics, which accounted for 24.7% (US $3.16 billions) of total expenditure for medicines purchased by these public health facilities. The overall proportion of Access group antibiotics ranges from 40.9% to 53.8% of the total antibiotic consumption over 5 years. CONCLUSION: This analysis identifies an unmet target of at least 60% of the total antibiotic consumption being Access group antibiotics and an unreasonable share of expenditure for non-essential antibiotics in public hospitals in Vietnam.

Willingness toward voluntary counseling and testing and associated factors among tuberculosis infected patients at public hospitals in Addis Ababa, Ethiopia.

Background: Voluntary counseling and testing for HIV has proven to be a highly effective and cost-efficient approach in many locations, yielding excellent results. It serves as a gateway to a range of HIV-related services, including the provision of antiretroviral drugs. Therefore, this study was aimed to assess the willingness toward VCT and associated factors among TB infected patients at Public Hospitals in Addis Ababa, Ethiopia; 2023. Methods: A facility-based cross-sectional study was undertaken at public hospitals in Addis Ababa from 1st to 30th of March 2023 with 235 participants using systematic random sampling. Trained data collectors employed a pretested data extraction tool for information gathering. Variables with p-value less than 0.05 in the multivariable logistic regression were considered statistically significant. Results: The prevalence of willingness toward VCT among TB infected patients was (78.3, 95%CI: 72.8, 83.4). Individuals with a primary education level (AOR: 6.32; 95%CI: 1.65, 24.25), government employees (AOR: 5.85; 95%CI: 1.78, 19.22) and private employees (AOR: 3.35; 95%CI: 1.12, 10.01), good knowledge of VCT (AOR: 3.12; 95%CI: 1.36, 7.16), perceived a higher risk (AOR: 6.58; 95%CI: 2.44, 17.73) and perceived stigma (AOR: 14.95; 95%CI: 4.98, 44.91) were factors associated with willingness toward VCT. Conclusion: The proportion of Tuberculosis infected patients expressing willingness toward Voluntary Counseling and Testing in this study was higher than in previous studies, it falls below the UNAIDS target of 90% of people knowing their HIV status. Notably, factors such as level of education, occupation, knowledge, perceived risk, and perceived stigma emerged as independent factors significantly associated with the willingness of TB-infected patients to undergo VCT. These findings underscore the importance of considering socio-demographic characteristics, knowledge levels, and psychosocial factors in designing strategies to enhance VCT acceptance among TB-infected individuals.

Assessment of epidemic risk state and its change trend of public hospital in underdeveloped area in different stages.

Objective: Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics. Methods: Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved. Results: The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P ^ t 0 ( S n ) = { 0 . 142 , 0 . 546 , 0 . 220 , 0 . 093 } , P ^ t 1 ( S n ) = { 0 . 025 , 0 . 364 , 0 . 254 , 0 . 357 } , and P ^ t 2 ( S n ) = { 0 . 020 , 0 . 241 , 0 . 191 , 0 . 548 } , respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness. Conclusion: This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

Assessment of the understanding and awareness of bioethics among healthcare professionals in all public and private hospitals of Haripur district, Pakistan: a multicentre cross-sectional study.

OBJECTIVE: To assess the level of bioethics awareness among healthcare professionals in Pakistan, focusing on the associations with sociodemographic characteristics, training and teaching of ethics, medical ethics practice and specific ethical issues. DESIGN: Cross-sectional study. SETTING: Public and private hospitals in Haripur, Pakistan. PARTICIPANTS: A total of 647 healthcare professionals participated in this study. METHODS: This study was conducted between March and May 2023, following Strengthening the Reporting of Observational Studies in Epidemiology checklist criterion, involving healthcare professionals with at least 6 months of experience in patient care practice. Providers under close supervision are advised not to respond to the bioethics knowledge, attitudes and practices survey form due to potential ethical dilemmas. RESULTS: Both physicians and non-physicians need to know more about bioethics. There was a significant difference (p<0.05) in ethical training and teaching based on job categories/designations, with ethical views differing greatly by job designation. Specific ethical issues, such as accepting gifts from patients and pharmaceutical companies, referral fees, advising specific products, disclosure of medical errors, patient confidentiality, not informing patients fully about treatment and performing tasks for financial gain, showed significant associations (p<0.05) with healthcare professional's designation. Ethical awareness scores also showed significant differences (p<0.05) based on age, ethnicity, place of posting, professional experience and the organisation's ethical guidelines. CONCLUSION: This study highlighted a notable gap in the understanding of certain ethical concerns among healthcare professionals, with nurses showing relatively lower awareness of healthcare practice compared with other professionals. Addressing these issues through targeted training and robust ethical guidelines is critical to improving patient care in Pakistan's healthcare system.

Prevalence and associated factors of atrial fibrillation among patients with rheumatic heart disease attending public referral hospitals in Bahir Dar city, Northwest Ethiopia, 2023.

BACKGROUND: Atrial fibrillation (AF) is a supraventricular arrhythmia associated with uncoordinated atrial activation. Atrial fibrillation is complication of rheumatic heart disease and is associated with substantial morbidity and mortality. It is a growing public health problem and economic and social burden. Studies investigating the prevalence and factors associated with atrial fibrillation among chronic rheumatic heart disease patients in Ethiopia are scarce. Therefore, this study aimed to determine the prevalence and factors associated with atrial fibrillation in patients with chronic rheumatic heart disease. METHODS AND MATERIALS: A hospital-based cross-sectional study was conducted. A total of 410 patients were selected using a systematic random sampling method. The data were entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 software for analysis. A binary logistic regression model was applied to identify significant variables related to AF. RESULTS: In this study, 410 patient charts were reviewed. The prevalence of atrial fibrillation was 43% (95% CI of 38% up to 48%). Male (AOR = 3.81, 95% CI 2.00-7.26), age greater than 30 years (AOR = 7.26, 95% CI 3.93-13.41), heart failure (AOR = 4.65, 95% CI 2.39-9.04), mitral valve stenosis (AOR = 6.36, 95% CI 2.92-13.87), and left atrial diameter enlargement (AOR = 3.41, 95% CI 1.64-7.09) were associated with atrial fibrillation. CONCLUSIONS AND RECOMMENDATIONS: Atrial fibrillation leads patients to frequent hospital admission and increases hospital mortality. As a result, health care professionals need to pay more attention to and apply more clinical treatment for older patients, those with heart failure, those with mitral valve stenosis, and those with left atrial diameter enlargement-associated causes of atrial fibrillation.

Community-based health insurance beneficiaries' satisfaction on laboratory services and associated factors in selected public hospitals in Jimma Zone, Oromia Region, Southwest, Ethiopia.

BACKGROUND: The community-based health insurance (CBHI) scheme is a growing initiative aimed at enhancing healthcare access for the most impoverished members of the community. The Ethiopian CBHI scheme aims to enhance access to essential healthcare services, including medical laboratory services, for the poorest members of the community, but there is limited evidence on satisfaction levels. The aim of this study was to assess the satisfaction level of CBHI beneficiaries with laboratory services and their associated factors among selected public hospitals in Jimma Zone, Oromia Region, Ethiopia. METHODS: A facility-based cross-sectional study was conducted on selected public hospitals in the Jimma Zone from September to October 2023. A total of 421 CBHI beneficiaries were enrolled in the study using a convenient sampling technique, and interviewers administered structured questionnaires to collect data. Data were entered into Epi-data and analyzed using the Statistical Package of Social Sciences version 25. Descriptive analysis was used to summarize independent variables; bivariate and multivariable logistic regression analyses were done to test the association between independent and dependent variables; and statistical significance was declared at P<0.05. RESULTS: More than half (55.8%) of the 419 study participants were female. Above half, 57.5% of the respondents were satisfied by the clinical laboratory services at public hospitals in Jimma Zone. Components with a higher satisfaction rate were providers' professional appearances (98.3%), procedures for specimen collection (87.6%), and availability of entertainment facilities at the waiting area (67.8%). On the contrary, longer waiting times to receive the test results (76.6%), inefficiency of the reception area (74.7%), and the inability of professionals to explain diagnostic procedures (58.0%) were associated with higher rates of dissatisfaction. Educational status and the number of hospital visits were found to have a statistically significant association with level of satisfaction with laboratory services. CONCLUSIONS: CBHI beneficiaries' satisfaction with laboratory service was at a moderate level in Jimma Zone public hospitals. Therefore, attention should be given to continuous monitoring of patients' satisfaction with services, improving reception areas, and practicing routine explanations about the purposes and procedures during specimen collection to improve the beneficiaries' satisfaction level with clinical laboratory services.

Enhancing patient informed consent in elective skin cancer surgeries: a comparative study of traditional and digital approaches in a German public hospital.

BACKGROUND: This study aims to investigate the integration of modern sources of patient information, such as videos, internet-based resources, and scientific abstracts, into the traditional patient informed consent process in outpatient elective surgeries. The goal is to optimize the informed consent experience, enhance patient satisfaction, and promote shared decision making (SDM) between patients and surgeons. By exploring different patient informed consent formats and their impact on patient satisfaction, this research seeks to improve healthcare practices and ultimately enhance patient outcomes. The findings of this study will contribute to the ongoing efforts to improve the informed consent process in public hospitals and advance patient-centred care. METHODS: Data collection occurred at the day care clinic of a prominent German public hospital, forming an integral component of a prospective clinical investigation. The study exclusively focused on individuals who had undergone surgical intervention for skin cancer. For the purpose of meticulous data examination, the statistical software SPSS version 21 was harnessed. In the course of this study, a chi-square test was aptly employed. Its purpose was to scrutinize the nuances in patient experiences pertaining to informed consent across four distinct categories, viz., oral informed consent discussion (Oral ICD), written informed consent discussion (Written ICD), video-assisted informed consent discussion (video-assisted ICD), and digitally assisted informed consent discussion (digital-assisted ICD). The primary dataset of this inquiry was diligently gathered via a structured questionnaire administered to a targeted cohort of 160 patients. Within this sample, a balanced representation of genders was observed, encompassing 82 males and 78 females. Their collective age span ranged from 18 to 92 years, with an average age of 71 years. A randomized selection methodology was employed to include participants in this study during the period spanning from July 2017 to August 2018. RESULTS: Significant differences were observed across the groups for all research questions, highlighting variations in patient responses. Video-assisted and digital-assisted IC were rated as superior in patient satisfaction with information compared to written and oral IC. Demographic profiles of the four study groups were found to be comparable. CONCLUSION: The findings of this study indicate that the incorporation of digital technologies in the informed consent process can enhance patient understanding during outpatient elective skin cancer surgeries. These results have important implications for increasing patient satisfaction and improving the SDM process within the hospital environment.

Predictors of burnout among midwives working at public hospitals in northwest Ethiopia, 2022: A multi-centred study.

PROBLEM: Midwives are susceptible to burnout due to the physically and emotionally demanding nature of their job. Burnout is an occupational phenomenon with far-reaching consequences. AIM: This study aimed to assess the magnitude of burnout and predictors among midwives working at public hospitals in northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was employed to include 640 study participants. Data were collected using a self-administered questionnaire, entered into Epi-data 4.6 software, and exported to SPSS version 25 for analysis. A multivariable linear regression analysis model was fitted to identify factors contributing to midwives' burnout. FINDINGS: The overall prevalence of midwives' burnout was 55.3 % (95 % CI = 51.7-58.9). The prevalence of personal, work-related, and client-related burnout was 58.3 %, 60.3 %, and 55.5 %, respectively. Factors that were significantly associated with burnout includes workplace violence (ß = 5.02, CI: 2.90, 7.13), not receiving training (ß = 4.32 CI: 1.81, 6.80), being exposed to blood and body fluids or needle stick injuries (ß = 5.13 CI: 3.12, 7.13), low superior support (ß = 5.13 CI: 1.94, 5.30), working in tertiary hospitals (ß = 12.77 CI: 9.48, 16.06), and job rotation of six months or less (ß = 16.75, CI: 13.12, 20.39). CONCLUSION: This study found that the prevalence of burnout among midwives was significantly high. Addressing burnout requires implementing effective burnout prevention measures including enhancing management support, offering professional training, creating a conducive working environment, and adhering to standard precautions.

Assessment of evidence based care and uniformity of practices through implementation of standardized medical protocols and guidelines in pediatric emergency departments.

OBJECTIVE: This study aims to assess compliance with medical protocols and outcomes, as well as determine the consistency in clinical practice across different Pediatric Emergency Departments (PED) in public sector hospitals of a low-middle income country. METHODS: A retrospective analysis was conducted on patients presenting to PEDs of five public sector hospitals, namely Civil Hospital Karachi (PED 1), National Institute of Child Health (PED 2), Abbasi Shaheed Hospital (PED 3), Sheikh Zayed Hospital Larkana (PED 4), and Ghulam Muhammad Mahar College Hospital Sukkur (PED 5). The analysis covered a three-month period from February 1, 2023, to April 30, 2023. Patients diagnosed with Acute asthma, Sepsis, and Septic Shock during the study duration were included. Outcomes for each disease were evaluated based on compliance with standardized protocols.The statistical significance of data was measured by adding the p values. RESULTS: 110,450 patients visited PED during the study period and mortality rate was 2% (n=2193). 12% (13,240) were diagnosed with the three diseases during the study period. Sepsis was on top (74%, n=9,751), followed by Septic Shock (14%, n=1898), and Acute Asthma (12%, n=1591). The overall compliance rate for the three diseases was 77% (n = 10,240). Adherence to standard protocols were 98% (n = 1561) for acute asthma, 85% (n = 8240) for Sepsis, and 23% (n = 439) for Septic Shock across the five emergency departments. Of the patients who were managed according to standard protocol, 31% (n = 3135) were discharged, 30% (n- 3094) were admitted, 11% (n = 1151) were referred, 15% (n = 1501) left against medical advice and 13% (n = 1359) did not survive. On the other hand, in patients where there was noncompliance to standard protocols, 27% (n = 805) did not survive, 27% (n = 807) were discharged, 24% (n = 710) were admitted, 8% (n = 260) were referred and 14% (n = 418) left against medical advice. The differences in adherence rates among the three diseases were statistically significant (p < 0.001). CONCLUSION: The overall mortality rate was 2% in these five emergency departments and the medical protocol was followed in every third patient out of fourth in those three diseases. The survival rate till ED disposition was doubled in those patients for whom medical protocols were followed as compared to those for non-compliant. The majority of PED demonstrated good compliance with standardized practices. However, this study identified areas that require attention and further training, especially early recognition and management of septic shock where compliances seem alarmingly low. Our data analysis indicates that adherence to guidelines has resulted in uniformity in clinical practice and the provision of early evidence-based quality care. Nevertheless, there is still room for improvement in ensuring consistent adherence to medical protocols in pediatric emergency settings and thus improving patient outcomes.