Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses.

Background: Electronic medical records or electronic health records, collectively called electronic records, have significantly transformed the healthcare system and service provision in our world. Despite a number of primary studies on the subject, reports are inconsistent and contradictory about the effects of electronic records on mortality. Therefore, this review examined the effect of electronic records on mortality. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline. Six databases: PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched from February 20 to October 25, 2023. Studies that assessed the effect of electronic records on mortality and were published between 1998 and 2022 were included. Joanna Briggs Institute quality appraisal tool was used to assess the methodological quality of the studies. Narrative synthesis was performed to identify patterns across studies. Meta-analysis was conducted using fixed effect and random-effects models to estimate the pooled effect of electronic records on mortality. Funnel plot and Egger's regression test were used to assess for publication bias. Results: Fifty-four papers were found eligible for the systematic review, of which 42 were included in the meta-analyses. Of the 32 studies that assessed the effect of electronic health record on mortality, eight (25.00%) reported a statistically significant reduction in mortality, 22 (68.75%) did not show a statistically significant difference, and two (6.25%) studies reported an increased risk of mortality. Similarly, among the 22 studies that determined the effect of electronic medical record on mortality, 12 (54.55%) reported a statistically significant reduction in mortality, and ten (45.45%) studies didn't show a statistically significant difference. The fixed effect and random effects on mortality were OR = 0.95 (95% CI: 0.93-0.97) and OR = 0.94 (95% CI: 0.89-0.99), respectively. The associated I-squared was 61.5%. Statistical tests indicated that there was no significant publication bias among the studies included in the meta-analysis. Conclusion: Despite some heterogeneity among the studies, the review indicated that the implementation of electronic records in inpatient, specialized and intensive care units, and primary healthcare facilities seems to result in a statistically significant reduction in mortality. Maturity level and specific features may have played important roles. Systematic Review Registration: PROSPERO (CRD42023437257).

Acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia: a retrospective cross-sectional observational study.

BACKGROUND: The electronic community health information system has been increasingly developed and deployed to quantify and support quality health service delivery by community health workers in Ethiopia. However, the success and failure of the electronic community health information system depend on the acceptability and use by its users. This study assessed the acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia. METHODS: A retrospective cross-sectional observational study was conducted among 587 randomly selected health extension workers from six regions of Ethiopia. The Revised Technology Acceptance Model was used as a theoretical framework for the study. Descriptive statistics, structural equation modeling, and principal component analysis techniques were used to analyze the data. For all significance tests, multiple comparison adjustments were made using the Bonferroni Correction Method. RESULTS: There was near universal acceptance of the electronic community health information system, ranging from 94.4 to 97.4% among health extension workers. However, actual use of the system was considerably lower, at 50%. Perceived usefulness of the electronic community health information system had a direct and positive effect on acceptability (ß3 = 0.415, p < 0.001). Perceived ease of use had both direct and indirect positive effects on electronic community health information system acceptability (ß2 = 0.340, p < 0.001 and ß1*ß3 = 0.289, p < 0.001, respectively), while acceptability had a direct and positive effect on the use of the electronic community health information system (ß3 = 0.297, p < 0.001). CONCLUSIONS: Despite the very high acceptability of the electronic community health information system among health extension workers, actual use of the system is considerably lower. Hence, an integrated and coordinated approach is required to close the acceptance-use gap.

Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia.

Background: The electronic community health information system (eCHIS) has been implemented in Ethiopia to support health services delivered by community health workers. Despite the many benefits of digitizing community health information systems, the implementation of the eCHIS is challenged by many barriers resulting in low uptake. This study assessed the barriers, facilitators, and motivators of eCHIS use among health workers with focus on health extension workers (HEWs) in Ethiopia. Methods: Phenomenological approach was used to assess the barriers, facilitators and motivators of eCHIS use in Amhara, Harari, Oromia, Sidama, South West Ethiopia and Southern Nation Nationalities and People's regions of Ethiopia. Data were collected from 15-29 May 2022. A total of 54 face-to-face in-depth interviews were conducted among HEWs, HEW supervisors, health information technicians and managers. The interviews were audiotaped using Open Data Kit, transcribed verbatim and translated into English. OpenCode 4.03 software was used for coding and categorizing the data. Thematic analysis was used to analyze the data. Results: The HEWs and other eCHIS users reported lack of infrastructure and resources; poor quality of training, follow-up, and supervision; parallel recording using the manual and electronic system; and HEWs' workload as barriers hindering eCHIS use. Data quality, retrievability, and traceability; tablet portability; encouragement from supervisors; and positive image in the community resulting from HEWs using tablets in their routine activities were the main facilitators of eCHIS use. Conclusion: The study identified various barriers that adversely affect the use of eCHIS. An integrated and coordinated approach to eCHIS implementation that encompasses removing the barriers, and reinforcing facilitators is required.

Effect of Deploying Trained Community Based Reproductive Health Nurses (CORN) on Long-Acting Reversible Contraception (LARC) Use in Rural Ethiopia: A Cluster Randomized Community Trial.

To investigate the effect of innovative means to distribute LARC on contraceptive use, we implemented a three arm, parallel groups, cluster randomized community trial design. The intervention consisted of placing trained community-based reproductive health nurses (CORN) within health centers or health posts. The nurses provided counseling to encourage women to use LARC and distributed all contraceptive methods. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where the new service providers were deployed, health post or health center. We calculated difference-in-difference (DID) estimates to assess program impacts on LARC use. After nine months of intervention, the use of LARC methods increased significantly by 72.3 percent, while the use of short acting methods declined by 19.6 percent. The proportion of women using LARC methods increased by 45.9 percent and 45.7 percent in the health post and health center based intervention arms, respectively. Compared to the control group, the DID estimates indicate that the use of LARC methods increased by 11.3 and 12.3 percentage points in the health post and health center based intervention arms. Given the low use of LARC methods in similar settings, deployment of contextually trained nurses at the grassroots level could substantially increase utilization of these methods.

Causal Beliefs Affect Treatment Practices and Preferences for Neonatal Danger Signs in Northwest Ethiopia: A Qualitative Study.

This study was conducted to explore the experiences of community members, particularly mothers, concerning their beliefs about the causes, treatment practices, and preferences for World Health Organization-defined neonatal danger signs in northwest Ethiopia. A phenomenological qualitative study was conducted in three districts of north Gondar Zone, Amhara region, Ethiopia, from March 10 to 28, 2016. Twelve focus group discussions were conducted involving 98 individuals. In-depth interviews were conducted with six health extension workers and 30 women who were either pregnant or who delivered in the past 6 months. Six subthemes emerged explaining the causes of neonatal danger signs. The causes varied from danger sign to danger sign and from person to person. Most of the perceived causes of danger signs in neonates do not align with the current biomedical science. Causal assumptions and perceived seriousness of danger signs influenced treatment practices and preferences. Four subthemes also emerged for treatment practices and preferences. In some cases, respondents indicated that non-biomedical sources of treatment were superior in outcome compared with biomedical treatment options. Unsatisfactory outcomes were mentioned as major reasons to opt for treatments from non-biomedical sources. Religious and cultural reasons were reported to be major impediments for treatment seeking for newborn danger signs. There is an urgent need to introduce or expand locally modified program interventions, such as community-based newborn care, to educate the community on the causes of neonatal danger signs and the need for prompt care seeking from qualified providers.

Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling.

BACKGROUND: Neonatal mortality contributes to nearly half of under-five mortality in Ethiopia. Treatment seeking for newborn danger signs remains low despite correlations with neonatal mortality. This study tests a theoretical model of factors affecting mothers' treatment seeking intention for neonatal danger signs in northwest Ethiopia. METHOD: A cross sectional study was conducted from March 3-18, 2016 in northwest Ethiopia. A total of 2,158 pregnant women and women who had delivered in the past 6 months were interviewed. Latent variables; knowledge of neonatal danger signs (KDS), household level women empowerment (HLWE) and positive perception toward the behavior of health care providers (PPBHCP) were measured using a Five Point Likert Scale. Socioeconomic status (SES), number of antenatal care attendance, perceived cost of treatment (PCT), average distance to health facilities (ADHF) and treatment seeking intention (TSI) were observed variables in the study. A structural equation modeling was applied to test and estimate the hypothesized model of relationships among latent and observed variables and their direct and indirect effects on TSI. RESULT: KDS, PPBHCP, HLWE, and PCT showed direct, positive and significant association with TSI (ß = 0.41, p<0.001, ß = 0.08, p<0.002, ß = 0.18, p<0.001, and ß = 0.06, p<0.002, respectively). SES was not directly associated with TSI. However, it indirectly influenced TSI through three pathways; KDS, number of ANC attendance and HLWE (ß = 0.05, p<0.05, ß = 0.08, p<0.001 and ß = 0.13, p<0.001, respectively). Number of antenatal care was not directly associated with TSI. But indirectly, it affected TSI through its direct effect on KDS and PPBHCP (ß = 0.05, p<0.05, ß = 0.14, p<0.001, respectively). PPBHCP and HLWE also showed indirect association with TSI through their direct effect on KDS (ß = 0.37, p<0.001, ß = 0.36, p<0.001, respectively). All in all, the model fitted the sample data and explained 31% of the variance in TSI. CONCLUSION: PPBHCP, HLWE, PCT and KDS were associated with mothers' TSI for newborn danger signs.

Why gone too soon? Examining social determinants of neonatal deaths in northwest Ethiopia using the three delay model approach.

BACKGROUND: Without improving the survival of newborns, meaningful reduction in under-five mortality is difficult. Most neonatal deaths are preventable when appropriate and timely care is sought. In Ethiopia, there is lack of evidence on the type and contribution of delays in treatment seeking to neonatal deaths. METHODS: A community based social autopsy (SA) of 39 neonatal deaths was conducted from March 16 to 24, 2016 in Dabat Health and Demographic Surveillance System (HDSS) in northwest Ethiopia. The result was linked with verbal autopsy (VA) information completed for each of the deaths as part of the ongoing HDSS. The SA tool was adapted from INDEPTH Network. Three delay model approach was used to classify the delay types that contributed for the deaths investigated. Descriptive statistics was used to analyze the data. RESULTS: SA was completed for 37 (94.9%) of the 39 neonatal deaths. Of all the deaths, 51.3% (19/37) of them occurred within the first 24 h, 75.6% (28/37) within the first 6 days and the remaining in 7-28 days. Birth asphyxia was the leading cause of death (34%) followed by bacterial sepsis (31%) and prematurity (16%). The median time from recognition of illness to initiation of modern treatment was 1 day (IQR 1-2.5 days). Delay in treatment seeking outside home (delay one) was associated with 81% of the deaths. Delay in receiving care at a health facility (delay three) and delay in transport (delay two) were associated with 16 and 3% of the deaths, respectively. The major contributors of death for delay one were bacterial sepsis (33.3%), birth asphyxia (30%), unspecified illness (20%) and acute lower respiratory tract illnesses (6.7%). For delay three, the major causes of death included birth asphyxia (50%), prematurity (33.3%) and bacterial sepsis (16.7%). CONCLUSIONS: Delays created at home and at health facility were the major delays contributing to the death of newborns. More focus has to be given in improving delays at home and at health facility.