ABSTRACT
BACKGROUND: Routine health information (RHI) systems are vital for the acquisition of data for health sector planning, monitoring, and evaluation, patient management, health education, resource allocation, disease prioritization, and decision-making. Use RHI for decision-making is low in Ethiopia. Thus, the study aimed to assess barriers and associated factors to the use of RHI among managers working at public hospitals in North Shewa, Ethiopia. METHODS: A facility-based mixed-method study was conducted from May to June 2020. A total of 102 randomly selected managers were included in the survey and six key informant interviews were done. Data were collected using a structured self-administered questionnaire and interview guide by trained data collectors. Data were entered into Epi-info version 7.1 and transferred into SPSS version 23 for further statistical analysis. Both bivariate and multivariable logistic regression analyses were performed. In the multiple logistic regression analysis, a less than 0.05 P-value was considered statistically significant. The odds ratio along with a 95% confidence interval was estimated to measure the strength of the association. Thematic analysis was done for key informant interview data. RESULTS: In this study, the level of RHI use for decision-making was 71.6% (95% CI: 61.8%, 79.4%). According to the multivariable logistic regression analysis, training on health information system (AOR = 0.28, 95% CI: 0.08-0.98) and supportive supervision (AOR = 0.27, 95% CI: 0.09-0.78) were found significantly associated with the use of RHI for decision-making. Moreover, the lack of staff motivation and computer and data analysis skills were the major reasons for not using RHI. CONCLUSION: Three-fourth of the managers working at public hospitals used RHI for decision-making. Training on health information systems and supportive supervision were factors associated with the use of RHI. Therefore, training of managers and the provision of supportive supervision were highly recommended.
ABSTRACT
BACKGROUND: Informed consent is a universally accepted precondition for scientific researches involving human participants. However, various factors influence the process of obtaining authentic informed consent, and researchers particularly working in resource-poor countries often face considerable difficulties in implementing the universally recommended procedures for obtaining informed consent. We have conducted this Rapid Ethical Assessment (REA) to accommodate the local cultural norms and to understand the relevant ethical issues in the Silti community before the conduct of a cluster-randomized controlled trial. METHODS: This REA was conducted in two purposively selected Woredas/Districts and Worabe Town administration of Silti Zone. Data were collected using in-depth interviews and focus group discussions. Purposive and convenient sampling techniques were used to select respondents. Five in-depth interviews and 15 Focus Group Discussions were conducted in the Amharic language. The collected data was transcribed, translated, and analyzed using a thematic approach. RESULT: Most of the community members never heard about research and therapeutic misconception was common. In the area, the permission of people working in the formal and informal community administration is essential before approaching individuals. The male head of the household should also be involved in the decision before individual household members participate in research. Furthermore, sensitizing the community using public and religious gatherings was suggested before individual recruitment. In the consent process, delivering selected information particularly the purpose and benefits of the research was emphasized and the tendency of preferring verbal consent was documented despite the willingness of the individuals to sign on the consent form. Local health workers were identified as appropriate personnel to communicate information and the procedures of the research were found to be acceptable. However, the value of small incentives was suggested to motivate potential participants. Finally, involving all concerned stakeholders and respecting the cultural norm of the community was emphasized. CONCLUSION: Through REA, we understand the research awareness of the community, their expectation, and the cultural norms relevant to the ethical conduct of research. It enabled us to devise culturally sensitive and scientifically sound strategies to secure authentic informed consent. The process of conducting REA was found to be feasible, quick, and efficient.
Subject(s)
Severe Acute Malnutrition , Therapeutic Misconception , Child , Humans , Informed Consent , Male , Prohibitins , Qualitative Research , Research PersonnelABSTRACT
BACKGROUND: Severe Acute Malnutrition (SAM) remains a major cause of child mortality. To improve the management and survival of children the World Health Organization (WHO) endorsed the protocol for the management of SAM. The protocol suggested the integration of psychosocial stimulation as part of the medico-nutritional care process to prevent the long-term adverse developmental impact of the SAM. However, there is little scientific evidence behind the recommended stimulation intervention. METHOD: A parallel-group cluster-randomized controlled trial will be conducted among 144 children with SAM age 6-59 months in Southern Ethiopia. The study will have two groups where: children with SAM admitted in the intervention health facilities will receive psychosocial stimulation in addition to the routine inpatient care and for 6 months after discharge. Children with SAM admitted in the SC of the control health facilities will receive the routine inpatient care without psychosocial stimulation and home-based follow up for 6 months after discharge. All mothers/ caregivers will also receive uniform health education on child health-related issues. The primary outcome of the study will be child development while the secondary outcomes will include child growth and treatment outcome. All outcomes will be assessed four times: at enrollment, upon discharge from the SC, at 3 and 6 months of follow up. The data will be analyzed using STATA Version 15 Statistical Software. The anthropometric Z-scores and percentile of the median will be calculated child using WHO Anthro Version 3.2.2 Statistical Software. To assess the overall effect of the intervention by controlling other potential contributing factors, a generalized linear mixed model will be used. DISCUSSION: The present study will have an important contribution in generating supplementary evidence regarding the effect of psychosocial stimulation interventions on the development and growth outcomes of children with SAM. The study will further address the impact of the intervention on treatment outcome indicators that are still under-researched areas requiring new scientific evidence. TRIAL REGISTRATION: Pan African Clinical Trials Registry -PACTR201901730324304. Registered 25 November 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5739.