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.

Pathways to improve health information systems in Ethiopia: current maturity status and implications.

BACKGROUND: To achieve national and international strategic goals, countries are advised to assess the maturity status of their health information systems (HIS), including business continuity and interoperability. This work aims to determine the existing maturity status of the Ethiopian HIS, set HIS improvement goals, and inform a path towards an improved national HIS by the end of 2024. METHODS: This assessment was a collaborative and transparent process that was carried out with the engagement of all key stakeholders through consultation. We used the Stages of Continuous Improvement (SOCI) tool to guide the assessment to measure the maturity level of the Ethiopian HIS in five core domains, 13 components and 39 subcomponents and to guide future plans. RESULTS: The overall average score of the national HIS maturity was 2.68/5, which is categorized between repeatable (stage 2) and defined (stage 3) maturity levels. The assessment findings revealed that three out of the five HIS maturity domains were at a repeatable stage. Only the leadership and governance and the data quality and use domains were at the defined maturity level. A majority (7/13) of the subcomponents were at the repeatable level of maturity, while four were at the defined level. Policy, legal and regulatory framework and compliance from the leadership and governance domain and interoperability from the data quality and use domain were categorized as having an emerging status. Considering the current HIS maturity status, gaps and strengths identified, ongoing HIS initiatives, existing platforms, and the interest and level of engagement of senior government leadership, this assessment put forward an improvement roadmap for achieving the desired managed stage (4.37) of maturity by the end of 2024. CONCLUSIONS: The findings show that the overall maturity level of the Ethiopian HIS is 2.68, which is between the repeatable and defined maturity stages. Enforcement of policies and legislation, data exchange among systems, and information and communication technology infrastructure business continuity planning are the main challenges of Ethiopian HIS requiring further investment. Strengthened and collaborative effort is critical to reaching the desired goal of "managed" HIS (stage 4) in the country by 2024.

The morbidity burden from emergency conditions in Jimma city, Southwest Ethiopia.

BACKGROUND: Sub-Saharan Africa shares a disproportionately large ratio of the global acute disease burden, however epidemiological data specific to the burden of emergency conditions are lacking. This study aimed to determine the morbidity burden of emergency conditions in Jimma city, Southwest Ethiopia. METHODS: A cross-sectional study was conducted using emergency case registries of three years from 2014 to 2017, at Jimma Medical Center and Shenen Gibe Hospital. 39,537 emergency visits were included in the study. The data were exported to SPSS V.23.0 for statistical analysis, descriptive analysis was used to summarize demographic characteristics, causes of visit, and morbidity rates. Findings were integrated with population-based health demographic reports quantifying the morbidity burden. Outcome measures were overall number of emergency visits and morbidity rates for the population groups. RESULTS: From a total of 39,537 visits, those between 15 and 29 years of age accounted for 42.1% (n = 16615), and 50.6% (n = 20004) were females. Communicable, Maternal, Neonatal and Nutritional (CMNNs) conditions accounted for 57.2%(n = 22597), followed by injuries (22.9%, n = 9055). Top five conditions were non-specific trauma (2.3%, n = 4861), complicated labor (8.4%, n = 3320), lower respiratory infections (8.1%, n = 3213), acute febrile illness (6.6%, n = 2600), and neonatal infections (3.7%, n = 1444). CONCLUSION: The burden of acute conditions presented to public hospitals in Jimma city is high. Traumatic injuries, obstetric emergencies, lower respiratory infections, and neonatal emergencies were the most frequent causes of acute visits. An appropriate emergency care system that addresses this high burden of acute emergencies should be established in the study area.

Length of Stay in the Emergency Department and Its Associated Factors at Jimma Medical Center, Southwest Ethiopia.

BACKGROUND: Prolonged emergency department stays can adversely affect patient outcomes leading to an increased length of hospital admission and higher mortality. Despite this fact, there are few data describing emergency department length of stay and associated factors in Ethiopia. OBJECTIVE: To assess length of stay in the emergency department and its associated factors among patients visited adult emergency department of Jimma Medical Center, Jimma town, southwest of Ethiopia. METHODS: Institution-based cross-sectional study was conducted from April 9, 2018 to May 11, 2018. Overall, 422 patients presented during study period were sequentially included in the study. A semi-structured questionnaire was used to collect data through interview, observation and medical record review. The collected data were cleaned, entered to Epi-data 3.1 and exported to SPSS version 21 for binary and multivariable logistic regression analysis. To identify factors associated with outcome variable, candidate variables were fitted to multivariable analysis, and those with P-values <0.05 were considered as significantly associated. RESULTS: More than one-third, 162 (38.4%), experienced prolonged length of stay in the emergency department. The odds of prolonged stay were higher among rural area residency (AOR, 3.0; CI, 1.279-7.042), evening presentation (AOR, 4.25; CI, 1.742-10.417), and night-time presentation (AOR, 14.93; CI, 4.22-52.63), and having at least one diagnostic investigation (AOR, 4.48; CI, 1.69-11.88). However, participants who did not experience shift changes of nurses during their stay (AOR, 0.003; CI, 0.001-0.010) had a less prolonged stay. CONCLUSION: A significant proportion of patients experienced a prolonged stay at the emergency department. Age, rural residency, evening and night-time presentation, shift change and having a diagnostic investigation were predictors of prolonged stay. Thus, establishing time-targeted service for patients can reduce the length of stay.