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BACKGROUND: Clinical ethical practice (CEP) is required for healthcare workers (HCWs) to improve health-care delivery. However, there are gaps between accepted ethical standards and CEP in Ethiopia. There have been limited studies conducted on CEP in the country. Therefore, this study aimed to determine the magnitude and associated factors of CEP among healthcare workers in healthcare facilities in Ethiopia. METHOD: From February to April 2021, a mixed-method study was conducted in 24 health facilities, combining quantitative and qualitative methods. Quantitative (survey questionnaire) and qualitative (semi-structured interviews) data were collected. For quantitative and qualitative data analysis, Stata version 14 and Atlas.ti version 7 were utilized. Multiple logistic regression and thematic analysis for quantative and qualitative respectively used. RESULTS: From a total of 432 study participants, 407 HCWs were involved in the quantitative analysis, 36 participants were involved in five focus group discussions (FGDs), and eleven key informant interviews (KIIs) were involved in the qualitative analysis. The score of good CEP was 32.68%. Similarly, the scores of good knowledge and attitude were 33.50% and 25.31%, respectively. In the multiple logistic regression models, satisfaction with the current profession, availability of functional CECs, compassionate leaders, previously thought clinical ethics in pre-service education and good attitude were significant factors associated with CEP. Among these significant factors, knowledge, compassionate leaders, poor infrastructure, a conducive environment and positive attitudes were also determinants of CEP according to qualitative findings. CONCLUSIONS: The CEP in health care services in Ethiopia is low. Satisfaction with the current profession, functional CECs, positive attitude, compassionate leaders and previously thought clinical ethics were significant factors associated with CEP. The Ministry of Health (MoH) should integrate interventions by considering CECs, compassionate leadership, and positive attitudes and enhance the knowledge of health professionals. Additionally, digitalization, intersectoral collaboration and institutionalization are important for promoting CEP.
Assuntos
Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Atenção à Saúde , Etiópia , Pessoal de Saúde , HumanosRESUMO
Background: Compassionate health care service is important for good clinical outcomes and patient satisfaction. However, complaints of non-compassionate care became very familiar and popular grievance of the community in the health care system. The aim of this study was to assess the level of compassionate health care service provision and its associated factors among health professionals working in public hospitals of Addis Ababa, Ethiopia. Methods: A facility based cross sectional study was conducted among six public hospitals of Addis Ababa, Ethiopia. Simple random sampling and systematic sampling methods were applied to select hospitals and each study participants respectively. Data were collected from 400 participants using a self-administered structured questionnaire. The mean of compassionate health care was taken as the cut point to label respondent as good and poor compassionate health care service provider. Bivariate and multivariable logistic regressions were done to determine the associated factors for compassionate care provision. Variables with p values < 0.05 at the multivariable analysis were considered as significantly associated with compassionate care provision. Results: Only 48.0% of health care professionals provided good compassionate care. Learned to be compassionate (AOR = 5.083; CI 95% 2.69, 9.58); patient and their family realistic expectation (AOR = 2.24; CI 95% 1.07, 4.66) were found to be significantly associated with good compassionate health care provision. Conclusions: and recommendations: Good compassionate health care service provision in Addis Ababa hospitals was very low. Teaching health science and medical students to be compassionate and ensuring health care clients to have realistic expectation may be important to farther enhance compassionate health care service provision.
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BACKGROUND: Compassionate respectful, and caring (CRC) creates a pleasant environment for health workforce (HWF), customers, and families. For the past five years, the Ethiopian Ministry of Health (EMoH) has developed a CRC plan to improve person-centered care. Therefore, we aimed to assess the implementation status of CRC and associated factors in the 16 model health facilities (MHFs) in Ethiopia. METHODS: A cross-sectional study was employed from February to April 2021. A structured and semi-structured questionnaire was used to assess the level of CRC implementation in model health care facilities. Epi-data version 4.3 and SPSS version 26 software were used for data entry and analysis, respectively. Binary logistic regressions analysis was used and significance was obtained at the odds ratio with a 95% confidence interval and P-value < 0.05. RESULTS: A total of 429 HWF participated in a self-administered questionnaire. The prevalence of compassionate and respectful care among HWF were 60.4%, and 64% respectively. Nurse professionals, midwives, having training on CRC, leader promoting CRC, having a conducive working environment and burnout management for HWF were significantly associated with compassionate care practice. Leaders promoting CRC, having a conducive working environment, and burnout management for HWF were significantly associated with respectful care practice. CONCLUSION: The findings identified distinct issues related to CRC implementation in each 16 MHF. Addressing HWF skill gaps, a conducive working environment, and burnout management are encouraged CRC continuity. Incorporate CRC in pre-service education, health system strengthening, and motivating HWF are important for CRC strategic implementation.
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Leishmania aethiopica is the etiological agent of cutaneous leishmaniasis (CL) in Ethiopia and can cause severe and complicated cases such as diffuse CL (DCL), mucocutaneous leishmaniasis or extensive CL, requiring systemic treatment. Despite the substantial burden, evidence-based treatment guidelines are lacking. We conducted a systematic review of clinical studies reporting on treatment outcomes of CL due to L aethiopica in order to help identify potentially efficacious medications on CL that can be taken forward for clinical trials. We identified a total of 24 records reporting on 506 treatment episodes of CL presumably due to L aethiopica. The most commonly used drugs were antimonials (n = 201), pentamidine (n = 150) and cryotherapy (n = 103). There were 20 case reports/series, with an overall poor study quality. We only identified two small and/or poor quality randomized controlled trials conducted a long time ago. There were two prospective non-randomized studies reporting on cryotherapy, antimonials and pentamidine. With cryotherapy, cure rates were 60-80%, and 69-85% with antimonials. Pentamidine appeared effective against complicated CL, also in cases non-responsive to antimonials. However, all studies suffered from methodological limitations. Data on miltefosine, paromomycin and liposomal amphotericin B are extremely scarce. Only a few studies are available on DCL. The only potentially effective treatment options for DCL seem to be antimonials with paromomycin in combination or pentamidine, but none have been properly evaluated. In conclusion, the evidence-base for treatment of complicated CL due to L aethiopica is extremely limited. While antimonials remain the most available CL treatment in Ethiopia, their efficacy and safety in CL should be better defined. Most importantly, alternative first line treatments (such as miltefosine or paromomycin) should be explored. High quality trials on CL due to L aethiopica are urgently needed, exploring group sequential methods to evaluate several options in parallel.