The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic... more The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic could pose a public health crisis indirectly through disruptions in essential health services. The aim of this study was to examine disruptions in health service utilization during the first nine months of the COVID-19 pandemic across 10 regions in Ethiopia. We analyzed utilization of 21 different health services across all of Ethiopia (except the Tigray region) for the period of January 2019 to December 2020. Data were extracted from the Ethiopian district health information system (DHIS2). Monthly visits in 2020 were graphed relative to the same months in 2019. Interrupted time series analysis was used to estimate the effect of the pandemic on service utilization in each region. We found that disruptions in health services were generally higher in urban regions which were most affected by COVID. Outpatient visits declined by 52%, 54%, and 58%, specifically in Dire Dawa, Addis Ababa an...
ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and i... more ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and improves patient outcomes. In low-resource settings, AMS implementation may require concurrent strengthening of clinical microbiology capacity therefore additional investments. We assessed the cost-effectiveness of implementing AMS at Tikur Anbessa Specialised Hospital (TASH), a tertiary care hospital in Ethiopia.DesignWe developed a Markov cohort model to assess the cost–utility of pharmacist-led AMS with concurrent strengthening of laboratory capacity compared with usual care from a ‘restricted societal’ perspective. We used a lifetime time horizon and discounted health outcomes and cost at 3% annually. Data were extracted from a prospective study of bloodstream infections among patients hospitalised at TASH, supplemented by published literature. We assessed parameter uncertainty using deterministic and probabilistic sensitivity analyses.SettingTertiary care hospital in Ethiopia, with 8...
Background Remaining underweight during Tuberculosis (TB) treatment is associated with a higher r... more Background Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. Methods Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus p...
Background Compassionate care is the sensitivity shown by health care providers to understand ano... more Background Compassionate care is the sensitivity shown by health care providers to understand another person’s suffering and a willingness to help and to promote the well being of that person. Although monitoring of compassionate care is key to ensuring patient-centered care, there is no validated tool in the Ethiopian context that can be applied to measure compassionate care. Therefore, this study aimed to assess the structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® (SCCCS) in the Ethiopian context. Methods The structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® were investigated in a sample of 423 oncology patients in the adult Oncology department of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The internal consistency of the instrument was examined based on Cronbach’s alpha coefficient, and the structural validity was evaluated by subjecting the items of the instrument to factor an...
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have... more Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the cou...
Background : Ethiopia is amongst the African countries that have received significant food aid. N... more Background : Ethiopia is amongst the African countries that have received significant food aid. Nonetheless, the common micronutrient deficiencies among food aid beneficiaries are not well documented. Objective : To find out the common micronutrient deficiencies among food aid beneficiaries in the country based on available data. Methods : Literature search was made from the Internet, peer-reviewed journals, various agency reports, national survey data, books, handouts and Masters in Public Health (MPH) theses since the year 2000. Micronutrient status information for food aid beneficiaries came mainly from studies in refugee/emergency settings, with very few published studies found documenting the nutritional status of non-emergency situations. The information obtained from the above mentioned sources was grouped under the major common micronutrient deficiencies in tabular forms that included the site where the study was conducted, subjects included in the assessment, sample size u...
Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framew... more Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framework for health systems (1). Human resources for health do consume a significant bulk of the health sector expenditures and also constitute a critical block of health systems as they affect the efficiency and effectiveness with which the other building blocks function. While HRH has remained neglected for years, recent decades have witnessed a wider attention both by the global health community and national governments as a critical ingredient to improving health outcomes. The World Health Report 2006 signifies an important milestone following which several consultations, initiatives and approaches to address HRH have taken effect at global, regional and country levels (2). The establishment of an HRH Secretariat within the WHO, the Global Forums on Human Resources for Health in Kampala and Thailand (3) as well as the ongoing efforts by the WHO African regional office to support ministrie...
Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tub... more Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tuberculosis (MDR-TB) and Tuberculosis/Human Immunodeficiency Virus (TB/HIV). Given the public health importance of the problem, it is apparent that probing the work done in this regard is essential to mitigate the problem and thus we reviewed research repositories and compile directories of researches in Ethiopia from Jan 1, 2001 to Dec 30, 2017 in order to avail evidence-based information to stakeholders and beneficiaries intervening the problem in the country. The evidences generated in this bibliography are through different databases and websites using key terms. A range of different published and unpublished literatures (journal articles, conference presentations, reports/manual/book, and graduate theses or dissertations) on TB, MDR-TB, extensively drug resistant TB (XDR-TB), or TB/HIV are presented. We presented literatures by four themes (Biomedical and clinical researches, epidemio...
A number of articles in this issue (1-4) highlight the importance of providing essential basic he... more A number of articles in this issue (1-4) highlight the importance of providing essential basic health services for achieving and maintaining optimal health status within a given population. The Ethiopian health system is also striving to address the need for providing essential health services within the perspective of universal health coverage (UHC) through its health care financing strategy (5) which is a basis for different reforms that include community based health insurance (CBHI) and social health insurance (SHI) schemes for people in the informal and formal sectors respectively as its health insurance strategy (6).
Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was fe... more Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.
The American Journal of Tropical Medicine and Hygiene, 2018
Mentoring is a critical component of career development for research scientists and is related to... more Mentoring is a critical component of career development for research scientists and is related to mentee success both in terms of career selection and advancement. However, there are limited data on the role of mentoring in low-and middle-income countries (LMICs). Cross-cultural mentorship programs have the potential to foster the transfer of knowledge and the development of capacity to resource-poor settings. This formative evaluation explores the cultural context of mentoring in the countries of Georgia and Ethiopia. Results were used to build culturally relevant mentor training programs for two Global Infectious Disease Research Training Programs focused on tuberculosis funded by the Fogarty International Center at the US National Institutes of Health. Four focus group discussions were conducted with research trainees and mentors to explore the perceptions of mentorship, identify obstacles for successful mentoring, and generate recommendations to strengthen mentoring in each program situated in a LMIC. Data revealed the barriers to mentoring in Ethiopia and Georgia included gaps in knowledge about mentoring roles and responsibilities, lack of knowledge about the responsibilities of the trainee in a mentoring relationship, and the need to set clear expectations between mentors and trainees. All of the focus group participants desired formal mentor training. These data informed six key components of the development and implementation of the mentor training programs in both countries. The topics included the following: a foundation in mentoring, establishing expectations between mentees and mentors, increasing interactions between mentees and mentors, additional mentor training, a case study curriculum, and methods of evaluating mentoring relationships.
Background In response to a physician shortage in Ethiopia, the number of medical students admitt... more Background In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a "flooding" policy. Objectives To assess medical student perceptions on the impact of the "flooding" policy on medical education and e-learning initiatives, as well as plans for future emigration. Design A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration. Results 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the "flooding" policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet PLOS ONE |
Background Global action plans to tackle antimicrobial resistance (AMR) include implementation of... more Background Global action plans to tackle antimicrobial resistance (AMR) include implementation of antimicrobial stewardship (AMS), but few studies have directly addressed the challenges faced by low and middle-income countries (LMICs). Our aim was to explore healthcare providers' knowledge and perceptions on AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in a referral hospital in Ethiopia. Methods Tikur Anbessa Specialized Hospital (TASH) is an 800-bed tertiary center in Addis Ababa, and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed approach of quantitative and qualitative methods, we performed a cross-sectional survey of pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of purposively selected respondents until thematic saturation. We analyzed differences in proportions of agreement between physicians and pharmacists using χ 2 and fisher exact tests. Qualitative data was analyzed thematically. Findings A total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 key informants (21 physicians and 14 pharmacists) were enrolled. The majority of survey respondents (>90%) strongly agreed with statements regarding the global scope of AMR, the need for stewardship, surveillance and education, but their perceptions on factors contributing to
The paper examines external multiple job holding practices in public health training institutions... more The paper examines external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries (Rwanda, Ethiopia, Mozambique). The study aims to contribute to broadening understanding about multiple job holding (nature and scale, drivers and reasons, impact, and efforts to regulate) in public health training schools in public universities. A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically. External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While it evidently contributes to increasing income of academics, which many described as enabling their continuing employment i...
Background: Shortages and imbalances in physician workforce distribution between urban and rural ... more Background: Shortages and imbalances in physician workforce distribution between urban and rural and among the different regions in Ethiopia are enormous. However, with the recent rapid expansion in medical education training, it is expected that the country can make progress in physician workforce supply. Therefore, the aim of this study was to examine the distribution of physician workforce in Ethiopia and assess the role of retention mechanisms in the reduction of physician migration from the public health sector of Ethiopia. Methods: This organizational survey examined physician workforce data from 119 hospitals from 5 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples Region [SNNPR], Tigray, and Harari) and 2 city administrations (Addis Ababa and Dire Dawa City). Training opportunity, distribution, and turnover between September 2009 and July 2015 were analyzed descriptively. Poisson regression model was used to find the association of different covariates with physician turnover. Results: There were 2,300 medical doctors in 5 regions and 2 city administrations in ~6 years of observations. Of these, 553 (24.04%) medical doctors moved out of their duty stations and the remaining 1,747 (75.96%) were working actively. Of the actively working, the majority of the medical doctors, 1,407 (80.5%), were males, in which 889 (50.9%) were born after the year 1985, 997 (57%) had work experience of <3 years, and most, 1,471 (84.2%), were general practitioners. Within the observation period, physician turnover among specialists ranged from 21.4% in Dire Dawa to 43.3% in Amhara region. The capital, Addis Ababa, was the place of destination for 32 (82%) of the physicians who moved out to other regions from elsewhere in the country. The Poisson regression model revealed a decreased incidence of turnover among physicians born between the years 1975 and 1985 (incident rate ratio [IRR]: 0.63; 95% confidence interval [CI]: 0.51, 0.79) and among those who were born prior to 1975 (IRR: 0.24; 95% CI: 0.17, 0.34) compared to those who were born after 1985. Female physicians were 1.4 times (IRR: 1.44; 95% CI: 1.14, 1.81) more likely to move out from their duty stations compared to males. In addition, physicians working in district hospitals were 2 times (IRR: 2.14; 95% CI: 1.59, 2.89) more likely to move out and those working in general hospitals had 1.39 times (IRR: 1.39; 95% CI: 1.08, 1.78) increased rate of turnover in comparison with those who were working in referral hospitals. Physicians working in the Amhara region had 2 times (IRR: 2.01; 95% CI: 1.49, 2.73) increased risk of turnover in comparison with those who were working in the capital, Addis Ababa. The probability of migration did not show a statistically significant difference in all other regions (P>0.05). Conclusion: The public health sector physician workforce largely constituted of male physicians, young and less experienced. High turnover rate among females, the young and less experienced physicians, and those working in distant places (district hospitals) indicate the need for special attention in devising human resources management and retention strategies.
IK Notes reports periodically on Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and ... more IK Notes reports periodically on Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and occasionally on such initiatives outside the Region. It is published by the Africa Region's Knowledge and Learning Center as part of an evolving IK partnership between the World Bank, communities, NGOs, development institutions and multilateral organizations. The views expressed in this article are those of the authors and should not be attributed to the World Bank Group or its partners in this initiative. A
Cervical cancer is the second commonest type and third cause of cancer death among women in low-i... more Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women living with HIV/AIDS are at greater risk of developing cervical cancer. The study aimed to identify the determinant factors forsuspected precancerous cervical lesions among HIV- positive women in Mekelle hospital, Ethiopia. Anunmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. In Mekelle Hospital, routine screening for lesions of the cervix uteri by visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses. Suspicious findings are treated by cryotherapy or referred to the Gynaecologist. A number of 116 cases, who had suspicious findings on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study The determinant factors for precancerous cervical lesion were analyzed using multiple logistic regression and descri...
Background. Long waiting time has been among the major factors that affect patient satisfaction a... more Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART) Clinic before and after introduction of an intervention of the systematic appointment system.Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent samplet-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time dif...
The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic... more The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic could pose a public health crisis indirectly through disruptions in essential health services. The aim of this study was to examine disruptions in health service utilization during the first nine months of the COVID-19 pandemic across 10 regions in Ethiopia. We analyzed utilization of 21 different health services across all of Ethiopia (except the Tigray region) for the period of January 2019 to December 2020. Data were extracted from the Ethiopian district health information system (DHIS2). Monthly visits in 2020 were graphed relative to the same months in 2019. Interrupted time series analysis was used to estimate the effect of the pandemic on service utilization in each region. We found that disruptions in health services were generally higher in urban regions which were most affected by COVID. Outpatient visits declined by 52%, 54%, and 58%, specifically in Dire Dawa, Addis Ababa an...
ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and i... more ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and improves patient outcomes. In low-resource settings, AMS implementation may require concurrent strengthening of clinical microbiology capacity therefore additional investments. We assessed the cost-effectiveness of implementing AMS at Tikur Anbessa Specialised Hospital (TASH), a tertiary care hospital in Ethiopia.DesignWe developed a Markov cohort model to assess the cost–utility of pharmacist-led AMS with concurrent strengthening of laboratory capacity compared with usual care from a ‘restricted societal’ perspective. We used a lifetime time horizon and discounted health outcomes and cost at 3% annually. Data were extracted from a prospective study of bloodstream infections among patients hospitalised at TASH, supplemented by published literature. We assessed parameter uncertainty using deterministic and probabilistic sensitivity analyses.SettingTertiary care hospital in Ethiopia, with 8...
Background Remaining underweight during Tuberculosis (TB) treatment is associated with a higher r... more Background Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. Methods Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus p...
Background Compassionate care is the sensitivity shown by health care providers to understand ano... more Background Compassionate care is the sensitivity shown by health care providers to understand another person’s suffering and a willingness to help and to promote the well being of that person. Although monitoring of compassionate care is key to ensuring patient-centered care, there is no validated tool in the Ethiopian context that can be applied to measure compassionate care. Therefore, this study aimed to assess the structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® (SCCCS) in the Ethiopian context. Methods The structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® were investigated in a sample of 423 oncology patients in the adult Oncology department of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The internal consistency of the instrument was examined based on Cronbach’s alpha coefficient, and the structural validity was evaluated by subjecting the items of the instrument to factor an...
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have... more Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the cou...
Background : Ethiopia is amongst the African countries that have received significant food aid. N... more Background : Ethiopia is amongst the African countries that have received significant food aid. Nonetheless, the common micronutrient deficiencies among food aid beneficiaries are not well documented. Objective : To find out the common micronutrient deficiencies among food aid beneficiaries in the country based on available data. Methods : Literature search was made from the Internet, peer-reviewed journals, various agency reports, national survey data, books, handouts and Masters in Public Health (MPH) theses since the year 2000. Micronutrient status information for food aid beneficiaries came mainly from studies in refugee/emergency settings, with very few published studies found documenting the nutritional status of non-emergency situations. The information obtained from the above mentioned sources was grouped under the major common micronutrient deficiencies in tabular forms that included the site where the study was conducted, subjects included in the assessment, sample size u...
Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framew... more Introduction Human resources for health (HRH) is one of the six building blocks of the WHO framework for health systems (1). Human resources for health do consume a significant bulk of the health sector expenditures and also constitute a critical block of health systems as they affect the efficiency and effectiveness with which the other building blocks function. While HRH has remained neglected for years, recent decades have witnessed a wider attention both by the global health community and national governments as a critical ingredient to improving health outcomes. The World Health Report 2006 signifies an important milestone following which several consultations, initiatives and approaches to address HRH have taken effect at global, regional and country levels (2). The establishment of an HRH Secretariat within the WHO, the Global Forums on Human Resources for Health in Kampala and Thailand (3) as well as the ongoing efforts by the WHO African regional office to support ministrie...
Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tub... more Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tuberculosis (MDR-TB) and Tuberculosis/Human Immunodeficiency Virus (TB/HIV). Given the public health importance of the problem, it is apparent that probing the work done in this regard is essential to mitigate the problem and thus we reviewed research repositories and compile directories of researches in Ethiopia from Jan 1, 2001 to Dec 30, 2017 in order to avail evidence-based information to stakeholders and beneficiaries intervening the problem in the country. The evidences generated in this bibliography are through different databases and websites using key terms. A range of different published and unpublished literatures (journal articles, conference presentations, reports/manual/book, and graduate theses or dissertations) on TB, MDR-TB, extensively drug resistant TB (XDR-TB), or TB/HIV are presented. We presented literatures by four themes (Biomedical and clinical researches, epidemio...
A number of articles in this issue (1-4) highlight the importance of providing essential basic he... more A number of articles in this issue (1-4) highlight the importance of providing essential basic health services for achieving and maintaining optimal health status within a given population. The Ethiopian health system is also striving to address the need for providing essential health services within the perspective of universal health coverage (UHC) through its health care financing strategy (5) which is a basis for different reforms that include community based health insurance (CBHI) and social health insurance (SHI) schemes for people in the informal and formal sectors respectively as its health insurance strategy (6).
Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was fe... more Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.
The American Journal of Tropical Medicine and Hygiene, 2018
Mentoring is a critical component of career development for research scientists and is related to... more Mentoring is a critical component of career development for research scientists and is related to mentee success both in terms of career selection and advancement. However, there are limited data on the role of mentoring in low-and middle-income countries (LMICs). Cross-cultural mentorship programs have the potential to foster the transfer of knowledge and the development of capacity to resource-poor settings. This formative evaluation explores the cultural context of mentoring in the countries of Georgia and Ethiopia. Results were used to build culturally relevant mentor training programs for two Global Infectious Disease Research Training Programs focused on tuberculosis funded by the Fogarty International Center at the US National Institutes of Health. Four focus group discussions were conducted with research trainees and mentors to explore the perceptions of mentorship, identify obstacles for successful mentoring, and generate recommendations to strengthen mentoring in each program situated in a LMIC. Data revealed the barriers to mentoring in Ethiopia and Georgia included gaps in knowledge about mentoring roles and responsibilities, lack of knowledge about the responsibilities of the trainee in a mentoring relationship, and the need to set clear expectations between mentors and trainees. All of the focus group participants desired formal mentor training. These data informed six key components of the development and implementation of the mentor training programs in both countries. The topics included the following: a foundation in mentoring, establishing expectations between mentees and mentors, increasing interactions between mentees and mentors, additional mentor training, a case study curriculum, and methods of evaluating mentoring relationships.
Background In response to a physician shortage in Ethiopia, the number of medical students admitt... more Background In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a "flooding" policy. Objectives To assess medical student perceptions on the impact of the "flooding" policy on medical education and e-learning initiatives, as well as plans for future emigration. Design A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration. Results 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the "flooding" policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet PLOS ONE |
Background Global action plans to tackle antimicrobial resistance (AMR) include implementation of... more Background Global action plans to tackle antimicrobial resistance (AMR) include implementation of antimicrobial stewardship (AMS), but few studies have directly addressed the challenges faced by low and middle-income countries (LMICs). Our aim was to explore healthcare providers' knowledge and perceptions on AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in a referral hospital in Ethiopia. Methods Tikur Anbessa Specialized Hospital (TASH) is an 800-bed tertiary center in Addis Ababa, and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed approach of quantitative and qualitative methods, we performed a cross-sectional survey of pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of purposively selected respondents until thematic saturation. We analyzed differences in proportions of agreement between physicians and pharmacists using χ 2 and fisher exact tests. Qualitative data was analyzed thematically. Findings A total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 key informants (21 physicians and 14 pharmacists) were enrolled. The majority of survey respondents (>90%) strongly agreed with statements regarding the global scope of AMR, the need for stewardship, surveillance and education, but their perceptions on factors contributing to
The paper examines external multiple job holding practices in public health training institutions... more The paper examines external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries (Rwanda, Ethiopia, Mozambique). The study aims to contribute to broadening understanding about multiple job holding (nature and scale, drivers and reasons, impact, and efforts to regulate) in public health training schools in public universities. A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically. External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While it evidently contributes to increasing income of academics, which many described as enabling their continuing employment i...
Background: Shortages and imbalances in physician workforce distribution between urban and rural ... more Background: Shortages and imbalances in physician workforce distribution between urban and rural and among the different regions in Ethiopia are enormous. However, with the recent rapid expansion in medical education training, it is expected that the country can make progress in physician workforce supply. Therefore, the aim of this study was to examine the distribution of physician workforce in Ethiopia and assess the role of retention mechanisms in the reduction of physician migration from the public health sector of Ethiopia. Methods: This organizational survey examined physician workforce data from 119 hospitals from 5 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples Region [SNNPR], Tigray, and Harari) and 2 city administrations (Addis Ababa and Dire Dawa City). Training opportunity, distribution, and turnover between September 2009 and July 2015 were analyzed descriptively. Poisson regression model was used to find the association of different covariates with physician turnover. Results: There were 2,300 medical doctors in 5 regions and 2 city administrations in ~6 years of observations. Of these, 553 (24.04%) medical doctors moved out of their duty stations and the remaining 1,747 (75.96%) were working actively. Of the actively working, the majority of the medical doctors, 1,407 (80.5%), were males, in which 889 (50.9%) were born after the year 1985, 997 (57%) had work experience of <3 years, and most, 1,471 (84.2%), were general practitioners. Within the observation period, physician turnover among specialists ranged from 21.4% in Dire Dawa to 43.3% in Amhara region. The capital, Addis Ababa, was the place of destination for 32 (82%) of the physicians who moved out to other regions from elsewhere in the country. The Poisson regression model revealed a decreased incidence of turnover among physicians born between the years 1975 and 1985 (incident rate ratio [IRR]: 0.63; 95% confidence interval [CI]: 0.51, 0.79) and among those who were born prior to 1975 (IRR: 0.24; 95% CI: 0.17, 0.34) compared to those who were born after 1985. Female physicians were 1.4 times (IRR: 1.44; 95% CI: 1.14, 1.81) more likely to move out from their duty stations compared to males. In addition, physicians working in district hospitals were 2 times (IRR: 2.14; 95% CI: 1.59, 2.89) more likely to move out and those working in general hospitals had 1.39 times (IRR: 1.39; 95% CI: 1.08, 1.78) increased rate of turnover in comparison with those who were working in referral hospitals. Physicians working in the Amhara region had 2 times (IRR: 2.01; 95% CI: 1.49, 2.73) increased risk of turnover in comparison with those who were working in the capital, Addis Ababa. The probability of migration did not show a statistically significant difference in all other regions (P>0.05). Conclusion: The public health sector physician workforce largely constituted of male physicians, young and less experienced. High turnover rate among females, the young and less experienced physicians, and those working in distant places (district hospitals) indicate the need for special attention in devising human resources management and retention strategies.
IK Notes reports periodically on Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and ... more IK Notes reports periodically on Indigenous Knowledge (IK) initiatives in Sub-Saharan Africa and occasionally on such initiatives outside the Region. It is published by the Africa Region's Knowledge and Learning Center as part of an evolving IK partnership between the World Bank, communities, NGOs, development institutions and multilateral organizations. The views expressed in this article are those of the authors and should not be attributed to the World Bank Group or its partners in this initiative. A
Cervical cancer is the second commonest type and third cause of cancer death among women in low-i... more Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women living with HIV/AIDS are at greater risk of developing cervical cancer. The study aimed to identify the determinant factors forsuspected precancerous cervical lesions among HIV- positive women in Mekelle hospital, Ethiopia. Anunmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. In Mekelle Hospital, routine screening for lesions of the cervix uteri by visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses. Suspicious findings are treated by cryotherapy or referred to the Gynaecologist. A number of 116 cases, who had suspicious findings on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study The determinant factors for precancerous cervical lesion were analyzed using multiple logistic regression and descri...
Background. Long waiting time has been among the major factors that affect patient satisfaction a... more Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART) Clinic before and after introduction of an intervention of the systematic appointment system.Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent samplet-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time dif...
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