BackgroundAnti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia.MethodsAn institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis.ResultsThe overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers.ConclusionThe overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital.
BackgroundIn Ethiopia and other developing countries, electronic medical record systems and other health information technology are being introduced. However, a small proportion of low-income countries have successfully implemented national health information systems. One cause for this can be the lack of digital literacy among medical practitioners. As a result, this study aimed to assess health professionals’ digital literacy level and associated factors in Northwest Ethiopia.MethodA quantitative cross-sectional study was employed among 423 health professionals working in a teaching and referral hospital in Northwest Ethiopia. We modified and applied the European commission’s framework for digital competency to assess the level of digital literacy among health professionals. We used stratified random sampling with proportional allocation to the size of the departments in the hospital to select study participants. Data were collected using a semi-structured, self-administered, and pretested questionnaire. Descriptive and binary logistic regression analysis techniques were used to describe respondents’ digital literacy level and identify its associated factor, respectively. The odds ratio with 95% CI and value of p were used to assess the strength of the association and statistical significance, respectively.ResultsOut of 411 participants, 51.8% (95% CI, 46.9–56.6%) of health professionals had adequate digital literacy. Holding a master’s degree (Adjusted OR = 2.13, 95% CI: 1.18–3.85), access to digital technology (AOR = 1.89, 95% CI: 1.12–3.17), having training in digital technology (AOR = 1.65, 95% CI: 1.05–2.59), and having a positive attitude towards digital health technology (AOR = 1.64, 95% CI: 1.02–2.68) were found to be significant factors associated with health professionals digital literacy level of health professionals.ConclusionLow level of digital literacy among health professionals was observed, with nearly half (48.2%) of them having poor digital literacy levels. Access to digital technology, training on digital technology, and attitude toward digital health technology were significant factors associated with digital literacy. It is suggested to increase computer accessibility, provide a training program on digital health technology, and promote a positive attitude toward this technology to improve the deployment of health information systems.
Background A strong health information system (HIS) is one of the essential building blocks for a resilient health system. The Ministry of Health (MOH) of Ethiopia is working on different initiatives to strengthen the national HIS. Among these is the Capacity-Building and Mentorship Partnership (CBMP) Programme in collaboration with public universities in Ethiopia since November 2017. This study aims to evaluate the outcomes and share experiences of the country in working with universities to strengthen the national HIS. Methods The study employed a mixed-methods approach that included 247 health organizations (health offices and facilities) of CBMP-implementing woredas (districts) and 23 key informant interviews. The programme focused on capacity-building and mentoring facilities and woreda health offices. The status of HIS was measured using a connected woreda checklist before and after the intervention. The checklist consists of items related to HIS infrastructure, data quality and administrative use. The organizations were classified as emerging, candidate or model based on the score. The findings were triangulated with qualitative data collected through key informant interviews. Results The results showed that the overall score of the HIS implementation was 46.3 before and 74.2 after implementation of the programme. The proportion of model organizations increased from 1.2% before to 31.8% after the programme implementation. The health system–university partnership has provided an opportunity for higher education institutions to understand the health system and tune their curricula to address real-world challenges. The partnership brought opportunities to conduct and produce local- and national-level evidence to improve the HIS. Weak ownership, poor responsiveness and poor perceptions of the programme were mentioned as major challenges in programme implementation. Conclusion The overall HIS has shown substantial progress in CBMP implementation woredas. A number of facilities became models in a short period of time after the implementation of the programme. The health system–university partnership was found to be a promising approach to improve the national HIS and to share the on-the-ground experiences with the university academicians. However, weak ownership and poor responsiveness to feedback were the major challenges identified as needing more attention in future programme implementation.
Background The health management information system has been implemented at all levels of healthcare delivery to ensure quality data production and information use in Ethiopia. Including the capacity-building activities and provision of infrastructure, various efforts have been made to improve the production and use of quality health data though the result is still unsatisfactory. This study aimed to examine the quality of health data and use in Wogera and Tach-Armacheho districts and understand its barriers and facilitators. Methods The study utilized a mixed-method; for the quantitative approach, institution-based cross-sectional study was conducted to determine the quality of health data and use by 95 departments in the two districts. The qualitative approach involved 16 in-depth interviewees from Wogera district. A descriptive Phenomenological design was used to explore factors influencing the quality and use of health data. The quantitative data were expressed descriptively with tables, graphs, and percent whereas the qualitative data were analyzed with content analysis guided by the social-ecological model framework. Result The average levels of information use for Wogera and Tach-Armacheho districts were estimated at 29 and 35.9, respectively. The overall average level of accuracy of reports for six different health services in the HCs of Wogera and Tach Armacheho districts were 0.95 and 0.86, respectively. The qualitatively identified factors that influence the production and use of quality health data include valuing data, getting staff training, being a patriotic staff, and getting supportive supervision, were identified from individual-level characteristics; similarly, coaching, supportive supervision, and peer-to-peer learning from relational/interpersonal level characteristics, and organizational culture, incentive, infrastructure establishing accountability, and staff turnover, were identified from organizational level characteristics. Conclusion The quality of data and routine information utilization was low and were influenced by a number of actors presented in and around the health system including individual, interpersonal, and organizational characteristics. Incentive affects data quality and information use directly or indirectly after modifying factors at all levels of the social-ecological model. Therefore, interventions should gear towards addressing multiple social-ecological factors of the health system concomitantly or intervene on incentive which has a multifaceted effect on the outcome.
Introduction: Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is the lack of communication between child caretakers and health workers. This necessitates developing an appropriate and uninterrupted vaccine delivery strategy with more focus on demand side interventions like forgetfulness.Objectives: This paper aimed to develop and test an automated mobile text message reminder system in the local context.Methods: Before development of the system, interview and document reviews were used for requirement gathering. This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Front end application was developed using Java technologies while back end applications were developed with Oracle database. Finally, pilot testing was done on 30 participants before actual implementation.Results: The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2.SMS application for automatic SMS text messaging. In the final testing, all the messages (100%) were delivered to the piloted mothers. Message speeds for each individual client ranged on average from 5 second to 30 seconds.Conclusion: Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message interventions should be carefully developed, tested and refined before implementation to ensure they are written in the most appropriate way for their target population.
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