Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery. Methods Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021. Results Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively). Conclusion and recommendations Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE.
Background: Electrocardiography is a graphic representation of the electrical activity of the heart. According to previous literature, nurses have poor knowledge and skills about basic electrocardiography interpretation. For instance, a previous survey conducted in Turkey showed that only 38.1 percent of nurses were able to recognize ventricular fibrillation, 54.3% myocardial infarction, and 33.3% third-degree atrioventricular block. Objective: This study was aimed at assessing Nurses’ competency in electrocardiography interpretation in adult emergency rooms in Addis Ababa, Ethiopia, in 2021. Method: An institutional-based descriptive, cross-sectional study design was used to conduct the study. A total of 175 nurses in five randomly selected hospitals with adult emergency rooms were included in this study. Semi-structured, self-administered questionnaires were used to collect the data. Data were entered into Epi data and analyzed using SPSS version 26. A Fisher’s exact test was used to identify the relationship between dependent and independent variables. Results: Of 203 respondents, 175 actively participated, for a response rate of 86.2%. From those 175 nurses, 159 (90.9%) were not competent (scored < 65%), and the mean score was 6.82 ± 3.65 SD. Conclusion: The overall level of competency of nurses in electrocardiography interpretation is low. This implies most nurses in the emergency room do not monitor and manage a patient's electrocardiography for manifestations of arrhythmias, electrolyte disturbance and other cardiac abnormalities. Level of education and training were a determinant factor to enhance their competency.
BackgroundThe Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. There is no study from Ethiopia that assessed financial risk of emergency abdominal surgery.MethodsUsing a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021.ResultsAppendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8% and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6% and 62.7% of patients sustained CE, respectively. Laparotomy and cholecystectomy resulted in higher rate of CE than appendectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Noninsured patients were 10.9 and 9.9 times more likely to sustain CE (p = 0.002 and p = 0.006 respectively).Conclusion and RecommendationsSignificant financial burden because of emergency abdominal surgery in Addis Ababa is very high. Insurance based financial care is shown to decrease risk of CE significantly. Policy makers should work on expanding insurance and other forms of surgical care financing to a larger proportion of population.
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