Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.
Background Community-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia. Methods This IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation. Results This IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers’ care-seeking behavior for their sick young infants. The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings. Conclusions The use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.
Background Type 2 diabetes mellitus (T2DM) is a chronic disease associated with worse clinical presentation. However, the current investigation practices in Ethiopia have limitations to demonstrate the scope of the clinical burden. Hence, this study was aimed at assessing the glycemic status and coronary heart disease (CHD) risk of persons with T2DM using HbA1c and atherogenic index of plasma (AIP). Method This institution-based cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Demographic, socioeconomic, and lifestyle data were collected through a face-to-face interview. Clinical information was retrieved from medical records whereas anthropometric and biochemical measurements were performed using the WHO protocols. Glycemic status was determined using HbA1c and CHD risk assessed using an atherogenic index of plasma (AIP). Gaussian variables were expressed using mean and standard deviation (SD), Log-normal variables using geometric mean and 95% CI and non- Gaussian variables using median and interquartile ranges. Categorical variables were summarized using absolute frequencies and percentages. Multivariable logistic regression was used to identify factors associated with glycemic control with a statistical significance set at 5%. Result A total of 195 male and 226 female subjects were involved in this study. The results demonstrated that 77% (324) had HbA1c value ≥7% and 87.2% (367) had high atherogenic risk for CHD. Besides, 57% and 67.9% of persons with T2DM had metabolic syndrome according to International Diabetes Federation (IDF) and the National Cholesterol Education Program—Adult treatment panel III (NCEP-ATP III) criteria, respectively. About 36.8% had one or more comorbidities. Having healthy eating behavior [AOR 1.95; CI 1.11–3.43] and taking metformin [AOR 4.88; CI 1.91–12.44] were associated with better glycemic outcomes. Conclusion High AIP level concomitant with poor glycemic control indicates increased risk for coronary heart disease among persons with T2DM in Northern Ethiopia.
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