Prehospital emergency medical service utilization and associated factors among critically ill COVID-19 patients treated at centers in Addis Ababa, Ethiopia

The majority of populations in developing countries are living in areas of no access or limited access to prehospital emergency medical services (EMS). In Addis Ababa, the reported prehospital EMS utilization were ranging from zero to thirty-eight percent. However, there is limited research on reasons for the low utilization of prehospital resources in Ethiopia. This study aimed to assess factors associated with prehospital EMS utilization among critically ill COVID-19 patients in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted to collect primary data from 421 COVID-19 patients in Addis Ababa between May and July 2021. Logistic regression was used to identify factors associated with prehospital service utilization. Andersen's Behavioral Model was implemented to address independent variables, including predisposing, enabling, need, and health behaviors-related variables. The level of prehospital care utilization was 87.6%. Being married [AOR 2.6(95%;CI:1.24–5.58)], belief that self-transport is quicker than the ambulance [AOR 0.13(95%;CI: 0.05–0.34)], and perceptions that ambulance provides transportation service only [AOR 0.14(95%;CI:0.04–0.45)] were predisposing factors associated with prehospital service utilization while the source of referrals [AOR 6.9(95%;CI: 2.78–17.30)], and prior knowledge on the availability of toll-free ambulance calling numbers [AOR 0.14(95%;CI: 0.04–0.45)] were identified as enabling factors. Substantial proportions of critically ill COVID-19 patients used prehospital services to access treatment centers. Prehospital EMS utilization in this study varies by predisposing and enabling factors, particularly: marital status, source of referral, prior knowledge on the availability of toll-free ambulances, belief that self-transport is quicker than ambulances, and perceptions that ambulance provides transportation service only. Our findings call for further actions to be taken by policymakers including physical and media campaigns focusing on the identified factors.

Prehospital characteristics of COVID-19 patients transported by emergency medical service and the predictors of a prehospital sudden deterioration in Addis Ababa, Ethiopia.

BACKGROUND: Severally ill COVID-19 patients may require urgent transport to a specialized facility for advanced care. Prehospital transport is inherently risky; the patient's health may deteriorate, and potentially fatal situations may arise. Hence, early detection of clinically worsening patients in a prehospital setting may enable selecting the best receiving facility, arranging for swift transportation, and providing the most accurate and timely therapies. The incidence and predictors of abrupt prehospital clinical deterioration among critically ill patients in Ethiopia are relatively limited. STUDY OBJECTIVES: This study was conducted to determine the incidence of sudden clinical deterioration during prehospital transportation and its predictors. METHODS: A prospective cohort study of 591 COVID-19 patients transported by a public EMS in Addis Ababa. For data entry, Epi data V4.2 and SPSS V 25 were used for analysis. To control the effect of confounders, the candidate variables for multivariable analysis were chosen using a p 0.25 inclusion threshold from the bivariate analysis. A statistically significant association was declared at adjusted relative risk (ARR) ≠ 1 with a 95 % confidence interval (CI) and a p value < 0.05 after adjusting for potential confounders. RESULTS: The incidence of prehospital sudden clinical deterioration in this study was 10.8%. The independent predictors of prehospital sudden clinical deterioration were total prehospital time [ARR 1.03 (95%; CI 1.00-1.06)], queuing delays [ARR 1.03 (95%; CI 1.00-1.06)], initial prehospital respiratory rate [ARR 1.07 (95% CI 1.01-1.13)], and diabetic mellitus [ARR 1.06 (95%; CI 1.01-1.11)]. CONCLUSION: In the current study, one in every ten COVID-19 patients experienced a clinical deterioration while an EMS provider was present. The factors that determined rapid deterioration were total prehospital time, queueing delays, the initial respiratory rate, and diabetes mellitus. Queueing delays should be managed in order to find a way to decrease overall prehospital time. According to this finding, more research on prehospital intervention and indicators of prehospital clinical deterioration in Ethiopia is warranted.

Factors Associated with Willingness to Call Emergency Medical Services for Worsening Symptoms of COVID-19 in Addis Ababa, Ethiopia.

Background: In response to the COVID-19 pandemic, the Ethiopian Ministry of Health has established ambulances and dispatch centers specifically designed to transport COVID-19 patients to city medical centers. Due to a lack of evidence in this area, it is critical to assess the factors that influence the willingness to call for emergency medical services. Methods: A community-based cross-sectional study was conducted from June to July 2021 in Addis Ababa. The data were gathered through use of a pretested questionnaire and analyzed using SPSS 25. Logistic regression was used to calculate odds ratios with and without confounding variable controls, and significant associations were declared at (0.05). For the variables that show significant associations in bivariate and multivariate analyses, a 95% confidence interval is provided. Results: Three-quarters of those surveyed said they would call ambulance if they experienced worsening COVID-19 symptoms. The individual's language was associated with the willingness to call EMS for worsening COVID-19 symptoms [AOR 0.51(95% CI: 0.28-0.92)].; awareness of the availability of toll-free ambulance services [AOR 3.4(95% CI: 1.92-5.95)]; recalling an EMS number [AOR 4.3(95% CI: 1.71-10.67)]; ambulance crew quality of care perception [AOR 3.6(95% CI: 2.09-6.10)]; ambulance service adequacy and accessibility perception [AOR 0.25(95% CI: 0.11-0.55)]. Conclusion: The study showed significant portion of the Addis Ababa community recognized the need to call EMS due to worsening COVID-19 symptoms. The individual's language, awareness of toll-free ambulance; ability to recall an ambulance number, perception of the ambulance crew's quality of care and adequacy and accessibility of service in the city influence the decision to call an ambulance. The finding highlights the significance of addressing problems through various media outlet, for advocacy and public awareness. More research, including qualitative studies, is needed to investigate the factors that encourage people to seek EMS.

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia.

BACKGROUND: The burden of critical illness in low-income countries is high and expected to rise. This has implications for wider public health measures including maternal mortality, deaths from communicable diseases, and the global burden of disease related to injury. There is a paucity of data pertaining to the provision of critical care in low-income countries. This study provides a review of critical care services in Ethiopia. METHODS: Multicenter structured onsite surveys incorporating face-to-face interviews, narrative discussions, and on-site assessment were conducted at intensive care units (ICUs) in September 2020 to ascertain structure, organization, workforce, resources, and service capacity. The 12 recommended variables and classification criteria of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) taskforce criteria were utilized to provide an overview of service and service classification. RESULTS: A total of 51 of 53 (96%) ICUs were included, representing 324 beds, for a population of 114 million; this corresponds to approximately 0.3 public ICU beds per 100,000 population. Services were concentrated in the capital Addis Ababa with 25% of bed capacity and 51% of critical care physicians. No ICU had piped oxygen. Only 33% (106) beds had all of the 3 basic recommended noninvasive monitoring devices (sphygmomanometer, pulse oximetry, and electrocardiography). There was limited capacity for ventilation (n = 189; 58%), invasive monitoring (n = 9; 3%), and renal dialysis (n = 4; 8%). Infection prevention and control strategies were lacking. CONCLUSIONS: This study highlights major deficiencies in quantity, distribution, organization, and provision of intensive care in Ethiopia. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.

The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors.

BACKGROUND: COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. METHODS: A total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. RESULTS: The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. CONCLUSIONS: There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.

Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. METHODS: A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. DISCUSSION: This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. TRIAL REGISTRATION: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.

Clinical Characteristics of COVID-19 Related Deaths in Ethiopia.

BACKGROUND: Since the occurrence of COVID-19 in the world, it has claimed nearly 1.39 million human lives in the world and more than 1500 lives in Ethiopia. The number of deaths is increasing with variable distribution in the world. Despite its increasing fatality, the clinical characteristics of the deceased patients are not yet fully known. Analyzing the clinical characteristics of deceased patients will help to improve the outcome of infected patients. Hence, this study aimed to determine the clinical characteristics of patients who died due to COVID-19 in Ethiopia. METHODS: Hospital based multi-center cross-sectional study was conducted using chart review of deceased patients. Since the number of COVID-19 related deaths was limited, all consecutive COVID-19 related hospital deaths were analyzed. The data was entered into and analyzed using SPSS version 25.0. Descriptive statistics was used to explain the data collected from the survey. RESULT: A total of 92 deceased patient charts were analyzed. Of these patients, 65(71%) were males. Age ranged from 17 to 92 years (mean age being 59 years). On arrival vital signs, 60.5% of them had hypoxia, 49% had tachycardia and only 32% of patients had fever. Three fourth of the patients 64/85 had at least one comorbidity. Diabetes mellitus (DM) was the commonest comorbidity accounting for 445.9%, followed by hypertension, 23/85(27%), and HIV/ AIDS, 15/85 (17.5%). CONCLUSION: The results of this study showed that COVID-19 deceased patients presented with respiratory failure and hypoxia. However, less than a third of these patients had fever. In addition, the presence of comorbid illnesses and non-COVID-19 diseases like AIDS defining illness in significant amount needs further study to identify their level of contribution to the increasing burden of COVID-19 deaths in Ethiopia.

Clinical and Socio-demographic Profile of the First 33 COVID-19 Cases Treated at Dedicated Treatment Center in Ethiopia.

BACKGROUND: Severe respiratory tract infection caused by family of Corona viruses has become world pandemic. The purpose of this study was to describe the first few COVID 19 cases in Ethiopia. METHOD: Descriptive study was conducted on the first 33 consecutive RT-PCR confirmed COVID 19 cases diagnosed and managed at Ekka-Kotebe COVID Treatment Center in Addis Ababa, Ethiopia. RESULT: The median age of the cases was 36 years. Cough, headache and fever were the most frequent symptoms. Diarrhea, sore throats, loss of taste and/or smell sensation were among the rare symptoms. Most (84.8%) had mild to moderate disease, and 15.2%(n=5) were critical at the time of admission. Among the five ICU admissions, four patients required invasive mechanical ventilation. Thirty cases were discharged after two pairs of nasopharyngeal and oropharyngeal samples turned negative for SARS CoV2. Three cases from the ICU died while on mechanical ventilator. The age of the two deaths was 65 years, and one was 60 years. With the exception of three, all cases were either imported from abroad or had contact with confirmed cases. CONCLUSION: Most of our patients were in the younger age group with male predominance and few with comorbidities. Cough was the commonest symptom followed by headache and fever. As it was in the early stage of the pandemic, observation of more cases in the future will reveal further clinical and demographic profiles of COVID-19 cases in Ethiopia.