Outcomes and factors associated with prolonged stays among patients admitted to adult intensive care unit in a resource-limited setting: a multicenter chart review.

The length of stay in an intensive care unit is used as a benchmark for measuring resource consumption and quality of care and predicts a higher risk of readmission. The study aimed to assess the outcome and factors associated with prolonged intensive care unit stays among those admitted to adult intensive care units of selected public hospitals in Addis Ababa from January 1, 2022, to December 31, 2022. A multicenter retrospective chart review was conducted involving 409 adult patients. Binary logistic regression was used to assess factors associated with a prolonged stay and chi-square tests were used to assess associations and differences in outcomes for prolonged stays. The study, involving 409 of 421 individuals, revealed a predominantly male (55.0%) and the median age of study participants was 38, with an interquartile range (27, 55). Approximately 16.9% experienced prolonged stays, resulting in a 43.5% mortality rate. After adjustments for confounders, there were significant associations with prolonged stays for sedative/hypnotics, readmission, and complications. The study revealed that for every six patients admitted to the intensive care unit, one patient stayed longer, with nearly half experiencing mortality, demanding increased attention. The study emphasized the critical need for improvement in addressing associations between sedative/hypnotics, readmissions, complications, and prolonged stays.

Knowledge, attitudes and beliefs about acute coronary syndrome among patients diagnosed with acute coronary syndrome, Addis Ababa, Ethiopia.

BACKGROUND: Acute coronary syndrome (ACS) morbidity and mortality are rising in low- and middle-income countries, including Ethiopia. The shift in health-care resources from communicable diseases to chronic conditions has created formidable health-care challenges. OBJECTIVE: The objective of this study was to examine the knowledge, attitudes and beliefs among ACS patients. METHODS: A cross-sectional design was used to enroll participants admitted to one of 3 emergency units in Addis Ababa, Ethiopia. Knowledge, attitudes and beliefs about ACS was measured using modified ACS response index questionaries. RESULTS: Participant's (N = 330) mean age was 57.9 ± 14.1, majority male (n = 219, 66.36%). Half of the study participants have inadequate Knowledge (n = 147, 44.6%), unfavorable attitudes (n = 152, 46%), and belief (n = 153, 46.4%) about ACS symptoms even after being diagnosed and treated in the emergency unit. The most frequently recognized ACS symptoms were chest discomfort (n = 274, 83%), fatigue (n = 267, 80.9%) and chest pain (n = 266, 80.6%) while Jaw pain (n = 101, 30%) neck pain (n = 146,44.2%), were less often recognized. Nearly two thirds of the participants (n = 214, 65%) would not prefer to use emergency medical services (EMS) to come to the hospital. Factors associated with adequate knowledge were age < 45 (AOR = 2.16, CI (1.1-4.0) p = 0.014), and female sex (AOR = 2.7, CI (1.5-4.4) p = 0.001) and diabetics (AOR = 1.9, (1.18-3.0) p = 0.008). Meanwhile, lack of formal education (AOR = 6.7, CI (3.1-14) p < 0.001) and unemployment (AOR = 2.0, CI (1.1-3.8) p = 0.021) were associated with unfavorable attitude. In addition, lack of social support (AOR = 1.9, (1.17-3.0) p = 0.009) and unfavorable attitude (AOR = 2.1, CI (1.3-3.4) p = 0.001) were significantly associated with unfavorable belief. CONCLUSION: Despite receiving treatment for ACS in an emergency unit, roughly half of participants did not have adequate knowledge, favorable attitude and belief towards ACS. This elucidates there is significant communication gap between the health care providers and patients. The study findings stipulate there is a need to provide health awareness campaigns using different media outlet with special attention to the uneducated and unemployed groups. Furthermore, most participants were less likely to utilize emergency medical service, which should be further investigated and addressed.

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.

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.

The Emory-Addis Ababa PhD in Nursing Program: A sustainable model for strengthening nursing research capacity in Ethiopia.

In 2015, Ethiopia's first PhD in nursing program was established in collaboration between the Addis Ababa University (AAU) and Emory University Schools of Nursing. Eleven students have entered the program since its inception, six have successfully defended their proposals, one has graduated, and two have received Fogarty Global Health Fellowships. This paper describes the evolution of this international partnership and the innovative processes and mechanisms involved in program implementation; the authors address the description of the program, central implementation challenges, notable outcomes, and student achievements. One key implementation challenge has been that, although nursing is one of the largest healthcare workforces in Ethiopia, nurses remain underutilized and undervalued in the workplace. This treatment is due, in part, to limited professional regulations, leading some of the PhD students to apply their leadership skills to advocate for national practice reform. According to students, the PhD program has been a means not only to improve nursing research capacity and education in Ethiopia, but also to generate the regulations necessary for graduates to practice according to their degree. While the opportunity to generate knowledge is vitally important, students also value the chance to transform the profession of nursing.