Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis.

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Risk prediction model of self-reported hypertension for telemedicine based on the sociodemographic, occupational and health-related characteristics of seafarers: a cross-sectional epidemiological study.

OBJECTIVES: High blood pressure is a common health concern among seafarers. However, due to the remote nature of their work, it can be difficult for them to access regular monitoring of their blood pressure. Therefore, the development of a risk prediction model for hypertension in seafarers is important for early detection and prevention. This study developed a risk prediction model of self-reported hypertension for telemedicine. DESIGN: A cross-sectional epidemiological study was employed. SETTING: This study was conducted among seafarers aboard ships. Data on sociodemographic, occupational and health-related characteristics were collected using anonymous, standardised questionnaires. PARTICIPANTS: This study involved 8125 seafarers aged 18-70 aboard 400 vessels between November 2020 and December 2020. 4318 study subjects were included in the analysis. Seafarers over 18 years of age, active (on duty) during the study and willing to give informed consent were the inclusion criteria. OUTCOME MEASURES: We calculated the adjusted OR (AOR) with 95% CIs using multiple logistic regression models to estimate the associations between sociodemographic, occupational and health-related characteristics and self-reported hypertension. We also developed a risk prediction model for self-reported hypertension for telemedicine based on seafarers' characteristics. RESULTS: Among the 4318 participants, 55.3% and 44.7% were non-officers and officers, respectively. 20.8% (900) of the participants reported having hypertension. Multivariable analysis showed that age (AOR: 1.08, 95% CI 1.07 to 1.10), working long hours per week (AOR: 1.02, 95% CI 1.01 to 1.03), work experience at sea (10+ years) (AOR: 1.79, 95% CI 1.33 to 2.42), being a non-officer (AOR: 1.75, 95% CI 1.44 to 2.13), snoring (AOR: 3.58, 95% CI 2.96 to 4.34) and other health-related variables were independent predictors of self-reported hypertension, which were included in the final risk prediction model. The sensitivity, specificity and accuracy of the predictive model were 56.4%, 94.4% and 86.5%, respectively. CONCLUSION: A risk prediction model developed in the present study is accurate in predicting self-reported hypertension in seafarers' onboard ships.

Comparative serum lipid and immunohematological values among adult pulmonary tuberculosis and tuberculosis lymphadenitis cases and their association with sputum bacilli load and time to culture positivity in Northwestern Ethiopia.

BACKGROUND: The serum lipid and immunohematological values of tuberculosis lymphadenitis (TBLN) patients is poorly documented relative to pulmonary tuberculosis (PTB) cases. Therefore, the aim of this study was to investigate the serum lipid and immunohematological values of patients with TBLN in comparison with PTB (PTB) patients. METHODS: An institution-based comparative cross-sectional study was conducted in Northwest Ethiopia from March to December 2021. The study participants were bacteriologically confirmed PTB (n = 82) and TBLN (n = 94) cases with no known comorbidity and whose ages was greater than 18 years and with no current pregnancy. Independent sample t-test, one-way ANOVA, box plot, and correlation matrix were used to analyze the data. RESULTS: The body mass index (BMI), CD4 + T cell count, and high-density lipoprotein-Cholesterol (HDL-C) values were significantly higher among TBLN cases compared with PTB cases. Additionally, the total white blood cell (WBC) count, hemoglobin (Hb), total Cholesterol (CHO) and creatinine (Cr) values were relatively higher among TBLN than PTB (P > 0.05). On the reverse, the platelet count and triacylglycerol (TAG) values were relatively higher among PTB than in TBLN cases. While the mean days of culture positivity were 11.6 days for TBLN, the mean days of culture positivity were 14.0 days for PTB. Anemia and serum lipid values showed no correlation with sputum bacilli load and time to culture positivity. CONCLUSION: Tuberculous lymphadenitis patients were well-endowed with serum lipid, immunological and nutritional status compared with PTB cases. Hence, the high incidence rate of TBLN in Ethiopia could not be explained by low peripheral immunohematological values, malnutrition, Anemia, and dyslipidemia. Further study for identifying the predictors for TBLN in Ethiopia is highly desirable.

In-depth evaluation of machine learning methods for semi-automating article screening in a systematic review of mechanistic literature.

We aimed to evaluate the performance of supervised machine learning algorithms in predicting articles relevant for full-text review in a systematic review. Overall, 16,430 manually screened titles/abstracts, including 861 references identified relevant for full-text review were used for the analysis. Of these, 40% (n = 6573) were sub-divided for training (70%) and testing (30%) the algorithms. The remaining 60% (n = 9857) were used as a validation set. We evaluated down- and up-sampling methods and compared unigram, bigram, and singular value decomposition (SVD) approaches. For each approach, Naïve Bayes, Support Vector Machines (SVM), regularized logistic regressions, neural networks, random forest, Logit boost, and XGBoost were implemented using simple term frequency or Tf-Idf feature representations. Performance was evaluated using sensitivity, specificity, precision and area under the Curve. We combined predictions of the best-performing algorithms (Youden Index ≥0.3 with sensitivity/specificity≥70/60%). In a down-sample unigram approach, Naïve Bayes, SVM/quanteda text models with Tf-Idf, and linear SVM e1071 package with Tf-Idf achieved >90% sensitivity at specificity >65%. Combining the predictions of the 10 best-performing algorithms improved the performance to reach 95% sensitivity and 64% specificity in the validation set. Crude screening burden was reduced by 61% (5979) (adjusted: 80.3%) with 5% (27) false negativity rate. All the other approaches yielded relatively poorer performances. The down-sampling unigram approach achieved good performance in our data. Combining the predictions of algorithms improved sensitivity while screening burden was reduced by almost two-third. Implementing machine learning approaches in title/abstract screening should be investigated further toward refining these tools and automating their implementation.

Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study.

BACKGROUND: Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. METHODS: A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. RESULTS: In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. CONCLUSION: This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community's educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU.

Racial/ethnic differences in the prevalence and incidence of metabolic syndrome in high-income countries: a protocol for a systematic review.

BACKGROUND: Metabolic syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure, and high blood glucose, but its prevalence varies widely by geographical region, sex, and race/ethnicity. The objective of this study is to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries. METHODS: We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g., cross sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g., different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g., abdominal obesity, dyslipidemia, high blood pressure, and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity. CONCLUSION: This systematic review will identify, evaluate, and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020157189.

Predicting skilled delivery service use in Ethiopia: dual application of logistic regression and machine learning algorithms.

BACKGROUND: Skilled assistance during childbirth is essential to reduce maternal deaths. However, in Ethiopia, which is among the six countries contributing to more than half of the global maternal deaths, the coverage of births attended by skilled health personnel remains very low. The aim of this study was to identify determinants and develop a predictive model for skilled delivery service use in Ethiopia by applying logistic regression and machine-learning techniques. METHODS: Data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was used for this study. Statistical Package for Social Sciences (SPSS) and Waikato Environment for Knowledge Analysis (WEKA) tools were used for logistic regression and model building respectively. Classification algorithms namely J48, Naïve Bayes, Support Vector Machine (SVM), and Artificial Neural Network (ANN) were used for model development. The validation of the predictive models was assessed using accuracy, sensitivity, specificity, and area under Receiver Operating Characteristics (ROC) curve. RESULTS: Only 27.7% women received skilled delivery assistance in Ethiopia. First antenatal care (ANC) [AOR = 1.83, 95% CI (1.24-2.69)], birth order [AOR = 0.22, 95% CI (0.11-0.46)], television ownership [AOR = 6.83, 95% CI (2.52-18.52)], contraceptive use [AOR = 1.92, 95% CI (1.26-2.97)], cost needed for healthcare [AOR = 2.17, 95% CI (1.47-3.21)], age at first birth [AOR = 1.96, 95% CI (1.31-2.94)], and age at first sex [AOR = 2.72, 95% CI (1.55-4.76)] were determinants for utilizing skilled delivery services during the childbirth. Predictive models were developed and the J48 model had superior predictive accuracy (98%), sensitivity (96%), specificity (99%) and, the area under ROC (98%). CONCLUSIONS: First ANC and contraceptive uses were among the determinants of utilization of skilled delivery services. A predictive model was developed to forecast the likelihood of a pregnant woman seeking skilled delivery assistance; therefore, the predictive model can help to decide targeted interventions for a pregnant woman to ensure skilled assistance at childbirth. The model developed through the J48 algorithm has better predictive accuracy. Web-based application can be build based on results of this study.

Corrigendum: Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media.

[This corrects the article DOI: 10.3389/fendo.2019.00135.].

Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media.

Introduction: This study aimed to identify popular diabetes applications (apps) and to investigate the association of diabetes app use and other factors with cumulative self-care behaviour. Methods: From November 2017 to March 2018, we conducted a web-based survey with persons 18 years of age and above. We recruited respondents via diabetes Facebook groups, online patient-forums and targeted Facebook advertisements (ads). Data on participants' demographic, clinical, and self-management characteristics, as well as on self-care behaviour and characteristics of the diabetes apps use were collected. Self-care behaviour was measured using a licensed version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The cumulative self-care score was calculated by summing up scores for "general diet," "specific diet," "exercise," "blood glucose testing," "foot care" and "smoking." To identify popular diabetes apps, users were requested to list all apps they use for diabetes self-management. Two sample t-test and multiple linear regression stratified by type of diabetes were performed to examine associations between app use and self-care behaviour, by controlling for key confounders. Results: One thousand fifty two respondents with type 1 and 630 respondents with type 2 diabetes mellitus (DM) entered the survey. More than half, 549 (52.2%), and one third, 210 (33.3%), of respondents with type 1 and 2 DM, respectively, reported using diabetes apps for self-management. "mySugr" and continuous glucose monitoring apps, such as "Dexcom," "Freestyle Libre," and "Xdrip+" were some of the most popular diabetes apps. In both respondent groups, the cumulative self-care behaviour score was significantly higher among diabetes app users (compared to non-users) and scores for three individual self-care components, namely "blood glucose monitoring," "general diet," and "physical activity" were significantly higher among diabetes app users than among non-users. After adjusting for confounding factors, diabetes app use increased the cumulative self-care score by 1.08 (95%CI: 0.46-1.7) units among persons with type 1 DM and by 1.18 (95%CI: 0.26-2.09) units among persons with type 2 DM, respectively. Conclusion: For both, persons with type 1 and type 2 diabetes, using diabetes apps for self-management was positively associated with self-care behaviour. Our findings suggest that apps can support changes in lifestyle and glucose monitoring in these populations.

Access to mobile phone and willingness to receive mHealth services among patients with diabetes in Northwest Ethiopia: a cross-sectional study.

OBJECTIVES: This study aimed at determining access to mobile phone and willingness to receive mobile phone-based diabetes health services as well as identify associated factors in Northwest Ethiopia. DESIGN: An institution-based cross-sectional survey was conducted from February to March 2016. PARTICIPANTS: Systematic randomly selected 423 patients with diabetes. SETTING: University of Gondar Hospital diabetic clinic. MAIN OUTCOME MEASURES: The main outcome measure was willingness to receive diabetic health service via mobile phone voice call or messaging services. RESULTS: Out of 423 patients with diabetes, 329 (77.8%) had access to a mobile phone. Among the latter, 232 (70.5%) were willing to receive mobile phone-based health services. The educational status of patients (adjusted OR (AOR): 2.6 (95% CI: 1.2 to 5.58)), route of medication (AOR: 3.2 (95% CI: 1.44 to 7.1)), transportation mechanism (AOR: 4.1 (95% CI: 1.2 to 13.57)), travel time to health facility (AOR: 0.3 (95% CI: 0.12 to 0.82)), current use of mobile phone as appointment reminder (AOR: 2.6 (95% CI: 1.07 to 6.49)) and locking mobile phone with passwords (AOR: 4.6 (95% CI: 1.63 to 12.95)) were significantly associated with the willingness to receive mobile phone-based diabetic health services. CONCLUSION: Access to a mobile phone and willingness to receive mobile phone-based health services were high. Educational status, route of medication, transportation mechanism, time to reach the service, using mobile phone as appointment reminder and locking mobile phone with passwords were significantly associated factors. Given the high proportion of access and willingness of patients to receive mobile phone-based health services, mHealth interventions could be helpful.

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey.

Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21⁻2.39); smokers (1.63, 95% CI: 1.15⁻2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15⁻2.32). CGM use (AOR = 0.66, 95% CI: 0.44⁻1.00); "general diet" (AOR = 0.86, 95% CI: 0.79⁻0.94); and "blood glucose monitoring" (AOR = 0.88, 95%CI: 0.80⁻0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09⁻0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04⁻3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00⁻1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74⁻3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07⁻5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41⁻0.96) and "general diet" self-care (AOR = 0.84, 95% CI: 0.75⁻0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.

Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes.

AIMS: Pooling the effect sizes of randomized controlled trials (RCTs) from continuous outcomes, such as glycated hemoglobin level (HbA1c), is an important method in evidence syntheses. However, due to challenges related to baseline imbalances and pre/post correlations, simple analysis of change scores (SACS) and simple analysis of final values (SAFV) meta-analyses result in under- or overestimation of effect estimates. This study was aimed to compare pooled effect sizes estimated by Analysis of Covariance (ANCOVA), SACS, and SAFV meta-analyses, using the example of RCTs of digital interventions with HbA1c as the main outcome. MATERIALS AND METHODS: Three databases were systematically searched for RCTs published from 1993 through June 2017. Two reviewers independently assessed titles and abstracts using predefined eligibility criteria, assessed study quality, and extracted data, with disagreements resolved by arbitration from a third reviewer. RESULTS: ANCOVA, SACS, and SAFV resulted in pooled HbA1c mean differences of -0.39% (95% CI: [-0.51, -0.26]), -0.39% (95% CI: [-0.51, -0.26]), and -0.34% (95% CI: [-0.48-0.19]), respectively. Removing studies with both high baseline imbalance (≥±0.2%) and pre/post correlation of ≥±0.6 resulted in a mean difference of -0.39% (95% CI: [-0.53, -0.26]), -0.40% (95% CI: [-0.54, -0.26]), and -0.33% (95% CI: [-0.48, -0.18]) with ANCOVA, SACS, and SAFV meta-analyses, respectively. Substantial heterogeneity was noted. Egger's test for funnel plot symmetry did not indicate evidence of publication bias for all methods. CONCLUSION: By all meta-analytic methods, digital interventions appear effective in reducing HbA1c in type 2 diabetes. The effort to adjust for baseline imbalance and pre/post correlation using ANCOVA relies on the level of detail reported from individual studies. Reporting detailed summary data and, ideally, access to individual patient data of intervention trials are essential.

Identifying Evidence-Informed Physical Activity Apps: Content Analysis.

BACKGROUND: Regular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps. OBJECTIVE: This study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps. METHODS: We identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1). RESULTS: The initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters "goals and planning" and "feedback and monitoring" were identified in all apps. CONCLUSIONS: Despite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion.

A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?

BACKGROUND: Anti-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. METHODS: An 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. RESULTS: The 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. CONCLUSION: The 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.

Civil servants' demand for social health insurance in Northwest Ethiopia.

BACKGROUND: Absence of reliable health insurance schemes is a key challenge to meet the universal health coverage target of the Sustainable Development Goals (SDGs). Ethiopian health system is characterized by under financing, low protection mechanisms for the poor, and lack of mechanisms of risk pooling and cost sharing. Ethiopia is implementing social health insurance (SHI) scheme to reduce out of pocket payment (OOP) and improve access and use of healthcare. This study aimed to determine the demand for SHI among civil servants and associated factors in Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted in Bahir Dar city from 557 randomly selected civil servants using structured and self-administered questionaire. The questionnaire included questions measuring demand for SHI and demographic, socio-economic, healthcare related and personal and behavioral factors. Data were first entered in Epi-Info version 7.0 and transferred to SPSS version 20 for analysis. Descriptive statistics, bivariate and multivariable logistic regression analysis were performed. RESULTS: From the total calculated sample size of 557, 488 respondents returned the questionnaire giving a response rate of 88%. Nearly three-fourth of the respondents, 355 (72.7%), reported their need to be enrolled in a SHI scheme. Two-third of the respondents 325 (66.6%) were willing to pay for their enrollment. Overall, three hundred and two (61.9%) were demanding SHI. Having good awareness about health insurance [AOR = 4.39, 95% CI = (1.82-12.89)] and trust on a health insurance agency [AOR = 3.0, 95% CI = (1.57-5.72)], were significantly associated with the demand for SHI among civil servants. CONCLUSION: The demand for SHI among civil servants were higher. The awareness towards SHI and trust on the SHI agency were significantly associated with demand for SHI. As Ethiopia aspires to insure all employees of the formal sector, and improving the awareness of civil servants about SHI and the agency providing the service could improve demand for SHI. Further research is important on healthcare organizational and professional readiness to handle the upcoming insurance driven quality health service need and health seeking behavioral change.

Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes: A Systematic Review, Meta-analysis, and Meta-regression Analysis.

BACKGROUND: Digital interventions may assist patients with type 2 diabetes in improving glycemic control. We aimed to synthesize effect sizes of digital interventions on glycated hemoglobin (HbA1c) levels and to identify effective features of digital interventions targeting patients with poorly controlled type 2 diabetes. MATERIALS AND METHODS: MEDLINE, ISI Web of Science, and PsycINFO were searched for randomized controlled trials (RCTs) comparing the effects of digital interventions with usual care. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane Risk of Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 (BCTTv1) was used to identify BCTs used in interventions. Mean HbA1c differences were pooled using analysis of covariance to adjust for baseline differences and pre-post correlations. To examine effective intervention features and to evaluate differences in effect sizes across groups, meta-regression and subgroup analyses were performed. RESULTS: Twenty-three arms of 21 RCTs were included in the meta-analysis (n = 3787 patients, 52.6% in intervention arms). The mean HbA1c baseline differences ranged from -0.2% to 0.64%. The pooled mean HbA1c change was statistically significant (-0.39 {95% CI: [-0.51 to -0.26]} with substantial heterogeneity [I2 statistic, 80.8%]) and a significant HbA1c reduction was noted for web-based interventions. A baseline HbA1c level above 7.5%, ß = -0.44 (95% CI: [-0.81 to -0.06]), the BCTs "problem solving," ß = -1.30 (95% CI: [-2.05 to -0.54]), and "self-monitoring outcomes of behavior," ß = -1.21 (95% CI: [-1.95 to -0.46]) were significantly associated with reduced HbA1c levels. CONCLUSIONS: Digital interventions appear effective for reducing HbA1c levels in patients with poorly controlled type 2 diabetes.

Evidence-based practice and its associated factors among medical laboratory professionals in West Amhara hospitals, Northwest Ethiopia.

BACKGROUND: Healthcare and clinical laboratory practices are constantly evolving, leading a need for evidence-based practice (EBP) among all laboratory professionals. However, EBP among laboratory professionals has not yet been studied in Ethiopia. AIMS: This study aimed to determine EBP and associated factors among medical laboratory professionals in West Amhara hospitals, Northwest Ethiopia. METHODS: An analytic and descriptive cross-sectional study was conducted in West Amhara hospitals from February to March 2014. Data were collected using a pretested, structured self-administered questionnaire. Bivariate and multivariate logistic regressions were performed to identify factors associated with evidence-based laboratory practice. Odds ratios with 95% confidence interval (CI) were computed and the level of significance determined. RESULTS: A total of 169 respondents completed the questionnaire (response rate 95.4%), 40.8% (n = 69) of whom had a good level of EBP. Knowledge about EBP [adjusted odds ratio (AOR) = 2.22, 95% CI: 1.10-4.49], internet access (AOR = 2.43, 95% CI: 1.12-5.29), adoption EBP (AOR = 2.79, 95% CI: 1.41-5.52) and being single in marital status (AOR = 2.21, 95% CI: 1.08-4.51) were factors associated with EBP in multivariable logistic regression after controlling the effects of the confounding variables. CONCLUSION: EBP among laboratory professionals was found to be low. Having good knowledge towards EBP, organizational adoption of EBP, having internet access in their organization and being single in marital status were factors associated with EBP.

Human Resource Information System implementation readiness in the Ethiopian health sector: a cross-sectional study.

BACKGROUND: Health workforce information systems in low-income countries tend to be defective with poor relationship to information sources. Human Resource Information System (HRIS) is currently in a pilot implementation phase in the Federal Ministry of Health and Regional Health Bureaus of Ethiopia. Before scaling up the implementation, it is important to understand the implementation readiness of hospitals and health departments. The aims of this study were to assess the readiness for HRIS implementation, identify associated factors, and explore the implementation challenges in public hospitals and health departments of the Amhara National Regional State, Ethiopia. METHODS: An institution-based cross-sectional study supplemented with a qualitative study was conducted from the 15th of February to the 30th of March 2016 in 19 public hospitals and health departments of the Amhara National Regional State, Ethiopia. A self-administered questionnaire was used to collect the data. The questionnaire includes items on socio-demographic characteristics and questions measuring technical, personal, and organizational factors adapted from the 32-item questionnaire of the Management Science for Health (MSH) HRIS readiness assessment tool. The data were entered and analyzed with statistical software. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed. Odds ratios with 95% confidence interval were computed to identify the factors statistically associated with readiness of HRIS implementation. In-depth interviews and observation checklists were used to collect qualitative data. Thematic content analysis was used to analyze the qualitative data. RESULT: A total of 246 human resource (HR) employees and 16 key informants have been included in the study. The HR employee's level of readiness for HRIS implementation in this study was 35.8%. Employee's Internet access (AOR = 2.59, 95%CI = 1.19, 5.62), availability of separate HR section (AOR = 8.08, 95%CI = 3.69, 17.70), basic computer skills (AOR = 6.74, 95%CI = 2.75, 16.56), and fear of unemployment (AOR = 2.83, 95%CI = 1.27, 6.32) were associated with readiness of HRIS implementation. Poor logistic supply, lack of competency, poor commitment, and shortage of finance were the challenges of HRIS implementation. CONCLUSION: In this study, readiness of HRIS implementation was low. Strategies targeting to improve skills, awareness, and attitude of HR employees would facilitate the implementation process.

Effectiveness of behavioral change techniques employed in eHealth interventions designed to improve glycemic control in persons with poorly controlled type 2 diabetes: a systematic review and meta-analysis protocol.

BACKGROUND: The incorporation of Behavioral Change Techniques (BCTs) in eHealth interventions for the management of non-communicable diseases (NCDs), such as type 2 diabetes mellitus (T2DM), might be a promising approach to improve clinical and behavioral outcomes of NCDs in the long run. This 3paper reports a protocol for a systematic review that aims to (a) identify the effects of individual BCTs in eHealth interventions for lowering glycated hemoglobin levels (HbA1c) and (b) investigate which additional intervention features (duration of intervention, tailoring, theory-base, and mode of delivery) affect levels of HbA1c in this population. The protocol follows the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 guideline. METHODS/DESIGN: To identify eligible studies, an extensive systematic database search (PubMed, Web of Science, and PsycINFO) using keywords will be conducted. This review will include randomized controlled trials examining the effects of eHealth interventions on HbA1c in persons with poorly controlled T2DM over a minimum follow-up period of 3 months. Relevant data will be extracted from the included studies using Microsoft Excel. The content of the interventions will be extracted from the description of interventions and will be classified according to the BCT taxonomy v1 tool. The quality of studies will be independently assessed by two reviewers using the Cochrane risk of bias tool. If the studies have adequate homogeneity, meta-analysis will be considered. The effect sizes of each BCT will be calculated using the random effect model. The quality of the synthesized evidence will be evaluated employing the Grading of the Recommendations Assessment, Development and Evaluation (GRADE) criteria. DISCUSSION: This systematic review is one of the firsts to appraise the effectiveness of eHealth interventions employing BCTs which aimed at improving glycemic control in persons with poorly controlled T2DM. The review will aggregate the effect sizes of BCTs on HbA1c levels. The results may inform future eHealth interventions targeting poorly controlled T2DM populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016049940.

Characterizing Active Ingredients of eHealth Interventions Targeting Persons With Poorly Controlled Type 2 Diabetes Mellitus Using the Behavior Change Techniques Taxonomy: Scoping Review.

BACKGROUND: The behavior change technique taxonomy v1 (BCTTv1; Michie and colleagues, 2013) is a comprehensive tool to characterize active ingredients of interventions and includes 93 labels that are hierarchically clustered into 16 hierarchical clusters. OBJECTIVE: The aim of this study was to identify the active ingredients in electronic health (eHealth) interventions targeting patients with poorly controlled type 2 diabetes mellitus (T2DM) and relevant outcomes. METHODS: We conducted a scoping review using the BCTTv1. Randomized controlled trials (RCTs), studies with or pre-post-test designs, and quasi-experimental studies examining efficacy and effectiveness of eHealth interventions for disease management or the promotion of relevant health behaviors were identified by searching PubMed, Web of Science, and PsycINFO. Reviewers independently screened titles and abstracts for eligibility using predetermined eligibility criteria. Data were extracted following a data extraction sheet. The BCTTv1 was used to characterize active ingredients of the interventions reported in the included studies. RESULTS: Of the 1404 unique records screened, 32 studies fulfilled the inclusion criteria and reported results on the efficacy and or or effectiveness of interventions. Of the included 32 studies, 18 (56%) were Web-based interventions delivered via personal digital assistant (PDA), tablet, computer, and/or mobile phones; 7 (22%) were telehealth interventions delivered via landline; 6 (19%) made use of text messaging (short service message, SMS); and 1 employed videoconferencing (3%). Of the 16 hierarchical clusters of the BCTTv1, 11 were identified in interventions included in this review. Of the 93 individual behavior change techniques (BCTs), 31 were identified as active ingredients of the interventions. The most common BCTs identified were instruction on how to perform behavior, adding objects to the environment, information about health consequences, self-monitoring of the outcomes and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided of a certain behavior Author: Please note that the journal discourages the use of parenthesis to denote either and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided "and/or" and prefers to be explicit to avoid ambiguity. Response: Checked and avoided, and feedback on outcomes of behavior. CONCLUSIONS: Our results suggest that the majority of BCTs employed in interventions targeting persons with T2DM revolve around the promotion of self-regulatory behavior to manage the disease or to assist patients in performing health behaviors necessary to prevent further complications of the disease. Detailed reporting of the BCTs included in interventions targeting this population may facilitate the replication and further investigation of such interventions.