The Quality of Care Provided To Patients with Chronic Non-Communicable Diseases: a Retrospective Multi-Setup Study In Jimma Zone; Southwest Ethiopia

BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However; access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non- Communicable Diseases received in hospital and health center setups. METHODS: A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes; Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality. RESULTS: Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1(95CI:34.1;36.0); 38.5(95CI:37.5;39.5) and 60.1(95)CI:59.3;61.0) of times on which patients were eligible; among patients with Diabetes; Hypertension and Epilepsy; respectively. After case mix adjustment; it was found that 45.9(95CI:45.4;46.5) of recommended components of care was actually provided to patients. This was 45.1(95CI:44.4;45.8) in the hospital and 30.5(95CI:29.7;31.3) in the health centers. Among patients for whom outcome data was available; optimal level of disease control was achieved only for 47 (30.5); 40(38.5) and 193 (52.9) of patients with Diabetes; Hypertension and Epilepsy; respectively. CONCLUSION: The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore; a continuous process of quality improvement is recommended in both settings. KEYWORDS: Health care; Health care quality; Quality indicators; Guideline Adherence; Chronic diseases; Diabetes; Hypertension; Epilepsy

A survey of illegal abortion in Jimma Hospital, south western Ethiopia.

A cross-sectional descriptive study of induced abortion was conducted in Jimma Hospital, South-western Ethiopia to determine socio-economic factors and associated problems during February 25-May 5, 1996. There were a total of 80 patients with a diagnosis of induced abortion were enrolled of which 50 (62.5%) cases were admitted for bleeding and infections. Thirty six (45%) of all cases were primigravidae. Students accounted for 28 (35%) of the cases. Seventy (87.5%) of the cases could read and write and only 31 (38.8%) were married. Seventy (87.5%) knew presence of family planning methods, and 40 (50%) used at least once previously. Eighteen (22.5%) gave economic problems as reason for abortion, and 76 (95%) of them used either rubber tubes or roots of plants to induce the abortion. Of the total 42 (52.5%) believed that the right of abortion concerns mainly themselves. The study showed that the problem is quite significant in the area. We recommend for a wide scale community based study concerning the problem. A well organized sex education, family planning services and family education are also suggested in order to alleviate the problem.

Community based study on maternal mortality in Jimma town, south western Ethiopia.

A cross-sectional five years retrospective community based study was conducted in 1990 to determine maternal mortality rate in Jimma town, south-western Ethiopia. The maternal mortality rate was found to be 4.02/1000 live births. The results of the study revealed that major causes of maternal mortality in this area are sepsis, eclampsia and abortion. Out of all deaths, more than 50% occurred after delivery of a child. Besides, the study indicates poor trend in following antenatal care and family planning among maternal mortality cases. Recommendations are made for detailed wide scale study to generate policy issues on the subject.

PIP: To develop reliable measures of the rate and causes of maternal mortality in south-west Ethiopia, a cross-sectional retrospective study was conducted in Jimma town. During the 5-year study period (September 1986-August 1990), 100 deaths occurred among women 15-49 years of age in the 5832 households from 10 kebeles included in the study. 15 of these deaths were maternal mortalities, for a rate of 4.02/100 live births. The causes of these deaths were sepsis (7 cases), eclampsia (3 cases), abortion (3 cases), and uterine rupture (2 cases). Eight maternal deaths occurred after delivery. Although 13 deaths took place in a health center or hospital, 8 of the 15 women received no antenatal care and 12 were not family planning acceptors. These findings indicate a need for more coordinated maternal health care services in Ethiopian towns as well as rural areas.

Khat chewing among Agaro secondary school students, Agaro, southwestern Ethiopia.

A cross-sectional study using a self-administered questionnaire was carried out to determine the prevalence of khat chewing among secondary school students in Agaro, southwestern Ethiopia in 1991. Two-hundred-forty-eight students randomly selected from grade 9 to 12 were included in the study with current prevalence of 64.9%. Khat chewing was found to be associated with being Muslim and male. The most frequent users were also in the age group of 15 to 22 years. The association between khat chewing and grade attended was statistically significant. The health and socioeconomic problems associated with the use of khat are discussed and possible interventions suggested.

Intestinal parasitism among Jiren elementary and junior secondary students in South-Western Ethiopia

A cross-sectional survey on intestinal parasites was conducted in Jiren Elementary et Junior Secondary School; Jimma. A total of 301 stool specimens were collected by systematic random sampling from a total of 1626 population. The stools were examined for ova and parasites by direct saline suspension (wet mount) method. The result showed high prevalence rate of parasitic infection (68.4 percent). A total of 10 species were identified among which Ascaris lumbricoides was the leading (52.2 percent) followed by Trichuris trichiura (18.6 percent); while Schistosoma mansoni was the least (0.3 percent). No statistically significant difference was seen in the prevalence rate of intestinal parasites by sex; (P.0.01). However; there is significant association between water source for drinking and parasitoses; (P;0.01); where; unprotected source of water favouring infection of all infected. Most of the infected children (92.2 percent) were asymptomatic. It is suggested that affective PHC strategies; such as health education in schools; expansion of school health services and chemotherapy with broad spectrum antihelminthics should be implemented

Prevalence of onchocerciasis in Blue Nile valley of western Ethiopia.

A epidemiological study of Onchocerciasis among different ethnic groups in the Blue Nile valley of Western Ethiopia was conducted to obtain baseline data on disease prevalence, skin snips samples were obtained from 493 persons, representing different ethnic groups (Nilotic and Oromos), living under different geographic and climatic conditions (lowlands, Midland and highland) or Mendi district for parasitological verification. A total of 169 (34%) had microfilariae of the skin by direct microscopy. The highest prevalence rate (81%) was found among the Nilotic people living along the southern banks of the Blue Nile River. Most patient had wide spread skin infection. Epidemiological differences were also observed.

PIP: The study area was the Blue Nile valley of Mendi District, with 1160 inhabitants within the Wollega administrative region of Ethiopia. The population of 3 villages representing different ethnic groups and residential altitudes were considered. The villages were Gomi (1700 m), Dalati (1200 m), and Siba (700 m) representing highland Oromos, Midland Oromos and Nilotics, and lowland Nilotics, respectively. Out of the total population, a sample size of 493 was selected randomly. Parasitological examination was done with one skin snip, 2-3 mm in diameter, taken from the pelvic girdle and another one from the shoulder area. 169 (34%) of the total 493 examined had onchocerciasis. Only 3 of 101 highland Oromos had microfilaria in the skin, while 130 (81%) of 160 Sirba Nilotic were infected. The Midland Oromos (Dalati) and Dalati Nilotics had infection rates of 6% and 24%, respectively. In the higher altitudes males were more often infected than females, probably because they travel more often to the infected lowland. No such tendency was seen among the Sirba Nilotics who live permanently in the lowland. In all areas, there were increased infection rates in older age. This was most significant in the Sirba and Dafati Nilotics among people above 30 years of age. In all places, positive skin snips were found slightly more often in the lower parts of the body. Out of total 169 infected persons, 46 (27%) had microfilaria in the pelvic girdle only, while 11 (7%) had positive result only in the shoulder area. 112 (66%) had positive skin snips both in the pelvic girdle and the shoulder. All 169 infected persons underwent eye examination. Moving microfilaria were not demonstrated in any of them by slit lamp examination of both eyes. Typical eye changes suggestive of onchocerciasis were not found. There were only 16 typical onchocercoma cases in 12 of the 169 infected persons. 2 of these were in the head, 8 in the shoulder or upper thorax and 6 in the pelvic girdle area. 10 of the 12 people with nodules were Sirba Nilotics.