Mapping the evidence on integrated service delivery for non-communicable and infectious disease comorbidity in sub-Saharan Africa: protocol for a scoping review.

INTRODUCTION: The concurrent occurrence of infectious diseases (IDs) and non-communicable diseases (NCDs) presents complex healthcare challenges in sub-Saharan Africa (SSA), where healthcare systems often grapple with limited resources. While an integrated care approach has been advocated to address these complex challenges, there is a recognised gap in comprehensive evidence regarding the various models of integrated care, their components and the feasibility of their implementation. This scoping review aims to bridge this gap by examining the breadth and nature of evidence on integrated care models for NCDs and IDs within SSA, thereby updating the current evidence base in the domain. METHODS AND ANALYSIS: Based on the Joanna Briggs Institute (JBI) framework for scoping reviews, this study will include peer-reviewed and grey literature reporting on integrated care models for NCD-ID comorbidities in SSA. A comprehensive search of published sources in electronic databases (PubMed, Scopus, Embase, the Cochrane Library, Health System Evidence and Research4Life) and grey literature (Google Scholar, EBSCO Open Dissertations and relevant organisational websites) will be conducted to identify sources of information reported in English from 2018 onwards. The review will consider sources of evidence reporting on integrated care model for NCDs such as diabetes; chronic cardiovascular, respiratory and kidney diseases; cancers; epilepsy; and mental illness, and comorbid IDs such as HIV, tuberculosis and malaria. All sources of evidence will be considered irrespective of the study designs or methods used. The review will exclude sources that solely focus on the differentiated or patient-centred care delivery approach, and that focus on other conditions, populations or settings. The reviewers will independently screen the sources for eligibility and extract data using a JBI-adapted data tool on the Parsifal review platform. Data will be analysed using descriptive and thematic analyses and results will be presented in tables, figures, diagrams and a narrative summary. ETHICS AND DISSEMINATION: Ethical approval is not required for this review as it will synthesise published data and does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to inform future research. STUDY REGISTRATION: OSF: https://doi.org/10.17605/OSF.IO/KFVEY.

Self-Care and Quality of Life Among Adult Patients With Heart Failure: Scoping Review.

Introduction: Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF. Methods: Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included. Results: Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF. Conclusion: Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.

Magnitude of admission, premature mortality and potential years of life lost due to acute diseases among pediatric patients admitted to public hospitals in Jimma City, Southwest Ethiopia.

Introduction: although evidence suggests recent reductions in infant and child mortality, little is known about the magnitude, and causes of pediatrics admission, premature mortality, and associated years of potential life lost among hospitalized children in Ethiopia, particularly in Jimma City. Methods: a retrospective cross-sectional study was conducted on hospital's care registries of pediatric patients who presented with acute disease over three years period, from September 7th, 2014, to September 10th, 2017, at Jimma Medical Canter and Shenen Gibe Hospital in Jimma City. The data were cleaned and imported to statistical package for the social sciences (SPSS) V.23.0 for descriptive statistical analysis. Results: a total of 7612 children were admitted to two public hospitals in Jimma City during the study period. Among them, 4457(58.6%) were males. The mean (SD) age of the children at admission was 4.1± (4.25) years. The major cause of admission was pneumonia in 2274 (29.9 %) children. The major causes of premature mortality were Pneumonia 36 (22.1%), sepsis 25 (15.3%), and severe acute malnutrition 25 (15.3%). A total of 9633 years were lost due to premature deaths, of which the majority 7663 (79.6%) were attributed to communicable and nutritional diseases. Pneumonia was responsible for the highest proportion of years of life lost 2178 (22.1%). Conclusion: it is indicated that the leading causes of hospital admissions and deaths were communicable and nutritional diseases. A significant number of years of life have been lost because of preventable and curable diseases. Therefore, early detection and initiation of an appropriate intervention could reduce the hospital´s burden and years of potential life lost due to these diseases.

Length of Stay in the Emergency Department and Its Associated Factors at Jimma Medical Center, Southwest Ethiopia.

BACKGROUND: Prolonged emergency department stays can adversely affect patient outcomes leading to an increased length of hospital admission and higher mortality. Despite this fact, there are few data describing emergency department length of stay and associated factors in Ethiopia. OBJECTIVE: To assess length of stay in the emergency department and its associated factors among patients visited adult emergency department of Jimma Medical Center, Jimma town, southwest of Ethiopia. METHODS: Institution-based cross-sectional study was conducted from April 9, 2018 to May 11, 2018. Overall, 422 patients presented during study period were sequentially included in the study. A semi-structured questionnaire was used to collect data through interview, observation and medical record review. The collected data were cleaned, entered to Epi-data 3.1 and exported to SPSS version 21 for binary and multivariable logistic regression analysis. To identify factors associated with outcome variable, candidate variables were fitted to multivariable analysis, and those with P-values <0.05 were considered as significantly associated. RESULTS: More than one-third, 162 (38.4%), experienced prolonged length of stay in the emergency department. The odds of prolonged stay were higher among rural area residency (AOR, 3.0; CI, 1.279-7.042), evening presentation (AOR, 4.25; CI, 1.742-10.417), and night-time presentation (AOR, 14.93; CI, 4.22-52.63), and having at least one diagnostic investigation (AOR, 4.48; CI, 1.69-11.88). However, participants who did not experience shift changes of nurses during their stay (AOR, 0.003; CI, 0.001-0.010) had a less prolonged stay. CONCLUSION: A significant proportion of patients experienced a prolonged stay at the emergency department. Age, rural residency, evening and night-time presentation, shift change and having a diagnostic investigation were predictors of prolonged stay. Thus, establishing time-targeted service for patients can reduce the length of stay.

Causes and factors associated with neonatal mortality in Neonatal Intensive Care Unit (NICU) of Jimma University Medical Center, Jimma, South West Ethiopia.

Background: The neonatal period is the most susceptible phase of life. In Ethiopia changes in neonatal mortality are not as significant as changes in post-neonatal and child mortality. The aim of this study was to assess the causes and factors associated with neonatal mortality at Jimma Medical Center. Materials and methods: A cross-sectional study was conducted for 11 days from February 12, 2018 at the Neonatal ICU of Jimma Medical Center. Data were extracted from the medical records of neonates admitted during a three year period from September 07, 2014 to August 31, 2017, using pretested checklists. Bivariate and multivariate logistic regressions were used to determine factors associated with neonatal mortality and P-values <0.05 were considered statistically significant. Results: Of 3,276 neonates admitted during the study period, 412 (13.3%) died, equating to a rate of 30 deaths per 1,000 institutional live births. The majority (249, 60.4%) of deceased neonates had low birth weight, while 230 (55.8%) were premature and 169(41%) had Respiratory Distress Syndrome (RDS). Residency being outside Jimma city (AOR 1.89, 95% CI: 1.43, 2.51) and the length of stay <7Days (AOR 3.93, 95% CI: 2.82, 5.50), low birth weight (AOR 1.54, 95% CI: 1.06, 2.25), prematurity (AOR 2.2, 95% CI: 1.41, 3.42), RDS (AOR 4.15, 95% CI: 2.9, 5.66), perinatal asphyxia (AOR 4.95, 95% CI: 3.6, 7.34), and congenital malformations (AOR 4, 95% CI: 2.55, 2.68) were significantly associated with neonatal mortality. Conclusions: A significant proportion of neonates attending the neonatal ICU died. Parental residency, the length of stay, low birth weight, prematurity, RDS, perinatal asphyxia, and congenital malformations were factors associated with neonatal mortality, which could be avoidable. Therefore, preventive measures such as enhancing the utilization of antenatal care services and, early identification and referral of high risk pregnancy and neonates could reduce the neonatal deaths.

Determinants of preterm birth at Jimma University Medical Center, southwest Ethiopia.

BACKGROUND: Preterm birth is the second leading cause of death next to pneumonia in children aged <5 years and the single-most important cause of death in the first month of life. Research examining determinants of preterm birth in Ethiopia is limited. Therefore, this study aimed to determine risk factors associated with preterm births at Jimma University Medical Center in southwest Ethiopia. METHODS: This unmatched case-control study was conducted from March 15 to April 1, 2017 from medical records of mothers and newborns delivered at Jimma University Medical Center from January 1 to December 30, 2016. Data were extracted using a structured checklist for cases (preterm) and controls (term) by reviewing maternal and newborn medical records using a simple random-sampling technique. Risk factors for preterm delivery were determined using bivariate and multivariate logistic regression models. Statistically significant associations were declared at P<0.05. RESULTS: The present study evaluated 218 maternal and newborn cases and 438 controls. Risk factors identified were history of previous preterm birth (AOR 6.4, 95% CI 2.9-13.9), preeclampsia (AOR 6.6, 95% CI 3.3-13.4), premature membrane rupture (AOR 11.7, 95% CI 6.2-21.9), antenatal care of fewer than four visits (AOR 4.8, 95% CI 1.2-19), birth interval <2 years (AOR 2.7, 95% CI 1.7-4.5), and multiple pregnancies (AOR 4.5, 95% CI 2.4-8.5). CONCLUSION: History of previous preterm births, preeclampsia, premature membrane rapture, antenatal care of fewer than four visits, birth interval <2 years, and multiple pregnancies were found to have a possible causal relationship with preterm births. Therefore, similar further studies should be conducted to generate more population-based evidence on determinants of preterm births.

A survey on Integrated Management of Neonatal and Childhood Illness implementation by nurses in four districts of West Arsi zone of Ethiopia.

BACKGROUND: In Ethiopia, one in 17 children dies before 1 year of age and one in 11 children dies before 5 years. Research that examines the factors influencing the implementation of the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy in Ethiopia is limited. This study aimed to identify the factors compelling the execution of IMNCI by nurses in four districts of West Arsi zone of Ethiopia. METHODS: A mixed-method cross-sectional study was conducted from February to March 2016 in West Arsi zone of Oromia regional state, Ethiopia. A total of 185 Integrated Management of Childhood Illness (IMCI)-trained registered nurses working at Under-Five Clinic were purposively chosen for the study among 291 registered nurses based at health centers and hospitals in the Arsi zone. The study was complemented by a qualitative method. RESULTS: More than half (57.8%) of the nurses interviewed had been trained (51.35% of them attended in-service training). The most common issues encountered in the implementation of IMCI were: lack of trained staff (56.2%), lack of essential drugs and supplies (37.3%), and irregular supportive supervision (89.2%). The qualitative data supplemented the factors that influence IMNCI implementation, including drug unavailability, lack of human resources, and lack of effective supportive supervision and follow-up visits. Therefore, interventions aiming at training nurses, with emphasis on performing supportive consistent supervision and supporting the system of health care by enhancing admittance to indispensable drugs and supplies, are recommended to help IMCI implementation.