Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses.

Background: Electronic medical records or electronic health records, collectively called electronic records, have significantly transformed the healthcare system and service provision in our world. Despite a number of primary studies on the subject, reports are inconsistent and contradictory about the effects of electronic records on mortality. Therefore, this review examined the effect of electronic records on mortality. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline. Six databases: PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched from February 20 to October 25, 2023. Studies that assessed the effect of electronic records on mortality and were published between 1998 and 2022 were included. Joanna Briggs Institute quality appraisal tool was used to assess the methodological quality of the studies. Narrative synthesis was performed to identify patterns across studies. Meta-analysis was conducted using fixed effect and random-effects models to estimate the pooled effect of electronic records on mortality. Funnel plot and Egger's regression test were used to assess for publication bias. Results: Fifty-four papers were found eligible for the systematic review, of which 42 were included in the meta-analyses. Of the 32 studies that assessed the effect of electronic health record on mortality, eight (25.00%) reported a statistically significant reduction in mortality, 22 (68.75%) did not show a statistically significant difference, and two (6.25%) studies reported an increased risk of mortality. Similarly, among the 22 studies that determined the effect of electronic medical record on mortality, 12 (54.55%) reported a statistically significant reduction in mortality, and ten (45.45%) studies didn't show a statistically significant difference. The fixed effect and random effects on mortality were OR = 0.95 (95% CI: 0.93-0.97) and OR = 0.94 (95% CI: 0.89-0.99), respectively. The associated I-squared was 61.5%. Statistical tests indicated that there was no significant publication bias among the studies included in the meta-analysis. Conclusion: Despite some heterogeneity among the studies, the review indicated that the implementation of electronic records in inpatient, specialized and intensive care units, and primary healthcare facilities seems to result in a statistically significant reduction in mortality. Maturity level and specific features may have played important roles. Systematic Review Registration: PROSPERO (CRD42023437257).

Acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia: a retrospective cross-sectional observational study.

BACKGROUND: The electronic community health information system has been increasingly developed and deployed to quantify and support quality health service delivery by community health workers in Ethiopia. However, the success and failure of the electronic community health information system depend on the acceptability and use by its users. This study assessed the acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia. METHODS: A retrospective cross-sectional observational study was conducted among 587 randomly selected health extension workers from six regions of Ethiopia. The Revised Technology Acceptance Model was used as a theoretical framework for the study. Descriptive statistics, structural equation modeling, and principal component analysis techniques were used to analyze the data. For all significance tests, multiple comparison adjustments were made using the Bonferroni Correction Method. RESULTS: There was near universal acceptance of the electronic community health information system, ranging from 94.4 to 97.4% among health extension workers. However, actual use of the system was considerably lower, at 50%. Perceived usefulness of the electronic community health information system had a direct and positive effect on acceptability (ß3 = 0.415, p < 0.001). Perceived ease of use had both direct and indirect positive effects on electronic community health information system acceptability (ß2 = 0.340, p < 0.001 and ß1*ß3 = 0.289, p < 0.001, respectively), while acceptability had a direct and positive effect on the use of the electronic community health information system (ß3 = 0.297, p < 0.001). CONCLUSIONS: Despite the very high acceptability of the electronic community health information system among health extension workers, actual use of the system is considerably lower. Hence, an integrated and coordinated approach is required to close the acceptance-use gap.

Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia.

Background: The electronic community health information system (eCHIS) has been implemented in Ethiopia to support health services delivered by community health workers. Despite the many benefits of digitizing community health information systems, the implementation of the eCHIS is challenged by many barriers resulting in low uptake. This study assessed the barriers, facilitators, and motivators of eCHIS use among health workers with focus on health extension workers (HEWs) in Ethiopia. Methods: Phenomenological approach was used to assess the barriers, facilitators and motivators of eCHIS use in Amhara, Harari, Oromia, Sidama, South West Ethiopia and Southern Nation Nationalities and People's regions of Ethiopia. Data were collected from 15-29 May 2022. A total of 54 face-to-face in-depth interviews were conducted among HEWs, HEW supervisors, health information technicians and managers. The interviews were audiotaped using Open Data Kit, transcribed verbatim and translated into English. OpenCode 4.03 software was used for coding and categorizing the data. Thematic analysis was used to analyze the data. Results: The HEWs and other eCHIS users reported lack of infrastructure and resources; poor quality of training, follow-up, and supervision; parallel recording using the manual and electronic system; and HEWs' workload as barriers hindering eCHIS use. Data quality, retrievability, and traceability; tablet portability; encouragement from supervisors; and positive image in the community resulting from HEWs using tablets in their routine activities were the main facilitators of eCHIS use. Conclusion: The study identified various barriers that adversely affect the use of eCHIS. An integrated and coordinated approach to eCHIS implementation that encompasses removing the barriers, and reinforcing facilitators is required.

The role of multi-dimensional women's empowerment in agriculture to improve the nutritional status of under-five children in rural cash crop producing, resource-limited settings of Ethiopia.

Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6-59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P > 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.

Hydrolyzed urine for enhanced valorization and toxicant degradation of wet coffee processing wastes: Implications for soil contamination and health risk reductions.

Coffee pulp (CP) and wastewater, from wet coffee processing plants, pollute water and soil ecosystems unless a greener management system is employed. The aim was to evaluate the effect of hydrolyzed human urine (HU) on the dynamics of total phenol, caffeine, and heavy metals during CP and coffee processing wastewater (CPWW) co-composting. The associated health risks reduction after application for cabbage production was also estimated. For the purpose, five treatments were prepared as C0 (CP, control), C1 (CP + CPWW), C2 (CP + 1:1 CPWW:HU), C3 (CP + 1:2 CPWW:HU) and C4 (CP + 1:3 CPWW:HU). The optimum compost was applied for cabbage cultivation in comparison with mineral fertilizer and without fertilization in a greenhouse. The total phenol reduction was in the order of C1 (77.71%) < C0 (78.66%) < C4 (79.89%) < C3 (91.20%) < C2 (91.48%), and maximum significant reduction of caffeine was also observed in C3 (81.34%) and C2 (82.66%). Pb and Cd were significantly reduced in C2, and Cr in C3 with a reduction of 4.38-15.13%, 12.50-33.00%, and 2.94-19.57%, respectively. The bio-concentration factor decreased in the order of Cd > Cr > Ni > Pb with concentrations, hazard quotient, hazard index (along with phenol) < 1, and cancer risk values below 1.00E-04, indicating very little risk. Thus, supplementing HU enhanced degradation of the anti-nutrient factors, and provide compost that enrich soil nutrients with little health risks of application.

Factors affecting adherence to lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019.

INTRODUCTION: Adherence to lifestyle modification in addition to medication adherence is very important in preventing complications. Nevertheless, lifestyle modification guidelines are not widely followed by patients with hypertension. The objective of the study was to explore the predictors of compliance with lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019. METHOD: A descriptive cross-sectional study design was used. A total of 384 patients with hypertension were included in this study. A systematic sampling method was used to select study participants. The data were collected through an interview method by using a structured questionnaire. The data were entered and analyzed using SPSS. Each variable was summarized using summary statistics. To measure the association between lifestyle modification and its predictors, a bivariate and multivariate logistic regression model was used. P-value < 0.05, odds ratio (OR), and 95% confidence interval (CI) were used to determine statistical significance, direction, and strength of association. RESULTS: Two hundred six (53.6%) patients with hypertension had poor adherence to the recommended lifestyle modification. Male patients with hypertension were more adherent to lifestyle modification compared with female patients (adjusted OR (AOR) = 0.60, 95% CI: 0.39-0.92). The rate of poor adherence was 1.86 times higher among patients with hypertension diagnosis of <5 years compared with patients with hypertension diagnosis of ⩾5 years(AOR = 1.86, 95% CI: 1.19-2.89). Patients who were adherent to their medication were 2.13 times to have poor adherence to lifestyle modification compared with medication non-adherent patients (AOR = 2.13, 95% CI: 1.38-3.27). CONCLUSION: High proportions of patients with hypertension were non-adherent to lifestyle modification. Sex, age, duration of the disease, and medication adherence were significantly associated with lifestyle modification adherence. Close follow-up of female patients, the elderly, and patients with a short duration of hypertension is recommended.

In vitro Antileishmanial Activity of Some Ethiopian Medicinal Plants.

INTRODUCTION: Leishmaniasis is a group of diseases caused by protozoan parasites, which remains a burden for developing countries. The lack of a vaccine as well as the emergence of resistance toward the recommended drugs pose a challenge for the control of the disease. This urges the demand for new antileishmanial agents to prevent and treat this disease. Consequently, four Ethiopian plants were selected and tested for their antileishmanial activity against two Leishmanial parasites. METHODS: Methanol (80%) was used to macerate the plant materials. In vitro antipromastigote activity of the crude extracts was then tested against promastigotes and axenically cultured amastigotes of Leishmania aethiopica and Leishmania donovani clinical isolates using Alamar Blue assay, and cell viability was measured fluorometrically. 1% DMSO and the media were used as a negative control while amphotericin B was used as a positive control. Furthermore, preliminary phytochemical analysis of the extracts was performed. RESULTS: From the four plants' extracts, Ferula communis and Otostegia integrifolia showed better activity with IC50 value of 11.38±0.55 and 13.03±0.87 µg/mL against L. aethiopica, respectively. However, the same plant extracts exhibited lower activity against L. donovani with IC50 values of 23.41±2.32 and 17.24±1.29 µg/mL, respectively. O. integrifolia exhibited highest effect against amastigotes of L. aethiopica (IC50: 16.84±0.65) and L. donovani (IC50:14.55±0.38). F. communis resulted second highest in growth inhibition against amastigotes of L. aethiopica and L. donovani with IC50 value of 14.32±0.54 and 31.12±0.19, respectively. The phytochemical analysis of the extracts indicated the presence of phenol, flavonoids, tannins, saponins, terpenoids, and alkaloids. CONCLUSION: The findings from this study demonstrate that crude extracts of F. communis and O. integrifolia showed promising antileishmanial activity against L. aethiopica and L. donovani that may be attributed to the presence of different secondary metabolites.

Exposure to urban particulate matter and its association with human health risks.

Human health and environmental risks are increasing following air pollution associated with vehicular and industrial emissions in which particulate matter is a constituent. The purpose of this review was to assess studies on the health effects and mortality induced by particles published for the last 15 years. The literature survey indicated the existence of strong positive associations between fine and ultrafine particles' exposure and cardiovascular, hypertension, obesity and type 2 diabetes mellitus, cancer health risks, and mortality. Its exposure is also associated with increased odds of hypertensive and diabetes disorders of pregnancy and premature deaths. The ever increasing hospital admission and mortality due to heart failure, diabetes, hypertension, and cancer could be due to long-term exposure to particles in different countries. Therefore, its effect should be communicated for legal and scientific actions to minimize emissions mainly from traffic sources.

Magnitude and associated factors of wasting among under five orphans in Dilla town, southern Ethiopia: 2018: a cross-sectional study.

BACKGROUND: About 24 million children across the world live without their parents. In resource-limited countries like Ethiopia, childhood malnutrition is common and intertwined with poverty. It is a leading cause of death for children contributing over half of child mortality in sub-Saharan Africa. Nevertheless; little is known about the prevalence of malnutrition and associated factors among under five age orphans, as most of the variable studies were geared towards under five children as wholesome. METHOD: A community based cross-sectional study design complemented with qualitative methods was conducted collecting data from mothers/caretakers of 367 orphans in Dilla town, Southern Ethiopia from 5, Dec.2017-18, Jan. 2018. Systematic random sampling technique was used, A structured pretested interviewer administered questionnaire complemented by focus group discussions and key informant in-depth interviews" was used. Anthropometric measurements were also carried. Data were entered in to EPi-info version 3.5.4 software and exported to SPSS version 20 for analysis. The prevalence of wasting among Orphans was assessed by calculating the percentages using ENA for SMART 2012 software and analysis was made using WHO Standard cut off point below- 2 S. D using z-scores. All variables with p value of < 0.25 during bivariate logistic regression analysis were entered to a multivariate analysis to identify variables independently associated with the outcome variable at p value 0.05 with 95% CI. For qualitative aspect, thematic framework analysis was employed. RESULTS: 11.1% orphans were wasted from which 3.3 are severely wasted. The main associated factors of wasting were found to be number of under-five orphans at home (AOR 1.420; 95% CI 1.094-3.086), duration of breast feeding (AOR 2.039; 95% CI 1.027-4.048), marital status of care givers (AOR 1.482; 95% CI 1.692-3.377), age when complementary meal started (AOR 2.023; 95% CI 1.028-3.980), wealth index (AOR 2.558; 95% CI 1.074-3.515) and access to balanced diet (AOR 2.022; 95% CI 1.026-3.889). CONCLUSION: The prevalence of wasting is high among under-five orphans; therefore, all concerned bodies should pay a great attention for proposed interventions like Strengthen the social interactions and indigenous institutions to maximize social care for under five orphans and Integrating locally available nutrition support programs to reach under 5 yrs orphans.

Quantification of total polyphenols, catechin, caffeine, L-theanine, determination of antioxidant activity and effect on antileishmanial drugs of ethiopian tea leaves extracts.

OBJECTIVE: In this study four tea samples Gumero black, Wushwush black and Wushwush green from Agri- Ceft Plc and East Africa black tea leaves from East African Agribusiness Plc were investigated for total polyphenols, caffeine, catechin and L-theanine content. MATERIALS AND METHODS: The aqueous extracts were investigated for their antioxidant and antileishmanial property and effect on amphotericin B, miltefocine and sodium stibogluconate, the commonly used antileishmanial drugs. Antileishmanial studies were conducted on L. aethiopica. RESULTS: Wushwush green tea had the highest content of polyphenol (19.98 ± 1.15 mg gallic acid equivalent /100 g dry leaf weight), catechin (37.06 mg/g) and L-theanine (48.54 mg/g but the lowest caffeine content). It exhibited the highest antioxidant activity. The highest antioxidant effect of Wushwush green tea may be attributed to the highest polyphenol content. East African black tea had the lowest L-theanine (20.72 mg/g) and antioxidant activity but the highest caffeine (16.60 mg/g) content. CONCLUSION: Wushwush green tea showed slight inhibitory effect on L. aethiopica while the lack tea extracts (Gumero, East Africa and Wushwush) exhibited no antileishmanial activity. Wushwush green tea did not show any synergistic or antagonistic effect on the antileishmanial drugs used in this study while Gumero, East Africa and Wushwush black tea extracts exhibited dose dependant inhibitory activity to the commonly used antileishmanial drugs included in this study.