Publications by authors named "Binyam Tilahun"

44 Publications

Effect of a phone reminder system on patient-centered tuberculosis treatment adherence among adults in Northwest Ethiopia: a randomised controlled trial.

BMJ Health Care Inform 2021 Jun;28(1)

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objectives: This study aimed to evaluate the effect of the phone reminder system on patient-centred TB treatment adherence during continuation phase, where patients are responsible for taking medication at home.

Methods: We conducted a two-arm randomised controlled trial on adult patients with TB during the continuation phase. In the intervention arm, patients received routine care plus phone-based weekly pill refilling and daily medication reminders. In the control arm, participants received only routine care. A covariate adaptive randomisation technique was used to balance covariates during allocation. The primary outcome was adherence to patient-centred TB treatment, and secondary outcomes included provider-patient relationship and treatment outcomes. We applied per-protocol and intention-to-treat analysis techniques.

Results: We randomised 306 patients to intervention (n=152) and control (n=154) groups. Adherence to patient-centred TB treatment was 79% (110/139) in intervention and 66.4% (95/143) in control groups, with relative risk (RR) (95% lower CI) (RR=1.632 (1.162 to ∞); p=0.018, one tailed). Good provider-patient relationship was 73.3% (102/139) in intervention group and 52.4% (75/143) in control group, p=0.0001. TB treatment success was 89.5% (136/152) in intervention group and 85.1% (131/154) in control group, p=0.1238.

Conclusions: Mobile phone-based weekly refilling with daily medication reminder system improved adherence to patient-centred TB treatment and provider-patient relationship; however, there was no significant effect on treatment success.

Trial Registration Number: Pan African Clinical Trials Registry (PACTR201901552202539).
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http://dx.doi.org/10.1136/bmjhci-2020-100268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237748PMC
June 2021

Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia.

JMIR Mhealth Uhealth 2021 06 15;9(6):e27603. Epub 2021 Jun 15.

Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message-based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia.

Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia.

Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial.

Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants.

Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended.

Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839.
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http://dx.doi.org/10.2196/27603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277338PMC
June 2021

Healthcare providers' acceptance of telemedicine and preference of modalities during COVID-19 pandemics in a low-resource setting: An extended UTAUT model.

PLoS One 2021 22;16(4):e0250220. Epub 2021 Apr 22.

Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Background: In almost all lower and lower middle-income countries, the healthcare system is structured in the customary model of in-person or face to face model of care. With the current global COVID-19 pandemics, the usual health care service has been significantly altered in many aspects. Given the fragile health system and high number of immunocompromised populations in lower and lower-middle income countries, the economic impacts of COVID-19 are anticipated to be worse. In such scenarios, technological solutions like, Telemedicine which is defined as the delivery of healthcare service remotely using telecommunication technologies for exchange of medical information, diagnosis, consultation and treatment is critical. The aim of this study was to assess healthcare providers' acceptance and preferred modality of telemedicine and factors thereof among health professionals working in Ethiopia.

Methods: A multi-centric online survey was conducted via social media platforms such as telegram channels, Facebook groups/pages and email during Jul 1- Sep 21, 2020. The questionnaire was adopted from previously validated model in low income setting. Internal consistency of items was assessed using Cronbach alpha (α), composite reliability (CR) and average variance extracted (AVE) to evaluate both discriminant and convergent validity of constructs. The extent of relationship among variables were evaluated by Structural equation modeling (SEM) using SPSS Amos version 23.

Results: From the expected 423 responses, 319 (75.4%) participants responded to the survey questionnaire during the data collection period. The majority of participants were male (78.1%), age <30 (76.8%) and had less than five years of work experience (78.1%). The structural model result confirmed the hypothesis "self-efficacy has a significant positive effect on effort expectancy" with a standardized coefficient estimate (β) of 0.76 and p-value <0.001. The result also indicated that self-efficacy, effort expectancy, performance expectancy, facilitating conditions and social influence have a significant direct effect on user's attitude toward using telemedicine. User's behavioral intention to use telemedicine was also influenced by effort expectancy and attitude. The model also ruled out that performance expectancy, facilitating conditions and social influence does not directly influence user's intention to use telemedicine. The squared multiple correlations (r2) value indicated that 57.1% of the variance in attitude toward using telemedicine and 63.6% of the variance in behavioral intention to use telemedicine is explained by the current structural model.

Conclusion: This study found that effort expectancy and attitude were significantly predictors of healthcare professionals' acceptance of telemedicine. Attitude toward using telemedicine systems was also highly influenced by performance expectancy, self-efficacy and facilitating conditions. effort expectancy and attitude were also significant mediators in predicting users' acceptance of telemedicine. In addition, mHealth approach was the most preferred modality of telemedicine and this opens an opportunity to integrate telemedicine systems in the health system during and post pandemic health services in low-income countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250220PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061916PMC
May 2021

Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study.

JMIR Mhealth Uhealth 2021 03 26;9(3):e19310. Epub 2021 Mar 26.

Department of Pediatrics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Background: Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff.

Objective: The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia.

Methods: An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78).

Results: In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use.

Conclusions: Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.
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http://dx.doi.org/10.2196/19310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096376PMC
March 2021

Acceptability, Barriers and Facilitators of Mobile Text Message Reminder System Implementation in Improving Child Vaccination: A Qualitative Study in Northwest Ethiopia.

J Multidiscip Healthc 2021 9;14:605-616. Epub 2021 Mar 9.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Mobile phone text message-based mHealth interventions have shown promise in improving health service delivery. Despite the promising findings at a small scale and few contexts, implementing new technologies as part of changes to health care services is inherently challenging. Though there is a potential to introduce mHealth initiatives to health systems of developing countries, existing evidence on the barriers and facilitators of implementation in different contexts is not adequate. Therefore, this study aimed to explore the acceptability, barriers and facilitators of implementing mobile text message reminder system for child vaccination in Ethiopia.

Methods: This study applied a phenomenological study design. The study was conducted in north-west, Ethiopia between July 28 and August 19, 2020. A total of 23 participants were purposively selected for the in-depth and key informant interviews. We used an interview guide to collect data and audio-records of interviews were transcribed verbatim. Coding was done to identify patterns and thematic analysis was conducted using ATLAS ti7 software.

Results: The findings indicated that mothers were receptive to mobile text message reminders for their child's vaccination. Low mobile phone ownership, access to mobile network, access to electricity and illiteracy among the target population were identified as barriers that would affect implementation. Confidentiality and security-related issues are not barriers to implementation of text message reminders for child vaccination service. Facilitators for implementation include stakeholder collaboration, providing orientation/training to users, and willingness to pay by clients.

Conclusion: In this study, using mobile phone text message reminders for child vaccination services are acceptable by clients. Barriers identified were related to inadequate ICT infrastructure and other technical issues. Addressing the potential barriers and leveraging the existing opportunities could optimize the implementation in resource-limited settings. Before actual implementation, program implementers should also consider providing orientation to users on the proposed mHealth program.
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http://dx.doi.org/10.2147/JMDH.S298167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955748PMC
March 2021

Commitment Levels of Health Care Providers in Using the District Health Information System and the Associated Factors for Decision Making in Resource-Limited Settings: Cross-sectional Survey Study.

JMIR Med Inform 2021 Mar 4;9(3):e23951. Epub 2021 Mar 4.

Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Changing the culture of information use, which is one of the transformation agendas of the Ministry of Health of Ethiopia, cannot become real unless health care providers are committed to using locally collected data for evidence-based decision making. The commitment of health care providers has paramount influence on district health information system 2 (DHIS2) data utilization for decision making. Evidence is limited on health care providers' level of commitment to using DHIS2 data in Ethiopia. Therefore, this study aims to fill this evidence gap.

Objective: This study aimed to assess the levels of commitment of health care providers and the factors influencing their commitment levels in using DHIS2 data for decision making at public health care facilities in the Ilu Aba Bora zone of the Oromia national regional state, Ethiopia in 2020.

Methods: The cross-sectional quantitative study supplemented by qualitative methods was conducted from February 26, 2020 to April 17, 2020. A total of 264 participants were approached. SPSS version 20 software was used for data entry and analysis. Descriptive and analytical statistics, including bivariable and multivariable analyses, were performed. Thematic analysis was conducted for the qualitative data.

Results: Of the 264 respondents, 121 (45.8%, 95% CI 40.0%-52.8%) respondents showed high commitment levels to use DHIS2 data. The variables associated with the level of commitment to use DHIS2 data were found to be provision of feedback for DHIS2 data use (adjusted odds ratio [AOR] 1.85, 95% CI 1.02-3.33), regular supervision and managerial support (AOR 2.84, 95% CI 1.50-5.37), information use culture (AOR 1.92, 95% CI 1.03-3.59), motivation to use DHIS2 data (AOR 1.80, 95% CI 1.00-3.25), health needs (AOR 3.96, 95% CI 2.11-7.41), and competency in DHIS2 tasks (AOR 2.41, 95% CI 1.27-4.55).

Conclusions: In general, less than half of the study participants showed high commitment levels to use DHIS2 data for decision making in health care. Providing regular supportive supervision and feedback and increasing the motivation and competency of the health care providers in performing DHIS2 data tasks will help in promoting their levels of commitment that can result in the cultural transformation of data use for evidence-based decision making in health care.
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http://dx.doi.org/10.2196/23951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974756PMC
March 2021

Mapping the role of digital health technologies in the case detection, management, and treatment outcomes of neglected tropical diseases: a scoping review.

Trop Med Health 2021 Feb 22;49(1):17. Epub 2021 Feb 22.

Health System Directorate, Ministry of Health, Addis Ababa, Ethiopia.

Background: Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that principally impact the world's poorest people. The use of digital health technologies is an emerging and promising way to improve disease prevention, diagnosis, case detection, treatment delivery, and patient follow-up and facilitating health facility appointments thereby improving health outcomes. While the growing implementation of digital health technologies is evident, there is a lack of comprehensive evidence on the impact of digital health technologies in the control of NTDs. The main objective of this review was to map different pieces of evidence on the use of digital health technologies for case detection, management, and treatment outcome of the neglected tropical diseases.

Methods: We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The studies were searched using electronic databases like MEDLINE (PubMed), Science Direct, Cochrane Library, and manual searching engines. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion or the third reviewer made the decision. We produced the distribution of geographical locations, residents (setting), types of publications, and digital health technologies used on neglected tropical diseases using tables and graphs.

Findings: A total of 996 potentially relevant studies were generated from the initial search, and six studies were found to satisfy all the inclusion criteria and included in the final review. The review found that telehealth, eHealth, mHealth, telemedicine, and electronic health record were used digital health technologies to assess their impact on case detection, disease management, and treatment outcome of neglected tropical diseases. Mobile health was a feasible digital health technology for lymphatic filariasis patient identification and mHealth, eHealth, and electronic health records found to improve the service access, outcomes, and monitoring of visceral leishmaniasis at the community health system.

Conclusion: The scoping review identified that there were limited studies to see the impact of digital health technologies on case detection, management, and treatment outcomes for neglected tropical diseases. We also found that digital health technologies like ehealth, electronic medical linkage, telemed, and telehealth were practicable for patient identification, for treatment and diagnosis through contact with health professionals and teleconsultation, and support in improving health service delivery at the community-health system for managing the disease in both rural and urban settings.
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http://dx.doi.org/10.1186/s41182-021-00307-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898439PMC
February 2021

Mothers intention and preference to use mobile phone text message reminders for child vaccination in Northwest Ethiopia.

BMJ Health Care Inform 2021 Feb;28(1)

Department of Health Informatics, Institute of Public Health,College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objectives: With the unprecedented penetration of mobile devices in the developing world, mHealth applications are being leveraged for different health domains. Among the different factors that affect the use of mHealth interventions is the intention and preference of end-users to use the system. This study aimed to assess mother's intention and preference to use text message reminders for vaccination in Ethiopia.

Methods: A cross-sectional study was conducted among 460 mothers selected through a systematic random sampling technique. Initially, descriptive statistics were computed. Binary logistic regression analysis was also used to assess factors associated with the outcome variable.

Results: In this study, of the 456 mothers included for analysis, 360 (78.9%) of mothers have intention to use text message reminders for vaccination. Of these, 270 (75%) wanted to receive the reminders a day before the vaccination due date. Mothers aged 35 years or more (AOR=0.35; 95% CI: 0.15 to 0.83), secondary education and above (AOR=4.43; 95% CI: 2.05 to 9.58), duration of mobile phone use (AOR=3.63; 95% CI: 1.66 to 7.94), perceived usefulness (AOR=6.37; 95% CI: 3.13 to 12.98) and perceived ease of use (AOR=3.85; 95% CI: 2.06 to 7.18) were predictors of intention to use text messages for vaccination.

Conclusion: In conclusion, majority of mothers have the intention to use text message reminders for child vaccination. Mother's age, education, duration of mobile phone use, perceived usefulness and perceived ease of use were associated with intention of mothers to use text messages for vaccination. Considering these predictors and user's preferences before developing and testing text message reminder systems is recommended.
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http://dx.doi.org/10.1136/bmjhci-2020-100193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898827PMC
February 2021

Routine health information system utilization for evidence-based decision making in Amhara national regional state, northwest Ethiopia: a multi-level analysis.

BMC Med Inform Decis Mak 2021 01 26;21(1):28. Epub 2021 Jan 26.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.

Background: Health Information System is the key to making evidence-based decisions. Ethiopia has been implementing the Health Management Information System (HMIS) since 2008 to collect routine health data and revised it in 2017. However, the evidence is meager on the use of routine health information for decision making among department heads in the health facilities. The study aimed to assess the proportion of routine health information systems utilization for evidence-based decisions and factors associated with it.

Method: A cross-sectional study was carried out among 386 department heads from 83 health facilities in ten selected districts in the Amhara region Northwest of Ethiopia from April to May 2019. The single population proportion formula was applied to estimate the sample size taking into account the proportion of data use 0.69, margin of error 0.05, and the critical value 1.96 at the 95% CI. The final sample size was estimated at 394 by considering 1.5 as a design effect and 5% non-response. The study participants were selected using a simple random sampling technique. Descriptive statistics mean and percentage were calculated. The study employed a generalized linear mixed-effect model. Adjusted Odds Ratio (AOR) and the 95% CI were calculated. Variables with p value < 0.05 were considered as predictors of routine health information system use.

Result: Proportion of information use among department heads for decision making was estimated at 46%. Displaying demographic (AOR = 12.42, 95% CI [5.52, 27.98]) and performance (AOR = 1.68; 95% CI [1.33, 2.11]) data for monitoring, and providing feedback to HMIS unit (AOR = 2.29; 95% CI [1.05, 5.00]) were individual (level-1) predictors. Maintaining performance monitoring team minute (AOR = 3.53; 95% CI [1.61, 7.75]), receiving senior management directives (AOR = 3.56; 95% CI [1.76, 7.19]), supervision (AOR = 2.84; 95% CI [1.33, 6.07]), using HMIS data for target setting (AOR = 3.43; 95% CI [1.66, 7.09]), and work location (AOR = 0.16; 95% CI [0.07, 0.39]) were organizational (level-2) explanatory variables.

Conclusion: The proportion of routine health information utilization for decision making was low. Displaying demographic and performance data, providing feedback to HMIS unit, maintaining performance monitoring team minute, conducting supervision, using HMIS data for target setting, and work location were factors associated with the use of routine health information for decision making. Therefore, strengthening the capacity of department heads on data displaying, supervision, feedback mechanisms, and engagement of senior management are highly recommended.
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http://dx.doi.org/10.1186/s12911-021-01400-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836202PMC
January 2021

Effectiveness and Feasibility of Using Local Medical Universities for Capacity Building to Improve the Immunization Program in Ethiopia: Quasi-Experimental Study.

J Multidiscip Healthc 2021 6;14:9-19. Epub 2021 Jan 6.

Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Introduction: Supportive supervision is one of the five essential components of the WHO's Reaching Every District (RED) strategy. However, it is generally not practiced based on the standard schedule because of capacity and low number of staff in the health system. Thus, this study aimed to test the feasibility and effectiveness of a capacity building and mentorship program in immunization by health science colleges to supplement the existing approach.

Methods: This study applied a pre-post quasi-experimental research design. The study included health workers of 30 health facilities (15 intervention and 15 control) followed for six months. A total of 90 health workers were included. To assess the effectiveness of the intervention package on immunization coverage and a change in RED strategy implementation over time, difference in difference (DID) analysis was used. Finally, a RE-AIM framework was used to evaluate the implementation process.

Results: The study indicated that the intervention package has a significant effect (P = 0.0001) on the overall implementation of RED outcomes. The DID analysis also indicated that health facilities in the intervention district have shown a higher Penta III coverage (17.4%) and complete vaccination coverage (16.6%) that are attributable to the intervention package. Similarly, knowledge and skills of health workers improved significantly (P < 0.05) after the intervention. The key informants also mentioned that the new approach was effective and acceptable.

Conclusion: The newly introduced capacity building and mentorship program by well-trained personnel of medical universities had positive effects on the immunization program. Thus, it is recommended to facilitate policy adoption and readiness for routine use at large scale.
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http://dx.doi.org/10.2147/JMDH.S285280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797338PMC
January 2021

Information Seeking on Covid-19 Pandemic: Care Providers' Experience at the University of Gondar Teaching Hospital, Northwest of Ethiopia.

J Multidiscip Healthc 2020 16;13:1957-1964. Epub 2020 Dec 16.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: During the pandemic, information is inevitable and important, and having knowledge on pertinent information is very crucial for health-care professionals in order to deliver sustainable and quality health services to their clients, and to combat the virus. Therefore, the aim of this study was to assess the health-care providers' information seeking behavior on COVID-19 pandemic.

Methods: A descriptive cross-sectional study had conducted among 291 respondents. The participant's characteristics were presented using frequency and percentage. The association between the independent and dependent variables was explained using chi-squared test.

Results: Out of the 291 respondents, 207 (71.1%) of them had sought information on COVID-19 pandemic. The association between the gender and educational status with the outcome variable was found insignificant. Age (χ=10.6, =0.011), respondent's working unit (χ=33.7, <0.001), profession (χ=12.7, =0.013), taking computer training (χ=17.44, =0.000), computer access at work place (χ=7.28, =0.007), internet access at work place (χ=22.2, <0.001), and frequency of internet use (χ=17.63, <0.001) were found significant with COVID-19 information seeking.

Conclusion: Information seeking behavior was positively associated with computer access, computer training, internet access and frequency of use. Therefore, comprehensive package is required to build the capacity of care providers on computer-related skills. Besides, institutions need to have internet and computer access.
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http://dx.doi.org/10.2147/JMDH.S283563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751601PMC
December 2020

The Applicability of the Modified Technology Acceptance Model (TAM) on the Sustainable Adoption of eHealth Systems in Resource-Limited Settings.

J Multidiscip Healthc 2020 3;13:1827-1837. Epub 2020 Dec 3.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: The implementation of eHealth systems with a trial-and-error approach is very expensive and unsuccessful. So, this study aims to examine the constructs and relationships of the modified technology acceptance model (TAM) to determine whether it can be applied to assess health professional's behavioral intention to adopt eHealth systems in resource-limited settings or not.

Methods: The institutional-based cross-sectional study design was conducted among a total of 384 healthcare professionals in referral hospitals of Amhara regional state, Ethiopia. Self-administered questionnaire was used to collect the data, and the data were entered using Epi-info version 7 and the descriptive data were analyzed using SPSS version 25. Structural equation modeling, using AMOS 22, was also applied to describe and validate the degree of relationships between variables.

Results: The findings of the structural equation modeling (SEM) indicate that perceived usefulness has a significant influence on attitude (β =0.298, P<0.01) and intention to use eHealth (β =0.387, P<0.01). Perceived ease of use has significant influence on perceived usefulness (β=0.385, P<0.05) and attitude (β=0.347, P<0.05) and intention to use eHealth (β=0.339, P<0.01). Technical infrastructure has significant influence on attitude (β =0.412, P<0.01) and intention to use eHealth (β =0.355, P<0.01). The staffs IT experience has a significant influence on perceived usefulness (β =0.595, P<0.01) and attitude (β =0.267, P<0.05), but the effect of IT experience on the intention to use eHealth was not significant. Among all the constructs, healthcare professionals attitude towards eHealth showed the strongest effect on the intention to use eHealth systems (β = 0.52, P<0.01).

Conclusion: Overall, this model describes 56.2% of the variance in behavioral intention to use eHealth systems. Therefore, the implementers should give priority in enhancing the organizations technical infrastructure, staff's IT skill, and their attitude towards eHealth by giving continuous support.
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http://dx.doi.org/10.2147/JMDH.S284973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721313PMC
December 2020

Healthcare providers' digital competency: a cross-sectional survey in a low-income country setting.

BMC Health Serv Res 2020 Nov 9;20(1):1021. Epub 2020 Nov 9.

Department of Health Informatics, University of Gondar, Institute of Public Health, Gondar, Ethiopia.

Background: Healthcare providers across all clinical practice settings are progressively relying and adapting information communication technologies to perform their professional activities. In this era of technology, healthcare providers especially in lower income countries should have at least basic digital competency if a successful application of technology is to be achieved. The aim of this study was to assess digital competency of healthcare providers among seven public health centers in North-West Ethiopia.

Methods: A cross-sectional study design was applied to assess the basic digital competency of healthcare providers working in seven public health centers in North-west Amhara regional state, Ethiopia. Self-administered questionnaire adopted from the European commission's digital competency framework for assessing digital competency were used. A multivariable logistic regression was performed to identify factors associated with basic digital competency with p-value< 0.05 as a rule out for statistical significance. The strength of association was explained in terms of coefficient estimate, adjusted odds ratio and a 95% confidence interval (CI).

Result: From the total of 193 healthcare providers included in the study, 167 of them responded which is a response rate of 86.5%. The majority of respondents 88 (52.7%) were males and the mean age was 28.2 years with a standard deviation of 5.5 years. The result indicated that all items demonstrated an adequate level of internal consistency with Cronbach alpha > 0 .7. Healthcare providers in those public health centers reported that problem solving, safety and communication are the most common challenges encountered. The multivariable logistic regression model indicated that factors such as sex, educational status, profession type, monthly income and years of experience are statistically significant predictors.

Conclusion: Basic digital competency level of healthcare providers working in public health centers in this setting is relatively low. The results highlight the need to improve digital competency among healthcare providers focusing on the identified skill gaps.
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http://dx.doi.org/10.1186/s12913-020-05848-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652588PMC
November 2020

What we know and don't know about the immunization program of Ethiopia: a scoping review of the literature.

BMC Public Health 2020 Sep 7;20(1):1365. Epub 2020 Sep 7.

Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.

Background: There has been significant recent prioritization and investment in the immunization program in Ethiopia. However, coverage rates have stagnated and remained low for many years, suggesting the presence of systemic barriers to implementation. Hence, there is a need to consolidate the existing knowledge, in order to address them and consequently improve program effectiveness.

Methods: A thorough literature review and Delphi method were used. In this review, we searched Pubmed/Medline, WHO library, Science direct, Cochrane library, Google scholar and Google using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to immunization program were included. In the Delphi method, a panel of 28 national and international experts were participated to identify current evidence gaps and set research priorities under the immunization program.

Results: In this review, a total of 55 studies and national documents were included. The review showed that the vaccination coverage ranged from 20.6% in Afar to 91.7% in Amhara region with large inequities related to socio-economic, health service access and knowledge about vaccination across different settings. Only one study reported evidence on timeliness of immunization as 60%. The review revealed that 80% of health facilities provide immunization service nationally while service availability was only 2% in private health facilities. This review indicated that poor vaccine storage, vaccine shortage, service interruptions, poor defaulter tracing, low community engagement and poor documentation were the main barriers for the Expanded Program on Immunization with variations across different regions. Through expert panel of discussion using Delphi method, 10 priority research areas were identified across different domains of the immunization program at national level.

Conclusion: We found out that there is substantial knowledge on vaccination coverage, however, there is little evidence on timeliness of vaccination. The existing barriers that affect full immunization coverage also varied from context to context which indicates there is a need to design and implement evidence based locally tailored interventions. This review also indicated evidence gaps with more focus on health system related implementation barriers at lower level and identified further research priorities in the immunization program of Ethiopia.
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http://dx.doi.org/10.1186/s12889-020-09304-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487697PMC
September 2020

Intention to use electronic medical record and its predictors among health care providers at referral hospitals, north-West Ethiopia, 2019: using unified theory of acceptance and use technology 2(UTAUT2) model.

BMC Med Inform Decis Mak 2020 09 3;20(1):207. Epub 2020 Sep 3.

Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Electronic Medical Records (EMRs) are systems to store patient information like medical histories, test results, and medications electronically. It helps to give quality service by improving data handling and communication in healthcare setting. EMR implementation in developing countries is increasing exponentially. But, only few of them are successfully implemented. Intention to use EMRs by health care provider is crucial for successful implementation and adoption of EMRs. However, intention of health care providers to use EMR in Ethiopia is unknown.

Objective: The aim of this study was to assess health care provider's intention to use and its predictors towards Electronic Medical Record systems at three referral hospitals in north-west, Ethiopia, 2019.

Methods: Institutional based cross-sectional explanatory study design was conducted from March to September among 420 health care providers working at three referral hospitals in north-west Ethiopia. Data were analyzed using structural equation model (SEM). Simple and multiple SEM were used to assess the determinants of health care providers intention to use EMRs. Critical ratio and standardized coefficients were used to measure the association of dependent and independent variables, 95% confidence intervals and P-value were calculated to evaluate statistical significance. Qualitative data was analyzed using thematic analysis.

Result: The mean age of the study subjects was 32.4 years ±8.3 SD. More than two-third 293(69.8%) of the participants were male. Among 420 health care providers, only 167 (39.8%) were scored above the mean of intention to use EMRs. Factors positively associated with intention to use EMRs were performance expectancy (β = 0.39, p < 0.001), effort expectancy (β = 0.24,p < 0.001),social influence (β = 0.18,p < 0.001),facilitating condition (β = 0.23,p < 0.001), and computer literacy (β = 0.08,p < 0.001). Performance expectancy was highly associated with intention to use EMRs.

Conclusion: Generally, about 40 % of health care providers were scored above the mean of intention to use EMRs. Performance expectancy played a major role in determining health care providers' intention to use EMRs. The intention of health care providers to use EMRs was attributed by social influence, facilitating condition in the organization, effort expectancy, performance expectancy and computer literacy. Therefore, identifying necessary prerequisites before the actual implementation of EMRs will help to improve the implementation status.
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http://dx.doi.org/10.1186/s12911-020-01222-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469309PMC
September 2020

E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey.

BMC Med Inform Decis Mak 2020 08 6;20(1):181. Epub 2020 Aug 6.

School of Business, Institute of Business, History & Social Sciences, University of South-Eastern Norway, Notodden, Norway.

Background: Chronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia.

Methods: Institutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05.

Result: In total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level.

Conclusion: Besides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.
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http://dx.doi.org/10.1186/s12911-020-01202-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407428PMC
August 2020

Developing and Piloting TB Medication and Refilling Reminder System in Ethiopia.

Stud Health Technol Inform 2020 Jun;270:1251-1252

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

This project followed waterfall model to develop a context tailored and user-friendly reminder system to support home based TB treatment. Piloting was conducted on expert and patient levels. We developed a flexible and user-friendly web-based system that allows medication and refiling reminder. Participants agreed on its usefulness despite infrastructure and personal related challenges.
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http://dx.doi.org/10.3233/SHTI200387DOI Listing
June 2020

Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis.

BMC Public Health 2020 Jun 11;20(1):908. Epub 2020 Jun 11.

Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia.

Method: This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs).

Results: Of the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317-4.343), from richest households (AOR = 2.381; 95% CI: 1.502-3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310-6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377-3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048-0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033-0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities.

Conclusion: In this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.
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http://dx.doi.org/10.1186/s12889-020-08935-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291496PMC
June 2020

Home-based HPV self-sampling assisted by a cloud-based electronic data system: Lessons learnt from a pilot community cervical cancer screening campaign in rural Ethiopia.

Papillomavirus Res 2020 06 8;9:100198. Epub 2020 May 8.

Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address:

Primary HPV testing and triage of HPV-positive women is an effective cervical cancer screening strategy. Such a multi-visit screening algorithm is also promising for community-based screening in resource-poor communities, provided a robust tracking system is in place. A cervical cancer screening campaign was conducted in a rural community in Ethiopia. All women aged 25-65 years were offered genital self-sampling using the Evalyn Brush®. Samples were HPV-DNA-tested at a central laboratory. Key indicators were captured on tablet computers and linked by a cloud-based information system. HPV-positive women were examined at the local clinic using portable colposcopy, p16/Ki-67 dual stain cytology and biopsy examination. CIN2+ women were referred for LEEP to the referral hospital. Of 749 enumerated age-eligible women 634 (85%, (95% CI 82-88)) consented to screening, 429 samples were adequate for HPV testing, giving a total testing coverage of 57% (95% CI 53-62). The hrHPV prevalence was 14% (95% CI 5-22), 72% (95% CI 60-84) attended the clinic for a triage examination. Home-based HPV-DNA self-sampling and clinic-based triage assisted by cloud-based information technology is feasible in rural Ethiopia. Key components of such strategy are broad community awareness, high competency of community workers, and establishment of an adequate self-sampling and HPV-DNA testing platform.
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http://dx.doi.org/10.1016/j.pvr.2020.100198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240728PMC
June 2020

Health Professionals' Readiness and Its Associated Factors to Implement Electronic Medical Record System in Four Selected Primary Hospitals in Ethiopia.

Adv Med Educ Pract 2020 21;11:147-154. Epub 2020 Feb 21.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Incorporating electronic medical record systems (EMRs) into the healthcare system is not only about modernizing the health system, but is about saving lives by facilitating communication and practicing evidence-based decision. Globally, more than 50% of EMR projects fail before they reach their target. Even though EMRs are an essential tool for health care, their adoption and utilization remains low in developing countries including Ethiopia.

Objective: The aim of this study was to determine health professionals' readiness and associated factors toward the implementation of EMRs in four selected primary hospitals in Ethiopia.

Methods: An institutionbased cross-sectional study supplemented with a qualitative approach was conducted on 414 health professionals from March 2 to May 5, 2018 in four selected primary hospitals in Ethiopia. A self-administered questionnaire was used to collect the quantitative data and in-depth interviews were employed for the qualitative data. The data were analyzed using SPSS version 20 software. Descriptive statistics, bivariable, and multivariable logistic regression analyses were done. An adjusted odds ratio (AOR) with 95% CI was used to determine the association between the determinants and the outcome variable.

Results: More than half (258; 62.3%) of health professionals were ready to use the electronic medical recording system. EMR knowledge (AOR = 2.64; 95% CI: [1.62, 4.29]), attitude (AOR = 1.63; 95% CI: [1.01, 2.63]), computer literacy (AOR = 3.30; 95% CI: [2.05, 5.31]), and EMR training (AOR = 3.63, ;5% CI: [1.69, 5.80]) were significantly associated with EMR readiness.

Conclusion And Recommendation: In general, the overall readiness of health professionals for EMR implementation was found to be low. Comprehensive packages of capacity-building are crucial to raise the level of knowledge, attitude, and computer skill among health workers.
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http://dx.doi.org/10.2147/AMEP.S233368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041609PMC
February 2020

Does phone messaging improves tuberculosis treatment success? A systematic review and meta-analysis.

BMC Infect Dis 2020 Jan 14;20(1):42. Epub 2020 Jan 14.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Compliance to anti-TB treatment is crucial in achieving cure and avoiding the emergence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success.

Methods: All randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process.

Results: A total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I = 7%, p < 0.0002). In the review, performance, detection and attrition biases were reported as major risk of biases.

Conclusions: Mobile-phone messaging showed a modest effect in improving anti-TB treatment success; however, the quality of evidence was low. Further controlled studies are needed to increase the evidence-base on the role of mHealth interventions to improve TB care.

Protocol Registration Number: CRD420170744339. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074439.
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http://dx.doi.org/10.1186/s12879-020-4765-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961375PMC
January 2020

Mobile phone short message service for adherence support and care of patients with tuberculosis infection: Evidence and opportunity.

J Clin Tuberc Other Mycobact Dis 2019 Aug 6;16:100108. Epub 2019 Jun 6.

TB Proof, 29 Almond Drive, Somerset West, Western Cape 7130, South Africa.

To attain the Global End Tuberculosis (TB) goals, the treatment of persons with TB requires advancements in coordinated approaches that are low-cost and highly accessible. Treating TB successfully requires prolonged medication regimens with good adherence, which in turn requires patients to be adequately supported. Furthermore, TB care-providers often wish to monitor treatment-taking by patients in order to track the success of their programs and ensure adequate completion of therapies by individuals. The standard-of-care for treatment monitoring in TB programs often includes directly observed therapy (DOT). Video observed therapy (VOT) has emerged as a method to mimic in-person visits or observations, especially in the smartphone era with internet data connections, but remains simply inaccessible to patients in areas where TB is most endemic. Both approaches may be considered more intensive than necessary for many patients, leaving an opportunity for more affordable and acceptable approaches. The rapid increase in mobile phone penetration provides an opportunity to reach patients between clinical visits. Short message services (SMS) are available on almost every mobile phone and are supported by first generation cellular communication networks, thus providing the farthest reach and penetration globally. Evidence from non-TB conditions suggests SMS, used in a variety of ways, may support outpatients for better medication adherence and quality of care but the evidence in TB remains limited. In this paper, we discuss how basic mobile phones and SMS-related services may be used in supporting global care of persons with TB, with a focus on patient-centered approaches.
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http://dx.doi.org/10.1016/j.jctube.2019.100108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830136PMC
August 2019

Effect of mobile phone text message reminders on improving completeness and timeliness of routine childhood vaccinations in North-West, Ethiopia: a study protocol for randomised controlled trial.

BMJ Open 2019 11 5;9(11):e031254. Epub 2019 Nov 5.

Institute of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Introduction: Non-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia.

Methods And Analysis: A two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother-infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother-infant pairs with 1:1 allocation ratio. Mothers assigned to the intervention group will receive text message reminder 1 day before the scheduled vaccination visit at 6 weeks, 10 weeks, 14 weeks and at 9 months. Initially, descriptive statistics will be computed. For the primary outcome log-binomial regression model will be used to identify associated factors, and relative risk with 95% CI will be reported. Primarily, iIntention-to-treat analysis principle will be applied. STATA V.14 software will be used for the analysis.

Ethics And Dissemination: This study obtained ethical approval from the University of Gondar Institutional Ethical Review Board. The trial findings on the effectiveness of mobile text message reminders in improving vaccination uptake will help to inform decision makers on the use of mobile health interventions in developing countries like Ethiopia. The scientific findings of the trial will also be published in reputable journals.

Trial Registration Number: PACTR201901533237287.
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http://dx.doi.org/10.1136/bmjopen-2019-031254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858152PMC
November 2019

Development of automated text-message reminder system to improve uptake of child vaccination in Ethiopia.

Online J Public Health Inform 2019 19;11(2):e15. Epub 2019 Sep 19.

Department of computer science, Faculty of Informatics, University of Gondar, Gondar, Ethiopia.

Introduction: Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is forgetfulness of caretakers to show up in vaccination schedules. This necessitates developing an automated reminder system with integration of mobile technologies.

Objectives: This paper aimed to develop and test an automated mobile text message reminder system in the local context of Ethiopia.

Methods: This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Requirement gathering was done before development of the system. Front end application was developed using java technologies while back end applications were developed with oracle database. Finally, pilot testing of the automated reminder system was done on 30 participants.

Results: The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2. SMS application for automatic SMS text messaging. In the pilot testing, all the text messages (100%) were dispatched from the automated system to the respective participants. Finally, the system has shown a notification that the text messages have been sent successfully.

Conclusion: Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message based mHealth interventions should be carefully designed, developed, tested and refined before actual implementation.
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http://dx.doi.org/10.5210/ojphi.v11i2.10244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788892PMC
September 2019

Willingness to Use Mobile based e-Partograph and Associated Factors among Care Providers in North Gondar Zone, Northwest Ethiopia.

Online J Public Health Inform 2019 19;11(2):e10. Epub 2019 Sep 19.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia.

Background: The proper use of Partograph supports to capture key maternal and fetal data. Paper-based Partograph are prone to error, incompleteness, delayed decisions and loss of clients' information. Electronic (e-Partograph) enables to easily retain and retrieve client data to ensure quality of care. Mobile technologies found an opportunity for resource-limited countries to improve access and quality of health care. Evidences were lacking on end users' acceptance to e-Partograph.

Objective: This study aimed to assess obstetric care providers' willingness to use mobile based e-Partograph and its associated factors.

Methods: Institutional based cross-sectional study was conducted from December 30, 2016 to January 21, 2017. A total 466 obstetric care providers were selected using multistage sampling technique in North Gondar Zone, Northwest Ethiopia. A structured self-administered questionnaire was used to collect the data. The data were entered in to Epi info version 7 and analyzed by using SPSS version 20. Cronbach's Alpha test was calculated to evaluate the reliability of data. A multivariable logistic regression analysis were used to identify factors associated with dependent variable. Adjusted odds ratio with 95%CI was used to determine the presence of association.

Results: The study found that 460(99.6%) of care providers owned mobile phone. Smartphone owners accounted only 102(22%). Of them, 205(46%) were willing to use mobile-phone for e-Partograph. Care providers aged >30 years (AOR=2.85, 95% C.I: 1.34-6.05), medical doctors and higher level clinicians (AOR=8.35, 95% C.I: 2.07-33.63), Health Center (AOR=4.41, 95% C.I:0.10-9.26), favorable attitude towards Partograph (AOR=2.76, 95% C.I: 1.49-5.09) and related in-service trainings (AOR=7.63, 95% C.I: 3.96-14.69) were enabling factors for willingness to use mobile phone.

Conclusions: Almost all obstetric care providers had access to mobile phone, however; smartphone ownership is still low. Willingness to use mobile-phone for e-Partograph was low. Younger aged, lower level clinicians, Hospital based workers, unfavorable attitude on Partograph and lack of in-service trainings were main factors for non-willingness. Hence awareness creation on partograph use and digital capacity building are crucial for effective e-partograph management.
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http://dx.doi.org/10.5210/ojphi.v11i2.9468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788899PMC
September 2019

Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study.

JMIR Pediatr Parent 2018 Oct 17;1(2):e9. Epub 2018 Oct 17.

eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, Gondar, Ethiopia.

Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition.

Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)-based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa.

Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message-based mHealth intervention.

Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718).

Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message-based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message-based mHealth interventions.
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http://dx.doi.org/10.2196/pediatrics.9618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715064PMC
October 2018

Combined effect of pill refilling and self-medication reminder system on patients' adherence to tuberculosis treatment during continuation phase in Northwest Ethiopia: a study protocol for randomised controlled trial.

BMJ Health Care Inform 2019 Aug;26(1)

University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia.

Introduction: Patients' failure to adhere on tuberculosis (TB) treatment leads to drug resistance, relapse and death. Non-adherence to TB treatment is higher during continuation treatment phase. The study aimed to evaluate effectiveness of combined pill refilling and medication reminders on adherence to TB treatment.

Methods And Analysis: A two-arm randomised controlled trial on adult patients with TB was used during continuation treatment phase. In the first arm, in addition to usual care, participants will receive cellphone-based daily medication and weekly pill refilling reminders. In the control arm, participants will receive only usual care. The study will use a covariate adaptive randomisation technique to balance covariates during allocation. The primary outcome is patients' adherence to TB treatment and secondary outcomes are attendance to clinic and treatment outcomes. We apply intention to treat with generalised linear mixed model.

Ethics And Dissemination: Ethical approval was obtained from Institutional Review Board of University of Gondar. Written informed consent was applied during enrolment. We will publish findings in peer-reviewed, scientific journals and conferences.

Trial Registration Number: PACTR201901552202539.
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http://dx.doi.org/10.1136/bmjhci-2019-100050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062340PMC
August 2019

How to Improve Local-Level Data Use Culture at Each Level of the Health System? An Implementation Science Study.

Stud Health Technol Inform 2019 Aug;264:1656-1657

College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Health programs are reliant on complex decision-making to efficiently utilize limited resources, but local-level data use is still challenging. This study aimed to assess barriers to fostering local-level data use culture at each level of a health system. Results show that awareness gaps, lack of motivation, inconsistent supervision, poor community engagement, and lack of accountability are major bottlenecks. Establishing an accountability system and capacity building on health data use could improve its implementation.
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http://dx.doi.org/10.3233/SHTI190582DOI Listing
August 2019

Effect of mobile text message reminders on routine childhood vaccination: a systematic review and meta-analysis.

Syst Rev 2019 06 28;8(1):154. Epub 2019 Jun 28.

Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: The World Health Organization estimates that 29% of under-five mortality could be prevented with existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the review was to systematically collect and summarize the available evidence on the effectiveness of text message reminders on childhood vaccination.

Methods: This review was conducted according to a priori published protocol on PROSPERO. A systematic literature search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias was assessed statistically using Harbord test.

Results: A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About 1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05-1.17) with a moderate level of heterogeneity (I = 64.3%, P = 0.003). The results from the Harbord test suggested that there is no evidence for publication bias (P = 0.340).

Conclusion: This review highlights the potential benefits of incorporating mobile text message reminders into the standard management of childhood immunizations, especially in low- and middle-income countries. The frequency and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders. Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs.

Systematic Review Registration: PROSPERO CRD42017074230.
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http://dx.doi.org/10.1186/s13643-019-1054-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598255PMC
June 2019
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