Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

Job Satisfaction Level and Associated Factors Among Rural Health Extension Workers of Sidama Region, Southern Ethiopia

Background Rural health extension workers (HEWs) are essential for the implementation of the promotion and prevention-based health care policy of Ethiopia. Job satisfaction is believed to be one of the key factors that influence their performance. Information regarding job satisfaction and associated factors are limited in the study area. Therefore, this study was aimed at assessing job satisfaction level and associated factors among rural Health Extension Workers of Sidama Region, Southern Ethiopia. Method A facility-based cross-sectional study was conducted among 341 rural HEWs from 1 March to 30 April 2021. Data was collected using trained data collectors using pre-tested and self-administered questionnaires. SPSS version-25 was used for data analysis. Bi-variable and multi-variable logistic regressions were used to observe the association between the outcome variable and associated factors. The outputs are presented using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Result This study revealed that 36.6% (95% CI: 31.6%-41.6%) of the rural HEWs were satisfied with their job. Increased odds of satisfaction were observed among rural HEWs who got training opportunities (AOR: 3.74, 95% CI: 2.01, 6.98), education opportunities (AOR: 3.06, 95% CI: 1.56, 7.46), management support (AOR: 4.59, 95% CI: 2.44, 8.67), supervisor support (AOR: 7.40, 95% CI: 3.84, 14.26), and a better salary/payment (AOR: 4.18, 95% CI: 2.19, 7.88) compared to their counterparts. Conclusion and Recommendation The job satisfaction level among rural HEWs in the study area was low. Strategies to stimulate and strengthen recognition of management, supportive supervision, performance-based regular salary increment, and career developments are recommended.

Measuring Hazards of Undetectable Viral Load among Hepatitis C Antibody Positive Residents of a Large Southern California County

Background Hepatitis C virus (HCV) infection is the most common bloodborne infection in the U.S. However, only a small proportion of persons are treated and cured. Previous research has not characterized sociodemographic characteristics of who receives treatment. We examined predictors of undetectable for HCV in Orange County, the sixth largest county in the United States, where HCV is the most commonly reported infection. Methods: From 2014 to 2020, we acquired public health surveillance data from 91,165 HCV antibody-positive care encounters from the California Reportable Disease Information Exchange (CalREDIE). We used a time-to-event proportional hazards framework to estimate individual and area-level correlates of time-to-HCV undetectable viral load among HCV + individuals. Results: Older adults (>65 years) showed an increased hazard of undetectable viral load relative to younger adults (HR = 2.00). In addition, residents of census tracts with greater enrollment in health insurance showed a greater likelihood of undetectable viral load (HR = 1.36). The moderating effect of higher tract median household income and higher tract levels of health insurance were more likely to have undetectable viral load and was statistically significant. Conclusion: In a large urban county, HCV antibody-positive older adults appear much more likely to show undetectable viral load compared to younger adults. Residents in areas with higher quartiles of health insurance enrollment have an increased likelihood of undetectable viral load. The extent to which constraints impede HCV care requires further investigation, including follow-up studies on health insurance type to test the relationship of health insurance type to undetectable viral load.

Developing Adult Vaccination Ecosystem in India: Current Perspective and the Way Forward

Introduction: A high burden of vaccine-preventable diseases, increasing elderly population, immunosenescence, and emerging drug resistance emphasize the need for robust adult immunization in India. While immunization guidelines from various societies exist, there is inadequate implementation of the same. Aim: We undertook this narrative review of the adult vaccination ecosystem in India to (i) gain insights into existing adult vaccination practices, (ii) identify barriers to adult vaccination and possible solutions, and (iii) improve collaboration between various stakeholders to help establish adult vaccination centers in the country. Results: Besides the high cost and lack of insurance coverage, the lack of adult vaccination centers contributes to the low coverage of adult immunization. Discussion: These challenges can be addressed through multiple approaches including community awareness and immunization programs, setting up mobile vaccination vans, patient/consumer education, and adequate training of healthcare providers. Successful implementation of these strategies requires active collaboration between the government, hospitals, different stakeholders, and policymakers.

Social Stability and Unmet Health Care Needs in a Community-Based Sample of Women Who Use Drugs

Objective To examine the relationship between social stability and access to healthcare services among a community-based sample of adult female drug users. Methods We developed a measure of social stability and examined its relationship to health care access. Data came from a cross-sectional sample of female drug users (N = 538) in Oakland, CA who were interviewed between September 2014 and August 2015. We categorized women as having low (1-5), medium (6-10), or high (11-16) social stability based on the tertile of the index sample distribution. We then used ordered logistic regression to examine the relationship between social stability and self-reported access to mental health services and medical care. Results Compared with women in the low stability group, those with high stability experienced a 58% decline in the odds of needed but unmet mental health services [AOR: 0.42; 95% C.I.: 0.26, 0.69] and a 68% decline in the odds of unmet medical care [AOR: 0.32; 95% C.I.: 0.19, 0.54] after adjusting for confounders. The coefficients we observed reduced in size at higher levels of the stability index suggesting a positive association between social experiences and access to healthcare services. Conclusion Women who use drugs are at increased risk of adverse health outcomes and often experience high levels of unmet healthcare needs. Our study highlights the importance of addressing social determinants of health and suggests that improving social factors such as housing stability and personal safety may support access to healthcare among female drug users.

The Effect of Incentive Management System on Turnover Rate, Job Satisfaction and Motivation of Medical Laboratory Technologists

Objectives: We investigated factors affecting turnover and assessed satisfaction with an existing Incentive Management System and to which extent it motivates employees. We also provide recommendations to improve the Incentive Management System. Methods: A cross-sectional questionnaire study utilizing a convenience sample from of a population of 250 Medical Laboratory Technologists. Findings: 100 medical laboratory technologists responded to the survey. We found discrepancy in wage allocation to be the most prominent factor affecting turnover intention with 51% strongly agreeing, followed by low incremental system with 48%. Other factors were: limited opportunities for promotion, insufficient allowances and benefits, and lack of continuing education and professional growth opportunities with 49%. 26% of respondents found lack of autonomy/independence to be a factor. Poor workgroup cohesion was least ranked (17%). 39% reported dissatisfaction with workload, 31% were dissatisfied with their provided allowance, with management support, and the working hours, and opportunities for promotion (44%). Opportunities for career growth and higher pay were highest ranked as incentives to remain, and additional vacation time and supportive colleagues to be the least relevant factors. There was a significant correlation between age and motivation levels (r = 0.223, p = 0.026). Discussion and Conclusions: Burnout and turnover can be costly to healthcare organizations, due to the impact on productivity and healthcare quality. Human resource departments must ensure to not only attract skilled employees, but also influence their motivation and retention due to the impact on productivity and health care quality. Incentive management systems support practices to enhance skills, knowledge, abilities and retention rates for healthcare employees. Our study findings support the continued improvement of Incentive Management Systems within the healthcare organization to reduce turnover rates, maximize quality outcomes, and increase the levels of commitment and motivation of employees.

Estimating the Period Prevalence of Mothers Who Have Abortions: A Population Based Study of Inclusive Pregnancy Outcomes

Introduction: The prevalence of induced abortion among women with children has been estimated indirectly by projections derived from survey research. However, an empirically derived, population-based conclusion on this question is absent from the published literature. Objective: The objective of this study was to describe the period prevalence of abortion among all other possible pregnancy outcomes within the reproductive histories of Medicaid-eligible women in the U.S. Methods: A retrospective, cross-sectional, longitudinal analysis of the pregnancy outcome sequences of eligible women over age 13 from the 17 states where Medicaid included coverage of most abortions, with at least one identifiable pregnancy between 1999 and 2014. A total of 1360 pregnancy outcome sequences were grouped into 8 categories which characterize various combinations of the 4 possible pregnancy outcomes: birth, abortion, natural loss, and undetermined loss. The reproductive histories of 4,884,101 women representing 7,799,784 pregnancy outcomes were distributed into these categories. Results: Women who had live births but no abortions or undetermined pregnancy losses represented 74.2% of the study population and accounted for 87.6% of total births. Women who have only abortions but no births constitute 6.6% of the study population, but they are 53.5% of women with abortions and have 51.5% of all abortions. Women with both births and abortions represent 5.7% of the study population and have 7.2% of total births. Conclusion: Abortion among low-income women with children is exceedingly uncommon, if not rare. The period prevalence of mothers without abortion is 13 times that of mothers with abortion.

Triple Aim and the Hospital Readmission Reduction Program

Objectives: Despite substantial attention on hospital readmission rates, the impact of the Hospital Readmission Reduction Program (HRRP) on a comprehensive set of Triple Aim goals has not been studied: improve hospital quality, reduce cost, and improve patient experience. Methods: We analyze inpatient claims data from 2006 to 2015 from the Dallas Fort Worth Hospital Council Foundation with a panel of 27,397 patients with chronic obstructive pulmonary disease and congestive heart failure. We deploy a quasi-natural experiment using a difference-in-difference specification to estimate the effect of HRRP effect on readmission rates, length of stay (LOS), and hospital satisfaction. Results: We find that the likelihood of 30-day readmissions declined by 2.6%, average LOS decreased by 7.9%, and overall hospital rating increased by 2.1% among hospitals that fell under the scope of the HRRP, compared to non-HRRP hospitals. Our results provide evidence of a spillover effect of the HRRP in terms of its impact not only on Medicare patients, but across all insurance types, and other performance measures such as cost and patient experience. Conclusion: Our findings indicate that HRRP hospitals do not trade-off reductions in readmission rates with lower quality across other patient health outcomes. Rather, we find evidence that the HRRP has affected all 3 dimensions of the Triple Aim with respect to patient and hospital outcomes.