Systematic review of the quality of care provided to sick children in Ethiopian health facilities.

Autor:	Bayou NB; Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.; Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia., Tesfaye BH; Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.; Maternal, Child and Adolescent Health lead Executive Office, Ministry of Health, Addis Ababa, Ethiopia., Alemu K; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia., Worku A; Schools of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia., Tadesse L; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia., Bekele D; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia.; Department of Gynecology and Obstetrics, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia., Tolera G; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Chan G; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia.; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA., Nigatu TG; The University of British Columbia, Addis Ababa, Ethiopia.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2024 Nov 01; Vol. 14, pp. 04243. Date of Electronic Publication: 2024 Nov 01.
DOI:	10.7189/jogh.14.04243
Abstrakt:	Background: Despite the increasing number of primary studies on the quality of health care for sick children in Ethiopia, the findings have not been systematically synthesised to inform quality improvement in policies or strategies. This systematic review provides a narrative synthesis of published evidence on the quality of care provided to sick children in Ethiopia's health facilities and on related barriers and enablers. Methods: We searched studies that measured the structure, process, and outcome measures of quality of care as proposed by Donabedian's framework. We searched in PubMed/Medline, EMBASE, and Web of Science using the Population, Concept, and Context (PCC) framework. Grey literature was searched in Google Scholar and institutional websites. We appraised the studies' quality using the Mixed Method Quality Appraisal Tool version 2018. Data were analysed using content thematic analysis and presented using a narrative approach. Results: We included 36 of 701 studies. Thirty (83.3%) were nonexperimental including 21 (70%) cross-sectional studies and five (16.7%) qualitative studies. Of the 31 facility-based studies, 29 (93.5%) were conducted in public facilities. The structural, technical, and interpersonal processes of care were low quality. While some studies reported the effectiveness of interventions in reducing child mortality, the uptake of services and providers' and caretakers' experiences were suboptimal. The major structural barriers to providing quality care included inadequacy of essential drugs, supplies and equipment, training, clinical guidelines, and ambulance services. Caretakers' non-compliance to referral advice was a common demand-side barrier. The enabling factors were implementing various health system strengthening interventions including quality improvement strategies such as user-centred service delivery and optimising engagement of community-level structures such as health promotors and religious leaders to create demand. Conclusions: The quality of care provided to sick children in health facilities is generally low in Ethiopia. Shortages of essential drugs, supplies and equipment, physical space, water, and electricity; and human resource-related challenges such as shortage, training, supervision, and retention were common structural barriers. Various health systems strengthening and quality improvement interventions, ranging from enhanced demand creation to realising a reliable and consumer-centred service delivery were key enablers. More research is needed on the quality of care provided in private facilities. Registration: PROSPERO: CRD42021285064. Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests. (Copyright © 2024 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
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