Browsing by Author "Eshetu, Eskinder (PhD)"

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    Assessment of psychometric properties, feasibility and usefulness of the EQ- 5D-5L in Ethiopian stroke patients
    (Addis Ababa University, 2023) Wehib,Ewennat; Eshetu, Eskinder (PhD); Belay,Yared Belete( PhD candidate)
    Background: Stroke ranks as the second-leading global fatality and affects the quality of life for survivors. Despite limited knowledge about the impact of acute stroke on health-related quality of life in Ethiopia, longitudinal studies on stroke patients offer some insight internationally. Objective: To assess the Psychometric properties, feasibility and usefulness of EQ-5D-5L among Ethiopian stroke patients. Methods: A sequential mixed-method study design was conducted among 200 patient-proxy dyads at 6 public hospitals of Addis Ababa, Ethiopia from November 2021-November 2022. STATA version 15 was used for the quantitative analysis.The internal consistency was assessed using Cronbach‘s alpha (α). Chi-square test was used for the problem/no problem report comparison among patients and proxies across different interview periods. Mean difference between patient and proxy in the EQ-5D index and EQ VAS was reported using paired t-test. In addition, patient/proxy response agreement, convergent validity, and known group validity were assessed. Qualitative data was analyzed thematically using MaxQDA version 20. Results: EQ-5D-5L demonstrated good internal consistency with a Cronbach‘s α of 0.86, 0.92 and 0.93 at baseline, Visit 2 and visit 3 respectively. In visits two and three compared to the baseline report, a better agreement was observed between patient and caregivers. There was a moderate to strong association between the mRS score and the EQ VAS and EQ-5D index. Significant differences in mean utility were noted among patients with different stroke disability levels, as measured by mRS. Patients, proxies, and data collectors found it easier to answer EQ- 5D-5L questions during follow-up visits compared to baseline. Two major themes were identified with respect to discrepancies in patient and proxy ratings, which attributed to reflections on the feasibility of questions and concerns on perceived disease impact. Conclusion: The EQ-5D-5L is a reliable and valid tool for assessing HRQoL in stroke patients. The findings also showed that proxy assessments acquired 3 and 6 months after stroke are more reliable than those obtained in the acute setting.
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    Patient and Provider Experiences on Differentiated Antiretroviral Therapy Service Delivery Models in Addis Ababa Health Fa cilities: A Mixed-Methods Study
    (Addis Ababa University, 2024-10) Mesele, Kidist; Eshetu, Eskinder (PhD); Tekle ,Girma
    Background: Following the World Health Organization's (WHO) recommendation of the Differentiated Service Delivery (DSD) models as a client-centered approach in 2016, Ethiopia has been implementing these models since 2017. However, there is paucity of information on the impact of the DSD model implementation in Ethiopia. Objective: To assess patient and provider experiences with the implementation of Antiretroviral therapy (ART) DSD models in selected health facilities of Addis Ababa, Ethiopia. Methods: A mixed-methods sequential explanatory study design was undertaken among People Living with HIV (PLWH) and healthcare professionals at 10 selected health facilities of Addis Ababa. For the quantitative study, convenient sampling was employed, while purposive sampling method was used for the qualitative study. Mann-Whitney U and Kruskal Wallis tests were performed to determine the difference in the patient satisfaction among subgroups of patients. Multivariable Tobit regression was performed to identify factors associated with patient satisfaction. Thematic analysis was used to interpret the qualitative data. Results: Four hundred fifteen PLWH were included in the final analysis. The majority (266, 64.1%) were female and 185 (44.6%) were enrolled in Appointment Spacing Model (ASM). The median score of patient satisfaction was 76.5. Viral load count of <1000 copies/ml, high adherence level and being on first line regimen were significantly positively associated with high patient satisfaction. There was no satisfaction difference among the DSD models. The qualitative analysis documented patients’ and professionals’ perspectives in the areas of service efficiency, perceived patient outcomes, and integration with other chronic patient care services. Conclusion and recommendation: The study found that patients expressed a high level of satisfaction with DSD models. Factors such as the type of regimen, patient adherence status, and viral load amount significantly influenced satisfaction. Perceived stigma with community DSD models, low awareness on DSD models, fear of detachment from the health facility, and supply chain inconsistency were the reported barriers with ART DSD models. Majority of the study participants believed that the integration of HIV care with other chronic condition was beneficial. Policy makers, federal ministry of health, and health care providers should consider addressing the barriers associated with DSD models.