Background Clinical practitioners are influential figures in the public’s health-seeking behavior. Therefore, understanding their attitudes toward the COVID-19 vaccine is critical for implementing successful vaccination programs. Our study aimed to investigate clinical practitioners’ acceptance of the COVID-19 vaccine and associated factors for evidence-based interventions. Methods Data from 461 clinical practitioners were collected using a cross-sectional design via an online self-administered survey. Descriptive and multiple logistic regression analyses and chi-square tests were conducted using R version 3.6.1. Results The COVID-19 vaccine was accepted by 84.4 percent of those polled, and 86.1 percent said they would recommend it to others. Individuals with advanced levels of education demonstrated greater readiness for vaccine acceptance (P<0.001) and willingness to recommend (P<0.001). On the other hand, practitioners with concerns about the safety of vaccines developed in emergency settings were less likely to accept vaccines (OR = 0.22). Practitioners influenced by social media posts (OR = 0.91) and religious beliefs (OR = 0.71) were found to be less willing to recommend the vaccine. Conclusion The study demonstrated that interventions to improve clinical practitioners’ acceptance and recommendation of the COVID-19 vaccine should consider the following factors: level of experience and education, religious beliefs, safety concerns, specific profession, and source of information. Vaccine literacy efforts that directly address specific concerns and misconceptions, such as those that reconcile social media information and religious beliefs with scientific literature, are recommended.

Background Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers’ contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.

Background More than 100,000 cleft lip and palate patients have benefited from reconstructive surgeries in Africa as a result of surgical missions by non-governmental organisations such as Smile Train. The Smile Train Express is the largest cleft-centered patient registry with over a million records of clinical records, globally. In this study, we reviewed the east African patient registry data to evaluate and understand the clinical profiles of cleft lip and palate patients operated at Smile Train partner hospitals in East Africa. Method A retrospective database review was conducted from April to June 2022 in all East African cleft lip and palate surgeries registered in the Smile Train database from November 2001 to November 2019. Results 86,683 patient records from 14 East African countries were included in this study. The mean age was 9.1 years, the mean weight was 20.2kg and 19kg for males and females, respectively, and 61.8 % of the surgeries were performed on male patients. Left cleft lip only (n=22,548, 28.4 %) and right cleft lip only (n=17862, 22.5%) were the most common types of clefts, with bilateral cleft lip only (n= 5712, 7.2%) being the least frequent. Complete right cleft lip with complete right alveolus was the most frequent cleft combination observed (n = 16,385) and Cleft lip to cleft lip and palate to cleft palate ratio (CL:CLP: CP) was 6.7:3.3:1. Unilateral primary lip-nose repairs were the most common surgeries (69%) and, alveolar bone grafts were the least common (0.8%). General anesthesia was used for 74.6 % (52847) of the procedures. Conclusion The study has highlighted the need for evidence-based collaborative initiatives to enhance cleft care in East Africa. The key areas of improvement include parental/caregiver education for early detection, and intervention, addressing gender disparities in care, early nutritional assessment and feeding counseling, undue attention to proper registration of anesthesia techniques, and inclusion of postoperative data in the Smile Train database.

BACKGROUND In many health systems globally, digital health technologies (DHT) have become increasingly commonplace as a means of delivering primary care. COVID-19 has further increased the pace of this trend. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how DHT implementation has been realised in the sub-Saharan Africa (SSA) healthcare environment remains to be further explored. OBJECTIVE To capture the multidisciplinary experiences of SSA experts and primary care healthcare providers using DHTs to explore the strengths and weaknesses, as well as opportunities and threats regarding the implementation and use of DHTs in SSA primary care settings. METHODS A combination of qualitative approaches was adopted (i.e., online focus groups and semi-structured interviews), using an online platform. Participants were recruited through AfroPHC and researchers contact networks, using convenience sampling, and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews and focus groups, using the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Transcripts were compiled verbatim and systematically reviewed by two independent reviewers using thematic analysis to identify emerging themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure the study meets the recommended standards of qualitative data reporting. RESULTS Strengths of DHT use ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust, to greater collaboration, enabling safer decision-making, and hastening progress towards universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline healthcare resource expenditure, and provide a means to learn international best practices. Major threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and means for patient data protection. CONCLUSIONS The research highlights the complex challenges of implementing DHTs in the SSA context, as a fast-moving health delivery modality, as well as the need for multi-stakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region, and its implications on health and health care equity, capitalising on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realised when informed by studies that incorporate patient perspective at every stage of the research cycle.

Background Medical training is academically rigorous and physically and psychologically demanding. Immense clinical responsibilities, substandard work environments, and the toll these take on the mind and body contribute to significant stress. Burnouts emanate from these factors and in turn affect the work performance and satisfaction of an individual at every level of practice. Material and method This is a cross-sectional study involving all surgical residents across all fields of specialty: general surgery, neurosurgery, pediatric surgery, urology, and plastic and reconstructive surgery in Addis Ababa University, College of Health Sciences. Result Of the 190 surgical residents in training at the time of the study, 159 completed the survey, amounting to a response rate of 83%. Following further exclusion of incomplete data, a total of 146 responses were analyzed. Of these, 88 (60%) fulfilled at least one criterion of the sub-scales for burnout while 21 (14.4%) met the criteria for burnout in all sub-scales. Considering the individual contributions of the factors, the result showed that both sleep for more than 6 hours (B=0.357, t=4.6, p<0.001) and residence within the hospital compound (B= 0.229, t=2.96, p=0.004) positively predicted Emotional Exhaustion subscale. In contrast, involvement in extra-professional activities (B=-0.247, t=-3.16, p=0.002) and taking vacations (B=-0.27, t=-3.47, p<0.001) were negative predictors of Depersonalization, while sleep more than 6 hours (B=0.212, t= 2.71 p=0.008) and frequent duties (>1 per week) (B=0.17, t=2.2, p=0.029) positively predicted it. Finally, residence within the hospital compound (B=-0.206, t=-2.62, p=0.01) negatively predicted Personal Accomplishment, while involvement in extra-professional activities (B=0.238, t=-3.03, p=0.003) and being religious (B=0.174, t= 2.21, p=0.028) positively predicted Personal Accomplishment. Conclusion The burnout rate was found to be high (60.3%) among our study population. Engagement in extra-professional activities, religious pursuits, and vacations was protective against at least one burnout sub-scale. Residence within the hospital compound, more frequent duty programs, and longer sleep hours were predictors of at least one of the burnout sub-scales. Institutions at large, and the specific residency programs therein should assess the rate of burnout in their respective programs along with the risk factors in order to dampen the rate and effects of it.