Utilization of Preventive Medical Check-Up and Associated Factors Among Public Hospital Workers in Addis Ababa, Ethiopia

doi:10.21203/rs.3.rs-4167974/v1

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Utilization of Preventive Medical Check-Up and Associated Factors Among Public Hospital Workers in Addis Ababa, Ethiopia

https://doi.org/10.21203/rs.3.rs-4167974/v1

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Background: The proper utilization of the Preventive Medical checkups (PMC) increases people’s quality of life and life expectancy by identifying treatable health issues and controlling life threatening diseases. Non-communicable diseases account for more than 71% of the overall global burden of diseases. The PMC is effective in preventing illness, promoting health, reducing morbidity and mortality. However, there is a paucity of evidence on the utilization of PMC in Ethiopia. Therefore, we aimed to assess the level of utilization of preventive medical check-ups and associated factors among workers in public hospitals.

Objective: To assess the utilization of preventive medical check-ups and associated factors among public hospital employees in Addis Ababa Ethiopia.

Methods: A Hospital-based cross-sectional study with quantitative approach was conducted in 2019 on 422 subjects selected by systematic random sampling technique among the employees of the public hospitals in Addis Ababa. Data were collected using a structured questionnaire through a face-to-face interview. Data were entered into Epi info version 7.2.2.6 and exported to SPSS version 23 statistical software for analysis. Variables with a p-value of less than 0.20 in bivariate analysis were included in multivariate logistic regression. Finally, variables with a p-value of less than 0.05 in multivariate analysis were considered as significantly associated.

Result: A total of 389 respondents were included in the study with response rate of 92.2%. The estimated utilization of PMC is 118(30.3%) within last twelve months and majority 319(82%) undergo PMC ever in their life. In the study area, respondents’ Age (AOR=6.56, 95%CI [1.87-23.06]), Work experience (AOR=0.75, 95%CI [0.65-0.70]) and NCDs history in respondent’s family (AOR=1.64; 95%CI: [1.70- 3.81]) were significantly associated with the utilization of PMCs.

Conclusion: The estimated utilization of PMC is very low (30.3%). It is critical to raise awareness about the importance of using PMC because, once established, the majority of chronic diseases can have a long-term impact on quality of life and wellness.

Preventive Medical Checkup

None-Communicable Diseases

Public Hospital Workers

Addis Ababa

Ethiopia.

Health is a vital public good, impacting employment, social relationships, and political participation. Health and family welfare services cover disease treatment, prevention, and promotion. The distinction between curative and preventive health care emerged in the late 19th century, with modern Non-Communicable Diseases (NCDs)_cancer, diabetes, cardiovascular disease, mental illness, and accidents) becoming leading causes of death in industrialized nations. Preventive medicine aims to prevent and promote health, addressing chronic, degenerative, and hereditary diseases and special old age problems (1)

Three levels of prevention are now recognized: primary (including primordial), targeting healthy individuals; secondary, targeting disease-infected individuals; and tertiary, aiming to reduce prevalence of chronic disability due to disease (2).

Primary prevention is an action taken before disease onset, aiming to prevent its occurrence. It can be achieved through measures promoting health, well-being, or specific protective measures. This concept is now being applied to chronic disease prevention (1).

Non-communicable diseases are becoming increasingly important among adults in both developed and developing countries. The prevalence of chronic diseases is increasing due to increasing life expectancy, changing lifestyles, and modern medical care, which is enabling many with chronic diseases to survive(3, 4).

The impact of chronic diseases on the lives of people is serious when measured in terms of loss of life, disablement, family hardship and poverty, and economic loss to the country(4, 5).

The WHO 2018 report reveals that NCDs burden adult populations 71% in developed countries and 60% in middle-income countries, with nearly 50% in high-mortality regions.(6).

Non-communicable diseases (NCDs) account for over half of the global disease burden and kill over three out of every five people globally, making them the leading cause of death and disability (7).

Chronic diseases (NCDs) are asymptomatic silent killers that can be cured by a few hours of exercise per year. Despite being common and costly, they are preventable. Effective prevention involves health promotion activities, early detection efforts, and appropriate management of existing diseases and related complications across individuals' entire lives (1, 2).

WHO warns developing countries to prevent non-communicable diseases epidemics due to socio-economic and health developments, estimating 60–70% can be prevented with timely assessment and intervention(6, 8).

Leadership, prevention, treatment, international cooperation, and monitoring and accountability were the five priority actions for responding to the crisis that the NCD Alliance, The Lancet NCD Action Group, and the UN High-Level Meeting on Non-Communicable Diseases (2011) proposed. These priority interventions were selected based on their impact on health, affordability, ease of implementation, and viability from a political and financial standpoint(9).

WHO recommends lifestyle changes as 80% of preventive measures for non-communicable diseases (NCDs), as developing countries lack standard healthcare due to risk factors like tobacco, alcohol, obesity, and inactivity (10).

Preventive Medical Check-ups (PMC) is a form of preventive medicine that involve regular medical examinations and screenings of asymptomatic individuals, aiming to prevent illnesses, promote health, reduce morbidity and mortality, detect non-communicable diseases like hypertension, breast cancer, and diabetes mellitus, and manage deviations (11).

Regular medical examinations are crucial for chronic diseases, which account for 71% of global diseases. Non-modifiable factors like age and family history determine screening frequency, while modifiable risk factors like alcohol consumption, smoking habits, unhealthy diet and inactivity influence frequency (11, 12).

In developing countries including Ethiopia where the practice of periodic medical check-up is poor(13), despite the steady increase of the burden of the non-communicable chronic disease, very few studies have been conducted on periodic medical checkups especially in Nigeria and India. Therefore, this study aims to assess PMC utilization and associated factors among public hospital workers in Addis Ababa, Ethiopia, addressing the lack of adequate study and documentation on PMC utilization.

2.1. Study design and setting description

A Hospital-based cross-sectional study was conducted on six public hospital workers in Addis Ababa City Administration, Ethiopia from November _ January 2019. The capital and seat of the African Union, Addis Ababa, has 52 hospitals, including 13 governmental ones, 98 primary health centers, and 534 clinics offering PMC in 11 sub-cities, making up 100% of the city's total geographic health service coverage. Six of the thirteen public hospitals are run by the Addis Ababa City Administration and employed 2780 workers.

2.2. Study population

The source population of this study was all public hospital workers in Addis Ababa city Administration whereas the study population was all public hospital workers who were working at least for the last twelve months during data collection period in Addis Ababa city administration public hospitals. Others, who were unable to communicate during data collection due to different reasons like serious sickness, unable to provide informed consent, and those already diagnosed as having a history of known NCDs and those under the routine treatment were excluded from the study.

2.3. Sample size determination

The required sample size for the study was determined by using single population proportion formula taking 50% of the prevalence of preventive medical service utilization (checkups) among the public hospital workers since there is no previous study on the same topic in Ethiopia.

n = Zα/₂)² *p (1-p))/d²= (1.96)2x0.5x0.5/ (0.05)2 = 384,

Where n = sample size, (Zα/₂)²=1.96, d = margin of error, p = 50%, although 0.05 significance and 80% power are default values(67). By adding 10% of the non-response tolerable rate on the determined sample size, a total of 422 study subjects included in this study.

2.4. Sampling technique

A representative sample selected by using a stratified random sampling method with a proportional allocation of sample to each stratum and simple random sampling technique. The procedure involved taking all six public hospitals found in AACA. Then, the total sample size determined, 422 was proportionally allocated to each hospital based on the total number of workers in each hospital, as shown in figure one below. The public hospital workers stratified into health care practitioners and health care administrative workers strata; this is because it is assumed that the two groups are heterogeneous for preventive medical check-up utilizations. And sample size proportionally allocated to each hospital was also proportionally allocated for each stratum. Finally, representative samples were drawn from each stratum by using a simple random sampling technique by merging the lists of workers from their payroll as sampling frame for each hospital.

2.5. Operational definition

Preventive Medical Checkup (PMC) Utilization

is a public hospital workers preventive health service visit/visits within the last twelve months before the survey. It is one or more visit/visits for major NCDs like Cardiovascular diseases (CVD), Cancers, Chronic respiratory diseases, Diabetes, and Mental illnesses to ensure once health on the right track to good health/ assess the current state of health and exposure to any particular disease in the future.

Public hospital workers

are professional health workers, Supportive staff, and administrative staff who were working in Addis Ababa city administration public hospitals.

None-communicable disease

is a medical condition or disease of public hospital workers that is non-infectious, non-transmissible and generally slow progression among people and it is a group of conditions that includes cardiovascular diseases, cancer, mental health problems, diabetes mellitus, chronic respiratory disease, and musculoskeletal conditions.

Perceived health status- is public hospital worker’s relative level of wellness and illness, taking into accounts the presence of biological or physiological dysfunctions, symptoms, and functional impairment. And it is subjective rating by the public hospital worker of his or her health status and recorded as the answer to the question ‘How would you describe your general health?’ with five possible responses, was grouped under ‘good health’ and ‘poor health’.

Health seeking behavior

is a sequence of remedial actions that public hospital workers undertake to rectify perceived ill-health. It was evaluated by asking the first experience of respondents during any health problems.

Alcohol drinking habit: is a pattern of drinking that raises blood alcohol concentration (BAC) levels to 0.08 g/dL. This usually happens in about two hours, after four drinks for women and five for men. This was assessed by asking staff members at public hospitals about their alcohol drinking habits. Then categorized as none-drinkers, moderate drinkers (1 once drink per day for females and 2 once drinks per day for males) and heavy drinkers (uses alcohol 5 or more days in a previous month).

Smoking habit

Defined as public hospital workers physical addiction to tobacco products like tobacco encased in cigarettes, pipes, and cigars and it was assessed by asking public hospital workers about their smoking habit to record as the answer with three possible responses to be grouped ‘Non-smoker’ and ‘Smoker”.

Physical inactivity

is a term used to identify respondents who did not get the recommended level of regular physical activity, which is categorized as low physical activities, moderate physical activities, and high (vigorous) physical activities.

Unhealthy diet habit: Unhealthy diet of public health workers is defined as overeating of fatty and greasy food, and of milky products, sweet foods, highly flavored food, too pungent food, as well as drinking too much alcohol, leading to the formation of damp-heat and which was assessed by asking public hospital workers’ diet habit to rate one out of five in each health benefit score questions and finally this was added to assess diet habit of each respondent as healthy diet habit if the sum of the score in health benefit score questions is greater or equal to average score (≥ 25) and unhealthy diet habit if the sum of the score in health benefit score questions is less than average score (< 25). Healthy diet habit: participants who scored greater and equal to average score ( > = 25) from the sum of the health benefit score questions and Unhealthy diet habit if the sum of the score is less than 25(< 25).

2.6. Data collection instrument and quality assurance

Data was collected using a pretested and a semi-structured questionnaire. The questionnaire used to assess the prevalence of the medical services utilization are adapted from reviewing different literatures (29, 44, 61, 68–70). The questionnaire is modified depending on the local situation and the research objective. It was first prepared in English and translated in to the local language (Amharic) and translated back in to English to check the consistency of data collection. Pretesting of the questionnaire was conducted on 5% of the sample size before data collection.

Six data collectors, one in each public hospital, and two supervisors, who are BSc graduates in health science and working in out of sampled organizations in Addis Ababa City, were employed to collect the data. Data collectors and supervisors with previous experience in surveys were recruited and trained by the principal investigator on the study instrument. The principal investigator and supervisor were constantly checked for strict adherence to the standards agreed upon by all field workers.

2.7. Statistical analysis

We used Epi info version 7.2.2.6 and SPSS 23.00 for data coding, entry and analysis. Descriptive statistics were computed to present results. Binary logistic regression was used to identify independent variables affecting the outcome variable, Preventive medical checkup utilization. We identified independent variables such as age, sex, marital status, education, work experience, professional background, income level, family NCD history, physical activities, healthier diet, and smoking habits that affect preventive medical checkup utilization. The Hosmer-Lemeshow test was used to test goodness of fit, and crude odds ratio with 95% CI was computed in bivariate analysis. Multivariate logistic regression was used by selecting independent variables with (p ≤ 0.2) in the bivariate analysis to observe independent effects on preventive medical checkup utilization. Finally, variables with a p-value of less than 0.05 in multivariate analysis were considered as significantly associated.

Socio-Demographic and Economic Characteristics

A total of 389 respondents were planned for the study, 179 males and 210 females, were successfully interviewed yielding a response rate of 92.2%. The mean age of the respondents was 33.3 years which ranges from 21–63 years. Majority of the respondent’s educational background was degree including medical doctors 262 (67.4%). Two hundred and fourteen (55%) were in marital union but 166(42.7%) were single. The majority (63%) of the respondents were health professionals, with 35.2% in nursing, 9.8% in HO, 6.2% MD & specialties, 3.6% lab, 6.4% pharmacists, 1.8% midwifery, and the rest 37% were administrative/supportive staffs. More than half, 264(67.87%) respondents have work experience of less than 10 years. The mean monthly income of respondents was 4750.3 ETB

Table 1

Socio-demographic characteristic of Public Hospital Workers in Addis Ababa, Ethiopia 2019(n = 389)
Variables	Categories of the variables	Frequency	Percentage
Sex	Male	179	46.00
Sex	Female	210	54.00
Age	21–29	153	39.33
	30–39	161	41.39
	40–49	58	14.91
	≥ 50	17	4.37
Educational level	Primary and secondary education (1–12)	29	7.50
	Some graduate level (certificate)	11	2.80
	Diploma	59	15.20
	Degree (including MD)	262	67.40
	Masters and above	28	7.20
Profession (field of study)
	Nurses	137	35.20
	Public Health officers	38	9.80
	MD and Specialties	24	6.20
	Lab	14	3.60
	Pharmacy	25	6.40
	Midwifery	7	1.80
	Administrative and other supportive staff	144	37
Marital status	Single	166	42.70
	Married	214	55.00
	Divorced	3	0.80
	Widowed	6	1.50
Experience in working years	< 10 years	264	67.87
Experience in working years	≥ 10 years	125	32.13
Income level	≤ 1,000 birr	9	2.30
	1,000–3,000 birr	47	12.10
	3,000–5,000 birr	117	30.10
	5,000–7,000 birr	112	28.80
	7,000–9,000 birr	81	20.80
	9,000 + birr	23	5.90

4.2. Utilization of preventive Medical Checkups

Out of the total study participants, three hundred eighty-nine, only 118(30.3%) visited health facilities for PMC within last twelve months, and about 319 (82%) ever undergo PMC. Among 118, 3(12%) of the respondents had at least one episode of visit in the last 12 months and the remaining 5% twice, 4% three times and 6% more than three times (Fig. 2).

4.3 Health Care Access-related Factors of Study Participants

4.3.1 Reasons for taking PMC

Out of 389 respondents, 68(17.5%) had genetic diseases and 10% believed preventive medical checkups were important for early detection and corrective actions of non-communicable diseases (NCDs). One hundred and eighteen (30.3%) respondents utilized PMC, 35% mainly for maintaining good health, 17.5% for early detection of NCDs and any deviation from good health, 8% for having disease signs,3.9% for having previous NCDs family history, and 10.3% for other reasons (Fig. 3).

The respondent underwent a test while utilizing PMC, identifying various diseases such as pre-hypertension & hypertension (45%), anemia (27%), hepatitis (15%), blood pressure (10), and blood sugar (2%). The tests were conducted at various health facilities, including their own hospital. The following diseases were identified during their PMC utilization: hyperglycemia, Hyperthyroidism, Elevated BP, Hypothyroidism, Pre-hypertension, Renal impairment, Hypertension, Anemia, Elevated LDL, Hepatitis, and Elevated TGL.

4.3.1 Main reasons for not to utilize PMC.

Two hundred and seventy-one (69.7%) respondents did not utilize PMC. Respondents gave the following as their top reasons for not using PMC were: 43.7% primarily because they were healthy, 28.8% due to their carelessness, 15.9% due to lack of free time, 3.1% due to lack of service, 1.5% due to lack of income, and other reasons.

4.3.2. Health care access-related factors of the study participants with utilization of the PMC

All of the respondents who had genetic disease history (68) in their family utilized PMC. Three hundred and thirty-nine (87.1%) of the respondents believed that PMC is important to early detection and take corrective action of NCDs. Three hundred and nineteen (82%) ever undergone a preventive medical checkup and 118(30.3%) visited health facility for PMC service with in last 12 months.

The study found that 248(63.8%) of respondents engage in work-related recreational physical activities, 115(29.6%) drink alcoholic beverages, 149(38.3%) engage in high or moderate physical activities, and 25(6.4%) smoke. One hundred and twenty-seven (32.6%) have unhealthy diet habits, and 283(72.8%) perceive their general health as good (Table 2).

Table 2

Health Care Access-related Factors of Study Participants with utilization of preventive medical checkup and public hospitals workers in Addis Ababa city administration, Binary logistic regression analysis, 2019. (n = 389)
Genetic disease (inherited health problems) in respondents’ family	Yes	68	17.5
	No	321	82.5
Among those who has genetic disease history in family who undertake PMC (68)	Yes	68	17.5
	No	0	0
Believe PMC is important to early detection and take corrective action of NCDs	Yes	339	87.1
	No	50	12.9
Ever undergone a preventive medical checkup	Yes	319	82.0
Ever undergone a preventive medical checkup	No	70	18.0
Visited with in last 12 months	Yes	118	30.3
Visited with in last 12 months	No	271	69.7
Frequency of visit within last 12 months (118)	One time	57	48.3
	Two times	32	27.1
	Three times	27	6.9
	Others	2	1.7
Reasons for undertaking PMC either within last year or at life time	It maintains good health	136	35.0
	To early detection of NCDs and any deviation from good health)	68	17.5
	Because of having sign of disease	31	8.0
	Because of previous NCDs history in family	15	3.9
	It helps to have a fit work force	6	1.5
Tests involved in the Preventive medical check – up	Cardiovascular diseases (CVD) check	46	11.8
	Chronic respiratory diseases check	25	6.4
	Cancer check	27	6.9
	Diabetes check	116	29.8
	Mental illnesses check	4	1.0
	HBSA	22	5.6
The place of last medical check – up	In own hospital	188	48.3
	Other public health facilities	18	4.6
	Private health facilities	24	6.2
	Abroad health facilities	2	.5
	Other	157	40.4
Habit of Physical activities	Low	219	56.3
	Moderate	149	38.3
	High (Vigorous)	20	5.1
Habit of drinking alcoholic beverages	Yes	115	29.6
Habit of drinking alcoholic beverages	No	274	70.4
Habit of smoking Cigarettes	Yes	25	6.4
Habit of smoking Cigarettes	No	364	93.6
Overall habits of eating healthy foods	Healthy diet	262	67.4
Overall habits of eating healthy foods	Unhealthy diet	127	32.6
Perceived health status	Good health	283	72.8
Perceived health status	Poor health	106	27.2

4.4 Associated Factors with Utilization of Preventive Medical Checkups

A total of 6 variables were selected as potential candidate variables during binary logistic regression analysis. These included: age of the study participant, Work Experience, NCDs history in respondent’s family, Habit of physical activities, Habit of eating healthier diet, and habit of smoking. These were the variables selected as candidates and entered into the final model.

During the multivariable logistic analysis, three variables showed statistically significant association with utilization of Preventive medical checkup. These included: Age (AOR = 6.564, 95%CI [1.868–23.059]), Work experience (AOR = 0.754, 95%CI [0.654–0.699]), and NCDs history in respondent’s family (AOR = 1.635, 95%CI: [1.701–3.814]) were significantly associated with the utilization of preventive medical checkups.

Participants who were in 30–39 years age category were 6.5 times (AOR = 6.56 ,95%CI [1.87–23.06]) more likely utilize PMC as compared with those 21–29 years age (lower age) category participants.

Study subjects who had less than 10 years’ work experience were 25% [AOR = 0.75, 95%CI [0.65–0.70] less likely utilized PMC than those who had above 10 years work experiences.

Respondents who had NCDs history in their family had utilized PMC 1.64 times [AOR = 1.64, 95%CI: [1.70–3.81] more likely than those who had no NCDs history in their family (Table 3)

Table 3

-Factors associated with utilization of preventive medical checkup and public hospitals workers in Addis Ababa city administration, logistic regression analysis, 2019. (n = 389)
Variables	Categories	Utilization of PMC within last twelve months		COA (95%CI)	AOR (95%CI)	p-value
		Yes	No
Age	21–29 yrs	38	115	1(0.60–1.67)	0.59(0.29–1.17)	0.13
	30–39 yrs	40	121	4.29(2.26–8.12)	6.56(1.87–23.06)	0.003*
	40–49 yrs	34	24	1.65(0.57–4.77)	0.45(0.09–2.31)	0.335
	≥ 50 yrs	6	11	1.00
Work Experience	< 10 yrs	77	215	2.04(1.27–3.30) 1.00	0.75(0.65–0.70)	0.024*
	≥ 10yrs	41	56
NCD history in respondents family	Yes	28	40	1.80(1.05–3.09) 1.00	1.64(1.70–3.81)	0.035*
	No	90	231
Habit of physical activities	Yes	56	85	1.98(1.27–3.08) 1.00	0.58(0.31–1.10) 1.00	0.095
	No	62	186

(*) = statistically significant variables that have p-value < 0.05 in the final model.

Preventive Medical Check-up (PMC) is a form of preventive medicine involving a thorough history, physical examination, and screening of asymptomatic persons by physicians regularly as part of a routine health care process. During routine or periodic medical checkup, some of the non-communicable diseases such as hypertension, breast cancer, cervical cancer, prostate cancer, and diabetes mellitus can be detected and any deviation from good health is noticed and managed in the form of preventive or curative services thereby reducing the mortality associated with them(11).

In this study, the utilization of PMC was 30.3% within last twelve months during survey in all respondents of public hospital workers in Addis Ababa. This finding is consistent when compared to a study finding ranging in Addis Ababa ranging from 2.3%(45) to less than 40%(46) and higher compared to studies conducted at different African settings, ranging 10–18.6% in Nigeria(38–40); 11.6% in Ghana(41); 13% in Uganda(42) and 18.3% in Zimbabwe(43). The difference in utilization of PMC in in this study might be due to the difference in study setting, difference in timing of the data collection, and sample size in different settings

This study is consistent with study done on cervical cancer screening service utilization of female health care workers in Addis Ababa with a magnitude of 25%, according to study done on cervical cancer screening knowledge and barriers among women in Addis Ababa, Ethiopia whereas, cervical cancer screening service utilization in Ethiopia varies from 2.3%(45) to less than 40%(46).This might be due to similarity in socio-demographic condition of the countries with the profile of low income African regions. In the contrary, the findings of this study is far lower than the study conducted in Nigeria, in which the utilization of routine medical checkup by tertiary health workers at a tertiary health facility showed that 92.4% of respondents actually had medical checkup before (29).This vast difference may be due to respondents’ professional difference, this study applied on both professional health care workers and administrative staffs whereas the Nigerian focuses only on professional health care workers. And also it may be because of difference in accessibility and availability of PMC services that could contribute to improving overall PMC utilization in the health facilities.

The majority of respondents, 57 (48.3%) of those who used PMC in the last twelve months, only made one visit to HF; the remaining 32 (27.1%) made two visits, 27 (6.7%) made three visits, and only 2 (1.7%) made more than three visits. This result is less than that of a study conducted in South West Nigeria on the knowledge, attitudes, and practices on periodic medical checkups. Of the 170 respondents, 126 (74.1%) had previously had a checkup and repeated it regularly (28). This might be due to difference in accessibility and availability of PMC services that could contribute to improving overall PMC utilization in the health facilities.

Similar to a study conducted in Nigeria, the reasons for PMC uptake are comparable. Of the respondents, 61 (35.9%) utilized the PMC for pre-employment purposes, with the remaining respondents doing so for other purposes (29), and the results of a study that assessed the utilization of cervical cancer screening and associated factors among female health workers in Arba Minch town and Zuria woreda showed that their primary reason for using the service were to maintain their health (59.8%) and to identify any changes in cervical cancer early (33.3%) (44).

However, according to our study the top four reasons given for not taking PMC were: being healthy (43.7%), carelessness (28.8%), lack of time (15.9%), and lack of services (3.1%). This is in line with study findings from Arba Minch town and Zuria woreda, which showed that the top three reasons for not getting screened were lack of time (10.3%), fear of the results (10%), and believing oneself to be healthy (39.5%) (44). The respondents' similar occupations and working environments may be the cause of their nearly identical reasons for not using PMC.

According to our study's findings, respondents in the 30- to 39-year-old age range were six times more likely to use PMC than respondents in the lower age group (AOR = 6.56,95%CI [1.87–23.06]). This suggests that the study participants' PMC utilization is determined by the age of the respondents. Additionally, this result was consistent with other research done in Addis Ababa, Ethiopia, to assess the socioeconomic status and hypertension of teachers and bankers (23). This may be because as people age, their experience and understanding of PMC improve.

Comparably, compared to study participants with more than ten years of work experience, those with less than ten years of work experience were 25% [AOR = 0.75, 95%CI [0.65–0.70] less likely to utilize PMC. This study was similar to a 2017 regional study conducted in public health centers in Addis Ababa, Ethiopia, to assess female health professionals' knowledge, attitudes, and practices regarding early detection methods for breast cancer (48). This significance suggests that the uptake of PMC in the study area was significantly determined by higher work experiences. As people age, they may have better exposure to NCDs and the benefits of the service associated with higher work experiences.

The history of NCDs in the respondents' families was another determinant factor supported by the study's findings; it was associated with odds ratios of 63.5% (AOR = 1.64, 95%CI: [1.70–3.81]) higher than those of respondents without such a history. The results of this study also in line with those of a study done in Uganda to assess medical staff members' knowledge, attitudes, and practices regarding cervical cancer screening at Mulago Hospital (42) and a study done in Debre Tabor Town to assess female employees' practices related to breast self-examination and related factors at Debre Tabor Town public health facilities in North West Ethiopia in 2018 (50).

There was low PMC utilization for public hospital workers in this study. It indicated that improving PMC utilization at health facilities require comprehensive approach to ensure early detection of diseases and adopt timely interventions.

Variables such as age, work experiences, and NCDs history in respondent’s family were found to be significantly associated with utilization of PMC at 95% CI and p-value of < 0.05. These findings highlight the need for research in order to identify factors that help explain the preventive medical checkup utilization.

Generally, in this study, there was a low status of PMC utilization which might be explained by the low socio-economic status, low level of knowledge and low education among respondents. There was also the high status of not using PMC (79.7%) which may be explained by the being healthy, negligence, carelessness and lack of free time among respondents and other associated factors.

Therefore, three issues need to be taken into account. First, since there was a low prevalence of PMC utilization among the public hospital workers, the hospital administrators and other concerned bodies should closely support all the employees to conduct regular preventive medical checkups.

Second, utilization of the PMC increases as age and year of work experience increases. Those of older and more experienced public hospital workers utilized PMC more. Younger age and junior health care staff need to be marked at first for preventive medical checkup utilization and other national NCDs screenings in order to achieve high coverage.

Third, those respondents who had NCDs history in their family utilized PMC more than respondents those who had no NCDs history in their family.

Generally, to increase the uptake of the PMC among public hospital workers, awareness creation on PMC, motivation and sensitization should be done and necessary support and advice should be provided. Further more, strategies should be designed to increase PMC utilization and avoid barriers of PMC utilization through advocacy. To this end, hospital administrators must support awareness creation platforms to be successful.

STRENGTH OF THE STUDY

The strength of this study is its originality in providing information about utilization of the medical services checkups and associated factors among workers of the public hospitals since there is shortage of information related to this area in the country at large.

LIMITATION OF THE STUDY

This study does not permit establishing cause-effect relationships as the study was a cross-sectional study design. In Ethiopia, there is no standardized tool and the tool for this study was adapted from different literatures which may have socio-economic, cultural, and health literacy differences

AOR= Adjusted Odds Ratio, AMT=Alternative Medical Therapy, CI=Confidence Interval, CSA=Central Statistical Agency, MM=Modern Medicine, COR=Crude Odds Ratio, OMT=Orthodox Medical Therapy, SNNPR=Southern Nations Nationalities and Peoples Region, SPSS=Statistical package for the Social Science, TCM=Traditional Chinese Medicine, THP=Traditional Health Practice, TM=Traditional Medicine, TMPs=Traditional Medicine Practitioners, UDHR=Universal Declaration of Human Rights, UNICEF=United Nations International Children’s Fund, WHO=World Health Organization

CONSENT FOR PUBLICATION

Not Applicable

COMPETING INTERESTS

The authors declare that they have no competing interests

ACKNOWLEDGEMENT

We would like to thank Kotebe Metropolitan University, Menelik-II Medical and Health Science College for the approval of the ethical clearance and funding. We are grateful to the Addis Ababa City administration health bureau, data collectors and supervisors. We also appreciate the study participants for their kind and voluntary participation as well as sincere response and for taking their precious time to answer all the questions requested by the interviewers.

AUTHORS’ CONTIRBUTIONS

Conceptualization: TA; Project administration and Funding acquisition by: TA and FW; Data Curation, Methodology, validation, software, visualization, formal analysis, investigation and writing-original draft performed by TA, TT, MW and FW; Supervision and Training of the Data Collectors done by TA; Writing-review and editing performed by all authors. All authors approved the final version of the manuscript.

AVAILABILITY OF THE DATA AND MATERIALS

Data is available from the corresponding author on a reasonable request.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Ethics approval was obtained from KMU Menelik II Medical and Health Science College with a reference no. kmpU/00212/2019 and Addis Ababa Health Bureau Public Health Research and Emergency Management (AAPHREM) ethics review committee with reference no. አአጤ/5890/227. In addition, a letter of approval and cooperation was obtained from AARHB and submitted to each lower-level sub-city health Office as well as to the selected public hospitals. After explaining the objective of the study as well as benefits and absence of the risk of participating in the study, both verbal and written informed consent were obtained from the participants before data collection. All the information collected from the study subjects was handled confidentially through omitting their personal identification and the interview conducted in a private place.

FUNDING

This study was funded by the Kotebe Metropolitan University, Menelik-II Medical and Health Science College

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No competing interests reported.

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Utilization of Preventive Medical Check-Up and Associated Factors Among Public Hospital Workers in Addis Ababa, Ethiopia

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Abstract

Figures

1. BACKGROUND

2. METHODS AND MATERIALS

2.1. Study design and setting description

2.2. Study population

2.3. Sample size determination

2.4. Sampling technique

2.5. Operational definition

2.6. Data collection instrument and quality assurance

2.7. Statistical analysis

3. RESULTS

4.2. Utilization of preventive Medical Checkups

4.3 Health Care Access-related Factors of Study Participants

4.3.1 Reasons for taking PMC

4.3.1 Main reasons for not to utilize PMC.

4.3.2. Health care access-related factors of the study participants with utilization of the PMC

4.4 Associated Factors with Utilization of Preventive Medical Checkups

4. DISCUSSION

CONCLUSION

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

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