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Addis Ababa University College of Health Sciences ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES SCHOOL OF PUBLIC HEALTH ASSESSMENT OF QUALITY OF REFERRAL SYSTEM AMONG HEALTH CENTERS IN EASTERN ZONE OF TIGRAY, ETHIOPIA, 2019 By: Fre Gebremeskel (BSc) THESIS SUBMITTED TO SCHOOL OF PUBLIC HEALTH, COLLEGE OF HEALTH SCIENCES, ADDIS ABABA UNIVERSITY IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF PUBLIC HEALTH IN HEALTH SYSTEM MANAGEMENT. October 22, 2019 Ethiopia, Addis Ababa 0 ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES SCHOOL OF PUBLIC HEALTH ASSESSMENT OF QUALITY OF REFERRAL SYSTEM AMONG HEALTH CENTERS IN EASTERN ZONE OF TIGRAY, ETHIOPIA, 2019 By: Fre Gebremeskel (BSc) Advisors: Dr Mesfin Addissie (MD, MPH) Mr. Gashaye Asrat (BSc, MPH) THESIS SUBMITTED TO SCHOOL OF PUBLIC HEALTH, COLLEGE OF HEALTH SCIENCES, ADDIS ABABA UNIVERSITY IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF PUBLIC HEALTH IN HEALTH SYSTEM MANAGEMENT. October 3, 2019 Addis Ababa, Ethiopia 1 Advisor’s Approval Sheet I, the under signed, declare that this thesis is my original work, has not been presented for a degree in any other university and that all resources of material used for this thesis have been fully acknowledged. Name of the student: Fre Gebremeskel Fitwi ID Number GSR/2201/10 Date. October 23, 2019 Signature _________________ Approval of the primary advisor and examining board This thesis work has been submitted with our approval as university advisor and examining board. Name of the primary advisor: Dr. Mesfin Addisie (MD, MPH) Date. October 23, 2019 Signature _________________ Name of external examiner: Dr Zelalem Adugna (MPH, PHD) Date. October 23, 2019 Signature _________________ Name of internal examiner: Mr. Werisaw Haileselassie (BSc, MPH, PhD candidate) Date. October 23, 2019 Signature _________________ 2 ACKNOWLEDGMENT First and foremost I would like to acknowledge Addis Ababa University for providing me this opportunity. My deep gratitude also goes to, my advisors Dr. Mesfin Addisie and Mr. Gashaye Asrat for their invaluable support starting from topic selection until completion of the study. My gratitude also goes to, the data collectors for their cooperation throughout the data collection time and also for all study participants for providing us their information. Finally, I would like to acknowledge my family, and friends for their encouragement and support throughout my research work. i TABLE OF CONTENT List of Table .....................................................................................................................iv List of Figure ................................................................................................................... v Acronym and Abbreviation ..............................................................................................vi Abstract .......................................................................................................................... vii 1 Introduction .................................................................................................................. 1 1.1Background ......................................................................................................................1 1.2 Statement of the Problem .................................................................................................2 1.3Rational of study ...............................................................................................................3 1.4 Significance of Study .......................................................................................................3 2 Literature Review ....................................................................................................... 4 2.1 Definition and concepts of terms ......................................................................................4 2.2 Structural part of referral system ...................................................................................5 2.3 Process of Referral System ..............................................................................................6 2.4 Patient satisfaction and factories associated with it .........................................................7 2.5 Conceptual Framework ...................................................................................................9 3 Objective .................................................................................................................... 10 3.1 General Objective .......................................................................................................... 10 3.2 Specific Objectives......................................................................................................... 10 5.Method and Material ................................................................................................... 11 4.1. Study setting ................................................................................................................. 11 4.2. Study Design and period ............................................................................................... 11 4.3. Population .................................................................................................................... 11 4.3.1 Source population ............................................................................................... 11 4.3.2 Study Population ................................................................................................ 11 4.4 Eligibility criteria .......................................................................................................... 11 4.4.1 Inclusion criteria ................................................................................................ 11 4.4.2 Exclusion criteria ............................................................................................... 11 4.5 Sample Size Determination and Sampling Procedure ..................................................... 11 4.5.1 Sample Size determination .................................................................................. 12 4.5.2 Sampling technique and Procedure ..................................................................... 13 4.6Data Collection instrument and procedure ..................................................................... 15 ii 4.7 operational definition .................................................................................................... 15 4.8 Study Variable ............................................................................................................... 16 4.9 Data Quality Management ............................................................................................. 17 4.10 Data management and Analysis procedure .................................................................. 18 4.11 Ethical Consideration .................................................................................................. 18 4.12 Dissemination of Result ............................................................................................... 18 5 Result ......................................................................................................................... 19 6 Discussion .................................................................................................................. 25 7. Strength and Limitation ............................................................................................ 29 7.1 Strength ......................................................................................................................... 29 7.2 Limitation ...................................................................................................................... 29 8. Conclusion and Recommendation............................................................................. 30 8.1 Conclusion .................................................................................................................... 30 8. 2 Recommendation .......................................................................................................... 30 9 Reference ................................................................................................................... 31 10 Annex ....................................................................................................................... 34 iii LIST OF TABLES TABLE 1 SAMPLE SIZE CALCULATION .................................................................................. 12 TABLE 2 SOCIODEMOGRAPHIC CHARACTERISTICS OF REFERRED PATIENTS ........................... 19 TABLE 3 FREQUENCY DISTRIBUTION OF A RELEVANT COMPONENT OF REFERRAL PAPERS ........ 20 TABLE 4 FREQUENCY DISTRIBUTION OF COMPONENTS OF FEEDBACK PAPER .......................... 21 TABLE 5 ASSESSMENT OF REFERRAL AND FEEDBACK PAPER QUALITY .................................... 21 TABLE 6 PATIENT SATISFACTION TOWARD REFERRAL ........................................................... 22 TABLE 7 FACTORS ASSOCIATED WITH PATIENTS REFERRAL SATISFACTION ............................. 24 iv LIST OF FIGURE FIQURE1, SCHEMATIC PRESENTATION OF CONCEPTUAL FRAMEWORK MODIFIED FROM DONABEDIAN MODEL .................................................................................................... 9 FIGURE 2, SCHEMATIC PRESENTATION OF SAMPLING PROCEDURE ........................................ 14 FIQURE3, PATIENT SATISFACTION TOWARD REFERRAL SYSTEM OF HEALTH CENTERS OF EASTERN TIGRAY, NORTHERN ETHIOPIA, 2019 ..........................................................
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