Utilization of Ambulance Services in Northwest Ethiopia: A mixed sequential explanatory study of practice, barriers, and perceived solutions

Background: Despite growing government concerns and interventional efforts in Ethiopia over the last decade to improve utilization of ambulance services, it is still unmet need of the community. Moreover, there is a scarcity of research that has been conducted to assess the utilization of ambulance services in Ethiopia. Thus, this study is aimed at assessing the practice, barriers, perceived solutions, and factors associated with ambulance utilization in Northwest Ethiopia. Methods: A multi-center, institutional-based, cross-sectional study design using a mixed sequential explanatory approach was conducted. Systematic random and purposive sampling techniques were used to select the study participants for the quantitative and qualitativestudies, respectively. Interviewer-administered questionnaires, in-depth interviews, and key-informant interviews were used to collect the data. Data were collected using KoboCollect software and then exported to STATA version 17 for analysis. Numerical descriptive statistics were expressed by using mean and/or median, whereas categorical variables were expressed by percentages. A binary logistic regression model was used, and variables having a p-value < 0.25 in the bivariable analysis were entered into the multivariable analysis model. The model goodness-of-fit test was checked using the Hosmer-Lemshow test. Adjusted odds ratio with 95% confidence intervals (CIs) were used to report the strength of association, and statistical significance was declared at a p-value less than 0.05. The audio records of qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. Finally, the result of qualitative data was summarized with narration. Results: A total of 428 study participants were included in this study. More than half (54.7%) of the study participants were males and about 187 (43.7%) had no formal education. This study found that 16.6 % of the study participants used an ambulance to get to the hospital. Factors positively associated with ambulance utilization were knowing the ambulance call (AOR=2.68; 95% CI: 1.05, 6.82), presenting at the emergency department during the night (AOR=6.60; 95% CI: 3.15, 13.83), having a triage score > 7 (AOR=9.76; 95% CI:4.07, 23.44), and having prior experience of ambulance use (AOR=2.99; 95CI%: 1.28, 6.99). The qualitative findings of this study found that unavailability of road infrastructure, delayed responses from ambulance drivers, and a lack of ambulance vehicles in kebele were the major barriers for ambulance utilization. The participants suggested that increasing the number of ambulances, situating ambulances at health facilities, and resolving of the current conflict were the perceived solutions. Conclusion and recommendations: The utilization of ambulances in the East Gojjam Zone was low. Knowing the ambulance call number, presenting to the ED at night, prior use of an ambulance, and having a higher triage score were determinants of ambulance utilization. Unavailability of road infrastructure, delayed responses from ambulance drivers, and a lack of ambulance vehicles were the major barriers to ambulance utilization. Increasing the number of ambulances, designing ambulance stations at health facilities, and resolving of the current conflict were the perceived solutions. Therefore, increasing the number of ambulances, improving community awareness, and coordination of available resources are essential to improve ambulance utilizations.