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Background <p>Ambulance services are a core component of emergency medical systems, yet utilization remains low in many low- and middle-income countries. Evidence from conflict-affected regions is scarce. This study assessed the prevalence, determinants, barriers, and perceived solutions of ambulance utilization in Northwest Ethiopia.</p> Methods <p>A multi-center, institutional-based cross-sectional study using a mixed sequential explanatory design was conducted. Systematic random sampling and purposive sampling techniques were used to select participants for the quantitative and qualitative components, respectively. Data were collected using interviewer-administered questionnaires, in-depth interviews, and key-informant interviews. Quantitative data were collected using KoboCollect software and exported to STATA version 17 for analysis. Descriptive statistics were presented using mean and/or median for numerical variables and percentages for categorical variables. A binary logistic regression model was used to identify associated factors. Variables with a p-value &lt; 0.25 in bivariable analysis were entered into the multivariable model. Model fitness was assessed using the Hosmer–Lemeshow goodness-of-fit test. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to report the strength of associations, and statistical significance was declared at <i>p</i> &lt; 0.05. For qualitative data, audio recordings were transcribed, translated, coded, and analyzed using thematic analysis.</p> Results <p>This study found that 16.6% of the study participants used an ambulance to get to the hospital. Independent factors 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 <i>≥</i> 7 (AOR = 9.76; 95% CI:4.07, 23.44), and having prior experience of ambulance use (AOR = 2.99; 95% CI: 1.28, 6.99). The qualitative findings identified three major barriers; ambulance unavailability, communication barrier, and road inaccessibility.</p> Conclusion and recommendations <p>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. Structural barriers, particularly conflict-related service disruption, substantially limit access n. Efforts should prioritize increasing the number of ambulances, decentralization of ambulance stations, public awareness campaigns, and resolving armed conflicts.</p>

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Utilization of ambulance services in Northwest Ethiopia: a mixed sequential explanatory study of practice, barriers, and community-led perceived solutions

  • 期刊论文

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  • 发表日期：

    2026年8月3日

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  • Mengistu Abebe Messelu,
  • Baye Tsegaye Amlak,
  • Bekele Getenet Tiruneh,
  • Getinet Nibret,
  • Mastewal Yechale,
  • Dejen Tsegaye Alem,
  • Haile Amha,
  • Mihretie Gedfew,
  • Menberu Gete,
  • Tesfahun Ayenew,
  • Setarg Ayenew Birhanie,
  • Temesgen Ayenew

摘要

Background

Ambulance services are a core component of emergency medical systems, yet utilization remains low in many low- and middle-income countries. Evidence from conflict-affected regions is scarce. This study assessed the prevalence, determinants, barriers, and perceived solutions of ambulance utilization in Northwest Ethiopia.

Methods

A multi-center, institutional-based cross-sectional study using a mixed sequential explanatory design was conducted. Systematic random sampling and purposive sampling techniques were used to select participants for the quantitative and qualitative components, respectively. Data were collected using interviewer-administered questionnaires, in-depth interviews, and key-informant interviews. Quantitative data were collected using KoboCollect software and exported to STATA version 17 for analysis. Descriptive statistics were presented using mean and/or median for numerical variables and percentages for categorical variables. A binary logistic regression model was used to identify associated factors. Variables with a p-value < 0.25 in bivariable analysis were entered into the multivariable model. Model fitness was assessed using the Hosmer–Lemeshow goodness-of-fit test. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to report the strength of associations, and statistical significance was declared at p < 0.05. For qualitative data, audio recordings were transcribed, translated, coded, and analyzed using thematic analysis.

Results

This study found that 16.6% of the study participants used an ambulance to get to the hospital. Independent factors 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; 95% CI: 1.28, 6.99). The qualitative findings identified three major barriers; ambulance unavailability, communication barrier, and road inaccessibility.

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. Structural barriers, particularly conflict-related service disruption, substantially limit access n. Efforts should prioritize increasing the number of ambulances, decentralization of ambulance stations, public awareness campaigns, and resolving armed conflicts.