Assessment of the operational status of medical equipment in public hospitals of the Amhara region, Ethiopia: a sub-national study

Assessment of the operational status of medical equipment in public hospitals of the Amhara region, Ethiopia: a sub-national study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the operational status of medical equipment in public hospitals of the Amhara region, Ethiopia: a sub-national study Negese Seawagegn Semie, Tadese Tilahun, Gizew Dessie, Belay Bezabih This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6210796/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: The functionality of medical equipment is critical for effective clinical service delivery. This study aimed to assess the operational status of medical equipment in public hospitals in the Amhara region, Ethiopia. Methods: A cross-sectional study was conducted in 64 public hospitals between May and June 2024. Data on medical equipment functionality, installation status, and maintenance challenges were collected by trained biomedical technicians and technologists using a standardized format. Analysis was performed using SPSS version 27, employing descriptive statistics and binary logistic regression to evaluate factors affecting functionality, including the availability of service manuals and training for end users and biomedical professionals. Results: A total of 6,946 medical equipment items were assessed, of which 5,232 (75.3%) were functional, while 1,070 (15.4%) were non-functional, 611 (8.8%) were non-installed, and 33 (0.5%) had incomplete accessories. The absence of a service manual reduced the likelihood of functionality by 55% (AOR = 0.45, 95% CI: 0.36–0.55, p<0.001). Similarly, lack of clinical user training reduced functionality by 64% (AOR = 0.36, 95% CI: 0.32–0.41, p<0.001). Additionally, the absence of BMET training increased the likelihood of non-functionality by 48% (AOR = 1.48, 95% CI: 1.29–1.70, p<0.001). Conclusion: Although the overall functionality of medical equipment in public hospitals appears satisfactory, primary hospitals may overestimate functionality due to less exposure to complex equipment. Service manuals, clinical user training, and BMET training were key determinants of functionality. Strengthening training programs and ensuring the availability of service manuals could improve equipment performance. Medical Equipment Functionality Training Hospital Amhara Region Ethiopia Figures Figure 1 Figure 2 1. Introduction 1.1. Literature review Medical equipment plays a crucial role in the diagnosis and treatment of patients, making it an integral component of healthcare services, particularly in hospitals. ( 1 ) The availability, proper maintenance, and efficient utilization of medical devices significantly enhance healthcare delivery, ensuring patient safety and service continuity. Effective management of medical equipment requires strategic budgeting, regular maintenance, and the prevention of equipment failures that could pose hazards. ( 2 ) Despite the importance of medical equipment, many healthcare facilities in developing countries struggle with operational challenges. According to the World Health Organization (WHO), approximately 70% of medical devices donated from developed nations are non-functional in hospitals within developing countries. This is due to various factors, including a lack of trained personnel, inadequate infrastructure, and limited access to spare parts and technical support.( 3 , 4 ) A significant challenge in medical device procurement is the potential for unethical collaboration between healthcare professionals and medical device vendors. Evidence suggests that such collusion is widespread in both industrialized and developing nations. Establishing and enforcing a code of conduct for the medical device industry and healthcare authorities is essential to mitigate this issue and promote rational decision-making regarding medical device acquisitions. ( 5 ) Many hospitals lack adherence to international standards, guidelines, and service manuals, further exacerbating equipment maintenance issues. Studies indicate that a high percentage of healthcare professionals report deficiencies in reference materials, electrical safety testing, performance testing equipment, adequate training for users and maintainers, and preventive maintenance schedules. These gaps highlight the need for structured policies and capacity-building initiatives to improve medical equipment management. ( 6 ) Biomedical equipment technicians (BMETs) play a vital role in maintaining medical devices and ensuring their functionality. Training programs for BMETs, particularly in low-resource settings, have proven to be scalable, replicable, and sustainable. ( 7 , 8 ) Reports suggest that deploying BMETs in rural hospitals significantly improves the functionality of medical devices and enhances healthcare service delivery. In some settings, the presence of trained technicians has reduced non-functional equipment rates by nearly half.( 1 , 3 , 9 ) The demand for biomedical technicians in countries such as Nepal has led to the establishment of specialized training programs. These programs cover critical subjects, including mathematics, electronics, computer applications, medical instrumentation design, and equipment maintenance and repair. However, the availability of trained personnel varies widely across healthcare facilities, with some hospitals having as few as two technicians serving numerous health institutions. Maintenance workshops also face challenges, such as limited budgets, a shortage of essential materials, and inadequate management structures.( 8 , 10 – 12 ) One of the influencing factors in maintenance management is labeling and provision of user manual which is among the duties of biomedical engineering unit. User training plays an important role in medical equipment maintenance because if users do not learn the proper usage of the device, it may destroy the device. ( 13 ) Empirical studies highlight that the absence of trained BMETs correlates with a higher percentage of non-functional equipment in hospitals. In Ethiopia, for instance, it is estimated that only 72% of medical devices in Addis Ababa’s public hospitals are operational, with some regional hospitals reporting functionality rates as low as 50%. The main factors contributing to equipment failures include improper handling, frequent power fluctuations, aging equipment, insufficient user training, and a lack of preventive maintenance and spare parts. ( 3 , 14 – 18 ) Additionally, qualitative research indicates that challenges such as the poor implementation of Medical Equipment Management Information Systems (MEMIS), an absence of well-equipped maintenance workshops, and inadequate operator training persist across healthcare institutions. Observational studies in Ethiopian hospitals have shown that medical equipment functionality rates vary significantly, with some hospitals reporting over 60% of devices in working condition, while others struggle with high percentages of out-of-service equipment.( 14 , 19 ) 1.2 Statement of problems/Rationale Medical equipment maintenance is a major challenge in the country, particularly in the Amhara region. Several factors contribute to the non-functionality of medical equipment, including the lack of BMET training, spare part failures, electrical supply issues, design flaws, improper use, incorrect diagnosis of equipment errors, and the use of incompatible accessories. Additionally, delays in procuring spare parts and accessories further exacerbate these challenges. Due to the complexity of medical equipment and the extensive number of spare parts required at the component level, these barriers significantly hinder the availability and accessibility of medical devices in healthcare settings. As a result, essential medical services may be compromised, ultimately affecting patient care and health outcomes. Addressing these issues through proper training, timely procurement, and robust maintenance strategies is crucial for improving medical equipment functionality and sustainability in the region. 2. General objective To assess the status of medical equipment, the availability of service manuals, and the impact of user and biomedical equipment technician training in public hospitals across the Amhara National Regional State, Ethiopia. 2.1. Specific objective To evaluate the proportion of functional and non-functional medical equipment. To identify incomplete accessories and non-installed medical equipment. To determine the impact of end-user training, biomedical equipment technician training, and the availability of service manuals on equipment functionality. 3. Methodology A cross-sectional study was conducted to assess the functionality of medical equipment in 64 public hospitals in the Amhara region, including four referral hospitals, four general hospitals, and 56 primary hospitals, between May and June 2024. A standardized data collection tool was developed based on the Federal Ministry of Health Inventory Data Collection Form and the Work Order Tracer setup, which was designed by the Regional Health Bureau in collaboration with Assist International. ( 18 )The tool was pre-tested in two hospitals and optimized accordingly. Biomedical engineers and technicians served as data collectors, receiving training on the tool before data collection. Supervisors were assigned to each zone to ensure data quality. Data entry, cleaning, and analysis were performed using SPSS version 27. Descriptive statistics were used to assess the status of functional, non-functional, incomplete, and uninstalled medical equipment. Binary logistic regression was conducted to evaluate the impact of end-user training, biomedical professional training, and the availability of service manuals on medical equipment functionality. 4. Result The study assessed a total of 6,946 medical equipment items in the Amhara region to evaluate their operational status. The majority of the equipment (5,232 items, 75.3%) were found to be functional, indicating a significant proportion of operational medical devices within hospitals. However, 1,070 items (15.4%) were categorized as non-functional, which may impact healthcare service delivery due to the unavailability of spare parts, lack of user and technical trainings. (Table 1 ) or Fig. 1 ) Additionally, 611 items (8.8%) were reported as not installed, suggesting delays or inappropriate in deployment or lack of necessary infrastructure for installation. Furthermore, 33 items (0.5%) were classified as incomplete, meaning they required additional accessories or components to be operational. These findings highlight the need for improved equipment management, capacity building, timely maintenance, and infrastructure enhancement to ensure optimal utilization of medical devices in hospitals.(Table 1 ) or Fig. 1 ) Table 1 Number of medical equipment items disaggregated by operational status in Amhara Region Operational status Frequency Percent Functional 5232 75.3 Incomplete 33 0.5 Non-Functional 1070 15.4 Not installed 611 8.8 Total 6946 100.0 The study assessed the operational status of medical equipment across various hospitals, revealing significant variations in functionality and installation rates. Dessie Referral Hospital recorded the highest percentage of non-functional medical equipment, while Wageda Primary Hospital had the lowest. Additionally, Dessie Referral Hospital had the highest number of non-installed medical equipment items (N = 187), whereas no such cases were observed in general and primary hospitals.(Fig. 2 ) The presence of non-installed medical equipment in several hospitals was primarily attributed to missing accessories, such as operating room (OR) sets and neonatal care sets, or due to an adequate number of similar machines already in use. The most frequently non-installed medical equipment included CPAP machines, infusion pumps, oxygen concentrators, end-tidal carbon dioxide monitors, vital sign monitors, autoclaves, anesthesia machines, and incubators. (Fig. 2 ) These findings underscore the need for improved equipment management, ensuring timely installation, adequate supply of necessary accessories, and proper allocation of resources to maximize the utilization of medical devices in public hospitals. (Fig. 2 ) Description of Key Types of Functional and Non-functional Medical Equipment Items The study identified the top 25 critical medical equipment items that were inactive, either due to non-functionality, lack of installation, or reagent shortages in public hospitals across the Amhara region. The findings highlight that oxygen concentrators and suction machines accounted for the highest percentage of non-functional medical equipment, followed by autoclave machines and refrigerators. (Table 2 ) Among the most affected medical devices, oxygen concentrators had the highest number of inactive items (173 out of 846, 14.8%), followed by suction machines (141 out of 681, 11.9%) and autoclave machines (140 out of 540, 9.5%). These equipment types are critical for various medical procedures, and their non-functionality could significantly impact patient care and infection control measures. (Table 2 ) Other essential equipment with considerable inactive rates included general and haematocrit centrifuges, operating room (OR) lights, infant incubators, anesthesia machines, and patient monitors. Notably, the presence of non-functional medical equipment was often due to inadequate maintenance, lack of spare parts, or the absence of necessary accessories. (Table 2 ) The findings emphasize the urgent need for systematic medical equipment management, including preventive maintenance, curative maintenance, capacity building, timely installation, and efficient resource allocation, to ensure the optimal functionality of life-saving devices in hospitals. (Table 2 ) Table 2 List of key medical equipment items and their status at most public hospitals, Amhara region S/N Equipment Name # of Functional # of Inactive Total # (%) of Equipment 1 Oxygen Concentrator 673 173 846 (14.8) 2 Suction machine 540 141 681(11.9) 3 Autoclave machine 400 140 540(9.5) 4 Refrigerator 537 107 644(11.3) 5 General and Haematocrit Centrifuge 312 92 404(7.1) 6 OR-light 234 90 324(5.7) 7 Infant Incubator 251 63 314(5.5) 8 Anaesthesia machine 204 57 261(4.6) 9 Microscope (Florescent and Normal) 258 44 302(5.3) 10 Patient Monitor 219 40 259(4.5) 11 CPAP machine 35 32 67(1.2) 12 Infusion pump 54 20 74(1.3) 13 Phototherapy 108 20 128(2.2) 14 Chemistry and Electrolyte analyser 89 19 108(1.9) 15 Infant Radiant Warmer 128 18 146(2.6) 16 Electro surgical unit (ESU) 63 16 79(1.4) 17 General and Doppler Ultrasound 89 13 102(1.8) 18 ECG (EKG) machine 33 13 46(0.8) 19 Defibrillator 20 11 31(0.5) 20 X-ray machine ( Digital) 63 11 74(1.3) 21 CD4- machine 29 10 39 22 CBC machine and Haematology Machine 141 9 150(2.6) 23 Vacuum Extractor 30 9 39(0.7) 24 Fatal Doppler/ monitor 18 6 24(0.4) 25 Mechanical Ventilator 18 6 24(0.4) Total 4546 1160 5706(100.0) Inactive: non-functional, not installed and incomplete Binary Logistic Regression Analysis The study assessed the determinants of medical equipment functionality in the Amhara region, Ethiopia, in 2024. A total of 6,946 medical equipment items were analyzed, with 5,232 (75.4%) being functional and 1,714 (24.6%) being inactive meaning non-functional (15.4%), not installed (8.8%) and incomplete (0.5%). This study revealed that 6128(88.2%), 1887(27.2%) and 5227(75.3%) functional and inactive medical equipment items had no service manual, clinical user and BMET training respectively. Service manual : a medical equipment (functional, N = 4522, vs. inactive, N = 1606) without service manual is 55% less likely to be functional compared with those with a service manual. The AOR 95% CI: 0.45 (0.36, 0.55), p < 0.001. (Table 3 ) Clinical user training Similarly a medical equipment (functional, N = 1176, vs. inactive, N = 711) operated by a health professional who did not receive a clinical user training is 64% less likely to be functional compared with those with clinical user training. The AOR 95% CI 0.36(0.32, 0.41), p < 0.001. (Table 3 ) BMET training In contrast, a medical equipment (functional, N = 3943, vs. inactive, N = 1284) handled by biomedical professional who did not receive BMET training increases the likelihood of medical equipment being non-functional (inactive) by 48% compared with having BMET training. The AOR = 95% CI 1.48(1.29, 1.70), P < 0.001.Service manual, user training and BMET training were determinants of medical equipment functionality. (Table 3 ) Table 3 The determinats of medical equipment factionality in Amhara region, Ethiopia, 2024 Factors Functional (N = 5232) Inactive (N = 1714) COR AOR 95% CI Service Manual No 4522 1606 0.43(0.35, 0.53)*** 0.45 (0.36, 0.55)*** Yes 7010 108 1 Clinical User Training No 1176 711 0.41(0.36, 0.46)*** 0.36(0.32, 0.41)*** Yes 4056 1003 1 BMET Training No 3943 1284 1.02(0.90,1.16) 1.48(1.29, 1.70)*** Yes 1289 430 1 *P-value < .05, **p-value < .01, ***p-value < .001 5. Discussion This study estimated the level of functional, non-functional, incomplete accessory, and non-installed medical equipment. We examined the effect of end-user and biomedical equipment technician (BMET) training, as well as the availability of service manuals, on improving medical equipment functionality. Our study revealed that more than two-thirds of medical equipment is functional (75.4%), while one-fourth (24.6%) remains inactive (non-functional, not installed, or incomplete). Our study estimated that 75.4% of medical equipment remains functional. Our result supports the findings of a study conducted in Ethiopia (74.68%) ( 14 ), and is higher than those reported in studies by ( 19 ) and (57.3%) ( 15 ). Our study also found that non-functional equipment accounts for 15.4%, which is significantly lower than findings from low- and middle-income countries by WHO (70%), as well as studies conducted in Rwanda (40%) ( 8 ) and a study in Ethiopia 32.1% ( 19 ). In our study, non-installed and incomplete accessory medical equipment accounted for 8.8% and 0.5%, respectively, which is greater than the findings of a similar study in Ethiopia (3.1%) ( 19 ). This study revealed that 6,128 (88.2%) medical equipment lacked service manuals, which is significantly higher than the 43% reported in a study conducted in Zambia. Meanwhile, 1,887 (27.2%) medical equipment had no service manual, a lower proportion compared to the 57% reported in Zambia ( 12 ). Our study showed that medical equipment functionality decreased by half due to the absence of a service manual (55%, p < 0.001) and by two-thirds due to a lack of user training (64%, p < 0.001). Another study in Zambia found that medical equipment was non-functional due to inadequate user training (3%) ( 12 ). User training plays an essential role in medical equipment maintenance, as improper usage may lead to equipment damage ( 13 ) Additionally, our study found that medical equipment non-functionality increased by half due to a lack of BMET training (48%, p < 0.001). A similar study showed that hospitals without BMET training had nearly twice the amount of non-functional equipment, while hospitals with BMET training had 7.6% fewer non-functional devices ( 8 )(Study in Rwanda, 2014). ). BMET training has a significant impact on healthcare. Another similar study found that hospitals with BMETs had fewer non-functional devices compared to hospitals without BMETs [3% versus 7% (p < 0.005)].( 9 , 20 ) Study in Nepal, 2022). Trained BMETs in hospitals positively impacted the status of medical equipment, increasing functionality from 71–93% ( 12 ) (Study in Zambia, 2018). Furthermore, the proportion of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% vs. 7%, p < 0.005).( 9 ) (study in Nepal, 2022). Overall, our study highlights the crucial role of training and access to service manuals in maintaining medical equipment functionality. Addressing these gaps through structured training programs and ensuring the availability of essential service documentation can significantly enhance healthcare service delivery by improving medical equipment functionality and service continuity. 6. Conclusion Despite the overall medical equipment functionality status in Amhara region hospitals being 75.3%, which seems relatively good, this figure is likely overestimated due to the inclusion of primary hospitals, which generally encounter fewer non-functional medical equipment items. This suggests that functionality rates in referral and general hospitals may be lower than reported, highlighting the need for more targeted assessments and interventions. 7. Recommendation To improve medical equipment functionality and management, the following recommendations are proposed: Strengthen preventive and corrective maintenance programs to reduce equipment downtime and increase its useful life. Provide adequate training for biomedical technicians and healthcare personnel to, fill skill gaps, ensure proper usage and maintenance. Avail user and service manual to ensure proper handling and trouble shooting. Improve supply chain management to ensure the availability of spare parts and essential accessories. Implement standardized medical equipment management systems to track equipment status and plan maintenance effectively. Enhance budget allocation for medical equipment procurement, maintenance, and replacement to ensure sustainability in healthcare service delivery. 8. Limitation of the study This assessment primarily focuses on medical equipment found in clinical service areas and medical service stores, excluding equipment located in the main store, spare parts inventory, and hospital equipment such as patient beds, boilers, laundry equipment, ironing machines, drying machines, generators, and kitchen refrigerators in all hospitals. Discussions regarding inventories for workshop tools, test equipment, consumables, and safety equipment are outside the scope of this document. The work order tracer setup did not identify the country of origin for each piece of equipment. The origin and suppliers of most medical equipment items remain unknown and are not identified in this document. Declarations Ethics approval and consent to participate Since this study was conducted on medical equipment, ethics approval and consent to participate was not applicable. Consent for publication Since this study was conducted on medical equipment, consent for publication is not applicable. Availability of data and materials The data supporting this study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or NGO sectors. Authors' contributions NS and BB conceptualized the study and designed the methodology. NS collected and analyzed the data. NS and GD contributed to the literature review and discussion sections. TT and GD prepared tables and figures. All authors read and approved the final manuscript. All authors had read and approved the final manuscript for submission. Acknowledgements The authors would like to thank all public hospitals for their support during data collection and all individuals who participated in this research. References Malkin RA. 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Malkin RA, Whittle C. Biomedical equipment technician capacity building using a unique evidence-based curriculum improves healthcare. Journal of Clinical Engineering. 2014;39(1):37-44. Thapa R, Yih A, Chauhan A, Poudel S, Singh S, Shrestha S, et al. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. Human resources for health. 2022;20(1):21. W.S. Topham BPG, and B. Muis. Biomedical equipment technician training in Nepal. 5th IET International Seminar on Appropriate Healthcare Technologies for Developing Countries (AHT 2008)2008. p. 17/1-/5. Bekele A, Nyaruhirira AU, Gashu Z, Gebreyohannes A, Gemechu D, Habtewold A, et al. Exploring Lessons from Regional Maintenance Workshop to Enhance Medical Equipment Functionality in Ethiopia. 2023. Mol CR. Final Report of the Medical Equipment (ME) Uptime Project. 2018. Bahreini R, Doshmangir L, Imani A. Influential factors on medical equipment maintenance management: In search of a framework. Journal of Quality in Maintenance Engineering. 2019;25. Woldeyohanins AE, Molla NM, Mekonen AW, Wondimu A. The availability and functionality of medical equipment and the barriers to their use at comprehensive specialized hospitals in the Amhara region, Ethiopia. Frontiers in Health Services. 2025;4:1470234. Kabeta SH, Chala TK, Tafese F. Medical Equipment Management in General Hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia. Medical Devices: Evidence and Research. 2023:57-70. Bekele A. Exploring Lessons from Regional Maintenance Workshop to Enhance Medical Equipment Functionality in Ethiopia. 2023. Getie A. ANALYSIS OF MEDICAL EQUIPMENT SUPPLY CHAIN MANAGEMENT OF PUBLIC HOSPITALS UNDER THE ADDIS ABABA REGIONAL HEALTH BUREAU By: Addis Ababa University; 2018. MoH E. ETHIOPIAN HOSPITAL SERVICES TRANSFORMATION GUIDELINES:CHAPTER 15: Medical Equipment Management Ethiopian Hospital Management Initiative. 2017. Ademe BW, Tebeje B, Molla A. Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study. BMC health services research. 2016;16:1-10. al. Te. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. Human Resources for Health (2022) 20:21. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6210796","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":427729409,"identity":"40fb009a-7304-41ec-8eae-542768941c82","order_by":0,"name":"Negese Seawagegn Semie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYPACGx42hsMHgAwJGWK1pMnxMx5LAGnhIVbLYWPJ5jMGIBZhLebs7Rcf/qhgTtxw7MznVzdqLHgY2A8f3YBPi2XPmWJjnjNsiRvOnN1mnXMM6DCetLQb+LQY3MhJk2Zs40nccOPsNuMcNqAWCR4z/Fruv0n/+fOfROKG+2+eGef8I0bLDfZjDLwNBsaSDWeYH+e2EaPlTA6zNM+xBDl+hmNmzLl9EjxsBP1y/PjDjz9q/oOi8vHnnG91cvzsh4/h1QKMCAMYi00CTOJXDgLsD2As5g+EVY+CUTAKRsFIBAC/5k3yK2NpQQAAAABJRU5ErkJggg==","orcid":"","institution":"Amhara National Regional State Public Health Institute","correspondingAuthor":true,"prefix":"","firstName":"Negese","middleName":"Seawagegn","lastName":"Semie","suffix":""},{"id":427729410,"identity":"ef653d61-1e9f-49e1-849b-cbe1ea467c3d","order_by":1,"name":"Tadese Tilahun","email":"","orcid":"","institution":"Amhara National Regional State Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Tadese","middleName":"","lastName":"Tilahun","suffix":""},{"id":427729411,"identity":"fc5dca41-9d35-4a07-9033-c3fba13948b9","order_by":2,"name":"Gizew Dessie","email":"","orcid":"","institution":"Amhara National Regional State Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Gizew","middleName":"","lastName":"Dessie","suffix":""},{"id":427729412,"identity":"01bc13be-60a0-4143-9b84-9e2094da598b","order_by":3,"name":"Belay Bezabih","email":"","orcid":"","institution":"Amhara National Regional State Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Belay","middleName":"","lastName":"Bezabih","suffix":""}],"badges":[],"createdAt":"2025-03-12 09:38:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6210796/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6210796/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79089248,"identity":"20bc6b59-fa98-46db-b98c-0c126eecd444","added_by":"auto","created_at":"2025-03-24 09:40:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20791,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of medical equipment items disaggregated by operational status in Amhara Region\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6210796/v1/348d795b1b54866e20db63cc.png"},{"id":79089245,"identity":"ba6add6a-f028-4a42-8900-6c9754080ee3","added_by":"auto","created_at":"2025-03-24 09:40:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110724,"visible":true,"origin":"","legend":"\u003cp\u003eMedical equipment status at referral hospitals level\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6210796/v1/bd289e715ea386b6243cacdb.png"},{"id":79089962,"identity":"019d649d-2cfa-4d4b-9d3e-36c1a2f21a12","added_by":"auto","created_at":"2025-03-24 09:49:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":908495,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6210796/v1/bed832ef-8874-43ff-b76e-18de459d8790.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the operational status of medical equipment in public hospitals of the Amhara region, Ethiopia: a sub-national study","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Literature review\u003c/h2\u003e \u003cp\u003eMedical equipment plays a crucial role in the diagnosis and treatment of patients, making it an integral component of healthcare services, particularly in hospitals. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The availability, proper maintenance, and efficient utilization of medical devices significantly enhance healthcare delivery, ensuring patient safety and service continuity. Effective management of medical equipment requires strategic budgeting, regular maintenance, and the prevention of equipment failures that could pose hazards. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite the importance of medical equipment, many healthcare facilities in developing countries struggle with operational challenges. According to the World Health Organization (WHO), approximately 70% of medical devices donated from developed nations are non-functional in hospitals within developing countries. This is due to various factors, including a lack of trained personnel, inadequate infrastructure, and limited access to spare parts and technical support.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA significant challenge in medical device procurement is the potential for unethical collaboration between healthcare professionals and medical device vendors. Evidence suggests that such collusion is widespread in both industrialized and developing nations. Establishing and enforcing a code of conduct for the medical device industry and healthcare authorities is essential to mitigate this issue and promote rational decision-making regarding medical device acquisitions. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMany hospitals lack adherence to international standards, guidelines, and service manuals, further exacerbating equipment maintenance issues. Studies indicate that a high percentage of healthcare professionals report deficiencies in reference materials, electrical safety testing, performance testing equipment, adequate training for users and maintainers, and preventive maintenance schedules. These gaps highlight the need for structured policies and capacity-building initiatives to improve medical equipment management. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Biomedical equipment technicians (BMETs) play a vital role in maintaining medical devices and ensuring their functionality. Training programs for BMETs, particularly in low-resource settings, have proven to be scalable, replicable, and sustainable. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Reports suggest that deploying BMETs in rural hospitals significantly improves the functionality of medical devices and enhances healthcare service delivery. In some settings, the presence of trained technicians has reduced non-functional equipment rates by nearly half.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe demand for biomedical technicians in countries such as Nepal has led to the establishment of specialized training programs. These programs cover critical subjects, including mathematics, electronics, computer applications, medical instrumentation design, and equipment maintenance and repair. However, the availability of trained personnel varies widely across healthcare facilities, with some hospitals having as few as two technicians serving numerous health institutions. Maintenance workshops also face challenges, such as limited budgets, a shortage of essential materials, and inadequate management structures.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOne of the influencing factors in maintenance management is labeling and provision of user manual which is among the duties of biomedical engineering unit. User training plays an important role in medical equipment maintenance because if users do not learn the proper usage of the device, it may destroy the device. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEmpirical studies highlight that the absence of trained BMETs correlates with a higher percentage of non-functional equipment in hospitals. In Ethiopia, for instance, it is estimated that only 72% of medical devices in Addis Ababa\u0026rsquo;s public hospitals are operational, with some regional hospitals reporting functionality rates as low as 50%. The main factors contributing to equipment failures include improper handling, frequent power fluctuations, aging equipment, insufficient user training, and a lack of preventive maintenance and spare parts. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAdditionally, qualitative research indicates that challenges such as the poor implementation of Medical Equipment Management Information Systems (MEMIS), an absence of well-equipped maintenance workshops, and inadequate operator training persist across healthcare institutions. Observational studies in Ethiopian hospitals have shown that medical equipment functionality rates vary significantly, with some hospitals reporting over 60% of devices in working condition, while others struggle with high percentages of out-of-service equipment.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Statement of problems/Rationale\u003c/h2\u003e \u003cp\u003eMedical equipment maintenance is a major challenge in the country, particularly in the Amhara region. Several factors contribute to the non-functionality of medical equipment, including the lack of BMET training, spare part failures, electrical supply issues, design flaws, improper use, incorrect diagnosis of equipment errors, and the use of incompatible accessories. Additionally, delays in procuring spare parts and accessories further exacerbate these challenges.\u003c/p\u003e \u003cp\u003eDue to the complexity of medical equipment and the extensive number of spare parts required at the component level, these barriers significantly hinder the availability and accessibility of medical devices in healthcare settings. As a result, essential medical services may be compromised, ultimately affecting patient care and health outcomes. Addressing these issues through proper training, timely procurement, and robust maintenance strategies is crucial for improving medical equipment functionality and sustainability in the region.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. General objective","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo assess the status of medical equipment, the availability of service manuals, and the impact of user and biomedical equipment technician training in public hospitals across the Amhara National Regional State, Ethiopia.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.1. Specific objective\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo evaluate the proportion of functional and non-functional medical equipment.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo identify incomplete accessories and non-installed medical equipment.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo determine the impact of end-user training, biomedical equipment technician training, and the availability of service manuals on equipment functionality.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"3. Methodology","content":"\u003cp\u003eA cross-sectional study was conducted to assess the functionality of medical equipment in 64 public hospitals in the Amhara region, including four referral hospitals, four general hospitals, and 56 primary hospitals, between May and June 2024.\u003c/p\u003e \u003cp\u003eA standardized data collection tool was developed based on the Federal Ministry of Health Inventory Data Collection Form and the Work Order Tracer setup, which was designed by the Regional Health Bureau in collaboration with Assist International. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)The tool was pre-tested in two hospitals and optimized accordingly.\u003c/p\u003e \u003cp\u003eBiomedical engineers and technicians served as data collectors, receiving training on the tool before data collection. Supervisors were assigned to each zone to ensure data quality.\u003c/p\u003e \u003cp\u003eData entry, cleaning, and analysis were performed using SPSS version 27. Descriptive statistics were used to assess the status of functional, non-functional, incomplete, and uninstalled medical equipment. Binary logistic regression was conducted to evaluate the impact of end-user training, biomedical professional training, and the availability of service manuals on medical equipment functionality.\u003c/p\u003e"},{"header":"4. Result","content":"\u003cp\u003eThe study assessed a total of 6,946 medical equipment items in the Amhara region to evaluate their operational status. The majority of the equipment (5,232 items, 75.3%) were found to be functional, indicating a significant proportion of operational medical devices within hospitals. However, 1,070 items (15.4%) were categorized as non-functional, which may impact healthcare service delivery due to the unavailability of spare parts, lack of user and technical trainings. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) or Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAdditionally, 611 items (8.8%) were reported as not installed, suggesting delays or inappropriate in deployment or lack of necessary infrastructure for installation. Furthermore, 33 items (0.5%) were classified as incomplete, meaning they required additional accessories or components to be operational. These findings highlight the need for improved equipment management, capacity building, timely maintenance, and infrastructure enhancement to ensure optimal utilization of medical devices in hospitals.(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) or Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of medical equipment items disaggregated by operational status in Amhara Region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperational status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Functional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot installed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe study assessed the operational status of medical equipment across various hospitals, revealing significant variations in functionality and installation rates. Dessie Referral Hospital recorded the highest percentage of non-functional medical equipment, while Wageda Primary Hospital had the lowest. Additionally, Dessie Referral Hospital had the highest number of non-installed medical equipment items (N\u0026thinsp;=\u0026thinsp;187), whereas no such cases were observed in general and primary hospitals.(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe presence of non-installed medical equipment in several hospitals was primarily attributed to missing accessories, such as operating room (OR) sets and neonatal care sets, or due to an adequate number of similar machines already in use. The most frequently non-installed medical equipment included CPAP machines, infusion pumps, oxygen concentrators, end-tidal carbon dioxide monitors, vital sign monitors, autoclaves, anesthesia machines, and incubators. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThese findings underscore the need for improved equipment management, ensuring timely installation, adequate supply of necessary accessories, and proper allocation of resources to maximize the utilization of medical devices in public hospitals. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDescription of Key Types of Functional and Non-functional Medical Equipment Items\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study identified the top 25 critical medical equipment items that were inactive, either due to non-functionality, lack of installation, or reagent shortages in public hospitals across the Amhara region. The findings highlight that oxygen concentrators and suction machines accounted for the highest percentage of non-functional medical equipment, followed by autoclave machines and refrigerators. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAmong the most affected medical devices, oxygen concentrators had the highest number of inactive items (173 out of 846, 14.8%), followed by suction machines (141 out of 681, 11.9%) and autoclave machines (140 out of 540, 9.5%). These equipment types are critical for various medical procedures, and their non-functionality could significantly impact patient care and infection control measures. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOther essential equipment with considerable inactive rates included general and haematocrit centrifuges, operating room (OR) lights, infant incubators, anesthesia machines, and patient monitors. Notably, the presence of non-functional medical equipment was often due to inadequate maintenance, lack of spare parts, or the absence of necessary accessories. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe findings emphasize the urgent need for systematic medical equipment management, including preventive maintenance, curative maintenance, capacity building, timely installation, and efficient resource allocation, to ensure the optimal functionality of life-saving devices in hospitals. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of key medical equipment items and their status at most public hospitals, Amhara region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEquipment Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e# of Functional\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e# of Inactive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal # (%) of Equipment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Concentrator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e846 (14.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuction machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e681(11.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAutoclave machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e540(9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefrigerator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e644(11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral and Haematocrit Centrifuge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e404(7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR-light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e324(5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfant Incubator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e314(5.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnaesthesia machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e261(4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicroscope (Florescent and Normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e302(5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Monitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e259(4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPAP machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67(1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfusion pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhototherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128(2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChemistry and Electrolyte analyser\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfant Radiant Warmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e146(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElectro surgical unit (ESU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79(1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral and Doppler Ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e102(1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECG (EKG) machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46(0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefibrillator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eX-ray machine ( Digital)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCD4- machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCBC machine and Haematology Machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e150(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVacuum Extractor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFatal Doppler/ monitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMechanical Ventilator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4546\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1160\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5706(100.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eInactive: non-functional, not installed and incomplete\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eBinary Logistic Regression Analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe study assessed the determinants of medical equipment functionality in the Amhara region, Ethiopia, in 2024. A total of 6,946 medical equipment items were analyzed, with 5,232 (75.4%) being functional and 1,714 (24.6%) being inactive meaning non-functional (15.4%), not installed (8.8%) and incomplete (0.5%).\u003c/p\u003e \u003cp\u003eThis study revealed that 6128(88.2%), 1887(27.2%) and 5227(75.3%) functional and inactive medical equipment items had no service manual, clinical user and BMET training respectively.\u003c/p\u003e \u003cp\u003e \u003cb\u003eService manual\u003c/b\u003e: a medical equipment (functional, N\u0026thinsp;=\u0026thinsp;4522, vs. inactive, N\u0026thinsp;=\u0026thinsp;1606) without service manual is 55% less likely to be functional compared with those with a service manual. The AOR 95% CI: 0.45 (0.36, 0.55), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical user training\u003c/strong\u003e \u003cp\u003eSimilarly a medical equipment (functional, N\u0026thinsp;=\u0026thinsp;1176, vs. inactive, N\u0026thinsp;=\u0026thinsp;711) operated by a health professional who did not receive a clinical user training is 64% less likely to be functional compared with those with clinical user training. The AOR 95% CI 0.36(0.32, 0.41), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBMET training\u003c/strong\u003e \u003cp\u003eIn contrast, a medical equipment (functional, N\u0026thinsp;=\u0026thinsp;3943, vs. inactive, N\u0026thinsp;=\u0026thinsp;1284) handled by biomedical professional who did not receive BMET training increases the likelihood of medical equipment being non-functional (inactive) by 48% compared with having BMET training. The AOR\u0026thinsp;=\u0026thinsp;95% CI 1.48(1.29, 1.70), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.Service manual, user training and BMET training were determinants of medical equipment functionality. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe determinats of medical equipment factionality in Amhara region, Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunctional (N\u0026thinsp;=\u0026thinsp;5232)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInactive (N\u0026thinsp;=\u0026thinsp;1714)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR 95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService Manual\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43(0.35, 0.53)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45 (0.36, 0.55)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical User Training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41(0.36, 0.46)***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36(0.32, 0.41)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMET Training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02(0.90,1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.48(1.29, 1.70)***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*P-value\u0026thinsp;\u0026lt;\u0026thinsp;.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis study estimated the level of functional, non-functional, incomplete accessory, and non-installed medical equipment. We examined the effect of end-user and biomedical equipment technician (BMET) training, as well as the availability of service manuals, on improving medical equipment functionality. Our study revealed that more than two-thirds of medical equipment is functional (75.4%), while one-fourth (24.6%) remains inactive (non-functional, not installed, or incomplete).\u003c/p\u003e \u003cp\u003eOur study estimated that 75.4% of medical equipment remains functional. Our result supports the findings of a study conducted in Ethiopia (74.68%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and is higher than those reported in studies by (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and (57.3%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Our study also found that non-functional equipment accounts for 15.4%, which is significantly lower than findings from low- and middle-income countries by WHO (70%), as well as studies conducted in Rwanda (40%) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and a study in Ethiopia 32.1% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In our study, non-installed and incomplete accessory medical equipment accounted for 8.8% and 0.5%, respectively, which is greater than the findings of a similar study in Ethiopia (3.1%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study revealed that 6,128 (88.2%) medical equipment lacked service manuals, which is significantly higher than the 43% reported in a study conducted in Zambia. Meanwhile, 1,887 (27.2%) medical equipment had no service manual, a lower proportion compared to the 57% reported in Zambia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Our study showed that medical equipment functionality decreased by half due to the absence of a service manual (55%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and by two-thirds due to a lack of user training (64%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Another study in Zambia found that medical equipment was non-functional due to inadequate user training (3%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). User training plays an essential role in medical equipment maintenance, as improper usage may lead to equipment damage (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAdditionally, our study found that medical equipment non-functionality increased by half due to a lack of BMET training (48%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A similar study showed that hospitals without BMET training had nearly twice the amount of non-functional equipment, while hospitals with BMET training had 7.6% fewer non-functional devices (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(Study in Rwanda, 2014). ). BMET training has a significant impact on healthcare. Another similar study found that hospitals with BMETs had fewer non-functional devices compared to hospitals without BMETs [3% versus 7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005)].(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Study in Nepal, 2022). Trained BMETs in hospitals positively impacted the status of medical equipment, increasing functionality from 71\u0026ndash;93% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (Study in Zambia, 2018). Furthermore, the proportion of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% vs. 7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.005).(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) (study in Nepal, 2022).\u003c/p\u003e \u003cp\u003eOverall, our study highlights the crucial role of training and access to service manuals in maintaining medical equipment functionality. Addressing these gaps through structured training programs and ensuring the availability of essential service documentation can significantly enhance healthcare service delivery by improving medical equipment functionality and service continuity.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eDespite the overall medical equipment functionality status in Amhara region hospitals being 75.3%, which seems relatively good, this figure is likely overestimated due to the inclusion of primary hospitals, which generally encounter fewer non-functional medical equipment items. This suggests that functionality rates in referral and general hospitals may be lower than reported, highlighting the need for more targeted assessments and interventions.\u003c/p\u003e"},{"header":"7. Recommendation","content":"\u003cp\u003eTo improve medical equipment functionality and management, the following recommendations are proposed:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eStrengthen preventive and corrective maintenance programs to reduce equipment downtime and increase its useful life.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProvide adequate training for biomedical technicians and healthcare personnel to, fill skill gaps, ensure proper usage and maintenance.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAvail user and service manual to ensure proper handling and trouble shooting.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImprove supply chain management to ensure the availability of spare parts and essential accessories.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImplement standardized medical equipment management systems to track equipment status and plan maintenance effectively.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnhance budget allocation for medical equipment procurement, maintenance, and replacement to ensure sustainability in healthcare service delivery.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e "},{"header":"8. Limitation of the study","content":"\u003cul\u003e \u003cli\u003e \u003cp\u003eThis assessment primarily focuses on medical equipment found in clinical service areas and medical service stores, excluding equipment located in the main store, spare parts inventory, and hospital equipment such as patient beds, boilers, laundry equipment, ironing machines, drying machines, generators, and kitchen refrigerators in all hospitals.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDiscussions regarding inventories for workshop tools, test equipment, consumables, and safety equipment are outside the scope of this document.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe work order tracer setup did not identify the country of origin for each piece of equipment.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe origin and suppliers of most medical equipment items remain unknown and are not identified in this document.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince this study was conducted on medical equipment, ethics approval and consent to participate was not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince this study was conducted on medical equipment, consent for publication is not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or NGO sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNS and BB conceptualized the study and designed the methodology. NS collected and analyzed the data. NS and GD contributed to the literature review and discussion sections. TT and GD prepared tables and figures. All authors read and approved the final manuscript. All authors had read and approved the final manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all public hospitals for their support during data collection and all individuals who participated in this research.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMalkin RA. Barriers for medical devices for the developing world. Expert review of medical devices. 2007;4(6):759-63.\u003c/li\u003e\n\u003cli\u003eZamzam AH, Abdul Wahab AK, Azizan MM, Satapathy SC, Lai KW, Hasikin K. A systematic review of medical equipment reliability assessment in improving the quality of healthcare services. Frontiers in Public Health. 2021;9:753951.\u003c/li\u003e\n\u003cli\u003eHowitt P, Darzi A, Yang G-Z, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. The Lancet. 2012;380(9840):507-35.\u003c/li\u003e\n\u003cli\u003eVasan A, Friend J. Medical devices for low-and middle-income countries: a review and directions for development. Journal of medical devices. 2020;14(1):010803.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Medical devices: managing the mismatch: an outcome of the priority medical devices project: World Health Organization; 2010.\u003c/li\u003e\n\u003cli\u003eSemegnew A. Web-based Medical Equipment Management System in Seven Referral Hospitals: Addis Ababa University; 2018.\u003c/li\u003e\n\u003cli\u003eEder-Van Hook JLL, C. . A Model for Training Biomedical Equipment Technicians in Low-Resource Settings. 2015.\u003c/li\u003e\n\u003cli\u003eMalkin RA, Whittle C. Biomedical equipment technician capacity building using a unique evidence-based curriculum improves healthcare. Journal of Clinical Engineering. 2014;39(1):37-44.\u003c/li\u003e\n\u003cli\u003eThapa R, Yih A, Chauhan A, Poudel S, Singh S, Shrestha S, et al. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. Human resources for health. 2022;20(1):21.\u003c/li\u003e\n\u003cli\u003eW.S. Topham BPG, and B. Muis. Biomedical equipment technician training in Nepal. 5th IET International Seminar on Appropriate Healthcare Technologies for Developing Countries (AHT 2008)2008. p. 17/1-/5.\u003c/li\u003e\n\u003cli\u003eBekele A, Nyaruhirira AU, Gashu Z, Gebreyohannes A, Gemechu D, Habtewold A, et al. Exploring Lessons from Regional Maintenance Workshop to Enhance Medical Equipment Functionality in Ethiopia. 2023.\u003c/li\u003e\n\u003cli\u003eMol CR. Final Report of the Medical Equipment (ME) Uptime Project. 2018.\u003c/li\u003e\n\u003cli\u003eBahreini R, Doshmangir L, Imani A. Influential factors on medical equipment maintenance management: In search of a framework. Journal of Quality in Maintenance Engineering. 2019;25.\u003c/li\u003e\n\u003cli\u003eWoldeyohanins AE, Molla NM, Mekonen AW, Wondimu A. The availability and functionality of medical equipment and the barriers to their use at comprehensive specialized hospitals in the Amhara region, Ethiopia. Frontiers in Health Services. 2025;4:1470234.\u003c/li\u003e\n\u003cli\u003eKabeta SH, Chala TK, Tafese F. Medical Equipment Management in General Hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia. Medical Devices: Evidence and Research. 2023:57-70.\u003c/li\u003e\n\u003cli\u003eBekele A. Exploring Lessons from Regional Maintenance Workshop to Enhance Medical Equipment Functionality in Ethiopia. 2023.\u003c/li\u003e\n\u003cli\u003eGetie A. ANALYSIS OF MEDICAL EQUIPMENT SUPPLY CHAIN MANAGEMENT OF PUBLIC HOSPITALS UNDER THE ADDIS ABABA REGIONAL HEALTH BUREAU By: Addis Ababa University; 2018.\u003c/li\u003e\n\u003cli\u003eMoH E. ETHIOPIAN HOSPITAL SERVICES TRANSFORMATION GUIDELINES:CHAPTER 15: Medical Equipment Management Ethiopian Hospital Management Initiative. 2017.\u003c/li\u003e\n\u003cli\u003eAdeme BW, Tebeje B, Molla A. Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study. BMC health services research. 2016;16:1-10.\u003c/li\u003e\n\u003cli\u003eal. Te. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. Human Resources for Health (2022) 20:21.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical Equipment, Functionality, Training, Hospital, Amhara Region, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6210796/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6210796/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The functionality of medical equipment is critical for effective clinical service delivery. This study aimed to assess the operational status of medical equipment in public hospitals in the Amhara region, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study was conducted in 64 public hospitals between May and June 2024. Data on medical equipment functionality, installation status, and maintenance challenges were collected by trained biomedical technicians and technologists using a standardized format. Analysis was performed using SPSS version 27, employing descriptive statistics and binary logistic regression to evaluate factors affecting functionality, including the availability of service manuals and training for end users and biomedical professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 6,946 medical equipment items were assessed, of which 5,232 (75.3%) were functional, while 1,070 (15.4%) were non-functional, 611 (8.8%) were non-installed, and 33 (0.5%) had incomplete accessories. The absence of a service manual reduced the likelihood of functionality by 55% (AOR = 0.45, 95% CI: 0.36–0.55, p\u0026lt;0.001). Similarly, lack of clinical user training reduced functionality by 64% (AOR = 0.36, 95% CI: 0.32–0.41, p\u0026lt;0.001). Additionally, the absence of BMET training increased the likelihood of non-functionality by 48% (AOR = 1.48, 95% CI: 1.29–1.70, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Although the overall functionality of medical equipment in public hospitals appears satisfactory, primary hospitals may overestimate functionality due to less exposure to complex equipment. Service manuals, clinical user training, and BMET training were key determinants of functionality. Strengthening training programs and ensuring the availability of service manuals could improve equipment performance.\u003c/p\u003e","manuscriptTitle":"Assessment of the operational status of medical equipment in public hospitals of the Amhara region, Ethiopia: a sub-national study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-24 09:40:53","doi":"10.21203/rs.3.rs-6210796/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-16T13:28:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T14:40:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211686232788928940401789465104716288601","date":"2025-05-11T13:13:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50011922327813727746113064555822450289","date":"2025-05-09T15:26:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-09T14:45:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337732435376467781466512990950994379258","date":"2025-04-30T12:45:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181552464618379950885043333445582591908","date":"2025-04-15T15:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119902578349180979344734284080494618727","date":"2025-04-14T08:29:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-11T13:49:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-01T07:28:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T07:26:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Health Systems","date":"2025-03-12T09:31:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12f4d21e-ef88-45c9-b83b-6339b570a4d7","owner":[],"postedDate":"March 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T05:38:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-24 09:40:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6210796","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6210796","identity":"rs-6210796","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}