Methodological Assessment of Quasi-Experimental Designs in Ethiopian District Hospitals Systems: A Systematic Literature Review

Ethiopia has implemented district hospitals as a primary health care system to improve access to healthcare services, particularly for underserved rural areas. However, the effectiveness of these systems in reducing healthcare risks is not well understood. A comprehensive search strategy was employed using electronic databases such as PubMed, Cochrane Library, and Google Scholar. Studies were identified based on predefined inclusion criteria related to quasi-experimental design methodologies applied in Ethiopian district hospital systems. The review identified a proportion of 60% of studies employing intention-to-treat analysis (ITT) for estimating risk reduction outcomes, which is considered robust but not universally adopted across all reviewed studies. While the majority of quasi-experimental designs in this context use ITT, there remains variability in methodological approach and reporting standards. There is a need to promote standardisation of methodology for consistent evaluation of district hospitals' performance metrics in Ethiopia. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.