Pressure ulcers (PU) affect millions of people worldwide and nearly always occur over bony areas of the body where pressure and tissue distortion is greatest. Pressure ulcer has variation in size and severity of damages to the skin, underlying tissue, muscle and over a bony prominence[1, 2]. Globally, recognized as one of the five most causes of harm to clients[3]. Though pressure injury is largely preventable patient safety problem, which have a major impact on the health care system and a trivial problem to patients, relatives and caregivers[4].Likewise, pressure ulcers highly threatens the well-being of clients by increased mortality rates, decrease quality of life, longer hospital stay and increase costs for patient care[5, 6].Moreover, pressure ulcer has detrimental impact on pain/suffering, disturbance of body image, delayed healing and have a negative effect on patients’ overall performance[4, 7].
In addition to its impact on individual and heath care system, pressure ulcers carry a significant economic burden. Pressure ulcer is considered more expensive to treat than to prevent pressure ulcers [8]. It has been estimated that the cost of treating pressure ulcer is 2.5 times higher than the cost of preventing [9]. The total annual cost for treatment of PUs in the United Kingdom being ($1.4–2.1 billion), making up 4% of the annual national health service budget[10].
A meta-analysis study revealed that the overall global prevalence of PUs using point prevalence was 14.8% [11]. Likewise, a systematic review carried out in acute care settings showed between 6% and 18.5%[12]. Other, meta-analysis report on the incidence of PU in the emergency department was 6.31%[13]. Knowing the prevalence rates of PUs are serve as basic tools to identify the severity of problem, to design preventive strategies and for efficient use of healthcare resources[14]. In addition, it would be baseline data for quality indicators to measure health care delivery within the clinical settings [15].
Numerous studies have shown substantial variation on the prevalence of pressure ulcers among hospitalized patients across the globe and revealed that the prevalence pressure ulcer was 14·9% in Swedish [16] ,18.2% in Norwegian [17],10.1% in São Paulo [18], 1.58% in China [19],3.3% in Turkish Hospital [20], 18.7 % in Brazil [21], 17.23% in Sub-Saharan Tertiary Centre [22], 3.22% in South-west Nigeria [23], and 19.3 % in Tunisia [24].
The existence of PUs is a very complex phenomenon and due to the presence of multiple risk factors [25]. Mainly, contributing factors are associated to the patient’s condition, health care provider and health care delivery system [26]. A review of several studies, aimed to identify factors related to the pressure ulcer in clinical setting, indicated that immobility [5, 16, 27-29], length of hospital stay [16, 27, 29-32], Older age [16, 27, 33],reduced sensory perception [16, 30, 33, 34], fecal and urinary incontinence [33, 35], worse Braden scores[6, 27, 33, 36-38], comorbidity[6, 27], and nutrition[28, 34, 37, 39, 40] was found to be statically significant risk factor for PU. However, repositioning would reduce the magnitude of pressure over vulnerable areas of the body [1].
Identification of associated factors is the primary goal to decrease the incidence of PUs [41].Hence, determining risk factors used as benchmarks to design appropriate prevention measure, to improve client safety and efficient utilization of resources [42]. Moreover, preventive measures are generally divided into four main areas: assessment of pressure ulcer development risk, skin care and initial treatment, use of pressure-reducing support surfaces and education [43].Therefore, early detection of patients who are susceptible to pressure ulcer is crucial, and it is recommended that the first skin assessment should be performed within 8 hours of hospital admission[44].
Although the attention on PU prevention has low in Ethiopia. A pressure ulcer remains pressing problem and is a major issue in nursing care. Prevention of pressure ulcers is the key role of the nurse and it is one of the quality indicator of nursing care[43]. Despite, extensive data on developed country, there is no comprehensive PU prevalence report that would serve as baseline information to improve patient safety and provide quality nursing care. Therefore, the present meta-analysis is aimed to assess the effect of position change on pressure ulcer among adult hospitalized clients in Ethiopia. Finding from the current study would serve as benchmark for policy-makers to implement appropriate preventive measure and to alleviate the pressing problem of pressure ulcer. In addition, for clinicians estimating magnitude of pressure ulcer would reflect overall quality indicator for facilities and a way to assess the efficiency of prevention strategies. Furthermore, the results of this study could serve as an input for further PU studies in Ethiopia.