Xpert MTB/RIF for rapid detection of rifampicin-resistant Mycobacterium tuberculosis from pulmonary tuberculosis patients in Southwest Ethiopia

AbstractObjective/backgroundAccurate and rapid detection of drug-resistant strains of tuberculosis (TB) is critical for early initiation of treatment and for limiting the transmission of drug-resistant TB. Here, we investigated the accuracy of Xpert MTB/RIF for detection of rifampicin (RIF) resistance, and whether this detection predicts the presence of multidrug resistant (MDR) TB in Southwest Ethiopia.MethodsSmear- or culture-positive sputa obtained from TB patients with increased suspicion of drug resistance were included in this study. GenoType MTBDRplus line-probe assays (LPAs) and Xpert MTB/RIF tests were performed on smear-positive sputum specimens and on cultured isolates for smear-negative specimens. We performed routine drug-susceptibility testing using LPA as the reference standard for confirmation of RIF and isoniazid (INH) resistance.ResultsFirst-line drug-susceptibility results were available for 67 Mycobacterium tuberculosis complex-positive sputum specimens using the LPA test, with our preliminary results indicating that 30% (20/67) were MDR-TB, 3% (2/67) were RIF monoresistant, 6% (4/67) were INH monoresistant, and 61% (41/67) were susceptible to both RIF and INH. Relative to routine RIF-susceptibility testing (LPA), Xpert MTB/RIF detected all RIF resistance correctly, with 100% sensitivity and 97.8% specificity and a positive-predictive value of 95.7%. Of the 23 RIF-resistant strains according to Xpert MTB/RIF, 87% (20/23) were resistant to both RIF and INH (MDR), 8.7% (2/23) were RIF monoresistant, and 4.3% (1/23) were sensitive to RIF according to the LPA test. A high proportion of RIF resistance was documented among patients previously categorized as failure cases (50%, 10/20), followed by relapse cases (31.6%, 6/19) and defaulters (28.6%, 2/7).ConclusionXpert MTB/RIF was highly effective at identifying RIF-resistant strains in smear- or culture-positive samples. RIF resistance based on Xpert MTB/RIF results could be used to estimate MDR and allow rapid initiation of MDR-TB treatment in regions with high levels of drug-resistant TB

Drug use evaluation of ceftriaxone in medical ward of Dessie Referral Hospital, North East Ethiopia

Background: Assessment of antimicrobial use can be performed by evaluating their use. Drug use evaluation is a performance improvement method that focuses on evaluation and improvement of drug use processes to achieve optimal patient outcomes. The objective of this study was to evaluate the rational use of ceftriaxone in Medical ward of Dessie referral Hospital, Dessie-Ethiopia.Methods: Retrospective systematic study was used to assess rational use of ceftriaxone. The study was conducted by reviewing medication records of 316 patients, who received ceftriaxone during hospitalization at Medical ward of Dessie referral Hospital from December 30, 2011 to January, 2013. A systematic sampling method was used to select inpatient prescriptions in this ward with ceftriaxone and patient cards were located based on the medical record number on the prescription papers. Data was collected by using structured format and evaluated against WHO criteria for drug use evaluation as per standard treatment guideline of Ethiopia.Results: Most patients were dosed as 2 g/day (79.4%). The duration of therapy was found to be high in the range 2-7 days (51.69%). Ceftriaxone was mainly used as pneumonia treatment (38.8%). Maintenance fluids were the most commonly co-administered medications with a frequency of 62.16%. The use of ceftriaxone was appropriate only in 170 cases (55.8%) for the justification of use. Most of inappropriate uses were seen in terms of duration during treatment of pneumonia followed by frequency for the treatment of meningitis. Consistency of prescriber to the national standard treatment guideline was found to be low.Conclusions: To improve rational use and prevent the development of resistance; prescribers should adhere to the national standard treatment guideline. Intensification of short term trainings and antibiotic control systems are some of the possible solutions the hospital has to do.ceftriaxone therapy does not meet the current STG of Ethiopia

Depression, anxiety and stress, during COVID-19 pandemic among midwives in ethiopia: A nationwide cross-sectional survey

IntroductionCOVID-19 has rapidly crossed borders, infecting people throughout the whole world, and has led to a wide range of psychological sequelae. Midwives who come close in contact with women while providing care are often left stricken with inadequate protection from contamination with COVID-19. Therefore, this study aimed to assess the level of depression, anxiety, and stress (DASS) among midwives in Ethiopia.MethodsA cross-sectional study was conducted from 20 June to 20 August 2020, among 1,691 practicing midwives in Ethiopia. A simple random sampling technique was used to select study participants. Data were collected through a structured telephone interview. A 21-item depression, anxiety, and stress scale (DASS-21) was used. Data were entered using the Google forms platform and were analyzed with SPSS version 24. Both bivariate and multivariable logistic regression analyses were employed. Variables with a p-value < 0.05 in the final model were declared statistically significant. Adjusted odds ratio (AOR) with the corresponding 95% confidence interval (95% CI) was used to determine independent predictors.ResultsThe prevalence of DASS among midwives in Ethiopia was 41.1, 29.6, and 19.0%, respectively. Being female [AOR = 1.35; 95% CI: 1.08, 1.69], working in rural areas [AOR = 1.39; 95% CI: 1.06, 1.82], having poor knowledge of COVID-19 [AOR = 1.40; 95% CI: 1.12, 1.75], having poor preventive practice [AOR = 1.83; 95% CI: 1.47, 2.28], and substance use [AOR = 0.31; 95% CI: 0.17, 0.56] were significantly associated with depression; while, working in the governmental health facility [AOR = 2.44; 95% CI: 1.24, 4.78], having poor preventive practice [AOR = 1,47; 95% CI: 1.16, 1.85], and having poor attitude [AOR = 2.22; 95% CI: 1.04, 1.66] were significantly associated with anxiety. Furthermore, working in rural areas [AOR = 0.57; 95% CI: 0.39, 0.83], substance use [AOR = 2.06; 95% CI: 1.51, 2.81], having poor knowledge [AOR = 1.44; 95% CI: 1.20, 1.90], and having poor preventive practice [AOR = 1.60; 95% CI: 1.23, 2.10] were associated with stress.ConclusionIn this study, the overall magnitude of depression, anxiety, and stress were high. Addressing knowledge gaps through information, training, and safety protocols on COVID-19 and the provision of adequate personal protective equipment (PPE) is essential to preserve the mental health of Midwives during COVID-19

HIV-1 INFECTION AMONG EMPLOYEES OF THE ETHIOPIAN FREIGHT TRANSPORT CORPORATION

SUMMARY: In the study on HIV-l infection conducted in July 1988, 995 long distance truck drivers, their assistants, and lorry technicians employed by the Ethiopian Freight Transport Corporation (EFTC) were enrolled. 89.4% of trips made by the drivers were along the Addis Ababa -Assab road. The HIV prevalence rates were 13% among 468 drivers, 12.9% among 209 drivers assistants, and 4.1% among 318 technicians. The prevalence rate among those who served for < 5 yrs was 4.7% (n = 297) .Those who served longer in the Corporation (82.9% of whom are drivers) had a mean prevalence rate of 12.5% (n=698). Drivers had more sexual partners and more frequently experienced sexually transmitted diseases than the technicians. The study indicated that the long distance truck drivers in Ethiopia practiced frequent contacts with female sex workers. They were at a significantly higher risk to acquire HIV infection than the technicians employed at the same corporation

Prevalence of medication non-adherence and associated factors among diabetic patients in a tertiary hospital at Debre Markos, Northwest Ethiopia

BACKGROUND: Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital.METHODS: A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05.RESULTS: A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications.CONCLUSION: The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients

Unwanted Pregnancy and Associated Factors among Pregnant Married Women in Hosanna Town, Southern Ethiopia

Of an estimated 210 million pregnancies that occur in the world each year, 38% are unplanned, out of which 22% end in abortion. In Ethiopia, the estimates of unintended pregnancy indicate that it is one of the major reproductive health problems with all its adverse outcomes. Women risk their lives in by seeking illegal abortions following unintended pregnancies. Thus, this study aims to determine the prevalence of unintended pregnancy and associated factors among pregnant married women residing in Hossana, Southern Ethiopia. A community-based cross-sectional study involving both qualitative and quantitative data collection methods was carried out in Hossana from April 02 to 15, 2011. 385 pregnant married women randomly selected from the census were included for the quantitative data and took in-depth interviews for the qualitative. Descriptive, binary and multiple logistic regression analyses were performed using SPSS version 16. Out of the total pregnancies, 131 (34%) were unintended and 254 (66%) were reported to be intended. A history of previous unintended pregnancy, the husband not wanting to limit family size, a desire for at least two children, the number of pregnancy 3–4 and parity of 5 and above were factors significantly associated with unintended pregnancy. With over one third of pregnancies unintended, having a previous unintended pregnancy, the number of previous pregnancies, and husbands’ disagreement over family size, and the desired number of children are factors that reproductive health programs should aim to focus on to reduce unintended pregnancy

Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study

BackgroundProphylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices.AimThis study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH).MethodsThe observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach.ResultSurgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds.ConclusionDeeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks

Pattern and Trend of Medical Admissions of Patients of Chronic Non-Communicable Diseases in Selected Hospitals in Addis Ababa, Ethiopia

Although chronic non-communicable diseases (NCDs) have been of major importance in developed countries for several decades, currently it is becoming recognized as a major public health threats in the developing world too.The increasing NCDs burden is compounded by failure in provision of clear and up-to-date evidence on the burden for key decision makers. The present study is designed to collect retrospective secondary data from selected Government and Private Hospitals in Addis Ababa that offer services to out-patients of NCDs through special referral clinics. The Objective of this research is to depict the patterns and trends of common NCDs in Government and Private Hospitals in Adds Ababa, and provide decision makers with  information on the burden of NCDs at  health facility level.In order to collect retrospective data, four Governments and five Private owned Hospitals in Addis Ababa that offer referral clinic for NCD were selected. Data of NCD out-patients from 2007 to 2011 were considered for present study. Records of cardiovascular diseases, diabetes mellitus, cancer, chronic kidney diseases and chronic pulmonary obstructive diseases including asthma were collected. The data were collected from Hospital registration and patient records anonymously by respective Hospital staff members assigned in the referral clinics.Records of 46,565 patients were collected and more than 60% data were obtained from TikurAnbessa Specialized Teaching Hospital and International cardiac center. Majority of the clients (77 %) were from urban areas while 23% from rural areas. With regard to gender, 56% of the patients are females and 44% males.  As age increases the proportion of patients with NCDs increased and there was a decline after 54 years. Among the patients who were attending outpatient clinics, the vast majority about 40% were patients were with cardiovascular diseases while diabetes and cancer each independently accounts 20% of the proportion. Patients with chronic pulmonary obstructive diseases including asthma, and chronic kidney diseases were 6% and 5%, respectively. Information regarding the status of patients while making follow-up was also collected. It resulted in about 56% of all NCDs out-patients were actively following their health condition by making   frequent visit to their respective out-patient referral clinics, about 2% were deceased and 1% referred to other hospitals, about 41.2% of all NCDs patients were found to be drop-out for unknown reasons. This research reveals that NCDs are becoming public health problems in Addis Ababa. Therefore, there is a need for population-based representative survey to quantify the burden with risk factors for policy formulation and interventions against this emerging epidemic. Moreover, further study is recommended to investigate the reasons of patients why they discontinue care & treatment offered at facility level

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas.

BACKGROUND: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. METHODS: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. DISCUSSION: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017