PATTERN OF ANTIDIABETIC MEDICATION UTILIZATION IN PATIENTS ATTENDING DIABETIC CLINIC IN HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL, HARAR, ETHIOPIA

Purpose: Diabetes mellitus (DM) is a chronic condition that can have a major impact on life expectancy and quality of life, especially if undetected or poorly controlled. Glycaemic control and management of co-morbid conditions and diabetes complications are alarmingly sub-optimal and perhaps one of the worst conditions in the world. This study aimed to assess the utilization pattern of antidiabetic medications in Hiwot Fana Specialized University Hospital (HFSUH). Methods: A cross sectional study was conducted from April 1 to May 31, 2014 and data were collected using structured questionnaire and data collection format. The data were entered and analyzed with the help of SPSS version 16. Descriptive statistics was used for most variables and Chi-square test was used. Resultsá¡ A total of 296 diabetes patients were involved in this study, 42.6% and 57.4% were males and females, respectively. Large proportion of the patients (42.4%) was unable to read and write. Majority of the respondents (64.9%) were from urban. Two hundred and twenty three (75.3%) of the respondents were diagnosed with type-2 diabetes. Almost all patients were on pharmacological therapy at the time of the study. Among those who were on pharmacological therapy, majority of them (42.9%) were taking insulin. Conclusionsá¡ The most prescribed antidiabetic medication was insulin, followed by glibenclamide and metformin, respectively. More than half of the patients used two syringes for monthly consumption. Most of the patients rotated major injection site and some of them also injected on lipodystrophied site. The incidence of microvascular complication was higher. What this study adds: It adds on the current trend of utilization of antidiabetic medications as well as indicates the widespread of diabetes in the study setting, which will be a baseline for the government and different stakeholders to intervene. What is already known about this subject: In the study setting, such a study has never been conducted. Key words: Antidiabetic medications, Diabetes mellitus, Co-morbid conditions, Glycaemic control, Hiwot Fana Specialized University Hospital.Â

Self-Medication and Contributing Factors Among Pregnant Women Attending Antenatal Care at Public Hospitals of Harar Town, Ethiopia

Background: Self-medication has been increasing in many developing and developed countries. Its use during pregnancy presents a major challenge due to potential undesirable effects on mother and the fetus. So the aim of this study was to assess the prevalence of self-medication and contributing factors, among pregnant women.Methodology: Institution based cross sectional study was conducted among 244 pregnant women attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal Hospital from February to March, 2017. A structured questionnaire based interview was used to collect data from each study subject. Then, data were categorized and analyzed using SPSS version 20 software. Logistic regression analysis was used to determine the significance of the association between the outcome and independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis.Results: The prevalence of self-medication during current pregnancy was 69.4%; out of which, 40.6% uses only herbal medicines to self-medicate. Time saving (50.7%) and prior experience of the drug (25.35%) were the main reasons for self-medication using conventional medicines while fewer side effects (59.86%) and effectiveness (35.92%) were the common reasons for self-medication using herbal medicines. Common cold and headache were among the common indications for self-medication. Friends (28.17%) and the pharmacist/druggist (23.94%) were the commonest source of information for conventional medicines while family/friends (69.72%) and neighbors (26.76%) were the common source of information for herbal medicines. Community drug retail outlets and neighbors were the commonly used sources of conventional medicines; while market place and self-preparation were the common sources of herbal medicines. Previous history of self-medication was significantly associated (P < 0.05) with current self-medication with conventional drugs and being a farmer by occupation and poor monthly income were significantly associated with herbal medicine use during pregnancy (P < 0.05).Conclusion: The prevalence of self-medication during pregnancy was very high in this study which showed a need for public trainings for all women of reproductive age about the risks of inappropriate self-medication

Appropriateness of Cotrimoxazole Prophylactic Therapy Among HIV/AIDS Patients in Public Hospitals in Eastern Ethiopia: A Retrospective Evaluation of Clinical Practice

Background: Cotrimoxazole prophylactic therapy (CPT) is a feasible, cost-effective, and safe way of using cotrimoxazole intervention to reduce HIV/AIDS related morbidities and mortalities associated with opportunistic infections. Despite its effectiveness in reducing the incidence of opportunistic infections, the actual drug utilization process has been shown to deviate from World Health Organization (WHO) guideline in Ethiopia. This study, therefore, aims to evaluate CPT among HIV/AIDS patients in Jugel Hospital (JH), Harar and Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia.Methods: A cross sectional study was conducted to evaluate the use of cotrimoxazole as prophylactic therapy. In this study, 556 medical records (305 in JH and 251 in DRH) of HIV/AIDS patients who had been taking CPT within September 2015–August 2016 were reviewed. Systematic random sampling was employed to obtain medical records from the sampling frame. Data were abstracted from the patient medical records using structured checklist customized from the WHO guideline. The data were entered into Epi-data 3.1 and exported to and analyzed with statistical Package for Social Sciences (SPSS) version 20. The finding was evaluated against the WHO guideline on the use of cotrimoxazole prophylaxis in HIV/AIDS patients. Descriptive statistics was used to present the data in tables, figures and pie chart.Results: Majority of the HIV/AIDS patients who had been taking CPT were adults (95.9%), female (61.2%), married (43.7%), Orthodox Christian (54.3%), and attended primary school (40.1%). At the initiation of CPT, most of the patients were at WHO clinical stage III (40.8%). The major comorbid illnesses identified were tuberculosis and pneumocystis-jiroveci pneumonia. Initially, majority of the patients were at CD4 count of less than 350 cells/mm3 (n = 504, 90.6%). Greater proportion of patients started CPT prior to initiating antiretroviral therapy (ART). Most of the patients took CPT for greater than 6 months. The primary reasons for premature discontinuation of CPT were CD4 greater than 350 cells/mm3, severe sulfa allergy and first trimester of pregnancy. Generally, the use of cotrimoxazole prophylaxis was consistent with the WHO guideline for indication to start (n = 519, 93.3%) and dose (n = 552, 99.28%), despite the presence of contraindication in 6.65% patients.Conclusion: In reference to the WHO guideline, the use of CPT was found to be fully appropriate in nearly two-thirds of HIV/AIDS patients. For the rest patients, inappropriate use of cotrimoxazole was observed based on the WHO criteria for initiation, discontinuation, continuation and dose with rate of discontinuation being the dominant one. Such practice may lead to adverse health outcomes including adverse drug reactions and negative treatment outcome

Effect of birthweight measurement quality improvement on low birthweight prevalence in rural Ethiopia.

BACKGROUND: Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent data reporting systems, and missing data from non-facility births. This paper describes birthweight data quality and the prevalence of LBW before and after implementation of a birthweight quality improvement (QI) initiative in Amhara region, Ethiopia. METHODS: A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine field supervision. After the QI implementation, birthweight data were prospectively collected from late August to early September 2019, and December 2019 to June 2020. Data quality, as measured by heaping (weights at exact multiples of 500 g) and rounding to the nearest 100 g, and the prevalence of LBW were calculated before and after QI implementation. RESULTS: We retrospectively reviewed 1383 delivery records before the QI implementation and prospectively measured 1371 newborn weights after QI implementation. Heaping was most frequently observed at 3000 g and declined from 26% pre-initiative to 6.7% post-initiative. Heaping at 2500 g decreased from 5.4% pre-QI to 2.2% post-QI. The percentage of rounding to the nearest 100 g was reduced from 100% pre-initiative to 36.5% post-initiative. Before the QI initiative, the prevalence of recognized LBW was 2.2% (95% confidence interval [CI]: 1.5-3.1) and after the QI initiative increased to 11.7% (95% CI: 10.1-13.5). CONCLUSIONS: A QI intervention can improve the quality of birthweight measurements, and data measurement quality may substantially affect estimates of LBW prevalence

Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study: protocol of a pragmatic clinical effectiveness study to improve birth outcomes in Ethiopia.

INTRODUCTION: The WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia. METHODS AND ANALYSIS: ENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at &lt;24 weeks gestation are enrolled (n=2400). ANC quality is strengthened across all centres. Health centres are randomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised salt and iron–folate (IFA), enhanced nutrition counselling and those with mid-upper arm circumference of &lt;23 cm receive a micronutrient fortified balanced energy protein supplement (corn soya blend) until delivery. In standard nutrition centres, women receive routine counselling and IFA. EIMP women have additional screening/treatment for urinary and sexual/reproductive tract infections and intensive deworming. Non-EIMP women are managed syndromically per Ministry of Health Guidelines. Participants are followed until 1-month post partum, and a subset until 6 months. The primary study outcomes are newborn weight and length measured at &lt;72 hours of age. Secondary outcomes include preterm birth, low birth weight and stillbirth rates; newborn head circumference; infant weight and length for age z-scores at birth; maternal anaemia; and weight gain during pregnancy. ETHICS AND DISSEMINATION: ENAT is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (001-A1-2019) and Mass General Brigham (2018P002479). Results will be disseminated to local and international stakeholders. REGISTRATION NUMBER: ISRCTN15116516

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Investigation of prescribing behavior at outpatient settings of governmental hospitals in eastern Ethiopia: an overall evaluation beyond World Health Organization core prescribing indicators

Abstract Background Rational prescribing remains an important component of rational drug use. The World Health Organization (WHO) standardized and validated core prescribing indicators for evaluating prescribing pattern of drugs. The prescribing practice has been shown to deviate from national and WHO guidelines in Ethiopia. The aim of this study was; therefore, to investigate the overall prescribing behavior of four governmental hospitals: Hiwot Fana Specialized University Hospital (HFSUH), Federal Harar Police Hospital (FHPH), Jugel Hospital (JH) and Southeast Command III Hospital (SECIIIH), Harar, eastern Ethiopia. Methods Hospital based retrospective cross-sectional study was employed to evaluate outpatient prescriptions dispensed from January 1 – December 31, 2016. A total of 2400 prescriptions (600 from each hospital) were assessed. A combination of prescription completeness and prescribing indicator forms were used to collect the data. Result From a total of 2400 prescriptions reviewed, only HFSUH and FHPH were using standard prescription at prevalence of 92.5 and 99.8%, respectively. Name and weight of the patient were the most and the least commonly recorded information, respectively. A total of 5217 drugs were prescribed with an average number of drugs per encounter to be 2.17 (±0.39) and the highest value (2.60) was observed at FHPH. The frequency of administration was the most commonly written component (85.0%) with an average of 1.85 per prescription. Among all prescriptions analyzed, the percentage of encounters with antimicrobials and injectables prescribed were 66.9 and 26.5%, respectively. The prevalence of drugs prescribed with generic name and from essential drug list were 4644 (89.01%) and 4613 (88.42%), respectively. Among health professional related information, dispenser name was the least documented in all hospitals with the prevalence being 3.9%. Conclusion JH and SECIIIH were not using standard prescriptions at all during the review period. Besides, some important components of the prescription such as age, sex and diagnosis were not properly recorded or missed at all in the selected hospitals. The tendency of prescribing drugs with dose and dosage form was very poor. Overall, none of the core prescribing indicators was in line with the WHO standards. These and other related problems should be investigated in-depth to find out the underlying problems for which interventional strategies can be designed to reverse this worrying practice

In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis

Objective: There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. Methods: PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2 -statistic were used to assess heterogeneity. Egger’s and Begg’s tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Result: Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17–0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05–0.23) compared to referral hospitals (PP = 0.24; CI: 0.17–0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19–0.27) and Northern Africa (PP = 0.22; CI: 0.16–0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. Conclusion: All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent

sj-docx-2-smo-10.1177_20503121221143646 – Supplemental material for In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis

Supplemental material, sj-docx-2-smo-10.1177_20503121221143646 for In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis by Fuad Adem, Semir Abdi, Firehiwot Amare and Mohammed A Mohammed in SAGE Open Medicine</p

sj-xlsx-1-smo-10.1177_20503121221143646 – Supplemental material for In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis

Supplemental material, sj-xlsx-1-smo-10.1177_20503121221143646 for In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis by Fuad Adem, Semir Abdi, Firehiwot Amare and Mohammed A Mohammed in SAGE Open Medicine</p