Predictors of Tuberculosis and Non-Communicable Disease Comorbidities Among Newly Enrolled Tuberculosis Patients, Southern Ethiopia

Mengistu Handiso Nunemo,1 Kassa Daka Gidebo,2 Eskinder Wolka Woticha,2 Yohannes Kebede Lemu3 1Department of Public Health, Wachemo University, Hossana, Central Region, Ethiopia; 2Department of Public Health, Wolaita Sodo University, Wolaita, South Region, Ethiopia; 3Department of Health, Behaviour and Society, Jimma University, Jimma, Oromia Region, EthiopiaCorrespondence: Mengistu Handiso Nunemo, Department of Public Health, Wachemo University, Po.Box: 667, Hosanna, Centeral Region, Ethiopia, Tel + 251 916357401, Email [email protected]: Non-communicable diseases are comorbid with tuberculosis, however only a few record review based studies have been conducted, which are more concentrated on elevated glucose levels. This study aimed to assess non-communicable disease comorbidity and its predictors among tuberculosis patients.Methods: A prospective cross-sectional study design was used and the data were collected by a previously validated tool from a sample of 443 tuberculosis patients using cluster random sampling methods. Multinomial logistic regression was interpreted by relative risk to predict the association of comorbidity status with independent variables.Results: The majority (87.81%) of TB patients were not comorbid with NCDs. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55%, and 5.64%, respectively. The people who had a risk score > 8 were 6.47 times more likely to have tuberculosis comorbid with one non-communicable disease compared to those with a risk score ≤ 8. The relative risk of tuberculosis patients with BMI > 25 is 3.33 times compared to those with a BMI < 23 of being comorbid with one non-communicable disease vs tuberculosis patients without non-communicable diseases. Those tuberculosis patients with an awareness of non-communicable disease comorbidities are 9.33 times more likely to have tuberculosis with multi-comorbidities compared to those who are unaware.Conclusion: The majority of TB patients were not comorbid with NCDs. The person’s weight, family size of more than five, monthly income > 3000 birr, risk score > 8 and BMI > 25 significantly predict comorbidity with one non-communicable disease compared to those without a comorbidity. The presence of non-communicable disease comorbidity, treatment awareness, and being aged 50+ years significantly predict the presence of multi-comorbidities compared to those without comorbidity. For early detection and management of both diseases, establishing bidirectional screening platforms in tuberculosis care programs is urgently required.Plain Language Summary: Non-communicable diseases are comorbid with tuberculosis, however, only a few record review based studies have been conducted, which are more concentrated on elevated glucose levels.This is a former prospective cross-sectional study of non-communicable disease comorbidities and their predictors among tuberculosis patients using the two stages of the WHO step-wise screening procedure.The majority (87.81%) of TB patients were not comorbid with NCDs, 7.22% were comorbid with one NCD and 4.97% were multi-comorbid. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55%, and 5.64%, respectively. The person’s weight, family size of more than five, monthly income > 3000 birr, risk score > 8 and BMI > 25 significantly predict the comorbidity with one non-communicable disease related to those without comorbidity. The presence of non-communicable disease comorbidity, treatment awareness, and being aged 50+ years significantly predicted the presence of multi-comorbidity compared to those without comorbidity. For early detection and management of both diseases, establishing bidirectional screening platforms in tuberculosis care programs is urgently required.Keywords: comorbidity, non-communicable disease, tuberculosis, prevalence, predictor

Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

Temesgen Sidamo Summoro,1 Kassa Daka Gidebo,2 Zewde Zemma Kanche,1 Eskinder Wolka Woticha2 1School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia.Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO) prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS® version 20.0 software.Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%), whereas their use in the other two hospitals was within the acceptable range. The use of antibiotics in all the hospitals in present study was higher than the acceptable range.Conclusion: Generally, it seems that there is need for improvement of the prescribing patterns in the hospitals, although this should be consolidated with further studies to link the patient diagnosis and the prescribed medications. Keywords: prescribing indicators, medicines, hospitals, rational prescribing, Ethiopi