Hypertension treatment practices and its determinants among ambulatory patients:Retrospective cohort study in Ethiopia

Objectives We examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP).Design A retrospective cohort study in six public hospitals, Ethiopia.Participants Adult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital.Outcome Controlled BP (&lt;140/90 mm Hg) and treatment intensification of patients with uncontrolled BP.Results The study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant-positive-determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09).Conclusions The level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.</p

Acute kidney injury risk factor recognition in three teaching hospitals in Ethiopia

Background. A key objective of the Nephrology Sister Centre Programme between the renal units in Cardiff and Addis Ababa, sponsored by the International Society of Nephrology, is to facilitate development of the local clinical service in Ethiopia specifically focused on the management of acute kidney injury (AKI). Objectives. To examine the relationship between AKI risk factor recognition and monitoring of renal function in three hospitals in Ethiopia. Methods. Cross-sectional data were gathered regarding renal function monitoring, recording the presence of AKI risk-associated comorbidities and prescription of nephrotoxic medications across the disciplines of medicine, surgery, obstetrics and gynaecology. Results. Patients were more likely to have their renal function checked at the hospital with specialist services. Across all centres, the highest proportion of patients who had renal function measurements were those admitted to a medical ward. There was a positive relationship between documented comorbidities and the measurement of renal function but not between the prescription of nephrotoxic drugs and measurement of renal function. Conclusion. There was great variability in the extent to which doctors recognised the presence of risk factors for the development of AKI. Failure to identify these risk factors represents a lost opportunity to identify patients at high risk of developing renal injury who would benefit from renal function monitoring

Acute kidney injury risk factor recognition in three teaching hospitals in Ethiopia

Background. A key objective of the Nephrology Sister Centre Programme between the renal units in Cardiff and Addis Ababa, sponsored by the International Society of Nephrology, is to facilitate development of the local clinical service in Ethiopia specifically focused on the management of acute kidney injury (AKI). Objectives. To examine the relationship between AKI risk factor recognition and monitoring of renal function in three hospitals in Ethiopia. Methods. Cross-sectional data were gathered regarding renal function monitoring, recording the presence of AKI risk-associated comorbidities and prescription of nephrotoxic medications across the disciplines of medicine, surgery, obstetrics and gynaecology. Results. Patients were more likely to have their renal function checked at the hospital with specialist services. Across all centres, the highest proportion of patients who had renal function measurements were those admitted to a medical ward. There was a positive relationship between documented comorbidities and the measurement of renal function but not between the prescription of nephrotoxic drugs and measurement of renal function. Conclusion. There was great variability in the extent to which doctors recognised the presence of risk factors for the development of AKI. Failure to identify these risk factors represents a lost opportunity to identify patients at high risk of developing renal injury who would benefit from renal function monitoring

Non-communicable diseases in Ethiopia: policy and strategy gaps in the reduction of behavioral risk factors

Introduction: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Over 80% of NCD deaths occur in developing countries. Four modifiable behaviors, namely tobacco use, consumption of unhealthy diet, physical inactivity, and the harmful use of alcohol, contribute to 80% of the NCD burden. Studies show that the vast majority of NCDs can be prevented through behavioral risk-reduction interventions. Properly executed, the interventions could lead to a decrease in the burden of NCDs, ranging from a 30% drop in the prevalence of cancer to a 75% reduction in cardiovascular diseases. This study examined the policy and strategy gaps in the reduction of the modifiable NCD behavioral risk factors in Ethiopia to inform and guide policy-makers and other stakeholders. Methodology: This study used a data triangulation methodology with a sequential, explanatory, mixed-method design conducted in two stages. The authors carried out quantitative analysis on the prevalence and distribution of behavioral risk factors from the Ethiopia NCD STEPwise approach to surveillance (STEPS) survey. Qualitative data on national policies and strategies complemented the analysis of the progress made so far and the existing gaps. Results and Discussion: Ethiopia has made substantial progress in responding to the NCD epidemic by developing a health sector NCD strategic action plan, generating evidence, and setting time-bound national targets on NCD behavioral risk factors. Activities mainly aimed at reducing tobacco use, such as implementation of the ratified WHO Framework Convention on Tobacco Control (FCTC), using evidence of the Global Adult Tobacco Survey (GATS), and the articulation of legislative measures are ongoing. On this paper our analysis reveals policy and strategy gaps, status in law enforcement, social mobilization, and awareness creation to reduce the major behavioral risk factors. Conclusions: NCDs share common risk factors and risk reduction strategies creates an opportunity for an effective response. However, the national response still needs more effort to have a sufficient impact on the prevention of NCDs in Ethiopia. Thus, there is an urgent need for the country to develop and implement targeted strategies for each behavioral risk factor and design functional, multisectoral coordination. There is also a need for establishing sustainable financial mechanisms, such as increasing program budgets and levying ‘sin taxes,’ to support the NCD prevention and control program. Ethiop. J. Health Dev. 2019; 33(4):259-268] Key words: NCDs, behavioral risk factors, policy, strategy, multisectoral coordination, Ethiopi

Tobacco use and its predictors among Ethiopian adults: A further analysis of Ethiopian NCD STEPS survey-2015

Background: Consuming any form of tobacco is one of the leading causes of preventable morbidity and mortality. Tobacco smoking has been identified as one of the major risk factors for NCDs, including cardiovascular, chronic respiratory diseases, and different cancers. Although there is national information on magnitude of tobacco use, to date there is limited nationally representative data on factors associated with tobacco use. The aim of this study is to assess the distribution and predicators of tobacco use in Ethiopian adult population between 15 -59.Objectives: The main aim of this study was to assess the prevalence of tobacco use and its predictor in Ethiopia.Methods: A cross-sectional population based study design was employed among population age from 15- 69 years. A stratified, three-stage cluster sampling was used to identify the study subjects. Households in each cluster were selected using simple random sampling method. The sampling frame was based on the population and housing census conducted for Ethiopia in 2007. Data was collected using WHO NCD STEPS questionnaire; current tobacco use of any type was taken as the dependent variable. Five hundred thirteen enumeration areas (EAs) as primary sampling units (PSUs) (404 rural and 109 urban) were selected with probability proportionate to size, followed by selection of households as a secondary sampling units (SSUs). A total of 10,260 households were selected from the 513 EAs (20 households per EA). Eligible individuals were selected from households using Kish method (a pre-assigned table of random numbers to find the person to be interviewed). Descriptive statistics using frequency table, mean, median, interquartile range and standard deviations were computed. Step wise logistic regression was used to analyse the predictors of tobacco use. An Estimator of 95% confidence interval was used both for computing descriptive statistics as well testing associations using logistic regression.Results: The prevalence of tobacco use (all tobacco products) was 4.2%. The mean age (± SD) of starting tobacco use was 21(7) years. The mean frequency of tobacco use was 2 times per day. Hierarchical Logistic regression analysis revealed that participants in age groups 30-44 years, and 60-69 years were less likely to use any tobacco type compared to younger age group of15-29 years. Heavy episodic drinking, AOR 2.46 [95% CI= 1.4 – 4.5], and khat chewing, AOR 4.71[95%= 2.26 – 9.8], were independently associated with tobacco use.Conclusion and recommendations: The overall prevalence of tobacco use was relatively higher in males. Factors associated with tobacco use were heavy episodic drinking and khat chewing. Although tobacco use is an important risk factor for different disease on its own, the additional use of these substances exposes individuals to increased risk of NCDs. The findings warrant the need to implement existing anti-tobacco laws in the country, enhance anti-tobacco awareness raising efforts, and implement interventions to help current tobacco users, focusing attention more on regions with high rates of tobacco use and males. Key words: Ethiopia, NCDs, Predictors, Risk factors, Tobacco use, WHO STEP

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

Abstract Objective This study was conducted to assess hypertension control and factors associated with it among hypertensive patients on treatment at Zewditu Memorial Hospital. Results A total of 225 patients were included in the study, of which 55.6% of patients were females. The mean age of the patients was 55.2 years and half of them had a family history of hypertension. About 29% of patients had comorbidities. Angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs) and beta-blockers (BBs) were the most frequently prescribed medications. Majority of (83.1%) the patients received combination therapy. The most frequent two and three drugs class combination were ACEI + BB and ACEIs + CCB + BB, respectively. Drug treatment was modified for 22.2% of patients and blood pressure (BP) was controlled in 26.2% of patients. Older age was associated with good BP control (AOR 2.58, CI 1.27–5.24), while treatment modification was associated with poor BP control (AOR 0.21, CI 0.07–0.65). The findings indicate that BP control was low and factors like middle age and treatment modification contributed to the low BP control. It is recommended that the physicians should be adherent to current guidelines regarding the selection of appropriate antihypertensive medications so as to achieve target BP goals

Management practice, and adherence and its contributing factors among patients with chronic kidney disease at Tikur Anbessa Specialized Hospital: A hospital-based cross-sectional study.

INTRODUCTION:Chronic kidney disease (CKD) has a complicated interrelationship with other diseases and major risk factor for cardiovascular disease. Therapeutic management for CKD patients is complicated due to co-morbidities and dominant risk factors of CKD. Non-adherence to treatment is an increasing problem for patients with CKD and it has not been extensively studied in patients with CKD. Hence, the present study was carried out to assess the management practice, medication adherence and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). METHODS:A hospital-based cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The degree of adherence was determined using eight-item Morisky Medication Adherence Scale. The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics such as frequency, percent, mean and standard deviation were used to summarize patients' baseline characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of medication non-adherence. RESULTS:About 55% patients with hypertension only were treated with non-angiotensin converting enzyme inhibition based regimens; 57.3% of diabetes mellitus with hypertension treated with combination of insulin and ACEI based regimens. About three-fourth of patients with anemia and osteodystrophy complications were treated with iron preparations and calcium based phosphate binder. Only 61.3% of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication non-adherence. Patients who had an average and high monthly income were 4.14 (AOR = 4.14, 95% CI: 1.45-11.84, p = 0.008) and 6.17 times (AOR = 6.17, 95% CI: 1.02-37.46, p = 0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR = 0.54, 95% CI: 0.27-1.10, p = 0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, teachers working in private school were about 7.46 times (AOR = 7.46, 95% CI: 1.49-37.26, p = 0.014) more likely to adhere compared with patients who were farmers. CONCLUSION:Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension co-morbidities. Very low income, increased number of prescribed medications and being a farmer were the predictors of medication non-adherence

Management Practice, and Adherence and Its Contributing Factors among Patients with Chronic Kidney Disease at Tikur Anbessa Specialized Hospital: A Hospital Based Cross-Sectional Study

The objective of this study was to assess the management practice, medication adherence, and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). Methods. A cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 CKD (stages 1 and 2=50, stage 3=88, stage 4=55, and stage 5=63) patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The rate of adherence was determined using 8-item Morisky medication adherence scale. The data were analyzed using SPSS version 20.0 statistical software. Univariate and multivariate binary logistic regression were used to investigate the potential predictors of medication nonadherence. Results. About 57.3% of diabetes mellitus with hypertension were treated with combination of insulin and ACEI based regimens. Other cardiovascular comorbidities were predominantly treated with Acetyl Salicylic Acid in combination with β-blocker. Only 61.3% (stages 1 and 2=70%, stage 3=73.9%, stage 4=54.5%, and stage 5=43%) of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication nonadherence. Patients who had an average and high monthly income were 4.14 (AOR=4.14, 95% CI: 1.45-11.84, p=0.008) and 6.17 times (AOR=6.17, 95% CI: 1.02-37.46, p=0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR= 0.54, 95% CI: 0.27-1.10, p=0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, or teachers working in private school were about 7.46 times (AOR=7.46, 95% CI: 1.49-37.26, p=0.014) more likely to adhere compared with patients who were farmers. Conclusion. Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension comorbidities. Very low income, increased number of prescribed medications, and being a farmer were the predictors of medication nonadherence