Potential Drug-Drug Interactionsamong Adult Patients Admitted to MedicalWards at a Tertiary Teaching Hospital inEthiopia

  Abstract Introduction: A Drug-drug interaction (DDI) is a decrease or increase in the pharmacological or clinical response to the administration of two or more drugs that are different from the anticipated response they initiate when individually administered. Objectives: To assess the prevalence and factors associated with potential DDIs among adult inpatients admitted to the medical wards of a tertiary teaching Hospital in Ethiopia. Methods: A retrospective cross-sectional study design was employed on adult patients who were admitted to the medical ward in one year period. A total of 384patients’ medical records were checked for a possible DDI using Micromedex DrugReax® drug interaction database and analyzed consecutively using SPSS version 20.0. Results: Among 384 adult patients enrolled in the study, 209 (54.4%) of them had medications with at least one potential DDI in their prescriptions. Of the 209 potential DDI, 26.3% were with a minimum of one major potential DDI. The median number of potential DDI per patient was 2.2. Overall, 296 potential DDI were identified in the current study. Among 296 identified potential drug-drug interactions, most of the interaction (49.7%) had good documentation. The number of medication prescribed per patient showed a significant (p< 0.001) association with the occurrence of potential DDIs. Conclusion: More than half of the patients’ prescription contains potentially interacting medications. This study, additionally, revealed that there is a significant association between potential DDIs and number of medications prescribed per patient. Key words: Drug-drug interactions, pharmacokinetic interaction, pharmacodynamic interaction, internal medicin

Concomitant use of medicinal plants and conventional medicines among hypertensive patients in five hospitals in Ethiopia

Background: Even if the use of medicinal plants has a long tradition in Ethiopia, little is known about which medicinal plants are concomitantly used with which conventional medicines, since patients’ disclosure to their treating physicians is low. The concomitant use of medicinal plants and conventional medicines may increase the risk of unwanted interactions, unexpected toxicities and possible under-treatment. The aim of this study was to identify plants concomitantly used with conventional medicines by hypertensive patients. Methods: A total of 365 patients and 17 healers were surveyed to identify medicinal plants commonly used by hypertensive patients. In addition, patients’ charts were reviewed to identify if they had any co-morbid conditions or history of taking medicinal plants. Descriptive statistics were used for the analysis. Results: Of 365 hypertensive patients, 171(46.8%) reported having co-morbidities, mainly hypercholesterolemia(28, 7.7%), diabetes mellitus(38, 4.9%) and asthma (12, 3.3%). While the majority (319, 87.4%) of patients preferred modern medicines for the management of their hypertension, some preferred taking holy water (24, 6.69%) and using medicinal plants (20,5.5%). The concomitant use of medicinal plants and conventional medicines was practiced by just under half of the patients (171, 46.8%). Hydrochlorothiazide, enalapril, nifedipine, amlodipine, atenolol and aspirin were the most commonly used conventional medicines. Moringa (Moringa stenopetala), damakase (OcimumlamiifoliumHochst.), haregresa (ZehneriascabraSond.) and thyme(Thymus serrulatus)were the most commonly used plants. However, none of these medicinal plants were standardized in terms of the dose, frequency, duration or method of preparation. Conclusions: Conventional medicine was the initial primary treatment choice for hypertensive patients. However, a high tendency of using medicinal plants concomitantly was observed due to the side-effects of conventional medicines, patients’ curiosity to try medicinal plants and the desire to achieve better blood pressure control. [Ethiop. J. Health Dev. 2019; 33(4):239-249] Key words: Hypertension, herb-drug interaction, medicinal plants, conventional medicine, Ethiopi

Knowledge and awareness of cervical cancer and human papillomavirus among female students in an Ethiopian University : A cross-sectional study

Financial support and sponsorship Nil.Peer reviewe

A semi-parametric mixed models for longitudinally measured fasting blood sugar level of adult diabetic patients

Abstract Background At the diabetic clinic of Jimma University Specialized Hospital, health professionals provide regular follow-up to help people with diabetes live long and relatively healthy lives. Based on patient condition, they also provide interventions in the form of counselling to promote a healthy diet and physical activity and prescribing medicines. The main purpose of this study is to estimate the rate of change of fasting blood sugar (FBS) profile experienced by patients over time. The change may help to assess the effectiveness of interventions taken by the clinic to regulate FBS level, where rates of change close to zero over time may indicate the interventions are good regulating the level. Methods In the analysis of longitudinal data, the mean profile is often estimated by parametric linear mixed effects model. However, the individual and mean profile plots of FBS level for diabetic patients are nonlinear and imposing parametric models may be too restrictive and yield unsatisfactory results. We propose a semi-parametric mixed model, in particular using spline smoothing to efficiently analyze a longitudinal measured fasting blood sugar level of adult diabetic patients accounting for correlation between observations through random effects. Results The semi-parametric mixed models had better fit than the linear mixed models for various variance structures of subject-specific random effects. The study revealed that the rate of change in FBS level in diabetic patients, due to the clinic interventions, does not continue as a steady pace but changes with time and weight of patients. Conclusions The proposed method can help a physician in clinical monitoring of diabetic patients and to assess the effect of intervention packages, such as healthy diet, physical activity and prescribed medicines, because individualized curve may be obtained to follow patient-specific FBS level trends

Embedding implementation research to strengthen efforts towards improving primary health care in resource limited settings

Immunization reaches more people than any other health service and it is a vital component of primary health care (PHC) (1,2). The Immunization Agenda 2030 emphasizes building strong national immunization programs integrated into primary health care services as the basis for achieving high vaccination coverage (2). In Ethiopia, immunization services are the backbone of PHC and are delivered in all public health facilities across the country (1). Even though the national EPI target is to reach a coverage of 90%(1), achieving and maintaining high immunization coverage is challenged by multifaceted demand and supply side implementation barriers (3–5). These barriers are related to community engagement, immunization service delivery, supply chain management, and surveillance and data management of the immunization program (5). Consequently, the national full vaccination coverage stalled at 43% (6)

Genetic Variability and Relationship of Camel (Camelus dromedarius) Populations in Ethiopia as Evidenced by Microsatellites Analysis

AbstractThis study was carried out to assess the genetic diversities and population structure of six camel populations of Ethiopia. Blood samples were collected from 114 camels (17-24 per population) and genotyped using10 camel microsatellite marker loci. The result revealed high genetic diversities in Ethiopian camel populations with average observed and expected heterozygosity, total number of alleles (TNA), mean number of alleles (MNA) and effective number of alleles of 0.55, 0.73,153, 6.8 (0.36) and 4.47(0.23), respectively. Among the 52 private alleles in the six Ethiopian camel populations, 31 of them were occurring at a frequency of ≥5%. It was also found that most of the variations in Ethiopian camels were attributed to within population variation (92%) while 8% was explained by between populations variation. Even though there was high heterozygosity, high inbreeding coefficient was detected in Ethiopian camel populations. From the sex camel populations 34.1, 33.4 and 28.6% alleles of Gelleb, Amibara and Liben camel populations respectively affected by inbreeding. The between population differentiation was (FST=0.11(0.01) indicating moderate population differentiation. The neighbor-joining tree and structure analysis show that the Ethiopian camel populations were clustered into four subgroups. The Afar camels were grouped into two together with the Ethiopian Somali camels (Jigjiga with Mille and Gelleb with Amibara) and the two Ogaden camels (Liben and Hoor) are separated into two subgroups indicating that some of the Afar and the Somali camels were admixed. Therefore, even though high hetrozygosity within population and moderate genetic differentiation between populations were observed, the presence of high inbreeding coefficient may affect hetrozygosity in the overall populations

Married women’s decision making power on family planning use and associated factors in Mizan-Aman, South Ethiopia: a cross sectional study

BACKGROUND: Women’s use of family planning service is influenced by many factors, especially by their decision making power. A woman’s decision-making power, be it individual or decision made in collaboration with a partner, is the most important factor in the use of family planning in a household. The purpose of this study was to assess the impact of women’s decision making power on family planning use and its associated factors. METHODS: A community-based cross-sectional study was conducted on married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method. Trained nurses collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95 % CI was computed to assess the strength of the association. Collinearity was also assessed by looking at standard errors in the final fitted model. RESULT: Overall, more than two-thirds [67.2 %: 95 % CI (63–71 %)] of the married women were found to be more autonomous to decide family planning use. Secondary education [AOR: 9.04, 95 % CI: (4.50, 18.16)], government employment [AOR: 4.84, 95 % CI: (2.03, 11.52)], being wives of government employed spouses [AOR 2.71, 95 % CI: (1.24, 7.97)], having husbands with college or university education [AOR: 11.29, 95 % CI: (4.66, 27.35)], and being in the younger age [AOR: 0.27, 95 % CI :(0.09, 0.75)] were significantly associated with women’s decision-making power on family planning. CONCLUSIONS: In this study, women had a high decision making power in family planning use. Age category (34–44-years), formal education, and occupational status had effects on women’s decision making power. Promoting parental adult education and engaging women in out of house employment is essential to improve their decision making power in using family planning

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas