Diarrheal disease and associated factors among children aged 6 to 59 months in Oda Bultum District, Eastern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Diarrhea is a serious health problem in children under the age of five that is both preventable and treatable. In low-income countries like Ethiopia, children under the age five years frequently experience diarrhea. However, the burden and associated factors of these diarrheal diseases are understudied in Eastern Ethiopia, Thus, this study aimed to determine the factors associated with the prevalence of diarrheal diseases in Eastern Ethiopia from September 1-30, 2022. METHODS: A cross-sectional study was conducted on the total of 602 children aged 6 to 59 months in Oda Bultum district in eastern Ethiopia. A multistage sampling method was used. Three kebeles were selected from nine kebeles by the lottery method. Data was entered into Epi data 4.0.2 and exported to SPSS version 21 for analysis. Descriptive analysis was used for frequency, mean, and standard deviations. In addition, bivariable, and multivariable Poisson regression model was used to identify predictors of diarrhea along with a 95% confidence interval. Finally, statistical significance was declared at a p-value of 0.05. RESULT: A total of 602 children were included in this study. The prevalence of diarrhea 7.4% (47/602), 95% CI; 5.5-9.7%) among the children. Factors such as being unvaccinated for any vaccine (AOR = 10.82, 95%CI; 4.58-25.48) and born from a mother who had medium level of empowerment (AOR = 0.34, 95%CI; 0.11-0.88) in the household had statistically significant association with diarrhea among the children compared to their counterparts. CONCLUSION: The study found that nearly one out of thirteen children aged 6 to 59 months had any form of diarrheal diseases in Oda Bultum District, Eastern Ethiopia. In addition, the study revealed that children who were vaccinated for their age developed diarrhea less likely compared to those who did not receive any form of vaccine for their age. Moreover, children with mothers who had a medium level of empowerment were less likely to get diarrhea than children with mothers who had a low level of empowerment.

The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia.

Background: Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia. Patients and Methods: An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant. Results: The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF. Conclusion: Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study.

Objective: Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods: A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results: Of the total participants, 116 (16.74%, 95% confidence interval: 14.1-19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00-2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64-6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07-2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10-2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14-2.84) were associated with an initial inappropriate antimicrobial use. Conclusion: Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.

Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study.

OBJECTIVE: Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia. DESIGN: Retrospective follow-up study. SETTING: Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia. PARTICIPANTS: Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021. PRIMARY OUTCOME: The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients. RESULTS: A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome. CONCLUSION: We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations.

Treatment Outcome and Associated Factors Among Patients Admitted with Hypertensive Crisis in Public Hospitals at Harar Town, Eastern Ethiopia: A Cross-Sectional Study.

Background: Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive crisis cases treatment outcome in the study setting. Objective: This study aimed to assess treatment outcome and associated factors among patients admitted with hypertensive crisis at Public Hospitals in Harar Town, Eastern Ethiopia. Methods: A cross-sectional study was conducted among 369 hypertensive crisis patients who had been admitted to the emergency department of Hiwot Fana Comprehensive Specialized Hospital and Jugol General Hospital from May 1, 2017, to May 1, 2022. All hypertensive crisis patients who fulfilled the inclusion criteria were included. The data were extracted from medical records using a data abstraction format. The collected data were analyzed using Statistical Package for Social Sciences version 22. Binary logistics regression model using bivariate and multivariable analysis with 95% confidence intervals and P-values were used to determine the association between variables. Results: The medical records of 369 patients in total were reviewed. Of these, the medical records of 363 patients contained all the necessary information and were used in the study. More than half of the patients (238; 65.6%) were males. Among 363 patients admitted with hypertensive crisis, 98 (27.0%, 95% Confidence Interval (CI):22.5%-31.9%) of them had poor treatment outcome of hypertensive crisis. Being female (Adjusted Odds Ratio (AOR)=3.4; 95% CI=1.7-7.9), residing in rural areas (AOR=2.4; 95% CI=2.7-5.1), taking captopril during admission (AOR=5.6; 95% CI=2.4-7.9), taking antihypertensive treatment before admission (AOR=0.5; 95% CI=0.2-0.9), and being non compliant to treatment (AOR=2.7; 95% CI=1.4-3.5) had statistically significant associations with poor treatment outcome of hypertensive crisis compared to their counterparts. Conclusion: The magnitude of poor treatment outcome of hypertensive crisis was high. Sex, residence, non-compliance, and type of emergency drug administered during admission were substantially related with poor treatment outcome of hypertensive crisis. Health professionals should put great emphasis on emergency drugs administered during admission to achieve the desired outcome.

The practice of menstrual hygiene management and associated factors among secondary school girls in eastern Ethiopia: The need for water, sanitation, and hygiene support.

BACKGROUND: During menstruation, school girls face obstacles connected to menstrual hygiene management in schools. Due to their monthly period, up to 20% of girls miss school globally, and one in ten will drop out entirely. Three hundred thirty-five million girls attended school without access to running water or soap. In Ethiopia, 67% of girls have no access to education on puberty and menstrual health; menstrual hygiene management continues to be one of the major problems among school girls. Thus, context-specific assessment of the practice may be useful in developing customized intervention approaches. Thus, the objective of the study was to assess practices of menstrual hygiene management and associated determinants among secondary school girls in East Hararghe, Ethiopia from 1 to 30 December 2020. METHODS: A school-based cross-sectional survey was undertaken with 486 randomly selected female students. Data were collected by pretested self-administered questionnaire. Descriptive statistical tests and multivariate logistic regression were used to describe the study variables and to examine the association. Statistical package for social science version 23 was used for data analysis, and a p-value of 0.05 was considered as a cut-off point for statistical significance. RESULTS: Of the total, 328 (68%) of the study participants practiced appropriate menstrual hygiene. Besides, 350 (72.6%) had a good level of understanding about menstrual hygiene. A higher level of knowledge (adjusted odds ratio = 2.12, 95% confidence interval = 1.28, 3.53), a greater wealth indexed family (adjusted odds ratio = 7.14, 95% confidence interval = 3.98, 12.88), earning permanent pocket money (adjusted odds ratio = 0.495, 95% confidence interval = 0.299, 0.821), and being in grade level (11-12) (adjusted odds ratio = 3.45, 95% confidence interval = 1.75, 4.501) were significant predictors of the good menstrual hygiene practice. CONCLUSION: One-third of the school girls had poor menstrual hygiene practices which may affect their school performance and the reproductive health. Hence, tailored menstrual hygiene information should be given to school girls and parents. Besides, efforts ought to be made for the provision of affordable sanitary materials in schools.

Extent of and Factors Associated with Self-Medication among Clients Visiting Community Pharmacies in the Era of COVID-19: Does It Relieve the Possible Impact of the Pandemic on the Health-Care System?

BACKGROUND: Self-medication is one aspect of self-care that has been shown to benefit primary health care. When done correctly, it provides significant benefits to customers, such as self-reliance and cost savings. Inappropriate methods, on the other hand, such as incorrect self-diagnosis and therapy selection, can be disastrous. The COVID-19 pandemic context may benefit the community in easing the burden on the health system. There have been no studies conducted on this possibility in the context of COVID-19 in a selected area, hence the purpose of this study was to determine the extent of and factors associated with self-medication among clients visiting community pharmacies in west Harerghe, Ethiopia from June 1 to 30, 2020. METHODS: This institution-based cross-sectional study used a systemic random sample of 416 community-pharmacy clients. To collect data, face-to-face interviews were conducted using pretested semistructured questionnaires modified from established techniques. EpiData 3.1 was used to enter data and SPSS 24 for analysis. To determine factors associated with self-medications, bivariate and multivariate logistic regression analyses were performed. AORs with 95% CIs are used to report associations, and the level of significance was set at P<0.05. RESULTS: The proportion of people self-medicating was 73.6% (95% CI 69.2%-77.9%). Self-medications were significantly associated with age 18-24 years (AOR 9.28, 95% CI 3.56-24.21) and 25-34 years (AOR 3.54, 95% CI 1.35-9.27), Amhara ethnicity (AOR 1.72, 95% CI 1.01-2.94), current single status (AOR 0.28, 95% CI 0.15-0.51), government employment (AOR 0.31, 95% CI 0.12-0.82), and limited knowledge (AOR 2.31, 95% CI 1.40-3.79). CONCLUSION: Three in four participants practiced self-medication in the era of COVID-19. Repetition was significantly associated with age, ethnicity, current marital status, type of occupation, and knowledge about self-medications. An alternative medical care-delivery system by all health-care providers and increasing community awareness should be promoted.

The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice.

INTRODUCTION: Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town. METHODS: A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22. RESULTS: From the 271 medical records reviewed majority of patients were from surgical ward (n = 85, 31.4%) followed by gynecology and obstetrics ward (n = 67, 24.7%). Demographically, the majority of the patients were female (n = 142, 52.4%). Patients in the age group of 20-29 years were dominant (n = 98, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n = 6), warfarin (n = 5), and enoxaparin (n = 1) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n = 80, 27.5%) followed by for the management of pneumonia (n = 62, 21.3%). The result of ceftriaxone use evaluation showed that majority (n = 190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n = 114, 60.0%) followed by wrong duration (n = 54, 28.4%). CONCLUSION: Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.

One in Five Street Traditional Coffee Vendors Suffered from Depression During the COVID-19 Pandemic in Harar Town, Ethiopia.

BACKGROUND: The COVID-19 crisis has already resulted in an economic and labor market shock and a rise of informal work sectors. Being an informal job, traditional coffee vending can predispose women to a myriad of mental disorders. Therefore, this study was aimed to assess depressive symptoms during the COVID-19 pandemic and associated factors among street traditional coffee vendors in Harar town, Eastern Ethiopia. METHODS: A cross-sectional study was employed on 180 women engaged in street traditional coffee vending business in Harar town. Data were collected through a face-to-face interview using a Public Health Questionnaire and analyzed using SPSS version 20. Binary logistic regression was executed to identify factors associated with depression at a cut-off point of P < 0.05. RESULTS: The mean age of the study participants was 31.83 (±10) years. The majority of the participants were currently married (n = 77, 42.8%), attended primary education (n = 68, 37.8%), had a family member of four or more (n = 60, 33.3%), and had two years or less work experience (n = 123, 68.3%). Most of the study participants obtained COVID-19-related information from television (n = 125, 69.4%). The prevalence of depression was found to be 18.9%. Attending primary education (AOR: 0.34; 95% CI: 0.12, 0.98), attending secondary education or higher (AOR: 0.23; 95% CI: 0.07, 0.69), and having four or more family members (AOR: 2.81; 95% CI: 1.14, 6.92) were significantly associated with depression. CONCLUSION: One in five street traditional coffee vendors suffered from depression during the COVID-19 pandemic. Lower odds of being depressed were observed in those who attended a minimum of primary education. On the contrary, having a greater family size was associated with higher odds of being depressed. This finding will direct the government and other concerned bodies to be involved in the provision of psychological and material support for such informal workers during COVID-19.

Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population.

Coronavirus disease in 2019 emerged in Wuhan, Hubei Province, China, in December 2019. After a month, it was declared a global threat to public health. The effects of the pandemic could be socio-economic, undermining the health system and risking livelihoods. Vulnerability to this infection has been associated with underlying comorbidities such as hypertension, diabetes, coronary heart disease, chronic respiratory diseases, cancer, and compromised immune systems. Co-morbidity has been common to the elderly, the disabled, and the homeless. In addition, more severe coronavirus disease outcomes have been reported in older males than females. Nonetheless, multiple variables are related to the concept of cultural gender that should be taken into account as women in more affected sectors are economically disadvantageous and over-represented. Similarly, although children are not the face of this pandemic, calamity has a profound effect on their welfare, especially for those living in poor and inconvenient situations. Moreover, the economic influence could be profound and universal when viewed through a migration lens as it is exacerbating xenophobic and discriminatory treatment. Protection measures to mitigate the outbreak of a pandemic, such as social distancing, may reduce social support for certain categories relied on for their day-to-day activities. The mental health of people would definitely be affected by the additional psychosocial burden of the pandemic, particularly in vulnerable groups. Integrated approaches are therefore mandatory to assist these groups and contain the pandemic.

Bacterial uropathogens and susceptibility testing among patients diagnosed with urinary tract infections at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

BACKGROUND: Urinary tract infection is a common infection posing a significant healthcare burden globally. Currently, it is becoming hard to manage due to the drug resistance of uropathogens. This study aimed to evaluate the rate of culture positivity and the susceptibility pattern of isolates among clinically diagnosed patients with urinary tract infection. METHODS: An institution-based cross-sectional study was conducted on patients clinically diagnosed with urinary tract infections and received a drug prescription at Hiwot Fana Specialized University Hospital from August 2018 to June 2019. A clean-catch mid-stream urine specimen was collected and bacterial identification and susceptibility test were performed using standard microbiological methods. Data were entered into EpiInfo 7 and exported to STATA 15 for analysis. Data were analyzed using descriptive analysis and bi-variate and multivariate regression analyses and presented with graphs, frequency, and tables. RESULTS: A total of 687 urine samples were collected from patients with clinically diagnosed urinary tract infections. The mean age was 31 years and 56.62% were female. 28.38% of the participants had a culture-positive result, of which 86.15% had monomicrobial infections. Inpatients (AOR = 3.8, 95% CI = (1.8-7.9)) and hypertensive patients (AOR = 2.1, 95% CI = (1.1-4.4)) had higher odds of culture-positive results. Staphylococcus species (35.3%), E. coli (25.34%), Pseudomonas species (6.8%), and other Enterobacterales are isolated. Most isolates showed resistance to more than one drug, and amikacin, gentamicin, and nitrofurantoin showed relatively higher activity against isolates. CONCLUSION: About one-third of the clinically diagnosed patients with urinary tract infection were culture-positive with many types of bacterial uropathogens. Inpatients and hypertensive patients had a higher risk of developing bacterial infections. Bacterial isolates showed different percentages of susceptibility to the tested antibiotics.

Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia.

INTRODUCTION: Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs). OBJECTIVE: This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016. METHODS: A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS: Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%). CONCLUSION: Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.

Hospital-Level Antibacterial Prescribing and Its Completeness in Ethiopia: Did It Adhere to Good Prescribing Practice?

BACKGROUND: Antibacterial agents are an integral part of chemotherapy and play a critical role in the prophylaxis and treatment of bacterial infections. However, prescribing errors such as incomplete prescriptions that do not adhere to good prescribing practice have become a contemporary concern in hospitals in resource-limited settings. Therefore, this study aimed to assess antibacterial prescribing and its completeness among prescriptions dispensed at four governmental hospitals in Eastern Ethiopia. METHODS: A cross-sectional study was employed to assess a total of 1308 prescription encounters containing at least one antibacterial agent obtained with simple random sampling from annual antibacterial-containing prescription data of four hospitals. The data were collected retrospectively using a structured checklist. RESULTS: A total of 2,855 drugs were prescribed from 1308 prescribing encounters with 1496 (52.39%) being antibacterial agents. The name, age, sex, and diagnosis of the patients were written in 1158 (88.3%), 815 (62.31%), 796 (60.58%), and 183 (13.99%) prescriptions, respectively. Besides, the route of administration, strength, duration, quantity, dose, and dosage form of the drug were recorded in 2322 (81.33%), 2118 (74.19%), 1516 (53.10%), 1525 (53.42%), 746 (26.13%) and 563 (19.72%) prescriptions, respectively. Nearly 50% of the prescribing encounters were documented without a prescriber name. Dispenser name and signature were also obtained in less than 10% of the prescriptions. Combining the data of all hospitals, amoxicillin, ceftriaxone, and ciprofloxacin were identified as the top three prescribed antibacterial drugs, whereas diclofenac, paracetamol, and tramadol were the most frequently co-indicated drugs. Regarding the pharmacologic class of antibiotics, penicillins were the most commonly prescribed antibiotics (n = 596, 39.77%) followed by cephalosporins (n = 318, 21.26%) and fluoroquinolones (n=285, 19.05%). CONCLUSION: Incomplete information about patient-related factors and major diagnosis, medication regimens, prescribers and dispensers was identified as a potential prescribing error and did not adhere to good prescribing practice. This can be considered as one part of the inappropriate use of antibacterial agents, a driving force for the emergence of antimicrobial resistance. This problem requires immediate and sustained action from the management of the hospitals to ensure the accountability of health professionals involved in the medication use process and to establish antimicrobial stewardship programs in such resource-limited settings.

Investigating In Vitro Antibacterial Activities of Medicinal Plants Having Folkloric Repute in Ethiopian Traditional Medicine.

Medicinal plants are targeted in the search for new antimicrobial agents. Nowadays, there is an alarmingly increasing antimicrobial resistance to available agents with a very slow development of new antimicrobials. It is, therefore, necessary to extensively search for new agents based on the traditional use of herbal medicines as potential source. The antibacterial activity of 80% methanol extracts of the leaves of Verbena officinalis (Vo-80ME), Myrtus communis (Mc-80ME), and Melilotus elegans (Me-80ME) was tested against 6 bacterial isolates using agar well diffusion technique. In each extract, 3 concentrations of 10, 20, and 40 mg/well were tested for each bacterium. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also determined. Vo-80ME and Mc-80ME exhibited promising antibacterial activity against Staphylococcus aureus with the highest zone of inhibition being 18.67 and 26.16 mm, respectively at concentration of 40 mg/well. Regarding gram-negative bacteria, Vo-80ME exhibited an appreciable activity against Escherichia coli and Salmonella typhi. Mc-80ME displayed remarkable activity against all isolates including Pseudomonas aeruginosa with the maximum zone of inhibition being 22.83 mm. Me-80ME exhibited better antibacterial activity against E coli, but its secondary metabolites had little or no activity against other gram-negative isolates. The MIC values of Vo-80ME ranged from 0.16 to 4.00 mg/mL. The lowest MIC was observed in Mc-80ME, with the value being 0.032 mg/mL. Mc-80ME had bactericidal activity against all tested bacterial isolates. Mc-80ME showed remarkable zone of inhibitions in all tested bacterial isolates. Besides, Vo-80ME showed good antibacterial activity against S aureus, E coli, and S typhi. Conversely, Me-80ME has shown good activity against E coli only. Generally, M communis L and V officinalis have good MIC and MBC results.

Evaluation of the Antispasmodic and Antisecretory Activities of the 80% Methanol Extracts of Verbena officinalis L: Evidence From In Vivo Antidiarrheal Study.

Verbena officinalis L. has a folkloric repute for the management of digestive disorders, including diarrhea. However, the safety and efficacy of the plant material has not been scientifically validated yet. This study was, therefore, aimed to evaluate the overall antidiarrheal activity of the 80% methanol extracts of V officinalis in mice. The antidiarrheal activity of the 80% methanol extracts of the roots (R-80ME) and the leaves (L-80ME) of V officinalis was tested in castor oil-induced diarrhea in mice. R-80ME was further evaluated using charcoal meal and entero-pooling. In each test, group I and group II (controls) received 10 mL/kg distilled water and standard drug (5 mg/kg loperamide), respectively, whereas groups III, IV, and V (test groups) received 100, 200, and 400 mg/kg of the 80ME, respectively. The R-80ME at 200 mg/kg (P < .01) and 400 mg/kg (P < .001) significantly delayed the onset of diarrhea compared with negative control. Both R-80ME and L-80ME at 200 and 400 mg/kg significantly decreased the frequency of wet fecal outputs (P < .01). Generally, 70.24% inhibition of the number of wet fecal output was recorded at R-80ME 400 mg/kg. Results from the charcoal meal test revealed that the R-80ME at 200 (P < .01) and 400 mg/kg (P < .001) produced a significant antimotility effect. In entero-pooling test, the R-80ME, at 200 and 400 mg/kg doses (P < .01), showed a significant decline in both the volume and weight of intestinal contents. The maximum in vivo antidiarrheal index was determined to be 95.25 at dose of 400 mg/kg R-80ME. This study demonstrated that the 80ME, mainly the root extract, produced promising antidiarrheal activity and hence provides a scientific support for acclaimed traditional use of the plant material for treatment of diarrheal diseases.

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

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.

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.

Ethnobotanical, Ethnopharmacological, and Phytochemical Studies of Myrtus communis Linn: A Popular Herb in Unani System of Medicine.

Myrtus communis L (Myrtaceae) is one of the popular drugs being used in the Unani system of phytomedicine since ancient Greece period. From time immemorial, different parts of this plant and essential oil have been used for a variety of purposes such as cosmetics (hair fall control), flavoring of food and drinks as well as extensive therapeutic purposes. Ethnobotanical information revealed that M communis L has been a folkloric repute for the treatment of several diseases like gastric ulcer, diarrhea, dysentery, cancer, rheumatism, hemorrhage, deep sinuses, leucorrhoea, hemorrhoid, inflammation, dyspepsia, anxiety, insomnia, diabetes, hypertension, pulmonary disorders, and skin diseases. Moreover, ethnopharmacological studies revealed that the plant is endowed with extensive pharmacological activities, including antimicrobial, antidiarrheal, antidiabetic, antispasmodic, vasodilator, antiulcer, antioxidant, anticancer, anxiolytic, sedative-hypnotic, and anti-inflammatory activities, among others. The plant has been known to contain phenolic acids, tannins, flavonoids, glycosides, and terpenes. The myrtle oil was also found to be rich in a variety of bioactive monoterpenes and sesquiterpenes with their derivatives. Most of these studies validate the aforementioned traditional claims of this medicinal plant. Further studies are needed to unravel other pharmacological activities of this plant in the long run.