Modifiable factors associated with a consistently high acute pain trajectory after surgical treatment of traumatic fractures in Ethiopia: a multi-center prospective cohort study.

BACKGROUND: In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. METHODS: This multi-center prospective observational cohort study included surgical candidates for traumatic fractures (n = 218). Worst pain intensity was measured with an 11-point numeric rating scale on the first 4 postoperative days and day of hospital discharge. Growth mixture modeling was used to identify subgroups of patients based on their pain trajectories, and logistic regression models to quantify associations between pain trajectories and demographic, clinical, psychological, and life style factors. RESULTS: Two postoperative pain trajectory subgroups were identified: rapid pain relief (48% of included individuals) and consistently high pain (52% of included individuals). Sub-analysis stratified by cause of injury demonstrated that higher preoperative pain was an independent risk factor for consistently high postoperative pain regardless of the patient's injury type: traffic accident (OR = 1.48, 95% CI 1.23-1.79), machine/tool injury or conflict (OR = 1.58, 95% CI 1.11-2.26), or fall (OR = 1.47, 95% CI 1.08-1.99). Moreover, longer surgical time was a risk factor for consistently high postoperative pain among patients who had a fall-related injury (OR = 1.02, 95% CI 1.00-1.03). In contrast, among patients with a traffic-related injury, receiving a nerve block was a protective factor (OR = 0.19, 95% CI 0.04-0.87) compared with general anesthesia. CONCLUSION: Higher preoperative pain and longer surgical time were associated with a consistently high acute postoperative pain trajectory. Clinicians may use these potentially modifiable factors to identify patients at risk for consistently high pain during the early postoperative period.

Impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines.

BACKGROUND: In many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities. OBJECTIVES: This study evaluated the impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines at selected health facilities in Ethiopia. METHODS: We have prospectively assessed 28 maternal-child health products and 14 childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list. Data were collected from 5 hospitals located in the Jimma zone of Oromia regional state in the southwestern part of Ethiopia. We extracted data on drug availability, and order fill rates for these pharmaceutical products between May 2019 and August 2020. RESULTS: The overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0-63.6%) prior COVID-19 and 42.6% (range 19-56.4) during COVID-19 time. The average monthly orders fill rates of hospitals for the selected products ranged from 39 to 79%. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing. CONCLUSION: This study illustrates that the availability of key essential medicines for maternal and child health in the study area was low. The overall stock-out situation of MCH products has worsened during COVID-19 compared to pre-COVID-19 pandemic. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals. To allow governments to guarantee these products are constantly available and affordable, a variety of policy frameworks and choices addressing inevitable epidemics should exist.

Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12 months after total knee arthroplasty - a longitudinal study.

OBJECTIVES: There are several known predictors of pain after total knee arthroplasty (TKA). However, it is unclear whether acute postoperative pain intensity and postoperative opioid intake are associated with pain 12 months after TKA. Thus, the aim of this study was to assess whether worst pain intensity and opioid intake during the early postoperative period are associated with moderate-severe pain 12 months after TKA. METHODS: A total of 202 patients undergoing primary TKA between October 2012 and September 2014 were prospectively enrolled. Age, sex, contralateral knee pain, BMI, physical status and opioid intake were collected preoperatively. Ketamine and daily opioid intake were collected on postoperative days (POD) 0-3. Using the Brief Pain Inventory, patients' "worst pain intensity" was measured preoperatively, on POD 0-4, and 12 months after TKA. Two logistic regression models evaluated the independent association of early postoperative pain intensity (model 1) and postoperative opioid intake (model 2) with moderate-severe pain 12 months after TKA, adjusting for possible confounders. RESULTS: In total, 187 patients with data at the 12 month postoperative follow-up were included in this analysis. Pain intensity on POD2 and POD3, as well as preoperative pain and BMI, were significantly associated with pain at 12 months in univariate models. However, in multivariable models adjusted for preoperative pain and BMI, neither pain intensity on POD 0-4 (model 1) nor opioid intake on POD 0-3 (model 2) were associated with pain at 12 months. Preoperative pain was still significant in both models, but BMI remained significant only in model 2. CONCLUSIONS: Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12 months after TKA when controlling for potential confounders. More research is needed to confirm these findings.

Drug-related problems and its predictors among hospitalized heart failure patients at Jimma Medical Center, South West Ethiopia: prospective interventional study.

BACKGROUND: Drug-related problems are associated with high mortality, complications, prolonged hospital stay, compromised quality of life, and increased healthcare costs. This problem is high in patients hospitalized with chronic conditions such as heart failure. However, there are limited studies conducted on this area, particularly in Ethiopia. OBJECTIVE: To evaluate drug-related problems, their predictors, and clinical pharmacist intervention among hospitalized heart failure patients at Jimma Medical Center, Ethiopia. METHODS AND PARTICIPANTS: A prospective interventional study was conducted among hospitalized heart failure patients from September 30, 2020, to May 28, 2021, at Jimma Medical Center. Drug-related problems were sorted based on the Pharmaceutical Care Network Europe drug classification tool version 9.0. Patient's specific data were collected using a structured questionnaire. Data was analyzed using statistical software package version 23.0. Multivariate logistic regression analysis was used to identify independent predictors of drug-related problems occurrence and statistical significance was considered at a p value < 0.05. RESULTS: A total of 237 heart failure patients were included in this study. The mean (SD) age was 49.06 + 17.79. About two-thirds (66.2%) of study patients had at least one drug-related problem during their hospital stay. A total of 283 drug-related problems were identified among 157 patients. Treatment effectiveness-related problem (55.48%) was the most common observed drug-related problem. The independent predictors of drug-related problems were khat chewing [AOR = 3.25, 95% CI = (1.46-7.23)], hospital stay > 18 days [AOR = 3.77, 95% CI = (1.93-7.37)]; presence of comorbid condition [AOR = 2.59, 95% CI = (1.35-4.96)] and polypharmacy [AOR = 2.94, 95% CI = (1.54-5.61)]. CONCLUSION: The prevalence of drug-related problems was high among hospitalized heart failure patients in the study area. Chewing khat, prolonged hospital stay, comorbidity, and polypharmacy were the predictors of drug-related problems. Hence, to overcome these problems, clinical pharmacists, physicians, and other health professionals have to work in collaboration.

Drug-related problems and determinants among elective surgical patients: A prospective observational study.

Objectives: The aim of this study was to assess drug-related problems and determinants among elective surgical patients admitted to Jimma University Medical Center. Methods: A hospital-based prospective observational study was conducted at Jimma University Medical Center, from April 10 to July 10, 2018. Data were collected through patients' interview and physicians' medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results: Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems. Conclusion: The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.

Potential adverse drug events and its predictors among hospitalized patients at medical center in Ethiopia: a prospective observational study.

Potential adverse drug event (PADE) is a medication error with the potential to cause associate degree injury however that does not cause any injury, either due to specific circumstances, chance, or as a result of the error being intercepted and corrected. This study aimed to assess the incidence, contributing factors, predictors, severity, and preventability of PADEs among hospitalized adult patients at Jimma Medical Center. A prospective observational study was conducted among hospitalized adult patients at a tertiary hospital in Ethiopia. Logistic regression was performed to identify factors predicting PADE occurrence. P-value < 0.05 was considered for statistical significance. A total of 319 patients were included. About 50.5% of them were females. The mean ± SD age of the participants was 43 ± 17.6 years. Ninety-four PADEs were identified. Number of medications (adjusted OR = 5.12; 95% CI: 2.01-13.05; p = 0.001), anticoagulants (adjusted OR = 2.51; 95% CI: 1.22-5.19; p = 0.013), anti-seizures (adjusted OR = 21.96; 95% CI: 6.57-73.39; p < 0.0001), anti-tuberculosis (adjusted OR = 2.2; 95% CI: 1.002-4.59, p = 0.049), and Elixhauser comorbidity Index ≤ 15 (adjusted OR = 6.24; 95% CI: 1.48-26.25, p = 0.013) were independent predictors of PADEs occurrence. About one-third of patients admitted to the hospital experienced PADEs.

Soil-Transmitted Helminthic Infections and Geophagia among Pregnant Women in Jimma Town Health Institutions, Southwest Ethiopia.

BACKGROUND: Pregnancy is a key step for human's reproduction and continuity of generation. Pregnant women are among at risk groups for the infection of soil-transmitted helminths (STHs). STHs are highly prevalent in low- and middle-income countries due to the deprived environmental sanitation and personal hygiene. Eating soil (geophagia) is also commonly practiced by pregnant women, particularly in developing countries. The aim of this study was to determine the prevalence of STHs and geophagia, and to assess associated factors among pregnant women in Jimma, Southwest Ethiopia. METHODS: A cross sectional study was conducted among 407 pregnant women attending antenatal care (ANC) at different health facilities located in Jimma Town. Data related to sociodemographic and geophagia practice was collected using a structured questionnaire and STH infections status was determined by using McMaster technique. RESULTS: A total of 407 pregnant women were included in this study. The overall prevalence of any STHs was 19.7% (80/407). Ascaris lumbricoides was the most prevalent 45(56.2%), followed by Trichuris trichiura 19(23.8%) and hookworms 12(15%). There were 4(5%) of double infection with A. lumbricoides and T. trichiura. Overall, 71 (17.4%) of the pregnant women responded to practice geophagia. STHs infection was significantly higher among geophagic pregnant women (p<0.01) and pregnant women who practiced geophagia were 3 times more likely (OR 2.9, 95% CI 1.3-4.2) to have the STHs compared to non-geophagic. Out of those who claimed soil eating habits, 59.1% preferred reddish soil type. Geophagia practice was significantly higher during the third trimester as compared to first and second (p<0.05). CONCLUSION: Geophagia is a risky behavior and this study showed a significant association of geophagia practice with STH infections, although the causal relation could not be established.

High levels of preoperative pain and fatigue are red flags for moderate-severe pain 12 months after total knee arthroplasty-A longitudinal cohort study.

BACKGROUND: Moderate/severe pain after total knee arthroplasty (TKA) is a poor surgical outcome. Many studies have identified preoperative risk factors of pain after TKA, but studies of the joint contributions of co-occurring symptoms are lacking. METHODS: Patients undergoing primary TKA (n = 202) were enrolled in a longitudinal cohort study. Preoperatively, patients completed questionnaires measuring demographics and symptoms (pain, fatigue, sleep problems and depression). Pain was re-assessed 12 months after TKA. Logistic regression analysis was used to compute the probabilities of moderate-severe pain at 12 months based on preoperative symptom levels, and results were combined into a risk matrix. RESULTS: More than one-third (40%) of patients (n = 187) reported moderate-severe pain after TKA. Among preoperative risk factors included in the logistic regression analyses were age, sex, pain, fatigue, sleep problems and depression. Adjusting for possible confounders, fatigue (p = 0.02) and pain (p = 0.01) were significant risk factors for moderate-severe pain at 12-months follow-up and were retained in the final risk matrix. The co-occurrence of high-preoperative fatigue and pain scores resulted in 57% estimated probability of moderate-severe pain at 12 months. Similarly, the co-occurrence of low-preoperative fatigue and pain scores resulted in 14% estimated probability of moderate-severe pain 12 months after TKA. CONCLUSION: The combination of high fatigue and pain scores prior to surgery was a key risk factor for moderate-severe pain 12 months after TKA. Mapping of these factors could be used preoperatively to identify patients who are at risk to experience a poor outcome of TKA.

Adverse Drug Events and Contributing Factors Among Hospitalized Adult Patients at Jimma Medical Center, Southwest Ethiopia: A Prospective Observational Study.

BACKGROUND: Adverse drug events (ADEs) are common complications of clinical care resulting in significant morbidity, mortality, and high clinical expenditure. Population-level estimates of inpatient ADEs are limited in Ethiopia. OBJECTIVE: This study aimed to assess the incidence, contributing factors, severity, and preventability of ADEs among hospitalized adult patients at Jimma Medical Center, Ethiopia. METHODS: A prospective observational study design was conducted among hospitalized adult patients at tertiary hospital in Ethiopia. A structured data collection tool was prepared from relevant literatures for data collection. Data were analyzed using statistical software. Logistic regression was performed to identify factors contributing to ADE occurrence. P values < 0.05 were considered statistically significant. RESULTS: A total of 319 patients were included with follow-up period of 5667 person-days. About 50.5% were women. The mean (SD) age of patients was 43 (17.6) years. One hundred sixteen ADEs were identified with the incidence of 36.4 (95% CI, 30.1-43.6) per 100 admissions and 20.5 (95% CI, 16.9-24.6) per 1000 person-days. Antituberculosis agents (adjusted odds ratio [aOR] = 2.52; 95% CI, 1.06-5.98; P = 0.036), disease of the circulatory system (aOR = 2.67; 95% CI, 1.46-4.89; P = 0.001), disease of the digestive system (aOR = 2.84; 95% CI, 1.45-5.57; P = 0.002), being on medication during admission (aOR = 3.09; 95% CI, 1.77-5.41; P < 0.001), and hospital stay more than 2 weeks (aOR = 3.93; 95% CI, 1.39-11.12; P = 0.010) were independent predictors of ADE occurrence. CONCLUSIONS: One in every 4 patients admitted to the hospital experienced ADEs during their hospital stay. Most ADEs were moderate in severity. About two-thirds of the ADEs identified were deemed probably or definitely preventable. Therefore, it is high time to reinforce large-scale efforts to redesign safer, higher quality health care systems to adequately tackle the problem.

Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions.

BACKGROUND: Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. METHODS: A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. RESULTS: A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212-9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029-2.450, p = 0.037). CONCLUSIONS: Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists' intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists' intervention was also substantially high.

Assessment of seasonality in soil-transmitted helminth infections across 14 schools in Jimma Town, Ethiopia.

INTRODUCTION: Up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children. METHODS: Assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p < 0.05. RESULTS: Infections with any STH were observed in 824/1,680 (49.0%) subjects. T. trichiura was the most prevalent (35.5%), followed by A. lumbricoides (23.4%) and hookworms (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for A. lumbricoides, 10.8% to 55.0% for T. trichiura and 0 % to 28.3% for hookworms. A significant difference in prevalence (for T. trichiura) and in infection intensity (for A. lumbricoides and T. trichiura) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season. CONCLUSION: Our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors.

Cosmetic Use and Its Adverse Events among Female Employees of Jimma University, Southwest Ethiopia.

BACKGROUND: Cosmetics is applied to human body for cleansing, beautifying, promoting attractiveness or altering appearance. Cosmetics is causing alarming adverse events to its users, yet evidence about its magnitude and cosmetic use among female employees in Ethiopia is limited. Therefore, this study was aimed at determining cosmetic use and its adverse events among female employees of Jimma University. METHOD: A cross-sectional study was done among female employees from December 2016 to January 2017. Samples of 426 participants were selected using stratified simple random sampling from all colleges, and data were collected using self-administered questionnaire. Descriptive statistics was used to compute proportions and logistic regression to assess the determinants of cosmetics-related adverse events. RESULT: A total of 387 females were participated, making a 90.8% response rate. The majority (80.1%) were using at least one cosmetic product, and 39.0% of them were between 25-29 years. The majority (86.6%) of the respondents used toothpaste, lotion, lipstick, or eye makeup. Cosmetics related adverse events were experienced by 19.0% of the respondents primarily on face and hairs. Lotion and hair cosmetics were the primary perceived causes of adverse events. Employees who had monthly income between 1000 and 3000 ETB (AOR=3.4; 95% CI: 1.4-8.4), above 3000 ETB (AOR=4.7; 95% CI: 1.8-12.2) and those who used traditional cosmetics (AOR=4.5; 95% CI: 2.1-9.6) were more likely to develop adverse events. CONCLUSION: A significant proportion of the users suffered from cosmetics related adverse events. The female employees have to be aware of the rational cosmetics utilization practices to minimize adverse events.

Assessment of Efficacy and Quality of Two Albendazole Brands Commonly Used against Soil-Transmitted Helminth Infections in School Children in Jimma Town, Ethiopia.

BACKGROUND: There is a worldwide upscale in mass drug administration (MDA) programs to control the morbidity caused by soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura and hookworm. Although anthelminthic drugs which are used for MDA are supplied by two pharmaceutical companies through donation, there is a wide range of brands available on local markets for which the efficacy against STHs and quality remain poorly explored. In the present study, we evaluated the drug efficacy and quality of two albendazole brands (Bendex and Ovis) available on the local market in Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS: A randomized clinical trial was conducted according to the World Health Organization (WHO) guidelines to assess drug efficacy, by means of egg reduction rate (ERR), of Bendex and Ovis against STH infections in school children in Jimma, Ethiopia. In addition, the chemical and physicochemical quality of the drugs was assessed according to the United States and European Pharmacopoeia, encompassing mass uniformity of the tablets, amount of active compound and dissolution profile. Both drugs were highly efficacious against A. lumbricoides (>97%), but showed poor efficacy against T. trichiura (~20%). For hookworms, Ovis was significantly (p < 0.05) more efficacious compared to Bendex (98.1% vs. 88.7%). Assessment of the physicochemical quality of the drugs revealed a significant difference in dissolution profile, with Bendex having a slower dissolution than Ovis. CONCLUSION/SIGNIFICANCE: The study revealed that differences in efficacy between the two brands of albendazole (ABZ) tablets against hookworm are linked to the differences in the in-vitro drug release profile. Differences in uptake and metabolism of this benzimidazole drug among different helminth species may explain that this efficacy difference was only observed in hookworms and not in the two other species. The results of the present study underscore the importance of assessing the chemical and physicochemical quality of drugs before conducting efficacy assessment in any clinical trials to ensure appropriate therapeutic efficacy and to exclude poor drug quality as a factor of reduced drug efficacy other than anthelminthic resistance. Overall, this paper demonstrates that "all medicines are not created equal".

Comparison of Kato-Katz thick-smear and McMaster egg counting method for the assessment of drug efficacy against soil-transmitted helminthiasis in school children in Jimma Town, Ethiopia.

BACKGROUND: There is a paucity of studies that compare efficacy of drugs obtained by different diagnostic methods. METHODS: We compared the efficacy of a single oral dose albendazole (400 mg), measured as egg reduction rate, against soil-transmitted helminth infections in 210 school children (Jimma Town, Ethiopia) using both Kato-Katz thick smear and McMaster egg counting method. RESULTS: Our results indicate that differences in sensitivity and faecal egg counts did not imply a significant difference in egg reduction rate estimates. CONCLUSION: The choice of a diagnostic method to assess drug efficacy should not be based on sensitivity and faecal egg counts only.

Prevalence and intensity of soil-transmitted helminth infections among pre-school age children in 12 kindergartens in Jimma Town, southwest Ethiopia.

BACKGROUND: Pre-school age children (preSAC) remain difficult to reach in mass drug administration (MDA) programmes to control soil-transmitted helminth (STH) infections. Kindergartens provide a unique platform to increase the coverage of MDA in preSAC in Ethiopia, but surveys assessing STHs among preSAC in kindergartens are scarce. METHODS: We report the prevalence and intensity of STH infections among 622 preSAC in 12 kindergartens in Jimma, Ethiopia. RESULTS: STHs were found in all kindergartens, with prevalence exceeding 50% in 8 kindergartens. The majority of the infections were of low intensity. CONCLUSIONS: This study highlights the importance of kindergartens as an additional opportunity for MDA in Ethiopia.