Correction: Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0228953.].

Knowledge, Attitude, and Practice of Unused and Expired Medication Disposal among Patients Visiting Ayder Comprehensive Specialized Hospital.

BACKGROUND: Accumulation of unused and expired medicines at home is a source of environmental hazards and public health problems due to lack of awareness on appropriate medicine disposal methods. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused and expired medicine disposal among patients visiting Ayder Comprehensive Specialized Hospital. METHODS: A descriptive cross-sectional study was conducted among 384 patients who visited Ayder Comprehensive Specialized Hospital outpatient pharmacy from April to June 2019. Convenience sampling was used to recruit the participants, and data was collected by a face-to-face interview using a structured questionnaire. The data were entered and analyzed by using SPSS version 21.0. Descriptive statistics on sample characteristics was computed, and results were presented in the form percentage using table and statements. RESULTS: Out of the 384 respondents included in the study, 205 (53.4%) of them were males. More than half (199 (51.8%)) of the respondents did not correctly knew about medicine waste, and 233 (60.7%) of them did not have any prior information regarding medicine waste disposal instruction. But 351 (91.4%) of the participants correctly responded that inappropriate unused and expired medicine disposal can cause environmental harm. Above half (218 (56.8%)) of the respondents "agreed" about the potential risks related to having unused/expired medicines at home, and 206 (53.6%) of them "strongly agreed" that children are more vulnerable. One hundred fifty-nine respondents had unused/expired medicines in their homes. The most commonly used disposal practice for unused medicines were throwing them in a household trash as reported by 297 (77.3%) followed by flushing unused medications in toilet/sink 152 (39.6%). Throwing them away in household garbage and flushing them in toilet/sink were also the most commonly preferred disposal practice for expired medicines. CONCLUSION: The majority of the study participants dispose unused and expired medicine in household garbage and toilet/sink. This is against the recommendations of both national and international policies and guidelines on safe and appropriate pharmaceutical waste disposal.

Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study.

BACKGROUND: Hypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet. OBJECTIVE: The study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis. METHODS: A retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients' medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE. RESULTS: A total of 141 patients' records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE. CONCLUSION: The prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.

Exit-Knowledge About Dispensed Medications and Associated Factors Among Ambulatory Patients Attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia.

BACKGROUND: Optimizing exit-knowledge of ambulatory patients is a major professional responsibility of pharmacists to reassure safe and cost-effective medicines use. The study assessed the exit-knowledge of ambulatory patients on their dispensed medications and associated factors. PATIENTS AND METHODS: Institutional-based cross-sectional study was conducted among ambulatory patients who visited the outpatient pharmacy of Ayder Comprehensive Specialized Hospital (ACSH) from December 2019 to February 2020. Data were entered, cleaned, and analyzed using SPSS version 20. Binary logistic regression was employed to determine factors associated with exit-knowledge on their dispensed medications. At a 95% confidence interval (CI), p≤0.05 was considered statistically significant. RESULTS: The study analyzed 400 patients; more than half of the participants were males (55.5%). The mean age of the participants was 41.3 years (mean ± standard deviation (SD), ±13). Less than half of the patients did not recall the name (44.5%) and major side effects (31.2%) of each medication. Furthermore, the overall sufficient knowledge was found to be 81%. Patients with single marital status were 4.454 times to have sufficient exit-knowledge of their dispensed medications than widowed (p=0.050) participants. Besides, patients who responded neutral clarity of pharmacist instruction had 4.745 times sufficient exit-knowledge than those who responded not clear (p=0.049). On the other hand, participants who got "enough" (p<0.0001) and "not enough" (p=0.006) information from the pharmacist were found to have a positive association with sufficient exit-knowledge than those who responded "I do not know". CONCLUSION: The majority of patients had sufficient exit-knowledge of their dispensed medications. Martially single, neutral clarity of pharmacist's instructions and adequacy of the information delivered by the pharmacist were positively associated with participants' exit-knowledge of their dispensed medications. Hence, conducting a multicenter study, we recommend pharmacists to counsel their patients to underpin patients' knowledge of their dispensed medications.

Public Knowledge and Attitudes towards Vitiligo: A Survey in Mekelle City, Northern Ethiopia.

BACKGROUND: The overall well-being, sense of stigmatization, and treatment outcome of persons with vitiligo are largely dependent on their social acceptance and this is linked with perception and attitude of this disease in a given population. Therefore, this study assessed the knowledge and attitude of the public towards vitiligo. METHODS: A cross-sectional survey was carried out using a self-reported questionnaire distributed to adults living in Mekelle city, Northern Ethiopia from August to November 2019. Individuals who were 18 to 65 years of age and not suffering from vitiligo were included in the study. A self-administered questionnaire that contains a demographic, knowledge, and attitudes parts was used to collect data. Data were entered using Epi Data® version 3.1 and analyzed using SPSS® version 21. RESULTS: Of the total 368 subjects, 300 completed the questionnaires giving 81.5% response rate. The mean age was 30 ± 8.3 years and the male-to-female ratio was 1.14 : 1. Friends or families were reported as the most common source of information (70%) about vitiligo. The overall vitiligo knowledge was sufficient in 68.3% of the participants. Higher vitiligo-related knowledge scores were recorded by people older than 30 and below 50, those of secondary school graduated or more, urban-dwellers, persons who had heard about vitiligo, and persons having families or friends affected by vitiligo. Attitudes towards vitiligo were positive in 43.3% of participants. This was more prevalent among employed persons, those of secondary school graduated or more, and persons having families or friends affected by vitiligo. Moreover, sufficient knowledge was significantly related to positive attitudes towards the disease (p < 0.0001). CONCLUSION: Even though the majority of the respondents had sufficient knowledge, we still found misconceptions and negative attitudes towards vitiligo. Therefore, it is still crucial to educate the public about vitiligo to ultimately improve the well-being of patients with vitiligo.

Clinico-Epidemiological Profile and Treatment Pattern of Vitiligo in Selected Dermatological Clinics of Mekelle City, Northern Ethiopia.

BACKGROUND: Vitiligo is not a well-studied disease in Ethiopia. Therefore, this study assessed its clinico-epidemiological profile and treatment patterns. METHODS: An institutional-based cross-sectional study was conducted in conveniently selected dermatologic clinics of Mekelle city, Ethiopia. A two-phased study was conducted, in which the first was to determine prevalence of vitiligo while the second phase was to describe the clinico-epidemiological profile and treatment pattern of vitiligo. Four-hundred three randomly selected dermatological patients were included in the first phase study. The second phase study included vitiligo cases from the first phase study and additional vitiligo cases found in a two months period prospective study. RESULTS: Of the 403 randomly selected dermatological patients who presented in the year 2017 to 2019, the prevalence of vitiligo was 13.15%. Of the 79 cases with vitiligo, nearly two-thirds (50, 63.3%) were males with five years as the median age at onset of the disease. Positive family history of vitiligo was recorded in about one-third (25, 31.6%) of the cases. Limbs (48, 44.5%) followed by the head and neck (26, 24%) were the most commonly affected parts of the body at the onset of the disease. The most prevalent clinical form of vitiligo was vulgaris (39.2%) followed by the focal type (26.6%). Emotional upset (24, 33.8%) and physical traumas (23, 32.4%) were the frequently reported triggering factors of vitiligo. Three-fourths (75.5%) of the cases had prescriptions of topical corticosteroids, and 24.5% of them had prescriptions of sun screen lotion. CONCLUSION: The prevalence of vitiligo was found to be high. The clinico-epidemiological profile of vitiligo in Ethiopia was similar with that found globally. However, treatment options of vitiligo were very limited in Ethiopia.

Off-label and unlicensed drug use in Ayder comprehensive specialized hospital neonatal intensive care unit.

BACKGROUND: Off- label drug use refers to the use of medicines outside of their marketing authorization with respect to dose, dosage form, route of administration, indication or age. Off-label/unlicensed drug use significantly associated with adverse drug reactions and medication errors in neonates and critically ill neonates are more vulnerable to these problems. OBJECTIVE: To assess the prevalence and associated factors with off-label and unlicensed drug use in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. METHODS: A cross-sectional study was conducted from March 01,2019 to April 30, 2019 in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. Neonates admitted for 24 h and took at least one medicine were included in the study. Data was collected from prescription and medical charts. The off-label and license status of the medicine was verified based on European medicine Agency electronic medicine compendium. Data was analyzed by SPSS version 21.0. Binary and multivariate logistic regression was done to assess the predictors of off-label/unlicensed medicine use at p-value ≤0.05 significance level. RESULT: A total of 364 medicines prescribed for 122 neonates were analyzed. The prevalence of off-label and unlicensed drug use was 246 (67.58%), and 86 (23.63%) respectively. Of the total 122 neonates, 114(93.44%), and 57(46.72%) of them were exposed to at least one off-label and unlicensed drug respectively. Antibiotics were the most commonly prescribed off-label and unlicensed drugs. No statistically significant association was found between demographic as well as health related variables with off-label/unlicensed medicine use at p-value of ≤0.05 significance level. CONCLUSION: Off-label and unlicensed medicine use was high among neonates admitted to intensive care unit of the hospital. Selecting the safest medicines for such vulnerable patients is crucial to promote rational prescribing and better therapeutic benefit.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study.

BACKGROUND: Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries. OBJECTIVE: The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. METHODS: A retrospective cross-sectional study was done by collecting data from patients' medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant. RESULTS: Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality. CONCLUSION: The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.

Insulin injection practices among youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia.

PURPOSE: The main aim of this study was to explore how participants were practicing insulin injections and assess its association with the insulin related-outcomes. METHODS: A hospital-based cross-sectional study was conducted among 176 youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia. The inclusion criterion was the use of insulin treatment for a minimum of one year. Data about insulin injection practices was derived from participants' report. Descriptive statistics was presented using frequency distributions and percentages for categorical variables while measure of central tendencies and dispersion for continuous variables. Chi-square test was employed to test for the association between compared variables. RESULTS: Participants were asked on how frequent they practice the appropriate insulin injecting practices. Based on that, eliminating air bubbles from a syringe, lifting skin fold during an injection, inserting a needle deep enough in the subcutaneous tissue, inspecting injection sites and self-monitoring of blood glucose were frequently done practices in more than 80% of the participants. Besides, over half of the participants reported that they frequently practice; insulin vial inspection, physical exercise, inject 1-3 cm apart from previous site, and insert a needle at 450. Regarding insulin storage, more than half of them store opened insulin in the refrigerator, though it is advisable to store it at room temperature. Appropriate injection site rotation was reported by nearly one-third of the participants. Questions such as; gentle re-suspension of cloudy insulin, adjust insulin dose when necessary and change insulin syringe at every injection were reported by very few of the participants. Coming to glycemic control of our study subjects, 83% of them had HgbA1C of above 7.5% (non-optimal) and 31% reported at least one episode of hypoglycemia. Non-optimal glycemic control was explained by poor injection site hygiene (p < 0.038) and infrequent inspection of injection sites (p < 0.049). CONCLUSION: Compared to previous studies, this study came with higher proportion of participants who frequently practice the appropriate insulin injection practices. However, it is still important to educate patients on some crucial injecting practices.

Effect of Insulin-Induced Lipodystrophy on Glycemic Control among Children and Adolescents with Diabetes in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Lipodystrophy is one of the clinical complications of insulin injection that affects insulin absorption and leads to poor glycemic control. OBJECTIVE: To assess insulin-induced lipodystrophy and glycemic control. METHODS: A cross sectional study was done on 176 diabetic children and adolescents who inject insulin for a minimum of one year. First, anthropometric and clinical characteristics of the patients were recorded in questionnaire, and then observation and palpation techniques were used in assessing lipodystrophy. RESULT: Out of the total 176 participants, 103 (58.5%) had insulin-induced lipodystrophy, of them 100 (97.1%) had lipohypertrophy and 3 (2.9%) had lipoatrophy. Being younger, failure to rotate the injection site every week and multiple reuse of insulin syringe had significant influence in development of insulin-induced lipohypertrophy. Lipohypertrophy in turn was associated with the use of higher dose of insulin and nonoptimal glycemic control. CONCLUSION: Findings of this study revealed that in spite of using recombinant human insulin, the magnitude of the lipohypertrophy still remained high. Therefore, a routine workup of insulin-injecting patients for such complication is necessary, especially in the individuals who have a nonoptimal glycemic control.