Factors associated with neurocognitive impairment in treatment experienced HIV+ Adults: A perspective from a Tertiary Care Center in Ethiopia: factors associated with HAND in Ethiopia

Background: Given the improvement in life expectancy of people living with HIV (PLWH) in sub-Saharan Africa, the risk of asymptomatic HIV-associated neurocognitive disorder (HAND) has increased. The study objectives were to investigate the prevalence of HAND and associated factors among treatment experienced adults in Ethiopia. Methods: A single-center observational cross-sectional study was conducted between December 2019 and June2020 to investigate HAND. International HIV dementia scale (IHDS) was used to screen for the disorder. Both descriptive and analytical statistics were used to analyze the data. Results: Total of 324 PLWH (63% females) who were on combination antiretroviral therapy for median of 144months (IQR: 108-168) were investigated. The mean age was 42.5 years (1SD=12.2). The prevalence of HAND was 75.3% and the difference was significantly more in those above 40 years of age (65.8% vs. 80.7%, p=0.003). Age is the only risk factor identified with multivariable logistic regression analysis. A linear decrement in the total score of cognitive performance was observed as the patient's age increase; age was responsible for 9.4% variation observed in IHDS score (r= -0.31, R2=0.094, p<0.0001). Although statistically not-significant, the trend for cardio-metabolic and behavioral risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol and khat use) was higher in the group diagnosed with HAND. Conclusion: The occurrence of neurocognitive impairment was more pronounced in individuals aged 40 years and above who were HIV positive, compared to those below 40 years. Age was found to be an independent predictor of HAND. Cardiovascular and behavioral risk factors were observed more among patients with HAND compared to no-HAND

Impact of COVID -19 on population health and economic wellbeing in Ethiopia: A national pilot survey

Introduction: The COVD-19 pandemic has resulted in unprecedented global health and economic crisis, particu-larly in countries struggling with poverty. We conducted a national survey to understand the economic and health impacts of COVID-19 in Ethiopia. Methods: A pilot, population-based, cross-sectional survey was conducted among adults randomly selected from the Ethio Telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview about the impact of COVID-19 on their economic well-being and the health-related risks associated with COVID-19. Results: Of 4,180 calls attempted, 1194 were answered, of which a successful interview was made with 614 par-ticipants. COVID-19 affected the family income of 343 [55.9%] participants, 56 [9.1%] lost their job, 105 [17.1%] perceived high stress in their household, and 7 [1.14%] reported death in their family in the past month. The odds of having a decreased income due to COVID-19 were 2.4 times higher among self-employed [adjusted odds ratio (AOR) 2.4, 95% CI (1.58-3.77)] and 2.8 times higher among unemployed [AOR 2.8, 95% CI (1.35-5.85)] participants. Two-hundred twenty-one [36%] participants had comorbidity in their household with hypertension, 72 [11.7%], diabetes,50 [8.1%], asthma, 48 [7.8%], and other chronic diseases, 51 [8.4%]. Forty-six [7.5%] participants had COVID-like symptoms in the previous month, where cough, headache, and fatigue were the most com-mon.

Efficacy and safety of chloroquine and hydroxychloroquine for the treatment of COVID19 infection: An umbrella review

Introduction: Among all therapeutic approaches for COVID-19, most controversies have been raised about the efficacy and safety hydroxychloroquine (HCQ) and chloroquine. We conducted an umbrella review to assess any potential benefits of hydroxychloroquine and chloroquine in treating COVID-19.Methods: We searched the Cochrane Database of Systematic Reviews, PubMed and covid-evidence.org from December 2019 until July 2022. Time to viral clearance, need for mechanical ventilation and mortality were assessed as main efficacy outcomes. The analysis was performed using R package version 4.1.2.Result : Hydroxychloroquine had no benefit in decreasing time to viral clearance at days 7 (RR 0.81; 95% CI 0.63, 1.03) and 14 (RR 1.00; 95% CI 0.90, 1.139). Chloroquine has no statistically significant effect in decreasing the time of viral negativity at days 7 (RR 1.20; 95%CI 0.64, 2.25) and 14 (RR 1.08; 95%CI 0.85, 1.36). There is no difference in the need for mechanical ventilation among hydroxychloroquine plus azithromycin versus standard of care groups. Hydroxychloroquine marginally increased the mortality rate compared to placebo but not statistically significant (RR 1.09; P-value 0.05). Adding azithromycin to hydroxychloroquine had no statistically significant effect of decreasing mortality (RR 0.52; 95%CI 0.13, 2.07). Treatments with hydroxychloroquine increased the risk of adverse effects (RR 2.71; 95%CI 1.66, 4.43; p-value <0.0001). Adding azithromycin to hydroxychloroquine increased the adverse events (RR 1.74; 95% CI 1.27, 2.38). Conclusion: Though access to antivirals is an important challenge in developing countries, the decision to sus-pend hydroxychloroquine and chloroquine in treating COVID-19 appears right

Clinical and socio-demographic profile of the first 33 COVID-19 cases treated at dedicated treatment center in Ethiopia

BACKGROUND:Severe respiratory tract infection caused by family of Corona viruses has become world pandemic. The purpose of this study was to describe the first few COVID 19 cases in Ethiopia. METHOD: Descriptive study was conducted on the first 33 consecutive RT-PCR confirmed COVID 19 cases diagnosed and managed at Ekka-Kotebe COVID Treatment Center in Addis Ababa, Ethiopia. RESULT: The median age of the cases was 36 years. Cough, headache and fever were the most frequent symptoms. Diarrhea, sore throats, loss of taste and/or smell sensation were among the rare symptoms. Most (84.8%) had mild to moderate disease, and 15.2%(n=5) were critical at the time of admission. Among the five ICU admissions, four patients required invasive mechanical ventilation. Thirty cases were discharged after two pairs of nasopharyngeal and oropharyngeal samples turned negative for SARS CoV2. Three cases from the ICU died while on mechanical ventilator. The age of the two deaths was 65 years, and one was 60 years. With the exception of three, all cases were either imported from abroad or had contact with confirmed cases. CONCLUSION: Most of our patients were in the younger age group with male predominance and few with comorbidities. Cough was the commonest symptom followed by headache and fever. As it was in the early stage of the pandemic, observation of more cases in the future will reveal further clinical and demographic profiles of COVID-19 cases in Ethiopia

Knowledge and adherence to antiretroviral therapy among adult people living with HIV/AIDS at Tikur Anbessa Specialized Hospital, Ethiopia.

Background: Adherence to antiretroviral therapy (ART) is necessary to achieve best virological response, lower the risk of drug resistance, and reduce morbidity and mortality. The objectives of the current study were to assess the extent of knowledge of patients on treatment plan and regimen, determine the rate of adherence and identify factors related to non-adherence to ART. Methods: A cross-sectional study was conducted at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia, using data from both semi-structured interview (self-report) and ART database (pharmacy refi ll) during the months of March and April 2013 using a total 350 participants. Results: The results indicated that 33% of the participants had good knowledge on the treatment plan and regimen. Using self-report and pharmacy refi ll record, 79.1% and 72.9% respectively showed adherence rate of ≥95%. Younger people were found to be less likely to adhere to ART (AOR [95%] = 0.51 [0.30, 0.85]) using pharmacy refi ll record. Risk factors for ART non-adherence using self-report were use of memory aids (AOR [95%] = 3.46 [1.72, 6.98]), treatment satisfaction (AOR [95%] = 2.33 [1.22, 4.07]), taking co-medication (AOR [95%] = 0.56 [0.32, 0.98]), and regimen switch (AOR [95%] = 0.41 [0.19, 0.85]). Whereas using pharmacy refill record risk factors were, knowledge on treatment plan and regimen (AOR [95%] = 2.50 [1.39, 4.51]), use of memory aids (AOR [95%] = 2.71 [1.34, 5.47]), treatment satisfaction (AOR [95%] = 3.78 [1.47, 9.71]), and regimen switch (AOR [95%] = 0.50 [0.27, 0.92]). Conclusion: Older age, good knowledge on treatment plan and regimen, use of memory aids, treatment satisfaction, and not having co-medications and regimen switch showed more adherence to ART.

Diabetic foot disease in Ethiopian patients: a hospital based study

Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability; morbidity and mortality among diabetic patients and about 15develop foot ulcers in their lifetime. So far; there are few published data in relation to the high-risk diabetic foot in Ethiopian subjects. Methods: A retrospective study was done to determine the various risks as well as antecedent factors; other long term complications; treatment profile and subsequent follow up of 196 patients with diabetic foot disease admitted to the Tikur Anbessa Specialized Referral Hospital from Jan 1999 to Dec 2003. Patients' medical records were reviewed using pre-prepared formats and relevant data were abstracted. The data were analyzed using Epi info version 3.4.3 statistical soft ware. Results: A total of 196 patients were included in this study. The male to female ratio was 3 to 1. The median age was 60 years (IQR; 47-65). Median duration of symptoms before presentation was 21 days (IQR; 14-30) and the median duration of diabetes mellitus was144 months (IQR; 60-216). More than two thirds had type 2 diabetes mellitus. Among 109 patients with identified antecedent risk factors for their foot problem; ill fitting or new shoes attributed in 48(44). Neuro-ischaemic ulcers were seen in 113 (58) of the cases and neuropathic ulcer in 63 (32). Ulcer with cellulitis or gangrene was the most common mode of presentation seen in 92 (47) of the patients. Ninety two (47) patients had amputations. Re-amputation was necessary in 24 (26) of these cases. Less than 40of the total cases had a regular follow up either at a clinic or hospital. Diabetes was diagnosed for the first time in 7 cases (4) on presentation with foot ulcer. The mean glycemic level was poorly controlled in over 80of the cases. The overall mortality rate was 21and sepsis was the most identified cause. Conclusion: Lack of regular patient follow up and diabetes education on foot care; poor glycemic control; delay in patient presentation and surgical intervention as well as patients' refusal to undergo surgical interventions were the reported contributing factors for the observed high mortality. Recommendation: Diabetic education on foot care; emphasis on metabolic control of diabetes; early presentation and surgical intervention when appropriate has to be highlighted in the management of diabetic patients. More studies have to be done in relation to the high-risk diabetic foot particularly in the Ethiopian setting emphasizing on preventive aspects. [Ethiop J Health Dev 2011;25(1):17-21]