Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study.

BACKGROUND: Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia. METHODS: An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018. RESULTS: Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome. CONCLUSION: The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.

Patient satisfaction with antiretroviral therapy service provided by pharmacists in Dembia district health institutions, Northwest Ethiopia.

BACKGROUND: The patients' perception of the health service is a vital tool for measuring health service quality. Besides, Patient satisfaction is an essential feature in assessing the quality of health services. Health institution leaders are considering quantifiable patient satisfaction data as a means to evaluate the health care service. METHOD: An institution-based cross-sectional study was employed from 21/8/2022 to 21/9/2022 among 308 patients attending ART pharmacy services in three health institutions of Dembia distinct. Data were collected by using a questionnaire and reviewing medical charts. Results were calculated and presented in the form of texts, tables, and graphs. Variables with a p-value of 0.05 were considered significant determinants of patient satisfaction. RESULT: A total of 308 HIV patients were recruited with a response rate of 100%. The overall prevalence of satisfaction among respondents was 231(75%). Being unable to read and write [1.21(AOR = 1.07-4.31)] and patient age greater than 48 years 1.9(0.73-2.59) were significantly associated with the level of patient satisfaction. Among the participants 66.9% were satisfied with clear and organized service, and 76% were satisfied with the convenience of a private counseling room. CONCLUSION: The general patient satisfaction at the antiretroviral therapy clinic did not achieve the national target of 85% satisfaction with significant differences among health centers. Being educated to a higher level, absence of signs and directions to ART clinics, and not having the opportunity to ask questions were the factors influencing patient satisfaction with ART service.

Antidiarrheal activities of methanolic crude extract and solvent fractions of the root of Verbascum sinaiticum Benth. (Scrophularaceae) in mice.

Background: In Ethiopian traditional medicine, V. sinaiticum is one of the most often utilized medicinal herbs for the treatment of diarrhea. Therefore, this study was conducted to validate the use of the plant for the treatment of diarrhea in the traditional medical practice of Ethiopia. Methods: Castor oil-induced diarrhea, enteropooling, and intestinal motility test models in mice were used to evaluate the antidiarrheal properties of the 80% methanol crude extract and the solvent fractions of the root component of V. sinaiticum. The effects of the crude extract and the fractions on time for onset, frequency, weight, and water content of diarrheal feces, intestinal fluid accumulation, and intestinal transit of charcoal meal were evaluated and compared with the corresponding results in the negative control. Results: The crude extract (CE), aqueous fraction (AQF), and ethyl acetate fraction (EAF) at 400 mg/kg (p < 0.001) significantly delayed the onset of diarrhea. Besides, the CE and AQF at 200 and 400 mg/kg (p < 0.001) of the doses, and EAF at 200 (p < 0.01) and 400 mg/kg (p < 0.001) significantly decreased the frequency of diarrheal stools. Furthermore, CE, AQF, and EAF at their three serial doses (p < 0.001), significantly reduced the weights of the fresh diarrheal stools as compared to the negative control. The CE and AQF at 100 (p < 0.01), and 200 and 400 mg/kg (p < 0.001) of their doses and EAF at 200 (p < 0.01) and 400 mg/kg (p < 0.001) significantly decreased the fluid contents of diarrheal stools compared to the negative control. In the enteropooling test, the CE at 100 (p < 0.05), and 200 and 400 mg/kg (p < 0.001), AQF at 200 (P < 0.05) and 400 mg/kg (p < 0.01), and EAF at 200 (p < 0.01) and 400 mg/kg (p < 0.001) significantly decreased the weights of intestinal contents compared to the negative control. Additionally, the CE at 100 and 200 (p < 0.05) and 400 mg/kg (p < 0.001), AQF at 100 (p < 0.05), 200 (p < 0.01), and 400 mg/kg (p < 0.001) of the doses, and EAF at 400 mg/kg (p < 0.05), produced significant reductions in the volumes of intestinal contents. In the intestinal motility test model, the CE, AQF, and EAF at all their serial doses (p < 0.001), significantly suppressed the intestinal transit of charcoal meal and peristaltic index compared to the negative control. Conclusion: Overall, the results of this study showed that the crude extract and the solvent fractions of the root parts of V. sinaiticum had considerable in vivo antidiarrheal activities. Besides, the crude extract, especially at 400 mg/kg, produced the highest effect followed by the aqueous fraction at the same dose. This might indicate that the bioactive compounds responsible for the effects are more of hydrophilic in nature. Moreover, the antidiarrheal index values were increased with the doses of the extract and the fractions, suggesting that the treatments might have dose-dependent antidiarrheal effects. Additionally, the extract was shown to be free of observable acute toxic effects. Thus, this study corroborates the use the root parts of V. sinaiticum to treat diarrhea in the traditional settings. Furthermore, the findings of this study are encouraging and may be used as the basis to conduct further studies in the area including chemical characterization and molecular based mechanism of actions of the plant for its confirmed antidiarrheal effects.

Evaluation of Wound Healing Activity of 80% Hydromethanolic Crude Extract and Solvent Fractions of the Leaves of Urtica simensis in Mice.

Background: Leaves of Urtica simensis (U. simensis) have been used traditionally for wound healing in different communities in Ethiopia. In spite of this, there were no scientific data documented regarding the wound healing activity of this plant. There is a need to investigate herbal remedies for the treatment of wounds in order to overcome the limitations of conventional drugs. Aim of the Study: Aim of the study was to evaluate the wound healing activity of extract and solvent fractions of the leaves of U. simensis in mice. Methods: Leaves of U. simensis were washed, dried under shade and ground into coarse powder and then extracted by 80% methanol with three consecutive macerations. Part of the extract was fractionated with n-hexane, chloroform and water. In excision and burn wounds, healing progress was measured by wound contraction, epithelialization period and histopathology investigation whereas incision wound healing was assessed by skin breaking strength. Results: In excision wound model, the 5% and 10% crude extract ointments showed significant (p < 0.001) wound contractions during day 8 to day 16 evaluations. Similarly, in burn wound model, both 5% and 10% crude extract ointments produced significant (p < 0.001) wound contractions starting from day 12 and 10, respectively. In both models, the periods of epithelialization were also significantly reduced and favorable histopathologic changes were produced by the crude extract ointments. The solvent fractions of the crude extract as well produced significant wound contractions as evaluated in excision wound model. The fractions also significantly reduced the period of epithelialization in this model. The aqueous fraction found to be more active than either chloroform or n-hexane fraction in wound healing. Conclusion: Results of this study indicated that methanol extract and aqueous fractions of the leaves of U. simensis possess dose-dependent wound healing activity, thus supporting traditional claims.

Laxative Activities of 80% Methanolic Extract of the Leaves of Grewia ferruginea Hochst Ex A Rich in Mice.

BACKGROUND: There are numerous medicinal plants including the leaves of Grewia ferruginea used as traditional medicine for the treatment of constipation. This study was conducted to evaluate the laxative activity of the leaves of G ferruginea. METHODS: The laxative activity of the leaves of G ferruginea was tested using 3 models: laxative activity, gastrointestinal motility, and gastrointestinal secretion tests. The effect of the plant extract on mean number of feces, fecal water content, ratio of intestinal distance traveled by the charcoal meal and intestinal fluid accumulation were evaluated and analyzed. RESULTS: Significant increase was observed in the mean weight of wet fecal matter at 200 (1.00 ± 0.03 g, P < .05) and 400 mg/kg (1.01 ± 0.02 g, P < .01), relative to loperamide constipated negative control group. Similarly, percent fecal water content was significantly improved in extract treated groups at 100 mg/kg (52.10% ± 2.04%, P < .05), 200 mg/kg (54.02% ± 2.15%, P < .01), and 400 mg/kg (54.25% ± 2.50%, P < .01) compared with the negative control group. The gastroinestinal transit ratio was also significantly increased with 200 mg/kg (P < .01) and 400 mg/kg (P < .001) of the extract relative to the constipated negative control. The crude extract showed significant increase in intestinal fluid accumulation at 200 mg/kg (0.48 ± 0.07 g, P < .05) and 400 mg/kg (0.51 ± 0.08 g, P < .01) compared with the negative control. CONCLUSION: The results of the present study indicated that 80% methanol extract of the leaves of G ferruginea possessed significant laxative activity. As such, this study corroborates the traditional claim of using G ferruginea in the treatment of constipation.

Patient Satisfaction with Psychiatric Outpatient Care at University of Gondar Specialized Hospital: A Cross-Sectional Survey.

BACKGROUND: Patient satisfaction is an imperative and commonly used indicator for measuring the quality of healthcare. Patient satisfaction with psychiatry services is an important construct, which influences multiple areas including treatment adherence and outcome. The aim of the present study was to assess the level of patient satisfaction and determine associated factors with psychiatric outpatient care. METHOD: An institution-based cross-sectional study was conducted from April 15 to May 15, 2017. A total of 250 psychiatric patients visiting psychiatric outpatient care in University of Gondar Specialized Hospital during the study period were included in the study. Data were collected using structured questionnaires and entered to and analyzed using Statistical Packages for Social Sciences (SPSS) version 20. Descriptive statistics and one-way ANOVA with post hoc test were used to determine the characteristics of the participants and examine the difference among different variables. P value<0.05 and confidence interval (CI) of 95% were used as cut-off points for determining statistical significance. RESULTS: During the one-month data collection period, 250 participants (92.593% response rate) were included in the analysis. Majority (133 (53.2%)) of them were males and cannot read and write (107 (42.8%)). Majority (194 (77.6%)) of study participants were satisfied with the outpatient care. The overall level of satisfaction among participants was good with a mean satisfaction score of 3.87. Majority (173 (69.2%)) of the participants claimed that health professionals working in outpatient care did not provide adequate information about payment for services. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness (t=2.224, P=0.043) and the participants' employment status (t=2.981, P=0.003). CONCLUSION: In general, the overall participants' satisfaction towards outpatient care was high. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness and the participants' employment status. Regular service evaluation is important to improve patient satisfaction and further research is needed to investigate why satisfaction difference exists among different types of mental illnesses.

Antidiarrheal Activity of 80% Methanolic Leaf Extract of Justicia schimperiana.

BACKGROUND: Diarrhea is one of the leading causes of preventable death in developing countries and mainly affects children and infants. It has been reported that the leaf of Justicia schimperiana is used as an antidiarrheal agent in Libo Kemekem district, northwest Ethiopia. METHOD: The 80% methanolic leaf extract of J. schimperiana was evaluated for its activity against castor oil-induced diarrhea, enteropooling, and gastrointestinal motility in mice. RESULTS: Significant reduction (p < 0.001) in the total defecation and diarrheal drops was produced by all the test doses of the extract. Percentage inhibition of wet feces was 42.58, 65.07, and 74.96% at 100, 200, and 400 mg/kg doses of the extract, respectively. The extract also significantly inhibited castor oil-induced enteropooling at all test doses. The percent reduction in mean weight of intestinal contents was 66.96, 67.83, and 76.52% at 100, 200, and 400 mg/kg doses of the extract, respectively. The extract significantly reduced gastrointestinal movement of charcoal meal as well at 200 (p < 0.01) and 400 mg/kg (p < 0.001) doses. CONCLUSION: In conclusion, the methanolic leaf extract of J. schimperiana has an antidiarrheal activity and this supports the use of this plant in the treatment of diarrhea in the traditional settings.

Herbal Medicines: Personal Use, Knowledge, Attitude, Dispensing Practice, and the Barriers among Community Pharmacists in Gondar, Northwest Ethiopia.

BACKGROUND: Herbal medicine use is increasing and the global market is estimated to be US$107 billion by the year 2017. OBJECTIVES: This study aimed at assessing community pharmacists' personal use, knowledge, attitude, dispensing practice, and the barriers regarding herbal medicines. METHODS: Institution based cross-sectional study was conducted among 47 community pharmacists in Gondar, Northwest Ethiopia, using a structured interviewing questionnaire. RESULTS: Nearly half of the respondents (n = 22, 46.8%) sometimes use herbal medicines. Although knowledge related to such preparations was self-rated as poor/acceptable (n = 34, 72.4%), majority (n = 44, 93.7%) of community pharmacists agree/strongly agree that herbal medicines have beneficial effects. Only 6 (12.7%) of them are sometimes/often engaged in dispensing herbal medicines and most of them (n = 34, 72.3%) rarely/never counseled clients regarding these preparations. Limited knowledge on and access to information regarding herbal medicines are the main barriers to the pharmacists' practice. CONCLUSION: Although community pharmacists in Gondar, Northwest Ethiopia, commonly use and demonstrated good attitude towards herbal medicines, they are less involved in dispensing such products. They are also challenged with limited knowledge on and access to herbal medicine information. Thus, pharmacy educators, professional organizations, and the government shall pay more attention to solve the problem. Regulatory provisions on herbal medicine dispensing must be enacted and communicated very well.

Pattern of acute organophosphorus poisoning at University of Gondar Teaching Hospital, Northwest Ethiopia.

BACKGROUND: Despite the apparent benefits of organophosphate compounds (OPCs) acute organophosphate (OP) pesticide poison is an increasing problem worldwide. In a country like Ethiopia, where agriculture is a major component of the economy, these compounds are readily available to the general public. There is paucity of evidence from Ethiopia showing the pattern of organophosphate poisoning (OPP) in healthcare facilities. The objective of this study was to evaluate retrospectively the pattern of acute OPP at the University of Gondar Teaching Hospital in northwest Ethiopia, during September 2010 through December 2014 was conducted. Data was collected through chart review of patients who were admitted due to poisoning. Data was analysed using SPSS 20. RESULTS: Organophosphate poisoning in University of Gondar teaching hospital accounts for about 38.46% of all emergency room admissions for poisoning. Out of the 90 cases studied 60% (54) were women, with male to female ratio of 1:1.5. The mean age of the patients was 25.5 with a standard deviation of 9.45. 56.7% of the cases studies lived in an urban environment compared to 43.3% who lived rurally. In the vast majority of patients, 90% (81) patients had ingested OP as an act of suicide. Regarding the route of exposure, oral ingestion was most common in suicidal cases (88.9%). The elapsed time between the time of poison ingestion and the start of the treatment, ranged from 13 min to 1 day. Health care professionals' useds decontamination methods such as gastric lavage and activated charcoal (45.6%) and 36.7% use atropine for OPP treatment. The mean hospital stay was 0.74 days. In the present study family problems were a leading cause of suicides and accounted for 45.8% of all cases. CONCLUSION: As a developing nation who economy relies heavily on agriculture, Ethiopia continues to have OP compounds remain a common cause of acute poisonings. This is particularly concerning for younger generation who have high rates of OPP and whose numbers continue to raise. This data suggests that it is essential to strengthen Ethiopians regulatory policy concerning the availability of OPCs. Additionally, it will be important to design an appropriate health education program for the prevention of both suicidal and accidental OPPs for the benefit of the public at large.

Antidiarrheal activity of methanolic extract of the root bark of Cordia africana.

An ethnobotanical study in Agew-Awi and Amhara peoples in northwest Ethiopia reported that Cordia africana is used traditionally in the treatment of liver disease, amebiasis, stomachache, and diarrhea. The root and root bark are reported to be used in the treatment of diarrhea. Therefore, this study was intended to evaluate the antidiarrheal effect of C. africana against castor oil-induced diarrhea in mice. The antidiarrheal effect of the plant was tested on castor oil-induced diarrhea in mice (23-25 g) of either sex. Number of diarrheic defecations, intestinal length traveled by the charcoal meal, and weight of intestinal fluid were taken as important parameters to evaluate the antidiarrheal activity of the plant extract. In preliminary phytochemical screening tests, the methanolic extract of C. africana was found to contain phenols, flavonoids, terpenoids, and saponins. Reduction in the number of diarrheic drops was observed in groups of mice that received 200 mg/kg (P<0.05) and 400 mg/kg (P<0.01) of the extract compared to the negative controls. The percent inhibition of intestinal fluid accumulation was 26.83%, 46.34%, and 53.66% at the doses of 100, 200, and 400 mg/kg of the extract, respectively. Relative to the negative control group, the mean percent of intestinal length moved by the charcoal meal was decreased by 24.41%, 39.89%, and 51.66% in groups of mice given 100, 200, and 400 mg/kg of the plant extract, respectively. To iterate the finding, the root bark extract of C. africana was found to be effective in preventing castor oil-induced diarrhea and intestinal motility in a dose-dependent manner. This reveals that the plant material has promising antidiarrheal activity as it is claimed in traditional medical practice.

Antidiarrheal activity of crude methanolic root extract of Idigofera spicata Forssk.(Fabaceae).

BACKGROUND: Till now many of medicinal plants having claimed therapeutic value traditionally are waiting scientific verification of their efficacy and safety. Accordingly this study is conducted to evaluate the antidiarrheal activity of hydromethanolic root extract of Indigofera spicata Forssk. in castor oil induced diarrhea model, misoprostol induced secretion model and its antimotility activity using charcoal as a marker. METHODS: In all the three models the animals were randomly allocated into five groups of six animals each and then group I mice were received 1 ml/100 g normal saline, group II were treated with standard drug as a positive control whereas group III, IV and V were treated with 100, 200 and 400 mg/kg extract doses, respectively. Statistical significance of differences in the mean of number of defecations, fluid content of faces, intestinal fluid accumulation ratio, intestinal fluid weight and distance travelled by charcoal between groups was analyzed by SPSS version-21 using one way ANOVA followed by Tukey's post hoc multiple comparison. RESULT: The hydromethanolic crude extract of Indigofera spicata at 200 and 400 mg/kg mg/kg doses showed statistically significant (p < 0.05) inhibition of the frequency of defecation and weight difference of the fluid content of the faces compared to the negative controls. For those doses the percentage inhibition of diarrheal feces was 43.62 and 53.51 %, respectively. The antisecretary activity of the extract in terms of fluid accumulation ratio was not found significant but in terms of intestinal fluid weight, all the extract doses revealed significant (p < 0.05) inhibition. Unlike the standard drug, the antimotility activity of the extract was not found statistically significant compared to the negative control. CONCLUSION: Root of Indigofera spicata Forssk. has shown promising antidiarrheal activity which validates its traditional use. Further studies are needed and possibly the plant may serve as a potential source of new agent in the therapeutic armamentarium of diarrhea.