Metabolic syndrome and its predictors among adults seeking medical care: A trending public health concern.

BACKGROUND: Metabolic syndrome (Mets) is a cluster of cardiovascular risk factors secondary to an inflammatory and insulin resistance state that increases the risk of cardiovascular disease and type 2 diabetes mellitus. However, there is limited evidence on it despite an increasing metabolic syndrome (Mets) related morbidity and mortality. OBJECTIVE: This study was to identify the magnitude and factors associated with Mets among adults seeking care in Southern Ethiopia. METHOD: An institution-based cross-sectional study design was conducted on randomly selected 361 adults through face-to-face interviews and biomarker assessments. Mets were defined according to the NECP/ATP III criteria which are based on biochemical and lifestyle indicators. Bivariable and multivariable logistic regression analyses were used to identify factors associated with Mets. Crude and adjusted odds ratio with their 95% confidence interval was reported. Model fitness was checked using the Hosmer and Lemeshow tests. Multicollinearity diagnostic was checked using inflated standard error and variance inflation factor. Statistical significance was affirmed at a p-value <0.05. RESULTS: A total of 351 respondents were studied, with a response rate of 97.2%. Overall, the magnitude of Mets among adults was 18.5% (95% CI: 14.4-22.6%). Individuals with BMI ≥25 kg/m2 (AOR = 4.1; 95% CI = 3.13-11.51), having a sedentary behavior ≥8 h per day (AOR = 3.76; 95% CI = 1.38-10.25), adequate fruit or vegetable consumption (AOR = 0.48; 95% CI = 0.27-0.92), being involved in physical activity (AOR = 0.41; 95% CI: 0.20-0.80) and consuming alcohol 5-6 days per week (AOR = 2.9; 95% CI: 1.11-7.55) were significantly associated with Mets. CONCLUSION: the burden of Mets is a major public health concern among adults which is closely linked to physical activity, optimum body weight, fruit and vegetable consumption, and sedentary lifestyles.

Analysis of Pharmaceuticals Inventory Management Using ABC-VEN Matrix Analysis in Selected Health Facilities of West Shewa Zone, Oromia Regional State, Ethiopia.

BACKGROUND: The medical materials, medical supplies, and medicines cover about one-third of the annual health care organization's budget. Effective inventory management is required to balance inventory expenditure against demands for medications. The study aimed to analyze the pharmaceuticals inventory management using ABC-VEN Matrix in selected health facilities of the West Shewa zone. METHODS: A facility-based cross-sectional study was conducted in health facilities of the West Shewa zone from March 15, 2019, to May 31, 2019, and analyzed by using an MS Excel spreadsheet. RESULTS: At selected public health facilities of West Shewa zone in three years between September 12, 2015, and September 5, 2018, about 539 pharmaceutical items were utilized and consumed 30,837,628.61 ETB. ABC analysis indicated that 64 (11.9%), 68 (13.74%), and 38 (11.14%) of items were classified as the class "A" items and consumed around 70% of the total pharmaceutical expenditures (TPE) at selected health facilities (aggregated), hospitals, and health centers (HC), respectively. VEN analysis revealed that 115 (35.94%), 99 (35.61%), and 40 (20.83%) items were categorized as vitals and consumed 53.9%, 51.59%, and 36.93% of TPE at selected health facilities. ABC-VEN matrix analysis indicated that category I items consumed 85% of TPE. CONCLUSION: ABC-VEN matrix analysis of present study showed that the category I pharmaceuticals consumed a majority of TPE that need great attention for control.

Tracer Pharmaceuticals Availability and Distribution Trends Prior to and During the Covid-19 Pandemic: A Comparative Study.

BACKGROUND: Coronavirus disease 2019 (Covid-19) has had an unprecedented impact on the health products delivery system. To maintain routine health services, tracer pharmaceuticals (TPs) should always be available and accessible in healthcare institutions. Thus, this study aimed to explore the influence of the Covid-19 on TPs availability and distribution trends in the context of the Covid-19 pandemic in Ethiopia. METHODS: An institution-based comparative study was undertaken on 25 TPs in the pharmaceutical supply agency. From the agency's logistical data, we collated the amount of TPs ordered, received, and distributed, as well as the stock status, by using an observation checklist. The collated data were recorded in Microsoft Excel and transferred to SPSS for analysis. A frequency and percentage analysis were performed to evaluate the fill rate, product availability, and stock-out duration. A dependent t-test was used to compare if there was a significant mean difference in TPs distribution before and after the Covid-19 at a p-value less than 5%. RESULTS: Before Covid-19, 18 (72%) of the TPs were refilled above 80% of amount ordered. After the pandemic, however, the fill rate dropped to 48%. The availability of TPs during the Covid-19 was 60%. During the six months of Covid-19, the average stock-out duration for all TPs was 34.68 days, with Cimetidine 200mg/mL injectable (line-item fill rate = 0, days out of stock = 180 days) being the most stocked-out item. Tracer pharmaceuticals distribution before Covid-19 (M = 81,317, SD = 139,274) were significantly different after the pandemic (M = 60,212, SD = 94,966) at the 5% significance level (t (24) = 2.289, p = 0.031). CONCLUSION: This survey reveals how Covid-19 has influenced service providers' logistics systems. Following the pandemic, the line fill rate fell below half with a three-fifths availability of products. To effectively manage supply chain disruptions experienced in Covid-19 and beyond, the agency in collaboration with stakeholders should make an effort to enhance end-to-end inventory visibility, establish a resilient logistics system, strengthen domestic manufacturers' capabilities, and develop contingency plans with supplying partners.

Assessment of Knowledge, Practices, and Challenges of Pharmaceuticals Inventory Control Among Pharmacy Professionals Working in Selected Public Health Facilities of West Arsi Zone, Oromia, Ethiopia.

BACKGROUND: Good pharmaceutical inventory control enables health facilities (HFs) to provide complete health care by ensuring the availability of safe, effective, and affordable pharmaceuticals and related supplies of the required quality, inadequate quantity, at the required place and at all times. It boosts patients' trust in the HFs and motivates working staff. However, it needs well-trained and skilled professionals. The aim of the current study was, therefore, assessing knowledge, practice, and challenges of pharmacy professionals conducting inventory control in selected public health facilities of West Arsi Zone, Oromia regional state for the year 2016 to 2018. METHOD: A mixed-methods study design was used to assess pharmacy professionals' knowledge, skills, and challenges in applying inventory management methods. A semi-structured questionnaire was implemented for quantitative, whereas an open-ended question was employed for key informants (KIs) to explore qualitative data. RESULT: Ninety percent of pharmacy professionals knew about VEN analysis concepts and 70% about ABC analysis. However, none of them had a concept of FSN and XYZ analysis. Among the respondents who knew the concept, 75% had gained knowledge through formal training and 10% of them learned from on-job training. When they asked about the methods of inventory control, 60% responded as they did not hear about it. Of those who said "Yes" on being asked to mention at least 1 method of it, 80% could not able to correctly mention the methods used in inventory control. However, 44%, 62.5%, and 75% of respondents had practiced ABC, VED, and ABC-VED matrix analysis respectively. The challenges that prevented these professionals from practicing pharmaceutical inventory control in their HFs were grouped into price-related, training-related, human resource-related, and managerial-related factors. CONCLUSION: Inventory control is the heart of the pharmaceutical supply system. Without its healthy action, HFs' goal attainment will not be viable. Problems of sick pharmaceutical inventory control are directly related to a lack of knowledge and appreciation of it by the concerned bodies. The current finding revealed almost all pharmacy professionals included in the study had little knowledge about how to manage their inventories. Managers' unwillingness to cooperate and facilitate necessary resources prevented the professionals from doing inventory control.

Evaluation of Cold Chain Management Performance for Temperature-Sensitive Pharmaceuticals at Public Health Facilities Supplied by the Jimma Pharmaceuticals Supply Agency Hub, Southwest Ethiopia: Pharmaceuticals Logistic Management Perspective Using a Multicentered, Mixed-Method Approach.

BACKGROUND: Effective and efficient cold chain management maximizes utilization of healthcare resources, reduces cold chain products wastage, and improves the quality of health services. It eventually guarantees that clients receive cold chain products they need at service delivery points. The objective of this study was to evaluate cold chain management performance for temperature-sensitive medicines at public health facilities in Southwest Ethiopia supplied by the Jimma Pharmaceuticals Fund and Supply Agency hub. Method and Materials. The study used an institution-based cross-sectional study design. Forty-seven (47) public health facilities in Southwest Ethiopia were evaluated using checklists adopted from the Logistic Indicators Assessment Tool, Vaccine Management Assessment Tool, and Logistic System Assessment Tool. RESULTS: The study revealed that the mean availability of essential cold chain products was 72.1 ± 14.8% while the average stock-out rate was 26.2 ± 8.6%. The median stock-out duration was 23 ± 21 days for all visited public health facilities. Two hundred and sixty-three (43.06 ± 15.3%) of the public health facilities' stock records were found accurate, and the wastage rate due to expiration was 9.2 ± 7.8% for all visited health facilities. Thirty public health facilities (63.8 ± 36.2%) had acceptable storage conditions. Conclusions and Recommendations. Supply chain performance at the study facilities was not adequate overall, and focused efforts need to be directed at managing the availability of critical cold chain medicines. Some cold chain management challenges demand the attention of the top management, while the rest can be addressed by operational management at the facilities through provision of appropriate training and supervision of the cold chain pharmaceutical handlers.

How is Information from ABC-VED-FNS Matrix Analysis Used to Improve Operational Efficiency of Pharmaceuticals Inventory Management? A Cross-Sectional Case Analysis.

PURPOSE: The categorization of inventories using various techniques optimizes the efficiency of warehouse operations. The ABC (always, better, and control); VED (vital, essential, and desirable); and FNS (fast-, normal-, and slow-moving) analyses provide items according to cost significance, criticality value, and consumption rate respectively. Thus, this study aimed to identify the categories of items requiring focused managerial control, priority, and replenishment intervals, as well as to evaluate whether the ABC-VED-FNS matrix is fit for effective and efficient inventory control of the Ethiopian Pharmaceutical Supply Agency (EPSA). METHODS: An institution-based cross-sectional descriptive study was conducted on 393 pharmaceuticals distributed by the EPSA-Jimma hub. The annual sales list with respective total quantity and unit price was collated from the logistics data records to perform the ABC analysis. The VED data were generated from the agency's pharmaceutical procurement list. To perform FNS analysis, we take into account the number of issue transactions as well as the average monthly consumption pattern for each item. Microsoft office Excel 2013 statistical functions were used to analyse the collated data. RESULTS: The ABC-VED analysis revealed that 187 (47.58%) of category I items account for 90% annual sales value; of which the highest proportion (63%) was AV items (36, 9%). Remarkably, there was no desirable (D) commodity that belongs to Class A. From the ABC-VED-FNS matrix analysis, category I consisted of 12 combinations with 187 (47.6%) items. Moreover, 28 (7.13%) items (CDN = 4 and CDS = 24) constituted category-III. CONCLUSION AND RECOMMENDATION: The ABC-VED-FNS matrix analysis can help organization implement inventory control policies and techniques, narrow down a group of items that require more managerial monitoring and control, prioritize a storage location (pick-face) plan, minimize the time and labor cost of put-away, picking, and packing, and dictate when products should be reordered or replenished.

Evaluation of Pharmaceuticals Inventory Management in Selected Health Facilities of West Arsi Zone, Oromia, Ethiopia.

BACKGROUND: Effective inventory management ensures an uninterrupted supply of safe, effective, and affordable pharmaceuticals which could be achieved through developing ABC-VEN (Always, Better, Control-Vital, Essential, Desirable) and FSN-XYZ (Fast, Slow, Non-moving-High, Medium, Low Value) matrix analysis. ABC-VEN matrix analysis is used to control inventory according to their annual consumption and on their functional importance whereas, FSN-XYZ matrix analysis is applied to control inventory by identifying the items to be discarded and the amount saved during the closing of annual accounts. OBJECTIVE: To evaluate inventory management in selected health facilities of West Arsi zone, Oromia regional state for the year 2016-2018. METHODS: Facility-based cross-sectional descriptive study complemented with a qualitative study was conducted in fourteen health facilities. Data were collected from goods issuing vouchers for the year 2016-2018 to perform ABC-VEN matrix analysis. The frequency of issue was collected to perform FSN analysis and the value of each closing stock was taken to get XYZ analysis. RESULTS: From the ABC-VEN matrix analysis, 26.6% of items were Category I of which the highest proportion were taken by class A and V items consuming 84.7% of annual drug expenditure (ADE). The remaining 49.2% and 24.2% of the drugs accounted for only 13.2% and 2.1% of the ADE being category II and III, respectively. Based on FSN-XYZ matrix analysis findings, category I with 41.% item share account for the highest budget (average 86.5% of values). Of this category, the XN group-non-moving and high-cost drugs had the high value (20%) which need managerial measure. In category III, the ZN group items, being 25% of drugs, only had 2.2% of value-that may increase wastage, inventory holding cost, and shortage of storage space. CONCLUSION: The matrix analysis for inventory control is a strong tool that enables one to identify items requiring close monitoring. The coupled ABC-VEN matrix analysis, combining their individual advantages - inventory's cost and its functional importance help in achieving a meaningful inventory management. However, to control the stock at an appropriate level with minimum shortage and oversupply, it has to be supported by XYZ-FSN matrix analysis. The XYZ-FSN matrix benefits the health facilities to determine the level of inventory with high value in dead-stock, and to take measures like transferring to others, discarding, or saving.

Integrated pharmaceutical logistics system implementation in selected health facilities of Ethiopia: The case of four WOLLEGA ZONES.

BACKGROUND: The pharmaceutical supply chain management system of Ethiopia has several problems including non-availability, poor storage, weak stock management and irrational use. However, few studies were conducted on progress and challenges towards implementation of Integrated Pharmaceuticals Logistics System (IPLS) in the study area. Therefore, this study aimed to assess the progress and challenges towards the implementation of IPLS in selected health facilities of Wollega zones, Western Ethiopia. METHODS: A cross sectional quantitative and qualitative study was conducted in selected health facilities from February 15 to March 15, 2015. The calculated sample size was 31 health facilities with 20% margin of error and 90% confidence interval (CI). The Logistics Indicator Assessment Tool (LIAT) was used to collect information from selected health facilities; while an in-depth interview was held with chief pharmacist to collect qualitative data. Correlation and multiple linear regression analysis were used at significance level of 90%CI. RESULTS: The average availability of bin cards for the selected products was 83.9% for hospitals, 75.4% for health centers, and 70.6% for health posts. On average, hospitals had an updated bin card for 43.8% of the product while health centers and health posts had an updated bin card for 32.9% and 32% of their products, respectively. On average the exact accuracy of request and resupply form (RRF) data for hospital and health center was 45.6% and 37.1%, respectively. IPLS implementation was related with health facility stores infrastructures (40.1%), Logistics Management Information System/LMIS/ (32.2%), stock availability and status (31.9%), storage condition (17.7%) and order fill rate (14.1%). Multivariable regression revealed LMIS (std. ß = 2.539, p = 0.022), stock status (std. ß = 0.848, p = 0.049) and availability of tracer medicines (std. ß = 0.212, p = 0.013) were positively associated with IPLS implementation. CONCLUSION: There have been significant improvements in supply chain indicators in the availability of essential health commodities since IPLS has been implemented, with some variation by level of facility and product type. Involvement of all stakeholders is necessary to sustain the system. Additionally, there needs to be more focus on monitoring and evaluation of IPLS including more focused studies.

Availability of Lifesaving Maternal and Child Health Commodities and Associated Factors in Public and Private Health Facilities of Addis Ababa, Ethiopia.

BACKGROUND: Inaccessible, unaffordable, and poor quality care are the key underlying reasons for the high burden of maternal and child morbidity and mortality in low- and middle-income countries. OBJECTIVE: To assess the availability of lifesaving maternal and child health (MCH) commodities and associated factors in public and private health facilities of Addis Ababa, Ethiopia, 2016. METHODS: Institutional-based, descriptive cross-sectional study was carried out in the selected health facilities (29 publics and 6 private) in Addis Ababa. The data were collected through pretested, structured questionnaire, and in-depth interviews. For the quantitative analysis, data were analyzed using SPSS version 20 statistical software, SPSS Inc. Descriptive statistics were used to summarize the variables, and the Spearman correlation test was run to determine the predictors of the outcome variables. For the qualitative data, the data were handled manually and transformed into categories related to the topics and coded on paper individually in order to identify themes and patterns for thematic analysis. RESULT: The overall availability of the lifesaving MCH commodities in the health facilities was 74.3%. There is a moderate, positive association between the availability of lifesaving MCH commodities with the adequacy of budget (rs = 0.485, P < .001), use of more than 1 selection criteria during selection (rs = 0.407, P = .015), and training given to health facilities on logistics management (rs = 0.490, P = .003). CONCLUSION: The availability of the lifesaving MCH commodities in the health facilities was within the range of fairly high to high. Adequacy of budget, use of more than 1 selection criteria during selection, and training given on logistics management were the predictors of the availability of the commodities.

Pattern of acute poisoning in Jimma University Specialized Hospital, South West Ethiopia.

BACKGROUND: Poisoning is a common cause of morbidity and mortality worldwide. People can be exposed to poisons either intentionally or accidentally. Designing appropriate treatment or prevention approaches depends on understanding of the nature and pattern of poisoning in a specific place. Information on the patterns of acute poisoning in Ethiopian hospitals is limited. This study was, therefore, conducted to evaluate the patterns of acute poisoning in Jimma University Specialized Hospital (JUSH), South West Ethiopia. METHODS: A record based retrospective analysis of acute poisoning cases presented to JUSH from January 1, 2012 to December 31, 2013 was conducted. The collected data was analyzed using SPSS version 16. RESULTS: Of the 103 patients, 49 (47.6%) were male and 54 (52.4%) were female. The highest prevalence of poisoning was observed in persons aged 12-20 years (70, 67.96%). Majority of the cases were intentional poisoning (52, 50.5%), and 28 (27.2%) of the cases were accidental. The common causes of poisoning were house hold cleansing agents (43, 41.7%), organophosphates (28, 27.2%) and drugs (13, 12.6%). Diarrhea and vomiting (49.5%), altered consciousness (16.5%) and epigastric pain (13.6%) were the common presenting symptoms. CONCLUSION: Majority of the victims of the acute poisoning in this study were aged 12-20 years. The most common mode of poisoning was intentional poisoning resulting from temporary quarrel. The common poisons used by the victims were found to be household cleansing agents.

Pattern of acute poisoning in Jimma University Specialized Hospital, South West Ethiopia / 世界急诊医学杂志（英文）

@#BACKGROUND: Poisoning is a common cause of morbidity and mortality worldwide. People can be exposed to poisons either intentionally or accidentally. Designing appropriate treatment or prevention approaches depends on understanding of the nature and pattern of poisoning in a specific place. Information on the patterns of acute poisoning in Ethiopian hospitals is limited. This study was, therefore, conducted to evaluate the patterns of acute poisoning in Jimma University Specialized Hospital (JUSH), South West Ethiopia. METHODS: A record based retrospective analysis of acute poisoning cases presented to JUSH from January 1, 2012 to December 31, 2013 was conducted. The collected data was analyzed using SPSS version 16. RESULTS: Of the 103 patients, 49 (47.6％) were male and 54 (52.4％) were female. The highest prevalence of poisoning was observed in persons aged 12–20 years (70, 67.96％). Majority of the cases were intentional poisoning (52, 50.5％), and 28 (27.2％) of the cases were accidental. The common causes of poisoning were house hold cleansing agents (43, 41.7％), organophosphates (28, 27.2％) and drugs (13, 12.6％). Diarrhea and vomiting (49.5％), altered consciousness (16.5％) and epigastric pain (13.6％) were the common presenting symptoms. CONCLUSION: Majority of the victims of the acute poisoning in this study were aged 12–20 years. The most common mode of poisoning was intentional poisoning resulting from temporary quarrel. The common poisons used by the victims were found to be household cleansing agents.