Implementation of evidence-based clinical practice and its associated factors among health care workers at public hospitals in Sidama regional state, southern Ethiopia.

BACKGROUND: Health disparities, inconsistent outcomes, and underwhelming health services continue to be problems for all nurses and doctors. Studies from a variety of nations have found that doctors and nurses have little familiarity with evidence-based practice. There is a knowledge vacuum about the degree of evidence-based nursing practice and its contributing factors in Ethiopia as well as the current study region. OBJECTIVE: The study's objective was to evaluate how healthcare professionals working in government hospitals in the Sidama regional state of 2022 are implementing evidence-based clinical practice and to identify associated factors. METHODS: From October 1 to December 30/2022, a cross-sectional institution-based study with a mix of quantitative and qualitative methods was carried out. A total of 422 healthcare workers were randomly selected to participate in the current study from 6 randomly selected public hospitals in the region. This study included 25 key informant interviews. The Friedman test and Funk's BARRIER scale were adapted into a semi-structured questionnaire quantitative. Multivariable logistic regression was used to assess the significance of the association between the dependent and independent variables. A pretest was conducted on 22 healthcare workers from Shashmane Hospital. RESULT: This study found that more than half, 51.7%, of the participants had a total implementation of evidence-based practice score below the mean score (40.4). only Access to the internet [having smart phone] (Adjusted Odds Ratio (AOR) = 3.03: 95% Confidence Interval (CI): (1.75-5.26))., favorable Attitude toward EBP of participants. (Adjusted Odds Ratio (AOR) = 1.84Confidence Interval (1.12-2.70)), inadequate Self-efficacy of Evidence-based practice skills (Adjusted Odds Ratio (AOR) = 0.29 Confidence interval = 0.19-0.46), and Knowledge of evidence-based practice (Adjusted Odds Ratio (AOR) = 0.45 Confidence interval = 0.30-0.77)were factors significantly associated with EBP implementation. CONCLUSION: More than half of the participants,51.7%, do not implement evidence-based practice in the care of their clients, which is unacceptable. The use of EBP has been significantly associated with access to the internet (having a smartphone), participants' positive attitudes toward it, their level of skill efficacy in finding and accessing it, and their knowledge of it. Therefore, stakeholders ought to think about addressing these obstacles to the adoption of EBP.

A Breakthrough in the Challenges of Tuberculosis Diagnosis: Lateral Flow Urine Lipoarabinomannan (LAM) Assay for the Diagnosis of Active Tuberculosis in a Subset of Human Immuno Deficiency Virus (HIV) Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

Background: Tuberculosis is commonly detected late or not at all in HIV-positive people. Rapid and sensitive molecular tests like Gene X-pert have recently become available to replace or supplement existing conventional tests for detecting tuberculosis, and the World Health Organization (WHO) recommends that these rapid techniques be used as the initial diagnostic test for tuberculosis to avoid delays in starting appropriate treatment. The lipoarabinomannan was approved by the national ministry of health in August 2021 for the detection of active tuberculosis in specified groups. Case Summary: It is not uncommon for tuberculosis to be difficult to diagnose in this population, and we believe that our experiences with urine lipoarabinomannan for the detection of active tuberculosis will benefit other clinicians and, ultimately, patients. We discussed the experiences of two human immunodeficiency virus (HIV) patients with putative active tuberculosis, whose tuberculosis workups were negative by conventional methods, including gene expert but found to be positive by urine lipoarabinomannan and who were started on anti-tuberculosis medicines and improved. They are now in a good condition and are taking their medications regularly without any problems. Conclusion: Ending the suffering of HIV patients necessitates lobbying for more accurate tuberculosis diagnosis. The urine Lipoarabinomannan (LAM) assay will address the shortcomings of traditional sputum-based diagnostic tests including sputum Acid Fast Bacilli (AFB) and Gene X-pert, making it a credible alternative for diagnosing tuberculosis in people with HIV. The results of this case series demonstrated that TB LAM is a milestone for the difficulties in TB diagnosis in HIV patients. As of now, the national guideline only suggests urine LAM for HIV patients who fulfill the set criteria. We recommend the stakeholders to increase the availability, and extrapolate the recommendation to other populations including non-HIV patients.

Fulminant Hepatitis and Ulcerative Colitis: Case Report of Ethiopian Child with Schistosomiasis and Amebiasis Co-Infection.

Background: Schistosomiasis is a neglected tropical disease (NTD) that affects around 200 million people worldwide, the majority of whom are children aged 5 to 15 years. It is one of the most significant public health problems in tropical and subtropical regions. Entamoeba histolytica infection is common in areas where schistosomiasis is endemic because Schistosoma mansoni infection can reduce the host's immune response, resulting in increased morbidity. Case Presentation: This is the story of a 12-year-old male adolescent from the Guji zone of the Oromia regional state of Ethiopia who presented to Hawassa University Comprehensive Specialized Hospital (HUCSH) complaining of bloody diarrhea of 1 week associated with vomiting of ingested matter of 2 weeks. He also had history of fever, chills, rigors, arthralgia, and weight loss during a 2 weeks period. Further questioning revealed that he had previously swum in a pond and had a self-limited itchy skin condition. The family said that similar cases had occurred in their town that resolved with medications provided at a local health center. Conclusion: Schistosomiasis and amebiasis are major public health issues, especially in impoverished areas. Schistosomiasis presents differently clinically depending on the phase and clinical form in which it manifests, making diagnosis and management challenging. As a result, it necessitates an integrated collaboration involving clinicians, pathologists, and public health professionals. We describe ulcerative colitis (UC) ascribed to schistosomiasis and amoebiasis coinfection, and fulminant hepatitis due to schistosomiasis. As there was no report of liver abscess on sonographic scanning, hepatitis may not be due to coinfection. This case will be an alert to clinicians and public health personnel who are striving for the ultimate eradication of schistosomiasis and also teaches us that treating co-infections of both is beyond just giving praziquantel and antiamebics.

Is It a Coincidence or Secondary Immune Thrombocytopenic Purpura? A Case of an 11-Year-Old Male Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.

Background: Isolated thrombocytopenia with normal levels of other cell lines in the absence of other reasons is referred to as "immune thrombocytopenic purpura" (ITP). Tuberculosis has been associated with a variety of hematologic abnormalities, although severe thrombocytopenia and tuberculosis presenting as immune thrombocytopenic purpura are extremely uncommon. Case Presentation: We discuss a case of an 11-year-old male adolescent who came with epistaxis and petechial rash lasting one day, as well as severe thrombocytopenia. Following the clinical diagnosis of ITP, the patient was started on prednisone, transfused with platelets, and later started on antituberculosis (ATT) after confirmation of tuberculosis. The patient had a satisfactory response during the course of treatment, and the platelet level was fully recovered after 6 months. Conclusion: Tuberculosis (TB) should be recognized as a cause of immunological thrombocytopenia in tuberculosis-endemic areas. Our patient's platelet count improved after 1 week of ATT and 2 weeks of prednisolone, and it was entirely restored after 6 months of ATT treatment. Unfortunately, there are no clear guidelines for treating TB-related immune thrombocytopenia or determining the cause of TB-related immune thrombocytopenia. Tuberculosis-induced ITP resolves with the ATT, even though more investigation is warranted.

The First Experience of Effective 3rd Line Antiretroviral Therapy - A Case of 40-Year-Old Female Retroviral-Infected Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.

BACKGROUND: Treatment failure continues to be an impediment to the efficacy of highly active antiretroviral therapy (HART) in the treatment of human immunodeficiency virus type 1 infection (HIV-1). The World Health Organization (WHO) recommends third-line antiretroviral therapy (ART) for patients who have failed second-line ART. Darunavir (DRV) boosted with ritonavir (DRV/r) has a higher genetic barrier to resistance, is active against multidrug-resistant HIV isolates, retaining virological activity even when multiple protease mutations are present, and has been shown to be cost-effective when compared to other boosted protease inhibitors (PIs). CASE SUMMARY: This is a case of a 40-year-old female known HIV/AIDS patient who has been on ART for the last 14 years with good adherence and regular follow-up, and who is now on 3rd line ART medication with TLD (tenofovir/lamivudine/dolutegravir)+DRV/r (in her 11th month) after being diagnosed with second-line treatment failure. After 6 months and 1 week of therapy, the viral load (VL) was sent, and the result was undetectable. The patient's clinical conditions had greatly improved. CONCLUSION: Third-line ART therapy, which was once thought to be a salvageable treatment, is now the primary option for second-line ART failure. TLD in combination with ritonavir-boosted darunavir is found to be effective at lowering viral loads in the blood below detectable limits. Despite a lack of data on the use of third-line ART in Ethiopia, access to third-line ART containing ritonavir-boosted darunavir is recommended because it has been shown to be an effective alternative for patients who have failed second-line ART. We recommend that more research be done with a larger sample size, and that the findings in this paper be used with caution.

Neonatal mortality in Ethiopia: a protocol for systematic review and meta-analysis.

BACKGROUND: A child's risk of dying is highest in the neonatal period, i.e. the first 28 days of life. Newborn death accounts for nearly half of under-five death. More than 80% of newborn deaths are the result of preventable and treatable conditions. Ethiopia has made significant progress towards reducing under-five mortality; however, the rate of neonatal mortality (NMR) still accounts for 41% of under-five deaths. With this systematic review and meta-analysis, we aim to determine the magnitude, causes, and determinants of neonatal mortality in Ethiopia. METHODS: We will conduct a comprehensive search of the following electronic databases: PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, and maternity and infant care databases as well as grey literature. We will assess the quality of studies by using Newcastle-Ottawa Scale (NOS) checklist. Two reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. We will analyse data by using STATA 11 statistical software. We will demonstrate pooled estimates and determinants of neonatal mortality with effect size and 95% confidence interval. DISCUSSION: The result from this systematic review will inform and guide health policy planners and researchers on the burden, causes, and determinants of neonatal mortality in Ethiopia. To our knowledge, this is the first systematic review in Ethiopia. We will synthesise the findings to generate up-to-date knowledge on neonatal mortality in Ethiopia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO-CRD42018099663.