Management of hospital-acquired infections among patients hospitalized at Zewditu memorial hospital, Addis Ababa, Ethiopia: A prospective cross-sectional study.

BACKGROUND: Hospital-Acquired Infections (HAIs) are acquired when the patient is hospitalized for more than 48 hours. In Ethiopia data are scarce in management appropriateness of HAIs. Hence, this study was aimed to assess the prevalence and management of HAIs among patients admitted at Zewditu Memorial Hospital. METHOD: A facility based prospective cross sectional study was conducted from March 1, 2017 to August 30, 2017. The sample was proportionally allocated among (medical, pediatrics, gynecology and obstetrics and surgical) wards, based on patient flow. Data were collected using data abstraction format and supplemented by key informant interview. Interview was made on eight physicians and four microbiologists who have been working in the wards during study period. Management appropriateness was assessed using Infectious Disease Society of America guideline and experts opinion (Infectious disease specialist). A multivariate logistic regression was used to identify factors associated with HAIs. RESULT: The prevalence of HAIs was 19.8%. Surgical Site Infection (SSI) and pneumonia accounted for 20 (24.7%) of the infections. Culture and sensitivity was done for 24 (29.6%) patients. Of the 81 patients who developed HAIs, 54 (66.67%) of them were treated inappropriately. Physicians' response for this variation was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR (Adjusted odds ratio) = 8.53, 95% CI: 2.67-27.30); male gender (AOR = 2.06, 95% CI: 1.01-4.22); longer hospital stay (AOR = 0.17, 95% CI: 0.06-0.51); and previous hospital admission (AOR = 3.22, 95% CI: 1.76-5.89); were independent predictors of HAIs. CONCLUSION: Prevalence of HAIs and inappropriate management were substantially high in this study. Pneumonia and SSI were the common types of HAIs. Locally conformable guidelines could help to correct such problems.

Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Patients with diabetes are at high risk of drug therapy problems (DTPs), as they are receiving multiple medications. To date, studies regarding DTPs in patients with diabetes in Ethiopia are limited. The aim of this study was to assess prevalence of DTPs, medication adherence and treatment satisfaction of patients with diabetes at Tikur Anbessa Specialized Hospital (TASH). METHOD: A cross-sectional study was conducted on randomly selected 418 participants who fulfilled the inclusion criteria. Data were collected using structured questionnaire and patients' chart review. Cipolle's classification system was used to determine DTPs. Modified Morisky's Adherence Scale (MMAS-8) was used to measure patients' adherence to their medication. Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) patient satisfaction assessment questionnaire was used to assess patients' treatment satisfaction. RESULTS: A total of 207 DTPs in 177 (42.3%) of participants were identified. Commonly identified DTPs were dosage too low (58, 28.0%), ineffective drug therapy (54, 26.1%), and need additional drug therapy (52, 25.1%). Factors associated with DTPs were female gender (Adjusted Odds Ratio [AOR] = 2.31,95% CI:1.30-4.12); ≥3comorbidities (AOR = 3.61, 95% CI:1.19-10.96); ever married (AOR = 2.58,95% CI:1.23-5.48); type 2 diabetes (AOR = 5.62, 95% CI:1.21-26.04); non-adherence (AOR = 5.26,95% CI:2.51-11.04) and residence out of Addis Ababa (AOR = 0.30, 95% CI:0.12-0.73). Twenty four percent of participants were non-adherent to their drug therapies. Factors associated with non-adherence were diabetes complications (AOR = 2.00, 95% CI: 1.2-3.32), the female gender (AOR = 1.67, 95%CI: 1.01-2.8) and level of education (AOR = 0.42, 95%CI: 0.18-0.96). Eighty one percent of participants were satisfied with the current treatment. CONCLUSION: A significant proportion of patients were satisfied with their treatment and a quarter of the study participants were non-adherent to their medications at TASH diabetic clinic. However, DTPs were considerably higher among the study participants. Hence, future interventions targeting prevention and resolution of DTPs deemed to be necessary.