Antibiotic appropriateness at outpatient settings in Ethiopia: the need for an antibiotic stewardship programme.

Background: Antibiotics are drugs of natural or synthetic origin used to treat various infections. The practice of excessive and inappropriate antibiotics use is the main global cause of bacterial resistance, which is one of the most serious global public health threats. It is estimated that about 50% of global antibiotic prescriptions are inappropriate. This study assesses the prevalence and pattern of inappropriate prescriptions of antibiotics amongst ambulatory care visits in Ethiopia. Methods: A facility-based, cross-sectional study with a quantitative approach was conducted amongst randomly selected prescriptions issued for outpatients from May to June 2022 at Debre Markos Specialized Comprehensive Hospital, Northwest Ethiopia. Descriptive statistics, such as frequencies and percentages, were computed. For group comparisons, χ2 and independent sample t-tests were computed. The statistical significance of the association was considered at p<0.05. Results: A total of 2640 antibiotics were prescribed for patients in the outpatient setting with various bacterial infections via 911 prescriptions, of which 49.5% were non-compliant with the national treatment guideline. Guideline non-compliant prescriptions increased remarkably amongst patients in the outpatient setting diagnosed with community-acquired pneumonia (38.8% versus 30.1%; p=0.006) and peptic ulcer disease (14.9% versus 9%; p=0.006). Moreover, inappropriate prescription was significantly higher amongst patients taking amoxicillin/clavulanic acid (33.2% versus 48.2%; p<0.001) and cephalexin (17.8% versus 24.3%; p=0.016). Conclusion: Large proportions of antibiotic prescriptions for outpatients were non-compliant with the national treatment guideline, suggesting that prescribers need to give special attention to outpatients whilst ordering antibiotics such as amoxicillin/clavulanic acid and cephalexin. Antibiotic stewardship efforts to optimize outpatient antibiotic prescriptions and reduce the use of potentially inappropriate antibiotics are needed in Ethiopia.

The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study.

Background: Low levels of living standards amongst street dwellers worldwide limit their access to conventional healthcare services, resulting in self-medication use for the treatment of an illness. Nevertheless, self-medication use has risks, including adverse drug reactions, increased polypharmacy, drug resistance, drug dependence, drug interactions and incorrect diagnosis. Ethiopia has a large street-dwelling community; however, there are no studies conducted in Ethiopia assessing self-medication use amongst street dwellers. This study provides insight into self-medication use and predictors amongst street dwellers in Ethiopia. Methods: A community-based, multicentre cross- sectional study was conducted amongst street dwellers from 1 September 2022 to 1 February 2023 at community drug-retail outlets in the three major cities in the Amhara region of Ethiopia. The data were obtained using an interviewer-administered questionnaire. Frequencies and percentages of descriptive statistics were calculated. Bivariable and multivariable logistic regression analyses were employed to indicate predictors of self-medication use. To determine statistical significance, a 95% confidence interval with a p value below 0.05 was utilized. Results: The prevalence of self-medication use was 67.4%. Time and financial savings were reported as the reasons for most self-medication use. The most commonly reported illnesses for which people sought self-medication were gastrointestinal diseases. Low monthly income (adjusted OR 3.72, 95% CI 2.34-5.91) and residing near sewage areas (adjusted OR 3.37, 95% CI 2.03-5.58) were significantly associated with self-medication use. Conclusion: Street dwellers had a high rate of self- medication use. Residing near sewage areas and having a low level of income were factors in self-medication use. Gastrointestinal diseases, respiratory ailments and dermatological conditions were the most frequently reported complaints, whereas antimicrobials and anthelmintics were the most commonly used medications. We recommend that healthcare services enhance outreach programmes to the most vulnerable people, such as street dwellers, especially those with lower monthly incomes and who live near sewage areas, to reduce self-medication rates.

In vivo antidiarrheal activity of the crude extract and solvent fractions of Rhamnus prinoides (Rhamnaceae) leaves.

Background: Even though numerous conventional anti-diarrheal agents are available, the inherent toxicities of the drugs urge the search for alternative drugs that are safe and effective. Objective: To evaluate the in-vivo anti-diarrheal activity of crude extract and solvent fractions of Rhamnus prinoides leaves. Materials and methods: The Rhamnus prinoides leaves were macerated using absolute methanol and then fractionated using solvents of different polarity indexes. For in-vivo antidiarrheal activity evaluation of the crude extract and solvent fraction, castor oil-induced diarrhea, castor oil-induced anti-enteropolling, and intestinal transit models were used. One-way analysis of variance was used to analyze the data, followed by a Tukey post-test. The standard and negative control groups were treated with loperamide and 2% tween 80 respectively. Results: A significant (p˂0.01) reduction in the frequency of wet stools and watery content of diarrhea, intestinal motility, intestinal fluid accumulation, and delaying the onset of diarrhea as compared with controls were observed in mice treated with 200 mg/kg and 400 mg/kg methanol crude extract. However the effect increased dose-dependently, and the 400 mg/kg methanol crude extract produced a comparable effect with the standard drug in all models. Amongst the solvent fractions, n-BF significantly delayed the time of diarrheal onset and reduced the frequency of defecation, and intestinal motility at doses of 200 mg/kg and 400 mg/kg. Furthermore, the maximum percentage inhibition of intestinal fluid accumulation was observed in mice treated with 400 mg/kg n-butanol extract (p˂0.01; 61.05%). Conclusions: The results of this study showed that crude extract and solvent fractions of Rhamnus prinoides leaves showed a significant anti-diarrheal activity which supports its traditional use as a diarrhea treatment.

Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021.

BACKGROUND: Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients. OBJECTIVE: This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021. METHODS: A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05. RESULTS: Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment. CONCLUSIONS: Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.

Antiplasmodial Activity of 80% Methanolic Extract and Solvent Fractions of Stem Bark of Acacia tortilis in Swiss Albino Mice.

Background: Malarial infection has significant negative impact on the health of the world population. It is treated by modern and traditional medicines. Among traditional medicinal plants, Acacia tortilis is used by different communities as antimalarial agent. Therefore, the objective of this study is to validate antimalarial activity of the stem bark of Acacia tortilis in mice. Methods: To evaluate antimalarial activity of the plant, 4-day suppressive, curative, and prophylactic antimalarial test models were used. Parasitemia, packed cell volume (PCV), survival time, rectal temperature, and body weight were used to evaluate the effect of the plant extracts. Data were analyzed using SPSS version 26 followed by Tukey's post hoc multiple comparison test. Results: The crude extract and dichloromethane fraction significantly suppressed the level of parasitemia (p < 0.001) and increased mean survival time (p < 0.01) at all tested doses. Similarly, significant effects were observed in mean survival time, % change of PCV, weight, and temperature in both curative and prophylactic antimalarial test models. Conclusions: The methanolic extract and solvent fractions of the stem bark of Acacia tortilis has shown antimalarial activity, and the finding supports the traditional use and the in vitro studies. Thus, this study can be used as an initiation for researchers to find the most active phytochemical entity and to conduct additional safety and efficacy tests.

Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study.

Objective: Irrational medicine use results in diseases worsening, disability, death, and wastage of limited resources. This study was predominantly aimed to evaluate the rationality of medicine use patterns by assessing prescribing, patient-care, and facility indicators at Debre Tabor Comprehensive Specialized Hospital by using World Health Organization core drug use indicators. Methods: A cross-sectional design was conducted to collect prescribing indicator data from 780 prescriptions retrospectively from 1 July 2020 to 30 June 2021 at outpatient pharmacy of the hospital and exit interview was held prospectively on 150 patients to evaluate patient-care indicators. In addition, indicators for health-facility were assessed by actual observation of the presence of different guidelines. Descriptive analysis of the collected data was computed using SPSS version 25. Result: Totally, 1521 drugs were prescribed to 780 encounters. On average, 1.95 drugs were prescribed per prescription. Percentage of encounters by generic name, encounters with antibiotics and injection, and drugs from essential drug list were 99.9%, 35.4%, 15.3%, and 100%, respectively. From healthcare provider-related information, the names of prescribers and dispensers were correctly written in 93.59% and 77.69%, respectively. Frequency (97.18%) and route (86.15%) of drug administration were better stated in the reviewed encounters, whereas dosage form is poorly stated (7.44%). Labeling of dispensed medicine was obtained for only 10% of patients and patient knowledge for correct dose was 94%. Availability of facility indicators was 95%. Conclusion: From the results of this study, it is possible to conclude that the prescribing, patient-care, and facility indicators did not fulfill many World Health Organization standards. Therefore, it is important if all prescribers, dispensers, patients themselves, and the governing bodies take an action to improve the prescribing and patient-care indicators for the best of the end users.

Antidiarrheal Effect of 80% Methanol Extract and Fractions of the Roasted Seed of Coffea arabica Linn (Rubiaceae) in Swiss Albino Mice.

BACKGROUND: Globally in 2019, diarrhea was the second leading cause of mortality in children, accounting for more than half a million under-five deaths yearly. Several societies use Coffea arabica Linn for the treatment of diarrhea. However, its use is not scientifically validated. OBJECTIVE: The study was conducted to evaluate antidiarrheal activity of 80% methanol extract and solvent fractions of roasted seed of Coffea arabica Linn in mice. METHODS: Coffea arabica Linn seed was roasted, milled, extracted, and fractionated using hexane, ethyl acetate, and distilled water. Castor oil-induced diarrhea, enteropooling, and motility tests were conducted. Effects on onset, number of feces, weight of feces, fluid content, volume and weight of intestinal content, and motility were evaluated by administering 100 mg/kg, 200 mg/kg, and 400 mg/kg of each extract. Negative controls received 10 ml/kg of the vehicle, and positive controls received either loperamide (3 mg/kg) or atropine (1 mg/kg). Data were analyzed using one-way ANOVA followed by Tukey's post hoc test. RESULTS: Ethyl acetate fraction at all tested doses significantly prolonged (p < 0.05) onset of diarrhea. The number and weight of feces were also reduced significantly by crude extract and ethyl acetate fraction. Reduction in fluid content was observed at 200 mg/kg and 400 mg/kg of the crude extract (p < 0.01) and aqueous fraction (p < 0.001) as well as all tested doses of ethyl acetate fraction (p < 0.001). Similarly, the crude extract, ethyl acetate fraction, and aqueous fraction showed a significant reduction in the volume and weight of intestinal content. At 400 mg/kg, the crude extract, hexane fraction, aqueous fraction, and all doses of ethyl acetate fraction showed significant antimotility activity. CONCLUSION: The results of this study revealed that the roasted seed of Coffea arabica Linn has antidiarrheal activity.

Validation of Antidiabetic and Antihyperlipidemic Effects of 80% Methanolic Extract of the Lonchocarpus laxiflorus Leaves in Streptozotocin-Induced Diabetic Swiss Albino Mice.

Introduction: Diabetes mellitus (DM) is a chronic endocrine disorder that requires long-term treatment. In Ethiopian traditional medicine practice, plants have been provided with a vital role in fighting human and animal diseases since ancient times. The aqueous extract of Lonchocarpus laxiflorus (L. laxiflorus) leaves has been consumed for treating diabetes mellitus without confirming its safety and efficacy scientifically. This experiment aimed to evaluate the safety and antidiabetic efficacy of the leaf extract of L. laxiflorus in mice models. Methods: The crude extraction was conducted using a cold maceration technique and 80% methanol solvent. Normoglycemic, oral glucose-loaded, and streptozotocin-induced (STZ) diabetic models were employed. Male Swiss albino mice were randomly grouped into five categories( with six mice per group during normoglycemic, oral glucose-loadingtest as a negative control, positive control, and three treatment groups. In STZ-induced diabetic models, the groups include normal and diabetic negative control, diabetic positive control, and three diabetic treatment groups. The negative control groups received vehicles, the positive control received 5 mg/kg glibenclamide, and the treatment groups received the crude extract at 100, 200, and 400 mg/kg doses, respectively. Results: Up to 2000 mg/kg crude extract, neither signs of toxicity nor death were observed. In normoglycemic mice, there was a significant blood glucose reduction at 200 and 400 mg/kg doses starting from the 2nd h post-administration. The oral glucose load showed a significant antihyperglycemic effect at 200 and 400 mg/kg of the crude extract and glibenclamide. In STZ-induced diabetic models, the 200, 400 mg/kg crude extract, and glibenclamide showed a significant antidiabetic activity and enhancement of a good serum lipid profile. Conclusion: This study confirmed that the leaf of L. laxiflorus was safe and possesses antidiabetic and antidyslipidemic activities.

Evaluation of Antidiarrheal Activity of 80% Methanolic Extract of the Leaves of Cordia africana (Lamiaceae) in Mice.

BACKGROUND: Diarrheal disease is a major cause of morbidity and mortality throughout the world, particularly in developing countries. Currently available drugs are linked with adverse effects, contraindications, and risk of resistance. Traditionally, the leaf concoction of Cordia africana is claimed to be used for diarrhea. However, the safety and efficacy of the leaf extract have not been scientifically approved yet. Therefore, the study was conducted to validate its antidiarrheal activity and safety profile in mice. METHOD: The hydromethanolic extract was obtained by the cold maceration technique in 80% methanol. Phytochemical screening tests were done for secondary metabolites by using standard tests. The antidiarrheal activity of the test extract at the doses of 100, 200, and 400 mg/kg was evaluated by using castor oil-induced diarrheal, gastrointestinal transit, and enteropooling models in mice. RESULT: In an acute toxicity study, there were no visible signs of toxicity and mortality following a single oral administration of 2000 mg/kg. Phytochemical screening tests revealed the presence of alkaloids, saponins, flavonoids, terpenoids, phenols, and tannins. The hydromethanolic extract significantly prolonged the onset of diarrhea and reduced the weight of wet and total feces at 100 (P < 0.01), 200 (P < 0.001), and 400 mg/kg (P < 0.001) in the castor oil-induced diarrheal model. However, in the gastrointestinal transit model, a significant (P < 0.001) reduction in the charcoal meal travel was observed in the middle (200 mg/kg) and higher (400 mg/kg) test doses. Similarly, the extract produced a significant (P < 0.001) reduction in the weight and volume of intestinal contents at the aforementioned doses. CONCLUSION: The study demonstrated that the test extract showed promising antidiarrheal activity. Hence, this study supports its antidiarrheal use in Ethiopian folklore medicine.