Attack Rate, Case Fatality Rate and Predictors of Pertussis Outbreak During Pertussis Outbreak Investigation in Ethiopia: Systematic Review and Meta-Analysis.

BACKGROUND: Pertussis, a highly contagious, vaccine-preventable respiratory infection caused by Bordetella pertussis, is a leading global public health issue. Ethiopia is currently conducting multiple pertussis outbreak investigations, but there is a lack of comprehensive information on attack rate, case fatality rate, and infection predictors. This study aimed to measure attack rates, case fatality rates, and factors associated with pertussis outbreak. METHODS: This study conducted a systematic review and meta-analysis of published and unpublished studies on pertussis outbreaks in Ethiopia from 2009 to 2023, using observational study designs, using the guideline Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study utilized databases like Science Direct, MEDLINE/PubMed, African Journals Online, Google Scholar and registers. The data were collected using an Excel Spreadsheet and then exported to STATA version 17 for analysis. Subgroup analysis was conducted to identify potential disparities. A random effects model was used to consider heterogeneity among studies. I2-squared test statistics were used to assess heterogeneity. The attack rate, case fatality rate, and odds ratio (OR) were presented using forest plots with a 95% confidence interval. Egger's and Begg's tests were used to evaluate the publication bias. RESULTS: Seven pertussis outbreak investigations with a total of 2824 cases and 18 deaths were incorporated. The pooled attack and case fatality rates were 10.78 (95% CI: 8.1-13.5) per 1000 population and 0.8% (95% CI: 0.01-1.58%), respectively. The highest and lowest attack rates were in Oromia (5.57 per 1000 population and in the Amhara region (2.61 per 1000 population), respectively. Predictor of pertussis outbreak were being unvaccinated [odds ratio (OR) = 3.05, 95% CI: 1.83-4.27] and contact history [OR = 3.44, 95% CI: 1.69-5.19]. CONCLUSION: Higher and notable variations in attack and case fatality rates were reported. Being unvaccinated and having contact history were the predictors of contracting pertussis disease in Ethiopia. Enhancing routine vaccination and contact tracing efforts should be strengthened.

Drug Use Evaluation of Tenofovir/Lamivudine/Dolutegravir (TLD) Fixed-Dose Combination for Initiation and Transition Among HIV-Infected Individuals Attending Lumame Primary Hospital, North West Ethiopia.

Background: A key strategy for quality improvement is drug use evaluation, which looks at the safe, appropriate use of medication principles. Tenofovir/Lamivudine/Dolutegravir (TLD-FDC) usage has not yet been sufficiently examined in published literature. The purpose of this study was to assess how TLD were used by HIV-positive patients Using WHO drug use evaluation standards in Lumame Primary Hospital, North West Ethiopia. Methods: Using WHO drug use evaluation standards, a retrospective study design was used to evaluate the appropriateness of TLD use. Systematic random sampling was utilized to gather patient medical records containing TLD. Accordingly, 100 records that met the inclusion criteria were selected and reviewed between April 1 and 15, 2021. Five criteria, namely, indication, dose, contraindication, drug interaction, and TLD safety monitoring were used to evaluate the appropriateness of TLD utilization. Results: 80% of patients were transited to TLD from other regimens. The median time on TLD was found to be 13 months with 9 months to 18 months IQR. The latest CD4 count as well as CD4 count at the initiation or transition of TLD was not done for 75% and 89% of the patients, respectively. 3/4 (75%) of the patients were found to have a scheduled medication refill history. TLD dosing, indications, and contraindications were found to be 100% appropriate. No, TLD safety monitoring tests were done for 21% of the patients in this study. However, viral load, liver/kidney function, and serum creatinine tests were done for 77% (95% CI: 74%-79%), 5% (95% CI: 2%-8%), and 14% (95% CI: 11%-17%) of the patients, respectively. More over, In 93% (95% CI: 91%-95%) of the patients, the TLD interaction was appropriate; in 7%, it was not. All recording, documenting, and reporting technologies were available and used efficiently, except for the Electronic Dispensing Tool. Conclusion: Generally, good adherence to national and WHO guidelines was obtained regarding dose, indication, and contraindications. However, improvement in safety monitoring tests and CPT utilization is recommended. Drug interactions satisfied the majority of the criteria's threshold, while certain standards were not followed.

Validation of Blood Glucose and Lipid-Lowering Effect of Solvent Fractions of the Crinum Abyssinicum Shoot Tips in Streptozotocin-Induced Diabetic Mice.

Background: Diabetes mellitus prevalence has reached epidemic levels despite the existence of contemporary treatments. People thus started looking at the possible therapeutic value of natural therapies. Crushed shoot tips of Crinum abyssinicum (Amaryllidaceae) are mixed with water in Ethiopia to treat diabetes, yet this practice is not well supported by science. Objective: In this experiment, mice models were used to verify the blood sugar and lipid-lowering benefits of solvent fractions of C. abyssinicum shoot tips. Materials and Methods: In a single-dose treated Streptozotocin (STZ)-induced diabetic model, mice were randomly grouped into eleven categories which include diabetic negative control, diabetic positive control, and 9 diabetic treatment groups. In repeated daily doses treated STZ-induced model, Mice were divided into 6 groups which included normal and diabetic negative control (TW80), diabetic positive control (5 mg/kg glibenclamide), and three diabetic treatment groups 100, 200, and 400 mg/kg). Finally, blood glucose, lipid level, and body weight were examined. Results: In the single-dose treated diabetic model, there was a significant blood glucose reduction at 200 and 400 mg/kg doses of aqueous fraction and glibenclamide starting from the sixth-hour post-administration unlike ethyl acetate and chloroform fraction compared to baseline and negative control. In repeated daily dose-treated diabetic mice, all three doses (100, 200, and 400 mg/kg of aqueous fraction) resulted in a substantial reduction (P < .001) in blood glucose compared to baseline and negative control on the seventh day and 14th day. Besides the AQF shows improvement in lipid levels and body weight parameters. Conclusion: The results of the study demonstrated that C. abyssinicum shoot tip fractions have the greatest potential to lower blood sugar and lipid levels, supporting conventional claims for the treatment of diabetes.

Acute coronary syndrome and its treatment outcomes in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Acute coronary syndrome (ACS) is the principal cause of death in developing countries including Ethiopia. No study reports the overall patterns of risk factors and burden of in-hospital mortality in Ethiopia. This study, therefore, aimed to assess the magnitude of risk factors, management, and in-hospital mortality of ACS in Ethiopia. METHODS: Electronic searching of articles was conducted using PubMed, Science Direct, EMBASE, Scopus, Hinari, and Google Scholar to access articles conducted in Ethiopia. The Preferred Reporting Items for Systematic Reviews checklist was used for identification, eligibility screening, and selection of articles. Data were extracted with an abstraction form prepared with Microsoft Excel and exported to STATA for analysis. Funnel plot, Begg's test, and Egger's test were used to determine publication bias. Heterogeneity between the studies was checked by I2 statistic. The pooled prevalence of risk factors and in-hospital mortality of ACS were estimated using a random-effects meta-analysis model. RESULTS: Most (59.367%) of the patients had ST-segment elevation myocardial infarction (STEMI). Hypertension (54.814%) was the leading risk factor for ACS followed by diabetes mellitus (38.549%). Aspirin (56.903%) and clopidogrel (55.266%) were most frequently used in patients with STEMI ACS, respectively. The pooled proportion of in-hospital mortality of ACS was 14.82% which was higher in patients with STEMI (16.116%). CONCLUSION: The rate of in-hospital mortality is still high which was higher in patients with STEMI. Initiation of treatment must consider the heterogeneity of each patient's risk factor and reperfusion therapy should be implemented in our setting.

Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review.

Introduction: The availability and affordability of safe, effective, accessible, and high-quality essential medicines is a critical benchmark for achieving the right to good health, and it is also one of the goals of the global health development agenda. To that end, it is critical to conduct rigorous studies to identify the major challenges confronting developing countries, particularly those in Africa. Objective: The purpose of this review was to identify the major challenges that Africans face in obtaining reasonably priced and readily available essential medicines. Methods: Generally the Boolean operators "AND" and "OR" were employed. Making progress also involves using duplicate checks, field definitions, and comparisons of articles and criteria. The analysis included all English-language papers published in any African country between 2005 and 2022, depending on the year of publication. The technique searches electronic databases for key phrases related to essential medication availability and affordability, such as PubMed, Web of Science, Scopus, Science Direct, Plos Medicine, and Google Scholar. Results: A total of 91 articles; by using search engines and handpicking including duplicates, were primarily searched. The electronic database search earned 78 articles while only eleven studies met the criteria for review and were reviewed of which 5 (50%) were from East African countries. Inadequate human resources, financial constraints, high cost of available medications on the market, poor inventory management, manual consumption forecasting, inefficiencies in drug registration, and trade-related aspects of intellectual property rights agreement regulations are all obstacles to the availability of essential medicines in African nations. Conclusion: This review revealed that in Africa, the availability and affordability of essential medicines face numerous challenges. The primary challenge, according to the review research, is a lack of adequate financing to pay for an appropriate set of essential medications, which account for a significant portion of household spending.

Antipyretic Potential of 80% Methanol Extract and Solvent Fractions of Bersama abyssinica Fresen. (Melianthaceae) Leaves Against Yeast-Induced Pyrexia in Mice.

Introduction: Since fever is a complicated physiological reaction to an infection or aseptic stimulus, finding safer solutions that are more potent and derived from plants is essential to resolving this issue. Bersama abyssinica (Melianthaceae) is traditionally used to treat fever, though this has yet to be proven scientifically. Objective: The present study aimed to assess the antipyretic potential of leaf extract and solvent fractions of B. abyssinica. Methods: The antipyretic activities of crude extract and solvent fractions of B. abyssinica leaves were evaluated using a yeast-induced pyrexia model at three different dose ranges (100mg/kg, 200mg/kg, and 400mg/kg) methanol extract as well as chloroform, ethyl acetate, and aqueous fractions to mice showing an increase in temperature of ≥0.5 °C. The rectal temperature of each mouse was recorded using a digital thermometer. To analyze the data, SPSS version 20 and one-way ANOVA followed by Tukey's HSD post hoc test to compare results between groups were utilized. Results: The crude extract demonstrated significant antipyretic potential (P<0.05 by 100 mg/kg and 200 mg/kg as well as P<0.01 by 400 mg/kg), with a maximum of 95.06% reduction in rectal temperature at 400 mg/kg, comparable to 98.37% at 2.5 hours by the standard drug. Similarly, all doses of the aqueous fraction, as well as 200 mg/kg and 400 mg/kg doses of the ethyl acetate fractions, resulted in a significant (P<0.05) reduction in rectal temperature when compared to the corresponding value of the negative control group. Conclusion: Extracts of B. abyssinica leaves were found to have a significant antipyretic effect. Thus, the use of the plant for pyrexia in traditional settings has scientific ground.

Medicinal Plants Used for the Management of Hepatitis Over the Past 15 Years in Ethiopia: A Systematic Review.

Background: Treatment of human and animal ailments using botanical sources has obtained significant attention in Ethiopia. The compounds available in plants comprise a plentiful source of bioactive ingredients able to treat many complications. The review aimed to present an updated list of plants used for managing hepatitis over the past 15 years in Ethiopia. Methods: Systematic, comprehensive search was undertaken from electronic databases (PubMed, Google Scholar, Science Direct, and Scopus) between September 01 and October 15, 2022, using standard search terms. Original researches carried out in Ethiopia, written and published in English between January 01/2007 and December 31/2021, and reported hepatitis as a disease treated by medicinal plants were included in the review. Plants beyond the list of Ethiopian and Eritrean floral were excluded. Data were extracted from texts and tables of original papers on a Microsoft Excel. Quality was assessed by applying the Joanna Briggs Institute Critical Appraisal Checklist. Results: A total of 317 papers were obtained from the database search. After removing duplicates and screening, 15 articles fit the inclusion criteria and selected for final review. Of the 24 plants identified, 35.7% were herbs. Leaf and root (35.7% each) were the predominant plant parts used for remedy preparation. Combined use of leaf and root comprised 10.7%. The families Apocynaceae, Asteraceae, Euphorbiaceae, Cucurbitaceae, and Fabaceae comprise the highest number of plant species. About 89.3% of remedies were administered orally. Conclusion: The majority of plants belong to herbs and the frequently used plant parts are leaf and roots. Evidence generated from the present review indicated that lots of plants have been used to manage hepatitis. Moreover, the findings could serve as preliminary information to formulate new drugs acting against hepatitis. Therefore, it is desirable for scholars to recognize, document, and keep plants and the associated knowledge appropriately.

Systematic Review of Safety of RTS,S with AS01 and AS02 Adjuvant Systems Using Data from Randomized Controlled Trials in Infants, Children, and Adults.

Background: Emergence of antimalarial drugs and insecticides resistance alarms scientists to develop a safe and effective malaria vaccine. A pre-erythrocytic malaria vaccine called RTS,S has made great strides. Aim: The review was aimed to assess the safety of the candidate malaria vaccine RTS,S with AS01 and AS02 adjuvants using data from Phase I-III randomized controlled clinical trials (RCTs). Methods: This systematic review was conducted based on PRISMA 2020. Regardless of time of publication year, all articles related with safety of RTS,S, RCTs published in the English language were included in the study. The last search of databases, and registry was conducted on 30 May, 2022. Pubmed, Google Scholar, Cochrane Library, Wiley Online Library, and Clinical trials.gov were thoroughly searched for accessible RCTs on the safety of RTS,S malaria vaccine. The studies were screened in three steps: duplicate removal, title and abstract screening, and full-text review. The included studies' bias risk was assessed using the Cochrane risk of bias tool for RCTs. This systematic review is registered at Prospero (registration number: CRD42021285888). The qualitative descriptive findings from the included published studies were reported stratified by clinical trial phases. Findings: A total of thirty-five eligible safety studies were identified. Injection site pain and swelling, febrile convulsion, fever, headache, meningitis, fatigue, gastroenteritis, myalgia, pneumonia, reactogenicity, and anemia were the most commonly reported adverse events. Despite few clinical trials reported serious adverse events, none of them were related to vaccination. Conclusion: Most of the adverse events observed from RTS,S/AS01 and RTS,S/AS02 malaria vaccines were reported in the control group and shared by other vaccines. Hence, the authors concluded that both RTS,S/AS01 and RTS,S/AS02 malaria vaccines are safe.

Magnitude of anemia and associated factors among adult patients at Baso Liben District: a cross-sectional study.

BACKGROUND: Despite the fact that anemia is a common health problem with many consequences, its magnitude among adults and the different contributing factors have not been documented in the study setting. Hence, this study aimed to determine the magnitude of anemia and associated factors among adult patients of Baso Liben District. METHODS: A facility-based cross-sectional study was conducted from 1 December 2019, to February 30, 2020. A total of 347 adult patients attending Yejubie Hospital were enrolled in the study. Socio-demographic data were collected through face-to-face interview. Patients' hemoglobin level was determined by a Mindray BC-5800 CBC hematology analyzer. The presence of intestinal parasites and malaria infection were assessed. RESULTS: The overall magnitude of anemia was 25.94% with moderate severity according to the WHO anemia classification. The prevalence of mild, moderate, and severe anemia was 13.54%, 8.36%, and 4.03%, respectively. Anemia was associated with age range ≥55 years (AOR = 31.66), large family size (AOR = 6.62), being married (AOR = 0.24), intestinal parasite infections (AOR = 4.05), malaria infection (AOR = 4.61), and pregnancy (AOR = 4.09). CONCLUSION: The prevalence of anemia was moderate. Intestinal parasitic infection, age, malaria, family size, and pregnancy were associated factors with anemia.

Prevalence of Medication Non-Adherence and Associated Factors among Diabetic Patients in A Tertiary Hospital at Debre Markos, Northwest Ethiopia.

Background: Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital. Methods: A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05. Results: A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications. Conclusion: The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients.

Probiotics, their prophylactic and therapeutic applications in human health development: A review of the literature.

Antibiotics do not differentiate between good and bad germs, disrupting normal microflora and causing vitamin deficiency in the human body. They also kill healthy bacteria in the gut and genital tract on a large scale, weakening the host's defense mechanism. Probiotics are a colony of bacteria that live in our intestines and are regarded as a metabolic 'organ' due to their beneficial effects on human health, including metabolism and immunological function. They are used in clinical settings to prevent and treat conditions such as diarrhoea, colon cancer, hypertension, diabetes, acute pancreatitis, Helicobacter pylori infection, ventilator-associated pneumonia, migraine and autism. Probiotics may modify immunological activity by increasing innate and adaptive immune responses, altering microbial habitat in the intestine, improving gut barrier function, competitive adherence to the mucosa and epithelium, and producing antimicrobial compounds. The aim of this study is to index that further in depth researches to be conducted on probiotics pivotal role in the prophylaxis and therapeutic usage for a variety of disease that may or may not have treatment alternatives. Key words such as probiotics, microbiota, prophylactics, and therapeutic applications were searched extensively in research databases such as PubMed, PubMed Central (PMC), Scopus, Web of Science, Research Gate, Google Scholar, and Cochrane Library. This concise narrative review article summarized primarily the history, selection, mechanism/mode of action, recent advances in prophylactic and therapeutic applications, and future directions in the use of probiotics for prophylactic and therapeutic applications.

Evaluation of Anti-Diabetic and Anti-Hyperlipidemic Activities of Hydro-Alcoholic Crude Extract of the Shoot Tips of Crinum abyssinicum Hochst. ex A. Rich (Amaryllidaceae) in Mice.

BACKGROUND: Despite the availability of synthetic antihyperglycaemic medications on the market, diabetes is on the rise. Though not scientifically proven, the Crinum abyssinicum Hochst. ex A. Rich. (Amaryllidaceae) has been used traditionally to treat diabetes. Crinum abyssinicum was tested in mice to see if it had anti-diabetic and anti-hyperlipidemic properties. METHODS: The hydro-alcoholic extract of Crinum abyssinicum shoot tips doses (100 mg/kg, 200 mg/kg, and 400 mg/kg) were administered to normoglycemic, oral glucose-loaded mice, and single and repeated dose-treated streptozotocin-induced diabetic model. Then, the blood glucose levels were measured for normoglycemic, oral glucose loaded and single dose treated streptozotocin model. Whereas in repeated dose-treated streptozotocin induced diabetic model, blood glucose level, body weight, and lipid profiles were measured. RESULTS: After oral administration, all extract doses (100 mg/kg (p < 0.01), 200 mg/kg (p < 0.001), and 400 mg/kg (p < 0.001)) significantly reduced blood glucose level of normal mice as compared to the control group. Significant reduction of post-prandial glucose was achieved with crude extract at a tested dose of 100 mg/kg (p < 0.05) both at 1st and 2nd hours; 200 mg/kg (p < 0.01) at the 1st hour and (p < 0.001) 2nd hours, and 400 mg/kg (p < 0.001) at the 1st and 2nd hours as compared to the negative control. In diabetic mice, the crude extract 200 mg/kg and 400 mg/kg; and glibenclamide 5 mg/kg significantly reduced (p < 0.001) blood glucose level on the 14th day as compared to the negative control. All doses of crude extract significantly improved the lipid profiles and the bodyweight of diabetic mice. CONCLUSION: These findings revealed that the hydro-alcoholic extract of Crinum abyssinicum shoot tips possess significant antihyperglycemic, antihyperlipidemic, and body weight improvements in streptozotocin-induced diabetic mice. Besides, it showed hypoglycaemic and anti-hyperglycaemic activities on normoglycemic and oral glucose loaded mice, respectively. These justify the claimed use of the plant in ameliorating diabetes mellitus in Ethiopian folk medicine.

Assessment of Drug Use Practices Using Standard WHO Indicators in Lumame Primary Hospital.

BACKGROUND: Irrational use of drugs has been one of the major problems around the globe. However, the degree of the problem is higher in developing countries like Ethiopia. The WHO has developed several indicators to evaluate the practices of drug use. This study aimed to assess the overall drug use practices using standard WHO indicators in Lumame Primary Hospital. METHODS: Hospital-based retrospective cross-sectional study was employed to investigate the overall drug use practices at the hospital. Six hundred prescriptions were selected from a total of 19,242 prescriptions by systematic sampling technique over one year from July 1, 2019, to June 30, 2020, in a retrospective review. For the patient care study, 100 patients were selected for collecting the required information. Facility indicators were assessed by checking the availability of STG/formularies and essential drugs. The results were interpreted according to the standard values of WHO. RESULTS: All 600 sampled prescriptions were 100% standard. Weight, dosage form, and quantity were written in 1.5-13.3% of the prescriptions. Patient address was recorded in 51%, while qualification of prescriber and dispenser were recorded in 71.5% and 56% of the cases, respectively, but all other information were complete in 88.5-100% of the prescriptions. The mean number of drugs per encounter, generic prescribing, prescribing from essential drug list, encounters with antibiotics and injectable drugs were 2.3, 97.9%, 99.8%, 48.8%, and 11.2%, respectively. The average dispensing time was found to be 171.9 seconds. Percentage of actually dispensed drugs, adequacy of labeling, patient knowledge, and patient satisfaction were 95.3%, 22.6%, 83%, and 88%, respectively. About 92% of tracer drugs and all reading materials, except national drug list and facility-level drug formulary, were available in the study period. CONCLUSION: Generally, appreciable results were obtained for most of the indicators but improvement in antibiotic prescribing, polypharmacy and labeling practice is recommended.