Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement.

PURPOSE: Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia. MATERIALS AND METHODS: A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality. RESULTS: Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%). CONCLUSIONS: In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.

Risk Factors of Birth Asphyxia among Newborns at Debre Markos Comprehensive Specialized Referral Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

Background: Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns. Methods: This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05. Results: Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia. Conclusion: In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.

Prevention of puerperal sepsis in northwest Ethiopia: Knowledge and practice of postnatal women; A multicenter cross-sectional study.

Objectives: Puerperal sepsis is a life-threatening condition that can lead to death and long-term morbidities of postnatal women, such as chronic pelvic pain, pelvic inflammatory disease, and secondary infertility. Therefore, the study aimed to assess the knowledge and practice of postnatal women at Debre Markos town health facilities toward the prevention of puerperal sepsis and its associated factors. Methods: A multicenter cross-sectional study was conducted from 1 to 30 July 2020. In all, 404 sampled postnatal women took part in the study. A systematic random sampling technique was employed to select each study participant. Data were entered into Epi data 4.6 and analyzed by statistical package for social sciences 25. Multivariate logistic regression was carried out for variables with a p value less than 0.25 in bivariate logistic regression to determine significant associations between the outcome and independent variables. The statistical significance was determined using a 95% confidence interval with a p value of less than 0.05. Results: The study reported that 44.6% and 40.8% of postnatal women had adequate knowledge, and good practice toward the prevention of puerperal sepsis, respectively. Factors associated with knowledge were urban residence [adjusted odds ratio = 5.84, 95% confidence interval = (3.54-9.46)], primiparity [adjusted odds ratio = 1.85, 95% confidence interval = (1.19-2.89)], and attending formal education [adjusted odds ratio = 2.41, 95% confidence interval = (1.11-5.22)] of study participants. Attending formal education [adjusted odds ratio = 2.46, 95% confidence interval = (1.13-5.37)] and having adequate knowledge [adjusted odds ratio = 2.34, 95% confidence interval = (1.49-3.67)] were factors associated with the prevention practice of postnatal women toward puerperal sepsis. Conclusion: Less than half of postnatal women had adequate knowledge and good practice to prevent puerperal sepsis. As a result, obstetric caregivers and other concerned bodies should consider strategies to increase the awareness level of women about puerperal sepsis. Interventions to improve the community's educational level should also be considered.

National burden of intestinal parasitic infections and its determinants among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis.

Objectives: The aim of this systematic review and meta-analysis is designed to assess the pooled prevalence and determine risk factors of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia. Methods: International databases: PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were systematically searched. Publication bias was determined using the funnel plot and Egger's regression tests. Heterogeneity between the studies included in this review was checked by I 2 statistic. The DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Sub-group, meta-regression, and sensitivity analysis were conducted. Overall, meta-analysis was done using Stata version 14 statistical software. Results: Twenty-seven studies with 8946 individuals were included, the estimated pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy was 40.24% (95% confidence interval = 33.8-46.6). Based on sub-group analysis, the highest prevalence was observed in the Tigray region 45.7% (95% confidence interval = 7.9-83.5), followed by Oromia region 42.2% (95% confidence interval = 28.8-55.6). Availability of latrine (odds ratio = 26.6, 95% confidence interval = 2.8-15.8), presence of animals at home (odds ratio = 2.7, 95% confidence interval = 1.2-5.8), and source of drinking water (odds ratio = 3.2, 95% confidence interval = 1.3-7.5) were significantly associated with intestinal parasitic infections. Conclusion: These findings indicated that the prevalence of intestinal parasites among people living with HIV/AIDS was high in Ethiopia.

Platelet Indices and Its Association with Microvascular Complications Among Type 2 Diabetes Mellitus Patients in Northeast Ethiopia: A Cross-Sectional Study.

PURPOSE: Platelet indices have been shown to be associated with complications of diabetes mellitus (DM). However, the clinical relevance of platelet indices for assessing the risk of being microvascular complications among patients with DM is largely overlooked. Hence this study aimed to determine the association of platelet indices with microvascular complications among type 2 DM patients. PATIENTS AND METHODS: A hospital-based cross-sectional study was conducted among 352 type 2 DM patients from April 1 to May 30/2019 at Debre Berhan Referral Hospital. Data were collected by interview, physical measurements, document review, and laboratory tests. Then the data were entered into Epi-data manager-4.4.1.0 and exported into SPSS-25 for analysis. Platelet indices were compared between participants with and without microvascular complications using an independent t-test. A logistic regression model was used to assess the association between microvascular complications and platelet indices. All inferences were considered statistically significant at P<0.05. RESULTS: One hundred seventeen (33.2%) of participants were suffering from at least one microvascular complications. The mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) were significantly increased in DM patients with complications as compared to without complications (13.57±2.17fl vs. 11.76±1.93fl), (16.57±2.49fl vs. 14.97±2.41fl) and (28.09±7.58% vs. 24.19±6.46%), respectively (all are P˂0.001). In multivariate logistic regression analysis, MPV (AOR=1.68, 95% CI: 1.37-2.05), PDW (AOR=1.37, 95% CI: 1.15-1.63), P-LCR (AOR=1.07, 95% CI: 1.01-1.14), age (AOR=1.07, 95% CI: 1.01-1.12), and duration of DM (AOR=1.31, 95% CI: 1.18-1.46) were significantly associated with the presence of microvascular complications. CONCLUSION: MPV, PDW, and P-LCR were significantly higher among type 2 DM patients with microvascular complications. This indicates that platelet indices can be used as prognostic markers of vascular complications and can be used as simple and cost-effective parameters to predict microvascular complications particularly in patients with old age and long duration of DM.

Cataract and associated factors among adults visiting ophthalmic clinic at Debre Markos comprehensive specialized hospital, northwest Ethiopia, 2020.

INTRODUCTION: Globally, it is estimated that 2.2 billion people have a visual impairment, of which around 65.2 million is due to cataract. Cataract is the leading cause of preventable blindness worldwide, with the greatest burden found in low-income countries. That is providing recent epidemiological data is very crucial to design intervention measures. The aim of this study was to assess the magnitude and associated factors of cataract among adults visiting ophthalmic clinic, Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2020. METHODS: The sample size was calculated using single population formula and determined to be 174. All adult participants aged ⩾40 were the source population and those fulfilling the inclusion criteria were the study population. An institutional-based cross-sectional study design using a systematic random sampling technique was conducted from July to August, 2020. Semi-structured questionnaires and patients' card were used to collect data. Data were entered into epi-data version 4.6 and the analysis was conducted using SPSS-25 software. Data were presented using graphs, tables and texts. Bivariable and multivariable binary logistic regression models were used to identify factors associated with cataract. Adjusted odds ratio with corresponding 95% confidence interval was computed to show the strength of association. A p-value < 0.05 was considered statistically significant. RESULT: From a total of 174 samples, 158 participated, giving a response rate of 90.8%. The prevalence of cataract was found to be 90 (57%). The variables-age 60-69 years (adjusted odds ratio = 6.667, 95% confidence interval: (1.662, 13.101)); age 70-79 years (adjusted odds ratio = 9.583, 95% confidence interval: (2.840, 32.342)), and single marital status (adjusted odds ratio = 2.945, 95% confidence interval: (1.241, 6.989))-had a significant association with cataract. CONCLUSION: The prevalence of cataract was found to be very high, which needs immediate intervention. Older age and single marital status were found to be significantly associated with cataract prevalence.

Prevalence of Diabetic Retinopathy and Its Associated Factors among Diabetic Patients at Debre Markos Referral Hospital, Northwest Ethiopia, 2019: Hospital-Based Cross-Sectional Study.

BACKGROUND: Diabetic retinopathy is a well-known sight-threatening microvascular complication of diabetes mellitus. Currently, 93 million people live with diabetic retinopathy worldwide. There are insufficient studies addressing the prevalence of diabetic retinopathy and risk factors in Ethiopia. OBJECTIVE: To assess the prevalence of diabetic retinopathy and its associated factors among diabetic patients on follow-up at Debre Markos Referral Hospital, northwest Ethiopia, 2019. METHODS: This institution- based cross-sectional study was conducted among 302 patients. They were selected through systematic sampling. Explanatory data were extracted from medical records and interviews. Blood pressure, weight, height, and visual acuity tests were assessed. Retinal examination was performed with a Topcon TRC-NW7SF fundus camera. Data were entered in EpiData 3.1 and exported in to SPSS 20 for analyses. Binary logistic regression with 95% CIs was used for analyses. Simple binary logistic regression followed by multiple binary logistic regression analysis was conducted to identify associated factors. RESULTS: There were 302 patients in this study, of which 57 (18.9%) had diabetic retinopathy. Among the diabetic retinopathy patients, 75.4% had the preproliferative type. Four in ten (37.7%) of the patients had visual acuity problems. Poor glycemic control (AOR 4.58, 95% CI 1.86-11.31), > 10 years' diabetes duration (AOR 3.91, 95% CI 1.86-8.23), body-mass index >25 kg/m2 (AOR 3.74, 95% CI 1.83-7.66), and hypertension (AOR 3.39, 95% CI 1.64-7.02) were factors significantly associated with diabetic retinopathy. CONCLUSION: About a-fifth of diabetic patients had diabetic retinopathy. Diabetic retinopathy was significantly associated with glycemic control, hypertension, body-mass index, and duration of illness. Routine assessment and early control of those associated factors may be important in reducing both the prevalence and impact of diabetic retinopathy, as evidenced in the current study.