Effectiveness and cost-effectiveness of community-based directly observed treatment (DOT) versus health facility-based DOT of tuberculosis in Africa: protocol for a systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) remains a significant global health challenge, especially prevalent in the WHO African region. The WHO's End TB Strategy emphasises effective treatment approaches such as directly observed therapy (DOT), yet the optimal implementation of DOT, whether through health facility-based (HF DOT) or community-based (CB DOT) approaches, remains uncertain. OBJECTIVE: To conduct a systematic comparison of the effectiveness and cost-effectiveness of Community-Based Directly Observed Treatment (CB DOT) versus Health Facility-Based Directly Observed Treatment (HF DOT) for tuberculosis (TB) treatment in African settings. METHODS: We will conduct a systematic review and meta-analysis following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search PubMed, Embase, Web of Science, Scopus and the Cochrane Library for articles published up to 30 March 2023, without date restrictions. Eligible studies must be full economic evaluations conducted in African countries, comparing CB DOT to HF DOT regarding treatment outcomes and costs. Exclusion criteria include non-English, non-peer-reviewed or studies lacking caregiver involvement in CB DOT, health facility-based DOT comparison, direct comparability between CB DOT and HF DOT, significant selection bias or non-economic evaluations. Data extraction will be performed independently by reviewers, and meta-analyses will use STATA software. To pool the data, a random-effect model will be applied, and quality assessment of the studies will be conducted. ETHICS AND DISSEMINATION: Ethical approval is not required as the study will use previously published articles available publicly. Findings will be presented at international and national conferences and published in open-access, peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42023443260.

Prevalence of metabolic syndrome and associated factors among patient with type 2 diabetes mellitus in Ethiopia, 2023: asystematic review and meta analysis.

BACKGROUND: Metabolic syndrome is a complex pathophysiologic state which characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidaemia. The Adult Treatment Panel III report (ATP III) of the National Cholesterol Education Programme identified the metabolic syndrome as a serious public health issue in the modern era. In Western and Asian nations, the frequency of metabolic syndrome is rising, especially in developing regions experiencing rapid socio-environmental changes, in Sub-Saharan Africa; metabolic syndrome may be present in more than 70% of people with type 2 diabetes mellitus. Therefore the objective of our study was to estimate the pooled prevalence of metabolic syndrome and associated factors among type II diabetes mellitus patient. METHOD: This systematic review and meta-analysis included original articles of cross sectional studies published in the English language. Searches were carried out in PubMed, Web of Science, Google Scholar, and grey literature Journals from 2013 to June 2023. A random-effects model was used to estimate the pooled prevalence of metabolic syndrome among type II Diabetes mellitus patient in Ethiopia. Heterogeneity was assessed using the I2 statistic. Subgroup analysis was also conducted based on study area. Egger's test was used to assess publication bias. Sensitivity analysis was also conducted. RESULTS: Out of 300 potential articles, 8 cross sectional studies were included in this systematic review and meta-analysis study. The pooled prevalence of metabolic syndrome among patient with type II diabetes mellitus in Ethiopia was found to be 64.49% (95% CI: 62.39, 66.59) and 52.38% (95% CI: 50.05, 54.73) by using NCEP/ATP III and IDF criteria, respectively. The weighted pooled prevalence of metabolic syndrome among type II diabetes mellitus patients by sub group analysis based on the study region was 63.79% (95% CI: 56.48, 71.11) and 52.23% (95%CI: 47.37, 57.22) by using NCEP/ATP III and IDF criteria, respectively. Being female and increased body mass index were factors associated with metabolic syndrome among type II diabetes mellitus patients. CONCLUSION: The prevalence of metabolic syndrome among type II patient is high. Therefore, policymakers, clinicians, and concerned stakeholders shall urge effective strategies in the control, prevention, and management of metabolic syndrome among type II diabetes mellitus.

Willingness to Pay for Social Health Insurance Among Health Care Professionals in North Wollo Zone, Amhara Region, Ethiopia: Mixed Method Study.

Background: Ethiopia introduced a social health insurance (SHI) scheme for the formal sector that will cost 3% of the monthly salary as a premium and provide universal health coverage. Since health care professionals (HCP) are the primary front-line service providers, their willingness to pay (WTP) for SHI may have a direct or indirect impact on how the programme is implemented. However, little is known about WTP for SHI among HCP. Objective: To assess WTP for SHI and associated factors among government employee HCP in the North Wollo Zone, Northeast Ethiopia. Methods: Using the contingent valuation method, a mixed approach and cross-sectional study design were applied. For the qualitative study design, in-depth interviews were performed with focal persons and officers of health insurance. Multistage systematic random sampling was used to select 636 healthcare professionals. Logistic regression analysis was used to determine independent predictors of WTP for SHI. Qualitative data were analyzed using thematic analysis. Results: A response rate of 92.45% was achieved among the 636 participants, with 588 healthcare professionals completing the interview. The majority (61.7%) of participants were willing to join and pay the suggested SHI premium. Participants' WTP was significantly positively associated with the presence of under five years of children but their willingness to pay was significantly negatively associated with the female gender and increasing monthly salary. On the other hand, on the qualitative side, the amount of premium contribution, benefits package, and quality of service were the major factors affecting their WTP. Conclusion: The majority of healthcare professionals were willing to pay for the SHI scheme, almost as much as the premium set by the government. This suggests proof that healthcare financing reform is feasible, particularly for the implementation of the SHI system.

Herbal medicine use among pregnant women at antenatal clinic in Ethiopia.

Background: Herbal medicines are raw or processed plant-derived ingredients. Their use during pregnancy may contributed to several adverse effects that could be lethal to the mother and their unborn children. Aims: This study aims to assess the prevalence of herbal medicine use and associated factors among pregnant women at Woldia General Comprehensive Specialized Hospital (WGCSH) in Ethiopia. Samples: The sample size in this study was 272. Methods: A facility-based cross-sectional study was conducted among 270 pregnant mothers from March 2 to April 2, 2021, at WGCSH in the antenatal care clinic. A standardized, structured questionnaire-based interviewer was used to collect the socio-demographic variables; obstetrics variables; and other related variables for this study. The prevalence of herbal medicine use and associated factors were determined using descriptive and logistic regression analysis, with p < 0.05 considered statistically significant. Results: The prevalence of herbal medicine use in this study was 22.6%. Most of the pregnant women used Ocimum lamiifolium and Rutachalepensis. The use of herbal medicines during pregnancy in rural areas was higher than in urban areas (OR 2.51; 95% CI 1.35-3.54). The place of residence (AOR 3.66; 95% CI 1.83-4.74), perception of needing to use herbal medicine (AOR 2.20; 95% CI 4.99-9.86), stage of pregnancy (AOR 2.56; 95% CI 1.16-9.36), distance from the health facility (AOR 2.90; 95% CI 1.52-12.65), and previous use of herbal medicine (AOR 3.23; 95% CI 2.74-7.56) were significantly associated with herbal medicine use. Conclusions: Nearly one-fourth of pregnant mothers at WGCSH used herbal products and preparations.

Drug Therapy Problems and Associated Factors Among Hypertensive Patients in North Wollo Public Hospitals, Northeast Ethiopia: Institutional-Based Cross-Sectional Study.

Background: Drug therapy problems (DTPs) are common in people with hypertension and may threaten the effective management of the disease. The purpose of this study was to determine the prevalence and predictors for DTPs in hypertensive people in North Wollo public hospitals. Methods: On patients with hypertension, a cross-sectional study based in a health institution was carried out using an interviewer-administered structured questionnaire and medical record review from 6 November 2022 to 18 January 2023. All hypertensive patients, ages 18 and older, who underwent regular follow-ups for at least 12 months were included in the study using a simple random sampling method. Multivariate logistic regression analysis was used to establish the association between independent variables and the occurrence of DTPs. Unnecessary drug therapy, the need for additional drug therapy, ineffective drugs, dosage too low, dosage too high, adverse drug reactions, and noncompliance were the outcome variables. Results: The study included 376 hypertensive patients. Of the total participants, 258 (68.6%) were female. The mean number of drug therapy problems per patient was 1.55 ± 0.307, with 298 participants (79.3%) reporting having at least one such problem. This study found that the need for additional drug therapy was the most prevalent problem (149, 39.66%). Polypharmacy (AOR = 2.487, 95% CI = 1.375-4.499, p = 0.003), presence of comorbidity (AOR = 1.886, 95% CI = 1.035-3.439, p = 0.038), and uncontrolled BP (AOR = 2.961, 95% CI = 1.669-5.254, p = <0.001) predicts the development of drug therapy problems. Conclusion: Patients with hypertension who are on follow-up experience drug therapy problems frequently. Promoting the involvement of clinical pharmacists in designing, implementing, and monitoring therapeutic plans is recommended to decrease the occurrence of drug therapy problems.

Evaluation of Analgesics and Anti-Inflammatory Activity of the Root Extract of Impatiens rothii (Balsaminaceae) in Rodents.

Background: The roots of Impatiens rothii has been used as a traditional remedy for painful conditions, rheumatism, isthmus and crural aches. However, the analgesic and anti-inflammatory properties of this plant have yet to be scientifically confirmed. The purpose of this study was to explore possible analgesic and anti-inflammatory activities 80% methanolic root extract of Impatiens rothii. Methods: To obtain the crude extract, the roots of Impatiens rothii that had been dried and ground up were macerated in 80% methanol. The analgesic activity was determined using acetic acid-induced writhing and hot plate tests in mice, whereas the anti-inflammatory activity was analyzed using carrageenan-induced paw edema model in rats. The extract was orally administered at a dose of 100, 200 and 400 mg/kg. Results: All tested doses of Impatiens rothii extract showed significant analgesic activity (p<0.05) at observations of 30 to 120 minutes compared to the negative control in the hot plate test. In acetic acid-induced writhing test all tested doses of the 80% methanol extract of Impatiens rothii significantly (p < 0.001) reduced the number of writhing. In comparison to the control group, all tested doses displayed a significant decrease in paw edema, which appeared 2-5 hours after induction (p<0.05). Conclusion: From the results of this study, it can be stated that 80% methanolic extract of Impatiens rothii possessed substantial analgesic and anti-inflammatory activities, hence providing scientific basis for the use of this plant in the treatment of pain and inflammatory diseases.

Evaluation of the Anti-Malarial Activity of the Crude Root Extract and Solvent Fraction of Sesamum indicum (Fabaceae).

Background: A major cumbersome factor in malaria control measure is the new coming antimalarial drug resistance strains. The increase of resistance to the available marketed antimalarial agents dictates the scientific community to search new alternative antimalarial agent from traditional plants. Therefore, our study assesses the antimalarial activity of the crude root extract and solvent fraction of Sesamum indicum in mice. Methods: The roots of Sesamum indicum were extracted by 80% methanol and fractionated using three solvents with different polarities. The in vivo antimalarial activity was assessed at 200 mg/kg, 400 mg/kg, and 600 mg/kg of the root crude extract and solvent fraction using the 4-day suppressive test. Similarly, the n- butanol fraction extract, which showed better suppression potential in 4-day suppressive test from other fractions was also evaluated in the curative model to assess its curative potential. The % parasitemia suppression, mean survival time, body weight change, rectal temperature change, and packed cell volume change were also evaluated in both models. Results: Our finding revealed that the crude extract and solvent fraction treated groups had a statistical significant parasitemia suppression and mean survival time improvement as compared to the negative control (p<0.001) in both models in a dose-dependent fashion. The higher dose n-butanol fraction treated group (600mg/kg) showed the highest suppression effect and mean survival time prolongation in both tests from the other two fractions. However, the lowest suppressive effect was observed in 200 mg/kg aqueous fraction extract-treated groups in the 4-day suppressive test. Conclusion: The crude root extract and solvent fractions of Sesamum indicum possessed a dose dependent antimalarial activity and a significant change in other parameters in both models that strengthen the traditional claim.

Analgesic and Anti-Inflammatory Activities of 80% Methanol Extract and Solvent Fractions of Ehretia cymosa Thonn (Boraginaceae) Leaves in Rodents.

Background: Ethnobotanical studies in various districts of Ethiopia reported that Ehretia cymosa (E. cymosa) is used for the management of headache, abdominal pain, arthritis and rheumatism. However, there is no scientific investigation done so far to confirm these traditional claims. Thus, the aim of this study was to assess the analgesic and anti-inflammatory effects of the 80% methanol extract and fractions of E. cymosa leaves. Methods: The dried and pulverized leaves of E. cymosa were soaked with 80% methanol to obtain a crude extract. Fractionation was done using chloroform, ethyl acetate and water by a soxhlet apparatus. The analgesic effects of the crude extract and solvent fractions were assessed using acetic acid-induced writhing and hot plate tests whereas anti-inflammatory activities were investigated using carrageenan-induced paw edema and cotton-pellet-induced granuloma models. Results: In all the tested doses, the 80% methanol extract and solvent fractions revealed substantial (p < 0.001) analgesic activities in acetic acid induced writhing test. In the hot plate method, all the tested doses of E. cymosa crude extract and the solvent fractions produced significant analgesic activities (p < 0.05). In the carrageenan-induced acute inflammation model, all tested doses of the crude extract and solvent fractions resulted in a significant decline in paw edema. The 80% methanol extract and solvent fractions of E. cymosa at all the tested doses significantly reduced inflammatory exudates and granuloma mass formations (p < 0.001). Conclusion: From the results of this investigation, it can be stated that 80% methanol extract, aqueous, ethyl acetate and chloroform fractions of E. cymosa exhibited considerable analgesic and anti-inflammatory activities, supporting the plant's traditional use as a remedy for a variety of painful and inflammatory conditions.