Extent of and Factors Associated with Self-Medication among Clients Visiting Community Pharmacies in the Era of COVID-19: Does It Relieve the Possible Impact of the Pandemic on the Health-Care System?

BACKGROUND: Self-medication is one aspect of self-care that has been shown to benefit primary health care. When done correctly, it provides significant benefits to customers, such as self-reliance and cost savings. Inappropriate methods, on the other hand, such as incorrect self-diagnosis and therapy selection, can be disastrous. The COVID-19 pandemic context may benefit the community in easing the burden on the health system. There have been no studies conducted on this possibility in the context of COVID-19 in a selected area, hence the purpose of this study was to determine the extent of and factors associated with self-medication among clients visiting community pharmacies in west Harerghe, Ethiopia from June 1 to 30, 2020. METHODS: This institution-based cross-sectional study used a systemic random sample of 416 community-pharmacy clients. To collect data, face-to-face interviews were conducted using pretested semistructured questionnaires modified from established techniques. EpiData 3.1 was used to enter data and SPSS 24 for analysis. To determine factors associated with self-medications, bivariate and multivariate logistic regression analyses were performed. AORs with 95% CIs are used to report associations, and the level of significance was set at P<0.05. RESULTS: The proportion of people self-medicating was 73.6% (95% CI 69.2%-77.9%). Self-medications were significantly associated with age 18-24 years (AOR 9.28, 95% CI 3.56-24.21) and 25-34 years (AOR 3.54, 95% CI 1.35-9.27), Amhara ethnicity (AOR 1.72, 95% CI 1.01-2.94), current single status (AOR 0.28, 95% CI 0.15-0.51), government employment (AOR 0.31, 95% CI 0.12-0.82), and limited knowledge (AOR 2.31, 95% CI 1.40-3.79). CONCLUSION: Three in four participants practiced self-medication in the era of COVID-19. Repetition was significantly associated with age, ethnicity, current marital status, type of occupation, and knowledge about self-medications. An alternative medical care-delivery system by all health-care providers and increasing community awareness should be promoted.

Drug-related problems in Ethiopian public healthcare settings: Systematic review and meta-analysis.

Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Electronic databases were searched including PubMed, EMBASE, Web of Science, MEDLINE and HINARI, Google Scholar and ResearchGate for both published and unpublished works. Data on study characteristics and outcomes were extracted using the format developed on Microsoft Excel. The primary measure was the pooled prevalence of drug-related problems. The meta-analysis was conducted using OpenMeta[Analyst].A total of 17 studies were included in this systematic review and meta-analysis. The pooled prevalence of drug-related problems of patients who experienced at least one drug-related problem during their therapy was found to be 69.4% (95% confidence interval: 61.5-77.4). The most frequently reported types of drug-related problems were "need for additional drug and "noncompliance," together accounting for more than half of the drug-related problems. The most frequently reported factors associated with drug-related problems were patients' age, polypharmacy, comorbidities and the number days of hospital stay.The prevalence of drug-related problems in Ethiopian public healthcare settings was found to be high. Inconsistent reporting of drug-related problems was observed across the studies. It is imperative to design and implement interventions aimed at reducing drug-related problems. Responsible stakeholders should adopt uniform drug-related problem classification approach to ensure uniform reporting of drug-related problems in Ethiopian healthcare settings.

Prevalence and associated factors of diabetic foot ulcers among type 2 diabetic patients attending chronic follow-up clinics at governmental hospitals of Harari Region, Eastern Ethiopia: A 5-year (2013-2017) retrospective study.

INTRODUCTION: Diabetic foot disease is a growing major public health problem and the leading cause of prolonged hospital admission, health-related costs, and reduced quality of life for diabetes patients. This study aimed to determine the prevalence of diabetic foot ulcers (DFU) and its associated factors among type 2 diabetes patients in Harari Region, East Ethiopia. METHODS: An institution-based retrospective study was conducted from 28 March to 30 April 2018, among type 2 diabetes patients diagnosed between 1 January 2013 and 31 December 2017, at three government hospitals of Harari Region. Data were collected using a standard checklist format. Data were entered into Epi Info Version 7 and analyzed using SPSS 24. Binary and multiple logistic regression models were used to determine the associated factors. Odds ratio with 95% confidence intervals was used to determine level of association. RESULT: A document of 502 type 2 diabetes patients was reviewed and included in the final analysis in this study. The prevalence of DFU among type 2 diabetes patients was 21.1%. Being currently married decreased the odds of DFU by 60% (adjusted odds ratio = 0.40; 95% confidence interval: 0.17-0.96). Factors associated with increased diabetes ulcers chance were physical inactivity 2.29 (adjusted odds ratio = 2.29; 95% confidence interval: 1.17-4.48), starting treatment with insulin 4.43 times (adjusted odds ratio = 4.43; 95% confidence interval: 1.84-10.67), obesity 27.76 (adjusted odds ratio = 27.76; 95% confidence interval: 13.96-55.23), delay to start follow-up 2.22 (adjusted odds ratio = 2.22; 95% confidence interval: 1.03-4.82), history of infection 3.50 (adjusted odds ratio= 3.50; 95% confidence interval: 1.83-6.69), and hypertension 3.99 (adjusted odds ratio = 3.99; 95% confidence interval: 2.08-7.65). CONCLUSION: The prevalence of DFU among type 2 diabetes is substantially high as more than one in five patients have this complication. Moreover, marital status, physical activity, baseline medication, obesity, delay for follow-up, infection history, and hypertension were significantly associated with the development of DFU.

Antibiotic Resistance Profile of Bacteria Isolated from Wastewater Systems in Eastern Ethiopia.

World Health Organizations launched a global action plan on antimicrobial resistance since 2015. Along with other objectives, the plan was aimed to strengthen knowledge of the spread of antimicrobial resistance through surveillance and research. Given their high bacterial densities and that they receive antibiotics, metals, and other selective agents, wastewater systems are a logical hotspot for antibiotic resistance surveillance. The current study reports on the result of antibiotic resistance surveillance conducted in selected wastewater systems of Eastern Ethiopia from Feb. 2018 to Oct. 2019. We monitored three wastewater systems in Eastern Ethiopia, such as the activated sludge system of Dire Dawa University, waste stabilization pond of Haramaya University, and a septic tank of Hiwot Fana Specialized University Hospital for 18 months period. We collected 66 wastewater samples from 11 sampling locations and isolated 722 bacteria using selective culture media and biochemical tests. We tested their antibiotic susceptibility using the standard Kirby-Bauer disk diffusion method on the surface of the Mueller-Hinton agar and interpreted the result according to EUCAST guidelines. The result shows the highest percentage of resistance for ampicillin among isolates of hospital wastewater effluent which is 36 (94.7%), 33 (91.7%), and 32 (88.9%) for E. coli, E. faecalis, and E. faecium, respectively. A lower rate of resistance was seen for gentamicin among isolates of activated sludge wastewater treatment system which is 10 (16.4%), 8 (13.3%), 11 (18.9%), and 12 (20.3%) for E. coli, E. faecalis, E. faecium, and P. aeruginosa, respectively. Hospital wastewater exhibited higher resistance than the other two wastewater systems. The Multiple Antibiotic Resistance Index (MARI) has significantly increased in the wastewater's course treatment process, showing the proliferation of resistance in the wastewater treatment system.

Knowledge, attitude and practice of lifestyle modification recommended for hypertension management and the associated factors among adult hypertensive patients in Harar, Eastern Ethiopia.

INTRODUCTION: Hypertension is an overwhelming global challenge. Appropriate lifestyle modifications are the cornerstone for the prevention and control of hypertension. In this regard, lack of knowledge and poor attitude toward lifestyle modification have been a major setback. OBJECTIVE: To assess knowledge, attitude and practice of lifestyle modification recommended for hypertension management and the associated factors among adult hypertensive patients in Harar, Eastern Ethiopia. METHODS: Hospital-based cross-sectional study was conducted among 274 hypertensive patients in Hiwot Fana Specialized University Hospital, from 1 March to 30 May 2019. The pre-tested structured questionnaire was used, and the data were collected through an interview. The data were analyzed using SPSS version 20. A multivariate logistic regression model was fitted to determine independent predictors of knowledge and practice of lifestyle modifications among hypertensive patients. Adjusted odds ratio (AOR) at 95% confidence interval (CI) was used for predicting the independent effect of each variable on the outcome variables. RESULTS: From the total participants, 200 (73.0%) of participants had good knowledge, 182 (66.4%) had favorable attitude and 136 (49.6%) had good practice on lifestyle modification recommended for hypertension management. Regarding factors associated with lifestyle modification, being in age range of 46-64 years (AOR: 4.08, 95% CI: 1.14-14.56); having formal education (AOR: 3.93, 95% CI: 1.27-12.23); being government employee (AOR: 8.06, 95% CI: 1.40-46.32) and being housewives (AOR: 5.10, 95% CI: 1.26-20.79) were factors significantly associated with good knowledge of lifestyle modification, However, favorable attitude was found to be the only factor associated with good practice of lifestyle modification (AOR: 9.20, 95% CI: 2.60-32.24). CONCLUSION: In the current study, knowledge and attitude toward lifestyle modification recommended for hypertension management was fairly good but practice level was poor. Concerted strategies are required to increase the knowledge, attitude and practice of the lifestyle modification measures in this population group.

Prescription drugs use during pregnancy in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The selection of safe drugs for pregnant women in developing countries, such as Ethiopia, where there are limited options of drugs would be challenging. Hence, the aim of this review was to determine the extent of prescribed drugs use and their potential to cause fetal harm among pregnant women in Ethiopia based on the United States Food and Drug Administration risk category. METHODS: Relevant studies were identified through systematic searches conducted in PubMed, HINARI, Google Scholar and Researchgate. Data on study characteristics and outcomes were extracted using the format developed in Microsoft Excel. The primary measure was pooled prevalence of prescription drugs use during pregnancy. The I2 index was used to assess heterogeneity among studies. The presence of publication bias across studies was evaluated using funnel plot. A random effects model was used to estimate the pooled prevalence. RESULTS: A total of nine studies published between 2013 and 2019 were included. The pooled prevalence of prescription drugs during pregnancy, excluding minerals and vitamins, was 45.9 (95%CI: 29.3, 62.5)%. The pooled prevalence of prescription drug use, including minerals and vitamins, was 86.9 (95%CI: 81.2, 92.6)%. The pooled proportion of medications used based on the United States Food and Drug Administration risk category was 56.1 (95%CI: 43.0, 68.4)%, 29.0 (95%CI: 27.9, 30.1)%, 12.1 (95%CI: 7.9, 18.1)%, 4.1 (95%CI: 3.6, 4.6)%, and 2.5 (95%CI: 1.8, 3.6)% for the United States Food and Drug Administration fetal risk category "A," "B," "C," "D," and "X," respectively. CONCLUSION: The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. Drugs with evidence of fetal harm were widely used. Hence, health care providers should select relatively safe drugs. Stakeholders should ensure safe prescribing practice for pregnant women through developing guidelines and updating professionals on the fetal risk status of commonly prescribed drugs.

Evaluation of Medication Use Pattern Among Patients Presenting to the Emergency Department of Hiwot Fana Specialized University Hospital, Using WHO Prescribing Indicators.

BACKGROUND: Ensuring rational drug use requires ongoing evaluation of drug prescribing, dispensing, and use by patients. Health care providers working in an emergency department face unique challenges, including making urgent decisions, patient overload, and limited resources, which contribute to inappropriate drug use. Rational medication use should be an important aspect of emergency care to improve patient outcomes. Thus, this study was conducted to assess medication utilization patterns using World Health Organization (WHO) prescribing indicators in the emergency department. METHODS: A cross-sectional study design was implemented among patients presenting at the emergency department of Hiwot Fana Specialized University Hospital (HFSUH) from January to March 2018. The data were collected from the medical charts of a total of 342 patients using a pre-prepared structured format according to WHO recommendations. The data were analyzed using SPSS version 21 software and presented in tables and figures. RESULTS: The most commonly reported clinical diagnosis was found to be soft tissue laceration or abrasion, in 75 patients (21.9%), followed by dyspepsia, in 50 (14.6%), and severe pneumonia, in 44 (12.9%). A total of 810 drugs were prescribed for the 342 patients. The main category of drugs prescribed were analgesics, constituting 125 (29.2%), followed by antibiotics, 120 (28.0%). Regarding WHO prescribing indicators, the average number of drugs prescribed per encounter was 2.36, the number of encounters at which antibiotics were prescribed was 127 (37.13%), and injections were prescribed at 300 (87.7%) encounters. All of the drugs prescribed were from the National Essential Medicine List (NEML) of Ethiopia, and 780 (98.1%) of the drugs were prescribed by international nonproprietary name. CONCLUSION: Overall, there were inflated use of antibiotics and injection drugs, whereas prescribing by international nonproprietary name and prescribing from NEML were according to the recommendations. Hence, the hospital should work to ensure the judicious use of antibiotics and injection drugs.

Job satisfaction among pharmacy professionals working in public hospitals and its associated factors, eastern Ethiopia.

BACKGROUND: Poor job satisfaction has been associated with less productivity and high staff turnover. Various factors are thought to contribute for job dissatisfaction among pharmacy professionals and very limited studies have been conducted in eastern part of Ethiopia. Therefore, the current study was aimed to assess the level of job satisfaction among pharmacy professionals and its predictors. METHODS: A cross-sectional study was conducted among 232 pharmacy professionals to assess level of job satisfaction in public hospitals located in the eastern Ethiopia. The data were collected using self- administered semi-structured questionnaires. Data were entered into Epi-Data version 3.1 and exported to STATA version 14.2 for analysis. Associations between the dependent and independent variables were assessed by multivariate analysis using an Adjusted Odds Ratio (AOR) at a 95% confidence interval (CI) and p-value less than 0.05 was considered as significant. RESULTS: A total 220 questionnaires were found complete and included in the analysis. The mean age of participants was 27.6(SD + 4.1). More than half of the respondents (55.4%) had a bachelor degree and the majority (86.4%) were working less than 40 h per week, mostly in dispensing units (75.4%). About one third of the participants (32.7, 95% CI; 26.8-39.2) were found to be satisfied with their job. Age category of 20 to 25 years in reference to age greater than 30 years (AOR = 3.5, 95% CI; 1.1-9.7), holding a bachelor degree in reference to having diploma (AOR = 4.2, 95% CI; 1.8-10.00), working for more than 40 h per week (AOR = 6.2, 95% CI, 2.4-16), and working in dispensing units (AOR = 2.4, 95% CI; 1.1-5.5) were found to have strong association with job dissatisfaction. CONCLUSION: In this study, the job satisfaction levels of pharmacy professionals were found to be very low. The age category of 20 to 25, holding a bachelor degree, working for more than 40 h per week, and working in dispensing unit were found to be strong predictors of job dissatisfaction. Hence, pharmacy directors and hospital administrators should work to reduce unnecessary workload on the staffs and create good working climate.

Assessment of patient satisfaction with pharmacy service and associated factors in public hospitals, Eastern Ethiopia.

BACKGROUND: A comprehensive understanding of the extent of patient satisfaction and its determinants are crucial in improving the quality of service. Hence, this research was designed to measure patient satisfaction with pharmacy service. METHODS: A cross-sectional study was conducted among 422 patients to assess satisfaction with pharmacy service in public hospitals located in Eastern Ethiopia from September to January 2018. Data were collected through an exit interview using structured questionnaires. Then, it was entered into EpiData version 3.1 and exported to STATA version 14.2 for analysis. Associations between dependent and independent variables were assessed by multiple logistic regression using an adjusted odds ratio at a 95% confidence interval and the p values of less than 0.05. RESULTS: A total of 407 samples were included in the final analysis. The mean overall satisfaction of clients measured out of five was 2.29 (standard deviation ± 0.56). The proportion of overall satisfaction was 46.19%. Patients within the age range of 26-35 years and 36-50 years were found to have 50% (adjusted odds ratio = 0.5, 95% confidence interval: 0.3, 0.9) and 60% (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) decreased likelihood of satisfaction compared with patients within the range of 18-25 years, respectively. Likewise, patients who attended only secondary education compared to their counterpart (a certificate and above) were less likely to be satisfied (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8). In contrast, rural dwellers and patients who collected all their medications from the respective hospital were found to be more satisfied compared with their equivalent (adjusted odds ratio = 3, 95% confidence interval: 1.8, 5.2) and (adjusted odds ratio = 2.2, 95% confidence interval: 1.4, 3.5), respectively. CONCLUSION: Patient satisfaction with pharmacy service was found to be very low considering the current health-care system movement toward delivering quality service. Hence, health-care providers and administrators should give due attention to contributing factors in order to improve the quality of service and ultimately increase patient satisfaction.

Assessment of Knowledge and Attitude among Pharmacists toward Pharmaceutical Care in Eastern Ethiopia.

OBJECTIVE: To assess knowledge and attitudes toward pharmaceutical care service among hospital and community pharmacists working in Harar and Dire Dawa town, Eastern Ethiopia. METHOD: A descriptive cross-sectional study was conducted among pharmacists working in hospital and community pharmacies, 2018. A total of 43 health settings (6 hospital and 37 community pharmacies) were involved in this study. All pharmacists who met the inclusion criteria were selected using a purposive sampling technique to take part in the study. The pretested structured self-administered questionnaires were used to collect data. The collected data was coded, entered, and analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. The findings were presented by frequencies and percentages, and summary measures were displayed using tables. Chi-Square test and Fisher's exact test were performed to determine the association between sociodemographic characteristics and the level of knowledge and attitude about pharmaceutical care. The study protocol was approved by the Harar Health Sciences College Research Ethics Review Committee. RESULTS: A total of seventy-eight pharmacists were included in the study with a response rate of 97.5%. The mean age (±Standard Deviation (SD)) of the study participants was 32.47 ± 7.42 years, and the majority (88.3%) of the respondents were males. 56.4% of the respondents were working in the hospitals while 43.6% were working in community pharmacy. Overall, 85.9% of the respondents had good knowledge of pharmaceutical care. The types of training curriculum of the participants showed an association with the attitude of pharmacists (P value = 0.022). Similarly, pharmacists' knowledge was associated with their practice setting (P value = 0.022). Similarly, pharmacists' knowledge was associated with their practice setting (. CONCLUSION: The majority of pharmacists are knowledgeable about PC. However, nearly half of the pharmacists had an unfavorable attitude toward pharmaceutical care. Harari Regional and Dire Dawa City Health Bureaus should organize and provide in-service training on pharmaceutical care to pharmacists working in community and hospital pharmacies. Furthermore, the bureaus should advocate pharmaceutical care as one area in a continuous professional development program.

Prevalence of Cardiovascular Disease and Associated Factors Among Type 2 Diabetes Patients in Selected Hospitals of Harari Region, Eastern Ethiopia.

Background: Cardiovascular disease (CVD) is the most prevalent complication and the leading cause of death among patients with diabetes mellitus (DM). Type 2 diabetes mellitus (T2DM) patients have a 2- to 4-fold increased risk of CVD. There is a scarcity of data about the magnitude of CVD among patients with diabetes in Ethiopia. This study aimed to assess the prevalence and associated factors of CVD among T2DM patients at selected hospitals of Harari regional state of Ethiopia. Methods: This hospital-based retrospective data review was conducted among T2DM patients on follow-up in the diabetes clinics of selected hospitals of Harari regional state. The records of T2DM patients who have been diagnosed between January 1, 2013, and December 31, 2017, were reviewed from March to April 2018. Data were collected by using structured checklists from all necessary documents of T2DM patients. Statistical analysis was done using STATA 14.1. Bivariate and multivariate logistic regressions were used to identify factors associated with CVD. Result: The records of 454 T2DM patients were extracted from three government hospitals in Harari regional state. Their age was ranging from 15 to 86 years with a mean age (±SD) of 45.39 (14.76). The overall prevalence of CVD among T2DM patients was 42.51%, composed of hypertensive heart diseases (38.99%), heart failure (6.83%), and stroke (2.20%). The final multivariate logistic regression model revealed that age older than 60 years [adjusted odds ratio (AOR) = 3.22; 95% CI: 1.71-6.09], being physically inactive (AOR = 1.45; 95 CI: 1.06-2.38), drinking alcohol (AOR = 2.39; 95% CI: 1.17-6.06), hypertension (AOR = 2.41; 95% CI: 1.52-3.83), body mass index >24.9 kg/m2 (AOR = 1.81; 95% CI: 1.07-3.07), and experiencing microvascular diabetic complications (AOR = 3.62; 95% CI: 2.01-6.53) were significantly associated with the odds of having CVD. Conclusion: The prevalence of CVD was high and associated with advanced age, physical inactivity, drinking alcohol, higher body mass index, hypertension, and having microvascular complications. Health care workers should educate T2DM patients about healthy lifestyles like physical activity, weight reduction, blood pressure control, and alcohol secession, which can reduce the risk of CVD.

Treatment Outcome of Tuberculosis and Associated Factors among TB-HIV Co-Infected Patients at Public Hospitals of Harar Town, Eastern Ethiopia. A five-year retrospective study.

BACKGROUND: The bidirectional relationship between the twin epidemics of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) causes major global health challenges in the twenty-first century. TB-HIV co-infected people are facing multifaceted problems like high lost to follow up rates, poor treatment adherence, high TB recurrence rate, and high mortality risk. Our objective was to assess the outcomes of TB treatment and associated factors among TB-HIV co-infected patients in Harar town, Eastern part of Ethiopia, 2018. METHODS: A retrospective study was conducted among systematically selected 349 TB/HIV co-infected patients who registered from 2012 to 2017 in two public hospitals in Harar town. The data were collected through document review by using a pre-tested structured data extraction checklist. The data were analyzed using SPSS Version 21. Bivariate and multivariate logistic regression were determined at 95% confidence intervals. RESULTS: Among the 349 TB/HIV co-infected patients included in the study, 30.1% were cured, 56.7% had completed their treatment, 7.7% died, 1.7% were lost to follow up, and 3.7% were treatment failure. Overall, 86.8% of the TB-HIV co-infected patients had successful TB treatment outcomes. The patients who were on re-treatment category (AOR = 2.91, 95% CI: 1.17-7.28), who had a history of opportunistic infection (AOR = 3.68, 95% CI: 1.62-8.33), and who did not take co-trimoxazole prophylaxis (AOR = 3.54, 95% CI: 1.59-7.89) had 2.91, 3.68, and 3.54 times higher odds of having unsuccessful TB treatment outcome than their counterparties, respectively. The chance of unsuccessful TB treatment outcome was 4.46 (95% CI: 1.24-16.02), 5.94 (95% CI: 1.87-18.85), and 3.01 (95% CI: 1.15-7.91) times higher among TB/HIV patients in stage 2, 3 and 4 than those in stage 1, respectively. CONCLUSIONS: The overall rate of the success of the TB treatment among TB-HIV co-infected patients in this study was higher compared with many previous studies. TB/HIV patients with a history of previous TB treatment, smear-positive pulmonary TB, late HIV stage, history of opportunistic infection and not being on co-trimoxazole prophylaxis therapy were at a high risk of getting poor treatment outcomes.

Monotherapy with Metformin versus Sulfonylureas and Risk of Cancer in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Accumulating evidence suggests that patients with type 2 diabetes mellitus and hyperinsulinemia are at an increased risk of developing malignancies. It remains to be fully elucidated whether the use of metformin, an insulin sensitizer, and/or sulfonylureas, insulin secretagogues, affects cancer incidence in subjects with type 2 diabetes mellitus. OBJECTIVE: A systematic review and meta-analysis was performed to compare the risk of cancer incidence associated with monotherapy with metformin compared with monotherapy with sulfonylureas in type 2 diabetes mellitus patients. METHODS: Search was performed throughout MEDLINE/PubMed, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up until December 2018. In this meta-analysis, each raw data (unadjusted) and study-specific (adjusted) relative risks (RRs) was combined and the pooled unadjusted and adjusted RRs with the 95% CI were calculated using the random-effects model with inverse-variance weighting. Heterogeneity among the studies was evaluated using I 2 statistics. Publication bias was evaluated using the funnel plot asymmetry test. The Newcastle-Ottawa scale (NOS) was used to assess the study quality. RESULTS: A total of 8 cohort studies were included in the meta-analysis. Obvious heterogeneity was noted, and monotherapy with metformin was associated with a lower risk of cancer incidence (unadjusted RR = 0.74, 95% CI: 0.55-0.99, I 2 = 97.89%, p < 0.00001; adjusted RR = 0.76, 95% CI: 0.54-1.07, I 2 = 98.12%, p < 0.00001) compared with monotherapy with sulfonylurea, using the random-effects model with inverse-variance weighting. CONCLUSIONS: According to this review, the monotherapy with metformin appears to be associated with a lower risk of cancer incidence than monotherapy with sulfonylurea in patients with type 2 diabetes. This analysis is mainly based on cohort studies, and our findings underscore the need for large-scale randomized controlled trials to establish the effect of metformin monotherapy, relative to sulfonylureas monotherapy on cancer.

Tuberculosis Treatment Outcomes and Associated Factors among TB Patients Attending Public Hospitals in Harar Town, Eastern Ethiopia: A Five-Year Retrospective Study.

INTRODUCTION: Tuberculosis remains a major public health threat throughout the world particularly in developing countries. Evaluating the treatment outcome of tuberculosis and identifying the associated factors should be an integral part of tuberculosis treatment. OBJECTIVES: The aim of this study was to assess the treatment outcome of tuberculosis and its associated factors among TB patients in the TB clinics of Harar public hospitals, Eastern Ethiopia, 2017. METHODS: A retrospective document review was conducted in two public hospitals of Harar town, located 516 km east of Addis Ababa. A systematic random sampling technique was used to select the document of TB patients who were registered in the hospitals from 1st of January, 2011, to 30th of December, 2015. The data were collected using a pretested structured data extraction format. SPSS Version 21 for window was used for data processing. Bivariate and multivariate analysis with 95% confidence interval was employed in order to infer the associations between TB treatment outcome and potential predictor variables. RESULTS: One thousand two hundred thirty-six registered TB patients' documents were reviewed. Of these, 59.8% were male, 94.2% were urban dwellers, 97% were new cases, 61.2% were presented with pulmonary TB, and 22.8% were HIV positive. Regarding the treatment outcome, 30.4% were cured, 62.1% completed their treatment, 3.9% died, 2.4% were defaulted, and the remaining 1.2% had failed treatment. The overall rate of the treatment success among the patients was 92.5%. In the present study, being female (AOR = 1.89, 95% CI: 1.14 - 3.14), having pretreatment weight of 20 - 29 kg (AOR = 11.03, 95% CI: 1.66 - 73.35), being HIV negative (AOR = 6.50, 95% CI: 3.95 - 10.71), and being new TB patient (AOR = 3.22 95% CI: 1.10 - 9.47) were factors independently associated with successful treatment outcome. On the other hand, being in the age group 54 - 64 years (AOR =10.41, 95% CI: 1.86 - 58.30) and age greater than 65 years (AOR =24.41, 95% CI: 4.19 - 142.33) was associated with unsuccessful TB treatment outcome. CONCLUSION: In the current study, the rate of successful TB treatment outcome was acceptable. This rate should be maintained and further improved by designing appropriate monitoring strategies.

Pattern of and reasons for antiretroviral therapy regimen change among adult HIV/AIDS patients at regional hospital in Eastern Ethiopia: A 10-year retrospective study.

OBJECTIVES: Despite the successes of treatment with antiretroviral therapy in reducing morbidity and mortality among HIV-infected patients, long-term sustainability of the initial regimen has become challenging. Therefore, this study is aimed to address pattern of and reasons for change of antiretroviral therapy regimens among HIV/AIDS patients at Jugel Hospital, Eastern Ethiopia. METHODS: A retrospective cross-sectional study was conducted to review medical records of 220 patients who had been on treatment and experienced regimen change at least once from September 2006 to August 2016. Structured data abstraction format was customized from World Health Organization guideline. Data were entered in Epi-data version 3.1, and exported to and analyzed with Statistical Package for Social Sciences version 20. Following descriptive statistics, binary logistic regression was run to determine the association between selected variables and second-time regimen change. RESULTS: The mean age of patients was 37.6 (±8.9) years and 62.3% of them were female. Majority of the patients were presented to the hospital with World Health Organization clinical stage III (59.1%) and CD4 count below 200 cells/mm3 (68.6%). The mean duration of stay on initial regimen was found to be 3.26 (±1.92) years. The average number of initial regimen changes per year was 22 (±11.28). In two-thirds (66.36%) of the patients, their initial regimen was changed to tenofovir disproxil fumarate-based alternatives. The most-frequent reason for initial regimen change was toxicity (32.3%). Among those who experienced the regimen change for the first time, the prevalence of second-time regimen change was found to be 18.18%. Patients who had been taking tuberculosis treatment along with antiretroviral therapy were more likely to get their regimen changed for the second-time compared to those who were not infected with tuberculosis (adjusted odds ratio: 3.40; 95% confidence interval: 1.87-6.47). Besides, patients who were on zidovudine-based (adjusted odds ratio: 0.26; 95% confidence interval: 0.33-0.47) and tenofovir disoproxil fumarate-based regimens (adjusted odds ratio: 0.03; 95% confidence interval: 0.01-0.12) were less likely to get their regimen changed for the second-time compared to those who were on stavudine-based regimens. CONCLUSION: The majority of the patients had their treatment regimen changed because of drug-related toxicities, treatment failure, and comorbid conditions. Some regimen changes might be attributable to failure of either hospital supply system or patient-related factors which would have been prevented considering limited number of treatment options. There must be consideration of risks and benefits prior to changing a particular regimen.

Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital.

BACKGROUND: Critically ill patients with moderate-to-severe physiologically stressful event are at high risk of developing stress ulcers. The use of pharmacological prophylaxis significantly reduces the incidence of stress ulcer in high-risk patients. OBJECTIVE: The aim of this study was to assess the use of pharmacological prophylaxis for stress ulcer in the medical wards of University of Gondar Hospital. METHODS: A cross-sectional study design was used. In total, 234 patients were selected through simple random sampling technique. The risk of stress ulcer development was assessed using Evidence-Based Medicine Guideline for stress ulcer prepared by Orlando Regional Medical Center. SPSS version 21 was used for data analysis. RESULT: The most common acute risk factor to stress ulcer was coagulopathy (18.4%), followed by hypoperfusion (9.8%). The concomitant non-steroidal anti-inflammatory drug use (16.7%), mild-to-moderate brain or spinal cord injury (11.1%), and concomitant or recent corticosteroid use (9.4%) were frequently seen risk factors that necessitate administration of a prophylaxis. In total, 82 (35%) study participants were given stress ulcer prophylaxis, among which 52 (63.4%) were given without indication. The most commonly used drug class in the prevention of stress ulcer was proton pump inhibitors (76/82, 92.7%). In total, 43 (18.4%) study subjects were not given stress ulcer prophylaxis while there was clear indication. Patients with a long hospital stay and a diagnosis of central nervous system disorders had significant risk for inappropriate stress ulcer prophylaxis use. CONCLUSION: In this study, inappropriate use of prophylaxis for stress ulcer was common. The higher proportion of inappropriateness was due to the use of stress ulcer prophylaxis while there was no enough indication. We recommend future researchers to assess the cost and impact of inappropriate stress ulcer prophylaxis use, and the physicians should be adherent to the standard guidelines.

Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia.

BACKGROUND: Pharmaceuticals are produced and consumed in increasing volume every year. Unfortunately, not all medications that go in to the hand of the consumers get consumed; large quantities remain unused or expire. The accumulation of medication at household and unsafe disposal of unwanted medicines could lead to inappropriate medicine sharing, accidental childhood poisonings and diversion of medicines to illicit use. METHODS: A descriptive cross-sectional study was conducted among 695 residents in kebele(ward) 16 of Jinela woreda(district), Harar city from February 27-April 27. A multi-stage sampling technique was used to select individual households. Face-to-face interview using structured questionnaires were conducted to collect data from each study subject. The cleaned data was entered in to epidata analyzed using SPSS version 20 software. Descriptive statistics on sample characteristics was computed including frequencies and percentage and presented using tables and figures. RESULTS: Most participants displayed correct understanding toward medication waste (72.9%) and its effect on environmental if disposed improperly (86%). A large portion of the respondents did not know about drug-take-back system 464 (66.9%). In order to minimize the entry of pharmaceuticals into environment, 68.6% of the participants suggested the need for proper guidance to the consumer. Majority of the respondents believed risk related to the presence of unwanted drug in home, potential harm to children, lack of adequate information on safe disposal practice and need for take-back program. Approximately 66% of the respondents had unused medicine stored at home and the common types of medicines kept in households were analgesics (62.7%) and antibiotics (24%). Preferred ways of disposal of both unused and expired medicine was throwing away in household garbage (53.2%) and two third of them disposed the pharmaceuticals in its original package and dosage form. CONCLUSION: In present study, there was high practice of keeping medication at home and most disposal approach indicated by the participants was not recommended methods. Awareness about proper disposal of unused and expired medicines among the public should be created. Guidelines on safe disposal are required and an organized method of collecting unused and expired pharmaceuticals needs to be introduced.

Assessment of drug related problems among type 2 diabetes mellitus patients with hypertension in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia.

OBJECTIVE: This study was conducted to assess magnitude and pattern of drug related problems among patients with type 2 diabetes mellitus (T2DM) and hypertension. RESULTS: This study identified 364 drug related problems (DRPs) across the three categories of drug related problems, giving an average of 1.8 DRPs per patient. The effect of drug treatment being not optimal 179 (49.2%), untreated indication and symptoms 77 (21.1%), unnecessary drug-treatment 39 (10.7%) and adverse drug reactions 69 (19%) were the most frequent categories of DRPs identified. In general, high prevalence of drug-related problems was identified among patients with T2DM hypertension. The effect of drug treatment being not optimal, untreated indication and symptoms, unnecessary drug-treatment and adverse drug reactions were the most frequent categories of drug related problems identified. Therefore, the clinicians should work to improve patient care through prevention and resolving drug related problems since it can affect the quality of the care significantly.

Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia.

PURPOSE: Community plays significant role in the process of emergence and spread of antibiotic resistance. The aim of this study is to assess knowledge, attitude, and practice toward antibiotic use among Harar city and its surrounding community, Eastern Ethiopia. PATIENT AND METHODS: A cross-sectional study was conducted among 384 subjects from February 1 to May 1, 2017, through interview using pretested structured questionnaires. The data was entered into EpiData 3.1 and analyzed using Statistical Package for Social Science for windows version 20. RESULTS: A large number of the respondents (83%) replied that antibiotics speed up the recovery from coughs and colds. The majority of participants (78.4%) agreed that the unnecessarily use of antibiotics can increase the resistance of bacteria. Many respondents agreed on the importance of taking full dose (92.1%) and not to keep antibiotics for future use in their home (87.2%). They (90%) also had belief that antibiotics should not be shared from family or friends without a physician consultation and significant participants (73.1%) emphasized on the need for prescription to collect antibiotics from pharmacy. Around 79% of the subjects reported the use of antibiotic 1 year prior to study period at least once. During this period many subjects (65.3%) self-prescribed antibiotics without consulting physicians. CONCLUSION: In the present study, widespread use of antibiotics was reported, most of this antibiotics being accessed without prescription. Respondent exhibited poor knowledge and attitude toward antibiotics use. There were also malpractices such as failing to take full dose. Therefore, educational interventions on antibiotics use and its association with drug resistance are needed to promote judicious use of antibiotic. Introducing and enforcing antibiotics regulations should be also considered to reduce antibiotics self-prescription.

Self-Medication Practices among Community of Harar City and Its Surroundings, Eastern Ethiopia.

PURPOSE: Self-medication practice is often associated with irrational medication use. The aim of this study was to assess self-medication practices among community of Harar City and its surroundings, Eastern Ethiopia. METHODS: A cross-sectional study was conducted through exit interview in selected drug outlets of Harar City among 370 clients from March to April, 2017. The data was coded and entered into epi-data and processed and analyzed using SPSS version 20. RESULTS: Many participants practiced self-medication to alleviate their headache (30.30%), to treat their respiratory disorders (29.50%), and to treat their gastrointestinal disorders (27%). More than half (57.8%) of study participants declared that they were practicing self-medication due to prior experience and seeking less expensive service (20.50%). Two-fifths of them (40.3%) reported pharmacy professionals as source of information while 18.9% of respondents were advised by neighbors, friends, or relatives. About one-third (31.9%) of them did not have any source of information for self-medication practice. The most common type of drug used for self-medication by the participants was analgesic (42.2%). Approximately one-third (31.1%) of the subjects were expecting to be counseled by the pharmacy professionals about the drug side effects and to be helped in selecting their self-medication drug (30.3%). CONCLUSION: Varieties of medications were used among study participants ranging from antipain to that of antibiotics for different complaints including headache, respiratory complaints, and gastrointestinal problems. Experience with drugs and diseases as well as affordability were frequently reported reasons for self-medication practice. Participants had different views toward the role of pharmacy professionals. Hence, it is very important to educate patients on responsible use of medications and create awareness on the role of pharmacist in self-selected medication use in community.