Antibiotics use evaluation among hospitalized adult patients at Jimma Medical Center, southwestern Ethiopia: the way to pave for antimicrobial stewardship.

BACKGROUND: An irrational antibiotic use is a common problem in developing countries like Ethiopia, which makes empiric antibiotics use difficult. It is considered to be the greatest health problem in our time and future unless intervened. Therefore, this study aimed to assess the patterns of antibiotics use among hospitalized adult patients to pave the way for antimicrobial stewardship. METHODS: A hospital-based prospective observational study was conducted at Jimma Medical Center, southwestern Ethiopia, from 30 October 2020 to 29 January 2021 with 360 adult hospitalized patients participating. A semi-structured questionnaire and consecutive sampling technique was used for data collection. The data were collected through medical record reviews and patient interviews. The collected data were entered into Epi-data and exported to SPSS® version 23.0 for analysis. Days of therapy (DOT) and essential medicine lists "Access, Watch, and Reserve (AWaRe)" antibiotics classification were used to assess antibiotic use pattern among participants. RESULTS: The majority of study participants were females (55.3%), attended formal education (59.4%), and live in rural areas (61.4%) with mean age ± (SD) of 37.65 ± (16.75). The overall rate of antibiotics consumption during the study was 111 days of therapy per 100 bed-days and about two-thirds (66%) of the prescribed antibiotics were from the "Watch" group antibiotics. The indicator level of antibiotics use for "Access" group antibiotics was 34% in this study based on the World Health Organization Essential Medicine List. Cephalosporins were the most commonly used class of antibiotics (93.9%). CONCLUSION: Higher antibiotics exposure and their consumption frequently observed among adult hospitalized patients in the study setting. There was a rapid increase in "Watch" group antibiotics use and about two-thirds of the prescribed antibiotics were from this group. The third-generation cephalosporin were the most commonly used class of antibiotics. Generally, higher consumption and inappropriate antibiotics use among hospitalized adult patients showed the need for urgent interventions by implementing Antimicrobial Stewardship Programs in hospitals.

Challenges of Anticoagulation Management Service and Need of Establishing Pharmacist-Led Anticoagulation Clinic in Tertiary Care Teaching Hospital, Ethiopia: A Qualitative Study.

Pupose: To explore the challenges of anticoagulation management (AMS) and assess the need for establishing a pharmacist-led anticoagulation clinic (PLAC) at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Methods: We conducted a qualitative study at TASH. Using a semistructured interview guide, we interviewed 15 physicians from different specialties, heads of pharmacy and laboratory departments. We also included 20 patients to explore their general perceptions, and experiences with and challenges of AMS; and the need to implement PLAC in the hospital. Results: Only three physicians responded that they had protocols for initiating and maintaining warfarin dosing. Having protocols for venous thromboembolism (VTE) risk assessment, VTE prophylaxis and treatment, bleeding risk assessment, and contraindication to anticoagulant therapy were reported by seven, six, four, and three participants, respectively. Lack of trained healthcare professionals and a separate AMS clinic, inconsistency in INR testing and anticoagulant availability, and longer appointment times were the biggest challenges of the existing AMS, according to 80% of respondents. Fourteen patient respondents indicated that their satisfaction with the AMS was affected by long wait times and inconsistent availability of anticoagulants and INR testing. The head of the laboratory stated that the facilities for INR testing are inadequate and affect the quality of AMS and customer satisfaction, and supplemented by the head of the pharmacy by adding irregularities of supplies and inadequate counseling on anticoagulants. Respondents suggested that there is a need to establish a PLAC with well-adopted standard operating procedures, qualified manpower, adequate training of assigned staff, and sustained supply of anticoagulants and INR testing. Conclusion: The hospital's AMS is not optimal to provide adequate services during the study period. Based on these findings and recommendations, the supporting literature, and the experiences of other facilities, the PLAC was established in TASH.

Prevalence and antimicrobial susceptibility of group B streptococci among pregnant women in Ethiopia: A systemic review and meta-analysis study.

OBJECTIVE: Maternal colonization or infection with drug-resistant Group B streptococcus is a serious disease that affects mother, fetus, and infant. The knowledge of maternal colonization and antimicrobial susceptibility test is substantially needed for a nation to formulate a policy or change the already existing one to reduce maternal, fetus, and infant mortality. As a result, the goal of this review was to determine the pooled prevalence Group B streptococcus colonization and antimicrobial susceptibility among Ethiopian pregnant women. METHODS: Literature searches were carried out in the electronic biomedical databases and indexing services such as PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and Google Scholar. Original records of research articles, available online from 2014 to December 2020, addressing prevalence and antimicrobial-resistance pattern of Group B streptococcus in pregnant women were identified and screened. Endnote citation manager software version X9 for windows was utilized to collect and organize search outcomes and for removal of duplicate articles. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measures analyses and subgrouping. The I 2 index was used to measure heterogeneity between studies and median, and interquartile (25%, 75%) was used to assess antimicrobial susceptibility rate. RESULTS AND CONCLUSION: Sixteen original articles were found in both qualitative and quantitative analyses. Group B streptococcus colonization was recorded in 979 of the 5743 pregnant women, resulting in a 16% overall frequency (95% confidence interval: 13%-20%). The estimated prevalence varied significantly between studies with significant heterogeneity (χ2 = 154.31, p = 0.001, I 2 = 90.28). Ampicillin (97.8%; interquartile range = 89.5%-100%), penicillin G (95.5%; interquartile range = 89.5%-100%), and vancomycin (100%; interquartile range = 89.5%-100%) susceptibility were all high in Group B streptococcus, whereas tetracycline (29%; interquartile range = 89.5%-100%) susceptibility was low. Group B streptococcus colonization rates in Ethiopian women during pregnancy were virtually similar to those in many underdeveloped countries, and Group B streptococcus isolates were highly sensitive to ampicillin, penicillin G, and vancomycin.

Prevalence of soil-transmitted helminths infections among preschool and school-age children in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: There is a lack of comprehensive national data on prevalence, geographical distribution of different species, and temporal trends in soil-helminthiasis (STHs). Therefore, this study aimed to provide a summary and location of the available data on STHs infection among preschool and school-age children in Ethiopia. METHODS: The search was carried out in Medline via PubMed, Scopus, Science Direct, Web of Science, and Google Scholar on data published between 1997 to February 2020 for studies describing the rate of STHs infection among preschool and school-age in Ethiopian. We followed the Patient, Intervention, Comparison, and Outcome (PICO) approach to identify the studies. Meta-regression was performed to understand the trends and to summarize the prevalence using the "metaprop" command using STATA software version 14.0 RESULTS: A total of 29,311 of the 61,690 children examined during the period under review were infected with one or more species of intestinal parasites yielding an overall prevalence of 48% (95% CI: 43-53%). The overall pooled estimate of STHs was 33% (95% CI: 28-38%). The prevalence was 44% (95% CI: 31-58%) in SNNPR, 34% (95% CI: 28-41%) in Amhara region, 31% (95% CI: 19-43%) in Oromia region and 10% (95% CI: 7-12%) in Tigray region. Soil-transmitted helminths infection rate has been decreasing from 44% (95% CI: 30-57%) pre-Mass Drug Administration (MDA) era (1997-2012) to 30% (95% CI: 25-34%) post-MDA (2013-2020), although statistically not significant (p = 0.45). A lumbricoides was the predominant species with a prevalence of 17%. CONCLUSION: Southern Nations Nationalities and Peoples Region, Amhara, and Oromia regions carry the highest-burden and are categorized to Moderate Risk Zones (MRZ) and therefore, requiring MDA once annually with Albendazole or Mebendazole. The prevalence of STHs decreased after MDA compared to before MDA, but the decline was not statistically significant. A. lumbricoides was the predominant species of STHs among preschool and school-age children in Ethiopia. The high prevalence of STHs observed in this review, underscores the need for better control and prevention strategies in Ethiopia.

Bacterial profile and antimicrobial resistance patterns of common bacteria among pregnant women with bacteriuria in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Globally, antimicrobial resistance (AMR) restricted the armamentarium of the health care providers against infectious diseases, mainly due to the emergence of multidrug resistant. This review is aimed at providing contemporary bacterial profile and antimicrobial resistance pattern among pregnant women with significant bacteriuria. METHODS: Electronic biomedical databases and indexing services such as PubMed/MEDLINE, Web of Science, EMBASE and Google Scholar were searched. Original records of research articles, available online from 2008 to 2021, addressing the prevalence of significant bacteriuria and AMR pattern among pregnant women and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measure analyses and subgrouping. RESULTS: The data of 5894 urine samples from 20 included studies conducted in 8 regions of the country were pooled. The overall pooled estimate of bacteriuria was 15% (95% CI 13-17%, I2 = 77.94%, p < 0.001) with substantial heterogeneity. The pooled estimate of Escherichia coli recovered from isolates of 896 urine samples was 41% (95% CI 38-45%) followed by coagulase-negative Staphylococci, 22% (95% CI 18-26%), Staphylococcus aureus, 15% (95% CI 12-18%), Staphylococcus saprophytic, 12% (95% CI 6-18%) Proteus mirabilis, 7% (95% CI 4-10%), Enterococcus species, 6% (0-12%), Pseudomonas aeruginosa, 4% (2-6%), Citrobacter species, 4% (95% CI 2-4%), Group B streptococcus, 3% (1-5%), and Enterobacter species, 2% (1-4%). Multidrug resistance proportions of E. coli, Klebsiella species, Staphylococcus aureus and Coagulase negative staphylococci, 83% (95% CI 76-91%), 78% (95% CI 66-90%), 89% (95% CI 83-96%), and 78% (95% CI 67-88%), respectively. CONCLUSION: The result of current review revealed the occurrence of substantial bacteriuria among pregnant women in Ethiopia. Resistance among common bacteria (E. coli, Klebsiella species, Staphylococci species) causing UTIs in pregnant women is widespread to commonly used antibiotics. The high rate of drug resistance in turn warrants the need for regular epidemiological surveillance of antibiotic resistance and implementation of an efficient infection control and stewardship program.

Epidemiology of staphylococci species and their antimicrobial-resistance among patients with wound infection in Ethiopia: a systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to determine the pooled estimate of Staphylococcus aureus and coagulase negative staphylococci and their antimicrobial-resistance in patients with wound infection. METHODS: Literature searches were carried out in the electronic biomedical databases and indexing services such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science and Google Scholar. Original records of research articles, available online from 1988 to March 2020, addressing the rates and antimicrobial-resistance pattern of staphylococcus aureus (S. aureus) and coagulase negative staphylococci (CoNS) in patients with wound infection were identified and screened. Endnote citation manager software version X9 for windows was utilized to collect and organize search outcomes and for removal of duplicate articles. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measures analyses and subgrouping. RESULTS: The electronic databases search yielded 378 studies, of which 39 met predefined inclusion criteria and included in the final analyses. The pooled estimate of wound infection was 36% [95% CI: 23-50%) for S. aureus and 12% [95% CI: 9-14%) for CoNS. S. aureus exhibited a higher rate of resistance to penicillin (84%), ampicillin (83%), amoxicillin (67%), methicillin (50%), cotrimoxazole (50%), tetracycline (61%), doxycycline (58%), chloramphenicol (49%) and erythromycin (45%). However, relative lower resistant rate was observed to Augmentin (amoxicillin-clavulanic acid) (35%), gentamicin (33%), norfloxacin (23%), ciprofloxacin (26%), ceftriaxone (36%), vancomycin (29%) and clindamycin (40%). Similarly, for CoNS there was high resistance to methicillin, 52% [95% CI: 26-78%]) and other antibiotics, but lower resistance to clindamycin, 15% [95% CI: 6-24]) and vancomycin, 22% [95% CI: 2-41%]). Ceftriaxone resistance was observed with prevalence of 36% [95% CI: 21-50%] for S. aureus and 42% [95% CI: 29-55%] for CoNS. CONCLUSION: There was high resistance of staphylococci bacterial species to commonly used antimicrobials in the clinical settings in Ethiopia. It is a high time to implement multitude strategies to contain the threat. Further research focusing on factors promoting resistance and the effect of resistance on treatment outcome studies on these virulent organisms are warranted.

Clinicopathological Features and Survival of Patients with Hepatocellular Carcinoma in Ethiopia: A Multicenter Study.

(1) Background: Hepatocellular carcinoma (HCC) is one of the deadliest cancers globally, killing over 700,000 people each year. Despite the rising incidence and mortality rates of HCC in Ethiopia, only few single-centered studies have been conducted; therefore, we aimed to explore the clinicopathological characteristics and survival of patients with HCC in multicenter settings. (2) Methods: We conducted a retrospective analysis of 369 patients with confirmed HCC diagnosed between 2016 and 2021. The survival of patients weas determined using the Kaplan−Meier method, and hazard ratios of the prognostic factors were estimated in Cox proportional hazard models. (3) Results: Majority patients were male (67%) and had a mean age of 52.0 ± 15.6 years. The majority of patients (87%) had a large tumor size (>5 cm) at diagnosis and presented with an advanced-stage condition. Cirrhosis (58%) and viral hepatitis (46.5%) were the main risk factors associated with HCC. The median overall survival was 141 days (95% CI: 117−165). Patients who took antivirals for HBV had a higher survival benefit compared to the untreated group (469 vs. 104 days; p < 0.001). The risk of death was 12 times higher in patients with Barcelona Clinic Liver Cancer-D (BCLC-D) terminal stage HCC compared to patients with an early stage (BCLC-A) HCC. The stage of HCC and treatment against HBV are the most significant survival predictors. (4) Conclusions: The overall survival of HCC patients in Ethiopia is poor. Cirrhosis and viral hepatitis are the primary risk factors linked with HCC. Patients who received antiviral therapy for HBV had a better survival outcome.

Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study.

BACKGROUND: Many studies conducted in the past focused on patients' sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians' adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians' prescribing patterns, patients' medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center. METHODS: A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients' specific data was collected with a face-to-face interview and from their medical charts. Clinicians' related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients' adherence. P-Values of less than 0.05 were considered statically significant. RESULTS: From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients' medication adherence was 46.6%, while clinicians' guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence. CONCLUSION: The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.

Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study.

INTRODUCTION: Despite the fact that the goals for the management of hypertension are well-defined and effective therapies are available, control of hypertension remains poor in countries with low resources including Ethiopia. This study aimed to determine blood pressure control rate and its determinants among ambulatory adult hypertensive patients at Jimma University Medical Center. METHODS: A general prospective cohort study was conducted among adult hypertensive patients who had regular follow-up at Jimma University Cardiac Clinic from 20 March to 20 June 2018. Hypertensive patients who fulfilled the inclusion criteria were selected in the first month of the data collection period. Then, only those patients who visited the clinic at the first month were consequently followed-up for the next 3 months. The Eighth Joint National Committee guideline was used to categorize controlled and uncontrolled blood pressures. Patients' specific data were collected using a structured data collection tool. Data were analyzed using the statistical software package SPSS version 21.0. Bivariate and multivariable logistic regression analysis was used to identify independent variables influencing blood pressure control. p-values of less than 0.05 were considered statistically significant. RESULTS: From a total of 416 patients, 237 (57.0%) were male with a mean age of 56.50 ± 11.96 years. Two hundred and fifty eight (62.0%) participants had comorbid conditions and 275 (66.1%) were on combination therapy. The rate of blood pressure control was 42.8%. Age ⩾60 years was negatively associated with uncontrolled blood pressure (adjusted odd ratio = 0.52, confidence interval = 0.31-0.88, p = 0.015). Medication non-adherence (adjusted odd ratio = 1.64, confidence interval = 1.04-2.58, p = 0.034) and non-adherence to international guidelines (adjusted odd ratio = 2.33, confidence interval = 1.49-3.64, p < 0001) were positively associated with uncontrolled blood pressure. CONCLUSION: The rate of blood pressure control among hypertensive patients was suboptimal. Age, clinicians' non-adherence to international guidelines, and patients' non-adherence to medications were independent predictors of blood pressure control. Physicians and clinical pharmacists should adhere to guidelines for better treatment and care of hypertensive patients.

Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study.

Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.

Treatment Outcome and Associated Factors of Neonatal Sepsis at Mizan Tepi University Teaching Hospital, South West Ethiopia: A Prospective Observational Study.

INTRODUCTION: Neonatal sepsis is the gravest problem in neonates, ending in significant morbidity and mortality. World wide 6.9 million neonates were spotted with potentially severe bacterial infections needing treatment and 2.6 million of them occurred in sub-Saharan Africa (SSA). Sepsis is the leading cause of neonatal mortality and is perhaps answerable for about 30-50% of the total neonatal deaths per year in emerging countries. OBJECTIVE: This study aims to assess the treatment outcome and associated factors of neonatal sepsis at Mizan Tepi University Teaching Hospital, South West Ethiopia. METHODS: A hospital-based prospective observational study was done at Mizan Tepi University Teaching Hospital (MTUTH) from May to November 2019 among neonates admitted with sepsis. Data were entered to Epi-data 4.2 and analyzed by SPSS version 21. Bivariate and multivariate Cox regression was used to identify the relationship between dependent and independent variables. All neonates ≤28 days who were admitted to MTUTH at the neonatal intensive care unit (NICU) and neonates diagnosed with sepsis by the attending physician either clinically or laboratory-confirmed included in the study. RESULTS: Of the 211 neonatal sepsis patients, 110 (52.1%) were females, 161 (76.3%) were admitted with late-onset sepsis, 16 (7.6%) were very low birth weight, and 156 (73.9%) were term. About 143 (67.8%) had a good outcome and 68 (32.2%) had a poor outcome. Very low birth weight [P = 0.006, AHR = 1.692, 95% CI: (1.245, 4.36)], age of neonate being less than 4 days at admission [P = 0.001, AHR = 9.67, 95% CI: (2.24, 41.70)], maternal infection [P = 0.032, AHR = 3.186, 95% CI: (1.32, 30.68)], and prolonged length of hospital stay [(P = 0.017, AHR = 12.29, 95% CI: (1.55, 96.31), were significantly associated to mortality. CONCLUSION: The mortality rate of neonatal sepsis was found to be high. Age of neonate <4 days, birth weight of the neonate <1500 gm, and prolonged length of hospital stay were identified as independently associated factors of increased risk of mortality.

Prevalence and Impact of Metabolic Syndrome on Short-Term Prognosis in Patients with Acute Coronary Syndrome: Prospective Cohort Study.

PURPOSE: Despite the increasing burden of metabolic syndrome (MS) and ischemic heart disease in sub-Saharan Africa, data on the prevalence of MS among patients with acute coronary syndrome (ACS) from the regions are limited. Hence, this study is aimed to evaluate the prevalence and impact of MS on 30-day all-cause mortality in patients hospitalized with ACS. PATIENTS AND METHODS: We prospectively assessed 176 ACS patients, who were admitted to two tertiary hospitals in Ethiopia. MS was diagnosed based on a harmonized definition of MS. In-hospital major adverse cardiovascular events (MACE) and 30-day mortality were recorded. Multivariable cox-regression was used to identify predictors of 30-day mortality. RESULTS: Among 176 ACS patients enrolled, 62 (35.2%) had MS. Majority of the patients (62.5%) were male with the mean age of 56±11.9 years. ACS patients with MS were older, presented with atypical symptoms, and they had history of hypertension, diabetes, dyslipidemia and coronary artery disease compared to those without MS. MS was also significantly associated with in-hospital MACE (30.6% vs 17.5%; p= 0.046) and 30-day mortality [adjusted hazard ratio (AHR) = 3.25, 95% CI=1.72-6.15]. The other significant predictors of 30-day mortality were pre-hospital delay >12h (HR= 4.32, 95% CI=1.68-11.100), killip class ≥2 (HR=10.7, 95% CI= 2.54-44.95), and ejection fraction <40 (HR= 2.59 95% CI=1.39-4.84). CONCLUSION: The prevalence of MS among patients with ACS in Ethiopia is high. MS was significantly associated with high in-hospital MACE and it was an independent predictor of 30-day mortality. Initiating appropriate strategies on MS prevention and timely diagnosis of MS components could decrease the burden of ACS and improve patient's outcome.

Burden of intestinal parasitic infections among pregnant women in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Comprehensive nationwide data on prevalence and distribution of intestinal parasites (IPIs) among pregnant women are lacking. Therefore, the aim of this study was to provide pooled prevalence estimate, prevalence in different regions and species-specific IPIs among pregnant women in Ethiopia. METHODS: The search was carried out in Medline via PubMed, Scopus, Science Direct, Web of Science and Google Scholar on published and unpublished data between 2008 and Sep 2020 for studies describing rate of IPIs among pregnant women in Ethiopian. A random-effects model and forest plots to estimate pooled effect size and effect of each study with their confidence interval (CI) were used to provide a visual summary of the data. We conducted meta-regression to understand the source of heterogeneity and pooled the prevalence using 'metaprop' command using STATA software version 14. RESULTS: A total of 3149 of the 9803 pregnant women were infected with one or more species of IPIs resulted in an overall prevalence of 29% (95% CI 22-37%). The prevalence estimate varied among studies with considerable heterogeneity (χ2 = 2069.19, p < 0.001 I2 = 98.84). The prevalence of IPIs was 36% (95% CI 22-50%) in Oromia region, 29% (95% CI 10-47%) in Amhara region, 24% (95% CI 17-32%) in southern nation, nationality and people region, 24% (95% CI 22-27%) in Tigray region and 24% (95% CI 20-29%) in Addis Ababa city. Hookworms with pooled prevalence estimate of 10% (95% CI 8-13%) followed by Ascaris lumbricoides 10% (95% CI 7-13%), and Entamoeba histolytica/dispar 6% (95% CI 4-8%) were the three common species of IPIs identified in this group of population. CONCLUSION: The prevalence of IPIs among pregnant women is relatively high in comparison to other general population. Hookworms and Ascaris lumbricoides were the most dominant species of intestinal helminths, whereas Entamoeba histolytica/dispar was the dominant intestinal protozoa among pregnant women in Ethiopia.

Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics).

INTRODUCTION: Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia. METHODS: A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization "AWaRe" classification scheme as "Access", "Watch" and "Reserve" group antibiotics and measured their consumption intensity. RESULTS: A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the "Watch" group had 2.10 DDD/100 outpatients per day. CONCLUSION: There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the "Watch" group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.

Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study.

BACKGROUND: Globally, surgical site infections are the most reported healthcare-associated infection and common surgical complication. In developing countries such as Ethiopia, there is a paucity of published reports on the microbiologic profile and resistance patterns of an isolates. OBJECTIVE: This study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at Jimma Medical Center in Ethiopia. METHODS: A prospective cohort study was employed among adult patients who underwent either elective or emergency surgical procedures. All the eligible patients were followed for 30 days for the occurrence of surgical site infection (SSI). From those who developed SSI, infected wound specimens were collected and studied bacteriologically. RESULTS: Of 251 study participants, 126 (50.2%) of them were females. The mean ± SD age of the patients was 38 ± 16.30 years. The overall postoperative surgical site infection rate was 21.1% and of these 71.7% (38/53) were culture positive. On gram stain analysis, 78% of them were Gram-negative, 11.5% were Gram-positive and 10.5% were a mixture of two microbial growths. Escherichia coli accounted for (21.43%), followed by Pseudomonas aeruginosa (19.05%), Proteus species (spp.) 14.29%), Staphylococcus aureus (11.90%), Klebsiella species (11.90%), Citrobacter spp. (9.5%), streptococcal spp. (7.14%), Coagulase-negative S. aureus (CoNS) (2.38%) CONCLUSION: Gram-negative bacteria were the most dominant isolates from surgical sites in the study area. Among the Gram-negative bacilli, Escherichia coli were the most common bacteria causing surgical site infection. As there is high antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.

Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study.

BACKGROUND: Surgical site infections are one of the leading health care-associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia. METHODS: A hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05. RESULTS: Of total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean ± SD age of patients was 38 ± 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score ≥3 [ Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03-4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71-6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3-14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16-6.80)], duration of operation ≥ 2 h [AHR = 4; 95% CI = (2.17-7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28-4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16-15.72)], and incision site [AHR (95% CI) = 2.5(1.14-5.42)] had statistically significant association with re-operation. CONCLUSION: The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study.

Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study.

BACKGROUND: Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. METHODS: A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. RESULTS: Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81-7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28-13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55-14.55) were independent predictors of time to in-hospital death among ACS patients. CONCLUSION: In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.

Gram-Negative Bacteria Isolates and Their Antibiotic-Resistance Patterns in Patients with Wound Infection in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia. METHODS: Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses. RESULTS: The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52-65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14-20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9-14%], Klebsiella pneumonia, 11% [95% CI: 9-13%], Proteus mirabilis, 8% [95% CI: 6-10%], Acinetobacter species, 4% [95% CI: 2-6%], Enterobacter species, 4% [95% CI: 3-5%], and Citrobacter species, 3% [95% CI: 2-4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66-86%], 84% [95% CI: 78-91%], 66% [95% CI:43-88%], 83% [95% CI:75-91%], 87% [95% CI:78-96%], 68% [95% CI:50-87%] and 71% [95% CI:46-96%], respectively. CONCLUSION: There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.

Impact of HIV status and predictors of successful treatment outcomes among tuberculosis patients: A six-year retrospective cohort study.

Tuberculosis (TB) remains a major global public health problem. Hence, the study aimed to assess the impact of human immune virus (HIV) status and predictors of successful treatment outcomes of TB patients enrolled at Nekemte specialized hospital. An institution-based retrospective cohort study was conducted and the data analyzed using SPSS version 24.0. A multivariable logistic regression model was fitted to identify the association between treatment outcome and potential predictor variables. The association was calculated using the Adjusted Odds ratio (AOR) and the statistical significance was considered at p < 0.05. Out of the total 506 study participants, 50.2% of them were males. The overall treatment success rate was 81.4% and 58.06% among HIV co-infected TB patients. Female sex (AOR = 2.01, 95%CI: 1.04-16.11), age 25-34 years (AOR = 3.982, 95%CI: 1.445-10.971), age 35-49 years (AOR = 5.392, 95%CI: 1.674-17.368), high school educational level (AOR = 5.330, 95% CI: 1.753-16.209), urban residence (AOR = 3.093, 95%CI: 1.003-9.541) and HIV negative (AOR = 10.3, 95%CI, 3.216-32.968) were positively associated with favorable TB treatment outcome. Whereas, being single (AOR = 0.293, 95%CI: 0.1-0.854), smear-negative pulmonary TB (AOR = 0.360, 95%CI: 0.156-0.834), extra-pulmonary TB (AOR = 0.839, 95%CI: 0.560-0.955) and retreatment case (AOR: 0.54, 95%CI: 0.004-0.098) were negatively associated with successful treatment outcome. The treatment success rate of TB patients was lower than World Health Organization target set of 85%. The increased unsuccessful outcome among TB/HIV patients requires urgent public health interventions to improve the evaluation policy and control framework.

Glycemic Control Among People Living with Diabetes and Human Immunodeficiency Virus in Ethiopia: Leveraging Clinical Care for the Looming Co-Epidemics.

BACKGROUND: Antiretroviral therapy has decreased human immunodeficiency virus related mortality. However, the incidence of diabetes mellitus is increasing among people living with human immunodeficiency virus and adds complexity to the standards of care. OBJECTIVE: The study was aimed to determine the glycemic control and delivery of clinical care among people living with diabetes and human immunodeficincy virus in Ethiopia. METHODS: A comparative prospective cohort study was conducted among patients living with diabetes at follow-up clinics of Jimma Medical Center in two study arms. The first arm was people living with diabetes and human immunodeficiency virus. The second arm was human immunodeficiency virus negative patients living with diabetes. The expanded English version of the summary of diabetes self-care activities scale was used to measure self-care behaviors. In order to identify the predictors of glycemic control, multivariable Cox regression analysis was used. Statistical significance at p-value ≤0.05 was considered. RESULTS: A total of 297 eligible participants were followed for one year, with a mean age of 44.35±12.55 years. Males accounted for 55.9%. After one year of follow-up, 61.9% of diabetes people living with human immunodeficiency virus, and 49% of human immunodeficiency virus-negative patients with diabetes poorly met blood glucose target (p=0.037). Female gender [AHR: 2.72; 95% CI (1.21-5.72)], age >31 years [AHR: 2.48; 95% CI (1.34-11.01)], increased waist circumference [AHR: 3.64; 95% CI (2.57-16.12)], overweight [AHR: 3.63; 95% CI (1.65-22.42)], chronic disease comorbidity [AHR: 2.02; 95% CI (1.44-2.84)], human immunodeficiency virus infection [AHR: 3.47; 95% CI (2.03-23.75)], living longer with diabetes (>5 years) [AHR: 3.67; 95% CI (3.26-4.14)] showed a higher risk of blood sugar control failure and were independent predictors of uncontrolled glycemia. Tuberculosis infection increased the risk of uncontrolled blood sugar among people living with diabetes and human immunodeficency virus[AHR:3.82;95% CI(2.86-5.84]. CONCLUSION: Significant gaps were observed in achieving the recommended glycemic target and involvement of patients on self-care care behavior in the study area. The co-occurrence of tuberculosis, human immunodeficiency virus, and diabetes is triple trouble needing special attention in their management. It is high time to leverage the clinical care of the looming co-epidemics through chronic comprehensive care clinic.