Treatment outcomes, types, risk factors, and common manifestations of stroke among admitted stroke patients in Ethiopia: Systematic review and meta-analyses.

INTRODUCTION: Stroke is the sudden onset of a reduced cerebral perfusion-related localized or widespread neurologic impairment. The two main causes of poor treatment outcomes are uncontrolled blood pressure and hospital arrival delays. Identifying the risk factors, types of stroke presentation, and treatment options might be used in the prevention, early detection, and management of stroke to provide the best care to patients. OBJECTIVE: This systematic review and meta-analysis aimed to assess the treatment outcomes, types, and risk factors of stroke patients in Ethiopia. METHODS: A variety of databases were searched, including African Journals Online (AJOL), Google Scholar, Scopus, EMBASE (Ovid), and HINARI, and published and unpublished articles from the Ethiopian Universities repository. To pool the outcome variables, a weighted inverse variance random-effects model at 95% Cl was employed. Heterogeneity and publication bias were assessed using Cochrane I2 statistics and Egger's test with funnel plot, respectively. A subgroup analysis was conducted based on sample size, case definition, and region to detect source of heterogeneity. RESULT: This study contained data from 26 studies, involving 6291 study participants, from different regions of Ethiopia. Out of 19 articles with I2 = 96.1%, p<0.001, the pooled prevalence of improved stroke treatment outcome was 47.50% (95% CI: 40.20-54.80), while the prevalence of mortality was 18.95% (95% CI: 15.62-22.29) from 19 articles with I2 = 87.9%, p<0.001. In Ethiopia, ischemic stroke accounted for 59.34% of all stroke cases (95% CI: 53.73-64.95). Among risk factors, substance abuse ranked second at 36.58% (95% CI: 25.22-47.93), after hypertension at 50.90% (95% CI: 43.77-56.27). According to the findings, hemiparalysis or hemiplegia was mentioned as a frequent clinical sign associated with stroke (56.87%) (95% CI: 45.65-68.06). CONCLUSION: The improved treatment outcome was not satisfactory, and the most common type of stroke was an ischemic stroke. Hypertension was the most common risk factor, followed by substance use. As a result, there should be a strengthening of post-stroke care and the creation of awareness about the risk factors and clinical manifestations for prevention and early detection of stroke in Ethiopian people.

The state of birth asphyxia in Ethiopia: An umbrella review of systematic review and meta-analysis reports, 2020.

BACKGROUND: To this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these studies are inconsistent which is difficult to make use of the findings for preventing birth asphyxia in the country. Therefore, umbrella review of these studies is required to pool the inconsistent findings into a single summary estimate that can be easily referred by the information users in Ethiopia. METHODS: PubMed, Science direct, web of science, data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for systematic reviews and meta-analyses (SRM) studies on the magnitude and risk factors of perinatal asphyxia in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and predictors of perinatal asphyxia were pooled and summarized with random-effects meta-analysis models. From checking PROSPERO, this umbrella review wasn't registered. RESULTS: We included four SRM studies with a total of 49,417 neonates. The summary estimate for prevalence of birth asphyxia was 22.52% (95% CI = 17.01%-28.02%; I2 = 0.00). From the umbrella review, the reported factors of statistical significance include: maternal illiteracy [AOR = 1.96; 95% CI: 1.44-2.67], primiparity [AOR = 1.29; 95% CI: 1.03-1.62], antepartum hemorrhage [AOR = 3.43; 95% CI: 1.74-6.77], pregnancy induced hypertension [AOR = 4.35; 95% CI: 2.98-6.36], premature rupture of membrane [AOR = 12.27; 95% CI: 2.41, 62.38], prolonged labor [AOR = 3.18; 95% CI: 2.75, 3.60], meconium-stained amniotic fluid [AOR = 5.94; 95% CI: 4.86, 7.03], instrumental delivery [AOR = 3.39; 95% CI: 2.46, 4.32], non-cephalic presentation [AOR = 3.39; 95% CI: 1.53, 5.26], cord prolapse [AOR = 2.95; 95% CI: 1.64, 5.30], labor induction [AOR = 3.69; 95% CI: 2.26-6.01], cesarean section delivery [AOR = 3.62; 95% CI: 3.36, 3.88], low birth weight [AOR = 6.06; 95% CI: 5.13, 6.98] and prematurity [AOR = 3.94; 95% CI: 3.67, 4.21] at 95% CI. CONCLUSION: This umbrella review revealed high burden of birth asphyxia in Ethiopia. The study also indicated significant risk of birth asphyxia among mothers who were unable to read and write, primiparous mothers, those mothers having antepartum hemorrhage, pregnancy induced hypertension, premature rupture of membrane, prolonged labor, meconium-stained amniotic fluid, instrumental delivery, cesarean section delivery, non-cephalic presentation, cord prolapse and labor induction. Moreover, low birth weight and premature neonates were more vulnerable to birth asphyxia compared to their normal birth weight and term counterparts. Therefore, burden of birth asphyxia should be mitigated through special consideration of these risk mothers and neonates during antenatal care, labor and delivery. Mitigation of the problem demands the collaborative efforts of national, regional and local stakeholders of maternal and neonatal health.

Evaluation of the antiulcerogenic activity of hydromethanol extracts of Solanum incanum L. (Solanaceae) leaves and roots in mice; single and repeated dose study.

OBJECTIVE: The aim of this study was to evaluate the antiulcer activity of hydromethanol extracts of Solanum incanum L. (Solanaceae) leaves and roots in mice. METHODS: The antiulcerogenic activity of the plant extracts were evaluated using Pylorus ligation and ethanol induced gastric ulcers in fasted mice. Data were analyzed using one way ANOVA, and P-values <0.05 were considered statistically significant. RESULTPYLORUS LIGATION-INDUCED ULCER: Single dose and repeated daily dose administration of the leaf and root extracts for 10 days didn't significantly (P > 0.05) affect pH, total acidity and volume of gastric secretion. Single dose of both extracts significantly reduced ulcer score (P = 0.036) and ulcer index (leaf, P = 0.037; root, P = 0.041) at the dose of 400 mg/kg. Similarly, significant reduction in ulcer score was observed after repeated daily treatment with 200 mg/kg (P = 0.030) and 400 mg/kg (P = 0.005) of the leaf extract and 400 mg/kg (P = 0.005) of the root extract. In addition, repeated administration of 400 mg/kg of the leaf (P = 0.004) and root (P = 0.005) extracts significantly reduced ulcer index. ETHANOL-INDUCED ULCER: Single dose of both extracts significantly reduced ulcer score at the dose of 200 mg/kg (leaf, P = 0.017; root, P = 0.036) and 400 mg/kg (leaf, P = 0.001; root, P = 0.001). Similarly, 200 mg/kg (leaf, P = 0.002; root, P = 0.018) and 400 mg/kg (leaf, P = 0.001; root, P = 0.001) of the extracts significantly reduced ulcer index after single dose treatment. Repeated daily treatment with leaf and root extracts for ten days caused a significant (P = 0.037, 0.001 and 0.001 for 100, 200 and 400 mg/kg leaf extract; P = 0.026, 0.018 and 0.001 for 100, 200 and 400 mg/kg root extract, respectively) reduction in ulcer score. In addition, both extracts significantly (P = 0.041, 0.004 and 0.000 for 100, 200 and 400 mg/kg leaf extract; P = 0.038, 0.008 and 0.000 for 100, 200 and 400 mg/kg root extract, respectively) reduced ulcer index after 10 days of treatment. CONCLUSION: This study has revealed hydromethanol extracts of Solanum incanum leaves and roots have antiulcerogenic activity using in vivo models. The antiulcer activity of the plant is not related to acid anti-secretory action, suggesting the plant may have cytoprotective effect on the gastric mucosa.

Does Timing of Antenatal Care Initiation and the Contents of Care Have Effect on Caesarean Delivery in Ethiopia? Findings from Demographic and Health Survey.

Background: Antenatal care (ANC) is an important preventive set of core healthcare services through pregnancy. Caesarean deliveries are significantly increasing in many low-, middle-, and high-income countries. However, overuse of the caesarean section service interferes with the quality and cost of the procedure. Hence, this study aimed to assess the effect of timing of first antenatal care initiation and the contents of care on caesarean delivery. Methods: A population level cross-sectional study was conducted with a total of 4757 study participants. The multivariable analysis was computed using the setup of 3 models. Results: The rate of caesarean section among women who initiated antenatal care in the first trimester was 1.32% (95% CI = 0.91-4.21). Women initiated antenatal care in the first trimester (AOR = 2.74; 95% CI = 1.49-6.2) and received contents of care (AOR = 1.98; 95% CI = 1.24-3.78])were more likely to have caesarean section delivery as compared to their counterparts. Conclusion: Caesarean section among women who initiated ANC in the first trimester is low. The finding suggests ANC initiated early (within 16 weeks) can have a positive impact on caesarean section delivery. In addition, being urban residents, primipara women, initiating antenatal care before 16 weeks, received contents of care, and having antenatal care visits three and more increase the odds of having caesarean section. As a result, different obstetric, medical, and surgical complications are detected and managed as early as possible.

Evaluation of the Antimalarial Activity of the Leaf Latex of Aloe weloensis (Aloaceae) against Plasmodium Parasites.

BACKGROUND: The lack of available vaccines and the emerging resistance to antimalarial drugs have provided the necessity to find noble antimalarial plant-based medicines. The leaf latex Aloe weloensis has been used in folk medicine against malarial and other human ailments in Ethiopia. Hence, the present study aimed to investigate the antimalarial activity of the leaf latex of A. weloensis against Plasmodium parasites. MATERIALS AND METHODS: The prophylactic and curative models were employed to determine the in vivo antimalarial activity of the leaf latex A. weloensis against P. berghei infected mice, and the antioxidant activity of the latex was assessed using diphenyl-1-picrylhydrazine (DPPH) assay. Female mice were recruited for toxicity study, and the leaf latex was administered to fasted mice at a dose of 5000 mg/kg. The mice were kept under continuous observation for fourteen days for any signs of overt toxicity. RESULTS: The leaf latex of A. weloensis was safe up to 5000 mg/kg, and the latex endowed free radical inhibition activity (IC50 = 10.25 µg/ml). The latex of A. weloensis leaf demonstrated the inhibitory activity against the 3D7 strain of P. falciparum (IC50 = 9.14 µg/ml). The prophylactic and curative effect of the latex was found to be dose-dependent. The mice's parasitemia level was significantly (p < 0.001) reduced at all tested doses of the leaf latex compared to negative control in the curative test. Parasitemia reduction was significant (200 mg/kg, p < 0.01, and 400 and 600 mg/kg, p < 0.001) in the prophylactic test compared to the control. In addition, the leaf latex significantly (p < 0.01) improved mean survival time, packed cell volume, rectal temperature, and bodyweight of P. berghei infected mice. CONCLUSION: The leaf latex of Aloe weloensis was endowed with the antimalarial activity at various doses, corroborating the plant's claimed traditional use.

Estimating the Prevalence and Risk Factors of Obstetric Fistula in Ethiopia: Results from Demographic and Health Survey.

INTRODUCTION: Obstetric fistula is the most common obstetric problem in low- and middle-income countries where maternal care is inaccessible. Obstetric fistula has serious social and economic consequences resulting in devastating health problems for women. There is a lack of national studies that show the burden of obstetric fistula and risk factors; as a result, this study aimed to estimate the prevalence of obstetric fistula, its symptoms, and risk factors in Ethiopia. METHODS: A population-level cross-sectional study was conducted with a total of 7590 women who gave birth in the last 5 years, using data from the 2016 Ethiopian Demographic and Health Survey. Complex sample analysis and normalized weighting were used to compensate for the disproportionate sampling in the survey. A multivariable logistic regression model was fitted to find a significant association between obstetric fistula and covariates. Both odds ratios (crude and adjusted) with their corresponding 95% confidence intervals (CI) were reported. RESULTS: Among the 7590 women having given birth in the last 5 years, 32 (0.42%) women with obstetric fistula were identified. Of these, 64% developed obstetric fistula after live birth and 23.1% developed obstetric fistula after stillbirth. More than 72.8% were associated with prolonged and very difficult labor. No history of contraceptive use (AOR = 3.43; 95% CI: 1.05-11.21), having a big problem of distance from the health facility (AOR = 3.7; 95% CI: 1.05-11.21), early marriage (AOR = 1.52; 95% CI: 1.12-3.5), and being a rural resident (AOR = 1.5; 95% CI:1.2-5.05) were risk factors associated with obstetric fistula. CONCLUSION: This study finding revealed that obstetric fistula is the most common devastating obstetric problem in Ethiopia. Early marriage, early initiation of sexual intercourse, distance from the health facility, no history of contraceptive use, and rural residence were the predisposing factors to develop an obstetric fistula. Thus, interventions should focus on creating community awareness regarding early marriage and its consequences, early seeking of health facility visiting, and avoiding unintended pregnancy to minimize the subsequent complications.

Knowledge of blood donation and associated factors in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: To assess the level of knowledge about blood donation and associated factors in Ethiopia. DESIGN: Systematic review and meta-analysis. METHODS: Both published and unpublished cross-sectional studies on the level of knowledge about blood donation in Ethiopia were included. Articles from different databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar and African Journals Online were searched. Cochrane I2 statistics were used to check for heterogeneity. Subgroup and sensitivity analyses of evidence of heterogeneity were carried out. Egger's test with funnel plot was conducted to investigate publication bias. RESULT: Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were included. The overall nationwide level of knowledge about blood donation was 56.57% (95% CI 50.30 to 62.84). Being in secondary school and above (adjusted OR=3.12; 95% CI 2.34 to 4.16) and being male (adjusted OR=1.81; 95% CI 1.44 to 2.28) were the factors associated with level of knowledge about blood donation. CONCLUSION: More than half of the study participants were knowledgeable about blood donation. Sex and educational status were the factors significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Assessment of Knowledge and Attitude towards Palliative Care and Associated Factors among Nurses Working in North Wollo Hospitals.

BACKGROUND: Palliative care improves the quality of life of patients facing a life-threatening illness. Nurses should improve their caregiving capacity. In Ethiopia, palliative care is underestimated. The availability of data regarding the knowledge and attitude of nurses towards palliative care is critically important. Thus, this study aimed to assess the level of knowledge and attitude of nurses towards palliative care. METHODS: Institution-based, cross-sectional study was conducted in North Wollo hospitals. A simple random sampling technique was used. The data was collected using structured self-administered questionnaires from February to March 2019. The analysis was done using a binary logistic regression model. P-value < 0.05 was considered as statistically significant. RESULTS: The result revealed that 59.7% of the respondents had good knowledge and 44.2% had a favorable attitude towards palliative care. Level of education, experience in caring for chronically ill patients, and experience in caring for dying family members within the last 6 months had a significant association with the knowledge of nurses. Monthly income, experience in caring for chronically ill patients, formal palliative care education, and knowledge were found statistically significant with the attitude of nurses towards palliative care. CONCLUSION: More than half of the nurses had good knowledge, but less than half of the respondents had a favorable attitude towards palliative care. Attention should be given towards palliative care by the health policy and needs to be incorporated into the national curriculum of nursing education.

Prevalence of rheumatic heart disease among school children in East Africa: a systematic review and meta-analysis.

INTRODUCTION: conducting researches and estimating the prevalence of rheumatic heart disease in school children is crucial to develop school-based strategies targeted to decrease the prevalence of this disease. Therefore, this systematic review and meta-analysis were aimed to estimate the overall prevalence of rheumatic heart disease (RHD) among school children in East Africa. METHODS: PubMed/MEDLINE, Google Scholar, Cochrane review, African Journals Online and African Index Medicus databases were searched to identify relevant research articles. The overall prevalence of rheumatic heart disease was pooled based on the weighted inverse variance random-effects model at a 95% confidence interval. The presence of heterogeneity, sensitivity analysis and presence of publication bias was tested. Results were presented with narrative synthesis, tables and forest plots. RESULTS: a total of thirteen research articles were included in the final analysis. The pooled prevalence of rheumatic heart disease in East African school children was 1.79% (17.9 cases per 1000 children (95% CI=11.6, 24.2; I2=95.1%; p<0.001)). From the subgroup analysis conducted by publication year, a lower prevalence of RHD in school children was reported among studies published after 2015 (six studies; overall prevalence=1.17% (11.7 cases per 1000 school children); with 95% CI=0.60, 1.73%; I2=88.8%; p<0.001). Additionally, the horn of Africa was found to have the lowest prevalence of RHD in school children among East African countries (six studies; overall prevalence=1.59% (15.9 cases per 1000 school children); with 95% CI=0.68, 2.51%; I2=94.2%; p<0.001). CONCLUSION: the prevalence of rheumatic heart disease (RHD) among school children in East Africa was considerably higher than the results from high-income countries. Therefore, community education on strep throat and its complications should be implemented through mass media. Rheumatic heart disease preventive strategies should be integrated with schools to reduce the prevalence of RHD among school children.

Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis.

BACKGROUND: In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. METHODS: PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. RESULTS: Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0-50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by "continent" and "income level", lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01-52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0-51.0%, I2 = 97.67%, p < 0.001) respectively. CONCLUSION: Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

Knowledge on Palliative Care and Associated Factors among Nurses in Ethiopia: A Systematic Review and Meta-Analysis.

Background: Palliative care is a multidisciplinary team-based care for patients facing life-threatening illness and their families which addresses their physical, psychological, social, and spiritual needs to improve the quality of care. There is a strategy for an increase in palliative care services by integrating with the healthcare system. Therefore, this systematic review and meta-analysis was aimed to assess the overall pooled prevalence of nurses' knowledge towards palliative care in Ethiopia. Method: PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar, and African Journals OnLine (AJOL) were the databases used to search for articles. Cochrane I 2 statistics and Egger's test were done to check heterogeneity and publication bias, respectively. Subgroup analysis by region, study period, and sample size was done due to the presence of heterogeneity. Sensitivity analysis was also done to detect the presence or absence of an influential study. Result: Nine studies with a total of 2709 study participants were included in the final analysis. The overall pooled prevalence of nurses' knowledge towards palliative care was 45.57% (95% CI: 35.27-55.87). Educational status and palliative care training were significantly associated factors with the level of nurses' knowledge towards palliative care. B.S. degree holder nurses (AOR = 3.01; 95% CI: 1.50-6.02) and nurses who had palliative care training (AOR = 4.64; 95% CI: 2.37-9.08) were found to be significantly associated factors with the nurses' level of knowledge. Conclusion: More than half of nurses had poor knowledge of palliative care. Educational status of nurses and palliative care training were significantly associated factors with the nurses' level of knowledge about palliative care. Therefore, palliative care training and improving nurses' careers through continuous professional development should be focused on regularly to improve nurses' knowledge about palliative care.

Knowledge on neonatal jaundice and its associated factors among mothers in northern Ethiopia: a facility-based cross-sectional study.

OBJECTIVE: This study aimed to assess mother's knowledge on neonatal jaundice (NNJ) and its associated factors in northern Ethiopia. DESIGN: Facility-based cross-sectional study. SETTING: Referral hospitals in Amhara region, Ethiopia. PARTICIPANTS: The study was done among 380 mothers selected using a systematic random sampling technique at referral hospitals in the Amhara region, northern Ethiopia, from 1 March 2019 to 30 July 2019. PRIMARY OUTCOME: Mother's knowledge on NNJ, modelled using binary logistic regression. SECONDARY OUTCOME: Factors associated with mother's knowledge about NNJ RESULTS: This study revealed that the overall mother's knowledge on NNJ was 39.2%. Having favourable attitude (AOR=2.05, 95% CI: 1.25 to 3.34), having a history of NNJ in previous children (AOR=7.51, 95% CI: 3.12 to 18.05), having a history of NNJ in the current child (AOR=1.97, 95% CI: 1.19 to 3.27), antenatal care (ANC) follow-up (AOR=3.85, 95% CI: 1.24 to 14.55) and resided in the urban area (AOR=2.63, 95% CI: 1.32 to 5.25) were factors significantly associated with mother's knowledge on NNJ. CONCLUSIONS: This study showed that mothers' knowledge on NNJ was low. The attitude of mothers on NNJ, previous and current child history of NNJ, ANC follow-up and residence were variables that had a significant association with mother's knowledge on NNJ. Enhancing NNJ educational programmes targeting mothers in raising awareness on the prevention of NNJ in the population are the recommended interventions.

Self-Care Practice and Associated Factors among Hypertensive Patients in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Hypertension is one of the leading causes of morbidity and mortality in developing countries including Ethiopia. Self-care practice has been provided as one of the most important preventive mechanisms of hypertension and is considered as a basic treatment for hypertension. There is no national-level study that assesses hypertensive self-care practice in Ethiopia. Therefore, this study aimed to assess the pooled level of hypertensive self-care practices and associated factors in Ethiopia. METHODS: This study was carried out using published and unpublished articles accessed from databases: PubMed/MEDLINE, HENARI, Google Scholar, Web of Science, Scopus, African Journals, and university repositories. Data were extracted using a standard data extraction format. Data analysis was carried out using STATA version 11. Heterogeneity across the included studies was assessed using Cochrane's Q statistics and I 2 test with its corresponding p values. Publication bias was determined using Egger's test and presented with a funnel plot. The pooled level of hypertensive self-care practice was estimated using a random-effects meta-analysis model. RESULTS: This systematic review included 17 cross-sectional studies with 5,248 study participants. The overall pooled level of self-care practice among hypertensive patients in Ethiopia was 41.55% (95% CI 33.06, 50.05). Participant formal education (AOR = 2.82; 95% CI 2.18, 3.64) and good knowledge of hypertension (AOR = 4.04; 95% CI 2.19, 7.44) were significantly associated with self-care practice among hypertensive patients in Ethiopia. CONCLUSION: In this study, more than half of hypertensive patients had poor hypertensive self-care practice in Ethiopia. Participant's formal education and good knowledge of hypertension were significantly associated with self-care practice among people living with hypertension in Ethiopia. Therefore, based on the evidence of this study, we recommended that programmers and policymakers should enhance the awareness of hypertensive patients on self-care practice domains and strengthen local programs working on noncommunicable diseases.

Determinants of diabetes ketoacidosis among diabetes mellitus patients at North Wollo and Waghimra zone public hospitals, Amhara region, Northern Ethiopia.

BACKGROUND: Diabetes Mellitus (DM) is a metabolic disorder associated with acute and chronic complications. Diabetic ketoacidosis (DKA) is the most serious diabetic emergency in patients with type one and type two diabetes mellitus. It is the leading cause of mortality in children and young adults. Even though the burden of DKA has increased, no research has been conducted on the determinants of Diabetes ketoacidosis in Ethiopia, particularly in the Amhara region. Thus, this study aimed to identify the determinants of diabetes Ketoacidosis among Diabetes Mellitus patients at North Wollo and Waghimra Zone public Hospitals. METHODS: An institution-based unmatched case-control study design was employed among 408 patients at North Wollo and Waghimra Zone Public Hospitals from March 1st to April 30th, 2020. A consecutive sampling method was used to select study participants. The data were collected using structured interviewer-administered questioners and reviewing of patient charts. The analysis was done using a binary logistic regression model. Then, P-value < 0.05 was considered statistically significant. RESULT: The mean (±SD) age of the study participants was 46.96 (± 15.175 SD) years. Irregular follow-up in diabetes clinic (AOR:4.19, 95% CI: 2.28-7.71), not received diabetic education (AOR: 2.87, 95% CI:1.44-5.72), alcohol drinking (AOR:2.99, 95% CI: 1.46-6.12), discontinuation of medications (AOR: 4.31, 95% CI:1.92-9.68), presence of comorbidity (AOR:2.57, 95% CI: 1.37-4.84), and being type one of diabetes mellitus (AOR: 2.01, 95% CI:1.11-3.63) were determinant factors of diabetic ketoacidosis . CONCLUSIONS: This study showed that the behavioral and clinical characteristics of diabetic patients were determinant factors of DKA. Follow-up in the diabetic clinic, diabetic education, discontinuation of medications, alcohol drinking, presence of comorbidities, and type of diabetes mellitus were independent determinants of diabetic ketoacidosis.

Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Undernutrition and tuberculosis are the major public health problems of people living in middle and low-income countries. Even though single studies have been reported from different areas of Ethiopia, there is no national-level study that estimates the overall burden of undernutrition among tuberculosis patients. Therefore, this study aimed to estimate the overall magnitude of undernutrition among adult tuberculosis patients in Ethiopia. METHODS: We searched out records from databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar, and African journals and the online Ethiopian University repositories for published and unpublished articles. The data were extracted using a standardized data extraction format. Meta-analysis was computed using STATA version 11 software. The Cochrane Q-test and I2 with its corresponding p-value were used to assess the heterogeneity of the study. The presence of publication bias was evaluated using Egger's test and presented with funnel plots. The random-effects meta-analysis model was computed to estimate the pooled prevalence of undernutrition among adult tuberculosis patients. RESULTS: A total of Twelve observational studies with 4963 study participants were included in this systematic review and meta-analysis. The pooled prevalence of undernutrition among tuberculosis patients in Ethiopia was 50.8% (95% CI 43.97, 57.63). The results of subgroup analysis showed that the highest prevalence of undernutrition among TB patients was observed from studies done in the Amhara region (65.63%). In this meta-analysis, the pooled prevalence of undernutrition among TB-HIV co-infected patients was 45.45% (95%CI 21.85, 56.07). CONCLUSION: The prevalence of undernutrition among TB patients in Ethiopia was noticeably high. The result of this study showed that undernutrition is more severe in the Amhara regional state. Additionally, TB-HIV co-infected patients are highly affected by undernutrition. Therefore, the Ministry of Health in collaboration with clinicians should give special attention to provide nutritional care and support for TB patients as part of regular care. Moreover, special nutritional support should be designed for TB-HIV co-infected patients.

A drug repositioning success: The repositioned therapeutic applications and mechanisms of action of thalidomide.

BACKGROUND: Thalidomide is the most teratogenic human medicine ever marketed and was associated with birth defects in approximately 10,000 children in the 1960s. The pharmacological effects of thalidomide are attributed to its anti-angiogenic, anti-inflammatory and modulatory effect on cytokines principally tumor necrosis factor-α, while the teratogenic effects are linked to two molecular targets, namely cereblon and tubulin. Teratogenicity is the gravest adverse effect of thalidomide depending on the dose and time of exposure. Nonetheless, with System for Thalidomide Education and Prescribing Safety program, the possibility of teratogenicity can be completely avoided. The sensitive period during pregnancy for thalidomide teratogenicity in humans is approximately 20-34 days after fertilization. METHODS: Relevant articles were identified from Google scholar and PubMed (MEDLINE) using different search strategies. CONCLUSION: Clinical trials showed that thalidomide has been found effective in the treatment of advanced renal cancer, esophageal cancer, chemotherapy refractory endometrial cancer and pancreatic cancer, which can suggest its future therapeutic potential in cancer treatment. Thalidomide is also used in the treatment of inflammatory skin disorders and has shown promising effect in the treatment of autoimmune disorders and inflammatory bowel disease. Despite thalidomide being a renowned teratogen and neurotoxin, it has been successfully repositioned and FDA approved for the treatment of erythema nodosum leprosum and multiple myeloma under strict control.

Intestinal parasitic infections and associated factors among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Intestinal parasitic infections are major public health problems throughout the world, particularly in people living with HIV/AIDS. People living with HIV/AIDS are vulnerable groups for a variety of diseases, hence they are easily affected by opportunistic and non-opportunistic intestinal parasites due to the weakening of their immunity. Therefore, this study aimed to estimate the pooled prevalence and factors associated with intestinal parasitic infections among people living with HIV/AIDS in Ethiopia. METHODS: Articles were identified through search engines in the online electronic databases PubMed/MEDLINE, EMBASE, HINARI, CINAHL, Cochrane Library, Google Scholar, and reference lists of previous studies following the PRISMA Protocol. Studies conducted between 2003 and 2020 with English language were included in this study. This review included papers with having high-quality NOS scores. Meta-analysis was computed using STATA version 11 software. Heterogeneity was assessed using the Cochrane Q-test and I2 test statistics. Subgroup and sensitivity analysis was employed with evidence of heterogeneity. Publication bias was determined using the funnel plot and Egger's regression test statistic. RESULTS: This study included a total of twenty-two cross-sectional studies with 5,833 study participants. The mean age of the study participants was 35 years old. The pooled prevalence of intestinal parasitic infection among people living with HIV/AIDS in Ethiopia was 39.15% (95%CI: 32.34, 45.95). The pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS who had taking ART and who had not to start ART was found to be 28.27% (95%CI 22.47, 34.06) and 41.63% (95%CI: 28.75, 54.52) respectively. Unavailability of latrine (AOR: 4.87, (95% CI: 2.39, 9.92)), CD4+ T cell count <200cells/µl ((AOR: 3.53, (95%CI: 1.98, 6.27)), and having a history of diarrhea (AOR: 4.79 (95%CI: 1.53, 14.99) were factors significantly associated with intestinal parasitic infections. CONCLUSION: In this study, the overall pooled prevalence of intestinal parasitic infections among HIV/AIDS patients in Ethiopia was relatively high. CD4+ T-cell count <200cells/µl, unavailability of a latrine, and history of diarrhea were significantly associated with intestinal parasitic infections. Therefore, the policymakers and health care professionals could give special attention to the presence of latrines, early detection and treatment of intestinal parasitic infections, and early initiation of ART drugs.

Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Early initiation of breast feeding has great importance for both mothers and newborns. Despite, recommendations for exclusive and early initiation of breast feeding within one hour of birth, Ethiopia reports that 58% of infants under six months of age are exclusively breastfed. Cesarean deliveries may affect timing of breastfeeding initiation, establishment of milk supply and infant breastfeeding interest compared to vaginal deliveries. The aim of this study was to assess the impact of cesarean delivery on breastfeeding initiation. METHODS: A cross-sectional study was conducted with a total of 7115 study participants from the 2016 Ethiopian Demographic Health Survey (EDHS). Both descriptive and analytical statistical analysis was employed. Univariable and multivariable logistic regression analyses were used to identify anyassociations between variables. Odds ratios with its corresponding 95% confidence intervals (CI) were reported. During multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. RESULTS: The prevalence of late initiation of breast feeding among women with their last live birth was 25.03% (95%CI; 20.5-32.2). Significant factors associated with late initiation of breastfeeding were cesarean delivery [AOR = 4.06 (95%CI, 2.66-6.2)], primipara mother [AOR = 1.45(95%CI, 1.13-1.7)], and having an unplanned pregnancy [AOR = 1.35(95%CI, 1.1-1.65)]. Positively associated with early initiation of breastfeeding was the mother's age, for women between 20-34 years-old. This association, reported as a negative association of late initiation of breast feeding was [AOR = 0.77(95%CI, 0.61-0.98)]. CONCLUSION: Cesarean delivery adversely affects the initiation of breast feeding. Cesarean delivery, unplanned pregnancy, and being primiparous, were associated with late initiation of breastfeeding. Women between the ages of 20-34 years of age had a reduced chance of late initiation of breastfeeding. Providing counseling regarding the strategy and importance of early initiation of breast feeding, could have crucial importance for the mother and her newborn.

Blood Donation Practice and Associated Factors in Ethiopia: A Systematic Review and Meta-analysis.

BACKGROUND: Blood donation is a novel act to save the lives of people who face serious medical and surgical conditions. Since the demand for blood supply is too high, there is a shortage of blood which causes significant morbidity and mortality. To increase blood supply and maintain adequate quantity of blood, regular and volunteer blood donation practice is needed, which meets the increased demand for blood. Therefore, this systematic review and meta-analysis was aimed at assessing the prevalence of blood donation practices and associated factors in Ethiopia. METHOD: PubMed/MEDLINE, HINARI, Embase, Scopus, Google Scholar, African Journals Online (AJOL), and published and unpublished articles from the Ethiopian University repository were searched to find articles. Cochrane I 2 statistics and Egger's test with funnel plots were done to check heterogeneity and publication bias, respectively. Subgroup analysis by region, study subjects, study setting, and sample size was done due to heterogeneity, as well as sensitivity analysis. RESULT: Twenty studies from different regions with a total study subject of 8546 were included in the final review. The pooled prevalence of blood donation practice in Ethiopia was 25.82% (95% CI: 21.45-30.19). Having good knowledge of blood donation (AOR = 2.85; 95% CI: 2.33-3.48) and favorable attitude (AOR = 4.35; 95% CI: 2.93-6.45) were factors associated with blood donation practice in Ethiopia. CONCLUSION: The pooled prevalence of blood donation practices in Ethiopia was short of the demand for blood due to the increase in serious medical conditions and road traffic accidents. Knowledge and attitude towards blood donation were significantly associated with blood donation practice. Therefore, awareness creation and health education programs targeting blood donation practice should be strengthened.