Seizure Remission and Its Predictors Among Epileptic Patients on Follow-Up at Public Hospitals in Eastern Ethiopia: A Retrospective Cohort Study.

Background: Epilepsy is one of the common chronic neurological disorders with varying therapeutic responses. Despite the high prevalence of epilepsy and the significant treatment gaps in developing nations, such as Ethiopia, there is a dearth of data on seizure remission and its predictors in Eastern Ethiopia in particular. Objective: This study aimed to determine seizure remission and its predictors among epileptic patients on follow-up in Hiwot Fana Specialized University Hospital (HFSUH) and Dilchora Referral Hospital (DCRH), from July 2 to 31, 2021. Methods: A retrospective cohort study was conducted among 418 newly diagnosed epilepsy patients receiving anti-seizure drugs (ASDs) between July 1, 2014, and July 31, 2019, in two public hospitals in Eastern Ethiopia. Relevant data were collected for all patients with a minimum follow-up period of two years. Data were analyzed using SPSS Version 21. Cox proportional hazards model was performed to identify predictors of seizure remission. Results: Overall, 252 (60.3%) of the study participants have achieved seizure remission for at least one year. The mean time to achieve seizure remission was 1.9 ± 0.87 years. Regarding the seizure remission pattern, 171 (40.9%) patients achieved early remission, 81 (19.4%) achieved late remission, and 166 (39.7%) achieved no remission. Shorter pre-treatment duration (AHR = 2.36, 95% CI: 1.28-4.37); good adherence to ASDs (AHR = 2.40, 95% CI: 1.33-4.34); and monotherapy (AHR = 0.56, 95% CI: 0.32-0.98) were predictors of seizure remission. Conclusion: We observed that less than two-thirds of epileptic patients had achieved seizure remission. A shorter pre-treatment duration, good adherence to ASDs, and monotherapy were predictors of seizure remission. Therefore, we recommend the requirement of an integrated effort from different health disciplines that increases patients' adherence to ASDs, promotes early visits to medical facilities, and improves the health-seeking behavior of epileptic patients.

Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study.

OBJECTIVE: Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia. DESIGN: Retrospective follow-up study. SETTING: Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia. PARTICIPANTS: Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021. PRIMARY OUTCOME: The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients. RESULTS: A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome. CONCLUSION: We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations.

Clinical Knowledge and Practice of "Ketofol" at University of Gondar Comprehensive Specialized Hospital.

Background: Ketamine and propofol in a single syringe are reported to create an admixture used for balancing cardiorespiratory effects during induction of general anesthesia. This study aimed to assess the clinical practice and knowledge of "ketofol" among anesthesia providers. Methods: A cross-sectional institutional-based study was conducted among anesthesia providers. Data abstracted format was prepared and distributed to senior anesthetists, junior anesthetist postgraduate students, and undergraduate students. The study was conducted from January 1, 2019, to January 30, 2019. Descriptive statistics and binary logistic regression were performed for frequency distribution and to determine the association, respectively. Result: From a total of 133 participants included in the study, the majority, 88 (66.2%), were men and 75 (56.9%) had 0-2 years of experience. More than two-thirds of participants, 105 (78.9%), have never had a seminar or educational session about combined use. Lack of experience among 11 participants (8.3%) was one of the reasons for not using "ketofol" followed by lack of knowledge among three (2.3%) participants. The majority of participants, 112 (84.2%), prefer ketamine and propofol to be administered one right after the other with separate syringes and the ratio to be 1:2, 64 (48.2). There was no significant association observed between sociodemographic and other characteristics and the practice of "ketofol." Conclusion: In this study, nearly half of the participants rated their knowledge at the average level, and the study identifies that there is clinical knowledge and practice gap among anesthesia providers working in the University of Gondar Comprehensive Specialized Hospital (UOGCSH). Preparing educational sessions regarding "ketofol" for addressing identified barriers is among the recommendations forwarded to UOGCSH.

In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis.

OBJECTIVE: To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa. METHOD: The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model. RESULT: A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17-0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24-0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12-0.19) and Southern Africa (18%, 95% confidence interval = 0.06-0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function. CONCLUSION: The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

Prevalence of metabolic syndrome and associated factors among psychiatric patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Psychiatric patients are at increased risk of being overweight or obese, and subsequently develop metabolic syndrome. Nevertheless, data regarding associated factors for weight gain are limited and inconsistent. OBJECTIVE: The present study aimed to determine the risk of metabolic syndrome and its associated factors among psychiatric patients. METHOD: A cross-sectional quantitative study was conducted among all psychiatric patients at the Psychiatric Unit of the University of Gondar Comprehensive Specialized Hospital from March 1- April 1, 2018. All eligible psychiatric patients were interviewed about their socio-demographic status,and clinical characteristics and useful parameters for the study were recorded from the medical records of the patients and by measuring waist to height ratio. Descriptive statistics were used to summarize baseline information.Binary logistic regression was used to determine the associated factors and P-value <0.05 and confidence interval (CI) of 95% were used as cut off points for determining statistical significance. RESULT: From 300 patients included in the study, 168(56%) patients were females,and around 50.3% of the study participants had low literacy levels. As per waist to a height ratio scale, 58% (174) of the patients had a risk of metabolic syndrome. The Binary logistic regression analysis indicated that sex (p-<0.0001), occupation (p -0.032), marital status (p-0.006), and distance from the hospital (p<0.0001) were statistically significant determinants of metabolic syndrome risk in the psychiatric patient in our setting. CONCLUSION: The majority of the psychiatric patients in the study setting had a risk of metabolic syndrome. Sex, marital status, employment status, and distance to the hospital were significantly associated with metabolic syndrome. Routine physical and laboratory investigations to detect metabolic syndrome are indispensable in psychiatric patients to prevent cardiovascular complications.

Level of Adherence to the Dietary Recommendation and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in Eastern Ethiopia: A Cross-Sectional Study.

BACKGROUND: Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised. OBJECTIVE: To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence. RESULTS: Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence. CONCLUSION: The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.

Pharmacy Students Motivation, Preparation and Factors Affecting Pursuing Postgraduate Education in Ethiopian University.

BACKGROUND: Pharmacy students seek postgraduate education (PGE) to develop their knowledge in a specified field of interest. Postgraduate Master's programs under the school of pharmacy in Ethiopia include clinical pharmacy, pharmacology, pharmacognosy, medicinal chemistry, pharmaceutical analysis, social pharmacy and administrative pharmacy, and pharmaceutics. This study aims to assess pharmacy student's motivation to study postgraduate programs and potential barriers to pursue postgraduate education. METHODS: Institutional-based cross-sectional study was conducted on regular pharmacy students of the University of Gondar. A survey was distributed to undergraduate regular pharmacy students from year one to five. PGE interested and non-interested student's difference in their characteristics was examined using chi-square. Binary Logistic regression was used to examine predictors of pursuing PGE. The study was conducted from February 1 to February 30, 2019. RESULTS: A total of 388 pharmacy students have participated in the study. More than half 215 (55.4%) of participants were males and in the age group 22-25, 204 (52.6%). Region (p-0.007), pharmacy as a first choice (p-0.001), experience in a leadership position (p-0.002), previous pharmacy-related work experience (p-0.001), and previous attendance at the conference (p-0.001) have shown statistically significant association with interest to pursue postgraduate education. CONCLUSION: Generally, few students rate their level of preparation and level of confidence to apply for PGE at high. Further works including preparing motivational speeches and details on admission requirements for available PGE programs have to be prepared in collaboration with the Ministry of Education (MOE) to enhance students' interest. Besides, potential development of scholarships for PGE may enhance the ability of some students to apply for PGE, who otherwise would be unable to.

Knowledge, attitude, and practice of pharmacy professionals on generic medicines in Eastern Ethiopia: A cross-sectional study.

BACKGROUND: Generic medicines are similar to innovator medicine in terms of safety, quality, efficacy, dosage form, strength, and route of administration. They have the same therapeutic use to innovator medicines and available at a far lower price. However, health professionals' poor knowledge and attitude may limit its utilization. The present study aimed at assessing the knowledge, attitude, and practice of pharmacy professionals towards generic medicines in Harar city, Eastern Ethiopia. METHODS: A cross-sectional survey was conducted among community pharmacists in Harar city. A self-administered thirty-three item questionnaire on Knowledge, attitude, and practice of community pharmacists was utilized. Logistic regression analysis was performed to predict the determinants of knowledge and attitude of pharmacists. An odds ratio at 95% confidence interval along with a p-value < 0.05 was considered significant. RESULTS: Among 80 community pharmacists' approached, 74 completed the survey, providing a response rate of 92.5%. Sixty-seven percent of the respondents knew that generic drugs are bioequivalent to brand drugs and claimed generic medicines are cheaper (86.5%). Nearly half (48.6%) of participants believe that generic medicines are less effective and slower in the onset of action (58.1%). More than half (54.1%) of study participants revealed their lack of belief in generic medicine as a factor hindering the selection and dispensing of generic medicines. In multivariate logistic regression, experience in community pharmacy practice (Adjusted odds ratio (AOR = 2.18, 95%CI: 1.21-63.1) and Sex (AOR = 3.88, 95%CI: 2.12-39.62) were significantly associated with knowledge and attitude toward generic medicines, respectively. CONCLUSION: The current study revealed that there is a gap in the knowledge and attitude of community pharmacists towards generic and brand drugs. More than averages of the respondents have known the concept of generic medicine including their right to perform generic substitution and had a positive attitude toward generics. Female pharmacists were more likely to have a positive attitude and the overall knowledge was higher in those who have more than 5 years of work experience.