Assessments of functional outcomes and its determinants among bipolar disorder patients in Northwest Ethiopia comprehensive specialized hospitals: a multicenter hospital-based study.

INTRODUCTION: Bipolar disorder is a severe and chronic mental illness that could continue for a lifetime. Although it is a leading cause of disability and impairments for significant numbers of patients, the levels of functional outcomes have not been studied in Ethiopia. Therefore, this study aimed to assess the functional outcome levels and associated factors among bipolar disorder patients in Northwest Ethiopia. METHOD: Hospital-based cross-sectional study was employed among bipolar disorder patients attending psychiatric clinics, in Northwest Ethiopia, from April to June 2021. Systematic random sampling was used to get respondents. Descriptive and inferential statistics were done. Data were entered into EpiData version 4.6.02 and exported to SPSS Version 22 for analysis. Bivariable and multivariable binary logistic regression analysis was used to identify the factors associated with functional outcome levels, and p value < 0.05 was considered significant with 95% CI. RESULT: Of the total 423 study participants approached, only 411 completed the questionnaire, with a response rate of 97.2%. The median (IQR) level of functional outcome was 6 (0-22) and 40% of the study subjects were impaired. Leisure time was the most normal functioning domain (92.2%), whereas cognitive (43.5%) and occupational (41.6%) domains were the most impaired domains. Unemployment (AOR (95%CI) = 3.9 (1.46-10.49), obesity (AOR (95% CI) = 6.5 (1.22-34.58), depressed and manic mood phases (AOR (95%CI) = 5.2 (2.84-9.35) and (AOR (95%CI) = 7.8 (3.31-18.34) respectively, medication non-adherence (AOR (95% CI) = 3.2 (1.71-6.05), and relapsed once or ≥ twice (AOR (95%CI) = 2.2 (1.25-3.98) and (AOR (95%CI) = 8.3 (2.73-25.30), respectively, were some of the important predictor variables that were significantly associated to the functional impairments levels. CONCLUSION: The median of functional outcomes levels was found in an acceptable range; however, significant numbers of bipolar patients were functionally impaired. Moreover, patients still need unrestricted interventions in the cognitive and occupational functional domains. Socio-demographic, clinical, medication, and psychosocial variables were significantly associated with functional outcomes. Bipolar patients need to be followed and managed to improve their functional outcome and all stakeholders should be involved to achieve the recommended levels.

The association of lipid-lowering therapy and blood pressure control among outpatients with hypertension at the Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Background: The lipid-lowering medications known as statins have been shown in controlled clinical trials to have pleiotropic properties, such as lowering blood pressure, in addition to lowering cholesterol levels. The purpose of this study was to see if there was a possible link between blood pressure control and statin therapy in outpatients with hypertension in a real clinical setting. Patients and methods: A retrospective comparative cohort study of 404 patients with hypertension was carried out. A systematic random sampling technique was used. For data entry, Epi-Data version 4.6 was used, and SPSS version 25 was used for further analysis. For group comparisons, chi-square and independent t-tests were computed. To determine the relationship between statin use and blood pressure control, a binary logistic regression model was employed. To declare statistical significance, a 95% confidence interval and a P-value of <0.05 were used. Results: Half of the study participants who were using a prescribed statin were assigned to the statin group, whereas the remaining participants who do not take statins were assigned to the control group. After 3 months of statin treatment, BP control to <130/80 mmHg was significantly greater (P = 0.022) in the statin group (52.5%) than in the control group (41.0%). The use of statins raises the likelihood of having blood pressure under control by 1.58 times when compared to statin non-users. After controlling for possible confounders, statin therapy still increased the odds of having controlled BP by a factor of 5.98 [OR = 5.98; 95% CI: 2.77-12.92]. Conclusion: This study revealed that blood pressure control was higher among statin user hypertensive patients. Favorable effects of statin use were independently observed, even after correction for age, presence of dyslipidemia, and duration of antihypertensive therapy. Therefore, the importance of concomitantly added lipid-lowering drugs such as statins and their role in managing poor blood pressure control should be given due emphasis.

Knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention in North West Ethiopia.

Background: In Ethiopia, there are no adequate studies made on the knowledge and practice of CVD and its risk factors among community pharmacists. Thus, this study aimed to assess knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention. Methods: A Cross-sectional study was conducted on a total of 81 community pharmacists from the first march to May 30, 2020, at Gondar town. Data was entered to EPI-INFO 7 and exported to SPSS software for windows version 20 for analysis. The results are presented by using tables and figures. The chi-square test was applied to test the relationship between Knowledge and independent variables. P-value ≤ 0.05 was considered as statistical significance. Result: Of the participants, 45 (55.6%) of them were found knowledgeable about cardiovascular disease. On the other hand, only 18.5%, 77.8%, and 93.8% of the study participants respectively were aware of CVD risk factors like symptoms of heart disease, the connection of family history of heart disease, and the connection between old age and heart disease. Only 21% of the study participants had known the existence of HTN guidelines in Ethiopia. X2 statistical analysis showed that there was no statistically significant association between age (P = 0.82), gender (P = 0.661). Marital statuses (P > 0.50), number of years of practice (P = 0.796) and cardiovascular disease. The main barriers to the prevention of CVD for community pharmacists were, lack of time (18.5%), inability to identify targeted patients (65.4%), lack of knowledge (23%), and lack of communication (26%). Conclusion: The overall assessment of the pharmacists demonstrated that more than half of the participants were found knowledgeable. However, only a small proportion of the study participants had known about the existence of National guidelines for cardiovascular disease in particular and non-communicable disease in general. Therefore, the provision of government policy that will regulate their training, certification, and practice for CVD screening and as well as provide a framework of incentives are recommended.

Medication-related burden and associated factors among diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital in northwest Ethiopia.

Background: Evaluating the medicine burden from the patients' perspective is essential for getting good health outcomes of diabetes mellitus (DM) management. However, data are limited regarding this sensitive area. Thus, the study was aimed to determine the medication-related burden (MRB) and associated factors among DM patients at Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in northwest Ethiopia. Methods: A cross-sectional study was conducted on 423 systematically selected DM patients attending the DM clinic of FHCSH from June to August 2020. The medication-related burden was measured by using the Living with Medicines Questionnaire version 3 (LMQ-3). Multiple linear regression was used to identify factors associated with medication-related burden and reported with 95% confidence interval (CI). p-value <0.05 was considered as statistically significant to declare an association. Results: The mean LMQ-3 score was 126.52 ( ± 17.39). The majority of the participants experienced moderate (58.9%, 95% CI: 53.9-63.7) to high (26.2%, 95% CI: 22.5-30.0) degrees of medication burden. Nearly half (44.9%, 95% CI: 39.9-49.7) of the participants were non-adherent to their prescribed medications. VAS score (B = 12.773, p = 0.001), ARMS score (B = 8.505, p = 0.001), and fasting blood glucose (FBS) on visit (B = 5.858, p = 0.003) were significantly associated with high medication-related burden. Conclusion: A significant number of patients suffered from high medication-related burden and non-adherence to long-term medicine. Therefore, multidimensional intervention to decrease MRB and to upgrade adherence is required to increase patients' quality of life.

Psychotropic medication non-adherence among patients with severe mental disorder attending at Bahir Dar Felege Hiwote Referral hospital, north west Ethiopia, 2017.

OBJECTIVE: Medication non-adherence is a major public health problem that has been called an "invisible epidemic". Globally, non-adherence rates among patients with severe mental illness ranged between 30 and 65%. It greatly increases the risk of illness exacerbation and hospitalizations. However, there is a paucity of studies examining treatment non-adherence and its associated factors among patients with severe mental disorder. Therefore, this study was aimed at determining the magnitude of medication non-adherence and associated factors among patients with severe mental disorder. RESULTS: A total of 409 study subjects were participated making a response rate of 92%. The overall prevalence of medication non-adherence was found to be 55.2% (95%, CI; 49.9%, 60.2%). Study participants whose age group of (25-34) [AOR = 3.04 (95% CI 1.27, 7.29)], study subjects taking their medication twice per day [AOR = 4.60 (95% CI 2.25, 9.43)], no social support [AOR = 4.4 (95% CI 1.78, 11.08)] and no insight for their treatment [AOR = 5.88 (CI 2.08, 16.59)] were significantly associated with medication non-adherence. The result of this study showed that non-adherence among patients with severe mental disorder was found to be high. Psychiatry health care providers have to consider the frequency of medication become once per day, continual awareness creation among professionals and engaging significant others for good social support system and continual treatment alliance is strongly commended for adherence.

Metabolic syndrome among type 2 diabetic patients in Ethiopia: a cross-sectional study.

BACKGROUND: Metabolic syndrome (MetS) increases risk of cardiovascular diseases (CVD), premature death as well as cost related to health care.This study was aimed at investigating the prevalence of MetS and its determinant factors among type2 diabetes mellitus (T2DM) patients attending a specialized hospital. METHODS: A cross-sectional study was conducted on a total of 256 T2DM patients from the first march to 30th May 2017 at university of gondar comprehensive specialized hospital (UGCSH). Data was collected based on STROBE (strengthening the reporting of observational studies in epidemiology) statement. Bivariable and multivariable logistic regression analysis were run to identify predictors of MetS from the independent variables and significance test was set at P <  0.05. RESULTS: The prevalence of MetS in this study was 70.3, 57 & 45.3% and it is more common in females (66.1, 83.3 & 70.7%) by using national cholesterol education program adult treatment panel III (NCEP-ATP III), International diabetic federation (IDF) and world health organization (WHO) criteria respectively. The most prevalent components of MetS were low level of high density lipoprotein (HDL) and triglyceride(TG). By usingIDF criteria, female gender was significantly associated with MetS (AOR = 0.2 at 95%CI: 0.1, 0.6 P = 0.00). Where as by NCEP-ATP IIIcriteria, age between 51 and 64 years old (AOR = 2.4 95% CI: 1.0,5.8, P = 0.04), self employment (AOR = 2.7 95% CI:1.1, 6.5, P = 0.03), and completetion of secondary school and above (AOR = 3.2, 95% CI:1.6,6.7, P = 0.001) were predictors for the development of MetS. In the WHO criteria, being single in marital status was significantly associated with MetS (AOR = 17 at 95%CI: 1.8, 166, P = 0.000). CONCLUSIONS: This study demonstrates that Metabolic syndrome is a major health concern for diabetic patients in Ethiopia and they are at increased risk of developing complications such as cardiovascular diseases and premature mortality. The predictors female gender, age between 51 and 64 years old, urban area residence, and being single are modifiable.Thus,health authorities shall provide targeted interventions such as life style modifications to these most at risk sub-populations of diabetic patients.

Compliance to iron and folic acid supplementation in pregnancy, Northwest Ethiopia.

OBJECTIVE: Strict compliance to iron and folic acid supplementation is vital for prevention of anemia in pregnancy. However, data are scarce in Ethiopia. So, we conducted this study to assess the level of compliance to iron and folic acid supplementation during pregnancy and its associated factors. RESULTS: Of 418 women, over half, 231 (55.3%), adhered to the recommended iron and folic acid supplementation. Women who started antenatal care (ANC) follow up early [AOR; 95% CI 2.43 (1.12-5.26)], had more frequent number of ANC visit [AOR; 95% CI 2.73 (1.32-5.61)], took small number of tablets per visit [AOR; 95% CI 3.0 (1.21-7.43)], had history of anemia [AOR; 95% CI 1.9 (1.17-3.12)], and were from urban areas [AOR; 95% CI 2.2 (1.29-3.77)], were more likely to conform to recommended iron and folic acid supplementation. Therefore, there need to be prescription of the lowest possible number of tablets per visit. Furthermore, education targeting on increasing maternal health service utilization need to be in place. There need to also be further research aimed at determining the number of tablets to be prescribed per visit specific to individuals' background characteristics.

Involvement of community pharmacists in continuing professional development (CPD): a baseline survey in Gondar, Northwest Ethiopia.

BACKGROUND: Health care professionals have been striving to maintain their competence to deliver the best quality of service. This study intended to determine involvement in continuing professional development of community pharmacists in Gondar, Northwest Ethiopia. METHODS: About 46 community pharmacists, each from a different setting, were interviewed using structured questionnaire. Data were analyzed using Pearson's Chi-square test of independence and Mann-Whitney U test with p < 0.05 taken as statistically significant. RESULTS: The majority (n = 26, 56.5%) reported of being unaware of the CPD concept. The mean hour spent per week on CPD is 4.1 ± 4.0. Most (n = 34, 73.9%) were engaged in self directed learning and expressed an interest to be more involved in CPD activities (N = 39, 84.8%). Interactive workshops were the most preferred modality. However they seek further support in the process of identifying learning needs (N = 34, 73.9%). The main barriers for CPD engagement include lack of (N = 36, 78.3%) and inaccessibility (N = 34, 73.9%) of CPD opportunities as well as time shortage (N = 33, 71.7%). CONCLUSIONS: The community pharmacists in Gondar, Northwest Ethiopia lack awareness of CPD concept but engaged in various types of CPD activities. They demonstrated good attitude and seek more support. The main barrier was lack of opportunities related to CPD.

The Needs and Resources of Drug Information at Community Pharmacies in Gondar Town, Northwest Ethiopia.

BACKGROUND: Community pharmacists are in a key position to provide information on drugs and thus promote the rational use of drugs. OBJECTIVES: The present study was designed to determine the needs and resources of drug information in community pharmacies. METHODS: A prospective institution based cross-sectional study was carried out and data were collected on 48 community pharmacists in Gondar, Northwest Ethiopia, using interviewer administered structured questionnaire. RESULTS: Almost all pharmacists (N = 47, 97.9%) often receive drug related queries and these were mainly from consumers (N = 41, 85.4%). While most questions relate to drug price (N = 29, 60.4%) and dosage (N = 21, 43.8%), the information resources mainly referred to were drug package inserts and national standard treatment guidelines. However, limited availability of information resources as well as limited ability to retrieve relevant information influenced the practice of pharmacists. Female pharmacists claimed better use of different information resources than males (P < 0.05). CONCLUSIONS: Community pharmacists in Gondar, Northwest Ethiopia, are often accessed for drug related information. But there are limitations in using up to date and most reliable resources. Therefore, intervention aimed at improving pharmacists' access to and evaluation of drug information is urgently needed.

Herbal Medicines: Personal Use, Knowledge, Attitude, Dispensing Practice, and the Barriers among Community Pharmacists in Gondar, Northwest Ethiopia.

BACKGROUND: Herbal medicine use is increasing and the global market is estimated to be US$107 billion by the year 2017. OBJECTIVES: This study aimed at assessing community pharmacists' personal use, knowledge, attitude, dispensing practice, and the barriers regarding herbal medicines. METHODS: Institution based cross-sectional study was conducted among 47 community pharmacists in Gondar, Northwest Ethiopia, using a structured interviewing questionnaire. RESULTS: Nearly half of the respondents (n = 22, 46.8%) sometimes use herbal medicines. Although knowledge related to such preparations was self-rated as poor/acceptable (n = 34, 72.4%), majority (n = 44, 93.7%) of community pharmacists agree/strongly agree that herbal medicines have beneficial effects. Only 6 (12.7%) of them are sometimes/often engaged in dispensing herbal medicines and most of them (n = 34, 72.3%) rarely/never counseled clients regarding these preparations. Limited knowledge on and access to information regarding herbal medicines are the main barriers to the pharmacists' practice. CONCLUSION: Although community pharmacists in Gondar, Northwest Ethiopia, commonly use and demonstrated good attitude towards herbal medicines, they are less involved in dispensing such products. They are also challenged with limited knowledge on and access to herbal medicine information. Thus, pharmacy educators, professional organizations, and the government shall pay more attention to solve the problem. Regulatory provisions on herbal medicine dispensing must be enacted and communicated very well.

Assessment of drug-related problems in pediatric ward of Zewditu Memorial Referral Hospital, Addis Ababa, Ethiopia.

Background Although medications play a vital role in the cure, palliation, and inhibition of disease, they also expose patients to drug-related problems (DRPs). DRPs are common in hospitalized patients. Specifically, pediatrics population are easily affected by DRPs, as dynamic and kinetic behaviors of drugs in this population are usually different than  in adults. Objectives To assess the prevalence of DRPs and associated factors in a pediatric setting in Ethiopia. Setting Pediatric ward of Zewditu Memorial Referral Hospital, Addis Abbeba, Ethiopia. Methods A cross-sectional study was conducted on 285 randomly selected patients. Data were obtained through review of physician medication orders and patient files. The prevalence and type of DRPs were studied and documented using the Pharmaceutical Care Network Europe Foundation classification system. The results were summarized using descriptive statistics including frequency, mean, and standard deviation. To identify the independent predicators of DRPs, logistic regression analysis was run and a P value ≤0.05 was considered as statistically significant. Main outcome measure DRPs, types of DRPs, drugs that are frequently involved in DRPs, and factors associated with DRPs. Main outcome measure Number of DRPs. Results Of the 1055 medication orders reviewed, a total of 106 DRPs were identified in 90 patients. This gives an overall rate of drug-related problems of 31.57%. The most frequently identified DRPs were dosing problems, with dose too low being 34.9% and dose too high being 7.5%. This was followed by drug-drug interactions (38.67%) and adverse drug reactions (8.49%). The number of prescribed drugs (AOR 2.3, 95% CI 1.3-4.3, P = 0.007) and total number of disease conditions (AOR 4.8, 95% CI 1.9, 12.1, P = 0.001) were potential risk factors for occurrence of DRPs. Conclusion The present study demonstrated that DRPs were common at the pediatric ward of Zewditu Memorial Referral Hospital and that it needs great attention. The most frequently identified DRPs were dosing problems, followed by drug-drug interactions and adverse drug reaction. Poly-pharmacy and number of disease conditions have been identified as important risk factors for occurrence of DRPs. The investigators recommend establishing a system for reporting DRPs in the pediatric ward of the hospital as it may facilitate appropriate measures for prospective interventions, such as training the healthcare team, as well as detail precautions to be followed by the practitioners. In addition to this, improving communication between the healthcare team members such as physicians, pharmacists, nurses, and other healthcare workers in the hospital is recommended.