RESUMO
Background: A drug therapy problem (DTP) is any undesirable event experienced by a patient that accompanies drug therapy, prevents the patient from achieving their desired therapeutic goals, and requires expert judgment to resolve. Pediatric populations are at a higher risk of DTP than adults due to their immature organ systems, including the liver and kidneys, which play crucial roles in drug metabolism and excretion. Most previous studies have focused on only one element of DTP. Therefore, by considering all elements of DTP, we aimed to assess the prevalence of DTP and associated factors among pediatric patients admitted to the Wolaita Sodo University Comprehensive Specialized Hospital. Methods: An institution-based cross-sectional study was conducted among pediatric patients admitted to Wolaita Sodo University Comprehensive Specialized Hospital from 8 July 2020, to 7 July 2021. A simple random sampling technique was employed to select study participants. Cipolle's and Strand's classification method of drug therapy problems was used to identify and categorize DTP. Data were obtained by reviewing the patient's medical records using a data abstraction checklist, entered into Epi data version 4.6, and exported to SPSS version 25 for analysis. Binary logistic regression analysis was performed to identify independent predictors of DTP. Results: Medical records of 369 pediatric patients were reviewed, and the overall prevalence of DTP was 60.2% (95% CI:55.2%, 65.2%) with a total of 281 identified DTPs. Among them, 164 (74.2%) had only one DTP. Need additional drug therapy was the most common (140 [49.8%]) DTP identified. The number of disease conditions (AOR = 2.13, 95% CI:1.16, 3.92), polypharmacy (AOR = 3.01, 95% CI:1.70, 5.32), and duration of hospital stay (AOR = 1.80, 95% CI:1.04, 3.10) were independent predictors of DTP among admitted pediatric patients. Conclusion: The prevalence of DTP in pediatric patients in the current setting was high. The number of disease conditions, polypharmacy, and duration of hospital stay were independent predictors of DTP. Enhancements to pharmaceutical care services, optimized dosage practices, improved deprescribing by clinicians, and efficient, comprehensive diagnostic procedures have the potential to significantly reduce specific drug therapy problems in hospitalized pediatrics.
RESUMO
Background: Antiretroviral therapy has improved the life expectancy of HIV-positive children. Treatment failure and drug resistance among children with HIV remain major public health concerns despite the rise in ART use. A dearth of evidence exists regarding treatment failure among Ethiopian children from multicenter settings. Therefore, this study sought to assess the incidence and predictors of treatment failure among children with HIV on first-line antiretroviral therapy at health facilities in Wolaita zone, Southern Ethiopia. Methods: A facility-based retrospective cohort study was conducted from January 1, 2017, to December 30, 2021, at health facilities providing ART in Wolaita zone, Southern Ethiopia. A total of 425 children with HIV on first-line ART were selected using a simple random sampling technique. Data were extracted by reviewing the patient's medical record. The data were entered using epi-data version 4.6 and exported to STATA version 15 for analysis. Both bi-variable and multivariable Cox regression analysis were employed. A p-value of less than 0.05 and a hazard ratio with 95 % CI was used to estimate the association between the predictor factors and treatment failure. Results: The overall incidence density rate of treatment failure was 3.2 per 1000 person-months of observation (95 % CI: 2.4-4.6). The factors significantly associated with antiretroviral treatment failure were caregiver marital status, single (AHR = 4.86, 95 % CI: 1.52, 15.60), and widowed (AHR = 3.75, 95 % CI: 1.16, 12.11), duration of follow-up (AHR = 4.95, 95 % CI: 1.81, 13.54), and baseline CD4 count (AHR = 4.70, 95 % CI: 1.68, 13.14). Conclusion: The incidence rate of ART failure among children with HIV was found to be significant. Low baseline CD4 count, short follow-up duration on ART, and having a single or widowed caregiver were significantly associated with antiretroviral treatment failure. Early identification of children with low CD4 count and subsequent initiation of ART should be emphasized by stakeholders working in HIV care programs. Healthcare professionals should pay special attention to and regularly monitor the treatment progress of children who have single or widowed caregivers, and those with shorter duration of follow-ups.
RESUMO
Background: Obstetric fistula among women of reproductive age is a significant public health issue in developing countries, including Sub-Saharan Africa. However, the pooled awareness of obstetric fistula among women of reproductive age in Sub-Saharan Africa and its variation between countries have not yet been studied. Hence, the review aims to assess variability and awareness of obstetric fistula among women of reproductive age in Sub-Saharan African Countries. Method: Articles were searched using different electronic databases, such as PubMed, Web of science, science direct (Scopus), Google scholar, and HINARI and manual search without regard to publication date. A random-effects model was used to ascertain the pooled prevalence of obstetric fistula awareness among women of reproductive age in Sub-Saharan Africa. Publication bias was checked by using funnel plot and Egger's test at a 5% level of significance. I2 test statistics was performed to evaluate heterogeneity among included studies. In addition, to identify the possible reason for the potential heterogeneity between the studies, sub-group and meta-regression analyses were conducted. A sensitivity analysis was performed to determine the impact of individual research on the overall results. The data were extracted by using Microsoft excel and analyzed using statistical software STATA/SE version 17. Result: A total of 22 studies with 79,693 women of reproductive age were included in this systematic review and meta-analyses. In Sub-Saharan Africa, the pooled prevalence of awareness towards obstetric fistula among women of reproductive age was 40.85% (95% CI: 33.48, 48.22%). Analysis of the subgroups by specific countries revealed significant variation. The highest awareness of obstetric fistula was found among Tanzanian women of reproductive age (61.10%, 95% CI: 55.87-66.33%), whereas the lowest awareness was found in research from the Gambia (12.80%, 95% CI: 12.20-13.40%).The likelihood of obstetric fistula awareness were lower by a factor of 0.424 among studies with sample sizes greater than 3542 (ß = -0.424 (95% CI: -0.767 to 0.081), p -value <0.05). Conclusion: According to the current review, there is a low level of awareness about obstetric fistula among women of reproductive age in sub-Saharan Africa, and the results of the sub-group analysis by country showed wide variations. Therefore, we emphasize the need for country-specific public health initiatives to raise awareness about obstetric fistula among women of reproductive age, which could reduce the risk of delayed treatment.
RESUMO
Background: Self-medication is a treatment based on symptoms without prescription and medical consultation. Despite being one of the critical practices that impose a harmful effect on the fetus and the woman herself, evidence on its practice and associated factors are not well-documented. This study, therefore, assessed the self-medication practice and associated factors among pregnant women in Wolaita Zone, Southern Ethiopia. Methods: An institutionally based cross-sectional study was conducted at public health institutions in Wolaita Zone, Southern Ethiopia by recruiting a total of 408 pregnant women using a systematic random sampling technique between March 2019 and April 2019. We used the Antenatal care (ANC) registry as a sampling frame. A pre-tested, structured, interviewer-administered questionnaire used to depict Self-medication practice and associated factors. Data entered using Epi-data and analyzed by SPSS 23.0. Results: The overall prevalence of self-medication was 14.9% (95% CI:11-18). The odds of using self-medication may decreased by 75% for women who were in their third trimester (AOR = 0.25, 95% CI: 0.10, 0.64). However, the odds of practicing increased by 13-folds among pregnant women reported earlier (previous) self-medication experience (AOR = 13.62, 95% CI: 6.66-27.84). Conclusion: The prevalence of self-medication was high in the current study setting. Women's gestational period (third trimester) and earlier self-medication experience were associated with their current self-medication practice.
