Development of functional cookies form wheat-pumpkin seed based composite flour.

To develop high quality cookies, even seemingly smallest changes depended on factors that can affect taste, texture, and nutritional value. In this light, this study aimed to investigate the upshot of refined wheat flour and pumpkin seed flour on properties of cookies such as antioxidant activity, thermal and oxidative stability. In view of the foregoing, the roasted pumpkin seeds of particle size below 500 µm were blended with wheat flour at different ratios (BR) to bake at selected pre-determined temperatures (T) and time durations (TD). The synergetic effect of aforesaid parameters on cookie development, BR, T, and TD was studied by varying the parameters between the range 6-15 %, 180-200 °C and from 8 to 12 min, respectively, for the baking process of cookies. Further, the process was modelled and scrutinized using numerical optimization to achieve a highly acceptable product. On that account, it was deduced that the optimal condition for BR, T, and TD were 12.87 %, 186 °C and 9.5 min, respectively, that could pave to beget the excellent quality cookies with overall acceptance score of 8, protein content 14.28 %, fat 17.85 %, ash 2.23 %, moisture 2.46 %, fiber 2.38 % and total color difference 12.01. The optimized cookies (OCs) were found to have higher protein (11.49-14.28 %), fiber (0.93-2.41 %), ash (2.19-1.77 %), total antioxidant activity (38.7158-43.1860 %), oxidative stability (28.61-51.24 h), Zn (1.42-2.63 mg/100g), and Fe (2.12-3.20 mg/100g) content as compared to the control. Laconically, the study results provided the optimized processing condition for developing high quality cookies with respect to improved nutritional value and comparable overall acceptability.

Health-Related Quality of Life and Healthcare Events in Patients with Monotherapy of Anti-Diabetes Medications.

This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). Diabetes patients ≥18 years old who had a complete record of physical component score and mental component scores in round 2 and round 4 of the survey were included. The primary outcome was HRQOL of diabetes patients as measured by the Medical Outcome Study short-form (SF-12v2TM). Multinomial logistic regression and negative binomial regression were conducted to determine associated factors of HRQOL and HCE, respectively. Overall, 5387 patients were included for analysis. Nearly 60% of patients had unchanged HRQOL after the follow-up, whereas almost 15% to 20% of patients showed improvement in HRQOL. The relative risk of declined mental HRQOL was 1.5 times higher relative to unchanged mental HRQOL in patients who were on sulfonylurea 1.55 [1.1-2.17, p = 0.01] than metformin users. The rate of HCE decreased by a factor of 0.79, [95% CI: 0.63-0.99] in patients with no history of hypertension. Patients on sulfonylurea 1.53 [1.20-1.95, <0.01], insulin 2.00 [1.55-2.70, <0.01], and TZD 1.78 [1.23-2.58, <0.01] had increased risk of HCE compared to patients who were on metformin. In general, antidiabetic medications modestly improved HRQOL in patients with diabetes during the follow-up period. Metformin had a lower rate of HCE as compared to other medications. The selection of anti-diabetes medications should focus on HRQOL in addition to controlling glucose level.

Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study.

BACKGROUND: Stroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke. METHOD: A hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients' interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association. RESULT: A total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06-5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94-17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04-17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000). CONCLUSION: Important factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.

Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia.

Background: Undernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia. Methods: An institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association. Results: A total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9-34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5-53.1%) were at risk of undernutrition (MNA-FL = 17-23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2-29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012-9.134, P-value < 0.001), with a duration of illness of 3-5 years (AOR = 3.225, CI: 1.138-9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592-11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06-4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407-6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481-10.560, P-value < 0.001) were at risk of developing undernutrition. Conclusion: Undernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.

Factors associated with stroke associated pneumonia among adult stroke patients admitted to university of Gondar hospital, Northwest Ethiopia.

Stroke is the major cause of disability and death in sub-Saharan African countries. The presence and severity of complications play a major role in the outcome of stroke. Stroke associated pneumonia is often noticed post stroke infection that has been linked to an increased risk of hospital mortality, a longer hospital stay and higher healthcare expenses. Report on details of stroke-associated pneumonia has never been documented in countries of sub-Saharan Africa. This study aimed to determine the incidence and risk factors of stroke-associated pneumonia among adult stroke patients in hospital settings, Northwest Ethiopia. The study was undertaken at a stroke care unit, University of Gondar hospital between January 1, 2020 and December 31, 2020. A convenience sampling method was used to recruit study subjects. Relevant clinical history was taken, focused physical examination was done, and brain imaging (CT scan or MRI) was performed to settle the diagnosis of stroke. A modified Centre for Disease Control and Prevention (CDC) criteria was used to diagnose stroke-associated pneumonia. All patients with stroke-associated pneumonia were treated according to the 2016 Infectious Diseases Society of America/American Thoracic Society Clinical Practice Guidelines. The Data were cleaned in Epi Info version 4.6.0.2, and analyzed using SPSS version 26. Variables associated with stroke-associated pneumonia were computed using logistic regression analysis. P value < 0.05 was considered to declare statistical significance. The study comprised a total of 325 adult stroke patients. The mean age of study subjects was 65.2 years (SD ± 15.7). The most prevalent type of stroke was ischemic stroke, which accounted for 68% of all cases. Hemiparesis (94%), facial palsy (87%), and swallowing disturbance (51%) were the frequently noticed neurological findings. Stroke-associated pneumonia complicated 116/325 (36%) of stroke patients. Multi-variate regression analysis revealed that patients who were elderly (age > 75 years) (AOR = 3.910, CI 1.181-12.936, P = 0.026), had swallowing disturbance (AOR = 4.656, CI 2.356-9.202, P-value < 0.001), epileptic seizures (AOR = 2.678, 95% CI 1.253-5.721, P-value < 0.001) and moderate to severe stroke (NIHSS score = 16-21) (AOR = 5.994, 95% CI 2.043-17.585, P-value < 0.001) were at risk of developing stroke-associated pneumonia. SAP was a substantial medical complication among stroke patients. Early identification and prompt intervention measures for the identified risk factors might address the burden of SAP.

Peptic ulcer disease among dyspeptic patients at endoscopy unit, University of Gondar hospital, Northwest Ethiopia.

BACKGROUND: Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Globally, peptic ulcer disease occurs in 3.5-32% of patients with dyspepsia. Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs/aspirin use are the widely known risk factors for peptic ulcer disease. There was no recent document on H. pylori infection rate among patients with peptic ulcer disease in Ethiopia. This study aimed to determine magnitude and associated factors of peptic ulcer disease among dyspeptic patients in Northwest Ethiopia. METHODS: An institutional-based cross sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit 218 study subjects. A pre-designed semi-structured questionnaire was used to extract clinical information. Olympus flexible fiber-optic endoscope (Olympus, GIF-E 600, Olympus Corp., Hamburg, Germany) was used to confirm the presence of peptic ulcer disease. Diagnosis of active H. pylori infection was made using the fecal H. pylori Antigen 25 T Card Test (Anamol Lab., Pvt. Ltd., Palghar, India). The Data were entered into EPI Info version 4.6.0.2, and then exported to SPSS version 20 for analysis. Explanatory variables associated with peptic ulcer disease were analyzed by applying logistic regression model. P value < 0.05 was used to declare significant association. RESULT: A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The mean (+ SD) age of patients was 42 ± 16.4 years. Forty nine percent (95% CI 42.4-56.2) of dyspeptic patients had active H. pylori infection. Peptic ulcer disease was diagnosed in 35% (95% CI 31.4-39.2) of patients with dyspepsia. H. pylori infection (AOR = 6.298, 95% CI 2.965-13.378, P value <  0.001) and NSAIDs/ASA use (AOR = 6.252, 95% CI 2.925-13.362, P value < 0.001) were identified as risk factors for peptic ulcer disease. CONCLUSION: Medical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.

Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study.

BACKGROUND: There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia. OBJECTIVE: The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital. METHOD: A retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients. RESULT: 387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03-0.78] and AOR:0.17[0.03-0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital stay than DKA precipitated by other causes; AOR: 4.59 [1.08-19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76-2.63]. CONCLUSIONS: New onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality.

Rate of glycemic control and associated factors among type two diabetes mellitus patients in Ethiopia: A cross sectional study.

OBJECTIVE: To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia. METHODS: A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control. RESULT: A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10-4.29). The odds of poor glycemic control in patients who did not understand the pharmacist's instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10-3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13-2.55). CONCLUSION: The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist's advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.

Unmet supportive care needs and determinants among cancer patients treated at University of Gondar Specialized Hospital, Northwest Ethiopia: A prospective cross-sectional study.

BACKGROUND: Assessment of supportive care needs is an important requirement to plan supportive care intervention. This study aimed to assess the unmet supportive care needs of cancer patients treated at the University of Gondar Specialized Hospital, Ethiopia. METHODS: A prospective cross-sectional study was conducted from January 1, 2017 to August 30, 2017. Adult (18 years and greater) cancer patients and those who were receiving therapy were included. The 34-Item short-form Supportive Care Needs Survey(SCNS-SF34) tool was used to assess unmet needs. The data collected were analyzed using SPSS version-21. RESULTS: A total of 150 interview guides were included in the analysis (97.4% of response rate). In the majority of 65(43.3%) the participants, the disease was metastasized even though they have undergone surgery 78 (52%). The overall mean score level of unmet need for cancer care was 3.49. The highest unmet need mean score was reported from the health system and information need domain. A significant unmet need difference concerning different need domain was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors for unmet supportive care needs. CONCLUSION: The overall level of unmet need was high. A significant unmet need difference was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors. Hence, professionals working in the oncology unit should be aware of unmet needs and expect changes over time. Certain programs and services to address the identified unmet needs should be urgently provided.

Correction to: Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia.

Following publication of the original article [1], the authors flagged that the name provided for the 4th author had been misspelled; the 4th author was (incorrectly) spelled as 'Eyob Alemayehu Gebreyohanns'.

Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia.

BACKGROUND: Asthma is one of the chronic diseases which affects the airway, and inhalers are the preferred medications to treat this problem. Improper inhalational technique leads to decreased efficacy of the medication by reducing its deposition in the lungs. The aim of this study was to assess the barriers to and competency with the use of Metered Dose Inhaler (MDI) and its impact on disease control among adult asthmatic patients. METHODS: A prospective cross-sectional study was conducted in University of Gondar comprehensive specialized hospital outpatient department (OPD) chronic follow up from 12-March-2018 to 15-May- 2018. Patients were interviewed face to face with questions which determined their competency, asthma control level and barriers for inhaler use. RESULT: Overall, 307 asthmatic patients were included in the study. More than half of participants were females, 170 (55.4%) and lived in urban area 185 (60.3%). The mean age of the respondents was 51.77 years with a standard deviation of ±15.40. The cost of medication, 282 (91.9%) and the perception that medication should be used in response to symptoms but not on a regular basis 277 (90.2%) were the most identified barriers. Only 56 (18.2%) were competent for Metered Dose Inhaler use (MDIU) and 17 (5.5%) patients had well controlled asthma. Being not competent AOR 0.168[0.41-0.687] was one of the factors decreasing asthma control. CONCLUSION: Generally from this study, cost of the medication and the perception that medication should be used only for symptoms were the major identified barriers that affect the MDI use among asthmatic patients. Patients show very poor competence to their MDI which in turn led to poor asthma control. So, patients need to be taught the correct inhaler technique in the hospital and pharmacy while they came for follow up every time.

Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia. METHODS: A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger's test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. RESULT: Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%). CONCLUSIONS: In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.

Risky sexual behavior and associated factors among patients with bipolar disorders in Ethiopia.

BACKGROUND: People with bipolar disorder are highly vulnerable to risky sexual behaviors (RSBs). The magnitude of RSBs among bipolar disorders was not studied in our population. The present study aimed to explore the prevalence of RSBs and associated factors among patients with bipolar disorder. METHOD: An institution based cross-sectional study was conducted from 1 April to 30 May 2017 among people living with bipolar disorder at outpatient departments of Amanuel Mental Health Hospital, Addis Ababa. Systematic random sampling was used to select participants. Risky sexual behavior was defined as having sex with two or more sexual partners, having unprotected sexual intercourse, sex after alcohol consumption, exchanged money for sex in a previous 12 months. Data collection was conducted through face-to-face interview by a structured questionnaire adopted from behavioral surveillance survey. Binary logistic regression was conducted to identify factors associated with RSBs. RESULT: A total of 424 participants were enrolled in the study, giving overall response rate of 96%. About 223(52.6%) were males. The prevalence of risky sexual behavior was 49.1% among bipolar patients. Male patients (Adjusted Odds Ratio (AOR) =2.23,95% CI = 1.27,3.92), patients in age group of 18-24(AOR = 2.08,95% CI = 1.47,3.81),current manic phase of the illness (AOR = 2.3195% CI,1.24,4.32) and current alcohol drinking (AOR = 3.70,95% CI = 2.01,6.78) had significant association with RSB. CONCLUSION: Almost half of bipolar patients reported a risky sexual behavior. Current manic episode and the consumption of alcohol were independently associated with RSB. To reduce the burden of RSBs, mental health services which focuses on sexual behaviors of bipolar patients is required.

Correction: The prognosis of heart failure patients: Does sodium level play a significant role?

[This corrects the article DOI: 10.1371/journal.pone.0207242.].

Contraceptive use among HIV-positive and negative women: implication to end unintended pregnancy.

BACKGROUND: With the advancement of antiretroviral therapy and improved life expectancy, women living with HIV/AIDS are enjoying a better sexual life. Yet, the consistent utilization of contraceptive in such patients is highly recommended. There is paucity of data regarding contraceptive use among HIV-positive and negative women in Ethiopia. The present study aimed at examining the use of contraceptives among HIV-positive and HIV-negative women in Ethiopia. METHODS: A comparative cross-sectional study was conducted among HIV-positive and HIV-negative women attending family planning Clinic of Gondar university referral hospital between January 2016 and August 2017. Descriptive statistics were used to present categorical data and Pearson's chi-square test was done to examine differences in the utilization of contraceptives between HIV-positive and HIV-negative women. Kaplan Meier test was also carried out to determine the incidence of unintended pregnancy. A p-value of 0.05 was deemed significant with corresponding 95% confidence intervals. RESULTS: A total of 894 participants consisting of 314 HIV-positive and 580 HIV-negative women were included in the study. The rate of previous unintended pregnancy was 280 (31.3%) in HIV-negative women and 115 (12.9%) in HIV-infected women. Women who routinely utilized contraceptives were more likely to avoid unintended pregnancy [log rank: 2.89, p < 0.05]. Unlike HIV-negative women (2.9%), HIV-positive (28.4%) women reported a higher rate of intrauterine device use. Male condom was used more commonly in HIV-infected women (26.7%) as compared to HIV negative (3.9%) women (p-value < 0.05). CONCLUSIONS: Intrauterine contraceptive device was reported to be the most commonly used contraceptive method in HIV patients. Further, unintended pregnancy was relatively common in women with low contraceptive practice. The use of dual contraceptives should be advocated for HIV-positive women so as to protect unintended pregnancy and curtail the transmission of HIV.

The effectiveness of pictogram intervention in the identification and reporting of adverse drug reactions in naïve HIV patients in Ethiopia: a cross-sectional study.

PURPOSE: In health communication, pictogram has a comprehensive place to aid attention, memory recall, and promote adherence. This study was conducted to assess whether pictorial intervention would help to identify and improve adverse drug reactions (ADRs) reporting in an antiretroviral therapy (ART) clinic in Northwest Ethiopia. PATIENTS AND METHODS: A cross-sectional study on ART-naïve HIV-positive patients was conducted from July 2015 to January 2016. The patients were randomly categorized into two groups. Group A was subjected to receive pictorial medication information and a pictogram-enhanced tool to identify and report ADRs, while group B did not receive any pictogram-enhanced tool. RESULTS: A total of 207 ART-naïve HIV-positive patients who were registered for the ART treatment attending Gondar University Hospital ART clinic were included. Bivariate analysis showed that sociodemographic characteristics, such as age, sex, education, employment, and marital status were the main predictors of identifying and reporting ADRs. Males were twice more likely to identify ADRs than females. Univariate analysis revealed that patients assigned to group A showed a significant association with the ability to identify ART medications using pictograms. Patients assigned to group A were more likely to identify lamivudine (OR [95% CI] =7.536 [4.042-14.021], P≤0.001), tenofovir (OR [95% CI] =6.250 [2.855-13.682], P≤0.001), nevirapine (OR [95% CI] =5.320 [1.954-14.484], P=0.001), efavirenz (OR [95% CI] =3.929 [1.876-8.228], P≤0.001), and zidovudine (OR [95% CI] =3.570 [1.602-7.960], P=0.002) using pictograms. Patients in group A were 4.3 times more likely to identify diarrhea as an ADR using pictogram compared with group B. CONCLUSION: The use of pictorial representation resulted in only slight improvement in identification and reporting of ADRs among naïve HIV-positive patients with limited literacy in Northwest Ethiopia. This representation of ADRs merits further investigation with regard to ADR identification and promoting patients' safety, particularly for HIV-positive patients with limited educational levels.

Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital.

BACKGROUND: A considerable proportion of cardiovascular events could be attributed to poor adherence to antihypertensive medications. Adverse effects can be severe enough to affect adherence to antihypertensive medications. This study aimed to measure the contribution of adverse effects on antihypertensive medications adherence. METHODS: The study was conducted from May 1 to June 30, 2017, at the ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH) in Gondar town. A binary logistic regression was performed to determine the significance of the association between adverse effects and adherence to antihypertensive medications. An institution-based cross-sectional study was conducted by administering a questionnaire to hypertensive patients who came for follow-up at the ambulatory clinic of UOGCSH. Level of adherence to antihypertensive medications was used as outcome measure. RESULTS: A total of 249 patients were included in the final analysis with a mean age of 56.51 years and a female majority (53%). The following variables were identified as predictors of poor adherence: tiredness [AOR (95% CI): 3.802 (1.723-8.391), p = 0.001], muscle pain [AOR (95% CI): 5.199 (1.407-19.214), p = 0.013], poor sleep [AOR (95% CI): 4.891 (1.578-15.160), p = 0.006] and, believing that the symptoms were caused by antihypertensive medications [AOR (95% CI): 3.249 (1.248-8.456), p = 0.016]. CONCLUSION: Adverse effect significantly contributes to antihypertensive medication non-adherence among hypertensive patients.

The prognosis of heart failure patients: Does sodium level play a significant role?

INTRODUCTION: Heart failure (HF), a major cardiovascular disorder, remains a grievous clinical condition regardless of advances in medical care. Hyponatremia is classified as a serum sodium concentration of <135 mEq/L, and the prevalence, clinical impact and prognostic factor of hyponatremia in heart failure patients varies widely. The current study was conducted with the aim of assessing the prevalence of hyponatremia in patients hospitalized with a diagnosis of HF and comparing baseline clinical characteristic of HF patients based on their sodium status. Survival difference between patients with hyponatremia and normonatremia was also assessed and the clinical prognostic indicators of overall mortality in HF patients were evaluated. METHOD: A retrospective cohort study was conducted to assess medical records of heart failure patients who were admitted to Gondar University Referral Hospital. Patients were categorized based on their sodium level status at their first admission to the internal medicine department. Each patient was assigned to either of the following groups: hyponatremia if sodium < 135 mmol/L, or normonatremia if sodium ≥ 135 mmol/L. RESULT: Among 388 participants, the prevalence of hyponatremia in the study cohorts was 51.03%. Kaplan-Meier survival curves showed that there was a significant difference in survival status of HF patients among the two cohorts (Log-Rank test, P <0.0001). Hence, patients with normal sodium levels had a higher chance of survival over hyponatremic patients. Multivariate Cox regression has revealed a statistically significant association of mortality with the following variables: advanced age (AHR = 1.035 (1.012-1.058), P = 0.003), hyponatremia (AHR = 4.003 (1.778-9.009), P = 0.001), higher creatinine level (AHR = 1.929 (1.523-2.443), P = <0.0001) and, prescription of angiotensin-converting enzyme inhibitors (AHR = 0.410 (0.199-0.842), P = 0.015) and spironolactone (AHR = 0.511 (0.275-0.949), P = 0.033. CONCLUSION: In conclusion, hyponatremia is one of the crucial factors in the clinical prognosis of heart failure patients. However, as other prognostic factors (i.e. medication, creatine level, and age) also played vital roles in overall survival, well-controlled clinical trials (complete with medication dosing, laboratory outputs and long-term prospective follow up) are required to further study the impact of hyponatremia in HF patient's prognosis in low income nations.

Treatment outcomes of visceral leishmaniasis in Ethiopia from 2001 to 2017: a systematic review and meta-analysis.

BACKGROUND: Ethiopia has the highest number of visceral leishmaniasis (VL) cases after Sudan in Sub-Saharan Africa. However, there was lack of comprehensive data on VL treatment outcome despite the huge burden of the diseases in the country. Hence, we aimed to perform a systematic review and meta-analysis on this topic to obtain stronger evidence on treatment outcomes of VL from the existing literature in Ethiopia. METHODS: The Cochrane guidelines to conduct meta-analysis following the Preferred Reporting Items for Systematic review and Meta-Analysis statement was used to conduct a computerized systematic search of the PubMed, Google Scholar, and ScienceDirect databases. Random effects model was used to combine studies showing heterogeneity of Cochrane Q P < 0.10 and I2 > 50. Treatment outcomes were assessed at end of treatment and at 6 months follow-up. Subgroup analyses were performed on treatment outcomes based on the different antileishmanial treatment options and patients' HIV status. RESULTS: Fifteen studies were included in the final analyses. At end of treatment, an overall treatment success rate of 82.6% was noticed. At 6 months follow-up, the overall treatment success rate was 72.2%. For patients treated with sodium stibogluconate (SSG), the treatment success rates at the end of treatment and at six-month follow-up were 81.5% and 80.7%, respectively. Multiple doses of liposomal-amphotericin B (L-AMB) had treatment success rates of 96.7 and 71-100% at the end of treatment and at 6 months follow-up, respectively. The combination of SSG with paromomycin (PM) gave treatment success rates of up to 90.1% at the end of treatment. HIV-infected individuals were found to have a higher mortality (odds ratio = 4.77, 95% CI: 1.30-17.43, P = 0.009) rate at 6 months follow-up. CONCLUSIONS: SSG alone has shown lower treatment efficacy in the management of VL when compared to combination of SSG with PM and multiple doses of L-AMB. The combination of SSG with PM gave good treatment success rates with shorter duration of treatment. Hence, the combination of SSG with PM should be used preferentially over SSG monotherapy. Multiple doses of L-AMB showed great efficacy especially among patients with complications, severe disease, HIV co-infection, and intolerance to the adverse effects of antimonials. HIV-infected individuals had a worse prognosis than their HIV-negative counterparts.

Epidemiology of Depression and Associated Factors among Asthma Patients in Addis Ababa, Ethiopia.

BACKGROUND: Depression in asthma patients can cause worsening of respiratory symptoms. Addressing mental illness in those with asthma improves asthma outcomes. This study aimed to assess the epidemiology of depression and associated factors among asthma patients attending government hospitals in Ethiopia. METHODS: Institutional based cross-sectional study was conducted on patients with asthma at three governmental hospitals of Addis Ababa from June to July 2017. Patient health questionnaire (PHQ-9) depression scale was used to assess prevalence of depression among asthmatic patients. The data were entered and analyzed using SPSS version 20 statistical software. Binary logistic regression analysis was conducted to identify associated factors for depression. To indicate the strength of association, odds ratios (OR) and 95% confidence intervals (95% CI) were used. RESULT: A total of 405 participants were enrolled in the study giving an overall response rate of 96%. The respondents had mean age of 54.46 and standard deviation (SD) of 10.01 years. About 273 (67.4%) were females. The prevalence of depression among asthma patients was 85 (21%). The odds of developing depression among single asthma patients were increased by 1.63 with 95% CI [1. 8, 3.493]. Depression among asthma patients who had comorbid cardiac illness was 6.2 times higher than those who do not have at CI [1.145, 24.109]. The prevalence of depression among uncontrolled asthma patients was 8 times higher than those with well-controlled asthma at CI [1.114, 19.025]. CONCLUSION: One-fifth of asthmatic patients were experiencing depression. Uncontrolled asthma, comorbid cardiac illness, and single patients were important predictors of depression among asthmatic patients. Proper control of asthmatic attack and cardiac illnesses is very important to reduce the burden of depression.