Drug therapy problems and contributing factors among patients with epilepsy.

BACKGROUND: Although antiseizure medications play a crucial role in the management of epilepsy, their benefit can be compromised due to drug-related problems. Drug therapy problems can lead to poor seizure control, reduced quality of life, and increased morbidity and mortality in patients with epilepsy. However, in our setting, there is limited knowledge about drug therapy problems and the factors that contribute to them. OBJECTIVE: The aim of this study was to investigate the prevalence and contributing factors of drug-therapy problems among patients with epilepsy. METHODOLOGY: A hospital-based prospective observational study was conducted at the neurologic clinic of Ayder Comprehensive Specialized Hospital, located in the Tigray region of Northern Ethiopia. The study included adult patients diagnosed with epilepsy who had been taking at least one antiseizure medication for a minimum of six months. Data were collected by conducting patient interviews and expert reviews of medical and medication records. Prior to data review and interviews, each patient provided written informed consent. Drug therapy problems were identified and classified using Cipolle's method, followed by a consensus review conducted with a panel of experts. Statistical analysis was performed using a statistical software package; SPSS version 22. Binary logistic regression analysis was conducted to determine the contributing factors of drug therapy problems. Statistical significance was determined at p<0.05. RESULTS: A study conducted on 250 participants revealed that 55.2% of the patients experienced one or more drug therapy problems. Our analysis identified a total of 282 drug therapy problems, with a mean of 2±0.52 drug therapy problems per patient. The most commonly observed drug therapy problems were dosage too low (30.0%), noncompliance (22%), adverse drug reaction (18%), and unnecessary drug therapy (16.4%). The commonly involved antiseizure medications in these drug therapy problems were phenytoin (22.8%), Valproic acid (20.8%), and Phenobarbital (18.4%). Furthermore, our findings revealed that combination therapy (AOR: 3.92, 95%CI: 1.19-12.97) and uncontrolled seizure (AOR: 108.37, 95%CI: 38.7-303.6) exhibited significant associations with drug therapy problems. CONCLUSION: Drug therapy problems were prevalent among patients with epilepsy. The use of combination therapy and the presence of uncontrolled seizures were identified as significant indicators of drug therapy problems. Therefore, more emphasis should be given to patients with multiple medications and uncontrolled seizures.

Patient Satisfaction with the Implementation of Telehealth in Ambulatory Care during the COVID-19 Pandemic: A Single Institution Experience.

Background: COVID-19 has reduced the capacity for delivering essential health services due to lockdown restrictions. Telehealth is an effective alternative option to improve healthcare access. However, there remain implementation challenges to patient adoption in resource-limited settings such as Ethiopia. Therefore, the purpose of this study was to assess patient satisfaction following the implementation of telehealth in ambulatory settings during the COVID-19 pandemic. Methods: A cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia. Patients who used the telehealth service were invited to participate in a patient satisfaction survey. All statistical analyses were performed using STATA Version 14.1. Result: A total of 149 patients have participated in the survey. Out of the total participants, 129 (86.6%) found that telehealth is easy to understand and overall satisfaction for telehealth was 87.9%. About two-thirds of the patients (97, 65.1%) reported that the telehealth visit is just as good as a traditional visit. The vast majority of participants (148, 98.6%) stated that they would definitely or probably use telehealth again and would recommend it to others. The majority of respondents (137, 91.9%) followed the recommendations provided. Conclusion: Patients have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. About two-thirds of patients said the telehealth visit was just as good as a traditional visit. The majority of patients followed the recommendations given to them by the healthcare providers and stated that they would definitely or probably use telehealth in the future and would recommend it to others. This high level of patient satisfaction with telehealth implementation suggests that the service could be considered in low-income countries as well.

Antimicrobial Use-Related Problems Among Hospitalized Pediatric Patients: A Prospective Observational Study.

Introduction: Antimicrobials are among the most commonly misused medications, leading to antimicrobial resistance, and therefore demand more attention. There are limited studies documenting "antimicrobial use-related problems" in developing countries, especially in pediatric patients. Objectives: This study aimed to evaluate the prevalence of antimicrobial use-related problems and risk factors among hospitalized pediatric patients. Materials and Methods: A hospital-based prospective observational study was conducted in Ayder comprehensive specialized hospital (ACSH) in the Tigray region, Ethiopia. The participants of the study were pediatric patients aged ≤15 years who were admitted with a diagnosis of infectious disease between September 2019 and November 2019. Results: A total of 232 pediatric patients were included in the study. Of these, 59.5% of the patients were male and the mean age (SD) of the patients was 5.8 (5.2) years. Of the 232 patients surveyed, a total of 177 antimicrobial use-related problems were identified. One or more antimicrobial use-related problems have occurred in more than half of the patients (53.9%). The commonest antimicrobial use problems were unnecessary antimicrobial therapy (22.8%) followed by need additional antimicrobial therapy (16.4%). In a multivariate logistic regression model, patients with comorbidities (Adjusted odds ratio (AOR): 1.84, 95% confidence interval (CI): 1.04-3.27) and hospital stays exceeding one week (AOR=1.88, 95% CI: 1.08-3.26) were predictors of antimicrobial use-related problems. Conclusion: Antimicrobial use-related problems were found in a significant proportion of pediatric patients. Addressing these issues necessitates collaborative efforts, emphasizing targeted education, strengthened antimicrobial stewardship, ensuring responsible antimicrobial use and enhancing pediatric care.

Drug therapy problems among hospitalized patients with cardiovascular disease.

BACKGROUND: Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases. METHOD: A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients' medical records. We employed Cipolle's method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05. RESULTS: The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68-9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47-5.11). CONCLUSION: More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.

Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure.

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47-13.43), illiteracy (AOR: 2.64, 95% CI: 1.52-6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21-3.61), and taking five or more medications (AOR: 1.83, 1.01-3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

Antimicrobial use related problems and determinants in surgical ward of Ethiopian tertiary hospital.

BACKGROUND: Antibiotic use related problems lead to the emergence of resistance, failure of therapy, morbidity, mortality, and unnecessary healthcare expenditure. However, little is known about antimicrobial use related problems in our setting particularly in hospitalized surgical patients. OBJECTIVE: The purpose of this study was to investigate antibiotic use related problems and their determinants among hospitalized surgical patients. METHODOLOGY: A prospective observational study was conducted from December 2018 to April 2019 at the surgical ward of the Ayder comprehensive specialized hospital, located in Northern Ethiopia. We included patients admitted to the surgical ward who were on antibiotic therapy or were candidates for antibiotic therapy/prophylaxis. The patients were recruited during admission and were followed daily until discharge. Data were collected through patient interviews and expert reviews of medical and medication records. The appropriateness of antibiotic use was evaluated according to the Infectious Disease Society of America, American Society of Health System Pharmacists, and World Health Organization guidelines. Subsequently, antibiotic use related problems were identified and classified based on Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify the determinants of antibiotic use related problems. Statistical significance was set at p <0.05. RESULTS: Among 272 patients, 167(61.4%) experienced antibiotics use related problems. A total of 235 antibiotics use related problems were identified equating 0.86±0.82 problems per patient. The commonly identified antibiotic use related problems were the need for additional drug therapy (29.4%), unnecessary drug therapy (15%), and dosage too high (12.1%). Cephalosporin (47.02%) was the most commonly implicated class of antibiotics in these drug related problems, followed by penicillin (18.45%) and metronidazole (16.02%). Prolonged hospitalization (AOR: 3.57, 95% CI: 1.91-6.70), number of medications≥5 (AOR: 2.08, 95%CI: 1.10-3.94), and lower qualifications of practitioners [general practitioners (AOR: 10.27, 95%CI: 4.13-25.58) and surgical residents (AOR: 2.28, 95%CI: 1.12-4.63)] were predictors of antibiotic use related problems. CONCLUSION: Antibiotic use related problems were common among the hospitalized surgical patients. Prolonged hospitalizations, number of medications, and lower qualifications of practitioners were predictors of antibiotic use related problems. Therefore, more emphasis should be given for patients with prolonged hospitalization and multiple medications. Moreover, practitioners with higher qualifications including surgical specialists need to be involved in patient evaluations.

Second-Line Antiretroviral Treatment Outcomes and Predictors in Tigray Region, Ethiopia.

Introduction: Ethiopia has one of the highest HIV burdens in sub-Saharan Africa. Despite the fact that second-line antiretroviral therapy (ART) has been available for more than ten years, studies on its effectiveness are scarce. Objective: To assess treatment outcomes and predictors of unfavorable outcomes in HIV patients receiving second-line ART at Ayder Comprehensive Specialized Hospital and Mekelle Hospital. Materials and Methods: An institution-based retrospective cohort study was conducted in two hospitals in Tigray Region, Ethiopia. We evaluated 192 patients aged ≥15 years who were switched to second-line from November 2009 to May 2020 after failure of first-line ART. The primary outcome was the time from the initiation of second-line ART to the occurrence of unfavorable treatment outcomes (treatment failure, death, and loss to follow-up). We performed Kaplan-Meier survival estimates to calculate the cumulative incidence rates of unfavorable outcomes. Results: The mean age (SD) at the initiation of second-line ART was 39 (10.03) years, and the median CD4 cell count was 121 cells/microL. During a median follow-up of 4.6 years, 24 (12.5%) patients had died, 11 (5.7%) patients were lost to follow up, and 47 (24,4%) patients were experienced treatment failure. The incidence rates for unfavorable outcomes were 7.8 per 100 patients/years. Predictors for unfavorable outcomes were body mass index (BMI) <18.5 (adjusted hazard ratio [aHR] = 2.51, 95% confidence interval (CI): 1.27-4.95) and CD4 counts ≤100 cells/microL (aHR = 1.74, 95% CI: 1.09-2.79). Despite the failure of second-line ART, none of the patients received third-line ART. Conclusion: The incidence rate of unfavorable treatment outcomes for second-line ART was found to be high. A low BMI and a low baseline CD4 count were significant predictors of unfavourable outcomes and should be given special consideration in HIV care. A third-line ART regimen should also be considered for people who have failed second-line ART.

The impact of war on HIV/AIDS service provision: In rural health facilities of Tigray, northern Ethiopia, a cross-sectional study.

BACK GROUND: HIV/AIDS remained among the common public health problems in developing country. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray. METHODS: The study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021. RESULT: A total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001). CONCLUSION: The war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.

Clinical and economic burden of healthcare-associated infections: A prospective cohort study.

INTRODUCTION: Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. OBJECTIVE: To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. MATERIALS AND METHODS: A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. RESULTS: A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality. CONCLUSION: HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.

Assessment of drug use pattern using WHO core drug use indicators in selected general hospitals: a cross-sectional study in Tigray region, Ethiopia.

OBJECTIVE: Inappropriate use of medicine is a global challenge with greater impact on developing countries. Assessment of drug use pattern is used to identify gaps in medicine utilisation to implement strategies for promoting rational drug use. This study aimed to assess drug use pattern using the WHO drug use indicators in selected general hospitals in Tigray region, Ethiopia. DESIGN: A cross-sectional study was conducted using WHO drug use indicators in two public hospitals located in Tigray. SETTING: Prescriptions recorded from 1 January 2017 to 1 June 2019 were randomly selected, and participants who visited the public hospitals from 1 March 2019 to 30 August 2019 and hospital pharmacies were interviewed. PARTICIPANTS: 100 patients who visited both outpatient clinics and hospital pharmacy departments of the public hospitals. RESULTS: The average number of medicines per prescription was 1.69 (±0.81). Prescriptions containing antibiotics and injectables were 58.2% and 15.9%, respectively. The percentages of medicines prescribed with a generic name from essential medicines list of Ethiopia were 97.5% (974) and 88.1% (970) in Mekelle Hospital and Quiha Hospital, respectively. The patients spent an average of 6.6(±3.5) min with their general practitioners, while only 22.8 (±21.7) s with their pharmacists. Of the patients interviewed, 56.9% knew their dosing regimen and 32.7% of them had their medication labelled. CONCLUSION: The finding of the present study revealed deviation of drug use pattern from the WHO optimal levels suggesting the hospitals had limitations in appropriate utilisation of medicines. Understanding the factors attributed to the observed gaps and implementing corrective measures are required to conform with the recommended standards of appropriate drug utilisation.

Do smallholder farmers ensure resource use efficiency in developing countries? Technical efficiency of sesame production in Western Tigrai, Ethiopia.

The study was designed to analyze the technical efficiency of input use among the sesame producer farmers' in Maykadra Kebelle, Kafta-Humera district, Tigrai, Ethiopia; identified factors that influence farmers' resource use efficiency. Primary and secondary data sources were used and random sampling method was applied to select 187 sample sesame producers. Primary data were collected using structured questionnaire interview. Tobit two-stage model was employed to estimate farmers' resource efficiency of sesame production. In the first stage, Data Envelopment Analysis (DEA) was used to analyze farmers' technical and scale efficiency. In the second stage, factors that influence farmers' resource use efficiency were identified using the Tobit model. The DEA result indicated that the technical and scale efficiency of sesame producer farmers were 52% and 55% respectively. The result also revealed that under-utilization of the production inputs under consideration, especially land size and amount of seed used. Moreover, farmers' planting method (P = 0.030∗∗), age of the household head (P = 0.042∗∗), land size (P = 0.002∗∗∗), education of the household head (P = 0.001∗∗∗), and total asset owned (P = 0.024∗∗) were associated with farmers optimal input-output mix of sesame production. As a result, it can be concluded that smallholder farmers in the study area were inefficient in using inputs in sesame production. Therefore, the current inefficiency in sesame production could be improved by giving special attention and working on the factors that affect optimal input-output mix at the farm level.

Self-medication practice and contributing factors among pregnant women.

BACKGROUND: The practice of self-medication during pregnancy is a global challenge that necessitates high attention as it poses a potential threat to the pregnant mother and fetus. However, little is known regarding self-medication practice and its contributors among pregnant women in our setting. OBJECTIVE: The main aim of this study was to investigate the practice of self-medication and its contributing factors among pregnant women. METHODOLOGY: A cross sectional study was conducted among pregnant women at antenatal care follow-up of Ayder comprehensive specialized hospital, Tigray, Ethiopia. Written informed consent was obtained from each participant before interview. Simple random sampling technique was employed to recruit participants in to the study. Data were collected by interviewing participants using the structured questionnaire. Binary logistic regressions analysis was performed to determine the contributing factors of self-medication practice during pregnancy. A p value of less than 0.05 was considered as significant. RESULTS: A total of 250 pregnant women were included in the study. Of the total, 40.8% practiced self-medication during the current pregnancy. Morning sickness (39.2%), headache (34.3%), and upper respiratory tract infections (29.4%) were the leading indications for self-medication. According to participant report, ease of access to medicines (25.5%), feelings that the disease is minor (21.6%) and timesaving (19.6%) were the most commonly reported reasons for self-medication practice. Absence of health insurance (AOR: 2.75, 95%CI: 1.29-5.89) and being on first trimester of pregnancy (AOR: 2.44, 95%CI: 1.02-5.86) were significant contributors of self-medication practice among pregnant women. CONCLUSION: In our study, high prevalence of self-medication was reported among pregnant women. Self-medication practice during pregnancy was higher among pregnant women on first trimester and those who were not having health insurance. Therefore, intervention programs should be designed to minimize the practice of self-medication during pregnancy.

Treatment optimization of beta-blockers in chronic heart failure therapy.

Although evidence based guidelines recommend optimal use of beta blockers in all patients with chronic heart failure unless contraindicated, they are often underutilized and/or prescribed below the recommended dosage in the majority of patients with heart failure. To our knowledge, however, the optimal use of beta-blockers in chronic heart failure is not investigated in Ethiopia. Therefore, the aim of our study was to investigate the utilization and optimization of beta blockers in the management of patients with chronic heart failure in Ethiopia. A prospective observational study was conducted among ambulatory patients with chronic heart failure in Ethiopia. We included adult patients with a diagnosis of heart failure with a baseline left ventricular ejection fraction < 40% who had been on follow-up for at least 6 months. Patients were recruited into the study during their appointment for medication refilling using simple random sampling technique. All patients were followed for at least 6 months to determine the optimal use of beta blockers. The optimal use of beta blockers was determined according to evidence based guidelines. After explaining the purpose of the study, we obtained written informed consent from all participants. Data were collected through patient interview and review of patients' medical records. Binary logistic regression analysis was performed to identify factors associated with utilization of beta blockers. A total of 288 patients were included in the study. Out of the total, 67% of the patients were receiving beta blockers. Among the patients who received beta blockers, 34.2% were taking guideline recommended beta blockers while 65.8% were taking atenolol, which is not guideline recommended beta blocker. Among the patients who received guideline recommended beta blockers, only 3% were taking optimal dose. Prior hospitalization [Adjusted Odds ratio (AOR) 0.38, 95% confidence interval (CI) 0.19-0.76], dose of furosemide > 40 mg (AOR 0.39, 95% CI 0.20-0.76), ischemic heart disease (AOR 3.27, 95% CI 1.66-6.45), atrial fibrillation (AOR 4.41, 95% CI 1.38-14.13) were significantly associated with the utilization of beta-blockers. Despite proven benefit, beta blockers were not optimally used in most of the participants in this study. The presence of ischemic heart disease and atrial fibrillation were positively associated with the utilization of beta blockers while hospitalization and higher diuretic dose were negatively associated with the utilization of beta blockers. Clinicians should attempt to use evidence based beta blockers at guideline recommended target doses that have been shown to have morbidity and mortality benefit in chronic heart failure. Moreover, more effort needs to be done to minimize the potentially modifiable risk factors for underutilization of beta blocker in chronic heart failure therapy.

Medical complications and mortality of hospitalized stroke patients.

BACKGROUND: Stroke medical complications and mortality are not precisely known in northern Ethiopia. Hence, the main purpose of the study was to assess stroke medical complications, mortality and factors associated with mortality amongst stroke patients. METHODS: A cross sectional study design was used to conduct the study. Patients medical chart was reviewed to collect patient information. Patients medical registries who were diagnosed with stroke and treated in Ayder Comprehensive Specialized Hospital were retrospectively reviewed. Sample size was estimated using single population formula. Medical charts assigned a number and patients were selected using systematic random sampling technique. The data was analyzed using SPSS version 22. Using logistic regression analysis method, factors associated with mortality in the hospital were identified. A p value less than 0.05 were deemed to be significant in all types of analyses. RESULTS: About 216 stroke patients were studied and 126(58.3%) patients were women. A total of 48(22.2%) patients died in the hospital with median time to death of 3 days, ranged 1-48 days and average time to death of 6.2±8.7 days. One hundred thirty-six (62.9%) patients had at least one medical complication. The total frequency of complication was 234 in number and aspiration pneumonia (n=92, 39.4%) was the frequent complication. Patients with severe (1-8) (Adjusted Odds Ratio=26.48, 95%CI: 7.11-98.58, P<0.001) and moderate (9-12) (Adjusted Odds Ratio=3.88, 95%CI: 1.05-14.39), P=0.043) record of Glasgow Coma Scale at admission were 26 times and four times more likely to die than patients with mild Glasgow Coma Scale, respectively. CONCLUSION: Substantially higher number of patients died at the hospital. Majority of the patients admitted to the hospital developed complication, aspiration pneumonia being the most frequently affirmed complication during their stay in the wards. Patients with severe and moderate Glasgow Coma Scale during admission were more likely to die at the hospital than patients with mild Glasgow Coma Scale. To precisely determine the mortality prevalence, medical complications frequency and to generalize the findings to the general population a multicenter prospective cohort study should be conducted.

Immunologic and Clinical Failure of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus within Two Years of Treatment.

BACKGROUND: Early initiation of highly active antiretroviral therapy (HAART) decreases human immunodeficiency virus- (HIV-) related complications, restores patients' immunity, decreases viral load, and substantially improves quality of life. However, antiretroviral treatment failure considerably impedes the merits of HAART. OBJECTIVE: This study is aimed at determining the prevalence of immunologic and clinical antiretroviral treatment failure. METHODS: A cross-sectional study design using clinical and immunologic treatment failure definition was used to conduct the study. Sociodemographic characteristics and clinical features of patients were retrieved from patients' medical registry between the years 2009 and 2015. All patients who fulfilled the inclusion criteria in the study period were studied. Predictors of treatment failure were identified using Kaplan-Meier curves and multivariable Cox regression analysis. Data analysis was done using SPSS version 21 software, and the level of statistical significance was declared at a p value < 0.05. RESULTS: A total of 770 were studied. The prevalence of treatment failure was 4.5%. The AZT-based regimen (AHR = 16.95, 95% CI: 3.02-95.1, p = 0.001), baseline CD4 count ≥ 301 (AHR = 0.199, 95% CI: 0.05-0.76, p = 0.018), and bedridden during HAART initiation (AHR = 0.131, 95% CI: 0.029-0.596, p = 0.009) were the predictors of treatment failure. CONCLUSION: The prevalence of treatment failure was lower with the risk being higher among patients on the AZT-based regimen. On the other hand, the risk of treatment failure was lower among patients who started HAART at baseline CD4 count ≥ 301 and patients who were bedridden during HAART initiation. We recommend further prospective, multicenter cohort studies to be conducted to precisely detect the prevalence of treatment failure using viral load determination in the whole country.

Treatment resistant hypertension among ambulatory hypertensive patients: A cross sectional study.

BACKGROUND: Treatment resistant hypertension(TRH) is detrimental risk of cardiovascular and premature deaths. Globally, the prevalence of resistant hypertension is inclining from time to time and it is yet to be determined in Ethiopia. OBJECTIVE: To assess the prevalence of apparent TRH and its predictors among ambulatory hypertensive patients on follow up in hypertension clinic of Mekelle Hospital, Northern Ethiopia. METHOD: A hospital based cross sectional study was conducted from Nov 25, 2018 to July 20, 2019, among 338 adult ambulatory hypertensive patients on follow up in Mekelle Hospital hypertension clinic. Hypertensive patient aged ≥18 years who were on regular follow up and taking antihypertensive medications for at least 6 months were included in the study. A simple random sampling technique was used to recruit the study patients. RESULTS: A total of 338 adult ambulatory hypertensive patients were analysed. More than half, 182 (53.8%) patients were females and the average age of the patients was 58.9 ±11.5. Three hundred thirty-three (98.5%) patients had no family history of hypertension. Majority, 66.8% of the patients were on monotherapy. The prevalence of apparent TRH was calculated to be 8.6% [Confidence Interval = 0.056-0.116]. Patients with Body Mass Index(BMI) greater than 30[Adjusted Odds Ratio(AOR) = 12.1, 95%CI:2.00-73.19, p = 0.007] and longer duration of hypertension were the predictors of resistant hypertension. CONCLUSION: Even if escalation of antihypertensive medications was not aggressive, apparent TRH was common in the study setting. Obesity (BMI greater than 30) and longer duration of hypertension since diagnosis were the predictors of TRH. Meticulous emphasis should be placed on to detect the prevalence of true hypertension resistance and future studies should discover the impact of aggressive antihypertensive medications scale up on the risks of TRH.

Healthcare professionals knowledge, attitude and practice of adverse drug reactions reporting in Ethiopia: a cross-sectional study.

OBJECTIVE: This study aimed to assess the knowledge, attitude and practice of adverse drug reactions (ADRs) reporting and identify factors associated with ADRs reporting among healthcare professionals (HCPs) working in Tigray region, Ethiopia. MATERIALS AND METHODS: A cross-sectional study was conducted between January and March of 2019 in a tertiary care hospital in Tigray region, Ethiopia. A self-administered, pretested questionnaire was administered to HCPs. Data were summarised using descriptive statistics. Logistic regression analysis was used to identify factors associated with poor ADRs reporting practices. RESULTS: In total, 362 questionnaires were distributed, and the response rate was 84.8% (n=307). Of all respondents, 190 (61.9%) were nurses, 63 (20.5%) were pharmacist and 54 (17.6%) were physicians. About 58.3% of HCPs had poor knowledge of ADRs reporting. The majority of the respondents had a positive attitude (59.9%), and only a few (32.1%) respondents have good ADRs reporting practices. Poor knowledge (adjusted OR (AOR)=2.63, 95% CI: 1.26 to 5.45) and lack of training on ADRs reporting (AOR=7.31, 95% CI: 3.42 to 15.62) were both negatively associated with ADRs reporting practice, whereas higher work experience (≥10 years) (AOR=0.36, 95% CI: 0.13 to 0.97) was positively associated with ADRs reporting practice. CONCLUSIONS: The majority of HCPs had poor knowledge and practice, but a positive attitude towards ADRs reporting. Poor knowledge, less work experience and lack of training were associated with poor ADRs reporting practice. Hence, strategies to improve the knowledge and practice of ADRs reporting should be implemented, particularly for untrained and less experienced HCPs.

Author Correction: Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions.

BACKGROUND: Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. METHODS: A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. RESULTS: A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212-9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029-2.450, p = 0.037). CONCLUSIONS: Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists' intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists' intervention was also substantially high.

Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study.

Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49-0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44-0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.