Spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data: Spatial and multilevel analysis.

BACKGROUND: Timely vaccination is the practice of administering the vaccine within the first birthday of the child. Not vaccinating the child at the appropriate age is the cause of improper protection of diseases and can be a possible factor in death. The problem of not completing the vaccine in the scheduled period is a globally distributed problem, but especially in sub-Saharan African countries, it is a bottleneck to child health. Even if timely vaccination is crucial for reducing the impact of VPDs, there are no current national-level studies to generate conclusive and tangible evidence in Ethiopia. OBJECTIVE: To assess spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data. METHOD: The secondary data analysis of a community-based cross-sectional study design was employed among 3094 participants. Stata-14 software was used for data cleaning, recording, and analysis. Arc GIS version 10.3 and Kuldorff SAT scan version 9.6 software are used for spatial and SAT scan statistics. A multilevel mixed-effect binary logistic regression analysis was used to identify the predictors of timely vaccination. The clustering effect was also evaluated by Moran's I statistics and intra class correlation. RESULTS: The timely completion of vaccination among Ethiopian women who had a child aged 12-35 months was 19.5% (95%CI: 18.2-20.8), and the spatial distribution of timely completion of vaccinations in Ethiopia was non-randomly distributed. A statistically significant high proportion of timely completion areas were clustered in the eastern part of Amhara, the south part of Afar, Addis Ababa, and Oromia. The primary cluster was located at a 13.11 km radius in Diredawa, which was 3.68 times higher than outside the window (RR = 3.68, LLR = 68.76, p-value < 0.001). History of antenatal care follow-up (AOR = 1.63, 95% CI: 1.3-2.04), giving birth at health facilities (AOR = 1.63, 95% CI: 1.25-2.13), age ≥ 35 years (AOR = 186, 95% CI: 1.35-2.63), age 25-34 years (AOR = 1.72, 95% CI: 1.33-2.21), and being richest (AOR = 2.71, 95% CI: 1.86-3.94) were the factors contributing to the timely completion of vaccination. CONCLUSION: The prevalence of timely completion of vaccination was low in Ethiopia, and the spatial distribution of timely completion of vaccination in Ethiopia was non-randomly distributed across the regions. The factors associated with the timely completion of vaccinations were ANC follow-up, place of delivery, age of the participant, and wealth index. We recommend expanding facility delivery, antenatal care services, and empowering women to scale up timely vaccination in Ethiopia.

Magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a tertiary hospital in Eastern Ethiopia: a cross- sectional study.

INTRODUCTION: Several studies conducted worldwide revealed the magnitude of early relaparotomy and its outcome among patients undergoing laparotomy. However, there was very little evidence on the magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in Ethiopia, especially in the study area. OBJECTIVE: this study aimed to the assess magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a Tertiary Hospital in Eastern Ethiopia. METHODS: A retrospective cross-sectional study was conducted. All patients who underwent laparotomy during the data retrieval period were included. Data were collected using a data abstraction checklist from patients' medical records. The collected data were entered, cleaned, and analyzed by using SPSS version 23. Descriptives statistics were generated where by continuous variables were summarized into means and standard deviation and categorical variables were summarized as the frequency with proportions. RESULT: The magnitude of relaparotomy was 6.8%. Among 82 patients included in the final analysis, 53 (64.6%) were males and the mean (± SD) age of patients was 33.32 ± 16.63 years. The major indications for relaparotomy were intra-abdominal collection (26.8%) and anastomotic leak (24.4%). Among 82 patients who underwent relaparotomy, 52(63.4%) were developed post relaparotomy complications, and 30(36.6%) patients died. CONCLUSION: The magnitude of early relaparotomy was 6.8%. The magnitude of in-hospital mortality was high in comparison to earlier study findings from developing countries. About three fourth of patients who underwent relaparotomy were developed postoperative complications.

Utilization of growth monitoring and promotion services among children younger than 2 years in West Armachiho district, Northwest Ethiopia.

Introduction: Inadequate physical growth and poor development of children are prevalent and significant problems worldwide, with 149 million children younger than 5 years stunted and 49 million wasted. Growth monitoring and promotion (GMP) is one of the major activities implemented with the aim of capturing growth faltering before the child reaches the status of undernutrition. In relation to this, the Amhara region, where the study area is found, is a highly burdened area for child malnutrition. Thus, it needs further investigation about the utilization of GMP services and associated factors among children younger than 2 years in the study area. Objective: The aim of this study was to assess the utilization of growth monitoring and promotion services and associated factors among children younger than 2 years. Methods: A community-based cross-sectional study was conducted in the West Armachiho district, including 703 mother-child pairs, with a response rate of 94.7%. A simple random sampling technique was used to select the respondents. Both bivariable and multivariable logistic regression analyzes were performed. An adjusted odds ratio (AOR) with a 95% confidence interval was used to measure the strength of the association. Results: The proportion of utilization of growth monitoring and promotion services in the West Armachiho district was 13.7% (95%Cl; 11.2, 16.4). Factors such as maternal educational status (AOR = 2.17, 95%Cl; 1.05, 4.49), institutional delivery (AOR = 3.16, 95%Cl; 1.62, 6.13), family size (AOR = 2.66, 95%Cl; 1.13, 6.23), access to health facility (AOR = 3.17, 95%Cl; 1.45, 6.95), and maternal knowledge (AOR = 4.53, 95%Cl; 2.71, 7.59) were significantly associated with the utilization of growth monitoring and promotion services. Conclusion: Utilization of growth monitoring and promotion services in children younger than 2 years in the West Armachiho district was low. Thus, giving due attention to the improvement of the knowledge of the mothers/caregivers about child GMP services and counseling them about the importance of facility delivery is vital to improving growth monitoring and promotion services in the area.

Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis.

Objective: Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa. Methods: The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model. Results: A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa. Conclusion: In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.

Food insecurity and its associated factors among lactating mothers in the Chiro district, Eastern Ethiopia: A community-based cross-sectional study.

Introduction: Lactating mothers are extremely vulnerable to both macro and micronutrient deficiencies due to the increased nutritional requirements and high magnitude of food insecurity in low-income countries. However, there are a dearth of studies conducted in sub-Saharan African countries regarding this study area. Thus, this study aimed to assess the magnitude of food insecurity and its associated factors among lactating mothers in the Chiro district, eastern Ethiopia. Methods: A community-based cross-sectional study was conducted among 446 randomly selected lactating mothers from 1-30 June, 2020. Data were collected through face-to-face interviews using a structured and pre-tested questionnaire. Data were entered using EpiData version 3.1 and exported to STATA version 14.2 for cleaning and analysis. Bi-variable and multivariable binary logistic regression analyses were fitted to check the association between independent variables and food insecurity. The level of statistical significance was declared at a p-value < 0.05. Results: The magnitude of food insecurity among lactating mothers was 68.8 % (95 % CI: 64.4, 72.9) and 12.1% (95 % CI: 9.4, 15.5) were severely food insecure. Residing in the rural (AOR =2.36, 95% CI:1.21, 4.62), poor wealth indices (AOR =4.68, 95% CI:2.02, 10.8), owning farmland of less than a hectare (AOR =2.35, 95% CI:1.06, 5.19), mothers who had less than three meals a day (AOR =2.70, 95% CI:1.33, 5.46), and who did not have their own income (AOR =2.32, 95% CI:1.36, 3.96) were significantly associated factors with food insecurity among lactating mothers. Conclusion: Food insecurity is highly prevalent in lactating mothers' households. Therefore, the government and other stakeholders need to take action that addresses factors affecting mothers' food security status through strengthening nutrition-sensitive interventions.

High burden of hypertension amongst adult population in rural districts of Northwest Ethiopia: A call for community based intervention.

BACKGROUND: Hypertension is a serious public health issue in Ethiopia, but there is a paucity of evidence in the country's rural areas. The aim of this study was to determine the prevalence of hypertension and its risk factors among adults in rural districts in northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from June to October 2020. The 1177 study participants were chosen using a multistage sampling procedure. A face-to-face interview was conducted using an adapted version of the WHO STEPwise approach questionnaire. Blood pressure was measured three times using an aneroid sphygmomanometer, and the mean of the last two readings were used for the analysis. Data was entered using Epidata and analyzed using STATA-16. Multivariable logistic regression was used to identify risk factors associated with hypertension. RESULTS: Of the total participants, 218 (18.5%) were found to be hypertensive. The prevalence of hypertension consistently increases with age. Hypertension was positively and significantly associated with female sex ((adjusted odd ratio (AOR) = 2.30, 95% CI: 1.53, 3.45)), age group 45-54 years (AOR = 4.63, 95% CI: 1.01, 21.37), 55-64 years (AOR = 14.40, 95% CI: 3.07, 67.63), ≥65 years (AOR = 19.37, 95% CI: 4.03, 93.09), having history of alcohol consumption (AOR = 3.25, 95% CI: 1.17, 9.02), used much amount of salt (AOR = 2.37, 95% CI: 1.53, 3.60) and too much amount of salt (AOR = 3.78, 95% CI: 1.85, 7.72), sleeping for a short duration (AOR = 2.05, 95%CI: 1.30, 3.24), and having family history of hypertension (AOR = 2.12, 95% CI; 1.32, 3.39). CONCLUSIONS: Hypertension was significantly high among the rural population we studied and is emerging as a public health problem. Female sex, advanced age, ever used alcohol, excessive salt intake, insufficient sleep, and a family history of hypertension were factors that were positively and significantly associated with hypertension. We recommend local health authorities integrate promotion of hypertension health education, lifestyle modification intervention on salt and alcohol reduction, and hypertension detection, particularly for the female and elderly population, at the health post level to avert the problem.

Perceived barriers and enablers influencing health extension workers toward home-based hypertension screening in rural northwest Ethiopia: interpretive descriptive study.

BACKGROUND: Hypertension, a major but modifiable risk factor for cardiovascular diseases, is a global health problem including Ethiopia. In a limited infrastructure task sharing of hypertension screening for community health workers is a feasible strategy to improve hypertension management. Recent finding have shown that trained health extension workers (HEWs) can identify high blood pressure, which was effective and feasible. Identifying barriers and enablers for home-based hypertension screening by HEWs is crucial for its implementation. This study aimed to explore barriers and enablers that influence health extension workers' home-based hypertension screening in the community. METHODS: The interpretive descriptive design was implemented. In-depth interviews were conducted during October, 2020. A total of 26 participants including HEWs, supervisors, and heads of district health office were purposively selected. They were asked to describe their perception toward home-based hypertension screening by the HEWs. The interviews were audio-recorded, transcribed verbatim into Amharic, and translated into English. The transcripts were coded and themes were identified. Thematic approach was used for data analysis. RESULTS: The participants identified key perceived barriers and enablers of HEWs home-based hypertension screening. The most common barriers were a lack of hypertension training, blood pressure measuring devices, blood pressure guidelines and manuals, skilled HEWs, financial incentives, and poor community awareness of the disease. The most common enablers were support from community leaders, presence of functional development army and community trust for HEWs, presence of routine campaign on vaccination and community based health insurance, and an integrated health system. CONCLUSIONS: Our findings have implications for the HEWs' ongoing implementation of home-based hypertension screening. Successful implementation of this strategy requires scaling up of hypertension training programs for health extension workers and their supervisors, provision of standardized protocols, provision of adequate blood pressure measuring equipment, and regular supportive supervision.

Undernutrition among khat-chewer and non-chewer lactating women in Chiro district, eastern Ethiopia: Comparative cross-sectional study.

Objectives: This study aims to assess the prevalence of undernutrition and factors associated with it among khat-chewer and non-chewer lactating women at Chiro district, west Hararghe zone, eastern Ethiopia. Methods: A community-based comparative cross-sectional study was conducted among 446 (223 khat chewers and 223 non-chewers) randomly selected lactating women who have children aged 6 and 23 months. Data were collected through face-to-face interviews using structured questionnaires followed by weight and height measurements to calculate and categorize nutritional status based on body mass index (kg/m2). Data were entered into EpiData version 3.1 and analyzed using STATA version 14.2. A binary logistic regression model was fitted to check the association between independent variables and undernutrition. The level of statistical significance was declared at a p-value less than 0.05. Results: The overall prevalence of undernutrition among lactating women was 30.7% (95% confidence interval = 26.6, 35.2). Undernutrition was significantly higher among khat chewers, 39.0% (95% confidence interval = 32.8, 45.6) than non-chewers, 22.4% (95% confidence interval = 17.4, 28.4), (χ2 (degree of freedom) = 14.4231, p < 0.0001). Chewing daily (adjusted odds ratio = 3.14, 95% confidence interval = 1.08, 9.15), reducing number of meals after chewing (adjusted odds ratio = 3.45, 95% confidence interval = 1.29, 9.20), and unavailability of latrine (adjusted odds ratio = 2.98, 95% confidence interval = 1.02, 8.75) were significantly associated with undernutrition among khat-chewer lactating women. Furthermore, age at first pregnancy (<18 years) (adjusted odds ratio = 3.17, 95% confidence interval = 1.17, 8.60), not taking any additional meals (adjusted odds ratio = 3.41, 95% confidence interval = 1.08, 10.7), and hand washing after toilet use (adjusted odds ratio = 6.10, 95% confidence interval = 2.51, 14.8) were significantly associated with undernutrition among non-chewer lactating women. Conclusion: The overall prevalence of undernutrition is higher than previous studies and is alarming among khat-chewer lactating mothers. Thus, nutritional and public health interventions should target khat-chewer lactating mothers particularly focusing on daily chewer either to improve their dietary practice during and after chewing or to stop khat chewing if possible, in order to reduce the effect of khat on food absorption. Besides, improving latrine coverage and use, and prevention of early pregnancy are of paramount importance in reducing undernutrition among lactating mothers.

Prevalence of malnutrition and associated factors among older adults from urban and rural residences of Metu district, Southwest Ethiopia.

BACKGROUND: In Ethiopia, the proportion of older adults is steadily increasing. This rapidly growing older adult population may increase the burden of malnutrition. However, malnutrition among older adults, particularly those living in rural areas, is regularly underrecognized and/or ignored. There have been no studies among older adults in the Metu district that have used the Min nutritional assessment (MNA). As a result, the purpose of this study is to determine the prevalence of malnutrition and its associated factors among older adults in Metu district, Southwest Ethiopia. METHODS: A community-based comparative cross-sectional study was conducted from May to June 2021 in Metu district. A multi-stage stratified sampling technique was employed. The nutritional status of the older adults was measured by MNA. Data from 616 older adults (308 from urban and 308 from rural residences) was collected through face-to-face interviews using a structured questionnaire. Bivariable and multivariable logistic regression analyses were done to identify factors associated with malnutrition. RESULTS: According to this study, the overall prevalence of malnutrition in Metu district was 17.5% (95% CI: 14.4%-20.7%). The prevalence of malnutrition in urban and rural residences was 9.9% and 25.2%, respectively. In the overall study, insomnia (AOR: 2.0, 95%CI: 1.1-3.7), residence (AOR: 3.47, 95%CI: 1.8-6.5), and smoking (AOR: 3.7, 95%CI: 2.1-6.7) were associated with malnutrition. In urban residences, depression (AOR: 3.4, 95%CI: 1.2-9.5), dietary diversity score (DDS) (AOR: 3.5, 95%CI: 1.2-10.0), and eating problems (AOR: 2.8, 95%CI: 1.1-7.3) were associated with malnutrition. In rural residence, age (AOR:3.8; 95%CI: 1.2-11), sex (AOR:2.2,95%CI:1.0-4.8), DDS (AOR:5.4,95%CI:2.2-13.3), depression (AOR: 4.6,95%CI:2.2-9.2), and chronic disease (AOR: 3.8 95%CI: 1.8-8.2) were associated with malnutrition. CONCLUSIONS AND RECOMMENDATIONS: Malnutrition was more prevalent among older adults living in rural areas than in urban areas. In the overall study, insomnia, residence, and smoking were significantly associated with malnutrition. DDS, depression, and eating difficulties were significantly associated with malnutrition among older adults living in urban areas, whereas sex, age, depression, chronic disease, and dietary diversity were factors influencing malnutrition in rural areas. Strengthening strategies aimed at addressing nutrition policy, as well as paying attention to the nutritional needs of the older adult population, can help to improve the health and quality of life of older adults.

Antimicrobial Use and Management of Childhood Diarrhea at Community Drug Retail Outlets in Eastern Ethiopia: A Matched Questionnaire-Based and Simulated Patient-Case Study.

Introduction: Antimicrobial agents have saved millions of lives worldwide. However, inappropriate use has become a global concern leading to the emergence and spread of antimicrobial resistance (AMR). In this regard, the dispensing practices of pharmacy professionals in the community drug retail outlets (CDROs) plays a central role. Therefore, this study was aimed to assess the knowledge and dispensing practices of pharmacy professionals in the management of childhood diarrhea in CDROs of Eastern Ethiopia. Methods: A community based cross-sectional study was conducted in 100 randomly selected CDROs in Eastern Ethiopia from 1 August to 30 September 2020. Data were collected with a structured questionnaire matched with a simulated patient case. Descriptive statistics were employed to summarize variables. Cohen's Kappa was analyzed to measure the degree of agreement between questionnaire-based and simulated patient-based methods. Binary logistic regression analysis was conducted to determine factors associated with inappropriate dispensing practice. Results: Majority of the participants were aged 25-34 years (median: 29 years). High proportion of them were male (65%) and had work experiences of two or more years. Majority (61%) of the professionals were knowledgeable about AMR. Out of 2886 scores, 745 scores were agreed on Cohen's Kappa interrater agreement scale with the overall percent agreement between the two methods being 26.0%. Besides, about 67% of dispensing practices to the simulated patient case was found inappropriate. On the multivariate analysis, insufficient knowledge of retailers on AMR was significantly associated with the inappropriate dispensing of antimicrobial agents. Conclusion: A considerable proportion of retailers had insufficient knowledge regarding the emergence and spread of AMR. Only a quarter of their questionnaire-based knowledge response agreed with simulated-patient-based actual practice, indicating weak agreement between the two methods and high level of inappropriate practice. Besides, insufficient knowledge of retailers was significantly associated with their inappropriate dispensing of antimicrobials.

Trained health extension workers correctly identify high blood pressure in rural districts of northwest Ethiopia: a diagnostic accuracy study.

BACKGROUND: Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia. METHODS: A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers' ability to identify high blood pressure in comparison to health professionals. RESULTS: The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively. CONCLUSIONS: The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.

Dietary practice and associated factors among type 2 diabetic patients having followed up at the University of Gondar Comprehensive specialized hospital, northwest Ethiopia, 2019.

BACKGROUND: Diabetes is a chronic, metabolic disorder characterized by elevated level of blood glucose. In order to delay and prevent diabetes related complications, healthy meal planning and leading active life are very crucial. However, appropriate feeding practice among type 2 diabetic patients is low in many developing countries including Ethiopia. Therefore, the aim of this study was to assess dietary practice and associated factors among type 2 diabetic patients. METHODS: Institution based cross sectional study was conducted from July to December 2019. A total of 422 type 2 diabetic patients who had follow up at the diabetes clinic of the University of Gondar Comprehensive Specialized hospital were include in the study. Logistic regression was used to see the strength of the association between dependent and independent variables. In the logistic regression, both bivariable and multivariable logistic regression analysis were computed to identify factors associated with dietary practice. RESULTS: The overall prevalence of good dietary practice among type 2 diabetic patients was 46.7 % [95 % CI: 41.7, 51.4]. In the multivariable logistic regression analysis attending secondary and above education [AOR = 4.08, 95 % CI: 1.76, 9.46], high wealth status [AOR = 5.34, 95 % CI: 2.72, 10.50], presence of family support [AOR = 2.54, 95 % CI: 1.40, 4.63], and absence of difficulty of choosing food [AOR = 2.27, 95 % CI: 1.47, 3.53] were significantly associated with good dietary practice. CONCLUSIONS: Less than half of the patients with type 2 diabetes had good dietary practice. Dietary practice was good among high economic status, presence of family support, high educational level and no difficulty of choosing food. Therefore, strengthening income generating activities, improving literacy rate of nations, developing family engagement and food choosing strategies by the health care providers, policy makers and the Government are very crucial to improve good dietary practice among type 2 diabetic patients.

Incidence and predictors of mortality among persons receiving second-line tuberculosis treatment in sub-Saharan Africa: A meta-analysis of 43 cohort studies.

BACKGROUND: Drug resistance remains from among the most feared public health threats that commonly challenges tuberculosis treatment success. Since 2010, there have been rapid evolution and advances to second-line anti-tuberculosis treatments (SLD). However, evidence on impacts of these advances on incidence of mortality are scarce and conflicting. Estimating the number of people died from any cause during the follow-up period of SLD as the incidence proportion of all-cause mortality is the most informative way of appraising the drug-resistant tuberculosis treatment outcome. We thus aimed to estimate the pooled incidence of mortality and its predictors among persons receiving the SLD in sub-Saharan Africa. METHODS: We systematically identified relevant studies published between January, 2010 and March, 2020, by searching PubMed/MEDLINE, EMBASE, SCOPUS, Cochrane library, Google scholar, and Health Technology Assessment. Eligible English-language publications reported on death and/or its predictors among persons receiving SLD, but those publications that reported death among persons treated for extensively drug-resistant tuberculosis were excluded. Study features, patients' clinical characteristics, and incidence and/or predictors of mortality were extracted and pooled for effect sizes employing a random-effects model. The pooled incidence of mortality was estimated as percentage rate while risks of the individual predictors were appraised based on their independent associations with the mortality outcome. RESULTS: A total of 43 studies were reviewed that revealed 31,525 patients and 4,976 deaths. The pooled incidence of mortality was 17% (95% CI: 15%-18%; I2 = 91.40; P = 0.00). The studies used varied models in identifying predictors of mortality. They found diagnoses of clinical conditions (RR: 2.36; 95% CI: 1.82-3.05); excessive substance use (RR: 2.56; 95% CI: 1.78-3.67); HIV and other comorbidities (RR: 1.96; 95% CI: 1.65-2.32); resistance to SLD (RR: 1.75; 95% CI: 1.37-2.23); and male sex (RR: 1.82; 95% CI: 1.35-2.44) as consistent predictors of the mortality. Few individual studies also reported an increased incidence of mortality among persons initiated with the SLD after a month delay (RR: 1.59; 95% CI: 0.98-2.60) and those persons with history of tuberculosis (RR: 1.21; 95% CI: 1.12-1.32). CONCLUSIONS: We found about one in six persons who received SLD in sub-Saharan Africa had died in the last decade. This incidence of mortality among the drug-resistant tuberculosis patients in the sub-Saharan Africa mirrors the global average. Nevertheless, it was considerably high among the patients who had comorbidities; who were diagnosed with other clinical conditions; who had resistance to SLD; who were males and substance users. Therefore, modified measures involving shorter SLD regimens fortified with newer or repurposed drugs, differentiated care approaches, and support of substance use rehabilitation programs can help improve the treatment outcome of persons with the drug-resistant tuberculosis. TRIAL REGISTRATION NUMBER: CRD42020160473; PROSPERO.

The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice.

INTRODUCTION: Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town. METHODS: A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22. RESULTS: From the 271 medical records reviewed majority of patients were from surgical ward (n = 85, 31.4%) followed by gynecology and obstetrics ward (n = 67, 24.7%). Demographically, the majority of the patients were female (n = 142, 52.4%). Patients in the age group of 20-29 years were dominant (n = 98, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n = 6), warfarin (n = 5), and enoxaparin (n = 1) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n = 80, 27.5%) followed by for the management of pneumonia (n = 62, 21.3%). The result of ceftriaxone use evaluation showed that majority (n = 190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n = 114, 60.0%) followed by wrong duration (n = 54, 28.4%). CONCLUSION: Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.

Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies.

BACKGROUND: Antipsychotic agents are the basis for the pharmacological management of acute and chronic schizophrenia, bipolar disorders, mood disorders with psychotic feature, and other psychotic disorders. Antipsychotic medication use is frequently associated with unfavorable adverse effects such as extrapyramidal side effects (EPSEs). Hence, this systematic review and meta-analysis was aimed to determine the magnitude of antipsychotic-induced EPSEs. METHOD: A literature search was conducted using legitimate databases, indexing services, and directories including PubMed/MEDLINE (Ovid®), EMBASE (Ovid®), google scholar and WorldCat to retrieve studies. Following screening and eligibility, the relevant data were extracted from the included studies using an Excel sheet and exported to STATA 15.0 software for analyses. The Random effects pooling model was used to analyze outcome measures at a 95% confidence interval. Besides, publication bias analysis was conducted. The protocol has been registered on PROSPERO with ID: CRD42020175168. RESULT: In total, 15 original articles were included for the systematic review and meta-analysis. The pooled prevalence of antipsychotic-induced EPSEs among patient taking antipsychotic medications was 37% (95% CI: 18-55%, before sensitivity) and 31% (95% CI: 19-44%, after sensitivity). The prevalence of antipsychotic-induced parkinsonism, akathisia, and tardive dyskinesia was 20% (95% CI: 11-28%), 11% (95% CI: 6-17%), and 7% (95% CI: 4-9%), respectively. To confirm a small-study effect, Egger's regression test accompanied by funnel plot asymmetry demonstrated that there was a sort of publication bias in studies reporting akathisia and tardive dyskinesia. CONCLUSION: The prevalence of antipsychotic-induced EPSEs was considerably high. One in five and more than one in ten patients experienced parkinsonism and akathisia, respectively. Appropriate prevention and early management of these effects can enhance the net benefits of antipsychotics.

One in Five Street Traditional Coffee Vendors Suffered from Depression During the COVID-19 Pandemic in Harar Town, Ethiopia.

BACKGROUND: The COVID-19 crisis has already resulted in an economic and labor market shock and a rise of informal work sectors. Being an informal job, traditional coffee vending can predispose women to a myriad of mental disorders. Therefore, this study was aimed to assess depressive symptoms during the COVID-19 pandemic and associated factors among street traditional coffee vendors in Harar town, Eastern Ethiopia. METHODS: A cross-sectional study was employed on 180 women engaged in street traditional coffee vending business in Harar town. Data were collected through a face-to-face interview using a Public Health Questionnaire and analyzed using SPSS version 20. Binary logistic regression was executed to identify factors associated with depression at a cut-off point of P < 0.05. RESULTS: The mean age of the study participants was 31.83 (±10) years. The majority of the participants were currently married (n = 77, 42.8%), attended primary education (n = 68, 37.8%), had a family member of four or more (n = 60, 33.3%), and had two years or less work experience (n = 123, 68.3%). Most of the study participants obtained COVID-19-related information from television (n = 125, 69.4%). The prevalence of depression was found to be 18.9%. Attending primary education (AOR: 0.34; 95% CI: 0.12, 0.98), attending secondary education or higher (AOR: 0.23; 95% CI: 0.07, 0.69), and having four or more family members (AOR: 2.81; 95% CI: 1.14, 6.92) were significantly associated with depression. CONCLUSION: One in five street traditional coffee vendors suffered from depression during the COVID-19 pandemic. Lower odds of being depressed were observed in those who attended a minimum of primary education. On the contrary, having a greater family size was associated with higher odds of being depressed. This finding will direct the government and other concerned bodies to be involved in the provision of psychological and material support for such informal workers during COVID-19.

Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology.

BACKGROUND: Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. METHODS: A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers' price to international buyers' reference price. The Mann-Whitney U test was employed to compare the median buyers' price between public and private health facilities. Kruskal-Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. RESULTS: The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0-31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7-93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann-Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers' price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. CONCLUSION: Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.

Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population.

Coronavirus disease in 2019 emerged in Wuhan, Hubei Province, China, in December 2019. After a month, it was declared a global threat to public health. The effects of the pandemic could be socio-economic, undermining the health system and risking livelihoods. Vulnerability to this infection has been associated with underlying comorbidities such as hypertension, diabetes, coronary heart disease, chronic respiratory diseases, cancer, and compromised immune systems. Co-morbidity has been common to the elderly, the disabled, and the homeless. In addition, more severe coronavirus disease outcomes have been reported in older males than females. Nonetheless, multiple variables are related to the concept of cultural gender that should be taken into account as women in more affected sectors are economically disadvantageous and over-represented. Similarly, although children are not the face of this pandemic, calamity has a profound effect on their welfare, especially for those living in poor and inconvenient situations. Moreover, the economic influence could be profound and universal when viewed through a migration lens as it is exacerbating xenophobic and discriminatory treatment. Protection measures to mitigate the outbreak of a pandemic, such as social distancing, may reduce social support for certain categories relied on for their day-to-day activities. The mental health of people would definitely be affected by the additional psychosocial burden of the pandemic, particularly in vulnerable groups. Integrated approaches are therefore mandatory to assist these groups and contain the pandemic.

Bacterial uropathogens and susceptibility testing among patients diagnosed with urinary tract infections at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

BACKGROUND: Urinary tract infection is a common infection posing a significant healthcare burden globally. Currently, it is becoming hard to manage due to the drug resistance of uropathogens. This study aimed to evaluate the rate of culture positivity and the susceptibility pattern of isolates among clinically diagnosed patients with urinary tract infection. METHODS: An institution-based cross-sectional study was conducted on patients clinically diagnosed with urinary tract infections and received a drug prescription at Hiwot Fana Specialized University Hospital from August 2018 to June 2019. A clean-catch mid-stream urine specimen was collected and bacterial identification and susceptibility test were performed using standard microbiological methods. Data were entered into EpiInfo 7 and exported to STATA 15 for analysis. Data were analyzed using descriptive analysis and bi-variate and multivariate regression analyses and presented with graphs, frequency, and tables. RESULTS: A total of 687 urine samples were collected from patients with clinically diagnosed urinary tract infections. The mean age was 31 years and 56.62% were female. 28.38% of the participants had a culture-positive result, of which 86.15% had monomicrobial infections. Inpatients (AOR = 3.8, 95% CI = (1.8-7.9)) and hypertensive patients (AOR = 2.1, 95% CI = (1.1-4.4)) had higher odds of culture-positive results. Staphylococcus species (35.3%), E. coli (25.34%), Pseudomonas species (6.8%), and other Enterobacterales are isolated. Most isolates showed resistance to more than one drug, and amikacin, gentamicin, and nitrofurantoin showed relatively higher activity against isolates. CONCLUSION: About one-third of the clinically diagnosed patients with urinary tract infection were culture-positive with many types of bacterial uropathogens. Inpatients and hypertensive patients had a higher risk of developing bacterial infections. Bacterial isolates showed different percentages of susceptibility to the tested antibiotics.

Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia.

INTRODUCTION: Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs). OBJECTIVE: This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016. METHODS: A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS: Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%). CONCLUSION: Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.