Treatment burden and regimen fatigue among patients with HIV and diabetes attending clinics of Tikur Anbessa specialized hospital.

Nascent studies showed that patients with chronic medical illnesses such as diabetes mellitus (DM) and HIV/AIDS are highly vulnerable to face both treatment burden and regimen fatigue. However, an attempt made so far in this sphere in sub-Saharan African health care context is dearth. Thus, this study aimed to determine the level of treatment burden and regimen fatigue of diabetic and HIV patients attending adult diabetic and ART clinics of TASH and explore patients' and health care workers' propositions to reduce treatment burden and regimen fatigue. An explanatory sequential mixed methods study was conducted at the adult HIV and DM clinics of TASH, Addis Ababa, Ethiopia from February 01-March 30, 2022. Simple random and purposive sampling techniques were employed to select participants for quantitative and qualitative studies, respectively. Descriptive analysis was done to summarize the quantitative data. Logistic and linear regression analyses were performed to identify predictors of treatment burden and regimen fatigue, respectively. P value < 0.05 was considered statistically significant. Qualitative data was analyzed by using a thematic analysis. A total of 300 patients (200 diabetes and 100 HIV) were included in the quantitative study. For the qualitative study, 14 patients and 10 health care workers (six nurses and four medical doctors) were included. Participants' mean global Treatment Burden Questionnaire (TBQ) and Treatment Regimen Fatigue Scale (TRFS) score were 28.86 ± 22.13 and - 42.82 ± 17.45, respectively. Roughly, 12% of patients experienced a high treatment burden. The presence of two or more comorbidities (adjusted odds ratio [AOR] = 7.95, 95% confidence interval [CI] 1.59-39.08), daily ingestion of more than five types of prescribed medications (AOR = 6.81, 95%CI 1.59-29.14), and good knowledge about DM and/or HIV (AOR = 0.33, 95%CI 0.12-0.92) were predictors of treatment burden. Poor availability of medications (ß = 0.951, p < 0.001) was the only predictor of regimen fatigue. Patients and health care workers primarily proposed to foster self-care efficacy, advance administrative services of the clinic and hospital, and improve healthcare system provision. The findings of this study unveiled that a considerable proportion of patients experienced low levels of treatment burden and regimen fatigue. This study showed that boosting the patients' self-care efficacy, upgrading administrative services of the clinic and hospital, and promoting the healthcare system provision had enormous significance in reducing treatment burden and regimen fatigue. Therefore, when designing patient-specific healthcare interventions for both HIV and diabetic patients' various factors affecting both treatment burden and regimen fatigue should be considered to achieve the desired goals of therapy.

Renal Function Abnormalities among Patients with Acute Stroke at a Tertiary Hospital in Ethiopia.

Background: Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality. Methods: A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl. Result: The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant. Conclusion: Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.

Knowledge of the Therapeutic Goals of Diabetes Care among Patients with Type 2 Diabetes at a Tertiary Hospital in Ethiopia.

Background: A comprehensive cardiovascular risk control reduces diabetes-associated complications but achieving the triplet goals (blood glucose, blood pressure (BP), and low-density lipoprotein (LDL-C)) remains a clinical challenge. Patients' knowledge of these diabetes therapeutic goals has been shown to improve glycemic control. However, this is not well studied in Ethiopia. Methods: A cross-sectional study was conducted from March to June 2020 in Tikur Anbessa Specialized Hospital among randomly selected 419 patients with type 2 diabetes. Data was collected using a pretested, structured questionnaire. A multivariable binary logistic regression was fitted to identify determinants of knowledge. Results: The mean age (±SD) of study participants was 57.4 (±10.8) years and the median duration (IQR) of diabetes was 12 (7, 20) years. A quarter of them achieved fasting glycemic control, a fifth of them attained the A1c goal and only 3% achieved the triple targets. Patients who reported knowing their target goals for BP, fasting blood sugar (FBS), A1C, and LDL-C were 79.5, 77.3, 11.7, and 7.2% respectively. The factors associated with knowledge of the therapeutic goals were longer diabetes duration, increased household income, age, being divorced as compared to married, having no formal education, and primary education. Conclusion: The majority of participants knew their BP and FBS targets while only a minority understood their A1c and LDL-C targets. It highlighted the need for the provision of patient-centered diabetes education to improve knowledge of the therapeutic targets.

Determinants of hypertension among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: A case-control study.

INTRODUCTION: Hypertension (HTN) in patients with diabetes mellitus (DM) is a common problem that increases the risk of mortality and morbidity, and lowers the quality of life. Despite the disproportionately high burden of HTN in DM patients, determinants for the comorbidity have not been sufficiently explored. Therefore, this study aimed to identify the determinants of HTN among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital. METHODS AND MATERIALS: We conducted a hospital-based unmatched case-control study at Tikur Anbessa Specialized Hospital on 386 randomly selected patients with type 2 diabetes on follow-up (200 cases and 186 controls). We collected data by using a structured interviewer-administered questionnaire and data extraction form. To identify determinants of hypertension, a multivariable binary logistic regression was fitted, and the findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS: The mean reported age (±SD) of the cases and the controls was 60.3 (±9.9) and 55.3 (±11.3) years, respectively. The eight identified independent determinants of hypertension with AOR [95% CI] were obesity: 2.82 [1.43, 5.57], sedentary activity of ≥4hrs/day: 1.75 [1.10, 2.79], higher stress score: 1.05 [1.01, 1.10], serum creatinine above 1.1 mg/dl: 2.35 [1.13, 4.91], age: 1.05 [1.02, 1.08], being government employee as compared to private workers: 2.18 [1.06, 4.50] and family history of hypertension: 2.11 [1.26, 3.54]. Further, interaction of diabetes duration with insulin use: 1.03 [1.01, 1.07] was also a significant predictor of HTN among DM patients. CONCLUSION: The finding calls for interventions for mitigating these determinants. Further research is needed to examine the interaction between diabetes duration and insulin use.