Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. METHODS: A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. DISCUSSION: This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. TRIAL REGISTRATION: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.

Phytochemical investigation and nephroprotective potential of Sida cordata in rat.

BACKGROUND: Plants are an efficient source of natural antioxidant against free radicals causing kidney damages. Sida cordata ethyl acetate fraction has been reported for strong in vitro antioxidant potency, previously. In the present study, our objective was to evaluate its in vivo antioxidant potency against CCl4 induced nephrotoxicity and investigates the bioactive phytochemicals by HPLC-DAD analysis. METHODS: Phytochemical analysis was performed by HPLC-DAD methodology. For in vivo study, 42 male Sprague-Dawley rats were treated with alternatively managed doses for 60 days. Group I animals were remained untreated. Group II animals were treated with vehicle (1 mL of olive oil) by intragastric route on alternate days. Group III was treated with 30% CCl4 (1 mL/kg b.w.) i.p. Group IV was treated with 30% CCl4 (1 mL/kg b.w.) i.p and silymarin intragastric. Group V and VI rats were treated with 30% CCl4 and SCEE (150 and 300 mg/kg b.w., respectively) intragastric. Group VII animals were treated with SCEE (300 mg/kg b.w.) intragastrically. Blood parameters, Serum proteins and urine profile were investigated. Activities of tissue enzyme i.e. catalase, peroxidase, superoxide dismutase, glutathione-S-transferase, glutathione reductase, GSH and γ-GT were evaluated. Histopathological observations, total protein contents, lipid peroxidation, DNA damage and relative weight were also analyzed. RESULTS: Gallic acid, catechin and caffeic acid were identified in SCEE fraction by HPLC-DAD. Decrease in the count of red blood cells, neutrophils, eosinophils and concentration of hemoglobin whereas increase in lymphocyte count and estimation of sedimentation rate (ESR) with 1 mL CCl4 (30% in Olive oil) administration (30 doses in 60 days) was restored dose dependently with co-treatment of SCEE (150 and 300 mg/kg b.w.). Treatment of rats with CCl4 markedly (P < 0.01) increased the count of urinary red blood cells and leucocytes, concentration of urea, creatinine and urobilinogen and specific gravity whereas creatinine clearance was reduced. Serum level of total protein, albumin, globulin, nitrite, creatinine and blood urea nitrogen (BUN) was significantly increased (P < 0.01) by CCl4 treatment. The activity of antioxidant enzymes; catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione reductase and content of reduced glutathione was decreased (P < 0.01) significantly. However, increased concentration (P < 0.01) of thiobarbituric acid reactive substances and histopathological injuries were noticed in the renal tissues of rats after the treatment with CCl4. Co-administration of SCEE, dose dependently, protected the alterations in the studied parameters of rats at 150 and 300 mg/kg b.w. The present study revealed that SCEE could be used as a possible remedy for renal toxicity abnormalities. CONCLUSION: These results are an evidence of the renal protective role of S.cordat ethyl acetate fraction against CCl4 induced nephrotoxicity in rats which may be due to its antioxidant compounds.

Proficiencies of Artemisia scoparia against CCl4 induced DNA damages and renal toxicity in rat.

BACKGROUND: Artemisia scoparia is traditionally used in the local system of medicine in kidney disorders. This study aimed at scrutinizing the nephroprotective prospective of A. scoparia methanol extract against carbon tetrachloride (CCl4) provoked DNA damages and oxidative stress in kidneys of rat. METHODS: Dried aerial parts of A. scoparia were powdered and extracted with methanol to obtain the viscous material (ASM). Sprague Dawley male rats (42) were grouped (7) having 6 rats in each. Group I remained untreated and Group II treated intraperitoneally (i.p) with DMSO + olive oil (1 ml/kg body weight (bw). Rats of Group III - VI were treated with CCl4 (1 ml/kg bw; i.p 30 % v/v in olive oil). Animals of Group IV were co-administered with 100 mg/kg bw of silymarin whereas rats of Group V and VI with 150 mg/kg bw and 300 mg/kg bw of ASM at an interval of 48 h for four weeks. Animals of Group VII were administered with ASM (300 mg/kg bw) alone. DNA damages were investigated with comet assay in renal tissues while the oxidative injuries were estimated in serum and renal tissues. RESULTS: Co-administration of ASM to rats significantly reduced the DNA damages at 300 mg/kg dose as indicated in comet length (40.80 ± 2.60 µm), head length (34.70 ± 2.21 µm), tail length (7.43 ± 1.24 µm) and DNA content in head (88.03 ± 2.27 %) to that of CCl4 for comet length (63.16 ± 2.11 µm), head length (23.29 ± 1.50 µm), tail length (39.21 ± 2.81 µm) and DNA content of head (74.81 ± 2.18 %) in renal cell's nuclei. Increased level of urea, creatinine, bilirubin, blood urea nitrogen whereas decreased concentration of proteins in serum of CCl4 treated animals were restored towards the normal level with co-administration of ASM. CCl4 injection in rats decreased the activity level of CAT, POD, SOD, GST and γ-GT and GSH contents while elevated levels of TBARS, H2O2 and nitrite contents were observed in renal tissues. A noteworthy retrieval of all these parameters and the altered histopathological observations was notified near to the normal values after treatment with both the doses of ASM. CONCLUSION: Results obtained suggested the therapeutic role of ASM in oxidative stress related disorder of kidneys.

Efficacy of Penicillin-Streptomycin Brands against Staphylococcus aureus: Concordance between Veterinary Clinicians' Perception and the Realities.

Antibiotics must be safe and effective for use in both human and veterinary medicine. However, information about the efficacy of different brands of antibiotics commonly used in veterinary practices is lacking in Ethiopia. In this study, we determined the efficacy of three brands of penicillin-streptomycin (Pen&strep, Penstrep, and Pro&strep) by performing antimicrobial susceptibility testing against Staphylococcus aureus isolated from cow milk from dairy farms in the towns of Sebata and Bishoftu, Central Ethiopia. We also assessed the knowledge, attitudes, and practices (KAP) of veterinarians regarding the quality and use of brand antibiotics and the antibiotic utilization practices of dairy farm personnel using a structured questionnaire. Of 43 S. aureus isolated and tested, 33 (77%), 10 (23%), and 1 (2%) were susceptible to brands A, B, and C, respectively. According to the respondents, all of them reported that penstrep is the most prescribed antibiotic in dairy farms (100%), followed by oxytetracycline (78%) and sulfa drugs (52%). All veterinarians perceived that antibiotics imported from Western countries have a higher efficacy than those from Eastern countries, and they preferred brand A to the other brands, witnessing its better clinical outcome. The majority (87%) and a little more than half (53%) of the respondents perceived the overuse of antibiotics in veterinary clinics and dairy farms, respectively. Our study revealed the better efficacy of brand A against S. aureus compared to the other brands. Interestingly, the veterinarians' perception of and preference toward the use of brand antibiotics agreed with the findings of our antibacterial susceptibility testing. The prudent use of brand A is critically important for sustaining effective treatment, avoiding the risk of antimicrobial resistance, and helping to address animal welfare issues.

In Vitro Anthelmintic Activity and Phytochemical Screening of Crude Extracts of Three Medicinal Plants against Haemonchus Contortus in Sheep at Haramaya Municipal Abattoir, Eastern Hararghe.

The current study was carried out to evaluate the anthelmintic efficacy of crude methanolic extracts of leaves of Croton macrostachyus and Nicotiana tabacum and rhizome parts of Zingiber officinale on nematode parasite, Haemonchus contortus. For these objectives, adult worm mortality assay (AWMA) was conducted on adult H. contortus to investigate the in vitro adulticidal effect of crude extracts from March to October 2021 G.C. The percentage yield of crude 99.9% methanolic extracts was 53%, 78%, and 44% for C. macrostachyus, N. tabacum, and Z. officinale, respectively. Phytochemical analysis using standard techniques was also used to detect secondary metabolites contained in the plants. The study revealed the presence of secondary metabolites such as tannins, flavonoids, steroids, and terpenoids in all extracts, which are considered to be the chemical components that are responsible for the wide therapeutic activities of several medicinal plants. In in vitro study, four graded concentrations of the crude extracts (500 mg/ml, 250 mg/ml, 125 mg/ml, and 62.5 mg/ml) were tested at regular time intervals, and parasite viability for 8 hours was recorded in triplicate. Albendazole (1.25 mg/ml) and distilled water were used as the positive and negative controls, respectively. At 4 hr posttreatment, the 62.5 mg/ml, 125 mg/ml, and 250 mg/ml concentrations of C. macrostachyus, N. tabacum, and Z. officinale extracts have caused significantly higher mortality (P < 0.05) compared to the albendazole. Methanolic extracts of C. macrostachyus, N. tabacum, and Z. officinale produced mortality of adult H. contortus significantly (P < 0.05) to the level of 93%, 83%, and 50% at concentration of 125 mg/ml at 4 hr posttreatment and meanwhile at 6 hr produced 100%, 100%, and 90%, respectively, at the same concentration. On the other hand, albendazole (1.25 mg/ml) killed 60% and 80% of the parasites at 4 hr and 6 hr posttreatment, respectively. Concentrations of all the extracts had showed a comparable and strong nematocidal effect on H. contortus having no significant difference with that of the positive control (P > 0.05) at 8 hr posttreatment period. Hence, the current study revealed that the extracts from three plants have potential anthelmintic effect, and we recommend further study on fractionating each component separately and validating the materials using other parasite developmental stages are warranted.

Evaluation of Wound Healing and Antibacterial Activities of Solvent Fractions of 80% Methanol Leaf Extract of Brucea antidysenterica J.F. Mill (Simaroubaceae).

Background: Brucea antidysenterica is a well-known medicinal plant that has traditionally been used to treat a variety of ailments, including wound healing. Supporting the traditional claims, wound healing, antibacterial, anti-inflammatory, and antioxidant activities of the crude extracts of different parts of the plant were reported. The aim of this study was to evaluate the wound healing and antibacterial activities of solvent fractions of the menthol leaf extract of Brucea antidysenterica. Methods: Methanol (80%) leaf extract of Brucea antidysenterica was fractionated using three solvents; water, n-butanol and chloroform. An ointment containing 2% and 4% of each fraction was formulated and applied to wounds inflicted on rats topically. The wound contraction rate, period of epithelialization, and breaking strength were analysed. In vitro antibacterial activities were tested using the agar diffusion method. The macro-tube dilution technique was used to determine the minimum inhibitory concentration (MIC), and the minimum bactericidal concentration (MBC) was determined by sub-culturing the MIC and concentrations below the MIC. Results: The 2% and 4% aqueous fractions (AF) significantly increased wound contraction (p 0.001) compared to the negative control and increased tensile strength compared to untreated (p 0.001). Among the three fractions, the n-butanol fraction showed the highest antibacterial growth inhibition, ranging from 8 mm (E. coli) to 16 mm (S. aureus). Conclusion: Data obtained from this study collectively indicated that the aqueous fraction of 80% methanol leaf extract of B. antidysenterica possesses wound healing and antibacterial activities.

Antibacterial activity of methanol extracts of the leaves of three medicinal plants against selected bacteria isolated from wounds of lymphoedema patients.

BACKGROUND: Patients with lymphoedema are at high risk of getting bacterial and fungal wound infections leading to acute inflammatory episodes associated with cellulitis and erysipelas. In Ethiopia, wound infections are traditionally treated with medicinal plants. METHODS: Agar well diffusion and colorimetric microdilution methods were used to determine the antibacterial activity of methanol extracts of the three medicinal plants against Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Shewanella alage, methicillin-resistant S. aureus ATCC®43300TM, Staphylococcus aureus ATCC25923, Escherichia coli ATCC25922, Klebsiella pneumoniae ATCC700603, and Pseudomonas aeruginosa ATCC37853. RESULTS: The methanol extract of L. inermis leaves showed high activity against all tested bacterial species, which was comparable to the standard drugs. Similarly, the extracts of A. indica showed activity against all tested species though at higher concentrations, and higher activity was recorded against Streptococcus pyogenes isolates at all concentrations. However, the extract of A. aspera showed the lowest activity against all tested species except Streptococcus pyogenes isolates. The lowest minimum inhibitory concentration (MIC) was recorded with the extract of L. inermis against E. coli isolate and S. aureus ATCC 25923. CONCLUSION: Methanol extracts of L. inermis, A. indica, and A. aspera leaves exhibited antimicrobial activity against selected bacterial isolates involved in wound infections, of which the methanol extracts of L. inermis exhibited the highest activity. The results of the present study support the traditional use of plants against microbial infections, which could potentially be exploited for the treatment of wound infections associated with lymphoedema.

Investigation of Wound Healing and Anti-Inflammatory Activities of Solvent Fractions of 80% Methanol Leaf Extract of Achyranthes aspera L. (Amaranthaceae) in Rats.

INTRODUCTION: The various fractions of leaves of Achyranthes aspera L. (A. aspera) have not yet been explored scientifically for in-vivo wound healing and anti-inflammatory activities. The objective of this study was, therefore, to evaluate in-vivo wound healing and anti-inflammatory activities of solvent fractions of 80% methanol leaf extract of A. aspera in rats. METHODS: The 80% methanol leaf extract of A. aspera was fractionated with chloroform, n-butanol and water. Wound healing and anti-inflammatory activities were evaluated using excision and incision wound models, rat paw edema and cotton pellet-induced granuloma models, respectively. For wound healing activity, fractions were evaluated at 5 and 10% ointments. The positive control groups were treated with nitrofurazone 0.2% ointment. Simple ointment treated for excision wound model and untreated for incision wound model rats were assigned as negative controls. For anti-inflammatory activity, fractions were evaluated at 100, 200 and 400mg/kg. Positive control groups were treated with indomethacin 10mg/kg for both rat paw edema and cotton pellet-induced granuloma models. The 2% Tween 80 treated rats were assigned as negative controls for both anti-inflammatory activity models. All groups comprised of 6 rats and treatment administrations were made topically and orally for evaluation of wound healing and anti-inflammatory activities. RESULTS: The 10% w/w chloroform fraction ointment revealed a high percentage of wound contraction and reduced period of epithelialization (p <0.01). Chloroform fraction was also found to be the most active fraction, which demonstrated the maximum percentage inhibition of edema (52.50%; p <0.01) and transudative and proliferative component of chronic inflammation (37.52 and 52.81%; p <0.01), which was comparable to indomethacin. CONCLUSION: Data obtained from this study collectively indicated that a chloroform fraction of 80% methanol leaf extract of A. aspera possessed significant wound healing and anti-inflammatory activities.

Investigation of Wound Healing and Anti-Inflammatory Activities of Leaf Gel of Aloe trigonantha L.C. Leach in Rats.

BACKGROUND: Traditionally Aloe trigonantha leaf is used for the treatment of different diseases. However, there were no in vivo studies which prove its claimed use for wound healing and anti-inflammatory activity. Therefore, the present study aimed at evaluating the in vivo wound healing and anti-inflammatory effects of the leaf gel of the plant in rats. METHODS: The leaf gel powder of the Aloe trigonantha was prepared after the gel gets lyophilized. It was evaluated for wound healing activity topically by incorporating it in a simple ointment base at a concentration of 5% (w/w) and 10% (w/w). Excision and incision models were used for wound healing activity in rats. For the excision wound model, wound contraction and period of epithelialization were evaluated, while wound tensile strength was evaluated using an incision wound model. A Xylene-induced ear edema model and cotton pellet-induced granuloma model were used for anti-inflammatory study. The leaf gel powder of Aloe trigonantha was given orally at a dose of 100, 200, and 400 mg/kg in both models of anti-inflammatory studies. An anti-inflammatory effect was measured by reduction of ear edema weight and reduction of wet exudate and dry granuloma weight in both of xylene-induced ear edema and cotton pellet-induced granuloma models, respectively. RESULTS: Treatment of wounds with ointment containing 5% and 10% (w/w) of the gel exhibited a significantly increased wound contraction rate, shorter epithelialization time, and higher skin breaking strength (p<0.05) compared to controls. Aloe trigonantha leaf gel powder also produced dose-dependent significant reductions (p<0.05) of inflammation compared to control in both models. CONCLUSION: Data obtained from this study collectively indicated that Aloe trigonantha is a potential wound-healing and anti-inflammatory agent in rat models of wound and inflammation which provides evidence for the traditional claim.

Antibacterial and Antifungal Activities of Ethiopian Medicinal Plants: A Systematic Review.

Background: Podoconiosis and lymphatic filariasis are the most common causes of lower limb lymphoedema in the tropics. Many sufferers experience frequent painful episodes of acute bacterial infection. Plant based traditional medicines are used to treat infections in many countries and are culturally established in Ethiopia. Ethiopian medicinal plants found to have antibacterial and antifungal activities were reviewed with the aim of increasing information about the treatment of wound infections in patients with lymphoedema. Methods: This study collates data from published articles on medicinal plants with antibacterial and antifungal activities in Ethiopia. A systematic search of Scopus, EMBASE, PUBMED/MEDLINE and Google Scholar was undertaken. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The protocol was registered on PROSPERO with registration number CRD42019127471. All controlled studies of in vitro antibacterial and antifungal activities were considered. All articles containing the descriptors published until June 28, 2019 were included. The outcome was measured as percent inhibition of microbial growth. For quality assessment of individual in vitro studies, OECD guidelines and the WHO-Good Laboratory Practice (GLP) handbook were used. Results: Seventy-nine studies met the inclusion criteria. A total of 150 plant species and three compounds had been tested against 42 species of bacteria, while 43 plant species had been tested against 22 species of fungus. Conclusion: Materials derived from several Ethiopian medicinal plants have been shown to have promising activity against a variety of bacteria and fungi. Those derived from Azadiractha indica A. Juss. and Lawsonia inerms L. are the most extensively studied against a wide range of gram-negative and positive bacteria, and fungal species.

Systematic review of Ethiopian medicinal plants used for their anti-inflammatory and wound healing activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Plant materials are used worldwide as complementary and alternative therapeutics for the treatment of various illnesses. In Ethiopia, folk medicines are utilized across a wide range of cultures and settings. Ethiopia has numerous plant species of which around 12% are endemic, making it a rich source of medicinal plants that are potentially important for human wellbeing. AIM OF THE STUDY: The aim of this study was to assess Ethiopian medicinal plants with anti-inflammatory or wound healing activities, in an attempt to compile the information required for further investigation of their potential role in the management of lymphoedema. METHODS: A systematic review protocol was developed according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The protocol for this review was registered on PROSPERO with registration number CRD42019127471. This review considers all controlled in vivo and in vitro anti-inflammatory and wound healing studies evaluating the efficacy and safety of Ethiopian medicinal plants. The search strategy included all articles containing descriptors such as Ethiopia, medicinal plants, herbal products, care, management, lymphoedema, lymphedema, swelling, podoconiosis, elephantiasis, wound, wound healing, inflammation, an anti-inflammatory that were published until June 28, 2019. Outcomes were measured as the percentage of inflammatory and pro-inflammatory cell inhibition, as the percentage of carrageenan-induced oedema (anti-inflammation) inhibition, and the percentage of cell migration and proliferation (wound healing). For quality assessment of individual animal studies, the Risk of Bias tool for animal intervention studies (SYRCLE's RoB tool) criteria were used. For quality assessment of individual in vitro studies, the OECD guidelines and the WHO Good Laboratory Practice (GLP) handbook were used. RESULTS: A total of 46 articles on anti-inflammatory and 17 articles on wound healing properties were reviewed. For the in vivo studies, Swiss albino mice and Wistar rats were used, and the concentration of plant extracts or fractions administered to the lab animals varied considerably. Acetone extract of Vernonia amygdalina showed the fastest anti-inflammatory activity at lower concentrations in carrageenan-induced paw oedema. CONCLUSION: Lawsonia inermis, Azadirachta indica, Achyranthes aspera, and Cuminum cyminum are the most studied plant species in terms of anti-inflammatory activity, while Lawsonia inermis and Azadirachta indica are the most studied ones for wound healing. The most common in vivo techniques used for the anti-inflammatory and the wound healing assays were carrageenan-induced paw oedema, and excision and incision wound models, respectively.

Ethiopian medicinal plants used for their anti-inflammatory, wound healing or anti-infective activities: protocol for systematic literature review and meta-analysis.

OBJECTIVES: Medicinal plants are used globally as alternative medicines in the management of a range of disease conditions and are widely accepted across differing societies. Ethiopia hosts a large number of plant species (>7000 higher plant species), of which around 12% are thought to be endemic, making it a rich source of plant extracts potentially useful for human health. The aim of this review is to evaluate Ethiopian medicinal plants for their anti-inflammatory, wound healing, antifungal or antibacterial activities. METHODS AND ANALYSIS: The guidance of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement will be used. This review will consider all controlled studies of anti-inflammatory and wound healing properties (both in vivo and in vitro) and in vitro anti-infective properties of medicinal plants found in Ethiopia. Data sources will be EMBASE, PubMed/Medline, Scopus and Google Scholar. Guidance documents on good in vitro methods and checklists for reporting in vitro studies will be used for quality assessment of in vitro studies. The risk of bias tool for animal intervention studies (the SYRCLE RoB tool) will be used to assess the validity of studies. The main outcomes will be percent inhibition of inflammation, time of epithelisation and tissue tensile strength in wounds and microbial growth inhibition. ETHICS AND DISSEMINATION: The findings of this systematic review will be disseminated by publishing in a peer-reviewed journal and via conference presentations. Ethical clearance was obtained from the Brighton and Sussex Medical School, Research Governance & Ethics Committee (RGEC) and Addis Ababa University, College of Health Science, Institutional Review Board. PROSPERO REGISTRATION NUMBER: This systematic literature review has been registered with PROSPERO (registration number CRD42019127471).

Antimicrobial susceptibility of bacteria isolated from the infected wounds of patients with lymphoedema in East Wollega, Ethiopia.

BACKGROUND: Lymphoedema is caused by dysfunction of the lymphatic system resulting in accumulation of high-protein content fluid in the interstitial space. To date, the bacteria associated with wound infections of patients with lower limb lymphoedema in Ethiopia have not been studied. This study identified pathogenic bacteria involved in wound infection and assessed antimicrobial susceptibility patterns in patients with lymphoedema in Ethiopia. METHODS: Swab samples were collected from the wounds of patients with lymphoedema and cultured using standard microbiological techniques. Micro-organisms were identified by colony morphology followed by identification and antimicrobial susceptibility testing using the automated VITEK 2 COMPACT Microbial Detection System. RESULTS: Swabs were collected from 103 patients and 84 were culture positive: 44 (52.4%) culture-positive samples showed polymicrobial growth and 40 (47.6%) grew single bacterial isolates. In total, 134 isolates were obtained, of which 26 gram-negative and 12 gram-positive bacterial species were identified. A total of 28/63 (44.4%) gram-negative isolates and 3/57 (5.3%) gram-positive isolates were multiple drug resistant. There was no resistance to ciprofloxacin, moxifloxacin or gentamycin among gram-negative or gram-positive bacteria. CONCLUSION: In this study, many infections were polymicrobial and showed multiple drug resistance. Fluoroquinolones and gentamycin, however, seemed to be effective against bacterial wound infection in this setting.

The quality of care provided to patients with chronic non-communicable diseases: a retrospective multi-setup study in jimma zone, southwest ethiopia.

BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups. METHODS: A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality. RESULTS: Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively. CONCLUSION: The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.