Quality of life and its predictors among clients visiting antiretroviral therapy clinics in Addis Ababa, Ethiopia.

This study assessed the quality of life (QoL) and associated factors among a group of clients visiting ART clinics in Addis Ababa, Ethiopia. A multi-site cross-sectional study was conducted from 1 to 30 August 2020. Adults with HIV and who fulfilled the inclusion criteria were considered. A systematic random sampling technique with proportional size allocation was employed. Data were collected using a modified EQ-5D and EQ-VAS tool. The analysis was done using SPSS version 26. Non-parametric statistical analyses were done using Mann-Whitney U, Kruskal-Wallis and Spearman's correlation tests. A p-value ≤ 0.05 and 95% confidence level were considered for analysis. The majority of the clients were from health centres (58%), were 43 years old or less (54%), and were males (63%). Pain/discomfort and depression/anxiety were the most prominent dimensions in the age group above 43 years. The mean score of EQ-5D index values was 0.87 (SD 0.05; 95% CI 0.86-0.87) and that of EQ-VAS was 81 (SD 15; 95% CI 80-83). About 38% and 43% of the clients showed an altered health state of some degree in functional and current overall status respectively. Comorbidity, history of current substance use, facility type, social support and sleep disturbance showed a statistically significant association with both outcomes. A considerable proportion of clients have altered functional and overall health status, with pain/discomfort and depression/anxiety most affected. Inclusion of multidisciplinary treatments for HIV and the highlighting of psychosocial issues that are likely among this group are warranted.

Prevalence and factors associated with diabetes mellitus and impaired fasting glucose level among members of federal police commission residing in Addis Ababa, Ethiopia.

BACKGROUND: The prevalence of diabetes mellitus and factors associated with it, nowadays, are increasing in alarming rates among different occupational groups. Of these occupational groups are Police officers that, often, are exposed to unique life styles and stressful situations which may lead to diabetes mellitus and other cardiovascular diseases. Due to this reason, the present study was conducted to assess the prevalence and factors associated with diabetes mellitus and impaired fasting glucose level among members of federal police commission residing in Addis Ababa, Ethiopia. METHODS: A cross-sectional study design was conducted from April to May 2015. Multistage and systematic random sampling techniques were employed to select the study participants. The study population was federal police commission members living in Addis Ababa and served for at least a year. The data were collected using structured questionnaire, physical examinations and blood samples, based on the WHO stepwise approach. Data were entered in to SPSS version 20.0 and descriptive statistics and logistics regression were used for analysis. RESULTS: Out of the 1003 eligible subjects, 936 (93.3%) police officers have participated in this study. The prevalence of overall impaired glucose homeostasis (IGH) was 120 (13%) of which 47 (5%) were diabetes and 73 (8%) were impaired fasting glucose. Whereas police rank, history of first degree relative who suffered from diabetes, hypertension and waist hip ratio showed a statistical significance with prevalence of diabetes mellitus, age, family history, hypertension, BMI and waist hip ratio were found to be associated with impaired fasting glucose. CONCLUSION: The study identified a high prevalence of IGH among the police officers. A priority should be given on preventive strategies of diabetes mellitus, as that of communicable diseases, by Federal Police Commission Health Service Directorate, Federal Ministry of Health and other concerned partners.

Validation of the Amharic version of perceived access to healthcare services for patients with cervical cancer in Ethiopia: A second-order confirmatory factor analysis.

BACKGROUND: Accessing healthcare services is a multifaceted phenomenon involving various elements, encompassing the demand, identification, reach, and utilization of healthcare needs. The literature offers methods for capturing patients' perceptions of healthcare access. However, to accurately measure patient perceptions, it is imperative to ensure the validity and reliability of such instruments by designing and implementing localized language versions. AIM: The primary aim of this study was to validate the Amharic version of the perceived access to health-care services among patients diagnosed with cervical cancer in Ethiopia. METHOD: A cross-sectional study was conducted among cervical cancer patients at oncology centers in Addis Ababa, Ethiopia. A consecutive sampling approach was used and data collection took place from January 1 to March 30, 2023. Following initial validation and pretesting, a KoboCollect mobile phone application was employed for data collection. Subsequently, the collected data underwent cleaning in Microsoft Excel and analysis through Amos software v.26 and R programming. Various validity and reliability tests, such as content validity, convergent validity, face validity, divergent validity, known-group validity, and reliability tests, were executed. A second-order confirmatory factor analysis was developed to calculate incremental model fit indices, including CFI and TLI, along with absolute measures, namely SRMR and RMSEA. RESULTS: A total of 308 participants were involved in the study, with 202 (65.6%) being patients referred from outside Addis Ababa. The initial evaluation of content validity by expert panels indicated that all criteria were met, with a CVR range of 0.5 to 1, I-CVI values ranging from 0.75 to 1, an S-CVI value of 0.91, and face validity values ranging from 2.4 to 4.8. The internal consistency of items within the final constructs varied from 0.76 to 0.93. Convergent, known-group, and most divergent validity tests fell within acceptable fit ranges. Common incremental fit measures for CFI and TLI were achieved with corresponding values of 0.95 and 0.94, respectively. The absolute fit measures of SRMR and RMSEA were 0.04 and 0.07, indicating good and moderate fit, respectively. CONCLUSION: The study indicated a high internal consistency and validity of items with good fit to the data, suggesting potential accuracy of the domains. A five-domain structure was developed which enables adequate assessment of perceived access to health-care services of patients with cervical cancer in Ethiopia. We suggest that the tool can be utilized in other patient populations with a consideration of additional constructs, such as geographic accessibility.

Access to advanced healthcare services and its associated factors among patients with cervical cancer in Addis Ababa, Ethiopia.

Objective: This study aimed to assess the extent of access to healthcare services, perception and associated factors among patients with cervical cancer in Addis Ababa, Ethiopia. Methods: A facility-based cross-sectional study was conducted from 01 July through 30 August 2023 at two tertiary hospitals. Cases with histopathologic and clinical confirmation of cervical cancer were enrolled using a consecutive sampling technique. Data was collected through a validated questionnaire administered by interviewers using the KoboCollect application. Subsequently, the collected data underwent analysis using Statistical Sciences for Social Sciences (SPSS) version 26.0. Bivariable and multivariable regression models were performed at p ≤ 0.2 and p<0.05 statistical significance, respectively. Results: A total of 391 patients were enrolled in the study. Health facilities were accessible for obtaining general medical services (56.5%), drugs (57.3%), laboratory diagnosis services (57.0%), imaging diagnosis services (56.8%), and radiotherapy services (55.8%) of the patients. Cost of services was affordable only in 11.5% of the cases. Essential anticancer medicines were out of stock for 229 (58.6%) of the patients during the past three months. About two-thirds of the patients have a good perception of access to healthcare services. In multivariable binary logistic regression, admission to the inpatient (AOR: 0.20, 95% CI: 0.06-0.67), joblessness (AOR: 0.19, 95% CI: 0.08-0.46), lower level of income to the extreme poverty line (3567ETB)(64.9 USD) (AOR: 0.19, 95% CI: 0.10-0.35), no CBHI coverage (AOR: 4.16, 95% CI: 1.76-9.85), having social support (AOR: 3.80; 95% CI: 1.96-7.41), and poor dietary practice (AOR: 2.36, 95% CI: 1.28-4.35) were found to have a statistically significant association with perceived good access to healthcare services. Conclusion: Only close to a half of the patients with cervical cancer, in Addis Ababa, have adequate access to healthcare services. Nearly two-thirds of the patients reported perceived good access to the services. Many factors were found to show a statistically significant association with patients' perceived access to healthcare services.

Thyroid Malignancy in Patients Who Underwent Thyroidectomy for Multinodular Goiter and Solitary Thyroid Nodule.

PURPOSE: Worldwide, incidence of thyroid malignancy is increasing. The purpose of this study was to evaluate the pattern and magnitude of nodule types. METHODS: A cross-sectional retrospective study was performed at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, among patients who underwent thyroidectomy from May 2018 to June 2022. Data were extracted using a structured format. Descriptive statistics were performed using SPSS version 26 software. Results were presented in terms of percentages and frequencies. RESULTS: During a 4-year period, 1,476 patients had thyroidectomies and histopathologic information of 212 malignant cases was studied. Within multinodular goiter (MNG), thyroid cancer accounted for 69.8% (n = 148) of patients, whereas in solitary nodules, it accounted for 30.2%. From the total, 160 participants (75.5%) were female, and the female:male ratio was 3.1 (mean, 41.72; ± standard deviation [SD], 16.44) years, and age range of 12-88 years versus men, who have a mean of 44.71 (±SD, 14.91) years and an age range of 21-78 years. The mean age of male cases with solitary nodule and MNG was 40.6 and 46.5 years, respectively. The most frequent cancer in both types of nodules, accounting for 59% of patients, was papillary carcinoma, which was found in 64% of solitary nodules and 57.4% of multinodular nodules. Overall, 14.1% of tumors had multiple centers (17.4% in multinodular nodules and 6.9% in solitary nodules). In 7.1% of patients, microcarcinoma (<1 cm) was found, with papillary carcinoma accounting for 91.7% of the total. CONCLUSION: Compared with men, women with cancer typically manifested at a younger age. Males with malignancy in solitary nodules had a lower mean age than those with MNGs. The most frequent and significant cause of multicentric presentation is papillary carcinoma.

Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis.

Objective: To compare mifepristone plus a misoprostol-combined regimen with misoprostol alone in the medical abortion of first trimester pregnancy. Methods: An internet-based search of available literature was performed using text words contained in titles and abstracts. PubMed/Medline, Cochrane CENTRAL, EMBASE, and Google scholar were used to locate English-based articles published until December 2021. Studies fulfilling the inclusion criteria were selected, appraised, and assessed for methodological quality. The included studies were pooled for meta-analysis, and the results were presented in risk ratio at a 95% confidence interval. Findings: Nine studies comprising 2,052 participants (1,035 intervention and 1,017 controls) were considered. Primary endpoints were complete expulsion, incomplete expulsion, missed abortion, and ongoing pregnancy. The intervention was found to more likely induce complete expulsion irrespective of gestational age (RR: 1.19; 95% CI: 1.14-1.25). The administration of misoprostol 800 mcg after 24 h of mifepristone pre-treatment in the intervention group more likely induced complete expulsion (RR: 1.23; 95% CI: 1.17-1.30) than after 48 h. The intervention group was also more likely to experience complete expulsion when misoprostol was used either vaginally (RR: 1.16; 95% CI: 1.09-1.17) or buccally (RR: 1.23; 95% CI: 1.16-1.30). The intervention was more effective in the subgroup with a negative foetal heartbeat at reducing incomplete abortion (RR: 0.45; 95% CI: 0.26-0.78) compared with the control group. The intervention more likely reduced both missed abortion (RR: 0.21; 95% CI: 0.08-0.91) and ongoing pregnancy (RR: 0.12; 95% CI: 0.05-0.26). Fever was less likely to be reported (RR: 0.78; 95% CI: 0.12-0.89), whereas the subjective experience of bleeding was more likely to be encountered (RR: 1.31; 95% CI: 1.13-1.53) by the intervention group. Conclusion: The review strengthened the theory that a combined mifepristone and misoprostol regimen can be an effective medical management for inducing abortions during first trimester pregnancy in all contexts. Specifically, there is a high-level certainty of evidence on complete expulsion during the early stage and its ability to reduce both missed and ongoing pregnancies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134213, identifier CRD42019134213.

Indications, types, and diagnostic implications of prenatal genetic testing in Sub-Saharan Africa: A descriptive study.

OBJECTIVE: To describe indications, test types, and results of prenatal diagnostic genetic amniocentesis among Ethiopian pregnant women. METHODS: This study was a descriptive study on prenatal diagnostic genetic testing among Ethiopian pregnant women with certain indications and it was conducted at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia) from January 2017 to April 2023. Data on sociodemographic characteristics, genetic testing indications, types, and results were collected electronically. Data were analysed using SPSS version 23. RESULTS: A total of 159 cases were analysed. The commonest indication for genetic testing among the study subjects was major fetal structural anomalies identified on specialized prenatal anatomic scanning of the index pregnancy detected in 71(44.7%) cases. Down syndrome and Edward syndrome were the commonest genetic aberrations detected accounting for 6.3% (10/159) and 4.4% (7/159), respectively. Among the rare genetic aberration detected were Di-George syndrome (0.6%) and Duchenne muscular dystrophy (0.6%). CONCLUSION: Findings of our study underscore the importance of diagnostic prenatal testing in a Sub-Saharan Africa setting, as common (trisomy 21&18) and rare genetic defects were identified using this important prenatal diagnostic testing. Considering the implications of detecting chromosomal abnormalities for future counselling and care, carrier state in parents for some chromosomal anomalies, and planning post-natal management of some abnormalities that are associated with aneuploidies (notably cardiac anomalies), initiation of diagnostic prenatal genetic testing service at tertiary public health facilities should be acted up on.

Adherence to Antiretroviral Medications Among People Living With HIV in the Era of COVID-19 in Central Ethiopia and Perceived Impact of the Pandemic.

AIM: This study assessed the level of adherence to antiretroviral drugs and the associated factors among clients who have a follow-up at public health facilities in central Ethiopia. METHOD: A multi-site cross-sectional study was conducted from August 1-30, 2020 at seven public health institutions. A systematic random sampling method was used to recruit 385 participants. Data was collected using a structured interviewer-administered questionnaire. Analysis was done using descriptive statistics, and binary logistic regression model. The OR with its 95% C.I was employed to present analytic outputs. Statistical significance for the multivariable model was considered at p ≤ 0.05. RESULTS: Of the 371 participants, the majority were females (233, 62.8%), attended health centers (215, 58.0%), and were married (173, 46.6%). Eighty-nine (89, 24.0%) of the participants have at least one comorbidity. About 72 (19.0%) and 50 (13.5%) of the respondents stated that the COVID-19 has posed challenges on their follow-ups and availability of medications respectively. Nearly a half of the people living with HIV and comorbid T2DM or hypertension (29, 48.0%) reported that they had encountered an increase in the price of medications compared to the pre-COVID-19 times. About half of the respondents in the study setting have perfect adherence to antiretroviral therapy (ART) (200, 54.0%). Basic education (aOR = 3.02: 95% CI: 1.57-5.80), marriage (aOR = 2.27: 95% CI: 1.24-4.15), attendance to a health center (aOR = 0.59: 95% CI: 0.36-0.98) and sleep disturbance (aOR = 0.47: 95% CI: 0.26-0.84) showed a statistically significant association with adherence to ART. CONCLUSION: About half of the respondents in the study settings have perfect adherence to their ART medications. As multiple factors interplay in the success rate of adherence to ART, stakeholders should place and strengthen practices, such as active follow-up and tracing of cases, ensuring medication affordability (access and low pricing), and psycho-social support to patients.

Association between delayed initiation of treatment indications and survival in patients with cervical cancer: A systematic review and meta-analysis protocol.

BACKGROUND: Cervical cancer is a growing public health problem globally. Despite the availability of management options, the progression of the disease as a function of waiting time may challenge the effort to attain a desired outcome. There is a conflicting report on the role of waiting time to initiate an appropriate treatment in improving patients' survival. OBJECTIVE: This review aims to evaluate the association between delayed time to initiate any treatment indication with survival in patients with cervical cancer. METHODS: An internet-based literature search will be performed using text words, MESH terms and truncated words in databases, namely MEDLINE, Cochrane CENTRAL, EMBASE, Web of Science and Scopus. Grey literature searches in Google Scholar, Networked Digital Library of Theses and Dissertations (NDLTD) and Dissertations and Theses Global will be made. All articles published until 30th of December 2021 on human subjects will be searched without a language restriction. Studies which fulfil the inclusion criteria will be screened in full reading, selected, appraised and assessed for methodological quality by two independent reviewers. Data on participants, study methods, interventions, and outcomes will be abstracted. Included studies will be pooled for meta-analysis. Microsoft-Excel and R packages will be employed to carry out the statistical analysis. Heterogeneity will be assessed using Cochrane Q statistic, Tau2, and I2. Results will be reported as a function of 4-week delay in treatment initiation and the corresponding hazard ratio (HR) at 95% confidence interval. Statistical significance will be considered at P<0.05. TRIAL REGISTRATION: PROSPERO registration number: CRD42022299689.

Depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia.

Evidence suggests that quarantine might have a wide-ranging, substantial, and long-lasting negative psychological impact especially when the necessary preventive measures are not taken. This study assessed the prevalence and associated factors of depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia. A community-based cross-section study was conducted among individuals under quarantine from June 5 to July 5, 2020, in Addis Ababa, Ethiopia. The hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety. Binary logistic regression analysis (multivariate analysis) was used to identify the potential determinants of depression and anxiety. A total of 297 participants were included in the study which makes the response rate 90.8%. The prevalence of anxiety, depression, and co-morbid anxiety and depression were 21.5%, 70.7%, and 15.8% respectively. In our multivariable analyses, stressful life events (AOR 2.61, 95%CI (1.46, 4.67)), spent time on sleeping (AOR 1.97, 95% CI (1.08, 3.62)), and believing that COVID-19 could be prevented by wearing a glove (AOR 0.30, 95% CI (0.11, 0.81)) showed a statistically significant association with anxiety, whereas being married (AOR 2.67, 95% CI (1.37, 5.22)), had stressful life event in the last six months (AOR 1.44, 95% CI (1.44, 5.25)) and spending of time by sleeping during the quarantine (AOR 1.97, 95% CI (1.42, 6.19)) predicted depression. In conclusion, the current study result indicated that a considerable proportion of individuals who were under quarantine during the COVID-19 pandemic have experienced psychological disturbances, such as anxiety and depression. The results suggest that attention needs to be given to mitigate mental health problems in the quarantined population during the COVID-19 outbreak.

Health-Related Quality of Life of Patients with Type 2 Diabetes Mellitus and Hypertension in Addis Ababa, Ethiopia.

Background: The aim of this study was to assess the health-related quality of life of patients with T2DM and hypertension attending public health facilities in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from 1st through 30th August 2020 at the selected institutions. Health facilities were chosen purposively based on patient load. Participants were drawn after proportional to size allocation. A translated EQ-5D-3L, and EQ-VAS instrument was used to collect the data. Analysis was done using SPSS v.26.0. Both parametric and non-parametric models were applied in the analysis. Results: Of the 409 participants included, the majority were in the age group of 46-60 (36.0%), females (56.0%), from hospitals (54.8%), jobless (25.4%), and married (63.3%). Over two-thirds of the patients reported no problems with self-care, usual activity, and depression/anxiety. All dimensions showed an increasing proportion of moderate to severe problems in the age group beyond 45. Facility type, comorbid condition and age showed a statistically significant score difference for QoL. The overall prevalence of any problem was 59.0%. Education level, visit to a health center, and marriage showed lower odds of affected HRQoL whereas, lower monthly income and presence of comorbidities were opposite. Conclusion: HRQoL of patients in the study settings was suboptimal and below the general population. Attributes, such as education, facility type, marital status, income level, and comorbid status have a statistically significant association with HRQoL. Arrangement of a safe and quality health services is paramount, especially, during the COVID-19 pandemic.

The Trend of Health Service Utilization and Challenges Faced During the COVID-19 Pandemic at Primary Units in Addis Ababa: A Mixed-Methods Study.

INTRODUCTION: The COVID-19 pandemic has imposed an extraordinary challenge to the health and socio-economic facet of nations globally. Health facilities have encountered tremendous challenges to contain service delivery at all levels. This study aims to assess the trend of health service utilization and challenges faced during the COVID-19 pandemic at primary units in Addis Ababa, Ethiopia. METHOD: A multi-facility-based cross-sectional study was conducted in Addis Ababa between 1 and 30 of August 2020. A mixed-methods design was employed, and both quantitative and qualitative data were collected at 5 health centers. Facilities were selected randomly from 5 sub-cities while interviewees were recruited purposively. A structured questionnaire was used to collect quantitative data from the HMIS units of each facility. Qualitative data was collected using a semi-structured key-informant interview guide. Quantitative data were analyzed using Microsoft Excel, and a 10-month time-series trend was generated. For the qualitative data, qualitative data analysis (QDA-minor) software was used. RESULTS: Time-series comparison of the pre-COVID-19 era loads with the COVID-19 period showed that there was an extensive disparity in the service delivery capacity of the health facilities. A huge drop in inpatient flow of some units such as PICT, VCT, FP services, and most sub-units of the OPDs has been recorded following the COVID-19 outbreak. The key-informant interview also revealed that such challenges, as fear of infection and stigma, poor infrastructure, challenges related to human resources, and challenges related to the supply of prevention and treatment inputs were prominently encountered at the health centers. CONCLUSION: The COVID-19 wave has negatively impacted many service delivery points in the study settings. The presence of weak infrastructure, lack of PPEs, fear of the infection and stigma, and staff workload have been mentioned as the predominant challenges faced during the outbreak. Health authorities should arrange multifaceted supports to ensure uninterrupted service delivery at primary healthcare units.

Has the COVID-19 Pandemic Impacted Healthcare Service Uptake at Hospitals in Addis Ababa?

BACKGROUND: The novel coronavirus has caused a profound impact on service utilization or delivery practices of health facilities globally. This study aims to evaluate the trend of health service utilization before and during the COVID-19 pandemic at selected hospitals in Addis Ababa, Ethiopia. METHOD: A facility-based cross-sectional study was conducted from 1st through 30th of August 2020 using a mixed-methods design. For the quantitative evaluation, ten months' time-series data, starting from September 2019 to July 2020 was retrieved from the HMIS unit of each hospital. Microsoft excel v.2010 was used to analyze quantitative data. Qualitative data was collected using a semi-structured key-informant interview guide and analyzed using QDA-minor software. RESULTS: Twelve service delivery departments were included in the evaluation of each hospital. Of all, OPD, ART, VCT, PICT, and EPI services showed major disruption in both hospitals following the COVID-19 outbreak. Noticeable change was recorded in March and April for most units. Qualitative exploration showed multiple challenges namely; inadequate supply, poor infrastructure, low service utilization, staff workload, increased risk, poor job satisfaction of health professionals, and perception or attitude-related problems to be persistent at the hospitals. CONCLUSION: Main service delivery units of the hospitals, such as OPD, ART, VCT, PICT, and EPI have faced massive depression during the COVID-19 pandemic. The facilities had also encountered multifaceted challenges most from the internal environment. Immediate action should be in place to halt the negative impacts of the pandemic on the identified spots and challenges.

Providers' View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present.

INTRODUCTION: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul's Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers' views and experiences of the past to present at this center. METHODS: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. RESULT: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. CONCLUSION AND RECOMMENDATION: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

Knowledge, Perception and Practice towards the Risks of Excessive Weight Gain during Pregnancy among Pregnant Mothers at Myung Sung Christian Medical General Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Being overweight and obese represents a severe public health deterioration affecting all population in general and vulnerable groups, such as pregnant women in particular. This study aimed to assess the knowledge, perception and practice towards the risks of excessive weight gain during pregnancy among pregnant mothers at Myung Sung Christian Medical General Hospital. METHODS: An institution based cross-sectional study was conducted from July to August, 2019. A systematic random sampling technique was employed to select participants. A total of 176 respondents were included in the study. Data was collected using interviewer administered questionnaire, observation checklist, and measurements of weight and height. Statistical product and service solution version 20.0 was employed for analysis. Descriptive statistics, using tables and charts, was used to present results. RESULTS: Gestational diabetes mellitus (83.5%) and high blood pressure (80.7%) were the major known risks associated with excessive weight gain during pregnancy. Based on the mean score, 96(54.5%) had poor knowledge while 80(45.5%) had good knowledge about the risks of excessive weight gain. The majority (92.0%) overweight and all obese pregnant mothers did not know their actual weight status. Similarly, 134(76.1%) of the study participants were not engaged in regular physical exercise during the current pregnancy. CONCLUSION: This study revealed that pregnant mothers attending in Korean General Hospital were generally poorly knowledgeable on the risks of excessive weight gain during pregnancy, had poor perception on current weight status and poor practices on their weight gain management. Facility based education and community awareness creation should accompany antenatal care services.

Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic.

OBJECTIVE: This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic. METHODS: A multi-site cross-sectional design was conducted from 1st through 30th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence. RESULTS: A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36-0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02-2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13-3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52-88.05) predicted high odds of poor adherence. CONCLUSION: Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.

Barriers to uptake of community-based health insurance in sub-Saharan Africa: a systematic review.

In the past two decades, community-based Health Insurance (CBHI) is expanding in most of sub-Saharan African countries with the aim of improving equitable access to health services for the informal sector population. However, population enrolment into CBHI and membership renewals thereafter remains stubbornly low. The purpose of this systematic review is to generate an evidence to better understand barriers to uptake of CBHI in sub-Saharan African countries. We systematically searched for relevant studies from databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychInfo, ProQest, Excerpta Medica dataBASE (EMBASE) and Africa-Wide Information. The search strategy combined detailed terms related to (i) CBHI, (ii) enrolment/renewal and (iii) sub-Saharan African countries. A narrative synthesis of findings was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this systematic review was registered with International Prospective Register of Systematic Reviews (PROSPERO) (ref: CRD42020183959). The database search identified 4055 potential references from which 15 articles reporting on 17 studies met the eligibility criteria. The findings revealed that barriers to uptake of CBHI in sub-Saharan Africa were multidimensional in nature. Lack of awareness about the importance of health insurance, socio-economic factors, health beliefs, lack of trust towards scheme management, poor quality of health services, perceived health status and limited health benefit entitlements were reported as barriers that affect enrolments into CBHI and membership renewals. The methodological quality of studies included in this review has been found to be mostly suboptimal. The overall findings of this systematic review identified major barriers of CBHI uptake in sub-Saharan African countries which may help policymakers to make evidence-informed decisions. Findings of this review also highlighted that further research with a robust methodological quality, depth and breadth is needed to help better understand the factors that limit CBHI uptake at individual, societal and structural levels in sub-Saharan Africa.

Assessment of Patient Counseling on Dispensing of Medicines in Outpatient Pharmacy of Tikur-Anbessa Specialized Hospital, Ethiopia.

BACKGROUND: Patients' care when dispensing of Medicines could be ensured through the delivery of drug information either orally or in written form. Pharmacists are expected to ascertain that patients or caregivers have gained clear and complete information. The objective of this study was to assess patient counseling during dispensing of medicines and associated factors in Tikur-Anbessa Specialized Hospital. METHOD: A cross sectional study was conducted to assess patients' counseling and a convenient sampling technique was employed to select study participants. Data was collected using a structured questionnaire and observation checklist and, analyzed by using SPSS version 20. Descriptive statistics and odds ratio were used to present study results. RESULTS: A total of 286 respondents were included in this study. Most (93.7%; 94.4%; 91%) of the respondents were told the drug unit dose, frequency of administration and duration of therapy respectively. Less than a third of the patients received information on drug-drug interactions, storage of medications and side -effects. None of the patients were told what to do on missed dose and, none were asked back to repeat their understanding. Three fourth of the patients reported that they were satisfied with the counseling services provided. Females were more likely to be satisfied than males whereas, level of education showed a negative association with pharmacist counseling services. CONCLUSION: Drug dose, frequency of administration and duration of therapy were the most frequently delivered information to patients. Gender and level of education have significant association with medication counseling service in the study setting.

Treatment Pattern and Factors Associated with Blood Pressure and Fasting Plasma Glucose Control among Patients with Type 2 Diabetes Mellitus in Police Referral Hospital in Ethiopia.

BACKGROUND: The prevalence of T2DM in Ethiopia is on the rise according to certain studies. Appropriate management approaches are required to achieve desired goals of therapy in the clinical setup. This study was conducted to assess the treatment pattern and the factors associated with BP and FPG control among patients with T2DM in Federal Police Referral Hospital. METHOD: An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A Systematic random sampling technique was employed in selecting the study participants. Data was collected using semi-structured interview and visiting medication records. SPSS version 20 was used for data analysis. RESULTS: Out of a total of 414 participants who fulfilled the inclusion criteria, 361 were successfully interviewed and considered for further analysis. Target BP level was achieved in 206(57.1%) of the patients, whereas the proportion of hypertensive diabetics who attained the recommended BP target was 19.4% (n=40). Of the 361 participants who were checked about their current FPG level, only 142(39.3%) were found to be <130mg/dl. However, 87(24.1%) participants were found to control both BP and FPG levels. Gender, military status, comorbidity, type of therapy and dietary adherence showed a statistically significant association with outcome variables. CONCLUSION: The proportion of participants with T2DM who achieved target BP, FPG or both was suboptimal. A comprehensive approach that involves targeted education on self-management strategies, individualized treatment plans, and continuous evaluation of treatment outcomes should be practiced.

Factors contributing to non-adherence with treatment among TB patients in Sodo Woreda, Gurage Zone, Southern Ethiopia: A qualitative study.

Poor adherence by tuberculosis (TB) patients to their medication contributes not only to the worsening of their TB situation but also paves a way for incidence of drug resistance. This study, hence, aims to explore factors contributing for non-adherence of TB treatment among TB patients in Sodo Woreda, Gurage Zone, Southern Ethiopia. A qualitative study, which included 22 in-depth interviews from four health centers and seven health posts, was conducted from February 25 to April 27, 2014. Although the drugs were given free of charge, many patients were unable to adhere to their treatment because of one or a combination of the following factors; lack of adequate food, poor communication between healthcare providers and patients, beliefs in traditional healing system, unavailability of the service in nearby health facilities, side-effect and pill burden of the drugs, stigma and discrimination. The patients take their anti-TB medications under difficult circumstances and experienced a wide range of interacting factors. This, in turn, has resulted for non-adhered treatment taking behavior by many patients. Health professionals and policy makers should be aware of such factors and initiate sustained educational campaigns directed towards all parties in the study area to obtain a good success with TB treatment.