Publications by authors named "Ginenus Fekadu"

46 Publications

Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis.

Public Health Rev 2021 9;42:1603969. Epub 2021 Apr 9.

Department of Nursing, Institute of Health Science, Wollega University, Nekemte, Ethiopia.

Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes. Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07-21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14-0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34-0.77) were found to have significant association with CKD. The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.
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http://dx.doi.org/10.3389/phrs.2021.1603969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377585PMC
April 2021

Cost-effectiveness of video-observed therapy for ambulatory management of active tuberculosis during COVID-19 pandemic in a high-income country.

Int J Infect Dis 2021 Oct 21. Epub 2021 Oct 21.

School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address:

Objective: The coronavirus-2019 (COVID-19) pandemic caused suspension of directly observed therapy (DOT) for active tuberculosis (TB). We aimed to estimate the outcomes of pandemic-related DOT suspension and cost-effectiveness of VOT during the pandemic.

Methods: A decision-analytic model was constructed to project outcomes of adult patients with active TB from the perspective of US healthcare provider. Two model-based analyses were conducted: (1) before (with DOT) and during (with self-administered therapy (SAT)) the pandemic; (2) VOT versus SAT during the pandemic. Primary outcome measures were direct medical costs and disability-adjusted life years (DALYs).

Results: In base-case analysis, the care during pandemic (with SAT) increased both cost (by USD285) and DALYs (by 0.2155) per patient. VOT reduced DALY (by 0.4870) and saved cost (by USD1,797). In probabilistic sensitivity analysis, the care during pandemic (with SAT) increased DALYs in 100% of 10,000 simulations and increased cost in 55.52% of the time. The care with VOT reduced DALYs and cost in 99.7% and 68.79% of the time, respectively. The probability of VOT to be cost-effective was 99.4% at the willingness-to-pay threshold of 50,000 USD/DALY.

Conclusion: DOT suspension during pandemic worsened treatment outcomes. VOT was cost-effective for active TB care in outpatient setting.
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http://dx.doi.org/10.1016/j.ijid.2021.10.029DOI Listing
October 2021

Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study.

Front Cardiovasc Med 2021 17;8:707700. Epub 2021 Sep 17.

Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia.

Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A -value < 0.05 was considered statistically significant. The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.
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http://dx.doi.org/10.3389/fcvm.2021.707700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484752PMC
September 2021

The pharmacotherapeutic management of pulmonary tuberculosis: an update of the state-of-the-art.

Expert Opin Pharmacother 2021 Aug 21:1-10. Epub 2021 Aug 21.

School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.

Introduction: Pulmonary tuberculosis (TB) remains an important global health challenge of the 21st century, and the emerging resistance against anti-TB drugs is still a growing concern. And while there was a significant cumulative reduction in the incidence of TB between 2015 and 2019, 2.8% of all TB cases in 2019 were reported to be drug resistant.

Area Covered: This review provides the reader with an update on pharmacotherapy for patients with TB susceptible or resistant to drug therapy. The authors also include promising investigational drugs herein. Finally, the authors share with the reader their expert opinions on the current state of the art and their future perspectives.

Expert Opinion: The current pharmacotherapeutic management aims to enhance favorable treatment outcomes and reduce treatment-related adverse events. One approach is to use shorter and all-oral regimens for eligible patients. Traditional longer regimens for most patients are also optimized to lower incidence of treatment failure and serious adverse events.
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http://dx.doi.org/10.1080/14656566.2021.1967930DOI Listing
August 2021

Impact of COVID-19 pandemic on chronic diseases care follow-up and current perspectives in low resource settings: a narrative review.

Int J Physiol Pathophysiol Pharmacol 2021 15;13(3):86-93. Epub 2021 Jun 15.

School of Pharmacy, Institute of Health Sciences, Wollega University Nekemte, Ethiopia.

Coronavirus is a respiratory disease that spreads globally. The severity and mortality risk of the disease is significant in the elderly, peoples having co-morbidities, and immunosuppressive patients. The outbreak of the pandemic created significant barriers to diagnosis, treatment and follow-up of chronic diseases. Delivering regular and routine comprehensive care for chronic patients was disrupted due to closures of healthcare facilities, lack of public transportation or reductions in services. The purpose of this narrative review was to update how patients with chronic care were affected during the pandemic, healthcare utilization services and available opportunities for better chronic disease management during the pandemic in resources limited settings. Moreover, this review may call to the attention of concerned bodies to make decisions and take measures in the spirit of improving the burden of chronic diseases by forwarding necessary recommendations for possible change and to scale up current intervention programs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310882PMC
June 2021

Men's involvement in family planning service utilization among married men in Kondala district, western Ethiopia: a community-based comparative cross-sectional study.

Contracept Reprod Med 2021 Jun 1;6(1):16. Epub 2021 Jun 1.

Department of Pharmacy, Institute of Health Sciences, Wollega University, P.O Box:395, Nekemte, Oromia, Ethiopia.

Background: Men involvement is one of the important factors in family planning (FP) service utilization. Their limitation in the family planning program causes a decrease in service utilization as well as the discontinuation of the method which eventually leads to failure of the program. Family planning uptake is low but there is no enough study conducted on the parameters of husband involvement in Ethiopia. Hence, this study focused to assess men's involvement in family planning service utilization in Kondala district, western Ethiopia.

Methods: Community based comparative cross-sectional study design was employed in urban and rural kebeles of kondala district using quantitative and qualitative data collection tools. The multi-stage sampling method was employed to select 370 participants from each of the four urban and eight rural kebeles. Logistic regression analysis was used to identify variables that affect husbands' involvement in FP service utilization. Statistical significance was declared at p-value of < 0.05 with 95% confidence interval (CI) and strength of association was reported by odds ratio (OR).

Results: The study showed that 203(55.6%) men from urban and 178(48.8%) from rural were involved in FP service utilization. The median age of the respondents was 36+ 8.5 years (IQR: 27.5-44.5) in urban and 35 years (IQR: 25-45) in rural parts. Respondents who had four and above current children (AOR = 3.25, 95%CI = 1.51-7.02) in urban and (AOR = 4.20, 95%CI = 1.80-9.79) in rural were positively associated with men's involvement in FP service utilization. In the urban setting, being government employee (AOR = 2.58, 95%CI = 1.25-5.33), wishing less than two children (AOR = 3.08, 95%CI = 1.80-5.24) and having a better attitude towards FP methods (AOR = 1.86, 95%CI = 1.16-2.99) were positively associated with FP service utilization. While good educational background (AOR = 2.13, 95%CI = 1.02-4.44), short distance from home to health facility (AOR = 2.29, 95%CI = 1.24-4.19) and having better knowledge (AOR = 4.49, 95%CI = 2.72-7.38) were positively associated with men involvement in FP service utilization in the rural area.

Conclusion: Low involvement of men in family planning service utilization was reported in both settings. Factors associated with husbands' involvement were varied between the two setups, except for the current number of children. Future FP program should incorporate infrastructure associated with the health facility, knowledge, and attitudinal factors.
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http://dx.doi.org/10.1186/s40834-021-00160-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167972PMC
June 2021

Knowledge, attitude, and practice of health professionals in Ethiopia toward COVID-19 prevention at early phase.

SAGE Open Med 2021 27;9:20503121211012220. Epub 2021 Apr 27.

Department of Nursing, Institutes of Health Science, Wollega University, Nekemte, Ethiopia.

Introduction: Coronavirus disease (COVID-19) is a potentially lethal disease having significant public health concerns. As the disease is new, nothing has been intervened yet. Therefore, here we show the health worker's knowledge, attitude, and practice toward COVID-19.

Methods: The online cross-sectional study design was conducted from April to May 2020, among Ethiopia health workers. The data were collected online, downloaded by an Excel sheet, and transferred to IBM SPSS version 24. Using questionnaire containing four parts sociodemographic, knowledge, attitude, and practice assessing. Linear logistic regression and binary logistic regression were performed to test the association between the dependent and the independent variables. We reported the 95% confidence intervals of adjusted odds ratios with a statistical significance level at less than 0.05 -values.

Results And Conclusion: A total of 441 health workers were included in this study. The majority of participants were from urban (88.7%), nurses (53.1%), male (88.4%), and have a degree educational level (66.7%). The mean knowledge level of respondents was 10.13 ± 0.057 standard deviation. The majority of respondents had a positive attitude toward control of COVID-19, 88%, and 77% of respondents had confidence that Ethiopia will control COVID-19. Similarly, male (2.746, 95% confidence interval (1.23, 6.02)) and good knowledge level (1.98, 95% confidence interval (1.01, 3.09)) were found to be a determinant for attitude regarding control of COVID-19. Good knowledge level 1.6 (1.02, 2.6), male sex 2.2 (1.07, 4.6), masters 2.33 (1.06, 5.08), and medical doctors 5.99 (1.76, 20.4) to practice wearing a mask when going out of the home. Knowledge, attitude, and practice of the participant health workers are considerable, but may not be enough to control the disease. Sex, age, and profession of the health workers were determinant factors for knowledge about COVID-19. Therefore, training has to be considered for updating health care workers on COVID-19 prevention and controlled at the national level.
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http://dx.doi.org/10.1177/20503121211012220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083007PMC
April 2021

A systematic review of pharmacoeconomic evaluations on oral diarylquinoline-based treatment for drug-resistant tuberculosis: from high to low burden countries.

Expert Rev Pharmacoecon Outcomes Res 2021 Oct 23;21(5):897-910. Epub 2021 Jun 23.

School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong.

: There is a rising global interest in the pharmacoeconomic evaluations of bedaquiline (BDQ), a novel oral diarylquinoline, for treatment of drug-resistant tuberculosis (DR-TB).: This article systematically reviewed publications retrieved from Medline, American Psychological Association-Psychology information, Web of Science, Embase, Scopus, Science direct, Center for Reviews and Dissemination, and CINAHL Complete during 2010-2020 on pharmacoeconomic studies on BDQ for DR-TB treatment. Ten Markov model-based cost-effectiveness analyses identified were conducted in high (n = 4), intermediate (n = 2), and low (n = 4) TB burden countries.: The paucity of model-based health economic analyses on BDQ-containing regimens for DR-TB indicated that further pharmacoeconomic research of BDQ-based regimens, on the aspects of duration of BDQ treatment, types of DR-TB indicated, and settings of regions and health-systems, is highly warranted to inform global cost-effective use of BDQ-based regimens for DR-TB treatment.
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http://dx.doi.org/10.1080/14737167.2021.1925111DOI Listing
October 2021

High Perceived Stigma Among People Living with HIV/AIDS in a Resource Limited Setting in Western Ethiopia: The Effect of Depression and Low Social Support.

HIV AIDS (Auckl) 2021 1;13:389-397. Epub 2021 Apr 1.

Maternal and Child Wellbeing Unit, African Population and Health Research Centre, Nairobi, Kenya.

Background: Antiretroviral therapy (ART) is only one part of a successful range of care among people living with HIV/AIDS (PLWHA). Stigma and low social support are emerging issues worsening the success of ART for PLWHA. This study thus aimed to investigate the level of perceived stigma among PLWHA.

Methods: An institution-based cross-sectional study was conducted in Nekemte, western Ethiopia. A multivariable logistic regression model was used to identify associations between perceived stigma and low social support, depression, and other potential predictor variables using SPSS version 24.0 and adjusted odds ratios (AORs), considering statistical significance at <0.05.

Results: A total of 418 study participants were included in the study, with a response rate of 100%. About 48.6% of PLWHA had experienced perceived stigma, and more than two-fifths had poor social support. The following factors were associated with perceived stigma among PLWHA: age (18-29 years) (AOR=4.88, 95% CI:1.76-13.5), female sex (AOR=2.10, 95% CI 1.15-3.82), <12 months on ART (AOR=2.63, 95% CI 1.09-6.34), depression (AOR=1.86, 95% CI 1.08-3.19), social support (poor: AOR=3.45, 95% CI 1.65-7.23; medium: AOR=2.22, 95% CI 1.09-4.54), and non-disclosure of HIV status (AOR=2.00, 95% CI 1.11-3.59).

Conclusion And Recommendation: The magnitude of perceived stigma among PLWHA was high, highlighting the importance of integrating social and mental health support within standard ART for PLWHA.
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http://dx.doi.org/10.2147/HIV.S295110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021262PMC
April 2021

Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study.

BMC Emerg Med 2021 03 31;21(1):41. Epub 2021 Mar 31.

Department of Pharmacology and Clinical Pharmacy, Collage of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.

Background: Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia.

Methods: A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant.

Results: Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81-7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28-13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55-14.55) were independent predictors of time to in-hospital death among ACS patients.

Conclusion: In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.
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http://dx.doi.org/10.1186/s12873-021-00433-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010978PMC
March 2021

HIV serostatus disclosure and associated factors among HIV positive pregnant and lactating women at Nekemte public health facilities, western Ethiopia.

PLoS One 2021 19;16(3):e0248278. Epub 2021 Mar 19.

School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Disclosure of Human Immune Virus (HIV) serostatus by pregnant and lactating women is crucial for the successful prevention of mother to child transmission of HIV/AIDS. However, little has been studied regarding the prevalence and factors associated with HIV status disclosure among HIV positive pregnant and lactating women in Ethiopia.

Methods: An institution-based cross-sectional study was conducted in the Nekemte Public Health facilities among 380 pregnant and lactating women enrolled in universal antiretroviral therapy (ART) treatment from January 2015-December, 2019. The data were collected by using a checklist, developed from Prevention of Mother to Child Transmission (PMTCT) logbook, ART intake forms, and medical cards of the patients. Epidata version 3.2 was used for data entry, and then the data were exported to STATA version 14 for further analysis. The binary logistic regression model was employed to determine factors associated with the disclosure status among HIV positive pregnant and lactating women. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared when it is significant at a 5% level (p-value < 0.05).

Results: A total of 380 women have participated in the study. Two hundred seventy-six (73.4%) of women had disclosed their HIV status to at least one individual. The study found living in urban (OR = 1.83, 95% CI: 1.04, 3.20), married women (OR = 4.16, 95% CI: 1.87, 9.24), higher educational status (OR = 2.35, 95% CI: 1.31, 5.51), positive HIV status of partner (OR = 2.35, 95%CI: 1.17, 4.70), and being multipara (OR = 4.94, 95% CI: 2.29, 10.66) were independent determinants of HIV status disclosure.

Conclusions: HIV status disclosure among pregnant and lactating women in the study area was sub-optimal. Empowering women through education, encouraging partners for HIV testing, and enhancing active male involvement in HIV treatment and control programs should get due attention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248278PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978369PMC
October 2021

Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: A multicenter prospective observational study.

PLoS One 2021 16;16(3):e0248575. Epub 2021 Mar 16.

Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia.

Background: Drug-related problem (DRP) is an event involving drugs that can impact the patient's desired goal of therapy. In hospitalized patients, DRPs happen during the whole process of drug use such as during prescription, dispensing, administration, and follow-up of their treatment. Unrecognized and unresolved DRPs lead to significant drug-related morbidity and mortality. Several studies conducted in different hospitals and countries showed a high incidence of DRPs among hospitalized patients. Despite the available gaps, there were scanties of studies conducted on DRPs among patients admitted to medical wards in Ethiopia. Therefore, this study assessed the magnitude of drug-related problems and associated factors among patients admitted to the medical wards of selected Southwestern Ethiopian hospitals.

Patients And Methods: A multicenter prospective observational study was conducted at medical wards of Mettu Karl Hospital, Bedele General Hospital and Darimu General Hospital. Adult patients greater than 18 years who were admitted to the non-intensive care unit (ICU) of medical wards and with more than 48 h of length of stay were included. Identified DRPs were recorded and classified using the pharmaceutical care network Europe foundation classification system and adverse drug reaction was assessed using the Naranjo algorithm of adverse drug reaction probability scale. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. Multivariable logistic regression was used to analyze the associations between the dependent variable and independent variables.

Result: Of the 313 study participants, 178 (56.9%) were males. The prevalence of actual or potential DRPs among study participants taking at least a single drug was 212 (67.7%). About 125 (36.63%) patients had one or more co-morbid disease and the average duration of hospital stay of 7.14 ± 4.731 days. A total of 331 DRPs were identified with an average 1.06 DRP per patient. The three-leading categories of DRPs were unnecessary prescription of drugs 92 (27.79%), non-adherence (17.22%) and dose too high (16.92%). The most common drugs associated with DRPs were ceftriaxone (28.37%), cimetidine (14.88%), and diclofenac (14.42%). The area of residence (AOR = 2.550, 95CI%: 1.238-5.253, p = 0.011), hospital stay more than 7 days (AOR = 9.785, 95CI%: 4.668-20.511, p≤0.001), poly pharmacy (AOR = 3.229, 95CI%: 1.433-7.278, p = 0.005) were predictors of drug-related problem in multivariable logistic regression analysis.

Conclusion: The magnitude of drug therapy problems among patients admitted to the medical wards of study settings was found to be high. Therefore, the clinical pharmacy services should be established in hospitals to tackle the DTPs in this area. Additionally, healthcare providers of hospitals also should create awareness for patients seeking care from health facilities of the importance of rational drug usage.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248575PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963049PMC
October 2021

Drug-related problems among patients with infectious disease admitted to medical wards of Wollega University Referral Hospital: Prospective observational study.

SAGE Open Med 2021 22;9:2050312121989625. Epub 2021 Jan 22.

Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia.

Introduction: Drug-related problems can affect the treatment outcomes of hospitalized patients and outpatients that lead to morbidity and mortality. Despite this, there were scanty of studies among patients with infectious diseases in Ethiopia. As the result, this study was tried to assess the magnitude and determinants of drug therapy problems among infectious disease patients admitted to the medical wards of Wollega University Referral Hospital.

Methods: A prospective observational study was conducted from May to August 2019. The prevalence and types of drug- related therapy problems were studied using the Pharmaceutical Care Network Europe Foundation classification system, and adverse drug reaction was assessed by using the Naranjo algorithm. Multivariable logistic regression analysis was used to determine the predictors of drug-related problems, and a significant association was declared if p-value < 0.05.

Result: Of the 172 study participants, 106 (61.6%) were males, and the patient's mean age was 39.1 ± 14.31 years. Over the study period, 123 (71.51%) patients had drug-related problems. Need for additional drug therapy was the widely occurred drug-related problem that accounts for 107 (22.77%), and the most common drug-associated with the drug therapy problem was ceftriaxone (77 (44.77%)). This inappropriate use of ceftriaxone might be due to the preference of physicians to prescribe this broad spectrum antibiotic in which it was prescribed for the majority of the infectious disease etiology. Polypharmacy (adjusted odds ratio (AOR) = 2.505, 95% confidence interval (CI): 1.863-11.131), length of hospital stay ⩾ 7 days (AOR = 4.396, 95% CI: 1.964-7.310), and presence of co-morbidity (AOR = 2.107, 95% CI: 1.185-4.158, p = 0.016) were determinants of drug-related problems.

Conclusion: The magnitude of drug-related problems was found to be high. Hence, the clinical pharmacy service should be established to tackle inappropriate indications, ineffective drug therapy, and adverse drug events in the study area.
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http://dx.doi.org/10.1177/2050312121989625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841694PMC
January 2021

Determinants of preterm birth among women delivered in public hospitals of Western Ethiopia, 2020: Unmatched case-control study.

PLoS One 2021 25;16(1):e0245825. Epub 2021 Jan 25.

School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Worldwide, preterm birth accounts for 1 million deaths of infants each year and 60% of these deaths occur in developing countries. In addition to the significant health consequences on the infant, preterm birth can lead to economic costs. There was a lack of study in western Ethiopia, and most of those studies conducted in other parts of a country were based on card review with a cross-sectional study design. The risk factors of preterm birth may vary from region to region within the same country due to variation in socioeconomic status and health care service coverage. Therefore, this study aimed to identify determinants of preterm birth in western Ethiopia.

Methods: An institutional-based case-control study was conducted from February 15 to April 15, 2020, in western Ethiopia. The eligible 188 cases and 377 controls were randomly selected for this study. Cases were women who gave birth after 28 weeks and before 37 completed weeks of gestation, and controls were women who gave birth at and after 37 weeks of gestation from the first day of the last normal menstrual period. Data were collected by a structured interviewer-administered questionnaire. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Multivariable logistic regression was used to identify determinants of preterm birth at P-value <0.05.

Results: From a total of 565 eligible participants, 516 (172 cases and 344 controls) participated in this study with a response rate of 91.3%. The result of the multivariable analysis shows that mothers who developed pregnancy-induced hypertension (AOR = 3.13, 95% CI; 1.78, 5.50), only one time ANC visits (AOR = 5.99, 95% CI; 2.65, 13.53), experienced premature rupture of membrane (AOR = 3.57, 95% CI; 1.79, 7.13), birth interval less than two years (AOR = 2.96, 95% CI; 1.76, 4.98), developed anemia during the current pregnancy (AOR = 4.20, 95% CI; 2.13, 8.28) and didn't get dietary supplementation during the current pregnancy (AOR = 2.43, 95% CI; 1.51, 3.91) had statistically significant association with experiencing preterm birth.

Conclusion: Antenatal care service providers should focus on mothers with pregnancy-induced hypertension, premature rupture of membrane, and anemia during pregnancy, and refer to the senior experts for early management to reduce the risk of preterm delivery. Antenatal care services such as counseling the mother on the benefit of dietary supplementation during pregnancy, antenatal care follow up, and lengthening birth interval should be integrated into the existing health extension packages. New and inclusive strategies such as the establishment of comprehensive mobile clinic services should also be designed to reduce the burden of preterm birth among women living in the rural community. Lastly, we recommend future researchers to conduct longitudinal and community-based studies supplemented with qualitative methods.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245825PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833256PMC
June 2021

Impact of HIV status and predictors of successful treatment outcomes among tuberculosis patients: A six-year retrospective cohort study.

Ann Med Surg (Lond) 2020 Dec 15;60:531-541. Epub 2020 Nov 15.

School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Tuberculosis (TB) remains a major global public health problem. Hence, the study aimed to assess the impact of human immune virus (HIV) status and predictors of successful treatment outcomes of TB patients enrolled at Nekemte specialized hospital. An institution-based retrospective cohort study was conducted and the data analyzed using SPSS version 24.0. A multivariable logistic regression model was fitted to identify the association between treatment outcome and potential predictor variables. The association was calculated using the Adjusted Odds ratio (AOR) and the statistical significance was considered at p < 0.05. Out of the total 506 study participants, 50.2% of them were males. The overall treatment success rate was 81.4% and 58.06% among HIV co-infected TB patients. Female sex (AOR = 2.01, 95%CI: 1.04-16.11), age 25-34 years (AOR = 3.982, 95%CI: 1.445-10.971), age 35-49 years (AOR = 5.392, 95%CI: 1.674-17.368), high school educational level (AOR = 5.330, 95% CI: 1.753-16.209), urban residence (AOR = 3.093, 95%CI: 1.003-9.541) and HIV negative (AOR = 10.3, 95%CI, 3.216-32.968) were positively associated with favorable TB treatment outcome. Whereas, being single (AOR = 0.293, 95%CI: 0.1-0.854), smear-negative pulmonary TB (AOR = 0.360, 95%CI: 0.156-0.834), extra-pulmonary TB (AOR = 0.839, 95%CI: 0.560-0.955) and retreatment case (AOR: 0.54, 95%CI: 0.004-0.098) were negatively associated with successful treatment outcome. The treatment success rate of TB patients was lower than World Health Organization target set of 85%. The increased unsuccessful outcome among TB/HIV patients requires urgent public health interventions to improve the evaluation policy and control framework.
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http://dx.doi.org/10.1016/j.amsu.2020.11.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704363PMC
December 2020

Fertility desire and associated factors among people living with HIV in Ethiopia: a systematic review and meta-analysis.

Arch Public Health 2020 Nov 23;78(1):123. Epub 2020 Nov 23.

Department of Public health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Increased Anti-Retroviral Therapy (ART) coverage improves health status and the survival of people living with Human Immunodeficiency Virus (HIV) as a result, reproductive health needs of the clients are increased. As part of continuum HIV care, understanding fertility desire and reproductive health care needs of HIV positive peoples will play paramount role in planning and delivering appropriate health services. The finding of studies conducted on the fertility desire and associated factors among People Living with HIV in Ethiopia presented inconclusive. Therefore, this study aimed to assess the pooled prevalence of fertility desire and associated factors among people living with HIV in Ethiopia.

Methods: A total of 26 studies conducted in Ethiopia were included in this Meta-analysis. Pub Med, HINARI, Google scholar and Google data bases were searched. Data from the included articles were extracted using a standardized data extraction tool. The included studies were analyzed using a random effects meta-analysis model. Analysis was done Using STATA version 14 statistical software. Heterogeneity was assessed statistically using the standard Chi-square, I The association between fertility desire and factors were examined using a random effects model.

Result: In this meta-analysis, the pooled prevalence of fertility desire in Ethiopia is 42.21% (95%CI 39.18, 45.25). Fertility desire is significantly associated with sex: being female (OR = 0.71,95%CI 0.57,0.86), partners desire (OR = 16.8, 95% CI: 9.45, 29.88), not having child (OR = 5.46 95%CI 4.24, 7.040), age < 30(OR = 2.34, 95%CI 2.10, 2.60), formal education (OR = 1.31 95%CI 1.09, 1.59)). However, use of family planning, residence, and Knowledge on Prevention of Mother to Child Transmission and disclosure status didn't show association with fertility desire.

Conclusion: In this finding, significant people of living with HIV have a desire to have a child. The finding showed the need to strengthen fertility desire and reproductive health care needs of HIV positive peoples. Therefore, strengthening the integration of fertility related issues with HIV continuum care will play a paramount role in averting risky sexual behaviors and Prevention of Mother to Child Transmission among peoples on ART.
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http://dx.doi.org/10.1186/s13690-020-00504-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685622PMC
November 2020

Impact of antenatal care on neonatal mortality among neonates in Ethiopia: a systematic review and meta-analysis.

Arch Public Health 2020 Nov 10;78(1):114. Epub 2020 Nov 10.

Department of Statistics, College of Natural Science, Dire Dawa University, Dire Dawa, Ethiopia.

Background: As compared to other regions of the world, Sub Saharan Africa (SSA) is the region with the highest neonatal mortality and is the region showing the least progress in the reduction of newborn death. Despite better progress made in reducing neonatal mortality, Ethiopia contributes the highest rate of neonatal death in Africa. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the impact of antenatal care on neonatal mortality among mother-neonate pairs in Ethiopia.

Methods: Published articles from various electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science, and Google Scholar were accessed. Also, unpublished studies from library catalogs were identified. All observational studies that were conducted on the association between antenatal care follow-up and neonatal mortality among neonates in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled impact on antenatal care on neonatal mortality. The presence of publication bias was assessed by funnel plots and Egger's statistical tests.

Results: Initially, a total of 345 studies were accessed. Finally, 28 full-text studies were reviewed and fourteen studies fulfilled inclusion criteria and included in the final meta-analysis. The overall pooled estimate indicates the odds of neonatal death among neonates from women with antenatal care were 65% lower than those neonates from women who had no antenatal care follow-up (OR: 0.35, 95% CI: 0.24, 0.51).

Conclusions: In this systematic review and meta-analysis, lack of ANC follow-up increase the probability of neonatal mortality as compared to having ANC follow-up. Thus, we will recommend for more coverages of appropriate antenatal care where risk groups can best be identified and managed.
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http://dx.doi.org/10.1186/s13690-020-00499-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653817PMC
November 2020

Patterns and associated factors of COVID-19 knowledge, attitude, and practice among general population and health care workers: A systematic review.

SAGE Open Med 2020 11;8:2050312120970721. Epub 2020 Nov 11.

Department of Nursing, College of Health Science, Selale University, Fiche, Ethiopia.

Introduction: Coronavirus disease 2019 is a pandemic disease, requiring persons around the world to take immediate action to reduce the risk of infection. This study was aimed to summarize the patterns and determinants of coronavirus disease 2019 knowledge, attitude, and practice among general populations and health workers.

Methods: A cross-sectional study from PubMed, HINARI, and Scopus were searched from March 16 to July 30, 2020. The review was done in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses-2009.

Result: We found 56 articles upon the initial search. Finally, 21 studies were filtered to be studied in this systematic review. Overall, the majority of the articles that were previously published had good knowledge about coronavirus disease 2019 that lies in the ranges from 40% to 99.5%. A good attitude lies in the ranges from 70% to 97.1%. Among impact of coronavirus disease 2019 on mental health, only anxiety was reported that ranges from 24.6% to 96.3%. We found the variable practice towards combating coronavirus disease 2019. Several factors were associated with poor knowledge, attitudes, and practice skills regarding the pandemic of coronavirus disease 2019 such as level of education, occupation, income, gender, age, residence, work experience, religion, having media, marital status, and race.

Conclusion: The majority of the articles that were previously published had found good knowledge and attitude about coronavirus disease 2019 and variable reports for practice to combat the disease. Most of them were severely worried about the disease. Therefore, the mental effect of the coronavirus disease 2019 should be studied at large, and every country should implement the strategy to combat the disease to increase the level of practice.
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http://dx.doi.org/10.1177/2050312120970721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675903PMC
November 2020

Knowledge and Attitude Towards Antimicrobial Resistance of Graduating Health Science Students of Wollega University.

Infect Drug Resist 2020 3;13:3937-3944. Epub 2020 Nov 3.

Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Antimicrobial resistance is a worldwide concern due to the inappropriate and irrational use of antibiotics. Thus, this study was aimed at determining the knowledge and attitude of graduating health science students of Wollega University towards antimicrobial resistance.

Methods: An institution-based cross-sectional study design was employed from June to July 2019. Epi-data version 3.1 was used to receive data and exported to SPSS version 25 for further analysis. Both bivariable and multivariable logistic regression analysis were done to find factors associated with attitudes of students towards antibiotic consumption and resistance at a 95% confidence level. The strength of association was measured with the odds ratio. Variables with a -value of <0.05 at multivariable analysis were considered to be a significant variable. Finally, texts and simple frequency tables were used to present the findings.

Results: Out of 249, 232 students were included in this survey yielding a response rate of 93.6%. Hundred fifty-eight (68.1%) of them had adequate knowledge about antibiotic identification, role, side effects, and resistance. Students with a family member who works in health and related professions had a lower probability of stopping antibiotics when they feel better (AOR = 0.50, 95% CI: 0.28-0.90) and using leftover antibiotics (AOR = 0.51, 95% CI: 0.28-0.92) compared to their counterparts.

Conclusion: Students' knowledge on antibiotic identification, role, side effects, and resistance was suboptimal, and the attitude of students towards antibiotic consumption was unfavorable. Respondents having a family member in a health-related field showed a good attitude. Respondents with three years of study also had a good attitude, female gender showed good attitude, and urban residence were independent predictors of attitude toward antibiotic consumption. Training on antimicrobial resistance should be arranged for graduating class nursing and medical students, as they are the future prescribers.
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http://dx.doi.org/10.2147/IDR.S264481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650017PMC
November 2020

Perceived Self-Efficacy and Associated Factors Among Adult Patients with Type 2 Diabetes Mellitus at Public Hospitals of Western Ethiopia, 2020.

Patient Prefer Adherence 2020 24;14:1689-1698. Epub 2020 Sep 24.

Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Diabetes Mellitus is a chronic disease and can be self-managed using five treatment approaches, including education, medical nutrition therapy, physical exercise, pharmacological intervention, and blood sugar monitoring. Improvement of patient compliance and self-efficacy are critical points that impact the self-care behavior in patients with type two diabetes mellitus in order to limit the morbidity and promote glycemic control. Therefore, the present study successfully assesses the effect of perceived self-efficacy and associated factors among patients with diabetes mellitus at public hospitals of western Ethiopia.

Methods: The cross-sectional study design was employed on a sample of 423 diabetic patients. A systematic random sampling method was employed. An interviewer-administered structured questionnaire was used. The data entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p <0.25 in bivariate were entered into multivariate analysis. The multivariable logistic regressions were used to determine factors associated with perceived self-efficacy by considering adjusted odds ratio at CI 95% and the significance level was set at p <0.05.

Results: Out of 423 participants sampled, 398 participated in the study giving a response rate of 94.1%. The level of perceived good self-efficacy among diabetes patients was 52.5%. Being married (AOR=1.611, 95% CI = 1.003, 2.587), home blood glucose test (AOR=3.359, 95% CI = 1.912,5.903), doing exercise (AOR=11.412, 95% CI = 2.488,52.346), having good appetite (AOR=2.587, 95% CI = 1.454,4.606), having special diet (AOR=4.902, 95% CI= 1.202, 19.992), and good self-care behavior (AOR=10.320, 95% CI= 5.657, 18.824) were significantly associated with good self-efficacy.

Conclusion: The level of perceived self-efficacy was high. Home blood glucose tests, good self-care behavior, married, doing exercise, good appetite, having a special diet were significantly associated with high perceived self-efficacy. The national policymaker focused on patients' behavioral change to develop perceived self-efficacy for confidently managing the disease.
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http://dx.doi.org/10.2147/PPA.S275887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522517PMC
September 2020

Postpartum depression and associated factors among postpartum women in Ethiopia: a systematic review and meta-analysis, 2020.

Public Health Rev 2020 16;41:21. Epub 2020 Sep 16.

Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia.

Introduction: The postpartum period is recognized as a high-risk period for the development of various mood disorders like postpartum depression. Globally, postnatal depression is a serious public health problem that has a negative impact on the mother's health and child development, especially in developing countries. In Ethiopia, even though there are different primary studies conducted on postpartum depression, there is no nationally representative evidence. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence and associated factors of postpartum depression in Ethiopia.

Methods: Published and unpublished articles from various electronic databases and digital libraries were accessed. This systematic review included studies that were conducted on the magnitude and factors associated with postpartum depression among postnatal women in Ethiopia. A random-effect model was used to estimate the pooled magnitude of postpartum depression with a 95% confidence interval (CI). Inverse variance (I) was used to visualize the presence of heterogeneity, and forest plot was used to estimate the pooled magnitude of postpartum depression. Publication bias was assessed by funnel plots and Egger's statistical tests. A meta-regression and subgroup analysis were computed to minimize underlying heterogeneity.

Result: Initially, a total of 764 studies were accessed. Twenty-eight full articles were assessed for eligibility criteria, of which twelve studies fulfilled inclusion criteria were included in the final meta-analysis. The overall pooled magnitude of postpartum depression was 22.89% (95% CI 17.75%, 28.03%) with the lowest (12.20%) and highest (33.82%) in the Southern nations region. Unplanned pregnancy, domestic violence, lack of social support, previous history of depression, infant loss, and dissatisfaction in marriage showed a statistically significant association with postpartum depression.

Conclusions: In the current analysis, the prevalence of postpartum depression was high as compared with other developing countries. Routine screening of mothers in the postpartum period and integrating mental health with maternal health care is highly recommended.
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http://dx.doi.org/10.1186/s40985-020-00136-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493842PMC
September 2020

Integrated pharmaceutical logistics system implementation in selected health facilities of Ethiopia: The case of four WOLLEGA ZONES.

Res Social Adm Pharm 2021 05 6;17(5):956-968. Epub 2020 Aug 6.

Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia. Electronic address:

Background: The pharmaceutical supply chain management system of Ethiopia has several problems including non-availability, poor storage, weak stock management and irrational use. However, few studies were conducted on progress and challenges towards implementation of Integrated Pharmaceuticals Logistics System (IPLS) in the study area. Therefore, this study aimed to assess the progress and challenges towards the implementation of IPLS in selected health facilities of Wollega zones, Western Ethiopia.

Methods: A cross sectional quantitative and qualitative study was conducted in selected health facilities from February 15 to March 15, 2015. The calculated sample size was 31 health facilities with 20% margin of error and 90% confidence interval (CI). The Logistics Indicator Assessment Tool (LIAT) was used to collect information from selected health facilities; while an in-depth interview was held with chief pharmacist to collect qualitative data. Correlation and multiple linear regression analysis were used at significance level of 90%CI.

Results: The average availability of bin cards for the selected products was 83.9% for hospitals, 75.4% for health centers, and 70.6% for health posts. On average, hospitals had an updated bin card for 43.8% of the product while health centers and health posts had an updated bin card for 32.9% and 32% of their products, respectively. On average the exact accuracy of request and resupply form (RRF) data for hospital and health center was 45.6% and 37.1%, respectively. IPLS implementation was related with health facility stores infrastructures (40.1%), Logistics Management Information System/LMIS/ (32.2%), stock availability and status (31.9%), storage condition (17.7%) and order fill rate (14.1%). Multivariable regression revealed LMIS (std. β = 2.539, p = 0.022), stock status (std. β = 0.848, p = 0.049) and availability of tracer medicines (std. β = 0.212, p = 0.013) were positively associated with IPLS implementation.

Conclusion: There have been significant improvements in supply chain indicators in the availability of essential health commodities since IPLS has been implemented, with some variation by level of facility and product type. Involvement of all stakeholders is necessary to sustain the system. Additionally, there needs to be more focus on monitoring and evaluation of IPLS including more focused studies.
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http://dx.doi.org/10.1016/j.sapharm.2020.07.026DOI Listing
May 2021

Diarrhea and associated factors among under-5 children in Ethiopia: A secondary data analysis.

SAGE Open Med 2020 31;8:2050312120944201. Epub 2020 Jul 31.

School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Objectives: Diarrhea is a major contributing factor for preventable childhood morbidity and death. Despite the occurrence of diarrhea is decreasing, its effect is increasing at an alarming rate among under-5 children particularly in developing countries. The survey was aimed to assess diarrhea and associated factors among children less than 5 years (0-59 months) in Ethiopia with nationally representative data.

Methods: The data were extracted from the Ethiopian National Survey of 2016. A logistic regression model was undertaken to identify the contributing factors for childhood diarrhea. Variables with p < 0.05 were considered as independent predictors of childhood diarrhea.

Results: From a total of 10,641 under-5 children, 5483(51.5%) were males and most of the children (62.3%) were above 24 months. About 10.2% had diarrhea 14 days before data collection, and the majority (93.1%) were born to married mothers. Receiving no treatment or advice for fever/cough (adjusted odd ratio (AOR) = 0.170, 95% confidence interval (CI): 0.139-0.208, p = 0.001), being permanent residence (AOR = 0.583, 95% CI: 0.347-0.982, p = 0.043), initiating breastfeeding after 24 h of birth (AOR = 1.553, 95% CI: 1.197-2.015, p = 0.001), and lack of prenatal care (AOR = 2.142, 95% CI: 0.624-0.875, p = 0.001) were independent predictors of diarrhea among under-5 children's in Ethiopia.

Conclusion: The result of this survey indicated that diarrhea is a significant health challenge among under-5 children. To tackle this illness, sufficient education on child and maternal health has to be provided for mothers focusing on predictive factors.
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http://dx.doi.org/10.1177/2050312120944201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406926PMC
July 2020

Association between pregnancy intention and late initiation of antenatal care among pregnant women in Ethiopia: a systematic review and meta-analysis.

Syst Rev 2020 08 20;9(1):191. Epub 2020 Aug 20.

Department of Public Health, College of Health Sciences, Jimma University, Jimma, Ethiopia.

Background: Antenatal care is one of the continua of reproductive health care, and inadequate antenatal care utilization results in an adverse feto-maternal outcome. Pregnancy intention is an essential factor that plays a paramount role on timing of antenatal care service. The finding of a few studies conducted on the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia presented inconclusive. Therefore, the objective of this systematic review and meta-analysis was to determine the pooled estimate of the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia.

Methods: Both published and unpublished studies were accessed through electronic search from databases such as MEDLINE, Scopes, PubMed, CINAHL, PopLine, MedNar, Cochrane library, the JBI Library, the Web of Science, and Google Scholar. All observational studies that were conducted on the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia were included. STATA 14.1 version was used for data analysis. A random effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). The Cochrane Q test statistic and I tests were used to assess heterogeneity. Presence of publication bias was checked by funnel plots and Egger's statistical tests.

Results: A total of 670 published and unpublished studies were identified from several databases and fourteen studies fulfilled inclusion criteria and included in the meta-analysis. The overall pooled estimate indicates the odds of late initiation of antenatal care were 2.16 times higher among pregnant women who had unintended pregnancy as compared to pregnant women who had intended pregnancy (OR 2.16, 95% CI 1.62, 2.88).

Conclusion: The systematic review and meta-analysis found a statistically significant effect of pregnancy intention on late initiation of antenatal care among pregnant women in Ethiopia. Increased effort should be made to improve women's behavior towards contraceptive use through health education and counseling, especially those with unintended pregnancies. Furthermore, health education, counseling, and communication campaigns related to the timing of ANC and frequency should be promoted nationally.
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http://dx.doi.org/10.1186/s13643-020-01449-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441676PMC
August 2020

Food Insecurity among People Living with HIV/AIDS on ART Follower at Public Hospitals of Western Ethiopia.

Int J Food Sci 2020 25;2020:8825453. Epub 2020 Jul 25.

Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Food insecurity and HIV/AIDS are intertwined in a vicious cycle through nutritional, mental health, and behavioral pathways. Food insecurity is a potentially important barrier to the success of antiretroviral treatment, increased hospitalizations, and higher morbidity among HIV-infected individuals in resource-poor settings particularly in sub-Saharan Africa including Ethiopia. Therefore, the purpose of this study was to assess the prevalence of food insecurity among people living with HIV/AIDS on follow up at public hospitals of western Ethiopia.

Methods: An institutional-based cross-sectional study design was conducted on a sample of 428 among people living with HIV/AIDS on follow up at public hospitals of western Ethiopia. A systematic random sampling technique was used to include all participants. Data was collected using interviewer-administered structured questionnaires. The data were entered into Epi data version 3.1 and then exported into Statistical Package for the Social Sciences window version 21 for analysis. Descriptive and inferential statistics were employed. Bivariable logistic and multivariable logistic analyses were used with AOR at CI 95% and < 0.05 were used.

Result: The finding of the study revealed that the majority of the respondents 221(53.1%) were female. The mean age of the respondents was 32.92 ± 7.304 years and 197 (47.4%) of the study participants were between 30 to 39 years' age group. The level of food insecurity among PLWHA receiving ART therapy was 68.8% which was partitioned as mild (23.32%), moderate (29.09%), and severe (16.35%) food in secured. Being single [AOR = 3.507(1.377, 8.934)], illiterate [AOR = 5.234(1.747, 15.686)], cigarette smoking [AOR = 3.577(2.104, 6.081)], presence of anemia (AOR = 2.650(1.563, 4.493)], and inadequate dietary diversity [AOR = 2.870(1.088, 7.569)] were predictors of food insecurity.

Conclusion: The prevalence of food insecurity was high. Educational status, marital status, cigarette smoking, presence of anemia, opportunistic infection, and inadequate dietary diversity were the major significant factors affecting food insecurity. We recommended a national health policy maker to integrate food and nutrition interventions as part of a package of care, treatment, and support services for people living with HIV and ART follower patients.
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http://dx.doi.org/10.1155/2020/8825453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416256PMC
July 2020

Adherence to Anti-Tuberculosis Treatment Among Pediatric Patients at Nekemte Specialized Hospital, Western Ethiopia.

Patient Prefer Adherence 2020 24;14:1259-1265. Epub 2020 Jul 24.

Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Science, Wollega University, Nekemte, Ethiopia.

Background: Non-adherence to tuberculosis treatment is the most challenging and hindering factor for successful tuberculosis therapy. The long duration of tuberculosis treatment and the undesirable effects of anti-tuberculosis drugs result in non-adherence to treatment among pediatric patients. Hence, this study was aimed to evaluate pediatrics adherence status among tuberculosis pediatric patients on anti-tuberculosis treatment at Nekemte Specialized Hospital.

Methods: A health facility-based cross-sectional study design was used to recruit pediatric TB patients who were receiving their treatment between February 15 and March 15, 2019. Adherence to tuberculosis therapy was evaluated using data obtained from face-to-face interviews of their respective caregivers. The collected data were entered into EPI-manager 4.0.2 software and analyzed using SPSS version 24. Logistic regression was used to analyze the variables and variables with p-value <0.05 had a statistically significant association with the adherence to anti TB treatment.

Results: Among 202 participants involved in the study, 120 (59.4%) of them were males and 119 (58.9%) were in the age category of 11-15 years. A total of 166 (82.2%) of the patients had extra-pulmonary tuberculosis and 174 (86.1%) of them were in the intensive phase. Of the pediatric tuberculosis patients, 48 (73.3%) of them have adhered to the treatment regimen. Female gender [AOR: 3.3, 95% CI: 1.52-7.2], younger age (0-5 years) [AOR: 5.96 95% CI: 1.81-19.6], living in urban area [AOR: 3.73, 95% CI: 1.67-8.36], and patients who did not experience side effect [AOR: 2.87, 95% CI: 1.41-5.81] were predictors of good adherence to tuberculosis treatment up on multivariable logistic regression analysis.

Conclusion: The level of adherence observed in our study area was low. Age, sex, residence, and side effect experience showed an association with tuberculosis treatment adherence. Therefore, health care providers should educate all patients with tuberculosis before the initiation of anti-tuberculosis treatment.
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http://dx.doi.org/10.2147/PPA.S258292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386810PMC
July 2020

Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia.

Int J Ment Health Syst 2020 29;14:56. Epub 2020 Jul 29.

Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

Background: Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC).

Methods: A cross-sectional, community-level study was conducted at Jimma town. The patient's data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used.

Results: Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. β = - 0.091, p = 0.009) and living with kids and spouse (std. β = - 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (β = 0.501, p < 0.001), number of relapses (std. β = 0.183, p < 0.01) and medication non-adherence (std. β = 0.084, p = 0.021) were positively associated with self-stigma.

Conclusion: The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.
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http://dx.doi.org/10.1186/s13033-020-00391-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391813PMC
July 2020

Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia.

Int J Hypertens 2020 19;2020:7526257. Epub 2020 Jun 19.

Pharmacology Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.

Background: Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20-60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes.

Objective: The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia.

Methods: A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at value <0.05 levels. The patient's written informed consent was obtained after explaining the purpose and procedures of the study.

Results: A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142-18.024, =0.032), duration with hypertension ≥5 years (AOR = 3.534, 95% CI = 1.062-11.760, =0.040), cigarette smoking (AOR = 7.697, 95% CI = 2.356-25.146, =0.001), nonadherence (AOR = 6.584, 95% CI = 2.337-18.553, < 0.001), and uncontrolled glycaemia (AOR = 21.630, 95% CI = 8.057-58.070, < 0.001) were independent predictors of uncontrolled blood pressure.

Conclusion: Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients' comorbid with diabetes.
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http://dx.doi.org/10.1155/2020/7526257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322590PMC
June 2020

Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia.

Cardiovasc Ther 2020 22;2020:2509875. Epub 2020 May 22.

Department of Pharmaceutical Sciences, University of Kashmir, Hazratbal Srinagar, 190006 Jammu and Kashmir, India.

Introduction: Beta-blocker use evaluation is a performance method that focuses on the evaluation of beta-blocker use processes to achieve optimal patient outcomes. Several studies conducted in different hospitals revealed a high incidence of inappropriate prescription of beta-blockers among hospitalized patients. Therefore, it is important to identify inappropriate beta-blocker prescribing since they may increase the risk of hospitalizations. Despite this, there was no study conducted related to drug use evaluation of beta-blockers in Nedjo general hospital (NGH). Thus, this study was aimed at assessing the use evaluation of beta-blockers in medical wards of NGH.

Methods: A retrospective cross-sectional study was conducted at medical wards of NGH from January 1, 2016, to December 31, 2017.

Results: Out of the total of 149 medical record of patients that contains beta-blockers, 84 (56.37%) were males and about one-third (31.54%) of the patients ages were between 41 and 50 years. Propranolol was the most commonly prescribed beta-blocker (62.76%), and 94.56% of beta-blockers were prescribed with correct indication. There were about 51%, 46.31%, 64.43%, and 46.98% of beta-blockers prescribed with the correct dose, duration, frequency, and route of administration, respectively. Regarding the routes of administration, 70 (46.98%) of them were prescribed with the correct route. Most drugs interacting were propranolol with cimetidine 26 (68.42%), and the most frequent condition for which beta-blockers were prescribed was hypertension (32.89%).

Conclusion: Overall, there was an inappropriate use of beta-blockers in terms of dosage and durations. So, prescribers of NGH should strictly adhere to the national treatment guideline when prescribing medications. Additionally, drug information centers have proved useful and effective in promoting rational drug use. Hence, it should be recommended for general use.
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http://dx.doi.org/10.1155/2020/2509875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284961PMC
July 2020

Effects of time of initiation of antiretroviral therapy in the treatment of patients with HIV/TB co-infection: A systemic review and meta-analysis.

Ann Med Surg (Lond) 2020 Jul 16;55:148-158. Epub 2020 May 16.

School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.

This systemic review and meta-analysis aimed to investigate the burden of tuberculosis immune reconstitution syndrome (TB-IRIS) and associated mortality to highlight the importance of future direction in preventing and treatment of TB-IRIS. Randomized clinical trials (RCTs) that compared early antiretroviral therapy (ART) versus late ART were included. PubMed, EMBASE, Science Direct and Cochrane Central Register of Controlled Trials electronic databases were searched. This meta-analysis included 8 RCTs with a total of 4, 425 participants. The result of analysis showed that early initiation of ART was associated with increase in TB-IRIS (RR = 1.83; 95% CI: 1.24-2.70,  = 0.002; I = 74%,  = 0.0007) and TB-IRIS associated mortality (RR = 6.05; 95% CI: 1.06-34.59,  = 0.04; I = 0%,  = 0.78). Early ART was associated with overall mortality compared with late ART initiation. Grade 3 or 4 adverse events, achieving lower viral load and development of new AIDS-defining illness were not associated with the time of ART initiation. Early ART in HIV/TB co-infected patients resulted conclusive evidence of increased TB-IRIS incidence and TB-IRIS associated mortality. Hence, the finding calls for clinical judgment as to the benefits of initiating ART earlier against the risk of TB-IRIS and associated mortality.
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http://dx.doi.org/10.1016/j.amsu.2020.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251303PMC
July 2020
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