Pharmacy Practice

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Evaluation of the Diuretic and Analgesic Activities of the Rhizomes of Rumex Abyssinicus Jacqinmice
(Addis Ababa University, 2008-10) Mekonnen, Teshale; Engidawork, Ephrem (PhD)
Rumex abyssinicus Jacq (Polygonaceae) is a widely spread medicinal plant used traditionally for treatment of several ailments, including hypertension, inflammatory and painful conditions. The present study aimed to examine the diuretic and analgesic activities of aqueous and 80% methanol extracts of the rhizomes of the plant at different doses in mice. To this effect, negative controls were orally treated with distilled water (DW) or Tween 80(4%) (TW80), solvents used for reconstitution of the extracts. Positive controls were treated with furosemide (10 mglkg) (FrIO) for diuretic test or aspirin (100 mg/kg) (ASA100) and morphine (10 mg/kg) (MIO) for acetic acid-induced writhing and hot-plate analgesic studies, respectively. For the diuretic study, treatment groups received an oral dose of SOO mgikg (RASOO), 7S0 mglkg (RA7S0) or 1000 mg/kg (RA1000) of the aqueous extract or 2S0 mglkg (RM2S0), SOO mg/kg (RMSOO) or 7S0 mglkg (RM7S0) of 80% methanolic extract. Urine volume was then measured at different time (1,2, 3, 4, and S h) and the urinary Na+, K+ and cr also measured at S h. For both analgesic tests, 2S0 mglkg (RM2S0), SOO mg/kg (RMSOO) or 1000 mglkg (RM1000) of 80% methanolic extract doses were used. Whereas the number of writhes was counted for 20 min just S min after intraperitonial injection of 0.6% acetic acid (O.lS mLilOg) for the writhing test, the reaction time of each mouse was evaluated at 30, 4S, 60, and 90 min after treatment for the hot-plate test. For the acute toxicity study, SOOO mglkg of aqueous or 80% methanolic extract was administered orally and observed for the following IS days. Both extracts displayed a clear dose-dependent diuretic and analgesic effect as compared to controls. RA1000 and RM7S0 were able to increase diuresis significantly (P
Cost as a Barrier to Access: Availability, Affordability and Identifying Component Cost of Essential Medicines
(Addis Ababa University, 2009-06) Nuru, Mohammedsied; Gedif, Teferi (PhD)
Cost as a Abrrier to Access: Availabilty, Affordability and Identifying Component Cost of Essential Medicines
(2009-06) Nuru, Mohammedsied; Gedif, Teferi (PhD)
Antipsychotic Medications Switch and Contributing Factors among Ambulatory Patients with Schizophrenia at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia
(Addis Ababa Universty, 2017-12) Asfaw, Getachew; Nedi, Teshome (PhD, Associate professor)
Antipsychotic medications switch and contributing factors among ambulatory patients with schizophrenia at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia Getachew Asfaw December, 2017 Antipsychotic medications are the cornerstone of treatment for schizophrenia. Antipsychotic switching is a common practice in the treatment of schizophrenia. As there is limited current data on antipsychotics medication switch among patient with schizophrenia in Ethiopia; this study aimed to generate information on antipsychotics medication switch among patient with schizophrenia. Using a systematic random sampling a cross sectional patient interview and retrospective chart review of the same patients was conducted from 1 to 30, November 2016. A total of 411 study participants were included in the study. Three Focus Group Discussion was also conducted with 24 health care professionals from different departments. Descriptive and inferential statistics were computed for the quantitative part of the study and a thematic analysis was taken for the qualitative study. The result showed that, there has been medication switch in 42.8% of the study participants and in 64% of the participants the switch was shown to be within the same class of First Generation Antipsychotics. For more than half of the patients (55.68%) who had a medication switch, the reasons for initial antipsychotic medication switch were not documented. Side effects, relapse, admission history, high and very high dose of antipsychotic were significantly associated with antipsychotic medication switches. The Focus Group Discussion revealed that interrupted supply of antipsychotic medication was raised as the major reason for the switch. The practice of antipsychotic medications switch in the setting is within the range in terms of prevalence worldwide and reasons for medications switch were not recorded for majority of the patients. Clear and complete recording of the reasons should be maintained by clinicians whenever switching is considered.
Insulin Induced Lipohypertrophy and Glycemic Control among Children and Adolescents with Diabetes in Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa Universty, 2017-12) Gebremeskel, Afewerki; Shibeshi, Workineh (PhD, Associate professor)
Insulin Induced Lipohypertrophy and Glycemic Control among Children and Adolescents with Diabetes in Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia Afewerki Gebremeskel Addis Ababa University, 2017 Lipohypertrophy (LH) is one of the clinical complications of insulin injection which affects insulin absorption and leads to poor glycemic control. Its occurrence was mainly associated with the use of non-human origins of insulin and repeated traumatization of injection sites. Aim of this study was to assess insulin induced LH and glycemic control among children and adolescent patients from April to July 2017 in Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. This cross sectional study was done on 176 diabetic children and adolescents who inject insulin for a minimum of one year. First, the anthropometric and clinical features of the patients were recorded in questionnaire and then observation and palpation techniques were used in assessing LH. Out of the total 176 participants, 103 (58.5%) had insulin induced LH, of them 3 (2.9%) had lipoatrophy. Factors such as age, weight, height and insulin syringe reuse had significant influence in development of insulin induced LH, considering p-value <0.05 as significant level. LH in turn was associated with the use of higher dose of insulin and non-optimal glycemic control. Overall, some insulin injection malpractices have been found among participants of this study. As a result injection site uncleaning was significantly associated with the occurrence of non-optimal glycemic control. Findings of this study revealed that inspite of using recombinant human insulin, the magnitude of the LH still remained high. Therefore, a regular examination of the diabetic patients for this complication is necessary, especially in the individuals who have a defective glycemic control.
Assessment of Prevalence, Management and Outcome of Acute Poisoning at St. Paul‘s Hospital Millennium Medical College and Addis Ababa Burn, Emergency and Trauma Hospital
(Addis Ababa Universty, 2018-01) Melese, Elias; Ayalneh, Belete (MSc)
Assessment of Prevalence, Management and Outcome of Acute Poisoning at Saint Paul’s Hospital Millennium Medical College and Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethopia Elias Melese Addis Ababa University, 2018 Acute poisoning is an injury in which the toxic effects occur immediately, usually within hours from time of exposure. It is a common reason for emergency department visit and hospitalization. There is sparse data on acute poisonings in Ethiopia, although case fatality rate is reported to range from 2.4% to 8.6%. The aim of this study was therefore to determine the prevalence, management and outcome of acute poisoning among acutely poisoned patients admitted to the emergency rooms of SPHMMC and AaBET hospital. The study was cross sectional study conducted between August 2015 to August 2016, involving extraction of data from patient charts and registries. The one year prevalence of acute poisoning in the two hospitals was 2.5% per total emergency visits and 6.2% per emergency admissions. The highest prevalence of poisoning cases was in the age group of 15-29 years (51.9%) and majority (54.5%) of them were females. Most (88.5 %) of the cases were intentional self-harm. Quarrel with family was the highest reason (25.8%) for intentional poisoning. About 64% of the cases were from rural areas and March- May (Tseday) was the most common months for acute poisioning (36.2%). Organophosphates (38.8%) were the leading causes of poisoning followed by bleaching agents (12.7%) and rodenticides (11.1%). Atropine was used as antidote for (25.8%) poisioined patient. Even though, most (68.9%) of the acutely poisoned patients survived without disability, the case fatality rate was found to be (8.4%). Out of the total deaths reported, organophosphate poisoning was the most common followed by herbicides and rodenticides. The prevalence and case fatality rate of acute poisoning in the two hospitals were found to be high Hence, controlling open market sales of agrochemicals, creating awareness on proper handling of chemicals and prescribed drugs, assesing the referal linkage of hospitals, improving availability of antidotes, proper record keeping and documentation practices, are recommended.
Management of Hospital-Acquired Infections among Hospitalized Patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Prospective Study
(Addis Ababa Universty, 2018-01) Gebremeskel, Segen; Shibeshi, Workineh (PhD)
Management of Hospital-Acquired Infections among Hospitalized Patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia Segen G/meskel Tassew Addis Ababa University, 2018 Hospital-acquired infections (HAIs) are acquired when the patient is hospitalized. The emergence of multidrug resistant bacteria is a threat for HAIs. In Ethiopia data are scarce in HAIs. Hence, this study aimed to assess the prevalence and management of HAI among patients admitted at Zewditu memorial hospital. A prospective cross sectional study was conducted in 410 patients who met eligibility criteria. The sample was proportionally allocated among different wards. Data were collected using data abstraction format and supplemented by key informant interview. Management appropriateness was assessed using Infectious disease society of America guideline and experts opinion (Infectious disease specialist). Multivariate logistic regressions was used to identify factors associated with HAIs. The prevalence of HAIs was 19.8%. Surgical site infection and pneumonia accounted for 24.7% of the infection. Culture and sensitivity was done for 29.6% patients and 29.1% of them show growth (E.coli, Acinetobacter and S.aureus). Of the 81 patients who developed HAIs, 33.3% and 66.7% of them were treated appropriately and inappropriately respectively. Physicians’ response for this discrepancy was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR=8.53, 95%CI: 2.67-27.30), male gender (AOR=2.06, 95%CI: 1.01-4.22), longer hospital stay (AOR= 0.17, 95%CI: 0.06-0.51), and previous hospital admission (AOR=3.22, 95%CI: 1.76- 5.89) were independent predictors of HAIs. Inappropriate management and prevalence of HAIs was substantially high in this study. Surgical site infections and pneumonia were the common types of HAIs. Locally conformable guidelines could help to correct such problems.
Drug Therapy Problems among Ambulatory Patients with Type 2 Diabetes at Endocrine and Metabolism Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(2018-01) Teklemariam, Gebre; Nedi, Teshome (PhD)
Drug Therapy Problems among Ambulatory Patients with Type 2 Diabetes at Endocrine and Metabolism Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia Gebre Teklemariam Demoz Addis Ababa University, 2018 Patients with diabetes are at high risk of drug therapy problems (DTPs), as they are outstanding to multiple-medications. To date, studies regarding DTPs in patients with diabetes are limited in Ethiopia. Thus, this study was aimed to assess the magnitude, pattern and factors associated with DTPs among patients with type 2 diabetes at Tikur Anbessa Specialized Hospital. A cross sectional study was conducted among 357 participants who fulfilled the inclusion criteria. Participants were interviewed using structured data collection format, involving medical chart review retrospectively. Drug therapy problems (DTPs) were assessed using Cipolle‘s classification system. Data were reported by mean/percentage and multivariate logistic regression analysis was performed to identify factors associated with DTPs. A total of 193 DTPs in 164(45.9%) of participants were identified. Most commonly identified DTPs were ineffective drug therapy 54(26.1%), need additional drug 52(25.1%) and dosage too low 47(22.7%), Factors independently associated with DTPs were female gender (Adjusted Odds Ratio [AOR] =2.21, 95%CI; 1.32-3.72), number of comorbidities (≥3) (AOR=3.18, 95%CI;1.21-8.38), non-adherence (AOR=4.52,95%CI;2.34-8.73). One-fourth (24.9%) of the participants were non-adherent to their medications. Factors associated with non-adherence were diabetes complications (AOR=2.02, 95%CI; 1.02-3.22), being female gender (AOR=1.71, 95%CI; 1.01-2.76) and primary and above level of education (AOR=0.42, 95%CI; 0.18-0.96). Drug therapy problems were substantially high. Ineffective drug therapy, need additional drug therapy and dosage too low, were commonly identified DTPs. Nearly one-fourth of the study participants were non-adherent to their medications. In response to this finding, tailored future intervention that target in prevention and resolution of those problems could be vital.
Treatment outcome and associated factors in acute heart failure patients at Tikur Anbessa Specialized Hospital, Ethiopia
(Addis Ababa Universty, 2018-02) Tirfe, Mulubirhan; Nedi, Teshome (PhD)
Treatment outcome and associated factors in acute heart failure patients at Tikur Anbessa Specialized Hospital, Ethiopia Mulubirhan Tirfe Tesfay Addis Ababa, Ethiopia February 2018 Heart failure is a syndrome when the heart fails to pump blood at a rate commensurate with the requirements of the body. Acute heart failure is a recent worsening of sign and symptom of heart failure requiring emergency visit and hospitalization. The aim of this study was to evaluate treatment outcome and associated factors that predict poor treatment outcome in acute heart failure patients at emergency department and medical ward. A prospective observational study was designed to evaluate predictors of poor treatment outcome. Data was reported as mean ± SD for continuous variables with normal distributed and median (interquartile range) with non-normal distributed variables; and chi square test was used for categorical variables. Bivariate and multivariate logistic regression analysis was used to evaluate factors that predict poor treatment outcome; p-value ≤ 0.05 was considered statistically significant and reported as 95% CI. Statistical package for social science (SPSS version 20) was used to enter and analyze data. The median age of patients with acute heart failure was 34 years (IQR = 23 to 50) and median hospital stay was four days (IQR = 3 to 6) with female (54.4%) dominance. The leading precipitating factor and underlying disease found at admission were pneumonia (47.5%) and chronic rheumatic heart disease (48.5%), respectively. Out of the 169 patients, 17.2% had poor treatment outcome among these six (3.6%) patients died. In multivariate logistic regression analysis smoking (adjusted odds ratio [AOR] = 8.7, p = 0.006), diabetes mellitus (AOR = 10.2, p = 0.005), pulmonary hypertension (AOR = 4.3, p = 0.016) and presence of adverse drug events (AOR = 4.2, p = 0.003) were predictors of poor treatment outcome.
Assessment of hypoglycemia and associated factors among diabetes mellitus type one patients attending to outpatient clinics of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
(Addis Ababa Universty, 2018-03) Kahsay, Halefom; Nedi, Teshome (PhD, Associate Professor)
Assessment of hypoglycemia and associated factors among diabetes mellitus type one patients attending to outpatient clinics of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Halefom Kahsay Addis Ababa University, 2018 Hypoglycemia is one of the most common acute complications of type one diabetes mellitus(T1DM). It is an often-neglected obstacle of diabetes therapy which has far reaching up to life threatening impact and precipitate major cardiovascular and cerebrovascular events. The knowledge of factors associated with hypoglycemia will help in the prevention and management of hypoglycemia. Therefore, this study was aimed to assess hypoglycemia and its associated factors among type one diabetic patients attended to diabetes outpatient clinics of St. Paul’s Hospital Millennium Medical College(SPHMMC). A cross sectional study was conducted from June 01, 2017 to August 01,2017. Data were collected using a structured questionnaire. Multivariate logistic regression model was analyzed to find the association. In this study, among 247 participants 233(94.3%) of them were experienced hypoglycemia since diagnosed. Short duration of diabetes history(<1years) was significantly associated with less experience of hypoglycemia (AOR= 0.09, 95%CI:0.01-0.90). But, blood glucose monitoring at home were found to be significantly associated with more report of hypoglycemia(AOR=5.77,95%CI:1.16-28.66). Nearly two-third (65.2%) of patients perform self-monitoring blood glucose(SMBG) irrespective of frequency while only 68(42.2%) of them preformed three times daily. Being male was significantly associated with less performance of SMBG (AOR=0.43,95%CI:(0.23-0.80)). Whereas, educational level (primary school, AOR=4.29,95%CI:1.24-14.90) and shorter duration with diabetes (<1years and 1-5years), (AOR=4.45,95%CI:2.19-9.05 and AOR=8.85, 95%CI: 3.45-22.73) respectively, were found to be significantly associated with better performance of SMBG. Taking together, the findings indicated that prevalence of hypoglycemia was substantially high and the performance of SMBG was suboptimal, which warrants the need for health care providers engaged in diabetic care to aggressively address the issue.
Assessment of Drug Therapy Problems among Ambulatory Epileptic Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa Universty, 2018-03) Bedru, Beshir; Engidawork, Ephrem (Professor of Pharmacology)
Assessment of Drug Therapy Problems among Ambulatory Epileptic Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia Beshir Bedru Addis Ababa University, 2018 About 90% of epileptic patients in developing countries are not receiving appropriate treatment due to different reasons. Recurrence and breakthrough seizures can be caused by both drug and non-drug related problems such as inadequate or suboptimal antiepileptic regimens, adverse reaction and poor adherence. This may lead to reduced quality of life, increased overall health care cost and increased risk of morbidity and mortality. Management of epilepsy especially in developing country is challenging and drug therapy problems (DTPs) and poor medication adherence might be the major reasons. There is limited evidence regarding DTPs in epileptic patients thus this study aimed to asses DTPs and medication adherence among ambulatory epileptic patients at Tikur Anbessa Specialized Hospital (TASH). A hospital based cross sectional study was conducted on 291 epileptic patients who had follow up at TASH. Data collection was done through patient interview and medical charts review. Epi Info7.2.1 was used for data entry and data was analysed using SPSS version 21. Descriptive statistics, cross-tabulation, binary and multiple logistic regressions were utilized and P < 0.05 was used to declare association. Phenobarbital (67%) and phenytoin (33.3%) were among the frequently prescribed antiepileptic drugs both as monotherapy and combination therapy and only (18.6%) of the study participants had controlled seizure. DTP was found in 70.4 % of the study participants. Adverse drug reaction (41.5%) was the top DTPs identified followed by ineffective drugs (27.8%), drug interaction (12.8%) and inappropriate dose (11.9%). Headache, depression and epigastric pain were frequently reported adverse drug reaction. Carbamazepine was involved in majority of the drug interaction and phenobarbital in inappropriate dose (dose too high). The rate of medication adherence was 57.3% and the common reasons for non-adherence were forgetfulness, medication unavailability and fear of side effects. Number of medications taken by the patients had a significant association with occurrence of DTPs, whereas source of medication and seizure free periods were found to have significant association with poor adherence. Prevalence of DTPs among ambulatory epileptic patients was high and about half of the patients were non adherent for their medication.
Outcomes of Fertility Inducing Drugs at Family Guidance Association of Ethiopia Obstetrics and Gynecology Special Clinic, Addis Ababa: A Retrospective Cross Sectional Study
(Addis Ababa Universty, 2018-06) Abate, Demilie; Engidawork, Ephrem (Professor of Pharmacology)
Outcomes of Fertility Inducing Drugs at Ethiopian Family Guidance Association Obstetrics and Gynecology Special Clinic, Addis Ababa: A Retrospective Cross Sectional Study Demilie Abate Addis Ababa University, 2018 Infertility refers to the inability of couples to conceive a clinical pregnancy after one year or more of trying to conceive. The cultural practices and attitudes of nations and nationalities in Ethiopia uphold reproduction as the most important function of families. Childlessness remains to be the most undesirable experience within marriage for most couples. Unfortunately, due to the long standing traditional outlooks of the vast majority of the society, women are expected to carry the burden of impaired fertility in a family. Like in many other populations, impaired fertility is an important health concern for Ethiopian women. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance. Currently the use of medical assistance to achieve fertility among couples who can’t conceive regardless of their trial to get pregnant is on the increase. In Ethiopia, evidence showed that infertility treatment has been provided since the past two decades. The aim of this study was to assess the outcomes of fertility inducing drugs at Ethiopian family guidance association obstetrics and gynecology special clinic. The study was conducted at family guidance association of Ethiopia (FGAE) from April-June, 2016, employing a three year (July 1, 2012- June 30 2015) patient charts review supplemented by qualitative data from key informants. A structured check list was used to collect quantitative data, whereas qualitative data was collected using in-depth-interview guide. Among the total of 422 patients, 82.5% were females and majority of the patients were on monotherapy (44.3%). Primolut N was the commonest monotherapy used (44.3%), while the combination of primolut N and clomiphene were 26.3%. on the other hand primolut N three times was used only 3.1% and clomiphene three times was 1.9%, and their combination was 3.6%.
Baseline Assessment of the Current Practice of Antimicrobial Use and Clinical Outcome in the Management of Patients with Pneumonia Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Prospective Observational Study
(Addis Ababa Universty, 2018-07) Fenta, Theodros; Engidawork, Ephrem (Professor of Pharmacology)
Baseline Assessment of the Current Practice of Antimicrobial Use and Clinical Outcome in the Management of Patients with Pneumonia Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Prospective Observational Study Theodros Fenta, Addis Ababa University, 2018 Increasing antimicrobial resistance presents a major threat to public health because it reduces the effectiveness of antimicrobial treatment, leading to increased morbidity, mortality, and health care expenditure. In spite of the need for new drugs to treat resistant infections, a growing number of drug companies are withdrawing from new antibiotic research and development. Therefore, the issue of how we can most effectively utilize these precious resources calls for urgent action. Hence, the objective of this study was to assess the current practice of antimicrobial utilization and clinical outcomes in the management of adult pneumonia at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia and design a strategy for appropriate intervention. A prospective observational study was conducted on adult patients with a diagnosis of pneumonia admitted to TASH. A data abstraction format incorporating self-administered questionnaire were used to gather information from patient charts and treating physicians. Data was analyzed using SPSS version 20. Descriptive statistics and logistic regressions were used. P-values of <0.05 were regarded as significant. Among the total of 200 patients, 52.0% were males and mean age of the patients was 39.79 (SD±17.76) years. Microbiologically and imaging/radiologically examined patients were 75 (37.5%) and 122 (61.0%), respectively. The treatment approaches in almost all patients (99.5%) were empirical. The most commonly used antimicrobial regimens were Ceftriaxone 1gm BID + Azithromycin 500mg, PO, QD, (30.0%) for community acquired pneumonia and Vancomycin 1gm BID + Piperacillin/tazobactam 4.5gm iv QID, (8.0%) for hospital acquired pneumonia and health care associated pneumonia. The duration of antimicrobial therapy was 12 (SD±5). The clinical outcomes of the patients were stable 133(66.5%), and in-hospital mortality 37 (18.5%). In conclusion, antimicrobials were prescribed empirically without sufficient evidence of indication such as microbiological and radiologic findings.
Assessment of the Survival Status and Risk Factors for the Mortality of Multidrug Resistant Tuberculosis Patients at Adama and Bishoftu General Hospitals, Oromia, Ethiopia.
(Addis Ababa Universty, 2018-07) Fantaw, Debalke; Nedi, Teshome (PhD)
Assessment of Survival Status and Risk Factors for Mortality of Multidrug Resistant Tuberculosis Patients at Adama and Bishoftu General Hospitals, Oromia, Ethiopia. Debalke Fantaw, Addis Ababa University, 2018 Multi-drug resistant tuberculosis is a wide spreading global problem. The magnitude of this disease varies significantly from country to country and the treatment outcomes are inadequately described in Ethiopia. Hence, this study aims to assess the survival status and risk factors for mortality of multidrug resistant tuberculosis patients at Adama and Bishoftu General Hospitals. Retrospective cross-sectional study design was conducted among cohorts of multidrug resistant tuberculosis patients treated from May 2013 to August 2017 at Adama and Bishoftu General Hospitals. Data were collected using data abstraction format from 164 patient cards. All patients were used as study participants. Data were analyzed using STATA Version 13 statistical software. Risks were estimated for the entire follow-up time corresponding to each event occurrence using Kaplan-Meier method and the covariates were fitted to Cox Proportional Hazard Regression Model where 164 patients were followed for a total of 63,141 person-days. The median survival time was 400.5 days or 1.1 year. Among 164 patients, 74 (45.10%) were male and the mean age was 31.5 years. There were 30 (18.30%) known deaths and the survival probability of the study participants at 6, 12, 18 and 24 months of treatment was 84%, 82%, 81% and 72%, respectively. In this study: HIV, co-morbidities and co-infections, low initial body weight, age, occupation and Khat use were identified as risk factors for the death of MDR-TB patients. Comparison of these risk factors showed that there is a significant difference in the probability of survival on MDR-TB patients. Cox Regression analysis Model result showed that factors independently associated with mortality of patients were: HIV (HR=2.75,95%CI(1.23-6.15) &P=0.01); low initial body weight(HR=0.44,95% CI(0.22-0.85) &P=0.02); co-morbidities & co-infections (HR=2.28,95% CI (1.99- 5.26) & P=0.05); age (HR=2.3,95% CI(1.35-3.79) & P=0.00); Khat use (HR=0.41, 95% CI (0.18-0.97) & P=0.04); Occupation (HR=1.31,95% CI (1.06-1.63) & P=0.01). In conclusion, a higher death rate was noted in patients who started MDR-TB treatment with initial low body weight, HIV positive, co-morbidities & co-infections, age and Khat user.
Assessment of Drug Therapy Problems among Ambulatory Heart failure Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa Universty, 2018-07) Seid, Elham; Beyene, Alemseged (B.Pharm, MSc, Assistant professor)
Assessment of Drug Therapy Problems among Ambulatory Heart failure patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia Elham Seid Addis Ababa University, 2018 Drug therapy problems (DTPs) are a major concern in health care and have been identified as contributing to negative clinical outcomes. The Care of heart failure patients is commonly complicated by the presence of comorbidity and poly-pharmacy, which inturn intensify the risk of occurrence of DTP. The occurrence of DTPs in heart failure patients is associated with worsening of disease, frequent hospitalization, adverse drug event, drug-drug interaction, and poor patient compliance. There is limited evidence regarding DTPs in heart failure patients. Thus, this study aimed at assessing DTPs and medication adherence among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH).A hospital based cross sectional study was conducted on 423 heart failure patients who had follow up at TASH. Data collection was done through patient interview and chart review. Majority of the patients were in New York Heart Association class III (55.6%) and 66% of patients had preserved systolic function. About half of the etiology of heart failure was chronic rheumatic valvular heart disease (50.8%). Of the 423 participants, 277(65.4%) had DTPs with average number of 2+0.86 per patient. The most common DTPs identified were Drug interaction (40.5%) followed by not the most effective drug (17.5%), ADR (14.7%), inappropriate dosage (9.7%) and the need for preventive drug therapy (9.6%). β blockers were the most frequent drug class involved in DTPs followed by ACEIs, mineralocorticoid receptor antagonist, and antiplatelets. Metoprolol tartrate and Nifedipine were drugs with the highest drug risk ratio. Age, gender, presence of comorbidity, average number of drugs per day and left ventricular ejection fraction were an important risk factor for DTPs. The rate of medication non-adherence was 45.2%. Duration of treatment, average number of medication per day and ADR were found to have significant association with medication non-adherence. Prevalence of DTPs among heart failure patients was high and about 45.2% of the patients were non-adherent to their medication. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient’s quality of life and optimize healthcare costs.
Identification and Resolution of Drug Related Problems in Pediatric Hematology/Oncology Ward of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2019-01) Berihun, Malede; Engidawork, Ephrem(PhD, Professor of pharmacology); Dr.Adam, Haileyesus(MD, Pediatrics Hemato/Oncologist)
Even though, medications play a major role in the cure, palliation and inhibition of disease, they also expose patients to drug related problems. Drug related problems are frequent and may result in reduced quality of life, and even morbidity and mortality. Many studies have shown that clinical pharmacists can effectively identify and resolve clinically significant drug related problems. There is no data regarding drug related problems in pediatric cancer patients in Ethiopia. This study was aimed to identify and resolve drug related problems in Pediatric Hematology/Oncology ward of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A prospective interventional study was used to assess drug related problems on patients admitted at the Pediatric Hematology/Oncology ward of Tikur Anbessa Specialized Hospital between 25 June to 25 October, 2018. Data were obtained from the patients’ medical chart, physician, patient/care giver, pharmacists and nurses. All the collected data were entered and analyzed using the Statistical Package for the Social Sciences version 25 software. Among the total 156 participants, Drug related problems were identified in 68.6% of the study subjects. Dosing problems which includes dosage too low and high were the top ranking (39.3%) of all drug related problems followed by needs additional therapy (27.2 %) and non-adherence (14.0%). Anti-infectives for systemic use were the most common drug classes involved in drug related problems followed by antineoplastic and immunomodulating agents. Trimethoprim-sulfamethoxazole, methotrexate, vincristine, ondansetron and metoclopramide were the top ranking drugs involved in drug related problems. Addition of drug and change in drug dose were the two most proposed intervention types. Among the proposed interventions, 223 (92.15%) were fully accepted, 9 (3.72%) partially accepted and 10 (4.13%)not accepted. Length of hospital stay (AOR = 30.63, 95%; CI: 6.72, 139.63; P=0.000) was found to be a risk factor for occurrence of drug related problems. Drug related problems are common among Pediatric Hematology/Oncology ward patients. The study also demonstrated that clinical pharmacists can effectively identify and resolve clinically significant dug related problems. Length of hospital stay is an important risk factor for DRPs, but there is no significant vi association between occurrence of DRP and sex, age, presence of neutropenic fever in the study subjects
Assessment of Drug Therapy Problems and Contributing Factors among Adult Ambulatory Hypertensive Patients in Ayder Referral Hospital, Mekelle Northern Ethiopia: A cross sectional study
(Addis Ababa University, 2019-02) Mahammedsied, Werkya; Shibeshi, Workineh(PhD); Feyissa, Mamo
Hypertensive patients are at high risk of Drug therapy problems (DTPs) as they often received multiple medications in order to achieve their target blood pressure. Currently studies concerning DTPs in patients with hypertension are limited in Ethiopia. Therefore, this study was aimed to assess the magnitude of DTPs and contributing factors among adult ambulatory hypertensive patients in Ayder referral Hospital. Institution based cross sectional study was conducted among 384 study subjects who fulfilled the inclusion criteria. Trained data collectors collected the data from patient interview and chart review using structured data collection format. DTPs were assessed using Cipolle‘s classification system. Logistic and multivariate regression analysis was performed to identify factors associated with DTPs. Data were reported as mean and percentage using tables and figures. DTPs were found in 52.8% of study subjects. A total of 277 DTPs were identified from 203 study subjects in which, 1 DTP was identified from 133(65.5%) patients, 2 in 66 (32.5%) patients and 3 in 4(1.97%) patients. The maximum number of DTPs found was 3 and the average number of DTPs per patient was 1.36. Unnecessary drug therapy was the top leading (32.5%) and dose too low (7.94%) was the least type of DTPs in the study subjects.ACEIs were the most frequent drugs involved in DTPs.The factor that was independently associated with DTPs was the total number of medications. The total number of medications taken by the patient per day was an important predictor of drug therapy problem AOR = 2.572 95% CI (1.062-6.229), P=0.01.
Assessment of Drug Therapy Problems and Medication Adherence among Ambulatory Hypertensive Patients on Follow up at Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2019-04) Tileku, Melaku; Engidawork, Ephrem(Professor of Pharmacology); Beyene, Alemseged(MSc., Assistant Professor); Abebe, Sintayehu(MD., Internist, Cardiologist)
Hypertensive patients are at high risk of drug therapy problems (DTPs), as there is multiple drug use for their comorbidities. To date, studies regarding DTPs in hypertensive patients are limited in Ethiopia. Thus, this study aimed to assess DTPs and medication adherence among ambulatory hypertensive patients on follow up at Tikur Anbessa Specialized Hospital (TASH). A hospital based cross sectional study was employed in 388 participants who fulfilled the inclusion criteria. Participants were interviewed and their medical chart was reviewed through a structured data collection formats. DTPs were assessed using Cipolle/Morely/Strand’s DTPs classification system. Data were reported as mean/percentage and multivariate logistic regression was performed to identify associated factors with DTPs. Out of 388 study participants, 283 of them had at least one DTP, of which 49.5% and 40.3% had drug interactions and adverse drug reactions (ADRs), respectively. Factors associated with DTPs, were old age (Adjusted Odds Ratio [AOR] =1.05, 5%CI:1.02-1.08), longer duration of treatment (AOR=1.06,95% CI:1.01-1.10), presence of complaints (AOR=2.23, 95%CI:1.06-4.71), ≥3 comorbidities (AOR=2.27, 95%CI:1.06-4.88), ≥5 drugs use (AOR=2.15, 95%CI:1.02-4.50), statins use (AOR=2.62, 95%CI:1.09-6.30) and aspirin use (AOR=3.79, 95%CI:1.11-12.87). About 45% of the study participants were non-adherent to their antihypertensives. Factors for non-adherence were monthly income of <500 Ethiopian birr (AOR=1.68, 95%CI: 1.03-2.72), ≥5 drugs use (AOR=2.36, 95%CI: 1.02-5.47), use of antidiabetics (AOR=1.95, 95%CI: 1.09-3.51) and non-steroidal anti-inflammatory drugs use (AOR=0.43, 95%CI: 0.20-0.91). DTPs were common among ambulatory hypertensive patients in TASH, indicating a need of multidisciplinary team that involved pharmaceutical care providers to identify and resolve DTPs in this setting.
Blood Pressure Control and Associated Factors among Hypertensive Patients Attending Shashemene Referral Hospital, Oromia, Ethiopia.
(Addis Abeba University, 2019-05) Jeldo, Aliyi; Dr. Nedi, Teshome (PhD, Associate Professor of pharmacology)
Hypertension is an important public health challenge worldwide. It is defined as persistently elevated arterial blood pressure (BP), systolic BP (SBP) ≥ 140 mmHg and/or diastolic BP (DBP) ≥ 9 0 mmHg or use of antihypertensive medication in adults older than 18 years. The aim of this study was to assess blood Pressure control and associated factors among hypertensive patients attending the outpatient department of Shashemene referral hospital. Hospital based cross sectional study was conducted to determine level of blood pressure control and associated factors among hypertensive patients on medical follow-up. A medical chart review and interview was conducted from July to October 2018. A total of 325 participants were included in this study with response rate of 320 (98.5%). More than half of study participants were males 171 (53.4%). The mean age of the respondents was 55.10 (SD=12.7) years and majority of the respondents 191 (59.7%) were within age of less than 60 years old. The mean SBP was 131.80 mmHg (SD=20.92) while the mean DBP was 82.30 mmHg (SD=10.52). About 51.30% of study participants had a controlled SBP and 54.7% had a controlled DBP as per JNC 7 while 36.9.3% and 44.4% had their SBP and DBP controlled as per ACC/AHA 2017 guideline respectively. The overall control of BP was achieved in 40.3% of the study participants as per JNC 7 and 31.3% as per ACC/AHA guideline. Multivariable logistic regression analysis showed that age, experience of side effects, adherence to medications, frequency of BP measuring, number of antihypertensive drugs used, duration on antihypertensive, source of medication and physical exercise showed significant association with blood pressure control. Blood pressure control level among chronic hypertensive patients at outpatient department was low. Adherence to antihypertensive medications and life style related factors, age of patients, educational level, experience of side effects, and number of antihypertensive drugs used were important determinant factors associated with blood pressure control among study participants. Other factors like class of antihypertensive drugs used, known family history of hypertension and presence of other comorbidities were not significantly associated with blood pressure control among study participants.
Assessment of the management of dyspepsia in health centers of Addis Ababa city administration, Ethiopia
(Addis Ababa University, 2019-06) Mustefa, Mintesnot; Nedi, Teshome(PhD)
Despite the progress made in reducing morbidity, dyspepsia is one of the most common GI diseases, resulting in impaired quality of life and work loss. The purpose of this study was to assess the management of dyspepsia in health centers of Addis Ababa city administration. A cross sectional study was conducted from September 1, 2016 to January 30, 2017 by using previously tested data extraction tool for extract relevant information, which then entered to Epi data and SPSS 20 was used for data analysis. A logistic regression was employed to examine the association between variables. A total of 850 patient with dyspepsia were enrolled, from those study participant 29% had got inappropriate managements. Of all dyspepsia patient who attend health centers 34.2% and 65.8 % were received one drug prescription and triple drug prescription respectively. Regarding appropriate management based on the cause of dyspepsia, patients with NSAIDS are less likely to have appropriate dyspepsia management (AOR= .718(.441, 1.168); P=0.001) than H. Pylori (AOR= 1; P= 0.001) and Stress cause dyspepsia (AOR= 1.642(.893, 3.021). Patients’ age group from 16 to 30 account 46.4%, which is a higher prevalence of dyspepsia compare to other age group in the study, also women 58.1% have a higher prevalence of dyspepsia. Based on the finding of this study, it can be concluded that health professionals are mostly follow the guidelines but not always with respect to the use of single and triple treatment in management of dyspepsia which depend on the cause. Proton pump inhibitors drugs have high prescription rate than histamine 2 antagonist and antacid regardless to the cause. Almost half of patients with dyspepsia use NSAIDS. Patient who need additional antibiotic that was not received were higher than patient who received antibiotic that was not needed so it is important that intervention is needed to educate clinicians about the danger of irrational drugs use and to promote the recommended guide lines in the management of dyspepsia.

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