College of Health Sciences

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30 day’ Post-operative complicationsof Intracranial Meningioma Surgery
(Addis Abeba University, 2020-01) Sileshi, Dagmawi; Kasahun, Azarias( MD, FCS (ECSA), Assistant professor)
Background: Meningioma is the most common primary intracranial tumor. Even though different management options exist in modern medicine, surgery is still the only cure for this benign tumor. Surgical options are not without risk. Identifying and predicting the short-term complications in an Ethiopian setup might be useful in the decision-making process before surgery for our patients. This study uses a prospective design that aims to assess 30 days of posoperative complications of intracranial meningioma. Methods: Aprospective study that was conducted at TASH, ZMH & MCM hospital between November 1, 2019, and September 1, 2020. Assessment of postoperative complications was determined in-person using a standard questionnaire in both inpatient & outpatient setup. For the investigation, pathology & Intraoperative findings data were collected from medical charts, radiology, and pathology archives.Data were checked for completeness and quality control aftewhich, it was entered on SPSS version 21 for analysis using logistic regression. Results:A total of 77 patients were enrolled in the study. The mean age of the patients was 40.94 years. 71 (92%) patients presented with headache and 62 (80.5%) patients had one or more focal neurologic deficits. Tumor was classified based on location and size. 47 (61%) of the tumors were skull base tumors.The surgical mortality rate which was defined as death within one month was 9.1%. Among all patients, 37 (48.1%)had one or more postoperative complications of which new-onset or worsened focal deficit was the commonest. A significant association was seen between skull base tumors and postoperative complications in both bivariate and multivariate analyses witha p-value of 0.01 (OR=5.79, 95% CI: 2.061-16.312. Conclusion: Even though the complications and mortality rates were high, surgery led to symptom improvement in a large proportion of patients. Skull base meningioma, anesthesia time more than 5 hours, and blood loss more than 1000ml hada significant association with postoperative complications.
A Queuing Analysis of Medicines Registration System Performance in Ethiopian Food and Drug Authority
(Addis Ababa University, 2023) Alamneh,Abebe; Ali,Eskinder Eshetu(Dr.); Marew,Tesfa
Background: The limited number of approved medicines and long waiting time for registration are the major challenges limiting the performance of the regulatory system in Ethiopia. Queue analysis is used for characterizing and estimating the queue process and operating variables of the system to alleviate the challenges related to target timelines. Objective: To assess the queuing performance of the registration system at the Ethiopian Food and Drug Authority (EFDA). Methods: A mixed sequential explanatory study design was used for the study. Quantitative data collection involved a review of applications submitted to the EFDA from July 8, 2019 to July 7, 2020. Basic operating characteristics of the registration system performance were executed using single queue multiple server model of the queuing analysis. In-depth interviews with purposively selected registration experts from the EFDA and private organizations were done for the qualitative data collection. Analysis of the interviews involved the thematic analysis approach. Results: Mean arrival rate of applications to the registration system (λ=10.99 services per day) was 23.74% higher than the mean effective service rate of the system (cμ=8.38 services/day). Basic system performance average operating characteristics of the system could not be estimated indicating that an infinite queue of applications built up over time and was hard to achieve any target timeline in EFDA’s current registration system. The qualitative study also showed that the system is being frequently challenged with backlogs. Conclusion: The study documented weak system performance with lengthy registration process. Appropriate measures to improve mean effective registration service rate should be introduced to meet international standards and the agreed citizen’s charter of 2016.
Acceptability and Associated Factors of Provider Initiated HIV Counselling and Testing among OPD Clients with Possible Clinical Sign of HIV Infection in West Arsi Zone, Ethiopia.
(Addis Abeba University, 2011-05) Tesfaye, Tsegaye; Dr. Addissie, Adamu (MD, MPH, MA)
Introduction: HIV counseling and testing is a gateway to prevention, treatment, care and support services and an essential tool in the control of HIV/AIDS epidemic. Currently HIV status has been very low which cannot be achieved only through the traditional VCT alone and another alternative, routine HIV testing and counseling of patients, also called provider initiated HIV Counseling and testing is proposed. Objective: To assess the acceptability and associated factors of provider initiated HIV counseling and testing among OPD clients with possible clinical sign of HIV infection in West Arsi zone, Ethiopia. Methods: Facility based cross sectional study was conducted on outpatient department clients with possible clinical sign of HIV infection in 6 selected health facilities in West Arsi Zone, Ethiopia. The health facilities were selected randomly; study subjects who came to the health facilities were consecutively interviewed. Data collected by a pre-tested, structured interview questionnaire. Regression model was used to assess factors associated with acceptability of provider initiated HIV Counseling and testing. Results: A total of 539 clients were interviewed with a response rate of 92.3%. The majorities (66.4%) were married, major age distribution was range from 25-29 (29.1%) and the main religion was Muslim (66.2%). Knowledge on importance of provider initiated HIV Counseling and testing was low. The willingness and overall acceptability rate was 86.5%, and 83.1% respectively. The major perceived barriers for acceptability were mainly thinking self as not being at risk, followed by fear of stigma and discrimination. On adjusted covariates of acceptability, acceptability of PIHCT was found to be associated with having information on PIHCT service (OR=0.36; CI=0.22-0.60), less and much support for PIHCT (OR=0.30; CI=0.11-0.85 and OR=0.31; CI=0.12-0.77) and tested for HIV before (OR=0.20; CI=0.10-0.41) Conclusion and Recommendations: The acceptability noticed in this study is high. The major perceived barriers for acceptability was thinking self as not being at risk. Having information on PIHCT service, tested for HIV before, and extent of support for PIHCT were found to be important predictors of acceptability of PIHCT. Hence, intensive IEC/BCC and promotional activities through different means should be in place to raise level of awareness, support and routine testing to facilitate its acceptability and reduce major barriers that affect PIHCT service utilization at all level.
Acceptability of Azithromycin Mass Treatment for Trachoma Elimination in Injibara Town and Adjacent Banja Woreda of Awi Zone, Amhara Region
(Addis Ababa University, 2014-06) Tilahun, Zelalem; Gedif, Teferi(PhD)
Trachoma is the leading cause of infectious blindness worldwide. Globally 1.2 billion people live in endemic areas. In Ethiopia, approximately 67 million people are at risk for trachoma. The Amhara National Regional State of Ethiopia is the most trachoma-endemic among all nine regional states and two city administrations, with Trachomatous inflammation Follicular prevalence of 62.6%. Mass azithromycin treatment is the one arm of the SAFE strategy. The trachoma elimination program would be successful if and only if the coverage is as high as possible with full community participation. If not all the community members attend the mass treatment, the trachoma infection will return to the baseline prevalence after the treatment stopped due to high transmission rate. The objective of this study was to assess the acceptability of the azithromycin mass treatment and its determinants in Injibara town and the adjacent Banja woreda of Awi zone, Amhara National Regional State. A community based cross sectional survey with both quantitative and qualitative methods was conducted from July 7-25, 2013. Households’ survey with structured questionnaire, FGDs and key informant interviews were used for data collection. A total of 5826 eligible household members from 1267 households were enrolled in the survey. The 2012 annual azithromycin mass treatment coverage obtained from the present study was 92.9%. From the total 6 rounds of azithromycin mass treatment in the study area, only half (50.6%) of the community took for more than three times. On average, each illegible person in the community had taken the drug for 3.6 times. The percentage of rural household members who had taken azithromycin more than three times was higher than the corresponding urban members. The rural residents were at better performance in taking the 2012 treatment as compared to the urban residents (AOR=2.35; 95%CI [1.80-3.06]). Household heads interference with the drug uptake of their family members’ has negative association with azithromycin uptake (AOR=0.153; CI=95% (0.086-0.272). All the study participants who were X greater than 30 years more likely took azithromycin more than 3 times as compared with children less than 15 years (COR=2.81, AOR=2.74, 95% CI [1.95-3.02]). Azithromycin uptake status of female household heads was less than the corresponding male household heads (AOR=0.41; 95% CI [0.24-0.720]). Household heads awareness about trachoma (AOR=2.55; 95% CI [1.19-5.44]) and azithromycin mass treatment (AOR=7.19; 95% CI [3.27-15.82]) had positive association with acceptability. The 2012 azithromycin mass treatment coverage in Injibara town and Banja woreda was higher than the WHO minimum target. But, concerning to the overall coverage, the data taken from the present study contradicts the coverage data taken from the woreda. The communities’ Azithromycin mass treatment acceptability had increased in the recent campaigns as compared to the previous campaigns. There is low coverage and acceptability of the treatment in the urban community as compared to the rural residents. Supplementary benefits of azithromycin, health education about trachoma and the drug, willingness and being old are some of the factors positively related with acceptability whereas educational status, marital status and experience with side effects were not associated with the drug uptake status. Strengthen the program in the urban and consideration of additional campaigns for both areas as well as providing additional health education with skilled health professionals is mandatory. Key words: Azithromycin mass treatment, Mass drug administration, Acceptability, Trachoma, Trachoma elimination
Acceptability of cervical cancer screening using See and Treat (SAT) approachand determinant factors among women of reproductive age in health centers in Addis Ababa, Ethiopia.
(2017-10) Bejiga, Birra; Ahimed(Professor), Ali
Background: Cervical cancer is one of the leading causes of morbidity and mortality amongst female cancer worldwide, especially in developingcountries, including Ethiopia. The level of women’s acceptance of cervical cancer screening and treatment service is low and not well documented in Ethiopia. The current study sought to assess women’s acceptance about cervical cancer screening and determinant factors of the service. Objective: The objective of this study was to assess the acceptability of cervical cancer screening and treatment of precancerous cervical lesions and determinant factors among Women aged 30–49 years at selected health centers in Addis Ababa, Ethiopia. Methodology: A facility based cross sectional study which contain quantitative and qualitative methods were conducted at 14 public health centers in Addis Ababa, from November, 2016 to October 2017.Totally a sample of 316 women aged 30–49 years were taken for Quantitative study and a single stage simple random sampling technique was employed to address the study subjects. For the Qualitative part 12 health professionals who were providing the service were interviewed purposively. Acceptability of cervical cancer screening and treatment service was measured after the women underwent the procedure, using women’s Satisfaction on service delivered.Descriptive, Binary and multiple logistic regressions were employed to determine factors associated with acceptance about cervical cancer screening and treatment service.The transcribed and translated qualitative data was coded using cut and paste method of similar item. Then finally the codes were categorized and thematically described. Result: one hundred forty seven (47%) of the participants accepted cervical cancer screening and treatment service. Almost half (48.6%) of the participant were not knowledgeable. After adjusting for covariates, acceptance of cervical cancer screening and treatment service was positively associated with being governmental employee [(AOR=5.85, 95% C.I:5.85(1.7, 20.0)], women who had history of vaginal burning [(AOR=4.57, 95% C.I:4.57(1.417,14.76)], information about status of women [ (AOR = 0.06,95% CI: (0.014,0.26)], Delay screening and treatment time [(AOR = 7.6,95% CI: 7.6(2.89,20)], happy with staff behavior,[(AOR =4.6, 95% CI: 4.6(1.1,19.77)], health education about the service [(AOR = 2.45, 95% CI: 2.45(1.049,5.74)] , and women who were happy with setup of examination room [(AOR = 3.96, 95% CI: 3.96(1.32,20.85)] respectively. Conclusion and Recommendation: This study shows a suboptimal acceptance of cervical cancer screening and treatment services. Occupational status, test related problem, Lack of health education, Delay screening and treatment time, setup of examination room and staff behavior were found to be important determinants. Efforts are needed to increase women’s acceptance and knowledge about the service. Organization working on cervical cancer should establish a separate service delivery on screening and treatment program and should highly enhancehealth education and awareness creation program.
Acceptability of COVID 19 Vaccines among Health Care Workers and its Determinants in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021G.C.
(Addis Abeba University, 2021-11) Abraham, Yisehak; Dr. Tilahun, Rahel(Senior Anesthesiologist); Dr.Birhanu. Tseganesh (Senior Anesthesiologist)
Background: Healthcare workers who have negative attitudes, are averted, or are hesitant about vaccinations share these unfavorable attitudes and tend to recommend vaccination to their patients infrequently(1). Despite the huge efforts made to achieve successful COVID-19 vaccines, a major hindrance can be related to vaccine hesitancy towards the approved and prospective COVID-19 vaccination(2). The willingness to accept the vaccine among health care workers range from 28% lowest in Congo to 77% in France(3,4). Objective: To assess the acceptability of a COVID-19 vaccine among healthcare workers in Tikur Anbessa specialized hospital, Addis Ababa 2020G.C. Method: Institutional based descriptive cross sectional study was conducted among health care workers of Tikur Anbessa specialized hospital. Which is one of the tertiary hospital in the country. The source population was health care worker of Tikur Anbessa specialized hospital. Stratified random sampling was used with a final sample size of 384. The data was collected using an online questionnaire. Data was checked for completeness and imported to SPSS 20 software for analysis. Descriptive analysis was done for Socio-demographic and clinical characteristics of the participants. Bivariate logistic regression was done for each predictor variable and outcome variable. Multiple logistic regressions were done and statistical significance p-value less than 0.05 was taken as a determinant factor. Result: Of the total 390 health care worker who started the online questionnaire 384 completed it a (98.4% completion rate). Among the 384 participants 256(66.7%) respondents were willing to have the COVID 19 vaccine, 50.8 % were willing to be vaccinated as soon as the vaccine becomes available while 49.2% would delay vaccination until the vaccine's safety is confirmed. Having a high risk of contracting COVID and believing that the COVID-19 vaccine should be compulsory for all increased probability of getting vaccinated Conclusion and recommendation: Healthcare workers are at great risk of contracting and spreading the disease and, unless wide-acceptance of the vaccine is achieved. One of the crucial method is to alleviate fear of side effects.
Acceptance of Index Case HIV Testing and Counseling among HIV Patients under Ossa Care and Support Outlets and Zewditu Memorial Hospital, Addis Ababa
(Addis Abeba University, 2013-09) Abraham, Haileyesus; Mitike, Getnet (PhD)
Background: HIV Counseling and Testing is one of the effective means for prevention of the spread of HIV infection. Partners and family members of PLHIVs are at higher risk for HIV infection. Thus, studying the acceptance of index case HTC and disclosure is important to improve the service. Objectives: This study aims to identify barriers to disclose HIV status by index clients and factors predict the acceptance of ICHTC. Methods: A cross-sectional study was conducted in Zewditu Memorial hospital and OSSA care and support outlet. A facility based systematic random sampling was followed to select 452 HIV positive individuals. Descriptive and inferential stastics wre usedto assess factors associated with acceptance of index case HTC and disclosure of HIV sero status. Result፡ The level of disclosure to main sexual partner was 56%. PLHIVs who had no sexual partner than spouse [OR: 8.15; 95% CI, 2.06-32.19] and had positive attitude to index case HTC [OR: 2.55; 95% CI, 1.63-4.0] were more likely to disclose their status. Index clients whose family and partner accepted HTC were 64% and 73%, respectively. Disclosure of status to family [OR: 2.40; 95% CI, 1.54-3.74] and friends [OR: 2.06; 95% CI, 1.19-3.57], being knowledgable [OR: 2.19; 95% CI, 1.39-3.44] and non-regular partnership [OR: 3.86; 95% CI, 1.68-8.83] were positively associated with acceptance of ICHTC. Nondisclosure to main sexual partner was protective to acceptance HTC. Conclusion and recommendation: Disclosure of self status, positive attitude to HTC, initiation for testng and being knowledgeable were factors influenced acceptance of HTC. Poor knowledge on HIV and risk assessment and negative attitude to ICHTC were barriers to disclosure. Intervention should prioritize mutual disclosure of HIV status, make clear understanding on HIV and its risks, benefits of ICHTC and develop positive attitude to ICHTC.
Acceptance Rate and Associated Factors of Immediate Postpartum Intrauterine Contraceptive Device among Women who Delivered Selected Public Hospitals of Addis Ababa, Ethiopia, 2021
(Addis Ababa University, 2021-05) T/silassie Wondossen; Mekonen Hussen( Prof); Mekonen Baize (Msc)
Background: Despite of highly effective, inexpensive, non-hormonal and immediately reversible. The acceptance rate of postpartum intrauterine contraceptive device was very low in developing countries including Ethiopia. Therefore, the goal of the study to determined acceptance rate with its associated factors among women who delivered in selected public hospitals of Addis Ababa. Objective Acceptance rate and associated factors of immediate postpartum intrauterine contraceptive device among women who delivered in selected public hospitals of Addis Ababa, Ethiopia. Method: - A cross-sectional study design based on an institution was used on 336 participants. Data collectors used a pre-tested and organized questionnaire to collect information. The data was entered into EpiData 4. 6 statistical packages and then exported to SPSS version 25 for further analysis. To assess the relationship between each independent variable and the dependent variable, bivariate and multivariate logistic regression analyses were utilized. Result: -The acceptance rate was founded to be a total of 336 participants responded (98.5 %). Immediately delivered women's educational status (AOR =0.160, 95 % CI: (0.040-0.649) Private employers, daily laborer, and student were significantly linked(AOR=4.269, 95 % CI: (1.280-14.234) (AOR=7.373, 95 % CI: (1.534-35.433)(P<0.013), and (AOR=11.004, 95 % CI: (1.602-75.572) respectively. Monthly income of 3201-5250, 5251-7900, and maternal monthly income greater than 7901 (AOR =4.731,95 % CI: (1.497-14.949) (AOR =5.712, 95 % CI: (1.489-21.910) and (AOR =6.589, 95 %CI: (1.736-25.009) were all significantly related. Favorable attitude (AOR = 14.457,95 % CI: (4.999-41.806). This was found to be significantly linked to the acceptance rate of immediate postpartum intrauterine contraceptive device. Conclusion and recommendations: The rate of immediate postpartum intrauterine contraceptive device uptake was low. Maternal education, occupation, monthly income,and attitude are all linked to acceptance rates. Health-care education, a change in women's attitudes, and frequent training for healthcare workers are all important.
Access to Essential Psychotropic Medicines in Addis Ababa: A CrossSectional Study
(Addis Ababa University, 2022-01) Ayehu, Molla Teshager; Prof.Fenta, Teferi Gedif; Prof.Araya, Mesfin
Background: Mental disorders are becoming a growing public health problem worldwide, especially in low- and middle-income countries. To provide quality mental health services, regular and adequate supplies of appropriate, safe and affordable medications are required. However, significant percentages of people with severe mental disorders are not getting the treatment. Availability and affordability of psychotropic medicines, amongst others, are the major barriers for many patients in meeting their medication needs. This study aimed to assess the availability, prices and affordability of essential psychotropic medicines in the private and public health sectors of Addis Ababa city. Methods: A cross-sectional study design was used in 60 retail medicine outlets. Quota sampling and purposive sampling was applied to select the retail outlets. Data was entered and analyzed by using the pre-programmed WHO/HAI workbook and SPSS version 25. Outcome measures were described as percentage availability, median price and median price ratios, and the number of days' wages needed to purchase medicines by the lowest-paid unskilled government worker. Finally, the results were presented as statements, tables, figures and graphs. Results: The mean availability of LPG psychotropic medicines was 24.33% in Addis Ababa (28.7% in the public sector and 19.80% in the private sector), and of OB medicines were 2.42 %( 2% in the private and 2.8% in the public sectors). Similarly, the public procurement prices for 16 LPGs ranged from 0.25-4.83 MPRs and the median procurement price was 0.96 MPR. The patient prices for the LPGs ranged from 0.52-6.43 MPRs in public and 1.08- 24.28 MPRs in private sectors. The patient prices for OB medicine were 5.21 MPR in public and 11.17 in private sectors. The cost of standard treatment varied from 0.1–7.8 days' wages in public and 0.8-25 days' in private sectors for the lowest-paid government worker to purchase a month's supply. Conclusions: Essential psychotropic medicines were poorly available with high prices and low affordability in Addis Ababa. To ensure access, an efficient supply across all levels of care and financial protection for key medicines should be in place.
Accuracy of Ultrasound in Fetal Sex and Weight Determination in the 2nd & 3rd Trimester When Performed By Radiology Residents & Recent Graduates: A Cross Sectional Facility Based Study
(Addis Ababa University, 2015-10) Hashim, Yasmin; Kebede, Tesfaye(Associate professor)
Background: Ultrasound is one of the non invasive methods for fetal sex determination and with its introduction visualization of the fetal genitalia has become possible. Although mainly fetal sex determination is done for parental curiosity it has also some clinical implication. Accurate prenatal EFW in late pregnancy and labor is extremely useful in management of labor, aiding in decision making about instrumental delivery, trial of labor after caesarean delivery and elective Cesarean section for patients suspected of having a macrosomic fetus. Objective: Purpose of this study was to assess the accuracy of ultrasound in fetal sex determination in 2nd & 3rd trimester & weight determination in those ≥ 38wks when it is performed by those with lesser experience and exposure Methods: Obstetric ultrasound and ultrasound of the perineal region of the fetus was done on 600 pregnant women to detect the sex of the fetus with gestational age from 16 weeks to term. Completer data and information was available in 55o of the study. There were 20 twins in the study making the overall fetuses in the study 570. For fetal weight accuracy study 235 mothers with gestational age of ≥38weeks were included. Ultrasound results were registered on pre-prepared form at the time of examination. The sex & weight was confirmed at the expected time of delivery through a phone call to the mothers and for some by revising their medical cards. Results: Out of 570 fetuses ultrasound was able to determine the sex for 527 (92.5%); 287 of whom were confirmed female and 240were male. Overall accuracy was 84.92%. Accuracy for females was 91.63% and for males was 92.08%. When the not sure cases are excluded and samples for which actual sex determination was done are analyzed the accuracy was found to be 92%. From the 235 samples with GA of ≥38 weeks the accuracy of ultrasound fetal weight estimation within 10% of actual birth weights was 85.5%. The mean absolute error of estimated fetal weight was 226.67gm. Ultrasound generally underestimated the birth weight. Specifically ultrasound overestimated the fetal weight in those <2500gm and underestimated in those>4000gm. Conclusion: Ultrasound is an accurate method to determine the fetal sex in the second and third trimesters with a sensitivity of 90% and specificity of 93.2% even when it is performed by those with less experience and exposure. In conclusion EFW by ultrasound in term pregnancies using the Hadlock formula was found to have a high accuracy rate when it is performed by those with less experience and exposure. So it can be applicable to make clinical decisions even when it is done by those with less experience. The over estimation of LBW and under estimation of macrosomia found in ultrasound weight estimation should be given due attention
Activity Testing, Toxicity Assay and Characterization of Chemical Constituents of Medicinal Plants Used to Treat Tuberculosis in Ethiopian Traditional Medicine
(Addis Ababa University, 2016-04) Kahaliw, Wubayehu; Engidawork, Ephrem (PhD); Abebe, Markos (PhD)
Background: Tuberculosis (TB) is the leading killer disease worldwide. In 1993, WHO declared TB as a ‘global emergency,’ which requires emergency action and launched several programs to curb the disease, including the search for newer remedies and/or anti- TB agents to complement currently used agents. Hence, herbal remedies have become the readily available alternatives in the search for new antimycobacterial compounds. Objective: To investigate antimycobacterial activity and toxicity of selected Ethiopian medicinal plants (Otostegia integrifolia, Vernonia amygdalina, Persea americana, Pterolobium stellatum and Carissa edulis) as well as to isolate the main active principles through a bioassay guided process. Methods: Antimycobacterial activity test was conducted using the broth microdilution and microtitre resazurin assay methods in 96 well microtitre plates and MIC was determined by colony counting and resazurin color change observation for all test materials. Cytotoxicity test was performed based on the CellTiter 96® AQueous One Solution Cell Proliferation Assay on HepG2 cells. Genotoxic effects of extracts were evaluated using SCGE method on HepG2 cells. Results: Chloroform and 80% methanol extracts of P. stellatum and O. integrifolia as well as 80% methanol and acetone extracts of P. americana had significant antimycobacterial activity (p < 0.001) against M. tuberculosis H37Rv, while chloroform extract of V. amygdalina and C. edulis didn’t show significant activity compared to negative controls. The MIC of positive control was 0.125 μg/ml against the standard strain. However, MDR-TB clinical isolates were isoniazid resistant. Fractionation and activity testing of the chloroform extract of P. stellatum revealed that ethyl acetate ii fraction to be the most active fraction against M. tuberculosis H37Rv with MIC of 0.195 μg/ml. The MICs of compound 1, 2 and 3 were 1.25, 2.5 and 0.625 μg/ml, respectively. In the cytotoxicity test, V. amygdalina chloroform extract showed the highest IC50 value (3.202±0.3375), which suggests its safety. O. integrifolia and P. stellatum chloroform extracts were the most toxic in dose dependent manner as one can see the steepness of the dose-response curve. DNA damage in the form of comet tail has been observed for 1 and 0.5 mg/ml P. stellatum chloroform and 80% methanol extracts on HepG2 cells, respectively. The rest of test extracts seemed to be without genotoxic effect up to a concentration of 0.5 mg/ml. Cytotoxicity test was not in the objectives of my study. Conclusion: P. stellatum, O. integrifolia and P. americana have potential to be developed into new anti-TB drugs or standardized herbal medicines. P. stellatum chloroform extract was the most active extract and hence, three compounds were isolated from ethyl acetate fraction and they were active against M. tuberculosis H37Rv. The results have also validated indigenous medical knowledge from the local people regarding the use of these species to treat TB. The IC50 value of P. stellatum chloroform extract was relatively higher compared to other extracts, suggesting its safety. In addition, its selectivity index was 13.5, which demonstrated > 10 selectivity index, considered as being of interest to the pharmaceutical companies. The genotoxicity assay findings revealed that the chloroform and 80% methanol extracts of P. stellatum caused DNA damage at 1 mg/ml and 0.5 mg/ml concentrations. Thus, necessary precautions should be taken during utilization of this plant.
Adequecy of Energy and Nutrient intake among Children aged 6-23 Months in Southern Ethiopia
(Addis Abeba Universty, 2016-03) Bedada, Beshadu; Hagos, Seifu(PhD)
Background In Ethiopia child malnutrition is the major public health problem as 44% and 10% of children under age five years were stunted and wasted respectively. Intake of complimentary food with inadequate energy and micronutrient density coupeled with inappriopriate child feeding practice remain common problem in Ethiopian infant and young child feeding. Despite the fact that there are number of studies indicating high burden of malnutrition in Ethiopia, energy and nutrient adequacy of complementary foods has not been well studied. Therefore this study is designed to assess the dietary adequacy of energy and micronutrients in complementary foods of children aged 6 -23 months. Objective: To determine the adequacy of energy and nutrient intakes among children aged 6-23 months. Methodology A community based cross sectional study was conducted in Southern Ethiopia from February to March 2016. The samples were selected using simple random sampling method. Data on foods and drinks consumed by children aged 6 – 23 months in the previous 24 hours before interview was collected using repeated multiple pass 24-hour dietary recall method. Nutrient content of food was calculated using food processor (version 8.1). Adequecy of nutrient intake and nutrient density were analysed using STATA 12.1. Prevalence of inadequacy was estimated using IMAPP 1.0. Skewness and kurtosis test were made to test normality of continuous variable. Descriptive statistics was carried out to characterize the study population. Result: One hundred ninety (n=190) mother or care givers of children aged 6 -23 months participated. Grain, roots and tubers were consumed by most of the children (94.68%). Vitamin A rich fruits and vegetable consumed by 71 (37.8%) children. Median protein intake exceed recommended intake for children aged 6 – 11 months and was below recommended intake for children aged 11 -23 months. Median intake of energy from complementary food was below the WHO recommendation for children aged 6 -23 months. Median intakes of micronutrients from complementary food were below the WHO recommendation for children aged 6 – 8 months. For children aged 9 – 11 and 12 -23 months median micronutrient intake from complimentary food were below the requirement except for vitamin B2 and vitamin B6. VII Conclusion: Protein intake from complimentary food was adequate for children aged 6 -11 months old. Energy intake from complimentary food was inadequate for children aged 6 -23 months. Micronutrient intake from complimentary food was inadequate except vitamin B2 and vitamin B6 intake were adequate were adequate for children aged 9 - 23 months. Recommendation: In food inscured area such as this, to enure adequate intake of macro and micro nutrient, nutritional counseling complmented with supplementation of may be needed. Key word inadequate intake, nutrient, energy, children 6-23 month
Adherence to Adjuvant Hormonal Therapy and Associated Actors Among Women with Breast Cancer Attending at Tikur Anbessa specialized hospital, Addis Abeba, Ethiopia, 2019.
(Addis Ababa University, 2019-06) Wako Zerko; Mengistu Daniel (prof); Getahun Negalign(BSc)
Background: Breast cancer is one of leading cause of morbidity and mortality in Ethiopia.Adjuvant hormonal therapy (AHT) is one of the treatment modality given for a patient withbreast cancer with estrogen receptor positive after primary treatment for 5-10 years. Nonadherence to adjuvant hormone therapy inbreast cancer survivors is commonand associated with increased risk of recurrence of cancer,invade the other breast,and consequently increase morbidity and mortality. Objective:Toassess level of adherence to adjuvant hormonal therapy and associated factors amongwomen with breast cancer who attends oncology outpatient at Tikur AnbessaSpecialized Hospital. Method: Institutional based cross-sectional study was conducted. Convenience sampling technique was used to select 216 participants. A semi-structured questionnaire was used after some modifications and Morisky Medication Adherence Scale (MMAS-8). Data were enteredin EpiData version 4.4.2.1 and exported to SPSS version 24, and analyzed using ordinal logistic regression with OR and 95%CI. Result: Out of 216, 209 women with breast cancer participated in the study with response rate of 97%. The level of adherence was 41%, 33%, and 26% for low, medium and high adherence respectively. Age group <45 is likely to be high adherence compared to >65 with (OR= 2.6,CI (3.8-7.6) p-value 0.001); being from urban (OR= 1.5, CI (1.1-2.8, p-value 0.001); being on tamoxifen (OR= 1.6, CI (0.4-2.2), p-value 0.005); having side effect (OR= 1.5, CI (0.4-1.9), pvalue 0.004); comorbidity (OR= 1.6, CI (1.5-3.4, p-value 0.001) and Getting a thorough therapeutic communication (OR= 1.7, CI (1.2-3.2), p-value 0.001) were found to be significantly associated with adherence to AHT. Conclusions and recommendations: In summary, the high adherence level to AHT among women with breast cancer was 26% in Tikur Anbessa Specialized Hospital. Age, place of residence, types of AHT, side effect, comorbidity, therapeutic communication from health care providers were significantly associated with adherence. Healthcare provider should give health education concerning medication usage, management of side effects and should also give due attention to rural patient.
Adherence to Antiretroviral Therapy in Currently Changed Treatment Guideline on People living with HIV/AIDS at Bishofitu Hospital, East Shoa, 2011. Ethiopa
(Addis Abeba Universty, 2011-01) W/Tsadik, Asegid; Work, Alemayehu(PhD)
Background: Adherence to antiretroviral therapy (ART) is crucial to ensure viral suppression, decrease the risk of disease progression and drug resistance. Non-adherence to ART, likewise, is common in all groups of treated individuals & lack of strict adherence to ART is considered to be one of the key challenges to AIDS care worldwide. Objective: To assess adherence to ART on currently changed guideline and factors associated with it among People Living with HIV/AIDS (PLWHA) attending ART unit at Bishofitu Hospital. Method: A cross sectional survey of 317 clients attending for ART at Bishofitu Hospital was carried out using both quantitative & qualitative design method. Using a structured and pre-tested questionnaire, data on drug adherence and other variables was collected through in-depth interview, peer educators FGD, patient’s self report (interview), pill count and by reviewing their clinical records. The nurse & ART Clinician who are working in the ART unit were involved in data collection after being trained. Ethical clearance was obtained from concerned bodies and consent was sought from the study subjects. Adherence is defined as the number of doses taken divided by the number of doses prescribed over a given period. It is considered as good if the patient took ≥ 95% of the prescribed doses correctly. Odds ratio was done to determine the strength of association for different variables. Major Findings The overall prevalence of HAART adherence was found to be, 398(95.4%) in this study. The highest proportion, 61 % of patients missed or delayed their doses due to simply forgetting & 47.4% due to being away from home & 29.4% being too busy. Independent positive predictors of HAART non adherence reported in this study comprise:-the participants who had: PLWHA’s residency far from Bishofitu hospital (>47 KM.), depression feelings , ART eligibility knowledge, medication adverse effect, history active substance uses, no adequate social support & one or two children under their care in the final adjusted multivariate analysis. Conclusions & Recommendations: The prevalence of ART adherence among clients using currently changed single combined fixed dose in this study was found higher than most studies done in developed countries & even much higher than the findings of other studies in Ethiopia. From these, we can infer that single & simplified ART has reduced the pill burden & helped the clients to take it at ease & this has increased the level of adherence behavior of clients, therefore continuous effort should be made to increase clients’ awareness to maintain the best level of adherence outcomes
Adherence to Antiretroviral Therapy in Currently Changed Treatment Guideline on People Living with HIV/AIDS at Bishofitu Hospital, East Shoa, 2011. Ethiopa.
(Addis Abeba Universty, 2011-01) W/tsadik, Asegid; Worku, Alemayehu(PhD)
Background: Adherence to antiretroviral therapy (ART) is crucial to ensure viral suppression, decrease the risk of disease progression and drug resistance. Non-adherence to ART, likewise, is common in all groups of treated individuals & lack of strict adherence to ART is considered to be one of the key challenges to AIDS care worldwide. Objective: To assess adherence to ART on currently changed guideline and factors associated with it among People Living with HIV/AIDS (PLWHA) attending ART unit at Bishofitu Hospital. Method: A cross sectional survey of 317 clients attending for ART at Bishofitu Hospital was carried out using both quantitative & qualitative design method. Using a structured and pre-tested questionnaire, data on drug adherence and other variables was collected through in-depth interview, peer educators FGD, patient’s self report (interview), pill count and by reviewing their clinical records. The nurse & ART Clinician who are working in the ART unit were involved in data collection after being trained. Ethical clearance was obtained from concerned bodies and consent was sought from the study subjects. Adherence is defined as the number of doses taken divided by the number of doses prescribed over a given period. It is considered as good if the patient took ≥ 95% of the prescribed doses correctly. Odds ratio was done to determine the strength of association for different variables. Major Findings The overall prevalence of HAART adherence was found to be, 398(95.4%) in this study. The highest proportion, 61 % of patients missed or delayed their doses due to simply forgetting & 47.4% due to being away from home & 29.4% being too busy. Independent positive predictors of HAART non adherence reported in this study comprise:-the participants who had: PLWHA’s residency far from Bishofitu hospital (>47 KM.), depression feelings , ART eligibility knowledge, medication adverse effect, history active substance uses, no adequate social support & one or two children under their care in the final adjusted multivariate analysis. Conclusions & Recommendations: The prevalence of ART adherence among clients using currently changed single combined fixed dose in this study was found higher than most studies done in developed countries & even much higher than the findings of other studies in Ethiopia. From these, we can infer that single & simplified ART has reduced the pill burden & helped the clients to take it at ease & this has increased the level of adherence behavior of clients, therefore continuous effort should be made to increase clients’ awareness to maintain the best level of adherence outcomes.
Adherence to diabetes self –management and associated factors among adolescents with Type 1 diabetes in public hospitals of Addis Ababa, Ethiopia, 2021.
(Addis Abeba University, 2021-06) Muse, Yomilan Geneti; Sr. Wondwossen, Kalkidan(Assistant Professor); Adimasu, Mekonen(BSC, MSC)
Background: Type 1 diabetes is one of the quickly growing problems in Ethiopia. Adherence to diabetes self-management of adolescents with type 1 diabetes is crucial for the control of type 1 diabetes to diminish mortality and morbidity. Prove of level of adherence to diabetes selfmanagement and associated factors in adolescents with type 1 diabetes in Ethiopia is unknown. Objectives: To determine adherence to diabetes self-management and associated factors among adolescents with type 1 diabetes in public hospitals of Addis Ababa, Ethiopia, from March 10 to April 25, 2021. Method: Institutional based cross-sectional study was done in four arbitrary chosen public hospitals of Addis Ababa. Systematic random sampling technique was used to select a total of 422 participants. A structured and pretested questionnaire was prepared and interview technique was used for data collection. The data was collected by utilizing Kobo collect version 1.30.1 and exported to excel for checking and cleaning. Later the data was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable and multivariable logistic regression analysis was performed. A variable that has a P-value of <0.2 in bi-variable logistic regression analysis was subjected to multivariable logistic regression analysis to control the confounding factors. The level of significance was pronounced at P-value <0.05. Results: With 98.1% response rate, a total of 414 diabetic adolescents were interviewed. About 218 participants (52.7%) had poor adherence to overall diabetes self-management. The prevalence of poor adherence to insulin administration, dietary management, management of hypoglycemia, blood glucose testing, and regulation of exercise were 56.8%, 68.4%, 42%, 54.8% and 50.5% respectively. Self-efficacy (AOR=8.7, 95% CI: (1.9, 14.1) and P=0.005), social support (AOR=4.6, 95%CI: (1.5,13.5) and P=0.006), age (AOR=0.2, 95%CI: (0.1,0.4) and P=0.001), good knowledge of the disease (AOR=9.046, 95%CI: (3.83,13.5) and P=0.000), moderate knowledge (AOR=6.763, 95%CI: (2.18,12.921) and P=0.001), and time since diagnosis of type 1 diabetes (AOR=0.1, 95%CI:(0.02-0.2) and P=0.005) were significantly associated with adherence to diabetes self-management. Conclusions and Recommendations: More than half of the participants had poor adherence. Planning a comprehensive rule of adherence and expanding the recurrence of follow-up visits in diabetic clinics were profoundly suggested.
Adherence to Highly Active Antiretroviral Therapy and its Associated factors among HIV Infected Adolescents in Addis Ababa, Ethiopia
(Addis Abeba University, 2014-06) Firdu, Naod; Dr. Enquoselassie, Fikre(PhD); Dr. Jerene, Degu(MD, PhD)
Background: For antiretroviral therapy (ART)to work effectively, adherence is very crucial. However, most of the studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents. Since the physical, biological and behavioral changes which occur during adolescence could affect ART adherence, we endeavored to assess the level of adherence among adolescents treated at three hospitals in Addis Ababa, Ethiopia. Study Objective: This study was carried out to assess the magnitude of ART adherence among HIV infected adolescents in Addis Ababa, Ethiopia. It also looked into the various sociodemographic, behavioral and clinical factors associated with ART adherence among adolescents. Study Methods: Using a cross-sectional study design, 273 HIV infected adolescents receiving ART were interviewed from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports among randomly selected adolescents aged 13-19 years. Data was entered using Epi Info version 3.5.4 and exported to SPSS version 21 for analysis. Bivariate and multivariate methods were used for analysis. Results: We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%)of the participants were female. Their mean age was 15.42 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). Most (96%)were on first line antiretroviral drugs. The median duration on ART was 7 years (IQR, 3). On Bivariate analysis; WHO stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART and having special instructions for ART medications were associated with optimum adherence. However only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 CI, 0.124-0.97)and adolescents with widowed parent (Adjusted OR, 0.087 with CI, 0.021-0.359) were significantly associated with optimum adolescent ART adherence. Conclusions: The level of self-reported ART adherence among HIV infected adolescents at the three hospitals was below the recommended threshold. Being in advanced WHO clinical stage was associated with better adherence levels, but history of taking CPT was associated with poorer adherence. Earlier presentation of adolescents to care should be encouraged, but more targeted adherence support should be planned for those who present at early stage of their illness.
Adherence to Option B+ and Associated factors among Pregnant women on Pmtct Services at Public Health facilities of East Shawa Zone, Oromia, Ethiopia
(Addis Abeba Universty, 2017-05) Tarekegn, Mihretu; Seme, Asefa (PhD)
Background: Anti-retroviral therapy has made a significant reduction in morbidity and mortality related to HIV/AIDS. However, it cannot be fully realized without addressing barriers related to retention in care and medication adherence. The roll out of simplified Option B+ was launched in Ethiopia in 2013 with the aim of eliminating new HIV infection in children in 2015 and to keep the mother alive. Objective: To assess levels of option B+ adherence and associated factors among pregnant women on PMTCT follow-up at public health facilities of the East Shawa zone, Ethiopia Methods and materials: The study was conducted in public hospitals and health centers in East Shawa zone from January to June 2017. A descriptive cross-sectional study design was implemented to select 304 pregnant women using a systematic random sampling method. Data were collected using a structured and pre-tested questionnaire; the collected data were cleaned and entered into SPSS Version 21 for analysis. Multivariate logistic regression was used to determine association between independent and dependent variables. Result: Two hundred ninety-three pregnant women who were on option B+ participated in the study. The mean ages and standard deviation of the participants were 29.2 ± 4.6. The overall ART adherence of pregnant women on ART medications was 82.6%. The study showed that participants educational status, AOR 4.54(95% CI; 1.72-11.95), participants status disclosure 2.61(95% CI; 1.01-6.71), social and financial support to the participants AOR 2.76(95% CI; 1.17-6.51), counseling on the benefit AOR 2.9(95% CI; 1.27-6.63), were all positively and significantly associated with adherence to option B+ treatment while experience of drug side effect AOR 0.24(95% CI; 0.1-0.6), and fear of stigma and discrimination AOR 15.79(95% CI; 4.64-53.67), were negatively associated with adherence to option B+ treatment. Conclusion and recommendation: While education, counseling on health benefit of treatment for the fetus and the mothers, social and financial support favors adherence, Fear of stigma and discrimination and drug side effects effect negatively affect adherences to option B+ among pregnant women attending PMTCT in public health facilities. The investigator recommends collaborative work among patients, healthcare professionals, and public to enhance ART adherences Key word: HIV, ART, Option B+, Adherence, pregnant women, Ethiopia
Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected government referral hospitals, Addis Ababa, Ethiopia, 2020.
(Addis Abeba University, 2020-06) Yimer, Aragaw Hamza; Haddis, Lidya(B.Sc. M.Sc.); Abrar, Meron(B.Sc. M.Sc.)
Background: Fasting of children before anesthesia is mandatory with the aim of to reduce the complications of due to regurgitation, vomiting, aspiration during anesthesia and surgery. Prolonged fasting times have several negative implications in children due to high ﬂuid turnover quickly leads to dehydration, perioperative hypotension, metabolic disturbances and hypoglycemia which leads to poor anesthetic outcomes. Objective: The aim of this study was to assess adherence to preoperative fasting guidelines and associated factors among pediatrics patients undergoing elective surgery in Addis Ababa selected government Hospitals, Ethiopia, 2020. Method: A cross-sectional survey was conducted in Addis Ababa selected government hospitals, Ethiopia in 2020. A total sample of 279 pediatric patients with age up 17 years scheduled for elective surgery included in the data collection. The data analysis was done with SPSS V.21 and the value of the variables and its associated factors was checked its association with logistic regression. Significance was determined at P -value <0.05. The result was presented by using text, tables, charts, and graphs. Results: A total of 279 pediatrics patients were responded in the analysis with a 98.6% response rate. Majority of the participants 251(89.96%) were not followed the guidelines of preoperative fasting. The mean fasting time for clear liquids was 10±4.03 (2-18 hrs.), for breast milk 7.18±2.26 (3.5-12 hrs.), and for solid foods 13.5±2.76 (8-19 hrs.). The reasons for which the preoperative fasting delayed was due to incorrect order 35.1% , prior cases procedures took longer times 34.1% changing sequence of schedule was 20.8%. Conclusion: The majority of children were still having prolonged fasting practice. The staff’s instructions and sequences of schedules are challenged to follow the international fasting guidelines protocol.
Adherence to Self Management and Associated Factors Among Hypertensive Patients Attending Chronic Follow Up Units of Public Health Hospitals in Addis Ababa, Ethiopia, 2016
(Addis Ababa University, 2016-06) Tibebu, Abel; Mengistu, Daniel (Assistant Professor)
Background - One of the most prevalent non communicable diseases is hypertension. The availability of effective antihypertensive medications didn‟t bring the expected outcomes in terms of controlling blood pressure. The rationale for these and other findings of uncontrolled hypertension direct towards poor adherence. The most neglected causes of uncontrolled hypertension are unhealthy lifestyles. Few studies are conducted to show the gap and magnitude of self-management adherence. Objectives – This study tried to assess the self-management adherence of hypertensive patients attending follow up at chronic follow up units of public health hospitals in Addis Ababa, Ethiopia,2016. Method – Institutional based cross sectional study was conducted in four public health hospitals which were selected by lottery method. The final calculated sample size was 416 which were proportionally allocated to each of the institutions and systematic random sampling was used. Data was checked, cleaned and entered in to Epidata software version 3.1, and was imported to SPSS version 21 software for analysis. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between independent variables and dependent variables were analyzed using bivariate and multivariate analysis. The study was conducted from February 15 – April 15, 2016. Results – The study included 404 respondents with 97% response rate. 210(52%) were male and mean age was 54±10.77 years. The respondents‟ adherence to lifestyle modifications and anti- hypertensive medications were 23% and 66.8% respectively. The lifestyle and medication related adherences were found to be better in females, patients who had comorbidities and have been knowledgeable about the disease and was poor among young adult respondents. Conclusion and Recommendations – The rates of adherence to medication and life-style changes were generally found to be low. Educational sessions that especially focus on lifestyle modifications and ongoing support for patients should be designed and studies which assess all the components of self-management should be conducted for comparison among different subgroups. Keywords – Self management, Adherence, Hypertension, Lifestyle modifications, Anti- hypertensive medications

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