Pharmacy Practice

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Anticoagulation Management Practice, and Associated Factors in Atrial Fibrillation Patients on Warfarin Therapy at Saint Paul Hospital Millennium Medical College
(Addis Abeba University, 2021-05) Shiferaw, Nuredin; Umer, Shemsu (PhD, Assistant Professor); Assefa, Tamrat (Assistant Professor)
Anticoagulants are cornerstones in management of Atrial Fibrillation to prevent stroke. Monitoring of warfarin depends on time in therapeutic range, frequency of international normalization range measurements, warfarin dose adjustments, warfarin drug interaction and bleeding adverse event. This study aimed to assess the anticoagulation management, and factors affecting anticoagulation management in atrial fibrillation patients taking warfarin. Institutionalbased Retrospective Cross-Sectional study was conducted from August to October 2019 at St. Paul Hospital Millennium Medical College. Data were collected retrospectively from a total of 300 patient medical records. Patients who have taken warfarin as an indication of primary prevention of atrial fibrillation were included in the study. A systematic random sampling technique was employed while recruiting the study participants. The data were entered to Statistical Package for Social Science window version 25 for analysis. Descriptive summaries were presented by using frequencies and percentages. Time in therapeutic range was calculated using the Rosendaal method, international normalization range frequency and drug interaction with warfarin were assessed and warfarin dose adjustments were also checked. Univariate and multivariate analysis were used to determine factors affecting time in therapeutic range and bleeding events. P-value ≤0.05 was considered as statistically significant. The mean age of the patient was 56.37 years and 65.3% of the study participants were females. Percent time in therapeutic range was found to be 42.03 ± 18.75. Only 12.67% patients had a time in the therapeutic range above 65%. Out of the 3162 INR tests, only 1094(34.60%) tests were within the therapeutic range. Bleeding event was recorded on 62 (20.70%) of the patients. Poor time in therapeutic range was associated with only age between 65 and 74, number of comedication of 1 and 2 and presence of congestive heart failure. Anticoagulation management was found to be poor in this study compared to other studies.
Antimicrobial Use Practice and Associated Factors among Hospitalized Adult Patient at Tikur Anbessa Specialized Hospital: Pave the way for Antimicrobial Stewardship.
(Addis Ababa University, 2023) Gugsa,Habtamu; Beyen,Alemsege(Ass.Prof.)
Background: Antibiotic use is frequent in the inpatient context, and approximately 50% of admitted patients receive at least one antibiotic during their hospital stay. Antimicrobials are frequently provided inappropriately to 44–97% of hospitalized patients in developing countries. Objective: The objective of this study was to assess antimicrobial use practices and associated factors among hospitalized adult patients at Tikur Anbessa Specialized Hospital (internal medicine, surgery, and gynecology/obstetrics wards), Addis Ababa, Ethiopia. Method: A hospital-based prospective observational study was conducted from September to December 2022. A total of 354 participants were recruited for this study. A semi-structured questionnaire was used to collect the data from medical records and patient interviews. The collected data were entered to SPSS version 26.0 for analysis. Descriptive statistics and logistic regression were used for statistical analysis. Result: Antibiotic use in 144 (45.7%) patients was considered inappropriate with category IIIA (long duration) being was the most common type of inappropriateness, accounting for 99 (68.7%). According to Define Daily Dose (DDD) measures the total antibiotic consumed per 100 patients per day was 4.71 DDD and based on the WHO antibiotic AWaRe stratification, 298 (62.8%) antibiotics were consumed from the "Watch" and "Reserve" groups. Patients whose age between 25 to 34 years were protective to inappropriate antibiotic use practice (AOR=0.24, 95% CI:(0.06– 0.89), P = 0.03), marital status of divorced (AOR=5.68, 95% CI:(1.6–19.3),P=0.001) and widowed (AOR=8.91,95%CI:(1.51–52.6),P=0.01), patents who were admitted at internal medicine (AOR=3.53, 95% CI:(1.04-11.9), P=0.04) and surgical ward (AOR=10.8, 95% CI:(3.59– 32.9), P=0.001) and patients who were hospitalized for 8 to 14 days (AOR=7.0, 95% CI:(1.59– 182.5), P=0.01), for 15 to 21 days (AOR=11.0, 95% CI:(1.2–100.8), P=0.03) and above 22 days (AOR=10.9,95%CI:(1.17–103.0),P=0.03) were determinants of inappropriate antibiotic usage. Conclusion: Generally, higher consumption and inappropriate antibiotic use were observed among hospitalized adult patients in the study area and need prompt antimicrobial stewardship interventions and stewardship program improvement in the study wards of the Hospital.
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.
Assessing Knowledge, Attitude, Prevention on Practice and Regulatory Body Practices of Food Adulteration on Selected Food Items among Bahir Dar City Dwellers
(Addis Ababa University, 2021-12) Fenta, Misganaw; Tamene, Ayanadis
Background: Food adulteration is an addition of another substance to a food item to increase the quantity which may result in the loss of actual quality of the food item. This practice critically diminishes the nutritional value of food; contributes to the society with many diseases ranging from mild to life-threatening and it has an impact on national economic development. To tackle such public health problems the knowledge, attitude, and prevention practice of the consumer and also regulatory practices of the health regulatory body are playing a great role. However, information on knowledge, attitude, prevention practice and regulatory body practices on food adulteration was not well studied and documented in the study area. Objectives: The objective of this study was to assess the knowledge, attitude, prevention practice and regulatory body practices of food adulteration on selected food items among Bahir Dar city dwellers. Methods: Community-based cross-sectional study was conducted from October 2020- November 2021. Systematic random sampling technique was used to select 422 household leader study participants. Face to face Interview administered questionnaires were used to collect the data. All questionnaires were checked for completeness, cleaned manually, coded, and entered into Epi info version 7.2.1.0 software and exported to SPSS version 23 for analysis. Descriptive parameters, such as mean, standard deviation, median and interquartile range for continuous data, frequencies and percentages for categorical data and graphs were used for data presentation. Result: The mean age and standard deviation of the participants were 43.61 (± 13.82) years. A total of 414 participants were participated in this study making a 98.1% response rate. Of the participants 239 (57.7%) were female and the remaining were male participants. From 414 participants, 259 (62.6%), 295 (71.3%), and 208 (50.2%) had good knowledge, favorable attitude, and good prevention practice towards food adulteration respectively. The most identified roles of regional regulatory bodies in this study were conducting inspection and surveillance, performing monitoring and evaluation through laboratory testing and or analysis, undertaking regulatory intelligence and emergency responses, and staff improvement and training programs for sustainable performance.Conclusion/recommendation: the study revealed that residents have good knowledge and attitude, but less preventive practice in regulating food adulteration. Food adulteration is becoming a public problem in Bahir Dar. It affects the consumers' right to eat safe, high-quality foods. As a result, all responsible persons, organizations, and governments, should do their part to defend the act of food adulteration and to disclose the recognized activities. Furthermore, consumers should take attention to the place where they buy any food items as food adulteration take place at retailing, distribution, and producing stages.
Assessment of Prerequisite Programs for Implementation of Hazard Analysis and Critical Control Point and Associated Factors among Hotels and Restaurants of Dukem and Bishoftu Towns of Ethiopia
(Addis Abeba University, 2022-04) Yadesa, Dano; Getachew, Paulos
Background: Prerequisite programs like GHP and GMP support the basic environmental and operating conditions which are important for the production of safe and wholesome food in the food establishments. Set of procedures that designed to provide fundamental base for operating conditions necessary for the production of safe food and also considered as HACCP plan. Objectives: This study aimed at assessing the prerequisite programs for implementation of HACCP and associated factors among hotels and restaurants in Dukem and Bishoftu Towns in Ethiopia. Methods: A cross-sectional, quantitative study was held on 266 hotels and restaurants from June 2021 to July 2021, in Dukem and Bishoftu Towns, Ethiopia. Data were collected from the managers of hotels and restaurants using pretested and structured questionnaires, entered, cleaned, and analyzed using SPSS version 23. Bivariate and multivariable logistic regressions were computed to identify the factors associated with Pre Request programs for implementation of HACCP. A p-value of <0.05 with 95% CI was cut-off points to declare the level of statistical significance. Results: The study showed that the prerequisite programs for implementation of HACCP was poor (13.5% (95%CI: 1.09-1.18) among the hotels & restaurants under the study. In the multivariate logistic regression analysis: The study revealed that, the odds to the implementation of prerequisite programs practices among hotels and restaurants had no documentation and record keeping ( AOR= 0.334, 95%CI: 0.139, 0.804) , the odds to the implementation of prerequisite programs practices among hotels and restaurants had no finance ( AOR= 0.115, 95% CI: 0.032, 0.419) ,and the odds on HACCP Practices among hotels and restaurants not know meaning of HACCP ( AOR= 0.083, 95% CI: 0.008, 0.900) showed statistically significant association with HACCP implementation prerequisite programs. Conclusions and recommendations: The prerequisite programs HACCP implementation in the evaluated hotels and restaurants was poor compared to other studies. Therefore, concerned government bodies (like health regulatory and hotel and tourism bureaus), owners of hotels, and restaurants should demonstrate their commitment so that the food provided by the establishments is safe to the consumers.
Assessment of Adequacy and Appropriateness of Pain Management Practice among Traumatic Patients at Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia: A Prospective Observational Study
(Addis Ababa University, 2022-04) Alemu, Wondwossen; Umer, Shemsu(B.Pharm, MSc, Ph.D., Assistant professor)
Acute pain is the most common and prevalent reason for emergency department (ED) visits with a prevalence of over 70% in the world. The study aimed to assess the adequacy and appropriateness of pain management practice at Aabet Hospital. An observational prospective study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult traumatic patients having pain (at least score 1 on the Numeric Rating Scale) with a Glasgow Coma Scale score >13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission, at 60, 120, 180, and 240 minutes. The time of first analgesics was registered. The adequacy and the appropriateness of the pain management practice were calculated through the pain management index (PMI) and Pain Medication Appropriateness Scale (PMAS), respectively. Two hundred thirty- two (232) participants were included in this study after obtaining their consent. The majority of the participants 126 (54.3%) were admitted due to road traffic accident followed by falls 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment. Among the study participants 72 (31%) received non opioids, 59 (25.6%) received weak opioids, and 37 (15.9%) received strong opioids. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score) and nearly two-third (140 (60.3 %)) of the participants were treated inappropriately. The type of analgesia administered, time to analgesia and pain intensity could predict 65% of variance in PMI score (R 2 = 0.65, P= .001). From this study it can be concluded that acute pain in traumatic patients was under and inappropriately treated. Thus, the clinical practitioners should to stay vigilant towards acute pain management in the trauma center.
Assessment of Clinical Outcome and Quality of Life of Chronic Kidney Disease Patients at Zewditu Memorial Hospital and Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2019-11) Berhe, Teshome; Beyene, Alemseged(B.pharm, MSc, Assistant professor of clinical pharmacy); Dr.Tsighe, Abel(MD, Assistant professor in medicine)
Chronic kidney disease (CKD) is a worldwide public health problem. Although there is a holistic management for chronic kidney disease, people with CKD have significantly higher rates of morbidity, mortality, hospitalizations, and healthcare utilization. Evaluating the clinical outcome and quality of life, is used to identify CKD patients in need of clinical attention and to evaluate interventions for CKD patients and lead to better outcome. The present study was aimed to assess the clinical outcome and quality of life of CKD patients at Zewditu Memorial Hospital and Tikur Anbesa Specialized Hospital. A cross-sectional study design was used. Data was collected using the Kidney Disease and Quality of Life (KDQOL™-36) tool and patients’ medical records. Multivariate logistic regression analysis was used to determine factors associated with clinical outcome and quality of life (QOL). P≤0.05 was considered as statistically significant. To compare scores of QOL subscales by socio-demographic and diseaserelated factors, the Student’s independent t-test and one-way ANOVA were conducted to compare two groups and three or more groups in the analysis of QoL. Out of the total of 300 CKD patients half (50.3%) of the patients developed CKD related complications ,one tenth of the CKD patients progressed to ESRD and near to one fourth of the total CKD patients had hospitalization event due to CKD during their life time. Forty two percent of CKD patients had diabetes mellitus and hypertension were managed with non-ACEIs based regimens plus insulin whereas two fifth of the total CKD patients with hypertension were managed with ACEIs/ARB based regimens. CKD patients treated with enalapril reduced the progression of ESRD by 80% (AOR=0.2, 95% CI(0.001-0.45,P=0.01). The progression to ESRD in patients with 0-2 complications was reduced by 87% when compared to those who had ≥3 complications (AOR=0.13 ,95% CI(0.02-0.85,P=0.03). Use of amlodipine (AOR=3.56, 95% CI (1.02-12.65 ,p=0.048) and atenolol (AOR=5.82 ,95% CI(1.46-23.27,p=0.01) were associated with poor outcome. Mean domain score on the physical component summary (PCS), mental component summary(MCS), burden of kidney disease(BKD), symptoms and problems of kidney II disease(SPKD) and effect of kidney disease (EKD) subscales were 50.4, 59.5, 63.1, 80.4, and 74.6, respectively. In multivariate analysis, the odds of impaired PCS QOL in rural residents was reduced by 90% when compared to the urban residents (AOR=0.10, 95%CI (0.02-0.64, P=0.015)). On the other hand, presence of ≥3 comorbidities (AOR=4.21, 95%CI (1.5-11.80, P=0.006), and ≥3 complications (AOR=5.85, 95%CI (1.62-21.08, P=0.007) were associated with impaired MCS QOL respectively. Almost one tenth of the total CKD patients had progressed to ESRD. Three or more CKD related complications, use of amlodipine and atenolol were the significant predictors of poor clinical outcome of the CKD patients. The overall mean score of PCS and MCS was impaired and below the standard level. Lowest score of KDQOL™-36 scales was found in the PCS compared to the domaines of MCS QOL. Furthermore, the study revealed that, level of education, elevated serum creatinin, and smoking status were the significant predictors of PCS QOL whereas presence of ≥3 comorbidities, ≥3 CKD related complications and hemoglobin level were the significant predictors of impaired MCS QOL.
Assessment of Drug Related Problems among Elderly Patients Visiting Menelik II Referral Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2020-06) Linger, Bedilu; Alebachew, Minyahil (B.Pharm, MSc, Assistant Professor of clinical pharmacy); Demessie, Samuel (MD, Internist); Mullu, Assefa(B.Pharm, MSc, Assistant Professor of clinical pharmacy)
Drug therapy in the elderly needs an emphasis on the age related changes in drug pharmacokinetics and pharmacodynamics profile. As the age increase, people usually have more health problems that lead to the use of more medications than younger people do. Identification and prevention of drug related problems (DRPs) in geriatric outpatients will be an important step towards reducing hospital admissions. There are different studies regarding to DRPs in general population but studies regarding DRPs in elderly patients are scarce specifically in MIIRH there is no previous studies. This study aimed to assess DRPs among chronic elderly patients. A hospital based crosssectional study was conducted on 236 chronic elder patients who were on follow up-care at MIIRH. Data collection was done through patient interview and medical charts review. Epi data version 4.2 and IBM SPSS version 23 were used for data entry and analysis respectively. Descriptive statistics, cross-tabulation, univariable and multivariable binary logistic regressions were used and P < 0.05 was used to declare association. More than two-thirds of patients had two or more comorbid disease. The most common diseases encountered were hypertension (72.0%) and diabetes mellitus (56.7%). In this study, 740 medications were used with the mean number of drugs per day was 3.14 ± 1.658 per patient. ACEIs 121(50.8%), antidiabetic agents 94(39.5%) and CCBs 75(31.5%) were commonly prescribed class of drugs. Forty nine percent of patients encountered at least one DRP and 118 drug related problems were identified. The average number of drug related problems per patient was 0.5. Non-compliance (45.8%) %) and needs additional drug therapy (24.6%) were major DRPs identified. antidiabetic agents were the most frequent drug class involved in DRPs. From 740 medications, 122(16.5%) drugs were from beers medication list, where (44.1%) of participants were exposed at least to one potentially inappropriate medications. To conclude, there is high prevalence of DRPs and PIMs. Marital status, number of comorbidity and number of drug prescribed have significant association with the occurrence of DRPs.
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.
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.
Assessment of Drug Therapy Problems and Cardiovascular Disease Risk among Adult Hypertensive Patients at All Africa Leprosy and Tuberculosis Rehabilitation and Training Centre, Addis Ababa, Ethiopia
(Addis Ababa University, 2019-07) Shafi, Miftah; Shibeshi, Workineh(PhD, Associate professor); Beyene, Alemseged(MSc, Assistant professor)
Hypertensive patients are at high risk of developing drug therapy problems (DTPs) and poor adherence due to different factors like: presence of comorbidities, polypharmacy and complexity of drug regimens. Occurrences of DTPs in hypertensive patients are associated with harmful health outcomes and unnecessary costs. Identifying types of DTPs and associated factors are very essential in DTPs prevention and reducing unnecessary health expenditures. Rise in each systolic blood pressure 20 millimeters of mercury and 10 mmHg diastolic blood pressure is associated with increasing risk of death from stroke and heart disease. This study was aimed to assess DTPs and cardiovascular disease risk among hypertensive patients on follow up at All Africa Leprosy and Tuberculosis Rehabilitation and Training Centre. A hospital based cross sectional study was conducted among 305 hypertensive patients. Data was collected through patient interview and medical charts review. DTPs were assessed based on Cipolle DTPs classification systems and cardiovascular disease risk was calculated by using American Heart Association pooled cohort Cardiovascular Risk Calculator. Descriptive statistics, binary logistic regressions were utilized and P< 0.05 was used to declare statistical significance. Out of 305 study participants, 223(73.1%) had at least one DTP. The commonest identified DTP was needs additional drug therapy (32.1%) followed by drug interaction (25.8%) and dosage too low (12.3%). Nonadherence was identified in 51.5% of study participants. The atherosclerotic cardiovascular disease (ASCVD) risk among 144 patients who had lipid profile was calculated and 40.3% of them had 20% or higher risk. Based on multivariate analysis alcohol use, number of medications and blood pressure (BP) control had association with DTPs occurrence whereas physical activity, salt restriction and duration of treatment had significant association with adherence. Occupation, alcohol use and BP control were statistically significant to ASCVD risk of 20% or higher.
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.
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 Medication Related Problems and Contributing Factors among Ambulatory Patient with Chronic Kidney Disease at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
(Addis Abeba University, 2020-06) Shiferaw, Eshetu; Nedi, Teshome (PhD); Hamza, Leja(MD, Consultant Internist and Nephrologist); Sada, Oumer (Mphar)
Chronic kidney disease (CKD)is the reduction in the Glomerular Filtration Rate (GFR) and urinary abnormalities or a structural abnormality of renal tract which is explained by pathologic kidney abnormalities, persistent proteinuria, and other urine abnormalities on two occasions separated by >90 days. As kidney function declines, number and complexity of medication increase with the progression of the disease. Due to this Patients with this disease are at high risk for medication-related problems because of their condition and the multiple medications required for treatment of the causative disorders, and the complications associated with the disease. This study aimed at establishing the extent of medication related problems among patients with chronic kidney disease as well as exploring associations of different covariates with the problem identified. Hospital based cross-sectional study was conducted among ambulatory patients with chronic kidney disease at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia from 1 of June to 30 th of August 2019. Patient with chronic kidney disease stage 1, 2, 3, and 4 adult ambulatory patients were included in the study. A total of 325 medication related problems were identified from 204 (82.3%) study participants giving 1.6 MRPs per participants. One medication related problem was identified in 114 (55.9%) patients while two in 64 (31.4%). From the total of identified problems most common class of MRP identified were need additional drug therapy problems 114 (35.1%) followed by non-compliance 54 (16.6%). This study showed that only occupation (AOR=5.2, 95% CI: 1.292-21.288, P=0.020) and Angiotensin converting enzyme inhibitor (ACEI)use (AOR=6.6, 95% CI: 2.202-19.634, P=0.001)had association with the occurrence of medication related problems. In general, our study suggest that medication related problems experienced by each chronic kidney disease patients were high. In terms of types of MRPs, this study showed that need additional drug therapy was frequently identified types. st
Assessment of medication therapy management service among adult diabetes mellitus patients on follow up clinic at Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2019-11) Negash, Zenebe; Shibeshi, Workineh(PhD); Beyene, Alemseged; Ahmed, Abdurazak
Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs) since they often receive multiple pharmacotherapeutic agents due to coexistence of multiple co-morbidities and complications associate with the disease. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. Thus, the aim of this study was to assess impact of introduction of MTM service at DM clinic of Tikur Anbessa Specialized Hospital (TASH). A prospective hospital based interventional study was carried out at DM clinic between July 2018 and April 2019. The intervention package includes patient counseling, education, identification and resolving of DTPs for the given six months followed by four-months post- interventional assessment of DTPs, medication adherence and treatment satisfaction. Data were collected, entered and analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics and logistic regressions were performed for data analyses. Of 423 participants, 409 fulfilled the inclusion criteria and included in the final analysis of the study. The mean age of the patients was 52.3(SD, 15.6) years. Most of the study participants were type-II DM (78.2%). About 73.1% had comorbidity. They had mean disease duration of 13.86(SD, 8.64) years. There were decreases in hemoglobin A1c (HbA1c), fasting blood sugar (FBS) and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl and 6.62 mm Hg respectively as compared with the pre-intervention phase (P< 0.05). The prevalence of DTPs in the pre- and post-intervention of MTM services were found to be 72.9 %( n=298) and 26.2 %( n=107) respectively. Primary education level (AOR=2.94, 95% CI: 1.25-6.91), charging for medication from pocket (AOR= 2.27, 95%CI: 1.08-4.77), male gender (AOR=3.06, 95% CI: 1.54-6.07) were significant predictors of DTPs. About 80.4% of participants were adherent to their medications at the end of MTM intervention. Poorly controlled glycemic control (AOR=2.33, 95% CI: 1.17-4.68) and presence of three and above co-morbidities (AOR=4.76; 95% CI: 1.4-15.8) were associated with poor adherence. Theoverall mean score of treatment satisfaction was 75.6(±9.7). Diabetes patients of age below 40years (77.66(SD, 8.18)), type-I DM (77.79(SD, 8.46)), treated with one medication (77.89(SD, 7.19)) and good adherence to their medication (76.17(SD, 8.89)) had higher satisfaction score (P<0.05). In conclusion, provision of MTM service showed a significant improvement in DTPs reduction, medication adherence, treatment satisfaction and clinical parameter relative to the pre-intervention MTM services.
Assessment of Medication Therapy Management Service outcome among Epilepsy Patients on Follow-up care at Ambulatory Clinic of Tikur Anbessa Specialized Hospital
(Addis Abeba University, 2020-05) Bulbula, Meaza; Engidawork, Ephrem (PhD, Professor of Pharmacology); Alebachew, Minyahil (Assistant Professor of Clinical Pharmacy); Mamushet, Yared (MD, Associate Professor of Neurology)
Background: The provision of medication therapy management services aims to prevent, identify and resolve drug-related problems (DTPs), thereby reducing morbidity and mortality as well as helping patients achieve improved clinical outcomes. Epilepsy is one of the most common neurological diseases affecting about 45.9 million people globally. However, about 90% of them are not receiving appropriate treatment due to lack of prioritization, poor health care system, and inadequate supply of antiepileptic drugs. Objective: This study aimed to assess the outcome of medication therapy management service among epileptic patients on follow up care at Tikur Anbessa Specialized Hospital. Methods: A pre/post study design and systematic random sampling technique were utilized. Data was collected through patient interview, medical charts and electronic data record review. Cipolle’s DTP classification, Treatment Satisfaction with Medicine Questionnaire, and Morisky Medication Adherence Scale were used as data collection tools. Data were entered and analyzed using statistical package for social science version 21. Descriptive statistics were used to summarize patients’ characteristics and paired sample t –test and McNamara’s was performed to examine the effect of intervention in the pre- and post-intervention phases. Inferential statistics (independent t-tests and logistic regression analysis) were used to examine the influences of different variables on outcome. P<0.05 was set as a level of significance. Results: From the total of 336 epileptic patients, generalized tonic-clonic seizure was the most common diagnosis (53.9%) followed by focal to bilateral (14.9%) and unclassified (14%). Majority of the study patients (57.7%) were on mono-therapy and phenobarbital (22.6%) was the most frequently prescribed antiepileptic drug. A total of 451 DTPs had been identified during the study and a significant reduction in the number of DTPs was noted in the post-intervention compared to the pre-intervention phase (t (335) =10.79, p< 0.005). Non-adherence, adverse drug reaction and dose too low showed significant reduction (p< 0.05) from pre to post study. Duration of seizure, number of comorbidities, total number of medications and seizure control status were significantly associated with DTPs (p<0.05). In the post-intervention phase 61% of the patients were adherent to their medication and the general treatment satisfaction was 72.1(SD ± 12.3). Conclusion: Implementation of medication therapy management service in the neurology clinic is associated with better patient outcomes, as revealed by reduction in the total number of DTPs and the number of patients with DTPs. Moreover, majority of the study patients were adherent to their medication and the general treatment satisfaction was good in the post-intervention phase.
Assessment of Medication Therapy Management Service outcome among Hypertensive Patients on Follow up at Ambulatory Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2021-02) Bulo, Belachew; Engidawork, Ephrem(PhD, Professor of Pharmacology); Beyene, Alemseged (Assistant Professor of Clinical Pharmacy); Mekonnen, Desalew(MD, Associate Professor of Medicine)
The high prevalence of hypertension with multiple comorbidities and use of multiple medications predisposes this group of patients to drug therapy problems (DTPs). This justifies the need for the implementation of medication therapy management (MTM) service. The aim of this study was to evaluate the impact of introducing MTM Services among patients with hypertension attending follow-up at ambulatory clinic of Tikur Ambessa Specialized Hospital (TASH). A quasi-experimental study was performed with patients followed-up for six months at renal clinic of TASH between July 2019 and April 2020. Data was analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, linear regression and logistic regressions were also performed for the purpose of data analyses. Out of 304 enrolled patients, 279 entered in to the final analysis, with attrition rate of 7.8%. Mean age of the patients was 56.38(SD, 11.81) years and 50.5% of them were females. Data showed a decline in the prevalence of DTPs from 63.1% at baseline to 31.1% during the post- interventions phase. Using ≥ 5 drugs (AOR = 2.46; 95%CI: 1.27-4.77) and presence of complication (AOR = 0.52; 95% CI: 0.27-0.99) were significantly associated with occurrence of DTP at baseline. Intervention also brought about a decrease in mean systolic blood pressure (SBP) (5.31 95% CI of difference 3.50-7.11: p < 0.001) and a significant increase (p < 0.001) in the number of study patients whose blood pressure (BP) reached to a goal BP. About (69.5%) of participants were adherent to their medications at the end of MTM intervention. Experiencing DTP (AOR= 2.40; 95% CI: 1.33-4.334) and living outside Addis Ababa (AOR= 1.73; 95% CI: 1.38-1.88) were significantly associated with non-adherence at the end of follow-up. The overall mean score (SD) of treatment satisfaction was 86.55 ± 10.34 at the end of MTM visit. Adherent patients were found to be significantly more satisfied (p < 0.001) than non-adherent patients. MTM service contributed to the resolution of DTPs and improvement of clinical outcomes. Majority of the patients were found to be adherent and high treatment satisfaction score was observed at the end of the MTM interventions.
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.
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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