Pharmacy Practice

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    Anticoagulation Outcomes and Associated Factors among Acute Kidney Injury Patients during Hemodialysis at Two Selected Hospitals in Addis Ababa, Ethiopia: A Prospective Study
    (Addis Ababa University, 2023-11) Muzeyin, Hanan; Ayalew,Eskinder(Ass.Prof.); Assefa,Tamrat(Ass.Prof.); Melkie,Addisu(Ass.Prof.)
    Background: During hemodialysis (HD), clots in the dialyzer reduce the effective surface area of the dialyzer and in extreme situations clots in the circuit may prevent treatment from continuing and result in loss of blood in the circuit. Anticoagulation is essential during HD to prevent clot formation the circuit without putting the patient at risk of bleeding. Objective: The study aimed to assess anticoagulation outcomes and associated factors among Acute Kidney Injury (AKI) patients during HD at Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. Method: A prospective, multicenter observational study was conducted between October 1st, 2021, and March 31st, 2022, at TASH and SPHMMC in Addis Ababa, Ethiopia. The study included all AKI patients who were undergoing HD at least once during the study period. Descriptive statistics were used to summarize the data while multinomial logistic regression analysis was used to determine factors associated with clotting and bleeding. Results: Data were extracted from 1010 HD procedures performed on 175 patients. Extracorporeal circuit clotting occurred in 34 patients in 39 (3.9%) dialysis sessions, and 27 patients in 29 (2.9%) sessions had experienced bleeding. The total number of HD sessions (AOR=1.932, 95% CI, 1.227-3.043) and blood flow rate (AOR=0.868, 95% CI, 0.812-0.928) showed a statistically significant association with clotting. Bleeding was associated with length of hospitalization (AOR=1.247, 95% CI, 1.053-1.478), serum creatinine at admission (AOR=1.886, 95% CI, 1.285-2.769), uremic signs and symptoms (AOR=0.092, 95% CI, 0.009-0.955), and use of an anticoagulant and/or antiplatelet drug (AOR=0.017, 95% CI, 0.001-0.446). Conclusion: A comparable number of circuit clotting was found when compared to other studies. However, it resulted in treatment interruptions and blood loss. Additionally, the study revealed a notable incidence of bleeding during HD, with most cases being minor.
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    Comprehensive Analysis of management and survival of patient with solid tumor and, patient Outcomes in Adults: A 5-Year Survival Analysis Study
    (Addis Ababa University, 2023-09) Moges, Mahlet; Chelkeba,Legese(PhD, Ass.Prof.)
    Background Cancer, a non-communicable disease, has surged globally in last two decades due to various factors, including racial, biological, socio-economic status and socio-cultural influences. Solid tumor accounts the highest number of cancer cases across worldwide. Africa faces the greatest challenges, marked by the worst outcomes and the shortest survival rate. This adversity exacerbated by lack of awareness, limited preventive strategies, and the prevalence of unhealthy lifestyles across the continent. Additionally, there is a notable dearth of comprehensive studies conducted in Ethiopia that delve into the disease spectrum, treatment modalities, drug utilization patterns, and patient survival trends over a five-year timeframe. Objective: This study seeks to elucidate the spectrum of cancer, treatment modalities, patterns of drug utilization, and the myriad factors that influence patient survival within the Tikur Anbesa specialized hospital solid tumor oncology center for solid tumor. Methods: Employing a convenient sampling technique, a retrospective observational follow-up study was carried out at TASH oncology facility from July to February 2022. Adult patient data spanning from January 2016 to February 2017 was meticulously extracted from medical records and phone addresses. An organized checklist, pre-tested in English and complete with contact information, was crafted for this purpose. Data analysis was performed using SPSS, with the Cox regression model being employed to identify variables impacting survival. Median and overall survivals were assessed through Kaplan-Meier analysis, and statistical significance was declared at a p-value ≤ 0.05. Results: Majority of patients with cancer were under 65 year of age .71.1% were from rural areas .over all cervical cancer accounts the highest incidence with 24.5% of the case, while colorectal cancer was the commonest one among males. At the 5-year mark, the overall survival rate of 10 months (8.956-11.044) with 73.8% of the study population having passed away. Notably, overall survival was significantly influenced by factors such as marital status, exposure to agricultural pests treatment methods, cancer stage, recurrence, complications, and the administration of specific drugs such as paclitaxel, doxorubicin, and hormonal agents. Patients with advanced cancer stage (Adjusted Hazard Ratio [AHR] 2.02, 95% Confidence Interval [CI] 1.525-2.676), complications (AHR 1.233, 95% CI 1.525-2.676), and those who did not receive chemotherapy (AHR 1.817, 95% CI 1.382-2.389) exhibited poorer survival outcomes, while patients treated with paclitaxel and hormonal therapy demonstrated improved survival. Conclusion: Our findings indicate suboptimal overall survival across all cancer types when compared to high-income nations with lower mortality rates. Particularly noteworthy is the persistently high incidence of cervical cancer, coupled with limited access to advanced radiation therapy within our center. We advocate for collaborative efforts aimed at addressing cancer prevention and treatment challenges, with a specific emphasis on immunization and the early detection of infectious malignancies.
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    Clinical outcomes of acute poisoning among hospitalized patients/ emergency room at Northern Ethiopia: Prospective Observational Study
    (Addis Ababa University, 2023-11) Dejene,Habte; Ayele,Teshale
    Background: In developed countries mortality rate from poisoning is 1-2% whereas about 17% of hospital admissions are due to acute poisoning in Sub-Saharan Africa. In Ethiopia, studies indicate variable mortality rate across the regions and shows an increasing trend. Objective: To assess clinical outcomes of acute poisoning among hospitalized patients/ emergency room at Northern Ethiopia. Method: Health facility-based prospective observational study was conducted from September 20, 2022 to March 10, 2023 among patients admitted with acute poisoning at Kuyu, Fitche, Dera and Muka Turi Hospitals. A convenient sampling method was employed to identify participants. The data were analyzed by Statistical Package for the Social Sciences (SPSS) version 25. Linear and Cox regression were performed to identify predictors of length of hospital stay and mortality or complication, respectively. Then statistical significance was declared at p-value <0.05. Result: Of 208 (58.2% female) victims, the majority 125 (60.1%) of them were urban residents. The mean (SD) age of the victims was 27.11 ± 14.20 years while the prevalence rate of acute poisoning was 13.6%. Among the victims, 49 (23.6%) have mixed clinical presentations involving gastro intestinal tract and central nervous system. In hospital complication was developed among 71(34.1%) of victims while the fatality rate of poisoning was 39(18.75%). The hazard of mortality was increased by 11.66 among victims exposed to rodenticide (AHR=11.665; 95% CI: 1.372, 99.164) as compared to alcohol. Length of hospital stay (LOS) is reduced by 1.67 times for victims arrived hospital before 2 hours (β = -1.67; 95%CI: -2.98, - 0.396).Similarly, patients who did not develop in hospital complication had 12.8 times shorter LOS (β= -12.818; 95%CI: -23. 807,-1.828).Moreover, the hazard of in hospital complication was increased by 11.64 times among victims suffered with carbon monoxide poisoning (AHR=11.642; 95%CI: 1.238, 109.515). Conclusion: This study found that significant clinical outcomes were observed. These impacts were related mainly with poisoning agents such as rodenticide, aluminum phosphate and carbon monoxide. Thus, hospitals should have to assure with caution among health professionals and community on the impacts posed by these fatal chemicals.
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    Treatment Outcome and Determinants of Mortality among Pediatric Patients with Severe Acute Malnutrition at Yekatit 12 Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2023-06) Mulu,Adugnaw; Abay,Solomon Mequanente(PhD); Sada,Oumer(Ass.Prof.)
    Malnutrition is categorized into two groups based on its severity: moderate acute malnutrition and severe acute malnutrition (SAM). The study aimed to assess the outcome of SAM treatment and its determinants of mortality at Yekatit 12 Hospital, Addis Ababa, Ethiopia. The study was conducted at Yekatit 12 Hospital which is one of the public teaching hospitals. A prospective follow up study was conducted from January 2020- January 2021. Each pediatric patient included in this study was followed throughout the treatment period and the outcome variable measured and declared at the end of the follow up period. The data was cleaned, coded and entered to EPI info 7 software version 7.1.4 and SPSS version 26 for analysis. Percentages, frequency, cross tabulation, odds ratio variables were determined. Bivariate and multivariable logistic regression was under taken to determine predictors of mortality among SAM patient. P-value < 0.05 was considered significant. In this study a total of 246 pediatric patients with the diagnosis of SAM were included, more than half 127 (51.6%) of them were males. Most of the study participants 104 (42.3%) were less than one year old at the time of study period and most majority of them 177 (72.0%) were residing in urban areas of the country. The most frequent co-morbid condition among study participants was pneumonia, which accounted for 39.4% of cases. Among the survived study participants, majority of them 189 (80%) were cured and discharged from the hospital. In the current study, the majority of the study participants (95.9%) survived at the end of the follow-up period. SAM patients with vomiting (AOR=24.3, 95% CI: 1.554-38.13, P=0.033), dermatitis (AOR=2.23, 95% CI: 1.082-4.612, P=0.030) and those who spent 8-12 days in phase I (AOR=2.23, 95% CI: 1.082-4.612, P=0.030) had a greater risk of death than their counterparts. On the other hand, children who got antibiotics for 15-21 and 22-28 days, as well as folic acid and ReSoMal, had a greater survival rate. Since a considerable number of SAM patients in this study were case relapses, long term monitoring and evaluation, set up procedures for keeping tracking and assessing the effectiveness of initiatives to lower SAM mortality.
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    Assessment of Health-Related Quality of Life, Treatment Outcome, Medication Adherence, and Associated Factors among Epileptic Patients at Meklle City Hospitals: A Multicentre Observational Study.
    (Addis Ababa University, 2024-07) Kahsay,Gebremicheal Gebreyohannes; Beyene,Alemseged(Ass.Prof.); Gidey,Kidu(Ass.Prof.)
    Background: Epilepsy is a chronic brain disorder with unpredictable treatment responses and a substantial impact on the patient's health-related quality of life (HRQoL). Understanding the treatment response and its determinants, patient's HRQoL, and medication adherence is crucial for designing an optimal treatment strategy for individuals living with epilepsy. However, there is no/limited data about HRQoL, treatment outcomes, and medication adherence in people living with epilepsy in the study settings. Objective: This study aimed to assess the HRQoL, treatment outcome, medication adherence, and associated factors among epileptic patients; at three selected hospitals in Mekelle City, Tigray, Ethiopia. Methodology: A multicenter observational study was conducted from May 10 to September 27 2023 G.C. Study participants were selected through stratified systematic random sampling. The HRQoL and medication adherence were evaluated using the Euro Quality of Life (Euro- QoL) questionnaire and the 8-item Morisk medication adherence scale (MMAS-8). Data analysis was done through STATA version 14. Mann-Whitney U test, Kruskal Wallis H test, tobit regression model, and logistic regression were used to analyze the data. Statistical significance was declared at a 95% Confidence Interval (CI) and p-value of <0.05. Results: A total of 351 study participants with a mean (±SD) age of 37.98 ±14.27 years were involved. More than half (179,51%) of the study participants had poor HRQoL, and the median (IQR) values for EQ-5D-5L utility and EQ-VAS of the study participants were 0.774 (0.56- 0.85) and 65 (50-80), respectively. Age over 60 years (β = -0.21, 95% CI = -0.402, -0.017), and frequent seizure episodes before treatment (β =-0.0054, 95% CI: -0.0102- 0.006) were negatively associated with HRQoL. On the other hand, the absence of co-morbidities (β = 0.095, 95% CI: 0.012 -0.178) and not experiencing seizure remitting-relapsing (β = 0.062, 95% CI: -0.0007- 0.125) were positively associated with HRQoL. More than one-third (39%) of the study participants had poorly controlled seizures with one out of five epileptic patients having seizure relapse. Living in urban areas (AOR=3.36, 95% CI; 1.1-10.4, p=0.037), being government-employed (AOR= 4.0, 95% CI; 1.1-14.5, p=0.035), and a student (AOR=4.0, 95% CI; 1.1-14.5, p=0.035) were factors significantly associated with good seizure control. In addition, half (50.6%) of the study participants were non-adherent to their medications, and being a farmer (AOR=4.2, 95% CI: 1.5-11.3, p=0.005), housewife (AOR=4.9, 95% CI: 1.4- 17.2, p=0.012), absence of co-morbidities (AOR=1.8, 95% CI: 1.11-11.28, p=0.008), and good seizure control (AOR=2.38, 95% CI: 1.55-3.71, p<0.001) were factors significantly associated with AED treatment adherence. Conclusion: More than half of the study participants had poor HRQoL, with anxiety/depression being the most frequently reported health problem. More than one-third of the study participants had poorly controlled seizures, and one out of five epileptic patients experienced seizure remission-relapse. In addition, half of the study participants were non- adherent to their medications.
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    Self-reported adverse drug reactions and adherence of dolutegravir containing antiretroviral therapy regimens among patients in Ayder Comprehensive Specialized Hospital, Mekelle City, Tigray region, Ethiopia
    (Addis Ababa University, 2024-08) Belay,Goitom; Makonnen,Eyasu (PhD); Beyene,Alemseged (MSc, Ass.Prof.); Abraha,Haftom Niguse (MSc, PhD student)
    Background: Despite being introduced into the ART regimen recently due to its many advantages, the tolerability of dolutegravir (DTG) has been questioned because of adverse reactions resulting in medication non-adherence and discontinuations. Therefore, this study aimed to assess self-reported adverse reactions and medication adherence of dolutegravir (DTG) based first line combination antiretroviral therapy (cART) at Ayder Comprehensive Specialized Hospital. Method: A hospital based cross-sectional study was conducted from July to September 2022. Data were collected from medical records of patients and face to face interview. Statistical Package for Social Science (SPSS) window version 25 was used to analyze the data. The continuous and categorical variables were reported by mean/SD and frequency/percentage, respectively. Multivariate logistic regression was performed to identify predictors. Statistical significance was set at p-value <0.05. Result: From a total of 357 participants, 38.9% (139) developed at least one adverse drug reaction. The most frequent reported ADRs were weight gain (21.8%), headache (19.6%) and insomnia (10.6%). Rural residence (AOR=0.362, 95%CI (0.134-0.977), p=0.045), WHO stage 1&2 (AOR=8.582, 95% CI (1.669-44.136), p=0.010), and co-medications (AOR=2.606, 95%CI (1.116-6.086), p=0.027), were significantly associated with self-reported adverse drug reactions in the multivariate analysis. In this study suboptimal adherence (84.6%) was reported. Participants who did not use co-trimoxazole prophylaxis (AOR=0.402, 95%CI (0.181-0.893), p=0.025), were found to be significantly associated with self-reported non-adherence. Conclusion: A substantial number of ADRs associated with DTG based cART were reported in the study setting. Residence, WHO stage at entry and co-medications were significant predictors of ADRs. The level of medication adherence among the participants was suboptimal and participants who did not take cotrimoxazole prophylaxis were associated with poor adherence.
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    Emergency Admission Among Cardiovascular Disease Patients; Outcome,Risk Factors and Drug-Related Admission, at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a Prospective Observational Study.
    (Addis Ababa University, 2024-02) Husein,Hikma; Ayalew,Eskinder(MSC, Asst.Prof.); Kefyalew,Merahi(Asst.Prof.)
    Background: In Ethiopia, the prevalence of cardiovascular diseases is rising, with varying prevalence from 1 to 20 percent across the nation. Moreover, drug-related hospital admissions are a common issue among these patients because of the greater number of medications required, the multiple issues caused by cardiovascular illnesses, and the usage of pharmaceuticals with a limited therapeutic index. Objective: This study aims to evaluate the results of cardiovascular patients treated in the emergency room of Tikur Anbessa Specialized Hospital, as well as the frequency of drug-related emergency admissions and the factors linked to both the drug-related admissions and the patient's outcome. Methodology: A prospective observational study was conducted from September to December 2022 on patients with cardiovascular illness who came to Tikur Anbessa Specialized Hospital's adult emergency department. All patients who visited ED during this time and met the requirements for inclusion was counted in the study. A questionnaire was used to gather data, and SPSS version 25 was used for analysis. While factors associated with drug-related emergency admission were identified by logistic regression analysis, cox regression analysis was used to estimate factors associated with emergency department survival. Result: In total, 401 patients made up the study; 51.1% of the patients were male and the median age was 50. Of the patients admitted to the emergency room, 9.5% passed away during the study period. Poly-pharmacy, diagnosis with dilated cardiomyopathy and atrial fibrillation, and history of smoking are associated with a higher mortality rate in these patients. 23% of all admission was due to drug related problems, with non-adherence being the most common cause. Conclusion: A mortality rate of 9.5% was found in cardiovascular disease patients, and the prevalence of drug related emergency admission among cardiovascular disease patients was 23% in this study.
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    Venous Thromboembolism Risk, Prophylaxis and Incidence among Patients attending Emergency Department of Tertiary Care Hospitals in Addis Ababa Ethiopia: A Multicenter Prospective Study
    (Addis Ababa University, 2024-06) Degefa,Worku; Beyene,Alemseged( MSc.Ass.Prof.); Alebachew,Minyahil( MSc.PHD); Mekonnen,Desalew(MD)
    Background: Venous Thromboembolism (VTE) constitutes pulmonary embolism and deep vein thrombosis. This problem is a major public issue associated with significant morbidity and mortality. There is initial evidence suggesting that early recognition of acute VTE and the nonspecificity of its symptoms and signs, however, there was a paucity of data to follow the guidelines for accurate risk assessment and tailored pharmacological thromboprophylaxis. Objective: To assess VTE risk, prophylaxis, incidence and its predictors among patients attending the emergency department (ED) of tertiary hospitals in Addis Ababa Ethiopia. Method: A multicenter hospital-based prospective study was conducted from June 1 to September 15/ 2023 in patients admitted to the adult ED of the three tertiary care hospitals namely Tikur Anbesa Specialized Hospital, St Paulos Hospital Millennium Medical College and Addis Ababa Burn Emergency and Trauma (AaBET) Hospital. The data was collected using questionnaire prepared by reviewing different literature and the Padua VTE risk assessment tool. The collected data was entered into Epidata version 4.2 then exported to SPSS version 25 for analysis. Multivariable Cox regression was performed to identify independent predictors for VTE occurrence. Adjusted hazard ratio was used to measure the strength of association. The P< 0.05 was considered as statistically significant. Result: A total of 422 patients were enrolled. About 70.64% of ED admitted patients were found to be in high risk of developing VTE according to Padua risk prediction score. Of eligible patients for pharmacological prophylaxis only 33.4% of them were given anticoagulant prophylaxis.VTE occurred in 18 (4.3%) patients after admitted in ED. The multivariable Cox regression analysis showed that the physically active patients prior to ED admission was less risk to develop VTE compared to physically inactive patients (Adjusted Hazard Ratio (AHR)= 0.67, 95% (CI): 0.082-1.579, P=0.014),getting pharmacological prophylaxis decreased the risk of developing VTE by 83% (AHR)=0.167, 95% (CI): 0.037-0.768, P=0.021), having acute infection such as sepsis increased the risk of developing VTE 8 fold than without infection(AHR=8.169, 95%CI: 1.045-63.854, P=0.045) and having active cancer (AHR=5.133, 95%CI: 1.241-21.093, P=0.023),) were independently associated with VTE event during follow up period. Conclusion: The VTE risk and occurrence was high among ED attaining adult patients and the rate of thromboprophylaxis use for those high-risk patients was low. Absence of pharmacological prophylaxis, physically inactive patients prior to admission, active cancer and acute infection were found to be independent predictors for the occurrence of VTE during the emergency ward stay.
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    Treatment Outcome of Epilepsy and Associated Factors among Pediatric Patients at Selected Hospitals in Addis Ababa, Ethiopia
    (Addis Ababa University, 2023) Markos,Bamlak; Alebachew,Minyahil( Ph.D. Fellow); Moges,Ayalew(MD)
    Background: Anti-seizure medications (ASMs) are the mainstay for achieving remission in patients with epilepsy. A successful therapy using anti-seizure medications can eliminate or reduce symptoms, and leads to freedom of seizures. Objective: To assess treatment outcome of epilepsy and associated factors among pediatric patients at selected hospitals. Methods: A hospital-based cross-sectional study was conducted among 300 pediatric patients with epilepsy at selected hospitals. Data were collected by interviewing and reviewing the medical records of the patients using semi-structured questionnaires. Data were entered into Epi data version 4.6.6 then analyzed using SPSS version 25. Descriptive statistics were used to present the results. Logistic regression was used to determine the relationship between independent and dependent variables and p-value <0.05 was considered statistically significant. Result: Males account 64.3% of the 300 patients. The mean age of patients was 8.2 ±4.2 years. The most common type of seizure (66%) was a generalized seizure followed by a mixed seizure (13.3%). Monotherapy was commonly 64.3% used in the management of seizures, with phenytoin being used in the majority (47.7%) of patients. The current study revealed that 62.3% of patients had an uncontrolled seizure. No statistically significant relationship was found between seizure control and serum level of antiseizure medications, Χ2 (df=1 N=58) P= 0.920. Female gender (AOR= 0.515, 95% CI: 0.285-0.931, P=0.028), primary education of caregivers (AOR=0.436, 95% CI: 0.192-0.99, P=0.047), and family history of epilepsy (AOR=0.363, 95% CI: 0.153-0.857, P=0.021) decreased odds of uncontrolled seizures. Seizure-triggers (AOR=3.63, 95% CI: 1.99-6.614, P<0.001), and polytherapy with anti-seizure medications (AOR=6.79, 95% CI: 3.221-14.311, P<0.001) increased odds of uncontrolled seizures. Conclusion: The finding of this study indicates that seizure control status among pediatrics was poor. Thus, Parents of children, health care providers and other concerned bodies should focus on factors that are associated with uncontrolled seizures, particularly polytheray with antiseizure medications, and seizure triggers.
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    Outcome of antiemetic prophylaxis among pediatric cancer patients receiving moderate to highly emetogenic chemotherapy at pediatric hemato-oncology ward of Tikur Anbessa specialized hospital: A prospective, observational, longitudinal study
    (Addis Ababa University, 2023) Mathewos,Hawaryaw; Ayalew,Eskinder( Ass.Prof.)
    Background: Chemotherapy induced nausea and vomiting (CINV) remains to be an important concern in pediatric patients receiving chemotherapy. However, outcomes of antiemetic prophylaxis in pediatric cancer patients are not well studied, especially in developing countries like Ethiopia. Objective: The study objective is to determine the outcome of antiemetic prophylaxis among pediatric cancer patients admitted at Tikur Anbessa specialized hospital Addis Ababa Ethiopia. Methods: A longitudinal prospective observational study design was carried out. Patients were prospectively observed for up to 120 hours post chemotherapy. The proportion of patients who had a complete response (no vomiting, no retching, and/or no need for rescue therapy) in the acute, delayed and overall phases was evaluated using descriptive statistics. Binary logistic regression was used to identify risk variables associated with the outcome of antiemetic prophylaxis with a p-value of 0.05 and 95 % confidence interval (CI). The Kaplan–Meier method was used to assess the time to first emesis event. Cox regression was used to analyze factors associated with the first emesis event using hazard ratio. Results: A total of 201 pediatric cancer patients were studied. The majority of patients 75.1% in the acute and 63.7% in the delayed phase received combination prophylactic antiemetics regimen. In the acute, delayed, and overall phases, the complete response rates were 71.1%, 68.2%, and 51.2%, respectively. A daily range of 0-8 episodes of emesis per single patient was observed in acute phase and 0-18 episodes in delayed phase. Emesis peaked on day one of treatment, occurring among 28.4% of patients and, decreased steadily throughout follow-up. Multivariable analysis revealed that emesis during the acute phase was associated with a history of motion sickness ([OR] odds ratio, 4.31, 95% CI [1.93, 9.64]), platinum-based chemotherapy (OR 5.42, 95% CI [1.97, 14.98]) and with a history of prior CIV (OR 5.02, 95% CI [2.24, 11.23]). Emesis during the delayed phase was associated with a multiple-day chemotherapy (OR 6.44, 95 % CI [1.9, 21.98], a history of prior CIV (OR 6.27, 95% CI [1.81, 21.7]), a receipt of rescue antiemetics at the acute phase (OR 3.85, 95% CI [1.18, 12.6]), and a history of motion sickness (OR 3.2, 95% CI [1.34, 7.61]). However, the likelihood of CIV was found to be reduced when steroids were present in the v chemotherapy regimen, (OR 0.16, 95 % CI [0.04, 0.73]). The time to first emesis event was markedly late in patients who took moderate emetogenic chemotherapy compared to high emetogenic chemotherapy (log rank test, P=0.025). In the overall observation period, a faster rate of first emesis event was associated with a receipt of concomitant intrathecal chemotherapy (hazard ratio [HR] 6.11, 95% CI= [1.51, 24.8]), a history of prior CIV (HR 2.0 95% CI= [1.01, 3.94]), platinum-based chemotherapy (HR 2.22 95% CI= [1.22, 4.02]), and a history of motion sickness (HR 2.1 95% CI= [1.36, 3.12]). Conclusion: A considerable number of participants could not achieve complete response. The platinum- based regimen, a history of motion sickness, and a history of prior CIV were found to have the poorest emesis control during the acute and delayed phases. Better CIV control was observed with combination antiemetic prophylaxis regimens. A delayed onset of emesis was observed with moderate emetogenic chemotherapy compared to high emetogenic chemotherapy.
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    Clinical Characteristics and Outcomes of Acute ischemic stroke with Atrial fibrillation among patients admitted to Tertiary Care Hospitals in Amhara Regional State: Retrospective-cohort study
    (Addis Ababa University, 2023) Debasu,Zenaw; Ayele,Teshale(Ass. Prof.)
    Background: Atrial fibrillation (AF) is commonly associated with cardioembolic stroke and is the major contributing factor to the increase in hospital expenditures for the care of stroke. However, evidence regarding clinical characteristics and outcomes of patients admitted with acute ischemic stroke (AIS) plus AF in Ethiopia is lacking. Objective: To assess clinical characteristics and outcomes of acute ischemic stroke with atrial fibrillation among patients admitted to Tertiary Care Hospitals in Amhara regional state. Methods: A retrospective cohort study was conducted among patients diagnosed with acute ischemic stroke and treated at Tibebe Ghion and Felege Hiwot CSHs from November 2018 - November 2021. Candidate patients were recruited using a consecutive sampling technique. Data were analyzed using SPSS version 25. Cox-regression analyses was used to identify the predictors of in-hospital mortality. The hazard ratio was used as a measure of the strength of the association and statistical significance was declared at p-value < 0.05. Besides, multivariate linear regression analysis was employed to explore predictors of length of hospital stay. The slope of regression line () with its 95% CI is used to declare statistical significance. Result: Of the 378 patients with acute ischemic stroke, 58.7% were male. AF was diagnosed in 102 (26.9%) patients. Patients with AF were more likely to have Glasgow coma scale <8 (83.3 vs 4%, p< 0.001), valvular heart disease (56.9 vs 4.7 %, p< 0.001), and coronary heart disease (11.8 vs 4%, p=0.005). The incidence rate of in-hospital mortality was high for patients with atrial fibrillation (38 per 1000 person-days vs 17 per 1000 person-days). Glasgow coma scale < 8: (AHR=12.69, 95%CI: 2.603-61.873; p=0.002), Aspirational pneumonia (AHR=2.602, 95%CI: 1.085-6.242; p=0.032), Acute Renal Failure (AHR=6.114, 95%CI: 1.817, 20.576; p=0.003), Hypokalemia: (AHR=1.179, 95%CI: 1.112, 3.373; p=0.013), atrial fibrillation :(AHR=1.104, 95%CI: 1.015, 5.404; p=0.003), HIV/AIDS :(AHR=8.302, 95%CI: 1.585, 43.502 ; p=0.012) and Chronic liver disease :(AHR=4.969, 95%CI: 1.192-20.704 ; p=0.028) were the independent predictors of in-hospital mortality. Besides, deep vein thrombosis (β=7.337, 95%CI: 1.226,13.448; p=0.019), atrial fibrillation (β=1.696, 95%CI: 0.851,2.542; p=0.000), post-stroke depression (β=4.831, 95%CI: 2.330,7.332; p=0.000) and aspiration pneumonia (β=2.089, 95%CI: 1.178,3.000; p=0.000) were predictors of length of stay. IX Conclusion: In this study, hospital mortality was higher in acute ischemic stroke associated with atrial fibrillation. Stroke-related complications were significant predictors of mortality and prolonged length of stay. Hence effective strategies should be in place to curb the impacts of these factors.
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    Treatment outcomes, adherence, and health-related quality of life of patients with immune thrombocytopenia in two teaching hospitals, Addis Ababa, Ethiopia: A retrospective cohort study.
    (Addis Ababa University, 2023) Beyene,Dessale Abate; Sisay,Eskindir Ayalew(Ass. Prof.); Gebremedhin,Amha(Ass. Prof.)
    Background: Treatment of immune thrombocytopenia (ITP) is challenging, and treatment outcomes depend on a variety of factors, most of which are unknown and specific to each patient. The severity and treatment outcomes of ITP are assessed clinically by platelet count, bleeding risk, and response to treatment. Corticosteroids are the cornerstone of ITP treatment but have many side effects, and long-term response is observed in only 25% of patients. More than 80% of ITP patients responded to corticosteroid treatment, but relapses were common after treatment was discontinued. ITP also affects the health-related quality of life (HRQoL) of affected patients. Treatment outcomes, treatment adherence, and HRQoL have not been studied in Ethiopian ITP patients. Objective: To assess treatment outcomes, treatment adherence, and HRQoL in patients with ITP at Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC). Methods: The retrospective hospital-based cohort study design was conducted from September 15/2022 to January 15/2023. Convenient sampling was used to recruit 214 study participants. Ethical clearance and approval of the study protocol were obtained from the institutional ethics review board of the School of Pharmacy, and permission was obtained from the respective study sites. Descriptive statistics were used to summarize the sociodemographic data and clinical and treatment characteristics. Multinomial regression analysis models were used to identify Predictive factors for treatment outcomes and linear regression analysis models were also used to identify Predictive factors for HRQoL. A p- value of less than 0.05 was generally considered statistically significant. Results: Most of the study participants 161(75.5%) were female patients. During diagnosis, 166(77.6%) had epistaxis and wet purpura (mucosal bleeding). Regarding the treatment, the majority 172(80.4%) of study participants took prednisolone alone, and 143(66.8%) of the study participant have experienced at least one side effect of corticosteroids throughout the treatment period. Regarding medication adherence 178(83.2%) of study participants had good adherence to their ITP medications. The complete response rate at 3 months was 139 (65.0%) and the overall impact of ITP on HRQoL was 35.41±9.27. Predictive factors for partial response to treatment were increased impact of ITP on HRQoL (AOR =1.221, 95% CI: 1.096-1.360), study site TASH (AOR =0.431, 95% CI: 0.197-0.941), and presence of heavy Page II menstrual bleeding (AOR =2.255, 95% CI: 0.925-5.497) compared with complete response. Hepatitis B virus-infected ITP patients (AOR = 0.052, 95% CI: 0.004-0.621) was also a predictive factor for no response compared with complete response. Furthermore, predictive factors for an increasingly higher impact of ITP on HRQoL were the development of emotionally related corticosteroid side effects (β= 0.392, 95% CI: 5.160-9.961, P< 0.001), the presence of fatigue during the assessment (β= 0.326, 95% CI: 4.394-9.475, P< 0.001), patients not taking cotrimoxazole prophylaxis treatment (β= 0.236, 95% CI: 2.236-6.570, P< 0.001), living far from the hematology clinic (outside Addis Ababa) (β= 0166, 95% CI: 1.107-5.114 P=0.003), having epistaxis and wet purpura (mucosal bleeding) (β= 0.191, 95% CI: 0.091-4.259, P=0.001), and skin symptoms (petechiae and ecchymosis) (β= 0.041, 95% CI: 0.091-4.259 P=0.041) during diagnosis. Conclusion: The highest complete response rate was achieved at 12 months and the impact of ITP on HRQoL was high in terms of daily energy level and work capacity. The patients had good adherence to their ITP medications, and more than half of the study participants experienced at least one side effect of corticosteroids throughout the treatment period.
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    Treatment Outcome of Deep Venous Thrombosis and Associated Factors among patients in Selected Hospitals of Addis Ababa; Ethiopia, Multi center Retrospective cross-sectional Study
    (Addis Ababa University, 2023) Birhane,Seble; Mulu,Assefa(Ass. Prof.); Tadesse,Fisihatsion (MD)
    Background: Pulmonary embolism and deep venous thrombosis are the two most important manifestations of venous thromboembolism (VTE).Anticoagulation is the mainstay of treatment. The aim of treatment of deep vein thrombosis (DVT) is to reduce morbidity and mortality. The major outcomes of DVT are death, recurrence and major bleeding due to anticoagulation therapy. Objective: To evaluate treatment outcome and associated factors among patients diagnosed with DVT in Tikur Anbessa Specialized Hospital, St. Paul’s Hospital Millennium Medical College and Zewditu Memorial Hospital. Methods: A retrospective cross-sectional study was conducted from October to March, 2021 among DVT patients admitted to wards of Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul’s Hospital Millennium Medical College from July 1, 2017, to July 2020 (3 years). Patient specific data was collected by using structured data collection tool. Data were collected and entered into Epi info 4.6.0.6 and analyzed using SPSS version 25. Binary logistic regression analysis was used to determine independent predictors of DVT treatment outcome. Candidate variables associated with the outcomes of interest (P<.25 in the bivariate analysis) were included in multivariate logistic regression analysis model. Results: The mean age of the study participants was 45.2, years (±15.36). Risk factors of DVT include immobilization (29.9%), previous surgery (27.5%), cancer (21.1), unprovoked (23), previous VTE (20.6%), infection (19.6%) and advanced age (>75 years) (8.1%). DVT recurrence rate was 22.5%. In a multivariate logistic regression analysis participants with bilateral DVT (AOR=2.8, 95%CI=1.14, 6.66), obese participants (AOR=3.3, 95%CI=1.15, 9.59), participants with hypertension (AOR=6.5, 95%CI=2.90, 14.70), participants with retro viral infection (RVI) (AOR=6.3, 95%CI=2.34, 16.94), baseline international normalized ratio (INR) (2-3) (AOR=6.6, 95%CI=2.86, 15.37) increase in likelihood of developing recurrence DVT. During the study period 2.2% of the participants died and 19.9% developed complication. Participants who had major bleeding were 4.5% with bilateral DVT (AOR=3.9, 95%CI=1.6, 9.7), participants having active cancer (AOR=6.5, 95% =2.9, 14.75) and whose age >75 years (AOR=6.8, 95%CI=2.03, 22.33) had increase risk of major bleeding than the opposite compartment. ii Conclusions: In the current study, the overall DVT recurrence rate was 22.5%, which is complicated by pulmonary embolism and causes 2.2% death. Patients who presented with PE had higher rates of death compared with patients with isolated DVT. Efforts are needed to identify patients who are most at risk for VTE complications and to develop better anticoagulation strategies suitable for long-term use and improve the treatment outcomes.
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    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.
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    Assessment of the quality of life, treatment practices, and associated factors among children with atopic dermatitis patients at All Africa Leprosy, TB and rehabilitation training center (A.L.E.R.T), Addis Ababa, Ethiopia: A prospective observational study
    (Addis Ababa University, 2023) Aynalem,Minychel Wale; Beyene,Alemseged(Asso. Prof.)
    Background: Atopic dermatitis (AD) is the most common chronic skin disease in children. It is chrcaterized by dry, itchy, eczematous skin symptoms. These symptoms produce dramatic negative impact on quality of life (QoL) of patients.There is a paucity of study on patients’ QoL, the pattern of treatment practices, and factors associated with poor QoL in children with AD in Ethiopia. Objective: To assess QoL, treatment practice, symptoms control status and its associated factors among children with AD at ALERT dermatovenerology unit, Addis Ababa, Ethiopia. Method: Prospective observational study was conducted at ALERT comprehensive specialized hospital dermatovenereology unit from September 01, 2022 to February 31, 2023. Structured questionnaire and CDLQI tool were used to collect the data. Data were collected, entered and analyzed using Statistical Package for the Social Sciences (SPSS®) version 25. Descriptive statistics were used to summarize the data while multivariable binary logistic regression analysis was used to determine factors associated with QoL. P-value <0.05 was considered as statistically significant. Results: Among 403 study partciapnst (53.6% , n= 216 ) were female. The mean (+SD) age of the study participants was 8.04 (+3.40) years. The age onset of the disease in (41.7 %, n= 168) study participants was mid onset. Among study participants, the majority of them, (84.6%, n= 341) had pure AD.The duration of the disease in (76.4 %, n= 308) patients were less than to 5 years. Among study participants, the majority of them, (42.2 %, n= 170) had Sub- Acute phase, Non lessional type AD (71.7 %, n= 289), followed by Moderate (57.6 %, n= 232). Topically applied readymade medicine, antihistamine and emollient was given for (55.6 %, n = 224), (24.3 %, n= 98) and (75.8%, n=305) partcipants, respectively. The mean CDLQI was 8.42(+ 3.57) crosponding to a moderate effect. Domain of itching, dressing and sleeping was the utmost affected QoL. Majority of the study partcipants (75.7%, n=305) had localized Pruritus followed by , dry skin (70.7%, n= 285) symptoms .AD symptoms was controlled among (76.9%, n = 310) patients. Multivariabel logistic regression showed that government employed caregivers [AOR=5.5 (95% CI: [1.18, 27.61)], P=0.038; daily laborer caregivers [AOR = 16.23 (95 % CI: [1.78, 148.1)], P= 0.014 ,having moderate AD [AOR = 4.20 (95% CI: [2.25, 7.8)], P=0.001), having Allergic rhinitis comorbidities [AOR=20.6 (95% CI: [1.55,275.5)], P=0.022 and who use topically applied Tacrolimus [AOR=5.63 (CI: 1.03, 30.92)] was signifcantly associated with QoL. IV Conclusion: Emollients, topically corticosteroids, and antihistamines were the mainstay treatment. AD has significant impact on the QoL of children, mainly through Symptom and feeling , sleeping problems and dressing problems. Majority of children with AD symptoms were controlled. Factors such as Government employee, daily laborer, moderate AD , allergic rhinitis, and use of topical tacrolimus were considered to have poor QoL. Thus, widening the AD management with education and evaluating of children QoL deemed to be imprortant.
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    Pre and Intra COVID-19ERA Comparison of Detection and Clinical Outcomes among Patients with Tuberculosis:A Four-Years Retrospective Follow-UP Study in Selected Public Hospitals in Addis Ababa, Ethiopia, 2023.
    (Addis Ababa University, 2023) Hadgu,Ruth; Chelkeba,Legese (PhD)
    Background: Tuberculosis (TB) is still the biggest cause of death from an infectious disease worldwide, with over 10 million people becoming infected each year. The coronavirus disease 2019 (COVID-19) outbreak has severely disrupted health-care systems and people's overall well- being around the world. People with TB are more likely to develop severe disease or die than people with COVID-19. The coexistence of COVID-19 with pulmonary TB can create a diagnostic dilemma and additional diagnostic challenges for clinicians. Despite these difficulties, there is not enough data to determine how COVID-19 affects TB patient detection and outcomes. Objective: To compare the detection and clinical outcomes of patients with TB pre and intra COVID-19 periods in selected public Hospitals of Addis Ababa, Ethiopia, 2023. Methods: A retrospective observational follow-up study was undertaken among TB patients with pre- and intra-COVID-19 era comparisons. This study was carried out in five public hospitals in Addis Ababa, which were chosen using a stratified sample technique. A 1.2-structured ODK version 2022 questionnaire was employed. Finally, it was exported to SPSS version 26 for analysis. Bivariate analysis at a P-value of 0.25 and multivariable analysis at a P-value of 0.05 were applied to announce for statistical significance Results: Patients who had known treatment outcomes in the selected hospitals were 375 during the COVID-19 period, compared with 469 TB during pre – COVID-19 period, showing a 20% decline in TB testing. Despite the decrement of susceptible (10.6%) and rifampicin resistance (RR) TB (47.7%), there was a 54.3% of multi-drug resistance (MDR) TB increment during the COVID- 19 period. Overall, there was significantly lower treatment success rate of TB during COVID-19 period (75.7% vs. 81.2%, p< 0.001), with higher rate of loss to follow up (8.8% vs. 6.2%, p= <0.001) as well as death (12.8% vs. 8.7%, p= < 0.001) compared with pre-C0VID-19 period. Factors such as treatment method in the pre-COVID-19 and age category, educational level, type of tuberculosis, and HIV status during COVID-19 period were significant indicators of successful TB treatment. Conclusion and recommendation: COVID-19 had a substantial detrimental influence on overall TB detection, RR-TB/MDR-TB, treatment success, lost-to-follow-up and mortality. To reduce the impact on TB case detection, the TB program must rapidly adjust to the new normal, strengthen patient-centered TB care, embrace digital health technology, increase awareness of generation, and guarantee that other opportunities given by the pandemic will be utilized.
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    Clinical Outcomes and Associated Factors in Patients Who Successfully Underwent Percutaneous Coronary Intervention: A 5-Year Multicenter Retrospective Crossectional Study
    (Addis Ababa University, 2023-10) Melesse,Wondimu; Assefa,Tamrat(Ass. Prof.); Alemayehu,Bekele(Ass. Prof.)
    Background: Myocardial infarction (MI) is the leading cause of death globally, with the majority of death occurring in low-and middle-income countries (LMICs). Percutaneous coronary intervention (PCI) became a standard management modality to improve patients’ quality of life and reduce mortality when combined with pharmacologic therapy. However, the PCI service was not well-practiced in Ethiopian health facilities and also poor outcomes had previously been reported. Objective: To assess the clinical outcomes and associated factors among myocardial infarction patients who underwent successful PCI in Addis Ababa, Ethiopia. Methods: A retrospective crossectional study was conducted at three healthcare facilities from March 01 to May 31, 2022. A total of 241 MI patients who underwent successful PCI between January 1, 2017, and December 31, 2021, were included. The outcome measures were in-hospital mortality, non-fatal major adverse cardiac and cerebrovascular events (MACCEs) and complication rates. Data were analyzed using SPSS version 21.0. Multivariable Cox-regression was carried out to identify predictors of in-hospital mortality. Variable with p -a value < 0.05 was considered statistically significant. Kaplan Meier analyses were also used to determine overall survival rates and median survival time. Results: Out of 241 participants, 194 (80.5%) were males and the mean age was57.2 ± 10.6 years. One hundred eight-three (75.9%) patients had ST-elevated myocardial infarction (STEMI). Dyslipidemia 198 (82.2%) was the leading risk factor for MI. One twenty three (51%) patients received pharmaco-invasive PCI and drug-eluting stent (DES) implantation (181, 75.1%) was the most commonly used reperfusion method in the study settings. The most commonly used medications in these patients were statins (100%) and aspirin (92.6%), followed by clopidogrel (88.4%). In-hospital mortality and non-fatal MACCEs rates were 3.7% and 24.1%, respectively. The predictors for in-hospital mortality were being female (AHR=8.39, 95% CI: 1.20-58.68, P= 0.03), pre-procedural obesity (AHR=6.54, 95% CI: 1.10-40.60, P=0.04), previous MI (AHR=9.68, 95% CI: 1.66-56.31, P=0.01), chronic heart failure (AHR=9.21, 95% CI: 1.38-61.78, P=0.02) and having previous history of stroke (AHR=18.99, 95% CI: 1.59-227.58, P=0.02). The overall estimated 1-year survival rate of MI patients who underwent successful PCI was 96.3%. Conclusion and recommendation: Pharmaco-invasive PCI was the most commonly deployed intervention in patients with myocardial infraction. The overall in-hospital mortality rate was low and about a quarter of study patients developed non-fatal MACCEs. The estimated one-year survival rate was higher. Although the current study's findings appear to be better, there is still improvement to be made in terms of providing essential medications, proper documentation of patient data, and expanding access of reperfusion therapy in the country
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    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.
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    Treatment outcomes and Prognostic Factors for Survival inPatientswith Gastric Cancer at Adult Oncology Unit of Tikur AnbessaSpecialized Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2022-06) Tsegaw, Hilina; Prof. Engidawork, Ephrem (PhD)
    Gastric cancer is the fifth most often diagnosed cancer and the third most frequent reasonforcancerdeath worldwide. InEthiopia, the survival status ofpatients diagnosed with gastric cancer was notwell understood. Thisstudy, therefore,aimedto determinetreatment outcomes and prognostic factorsfor survival status ofpatients diagnosed with gastric cancer at TikurAnbessaSpecialized Hospital,oncology unit; Addis Ababa, Ethiopia.This hospital-based retrospective cohort study wasconductedon164 study participantsselected from patient’s registry between January 01, 2016 toDecember 31, 2020.Datawerecollected using a structured tool from medical records and telephoneinterviews.AKaplan–Meier survival analysis with a log-rank test and bivariate and multivariableanalysis using the Cox proportional hazard model wereused. The median (±SD)age of the studyparticipant at diagnosis was 48.50±14.48 years(range:18–87),withamale to female ratio of 1.8:1.Adenocarcinoma accounted for 73.8% of the cases. Regarding clinical-stage,92(56.1%) of thepatients were diagnosed with stage IV.About 39.6% (65) of thecases were treated with partialgastrostomyfollowed by bypass surgery. The commonest chemotherapy regimen was cisplatin withpaclitaxel (85, 51.8%) followed by cisplatin with 5-Fluorouracil (5-FU), and84 (51.2%) of the caseshad metastasized cancer, of which47 (28.7%) of them had liver metastasis.110(67.1%)of thepatients were dead at the end of the treatment follow-up.A5-yearoverall survival rate was 11% witha median survival time of 18.6 months.In multivariate logistic regression, ECOG ≥ 2, Adenocarcinomahistologic type,ovary metastasis, liver+lung metastasis,andpaclitaxel + carboplatinchemotherapywere found to significantly affect survival of thepatients.The survival outcome ofgastric cancer islowand requiresearly detection.
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    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.