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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 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.
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    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 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.
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    Comparative Safety and Survival Rate of Dolutegravir with Efavirenz based Antiretroviral Therapies for First-line HIV Treatment among Patients in Amhara Region, Ethiopia: Retrospective Cohort Study.
    (Addis Ababa University, 2022-02) Alemnew, Melese; Beyene, Alemseged(B.Pharm,MScAssistantProfessor)
    Background: In combination with other two anti retroviral drugs,Efavirenz(EFV) was the treatment of choice for human immuno deficiency virus(HIV) infection.Given concern sabout safety and resistance,dolutegravir(DTG)-based regimen have been considered as preferred first-line treatments for both treatment naive and treatment experienced HIV patents. Objective:To determine the safety and survival rate of DTG compared with EFV-based anti retro viral therapies as first-line HIV treatment among HIV patients. Objective: To determine the safety and survival rate of DTG compared with EFV-based antiretroviral therapies as first-line HIV treatment among HIV patients. Methods: A retrospective hospital-based cohort study carried out from September 1, 2019 to August 30, 2020 at HIV clinics of three selected hospitals with HIV treatment centers in Amhara region, Ethiopia. All HIV patients ≥3 years old, those had been either on DTG or EFV-based combination anti-retroviral therapy (cART), and had detectable VL were included. All HIV patients who fulfill inclusion criteria were studied. Data was extracted from patient chart using structure questionnaire. Descriptive statistics, chi-square test, univariate and multivariate cox-regression were performed for data analysis. A statistical significance was considered at p-value ≤ 0.05. Result: Overall, 990 HIV patients were included in the analysis of which 694 took DTG and 296 received EFV based-regimen. A viral load of < 50 copies/mL was observed in 479 of 694 participants (69%) in the DTG group and 196 of 296 participants (66%) in the EFV group (AHR=1.28, 95%CI: 1.08-1.51; p=0.004).Among patients with a baseline viral load of ≥1000 copies/ mL, a total of 66 from 174 participants (38.0%) in the DTG group and 35 out of 96 participants (36.5%) in the EFV group had a viral load of <50 copies/mL (AHR=0.45, 95%CI: 0.37-0.56; p<0.001). Eleven (1.6%) patients in the DTG group and 8 (2.7%) patients in the EFV group showed virologic failure (p=0.241).Out of the total, 289 (42%) of patients in the DTG group reported adverse drug event (ADE) compared with 147 (50%) in the EFV group (p=0.020).Younger age, opportunistic infections (OI), bedridden condition, no prophylaxis for OI, low baseline cluster differentiation (CD4), high baseline viral load, poor adherence and ADE were predictors of poor survival and also younger age, OI, low baseline CD4, DTG-based initial regimen, poor adherence for cART, naïve treatment history and student job type were predictor of poor safety outcomes. Conclusions: DTG-based regimen demonstrates improved survival rate and good safety profile than EFV-based regimen for the treatment of HIV infected patients. Baseline CD4+ T-cell count < 200 cells/mm3, opportunistic infections and poor adherence were factors associated with poor survival outcome and safety outcomes. HIV patients with these risk factors should be treated and monitored regularly
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    Evaluation of the Diuretic and Analgesic Activities of the Rhizomes of Rumex Abyssinicus Jacqinmice
    (Addis Ababa University, 2008-10) Mekonnen, Teshale; Engidawork, Ephrem (PhD)
    Rumex abyssinicus Jacq (Polygonaceae) is a widely spread medicinal plant used traditionally for treatment of several ailments, including hypertension, inflammatory and painful conditions. The present study aimed to examine the diuretic and analgesic activities of aqueous and 80% methanol extracts of the rhizomes of the plant at different doses in mice. To this effect, negative controls were orally treated with distilled water (DW) or Tween 80(4%) (TW80), solvents used for reconstitution of the extracts. Positive controls were treated with furosemide (10 mglkg) (FrIO) for diuretic test or aspirin (100 mg/kg) (ASA100) and morphine (10 mg/kg) (MIO) for acetic acid-induced writhing and hot-plate analgesic studies, respectively. For the diuretic study, treatment groups received an oral dose of SOO mgikg (RASOO), 7S0 mglkg (RA7S0) or 1000 mg/kg (RA1000) of the aqueous extract or 2S0 mglkg (RM2S0), SOO mg/kg (RMSOO) or 7S0 mglkg (RM7S0) of 80% methanolic extract. Urine volume was then measured at different time (1,2, 3, 4, and S h) and the urinary Na+, K+ and cr also measured at S h. For both analgesic tests, 2S0 mglkg (RM2S0), SOO mg/kg (RMSOO) or 1000 mglkg (RM1000) of 80% methanolic extract doses were used. Whereas the number of writhes was counted for 20 min just S min after intraperitonial injection of 0.6% acetic acid (O.lS mLilOg) for the writhing test, the reaction time of each mouse was evaluated at 30, 4S, 60, and 90 min after treatment for the hot-plate test. For the acute toxicity study, SOOO mglkg of aqueous or 80% methanolic extract was administered orally and observed for the following IS days. Both extracts displayed a clear dose-dependent diuretic and analgesic effect as compared to controls. RA1000 and RM7S0 were able to increase diuresis significantly (P
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    Valuation of Stress Ulcer Prophylaxis Use and Associated Factors at Adult Medical Ward and Intensive Care Unit of Tikur Anbessa Specialized Hospital; A Cross-sectional Study
    (Addis Abeba University, 2021-07) Yassin, Samiya; Abula, Tefera(Professor, PhD); Sada, Oumer (Assistant Professor)
    Stress ulcer is an inflammatory condition involving the gastric mucosa that may appear at some point of physiological stress such as serious illness. Prophylaxis against stress ulcers using Acidsuppressive therapy (AST), such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H 2 RAs), often is used to prevent gastric complications, in patients with serious illnesses as they have a high risk of developing gastric ulceration and bleeding. Currently there is a growing concern about improper use of stress ulcer prophylaxis (SUP) in hospitalized patients. Hence, this study was aimed to determine appropriateness and associated factors for the use of SUP among patients treated at adult medical ward and intensive care unit of TASH. An institutional based Cross-Sectional study was conducted from August 9 th , 2019 to December 9 , 2019. Data was collected prospectively from 368 patient medical records. The data were entered into Epi-info version 7 and then exported to and analyzed using Statistical Package for Social Sciences, version 25. Descriptive statistics were used to summarize the data while multivariable binary logistic regression analysis was used to determine factors associated with appropriateness of SUP use. P-value <0.05 was considered as statistically significant. The median age of the study participants was 32 years. Of the included study participants, 144 (39.13%) were on SUP; among patients on SUP more than one-third of them (39.13%) received SUP without an appropriate indicationand140 (62.50 %) patients had indications but did not receive SUP. In multivariable logistic regression, patients who were on NG tube feeding, patients with coagulopathy and history of UGIB, PUD and gastritis showed statically significant association with inappropriateness of SUP use. Inappropriate SUP use was observed in significant number of study participants. Greater proportion of this inappropriateness was attributed to the underutilization of SUP for high-risk patients. Hence, it is necessary to implement and comply to standardized SUP guidelines for ICU and medical ward patients in our hospital setting.
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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.
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    Prevalence and Predictors of Drug Related Hospitalizations in Multicenter Study Settings, Addis Ababa, Ethiopia: A Prospective Observational Study
    (Addis Abeba University, 2021-05) Belete, Mulate; Beyene, Alemseged (B.pharm, MSc, Assistant Professor)
    Abstract Background: Drug related hospitalizations (DRHs) represent a substantial burden on health care resources worldwide and are considered as one of the leading causes of morbidity. Studies carried out in various countries, the extent of DRHs has been estimated to be between 16% to 41.3%.Of those, more than half of the cases were preventable. Whereas in Ethiopia the prevalence and factors independently associated with DRHs are not known. Therefore, the aim of this study was to determine the prevalence and predictors of DRHs in emergency ward of Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. Methods: A prospective observational study was conducted from August to September, 2020 in the three selected hospitals. Participants were interviewed and their medical charts were reviewed through a structured data collection format. DRHs were assessed using Helper’s and strand’s drug therapy problems classification system. The data were entered and analyzed using Statistical Package for Social Science (SPSS) version 26.Descriptive statistics and binary logistic regressions were performed. P-value <0.05 in multiple binary logistic regression was taken as significant level and results were presented in texts, tables and charts. Result: The numbers of recruited and screened patients were 2655.Out of them, 423 participants who fulfilled the inclusion criteria were enrolled in the study. Of those who met the inclusion criteria, more than half of them (216, 51.1%) were females. The mean age (SD) of the study participants was 47.50 (±17.21) years. The mean length of hospital stay (SD) was 10.29(±8.99) days and ranges from 2 to 96 days. Among the included study participants, near to three fifth (245, 57.9%) of patients were hospitalized due to drug related problems, of which 87.8% were deemed preventable. Of those, more than half (130, 53%) of them experienced failure to receive drugs followed by untreated indications (94, 37.8%). The main reasons for failure to receive drugs were due to patients preferred not to take the medications (43, 33.1%), they feared adverse events (18, 13.8%) ,drug products were not available (17, 13.1%), patients felt better (17,13.1%) and cost of medications was too expensive (16,12.3%).Factors associated with DRHs were old age (age > 64 years (Adjusted Odds Ratio [AOR] = 7.451, 95%CI: 1.889-29.397), tertiary educational level (AOR=0.360, 95%CI: 0.141-0.923), participants who did not have any occupation (AOR=3.409, 95%CI: 1.120-10.374),students (AOR=6.331,95%CI:1.375-29.153) presence of co-morbid diseases (AOR=2.004,95%CI: 1.095-3.668), and hospital stay > seven days (AOR=2.186, 95%CI: 1.412-3.382). Conclusion: DRHs were common among emergency ward patients in the study settings. More than four fifth of DRHs were deemed to be preventable.