Antiretroviral treatment failure and associated factors among HIV patients on the first-line antiretroviral therapy at Mizan-Tepi University teaching hospital, Southwest Ethiopia: A cross-sectional study

ABSTRACT

The use of Antiretroviral therapy (ART) has become a standard of care for the treatment of HIV infection. The therapy restores immune function and reduces HIV-related adverse outcomes. However, treatment failure erodes this advantage and leads to an increased morbidity and compromised quality of life in HIV patients. Thus, this study aimed to assess anti-retroviral treatment failure and associated factors among HIV patients on the first line ART at Mizan-Tepi University Teaching Hospital. A cross-sectional study was undertaken among adult patient who have been on ART and attending ART Clinic of Mizan-Tepi University Teaching Hospital from September 2014 to September 2018. Data were collected retrospectively by reviewing patients' medical charts using a standard structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of anti-retroviral treatment failure, multiple stepwise backward logistic regression analysis were done. P value < .05 was considered as statistically significant. Among 221 patients included in the study, 118 (53.39%) were females. The mean weight of study participants at ART initiation was 57.04 kg. Of the 221 patients on the first line ART, 10 (4.5%) experienced treatment failure. Of these patients, 5 (50%) and 3 (30%) experienced virological failure and clinical failure, respectively. Functional status (AOR: 3, CI: [1.13-6.5], P < .001) and low baseline CD4 cell count (AOR: 4.3, CI: [3.4-10.6], P < .0001) were found to be an independent predictors of treatment failure. The rate of first-line ART treatment failure in the study setting was substantial. Functional status and low baseline CD4 cell count were found to be an independent predictors of virological, clinical and immunological failure. Therefore, more attention should be given for the lifestyle of pateints' on ART and maximize virological tests for monitoring treatment failures.

Adherence to Antiretroviral Therapy Among HIV-Positive Pregnant Women on followup at Mizan Tepi University Teaching and Tepi General Hospitals, Southwest Ethiopia

Background: The introduction of highly active antiretroviral therapy has not only improved longevity in human immunodeficiency virus (HIV)–infected individuals but in addition has had a significant impact on the rate of mother-to-child transmission of the infection. Objective: To assess antiretroviral therapy adherence among HIV-positive pregnant women on follow-up at antiretroviral therapy clinic of Mizan Tepi University Teaching and Tepi General Hospitals. Methods: A descriptive cross-sectional study was undertaken in antiretroviral therapy clinics of Mizan Tepi University Teaching and Tepi General Hospitals from April to May 2018. Data were collected through face to face interview using structured and pretested questionnaires and analyzed using Statistical Package for Social Sciences version 20. Results: Majority of the patients had good adherence to their antiretroviral therapy, 68 (66.00%). Medication side effects, 12 (34.00%) and forgetfulness and distance of the hospital from home, each accounting 11 (31.00%) were the main reasons for nonadherence among nonadherent patients. Frequency of counseling (P = .000), CD4 count (χ² = 37.529, P = .000), World Health Organization’s clinical stage (χ² = 17.515, P = .000), stigma (χ² = 70.426, P = .000), and family support (χ² = 46.383, P = .000) were found to be associated with patients’ medication adherence. Conclusion: The overall patient adherence to antiretroviral therapy in the study facilities was good. Collaborative work among patients, health care organizations, and the public are necessary to tackle the adherence obstacles and enhance patient adherence to the prescribed medication.

Healthcare Professionals' Willingness and Preparedness to Work During COVID-19 in Selected Hospitals of Southwest Ethiopia

BACKGROUND

Many healthcare professionals are dying of COVID-19 while trying to save others. The loss in the healthcare workforce due to sickness and absence will double the risk of a crisis. Identifying barriers of willingness to work during epidemics outbreak and preparedness of healthcare professionals is important to minimize the shortage of human power.

METHODS

Facility-based cross-sectional study was conducted among healthcare professionals working in the selected hospitals of Southwest Ethiopia from June 1-30/2020. The data entry was done by Epi-Data Manager version 4.4.1.0 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis with a backward stepwise approach was done to identify independent predictors of poor preparedness and willingness of the healthcare professionals to work during COVID-19 and Variables with P-value <0.05 were considered as a statistically significant determinant.

RESULTS

Of 407 healthcare professionals who participated in the study, 246 (60.4%) were male. The mean age of the respondents was 28.47±5.60 years. Forty-seven (11.55%) Physicians, 59 (14.50%) pharmacy personnel, 52 (12.78%) Laboratory personnel, 31 (7.62%) Midwives, and 195 (47.91%) Nurses were included in the study. The healthcare professionals who were not prepared for the provision of services during COVID-19 and not willing to work during COVID-19 were 165 (40.5%) and 86 (21.1%) respectively. Having 6 to10 years' experience (AOR=4.046, CI: 1.05-15.58), and divorced marital status (AOR=7.855, CI: 1.781-34.65) were independent predictors of not willing to work during COVID-19. Similarly, lack of personal protective equipment (AOR=28.089, CI: 13.9-56.67) and shortage of infrastructure at the work place (AOR=28.1, CI: 13.9-56.67) were independent predictors of poor preparedness.

CONCLUSION AND RECOMMENDATIONS

Healthcare professionals' willingness and preparedness to work during COVID-19 was low. Use of Telemedicine, provision of personal protective equipment, increasing hospital's safety with adequate infection control policy, and assigning staff who have experience of more than ten years in the risky wards of the hospitals may decrease staffs absentee and increase in the provision of continuous service.

Multi-Drug Resistant Post Corneal Repair Klebsiella oxytoca's Keratitis

Background

Bacterial keratitis can threaten vision through permanent corneal scarring and even perforation, resulting in loss of the eye. Klebsiella oxytoca is resistant to several antibiotics because it produces extended-spectrum β-lactamase encapsulated with polysaccharide. Thus, this article is aimed at reporting a rare case of Klebsiella oxytoca-induced keratitis in Jimma University Medical Centre, Jimma, Ethiopia.

Case Presentation

TA 25-year-old female patient presented with photophobia, redness, and purulent discharge from the right eye. She had matted cilia of the eyelid, conjunctiva injection, corneal ulcer, and deep fibrinous anterior chamber reaction. She had light perception (LP) visual acuity for the same eye and it was firm when examined digitally. The cornea-scleral repair was performed one month earlier, due to open globe injury. The patient had taken empirical fortified antibiotics before the identification of the specific pathogen. Culture and drug sensitivity test was performed in order to identify the aetiology. The result of the test revealed that the identified pathogen was multi-drug-resistant Klebsiella oxytoca. Based on this result and drug availability, high dose topical fluoroquinolones eye drops (Ciprofloxacin eye drop 0.3% and Ofloxacin 0.3%) were given. Besides, dexamethasone 0.1% eye drop was added to the aforementioned antibiotics. After four months of treatment, the visual outcome was changed from LP to hand motion.

Conclusion

A rare case of multi-drug resistant Klebsiella oxytoca induced keratitis which was isolated in a biochemical test was successfully treated with a high dose of fluoroquinolones.

Evaluation of Drug Use Based on the WHO Prescribing Indicator in Mizan-Tepi University Teaching Hospital, South Western Ethiopia: A Cross-sectional Study

Background:

Rational drug use comprises aspects of prescribing, dispensing, and patient use of medicines for different health problems. This study is aimed to assess drug prescribing practices based on the world health organization prescribing indicators in Mizan-Tepi University teaching hospital.

Methods:

An institutional-based, retrospective, cross-sectional study was conducted to evaluate the prescribing practices in Mizan-Tepi University teaching hospital. Data were collected based on the World health organization's drug use indicators using prescription papers. A total of 600 prescriptions, written for a 1-year time, dispensed through the general outpatient pharmacy of the hospital were collected by a systematic random sampling method from Mizan-Tepi University teaching hospital.

Results:

The present study found that the average number of drugs per prescription was 2.04 ± 0.87 in Mizan-Tepi University teaching hospital, with a range between 1 and 5. Prescribing by generic name was 97.6%, and 47.8% of prescriptions contained antibiotics in the hospital. 27.7% of prescriptions contained at least one injectable medication in Mizan-Tepi University teaching hospital. From prescribed drugs, 96.7% of them were prescribed from the Ethiopian essential drug list.

Conclusion:

: Present study indicated that the average number of drugs prescribed per encounter, the percentage of generic prescribing, and prescribing from the EDL were close to the optimal value. However, the percentage of encounters with antibiotics and injections prescribed was found to be very high. Thus, the study highlights some improvements in prescribing habits, particularly by focusing on the inappropriate consumption of antibiotics and injections.

Medication Error and Its Contributing Factors Among Pediatric Patients Diagnosed with Infectious Diseases Admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study

Background

Medication errors in pediatric patients are grossly underreported. Pediatric patients are quite susceptible to medication errors. Potential injury by medication error is higher in young children and infants. It results in serious morbidity and mortality. Thus, this study aimed to assess medication error and its contributing factors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center.

Methods

A prospective observational study was conducted among pediatric patients with infectious diseases admitted from April 1 to June 30, 2018. The patient’s written informed consent was obtained after explaining the purpose of the study. The data were collected by structured questionnaire. Data were entered into EpiData version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of medication error, backward logistic regression analysis was done.

Results

From a total of the 325 study participants, 136 (41.8%) patients had at least one medication error during their hospital stay. A total of 273 medication errors were identified among 136 patients. Medication errors frequently occurred at prescribing stage 94 (34.4%). The most common types of medication errors were wrong dosing 72 (26.4%) and wrong frequency 47 (17.2%). Presence of disease comorbidity (AOR=1.64, 95%CI=1.01–2.67), being male (AOR=1.79, 95%CI:1.13–2.86) and presence of two infectious diseases (AOR=1.96, 95%CI: 1.20–3.23) and more than three infectious diseases (AOR=2.04, 95%CI: 1.03–4.01) were independent predictors of medication error occurrence.

Conclusion and Recommendation

Medication errors were common in pediatric patients with infectious diseases in the study area. Presence of comorbidities, being male and the number of infectious diseases were associated with the occurrence of medication errors. Therefore, to reduce medication errors in the study setting, e-prescribing, computerized provider order entry, medication reconciliation, and collaboration of clinical pharmacists with other health professionals are needed.

Depression and Its Associated Factors among Diabetes Mellitus Patients Attending Selected Hospitals in Southwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus and depression are very common diseases worldwide, and the prevalence rates of both conditions are increasing rapidly. Depression among patients with diabetes mellitus results in poor glycemic control through different mechanisms. Besides, the coexistence of a chronic medical illness with depression reduces the probability of recognizing and treating depression. The study is aimed at assessing the prevalence and factors associated with depression among adults with diabetes mellitus.

METHODS

A hospital-based cross-sectional study was conducted among adult diabetes mellitus patients on follow-up in Mizan-Tepi University Teaching Hospital and Tepi General Hospital. A consecutive sampling technique was employed to recruit the study participants, and data were collected through face-to-face interview and medical chart review. Depression was measured using Patient Health Questionnaire-nine (PHQ-9). Binary logistic regression analysis was done and a p value of less than 0.05 was used as a level of significance.

RESULTS

The prevalence of depression among study participants was 37.0% (95% CI 32.0%-42.0%). The majority (44.7%) of the patients had mild depression, while only 2% had severe depression. Being male (AOR = 1.92, 95% CI: 1.15-3.22), urban residence (AOR = 3.02, 95% CI: 1.57-5.78), single marital status (AOR = 7.72, 95% CI: 3.6-16.53), duration of diabetes mellitus 5 years and more (AOR = 2.00, 95% CI: 1.21-3.5), and having sexual dysfunction (AOR = 3.55, 95% CI: 2.13-5.91) were associated with increased odds of depression among diabetes mellitus patients.

CONCLUSIONS

The prevalence of depression among diabetes mellitus was high. Therefore, the patients should be thoroughly screened for this comorbid condition, and the significant factors should be addressed during routine follow-up.

Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study

OBJECTIVE AND BACKGROUND

In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017.

METHODS

Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control.

RESULT

The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16].

CONCLUSION

Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.

Determinants of poorly controlled asthma among asthmatic patients in Jimma University Medical Center, Southwest Ethiopia: a case control study

OBJECTIVE

The aim of this study was to assess determinants of poorly controlled asthma among asthmatic patients on follow up at Jimma University Medical Center, Southwest Ethiopia. A facility based case control study involving chart review and patient interview was conducted from April 01/2017 to May 30/2017. Consecutive sampling method was used to select 121 cases and 121 controls. Descriptive statistics were used to present socio demographic data and drug prescription pattern while logistic regression was used to identify predictors of poorly controlled asthma.

RESULTS

From a total of 242 studied asthmatic patients, 52.9% of controls and 44.6% of cases were males. Poor knowledge about asthma [Adjusted odd ratio(AOR) = 7.30; 95% confidence interval (CI) 1.72-30; P = 0.007], negative attitude about asthma [AOR = 5.10; 95% CI 1.40-18.7; P = 0.014], moderate asthma [AOR = 13.47; 95% CI 2.69-47.23; P = 0.002] and non-adherence to inhaled corticosteroid (ICS) [AOR = 8.52%; 95% CI 2.41-13.45; P = 0.001] were determinants of poorly controlled asthma.