Medication Non-Adherence and Associated Factors Among Diabetic Patients Visiting General Hospitals in the Eastern Zone of Tigrai, Northern Ethiopia

INTRODUCTION

Medication non-adherence is a major public health problem among diabetes mellitus patients. However, there is a lack of data regarding its magnitude and the factors contributing to Ethiopia's non-adherence, especially in the Tigrai region. This study was conducted to assess the magnitude of non-adherence and its contributing factors among diabetes mellitus patients in the Eastern Zone of Tigrai, Northern Ethiopia.

MATERIALS AND METHODS

A hospital-based cross-sectional study was conducted at Adigrat and Wukro General Hospitals using a pre-tested, self-administered, semi-structured questionnaire developed from the relevant literature and a checklist developed to review patient medical cards for the period of the 15th of March to the 15th of July, 2019. Data were analyzed using Statistical Package for Social Sciences version 20. Association between the dependent and the independent variable was performed using logistic regression and a p-value of <0.05 was considered significant.

RESULTS

From a total of 321 study participants, 63.9% of the patients were non-adherent to their medications. Two-month dose issued on each visit (AOR = 2.865, 95% CI 1.380-5.949), dose issued for more than three months (AOR = 4.314, 95% CI 1.526-12.195), monthly income below 500 birr (AOR = 5.048, 95% CI 2.094-12.168), monthly income between 500 and 2000 birr (AOR = 2.593, 95% CI 1.032-6.517), distance greater than 24 kilometers from hospital to home (AOR = 10.091, 95% CI 3.509-29.020), more than four prescribed medications per visit (AOR=7.192, 95% CI= 2.171-23.824), never receiving counseling (AOR=22.334, 95% CI= 9.270-53.810), and diabetes-related admission (AOR=0.248, 95% CI= 0.078-0.789) were significantly associated with patients' non-adherence to diabetes mellitus medications.

CONCLUSION

The level of diabetic medication adherence was suboptimal, and our study highlights that better monthly earning, nearby health-care accessibility, fewer prescribed medication, and getting appropriate counseling about diabetes mellitus were predictive of adherence to medications. Hence, an urgent intervention targeting the development of guidelines that involve these determinates should be employed to improve health care.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study

BACKGROUND

While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

METHODS

In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

RESULTS

GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

CONCLUSIONS

GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017

BACKGROUND

Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

METHODS

We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

FINDINGS

In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

INTERPRETATION

Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

<p>Anti-Nociceptive and Anti-Inflammatory Activity of <em>Hygrophila schulli</em> Leaves</p>

Purpose

The management of pain and inflammation with non-steroidal anti-inflammatory drugs and opioid analgesics are currently encountering severe adverse reactions. To overcome these problems, herbal remedies may offer new alternative medicines. Hygrophila schulli is a medicinal plant traditionally used for the treatment of pain and inflammation-related disorders; yet, these claims are not scientifically validated. Hence, this study was aimed to validate the traditional use of Hygrophila schulli leaves as anti-inflammatory and analgesic remedy.

Methods

In vitro anti-hyaluronidase assay and in vivo carrageenan-induced hind paw oedema model were used to evaluate the anti-inflammatory property of ethanolic leaf extract of Hygrophila schulli. Tail immersion and acetic acid-induced writhing tests were performed to determine the central and peripheral analgesic activity of the leaf extract, respectively.

Results

The ethanolic leaf extract exhibited significant anti-hyaluronidase activity (P<0.001) and significant inhibition of carrageenan-induced paw oedema (P<0.05) compared to untreated controls. Similarly, the extract significantly prolonged the reaction time of mice (P<0.05) for the hot-water stimuli. Furthermore, an oral dose of the extract showed significant inhibition (P<0.01) of acetic acid-induced abdominal contractions of mice. Besides, the ethanolic leaf extract did not cause any obvious sign of acute toxicity at a single oral dose of 2 g/kg.

Conclusion

The findings of this study may partially support the acclaimed traditional use of Hygrophila schulli leaves for the treatment of pain and inflammatory conditions.

Anti-inflammatory and anti-nociceptive property of Capparis tomentosa Lam. root extracts

ETHNOPHARMACOLOGICAL RELEVANCE

Capparis tomentosa Lam. root is one of the commonly used traditional medicines for the treatment of pain and inflammatory conditions by the Kunama ethnic group of Ethiopia. Yet, its ethnomedicinal claim has not been scientifically investigated.

AIM OF THE STUDY

This study aims to evaluate the anti-inflammatory and anti-nociception activities of root extracts of Capparis tomentosa Lam.

MATERIALS AND METHODS

The anti-inflammatory activity of the 70% ethanolic extracts and solvent fractions was determined using invitro hyaluronidase inhibition assay and in vivo carrageenan-induced paw edema in Swiss albino mice model. The anti-nociception effect was determined using the acetic acid-induced writhing model and tail immersion model in Swiss albino mice.

RESULTS

The root extract of Capparis tomentosa has exhibited significant hyaluronidase inhibition activity which was comparable with the reference drug, indomethacin. Significant inhibition of carrageenan-induced paw edema was observed in all the test sample treated mice compared to the negative control with the highest activity observed from butanol fraction which was equivalent to the effect of acetylsalicylic acid. All the root extract and solvent fractions have possessed a significant and dose-dependent abdominal writhing inhibition with the highest effect observed in the aqueous fraction. Additionally, the crude extract was found better in increasing the reaction latency of the mice to the hot water stimulus than the solvent fractions which were significant after 60-120 min compared to the distilled water treated group. The root extract and solvent fractions were also found safe at a single oral dose of 2 mg/g in Swiss albino mice.

CONCLUSION

The findings of the present study may partially support the folkloric use of Capparis tomentosa root for the treatment of pain and inflammation.

Antidiabetic Activity of Extracts of Terminalia brownii Fresen. Stem Bark in Mice

Background

Diabetes mellitus is a chronic metabolic disorder that imposes a huge health and economic burden on societies. Because the currently available medications have many drawbacks, it is important to search for alternative therapies. Medicinal plants used in traditional medicines are ideal candidates. Hence, this study was undertaken to investigate the antidiabetic activity of crude extract and solvent fractions from the stem bark of Terminalia brownii Fresen. (Combretaceae) in mice.

Materials and Methods

The in vitro α-amylase inhibition assay was performed using the chromogenic 3, 5-dinitrosalicylic acid (DNSA) method while the antihyperglycemic activity was assessed using three mouse models: streptozotocin-induced diabetic mice, normoglycemic mice, and oral glucose challenged mice. Experimental diabetes was induced by a single intraperitoneal injection of streptozotocin at a dose of 150 mg/kg and animals with fasting blood glucose level (BGL) >200 mg/dL were considered diabetic. Glibenclamide (5 mg/kg) was used as a standard drug. Fasting BGL and body weight were used to assess the antidiabetic activity. The result was analyzed using GraphPad Prism software version 8 and one-way ANOVA followed by Tukey’s post hoc test with p<0.05 considered as statistically significant.

Results

The crude extract of T. brownii at all tested dose levels (250, 500 and 750 mg/kg) showed a significant BGL reduction in all the three animal models. Moreover, the ethyl acetate and aqueous fractions (at 500 mg/kg) significantly (p<0.01) reduced the BGL in the streptozotocin induced diabetic model. The crude extract and different solvent fractions also showed a dose-dependent in vitro α-amylase inhibitory activity and improvement of body weight.

Conclusion

T. brownii crude extract and its solvent fractions showed a significant antihyperglycemic activity in STZ induced diabetic mice, hypoglycemic activity and improvement of oral glucose tolerance in normal mice.

In vitro α-amylase inhibitory effect of TLC isolates of Aloe megalacantha baker and Aloe monticola Reynolds

Background

About 425 million adults had diabetes mellitus globally in 2017. Type 2 diabetes accounts for the enormous majority of diabetes cases and it is gradually growing which is predicted to increase by 48% in 2045. Imbalanced cellular carbohydrate and lipid metabolism cause an increase in postprandial blood glucose level which eventually leads to the onset and progression of type 2 diabetes mellitus. The lack of effective and safe carbohydrate hydrolyzing enzyme inhibitors contributes to the increasing prevalence. Thus, this study was targeted to assess the α-amylase inhibitory potential of isolates obtained from Aloe megalacantha Baker and Aloe monticola Reynolds, which are among the commonly used folkloric remedies for the management of diabetes mellitus.

Method

The α-amylase inhibitory effect of Aloe megalacantha Baker and Aloe monticola Reynolds were evaluated using the 3,5-dinitro salicylic acid method. 2, 2-Diphenyl-2-picrylhydrazyl free radical scavenging property was also used to test the antioxidant effect of both plants. Results were analysed using GraphPad Prism software version 8.

Results

The more polar isolates (AM₁ and AG₁) were possessed stronger α-amylase inhibition activity than the leaves latex and the other strains (AM₂ and AG₂). Leaf latex of A. megalacantha, AM₁, AM₂, leaf latex of A. monticola, AG₁, and AG₂ were found to have an IC₅₀ value of 74.76 ± 1.98, 37.83 ± 3.31, 96.75 ± 1.98, 78.10 ± 1.88, 56.95 ± 1.88 and 64.03 ± 3.60 μg/mL, respectively (P < 0.001). The leaf latexes of A. megalacantha and A. monticola showed a significant (P < 0.001) free radical hunting property with an IC₅₀ value of 890.1 ± 1.73 and 597.5 ± 2.02 μg/mL, respectively.

Conclusion

Hence, the outcomes of the present investigation partly justify the acclaimed use of Aloe megalacantha and Aloe monticola for the treatment of diabetes.