HIV/AIDS services quality in health centers of East Shoa zone, Oromia, Ethiopia

Background

HIV/AIDS is a major public health, social and economic problem in Ethiopia. However, little has been done on assessment of the quality of the services given to patients in this country.

Objective

To assess the quality of HIV/AIDS services in health centers of East Shoa Zone, Oromia region, Ethiopia.

Method

Cross sectional survey was undertaken in selected health centers of East Shoa Zone between February and May, 2017. Data was collected using researcher administered structured questionnaire, logistics indicators assessment tool and observation check list. SPSS for windows version 20 was utilized in the analysis of the collected data.

Results

The study facilities were providing various services to HIV/AIDS patients. All (100%) and 6(75%) facilities respectively had shortage of trained human power required to give ART and TB services. Regarding ARV medicines availability, majority of the study facilities, 5 (62.50%) reported that they had the stockout of AZT300/3TC150/NVP200 in six months prior to study while 4 (66.7%) of the facilities had the stockout of NVP 240ml (50mg/5ml) syrup on day of visit. Among anti-TB medicines, E100 was out of stock in three facilities (37.5%) on day of visit and INH100 had been out of stock in 4 (50%) of the facilities in six months prior to the study. From OIs medicines, Cotrimoxazole 960mg tablet stockedout in 4 (66.70%) on day of visit and in 5 (83.30%) health centers in six months prior to the study. Considerable number of study facilities, 4 (66.70%) had the stockout of tramadol 50mg tablet on day of visit and ibuprofen 400mg tablet in six months prior to the study, 5 (71.40%).

Conclusion

The studied facilities were challenged by different factors including, scarcity of human power, stockout of various HIV/AIDS related medicines and inability to make patients adhere to the services given by the facilities. The consequences of these factors can be dangerous to the patients as well as to the wider public and hence making available the appropriate human resource and HIV/AIDS related commodities including medicines should be the priority for the health facilities and the region to improve the quality of HIV/AIDS services in the study area.

Association between delayed initiation of treatment indications and survival in patients with cervical cancer: A systematic review and meta-analysis protocol

Background

Cervical cancer is a growing public health problem globally. Despite the availability of management options, the progression of the disease as a function of waiting time may challenge the effort to attain a desired outcome. There is a conflicting report on the role of waiting time to initiate an appropriate treatment in improving patients’ survival.

Objective

This review aims to evaluate the association between delayed time to initiate any treatment indication with survival in patients with cervical cancer.

Methods

An internet-based literature search will be performed using text words, MESH terms and truncated words in databases, namely MEDLINE, Cochrane CENTRAL, EMBASE, Web of Science and Scopus. Grey literature searches in Google Scholar, Networked Digital Library of Theses and Dissertations (NDLTD) and Dissertations and Theses Global will be made. All articles published until 30th of December 2021 on human subjects will be searched without a language restriction. Studies which fulfil the inclusion criteria will be screened in full reading, selected, appraised and assessed for methodological quality by two independent reviewers. Data on participants, study methods, interventions, and outcomes will be abstracted. Included studies will be pooled for meta-analysis. Microsoft-Excel and R packages will be employed to carry out the statistical analysis. Heterogeneity will be assessed using Cochrane Q statistic, Tau2, and I2. Results will be reported as a function of 4-week delay in treatment initiation and the corresponding hazard ratio (HR) at 95% confidence interval. Statistical significance will be considered at P<0.05.

Trial registration

PROSPERO registration number: CRD42022299689.

Inventory Management of Health Commodities in a Tertiary Teaching Hospital in Ethiopia

Background: Analyzing purchased health commodities based on their budgetary consumption and importance is crucial for efficient utilization of a hospital’s budget. However, it is rarely seen when hospitals, mostly in developing countries, conduct such kinds of analyses and make an informed decision, including to utilize their limited budget efficiently. Therefore, the purpose of this study was to analyze a 3-year inventory of health commodities (medicines, medical supplies, and laboratory reagents and chemicals) in Saint Paul Hospital Millennium Medical College (SPHMMC).

Methodology: The study was conducted in SPHMMC located in Addis Ababa, Ethiopia. It is one of the largest specialized public hospitals in the country. It is a huge teaching hospital in the country where a large amount of budget is utilized. Three years of data were collected and ABC, VEN, and ABC-VEN matrix techniques were applied for the analysis. The data collection period was from March to April 2017.

Results: An average of 296 medicines, 194 laboratory commodities, and 105 medical supplies were purchased over 3 years. Class A medicines, which consume 80% of the total annual pharmaceutical expenditures (APE) account, are 17.8%–20% of the total medicines by quantity. Antibiotics (ceftriaxone 1 gm injection and metronidazole), IV fluids (sodium chloride 0.9% injection and dextrose 40% injection), and antidiabetic medication (insulin zin suspension and metformin) are among the top 10 medications by value that consume significant amounts of the budget of the hospital. On VEN analysis, an average of 24% of the items were vital, 67% were essential, and 4–8–8.9% were nonessential. Nonessential items consumed 0.49%, 9.9%, and 1.1% of Annual Expenditures (AEs) in 2013/14, 2014/15 and 2015/16, respectively. On ABC-VEN matrix analysis, a single expensive and nonessential medicine (valganciclovir HCL 450 mg tablet) consumed 9.4% of expenditure in 2014/15. Class A laboratory commodities, which consume 70%–80% of the total laboratory expenditures represented 8.5%–20% of the total laboratory commodities analyzed for the 3 years. From class A items, antimonoclonal antibodies in 2013/14, hemocue glucose 201 4 × 25 tests in 2014/15, and glucose tests in 2015/16 consumed the highest percentages: 9.2%, 8.2%, and 23.7% of the AEs, respectively. There were laboratory commodities procured out of the VEN list, and these accounted for 6.8%–31.2% of the total laboratory expenditures over the 3 years. Class A medical supplies, which consumed 80% of the total medical supply expenditures, represented only 8.2%–15.8% of the total items over the 3 years studied. Surgical gauze 90 cm × 100 m, surgical gloves sterile latex number 7.5, and examination gloves were the top three based on expenditures in all the studied years. In 2015/16, examination gloves alone consumed 71.9% of the total expenditure.

Conclusion: SPHMMC manages large numbers of health commodities (more than 500 excluding program commodities) which necessitate efficient inventory management practice in place. However, the purchase of the commodities particularly those products used for laboratory diagnosis is not strictly based on the hospital’s VEN list, indicating the need for better communication of the laboratory unit with the Drug and Therapeutic Committee (DTC) of the hospital. The DTC of the hospital should update the VEN list of the health commodities and strictly enforce the hospital procurement to adhere to the agreed upon list of medicines. In addition, the hospital should prioritize and decide the quantity and frequency of ordering health commodities based on regular ABC-VEN results.

Quality of life and its predictors among clients visiting antiretroviral therapy clinics in Addis Ababa, Ethiopia

This study assessed the quality of life (QoL) and associated factors among a group of clients visiting ART clinics in Addis Ababa, Ethiopia. A multi-site cross-sectional study was conducted from 1 to 30 August 2020. Adults with HIV and who fulfilled the inclusion criteria were considered. A systematic random sampling technique with proportional size allocation was employed. Data were collected using a modified EQ-5D and EQ-VAS tool. The analysis was done using SPSS version 26. Non-parametric statistical analyses were done using Mann-Whitney U, Kruskal-Wallis and Spearman's correlation tests. A p-value ≤ 0.05 and 95% confidence level were considered for analysis. The majority of the clients were from health centres (58%), were 43 years old or less (54%), and were males (63%). Pain/discomfort and depression/anxiety were the most prominent dimensions in the age group above 43 years. The mean score of EQ-5D index values was 0.87 (SD 0.05; 95% CI 0.86-0.87) and that of EQ-VAS was 81 (SD 15; 95% CI 80-83). About 38% and 43% of the clients showed an altered health state of some degree in functional and current overall status respectively. Comorbidity, history of current substance use, facility type, social support and sleep disturbance showed a statistically significant association with both outcomes. A considerable proportion of clients have altered functional and overall health status, with pain/discomfort and depression/anxiety most affected. Inclusion of multidisciplinary treatments for HIV and the highlighting of psychosocial issues that are likely among this group are warranted.

Antibiotics self-medication practices among health care professionals in selected public hospitals of Addis Ababa, Ethiopia

BACKGROUND

Self-medication is the first option and response to most illness episodes. Use of antimicrobials without health care professionals' guidance may result in greater probability of inappropriate use, missed diagnosis, delays in appropriate treatment, pathogen resistance and increased morbidity. There is no sector in the health care community which is immune to drug abuse or misuse of which the worst offenders include physicians, nurses and pharmacy professionals. Self-medication among health care professionals may be an indicator that the health professional is neglecting his or her own health. This represents serious issues for both patients and the professionals.

OBJECTIVE

To assess self-medication practices with antibiotics among health care professionals in selected hospitals of Addis Ababa, Ethiopia.

METHOD

Facility based cross-sectional study was conducted from April to May, 2017 among 317 health care professionals. Convenient sampling technique was used to select study participants. Data were collected through self-administered questionnaire and analyzed using Statistical Package for Social Sciences software version 20. Binary logistic regression analysis was done to check the relationship between the dependent variable (antibiotic self-medication) and selected independent variables (sex, age, marital status, income, professional qualification and work experience).

RESULTS

The prevalence of self-medication with antibiotics among health care professionals in one month recall period was found to be 72 (22.7%). The main reasons given for this practice were being familiar with the treatment options, 31 (43.1%) and need for rapid relief, 25 (34.7%). Respiratory problems, 29 (40.3%) and gastro intestinal problems, 28 (38.9%) were the most common illnesses for which self-medication with antibiotics was practiced while penicillins, 30 (41.6%) and fluoroquinolones, 29 (40.3%) constituted the two most commonly used antibiotics for the same. None of the variables had significant association with the practice of self-medication with antibiotics.

CONCLUSION

Self-medication with antibiotics was common among the study participants. Efforts should be made by health authorities including Drug and Therapeutics Committee, Drugs Regulatory Authority, Hospitals' management and other stakeholders to ensure safe usage of antibiotics.

Ethnobotanical Study of Medicinal Plants Used by Traditional Healers to Treat Cancer-Like Symptoms in Eleven Districts, Ethiopia

There is no ethnobotanical study conducted specifically on medicinal plants traditionally used to treat cancer in Ethiopia. Yet, traditional herbalists in different parts of the country claim that they have been treating cancer-like symptoms using herbal remedies. The objective of this study was to document medicinal plants traditionally used to treat cancer-like symptoms in eleven districts, Ethiopia. Traditional herbalists were interviewed using semistructured questionnaires, and field visits were also carried out to collect claimed plants for identification purpose. Seventy-four traditional herbalists, who claimed that they knew about and/or had used medicinal plants to treat cancer-like symptoms, were selected using the snowball method and interviewed. Herbalists used their intuition and relied on the chronicity, growth of external mass, and spreading of the disease to other parts of the body, as a means to characterize cancer symptoms. Furthermore, in some of the study districts, herbalists reported that they treat patients who had already been diagnosed in modern healthcare institutions prior to seeking help from them. The inventory of medicinal plants is summarized in a synoptic table, which contains the scientific and vernacular names of the plants, their geographical location, the parts of the plants, and the methods used to prepare the remedies. A total of 53 traditionally used anticancer plants, belonging to 30 families, were identified during the survey. The most frequently reported anticancer plants were Acmella caulirhiza Del (Asteraceae), Clematis simensis Fresen. (Ranunculaceae), Croton macrostachyus Del. (Euphorbiaceae), and Dorstenia barnimiana Schweinf. (Moraceae). Organizing traditional healers, documenting their indigenous knowledge, and scientifically validating it for the development of better cancer therapeutic agents constitute an urgent and important task for policymakers and scientists.

Prices and availability of locally produced and imported medicines in Ethiopia and Tanzania

Background

To assess the effect of policies supporting local medicine production to improve access to medicines.

Methods

We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR).

Results

The Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively.

The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively.

Conclusions

Our results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.

Quality of life of people living with HIV/AIDS and on highly active antiretroviral therapy in Ethiopia

The Amharic version of the Short Form-36 Health Survey (SF-36) was used to measure quality of life among patients on highly active antiretroviral therapy (HAART) at selected governmental hospitals in central and southern Ethiopia. The study was cross-sectional and used SF-36-specific software for automatic scoring of the form's scales and dimensions. Pearson bivariate correlations showed moderate correlation between the SF-36 scales, ranging from 0.2673 between 'general health' and 'vitality,' to 0.8583 between 'role physical' and 'role emotional.' Cronbach's-αwas >0.70 for six out of eight multi-item scales, with values ranging from 0.6500 to 0.8860 for all scales, thus indicating good internal reliability of the Amharic version of the SF-36. The independent variables shown to positively affect mean scores were: duration of treatment, CD4 cell count, and adherence to doses of antiretrovirals. Participants treated for >12 months had higher mean scores for all domains than those who had been treated for ≤12 months. Likewise, those with a CD4 cell count >200 cells/mm(3) had better mean scores for all scales except 'social functioning' and 'mental health' than those with counts ≤200. Participants adhering to treatment (in the last 15 days, according to self-report) had better mean scores for all scales except 'role physical,' 'bodily pain' and 'vitality' in comparison to those who were not adherent. The findings suggest that the Amharic version of the SF-36 is a valid and reliable health survey instrument for use in Ethiopia to assess the quality of life of people living with HIV/AIDS on HAART.

Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: a comparative study

BACKGROUND

Fresh leaves and buds of the Khat plant (Catha edulis) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults.

METHODS

We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height.

RESULTS

The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups.

CONCLUSION

Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.

Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia

OBJECTIVE

To determine the adherence rate and its determinants among people living with HIV/AIDS on highly active antiretroviral therapy (HAART) in selected governmental hospitals from central and south Ethiopia.

METHODOLOGY

A cross-sectional study involving both qualitative and quantitative methods was conducted between August and October 2007 in Yirgalem, Hawassa, and Shashemene Hospitals. Quantitative data collection techniques include patient self-report and unannounced pill count and the qualitative methods employed were focus group discussions (FGDs), semi-structured interviews, and observations of health facilities.

RESULTS

Whereas females accounted for 56.4% (238), male participants were 43.6% (184) of the total participants. Adherence rate was 93.1% using 15-days self-report, but the rate came down to 88.1% when calculated using the unannounced pill count method (n = 90). Multivariate analysis revealed that being unmarried (OR = 0.119, CI = 0.016-0.901, p = 0.039), unemployment (OR = 0.011, CI = 0.000-0.288, p = 0.007); failure to disclose HIV status (OR = 0.433, CI = 0.198-0.949, p = 0.037); lack of support from family (OR = 0.393, CI = 0.163-0.947, p = 0.037); or others (OR = 0.332, CI = 0.144-0.845, p = 0.043); alcohol drinking (OR = 0.210, CI = 0.071-0.617, p = 0.003); treatment regimen, stavudine(40)-lamuvidine-nevirapine (OR = 0.174, CI = 0.033-0.923, p = 0.040), azathymidine-lamuvidine-nevirapine (OR = 0.172, CI = 0.034-0.867, p = 0.033) and dosing three times daily (OR = 0.073, CI = 0.018-0.290, p = 0.000) regimens were found to be associated with non-adherence. Moreover, time since diagnosis was associated with adherence, as those tested HIV-positive >or= 6 months prior to date of interview (OR = 4.064, CI = 1.23-19.316, p = 0.047) had better adherence rate.

CONCLUSION

The adherence rate obtained in this study was higher than the rates seen in developed countries despite the fact that many of the participants live in very poor conditions.

Assessment of drug use among pregnant women in Addis Ababa, Ethiopia

PURPOSE

To assess the drug use among antenatal care (ANC) attendant pregnant women in Addis Ababa.

METHODS

Institution-based cross sectional study was conducted reviewing the antenatal care follow up cards and interviewing pregnant women using semi-structured questionnaire.

RESULTS

A total of 1268 women were included in the study; of which 71.3% of them were prescribed at least one drug during pregnancy. Twelve point four per cent of the pregnant women who reported illness in the 2 weeks prior to the date of the interview, self-medicated themselves with either over the counter or prescription drugs or traditional herbs. The majority of the drugs prescribed were iron and vitamins followed by anti-infectives. Nearly 4% of the pregnant women were prescribed with drugs from category D or X of the US-FDA risk classification.

CONCLUSION

A considerable proportion of pregnant women were exposed to drugs, including those with potential harm to the fetus. Furthermore, pregnant women self-medicated themselves with modern medications or traditional herbs. Health care providers should thus weigh the therapeutic benefits of the drug to the mother against its potential risk to the developing fetus before prescribing. In addition it is essential to routinely inquire about the woman's self-medication practice and provide the appropriate advice to the pregnant women.

Ethnomedical survey of Berta ethnic group Assosa Zone, Benishangul-Gumuz regional state, mid-west Ethiopia

Traditional medicine (TM) has been a major source of health care in Ethiopia as in most developing countries around the world. This survey examined the extent and factors determining the use of TM and medicinal plants by Berta community. One thousand and two hundred households (HHs) and fourteen traditional healers were interviewed using semi-structured questionnaires and six focused group discussions (FGDs) were conducted. The prevalence of the use of TM in the two weeks recall period was 4.6%. The HH economic status was found to have a significant effect while the educational level and age of the patients have no effect either on the care seeking behavior or choice of care. Taking no action about a given health problem and using TM are common in females with low-income HHs. Forty plant species belonging to 23 families were reported, each with local names, methods of preparation and parts used. This study indicates that although the proportion of the population that uses TM may be small it is still an important component of the public health care in the study community as complementary and alternative medicine.

The use of medicinal plants in self-care in rural central Ethiopia

Medicinal plants are an important element of Ethiopian traditional medicine. This questionnaire survey examined the extent and type of medicinal plants used in self-care by rural Ethiopian community. Six hundred mothers were interviewed using a semi-structured questionnaire. The prevalence of the use of herbal drugs in self-care was found to be 12.5%. Twenty-five plant species belonging to 21 families were reported, each with local names, methods of preparation and parts used. This study showed that self-care using medicinal plants is a major part of health care options in Butajira community.

Treatment of malaria in Ethiopian folk medicine

Key informant interviews of herbalists were conducted to document the traditional management of malaria in Ethiopia. The perceptions of the cause and symptoms of malaria, the use of plants, their preparation and administration were recorded. Interviews were performed in rural Butajira and Addis Ababa (the main city). The result showed that 33 (75%) of the interviewed healers treat malaria using herbal drugs. Sixteen plants were reported to have been used of which eight were used as a single remedy and the rest as composite remedies with other plants. The ethnopharmacological data generated in this study on antimalarial plants is useful for further evaluations of the traditional claims of antimalarial plants in Ethiopia.

Epidemiology of herbal drugs use in Addis Ababa, Ethiopia

OBJECTIVE

To study the utilization patterns of herbal drug use in urban Ethiopia.

METHODS

A cross-sectional community-based survey was conducted in Addis Ababa, capital city of Ethiopia, using a pretested semi-structured questionnaire. The questionnaire was administered to 600 heads of households, largely mothers, selected using a multi-stage systematic random sampling technique, where the final sampling units were households.

RESULTS

The prevalence of herbal drugs use was found to be 37%. The main reasons given for choosing herbal medicine as the first line medication option were: dissatisfaction with the services of modern health institutions due to their time consuming nature, cost considerations and perceived efficacy.

CONCLUSION

This study showed that in spite of the geographic accessibility of modern health institutions in urban areas, the use of traditional medicine, particularly herbal drugs, remains a major form of health care option. Hence health planners should give appropriate consideration to this sector.

Pattern of drug use in Addis Ababa community

Though important in the development of educational materials for the public, community drug use studies are rare in Ethiopia. This community based cross-sectional study was conducted in Addis Ababa between November 1995 and January 1996 to describe community's perception on drugs, identify people's various sources of modern drugs and determine factors associated with drug use. The study results show that out of the 903 persons who reported an illness in the four weeks recall period, 231 (26%) did not take any action for their illness. The reasons being mainly the perception that the illness was minor and economic inaccessibility. Regarding sources of modern drugs, the majority 398 (63%) of those who used modern drugs obtained their medications from government health institutions. Drug sharing was practiced by 156 (17%) of the respondents. In addition, 39 (6%) prematurely discontinued their treatment course and the majority did so either due to inability to comprehend the instructions or having some social entertainment. It was also found that 178 (20%) of the studied households were found hoarding drugs and the most common ones were oral antibiotics and antipyretic analgesics. In addition, gender and education were found to have an association with drug hoarding. The study also identified factors associated with household drug hoarding and drug sharing among family members or neighbours; in this respect, the former was found associated with education and gender but the latter was associated with sex, age, education and marital status. In conclusion, drug sharing among families, friends or relatives are commonly practiced in Addis Ababa community. In addition, many patients stopped taking their prescribed drugs once they started to feel better.