Nurse-led self-management education and support programme on self-management behaviour and quality of life among adults with type 2 diabetes: A pilot randomized controlled trial

AIM

This study examined the preliminary effects of a nurse-led self-management education and support programme on the self-management behaviours and quality of life among people with type 2 diabetes in Western Ethiopia.

METHODS

A pilot randomized controlled trial was conducted between January and August 2021. Participants were recruited in the hospital and randomly assigned to the control arm to continue usual care (n = 38) or the intervention arm to receive usual care and the diabetes self-management education and support programme (n = 38) in the community. Self-management behaviours and quality of life were assessed using a 10-item summary of diabetes self-care activity (expanded) scale and a 34-item diabetes quality of life measure, respectively, at baseline and 2 months after follow-up. Generalized estimating equation models were used to examine the preliminary effects of the programme on the outcomes.

RESULTS

Preliminary results indicated that the programme outperformed usual care in self-management practise, with large effect sizes immediately postintervention and at 2 months after the intervention, and quality of life at 2 months after the intervention.

CONCLUSION

A nurse-led diabetes self-management education and support intervention, including the families of people with diabetes, may be an option to boost the self-management practise and quality of life of patients with diabetes.

Nurses' perception of the hospitals' culture and readiness of evidence-based practise integration in the hospital's system in western Ethiopia

BACKGROUND

Evidence-based practise is a method by which healthcare professionals integrate the best available evidence, individual expertise and patient preferences to improve patient safety and utilise quality healthcare. No study was conducted in Ethiopia to assess the nurses' perception of the hospitals' culture and readiness for evidence-based practice integration into the hospital's system. Hence, this study aimed to assess the perception of nurses on the hospitals' culture and readiness of evidence-based practise integration in hospitals' systems in Western Ethiopia.

METHODS

A cross-sectional study involving 412 nurses in six hospitals in western Ethiopia was conducted between December 2022 and February 2023. A 25-item Organisational Culture and Readiness of System-Wide Integration of EBP scale was used, with a Cronbach's alpha of 0.94. While 25 is the minimum score, 125 is the maximum; higher scores indicate better hospital culture and readiness for system-wide integration of evidence-based practice. A self-administered data collection technique was used. Descriptive statistics were computed using Statistical Package for the Social Sciences version 25 software.

RESULTS

Four hundred and twelve nurses participated in the study. The majority (85.9%) were bachelor's degree holders and over a third (34.7%) worked in primary hospitals. Only a quarter (26.5%) had ever received mentorship from their leader on implementing evidence-based practice. The overall hospital culture and readiness score for system-wide integration of evidence-based practice among nurses in six hospitals was 70.3 ± 17.3.

CONCLUSION

The nurses' perception of the hospitals' culture and readiness score for system-wide integration of evidence-based practice in six hospitals in Western Ethiopia was equivocal. There is a need to engage all resources and increase leadership commitment to make evidence-based practice a hospital culture. Further research is warranted to understand the national hospitals' status in establishing and sustaining evidence-based practise culture.

Effects of family-based diabetes self-management education and support programme on support behaviour amongst adults with type 2 diabetes in Western Ethiopia

Support from family and peers may enhance the outcomes of diabetes management. This study reported the preliminary effect of a family-based diabetes self-management education and support (DSMES) programme on the perceived support status of people with diabetes and the family's caregiver support behaviour amongst dyads living in Western Ethiopia. A 1:1 two-armed pilot randomised controlled trial (RCT) was conducted. A total of 76 dyads were recruited using the convenience sampling method and randomly assigned to either intervention or control groups. The control group continued the usual care, whereas the intervention group continued the usual care and additionally received a 12-h social cognitive theory (SCT)-guided, family-supported DSMES programme in the community. Generalised estimating equations models were computed to test the preliminary effects of the DSMES programme on the outcomes. P-value < 0.05 was set as statistically significant. The pilot RCT shows a statistically significant between-group difference in the changes in support needed at T1 (d = 0.88) and T2 (d = 1.35) and support received at T1 (d = 0.88) and T2 (d = 1.44). The DSMES programme has outperformed usual care with a medium effect size at T1 (d = 0.54) and a large effect size at T2 (d = 0.97) on the family's supportive behaviour. Although the intervention group was not statistically significant at T1 (d = 0.43), a large effect size was obtained at T2 (d = 0.97) on the family's non-supportive behaviour. A SCT-guided, family-supported DSMES programme produced a promising positive effect on enhancing the support needed and support received from their family/friends, and it also improved the family's supportive behaviour. Thus, family support could be incorporated into DSMES programmes for diabetes management in Western Ethiopia. The trial was registered by the Chinese Clinical Trial Registry ( http://www.chictr.org.cn ); Registration number: ChiCTR2000040292.

Burden of intestinal parasitic infections and associated factors among pregnant women in East Africa: a systematic review and meta-analysis

BACKGROUND

The ultimate goal of preventing intestinal parasites among pregnant women is to reduce maternal and newborn morbidity and mortality. Numerous primary studies were conducted in East Africa presented intestinal parasite infection and associated factors among pregnant women. However, the pooled finding is not known. Therefore, this review aimed to identify the pooled prevalence of intestinal parasite infection and its determinants among pregnant women in East Africa.

METHODS

Articles published from 2009 to 2021 were searched in PubMed, Web of Science, EMBASE, and HINARI databases. The search for unpublished studies such as thesis and dissertations was checked in Addis Ababa University and Africa Digital Library. PRISMA checklist was used to report the review. Articles published in the English Language were considered. The data were extracted by two authors using data extraction checklists on Microsoft excel. Heterogeneity among the included studies was checked using I² statistics on forest plots. Sensitivity and sub-group analyses were conducted to assess the presence of primary studies, and study characteristics responsible for the observed heterogeneity.

RESULTS

Of the 43 identified articles, about 23 articles were removed due to duplications. Then, by assessing the abstracts and full texts, four articles were removed because they failed to meet the eligibility criteria. Finally, 16 articles were included in the systematic and meta-analysis.The pooled prevalence of intestinal parasites among pregnant women in East Africa was 38.54 (28.77, 48.32). In this study, variables like residing in rural areas (OR: 3.75; CI: 1.15,12.16), availability of latrine(OR: 2.94; 95% CI: 2.22, 3.91), eating raw fruits/vegetables (OR: 2.44; 95% CI: 1.16, 5.11). and sources of water as unprotected sources (OR: 2.20; 95% CI: 1.11,4.35) show statistically significant association with the increased burden of intestinal parasites among pregnant women.

CONCLUSION

The burden of intestinal parasite infection among pregnant women in East Africa was high. Therefore, efforts should be made in deworming pregnant women at the community and institutional level by stakeholders to reduce the burden of intestinal parasite infections and related complications.

Effects of a culturally tailored, family-supported, community-based self management education and support programme on clinical outcomes among adults with type 2 diabetes in Western Ethiopia: A pilot randomised controlled trial

AIM

To examine the preliminary effects of a culturally tailored, family-supported, community-based diabetes self management education and support (DSMES) programme for Ethiopian people with type 2 diabetes on glycosylated haemoglobulin (HbA_1c ), blood pressure, body mass index and lipid profiles.

METHODS

A two-arm pilot randomised controlled trial (RCT) was conducted involving 76 participant-caregiver dyads from Western Ethiopia, which were randomly allocated to the intervention arm to receive 12 h of DSMES intervention guided by social cognitive theory on top of usual care, or to the control group, which received usual care. While HbA_1c was a primary outcome, the blood pressure, body mass index and lipid profiles were secondary outcomes. Primary outcome was the change in HbA_1c between baseline and 2-month follow-up between the groups. Generalised estimating equations was used to test the preliminary effect of the DSMES programme on the outcomes at baseline, post-intervention and at 2-month follow-up for secondary outcomes. Cohen's d was used to estimate the between-group effect sizes of the intervention.

RESULTS

The DSMES produced significant improvement in HbA_1c with large effect size (β = -1.667, p < 0.001, d = -0.81) and triglycerides with medium effect size (d = -0.50). HbA_1c in the intervention group was decreased by 12 mmol/mol (1.1%). Although nonsignificant, the DSMES also had small to moderate effects (d = -0.123 to 0.34) on blood pressure, body mass index, total cholesterol, low-density and high-density lipoproteins when compared with usual care.

CONCLUSION

A culturally tailored, social cognitive theory-guided, family-supported, community-based DSME programme could have a benefit on HbA_1c and triglycerides. A full RCT is warranted to test the effectiveness of the DSMES programme.

Factors predicted quality of life of people with type 2 diabetes in western Ethiopia

BACKGROUND

Multiple factors predict the quality of life of adults with diabetes. However, the relationships of demographics, self-management practice, and support status with the quality of life of people with diabetes are unknown. Therefore, the study aimed to assess factors related with the quality of life of adults with type 2 diabetes in western Ethiopia.

METHODS

A hospital-based cross-sectional study involving adults with type 2 diabetes was conducted in western Ethiopia from June 02, 2020, to August 31, 2020. Convenience sampling technique was used in selecting subjects. The translated and psychometrically tested summary of diabetes self-management activities (expanded), diabetes quality of life, and diabetes care profile support scales were used in measuring self-management practice, quality of life, and support status, respectively. Data were collected via face-to-face interviews. Factors related with quality of life were examined through bivariate analysis and multivariable linear regression. In all statistical tests, P value <0.05 and confidence level that excluded zero were considered statistically significant.

RESULTS

A total of 417 adults with type 2 diabetes participated in the study. In a multivariable linear regression, seven factors including age, male, homemakers, those separated/divorced, number of years since diabetes diagnosis, self-management practice and support needed were related with quality of life. Male patients (β = 2.786, 95% CI = 1.285 to 4.287, p < 0.001), homemakers (β = 0.366, 95% CI = 0.056; 0.677, p = 0.021), self-management practice (β = 4.528, 95% CI = 3.851 to 5.205, p < 0.001) and those who needed support from their families or peers (β = 1.623, 95% CI = 0.458; 2.788, p = 0.006) were related positively with quality of life whereas those who separated or divorced (β = -1.698, 95% CI = -3.371 to -0.025, p = 0.047), older age (β = -0.195, 95% CI = -0.269 to -0.121, p < 0.001) and those who lived with diabetes for a longer duration (β = -2.206, 95% CI = -4.151 to -0.261, p = 0.026) were related negatively with quality of life.

CONCLUSION

Quality of life of people with type 2 diabetes living in western Ethiopia was predicted positively by being male, homemakers, having self-management practice, and support needed, whereas negatively influenced by old age, separation or divorce, and long diabetes life. Thus, encouraging self-management practice, and continuous family or friend support are necessary to enhance quality of life of people with type 2 diabetes. Further study should employ random sampling techniques and involve participants from multiple study settings to increase representativeness of the samples.

HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission

Background

Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa.

Objectives

To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa.

Methods

HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses.

Result

The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure.

Conclusion

The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.

Nurses are leaving the nursing profession: A finding from the willingness of the nurses to stay in the nursing profession among nurses working in selected public hospitals of Wollega Zones, Oromia, Ethiopia

Background:

The willingness of nurses to stay in nursing profession is nurses stay in the nursing profession without having intention to shift their works to other professions. In healthcare systems, nurses are currently leaving their work. To give quality of health, nurses have to stay in their work. The aim of this study was to find the willingness of the nurses to stay in the nursing profession and associated factors.

Methods:

An institution-based cross-sectional study was employed among nurses in selected hospitals. After checking for completeness, the data were interred into Epi Data version 3 and exported to Stata SE version 14 for analysis. Then, the descriptive statistics were computed. To find association, logistic regression was computed. Covariates from binary logistic regression were a candidate for multivariate logistic regression at p-value ⩽ 0.25. Variables in the final model were selected by the stepwise backward selection procedure. In the end, variables with a p-value ⩽ 0.05 were considered as statistically significant.

Results:

In this study, 349 nurses have participated with a 100% response rate and more than half of the participants were male 188 (53.87%). The proportion of nurses who have the willingness to stay in the nursing proportion is 54.44% (95% confidence interval = 0.491, 0.59). Getting relatively high salary (adjusted odd ratio = 1.81 (95% confidence interval = 1.05, 3.11)), no presence of support among colleagues (adjusted odd ratio = 0.10 (95% confidence interval = 0.05, 0.22)), not having participation in training (adjusted odd ratio = 0.49 (95% confidence interval = 028, 0.86)), having relative low experience in nursing profession that is less than 6 years (adjusted odd ratio = 0.46 (95% confidence interval = 0.26, 1.81)), having good autonomy in the nursing profession (adjusted odd ratio = 0.41 (95% confidence interval = 0.23, 0.70)), and having a good sense of self-calling for the nursing profession among nurses (adjusted odd ratio = 2.85 (95% confidence interval = 1.64, 4.97)) are the factors related with willingness of the nurses to stay in the nursing profession.

Conclusion and recommendation:

To bring development in the nursing profession, it is a must to staying experienced nurses in the nursing profession. Therefore, to increase the willingness of nurses in the nursing profession, it is better to increase the salary of nurses, giving frequent training for the nurses, initiate the nurses to support one another, and encourage the nurses to have sense of self-calling for nursing profession. This is accomplished if there is a harmonious relationship between the governments, nurses, and other stakeholders in the healthcare delivery system.

Impact of COVID-19 pandemic on chronic diseases care follow-up and current perspectives in low resource settings: a narrative review

Coronavirus is a respiratory disease that spreads globally. The severity and mortality risk of the disease is significant in the elderly, peoples having co-morbidities, and immunosuppressive patients. The outbreak of the pandemic created significant barriers to diagnosis, treatment and follow-up of chronic diseases. Delivering regular and routine comprehensive care for chronic patients was disrupted due to closures of healthcare facilities, lack of public transportation or reductions in services. The purpose of this narrative review was to update how patients with chronic care were affected during the pandemic, healthcare utilization services and available opportunities for better chronic disease management during the pandemic in resources limited settings. Moreover, this review may call to the attention of concerned bodies to make decisions and take measures in the spirit of improving the burden of chronic diseases by forwarding necessary recommendations for possible change and to scale up current intervention programs.

The effects of diabetes self-management interventions on physiological outcomes in people living with diabetes in Africa: A systematic review and meta-analysis

AIM

To examine the effects of diabetes self-management interventions on physiological outcomes among people living with diabetes in Africa compared with patients receiving usual care.

METHODS

Relevant databases including PubMed, CINAHL Complete, Scopus, the Cochrane Library and Google Scholar were searched from inception to 28 September 2019, for randomised controlled trials (RCTs) involving adults living with diabetes in Africa. Nine RCTs were included in the review, and the quality of the studies was assessed using Cochrane's collaboration risk of bias tools.

RESULTS

A meta-analysis of the outcomes showed the significant effects of diabetes self-management interventions on blood pressure, total cholesterol and body mass index, whereas non-significant and inconclusive results were obtained for waist circumference and glycosylated haemoglobin, respectively.

CONCLUSIONS

The diabetes self-management interventions (DSM) effectively improved many physiological outcomes, but their effectiveness in HbA_1c was inconclusive, suggesting a need for modifications in DSM interventions for African people living with diabetes.

Impact of HIV status and predictors of successful treatment outcomes among tuberculosis patients: A six-year retrospective cohort study

Tuberculosis (TB) remains a major global public health problem. Hence, the study aimed to assess the impact of human immune virus (HIV) status and predictors of successful treatment outcomes of TB patients enrolled at Nekemte specialized hospital. An institution-based retrospective cohort study was conducted and the data analyzed using SPSS version 24.0. A multivariable logistic regression model was fitted to identify the association between treatment outcome and potential predictor variables. The association was calculated using the Adjusted Odds ratio (AOR) and the statistical significance was considered at p < 0.05. Out of the total 506 study participants, 50.2% of them were males. The overall treatment success rate was 81.4% and 58.06% among HIV co-infected TB patients. Female sex (AOR = 2.01, 95%CI: 1.04–16.11), age 25–34 years (AOR = 3.982, 95%CI: 1.445–10.971), age 35–49 years (AOR = 5.392, 95%CI: 1.674–17.368), high school educational level (AOR = 5.330, 95% CI: 1.753–16.209), urban residence (AOR = 3.093, 95%CI: 1.003–9.541) and HIV negative (AOR = 10.3, 95%CI, 3.216–32.968) were positively associated with favorable TB treatment outcome. Whereas, being single (AOR = 0.293, 95%CI: 0.1–0.854), smear-negative pulmonary TB (AOR = 0.360, 95%CI: 0.156–0.834), extra-pulmonary TB (AOR = 0.839, 95%CI: 0.560–0.955) and retreatment case (AOR: 0.54, 95%CI: 0.004–0.098) were negatively associated with successful treatment outcome. The treatment success rate of TB patients was lower than World Health Organization target set of 85%. The increased unsuccessful outcome among TB/HIV patients requires urgent public health interventions to improve the evaluation policy and control framework.

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Tuberculosis (TB) remains a major global public health problem.

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TB is the leading cause of death for HIV-infected patients, and HIV is also risk factor for developing active TB.

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The co-infection has emerged as a major public health threat throughout the world and have worse treatment outcomes.

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Management of co-infected patients can be complex because of overlapping drug toxicities and interactions.

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The increased unsuccessful outcome among TB/HIV patients requires urgent public health interventions.

Predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia

Background

Diabetes Mellitus recognized as one of the emerging public health problems in developing countries. Self-monitoring needs to be individualized and should assist people with diabetes. This study aimed to assess the predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from November 2017 to February 2018 in hospitals located in western Oromia, Ethiopia. An interview was made with a total of 400 diabetic patients attending the diabetes center and admitted to ward in the study hospitals. The data were entered into Epi Info software version 3.5.4. Data analysis was made using a statistical package for the social sciences (SPSS) version 20. Odds ratio (OR) was used to show the association. The statistical significance was considered at P<0.05, and potential confounding variables were controlled using logistic regression. The analyzed data were presented in texts and tables.

Results

From a total of 398 interviewed patients, 129 (32.4%) practiced diabetes self-management. About 63.6% of the study participants’ self-management practice was good. Most 103 (79.84%) of those who practiced self-management were presented with one of diabetes mellitus-related complications. Logistic regression analysis results showed that merchants were about six times higher in self-management practice [AOR of 5.945 (1.177–30.027 at 95% CI)] and those having family support in diabetes practiced self-management 2.87 times than others [AOR of 2.835 (1.386–5.801 at 95% CI)].

Conclusions

Compared to the findings of previous studies, diabetes self-management practices of the participants was good. The study participants regular physical activity, food intake, medication adherence, and foot self-examination were moderate. Two variables, being a merchant and having family support were found to be the predictors of self-management practices. Predictors of self-management should be considered to boost self-management practice.

Primary school teachers' misconceptions about Attention Deficit/Hyperactivity Disorder in Nekemte town, Oromia region, Western Ethiopia

Objective

Teachers’ misconception on Attention Deficit/Hyperactivity Disorder (ADHD) in general and the implementation of effective educational strategies for children with this problem in particular is one obstacle that largely impacts the academic and overall success of school children with this problem. In Ethiopia, despite there are thousands of school children with this ADHD, no studies have been conducted to examine school teachers’ understanding about problem. This research was therefore aimed to investigate primary school teachers’ misconceptions about ADHD in Western Ethiopia.

Result

In this study, 76.2% of respondents had misconception on general awareness of ADHD. More than half (62.7%) of them had misconceptions on the diagnosis and on 81% had misconceptions regarding treatment of the problem. Concerning teachers’ misconception on the contemporarily recommended educational placement of students with ADHD, 141 (68.3%) have said that such students should be placed in part time special education. The findings of this research have clearly indicated that primary school teachers have a wide range of misconceptions about the ADHD. It also reflects the need of equipping teachers with basic knowledge of ADHD which also enables them provide effective support for students with this exceptionality.