RESUMEN
BACKGROUND: Non-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there's limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia. METHODS: A hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant. RESULTS: In the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2-1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21-0.64, p < 0.001), concurrent infections (AOR: 0.36, 95% CI: 0.16-0.86, p < 0.001), chronic kidney diseases (CKD) (AOR: 0.35, 95% CI: 0.14-0.85, p = 0.02), and complications during hospitalization (AOR: 6.36, 95% CI: 3.45-11.71, p < 0.001). CONCLUSION: Our study reveals a substantial prevalence of NCDs among hospitalized patients, affecting approximately one in four individuals, primarily with CVDs and cancer. Alarmingly, a significant proportion of these patients did not survive their hospitalization, emphasizing the urgent need for targeted interventions to enhance outcomes in this population.
Asunto(s)
Hospitalización , Enfermedades no Transmisibles , Centros de Atención Terciaria , Humanos , Femenino , Masculino , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/mortalidad , Persona de Mediana Edad , Estudios Prospectivos , Etiopía/epidemiología , Prevalencia , Adulto , Hospitalización/estadística & datos numéricos , Anciano , Mortalidad Hospitalaria , Neoplasias/epidemiología , Neoplasias/mortalidad , Diabetes Mellitus/epidemiología , Adulto Joven , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , AdolescenteRESUMEN
INTRODUCTION: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD. METHODS: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded. RESULTS: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol. CONCLUSION: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment.
Asunto(s)
Insuficiencia Cardíaca/epidemiología , Isquemia Miocárdica/epidemiología , Adulto , Factores de Edad , Anciano , Estudios de Cohortes , Diabetes Mellitus/epidemiología , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Insuficiencia Cardíaca/etiología , Hemoglobinas/análisis , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Estudios Retrospectivos , Factores Sexuales , Factores de TiempoRESUMEN
BACKGROUND: In population studies of heart failure (HF), diabetes has been shown to be an independent risk factor. However, the evidence evaluating diabetes mellitus (DM) as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients in Ethiopia. METHODS: A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Hypertension was examined as a possible effect modifier as well. RESULTS: The mean age was 56.8 years, 69% were male, and 31% were diabetic. During the 24 months follow-up period, 196 (64.1%) had incident HF. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% confidence interval (CI): 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p < 0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p = 0.001] (compared to those with neither). CONCLUSION: DM is the strongest predictor of incident HF, compared to other traditional risk factors, in Ethiopian patients with IHD. Those with both DM and HTN are at the highest risk.
Asunto(s)
Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Isquemia Miocárdica/epidemiología , Adulto , Anciano , Diabetes Mellitus/diagnóstico , Etiopía/epidemiología , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
Introduction: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD. Methods: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded. Results: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol.Conclusion: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment
Asunto(s)
Estudios de Cohortes , Etiopía , Cardiopatías , Insuficiencia Cardíaca , Isquemia MiocárdicaRESUMEN
Tricuspid valve infective endocarditis is a known complication of injecting drug use (IVDU) and is said to be rare in Africa. The most common etiological microbial agent of infective endocarditis (IE) in IVDU is Methicillin sensitive Staphylococcus aureus. Antibiotic treatment should start immediately after blood cultures have been obtained once IE is diagnosed. Treatment of IE in patients with IVDU is more difficult, and has a high recurrence rate due to medical non-compliance and continuing IVDU. The status of IVDU in Ethiopia is not known. The updated strategies of diagnosis and treatment as well as prognosis of IE in an IVDU patient who presented with respiratory symptoms and later diagnosed with TV endocarditis will be discussed.
Asunto(s)
Endocarditis Bacteriana/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Abuso de Sustancias por Vía Intravenosa/complicaciones , Válvula Tricúspide/diagnóstico por imagen , Adulto , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/etiología , Humanos , Masculino , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , UltrasonografíaRESUMEN
BACKGROUND: Cardiovascular disorders vary throughout the world in type and distribution especially between the developed and the developing countries. Data on spectrum of cardiovascular diseases in Ethiopia is scarce. OBJECTIVE: To assess the spectrum of cardiovascular disorders at Tikur Anbessa Specialized Tertiary Referral Hospital. METHODS: A record review of patient registers from January 2001 to December 2012 was done for 3282 Ethiopian patients with confirmed cardiovascular disorders at adult Cardiology clinic and Neurology clinic of Tikur Anbessa Specialized hospital. Spectrum of valvular heart disease, heart failure, hypertension, ischemic heart disease, congenital heart disease, arrhythmias, cardiomyopathies, cerebrovascular diseases, and peripheral vascular diseases, defined by Physician International Classification of Diseases, Version 9, codes, were directly standardized to the population. Descriptive statitistics was applied to present results. RESULTS: The study population contained more women (n = 1937 [59.0%]) than men. The mean age of the patients was 31.6 +/- 16.6 years. Women were younger than men (mean 29.6 [SD 15.1] years vs 34.52 [18.3] years). Valvular Heart Disease was the most common primary diagnosis in 2036 (62.0%) with significantly higher proportion in the 3rd decade of life. About 300 (9.1%) of the patients were diagnosed with heart failure. Other major diagnoses included hypertension 482 (14.7%), cerebrovascular diseases or stroke 377 (11.5%), congenital heart disease 279 (8.5%) and ischemic heart disease 224 (7.4%). Fifty seven (26.5%) patients with ischemic heart disease had diabetes mellitus. CONCLUSION: While valvular heart disease is the commonest cardiovascular disorder in Ethiopian patients at the largest public hospital of the country, ischemic heart disease has dramatically increased over the years. It is high-time that effective population-based, health promotive strategies for primary prevention as well as secondary measures for the established cardiovascular disorders and risk factors are in place.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Etiopía/epidemiología , Femenino , Hospitales de Enseñanza , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: Adverse drug reactions (ADRs) are frequently encountered among patients taking Antiretroviral Treatment (ART). The aim of this study was to describe the type and frequency of ADRs among adult Ethiopians on ART. OBJECTIVE: to describe the type and frequency of short term adverse drug reactions among adult Ethiopian patients on ART at Tikur Anbessa teaching Hospital in Addis Ababa, Ethiopia. METHODS: From October 2008 to December 2009, 228 HIV positive patients were enrolled to a tertiary teaching hospital in Addis Ababa. Patients were closely monitored for ADRs for a median observation period of 18 weeks (79 total person-years of observation). Time-dependent occurrence of clinical adverse effects and abnormal laboratory values as defined by the AIDS Clinical Trial Group were analyzed (41). RESULTS: A total of 392 ARV drug related ADRs occurred Mild GI disturbances (36.8%) and headache (35.9%) were the most frequently reported symptoms. Thirty (7.7%) of the ADRs were severe requiring change or interruption of therapy (19 hematological and 11 hepatotoxic). Severe hematological complications were anemia (4.8%), neutropenia (2.6%) and thrombocytopenia (0.9%). Anemia occurred earl), in the first 4 weeks of ART treatment. Hepatic toxicity was also seen early but continued throughout the observation period, decreasing over time. Other ADRs encountered were grade I/II toxicities of rash, peripheral neuropathy, and metabolic disturbances. CONCLUSION AND RECOMMENDATIONS: ADRs occurred frequently in patients receiving ART. Grade III/IV toxicity that required withholding or change of treatment occurred in nearly 10% of the patients. Regular clinical, and laboratory monitoring appropriate to centers with limited resources need to be devised to monitor toxicity of ART Patient education on the easily recognizable ADRs could also reduce severe drug toxicities.