RESUMEN

BACKGROUND: The Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs. METHODS: A mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia. Semi-structured interviews were conducted with 10 primary healthcare clinicians and one healthcare administrator. Organisational Readiness for Implementing Change (ORIC) questionnaire was self-completed by 124 health workers and analysed using Kruskal Wallis ranked test to investigate median score differences. Qualitative data were mapped to the Consolidated Framework for Implementation Science (CFIR) and the Theoretical Domains Framework (TDF). Expert Recommendations for Implementing Change (ERIC) were employed to select implementation strategies to address barriers. RESULTS: Four domains were identified: EPHCG training and implementation, awareness and meeting patient needs (demand side), resource constraints/barriers (supply side) and care pathway bottlenecks. The innovative facility-based training to implement EPHCG had a mixed response, especially in busy facilities where teams reported struggling to find protected time to meet. Key barriers to implementation of EPHCG were non-availability of resources (CFIR inner setting), such as laboratory reagents and medications that undermined efforts to follow guideline-based care, the way care was structured and lack of familiarity with providing care for people with NCDs-MHCs. Substantial barriers arose because of socio-economic problems that were interlinked with health but not addressable within the health system (CFIR outer setting). Other factors influencing effective implementation of EPHCG (TDF) included low population awareness about NCDs/MHCs and unaffordable diagnostic and treatment services (TDF). Implementation strategies were identified. ORIC findings indicated high scores of organisational readiness to implement the desired change with likely social desirability bias. CONCLUSION: Although perceived as necessary, practical implementation of EPHCG was constrained by challenges across domains of internal/external determinants. This was especially marked in relation to expansion of care responsibilities to include NCDs/MHCs. Attention to social determinants of health outcomes, community engagement and awareness-raising are needed to maximize population impact.

Asunto(s)

RESUMEN

Introduction: Chronic respiratory diseases (CRDs) are diseases of the lung airways and parenchyma. Globally, they are the leading causes of morbidity and mortality. This study aimed to characterize the common CRDs, along with their lung function and possible determinants in symptomatic patients attending Bishoftu General Hospital, Ethiopia. Methods: A cross-sessional study was conducted at the outpatient of Bishoftu Hospital, Ethiopia from June 2019 to March 2020. Consecutive adult patients aged 18 and above with CRDs (≥8 weeks) were recruited. Questionnaires were used to collect data on demographics, symptoms, diagnoses, and putative risk factors. Lung function was measured by spirometry. Result: A total of 170 participants were recruited, the majority 102(60.0%) were female. The mean age was 49 years (SD=16). The most common symptoms were wheezing in the last twelve months 156 (91.8%), cough 138 (81.2%), and severe exertional breathlessness 137 (80.6%). Thirty-nine (22.9%) were either active or passive smokers. Half of the patients (50.3%) were exposed daily to vapors, dust, gases, or fumes and 58 (34.3%) were exposed to biomass smoke. In total, 138 (81.2%) had a positive allergen skin prick test. Chronic bronchitis (49.1%) and asthma (36.1%) were the most common clinical diagnoses. Classification of lung function revealed 23 (15%) normal, 29 (19%) obstructive, 36(23.5%) restrictive and 61(39.9%) mixed patterns. Airflow obstruction was independently associated with increasing age (p<0.05), exertional breathlessness (p<0.001), previous history of asthma (p<0.05), BMI (p<0.05), and doctor-diagnosed chronic obstructive pulmonary disease (p<0.001) and asthma (p<0.05). Conclusion: This study shows a high burden of abnormal lung function in patients attending clinics because of CRDs symptoms. These findings support the critical need for spirometry services to determine lung abnormality in patients with chronic respiratory symptoms.

Asunto(s)

RESUMEN

Background: With a neonatal mortality rate of 33 per 1,000 live births in 2019, Ethiopia is striving to attain the Sustainable Development Goal target of 12 deaths per 1,000 live births by 2030. A better understanding of the major causes of neonatal mortality is needed to effectively design and implement interventions to achieve this goal. Minimally Invasive Tissue Sampling (MITS), an alternative to conventional autopsy, requires fewer resources and through task-shifting of sample collection from pathologists to nurses, has the potential to support the expansion of pathology-based post-mortem examination and improve mortality data. This paper evaluates the accuracy and adequacy of MITS performed by nurses at a tertiary and general hospital and in the home of the deceased. Methods: Nurses in a tertiary and general hospital in Ethiopia were trained in MITS sample collection on neonatal deaths and stillbirths using standardized protocols. MITS sample collection was performed by both pathologists and nurses in the tertiary hospital and by nurses in the general hospital and home-setting. Agreement in the performance of MITS between pathologists and nurses was calculated for samples collected at the tertiary hospital. Samples collected by nurses in the general hospital and home-setting were evaluated for technical adequacy using preestablished criteria. Results: One hundred thirty-nine MITS were done: 125 in hospitals and 14 inside homes. There was a perfect or almost perfect agreement between the pathologists and the nurses in the tertiary hospital using Gwet's agreement interpretation criteria. The adequacy of MITS samples collected by nurses in the general hospital was more than 72% when compared to the preset criteria. The adequacy of the MITS sampling yield ranged from 87% to 91% on liveborn neonatal deaths and 76% for the liver, right and left lungs and 55% for brain tissues in stillbirths. Conclusions: This study demonstrated that task-shifting MITS sample collection to nurses can be achieved with comparable accuracy and adequacy as pathologists. Our study showed that with standardized training and supportive supervision MITS sample collection can be conducted by nurses in a tertiary, general hospital and, at the home of the deceased. Future studies should validate and expand on this work by evaluating task-shifting of MITS sample collection to nurses within community settings and with larger sample sizes.

RESUMEN

Purpose: Different biological characteristics, therapeutic responses, and disease-specific outcomes are associated with different molecular subtypes of breast cancer (BC). Although there have been different studies on BC in the Ethiopian capital city of Addis Ababa, there have been few studies in other parts of the nation, and none have evaluated biological characteristics in other locations in the context of the extensive ethnic and genetic diversity found in Ethiopia. This study was carried out to evaluate the distribution of immunohistochemistry (IHC) subtypes of BCs throughout four Ethiopian regions. Methods: A total of 227 formalin-fixed paraffin-embedded (FFPE) tissue blocks were collected from tertiary hospitals in four Ethiopian regions between 2015 and 2021. The IHC staining was performed for subtyping, ER, PR, HER2, and Ki-67 proliferation markers. Results: The mean age at diagnosis was 43.9 years. The percentage of ER and PR-negative tumors were 48.3% and 53.2%, respectively. The IHC subtypes showed the following distribution: 33.1% triple-negative breast cancer (TNBC), 27.6% luminal B, 25.2% luminal A, and 14.1% HER2 enriched. In multiple logistic regression analysis, grade III and HER2 positivity were associated with larger tumor size, and also originating from Jimma compared to Mekele. Conclusion: Patients with ER-negative, PR-negative, and TNBC were found in 48.3%, 53.2%, and 33.1% of cases, respectively, showing that half the patients could potentially benefit from endocrine treatment. A considerably high prevalence of TNBC was reported in our study, demanding additional research that includes genetic predisposition factors. Additionally, aggressive tumors were found in a high percentage of younger age groups, which must be considered when planning personalized treatment strategies.

Asunto(s)

RESUMEN

INTRODUCTION: Matrix metalloproteinases (MMPs) play a pathophysiological role in cancer initiation and progression. Numerous studies have examined an association between MMP-2, MMP-9, and MMP-11 expression and clinicopathological characteristics of breast cancer (BC); however, no research has been done on the MMP expression levels in BC cases from Ethiopia. MATERIALS AND METHODS: A total of 58 formalin-fixed paraffin-embedded breast tissue samples encompassing 16 benign breast tumors and 42 BC were collected. The RNA was extracted and quantitative reverse-transcription PCR was performed. GraphPad Prism version 8.0.0 was used for statistical analysis. RESULTS: The MMP-11 expression levels were significantly higher in breast cancer cases than in benign breast tumors (P = 0.012). Additionally, BC cases with positive lymph nodes and ER-positive receptors had higher MMP-11, MMP-9, and MMP-2 expression than cases with negative lymph nodes and ER-negative, respectively. The MMP-11 and MMP-9 expressions were higher in grade III and luminal A-like tumors than in grade I-II and other subtypes, respectively. CONCLUSION: The MMP-11 expression was higher in BC than in benign breast tumors. Additionally, MMP-11, MMP-9, and MMP-2 were higher in BC with positive lymph nodes and estrogen receptors. Our findings suggest an important impact of MMPs in BC pathophysiology, particularly MMP-11.

Asunto(s)

RESUMEN

Introduction: Evidence on the interplay between HIV and COVID-19 is not entirely consistent. Methods: A retrospective cohort study was conducted on the medical records of patients who had a positive RT-PCR for COVID-19 and were admitted to Eka Kotebe General Hospital between March 2020 and October 2021. Results: A total of 427 patients, including 108 people living with HIV/AIDS (PLWH) and 319 people without HIV/AIDS, were included in the study. The median age of PLWH and people without HIV was 49.5 years (interquartile range 40-59 years) and 48 years (interquartile range 32-65 years), respectively. Of these patients, 258 (60.4%) were male and 169 (39.6%) were female. There were significant differences between PLWH and people without HIV in terms of age, tuberculosis, pregnancy, chronic liver disease, complications, shock, white blood cell count, and end outcome (alive or dead). There was no association between HIV status and the need for oxygen, intensive care unit admission, or disease severity. After adjusting for other variables, mortality was significantly higher among PLWH (adjusted odds ratio 2.25, 95% confidence interval 1.11-5.56; P = 0.023). Conclusions: PLWH with COVID-19 had a higher rate of in-hospital mortality than people without HIV, although no association was found between HIV status and the requirement for intensive care unit admission, mechanical ventilation, oxygen support, or the severity of the disease at the time of admission.

RESUMEN

INTRODUCTION: In hospitalized COVID-19, neutrophil-to-lymphocyte ratio (NLR) and serum creatinine is sometimes measured under assumption they predict disease severity and mortality. We determined the potential value of NLR and serum creatinine as predictors of disease severity and mortality in COVID-19. METHODS: Prospective cohort study of COVID-19 patients admitted to premier COVID-19 treatment hospitals in Ethiopia. Predictive capability of biomarkers in progression and prognosis of COVID-19 was analyzed using receiver operating characteristics. Survival of COVID-19 patients with different biomarker levels was computed. Logistic regression assessed associations between disease severity and mortality on NLR and serum creatinine adjusted for odds ratio (AOR). RESULTS: The study enrolled 126 adults with severe (n = 68) or mild/moderate (n = 58) COVID-19, with median age 50 [interquartile range (IQR 20-86)]; 57.1% males. The NLR value was significantly higher in severe cases [6.68 (IQR 3.03-12.21)] compared to the mild/moderate [3.23 (IQR 2.09-5.39)], with the NLR value markedly associated with disease severity (p<0.001). Mortality was higher in severe cases [13 (19.1%)] compared to mild/moderate cases [2 (3.4%)] (p = 0.007). The NLR value was significantly higher in non-survivors [15.17 (IQR 5.13-22.5)] compared to survivors [4.26 (IQR 2.40-7.90)] (p = 0.002). Serum creatinine was significantly elevated in severe cases [34 (50%)] compared with mild/moderate [11 (19%)] (p<0.001). Disease severity [AOR 6.58, 95%CI (1.29-33.56), p = 0.023] and NLR [AOR 1.07, 95%CI (1.02-1.12), p = 0.004)] might be associated with death. NLR had a sensitivity and specificity of 69.1% and 60.3% as predictor of disease severity (cut-off >4.08), and 86.7% and 55.9% as prognostic marker of mortality (cut-off >4.63). CONCLUSION: In COVID-19, NLR is a biomarker with only modest accuracy for predicting disease severity and mortality. Still, patients with NLR >4.63 are more likely to die. Monitoring of this biomarker at the earliest stage of the disease may predict outcome. Additionally, high creatinine seems related to disease severity and mortality.

Asunto(s)

RESUMEN

Abnormal inflammatory mediator concentrations during SARS-CoV-2 infection may represent disease severity. We aimed to assess plasma inflammatory mediator concentrations in patients with SARS-CoV-2 in Addis Ababa, Ethiopia. In this study, 260 adults: 126 hospitalized patients with confirmed COVID-19 sorted into severity groups: severe (n=68) and mild or moderate (n=58), and 134 healthy controls were enrolled. We quantified 39 plasma inflammatory mediators using multiplex ELISA. Spearman rank correlation and Mann-Whitney U test were used to identify mechanistically coupled inflammatory mediators and compare disease severity. Compared to healthy controls, patients with COVID-19 had significantly higher levels of interleukins 1α, 2, 6, 7, 8, 10 and 15, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1 (VCAM-1), IFN-γ-inducible protein-10 (IP-10, CXCL10), macrophage inflammatory protein-1 alpha (MIP-1α, CCL3), eotaxin-3 (CCL26), interferon-gamma (IFN-γ), tumor necrosis factor-α (TNF-α), basic fibroblast growth factor (bFGF), placental growth factor (PlGF), and fms-like tyrosine kinase 1 (Flt-1). Patients with severe COVID-19 had higher IL-10 and lower macrophage-derived chemokine (MDC, CCL22) compared to the mild or moderate group (P<0.05). In the receiver operating characteristic curve, SAA, IL-6 and CRP showed strong sensitivity and specificity in predicting the severity and prognosis of COVID-19. Greater age and higher CRP had a significant association with disease severity (P<0.05). Our findings reveal that CRP, SAA, VCAM-1, CXCL10, CCL22 and IL-10 levels are promising biomarkers for COVID-19 disease severity, suggesting that plasma inflammatory mediators could be used as warning indicators of COVID-19 severity, aid in COVID-19 prognosis and treatment.

Asunto(s)

RESUMEN

Data from much of Africa are still scarce on the clinical characteristics, outcomes of treatment, and factors associated with disease severity and mortality of COVID-19. A cross-sectional study was conducted at Eka Kotebe General Hospital, Ethiopia's first COVID-19 treatment center. All consecutive symptomatic SARS CoV-2 RT-PCR positive individuals, aged 18 and older, admitted to the hospital between March 13 and September 16, 2020, were included. Of the total 463 cases, 319 (68.9%) were male. The median age was 45 years (interquartile range 32-62). The most common three symptoms were cough (69%), shortness of breath (SOB; 44%), and fatigue (37%). Hypertension was the most prevalent comorbidity, followed by diabetes mellitus. The age groups 40 to 59 and ≥ 60 were more likely to have severe disease compared with those < 40 years of age (adjusted odds ratio [aOR] = 3.45, 95% confidence interval [CI]: 1.88-6.31 and aOR = 3.46, 95% CI: 1.91-6.90, respectively). Other factors associated with disease severity included the presence of any malignancy (aOR = 4.64, 95% CI: 1.32-16.33) and SOB (aOR = 3.83, 95% CI: 2.35-6.25). The age group ≥ 60 was significantly associated with greater in-hospital mortality compared with those < 40 years. In addition, the presence of any malignancy, SOB, and vomiting were associated with higher odds of mortality. In Ethiopia, most COVID-19 patients were male and presented with cough, SOB, and fatigue. Older age, any malignancy, and SOB were associated with disease severity; these factors, in addition to vomiting, also predicted mortality.

Asunto(s)

RESUMEN

There has been a significant increase in the number of students, residents, and fellows from high-income settings participating in short-term global health experiences (STGHEs) during their medical training. This analysis explores a series of ethical conflicts reported by medical residents and fellows from Emory University School of Medicine in the United States who participated in a 1-month global health rotation in Ethiopia. A constant comparative analysis was conducted using 30 consecutive reflective essays to identify emerging categories and themes of ethical conflicts experienced by the trainees. Ethical conflicts were internal; based in the presence of the visiting trainee and their personal interactions; or external, occurring due to witnessed events. Themes within internal conflicts include issues around professional identity and insufficient preparation for the rotation. External experiences were further stratified by the trainee's perception that Ethiopian colleagues agreed that the scenario represented an ethical conflict (congruent) or disagreed with the visiting trainee's perspective (incongruent). Examples of congruent themes included recognizing opportunities for collaboration and witnessing ethical conflicts that are similar to those experienced in the United States. Incongruent themes included utilization of existing resources, issues surrounding informed consent, and differing expectations of clinical outcomes. By acknowledging the frequency and roots of ethical conflicts experienced during STGHEs, sponsors may better prepare visiting trainees and reframe these conflicts as collaborative educational experiences that benefit both the visiting trainee and host providers.

Asunto(s)

RESUMEN

INTRODUCTION: Lung cancer is the most common cause of cancer deaths worldwide, accounting for 1.8 million deaths each year. Only 20% of lung cancer cases are reported to occur in low- and middle-income countries. An estimated 1.5% of all Ethiopian cancers involved the lung; however, no nationwide cancer registry exists in Ethiopia. Thus, accurate data on clinical history, histopathology, molecular characteristics, and risk factors for lung cancer are not available. The aim of this study was to describe the clinical, radiologic, and pathologic characteristics, including available molecular profiles, for lung cancer at Tikur Anbessa Specialized Hospital (TASH), the main tertiary referral center in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted at TASH among 146 patients with pathologically confirmed primary lung cancer, diagnosed from 2015 to 2019 and recorded in the Addis Ababa Cancer Registry at TASH. Clinical data were extracted from patient medical records, entered into a Research Electronic Data Capture database, and analyzed using Statistical Package for the Social Sciences statistical software. Variables collected included sociodemographics, personal exposures, comorbidities, clinical manifestations at presentation, chest imaging results, diagnostic procedures performed, histopathological classification, cancer staging, and type of treatment (if any). A subset of lung biopsies fixed in formalin for 2 to 7 days, which could be retrieved from the files of the Pathology Department of TASH, were reviewed, and molecular analysis was performed using next-generation sequencing to identify the tumor-oncogenic drivers. RESULTS: Among the 146 patients studied, the mean (SD) age was 54 plus or minus 13 years; 61.6% (n = 90) were male and 25.3% (n = 37) had a history of tobacco use. The most common clinical manifestations included cough (88.4%, n = 129), chest pain (60.3%, n = 88), and dyspnea (53.4%, n = 78). The median duration of any symptoms was 6 months (interquartile range: 3-12 mo). The most common radiologic features were lung mass (84.9%, n = 129) and pleural effusion (52.7%, n = 77). Adenocarcinoma accounted for 35.7% of lung cancers (n = 52) and squamous cell carcinoma 19.2% (n = 28) from those specimens was reported. Among patients on whom staging of lung cancer was documented, 92.2% (n = 95) of the subjects presented at advanced stages (stages III and IV). EGFR mutation, exons 19 and 20, was found in 7 of 14 tissue blocks analyzed. No specific risk factors were identified, possibly reflecting the relatively small sample size and limited exposures. CONCLUSIONS: There are marked differences in the presentation, risk factors, and molecular characteristics of lung cancer in Ethiopia as compared with other African and non-African countries. Adenocarcinoma was the most common histologic type of lung cancer detected in our study, similar to findings from other international studies. Nevertheless, compared with high-income countries, lung cancer in Ethiopia presents at a younger age, a later stage, and without considerable personal tobacco use. The relatively higher prevalence of EGFR mutation, from the limited molecular analyses, suggests that factors other than smoking history, such as exposure to biomass fuel, may be a more important risk factor. Country-specific screening guidelines and treatment protocols, in addition to a national tumor registry and greater molecular mutation analyses, are needed to improve prevention and management of lung cancer in Ethiopia.

RESUMEN

Management of patients with severe or critical COVID-19 is mainly modeled after care of patients with severe pneumonia or acute respiratory distress syndrome from other causes. These models are based on evidence that primarily originates from investigations in high-income countries, but it may be impractical to apply these recommendations to resource-restricted settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for microbiology and laboratory testing, imaging, and the use of diagnostic and prognostic models in patients with severe COVID-19 in LMICs. For diagnostic testing, where reverse transcription-PCR (RT-PCR) testing is available and affordable, we recommend using RT-PCR of the upper or lower respiratory specimens and suggest using lower respiratory samples for patients suspected of having COVID-19 but have negative RT-PCR results for upper respiratory tract samples. We recommend that a positive RT-PCR from any anatomical source be considered confirmatory for SARS-CoV-2 infection, but, because false-negative testing can occur, recommend that a negative RT-PCR does not definitively rule out active infection if the patient has high suspicion for COVID-19. We suggest against using serologic assays for the detection of active or past SARS-CoV-2 infection, until there is better evidence for its usefulness. Where available, we recommend the use of point-of-care antigen-detecting rapid diagnostic testing for SARS-CoV-2 infection as an alternative to RT-PCR, only if strict quality control measures are guaranteed. For laboratory testing, we recommend a baseline white blood cell differential platelet count and hemoglobin, creatinine, and liver function tests and suggest a baseline C-reactive protein, lactate dehydrogenase, troponin, prothrombin time (or other coagulation test), and D-dimer, where such testing capabilities are available. For imaging, where availability of standard thoracic imaging is limited, we suggest using lung ultrasound to identify patients with possible COVID-19, but recommend against its use to exclude COVID-19. We suggest using lung ultrasound in combination with clinical parameters to monitor progress of the disease and responses to therapy in COVID-19 patients. We currently suggest against using diagnostic and prognostic models as these models require extensive laboratory testing and imaging, which often are limited in LMICs.

Asunto(s)

RESUMEN

INTRODUCTION: Integrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa. METHODOLOGY: We will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study. ETHICS AND DISSEMINATION PLAN: Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

PURPOSE: Anemia is one of the common complications of diabetes mellitus (DM), which has an adverse effect on the progression and development of other diabetes-related complications. In spite of this, relatively little information is available on the prevalence of anemia and associated factors among type 2 diabetes mellitus (T2DM) patients in Ethiopia, particularly in the study area. Thus, this study assessed the prevalence of anemia and associated factors among T2DM patients at Debre Berhan Referral Hospital (DBRH), North-East, Ethiopia. PATIENTS AND METHODS: A hospital-based cross-sectional study was conducted from April 1 to May 30, 2019, among 249 T2DM patients with follow up at DBRH, selected using a systematic random sampling technique. Data were collected by face-to-face interviews, anthropometric measurements, and laboratory tests; such as hemoglobin measurements, red blood indices, and serum creatinine analysis. The data were coded and entered into Epi-data manager version 4.4.1.0, and analysis by using SPSS version 22 was carried out. To identify the determinant factors of anemia, bivariate and multivariate logistic regression analyses were performed. P-value <0.05 was considered as statistically significant. RESULTS: The study showed 20.1% of the participants were anemic. Being age >60 years (AOR=3.06, 95% CI: 1.32-7.11), poor glycemic control (AOR=2.95, 95% CI: 1.22-7.15), eGFR 60-89.9 mL/min/1.73m2 (AOR=2.91, 95% CI: 1.15-7.37), eGFR <60 mL/min/1.73m2 (AOR=6.58, 95% CI: 2.42-17.93), DM duration >10 years (AOR= AOR=2.75, 95% CI: 1.17-6.48), and having diabetic complications (AOR=3.81, 95% CI: 1.65-8.81) were significantly associated with anemia. CONCLUSION: One out of five T2DM patients had anemia. Poor glycemic control, decreased eGFR, presence of DM complications, duration of DM >10 years, and age >60 years were significantly associated with the occurrence of anemia among T2DM. Regular screening for anemia in all T2DM patients may help in the early detection and management of anemia.

RESUMEN

BACKGROUND: Ethiopia is striving to achieve a goal of "zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths." However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS: A retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality. RESULTS: The median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality. CONCLUSION: The overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.

Asunto(s)

RESUMEN

BACKGROUND: Patient awareness of asthma severity is important for optimal asthma management. However, there is often a discrepancy between physician assessment of asthma control based on guidelines and patient discernment of control. We compared physician and patient perception of asthma control in a clinic population seen at a tertiary hospital in Addis Ababa, Ethiopia. METHODS: In this cross-sectional study, 182 consecutive patients with a physician diagnosis of asthma seen in Chest Clinic at Tikur Anbessa Specialized Hospital (TASH) between July and December 2015 were studied. Demographics, asthma symptoms, medication use in the past month, and self-perception of asthma control in the past 7 days were obtained from the clinic records. Physician assessed asthma control was based on the GINA asthma symptom control assessment tool. Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol. RESULTS: Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years, and the mean (SD) duration of asthma was 19.4 ± 12.7 years. Forty-four (24.2%) patients had physician determined well-controlled asthma and 138 (75.8%) patients had physician determined partly controlled/uncontrolled asthma. One hundred and fifty-one (83%) patients thought their asthma control was good. However, the degree of concordance between physician evaluation and patient perception of asthma control was low (kappa index = 0.09). On multivariate analysis, self-perceived poor asthma control was associated with any activity limitation due to asthma and inconsistent inhaled corticosteroid use. CONCLUSION: In our study, the first of its kind in Ethiopia, a high percent of patients with physician determined well-controlled asthma has appropriate perception of their disease state. However, those patients with partly controlled/uncontrolled asthma had poor self-perception of their disease, emphasizing the need for further patient education. These conclusions may be especially useful in the care of asthmatics from other low-income countries.

Asunto(s)

RESUMEN

INTRODUCTION: In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.

Asunto(s)

RESUMEN

OBJECTIVE: Uncontrolled asthma negatively impacts patients, families, and the community. The level of symptom control among asthmatics in Ethiopia has not been well studied. We investigated the level of asthma control and risk factors for poor asthma control in clinic patients seen in the largest public hospital in Ethiopia. RESULTS: In this cross-sectional study, we studied all 182 consecutive subjects with a physician diagnosis of asthma who were seen in chest clinic at Tikur Anbessa Specialized Hospital between July and December 2015. Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years and the median duration of asthma was 20 ± 12.7 years. One hundred and seventeen subjects (64.3%) had nighttime awakening due to asthma. Fifty-eight (31%) were not using controller medications and 62 (34.6%) had improper inhaler technique. Only 44 (24.2%) subjects had well-controlled asthma. On multivariate analysis, variables associated with uncontrolled asthma included: use of biomass fuel for cooking, longer duration of asthma (> 30 year), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Most asthmatics attending in the largest public hospital in Ethiopia, had uncontrolled asthma. Several risk factors for poor asthma control were identified. Improved asthma control is possible through directed interventions.

Asunto(s)