Factors associated with poor medication adherence during COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia: a cross-sectional study.

OBJECTIVE: This study aimed to assess factors associated with poor medication adherence during the COVID-19 pandemic among hypertensive patients visiting public hospitals in Eastern Ethiopia. SETTING: Hospital-based cross-sectional study was conducted in Harari regional state and Dire Dawa Administration from 1 January to 30 February 2022. Both settings are found in Eastern Ethiopia. PARTICIPANTS: A total of 402 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study. MAIN OUTCOME MEASURES: The main outcome measure was poor medication adherence during the COVID-19 pandemic. RESULTS: The level of poor antihypetensive medication adherence was 63% (95% CI 48.1 to 67.9). Patients who had no formal education (adjusted OR (AOR)=1.56, 95% CI 1.03 to 4.30), existing comorbid conditions (AOR=1.98, 95% CI 1.35 to 4.35), self-funded for medication cost (AOR=2.05, 95% CI 1.34 to 4.73), poor knowledge about hypertension (HTN) and its treatment (AOR=2.67, 95% CI 1.45 to 3.99), poor patient-physician relationship (AOR=1.22, 95% CI 1.02 to 4.34) and unavailability of medication (AOR=5.05, 95% CI 2.78 to 12.04) showed significant association with poor medication adherence during the pandemic of COVID-19. CONCLUSION: The level of poor antihypertensive medication adherence was high in this study. No formal education, comorbidity, self-funded medication cost, poor knowledge about HTN and its treatment, poor patient-physician relationship, and unavailability of medication during the COVID-19 pandemic were factors significantly associated with poor adherence to antihypertensive medication. All stakeholders should take into account and create strategies to reduce the impact of the COVID-19 pandemic on medication adherence of chronic diseases.

Association of Pre-Existing Comorbidities with Disease Severity Among COVID-19 Patients in Eastern Ethiopia.

Background: Comorbidities and advanced age increase the risk of severe outcomes of COVID-19. In order to shift the possible unfavorable treatment outcome in patients with chronic illnesses, information related to the prevalence of chronic illness and its effect on severity of COVID-19 infection has paramount importance. Objective: This study was aimed at assessing the prevalence of comorbidities and associated severity among COVID-19 patients admitted to COVID-19 treatment center, eastern Ethiopia. Methods: An institution-based cross-sectional study design was employed among 422 COVID-19 patients admitted to COVID-19 treatment center, eastern Ethiopia from April 10, 2020, to August 10, 2021. Binary logistic regression was fitted to identify comorbidities and other factors associated with severe clinical outcome, associations were presented with adjusted odds ratios (AORs) and 95% confidence intervals (CIs). In all analyses statistical significance were declared at p-value <0.05. Results: More than half (52.4%) of the COVID-19 patients were presented with comorbid conditions. One third (34.6%) of the admitted COVID-19 patients were in severe clinical stages. Marital status (AOR=4.56; 95% CI: 1.40, 14.76), hypertension (AOR=2.08; 95% CI: 1.09, 3.97), diabetes mellitus (AOR=3.31; 95%:1.84, 5.98), and cardiovascular diseases (AOR=4.22; 95% CI: 2.18, 8.15) were identified as factors associated with severe clinical stages. Conclusion: The comorbid conditions such as diabetes, hypertension, and cardiovascular diseases, and marital status were identified as significant predictors of severe outcomes of COVID-19. Therefore, identifying the people with chronic comorbidities as a risk group would help to anticipate and prevent the serious outcomes of COVID-19 infection.

Health-care Workers' Willingness to Pay for COVID-19 Vaccines in Eastern Ethiopia: Using Contingent Valuation Method.

Background: Health-care workers (HCWs) are among the highest risk groups for COVID-19 infection. The vaccine is found to be vital for HCWs, their household contacts, and their patients to protect against COVID-19 infection and maintain the safety of health systems. The actual willingness to pay for COVID-19 vaccination and associated factors remain uncertain among health-care workers in Ethiopia. Therefore, studying health-care workers' willingness to pay (WTP) for COVID-19 vaccination helps to have an insight on valuation of the vaccine. Methods: Institution-based cross-sectional study was conducted among 403 randomly selected health-care workers working in health facilities in eastern Ethiopia from February 3 to March 20, 2021. Pretested structured questionnaire was used to collect data. Binary logistic regression analysis was fitted to test the associations between outcome and explanatory variables. A p-value of <0.05 with 95% confidence interval was used to declare statistical significance. Results: The magnitude of willingness to pay for a COVID-19 vaccine was 42.8%. The median amounts of money respondents willing to pay was 400 ETB (US$ 10.04). Sex (male, AOR = 2.33; 95% CI: 1.39, 3.93), monthly income (>7000 ETB, AOR = 1.22; 95% CI: 1.11, 2.51), affordability (AOR = 1.99; 95% CI: 1.18, 3.35), fear of side effects (AOR = 3.75; 95% CI: 2.13, 6.60), support vaccinations (AOR = 2.97; 95% CI: 1.65, 5.35), the likelihood of getting COVID-19 infection (AOR = 2.11; 95% CI: 1.26, 3.52) were independent determinants of WTP for a COVID-19 vaccine. Conclusion: Health-care workers' willingness to pay for COVID-19 vaccination was found to be low. Detailed health education and training about COVID-19 vaccines are required regarding their side effects, and efficacy to make an informed decision to enhance the willingness to pay for the vaccine. Moreover, the government should consider providing COVID vaccines free of charge for low-income groups and at an affordable price for those who could pay.

Extent of and Factors Associated with Self-Medication among Clients Visiting Community Pharmacies in the Era of COVID-19: Does It Relieve the Possible Impact of the Pandemic on the Health-Care System?

BACKGROUND: Self-medication is one aspect of self-care that has been shown to benefit primary health care. When done correctly, it provides significant benefits to customers, such as self-reliance and cost savings. Inappropriate methods, on the other hand, such as incorrect self-diagnosis and therapy selection, can be disastrous. The COVID-19 pandemic context may benefit the community in easing the burden on the health system. There have been no studies conducted on this possibility in the context of COVID-19 in a selected area, hence the purpose of this study was to determine the extent of and factors associated with self-medication among clients visiting community pharmacies in west Harerghe, Ethiopia from June 1 to 30, 2020. METHODS: This institution-based cross-sectional study used a systemic random sample of 416 community-pharmacy clients. To collect data, face-to-face interviews were conducted using pretested semistructured questionnaires modified from established techniques. EpiData 3.1 was used to enter data and SPSS 24 for analysis. To determine factors associated with self-medications, bivariate and multivariate logistic regression analyses were performed. AORs with 95% CIs are used to report associations, and the level of significance was set at P<0.05. RESULTS: The proportion of people self-medicating was 73.6% (95% CI 69.2%-77.9%). Self-medications were significantly associated with age 18-24 years (AOR 9.28, 95% CI 3.56-24.21) and 25-34 years (AOR 3.54, 95% CI 1.35-9.27), Amhara ethnicity (AOR 1.72, 95% CI 1.01-2.94), current single status (AOR 0.28, 95% CI 0.15-0.51), government employment (AOR 0.31, 95% CI 0.12-0.82), and limited knowledge (AOR 2.31, 95% CI 1.40-3.79). CONCLUSION: Three in four participants practiced self-medication in the era of COVID-19. Repetition was significantly associated with age, ethnicity, current marital status, type of occupation, and knowledge about self-medications. An alternative medical care-delivery system by all health-care providers and increasing community awareness should be promoted.

Factors associated with prolonged length of hospital stay among COVID-19 cases admitted to the largest treatment center in Eastern Ethiopia.

INTRODUCTION: The hospital admissions load and how long each patient will stay in the hospital should be known to prevent the overwhelming of the health system during coronavirus disease 2019 era. Even though the length of hospital stay could vary due to different factors, the factors that affect the stay are not well characterized yet, particularly in the resource-limited settings. Knowing the time spent by the coronavirus disease 2019 patients in the hospital and its associated factors are important to prioritize mobilizing resources, such as beds, pharmacological and non-pharmacological supplies, and health personnel. Therefore, this study was intended to determine the median and identify factors associated with the length of hospital stay among coronavirus disease 2019 cases. METHODS: A facility-based cross-sectional study design was implemented on 394 randomly selected hospitalized patients. Epidata Version 3.1 software was used for data entry, and further analysis was done using Stata version 14.2 software. Frequencies, median with interquartile range, and chi-square test were performed. A logistic regression model was used to identify the association between outcome and explanatory variables. The statistical significance was declared at p-value of less than 0.05 at 95% confidence interval. RESULTS: The analysis was done for a total of 394 cases admitted for coronavirus disease 2019. The median age of the study participants was 40 years with interquartile range of 28-60 years. The median length of hospital stay was 12 days with the interquartile range of 8-17 days. The patients presented with shortness of breathing (AOR = 2.74, 95% confidence interval: 1.33-5.66), incident organ failure (AOR = 3.65, 95% confidence interval: 1.15-11.58), increased leukocyte count (AOR = 0.95; 95% confidence interval: 0.91-0.99), and blood urea nitrogen (AOR = 0.98, 95% confidence interval: 0.97-0.99) had a significant association with prolonged hospital stay. CONCLUSION: This study demonstrated that the proportion of patients stayed above the median hospital stay of the total patients was 185 (46.9%) with the median length of 12 (interquartile range = 8-17) days. Patients presented with difficulty of breathing, had incident organ failure, had decreased leukocyte, and blood urea nitrogen level should be estimated to stay longer in the hospital. Hence, patients with prolonged hospital length of stay associating factors should be expected to consume more pharmacological and non-pharmacological resources during hospital care receiving.

Incidence and predictors of organ failure among COVID-19 hospitalized adult patients in Eastern Ethiopia. Hospital-based retrospective cohort study.

BACKGROUND: Organ failure is incapability of at least one of the body organs to carry out a normal body functions. Identifying the predictors of the organ failure is crucial for improving COVID-19 patients' survival. However, the evidence related to this information is not well-established in developing countries, including Ethiopia. Therefore, this study aimed to determine the incidence and predictors of organ failure among adult patients admitted to Hiwot Fana Specialized University Hospital (HFSUH) COVID-19 treatment center from 1st May 2020 to 20th August 2021, Eastern Ethiopia. METHODS: A hospital-based retrospective cohort study design was implemented. Descriptive measures such as mean with standard deviation (SD), median with interquartile range (IQR), percentages, and frequencies were computed. The binary logistic regression was used to identify the association between outcome variables (organ functional status) and independent variables with an adjusted odds ratio (AOR) at a 95% confidence interval. A significance level was declared at a p-value of less than 0.05. RESULTS: The mean age of study participants was 47.69 years with the standard deviation (SD) of ± 17.03. The study participants were followed for the median time of 8 days with IQR of 4, 14. The incidence of organ failure was 11.9 per 1000 person-day contribution (95% CI: 9.5, 14.9). Predictors such as age above 60 years (AOR = 1.71, 95% CI: 1.44, 4.53), smoking history (AOR = 5.07, 95% CI: 1.39, 8.15), cardiovascular disease (AOR = 5.00, 95% CI: (1.83, 11.72), and critical clinical stages of COVID-19 (AOR = 5.42, 95%: 1.47, 14. 84) were significantly associated with organ failure among COVID-19 hospitalized patients. CONCLUSIONS: The incidence of organ failure was 11.9 per 1000 person-day contribution. Age, smoking, comorbidity, and clinical stages were significantly associated with organ failure among COVID-19 hospitalized cases. Therefore, clinicians should stringently follow the patients experiencing modifiable predictors of organ failure, especially patients with comorbidities and severe clinical stages. Moreover, the prevention programs that target elders and smokers should be strengthening to save this segment of populations before suffering from organ failure following COVID-19.

Predictors of Mortality Among Hospitalized COVID-19 Patients at a Tertiary Care Hospital in Ethiopia.

BACKGROUND: The very unprecedented virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued causing catastrophes in economy and loss of human lives. Despite countries' urgent and resilient public health actions against the COVID-19 pandemic, the disease is causing a large number of deaths. However, predictors of mortality among hospitalized COVID-19 patients have not been well investigated in Ethiopia. Therefore, this study aimed to identify the predictors of mortality among hospitalized COVID-19 patients at a tertiary care hospital in Ethiopia. METHODS: A hospital-based retrospective cohort design study was implemented among hospitalized COVID-19 patients at a tertiary care hospital in Harar, Ethiopia from March 20 to August 20, 2021. Data of 531 admitted patients were entered using Epi-data 3.1 and exported to STATA 14.2 for analysis. Binary logistic regression was used to identify significant predictors of outcome variables with an adjusted odds ratio (AOR) with a 95% confidence interval. RESULTS: Of the total 531 study participants, 101 deaths occurred. The mortality rate was 16.2 per 1000 person-days of observation with median survival time of 44 days with IQR [28, 74]. Smoking history [AOR=2.55, 95% CI (1.15, 5.65)], alcohol history [AOR=2.3, 95% CI (1.06, 4.97)], comorbidities [AOR=2.95, 95% CI (1.26, 6.91)], and increasing oxygen saturation [AOR=0.92, 95% CI (0.89, 0.95)], and lymphocyte count [AOR=0.90, 95% CI (0.88, 0.97)] were independent significant predictors of death from Covid-19. CONCLUSION: The incidence of mortality among hospitalized COVID-19 patients was found to be high. Devising individual, tailored management for patients with "risk" behaviors, comorbid conditions, and poor prognostic markers such as lymphopenia and low oxygen saturation, may reduce the incidence of death among hospitalized COVID-19 patients.

Community risk perception and health-seeking behavior in the era of COVID-19 among adult residents of Harari regional state, eastern Ethiopia.

BACKGROUND: COVID-19 brought significant challenges to public health. It changed the view of global health and safety, trust in the healthcare system, and clients' willingness to seek healthcare. To contain the course of the COVID-19 pandemic and its detrimental effects, understanding peoples' health behavior, especially healthcare-seeking, and determining the community risk perception is very important. Thus, this study aimed to determine the health-seeking behavior, community's risk perception to COVID-19 pandemics, and factors influencing the community risk perception in Harari regional state, Ethiopia. METHODS: Community-based cross-sectional study was conducted from 5 to 30 February 2021. A total of 1320 adult (>18 years) participants were selected using systematic random sampling. The data were collected using an online kobo collect toolbox and analyzed using descriptive statistical tests. Chi-square test and multiple binary logistic regression were applied to examine the difference between variables. A p-value < 0.05 was considered to be of statistical significance. RESULTS: The study included 1296 respondents >18 years old. The overall prevalence of willingness to seek healthcare in the study area was 35.6% (95% CI: 33%-38.3.0%). The mean cumulative score of risk perception was 30.5 (SD ± 7.25) with the minimum and maximum score of 13 and 63, respectively. A total of 656 (50.6%) of the participants had low-risk perceptions concerning COVID-19. The study found a statistically significant association between risk perception and sociodemographic characteristics (age, educational status, and income), and knowledge of the respondents. CONCLUSION: The overall prevalence of willingness to seek healthcare was 35.6%. Healthcare intervention aimed to contain the COVID-19 pandemic should consider the factors associated with the study area. Similarly, the study found a low-risk perception among the community that needs critical action to manage the COVID-19 pandemic and to protect the community as a whole. Thus, it is necessary to improve community risk perception through health education.