ABSTRACT
Background: Oral anticoagulation therapy with warfarin requires frequent monitoring level of anticoagulation by the international normalized ratio (INR). Aim(s): Therefore, this systematic review aimed to systematically summarize anticoagulation control, treatment outcomes, and associated factors in long-term patients receiving warfarin in Africa. Method(s): The literature search was conducted in PubMed, Cochrane Library, African Journal of Online databases, Google Scholar, and Google. An advanced search strategy was computed to retrieve relevant studies related to anticoagulation control and outcomes. Duplication, title and screening, and full-text assessment were conducted in Covidence software. Study quality was assessed using the Joanna Briggs Institute Critical appraisal quality assessment tool. The systematic review is registered in PROSPERO (CRD42021260772) and performed based on the PRISMA guideline. Result(s): Out of 298 identified articles, 18 articles were eligible for the final review and analysis. The mean of 39.4 +/- 8.4% time in therapeutic range (TTR) (29.4% to 57.3%), 36.7 +/- 11.5% TTR (range 25.2-49.7%) and 46% TTR (43.5-48.5 %) was computed from studies that determined TTR by Rosendaal, direct and cross-section- of- the- files methods, respectively. The lowest percentage of TTR was 13.7%, while the highest was 57.3% was observed in this review. The highest percentage of patients (32.25%) who had TTR >= 65% was reported in Tunisia, but the lowest percentages were in Namibia (10%, TTR >= 65%) and Kenya (10.4%, TTR >= 70%). Generally, 10.4-32.3% of study participants achieved desired optimal anticoagulation level. Regarding secondary outcomes, 1.6-7.5% and 0.006-59% of patients experienced thromboembolic complications and bleeding events, respectively. The presence of chronic comorbidities, taking more than two drugs, and presence of medications that potentially interact with warfarin was the frequently reported predictors of poor anticoagulation therapy. Conclusion(s): Oral anticoagulation control was suboptimal in patients taking warfarin as evidenced by low TTR in Africa. Therefore, there is an urgent need for further improving oral anticoagulation management service.
ABSTRACT
Background: Reports indicated association of COVID-19 with coagulation dysfunction and venous thromboembolism (VTE) prevalence was in the range of 20-40%. All patients with COVID-19 who are hospitalized should receive pharmacologic prophylaxis unless they have contraindications. Aim(s): To assess VTE risk, incidence and its management in patients with COVID-19 admitted to Tikur Anbessa Specialized Hospital (TASH). Method(s): A retrospective study was conducted among 146 COVID-19 patients admitted to TASH. A pre-tested data ion format was used to collect patients' clinical information and VTE risk by using the modified Caprini Risk Score in COVID-19. We used Statistical Package for the Social Sciences (SPSS) version 26 for data analysis. Descriptive statistics was used to summarize the findings and binary logistic regression analysis to assess association between the variables of interest. Result(s): Result: Out of 146 patients, 57.53% were males and mean age was 45.56 +/- 18.17 years. All patients were at risk of developing VTE. The most often observed VTE risk factors were being COVID-19 symptomatic (88.40 %), serious lung diseases (56.2%) and age > 40 years (52.10 %). The incidence of VTE was 23 (15.75 %) and majorly (91.3%) occurred in highest VTE risk (>= 5 score) patients, >40 years patients and in patients with severe COVID-19 symptoms (100%). However, parenteral thromboprophylaxis was prescribed only for 98 (67.12 %) patients. Out of 23 patients developed VTE, 15 didn't receive prophylaxis and the remaining 8 received the thromboprophylaxis. Unfractionated heparin (UFH) was the most widely used prophylaxis. For patients who developed VTE, majority of them 20 (86.96%) were given therapeutic dose of UFH. Conclusion(s): All patients with COVID-19 were at risk of developing VTE. Only one third received thromboprophylaxis. The incidence of VTE was high and majorly occurred in patients that didn't receive prophylaxis.
ABSTRACT
In this paper, we present the initial changes and continuing challenges that are faced by teachers and students due to the unexpected transition to online learning from the COVID-19 pandemic at Bahir Dar University, Ethiopia. For this, the authors applied a phenomenological-case-study design, collecting qualitative data from purposively selected Ph.D. students (n = 10) and teachers (n = 4), examiners (n = 2), as well as the postgraduate coordinator. The results indicate that the teachers experienced some difficulties in effectively using learning technologies. Moreover, the students were overburdened with increased accountability and excessive challenges. However, the institutional capacity to support was relatively minimal. Despite these odds, the study participants showed higher levels of willingness and completed the program successfully. The study participants reported moderate satisfaction with their personal and professional experiences. The COVID-19 pandemic is an opportunity to remind universities and colleges about the essential skills that students need in this unpredictable world, for example, informed decision making, creative problem solving, and adaptability.
ABSTRACT
Coronavirus disease 2019 is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The world was affected by the Coronavirus Disease in 2019. In sub-Saharan Africa, including Ethiopia, there is no study conducted on the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Health care workers, specifically Nurses. This study aims to assess the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Nurses who work in South Gondar Zone, Hospitals, Northwest Ethiopia, 2020. An Institution based cross-sectional study was conducted among 166 Nurses in South Gondar Zone, Ethiopia, From 1 June to 30 June 2020. For selecting the study participants after proportional allocation of study subjects to each hospital, simple random sampling techniques were to be used. Data were entered into Epi info version 7.2.0.1, and exported to Statistical Package for Social Sciences window version 24 for analysis. Binary and multivariable logistic regression was used to see the association between dependent and independent variables. Adjusted odds ratio with 95% confidence interval was computed. P-value < 0.05 was used to declare association. Finally, the result is presented in the form of texts, tables, and graphs. Of 166 Nurses, 166 (100% response rate) responded to the online interview questionnaire. Of the participating 166 nurses, 57.2% were females and 42.8% were males; 41.6 % of the respondents were between the ages of 20 and 29 years. About 84.9 % had good knowledge and 63.3% favourable attitude of COVID-19. Wearing general medical masks can prevent one from acquiring infection by the COVID-19 virus. AOR = 0.44, 95% CI = 0.005-0.362 were factors of knowledge about COVID-19, whereas, 'I strongly agree' Medical staff were ready to participate in anti-epidemic in the community, AOR = 0.08, 95% CI = 0.003-1.76 were factors of attitude about COVID-19. Where factors of attitude about COVID-19. In this study, most of the nurses had good knowledge and a favourable attitude regarding of COVID-19. Wearing general medical masks that can prevent one from acquiring infection by the COVID-19 virus were factors in association with the knowledge of nurses on COVID-19. Similarly, Medical staff were ready to participate in anti-epidemic community factors associated with the attitudes of nurses on COVID-19.