Health-related quality of life and utility values among patients with anxiety and/or depression in a low-income tertiary care setting: a cross-sectional analysis.

OBJECTIVES: To describe the health-related quality of life (HRQoL), estimate the associated health state utility values (HSUVs) and explore factors associated with HRQoL of patients with anxiety and/or depression in a resource-limited hospital setting. METHODS: A cross-sectional survey involving 462 participants was conducted in a hospital setting. The Amharic version of the EQ-5D-5 L assessed HRQoL, while the GAD-7 and PHQ-9 measured severity of anxiety and depression symptoms respectively. HSUVs were analysed based on clinical and demographic profiles; mean differences were compared using t-tests and one-way ANOVA; Scheffe's post hoc comparisons and effect sizes (Cohen's d statistic) were used to assess the magnitude of group differences. Factors associated with HRQoL were explored using regression analysis. RESULTS: The mean HSUV was 0.87 (SD = 0.17) and the EQ VAS was 71.4 (SD = 19.1). Patients with both anxiety and depression scored significantly lower (HSUV = 0.83 [0.16], EQ VAS = 64.4 [17.9]) compared to those with either anxiety only (HSUV = 0.88 [0.17], EQ VAS = 75.3 [17.9]) or depression only (HSUV = 0.89 [0.18], EQ VAS 74.4 [19.7]). Males had slightly higher mean scores than females, while those aged 18-35 years demonstrated the highest scores on both the EQ-5D-5 L and EQ VAS. Older age (ß=-0.002), higher PHQ-9 scores (ß=-0.008) and comorbid hypertension (ß=-0.07) associated with lower HSUVs. Lower EQ VAS scores were associated with being female (ß=-4.4), having comorbid hypertension (ß=-7.4) and higher PHQ-9 scores (ß=-0.86), while a positive association was found with having 'more than enough' income (ß = 11.8). CONCLUSIONS: Older age, severity or co-diagnosis of anxiety or depression and comorbid conditions were associated with lower HRQoL, highlighting the need for better interventions to improve the HRQoL of patients with anxiety and depression in Ethiopia.

Health-related quality of life in children, adolescents and young adults with self-harm or suicidality: A systematic review.

OBJECTIVE: Self-harm and suicidality are associated with substantial social and economic burden, especially among children, adolescents and young adults. The aim of this review was to systematically synthesize the literature on the association between health-related quality of life and self-harm/suicidality in children, adolescents and young adults. METHODS: Searches were conducted via MEDLINE, PsycINFO, CINAHL, EconLit and EMBASE. Search terms were the combination of the following blocks: (1) self-harm/suicidality, (2) health-related quality of life/well-being/life satisfaction and (3) children/adolescents/young adults. The quality of studies was assessed using the Effective Public Health Practice Project tool. RESULTS: We identified 23 relevant studies. Findings showed that participants who reported self-harm had lower well-being, life satisfaction or overall health-related quality of life compared to those without self-harm. There was also evidence supporting the association between health-related quality of life and suicidal attempt. However, the results for the association with suicidal ideation remained inconsistent. Additionally, mental health, emotional well-being, physical health, oral health, existential well-being and family quality of life were found to be significant domains associated with self-harm or suicidality. Regarding the quality of included studies, 35% (n = 8), 39% (n = 9) and 26% (n = 6) of studies were scored as 'Strong', 'Moderate' and 'Weak', respectively. CONCLUSION: Findings from the review showed that health-related quality of life varied according to the severity of suicidality (from ideation to attempt). There was also no evidence to infer the direction of causality between health-related quality of life and self-harm/suicidality. The findings suggest a need for further research, in particular longitudinal studies to fill identified gaps in the literature.

Cost Effectiveness of Pharmacological and Non-pharmacological Treatments for Depression in Low- and Middle-Income Countries: A Systematic Literature Review.

BACKGROUND: Various treatment approaches are available for depression. Given the scarcity of healthcare resources, it is important to optimise treatment availability in an efficient manner. Economic evaluations can inform the optimal allocation of healthcare resources. However, there is currently no review synthesising what is known about the cost effectiveness of treatments for depression in low- and middle-income countries (LMICs). METHODS: This review identified articles from six database searches: APA PsycINFO, CINAHL Complete, Cochrane Library, EconLit, Embase and MEDLINE Complete. Trial- and model-based economic evaluations published between 1 January 2000 and 3 December 2022 were included. The quality of health economic studies (QHES) instrument was used to assess the quality of the included papers. RESULTS: This review comprised 22 articles, with most studies (N = 17) focusing exclusively on the adult population. Even though evidence regarding the cost effectiveness of antidepressants for treating various forms of depression was inconsistent; an atypical antipsychotic (aripiprazole) was frequently reported to be cost effective for treatment-resistant depression. Task shifting (aka task sharing) to lay health workers or non-specialist health care providers appeared to be a cost-effective approach for treating depression in LMICs. CONCLUSIONS: Overall, this review found mixed evidence on the cost effectiveness of depression treatment choices among LMICs, with some indication that task sharing with lay health workers may be cost effective. Future research will be needed to fill the gaps around the cost effectiveness of depression treatments in younger people and beyond healthcare facilities.

Examining the psychometric properties of a split version of the EQ-5D-5L anxiety/depression dimension in patients with anxiety and/or depression.

PURPOSE: This study explored differences in self-reported responses and the psychometric performance of the composite EQ-5D-5L anxiety/depression (A/D) dimension compared with a split version of the dimension where 'anxiety' and 'depression' are measured separately. METHODS: People with anxiety and/or depression who visited the Amanuel Mental Specialized Hospital in Ethiopia completed the standard EQ-5D-5L with the added subdimensions. Correlation analysis was used to examine convergent validity with validated measures of depression (PHQ-9) and anxiety (GAD-7), while ANOVA was used to assess known-groups' validity. Agreement between ratings for composite and split dimensions was compared using percent agreement and Cohen's Kappa, while the proportion of 'no problems' reports was compared using the chi-square test. Discriminatory power analysis was undertaken using the Shannon index (H') and Shannon Evenness index (J'). Open-ended questions explored participants' preferences. RESULTS: Of the 462 respondents, 30.5% reported no problems with the composite A/D, while 13.2% reported no problems on both subdimensions. Agreement between ratings for composite and split dimensions was highest for respondents with comorbid anxiety and depression. The depression subdimension had higher correlation with PHQ-9 (r = 0.53) and GAD-7 (r = 0.33) than the composite A/D dimension (r = 0.36 and r = 0.28, respectively). The split subdimensions and composite A/D could adequately differentiate respondents based on their severity of anxiety or depression. Slightly better informativity was observed in EQ-4D-5L + anxiety (H' = 5.4; J' = 0.47) and EQ-4D-5L + depression (H' = 5.31; J' = 0.46) than EQ-5D-5L (H' = 5.19; J' = 0.45). CONCLUSIONS: Adopting two subdimensions within the EQ-5D-5L tool appears to perform slightly better than the standard EQ-5D-5L.

Limited Public Knowledge of Chronic Kidney Disease in a Resource-Limited Setting: A Cross-Sectional Study.

Background: The general public's awareness and knowledge of chronic kidney disease (CKD) and its risk factors remains low, which may contribute to the development of CKD and undiagnosed disease. Therefore, the current study aimed to assess public knowledge of CKD in the Ethiopian community using a validated tool. Methods: A community-based cross-sectional study was conducted in Ethiopia's capital, Addis Ababa. For administrative purposes, the city is divided into ten sub-cities; proportional numbers of study participants were drawn from each sub-city based on their total population size. This study's target population was the general public, and health professionals were excluded. SPSS version 26 was used to analyze the data, and frequencies, tables, percentages, mean, and standard deviation were used to describe the responses of the participants. To identify factors associated with public knowledge of CKD, an independent T-test and one-way ANOVA statistics were used. Results: A total of 350 people were approached, with 301 of them completing and returning the questionnaire, yielding an 86% response rate. The mean (S.D.) knowledge score of participants in this study was 11.12 (±4.21), with a minimum of 0 and a maximum of 22. In terms of the distribution of the CKD knowledge score, half of the respondents have a score of 11 or less. One-way ANOVA revealed that respondents with a degree educational background and family history of CKD had higher knowledge scores. An independent t-test was also performed, but it found no link between socio-demographic characteristics and knowledge score. Conclusion: The Ethiopian population has a low level of general knowledge about CKD and its risk factors. Non-communicable diseases, such as diabetes and hypertension, are currently a public health concern and one of the major risk factors for CKD.

Reliability and validity of using EQ-5D-5L among healthy and adolescents with major mental health disorders in Ethiopia.

BACKGROUND: The EQ-5D is a validated and widely used generic measure of health-related quality of life (HRQoL) in both healthy individuals and those with various medical conditions. The objective of this study was to test whether EQ-5D-5L is reliable and valid for use among school sample adolescents and those with major mental health disorders in Ethiopia. METHODS: Participants were recruited from ten sub-districts comprising the Butajira Rural Health Programme (BRHP) and Butajira major mental health disorders center. Data were collected using an Amharic (Ethiopia) EQ-5D-5L self-complete-paper and the questionnaire was administered 10 days after the first completion for test-retest procedures. Two-way mixed-effects models absolute intraclass correlation coefficient (ICC) was used to test reliability of the instrument while Kruskal-Wallis rank test with pairwise comparison was used to assess the known group validity of the instrument. RESULTS: There were 501 (201 school sample and 300 adolescents with major mental health disorders) participants recruited and 497 were included in the sample for analysis. The ICC was high (ICC > 0.7, p < 0.001) for all EQ-5D-5L dimensions, EQ-5D-5L utility index and EQ-VAS scores. The findings revealed that the Amharic EQ-5D-5L has significant known group validity as shown by the difference in scores among various disease group (depression, schizophrenia, and bipolar) and experience of chronic illness. CONCLUSIONS: The results shows that the Amharic EQ-5D-5L is reliable and valid instrument for the measurement of HRQoL among adolescent populations in Ethiopia.

Cost-Utility Analysis of Dolutegravir- Versus Efavirenz-Based Regimens as a First-Line Treatment in Adult HIV/AIDS Patients in Ethiopia.

BACKGROUND: In several countries, the dolutegravir (DTG)-based regimen is generally preferred as first-line antiretroviral therapy (ART) over the efavirenz (EFV)-based regimen, but the evidence in low-income countries is limited. OBJECTIVE: Our study aimed to evaluate the cost effectiveness of DTG- versus EFV-based first-line human immunodeficiency virus (HIV) treatment in Ethiopia. METHODS: We developed a microsimulation model for the progression of HIV/acquired immune deficiency syndrome (AIDS) to examine the cost effectiveness of DTG-based first-line ART compared with an EFV-based regimen from a healthcare payer perspective. We used a lifetime horizon with a 1-month cycle length and a 3% annual discount rate. The primary outcomes were a lifetime cost in US dollars ($), quality-adjusted life-months (QALMs) that converted to QALYs using the formula QALY = QALM/12, and incremental cost-effectiveness ratio (ICER). Deterministic sensitivity analysis was conducted to account for parameter uncertainty. RESULTS: Compared with the EFV-based regimen, the DTG-based regimen was associated with an expected lifetime cost of $12,709 (vs. $12,701) and expected QALYs of 15.3 (vs. 14.7 QALYs) per patient, resulting in an ICER value of $13.33 per QALY. From an alternative analysis with a 5-year time horizon, DTG-based ART was found to be dominant, with expected gains of 0.17 QALYs at a lower cost of $1 per patient. The deterministic sensitivity analysis depicted that the maximum increase in ICER value was $72 per QALY, and all ICER values were below the estimated threshold value. CONCLUSIONS: The DTG-based first-line regimen appears to be cost effective compared with the EFV-based regimen for the treatment of HIV/AIDS patients in an Ethiopian setting.

Health-related quality of life of patients with HIV/AIDS at a tertiary care teaching hospital in Ethiopia.

BACKGROUND: Patients' health-related quality of life (HRQoL) and health state utility values are critical inputs in the clinical and economic evaluation of treatments for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). However, information on health state utility values is lacking in the context of Ethiopia. Here, we aimed to assess HRQoL and determine health state utility values and factors that influence the values among HIV/AIDS patients in Ethiopia. METHODS: A cross-sectional study was conducted among 511 HIV/AIDS patients at Tikur Anbessa Specialized Hospital in Ethiopia. Patients aged 18 years or older were eligible for the interview and those who were mentally unstable and with hearing impairment were excluded from the study. We performed face-to-face interviews using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) in combination with EuroQol-Visual Analog Scales (EQ-VAS). Level-specific disutility coefficients obtained from the general population were used for computing utility values. Patients' health profiles were described using percentages and different statistical analysis were conducted to determine factors associated with the EQ-5D index and EQ-VAS scores. RESULTS: A total of 511 patients participated in the study. A higher proportion of patients reported slight or more severe problems on the anxiety/depression (55.2%) and pain/discomfort (51.3%) dimensions. The overall median utility value of HIV/AIDS patients was 0.94 (IQR = 0.87, 1) from the EQ-5D index and 80% (IQR = 70%, 90%) from the EQ-VAS scores. Demographic characteristics including age, occupational status, and household monthly income significantly affected patient's utility values. Moreover, statistically significant (p < 0.001) differences were seen between the EQ-5D index values of patients with different CD4 count intervals. Furthermore, number of medicines that the patients were taking at the time of the study and comorbidities were significantly associated with the EQ-5D utility index and EQ-VAS score, p < 0.001. CONCLUSIONS: The anxiety/depression and pain/ discomfort dimensions were identified to have critical influence in reducing the HRQoL of adult HIV/AIDS patients in the context of Ethiopia. The study is also the first to use the EQ-5D-5L tool to identify health state utility values for Ethiopian adult HIV/AIDS patients. Future economic evaluations of HIV/AIDS interventions are encouraged to employ the identified utility values.

The characteristics of drug information inquiries in an Ethiopian university hospital: A two-year observational study.

The types of drug-related information request from patients and health professionals, the extent of inquiry and capability of existing drug information centers are seldom studied in Ethiopia. This study aimed to identify the types and potential areas of drug information inquiry at the Drug Information Center (DIC) of Gondar University specialized Hospital (GUSH), Ethiopia. An observational study was employed. The drug information query was collected by distributing the drug information queries in different hospital units through two batches of graduating undergraduate pharmacy students. Descriptive statistics used to describe, characterize and classify drug related queries. Binary logistic regression test was employed to identify predictor variables to type of drug information query. A total of 781 drug related queries were collected and 697 were included in the final analysis. Near to half (45.3%) of queries comes from the pharmacists followed by general practitioners (11.3%) and nurses (10.2%). Slightly greater than half of the queries (51.9%) were focused on therapeutic information. 39.6% of drug related queries related to infectious disease case scenarios, followed by cardiovascular cases in 21.3% of queries. More than half of (53.9%) and nearly one in five (19.4%) of the queries took 5 to 30 minutes and 30 minutes to 1 hour of literature searching to answer, respectively. Pharmacists (with odds ratio of 2.474(95% CI (1.373-4.458)) and patients (with odds ratio of 4.121(1.403-12.105)) ask patient-specific questions in their drug related queries higher than other group of health professionals. Pharmacists are the primary drug information users and frequent drug related information inquirers at the DIC. Most of the queries targeted therapeutic indications, adverse drug events, infectious or cardiovascular disease related requests. This is imperative that drug information services can assist the growing role of pharmacists in addressing the patient specific drug related needs.

Assessment of Drug-Drug Interaction in Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia: A Retrospective Study.

INTRODUCTION: Adverse drug interaction is a major cause of morbidity and mortality. Its occurrence is influenced by a multitude of factors. The influences of drug-drug interactions (DDIs) can be minimized through creation of awareness to health care professionals. OBJECTIVE: The objective of this study was to assess DDIs in Ayder Comprehensive Specialized Hospital (ACSH). METHODOLOGY: A retrospective study design was employed on patient prescriptions available in the outpatient department of pharmacy and filled from September 2016 to February 2017 in ACSH. RESULT: From the 600 prescription records assessed, the average number of drugs on single prescription was 2.73. Regarding the interaction observed 34 (9.63%) prescriptions with major drug-drug interaction, 210 (59.5%) moderate, 87 (24.65%) minor, and 22 (6.22%) unknown were identified. Age category showed significant association to affect the occurrence of DDIs and polypharmacy had statistically significant association with DDIs in bivariate analysis which was lost in adjusted OR. CONCLUSION: From the current study it can be concluded that nearly half of the prescription ordered in ACSH contained DDIs and from the prescription with interacting medications majority of them had moderate DDIs.

Assessment of counseling practice in medicine retail outlets in Mekelle City, Northern Ethiopia.

INTRODUCTION: Patient counseling can ideally be providing medication information orally or in written form to patients or their attendants, and it helps to form a concordant approach on encouraging patient involvement in the pharmaceutical care process and to explore patient's knowledge and understanding. Lack of adequate knowledge on drugs and up-to-date drug information are the major factor that hinders counseling services. This study assessed counseling practice of pharmacy professionals in Mekelle City. METHODS: A facility-based cross-sectional study was conducted. Professionals who volunteered to participate were involved. Self-administered questionnaires were used as data collecting tool to grasp professionals' practice on patient counseling, and the data were analyzed by using SPSS version 23. One-way analysis of variance and post hoc statistical tests were done to check for association between sociodemographic and other variables of counseling practice. In the statistical analyses, p-value of 0.05 and 95% confidence interval were considered. RESULTS: The most frequent drug information given by the pharmacy professionals to clients were unit dose (65%), frequency of administration (79%), and duration of therapy (62%). Study participants claimed that lack of knowledge (37%), lack of updated drug information (49%), high patient load (62%), and absence of a private counseling room (51%) were the main factors that prohibit pharmacy professionals from counseling their patients. Those pharmacy professionals whose monthly income was <2000 Ethiopian Birr claimed lack of knowledge (p=0.007), limited access for updated drug information (p=0.009), and lack of experience (p=0.039) as factors for poor counseling practice. Results of the post hoc analysis showed significant difference among the participants with <5 and >10 years of experience in providing information on storage conditions and written materials with p-value of 0.025 and 0.016, respectively. CONCLUSION: This study proves that the level of satisfactory counseling is still very low compared to the expected practice. Lack of knowledge, lack of updated drug information, high patient load, absence of private counseling room, and underestimating the importance of counseling were identified as some of the factors that impede counseling services.

Community pharmacists' interest in and attitude to pharmacy practice research in Ethiopia: A cross-sectional study.

Pharmacy practice-research became an important component in the pharmacy practice. However, limited studies were conducted in sub-Saharan Africa to understand the pharmacists' interest and attitude towards pharmacy practice-research. We aimed to assess the community pharmacists' interest and attitude towards pharmacy practice-research in Ethiopia. A cross-sectional survey was conducted among community pharmacists in eight major cities in Ethiopia. A validated 25-item self-administered questionnaire covering interest and attitude related to pharmacy practice-research was distributed. Responses were analysed using descriptive and inferential statistics. A total of 389 community pharmacists responded to the survey (response rate- 88.4%). Most of community pharmacists showed a high level of interest and positive attitude in being involved in all aspects of pharmacy practice-research. The median summary score for interest and attitude were 38 (IQR 20-40) (range possible 10-50) and 30 (IQR 18-39), respectively. Sixty-seven percent of the respondents thought about being involved in research, felt research is important for their career (57.6%), confident to conduct the research (56.2%), and agreed that research is a part of pharmacy practice (48.5%). However, only forty-six percent agreed that they underwent research training. A multivariate analysis showed that females were more interested in pharmacy practice research than males [AOR: 1.50, 95% CI: 0.99-2.27; p<0.05]. Community pharmacists showed high interest towards several areas of research competencies and demonstrated positive attitude towards pharmacy practice-research. Our findings suggest that providing research training to community pharmacists may contribute in undertaking research activities and build the research capacity in Ethiopia.

Job satisfaction among community pharmacy professionals in Mekelle city, Northern Ethiopia.

INTRODUCTION: Job satisfaction is a multidimensional, enduring, important, and much-researched concept in the field of organizational behavior and has been identified as recognition in one's field of work, level of salary, opportunities for promotion, and achievement of personal goals. Job satisfaction directly affects the labor market behavior and economic efficiency by means of the impact on productivity and turnover of staff. The aim of this study was to assess the satisfaction level of pharmacy professionals in Mekelle city. METHODS: This institution-based cross-sectional study was conducted as a survey and only included voluntary participants. Those participants who did not volunteer to participate were excluded from the study. A structured questionnaire was used as a data collection tool; it was developed from different literature in the English language, and then the original tool was translated to the local language for the purpose of understanding. RESULTS: In Mekelle, ~100 pharmacy professionals work in private medicine retail outlets. From those, only 60 volunteered to participate in this study. Significant difference in job satisfaction and job stress were observed between those working full-time and part-time, with P-values of 0.031 and 0.021, respectively. CONCLUSION: From the findings of the current study, it can be concluded that around two-thirds of pharmacy professionals in Mekelle city were satisfied with their professional practice.

Influence of Medical Representatives on Prescribing Practices in Mekelle, Northern Ethiopia.

BACKGROUND: Drug promotion by medical representatives is one of the factors that influence physicians' prescribing decisions and choice of drugs. OBJECTIVE: To assess the influence of medical representatives on prescribing practice of physicians in health facilities, Mekelle, Northern Ethiopia. MATERIALS AND METHODS: Facility-based cross-sectional study was conducted enrolling all physicians working in public and private health facilities. All public and private health facilities were included and similarly, all physicians rendering services in these facilities were sampled in the study. The data were collected from February to March, 2015. Data were then entered into Epidata Version 3.1 and transferred to STATA version 12 for analysis. Both bivariable and multivariable logistic regressions were used to determine predictors. RESULTS: Of the ninety physicians approached in this study, 40 (48.2%) of the physicians believed that their prescribing decisions were influenced by visits of medical representatives (MRs). The odds of physicians who received gifts from MRs being influenced to prescribe their respective products was six times higher than those who reported not accepting any gifts [AOR = 6.56, 95% CI: 2.25, 19.13]. Stationery materials 23(35.4%) and drug samples 20(54.2%) were the commonest kinds of gifts given to physicians and face to face talking 45(54.2%) was the most frequent promotional methods. The finding of this study showed that around thirty-nine percent of MRs have had negative attitude toward competitors' product. Moreover, working in private health facility was also another predictor of influence of prescribing decision in the study area [AOR = 12.78, 95% CI: 1.31, 124.56]. CONCLUSION: Nearly half of the physicians working in Mekelle reported that their prescribing decisions were influenced by MRs in the last 12 months. Accepting gifts and working in private health facilities were predictors of influencing prescribing decisions. However, most MRs fails to provide adequate and accurate information regarding their products and they had a negative attitude towards the competitors' product(s).