Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis.

Objective: To compare mifepristone plus a misoprostol-combined regimen with misoprostol alone in the medical abortion of first trimester pregnancy. Methods: An internet-based search of available literature was performed using text words contained in titles and abstracts. PubMed/Medline, Cochrane CENTRAL, EMBASE, and Google scholar were used to locate English-based articles published until December 2021. Studies fulfilling the inclusion criteria were selected, appraised, and assessed for methodological quality. The included studies were pooled for meta-analysis, and the results were presented in risk ratio at a 95% confidence interval. Findings: Nine studies comprising 2,052 participants (1,035 intervention and 1,017 controls) were considered. Primary endpoints were complete expulsion, incomplete expulsion, missed abortion, and ongoing pregnancy. The intervention was found to more likely induce complete expulsion irrespective of gestational age (RR: 1.19; 95% CI: 1.14-1.25). The administration of misoprostol 800 mcg after 24 h of mifepristone pre-treatment in the intervention group more likely induced complete expulsion (RR: 1.23; 95% CI: 1.17-1.30) than after 48 h. The intervention group was also more likely to experience complete expulsion when misoprostol was used either vaginally (RR: 1.16; 95% CI: 1.09-1.17) or buccally (RR: 1.23; 95% CI: 1.16-1.30). The intervention was more effective in the subgroup with a negative foetal heartbeat at reducing incomplete abortion (RR: 0.45; 95% CI: 0.26-0.78) compared with the control group. The intervention more likely reduced both missed abortion (RR: 0.21; 95% CI: 0.08-0.91) and ongoing pregnancy (RR: 0.12; 95% CI: 0.05-0.26). Fever was less likely to be reported (RR: 0.78; 95% CI: 0.12-0.89), whereas the subjective experience of bleeding was more likely to be encountered (RR: 1.31; 95% CI: 1.13-1.53) by the intervention group. Conclusion: The review strengthened the theory that a combined mifepristone and misoprostol regimen can be an effective medical management for inducing abortions during first trimester pregnancy in all contexts. Specifically, there is a high-level certainty of evidence on complete expulsion during the early stage and its ability to reduce both missed and ongoing pregnancies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134213, identifier CRD42019134213.

Adherence to Antiretroviral Medications Among People Living With HIV in the Era of COVID-19 in Central Ethiopia and Perceived Impact of the Pandemic.

AIM: This study assessed the level of adherence to antiretroviral drugs and the associated factors among clients who have a follow-up at public health facilities in central Ethiopia. METHOD: A multi-site cross-sectional study was conducted from August 1-30, 2020 at seven public health institutions. A systematic random sampling method was used to recruit 385 participants. Data was collected using a structured interviewer-administered questionnaire. Analysis was done using descriptive statistics, and binary logistic regression model. The OR with its 95% C.I was employed to present analytic outputs. Statistical significance for the multivariable model was considered at p ≤ 0.05. RESULTS: Of the 371 participants, the majority were females (233, 62.8%), attended health centers (215, 58.0%), and were married (173, 46.6%). Eighty-nine (89, 24.0%) of the participants have at least one comorbidity. About 72 (19.0%) and 50 (13.5%) of the respondents stated that the COVID-19 has posed challenges on their follow-ups and availability of medications respectively. Nearly a half of the people living with HIV and comorbid T2DM or hypertension (29, 48.0%) reported that they had encountered an increase in the price of medications compared to the pre-COVID-19 times. About half of the respondents in the study setting have perfect adherence to antiretroviral therapy (ART) (200, 54.0%). Basic education (aOR = 3.02: 95% CI: 1.57-5.80), marriage (aOR = 2.27: 95% CI: 1.24-4.15), attendance to a health center (aOR = 0.59: 95% CI: 0.36-0.98) and sleep disturbance (aOR = 0.47: 95% CI: 0.26-0.84) showed a statistically significant association with adherence to ART. CONCLUSION: About half of the respondents in the study settings have perfect adherence to their ART medications. As multiple factors interplay in the success rate of adherence to ART, stakeholders should place and strengthen practices, such as active follow-up and tracing of cases, ensuring medication affordability (access and low pricing), and psycho-social support to patients.

Risk factors of early mortality among COVID-19 deceased patients in Addis Ababa COVID-19 care centers, Ethiopia.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 is a global health care problem with high mortality. Despite early mortality seeming alarming, data regarding factors that lead to increased early mortality of COVID 19 patients is not well-documented yet. The objective of this study was to identify the risk factors of early mortality in patients with confirmed COVID-19 infections. METHODOLOGY: A case-control study design was employed. With this, a total of 261 COVID-19 deceased recordings were reviewed. The cases of the study were recordings of patients deceased within three days of intensive care unit admission whereas, the rest 187 were recordings of patients who died after three days of admission. Data were collected using an extraction checklist, entered into Epi data version 4.4.2.2, and analyzed by SPSS version 25. After the description, binary logistic regression was run to conduct bivariate and multivariable analyses. Finally, statistical significance was declared at p-value <0.05, and an adjusted odds ratio with a 95% confidence interval was used to report the strength of association. RESULT: The analysis was performed on 261 (87 cases and 174 controls) recordings. About 62.5% of the participants were aged above 65 years and two-thirds were males. The presence of cardiovascular disease (AOR = 4.79, with 95%CI: 1.73, 13.27) and bronchial-asthma (AOR = 6.57; 95% CI: 1.39, 31.13) were found to have a statistically significant association with early mortality. The existence of complications from COVID-19 (AOR = 0.22; 95% CI: 0.07, 0.74) and previous history of COVID-19 infection (AOR = 0.17, 95% CI: 0.04, 0.69) were associated with decreased risk of early mortality. CONCLUSIONS: Having cardiovascular diseases and bronchial asthma was associated with an increased risk of early mortality. Conversely, the presence of intensive care unit complications and previous history of COVID-19 infection were associated with decreased risk of early mortality.

Health-Related Quality of Life of Patients with Type 2 Diabetes Mellitus and Hypertension in Addis Ababa, Ethiopia.

Background: The aim of this study was to assess the health-related quality of life of patients with T2DM and hypertension attending public health facilities in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from 1st through 30th August 2020 at the selected institutions. Health facilities were chosen purposively based on patient load. Participants were drawn after proportional to size allocation. A translated EQ-5D-3L, and EQ-VAS instrument was used to collect the data. Analysis was done using SPSS v.26.0. Both parametric and non-parametric models were applied in the analysis. Results: Of the 409 participants included, the majority were in the age group of 46-60 (36.0%), females (56.0%), from hospitals (54.8%), jobless (25.4%), and married (63.3%). Over two-thirds of the patients reported no problems with self-care, usual activity, and depression/anxiety. All dimensions showed an increasing proportion of moderate to severe problems in the age group beyond 45. Facility type, comorbid condition and age showed a statistically significant score difference for QoL. The overall prevalence of any problem was 59.0%. Education level, visit to a health center, and marriage showed lower odds of affected HRQoL whereas, lower monthly income and presence of comorbidities were opposite. Conclusion: HRQoL of patients in the study settings was suboptimal and below the general population. Attributes, such as education, facility type, marital status, income level, and comorbid status have a statistically significant association with HRQoL. Arrangement of a safe and quality health services is paramount, especially, during the COVID-19 pandemic.

Depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia.

Evidence suggests that quarantine might have a wide-ranging, substantial, and long-lasting negative psychological impact especially when the necessary preventive measures are not taken. This study assessed the prevalence and associated factors of depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia. A community-based cross-section study was conducted among individuals under quarantine from June 5 to July 5, 2020, in Addis Ababa, Ethiopia. The hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety. Binary logistic regression analysis (multivariate analysis) was used to identify the potential determinants of depression and anxiety. A total of 297 participants were included in the study which makes the response rate 90.8%. The prevalence of anxiety, depression, and co-morbid anxiety and depression were 21.5%, 70.7%, and 15.8% respectively. In our multivariable analyses, stressful life events (AOR 2.61, 95%CI (1.46, 4.67)), spent time on sleeping (AOR 1.97, 95% CI (1.08, 3.62)), and believing that COVID-19 could be prevented by wearing a glove (AOR 0.30, 95% CI (0.11, 0.81)) showed a statistically significant association with anxiety, whereas being married (AOR 2.67, 95% CI (1.37, 5.22)), had stressful life event in the last six months (AOR 1.44, 95% CI (1.44, 5.25)) and spending of time by sleeping during the quarantine (AOR 1.97, 95% CI (1.42, 6.19)) predicted depression. In conclusion, the current study result indicated that a considerable proportion of individuals who were under quarantine during the COVID-19 pandemic have experienced psychological disturbances, such as anxiety and depression. The results suggest that attention needs to be given to mitigate mental health problems in the quarantined population during the COVID-19 outbreak.

Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic.

OBJECTIVE: This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic. METHODS: A multi-site cross-sectional design was conducted from 1st through 30th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence. RESULTS: A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36-0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02-2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13-3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52-88.05) predicted high odds of poor adherence. CONCLUSION: Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.