Opportunities, associations, and impact of early intravenous to oral antimicrobial switch for hospitalized patients in Ethiopia.

Objective: Short intravenous antimicrobial therapy for 2-3 days followed by its per oral comparable antimicrobial course is a crucial part of the antimicrobial stewardship program. However, nothing is known about this practice in Ethiopian hospitals. Therefore, this study assessed the proportion, associations, and outcomes of early intravenous to per oral antimicrobial switch for patients who were admitted to the three wards of Ambo University Referral Hospital. Method: A hospital-based prospective cohort pilot study was conducted. During the 3-month period, 117 patients met initial inclusion criteria and were followed until Day 3 of intravenous antimicrobial. Of these, 92 (78.6%) subsequently met criteria for early intravenous to per oral switch and are the cohort investigated in this study. Written informed consent was sought from participants and/or parents or guardian for ages 15-17 years. Logistic regression models and independent t-tests were done with a significance of p ⩽ 0.05. Results: Out of 92 study participants, early intravenous to per oral antimicrobial switch was done only for 36 (39.1%). The only independent predictors for lack of early intravenous to per oral antimicrobials switch were poly-pharmacy (adjusted odds ratio = 3.4 at 95% confidence interval, 1.036-11.16; p = 0.044). There was a significant difference in terms of mean length of hospital stay (8.80 ± 3.57 versus 3.17 ± 0.74; p < 0.0001), in-hospital complication rate (95% versus 5%; p < 0.0001), and the mean cost of healthcare in Ethiopian Birrs (652.29 ± 403.29 versus 126.67 ± 29.47; p < 0.0001) between the comparator/early intravenous to per oral not switched and early switched group, respectively. Conclusion: The proportion of early intravenous to per oral antimicrobial switch was unsatisfactory. There was a significant difference between the intervention and comparator groups in terms of length of hospital stay, in-hospital complications, and extra cost. Therefore, implementation of interventions that improve the practice of early intravenous to per oral switch is needed urgently.

Prevalence of Internet Addiction and its Correlates Among Regular Undergraduate Medicine and Health Science Students at Ambo University. Cross-Sectional Study.

INTRODUCTION: Internet addiction (IA) is causing academic failure, decreased concentration ability, and a negative affective state. In Ethiopia, studies conducted on IA were limited; therefore, this study aimed to assess its prevalence and risk factors among medicine and health science (MHS) students of Ambo University. MATERIALS AND METHODS: This study was a cross-sectional study and included MHS students of Ambo University from July 15 to August 15, 2021. Data were collected using a self-administered questionnaire after receiving informed consent from study participants. The results were analyzed using the statistical software for social sciences version 24. Bivariate and multivariate logistic regressions were performed to explore the relationship between IA and dependent variables. RESULTS: Of the 253 participants who participated in the study, 201 (79%) were found to have an IA. Having one's own computer, Internet access at home and an email account were 2 times more risky to develop IA compared to their counterparts with AOR = 2.615 (95% CI = 1.118-5.956) with a P value of .022, AOR = 2.154 (95% CI = 1.054-4.405) with a P value of .35 and (=2.154 (95% CI = 1.054-4.405 with a P value of .035 respectively. Additionally, those who use the Internet for news were 2.5 times more likely to develop IA compared to those who do not (AOR = 2.551 (95% CI = 1.225-5.349) with a P-value of .013). The use of the Internet for scientific research and education reduces IA by 0.7 times (AOR = 0.323 (95% CI = 0.120-0.868) with a P value of .025). CONCLUSIONS: The prevalence of IA was found to be high in this study. Therefore, strategies are needed to minimize the prevalence of this problem.

Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study.

BACKGROUND: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. OBJECTIVE: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). METHOD: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. RESULTS: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [P = .03]. CONCLUSION: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

Feeding practice, energy, and nutrient intake adequacy among children aged 6-23 months in Southern Ethiopia: a community based cross-sectional study.

After 6 months, children require increased food and nutrient intake from complementary food for their growth and development. However, quantitative data on macro and micronutrient intakes from complementary food is limited. Thus, this study is designed to identify the adequacy of energy and micronutrient intake from complementary foods among children aged 6-23 months and to characterize current feeding practice in Southern Ethiopia. A community-based cross-sectional study was conducted from February to March 2016. Simple random sampling was used to recruit 190 mothers/primary caregivers of children aged 6-23 months. A repeated interactive multiple-pass 24-hr recall survey was used to assess' food and nutrient intake of children. Complementary food was low in animal sources, fruits, and vegetables. Most of the children (94.7%) consume grain, roots, and tubers. Vitamin A-rich fruits and vegetables are consumed by 71 (37.8%) children. Very few (1.6%) children consume iron-fortified food. Median protein intake exceeds the estimated requirement from complementary food. Except for vitamin B2 and B6, intake of energy and micronutrient were below world health organization (WHO) recommendations among children aged 9-23 months. In conclusion, infant and young child feeding practices in Butajira district did not conform to recommendations. Intake of energy and micronutrient from complementary food among children aged 6-23 months in Butajira district was inadequate. Consumption of a diverse diet by including animal source food (ASF) such as poultry, organ meat, chicken liver, beef, fruits, and vegetables is needed to fill the nutrient intake gap among the study participant.

Self-Reported Morbidity and Health-Seeking Behavior and its Predictors Among a Geriatric Population in Western Ethiopia: Community-Based Cross-Sectional Study.

BACKGROUND: Planning for health care services provision depends on the morbidity profile, health-seeking behavior (HSB), and its predictors. Thus, this study aimed to identify the level of self-reported morbidity, HSB and its predictors. PATIENTS AND METHODS: A community-based cross-sectional study was conducted among the geriatric (≥60 years) population in West Shoa Zone. A multi-stage systematic sampling technique was employed to select the study participants. After testing for collinearity, variables with p-value <0.25 on binary logistic regression were entered into backward multivariate logistic regression analysis with statistical significance at p-value <0.05. RESULTS: With a response rate of 98%, 779 study participants were recruited. The median (IQR) age of the respondents was 70 (70-78) years. Five hundred eighty-four (3/4) of the study participants reported that they experienced morbidity at least once in the year before interview. Of 584 study participants, 53.9% had poor HSB. Living in village (p-value = 0.034), being housewife (p-value = 0.048), wealth index [being rich (p-value = 0.033), being in moderate economic status (p-value= 0.001), and being poor (p-value= 0.049) relative to richest], being head of polygamous household (p-value= 0.019), non-smoker (P-value = 0.012), not having community-based health insurance coverage (CBHI) (p-value< 0.0001), having ≤3 times number of illness (p-value <0.0001), self-medication (p-value < 0.0001), not having hypertension (p-value=0.016), not having diabetes mellitus (DM) (p-value=0.012), and not having oro-dental problem (p-value= 0.043) were positively associated with poor HSB. Nevertheless, self-perceived mild severity of illness (p-value= <0.0001), good health status (p-value= 0.001), and not having musculoskeletal problem (p-value< 0.0001) were negatively associated with poor HSB. CONCLUSION: There was a high prevalence of self-reported morbidity and poor HSB. There should be an effort to improve the HSB and CBHI utilization of the geriatric population by all stakeholders. Moreover, modifiable predictors of HSB needs to be improved.

Prevalence, Predictors and Treatment Outcome of Acute Poisoning in Western Ethiopia.

BACKGROUND: Acute poisoning is a common reason for visiting the emergency department (ED) worldwide. However, little is known about this issue in the western part of Ethiopia. This study was carried out to determine the prevalence, predictors, and treatment outcome of acute poisoning at the ED of western Ethiopia. PATIENTS AND METHODS: A hospital record-based retrospective study design was conducted on all patients admitted to the ED of the two hospitals between 01 January 2018 to 17 March 2019. Socio-demographic, clinical presentation, medication history, poisoning characteristics, time to hospital arrival, treatment given, and outcome of treatment were collected. All collected data were analyzed using SPSS Version 20. Backward multiple logistic regression analysis at p-value ≤0.05 tested the predictor for treatment outcome. RESULTS: The prevalence of acute poisoning was 134/7883 (1.7%) per ED admissions. The mean ±SD age of the study participants was 23.90±10.606 with female to male ratio of 1:1.06. The most vulnerable patients to poisoning were individuals in the age range of 18 to 29 years 68/134 (50.7%) for both genders. Moreover, the most common poisoning agent was organophosphate 72/134 (53.7%). Besides, intentional poisoning was the most common 103/134 (76.9%) manner of poisoning with family disharmony 37/103 (35.9%) as the common reason. The case fatality rate of acute poisoning in the two hospitals was 2/134 (1.5%). The mean ±SD length of hospital stay was 1.86 ±0.943. The independent predictors of poor treatment outcome of acute poisoning were age ≥35 years [p-value= 0.049], female gender [p-value= 0.027], and hospital stay of >48 hours [p-value= 0.035]. CONCLUSION: The prevalence of acute poisoning in western Ethiopia is higher than the ever-reported data in Ethiopia. Thus, stakeholders should have to pay more attention to prevention and control strategies and appropriate handling of agrochemical substances to minimize their negative effects on this productive age group.

The Association Between Incorrect Use of Antibiotic Prophylaxis and in-Hospital Surgical Site Infections - A Prospective Observational Study.

BACKGROUND: Surgical site infection (SSI) is the most prevalent in developing countries where 61-90% of cases develop in-hospital. The study aimed to assess the correctness of antibiotic prophylaxis (AP) use, the incidence of in-hospital SSI, and its determinants. PATIENTS AND METHODS: A 3-month hospital-based prospective observational study design was used on general surgery patients. The criteria for identification of SSI were performed based on the Center for Disease Control and Prevention's (CDC's) definition of SSI. The correctness of AP was performed based on the American Society of Health System Pharmacist 2013 guideline (ASHP). Multiple stepwise backward logistic regression analysis was used at p-value <0.05 to predict SSI. RESULTS: Of 269 adult patients, the type of admission was almost equal between emergency and elective surgery. The mean (± SD) age of the study participants was 41.95±17.764. Only 19.7% of the study participants used AP correctly. The incidence rate of in-hospital SSI was 16.7% (45/269), which corresponds to 45/4736 or 9.5/1000 person-days. Independent predictors for SSI were American Society of Anesthesiology (ASA) class III-IV (p-value <0.0001), patients with age-adjusted Charlson co-morbidity index (CCI) of ≥1 score (p value=0.008), and incorrect use of AP (p-value =0.025). CONCLUSION: Incorrect antibiotic prophylaxis use contributed to an increased risk of SSI, which needs urgent attention in the present study area.

Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study.

BACKGROUND: Data regarding prolonged length of hospital stay (PLOS) and in-hospital mortality are paramount to evaluate efficiency and quality of surgical care as well as for rational resource utilization, allocation, and administration. Thus, PLOS and in-hospital mortality have been used as a surrogate indicator of satisfactory treatment outcome and efficient utilization of resources for a given health institution. However, there was a scarcity of data regarding these issues in Ethiopia. Therefore, this study aimed to assess treatment outcome, length of hospital stay, in-hospital mortality, and their determinants. METHODS: Health facility-based prospective observational study was used for three consecutive months among adult patients hospitalized for the surgical case. Socio-demographic, clinical history, medication history, in-hospital complications, and overall treatment outcomes were collected from the medical charts' of the patients, using a checklist from the day of admission to discharge. PLOS is defined as hospital stay > 75th percentile (≥33 days for the current study). To identify predictor variables for both PLOS and in-hospital mortality, multivariate logistic regression was performed at p-value < 0.05 using SPSS version 20. Written informed consent was sought and secured. RESULTS: Of 269 study participants, 91.8% were improved and discharged. PLOS was recorded in 25.3%; at least 33 days of hospital stay. Overall in-hospital mortality was 4.8%; which is equal to an incidence rate of 0.00193 per person-days, 5.2% in-hospital sepsis, and 2.6% of Hospital-acquired pneumonia (HAP), during their hospital stay. After adjusting for other factors; female gender (p = 0.003), emergency admission (p = 0.015), presence of Poly-pharmacy (p = 0.017), and presence of sepsis (p = 0.006) were found to be independent predictors for in-hospital mortality. On top of this, female gender (p = 0.026), patients who was paid by government (p = 0.007), burn-related surgery (p = 0.049), presence of cancer (p = 0.027), > 2 antibiotic exposure (p < 0.0001), and waiting for surgery for > 7 days (p < 0.0001) were independent predictors for PLOS. CONCLUSION: In-hospital mortality rate was almost comparable to reports from developing countries, though it was higher than the developed countries. However, the length of hospital stay was extremely higher than that of reports from other parts of the world. Besides, different socio-demographic, health facility's and patients' clinical conditions (baseline and in-hospital complications) were identified as independent predictors for both in-hospital mortality and PLOS. Therefore, the clinician and stakeholders have to emphasize to avoid the modifiable factors to reduce in-hospital mortality and PLOS in the study area; to improve the quality of surgical care.

Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study.

BACKGROUND: Drug therapy problems (DTPs) are of major concern in health care because of the associated increased cost of treatment, morbidity, and mortality. Thus, clinical practice should constitute the mainstream practice of clinical pharmacy in every ward. However, nothing is known about DTPs and the role of clinical pharmacist in the surgical ward of Ethiopia (the neglected ward). OBJECTIVE: To assess the prevalence of DTP among patients hospitalized at the surgical ward and the role of clinical pharmacists in their identification and resolution. METHODS: Hospital-based prospective observational and interventional study design was used with daily patients' chart review using a semi-structured questionnaire among hospitalized adult patients at the surgical ward. After identification of DTP, verbal communication was used as a means of intervention with the treating physician. Acceptance of clinical pharmacist's intervention was considered only if a change was made to the patients' medication order. To identify determinants of DTPs, multiple stepwise forward logistic regression analysis was done by SPSS version 20.0. Statistical significance was considered at p-value < 0.05. Written informed consent was sought and the data were secured. RESULTS: The response rate was 97.1% (300) for the final analysis. The mean (±SD = standard deviation) age of the participants was 42.62 ±18.29 with male (67%) predominance. DTP was identified in 76% of study participants. A total of 449 DTPs were identified, which equates with an average of 1.97 per patient. Dose too low 124/449 (27.6%) and dose too high 81/449 (18.0%) were found to be the most common types of DTPs. The intervention rate was 86.0% (196/228 per patients) and 86.2% (387/449 DTPs), with the acceptance rate of 85.2% (167/196 per patients) and 78% (302/387 per DTP) which mean (67.3%) 302/449 of the problems were fully resolved by the clinical pharmacist. Poly-pharmacy [AOR, 7.23; 95% CI, 2.29-22.13: P-value < 0.001] and hospital stay > 20 days [AOR, 5.42; 95% CI, 2.74-10.70; p < 0.001] were the only independent predictors for DTPs. CONCLUSION AND RECOMMENDATION: This study identified a high prevalence of DTP which was independently predicted by the presence of poly-pharmacy and >20 days of hospital stay. The rate of intervention provided and acceptance from the physician was high, which is one indicator that the role of clinical pharmacists in the identification and resolution of DTP was paramount in the surgery ward and should be implemented as a must not as optional.

Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study.

BACKGROUND: The breast cancer chemotherapy leads to diverse aspects of noxious or unintended adverse drug reactions (ADRs) that cause the relative dose intensity (RDI) reduced to below optimal (i.e., if the percentage of actual dose received per unit time divided by planned dose per unit time is less than 85%). Hence, this prospective observational study was conducted to evaluate chemotherapy-induced ADRs and their impact on relative dose intensity among women with breast cancer in Ethiopia. METHODS: The study was conducted with a cohort of 146 patients from January 1 to September 30, 2017, Gregorian Calendar (GC) at the only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. The ADRs of the chemotherapy were collected using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4.03). The patients were personally interviewed for subjective toxicities, and laboratory results and supportive measures were recorded at each cycle. SPSS version 22 was used for analysis. RESULTS: Grade 3 neutropenia (23 (15.8%)) was the most frequently reported ADR among grade 3 hematological toxicity on cycle 4. However, overall grade fatigue (136 (93.2%)) and grade 3 nausea (31 (21.2%)) were the most frequently reported nonhematological toxicities on cycle 1. The majority of ADRs were reported during the first four cycles except for peripheral neuropathy. Oral antibiotics and G-CSF use (17 (11.6%)) and treatment delay (31 (21.2%)) were frequently reported on cycle 3. Overall, 61 (41.8%) and 42 (28.8%) of study participants experienced dose delay and used G-CSF, respectively, at least once during their enrollment. Of the 933 interventions observed, 95 (10%) cycles were delayed due to toxicities in which neutropenia attributed to the delay of 89 cycles. Forty-four (30.1%) of the patients received overall RDI < 85%. Pretreatment hematological counts were significant predictors (P < 0.05) for the incidence of first cycle hematological toxicities such as neutropenia, anemia, and leukopenia and nonhematological toxicities like vomiting. CONCLUSION: Ethiopian women with breast cancer on anthracycline-based AC and AC-T chemotherapy predominantly experienced grade 1 to 3 hematological and nonhematological ADRs, particularly during the first four cycles. Neutropenia was the only toxicity that led to RDI < 85%. Thus, enhancing the utilization of G-CSF and other supportive measures will improve RDI to above 85%.

Health-related quality of life and its determinants among ambulatory patients with epilepsy at Ambo General Hospital, Ethiopia: Using WHOQOL-BREF.

BACKGROUND: Health-related quality of life (HRQOL) is used as a measure of treatment outcomes, in addition to seizure control. Hence, the study was aimed to assess HRQOL and its determinants among adult patients with epilepsy (PWE). METHOD: A hospital-based cross-sectional study was conducted from April 20 to June 27/2019, through patient interviews and patient's chart review (medication and clinical information). Data were analyzed using SPSS version 20. The psychometric property was done using Cronbach's alpha test value of >0.7 as accepted internal consistency and Kaiser-Meyer-Olkin (KMO) measure of sample size adequacy value of ≥0.5 as acceptable construct validity, for Afaan Oromo version questionnaire. Multivariate linear logistic regression analysis was done to find predictors for the HRQOL score. RESULTS: Of 121 PWE included in the study, 24.4% had overall poor HRQOL with the overall mean ±SD score of 56.42±10.96. The predictors for low overall HRQOL score were: presence of co-morbidity (B = -5.620, SE = 1.531, p<0.0001, 95% C.I = -8.656 to -2.584), uncontrolled seizure for at least 2 years (B = -4.239, SE = 1.296, p = 0.001, 95% C.I = -6.809 to -1.670), divorced (B = -8.423, SE = 2.241, p<0.0001, 95%C.I = -12.867 to -3.978) relative to married, and no education (B = -8.715, SE = -8.15, SE = 2.604, p = 0.001, 95%C.I = -9.648 to -1.316) relative to who had level of education above tertiary. In addition, uncontrolled seizure (irrespective of time since seizure-free) (B = -10.083, SE = 2.104, p<0.0001, 95%C.I = -14.256 to -5.910), being widowed (B = -9.300, SE = 3.594, p = 0.011, 95%C.I = -16.429-2.170) relative to married and being illiterate/no education (B = -13.004, SE = 3.910, p = 0.001, 95%C.I = -20.760 to -5.248) relative to educational level of tertiary and above were found to be the strongest negative predictors of HRQOL of physical health. Moreover, uncontrolled seizure (irrespective of time since seizure-free) (B = -12.668, SE = 2.019, p<0.0001, 95%C.I = -16.671 to -8.664) and being divorced (B = -10.153, SE = 3.228, p = 0.002, 95%C.I = -16.556 to -3.751) compared to married were strong predictors for low HRQOL score of psychological health. Absence of Poly-pharmacy (B = 9.050, SE = 3.027, P = 0.003, 95%C.I = 3.047 to 15.054), being single (B = -9.551, SE = 2.095, p<0.0001, 95%C.I = -14.419 to -4.683), and divorced (B = -11.022, SE = 3.351, P = 0.001, 95%C.I = -17.668 to -4.376) relative to married were found to be strong predictors for HRQOL score of social health. Moreover, low HRQOL score of environmental health was predicted by rural residence (B = -5.795, SE = 2.101, p = 0.007, 95%C.I = -9.962 to -1.628), co-morbidity (B+ -4.230, SE = 2.125, p = 0.049, 95%C.I = -8.444 to -0.015) & uncontrolled seizure irrespective of time since seizure-free (B = -6.907, SE = 1.945, p = 0.001, 95%C.I = -10.765 to -3.049) and uncontrolled seizure of at least 2 years (B = -4.520, SE = 1.798, p = 0.014, 95%C.I = -8.088 to -0.953). CONCLUSIONS: The majority of the study participants had a good overall HRQOL. In general, a low level of HRQOL score was significantly associated with the marital status of single/widowed/divorced, low level of education, low level of monthly income, co-morbidity, uncontrolled seizure, and poly-pharmacy; irrespective of HRQOL domains. Therefore, it is required to improve HRQOL, by avoiding modifiable factors for PWE to achieve the optimum HRQOL.

Clinical Characteristics, Treatment Outcomes, and its Predictors Among Hospitalized Stroke Patients in Ambo University Referral Hospital, West Ethiopia: A Retrospective Hospital-Based Study.

BACKGROUND: Stroke is becoming a leading cause of death and adult disability in the developing world. OBJECTIVE: The objective of the study was to assess the clinical characteristics, treatment outcomes, and its predictors among stroke patients admitted to Ambo University Referral Hospital (AURH), West Ethiopia. METHODS: All 111 stroke patients hospitalized from April 2016 to May 2019 were included using a hospital-based retrospective study. Socio-demographic profile, past medication history, clinical presentation, drugs prescribed for comorbid condition and stroke treatment, and outcomes data were collected using data abstraction formats and results were summarized using both descriptive and inferential statistics. KEY FINDINGS: According to WHO clinical criteria, 89 (80.2%) were diagnosed with ischemic stroke, and 20 (18.0%) were diagnosed with hemorrhagic stroke. The majority of the patients 94 (84.7%) had at least one antecedent risk factor in which hypertension accounted for 44.1%. More than half, 69 (62.2%), of hospitalized stroke patients had good treatment outcomes while 42 (37.8%) had a poor outcome. The overall case-fatality rate was 18 (16.2%), 12 (13.5%) from ischemic stroke, and 6 (30.0%) from hemorrhagic stroke. Acetyl salicylic acid (ASA) with atorvastatin/simvastatin, 67 (73.5%) in ischemic stroke and 12 (60.0%) in hemorrhagic stroke, was the most frequent medications prescribed for stroke during admission while it was frequently prescribed for 48 (53.6%) of ischemic stroke and 10 (50.0%) of the hemorrhagic stroke on discharge. Overall, ceftriaxone + metronidazole 32 (28.8%) was frequently prescribed concomitant medications during admission. The major predictors identified for poor stroke outcomes were substance abuse (AOR=2.839, P=0.024) and have had not received any medication for stroke treatment during admission (AOR=12.503, P≤0.001). CONCLUSION: A significant number of the admitted stroke patients had poor treatment outcome in which the case-fatality rate was relatively high. Substance abuse and having not received medication for stroke were the significant predictors for poor treatment outcome. Hence, a well-established stroke unit setup at AURH is required for accurate diagnosis and management of stroke to overcome stroke-related mortality and/or poor treatment outcome.

Antimicrobial use-related problems and their costs in surgery ward of Jimma University Medical Center: Prospective observational study.

INTRODUCTION: Antibiotics are among the most commonly misused of all drugs, which results in antibiotic resistance and waste of resources and it has not been studied in Ethiopia. Therefore, this study was carried out to assess antibiotic use-related problems and their costs among patients hospitalized at the surgical ward of Jimma University Medical Center. METHODS: Hospital-based prospective observational study was used to assess the prevalence, cost, and determinants of antibiotic use-related problems; multiple stepwise backward logistic regression analysis was done for a P value of < 0.25 to look for predictors of antibiotic use-related problems. Written informed consent was obtained and confidentiality was secured. RESULTS: Among 300 participants, antibiotic use-related problems (ABURPs) were found in 69.3% of the study participants. The direct total cost attributed to these problems was approximated to a minimum of 2230.15 US$. Independent predictors for antibiotic use-related problems were: indication for antibiotic use like: use of antibiotic for prophylaxis; p < 0.0001, antibiotic use for both therapeutic & prophylaxis; p < 0.0001, CDC wound class I and II; p = 0.016 and; p = 0.002 respectively, overall poly-pharmacy and greater than 2 antibiotic exposure during hospital stay; p = 0.019and p = 0.006 respectively and hospital stay for ≥21 days; p = 0.007. CONCLUSION: The prevalence of antibiotic use-related problems was high and resulted in extra cost. Antibiotic use for prophylaxis, prophylaxis, and treatment, poly-pharmacy, greater than 2 antibiotic exposures during the hospital stay, CDC wound class I and II, and duration of hospital stay of ≥ 21 days was found to be independent predictors of antibiotic use-related problems.