Time to death and its predictors among adult patients on mechanical ventilation admitted to intensive care units in West Amhara comprehensive specialized hospitals, Ethiopia: a retrospective follow-up study.

INTRODUCTION: Mechanical ventilation is the most common intervention for patients with respiratory failure in the intensive care unit. There is limited data from African countries, including Ethiopia on time to death and its predictors among patients on mechanical ventilators. Therefore, this study aimed to assess time to death and its predictors among adult patients on mechanical ventilation admitted in comprehensive specialized hospitals in West Amhara, Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted from January 1, 2020, to December 31, 2022. A simple random sampling was used to select a total of 391 patients' charts. Data were collected using data the extraction tool, entered into Epi-data version 4.6.0, and exported to STATA version 14 for analysis. Kaplan-Meier failure curve and the log-rank test were fitted to explore the survival difference among groups. The Cox regression model was fitted, and variables with a p-value < 0.25 in the bivariable Cox regression were candidates for the multivariable analysis. In the multivariable Cox proportional hazard regression, an adjusted hazard ratio with 95% confidence intervals were reported to declare the strength of association between mortality and predictors when a p value is < 0.05. RESULTS: A total of 391 mechanically ventilated patients were followed for 4098 days at risk. The overall mortality of patients on mechanical ventilation admitted to the intensive care units was 62.2%, with a median time to death of 16 days (95% CI: 11, 22). Those patients who underwent tracheostomy procedure (AHR = 0.40, 95% CI: 0.20, 0.80), received cardio-pulmonary resuscitation (AHR = 8.78, 95% CI: 5.38, 14.35), being hypotensive (AHR = 2.96, 95% CI: 1.11, 7.87), and had a respiratory rate less than 12 (AHR = 2.74, 95% CI: 1.48, 5.07) were statistically significant predictors of time to death among mechanically ventilated patients. CONCLUSION: The mortality rate of patients on mechanical ventilation was found to be high and the time to death was short. Being cardiopulmonary resuscitated, hypotensive, and had lower respiratory rate were significant predictors of time to death, whereas patients who underwent tracheostomy was negatively associated with time to death. Tracheostomy is needed for patients who received longer mechanical ventilation, and healthcare providers should give a special attention for patients who are cardiopulmonary resuscitated, hypotensive, and have lower respiratory rate.

Determinants of Community-Acquired Pneumonia Among Adults Patients Attending Debre Berhan University Hakim Gizaw Hospital, Northeast Ethiopia: A Case-Control Study.

Background: Community-acquired pneumonia among adults remains an important cause of morbidity and mortality in both industrialized and developing countries, including Ethiopia. Moreover, despite the availability of the best clinical standards, morbidity and mortality from community-acquired pneumonia have not improved over the last few decades. Therefore, prompt assessment and correction of modifiable risk factors are crucial to reduce morbidity and mortality. However, there are limited data on the determinants of community-acquired pneumonia among adults in the current study area. Purpose: This study aimed to identify the determinants of community-acquired pneumonia among adult patients visiting Debre Berhan University Hospital, Ethiopia, May 2023. Methods: A hospital-based unmatched case-control study design was conducted to select 113 cases and 113 controls using a consecutive sampling technique. Using the SPSS version 25 software bi-variable and multivariable logistic regression analyses were performed to identify the determinants of community-acquired pneumonia. Adjusted odds ratios with 95% confidence intervals and p-values < 0.05 were used to assess the level of significance. Results: In this study, recent history of common cold [AOR: 4.35, 95% CI: (2.22, 8.51)], recent history of toothache [AOR: 2.51, 95% CI: (1.18, 5.33)], and not brushing teeth regularly [AOR, 2.79; 95% CI: (1.32, 5.88)] were significantly associated with community-acquired pneumonia. Conclusion: In this study, common cold, recent history of toothache, and lack of regular oral hygiene were significantly associated with community acquired pneumonia in adults. Therefore, health promotion of oral hygiene and the common cold is recommended to decrease the risk of pneumonia.

Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study.

Background: Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited. Objective: To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023. Methods: This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval). Results: In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events. Conclusion: The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.

Time to Virological Failure and Its Predictor Among HIV-Positive Clients with the Differentiated Service Delivery Model of HIV at Debre Berhan Comprehensive Specialized Hospital, Amhara Regional State, Ethiopia, 2021: A Retrospective Cohort Study.

Diversified antiretroviral therapy (ART) approach is needed in methods that were acceptable to communities and maintain good viral suppression outcomes to reach the UNAIDS targets to end the HIV/AIDS epidemic by 2030. Ethiopia is fully implementing differentiated service delivery (DSD) approaches, appointment spacing, and standard care. This study aimed to determine the time to HIV virological failure and its predictors among patients with a DSD model. An institution-based retrospective cohort study was conducted with data collection dates ranging from May 1, 2021, to May 30, 2021. All adult HIV-positive patients (n = 2,148) between January 2018 and January 2021 were a source population. Data were extracted using a standard checklist by trained data collectors and entered into EpiData, exported to SPSS version 20 for data management, and then exported to R Studio version 1.4 for analysis. Kaplan-Meier survival curves, the log-rank test, and Cox proportional hazard regression models were employed. The incidence of virological failure was 86 per 10,000 person-months. The independent predictors for the hazard of virological failure were being on standard care [adjusted hazard ratios (AHR) = 1.91; 95% confidence interval (CI) 1.07-3.40], primarily educated (AHR = 3.46; 95% CI 1.02-11.72), having no education (AHR = 3.45; 95% CI 1.01-11.85), and ambulatory status at baseline (AHR = 1.81; 95% CI 1.06-3.09). Patients who had a viral load with a detectable range from 50 to 999 at engagement (AHR = 2.65; 95% CI 1.33-5.27) and a 1-month increase in ART for HIV patients (AHR = 1.045; 95% CI 1.01-1.09). The incidence of virological failure was 86 per 10,000 person-months, whereas the incidences were 52 per 10,000 person-months and 71 per 10,000 person-months on appointment spacing model and standard care, respectively, with independent predictors: patient category, educational status, baseline functional status, viral load at engagement, and duration of ART.

Effect of menstrual irregularity on academic performance of undergraduate students of Debre Berhan University: A comparative cross sectional study.

BACKGROUND: Menstrual period is a critical time in the life of females. For the first few years after menarche, irregular cycle is common due to premature hypothalamic-pituitary ovarian (HPO) axis physiologically. If persistent, it becomes a major problem in student's life. But few studies conducted on effect of menstrual cycle irregularity on academic performance among university students were descriptive. However assessing the effect of menstrual irregularity on academic performance by using average grade point approach is critically important to magnify its effect. OBJECTIVE: To compare effects of menstrual irregularity on academic performance among undergraduate students of Debre Berhan University, Ethiopia 2020. METHODS: A comparative cross sectional study was conducted among 404 students in Debre Berhan University, Ethiopia, 2020. A standard tool of menstrual cycle regularity which is prepared by international federation of gynecologist and obstetrics (IFGO) was used to screen students who have menstrual irregularity. Independent sample t- test was done to compare the mean difference of academic performance between the two groups of students. RESULTS: The age of study participants ranges between 18 and 26 years with a mean age of 20.69 ± 1.43 years. The mean age at menarche was 14.9 ± 1.67 ranging from 9 to 18 years. Students who had menstrual irregularity had mean average grade point (AGP) of (2.78 ± 0.57) and students who had regular menstruation had mean AGP of (2.97 ± 0.53). Students who had menstrual irregularity had lower mean average grade point by a mean difference of 0.19 (95%CI: 0.09-0.30). CONCLUSION: This study found that students who had menstrual irregularity had significantly lower mean AGP as compared with students who had regular menstruation.

Midwife-led continuity of care increases women's satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: The provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women's satisfaction with care in a low-income/resource setting. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women's home at the end of the postpartum period. The study's outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest). FINDINGS: Compared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18-1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22-1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88-1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54-1.94)). CONCLUSION: MLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: In a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FINDINGS: Women in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101-1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227-0.683)). CONCLUSION: In this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.

Predictors of Death from Complicated Severe Acute Malnutrition in East Ethiopia: Survival Analysis.

BACKGROUND: Severe acute malnutrition (SAM) is still the leading cause of global child morbidity and mortality, with a greater burden in sub-Saharan Africa. A facility-based treatment of SAM demands critical care for improved outcomes and survival of children. However, there is a need to understand predictors for time to death among SAM children for effective interventions. OBJECTIVE: To assess the predictors of death from complicated severe acute malnutrition among admitted children treated in East Ethiopia. METHODS: A 31-month retrospective cohort study was conducted among a total of 665 under-five children admitted with complicated SAM in Dilchora hospital, eastern Ethiopia. The data was extracted from the patient register and medical charts using the kobo tool. The life table, survival, and hazard curves were plotted. Kaplan-Meier with Log rank tests was used to estimate and compare the mean survival time. The bivariable and multivariable Cox proportional hazards models were used to identify predictors of time to death. Crude and adjusted hazard ratios with 95% confidence intervals and p-values were reported. RESULTS: A total of 665 full medical charts were reviewed with a total of 60 (9%; 95% CI: 6.8-11.2%) deaths were observed, where most of the deaths occurred during the first two weeks of admission, while 74 (11%) and 449 (68%) were cured and recovered (stabilized and transferred to outpatient), respectively. Admitted children having good appetite (AHR=0.15; 95% CI: 0.64-0.33), pneumonia (AHR=2.46, 95% CI: 1.436, 4.22), diarrhea (AHR=2.16, 95% CI: 1.16, 4.06), tuberculosis (AHR=2.86, 95% CI: 1.08, 7.63) and having a nasogastric tube inserted (AHR=2.33, 95% CI: 1.15, 4.72) were significant predictors of time to death among SAM children. CONCLUSION: There is unacceptably high under-five mortality due to SAM, which is predicted by co-morbidities (pneumonia, diarrhea, and tuberculosis), with medical complications and nasogastric tubes.

Health care providers' perceptions and experiences related to Midwife-led continuity of care-A qualitative study.

BACKGROUND: Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. OBJECTIVE: The aim of this study was to explore health care providers' perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia. METHODS: A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. FINDING: The main theme extracted was "Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload". The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. CONCLUSION: In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model.

Determinants of Selected Cardiovascular Diseases among Adult Patients at Cardiac Clinic of Debre Berhan Referral Hospital, Ethiopia: Unmatched Case-Control Study.

BACKGROUND: Africans are experiencing a rapid epidemiological transition characterized by urbanization and lifestyle changes, which are thought to contribute to increased incidence and prevalence of cardiovascular diseases (CVDs) in many African countries, including Ethiopia. Despite this, however, there is scarcity of evidence on cardiovascular disease risk factors among adults in the current research setting. This study thus aimed at assessing determinants of selected cardiovascular diseases among adult patients at Debre Berhan Referral Hospital (DBRH). Methodology. An unmatched case-control study was conducted on 143 newly diagnosed patients with CVDs and 286 controls at the cardiac clinic of DBRH from June to September 2017. Primary data were collected using the WHO-STEPS wise structured questionnaires. Multiple logistic regression analysis was used to identify potential risk factors for cardiovascular diseases at p values < 0.05. RESULT: The mean age of study participants is estimated as 45.5 ± 13.8 and ranges from 25 to 64 years. Sixty-one (42.7%) of cases and 147 (51.4%) of controls are males. Half of the cases (49.9%) had ischemic heart diseases (IHD), and 44.1% of cases had hypertensive heart disease (HHD), whereas the rest had chronic valvular heart disease (CRVHD) (4.2%) and peripheral and vascular disease (2.1%). This study identified older age as a risk factor for CVD: age group 35-44 years (adjusted odds ratio (AOR) = 2.20; 95% CI: 1.05-4.62), 45-54 years (AOR = 4.23; 95% CI: 2.19-8.16), and 55-64 years (AOR = 5.98; 95% CI: 3.26-10.98). Other risk factors were smoking history (AOR = 9.52; 95% CI: 2.12-42.8), low level of physical activity (AOR = 2.19; 95% CI: 1.10-5.02), and higher waist circumference (AOR = 2.75; 95% CI: 1.16-6.56). CONCLUSION: This study has demonstrated that the most frequent risk factors for CVD were older age, cigarette smoking, physical inactivity, and abdominal obesity. Therefore, behavior change communication focusing on lifestyle modification including regular physical activities, smoking cessation, and a balanced diet should be strengthened.

Self-reported physical activity status among adolescents in Debre Birhan town, Ethiopia: Cross-sectional study.

BACKGROUND: Regular physical activity reduces the risk of ischaemic heart disease, stroke, diabetes, and breast and colon cancer. But, adolescents are insufficiently physically active. Therefore, this study was aimed to assess self- reported physical activity status and associated factors among adolescents in Debre Birhan town, Ethiopia. METHODS: School based cross-sectional study was conducted from April 20 to May 10/2019 in Debre Berhan town Secondary schools. Multi-stage sampling technique was used to select 580 study participants from three secondary schools. Physical activity was assessed using questions adopted from recreation, sport, and leisure-time physical activity assessment section of international physical activity questionnaire (IPAQ). Adolescents who have done moderate to vigorous exercise for 60 minutes per day for at least three days in the last seven days were categorized as physically active. Descriptive statistics, bivariable and multivariable logistic regression analysis was done. Probability value less than 0.05 was used as a cut of point to determined statistically significant association. RESULT: A total of 580 students participated in this study. Less than 1 in 5 (17.2%, 95% confidence interval (CI) = 14.13%-20.27%) students were physically active. Male student (Adjusted odds ratio (AOR): 2.63, 95%CI = 1.5-4.59), age less than or equal to 16 (AOR: 2.04, 95% CI = 1.12-3.71) and access to sports center (gymnasium) (AOR: 2.09, 95% CI = 1.12-3.89 were positively associated with physical activity. CONCLUSION: Physical activity status was very low. Therefore, the local, regional and national administrators in collaboration with sport and health offices administrators should make facilities accessible.

Magnitude of sedentary behavior and associated factors among secondary school adolescents in Debre Berhan town, Ethiopia.

BACKGROUND: Sedentary life style is becoming increasingly common in this industrial age due to changes on the way people manufacture, transport and communicate. Sedentary lifestyle is associated with chronic diseases (diabetes, cardiovascular disease, and cancer), depression, obesity and premature mortality. The objective of this study was to assess the magnitude and associated factors of sedentary behavior. METHODS: School based cross sectional study was conducted among 580 students from April 20 to May 10, 2019 in secondary schools in Debre Berhan City Administration. Sedentary behavior was measured using time spent on four activities (watching TV/Video, listening to music, surfing internet and playing games). Adolescents are considered sedentary if they spend two or more hours in one or all listed activities per day. Data was entered to Epidata version 4.2.2.1 and exported to SPSS version 20 for analysis. RESULT: A total of 580 (44.3% male and 55.7% female) students participated in this study. The magnitude of sedentary behavior (≥2 h per day) was 65.5% (95% CI = 61.32% - 69.08). Family monthly income greater than 8000 birr (AOR: 6.42, 95%CI = 2.18-18.78), maternal education (AOR: 5.12, 95%CI = 1.09-23.83), access to TV (AOR: 4.87, 95%CI = 1.99-11.87), access to mobile internet (AOR: 2.37, 95% CI = 1.14-4.93) and utilization of social media (AOR: 2.98, 95%CI = 1.43-6.17) were positively associated with adolescent sedentary behavior. CONCLUSION: The prevalence of sedentary behavior was high among adolescents of Debre Berhan town. Therefore, schools in the town should work towards creating awareness on the wise use of screen based entertainments.

Developing models for the prediction of hospital healthcare waste generation rate.

An increase in the number of health institutions, along with frequent use of disposable medical products, has contributed to the increase of healthcare waste generation rate. For proper handling of healthcare waste, it is crucial to predict the amount of waste generation beforehand. Predictive models can help to optimise healthcare waste management systems, set guidelines and evaluate the prevailing strategies for healthcare waste handling and disposal. However, there is no mathematical model developed for Ethiopian hospitals to predict healthcare waste generation rate. Therefore, the objective of this research was to develop models for the prediction of a healthcare waste generation rate. A longitudinal study design was used to generate long-term data on solid healthcare waste composition, generation rate and develop predictive models. The results revealed that the healthcare waste generation rate has a strong linear correlation with the number of inpatients (R(2) = 0.965), and a weak one with the number of outpatients (R(2) = 0.424). Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching and private). In these models, the number of inpatients and outpatients were revealed to be significant factors on the quantity of waste generated. The influence of the number of inpatients and outpatients treated varies at different hospitals. Therefore, different models were developed based on the types of hospitals.

Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia.

In many developing countries, the inadequacy of data regarding the quantity and composition of healthcare waste is one of the major reasons for improper healthcare waste management. We investigated the generation rate and composition of healthcare wastes in six public and three private hospitals. We conducted healthcare waste composition and characterization measurements for seven consecutive days in the selected hospitals following the protocol described by the World Health Organization (WHO). The results revealed that the total generation rate of healthcare wastes of hospitals ranged from 0.25 to 2.77 kg/bed/day with a median value of 1.67 kg/bed/day for inpatients to 0.21-0.65 in kg/patient/day with a median value of 0.31 kg/patient/day for outpatients. The waste generation rate in private hospitals (median 3.9 kg/bed/day) was significantly greater (Kruskal-Wallis test, P < 0.05) than in government hospitals (median 1.5 kg/bed/day). The median values of percent hazardous waste estimated for private and government hospitals were 63.4% and 52.2%, respectively. These figures are about three times greater than the threshold values recommended by the WHO. This situation might be attributed to the improper practice of healthcare waste segregation by health professionals and auxiliary health workers due to inadequate risk perception and lack of enforced public health regulations. The study revealed that the generation rate and proportion of hazardous waste significantly varies between public and private hospitals and number of patients treated per day.