A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study.

BACKGROUND: The widespread use and misuse of antimicrobials are the major driving factor for antimicrobial resistance (AMR) that threatens the health of human beings globally. Thus, monitoring antimicrobial consumption at national level is crucial to prevent and contain AMR. Nevertheless, there is no well-established system for recording and reporting of antimicrobial consumption in Ethiopia. Hence, the national antimicrobial consumption survey was conducted to generate evidence for decision-making on the appropriate use of antimicrobials in Ethiopia and tackle AMR. METHODS: All imported and locally manufactured antimicrobials from 2017 to 2019 were from the Ethiopian Food and Drug Authority and local manufacturers database, respectively. Data were collected and analyzed descriptively in accordance with the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) and defined daily doses (DDD) classification and methodology. RESULTS: The average DDD/1,000 inhabitants for all antimicrobials was 15.36. The DDD/1,000 inhabitants fell down sharply from 37.03 in 2017 to 4.30 in 2018, before slightly rising to 4.75 in 2019. The majority of the consumed antimicrobials were comprised of oral antimicrobials (98.6%), while parenteral antimicrobials made up 1.4%. Tetracyclines (35.81%), fluoroquinolones (20.19%), macrolides (13.92%), antiretrovirals (10.57%), and cephalosporins (9.63%) were the most frequently consumed classes of antimicrobials during the three years period. About 75.83% of the consumed antimicrobials fall under the WHO AWaRe classification and 67.87% of antimicrobial consumption was from the WHO Access class medications, with Watch and Reserve classes accounting for 32.13% and <1%, respectively. Similarly, about 86.90% of the antimicrobials fall under the Ethiopian AWaRe classification, with Access, Watch, and Reserve accounting for 87.73%, 12.26%, and <1%, respectively. CONCLUSION: Due to the peculiarities of our settings, our findings may have some similarities and differences with similar studies from other countries. Hence, we recommend for all concerned bodies to work collaboratively to improve monitoring of antimicrobial consumption at different levels of the Ethiopian healthcare tier system. Future work is necessary to establish a strong system of reporting of antimicrobial consumption patterns in Ethiopia.

The Protracted Civil and Armed Conflicts in Ethiopia Fueling the COVID-19-Related Health Crisis: Perspective on Building a Resilient Health System to Shocks.

Prior to the intensified civil and armed conflicts in Ethiopia, remarkable progress was made in the health sector, which has persuaded the Ministry of Health to give special focus on building a responsive and resilient health system in the second five-year health sector transformation plan (HSTP II 2021-2025). However, the years-long civil and armed conflicts have been fueling the COVID-19 crisis and have caused multi-sectoral infrastructure damage, human life loss, and economic crisis. In 2021 alone, the conflict causes more than five million internal displacements of persons (IDP) and thousands civilian deaths. Review of reported government data has shown that 3,508 health posts, 750 health centers, and 76 hospitals were partially or completely damaged in four regions. Looting of medical equipment and facilities for amenities was devastating. More than 19 million people were affected by the armed and civil conflicts between 2020 and 2021. Unless peace is ensured across the nation the sooner possible, it is foreseen that the devastation may further worsen, and recovery may be a far-fetched possibility. Therefore, in addition to restoration of the disrupted health services, it is the right time for the Ministry of Health to incorporate the humanitarian-development nexus as a joint strategy with the Disaster Prevention and Preparedness Commission (DPPC) to ensure a resilient health system for similar multifaceted conflict-related health crisis, disasters, and infectious outbreaks.

Multicentre point-prevalence survey of antibiotic use and healthcare-associated infections in Ethiopian hospitals.

OBJECTIVE: Effective antimicrobial containment strategies such as Antimicrobial Stewardship Programs (ASPs) require comprehensive data on antibiotics use which are scarce in Ethiopia. This study sought to assess antibiotics use and healthcare-associated infections (HCAIs) in Ethiopian public hospitals. DESIGN: We conducted a cross-sectional study using the WHO point-prevalence survey protocol for systemic antibiotics use and HCAIs for low/middle-income countries. SETTING: The study was conducted among 10 public hospitals in 2021. PARTICIPANTS: All patients admitted to adult and paediatric inpatient and emergency wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURE: The primary outcome measures were the prevalence of antibiotic use, HCAIs and the hospitals' readiness to implement ASP. RESULTS: Data were collected from 1820 patient records. None of the surveyed hospitals had functional ASP. The common indication for antibiotics was for HCAIs (40.3%). Pneumonia was the most common bacterial infection (28.6%) followed by clinical sepsis (17.8%). Most treatments were empiric (96.7%) and the overall prevalence of antibiotic use was 63.8% with antibiotics prescription per patient ratio of 1.77. Ceftriaxone was the most commonly prescribed antibiotic (30.4%) followed by metronidazole (15.4%). Age, having HIV infection, ward type, type of hospital, catheterisation and intubation history had significant association with antibiotic use. Patients who were treated in paediatric surgical wards were about four times more likely to be on antibiotics compared with patients treated at an adult emergency ward. Patients on urinary catheter (adjusted OR (AOR)=2.74, 95% CI: 2.04 to 3.68) and intubation device (AOR=2.62, 95% CI: 1.02 to 6.76) were more likely to be on antibiotics than their non-intubated/non-catheterised counterparts. Patients treated at secondary-level hospitals had 0.34 times lower odds of being on antibiotics compared with those in tertiary hospitals. CONCLUSIONS: Antibiotic use across the surveyed hospitals was common and most were empiric which has both practical and policy implications for strengthening ASP and promoting rational antibiotics use.

Drug-Induced Movement Disorders and Its Associated Factors Among Patients Attending Treatment at Public Hospitals in Eastern Ethiopia.

BACKGROUND: Antipsychotic medications have both beneficial and undesired effects at a dose used for treatment purposes. Among undesired effects caused by antipsychotics, movement disorders are prevalent. However, there is no study done to determine the prevalence of movement disorders that occurred due to antipsychotics and their determinants in eastern Ethiopia. OBJECTIVE: This study aimed to find out the prevalence of drug-induced movement disorders and its determinants among patients who had been on follow-up at public hospitals in eastern Ethiopia. METHODS: A cross-sectional study was conducted from May to June 2018 at HFSUH and Jugal hospital. Extrapyramidal symptom rating scale (ESRS) was used to identify patients with drug-induced movement disorders in a sample of 411 outpatients. A systematic random sampling method was used to select the sample. Logistic regression was done to identify factors associated. RESULTS: A drug-induced movement disorder was found in 44% of the participants: Of this, 27.3% had drug-induced pseudo-Parkinsonism, 21.2% had drug-induced akathisia, 9.5% had drug-induced tardive dyskinesia, and 3.4% had drug-induced tardive dystonia. Being female was associated with pseudo-Parkinsonism (AOR=3.6, 95% CI: 2.03, 6.35), akathisia (AOR=4.9, 95% CI: 2.73, 8.78), and tardive dyskinesia (AOR=2.51, 95% CI: 1.08, 5.86) and being male with tardive dystonia (AOR=4.6, 95% CI: 1.8, 18.5). Alcohol use was associated with tardive dyskinesia (AOR= 5.89, 95% CI: 2.20, 15.69). CONCLUSION: Drug-induced movement disorder in this study was high and nearly half of patients on antipsychotic treatment were experiencing it. Age, sex, and doses of antipsychotics were factors associated with all of the types of drug-induced movement disorders.

Internalized Stigma and Associated Factors among Patients with Major Depressive Disorder at the Outpatient Department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2019: A Cross-Sectional Study.

BACKGROUND: Internalized stigma has been found to be widespread among patients with major depressive disorder. When internalized stigma exists in patients with depression at a high level, it worsens the treatment outcome and quality of life. So the aim of the study is to assess the magnitude of internalized stigma and associated factors among outpatients with major depressive disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. METHODS AND MATERIALS: An institutional-based cross-sectional study was conducted among 415 respondents from May 6 to June 13, 2019. Internalized stigma was assessed by using the internalized stigma of mental illness scale. Data was entered to Epi-data version 3.1 and analyzed using SPSS version 20. Bivariable and multivariable binary logistic analysis was done, and p values less than 0.05 were considered statistically significant with 95% CI. RESULTS: The prevalence of high internalized stigma among patients with major depressive disorder was 33.5% (95% CI: 29.2, 38.3). Being single (AOR = 2.54, 95% CI: 1.30, 4.95), having an illness greater than or equal to 2 years of duration (AOR = 3.21, 95% CI: 1.66, 6.19), history of suicidal attempt (AOR = 2.33, 95% CI: 1.35, 3.99), nonadherence to treatment (AOR = 2.93, 95% CI: 1.62, 5.29), poor social support (AOR = 4.72, 95% CI: 2.09, 10.64), and poor quality of life (AOR = 3.16, 95% CI: 1.82, 5.49) were significantly associated with high internalized stigma at p value < 0.05. CONCLUSION: The magnitude of internalized stigma was high among patients with major depressive disorder. Reduction of internalized stigma through antistigma campaigns and supports given to patients at the earliest possible time is important to improve treatment outcome and quality of life and minimize suicidal behavior in patients with major depressive disorder.

Perceptions of the causes of schizophrenia and associated factors by the Holy Trinity Theological College students in Ethiopia.

INTRODUCTION: There is a cultural variability around the perception of what causes the syndrome of schizophrenia. As far as the cause of schizophrenia by the general public concerned, people living in western countries focus mainly on biological and social risk factors such as genetic vulnerability, disease of the brain, infection or stressful social conditions or personal weakness, but the predominant views held by people living in non-western countries focus mainly on supernatural and religious factors. Awareness and beliefs about the causes of mental illnesses influence the preferred treatments. The aim of this study was to determine the perceptions regarding the etiology of schizophrenia and the associated factors by theology students. METHODS: An institution-based cross-sectional study was conducted among Holy Trinity Theological College students from May to June 2016. Self-administered Short Explanatory Model Interview was used to assess the perception of what causes the syndrome of schizophrenia. Data entry was performed by Epi-info version 3.5.3 and the Statistical Program for Social Science (SPSS version 20) was used for data clearance, and analyses. RESULTS: A total of 409 students were involved in the survey. The mean age of the participants was 33.3 years (standard deviation ± 8.3) and almost all 94.4% of them were males. The majority (81.7%) of the participant recognized schizophrenia as a mental illness. Only 16.9% of the participants attributed supernatural phenomenon as a cause of schizophrenia and most of them 76.5% (313) thought of psychosocial problems as the cause of schizophrenia. About 40.1% of the participant endorsed biological factors as a cause of schizophrenia. About two-thirds (68.2%) of the participant thought schizophrenia as severe but not fatal illness and about 22.2% of them thought both severe and fatal illness. As far as the course concerned majority (88.5%) of the participants thought schizophrenia as a chronic illness and about 11.5% thought acute illness. Regarding the treatment, almost all (99.8%) of reported schizophrenia is treatable. Moreover, concerning the consequences of the illness about 18.8% reported the death as a consequence and about 66.7, 34.7 and 7.8% reported madness, family disintegration and losing a job, respectively. Urban residency and holding other degree were significantly associated with biological factors as a cause of schizophrenia (p < 0.05). Whereas getting information from mass media and health professional, marital status (married) and urban residence were significantly associated with psychosocial factors as the cause of schizophrenia. Furthermore, rural residency was significantly associated with the supernatural phenomenon as the cause of schizophrenia. CONCLUSION: In the current study, the majority of the participant recognized schizophrenia as a mental illness and a treatable syndrome. A vast majority of the participant thought of psychosocial problems as the cause of schizophrenia about two-thirds of the participant thought schizophrenia as a severe but not fatal illness. As far as the course concerned majority (88.5%) of the participants thought schizophrenia as a chronic illness. Concerning the consequences of the illness, about 18.8% reported the death as a consequence and about 66.7, 34.7, and 7.8% reported madness, family disintegration and losing a job, respectively. Residency, marital status, and source of information were significantly associated with perceived causes of schizophrenia. Linking mental health service with spiritual care to address community mental health care needs and for early detection as well as referral linkage of mentally ill patients is warranted.