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Objective: This study aimed to assess the extent of access to healthcare services, perception and associated factors among patients with cervical cancer in Addis Ababa, Ethiopia. Methods: A facility-based cross-sectional study was conducted from 01 July through 30 August 2023 at two tertiary hospitals. Cases with histopathologic and clinical confirmation of cervical cancer were enrolled using a consecutive sampling technique. Data was collected through a validated questionnaire administered by interviewers using the KoboCollect application. Subsequently, the collected data underwent analysis using Statistical Sciences for Social Sciences (SPSS) version 26.0. Bivariable and multivariable regression models were performed at p ≤ 0.2 and p<0.05 statistical significance, respectively. Results: A total of 391 patients were enrolled in the study. Health facilities were accessible for obtaining general medical services (56.5%), drugs (57.3%), laboratory diagnosis services (57.0%), imaging diagnosis services (56.8%), and radiotherapy services (55.8%) of the patients. Cost of services was affordable only in 11.5% of the cases. Essential anticancer medicines were out of stock for 229 (58.6%) of the patients during the past three months. About two-thirds of the patients have a good perception of access to healthcare services. In multivariable binary logistic regression, admission to the inpatient (AOR: 0.20, 95% CI: 0.06-0.67), joblessness (AOR: 0.19, 95% CI: 0.08-0.46), lower level of income to the extreme poverty line (3567ETB)(64.9 USD) (AOR: 0.19, 95% CI: 0.10-0.35), no CBHI coverage (AOR: 4.16, 95% CI: 1.76-9.85), having social support (AOR: 3.80; 95% CI: 1.96-7.41), and poor dietary practice (AOR: 2.36, 95% CI: 1.28-4.35) were found to have a statistically significant association with perceived good access to healthcare services. Conclusion: Only close to a half of the patients with cervical cancer, in Addis Ababa, have adequate access to healthcare services. Nearly two-thirds of the patients reported perceived good access to the services. Many factors were found to show a statistically significant association with patients' perceived access to healthcare services.
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Background: The use of herbal medicine is common in Ethiopia. However, evidence on the extent and predictors of concomitant use of herbal medicine with conventional treatment among HIV/AIDS and tuberculosis patients is limited. Objective: To assess the extent of concomitant use of herbal medicine with conventional therapy and associated factors among HIV/AIDS and tuberculosis patients in Metekel Zone, Northwest Ethiopia. Method: A cross-sectional study was conducted from January to March 2020. HIV/AIDS and tuberculosis patients who visited the health facilities during the study were interviewed face-to-face using a structured and pretested questionnaire. The descriptive statistics and univariate and multivariate logistic regression analyses were conducted using SPSS version 25. A P-value of <0.05 was considered significant. Results: 412 patients on conventional treatment were included in this study; 355 (86.2%) were HIV patients, and 57 (13.8%) were TB patients. More than half, 217 (52.7%) participants reported using herbal medicine while on conventional therapy. Among those who claimed to have used herbal medicines, 32 (14.7%) received herbal medicine from traditional healers. About four of five herbal users did not disclose their use to their healthcare providers. The type of health facility on follow-up (P=0.03), disease status (P=0.01), occupation (P=0.02), discontinuing ART (P=0.03), and encountering side (P=0.04) were the determinant factors for the use of herbal medicine among our study participants. Conclusion: In the Metekel Zone, concomitant consumption of herbal medication is common among HIV/AIDS and tuberculosis patients. Furthermore, most patients did not disclose the healthcare practitioners about their herbal use. Therefore, healthcare practitioners must assess and counsel patients regarding the potential adverse effects and herb-drug interaction to optimize therapy.
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Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a major public health, social, and economic problem in Ethiopia. Even though the government is working to scale up Anti-Retroviral Therapy (ART) services, patient loss to follow-up and ensuring adherence to ART regimens remain major challenges of the ART program in the country; little has also been done on the assessment of patient satisfaction on different HIV/AIDS service dimensions. This study aimed at assessing patient satisfaction with HIV/AIDS services in health centers of East Shoa Zone, Oromia region, Ethiopia. The study employed a cross-sectional survey between February and May 2017. Data was collected through exit interviews using five-point Likert scale-based questions and analyzed using Statistical Package for Social Sciences (SPSS) version 20. The overall mean patient satisfaction score was 3.16 (SD = 0.87) on a 1 to 5 scale. Availability of anti-Tuberculosis (anti TB) drugs in pharmacy was an item with the highest mean satisfaction score (4.18 ± 0.61) while waiting time to get pharmacy service was ranked least by the patients (mean score of 1.92, SD = 0.81). Merchants and students were more likely to be satisfied compared to other occupational groups. Overall, there was a wider gap in the study facilities concerning patient satisfaction and, therefore, health facility managers, Zonal and Woreda health offices, and Oromia Region Health Bureau should work in collaboration with other stakeholders to improve patient satisfaction with items for which the satisfaction score was low.
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Intense antibiotic consumption in Low- and Middle-Income Countries (LMICs) is fueled by critical gaps in laboratory infrastructure and entrenched syndromic management of infectious syndromes. Few data inform the achievability and impact of antimicrobial stewardship interventions, particularly in Sub-Saharan Africa. Our goal was to demonstrate the feasibility of a pharmacist-led laboratory-supported intervention at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, and report on antimicrobial use and clinical outcomes associated with the intervention. Methods: This was a single-center prospective quasi-experimental study conducted in two phases: (i) an intervention phase (November 2017 to August 2018), during which we implemented weekly audit and immediate (verbal and written) feedback sessions on antibiotic prescriptions of patients admitted in 2 pediatric and 2 adult medicine wards, and (ii) a post-intervention phase (September 2018 to January 2019) during which we audited antibiotic prescriptions but provided no feedback to the treating teams. The intervention was conducted by an AMS team consisting of 4 clinical pharmacists (one trained in AMS) and one ID specialist. Our primary outcome was antimicrobial utilization (measured as days of therapy (DOT) per 1,000 patient-days and duration of antibiotic treatment courses); secondary outcomes were length of hospital stay and in-hospital all-cause mortality. A multivariable logistic regression model was used to explore factors associated with all-cause in-hospital mortality. Results: We collected data on 1,109 individual patients (707 during the intervention and 402 in the post-intervention periods). Ceftriaxone, vancomycin, cefepime, meropenem, and metronidazole were the most commonly prescribed antibiotics; 96% of the recommendations made by the AMS team were accepted. The AMS team recommended to discontinue antibiotic therapy in 54% of cases during the intervention period. Once the intervention ceased, total antimicrobial use increased by 51.6% and mean duration of treatment by 4.1 days/patient. Mean LOS stay as well as crude mortality also increased significantly in the post-intervention phase (LOS: 24.1 days vs. 19.8 days; in hospital death 14.7 vs. 6.9%). The difference in mortality remained significant after adjusting for potential confounders. Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.
