Predictors of Loss to follow-up in Patients Living with HIV/AIDS after Initiation of Antiretroviral Therapy.

BACKGROUND: Long-term regular follow up of ART is an important component of HIV care. Patients who are lost to follow-up (LTFU) while on treatment compromise their own health and the long-term success of ART programs. AIM: This study was aimed at determining the incidence and risk factors for LTFU in HIV patients on ART at ART clinic of Mizan-Aman General Hospital, Ethiopia. MATERIALS AND METHODS: A retrospective cohort study of 2133 people living with HIV/AIDS and attending an ART clinic between 2005 and 2013 was undertaken. LTFU was defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill and not yet classified as 'dead' or 'transferred-out'. The log-rank test was used to measure differences in time to LTFU between groups and Cox proportional hazards modeling was used to measure predictors of LTFU. RESULTS: Of 2133 patients, 53.9% were female. The mean (SD) age of the cohort was 31.5 (8.0), 16 (2.2), and 3.8 (3.0) years for adults, adolescents, and children, respectively. Around 574 (26.7%) patients were defined as LTFU. The cumulative incidence of LTFU was 8.8 (95% CIs 8.1-9.6) per 1000 person months. Patients with regimen substitution (HR 5.2; 95% CIs 3.6-7.3), non-isoniazid (INH) prophylaxis (HR 3.7; 95% CIs 2.3-6.2), adolescent (HR 2.1; 95% CIs 1.3-3.4), and had a baseline CD4 count < 200 cells/mm(3) (HR 1.7, 95% CIs 1.3-2.2) were at higher risk of LTFU. WHO clinical stage III (HR 0.6; 95% CIs 0.4-0.9) and IV (HR 0.8; 95% CIs 0.6-1.0) patients at entry were less likely to be LTFU than clinical stage I patients. There was no significant difference in risk of LTFU in males and females. CONCLUSION: Overall, these data suggested that LTFU in this study was high. Patients phase of life, drug related factors, and clinical stages were associated with LTFU in this study. Effective control measures in the at-risk population need to be implemented to improve retention.

Ethnoveterinary medicines in four districts of Jimma zone, Ethiopia: cross sectional survey for plant species and mode of use.

BACKGROUND: Traditional medicines have been used for nearly 90% of livestock populations in Ethiopia where complimentary remedies are required to the modern health care system. All plants with pharmacological activity complimentarily prescribed as best choice against livestock diseases. A community based cross - sectional survey was conducted to investigate ethno-veterinary knowledge and practices of study area by purposive sampling techniques. The data from respondents were collected through face-to face interview using pre-tested semi-structured questionnaires, which was further accompanied by field observations of the medicinal plants. The vast majority of the statistics were analyzed descriptively by SPSS 16 Windows version to extrapolate our findings in ethno-botanical knowledge. RESULTS: In the study, a total of 74 species of ethnoveterinary medicinal plant species from 31 families have been identified for treating 22 different livestock ailments. The three families: Asteraceae, Cucurbitaceae and Solanaceae make up larger proportion of reported medicinal plants which accounted for 10.41%, 8.33% and 6.25%, respectively. Of reported medicinal plants, 16.7% informant consensus was recorded for the species Croton macrostachyus Del., 10.7% for Nicotiana tabacum L. and 9.5% for Olea capensis L.Subsp. macrocarpa (C.H. Wright) I.Verd. in treatment of one or more veterinary ailments. The greater varieties of medicinal plant species that accounted for 28.2% were used against management of blackleg which was common livestock diseases in the study area. The findings showed, trees accounted for 43.24%, followed by shrubs (33.78%) and herbs (14.86%). Eighty one percent of medicinal plants reported by respondents were collected from wild habitats, and leaves reported to be used by 68% of the informants for ethnoveterinary medicines preparations. The preparations were applied through different routes of administration; oral administration accounted for (76.2%), followed by application of topical (9.53%) and nasal (5.19%). CONCLUSIONS: Ethnoveterinary practices significantly suggested to play greater roles in livestock health care as an alternative or integral part of modern veterinary practices. The traditional knowledge in treatment of livestock diseases of the study districts needs further scientific evaluations by phytochemical and antimicrobial experimentation to determine safety, efficacy, mode of delivery, drug development and dosage in pharmacological laboratory.

Prevalence and assessment of factors contributing to adverse drug reactions in wards of a tertiary care hospital, India.

BACKGROUND: Adverse drug reactions account for the highest proportion among the causes of morbidity and mortality in clinical wards and are posing a considerable challenge. Hence, the objective of this study was to find out the prevalence of adverse drug reactions and the factors which contribute to their prevalence. METHODS: A prospective patient record review was carried out at a tertiary care hospital in North India from August 2010-May 2011. A total of 1033 subjects admitted to hospital for any kind of treatment were included while patients admitted in the ward because of adverse drug reactions were excluded. The ward where we collected the data includes multispecialty and cardiovascular wards. The causality, severity, and preventability of adverse drug reactions were assessed using Naranjo, modified Hartwig, and Schumock and Thornton criteria, respectively. Kolmogorov-Smyrnov, chi -square and multiple logistic regression tests were used to determine adverse drug reactions ascribed to drugs. RESULTS: Out of 1033 patients whose records were assessed, 167(16.2%) experienced one or more adverse drug reactions. The metabolic systems, which accounted for 49(24.6%) were most frequently affected by adverse drug reactions, followed by gastrointestinal, 45(22.6%); hematological, 28(14.1%) and cutaneous, 21(10.6%) systems. The drug classes most frequently associated with the reactions were antibiotics 40(20.1%), diuretics 35(17.6%) and anticoagulants 30(15.1%). According to the selected preventability scale, 72(36.2%) adverse drug reactions were classified as probably or definitely preventable. About 165(83%) of the reactions were type A, which represents augmentation of the pharmacological action of a drug. Number of drugs, length of hospitalization and number of diagnosis were identified as significant predisposing factors for ADRs. CONCLUSION: The result of this study suggested that adverse drug reactions were significant causes of superimposed health problems that occur following hospitalization. The major risk factors associated with ADR include number of drugs, length of hospitalization and number of diagnosis. Based on the findings a rigorous study is recommended to determine the burden and identify the risk factors of adverse drug reactions to target interventions.