RESUMO
Background: Diabetic ketoacidosis is a potentially fatal disease that affects adults. Therefore, rapid detection and treatment are required to decrease mortality rates. Most of the earlier research on diabetic ketoacidosis in Ethiopia concentrated on its prevalence and associated factors. This study aimed to assess the treatment outcomes of diabetic ketoacidosis and its associated factors in adult patients admitted to St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, in 2023. Methods: This institution-based retrospective cross-sectional study was conducted with a sample size of 357. The data were entered in Epidata version 4.6 and exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Adjusted Odds Ratio (AOR) with a 95% confidence interval was estimated to determine its association with outcome of treatment. Results: Three hundred fifty-seven diabetic ketoacidosis patients' charts were reviewed. Fourteen (3.9%) diabetic ketoacidosis (DKA) patients had died. Those Patients with diabetic ketoacidosis who had acute comorbidity (presence of sepsis) (AOR = 3.24, 95% CI: 1.20-10.2), international unit (IU) insulin administration in the 1st 24 hours (AOR = 8.046, 95% CI: 3.881-25.32), fluid replacement in the 1st 24 hours (AOR = 5.84, 95% CI: 1.53-10.07), and potassium replacement (AOR = 3.08, 95% CI: 1.835-5.817) were independently associated with treatment outcome of diabetic ketoacidosis. Insulin administration for the first 24 hours more than >60 IU insulin showed improvement in treatment outcome by 8.04 times more likely than less <60 IU insulin administration for the first 24 hours. More >6 liters fluid replacement in the first 24 hours had improvement in treatment outcome by 5.84 times more likely than <6 liters fluid replacement. Conclusion: A considerable proportion of the patients with diabetic ketoacidosis died at St. Paul's hospital millennium medical college. Stakeholders must emphasize the treatment of patients with diabetes (diabetic ketoacidosis), according to the recommendations of local and international guidelines.
RESUMO
BACKGROUND: Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. METHODS: Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. RESULTS: Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. CONCLUSION: The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.
