Knowledge and associated factors of healthcare professionals in detecting patient-ventilator asynchrony using waveform analysis at intensive care units of the federal public hospitals in Addis Ababa, Ethiopia, 2023.

BACKGROUND: The interaction between the patient and the ventilator is often disturbed, resulting in patient-ventilator asynchrony (PVA). Asynchrony can lead to respiratory failure, increased artificial ventilation time, prolonged hospitalization, and escalated healthcare costs. Professionals' knowledge regarding waveform analysis has significant implications for improving patient outcomes and minimizing ventilation-related adverse events. Studies investigating the knowledge of healthcare professionals on patient-ventilator asynchrony and its associated factors in the Ethiopian context are limited. Therefore, this study aimed to assess the knowledge of healthcare professionals about using waveform analysis to detect asynchrony. METHODS: A multicenter cross-sectional study was conducted on 237 healthcare professionals (HCPs) working in the intensive care units (ICUs) of federal public hospitals in Addis Ababa, Ethiopia, from December 2022 to May 2023. The data were collected using a structured and pretested interviewer-administered questionnaire. Then, the collected data were cleaned, coded, and entered into Epi data V-4.2.2 and exported to SPSS V-27 for analysis. After description, associations were analyzed using binary logistic regression. Variables with a P-value of < 0.25 in the bivariable analysis were transferred to the multivariable analysis. Statistical significance was declared using 95% confidence intervals, and the strengths of associations were reported using adjusted odds ratios (AORs). RESULTS: A total of 237 HCPs participated in the study with a response rate of 100%. Half (49.8%) of the participants were females. The mean age of the participants was 29 years (SD = 3.57). Overall, 10.5% (95% CI: 6.9-15.2) of the participants had good knowledge of detecting PVA using waveform analysis. In the logistic regression, the number of MV-specific trainings and the training site had a statistically significant association with knowledge of HCPs. HCPs who attended more frequent MV training were more likely to have good knowledge than their counterparts [AOR = 6.88 (95% CI: 2.61-15.45)]. Additionally, the odds of good knowledge among professionals who attended offsite training were 2.6 times higher than those among professionals trained onsite [AOR = 2.63 (95% CI: 1.36-7.98)]. CONCLUSION: The knowledge of ICU healthcare professionals about the identification of PVA using waveform analysis is low. In addition, the study also showed that attending offsite MV training and repeated MV training sessions were independently associated with good knowledge. Consequently, the study findings magnify the relevance of providing frequent and specific training sessions focused on waveform analysis to boost the knowledge of HCPs.

Incidence of switching to second-line antiretroviral therapy and its predictors among children on antiretroviral therapy at general hospitals, Northern Ethiopia: A survival analysis.

BACKGROUND: With expanding access to pediatric antiretroviral therapy, several patients in the developing world were switched to the second-line regimen, and some require third-line medications. A delay in a second-line switch is associated with an increased risk of mortality and other undesired therapeutic outcomes, drives up program costs, and challenges the pediatric antiretroviral therapy service. Nevertheless, there remain limited and often conflicting estimates on second-line antiretroviral therapy use during childhood, especially in resource-limited settings like Ethiopia. Thus, this study intended to determine the incidence and predictors of switching to second-line antiretroviral therapy among children. METHODS: A retrospective cohort study was conducted by reviewing records of 424 randomly selected children on first-line antiretroviral therapy from January 2014 to December 2018 at public hospitals in the Central and Southern Zones of Tigray, Northern Ethiopia. Data were collected using extraction tool; entered into Epi-data; cleaned, and analyzed by STATA version-14. Kaplan-Meier curve, log-rank test, and life table were used for data description and adjusted hazard ratios and p-value for analysis by Cox proportional hazard regression. Variables at a P-value of ≤0.20 in the bi-variable analysis were taken to multivariable analysis. Finally, statistical significance was declared at a P-value of ≤0.05. RESULTS AND CONCLUSION: Analysis was conducted on 424 charts with a total person-time observation of 11686.1 child-months and an incidence switch rate of 5.6 (95%CI: 4.36-7.09) per 1000 child-month-observations. Being orphan [AHR = 2.36; 95%CI: 1.10-5.07], suboptimal adherence [AHR = 2.10; 95% CI: 1.12-3.92], drug toxicity [AHR = 7.05; 95% CI: 3.61-13.75], advanced latest clinical stage [AHR = 2.75; 95%CI: 1.05-7.15], and tuberculosis co-infection at baseline [AHR = 3.08; 95%CI: 1.26-7.51] were significantly associated with switch to second-line antiretroviral therapy regimen. Moreover, a long duration of follow-up [AHR = 0.75; 95% CI: 0.71-0.81] was associated with decreased risk of switching. Hence, it is better to prioritize strengthening the focused evaluation of tuberculosis co-infection and treatment failure with continuous adherence monitoring. Further research is also needed to evaluate the effect of drug resistance.

Risk factors of early mortality among COVID-19 deceased patients in Addis Ababa COVID-19 care centers, Ethiopia.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 is a global health care problem with high mortality. Despite early mortality seeming alarming, data regarding factors that lead to increased early mortality of COVID 19 patients is not well-documented yet. The objective of this study was to identify the risk factors of early mortality in patients with confirmed COVID-19 infections. METHODOLOGY: A case-control study design was employed. With this, a total of 261 COVID-19 deceased recordings were reviewed. The cases of the study were recordings of patients deceased within three days of intensive care unit admission whereas, the rest 187 were recordings of patients who died after three days of admission. Data were collected using an extraction checklist, entered into Epi data version 4.4.2.2, and analyzed by SPSS version 25. After the description, binary logistic regression was run to conduct bivariate and multivariable analyses. Finally, statistical significance was declared at p-value <0.05, and an adjusted odds ratio with a 95% confidence interval was used to report the strength of association. RESULT: The analysis was performed on 261 (87 cases and 174 controls) recordings. About 62.5% of the participants were aged above 65 years and two-thirds were males. The presence of cardiovascular disease (AOR = 4.79, with 95%CI: 1.73, 13.27) and bronchial-asthma (AOR = 6.57; 95% CI: 1.39, 31.13) were found to have a statistically significant association with early mortality. The existence of complications from COVID-19 (AOR = 0.22; 95% CI: 0.07, 0.74) and previous history of COVID-19 infection (AOR = 0.17, 95% CI: 0.04, 0.69) were associated with decreased risk of early mortality. CONCLUSIONS: Having cardiovascular diseases and bronchial asthma was associated with an increased risk of early mortality. Conversely, the presence of intensive care unit complications and previous history of COVID-19 infection were associated with decreased risk of early mortality.

Incidence and predictors of attrition among children attending antiretroviral follow-up in public hospitals, Southern Ethiopia, 2020: a retrospective study.

Background: It is a global challenge to enrol and retain paediatric patients in HIV/AIDS care. Attrition causes preventable transmission, stoppable morbidity and death, undesirable treatment outcomes, increased cost of care and drug resistance. Thus, this study intended to investigate the incidence and predictors of attrition among children receiving antiretroviral treatment (ART). Method: A retrospective follow-up study was conducted among children <15 years who had ART follow-up in Gedeo public hospitals. After collection, data were entered into Epi-data V.4.6, then exported to and analysed using STATA V.14. Data were described using the Kaplan-Meier statistics, life table and general descriptive statistics. The analysis was computed using the Cox proportional hazard regression model. Covariates having <0.25 p values in the univariate analysis (such as developmental stage, nutritional status, haemoglobin level, adherence, etc) were fitted to multivariable analysis. Finally, statistical significance was declared at a p value of <0.05. Results: An overall 254 child charts were analysed. At the end of follow-up, attrition from ART care was 36.2% (92 of 254), of which 70 (76.1%) were lost to follow-up, and 22 (23.9%) children died. About 8145.33 child-months of observations were recorded with an incidence attrition rate of 11.3 per 1000 child-months (95% CI: 9.2 to 13.9), whereas the median survival time was 68.73 months. Decreased haemoglobin level (<10 g/dl) (adjusted HR (AHR)=3.1; 95% CI: 1.4 to 6.9), delayed developmental milestones (AHR=3.6; 95% CI: 1.2 to 10.7), underweight at baseline (AHR=5.9; 95% CI: 1.6 to 21.7), baseline CD4 count ≤200 (AHR=4.4; 95% CI: 1.6 to 12.2), and poor or fair ART adherence (AHR=3.5; 95% CI: 1.5 to 7.9) were significantly associated with attrition. Conclusion and recommendation: Retention to ART care is challenging in the paediatrics population, with such a high attrition rate. Immune suppression, anaemia, underweight, delayed developmental milestones and ART non-adherence were independent predictors of attrition to ART care. Hence, it is crucial to detect and control the identified predictors promptly. Serious adherence support and strengthened nutritional provision with monitoring strategies are also essential.