A cross-sectional study measuring injury mortality and its associated factors among adult patients in comprehensive specialized hospitals in Amhara National Regional State, Ethiopia.

Background: Injury has become a life-threatening community health problem related to vital morbidity and mortality worldwide. Approximately 90% of injury-related deaths occurred in low-income and middle-income countries. There are limited data that address the outcomes of injuries in adult trauma patients at the time of discharge to improve the outcome of trauma care in developing countries, including Ethiopia. Therefore, this study aimed to determine the mortality following injury and its associated factors among adult patients in comprehensive specialized hospitals in Amhara's national regional state. Methods: An institution-based cross-sectional study was conducted among 596 adult trauma patients admitted between 1 January 2018 and 30 December 2020. A systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into Epi-data version 4.6, and analysis was done using Stata version 16. The binary logistic regression model was fitted, and both bi-variable and multi-variable logistic regression analyses were employed. Result: A total of 581 adult trauma patient charts with a recorded rate of 97.5% were included in the final analysis. The overall mortality outcome of injury at discharge was found to be 8.3% (95% CI: 6-10.5%). Age 26-40 years [adjusted odds ratio (AOR): 3.35 (95% CI: 1.35-8.33)], revised trauma score 10 [AOR: 3.11, (95% CI: 1.39-6.99)], duration of time before arrival in hospital more than 24 h [AOR: 3.61 (95% CI: 1.18-11.02)], and surgical management in hospital [AOR: 0.25 (95% CI: 0.12-0.54)] were predictors of mortality in patients with injuries. Conclusion: In this study, the mortality outcome of injury is considerably high, and the middle age group, late presentation to the hospital, lower revised trauma score, and surgical management were significantly associated with the mortality outcome of injury on discharge from the hospital. Therefore, it is better if clinicians emphasize traumatically injured patients, especially for middle age groups, and lower revised trauma scores.

Mortality and its associated factors among mechanically ventilated adult patients in the intensive care units of referral hospitals in Northwest Amhara, Ethiopia, 2023.

Background: Worldwide, nearly half of the patients admitted to intensive care units require ventilatory support. Despite advances in intensive care unit patient management and mechanical ventilator utilization, the odds of mortality among mechanically ventilated patients are higher in resource-limited settings. Little is known about the mortality of patients on mechanical ventilation outside the capital of Ethiopia. This study aimed to assess mortality and its associated factors among mechanically ventilated adult patients in intensive care units. Method: An institutional-based cross-sectional study was conducted on mechanically ventilated patients in intensive care units from 1 February 2020 to 1 March 2023. A simple random sampling technique was used to select 434 patients' charts. A data extraction tool designed on the Kobo toolbox, a smartphone data collection platform, was used to collect the data. The data were exported into Microsoft Excel 2019 and then into Stata 17 for data management and analysis. Descriptive statistics were used to summarize the characteristics of the study participants. A bivariable logistic regression was conducted, and variables with p ≤ 0.20 were recruited for multivariable analysis. Statistical significance was declared at p < 0.05, and the strength of associations was summarized using an adjusted odds ratio with 95% confidence intervals. Result: A total of 404 charts of mechanically ventilated patients were included, with a completeness rate of 93.1%. The overall proportion of mortality was 62.87%, with a 95% CI of (58.16-67.58). In the multivariable logistic regression, age 41-70 years (AOR: 4.28, 95% CI: 1.89-9.62), sepsis (AOR: 2.43, 95% CI: 1.08-5.46), reintubation (AOR: 2.76, 95% CI: 1.06-7.21), and sedation use (AOR: 0.41, 95% CI: 0.18-0.98) were found to be significant factors associated with the mortality of mechanically ventilated patients in the intensive care unit. Conclusion: The magnitude of mortality among mechanically ventilated patients was high. Factors associated with increased odds of death were advanced age, sepsis, and reintubation. However, sedation use was a factor associated with decreased mortality. Healthcare professionals in intensive care units should pay special attention to patients with sepsis, those requiring reintubation, those undergoing sedation, and those who are of advanced age.

Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia.

BACKGROUND: Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units. METHODS: Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan-Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively. RESULT: The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients. CONCLUSION: The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality.

Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis.

BACKGROUND: Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia. METHOD: The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05. RESULT: This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers. CONCLUSION: The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.

Practices and Barriers towards Physical Assessment among Nurses Working in Intensive Care Units: Multicenter Cross-Sectional Study.

BACKGROUND: In the intensive care units, patients need special consideration and monitor frequently with appropriate physical assessment skills. Nurses working in the intensive care units play a fundamental role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Most of the nursing activities were poorly assessed in low-income countries including Ethiopia. Therefore, this study was aimed to assess the nurses' practice and barriers to physical assessment among critically ill patients in Northwest Ethiopia. METHODS: An institution-based multicenter cross-sectional study was conducted at Amhara regional state referral hospitals from March to September 2019. A total of 299 nurses working in the intensive care units were recruited through the convenience sampling method. A 30-item physical assessment practice and 36-item barriers to nurses' use of the physical assessment scale inventory were used. The linear regression analysis model was fitted, and the adjusted unstandardized beta (ß) coefficient with a 95% confidence interval was used. A p value < 0.05 was considered statistically significant. RESULTS: The mean score of the nurses' practice towards physical assessment among critically ill patients was 101.26 ± 24.99. Greater perceived reliance on others and technology (ß = -0.78, 95% CI (-1.07, -0.48)), ward culture (ß = -0.48, 95% CI (-0.85, -0.11)), specialty area (ß = -1.46, 95% CI (-2.01, -0.90)), lack of nursing role model (ß = -0.54, 95% CI (-1.06, -0.02)), being unmarried (ß = -6.10, 95% CI (1.75, 10.46)), taken training (ß = 11.53, 95% CI (6.34, 16.72)), and knowledge score (ß = 2.81, 95% CI (2.00, 3.63)) were the factors significantly associated with the nurses' practice score towards physical assessment. Reliance on others and technology towards physical assessment practice was the most important barrier followed by ward culture and specialty area. CONCLUSION: Nurses working in the intensive care units had a good practice towards physical assessment among critically ill patients. Hence, to increase the practice towards physical assessment in intensive care settings, especially for married nurses, experienced critical care nurses, and specialist professionals, practice support training, modifying ward environment, and educational support care are recommended.

Magnitude and Determinants of Needlestick and Sharp Injuries among Nurses Working in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Needlestick and sharp injuries are a big risk to the health of nurses. Every day, nurses face the likelihood that they will injure themselves. Although many injuries will have no adverse effect, the possibility of acquiring infections like hepatitis C virus, hepatitis B virus, and human immunodeficiency virus can cause untold psychological harm. Nurses are in danger of injuries caused by needlestick and sharp instruments in hospitals. OBJECTIVE: The objective of this study was to assess the magnitude and determinants of needlestick and/or sharp injuries among nurses working at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2018. METHODS: An institution-based cross-sectional study was conducted among 268 nurses working at Tikur Anbessa Specialized Hospital from February to March 2018. A stratified random sampling technique was used to select the study participants. Data were collected using a self-administered questionnaire. A bivariate and multivariate logistic regression model was fitted to spot factors associated with needlestick and/or sharp injury. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance. RESULT: The prevalence of needlestick and/or sharp injuries among nurses was 36.2% (95% CI 30.2%, 42.3%). Presence of contaminated needles and/or sharp materials in the working area (AOR = 2.052 (95% CI 1.110, 3.791)), needle recapping after use (AOR = 1.780 (95% CI 1.025, 3.091)), working in the pediatric ward (AOR = 0.323 (95% CI 0.112, 0.930)), and being female (AOR = 0.461 (95% CI 0.252, 0.845)) were significantly associated with needlestick and/or sharp injury at p value of ≤0.05. Conclusion and Recommendation. The proportion of needlestick and/or sharp injury was high among nurses. The safety of nurses depends directly on the degree to which nurses can identify and control the numerous occupational hazards specific to jobs. Thus, working unit specific safety precautions, a safe working environment, and appropriate needle and sharp disposal improve nurses' safety practices and thereby decrease the injuries.

High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: HIV/AIDS are pressing global health problems. Pain is a common symptom reported by patients living with HIV/AIDS. The exact cause of pain in HIV patients has not been thoroughly described, but it may, due to a symptom of HIV itself, result from opportunistic infections, as a side effect of antiretroviral drugs, concurrent neoplasia or other causes. In addition, pain perception of HIV-infected patients is highly variable and may vary based on cultural context and patient demographics. In Ethiopia, there is insufficient evidence on the prevalence and factors associated with HIV-related pain. METHODS: A cross-sectional study was conducted among 422 adult HIV-infected patients at Gondar University Hospital antiretroviral care clinic from March 1 to May 1, 2016. Systematic random sampling was used to select study participants. A pretested interviewer-administered questionnaire and a standardized medical record data abstraction tool were used to collect data. A short form brief pain inventory tool was used to measure the outcome. Bivariate and multivariate logistic regression models were fitted to identify factors associated with pain among adult HIV patients. RESULTS: The prevalence of pain was found to be 51.2% (95% CI: 46.4%-55.9%). Headache (17.9%), abdominal pain (15.6%), and backache (13.3%) were the most common symptoms of study participants. Being female (adjusted odds ratio [aOR]=1.8, 95% CI: 1.1-2.9); regular alcohol intake (aOR=3.3, 95% CI: 1.5-7.2); baseline World Health Organization clinical disease stage: II (aOR=2.5, 95% CI: 1.2-4.9), III (aOR=2, 95%, CI: 1.1-3.6), and IV (aOR=2.4, 95% CI: 1.1-5.3); and the presence of a chronic comorbid condition (aOR=5.9, 95% CI: 2.1-16.7) were significantly associated with pain. CONCLUSION: Adult HIV patients in this sample reported a high level of chronic pain. Healthcare providers should better implement a routine pain assessment among HIV-positive patients to alleviate their suffering.