Ayder Referral Hospital Research Articles

Prevalence and Clinical Significance of Potential Drug-Drug Interactions at Ayder Referral Hospital, Northern Ethiopia

Introduction: Clinically significant drug-drug interactions reduce effectiveness of drugs or cause fatal adverse events. Although harmful drug interactions are preventable, clinicians’ recognition and detection of drug interactions is not optimal. Objective: To assess prevalence, clinical significance and factors associated with potential drug-drug interactions at medical ward of Ayder Referral Hospital, Ethiopia. Methods: A cross-sectional study was conducted to determine potential drug-drug interactions. A total of 204 patients’ medical records were analyzed for drug-drug interaction using Micromedex drug interaction software. Data were analyzed using SPSS version 16. Results: We identified 135 interacting-combinations in a total of 266 potential drug-drug interactions (pDDIs) with a mean of 1.3 pDDIs per patient. Of these, 30.1% and 53.7% of patients had at least one major and one moderate pDDIs respectively. The most common pDDIs involved were concurrent use of clarithromycin with simvastatin, aspirin with heparin and dexamethasone with rifampin which have contraindication, major and moderate severity respectively. There was significant association of occurrence of pDDIs with polypharmacy (p<0.01). Conclusion: Potential drug-drug interactions were common at the medical ward of our hospital.

Achievements of Diabetes Goals and Their Determinants in Type 2 Diabetic Patients Attending Outpatient Diabetic Clinic in Northern Ethiopia.

Background The aim of this study was to assess target diabetic goal achievements and to explore variables associated with them. Methods A cross-sectional study was conducted between December 2015 and April 2016 on 188 type 2 diabetic patients attending Ayder Referral Hospital's outpatient diabetic clinic. Glycemic control was assessed using fasting plasma glucose values and total cholesterol and triglyceride were used to evaluate lipid profiles. Bivariate and multivariate logistic regression analyses were done to identify factors associated with poor glycemic control, hypertension, and dyslipidemia. Result Mean duration of diabetes was 6.5 years. Combined glycemic, lipid, and blood pressure targets were achieved only in 8.5% of the participants. More males achieved combined targets than females. Separately, while above two-thirds of the patients had poor glycemic control (67%), more than half of the participants have had poor lipid (58.5%) and blood pressure (52.1%) control. A significant portion of the patients (68.1%) had also comorbidities other than hyperglycemia. In bivariate and multivariate analyses, longer duration of diabetes disease (AOR: 3.4; P = 0.013) and marked month to month fasting plasma glucose (FPG) variability as measured by large standard deviation (AOR: 2.5; P = 0.023) were significantly associated with overall poor mean FPG results. Female sex was also significantly associated with dyslipidemia (AOR: 1.9; P = 0.049). Conclusion The study showed that achievements of combined diabetic goals are generally poor.

PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATIONS IN AYDER REFERRAL HOSPITAL, TIGRAY REGION, NORTHERN ETHIOPIA: PROSPECTIVE STUDY

Background : Potentially inappropriate medication (PIM) use includes the use of drugs with higher risk where adverse drug effect outweighs the clinical benefit, especially when more effective alternative therapy is available. Objective : The aim of this study was to assess prevalence and risk factors associated with the use of PIMs in elderly patients at medical ward of Ayder Referral Hospital (ARH), Tigray region, Northern Ethiopia. Methods : A facility based prospective cross sectional study was conducted among 140 elderly patients from February 6, 2014 to May 05, 2014 in ARH. Patients with age ≥ 60 years admitted to medical ward during the study period were randomly selected. Data were collected with a structured questionnaire and analyzed using statistical package for social science (SPSS, IBM Corporation) version 20. Binary logistic regression was used to analyze factors associated with occurrence of PIM. Results : Of 140 patients, 52.1% were males and forty (28.6%) of patients received at least one potentially inappropriate medication. The most commonly used potential inappropriate medications were metoclopramide (25.58%), nifedipine (16.28%), diazepam (13.95%) and meperedine (13.95%). Above half of (58%) patients encountered polypharmacy. Thirty eight percent of the participants’ had comorbid conditions. In the binary logistic analysis, patients with polypharmacy were more likely to receive PIMs [AOR 4.163: 95 % CI 1.75– 9.92, p=0.001]. Conclusions : Prevalence of PIMs in elderly patients admitted to ARH was high. Polypharmacy was identified as the independent predicator of the uses of PIMs. Clinical pharmacists’ are in a position to alert and monitor the exposure to PIMs as part of multidisciplinary team. Keywords : Elderly, Potential inappropriate medication, Beer’s criteria, Ethiopia

Potential drug-drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross sectional study.

BackgroundThe elderly are considered as special population, as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics, vulnerability to drug–drug interactions and adverse drug reactions. Despite the fact that the elderly patients are at high risk of having drug interaction and potential adverse outcomes, studies in this regard are scarce in resource limited settings like Ethiopia. The aim of this study was to assess the prevalence and determinants of potential drug–drug interaction in elderly patients admitted to medical ward of Ayder Referral Hospital in Northern Ethiopia.MethodsA cross sectional study was conducted among elderly inpatients aged 60 years and above. The study was conducted from February to May 2014. Prescribed drugs being taken concurrently for at least 24 h were included and checked for drug–drug interaction using Micromedex® 2.0 online drug reference. Data were analyzed using statistical software, statistical package for social sciences for windows version 20. Logistic regression model was used to analyze factors associated with occurrence of drug interaction. P value of <0.05 was considered statistically significant.ResultsA total of 140 patients were participated in the study. The mean age (±standard deviation) of participants was 68 (±7) years. Majority (61.4 %) of patients were diagnosed with cardiovascular and/or renal diseases. A total of 814 drugs were prescribed with a mean of 6 (±4) medications per patient during a 13 (±9) days of hospital stay. About two-third (62.2 %) of the respondents were exposed to at least one potential drug–drug interaction. Among these 3.6, 32.9 and 25.7 % of patients had taken contraindicated drug combination, at least one major and at least one moderate drug–drug interaction, respectively. Patients with five or more prescribed medications were four times at risk of having drug–drug interaction (P = 0.00; adjusted odds ratio 4.047; 95 % confidence interval 1.867–8.775).ConclusionDrug–drug interaction in elderly patients was common in this resource limited set-up. Awareness creation and clinical pharmacist involvement in minimizing the risk associated with potentially harmful drug combinations are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2238-5) contains supplementary material, which is available to authorized users.

Evaluation of antibacterial activity of honey against multidrug resistant bacteria in Ayder Referral and Teaching Hospital, Northern Ethiopia.

BackgroundMultidrug resistance is a global health issue. Hence integration of traditional medicine like honey and modern medicine could be a best option in the treatment of patients infected with drug resistant bacteria. Despite the multi floral and huge honey production in the region, there are no studies that evaluate the antibacterial activity of honey against multidrug resistant bacteria.ObjectiveTo evaluate the antibacterial activity of honey against multidrug resistant human pathogenic bacterial isolates of wound and ear infections.MethodsRed and white honeys were obtained from three districts Eastern Zone of Tigray namely Temben, Atsbi and Samre. The antibacterial potential of these honeys was determined against multidrug resistant isolates of clinical isolates of bacterial species of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Coagulase negative Staphylococcus, Streptococcus pyogenes and Klebsiella pneumonia, and five controls bacterial using tube dilutions methods. Undiluted and twofold serial dilutions of honeys were tested to determine minimum inhibitory concentration (MIC) using broth tube dilution methods through visual inspection and minimum bactericidal concentration (MBC) was determined by sub-culturing tubes showing no visible sign of growth/turbidity in MIC.ResultsThe mean MIC of red honeys for control and test bacteria was 7.7–8.9 and 12.6–17.9 % (v/v) respectively. Whilst the MIC of white honey was 12.2–12.5 % (v/v) for control and 16.1–27.7 % (v/v) for test bacteria. Mean MBC of red honeys for control and test isolates was from 25–40 to 30.4–62.5 % (v/v) respectively, and 40–55 and 60.7–75 % (v/v) for white honeys. Honey collected from Samre area has shown better antibacterial activity than other sites. Similarly red honeys from all areas were found to have better antibacterial activity against the multidrug bacteria than the white honey. Over all the MIC and MBC of all isolates was between 6.25–50 and 12.5–100 % (v/v) respectively.ConclusionRed honey from all sites showed better antibacterial activity than the white honey. Likewise, honey from Samre area showed better antibacterial activity than Temben and Atsbi districts. All collected honeys showed varied bacteriostatic and bactericidal activities, and none of the isolates was resistant to tested honeys.

Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia.

Middle Ear infection is a common problem for both children and adults particularly in resource limited countries. Nevertheless, in Ethiopia and particularly in the study area, there is scarcity of recent data that indicate the magnitude of the problem. Thus this study aimed to identify bacterial isolates and determine their drug susceptibility patterns from patients who had ear infection. Cross sectional study was carried out on patients with ear infection and who visited the Ear, Nose and Throat clinic of Ayder referral and teaching hospital from November 2014 to June 2015. Middle ear discharges were collected and processed for bacterial culture and antimicrobial susceptibility testing using standard bacteriological techniques. Clinical and demographic data were collected using standard questionnaire. Data were entered and analyzed using SPSS version 20 software and p value of < 0.05 was considered statistically significant. Of the total of 162 patients with ear discharges, 68.5 % were from rural areas, 71 % with chronic infection, 54.9 % referred cases and 67.3 % of them had decreased hearing status. Pathogens were isolated from 157 (98.2 %) of the patients with a total of 216 isolates. Staphylococcus aureus 46 (28.4 %), Proteus mirabilis 39 (24.1 %), Pseudomonas aeruginosa 27 (16.7 %), Klebsiella spp. and Haemophilus influenzae 18 (11.1 % each) were the dominant bacteria. Out of the individuals with ear infection, single and mixed bacterial infection was seen among 185 (90.7 %) and 59 (39.5 %) respectively. Age group of 0–5 years (p = 0.02), chronic patients (p = 0.042) and referred cases (p = 0.045) showed high bacterial isolates. High resistance was seen to most antibiotics. Ciprofloxacin, Gentamicin Norfloxacin and Erythromycin were effective against isolated bacteria. The overall multi drug resistance rate of bacteria in this study was 74.5 %. Prevalence of bacteria associated with otitis media and multidrug resistance was very high in the study area. Ciprofloxacin, gentamicin, norfloxacin and erythromycin can be used to treat otitis media. Treatment of patients should be based on antimicrobial susceptibility test to prevent complications, development of further antibiotic resistance and extra treatment costs.

Gastrojejunocolic fistula after gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases.

BackgroundGastrojejunocolic fistula (GJCF) is a late and severe complication of a stomal ulcer after gastrojejunostomy, which develops as a result of inadequate resection of stomach or incomplete vagotomy. The occurrence of perforation in a GJCF is even more a rare complication because long evolution time or latent period is required for its appearance. Patients with this condition usually present with diarrhea, weight loss, feculent vomiting, under-nutrition and features of peritonitis that require immediate surgical intervention.Case presentationWe described two cases of gastrojejunocolic fistula in men aged 60 and 40, first cases of gastrojejunocolic fistula seen in our referral hospital and in the whole region following more than a decade after gastrojejunostomy. Both patients initially presented with watery diarrhea, vomiting of fecal materials, poor appetite and weight loss. Upper GI series or barium enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course and outcome was one cure and one death.ConclusionAs it is rare phenomenon, high clinical suspicion is very important in the diagnosis of GJCF on patients who manifest with chronic diarrhea, vomiting of fecal matter, abdominal pain and features of malnutrition. Careful preoperative preparation is mandatory before any type of surgical procedure is carried out. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery. Adequate resection of the stomach after Gastrojejunostomy and complete vagotomy is important to prevention development of GJCF.

Isolation and anti-microbial susceptibility pattern of group B Streptococcus among pregnant women attending antenatal clinics in Ayder Referral Hospital and Mekelle Health Center, Mekelle, Northern Ethiopia.

BackgroundVaginal colonization with group B Streptococcus (GBS) is the predominant risk factor for the development of invasive neonatal GBS diseases and puts newborns at increased risk for morbidity and mortality. This study is aimed to determine the colonization rate and antimicrobial susceptibility pattern of group B Streptococcus among pregnant women.MethodsHospital based cross-sectional study was conducted from August to December 2014 at selected health facilities. A total of 139 antenatal clinics attendees, proportionally allocated, were recruited consecutively. Socio-demographic and clinical factors were collected using a structured questionnaire. Vaginal swabs were collected and cultured on Todd Hewitt broth and in 5 % sheep blood agar. Antimicrobial susceptibility test was done using Kirby-Bauer disk diffusion test. Statistical analysis was performed using Pearson’s Chi square test.ResultsAmong the 139, 19 (13.7 %) were positive for GBS. All the GBS isolates were susceptible (100 %) to penicillin G, vancomycin, ampicillin, erythromycin and gentamicin. Two of the GBS isolates showed multidrug resistance against norfloxacin and ciprofloxacin. No statistically significant difference was observed for GBS colonization with any independent variables.ConclusionVaginal colonization of GBS for the present study put emphasis on further investigation and accomplishment of routine GBS screening practices. The recovery of resistant strains to antimicrobial agents recommended in cases of penicillin allergic mothers indicates the importance of susceptibility test.

Magnitude and associated factors of Atopic dermatitis among children in Ayder referral hospital, Mekelle, Ethiopia.

BackgroundAtopic Dermatitis (AD) is now a day’s increasing in prevalence globally. A Prevalence of 5–25 % have been reported in different country. Even if its prevalence is known in most countries especially in developing countries there is scarcity with regard to prevalence and associated risk factors of AD among children in Ethiopia settings. The aim of this study was to determine the magnitude and associated factors of atopic dermatitis among children in Ayder referral hospital, Mekelle, Ethiopia.MethodsA facility-based cross-sectional study design was conducted among 477 children aged from 3 months to 14 years in Ayder referral hospital from July to September, 2014. A systematic random sampling technique was used to identify study subjects. Descriptive analysis was done to characterize the study population. Bivariate and multivariate logistic regression was used to identify factors associated with AD. The OR with 95 % CI was used to show the strength of the association and a P value < 0.05 was used to declare the cut of point in determining the level of significance.ResultsAmong the total respondents, 237 (50.4 %) were males and 233 (49.6 %) were females. The magnitude of the atopic dermatitis was found to be 9.6 % (95 % CI: 7.2, 12.5). In multivariate logistic regression model, those who had maternal asthma (AOR: 11.5, 95 % CI:3.3–40.5), maternal hay fever history (AOR: 23.5, 95 % CI: 4.6–118.9) and atopic dermatitis history (AOR: 6.0, 95 % CI:1.0–35.6), Paternal asthma (AOR: 14.4, 95 % CI:4.0–51.7), Paternal hay fever history (AOR: 13.8, 95 % CI: 2.4–78.9) and personal asthma (AOR: 10.5, 95 % CI:1.3–85.6), and hay fever history (AOR: 12.9, 95 % CI:2.7–63.4), age at 3 months to 1 year (OR: 6.8, 95 % CI: 1.1–46.0) and weaning at 4 to 6 months age (AOR: 3.9, 95 % CI:1.2–13.3) were a significant predictors of atopic dermatitis.ConclusionIn this study the magnitude of atopic dermatitis was high in relation to other studies conducted so far in the country. Maternal, paternal, personal asthma, hay fever histories, maternal atopic dermatitis history, age of child and age of weaning were independent predicators of atopic dermatitis. Hence, the finding alert a needs of strengthening the national skin diseases prevention and control services in particular in skin care of children related to atopic dermatitis and others. In avoiding early initiation of supplementary feeding specially with personal and families with atopic problem needs further attention of prevention activities.

Retrospective Assessment of Malnutrition among Under-five Children in Ayder Referral Hospital, Tigray Ethiopia

Currently worldwide there are about 60 million children with moderate acute and 13 million with severe acute malnutrition. About 9% of sub-Saharan African and 15%of south Asian children have moderate acute malnutrition and about 2% of children in developing countries have severe acute malnutrition. The objective of aim the study was&lt;strong&gt; &lt;/strong&gt;to assess the magnitude of malnutrition in under five children in Ayder referral hospital using a retrospective cross-sectional study design. This study showed that male children, 168(58.1%), were higher than female, 121(41.9%).. Majority, 133(46%), were in the age group b/n 12 to 24 months .More than half, 186(64.4%) were rural dwellers. The types of malnutrition identified were Marasmus, kwashiorkor, Marasmic kwash and underweight which account for 116(40.1%), 69(23.9%), 54(18.7%) and 50(17.5%) respectively. Marasmus was the predominant type of malnutrition in all age groups of under five malnourished children with prevalence of 40.1% where as underweight was the prevalent type of malnutrition (17.3%). More over the infant feeding practices such as exclusive breast feeding, timely initiation of complementary feeding, and having history of breast feeding once in their life during infancy were relatively higher among the children as compared with other studies.

Retrospective Assessment of Malnutrition among Under-five Children in Ayder Referral Hospital, Tigray Ethiopia

Currently worldwide there are about 60 million children with moderate acute and 13 million with severe acute malnutrition. About 9% of sub-Saharan African and 15%of south Asian children have moderate acute malnutrition and about 2% of children in developing countries have severe acute malnutrition. The objective of aim the study was&lt;strong&gt; &lt;/strong&gt;to assess the magnitude of malnutrition in under five children in Ayder referral hospital using a retrospective cross-sectional study design. This study showed that male children, 168(58.1%), were higher than female, 121(41.9%).. Majority, 133(46%), were in the age group b/n 12 to 24 months .More than half, 186(64.4%) were rural dwellers. The types of malnutrition identified were Marasmus, kwashiorkor, Marasmic kwash and underweight which account for 116(40.1%), 69(23.9%), 54(18.7%) and 50(17.5%) respectively. Marasmus was the predominant type of malnutrition in all age groups of under five malnourished children with prevalence of 40.1% where as underweight was the prevalent type of malnutrition (17.3%). More over the infant feeding practices such as exclusive breast feeding, timely initiation of complementary feeding, and having history of breast feeding once in their life during infancy were relatively higher among the children as compared with other studies.

Prevalence of potenial drug-drug interactions among psychitric patients in Ayder referral hospital, Mekelle, Tigray, Ethiopia

Introduction: A clinically relevant drug-drug occurs when the effectiveness or toxicity of one medication is altered by the administration of another medicine. Potential Drug-drug interactions are an important cause of adverse drug reactions. Psychiatric patients are increasingly susceptible to drug interactions due to the polypharmacy, nature of the prescribed drugs and most of the drugs prescribed are either enzyme inhibitor or inducers. Objective: To determine the prevalence of the potential drug-drug interactions. Methodology: A retrospective cross sectional study was performed from to March to June, 2013. Medications on patients’ medical charts were reviewed and analyzed for potential drug-drug interactions based on Micromedex Online Drug Reference. Results: In our study, total of 463 potential drug-drug interactions were identified, with median number of one potential drug-drug interaction per patient. Overall 81.65 % of the patients had at least one potential drug-drug interaction; 49.5 % patients had at least one major; and 52.3 % had at least one moderate potential drug-drug interactions. The most frequent potential drug-drug interactions identified were Haloperidol-Trihexphenidyl 74 times and Chlorpromazine–Haloperidol 36 times. Conclusion: A high prevalence of potential drug-drug interaction is recorded in our study area. Most potential drug-drug interactions recorded in this stud may cause cardio toxicity and QT prolongation. Patients with the risk of cardiovascular comorbidities and those who are prescribed multiple medications need to be monitored more closely.

Antibiotics prescribing pattern in pediatric unit of Ayder referral hospital, Tigray region, Northern Ethiopia

Introduction: Antibiotics are among the most commonly prescribed drugs in pediatrics. Because of the emergence of antibiotic resistance, overall increase in health care cost and lack of uniformity in drug prescribing, monitoring as well as control of antibiotic use is important. Methodology: A retrospective crosssectional study was conducted to assess the prescribing patterns of antibiotics in the Pediatrics ward of the Ayder Referral Hospital from March until May 2013 based on patient medical records. A total of 190 patient medical records were taken in this study. Data was entered into the computer and analyzed by using Microsoft Excel 2007 and SPSS version 16.0. Results: The average number of drugs per patient was four and the average number of antibiotics per patient was two. More than 95% of the patients were exposed to at least two drugs. The maximum number of drugs per patient was ten while the maximum number of antibiotic per patient was five. The most common diseases were pneumonia 51 (16.3%), sever acute malnutrition 39(12.5%) and Acute gastroenteritis 21(6.7%). The most commonly prescribed antibiotics were ceftriaxone 76(19.6%), Gentamicin 59(15.8%) and Ampicillin 57(14.7%). Most of (71.8%) of the drugs were administered parentally. Pediatrics of age 1-5 years received more antibiotics than &lt; 1 and 5-14 years with proportion of 37.8%, 36.6% and 25.5% respectively. About 649 (94.9%) of all the drugs were prescribed by their generic name. About 651 (95.2%) of drugs were prescribed from Essential Drug List but 33(4.8%) were not. Conclusion: Children of age 1-5 years receive more antibiotic than other age group. Therefore, strategies that promote rational use of antibiotic should focus on these patients’ populations.

Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013

ObjectiveTo review cases of uterine rupture at a center in northern Ethiopia. MethodsIn a retrospective chart review, data were assessed for cases of symptomatic uterine rupture treated at Ayder Referral Hospital in Mekelle between January 1, 2009, and December 31, 2013. ResultsIn the 5-year study period, there were 5185 deliveries and 47 cases of uterine rupture, giving a rate of one case per 110 deliveries. All patients underwent laparotomy for suspected uterine rupture. Mean parity was 3.6 (range 0–8). The most common predisposing factors were cephalopelvic disproportion (35 [74%] patients), previous cesarean delivery (5 [11%)], and fetal malpresentation (4 [9%]). Hysterectomy was undertaken for 35 (74%) patients; the other 12 (26%) were treated conservatively by simple repair of the rupture. There were 44 (95%) stillbirths and 1 (2%) maternal death. ConclusionUterine rupture remains an important clinical problem in northern Ethiopia. Changes in the cultural preference for home delivery, better transport and referral systems, and improved obstetric training and hospital management of laboring women are needed.

Factors associated with medication adherence among patients with schizophrenia in Mekelle, Northern Ethiopia.

BackgroundNon-adherence to antipsychotic medication has a negative impact on the course of illness resulting in increased risk of relapse, rehospitalization and suicide, and increased costs to healthcare systems. The objective of this study was to investigate factors associated with medication adherence among patients with schizophrenia at Ayder Referral Hospital and Mekelle Hospital in Mekelle, Tigray region, Northern Ethiopia.MethodsThe study was a cross-sectional survey in which sociodemographic characteristics, drug attitudes, insight and side effects were measured and explored in terms of their relationship with medication adherence. A structured questionnaire as a data collection tool was used. Data were analyzed with the help of SPSS Version 20.0.ResultsA total of 393 patients participated, 26.5% were non-adherent to their antipsychotic medication. The factors significantly associated with better adherence were positive treatment attitudes (AOR = 1.40, 95% CI: 1.26, 1.55), fewer side effects (AOR = 0.97, 95% CI: 0.94, 0.99), awareness of illness (AOR = 1.44, 95% CI: 1.12, 1.85) and the ability to relabel symptoms (AOR = 1.57, 95% CI: 1.19, 2.07). However, khat chewers (AOR = 0.24, 95% CI: 0.09, 0.68), being illiterate (AOR = 0.13, 95% CI: 0.03, 0.47) and older age group (AOR = 0.03, 95% CI: 0.01, 0.16) were associated with less medication adherence.ConclusionsA high prevalence of medication non-adherence was found among patients with schizophrenia. Intervention strategies focused on educating the patients to better understand the illness, medications and their potential side effects might be useful in improving adherence to antipsychotic medication treatment.

Prevalence and Factors Associated With Diabetic Foot Ulcer among Adult Patients in Ayder Referral Hospital Diabetic Clinic Mekelle, North Ethiopia, 2013

Background: Diabetes mellitus is one of the most common metabolic disorders which is characterized by multiple long-term complications affecting almost every system in the body. Foot ulcer is one of the main complications of diabetes mellitus. The prevalence of foot ulcers ranges from 4% to 10% among persons diagnosed with diabetes mellitus. The objective of this study was to assess the prevalence factors associated with foot ulcer among diabetes patients in Ayder referral hospital. Methods: This institutional based cross sectional study was conducted in Ayder referral hospital from in December 2013-January 2014. Systematic random sampling was used to select 228 participants. Structured questionnaire developed from the literatures was used to collect data. Data analysis was done manually and summarized using descriptive statistics as well as texts, figures, and tables were used to present the findings. Data was collected after getting approval for the project proposal from Mekelle university department of nursing ethical review committee. Result: Among the 228 study participants all of them have regular follow up to the diabetic clinic of Ayder Referral hospital and 75% of them had type 2 diabetic mellitus. 12% of the 228 diabetic patients have foot ulcer currently with 38% of them are with Wagner’s grade 0 Conclusion: this study concluded that 12% diabetic patients have foot ulcer. The main reasons to develop foot ulcer were poor glycemic control, wearing inappropriate Shoes and having no special foot care.

Prevalence and Associated Factors of Sexually Transmitted Infections Based on the Syndromic Approach among HIV Patients in ART Clinic; Ayder Referral Hospital, Northern Ethiopia

Background: Sexually transmitted Infections represent a large burden of disease worldwide with an annual incidence of about 333 million cases. In Ethiopia, studies on Sexually Transmitted Infections (STIs) among HIV patients are very few; therefore, conducting research on STIs in general and among HIV patients in particular is an important input to design policy and strategy aimed at preventing and controlling the infections. Objective: To determine the prevalence and associated factors of sexually transmitted infections among HIV patients in ART clinic; Ayder referral hospital, Tigray, Ethiopia. Methods: Institution based cross sectional study design was conducted among 353 HIV patients in Ayder hospital, ART clinic from July to September 2014. A systematic random sampling technique was used to identify study subjects. Data were collected using structured questionnaire and entered into and analyzed using SPSS 20 for windows. Descriptive analyses were used to estimate the prevalence of STIs and selected characteristics of patients. The effects of predictors on having STIs were analyzed using logistic regression and their effects were depicted using OR adjusted for confounding. P-value less than 0.05 were considered as statistical significant for all tests. Result;: Among total respondents; 150 (42.5%) were male and 203 (57.5%) female HIV patients .The prevalence of sexually transmitted infections based on the syndromic approach was 8.5% with specific prevalence of (4.6%) urethral discharge syndrome,(2.8%) genital ulcer syndrome, none of them scrotal swelling syndrome, (2.5%) lower abdominal pain syndrome,(0.3%)inguinal bubo and (5.5%) had vaginal discharge syndrome. 8 patients (26.7%) had recurrent disease and 28 patients (93.3%) treated without their partners. After multivariable logistic regression analysis, age (AOR=11.3 (95%CI: 1.1-116.5), marital status (AOR=0.031 (95%CI: 0.001-0.93) and having new sexual partner within the last three months (AOR=152.7 (95%CI: 3.7-6274) were significantly associated with STI syndromes p-value<0.05. Conclusion and recommendations: The prevalence of sexually transmitted infections based on the syndromic approach among HIV patients was 8.5% and the factors associated with STIs among HIV patients were: age, marital status and having new sexual partner within the last three months. Moreover, further studies to explore the predictor variables are highly recommended.

Peer review report 1 on “Gastrojejunocolic Fistula after Gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases”

Peer review report 1 on “Gastrojejunocolic Fistula after Gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases”

A Joint Model for a Longitudinal Pulse Rate and Respiratory Rate of Congestive Heart Failure Patients: at Ayder Referral Hospital of Mekelle University, Tigray, Ethiopia

Pulse rate(PR) and respiratory rates(RR) are main symptoms of congestive heart failure(CHF) and the abnormal PR and RR are broad indicators of major physiological instabilities. The lower PR and RR are associated with a strong and healthier heart. CHF is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. The main objective of this study is, to investigate the joint evolution of PR and RR of CHF patients and identify the potential risk factors affecting the two end points. The latest data from Sep.2012 up to Aug.2013 have been taken from medical charts of 264 adult CHF patients to model separate and joint linear mixed effect for PR and RR. The baseline mean and standard deviation of PR and RR are 126.11 and 18.98 and 31.64 and 10.99 respectively. The association of the evolution for PR and RR was estimated to be (ρ=0.7054) which is statistically significant with 95% CI of (0.642, 0.769). PR and RR showed a decreasing pattern over time in both joint and separate models. Furthermore, a positive and significant association was observed between the two end points and all covariates except LVEF and time. Finally, to identify associated effect fitting joint model for paired endpoints is recommended.

ASSESSMENT OF DRUG USE AND EFFECT IN PREGNANT WOMEN ATTENDING ANTENATAL CARE IN HOSPITALS OF MEKELLE, TIGRAY, ETHIOPIA

Objectives: To assess the extent and nature of drug utilization among pregnant women attending antenatal care in hospitals of Mekelle, Tigray, Ethiopia. Methods: Institution-based cross sectional study was conducted by reviewing the antenatal care follow up cards and interviewing pregnant women using semi-structured questionnaire by nurses working in the four hospitals. Details of drugs self utilized and prescribed during the current pregnancy were investigated and categorized according to the United States Food and Drug Administration fetal risk classification. Data was analyzed using SPSS version 20.0. Result: Of the 400 participants, majority 199 (49.8%) were in age group of 26-36years. 38 (9.5%) and 8 (2%) have self utilized modern and herbal drugs, respectively. Majority 26 (59.1%) were analgesics. Most 32 (84.2%) of the self medicated modern drugs were from category C, followed by category B. Illiterates and secondary school complete participants have practiced self medication 3.7 times (AOR 3.65 (1.31, 10.20), p=0.014) and 4.03 times (AOR 4.03 (1.09, 14.96), p=0.038) more than the tertiary complete participants, respectively. Self medication use was 3.7 times more among non government employees than governmental employees (AOR 3.68 (1.11, 12.17), p=0.033). Forty one (10.2%) of the participants had chronic diseases where most 26 (39.4%) were from category C, followed by category D 17 (25.8%). Of all the participants, 249 (62.2%) consumed one or more prescription drugs, with 1.86±0.94 average number of drugs prescribed per pregnant women. Majority 190 (76.3%) were from category B, followed by category C 94 (37.8%), category A 53 (21.3%), category C/D 23 (9.2%), category D 22 (8.8%), category B/C 7 (2.8%), category A/C 3 (1.2%) and category X 1 (0.4%). One hundred one (40.6%) of the drugs were prescribed in Ayder referral hospital, followed by Mekelle 93 (37.3%), kalkidan 31 (12.4%) and Meskerem 24 (9.6%) hospitals. Majority of the drugs prescribed in each hospital were from category B (80 (32.1%), 71 (28.5%), 21 (8.4%) and 18 (7.2%), respectively. Antibacterial drugs were the most commonly prescribed 146 (38.7%). Conclusion: Majority consumed one or more prescription drugs. Most of them were from category B. Keywords: pregnancy, self medications, prescription drugs, US FDA fetal risk classification, Hospitals of Mekelle.