Dilla University Referral Hospital Research Articles

Prevalence, impact and associated factors of abnormal preoperative investigation result in patients undergoing surgery in Dilla University referral hospital, cross-sectional study

Background: As one domain of preoperative assessment, Pre-operative investigations are often ordered to evaluate patient’s medical condition, for risk stratification and assessing patient status to undergoing surgery. Despite the fact that laboratory testing can assist ensure the best possible preoperative condition, routine screening examinations have a number of drawbacks. Although there are evidence-based recommendations for which investigations should be done, the tradition of routine preoperative testing is still prevalent and clinical practice with abnormal result detected varies. Method: Institution based cross-sectional study design was conducted from July1 to September 30 at Dilla University Referral Hospital. Data was collected from complete pre-anaesthesia check-up sheets, investigations already done. It was collected at the individual level by using, closed ended self-guided questionnaire. The collected data was entered, cleaned, edited and checked using SPSS version 26 for data processing and analysis. Logistic regression was performed to examine impacts of abnormal preoperative investigation result and summarized by using tables and figures. An Adjusted odds ratio with 95% confidence interval was computed to determine the level of significance. Result: Data of 208 patients (65.9 female) with mean±standard deviation age 30.83±15.340 years and 22.59±2.99 BMI were analysed. Patients were mostly American Society of Anaesthesiologists I and II underwent National Institute of Clinical and Health Excellence Grade 2 surgeries and surgical shape class 3. Totally, 178 (44.5%) test results were abnormal. CBC is the most detected abnormal result. Only 15(3.75%) abnormalities had an impact in terms of delay, further investigations, and surgical technique. Comorbidity (AOR 7.982, 95% CI, P-value=0.041), medication history (AOR 1.463, 95% CI, P=0.013), ASA physical status II (AOR3.287, 95% CI, P=0.029) and history of smoking (AOR 1.577, 95% CI, P-value=0.049) were factors which was significantly associated with abnormal preoperative investigation result Conclusion: Only 0.6% of all tests had a significant impact in terms of changing perioperative anesthetic management. Significant impact of abnormal investigation result noticed was delay surgery

Effectiveness of different doses of dexmedetomidine on intraoperative haemodynamic profiles and postoperative pain in patients undergoing abdominal surgery at Dilla University Referral Hospital, Ethiopia, 2024: a double-blind randomized controlled trial.

Abdominal surgery stands as one of the most frequently conducted procedures across surgical specialties, accounting for up to half of surgery-related expenses. Hemodynamic instability emerges as a significant concern during anaesthesia and surgery, provoked by the stress of intubation, surgical incision, and anaesthetic agents. Following abdominal surgery, pain is an inevitable consequence, typically managed with opioid-based analgesia. However, the adverse effects associated with opioids often overshadow their analgesic benefits, particularly in the context of abdominal surgery. Consequently, there exists a necessity to explore and assess alternative non-opioid pain management options post-abdominal surgery as part of a broader strategy to reduce opioid usage. The primary aim of this investigation is to assess the effectiveness of varying doses of dexmedetomidine in regulating intraoperative hemodynamics and alleviating postoperative pain in patients undergoing abdominal surgery. Ethical clearance and institutional review board were obtained from the ethical clearance committee of Dilla University College of Medicine and Health Sciences with protocol unique number of duirb/008/22-01. Our trial has been prospectively registered on the Pan African Clinical Trial Registry with a unique identification number for the registry PACTR202208813896934. Statistical package and analysis were performed by using SPSS version 25. The distribution of data was checked by using Shapiro-Wilk test and the homogeneity of variance was checked by Levene's test. Analysis of variance (ANOVA) and Kruskal-Wallis H test were used for normally distributed continuous data and non-normally distributed or non-parametric data, respectively. P value less than 0.05 with a power of 90% was considered statistically significant. There was a statistically significant increase in mean SBP in the control group at the different critical time points (P<0.05), as compared to the baseline value, while there was no significant difference in mean systolic blood pressure (SBP) between the baseline and all other levels for group 2 and group 3. A statistically significant increase in mean arterial pressure (MAP) was detected in the control group at immediately after intubation (P=0.009) as compared to the baseline value, while a statistically significant reduction in mean heart rate (HR) was observed in group 3 at 15th min after infusion and at 30th 30 min after induction compared to baseline with a P value of 0.002 and 0.008, respectively.Conclusion:Perioperative low-dose infusion of dexmedetomidine at the rate of 0.4mcg/kg/h is a useful anaesthesia adjuvant to control hemodynamic stress response to critical periods. It is wise to use this infusion dose as part of general anaesthesia to achieve better hemodynamic stability.

Anti-Hypertensive Medication Adherence and Associated Factors among Adult Hypertensive Patients at Dilla University Referral Hospital, South Ethiopia

Background: Hypertension is a global public health challenge that contributes to the burden of hypertensive heart disease, stroke, renal failure, premature morbidity, and mortality. The availability of effective antihypertensive medications didn’t bring expected outcomes in terms of adherence for antihypertensive medication. Objective: The aim of this study was to assess antihypertensive medication adherence and associated factors among adult hypertensive patients at Dilla university referral hospital, Southern Ethiopia, 2021. Methods: A hospital-based cross-sectional study was conducted, at Dilla University Referral Hospital from June 10, 2021, to July 10, 2021, and 205 study participants were selected from the study population using a systematic random sampling procedure. Patients in the study were interviewed while their medical records were reviewed using a data abstraction sheet. Adherence was assessed using an eight-item Morisky Medication adherence scale (MMAS-8); a MMAS-8 score of less than 6 was considered non-adherence, and a MMAS-8 score greater than or equal to 6 was considered adherence. Factors associated with adherence were identified using binary and multivariate logistic regression analyses. The crude odds ratio and adjusted odds ratio with a 95% confidence interval were calculated using SPSS version 20. Variables with a P-value &lt;0.05 in the multivariable analysis were assumed to be statistically significant factors. Results: 205 respondents were interviewed, with a response rate of 100%. More than half (57.6%) of the study participants were male. 65.3% (58.784–71.816) of the study participants were found to be adherent to their medication. Longer Duration of diagnosis of hypertension (AOR =0.280, 95% CI = 0.025–0.836), participants who can’t read and write (AOR = 0.40, 95% CI = 0.00-0840), and traditional drug users (AOR =0.15, 95% CI =0.003-0.489) were inversely significant associated with antihypertensive medication adherence. Conclusion: An adhesion level of 65.3% was found to be suboptimal. Traditional drug users, being uneducated and the duration of the diagnosis of hypertension were adversely influencing medication adherence. Therefore, routine health education and awareness creation are strongly recommended

Postoperative analgesic effects of intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Ethiopia, 2023: a double-blind randomized controlled trial.

The use of cesarean section (CS) worldwide has increased to unprecedented levels. In Ethiopia, the CS delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. The administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed. This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Southern Ethiopia. A double-blinded randomized controlled trial (RCT) was done on 112 patients undergoing elective CS under spinal anesthesia who were allocated randomly into normal saline and dexamethasone groups. Total analgesic consumption, time to first analgesic request, and postoperative pain score with the numerical rating scale (NRS) were followed for 24 h in both groups. Shapiro-Wilk tests were used to check normality. Independent samples t-test was used for the comparison of means between groups, Mann-Whitney U test for non-normally distributed data, and χ 2 test for categorical variables, and P-value <0.05 was considered statistically significant with a power of 80%. The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group at 2, 4, 6, 12, 18, and 24 h with a statistically significant P-value <0.05. There was also a significant difference in the time to the first rescue analgesic request between the two groups, with the dexamethasone group (median=347.5 min) and the normal saline group (median=230 min) with P=0.001. The authors conclude that preoperative administration of 8 mg of dexamethasone prolongs the first analgesic request time, decreases postoperative tramadol and diclofenac consumption, and decreases the postoperative pain score. The authors recommend that researchers conduct further RCTs with a different dose of dexamethasone and on a multicenter basis.

Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles and Block Characteristics Among Parturients Undergoing Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial.

Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics. To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital. 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t-test or Mann-Whitney U-test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%. The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001). We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery.

Delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia, 2022: a cross-sectional study.

Delay in psychiatric treatment leads to increased morbidity and mortality, as well as the emergence of several psychiatric and physical comorbidities and the use of life-threatening and life-altering self-treatments (such as licit and illicit substance misuse). Delaying detection and taking preventive measures against its modifiable factors are crucial for a better prognosis. To assess delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia. An institution-based cross-sectional study was conducted between 8 June and 11 September at Dilla University Referral Hospital in the southern region of Ethiopia in 2022. Epicollect was used to collect data from 414 randomly selected participants using an interviewer-administered questionnaire. Delayed treatment seeking was determined using participants' medical records and a semi-structured questionnaire. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. A logistic regression analysis was conducted to identify the explanatory variables for delayed treatment. The magnitude of delayed treatment seeking was 49.8% (95%CI = 44.9, 54.3). Study participants with disengaged family cohesion [AOR = 3.97, 95%CI = (2.999, 7.193)], inflexible family adaptability [AOR = 2.00, 95%CI = (1.686, 4.044)], who lack awareness about the availability of psychiatric treatment [AOR = 1.63, 95%CI = (1.362, 2.626)], high internalized stigma [AOR = 3.24, 95%CI = (2.770, 5.514)], and those with a negative attitude toward psychiatric treatment [AOR = 2.88, 95%CI = (2.034, 4.469)] had delayed seeking treatment. However, the participants whose educational status was higher than diploma [AOR = 0.040, 95%CI = (0.026, 0.077)] and high school [AOR = 0.09, 95%CI = (0.071, 0.204)] were less likely to have delayed seeking treatment. There is a significant delay in seeking modern psychiatric treatment. Stigma, a lack of awareness of where treatment is available, disengaged family cohesion, inflexible family adaptability, distance to a health facility >5 km, and a negative attitude toward psychiatric treatment were barriers to seeking appropriate care.

Prevalence, Antibiotic Susceptibility Pattern, and Associated Factors of Enteric Bacterial Pathogens Among HIV Infected Patients with Diarrhea Attending the ART Clinic of Dilla University Referral Hospital, Southern Ethiopia.

In people with human immunodeficiency virus infection, diarrhea is reportedly associated with significant morbidity and mortality. Therefore, the aim of this study was to determine the prevalence, antibiotic susceptibility pattern, and associated factors of enteric bacterial pathogens among HIV infected patients with diarrhea attending the antiretroviral treatment (ART) clinic of Dilla University Referral Hospital, southern Ethiopia. This institutional-based cross-sectional study was conducted on 422 study participants attending at ART clinic of Dilla University Referral Hospital from March to August 2022. Demographic and clinical data were collected by using a semi-structured questionnaire. Stool specimens were inoculated on selective media like Butzller's medium and Xylose Lysine Deoxycholate (XLD) agar. Antimicrobial resistance pattern was assessed by using Kirby-Bauer disk diffusion techniques. Adjusted odds ratio (AOR) and 95% Confidence Interval (CI) was used to determine the presence of association. A total of 422 adult patients were enrolled in this study, 51.7% were females. The mean age of the study participants was 27.4 (±15.6 SD) years. The overall prevalence of enteric pathogens was 14.7% (95% CI=11.4-18.2). Shigella spp was the most prevalent organism. Being a farmer (AOR=5.1; 95% CI=1.4-19.1; p<0.015), the habit of hand washing after toilet (AOR=1.9; 95% CI=1.02-3.47; p<0.04), low CD4 cell count of <200 cells (AOR=2.22; 95% CI=1.15-4.27; p<0.02), and longer duration of diarrhea (AOR=2.68; 95% CI=1.23-5.85; p<0.01) were statistically associated. In total, 98.4% of enteric bacterial isolates were sensitive for Meropenem, whereas 82.5% were resistant against Ampicillin. Multidrug resistance was detected in 49.2% of enteric bacteria. We found that enteric bacteria are common causative agents of diarrhea in immune-compromised patients. The high rate of drug resistance calls for escalating antimicrobial susceptibility testing before prescribing antimicrobial agent.

Cognitive disorder and associated factors among pregnant women attending antenatal service at Dilla University Referral Hospital, 2022.

Cognition is defined as the mental activity or process of learning information and understanding through reason, experience, and the senses. In Sub-Saharan African nations like Ethiopia, such assessments of a pregnant mother's mental health during antenatal care are uncommon procedures. Instead, there is a greater focus on the physical well-being of the woman and her fetus. As a result, this study aimed to evaluate the cognitive deficits and related factors in a pregnant women attending an antenatal care service. This hospital-based cross-sectional study included 415 pregnant women who were receiving antenatal care at Dilla University Referral Hospital in Dilla, Gedeo Zone, Ethiopia. In this study, respondents were chosen using systematic random sampling, and study participants were interviewed using administered questions to gather pertinent data. This study used the OSLO Social Support Scale, the Alcohol, Smoking, and Substance Involvement Screening Test, and the Mini-Mental Status Examination to assess the social support, cognitive status, and current substance use history of a respondent. Descriptive statistics including frequencies, graphs, and percentages were used to describe the results. A logistic regression analysis was conducted to determine the connection between independent factors and the outcome variable at a 95 percent confidence level and p < 0.05. Among all respondents who came for antenatal care visits, only 24 (5.8%) were unmarried (single, divorced, widowed). The mean age of respondents was 26 years old and 155 (37.3%) had attended secondary school. Variables such as strong social support [0.11 (0.03-0.23), p < 0.02], being a follower of orthodox religion [0.24 (0.12-0.39), p < 0.04], ≥5,000 Ethiopian birr monthly income [0.28 (0.17-0.48), p < 0.02], age >26 years old [1.23 (1.14-2.54), p < 0.04], unplanned pregnancy [2.78 (1.45-4.32), p < 0.02], and rural residence [3.90 (2.23-7.34), p < 0.04] were significantly associated with cognitive impairment at 95% confidence interval and a p-value <0.05. This study found that pregnant women who attended antenatal care experienced a significant reduction in cognitive disorders. Additionally, this study revealed adjustable factors such as unwanted pregnancy, social support, and religiosity. It is preferable to check a pregnant woman's cognitive condition at antenatal services and to follow-up on each additional visit.

Artificial Intelligence and Machine Learning Based Prediction of Viral Load and CD4 Status of People Living with HIV (PLWH) on Anti-Retroviral Treatment in Gedeo Zone Public Hospitals.

Despite the success made in scaling up HIV treatment activities, there remains a tremendous unmet demand for the monitoring of the disease progression and treatment success, which threatens HIV/AIDS treatment and control. This research presented the assessments of viral load and CD4 classification of adults enrolled in ART care using machine learning algorithms. We trained, validated, and tested eight machine learning (ML) classifier algorithms with historical data, including demographics, clinical, and laboratory data. Data were extracted from the ART registry database of Yirgacheffe Primary Hospital and Dilla University Referral Hospital. ML classifiers were trained to predict virological failure (viral load >1000 copies/mL) and poor CD4 (CD4 cell count <200 cells/mL). The model predictive performances were evaluated using accuracy, sensitivity, specificity, precision, f1-score, F-beta scores, and AUC. The mean age of the sample participants was 41.6 years (SD = 10.9). The experimental results showed that XGB classifier ranked as the best algorithm for viral load prediction in terms of sensitivity (97%), f1-score (96%), AUC (0.99), accuracy (96%), followed by RF. The GB classifier exhibited a better predictive capability in predicting participants with a CD4 cell count <200 cells/mL. In this study, the XGB and RF models had the highest accuracy and outperformed on various evaluation metrics among the models examined for viral load classification. In the prediction of participants CD4, GB model had the highest accuracy.

Determinants of postoperative emergence delirium in patient undergoing general anesthesia in Dilla University referral hospital. A case-control study.

Delirium is affecting of concentration, decreases the ability to forward-thinking, attention, sustainability, change, and decreases orientation to the environment. Delirium has a serious impact on the overall outcome of the patient. Post-operative emergence delirium (POED) increases hospital mortality by 5% and post-discharge hospitalization by 33%, compared to those without postoperative delirium. Postoperative delirium incidence has different summative risk factors and recognizing the multiple risks of delirium complications may help the clinician to design supportive measures to prevent delirium. Delirium can cause a series of outcomes and is increase the length of hospital stay, independent predictor for intensive care unit (ICU) admission and institutional morbidity and mortality, increase institutional care, for those patients and increase hospital expenses. Unmatched case-control study was employed from September 2019 to October 2020. This study was conducted on 264 patients above 18years. A structured questionnaire prepared in English was used for data collection. Data were analyzed by using the SPSS software. Bivariate and multiple logistic regression models were used to identify associated risk factors for incidence of POED and a P-Value of less than 0.05 was the risk factor for this medical condition. Out of 264 participants included in the study 56.4% were female. ASA I and II constitute 97.4%. Substance abuse, premediate with diazepam, & ketamine were high risk for POD with p-value of 0.000, 0.005, & 0.047 respectively. We conclude that older age, current substance use, Coexisting disease, Benzodiazepine exposures, Ketamine, ASA physical status, and coexisting disease were determinant risk factors for postoperative delirium clients undergoing general anesthesia.

Magnitude of surgical site infection and determinant factors among postoperative patients, A cross sectional study

Surgical site infections (SSIs) are infections that occur within 30 days of surgery or within 1 year in patients with implants at or around the surgical site. They are among the dangerous complications of surgical procedures that expose patients to higher costs and increase the risk of death because of severe morbidity and associated longer hospital stays. This study aimed to determine the extent and determinants of surgical site infections in surgically treated cases during the study period. A hospital-based cross-sectional study was conducted among surgically treated patients at Dilla University Referral Hospital in the surgical department. The calculated sample size was 408, calculated using the single population proportion formula, and the required information was collected from the medical records of the study participants using checklists. Bivariate logistic regression was performed to identify candidate variables, and all candidate variables with a P-value < of 0.25 were included in multivariable logistic regression. Variables with a P-value < 0.05 were considered statically significant, and the strength of association was measured by odds ratio (OR) with 95% confidence intervals (CIs). As our finding showed magnitude of surgical site infections was 19.3%. The factors which had significant association with surgical wound infections were blood transfusion (AOR=0.16 (0.04-0.73), hemoglobin level < 7g/dl (AOR=10.40 (3.39-32.49), shock (AOR=19.09 (4.69-77.51), previous surgery (AOR=11.53(3.73-35.61), hospitalization 7-14 days (AOR=5.51(1.52-19.91) and hospitalization >14 days (AOR=8.18(1.84-36.75). The percentage of surgical site infections was high. Shock, low haemoglobin level, blood transfusion, previous surgery, and longer length of hospital stay were significantly related to surgical site infections.

Self-referrals and associated factors among laboring mothers at Dilla University Referral Hospital, Dilla, Gedeo Zone, Ethiopia: a cross-sectional study

BackgroundWhen medical cases are difficult to manage at the level of primary health care units (PHCU), formal referral assists patients transferring to a higher level of care. In contrast, self-referral and bypassing are synonymously used in literature to describe the phenomenon of patients skipping their units to get basic medical services, even though they are close to their residence. Though proper and timely referral prevents the majority of deaths from obstetric complications in developing countries, more than 50% of referrals are self-referral trends. Such patient practice is increasingly becoming a concern for many health-care systems.ObjectiveTo assess the magnitude of self-referrals and associated factors among laboring mothers at Gedeo Zone, Ethiopia.MethodsFacility-based cross-sectional study was conducted from August 1-September 30/2021 among laboring mothers at Dilla University Referral Hospital. A systematic random sampling technique was used to select 375 laboring mothers. Data were collected using a face-to-face interview with a structured questionnaire. Data were entered into a computer using Epi-Data 4.6 statistical program and then exported to STATA version 16 for analysis. In bivariate analysis variables with a p-value ≤ 0.25 were selected as a candidate variable for the multivariable analysis. P-value < 0.05 at 95% confidence interval considered as a statistically significant associations in the multivariable analysis.Result375 eligible mothers participated in the study, with a response rate of 98.16%. The magnitude of self-referrals among laboring mothers was 246 (65.6%) with 95% CI (0.60–0.70). Time ≥ 30 min to reach nearby facilities (AOR = 1.74, 95% CI, 1.08, 2.81), having no medicine supplies at nearby facilities (AOR = 1.75, 95% CI, 1.08, 2.82), having no equipment and supplies at nearby facilities (AOR = 1.70, 95% CI, 1.03, 2.78), having ANC visits ˃ 3 times (AOR = 0.29, 95% CI, 0.15, 0.55) and having poor perception of health provider technical competence at nearby facilities (AOR = 2.97, 95% CI, 1.83, 4.79) were found as significant factors for self-referral.ConclusionThe magnitude of self-referral was high. Frequent Antenatal visits were protective, however time to reach the nearest facilities, perception towards health care providers, medicine, equipment and supplies at the nearest facilities were positive influencing factors. Government stakeholders should keep working on improving the quality of health service, especially at primary health care units(PHCU).

Knowledge, attitude, and practice towards basic life support among graduating class health science and medical students at Dilla University; a cross sectional study

IntroductionBasic Life Support is a level of medical care Applied to victims of life-threatening illnesses and injuries before professional help is provided. This study aimed to assess the knowledge, attitude, and practice toward Basic Life support in Graduating class of health science and medical students at Dilla university referral hospital. Methodology: A cross-sectional study was conducted on graduating class students of Dilla University, college of medicine and health science from September 10/2021 to December 13/2021. A total of 167 participants were selected by a systematic random sampling technique. A bi-variable and multi-variable logistic regression analysis were carried out. ResultAmong the study participants, 95 (56.9%) and 86(51.5%) have good knowledge and good practice towards basic life support respectively. Being trained for basic life support and advanced life support, exposure with the person in need of basic life support were found more knowledgeable with odd ratio of [AOR = 13.8, 95% CI (6.3–30.1)], [AOR = 27.7, 95% CI (6.4–119)] and [AOR = 15.7, 95% CI (6.6–37.5)]. Learning anesthesia increases knowledge about basic life support nearly two times [AOR = 1.8, 95% CI (o.4–9.5)] when compared to medicine. ConclusionThe findings of this study suggest that nearly half of health science students in our hospital lack adequate knowledge and skills in BLS. Training on basic life support and advanced life support, learning in anesthesia and medicine departments, and exposure to the person in need of basic life support were significantly associated with high knowledge. To increase knowledge of BLS standardized Training and assessments are recommended.

Prevalence and Multi-Drug Resistance of Streptococcus pneumoniae Infection Among Presumptive Tuberculosis Adult Cases at Dilla University Referral Hospital, Dilla, Ethiopia.

IntroductionStreptococcus pneumoniae is the leading cause of community-acquired pneumonia in Africa. The simultaneous occurrence of both infections leads to delayed diagnosis and inadequate treatment. The study aimed to determine the prevalence, antimicrobial susceptibility pattern and associated factors of Streptococcus pneumoniae infection among presumptive Tuberculosis adult cases at Dilla University Referral Hospital, Dilla, Ethiopia.MethodsAn institution-based cross-sectional study was conducted on 422 presumptive TB cases visiting TB clinic at Dilla University Referral Hospital from April to June 2021. Following the Bartlett’s criteria, the accepted sputum samples were cultured on Blood agar plate and chocolate agar plate. Streptococcus pneumoniae was identified and confirmed by typical colony morphology, alpha-hemolysis, gram staining, optochin susceptibility and bile solubility tests. Antimicrobial susceptibility test was done by using the Kirby-Bauer disc diffusion method. Semi-structured questionnaires were used to collect data. Bivariate and multivariate logistic regression analyses were done by using SPSS version 23.0, computer software.ResultsThe overall prevalence of S. pneumoniae in presumptive tuberculosis adult cases was 21.4% (95% CI: 17.7–25.5). S. pneumoniae has a high level of resistance to penicillin (74.1%), tetracycline (78.7%) and Trimethoprim-sulfamethoxazole (46%). Multidrug resistance was observed in 46.1% of bacterial isolates. Being primary education, more than five family size and one or two rooms in the house had more likely to cause S. pneumoniae infection.ConclusionThis study revealed a relatively high prevalence of multidrug resistance of Streptococcus pneumoniae infection. Primary educational status, living in a crowded family, below two rooms in the house, had a significant association with S. pneumoniae infection.

Assessment of patient’s perception and knowledge towards anesthesia services at Dilla University Referral Hospital, South Ethiopia, 2021: a cross-sectional study

Background: The poor community understanding of anesthesia professionals and their discipline has been a long-standing and obvious problem. Many studies have been done in the developed countries investigating public awareness of anesthetists but there are few publications from the developing countries including Ethiopia. Patients’ knowledge of anesthetists and their roles inside and outside the operation theatre is poor worldwide. Objective: This study is aimed to assess patients’ perception and knowledge of anesthesia service among patients admitted for surgery at Dilla University Referral Hospital (DURH), Southern Ethiopia, 2021. Methods: An institutional-based cross-sectional questionnaire survey was carried out on consecutive adult patients aged 18 years and above that had undergone surgery at DURH, conducted over four months. Data were presented using tables, and graphs and summarized by using dummy tables. After carefully analyzing the collected data, a conclusion was made with constructive recommendations. Result: A total of 396 patients were initially included in the study while 27 patients declined to participate with a 93% response rate. The mean age of participants was 39.5±14.9 years, and more than half of the respondents 225 (61%) were male. Regarding the type of surgery done 238 (64.6%) respondents were emergency the rest of 35.4% were elective surgery. Of 369 respondents, only 42% knew that anesthetist is the one who gives anesthesia and 38% knew that a doctor does. Conclusion: The perception of most patients is that anesthesia is all about “putting patients to sleep and waking them up.” There was poor knowledge of patients regarding the role of anesthetists beyond the confines of the operating theater. Therefore, there is a need for intensified public education on the importance of anesthesia and the diverse roles anesthetists play in ensuring holistic health care delivery.

Determinants of neonatal mortality in the neonatal intensive care unit of Dilla University Referral Hospital, Southern Ethiopia; 2019–2020; A matched, case–control study

BackgroundNeonatal mortality rate (NMR) refers to the number of deaths occurring from birth to 28 days of life per-1000 Live Births (LB). The global NMR declined from 37 deaths per- 1,000 LB in 1990 to 18 in 2017, whereas it was 27 deaths per 1000 LB in the Sub-Saharan region. Ethiopia plans to reduce the NMR from 28 deaths to 11 deaths per 1,000 LB by 2020 and to end all preventable child deaths by 2035. The aim of this study was to identify the determinants of neonatal mortality in the neonatal intensive care unit (NICU) of Dilla University Referral Hospital (DURH). MethodsAn age-matched case control study was conducted at DURH's NICU. Two controls having age 2 days before or after the case were used for matching. One hundred eighteen cases (died) and 236 controls (survived) neonates admitted to the NICU from January 11, 2018, to February 25, 2020, were studied. Missed data were filled by multiple imputations. Multicollinearity was checked by the variance inflation factor. For variables with a P-value <0.2 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was performed to control for confounders using clogit command in a survival package to identify the risk factors for neonatal mortality using R version 3.6.3. ResultGestational age <37 weeks (Adjusted matched odds ratio (AmOR): 14.02; 95% confidence interval (CI): 3.68–53.46), first-minute APGAR score <7 (AmOR: 5.68; 95% CI: 1.76–18.31), perinatal asphyxia (PNA) (AmOR: 4.62; 95% CI: 1.15–18.53) and being twins (AmOR: 6.84; 95% CI: 1.34–34.96) were significantly associated with neonatal deaths in our study. Furthermore, antenatal care and follow-up during pregnancy (AmOR: 0.15; 95% CI: 0.04–0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95% CI: (0.02–0.66) were found to be determinant of neonatal mortalities in our study. ConclusionGestational age less than 37 weeks, first-minute APGAR scores <7, being twins, diagnosis of PNA, antenatal care and follow-up of mothers during pregnancy and normoglycemia in neonates at admission were significant determinant of neonatal death in the NICU of DURH.

Magnitude of patient satisfaction and its associated factors at the outpatient psychiatry service of Dilla university referral hospital, Southern Ethiopia, Dilla, 2020.

BackgroundPatient satisfaction is a subjective attitudinal response of a client to a health institution’s services and a pillar of quality assurance. Patients who are happy with their treatment are much more likely to stick with it, improve quickly, and function normally. Satisfied patients are more compliant, improve faster, and are more functional. However, there haven’t been enough studies conducted across the country, and none have been conducted in this study area. As a result, the purpose of the study was to estimate the size of patient satisfaction and associated determinants at Dilla University Referral Hospital’s psychiatry unit in Dilla, 2020.MethodsThis was a hospital-based cross-sectional study design utilized using a simple random sampling technique. To assess patient satisfaction, we used the 24-item Mental Health Service Satisfaction Scale which was a validated tool in Ethiopia. The link between the outcome and the independent variable was determined using linear regression analysis (P< 0.05).ResultThis study enrolled 409 respondents with a response rate of 97%. The overall mean percentage score of patient satisfaction was 55.4% (95% CI (48.4%– 59.2%). Having bipolar disorder diagnosis [β = -2.93, 95% CI (-4.33, -1.96), p = .000], distance from the hospital [β = -2.34), 95% CI (-3.765, -1.735), P = .001], waiting time [β = -2.19, 95% CI (-3.49, -1.10), p = .000], monthly income (2.95, 95% CI (1.65, 5.23) and Urban residence (β = 1.43, 95% CI (1.03–3.43), p = 0.01) were variables significantly associated with perceived patient satisfaction.Conclusions and recommendationsIn this study, more than half of the respondents scored above the mean percentage score of patient satisfaction. The amount of time spent in the waiting area and the distance traveled to the hospital were identified as variables that could be improved by working with different stakeholders.

Laboratory Findings in Different Disease Status of COVID-19 Admitted Patients at Dilla University Referral Hospital Treatment Center, South Ethiopia.

BackgroundMillions were infected and many were dying because of the coronavirus disease 2019, since its emergence. The patients experience asymptomatic, mild, moderate, severe and critical disease with varying signs and symptoms. Decreased lymphocytes and abnormal liver and renal function tests are common among COVID-19 patients. Severe and critical cases show higher number of white blood cells, and neutrophils. However, studies showed different laboratory findings in different disease status. Therefore, this study investigated laboratory findings of COVID-19 admitted patients at Dilla University Referral Hospital treatment center, South Ethiopia.MethodsA retrospective study design was conducted on 220 patients confirmed by real time polymerase chain reaction, and admitted to Dilla University Referral Hospital treatment center from September 2020 to July 2021. Data were collected from the patients’ record, and analyzed by GraphPad Prism version 8.0.1.244 software. Descriptive statistics were used to analyze the frequency while independent t-test was used to compare means of each parameter for each disease status.ResultsOf the 220 study cases, 120 (54.5%) were severe, 89 (40.5%) were moderate and 11 (5.0%) were mild. One hundred forty (71.1%) of the 197 laboratory tested cases, 87 (77.7%) of severe, and 49 (64.5%) of the moderate cases had neutrophils above normal range. However, 134 (68.0%) of them, 82 (73.2%) of severe and 49 (64.5%) of moderate cases showed decreased lymphocyte level. Most of the cases showed an increased level of aspartate transaminase, alanine transaminase, alkaline phosphatase, total bilirubin, and total calcium. There was statistically significant mean neutrophils (p=0.04), number of white blood cells (p= 0.02), and creatinine level (p=0.00) difference between severe and mild cases.ConclusionMost of the severe COVID-19 patients showed increased neutrophils, liver function tests; and decreased lymphocytes; suggesting higher inflammation and lymphopenia. Therefore, patients with severe and critical disease status require close follow-up.

Psychological Distress and Associated Factors Among Patients Attending Orthopedic Unit, Dilla University Referral Hospital, Dilla, Gedeo Zone, South Ethiopia 2021

Background: Psychological discomfort is a state of emotional distress caused by everyday stressors and obligations that are difficult to manage. It’s one of the most common mental health problems on the planet. The physical status of a person has an impact on his or her psychological well-being, and if not handled well, it will eventually have an impact on his or her well-being. Orthopedic trauma has a wide range of effects on survivors’ physical health, as well as a variety of mental health concerns that impede recovery. Psychiatric problems and behavioral abnormalities are 3-5 times more common in people who have been harmed, and they are a predictor of poor outcomes. It is crucial to begin further therapies as soon as possible.

Assessment of postoperative patient handover practice and safety at post anesthesia care unit of Dilla University Referral Hospital, Ethiopia: A cross-sectional study

IntroductionGood handover creates a common understanding of responsibility and patients’ status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams. MethodologyA descriptive cross-sectional study was conducted at post anesthesia care unit of Dilla University Referral Hospital from October 1 to November 30, 2020. To conduct the study, consecutively selected 208 handovers of patients from operation theatre (OT) to PACU were assessed. A checklist was developed based on a combination of criteria adopted from the Australian Medical Association 2006 and British Doctors Committee 2004. It was pilot tested and changes were made before the actual data collection. ResultOur study found that the postoperative patient handover practice among professionals was poor (below 50%) in the areas of patients’ full name, age, medical registration number (MRN), ASA class, allergic history, medical history, baseline vital signs, preoperative diagnosis and surgical procedure performed. Our study also found poor postoperative hand overing regarding the intraoperative blood loss 9.6%, intraoperative clinical incidents 5.3%, recovery condition 7.2%, postoperative analgesia plan 18.8%, and post operative antibiotic plan 8.2%. Whereas, type of anesthesia 81.3%, intraoperative vital signs 80.8%, and intraoperative analgesia used 79.8%, intraoperative fluid management 80.8% were among the indicators with >50% completion rate. Conclusion and recommendationOur study found a poor practice of patient handover regarding sociodemographic and preoperative profile, anesthesia, surgery and other necessary information. We believe standardizing this process and providing training will improve the quality of postoperative handovers and the safety of patients during this critical period.