Jimma University Hospital Research Articles

Investigating the knowledge, perception, and practice of healthcare practitioners toward rational use of compounded medications and its contribution to antimicrobial resistance: a cross-sectional study

BackgroundPharmaceutical compounding ensures access of individuals with specific requirements to individualized therapy. However, there is an inconsistency of compounded medication quality. Therefore, advancing the rational use of compounded medication is essential for patient safety and medication effectiveness.ObjectiveThe presented study was aimed to investigate the healthcare practitioners’ knowledge, perception, and practice of extemporaneous compounding and its contribution to the prevalence of antimicrobial resistance.MethodA descriptive cross-sectional survey using a structured questionnaire was conducted. The study participants were 300 healthcare practitioners working in Jimma University Medical Center, hospital pharmacies, and community pharmacies in Jimma and Mettu Town, Southwest Ethiopia.ResultsMost respondents were pharmacists (62.7%) and first-degree holders (48.3%). The majority of them had experience in administering (57.7%), preparing (38%), prescribing (21%), and repackaging and labeling (14%) compounded medications. Commonly they request compounded medications when prepackaged products (77.7%) and needed dosage regimens (72.3%) were not available in the market. However, most of them believed that compounded medications might lack quality (49%) and had poor patient compliance (40.7%). Moreover, they fear that inappropriate preparation processes (75%) and under-dose administration (59%) of compounded medication might contribute to the development and prevalence of antimicrobial resistance.ConclusionMost healthcare practitioners practice rational use of compounded medications and strongly agree that inappropriate compounding of antimicrobials contributes to antimicrobial resistance development.

#70: Comparing Prospectively Identified Etiologic Agents of Neonatal Sepsis in Southwest Ethiopia with WHO Empiric Antibiotic Guidelines

Abstract Background Neonatal sepsis accounts for one third of global neonatal mortality. To improve access to treatment for neonatal sepsis, in 2015 the World Health Organization (WHO) released guidance for outpatient treatment (when referral is not possible or refused) of Possible Serious Bacterial Infection (PSBI).1 However, studies from low and middle-income countries suggest that bacteria causing neonatal infection differ from high-income countries, with higher rates of Staphylococcus aureus, Escherichia coli, and Klebsiella species and high rates of antimicrobial resistance. For this reason, local surveillance is vital to develop local antibiograms and tailor appropriate prescribing. Methods This is an analysis of the first 6 months of a prospective study of young infants admitted to Jimma University Hospital with PSBI. Young infants admitted to Jimma University Hospital with PSBI (defined by WHO danger signs: poor feeding, seizures, fever, lethargy, hypothermia, tachypnea, and increased work of breathing) are being recruited over a 12-month period. Blood cultures are obtained on admission, incubated in the BACTEC system and positive cultures evaluated for antibiotic susceptibility by Kirby-Bauer Disc diffusion. Primary outcomes are culture positivity, organism identification, and rates of antimicrobial resistance. Secondary outcomes include mortality rates and duration of hospital stay. The data included in this analysis were collected from March 21, 2019, through September 20, 2019. Data collection is ongoing. Results In total, 196 infants have been enrolled with a culture positivity rate of 58%. At this time, most frequently identified organisms are Klebsiella spp. (43.4%) and Staphylococcus aureus (12.2%). Gram-negative rods represent 67.8% of the isolates and gram-positive cocci 32.2%. Less than half the isolates (44.4%) were susceptible to either first-line antibiotic (ampicillin and gentamicin). Only 17.4% of the gram-positive cocci were sensitive to oxacillin. In-hospital mortality rates for those with positive cultures approached 15% (compared with 5% for culture negative). The average hospital stay for infants with positive cultures was 13.9 days compared with 10.1 for those with negative cultures. Conclusion Klebsiella spp. are responsible for a plurality of neonatal sepsis admissions at Jimma University Hospital. The organisms responsible for neonatal sepsis in southwest Ethiopia are highly resistant to the WHO recommended first-line antibiotics. It is possible that adoption of the WHO guidelines may be inappropriate in this population, which could be better served by tailoring empiric antibiotics to the identified organisms. Reference 1. World Health Organization. Guideline: Managing possible serious bacterial infection in young infants when a referral is not feasible. (2015) Geneva, CH.

Development and Optimization of Biochar from Pyrolysis of Combustible Healthcare Waste

TPS 624: Exposures to pops, voc and other chemicals, Johan Friso Foyer, Floor 1, August 26, 2019, 3:00 PM - 4:30 PM Background: Inappropriate hazardous healthcare waste management practices have direct and indirect effects on the environment and human health causing air, water and land pollution. Treatment of healthcare waste by incineration and sanitary land fill release pollutants in the environment. This study was aimed at developing and optimizing the production of bio-char from combustible healthcare waste and compare pyrolysis efficiency and calorific value of locally made pyrolysis equipment with commercial one. Methods: Healthcare wastes were collected from different wards of the Jimma University Hospital for seven consecutive days in 2017. The wastes were segregated to separate the organic biomass, mixed, weighed, sterilized, dried, shredded, and samples taken for pyrolysis. Pyrolysis experiments were carried out on a fixed bed of reactor under atmospheric pressure at different temperatures of 300° and 400°C using both locally made and commercial pyrolysis equipment. Results: About 65% of the general healthcare waste was found to be combustible. Higher temperature gave less char in all types of pyrolysis reaction. Volatile matters were observed to be nearly the same figures in all observations. The yield of the bio-char at 300°C for commercial pyrolysis and Local pyrolysis was 40.56 and 33.13 w.t% and was estimated to produce bio-char of heating value of 24.85 and 25.83 MJ/Kg respectively. There was less bio-char yield and calorific value in the bio-char produced by commercial pyrolysis at 400°C. Generally the calorific value of bio-char produced by both local and commercial pyrolysis fulfills FAO standards. Conclusions: Combustible healthcare wastes have the potential to be a very effective feedstock for bio-char production. For energy efficiency, both local and commercial pyrolysis at 300° were recommended. Pyrolysis of healthcare waste in different proportion by mixing with municipal solid waste may need another investigation. Life cycle analysis shows that bio-char reduces greenhouse gas emission.

Infection control practices in Jimma, Ethiopia

Healthcare-associated infections (HAIs) are frequent adverse outcomes of medical care. The HAI burden in low- and middle-income countries is much higher and associated with more severe outcomes. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework that can be used to identify barriers and facilitators of infection control practices and evaluate interactions between structures, processes, and outcomes. 
 A qualitative study was done to evaluate the implementation of effective infection control practices at Jimma University Hospital in Jimma, Ethiopia. Twenty-two semi-structured interviews of hospital employees, selected by convenience sampling, were conducted to assess the five components of SEIPS framework: person, physical environment, tasks, organization and tools. The interviews were transcribed, coded for themes, and analyzed using the software Dedoose (Version 8.0.42 SocioCultural Research Consultants, Los Angeles, CA).
 Staff overwhelmingly reported a shortage of personal protective equipment (PPE) as a barrier to adequate infection prevention and control (IPC) practices but cited poor supply chain management versus financial resources as the cause. Most interviewees also noted unreliable water availability as an impediment for hand hygiene. Prominent facilitators of effective IPC included a manageable workload, sufficient budget, and positive individual attitude towards improving IPC. The major barriers were identified as an inconsistent and incomplete training program for employees, a lack of IPC policies, and a nurse rotation program that increases unit staff turnover. 
 Interventions designed to address the identified barriers include developing IPC policies and protocols, regularly scheduled IPC training, and establishing an HAI surveillance program to better identify IPC trends and track progress. Innovative interventions are needed to improve IPC practices, such as faculty training on supply chain management and utilization of simple local resources to increase hand washing practices.

454. Barriers and Facilitators to Control of Hospital Acquired Infections in Jimma, Ethiopia

BackgroundGiven the complex, interdisciplinary nature of infection prevention, a systems approach may be useful to promote and sustain effective infection prevention practices. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework that can be used to identify barriers and facilitators of infection control practices and evaluate interactions between structures, processes, and outcomes.MethodsA qualitative study was done to evaluate barriers and facilitators to implementation of effective infection control practices at Jimma University Hospital in Jimma, Ethiopia. Twenty-two semi-structured interviews of hospital employees, selected by convenience sampling, were conducted to assess the five components of SEIPS framework: person, physical environment, tasks, organization and tools. The interviews were transcribed, coded for themes, and analyzed using the software Dedoose.ResultsThe primary facilitators to effective infection control were identified at the task, organization, and person level. Prominent themes included a manageable workload, a management system supportive of institutional feedback, sufficient budget, and positive individual attitude toward improving infection control. The primary barriers to effective infection control were found to be at the technology and tools, person, and organization levels. The major themes within these levels include poor supply chain management leading to personal protective equipment (PPE) shortages, an inconsistent and incomplete training program for employees, a lack of infection control policies, a lack of involvement of environmental services, and a nurse rotation program that increases unit staff turnoverConclusionTo address the identified barriers, possible interventions to consider should include: developing infection control policies and protocols, using these to implement a regular staff training program, incorporation of environmental services to the healthcare team, identify and train infection control team member to manage the PPE supply chain, and establishing an HAI surveillance program to better identify current risk areas as well as track progress.Disclosures All authors: No reported disclosures.

Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: A prospective study.

BackgroundThe mortality and neurologic sequelae associated with acute bacterial meningitis (ABM) remain high despite advances in medical care. The main aim of this study was to evaluate short-term outcome in patients treated as bacterial meningitis at a teaching hospital in Ethiopia to identify factors that could be focused on to improve outcome in this setting.MethodsA hospital based longitudinal study was conducted at Jimma University Hospital in southwest Ethiopia from March 1, 2013 to December 31, 2015. Participants of this study were patients of age 18 years and older who were treated as confirmed or possible cases of ABM. Patients were followed throughout their hospital stay for change in their clinical course and predefined end points. A multivariable analysis was done to identify factors associated with unfavorable outcomes.Result90 patients admitted with diagnosis of acute bacterial meningitis were included in the study; cerebrospinal fluid was analysed for 85 (94.4%) of them. Causative bacteria were isolated in 26 (28.9%) patients only; most of these isolates (84.6%) were either Streptococcus pneumoniae or Neisseria meningitidis. Patients managed as cases of ABM at the hospital suffered from a high rate of unfavorable outcome (36.7%) and an overall mortality rate of 22.2%. Impaired level of consciousness (AOR = 0.766, 95% CI = 0.589–0.995), dexamethasone therapy (AOR = 4.676, 95% CI = 1.12–19.50) and fever persisting after two days of admission (AOR = 24.226, 95% CI = 5.24–111.96) were found to be independently associated with unfavorable outcome.ConclusionOutcome in patients treated for ABM at the hospital was found to be poor. Impaired mentation, treatment with adjunctive dexamethasone and persistent fever were found to be associated with poor outcome. Thus, development of clinical guidelines for treatment of ABM that suit the local context is essential to improve patient management and outcome.

Access to Cancer Medicine Issues: Implication for Policy and Practice in Ethiopia

Abstract 55 Purpose Cancer currently is a major public health problem in developing countries. In Ethiopia, cancer is responsible for 5.8% of total national deaths. Patients often present with advanced stage cancer and have limited access to screening, diagnosis, and treatment. Access to affordable cytotoxic medicines is a major challenge in the care of patients with cancer, especially in resource-poor settings, such as Ethiopia. This aim of this study was to explore perceived challenges in the accessibility of cancer chemotherapy drugs among different stakeholders in Ethiopia. Methods A qualitative study was performed using face-to-face in-depth interviews with such key informants as health care providers, supply chain management experts, and decision makers working in the Ministry of Health. Results A total of six key informants participated in this case report, with two oncology pharmacists, two supply chain management experts, one expert from the Ministry of Health, and one private supplier. Challenges were explored and viewed from the perspectives of policy, supply chain management, and health service. The most frequently identified challenges were the presence of inconsistent services and few currently active cancer centers, such as Tikur Anbesa Specialized Hospital, Gondar University Hospital, and Jimma University Hospital; difficulties in cancer commodity management; implementation challenges with cancer medicine cost subsidy programs; lack of an efficient stock status reporting system; supplementary medicine requirements; an inefficient market (costly, few suppliers, and noneconomic quantities); the need for combinations of cancer medicines; and a lack of national treatment guidelines. Conclusion Respondents suggested ways forward that included the participation of relevant and specific stakeholders, such as government and private pharmaceutical suppliers, the Ministry of Health, nongovernmental organizations, and hospitals. Strengthening supply chain management at all levels and sustainable subsidy programs for cancer medicines should be sought to avoid frequent interruptions in the availability of chemotherapy drugs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Assessment of Pediatrics Radiation Dose from Routine X-Ray Examination at Jimma University Hospital, Southwest Ethiopia.

Given the fact that children are more sensitive to ionizing radiation than adults, with an increased risk of developing radiation-induced cancer, special care should be taken when they undergo X-ray examinations. The main aim of the current study was to determine Entrance Surface Dose (ESD) to pediatric patients arising from routine x-ray examination in the Radiology Department of Jimma University Specialized Hospital (JUSH). Descriptive cross-sectional study was conducted on pediatric patients less than 15 years of age who visited to seek x-ray examinations in JUSH. In this study, chest (AP), skull (AP), Abdomen (AP) and Pelvic (AP) x-ray examinations were analyzed. Radiographic exposure factors were recorded in each examination. ESD was calculated using exposure parameters. The calculated ESD values were weighed against the Diagnostic Reference Level (DRL) recommended doses and similar published studies. Comparison was made among different age groups through mean comparison. The obtained ESD values were mostly higher than the values in internationally published studies and DRL for all age groups. For chest AP, the mean ESD values were 1.82mGy which is higher than similar studies in Nigeria (0.642Mgy), Brazil (o.o62mGy) and NRPB (0.050mGy) for ages of 0-1 years. The higher pediatric patient dose obtained in this study is a further indicator that doses delivered to pediatric patients are not according to ALARA principle, and there is a need to optimize service and patients' radiation exposure in JUSH in particular and in Ethiopia in general.

Multi-state models for the analysis of time-to-treatment modification among HIV patients under highly active antiretroviral therapy in Southwest Ethiopia

BackgroundHighly active antiretroviral therapy (HAART) has shown a dramatic change in controlling the burden of HIV/AIDS. However, the new challenge of HAART is to allow long-term sustainability. Toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. The aim of this study was to evaluate the durability of first line antiretroviral therapy and to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART.MethodsA Hospital based retrospective study was conducted from January 2007 to August 2013 at Jimma University Hospital, Southwest Ethiopia. Data on the prescribed ARV along with start date, switching date, and reason for change was collected. The primary outcome was defined as the time-to-treatment change. We adopted a multi-state survival modeling approach assuming each treatment regimen as state. We estimate the transition probability of patients to move from one regimen to another.ResultA total of 1284 ART naive patients were included in the study. Almost half of the patients (41.2%) changed their treatment during follow up for various reasons; 442 (34.4%) changed once and 86 (6.69%) changed more than once. Toxicity was the most common reason for treatment changes accounting for 48.94% of the changes, followed by comorbidity (New TB) 14.31%. The HAART combinations that were robust to treatment changes were tenofovir (TDF) + lamivudine (3TC)+ efavirenz (EFV), tenofovir + lamivudine (3TC) + nevirapine (NVP) and zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP) with 3.6%, 4.5% and 11% treatment changes, respectively.ConclusionMoving away from drugs with poor safety profiles, such as stavudine(d4T), could reduce modification rates and this would improve regimen tolerability, while preserving future treatment options.

Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings.

BackgroundHyponatremia is a common electrolyte abnormality in patients with heart failure (HF). It is independently associated with increased short-term and long-term morbidity and mortality. The main objective of this study was to assess patterns of hyponatremia and its association with discharge outcomes in patients with HF admitted to a teaching hospital in Ethiopia.Patients and methodsThis is a descriptive, prospective, hospital-based cohort study of patients with HF admitted to Jimma University Hospital, Ethiopia, between November 1, 2013 and July 31, 2014. A structured questionnaire was used to collect information on sociodemographic characteristics, clinical profile at admission, and outcomes at discharge. Plasma sodium concentration was analyzed at admission for all patients. The relationship between hyponatremia at admission and in-hospital mortality, as well as length of hospital stay, was assessed using both bivariate analysis and multivariable logistic regressions. The level of statistical significance was set at P<0.05.ResultsOf 152 participants admitted with HF, 44 (28.9%) had hyponatremia, which is defined as serum sodium level <135 mmol/L. Patients on salt restriction, on chronic diuretic treatment (furosemide and spironolactone), and with impaired renal function at admission were found to be highly affected. Hyponatremia was found to be associated with increased in-hospital mortality (P=0.008) and longer hospital stay (16.6 vs 12 days, P<0.001). Patients with hyponatremia also had lower blood pressure and poor functional status at discharge.ConclusionThis study demonstrates that hyponatremia is highly prevalent in patients hospitalized with HF and is associated with increased in-hospital mortality and longer hospital stay. Thus, great emphasis should be given to identify high-risk patients, and prevention and early detection of hyponatremia to prevent its deleterious effects. Large-scale national studies are also needed to complement our findings.

Prevalence and antimicrobial susceptibility pattern of anorectal and vaginal group B Streptococci isolates among pregnant women in Jimma, Ethiopia.

BackgroundStreptococcus agalactiae (group B Streptococcus, GBS) is the most frequent pathogen isolated from neonates with invasive bacterial disease and responsible for serious infections in newborns such as pneumonia, septicemia and meningitis. Infection is primarily acquired vertically from mothers colonized with GBS. However, the prevalence and antimicrobial susceptibility pattern of GBS among pregnant women in Ethiopia are less studied.MethodsThis cross-sectional study involved 126 pregnant women at 35–37 weeks of gestation attending the antenatal clinic at Jimma University Hospital. Anorectal and vaginal swabs were cultured on to Todd-Hewitt broth medium supplemented with Gentamicin and Nalidixic acid and subsequently sub-cultured on 5 % sheep blood agar followed by identification of isolates based on colonial morphology, Gram stain, catalase reaction, hippurate hydrolysis and Christie, Atkins, Munch-Petersen (CAMP) test, and testing for their susceptibility to antimicrobial agents using the Kirby–Bauer method.ResultsThe overall carriage rate of GBS was 19.0 % (24/126), and the rectal and vaginal carrier rates were 14.3 % (18/126) and 10.4 % (13/126), respectively. Concomitant vaginal and anorectal colonization was recorded in 29.2 % (7/24) of the women who were culture positive. All GBS isolates were susceptible to penicillin G, ampicillin, and vancomycin, but a considerable proportion was resistant to clindamycin (3.2 %), erythromycin (6.5 %), ciprofloxacin (9.7 %), ceftriaxone (9.7 %), norfloxacin (12.9 %), cotrimoxazole (29 %), and tetracycline (45.2 %).ConclusionThis study reveals high carriage rate of GBS among pregnant women compared to some previous studies in Ethiopia. However, further epidemiological investigations should be done in different parts of the country in order to know the actual GBS colonization rate of pregnant women and to consider the possibility of implementing prophylactic treatment to prevent potential adverse maternal and neonatal outcomes. Future studies should be conducted to reveal serotype distributions of GBS in this community.

Mean Normal Portal Vein Diameter Using Sonography among Clients Coming to Radiology Department of Jimma University Hospital, Southwest Ethiopia.

Mean portal vein diameter is considered as the best indicator for portal hypertension. However, the cutoff point differs from study to study (above 10-15 mm) despite the existence of normal mean portal vein diameter between 10-15 mm in different settings.This implies the existence of limited evidence on normal portal vein diameter for all populations in all countries prior to setting the cutoff points. Therefore, the aim of this study was sonographic assessment of normal mean portal vein diameter among patients referred to The Department of Radiology in Jimma University Hospital. A facility based cross-sectional study was conducted from November to December 2014 at Jimma University Hospital on a total of 195 clients. Data about portal vein diameter for eligible clients were collected by radiologists using Sonography. Data were edited manually, entered and analyzed using SPSS version 16. Data were collected from a total of 195 participants. Among these, 121(62.1%) were males and the median age of the participants was 35 years. The study revealed a normal mean portal vein diameter of 10.6 mm ±1.8 SD with a respirophasic variation of 25.6%. Likewise, the normal mean portal vein diameter seemed to have varied significantly by age and sex. The study revealed a normal mean portal vein diameter ranging below 13 mm. Hence, decisions made in clinical settings should base on these findings. Besides, there is a need for large scale study to determine portal vein diameter variation by age and sex, controlling other confounders.

Knowledge about Radiation Related Health Hazards and Protective Measures among Patients Waiting for Radiologic Imaging in Jimma University Hospital, Southwest Ethiopia.

Radiologic diagnostic and therapeutic procedures using ionizing radiation carry potential health risks. Hence, clients' knowledge about radiation would play a key role in reducing unnecessary imaging and its impacts. However, information on client's knowledge in low income countries specifically in the Ethiopian context has been was limited. Therefore, the aim of this study was to assess knowledge about radiation related hazards and protective measures among patients waiting for radiologic imaging. Descriptive cross sectional study design was employed on 388 patients waiting for radiologic imaging in Jimma University Hospital from Dec.25/2014 to Jan. 10/2015. Eligible participants were interviewed using pretested questionnaire. Data were entered and analyzed using IBM SPSS version 21. A descriptive analysis was conducted to get summary values of clients' radiation related knowledge. A total of 386 clients were included to the analysis.Two hundred and three (52.6%) participants had ever heard radiation related health hazards. Among these, 74.9% mentioned infertility, 64.0% indicated cancer followed by 26.6% who mentioned cataract as radiation related health hazards. A large number of clients (75.6%) had no idea about radiation protective measures, whereas 22% of them mentioned not entering examination room unless ordered by health professionals and 10.6% indicated covering sensitive body parts with lead (pb). The majority (85.8%) of the clients did not support unjustified repeated radiation imaging for diagnostic or other purposes. The overall knowledge of clients about radiation imaging seems inadequate. Thus, comprehensive awareness raising programmes targeted at different settinsg and levels should be designed and implemented.

Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study.

Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia. Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer. The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40-59 years), (OR= 4.7; 95%CI= 2.3-9.6), more than one husband (OR= 2.0; 95%CI=1.0-3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5-5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6-29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5-22.0) were statistically significant and the latter two were independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done. Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.

Bioimpedance index for measurement of total body water in severely malnourished children: Assessing the effect of nutritional oedema

Restoration of body composition indicates successful management of severe acute malnutrition (SAM). Bioimpedance (BI) index (height(2)/resistance) is used to predict total body water (TBW) but its performance in SAM, especially with oedema, requires further investigation. Children with SAM (mid-arm circumference <11.0cm or weight-for-height <70% of median of NCHS reference and/or nutritional oedema) admitted to Jimma University Hospital were included. Tetrapolar-whole-body impedance (Z), resistance (R) and reactance (Xc) were measured at 50 and 200kHzs. Pre- and post-deuterium dose saliva samples were analysed using isotope-ratio mass spectrometry. TBW was regressed on H(2)/Z. Xc and R were height (H)-indexed, and Xc/H plotted against R/H. Thirty five children (16 non-oedematous and 19 oedematous) with median (interquartile range) age of 42 (26-54) months were studied. Height-for-age z-score (mean±SD) was low in both non-oedematous (-3.9±2.8) and oedematous (-3.6±1.7) children. Oedematous children had lower BI parameters than non-oedematous (p<0.001) and hence higher H(2)/Z for a given amount of TBW. At both 50 and 200kHz, association between H(2)/Z and TBW was stronger in non-oedematous children than oedematous (60% higher coefficient of determination and 20% lower standard error of estimate). Intercepts and regression estimates at 50 and 200kHz were similar, in both oedematous and non-oedematous children. In children with oedematous SAM, BI index was weak in predicting TBW. Moreover, predicted TBWs at 200kHz and 50kHz did not differ and hence BI measurement at 50kHz is still practical for TBW estimation.

Investigations of pain status in children admitted to pediatric critical care in a tertiary medical center in Ethiopia.

The pain status of hospitalized pediatric patients in Ethiopia remains unstudied. This hospital based prospective survey assessed 162 children for pain before, at and after admission using previously validated age specific pain assessment tools. Sociodemographic, clinical and treatment profile of patients were abstracted from charts and interview. The aim was to describe the prevalence, severity, documentation and treatment of pain at Jimma University Hospital during April 1 to May 25, 2013. At admission moderate to severe pain prevalence was 90.1% at admission. Analgesics were prescribed for 44 of the children only, while 2 received combination of paracetamol and Tramadol. There existed significant association (p

Adherence to topical glaucoma medications in Ethiopian patients.

Purpose:Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia.Materials and Methods:A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant.Result:Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment.Conclusion:A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.

Repeated reuse of insulin injection syringes and incidence of bacterial contamination among diabetic patients in Jimma University Specialized Hospital, Jimma, Ethiopia

ObjectiveTo determine the level of bacterial contamination of reused insulin syringes among diabetic patients. MethodsA facility based cross sectional study was conducted among diabetic patients. Data on socio-demographic variables, history of injection syringe reuse, and frequency of reuse of syringes were collected using predesigned questionnaire. Finally, the samples from the syringes were cultured according to standard microbiological techniques. ResultsEighteen diabetic patients at Jimma University Hospital participated. A total of 83.3% of participants reused a single injection syringe for >30 consecutive injections, while 16.7%, reused for ≤30 injections. Our results showed 22.2% of syringes were contaminated with methicillin resistant Staphylococcus aureus. ConclusionsWe conclude reuse of syringes is associated with microbial contamination. The findings that 4/18 syringes being contaminated with bacteria is an alarming situation. A mechanism should be designed for patient's to get injection syringes with affordable price. If reusing is not avoidable, reducing number of injections per a single syringe and avoiding needle touching with hand or other non-sterile material may be an alternative to reduce the risk of contamination.

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Background: In this study, it was hypothesized that tuberculosis co-infection independently increases the risk of mortality in people living with HIV (PLWHs) even if they are on antiretroviral therapy (ART). Therefore, investigating this hypothesis among cohort of adult PLWHs in south west Ethiopia was the aim of the present work. Methods: A cohort study was conducted from December to August 2012 at Jimma University Specialized Hospital (JUSH). PLWHs initiating ART between 2008 and 2011 were included using simple random sampling. The effect of TB co-infection on all-cause mortality was assessed using Cox proportional hazard model. Results: In crude analysis, all-cause mortality of TB co-infected patients was higher by 6.5% (P=0.004). However, multivariate analysis showed that TB co-infection didn’t increase mortality (AHR, 1.31(0.573-3.007), P=0.52). Instead, factors which increased death were low baseline functional status, malnutrition, CD4 count <100cells/mm 3 at the initiation of ART. Conclusion: In this study, it was shown that TB co-infection didn’t independently increase mortality provided that patient is on ART. Therefore, beside TB, addressing patient’s nutritional status and intervention to facilitate early presentation to health facilities before they deteriorate functionally and immunologically is mandatory to reduce mortality on ART.

Predictors of oedema among children hospitalized with severe acute malnutrition in Jimma University Hospital, Ethiopia: a cross sectional study

BackgroundSevere acute malnutrition has two main clinical manifestations, i.e., oedematous and non-oedematous. However, factors associated with oedema are not well established.MethodsChildren 0.5-14 years of age with SAM (MUAC < 11.0 cm or weight-for-height < 70 % of median and/or nutritional oedema) admitted to the nutrition unit were included. Information on infections before and during admission was collected together with anthropometry. Predictors of oedema was analysed separately for younger (< 60 months) and older children (≥ 60 months).Results351 children were recruited (median age: 36 months (interquartile range 24 to 60); 43.3% females). Oedema was detected in 61.1%. The prevalence of oedema increased with age, peaked at 37–59 months (75%) and declined thereafter. Infection was more common in the younger group (33% vs. 8.9%, p < 0.001) and in this group children with oedema had less infections (25.2% vs. 45.1%, p = 0.001). In the older group the prevalence of infections was not different between oedematous and non-oedematous children (5.5% v. 14.3%, p = 0.17). In the younger group oedema was less common in children with TB (OR = 0.20, 95% CI: 0.06, 0.70) or diarrhea (OR = 0.40, 95% CI: 0.21, 0.73).ConclusionsThe proportion of oedema in SAM peaked at three to five years of age and a considerable proportion was above 5 years. Furthermore, the prevalence of infection seemed to be lower among children with oedema. Further studies are needed to better understand the role of infection-immunity interaction.