Jimma University Specialized Hospital Research Articles

Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study

Uncontrolled hypertension and associated factors among adult hypertensive patients on follow-up at Jimma University Teaching and Specialized Hospital: cross-sectional study

Up to Date Inventory System for Effective Management of Healthcare Technology: Case Study in Jimma University Specialized Hospital (JUSH)

Up to Date Inventory System for Effective Management of Healthcare Technology: Case Study in Jimma University Specialized Hospital (JUSH)

The effect of psychometric variables in predicting physical activity behavior among diabetes mellitus type-2 patients.

BackgroundDiabetes mellitus type-2 (DMT-2), the most common endocrine disease in the world, is a major global public health-related issue. Diabetes mellitus is one of the most common non-communicable diseases globally, and there is substantial evidence that it is epidemic in many low- and middle-income countries. It is widely recognized that physical activity is important in preventing and treating DMT-2. The aim of this study was to identify predictors of physical activity among DMT-2 patients attending Jimma University Specialized Hospital (JUSH), Southwest Ethiopia.MethodsA facility-based cross-sectional study was conducted in 2013 at JUSH, Southwest Ethiopia. A systematic random sampling technique was employed to select 322 diabetes patients. Data were collected using a structured questionnaire on interviewer-administered basis. A summary of descriptive statistics, and binary and multiple logistic regression analysis were computed to identify potential predictors of physical activity among diabetes mellitus patients.ResultsAmong the 319, 70 (21%) engaged in the recommended physical activity (such as running, jogging, going to the gym, or brisk walking). Two hundred seventy-nine (87.5) of the respondents had adequate general knowledge of diabetes and 31.7% of the respondents had adequate general knowledge of physical activity. The likelihood of engaging in the recommended physical activity was associated with perceived barrier (odds ratio [OR]=0.58, 95% confidence interval, CI [0.56, 0.67]; p<0.000), perceived self-efficacy (OR=1.33, 95% CI [1.12, 1.57] p<0.001) and perceived benefit (OR=1.16 (95% CI [1.03, 1.29] p<0.000).ConclusionThis study illustrated that practicing the recommended physical activities among DMT-2 patients was insufficient. Perceived barrier, perceived benefit and perceived self-efficacy became potential predictors of physical activity of DMT-2 patients. None of the socio-demographic factors affect the physical activity behavior of these groups. Diabetes intervention messages should focus on building individual self-efficacy to overcome those barriers with a due emphasis to suggested concrete benefit of physical activity.

Immunological outcomes of Tenofovir versus Zidovudine-based regimens among people living with HIV/AIDS: a two years retrospective cohort study

BackgroundTenofovir (TDF) based regimen was reported to have better immunological outcomes. Unfortunately, there is limited information regarding the immunologic outcome associated with this regimen in Ethiopia, as its routine utilization in this setting begun since 2013.MethodsA 2 years retrospective cohort study was conducted at Jimma University Specialized Hospital, 346 km Southwest of Addis Ababa, Ethiopia. A total of 280 patients’ data from September 2012 to July 2014 was extracted from records from February 10, 2015 to March 10, 2015. Records were selected using a simple random sampling technique. Data on socio-demographic, clinical and drug related variables were collected; entered into EpiData 3.1 and analyzed by STATA 13.1. Mixed effect linear regression was performed to assess difference in CD4+ change between groups adjusting for baseline characteristics. The change in predicted CD4 count attributed to each regimen was also assessed by marginal analysis. P < 0.05 for slopes of the random effect linear regression was used as indicators for presence of association.ResultsThe mean (SD) duration of cohort follow up was 714.2 (69.6) and 708.8 (78.9) days (P = 0.753) for TDF and AZT groups respectively. The minimum follow up duration was 7.4 and 8.9 months for TDF and AZT groups respectively. Most of TDF (93.6%) and AZT (91.4%) groups completed their follow up, 5 (3.6%) TDF and 6 (4.3%) AZT groups died and 4 (2.9%) TDF and 6 (4.3%) AZT groups were lost for follow-up (P = 0.769). There was statistically significant difference in immunologic recovery between the groups (B = +34.08, 95% CI [7.8, 60.35], P = 0.027) over time. The predicted CD4+ count for TDF/3TC/EFV was (B = +347.65 cells/mm3, P < 0.001) whereas that of AZT/3TC/EFV was (B = +281.54 cells/mm3, P < 0.001).ConclusionsTDF based regimens have shown more efficacy compared to AZT based regimens though AZT based regimens are more affordable in low income countries like Ethiopia. However, we recommend further study with quality design to assess the prevalence of sub-optimal CD4+ response (net CD4 gain <50 cells/µl/6 month) in this set-up among TDF users.

Clinical Outcomes of Tenofovir Versus Zidovudine-based Regimens Among People Living with HIV/AIDS: a Two Years Retrospective Cohort Study.

Background:Tenofovir (TDF) based regimen is one of the first line agents that has been utilized routinely since 2013 in Ethiopia. Unfortunately, there is limited information regarding the Clinical outcomes and associated risk factors in this setting, where patients generally present late, have high rates of TB and other infectious conditions.Methods: A two year retrospective cohort study was conducted from February 10/2015 to March 10/2015 at Jimma University Specialized Hospital. A total of 280 records were reviewed by including data from September 3, 2012 to July 31, 2014. Records were selected using a simple random sampling technique. Data was collected on socio-demographic, clinical and drug related variables. Data was analyzed using STATA 13.1. Kaplan-Meier and Cox regression were used to compare survival experience and identify independent predictors. Propensity score matching analysis was conducted to elucidate the average treatment effects of each regimen over opportunistic infections.Results:Of 280 patients, 183(65.36%) were females and 93(33.32%) of females belong to Tenofovir group. Through 24 months analysis, TDF based regimen had a protective effect against death and opportunistic infections (OIs), (AHR=0.79, 95% CI [0.24, 2.62]) and (AHR=0.78, 95%CI [0.43, 1.4] respectively. The average treatment effect of TDF/3TC/EFV was (-71/1000, p=0.026), while it was (+114/1000, p=0.049) for AZT/3TC/EFV. However, TDF/3TC/NVP was associated with statistically insignificant morbidity reduction (-74/1000, p=0.377). Those with body mass-index (BMI) <18.5kg/m2 (AHR=3.21, 95%CI [0.93, 11.97]) had higher hazard of death. Absence of baseline prophylaxis (AHR=8.22, 95% CI [1.7, 39.77]), Cotrimoxazole prophylaxis alone (AHR=6.15, 95% CI [1.47, 26.67]) and BMI<18.5kg/m2 (AHR=2.06, 95% CI [1.14, 3.73]) had higher hazards of OIs.Conclusion:The survival benefit of TDF based regimen was similar to AZT based regimen and therefore can be used as an alternative for HIV/AIDS patients in resource limited setups. However, since this study was not dealt with toxicity of the regimens, we recommend to conduct high quality design on this issue.

Determinants of Adverse Pregnancy Outcomes among mothers who gave birth from Jan 1-Dec 31/2015 in Jimma University Specialized Hospital, Case control study, 2016

Background: Adverse pregnancy outcomes lead to serious health consequences to the mother and/or the baby. These Adverse birth outcomes; prematurity, low birth weight and still birth represent significant problems in both developing and developed countries. Adverse pregnancy outcomes are still major public health problems in developing countries including Ethiopia where most pregnancies are unplanned, complications are many and outcomes are generally Unfavorable for both mother and infant. Objective: To identify determinants of adverse pregnancy outcomes among deliveries takes place in Jimma University specialized hospital from January 1 – December 31 / 2015. Methods: The study was a facility based unmatched casecontrol study design conducted by reviewing mothers and newborn cards and registration log book who delivered in Jimma university specialized hospital from January 1 / 2015 to December 31/2015, southwest Ethiopia. The study was done on randomly selected 86 cases and 258 controls using structured data collection checklist. Data analysis was done by SPSS version 20 and multiple logistic regression statistical methods were used to identify the predictors. Result: In this study 344 mothers and newborns cards were included yielding 100% response rate. From this 86 mothers and newborn cards were selected for case group and 258 mothers and newborn cards were selected for control group. Most of the cases 80.2% and controls 82.9% were between the age group of 20-34 years. Mothers who are referred for delivery service from other area are more than five times to have adverse pregnancy outcomes than mothers who are not referred, AOR=5.49 95% CI [2.80-10.76]. And mothers who had illness during current pregnancy are seven times to be case than controls, AOR=7.22, 95% CI [1.65-31.58]. Mothers who attend ante natal care (ANC) were 83% less likely to have adverse pregnancy outcome, than mothers who didn’t attended ANC follow up, AOR = 0.17 95% CI [0.06-0.49]. Pregnant mothers who are anemic or had hemoglobin level of less than 11 gram/dl are more than seven times to have adverse pregnancy outcomes than non-anemic pregnant mothers, AOR=7.29 95% CI [2.85-18.67]. Additionally, women who had obstetric emergencies during current pregnancy, complications during current delivery, and multiple pregnancy are more than 18 times AOR=18.40[6.12-55.37], 2 times AOR=2.65[1.38-5.11] and 7 times AOR=7.59[1.49-38.65] to have adverse pregnancy outcomes than their counterparts respectively. Conclusion: According to the findings of this study; referral, illness during current pregnancy, having ANC attendance, anemia during current pregnancy, complication during delivery, multiple pregnancy and having obstetric emergencies are statistically significant predictors of adverse pregnancy outcomes.

Skin Manifestation among HIV Patients and Its Correlation with CD4 Count and WHO Clinical Staging in Jimma University Specialized Hospital, Southwest Ethiopia

Background: More than 90% of human immunodeficiency virus (HIV+) infected patients develop skin lesions at some time throughout the course of the disease. Several skin diseases have proved to be sensitive and useful indicators of progression of HIV+ infection. Although these conditions may be seen in general healthy population, their occurrence in patients with acquired immunodeficiency syndrome is often atypical, more severe and explosive. Objective: The aim of the study was to assess the magnitude and prevalence of skin manifestation among HIV patients in JUSH ART Clinic. Methods: A retrospective study was conducted among HIV patients in JUSH ART Clinic using a structured data collection format and the data was collected from patient’s record (card) and was analyzed by using SPSS version 20. The result was presented using numbers, ratios and tables. Results: Of 268 HIV/AIDS, patients who have follow-up in Jimma University Specialized Hospital (JUSH) Antiretroviral therapy (ART) clinic 137 (51.1%) were having skin manifestations. The commonest type of skin lesion identified was Herpes Zoster, 74 (54%). This study showed that HIV positive (HIV+) patients with advanced stages of skin disorders had relatively lower CD4+ cell counts. Skin manifestation was significantly associated with WHO clinical stage with P=0.019 and CD4+ cell count with a P-value 0.0001. Conclusion: Skin diseases are highly prevalent among HIV- Positive patients and the frequency and number of these manifestations are well correlated to the patient’s immune status and World Health Organization (WHO) staging. Therefore, examination of skin disorders, as early diagnosis and management of skin problems will improve the quality of life in HIV positive patients.

Determinants of Long Hospital Stay among Diabetic Patients Admitted with Diabetic Ketoacidosis at Jimma University Specialized Hospital

Background: Diabetic ketoacidosis (DKA) is a common life-threatening acute complication of diabetes. The objective of this study is to assess determinants of long hospital stay among diabetic patients admitted with DKA at Jimma University Specialized Hospital. Methods: We conducted a retrospective chart review of DKA patients from January 01/2011 to December 31/2013. Data extracted included sociodemographic characteristics, laboratory investigations, length of hospital stay and in-hospital mortality. We performed chi-square tests and logistic regression analysis on SPSS. Variables with p<0.05 were considered statistically significant. Results: A total of 350 patients were admitted with DKA out of which 151 patients medical records contained complete information and were studied. Mean age of the patients was 35 ± 15.3 years ranging from 15-84 years. The majority of patients were males; 91(60.3%). More than one third (68.9%) of patients had type 1 diabetes. Nearly half, 71(47%), of the patients had long hospital stay. There were 15 deaths. Hypoglycemic episodes after resolution of DKA and previous history of diabetes are determinants of long hospital stay. Conclusions: Long duration of hospital stay of patients admitted with DKA is a common problem in our hospital. Therefore, we recommend better DKA management and care at the hospital.

Assessment of Adherence to Insulin Self-Administration and Associated Factors Among Type I Diabetic Patients at Jimma University Specialized Hospital, Ethiopia

Background: Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with disturbances of metabolism of food resulting from defects in insulin secretion, insulin action, or both. Adherence is defined as the extent to which a patient’s behaviour coincides with the prescribed health care regimen. Achieving glucose control requires adherence to a variety of self-management regimens, most notably to insulin injection for type I diabetes. Objective: The aim of this study was to assess the level of adherence to insulin self-administration and associated factors among type I diabetic patient at Jimma University specialized hospital, Ethiopia. Methods: Institutional based quantitative cross-sectional study method was employed on 263 sampled type I diabetes patients by simple random sampling from February 1 to April 30, 2013. Data was collected using structured and pre-tested questionnaire by trained data collectors and was entered to Epidata version 3.1 and analysed using SPSS Windows version 16.0. Bivariate and multivariate logistic regression analysis was used in analysing the data and finally, the result was presented in graphs and tables. Results: According to this study 30.9% of the respondents were adhered and 69.1% were notadhered to insulin self-administration within the last three months. About 7.4%, 73.1% and19.5% of the respondents have poor, fair and good knowledge respectively. Most of the respondents 176(68.8%) mix insulin before injection by shaking. Logistic regressions showed that factors associated with adherence were, marital status (p= 0.038), forgetfulness (p= 0.000), lack of transportation (p= 0.006) and being busy (p= 0.002) but some socio-demographic factors like religion and occupation were found to be insignificant. Conclusion: Finding of this study indicated that majority of the respondents did not adhere to insulin self-administration (69.1%). Thus, it can provide alarming information for concerning bodies to take action since diabetes is a major public problem.

Grand Multiparity and Pregnancy Related Complications among Women Who Gave Birth at Jimma University Specialized Hospital, Jimma, Southwest Ethiopia

Introduction: The term ‘Grand-multiparity’ was introduced by Solomon (1934), who called it the “dangerous multipara” [1]. Since then grand multiparity has been considered as a risk factor for both mother and the fetus [1-4]. The International Federation of Gynecology and Obstetrics define grand multiparity as delivery of the fifth or more newborn and in this study grand multiparity is defined when a pregnant woman have five or more births above the gestational age of 28 weeks [2]. The objective of this study is to compare maternal and perinatal outcome in grand multiparity and low parity. In developing countries grand multiparity is very common while in developed countries rare. Methods and materials: Prospective cross sectional comparative study was done in Jimma University specialized Hospital in 2015. Data was collected from119 grand multiparous (parity >= 5) and 238 low parity (parity2-4) women who gave birth in the hospital and data were analyzed by using statically package social science (spss) 20.3. p-value<0.05 considered significant. Result: There were 357 parous women participated in the study, among then 125 were grand multiparous making the incidence 8%. Grand multiparty was associated with anemia (3.5; 1.5-8.4), nonreassuring fetal condition intraparum (3.2; 1.3-8.0) and perinatal mortality (5; 1.7-7.4). Conclusion: Grand multiparty was associated both maternal and perinatal mortality and morbidity. Limiting parity might decrease both maternal and perinatal mortality and both at community and health facility family planning awareness should be made.

Health Related Quality of Life And its Associated Factors Among Diabetic Patients Attending Diabetes Clinic in Jimma University Teaching Hospital, Ethiopia,2014

Background: Diabetes mellitus is likely to become one of the most prevalent and economically important diseases of the 21st century. Diabetes mellitus, like any chronic medical condition, impacts on quality of life. Objective: The aim of this study was to assess quality of life and associated factors among diabetic patients having follow-up in diabetes clinic in Jimma University Specialized Hospital, Jimma ,south west Ethiopia. Methods: Institution based cross sectional study was conducted from February-May, 2014. Consecutive sampling technique was used to select 356 participants. Data collection technique was interview; review of medical records and the mean fasting blood sugar was used as index of glycemic control. Results: A total of 341 respondents participated in the study and the response rate was 96.2%. The sample consisted of 183 males (56%) and 158 females (44%) with mean age 46.37 ± 15.9 years. Mean duration of DM was 5.7 ± 5 years, 229(66.9%) were type II diabetes, mean BMI and FBS were 23.4 ± 4.3 and 172 mg/dl ± 67 respectively. Highest percentages (57%) of poor health related quality of life was found in general health followed by role physical (36%) and highest good quality of life found in bodily pain dimensions in which 88% of the respondents had good quality of life. Additionally, in this study depression symptom, type II diabetes, increased number of drugs, longer duration of illness and number of co morbidity were important predictors of impaired health related quality of life. Conclusion: Depression symptoms, type II diabetes, higher number of drugs, longer duration of illness and number of co morbidity were important predictors of impaired health related quality of life. Additionally, general health and role physical dimensions of respondents’ quality of life were severely impaired. As a result programs addressing the physical and mental needs of the population are required.

Validity of Prediction of Thoracic Gas Volume and Body Composition Using Air Displacement Plethysmography in People Living with HIV in Southwest Ethiopia

Background: Body composition assessment has become increasingly popular in clinical and research areas. But any body composition measurement technique that is used in both clinical and research settings should be reliable and valid. Objectives: Our first aim was to compare predicted thoracic gas volume (Vtgpred) with measured thoracic gas volume (Vtgmeas) using the BOD POD in people living with HIV/AIDS (PLWHA) in Southwest Ethiopia. The second aim was to determine the effect of thoracic gas volume (Vtg) measurement ways on estimation of body fat (BF) using the BOD POD in PLWHA in Southwest Ethiopia. Method: Cross-sectional study was conducted on 68 PLWHA who had follow up at Jimma University Specialized Hospital (JUSH). Subjects were collected using convenience sampling technique. Agreement between the methods was tested using paired t-test, Pearson’s correlation, linear regression, and Bland-Altman plot. Result: Much percent of study subjects were malnourished (60.3%). Vtg and percent body fat (%BF) did not differ significantly (p>0.05) between the two modes of assessment (predicted and measured). Strong correlation was observed between Vtgpred and Vtgmeas (r=0.82, p<0.001). Correlation between predicted %BF (%BFpred) and measured %BF (%BFmeas) was also strong(r=0.92, p<0.001). The regression of Vtgmeas(Y) against Vtgpred (X) (Y=- 0.369+1.140X, R2=0.68, SEE=0.015) did not significantly deviated from the line of identity. Similarly, the regression of %BFmeas (Y) against %BFpred (X=1·70+0.94X, R2=0·96) did not significantly deviated from the line of identity. Bland- Altman plot of the differences against the mean of Vtgpred and Vtgmeas and the differences against the mean of %BFpred and %BFmeas showed no systematic differences. Conclusion: The BOD-POD is a reliable technique to predict Vtg and body composition in PLWHA in Southwest Ethiopia. Therefore, researchers and clinicians can confidently use the predicted Vtg and body fat in place of the measured ones in PLWHA in Southwest Ethiopia.

Major Micro vascular Complications and Associated Risk Factors among Diabetic Outpatients in Southwest Ethiopia

Background: Diabetic complications and comorbidities, mainly due to poorly controlled diabetes, are the common causes of hospital admissions and mortalities among diabetic populations. Although studies from Ethiopia show high incidence of complications, data on associated risk factors is scarce. The current study was aimed to assess the potential risk factors contributing to microvascular diabetic complications in the study area. Methods: Hospital-based, cross-sectional study was conducted during October and December of 2015 among systematically selected diabetic patients, at outpatient clinic of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. At recruitment, 5 ml of venous blood was collected without any prior special preparation such as fasting, and used for HbA1C level determination. Data on sociodemographic and diabetic complications was documented for each patient on the format prepared for this study. Binary logistic-regression analysis was used to identify the risk factors associated with the microvascular complications. A p-value <0.05 was considered significant. Results: The sample analyzed consisted of 236 diabetic patients: 53.4% male, 58.5% Type 2 diabetics, 40% overweighed, and 75.0% younger than 60 years and with diabetes for less than 7 years. The mean ± SD of HbA1C was 9.1 ± 2.8%. Nearly two-third (65%) of the patients had HbA1C greater than 8.0%, indicating poor glycemic control. Self-reported genetic risk factors were evident in almost 20% of the study population. At least one major microvascular complication was recorded in 41.5% of the sampled population. The overall prevalence of the major microvascular complications was associated with high HbA1C level (> 8.0%), female sex and genetic risk factors, as evidenced by adjusted odds of 2.7, 2.2 and 3.2, respectively. Conclusions and recommendation: The overall prevalence of microvascular complications was high. To reduce the risk of the costly complications, new diabetes care policies objectively targeting a stringent glycemic goal of HbA1C <8.0% should be implemented.

Retrospective Study of Obstetric Fistula among Clients Admitted To Fistula Unit Jimma University Specialized Hospital, Oromia Region, South West Ethiopia

Background: Obstetric fistula is an injury that occurs during prolonged and obstructed labor causing tissue damage to organs inside the pelvis and result in urinary and fecal incontinence or both. It remains a major public health problem in areas where unattended obstructed labor is common. Objective: To assess obstetric fistula among women admitted to Jimma University Specialized Teaching Hospital (JUSH), Gynecology ward. Methods: Hospital based one year retrospective study was conducted in JUSH from September 03, 2016 to September 15, 2016. A total of 93 patients were admitted to JUSTH fistula unit from September 11, 2014 to September 10, 2015 out of which 86 patients were included in the study because of lost chart and incomplete documentation. The data was collected using structured questionnaire. The cards of patients were collected from Gynecology ward with fifth year five medicine students. Then the data was summarized and analyzed using SPSS software, result is displayed using graphs and texts. Result: A total of 86 patients chart who were admitted to fistula unit of JUSH from September 11, 2014 to September 10, 2015 were included in this study. Out of this 68 (79.1%) developed Vesico-vaginal fistula (VVF), 13 (15.1%) developed Recto vaginal fistula (RVF) and 5.8% developed Recto vesico-vaginal fistula (RVVF). Majority of the respondents were from rural area and 65.1% of them were illiterate. Most of the patients were in the age group of 18 to 24 years, 65.1% of them were primparous and 60.5% had no regular antenatal care follow-up. About 61.6% of the obstetric fistula cases were due to obstructed labor followed by prolonged labor accounting for 34.9%. Conclusion and Recommendation: Most of the women with obstetric fistula are from rural areas and are illiterate so efforts should be made to increase educational status especially in rural areas so that to improve maternal and child health.

Modeling Time-to- Recovery of Adult Diabetic Patients Using Cox-Proportional Hazards Model

Diabetes is a group of diseases marked by high or low level of glucose resulting from defects in insulin production, insulin action or both. The objective of this study is to model time-to-first recovery of adult diabetic patients using Cox Proportional Hazards model. A retrospective data was obtained from Jimma University Specialized Hospital diabetic patient clinic whose age 18 years and under treatments in between September 2010 and August 2013 are included in the study. Time of fasting blood sugar level to reach the first normal range, 70-130 mg/dl of blood were the response variable. Cox Proportional Hazard model were used. Types of diabetic, bodyweight at baseline, fasting blood sugar at baseline, sex and age of patients are significantly associated with time to first recovery of diabetic patients. These variables are important factors that should be considered during the selection phase a treatment (combination of treatments) for diabetes.

Evaluation of serum ferritin and some metal elements in type 2 diabetes mellitus patients: comparative cross-sectional study.

BackgroundThe chronic hyperglycemia of diabetes has been associated with an imbalance of some trace metal elements in the blood sample of type 2 diabetes patients.AimTo evaluate the status of serum ferritin and some selected metal elements among type 2 diabetes mellitus (T2DM) patients.MethodsFacility-based comparative cross-sectional study was conducted from February 15, 2015 to October 30, 2015, at Jimma University Specialized Hospital, Ethiopia. A total of 428 type 2 diabetes and nondiabetes study subjects were recruited to the study. After overnight fasting, 10 mL of venous blood samples were taken for biochemical and trace metal element analysis. Data were entered into EpiData version 3.5.1 and exported to SPSS version 20 for Windows for analysis.ResultsSerum concentration of Zn+2, Mg+2, Cr+3, ferritin, and Fe+3 in patients with type 2 diabetes was significantly lower (p<0.0001) than nondiabetes patients. In contrast, serum Cu+2 was significantly higher (p<0.0001) in type 2 diabetes patients than nondiabetics. In addition, significant differences were not seen in both groups with regard to serum Mn+2, Ca+2, and Po4−3. Waist-to-hip ratio (WHR), serum Fe+3, ferritin, and Mn+2 were significantly higher among oral hypoglycemic agent users of type 2 diabetes patients than the injectable insulin users. Serum Zn+2 had significant positive correlation with serum Mg+2 (r=0.738), Cr+3 (r=0.233), Ca+2 (r=0.238), and Po4−3 (r=0.222). In addition, serum Zn+2 had shown significant and negative correlation with body mass index (BMI, r=−0.331), WHR (r=−0.340), and fasting blood glucose (FBG, r=−0.186). Likewise, serum Mg+2 and Po4−3 are significantly and negatively correlated with BMI, WHR, and FBG.ConclusionThe imbalance of trace metal elements in the blood sample of diabetes is uncertain. Thus, we recommend a prospective cohort study to find out the principal factors behind the problem.

Assessment of Blood Pressure Control among Hypertensive Patients in Southwest Ethiopia.

BackgroundThe rate of blood pressure control among hypertensive patients is poor and the reasons for poor control of blood pressure remain poorly understood globally.ObjectiveTo assess the rate of blood pressure control among adult hypertensive patients at Jimma University Specialized Hospital.Materials and MethodsWe conducted a hospital based cross sectional study among adult hypertensive patients at Jimma University Specialized Hospital hypertension clinic from March 4, 2015 to April 3, 2015. Data on sociodemographic characteristics of the participants and adherence to antihypertensive medication(s) were collected from patients by face to face interview using a pretested structured questionnaire. Comorbidities, antihypertensive medication(s) and blood pressure measurements were collected retrospectively from medical records. Medication adherence was assessed using Morisky’s Medication Adherence Scale-8 score. We did the statistical analysis using chi-square test and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p<0.05.ResultsOut of 311 participants, 286 patients were eligible and were studied. More than half, 154 (53.8%), of the participants were males. The mean age of the participants was 54.8± 12.6 years (range 26 to 94). The majority, 196 (68.53%), of the participants were taking more than one antihypertensive medication. More than one third (39.5%) of the participants were non adherent to their medication(s). The rate of blood pressure control was 50.3%. In a univariate logistic regression analyses, age ≥65 years old (P = 0.008), physical inactivity (p<0.001), chat chewing (P<0.001), adding salt to food (P<0.001), and coffee use (P<0.001) are significantly associated with uncontrolled blood pressureConclusionAlmost half of the hypertensive patients on follow up had uncontrolled blood pressure. We recommend better health education and care of patients to improve the rate of blood pressure control at the hospital.

Change in serum 25-hydroxyvitamin D with antiretroviral treatment initiation and nutritional intervention in HIV-positive adults.

Low vitamin D level in HIV-positive persons has been associated with disease progression. We compared the levels of serum 25-hydroxyvitamin D (25(OH)D) in HIV-positive and HIV-negative persons, and investigated the role of nutritional supplementation and antiretroviral treatment (ART) on serum 25(OH)D levels. A randomised nutritional supplementation trial was conducted at Jimma University Specialized Hospital, Ethiopia. The trial compared 200 g/d of lipid-based nutrient supplement (LNS) with no supplementation during the first 3 months of ART. The supplement provided twice the recommended daily allowance of vitamin D (10 μg/200 g). The level of serum 25(OH)D before nutritional intervention and ART initiation was compared with serum 25(OH)D of HIV-negative individuals. A total of 348 HIV-positive and 100 HIV-negative persons were recruited. The median baseline serum 25(OH)D level was higher in HIV-positive than in HIV-negative persons (42·5 v. 35·3 nmol/l, P<0·001). In all, 282 HIV-positive persons with BMI>17 kg/m2 were randomised to either LNS supplementation (n 189) or no supplementation (n 93) during the first 3 months of ART. The supplemented group had a 4·1 (95 % CI 1·7, 6·4) nmol/l increase in serum 25(OH)D, whereas the non-supplemented group had a 10·8 (95 % CI 7·8, 13·9) nmol/l decrease in serum 25(OH)D level after 3 months of ART. Nutritional supplementation that contained vitamin D prevented a reduction in serum 25(OH)D levels in HIV-positive persons initiating ART. Vitamin D replenishment may be needed to prevent reduction in serum 25(OH)D levels during ART.

Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

BackgroundPsychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH).MethodsData were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable.ResultsThe prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31).ConclusionsThe high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

Central corneal thickness in newly diagnosed glaucoma patients in South West Ethiopia: a cross-sectional study

BackgroundReports of central corneal thickness (CCT) among glaucoma patients, particularly for pseudoexfoliative glaucoma (PXG) and Primary Angle Closure Glaucoma (PACG) are scarce in the Sub-Saharan African (SSA) population. The aim of this study is to evaluate CCT in black patients with newly diagnosed glaucoma and ocular hypertension (OHT) in South West Ethiopia.MethodsThis was a prospective study undertaken with an ultrasonic pachymeter from June 2014 to February 2015 in Jimma University Specialized Hospital. Patients aged 18 years and older newly diagnosed with glaucoma or OHT were included.ResultsA total of 162 eyes of 162 subjects were included. Hundred and fifty five subjects were glaucomatous: (67 PXG, 42 Primary Open Angle Glaucoma (POAG), 28 PACG, 14 Normal Tension Glaucoma (NTG), 5 Juvenile Open Angle Glaucoma (JOAG) and 6 (OHT). The mean age was 59.3 ± 12.8 years.For the whole sample, CCT was 518.67 (±39.97) μm. OHT group had significantly greater CCT (576.33 ± 49.32 μm) than the glaucomatous groups (p = 0.004). POAG (506.69 ± 35.08 μm) and NTG (510.79 ± 44.37 μm) groups had thinner CCT than PXG (520.48 ± 38.95 μm), PACG (524.00 ± 37.16 μm), and JOAG (518.00 ± 30.82 μm) groups, but this was not statistically significant (p = 0. 296). There was a statistically significant decline of CCT with advanced age (P = 0.02). There wasn’t significant difference of average CCT between the ethnic groups (P = 0.3) and gender (P = 0.064).ConclusionThe mean CCT of Ethiopian glaucoma patients is thinner than Caucasians and similar to those reported from previous studies in Sub Saharan Africa. OHT patients had thicker CCT; there was no statistically significant difference observed in average CCT amongst glaucoma subtypes.