Jimma University Teaching Hospital Research Articles

Self-Reported Chronic Disease Co-morbidities among Patients on Antiretroviral Therapy: A facility based cross-sectional study in Jimma, Southwest Ethiopia

Background: People living with HIV who have access to antiretroviral therapy (ART) are living longer and healthier lives. The clinical management of such patients is evolving towards a new spectrum of comorbidities. People living with HIV are increasingly experiencing a range of multiple comorbidities conditions. Measurement of comorbidity has currently received more attention from medical researchers. Therefore, this study has assessed self-reported chronic disease comorbidities among patients on antiretroviral therapy in Jimma, Southwest Ethiopia. Methods: A facility based cross-sectional study design was employed among 351 ART clients visiting Jimma University Teaching Hospital in March 2014 that were identified by systematic random sampling. Data were collected by interviewer-administered questionnaires that mainly assessed socio-demographic data, disease-related care factors, community factors and treatment delivery-related factors. Descriptive analysis was performed. Bivariate and multivariate logistic regression analyses were used to identify associated factors by using SPSS version software. Association between the explanatory and dependent variables was assessed at the p-value of less than 0.05. The results were presented in a narrative form, tables and graphs. Results: Of the total respondents, 137 (39%) had comorbidities with different diseases. From this, the majority of them have tuberculosis 71 (51.82 %), followed by hypertensions 26 (19.0%), asthma 21 (15.3%), diabetes 11 (8.0 %) and heart diseases 8 (5.8%).Being current CD4 count < 250 cells/ml (AOR=2.715 [CI = 1.461, 5.1 poor level of general health conditions (AOR=5.894 [CI= 3.172, 10.951]), discontinuation opportunistic infection prophylaxes (AOR= 2.578 [CI = 1.371,4.845]), having any clinical symptoms for HIV/AIDS (AOR= 6.46 [CI= 3.428, 12.175]) and having substance use disorders (AOR= 4.925 [CI= 2.629, 9.225]) were factors that shown statistically significant associations with having comorbidities. Conclusions: The finding indicated that magnitudes of comorbidities were numerous. Different clinical and behavioral factors mentioned above lead the patients to the development of comorbidities. Therefore, we recommend the concerned organization to give greater emphasis on those identified factors as influential and due attention should be given to those factors curving the problems and burden of comorbidities among the HIV/AIDS patients.

HIV Care continuum Outcomes: Can Ethiopia Meet the UNAIDS 90-90-90 Targets?

Ethiopia has pledged to the UNAIDS 90-90-90 framework. However, the achievements of these UNAIDS targets are not assessed in Southwest Ethiopia. Using HIV care and treatment outcomes as surrogate markers, we assessed all targets. Complex surrogate makers were used to assess the HIV care continuum outcomes using antiretroviral therapy data in Jimma University Teaching Hospital. Early HIV diagnosis was a surrogate marker to measure the first 90. Numbers of people on HIV treatment and who have good adherence were used to measure the second 90. To measure the third 90, we used immunological success that was measured using numbers of CD4 counts, clinical success using WHO clinical stages and treatment success using immunological and clinical successes. In total, 8172 patients were enrolled for HIV care from June 2003 to March 2015. For the diagnosis target, the prevalence of early HIV diagnosis among patients on ART was 35% (43% among children and 33.3% among adults). For the treatment target, 5299(65%) received ART of which 1154(22%) patients lost to follow-up or defaulted from ART treatment, and 1015(19%) patients on treatment transferred out to other sites. In addition, 17% had fair or good adherence. Finally, 81% had immunological success, 80% had clinical success and 66% treatment success. The study revealed that Southwest Ethiopia achieved 35%, 65% and 66% of the first, second and third UNAIDS targets, a very far performance from achieving the target. These highlight further rigorous interventions to improve outcome of HIV continuum of care.

Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: A descriptive analysis.

PurposeCervical cancer remains the second most common cancer and cancer-related death among women in Ethiopia. This is the first study, to our knowledge, describing the demographic, and clinicopathologic characteristics of cervical cancer cases in a mainly rural, Southwestern Ethiopian population with a low literacy rate to provide data on the cervical cancer burden and help guide future prevention and intervention efforts.MethodsA descriptive analysis of 154 cervical cancer cases at the Jimma University Teaching Hospital in Southwestern Ethiopia from January 2008 –December 2010 was performed. Demographic and clinical characteristics were obtained from patient questionnaires and cervical punch biopsies were histologically examined.ResultsOf the 154 participants with a histopathologic diagnosis of cervical cancer, 95.36% had not heard of cervical cancer and 89.6% were locally advanced at the time of diagnosis. Moreover, 86.4% of participants were illiterate, and 62% lived in a rural area.ConclusionA majority of the 154 women with cervical cancer studied at the Jimma University Teaching Hospital in Southwestern Ethiopia were illiterate, had not heard of cervical cancer and had advanced disease at the time of diagnosis. Given the low rates of literacy and knowledge regarding cervical cancer in this population which has been shown to correlate with a decreased odds of undergoing screening, future interventions to address the cervical cancer burden here must include an effective educational component.

Counseling Practice and its Effectiveness (The Case of Amanuel Mental Health Specialized Hospital and Jimma University Teaching Hospital)

Counselors play a critical role in helping people who are experiencing mental or emotional problems to get their lives back on track. And it is one of the treatment options for mentally ill peoples for its deal with wellness, personal growth, and career, education, and empowerment concerns. The purpose of the study is to assess the practice of counseling and its effectiveness in Jimma University Teaching Hospital (JUTH) and Amanuel Mental Health Specialized Hospital (AMHSH). It guided by mixed research design, quantitative and qualitative data about study variables was collected from 123 patients from both institutions, Qualitative data were analyzed by direct quotation according to the theme of the questions. Descriptive percentage and ANOVA analysis were used to analyze quantitative data. Descriptive statistics showed that there is a difference in the applications of counseling within the institution Analysis of ANOVA showed counseling is more effective in the treatment of depression and substance abuse. The difference in counseling provision in both institutions is also supported by qualitative analysis of the data. So, JUTH has to incorporate counseling service in the part of treatment, and AMUSH has to work on addressing a huge number of in need patients by expanding the institution.

Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study

BackgroundDepression and heart disease are an important public-health problem. Depression is one of the most prevalent and disabling psychiatric disorders with more than three times increased risk among patients with cardiovascular disorders.ObjectiveTo identify the prevalence and associated factors of depressive disorder among adult patients with cardiovascular disease.MethodsInstitution based cross-sectional study design was used to conduct this study on 293 study participants attending an outpatient cardiac clinic at Jimma University Teaching Hospital. All eligible patients were recruited into the study consecutively. Depression was assessed using patient health questionnaire-9. The patient health questionnaire-9 had a total score of 27, from which 0–4: no/minimal depression, 5–9: mild depression, 10–14: moderately depression, 15–19: moderately severe depression and 20–27 severe depression. The data was feed into Epi-data version 3.1 and lastly exported to SPSS version 21 for analysis. Bivariate analysis was used to analyze the statistical association of covariates of interest with depressive disorder among patients with cardiovascular disease. Then, logistic regression analysis was used as a final model to control confounders. The strength of association was measured by a 95% confidence interval.ResultsA total of 293 adult patients diagnosed with the cardiovascular disease were included in the study with 97% (n = 284) of response rate, 47.2% (n = 134) males and 52.8% (n = 150) females, making female to a male ratio around 1.1:1. The prevalence of depression was 52.8% (n = 150/284). Out of the subjects with depression 52.67% (n = 79), 36.0% (n = 54) and 11.33% (n = 17) were mild, moderate and severe depression, respectively. Variables such as employed, unemployed, physical activity, current cigarette user and poor social support were independently associated with depression in the final model.ConclusionsIn this study, depression was found to be highly prevalent psychiatric comorbidity in adult cardiovascular disease patients.

Help-seeking behaviour for depressive disorders among adult cardiovascular outpatient cardiac clinic Jimma University Teaching Hospital, Jimma, South-West Ethiopia: crosssectional study

BackgroundDepression in healthy person without cardiac disease has been associated with the development of coronary artery disease and cardiovascular disease also risk factor for development of depression. This has devastating effect the patient’s quality of live, illness progression, morbidity and mortality. Despite this fact help seeking behavior of cardiovascular patients with depression has not been addressed in Ethiopia.ObjectiveTo assess help-seeking behaviors of adult cardiovascular patients with depression for their depressive disorders in Jimma university teaching hospital.MethodInstitution based cross sectional study conducted October to December in 2014. The study was conducted on 353 cardiovascular patients who attended at cardiac clinic. Depression was assessed using patient health questionnaire version nine (PHQ-9), which is validated in Ethiopia, Help seeking behavior using actual help seeking questionnaire and social support using Oslo social support-3 item scale.ResultFrom the total of 339 participants, 57.5% (n = 195) of them fulfill the case definition of depression and 12.1% (n = 41) of participant reported idea of hurting themselves. Only 33.3% sought help for their depression. Of those participants who sought help, 88.6% sought help from one or more of an informal help source. Occupation (odds of = 4.24, 95% confidence interval (CI) 1. 31, 13.78), education level (AOR 7.6, CI 2. 13, 27.11), the presence of a history of mental illness in the family (AOR 7.33, CI 2. 72, 19.80), ideal of hurting themselves, knowing the availability of the psychiatric service in this hospital and having previous seeking help were significantly associated with help seeking behavior.Conclusion and recommendationThe number of patients not seeking help for depression is high. There for scaling up mental health service in tertiary hospitals through multidisciplinary approach should be given high priority.

Assessment of Rheumatic Heart Disease Adherence to Secondary Prophylaxis and Factor Affecting Among Patients with Rheumatic Heart Disease Attending Jimma University Teaching Hospital, South West of Ethiopia

Background: Rheumatic heart disease is a chronic heart condition caused by rheumatic fever that can be prevented and controlled by secondary prophylaxis. However, there is paucity of information on adherence of patients to rheumatic heart disease secondary prophylaxis in Jimma, southwest of Ethiopia. Objective: To assess level of adherence to secondary prophylaxis and factor affecting among patients with rheumatic heart disease attending Jimma University Teaching Hospital, Cardiac clinic. Methodology: Facility based cross-sectional study was done on all rheumatic heat disease patients (277) coming for follow-up during specified period at Jimma University Teaching Hospital cardiac follow-up clinic. Records of all patients were reviewed. Using structured questionnaire the patients or their attendants were interviewed. The descriptive statistics and chi square were used to analyze/compute some variables by using computer. Results: Of the total 277 who gave responses, 249 (89.9%) took rheumatic heart disease secondary prophylaxis and all of them used benthanthine penicillin. One fifth (20.5%) patients out of 249 on secondary prophylaxis missed their regular injection at least once. Distance from treatment center and knowledge on disease prevention were strongly associated with adherence to rheumatic heart disease secondary prophylaxis (p<0.03). Conclusion and Recommendation: About one-fifth of the patients were missed their secondary prophylaxis and the main reasons were distance from hospital, lack of money, dissatisfaction with staff and lack of knowledge. Educating patients/care givers on the cause and prevention rheumatic heart disease as well as complication following missing of secondary prophylaxis are helpful to improve adherence level of patients to secondary prophylaxis.

Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study

ObjectiveTo assess the prevalence, trend and associated factors for immunological failure (IF), and the magnitude of antiretroviral therapy (ART) shift among adults infected with HIV in Southwest Ethiopia.SettingA retrospective cohort...

Late presentation for HIV care in Southwest Ethiopia in 2003\u20132015: prevalence, trend, outcomes and risk factors

BackgroundEarly presentation for HIV care is vital as an initial tread in the UNAIDS 90–90–90 targets. However, late presentation for HIV care (LP) challenges achieving the targets. This study assessed the prevalence, trends, outcomes and risk factorsfor LP.MethodsA 12 year retrospective cohort study was conducted using electronic medical records extracted from an antiretroviral therapy (ART) clinic at Jimma University Teaching Hospital. LP for children refers to moderate or severe immune-suppression, or WHO clinical stage 3 or 4 at the time of first presentation to the ART clinics. LP for adults refers to CD4 lymphocyte count of < 200 cells/ μl and < 350 cells/μl irrespective of clinical staging, or WHO clinical stage 3 or 4 irrespective of CD4 count at the time of first presentation to the ART clinics. Binary logistic regression was used to identify factors that were associated with LP, and missing data were handled using multiple imputations.ResultsThree hundred ninety-nine children and 4900 adults were enrolled in ART care between 2003 and 15. The prevalence of LP was 57% in children and 66.7% in adults with an overall prevalence of 65.5%, and the 10-year analysis of LP showed upward trends. 57% of dead children, 32% of discontinued children, and 97% of children with immunological failure were late presenters for HIV care. Similarly, 65% of dead adults, 65% of discontinued adults, and 79% of adults with immunological failure presented late for the care. Age between 25- < 50 years (AOR = 0.4,95% CI:0.3–0.6) and 50+ years (AOR = 0.4,95% CI:0.2–0.6), being female (AOR = 1.2, 95% CI: 1.03–1.5), having Tb/HIV co-infection (AOR = 1.6, 95% CI: 1.09–2.1), having no previous history of HIV testing (AOR = 1.2, 95% CI: 1.1–1.4), and HIV care enrollment period in 2012 and after (AOR = 0.8, 95% CI: 0.7–0.9) were the factors associated with LP for Adults. For children, none of the factors were associated with LP.ConclusionsThe prevalence of LP was high in both adults and children. The majority of both children and adults who presented late for HIV care had died and developed immunological failure. Effective programs should be designed and implemented to tackle the gap in timely HIV care engagement.

Patterns of psychiatric admissions and predictors of patient\u2019s outcome in Jimma University Teaching and Referral Hospital: a retrospective study

BackgroundPsychiatric morbidity burden accounts 12.45% of the disease admission burden in Ethiopia; only two referral hospitals are found to manage all cases. The aim of this study is to assess the predictors of patient outcomes.MethodA 3 years retrospective patients’ cards, charts and medical notes review in psychiatry case admission department of Jimma university teaching and training specialised hospital was conducted. All the admitted cases included in this study. Bivariate and multivariable logistic regression analyses were conducted to identify independent predictors of outcomes.ResultAmong 402 study participants, the majority of them 301 (74.9%), were improved from their mental illnesses. First to eight grades completed study participants were found to be 1.34 times more likely improved mental illness than not able to read or write [AOR = 1.34, 95% CI (1.18–2.78), P < 0.009)]. The probability of improving from mental illness on married study participants was found 2.81 times more likely than single study participants [AOR = 2.81, CI (1.90–4.50), P < 0.043]. First time admitted cases improved 2.82 times more likely than those having a previous admission history [AOR = 2.82, CI (2.05–3.17), P < 0.05]. Duration of stay from 31 to 44 days showed more likely than from 1 to 20 days on patient improvement, [AOR = 1.88, CI (1.42–2.65), P < 0.034]. However, the hospital stay above 44 days does not show any statistical association with patient’s medical improvement.ConclusionMarried, better educated, and the hospital stay of one to one-and-half month predicts better health outcome. Thus, this study suggests, psychiatric case management needs the collaborative care of the family in concurrence with counselling and guidance with enough time to better-off patients’ outcomes. Our findings are useful in designing and improving—patient services for psychiatric patient programs and focused health communication and counselling strategies in relation to psychoactive substances in Ethiopia.

Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia

BackgroundDepression is a serious mental illness that affects patients’ treatment outcome and caregiver’s day to day life. The prevalence of depression among caregivers of patients with severe mental illness is greater than the general population. Little is known about depression among primary caregivers of patients with severe mental illness in Ethiopia. This study is aimed at assessing prevalence of depression and associated factors among primary caregivers of patients with mental illness.MethodsA cross-sectional study was conducted among primary caregivers of patients with severe mental illness in Jimma University Teaching Hospital. Patient health questionnaire (PHQ-9) was used to assess depression. A multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support; Cut down, Annoyed, Guilty, Eye opener (CAGE) scale was used to assess alcohol use disorder. After conducting descriptive analyses, logistic regression analysis was finally used for bivariate and multivariable analysis.ResultThe overall prevalence of depression among primary caregivers of patients with mental illness was 12 (19%). Out of those caregivers with depressions, 11.3, 3.5 and 4.2% had moderate, moderately severe and severe types of depression respectively. The prevalence of depression among female primary caregivers was 25% (n = 40). Being single (aOR 2.62, 95% CI = 1.07, 6.41), giving care more than six hours per day (aOR 3.75, 95% CI = 1.51, 9.33) and caring for a patient who had more than once episodes of suicidal attempts (aOR 1.48, 95% CI = 1.07, 3.42) were positively associated with depression among caregivers of patients with mental illness.ConclusionWe found that the prevalence of depression among primary caregivers was high. Depression among caregivers was associated with giving care more than six hours per day and caring for a patient who had two or more episodes of suicidal attempts. The prevalence of depression among female caregivers was higher than that of the male caregivers. Therefore, special focus should be given to primary caregivers spending long hours for providing care, those with low perceived social support; caregivers of patients with suicidal ideation and female caregivers.

Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia.

BackgroundAntibiotics use in in children are different from adults due to a lack of data on pharmacokinetics, pharmacodynamics, efficacy and safety of drugs, different physiological spectrum, pediatrics populations being vulnerable to the majority of the illnesses, and the adverse effect of their irrational use is more serious. However, antibiotic use is not explored much in a paediatric population. The current study focused on antibiotic use among pediatric population using data from a tertiary hospital in Ethiopia.MethodsA retrospective cross-sectional study collated data from 614 pediatrics patients admitted in pediatrics ward at Jimma University Teaching Hospital, Southwest Ethiopia. Descriptive analyses were performed to describe the type and pattern of antibiotics. The number of prescriptions per a patient was also compared with the WHO standard. Data analysis was carried out using SPSS version 20 for mackintosh.ResultsAntimicrobials were prescribed for 407(86.4%) patients of which 85.9% were in the form of injectables. A total of 1241 (90%) medicines were administered parenterally followed by oral 110 (8%). The maximum number of medicines per prescription was eight for all types of drugs in general, and five for antimicrobials in particular. All antimicrobials were prescribed empirically without any microbiological evidence. Pneumonia, sepsis and meningitis were the main reasons for antimicrobial use in the ward. Out of the total of 812 antibiotics prescribed; Penicillin G crystalline was the most (20%) frequently prescribed, followed by gentamicin (19%) and ampicillin (16).ConclusionsMajority of the prescribed antibiotics were antimicrobials, and was in the form of injectables. Antimicrobials were over prescribed and the number of drugs per prescription was also far from WHO recommendation. Strict prescribing standard guidelines and treatment habits should be developed in the country, to prevent antimicrobial resistance.

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

Psychological morbidity and substance use among patients with hypertension: a hospital-based cross-sectional survey from South West Ethiopia

BackgroundPsychological morbidity and substance use disorders have been linked to cardiovascular diseases; affecting patients’ medical outcome and quality of life. However, little is known about psychological morbidity and substance use among patients with hypertension in Ethiopia. Therefore, we aimed to assess psychological comorbidity and substance use among hypertensive patients in Southwest Ethiopia.MethodsA cross-sectional study was conducted among 396 hypertensive patients on follow-up at Jimma University Teaching Hospital in Ethiopia during the study period. Structured questionnaires were used to assess alcohol use, khat chewing and cigarette smoking. Psychological morbidity was assessed using the Kessler-6 scale. Multiple logistic regression analysis was carried out to identify the independent association between outcome and explanatory variables.ResultsThe prevalence of psychological morbidity among hypertensive patients was 31.6%. Of the total participants, 31 (7.8%) of them had alcohol use disorders and 79 (19.9%) of them were using khat regularly at the time of the study. Singles were more likely to have psychological morbidity than married participants (AOR = 4.72; 95% CI 1.83, 12.20, p = 0.001), whereas those who were able to ‘read and write’ were less likely to have psychological morbidity than non-literate ones (AOR = 0.46; 95% CI 0.24, 0.89, p = 0.02). However, no association was seen between psychological morbidity and substance use (khat chewing, alcohol use and cigarette smoking), belief about hypertension, ever discontinuation of medication and lifestyle (exercise, salt consumption).ConclusionPsychological morbidity and substance use are prevalent among hypertensive patients on follow-up at the hospital. The findings of the study imply that there is a need for further studies to understand the effect of psychological morbidity on the clinical outcomes of hypertensive patients.

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.

Antiepileptic drugs use among patients attending epilepsy clinic at Jimma university teaching and referral hospital, southwest Ethiopia: Retrospective facility based cross-sectional descriptive study

Antiepileptic drugs use among patients attending epilepsy clinic at Jimma university teaching and referral hospital, southwest Ethiopia: Retrospective facility based cross-sectional descriptive study

Medication Non-adherence and Use of Traditional Treatment Among Adult Psychiatric Patients in Jimma Town Treated at Jimma University Teaching Hospital Psychiatric Clinic. Community Based Cross-sectional Study, 2016

Background: Medication non-adherence is common problem across all branches of medicine including psychiatry especially in severe mental illness. Many people with mental illness are known to use both modern and traditional treatment for their illness. However, the level of medication non-adherence among this group of patients is not yet explored. This study was conducted to assess the magnitude of non-adherence and traditional treatment as well as associated factors with non-adherence. Methods: Community based cross sectional study was conducted from April June, 2016 in Jimma town. Data was collected using interviewer administered questionnaire and from patients’ medical record. The four-item Morisky medication adherence scale was used to assess degree of medication non adherence. Pre-test was done on patients who had follow-up at Jimma University teaching Hospital psychiatric clinic and outside the study area. Data was analyzed using SPSS version 20 for windows and descriptive statistics and binary logistic regression statistical methods were applied. P-Value of less than 0.05 was considered statistically significant association in the final model. Results: Out of 300 patients, 61.7% males and 38.3% were females. The prevalence rate of medication nonadherence was 39.3% and 198 (66%) of the participants were traditional treatment users. Using religious types of traditional treatment [AOR=3.763, 95% C.I (1.459, 9.707)], longer duration of treatment (>10 years) [AOR=0.375, 95% C.I (0.155, 0.908)], no history of treatment default [AOR=0.375, 95% C.I (0.155, 0.908)] and no relapse history [AOR=0.365, 95% C.I (0.190, 0.702)] were independently associated variables with medication non-adherence. Conclusion: This study showed that high magnitude of non-adherence and majority of the participants were users of traditional treatments which significantly affects medication adherence. Therefore, mental health professionals should focus on methods how to work cooperatively with traditional treatment giver to decrease non adherence and improve counseling service for patients about being non adherent and its effect on clinical outcome.

Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia.

BackgroundTuberculosis/HIV co-infection is a bidirectional and synergistic combination of two very important pathogens in public health. To date, there have been limited clinical data regarding mortality rates among tuberculosis/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in Ethiopia. This study assessed the incidence and predictors of tuberculosis/HIV co-infection mortality in Southwest Ethiopia.MethodsA retrospective cohort study collated tuberculosis/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used proportional hazards cox regression model at P value of ≤ 0.05 in the final model.ResultsFifty-five (20.2 %) patients died during the study period and 272 study participants contributed 3 082.7 person month observations. Factors including: being aged between 35–44 years (AHR = 2.9; 95 % CI: 1.08–7.6), being a female sex worker (AHR = 9.1; 95 % CI: 2.7–30.7), being bed ridden as functional status (AHR = 3.2; 95 % CI: 1.2–8.7), and being at World Health Organization HIV disease stages 2 (AHR = 0.2; 95 % CI: 0.06–0.5), 3(AHR = 0.3; 95 % CI: 0.1–0.8) and 4(AHR = 0.2; 95 % CI: 0.04–0.55) were significant predictors of mortality for tuberculosis/HIV co-infected patients.ConclusionsContrary to our expectations, the World Health Organization (WHO) HIV disease stage 1 was found to be a significant predictor of mortality. Higher mortality rates were observed in WHO disease stage 1 patients compared to patients in stages 2, 3 and 4. The current study also confirmed and reaffirmed known significant predictors of the mortality for tuberculosis/HIV co-infected patients including being 35–44 years, being a female sex worker and being bed ridden functional status. The occurrence of high death rate among tuberculosis/HIV co-infected cases needs actions to reduce this poor outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0202-1) contains supplementary material, which is available to authorized users.

English

Post-operative sore throat significantly impact patients&rsquo; satisfaction during post-operative period. Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management. To determine the predictors and incidence of postoperative sore throat. In this facility based cross sectional study, 245 elective gynecologic and general surgical patients who had had surgery at Jimma University Teaching Hospital between February 01 and April 30, 2015 were interviewed during postoperative period&nbsp; between 6 and 24 h using a structured questionair. After outliers and missing value checked the data manually entered into SPSS Version 20 IBM. In addition to descriptive analysis odds ratio with 95% confidence interval was used in bivariate and multivariate logistic regression analysis to determine the effect of predictors on the postoperative sore thoat and hoarsness of voices. A total of 245 surgical patients was interviewed with a complete response rate of 228(93.1%). Their age ranges from 18 to 87years, with a majority between 31 and 40 years. From a total respondent 120 (52.6%) were females, 171(75%) American Society of Anesthesiologist class-I, 137(60.1%) cannot read and write, and 108 (47.4%) were farmer. Majority 47(20.6%) of surgery was orthopedics surgery; followed by 25(11%) breast surgery, 23(10.1%) hysterectomy and others. One hundred twenty nine (56.6%) participants had suffered postoperative sore throat and 68 of them had had hoarseness of voices. The sore throat was found to be more common with certain patient, anesthetic and surgical related factors; difficulty level of intubation, duration of ETT in trachea, being not premedicated with opioid, unexperienced anesthetists, other than ketamine anesthetic&nbsp; induction agent,&nbsp; bleeding on tip of laryngoscope/ETT, perioperative hypotension and higher estimated blood loss during surgery. Significant incidence of postoperative sore throat and hoarseness of voice were seen during study period in the study area. Awareness creation on the predisposing factors and appropriate care especially during endotracheal intubation would help in reducing or avoiding the incidence of postoperative sore throat. &nbsp; Key words: Endotracheal intubation, elective surgery, postoperative complications, sore throat.

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort.

BackgroundA delay presentation for human immunodeficiency virus (HIV) patient’s care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia.MethodsA retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model.ResultsThe prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3–1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3–0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0–3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8–25.1) functional status was higher than with working status.ConclusionsThree out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0193-y) contains supplementary material, which is available to authorized users.