Gonder, Ethiopia
Gonder, Ethiopia

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Bezabhe W.M.,University of Tasmania | Bezabhe W.M.,Bahir Dar University | Bereznicki L.R.,University of Tasmania | Chalmers L.,University of Tasmania | And 4 more authors.
Drug Safety | Year: 2015

Introduction: In Ethiopia, the use of antiretroviral therapy (ART) has been scaled up for HIV/AIDS over the past decade. Adverse drug reactions (ADRs) associated with ART pose a unique challenge in the treatment of the infection in this resource-limited setting. Objectives: The aims of this study were to examine the incidence and nature of ADRs, identify the risk factors associated with the development of ADRs, and assess their impact on treatment outcomes. Methods: A prospective cohort study was conducted in adult patients (≥18 years of age) with HIV/AIDS who commenced ART. All ADRs in the first 12 months of therapy were recorded, and the severity, causality, and preventability assessed. The impact of severe ADRs on self-reported adherence, immunological, and body mass index (BMI) outcomes were assessed. Results: Of the 211 patients included in the analysis, 181 (85.7 %) experienced at least one ADR and 66 (31.3 %) experienced at least one severe ADR within 12 months of commencing ART (incidence rates for any ADR and severe ADR of 14.8 and 3.2 per 100 person-months, respectively). Logistic regression analysis indicated that taking zidovudine-containing regimens (odds ratio [OR] 4.2, 95 % confidence interval [CI] 2.1–8.4) or being unemployed (OR 2.2, 95 % CI 1.1–4.3) were independent predictors of experiencing severe ADRs. Patients who experienced a severe ADR were less likely (OR 0.4, 95 % CI 0.2–0.9) to be ≥90 % adherent to ART. The mean gain in BMI was significantly lower in patients with severe ADRs after 3 and 12 months of therapy. Conclusions: ADRs were common within the first 3 months in patients initiated on ART. Severe ADRs were negatively associated with self-reported adherence and gain in BMI. Measures need to be implemented to routinely monitor for severe ADRs to improve ART adherence and treatment outcomes. © 2015, Springer International Publishing Switzerland.


Abdella N.M.,Gondar University Hospital | Tefera M.A.,University of Gondar | Eredie A.E.,Health Science University | Landers T.F.,Ohio State University | And 2 more authors.
BMC Public Health | Year: 2014

Background: Health care associated infections are more predominant in developing countries where Hand hygiene compliance is associated with so many factors. However, these factors have not been studied so far in the study area. This study sought to determine Hand hygiene compliance and associated factors among health care providers. Methods. Institution based cross-sectional study was conducted from April to May, 2013 in Gondar University Hospital. Stratified sampling technique was used to select 405 health care providers. Standardized questionnaire and world health organization observational checklist was used to collect the data. Data was entered and analyzed by using SPSS version 20. Descriptive statistics and binary logistic regression model was used to summarize the result. Results: A total of 405 study participants were interviewed and observed with a response rate of 96.4%. Good Hand hygiene compliance of healthcare providers was found to be 16.5%. Having knowledge about hand hygiene compliance, (AOR = 3.80, 95% CI 1.60, 8.97), getting training (AOR = 2.60, 95% Cl 1.21, 5.62), the presence of individual towel/tissue paper (AOR = 1.91, 95% CI 1.03, 3.56) presence of alcohol based hand rub for Hand hygiene compliance (AOR = 6.58, 95% CI 2.67, 16.22) and knew the presence of infection prevention committees (AOR = 2.6, 95% CI 1.23, 5.37) were significantly associated with hand hygiene compliance. Conclusions: Hand hygiene compliance among health care providers in Gondar University Hospital was found to be low. It is better to give training on Hand hygiene compliance and provide Alcohol based hand rub and individual towel or tissue paper for hand hygiene compliance. © 2014 Abdella et al.; licensee BioMed Central Ltd.


Bezabhe W.M.,University of Tasmania | Bezabhe W.M.,Bahir Dar University | Chalmers L.,University of Tasmania | Bereznicki L.R.,University of Tasmania | And 3 more authors.
PLoS ONE | Year: 2014

Background: Antiretroviral therapy (ART) has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country's ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia. Methods: Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English. Results: Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART. Conclusions: Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved patient outcomes. © 2014 Bezabhe et al.


Barone M.A.,Engender Health | Widmer M.,The World Bank | Arrowsmith S.,Engender Health | Ruminjo J.,Engender Health | And 20 more authors.
The Lancet | Year: 2015

Background Duration of bladder catheterisation after female genital fistula repair varies widely. We aimed to establish whether 7 day bladder catheterisation was non-inferior to 14 days in terms of incidence of fistula repair breakdown in women with simple fistula. Methods In this randomised, controlled, open-label, non-inferiority trial, we enrolled patients at eight hospitals in the Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Niger, Nigeria, Sierra Leone, and Uganda. Consenting patients were eligible if they had a simple fistula that was closed after surgery and remained closed 7 days after surgery, understood study procedures and requirements, and agreed to return for follow-up 3 months after surgery. We excluded women if their fistula was not simple or was radiation-induced, associated with cancer, or due to lymphogranuloma venereum; if they were pregnant; or if they had multiple fistula. A research assistant at each site randomly allocated participants 1:1 (randomly varying block sizes of 4-6; stratified by country) to 7 day or 14 day bladder catheterisation (via a random allocation sequence computer generated centrally by WHO). Outcome assessors were not masked to treatment assignment. The primary outcome was fistula repair breakdown, on the basis of dye test results, any time between 8 days after catheter removal and 3 months after surgery. The non-inferiority margin was 10%, assessed in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT01428830. Findings We randomly allocated 524 participants between March 7, 2012, and May 6, 2013; 261 in the 7 day group and 263 in the 14 day group. In the per-protocol analysis, ten (4%) of 250 patients had repair breakdown in the 7 day group (95% CI 2-8) compared with eight (3%) of 251 (2-6) in the 14 day group (risk difference 0·8% [95% CI -2·8 to 4·5]), meeting the criteria for non-inferiority. Interpretation 7 day bladder catheterisation after repair of simple fistula is non-inferior to 14 day catheterisation and could be used for management of women after repair of simple fistula with no evidence of a significantly increased risk of repair breakdown, urinary retention, or residual incontinence up to 3 months after surgery. Funding US Agency for International Development. © 2015 Elsevier Ltd.


Fekadu S.,Jimma University | Yigzaw M.,Gondar University Hospital | Alemu S.,Gondar University Hospital | Dessie A.,Gondar University Hospital | And 5 more authors.
European Journal of Clinical Nutrition | Year: 2010

Background/Objectives:Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case-control study to evaluate its social and nutritional determinants.Subjects/Methods:Men and women with insulin-requiring diabetes (n=107), aged 18-40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex (n=110) were recruited from patients attending other hospital clinics.Results:Diabetes was strongly associated with subsistence farming, odds ratio3.5 (95% confidence interval: 1.5-7.8) and illiteracy/low levels of education, odds ratio4.0 (2.0-8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio=5.5 (1.0-29.0) the mother's death during childhood, odds ratio3.9 (1.0-14.8), and markers of poverty including poorer access to sanitation (P=0.004), clean water (P=0.009), greater overcrowding (P=0.04), increased distance from the clinic (P=0.01) and having fewer possessions (P=0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass (P=0.01). In addition, men with the disease tended to be shorter, were lighter (P=0.001), with reduced sitting height (P=0.015) and reduced biacromial (P=0.003) and bitrochanteric (P=0.008) diameters.Conclusions:Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure. © 2010 Macmillan Publishers Limited All rights reserved.


Hailu W.,Gondar University Hospital | Weldegebreal T.,Arba Minch Hospital | Hurissa Z.,Gondar University Hospital | Tafes H.,Arba Minch Hospital | And 4 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2010

In sub-Saharan Africa, visceral leishmaniasis (VL) is treated with either PentostamTM (sodium antimony gluconate) or generic sodium stibogluconate (SSG), except in Uganda where Glucantime® (meglumine antimoniate) has been in use for at least a decade. Between January 2008 and February 2009, 54 Ethiopian VL patients were treated with Glucantime. The medical charts of these patients were reviewed to assess the effectiveness and safety profile of Glucantime in a routine healthcare setting. None of the patients from south Ethiopia (n=24) and 46.4% of the patients from north Ethiopia (n=30) were HIV co-infected. At completion of treatment (Day 31), cure rates were 78.6% (95% CI 59.0-91.7%) in north Ethiopia and 100% (95% CI 85.8-100%) in south Ethiopia. Thirty-three non-serious and six serious adverse events (two pancreatitis, one renal failure and three deaths) were observed in 26 patients. One-third of the non-serious adverse events were due to biochemical pancreatitis. During treatment, a case-fatality rate of 10.0% in north Ethiopia and 0.0% in south Ethiopia was noted. These data show that Glucantime can be as effective as Pentostam or SSG in HIV-negative patients. The data also point to clinical pancreatitis as a safety concern, especially in patients with HIV co-infection. © 2010 Royal Society of Tropical Medicine and Hygiene.


Weldetsadik A.T.,Gondar University Hospital
Ethiopian Medical Journal | Year: 2013

Back ground: Hematological malignancies are primary cancers of the blood and blood-forming organs (bone marrow and lymphoid tissues), which includes leukemia, lymphoma and plasma cell dyscrasia. The overall incidence of hematological malignancies appears to be rising in United States of America and Europe, and estimated to be rising in Africa. This study was conducted as there is scarcity of information regarding clinical characteristics of hematological malignancies in Ethiopia. Objective: The study aims to determine the distribution and spectrum of various hematological malignancies encountered in the locality. Method: This is a retrospective descriptive study done in Gondar University Hospital, North West Ethiopia from January 2008 to December 2011 in those admitted with the diagnosis of hematological malignancies. Results: Sixty-seven patients were admitted with the diagnosis of hematological malignancies during the study period. The mean and median ages of patients with hematological malignancies were 42yrs and 45yrs respectively. Non-Hodgkin 's lymphoma (NHL) comprised 22/67 (32.8%) of all hematological malignancies, followed by 17/67 (25.4%) chronic myeloid leukemia (CML) and 13/67 (19.4%) chronic lymphocytic leukemia (CLL). Majority of patients with NHL presented with advanced disease (77%), high-grade type (73%) with B-symptoms (68%), reflecting aggressive nature of the disease. Patients with acute leukemia, especially acute lymphoblastic leukemia (ALL), presented with features of cytopenia (fatigue, fever and bleeding tendency), while chronic leukemia (CML and CLL) cases had fatigue, weight loss and organomegaly on admission. Among patients with CML, 12/17 (71%) were in chronic phase, 4/17 (23%) in accelerated phase and 1/17 (6%) in blast phase on admission. Majority of CLL patients had advanced disease on admission with 9/13 (69%) Binet C and 10/13 (76%) ( Rai stage 111 and IV) Conclusion: The distribution and spectrum of various hematological malignancies in this study is grossly similar to the pattern reported in other African countries.


Muluye D.,Health Science University | Wondimeneh Y.,Health Science University | Moges F.,Health Science University | Nega T.,Gondar University Hospital | Ferede G.,Health Science University
BMC Research Notes | Year: 2014

Background: The type and pattern of organisms that cause ocular infection changes over time. Moreover, the causative organisms have developed increased drug resistance. Therefore, the aim of this study was to determine the prevalent bacterial agents of eye discharge and their drug susceptibility patterns to commonly used antimicrobial agents. Methods. A retrospective study was conducted at Gondar University Hospital, Northwest Ethiopia from September, 2009 to August, 2012. Culture and drug susceptibility test results of patients who had eye infections were taken for analysis. Eye discharge samples were cultured on MacConkey agar, blood agar and chocolate agar plates. A standard biochemical procedure was used for full identification of bacterial isolates. Antimicrobial susceptibility tests were done on Mueller-Hinton agar by using disk diffusion method. Data was entered and analyzed by using SPSS version 16 software. Result: A total of 102 eye discharges were submitted for microbiological evaluation, of which (60.8%) had bacterial growth. The most frequently isolated bacterial isolates were gram-positive bacteria (74.2%). The predominant bacterial species isolated was Coagulase-negative staphylococci (27.4%) followed by S. aureus (21%). Within the age group of 1 day-2 years old, (66.1%) of bacteria were isolated. Most of the bacterial isolates were resistance to ampicilin (71%), amoxicilin (62.9%), erythromycin (43.5%), gentamicin (45.2%), penicillin (71%), trimethoprim-sulphamethoxazole (58.1%), and tetracycline (64.6%) while Ceftriaxon and Ciprofloxacin showed (75.8%) and (80%) susceptibility respectively. From the total bacterial isolates, (87.1%) were showed multi drug resistance (MDR) to two or more drugs. Conclusion: The prevalence of bacterial isolates in eye discharge was high in the study area and majority of isolates were gram-positive bacteria. Most of the bacterial isolates were resistant to frequently used antimicrobials. Therefore, drug susceptibility test is necessary before prescribing any antimicrobials. © 2014 Muluye et al.; licensee BioMed Central Ltd.


Muluye D.,Health Science University | Wondimeneh Y.,Health Science University | Ferede G.,Health Science University | Moges F.,Health Science University | Nega T.,Gondar University Hospital
BMC Ear, Nose and Throat Disorders | Year: 2013

Abstract. Background: Ear infection is a common problem for both children and adults especially in developing countries. However in Ethiopia particularly in the study area, there is no recent data that shows the magnitude of the problem. The aim of this study was to determine the bacterial isolates and their drug susceptibility patterns from patients who had ear infection. Method. A retrospective study was conducted from September, 2009 to August, 2012 at Gondar University Hospital, Northwest Ethiopia. Ear discharge samples were cultured on MacConkey agar, blood agar and chocolate agar plates. A standard biochemical procedure was used for full identification of bacterial isolates. Antimicrobial susceptibility tests were done on Mueller-Hinton agar by using disk diffusion method. Data were entered and analyzed by using SPSS version 20 software and P-value of < 0.05 was considered statistically significant. Result: A total of 228 ear discharge samples were tested for bacterial isolation and 204 (89.5%) cases were found to have bacterial isolates. From the total bacterial isolates, 115 (56.4%) were gram negative bacteria and the predominant isolate was proteus species (27.5%). Of individuals who had ear infection, 185 (90.7%) had single bacterial infection while 19 (9.3%) had mixed infections. Under five children were more affected by ear infection. The prevalence of ear infection was significantly high in males (63.7 vs 36.3%) (P = 0.017). Of all bacterial isolates, 192 (94.1%) had multiple antibiotic resistant pattern. Non Lactose Fermenter Gram Negative Rods (46.0%), Klebsella species (47.7%) and Pseudomonas species (48.5%) were resistant against the commonly used antibiotics. Conclusion: The prevalence of ear infection was very high in the study area. Majority of the bacterial isolates were resistant to multiple antibiotics. Hence antibiotics susceptibility test is mandatory before prescribing any antibiotics. © 2013 Muluye et al.; licensee BioMed Central Ltd.


Gordon D.M.,2040 Fell Street | Frenning S.,Gondar University Hospital | Draper H.R.,Gondar University Hospital | Kokeb M.,Gondar University Hospital
Journal of Tropical Pediatrics | Year: 2013

Background: Little is known about pediatric hospital admissions in Ethiopia. Methods: This cross-sectional study analyzed all data entered into the Gondar University Hospital pediatric ward's admission registration books over 1 year. Patient age, sex, origin, length of stay, diagnosis and discharge condition were transcribed into an electronic database for all observations. Missing data were retrieved by chart and death certificate review. Primary outcome measures included death and death in the first 24 h of admission. Results: In all, 1927 patients were admitted to our facility during the year of study. Of these, 64.5% improved, 4.6% were discharged unchanged, 6.5% disappeared and 7.5% died; the remaining 17.0% of outcome data were registered as 'non-death' but could not be specified further. The median age of admission was 2.2 years (interquartile range 1-7 years), with more admissions for children younger than 5 years (70.3%) and more male subjects admitted than female subjects (59.6% male). The median length of stay was 4.0 days (interquartile range 2-10 days). Eighty-one percent of admissions originated from Gondar or its neighboring districts. Most admissions carried a respiratory, nutritional or infectious diagnosis (47.5, 46.8 and 36.5%, respectively). Conditions diagnosed most commonly (>200 cases) included community-acquired pneumonia (812 cases), severe acute malnutrition (381), anemia (274) and acute gastroenteritis (219). Seven diagnoses were associated with mortality after adjusting for demographic covariates: severe acute malnutrition (odds ratio (OR) 2.5, P<0.001), coma (OR 4.2, P<0.001), meningitis (OR 2.3, P=0.018), congestive heart failure (OR 2.4, P=0.001), severe dehydration (OR 2.5, P=0.004), aspiration pneumonia (OR 5.4, P<0.001) and sepsis (OR 3.2, P<0.001). Thirty-three percent of deaths occurred in the first 24 h of admission, with four diagnoses associated with first-24-h mortality after adjusting for demographic covariates: coma (OR 7.0, P<0.001), meningitis (OR 3.2, P=0.008), congestive heart failure (OR 3.1, P=0.008) and aspiration pneumonia (OR 12.1, P<0.001). Conclusions: This study demonstrates a mortality pattern at our hospital that differs considerably from Ethiopia as a whole, and may differ from other hospitals in sub-Saharan Africa. Hospitals must look beyond national and regional agenda when identifying mortality reduction targets © The Author [2013].

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