Endalkachew Mekonnen Eticha* and Workineh Diriba Gemechu
Background: Cases of COVID-19 have been increasing in number and spread globally. Pharmacists are an important part of the health care system and their role is critical in completing the management cycles of Coronavirus outbreak surveillance.
Methods: A multi-centric cross-sectional study was conducted on 84 pharmacy professionals recruited from both community and hospital pharmacies in Jigjiga City to assess the knowledge, attitude and practice towards COVID-19. Self-administered questionnaires were developed and distributed to the participants. All extracted data were cleaned, coded and entered into the Statistical Package for the Social Science software version 20 and subsequently analyzed. Binary logistic regression analysis was used to identify determinants of knowledge, attitude and practice towards COVID-19.
Results: All of the respondents had already heard about COVID-19. More than 90% of the participants had adequate knowledge regarding typical symptoms, etiological causes, modes of transmission, measures to protect the infection, risky patients and primarily affected organ system by COVID-19. The majority of the respondents (71.4%) had adequate knowledge regarding COVID-19. The finding indicated that pharmacists had 8 times higher odds (AOR=8.34 95% CI (1.33-36.04)) of adequate knowledge than the pharmacy technicians. Greater than half of the study participants (53.6%) had a positive attitude towards COVID-19. More than 4 out of 5 participants were confident that Ethiopia can win the battle against the pandemic. Participants with less than five years of experience had 6 times greater odds (AOR=6.16; 95% CI (1.52-24.86)) of a positive attitude than their comparator. A low number of participants (16, 22.6%) exercised adequate practice to prevent and control the novel coronavirus spread.
Conclusion: The community and hospital pharmacists had good knowledge but had a poor attitude and practice towards the COVID-19. The majority of the participants perceived that they can play a great role in this pandemic.
Vian Namanya*, Dickens Owamaani and Edmund Byamukama
DOI: DOI: 10.37421/2155-6113.2022.13.891
HIV remains a global human threat with about 39 million people infected and it has claimed the lives of over 25 million over the last 25 years. Over 80% of these are in sub-Saharan Africa. As of 2019, Uganda had an estimated population of 41.5 million, of whom 1,915,533 live with HIV/AIDS with HIV incidence among susceptible individuals at 1.4%, the ultimate highest. About 53000 people were infected with HIV in 2018 whereas 23000 died of the illness in Uganda in 2018. In Uganda, 84% of the people living with HIV knew their status, 72% were on ART and 64% were virally suppressed. Among adults (15-64 years, the most sexually active), the prevalence is 6.2%. In western Uganda, the prevalence stands at 7.9% slightly below western Nile with the highest at 8%.
Vian Namanya* and Kalema Bashir Amza
DOI: DOI: 10.37421/2155-6113.2022.13.892
Introduction: Worldwide the efficacy and safety of Azithromycin and 4-Aminoquinoline regimen in the treatment of COVID-19 has remained uncertain in both pregnant and other mothers. Pregnancy complications studies are still lacking, although a high preterm birth rate due to the combination of this regimen has been reported which is mostly caused by iatrogenic preterm birth owing to the diagnosis of COVID-19 principally preterm cesarean deliveries and perinatal transmission may occur but seems rare. There is lack of evidence reporting an increase in the incidence of congenital abnormalities, an increase in stillbirth or neonatal death (miscarriages), Fetal Growth Restriction (FGR) among pregnant mothers with COVID-19.
Aim: This study aimed at systematically reviewing studies regarding the use of Azithromycin and 4-Aminoquinoline based regimens in COVID-19 positive pregnant mothers.
Methods: This was asystematic literature review. A systemic search of articles was done on PubMed, TRIP, EPPI COVID Living Map, Web of Science, and medRxiv databases until 2020 using the keywords “COVID-19”, “SARS-CoV-2”, “coronavirus”, “hydroxychloroquine”, and “mortality”. Relevant articles were chosen for further evaluation based on a review of their titles and abstracts. In vivo and in vitro studies were included assessing the safety and effectiveness of Azithromycin and 4-aminoquinline for treatment of COVID-19 pregnant mothers.
Results: A total of 438 articles were screened and 12 eligible clinical studies (seven peer-reviewed and published studies and five non-peer-reviewed studies from pre-print servers were included) selected. A number of studies have established very good virological and clinical outcomes with 4-Aminoquinoline in particular HCQ therapy alone or in combination with Azithromycin among COVID-19 pregnant mothers. However, some studies have shown negative results with combination of HCQ treatment and Azithromycin among COVID-19 pregnant mothers.
Conclusion: In this systematic review, we have found that the results of effectiveness and safety of Azithromycin and 4-aminoquinoline combination in COVID-19 pregnant mothers as obtained from 12 eligible clinical studies, is not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of Azithromycin and 4-aminoquinoline combination regimen in the treatment of COVID-19. Clinical prudence is required to advocate of Azithromycin and 4-aminoquinoline combination regimen as an unmitigated therapeutic armamentarium in pregnant mothers with COVID-19. Also, the potential of HCQ as a chemo-prophylactic agent against COVID-19 needs to be explored.
Vian Namanya* and Ubaldo Sobimana
DOI: DOI: 10.37421/2155-6113.2022.13.872
Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality Worldwide. The risk of maternal death is much more common in developing countries than developed countries. Therefore it is necessary to recognize the signs and symptoms to predict the disease before it threatens the survival of both mother and fetus since it complicates about 3% of all pregnancies. Health workers like midwives, clinicians and doctors are the primary care givers in treating, understanding and explaining preeclampsia, its diagnosis, risk factors and complications as delay in diagnosis and prompt initiation of treatment could result in disastrous consequences for both the mother and the baby. The risk of maternal death is very high in lower health centers where there no enough trained doctors and other HWs. There is also inadequate supply of drugs used in management of preeclampsia. The study seeks to ascertain whether there are gaps in knowledge and practices by health workers in Bushenyi district contributing to the nationally high mortality rate in rural areas due to pre-eclampsia.36 health workers handling preeclampsia mothers in Bushenyi district were randomly selected and administered a questionnaire to assess their skills and knowledge. Study found that most health workers knew about preeclampsia, its risks but 46% knew less about HELLP syndrome. This study also finds that 52% of the health workers could not adequately prescribe magnesium sulphate and 46% could not signs of magnesium toxicity.
The researchers recommend more refresher course for health workers in Bushenyi and Uganda at large as well as emphasizing use of preeclampsia phone applications and strengthening hands on training for students in health training institutions.
Vian Namanya and Isaac Mugume*
DOI: 10.37421/2155-6113.2022.13.889
Gaspard Tekpa, Sylvain Honore Woromogo*, Eudes Gbangba Ngai, Valentin Fikouma, Larissa Eleonor Kpengougna, Prince Wilikoe and Boniface Koffi
DOI: DOI: 10.37421/2155-6113.2022.13.906
Background: Haematological manifestations during HIV infection in Bangui are common and poorly documented. The objective of our study was to evaluate the frequency of anaemia before and during antiretroviral treatment in people living with HIV (PLHIV) and to identify associated factors.
Methods: This was a retrospective analytical study covering the period from 1 January 2012 to 31 December 2016. PLHIV who were naive or had been treated with ARVs for more than six months and whose medical records included a blood count and a CD4 T-cell count were included. Sociodemographic and clinicobiological characteristics were collected using an anonymous questionnaire. The prevalence of anaemia was measured before and at the sixth month of antiretroviral treatment. Multiple logistic regressions were used to identify associated factors.
Results: We included 532 patients of whom 149 were men (28%). The average age was 37.5 ± 9.4 years. The patients were seen in stages 3 and 4 of the WHO classification of HIV infection in 70.81% of cases. The mean CD4 T cell count increased from 201 ± 175/mm3 before antiretroviral therapy (ART) to 361 ± 182/mm3 after six months of ART. Risk factors for anaemia in PLHIV before ART were CD4 200/mm3 (p=0.0391) and thrombocytosis (p=0.0083); on ART, anaemia was associated with cotrimoxazole use (p=0.0285) and thrombocytosis (p=0.0212).
Conclusion: Anemia in PLWH is common and has multiple risk factors, some of which are preventable, such as late treatment and tuberculosis. Better knowledge of risk factors, early detection and management could help reduce anaemia-related morbidity and mortality.
DOI: DOI: 10.37421/2155-6113.2022.13.907
Background: Knowledge about HIV and AIDS is important in promoting safer sexual behaviour. Given that there is no vaccine or cure for HIV and AIDS, knowledge about HIV and AIDS is an important enabler in the prevention efforts. The aim of the study is to investigate HIV and AIDS knowledge and predictors among students at Nelson Mandela University in South Africa.
Methods: The study was conducted using cross-sectional and quantitative research methodology among students at Nelson Mandela University. Stratified sampling was employed to select 884 undergraduate students. A self-administered questionnaire was used to collect data analysed using SPSS version 26. A bivariate and multivariable binary logistic regression model was employed to identify predictors of HIV and AIDS knowledge. The p-value <0.05 and odds ratio with 95% confidence interval were used to determine statistical significance of the findings.
Results: Findings show that 52.5% of the students had good knowledge about HIV and AIDS. Having a monthly stipend >2000 rand from parents/relatives (AOR=2.71 (1.35–5.49)), being in the third year level of study and higher up (AOR=5.35 (2.93–9.77)), and being in the health science faculty (AOR=16.29 (8.22–32.29)) were significant predictors of good level of HIV and AIDS knowledge.
Conclusion: Almost half of the students reported poor knowledge about HIV and AIDS. There were misconceptions about HIV transmission routes among students. Monthly income, level of the study, and faculty of study were reported to be significant predictors of HIV and AIDS knowledge. This study calls for the need to provide students with more HIV and AIDS education to address HIV and AIDS knowledge gaps and promote behavioural change.
DOI: 10.37421/2795-6113.2023.14.927
Background: The use of structural equation modeling and latent variables remains unusual in epidemiology despite its potential usefulness and assessment of causal relations. Measuring the direct and indirect effect of latent variables helps with proper intervention and for the ART program to be effective. The main objective of the current investigation was to assess causal inference of assessment of the direct and indirect effect of latent covariates on CD4 cell count change for HIV positive adults under HAART.
Methods: Based on the repeated measures of CD4 cell count change data obtained in the ART section at Felege Hiwot teaching and specialized hospital, AMOS software was used for parameter estimation. The study was conducted on 792 randomly selected HIV positive adults. The data were collected by the health staff after a brief orientation of the variables under study.
Results: CD4 cell count change was directly and indirectly affected by the latent variables. The powers of effects of observed variables with and without latent variables were a little bit different from each other. Hence, the powerful effect of observed variables with latent variables was lower as compared to those without latent variables. The direct effect of latent variables on the response variable was a little bit greater than the indirect effect.
Conclusion: The power of the effects of observed variables was stronger than their effects with latent variables. Hence, the latent variables had significant contributions to the progress of CD4 cell count change. Health related education about the direct and indirect effects of latent variables should be given to patients under HAART. Knowledge of direct and indirect effects on the variable of interest is important for proper intervention in ART programs.
DOI: 10.37421/2155-6113.2023.14.928
Background: The rate of prevalence of HIV among adults has been increasing in Sub-Saharan African countries over the last decade. The objective of this study was to identify the joint predictors of cART adherence and disclosure of HIV status among HIV infected adults at Felege Hiwot teaching and specialized hospital, North-West Ethiopia.
Methodology: A retrospective cohort of longitudinal data was conducted on 792 randomly selected patients in the study area. A joint model was used to identify predictor variables. The two response variables under the current investigation were cART adherence and disclosure of HIV status. Binary logistic regression was conducted for separate models.
Results: Among the predictors, the age of patients (AOR=1.020, 95% CI: (1.016,1.191); p-value=0.005), the number of follow-ups (AOR=1.014, 95% CI: (1.023, 1.030); p-value<0.0001). CD4 cell count (AOR=0.981; 95% CI: (0.765, 0.971), p-value<0.01), marital status (AOR=1.013; 95% CI: (1.002, 1.015), p-value=0.006), female patients (AOR=1.014; 95% CI; (1.001, 1.121), p-value<0.007), rural (AOR=0.982; 95% CI; (0.665, 0.998), p-value=0.004), non-educated adult patients (AOR=0.950, 95% CI; (0.92. 0.98). p-value=0.003), non-existence of social violence (AOR=1.012, 95% CI: (1.008, 1.234), p-value<0.01), an adult with non-opportunistic diseases (AOR=1.021, 95% CI; (1.002, 1.042). p-value=0.001) significantly affected the two response variables jointly.
Conclusion: Several variables that affected both disclosures of HIV status and adherence to cART had been identified in the current investigation. Due attention should be given to younger patients, rural residents, and non-educated patients to disclose the disease status and to have a long life with the virus.
Awoke Seyoum Tegegne* and Awoke Fetahi
DOI: 10.37421/2168-6113.2023.14.929
Background: Hepatitis B is the most common liver infection in the world which is caused by the Hepatitis B Virus (HBV). The virus can attack and injure the liver. The infection of hepatitis B virus leads to chronic viral hepatitis infections in hundreds of millions of people in worldwide. The objective of current study was to identify factors that affect the progression rate of hepatitis B virus in patients’ liver who were treated at Felege-Hiwot teaching and specialized hospital, during treatment period.
Methods: The data for this study was obtained from hepatitis B patients chart registered for treatment during January 2013 to December 2016 at chronic hepatitis B patients’ clinic at Felege-Hiwot teaching and specialized hospital, Bahir Dar, Ethiopia. A retrospective study design was conducted in current investigation. The estimation of the model parameters was done by Restricted Maximum Likelihood (REML) procedures.
Results: From the linear mixed effect model, main effects like visiting time (p-value<0.001), sex (p-value=0.0332), age (p-value<0.001), vaccination history (p-value=0.0141), marital status (p-value=0.0032), alanine aminotransferase (p-value=0.0057), genotype, A (p-value=0.0154), genotype, B (p-value=0.0183), genotype, C (p-value=0.0143) and albumin (p-value=0.0329) significantly affected the variable of interest. Similarly, interaction effects of time with marital status (p-value=0.0042) played statistically significance role on the progression rate of hepatitis B virus in the liver of patients.
Conclusion: A certain groups which are at maximum risk and needs intervention have been identified. Highly concrete evidences have been increased from time to time for certain population with chronic HBV infection being at great risk for progression of liver disease. Hepatitis B virus infected patients at the study area should have information about factors that can affect the progression rate of HBV. Ministry of health or health staff should aware the community to take vaccination that helps to protect individuals from hepatitis B virus.
Awoke Seyoum Tegegne* and Chalachew Agimass
DOI: 10.37421/2168-6113.2023.14.930
Background: The main objective of this study was to investigate joint predictors of pulse rate and time to first recovery among diabetes mellitus patients under treatment.
Method: A retrospective cohort study design was conducted in this study. Linear mixed model and cox-proportional hazard model for separate analysis and joint model for the two responses were used.
Results: Among the participants, 66.7% of patients were female, and 19% of the patients had a family disease history. The time needed to reach the first recovery among male patients was significantly longer compared to female patients. The time needed to reach the first recovery among patients with no other related disease was significantly shorter as compared with patients with other related diseases (HR=0.0893).The estimated association parameter (α) in the joint model was -1.5108, with a p-value<0.001. The result indicates that the higher the pulse rate was associated with the lower time to the first recovery.
Conclusion: The variable age, residence area, other related diseases, and hypertension significantly and jointly affected both of the two responses. Due attention should be given to aged patients, patients with family disease history, patients with other related diseases, and rural patients.
Haimanot Hailu*, Wegene Ewnetu Hailu, Andalak Gizaw and Temesgen Geleta
DOI: 10.37421/2155-6113.2023.14.931
Background: World Health Organization (WHO) recommends viral load monitoring to ensure viral load suppression is achieved and maintained, there by decreased morbidity and mortality, but large gaps remain particularly in low and middle income countries. Virologic failure and treatment failure remained a major problem in Addis Ababa. Identifying the factors for virologic failure has benefits in controlling transmission and reducing disease burden.
Objectives: To identify the determinants of virologic failure in people living with HIV on antiretroviral therapy in two selected public health facilities in Addis Ababa, Ethiopia
Methods: A hospital based case control study was to identify determinants of virologic failure among HIV/AIDS patients who are on ART in Saint Peter’s specialized hospital and Zewditu memorial hospital. A total of 350 participants were recruited with 117 cases and 233 controls with 1:2 ratios of cases to controls. Those who have viral suppression (VL<1000 copies/ml) was taken as controls and those who don’t have viral load suppression were classified as cases. Epi info version 7.2.4 and SPSS version 25 were used for data entry and analysis respectively. Bivariate and multivariable regression analysis were conducted to identify factors associated with viral load non-suppression
Results: The majority of the study participants (62.6%) were female while 38.4% were male. Factors associated with viral load non-suppression included younger age (AOR=8.883), disclosure status (AOR=9.123), poor adherence (AOR=21.953), history of chronic disease (AOR=0.14), less duration on treatment (AOR=0.193), 2nd line regimen (AOR=7.611), and treatment failure as a reason for regimen change (AOR=16.381).
Conclusion: Being in the younger age group, poor adherence, long duration on treatment, being on second line regimen were the factors which increase chance of virologic failure. Behavioral intervention to prevent treatment interruption is required to sustain human immunodeficiency virus treatment adherence by focusing on age and treatment duration.
Gezahegn Bewket and Zegeye Getaneh
DOI: 10.37421/2155-6113.2023.14.939
Introduction: Antiretroviral Therapy (ART) shows a great impact on immunological restoration and viral load suppression in individuals living with the Human Immune Deficiency Virus (HIV). Currently, among 38.4 million individuals living with HIV in the globe, around 28.7 million are under ART. Good adherence and follow-up of ART treatment decrease the morbidity and mortality rates of HIV positive individuals and increase the quality of life. Although it is a retrospective cohort study, we aimed to assess how ART regimens influence the restoration of immunological and hematological parameters, and the clinical progression after 2 and half years of ART treatment and follow-up.
Methodology: Retrospectively, we reviewed the medical records of HIV patients. Based on our follow-up requirements, we collected the medical records of 320 HIV patients retrospectively and followed them for 2 and half years. All the socio-demographic data with immunological, hematological, BIM, and clinical data of HIV patients under follow-up were collected every six months for 30 months period. Data were entered into SPSS version 23 and graph pad prism version 5.1 (graph pad software, San Diego, CA). The data were described and statistically analyzed with simple frequency and repeated measures of ANOVA.
Result: Among the 320 HIV patients who followed, 61.9% were females. In this study, The CD4 T cell count showed significant improvement from the baseline to the 12th, 18th, 24th, and 30th month follow-up; from the 6th to 18th, 24th, and 30th month follow-up, and from 12th month to 24th and 30th month, indicating that ART significantly restored the immune response in HIV patients across the follow-up periods. The Body Mass Index (BMI) also showed similar significant improvement patterns with the CD4 T cell count. There was a significant improvement in the World Health Organization (WHO) clinical stage of HIV patients after follow-up as indicated by our result that the majority of HIV patients at baseline were at WHO stage III 168 (58.5%), however, after 2 and half year follow-up, only 16.3% remained at WHO stage III. In addition, at baseline (before initiation of ART), the proportion of HIV patients at WHO clinical stage I was only 12.8%, and that was increased to 44% at the end of the follow-up period. The burden of opportunistic infections also significantly decreased from 413.1% at baseline to 0.9% after follow-up. The hematological parameters such as total WBC count, platelet count, and hemoglobin levels were also significantly improved through the course of the follow-up periods.
Conclusion: Our study showed that good ART treatment and good follow-up of HIV management in patients with HIV can bring indispensable progress in their immunological, hematological, and clinical parameters.
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