Ethiopian Journal of Health Sciences

Yibeltal Siraneh — 2024-11-01

TABLE OF CONTENTS

Editorial: Investing on strengthening health data management for better health service and outcome in Africa

Daniel Yilma — 2024-11-01

Editorial message

Exploring the Challenges of Implementing Managers’ Competency Assessment Center in the Health System: A Phenomenological Study

Maryam Naghshi — 2024-11-01

BACKGROUND: The health system needs competent managers to ensure and improve the health of people and manage resources, if managers are chosen correctly. The Managers' Competency Assessment Center is a popular and effective method for selecting, promoting, and developing management competencies. The present study aimed to explain the challenges of implementing an Assessment center in the health sector.

METHODS: The present study was conducted with a qualitative and phenomenological approach in 2023 at Tabriz University of Medical Sciences. Interview data were collected through semi-structured interviews with 33 key informants including official assessors of the center, assessed managers by Assessment Centers, senior managers, and executive officers of the center for assessment of the competence of managers. then analyzed by the content analysis method through the software MAXQDA-18.

Results: The results of the present study were categorized into two main themes and nine sub-themes, which are internal challenges, including challenges related to assessed managers, assessors, competency assessment tools, assessment process, and Challenges of training courses for the development of managers and the external challenges including extra_ organizational, organizational, cultural, and political challenges.

CONCLUSIONS: The establishment of Assessment Centers within the health system is relatively recent. However, their implementation faces both external and internal challenges. To address this, policymakers should systematically analyze these challenges, prioritize them based on significance and feasibility, and then collaborate with other national centers and draw from international experiences.

Knowledge and Practice of Maternal Vaccination during Pregnancy: A Cross-sectional Survey of Selected Obstetricians

Akaninyene Eseme Ubom — 2024-11-01

BACKGROUND: Maternal vaccination is a key strategy to meet Sustainable Development Goal 3, aiming to eliminate preventable deaths among newborns and children under five by 2030. This study explored obstetricians' knowledge and practices regarding maternal vaccination globally.

METHODS: A cross-sectional survey targeting obstetricians was conducted by the World Association of Trainees in Obstetrics and Gynaecology (WATOG,) from June 25 to July 18, 2023. A structured 25-item questionnaire, distributed electronically, gathered data on sociodemographics and vaccination knowledge and practices. Data analysis was performed using IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, version 24.

RESULTS: Ninety-two obstetricians participated. Only 16.3% exhibited good knowledge of safe vaccines in pregnancy. Fear of teratogenicity was the primary reason (58.7%) for vaccine hesitancy among pregnant women. Approximately 47.8% of participants indicated that only tetanus toxoid was routinely available in their hospitals, with 48.9% reporting that women had to pay for vaccines. Nonetheless, 62% stated their countries had national vaccination guidelines for pregnant women.

CONCLUSION: The study identifies significant gaps in obstetricians' knowledge of vaccine safety, alongside barriers related to availability and cost, impacting maternal vaccination uptake.

Investigating Disaster Response Capability and Exploring Solutions to Improvement Response Process of Hospitals to the Infectious Diseases Pandemic: An Explanatory Sequential Mixed-Methods Study

Hojjat Farahmandnia — 2024-11-01

BACKGROUND: Hospitals play a crucial role in local and national responses to various emergencies and disasters, including outbreaks of communicable diseases. This study aimed to investigate the disaster response capabilities of hospitals and to explore solutions for improving their response processes to infectious disease pandemics (IDPs) in Iran.

METHODS: This study employed an explanatory sequential mixed-methods design (quantitative and qualitative). In the quantitative phase, we assessed the response levels of reference hospitals (government, military, and private) in Kerman City, Iran, in 2023. This assessment utilized a researcher-designed questionnaire to evaluate the hospitals' capacity to admit pandemic patients. In the qualitative phase, we explored solutions to enhance the response processes of hospitals to IDPs through semi-structured interviews and a conventional qualitative content analysis approach.

RESULTS: The quantitative results indicated that the overall response level of hospitals to IDPs, with a mean score of 152.88±18.28, was moderate. The qualitative findings identified four main categories and nine subcategories of solutions to improve hospitals' response processes to IDPs.

CONCLUSION: Hospitals are vital in providing quality healthcare during emergencies. Lessons learned from our institution's response to the COVID-19 pandemic will guide more efficient services and preparedness for future emergencies. Given the novel nature of the COVID-19 virus and the potential for similar pandemics in the future, a structured framework is needed to manage epidemic disasters effectively.

Assessment of Drug-related Problems among Patients of Chronic liver Disease in a Tertiary Care Hospital

Twinkle M J S — 2024-11-01

BACKGROUND: Chronic Liver Disease (CLD) is a long-term condition marked by a gradual decline in liver function. Patients with CLD often experience multimorbidity and polypharmacy, which can adversely affect their health outcomes. The objective of the current study is to identify and resolve the drug-related problems associated with chronic liver disease.METHODS: This prospective observational study involved 150 patients with CLD over a six-month period. Eligible participants included individuals over 18 years old, diagnosed with CLD based on the Child-Pugh score, and currently receiving treatment. Drug-related problems (DRPs) were identified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. Data analysis was conducted using Chi-square and Fisher’s exact tests with SPSS software version 29.

RESULTS: A total of 212 DRPs were identified and resolved. The most frequent type of DRP was related to treatment efficacy, with 96 instances (45.29%). Within this category, the subcategory 'effect of drug treatment not optimal' was the most common, accounting for 45 patients (21.23%). Drug interactions were identified as the leading cause of DRPs, comprising 65 cases (30.66%). Most issues were addressed at the prescriber level, with 48.11% of interventions accepted by physicians.

CONCLUSION: This study provides valuable insights into identifying and managing DRPs that can negatively impact treatment outcomes in CLD patients. The findings can assist healthcare professionals in prioritizing strategies to enhance clinical results.

Hematologic Indices and Global Registry of Acute Coronary Events (GRACE) Risk Score in Acute Coronary Syndrome Patients in Ethiopia

Samuel Tadesse — 2024-11-01

BACKGROUND: Prognostic ratings are essential for making quick clinical decisions. In patients with acute coronary syndrome (ACS), the Global Registry of Acute Coronary Events (GRACE) score is often used to predict in-hospital mortality. Hematological indices are strongly correlated with the likelihood of adverse outcomes in ACS patients, given the systemic hypoxemia and inflammation linked to its pathophysiology. This study aimed to assess the relationship between hematologic indices and the GRACE risk score in ACS patients.

METHODS: We consecutively recruited patients diagnosed with ACS at Jimma Medical Center (JMC) from May 1, 2022, to October 31, 2023. We performed biochemical analyses and complete blood counts, calculating GRACE scores. We correlated two continuous parameters and evaluated GRACE risk score independent predictors using multivariate linear regression analysis.

RESULTS: A total of 110 patients were included, with 74 (67.3%) being men. The mean age was 56 (±11) years. Significant correlations were found between red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit, and platelet count with worse GRACE risk scores (r = 0.569, P < 0.001; r = 0.585, P < 0.001; r = 0.400, P < 0.001; r = 0.274, P < 0.013, respectively). In multivariable linear regression, higher RDW and MPV were associated with higher GRACE risk scores.

CONCLUSION: This study revealed significant differences in hematologic parameters among ACS patients with varying GRACE risk scores. Increased RDW and MPV were identified as independent predictors for high GRACE risk scores.

Prevalence of Erectile Dysfunction and Associated Factors among Diabetic Patients in a Tertiary Hospital: A Cross-sectional Study

Desalegn Yayeh Dagnaw — 2024-11-01

BACKGROUND: Erectile dysfunction (ED) is one of the earliest chronic complications of diabetes, with a worldwide prevalence ranging from 35% to 90%. This study aimed to assess the current prevalence and related factors of ED in individuals with diabetes.

METHODS: An institution-based cross-sectional study was conducted with 269 participants. A validated questionnaire, including the International Index of Erectile Function-5 (IIEF-5), was utilized. Statistical analyses included chi-square tests and logistic regression to calculate the odds ratio (OR) and 95% confidence interval (CI). The strength of the association was determined using odds ratio (OR) with a 95% CI.

RESULTS: The mean age of respondents was 54.45 ± 13.19 years, and the mean duration of diabetes was 12.89 ± 8.98 years. Among the 269 respondents, 243 (90.3%) experienced varying degrees of ED. Statistically significant positive associations were identified for patients with a longer duration of diabetes (adjusted OR [AOR]: 19.10CI: 2.35-155.31), microvascular complications (AOR: 6.75,CI:1.55-29.17 ), insulin therapy (AOR: 4.76,CI: 1.34-17.07), comorbidities (AOR: 8.77,CI: 3.06-25.17), and medications other than those for diabetes (AOR: 4.62,CI: 1.16-18.45). Notably, 82.2% had never discussed ED with their physicians.

CONCLUSION: The prevalence of ED among diabetic patients is alarmingly high. This study identified significant positive associations between ED and factors such as diabetes duration, microvascular complications, insulin therapy (with or without oral agents), comorbid conditions, and the use of non-diabetes medications. Therefore, screening, treatment, and addressing key determinants of erectile dysfunction should be integrated into diabetes care.

Lifestyle Factors and Quality of Life among Patients with Chronic Diseases at the Primary Healthcare Centers in Riyadh, Saudi Arabia

Reem S. Alanezi — 2024-11-01

BACKGROUND: The current study was conducted to assess the common lifestyle risk factors affecting the quality of life (QoL) among patients with chronic diseases.

METHODS: This cross-sectional study was conducted using a valid structured questionnaire among 734 patients with chronic diseases. Patients were randomly selected from five primary health care centers in Riyadh of Saudi Arabia during January to February 2024. The study survey included a checklist of socio-demographic and lifestyle variables; the Arabic short version of the World Health Organization QoL questionnaire was used. The SPSS (version 24) was used for data analysis.

RESULTS: A total of 734 patients (14.7% males and 85.3% females) were included. The mean age of the patients was 48.54±19 years. The total QoL and its four domains mean scores were relatively high, with no statistically significant differences were found between males and females. Statistically significant reductions in the positive (good) QoL were found in patients with obesity; patients who using butter and animal fat in cooking; and patients who eating meals out > 3 times per week (OR 0.64 CI 95% (0.325-0.891)), (OR 0.21 CI 95% (0.031-0.754)), and (OR 0.42 CI 95% (0.112-0.851)) respectively.

CONCLUSION: The current study shows high level (69.3%) of good QoL among patients with chronic diseases at the primary healthcare centers in Riyadh of Saudi Arabia. Furthermore, obesity, poor cooking practices, and eating meals outside-home are the main unhealthy lifestyle factors that impaired the level of the QoL among the studied population.

Effect of Body Mass Index on Effective Dose in Multi Detector Computed Tomography Abdomen Using Automatic Exposure Control

Shailesh Nayak S — 2024-11-01

BACKGROUND: Computed Tomography (CT) of the abdomen is one of the most frequently performed scans in adults for various abdominal pathologies. Its popularity stems from the immediate image reconstruction following acquisition. However, CT scans are known for their high radiation doses compared to other diagnostic X-ray procedures. This study aimed to analyze the effective dose in patients with varying body habitus during multidetector CT of the abdomen using automatic exposure control.

METHODS: This prospective study was conducted in the Department of Radiodiagnosis and Imaging from February 2017 to March 2018. Patients aged 18 and older, regardless of gender, undergoing routine Contrast-Enhanced CT (CECT) of the abdomen were included. Participants were categorized into three groups based on Body Mass Index (BMI): normal weight, overweight, and obese.

RESULTS: A total of 168 patients were enrolled, with a mean age of 49.8 ± 15.6 years, predominantly male (66.1%). Obese individuals exhibited significantly higher effective dose values (16.57 ± 2.27 mSv) compared to normal weight (9.45 ± 0.92 mSv) and overweight individuals (11.88 ± 0.77 mSv) (p < 0.01). Similarly, obese patients had significantly higher values for Computed Tomography Dose Index Volume (CTDIvol) (18.32 ± 2.54 mGy) and Dose Length Product (DLP) (1104.86 ± 151.84 mGycm) compared to normal weight (CTDIvol: 11.38 ± 1.24 mGy; DLP: 630.55 ± 61.57 mGycm) and overweight individuals (CTDIvol: 13.56 ± 1.15 mGy; DLP: 792.37 ± 51.56 mGy*cm) (p < 0.05).

CONCLUSION: The effective dose received by obese patients during abdominal CT exams with Automatic Exposure Control (AEC) is nearly double that of normal-weight patients.

Transporting Blood to Remote Areas: The Impact of Blood Shaker Machine Vibration on the Quality of Erythrocytes, Hemoglobin, and Lactate Dehydrogenase Levels

Jeffri Ardiyanto — 2024-11-01

BACKGROUND: Effective transportation of blood is essential for ensuring accessible and high-quality blood for transfusion. However, vibration can have a negative impact on blood quality, leading to the loss of erythrocytes and hemoglobin. The aim of the study was to analyse the effect of different vibration exposures for 15 minutes on erythrocyte, haemoglobin and lactate dehydrogenase (LDH) levels of blood samples.

METHODS: A quasi-experimental study was conducted on blood donors at the Semarang, Central Java, unit vehicle of the Indonesian Red Cross. Blood samples were collected from donors and exposed to different vibration frequencies for 15 minutes. The erythrocyte, hemoglobin, and lactate dehydrogenase (LDH) levels of the blood samples were then measured. Tests were carried out on three treatment groups, namely control, 6 Hz vibration, and 11 Hz with 30 bags of blood tested with each treatment group of 10 samples.

RESULTS: The results showed that vibration had a significant impact on the integrity of erythrocytes and hemoglobin in whole blood. The group exposed to 6 Hz vibration had significantly lower erythrocyte levels than the control group and the group exposed to 11 Hz vibration. The hemoglobin levels after treatment also varied significantly between treatment cohorts, with significantly lower hemoglobin levels observed in the 11 Hz vibration group compared to both the control group and the 6 Hz vibration group. In addition, there was a significant difference between the LDH levels of the various groups following treatment.

CONCLUSION: The findings of this study suggested that vibration can have a negative impact on blood quality, leading to the loss of erythrocytes and hemoglobin. To protect blood product integrity and reduce the risk of transfusion-related losses, it is essential to implement appropriate vibration mitigation strategies during blood product transport.

Prevalence of Visual Impairment and Associated Factors among Adult Glaucoma Patients Attending Tertiary Eye Care Center in Gondar, Ethiopia, 2022

Getenet Shumet Birhan — 2024-11-01

BACKGROUND: Glaucoma is a group of eye diseases characterized by damage to the optic nerve, often associated with increased intraocular pressure. Untreated damage from glaucoma can cause irreversible vision loss, making it one of the leading global causes of blindness. This study aimed to determine the prevalence of visual impairment and associated factors in adult glaucoma patients.

METHODS: An institutional cross-sectional study was conducted on a sample of 423 glaucoma patients selected by systematic random sampling from May 15 to June 30, 2022, at the University Gondar, Tertiary Eye Care and Training Center. Data were collected through personal interviews using a pre-tested structured questionnaire and a review of medical records. Descriptive statistics were summarized by frequency, percentage, and summary statistics. Binary logistic regression was performed, and variables with a P value <0.05 in the multivariable model were considered significantly associated.

RESULTS: This study found visual impairment in 77.6% (95% CI: 74.2%–82.9%) of adult participants with glaucoma. Female gender (AOR=2.45, 95% CI=1.18–3.48), rural residence (AOR=2.45, 95% CI=1.91-3.33), primary open-angle glaucoma (AOR=1.83, 95% CI=1.35-2.97), advanced-stage glaucoma (AOR=2.54, 95% CI=1.05–6.17), and longer duration of diagnosis (AOR=3.89, 95% CI=2.29–6.58) were significantly associated with visual impairment in adult glaucoma patients.

CONCLUSION: The results of this study showed that visual impairment was significantly higher in adult glaucoma patients. Female gender, rural residence, primary open-angle glaucoma, advanced stage glaucoma, and longer duration of diagnosis were significantly associated with visual impairment in adult glaucoma patients.

Prevalence and Knowledge Levels of Polycystic Ovarian Syndrome among Female Adolescents in Educational Institutions in Hyderabad, India: A Cross-sectional Study

Nallavothu Jahnavi — 2024-11-01

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a complex endocrine condition that is frequently misdiagnosed, and its prevalence is rising rapidly worldwide. Adolescent girls often lack adequate knowledge about PCOS. This study examined the prevalence of PCOS and awareness among female adolescents.

METHOD: A cross-sectional study was conducted among female adolescents from selected educational institutions in the north zone of Hyderabad. Institutions were carefully chosen to represent a diverse student population. Data were collected and analyzed using IBM SPSS Statistics version 25. The Chi-square test of independence and logistic regression were employed to identify variables associated with PCOS knowledge levels.

RESULTS: Three hundred eighty-two female adolescents participated. The mean age was 18.19 years (±0.92 SD). Forty-four participants were diagnosed with PCOS (11.5%), and 17.3% were suspected PCOS. Over 89% of participants demonstrated good knowledge across various PCOS domains. A significant association was found between the level of education and learning about PCOS (p=0.05). There was a weak positive correlation between the level of study and knowledge scores (p=0.05). Bivariate and multivariate logistic analysis revealed that university girls [AOR: 1.9, 95% CI: (1.12-3.25)] and those with PCOS [AOR: 6.8, 95% CI: (1.4-32.4)] were more knowledgeable than their counterparts with lower education levels and without PCOS, respectively.

CONCLUSION: While knowledge of PCOS among female adolescents was generally good, the disease burden was high. Targeted counseling and lifestyle management interventions are essential to prevent long-term complications of PCOS.

Family Functioning and Psychosocial Burden in Caregivers of Children with Sickle Cell Disease in a Tertiary Centre in North- Central Nigeria

Mohammed Abdulkadir — 2024-11-01

BACKGROUND: Sickle cell disease (SCD) is a chronic genetic disorder that has significant psychosocial consequences for both patients and their families. This study aimed to investigate family functioning and the psychosocial burden experienced by caregivers of children with SCD.

METHODS: This descriptive, cross-sectional study involved 170 caregivers of children with SCD, selected through systematic random sampling. Data were collected using both structured and semi-structured questionnaires. Family functioning was assessed using the Family APGAR ( Adaptation, Partnership, Growth, Affectation, Resolve) while the psychosocial burden was evaluated using the Sickle Cell Disease Burden Instrument (SCDBI). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.

RESULTS: The mean age of the participants was 34.7 years, and 83% were female. The majority of caregivers reported a high level of family functioning. However, significant psychosocial burden was observed in areas such as finances, disruption of routine family activities, and the caregivers' coping abilities. The impact on family interactions was minimal.

CONCLUSION: Most caregivers in this study demonstrated good family functioning. Although caring for a child with sickle cell disease imposed a significant psychosocial burden, the negative impact on family interactions was minimal.

Direct and Indirect Cost of Treatment for Chronic Kidney Disease among Patients at the Renal Unit of the University of Nigeria Teaching Hospital, Enugu

Arodiwe Ejikeme Benneth — 2024-11-01

BACKGROUND: Chronic kidney disease (CKD) is a growing global health issue, particularly in low- and middle-income countries. The cost of managing CKD is high, yet there is limited information available regarding this burden in sub-Saharan Africa.

METHODS: This descriptive cross-sectional study involved 100 CKD patients at the Renal Unit of a hospital between July and December 2019. Data was collected using a pre-tested, semi-structured questionnaire. Frequencies, means, percentages, standard deviations, medians, and interquartile ranges were used for data analysis. ANOVA and chi-square tests were also employed to assess correlations.

RESULTS: The mean total monthly cost of treatment was 135,199 ± 81,060 Naira ($417 ± 250), with direct and indirect costs averaging 127,565 ± 76,139.8 Naira ($393 ± 235) and 8,309 ± 16,735 Naira ($26 ± 52), respectively. Direct costs accounted for 94% of the total illness cost, with hemodialysis alone representing 86.1% of the total cost. There were no significant differences in treatment costs across socioeconomic classes. Out-of-pocket spending accounted for 88% of healthcare expenses.
Conclusion: The cost of CKD management is high, with hemodialysis comprising the majority of the cost. Most patients pay out of pocket. It is recommended that a comprehensive health insurance scheme be implemented, especially to cover hemodialysis treatment.