Project description:BackgroundThe incidence of eclampsia and its adverse maternal outcomes are very high in developing countries, particularly in Subsaharan African Countries. Identifying predictors for adverse maternal outcomes of eclampsia has paramount importance for helping health care providers to optimize their management outcomes. Therefore, this study aimed to assess the incidence of adverse maternal outcomes of eclampsia and its determinant factors.MethodsA retrospective follow-up study design was applied. The data were extracted from patient charts using a structured, pre-tested, questionnaire. Descriptive analyses (frequencies, means, and standard deviation) were calculated, and bi-variable and multivariable logistic regression models were used to testing the association between independent variables and an outcome variable. After the data were coded and entered into Epi-Info Version 7.2 Software, the data were analyzed using STATA Version 14 Statistical Software.ResultsThe magnitude of eclampsia was 5.36 per 1000 pregnancies (95% CI: 4.72, 6.10). The incidence of adverse maternal outcomes in eclamptic mothers was 53.7% (95% CI: 47.02, 60.24%). After adjusting for covariates maternal age 30-34, AOR 5.4 [95% CI = 1.02, 28.6]; age above 34, AOR 10.5 [95% CI = 1.3, 88.6]; gravidity 2-4, AOR 0.3 [95% CI = 0.1, 0.9]; 10 or more convulsions, AOR 4.6 [95% CI = 1.4, 14.9]; mild pyrexia, AOR 20.4 [95% CI = 3.7, 112.7]; moderate pyrexia, AOR 14.6 [95% CI = 1.7125.1]; platelet count below 50,000 cells/mm3, AOR 34.9 [95% CI = 3.6, 336.2]; platelet count between 50,000 and 99,000 cells/mm3, AOR 24.5 [95%CI = 5.4111.6]; and stillbirth of the current pregnancy, AOR 23.2 [95%CI = 2.1257.5] were strong predictors of adverse maternal outcomes in eclamptic mothers.ConclusionsThe incidence of adverse maternal outcomes of eclampsia was found to be high compared to similar studies discussed in this study. This study recommends early identification of patients with the risk factors (having many convulsions, high body temperature, low platelet count, patient age above 30 years, and 2-4 pregnancies), strengthening the referral system, and advocation of research on the area of adverse maternal outcomes and thereby encourage evidence-based medicine.

Project description:BackgroundDiscontinuing contraception without switching to a different type of family planning (FP) method contributes to unwanted pregnancy and unsafe abortion. Unplanned discontinuation of Implanon (which is discontinuation of Implanon without switching, but not for reasons of wanting to get pregnant) during the first year and its possible determinants have not been well investigated in Ethiopia. Therefore, this study aimed to determine the incidence and predictors of unplanned discontinuation of Implanon during the first year.MethodsA retrospective follow-up study was conducted among 413 consecutive series of eligible women at Ayder Comprehensive Specialized Hospital in Northern Ethiopia. Data were drawn from both FP initiation and removal registration books and from contacting users by phone over a one-year period (April 2016 and March 2017). The inclusion of the categorical predictor in the final Cox model was considered if the test had a P-value of <0.25 in the log-rank test. We identified predictors of time to unplanned discontinuation using a multivariable Cox regression analysis. Adjusted hazard ratios with 95% confidence intervals (CI) were used to assess the association of covariates with the risk of discontinuation. There were no statistically significant interaction terms and proportionality assumption was fulfilled.ResultsThe unplanned discontinuation rate of Implanon during the first year was 18.2%, with an incidence density of 16.3 discontinuations/1000 women-months. Compared with those under 20 years of age, women aged 20 to 24 years (AHR = 0.42; 95% CI: 0.19-0.91) had a protective effect against discontinuation. On the other hand, clients whose partner's educational level was lower than secondary (AHR = 2.20; 95% CI: 1.08-4.49) and who had never used any modern contraception method before (AHR = 3.26; 95% CI: 1.61-6.61) had a higher risk of discontinuation.ConclusionsOur findings have significant implications for understanding why Implanon is discontinued in an unplanned manner, and will help policy makers plan the interventions needed to improve Implanon continuity by overcoming identified barriers. Providers in similar settings should pay more attention to clients whose partners have lower educational status and who are new acceptors.

Project description:ObjectivesRetaining on antiretroviral therapy is essential for reducing HIV-related morbidity and mortality. However, attrition in HIV-positive children remains a critical challenge in resource-limited settings, including Ethiopia. This study aims to determine the incidence and predictors of attrition among children on antiretroviral therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsAn institution-based retrospective follow-up study was conducted among 357 HIV-positive children at the University of Gondar Comprehensive Specialized Hospital from 1 January 2005 to 30 December 2018 (G.C.). Data were collected by chart review using a structured and pre-tested data abstraction checklist. SPSS 22 and STATA 14.0 were used for data entry and analysis, respectively. In the Cox proportional hazard model, bivariables had a 0.25 computed to multivariable, and variables with a p-value of 0.05 at a 95% confidence interval were considered statistically significant predictors of attrition incidence.ResultsA total of 344 child records with a completeness rate of 96.4% were reviewed and included in the analysis. The median follow-up period was 4.3 (interquartile range = 4.3 ± 4.7) years, and the median survival time was 132 months. The incidence rate of attrition was 6.6 per 100 person year observation (PYO) (95% confidence interval = 5.5, 8.0). In all, 105 (30.5%) children were recorded as attrition in the follow-up period. Baseline WHO clinical staging 3 and 4 (adjusted hazard ratio = 2.3 (95% confidence interval = 1.3, 4.0)), baseline weight-for-age -2 Z-score (adjusted hazard ratio = 3.1 (95% confidence interval = 1.7, 5.3)), cotrimoxazole non-users (adjusted hazard ratio = 2.5 (95% confidence interval = 1.4, 4.3)), and baseline hemoglobin levels 10 mg/dL (adjusted hazard ratio = 2.7 (95% confidence interval = 1.5, 47)) were found to be a predictor of attrition.ConclusionThe overall incidence of the rate of attrition was high. Baseline WHO clinical staging 3/4, baseline hemoglobin 10 mg/dL, cotrimoxazole (cotrimoxazole preventive therapy) non-user, and underweight at baseline (weight-for-age 2 Z-score) were found to be the main predictors of attrition.

Project description:BackgroundThere was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia.ObjectiveThe aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital.MethodA retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients.Result387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03-0.78] and AOR:0.17[0.03-0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital stay than DKA precipitated by other causes; AOR: 4.59 [1.08-19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76-2.63].ConclusionsNew onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality.

Project description:BackgroundAs the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from March 1-30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant.ResultsA total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively.ConclusionsThe total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.

Project description:BackgroundDiabetic ketoacidosis (DKA) is a morbid complication of Type 1 diabetes mellitus(T1DM), and its occurrence at diagnosis has rarely been studied in Ethiopia, despite the many cases seen in the pediatric population.ObjectiveThe aim of this study was to know the prevalence of DKA among patients with newly diagnosed diabetes mellitus and identify avoidable risk factors.MethodThis institution-based retrospective cross-sectional study was conducted from December 1, 2018 to December1, 2022. Newly diagnosed T1DM under 15 years were included in the study. DKA and the new diagnosis of type 1 DM were defined based on the 2022 ISPAD and other international guidelines. A data collection form was used to collect sociodemographic and clinical data. Descriptive, bivariate, and multivariate logistic regression analyses were conducted to identify the risk factors.ResultAmong the 61 newly diagnosed T1DM pediatric patients admitted, DKA was the initial presentation in 37 patients, accounting for 60.7% of the cases. The mean age at diagnosis was 8 (±3.85) years, with females being more affected. Clinical presentation revealed vomiting accompanied by signs of dehydration (32.4%), with polyuria, polydipsia and weight loss (26.2%) being the most common symptoms. The presence of adequate knowledge of signs and symptoms of DM (AOR = 0.07, 95%CI 0.019-0.0897, P value 0.017) and a family history of DM (AOR = 0.129 95%CI 0.019-0.897, P value 0.039) were protective factors against DKA as the initial diagnosis of DM. Moreover, new-onset type 1 DM without DKA was 1.5 times higher in children from families with a high monthly income (AOR = 1.473, 95% CI 0.679-3.195 p value 0.000) compared to those from families with low income. The presence of an infection prior to DKA (AOR = 11.69,95%CI 1.34-10.1,P value 0.026) was associated with the diagnosis of DKA at the initial presentation of DM.ConclusionA high number of children present with diabetic ketoacidosis (DKA) at the initial diagnosis of diabetes mellitus (DM), which is associated with inadequate knowledge of the signs and symptoms of DM as well as the masking effect of concomitant infections in these children. Healthcare professionals should endeavor to suspect and screen children. Continuous awareness creation of DM is encouraged to diagnose diabetes mellitus earlier and to decrease the prevalence of DKA as an initial presentation.

Dataset Information

Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study

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