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Objective This study aimed to assess the risk, incidence and predictors of venous thromboembolism (VTE) among patients admitted to the emergency department of tertiary hospitals in Addis Ababa city, Ethiopia.Design A multicentre hospital-based prospective follow-up study was conducted.Setting The study was conducted in three tertiary care hospitals in Addis Ababa city, Ethiopia: Tikur Anbesa Specialized Hospital, Addis Ababa Burn Emergency and Trauma Hospital and St. Paulos Hospital Millennium Medical College.Participants A total of 422 patients admitted to the adult emergency wards of the selected hospitals during the study period were included.Main outcome measures The study assessed the level of VTE risk, incidence and independent risk factors for VTE.Results Nearly half (51.7%) of the study participants were male, with a mean age of 49.36 (±17.12) years. Around one-third of patients (130, 30.8%) were unable to perform physical activity, and about two-thirds had comorbid illnesses. The most common admission diagnosis was trauma (23.7%), followed by infectious disease (19.2%). More than two-thirds (70.64%) of patients were at high risk of developing VTE according to the Padua Risk Prediction Score. Eighteen patients (4.3%) were diagnosed with VTE during their emergency stay. Multivariate Cox regression analysis revealed that patients who were physically active prior to admission (adjusted hazard ratio (AHR)=0.67, 95% CI 0.082 to 1.579, p=0.014) and those receiving pharmacological prophylaxis (AHR=0.167, 95% CI 0.037 to 0.768, p=0.021) were found to have a protective effect against the risk of developing VTE. Conversely, patients with acute infection (AHR=8.169, 95% CI 1.045 to 63.854, p=0.045) and active cancer (AHR=5.133, 95% CI 1.241 to 21.093, p=0.023) had a higher risk of VTE incidence.Conclusion The study found that the risk and incidence of VTE were high among patients in the emergency department. Absence of pharmacological prophylaxis, physical inactivity prior to admission, active cancer and acute infection were identified as independent predictors of VTE incidence during emergency ward stays.

Background Globally, approximately 1.9 million cases of tuberculosis (TB) were attributable to undernutrition. Nearly 19 000 deaths occur annually in Ethiopia due to TB. TB makes undernutrition worse and undernutrition deteriorates the body’s defence system thus increasing the chance of developing an active illness. However, there is a dearth of studies regarding undernutrition among adult patients with TB in the study setting.Objective This study aimed to assess the magnitude of undernutrition and its associated factors among adult patients with TB in the South Ethiopia Region.Design We conducted a multicentre cross-sectional study using structured and pretested questionnaires.Settings The study was conducted from 5 August 2022 to 5 September 2022, among adult patients with TB on follow-up care in the South Ethiopia Region.Participants Three hundred ninety-eight randomly selected adult patients with TB on follow-up care in public healthcare facilities in the Southern Ethiopia region participated in the study.Methods Data were collected using structured and pretested questionnaires. Anthropometric measurements were taken by calibrated instruments. EpiData V.3.1 was used for data entry. Data analysis was done by SPSS V.25. Tables, graphs and texts were used to present descriptive statistics. Variables with a p value

Background Alcohol is a major public health problem in pregnant women due to its harmful effects on pregnancy and adverse birth outcomes. Therefore, assessing the prevalence and the factors associated with hazardous alcohol consumption among HIV-positive women is important for early identification and intervention and implementation of rehabilitation centres in healthcare settings in order to prevent maternal adverse birth outcomes.Objective The aim of this study was to assess the prevalence of hazardous alcohol consumption and the associated factors among HIV-positive pregnant women attending public hospitals in Northwest Ethiopia.Design and study setting A facility-based, cross-sectional study was conducted among 401 HIV-positive pregnant women attending public hospitals in Northwest Ethiopia from 7 February to 7 April 2021.Participants From a total calculated sample size of 423, 401 HIV-positive pregnant women who had a follow-up with selected hospitals’ prevention of mother-to-child transmission (PMTCT) clinics completed the interview (17 participants refused to provide information and 5 terminated the interview in the middle of it due to serious illness).Main outcome measures The main outcome measure of this study was hazardous alcohol consumption assessed using the Fast Alcohol Screening Test. Bivariate and multivariable binary logistic regressions were used to identify factors associated with hazardous alcohol consumption. Statistically significant associations were set at p

Introduction The concurrent occurrence of infectious diseases (IDs) and non-communicable diseases (NCDs) presents complex healthcare challenges in sub-Saharan Africa (SSA), where healthcare systems often grapple with limited resources. While an integrated care approach has been advocated to address these complex challenges, there is a recognised gap in comprehensive evidence regarding the various models of integrated care, their components and the feasibility of their implementation. This scoping review aims to bridge this gap by examining the breadth and nature of evidence on integrated care models for NCDs and IDs within SSA, thereby updating the current evidence base in the domain.Methods and analysis Based on the Joanna Briggs Institute (JBI) framework for scoping reviews, this study will include peer-reviewed and grey literature reporting on integrated care models for NCD-ID comorbidities in SSA. A comprehensive search of published sources in electronic databases (PubMed, Scopus, Embase, the Cochrane Library, Health System Evidence and Research4Life) and grey literature (Google Scholar, EBSCO Open Dissertations and relevant organisational websites) will be conducted to identify sources of information reported in English from 2018 onwards. The review will consider sources of evidence reporting on integrated care model for NCDs such as diabetes; chronic cardiovascular, respiratory and kidney diseases; cancers; epilepsy; and mental illness, and comorbid IDs such as HIV, tuberculosis and malaria. All sources of evidence will be considered irrespective of the study designs or methods used. The review will exclude sources that solely focus on the differentiated or patient-centred care delivery approach, and that focus on other conditions, populations or settings. The reviewers will independently screen the sources for eligibility and extract data using a JBI-adapted data tool on the Parsifal review platform. Data will be analysed using descriptive and thematic analyses and results will be presented in tables, figures, diagrams and a narrative summary.Ethics and dissemination Ethical approval is not required for this review as it will synthesise published data and does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to inform future research.Study registration OSF: https://doi.org/10.17605/OSF.IO/KFVEY.

Objective This systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan Africa.Design A systematic review and meta-analysis was used.Data sources Five databases, namely, MEDLINE, Scopus, Web of Science, Cochrane Library and Google Scholar, were systematically searched for relevant articles up to 23 August 2023.Eligibility criteria It was focused on randomised controlled trials involving children and adolescents in sub-Saharan Africa, exploring the effects of iron supplementation on various outcomes, such as serum ferritin and haemoglobin levels, anaemia, mental health and school performance.Data extraction and synthesis The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with two independent reviewers thoroughly evaluating each paper. Using the Cochrane risk of bias tool, we evaluated the certainty of evidence such as the risk of bias, inconsistency, indirectness, imprecision and publication bias.Results A systematic review of 10 articles revealed that WIFAS significantly increased serum ferritin levels in adolescent girls (Hedge’s g=0.53, 95% CI 0.28 to 0.78; heterogeneity I2=41.21%, p

Introduction Leveraging data science could significantly advance the understanding of the health impacts of climate change and air pollution to meet health systems’ needs and improve public health in Africa. This scoping review will aim to identify and synthesise evidence on the use of data science as an intervention to address climate change and air pollution-related health challenges in Africa.Methods and analysis The search strategy will be developed, and the search will be conducted in the Web of Science, Scopus, CAB Abstracts, MEDLINE and EMBASE electronic databases. We will also search the reference lists of eligible articles for additional records. We will screen titles, technical reports, abstracts and full texts and select studies reporting the use of data science in relation to the health effects and interventions associated with climate change and air pollution in Africa.Ethics and dissemination There are no formal ethics requirements as we are not collecting primary data. Results, once published, will be disseminated via conferences and shared with policy-makers and public health, air pollution and climate change key stakeholders in Africa.

Objective To review patient-report/caregiver-report measures of rehabilitation service use following acquired brain injury (ABI).Data sources Medline, APA PsycINFO, Embase and CINAHL were searched on November 2021 and November 2022. Authors were contacted if measures were not included in manuscripts/appendices.Study selection Included articles were empirical research or a research protocol, available in English and described measures of patient report/caregiver report of rehabilitation service use post-ABI via quantitative or qualitative methods. Two reviewers independently screened 5290 records using DistillerSR. Discrepancies were resolved by team adjudication.Data extraction Data extraction was piloted with high levels of agreement (k=.94). Data were extracted by a single member with team meetings to seek guidance as needed. Data included administration characteristics (reporter, mode of administration, recall period), psychometric evidence and dimensions assessed (types of services, setting, frequency, duration, intensity, qualitative aspects).Data synthesis One hundred and fifty-two measures were identified from 85 quantitative, 56 qualitative and 3 psychometric studies. Psychometric properties were reported for four measures, all of which focused on satisfaction. Most measures inquired about the type of rehabilitation services used, with more than half assessing functional (eg, physical therapy) and behavioural health rehabilitation services, but fewer than half assessing community and academic reintegration (eg, special education, vocational rehabilitation) or cognitive (eg, neuropsychology) services. Fewer than half assessed qualitative aspects (eg, satisfaction). Recall periods ranged from 1 month to ‘since the ABI event’ or focused on current use. Of measures that could be accessed (n=71), many included a limited checklist of types of services used. Very few measures assessed setting, frequency, intensity or duration.Conclusions Despite widespread interest, the vast majority of measures have not been validated and are limited in scope. Use of gold-standard psychometric methods to develop and validate a comprehensive patient-report/caregiver-report measure of rehabilitation service use would have wide-ranging implications for improving rehabilitation research in ABI.

Introduction Landscape fire smoke (LFS) contains several hazardous air pollutants that are known to be detrimental to human health. People with asthma are more vulnerable to the health impact of LFS than general populations. The aim of this review is to investigate the effectiveness of personal strategies to reduce the effect of LFS on asthma-related outcomes.Methods and analysis We will electronically search databases such as Medline, Embase, CINAHL and Cochrane Clinical Trials Register to identify eligible articles for the review. Screening of search results and data extraction from included studies will be completed by two independent reviewers. The risk of bias (RoB 2) will be assessed using the Risk of Bias Assessment Tool for Non-Randomised Studies for observational studies, the Cochrane Collaboration tool for assessing the RoB 2 for randomised controlled trials (RCTs) and the Risk Of Bias In Nonrandomized Studies of Interventions tool for non-RCTs. A random-effect meta-analysis will be performed to determine the pooled summary of findings of the included studies. If meta-analysis is not possible, we will conduct a narrative synthesis. Findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and dissemination This study will synthesise the available evidence obtained from published studies and as such, no ethical approval is required. The review will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration number CRD42022341120.

Objective To determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy.Design Institution-based cross-sectional study based on random case selection was conducted.Setting The study was carried out at Mizan-Tepi University Teaching Hospital located in Southwest Ethiopia.Participants A total of 346 patients with epilepsy who visited the psychiatric clinic for follow-up for at least 3 months and who were 18 years or older were included in the study.Main outcome measure Health-related quality of life in epilepsy measured using quality-of-life in epilepsy (QOLIE)-31 health survey evaluated as a dependent variable with simple and multivariable linear regressions.Results The overall weighted mean score of health-related quality of life was 55.6 (SD=20.9). Only 50.3% of patients scored above a total score of 50. Age (β=−0.35, 95% CI−0.46 to –0.23), anxiety (β=−6.79, 95% CI −9.26 to –4.32), depression (β=−7.36, 95% CI −10.16 to –4.55), low self-esteem (β=−5.29, 95% CI −8.07 to –2.51), perceived stigma (β=−3.62, 95% CI −6.30 to –0.94), taking medication two times or more times per day (β=−2.4, 95% CI −4.58 to –0.27), being illiterate (β=−4.1, 95% CI −6.87 to –1.31) and having more than two seizures for a year (β=−4.18, 95% CI −6.97 to –1.39) were negatively affecting health-related quality of life while income of >1000 birr per month (β=4.5, 95% CI 2.00 to 6.99), social support (β=0.34, 95% CI 0.27 to 0.40) and being free of seizure for a year (β=6.5, 95% CI 3.66 to 9.33) were positively affecting health-related quality of life.Conclusions Only half of the patients with epilepsy in the study area are leading a better quality of life and the overall mean health-related quality of life score is lower than the global mean score. Health-related quality of life was inversely associated with age, anxiety, depression, low self-esteem, perceived stigma, taking medication two times a day or more, being illiterate and experiencing more than two seizures in a year. Besides controlling seizures, public educational campaigns should be conducted to raise public awareness regarding the need for social support.

Background Owing to the unavoidable consequences of nutritional transition, the double burden of malnutrition (DBM) is an emerging public health problem. An increasing number of studies have found that Ethiopians face a DBM. However, country-level evidence has not yet been summarised using a scoping review study design.Objective The main objective of this review was to map the national evidence on DBM in Ethiopia for the implications of research gap identifications.Eligibility criteria The population, concept and context approach was used. All age groups, box sexes, all dates of publication and articles in English language focused on DBM conducted in Ethiopia were included.Sources of evidence Primary research articles, systematic reviews, meta-analyses and scoping reviews searched from electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar and Google were the sources of evidence.Charting methods The Joanna Briggs Institute Reviewer’s manual was used as a review methodology. The authors, publication year, region, study design, sample size, population group, measured outcomes and main findings were charted in a table.Results A total of 35 articles met the inclusion criteria among 124 426 participants. The average summarised prevalence of DBM was 33.6%, with the average proportions of undernutrition and overnutrition at 21.5% and 12.1%, respectively. The major factors that influenced the DBM were categorised as child, maternal, adolescent, household and adult-related factors.Conclusion In Ethiopia, the overall prevalence of DBM is high, which makes one-third of the population affected by DBM. The foremost determinant factors that influenced the DBM were characterised as child, maternal, adolescent, household and adult-related factors. Therefore, a double-duty interventions should be used to address DBM, considering multilevel factors at the individual, community and societal levels.Protocol registration This review was registered on the figshare website on 28 February 2021, with DOI number https://doi.org/10.6084/m9.figshare.14131874. The review protocol was published with a DOI number http://dx.doi.org/10.1136/bmjopen-2021-050805.

Objective The purpose of this study was to assess nurses caring behaviours and its associated factors among nurses working at public hospitals in the Gamo zone of southern Ethiopia in 2022.Design Institutional based cross-sectional study was used.Setting This study was conducted in five public hospitals in Gamo zone, southern Ethiopia.Participants A total of 360 nurses of different level of qualification were included in this study using a proportional allocation method from the five hospitals and final study participants were recruited from all wards using a simple random sampling method from 20 June to 20 July 2022.Outcome measurements Caring behaviour was assessed using 24 standardised Caring Behaviour Inventory (CBI) scales. Data were collected using a structured questionnaire and, analysed using the logistic regression method, and those variables with a p value of

Objective This analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019.Design This analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI).Study setting The study includes nine region states and two chartered cities of Ethiopia.Outcome measures We calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates.Results In 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6–8918), 59.4 (95% UI 49.8–71.4) and 2404.5 (95% UI 2059.4–2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions—Benishangul-Gumuz 101.8 (95% UI 84.0–121.7) and Afar 103.7 (95% UI 86.6–122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country.Conclusion In Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.

Objective Since community perceptions of the risk of biomass smoke and the benefits of improved stoves play a critical role in behaviour change to the uptake and sustainable utilisation of improved stoves, we aimed to assess the level of health risk perception on kitchen smoke and benefits of using improved stoves among pregnant women.Design A community-based cross-sectional mixed method study.Setting In six kebeles of a low-income rural community of South Gondar Zone, Northwestern Ethiopia.Participants All 455 households with pregnant women aged 18–38 years, in their first-trimester or second-trimester gestation, exclusively use traditional biomass-fuelled or locally modified mud stoves, and the primary cook in her household were included. But completed data were obtained only from 422 households.Result From 422 completed data, more than half, 63% (95% CI 58% to 68%) had high-level health risk perception of household air pollution, and nearly three-fourths, 74% (95% CI 70% to 79%) of the respondents perceived that using improved stove had benefits for their families. Participants in the 32–38 years age group, rich in asset index, presence of under-five children, being a member of any women group and large family size were positively associated with high-level health risk perception. Whereas respondents in the 18–24 years age group, presence of under-five children, husbands of primary or higher education, high health risk perception and not happy with the current stove were positively associated with perceived benefits of using an improved stove.Conclusion The observed level of health risk perception of biomass smoke and the benefits of using improved stoves may help to adopt effective intervention measures. This study also suggests that for successful intervention, clean cooking programmes and policies must consider many local factors influencing health risk perception and benefits of using improved stoves.Trial registration number ACTR202111534227089.

Introduction Chronic kidney disease (CKD) is associated with significant morbidity, mortality, healthcare cost and reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and associated factors among patients with CKD at both Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia.Method A cross-sectional study design was performed. All patients who visited the renal clinics in both hospitals from March to July 2019 were targeted, and data were collected using interviews and medical records. HRQoL was assessed using the Kidney Disease and Quality of Life-36 tool. Normality assessment was done for HRQoL subscales. Descriptive statistics, logistic regression, t-test and one-way analysis of variance were performed.Result A total of 300 patients with CKD were included. Around 62% of them were in either stage 3 or 4 CKD. The mean domain scores of physical component summary (PCS), mental component summary (MCS), burden of kidney disease, effect of kidney disease and symptoms and problems of kidney disease (SPKD) subscales were 50.4, 59.5, 63.1, 74.6 and 80.4, respectively. The lowest HRQoL was seen in the PCS scale, while the highest was in SPKD. In addition, the study revealed that a lower level of education, elevated serum creatinine and a history of smoking were significantly associated with poor PCS score. Further, the presence of three or more comorbidities, CKD-related complications and a lower haemoglobin level were significantly associated with poor MCS.Conclusion The overall mean scores of PCS and MCS were low, below the standard level. Level of education, serum creatinine and smoking history were significantly associated with PCS, while the presence of comorbidity, complications and haemoglobin level were significantly associated with MCS. Stakeholders working on CKD management should design a relevant strategy targeting patients, patients’ care providers and healthcare professionals to improve HRQoL of patients.

Objective This study aims to assess viral suppression and associated factors among children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia.Design An institutional cross-sectional study was conducted. An observational checklist was used to collect the data. Data were entered into EpiData and analysed using SPSS (V.25). The data were analysed descriptively. Variables with p=0.25 from the bivariable analysis were entered into a multivariable logistic regression model, and significant variables (p=0.05) were retained in the multivariable model.Setting and participants This cross-sectional study was conducted among 522 randomly selected children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia. The study included children under the age of 15 years with complete records.Results Viral suppression was 73% (95% CI: 60.41% to 77.63%). Treatment duration on antiretroviral therapy (adjusted OR (AOR)=0.207; 95% CI: 0.094 to 0.456) and regimen substitution (AOR=0.490; 95% CI: 0.306 to 0.784) were significantly associated with viral suppression rate.Conclusions In this study, the overall magnitude of viral suppression in Amhara Public Health Institute, Dessie Branch is low as compared with the WHO’s 95% viral suppression target. Viral suppression was significantly associated with antiretroviral therapy duration and regimen substitution.

Objective Early postnatal care service usage in developing countries is one of the healthcare service usage problems among postnatal women, which is related to extensive maternal and neonatal complications and mortality. Identification of the prevalence of early postnatal care services usage and associated factors among postnatal women is imperative to develop intervention measures to mitigate their complications and public health impact, which is not well known in Ethiopia, particularly in the selected study area. Thus, this study aimed to assess the prevalence of early postnatal care services usage and associated factors among postnatal women of Wolkite town, southeast Ethiopia.Design A community-based cross-sectional study design was conducted among 301 postnatal women from 15 May to 15 June 2021.Measurements Data were collected using a pretested structured questionnaire. The collected data were cleaned and entered in EpiData V.3.1 and then exported to SPSS V.23 for analysis. Finally, a multivariate logistic regression model was fitted to identify the factors associated with early postnatal care services usage. The p value4) (AOR=2.90, 95% CI 1.18 to 7.11) and had spontaneous vertex delivery (AOR=2.18, 95% CI 1.07 to 9.39) were statistically significant factors of early postnatal care service usage.Conclusion This study has shown that the prevalence of early postnatal care services usage was slightly low when compared with other studies. Thus, community-based health promotion should be an important recommendation to increase early postnatal care service usage among postnatal mothers to improve the level of awareness of early postnatal check-up schedules; done by healthcare providers.

Objective This study aimed to assess the morbidity and mortality patterns of preterm neonates with low birth weight admitted in the Amhara region referral hospitals in Ethiopia.Design Hospital-based retrospective follow-up study.Setting Amhara region referral hospitals, Ethiopia.Participants A total of 291 preterm neonates low birth weight that were admitted to referral hospitals in the Amhara region between 1 January 2017 and 30 December 2018 were reviewed. Data were entered into Epi-data V.4.4.2.1 and exported to STATA V.14 for analysis, and variables with a p value of

Objectives Migration of physicians is one of the most pressing global health problems of our time with the greatest implications in sub-Saharan African countries. Although other studies have explored and produced important quantitative data about the impact of medical migration in the health sector of Ethiopia, the motive behind Ethiopian physician migration have been explored less thoroughly. This article explores the perceptions of a group of physicians about the complicated and continuously evolving driving forces of physician migration in Ethiopia.Design Qualitative study using in-depth, virtual semistructured interviews.Participants Using purposive sampling, 12 physicians participated.Setting Skype interviews with 12 participants working in Tikur Anbessa Specialised Hospital in Addis Ababa, Ethiopia.Results Four themes emerged reflecting the perceptions of Ethiopian medical doctors on the driving forces of physician migration: (1) Economic push and pull factors; (2) Professional push and pull factors; (3) Social and Political push and pull factors and (4) Medical migration governance.Conclusion The emigration of Ethiopian physicians is made after weighing the push and pull factors. Push factors are more crucial than pull factors, and financial reasons play the leading role. Junior physician unemployment, politicisation of hospital administration, and poor medical migration governance are growing problems. Junior physician unemployment is a recent phenomenon in Ethiopia and with a potential to be a leading push factor if appropriate intervention is not taken. The findings of this study are worrying and urge for comprehensive solutions to be devised by policy-makers to deal with physician migration in Ethiopia.

Objective To determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients.Study design, setting and participants A one-group pre–post quasi-experimental study was conducted on 423 ambulatory HF patients at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. All ambulatory HF patients ≥18 years old attending the adult cardiac clinic of TASH and having a complete medical record and fully met the inclusion criteria were taken as study participants.Interventions Educational interventions along with a brochure with information on the nature of HF disease and its treatment were provided to study participants. DTPs encountered were resolved by a team of pharmacists and physicians.Results In the preintervention phase, 288 DTPs were identified with a mean (SD) of 1.3±1.1. A significant reduction of DTPs (0.67±1.1, p

Objectives This study aimed to determine the prevalence, categories and predictors of drug-related hospitalisation (DRH) among patients visiting emergency departments of Addis Ababa city hospitals, Ethiopia.Design A multicentre prospective observational study was conducted through patients’ interview and chart review.Settings The study was undertaken in three tertiary care hospitals in Addis Ababa, Ethiopia.Participants A total of 423 patients fulfilling the inclusion criteria were included.Outcome measures Prevalence and preventability of DRH, categories of drug-related problems causing DRH, medications and diseases involved in DRH, and factors significantly associated with DRH.Result More than half of the patients (216, 51.1%) were female. The mean age (SD) was 47.50 (±17.21) years. The mean length of hospital stay (SD) was 10.29 (±8.99) days. Nearly 60% (249) of them were hospitalised due to drug-related problems, of which 87.8% were preventable. The cause for hospitalisation for more than half (130, 53%) of them was a failure to receive drugs, and 37.85 (94) patients were categorised as untreated indications. Age ≥65 years (adjusted OR (AOR)=7.451, 95% CI: 1.889 to 29.397), tertiary educational level (AOR=0.360, 95% CI: 0.141 to 0.923), participants who did not have any occupation (AOR=3.409, 95% CI: 1.120 to 10.374) and presence of comorbid conditions (AOR=2.004, 95% CI: 1.095 to 3.668) were predictors of DRH.Conclusion Nearly 90% of DRH was deemed to be preventable in the study settings. Older age, lower educational level, unemployment and presence of comorbid conditions in hospital as an inpatient were predictors of DRH.

Introduction Currently, the double burden of malnutrition (DBM) is an emerging public health problem due to the inevitable consequences of nutritional transition. An increasing number of studies have reported the DBM in Ethiopian populations. However, organised and summarised national evidence is not yet available. Therefore, the main aim and research question of this scoping review is to map the national evidence on the DBM in the last decades in Ethiopia.Methods This scoping review will be mapping the national evidence on the DBM in different population groups of Ethiopia including all ages and both sexes from 1 January 2021 to 30 September 2021. The Joanna Briggs Institute Reviewer’s Manual will be used as the methodology of review for this review. The search strategy will be conducted using electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar, and grey literature sources and reference lists of key studies to identify studies appropriate for inclusion in the review. Two independent reviewers will be screened independently with all abstracts and full-text studies for inclusion. Data will be abstracted into tables and logically organised according to the items addressed in the specific research questions.Ethics and dissemination The data will be used from publicly available secondary sources. Therefore, no ethical review and approval will be required for this review. Dissemination of results will be sought through peer-reviewed publications, conference presentations and stakeholder meetings. Regarding registration, this review protocol is registered on the figshare website on 28 February 2021, with the DOI number https://doiorg/106084/m9figshare14131874.

Introduction Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records.Methods and analysis This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported.Ethics and dissemination Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences.

Context and objective Ethiopia’s primary care has a weak referral system for sick children. We aimed to identify health post and child factors associated with referrals of sick children 0–59 months of age and evaluate the healthcare providers’ adherence to referral guidelines.Design A cross-sectional facility-based survey.Setting This study included data from 165 health posts in 52 districts in four Ethiopian regions collected from December 2018 to February 2019. The data included interviews with health extension workers, assessment of health post preparedness, recording of global positioning system (GPS)-coordinates of the health post and the referral health centre, and reviewing registers of sick children treated during the last 3 months at the health posts. We analysed the association between the sick child’s characteristics, health post preparedness and distance to the health centre with referral of sick children by multivariable logistic regressions.Outcome measure Referral to the nearest health centre of sick young infants aged 0–59 days and sick children 2–59 months.Results The health extension workers referred 39/229 (17%) of the sick young infants and 78/1123 (7%) of the older children to the next level of care. Only 18 (37%) sick young infants and 22 (50%) 2–59 months children that deserved urgent referral according to guidelines were referred. The leading causes of referral were possible serious bacterial infection and pneumonia. Those being classified as a severe disease were referred more frequently. The availability of basic amenities (adjusted OR, AOR=0.38, 95% CI 0.15 to 0.96), amoxicillin (AOR=0.41, 95% CI 0.19 to 0.88) and rapid diagnostic test (AOR=0.18, 95% CI 0.07 to 0.46) were associated with less referral in the older age group.Conclusion Few children with severe illness were referred from health posts to health centres. Improving the health posts’ medicine and diagnostic supplies may enhance adherence to referral guidelines and ultimately reduce child mortality.

Introduction Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it.Methods and analysis This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: ‘pre-KMC facility’—to maximise the number of newborns getting to a facility that provides KMC; ‘KMC facility’—for initiation and maintenance of KMC; and ‘post-KMC facility’—for continuation of KMC at home. Stable infants with birth weight

Introduction Opioid use has increased globally for the management of chronic non-cancer-related pain. There are concerns regarding the misuse of opioids leading to persistent opioid use and subsequent hospitalisation and deaths in developed countries. Hospital admissions related to surgery or trauma have been identified as contributing to the increasing opioid use internationally. There are minimal data on persistent opioid use and opioid-related harm in New Zealand (NZ), and how hospital admission for surgery or trauma contributes to this. We aim to describe rates and identify predictors of persistent opioid use among opioid-naïve individuals following hospital discharge for surgery or trauma.Methods and analysis This is a population-based, retrospective cohort study using linked data from national health administrative databases for opioid-naïve patients who have had surgery or trauma in NZ between January 2006 and December 2019. Linked data will be used to identify variables of interest including all types of hospital surgeries in NZ, all trauma hospital admissions, opioid dispensing, comorbidities and sociodemographic variables. The primary outcome of this study will be the prevalence of persistent opioid use. Secondary outcomes will include mortality, opioid-related harms and hospitalisation. We will compare the secondary outcomes between persistent and non-persistent opioid user groups. To compute rates, we will divide the total number of outcome events by total follow-up time. Multivariable logistic regression will be used to identify predictors of persistent opioid use. Multivariable Cox regression models will be used to estimate the risk of opioid-related harms and hospitalisation as well as all-cause mortality among the study cohort in a year following hospital discharge for surgery or trauma.Ethics and dissemination This study has been approved by the Auckland Health Research Ethics Committee (AHREC- AH1159). Results will be reported in accordance with the Reporting of studies Conducted using Observational Routinely collected health data statement (RECORD).

Objective This study aimed to pool out the available evidence on the effectiveness of the solar disinfection water treatment method for reducing childhood diarrhoea.Design Systematic review and meta-analysis.Setting Global.Methods Searches were conducted in Medline/PubMed, Scopus, Google Scholar, Cochrane Library databases and references to other studies. The review included all children living anywhere in the world regardless of sex, ethnicity and socioeconomic status published in English until December 2019. Studies that compared the diarrhoea incidence between the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The outcome of interest was the change in observed diarrhoea incidence and the risk from baseline to postintervention. Two independent reviewers critically appraised the selected studies. Effect sizes were expressed as risk ratios, and their 95% CIs were calculated for analysis.Results We identified 10 eligible studies conducted in Africa, Latin America and Asia that included 5795 children aged from 1 to 15 years. In all identified studies, solar disinfection reduced the risk of diarrhoea in children, and the effect was statistically significant in eight of the studies. The estimated pooled risk ratio of childhood diarrhoea among participants that used the solar disinfection water treatment method was 0.62 (95% CI 0.53 to 0.72). The overall pooled results indicated that the intervention of solar disinfection water treatment had reduced the risk of childhood diarrhoea by 38%.Conclusions The intervention of solar disinfection water treatment significantly reduced the risk of childhood diarrhoea. However, the risk of bias and marked heterogeneity of the included studies precluded definitive conclusions. Further high-quality studies are needed to determine whether solar disinfection water treatment is an important method to reduce childhood diarrhoea.PROSPERO registration number CRD42020159243

Introduction Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses.Methods We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.Results There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2–59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences −4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services.Conclusion We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period.Trial registration number ISRCTN12040912.

Objective To provide a framework for quantifying the robustness of treatment ranks based on Surface Under the Cumulative RAnking curve (SUCRA) in network meta-analysis (NMA) and investigating potential factors associated with lack of robustness.Methods We propose the use of Cohen’s kappa to quantify the agreement between SUCRA-based treatment ranks estimated through NMA of a complete data set and a subset of it. We illustrate our approach using five published NMA data sets, where robustness was assessed by removing studies one at a time.Results Overall, SUCRA-based treatment ranks were robust to individual studies in the five data sets we considered. We observed more incidences of disagreement between ranks in the networks with larger numbers of treatments. Most treatments moved only one or two ranks up or down. The lowest quadratic weighted kappa estimate observed across all networks was in the network with the smallest number of treatments (4), where weighted kappa=40%. In the network with the largest number of treatments (12), the lowest observed quadratic weighted kappa=89%, reflecting a small shift in this network's treatment ranks overall. Preliminary observations suggest that a study’s size, the number of studies making a treatment comparison, and the agreement of a study’s estimated treatment effect(s) with those estimated by other studies making the same comparison(s) may explain the overall robustness of treatment ranks to studies.Conclusions Investigating robustness or sensitivity in an NMA may reveal outlying rank changes that are clinically or policy-relevant. Cohen’s kappa is a useful measure that permits investigation into study characteristics that may explain varying sensitivity to individual studies. However, this study presents a framework as a proof of concept and further investigation is required to identify potential factors associated with the robustness of treatment ranks using more extensive empirical evaluations.

ObjectivePostnatal care (PNC) is essential for preventing maternal and newborn deaths; however, it still remains less well recognised in low-income and middle-income countries. This study was aimed to explore geographical patterns and identify the determinants of PNC usage among women aged 15–49 years in Ethiopia.MethodsA secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. A total of 7193 women were included in this analysis. We employed spatial scan statistics to detect spatial inequalities of PNC usage among women. A multilevel binary logistic regression model was fitted to identify factors associated with women’s PNC.ResultsThe prevalence of PNC usage among women was 6.9% (95% CI 6.3% to 7.5%). The SaTScan spatial analysis identified three most likely clusters with low rates of PNC use namely southwestern Ethiopia (log likelihood ratio (LLR)=18.07, p

Introduction Parenteral anticoagulants may improve outcomes in patients with cancer by reducing risk of venous thromboembolic disease and through a direct antitumour effect. Study-level systematic reviews indicate a reduction in venous thromboembolism and provide moderate confidence that a small survival benefit exists. It remains unclear if any patient subgroups experience potential benefits.Methods and analysis First, we will perform a comprehensive systematic search of MEDLINE, EMBASE and The Cochrane Library, hand search scientific conference abstracts and check clinical trials registries for randomised control trials of participants with solid cancers who are administered parenteral anticoagulants. We anticipate identifying at least 15 trials, exceeding 9000 participants. Second, we will perform an individual participant data meta-analysis to explore the magnitude of survival benefit and address whether subgroups of patients are more likely to benefit from parenteral anticoagulants. All analyses will follow the intention-to-treat principle. For our primary outcome, mortality, we will use multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect. We will adjust analysis for important prognostic characteristics. To investigate whether intervention effects vary by predefined subgroups of patients, we will test interaction terms in the statistical model. Furthermore, we will develop a risk-prediction model for venous thromboembolism, with a focus on control patients of randomised trials.Ethics and dissemination Aside from maintaining participant anonymity, there are no major ethical concerns. This will be the first individual participant data meta-analysis addressing heparin use among patients with cancer and will directly influence recommendations in clinical practice guidelines. Major cancer guideline development organisations will use eventual results to inform their guideline recommendations. Several knowledge users will disseminate results through presentations at clinical rounds as well as national and international conferences. We will prepare an evidence brief and facilitate dialogue to engage policymakers and stakeholders in acting on findings.Trial registration number PROSPERO CRD42013003526.