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This study aimed to retrospectively assess the cost-effectiveness of various COVID-19 vaccination strategies in Ethiopia. It involved healthcare workers (HCWs) and community participants; and was conducted through interviews and serological tests. Local SARS-CoV-2 variants and seroprevalence rates, as well as national COVID-19 reports and vaccination status were also analyzed. A cost-effectiveness analysis was performed to determine the most economical vaccination strategies in settings with limited vaccine access and high SARS-CoV-2 seroprevalence. Before the arrival of the vaccines, 65% of HCWs had antibodies against SARS-CoV-2, indicating prior exposure to the virus. Individuals with prior infection exhibited a greater antibody response to COVID-19 vaccines and experienced fewer new infections compared to those without prior infection, regardless of vaccination status (5% vs. 24%, p < 0.001 for vaccinated; 3% vs. 48%, p < 0.001 for unvaccinated). The cost-effectiveness analysis indicated that a single-dose vaccination strategy is optimal in settings with high underlying seroprevalence and limited vaccine availability. This study underscores the need for pragmatic vaccination strategies tailored to local contexts, particularly in high-seroprevalence regions, to maximize vaccine impact and minimize the spread of COVID-19. Implementing a targeted approach based on local seroprevalence information could have helped Ethiopia achieve higher vaccination rates and prevent subsequent outbreaks. [ABSTRACT FROM AUTHOR]

Background and Objectives: Antibiotic resistance is a significant problem that restricts the options for treating bacterial pneumonia. This research aimed to determine the bacterial causes of pneumonia and antibiotic resistance among hospitalized patients in southwest Ethiopia. Materials and Methods: We collected and analyzed 150 sputum samples from individuals with community-acquired pneumonia from April 1st to October 30th, 2019. Standard bacteriological procedures were used to identify the bacteria. Kirby Bauer's disk diffusion method was used to assess the bacteria's susceptibility patterns. Production of carbapenemase and extended-spectrum-lactamase were confirmed phenotypically. Odds ratios and the chi-square test were computed. Results: On the whole, bacterial pathogens were verified in 50% of the sputum samples. The predominant bacterial isolates were Klebsiella species, followed by Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. About 77.5% of isolates were multidrug resistant. Moreover, 40.5% and 10.8% of the isolates were ESBL and carbapenemase producers, respectively. Aging, tobacco smoking, previous history of pneumonia, heart disease, and chronic respiratory disease had association with sputum culture-positivity. Conclusion: As a result, it is important to regularly monitor the bacterial etiologies and their patterns of resistance. Additionally, sociodemographic and clinical characteristics should all be taken into account while managing patients with pneumonia empirically in this context. [ABSTRACT FROM AUTHOR]

Background: Ethiopia, like many African countries, took immediate actions to contain the coronavirus disease (COVID-19) outbreak and its impacts. However, the pandemic control measures were not guided by robust local evidence and not tailored to national contexts. In this review, we aimed to evaluate the evidence gaps and challenges of COVID-19 control measures in Ethiopia during the early months of the pandemic. Design: Scoping Review. Data Source: Searches were conducted in PubMed, LitCovid, Web of Sciences, Embase, MedRx, ChemRxiv, BioRx, and Google Scholar. Eligibility Criteria: Peer-reviewed or pre-print original research articles on COVID-19 from Ethiopia during a period of January 1, 2020 and October 10, 2020 were included in this review. Results: Of 573 articles found, 64 were eligible for inclusion. However, only 25 of them were peer-reviewed; 78% (50/64) were based on cross-sectional descriptive studies. Most of the studies focused on human behavior and healthcare system; only 13 articles addressed epidemiology and clinical spectrum of COVID-19. The studies have revealed a good level of awareness and a favorable attitude by community and healthcare workers (HCWs) towards COVID-19 and its control. However, the practices of infection prevention were found to be low among HCWs and the community. The outbreak unfolded at a slower rate than initially feared but the impact of the counter measures against COVID-19 on the delivery of essential healthcare services was felt more than the direct impact of the pandemic. Moreover, the actions taken by the country did not appear to be tailored to the pattern of the outbreak and existing local evidence. The overall number of published COVID-19-related scientific articles from Ethiopia during the review period was found to be limited. Conclusion: COVID-19 control in Ethiopia was challenged by lack of robust local scientific evidence, and the pandemic control measures were not adapted to local context and the outbreak patterns. Thus, Ethiopia and other African countries should design culturally sensitive and locally acceptable public health interventions for COVID-19 and potential future outbreaks based on locally generated scientific evidence. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia. Methods: A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors. P-value < 0.05 and 95% CI were used on multivariable logistic regression analysis as threshold for significant statistical association. Results: Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02– 1.05), BMI with overweight (AOR=2.52, 95% CI=1.35– 4.71), triglyceride (AOR=1.83, 95% CI=1.29– 2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03– 2.54) were factors significantly associated with HTN. Conclusion: As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia. Methods: A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization "AWaRe" classification scheme as "Access", "Watch" and "Reserve" group antibiotics and measured their consumption intensity. Results: A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the "Watch" group had 2.10 DDD/100 outpatients per day. Conclusion: There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the "Watch" group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital. [ABSTRACT FROM AUTHOR]

Background: Chronic liver disease (CLD) is a progressive destruction of liver tissue with subsequent necrosis that persists for at least 6 months. In Ethiopia, despite the high burden report, data on CLD is limited. The objective of this study was to assess short-term clinical outcomes in patients admitted with chronic liver disease to three tertiary teaching hospitals in Ethiopia and to identify predictors of mortality. Methods: A cohort of 109 patients admitted with CLD to three tertiary teaching hospitals in Ethiopia, were prospectively followed from the time of admission to 30-days of hospital discharge. The study was conducted from April 1, 2018, to October 5, 2018. Kaplan-Maier curve was used to estimate survival and cox-regression analysis to identify predictors of mortality. Result: A total of 109 patients (80% male) diagnosed with CLD were included. Median age of the participants was 38(IQR, 30–48). The overall median length of hospital stay was 7(IQR, 4–11) days. Of the total, 39(35.8%) patients were HBsAg positive, and 12(11%) patients were anti-HCV positive. The 30-day mortality was 38(34.9%), and most of the deaths, 31(81.6%) occurred before hospital discharge. Hepatic encephalopathy at admission; being with unidentified risk factor/etiologies of CLD and total bilirubin level were independent predictors of in-hospital mortality. Patients with hepatic encephalopathy at admission had approximately 11 times increased risk of death as compared to patients without hepatic encephalopathy at admission. Similarly, the hazard of mortality was 5.8 times higher in those patients with unidentified risk factor/etiology as compared to others. The risk of dying had also increased with an increase in bilirubin (1.188[95% CI, 1.0719–1.316]) level. Conclusion: Approximately one-quarter of patients with CLD died during their hospital stay, and the risk of death continued after hospital discharge. Hepatic encephalopathy at admission, unidentified risk factor/etiology and increased level of total bilirubin are poor prognostic factors. Given that more than one third the patients had HBV-infection, access to antiviral drugs could help improve the prognosis of patients with end-stage liver disease in Ethiopia, as well as prevent the progression of the disease if initiated earlier. [ABSTRACT FROM AUTHOR]

Background: The mortality and neurologic sequelae associated with acute bacterial meningitis (ABM) remain high despite advances in medical care. The main aim of this study was to evaluate short-term outcome in patients treated as bacterial meningitis at a teaching hospital in Ethiopia to identify factors that could be focused on to improve outcome in this setting. Methods: A hospital based longitudinal study was conducted at Jimma University Hospital in southwest Ethiopia from March 1, 2013 to December 31, 2015. Participants of this study were patients of age 18 years and older who were treated as confirmed or possible cases of ABM. Patients were followed throughout their hospital stay for change in their clinical course and predefined end points. A multivariable analysis was done to identify factors associated with unfavorable outcomes. Result: 90 patients admitted with diagnosis of acute bacterial meningitis were included in the study; cerebrospinal fluid was analysed for 85 (94.4%) of them. Causative bacteria were isolated in 26 (28.9%) patients only; most of these isolates (84.6%) were either Streptococcus pneumoniae or Neisseria meningitidis. Patients managed as cases of ABM at the hospital suffered from a high rate of unfavorable outcome (36.7%) and an overall mortality rate of 22.2%. Impaired level of consciousness (AOR = 0.766, 95% CI = 0.589–0.995), dexamethasone therapy (AOR = 4.676, 95% CI = 1.12–19.50) and fever persisting after two days of admission (AOR = 24.226, 95% CI = 5.24–111.96) were found to be independently associated with unfavorable outcome. Conclusion: Outcome in patients treated for ABM at the hospital was found to be poor. Impaired mentation, treatment with adjunctive dexamethasone and persistent fever were found to be associated with poor outcome. Thus, development of clinical guidelines for treatment of ABM that suit the local context is essential to improve patient management and outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Over the past few years, we have witnessed a dramatic increase in the number of patients presenting with severe pancytopenia to Jimma University Hospital. We now present sociodemographic and clinical characteristics of adult patients admitted with pancytopenia of unknown cause to Jimma University Hospital during the period of March 2015 to June 2016. Complete blood count and other diagnostic tests were done for all patients to uncover underlying causes. RESULT: Out of 65 cases admitted with pancytopenia during the specified period, 40 were excluded for various reasons. The rest 25 patients were included in this review. The mean age was 32.1 years (SD=14.9); 14 were younger than 30 years of age. The mean hemoglobin level, white cell count and platelet count were 48.6 g/L (SD=1.9), 1,918/µL (SD=879.8) and 36,200/µL (SD=26,131) respectively. The major presenting symptoms were generalized malaise and fever. No geographic or seasonal clustering of the cases was seen. CONCLUSION: The number of cases with pancytopenia of unidentified cause seen at the hospital over the specified period is alarmingly high and deserves great attention. The hematologic alteration in most of the patients was found to be severe with poor clinical outcome. This calls for large scale community based investigation to uncover the root cause of the problem. [ABSTRACT FROM AUTHOR]

Background: The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia. Methods: This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity. Result: ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems - the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity. Conclusion: ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available. [ABSTRACT FROM AUTHOR]

Background: the HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors. Methods: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged =14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression. Results: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality. Conclusion and recommendation: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010. [ABSTRACT FROM AUTHOR]

Background: Psychological morbidity and substance use disorders have been linked to cardiovascular diseases; affecting patients' medical outcome and quality of life. However, little is known about psychological morbidity and substance use among patients with hypertension in Ethiopia. Therefore, we aimed to assess psychological comorbidity and substance use among hypertensive patients in Southwest Ethiopia. Methods: A cross-sectional study was conducted among 396 hypertensive patients on follow-up at Jimma University Teaching Hospital in Ethiopia during the study period. Structured questionnaires were used to assess alcohol use, khat chewing and cigarette smoking. Psychological morbidity was assessed using the Kessler-6 scale. Multiple logistic regression analysis was carried out to identify the independent association between outcome and explanatory variables. Results: The prevalence of psychological morbidity among hypertensive patients was 31.6%. Of the total participants, 31 (7.8%) of them had alcohol use disorders and 79 (19.9%) of them were using khat regularly at the time of the study. Singles were more likely to have psychological morbidity than married participants (AOR = 4.72; 95% CI 1.83, 12.20, p = 0.001), whereas those who were able to 'read and write' were less likely to have psychological morbidity than non-literate ones (AOR = 0.46; 95% CI 0.24, 0.89, p = 0.02). However, no association was seen between psychological morbidity and substance use (khat chewing, alcohol use and cigarette smoking), belief about hypertension, ever discontinuation of medication and lifestyle (exercise, salt consumption). Conclusion: Psychological morbidity and substance use are prevalent among hypertensive patients on follow-up at the hospital. The findings of the study imply that there is a need for further studies to understand the effect of psychological morbidity on the clinical outcomes of hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: The rate of blood pressure control among hypertensive patients is poor and the reasons for poor control of blood pressure remain poorly understood globally. Objective: To assess the rate of blood pressure control among adult hypertensive patients at Jimma University Specialized Hospital. Materials and Methods: We conducted a hospital based cross sectional study among adult hypertensive patients at Jimma University Specialized Hospital hypertension clinic from March 4, 2015 to April 3, 2015. Data on sociodemographic characteristics of the participants and adherence to antihypertensive medication(s) were collected from patients by face to face interview using a pretested structured questionnaire. Comorbidities, antihypertensive medication(s) and blood pressure measurements were collected retrospectively from medical records. Medication adherence was assessed using Morisky’s Medication Adherence Scale-8 score. We did the statistical analysis using chi-square test and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p<0.05. Results: Out of 311 participants, 286 patients were eligible and were studied. More than half, 154 (53.8%), of the participants were males. The mean age of the participants was 54.8± 12.6 years (range 26 to 94). The majority, 196 (68.53%), of the participants were taking more than one antihypertensive medication. More than one third (39.5%) of the participants were non adherent to their medication(s). The rate of blood pressure control was 50.3%. In a univariate logistic regression analyses, age ≥65 years old (P = 0.008), physical inactivity (p<0.001), chat chewing (P<0.001), adding salt to food (P<0.001), and coffee use (P<0.001) are significantly associated with uncontrolled blood pressure Conclusion: Almost half of the hypertensive patients on follow up had uncontrolled blood pressure. We recommend better health education and care of patients to improve the rate of blood pressure control at the hospital. [ABSTRACT FROM AUTHOR]

Background: Bacterial meningitis is associated with significant morbidity and mortality despite advances in medical care. The main objective of this study was to assess the association of adjunctive dexamethasone treatment with discharge outcome of patients treated as bacterial meningitis in low income setting.Methods: A retrospective study was conducted at four teaching hospitals across Ethiopia. Patients of age 14 years and older treated as cases of bacterial meningitis between January 1, 2011 and April 30, 2015 were included in this study. Information regarding sociodemographic data, clinical presentations, laboratory data, treatments given and status at hospital discharge were retrieved from patients' medical records using a structured questionnaire. Predefined outcome variables at discharge were analysed using descriptive statistics. Multivariable logistic regression was used to identify factors independently associated with poor outcome.Results: A total of 425 patients treated with the presumptive clinical diagnosis of bacterial meningitis were included in this study (lumbar puncture done in 56 %; only 19 % had CSF findings compatible with bacterial meningitis, and only 3 % had proven etiology). The overall in hospital mortality rate was 20.2 %. Impaired consciousness, aspiration pneumonia, and cranial nerve palsy at admission were independently associated with increased mortality. Adjuvant dexamethasone, which was used in 50.4 % of patients, was associated with increased in-hospital mortality (AOR = 3.38; 95 % CI 1.87-6.12, p < 0.001) and low Glasgow outcome scale (GOS) at discharge (AOR = 4.46 (95 % CI 1.98-10.08). This association between dexamethasone and unfavorable outcome was found to be more pronounced in suspected but unproven cases and in those without CSF alterations compatible with bacterial meningitis.Conclusion: Most patients treated for suspected bacterial meningitis did not receive proper diagnostic workup. Adjuvant dexamethasone use in clinically suspected but unproven cases of bacterial meningitis was associated with an increased mortality and poor discharge GOS. These findings show that there are potential deleterious effects in unconfirmed cases in this setting. Physicians practising under such circumstances should thus abide with the current recommendation and defer the use of adjuvant corticosteroid in suspected cases of bacterial meningitis. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia is a common electrolyte abnormality in patients with heart failure (HF). It is independently associated with increased short-term and long-term morbidity and mortality. The main objective of this study was to assess patterns of hyponatremia and its association with discharge outcomes in patients with HF admitted to a teaching hospital in Ethiopia. Patients and methods: This is a descriptive, prospective, hospital-based cohort study of patients with HF admitted to Jimma University Hospital, Ethiopia, between November 1, 2013 and July 31, 2014. A structured questionnaire was used to collect information on sociodemographic characteristics, clinical profile at admission, and outcomes at discharge. Plasma sodium concentration was analyzed at admission for all patients. The relationship between hyponatremia at admission and in-hospital mortality, as well as length of hospital stay, was assessed using both bivariate analysis and multivariable logistic regressions. The level of statistical significance was set at P<0.05. Results: Of 152 participants admitted with HF, 44 (28.9%) had hyponatremia, which is defined as serum sodium level <135 mmol/L. Patients on salt restriction, on chronic diuretic treatment (furosemide and spironolactone), and with impaired renal function at admission were found to be highly affected. Hyponatremia was found to be associated with increased in-hospital mortality (P=0.008) and longer hospital stay (16.6 vs 12 days, P<0.001). Patients with hyponatremia also had lower blood pressure and poor functional status at discharge. Conclusion: This study demonstrates that hyponatremia is highly prevalent in patients hospitalized with HF and is associated with increased in-hospital mortality and longer hospital stay. Thus, great emphasis should be given to identify high-risk patients, and prevention and early detection of hyponatremia to prevent its deleterious effects. Large-scale national studies are also needed to complement our findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia.Methods: This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records.Result: A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%.Conclusion: Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Background Left ventricular hypertrophy (LVH) is an independent cardiovascular risk factor in patients with essential hypertension. The main objective of this study was to assess the echocardiographic prevalence of left ventricular hypertrophy in patients with hypertension, its risk factors and effect of antihypertensive drugs on its prevalence. Methods A hospital based cross sectional study was conducted on 200 hypertensive patients on treatment in southwest Ethiopia. A pretested structured questionnaire was used to collect data from participants and their clinical records. Blood pressure and anthropometric measurements were taken according to recommended standards. Left ventricular mass was measured by transthoracic echocardiography. Associations between categorical variables were assessed using chi-square test and odds ratio with 95% confidence interval. Logistic regression model was done to identify risks factors of LVH. P values of < 0.05 were considered as statistically significant. Results The mean age, systolic blood pressure, diastolic blood pressure and body mass index were 55.7 ± 11.3 years, 139.2 ± 7.7 mmHg, 89.2 ± 5.7 mmHg and 24.2 ± 3.4 Kg/m2 respectively. The overall prevalence of LVH among these study subjects was 52%. Age ⩾50 years (OR: 3.49, 95% CI 1.33-9.14, P = 0.011), female gender (OR: 7.69, 95% CI 3.23-20.0, P < 0.001), systolic blood pressure ⩾140 mmHg (OR: 2.85, 95% CI 1.27-6.41, P = 0.011), and duration of hypertension (OR: 3.59, 95% CI 1.47-8.76, P = 0.005) were independent predictors of left ventricular hypertrophy. Angiotensin converting enzyme (ACE) inhibitors were the only antihypertensive drugs associated with lower risk of left ventricular hypertrophy (OR: 0.08, 95%CI 0.03-0.19, p < 0.001). Conclusion Left ventricular hypertrophy was found to be highly prevalent in hypertensive patients in Ethiopia. ACE inhibitors were the only antihypertensive drugs associated with reduced risk of LVH. We thus recommend strategies to early detect and treat hypertension and to timely screen for LVH among patients with hypertension. Multicenter prospective studies in Africa settings would be ideal to identify the best antihypertensive agents in black Africans. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hypertension is the leading cause of death in the world and is the commonest cause for outpatient visits to physicians. The objective of this study was to assess the prevalence of hypertension and its risk factors among adults in Bedele Town, South-west Ethiopia. METHOD: A community-based cross-sectional survey was conducted by interviewing participants regarding their socio-demographic characteristics, history of hypertension, its risk factors and knowledge of its complications and treatment. Measurements of their blood pressure, body weight, height, and waist circumferences were also done on the same day. The data were analyzed using SPSS Version 16 statistical software. Chi-square test and odds ratio with 95% CI were used to assess the association between dependent and independent variables. Logistic regression model was used to determine the independent risk factors for hypertension. P-values of < 0.05 were considered statistically significant. RESULTS: A total of 396 adults of whom 67.4% were males participated in the study. Prevalence of hypertension, defined as systolic blood pressure ⩾140 mmHg or diastolic blood pressure ⩾ 90 mmHg or reported use of anti-hypertensive medication, was 16.9%. However, only 44.8% of those with hypertension were aware of their status, and the overall control rate of hypertension was only 22.4%. Only age and waist circumference were found to be independent predictors of hypertension in the community. CONCLUSION: Hypertension was found to be prevalent in the community. However, the respondents' awareness about the problem and the overall control rates were very low. Activities targeted at increasing awareness of hypertension in the community and its risk reduction are very important for intervention. There should also be a national strategy for early detection and treatment of hypertension and related cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common medical condition worldwide. It is an important public health challenge because of the associated morbidity, mortality, and the cost to the society. The objective of this study was to determine the prevalence of hypertension and its risk factors among attendants of adult outpatient departments at Jimma University Specialized Hospital in southwest Ethiopia. Materials and methods: A hospital-based cross-sectional study was conducted on 734 participants aged 15 years or older from May 2012 to June 2012. A pretested structured questionnaire consisting of characteristics related to sociodemographic profiles and risk factors for hypertension was used for data collection. Three separate measurements of blood pressure and relevant anthropometric evaluation were taken according to current recommended standards. Chi-square test and other statistical analyses were done to employ appropriate interpretations of the findings. P-values of ,0.05 were considered statistically significant. Results: The mean age of the participants was 42.3 ± 13.2 years and 71.7% of them were 35 years and older; 58% of them were females. Overall prevalence of hypertension - defined by systolic blood pressure ⩾140 and/or diastolic blood pressure ⩾90 or reporting history of hypertension - was found to be 13.2%. Only 35.1% of them were aware of their hypertension and only 23.7% were on treatment. The overall control rate was 15.5%. Family history of hypertension, having diabetes mellitus, being overweight, and oral contraceptive use were associated with high blood pressure. Conclusion: Hypertension was found to be prevalent; morbidity, awareness, treatment, and control in those with hypertension were low. Hence, intervention measures should be undertaken at the community level; particular emphasis should be placed on prevention by introducing lifestyle modifications and creating awareness about the problem so that early detection and intervention is possible. [ABSTRACT FROM AUTHOR]

• The positive predictive value of the clinical algorithm for identifying patients with suspected TB and a negative Xpert MTB result in hospitalized patients is poor. • Most patients with microbiologically confirmed cases were empirically treated; however, the rate of overtreatment was high. • Empiric TB treatment did not have an impact on survival. The ability of clinical algorithms to identify tuberculosis disease and the impact of empiric treatment on survival in people with a negative Xpert MTB/RIF (Xpert) result remains poorly documented. Hospitalized Xpert-negative patients (125 initiated on empiric tuberculosis treatment based on a clinical algorithm and 125 in whom tuberculosis treatment was not started) were enrolled. Sputum samples were evaluated for Mycobacterium tuberculosis by culture. All study participants were followed up for 6 months. Xpert-negative inpatients in whom empiric tuberculosis treatment was initiated were more likely to have microbiological confirmed tuberculosis compared to those in whom empiric tuberculosis treatment was not started (24.8% vs 6.4%, p = 0.0001). Six-month risk of death was 5.2%, but the risk was twice as high in people with bacteriological confirmation of TB (10.3% vs 4.3%, p = 0.12). Cardinal symptoms of TB were associated with bacteriological confirmation and a decision to start empiric treatment. The positive predictive value of the clinical algorithm was 24.8% and empiric treatment did not affect 6-month risk of death (5.6% vs 4.8%, p = 0.78). Clinical algorithm identifies the majority of confirmed tuberculosis cases among Xpert-negative inpatients. Empiric treatment did not impact survival and resulted in substantial overtreatment. The more sensitive Xpert Ultra assay should be used to eliminate the need for empiric tuberculosis treatment. [ABSTRACT FROM AUTHOR]