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Introduction: Pain is unpleasant sensory and emotional experiences associated with actual and/or potential tissue damage. It is the most common and prevalent reason for emergency departments (ED) visits with prevalence over 70% in the world. Aim of the Study: The study aimed to assess the adequacy and appropriateness of pain management at Aabet Hospital, Addis Ababa, Ethiopia. Methods: A hospital-based prospective cross-sectional study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult trauma patients having pain (at least score 1 on Numeric Rating Scale) with Glasgow Coma Scale score > 13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission (o minute) and then at 60, 120, 180, and 240 minutes. The time of the first analgesics was registered. The adequacy and the appropriateness of the pain management were calculated through pain management index (PMI). Results: Two hundred thirty-two (232) participants were included in this study of which 126 (54.3%) were admitted due to road traffic accident followed by fall 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment at all within 240 minutes. The mean pain intensity score at admission was 5.55 ± 2.32 and reduced to 4.09 ± 2.69. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score). There was a weak and negative correlation between PMI and time to analgesia (r = −.159, p = 0.0001). The type of analgesia used, the time to analgesia, and the degree of pain may predict 65% of the variance in PMI score (R2 = 0.65, P =.001). Conclusion: From the results of this study, it can be concluded that acute pain in trauma patients was under and inappropriately treated. [ABSTRACT FROM AUTHOR]

Local production of generic medicines in developing countries has a critical role to meet public health needs by ensuring the availability of essential medicines and providing patients' relief from the burden of unaffordable medical bills. Compliance with bioequivalence (BE) requirements increase the quality and competitiveness of generic drugs regardless of the source. In this regard, a regional BE center has been established in Addis Ababa, Ethiopia to serve the needs of Ethiopia and neighbouring countries. The present study aimed to assess the knowledge and perceptions of health professionals working in Addis Ababa regarding local production and BE studies of generic medicines. A cross-sectional survey was employed and physician participants working at public hospitals and pharmacists from various practice settings were selected using convenient sampling technique. Data was collected using self-administered structured questionnaire. Descriptive statistics was used to summarize the data and multinomial logistic regression analyses was used to assess predictors of health professionals' perception towards the source of drugs. Statistically significant association was declared at p-value < 0.05. A total of 416 participants responded and 272 (65.4%) of them were male. Nearly half of the study participants (n = 194) preferred the imported products. Compared to physicians, participants with diploma (AOR = 0.40; 95%CI: 0.18–0.91, p = 0.028) and bachelor degree and above holders (AOR = 0.32; 95%CI: 0.15–0.68, p = 0.003) in pharmacy were more likely to prefer locally produced products. Participants who practiced in pharmaceutical industries (AOR = 0.40, 95%CI: 0.22–0.77, p = 0.006) preferred locally manufactured products as compared to those practicing in the hospital. While a majority (321, 77.2%) believed in the advantages of doing BE studies locally, only 106 (25.5%) recognized that local pharmaceutical manufacturers did not implement BE studies for their generic products and lack of enforcement by the national regulatory body was raised as a reason for not conducting BE studies by most of the participants (67.9%). The present study revealed a modest preference by physicians and pharmacy professionals towards locally produced products. Majority of participants supported the idea of doing BE studies locally. However, manufacturers and regulators should devise ways to increase health professionals' confidence in local products. Strengthening local BE study capacity is also highly recommended. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is common among neonates, and is often fatal. Hospitalization results in severe nosocomial infections which could be resistant to antibiotics. It also incurs higher fees for medical care. Methods: A retrospective follow-up study, which includes 206 neonates, was conducted to assess the length of hospital stay among neonatal sepsis patients from September 2018 to September 2020 at TASH Hospital, Addis Ababa, Ethiopia. Data were collected from medical charts. Mean length of hospital stay was compared using independent sample t-tests. Risk factors for length of stay were identified using binary logistic regression analysis. Results: All neonates stayed a total of 325 days, which gives 75,512 neonate-days. Neonates who stayed more than 7 days had low mean birth weight and higher mean age at admission. Mean length of stay was higher among neonates with comorbid illness, neonates with drug therapy problems and male neonates. Even though the mean length of stay is shorter among neonates with maternal PROM and CS delivery, these maternal factors were found to be insignificant in the multivariate logistic regression. Discussion: Similar to other studies, neonates with low birth weight and comorbidity had a longer hospital stay. Neonates with maternal PROM and CS delivery had a shorter stay. But these maternal factors, identified by prior studies as risk factors for neonatal sepsis and its mortality, are not found to be predictors of prolonged hospitalization. Having neurologic features and drug therapy problems among neonates with sepsis prolonged hospital stay. Conclusion: The mean length of stay varies with respect to maternal and neonatal factors. Lower birth weight, presence of neurologic features, presence of comorbidity, presence of drug therapy problems and being male are found to be predictors of a longer hospital stay among neonates with sepsis. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 poses significant health and economic threat prompting international firms to rapidly develop vaccines and secure quick regulatory approval. Although COVID-19 vaccination priority is given for high-risk individuals including healthcare workers (HCWs), the success of the immunization efforts hinges on peoples' willingness to embrace these vaccines. Objective: This study aimed to assess HCWs intention to be vaccinated against COVID-19 and the reasons underlying vaccine hesitancy. Methods: A cross-sectional survey was conducted among HCWs in Addis Ababa, Ethiopia from March to July 2021. Data were collected from eligible participants from 18 health facilities using a pre-tested semi-structured questionnaire. Data were summarized using descriptive statistics and multivariable logistic regression was performed to explore factors associated with COVID-19 vaccine hesitancy. A p<0.05 was considered statistically significant. Results: A total of 614 HCWs participated in the study, with a mean age of 30.57±6.87 years. Nearly two-thirds (60.3%) of HCWs were hesitant to use the COVID-19 vaccine. Participants under the age of 30 years were approximately five times more likely to be hesitant to be vaccinated compared to those over the age of 40 years. HCWs other than medical doctors and/or nurses (AOR = 2.1; 95%CI; 1.1, 3.8) were more likely to be hesitant for COVID-19 vaccine. Lack of believe in COVID-19 vaccine benefits (AOR = 2.5; 95%CI; 1.3, 4.6), lack of trust in the government (AOR = 1.9; 95%CI; 1.3, 3.1), lack of trust science to produce safe and effective vaccines (AOR = 2.6; 95%CI; 1.6, 4.2); and concern about vaccine safety (AOR = 3.2; 95%CI; 1.9, 5.4) were also found to be predictors of COVID-19 vaccine hesitancy. Conclusion: COVID-19 vaccine hesitancy showed to be high among HCWs. All concerned bodies including the ministry, regional health authorities, health institutions, and HCWs themselves should work together to increase COVID-19 vaccine uptake and overcome the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Venous thromboembolism (VTE) is the most common preventable cause of hospitalization-associated mortality. In the absence of optimal prophylaxis and depending on the type of surgery and patient-related factors, the risk of developing VTE increases by 10% to 50%. We aimed to assess VTE risk and thromboprophylaxis among surgical patients hospitalized at surgical wards of Tikur Anbessa Specialized Hospital (TASH). Addis Ababa, Ethiopia. Materials and Methods: A retrospective cross-sectional study was conducted from September 1, 2018 to February 28, 2019. Data were collected using a pretested observational checklist which is prepared based on the VTE Caprini risk assessment model. Then, the collected data were checked for completeness and finally entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: Out of 155 admitted patients, almost equal numbers of males (49.68%) and females (50.32%) participated in the study with a mean age of 41.87± 16.84 and an age range of 13 to 89 years. Undergoing major surgery, resting in bed for more than 3 days and having acute infections (including pneumonia) were the most frequently seen VTE risk factors. Most of the study participants (135, 87.10%) were at risk of developing VTE (> 1 Caprini risk score), and 47.11% were in the highest risk category (≥ 5 Caprini score). The maximum and minimum total risk scores were 19 and 1, respectively with a mean score of 4.53± 2.31. Among patients who were at risk of developing VTE and eligible for thromboprophylaxis, only 17.78% received thromboprophylaxis and two ineligible patients received prophylaxis. Parental unfractionated heparin twice or three times per day was the most widely used thromboprophylaxis regimen. A total of 29 (18.71%) patients had one or more contraindication(s) for thromboprophylaxis and three of them took prophylaxis despite the contraindications. Only 3 (1.93%) patients admitted to surgical wards developed VTE during hospitalization. Conclusion: As per the Caprini risk assessment model, the majority of surgical patients treated at TASH were at risk of developing VTE. However, thromboprophylaxis was underutilized. The incidence of VTE was 1.93% in our study. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second most common cancer in Ethiopia next to breast cancer. Despite the high burden of the disease and availability of free screening services in Ethiopia, uptake is still trivial. This study aims to identify factors associated with cervical cancer screening uptake, VIA (visual inspection with acetic acid) positivity and its predictors among women attending cervical cancer screening service in Addis Ababa, Ethiopia.Methods: Concurrent mixed study approach of qualitative interview (n = 15) and cross-sectional study among 844 screened women was conducted from February to July 2018. A multistage sampling technique was employed to recruit survey participants from the selected health facilities while the key informants for an in-depth interview were selected purposively. Descriptive statistics were used to summarize the quantitative data and multivariable logistic regression was employed to explore factors associated with VIA positivity of the cervix among screened women. Qualitative data were analyzed using thematic analysis approach.Results: The VIA positivity of the cervix was 10.3%. Mean age of study participants was 35.74 ± 7.6 years and women in the age group of ≥45 years were about > 8 times more likely to have VIA test positive result compared to younger women (≤24 years). Being single (AOR = 3.2, 95%CI: 1.4-7.31), widowed (AOR = 18.6, 95%CI: 3.8-91.2), initiating sexual intercourse early (< 16 years) (AOR = 2.72; 95%CI: 1.65-4.49), and having two or more lifetime sexual partners (AOR = 4.9; 95% CI: 1.31-8.75) were also found to be predictors of being VIA positive. Lack of awareness, inaccessibility of the screening service, cultural beliefs and negative perception towards cancer were found to be the major reasons for low uptake of cervical cancer screening.Conclusion: The VIA positivity among screened women in Addis Ababa was found to be moderately low compared to reports in other parts of Ethiopia. Having multiple sexual partners, being older age and initiation of sexual intercourse at an early age were associated with VIA positivity of the cervix. Thus, concerted efforts must be taken to increase accessibility of screening services and improve awareness regarding cervical cancer screening. [ABSTRACT FROM AUTHOR]

Background: Invasive candidiasis and/or candidemia (IC/C) is a common fungal infection leading to significant health and economic losses worldwide. Caspofungin was shown to be more effective than fluconazole in treating inpatients with IC/C. However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-utility of caspofungin compared to fluconazole-initiated therapies as primary treatment of IC/C in Ethiopia.Methods: A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-utility ratio (ICUR). These QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia's gross domestic product/capita (i.e.,US$476). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings.Results: In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. At a cost-effectiveness threshold of US$476/QALY, treating IC/C patient with fluconazole-initiated treatment followed by caspofungin was more likely to be cost-effective in 67.2% of simulations.Conclusion: Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment for patients with IC/C in Ethiopia. [ABSTRACT FROM AUTHOR]

Introduction: the World Health Organization has identified vaccine hesitancy as one of the top ten threats to global health. The purpose of this study was to explore factors contributing to COVID-19 vaccine hesitancy among healthcare providers, their perspectives regarding vaccine uptake by the public and their recommendations to improve vaccine uptake in Ethiopia. Methods: a phenomenological qualitative study was conducted among purposively selected healthcare providers working in the Ministry of Health (MoH), regulatory authority, public and private hospitals and health centres who hesitated to take the COVID-19 vaccine in Addis Ababa, Ethiopia in June 2021. A total of twenty in-depth interviews were conducted using a semi-structured open-ended interview guide. Participants included nurses, physicians, pharmacists, health officers, Medical Laboratory technologists and midwives. A qualitative content analysis approach was chosen to analyse the data. Results: all the participants agreed (n=20) that lack of consistent information and inadequate evidence about COVID-19 vaccine safety, efficacy and quality were the main reasons for COVID-19 vaccine hesitancy. History of perceived and confirmed COVID-19 infection history, misinformation, religious views, unknown short and long-term effects of the vaccine and undefined length of time of vaccine's protection were also other reasons mentioned by the participants. Conclusion: healthcare providers were hesitant toward COVID-19 vaccine mainly due to lack of clear evidence regarding the vaccine's short and long-term safety, efficacy and quality profiles. Hence, the long-term safety and efficacy of the vaccine should be extensively studied and evidence dissemination and communication should be clear and transparent. [ABSTRACT FROM AUTHOR]