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Abel Hailu,1 Amha Mekasha,1 Daniel Hailu,1 Atalay Mulu Fentie,2 David N Korones,3 Abdulkadir Mohammedsaid Gidey1 1Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia; 2Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Pediatrics, University of Rochester, New York, NY, USACorrespondence: Abel Hailu, Email abelhailuho21@gmail.comIntroduction: More than 85% of childhood malignancies occur in developing countries with less than a 30% cure rate as opposed to more than 80% cure rate in developed countries. This disproportionately significant difference might be due to delays in diagnosis, treatment initiation, lack of adequate supportive care, and treatment abandonment. We aimed to determine the impact of overall treatment delay on induction mortality of children with acute lymphoblastic leukemia treated at Tikur Anbessa specialized hospital (TASH).Methods: A cross-sectional study was conducted among children who were treated from 2016 to 2019. Children with Down syndrome and relapsed leukemia were excluded from this study.Results: A total of 166 children were included; most patients were males (71.7%). The mean age at diagnosis was 5.9 years. The median time interval from the onset of symptoms to the first TASH visit was 30 days and the median period from TASH’s first clinic visit to diagnosis was 11 days. The median time to initiate chemotherapy after diagnosis was 8 days. The total median time from the first onset of symptoms to chemotherapy initiation was 53.5 days. Induction mortality was 31.3%. High-risk ALL and patients with an overall delay between 30 and 90 days were more likely to experience induction mortality.Discussion: Patient and healthcare system delay is high compared to most studies done and a significant association has been noted with induction mortality. Efforts to expand the pediatric oncology service in the country and efficient diagnostic and treatment approach need to be established to reduce mortality associated with overall delay.Keywords: delay, acute lymphoblastic leukemia, induction mortality, Ethiopia

Optimal chemotherapy management is substandard in low and middle-income countries. We aimed to identify major gaps to design interventional strategies for improved chemotherapy management at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. This study was conducted using an observational checklist, open-ended questions, record review, and key informant interviews of department heads and focal persons at TASH. Findings were categorized into specific themes that developed. Chemotherapy represented 60.2% of the hospital medication budget. Drug utilization was quantified via monthly consumption documentation and forecasting. However, unreliable data resulted in frequent stockouts (unavailability of the item when it is needed) of chemotherapy with only 67.8% availability. Thirteen healthcare personnel (9 nurses, 2 pharmacists and 2 hospital cleaners) were interviewed: all clinical staff but neither of hospital cleaners believed that they were at risk of hazardous agents. Challenges identified included inadequate and frequent stockouts (unavailability of the item when it is needed) of personal protective equipment, lack of standardized guidelines for chemotherapy handling, admixture, and disposal, lack of designated preparation rooms, and lack of training. All nine nurses handled chemotherapy admixtures despite only two nurses previously receiving in-service training. Most of the participants had never witnessed the disposal of anticancer drugs. Prompted by the results of this study, a dialogue was initiated among members of TASH, the American Cancer Society and the University of North Carolina to implement action-oriented projects to address the gaps identified at TASH. These gaps directly and indirectly affect care and treatment outcomes of patients at a large cancer center. Collaborations with well-resourced centers are potential models for improving chemotherapy management.

Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for.LEARNING POINTS The African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge. African pediatric oncology teams rely on a multitude of international sources for training while developing their own. There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses. Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced. Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.

Atalay Mulu Fentie,1 Anteneh Belete,2 Muluken Nigatu Selam2 1Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Muluken Nigatu Selam, Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia, Tel +251912159807, Email muluken.nigatu@aau.edu.etAbstract: Ethiopia registers 77,352 new cases of cancer and 51,865 deaths every year, and the number is showing an increasing trend year to year. Despite the importance of providing palliative care, the country has a long way to go to match the needs of and provide relief for patients with cancer. The promotion and expansion of palliative care services is challenged by a number of problems, among which lack of access to pain-relieving medicine is one of, if not the main, problems raised by health professionals and by various parties involved in health care. Oral morphine is effective and the preferred pain-relieving medicine with tolerable side effects, especially when given by titrating the dose. However, Ethiopia is facing a shortage of oral morphine in health-care facilities and other places where the product is needed. Unless an immediate solution is sought to address the inaccessibility of this medicine, the problem of palliative care will be pronounced and the suffering of patients will continue.Keywords: palliative care, morphine, cancer, Ethiopia

Eskinder Ayalew Sisay,1 Bethlehem Lemma Mengistu,1 Workeabeba Abebe Taye,2 Atalay Mulu Fentie,1 Abdella Birhan Yabeyu3 1Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Pharmacy, Ambo University, Ambo, EthiopiaCorrespondence: Eskinder Ayalew Sisay, Email eskinder.ayalew@aau.edu.etIntroduction: 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.Keywords: neonatal sepsis, Ethiopia, hospital stay

Background The impact and downstream effects of the chemotherapy supply chain in Ethiopia are not well understood. The purpose of this study was to identify perceived gaps in supply chain and characterize their impact on patient care. Methods A concurrent mixed-method study was conducted at a large academic cancer center in Ethiopia. In-depth interviews (IDIs) and surveys were completed in collaboration with external stakeholders with knowledge about chemotherapy supply chain in Ethiopia. Thematic coding was used for qualitative analysis of IDI and descriptive statistics were used to summarize quantitative survey data. Results Six stakeholders participated in the IDIs and seven completed surveys. IDIs revealed that most chemotherapeutic agents are purchased by the Ethiopian Pharmaceutical Supply Agency (EPSA) and are distributed to cancer treatment centers. A free-market purchasing option also exists, but for chemotherapy obtained outside of government-subsidized channels, the potential for substandard or falsified chemotherapy was a concern. Participants expressed confidence that the correct treatment was administered to patients, but viewpoints on reliability and consistency of medication supply were variable. Quantitative data from the survey showed that participants were not confident that medications are prepared safely and correctly. Improper storage and manipulation of high-risk medications remain a significant risk to staff. Conclusions This study provides insight from a healthcare staff perspective on how gaps in the chemotherapy supply chain process impact patient care in a low-income country. Inventory management, disruptions in supply chain, and product integrity were perceived as the largest gaps in the current chemotherapy supply chain structure.

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.

Background: Caspofungin was shown to be more effective than fluconazole in treating patients with invasive candidiasis and/or candidaemia (IC/C). However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-effectiveness of caspofungin compared to fluconazole 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-effectiveness ratio (ICER). 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. 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. Probabilistic sensitivity analysis confirmed the stability of our findings.Conclusions: 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 to treat IC/C in Ethiopia and other low-income countries.

Background Despite the availability of effective drugs, tuberculosis remains a major public health problem that predominantly affects low- and middle-income countries. This study aimed to assess tuberculosis treatment outcomes among patients treated at one of the primary health care levels in Addis Ababa, Ethiopia. Methods An institutional-based retrospective cross-sectional study was conducted at a tuberculosis clinic in public primary healthcare facility. The study populations were all patients with tuberculosis who had been completed their treatment course in the center from July 2014 to July 2018. After getting Ethical clearance and permission from the health center, trained data collectors working in the center were recruited. The collected data were checked for completeness every day by the principal investigators. Data were edited, cleaned, and analyzed using SPSS version 25. Descriptive statistics were used to summarize the data while multinomial logistic regression was employed to explore associations among variables of interest, and p Results A total of 352 patients with tuberculosis were included for the study with a median age of 25 years which ranged from 1 to79 year. Most (36.4%) participants were in the age group of 15 to 24 years. The majority (38.8%) of patients had extrapulmonary tuberculosis, 11.9% of them were HIV positive and only two had family history of tuberculosis. Regarding treatment outcome, 238(67.6%) completed the treatment, 95(27%) cured and the rest were unsuccessful treatment outcomes 19(5.4%) either died, defaulted or treatment failed. The odds ratio for cured in relation to unsuccessful treatment outcome was found to be significantly higher in HIV negative patients (AOR = 6.1; 95%CI 2.1–13.9) compared with those patients tested positive for HIV. While patients with smear-positive pulmonary tuberculosis (AOR = 10.5, 95% CI 5.36–16.31) were significantly associated with the odds of having complete treatment cure as compared to patients with extrapulmonary tuberculosis. Similarly being HIV positive and extrapulmonary tuberculosis were predicting factors for unsuccessful treatment compared with their counterparts. Conclusions The finding of the present study showed that successful tuberculosis treatment outcome was found to be optimal.

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.

Multiple Myeloma (MM) is the most common malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Clinical investigation of MM requires the evaluation of bone marrow for plasma cell infiltration, and detection and quantification of monoclonal protein in the serum or urine, and evidence for end-organ damage (i.e., hypercalcemia, renal insufficiency, anemia, or bone lesions). The overall goal of treatment of MM is to improve survival. The treatment landscape and clinical outcome of MM have changed in the last two decades, with an improved median survival of 8–10 years. Management of MM involves induction, consolidation, and maintenance therapy. Currently, Autologous stem cell transplant (ASCT) is considered as the standard care of treatment for newly diagnosed fit MM patients. Multiple combinations of proteasome inhibitors (PIs) and immunomodulatory drugs (IMIDs) such as Thalidomide, lenalidomide, and pomalidomide have been under evaluation in ASCT-eligible and ineligible settings, and studies are still ongoing. For patients with ASCT-eligible newly diagnosed MM, induction therapy with triple drugs should contain an IMiD, a PI, and a corticosteroid, usually lenalidomide-bortezomib-dexamethasone. For ASCT-ineligible patients on lenalidomide with dexamethasone (Rd), with addition of bortezomib or daratumumab can be considered.

In Ethiopia, cancer accounts for about 5.8% of total national mortality, with an estimated annual incidence of cancer of approximately 60,960 cases and an annual mortality of over 44,000 persons. This is likely an underestimation. Survival rates for pediatric malignancies are likewise suboptimal although exact figures are unknown since a national cancer registry is unavailable. The World Health Organization (WHO) provides recommendations for the creation of cancer registries to track such data. Here we describe our pharmacist-led, pre-implementation assessment of introducing an enhanced national pediatric cancer registry in Ethiopia. Our assessment project had three specific aims around which the methods were designed: 1) characterization of the current spreadsheet-based tool across participating sites, including which variables were being collected, how these variables compared to standards set by the WHO, and a description of how the data were entered and its completeness; 2) assessment of the perceptions of an enhanced registry from hospital staff; and 3) evaluation of workflow gaps regarding documentation. The hospital staff and leadership have generally positive perceptions of an enhanced pediatric cancer registry, which were further improved by our interactions. The workflow assessment revealed several gaps, which were addressed systematically using a three-phase implementation science approach. The assessment also demonstrated that the existing spreadsheet-based tool was missing WHO-recommended variables and had inconsistent completion due to the workflow gaps. A pediatric oncology summary sheet will be implemented in upcoming trips in patient charts to better summarize the patients’ journey starting from diagnosis. This document will be used by the data clerks in an enhanced-spreadsheet to have a more complete data set.

Background: Antiretroviral therapy (ART) has significantly reduced mortality and morbidity of people living with HIV/AIDS (PLWHA); however, the nature of infection and treatment associated with adverse drug reactions often adversely affect patient's health-related quality of life (HRQoL). The purpose of this study was to assess the HRQoL and its associated factors among PLWHA in Ethiopia.Methods: A hospital-based cross-sectional study was conducted among patients taking HAART at Zewditu Memorial General Hospital in Addis Ababa. A face-to-face interview was performed using the HIV/AIDS targeted quality of Life (HAT-QoL) instrument. Patients who met eligibility criteria were approached consecutively while they came to the pharmacy for a medication refill. Descriptive statistics were used to present patient characteristics and HRQoL profiles. Independent t-test and one-way ANOVA were carried out to identify predictors for HRQoL. All statistical tests considered significant at p-value < 0.05.Results: A total of 300 participants were interviewed. The mean age of patients was 41.47 ± 9.45 years and the majority (63.13% ) were females. More than two-thirds (69.7%) of patients were adherents to their medication. The highest HAT-QoL mean score was observed in the overall function domain (84.96±19.87) followed by life satisfaction (83.02±14.61) and physician trust (80.53±20.79). Moderate mean scores were reported in the domains of health worries (71.90±27.00), medication worries (69.44±21.53) and disclosure worries (63.65±30.94) had moderate mean scores, while HIV mastery (56.94±32.52), financial worries (48.81±44.64), and sexual function (12.57±45.56) recorded lower mean scores. Being female, higher educational status, older age, low household income, taking prophylactic therapy, low CD4+ count, and non-adherence were significantly associated with HAT-QoL domains.Conclusions: Overall, HIV/AIDS patients in Addis Ababa had an average level of HRQoL. This study demonstrated that several sociodemographic and clinical variables contribute to reduced HRQoL. Hence, healthcare providers should be paid attention to associated factors that contributed to reduced HRQoL.

Limited data are available regarding cancer in low and middle-income countries (LMICs), distorting the true burden of paediatric cancer.1 A sobering statistic based on available data shows that more than 80% of children diagnosed with cancer in high-income countries survive, while fewer than 25% of children in LMICs survive.2 While access to paediatric oncological care in Ethiopia is improving, the establishment of a national paediatric cancer registry remains an unmet need. Building on our previous work, we sought to standardise patient treatment documentation within the paediatric haematology and oncology department at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia, to begin formal paediatric cancer registration at TASH.3 We interviewed medical record users and observed that there was a lack of consistency in treatment documentation as well as variability in the collection of data relating to cancer diagnoses. We attempted to address these gaps in documentation through the creation of two separate sets of data …

Dessale Abate,1 Munir Awol Aman,2 Beshir Bedru Nasir,1 Girma Tekle Gebremariam,1 Atalay Mulu Fentie1 1Tikur Anbessa Specialized Hospital, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Tikur Anbessa Specialized Hospital, Adult Oncology Center, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Atalay Mulu Fentie PO Box: 1176 Tel +251923295462Email atalay.mulu@aau.edu.etBackground: Cancer is one of the leading causes of morbidity and mortality in the world. It results in considerable mental, physical, and emotional stress for patients. Because of the nature and impact of the disease, and its treatment, measurements of patient satisfaction are important to bring to the attention of health-care providers in order to improve care.Objective: To assess patient satisfaction at the adult oncology center of Tikur Anbessa Specialized Hospital, Ethiopia using the EORTC PATSAT-C33 tool.Methods: A facility-based cross-sectional study was conducted from January 2019 to May 2019. A consecutive sampling technique was employed to recruit a total of 384 study participants. Informed consent was obtained for each participant and data were collected using an interviewer-administered questionnaire. Ethical clearance and approval of the study protocol were obtained from the institutional ethics review board of the school of pharmacy. Descriptive statistics was used to summarize the data, while multivariate linear regression analysis was employed to explore factors affecting patient satisfaction. P< 0.05 was considered as statistically significant.Results: Among a total of 384 study participants, the majority were female (65.9%) and the median age was 49 years. In most (65.9%) participants, the health-care service cost was covered by patients themselves; the majority of them were treated for gynecological malignancy (37.2%) and most received chemotherapy + surgery (37.2%). The mean score for the EORTC-PATSAT33 scales for overall satisfaction was 44.8 out of 100. Place of residence, gender, type of cancer, duration since treatment started, age and source of health-care costs were factors associated with patient satisfaction and all together explained 83% (adjusted R square=0.830, P< 0.0001) of variance. Of these, residence (where patients came from) accounted for most (78.7%) of the variance (adjusted R square=0.787, P< 0.0001).Conclusion: The mean overall satisfaction of patients with the services provided at the outpatient adult oncology center of TASH was significantly lower than previously reported in the world literature, which was > 70. Hence, a concerted effort must be made to understand and improve patient satisfaction in oncology health-care services in Ethiopia.Keywords: adult oncology, cancer care, patient satisfaction, EORTC PATSAT-C33

Intense antibiotic consumption in Low- and Middle-Income Countries (LMICs) is fueled by critical gaps in laboratory infrastructure and entrenched syndromic management of infectious syndromes. Few data inform the achievability and impact of antimicrobial stewardship interventions, particularly in Sub-Saharan Africa. Our goal was to demonstrate the feasibility of a pharmacist-led laboratory-supported intervention at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, and report on antimicrobial use and clinical outcomes associated with the intervention. Methods: This was a single-center prospective quasi-experimental study conducted in two phases: (i) an intervention phase (November 2017 to August 2018), during which we implemented weekly audit and immediate (verbal and written) feedback sessions on antibiotic prescriptions of patients admitted in 2 pediatric and 2 adult medicine wards, and (ii) a post-intervention phase (September 2018 to January 2019) during which we audited antibiotic prescriptions but provided no feedback to the treating teams. The intervention was conducted by an AMS team consisting of 4 clinical pharmacists (one trained in AMS) and one ID specialist. Our primary outcome was antimicrobial utilization (measured as days of therapy (DOT) per 1,000 patient-days and duration of antibiotic treatment courses); secondary outcomes were length of hospital stay and in-hospital all-cause mortality. A multivariable logistic regression model was used to explore factors associated with all-cause in-hospital mortality. Results: We collected data on 1,109 individual patients (707 during the intervention and 402 in the post-intervention periods). Ceftriaxone, vancomycin, cefepime, meropenem, and metronidazole were the most commonly prescribed antibiotics; 96% of the recommendations made by the AMS team were accepted. The AMS team recommended to discontinue antibiotic therapy in 54% of cases during the intervention period. Once the intervention ceased, total antimicrobial use increased by 51.6% and mean duration of treatment by 4.1 days/patient. Mean LOS stay as well as crude mortality also increased significantly in the post-intervention phase (LOS: 24.1 days vs. 19.8 days; in hospital death 14.7 vs. 6.9%). The difference in mortality remained significant after adjusting for potential confounders. Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.

ObjectivesImatinib has shown to be highly efficacious in the treatment of chronic myeloid leukemia (CML) but continuous dosing and patient adherence is essential treatment success. The study aimed to assess prevalence and reasons for non-adherence to Imatinib in newly diagnosed patients with CML in the first 3-months of treatment.MethodsThe study was conducted from October 1, 2016 to November 30, 2017 at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A total of 147 newly diagnosed patients were followed and their adherence status was determined using the 8-items Morisky Medication Adherence Scale and reasons for their non-adherence were evaluated using semi-structured questionnaire. Descriptive statistics were used to summarize the data while multivariable logistic regression was employed to explore associations among variables of interest.ResultsParticipants' median age at time of confirmed diagnosis was 36 years; with most of them in the age group of ConclusionsOverall treatment adherence is suboptimal. Thus, efforts should be made to improve adherence and further study is required to explore impact adherence on the cytogenetic and molecular responses of Ethiopian patients with CML.

Chronic myeloid leukemia is a slowly progressive and clonal myeloproliferative disorder characterized by the presence of Philadelphia chromosome. Even if the global incidence is unknown, CML accounts for 15% to 20% cases of adult leukemia’s in USA and is predominantly the disease of adults. It has three phases reflecting the grade of malignancy; chronic phase, accelerated phase and blast crisis phase. Initial diagnosis and monitoring of treatment response is based on hematologic, cytogenetic and molecular assessments that need to be regularly checked. The treatment in each phase had undergone a profound progress over a relatively short period of time, starting with arsenic therapy, radiotherapy, allogeneic hematopoietic stem cell transplantation, recombinant interferon-alfa, busulfan, and hydroxyurea, and more recently with the tyrosine kinase inhibitors. Among tyrosine kinase inhibitors national comprehensive cancer network puts imatinib, dastinib and nilotinib as category 1 recommendation for initial treatment of chronic phase chronic myeloid leukemia. Second generation tyrosine kinase inhibitors; nilotinib, dasatinib, bosutinib and ponatinib had shown inducing higher rates of early optimal responses, although their impact on long-term overall survival remains to be determined. There are also drugs for the treatment of chronic myeloid leukemia such as histone deacetylase inhibitors, proteasome inhibitors and farnesyl transferase inhibitors which are under investigation. In addition to these vaccines are under investigation as a part of treatment for chronic myeloid leukemia which still needs further research.