Traditional healers in Ethiopia use a wide range of medicinal plants with antidiarrheal properties. Among these, Croton macrostachyus is one such plant claimed to have an antidiarrheal activity in Ethiopian folklore medicine. Previous studies showed that the crude extract is endowed with the claimed property. The present study was undertaken to further the claim by screening different fractions for the said activity so that it could serve as a basis for subsequent studies. The fractions were obtained by successive extraction in soxhlet apparatus with solvents of different polarity (chloroform & methanol) followed by cold maceration of the deposit of the methanol fraction with distilled water. The antidiarrheal activity was evaluated using castor oil induced diarrheal model, charcoal meal test and anti-enteropooling test in mice. The test groups received various doses (300, 400, 500 mg/kg and an additional dose of 1000 mg/kg for the aqueous fraction) of the fractions, whereas positive controls received either Loperamide (3 mg/kg) or Atropine (5 mg/kg) and negative controls received vehicle (10 ml/kg). In the castor oil induced model, the chloroform (at all test doses) and methanol (at 400 & 500 mg/kg) fractions significantly delayed diarrheal onset, decreased stool frequency and weight of feces. The aqueous fraction was however devoid of significant effect at all the tested doses. Chloroform and methanol fractions produced a significant dose dependent decline in the weight and volume of intestinal contents while the aqueous fraction did not have a significant effect. All the fractions produced a significant anti-motility effect either at all doses (chloroform fraction) or at middle and higher doses (methanol and aqueous fractions). The present study demonstrated that the chloroform and methanol fractions possessed significant anti-diarrheal activity. Nevertheless, the aqueous fraction showed only significant anti-motility effect at the higher dose (1000 mg/kg) employed in the study.

Background: Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised. Objective: To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia. Methods: A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence. Results: Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence. Conclusion: The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.

Objective: To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa. Method: The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute’s critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model. Result: A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17–0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24–0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12–0.19) and Southern Africa (18%, 95% confidence interval = 0.06–0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function. Conclusion: The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

Although cervical cancer is preventable, it is still the second leading cause of cancer deaths among women in the world. Further, it is estimated that around 5–10% of hospital admissions are due to drug related problems (DRPs), of which 50% are avoidable. In cancer therapy, there is an immense potential for DRPs due to the high toxicity of most chemotherapeutic regimens. Hence, this study sought to assess DRPs among patients with cervical cancer at Kenyatta National Hospital (KNH). A cross-sectional study was conducted at the oncology units of KNH. A total of 81 study participants were recruited through simple random sampling. Data were collected from medical records and interviewing patients. The appropriateness of medical therapy was evaluated by comparing with National Compressive Cancer Network and European Society for Medical Oncology practice guideline of cervical cancer treatment protocol. The degree of adherence was determined using eight-item Morisky medication adherence scale. The likelihood of drug interaction was assessed using Medscape, Micromedex and Epocrates drug interaction checkers. The data were entered in Microsoft Excel and analysed using statistical software STATA version 13.0. Descriptive statistics such as mean, percent and frequency were used to summarise patients’ characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of DRPs. A total of 215 DRPs were identified from 76 patients, translating to a prevalence of 93.8% and a mean of 2.65 ± 1.22 DRPs. The predominant proportion of DRPs (48.2%) was identified in patients who had been treated with chemoradiation regimens. Adverse drug reactions 56(69.1%) and drug interactions 38(46.9%) were the most prevalent DRPs. Majority (67.9%) of the study population were adherent to their treatment regimens. Forgetfulness 18(69.2%), expensive medications 4(15.4%) and side effects of medications 4(15.4%) were the main reasons for medication non-adherence. Patients with advanced stage cervical cancer were 15.4 times (AOR = 15.4, 95% CI = 1.3–185.87, p = 0.031) more likely to have DRPs as compared to patients with early stage disease. Adverse drug reactions, drug interactions, and need of additional drug therapy were the most common DRPs identified among cervical cancer patients. Advanced stage cervical cancer was the only predictor of DRPs.

Objective: Surgical site infection (SSI) is one of the leading causes of hospital-acquired infection among hospitalized patients. It causes significant health problems and results in an extended length of hospital stay, increased cost, and increased patient morbidity and mortality. To prevent the development of SSI, surgical antibiotic prophylaxis (SAP) administration before surgery is an evidence-based practice. Therefore, this study aimed to assess the prevalence of SSIs and surgical antibiotic prophylaxis practice, and identifying the gap in practicing prophylactic surgical antibiotic use. Methods: A retrospective cross-sectional study design was conducted on randomly selected 281 participants who fulfilled the inclusion criteria. Appropriateness of surgical antibiotic prophylaxis was assessed by clinical pharmacists based on the standard treatment guideline. Descriptive and multivariate logistic regression analyses were performed in SPSS version 25. Statistical significance was set at p < 0.05. Results: The overall prevalence of SSI was 19.6% (95% CI: 19– 20.2). Majority of surgical patients (88.6%) got surgical antibiotic prophylaxis. Ceftriaxone and metronidazole (45.4%), and ceftriaxone (33.3%) were the most frequently used prophylactic antibiotics. Presence of comorbidity (AOR=9.18, 95% CI: 5.17– 17.9, p< 0.001), contaminated (AOR=6.01, 95% CI: 1.77– 16.8, p=0.019) and dirty (AOR=7.20, 95% CI: 1.23– 12.1, p=0.029) wound classes, devoid of prophylactic antibiotics (AOR=6.63, 95% CI: 0.89– 19.3, p=0.006), the timing of prophylactic antibiotic administration between 1 hour and 2 hours before incision (AOR=8.2, 95% CI: 4.34– 18.1, p=0.001), and 48 hours duration of surgical antimicrobial prophylaxis (AOR=7.20, 95% CI: 1.23– 28.17, p=0.027) were significantly associated with the development of SSIs. Conclusion: The prevalence of SSI was relatively high despite most surgical patients were given prophylactic antibiotics. The presence of comorbidity, contaminated and dirty wound classes, devoid of prophylactic antibiotics, administering prophylactic antibiotics between 1 hour and 2 hours before incision, and 48 hours duration of surgical antibiotic prophylaxis were significantly associated with SSIs.

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. If untreated and undetected at the early stage, it causes death by spreading to distant organs. Despite various studies suggesting the high prevalence of drug-related problems among cancer patients, there was a paucity of data regarding the problems among breast cancer patients in our setting. Hence, this study was aimed to assess the drug-related problems among patients with breast cancer at the Oncology Unit of the University of Gondar Comprehensive Specialized Hospital. Methods: A retrospective cross-sectional study was conducted at the Oncology Unit of the University of Gondar Comprehensive Specialized Hospital. The data were collected by retrospective reviewing medical records of 107 breast cancer patients. The data entry and analysis were done using SPSS version 20.0 statistical software. Descriptive statistics such as percent and frequency were used to summarize categorical variables of patients’ characteristics. Univariable and multivariable binary logistic regression analyses were used to investigate the potential predictors of drug-related problems. A p-value of < 0.05 was considered statistically significant. Results: A total of 203 drug-related problems were identified from 76 breast cancer patients, translating to a prevalence of 71.03%. Among the drug-related problems identified, adverse drug reaction (48.6%), need for additional drug therapy (45.8%), and non-adherence (32.7%) were the most prevalent. In the multivariable analysis, breast cancer patients who had concurrent co-morbidities were almost three times (AOR = 2.97, p = 0.035) more likely to experience drug-related problems as compared to those patients without co-morbidity. Moreover, those patients who had been treated with neoadjuvant chemotherapeutic regimens were 0.34 times less likely (crude odd ratio = 0.34, p = 0.023) to have drug-related problems as compared to patients treated with adjuvant chemotherapy regimens. Conclusion: The prevalence of drug-related problems was high in our setting. Adverse drug reactions, the need for additional drug therapy, and non-adherence were the most frequently occurring drug-related problems in the study setting. Neoadjuvant chemotherapy and the presence of co-morbidities were significant predictors of drug-related problems among breast cancer patients.