Objectives Due to numerous comorbidities, complicated medical regimens and age-related difficulties, older adults frequently confront substantial treatment burdens and poor medication adherence, which could result in poor health outcomes. This study assessed the treatment burden and medication adherence among older adults in comprehensive specialised hospitals in the Amhara Region in Ethiopia. Design A multicentre hospital-based cross-sectional study was conducted from 30 March to 30 July 2024. Setting The study was conducted at four comprehensive specialised hospitals in Northwest Ethiopia. Participants Patients were ≥65 years old, diagnosed with two chronic illnesses and were receiving medical attention for the relevant issue. Outcome measures This study employed the Multimorbidity Treatment Burden Questionnaire to assess treatment burden and the General Medication Adherence Scale to assess medication adherence. Data analysis was conducted using STATA version 17. Linear and binary logistic regressions were used to analyse the dependent variables of treatment burden and medication adherence to the determining factors, respectively. Results 422 patients took part in this study. Regarding treatment burden, 75% report a high burden. Of the patients, 32.20% adhered well, whereas 67.80% did not. The medication regimen complexity index (MRCI; β=0.029, 95% CI 0.001 to 0.058; p=0.047), age (β=0.027, 95% CI 0.009 to 0.044; p=0.004) and number of medications (β=0.168, 95% CI 0.045 to 0.291; p=0.007) were associated with higher treatment burden. Variables associated with medication non-adherence included rural residence (adjusted OR 2.249, 95% CI, 1.356 to 3.732; p=0.002), care provided by relatives (1.744, 1.055 to 2.883; p=0.030), moderate Charlson comorbidity index (CCI; 2.241, 1.220 to 4.117; p=0.009), severe CCI (6.953, 3.526 to 13.715; p=0.000), polypharmacy (1.615, 1.055 to 3.230; p=0.044) and treatment burden (1.501, 1.023 to 3.090; p=0.015). Conclusion Of the older adult patients enrolled in this study, three-quarters had a high treatment burden, and more than two-thirds had poor adherence. A high treatment burden was associated with age, medication use and MRCI, whereas non-adherence was associated with self-management, residency, CCI, medication use, MRCI and treatment burden.

Heart failure represents a substantial public health challenge, affecting over 64 million individuals worldwide. Effective adherence is essential to enhance patient quality of life and mitigate the risks of hospitalization associated with these progressive conditions. This study aims to assess the magnitude of non-adherence and identify associated factors among Chronic Heart Failure patients receiving follow-up care. A multicenter prospective cross-sectional institutional-based study involving 360 adult CHF patients was conducted from December 2023 to April 2024. Data were systematically collected utilizing a pretested abstraction format. Non-adherence rates were quantized, and multivariate logistic regression analysis was performed to identify significant predictors of non-adherence, with effect size measured by odds ratio. The study identified a non-adherence rate of 17.7% among the cohort. Key factors associated with increased non-adherence include irregular follow-up visits (AOR 1.11, CI 1.06–1.16), presence of orthopnea (AOR 5.02, CI 1.04–12.21), and cor pulmonale (AOR 12.00, CI 1.14–15.30). These findings suggest that experiencing orthopnea and those with irregular follow-ups are markedly more likely to have poor adherence to prescribed therapies. Improving medication adherence through regular follow-up and symptom management is crucial for better outcomes and reducing healthcare burdens in CHF patients.

Background: Drug-related problems (DRPs) are a significant concern in hospitalized patients. In Ethiopia, DRPs occur at a rate of 9.2 per 100 admissions and 9.4 per 1,000 patient days; however, pediatric-specific data are limited. Objective: This study assessed the magnitude, types, and predictors of DRPs and evaluated the acceptability of pharmacist-led interventions in pediatric intensive care units (PICUs) in Northwest Ethiopia. Design: A multicenter prospective interventional study Methods: All pediatric patients admitted to the PICU during the study period were consecutively enrolled. The study was conducted from January 1, 2025 to March 31, 2025 across four specialized hospitals, resulting in a total of 394 participants. DRPs were identified through medical record reviews, caregiver interviews, and direct bedside assessment by a clinical pharmacist. Each DRP was classified according to the Pharmaceutical Care Network Europe (PCNE) classification system version 8.01. Binary logistic regression was performed to identify independent predictors of DRPs. Results: Of the patients, 251 (63.7%) experienced at least one DRP, with 522 DRPs identified (mean 1.3 ± 0.8 per patient). The dominant domains were treatment effectiveness (54.6%) and treatment safety (30.3%), and 97.7% were deemed preventable. Drug and dose selection were the main causes (46.0% and 43.8%, respectively). Independent predictors included age 29 days–1 year (AOR = 2.2, 95% CI: 1.0–4.8), polypharmacy (⩾5 medications; AOR = 1.7, 95% CI: 1.0–2.8), multiple prescribers (AOR = 1.8, 95% CI: 1.1–2.9), prolonged ICU stay (⩾10 days; AOR = 2.4, 95%CI: 1.2–4.7), circulatory system disease (AOR = 3.5, 95% CI: 1.4–9.0), the use of anti-infectives (AOR = 5.0, 95% CI: 2.0–13.7), and antiepileptics medications (AOR = 2.1, 95% CI: 1.0–4.3) were independent predictors of DRPs. Conclusion: DRPs were common in PICU but predominantly preventable. Despite a modest mean number of DRPs per patient, the type and causes identified indicate opportunities for optimizing medication use. Younger age, polypharmacy, multiple prescribers, prolonged PICU stays, circulatory system disease, and specific drug classes were independent predictors. The high acceptance and effectiveness of pharmacist-led interventions underscore their crucial role in improving medication safety and optimizing pharmacotherapy in resource-limited intensive care settings.

Objective: To determine the prevalence of potentially inappropriate prescribing (PIP), potentially inappropriate medication (PIM), potential prescription omission (PPO), potentially harmful drug–drug interactions (PDDI) and identify associated factors among older Ethiopians. Design: Systematic review and meta-analysis Data source: We searched PubMed, HINARI, Scopus and Web of Science databases to identify eligible studies published up to 31 October 2025. Study selection: Observational studies reported the prevalence of PIP, PIM, PPO and PDDI among older adults from any healthcare settings were screened. Data extraction and synthesis: Two independent reviewers selected studies, extracted data and assessed the risk of bias. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale and Hoy risk of bias tool, respectively, while the certainty of evidence of outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation based on Cochrane recommendations. We used a random-effects model for analyses to estimate the pooled prevalence and associated factors. All data analyses were done using Stata V.17 software. Main outcomes and measures: The national prevalence of PIP, PIM, PPO and PDDI was estimated as main outcomes. Variations were estimated based on regions, age groups, outcome evaluation tool, disease type and healthcare setting. Results: The review included 25 studies (n=5662 participants) for PIP or PIM, 14 studies (n=2706 participants) for PDDI and 6 studies (n=1342 participants) for PPO. The pooled prevalence estimate was 41% (95% CI 33% to 48%), I ² =96.87% for PIP, 37% (95% CI 31% to 44%), I ² =96.33% for PIM, 55% (95% CI 36% to 73%), I ² =99.00% for PDDI and 14% (95% CI 6% to 24%), I ² =95.07% for PPO. The majority of the studies have very good quality (very good=13, good=1, satisfactory=11 for PIP and PIM; very good=11, satisfactory=3 for PDDI; very good=6 for PPO) and low risk of bias (low risk=18, moderate risk=7 for PIP and PIM; low risk=12, moderate risk=2 for PDDI and low risk=6 for PPO), while all studies for each outcome have low certainty of evidence. Subgroup analyses revealed significant regional and contextual variations. Polypharmacy was significantly associated with PIP (OR=3.72, 95% CI 2.53 to 5.46, p<0.01, I ² =69.56%), PIM (OR=4.20, 95% CI 2.91 to 6.06, p<0.01, I ² =57.83%) and PDDI (OR=4.51, 95% CI 3.05 to 6.69, p<0.01, I ² =0.00%), while hypertension (OR=2.46, 95% CI 1.38 to 4.36, p<0.01 I ² =0.00%) was associated with PIP. Conclusions and relevance: This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study indicates a high burden of inappropriate medication prescribing and its associated factors, underscoring the importance of further robust studies to clarify prescribing practices and associated factors. PROSPERO registration number: CRD42024556744.

Millions of people worldwide suffer from heart failure, which is a serious public health concern that results in high medical costs from prolonged hospital stay. This study aimed to assess the determinant factors associated with prolonged hospitalization among admitted acute heart failure at Jimma Medical Center, south west Ethiopia. The study was conducted at Jimma Medical Center in Ethiopia from December 2023 to April 2024, employing a prospective observational design. Statistical analysis was performed using Epi-data V.4.6 and STATA V.17 and multiple linear regression was employed. T test and ANOVA were conducted and a p-value is deemed significant if it is less than 0.05, corresponding to a 95% confidence interval. A total of 294 individuals were enlisted, with a mean age of 56. Over half of the patients (53.4%) stayed eight days or more throughout their average 11.4-day hospital stay. The following were significant risk factors for extended hospital stays: living in a rural; being admitted to a cardiac unit having neck vein distension, having a third heart sound, having ankle edema; having hepatomegaly, and having pleural effusion were predictor’s of length of hospital stay. Based on this finding, the length of hospital stay in heart failure patients is influenced by various factors. Addressing these factors can help reduce the duration of hospitalization. Implementing targeted interventions, such as improving physical activity, managing comorbidities, and enhancing discharge planning, may lead to better patient outcomes and decrease the prolongation of hospital stays for those with heart failure.

Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) to reduce morbidity and mortality. However, adherence to GDMT is often suboptimal in resource-limited settings, such as the Jimma Medical Center, Ethiopia. To assess prescriber adherence to guideline-based medical therapy in heart failure at Jimma Medical Center, Ethiopia. A convergent mixed-methods study was conducted from December 2023 to April 2024, enrolling 215 adult HFrEF patients. Prescriber adherence was measured using the Guideline Adherence Index (GAI) and QUALIFY scores. Semi-structured interviews with physicians explored the qualitative factors that affect adherence. Multinomial logistic regression identified the factors associated with adherence. Only 13.5 % of patients were discharged on all four recommended GDMT classes (ACEI/ARB, beta-blockers, MRAs, and SGLT2 inhibitors). Moderate and poor prescriber adherence occurred in 70.1 % and 16.3 % of the cases, respectively. Patient adherence was higher (74.9 % by MARS-5), yet 94 % were physically inactive, and 54.4 % regularly consumed salt. Insurance coverage (AOR: 4.81; p = 0.001), salt restriction (AOR: 6.62; p = 0.003), and shorter hospital stays (AOR: 0.90; p = 0.005) were linked to better adherence, whereas higher ejection fraction (AOR: 1.07; p = 0.005) and more comorbidities (AOR: 2.36; p = 0.037) predicted poorer adherence. The qualitative findings highlighted medication stock-outs, financial barriers, and clinical complexities as key challenges, with institutional support and multidisciplinary care as facilitators. Prescriber and patient adherence to GDMT for HFrEF at Jimma Medical Center was suboptimal. Interventions targeting prescriber training, expansion of insurance coverage, patient education, and multidisciplinary care are needed to improve outcomes.