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1.  Patterns of Diabetic Complications at Jimma University Specialized Hospital, Southwest Ethiopia 
Background
Diabetes Mellitus is common metabolic disease worldwide. Its complications in the Ethiopian care setup has not been well documented. The objective of this study was to assess the pattern and distribution of diabetic complications among patients having follow-up at Jimma University specialized Hospital diabetic clinic.
Methods
A cross sectional study based on record review of 305 patients, selected using systematic sampling with replacement was carried out in October 2008. The data were analyzed using SPSS for Windows version 13.0.
Results
Larger proportion, 189 (62.0%), of patients had type II diabetes and 163 (53.4%) of them were diabetic for less than 5 years. Seventy three of the 76 (96.1%) patients with type II diabetes mellitus had hypertension. Acute complications were observed in 93 (30.5%) of the patients of which Diabetic Ketoacidosis was documented in 66(71.0%).
Forty eight (45.7%) of patients had proteinuria, 90 (29.5%) had peripheral neuropathy, 13(6.8%) had impotence. Diabetic foot ulcer, skin and/or subcutaneous tissue infection, dental problems and tuberculosis were documented in 14(4.5%), 31(10.0%), 31(10.0%), and 17(5.6%) patients, respectively. Any of the chronic complications were not different by sex of the patient but age had statistically significant association with hypertension, visual disturbance and neuropathy (p< 0.05). Type of diabetes had statistically significant association with all the tested complications except infection (P<0.05) where most of the complications occurred in type II diabetics. Statistically significant association was observed between the duration of the diabetes and impotence and visual disturbances (p < 0.05).
Conclusion
The majority of patients were type II diabetics. Acute complications were observed more commonly among type I diabetics and DKA was the commonest acute complication. The frequency of chronic complications was high. Increased occurrence of retinopathy, peripheral neuropathy, hypertension and nephropathy was observed with longer duration of illness. Impotence and diabetic nephropathy were more common in type II diabetics. The study showed that age, sex, type of diabetes mellitus and duration of diabetes were significantly associated with the development of diabetic complications.
PMCID: PMC3275895  PMID: 22434958
Diabetes mellitus; chronic complications; Southwest Ethiopia
2.  Medication prescribing errors in the intensive care unit of Jimma University Specialized Hospital, Southwest Ethiopia 
Background
A number of studies indicated that prescribing errors in the intensive care unit (ICU) are frequent and lead to patient morbidity and mortality, increased length of stay, and substantial extra costs. In Ethiopia, the prevalence of medication prescribing errors in the ICU has not previously been studied.
Objective
To assess medication prescribing errors in the ICU of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia.
Methods
A cross-sectional study was conducted in the ICU of Jimma University Specialized Hospital from February 7 to April 15, 2011. All medication-prescribing interventions by physicians during the study period were included in the study. Data regarding prescribing interventions were collected from patient cards and medication charts. Prescribing errors were determined by comparing prescribed drugs with standard treatment guidelines, textbooks, handbooks, and software. Descriptive statistics were generated to meet the study objective.
Results
The prevalence of medication prescribing errors in the ICU of Jimma University Specialized Hospital was 209/398 (52.5%). Common prescribing errors were using the wrong combinations of drugs (25.7%), wrong frequency (15.5%), and wrong dose (15.1%). Errors associated with antibiotics represented a major part of the medication prescribing errors (32.5%).
Conclusion
Medication errors at the prescribing phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Health care providers need to establish a system which can support the prescribing physicians to ensure appropriate medication prescribing practices.
doi:10.2147/JMDH.S24671
PMCID: PMC3215350  PMID: 22135494
medication error; prescribing error; intensive care unit
3.  Medication Non-Adherence Among Adult Psychiatric Out Patients in Jimma University Specialized Hospital, Southwest Ethiopia 
Background
Information on adherence of adult psychiatric patients to biological modes of treatment is scarce in Ethiopia. Knowledge on adherence is essential in terms of future prognosis, quality of life and functionality of such patients. This study was conducted to assess the magnitude and associated factors of non-adherence to medication.
Methods
A hospital based cross-sectional study was conducted in November 2011 at the psychiatry facility of Jimma University Specialized Hospital, which provides service to more than 10 mill people. A sample of 422 adults with psychiatric illness in the follow-up outpatients was selected consecutively. Data was collected using a pre-tested questionnaire by face-to-face interview and from patient medical records. The four-item Morisky scale was used to assess degree of medication adherence. Data was analyzed using SPSS version 16 and descriptive, chi-square test and logistic regression statistical methods were used. P-Value of less than 0.05 was considered as statistically significant in the final model.
Results
Out of the 422 patients, 40.3% were females and 59.7% males. The prevalence rate for non-adherence was 41.2%, non-affective psychoses diagnosis contributing the highest rate (44.5%). From the total non-adherent respondents, 78.2% attributed their non-adherence to forgetting. Irregular follow-up, poor social support and complex drug regimen were independently associated variables with non-adherence.
Conclusions
The result of the study showed that non-adherence among psychiatric patients in Southwest Ethiopia is high and revealed possible associated factors. Adherence needs integrated efforts in creating a mechanism in enhancing regular follow-up, informal social support system and ongoing awareness creation among professionals.
PMCID: PMC3847532  PMID: 24307822
mental illness; non-adherence; Jimma University Specialized Hospital; Ethiopia
4.  The Quality of Care Provided to Patients with Chronic Non-Communicable Diseases: A Retrospective Multi-Setup Study in Jimma Zone, Southwest Ethiopia 
Background
Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.
Methods
A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.
Results
Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.
Conclusion
The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.
PMCID: PMC3275857  PMID: 22434991
Health care; Health care quality; Quality indicators; Guideline Adherence; Chronic diseases; Diabetes; Hypertension; Epilepsy
5.  Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia 
Background:
Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved.
Aims:
The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia.
Patients and Method:
The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic.
Result:
Oral hypoglycemic agent were prescribed for 351(91.4) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%). About 312 (88.9%) patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3%) and metformine 80(25.7%). Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1%) followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied.
Conclusion:
Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.
doi:10.4297/najms.2011.3418
PMCID: PMC3271397  PMID: 22362451
Type 2 diabetes; oral hypoglycemic agent; self-management; Ethiopia
6.  Prevalence of hypertension and its risk factors in southwest Ethiopia: a hospital-based cross-sectional survey 
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.
doi:10.2147/IBPC.S47298
PMCID: PMC3753877  PMID: 23986649
hypertension; cardiovascular disease; Ethiopia; Jimma
7.  Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia 
BMC Public Health  2008;8:265.
Background
The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV) drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia.
Methods
The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0) and third month (M3) follow up visits.
Results
A total of 400 and 383 patients at baseline (M0) and at follow up visit (M3) respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food) was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21). Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81). However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55) and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51) were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases.
Conclusion
The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot reliably be predicted by a few patient characteristics that are assumed to vary with time. Adherence is a process, not a single event, and adherence support should be integrated into regular clinical follow up.
doi:10.1186/1471-2458-8-265
PMCID: PMC2518153  PMID: 18667066
8.  Medication administration errors in an intensive care unit in Ethiopia 
Background
Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU). In Ethiopia, the prevalence of medication administration errors in the ICU is not studied.
Objective
To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia.
Methods
Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study.
Results
Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%). Common administration errors were attributed to wrong timing (30.3%), omission due to unavailability (29.0%) and missed doses (18.3%) among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%).
Conclusion
Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don’t occur as frequently as observed in this study.
doi:10.1186/1755-7682-5-15
PMCID: PMC3536604  PMID: 22559252
Medication error; Medication administration error; Intensive care unit
9.  Relatively low primary drug resistant tuberculosis in southwestern Ethiopia 
BMC Research Notes  2012;5:225.
Background
The prevalence of drug resistant tuberculosis (TB) in Ethiopia in general, and Jimma area in particular, is not well documented. We conducted a study at Jimma University specialized hospital in southwest Ethiopia among new cases of smear positive TB patients to determine the pattern of resistance to first-line drugs.
Methods
A health institution based cross sectional study was conducted from November 2010 to September 2011. Any newly diagnosed smear positive TB patient 18 years and above was included in the study. Demographic and related data were collected by trained personnel using a pretested structured questionnaire. Mycobacterial drug susceptibility testing (DST) to the first line drugs isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (STM) was performed on cultures using the indirect proportion method. M. tuberculosis complex (MTBC) was identified with the Capilia TB-Neo test.
Results
136 patients were enrolled in the study. Resistance to at least one drug was identified in 18.4%. The highest prevalence of resistance to any drug was identified against INH (13.2%) followed by STM (8.1%). There was no statistically significant difference in the proportion of any resistance by sex, age, HIV status and history of being imprisoned. The highest mono resistance was observed against INH (7.4%). Mono resistance to streptomycin was associated with HIV infection (crude OR 15.63, 95%CI: 1.31, 187). Multidrug-resistance TB (MDR-TB) was observed in two patients (1.5%).
Conclusion
Resistance to at least one drug was 18.4% (INH-13.2% and STM-8.1%). STM resistance was associated with HIV positivity. There was relatively low prevalence of MDR-TB yet INH resistance was common around Jimma. The capacity of laboratories for TB culture and DST should be strengthened, in order to correctly manage TB patients and avoid amplification of drug resistance.
doi:10.1186/1756-0500-5-225
PMCID: PMC3441821  PMID: 22574696
Tuberculosis; Drug resistance; Ethiopia; Jimma
10.  Risk Factors for Cardiovascular Diseases among Diabetic Patients In Southwest Ethiopia 
Background
Studies on cardiovascular risk factors among diabetic persons in Ethiopia are lacking. The objective of this study was to determine the prevalence of the cardiovascular risk factors (hypertension, obesity, physical inactivity, dyslipidemia and smoking) among diabetic patients at the diabetic clinic of Jimma University Specialized Hospital.
Methods
A cross-sectional study was conducted from October to December 2007. Three hundred one individuals were randomly selected from 950 patients on follow-up. Data were collected using a structured format and appropriate equipments and reagents. Laboratory data were recorded in a separate checklist. The data were entered into SPSS for Windows version 12. Multivariate regression analysis was carried out to identify predictors of hypertension, obesity and dyslipidemia.
Results
Two hundred and fifty six (85.1%) of the sample participated in the study. The prevalence of hypertension, obesity, dyslipidemia, physical inactivity and current smoking was 46.5%, 23.4%, 63.5%, 55.1% and 5.5% respectively. Age ≥ 45 years, type 2 diabetes and obesity were predictors of hypertension. Females were less likely to be hypertensive (OR =2.26, 3.37, 3.79 and 0.48 respectively). Type 2 diabetics and females were more while rural diabetics were less likely to be obese. (OR =6.08, 4.17 and 0.37 respectively). Female gender, hypertension and fasting blood glucose ≥ 180mg/dl were predictors of dyslipidemia. Alcohol users were less likely to be dyslipidemic. (OR =4.25, 3.5, 3.56 and 0.39, respectively)
Conclusion
Hypertension, obesity, dyslipidemia and physical inactivity were common while smoking was uncommon among diabetic patients in Jimma University Specialized Hospital. Type 2 DM was a predictor of hypertension and obesity. Diabetic women were more likely to be obese and dyslipidemic. We recommend screening and management of these risk factors.
PMCID: PMC3275835  PMID: 22434970
Diabetes Mellitus; Hypertension; Obesity; Dyslipidemia; Ethiopia
11.  Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008) 
This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women’s mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.
doi:10.2147/IJWH.S43617
PMCID: PMC3720572  PMID: 23901297
global mental health; low income country; Africa; gender differences
12.  Drug-related problems among medical ward patients in Jimma university specialized hospital, Southwest Ethiopia 
Objective:
The increasing number of available drugs and drug users, as well as more complex drug regimens led to more side effects and drug interactions and complicates follow-up. The objective of this study was to assess drug-related problems (DRPs) and associated factors in hospitalized patients.
Methods:
A hospital-based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, located in the south west of Addis Ababa. All patients who were admitted to the medical ward from February 2011 to March 2011 were included in the study. Data on sociodemographic variables, past medical history, drug history, current diagnosis, current medications, vital signs, and relevant laboratory data were collected using semi-structured questionnaire and data collection forms which were filling through patient interview and card review. Data were analyzed using SPSS version 16 for windows. Descriptive statistics, cross-tabs, Chi-square, and logistic regression were utilized.
Findings:
Out of 257 study participants, 189 (73.5%) had DRPs and a total of 316 DRPs were identified. From the six classes of DRPs studied, 103 (32.6%) cases related to untreated indication or need additional drug therapy, and 49 (15.5%) cases related to high medication dosage. Unnecessary drug therapy in 49 (15.5%) cases, low medication dosage in 44 (13.9%) cases, and ineffective drug therapy in 42 (13.3%) cases were the other classes of problems identified. Noncompliance in 31 (9.8%) cases was the least prevalent DRP. Independent factors which predicted the occurrence of DRPs in the study population were sex, age, polypharmacy, and clinically significant potential drug-drug interactions. The prevalence of DRPs was substantially high (73.5%).
Conclusion:
Drug-related problems are common among medical ward patients. Indication-related problems, untreated indication and unnecessary drug therapy were the most common types of DRPs among patients of our medical ward.
doi:10.4103/2279-042X.132702
PMCID: PMC4078648  PMID: 24991628
Drug-related problems; inappropriate dosage; ineffective drug therapy; unnecessary drug therapy
13.  Adherence to medication for the treatment of psychosis: rates and risk factors in an Ethiopian population 
Background
Medication-taking behavior, specifically non-adherence, is significantly associated with treatment outcome and is a major cause of relapse in the treatment of psychotic disorders. Non-adherence can be multifactorial; however, the rates and associated risk factors in an Ethiopian population have not yet been elucidated. The principal aim of this study was to evaluate adherence rates to antipsychotic medications, and secondarily to identify potential factors associated with non-adherence, among psychotic patients at tertiary care teaching hospital in Southwest Ethiopia.
Methods
A cross-sectional study was conducted over a 2-month period in 2009 (January 15th to March 20th) at the Jimma University Specialized Hospital. Adherence was computed using both a compliant fill rate method and self-reporting via a structured patient interview (focusing on how often regular medication doses were missed altogether, and whether they missed taking their doses on time). Data were analyzed using SPSS for windows version 16.0, and chi-square and Pearsons r tests were used to determine the statistical significance of the association of variables with adherence.
Result
Three hundred thirty six patients were included in the study. A total of 75.6% were diagnosed with schizophrenia, while the others were diagnosed with other psychotic disorders. Most (88.1%) patients were taking only antipsychotics, while the remainder took more than one medication. Based upon the compliant fill rate, 57.5% of prescription fills were considered compliant, but only 19.6% of participants had compliant fills for all of their prescriptions. In contrast, on the basis of patients self-report, 52.1% of patients reported that they had never missed a medication dose, 32.0% sometimes missed their daily doses, 22.0% only missed taking their dose at the specific scheduled time, and 5.9% missed both taking their dose at the specific scheduled time and sometimes missed their daily doses. The most common reasons provided for missing medication doses were: forgetfulness (36.2%); being busy (21.0%); and a lack of sufficient information about the medication (10.0%). Pill burden, medication side-effects, social drug use, and duration of maintenance therapy each had a statistically significant association with medication adherence (P ≤ 0.05).
Conclusion
The observed rate of antipsychotic medication adherence in this study was low, and depending upon the definition used to determine adherence, it is either consistent or low compared to previous reports, which highlights its pervasive and problematic nature. Adherence must therefore be considered when planning treatment strategies with antipsychotic medications, particularly in countries such as Ethiopia.
doi:10.1186/1472-6904-12-10
PMCID: PMC3416691  PMID: 22709356
Medication adherence; Antipsychotic; Compliant fill rate; Jimma
14.  Assessing Control of Asthma in Jush, Jimma, South West Ethiopia 
Background
Despite international guidelines, asthma control is short of the goal in different parts of the world. The objective of this study was to assess control of asthma in patients older than 14 years at the Chest Clinic of Jimma University Specialized Hospital/JUSH, South West Ethiopia.
Methods
A cross-sectional hospital-based study was conducted on 234 physician-diagnosed asthmatic patients attending the chest follow up clinic from June 01 to July 31, 2012. Asthma control was assessed using the GINA algorithm and the ACT questionnaire. Pulmonary function test was measured using a spirometer for 160 subjects. Data were cleared, entered and analyzed using SPSS version 16 and independent variables were assessed for association with the level of asthma control using bivariate and multinomial analyses.
Results
Using the GINA based algorithm, 42 respondents (26.2%) were considered to have partly controlled asthma and the majority, 117 (76.1%), had uncontrolled asthma. Asthma was uncontrolled (ACT score <19) in 71.4% subjects and well-controlled (ACT score = 20–25) in 28.6%. Inhaled corticosteroids alone or in association with long-acting b-agonists, which are the prophylactic treatments recommended by GINA, were used by only 9 subjects (3.8%). Factors associated independently with asthma control were individual patient's age group, unscheduled visit, frequency of SABA use, type of treatment and perceived rate of asthma control.
Conclusion
Asthma control is unacceptably poor in Jimma, South West Ethiopia. This could be changed through improved appropriate treatment and frequent monitoring to achieve and maintain control.
PMCID: PMC3929928  PMID: 24591799
Control of asthma; Spirometry; Asthma treatment; Sub-Saharan Africa
15.  Substance Use and Sexually Transmitted Infections Among Anti-Retroviral Treatment Attendees in Jimma University Specialized Hospital, Jimma, Ethiopia 
Background
Substance use increases both the risk of Human Immunodeficiency Virus and other Sexually Transmitted Infections, either directly or indirectly. The association of substance use and Sexually Transmitted Infections has not yet studied in Southwestern Ethiopia. The main aim of this study is to determine the associations between substance use and Sexually Transmitted Infections on clients under follow up in Anti-Retroviral Treatment clinic at Jimma University Specialized Hospital.
Methods
A cross-sectional study was conducted on clients under follow up at Anti-Retroviral Treatment clinic from June 10 to July 10, 2011 at Jimma University Specialized Hospital. Data collection was done using a pre-coded and pre-tested questionnaire. Trained Anti-Retroviral Treatment adherence counselors collected the data. Data were entered and analyzed using SPSS for Windows version 16.0. Chi-square test was used to measure the levels of significance. P-value < 0.05 was considered as significant.
Results
Three hundred thirty eight Anti-Retroviral Treatment attendees participated in the study. Two hundred twenty (65.1%) of the study participants were females and their mean (±SD) age was 33.6 ± 8.04 years while 156 (46.2%) of them lied in the age group of 25–34 years. Clients who reported that they had Sexually Transmitted Infections were 120 (35.5%). Those who consumed alcohol were more likely to have contracted in Sexually Transmitted Infections: AOR (95% CI) =0.46 (0.26–0.80).
Conclusion
Prevalence of Sexually Transmitted Infections was comparable among females and males. Substance use, particularly alcohol consumption, found to be a potential risk factor for Sexually Transmitted Infections.
PMCID: PMC3511896  PMID: 23209352
Substance use; Sexually Transmitted Infections; HIV
16.  Determinants of Glycemic Control among Insulin Treated Diabetic Patients in Southwest Ethiopia: Hospital Based Cross Sectional Study 
PLoS ONE  2013;8(4):e61759.
Background
Good glycemic control reduces the risk of diabetic complications. Despite this, achieving good glycemic control remains a challenge in diabetic patients. The objective of this study is to identify determinants of glycemic control among insulin treated diabetic patients at Jimma University Hospital, Southwest Ethiopia.
Methods
Hospital-based cross-sectional study was conducted on systematically sampled 284 insulin-treated diabetic patients with a regular follow up. Data was collected by interviewing patients during hospital visits and reviewing respective databases of September 2010 to December 2011. Data collection took place from February 20 to May 20, 2012. Poor glycemic control was defined as fasting blood sugar (FBS) ≥126 mg/dL. Binary logistic regression analysis was conducted to identify predictors of poor glycemic control.
Results
Patients had a mean age of 41.37 (±15.08) years, 58.5% were males, the mean duration of insulin treatment was 4.9 (±5.1) years, 18.3% achieved good glycemic control (FBS≤126 mg/dL), 95% self-reported repeated use of disposable insulin syringe-needle and 48% correctly rotating insulin injection sites. Most (83.1%) of study participants had one or more complications. On multivariable logistic regression analyses, body weight of >70 Kg (AOR = 0.21; P<0.001), total daily dose of insulin ≤35 IU/day (AOR = 0.26; P<0.001), total daily dose variation without checking glycemic level (AOR = 3.39; P = 0.020), knowledge deficit about signs and symptoms of hyperglycemia (AOR = 3.60; P = 0.004), and non-adherence to dietary management (AOR = 0.35; P = 0.005) were independent predictors of poor glycemic control.
Conclusions
The proportion of patients with poor glycemic control was high, which resulted in the development of one or more complications regardless of duration on insulin treatment. Hence, appropriate management of patients focusing on the relevant associated factors and independent predictors of poor glycemic control would be of great benefit in glycemic control.
doi:10.1371/journal.pone.0061759
PMCID: PMC3631159  PMID: 23620789
17.  The Pattern of Cardiac Diseases at the Cardiac Clinic of Jimma University Specialised Hospital, South West Ethiopia 
Background
Rheumatic heart disease is the commonest cardiac disease in most sub-Saharan African countries, followed by hypertensive heart disease which is rising along with the other non-communicable diseases. However the pattern in our setting is not known. This study aimed to determine the pattern of cardiac diseases among adult patients on follow-up at the cardiac follow-up clinic of Jimma University Specialized Hospital.
Methods
A cross-sectional study was conducted on cardiac patients who are newly enrolled to the cardiac follow up clinic of Jimma university specialized hospital during a five year period from 2003 to 2008. Out of the total 837 cases that were newly enrolled to the clinic in the five year period, 781 patients who had complete record about etiologic diagnosis were included in the study. The data were collected using structured record review checklist. The collected data were then analyzed using SPSS for windows version 12.0.
Results
Rheumatic heart disease was the diagnosis in 256 (32.8%) of the cardiac cases on follow-up followed by hypertensive heart disease and cardiomyopathy accounting for 189 (24.2%) and 158 (20.2%) of cases, respectively. Among Rheumatic heart disease patients; male to female ratio was 0.86:1 and the mean age was 31.4 years. One hundred ninety three (75.4%) of the cases with rheumatic heart disease had echocardiographic report that showed valve(s) involvements of pure MS in 99 (51.3%) and combined MS, MR in 49 (25.4%). Overall, hypertension contributed for a total of 241 (30.9%) of cardiac patients that included 189 (24.2%) hypertensive heart disease and 52 (6.7%) as one major risk factor for ischemic heart disease.
Conclusion
Rheumatic, hypertensive and cardiomyopathic heart diseases accounted for more than three-quarters of cardiac diseases in the study population. This study highlighted the need for further study to determine the burden at community setting.
PMCID: PMC3275840  PMID: 22434967
Cardiac diseases; Pattern; Jimma
18.  Incidence, Causes and Outcome of Obstructed Labor in Jimma University Specialized Hospital 
Background
Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital.
Methods
Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0.
Results
The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score.
Conclusion
The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications.
PMCID: PMC3275845  PMID: 22434973
Obstructed labor; cephalo-pelvic disproportion; uterine rupture; Jimma
19.  Relationship Between Leadership Styles of Nurese Managers and Nurses' Job Satisfaction in Jimma University Specialized Hospital 
Background
Leadership style of nurse managers plays a significant role in nurses' job satisfaction. However, there is limited literature in areas related to nurses' manager leadership style. The objective of this research was thus to investigate the relationship between leadership style of nurse managers and nurses' job satisfaction in Jimma University Specialized Hospital.
Methods
The study was conducted at Jimma University Specialized Hospital from January to June 2012 and used a non-experimental correlation design. All full time, non-supervisory nurses with an experience of more than one year in nursing profession were participated in the study. The Multifactor Leadership Questionnaire and Minnesota Satisfaction Questionnaire were used to collect data. Data were entered and analyzed using SPSS version16.0 statistical software. The results were analyzed through descriptive statistics followed by the application of inferential statistics on the variables. Significance level was considered when p<0.05.
Results
A total of 175 copies of the questionnaires were returned out of 186 copies distributed to respondents. The result indicated that nurses can prefer transformational leadership style over transactional leadership style and had moderate-level intrinsic (M=2.72, SD=0.71) but low level of extrinsic job satisfaction (M=1.83, SD=0.68). Furthermore, from transactional leadership, only contingent reward was found to be statically significant and correlated with extrinsic (B=0.45, p<0.01) and intrinsic job satisfaction (B=0.32, p<0.05) while all five dimension of transformational leadership style were statistically significant and correlated with both intrinsic and extrinsic job satisfaction.
Conclusion
Nurses tended to be more satisfied with the transformational leadership than transactional leadership style. Therefore, nurses' managers should use transformational leadership style in order to increase nurses' job satisfaction.
PMCID: PMC3613815  PMID: 23559838
Leadership; Nurses; Job satisfaction; Jimma University Specialized Hospital
20.  Job Satisfaction and Its Determinants Among Health Workers in Jimma University Specialized Hospital, Southwest Ethiopia 
Ethiopian Journal of Health Sciences  2011;21(Suppl 1):19-27.
Background
Human power is the back bone for the provision of quality health care for the population. High level of professional satisfaction among health workers earns high dividends such as higher worker force retention and patients satisfaction. There is limited amount of literature in the areas related to factors affecting job satisfaction and retention. The objective of this study was to determine the job satisfaction of health professionals working in Jimma University Specialized Hospital and factors affecting their level of satisfaction.
Method
A cross-sectional study was conducted to determine the level and factors affecting job satisfaction and retention of health professionals working in Jimma University Specialized Hospital. The study was conducted from March to October 2009 and included all categories of health professionals working in the hospital during the study period. Data was collected using self administered questionnaire and focus group discussion. After the data was collected, it was entered into a computer and analyzed using SPSS version16.0 windows statistical software. Chi-square tests were made to evaluate association of different variables with job satisfaction, and P-value < 0.05, at 95% CI was taken as cut off point for statistical significance.
Results
A total of 145 health professionals have responded for the self administered questionnaire. The result showed that sixty seven (46.2%) of the health workers are dissatisfied with their job. The major reasons reported for their dissatisfaction were lack of motivation, inadequate salary, insufficient training opportunities and inadequate number of human resources. Only sixty (41.4%) health professionals were satisfied with their job, the major reasons given were getting satisfaction from helping others and professional gratification. Suggestion given by the respondents to improve job satisfaction and increase retention rate included motivation of staff through different incentives such us bonus, house allowance, salary increment, establishing good administration management system and improving hospital facilities and infrastructure.
Conclusion
Job satisfaction of health professionals in Jimma University Specialized Hospital was found to be low. Responsible bodies should devise mechanisms to improve job satisfaction and retention of health professional so as to improve the healthcare services of the hospital.
PMCID: PMC3275875  PMID: 22435005
Job satisfaction; Health Workers; Jimma University Specialized Hospital
21.  Vision Loss and Psychological Distress among Ethiopians Adults: A Comparative Cross-Sectional Study 
PLoS ONE  2013;8(10):e78335.
Background
Vision loss causes major changes in lifestyle and habits that may result in psychological distress and further reduction in the quality of life. Little is known about the magnitude of psychological distress in patients with vision loss and its variation with the normal. The aim of this study is, therefore, to investigate the psychological effects of vision loss and its determinants among Ethiopians.
Methods
A comparative cross-sectional study was conducted on adults attending the Eye clinic of Jimma University Hospital. One hundred fifteen consecutive adults with visual loss at least in one eye and 115 age-and sex-matched controls with normal vision were studied. The psychological distress was measured using standardized Self-Reporting Questionnaire (SRQ-20). Chi-square test and logistic regression were carried out and associations were considered significant at P<0.05.
Results
The overall prevalence of psychological distress was 33.4%. While psychological distress was found in 49.8% of patients who had loss of vision at least in one eye, only 18.3% of the controls had it. In the adjusted analysis, patients with vision loss had 4.6 times higher risk of suffering from psychological distress compared to patients with normal vision (AOR 4.56; 95% CI 2.16-9.62). Moreover, patients with vision loss in both eyes (AOR 4.00; 95% CI 1.453-11.015) and with worse visual acuity in the better eye (AOR 3.66; 95% CI 1.27-10.54) were significantly more likely to have psychological distress than those patients with vision loss in one eye only and good visual acuity in the better eye respectively. The cause of visual loss, pattern of visual loss, duration of visual loss and sociodemographic variables did not influence the likelihood of having psychological distress.
Conclusion
Prevalence of psychological distress was significantly higher in patients with visual loss compared to patients with normal vision. There is a need for integration of psychosocial care into the current medical and surgical treatment of patients with vision loss.
doi:10.1371/journal.pone.0078335
PMCID: PMC3808291  PMID: 24205202
22.  Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia 
Background
Wound infection is one of the health problems that are caused and aggravated by the invasion of pathogenic organisms. Information on local pathogens and sensitivity to antimicrobial agents, and topical agents like acetic acid is crucial for successful treatment of wounds.
Objectives
To determine antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital.
Methods
A cross sectional study was conducted among patients with wound infection visiting Jimma University Specialized Hospital, from May to September 2013. Wound swab was collected using sterile cotton swabs and processed for bacterial isolation and susceptibility testing to antimicrobial agents, acetic acid, hydrogen peroxide and dabkin solution following standard bacteriological techniques. Biochemical tests were done to identify the species of the organisms. Sensitivity testing was done using Kirby- Baur disk diffusion method. Minimum inhibitory and bactericidal concentration was done using tube dilution method.
Results
In this study 145 bacterial isolates were recovered from 150 specimens showing an isolation rate of 87.3%. The predominant bacteria isolated from the infected wounds were Staphylococcus aureus 47 (32.4%) followed by Escherichia coli 29 (20%), Proteus species 23 (16%), Coagulase negative Staphylococci 21 (14.5%), Klebsiella pneumoniae 14 (10%) and Pseudomonas aeruginosa 11 (8%). All isolates showed high frequency of resistance to ampicillin, penicillin, cephalothin and tetracycline. The overall multiple drug resistance patterns were found to be 85%. Acetic acid (0.5%), Dabkin solution (1%) and 3% hydrogen peroxide were bactericidal to all isolated bacteria and lethal effect observed when applied for 10 minutes.
Conclusions
On in vitro sensitivity testing, ampicillin, penicillin, cephalothin and tetracycline were the least effective. Gentamicin, norfloxacin, ciprofloxacin, vancomycin and amikacin were the most effective antibiotics. Acetic acid (0.5%), dabkin solution (1%) and H2O2 (3%) were bactericidal to all isolates.
doi:10.1186/1476-0711-13-14
PMCID: PMC4017222  PMID: 24731394
Bacterial pathogens; Drug resistance; Wound infection; Jimma; Ethiopia
23.  Patterns of Eye Diseases in Children Visiting a Tertiary Teaching Hospital: South-western Ethiopia 
Background
About 19 million children worldwide live with visual impairments resulting from different ocular morbidities. This study aimed to identify the different causes of eye diseases in children visiting a tertiary eye centre at Jimma University Hospital.
Methods
We conducted a retrospective review of charts of patients of <16 years of age who presented to Jimma University, Department of Ophthalmology (JUDO,) between January 1, 2010 and December 31, 2010. Data on age, sex, final diagnosis and treatments were collected and analyzed using SPSS version 16.0. Ratios, percentages and associations were calculated, interpreted and discussed. P-values below 0.05 were considered statistically significant.
Results
Three-hundred-eighty children were seen at JUDO in the year 2010, most of them repeatedly. We evaluated the reports of 341 children (53% males). Children aged 11–15 years constituted the largest group (37%). The commonest childhood ocular diseases diagnosed in 2010 were ocular surface and eyelid infections (30.5%), ocular allergies (28.1%), ocular traumas and injuries (15.5%) and refractive errors (5.8%). Avoidable eye diseases accounted for about 97% of ocular morbidities.
Conclusion
Infectious causes of childhood ocular diseases are the major reasons of visits of children seen at the Eye Department. Most of the ocular morbidities in children during the study year were either treatable or preventable. Further study on childhood eye diseases at community level is required to design proper preventive and curative strategies for childhood eye diseases in the region.
PMCID: PMC3929930  PMID: 24591801
Childhood eye diseases; visual impairment; Jimma; Ethiopia
24.  Association of Hepatitis C Virus Infection with Type II Diabetes in Ethiopia: A Hospital-Based Case-Control Study 
Background. Chronic hepatitis C virus (HCV) has become the global “epidemic” with an estimated 123 million people currently infected worldwide. As the same time diabetes is also rapidly emerging as a global health care problem that threatens to reach pandemic levels by 2030. Objective. To investigate the magnitude of HCV infection in type II diabetes as compared to controls. Methodology. A case control study design was conducted at Jimma University Specialized Hospital from May to June 2010. A total of 604 study subjects were included in this study. Sociodemographic and risk factor data were collected by questionnaire. From serum sample, HCVAb screening was done by rapid antibody screening test. Liver functioning tests and total cholesterol tests were done by Dr. Lange LP 800 spectrophotometer. Results. The prevalence of HCV in type II diabetes and nondiabetic controls was 9.9% and 3.3%, respectively. In multivariate analysis, HCV seropositives have high risk of developing diabetes as compared with seronegatives (AOR = 2.997, 95% CI: (1.08, 8.315)). Conclusion. In this study, we found a positive association between past HCV infection and type II diabetes. As we did not perform HCV RNA test, we could not assess the association with HCV viremia.
doi:10.1155/2012/354656
PMCID: PMC3461610  PMID: 23049551
25.  HIV Sero-Prevalence Trend among Blood Donors in Jimma University Specialized Hospital, Southwest Ethiopia 
Background
HIV/AIDS epidemics continue unchecked in African countries at all level of society bearing the heaviest burden of the scourge. Different researches have been done to see the progress of disease from time to time However, information that shows the trend of HIV among the healthy population over a period of time in Ethiopia is very limited.
Methods
A descriptive retrospective cross-sectional study was carried out to see the trend of HIV Sero-positivity and associated socio-demographic factors. The data was retrieved from records of people who donated blood during the period of January 2007 to December 2010, at Jimma University Specialized Hospital (JUSH). Data on socio-demographic variables and serologic status of the subjects were abstracted from their records using structured format. Then the data were cleaned, edited and entered into computer and analyzed by Microsoft Excel sheet. Then Chi-Square (X2) Statistical test was used for testing associations and P value less or equal to five percent (P ≤ 0.05) was considered significant.
Results
A total of 3788 subjects had donated blood from 2007 to 2010 of which 3034 (80.1 %) were males. Thirty nine (1%) of the donors were positive for HIV upon screening by Enzyme Linked Immuno Sorbent Assay (ELISA) method. The prevalence of HIV infection was 1.2% for males and 0.5% for females. The age specific prevalence was highest in the age group 30–39 years (2.2%) followed by 40 – 49 (1.4%). HIV sero-prevalence was higher among rural dwellers (1.4%) than urban (0.8%); drivers and their assistants (2.8%), and daily laborers (2.6%) had higher prevalence. Similarly, those who donated blood for replacement purpose had higher sero-prevalence (1.5%) as compared to those on voluntary basis (0.3%).
Conclusion
There is decreasing trend of sero-positivity over the years, with higher prevalence among sexually active age groups and rural dwellers.
PMCID: PMC3437978  PMID: 22984330
HIV; sero-positivity; trend; blood donors

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