Conectar
by Yordanos Getachew, Tamirat Tamiru, Mekdelawit Fisseha, Sami Sebri, Tadesse Shume, Regasa Diriba, Kassu Desta
BackgroundMultidrug-resistant Enterobacteriaceae (MDRE) is among the leading causes of hospital-acquired infections, resulting in prolonged hospitalization, increased healthcare costs, and mortality. Carbapenem are often used as last-resort antibiotics; however, the emergence of carbapenemase-producing Enterobacteriaceae (CPE) has severely limited treatment options. In Ethiopia, data on their burden from routine diagnostic laboratory settings remain limited. This study assessed the prevalence of multidrug-resistant and carbapenemase-producing Enterobacteriaceae among clinical isolates in Addis Ababa.
MethodsA laboratory-based cross-sectional study was conducted from January 2, 2025, to April 2, 2025 on clinical specimens referred to Wudassie Advanced Medical Laboratory in Addis Ababa, Ethiopia. A total of 1105 clinical specimens collected through convenience sampling method were processed. Bacterial identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (EXS 3000, Zybio Inc., China). Antimicrobial susceptibility testing was conducted using the Kirby–Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI 2024) guidelines. Carbapenemase production was confirmed using the modified Carbapenem Inactivation Method (mCIM). Data were analyzed using SPSS version 26.
ResultsOf the 1105 clinical specimens, 288/1105 (26.1%) showed bacterial growth. Enterobacteriaceae accounted for 156/288 (54.2%) of the isolates. The most common isolates were Escherichia coli 89/156 (57.1%) and Klebsiella pneumoniae 47/156 (30.1%). Overall, 123/156 (78.8%) of Enterobacteriaceae were multidrug resistant. Carbapenem resistance was detected in 35/154 (22.7%) of isolates, and 30/154 (19.5%) were confirmed as carbapenemase producers. Klebsiella pneumoniae 24/30 (80%) was the predominant carbapenemase-producing organism. Most CPE isolates were recovered from urine specimens, followed by wound and sputum samples.
ConclusionThis study demonstrates a high prevalence of multidrug-resistant and carbapenemase-producing Enterobacteriaceae in Addis Ababa. The findings highlight the urgent need for strengthened antimicrobial stewardship programs, early detection strategies, and enhanced infection prevention and control measures in the private health facilities.
To determine the time to major adverse cardiovascular events (MACE) and identify its predictors among patients with acute coronary syndrome (ACS) discharged on secondary prevention medications in Ethiopia.
Institution-based retrospective cohort study.
University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia.
A total of 400 adult patients diagnosed with ACS and discharged with secondary prevention medications between January 2020 and December 2024.
The primary outcome was time to first MACE, defined as reinfarction, stroke or heart failure, measured in years from hospital discharge. A Cox proportional hazards regression model was fitted to identify predictors of time to develop MACE. Data collected from patient medical charts were exported to STATA V.17 for analysis. The log-rank test was used to determine the survival difference between subgroups of participants.
During follow-up, 33.8% of patients experienced at least one MACE. The median time to MACE was 1.5 years. Female sex (adjusted HR (AHR)=2.08; 95% CI 1.24 to 3.49), presence of chronic comorbidities (AHR=2.09; 95% CI 1.42 to 4.41) and higher Killip class (IV vs I: AHR=1.57; 95% CI 1.22 to 1.78) were independently associated with a shorter time to MACE. Patients aged ≤55 years had a lower risk of MACE compared with those aged ≥66 years (AHR=0.77; 95% CI 0.54 to 0.98).
Among patients with ACS discharged on secondary prevention medications, one-third experienced MACE within a median of 1.5 years. Older age, female sex, presence of comorbidities and higher Killip class were significant predictors of shorter time to MACE. These findings highlight the need for targeted postdischarge monitoring and secondary prevention strategies, particularly in resource-limited settings.
This study aimed to assess the pooled proportion of dropout from the maternal continuum of care (CoC) and its associated factors in low-income and middle-income countries (LMICs).
Cross-sectional study using nationally representative demographic and health survey (DHS) data.
41 LMICs with DHS data available after the establishment of the Sustainable Development Goals from 2016 to 2024 were included. A total of 217 083 (weighted 213 474) women were included. Using Stata V.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from the CoC. The adjusted ORs (AORs) with 95% CIs were calculated, and p
Women of reproductive age (15 to 49 years) who had at least one live birth within 2 years preceding the survey.
Dropout from the CoC was the primary outcome of this study, defined as initiating antenatal care but failing to receive skilled birth attendance and/or postnatal care.
The pooled proportion of CoC dropout was 50% (95% CI 45 to 56%), with significant heterogeneity, which ranges from 19% in Albania to 85% in Ethiopia. Factors associated with higher odds of dropout were multiparity (AOR=1.30, 95% CI 1.26 to 1.34), grand multiparity (AOR=1.70, 95% CI 1.62 to 1.78), delayed first ANC (AOR=2.87, 95% CI 2.79 to 2.95), regions compared with the North Africa/West Asia/Europe region; SSA (AOR=2.65, 95% CI 2.34 to 3.00), Central Asia (AOR=1.78, 95% CI 1.40 to 2.26), South and Southeast Asia (AOR=2.43, 95% CI 2.14 to 2.75), Oceania (AOR=2.41, 95% CI 1.98 to 2.94), Latin America and the Caribbean (AOR=8.47, 95% CI 6.81 to 10.54), distance from health facility (AOR=1.15, 95% CI 1.12 to 1.18), getting permission (AOR=1.27, 95% CI 1.23 to 1.32), pregnancy intention (AOR=0.76, 95% CI 0.73 to 0.78) and rural residence (AOR=1.57, 95% CI 1.51 to 1.64), primary education (AOR=0.83, 95% CI 0.80 to 0.86), secondary education (AOR=0.60, 95% CI 0.58 to 0.62), higher education (AOR=0.43, 95% CI 0.41 to 0.46), middle wealth index (AOR=0.80, 95% CI 0.77 to 0.83), rich wealth index (AOR=0.65, 95% CI 0.63 to 0.68), media exposure (AOR=0.70, 95% CI 0.69 to 0.72), women aged between 20 and 34 (AOR=0.76, 95% CI 0.72 to 0.79) and age ≥35 years (AOR=0.60, 95% CI 0.56 to 0.63) were associated with lower odds of dropout.
This study found a 50% dropout from CoC in LMICs with considerable heterogeneity. Factors identified as contributing to reducing dropout rates include improving women’s education, increasing media exposure, enhancing women’s decision-making power, ensuring better access to healthcare facilities, particularly in remote areas, and reducing adolescent pregnancies. To achieve Sustainable Development Goal 3 for maternal and child health by 2030, a coordinated, multi-level strategy is required.
by Mesay Milkias, Semagn Mekonnen, Hailemariam Getachew, Hailemariam Mulugeta, Siraj Ahmed, Melkamu Kebede, Belete Destaw, Medhanit Melese, Zemedu Aweke
BackgroundPost-operative pain is among the major post-cesarean problems, with an incidence ranging from 25.5% to 80%. Despite its simplicity, the effectiveness of wound infiltration with a mixture of bupivacaine and tramadol is still unknown. Therefore, this study aims to compare the analgesic effectiveness of wound infiltration with bupivacaine versus a combination of bupivacaine and tramadol for postoperative pain management among parturients undergoing cesarean section under spinal anesthesia.
MethodologyA double-blind, parallel, randomized controlled trial was conducted on 60 parturients. Parturients were randomized to take either bupivacaine (B = 30) or a combination of bupivacaine and tramadol (BT = 30). The homogeneity of variance was assessed using Levene’s test, and normality was assessed using the Shapiro-Wilk test. A numeric rating scale was used to measure pain severity. The independent t-test and the Mann-Whitney U test were used, respectively, for parametric and non-parametric data. A generalized estimating equation was used to assess repeated measurements.
ResultIn total, 60 parturients were analyzed with no dropouts. The severity of pain at the 6th hour was six times greater in the B group compared to the BT group (OR = 6.289, CI, 2.097–18.858, P = 0.001). The mean tramadol consumption was lower in the BT group (140.00 ± 48.066 mg) than in the B group (175.00 ± 34.114 mg), with a statistically significant mean difference of 10.761 (95% CI, 13.459 to 56.541), t (58) = 3.252, P = 0.002, (d = 0.839). The mean first analgesia request time was higher in the mixture of the BT group (367.33 ± 50.099 min) than in the B group (216.33 ± 68.744 min), with a statistically significant difference of 15.530 (95% CI, −182.087 to −119.913), t (58) = 5.6553, P = 0.001.
ConclusionWound infiltration with a combination of bupivacaine and tramadol is more effective than bupivacaine alone for postoperative analgesia in pregnant patients who underwent cesarean section under spinal anesthesia. This clinical trial study was registered at the Pan African Clinical Trial Registry with a unique trial registration number of PACTR202310525672884 (13/10/2023).
FreshRSS 