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To assess health-related quality of life (HRQoL), treatment satisfaction and associated factors among older adults with acute heart failure in Northwest Ethiopia.
Prospective, multicentre observational study.
Three tertiary hospitals in Northwest Ethiopia provide secondary and tertiary care services.
A total of 422 patients aged ≥60 years with a confirmed diagnosis of acute heart failure were consecutively enrolled between December 2024 and April 2025. Patients with unstable psychiatric conditions or advanced kidney disease were excluded.
HRQoL was assessed using the WHO Quality of Life – Brief Version questionnaire, and treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Multiple linear regression identified factors associated with HRQoL and treatment satisfaction.
95% of participants reported moderate HRQoL, and 3% reported poor HRQoL. Weight loss was positively associated with HRQoL (β=1.52; 95% CI 0.04 to 3.07; p=0.021), whereas asthma was negatively associated with HRQoL (β = –3.28; 95% CI 6.94 to 0.37; p=0.001). Regarding treatment satisfaction, 65% of patients were moderately satisfied, with notable concerns regarding medication safety and overall experience. Rural residents reported lower satisfaction than urban residents (β = –0.20; 95% CI 0.34 to 0.05; p=0.007). Patients with New York Heart Association (NYHA) class III had higher satisfaction (β=0.25; 95% CI 0.05 to 0.45; p=0.016). Effective hypertension management was linked to increased satisfaction (β=0.20; 95% CI 0.02 to 0.37; p=0.026), whereas coronary heart disease was associated with lower satisfaction (β = –0.40; 95% CI 0.64 to 0.88; p=0.012).
Among older adults with heart failure in Northwest Ethiopia, 98% reported moderate to low HRQoL. Asthma and polypharmacy negatively affected HRQoL, whereas weight loss was positively associated with HRQoL. An NYHA class III status and well-managed hypertension improved treatment satisfaction, whereas rural residency and coronary heart disease were associated with lower satisfaction. These findings underscore the need for targeted interventions to enhance outcomes and QoL in this vulnerable population.
by Chalachew Genet, Wendemagegn Enbiale, Anna Rommerskirchen, Rajiha Abubeker, Wudu Tafere, Tsehaynesh Gebre-Eyesus, Michael Getie, Alem Tsega, Muluken Acham, Addisu Melese, Tewachew Awoke, Wondemagegn Mulu, Degu Ashagrie, Tadele Amsalu, Achenef Motbainor, Endalew Gebeyehu, Mulugeta Kibret, Bayeh Abera, Endalkachew Nibret, Abaineh Munshea
IntroductionExtended spectrum β-lactamase (ESBL) and carbapenemase-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) emanating from raw cow milk are among the leading contributors to the spread of antimicrobial resistance (AMR). Due to the misuse and overuse of antibiotics in dairy farms, cow’s milk has become a reservoir of ESBL- and carbapenemase-producing E. coli and K. pneumoniae posing a growing public health threat, especially in areas where the consumption of raw milk is common. However, compared to the clinical sector, the prevalence of ESBL- and carbapenemase-producing E. coli and K. pneumoniae in the food sector is under-studied.
ObjectiveThis study aimed to determine the prevalence of ESBL and carbapenemase-producing E. coli and K. pneumoniae in raw bulk cow milk from Dairy Cooperatives in Northwest Amhara, Ethiopia.
MethodsA cross-sectional study was conducted from January to April, 2025 among 257 dairy cooperative member farms. Sociodemographic and related data were collected using a structured questionnaire. Five milliliters of raw bulk cow milk were collected aseptically from each farm in four Dairy Cooperatives (DCs) (DC-A to D). 10 microliters of milk sample were directly inoculated into MacConkey agar. Escherichia coli and K. pneumoniae were identified using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. ESBL and carbapenemase production were confirmed phenotypically via combination disk tests and modified carbapenem inactivation methods, respectively.
ResultsThe prevalence of E. coli and/or K. pneumoniae in raw cow milk was 21% (95% CI, 16.5–26.4%), with respective individual prevalence of 8.2% and 14.8%. ESBL-producing E. coli and K. pneumoniae accounted for 23.8% and 15.8% of isolates, respectively, while 2.6% of isolates (only K. pneumoniae) were carbapenemase producers. Resistance to ampicillin and amoxicillin-clavulanic acid exceeded 70%. All E. coli and 94.7% of K. pneumoniae isolates remained susceptible to carbapenems. Nearly half of all isolates (45.8%) were multidrug resistant (MDR), and 51.9% of MDR isolates were co-resistant to at least six antibiotics. Having additional non-farming occupations (AOR: 4.17, 95% CI: 1.49–11.67), large herd size (AOR: 3.21, 95% CI: 1.26–8.18), having pet animals (AOR: 6.53, 95% CI: 1.39–30.7), and use of calabash milk pail (AOR: 7.37, 95% CI: 1.45–37.49) were significantly associated with milk culture positive result for E. coli and/or K. pneumoniae.
ConclusionRaw milk in Northwest Amhara harbors ESBL and carbapenemase-producing E. coli and K. pneumoniae posing a substantial public health risk coupled with MDR and resistance to critically important antimicrobials. Strengthened AMR surveillance, improved farm hygiene, restricted antibiotic use, and public education on milk safety are urgently needed.
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).
Assess the magnitude of adverse pregnancy outcomes and associated factors among mothers who had operative vaginal delivery in Amhara Region Comprehensive Specialized Hospitals, 2024.
A cross-sectional study was conducted from 1 November 2024 to 20 February 2025.
Seven comprehensive specialised hospitals were included in the study.
The study was employed on 389 mothers who had operative vaginal delivery.
Systematic sampling was used. Data were collected via questionnaires, chart reviews and observation. Data were entered into Epi Data V.4.6 and analysed using V.25 statistical package of social sciences. Variables with p
Adverse pregnancy outcomes of operative vaginal delivery.
Adverse pregnancy outcomes of operative vaginal delivery were 42.2%. Among them, 46 (11.8%) had only maternal complications, 55 (14.1%) had only neonatal complications and 63 (16.2%) had both maternal and neonatal complications. Perineal tear 29 (7.5%) and episiotomy extension 31 (8%) were the most common maternal complications, while caput succedaneum 45 (11.6%) was the most neonatal complication. The most common indication of operative vaginal delivery was prolonged second stage 203 (52.2%). Vacuum-assisted delivery (AOR 0.53; 95% CI 0.29 to 0.96), two tractions (AOR 2.19; 95% CI 1.23 to 3.90), birth weight less than 2.5 kg (AOR 1.85; 95% CI 1.21 to 2.83) and mid fetal station (AOR 2.9; 95% CI 1.49 to 5.64) were significantly associated with adverse pregnancy outcomes.
Adverse pregnancy outcomes following operative vaginal delivery were high. Type of instrumental vaginal delivery, number of tractions, fetal birth weight and fetal station were significantly increased risks. Therefore, operators should minimise traction attempts during operative vaginal delivery to reduce adverse outcomes.
To assess the incidence of delirium and its predictors among adult patients admitted to the intensive care units of comprehensive specialised hospitals in the Amhara region of northwest Ethiopia from 18 October 2024 to 20 February 2025.
A multicentre prospective observational study was conducted.
Four comprehensive specialised hospitals in the Amhara region of northwest Ethiopia, from 18 October 2024 to 20 February 2025.
A total of 351 patients were included in the final analysis during the study period.
The primary outcome measure of this study was the incidence of delirium. Additionally, the study investigated the factors associated with delirium incidence among adult patients admitted to intensive care units.
The incidence of delirium among adult patients in intensive care units was 42.17% (95% CI: 37.08 to 47.42). Pain (adjusted HR (AHR) = 4.74; 95% CI: 2.38 to 9.44), mechanical ventilation (AHR = 2.96; 95% CI: 1.56 to 5.63), age 65 years or older (AHR = 2.18; 95% CI: 1.48 to 3.21) and agitation (Richmond Agitation-Sedation Scale (RASS) ≥1) (AHR = 3.26; 95% CI: 2.09 to 5.09) were statistically significant factors associated with delirium.
In the present study, more than one-third of patients developed delirium. Pain, mechanical ventilation, age 65 or older and agitation (RASS≥1) were significantly associated with delirium occurrence. To reduce the incidence of delirium, the current study recommends treating or preventing pain and agitation. Additionally, special attention should be given to patients receiving mechanical ventilation and those aged 65 or older during care.
FreshRSS 