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Time to tuberculosis development and its predictors among HIV-positive patients: A retrospective cohort study

by Abraham Teka Ajema, Yilkal Simachew, Meiraf Daniel Meshesha, Taye Gari

Objectives

To assess the incidence and predictors of time to Tuberculosis (TB) development among Human Immunodeficiency Virus (HIV) positive patients attending follow-up care in health facilities of Hawassa, Ethiopia.

Methods

We conducted a retrospective cohort study from April 1–30, 2023. A total of 422 participants were selected using a simple random sampling method. Data was collected from the medical records of patients enrolled between January 1, 2018 –December 31, 2022, using the Kobo toolbox. We used Statistical Package for Social Studies (SPSS) version 26.0 for data analysis. To estimate the duration of TB-free survival, we applied the Kaplan-Meier survival function and fitted Cox proportional hazard models to identify the predictors of time to TB development. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated and statistical significance was declared at a P-value of 0.05.

Results

The overall incidence rate of TB among HIV-positive patients was 6.26 (95% CI: 4.79–8.17) per 100 person-years (PYs). Patients who did not complete TB Preventive Therapy (TPT) were more likely to have TB than those who did (AHR = 6.2, 95% CI: 2.34–16.34). In comparison to those who began antiretroviral therapy (ART) within a week, those who began after a week of linkage had a lower risk of TB development (AHR = 0.44, 95% CI: 0.21–0.89). Patients who received ART for six to twelve months (AHR = 0.18, 95% CI: 0.05–0.61) and for twelve months or longer (AHR = 0.004, 95% CI: 0.001–0.02) exhibited a decreased risk of TB development in comparison to those who had ART for less than six months.

Conclusion

The incidence of TB among HIV-positive patients is still high. To alleviate this burden, special attention should be given to regimen optimization and provision of adherence support for better completion of TPT, sufficient patient preparation, thorough clinical evaluation for major (Opportunistic Infections) OIs prior to starting ART, and ensuring retention on ART.

Use of herbal medicine during pregnancy and associated factors among pregnant women with access to public healthcare in west Shewa zone, Central Ethiopia: sequential mixed-method study

Por: Bekele · G. G. · Woldeyes · B. S. · Taye · G. M. · Kebede · E. M. · Gebremichael · D. Y.
Objective

This study was aimed at assessing the prevalence of herbal drug use among pregnant women with access to modern medicine and associated factors in public health facilities in the west Shewa zone, Oromia regional state, Ethiopia.

Design

A sequential mixed-method study approach was carried out among pregnant women and other stakeholders.

Setting

This study was conducted at public health facilities, including 3 public hospitals and 20 health centres, in the west Shewa zone of Ethiopia.

Participants

A systematically selected sample of 411 pregnant women was participated in the quantitative study. For the qualitative method, focus group discussions and in-depth interviews were conducted among pregnant women attending antenatal care and key informants using an interview guide until data saturation was achieved.

Primary outcome

For outcome variables, the respondents were asked if they used any herbal medicine during their current pregnancy. It was then recorded as 0=no and 1=yes.

Results

The prevalence of herbal medicines was found to be 19.7%. The most commonly used herbal medicines were Zingiber officinale, Ocimum gratissimum, Eucalyptus globules, Allium sativum and Rutacha lepensis. Herbal medicine use during pregnancy was significantly associated with older maternal age (adjusted OR (AOR) 2.4, 95% CI 1.2 to 5.1), urban residence (AOR 2.3, 95% CI 1.3 to 3.7) and second trimester of pregnancy (AOR 2.3, 95% CI 1.3 to 4.5).

Conclusions

In this study, one in five pregnant women uses herbal medicine, which is relatively low. Sociodemographic factors and the duration of pregnancy affected the utilisation of herbal drugs during pregnancy. The most common herbals used by pregnant women were intended to treat minor disorders of pregnancy and medical disorders such as hypertension.

Gap analysis of service quality and associated factors at the oncology center of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2022: a cross-sectional study

Por: Wasihun · G. A. · Addise · M. · Nega · A. · Kifle · A. · Taye · G. · Gebrekidan · A. Y.
Objective

To measure the gap between expectations of patients with cancer for oncology services and their perceptions of the actual service and to identify associated factors at the oncology centre of Tikur Anbessa Specialized Hospital, Ethiopia.

Design

An institutional-based cross-sectional study design was conducted using the service quality (SERVQUAL) tool from March to April 2022 on a sample of 256 hospitalised patients with cancer at the oncology centre of Tikur Anbessa Specialized Hospital. A paired Wilcoxon test and Kruskal-Wallis tests were used to determine the statistically significant difference between expectation and perception and to quantify the strength of association between the level of gap in the quality of oncology service and dependent variables, respectively.

Results

Out of 256 patients with cancer included in the study, all of them agreed and participated, making the response rate 100%. The overall gap in service quality explained by the mean and SD is –1.42 (±0.41). The overall score for expectation and perception is 4.24 (±0.31) and 2.82 (±0.37), respectively. Being female, age greater than 65, having a college degree and above, being a patient with cervical cancer, patients with stage 4 cancer and patients who waited for more than 12 months for radiotherapy were found to have a statistically significant higher expectation compared with their perceived care in one or more dimensions of the SERVQUAL tool.

Conclusion

Patient perceptions of the quality of service they received were lower than their expectations of the quality of service in all service quality aspects at Tikur Anbessa Specialized Hospital’s oncology centre, implying unmet quality expectations from the oncology service users, with tangibility, assurance and empathy being the dimensions with the highest gap recorded, respectively. Therefore, the hospital and other stakeholders should strive to exceed patient expectations and the overall quality of care.

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