Biomedical Science

Rheumatic heart disease in Southwestern Ethiopia: Burden, Severity and Self Management Education Effectiveness

2024-06-18T00:00:00Z

Rheumatic heart disease in Southwestern Ethiopia: Burden, Severity and Self Management Education Effectiveness Hiwot Berhanu Meshesha; Andualem Mossie; Morankar Sudhakar Background: Rheumatic heart disease (RHD) is a long-term complication that arises from a systemic, inflammatory, and autoimmune reaction triggered by Group A Streptococcus bacteria. RHD causes impairment of one or more heart valves, resulting in significant structural and hemodynamic abnormalities. According to the estimated data from the Global Burden of Disease, RHD has impacted over 40.5 million individuals and resulted in approximately 1,100,000 cases of heart failure as well as 320,000 deaths annually. Despite RHD being the leading cause of cardiovascular disease in Ethiopia, the country lacks established policies, guidelines, or programs aimed at reducing the morbidity and mortality associated with this preventable condition. Ethiopia, a nation heavily affected by RHD, experiences a significant burden from the disease. However, the full extent of this burden and its underlying determinants has not been adequately studied. In addition, there is a lack of research and evidence regarding educational interventions that could potentially improve clinical outcomes for patients with RHD in Ethiopia's existing health care system. Objectives: To determine the prevalence, severity and determinants of rheumatic heart disease, as well as to investigate the effectiveness of chronic disease self-management education among patients with RHD in Southwestern Ethiopia, Jimma Medical Centre. Methods: This study utilized systematic review and meta-analysis, cross-sectional and quasi experimental study designs. Data collection was done using structured questionnaires containing both open- and closed-ended questions. Data were gathered through interviews and reviews of patient’s medical records. Study participants were recruited from a purposively selected hospital at Jimma Medical Center in Southwest Ethiopia based on caseloads. Data collectors were trained nurses from cardiac clinics. For the systematic review and meta-analysis, various databases such as PubMed/Medline, Scopus, HINARI, and Google Scholar were searched for peer-reviewed articles. The pooled prevalence of RHD in Ethiopia was calculated using a random-effects model at a 95% confidence interval (CI), taking into account the weight of each study. Statistical meta-analysis was conducted using STATA Version 16.0 software to determine the pooled prevalence of RHD. Descriptive statistics for frequency, means and standard deviations were used to summarize the dependent and independent variables. Bivariable and multivariable logistic regressions were conducted to determine the association between the dependent and independent variables. Variables with a p-value of ≤ 0.25 on bivariable analysis were then entered into multiple logistic regressions to control confounders. Finally, variables with a p-value of < 0.05 on multivariable regression were considered as determinants of RHD. Model fitness was assessed with the Hosmer-Lemeshow test. Adjusted Odds ratios with a 95% CI were used to indicate the degree of association between the dependent and independent variables. For the echocardiographic study, 115 patients were recruited and evaluated by two cardiologists following the recommendations established by the American Society of Echocardiography. The data were entered into Epidata 3.1, and then transferred to SPSS Version 25.0 for analysis. The Kolmogorov-Smirnov test was used to evaluate the normality of variables and revealed that the data were normally distributed. The outputs of the analysis were then summarized by categorizing and presenting the data using counts, percentages, and standard deviations. A Chi square test was utilized to compare the proportions of categorical variables, evaluate the statistical significance of the association, and determine the level of significance. For the interventional study, 174 study participants were recruited. A one-group quasi experimental study using a pre-test and post-test was implemented using a consecutive sample xv technique. Clinical and laboratory measurements were taken before and after education. One-to one nurse-led multicomponent chronic disease self-management education (CDSME) was endured for four consecutive months. Hospital Anxiety and Depression Scale (HADS) was used to detect the levels of anxiety and depressive symptoms. Data analysis was done on SPSS Version 25.0. Values are presented as means ± SD for continuous variables and percentages for categorical variables. Continuous data were considered statistically significant at p-value <0.05 with two-tailed t-tests. Results: For the systematic review and meta-analysis, the pooled prevalence of RHD was 3.19% (95% CI: 1.46-5.56%). The prevalence was higher among the population who visited hospitals at 5.42% (95% CI: 1.09-12.7%) compared to schoolchildren at 0.73% (95% CI: 0.30-1.34%) and community based studies at 3.83% (95% CI: 3.16-4.55%). Addis Ababa had the lowest prevalence of RHD (0.75% (95% CI: 0.38-1.25%), whereas the highest prevalence was observed in the Amhara (8.95% (95% CI: 7.21-11.06%) and Oromia (5.29% (95% CI: 0.65-13.92%) regions. In the cross-sectional study, the most frequent morbidity encounter was RHD in 27.9% of cases. Female sex [AOR=3.06: 95% CI 1.73–5.47], using wood (biomass fuel) for cooking [AOR=1.94: 95% CI 2.22-6.86], dental caries [AOR=2.09: 95% CI 1.12-3.87], and living in crowded households [AOR=2.02: 95% CI 1.15-3.52] were identified as determinants of RHD. For the echocardiographic study, it was found that the mitral valve was affected in 98.26% of cases, while abnormalities in the aortic and tricuspid valves were diagnosed in 49.5% and 21.17% of cases, respectively. The most common combinations of valve lesions were mitral regurgitation (MR) + mitral stenosis (MS) + aortic regurgitation (AR) (15.7%), followed by MR + AR + TR (8.7%). The occurrence of MR + MS + AR was higher in males (24.1%) compared to females (20.9%). Females also had a significantly lower ejection fraction compared to males (84% vs. 15.2%, p = 0.044). Additionally, nearly two-thirds (63.5%) of individuals experienced RHD-related complications the most commonly encountered complications were pulmonary hypertension (26.1%) and atrial fibrillation (19.1%). In the quasi-experimental study, systolic blood pressure decreased from 131.31 mmHg (SD±15.68) before education to 113.77 mmHg (SD±20.98) after education (t-12.25, p<0.001). The diastolic blood pressure also decreased from 94.87 mmHg (SD±19.41) pre-education to 79.28 mmHg (SD±9.33) post-education (t-12.306, p<0.001). Hemoglobin levels changed from 11.97 g/dl (SD±1.99) before the intervention to 13.84 g/dl (SD±1.37) after the intervention (t-11.96, p<0.001). Similarly, the mean score for the HADS depression subscale decreased from 11.93 (SD±3.43) at the pre-test to 9.48 (SD±3.67) at the post-test (t-8.37, p<0.001). As for the HADS anxiety subscale, the mean score before the education program was 8.59 (SD±2.91) and decreased to 7.30 (SD±1.97) after education (t-6.44, p<0.001). Conclusion: Rheumatic Heart Disease poses a major public health challenge in both Ethiopia and the study area. Female sex, biomass use, malnutrition, dental caries, and overcrowding were identified the determinants factors. The majorities of patients in the study has multiple valve lesions and have experienced RHD-related complications. Chronic disease self-management education has been shown to improve patients' clinical outcomes, including a reduction in anxiety and depression levels. These findings implicates need to strengthen RHD surveillance and improve access to early diagnosis. Addressing female healthcare, reducing biomass fuel exposure, improving nutritional status, providing regular dental care, and enhancing living conditions are all potential strategies to reduce the disease burden. The study also underscores the importance of developing policies, programs, and guidelines for RHD prevention and treatment.

Prevalence and associated factors of digital eye Strain among regular undergraduate students of Wolaita sodo university, wolaita sodo, Ethiopia: a Cross-sectional study

2025-01-01T00:00:00Z

Prevalence and associated factors of digital eye Strain among regular undergraduate students of Wolaita sodo university, wolaita sodo, Ethiopia: a Cross-sectional study Ephrem Yohannes; Asfaw Gerbi; Addis Temie; Getachew Chane; Niguse Hamba; Diliab Desta Introduction: The widespread use of digital devices like computers and smartphones has increased Digital Eye Strain (DES), particularly among students. DES is associated with prolonged device use, poor ergonomics, inadequate screen settings, multitasking, varying lighting conditions, and lack of breaks. This condition can affect vision, academic performance, and overall well-being. Objectives: To assess the prevalence of digital eye strain and its associated factors among regular undergraduate students of Wolaita Sodo University, Wolaita Sodo, South Ethiopia. Methodology: An institution-based cross-sectional study was conducted from October to December 2024 at Wolaita Soddo University among regular undergraduate students. Data were collected using a self-administered structured questionnaire, entered into Epi Data version 3.1, and analyzed using SPSS version 26. Descriptive statistics like frequency, mean, standard deviation, percentage, and proportion were computed. Bivariate and multivariate logistic regression analysis was performed to identify the factors associated with digital eye strain. Adjusted odds ratio (AOR) with 95% CI and p-value <0.05 were used to determine the level of significant association. Results: Of the 422 students, 267 (63.3%) were male. Most (95%) reported using digital devices for more than 5 hours daily, 75% used multiple devices, 42% adjusted screen brightness, 17% were aware of the 20-20-20 rule, and 30.6% used blue light filters. The prevalence was 79.6%. Factors significantly associated with DES included the use of multiple digital devices (AOR = 5.21, 95% CI: 2.68–10.11), more than 5hrs spent per day on digital devices (AOR = 3.89, 95% CI: 1.07–14.10), lack of protective eyewear (AOR = 6.46, 95% CI: 3.33–12.52), failure to adjust screen brightness (AOR = 3.9, 95% CI: 2.09–7.32), lack of knowledge of the 20-20-20 rule (AOR = 5.77, 95% CI: 2.81–11.82), and not using blue light filters (AOR = 3.15, 95% CI: 1.69–5.83) (p < 0.05). Conclusion and recommendation: The study found a DES prevalence of 79.6% and identified factors including prolonged screen time (>5hr/d), multiple device usage, and inadequate eye care practices. To reduce DES, students should limit screen time, use the 20-20-20 rule, wear protective eyewear, and adjust brightness. The university should implement awareness campaigns on DES prevention

Evaluation of Nutritional Status, and Associated Factors among Adult Gastrointestinal Cancer Patients at the Oncology Department of Jimma University Medical Center Jimma, Ethiopia

2024-06-06T00:00:00Z

Evaluation of Nutritional Status, and Associated Factors among Adult Gastrointestinal Cancer Patients at the Oncology Department of Jimma University Medical Center Jimma, Ethiopia Mabratu Takele Desisa; Belay Zewdie; Bati Leta; Mulualem Tadese; Abebe Dukesa Background:-Malnutrition is a prevalent issue that significantly contributes to high morbidity and mortality rates among adult patients with gastrointestinal cancer. Increasing evidence shows that alteration of serum biomarkers, nutritional status, and malnutrition associated factors leads to life-threatening complications and influences the clinical prognosis. Yet, there is a lack of adequate empirical data regarding, serum biomarker alteration linked to tonutritional status, and malnutrition associated factors among gastrointestinal cancer patients in Ethiopia. Objective:- This study aimed to evaluate nutritional status, and associated factors among adult gastrointestinal cancer patients at Jimma University Medical Center (JUMC), Ethiopia, in 2024. Method:- A facility-based cross-sectional study design was used among 134 adult gastrointestinal cancer patients at the oncology department of JUMC, Jimma, Ethiopia, from April 1, 2024, to June 25, 2024. The study participants were selected by sing concesus sampling method of all adult gastrointestinal cancer patients who were on treatment during study period. Nutritional status was collected using the subjective global assessment tool. Data entry and statistical analysis were performed using Epi Data Version 3.1 and SPSS version 26, respectively. Descriptive statistics, independent sample t-test, and bivariate and multiple logistic regression were used to determine associations, with a P value ≤ 0.05 considered statistically significant. Results:- Out of 133 participants, 78.9% (95% CI: 71.0-85.5) were malnourished, and the prevalence of electrolyte disorders among adult gastrointestinal cancer patients were 65.4% (95%CI: 56.7 to 73.4). There was a significant decrease in the mean level of Serum Albumin= 3.10±.593 vs. 3.90±.396, P= <.0001; Hemoglobin:11.92±2.083 vs. 13.79±1.410, P= <.0001; Prognostic Nutritional Index: 39.45±7.305 vs. 47.86±5.799, P= <.0001; Geriatric Nutritional Risk Index: 79.73±10.681 vs. 97.83±6.550; P = <.0001, and Nutritional Risk Index: 81.51±10.650 vs. 100.48±6.878, P = <.0001), in malnourished as compared to well-nourished patients respectively. Low serum albumin, Stage IV cancer, Poor performance status, and longer duration of illness (25 months or more), increased the risk of malnutrition by 8.29 times(AOR = 8.29, 95% CI: 2.13-32.2, P=.002; 7.59 times (AOR = 7.59, 95% CI: 1.05-25.3, P=.045; 5.77 times (AOR = 5.77, 95% CI: 1.20-27.6, P=.028), and had 7.81 times(AOR = 7.81, 95% CI: 1.47- 41.6, P=.016), respectively. Conclusion and Recommendation Malnutrition is highly prevalent among adult gastrointestinal cancer patients. There was a significant decrease in the mean level of serum albumin, hemoglobin, geriatric nutritional risk index, nutritional risk index, and prognostic nutritional index in malnourished as compared to well-nourished patients. These biomarkers are recommended as alternative or supplementary screening tools for early detection of malnutrition in adult gastrointestinal cancer patients.

Evaluation of Metabolic Biomarkers and Associated Factors Among Benign Prostatic Hyperplasia Patients at Jimma University Medical Center, Southwest Ethiopia

2024-06-01T00:00:00Z

Evaluation of Metabolic Biomarkers and Associated Factors Among Benign Prostatic Hyperplasia Patients at Jimma University Medical Center, Southwest Ethiopia Hundesa Emana; Zerihun Aseffa; Gessese Legesse Background: Benign prostatic hyperplasia is a common cause of lower urinary tract obstruction in older adults, attributed to the growth of smooth muscle cells in the prostatic transition zone. The ma jor risk factor for Benign Prostatic Hyperplasia is metabolic syndrome, despite the high burden of metabolic syndrome in Ethiopia, not much study has been done on its association with benign pros tatic hyperplasia Objective: This study aims to determine selected metabolic biomarkers in individuals diagnosed with BPH attending Jimma University Medical Center Methods and Materials: Hospital-based cross-sectional study was conducted at Jimma University medical center among 158 consecutive male BPH patients from January 15 to April 15. A structured questionnaire was used to collect socio-demographic characteristics. Data were collected by trained clinical nurses. A 5ml blood sample was drawn and analyzed using a Cobas 6000 chemistry analyzer by a laboratory technologist and under the close supervision of a principal investigator. All anthro pometric, and blood pressure measurements were taken according to their specific principles with appropriate measurement devices. Data was entered into Epi-data version 4.6.0.6 and analyzed using a statistical package for social sciences version 26. National Cholesterol Education Program Adult Treatment Panel criteria were used to determine the occurrence of metabolic syndrome. Logistic re gression was used to assess factors associated with metabolic syndrome. Result: The overall prevalence of metabolic syndrome among patients with BPH patients attending JUMC was 38.6% (0.31,0.46). Factors such as age AOR: 3.43 (95% CI:1.3, 9), urban residence AOR:3.35 (95% CI: 1.35, 8.30), total cholesterol AOR:3.20 (95% CI:1.27, 8.06), high LDL (130mg/dl) AOR:3.54 (95% CI:1.08, 11.56), WHR >0.9 AOR: 5.07 (95% CI:2.15, 11.98), BMI≥25kg/m2 AOR: 3.47 (95% CI: 1.44,8.32), and serum uric acid AOR: 3.21 (95% CI:1.02, 10.01) were significantly associated with metabolic syndrome. About 33.5% (95% CI: 0.26,0.40) of partici pants had prostate volumes ≥80ml. Obesity (WC>40inch) AOR:2.49 (95% CI:1.18,5.24) (HDL<40mg/dl), AOR:2.87 (95% CI:1.26,6.53), and (FBS≥100mg/dl) AOR:2.46 (95% CI:1.14,5.3) were significantly associated with increased prostate volume. Conclusion and recommendation: The prevalence of metabolic syndrome in Benign Prostate Hy perplasia patients was significantly high. There is a need to assess components of metabolic syn drome for the betterment of patient management to curtail further complications.