Aim: Non adherence to self-care behaviour is common in patients with heart failure leading to reduced quality of life, increased morbidity, mortality and health care costs. We assessed adherence to self-care behaviours and knowledge among adult patients with heart failure on active follow up. Method and results: Hospital based cross-sectional study was employed and patient reported adherence to self-care behaviours and knowledge on heart failure was assessed among 328 adult heart failure patients. The mean (± standard deviation (SD)) age was 52 (± 17) years; 55.5% were men. Among 26 self-care behaviours studied, four of the top eight most frequently performed were related to taking prescribed medications, and the seven least frequently performed ones were concerned with symptom monitoring or management. Adherence to individual self-care behaviours ranged from 9.7% to 99.7% however, cumulative good adherence was low at 62.7%, and only 17.4% of patients reported good adherence with all 26 self-care recommendations, indicating high rates of selective adherence. The mean (± SD) total knowledge score was 7.38 ± 2.2 out of a maximum score of 14. Multivariate analysis showed that age, co-morbidity, NYHA functional class and heart failure knowledge score were independent predictors of poor adherence to self-care behaviours (P<0.01). Conclusion: Overall adherence to heart failure self-care behaviours is low and selective. Majority of patients had a sever knowledge deficit related to heart failure and self-care behaviours. Age, co-morbidity, NYHA class and heart failure knowledge score were independent predictors for poor over all adherences.

Background/Objectives: Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case-control study to evaluate its social and nutritional determinants. Subjects/Methods: Men and women with insulin-requiring diabetes (n ¼ 107), aged 18-40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex (n ¼ 110) were recruited from patients attending other hospital clinics. Results: Diabetes was strongly associated with subsistence farming, odds ratio ¼ 3.5 (95% confidence interval: 1.5-7.8) and illiteracy/low levels of education, odds ratio ¼ 4.0 (2.0-8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio ¼ 5.5 (1.0-29.0) the mother's death during childhood, odds ratio ¼ 3.9 (1.0-14.8), and markers of poverty including poorer access to sanitation (P ¼ 0.004), clean water (P ¼ 0.009), greater overcrowding (P ¼ 0.04), increased distance from the clinic (P ¼ 0.01) and having fewer possessions (P ¼ 0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass (Po0.01). In addition, men with the disease tended to be shorter, were lighter (P ¼ 0.001), with reduced sitting height (P ¼ 0.015) and reduced biacromial (P ¼ 0.003) and bitrochanteric (P ¼ 0.008) diameters. Conclusions: Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure.

BackgroundEmergence of antimicrobial resistance by Staphylococcus aureus has limited treatment options against its infections. The purpose of this study was to determine the pooled prevalence of resistance to different antimicrobial agents by S. aureus in Ethiopia.MethodsWeb-based search was conducted in the databases of PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals (DOAJ) to identify potentially eligible published studies. Required data were extracted and entered into Excel spread sheet. Statistical analyses were performed using Stata version 13.0. The metaprop Stata command was used to pool prevalence values. Twenty-one separate meta-analysis were done to estimate the pooled prevalence of the resistance of S. aureus to twenty-one different antimicrobial agents. Heterogeneity among the studies was assessed using the I2 statistic and chi-square test. Publication bias was assessed using Egger’s test. Because of significant heterogeneity amongst the studies, the random effects model was used to pool prevalence values.ResultsThe electronic database search yielded 1317 studies among which 45 studies met our inclusion criteria. Our analyses demonstrated very high level of resistance to amoxicillin (77% [95% confidence interval (CI): 68%, 0.85%]), penicillin (76% [95% CI: 67%, 84%]), ampicillin (75% [95% CI: 65%, 85%]), tetracycline (62% [95% CI: 55%, 68%]), methicillin (47% [95% CI: 33%, 61%]), cotrimoxaziole (47% [95% CI: 40%, 55%]), doxycycline (43% [95% CI: 26%, 60%]), and erythromycin (41% [95% CI: 29%, 54%]). Relatively low prevalence of resistance was observed with kanamycin (14% [95% CI: 5%, 25%]) and ciprofloxacin (19% [95% CI: 13%, 26%]). The resistance level to vancomycin is 11% 995% CI: (4%, 20%). High heterogeneity was observed for each of the meta-analysis performed (I2 ranging from 79.36% to 95.93%; all p-values ≤0.01). Eggers’ test did not show a significant publication bias for all antimicrobial agents except for erythromycin and ampicillin.Conclusions S. aureus in Ethiopia has gotten notoriously resistant to almost to all of antimicrobial agents in use including, penicillin, cephalosporins, tetracyclines, chloramphenicol, methicillin, vancomycin and sulphonamides. The resistance level to vancomycin is bothersome and requires a due attention. Continued and multidimensional efforts of antimicrobial stewardship program promoting rational use of antibiotics, infection prevention and containment of AMR are urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-017-0243-7) contains supplementary material, which is available to authorized users.

Introduction: Tuberculosis (TB) is a chronic infectious disease that has represented a major health problem over the centuries. The human immune deficiency virus (HIV)/AIDS has substantially altered the epidemiology of TB by increasing the risk of reactivating latent TB, increasing chance of TB infection once exposed to tubercle bacilli (re-infection) and by increasing the risk of rapid progression soon after infection. Methodology: This study employs a retrospective review analysis of patient medical records. A total of 499 HIV/AIDS patient cards were reviewed and variables were recorded. Frequencies and odds ratio were calculated to determine prevalence and associated risk factors respectively. Results: A total of 499 HIV/AIDS positive patient cards were reviewed. Ninety one (18.2%) of the study participants were found to have tuberculosis of which 20 (22%), 58 (64%) and 13 (14%) were smear positive, smear negative and extra-pulmonary tuberculosis cases, respectively. In multivariate logistic regression being female (AOR=0.

Introduction: Large quantities of antimicrobials are used in hospitals for patient care and disinfection. Antibiotics are partially metabolized and residual quantities reach hospital wastewater, exposing bacteria to a wide range of biocides that could act as selective pressure for the development of resistance. Methodology: A cross-sectional study was conducted between December 2010 and February 2011 on hospital wastewater. A total of 24 composite samples were collected on a weekly basis for bacteriological analysis and susceptibility testing. Indicator organisms and pathogenic and potentially pathogenic bacteria were found and isolated on selective bacteriologic media. Disinfectant activity was evaluated by use-dilution, and minimum inhibitory concentration (MIC) was determined by the agar dilution method. Similarly, antibiotic susceptibility tests were performed using the Kirby-Bauer disk diffusion method. Results: Pathogenic (Salmonella, Shigella, and S. aureus) and potentially pathogenic (E. coli) bacteria were detected from effluents of both hospitals. Dilution demonstrated tincture iodine to be the most effective agent, followed by sodium hypochlorite; the least active was 70% ethanol. MIC for ethanol against S. aureus and Gram-negative rods from Yirgalem Hospital (YAH) showed 4 and 3.5 log reduction, respectively. Salmonella isolates from YAH effluent were resistant to ceftriaxone, tetracycline, and doxycycline. Isolates from Hawassa University Referral Hospital (HURH) effluent were resistant to the above three antibiotics as well as gentamycin. Conclusions: Hospital effluents tested contained antibiotic-resistant bacteria, which are released into receiving water bodies, resulting in a threat to public health.