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Determinants of treatment outcomes among hospitalised patients with skin and soft tissue infections: a prospective observational study

Por: Biyazin · A. A. · Mekonnen · G. B. · Anberbr · S. S. · Tarekegn · G. Y. · Zerihun · T. E. · Getahun · A. D. · Abebe · R. B.
Objectives

The study aimed to determine treatment outcome and factors affecting treatment outcomes among hospitalised patients with skin and soft tissue infections (SSTIs) at the University of Gondar Comprehensive Specialised Hospital (UOGCSH) in Ethiopia.

Design

An institution-based prospective observational study.

Setting

UOGCSH, Northwest Ethiopia.

Participants

423 patients from all age groups with clinically diagnosed SSTIs from 25 June to 25 December 2023 at the UOGCSH were included.

Outcome measures

Primary treatment outcomes were early apparent clinical response within 48–72 hours and treatment failure after 72 hours of optimal antibiotic therapy. Secondary treatment outcomes included hospital length of stay (HLOS) and in-hospital mortality. Multiple linear regression assessed factors influencing the HLOS, and multivariable logistic regression identified predictors of treatment failure.

Results

The average HLOS was 13.46±3.01 days. Of the patients, 39.3% had an early clinical response within 48–72 hours, whereas 34.4% had treatment failure. At 0.7%, the in-hospital death rate was modest. Living in a rural area (adjusted OR (AOR) 5.54, 95% CI 2.67 to 11.37), having concurrent illnesses (AOR 2.11, 95% CI 1.10 to 4.07) and starting antibiotics later than 12 hours (AOR 0.08, 95% CI 0.04 to 0.17) were significantly associated with treatment failure. Concomitant disorders and complex comorbidities were also associated with longer HLOS, whereas higher socioeconomic level, oral step-down therapy, early antibiotic initiation and early clinical response were linked to better results and shorter hospital stays.

Conclusion

Timely antibiotic initiation, efficient source control, patient comorbidities and socio-economic considerations affect the treatment course for SSTIs. Prolonged treatment and the frequent use of ‘watch’ and ‘reserve’ antibiotics underscore the need for improved antimicrobial stewardship. In this situation, optimising clinical results and minimising HLOS requires prompt clinical evaluation and customised antibiotic therapy. However, the single-centre design and potential residual confounding may introduce bias.

Treatment adherence, survival outcomes and barriers to care of non-Hodgkin lymphoma in Northwest Ethiopia: a mixed-methods study

Por: Kassaw · A. T. · Teferi · E. T. · Zerihun · T. E. · Mussie · D. A. · Melese · T. B. · Admasu · M. T. · Wallie · B. Y. · Birarra · M. K.
Objective

To evaluate treatment adherence, survival and systemic patient and provider level factors associated with non-Hodgkin’s lymphoma (NHL) management as reported by healthcare providers.

Design

Explanatory sequential mixed-methods study comprising a retrospective hospital-based cohort and a qualitative descriptive study.

Setting

Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar, Ethiopia, and the University of Gondar Comprehensive Specialized Hospital in Gondar, Ethiopia.

Participants

Adults (≥18 years) with histologically confirmed NHL who initiated systemic chemotherapy were eligible. We randomly selected 182 patients with NHL treated and diagnosed between 1 August 2019 and 31 July 2024, for retrospective chart review out of a total of 283 patients during the study period. 14 healthcare professionals with at least 1 year of oncology experience participated in in-depth interviews.

Primary and secondary outcome

The primary outcome was overall survival, defined as the time from histological diagnosis to death from any cause. The secondary outcome was treatment adherence, defined as interruption between cycles or abandonment of prescribed chemotherapy.

Results

At a median follow-up of 18 months, the estimated 3-year overall survival rate was 48.5% (95% CI 37.8% to 58.4%). Lower survival rate was independently associated with B-symptoms (adjusted HR (AHR) 2.7, 95% CI 1.6 to 4.4), high intermediate International Prognostic Index (IPI) (AHR 3.7, 95% CI 1.8 to 6.9) and high IPI (AHR 5.5, 95% CI 2.7 to 11.3). Treatment abandonment and interruption occurred in 22.5% and 20.5% of patients, respectively. Exposure to rituximab was more likely to abandon therapy (²=4.8, p=0.03). Patient residence in rural areas was associated with higher rates oftreatment interruption (² = 6.0, p = 0.01), whereas absence of healthinsurance was associated with treatment abandonment (² = 8.0, p =0.005).

In the qualitative analysis, healthcare providers identified multilevel barriers to NHL care, including low patient awareness and late presentation, frequent misdiagnosis at the primary care level, weak referral systems, financial constraints, inconsistent drug availability and limited diagnostic capacity. These systemic and patient-level challenges are often associated with delayed diagnosis, treatment interruption and suboptimal survival outcomes.

Conclusions

3-year survival among adults with NHL in Northwest Ethiopia was substantially lower than reported in high-income settings. Mortality was higher among patients with B-symptoms and elevated IPI scores. High rates of treatment interruption and abandonment were observed. Patient-level and system-level factors are associated with reduced survival and treatment continuity. Strengthening early diagnosis, risk stratification and financial protection may support improved treatment adherence and survival outcomes.

Surgical patients awareness about their diagnosis and management plans in Ethiopia: cross-sectional study

Por: Mossie · K. D. · Zerihun · M. T. · Wubet · H. B. · Asmare · T. B. · Belete · K. G. · Gobezie · N. Z. · Demissie · B. · Deress · G. M.
Background

Patient awareness of their diagnosis and management plan is crucial for improving compliance, empowering patients and enhancing outcomes. We aimed to assess surgical patients’ awareness of their diagnosis, management plans and associated factors.

Method

A cross-sectional study was conducted from December 2024 to March 2025 on 400 adult surgical inpatients who had undergone surgery in the general surgery, gynaecology and obstetrics, and orthopaedic wards at Debre Tabor Comprehensive Specialized Hospital, Ethiopia. Data were collected using a structured written questionnaire and analysed using the SPSS V.25. Bivariate and multivariate logistic regression were used to identify factors associated with patients’ awareness of their diagnosis and care plan, with significance determined using adjusted ORs and 95% CIs.

Result

Overall, 52% of respondents had global awareness of their clinical conditions and management plans. Awareness was highest for clinical diagnosis (78.9%), necessity of admission (78.9%) and operations performed (72.0%). However, more than 50% of respondents did not seek information on the diagnosis, possible cause and investigation related to their condition. In multivariable analysis, patients with tertiary education were 7.12 times more likely to have global awareness than those without formal education (adjusted OR, AOR=7.12; 95% CI 1.95 to 25.95), and patients living in urban areas were 3.15 times more likely to have global awareness than those in rural areas (AOR=3.15; 95% CI 1.63 to 6.10; p

Conclusions

Awareness of various aspects of healthcare ranged from 35.5% to 78.9%, with about half of respondents demonstrating global awareness of their diagnosis and management plans. Implementing shared decision-making models may improve patients’ understanding of their care plans.

Assessment of health-related quality of life and treatment satisfaction and their associated factors among older adults with heart failure: a prospective observational study in selected hospitals in Northwest Ethiopia

Por: Tarekegn · G. Y. · Dagnew · F. N. · Wondm · S. A. · Anberbr · S. S. · Tamene · F. B. · Tsega · S. S. · Asmare · Z. A. · Zeleke · T. K. · Dagnew · S. B. · Zerihun · T. E. · Kassaw · A. T. · Mussie · D. A. · Melese · T. B. · Moges · T. A.
Objectives

To assess health-related quality of life (HRQoL), treatment satisfaction and associated factors among older adults with acute heart failure in Northwest Ethiopia.

Design

Prospective, multicentre observational study.

Setting

Three tertiary hospitals in Northwest Ethiopia provide secondary and tertiary care services.

Participants

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.

Outcome measures

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.

Results

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).

Conclusions

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.

Prevalence, determinants and consequences of delayed treatment intensification among type 2 diabetes mellitus patients at the University of Gondar Comprehensive Specialised Hospital, Northwest Ethiopia, 2024: a mixed-methods study

Por: Mussie · D. A. · Zerihun · T. E. · Kassaw · A. T. · Muche · E. A.
Objective

To ascertain the clinical impact, prevalence and associated determinants of delayed treatment intensification, defined as delaying the escalation of treatment plans for individuals with type 2 diabetes mellitus who fail to attain ideal glycaemic control, at the University of Gondar Comprehensive Specialised Hospital in Northwest Ethiopia.

Design

A mixed-methods study.

Setting

University of Gondar Comprehensive Specialised Hospital.

Participants

420 patients with type 2 diabetes mellitus with poor glycaemic control after the index date were included in this study. A simple random sampling technique was employed to select the required sample size. Data were collected retrospectively and entered into EpiData V.4.6 and exported to Stata V.14.2 for analysis.

Method

Multivariable logistic regression was used to identify factors associated with delayed treatment intensification. A p value of 0.05 in the multivariable analysis was considered statistically significant. Qualitative data were collected through in-depth interviews with eight selected healthcare providers, and thematic analysis was undertaken to identify the underlying barriers to timely treatment intensification.

Primary outcome

Delayed treatment intensification.

Results

The prevalence of delayed treatment intensification was 51.4% (95% CI 46.6% to 56.2%), with a median delay of 14 months (IQR: 7.5–42 months) from the index date. Among those experiencing delayed treatment intensification, 43.1% developed new chronic diabetic complications, including retinopathy (18.1%), neuropathy (14.4%) and nephropathy (6.0%). Other complications (hypertension, stroke, heart failure and diabetic foot ulcer) accounted for 4.64% of the cases. Significant predictors of delayed treatment intensification included longer duration of diabetes (adjusted ORs (AOR) 1.68; 95% CI 1.13 to 2.5), presence of comorbidities (AOR 1.83; 95% CI 1.04 to 3.2) and use of cardioprotective medications (AOR 1.59; 95% CI: 1.04 to 2.43). The qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness and non-adherence among patients. Additionally, healthcare provider-related factors, including professional fatigue and knowledge gaps, as well as health institution-related factors such as inadequate healthcare infrastructure.

Conclusions

This study found a high prevalence of delayed treatment intensification (51.4%), associated with comorbidities, longer disease duration, low patient awareness, cardioprotective drug use and barriers related to the system and providers. To address these gaps, priorities should include strengthening patient education, scheduling regular reviews for high-risk patients and improving clinical decision support tools for timely treatment intensification. Enhancing healthcare infrastructure, such as medication supply and diagnostic services, and offering refresher training to reduce provider fatigue, are also crucial for improving the delivery of diabetes care.

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