5.1. Socio- demographic and economic characteristics of respondents
From the expected 422 respondents, 401 agreed to be enrolled in the study giving response rate of 95%. Among 401 patients which participated in the study majority of them were males 65.8% (n=264). The mean age of the respondents was 41.14(SD = ±15.92 years) with minimum and maximum ages ranging from 10 to 79 years respectively. From the study participants enrolled in the study majority of them were oromo by ethnicity 69.8% (n=280), 60.9% (n=241) of them were married, self-employed 56.6% (n=227) and were illiterate 33.7% (n=135). Regarding the patients distribution within the emergency ward, most of the patients were in surgical room 40.9% (n=164). (Table 1)
Table 1:- Socio- and demographic characteristics of participants among Jimma university medical center, emergency ward, August 2022 (N=401)
Variable
|
|
Frequency (n)
|
Percentage %
|
Gender
|
Male
|
264
|
65.8
|
Female
|
137
|
34.2
|
Age
|
Less than 30
|
108
|
26.9
|
30-39
|
82
|
20.4
|
40-49
|
84
|
20.9
|
50-59
|
61
|
15.2
|
60-69
|
37
|
9.2
|
70-79
|
29
|
7.2
|
Ethnicity
|
Oromo
|
280
|
69.8
|
Amhara
|
23
|
5.7
|
Tigre
|
2
|
0.5
|
Afar
|
3
|
0.7
|
Other
|
93
|
23.2
|
Marital status
|
Married
|
241
|
60.1
|
Single
|
89
|
22.2
|
Divorced
|
44
|
11.0
|
Widowed
|
27
|
6.7
|
Economic Status
|
<2000
|
150
|
37.2
|
2001-2999
|
15
|
3.7
|
3000-4999
|
107
|
26.6
|
>5000
|
31
|
7.7
|
Occupation
|
Government Employed
|
65
|
16.2
|
Self-Employed
|
227
|
56.6
|
NGO
|
3
|
0.7
|
No Job
|
24
|
6.0
|
Private employed
|
82
|
20.4
|
Educational Status
|
Iliterate
|
135
|
33.7
|
Primary School
|
114
|
28.4
|
Secondary School
|
86
|
21.4
|
Diploma and above
|
66
|
16.5
|
Emergency Ward
|
Medical
|
132
|
32.9
|
Surgical
|
164
|
40.9
|
Resuscitation
|
105
|
26.2
|
The study also revealed that 16.2% (n=65) of the study participants chewed khat at least once in their lifetime. Regarding drinking alcohol habit, 14.7% (n=59) reported that they drink alcohol at least once in their lifetime while 6.7% (n=27) were drinking alcohol over the last 30 days prior to the study. The study showed that 3.2 % (n=13) of the respondents smoked cigarettes at least once in their life time whereas 3.2 %( n=13) of the respondents have been smoking cigarettes in the past 30 days.
Furthermore, the study also revealed that 4% (n=16) of participants had previous exposure to antipsychotics and also it was found from the research that 5.2 %( n=21) of study participants also were exposed to benzodiazepines. Regarding history of polytherapy around 40.4 %( n=162) of the participants were on polytherapy.
In addition, 8.2% (n=33) of study participants had history of hearing impairment whereas 13.5 %( n=54) had history of visual impairment. It is also found that 39.2% (n=157), 82.3 %( n=330), 14.5 %( n=58) of the participants had bladder catheterization, intravenous fluid and frequent admission respectively. (Table 2)
Table 2 Substance use, clinical and medication related characteristics among patients admitted in emergency ward, Jimma medical center, August 2022 (N=422)
Variable
|
|
|
Frequency(n)
|
Percent (%)
|
Alcohol use
|
Lifetime
|
Yes
|
59
|
14.7
|
No
|
342
|
85.3
|
Current use
|
Before 1 month
|
32
|
8.0
|
During the past 1 month
|
27
|
6.7
|
Cigarette smoking
|
Lifetime
|
Yes
|
13
|
3.2
|
No
|
388
|
96.8
|
Current use
|
Before 1 month
|
6
|
1.5
|
During the past 1 month
|
8
|
2.0
|
Khat use
|
Lifetime
|
Yes
|
65
|
16.2
|
No
|
336
|
83.8
|
Current use
|
Before 1 month
|
31
|
7.7
|
During the past 1 month
|
35
|
8.7
|
Previous or current use of antipsychotics
|
Yes
|
16
|
4
|
No
|
385
|
96
|
Previous or current use of benzodiazepines
|
Yes
|
21
|
5.2
|
No
|
380
|
94.8
|
History of polytherapy
|
Yes
|
162
|
40.4
|
No
|
239
|
51.6
|
Bladder catheterization
|
Yes
|
157
|
39.2
|
No
|
244
|
60.8
|
Intravenous fluid
|
Yes
|
330
|
82.3
|
No
|
71
|
17.7
|
Frequent Admission
|
Yes
|
58
|
14.5
|
No
|
343
|
85.5
|
Previous Hearing impairment
|
Yes
|
33
|
8.2
|
No
|
368
|
91.8
|
Previous Vision impairment
|
Yes
|
54
|
13.5
|
No
|
347
|
86.5
|
5.2. Prevalence of Delirium
Approximately one third (26.6 %, n=107) of the patients in the study had delirium. 3.0 % (12) had mild delirium; 5.0% (n=20) had moderate delirium, while 18.6% (n=75) had severe delirium.
Furthermore, among patients who were found to be positive for delirium 10.9 % (n=44) had hyperactive subtype, while 14.8% (n=60) had hypoactive delirium and those who had mixed type were 0.7% (n=3).
In addition regarding cognitive status, it was revealed from the study that 94(87.8%) had severe cognitive impairment, 10(9.3%) had moderate cognitive impairment, 6(5.6%) had mild cognitive impairment while none had normal mental functioning.
From study participants with delirium 67(62.6%) of them had severe comorbidity, and while 40(37.3%) had mild to moderate comorbidity.
5.3. Factors associated with delirium
Socio-demographic and economic characteristics of patients like age ,ethnicity, occupation and economic status didn’t show any association with delirium on bivariate analysis while sex, educational status and sub-wards in emergency ward were associated with delirium. (Table 3)
Table 3:- Bivariate analysis of socio-economic characteristics of study participants among Jimma medical center, August 2022. (N=422)
|
|
Delirium
|
COR &95%CI
|
P-value
|
Variable
|
|
No (N%)
|
Yes (N%)
|
|
|
Gender
|
Male
|
178(44.39%)
|
81(20.2%)
|
2.030(1.232-3.347)
|
0.05*
|
Female
|
116(28.92%)
|
26(6.48%)
|
1
|
1
|
Age
|
Less than 30
|
74(18.45%)
|
34(8.47%)
|
1
|
1
|
30-39
|
63(15.71%)
|
19(4.73%)
|
0.65(0.34-1.26)
|
0.207
|
40-49
|
69(17.2%)
|
15(3.74)
|
3.47(2.237-6.94)
|
0.034*
|
50-59
|
45(11.22%)
|
16(3.99%)
|
0.774(0.384-1.559)
|
0.473
|
60-69
|
24(5.98%)
|
13(3.24%)
|
1.179(0.536-2.592)
|
0.682
|
70-79
|
19(4.73%)
|
10(2.48%)
|
1.146(0.481-2.725)
|
0.759
|
Ethnicity
|
Oromo
|
213(53.1%)
|
67(16.7%)
|
1.444(0.148-4.051)
|
0.533
|
Amhara
|
13(3.24)
|
10(2.49%)
|
1.880(0.736-4.805)
|
0.187
|
Tigre
|
1(0.25%)
|
1(0.25%)
|
0.769(0.455-1.300)
|
0.327
|
Afar
|
1(0.25%)
|
2(0.49%)
|
2.889(0.425-5.619)
|
0.203
|
Other
|
66(16.46%)
|
27(6.73%)
|
1
|
1
|
Marital status
|
Married
|
180(44.88%)
|
61(15.21%)
|
1
|
1
|
Single
|
67(16.7%)
|
22(5.48%)
|
0.969(0.552-1.700)
|
0.912
|
Divorced
|
31(7.73%)
|
13(3.24%)
|
1.237(0.609-2.516)
|
0.556
|
Widowed
|
16(3.99%)
|
11(2.74%)
|
2.029(0.813-4.610)
|
0.091
|
Economic Status
|
<2000
|
107(26.68%)
|
49(12.21%)
|
1
|
1
|
2001-2999
|
16(3.99%)
|
2(0.49%)
|
2.486(1.317-4.692)
|
0.998
|
3000-4999
|
75(18.7%)
|
33(8.22%)
|
2.285(1.16-4.488)
|
0.016*
|
>5000
|
22(5.48%)
|
9(2.24%)
|
2.097(0.87-5.381)
|
0.124
|
Occupation
|
Government Employed
|
54(13.46%)
|
11(2.74%)
|
0.779(0.336-1.880)
|
0.560
|
Self-Employed
|
157(39.15%)
|
70(17.45%)
|
1.705(0.932-3.18)
|
0.083
|
NGO
|
2(0.49%)
|
1(0.25%)
|
1.912(0.163-2.357)
|
0.606
|
No Job
|
16(3.99%)
|
8(1.99%)
|
1.912(0.70-5.211)
|
0.205
|
Private employed
|
65(16.2%)
|
17(4.23%)
|
1
|
1
|
Educational Status
|
Illiterate
|
88(21.9%)
|
47(11.72%)
|
1.984(0.497-3.948)
|
0.05*
|
Primary School
|
84(20.94%)
|
30(7.48%)
|
1.327(0.644-2.732)
|
0.443
|
Secondary School
|
70(17.45%)
|
16(3.99%)
|
0.894(0.381-1.893)
|
0.689
|
Diploma and above
|
52(12.96%)
|
14(3.49%)
|
1
|
1
|
Emergency Ward
|
Medical
|
108(26.93%)
|
24(5.98%)
|
1
|
1
|
Surgical
|
124(30.92)
|
40(9.97%)
|
3.121(1.752-5.625)
|
0.003*
|
Resuscitation
|
62(15.46%)
|
43(10.72%)
|
1.452(0.823-2.562)
|
0.198
|
Bivirate analysis indicated that, khat chewing and Intravenous fluid were not significantly associated with delirium while cigarette smoking, hearing impairment, visual impairment, alcohol use, antipsychotic, bladder catheterization, benzodiazepine use and poly therapy were associated with delirium and entered to multivariate logistic regression model (Table 4).
Table 4:- Bivariate analysis of Substance use, clinical and medication related charactertics among patients admitted in emergency ward, Jimma medical center, August 2022 (N=422)
Variable
|
|
Delirium
|
COR &95%CI
|
P-value
|
No(N%) Yes(N%)
|
|
Alcohol use
|
Lifetime
|
No
|
267(66.58%)
|
75(18.7%)
|
1
|
1
|
Yes
|
27(6.733%)
|
32(7.98%)
|
0.237(0.134-0.420)
|
0.00
|
Current use
|
No
|
21(20.8%)
|
11(2.74%)
|
1
|
1
|
Yes
|
6(1.49%)
|
21(5.23%)
|
6.68(2.08-3.201)
|
0.01
|
Cigaratte smoking
|
Lifetime
|
No
|
291(72.56%)
|
97(24.18%)
|
1
|
1
|
Yes
|
3(0.75%)
|
10(2.49%)
|
3.100(1.27-5.371)
|
0.001*
|
Current use
|
No
|
6(1.49%)
|
1(0.25%)
|
1
|
1
|
Yes
|
3(0.75%)
|
3(0.75%)
|
2.052(1.060-3.972)
|
0.033*
|
Khat use
|
Lifetime
|
No
|
268(66.83%)
|
68(16.95%)
|
1
|
1
|
Yes
|
26(6.48%)
|
39(9.72%)
|
0.169(0.096-0.297)
|
0.004*
|
Current use
|
No
|
17(4.24%)
|
14(3.49%)
|
1
|
1
|
Yes
|
10(2.49%)
|
25(6.23%)
|
0.410(0.287-0.585)
|
0.031*
|
Previous or current use of antipsychotics
|
Yes
|
3(0.75%)
|
18(4.48%)
|
0.051(0.015-0.177)
|
0.013*
|
No
|
291(72.56%)
|
89(22.19)
|
1
|
1
|
Previous or current use of benzodiazepines
|
Yes
|
3(0.75%)
|
18(4.48%)
|
0.051(0.15-0.77)
|
0.0043*
|
No
|
291(72.56%)
|
89(22.19%)
|
1
|
1
|
History of polytherapy
|
Yes
|
70(17.45%)
|
92(22.94%)
|
0.051(0.028-0.094)
|
0.0023*
|
No
|
224(55.86%)
|
15(3.74)
|
1
|
1
|
Bladder catheterization
|
Yes
|
80(19.95%)
|
77(19.2%)
|
0.146(0.089-0.239)
|
0.002*
|
No
|
214(53.36%)
|
30(7.48)
|
1
|
1
|
Intravenous fluid
|
Yes
|
223(55.61%)
|
107(26.68)
|
0.23(0.874-1.652)
|
0.99
|
No
|
71(17.7)
|
0(0%)
|
1
|
1
|
Frequent Admission
|
Yes
|
15(3.74%)
|
43(10.72)
|
0.080(0.042-0.153)
|
0.0021*
|
No
|
279(69.57%)
|
64(15.96%)
|
1
|
1
|
Hearing impairment
|
Yes
|
14(3.49%)
|
19(4.73%)
|
0.232(0.112-0.481)
|
0.0033*
|
No
|
280(69.82%)
|
88(21.94%)
|
1
|
1
|
Vision impairment
|
Yes
|
26(6.48%)
|
28(6.98%)
|
0.274(0.152-0.494)
|
0.0015*
|
No
|
268(66.83%)
|
79(19.7%)
|
1
|
1
|
From Multivariate logistic regression analysis it was found that current use of alcohol, visual impairment, frequent admission, bladder catheterization, and benzodiazepine exposure had significant association with delirium. In to their respective odd ratio, The odds of having delirium among patients with bladder catheterization was 7.7 fold higher in contrast to patients without bladder catheterization. The odds of participants with benzodiazepine exposure to had delirium were 7 times the odds of those without benzodiazepine exposure. Visual impairment was also associated with delirium; those participants with visual impairment were 2.7 times more likely to have delirium as compared with their counter parts current alcohol users 2.1 fold risk of having delirium than their counter parts and those participants who had frequent admission were 4.8 times more likely to have delirium as compared with their counter parts. (Table-5)
Table 5:- Multivariate analysis of factors associated with delirium among patients at Jimma medical center ,August,2022. N=422
Variable
|
|
Delirium
|
AOR &95%CI
|
P-value
|
No (N%) Yes (N%)
|
|
Alcohol use
|
Current use
|
No
|
21
|
11
|
1
|
1
|
Yes
|
6
|
21
|
0.216(0.086-0.542)
|
0.001*
|
Previous or current use of benzodiazepines
|
Yes
|
3
|
18
|
6.503(1.57-29.558)
|
0.034*
|
No
|
291
|
89
|
1
|
1
|
Bladder catheterization
|
Yes
|
80
|
77
|
7.746(3.752-15.993)
|
0.026*
|
No
|
214
|
30
|
1
|
1
|
Frequent Admission
|
Yes
|
15
|
43
|
4.838(2.068-11.316)
|
0.013*
|
No
|
279
|
64
|
1
|
1
|
Vision impairment
|
Yes
|
26
|
28
|
0.273(0.115-0.651)
|
0.004*
|
No
|
268
|
79
|
1
|
1
|