Tuberculous Dactylitis: An Uncommon Presentation of Skeletal Tuberculosis

BACKGROUND: Skeletal involvement accounts 1-5% of all cases of Tuberculosis. The vertebrae are more commonly affected. The bones of the hands are more affected than the bones of the feet. The term “spina ventosa” has been used to describe this disorder because of its radiographic features of cystic expansion of the involved short tubular bones. Tuberculous dactylitis mainly occurs through lympho-hematogenous spread. The lung is the primary focus in 75% of cases.CASE DETAILS: A 4 years old female child developed a painless swelling on her left index finger two months prior to her presentation. Following an unsuccessful treatment as a case of osteomyelitis with antibiotics, imaging showed an expansile lytic lesion with sclerosis, and fine needle aspiration confirmed tuberculous dactylitis. The child was initiated on anti-tubercular treatment with subsequent marked clinical and radiologic improvement.CONCLUSION: Presence of longstanding finger swelling and pain should alert a clinician to consider active disseminated tuberculosis. Furthermore, proper interpretation of imaging and use of fine needle aspiration has been highlighted.KEYWORDS: Tuberculous dactylitis, Spina ventosa, Expansile lytic lesion, Tuberculosi

Results of the performance of automated GeneXpert in childhood tuberculosis in Addis Ababa, Ethiopia: a retrospective cross-sectional study

Background: Approximately 81% of all childhood tuberculosis cases occur among 22 high-burden countries and Ethiopia ranks eighth among these high burden countries. The GeneXpert Mycobacterium tuberculosis DNA and resistance to rifampicin (MTB/RIF) test can detect pediatric tuberculosis and its multidrug-resistant form with very high sensitivity and specificity, but limited data exists on its use in our country. We aimed to evaluate the effectiveness of the GeneXpert assay in comparison to children with a clinical diagnosis of Tuberculosis. Methods: A descriptive retrospective study on 144 TB-diagnosed children younger than 15 years was conducted at Tikur-Anbessa specialized hospital and Yekatit 12-referral hospital, pediatrics departments, Addis Ababa, Ethiopia. The performance of the GeneXpert test was evaluated by re-vising the charts of patients who have begun anti-tuberculosis treatment. We extracted information from the chart review of 144 eligible children who were diagnosed with tuberculosis and began anti-TB treatment from February 2014 to July 2016. Result: In the study, 144 patients with clinical diagnosis of tuberculosis were included, and 23% of them also had concurrent HIV infection. Equal numbers of male and female were present; 48.6% were from Addis Ababa. Thirty-four patients (23.6%) were missing their childhood vaccinations. The GeneXpert assay detected disease in only 24 (16.7%) of clinically diagnosed pediatric tuberculosis patients. Conclusion: Although the GeneXpert assay is helpful in the diagnosis of pediatric tuberculosis, most patients were still receiving treatment even after a negative GeneXpert test, necessitating the need for a more sensitive test

Case Report: Frontal lobe tuberculoma: A clinical and imaging challenge

Background: Pediatric nervous system tuberculomas are usually infra-tentorial and multiple. A frontal lobe location is rare.Case Details: We report a 10 year-old boy who presented with a chronic headache and episodes of loss of consciousness. He had no signs of primary pulmonary tuberculosis and a diagnosis of frontal tuberculoma was made upon a post-operative biopsy. He improved following treatment with anti-tubercular drugs.Conclusion: Tuberculosis should be considered in children with a chronic headache or focal neurologic deficit and a supra-tentorial intracranial mass in endemic countries like Ethiopia.Keywords: Tuberculoma, Tuberculosis, Frontal lobe, Ethiopi

Gender Inequity in Higher Education in Ethiopia

Despite their recognizable role in the political arena and resultant gender mainstreamed policies, women in Ethiopia face day-to-day obstacles to ensure gender equity, and academia is no exception. In the past few decades, higher education in Ethiopia has rapidly expanded, resulting in increased enrollment of female students and faculty employment in various academic fields. Although the progress in the sector is highly promising, ensuring gender equality has still been a significant challenge. Several studies have revealed different barriers to women's academic, leadership, and research participation in higher educational institutions in Ethiopia

Women’s Health Research Working Group: A Mentorship Model to Increase Women’s Participation in Research

AbstractBackground: Female academia makes up only a fifth of all faculty at Addis Ababa University, where only a few are actively engaged in research. With a belief that dedicated mentorship could bring positive change in research participation, a female-to-female mentorship group was established at the College of Health Sciences. Objective: This study aimed to assess the effectiveness of mentorship in improving the research participation of young female academia from August 2016-April 2019. Methods: The implementation was instituted by establishing a female-only research working group to enhance the participation of young female faculty members who were newly employed in a relatively large number. The main interventions were the coupling of mentors and mentees based on their respective research areas for two hours’ weekly lunchtime and providing need-based training and life skill talks by exemplary women. We used a desk review and written testimonies of the Group to evaluate the effectiveness of the intervention. Results: Young academics of the Group started to author scientific articles while the mentors had increased their publication track. The Group won a competitive three-year research grant. from Addis Ababa University. Its visibility due to its research output has helped to attract more members and encouraged the establishment of other sister groups in the University. The Group has also received the best female research group award from the Ministry of Science and Higher Education. Conclusion: Female-to-female mentorship had helped researchers in their early careers to publish and won grants. This could be an exemplary intervention which only requires a commitment of staff time. [Ethiop. J. Health Dev. 2021; 35(SI-2):08-14]Keywords: Female faculty, Implementation research, Mentorship, Research working grou

Pneumococcal carriage, serotype distribution and risk factors in children with community-acquired pneumonia, 5 years after introduction of the 10-valent pneumococcal conjugate vaccine in Ethiopia

Background: There is a scarcity of data on pneumococcal serotypes carried by children in Ethiopia. We studied pneumococcal nasopharyngeal carriage rate, serotypes, and risk factors among children with community acquired pneumonia (CAP). Methods: A prospective observational cohort study was performed in children with CAP, aged 0-15 years, in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Nasopharyngeal swabs were cultured, and serotypes of Streptococcus pneumoniae were determined by sequencing the cpsB gene and by the Quellung reaction. Risk factors were analyzed by using binary logistic regression. Results: Nasopharyngeal swabs were collected from 362 children with CAP. Pneumococcal carriage rate was 21.5% (78 of 362). The most common serotypes were 19A (27%), 16F (8.5%), and 6A (4.9%). In addition, 8.5% of the pneumococcal isolates were nontypeable. In bivariate analysis, children with a parent that smokes were more likely to carry pneumococci (crude odds ratio, 3.9; 95% confidence interval [CI], 1.2-12.3; P =.023) than those with parents that do not smoke. In multivariable analysis, living in a house with >= 2 rooms (adjusted odds ratio [AOR], 0.48; 95% CI, 0.28-0.82; P =.007) and vaccination with = 2 doses of 10-valent pneumococcal conjugate vaccine (PCV10) (AOR, 0.37; 95% CI, 0.15-0.92; P =.033) were protective of pneumococcal carriage. Conclusions: Five years after introduction of PCV10 in Ethiopia, the vaccine-related serotype 19A was predominant in the nasopharynx of children with CAP. Continued evaluation of the direct and indirect impact of PCV10 on pneumococcal serotype distribution in Ethiopia is warranted

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

To achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child's treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR = 0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR = 5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR = 12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child's medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings

Predictors of hospitalization among children on ART in Ethiopia: A cohort study

Background: Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia.Methods: A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and  ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical  Monitoring (ACM) till December 31, 2012 were included. From the database,  information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA.  Descriptive analyses and modeling was done using logistic regression.Results: Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%)  were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of  the eighty four admitted children were hospitalized in the first six months of ART  initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value <0.05). As the duration on ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P < 0.001). Whereas the incidence (number) of OI’s increased by one, the risk of being hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002).Conclusion: This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.Key words: Hospitalization, Children, HIV/AIDS, HAAR

Bacteremic community-acquired pneumonia in Ethiopian children : etiology, antibiotic resistance, risk factors, and clinical outcome

Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. We sought to determine the magnitude, etiology, and risk factors of CAP in children 5 years after introduction of pneumococcal conjugate vaccine (PCV) 10 in Ethiopia. Methods: We conducted a prospective observational study on the bacterial etiology and risk factors of CAP among children aged 0–15 years in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Blood culture, antibiotic susceptibility testing, and amplification of pneumococcal lytA and cpsB genes were performed. Serotypes of Streptococcus pneumoniae were determined by Quellung reaction and sequencing the cpsB gene. Results: Out of 643 eligible children, 549 were enrolled. The prevalence of bacteremic pneumonia was 5.6%. Staphylococcus aureus (26.5%) was the predominant pathogenic species, followed by Enterococcus faecium (11.8%), Escherichia coli (11.8%), and Klebsiella pneumoniae (11.8%). In univariate analysis, parental smoking and nonvaccination with PCV10 were associated with bacteremic CAP. In multivariable analysis, female sex (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–4.9), weight-for-age z-score (WAZ) <–2 SDs (aOR, 2.2; 95% CI, 1.1–4.8), and lower chest indrawing (aOR, 0.44; 95% CI, 0.2–0.95) were independently associated with bacteremic CAP. The overall in-hospital case fatality rate was 2.37% (13/549), and WAZ <–3 SDs (OR, 13.5; 95% CI, 3.95–46.12) was associated with mortality. Conclusions: Five years after the introduction of PCV10 in Ethiopia, S. aureus was the main cause of bacteremic CAP in children, the contribution of S. pneumoniae was low, and there was a high level of antibiotic resistance among isolates

Infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundInfection prevention and control (IPC) is a set of practices that are designed to minimize the risk of healthcare-associated infections (HAIs) spreading among patients, healthcare workers, and visitors. Implementation of IPC is essential for reducing infection incidences, preventing antibiotic use, and minimizing antimicrobial resistance (AMR). The aim of the study was to assess IPC practices and associated factors in Pediatrics and Child Health at Tikur Anbessa Specialized Hospital.MethodsIn this study, we used a cross-sectional study design with a simple random sampling method. We determined the sample size using a single population proportion formula with the assumption of a 55% good IPC practice, a 5% accepted margin of error, and a 15% non-response rate and adjusted with the correction formula. The final sample size was 284 healthcare workers. The binary logistic regression model was used for analysis. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) tool was used to assess IPC core components.ResultA total of 272 healthcare workers participated in the study, with a response rate of 96%. Of the total participants, 65.8% were female and 75.7% were nurses. The overall composite score showed that the prevalence of good IPC practices among healthcare workers was 50.4% (95% CI: 44.3–56.5). The final model revealed that nursing professionals and healthcare workers who received IPC training had AORs of 2.84 (95% CI: 1.34–6.05) and 2.48 (95% CI: 1.36–4.52), respectively. The final average total IPCAF score for the IPC level was 247.5 out of 800 points.ConclusionThe prevalence of good IPC practice was suboptimal. The study participants, who were nursing professionals and healthcare workers who received IPC training, showed a statistically significant association with the IPC practice level. The facility-level IPCAF result showed a “Basic” level of practice based on the WHO categorization. These evidences can inform healthcare workers and decision-makers to identify areas for improvement in IPC practice at all levels. Training of healthcare workers and effective implementation of the eight IPC core components should be strengthened to improve suboptimal practices