The changing pattern of diseases in the Mid 1990's: experience of a teaching hospital in North Western Ethiopia

Abstract: Between October 1994 and September 1995 consecutive adult medical admissions to the Gondar College of Medical Sciences (GCMS) teaching hospital were studied prospectively. The final diagnoses made or verified by consultant physicians before discharge or death were used for analysis. The median age was 30 years (range 12-98). Those below 50 and 40 years constituted 80.6% and 66.7%, respectively. Male to female ratio was 1.05:1.00. The median duration of hospital stay was 12 days (range 1-141). Tuberculosis and Insulin dependent Diabetes Mellitus were diseases associated with prolonged hospitalization, [OR, 95% CI = 4.66 (3.46, 6.29) and 2.4 (1.51, 3.83), respectively]. Of all admissions, 458 (40.2%) were screened for human immuno deficiency virus (HIV) and 232 (50.6%) were positive. The top ten diseases responsible for admissions, in order of decreasing frequency, were as follows: tuberculosis (25.4%), anaemia (6.5%), acute gastroenteritis and colitis (6.1%), diabetes mellitus (6.0%), pneumonia (5.9%), chronic diarrhea (4.96%), falciparum malaria (4.6%), chronic liver disease (4.2%), severe hypertension (4.2%), and stroke (3.0%). The mortality rate was 19.1%, which is high in comparison with similar reports from elsewhere. Tuberculosis and central nervous system diseases were the leading causes of hospital mortality, accounting for 35% and 18% of all deaths, respectively. There is a striking change in the pattern of diseases responsible for hospitalization compared to reports in the past. There is no study that revealed a single disease to be responsible for more than 20% of hospitalization except tuberculosis in this report. In addition, anaemia, chronic diarrhea, diabetes mellitus, hypertension, stroke and intracranial space occupying lesions were increasingly encountered. This marked change in pattern is partly explained by the current pandemic of human immuno deficiency virus/acquired immuno deficiency syndrome (HIV/AIDS) but other factors remain to be explained. [Ethiop. J. Health Dev. 1999;13(1):1-7

Spatiotemporal dynamics and prevention strategies of cervical cancer incidence in Addis Ababa, Ethiopia : an ecological study

Objective: This study analysed the spatial and temporal patterns of cervical cancer incidence in Addis Ababa from 2012 to 2021. Design: An ecological study was conducted from 1 September to 30 November 2023 to examine the spatiotemporal trends of cervical cancer incidence. Setting: The research was conducted in Addis Ababa, the capital city of Ethiopia. Participants: Included were all patients with clinically and/or histopathologically confirmed diagnoses of cervical cancer. Data analysis: The study employed advanced analytical tools including R programming, Quantum Geographic Information System V.3.36.0, GeoDa V.1.2.2 and System for Automated Geoscientific Analyses GIS V.9.3.2. Techniques such as Bayesian empirical testing with a block weighting matrix for hotspot identification, Global Moran’s I for spatial autocorrelation, nearest neighbour imputation and universal Kriging interpolation were used to manage data gaps. Joinpoint trend analysis and direct age-standardised incidence rate (ASIR) using the Segi’s World standard population was applied to compare trends across subcities. A statistical significance threshold was set at p<0.05. Results: Between 2012 and 2021, a total of 2435 new cervical cancer cases were recorded in the Addis Ababa City Population-based Cancer Registry, with significant spatial clustering observed in Nifas Silk Lafto, Bole, Kirkos as well as parts of Gulele and Yeka sub cities (z score>1.96) in 2018. The citywide age-standardised incidence rate varied from 19 to 26 cases per 100 000 women-years during 2013 and 2016, respectively. Subcity trends varied significantly, with increases and decreases noted in Akaki Kality and Kolfe Keraniyo over different periods while Bole subcity showed modest increase at 4.2% APC (95% CI: 0.6% to 7.9%; p=0.026). Conclusion: The study highlights substantial fluctuations in ASIR and significant geographic disparities in cervical cancer throughout Addis Ababa. To address these challenges, the implementation of school-based human papillomavirus vaccination programmes, alongside targeted interventions, active campaigns and sustained surveillance, is critical. These strategies are essential to effectively reduce the cervical cancer burden and improve health outcomes in the community

Severity of Injury and Associated Factors among Injured Patients Who Visited the Emergency Department at Wolaita Sodo Teaching and Referral Hospital, Ethiopia

BACKGROUND: An injury is a physical damage that occurs when the body is exposed to an excessive amount of energy. Physical agents, radiation, chemical agents, biological agents and physiological needs deprivation can cause injury. The study was aimed at assessing the severity of injury and identifying the factors associated with it among injured patients.METHODS: A cross-sectional study was conducted among patients who visited the emergency department of Wolaita Sodo Teaching and Referral Hospital from January 1, 2012 -January 1, 2017. A total of 320 patient records were included in the study and selected using simple random sampling. Statistical association was done for categorical variables using Chi-square. Rank correlation was done for three ordered options independent variables, Chi-squared test for trend used for two options independent variables, and General Chi-square test of independence used for independent variables with not ordered three and above options. Multivariate multinomial logistic regression was conducted. A P-value &lt;0.05 was taken as a significant association.RESULTS: The study indicated that the majority (45.3%), 128(40%) and 47(14.7%) had minor, moderate and severe injury, respectively. Residence (AOR 0.462; 95%CI 0.268, 0.798), cause of injury (AOR 3.602; 95%CI 1.336, 9.714), night time injury (AOR 4.895; 95%CI 1.472, 16.277), afternoon time injury (AOR 8.776; 95%CI 2.699, 28.537), and chest injury (AOR 2.391; 95%CI 1.048, 5.454) were significant predictorsof moderate injury. Afternoon time of injury (AOR; 4.683; 95%CI 1.137, 19.296) and head, neck and spinal cord injury (AOR; 4.933; 95%CI 1.945, 12.509) were predictors of severe injury

Socio-demographic and Haematological Determinants of Breast Cancer in a Tertiary Health Care and Teaching Hospital in Addis Ababa, Ethiopia

AbstractBackground: Breast cancer is the major cause of cancer deaths among women globally. Socio-demographic and haematological characteristics are among the determinants of breast cancer, and these characteristics are supposed to be monitored during early diagnosis and treatment of cases.Objective: The objective of this study was to assess socio-demographic and haematological profile of patients with breast cancer at Tikur Anbessa Specialized Hospital.Methods: Case controlled study was conducted among 230 cases and 230 controls from May 2018 to June 2019. Descriptive analysis was made to assess socio-demographic characteristics and independent sample t- test was performed to compare the mean haematological parameters.Results: The mean age was 42.8 + 12.1 years and 39.3 + 11.1 years for cases and controls, respectively. About 43.5% of the cases and 14.8% of the controls were not able to read and write. About 76.1% of the cases and 67.4% of the controls were married. The mean values of Haemoglobin, Red Blood cell, Packed Cell Volume for the cases were 13.1 + 1.6g/dl; 4.6 + 0.54x1012/L; and 38.7 + 4.5 %, respectively. These were significantly lower than those of the controls (14.0 + 1.3g/dl, 4.8 + 0.47 x 1012/L, 40.5 + 3.5%, respectively). Mean platelet count was higher among the cases, whereas total White Blood cell count was almost similar.Conclusion and recommendations: Majority of the cases were less than 40 years of age and were not able to read and write. Most of the RBC parameters of cases were significantly lower than the controls. Therefore, attention should be given for exposed groups and those with the designated haematological abnormalities. [Ethiop. J. Health Dev. 2021; 35(2):125-132]Keywords: Breast cancer, Haematological parameters, Socio-demographic factors, Ethiopi

Reasons for not undergoing cervical cancer screening: perspectives from women and health care providers in Addis Ababa: a qualitative study

BackgroundCervical cancer is a major public health problem in low-income countries, including Ethiopia. Various pieces of evidence show that the uptake of cervical cancer screening is low in Ethiopia. The reasons for this low uptake of cervical cancer screening have not been well documented.ObjectiveThe aim of this study is to explore the reasons for not taking up cervical cancer screening and gather the perspectives of women and healthcare providers in Addis Ababa, Ethiopia.MethodsAdult women and healthcare providers participated in the study. Eleven focus group discussions were conducted with women from the community. A total of 18 key Informant interviews were conducted with healthcare professionals who providing cervical cancer screening services and family health team leaders. Interviews and discussions were audio recorded, transcribed, and coded. We used MAXQDA software v.20 for data reduction to facilitate thematic analysis and interpretation.ResultsEleven focus group discussions and 18 key informant interviews were conducted. In this study, individual-level barriers, such as low knowledge of cervical cancer and screening, feeling healthy, fear of the screening procedure and results, fear of not being cured, fear of divorce, stigma and discrimination, preference for female healthcare providers, and spousal disapproval or resistance, were identified as the main reasons for the low uptake of screening. Community-level barriers such as perceiving cervical cancer as a deadly disease; misconceptions, such as screening causing infertility, and the absence of open discussion, were also found to contribute to low screening uptake.Conclusion and recommendationsKnowledge about cervical cancer and screening was found to be inadequate. Individual and community-level socio-cultural barriers were identified as reasons for the low uptake of screening. Therefore, it is crucial to conduct behavioral change and communication activities at both the individual and community levels to increase knowledge of cervical cancer and screening, reduce sociocultural barriers, and improve the uptake of cervical cancer screening

Contemporary treatment patterns and survival of cervical cancer patients in Ethiopia.

BACKGROUND Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country. METHODS Women with histologically verified cervical cancer who were seen in 2014 (January 1, 2014 to December 31, 2014) at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients' medical record files. The information on vital status was obtained from medical chart and through telephone calls. RESULT Among 242 patients included in the study, the median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.6 months (range 2 to 9 months). Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among 151 patients treated with curative intent, only 34 (22.5%) of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. The 5-year overall survival rate was 28.4% (20.5% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care. CONCLUSION The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy, leading to stage migration in substantial proportion of the cases. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical cancer and to shorten the unacceptable, long waiting time for radiotherapy

Health-related quality of life assessment among patients with oesophageal cancer at Tikur Anbessa Specialised Tertiary Hospital in Ethiopia : a cross sectional study

Background: In low-income countries, oesophageal cancer often presents at an advanced stage, leaving patients with limited curative treatment options. Furthermore, palliative treatments such as oesophageal stents or brachytherapy are lacking. This has a detrimental effect on their quality of life. In this study, we investigated the health-related quality of life of patients with oesophageal cancer at a tertiary hospital in Ethiopia. Methods: This cross-sectional study was conducted at Tikur Anbessa Specialised Tertiary Hospital in Ethiopia. The validated Amharic version of the questionnaire of the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire Cancer 30 (EORTC QLQ C-30) and the oesophageal cancer disease-specific questionnaire QLQ-OES18 were used to assess the quality of life of each patient. Results: The overall mean score for the EORTC QLQ C-30 was 35.43 (SD 18.04). The mean scores for the functional scales revealed that cognitive function was the highest, whereas role function was the lowest. The symptom scale results showed the highest score for pain and the lowest for diarrhoea. Dysphagia, choking, role functioning and financial difficulty correlated with the quality of life of patients with oesophageal cancer. Conclusion: Dysphagia, choking, role functioning and financial difficulty are important factors that affect the quality of life of patients with oesophageal cancer patients. Increasing the availability of palliative treatments for dysphagia to improve the quality of life in patients with oesophageal cancer is recommended

Patterns of Care of Cancers and Radiotherapy in Ethiopia

PURPOSE: Radiotherapy (RT) is an essential component of cancer treatment. There is a lack of RT services in sub-Saharan Africa as well as limited knowledge regar

Human breast tissue microbiota reveals unique microbial signatures that correlate with prognostic features in adult Ethiopian women with breast cancer

Breast cancer (BC) is the leading cause of cancer mortality among women in Ethiopia. Overall, women of African ancestry have the highest death toll due to BC compared to other racial/ethnic groups. The cause of the disparity in mortality is unclear. Recently, studies conducted in the United States and other high-income countries highlighted the role of microbial dysbiosis in BC initiation, tumor growth, and treatment outcome. However, the extent to which inter-individual differences in the makeup of microbiota are associated with clinical and histopathological outcomes in Ethiopian women has not been studied. The goal of our study was to profile the microbiome in breast tumor and normal adjacent to tumor (NAT) tissues of the same donor and to identify associations between microbial composition and abundance and clinicopathological factors in Ethiopian women with BC. We identified 14 microbiota genera in breast tumor tissues that were distinct from NAT tissues, of which Sphingobium, Anaerococcus, Corynebacterium, Delftia, and Enhydrobacter were most significantly decreased in breast tumors compared to NAT tissues. Several microbial genera significantly differed by clinicopathological factors in Ethiopian women with BC. Specifically, the genus Burkholderia more strongly correlated with aggressive triple negative (TNBC) and basal-like breast tumors. The genera Alkanindiges, Anoxybacillus, Leifsonia, and Exiguobacterium most strongly correlated with HER2-E tumors. Luminal A and luminal B tumors also correlated with Anoxybacillus but not as strongly as HER2−E tumors. A relatively higher abundance of the genus Citrobacter most significantly correlated with advanced-stage breast tumors compared to early-stage tumors. This is the first study to report an association between breast microbial dysbiosis and clinicopathological factors in Ethiopian women

Intrinsic subtypes in Ethiopian breast cancer patient

Purpose: The recent development of multi-gene assays for gene expression profiling has contributed significantly to the understanding of the clinically and biologically heterogeneous breast cancer (BC) disease. PAM50 is one of these assays used to stratify BC patients and individualize treatment. The present study was conducted to characterize PAM50-based intrinsic subtypes among Ethiopian BC patients. Patients and methods: Formalin-fixed paraffin-embedded tissues were collected from 334 BC patients who attended five different Ethiopian health facilities. All samples were assessed using the PAM50 algorithm for intrinsic subtyping. Results: The tumor samples were classified into PAM50 intrinsic subtypes as follows: 104 samples (31.1%) were luminal A, 91 samples (27.2%) were luminal B, 62 samples (18.6%) were HER2-enriched and 77 samples (23.1%) were basal-like. The intrinsic subtypes were found to be associated with clinical and histopathological parameters such as steroid hormone receptor status, HER2 status, Ki-67 proliferation index and tumor differentiation, but not with age, tumor size or histological type. An immunohistochemistry-based classification of tumors (IHC groups) was found to correlate with intrinsic subtypes. Conclusion: The distribution of the intrinsic subtypes confirms previous immunohistochemistry-based studies from Ethiopia showing potentially endocrine-sensitive tumors in more than half of the patients. Health workers in primary or secondary level health care facilities can be trained to offer endocrine therapy to improve breast cancer care. Additionally, the findings indicate that PAM50-based classification offers a robust method for the molecular classification of tumors in the Ethiopian context