Tenure security and land-related investment - evidence from Ethiopia

The authors use a large data set from Ethiopia that differentiates tenure security and transferability to explore determinants of different types of land-related investment and its possible impact on productivity. While they find some support for endogeneity of investment in trees, this is not the case for terraces. Transfer rights are unambiguously investment-enhancing. The large productivity effect of terracing implies that, even where households undertake investments to increase their tenure security, this may not be socially efficient. In Ethiopia, government action to increase tenure security and transferability of land rights can significantly enhance rural investment and productivity.Land and Real Estate Development,Environmental Economics&Policies,Municipal Housing and Land,Labor Policies,Payment Systems&Infrastructure,Environmental Economics&Policies,Municipal Housing and Land,Banks&Banking Reform,Land and Real Estate Development,Real Estate Development

The Surgical Management of Primary Hyperparathyroidism: The Experience in Tikur Anbessa Specialized Tertiary Referral and Teaching Hospital, Addis Ababa, Ethiopia

Primary hyperparathyroidism is an endocrine disorder characterized by excessive and inappropriate release of Parathormone (PTH) from parathyroid glands resulting in diverse clinical manifestations involving the skeletal system in the form of bone and joint pains and pathological fractures, the gastrointestinal system in the form of dyspepsia from Peptic ulcer disease and pancreatitis, nephrolithiasis and other neuropsychiatric and nonspecific symptoms. There is nothing known about the epidemiology of this condition in our country and experience in Parathyroidectomy is very limited. In the biggest tertiary referral and teaching hospital in the country, only seven cases have been seen and treated over a period of seven years from 2007-2014 and only three had complete medical documents. We therefore present these three cases in detail and review the available literature in the management of primary hyperparathyroidism.Key words: Primary hyperparathyroidism, hungry bone disease, parathyroid adenom

Bronchiectasis: Experience of Surgical Management at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND: Bronchiectasis is one of the major health problems in Ethiopia. We analyzed the outcome of surgery done for bronchiectasis in a resource-limited setup.METHODS: A retrospective cross-sectional analysis of 22 patients who underwent surgery for bronchiectasis in Tikur Anbessa specialized hospital (TASH) during the period 2012 - 2017 were done.RESULTS: There were 13(59%) female and 9(41%) male patients with a mean age of 34.1 +/-16.9 years. The mean duration of symptoms was 2.2 years. Blood streak sputum, 13(59%), dyspnea, 9(49.9%), fetid sputum, 8(36.4%), dry cough, 6(27.3%), chest pain, 6(27.3%) and massive hemoptysis 3(13.6%) were the main presenting symptoms. In 20(91%) of the patients, previous history of TB treatment was identified. Recurrent childhood infection, 1(4.5%), and tumor obstruction, 1(4.5%), were also seen. Bronchiectasis was left sided in 12(54.5%), right-sided in 7(31.8%) and bilateral in 3(13.6%) patients. The disease affected multiple lung lobes in 9(40.9%), left lower lobe in 6(27.3%) and left upper lobe in 3(13.6%) cases. Indications for surgery were the failure of medical management in 10(45.5%), destroyed lung in 9(40.9%), and massive hemoptysis in 3(13.6%) cases. The procedures performed were lobectomy in 14(63.6%) and pneumonectomy in 8(36.4%) cases. Postoperative complications occurred in 5(22.7%)patients with one (4.5%) death. On the other hand, 77.3% of operated patients had significant improvement compared to their preoperative symptoms.CONCLUSIONS: In a resource-limited setup like TASH, localized bronchiectasis can be treated surgically with an acceptable result. Proper selection and preparation with complete resection of the involved segments are needed for maximum control of symptoms and better outcomes

Pattern of Vascular Diseases at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND: Vascular diseases are evolving fast in sub-Saharan Africa, but its management is challenged by lack of expertise and infrastructure. In the light of the prevailing challenge, this study was done to see the pattern of vascular disease and its treatment in a tertiary referral hospital.METHODS: A prospective cross-sectional study was done over a period of one year (February 9, 2016 to February 8, 2017) at Tikur Anbessa specialized hospital (TASH) at Addis Ababa, Ethiopia.RESULTS: A total of 386 patients were seen at the surgical OPD. Of these, 78(20.2%) were admitted and operate on. The male to female ratio was 1.3:1. The mean age affected was 39 +/- 10 (Range 12-91 years). On the other hand, 132 (34.2%) patients came with PAD. Of them, 46(34.8%) presented with either frank Gangrene or pre-gangrene stage. The rest 86(65.1%) had claudication pain. The other diseases seen are Varicose Vein, 100(25.9%), Carotid body tumors, 60(15.4%), Aneurysmal diseases, 36(9.1%), Vascular malformations, 34(8.7%), and Vascular injuries, 22(5.6%). During the study period, 28(35.9%) PAD, 22(28.2%) trauma patients, 8(10.2%) Chemodectomas, 8(10.2%) aneurysms, 6(7.7%) hemangiomas, 4(5.1%) varicose vein and 2(2.6%) AV fistula patients were operated.CONCLUSION: The pattern of vascular disease in Ethiopia is becoming a challenge. The gap created due to limited vascular surgeons, poor infrastructure and absent supply chain system has significantly compromised the number and type of operated-on patients. These challenges result in preventable morbidity and mortality

Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital

Background: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting.Methods: A two years (January 1, 2016 - December 30, 2018) retrospective cross- sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa,Ethiopia.Results: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was <10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(2-30)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP <90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate.Conclusions: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential

SCHSTOSOMIASIS IN THE FINCHAA RIVER VALLEY, WELLEGA REGION, WESTERN ETIHIOPIA

ABSTRACT: Parasitological and malacological surveys were carried out in the Finchaa Valley, Wellega Region, western Ethiopia. Stool examination of 960 persons in the 10 communities surveyed showed an average human prevalence of 12.4% for Schistosoma mansoni. Infected individuals were present in 6 communities, but prevalence was greater than 10% in only three of them, reaching 40% among school children in one community. In endemic localities, the intensity of infection in terms of eggs per gram of faeces were 200 and 199 among school children and farm labours respectively. The age specific prevalence and intensity of infection were highest among the 5-14 year age group. The intermediate host of S. mansoni, Biomphalaria pfeifferi were collected from three sites, but transmission was identified at only one site located in the lower portion of the valley. Bulinus truncatus, the potential intermediate host of S. haematobium in Ethiopia, was also present in the area. The occurrence of infected human subjects and snail intermediate host confirm that Schistosoma mansoni is well established in the valley, particularly in the lower portion where a large irrigation development is under way. In this report, the threat posed by both S. Mansoni and S. haematobium is discussed and the preventive/control measures to be taken are suggested. [Ethiop. J. Health Dev. 1993; 7(1):9-15

Low awareness and common misconceptions about schistosomiasis in endemic lowland areas in Western Ethiopia: a mixed-methods study

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How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

Background Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery. Methods A qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework. Results The following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality. Conclusions Delayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.This research was funded by the JW LEE Center for Global Medicine of Seoul National University College of Medicine, Seoul, the Republic of Korea

Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study

Objectives Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment. Methods Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis. Results Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working. Conclusions Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.publishedVersio

Embodying the Spirit(s): Pentecostal Demonology and Deliverance Discourse in Ethiopia

The article explores Pentecostal embodiment practices and concepts with regard to Holy Spirit baptism and demon possession. The studied material is connected to a specific and highly controversial debate in Ethiopian Pentecostalism, which revolves around the possibility of demon possession in born-again and Spirit-filled Christians. This debate runs through much of Ethiopian Pentecostal history and ultimately is concerned with whether or how Christians can host conflicting spiritual forces, in light of the strong dualism between God and evil in Pentecostal cosmology. The article shows that the embodiment of spirits and/or the Holy Spirit is related to theological concepts of the self, because these concepts define what may or may not be discerned in certain bodily manifestations. Moreover, the article contends that this debate thrives on a certain ambiguity in spirit embodiment, which invites the discernment of spiritual experts and thereby becomes a resource of power