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

Khat chewing in pregnant women associated with prelabor rupture of membranes, evidence from eastern Ethiopia

Introduction: prelabor rupture of membranes (PROM) is a major factor that affects pregnancy outcome. Results from previous studies have suggested that there is an association between pregnant women, khat chewing and preterm birth, but evidence of association with PROM is sparse. This study therefore aims at identifying association between khat chewing in pregnancy and premature rupture of membranes in eastern Ethiopia. Methods: A health facility-based cross-sectional study was conducted among 1688 pregnant women who came for delivery service in Harar town, Eastern Ethiopia between June to October in 2016. Data were collected using a pre-tested structured questionnaire and checklist to extract data from the medical record. The association between khat and PROM was examined using logistic regression analysis. A statistical significance was declared at p-value < 0.05. Results: Of the 1688 pregnant women who participated in the study, 397 had prelabor rupture of the membranes, representing a proportion of 23.5% [(95% CI: (21.5, 25.6%)]. Of these 397 prelabor rupture of the membranes 198 (31.53%) were from Khat chewing mothers and, 199(18.77%) were from non-khat chewing mothers. After controlling for potential confounders, the multivariable logistic regression analysis revealed the odds of PROM was 1.51 times higher among khat chewed pregnant women [AOR = 1.51; 95% CI; (1.11, 2.07)] were had no khat chewing. Conclusion: this study found a significant association between khat chewing in pregnancy and PROM. Efforts to reduce PROM need to consider prevention of khat chewing in pregnancy. A specific strategy need to protect pregnant women from khat chewing

Magnitude of Childhood Vaccine Hesitancy and Associated Individual/Social Group Factors among Parents in Degahbur Town, Somali Region, Ethiopia

Since the introduction of effective and safe vaccines, vaccination has made enormous contributions to public health. Throughout its time, the effectiveness of vaccination programs were governed by multiple factors. Vaccine hesitancy is an emerging public health concern which gained more attention in recent years. Magnitude of vaccine hesitancy is not well known across many parts of the world. The objective of this study was to assess magnitude of childhood vaccine hesitancy and associated individual/social group factors among parents in Degahbur town. Community based cross-sectional study was undertaken in 422 households. Cluster sampling technique was employed to select six study units in Degahbur. Structured questionnaire was used for data collection. EPIDATA 3.02 was used for data entry and SPSS version 20 for data analysis. Bivariate and multivariate analysis was conducted to check the associations between outcome and explanatory variables using binary logistic regression model. Out of the total 422 households selected, 412 (97.6%) have responded to the interviews. From the 412 study participants, 46 (11.2%) were labelled as vaccine hesitant. Perceiving vaccination as not health beneficial (Adjusted Odds Ratio (AOR) = 3.84, 95% CI (1.2, 13.6)), Beliefs in other alternatives (AOR= 4.8, 95% CI (1.5, 15.4)), beliefs that vaccination can’t protect children from serious diseases (AOR= 5.82, 95% CI (1.3, 25.6)) and being daily laborer (AOR= 12.9, 95% CI (2.6, 63.5) were predictors of vaccine hesitancy.Magnitude of childhood vaccine hesitancy in Degahbur is lower than that reported in other studies. In this study, negative perceptions and beliefs towards vaccines and occupation of parents are associated with vaccine hesitancy. Community based health education programs and vaccination surveillance system should be advocated and developed

Determinants of Acute Malnutrition among Children Aged 6–59 Months in Public Health Facilities of Pastoralist Community, Afar Region, Northeast Ethiopia: A Case Control Study

Background. In low income countries, acute malnutrition continues to be the most important risk factor for illnesses and deaths. The aim of this study was to assess the determinants of acute malnutrition among children aged 6–59 months. Methods. A facility based unmatched case control study was employed on 420 (140 cases and 280 controls) children aged 6–59 months with their caregivers between January 20 and February 20, 2014. Data was analyzed using SPSS version 20.0. A P value < 0.05 was considered statistically significant. Results. Children aged 12–23 months [AOR = 10.51, 95% CI = 4.93, 22.34], rural residence [AOR = 2.42, 95% CI = 1.22, 4.79], illiterate father [AOR = 2.47, 95% CI = 1.32, 4.61], Monthly income of less than 1000 birr [AOR = 3.98, 95% CI 2.05, 7.69], and food served together with family [AOR = 2.18, 95% CI = 1.10, 4.30] were associated with acute malnutrition. Conclusion. Rural residence, illiterate father, monthly income of less than 1000 birr, and food served together with family are statistically associated with acute malnutrition. Improving practices of parents on appropriate child feeding and creating awareness related to key risk factors of acute malnutrition should be further strengthened

Grouping of environments for testing navy bean in Ethiopia

Common bean variety selection within its production environment is often challenged by the occurrence of significant genotype-by-environment interactions (GEI) in the variety development process. Grain yield performance of 16 navy bean (Phaseolus vulgaris L.) lines was tested in a multi-environment variety trial during 2010 and 2011 main growing seasons of Ethiopia. Field experiments were conducted in Randomized Complete Block Design (RCBD) with three replications in 14 rainfed environments of the major common bean growing areas. The objectives were to assess the line by environment interactions (LEI), determine stable genotypes, and grouping of test environments. Significant differences were found among the lines for grain yield on each environment and combined over environments. The combined analysis of variance across environments indicated that both environment and LE interactions were significantly influenced lines yield. All interactions in relation to L×E showed high significant difference (P&lt;0.01) for grain yield. Statistical methods as AMMI, GGE and some stability parameters were used to describe the LE interaction and to define stable lines in relation to their yield. The highest yield (2435 kg ha-1) was obtained from the line ICA BUNSI X SXB 405/1C-C1-1C-87. The stability analysis also identified lines ICA BUNSI X SXB 405/1C-C1-1C-87 and ICA BUNSI X SXB 405/1C-C1-1C- 37 as the most stable lines. Lines identified as superior differed significantly from the standard varieties and can be recommended for use by farmers in the bean growing areas of Ethiopia. Cluster analysis, based on grouping of locations showed that Melkassa, Alemtena and Haramaya as potential and high yielding, but Jimma, Bako, Pawe, Areka, Assosa and Sirinka as low to medium yielding locations

Vaccine safety practices and its implementation barriers in Northwest Ethiopia: A qualitative study

AbstractIntroduction: Even if immunization coverage increases over time, it is imperative to ascertain the safety and efficient coverage of immunization services. However, evidence on the safety practices of vaccines is limited. Assessing the implementation status of vaccine safety practices and its implementation barriers is crucial for program monitoring, interventions, and improvements. Therefore, this study aimed to assess vaccine safety practices and its implementation barriers in the public health facilities of Northwest Ethiopia.Aim: The objective of this study was to assess the safety practices of vaccines and to explore its implementation barriers.Methods: A qualitative research approach was adopted for this study. Face-to-face in-depth interviews with key-informants and immunization session-observations were the main data collection methods used in this study. Study participants were purposively selected based on their experience and knowledge about the subject matter and framework analysis was performed.Result: The study's findings revealed that the safety practices of vaccines from the cold chain system, vaccine administration and waste disposal and management perspective was suboptimal. Many barriers influencing vaccine safety practices were also explored. They are 1) vaccine storage and handling, 2). vaccine administration/delivery, 3) waste disposal and management, 4) communication, 5) monitoring and evaluation and 6) and resource.Conclusion: Efforts to promote the safety of vaccines and vaccination practices is a complex phenomenon and demands multidisciplinary action. Based on our findings, improved vaccine storage and handling, proper administration of vaccines based on guidelines, proper disposal and management of waste, and effective communication, and monitoring can contribute to the safe delivery of vaccination practices. Furthermore, improving the financial freedom of the facilities could increase the availability of essential resources and equipment that can safely store vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3): 111-117]Keywords: Immunization safety practice, Qualitative study, Framework analysis, Northwest Ethiopi

Determinants of patient delay in diagnosis of pulmonary tuberculosis in somali pastoralist setting of Ethiopia : a matched case-control study

Background; : Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia.; Methods; : A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ≥ 15 years who delayed &gt; 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression.; Results; : After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and &gt;1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay &gt; 30 days [; p; &lt; 0.05].; Conclusion; : Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings

Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia

Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia.; A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged ≥15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays.; Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR = 33-70). Cavitation was significantly associated with diagnosis delay [P &lt; 0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95% CI) = 0.67(0.62-0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p = 0.02]. Other factors associated with cavitation were age ≤ 35 years [APR (95% CI) =1.3(1.01-1.6)], chronic diseases [APR (95% CI) = 1.8(1.2-2.6)] and low MUAC*; female; [APR (95% CI) = 1.8(1.2-2.8)]. Smear positivity was also associated with age ≤ 35 years [APR (95% CI) =1.4(1.1-1.8)], low BMI [APR (95% CI) =1.3(1.01-1.7)] and low MUAC [APR (95% CI) =1.5(1.2-1.9)].; This study highlights delay in diagnosis of pulmonary TB remained high and increased infectiousness of patients in pastoral settings of Ethiopia. Hence, delay should be targeted to improve patient outcomes and reduce transmission in such settings

Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia

BACKGROUND: Leprosy or Hansen’s disease is known to cause disability and disfigurement. A delay in case detection of leprosy patients can lead to severe outcomes. In Ethiopia, the disability rates caused by leprosy among new cases are relatively high compared to other endemic countries. This suggests the existence of hidden leprosy cases in the community and a delay in timely detection. To reduce disability rates, it is crucial to identify the factors associated with this delay. This study aimed to determine the extent of delay in case detection among leprosy cases in Eastern Ethiopia. METHODS: This cross-sectional explorative study was conducted in January and February 2019 among 100 leprosy patients diagnosed ≤6 months prior to inclusion. A structured questionnaire was used to collect data, including the initial onset of symptoms, and the reasons for delayed diagnosis. Descriptive statistics, including percentages and medians, were used to describe the case detection delay. Logistic regression analysis was carried out to evaluate the predictors of delay in case detection of >12 months. FINDINGS: The median age of patients was 35 years, with a range of 7 to 72 years. The majority were male (80%) and rural residents (90%). The median delay in case detection was 12 months (interquartile range 10–36 months) among the included patients. The mean delay in case detection was 22 months, with a maximum delay of 96 months. The overall prevalence of disability among the study population was 42% (12% grade I and 30% grade II). Fear of stigma (p = 0.018) and experiencing painless symptoms (p = 0.018) were highly associated with a delay in case detection of >12 months. CONCLUSIONS: Being afraid of stigma and having painless symptoms, which are often misinterpreted as non-alarming at the onset of the disease, were associated with a delay in case detection. This study showed the need to increase knowledge on early symptoms of leprosy among affected communities. Furthermore, it is important to support initiatives that reduce leprosy related stigma and promote health worker training in leprosy control activities