A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol

Background With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. Methods This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. Discussion This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality

Impact of COVID-19 on Care Seeking Behavior of Patients at Tertiary Care Chronic Follow-up Clinics in Ethiopia: A Cross-Sectional Telephone Survey.

AbstractBackground: Health service delivery and the uptake of health services were greatly affected by COVID-19. The current study assessed the change in patients' care-seeking behavior after the first COVID-19 case was reported in Ethiopia.Methods: A cross-sectional survey was conducted among patients who were appointed at Tikur Anbessa Specialized Hospital (TASH), between mid-March to mid-June 2020. Data was collected through telephone, using a pre-tested, structured questionnaire. Data were analyzed using SPSS software version 25. Descriptive statistics and binary logistic regression models were used to describe the data and assess factors associated with loss to follow-up (LTFU).Results: Among 644 interviewed patients, 70% were lost to follow-up. Fear of COVID-19 infection (87.1%) and transportation problem due to lockdown (82.7%) were among the main reasons for loss to follow-up. Patients aged ≥60 years had highest odds of missing a follow-up in the multivariable logistic regression analysis. The odds of loss to follow up (LTFU) for the fear of COVID-19 was 13 times higher than among patients who did not have fear (AOR=13.39, 95% CI: 7.96-22.50). The odds of loss to follow up among patients who reported transportation problems were 3.6 times higher than among those who did not have transport problems (AOR=3.64, 95% CI: 1.93-6.88,). The odds of loss to follow up among patients with severe and very severe illness were about three times higher (AOR=2.7, 95% CI: 1.48-5.01).Conclusion: Patient’s care-seeking behavior with chronic medical conditions at the chronic care clinics of TASH were seriously compromised during COVID-19. Patient’s age (>60 years), chronic disease severity, fear of COVID 19 and transportation problems significantly predicted LTFU. Strategies such as task shifting and establishment of telemedicine services should be explored to meet the ongoing health needs of chronically ill patients on established follow up care. [Ethiop. J. Health Dev. 2021; 35(3):200-207]Keywords: Care-seeking behavior, chronic disease, COVID-19, Ethiopia, Loss to follow u

Surgical outcome and predictors of neonates with esophageal atresia admitted at Tikur Anbesa Specialized Hospital.

BackgroundEsophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. This anomaly continues to cause considerable morbidity and mortality in Sub-Saharan Africa, presenting various concerns about how to treat esophageal atresia. Esophageal atresia-related neonatal mortality can be reduced by evaluating the surgical outcome and identifying associated factors.ObjectiveThis study aimed to assess the surgical outcome and identify predictors of neonates with esophageal atresia admitted at Tikur Anbesa specialized hospital.MethodsRetrospective crossectional study design was employed on 212 neonates with esophageal atresia who were undergone surgical intervention in Tikur Anbesa specialized hospital. Data were entered into epi data 4.6 and exported to Stata version 16 software for further analysis. A logistic regression model with Adjusted odds ratio (AOR), confidence interval (CI) and p-value ResultIn this study, 25% of newborns who underwent surgical intervention at TikurAbnbesa specialized hospital had successful surgical outcomes, compared to 75% of neonates with esophageal atresia who had poor surgical outcomes. Significant predictors of the poor surgical outcome of neonates with esophageal atresia were severe thrombocytopenia (AOR = 2.81(1.07-7.34)), timing of surgery (AOR = 3.7(1.34-10.1), aspiration pneumonia (AOR = 2.93(1.17-7.38)) and related abnormalities (AOR = 2.26(1.06-4.82)).ConclusionThe results of this study showed that, when compared to other studies, a substantial percentage of newborn children with esophageal atresia had poor surgical outcomes. Early surgical management, aspiration pneumonia and thrombocytopenia prevention and therapy play a big part in improving the surgical prognosis for newborns with esophageal atresia