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

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 <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

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

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

CYP2J2∗7 Genotype Predicts Risk of Chemotherapy-Induced Hematologic Toxicity and Reduced Relative Dose Intensity in Ethiopian Breast Cancer Patients

Chemotherapy-induced hematologic toxicity is the primary reasons of dose reductions and/or delays, low relative dose intensity (RDI), and predicts anticancer response. We investigated the incidence and predictors of chemotherapy-induced hematologic toxicities and reduced RDI in Ethiopian breast cancer patients, and implication of pharmacogenetics variations. Breast cancer patients (n = 249) were enrolled prospectively to receive cyclophosphamide based chemotherapy. Hematological toxicity (neutropenia, anemia, and thrombocytopenia) were monitored throughout chemotherapy cycle. The primary and secondary outcomes were incidence of grade 3 or 4 toxicity and reduced RDI, respectively. CYP2B6∗6, CYP3A5∗3, CYP2C9 (∗2,∗3), CYP2C19 (∗2,∗3), CYP2J2∗7, POR∗28, and ABCB1 (rs3842) genotyping were done. Cox proportional hazard and logistic regression were used to estimate risk predictors of toxicity and reduced RDI, respectively. Majority (73.5%) of the patients were < 45 years of age. The incidence of grade 3 or 4 hematological toxicity was 51.0% (95% CI = 44.54–57.46%). Multivariate Cox proportional hazard regression indicated CYP2J2∗7 genotype [Hazard ratio (HR) = 1.82; 95% CI = 1.14–2.90], pretreatment grade 1 leukopenia (HR = 2.75; 95% CI = 1.47–5.15) or grade 1 or 2 neutropenia (HR = 2.75; 95% CI = 1.73–4.35) as significant predictors of hematologic toxicities. The odds of having hematologic toxicities was lower in CYP2C9∗2 or ∗3 carriers (p = 0.024). The prevalence of reduced RDI was 56.6% (95% CI = 50.3–62.9%). Higher risk of reduced RDI was associated with CYP2J2∗7 allele [Adjusted odds ratio (AOR) = 2.79; 95% CI = 1.21–6.46], BMI ≤ 18.4 kg/m2 (AOR = 5.98; 95% CI = 1.36–26.23), baseline grade 1 leukopenia (AOR = 6.09; 95% CI = 1.24–29.98), and baseline neutropenia (AOR = 3.37; 95% CI = 1.41–8.05). The odds of receiving reduced RDI was lower in patients with CYP2B6 ∗6/∗6 genotype (AOR = 0.19; 95% CI = 0.06–0.77). We report high incidence of chemotherapy-induced hematological toxicities causing larger proportion of patients to receive reduced RDI in Ethiopian breast cancer patients. Patients carrying CYP2J2∗7 allele and low baseline blood counts are at a higher risk for chemotherapy-induced hematologic toxicities and receiving reduced RDI, and may require prior support and close follow up during chemotherapy

Prevalence of human papillomavirus and Helicobacter pylori in esophageal and gastroesophageal junction cancer biopsies from a case-control study in Ethiopia

peer reviewe

Prognosis of colorectal cancer in Tikur Anbessa Specialized Hospital, the only oncology center in Ethiopia.

IntroductionColorectal cancer is the third most commonly diagnosed cancer in males and the second in females worldwide. According to the Addis Ababa cancer registry, it is the first in male and fourth in female in Ethiopia. However, there have not been studies on prognostic factors and survival of colorectal cancer. Hence, this study aimed to estimate survival time and identify prognostic factors.MethodsIn this institution based retrospective study, medical records review of 422 colorectal cancer patients and telephone interview was used as sources of data. Survival time was estimated using Kaplan-Meier estimator. Prognostic factors were identified using the multivariable Cox regression model.ResultsPatients diagnosed with rectal cancer had 76% (HR: 1.761, 95% CI: 1.173-2.644) increased risk of dying compared to colon cancer patients. Node positive patients were 3.146 (95% CI: 1.626-6.078) times likely to die compared to node-negative and metastatic cancer were 4.221 (95% CI: 2.788-6.392) times likely to die compared to non-metastatic patients. Receiving adjuvant therapy reduced the risk of death by 36.1% (HR: 0.639 (95% CI: 0.418-0.977)) compared to patients who had an only surgical resection. The median survival time was 39 months and the overall five years survival rate was 33%.ConclusionsThe overall survival rate was low and a majority of the patients were young at presentation. Patient's survival is largely influenced by the advanced cancer stage at presentation and delays in the administration of adjuvant therapy. Receiving adjuvant therapy was among the good prognostic factors