Analysis and Economic Implication of X-Ray Film Reject in Diagnostic Radiology Department of Jimma University Specialized Hospital, Southwest Ethiopia

BACKGROUND: Patients usually undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to poor image quality. This subjects the patients to excess radiation exposure and extra cost.It is therefore investigating the magnitude and causes of reject is mandatory. This study aimed to assess the reject rate of X-ray films and its economic implication in order to obtain information for further recommendations on image quality, cost and radiation exposure.METHOD: A cross-sectional study approaches was employed. Reject rate was measured for two x-rays in the department across all plain x-ray films examinations using a structured format on which relevant data for reject were recorded by investigators. The results were then collected and entered into a database for analysis.RESULT: Reject rate and cause of reject were measured across all plane x-ray examinations for the hospital. From a total of 6563 exposed films, 16.85% were rejected. This leads to economic waste of 24,721.99 ETB, or 17.8% of a total cost in 4month period and increase in radiation dose to both patients and staff.CONCLUSION: The findings from this study show that both the overall reject rate and individual reject rate were higher than the accepted range which could be due to machine fault, operator’s technical limitations, or absence of quality control program in the department. We recommend that regular quality assurance and quality control procedure which are well documented should be established in the department.KEYWORDS: Rejected films, reasons for rejection, reject rate, Cost implicatio

Lumbo-Costo-Vertebral Syndrome with Congenital Lumbar Hernia: Case Report

Background: Lumbo-costo-vertebral syndrome is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall.Case: We present a case of Lumbo-costo-vertebral syndrome in a 6-month old female infant who had a progressive swelling over the right lumbar area since birth. Clinical examination revealed a reducible swelling on the right flank with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the right lumbar region. Chest X-ray revealed scoliosis and hemivertebrae with absent lower ribs on the right side. Computer tomography scan showed hernia sac containing the bowel and the right lobe of the liver with cross fused kidney.Conclusion; Lumbo-costo-vertebraly syndrome is a rare condtion which could be associated with different organ malformations. Simple closure or meshplasty could be done depending on the size of the defect

Assessment of pediatrics radiation dose from routine x-ray examination at Jimma University Hospital, Southwest Ethiopia

Background: Given the fact that children are more sensitive to ionizing radiation than adults,with an increased risk of developing radiation-induced cancer,special care should be taken when they undergo X-ray examinations. The main aim of the current study was to determine Entrance Surface Dose (ESD) to pediatric patients arising from routine x-ray examination in the Radiology Department of Jimma University Specialized Hospital (JUSH).Methods: Descriptive cross-sectional study was conducted on pediatric patients less than 15 years of age who visited to seek x-ray examinations in JUSH. In this study, chest (AP), skull (AP), Abdomen (AP) and Pelvic (AP) x-ray examinations were analyzed. Radiographic exposure factors were recorded in each examination. ESD was calculated using exposure parameters. The calculated ESD values were weighed against the Diagnostic Reference Level (DRL) recommended doses and similar published studies. Comparison was made among different age groups through mean comparison.Result: The obtained ESD values were mostly higher than the values in internationally published studies and DRL for all age groups. For chest AP, the mean ESD values were 1.82mGy which is higher than similar studies in Nigeria (0.642Mgy), Brazil (o.o62mGy) and NRPB (0.050mGy) for ages of 0-1 years.Conclusion: The higher pediatric patient dose obtained in this study is a further indicator that doses delivered to pediatric patients are not according to ALARA principle, and there is a need to optimize service and patients’ radiation exposure in JUSH in particular and in Ethiopia in general.Keywords: Pediatrics, Radiation Dose, Exposure Parameters, X-ray, Jimma, Ethiopi

Leech in the Rectum Causing Lower GI Bleeding in a Four Years Old Child: A Case Report

BACKGROUND፡ Leeches belong to a group of annelids of the class Hirudinea which are blood feeding ecto-parasites of humans, wild animals and domesticated animals. A leech can suck out as much blood as ten times its own weight. Leech can occur at different sites in humans commonly in the eyes, nasopharynx, larynx, urethra, and vagina and rarely in the rectum.CASE DETAILS: This is a four years old male child who presented with painless, bright red rectal bleeding for two weeks. Heamatocrit was 9.2%. Leech was removed from the rectum by letting the child sit on a bucket of water. The patient was transfused, followed for 24 hours and discharged with iron sulphate syrup.CONCLUSION: Leech infestation should be considered in the differential diagnosis of a child presenting with hematochezia

Aphalia: An Extremely Rare Congenital Genitourinary Malformation-A Case Report

BACKGROUND: Congenital aphalia is an extremely rare, urogenital malformation of the external genitalia characterized by congenitally absent penis in a karotypically XY child. It occurs 1 in 30 million live births.So far, only less than 100 cases have been reported.CASE DETAILS: A 3-hour old newborn was diagnosed with aphalia after being referred from health center for respiratory distress and congenital malformation of the external genitalia. He had deranged renal function tests, hypoplastic kidneys, small patent foramen ovale and ventricular septal defect. Management of the acute conditions and parental counseling were done, but he passed away on the 8th day of life, due to the underlying diseases.CONCLUSION: A patient with aphalia needs thorough evaluation for possible associated malformations. Management is multistaged and multidisciplinary. Parental counselling should be started as early as possible, and their decision should be respected

Parents’ Knowledge of Danger Signs and Health Seeking Behavior in Newborn and Young Infant Illness in Tiro Afeta District, Southwest Ethiopia: A Community-based Study

BACKGROUND: Neonatal mortality rates in Ethiopia are among the highest in the world. Reducing neonatal and young infant mortality highly relies on early recognition of symptoms and appropriate care-seeking behavior of parents/care givers. The main aim of this study was to assess the knowledge of danger signs and health seeking behavior of parents/care givers in newborn and young infant illness in Southwest Ethiopia.METHODS: A community-based cross-sectional study was conducted using cluster sampling technique to get 422 samples of parents/care givers who had infants of less than 6 month old. Data was collected through face-to-face interviews using structured questionnaire. Logistic regression was used to identify factors affecting care seeking behavior and knowledge of parents/care givers on newborn and young infant illness.RESULT: Care seeking behavior for newborn and young infant illness was high (83%), the major factor associated with care seeking behavior being place of delivery. Only less than half of the respondents had adequate knowledge of symptoms of illness of newborns and young infants. The major factors associated with knowledge of parents/care givers were maternal education and  paternal education.CONCLUSIONS: To improve the knowledge of parents/care giversabout newborn and young infant illness, counseling about the major symptoms of newborn and young infant illness should be intensified.KEYWORDS: Neonatal illness, care seeking behavior, new born,knowledg

Variation of Ultrasonic Renal Volume between Hypertensive and Non-Hypertensive Individuals in Relation to Body Size Parameters

BACKGROUND፡ Estimation of renal size is vital for the diagnosis of abnormal structural change on the kidneys due to the adverse effects of chronic diseases like hypertension. This study evaluated renal volume by ultrasound in relation to body size parameters, notably body mass index (BMI) and body surface area(BSA) in hypertensive and non-hypertensive individuals.METHODS: A hospital-based comparative cross-sectional study was conducted from February to September 2018 at the Radiology department of the Jimma University Medical Center (JUMC). The study included consecutively selected samples of 85ambulatory hypertensive patients and 60non-hypertensive controls recruited consecutively on voluntary basis. After receiving verbal consent, each subject underwent abdominal ultrasound examination and length, width and thickness of both kidneys were measured and used for estimation of renal volume. The statistical evaluation included independent samples t-tests for mean differences with regard to ultrasonic renal measurements between hypertensive and non-hypertensive groups.RESULTS: A total of 145 adults aged 16 - 80 years (mean ±SD=44 ±17) participated in the study. In the hypertensive group, mean renal volume of 97.7cm3 for the right kidney and104.4cm3 for the left kidney whereas in the control group, it was 101.1cm3 for the right and 111.8 cm3 for the left kidney. The mean right renal volume to BSA ratio was 58.2cm3/m2 in hypertensive group, while it was 62.6cm3/m2 among the control group (p=0.076). The mean left renal volume to BSA of the patients was 62.2cm3/m2 and significantly (p=0.012) lower than that of the non-hypertensive group, which was 69.3 cm3/m2.CONCLUSION: Slightly smaller bilateral renal volume among hypertensive patients as compared the controls was obtained

Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia

BACKGROUND፡ Abnormal blood glucose level is one of the most frequently encountered problems in children with severe illnesses. However, its magnitude and outcome have rarely been determined in Ethiopia. We aimed to determine the magnitude, associated factors and outcome of dysglycemia in critically ill children admitted to Jimma Medical Center.METHODS: Prospective longitudinal study was conducted on children aged 28 days to 14 years admitted with critical illnesses at the different units of the Department of Pediatrics and Child Health of Jimma Medical Center, Southwest Ethiopia, from June to August 2019. Data were collected by trained medical personnel using structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) windows version 20.0. Dysglycemia was considered whenever the child had a random blood sugar >150mg/dl or <45mg/dl.RESULT: Dysglycemia was seen at admission in 139/481, 28.9% children; 24 (5.0%) had hypoglycemia whereas 115 (23.9%) had hyperglycemia. The factors associated with dysglycemia at admission were severe acute malnutrition (p=002, AOR=3.09, CI=1.18,7.77), impaired mental status (p=0.003, AOR=4.63, CI=1.68, 12.71), place of residence (p=0.01, AOR=1.85, CI=1.15-2.96) and presence of diarrhea on date of admission. Among the children who had dysglycemia at admission, 16/139, 11.5% died.CONCLUSION: Dysglycemia is a common problem in critically ill children in the setting. Blood glucose level should be determined for all critically ill children, and routine empirical administration of dextrose should be minimized since most of the children with dysglycemia had hyperglycemia than hypoglycemia

The cost of suspected and confirmed bacterial meningitis cases treated at Jimma University Medical Center, Ethiopia

BACKGROUND: Infections of the central nervous system (CNS) such as meningitis or encephalitis can be caused by myriad of microorganisms and may be life-threatening. In Ethiopia, it is an important cause of premature death and disability, being the 9th most common cause of years of life lost and loss of disability adjusted life years. The objective of this study was to estimate the cost of suspected and confirmed bacterial meningitis among inpatient managed patients at JUMC.METHODS: A facility-based cross-sectional study was conducted from July 28 to September 12, 2018. A semi-structured questionnaire was used in this study. Checklists were used to collect the types of laboratory tests performed and prescribed medications. This cost of illness study was conducted from the patient perspectives. We employed a micro-costing bottom-up approach to estimate the direct cost of meningitis. The humancapital approach was used for estimating wages lost.RESULT: Among total patients admitted and treated in JUMC, higher proportions (69.8%) were suspected bacterial meningitis but have been treated as confirmed cases. Total median costs for both suspected and confirmed bacterial meningitis patients were estimated to be ETB 98,812.32 (US $3,593.2; IQR 1,303.0 to 5,734.0). Total median direct cost was ETB 79,248.02 (US$2,881.75; IQR 890.7 to 3,576.7). Moreover, 45.3% of the patients reported that they were either admitted or given medication at JUMC or nearby health facility before their current admissions.CONCLUSION: These findings indicate that most cases of bacterial meningitis were treated only empirically, and the cost of the treatment was high, especially for resource-limited countries like Ethiopia. To minimize the burden of meningitis and avoid unnecessary hospitalizations, the availability of diagnostic techniques is vitally important

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia

BACKGROUND፡ Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia.METHODS: A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization’s case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected.RESULTS: Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%;164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria.CONCLUSION: Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia