Truncal Vagotomy for Peptic Pyloric Stenosis and Assessment of Completeness by Acid Tests

Background: Several types of operations are used for Peptic pyloric stenosis (PPS) which includes Vagotomy with antrectomy or drainage procedures. This study was done primarily to analyze the completeness of Truncal vagotomy (TV) by gastric acid secretion tests. The secondary analyses included demographic, clinical profile and out come of the operation.Methods: From December 27/2004 to June 26/2006, 32 consecutive patients, aged 10 to 65 years underwent trans-abdominal (TV) and Posterior Gastrojejunostomy for PPS at Glen C. Olsen memorial hospital. TV without mobilizing and encircling the esophagus. Prospective longitudinal case serial analysis was done to assess the completeness of TV. Outcome measures used for assessment were the pre-operative basal acid output (BAO), Post-operative BAO, Postoperative sham feeding acid out put (SAO) and other relevant clinical characteristics.Results: After surgery, the average pre-operative BAO had decreased from 6.07+/- 2.7mmol/hour to 0.42+/-0.29mmol/hour. The BAO was decreased by 91.3%. Mean peak acid response after TV to SAO was 0.83+/- 0.45mmol/hour. The difference between the peak 15minutes out put of SAO and lowest 15 minutes out put of post-operative BAO did not exceed 0.6mmol in 30/32 patients. This shows that TV was complete in 93.7%. There was no operative mortality and clinically significant post-operative complication developed in only three patients.Conclusion: Trans-abdominal TV done without mobilizing and encircling the esophagus was found safe and effective means of reducing acid secretion for patients with long standing peptic pyloric stenosis

A 3- Year Review of Patients with Chronic Empyema Treated Surgically at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Background: Empyema thoracic is one of the main causes of morbidity and mortality in developing countries. This study was aimed at determining the causes, clinical presentation, outcomes of surgical intervention and variables associated with adverse outcomes in patients with chronic empyema treated surgically. Methods: This was a cross sectional hospital based longitudinal case series analysis done at Tikur Anbessa Specialized referral hospital, Addis Ababa, Ethiopia. All patients admitted and operated for chronic Empyema over a period of three year. (April 01, 2011 - March 30, 2014) were studied. Results: A total of 62 patients were operated for empyema thoracis. The Male to female ratio was 5.9:1 and mean age at presentation was 29.96+/-10.6 years. Patients presented after an average of 8.02 +/- 4.37 months from the onset of symptoms (range from 1-16 months). Shortness of breath 43(69.4%), cough 43(69.4%), chest pain 47(75.8%), fever 30(48.4%), weight loss 21(33.9%) poor appetite 9(14.5%) and haemoptysis 1(1.6%) were the leading causes of symptoms on admission. Thirty seven (59.7%) patients were previously treated for tuberculosis, 11 (17.7%) had pneumonia and 53(85.5%) of them gave history of trauma. The right {32(51.6%)} and left pleural space, {29(46.8%)} were affected with similar incidence. Only one patient was admitted with bilateral empyema. In the majority of patients, 46(74.2%), open thoracotomy with abscess drainage and decortications were done. In addition to this, either lobectomy or pnemonectomy was done for 4 (6.5%) and 7 (11.3%) patients respectively. Three patients were treated by rib resection and open drainage. The average post-operative hospital stay was 12 days (range 3 - 63days). Major complications encounter were lung laceration 15(24.2%), BPF 8(12.9), recurrent empyema 10(16.1%), and persistent air space 14(22.6%). Two (3.2%) patients died in their hospital stay. During follow up visits, 52(83.9%) patients had shown significant subjective improvement of symptoms. Conclusion: In general, our experience on the outcome of open thoracotomy and decortication done for chronic empyema was excellent with low mortality and very good Functional results as majority of patients either returned to normal activities or showed significant improvement of symptoms.Key words: Chronic Empyema, Decortication, Bronchopleural fistul

Trauma in Ethiopia Revisited: A systematic Review

Background: This is a systematic review on trauma/injury incidents which has tried to examine the variety of socio-demographic, vehicular,  environmental, and behavioral factors that are associated with injury and its outcome across different settings.Data Sources: Electronic searches for trauma/injuries from peer-reviewed literature and websites from 1960 to August 2013.Study Selection: 36 studies met the study inclusion criteria.Data Extraction: A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables.Results: A higher proportion of injury was found in economically active age groups of 15-59 years (Range 56.4 %–80%) across all studies. Similarly majority of the articles reported a higher proportion (Mostly 2/3rd) of injuries among male than female patients (range 53.9 %-91.2 %). Eventhough in all studies injuries were a concern for every population, some studies [12, 13, 15, and, 29] showed a higher incidence among farmers, students and house wife that other occupation. Unintentional injuries were the primary cause for the majority of injury-related reports made withthe weighted pool average percentage of 60.7% (range from 44.6 %11 to 98%20). MVIs were the leading cause of injury among lists of unintentional injuries followed by Falls (16%) machine/tools injury (5.9%), burn (5.3%), poisoning (1.0%) and Animal bite (1.3%). Trauma from interpersonalviolence (Homicide) is the leading causes of intentional injury (24.4%) reported followed by disproportionately low incidence of Fire arm(5%) and Self-harm injuries( 2.1%). Nine of the 36 articles reported percentage distribution of Mortality by Mechanism of injury and the rates of deathfrom MVIs and homicide are generally higher with an average weighted pool percentage of 37.5% and 24.1% respectively.Conclusion: The review showed injury as a significant cause of morbidity and mortality in Ethiopia. Based on the available data, possible strategies relating to trauma prevention are discussed. Because of the uncertainties about the quality and the absence of some data in certain region of Ethiopia, we recommend a need to more accurately define this burden at a national scale.Key words: Trauma, Injury, Accident, Ethiopi

Pattern of Injury and Associated Variables as Seen in the Emergency Department at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Background: Traumatic injuries represent a significant and growing disease burden in the developing world, and now represent one of the leading causes of death in economically active adults in many low- and middle-income countries. This study was aimed at determining the patternof injuries and variables associated among patients visiting Emergency Department (ED) due to injury at Black Lion Hospital, Addis Ababa, Ethiopia.Methods: This was a prospective cross sectional hospital based study done with a systematic random sampling method. The study was done in Tikur Anbessa specialized referral hospital. The study was conducted in between February 1 to April 30, 2013. Results: A total of 3287 new patients were seen in the ED, of whom 989 (32.5%) reported to be injury victims, of them 321 patients were included in the study. The M: F ratio is3.58:1.  More than 41% of patients were aged between 20 and 29.The most  frequent cause of injury was Road Traffic Accident (RTAs), 123(38.3%), followed by stuck/hit by a person or object, 101(31.5%), and fall accident 68(21.2%).Further analysis showed that the odds of injury of assault to be increased for males (P= 0.037, AOR, 2.528, 95%CI (1.058-6.037),  patients with monthly income < 650 Ethiopian birr{(P= 0.002, AOR 2.91, 95% CI (1.493-5.705)},and age< 40 years old is significantly associated with injury of assault {(P= 0.004, AOR 3.27, 95%CI(1.451-7.375)}. Injury of assault is 61% less likely to be occurred in rural areas than the urban dwellers {(P= 0.002, AOR 0.39%CI (.219-.707)}.Conclusion: Appropriate interventions to reduce the occurrences of injuries should be instituted by the local authorities and other responsible body. There is also a need to educate the community members particularly risk groups on how to prevent injuries. Key Words: Injury, Variables associated with injury, Emergency departmen

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

Predictors of unintended pregnancy in Kersa, Eastern Ethiopia, 2010

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, little is known about pregnancy among rural women. Proper maternal health care depends on clear understanding of the reproductive health situation. The objective of this study was to identify predictors of unintended pregnancy in rural eastern Ethiopia.</p> <p>Methodology</p> <p>This study was part of pregnancy surveillance at Kersa Demographic Surveillance and Health Research Center, East Ethiopia. Pregnant women were assessed whether their current pregnancy was intended or not. Data were collected by lay interviewers using uniform questionnaire. Odds Ratio, with 95% confidence interval using multiple and multinomial logistic regression were calculated to detect level of significance.</p> <p>Results</p> <p>Unintended pregnancy was reported by 27.9% (578/2072) of the study subjects. Out of which, 440 were mistimed and 138 were not wanted. Unintended pregnancy was associated with family wealth status (OR 1.47; 95% CI 1.14, 1.90), high parity (7 +) (OR 5.18; 95% CI 3.31, 8.12), and a longer estimated time to walk to the nearest health care facility (OR 2.24; 95% CI: 1.49, 3.39).</p> <p>In the multinomial regression, women from poor family reported that their pregnancy was mistimed (OR 1.69; 95% CI 1.27, 2.25). The longer estimated time (80 + minutes) to walk to the nearest health care facility influenced the occurrence of mistimed pregnancy (OR 2.58; 95% CI: 1.65, 4.02). High parity (7+) showed a strong association to mistimed and unwanted pregnancies (OR 3.11; 95% CI 1.87, 5.12) and (OR 14.34; 95% CI 5.72, 35.98), respectively.</p> <p>Conclusions</p> <p>The economy of the family, parity, and walking distance to the nearest health care institution are strong predictors of unintended pregnancy. In order to reduce the high rate of unintended pregnancy Efforts to reach rural women with family planning services should be strengthened.</p

Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh

© 2018 The Author(s). Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions