The Role of Current Emergency Radiology Practice: A prospective Cross-sectional Study Done at Tikur Anbessa Specialized Hospital

Background: The role of radiogy in the management of emergency  patients is tremendous. Which imaging modality best evaluates specific clinical emergencies has evolved and continues to advance with clinical practice trends. The purpose of this study was to show the role of radiology in emergency patient handeling and compare specific clinical entities with the standard.Methods: A prospective cross sectional study was done to describe the pattern of duty hour emergency utilization at Tikur Anbessa Hospital Department of Radiology. A total of 384 patient’s data were collected for the period of Jananuary 1st to April 30th 2010. The data which weredemographic variables, clinical diagnosis, radiologic diagnosis, type of investigation used, type of anatomic area imaged, whether primary investigation used or not, recommendations made by the radiology residents were collected and tabulated.Results: There were 242 (63%) males and 142 (37%) females. Suspected fracture was the commonest clinical indication for referring patients to the department of radiology at the duty hours and accounted for 40.9% of all cases. Otherclinical diagnoses included pnumonia (21.6%), blunt  abdominal trauma (5.7%) and pulmonary edema (4.7%). Plain  radiographs were taken in 88% of patients sent for imaging. Among the sonographic studies done, 43.4% were for patients presenting with blunt abdominal trauma. Of all patients in 90.4% primary investigative  modalities were used. Comparison of clinical and radiologic diagnosis was made in most common clinical cases and in general 51.3% of radiologic interpretations were normal.Conclusion: Plain radiography was used as the cornerstone investigative modality for emergency imaging. Fracture and pneumonia constituted the commonest indications for emergency imaging in all age groups. Over half of radiologic investigations were normal. It was observed that lack ofappropriate investigative modalities such as CT scan, doppler and high frequency ultrasonography greatly affected the quality of service the department offered and also negatively affected the training process.Key words: Emergency, Radiology, Practic

Lessons from the evolution of human resources for health in Ethiopia: 1941-2010

Human resources for health (HRH) policy and planning is highly challenging in any setting but the more so in underdeveloped countries. Ethiopia has relatively vast and distinctive experience in accelerated training, use of substitute categories/task-shifting… from which important lessons could be drawn.Based on thorough analysis of documents (official, unofficial, government and others) and 1st hand experience of the authors, the paper explores the major issues in HRH development between 1941 – end of the Italian Occupation - and 2010 – end of the Health Sector Development Program (HSDP) III.The socio-cultural and economic context; development in education, higher education in particular and the general human resources development policy, strategy and plans in the successive periods are assessed briefly.Major developments of• Reconstruction and Basic Health Services Period (1941-1974): the successive five-year plans; the training of orderlies/dressers, the 1st nursing schools, training abroad…; the Gondar Public Health College and the Gondar Team; the beginnings of medical education …• Primary Health Care Period (1974-1991) the Ten Years Perspective Health Plan; the training of Community Health Workers - Community Health Agents and Trained Traditional Birth Attendants -, nurse practitioners, health assistants; discontinuation of the health officers (HO) training, the initiation of Jimma College of Health Sciences and of post-graduate training in medicine at the Faculty of Medicine Addis Ababa University…• Sector-Wide Approach Period (1991-2010) the Health Sector Development Programs I-III, the reintroduction of Health Officers training, the accelerated training/‘Flooding Strategy’, Health Extension Workers, retention/‘Brain-Drain’ of health workers…are explored in some depth and lessons drawn for future HRH development in the country.The conclusions underscore the laudable efforts in all periods but difficulties of learning from the past; the continued very low workforce density and the highly skewed distribution; the recurring challenges of sustained human resources development – quality, motivation, retention… - of the task-shifting and accelerated training attempts and the need to develop specific HRH policy and strategy

Smallholder-based fruit seedling supply system for sustainable fruit production in Ethiopia: lessons from the IPMS experience

Ethiopia has a diverse agroecology and many areas are suitable for growing temperate, subtropical or tropical fruits. Substantial areas receive sufficient rainfall and many lakes, rivers and streams could also be used to support fruit production. Despite this potential, the total land area under fruits is very small and mainly smallholder-based. According to the Ministry of Agriculture and Rural Development (MoARD), the area under fruits is about 43,500 ha with a total annual production of about 261,000 metric tonnes of which less than 2% is exported. Many supply and demand reasons are associated with the poor performance of the sub-sector including technical, organisational and institutional factors. The lack of sufficient supply of planting materials of improved fruit varieties/cultivars and accompanying knowledge were identified as key constraints during a participatory rural appraisal (PRA) study conducted by the IPMS project in 2005. This is because the source of planting materials for tropical, sub-tropical improved and temperate fruits are limited to a few mostly government operated sites, which are located far away from potential planting places. To alleviate this problem, IPMS in collaboration with district Offices of Agriculture and Rural Development (OoARD) initiated smallholder farmer-based improved fruit seedling supply system in many of its project districts. This initially required the establishment of improved mother trees and farmer capacity building on nursery and fruit tree management, among others. The objective of this paper is, to share the IPMS experiences in the establishment of sustainable farmer-based improved fruit seedling supply system which contributed to the improvement of livelihoods of many farmers. Nursery operators earned between 100 and 11,000 USD equivalent from sale of seedlings/suckers or fruits in a season. The lessons learnt indicate that farmer-based fruit nurseries a) can be established by linking the right public and private sector actors for knowledge, skills development and input supply b) are cost effective compared to the current suppliers, in most cases c) convinced all actors that farmers can handle the seemingly difficult grafting/budding techniques d) created employment opportunities for the landless youth, individual male and female farmers, e) generates a significant income for nursery operators, f) reduce transport cost of the seedlings significantly. This paper also uses a spatial analysis tool, DIVA-GIS software, to analyse likelihood of adaptability of four fruit species to a wider area within the study districts and the likely production potential and value

Primaquine in vivax malaria: an update and review on management issues

Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. It has remained the only FDA licensed drug capable of clearing the intra-hepatic schizonts and hypnozoites of Plasmodium vivax. This update and review focuses on five major aspects of primaquine use in treatment of vivax malaria, namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use, c) critical analysis of reported resistance against primaquine containing regimens; d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance; and e) the potential for replacement of primaquine with newer drugs