Hospital Millennium Medical College Research Articles

Knowledge and Attitude Towards Insulin Therapy in Type 2 Diabetes Mellitus Patients and Associated Factors at an Adult Endocrine Clinic of SPHMMC Addis Ababa Ethiopia

<i>Background:</i> Diabetes Mellitus (DM), a chronic disease characterized by elevated blood glucose levels, is associated with severe complications. Type 2 DM (T2DM), the most prevalent form of DM in adults, is characterized by varying degrees of insulin deficiency or resistance. The prevention or delay of macrovascular and microvascular problems associated with DM depends on achieving appropriate glycemic control. The percentage of T2DM patients failing to reach glycemic targets keeps rising even with the expanded availability of numerous anti-hyperglycemic drugs and evidence-based treatment guidelines. The delay in treatment intensification despite inadequate glucose control—often referred to as clinical or therapeutic inertia-contributes significantly to this trend.<i> Objective:</i> This study aims to evaluate the understanding and perceptions of insulin therapy among patients with T2DM. The study focuses on patients under follow-up care at the Adult Endocrine Clinic of St. Paul Hospital Millennium Medical College.<i> Method and Material:</i> An institutional-based, cross-sectional study was carried out from January to March 2021 to evaluate knowledge and attitudes regarding insulin therapy and related factors. A structured questionnaire was used for interviews with a representative sample of 271 T2DM patients who are receiving follow-up care at the endocrine clinic at SPHMMC. The SPSS, version 25, was the software utilized. The statistical significance of the relationship between the dependent and independent variables was assessed using a 95% confidence interval and a p-value less than 0.05.<i> Results:</i> The majority of the respondents were between the ages of 56 and 65, with a mean age of 57.35 years. More than half of the participants, accounting for 231 (85.2%) of the total, were from urban areas. Out of the 271 respondents, approximately 85.6% demonstrated poor knowledge of insulin therapy, and around 37.6% exhibited negative attitudes towards it. Factors such as age, occupation, and a history of long-term Oral Antidiabetic Drug use were found to be associated with the level of knowledge about insulin. In addition to these factors, marital status and a family history of insulin use were found to be associated with patients’ attitudes towards insulin. <i>Conclusions:</i> Our study identified a significant knowledge gap about insulin usage among T2DM patients in the designated study area. We recommend the implementation of regular, structured health education programs, delivered by trained health professionals. This approach is expected to enhance both the knowledge and attitudes toward insulin usage among patients attending follow-up sessions at the SPHMMC diabetic clinic.

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BackgroundDepression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.MethodsA hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul’s Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.ResultsThe mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53–61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30–4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47–6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05–12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97–12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72–10.18).ConclusionsThis study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Prevalence and factors associated with suicidal ideation and attempts among mentally ill patients in the psychiatry OPD at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

BackgroundEvery year, more than 800,000 people die due to suicide (one person every 40 s), ranking as the second leading cause of death next to traffic accidents in individuals aged 15–29 years. The objective of this study was to assess the prevalence and factors associated with suicidal ideation and attempts among mentally ill patients.MethodAn institutional-based, cross-sectional study was conducted between December 2019 and January 2020. Data were collected using a convenient sampling technique until the required sample size was achieved. The total sample size was 385. The Suicidal Behavior Questionnaire-Revised (SBQ-R), Oslo Social Support Scale, and self-prepared to assess suicide were used. Data collection was carried out by psychiatry professionals through face-to face interviews. Data were analyzed, and bivariate and multivariable logistic regression analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 23.ResultA total of 385 patients participated in the study. Of these, 216 (56%) were men. The prevalence of suicide ideation was 255 (66.2%). The odds of suicidal ideation and attempt was almost three times higher [adjusted odds ratio (AOR) = 2.79, 95% confidence interval (CI) 1.11–6.98]; among patients who felt hopeless, the OR was around two times higher (AOR = 2.44, 95% CI 1.17–5.08); among patients who had a family history of suicide, the OR was almost three times higher (AOR = 2.56, 95% CI 1.00–6.53); among patients who stopped their medication, the OR was approximately two times higher (AOR = 2.25, 95% CI 1.14–4.46); the OR of suicidal ideation and attempts was almost six and four times higher (AOR = 5.86, 95% CI 1.30–26.41; and AOR = 3.61, 95% CI 1.01–12.88) among patients who were educated to primary and secondary level, respectively.ConclusionIn this study, carried out in Ethiopia, suicidal ideation and attempts were more common among men than women. The prevalence of suicidal ideation and attempts showed a significant public health issue among hospital-attending and chronic mentally ill adolescents, which requires a large emphasis. We recommend that suicide prevention needs to involve non-governmental and non-profit organizations, universities, and civil society at different levels.

Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors.

Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia. A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI. During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012). HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.

Premature luteinization and pregnancy outcomes in depot goserelin-downregulated assisted reproductive technology cycles: A cross-sectional study from Ethiopia.

To compare the rate of premature luteinization in depot goserelin-downregulated invitro fertilization (IVF) cycles with other IVF protocols at a teaching hospital in Ethiopia. We conducted a cross-sectional study on the effects of premature luteinization on IVF outcomes at St. Paul's Hospital Millennium Medical College, a tertiary teaching hospital in Ethiopia. Patients who had IVF at this hospital between 2019 and 2020 were included in the study. Patient records were reviewed and collected on Open Data Kit. We used Stata release 15 to analyze the data. A simple descriptive analysis and bivariate analysis were performed as appropriate. A P-value less than 0.05 was considered asstatistically significant. A total of 305 patients (40 cases with premature luteinization and 265 without premature luteinization) were included. There was no difference in the rate of premature luteinization in the depot goserelin long protocol cycles (6.4%), compared to minimal stimulation (14.1%) and antagonist protocols (16.7%), P = 0.19. Embryo transfer was carried out in 27 (67.5%) patients in the premature luteinization group, which was lower than the 86.0% (228/265) in the non-premature luteinization group, P = 0.003. There was no difference in the median number of oocytes retrieved (8.5 [interquartile range 5.0, 13.0] per cycle in the premature luteinization group vs 5.0 [interquartile range 3.0, 10.0] in those without premature luteinization, P = 0.10). A depot goserelin-downregulated long protocol for IVF is a cost-effective and convenient option for controlled ovarian hyperstimulation without increased risk of having premature luteinization compared to antagonist and minimal stimulation protocols.

Palliative care service utilization and associated factors among cancer patients at oncology units of public hospitals in Addis Ababa, Ethiopia.

Palliative care helps patients and their families deal with the hardships that come with a life-threatening illness. However, patients were not fully utilizing the palliative care services provided by healthcare facilities for a number of reasons. In Ethiopia, there hasn't been any research done on the variables that influence the utilization of palliative care services. To assess palliative care service utilization & associated factors affecting cancer patients at public hospitals oncology units in Addis Ababa, Ethiopia. An institution-based cross-sectional study design was carried out. A structured and pre-tested questionnaire was administered to 404 participants at Tikur Anbesa Specialized Hospital and Saint Paul's Hospital Millennium Medical College from July 4 to August 2, 2022. A systematic random sampling technique was used to select the study participants. The data was collected by ODK-Collect version 3.5 software and exported to excel and then to SPSS version 25 for recoding, cleaning, and analysis. Logistic regression model was employed. P-values <0.05 were regarded as statistically significant. About 404 participants' responded questionnaire giving a 97.6% response rate. The extent of Palliative care service utilization was 35.4% [95% CI: 31.4, 40.3%]. College or university education were 2.3 times more likely and living in a distance of <23 km from PC service centers were 1.8 times more likely to use palliative care services. Factors hindering palliative care service utilization were inability to read & write, treatment side effects, long distance to a health institution, and low satisfaction with the health care service. The extent of palliative care service utilization which was low. Factors to palliative care service utilization were clients' education level, treatment side effects, distance to a health institution, and patients' satisfaction. Interventions to enhance health education and counseling of cancer patients, early detection and management of treatment side effects and accessibility of palliative care services for cancer patients should be emphasized and implemented by all concerned stakeholders.

Treatment outcome and survival status among adult patients treated for lupus nephritis in selected tertiary hospitals of Ethiopia

Lupus nephritis (LN) is kidney involvement of systematic lupus erythematous that ranges from mild to severe and occurs in 60% of adult patients. Despite advances in therapy, LN morbidity and mortality remains high. There is a paucity of data regarding adult LN patient's treatment outcome, survival status, and associated factors in developing countries, particularly in Ethiopia. This study aimed to assess the treatment outcome, survival status, and associated factors of adult patients treated for LN in two selected tertiary hospitals [Tikur Anbessa Specialized Hospital (TASH) and St. Paul’s Hospital Millennium Medical College (SPHMMC)] of Addis Ababa, Ethiopia. A hospital-based retrospective cross-sectional multicenter study was conducted from January 1, 2016 to January 1, 2021. Socio-demographic, clinical, and treatment-related data were collected from patient’s medical records by using a structured abstraction checklist. Descriptive statistics were used to summarize the quantitative data as appropriate. The modified Aspreva Lupus Management Study (mALMS) criteria was applied to categorize LN treatment outcomes into complete, partial, and non-response. Multinomial logistic regression analysis was performed to identify predictors of LN treatment outcome. Patients’ survival was estimated by using Kaplan–Meier and Cox proportion regression analysis. P value < 0.05 was considered to declare statistical significance. A total of 200 LN patients were included in the final analysis. Amongst these, the majority of them (91.5%) were females. The median age of the patients was 28 (15–60) years. The mean duration of treatment follow-up was 28 months. The commonly prescribed immunosuppressive drugs during both the induction (49.5%) and maintenance (60%) phases were a combination of mycophenolate mofetil with prednisolone. Complete, partial, and non-responses at the last follow-up visit accounted for 66.5%, 18.0%, and 15.5%, respectively. Patient survival at the last follow-up visit was more than 90% for patients with complete response to the induction therapy. Non-response at the last follow-up visit was significantly associated with severe disease activity index (adjusted odds ratio [AOR] = 6.25, 95% confidence interval [CI] 1.49–26.10), presence of comorbidity (AOR = 0.21, 95% CI 0.05–0.92), baseline leucopenia (AOR = 14.2, 95% CI 1.04–201.3), partial response at the end of induction therapy (AOR = 32.63, 95% CI 1.4–736.0), and duration of induction therapy of greater than 6 months (AOR = 19.47, 95% CI 1.5–258.8). This study unveiled that lower numbers of LN patients were presented with non-response at the last follow-up visit and non-response to induction therapy was associated with lower patients’ survival rates compared with complete or partial response.

2,4- Dichlorophenoxyacetic acid poisoning in St.Paul’s hospital millennium medical college: A case report

Background: 2,4-Dichlorphenoxyacetic acid (2,4-D) is an extremely lethal toxin.Poisoned patients should get urine alkalization &amp; early hemodialysis in addition to supportive care.This report aimed to explain the diagnosis, treatment, and challenges.Case presentation: we reported a case of a 20-year-old male patient who presentedto the ED after he ingested an unspecified amount of 2,4-D herbicide &amp; lostconsciousness for about 16 hours duration. Associated with this was frequentvomiting of unspecified amounts of ingested matter.Conclusion: Delayed presentation to the ED &amp; delayed hemodialysis had a negativeeffect on patient outcome.

Pattern, Outcome and Associated Factors of Oncologic Emergencies Among Patients Visiting Saint Paul ‘s Hospital Millennium Medical College Adult Emergency Department: One Year Cross Sectional Study

Introduction: Cancer patients are at high risk of developing a wide range of medicalemergencies.Patients with cancer face unique disease and treatment-related complications that promptfrequent visits to the emergency department (ED), constituting a significant patient andhealth care burden, resulting in more utilization of resources and ED overcrowding, whichmay hamper the administration of quality and focused care.Objective: The study aimed to assess the patterns, outcomes, and associated factors ofoncologic emergencies among patients visiting Saint Paul's Hospital Millennium MedicalCollege adult emergency department from March 1/2021, to April 30/2022.Methods: A retrospective institutional-based cross-sectional study was used. Data wascollected using a standardized data extraction tool by trained data collectors from patientmedical records and health management information system registry books using asystematic sampling method. A total of 173 cancer patients were included. Data wasanalyzed using SPSS version 25.0.Results: A total of 173 cancer patients were included in the study. The mean age of thestudy participants was 53.05 ± 14.801 years. 56.6% were females, and 43.4% were males.The most prevalent primary tumors were those of the gastrointestinal tract (49.7%) andgenitourinary system (19.1%). About 39.9% of the cases had metastasis. Only 39.3% ofcases started cancer treatment. Oncologic emergencies account for 68.8% of the cases. Themost frequently observed oncologic emergencies were structural (Mass effect) in 64.7% ofcases and hematologic emergencies in 34.45%. About 19.3% of patients with oncologicemergencies have died. The commonest cause of death was due to Gastrointestinalmalignancies, seen in 34.6% of the cases. Those with Hematologic Emergencies had a 4.2times risk of death as compared to patients with local mass effects (P value &lt; 0.006).Conclusion: Oncologic emergencies comprised 68.8% of the cases, of which 19.3% resultedin mortality. There should be a well-organized system with chemotherapy, radiotherapy,and palliative care facility service for patients with oncologic emergencies to reduce patientmortality.

Prevalence and associated factors of hearing loss among patients visiting St. Paul’s Hospital Millennium Medical College, Ethiopia

Background: Globally, 5% of the population is estimated to have disabling hearing loss (HL) requiring rehabilitation. By 2050, over 700 million people, or 1 in 10 people, will have HL. HL can happen during different lifetimes, but the prevalence of HL increases with age. Over 25% of people older than 60 are affected by disabling HL. WHO estimates that 1.1 billion young people are at risk of HL due to unsafe hearing practices. Objective: To assess the prevalence and associated factors of HL among patients visiting St. Paul’s Hospital and Millennium Medical College. Materials and Method: a descriptive cross-sectional study conducted from August 1st to 30th, 2023. Data was collected from 352 participants using an interviewer-administered questionnaire by systematic sampling technique. Data was checked for completeness, cleared, entered into Epi-Info, and exported to Statistical Package for Social Science (SPSS) version 25. Bivariate and multivariate logistic regression analyses were conducted, and the statistical association between variables was described using a p-value of &lt; 0.05. Result: Of all study participants, 213 (60.5%) were male; the mean age and standard deviation were 35.36 + 17.03 years; and 199 (56.5%) had a different degree of hearing loss. Mild, moderate, severe, and profound hearing loss were recorded among 17%, 20%, 15%, and 4% of the respondents, respectively. Factors of hearing loss were age group, occupation, hearing difficulty, noisy work exposure, drinking alcohol, and Khat chewing. Conclusion: The overall prevalence of hearing loss was very high, and preventive interventions like improving knowledge on risk factors, ensuring a safe working environment, and avoiding chewing Khat for the at-risk population were recommended.

Outcome of HIV exposed infants towards prevention of mother to child transmission (PMTCT) program and its associated factors in selected health facilities of Addis Ababa, Ethiopia, 2020. Retrospective cross sectional study

BackgroundGlobally, an estimated 36.9 million (31.1–43.9 million) people were living with HIV in 2017, of whom 17.8 million were women and 1.8 million (1.3–2.4 million) children under 15 years of age. Ethiopia has developed an HIV/AIDS prevention, care, and treatment strategic plan in an investment case approach that has been implemented from 2015 to 2020. The study aim was to assess the outcome and risk factors for HIV-exposed infants receiving Prevention of Mother to Child Transmission (PMTCT) follow-up. MethodA cross-sectional retrospective study was done. All HIV-exposed infants who were on follow-up in the ART and (PMTCT) clinics of St Paul’s Hospital Millennium Medical College, Yekatit 12 Hospital Medical College, and Selam Health Center beginning from September 2016 to January 2019 were included. Data collection was done using a well-designed questionnaire and a review of mothers’ and infants’ medical record charts and HMIS log book. Descriptive and logistic regression analysis was performed to assess the association between dependent and independent variables. Differences are considered statistically significant at p < 0.05, and their strength is presented using an odds ratio and 95% confidence interval. ResultAmong the 302 enrolled HIV-exposed infants, 27 (8.9%) were diagnosed as HIV positive. Maternal ART initiation during labor and delivery (AOR = 3.468, 95% CI: 1.22, 13.34, p = 0.04), frequent hospital admission of the infant (AOR = 17.49, 95% CI: 5.41, 56.2, p = 0.001), and mixed feeding option (AOR = 8.25, 95% CI: 2.212, 30.77, p = 0.02) were the major factors associated with positive HIV serostatus among HIV-exposed infants. Conclusionand Recommendation: The level of HIV infection among infants born to HIV-positive mothers is high as compared to the national and WHO goals. Exclusive breastfeeding should be advocated for all HIV-exposed infants, especially in resource-limited settings like Ethiopia due to the increased prevalence of diarrheal illness.

Assessment of the hematological profile of children with chronic kidney disease on follow-up at St. Paul’s Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia

BackgroundChronic kidney disease (CKD) is a major public health issue with an increasing incidence and prevalence worldwide. In CKD, hematological parameters are influenced, and the effect increases with CKD stage. Thus, the aim of this study was to assess hematological profile of children with CKD on follow up at Tikur Anbessa Specialized Hospital and St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia.MethodsA cross-sectional study was carried out from March 1 to June 30, 2021 among 238 children with CKD. EDTA tubes were used to collect 4 ml blood samples, which were then examined by Beckman Coulter automated hematology analyzer. SPSS Version 20 was used for statistical analysis, and a bivariate and multivariate regression model were applied to assess correlations. Mean and standard deviation was used to determine hematological profiles.ResultsThe total number of patients in the study were 238, with 42 (59.7%) of them being men. The majority of the patients (81%) had CKD stage 1. Mean ± standard deviation determined for white blood cell (WBC) parameters in (thousand/µL); WBC, Neutrophil, Lymphocytes, Eosinophil, Monocytes and Basophil were 8.93 ± 3.32, 4.6 ± 8.31, 2.79 ± 1.62, 0.31 ± 0.51, 0.50 ± 3.03 and 0.03 ± 0.24, respectively. For some of red blood cell (RBC) parameters; RBC (million/ µL), Hemoglobin (Hgb) (g/dL), Hematocrit (Hct) (%) and Mean cell volume (fl.) were 4.73 ± 0.87, 12.82 ± 2.76, 38.28 ± 7.53 and 80.32 ± 7.89, respectively. For the platelet count (PLT) (thousand/µL) and Mean Platelet volume (MPV) (fL) 349.34 ± 130.18 and 9.03 ± 4.31 were determined, respectively. This study also found hematologic parameters such as RBC, HGB, HCT and MPV were found to be positively correlated with eGFR with a P-value < 0.05 for all parameters.ConclusionThe study found that the majority of study participants were in stages 1 to 3 based on their estimated glomerular filtration rate (eGFR). Some of hematological parameters found to have positive correlation with eGFR. There is a need to improve multiple aspects of CKD management, including routine hematological tests for children with chronic kidney disease.

Second-trimester dilatation and evacuation: Comparison of routine intraoperative ultrasonography versus problem-based intraoperative ultrasonography in reducing procedure-related complications: A pre-post study.

To investigate whether routine intraoperative ultrasonographic guidance during second-trimester dilatation and evacuation (D&E) reduces procedure-related complications in an Ethiopian setting. We conducted a pre-post study on routine ultrasonography during second-trimester D&E at St. Paul's Hospital Millennium Medical College (Ethiopia). Second-trimester D&E cases that were managed at the hospital between 2017 and 2022 were retrospectively analyzed by grouping them into an intervention group (using routine ultrasound intraoperatively for all cases) and a non-intervention group (problem-based intraoperative use of ultrasound, where ultrasound was used in problem cases only). SPSS version 23 was used for analysis and simple descriptive statistics, χ2 test, multivariate regression analysis, and Fisher exact test were performed as appropriate. Pvalues less than 0.05 and odds ratio with 95% CIwere used to present the results' significance. A total of 242 second-trimester D&E cases were analyzed (84 cases managed under routine intraoperative ultrasound guidance and 158 cases managed with a problem-based intraoperative use of ultrasound). Compared with problem-based intraoperative use of ultrasound (using it only in selected cases), routine intraoperative ultrasound use was not associated with a decrease in D&E complications (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.04-1.16). The two factors associated with increased D&E procedure complications were advanced gestational age (aOR 13.52, 95% CI 1.86-98.52), and need for additional mechanical cervical dilatation during the D&E procedure (aOR 9.53, 95% CI 1.32-69.07). Provider experience, cervical preparation methods (laminaria vs Foley), and maternal age were not associated with occurrence of D&E complications. Our study does not support the preference of routine intraoperative ultrasound guidance over problem-based (in selected cases) intraoperative ultrasound use during the second-trimester D&E procedure. More research is needed to make a strong clinical recommendation on using routine intraoperative ultrasound guidance during all second-trimester D&E procedures.

Utilization of third-trimester fetal transcerebellar diameter measurement for gestational age estimation: a comparative study using Bland-Altman analysis

BackgroundSeveral studies show that gestational estimation during third trimester using fetal transcerbellar diameter (TCD) is superior to that measured by fetal biometry (BPD, HC, AC, and FL). However, the conclusions of studies stem from findings of correlation and regression statistical tests, which is not the recommended statistical analysis method for comparing the values of one variable as measured by two different methods. ObjectiveTo compare the accuracy of gestational age estimation by TCD to that by fetal biometry during the third trimester using Bland-Altman statistical analysis. MethodsThis was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester (28-41 weeks) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on Open Data Kit (ODK). The primary outcome of our study was mean bias of gestational estimation (error in estimating gestational age) using TCD and fetal biometry (composite GA). Data were analyzed using STATA 15.p.l.c. Simple descriptive analysis, Bland-Altman(B&A) analysis, and Kendall's τa discordance measurement were performed as appropriate. Mean bias(error) and limits of agreement were used to present the finding significance. ResultsA total of 104 pregnant women in the third trimester were included in the study. The mean error(bias) when TCD was used to estimate the gestational age was 0.65 weeks versus a bias of 1.1 weeks by composite biometry, compared to gold standard method from crown-lump length (CRL) (in both cases). The calculated estimated limits of agreement was narrower in the case of TCD than by composite-fetal biometry (-3.56 to 2.25 vs -4.73 to 2.53). Kendall's τa discordance measurement revealed that gestational age estimation using composite biometry and that calculated from CRL were 51% to 70% more likely to agree than disagree whereas gestational age calculated from TCD and CRL were 62% to 77% more likely to agree than to disagree (P-value= <0.001). ConclusionGestational age calculation using TCD is more accurate than using composite gestational age (BPD, HC, FL, and AC) and it should be utilized to date third trimester pregnancies with unknown gestational age (unknown LNMP with no early ultrasound milestone).

Surgical residents' perceptions of the operating theatre educational environment at St. Paul's Hospital Millennium Medical College: A cross-sectional survey

BackgroundThe educational environment refers to the “climate” that influences all aspects of learning in an educational context and the experience in the operating room is particularly crucial in surgical residents learning. Hence, this study aimed to assess surgical residents' perceptions of the operating theatre educational environment and associated factors in the surgical department at St. Paul's Hospital. MethodsThis cross-sectional study was conducted in March 2022 among surgical residents at St. Paul's Hospital Millennium Medical College to assess their perceptions of the operating room educational environment using the OREEM questionnaire. Descriptive statistics (mean, median, SD) were used to summarize demographic data and OREEM scores. The student t-test and one-way analysis of variance (ANOVA) testing followed by posthoc tests were used for comparison of quantitative data, with p-values < 0.05 considered significant. ResultsOf the participants, 103 (79.8%) were male and 26 (20.2%) were female with a mean age of 28 years. The overall mean score was 69% with subscale scores for teaching and training at 47.9/65.0 (73.7%), learning opportunities at 34.5/55.0 (62.7%), the atmosphere at 28.9/40.00 (72.4%) and workload/supervision/ support at 27.5/40.0 (68.7%). Male and female residents differed significantly in perceptions of “atmosphere” (t127 = 3.35, p < 0.001) and in junior versus senior residents' perceptions of the “learning opportunities” and “atmosphere” at p-values of 0.023 and 0.028 respectively. However, age, marital status, and specific surgical training programs did not have a significant effect on the scores. ConclusionOverall, residents had positive perceptions of their training and teaching, learning opportunities, the atmosphere in the operation theatre, and the supervision they received in the operation theatre. The operating room's “teaching and training” component received the highest score, while the operating room's “learning opportunities” component received the lowest. This indicates the importance of establishing a positive learning environment with sufficient “hands-on” experience, especially during emergencies. In addition, preoperative planning, case discussions, and feedback after the surgery should be routine.

Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia

BackgroundKnowledge and practice gap among providers has been cited among factors behind underutilization of aspirin for preeclampsia prevention, globally. ObjectiveTo determine the knowledge and practice level of prenatal care providers at a national tertiary referral hospital in Ethiopia and it's catchment health institutions. Study DesignThis was a cross-sectional survey on the knowledge and practice of preeclampsia prevention through ASA prophylaxis among prenatal care providers at St. Paul's Hospital Millennium Medical College (Ethiopia) and it's catchment health institutions. Data were collected prospectively using a structured questionnaire on ODK. The primary objective of our study was determining the knowledge and practice level among the prenatal care providers. Data were analyzed using SPSS version 23. Simple descriptive analysis were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 92 prenatal care providers working at 17 health institutions were approached and 78 of them agreed to participate in the study, constituting a response rate of 84.8%. The mean score of knowledge and practice of prevention for pre-eclampsia using Aspirin was 42.9(±0.13) and 45.8(±0.07) respectively. Most of the providers had poor knowledge (score less than 50%) and poor practice (score less than 50). Only 23.8% (19/78) and 36.3% (29/78) had good knowledge and good practice, respectively. More than half (61.3%, 49/78) of the respondents mentioned “lack of national guidelines for use of aspirin in pregnancy” as the main factor that impacted their practice on Aspirin for preeclampsia prevention in pregnant women. Among the resources utilized as a reference for practice of use of aspirin for pre-eclampsia prevention, FIGO or WHO guidelines (56.3%, 45/78), followed by ACOG (45%, 36/78) and clinical judgment (45%, 36/78) were the most frequently used resources. ConclusionResults of this study support previous reports of significant knowledge-to-practice gap in the use of ASA prophylaxis for prevention of preeclampsia, among prenatal care providers. It underscores the need for immediate action in narrowing this gap among the providers through availing practical national guidelines for prevention of pre-eclampsia and in-service trainings.

One-day versus two-day mifepristone–misoprostol interval prior to initiation of misoprostol during late second trimester medication abortion: A cohort study

ObjectivesTo compare one-day versus two-day mifepristone–misoprostol interval in late second trimester medication abortion. Study designThis retrospective cohort study was conducted at St. Paul’s Hospital Millennium Medical College, in Ethiopia. Data were collected retrospectively and analysed with SPSS 23 using simple descriptive analysis, t-test, Chi-squared test, and regression analysis, as appropriate. P-value < 0.05 and adjusted odds ratio (AOR) with 95% CI were used to present results significance. ResultsA total of 282 women who had medication abortion in the late second trimester (167 with one-day and 115 with two-day mifepristone-misoprostol intervals) at 20–28 weeks of gestation were analysed. Both median and mean induction to expulsion interval (I-E) were much higher in the one-day mifepristone-misoprostol (mife-miso) interval than in the two-day mife-miso interval group. The median (and mean) I-E in the one-day interval group was 24 hours (21.9+/−6.6 hours) compared to 12 hours (14.6+/−8.8 hours) in the two-day mife-miso interval group (p-value < 0.001). Expulsion rate within 12 hours of starting misoprostol was significantly higher in the two-day cohort than in the one-day cohort (73% vs 25.6%, p-value < 0.001, aOR = 19.08 95%, CI = 5.1–70.7). ConclusionsFor second trimester medication abortion at later gestation, a two-day mifepristone-to-misoprostol interval significantly reduces induction to expulsion time compared to a one-day interval. ImplicationsCompared to one-day interval, administration of mifepristone two days prior to misoprostol initiation has a shorter interval of induction to expulsion and a higher rate of abortion completion within 12 hours of initiation of misoprostol during late second trimester medication abortion.

Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa

BackgroundRecent studies show that aspirin for pre-eclampsia prevention is underutilized despite it's effectiveness in preventing pre-eclampsia in patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. ObjectiveTo determine the missed opportunity for ASA prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. Study DesignThis was a cross-sectional study on pregnant women complicated by preeclampsia who were managed at St. Paul's Hospital Millennium Medical College (Ethiopia) over 6 months (April 1, 2023-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was proportion of women who had an indication for ASA prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for ASA) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. An intention-to-treat (ITT) analysis was used. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded according to the inclusion and exclusion criteria. Among the 395 preeclamptic pregnant women included in the final analysis, 195(50.6%) had an indication for ASA prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressures at presentation were 153.8(±12.8) and 100.6(±8.5) mm Hg, respectively. Most patients had proteinuria (51.7% had urine dip-stick protein +2 while another 18.5% (74/395) had urine dip-stick protein +1 and 10.9% had 24-hour urine protein in the pre-eclampsia range). Among these women who had indication for ASA prophylaxis, in only 1.1 % was ASA utilized (the missed opportunity for ASA prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9 % while neonatal ICU admission rate was 20.5%. The 5th minute low Apgar score rate was 8.9% Eight mothers (2.1%) were complicated by HELLP syndrome while another 3(0.8%) mothers developed pulmonary edema. ConclusionIn this study, the missed opportunity for administration of ASA prophylaxis for the prevention of preeclampsia was unacceptably high though more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates adverse perinatal outcomes and serious maternal morbidity.

Epidemiological, clinical and laboratory profile of patients presenting with severe acute respiratory syndrome (SARS-CoV-2) in Ethiopia.

Data regarding patients presenting with severe acute respiratory syndrome (SARS-CoV-2) illness have not adequately been documented which provides distinct insights into low-resource settings like Ethiopia. Thus, the study aimed to compare epidemiological, clinical and laboratory profiles of patients presenting with acute respiratory syndrome illness in Addis Ababa Ethiopia. We used a comparative cross-sectional study design among patients with SARS-CoV-2 illness at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia from October 2020 to September 2021. Using a structured questionnaire a consecutive sampling technique was applied to collect socio-demographic data. Additionally, nasal swabs were collected to confirm SARS-CoV-2 infection using a Real-Time Polymerase Chain Reaction. Blood samples were also collected from the participants for laboratory profiles (hematological tests like; white blood cell count, hematocrit, and platelet count; and biochemical and enzymatic tests like; aspartate transaminase (AST), creatinine, etc) analysis. Data were entered and analyzed using SPSS version 23.0 and p-values ≤0.05 were considered as statistically significant. Of the total 413 participants presenting with SARS-CoV-2 illness, 250 (60.5%) participants tested positive for COVID-19 disease. COVID-19 patients were less likely to use an alcohol-based method of hand washing (12.5% vs 87.5%; p = 0.048). The COVID-19 patients had a higher proportion of headache (67.3% vs 32.7%, p = 0.001), sore throat (72.5% vs 27.5%, p = 0.001), and loss of sense of taste (74.4% vs 25.6%, p = 0.002). Patients with COVID-19 have significantly higher neutrophil than their counterparts (68.2% vs 31.8%; p = 0.001). Similarly, creatinine (64.9% vs 35.1%, p = 0.001) from renal function and alkaline phosphatase (66.8% vs 33.2%, p = 0.046) in the liver function tests were significantly higher in the COVID-19 patients. Our findings suggest the need to substantially consider headache, sore throat, and loss of taste as potential clinical diagnostic symptoms for early screening and testing. Elevation of neutrophil, creatinine, alkaline phosphatase profiles are also used for potential diagnostic biomarkers in screening and testing suspected patients.

Comparison of induction-to-expulsion interval during second-trimester medication abortion in pregnancies with anencephaly and other congenital anomalies compared to those without anomalies: A retrospective cohort study

To investigate whether induction to expulsion interval during second-trimester medication abortion in pregnancies complicated by anencephaly or other fetal anomalies is prolonged compared to pregnancies without fetal anomalies STUDY DESIGN: This was a retrospective cohort study of women who had second-trimester medication abortion at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia). We assigned subjects to one of three groups based on fetal diagnosis: 1) anencephaly group 2) other congenital anomaly group 3) no anomaly group. Data were collected by reviewing patients' charts. We used SPSS version 23 to analyze the data. Simple descriptive analysis and Chi-squared test were performed as appropriate. A total of 303 women had second trimester medication at 14-28 weeks, of which 58 had anencephaly, 19 had congenital anomalies other than anencephaly, and the remaining 226 had no fetal anomalies. There was no difference in induction to expulsion interval among the groups. The mean induction to expulsion interval was 18.4 hours in the anencephaly group vs, 19.4 hours in the other congenital anomaly group vs. 19.2 hours in those without anomaly (p-value=0.924). The 24-hours non-expulsion rate was also comparable among the groups, with 5.25% rate of non-expulsion in the anencephaly group vs 15.8% in the other congenital anomaly group vs 11.15 % in the no anomaly group, (p-value=0.594). In multivariable regression analysis after controlling for parity, the 24-hour non-expulsion rate was not significantly different. In this study, pregnancies undergoing second-trimester medication abortion for fetal anomalies had comparable induction to expulsion interval and 24-hour expulsion rates compared to those who had the same procedure for other or no anomalies. Second-trimester medication abortion procedure length in pregnancies complicated by anencephaly is similar to those pregnancies without anomalies. All data generated or analyzed during this study are included in this published article.