Paul's Hospital Millennium Medical Research Articles

Contraceptive Counselling and Uptake Among Female Kidney Transplant Recipients in Ethiopia

ABSTRACTBackgroundContraceptive counselling and utilization for kidney transplant patients is a vital component of their kidney transplant care. The use of standardized information on contraceptive methods to prevent unplanned post‐transplant pregnancies in Africa in general is less studied. This study aimed to describe contraceptive counselling and uptake among kidney transplant recipients at a kidney transplant centre in Ethiopia.MethodsA descriptive study on contraceptive counselling and uptake among female Ethiopian kidney transplant recipients was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 15 to July 15, 2023. Data on women's sociodemographic, renal transplantation and contraceptive counselling and use were collected through interviewing the participants using a structured questionnaire. Data were analyzed on SPSS 23 using simple descriptive analysis. Percentages and frequencies were used to present the results.ResultsA total of 60 participants were included in the final analysis. The mean age of the participants was 33.7 ± 8.4 years. The median duration from the time of renal transplant was 19 months. Most (49/60, 81.7%) of the participants reported that they did not receive family planning counselling on contraceptive methods in the early post‐transplant phase. The rate of contraceptive uptake was 8.3% (5/60) with two patients being copper IUD users, and Implanon, tubal ligation and combined oral contraceptives each utilized by a single kidney transplant patient.ConclusionContraceptive counselling and uptake rates among female kidney transplant recipients in this study were very low, which is consistent with findings from previous studies. Increasing female kidney transplant patients’ awareness on safe and effective contraceptive use through adequate contraceptive counselling is essential.

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.

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.

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.

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.

Factors Associated with COVID-19 Severity Among Kidney Transplant and Non-Kidney Transplant Patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

The COVID-19 epidemic is a rapidly shifting situation that has resulted in significant regulatory reforms and widespread initiatives to deal with the initial crisis and its effects. The COVID-19 pandemic has had a significant impact on transplantation activities. The COVID-19 pandemic has caused various important challenges in the kidney transplant industry. To identify the factors influencing COVID-19 severity in kidney transplant and non-kidney transplant patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. A comparative cross-sectional study was conducted. This study included 364 patients (182 kidney transplants and 182 non-kidney transplants). A systematic random sampling was used to select the respondents. Professional nurses collected data for this study using a data extraction tools. Data were analyzed by using SPSS version 25 software. A multivariable logistic regression analysis was performed to identify the association between independent variables and COVID-19 severity with adjusted odds ratio (AOR), and 95% CI for AOR and P-value for testing significance. This study included 364 patients. Off the total, 34.1% developed severe COVID-19. In Multivariable logistic regression analysis, patients with 60 years and above age groups (AOR = 4.73; 95% CI: 1.86, 12.02), aged 40-59 years (AOR = 2.70; 95% CI: 1.17, 6.22), chest congestion (AOR = 4.49; 95% CI: 2.37, 8.50), history of muscle or body aches (AOR = 0.47; 95% CI: 0.22, 0.99) shortness of breath (AOR = 3.03; 95% CI: 1.36, 6.74), changed or lost sense of taste or smell (AOR = 2.77; 95% CI: 1.34, 5.71), and muscle pain (AOR = 3.05; 95% CI: 1.40, 6.65) were significant variables associated with COVID-19 severity after adjusting for other variables. The study revealed that 34.1% of patients had severe COVID-19. The majority of these patients underwent non-kidney transplants. Age groups and symptoms, such as chest congestion, shortness of breath, changed or lost sense of taste or smell, and muscle pain, were significant predictors of COVID-19 disease severity.

Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: Acase series.

To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.

Fecal Carriage of Carbapenem Resistant Enterobacterales and Associated Factors Among Admitted Patients in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

The Enterobacterales family colonizes the human gut as normal flora in all age groups, with bacterial infections being the most common cause. Resistance is currently observed in all normal flora. The aim of this study was to determine the frequency of fecal carriage of carbapenem-resistant Enterobacterales (CRE), carbapenemase-producing Enterobacterales (CPE), and associated factors in the faeces of admitted patients. A cross-sectional study was conducted in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. A total of 384 rectal swabs were collected from various wards in admitted patients who have consented to participate. The specimens were inoculated on a MacConkey agar plate, and then they were incubated at 37 °C for 18 to 24 hours. Using the BD PhoenixTM M50 compact system identification and antimicrobial susceptibility testing were performed. Using the modified carbapenem inactivation method, it was determined whether the carbapenem-resistant bacterial isolate produced carbapenemase or not. Overall prevalence of carbapenem-resistant Enterobacterales carriage and carbapenemase producing Enterobacterales in admitted patients was 17.2% (95%, Confidence Interval: 13.3-21.1%) and 7% (95%, Confidence Interval: 4.7-9.9%), respectively. The predominate carbapenem-resistant Enterobacterales in fecal carriage was K. pneumoniae, 15.4% (23/149), E. cloacae 15.4% (6/39), followed by E. coli 12.4% (37/307) of carbapenem-resistant Enterobacterales (CRE) isolate. Carbapenem-resistant Enterobacterales carriage isolates showed large level of resistance to ciprofloxacin, and sulfamethoxazole-trimethoprim. Prior intake of antibiotics (Odds Ratio 2.42, 95% CI: 11.186-4.95) was significantly associated with higher carbapenem-resistant Enterobacterales carriage. We observed a high prevalence of carbapenem-resistant Enterobacterales carriage and carbapenemase-producing Enterobacterales among admitted patients. There were only amikacin and colistin that could be effective for carbapenem-resistant Enterobacterales isolates. Hence, the control of carbapenem-resistant Enterobacterales carriage should be given priority by carbapenem-resistant Enterobacterales screening for fecal of admitted patients, and adhering to good infection prevention practice in hospital settings.

Pattern of cardiovascular diseases at a teaching hospital in Addis Ababa, Ethiopia: An echocardiographic study of 1500 patients.

Cardiovascular diseases (CVD) represent a significant global health problem. They account for nearly one third of deaths worldwide. With improvements in diagnostic modalities, their prevalence in sub-Saharan Africa (SSA) is rising. Disease pattens vary in different regions and communities and the pattern in our setting is not known. Echocardiography is a noninvasive diagnostic tool that essential for structural and hemodynamic assessment of the heart. It stands at the far front for comprehensive evaluation of the heart because of its relative low cost and wide availability. The aim of this study was to assess pattern of CVDs among patients who had echocardiography done at a teaching Hospital in Addis Ababa, Ethiopia. A retrospective review of 1500 echocardiograms of patients referred to the echocardiography laboratory of St. Paul Hospital Millennium Medical College (SPHMMC) for cardiac evaluation from January 1, 2018 to June 30, 2019 was performed. All subjects had standard transthoracic echocardiography performed by cardiologists using General Electric Vivid E9 and E95 machines. Demographic parameters and echocardiographic findings were collected using a structured checklist from the echocardiography register. Descriptive statistics were used to assess the echocardiographic findings. The mean age of subjects was 48.2 (SD of 18.2) and ranged between 14 and 100 years of age. Both males and females were nearly equally distributed with males accounting for 48.3%. Most (77.9%) of the subjects had an abnormal echocardiographic report; only 332 (22.1%) had a normal study. Diastolic dysfunction (DD) (33.4%), valvular heart disease (18.4%), and left ventricular hypertrophy (LVH) (13.7%) were the most common findings in our hospital. Among patients with DD, Grade 1 dysfunction accounted for the majority (79.8%), of which 41% had associated LVH. Pulmonary hypertension (PH), cardiomyopathy and ischemic heart disease were also not uncommon. Abnormal echocardiographic findings are common in patients referred to our hospital for transthoracic echo. The commonest echocardiographic abnormalities were DD, Valvular heart disease (both rheumatic and calcific valves) and LVH.

Assessment of pediatric residents’ knowledge, attitude, and practice regarding oxygen therapy and its complications at Tikur Anbessa Specialized Hospital and St. Paul Hospital Millennium Medical College, Ethiopia

Background: Oxygen therapy is beneficial, but too much of it or any oxygen therapy errors could be dangerous. Proper knowledge, appropriate practice, and favorable attitudes are important aspects of treatment. Hence, this study aimed to assess the knowledge, attitude, and practice of pediatric residents about oxygen therapy, its complications, and associated factors.&#x0D; Methodology: A cross-sectional study was conducted among pediatric residents at Tikur Anbessa Specialized Hospital and St. Paul Hospital, Millennium Medical College in Addis Ababa, Ethiopia, from June to August 2021. using a self-administered questionnaire. Level of knowledge, attitude, and practice was grouped by Bloom’s original cut-off points. A multinomial logistic regression model was fitted to identify significant predictor variables at a 5% level of significance.&#x0D; Results: Of 141 pediatric residents who responded, this study found 17.7%, 40.4%, and 19.1% prevalence of good knowledge, attitude, and practice, respectively. On the chi-square test, the total duration of service as a general practitioner and the year of residency were significantly associated with knowledge and attitude (P values = 0.027 and 0.037, respectively). Residents' knowledge level and year of residency were found to be independently associated with oxygen administration practice. The odds of residents with good knowledge having good practice than poor practice is 8 times (adjusted odds ratio: 7.90, 95% CI 1.15-45.25, P-value =0.035) higher than residents with poor knowledge levels and year of residency was also a significant predictor of practice level (adjusted odds ratio: 0.24, 95% CI 0.06-0.94, P-value =0.042).&#x0D; Conclusions: - The majority of participants had a positive attitude and had moderate to inadequate knowledge of oxygen administration. Their practice, on the other hand, was generally poor. Regular education and training in oxygen administration can help them improve their knowledge.

A randomized controlled trial of sequential vs simultaneous use of Foley balloon catheter and oxytocin for induction of labor in nulliparous pregnant women

Although recent evidence suggests the simultaneous approach use of oxytocin for induction of labor in nullipara, there is limited data from low-income settings that support this. This study aimed to determine whether induction of labor with simultaneous use of oxytocin and a Foley balloon catheter decreases the induction of labor to delivery interval in nulliparous women, compared with sequential use of a Foley balloon catheter followed by oxytocin. This was a randomized controlled trial of nulliparous women with singleton pregnancies presenting for induction of labor at >28 weeks of gestation at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia). The participants were randomly assigned to either the simultaneous group (the use of oxytocin and a Foley balloon catheter for induction of labor) or the sequential group (overnight intracervical Foley balloon catheter placement followed by the use of oxytocin the next morning). The primary outcome was induction of labor to delivery interval. Comparisons between the groups were made using the Student t test or Wilcoxon rank-sum test and chi-square test on Stata (version 15; StataCorp LLC, College Station, TX). This study is registered with the Pan African Clinical Trials Registry (identifier: PACTR201709002509200). From November 2019 to March 2020, a total of 140 women were randomly assigned to the simultaneous group (70 women) or the sequential group (70 women). The median oxytocin initiation to delivery intervals were 6.09 hours (range, 4.03-10.7) in the sequential group and 8.1 hours (range, 4.7-11.6) in the simultaneous group (P=.46). The mean Foley balloon catheter insertion to delivery intervals were 16.09±5.7 hours in the sequential group and 8.06±4.2 hours in the simultaneous group (P<.001). Cesarean delivery rate, composite neonatal outcomes, and chorioamnionitis were not different between the 2 groups. In nulliparous pregnant women, induction of labor using the simultaneous approach did not shorten the oxytocin initiation to delivery interval compared with the sequential approach. Moreover, both approaches showed no difference in the rates of adverse maternal and neonatal outcomes.

Abortion care in women with underlying medical conditions: The role of multidisciplinary team approach in increasing safety of abortion procedures

AbstractBackgroundThere are no clear data driving most clinical recommendations for abortion care in women with underlying medical conditions, such as cardiac disease. Current abortion practice in such women is based on limited retrospective studies, mainly case reports and case series. In our institution (a tertiary center in Ethiopia), we practice a multidisciplinary team approach to abortion care for patients with medical conditions.ObjectiveDescribe the value of a multidisciplinary team approach in abortion care in patients with underlying medical conditions.MethodsThis is a retrospective descriptive analysis of abortion care in women with underlying medical conditions (cardiac and noncardiac medical conditions) over a 5‐year period (November 2016–October 2021) at St. Paul's Hospital Millennium Medical College, in Ethiopia. Data were extracted by reviewing patients’ medical records using a structured questionnaire. Simple descriptive statistics were applied for analysis using SPSS version 23. Results are presented as frequencies and percentages.ResultsFifteen induced abortion cases in women with underlying medical conditions were analyzed, out of which 11 were in women who were critically ill. The median gestational age was 20 weeks. Ten subjects, 10/15 (66.7%), had a cardiac condition, whereas the rest 5/15 (33.3%) were noncardiac cases. Ten out of the 11 critically ill patients were managed under multidisciplinary team approach, and there were no complications encountered. Out of these, 7/10 (70%) received medication abortion care between 19 and 25 weeks gestation, including 5 cardiac patients with New York Heart Association‐III and IV conditions.ConclusionIn this study, more than three quarters of women with medical conditions who had abortion care were critically ill, and almost all of them were managed with a multidisciplinary team approach. None of the patients suffered a deterioration of their medical conditions, demonstrating the utility of incorporating a multidisciplinary team approach during abortion care for such cases.