Teaching Hospital In Ethiopia Research Articles

Evaluating Pericardiectomy Outcomes and Determinants; an 8-Year Retrospective Study at Tertiary Teaching Hospitals in Ethiopia

<i>Background</i>: Constrictive pericarditis has a variety of etiologies which leads to severe symptoms and heart failure which affects the quality of life. So far the main modality of treatment is pericardiectomy. <i>Objective</i>: The aim of this research was to know pericardiectomy outcomes and determinants among constrictive pericarditis patients who were operated at Tikur Anbessa Specialized Hospital from 2014 - 2022. <i>Methods</i>: A retrospective study was done among 65 patients. Data was presented using frequencies with percentages, mean (±standard deviation) and/ or median (interquartile range) as required. Perioperative mortality and complications were summarized using incidence density with 95% confidence interval (CI). <i>Result</i>: Most patients were in their 20s (53.8%) and where male are (84.6%). The commonest presenting symptom was shortness of breath (100%), fatiguability (96.9%), and coughs (66.2%). The median time of presentation was 12.3 months (IQR, 7.0-25.5). There were also cases with clinical symptoms of tuberculosis (13.8%). The etiology of constrictive pericarditis was infectious in 83.1% of cases. The mean length of surgery was 3.3 ± 0.6 hours. The median duration of hospital stay is 9.0 days (IQR, 7.0-12.0). The incidence rate (IR) of perioperative death was 7.9 per 1000 person-days (PD) of observation (94% CI = 3.3 – 19.2) and the incidence rate of complication was 4.8 per 1000 PD (95% CI = 1.5 -14.9). <i>Conclusion</i>: Pericardiectomy is the best treatment for patients with constrictive pericarditis. The majority of patients had a good outcome, with an improvement in symptoms and functional status. The mortality rate was low, and the complication rate was acceptable. However, this study is based on relatively small sample size, and it is a retrospective study from a single center. Hence, further prospective studies are needed to confirm the findings of this study.

Evaluation of hospital quality of care outcomes in a teaching hospital in Ethiopia: a retrospective database study

ObjectivesWe aimed to evaluate hospital mortality rates, readmission rates and length of hospital stay (LOS) among adult medical patients admitted to a teaching hospital in Ethiopia.DesignWe performed a retrospective study...

Accuracy of focused cardiac ultrasound interpretation among emergency and critical care medicine residents in Ethiopia: A multi-center cross-sectional study

IntroductionFocused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia. MethodsA cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI). ResultThe overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, p = 0.047) demonstrated significantly higher accuracy. ConclusionThe study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.

Medication non-adherence and its associated factors among kidney transplant patients in a large teaching hospital in Ethiopia

BackgroundThis study examines medication adherence among kidney transplant patients at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, focusing on the level of adherence and associated factors to immunosuppressant medicines.Methods and materialsA cross-sectional study was conducted on 270 patients from October 2021 to January 2022 using a structured questionnaire analyzed with SPSS version 26. The prevalence of medication adherence was computed, and a binary logistic regression was fitted to estimate the association. Medication adherence level measurement in post-kidney transplant patients was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and Basel Adherence Assessment Scale in Immunosuppressants (BAASIS). A 95% confidence interval and p-value < 0.05 were used for statistical significance.ResultsThe study found that 71.5% of kidney transplant patients were male, with a median age of 37 and a mean duration of 3.55 years. Medication adherence in post-kidney transplant patients was 81.9%. Post-transplant duration above 5 years and missing follow-up visits more than two times was associated with a 92.6% and 91.2% in medication non-adherence rate respectively. Additionally, forgetfulness was associated with a 90.6%, non-adherence level compared to drug unavailability and financial reasons.Conclusion and recommendationThe study indicates that our patients exhibit higher medication adherence than WHO-measured levels, suggesting the need for healthcare providers to strengthen their intervention, especially for those above 5 years post-kidney transplant. The reason for increased adherence could be explained by the health education program about the medication name, dosing, frequency of ingestion and adverse effects of the drug, and effects of non-adherence.

Neonatal Sepsis Due to Multidrug-resistant Bacteria at a Tertiary Teaching Hospital in Ethiopia.

The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia. An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH). A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens. The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.

Profile of Patients Receiving Computed Tomography Scans for Mild Traumatic Brain Injury in a Tertiary Care Hospital in Ethiopia

Traumatic brain injury (TBI) is a leading contributor to emergency department (ED) mortalities in Ethiopia. Mild TBI patients comprise half of all TBI patients presenting for care in Ethiopia and have a high potential for recovery. As such, context-specific care-improving strategies may be highly impactful for this group of patients. This study examines the presentation and disposition of mTBI patients who received a computed tomography scan of the head (CTH) upon arrival at the largest teaching hospital in Ethiopia. A retrospective cohort study was conducted from 2018-2021 including patients >13 years old with a head injury and a Glasgow Coma Score of 13-15 who obtained a computed tomography scan of the head (CTH). Variables were collected from medical charts and single and multi-variable analyses assessed outcomes of clinically important TBI (ciTBI) requiring a neurosurgical procedure or admission. A total of 193 patients were included. They were predominantly young men with no comorbidities, injured in road traffic accidents or by assault, had stable vital signs and were treated in lower-acuity ED areas. A minority demonstrated focal deficits, and 29.5% of patients had ciTBI. Most patients were discharged from the ED, but 13% were taken for operative neurosurgical procedures and 10.4% were admitted to the neurosurgery ward for observation. ED stays ranged from 8 hours to 10 days, as patients waited for CT availability, neurosurgical decision, or transportation. Female sex was independently protective of ciTBI. Self-referral status was independently protective against operative intervention. Female sex and self-referral status were independently protective of a disposition of admission and/or going to the operating room. This study characterizes the mTBI subgroup of head injury patients in Ethiopia's busiest ED: predominantly healthy young men with low-acuity presentations and only a fraction with abnormal neurological examinations. Nonetheless, about one-third had clinically important TBI and a minority were taken for neurosurgical procedures or admission, with female sex and self-referral identified as protective factors. Meanwhile, many patients stayed in the ED for days due to social or other non-medical reasons. As TBI care in Ethiopia continues to improve, optimizing care for the mTBI subgroup is tantamount given their high recovery potential. This care will benefit from efficiently identifying those who need intervention or hospital level of care, and discharging those who do not.

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.

Seniors Improved the Documentation of Junior Physicians’ Medical Records in a Teaching Hospital in Ethiopia

Seniors Improved the Documentation of Junior Physicians’ Medical Records in a Teaching Hospital in Ethiopia

28-day perioperative pediatric mortality and its predictors in a tertiary teaching hospital in Ethiopia: a prospective cohort study

BackgroundPerioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up.MethodsThe data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance.ResultsThere were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality.ConclusionsIn this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.

Collaborative Advanced Trauma Care (CATC): Evaluation of a trauma education program developed in Pakistan in an Ethiopian context

Trauma globally represents an overwhelming burden of morbidity and mortality. Effective management with trauma teams has proven to reduce time to resuscitation and definitive care leading to decreased mortality and length of stay of trauma patients. Building upon previous partnership we undertook to implement and evaluate Collaborative Advanced Trauma Care (CATC) at a public teaching hospital in Ethiopia, based on course developed in Pakistan. A total of 140 participants were trained in CATC (83 physicians, 57 nurses), with improvement in fundamental trauma knowledge and leadership and teamwork. These findings are similarly reflective of evaluation scores of CATC in Pakistan, demonstrating that CATC can be expanded in settings that share similar medical education and emergency department structures.

Pattern of cutaneous neoplasms and associated factors at a tertiary teaching hospital pathology center in Ethiopia: An eight-year histopathological review

Background: Cancer is the leading cause of death globally and is on the rise in Africa. Cutaneous neoplasms are becoming increasingly common worldwide. Understanding the pattern of this disease is essential for developing data-driven preventive, screening, and treatment services. However, there are limited studies in Ethiopia so far. Therefore, the study aimed to assess the pattern and associated factors of cutaneous neoplasm among patients with histopathologically confirmed biopsy results at a tertiary teaching hospital in Ethiopia from March 2014 to October 2022.Methods: A retrospective record review study was conducted among 1006 patients with histopathologically confirmed cutaneous neoplasms from the biopsies that were assessed at St. Paul’s Hospital Millennium Medical College. Data was summarized using frequencies, percentages, median (interquartile range), and graphs. To identify significant factors associated with malignant cutaneous neoplasm, a multivariable binary logistic regression model was fitted, where Adjusted Odds ratio (AOR), 95% CIs for AOR, and p-values were used for interpretation of results.Result: From the 1006 cases, 265 (26.3%, 95%CI=23.5%-29.3%) were malignant, of which sarcoma (26.0%) and squamous cell carcinoma (25.7%) were the most frequent and found to be prevalent in younger (19-29 years) and older (≥60 years) patients, respectively. The trunk was the commonest site (54.2%) for all the malignancies, especially sarcoma (80.4%). Age was found to be a significant exposure that is associated with the development of malignant cutaneous neoplasm for those ≥30 years as compared with those ≤18 years, with the odds increasing with age (AOR=2.66, 95% CI=1.10,6.45 for 30-39 years, AOR=4.98, 95% CI= 2.01,12.36 for 40-49 years, AOR=5.33, 95% CI=2.15,13.22 for 50-59 years and AOR= 6.62, 95% CI=2.79,15.66 for ≥60).Conclusion: The prevalence of malignant cutaneous neoplasm is higher than previously reported in the country and the malignancy pattern and distribution are different from what is known so far. This could signal a shift in disease epidemiology, and the findings should be factored into clinical decision making and program design for disease prevention, screening, and treatment. It also calls for further prospective research to learn more about the conditions in the context of additional relevant personal and clinical characteristics

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.

Incidence and root causes of medication errors by anesthetists: a multicenter web-based survey from 8 teaching hospitals in Ethiopia

BakgroundThe operating room is a demanding and time-constrained setting, in comparison to primary care settings, where perioperative medication administration is more complicated and there is a high risk that the patient will experience a medication error. Without consulting the pharmacist or seeking assistance from other staff members, anesthesia clinicians prepare, deliver, and monitor strong anesthetic drugs. The purpose of this study was to determine the Incidence and root causes of medication errors by anesthetists in Amhara region, Ethiopia.MethodsA multi-center cross sectional web-based survey study was conducted from October 1 to November 30, 2022, across eight referral and teaching hospitals of Amhara region. A self-administered semi structured questionnaire was distributed using survey planet. Data analysis was conducted using SPSS version 20. Descriptive statistics were computed and binary logistic regression was used for data analysis. A p-value < 0.05 was considered statistically significant.ResultsThe study included 108 anesthetists in total, yielding a response rate of 42.35%. Out of 104 anesthetists, Majority of participants (82.7%) were male. During their clinical practice, more than half (64.4%) of participants experienced atleast one drug administration error. 39 (37.50%) of the respondents revealed that they experienced more medication errors while on night shifts. Anesthetists who did not always double-check their anesthetic drugs before administration had a 3.51 higher risk of developing MAEs compared to those who always double-check anesthetic drugs before administration (AOR = 3.51; 95% CI: 1.34, 9.19). Additionally, participants who administer medications that have been prepared by someone else are about five times more likely to experience MAEs than participants who prepare their own anesthetic medications prior to administration (AOR = 4.95; 95% CI: 1.54, 15.95).ConclusionThe study found a considerable rate of errors in the administration of anaesthetic drugs. The failure to always double-check medications before administration and the use of drugs prepared by another anaesthetist were identified to be underlying root causes for drug administration errors.

Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78-12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17-13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19-9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.

Chemotherapy Induced Neutropenia, Febrile-Neutropenia and Determinants Among Solid Cancer Patients Attending Oncology Unit of a Tertiary Care Teaching Hospital in Ethiopia.

Globally the incidence of cancer is about 19.3 million new cases per year. Chemotherapy is among the standard treatments for cancer but neutropenia and febrile neutropenia are the most common side effects. To assess the incidences of chemotherapy-induced neutropenia, febrile-neutropenia and associated factors in solid cancer patients attending Oncology unit of St. Paul Hospital Millennium Medical College in Addis Ababa, Ethiopia. In this institution-based longitudinal study conducted from February to September, 2020 at one of the largest teaching and referral hospitals of Ethiopia, 101 patients who were diagnosed with any type of solid cancer were recruited using convenience sampling method. Patients were followed-up until they completed five cycles of chemotherapy. Data were analyzed using SPSS version 23 software. Paired sample t-test was used to compare the pre- and post-treatment results. Chi-squared test was employed to determine associated factors of neutropenia, and p-values less than 0.05 were taken as statistically significant. Of the total 101 participants, 98 were eligible per inclusion criteria and 6 (6.1%) of them died during the study period. The age of the participants ranged from 16-84 years with a mean age of 45. Of them, 48 (49.0%) were in the age group of 16-44 years, 73 (74.5%) were female, 66 (67.3%) were married, and 42.9% attained primary education. Among 92 patients, the incidence of neutropenia was 65 (70.7%) and the incidence of febrile neutropenia was 46 (50.0%). Adriamycin + cyclophosphamide and Adriamycin + cyclophosphamide + paclitaxel were the most commonly used anti-cancer treatments in this study. None of the tested factors were associated with chemo-induced neutropenia. More than two thirds of the patients had chemotherapy associated neutropenia while half of the patients had febrile neutropenia; close monitoring of such patients is warranted.

Multiple-site neural tube defects complicated by multiple-site split cord malformations and thickened filum terminale: experience at a pediatric neurosurgical teaching hospital in Ethiopia. Illustrative case.

BACKGROUNDMultiple-site open neural tube defects (MNTDs) and multiple-site split cord malformations (MSCMs) are extremely rare congenital anomalies that are defined by the simultaneous noncontiguous occurrence of more than one neural tube defect (NTD) and split cord malformation (SCM), respectively, in a single case with normal neural tissue in between. This work shows the cooccurrence of MNTDs and MSCMs, which has never been reported in the literature.OBSERVATIONSA single-stage repair for a 13-day-old female neonate with a preoperative diagnosis of MNTDs (thoracic meningocele and thoracolumbar myelomeningocele) plus an additional intraoperative diagnosis of MSCMs (type 3c) of thoracic and thoracolumbar spine, and thickened filum terminale was done with a favorable smooth postoperative course.LESSONSThe use of intraoperative meticulous surgical technique along with preoperative skin stigmata helped for anticipation, detection, and treatment of associated complex spinal MNTDs, especially in resource-limited settings, where preoperative magnetic resonance imaging is not routinely used. Whether to repair the MNTDs as a single- versus multiple-stage procedure is mainly a function of the patient’s tolerance to the duration of anesthesia and the anticipated blood loss for the patient’s age. The overall developmental biology and long-term clinical outcome of MNTDs compared to single NTD/SCM is poorly understood and needs further study.

Magnitude and factors associated with anxiety and depression among patients with breast cancer in central Ethiopia: A cross-sectional study.

BackgroundPatients with breast cancer are assumed to be susceptible to anxiety and depression, while there is a lack of evidence about the epidemiology and underlying factors in Ethiopia. Hence, we aimed to assess the prevalence and predictors of anxiety and depression among patients with breast cancer in Ethiopia.MethodAn institutional-based cross-sectional study was conducted among patients with breast cancer who were attending treatment at the Oncology Center of the Tikur Anbessa Specialized Hospital, the largest referral teaching hospital in Ethiopia. The Hospital Anxiety and Depression Scale (HDAS) was used to evaluate the anxiety and depression status of the participants, and a structured questionnaire was used to collect sociodemographic, socioeconomic, and clinical data from the participants. Medical records of the participants were reviewed to collect and correlate information about the grade and stage of cancer. An analysis was done using STATA 15.1.ResultsThe study included 333 randomly selected participants, of which 35.4% were on stage III and 33% on stage II, and 67.9% were on chemotherapy and surgery. The prevalence of anxiety and depression were 60.7 and 58.6%, respectively. Poor patient-provider interaction (adjusted odds ratio [AOR] = 4.5, 95% CI: 2.49, 8.12) and having no financial support (AOR = 2.83, 95% CI: 1.63, 4.91) were the significant predictors of anxiety. Age >49 years (AOR = 0.48, 95% CI: 0.25, 0.90), poor patient-provider interactions (AOR = 3.36, 95% CI: 1.87, 6.02), and having no financial support (AOR = 3.36, 95% CI: 1.95, 5.79) were the significant predictors of depression.ConclusionIn this study, the prevalence of anxiety and depression was high among patients with breast cancer, and the lack of financial support and poor patient-provider interactions were significant predictors of anxiety and depression among these groups of patients. Patients with cancer need regular screening for mental health and better emotional support from their healthcare providers and families to prevent and treat anxiety and depression.

Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia.

Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1". 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become "POCUS1 Master Instructors" to continue the program during the SARS-CoV-2 global pandemic. The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.

Clinical Profiles and Surgical Outcome of Hypospadias Repair at a Teaching Hospital in Ethiopia.

Hypospadias repair is one of the commonest and challenging surgery done in pediatric age groups. This study was conducted to assess clinical profiles and surgical outcomes of hypospadias repair. A retrospective analysis of pediatric hypospadias repairs at St. Paul's hospital millennium medical college from September 2015 to August 2019 was conducted. A total of 277 patients with hypospadias repair were investigated. The mean age was 3.7+/- 3.5 years (Range, 0.5-14 years) and only one-third (98,35.4%%) of patients were operated on in the recommended age group (6-18 months). Anterior/distal hypospadias was the commonest (123,44.4%) variant identified. The majority (176,63.5%) had chordee and 105(37.9%) were severe forms. Tubularized incised plate repair was the major (164,59.2%) surgical technique employed followed by staged urethroplasty (61,22%). Post-operative complications occurred in 135(48.7%) patients and the commonest was urethrocutanous fistula (95,34.3%). No significant correlation was found between the occurrence of these complications and factors such as age at repair, the severity of hypospadias, presence of concomitant urogenital anomaly, type of procedure and duration of urinary diversion. However, the presence of severe chordee (AOR=3.09; 95%CI 1.21-7.54; p=0.013) was an independent factor found to be associated with postoperative complications on multivariate analysis. Higher rate of complications following hypospadias repair was observed in our study. Our study also demonstrated no significant advantage of any repair technique in reducing operative complications. Extensive preoperative evaluation, proper operative plan and regular follow-up of such patients is paramount for a better outcome.

Return of Sexual Activity Within Six Weeks of Childbirth Among Married Women Attending Postpartum Clinic of a Teaching Hospital in Ethiopia.

Introduction:Postpartum sexual health gets very little attention compared to pregnancy and childbirth, even though most maternal deaths and disabilities occur during this time. Therefore, the study aimed to assess return of sexual activity within 6 weeks of childbirth among married women attending postpartum clinic of a teaching hospital in Ethiopia, 2021.MethodsThe hospital-based cross-sectional study design was implemented from September to October 2021. Eligible postpartum women were sampled by systematic random sampling technique. The data was entered into EPI-info and exported to SPSS version 24 for further analysis. All variables with a p-value < 0.05 in multivariable analyses were taken as associated factors with the return to sexual activity before 6 weeks of childbirth.ResultsA total of 421 postpartum women participated in the study. The prevalence of women who return to sexual activity 6 weeks after childbirth was 31.6%. The study revealed that monogamy (Adjusted Odds Ratio (AOR) = 4.4, 95% Confidence Interval (CI) (2.1, 9.4)), parity (AOR= 0.11, 95% CI (0.02–0.81)) and (AOR = 0.1, 95% CI (0.015–0.72)), postnatal care (AOR= 1.8, 95% CI (1.01–3)) and infants feeding status (AOR=2.3, 95% CI (1.3–4)) were significantly associated with return of sexual activity before 6 weeks of childbirth.ConclusionThe findings of this study suggested that, nearly one-third of postpartum women engaged to sexual activity within 6 weeks of childbirth. Return of sexual activity within 6 weeks of childbirth associated with monogamy type of marriage, parity, postnatal care, and child feeding status. Strengthening postpartum counseling regarding the appropriate time to resume sexual activity is crucial. Regular postpartum visits following deliveries should also be encouraged by health care providers.