Tikur Anbessa Specialized Hospital Research Articles

Outcome of antiemetic prophylaxis among pediatric cancer patients receiving moderate to highly emetogenic chemotherapy at pediatric hemato-oncology ward of Tikur Anbessa specialized hospital: A prospective observational study.

Chemotherapy-induced nausea and vomiting (CINV) is a major issue for chemotherapy pediatric patients, especially in developing countries due to limited access to essential antiemetics. This study aimed to assess antiemetic prophylaxis outcomes in pediatric cancer patients at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. A longitudinal prospective observational study design was conducted among 201 pediatric cancer patients followed up to 120 h post-chemotherapy. The majority of patients (75.1%) received combination prophylactic antiemetics in the acute phase. Complete response (CR) was the highest in the acute phase (71.1%). Emesis episodes occurred most frequently on the first day of treatment (28.4%) and gradually decreased over time. History of motion sickness, platinum-based chemotherapy, and prior chemotherapy-induced vomiting (CIV) were associated with emesis during the acute phase whereas multiple-day chemotherapy, prior CIV, receipt of antiemetics, and a history of motion sickness in the delayed phase. However, the odds of CIV were reduced with steroid presence in the chemotherapy regimen. A considerable number of participants could not achieve a CR. It is important for clinicians to be cognizant of risk factors that influence the outcome of antiemetic prophylaxis to achieve better control of CINV among pediatric cancer patients.

The incidence and factors associated with anemia in elective surgical patients admitted to a surgical intensive care unit: a retrospective cohort study

BackgroundAnemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90% of patients are found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. Thus, this study aimed to determine the incidence and identify factors associated with anemia in elective surgical patients admitted to the surgical intensive care unit.MethodsA retrospective follow-up study involving 422 hospitalized patients was carried out between December 2019 and December 2022 in the surgical intensive care unit after elective surgery at Tikur-Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were gathered from the patients’ charts, and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. Bivariable and multivariable binary logistic regression were used to examine associations between variables.ResultsThe incidence of anemia in elective surgical patients admitted to the intensive care unit was 69.9% (95% CI 65.4–74.5%). American Society of Anesthesiologists’ class III (ASA III) [AOR: 8.53, 95% CI 1.92–13.8], renal failure [AOR:2.53, 95% CI (1.91–5.81)], malignancy [AOR: 2.59, 95% CI (1.31–5.09)], thoracic surgery [AOR: 4.07, 95% CI (2.11–7.87)], urologic surgery [AOR: 6.22, 95% CI (2.80–13.80)], and neurosurgery [AOR: 4.51, 95% CI (2.53–8.03)] were significantly associated with anemia in surgical patients admitted to the intensive care unit.ConclusionMore than two-thirds of the intensive care unit-admitted surgical patients experienced anemia. An American Society of Anesthesiologists’ (ASA III score), renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with this condition. Early identification helps to institute preventive and therapeutic measures.

Stoma-related complications and quality-of-life assessment: A cross-sectional study with patients from Ethiopia and Sweden.

The situation for patients with ostomy can be challenging, probably more in a resource-constrained environment. Our objective was to evaluate quality of life (QoL) (using EQ5D-5L) and stoma-specific QoL (using Stoma QoL) in a high- and low-income setting. In this cross-sectional study from the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, and South General Hospital (SGH), Stockholm, patients with a permanent or temporary ostomy at TASH (EthioPerm), (EthioTemp), and patients with ostomy at SGH (SweSto) were included in October 2022-January 2023. Patients N=66 were included in groups: EthioPerm N=28, EthioTemp N=17, and SweSto N=21. In EthioTemp, 88% used homemade stoma bags. Although morbidity related to the nipple itself was similar in the groups, the overall score from Stoma QoL was significantly lower in EthioPerm, 48/100 than in SweSto, 74/100. Scores were significantly lower for pouch-related problems and social interactions in Ethiopian patients. In EthioPerm, 71% of the patients worried that they were a burden to the people close to them compared to 14% in SweSto (p<0.001). Leakage was over four times more common in EthioPerm than in SweSto. Mean overall EQ5D-5L score was 18 percentage points lower than the national mean score in EthioPerm and 2 percentage points lower in SweSto. QoL was more affected in the Ethiopian study participants than in the Swedish, even when commercial stoma bags were available. The largest problems were leakage, embarrassment with social interactions, and pouch-related problems. NCT05970458 Clinicaltrials.gov, https://clinicaltrials.gov/study/NCT05970458?locStr=Ethiopia&country=Ethiopia&distance=50&cond=Stoma%20Ileostomy&rank=1.

Predictors and Prevalence of Obstructive Coronary Artery Disease in Patients Who Underwent Elective Invasive Coronary Angiography for Chronic Coronary Syndrome at Catheterization Laboratory of Tikur Anbessa Specialized Hospital and Gesund Cardiac and Medical Center, Addis Ababa Ethiopia: Retrospective Study

Predictors and Prevalence of Obstructive Coronary Artery Disease in Patients Who Underwent Elective Invasive Coronary Angiography for Chronic Coronary Syndrome at Catheterization Laboratory of Tikur Anbessa Specialized Hospital and Gesund Cardiac and Medical Center, Addis Ababa Ethiopia: Retrospective Study

Seroprevalence of SARS-CoV-2 and Hepatitis B Virus Coinfections among Ethiopians with Acute Leukemia.

SARS-CoV-2 and blood-borne viral coinfections are well reported. Nevertheless, little is known regarding the seroprevalence of SARS-CoV-2 and coinfection with blood-borne viruses in hematologic malignancy patients in Ethiopia. We aimed to assess the seroprevalence of SARS-CoV-2 and associated infections with hepatitis B and other viruses among adolescent and adult acute leukemia patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from July 2020 to June 2021. Blood samples were tested for the presence of anti-SARS-CoV-2, HBV, HCV, and HIV with ELISA kits and occult hepatitis B infection with a real-time polymerase chain reaction assay. Out of a total 110 cases, the SARS-CoV-2 seroprevalence was 35.5%. The prevalence showed a significant increment from July 2020 to the end of June 2021 (p = 0.015). In 22.7% and 2.7% of leukemia cases, HBV and HIV, respectively, were detected. No HCV was identified. The rate of SARS-CoV-2 coinfection with HBV and HIV was 28% (11/39) and 2.6% (1/39), respectively; however, there was no statistically significant association between SARS-CoV-2 seropositivity with HBV and HIV (p > 0.05). There is a need for viral screening in leukemia cases to monitor infections and inform management.

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia.

The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia. This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer. A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval. Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021). Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.

Abstract 7001: Profiling the CpG methylation patterns of Epstein-Barr virus DNA in lymphoma patients from Ethiopia

Abstract Introduction: Epstein-Barr virus (EBV) is a tumor virus associated with various malignancies, driven by genetic mutations and epigenetic alterations, including DNA methylation. Abnormal CpG methylation holds promise as a diagnostic and therapeutic biomarker for EBV-associated tumors. However, the understanding of EBV's epigenetic mechanisms remain limited. Determining the methylation profile of EBV is crucial for gaining insights into the pathogenesis of EBV-associated tumors, developing diagnostic biomarkers, and exploring potential therapeutic strategies. Therefore, our study aimed to assess the CpG methylation profile of EBV DNA in lymphoma patients from Ethiopia. Methods: This study enrolled 115 lymphoma patients from Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. Plasma and formalin-fixed paraffin-embedded blocks were collected from the participants, and isolation of DNA was performed from these samples. The methylation analysis was performed using the methylation-iPLEX assay. iPLEX capture and extension primers were designed to amplify and target EBV CpGs from bisulfite-converted DNA sequences. Ethical approval was also obtained from respected institutions. Results: Among the 115 participants, 65.2% (n = 75) were male patients. The largest proportion (n = 35, 30.4%) fell within the 41-60 age group. Non-Hodgkin lymphoma (NHL) was diagnosed in 96 patients, while 19 had Hodgkin lymphoma (HL). In the NHL group, the majority (n = 27, 28.1%) were classified as diffuse large cell lymphoma, followed by follicular lymphoma (n = 24, 25%). Out of the different EBV genome methylation sites, we have identified 24 EBV genes to assess the methylation status of the EBV genome. Average methylation levels of these genes were ranged from 45% to 50%. Notably, the HL group exhibited significant heterogeneity in methylation levels, while the CpG methylation status of EBV genes in NHL subtypes demonstrated a consistent pattern. A significant proportion of our samples exhibited methylation loss in the lytic gene BZLF1 and at the origin of replication associated with lytic replication. Conclusions: This study presents the first data from East Africa, shedding light on the EBV DNA methylation status in a diverse group of lymphoma patients. Further investigations in different locations are necessary to elucidate the impact of EBV DNA methylation on tumor progression. Citation Format: Seifegebriel T. Feleke, Kidist Z. Shita, Abdulaziz A. Sherif, Fisihatsion T. Woldegebriel, Christoph Weigel, Elshafa H. Ahmed, Tamrat A. Zeleke, Robert A. Baiocchi. Profiling the CpG methylation patterns of Epstein-Barr virus DNA in lymphoma patients from Ethiopia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7001.

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.

Intravenous Lidocaine Efficacy in Preventing Succinylcholine-Induced Postoperative Myalgia in Surgical Adult Patients at Tikur Anbessa Specialized Hospital

Intravenous Lidocaine Efficacy in Preventing Succinylcholine-Induced Postoperative Myalgia in Surgical Adult Patients at Tikur Anbessa Specialized Hospital

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital.

Diabetes mellitus (DM) increases cardiovascular disease (CVD) incidence and mortality. While guidelines endorse statin use in type 2 DM (T2DM) to mitigate cardiovascular risks and mortality, challenges like statin initiation and prompt treatment adjustments affect patient outcomes. This study aimed to assess the appropriateness of indications for and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH). A hospital-based cross-sectional study was conducted from April 1 to June 30 2020. In total, 405 T2DM patients were selected using a systematic random sampling technique. The data were analyzed using SPSS version 26.0. An adjusted odds ratio (OR) was used and a 95% confidence interval (CI) and p-values of <0.05 were utilized to determine statistical significance. Of the total 405 participants, 346 (85.4%) started taking statins for primary or secondary prevention purposes. Indication for statin use was appropriate in 96.2% patients, while for 216 (62.4%) patients their doses were appropriately intensified. Predictors of the inappropriateness of statin use were an atherosclerotic cardiovascular disease (ASCVD) score of ≥7.5% (AOR=0.28; 95% CI: 0.102-0.738, p=0.01), the presence of dyslipidemia (AOR=4.48; 95% CI: 1.85-10.84; p=0.001), initiation of aspirin therapy (AOR=3.7; 95% CI: 1.522-9.144; p=0.004), and an LDL-cholesterol level of 70-189 mg/dL (AOR=0.124; 95% CI: 0.042-0.365; p=0.001). DM duration of ≥10 years (AOR=2.51; 95% CI: 1.35-4.66, p=0.004), male gender (AOR=2.04; 95% CI: 1.16-3.58, p=0.013), age ≥65 years (AOR=2.15; 95% CI: 1.23-3.75, p=0.007) and uncontrolled blood pressure (AOR=2.09; 95% CI: 1.07-4.08, p=0.031) were associated with inappropriate statin intensification. The study found that indication of statins was optimal and about two-thirds of patients had their doses appropriately intensified. Monitoring is needed to avoid inappropriate intensification of statin therapy, particularly in patients with longer diabetes duration, those of male gender and advanced age, and those with uncontrolled blood pressure.

Mortality rate and predictors among neonates admitted to a neonatal intensive care unit in Addis Ababa, Ethiopia: a retrospective follow-up study.

Addressing neonatal mortality is an important priority for improving the health and well-being of newborns. Almost two-thirds of infant deaths occur in the first month of life; among these, more than two-thirds die in their first week. Therefore, the aim of this study was to assess the mortality rate and predictors of mortality among neonates admitted to the neonatal intensive care unit (NICU) at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, in 2023. An institutional-based retrospective follow-up study was conducted using 459 neonates who were admitted to the NICU at Tikur Anbessa Specialized Hospital from January 2020 to December 2022. The data were extracted from randomly selected charts using a pretested data extraction checklist. The Nelson Alan curve with log-rank test was used to compare the presence of differences in the mortality rate of different groups over different categorical variables. The cox proportional hazards analysis model was used to identify predictors of neonatal death. The presence and absence of statistical significance was considered at a p-value of less than 0.05 and the strength of association was measured using AHR. The neonatal mortality rate was 3.1 (95% CI: 1.3-4.9) per 1,000 neonate-days. Low birth weight (AHR = 1.44: 95% CI: 1.06-3.13), exclusive breast-feeding (AHR = 0.74: 95% CI: 0.35-0.95), and time of exclusive breast-feeding (AHR = 0.92: 95% CI: 0.49-0.99) were the identified predictors of newborn mortality. The neonatal mortality rate was high. Low birth weight of the neonate, exclusive breast-feeding initiation, and time of exclusive breast-feeding were independent predictors of neonatal death. Therefore, empowering mothers to exclusively breastfeed their children, which is a cost-effective, safe, and realistic option, can significantly minimize infant mortality.

Epidemiology and Outcomes of Critical Illness and Novel Predictors of Mortality in an Ethiopian Medical Intensive Care Unit.

Low- and middle-income countries (LMICs) bear most of the global burden of critical illness. Managing this burden requires improved understanding of epidemiology and outcomes in LMIC intensive care units (ICUs), including LMIC-specific mortality prediction scores. This study was a retrospective observational study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, examining all consecutive medical ICU admissions from June 2014 to April 2015. The primary outcome was ICU mortality; secondary outcomes were prolonged ICU stay and prolonged mechanical ventilation. ICU mortality prediction models were created using multivariable logistic regression and compared with the Mortality Probability Model-II (MPM-II). Associations with secondary outcomes were examined with multivariable logistic regression. There were 198 admissions during the study period; mortality was 35%. Age, shock on admission, mechanical ventilation, human immunodeficiency virus, and Glasgow Coma Scale ≤8 were associated with ICU mortality. The receiver operating characteristic curve for this 5-factor model had an AUC of 0.8205 versus 0.7468 for MPM-II, favoring the simplified new model. Mechanical ventilation and lack of shock were associated with prolonged ICU stays. Mortality in an LMIC medical ICU was high. This study examines an LMIC medical ICU population, showing a simplified prediction model may predict mortality as well as complex models.

Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally.

Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.

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.

Sonohysterography Assessment of the Structural Abnormalities of the Uterus in Women with Infertility in Ethiopia

Background: Female factor infertility is associated with a high incidence of the uterine cavity and fallopian tube pathology in developing countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of the female reproductive system, among them is saline infusion sonohysterography (SISHG). The study aimed to assess the role of SISHSG in female infertility evaluation in areas where the gold standard investigating modalities are not readily available.&#x0D; Methods: A hospital-based cross-sectional study was carried out in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, between January 2019 to August 2019 G.C. SISHSG consists of instillation of saline into the endometrial cavity with simultaneous pelvic ultrasonography (US). Fifty consecutive female patients referred to the Radiology Department for SISHSG are included in the study. Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG.&#x0D; Result: The majority of the patients were in the age group of 35-40(38%) and 34 (68%) had secondary infertility. The commonest abnormalities detected were uterine myoma 10(20%), Asherman syndrome/cervical stenosis 7 (14%), and tubal blockage 6(10%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SISHSG in normal study, Asherman syndrome/cervical stenosis and chronic endometritis was 100%, as compared to the gold standard conventional HSG. For bilateral tubal blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had low sensitivity 33%.&#x0D; Conclusion: SISHSG is readily available, easy-to-do, safe and radiation-free procedure and has high sensitivity and specificity in detecting uterine cavity abnormality. We advocate its use as a first step of investigation modality in the evaluation of female infertility.

Infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia.

Infection prevention and control (IPC) is a set of practices that are designed to minimize the risk of healthcare-associated infections (HAIs) spreading among patients, healthcare workers, and visitors. Implementation of IPC is essential for reducing infection incidences, preventing antibiotic use, and minimizing antimicrobial resistance (AMR). The aim of the study was to assess IPC practices and associated factors in Pediatrics and Child Health at Tikur Anbessa Specialized Hospital. In this study, we used a cross-sectional study design with a simple random sampling method. We determined the sample size using a single population proportion formula with the assumption of a 55% good IPC practice, a 5% accepted margin of error, and a 15% non-response rate and adjusted with the correction formula. The final sample size was 284 healthcare workers. The binary logistic regression model was used for analysis. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) tool was used to assess IPC core components. A total of 272 healthcare workers participated in the study, with a response rate of 96%. Of the total participants, 65.8% were female and 75.7% were nurses. The overall composite score showed that the prevalence of good IPC practices among healthcare workers was 50.4% (95% CI: 44.3-56.5). The final model revealed that nursing professionals and healthcare workers who received IPC training had AORs of 2.84 (95% CI: 1.34-6.05) and 2.48 (95% CI: 1.36-4.52), respectively. The final average total IPCAF score for the IPC level was 247.5 out of 800 points. The prevalence of good IPC practice was suboptimal. The study participants, who were nursing professionals and healthcare workers who received IPC training, showed a statistically significant association with the IPC practice level. The facility-level IPCAF result showed a "Basic" level of practice based on the WHO categorization. These evidences can inform healthcare workers and decision-makers to identify areas for improvement in IPC practice at all levels. Training of healthcare workers and effective implementation of the eight IPC core components should be strengthened to improve suboptimal practices.

Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review

BackgroundPericardial effusion (PE) is a rare yet an important cause of child mortality due to collection of excess fluid in pericardial space. The study aimed to describe the PE profile in the national cardiac referral hospital, Addis Ababa, Ethiopia.MethodsThe study employed cross-sectional study design for a 7-year review of childhood PE in Tikur Anbessa Specialized Hospital. Descriptive and analytic statistics were applied.ResultsThere were 17,386 pediatric emergency/ER admissions during the study period, and PE contributed to 0.47% of ER admissions. From 71 included subjects, 59% (42) were males with mean age of 7.8 ± 3.3 years. Cough or shortness of breath,73.2% (52) and fever or fast breathing, 26.7% (19), were the common presenting symptoms. The median duration of an illness before presentation was 14days (IQR: 8–20). The etiologies for pericardial effusion were infective (culture positive–23.9%, culture negative–43.6%, tuberculous-4.2%), hypothyroidism (4.2%), inflammatory (12.7%), malignancy (7%) or secondary to chronic kidney disease (1. 4%). Staphylococcus aureus was the most common isolated bacteria on blood culture, 12.7% (9) while the rest were pseudomonas, 7% (5) and klebsiella, 4.2% (3). Mild, moderate and severe pericardial effusion was documented in 22.5% (16), 46.5% (33), and 31% (22) of study subjects, respectively. Pericardial tamponade was reported in 50.7% (36) of subjects. Pericardial drainage procedure (pericardiocentesis, window or pericardiotomy) was performed for 52.1% (37) PE cases. The case fatality of PE was 12.7% (9). Pericardial drainage procedure was inversely related to mortality, adjusted odds ratio 0.11(0.01–0.99), p 0.049).ConclusionPE contributed to 0.47% of ER admissions. The commonest PE presentation was respiratory symptoms of around two weeks duration. Purulent pericarditis of staphylococcal etiology was the commonest cause of PE and the case fatality rate was 12.7%. Pericardial drainage procedures contributed to reduction in mortality. All PE cases should be assessed for pericardial drainage procedure to avoid mortality.

Competence of pediatric residents and nurses in metered-dose inhaler techniques for asthma patients at Tikur Anbessa Specialized Hospital

Introduction: A Metered Dose Inhaler (MDI) is a device containing dissolved or suspended drugs to deliver drugs for pulmonary diseases efficiently. However, studies in Ethiopia show low competency among health professionals. Thus, we assessed the competency of residents and nurses working in a tertiary hospital. &#x0D; Methods: From June to September 2022, 181 pediatrics and child health department residents and nurses participated in a pretested questionnaire and MDI technique practice. The knowledge score for residents and nurses was determined based on correct answers to questions from 0 to 6 for residents and 0 to 5 for nurses. Good knowledge was defined as a score of 80–100%, moderate knowledge from 60–79%, and poor knowledge from &lt;60% of the total score. The good practice was ≥7 from 11 and all essential steps, while the poor practice was &lt;7 of the total score and skipped essential steps. The chi-square or Fisher exact test was employed to compare groups as appropriate. The 95% confidence interval and a p-value of 0.05 were used to determine statistical significance. . &#x0D; Results: Of the 181 study participants, 103 (56.9%) were residents. The participants' mean age was 32. MDI technique knowledge was poor for more than half of the residents (52.4%) and 46.4% of the nurses. Twenty-six (14.4%) of participants practiced the MDI technique steps, scoring 7 out of 11 steps. However, only 3.3% practiced the technique correctly. Whereas only 5.8% of residents and 0% of nurses practiced the essential steps of the MDI technique. When using a new inhaler drug, nearly half of the participants (47%) did not assess the patients' practice. &#x0D; Conclusion: Healthcare professionals' competency in performing the MDI technique is low. Appropriate training programs are needed to enhance their ability to use inhaled devices and ensure successful drug delivery.

Vitamin d levels in pediatric epilepsy patients on the anti-epileptic drugs at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: Epilepsy is a common neurological disorder of childhood repeatedly necessitating prolonged use of anticonvulsants. This study was done to evaluate the status of vitamin D in epileptic children. We targeted to describe the prevalence and risk factors for vitamin D deficiency among children with epilepsy. &#x0D; Methods: A hospital-based descriptive cross-sectional study design with prospective data collection was used among children with epilepsy on anti-epileptic drugs attending the Pediatric Neurology Clinic and their primary caretakers. For this study, a sample of 226 children and adolescents were included in the study and a blood sample for the determination of serum vitamin D was taken. The participants were interviewed, and medical records were thoroughly reviewed. Descriptive statistics and binary logistic regression analysis was done to assess determinants of vitamin D deficiency. . &#x0D; Results: In this study, the prevalence of vitamin D deficiency was found to be 42%. Children on polytherapy (AOR = 4.3 (1.2 - 16)), 3 or more AEDs (AOR = 0.1 (0.0 - 0.8)), female sex (AOR = 1.8 (1.7 - 2.6)), age &gt;15 years (AOR = 2.12 (1.0 - 1.5)), 4 months of exclusive breastfeeding (AOR = 5.6 (4.9 - 36)), family diet (AOR = 0.3 (0.1 - 0.8)) and non-ambulation (AOR = 1.7 (1.8 - 3.6)) were factors associated with being in the vitamin D deficiency group.&#x0D; Conclusion: According to this study patients who take Anti-Epilepsy drugs are at a higher risk of a poor vitamin D status. Based on this finding, the need for timely and appropriate vitamin D supplementation and periodic follow-up seems to be very evident.