Tikur Anbessa Specialized Research Articles

Establishing the first ever pediatric procedural sedation clinic in a low-income country: Assessment of the safety and efficacy.

Pediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5years since its establishment. A multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital. In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures. One hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality. Based on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.

WCN24-2293 Knowledge, Attitude and Practice Towards Clean Intermittent Catheterization Among Health Care Professionals and Caregivers of Children with Neurogenic Bladder in Tikur Anbessa Specialized and Zewditu

WCN24-2293 Knowledge, Attitude and Practice Towards Clean Intermittent Catheterization Among Health Care Professionals and Caregivers of Children with Neurogenic Bladder in Tikur Anbessa Specialized and Zewditu

Adherence to Chemotherapy among Women with Breast Cancer Treated at Tikur Anbessa Specialized and Teaching Hospital, Addis Ababa, Ethiopia.

Adherence is important for women with breast cancer because it is a primary determinant for effectiveness of treatment and optimum clinical benefit. Though Breast cancer is the leading cancer in Ethiopia,adherance to chemotherapy is not investigated in Ethiopian women. This study aimed to assess adherence to chemotherapy among women with breast cancer treated at Tikur Anbessa specialized and Teaching Hospital. Cross-sectional study was conducted among 164 breast cancer patients with chemotherapy. After eligible participants were identified, data were collected using face-to-face interviews, card reviews and telephone interviews. Adherence was calculated as the number of doses taken divided by number of recommended or expected doses. Pearson chi-square test was used to evaluate predictors of adherence. Among a total of 164 breast cancer patients, majority, 119, (72.6%) of them were urban residents. The mean age of study participants was 41.99 + 10.9 years. The majority 149, (90.9%) of patients were married. More than half 94, (57.3%) of the women were literate. In this study, 137 out of 164 (83.5%) women were adherent to their chemotherapy. Of the 27 non adherent participants. he reason for non-adherence to chemotherapy was unknown for 7, (25.9%) of women. Among different identified reasons for non-adherent, sever illness prevents patients to receive chemotherapy. Based on Pearson chi square test, distance from referral center and treatment regimen were significantly associated with non-adherence rate. The present study the results showed that the majority 137, (83.5%) of patients were in good adherence to their chemotherapy. The most identified factor of non-adherence was inability to come for their therapy as a result of severity of illness. Therefore, expansion of cancer diagnosis and treatment centers should be encouraged in order to maximize patient's access and adherence to chemotherapy.

Incidence and Associated Factors of Postoperative Pulmonary Complications after Abdominal Surgery in the Public Hospital, Addis Ababa, Ethiopia.

Background Postoperative pulmonary complications are a wide variety of disorders that affect normal respiratory functions, which in turn lead to morbidity and mortality. The extent to which it occurs is not yet studied in most clinical settings. This study assessed the incidence and risk factors of postoperative pulmonary complications in patients undergoing abdominal surgery under general anesthesia. Methods A multicenter, prospective cross-sectional study was conducted at Menelik II, Tikur Anbessa Specialized, Zewditu Memorial, and Yekatit 12 Memorial hospitals after obtaining ethical clearance from each hospital. The study recruited a total of 287 participants using systematic random sampling. The data collection tool included sociodemographic, surgical, and anesthetic factors. Participants were followed for 7 days postoperatively, and any respiratory problems were recorded once identified. The collected data were entered and analyzed using SPSS version 26. Both bivariate and multivariate logistic regressions were used for analysis. A p value of <0.05 was considered statistically significant. Results About 33% of the participants that underwent abdominal surgery developed postoperative pulmonary complications. Age > 65 years (AOR = 12.091, 95% CI = 3.310–44.169), duration of surgery >3 hours (AOR = 11.737, 95% CI = 3.621–38.039), preoperative oxygen saturation <94% (AOR = 10.671, 95% CI = 3.794–30.016), and postoperative serum albumin level <3.5 g/dl (p value <0.001) were associated with postoperative pulmonary complications significantly. Conclusion and Recommendations. The incidence of postoperative pulmonary complications after abdominal surgeries was high. Age >65years, duration of surgery >3 hours, preoperative SpO2% <94%, cigarette smoking, and postoperative serum albumin level <3.5 g/dl were factors strongly associated with postoperative pulmonary complications. We recommend special care for elderly patients, limit the surgical duration to less than 3 hours, treat the underlying cause of desaturation, and correct postoperative serum albumin to prevent the occurrence of postoperative pulmonary complications.

Descriptive epidemiology of nasopharyngeal carcinoma at Tikur Anbessa Hospital, Ethiopia

BackgroundNasopharyngeal cancer is distinguished from other cancers of the head and neck in its epidemiology, histopathology, clinical characteristics, and therapeutic outcome. Its unique clinico-epidemiologic pattern of the disease is an area focus for this investigation. Accordingly, the study investigated the demographic and histologic characteristics, as well as the clinical stage at presentation of nasopharyngeal carcinoma patients at Tikur Anbessa Specialized hospital.MethodsHospital based retrospective descriptive study was conducted from September 2017 – October 2020. All biopsy proven incidental cases during the study period are included. SPSS version 26 is used for data entry and analysis.ResultA total of 318 patients with histologically confirmed nasopharyngeal carcinoma cases during the study period were included. There were 218 males and 90 females, with a male: female ratio of 2.5:1. The age of patients ranges from 13 to 81 years with a mean age of 37.8 ± 15 years. The median age at diagnosis was 38 years. Age distribution has two peaks for males, first between 30 to 39 and second 50 to 59 years of age. While the peak age of occurrence for females is in the 20–39 age range. Juvenile cases constituted 34% of the study group. The study revealed, nonkeratinizing carcinoma as the most prevalent histology at 94.3% (undifferentiated type 85.9% and differentiated keratinizing squamous cell carcinoma 8.4%) and 5.7% of the cases showed keratinizing squamous cell carcinoma. Majority of the patients, 86%, presented late with stage III and IV disease.ConclusionNasopharyngeal cancer is commonly found among the young and productive age group, under the age 30. Nonkeratinizing carcinoma is the predominant histopathologic variant resembling that seen in endemic areas of the world. Thus, genetic and early life environmental exposures should be well studied to identify possible risk factors in the region. Late-stage presentation at diagnosis impacts the treatment outcome of patients, thereby indicating the need for a raised index of suspicion among health professionals for early diagnosis and better prognosis of patients.

Neonatal and Maternal Complications of Placenta Praevia and Its Risk Factors in Tikur Anbessa Specialized and Gandhi Memorial Hospitals: Unmatched Case-Control Study.

Background Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.

Drug therapy problems and treatment satisfaction among ambulatory patients with epilepsy in a specialized hospital in Ethiopia.

ObjectiveEpilepsy management especially in developing country is challenging. Seizures recurrence can be caused by both drug and non-drug related problems such as inadequate antiepileptic regimens, adverse drug reaction and poor adherence. Patient treatment satisfaction also affects the treatment out comes by improving medication adherence. This study aimed to assess drug therapy problems (DTPs) and treatment satisfaction among ambulatory epileptic patients at Tikur Anbessa Specialized Hospital.MethodsA prospective cross-sectional study was conducted on 291 epileptic patients. Data was collected through patient interview and medical charts review. DTPs were identified based on the standard treatment guidelines and Micromedex® was used as drug interaction checker. Cipolle DTPs classification was used to classify the DTPs and Treatment Satisfaction with Medicine Questionnaire (SATMED-Q) was used to assess treatment satisfaction. Binary logistic regressions were utilized to identify the associated factors.ResultsPhenobarbital 195 (67%) and phenytoin 97 (33.3%) were the most frequently prescribed antiepileptic medications as monotherapy or combination therapy. Only 54 (18.6%) of the study participants had controlled seizure. DTP was found in 205(70.4%) of the study participants. From 352 DTPs identified, adverse drug reaction 146 (41.5%) was the leading DTPs followed by ineffective drugs 98 (27.8%) drug interaction 45 (12.8%) and inappropriate dose 42(11.9%). Headache, depression and epigastric pain were frequently reported adverse drug reaction. Among the study participants 167 (57.3%) were adherent to their medications. The number of medications taken by the patients had significant association with occurrence of DTPs, whereas source of medication and seizure free periods were found to have significant association with poor adherence. The global patient satisfaction was (67.4%) and lower satisfaction rate was found with regard to impact on daily activities (62.0%), treatment effectiveness (64.7%) and medical care (65.9%).ConclusionPrevalence of DTPs among ambulatory epileptic patients was high and about half of the patients were nona-dherent for their medication. The overall treatment satisfaction of the patients was suboptimal.

Drug-related problems and potential contributing factors in the management of deep vein thrombosis.

BackgroundPatients receiving anticoagulant drugs must be carefully screened for drug-related problems, as such medications, including warfarin have narrow therapeutic ranges and a high potential for complications. Thus, this study was designed to assess drug-related problems in the management of patients with deep vein thrombosis at Tikur Anbessa Specialized Hospital.MethodsA cross-sectional descriptive study involving retrospective chart review of adult patients with deep vein thrombosis was conducted from patients who visited the hospital from July 2012 to June 2013, using structured data collection format and this was complemented by key informant interview.ResultsThe study included 91 patients with venous thromboembolism. Fifty three (58.2 %) were females. Mean age was 38.6 (±13.76) years and more than 2/3 were below the age of 44 years. About 54 % of them presented with concurrent medical conditions and most commonly with cancer. Adjustment of warfarin dose up or down was done in increments of 16 to 100 % for recent subtherapeutic International Normalized Ratios, 16 to 50 % for therapeutic and 11 to 66 % for overtherapeutic International Normalized Ratios, with the mean of 36.5 (±18.03) based on the cumulative weekly dose of warfarin. There was significant linear relationship between percentage of dose change and consequent International Normalized Ratio values (R2 = 0.419; p = 0.000). Accordingly, more than 51 % of them presented with nontherapeutic International Normalized Ratio ranges following dose adjustment.ConclusionsThe most prevalent anticoagulation drug-related problems were subtherapeutic doses, overtherapeutic doses and potential drug interactions. Institutional validated decision support tools for dosing decisions during maintenance anticoagulation therapy should be developed and used accordingly in order to prevent recurrent and hemorrhagic complications and to improve clinical outcomes.