Tikur Anbessa Research Articles

The Prevalence of Scoliosis among Adolescent Chest Radiographs Obtained at Tikur Anbessa Specialized Hospital in 2019.

Scoliosis is an abnormal side-to-side spinal curve of greater than or equal to 100 Cobb angle. It is the most common spinal deformity in children and adolescents. Epidemiological evidence about scoliosis is scarce in Africa, including Ethiopia. This study was aimed at determining the prevalence of scoliosis among adolescents and analysing its association with age and sex using plain chest radiographs obtained for non-spinal reasons in Tikur Anbessa Specialized Hospital. All non-tilted, non-rotated, and non-poorly penetrated digital plain chest radiographs of adolescents aged 10 to 19 years obtained at Tikur Anbessa Specialized Hospital between January 1 and December 31, 2019, were measured for the coronal Cobb angle. The data were cleaned, coded, and entered into SPSS version 26 for analysis. Chi-square, and linear regression, and logistic regression analyses were also carried out to evaluate the effect of sex and age on scoliosis. The Cobb angles of 1,369 posteroanterior chest radiographs of adolescents were measured. Thirty (2.2%, 95% CI: 1.4%, 3.0%) of these were found to have scoliosis. The mean coronal Cobb angle was 2.270±6.320. There was no statistically significant difference between the prevalence of scoliosis in boys (2.21%) and girls (2.17%) (X2=0.003, P=0.954). Likewise, age did not show any statistically significant difference in the prevalence of scoliosis (X2=2.655, P=0.265). This study revealed that incidental finding of adolescent scoliosis in plain chest radiographs is common. Further study using whole spine radiography should be carried out to determine the true general population prevalence of scoliosis in Ethiopia.

The Burden of Epstein-Barr Virus (EBV) and Its Determinants among Adult HIV-Positive Individuals in Ethiopia.

Epstein-Barr virus (EBV) is a well-known risk factor for the development of nasopharyngeal carcinoma, Hodgkin's lymphoma (HL), and Non-Hodgkin's lymphoma (NHL). People with HIV infection (PWH) are at increased risk for EBV-associated malignancies such as HL and NHL. Nevertheless, there are limited data on the burden of EBV among this population group in Ethiopia. Hence, this study aimed to determine the burden of EBV infection among adult HIV-positive individuals in Ethiopia and assess the determinants of EBV DNA positivity. We conducted a cross-sectional study at the Tikur Anbessa Specialised Hospital from March 2020 to March 2021. Two hundred and sixty individuals were enrolled in this study, including 179 HIV-positive and 81 HIV-negative individuals. A structured questionnaire was used to capture demographic and individual attributes. In addition, the clinical data of patients were also retrieved from clinical records. EBV viral capsid antigen (VCA) IgG antibody was measured by multiplex flow immunoassay, and EBV DNA levels were tested by quantitative real-time polymerase chain reaction (q-PCR) assays targeting the EBNA-1 open reading frame (ORF). Descriptive statistics were conducted to assess each study variable. A multivariable logistic regression model was applied to evaluate the determinants of EBV infection. Statistical significance was determined at a p-value < 0.05. Two hundred and fifty-three (97.7%) study participants were seropositive for the EBV VCA IgG antibody. Disaggregated by HIV status, 99.4% of HIV-positive and 93.8% of HIV-negative participants were EBV seropositive. In this study, 49.7% of HIV-positive and 24.7% of HIV-negative individuals were EBV DNA positive. PWH had a higher risk of EBV DNA positivity at 3.05 times (AOR: 3.05, 95% CI: 1.40-6.67). Moreover, among PWH, those with an HIV viral load greater than 1000 RNA copies/mL (AOR = 5.81, 95% CI = 1.40, 24.13) had a higher likelihood of EBV DNA positivity. The prevalence of EBV among PWH was significantly higher than among HIV-negative individuals. Higher HIV viral loads in PWH were associated with an increased risk of EBV DNA positivity. Since the increases in the viral load of EBV DNA among PWH could be related to the risk of developing EBV-associated cancers, it is necessary for more research on the role of EBV in EBV-associated cancer in this population group to be carried out.

Nutritional status and quality of life among breast Cancer patients undergoing treatment in Addis Ababa, Ethiopia

BackgroundThe prevalence of malnutrition in cancer patients ranges from 30 to 60%. While it is known that malnutrition is prevalent among cancer patients, the relationship between undernutrition and quality of life among breast cancer patients has not been adequately explored. Therefore, the present study was aimed at assessing the association between undernutrition and quality of life among Breast Cancer patients under treatment in Addis Ababa, Ethiopia.MethodsA cross-sectional study on breast cancer patients under treatment at the outpatient and in-patient departments of oncology centers of two tertiary hospitals in Addis Ababa – Tikur Anbessa Specialized Hospital (TASH) and St. Paul Millennium Medical College (SPHMMC) oncology was conducted from May 12 to August 26,2020. Nutritional status was assessed using Subjective Global Assessment (SGA) screening tool. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cancer 30 (EORTC QLQ C30) a standard quality of life measurement scale for cancer patients. To determine the relationship between quality of life scores and nutritional status multivariable linear regression was fitted.ResultsA total of 411 breast cancer patients with mean age of 44.4 (± 11.47) years. And 393 (95.6%) of them female were included in the study. A high prevalence of moderate 127 (30.9%) and severe 106 (25.8%) malnutrition was observed. Moderate (β = −9.21 CI (− 14.59, − 4.67)) and severe (β = −17.81 CI (− 16.6, 2 − 2.91)) malnutrition were negatively associated with the overall quality of life. Malnutrition also showed negative associations with all domains of functional status (P < 0.05) and strong positive associations with symptom scores covered in the EORTC QLQ C-30 (P < 0.05).ConclusionThis study indicated that malnutrition is a major problem among breast cancer patients and the nutritional status breast cancer patients was related to their quality of life….

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

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

Barriers to optimal use of continuous positive airway pressure machines in preterm babies with respiratory distress syndrome at a Tertiary Referral Hospital in Addis Ababa, Ethiopia

Background: Neonatal mortality is a significant contributor to under-five mortality in low-income countries like Ethiopia, carrying neonatal mortality of 30 per 1000 live births. Preterm newborns with respiratory distress can be effectively managed with a Continuous Positive Airway pressure machine. It is recommended as an essential lifesaving intervention by the World Health Organization. The study aimed to assess barriers to the optimal use of continuous positive airway pressure machines in preterm babies by Pediatrics residents at a tertiary referral hospital.&#x0D; Methods: A hospital-based cross-sectional study was carried out among pediatric residents at Tikur Anbessa Specialized Hospital from September to October 2021. The data were collected through a self-administered structured questionnaire and analyzed using SPSS version 25. A Pvalue &lt;0.05 was considered statistically significant.&#x0D; Results: One hundred twelve pediatrics residents were included; 41(36.6%) were females and 89 (79.5 %) were aged between 25-30 years and 106 (94.6%) had NICU experience of less than one year. Forty-one (36.6%) had a moderate level of practicing continuous positive airway pressure safety checklists. There was a statistically significant difference in the practice of CPAP safety checklist usage with the year of residency (P= 0.001). A majority, 90 (80.4%), of `pediatrics residents used locally-made improvised water bottle systems as bubble continuous positive airway pressure machines. The perceived barriers to continuous positive airway pressure machine use included lack of commercial bubble machine, 77 (85.5%), unavailability of oxygen, and lack of appropriately sized nasal prongs.&#x0D; Conclusion: Lack of commercial continuous positive airway pressure machines and essential equipment were the reported barriers. Tackling the perceived barriers would contribute to the national effort to decrease neonatal mortality and achieve Sustained Development-3

Health Related Quality of Life and Associated Factors Among Adult Patients with Rheumatic Heart Disease Patients in Ethiopia.

Quality of life (QOL) is defined as "individuals" perceptions of their position in life. Rheumatic heart disease (RHD) is a consequence of severe, single, or recurrent bouts of acute rheumatic fever. To improve overall patient outcomes, there is currently a greater emphasis on assessing the QOL of these patients. The purpose of this study is to assess the QOL of adult RHD patients who had followed up at St Peter and Tikur Anbessa Hospital, Ethiopia. An institutional-based cross-sectional study done at St Peter and Tikur Anbessa Hospital, Ethiopia from March 1-June 30/2021 in adult RHD patients. The sample size was 297. Socio-demographic and clinical data were collected using a structured questionnaire. The Amharic version of Short form-36 (SF-36) was used to assess the QOL. A logistic regression model was used to identify associated factors. The study included 297 patients. The majority are female (71%), and half of them are aged between 18-30 years of age. Of the patiends, 81.1% had no comorbidity, and 15.8% had interventions. RHD affects all domains and summary scores of short form 36 QOL parameters compared to normative values. Age, marital status, place of residence, presence of comorbidity, number of medications, and whether an intervention was done are associated with the QOL of these patients. RHD patients had poor QOL assessed by SF-36. It affects all domains and summary score of short form 36 QOL parameters. Old age, divorce, living in rural areas, associated comorbid conditions, and no intervention done are associated with poor QOL. Identification and treating comorbid conditions and intervention may improve QOL.

Oral Health Awareness and Self-Care Practice among Diabetic Patients Attending Diabetic Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: Good oral health awareness and self-care practice play a vital role in the early diagnosis and management of diabetes-related complications including oral disease. However, the status of oral health awareness and self-care practice among diabetic patients has never been reported in Ethiopia. Therefore, this study aimed to assess the level of oral health awareness, and self-care practices among diabetic patients attending the diabetic clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A facility-based cross-sectional study and systematic random sampling method were used to recruit diabetic patients in this study from March to May 2020. Collected data were entered, and edited, using Epi data version 3.1 statistical packages and analyzed using STATA version 14. Descriptive statistics were used to describe the level of oral health awareness and selfcare practice among the study participants. Results: The study found lesser number (39.25%) of the study participants know the relationship between diabetes and oral health. Further, our finding revealed that only (43.55) of the study participants knew their diagnosis (the type of DM). About 31.72% of the study participants had received information regarding oral health care. Further, the study found about 39.78 % of the participants clean their teeth once a day, and (40.13%) of them had a history of dental care visits within five years. Conclusion: The study concludes level of oral health awareness and self-care practice among diabetic patients was low in the study area. Therefore, healthcare providers and stakeholders should invest efforts in improving the patient’s oral care awareness and self-care practice.

Awareness of prostate cancer and its associated factors among male patients attending care in the urology unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BackgroundGlobally, prostate cancer is the most common cancer among men. It is the second most common cause of cancer-related deaths in men. Symptoms may be non-specific and may not present...

Application of the Joint Frailty Copula Model for Analyzing Time to Relapse and Time to Death of Women with Cervical Cancer.

Worldwide, there were 12.7 million new cervical cancer cases, of which 5.6 million took place in industrialized nations and 7.1 million in underdeveloped nations. In eastern, western, middle, and southern Africa, it is the main cancer-related cause of death in female patients. In Ethiopia, cancer was responsible for roughly 5.8% of all fatalities. This study makes use of sophisticated statistical models that take into account population heterogeneity in terms of frailty and dependence between two endpoints in terms of copulas. Based on hospital registry data, this retrospective study intends to examine the time to relapse and time to death of cervical cancer. This study analyzes 907 cervical cancer-positive women from various parts of Ethiopia. The copula model was used to link time to relapse and time to death of women with cervical cancer. Shared frailty model was used to incorporate unexplained heterogeneity for women with cervical cancer patients. Of the 907 cervical cancer patients, 275 (30.32%) experienced a relapse, 353 (38.92%) died, and 554 (61.08%) were censored. Age, smoking status, family planning, HIV status, family history, abortion, and stage are the most reliable predictors of both time to relapse and time to death of cervical cancer patients. The estimate of the copula parameter (θ = 1.476, 95% CI: 1.082, 1.870) shows moderate amount of dependence between time to relapse and time to death (Kendall's rank correlation (τ) = 0.425). The estimate of the variability (heterogeneity) parameter in the population of clusters (region) is η = 0.495, 95% CI: 0.101, 0.889. Age, smoking status, family planning, HIV status, family history, abortion, and more advanced stage significantly increase the risk of relapse and death of female cervical patients. There was a significant association between the time to relapse and the time to die for women with cervical cancer. There was a significant heterogeneity effect in the Tikur Anbessa Specialized Hospital.

Epidemiological and clinical profile of amyotrophic lateral sclerosis in Ethiopia: a 5-year multicenter retrospective study

Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that results in progressive weakness of skeletal muscles including respiratory muscles. Epidemiological and clinical aspects of ALS are derived from a few world regions with very little representation of low- and middle-income countries. We therefore set out to determine the epidemiological and clinical phenotype of individuals with ALS in Ethiopia. Methods Multicenter retrospective analysis was conducted using clinical records from ALS patients seen in Ethiopia at Tikur Anbessa Specialized Hospital and Yehuleshet specialty clinic between January 2016 and August 2021. The data collected included clinical characteristics, disease-related symptoms, a revised ALS functional rating scale, and medications. Results Patients in Ethiopia had a younger age of onset with a mean age of disease onset of 51.9 years. 2.9% of patients had juvenile ALS, and the male-to-female ratio was almost 2:1. 4.9% had a positive family history of the disease. 68% of patients had spinal region involvement at onset, while 32% had bulbar region involvement at onset. Riluzole was used by 31% of ALS patients. 20.6% of patients had some respiratory symptoms, but none received a standard respiratory function assessment. 33.3% of patients were wheelchair-bound. Conclusion In this retrospective study spanning 5 years, we examined the clinical phenotype of ALS in Ethiopian patients. Our findings suggest that most patients had clinically definite ALS with spinal region involvement. Further research, including genetic and epigenetic information, is necessary to understand the early onset of the disease in Ethiopia.

Clinical presentation, treatment patterns, and outcomes of colorectal cancer patients at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia: A prospective cohort study.

Colorectal cancer (CRC) is the third most common cause of cancer death in both genders worldwide. This study aimed to evaluate the outcomes and prognostic factors of CRC patients at Tikur Anbessa Specialized Hospital in Ethiopia. A prospective cohort study was conducted on 209 patients from January 2020 to September 2022. Kaplan-Meier curves and bivariate and multivariate Cox regression analyses were used to analyze overall and progression-free survival, with a significance value of P < .05. Results showed an overall mortality rate was 67.46% (95% confidence interval [CI]: 61.0-74.0), while the 1-year overall survival (OS) rate was 63.16% (95% CI: 56.23-69.29), with a median follow-up duration of 20 months. The median OS and progression-free survival times were 17 and 11 months, respectively. Age above 40 years (hazard ratio [HR] = 1.53, 1.02-2.29, p < .040), lower educational level (high school and below) (HR = 2.20, 1.24-3.90, p < .007), poor performance status (HR = 1.60, 1.03-2.48, p < .035), Hgb ≤12.5 g/dL (HR = 1.55, 1.03-2.08, p < .035), T-4 disease (HR = 6.05, 2.28-16.02, p < .000), and metastases at diagnosis (HR = 8.53, 3.77-19.25, p < .000) were all associated with poorer survival. These findings suggest that poor survival of CRC patients in Ethiopia is largely due to advanced stage of the disease and lack of timely treatment, and highlight the urgent need for improved access to cancer treatment in the region.

Magnitude and Determinant Factors of Pediatrics Seizures in Pediatrics Emergency Unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020: A Retrospective and Descriptive Study.

One of the most prevalent medical problems affecting kids is epilepsy, which is the most prevalent chronic neurological condition in kids in both developed and developing nations. The spectrum of diseases that make up childhood epilepsy syndromes ranges from mild to potentially fatal. Children may experience seizures due to a variety of illnesses, such as infection, severe brain injury, and anatomical deformity. It is the foremost visit calculates in neurological and cognitive impedance in children in low-income countries as well as the foremost common reason for pediatric clinic confirmations in children from destitute countries. All things considered, constrained things have been conducted in Ethiopia. Hence, this ponder points to survey the size and related variables of pediatric seizures among children conceded to Tikur Anbessa pediatric emergency. By looking through 256 patient charts, an institution-based retrospective cross-sectional analysis was done. Data collection utilized a systematic checklist that had been evaluated beforehand. The EpiData version 4.4.2.2 was used to enter the data, which was then exported for analysis to the SPSS version 25. Binary logistic regression and descriptive statistics were employed. Variables from the bivariate analysis that had a p-value of less than 0.25 were carried over to multivariate analysis. The strength and existence of the link were assessed using adjusted odds ratios with a 95% confidence interval and a p-value of 0.05, respectively. Patients' ages ranged from 3.7 to 2.8 years on average. 4.5% of patients had seizures, and 155 of them (60.5%) were men, with a male-to-female ratio of (1.5 : 1). Males and females experienced seizures on average at 1.3 (95% CI: 1.1, 1.5) and 2 (95% CI: 1.6, 2.5) years old, respectively. AOR: 2.68 (95% CI: 1.192, 6.68, p = 0.02) and AOR: 2.8 (95% CI: 2.576, 5.302, p = 0.04) both demonstrated statistically significant correlations with pediatric seizure. A vast number of children experienced convulsions, with generalized seizures being the most prevalent form. The chances of a child having a seizure were linked to their family history and where they were born. Therefore, health workers and other people who are involved in healthcare need to work harder on the factors that they have already identified.

Multiple anti-seizure medications use and pattern of seizure control in children with epilepsy at neurology follow up clinic, Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

Antiseizure drug treatment is the mainstay of the management of epilepsies. Thirty percent of individuals with epilepsy experience refractory or drug resistant seizures which often require treatment with combinations of antiseizure drugs. This was a cross sectional descriptive study of three hundred fifty-five children with epilepsy attending Tikur Anbessa hospital in Addis Ababa, Ethiopia. Children with epilepsy who had been on Antiseizure medications for six months and more were consecutively enrolled from October 1 2018 to December 30 2018 to reach the calculated sample size. The history and laboratory result information were extracted from patient's records and was supplemented by direct inquiry. Data was analyzed using SPSS for windows version 24. Multivariate logistic regression analysis was done for those that had P-value (<0.05) on bivariate analysis and adjusted odds ratio were used to explore the association. One hundred twenty nine of the 355 children (36.3 %) were on multiple AEDs; 114(32.1%) were on dual therapy while 15(4.1%) were on three anti epileptic drugs. One third of children with epilepsy attending the pediatric neurology clinics were being managed with multiple Anti-seizure drug therapy. Almost half of the participants had achieved seizure freedom in the past six months.

Frequency of viral infections in adolescent and adult in-patient Ethiopians with acute leukemia at presentation to a tertiary care teaching hospital: a cross-sectional study

BackgroundLeukemic patients are prone to infectious agents such as viruses due to dysregulated immune system resulting from infiltration of the bone marrow by malignant cells, chronic stimulation, reactivation of some viruses and viral pathogenicity as well as rarely from acquisition of a new infections leading to severe complications. However, the prevalence of these infections has not been systematically documented in resource-limited settings such as Ethiopia.ObjectiveTo determine the prevalence of HBV, HCV, and HIV among adult and adolescent in-patients with acute leukemia before the administration of chemotherapy, at the Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia.MethodsA cross sectional study was conducted on 176 adult and adolescent inpatient Ethiopians, who were diagnosed with acute leukemia from April 2019 to June 2021. Socio-demographic characteristics and relevant clinical data were collected. Peripheral blood samples were collected and tested for HBV, HIV, and HCV using Enzyme-Linked Immunosorbent Assay (ELISA) and real-time PCR. Chi-square tests were used to assess associations between variables.ResultsOf the 176 patients, 109(62%) were males. The median age was 25[IQR,18–35] yr, with a range from 13 to 76 year. The prevalence of HBV (positivity for HBsAg plus HBV DNA), HCV and HIV was 21.6%, 1.7%, and 1.7%, respectively. HBsAg was positive in 19 cases (10.8%). Among 157 HBsAg negative patients, 52(33.1%) were positive for Anti-HBcAg; of these seropositive cases, 47.5% were positive for HBV DNA. Most DNA positive, HBsAg negative cases (79.0%) had DNA concentrations below 200 IU/ml indicating true occult HBV infection (OBI). Of the 176 cases, 122 had a history of blood transfusions, but no statistically significant association was found between HBV infection and blood product transfusion history (P = 0.963).ConclusionsThe prevalence of HBV, HIV and HCV in patients with acute leukemia was similar to the national prevalence level of these infections. Given the HBsAg positivity and the high prevalence of occult hepatitis B infection in our study, these patients may be at increased risk for chemotherapy related hepatitis flares. Hence, clinicians caring these patients are strongly advised to screen their patients for HBV and also for HIV and HCV infections routinely.

Using bedside whiteboard to improve patient-centered care for hospitalized patients in a resource-limited setting: A quality improvement report

Abstract Background In our assessment, hospitalized patients have difficulty of identifying their assigned health-care providers because of frequent rotation of physicians, residents, and interns in a teaching hospital like Tikur Anbessa Specialized Hospital. In addition, patients are not routinely communicated about their daily plan of care and estimated date of discharge. As a solution to these problems, bedside whiteboards could be used with an ultimate goal of improving patient-centered care. Methods Pre-intervention survey was conducted on patients from selected medical wards of the hospital over 3 months (N = 52). Whiteboards were then used on newly admitted patients in the same medical wards, and a post-intervention survey was conducted on these patients over 3 months (N = 47). Responses to the Stanford’s Quality Improvement Team patients’ knowledge assessment and Press Ganey patient satisfaction questionnaires were used as the outcome measures. A pre-/post-intervention study design was used, and all statistical analyses were performed using SPSS Statistical Software 25. Results Most patients were literate, and use of whiteboards significantly increased the proportion of patients who knew their attending doctors and nurses (P &amp;lt; 0.001), daily plans of investigations and treatment options (P &amp;lt; 0.001), and their estimated discharge date (P &amp;lt; 0.001). Patients were also more satisfied with their treatment in all satisfaction assessment questionnaires with significantly higher mean Likert scores in the intervention group compared to the non-intervention group (P ≤ 0.001). Conclusion The findings of this quality improvement project show that bedside whiteboards are effective tools to improve patients’ awareness of their care team, daily care plans, and estimated date of discharge and increase their satisfaction.

Incidence and determinants of hematotoxicity in acute lymphoblastic leukemia children who received 6-mercaptopurine based maintenance therapy in Addis Ababa, Ethiopia.

The maintenance phase of acute lymphoblastic leukemia treatment is the final and longest stage of treatment, mainly focused on antimetabolite therapy. This phase is essential to eliminate residual leukemic clones and prevent relapse. However, dose-limiting hematotoxicity is a major problem during this phase resulting in dose reduction or treatment discontinuation. In this cohort study, the clinical features and risk factors of hematological toxicity during the maintenance phase of treatment were analyzed in pediatric patients from Ethiopia. A total of 160 patients from Tikur Anbessa specialized hospital were included in the study of which 142 had sufficient data available for analysis. Patient characteristics as well as information about the care-givers, sides-effects as reported by the care-givers and clinical factors were collected. Bivariable followed by multivariable analysis was performed to investigate which factors were associated with hematological toxicity during the maintenance phase. During the first six months of maintenance phase treatment grade 4 neutropenia was detected in 52.8% of the patients. The risk of developing grade 4 neutropenia was increased by about two fold in children with the age of 6 years and less compared to those with the age of more than 6 years. Similarly, the rate of developing grade 4 neutropenia among children with less than 4,500 maintenance day 1 white blood cell counts was significantly higher than that of children with normal maintenance day 1 white blood cell counts (AHR 2.477, 95% CI = 1.461-4.200, p = 0.001). In conclusion, child's age and day 1 maintenance white blood cell/absolute neutrophil counts significantly affected the occurrence of grade 4 hematotoxicity. Close monitoring for white blood cell and absolute neutrophil counts during maintenance phase treatment is recommended for early diagnosis of hematotoxicity.

Cost of childhood cancer treatment in Ethiopia.

Despite the recent interest in expanding pediatric oncology units in Ethiopia, reflected in the National Childhood and Adolescent Cancer Control Plan (NCACCP), little is known about the cost of running a pediatric oncology unit and treating childhood cancers. We collected historical cost data and quantity of services provided for the pediatric oncology unit and all other departments in Tikur Anbessa Specialized Hospital (TASH) from 8 July 2018 to 7 July 2019, using a provider perspective and mixed (top-down and bottom-up) costing approaches. Direct costs (human resources, drugs, supplies, medical equipment) of the pediatric oncology unit, costs at other relevant clinical departments, and overhead cost share are summed up to estimate the total annual cost of running the unit. Further, unit costs were estimated at specific childhood cancer levels. The estimated annual total cost of running a pediatric oncology unit was USD 776,060 (equivalent to USD 577 per treated child). The cost of running a pediatric oncology unit per treated child ranged from USD 469 to USD 1,085, on the scenario-based sensitivity analysis. Drugs and supplies, and human resources accounted for 33% and 27% of the total cost, respectively. Outpatient department and inpatient department shared 37% and 63% of the cost, respectively. For the pediatric oncology unit, the cost per OPD visit, cost per bed day, and cost per episode of hospital admission were USD 36.9, 39.9, and 373.3, respectively. The annual cost per treated child ranged from USD 322 to USD 1,313 for the specific childhood cancers. Running a pediatric oncology unit in Ethiopia is likely to be affordable. Further analysis of cost effectiveness, equity, and financial risk protection impacts of investing in childhood cancer programs could better inform the prioritization of childhood cancer control interventions in the Ethiopia Essential Health Service Package.

Treatment pattern and outcome of locally advanced rectal cancer in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia: An institution-based cross-sectional study.

e15640 Background: The standard management of locally advanced rectal cancer (LARC) is neo-adjuvant concurrent chemo radiation (CCRT) followed by total meso-rectal excision. Recently there is an increased interest in total neo-adjuvant treatment (TNT). Most patients with rectal cancer in developing countries present in advanced stage for several reasons including lack of resources and delayed health seeking behavior. Most patients are not able to get standard management. This study tries to assess treatment patterns and outcomes in LARC. Methods: A cross-sectional study was conducted in patients with LARC that are treated at TASH from Jan 1, 2020 up to Sept. 2022. The data was collected from Patient’s cards using a pre-structured format that included demographic data, laboratory, pathological and imaging information. Data analysis was conducted by using IBM SPSS version 25. Results: 100 patients were included in the study, 51% were male. The median (range) age at diagnosis was 45.5 (20-86) years. 81% of patients came to our center without getting any oncologic treatment and 75.3% of them were presented on a multi-disciplinary tumor board for their treatment decision. Upfront surgery was decided in 48.1% (39/81) of patients. Standard neo-adjuvant treatment of either TNT or CCRT was decided in 23.4% (19/81) and 8.6% (7/81) of patients respectively. There is no significant association between tumor location, TNM stage, mesorectal fascia status and first treatment decision. Only 12 (14.8%) patients were able to finish their whole treatment plan. The most common reason for not finishing all treatment was prolonged radiation waiting time, with the median (range) waiting time of 10 ± 7.1 (1-26) months. From 81 treatment naive patients, 79 were decided to have surgery; and 59.5% (47/79) underwent the planned surgery with 89.9% R0 resection rate. R0 resection rate in patients who undergo upfront surgery was 91.2% (31/34). Neo-adjuvant chemotherapy was given to 34.6% (28/81); and only 18% (5/28) underwent subsequent surgery. The most common reason for not undergoing subsequent surgery was disease progression 43.5% (10/23) during or after finishing the neo-adjuvant chemotherapy. Only 24% of the study participants received radiotherapy. From the patients who took radiotherapy, only two patients received short course radiotherapy. Conclusions: Treatment decisions for rectal cancer in our study did not conform to standard treatment recommendations. Upfront surgery maybe a better option than neoadjuvant chemotherapy, since timely administration of standard neoadjuvant treatment is not possible. Alternative radiotherapy treatment options like short course radiotherapy may be better in resource limited setting to alleviate the longer radiotherapy waiting time.

Magnitude of paternal postpartum psychological distress and associated factors in Addis Ababa, Ethiopia: a facility-based cross-sectional study

BackgroundThe psychological distress of fathers in the postpartum period can have adverse effects on the well-being of the family and the newborn’s development in particular. However, fathers’ mental health throughout the postpartum has remained understudied and clinically overlooked in many developing countries, including Ethiopia. This study aims to assess the prevalence of psychological distress among fathers in the postpartum period and to examine the associated factors in an Ethiopian population.MethodsA facility-based, cross-sectional study was conducted at Tikur Anbessa Specialized Hospital (TASH) and Gandhi Memorial Hospital (GMH) in Addis Ababa, Ethiopia. A systematic sampling method was employed to include 280 fathers whose partners gave birth 6 to 8 weeks before the interview. Psychological distress was assessed using a validated Amharic version of the Kessler Psychological Distress Scale (K10) through a telephone interview. The collected data was analyzed using SPSS version 26. Descriptive statistics were used to summarize the data. Multivariable logistic regression was run to determine the variables associated with paternal postpartum psychological distress (K10 total score ≥ 7, a validated cut-off score in an urban Ethiopian setting), and odds ratio with 95% confidence intervals were obtained. A two-tailed p-value < 0.05 was considered for statistical significance.ResultsAbout one-fifth of the fathers endorsed having distress symptoms during the postpartum period. Those with lower income (AOR = 11.31, 95% CI: 4.10, 31.15), unintended pregnancy (AOR = 3.96, 95% CI: 1.02, 15.46), poor social support (AOR =3.28 95% CI: 1.43, 7.50), poor infantile health (AOR = 8.20, 95% CI: 2.35, 28.66) and maternal postpartum distress (AOR = 12.10, 95% CI: 3.15, 46.48) had significantly higher odds of having paternal postpartum distress.ConclusionsPaternal postpartum distress was present in one-fifth of the fathers included in this study. This calls for due attention and efforts for early detection of those at risk of paternal distress and the development of interventions that consider their specific needs.

Quality of life and associated factors among chronic kidney disease patients at Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia: a cross-sectional study design

IntroductionChronic kidney disease (CKD) is associated with significant morbidity, mortality, healthcare cost and reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and associated factors among patients...