Zewditu Memorial Hospital Research Articles

Tuberculosis Treatment Outcomes and Associated Factors at Zewditu Memorial Hospital, Ethiopia

<i>Background:</i> Tuberculosis (TB) remains a leading cause of morbidity and mortality in Ethiopia, with treatment success rates consistently below the WHO target. Various factors contribute to poor treatment outcomes. <i>Objective:</i> To assess treatment outcomes for TB and associated factors at Zewditu Memorial Hospital (ZMH) from 2017 to 2021. <i>Methods:</i> An institutional-based analytical cross-sectional study was conducted using TB logbook data. After bivariable analysis, clinically relevant variables and variables with a p-value < 0.2 were included in multivariable logistic regression analysis. Statistical significance was set at p-value < 0.05. <i>Results:</i> The overall successful treatment outcome (cured or completed) was 197 (83.1%). Factors significantly associated with poor treatment outcomes included age group 35 to 44 years (AOR=4.663; 95% CI: 1.215-17.901), extrapulmonary TB (AOR=3.451; 95% CI: 1.172-10.16), and registration in 2019 (AOR=4.367; 95% CI: 1.2-15.87). <i>Conclusion:</i> The treatment success rate falls short of the national target of 85%, highlighting the need for targeted improvements in TB management. The associations with age and extrapulmonary TB emphasize the necessity for focused control measures. Strengthening targeted TB programs at ZMH is recommended.

Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40–60 years in Addis Ababa, Ethiopia: a cross-sectional study

BackgroundThe onset of menopause leads to diminished estrogen exposure, resulting in a high morbidity burden related to menopausal symptoms. Menopausal hormonal therapy is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years.ObjectiveThis study aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and assess the use of menopausal hormone therapy among women aged 40–60 who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted from January 2022 to June 2022 at Gandhi Memorial Hospital, Tikur Anbessa Hospital, and Zewditu Memorial Hospital on 296 middle-aged women. Data were collected using an interviewer-administered structured questionnaire and analyzed for sociodemographic factors, utilization of menopausal hormone therapy, and prevalence of menopausal symptoms using the menopause rating scale. Data were analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to identify independent predictors of each subscale of menopausal symptoms. The strength of the association was measured using odds ratios with 95% confidence intervals, and statistical significance was set at a value of P < 0.05.ResultThe prevalence of menopausal symptoms was 89.9%. According to the menopausal rating scale, the frequency of reported symptoms was hot flushes (54.7%), muscle and joint pain (32.1%) on the somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. This study also showed that the age of women [aOR: 0.317, 95%CI (0.102, 0.990)], and monthly family income [aOR = 0.182, 95% CI (0.041, 0.912)] were significantly associated with somatic menopausal symptoms. There was no utilization of menopausal hormonal therapy to treat menopausal symptoms and to prevent complications.ConclusionThe prevalence of menopausal symptoms is high; however, the utilization of individualized administration of menopausal hormone therapy according to symptoms is negligible. It appears essential for these institutions to work on service availability and delivery of menopausal hormone therapy for those in need of wider benefits for their clients.

Survival status and predictors of mortality among severely acute malnourished under-5 children admitted to stabilisation centers in selected government hospitals in Addis Ababa, Ethiopia, 2022: a retrospective cohort study

ObjectiveThis study aims to assess the survival status and predictors of mortality among under-5 children with severe acute malnutrition in Addis Ababa, Ethiopia.DesignA retrospective cohort study was employed on randomly...

Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study

BackgroundPulmonary embolism (PE) and deep venous thrombosis (DVT) are the two most important manifestations of venous thromboembolism (VTE). DVT remains a significant condition since associated morbidity is significant and has elevated healthcare-related costs.MethodsA retrospective cohort study was conducted among DVT patients admitted to Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul’s Hospital Millennium Medical College on follow-up from July 1, 2017, to July 01, 2020. Data on sociodemographic characteristics, types of DVT, laboratory findings, medications, risk factors of DVT, complications and outcomes of DVT were collected. The data were analyzed using SPSS version 25. Multivariate logistic regression analysis was conducted to determine predictors of DVT recurrence and major bleeding. A P value < 0.05 was considered to identify significant predictors.ResultsThe mean age of the participants was 45.2 years, with SD of 15.36. The major causes of DVT included immobilization (29.9%), previous surgery (27.5%) and cancer (21.1%). The DVT recurrence rate was 22.5%. Nine (2.2%) of the participants died, and 19.9% developed complications. Bilateral DVT (Adjusted odds ratio (AOR) = 2.8, 95% Confidence interval (CI) = 1.14, 6.66), obesity (AOR = 3.3, 95% CI = 1.15, 9.59), hypertension (AOR = 6.5, 95% CI = 2.90, 14.70) and retroviral infection (AOR = 6.3, 95% CI = 2.34, 16.94) were predictors of recurrent DVT. Nineteen (4.7%) patients had major bleeding, and patients with bilateral DVT, active cancer and terminal age had an increased risk of major bleeding.ConclusionsThe overall DVT recurrence rate was alarmingly high and further complicated by PE, post thrombotic syndrome and chronic vein insufficiency, resulting in a 2.2% death rate. Major bleeding after DVT and PE remained high. Close monitoring should be performed for patients with advanced age, active cancer, bilateral DVT, retroviral infection, obesity and hypertension to prevent the recurrence of DVT and major bleeding.

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.

The impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy at a referral hospital in Ethiopia.

The world continues to be challenged by the Coronavirus disease 2019 (COVID-19) and preventive measures like maintaining social distancing and lockdowns challenge patients to attend regular follow-ups and get a refill for medication that causes adherence problems. Hence, this study attempts to assess the impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy. A total of 276 patients with epilepsy were enrolled in the study. Data collection was carried out through medical record reviews and patient interviews. Patients who visited Zewditu Memorial Hospital from August to September 2021 and those who had follow-up at least for two years before the outbreak of the pandemic were included. The data was analyzed using SPSS v.24. About 69.6% of patients were adherent to their treatment and 83.3% of the patients had a seizure-free period of less than 1 year. Ninety (32.6%) of the participants missed their treatment follow-up during the pandemic, mainly due to fear of being infected with COVID-19. Sixty-eight (24.6%) patients have experienced increased seizure episodes during the pandemic as compared to the previous times. Moreover, 56 (20.3%) participants were not taking their antiseizure medications (ASMs) during the pandemic because of the unavailability of medications and they discontinued hospital visits for their medication refills. Among those who missed their treatment follow-up, 20% had seizure-related physical injuries. Only educational level has a significant association with visiting health facilities during the pandemic. Thus, participants who completed college and above (OR = 2.58, 95% CI (1.32-6.38)) were more likely to attend their follow-up during the pandemics as compared to participants who can't read and write. The present study revealed that COVID-19 might have impacts on treatment follow-up and medication adherence due to fear of infection, travel restrictions and the indirect impact on the availability and affordability of medications. These might lead to poor treatment outcomes like increased seizure frequency and seizure-related physical injuries.

Prescription Error

Objective: This research study aimed to investigate prescription errors and their intervention outcomes at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, during the year 2023. The study assessed the prevalence of prescription errors, identified contributing factors, evaluated the effectiveness of medication safety interventions, and examined the impact of adverse drug events on patient outcomes and healthcare costs. Methods: A cross-sectional study design was employed, and data were collected from the hospital's prescription files. Prescription errors were classified into various categories, and the frequency and proportion of errors were calculated. The study also evaluated different medication safety interventions' effectiveness in reducing prescription errors and assessed healthcare professionals' adherence to medication safety protocols. Additionally, the study conducted a cost analysis of adverse drug events to assess their financial implications. Results: The study revealed a prescription error rate of 25.1%, with wrong dosage, drug omission, drug-drug interactions, and illegible prescriptions being the most common error categories. Adverse drug events resulting from prescription errors affected 12.2% of patients, leading to patient harm and increased healthcare utilization. The electronic prescribing system emerged as the most effective intervention, reducing prescription errors by 60.1%. High adherence rates were observed for double-checking high-risk medications and conducting medication safety huddles. However, there was room for improvement in implementing barcoding technology and tall man lettering. Conclusion: Prescription errors and adverse drug events pose significant challenges to medication safety at Zewditu Memorial Hospital. Implementing electronic prescribing systems and enhancing medication reconciliation processes can significantly reduce prescription errors and improve patient outcomes. Furthermore, fostering a culture of safety, promoting interprofessional collaboration, and investing in education and training programs are essential to enhance medication safety practices. Continuous quality improvement initiatives and regular audits should be conducted to address medication safety challenges and support a culture of learning from errors. Policymakers should be engaged to support medication safety initiatives, and multi-center studies are recommended to enhance generalizability.

Prevalence of Episiotomy and Factors Associated with Its Practice in Three Teaching Hospitals, Addis Ababa, Ethiopia

Background: Episiotomy is a surgical incision into the perineum and posterior vaginal wall during the second stage of labor to increase the diameter of the soft tissue pelvic outlet to facilitate delivery. Episiotomy rates vary from population to population. Limited information exists related to the practice of episiotomy in Ethiopia. Objective: To assess the prevalence of episiotomy practice and associated factors at three teaching hospitals (Tikur Anbessa Hospital, Gandhi Memorial Hospital, and Zewditu Memorial Hospital) in Addis Ababa Ethiopia. Method and Materials: Hospital-based cross-sectional study was conducted from January 2022 to March 2022 on 386 mothers who had a vaginal delivery in the three hospitals. A structured questionnaire was used to collect data. The data was entered, coded, and analyzed using Statistical Package for Social Science (SPSS) version 25. Binary and multivariable logistic regression analyses were performed. P value ? 0.05 was used to determine the level of statistically significant variables. Results: The prevalence of episiotomy was 49%. Age ?24 years (AOR=0.17, 95%CI=0.055, 0.52), operative vagainal delivery (vacuum AOR=3.1, 95%CI=1.50,18.67 and forceps AOR=3.5, 95%CI=1.87, 11.06), duration of second stage of labor ?2HR (AOR=3.5, 95%CI=1.87, 11.06), birth weight of newborn ?4000 grams (AOR=5.3, 95%CI=95%CI, 1.28, 22.02) and FGM (AOR=2.8, 95%CI=1.64, 4.94) were factors significantly associated with episiotomy practice. Conclusion: The prevalence of episiotomy in this study (49%) is higher than the WHO’s recommendation (10%). Variables that remained associated significantly with episiotomy were maternal age, instrument delivery, duration of the second stage of labor ?2HR, newborn weighing ?4000 grams, and FGM. An effort should be made to reduce the prevalence of episiotomy by adhering to the correct indications and preparing periodic on-job training regarding the indication of episiotomy to all obstetric care providers.

Prevalence and Factors Associated with Dyslipidemia Among People Living with HIV/AIDS on Follow-Up Care at a Tertiary Care Hospital in Ethiopia: A Cross-Sectional Study.

Despite its importance as a major risk factor for cardiovascular disease, dyslipidemia remains poorly characterized in the African population. To assess the prevalence and factors associated with dyslipidemia in people with HIV/AIDS in follow-up at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. A hospital-based retrospective cross-sectional study evaluated the charts of 288 people living with HIV/AIDS who had received Highly Active Antiretroviral Treatment for at least six months at Zewditu Memorial Hospital from July to September 2021. Sociodemographic and clinical data were collected from the patient's charts. Statistical analysis was performed using the Statistical Package for Social Sciences software version 25. The overall prevalence of dyslipidemia was 55.2% in people living with HIV/AIDS. The prevalence of high-density lipoprotein cholesterol <40 mg/dl in men and <50 in women was 46.9%; total cholesterol ≥200 mg/dl was 22.6%; triglycerides ≥150 mg/dl was 18.8%, and low-density lipoprotein ≥130 mg/dl was 4.9%. Sex [Female adjusted odds ratio (AOR) = 0.595, 95% CI: 0.37-0.956], age greater than 40 years (AOR = 1.026, 95% CI: 1.005-1.048), body mass index >25 kg/m2 (AOR = 1.767, 95% CI: 1.099-2.84), viral load >50 (AOR = 0.477, 95% CI: 0.27-0.842), and CD4 <500 (AOR = 1.938, 95% CI: 1.18-3.183) were identified as determinants of dyslipidemia. There was a high prevalence of dyslipidemia among study participants compared to several studies published in a similar population. Being male, older age, higher BMI, low CD4 count, and viral load of < 50 copies/mL were associated with dyslipidemia in people living with HIV/AIDS. Therefore, lipid profile measurements at baseline must be part of routine care to prevent the devastating effects of dyslipidemia.

Knowledge, Attitude and Practice on Cervical Cancer Screening Among Female Reproductive Health Clients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia

<i>Background: </i>Cervical cancer is the most common gynaecologic malignancy among women. In general, poor level of awareness, lack of effective screening program, overshadowed by other health concerns (such as AIDS, TB, cardiovascular and mental health), and lack of attentiveness to women’s health are a few of the possible factors for the noticed higher incidence rate of cervical cancer in Ethiopia.<i> Objective: </i>To assess the level of knowledge, attitude, and practice on cervical cancer screening among reproductive health clients aged 18-49 of Zewditu Memorial Hospital, Addis Ababa, Ethiopia. <i>Methods:</i> The study design was a cross-sectional descriptive study, conducted on 237 women who were enrolled with a simple random sampling method from March to October 2020. A structured pretested questionnaire was carried out to gather data and the collected data were entered into SPSS version 23 for analysis. Descriptive analysis using frequency, percentages, mean, and SD with bivariate analysis and multiple regressions was done. <i>Result: </i>About three-quarters (75.1%) of the participants heard about cervical cancer and out of the total participants 59% of them were found to have adequate knowledge, 58.2% with a positive attitude, and 51% of the participants were screened for cervical cancer. Lack of information about cervical cancer was the most reported reason for not attending cervical cancer screening. <i>Conclusion and recommendation:</i> The study showed more than half of the respondents had adequate knowledge, attitude, and practice on cervical cancer and screening for a premalignant cervical lesion. But still, there is a need to promote cervical cancer screening among women by informing them on their susceptibility to cervical cancer and encouraging a belief that active and regular screening can detect cervical cancer at the precancerous stage, hence enabling the early treatment and prevention of cancer development.

Predictors of Viral Load Status Over Time Among HIV Infected Adults Under HAART in Zewditu Memorial Hospital, Ethiopia: A Retrospective Study.

HIV attacks the CD4 cells which are responsible for the body's immune response to infectious agents. The main objective of this study was to identify predictors of viral load status over time among HIV patients under HAART in Zewditu Memorial Hospital. A retrospective institutional-based cohort study design was conducted on 161 HIV-infected adults under HAART whose follow-ups were from January 2014 up to December 2017. A generalized linear mixed-effects model was conducted to infer predictors of the status of viral load at 95% of CI). The descriptive statistics revealed that about 55.9% of the adults under treatment had a detected viral load status.Among the potential predictors,visiting time of patients (AOR = 0.731, 95%: (0.634,0.842) and p-value <0.01),age of patients (AOR = 1.0666, 95% CI: (1.0527,1.0917) and p-value <0.01), weight (AOR=. 0.904, 95% CI: (0.862, 0.946) and p-value <0.01), baseline CD4 cell count (AOR = 0.996, 95% CI: (0.994, 0.998) and P-value <0.01), educated patients (AOR = 0.030, 95% CI: (0.002, 0.385) and p-value=0.0053),rural patients (AOR = 6.30,95% CL: (1.78, 2.25) and p-value=0.0043),working status patients (AOR =0.5905, 95% CI: (0.547,0.638), p-value <0.01), poor adherent patients (AOR = 1.120, 95% CI; (1.035,1.391) and p-value = 0.016) and patients disclosed the disease status (AOR = 0.195, 95% CI: (0.023, 0.818) and p-value=0.0134) significantly affected the detection status of viral loads, keeping all other covariates constant. The predictor variables;visiting times, the weight of patients, residence area, age of patients, educational level, clinical stages, functional status, baseline CD4 cell count, adherence status, and disclosure status of the disease statistically and significantly affected the status of viral load.Hence, health-related education should be given for patients to disclose their disease status, to be good adherents based on the prescription given to the health staff. Due attentions should be given for rural and uneducated patients. Attention should be forwarded to for non-adherent patients to follow the instruction given by the health staff.

Mortality in hemodialysis patients in Ethiopia: a retrospective follow-up study in three centers

BackgroundThe prevalence of chronic kidney disease (CKD) is between 10 and 15% worldwide. Ethiopia is seeing a consistent increase in the number of dialysis patients. Patients on chronic hemodialysis have high mortality rates, but there is little information available in Ethiopia. Thus, this study looked into patient mortality and the factors that contributed to it at three dialysis centers in Addis Ababa for hemodialysis patients.MethodA facility-based retrospective follow-up study was employed among End-Stage Renal Disease patients on hemodialysis from 2016 to 2020 at St. Paul Millennium Medical College (SPMMC), Zewditu Memorial Hospital (ZMH), and Menelik II Hospital. The proportional hazard assumption was checked by using the Log (-log (St)) plots and tests. Life-table analysis was fitted to estimate the one and five-year’s survival probability of these patients and Cox Proportional regression analysis to model the predictors of mortality at p-value < 0.05.ResultOver the course of 2772 person-months, 139 patients were tracked. Of these patients, 88 (63.3%) were male and the mean age (± SD) of the patients was 36.8 (± 11.9) years. During the follow-up period, 24 (17%) of the patients died, 67 (48.2%) were alive, 43 (30.9%) received a kidney transplant, and 5 (3.6%) were lost to follow-up. The mean survival time was 46.2 months (95% CI: 41.8, 50.5). According to estimates, there were 104 deaths per 1000 person-years at the end of the follow-up period. The likelihood that these patients would survive for one and 5 years was 91%% and 65%, respectively. Our analysis showed that patients with hypertension (Adjusted Hazard Rate (AHR) = 4.33; 95% CI: 1.02, 34.56), cardiovascular disease (AHR = 4.69; 95% CI: 1.32, 16.80), and infection during dialysis (AHR = 3.89; 95% CI: 1.96, 13.80) were more likely to die.ConclusionThe hemodialysis patients' death rate in the chosen dialysis facilities was high. Preventing and treating comorbidities and complications during dialysis would probably reduce the mortality of CKD patients. Furthermore, the best way to avoid and manage chronic kidney disease is to take a complete and integrated approach to manage hypertension, diabetes, and obesity.

Prevalence of Surgical Site infections among Surgical operated patients in Zewditu Memorial Hospital. Addis Ababa Ethiopia December 2020.

Background: Surgical site infections are the most common kinds of hospital-acquired infections. It's a common complication that can cause serious morbidity and mortality after surgery. It is also the major cause of extended hospital stays, accounting for up to 20% of hospital expenses. Methods and materials: A random sample of 144 surgical patients was analyzed utilizing a hospital-based retrospective cross-sectional study technique from January 1 to December 31, 2019. The information was acquired using a World Health Organization-developed modified standardized checklist for surgery safety and the national surveillance network for nosocomial infections. A rigorous random sampling strategy was used to choose study participants. Descriptive statistics such as frequency and percentage were used to describe the data. Result: A total of 13 of the 144 patients who were operated on had surgical site infections (9.02 percent). Elective surgical cases made up 102 (71%) of the total, while emergency surgical cases comprised 42 (29%). Preventive antibiotics were administered to the remaining 99 (69%) research participants, with 73 (73%) receiving ceftriaxone, 3% receiving ampicillin, and 23 (24%) receiving a combination of ceftriaxone and metronidazole. There were 13 cases of surgical site infections in all (9.02 percent). Six (46%) were superficial surgical site infections, four (31%) were deep surgical site infections, and three (23%) were organ space surgical site infections. 11 (84%) patients were treated with IV antibiotics and wound treatment, 1 (8%) cases with wound debridement, and the remaining 1 (8%) cases with laparotomy, antibiotics, and wound management. Conclusion: In this study area, surgical site infection is infrequent. The bulk of the population is made up of women. The use of prophylactic antibiotics and the age of the patients were both variables in the development of surgical site infections

Cardiometabolic syndrome in HIV-positive and HIV-negative patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a comparative cohort study.

A comparative cohort study was designed. The National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools were used to determine the outcome variables. Association studies were done using logistic regression. CMetS was found to have a greater point and period prevalence, and incidence estimation in HIV-negative than HIV+ patients using both the NCEP and the IDF tools. Using the NCEP tool, the risk of obesity was 44.1% [odds ratio (OR) = 0.559, 95% confidence interval (CI), (0.380-0.824); P = 0.003] lower in HIV+ than in HIV-negative participants. By contrast, no apparent difference was noted using the IDF tool. Similarly, hyperglycemia [OR = 0.651, 95% CI (0.457-0.926); P = 0.017], and hypertension [OR = 0.391, 95% CI (0.271-0.563); P < 0.001] were shown to be lower in HIV+ patients than HIV-negative patients by 34.9% and 60.9%, respectively. The study revealed significant variation in all biomarkers across the follow-up period in both HIV+ and HIV-negative participants, except for SBP. CMetS caused more overall disruption in HIV-negative people with chronic diseases than in HIV-positive people. All of the indicators used to assess the increased risk of CMetS were equally meaningful in HIV+ and HIV-negative subjects.

Determinants of viral load status among HIV positive children on ART at Zewditu Memorial Hospital, Addis Ababa: A case control study

Introduction: Human Immunodeficiency Virus causes an immense amount of problems throughout the world, especially in sub-Saharan countries. Recently viral load is thought to be a good indicator in assessing HIV progression. Complementary feeding practice and type of complementary food are the major factors that affect VL Status. However, in Ethiopia there is paucity of evidence on the factors that could affect viral load among HIV exposed infants. Therefore, this study aimed to identify factors that affect VL Status among HIV positive children on ART at Zewditu Memorial Hospital (ZMH), Addis Ababa, Ethiopia using a case control study design. Methods: Institution based unmatched case- control study was employed among a total of 241 (71 cases and 170 controls) children attending for follow up in ZMH ART clinic from July to August 2020. The interviewer conducts a face-to-face interview for 24 hour’s dietary diversity from mothers using standardized and pre tested questioner. SPSS 20 was used for data entry and cleaning, while Stata 14 was used for data analysis. Backward stepwise logistic regression analysis was used to determine the association of the factors with the outcome variable. A P-value ≤ 0. 05 was considered statistically significant at 95% confidence level throughout the study. Result: Out of 241 children, 71 of them had high VL status, while the rest 170 of them had low VL status. Poor dietary diversity increases the risk of high VL on ART children [AOR= 4. 37, 95% CI: 2. 12-10. 71]. The risk of high VL increase on children whose mother’s marital status was single [AOR=4, 95% CI: 1. 40, 9. 70], among children who have a daily laborer mothers [AOR= 10. 6, 95% CI: 3. 20, 21. 67], and working on nongovernmental organizations [AOR=5. 32, 95% CI: 1. 68, 10. 51]. Children on WHO clinical stage 3 and 4 [AOR =15. 22, 95% CI: 4. 1, 39. 41], those children who started complementary feeding lately (after 6 months) [AOR= 4. 69, 95% CI: 2. 35, 13. 6] and children with poor Infant dietary diversity score [ AOR= 4. 37, 95% CI: 2. 12-10. 71]. Conclusion: Maternal marital status, maternal occupation, WHO clinical stage, late initiation of complementary feeding practice, and infant dietary diversity score are the factors affecting VL status in HIV positive children on ART at Zewditu memorial hospital.

Incidence and predictors of Tuberculosis among patients enrolled in Anti-Retroviral Therapy after universal test and treat program, Addis Ababa, Ethiopia. A retrospective follow -up study.

IntroductionTuberculosis (TB) is the leading killer of people living with HIV (PLHIV) and almost one-third of deaths in the world are attributed to it and many of these deaths occur in developing countries. Despite these evidences, after the implementation of universal test and treat (UTT) strategy, information regarding the incidence and predictors of tuberculosis among PLHIV is limited in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of tuberculosis among patients enrolled in Anti-Retroviral Therapy (ART) after universal test and treat program at St. Peter hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia.MethodsInstitutional-based retrospective cohort study was conducted from November 1 to 30, 2020. Simple random sampling was used to select a total of 539 adults records which was enrolled on ART. Data was collected and entered into EPI DATA 3.1 and analyzed using STATA version 14.1. Time-to-event distributions were estimated using Kaplan–Meier estimates. Hazards across different categories were compared using log-rank tests. Predictors were identified using the Cox proportional hazards model. The hazard ratio (HR) and 95% confidence interval (CI) were computed. Variables having P-value < 0.05 from the multivariable analysis were considered as a statistically significant.ResultAmong 539 records reviewed, 529 (98%) were included in the final analysis. The total follow-up period was 1529 Person-Year (PY). The incidence rate in this cohort was found to be 4.84 per 100-person year (95%CI,3.83–6.11). CD4 count<200 (AHR: 3.14,95% CI:1.64–7.10), poor adherence (AHR:2.16, 95% CI:1.21–3.85), underweight (AHR:2.42, 95% CI: 1.30–4.51), not taking isoniazid prophylaxis therapy (AHR: 2.78,95% CI: 1.06–7.30), being bedridden 3.06; (AHR: 3.06, 95% CI: 1.50–6.24), and baseline WHO stage three or four (AHR:2.33, 95% CI:1.08–5.02) were independent predictors for the incidence of TB among HIV positive patients.ConclusionIn this study, the incidence of tuberculosis is relatively low as compared to studies done before the initiation of test and treat program in Ethiopia. low CD4count, poor level of adherence, low BMI, not taking IPT prophylaxis, bedridden functional status, and being on baseline WHO stage III or IV were found to increase the hazard of tuberculosis. Hence, close follow up, reminders, surveillance, and tracing mechanisms targeting this higher risk group would decrease Tuberculosis among PLHIV.

Prevalence and Associated Factors of Poststroke Depression among Outpatient Stroke Patients Who Have a Follow-Up at the Outpatient Neurology Clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

Background Poststroke depression is the most common and burdensome poststroke psychiatric complication. Studies showed discrepancies in reporting frequencies and risk factors for poststroke depression. Updated local data are relevant for efficient strategies of poststroke depression screening and prevention. Objectives To determine the prevalence and associated factors of poststroke depression among outpatient stroke patients from the outpatient neurology clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted on 249 stroke patients. Data was collected through structured questionnaire using interviews and a review of medical charts. PHQ-9 depression questionnaire was used to diagnose poststroke depression. Descriptive analysis was used to see the nature of the characteristics of interests. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using an odds ratio with 95% CI and p value < 0.05. Results Point prevalence for poststroke depression was 27.5 percent. Female gender, unemployment, low social support level, diabetes mellitus, and poststroke period under 2 years were statistically significant and independent predictors for poststroke depression. Conclusions The point prevalence estimate of poststroke depression was comparable with other studies. Low social support levels increased the odds for poststroke depression by more than eight folds. It appeared that external factors are more important in the pathogenesis of poststroke depression in the African population. Detection and prevention programs should consider disparities of poststroke depression incidence and risk factors.

Comparison of sequential versus pre mixed administration of intrathecal fentanyl with hyperbaric bupivacaine for patients undergoing elective Caesarean section at Zewditu memorial referral hospital: A prospective cohort study

BackgroundSpinal anesthesia (SA) is the method of choice for surgery below umbilicus like elective cesarean section. However, Spinal anesthesia is associated with hypotension and limited analgesia duration. To minimize those complications adding opioids like fentanyl either sequentially with separate syringe or pre mixed with local anesthetics become common practice. ObjectiveTo compare the hemodynamic and analgesic effect of sequential versus pre mixed injection of intrathecal fentanyl with hyperbaric bupivacaine for patients who underwent elective CS under Spinal anesthesia. MethodA prospective cohort study was performed on parturient who undergone elective cesarean section from 01 January 2020 to 30 March 2020. The decision to give either sequential or premixed drug was based on the responsible anesthetists. Sixty-six American society of Anesthesiologist Ⅱ age ≥18 was recruited. Those who received sequentially were grouped as (S- group) and those who had received pre mixed technique were grouped as (M-group). Data were entered into Epi Info version 7.0 and transported into SPSS Version 22 for analysis. Based on normality assumption, analysis was done by independent t-test for normally distributed data. Whereas Mann –Whitney U test for non-normally distributed data and x2 (Chi-square) test for categorical variable. P-value <0.05 was considered as statistically significant. ResultSignificant reduction in intra operative mean arterial blood pressure was seen in premixed group compared to Sequential group until 15th minute immediately after spinal anesthesia. Thus, the incidence of hypotension was higher in M − group compared to S- group, (p < 0.05). The median Postoperative pain VAS score was significantly lower in the S - group compared to M − group of 4th, 5th and 6th hr. The mean time for 1st rescue analgesic request time was prolonged in the S - group compared to M − group (287.909 ± 15.255 vs. 261.39 ± 25.378) min respectively (p < 0.001). ConclusionThe Sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided significant improvement in the blood pressure stability and of sensory and motor block compared to premixed groups.

Diagnosis of Diabetes Mellitus Using Gradient Boosting Machine (LightGBM).

Diabetes mellitus (DM) is a severe chronic disease that affects human health and has a high prevalence worldwide. Research has shown that half of the diabetic people throughout the world are unaware that they have DM and its complications are increasing, which presents new research challenges and opportunities. In this paper, we propose a preemptive diagnosis method for diabetes mellitus (DM) to assist or complement the early recognition of the disease in countries with low medical expert densities. Diabetes data are collected from the Zewditu Memorial Hospital (ZMHDD) in Addis Ababa, Ethiopia. Light Gradient Boosting Machine (LightGBM) is one of the most recent successful research findings for the gradient boosting framework that uses tree-based learning algorithms. It has low computational complexity and, therefore, is suited for applications in limited capacity regions such as Ethiopia. Thus, in this study, we apply the principle of LightGBM to develop an accurate model for the diagnosis of diabetes. The experimental results show that the prepared diabetes dataset is informative to predict the condition of diabetes mellitus. With accuracy, AUC, sensitivity, and specificity of 98.1%, 98.1%, 99.9%, and 96.3%, respectively, the LightGBM model outperformed KNN, SVM, NB, Bagging, RF, and XGBoost in the case of the ZMHDD dataset.

"I want to perform and succeed more than those who are HIV-seronegative" Lived experiences of youth who acquired HIV perinetally and attend Zewditu Memorial Hospital ART clinic, Addis Ababa, Ethiopia.

In Ethiopian Human Immunodeficiency Virus (HIV) prevention program one of the focusing areas is prevention of mother-to-child transmission and decreasing morbidity and mortality among those who already acquired it. However, the needs and the sexual behavior of children who acquired HIV perinatally was not given due attention. Therefore, we conducted this study with the aim of exploring the lived experiences of youth who acquired HIV perinatally to contribute to HIV prevention and control program. We conducted a qualitative study using a phenomenological approach from March to May 2018 among 16 purposively selected youth who were infected with HIV vertically and receive ART services at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. They were recruited based on their willingness after obtaining written informed consent and assent. Data were audio taped, transcribed verbatim in Amharic and later translated to English, and coded using Open Code version 4.02 software. Findings were summarized under four themes by applying interpretative phenomenological analysis. Seven males and nine females, aged 16 to 22 years have participated in the study. These youth reported as they had support from families and ART clinics, while pill-load, and fear of stigma are some of challenges they have faced, especially majorities don't want to disclose their status because of fear of stigma and discrimination. Half of them have ever had sexual relations usually with a seronegative partner and most of these had their first sex in their17-18 years of age. Unsafe sex was common among them where four girls reported to have had unprotected sex with their seropositive or seronegative sexual partners. Most wish to have purposeful life and love mate of the same serostatus but also fear they may remain alone. Youth who had acquired HIV from parents are challenged due to their serostatus and were not sure what type of life they may have in the future. They were also not comfortable in disclosing their serostatus and also engaged in unsafe sexual relation. This calls for an urgent intervention among HIV infected youth and their families; health care providers, and young people in general to halt HIV transmission. Special attention should be given on sexual behavior of all young people (10-24) and in disclosure of HIV status to children and life skills education to cop-up with stigma and discrimination.