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Editorial
Abstract 187
Original Article
Abstract 445
DETERMINANTS OF FEMALE GENITAL MUTILATION PRACTICES IN EAST GOJJAM ZONE, WESTERN AMHARA, ETHIOPIA
Mulusew Andualem
Background: Female genital mutilation is one of the harmful traditional practices among women and girls. More than 130 million girls and women live today who have undergone female genital mutilation. In Ethiopia, a high prevalence (74.3% national and 68.5% in Amhara region) has been reported. This study was aimed to identify determinant factors of female genital mutilation practices in East Gojjam Zone, Western Amhara, Ethiopia.
Methods: A community based cross sectional study was conducted among 730 women aged 15-49 years and having children < 5 years old in September, 2014. Data were collected using a pretested interviewer administered questionnaire. Descriptive statistics were used to describe study objectives, and bivariate and multivariate analysis to identify determinant factors to female genital mutilation.
Results: 718 women and 805 daughters participated in the study. FGM prevalence was 689 (96%) and 403 (49%) among women and daughters< 5 years of age, respectively. Type1 and type 2 FGMs were common and daughters <1 years of age exhibited 91% female genital mutilation. Daughters' age, parent education level, residence, women circumcision history, culture, health education, frequent health extension workers follow up and participation in anti FGM interventions were risk factors to female genital mutilation practice.
Conclusions: Female genital mutilation practices continues to be a major problem to women and daughter <5 years of age in the study area. A number of factors were associated with FGM practices including daughters’ age, parent education level, residence, health education, culture, mothers circumcision history, frequent health extensions workers follow up and participation in anti FGM interventions were determinants to higher FGM practices.
Key words: Female genital mutilation, determinant factors, Goncha District, Ethiopia
Abstract 518
PATTERN AND OUTCOME OF RENAL DISEASES IN HOSPITALIZED CHILDREN IN TIKUR ANBESSA SPECIALIZED TEACHING HOSPITAL, ADDIS ABABA, ETHIOPIA
Kebede Mola, Damte Shimelis
Background: Renal diseases are major causes of morbidity and mortality in pediatric practice. Pediatric patients with renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinary tract. Unexplained fever or failure to thrive may be the only manifestation. Most children with renal diseases in our hospital arrive very late either because of inadequate health awareness among the parents or failure of recognizing the symptoms of renal diseases at a lower health care level. This review will highlight the symptoms of renal diseases at presentation and outcomes of treatment in children in a major referral hospital.
Methods: A cross-sectional retrospective chart review was done over a period of 3 years (June, 2012 to May, 2015) in 381 admitted children (Birth-17 years) at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia.
Results: Out of 14521 pediatric ward admissions in the study period, kidney diseases accounted for 473 admissions in 381 children, accounting for 3.3% of all admissions. The three most common renal diseases observed were congenital anomalies of the kidney and urinary tract (CAKUT) seen in 127 children (26.8%), followed by nephrotic syndrome in 80 children 16.9% and acute glomerulonephritis in 58 children (12.2%). Other renal diseases observed were urinary tract infection 8.0%, urolithiasis 6.7%, Wilm’s tumor 6.3%, acute kidney injury 4.2% and chronic kidney disease 4.0%. Other less frequently detected diseases were bladder exstrophy, lupus nephritis, Henock shonlein Purpura nephritis and prune-belly syndrome.
Out of 381 children 207 (54.3%) recovered normal renal function, 20(5.2%) remained with proteinuria, 13(3.4%) progressed to chronic kidney disease and 11(2.9%) died. Sixty one nephrotic children (76.3%) achieved remission but 17 children (21.3%) remained with proteinuria; one steroid resistant child died of end stage renal disease. Ten children (2.6%) with different renal diseases were lost to follow-up and 5 (1.3%) discharged against medical advice.
Conclusions: This data reflects that many of the renal diseases are preventable or potentially curable. Therefore, improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality.
Key Words: Renal disease, Children, Ethiopia
Abstract 238
REVIEW OF THE CLINICAL, COMPUTERIZED TOMOGRAPHY SCAN AND/OR MAGNETIC RESONANCE IMAGING FINDINGS OF INTRACRANIAL TUBERCULOMA IN AN ETHIOPIAN TEACHING HOSPITAL
Getachew Assefa, Fathia Omar, Hagos Biluts, Mersha Abebe
Abstract
Background: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas.
Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma
Methods: A retrospective review of patient’s medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013.
Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.
Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and comonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries.
Key Words: Intracranial Tuberculoma, computerized tomography, magnetic resonance imaging, Ethiopia
Abstract 558
A FOUR-YEAR REVIEW OF GERIATRIC MENTAL HEALTH SERVICES IN A LAGOS BASED HOSPITAL, NIGERIA
Richard Ademola Adebayo, Andrew Toyin Olagunju, Michael Olasunkanmi Olutoki, Babatunde Fadipe,...
Background: There is a growing global concern about the public health implications of the increasing population of the elderly. One main issue of concern is centered on how to address their mental health needs using home-grown interventions and services. We expect that important lessons on geriatric mental health issues would be brought to fore in this report.
Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaires were filled with socio-demographic and clinical data obtained from patients’ case notes based on the objectives of the study.
Results: The mean (standard deviation) age of elders was 69.6 (±7.93) years, and 65.5% were females. Majority were married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively). Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychotic disorders (34.8%), while 5.5% had Alzheimer’s dementia. Some 96.5% of the elders were solely on medications. About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, with cardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very old elders (aged ?70years), and those with at least tertiary education, were more likely to present with dementia. Elders with dementia were more likely to present with index episode of mental illness and receive outpatient care.
Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities and commute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is need for sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatric mental health services. Further research is needed on how to appropriately link and/or integrate geriatric care with services at all-tiers of health care delivery.
Keywords: geriatrics; mental health; Nigeria; policy; service design
Case Series
Abstract 266
PANCYTOPENIA IN PREGNANT MOTHERS FROM EASTERN SHOA ZONE OF ETHIOPIA
Sisay Teklu, Amaha Gebre Medhin, Alula Meressa, Buruhan Feki
Abstract
Pregnancy is a state of high metabolic demand. Anemia and thrombocytopenia, commonly as a result of the normal dilutional effect of increased plasma volume during pregnancy, are frequently seen in pregnant women but are not severe enough to require intervention unless aggravated by deficiency of micronutrients. Nutritional deficiency related anemia is often seen in developing countries. In this study, we describe seven cases of severe thrombocytopenia, anemia and leukopenia (pancytopenia) from the same geographic locality and similar clinical presentation. The cases were referred to the Tikur Anbessa Specialized Hospital (TASH) for investigation and treatment. Potential causes, methods of prevention and treatment options are discussed along with relevant clinical and laboratory findings of the cases.
Key words: Pancytopenia, Pregnant mothers, East Shoa Zone
Case Report
Abstract 190
HYDATID CYST DISEASE IN THE LEFT LATERAL NECK: AN UNCOMMON PRESENTATION
Engida Abebe, Ayeligh Tsehay
Abstract
Cysts commonly occurring in the neck include thyroglossal cyst and dermoid cysts in the midline, cystic thyroid nodules, branchial cysts and cystic Hygroma in the lateral neck. Hydatid cyst disease is commonly seen in the right lobe of the liver, the lung and rarely in other parts of the body. In general, cysts in the neck are not common in the second decade of life. In this article, we present a case of hydatid cyst presenting as left lateral cystic mass in an Ethiopian boy. The diagnostic difficulty, the need for diagnostic suspicion and consideration of hydatid cyst in the differential diagnosis and the management options are discussed.
Key words : Hydatid cyst, Neck, Fine needle aspiration cytology, Ethiopia.
Abstract 257
RE-EXPANSION PULMONARY EDEMA FOLLOWING REPAIR OF MISSED POST TRAUMATIC DIAPHRAGMATIC HERNIA A CASE REPORT AND REVIEW OF LITERATURES
Ephraim Teffera
Abstract
Reexpansion pulmonary edema following repair of missed diaphragmatic hernia is very rare .Here reported is a case of bilateral reexpansion pulmonary edema occurring after reconstruction of left sided post traumatic diaphragmatic hernia. The patient was re intubated and ventilated later put on supplemental oxygen via a catheter through the endotracheal tube followed by extubation and non re breather face mask to compensate for hypoxemia. He was given intravenous diuretics and inotropic support. Forty-eight hours after the acute event, the patient recovered with minimal residual hypoxemia. Reexpansion pulmonary edema after repair of missed diaphragmatic hernia is a rare complication with a high mortality rate of up to 20%. It should be considered in cases of hypoxemia following any chest reexpansion procedure. The exact pathophysiology leading to this complication is not clear but it is believed to be permeability pulmonary edema as a result of pulmonary micro vascular damage. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to insertion of chest tubes. Treatment is supportive and emphasis should be given for preventive measures.
Key Words: Reexpansion Pulmonary Edema, Diaphragmatic Hernia
Viewpoint
Abstract 218