Vol 56, No 4 (2018): EMJ Current Issue
Issue Description
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Editorial
Original Article
Abstract 568
PREVALENCE OF SYMPTOMS OF ASTHMA AND ASSOCIATED FACTORS AMONG PRIMARY SCHOOL CHILDREN IN ADDIS ABABA
Mikyas Deimssie Woldetsadik, Abera Kumie
ABSTRACT
Background: Asthma prevalence is expected to increase globally by 50 % every decade. Respiratory illness, including asthma among children has become a public health concern in Ethiopia.
Objective: To determine the prevalence of symptoms of asthma and associated factors among primary school children in Addis Ababa.
Methods: Cross sectional study was conducted from January 2015 to March 2015 using questionnaire adapted from International Study of Asthma and Allergies in Childhood. A total of 20 primary schools were selected randomly from Addis Ababa to collect data from school children. The questionnaires were completed by parents/guardians of the children. Descriptive and analytic methods of data analysis were used.
Results: A total of 1259 primary school children aged 6-7 years were included in this study. The prevalence of ever wheeze, wheeze in the past 12 months, ever diagnosed asthma, exercise induced wheeze in the past 12 months, and dry cough at night in the past 12 months were 13.1% (95 % CI, 11.21% -14.99 %), 8.9% (95% CI, 7.30% -10.50%), 4.1% (95% CI, 2.98% -5.22%), 6.5% (95% CI, 5.09% -7.91%), and 19.2% (95% CI, 16.99% -21.41%) respectively. Diet (eating pasta ?3 time per week in the past 12 months) and fuel for cooking (kerosene) were significantly associated with wheezing in the past 12 months.
Conclusion: The prevalence of wheeze in the past 12 months was high and factors associated with it were eating pasta frequently and use of kerosene as a fuel for cooking.
Keywords: Asthma, Child, Cross-sectional studies, Ethiopia, Prevalence, School
Abstract 292
ACUTE PANCREATITIS IN ADULT ETHIOPIANS: EXPERIENCE FROM ST. PAUL’S MILLENNIUM MEDICAL COLLEGE HOSPITAL, ADDIS ABABA
Girmaye Tamirat, Mahteme Bekele, Reiye Esayas, Mulat Taye, Sahlu Wondimu
Background: Acute pancreatitis is a disease of variable severity, and a high index of clinical suspicion supported by relevant laboratory and imaging studies is necessary to make early diagnosis and improve patient outcome. Objective: This study aims to revise the most common presenting symptoms and signs of acute pancreatitis and the diagnostic modalities used in adult Ethiopian patients.
Methods: A cross-sectional descriptive study was conducted among adult patients with acute pancreatitis admitted to St. Paul’s Millennium Medical College Hospital from January 2005 - December 2011. Data on clinical presentation and outcome of illness was collected from medical records using a structured and pretested questionnaire and analyzed using SPSS Version 16.
Results: A total of 40 patients were admitted to the hospital during the study period. Medical records were retrieved for 30 of them. The male to female ratio was 5:1 and the mean age was 40 years. The majority (76.7%) of patients presented within 3 days of onset of illness. Abdominal pain and vomiting were the most common presenting symptoms seen in 86.7% and 60%, respectively. Tachycardia (60%) abdominal distention (73%) and tenderness (80%) were physical findings. Serum amylase level was elevated in all patients, but was highly elevated in 16 (40%). Ultrasound examination showed features of acute pancreatitis in six (31.6%). Acute pancreatitis was diagnosed on clinical evaluation in 18 (60%) of the cases and intra-operatively in 12 (40%). Six (20%) of the cases died and five of them were among those who underwent surgery.
Abstract 217
Diagnostic Accuracy of Chest Ultrasonography in comparison with Chest x-Ray in Detection of Community Acquired Pneumonia in under five children at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
abebe habtamu tamre, tesfaye kebede legesse, assefa getachew, tigist abate
Background: Ultrasound (US) has been found to be safe, inexpensive, and relatively easier in diagnosing CAP in other settings and minimizes exposure to ionizing radiation. We aimed to assess the feasibility and reliability of chest US for the diagnosis of CAP as an alternative to chest radiography in a hospital setting in Ethiopia.
Methods: A prospective cross sectional study was conducted among under five children with a clinical diagnosis of pneumonia who visited the radiology department of Tikur Anbessa Specialized Hospital (TASH) for CXR examination from February to August, 2016. Relevant US findings were collected on a pretested data collection instrument and we used SPSS to analyze and compare US finding with chest radiography (used as the gold standard) finding.
Results: seventy two patients were included in the study with a mean age of 22.1 months (standard deviation ± 19.6 months) and 42 (58%) were male. We identified 44 (61%) and 48 (66%) CAP cases by CXR and chest US, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of chest US as compared to CXR were 95% (95% CI, 89-100), 86% (95% CI, 80-92), 91% (95% CI, 85-97) and 92% (95% CI, 86-98), respectively. Consolidation was found in 44 of the 48 CAP cases.
Conclusion: Chest US of the lung has a high sensitivity and specificity in identifying cases of CAP and is technically feasible. Chest US could be used as an alternative modality in the diagnosis of CAP in our setting where access to x-ray is limited.
Abstract 315
Assessment of the causes and risk factors of portal hypertension among children < 15 years in Black Lion Hospital AAU, Ethiopia.
tesfaye Kebede legesse
Background - Portal hypertension (PHT) may be caused by a wide variety of conditions, each with a different course and natural history. It frequently presents with bleeding from oesophageal varices, which is the commonest cause of serious upper gastrointestinal haemorrhage in children. Precise diagnosis, a sound understanding of the therapeutic options, and a multidisciplinary approach are essential for successful management. This study was done to assess the causes and risk factors of portal hypertension among children <15 years
Methods: this was a retrospective facility based study conducted at BLH by collecting all children who have a clinical diagnosis of portal HTN and or gastroscopy findings. Data was collected with the trained nurse using a structured questioner.
Results: a total of 214 cases were included with mean age of 9.3yrs + 3. Hepatic causes were the commonest causes cirrhosis being the leading causes of portal HTN followed by portel vein thrombosis. Ultrasound was done for 116 cases and identified the cause of portal HTN in 50%of the cases and in 26.7 % of cases findings were normal.
Conclusion: patients with cirrhosis should always be followed for the features of portal HTN. Problem centered strategy and commitment to health education for health professionals and the community at large should particularly address hepatic causes of portal HTN.
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Abstract 350
Experience of Open Mesh Hernia Repair at a Teaching Hospital in Addis Ababa, Ethiopia- A Three Year Retrospective Study
Engida Abebe Gelan
Background- the treatment of hernias has been evolving very fast in the last few decades. The use of mesh for hernia repair has become increasingly popular & many centers considered it as a standard of care.
Objective - To determine the rate and types of abdominal wall hernias treated with mesh repair techniques and outcomes of patients.
Methods-A retrospective review medical records of all adult patients who underwent open mesh repair at St. Paul’s Hospital Millennium Medical College from September 2013 to August 2016.
Results- Hernia surgeries made 8% of adult elective surgeries. Of these, 130(40.9 %) had mesh repair. Incisional hernias (IH) 68(52.3%) and groin hernias 44(33.8%) being the most common forms repaired with mesh. Except inguinal hernias all hernias were more common in females. Laparotomy for bowel surgery and 29(42.6%) and cesarean section/gynecologic surgeries, 27(29.7%) were the most common surgeries resulting IH. Of IH 57.4 %( n=39) had emergency surgery & 33.8% (n=23) had a low midline incision. Recurrent hernias accounted for 28.5 %( n=37) of the cases repaired with mesh. Postoperative complication was seen in 14 patients (10.8%) surgical site infection being the main form followed by seroma formation (n=3) & recurrence (n=3). There was an increased rate of complications in females (p=0.043) & in patients with co-morbidity (p=0.041). No death.
Conclusion- Our study found that meshes are being used increasingly for incisional & recurrent inguinal hernias. Outcomes of our patients are comparable to published literatures.
Key words-Inguinal hernia; incisional hernia; Mesh repair
Abstract 554
Prevalence of Congenital Heart Defects and Associated Factors among Children Diagnosed with Congenital Anomalies in Addis Ababa Governmental Hospitals, Ethiopia.
Girma Seyoum
Abstract
Back ground: Congenital heart defect (CHD) is structural heart defect present at birth and it accounts for nearly one-third of all major congenital anomalies. Worldwide, CHD constitutes one of the major causes of infant mortality, particularly in developing countries.
Methods and Materials: Hospital based cross-sectional study was carried out, involving children with congenital anomalies, in four referral hospitals. The data were collected using a structured questionnaire and the diagnosis of CHD of children was recorded from the children’s medical records and sample size was 271.
Result: The prevalence of CHD among children diagnosed with congenital anomalies was 35.8%. The most common CHD was VSD (Ventricular Septal Defect) 30 (30.9%), followed by ASD (Atrial Septal Defect) 23(23.7%). Previous history of abortion AOR (Adjusted odd ratio=1.96; CI= (0.277-0.935); p=0.03) and past history of drug intake during pregnancy (AOR= 2.149; CI= (0.252-0.861); p= 0.015) were significantly associated with CHD.
Conclusion: The present study has shown that the burden of CHDs among congenital anomalies was high. Mothers who had previous history of abortion and drug intake during pregnancy were significantly associated with the occurrence of CHD. This study has given insight into the magnitude of the problem and provided baseline data for future detailed studies, as there was very little data available in the past. Information from this study would be used in developing strategies for improved management and rehabilitation of patients with CHD. Further detailed studies that would influence decision making should be conducted.
Key words: congenital heart defects, prevalence, associated factors
Abstract 208
Validation of Maternal Anatomical Anthropometric Measurements to Predict Cephalopelvic Disproportion Among primigravid Women Visiting Governmental Hospitals in Addis Ababa, Ethiopia
Girma Seyoum
ABSTRACT
Background: CPD (Cephalopelvic Disproportion) is defined as a mismatch between the maternal birth canal (the pelvis), and the fetal head. In developing countries, a significant number of maternal deaths are attributable to the complications of obstructed labor typically CPD.
Objective of the study: To assess Validity of Maternal Anatomical Anthropometric Measurements to Predict CPD.
Methods: Hospital based prospective cohort study was carried out in three hospitals. The sample size was 384. The data collected included socio-demographic characteristics such as age, residence, level of education and occupation of mothers. Data for gestational age, socio demographic and mode of delivery were collected from ante natal care follow up charts.
Results: Among 384 nulliparous mothers 337 of them were delivered through spontaneous vaginal delivery and 47 mothers gave birth by cesarean section (CS) due to confirmed CPD. Statistically significant decrease (p=0.013) in the mean fetal weight was observed in children who were delivered through spontaneous vaginal delivery (SVD). Significant differences were noted for height, foot length, Michaelis horizontal and head circumference of mothers with and without CPD. When foot length is combined with other anthropometric measurements such as height, Michaelis horizontal and maternal head circumference its sensitivity increased to 59.6%, 33.3% and 30.4% respectively
Conclusions: In the present study, the variable that predicted Cephalopelvic Disproportion the most was maternal height. In addition, foot length, head circumference and Michaelis horizontal diameter were also found to be predictors of CPD.
Key words: Cephalopelvic disproportion, Spontaneous vaginal delivery, anthropometric measurements.
Abstract 109
THE OUTCOME AND DEMOGRAPHIC CHARACTERSTICS OF 20 VALVE SURGERIES BY TEAM ETHIOPIA.
fekede agwar debel
Background: Ethiopia with largest burden of rheumatic heart disease is still struggling to have a regular heart surgery programs. Since the commencement of open-heart surgery at Cardiac Center of Ethiopia by the local team 20 valve surgeries with different complexities have been performed. The aim of this pilot study is to assess the performance and outcome of local cardiac surgical team with valve surgeries.
Method: A retrospective study of patients who underwent valve surgeries at Cardiac Center of Ethiopia by the local team in the duration of nine months from may 2017 up to march 2018 time period were analyzed. This study assesses the outcome of the local team and demonstrates the general characteristics of the patients.
Result: A total of 20 valve surgeries were performed in this nine months duration. Patient’s age groups from 9 years to 75 years have the surgery with mean age of 26.4 years. Three fourth of the patients got mechanical valve replacement and 10% had tissue valve replacement. Three patients underwent mitral valve repair and 3 patients also had double valve replacement [DVR]. Two patients underwent MVR plus left maze procedure. There was one mortality attributed to the loss of one patient who underwent MVR.
Conclusion: The outcome of team Ethiopia who performs 20 valve surgeries at the commencement of open-heart surgery in our soil land is encouraging. The mortality rate for this small series is 5% and few other complications.
Case Report
Abstract 173
A Unique Case of Thrombotic Thrombocytopenic Purpura (TTP) Associated With Plasmodium vivax Malaria
Dawit Kebede Huluka, Lalise Gemechu Nemie, Fissehatsion Tadesse Woldegebriel, Addisu Melkie...
Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by capillary thrombosis and a pentad of findings: microangiopathic anemia, thrombocytopenia, acute renal failure, fever, and fluctuating neurologic abnormalities. We report the unusual case of a young woman with both TTP and Plasmodium vivax malaria. A causal relationship between these two diseases remains unclear. Early recognition of TTP in patients suspected to have malaria requires a high index of suspicion, which is crucial for initiating lifesaving treatment. To our knowledge, this is the first case report in Africa of TTP associated with Plasmodium vivax malaria.
Abstract 189
Primary Pulmonary Choriocarcinoma: a Case Report
Dawit Kebede Huluka, Temesgen Damtew Nurye, Tewodros Haile Gebremariam, Amsalu Bekele Binegdie,...
Primary pulmonary choriocarcinoma (PPC) is a rare malignant tumor of the lung. It is classified as one of the primary extragonadal choriocarcinomas (EGCC), which often involve midline structures such as the mediastinum, retroperitoneum, intracranium, stomach, intestines, bladder, and prostate; and have two unique characteristics: they are not associated with abnormal gestation and are not part of a germ cell neoplasm involving the reproductive organs. Diagnosis of PPC is often challenging and treatment is usually ineffective. We present the first case of PCC reported from East Africa and one of only 56 casesreported in the literature.
Abstract 220
Unsuspected Reservoir of Rabies in Ethiopia: Mongoose
Yared Mamushet Yifru
A five years old female child from Hosanna town, Hadya Zone, South Ethiopia presented to health facility following an aggressive bite by a mongoose. Following the bite, she received wound care and sent home with reassurance. After about 90 days, she presented with classical signs and symptoms suggestive of rabies and died after 5 days of presentation.
Teaching Article ( Part I)
Abstract 311
EMJ SERIES ON METHODS AND STATISTICS Part III: Presenting and Summarizing Data Using Summary Statistics
Sileshi Lulseged, Sanni Ali, Girmay Medhin
Research data is collected on individual units of observation, which can only be interpreted meaningfully if analyzed and summarized using descriptive statistics. This, often done as an initial step in the analysis of a data set, provides simple summaries about the sample and about the observations that have been made. The summaries may be in the form of summary statistics or in the form of tables or graphs. These summaries may either form the basis of the initial description of the data as part of a more extensive statistical analysis, or they may be sufficient in themselves for a particular investigation. Some measures that are commonly used to summarize or describe a data set are measures of central tendency or location and measures of dispersion or variability. Measures of central tendency or location include the mean, median and mode, while measures of dispersion or variability include the standard deviation (or variance), the range and interquartile range. The mean is the most informative measure when the data is symmetrical and the median is a preferred measure of central tendency when data is skewed (non-symmetrical). The measures of dispersion are usually used in conjunction with a measure of central tendency. A thorough understanding of these descriptive measures is important first step of data analysis that helps to do informed selection of inferential analysis methods, critical appraisal of the literature and write-up of scientific articles.
Teaching Article ( Part II)
Abstract 117
EMJ SERIES ON STATISTICS AND METHODS Part IV: Presenting and Summarizing Data Using Graphical Tools
Sileshi Lulseged, Sanni Ali, Girmay Medhin
ABSTRACT
Graphs are a way to present data in visual form and if properly prepared can be a powerful way in which to convey statistical information. Graphs are a useful tool for displaying many types of data, and one of the easiest ways to see relationships between variables and/or compare numbers. To ensure that they are easy to interpret, graphs need to be presented in a way that enables them to stand-alone. They should be clutter free and use appropriate titles, legends, axis titles and footnotes. There are a range of different types of graphs that can be used. Care should be taken to ensure that the type of graph chosen is appropriate for the type of data that is being plotted. This article presents a brief overview of the most common types of graphs- It provides guidelines on how to create meaningful, easy to read and well-formatted graphs that are commonly used, including histograms, frequency polygon, line graphs, scatter plots, bar charts, and pie charts. It also highlights the design and presentation of components of a graphs - titles, axis labels, legends and footnotes, and appropriate representation of both axes, scale and error.