Background: One-third of the world population is infected with mycobacterium tuberculosis. Most people exposed to mycobacterium tuberculosis showed no evidence of active disease. About 5-10% of latent tuberculosis infection without HIV will progress to developed active tuberculosis in their lifetimes. This study was conducted to determine the magnitude of Latent TB among the adult population at a teaching and referral Hospital in Ethiopia.

Methods: This study was conducted at the Chest clinic of Tikur Anbessa Specialized Hospital during 2010-2013.The study was a cross-sectional study conducted among healthy adults after informed consent was obtained from each individual. Tuberculin skin test and Interferon Gamma whole blood assay (Quantiferon-Tuberculosis-Gold) was performed using Enzyme linked Immuno-sorbent Assay. Average CD4, CD8, CD3 and CD4:CD8 ratio was determined for all study participants. 

Results:From a total of 70 healthy adults tested for latent tuberculosis infection using Quantiferon Gold,45(64%) tested positiveand 25 (36%) were negative for latent tuberculosis infection. From the sixty six healthy individuals who were tested using tuberculin skin test for latent tuberculosis infection, 42 (62%) individuals were Tuberculin skin test positive and 25 (38%) individuals were Tuberculin skin test negative.  Average CD4, CD8, CD3 and CD4:CD8 ratio was 748, 598, 1401 and 1.4, respectively.

Conclusions: The magnitude of latent tuberculosis infection was high in this study, which reflects existing high prevalence of tuberculosis.Tuberculin skin test and Quantiferon-Tuberculosis-Goldassay show similar efficacy for the diagnosis of latent tuberculosis infection in healthy Ethiopian adults.  The absolute CD4 T-cell counts of healthy HIV-negative Ethiopian's are considerably lower than other countries.

Key Words: Latent tuberculosis ,Chest clinic , adult population , TAH

Aims/Purpose: TB outbreaks emerge occasionally in long-term care facilities, including various educational establishments. This study was designed to determine the five years overall prevalence and trend of tuberculosis and associated factors among students at Adama Science and Technology University and Addis Ababa University 6 kilo campus.

Methods: A five years retrospective  study was conducted on students’ medical records from  TB Directly Observed Treatment Short Course (DOTS) clinics. The overall prevalence and the trend of smear positive, smear negative and extra pulmonary TB cases were determined. Odds ratio with 95 percent C.I was calculated using the Logistic Regression model. Furthermore, an in-depth assessment of AFB sputum smear examination practices of the lab staffs were  conducted using the WHO's  standard checklist.

Results: A total of 112 and 263  TB cases were recorded in Addis Ababa University (AAU), 6 kilo campus and Adama Science and Technology University (ASTU), respectively. There was a statistically significant difference in prevalence  of TB among students  in ASTU compared to that in AAU, 6 kilo campus [AOR:  2.881, 95% CI (1.76-4.71)]. An in-depth interview with the respective University Clinic lab chiefs indicated that the  University  labs were not linked with  the national tuberculosis program and hence quality of sputum smear microscopy examination practices in both study Universities were found to be poor. 

Conclusions: The numbers of tuberculosis cases observed in this study were high. Governmental and Nongovernmental agencies involved in  TB control  must consider higher education institutions as focal points  for prevention and elimination of tuberculosis in Ethiopia.

Introduction: Retention of patients on anti-retroviral treatment in Ethiopia is a challenge. Use of anti-retroviral treatment experienced patients to prepare and re-engage them when they miss follow-ups is recommended, but evidence on its effectiveness is limited. This study evaluated its effectiveness.

Methods: A retrospective cohort study in 10 randomly selected health facilities was conducted to compare outcomes before and after initiation of the adherence supporters program in HIV care and treatment from September 2001 to August 2013. Data analysis involved Kaplan-Meier survival and Log-rank test analysis on STATA statistical software Version 12 to compare survival experiences.

Results: Of 18,835 records that were available, 938 (4.36%) records with missing values were excluded and data from the remaining 17,897 was analyzed. The incidence of first instance lost to follow-up was 22.2 per 100 person-years (95% confidence interval 21.7-22.7). The risk of missing follow-ups after initiation of the program was high (Hazard Ratio –1.22, P < 0.001). The incidence of restarting after missed follow-ups was 23 per 100 PY (95% CI 22.2-24.0). The likelihood of restarting after missed follow-ups was four times higher during the period adherence supporters were present (P<0.001). Patients who stayed longer in care before missing follow ups were more likely to restart (5.7 times the chance of restarting treatment for those whose first lost to follow-up occurred at?12 months compared to <3 months, P< 0.001).Time to restarting treatment was shorter after the initiation of the adherence supporters program (median 37 vs. 115 days). The risk of recurrence of being lost to follow-up in the presence of adherence supporters was significantly higher than when there were no adherence supporters; 38.8 (95% CI 36.3-41.6) per 100 PY vs. 26.1 (95% CI 19.8-34.4) per 100 PY, respectively. 

Conclusion: Adherence supporters were effective in improving re-engagement of patients in treatment and care after they were lost to follow-up. Yet, prevention of lost to follow-up cases has remained a challenge to the program.

Key Words: Adherence, adherence supporters, lost to follow-up, HIV, antiretroviral treatment

Purpose : Even though atrial fibrillation  is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.

Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.

Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).

Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.

Keywords: cerebrovascular accident, cardiac disease, electrocardiography, anticoagulation

Abstract

Back ground/ Purpose:The survival of neonates with surgical condition has greatly improved in developed countries but still poor in developing countries due to several challenges with neonates requiring surgical care. 

The aim of this study is to determine major causesof surgical neonatal admissions and their immediate outcome.

Materials and Methods: A retrospective review of medical records of surgical neonates who were admitted and treated at Tikur Anbesa Hospital between January1^st2010 and December 31^st2014.

Results:There were a total of 652 surgical neonatal admissions during the study period of which 396 were males, 252 females and 4 with indeterminate genitalia with M:F ratio of 1.6:1. Majority of the cases (86.2%) were having congenital diagnoses. Lesions of the gastrointestinal tract (43.3%) mainly anorectal malformations followed by abdominal wall defects (15.5%) were the major pathologies. Two-third of the cases (66.6%) underwent surgical management. The overall hospital mortality following admission was 24.4%. Case fatality rate ranging from 0.03% forHirschsprung’s disease to 73.2% for esophageal atresia with or without fistula. The immediate causes of death among these neonates were ascribed to septic shock and respiratory failure. 

Conclusion:Neonatal surgical admission is common in our institution.Overall mortality after neonatal surgical admission was quite high. Type of principal diagnosis and age of the neonate at admission significantly associated with outcome.Creating awareness about neonatal surgical condition may help to improve the current poor result. 

Key word:-  surgical neonate, principal diagnosis, outcomes

 Background: Referral is part of patient care when done appropriately. Common reasons for referral include seeking expert advice, technical examination and/or intervention, care beyond the facility’s capacity.

 Objectives: Determine the rate, reason for and type of cases referred among patients seen at surgical Emergency Room of SPHMMC during May to July 2015.

Material and Methods: Cross sectional study was done at St. Paul’s Hospital Millennium Medical College Emergency Room, including all surgical patients seen in three months period. Data was collected from the individual patient’s medical records, records of the ER and the liaison office and Interns morning reporting book. Data was analyzed with SPSS version 20.

Results: Total of 2,492 patients were seen. The mean number of patients seen per day was 27.7 with a range from 13 to 51. Trauma made 70% (1746) of all cases seen. Cases that needed admission made 30.1% (755), but only 49.5 % (374) of them were admitted. The overall referral rate was 15.3%. The referral rate in patients who needed admission was 50.5 % (381).  Trauma made 77.4% (295) of the referrals, mainly orthopedic, 54.6% (161) and neuro-traumas, 38% (112). Among non trauma cases acute abdominal conditions tops, 75% (56).  Lack of inpatient beds was the main reason for referral 65.6% (250). Specialist care need was the reason for referral in 34.5% (131) of cases. Among patients referred only 14.4% (55) left the hospital at the time of referrals. Four percent (13) of the kept patients died in the ER waiting for referrals.

Conclusions: The rate of referral from St. Paul’s Hospital Millennium Medical College Emergency Room is high. It is higher in trauma cases, specifically orthopedic and neuro-traumas. Main reason for referrals was lack of bed. The capacity of the hospital and other hospitals in AA in absorbing traumas, specifically orthopedic and neuro-traumas need to be evaluated and necessary policy adjustments should be implemented. Further study at each hospital and the whole city gives better picture of referrals among hospitals in Addis Ababa.

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