Vol 58 (2020): Special Issue From Medical Education Partnership Initiative (MEPI)

Background:There is a growing body of evidence for an association between common mental disorders and food insecurity. However, since most studies have been cross-sectional, it has not been possible to differentiate the direction of the association. The aim of this study was to determine the effect of common mental disorders on food insecurity using a prospective cohort study design. Methods: The study was carried out in Butajira, south-central Ethiopiaamong mothers who were enrolled in the CMaMiEcohort. A total of 1815 enrolled women were evaluatedfor symptoms of CMD using the Self-Reporting Questionnaire-20 (SRQ-20) at two time points; August 2012 (time 1, T1) and in August 2014 (time 2, T2). Probable CMD was defined when mothers reportedsix or more affirmative (yes) responsesto the SRQ-20. Household food insecuritywas measured using the Household Food Insecurity Access Scale (HFIAS) in December 2017 (time 3, T3). Zero inflated negative binomial regression was used to determine the independent effects of CMDs at T1 and T2 on food insecurity score at T3. APoisson working model was also used to determine the risk of being severely food insecure associated with having CMD. 

Introduction: Congenital anomalies require multitude of surgical procedures at a very early life and impose a large impact on the lives of patients and parents and yet causes are still largely unknown, but assumed to be multifactorial. A few studies focused on environmental risk factors, but evidence is still scarce.

Methods: This is a case control study of infants less than 3 months of age   with congenital anomalies evaluated or admitted to the hospital between December 1 2017 and May 31 2018. Face-to-face interviews with parents of young infants were carried out to collect socio-demographic and clinical information.

Results: Analysis of the data showed that among 200 young infants with congenital anomalies enrolled in the study, gastrointestinal system is most commonly affected organ system. Maternal factors that were significantly associated with congenital anomalies included the lack of peri-conceptional use of folic acid (OR = 3.6; 95% CI = 1.6-7.7; p = 0.005), an inadequate attendance to antenatal clinic (OR = 2.3; 95% CI = 1.5-3.6; p < 0.001), family history of congenital anomalies in 3 %of cases (OR 2.4:95% CI =1.5-3.6; P< 0.001). Infant factors that were significantly associated with congenital anomalies were male sex, and birth weight of 2.5 kg or less.

Conclusions: In this study, the proportion of women taking folic acid supplements during pregnancy was very low and mothers of infants with congenital anomalies has less antenatal follow up.

Background:  The epilepsy stigma and treatment gap is enormous in Ethiopia. The epilepsy resolution by the world health assembly calls for coordinated country wide action on the health, social and public knowledge.  Effective epilepsy education should target to empower people with epilepsy, create school based awareness and cascade public education campaign. This emphasizes the need to develop innovative, collaborative, linguistically and culturally appropriate community epilepsy education manuals tailored to the needs of the target population.   

Objective: To develop and standardize epilepsy education manuals for use by mothers and primary students, and to teachers and health extension workers in Ethiopia.

Methods:  Collaborative frame work design and processes, using the principles of experience- based co-design, was implemented to improve the quality of the epilepsy education manuals. 

Results: The overall feedback from experts and stake holders was very positive. Students, teachers and parents who had participated in the focused group discussion reported a positive view of the epilepsy education manuals. The feedbacks from the study participants were used to develop optimized epilepsy educational manuals for “students and mothers” and “teachers and health extension workers.”  

Conclusion: The applied experience based framework design identified the strengths and weaknesses of the draft epilepsy education manuals. This design allowed experts and stake holders to identify improvement priorities and to formulate and employ changes on the draft epilepsy education manuals.  Follow up pilot and large scale implementation trails will clarify the potential of the educational manuals to alleviate epilepsy stigma and treatment gap in Ethiopia.

Background and aim: Streptococcus agalactiae or Group B Streptococci (GBS) frequently colonizes the human genital and gastrointestinal tract and a risk factor for subsequent infection in pregnant women and newborns. The study was conducted to determine the prevalence of maternal vaginal colonization of GBS during delivery, transmission rate to the newborns, to identify the possible risk factors and determine the antimicrobial susceptibility pattern of GBS isolates. 

Subjects and Methods: A cross-sectional study design was used to enroll 250 pregnant women coming for delivery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Both maternal vaginal and neonatal oropharyngeal swabs were collected and inoculated onto CHROMagarTM StrepB and 5% sheep blood agar plates. Isolates were identified based on the mauve color on GBS CHROMagar, colony morphology, gram reaction and hemolysis on 5% sheep blood agar. Antimicrobial susceptibility testing was performed by using Kirby–Bauer disk diffusion method according to the Clinical Laboratory Standard Institute (CLSI) guidelines.

Results: The overall prevalence of GBS colonization among the participants was 23.6% with a transmission rate to the newborns of 47.4%. GBS colonization was significantly associated with occupation and parity (p< 0.05) GBS isolates had significantly high resistance level to cefepime (59.4%) and penicillin (57.7%). Highest susceptibility to vancomycin (93.3%), clindamycin (86.4%) and chloramphenicol (79.6%) were observed.

Conclusions: There was high rate of maternal colonization and maternal to child transmission of GBS with high resistance to commonly used antibiotics.

Keywords: Antibiotics susceptibility, Group B streptococcus, Intra-partum antibiotic

Background: Child injuries are a growing public health problem yet it remains overlooked in resource-limited countries. We aim to assess the patterns, clinical presentation, and outcome of childhood injuries among children visiting the emergency department of AaBET Hospital, Addis Ababa, Ethiopia using a trauma registry form.

Methods: A cross-sectional study was conducted on pediatric injuries at the AaBET Hospital Emergency department between December 2017 to May 2018. Data were collected prospectively with a trauma registry form which priory prepared and tested 6 months prior to this study. The data were entered and analyzed using SPSS version 20 software using analytic and descriptive parameters. Pediatric trauma score and disposition from the emergency room was taken as the assessment of severity. 

Results: In this study, 407 children aged less than or equal to 18 were included and 280(68.8%) were males. The majority of injuries were road traffic injuries 162(39.8%) followed by falls 105(25.5%). 78.6 % of the Road traffic injury occurred on pedestrians. Only 109(26.8%) of injured children arrived at AaBET Hospital via ambulance, only 25(6.1%) received emergency care before arrival. es occurred in pedestrians and on the street. Use of Ambulance service and pre-hospital care, timely presentations are low. Adequate and comprehensive public education and significant improvement in advanced trauma services with improved prehospital services is imperative.

Introduction: Diabetes mellitus (DM) is a major public health problem and responsible for premature death, and chronic disabling complications. Implementation of evidence-based interventions have resulted in improvement in achievement of diabetes care goals in several high-income countries. However, there is limited evidence for this in low-middle-income countries.

Objective: To assess achievement of diabetes care goals in people with diabetes at the Tikur Anbessa Hospital diabetes center in Ethiopia.

Methods: We conducted a cross-sectional hospital-based study (n=421) at Tikur Anbessa Specialized Hospital, in Addis Ababa. The study was done among ambulatory patients with type 2 diabetes and type 1 diabetes of > 5 years duration. We used a structured questionnaire and data abstraction checklist to document demographic characteristics and diabetes-related information. We also conducted physical examination and laboratory tests.

Results: Overall, 421 study participants were included. The mean age was 52.7±13 years.  Majority was female (55.6%). Sixty-one percent access health care service for free. Majority (81.5%) of the study participants were type 2.  The mean duration of diabetes was 12.6± 8.9 years. More than 50% of the study participants had diabetes for more than 10 years. 45% were on Insulin, 30% on metformin and 25% on combined oral agents.

Conclusion: The achievement of diabetes care goals is lower as compared to other studies done in Ethiopia. The absence of standardized monitoring tool, inconsistent patient-doctor relationship and follow up by internal medicine residents with little supervision may have contributed for the lower rate of diabetes care goal achievement.

Background: Ethiopia is one of the countries with the highest maternal mortality ratio at 412/100,000 live births in 2018. By way of decreasing maternal mortality, the Federal Ministry of Health of Ethiopia (FMoH) has launched the maternal death surveillance and response (MDSR) system to make maternal deaths as one of the reportable events by the health care system since 2013 in addition to the existing Health Management Information System (HMIS)

Objective: this study aimed to assess the reporting of in-hospital maternal deaths in three hospitals of Addis Ababa, Ethiopia.

Methods: We extracted data from death certificates and medical records of all females aged 15-49 years who died between   January 2015 and December 2017 using practical data capturing tool developed by the Initiative for maternal mortality program assessment (IMMPACT) called; rapid ascertainment process of institutional death (RAPID). 

Result: During the study period there were 1210 women deaths in the age group of 15-49 years with 1137 well documented death certificates. We reviewed medical charts of 876 (77.04 %) female deaths and found 84 (9.58%) maternal deaths using the IMMPACT RAPID tool.  Using HMIS and /or MDSR systems 47 (56%) of the maternal deaths were reported by the studied hospitals resulting in underreporting of 37 (44%) of female deaths. Most deaths (28.6%) occurred in the adult emergency department and (27.4%) in the intensive care units of the hospitals. 

Background: The Medical Education Partnership Initiative Junior Faculty (MEPI-JF) Program at College of Health Sciences (CHS), Addis Ababa University (AAU) is designed to enable junior faculty physicians to conduct research in collaboration with mentors from AAU and partner universities abroad. The program has been implemented since 2016 to achieve its goal of nurturing the next generation of researchers. The program has enrolled a total of 44 scholars grouped in five cohorts.

Objective: The aim of this study was to assess the output and possible impact of the MEPI-JF program on the scholars and within the CHS and AAU at large.

Methods: This was a mixed method study that employed both quantitative and qualitative data collection techniques.

Results: Fifty-three researches have published by the first three cohorts of MEPI-JF scholars after joining the program. In addition, these three cohorts of scholars have made 63 paper presentations at local and international conferences, and secured eleven grant awards from funders for advancing their research careers. The program has introduced the journal club culture in the college with weekly journal club presentations by the scholars to the College community.

Conclusion: the contribution of MEPI-JF program has created a great opportunity by building the research capacity of physicians to generate evidence to improve their practice and develop their particular fields of specialty in the College.