Vol 59, No 01 (2021): EMJ January 2021 issue

Background: Effectiveness of antiretroviral therapy (ART) can be measured with a change in CD4 cells counts. The aim of this study is to estimate the magnitude and identify predictors of adequate immunologic response (AIR) in Saint Paul’s Hospital Millennium Medical College (SPHMMC).
Methods: A retrospective cohort study was conducted among individuals, who are enrolled in SPHMMC ART clinic in the period September, 2011- September, 2016. The data was collected using a data abstraction tool adopted from the patient’s chart. And managed and analyzed by using SPSS, Version 20.0. Descriptive statistics was used to describe study participants characteristics. In addition, a multiple binary logistic regression was used to identify predictors of AIR.
Result: A total 662 individuals participated in this study and 445(67.2%) of them had AIR. Disclosing HIV status; increase in base line hemoglobin; being stage II; and working functional status were more likely to have AIR (Adjusted Odds Ratio (AOR) =1.79 [95% Confidence Interval(CI): 1.16, 2.76]), (AOR =1.14 [95% CI: 1.05, 1.24]), (AOR =2.66 [95% CI: 1.29, 5.45]), and (AOR =1.84 [95% CI: 1.03, 3.29]) respectively. And attending primary education; and increase in baseline CD4 were less likely to have AIR (AOR =.55 [95% CI: .31, .96]) and (AOR =.90 [95% CI: .84, .96]) respectively.
Conclusion: The government and other concerned bodies should work in encouraging people living with HIV (PLHIV) to disclose their status and educating the community should be given attention.

Background: Spina bifida, one of the Neural tube defects (NTDs) is preventable cause of morbidity and mortality worldwide and its burden is not well registered in low income countries. The aim of this study was to determine the clinical epidemiology and associated factors of folic acid supplements resistant spina bifida in Addis Ababa, Ethiopia.
Methodology: A case-control study was conducted in Zewditu Memorial Hospital, Addis Ababa, Ethiopia among mothers came for maternal and child health services. Both case and control participants were selected conveniently, consecutive participants were considered from their respective wards. Data was collected by trained nurses and midwives using structured template and analyzed by SPSS Version 21.0. Descriptive techniques and multiple binary logistic regression were employed. In all the statistical analysis, p-value < 0.05 was considered as statistically significant.
Results: A total of 225 mothers were approached for the study, and 219 (74 Cases Vs 145 Controls) of them were willing to participate. Of the mothers with a spina bifida birth outcomes, 52(70.3%) has gestational diabetes, 47(63.5%) had poor adherence to folic acid supplementation. Mothers who are rural residents, and have gestational diabetes were more likely to have newborn with spina bifida (Adjusted Odds Ratio (AOR) =7.99 [95% Confidence Interval (CI): 3.99, 16.3]) and (AOR=5.01 [95% CI: 2.55, 10.04]) respectively.
Conclusion: Being diabetic during gestational age and rural resident were associated factors with folic acid supplements resistant spina bifida. Therefore, the government should give attention to rural and diabetic mothers to decrease the disease burden in the newborns.

Background

Low back pain (LBP) is a common cause of morbidity in the general public as well as the healthcare professionals. The lifetime prevalence of LBP among nurses is high. There is limited information about the problem among nurses working in hospitals in Ethiopia. The aim of this study was to assess the prevalence and risk factors of LBP among nurses working at Zewditu Memorial (ZMH) and Tikur Anbessa Specialized hospitals (TASH), Addis Ababa, Ethiopia.

Methods

A cross-sectional study including randomly selected nurses currently working in the above two hospitals was conducted using a structured self-administered questionnaire.

Results

Among 316 nurses (123 [38.9%] males and 193 [61.1%] females), the 12-month prevalence of LBP was 46.5% with a slightly higher prevalence among female nurses (50.3%). The significant risk factors were long working hours [AOR=.001, 95%CI: 3.353 (1.632-6.887)], poor body posturing [AOR = .000, 95%CI: 4.080 (2.191-7.601)], direct patient contact [AOR = 0.004, 95%CI: 4.168 (1.566-11.097)] and history of trauma [AOR= .001, 95%CI: 15.783 (3.038-82.007)]. Only 13 (8.8%) nurses reported severe LBP. Chronic LBP accounted for 83.7% of cases. Only 63 (42.9%) nurses sought medical treatment. Forty-nine (27.1%) nurses had been on medical leave at one time or another in the past one year and the total work days lost were 427.

Conclusion

A number of different factors increased the risk of LBP which can decrease the day to day effectiveness and job satisfaction of nurses and affect the quality of their lives as well as patient care.

Keywords: back-pain, nursing, occupational hazard, lost work days

Background: HIV infection is a major public health concern worldwide. This cytopathic retrovirus destroys the immune system that leads to opportunistic infections and tumors. Various organs of the body may be affected, leading to a variety of clinical presentations. Radiology plays an important role in the management.  Not many papers have focused on this role in Ethiopia and little attention has been given to the use of ultrasound in the evaluation of patients with HIV/AIDS.

Materials and Methods: institutional based prospective cross sectional study of 111 HIV/AIDS patients who presented for abdominal ultrasound to the Department of Radiology, Black Lion Hospital, from November 2015 to July 2016

Results:   The most common finding was hepatomegaly found in 50(45.5%). Other findings were hyperechoic (fatty) liver in 26(23.4%), splenomegaly in 31(27.9%), lymphadenopathy in 13(11.71%) and ascites in 11(9.91%). Gallbladder and biliary ductal and renal findings were uncommon in this study.

Conclusion:  The findings in this study demonstrate that a myriad of ultrasonographic abnormalities can appear in the abdomens of HIV/AIDS patients. These sonographic abnormalities are non-specific to a particular pathogen or disease entity.  However, such findings in the right clinical context and laboratory evaluation will help clinicians to arrive at a diagnosis, leading to better patient care and management.

Objective: This study is aimed to assess the trends and outcomes of cholecystectomy in a teaching hospital in Addis Ababa by comparing the recently introduced laparoscopic cholecystectomy with the open method using different variables.

Methods: A comparative retrospective cross sectional study was conducted and all patients who have undergone cholecystectomy for gallstones were included. Data was collected through chart review and analyzed by SPSS version 20. Independent sample T-test was used to compare the operation time and the post operative hospital stay of patients of both groups.

Results: A total of 471 cholecystectomies were performed out of which 32% were laparoscopic. The female to male ratio was 5.12:1 with mean age of 41.64±12.45 years. The mean operation time was 52.96 minutes for the open group and57.59 minutes for the laparoscopic group.  The post operative hospital stay was 3.42 days and 2.45 days for the open and laparoscopic group respectively. There was no statistically significant difference in operation time, morbidity and mortality between the two groups. However, the post operative hospital stay was significantly shorter for the laparoscopy group. The conversion rate from laparoscopic cholecystectomy was 2.6%.

Conclusion: Although laparoscopic cholecystectomy is introduced recently in our institution, the above results show that it has encouraging outcome. Hence, future effort should be directed towards expanding this service to more health institutions in the country.

Abstract

Background: Road traffic crash threaten human health due to  crash injury mainly occurred by drivers fault.

Objective:  Estimating Exposure-Controlled Crash Risk at Roundabout among drivers in Addis Ababa City Administration.

Method: A case control study was conducted for driver of two vehicle crash paired by collusion. A total of 162 cases and 162 controls were randomly selected. Crash data were collected from November 2018 to March 2019. A statistical analysis of quasi-induced exposure and conditional logistic regression were conducted using STATA 14 software. Ethical clearance was obtained from Addis Ababa University, College of Health Science ethical review board.

Result: The vast majority of drivers were males (95.3% of the cases and 93.8 of the controls). The mean age of cases and controls was 34.3 + 9.0 and 34.6 + 10.7 years respectively. The study indicated that 37% cases and 30.9% controls have made fault of drive following too close driving, where as 30.3 % cases and 20.4 controls have made a fault of blocking the overtaking vehicle path.

Under 5-year vehicle age cause crash at a rate of 2.8: 1. Taxi drivers (OR=2.5 95% CI=1.0- 5.9) were at higher risk of crash responsibility compared to Automobile driver.

Conclusion: the majority of road traffic crash risk at roundabout were males, younger vehicle, taxi deriving and the driving fault like blocking the other overtaking vehicle path. Therefore, increasing number of lane & skilling up the driver to proceed cautiously at roundabout were recommended. 

Keywords: Road traffic crash, crash responsibility, induced exposure

Objective: - To assess the rates of breast milk feeding among children born with orofacial clefts at the only multidisciplinary cleft care providing center in Ethiopia. 

Methodology: - Parents of children born with Cleft Lip and/or Palate (CL/P), treated and on follow up at our center were interviewed using structured questionnaire. They were asked about the delivery status (attended or unattended), regrading feeding practices, whether they received feeding counseling or not and related questions. The data collection was done for 5 months from August 1-to December 30, 2018.

Results and Recommendations: - we retrieved data from 61 parents of children born with orofacial clefts.  In this study 92% of the participants had institutional delivery. In spite of this only 47% of the parents received feeding counselling and demonstration. This study found out low breast milk feeding rate among cleft babies and low professional counselling for successful breast milk feeding. This could be because the nurses, midwives and other health professionals did not have enough understanding on how to feed a child born with CL/P. We also found that very few parents used supportive feeding devices.

Conclusion: We assessed the practice of breast milk feeding in patients born with orofacial clefts for the first time in Ethiopia and found out that it is much lower than the non-cleft population. We recommend including cleft feeding counseling in the training of midwifes and nurses providing delivery service. It is also important to make supportive feeding devises (bottles) available as we found them unavailable.

Abstract

BACKGROUND 

Genital wart is one of the commonest sexually transmitted diseases caused by human papilloma virus. Many modalities of treatment are available with variable success rate, cost and side effect profiles but none is uniformly effective.   

METHOD

A prospective open -label non randomized comparative study done in patients with anogenital wart to compare the efficacy and side effect profile of 10% potassium hydroxide solution and 80% TCA in the treatment of genital wart. Over 15 months period patients with anogenital wart were assigned to either 10% KOH or 80% trichloroacetic acid alternately and the outcome was assessed.

RESULT

 Eighty two participants were completed the study. The mean duration of healing in weeks for KOH group is 4.1weeks (SD=2.7) while for TCA group it is 7.4weeks (SD=3.2).  After adjusting for lesion size, lesion number and HIV status it is found that adjusted hazard ratio AHR for KOH is 1.98 (95% CI 1.16-3.38) which is significant with p value of 0.012.  7.5 % from KOH group and 14.3 % from TCA group has recurrences which is not statistically significant (p value = 0.68).

CONCLUSION

10% potassium hydroxide solution is effective in treatment of genital wart with shorter healing time when compared to 80% TCA. Thus it can be used as one of the treatment modalities in the treatment of genital wart.