In a 2017 study, the incidence of glove perforation in Addis Ababa was found higher than most other publications. This poses a significant threat to both patients and the surgical workforce. We hypothesized that poor surgical glove quality may have contributed to the high incidence. Hence, we tested the integrity of six  brands of sterile gloves. The assumption was the perforation rate in these gloves would be higher than the standard acceptable quality level (AQL).

From the 1,200 single gloves evaluated, 59 (4.9%) gloves had perforations. Brand 1 (13.5%) and Brand 5 (10%) had the highest rate of perforations, followed by Brand 3 (3.0%) Brand 6 (2.0%), Brand 2 (1.0%) and Brand 4, which had 0 perforations. Compared to the standard AQL 1.5 for surgical gloves at the time of the study, Brand 1 and Brand 5 had a significantly higher perforation rate (13.5%, CI=8.8%-18.2%, p=0.000) and (10.0%, CI=5.8%-14.2%, p=0.000), respectively.

Our study results showed unacceptably high rates of perforation for 2 glove brands. The implications of this are staggering for surgical staff.  In Ethiopia, choice of surgical glove brand may be a determinant of surgical safety.

In view of our findings of a large proportion of glove perforations prior to use, we recommend, at minimum, that surgeons visually inspect gloves before and after donning. Relevant government institutions, contractors, importers, hospital administrators, and surgical teams must take collective responsibility for ensuring appropriate quality of gloves. Quality enforcement must be strengthened, and local production must be considered.

Background: The spread of coronavirus disease 2019 (COVID19) pandemic disrupted the personal and professional lives of many throughout the world. To combat the adverse effect of the virus, Addis Ababa University introduced an online teaching/learning method to reduce the physical engagement of faculty members and residency trainees; a major shift in the history of the country’s oldest and largest university.

Objectives: Thist study attempts to understand how trainees managed to cope up with the sudden changes in teaching/learning system, assess the ensuing satisfaction with the new method of teaching/learning, and draw important lessons that must be either sustained or treated in the aftermath of the pandemic.

Methods: Descriptive research design was adopted and analysis of variance (ANNOVA) and T-tests were used to test hypotheses. Analysis of data collected from 58 radiology residency program trainees found that, the residents appreciated the participatory nature of the newly introduced online learning method.

Results: The results showed that residents have accepted the new teaching/learning method and are satisfied with it. Furthermore, tests of hypotheses reveals that there is no significant difference in level of satisfaction between female and male residents as well as throughout the three levels of radiology residency training.

Conclusion: Poor internet network, reduced in-person mentoring, failure to make engaging discussions due to large number of participants, and neglect of practical aspects of trainings were identified as major bottlenecks to sustain the new system in the aftermath of the pandemic.

Background: Guillain-Barré syndrome is an acute immune-mediated polyradiculoneuropathy characterized by progressive weakness and areflexia with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation and outcome of GBS are poorly understood and not studied in our setup which complicates the care and treatment.

Objectives:   Assessed the factors affecting the outcomes of Guillain-Barré syndrome (GBS) among children <15 years in Tikur Anbesa Specialized Hospital.

Methods: Institution based analytical cross-sectional study was done among 91 patients with GBS on follow-up identified by chart tracing and reviewed at Tikur Anbesa specialized hospital from October 1/2012 to January 30/2019. Required data were collected using a checklist. The data were entered into a computer using Ep-info and exported to Statistical Package for Social Sciences Version 23 for analysis.

Results: There were 91 patients with a male to female ratio of 1.1:1 and 80 % of them are between 2-10 years of age.   Cranial nerve involvement was found in 24/91(26.4 %) and 36/91(39.6%) had dysautonomia. The commonest sub-type was AMAN, 67/91 (73%). Functional independence was achieved by 47/91(52%) at 3 months and 80/91(88%) at 6 months. Poor functional outcome of GBS was significantly associated with the presence of sensory symptoms, dysautonomia, and the need for mechanical ventilation, P < 0.05.

Conclusion:  The severity of motor weakness at nadir is associated with a lower likely hood of functional independence and patients with longer hospital stays require a longer time for functional independence.

Background: Burnout is a psychological condition characterized by emotional and physical exhaustion, depersonalization, and low personal accomplishment. Workplace stress a precursor to burnout. Burnout negatively affects patient care and causes poor physician mental health. So far, the level of stress, burnout and associated factors among interns working in Ethiopia is not known.

Methods: A cross-sectional survey was conducted among 72 interns using a structured online survey. Burnout was assessed using Maslach Burnout Inventory and stress was evaluated using Perceived Stress Scale-10 questionnaires. Statistical package for social sciences version 23 was used for data analysis. Univariate and multivariate logistic regression analysis were used to determine associated factors. All variables with a p-value of < 0.05 in the multivariate regression model were considered to be statistically significant.

Results: High emotional exhaustion, high depersonalization, and highly reduced sense of personal accomplishment were seen in 69.4%, 41.7%, and 44.4% of participants respectively. High level of stress was seen in 37% of the participants. Logistic regression analysis showed that emotional exhaustion and depersonalization were independently associated with having plans to change profession, having financial worries and high perceived stress. Reduced personal accomplishment was associated with high perceived stress. High level of perceived stress was associated with having plans to change profession.

Conclusions: In conclusion, the levels of burnout and stress among interns were high. Increased perceived stress, having financial worries, and having plans to change profession were independently associated with burnout.

Background

Menarche is the first menstrual period of a girl, marking the start of puberty. Age at menarche is a complex trait and has a strong genetic component. The mean age of menarche varies from population to population and is known to be a sensitive indicator of various characteristics of the population, including nutritional status, environmental conditions, and magnitude of socioeconomic inequalities in society

Objectives To assess the mean age of menarche, influencing factors, and menstrual patterns of secondary school female adolescent

Methods

A cross-sectional study was conducted in selected high schools in Addis Ababa. All-female adolescents within the selected schools who were in grades 9^th and 10^th and who fulfilled the eligibility criteria were included. A p-value of<0.05 was used to determine statistical significance. 

Results

The mean and median ages at menarche in this study were13.75(±1.30) and 13 years, respectively. The mean age at menarche was 0.96 years younger for private school girls(12.82 years) compared to government school girls(13.78 years). The private school girls had about 4 times higher odds of having menarche at an earlier age(AOR 4.12;95% CI 2.44-6.95). Of the total study population, 77(19.3%) adolescents had a menstrual cycle length shorter than 21 days. 

Conclusion

The mean age of menarche of the respondents in this study was 13.26 ±1.319 years. Age at menarche was influenced by the socioeconomic status of the girl child and her families. Sociodemographic attributes may be a marker for the age of menarche and symptoms.

Key words: Age at menarche, adolescents, perimenstrual symptom

Abstract

Background: Intestinal parasites are a significant cause of morbidity and mortality in most developing countries which affected more than 3.5 billion people throughout the world. The prevalence of intestinal parasites is relatively high in people living with HIV/AIDS. However, data on the prevalence of intestinal parasites among people living with HIV/ AIDS are insufficient in the study area. Hence, this study aimed to determine the prevalence of intestinal parasites and associated risk factors among people living with HIV/AIDS at Debre Brehan Referral Hospital, Central Ethiopia.

Methods: A cross-sectional study was conducted among 350 people living with HIV/AIDS from March to August 2019. Stool samples were collected with clean screw cupped containers and processed using direct microscopy, formol-ether concentration and modified acid-fast staining laboratory techniques.

Results: The overall prevalence of intestinal parasites among HIV/AIDS patients was 20.3% (71/350). Among these, Entamoeba histolytica/dispar takes the highest rank (13.4%) followed by Gardia lamblia (2.9%). Lack of latrine, high viral load count, and bad health practice of the participants were significantly associated with intestinal parasitosis.

Conclusion: The prevalence of intestinal parasites in this study was high. Thus to reduce the disease burden; government officials and stakeholders should work on reducing risk factors and increase awareness how to prevent and control of acquiring the disease.

Key words: Intestinal parasites, HIV/AIDS, Prevalence, Debre Brehan, Ethiopia

Abstract

Background: Vulvar cancer is a rare disease that occurs most often in older women; however, this is not reflected in clinical practice at Tikur Anbessa Hospital (TAH). Overall there is limited information regarding vulvar cancer in Ethiopia.

Aim: The aim of this study was to describe demographic characteristics and the clinical profile of Vulvar Cancer patients treated at Tikur Anbessa Specialized Hospital.

Methods: This is a retrospective study. Data on primary vulvar cancer patients managed between August 30 2012 and August 30 2017 were gathered from patients’ chart and analyzed.

Results:  The median/mean age was 39/43.17 ranging from 22 to 85 years. The patients presented with more than one symptom. The mean duration of the symptoms was about 2 years. Labium majus(91.5%), labium minus (89%) were mainly affected. In most (79.7%) patients the disease was locally advanced. Sixty six percent of the cases were positive for HIV. The mean/ median duration of HIV infection was 72.14/72 months. All of them were taking HAART. The majority (32.2%) were treated with chemo-radiation followed by surgery alone (16.9%). A Surgical procedure was done for 22 patients. Few patients developed complications.

Conclusion: Vulvar cancer in Ethiopia appears to be a burden of mainly the young and HIV positive patients. Most present in late stage of the disease despite visiting a health care facility for HIV care/HAART and long standing symptoms. Delivering education about vulvar cancer to Patients, particularly HIV positive ones, and health care providers may ameliorate the disease burden in Ethiopia.

Background: Nurturing leadership and governance is salient to strengthen health systems. However, literature that reports the effect of programs related to this, particularly in low and middle-income countries’ health systems is limited.

Aim: To examine the effect of integrated health system leadership, management, and governance capacity-building program on institutional delivery performance.

Methods: A prospective quasi-experimental study, on one-hundred-thirty-four health facility teams, was conducted in northwest Ethiopia. Teams were allocated to intervention and control groups in a 1:1 ratio, non-randomly. Integrated leadership, management, and governance capacity-building program was employed in teams of the intervention group over six months. Using a challenge model, they implemented a six-month project on institutional delivery performance. Here, the outcome of interest was mean institutional delivery performance. Data from each group were collected at baseline and end line. Data were analyzed using analysis of covariance. Statistical significance was determined at p<0.05. The program’s effect size was reported using partial eta squared, which was also double-checked with a 95% confidence interval in the contrast-results.

Results: Integrated leadership, management, and governance capacity-building program had a statistically significant effect on mean institutional delivery performance (p<0.001). The program’s effect size was 65%, somewhere between 12.2 and 15.8.

Conclusions: Integrated leadership, management, and governance capacity-building program is a plausible cause of improved mean institutional delivery performance. The current findings could make the program sustainable across time and scalable across similar settings.  To identify the program’s true causation, further research could be done using a randomized control trial.

Background: Uterine cramping pain is a documented morbidity in the immediate postpartum period but there is no protocol yet, for its management. The study aims to compare the efficacy of multiple doses of oral paracetamol and diclofenac in the control of uterine cramping pain in women that had spontaneous vaginal delivery

Methods: It is a randomized controlled trial among 291 women that had spontaneous vaginal delivery at LAUTECH Teaching Hospital Ogbomoso. They were recruited in the labour ward and randomized into Paracetamol, Diclofenac or Placebo group. Initial pain intensity was assessed followed by administration of the drugs within 1hour of delivery and then 8hourly until 24 hours. The instrument of survey was a proforma and data was analyzed using SPSS 22. Primary outcome measures were adequacy of pain relief, onset of breastfeeding and maternal satisfaction. Secondary outcome was potential maternal side effects of the drugs.

Results: The incidence of after-pain was found to be 100% with a large proportion (97.9%) being severe. Respondents’ age, gestational age, duration of labour and oxytocin augmentation of labour correlated significantly with severity of pain. Diclofenac was significantly better than paracetamol which in turn was better than placebo in relieving the pain, mean SPID- 8.71 [SD-1.17; CI-8.48-8.95], 6.78 [SD-2.25; CI-6.33-7.24] and 1.54[SD-1.35, CI-1.26-1.31], F-487.31; p< 0.001 for diclofenac, paracetamol and placebo respectively. Maternal side effects were seen only in diclofenac group.

Conclusion: Multiple doses of oral Diclofenac and Paracetamol were efficacious in relieving uterine cramping after-pain although more with diclofenac.