Vol 60, No 2 (2022): April 2022 Issue

Background: Coronavirus disease 2019 (COVID-19) is characterized as a global pandemic by World Health Organization. For the safety of medical laboratory personnel and the environment, thermal inactivation of clinical samples is a common practice performed by most laboratories before nucleic acid extraction. However, there are conflicting reports in the literature regarding the effect of thermal inactivation on the analytical sensitivity of molecular assays.

Objective: To test the impact of thermal inactivation using alternative methods on the analytical sensitivity of respiratory samples.

Method: We compared the impact of thermal inactivation of biological samples after adding lysis buffer at 72⁰C for 10 minutes by dry heat block and water bath on analytical sensitivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Furthermore, we tested the effect of the thermal inactivation method at 56⁰C using a water bath on the detection rate of SARS-CoV2.

Result: All samples tested positive in dry heat block was also tested positive in the water bath. We observed a similar viral detection rate of viral RNA at 56⁰C for 15 min and 30 min, whereas inactivating samples at 56⁰C on the water bath for 45 minutes drastically reduces the virus detection rate by 20%.

Conclusion: Water bath is not inferior to dry heat block to treat samples with lysis buffer, and can be used instead of dry heat block in district laboratories. However, the inactivation of samples at 56⁰C over 30 minutes drastically reduces the virus detection rate. Hence, samples shall not be heat-treated before nucleic acid extraction.

Background: The knowledge of the prevalence of the palmaris longus (PL) tendon according to gender and ethnicity is important for surgeons planning to use its tendon for transfer and transplant. Unfortunately, there is no information related to the prevalence of PL agenesis in the African Antiguan population. This study aimed to determine the prevalence of PL agenesis and its association with gender, body side and hand dominance in the African Antiguan population by using the Chi-square test.

 Methods: Six hundred subjects (300 males and 300 females; age range 18-62 years) were examined for the presence or agenesis of PL tendon, using the clinical test.

Results: Overall agenesis of PL in the present study reached 12.8%, unilateral agenesis (7%) was more common than bilateral absence (5.8%). The PL agenesis was found significantly greater (p=0.037) in females (15.6%) than the males (10%). The muscle agenesis was significantly more often on the left side than the right (p=0.02). In both right-hand (p>0.05) and left-hand (p<0.05) dominant subjects, the left-sided agenesis was greater.

Conclusions: This study reaffirms the existence of ethnic differences in the prevalence of PL agenesis. The prevalence of PL agenesis in the African Antiguan population is lesser than the reported incidence of 15% in standard textbooks and much higher than the black and Asian populations. The PM tendon is prevalent in the vast majority (87.2%) of African Antiguans, and it is not diminishing rapidly like in middle eastern populations. Hence the surgeons can still harvest the tendon for various reconstructive and tendon graft surgery in African Antiguans.

Background: Intestinal helminths infection mainly occurs in the tropics and sub-tropics and affects the health status of school children by causing anemia, malnutrition and also restrictions in physical and cognitive development.This study aimed to access the prevalence of intestinal helminths and associated risk factors among primary school children in Gedeo Zone, Southern Ethiopia.

Methods: A cross-sectional study was conducted from February to April 2020. Stool samples were collected and processed by using Wet Mount (WM) and Formol-Ether Concentration (FEC) techniques. The Pearson’s chi-square and multivariate analysis was performed to verify the association between helminths and associated risk factors.

Result: A total of 413 school children were participated. The mean age ± SD of the study participants was 10.7±2.64 years. The overall prevalence of intestinal helminths was 27.3%. Ascaris lumbricoids was the most prevalent intestinal helminths 77(18.6%) followed by Trichuris trichura 9(2.2%) and Hook worm 15(3.6%).Poor hand washing practice before meal (AOR=0.46; 95% CI: 0.232-0.915; P= 0.027), drinking water from river (AOR=1.01; 95% CI 0.004-2.600; P=0.000), living in rural area(AOR=0.63; 95% CI: 0.397-0.915; P= 0.052)  and poor toilet use habit (AOR=0.45; 95% CI: 0.114-0.520; P= 0.000) were factors significantly associated with intestinal parasite infections.

Conclusions: The prevalence of intestinal helminths was high in the study area, 114 (27.3%). Therefore, intervention measures including periodic school-based deworming programmes needed to improve the health of school children.

Abstract

Background-Heart failure is a burden for health-care system. There is clear evidence from land-mark studies that optimal uses of ACEI, ARB, BB, and MRA with the aim of achieving target dose used in RCTs improves survival and reduce morbidity in patient with HF with reduced EF.

Objective of this study is to evaluate physicians’ adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced EF.

Method-Retrospective Cross-sectional study was conducted and a medical record of 364 patients with HFrEF treated at TASH from 2012 to 2018 was reviewed. GCA score was used to score use of ACEI, BB, ARB, and MRA according to international guideline. SPSS 20 software was used for data entry and analysis.

Result-GCA score was good in 36%, moderate in 47%, poor in 17% of the study patients. Class adherence for individual drug was 67% for ACEI, 48.7% for MRA, and 73.6% for Beta blockers. Proportion of patient at target dose (100%) was 7.6% for ACEI, 0.8% for Beta blockers and 1% for MRA. Use of more than 50% target dose was 36.7 % for ACEI, 6.6% for beta-blocker, 49% for MRA. Duration of heart failure > 5 years was associated with a good GCA(P=0.003). Diabetic patients were prescribed higher doses of ACEI, compared to non-diabetics (p=0.001).

Conclusion In these study use of all indicated medication was low (36%) and majority of patients were in less than 50% target dose, especially for beta-blocker and ACEI.

Background: Operating room (OR) efficiency is a measure of how well time and resources are used for their intended purposes in the operating room. Commonly used parameters are cancelation rate, first case start-time, turnover time, and utilization rate. While previous similar study from our hospital showed inefficient OR utilization, the difference in performance among available ORs has not been described.

Methods: A cross sectional study was done at Tikur Anbessa Specialized Hospital, 550 bed tertiary teaching hospital, from November 2, 2020, till Jan 22, 2021. Out of total 9 operating rooms, four, i.e., Gastrointestinal, Gynecology, Pediatric Surgery and Endourology operating rooms were studied for efficiency parameters .

Results: Out of the 570 patients listed for surgery,404 were operated. The average cancellation rate was 27.3%,the highest being for Gynecology OR  (41.5%) and lowest for Pediatric Surgery OR (18.2%). Average start time was 8:43am (SD = ± 25min). Start time was delayed by 43 minutes from the agreed 8:00 am. Only 2.5% of OR days were started within agreed time. Mean turnover time for all ORs was 25.2 minutes, the highest being for Gynecology OR(35min) and lowest for Pediatric Surgery OR(14min). Average OR utilization was 6hrs 30 min, which was 72%  of the daily allocated 8hrs time.

Conclusion: Our operating rooms have a high cancellation rate and delayed start time. Turn over time and OR utilization were in general acceptable. There were significant differences in efficiency parameters across the four ORs. The OR manager in collaboration with all teams should work on improving start time and cancellation rates, and also identify why some ORs performed better than others while in the same institution.

Background: Achieving incredible performance is a function of the way in which the health system organizes the six key building blocks. Particularly, strengthening leadership and governance supports understanding the proximate facilitators and barriers of maternal health delivery performance. This study aimed at exploring facilitators and barriers of maternal health performance with special reference on institutional delivery performance in North-West Ethiopia.

Methods: Phenomenological study was conducted from October to November 2018 at health centers located in North-West Ethiopia. Data were collected, until information saturation, from eleven purposively selected key-informant interviews. Using open code software, data were analyzed thematically. Data were transcribed, coded, categorized and thematized.

Results: Strong management system, enhanced work environment, ambulance, integrated maternal waiting home, and quality maternal service emerged as core dimensions for improved institutional delivery performance. Strong management system was characterized by the involvement of key stakeholders, strong ambulatory health team, functional health development army, and regular pregnant women’s conference. Enhanced work environment was explained by staff morale and ethics, improved staff motivation and commitment and strong health center-health post linkage. The ambulance service was described in terms of ownership, and whether the ambulance was used to transport women home after giving birth. Integrated maternal waiting home was linked to basic services (food, water, and bathroom), cultural ceremonies. Quality maternal service was defined with staff empathy, improved pregnant women counseling, enhanced communication, strong referral linkage, and enhanced customer satisfaction.

Conclusions: Strong management system, enhanced work environment, ambulance, integrated maternal waiting home, and quality service facilitate the institutional delivery performance. Applied research could be conducted to test the practicability of these facilitators

Background: Healthcare facilities play a critical role within the health system in providing essential medical care to the community, particularly in a crisis or pandemic. Evidence regarding hospital preparedness during Corona Virus (COVID-19) pandemic is scarce in Ethiopia. Therefore, this study aimed to assess the level of hospital preparedness for the COVID-19 Response in Southeast Ethiopia.

Methods: A facility-based cross-section study was conducted in the health facilities of Bale, East Bale, and West Arsi zone from June 15-30, 2020. A total of ten hospitals were included in this study. Data were collected using a structured questionnaire. EpiData version 3.1 was used for data entry and SPSS version 20 was used for analysis. The results were described using tables and texts. 

Results: None of the included hospitals started the COVID-19 testing service during the study period. Six hospitals have intensive care (ICU) units for adults, however, the maximum bed capacity per hospital was five. Only four hospitals incorporated COVID-19 disaster planning into their planning. Most (90%) of the hospital established multidisciplinary teams to address COVID-19. Nine hospitals prepared information materials on COVID-19 to communicate to patients and their families.

Conclusion: Hospital preparedness for the management and response to the COVID-19 pandemic was not practiced according to the standard set by the World Health Organization and Ministry of Health. Capacity-building activities are strongly recommended to fulfill the required supplies and skilled manpower.

Introduction: Rheumatic heart disease (RHD) is one of the major causes of cardiovascular disease in developing countries. Secondary prophylaxis is effective for preventing recurrent acute rheumatic fever (ARF) and the progression of RHD. The purpose of the study was to assess adherence and barriers to use secondary prophylaxis for RHD at Tikur Anbessa Specialized Hospital (TASH).

Methods: Cross-sectional study was conducted from June 5, 2020, to September 4, 2020, at Tikur Anbessa Specialized Hospital, Ethiopia. A structured questioner was used for the data collection on awareness, adherence, and barriers for benzathine penicillin prophylaxis in adults with RHD. Data were analyzed using SPSS version 26.

Results: A total of 385 patients participated in this study, 305(79.6%) patients were aware about sore throat associated with heart disease, and about 288 (75.6%) patients know that benzathine penicillin prevents tonsillitis. Adherence rate was 77.9%. The main barriers for nonadherence in this study were the unavailability of medications, schedule forgetfulness, and health professionals’ refusal to inject benzathine penicillin. Increased age was found to have a significant association with adherence to B. penicillin. For each one-year increase in the age of patients with RHD, the adherence decreases by 3% [AOR= 0.97; 95% CI 0.95, 0.99], P value = 0.006)

Conclusion: Adherence level to monthly benzathine penicillin injection was low, which is below WHO recommendation. This study has revealed major barriers that affect adherence to secondary prophylaxis for RHD that can be used to develop interventions to improve adherence.

Background: Esophageal carcinoma is a significant cause of morbidity and mortality among cancer patients in Tanzania. Squamous cell carcinoma is the most predominant subtype encountered.  Risk factors and treatment of these two histological subtypes vary significantly. This study aimed to understand the prevalence of Distal oesophageal cancer and of adenocarcinoma.

Methods: This was a retrospective chart review for patients treated with oesophageal cancer from April 2013 to April 2017 at Muhimbili National hospital. Patients with Distal oesophageal cancer were identified and their socio-demography, Takita’s dysphagia grade, tumor length from the upper incisor teeth, endoscopic tumor morphology, histology and stage of the disease was abstracted. Data was analyzed using SPSS where descriptive statistics were computed. Associations were determined using chi-square test with significance set at <5%. Ethical approval was obtained from Muhimbili University Institutional Review Board.

Results: Distal oesophageal cancer made 34.1% of all esophageal cancers, with no variations over the five-year review. The mean age of patients with Distal oesophageal cancer was 59.7 years with female predominance at 2:1 for men. Adenocarcinoma was the most predominant histological subtype at 3:1 for squamous cell carcinoma. Low socio-economic status, alcohol drinking, smoking cigarettes and positive history suggestive of Gastro Oesophageal Reflux Disease were common among these patients. Most of the tumors are fungating with late presentation judged clinically with dysphagia as the most common presentation.

Conclusion: Clinicians and researchers should be aware of the higher incidence of Distal oesophageal cancer presenting with adenocarcinoma. Failure to recognize this unique entity in a region where squamous cell carcinoma is the most predominant type might result in misinterpretation of data and misallocation during treatment and prognostication.

Background: The security of the drinking water supply has been sullied by antimicrobial-resistant bacteria at the source, within the dispersion framework, and amid families dealing with, which may cause intense or incessant wellbeing issues. Therefore, this study aimed at determining the antimicrobial-resistant bacterial contamination, health risk, and associated factors of drinking water in Northwest Ethiopia.

Methods: A laboratory-based cross-sectional study was employed by taking 60 water samples collected from the household tap and drinking water storage container by following the standard microbial analysis method. Besides, a sanitary survey was conducted for the municipal water supply system from March to May 2020. Descriptive statistics and multiple linear regression models were employed.

Results: The prevalence rate of multidrug resistance Escherichia coli species was 80% (95% CI: 76.9-81.2 %), Salmonella species was 40% (95% CI: 38.7-45%) and Shigella species was 60% (95% CI: 56.9-65%). The overall Health risk index (HRI) of drinking water showed that 45.83%, 41.67%, and 12.5% of them were categorized as low, intermediate, and high-risk classes, respectively. The load and health risk could be strongly correlated with the low residual chlorine of drinking water.

Conclusions: The contamination of drinking water with antimicrobial-resistant waterborne bacteria in the community could indicate an occurrence of treatment failure. Hence, proper drinking water treatment and strict supervision are needed to prevent the contamination of the water and related consequences.