Vol 56, No 2 (2018): April Issue

Introduction: There are limited up-to-date studies addressing the relationship between intimate partner violence and birth outcome among women in Ethiopia. This study was, therefore, conducted to examine the association between intimate partner violence during pregnancy and birth weight of newborns.

Methods: The study employed a facility-based case control design and conducted in pregnant women who gave birth in public Hospitals in Addis Ababa during March-June 2014. The study used a pre-tested questionnaire to collect data through face-to-face interviews. Exposure to intimate partner violence and other explanatory factors were examined in a total of 112 neonates with low birth weight and235 neonates with normal birth weight. The data were analyzed using bivariate and multivariable regression analysis.

Results: The proportion of physical violence by partner was 33.9% among cases and 17.4% among controls, and sexual violence was 41.1% and 18.7% among cases and controls, respectively. After adjusting for socio-demographic factors, obstetric conditions and substance use, the odds of experiencing physical violence (AOR=8.11; 95% CI; (1.92, 34.3)), sexual violence (AOR=6.02; 95% CI; (1.77, 20.5)), and physical or sexual violence (AOR=5.18; 95%CI;(1.53, 17.6)), by intimate partner was significantly higher among cases compared to controls.

Conclusion: Low birth weight is strongly associated with intimate partner violence during pregnancy. We recommend health professionals providing antenatal care services to engage spouses to ensure their understanding and involvement in

the prevention of intimate partner violence.

Key words: IPV, Low birth weight, Physical, Sexual Violence.

Back ground: Emergency medicine (EM) is one of the most rapidly developing medical specialties in Africa. After just 8 years since its introduction in Ethiopia, there were 22 qualified emergency medicine specialists and 2 pediatric emergency specialists in the country. The aim of this study was to qualitatively assess the status of emergency medicine and the challenges and opportunities of working as an emergency physician in Ethiopia.

Methodology: An interview and a videotaped focus group discussion involving 17 selected participants were done in December of 2016. The data was transcribed, translated and analyzed by identifying the most common themes that emerged.

Result:  All the participants agreed the field of emergency medicine is rapidly expanding in Ethiopia. Six themes were identified as challenges: The undeveloped state of the emergency medical system, the disorganization prevalent in emergency rooms, an undefined scope of practice, problems with acceptance of the specialty, poor continuity of care, and an unsatisfactory remuneration. Meanwhile, the increasing attention given by the government and the demand for pre-hospital and in hospital emergency care were identified as future opportunities for growth of the specialty.

Conclusion: Emergency medicine in Ethiopia faces multiple challenges as it is a new field in a resource limited setting. The challenges range from problems with acceptance to difficulties of patient disposition. In order to overcome these challenges, government level support and advocacy work among health sectors, physicians, and medical associations is imperative.

Key words: Emergency medicine; new specialty; Ethiopia

Objective: The aims of the study were to determine the incidence of eclampsia and describe its clinical correlates and pregnancy outcomes.

Patients and Methods: A one-year prospective study of 93 cases of eclampsia using a structured questionnaire which included socio-demographic data, clinical presentation, work-up, management and feto-maternal outcomes was done at Karamara Regional Hospital, Eastern Ethiopia.

Results: The incidence of eclampsia was 2.7% (93 in 3500 deliveries). Most of the cases were young (45%), nulliparous (70%) women who had not received any antenatal care (63%). Almost two thirds of the women (n=57, 61%) presented with eclampsia in antepartum, whereas 26 cases (28%) occurred in intrapartum, and there were 10 cases (11%) with eclampsia postpartum. Preceding symptoms were reported in 78.5 % of patients with severe hypertension recorded in 66%. The average gestational age at presentation was 32 weeks. Hydralazine was used for emergency control of hypertension in 91% of the cases. Magnesium was administered to 92 (99%) of the patients. Delay greater than 12h from admission to delivery occurred in 45% of the women with eclampsia. Cesarean section (CS) was performed in 14 (17%) and instrumental delivery in 15 (18%). The maternal and perinatal case fatality rates of eclampsia were 34.7% and 11% respectively.

Conclusion: The incidence of eclampsia was very high with corresponding high maternal and perinatal deaths. The presentation of patients was late and the work up and management of cases substandard. Hence capacity building of health facilities, implementation of standard guidelines and criteria based auditing are recommended.

Keywords: eclampsia , pregnancy outcomes, eastern Ethiopia.

Introduction: Either regional or general anesthesia is an acceptable approach to providing anesthesia for cesarean delivery. However, regional anesthesia is the widely preferred option considering its multiple benefits. The aim of this study was to assess the prevalence of spinal anesthesia use, attitude of mothers towards spinal anesthesia, and magnitude of its complications.

Methods: This is a hospital-based cross-sectional study conducted from April-June 2014 at Tikur Anbessa Specialized Hospital and Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Data was collected using a pre-tested questionnaire and analyzed using SPSS version 21 statistical software.

Result: During the study period, there were 1,713 deliveries, with overall cesarean section delivery prevalence of 32.5%. The overall proportion of cesarean delivery with spinal anesthesia was 68.2%. Only two mothers were given spinal anesthesia in left lateral position. The experience of the anesthetist was the only factor significantly associated with the occurrence of hypotension in a multivariable analysis. Postdural puncture headache after cesarean section with spinal anesthesia was reported in 34.2% of the cases. After the operation, 90.3% of the mothers were happy with the type of anesthesia administration.

Conclusion: The rate of spinal anesthesia for cesarean delivery in this study is significantly lower than reports from the developed as well as sub-saharan countries implying a need to increase use of this procedure to achieve the recommended 90-95% target and avail epidural anesthesia as an option for those in need. The current practice in administering spinal anesthesia needs to be revised to minimize such side effects.

Keywords: Regional anesthesia, Cesarean delivery, Lidocaine, Bupivacaine.

Introduction: Gullian-Barré Syndrome (GBS) is an acute monophasic demyelinating polyradiculoneuropathy which is characterized by progressive weakness and areflexia. Different antecedent events are associated with GBS and one of those is an anti-rabies vaccine prepared from infected animal brain.

Objective: The study goal was to determine epidemiological features of and to describe the clinical and short-term outcomes of Gullian-Barré syndrome.

Materials and Methods: A cross sectional descriptive study with retrospective data collection was done on children admitted with a diagnosis of Gullian-Barré Syndrome from September 2006 to September 2012.

Result: 112 children were identified. The male to female ratio was 1.6. All had motor weakness, only one patient (0.9%) had sensory loss, 34(30.3%) had cranial nerve involvement and 37 (32.9%) had dysautonomia. Respiratory involvement which necessitated ventilation was found in 14 (12.5%) of our cases. Antecedent events were recorded in 82 (73.2%) of children and among them; upper respiratory infection (URTI) was the most frequent (43.8%). Of the 15 patients with vaccination antecedents, 7 (6.35%) had received anti-Fermi type rabies vaccine. The GBS subtype distribution among the 31 patients who had electrodiagnostic studies performed was as follows: acute inflammatory demyelinating neuropathy (AIDP) 3 (10%), acute motor axonal neuropathy (AMAN) 24 (80%),acute motor-sensory axonal neuropathy (AMSAN) 1 (3.3%), and both axonal and demyelinating neuropathy 3 (10%). Complete recovery was noted in 31 (27.7%) patients and there were 9 (8%) deaths.

Conclusion: Male preponderance and presence of antecedent illness was observed in the majority of subjects. Acute motor axonal neuropathy was the commonest subtype of Guillain-Barré. Prior anti-Fermi-type rabies vaccine may have been one predisposing factor.

Keywords: Guillain-Barré syndrome, Rabies vaccine, Ethiopia

Background: Primary cerebral and spinal hydatidosis are very rare accounting for 2 and 1 percent of hydatidosis respectively. The aim of this study is to describe the MRI and CT imaging features and the pathological correlates of primary cerebral and spinal hydatidosis and discuss the differential diagnosis.

Materials and Methods:  The MRI and CT images of assorted seven cerebral and three spinal primary hydatidosis who were operated on in teaching and tertiary referral hospitals between 2006 and 2016 and had histological confirmation were analyzed after exclusion of primary visceral hydatidosis using chest x-ray and abdominal ultrasound.

Results:  There were seven cerebral and three spinal primary hydatidosis. Their median age was 11.5 years with female to male ratio of 1.5:1. Cerebral hydatidosis presented with focal neurological deficits, seizure and blurred vision and the spinal cases presented with paraparesisincontinence. The cerebral hydatids were intra-axial with an average size of 8 cm and located in the temporoparietal and parietooccipital lobes, and of the three spinal hydatids, two were located in the thoracic and one in the sacral region. The latter cases involved the spinal canal and paravertebral regions compressing the spinal cord and the dura and destroying the vertebrae.

Conclusion: Primary central nervous system (CNS) hydatidosis is being observed in a relatively increased frequency in the Ethiopian setting after the recent introduction of MRI and CT imaging in teaching tertiary referral hospitals. Therefore, awareness should be raised in the differential diagnosis of cystic CNS mass lesion especially in pediatric and young adult patients from rural Ethiopia to improve treatment outcomes.

Key words: CNS hydatidosis, CT/MRI imaging

Introduction: Subarachnoid hemorrhage is a devastating neurological emergency associated with high mortality and disability. Little is known about its occurrence and clinical profile in Ethiopia. We, therefore, studied the clinical presentation, causes and outcome of the condition among in a tertiary facility.

Methods: A retrospective analysis of records of patients admitted with the diagnosis of subarachnoid hemorrhage to Tikur Anbassa Specialized Hospital over a period of 12 years, January 2001 to January 2012, was undertaken.

Results: Of 725 patients admitted with the diagnosis of stroke 52 (7.1%) patients were diagnosed to have subarachnoid hemorrhage. Death was registered in 18(34.6%) and disability in seven (13.4%).  Hypertension was the most common risk factor, observed in 36 (69.21 %) of the patients, and seizure disorder and electrolyte abnormalities-hyponatremia were the most common complications.

Conclusion: The outcome of subarachnoid hemorrhage in this study is comparable with reports from elsewhere. A prospective and well-designed epidemiological study is recommended. There is a need to improve the diagnostic and interventional capacity of the hospital.

Key words:  Stroke. Subarachnoid Hemorrhage. Ethiopia

Introduction: Limb amputation in pediatric age group is relatively infrequent compared to adults and is often associated with profound social, psychological and economic impacts on the growing child and family. There is few published literature specifying the cause of limb amputation in pediatrics in Ethiopia. The aim of this study is to determine the cause and patterns of paediatric limb amputation at 'Tikur Anbessa' specialized hospital and make recommendations towards reducing the incidence.

Methods: This was a retrospective study conducted at ‘Tikur Anbessa’ Specialized teaching Hospital between May 2005 and April 2015. Data were retrieved from medical records and operation logbook of all pediatric patients aged 15 years and below who underwent limb amputations during the study period. Information regarding age, sex, indications and levels of amputation were studied.

Results: A total number of 99 patients with 102 amputations were involved in the study. Their age ranged between 4 and 15 years with mean age of 10.5 ( SD ±3.2) years. There were 75 boys and 24 girls (male: female ratio=3.1:1). The most common indication for limb amputation was gangrene arising from treatment of limb injuries by traditional bone setters, locally called “Wogeshas” (55.5%), followed by malignancy (29.2%) and trauma (11.1%). An intractable bone and soft tissue infection accounted only for 2% of the amputations (2). Three limb amputations in one patient and two in another one were due to a condition with unclear vascular etiology resulting in multiple gangrenous limbs. Majority of the amputations were in the upper limbs.

Conclusion: Traditional bone setters’ practice related gangrene, late presenting musculoskeletal malignancy and trauma were the three most common causes for pediatric limb amputation in Ethiopia. Given that, all are non-communicable conditions, we can conclude that the majority of the amputations could have been prevented by provision of health education, early presentation and appropriate treatment in a modern health facility.

 Keywords: pediatrics, limb amputation, gangrene, traditional bone setters, “Wogeshas”.

Introduction: Clinical trials are a cornerstone of modern evidence based medicine. They are an important step in discovering new treatments for certain diseases as well as new ways to detect, diagnose, and reduce the risk of disease. They also highly support the clinical practice by generating local evidence. The aim of this study is to evaluate the status and trend of clinical trials in Ethiopia from international trial registries.

Material and Methods: We have searched WHO International Clinical Trial Registry Platform (WHO ICTRP) for all trials with at least one recruitment center in Ethiopia. The results were exported in XML format and a rational database was formed.

Results: Up to November 15,2016; 145 clinical trials were found to be registered from Ethiopia. Majority of trials were design on infectious disease (n = 87, 60%) and the rest were done on NCD. The five most common infectious disease evaluated were Malaria (n=15; 10%), Tuberculosis (n=13; 9%), trachoma (n=12; 8%), HIV (n=11; 8%) and helminthiasis (n=6; 4%). The most common NCD was malnutrition (n = 19; 13%) and only one trial was on cancer, namely Wilms Tumor (1%). London School of Hygiene and Tropical Medicine was the sponsor with the highest number of registered trials (n=8, 6% of all trials), followed by Columbia, Jimma and Ghent University with 5 (3%) trials each.

Conclusions:The clinical trials done in Ethiopia are very much limited in number and variety. To improve the situation the government, industry, academic institutions, patient advocacy groups, professional societies and other organizations should work together.