ABSTRACT

Background: Asthma prevalence is expected to increase globally by 50 % every decade.  Respiratory illness, including asthma among children has become a public health concern in Ethiopia.

Objective: To determine the prevalence of symptoms of asthma and associated factors among primary school children in Addis Ababa.

Methods: Cross sectional study was conducted from January 2015 to March 2015 using questionnaire adapted from International Study of Asthma and Allergies in Childhood. A total of 20 primary schools were selected randomly from Addis Ababa to collect data from school children. The questionnaires were completed by parents/guardians of the children. Descriptive and analytic methods of data analysis were used.

Results: A total of 1259 primary school children aged 6-7 years were included in this study. The prevalence of ever wheeze, wheeze in the past 12 months, ever diagnosed asthma, exercise induced wheeze in the past 12 months, and dry cough at night in the past 12 months were 13.1% (95 % CI, 11.21% -14.99 %), 8.9% (95% CI, 7.30% -10.50%), 4.1% (95% CI, 2.98% -5.22%), 6.5% (95% CI, 5.09% -7.91%),  and 19.2% (95% CI, 16.99% -21.41%) respectively. Diet (eating pasta ?3 time per week in the past 12 months) and fuel for cooking (kerosene) were significantly associated with wheezing in the past 12 months.   

Conclusion: The prevalence of wheeze in the past 12 months was high and factors associated with it were eating pasta frequently and use of kerosene as a fuel for cooking.

Keywords: Asthma, Child, Cross-sectional studies, Ethiopia, Prevalence, School

Background: Acute pancreatitis is a disease of variable severity, and a high index of clinical suspicion supported by relevant laboratory and imaging studies is necessary to make early diagnosis and improve patient outcome. Objective: This study aims to revise the most common presenting symptoms and signs of acute pancreatitis and the diagnostic modalities used in adult Ethiopian patients.

Methods: A cross-sectional descriptive study was conducted among adult patients with acute pancreatitis admitted to St. Paul’s Millennium Medical College Hospital from January 2005 - December 2011. Data on clinical presentation and outcome of illness was collected from medical records using a structured and pretested questionnaire and analyzed using SPSS Version 16.

Results: A total of 40 patients were admitted to the hospital during the study period. Medical records were retrieved for 30 of them. The male to female ratio was 5:1 and the mean age was 40 years. The majority (76.7%) of patients presented within 3 days of onset of illness. Abdominal pain and vomiting were the most common presenting symptoms seen in 86.7% and 60%, respectively. Tachycardia (60%) abdominal distention (73%) and tenderness (80%) were physical findings. Serum amylase level was elevated in all patients, but was highly elevated in 16 (40%). Ultrasound examination showed features of acute pancreatitis in six (31.6%). Acute pancreatitis was diagnosed on clinical evaluation in 18 (60%) of the cases and intra-operatively in 12 (40%). Six (20%) of the cases died and five of them were among those who underwent surgery.

Background: Ultrasound (US) has been found to be safe, inexpensive, and relatively easier in diagnosing CAP in other settings and minimizes exposure to ionizing radiation. We aimed to assess the feasibility and reliability of chest US for the diagnosis of CAP as an alternative to chest radiography in a hospital setting in Ethiopia.

Methods: A prospective cross sectional study was conducted among under five children with a clinical diagnosis of pneumonia who visited the radiology department of Tikur Anbessa Specialized Hospital (TASH) for CXR examination from February to August, 2016. Relevant US findings were collected on a pretested data collection instrument and we used SPSS to analyze and compare US finding with chest radiography (used as the gold standard) finding.

Results: seventy two patients were included in the study with a mean age of 22.1 months (standard deviation ± 19.6 months) and 42 (58%) were male. We identified 44 (61%) and 48 (66%) CAP cases by CXR and chest US, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of chest US as compared to CXR were 95% (95% CI, 89-100), 86% (95% CI, 80-92), 91% (95% CI, 85-97) and 92% (95% CI, 86-98), respectively. Consolidation was found in 44 of the 48 CAP cases.

Conclusion: Chest US of the lung has a high sensitivity and specificity in identifying cases of CAP and is technically feasible. Chest US could be used as an alternative modality in the diagnosis of CAP in our setting where access to x-ray is limited.

Background - Portal hypertension (PHT) may be caused by a wide variety of conditions, each with a different course and natural history. It frequently presents with bleeding from oesophageal varices, which is the commonest cause of serious upper gastrointestinal haemorrhage in children. Precise diagnosis, a sound understanding of the therapeutic options, and a multidisciplinary approach are essential for successful management. This study was done to assess the causes and risk factors of portal hypertension among children <15 years

Methods: this was a retrospective facility based study conducted at BLH by collecting all children who have a clinical diagnosis of portal HTN and or gastroscopy findings. Data was collected with the trained nurse using a structured questioner.

Results: a total of 214 cases were included with mean age of 9.3yrs + 3. Hepatic causes were the commonest causes cirrhosis being the leading causes of portal HTN followed by portel vein thrombosis. Ultrasound was done for 116 cases and identified the cause of portal HTN in 50%of the cases and in 26.7 % of cases findings were normal.

Conclusion: patients with cirrhosis should always be followed for the features of portal HTN.  Problem centered strategy and commitment to health education for health professionals and the community at large should particularly address hepatic causes of portal HTN.

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Background- the treatment of hernias has been evolving very fast in the last few decades. The use of mesh for hernia repair has become increasingly popular & many centers considered it as a standard of care.

Objective - To determine the rate and types of abdominal wall hernias treated with mesh repair techniques and outcomes of patients.

Methods-A retrospective review medical records of all adult patients who underwent open mesh repair at St. Paul’s Hospital Millennium Medical College from September 2013 to August 2016. 

Results- Hernia surgeries made 8% of adult elective surgeries. Of these, 130(40.9 %) had mesh repair. Incisional hernias (IH) 68(52.3%) and groin hernias 44(33.8%) being the most common forms repaired with mesh. Except inguinal hernias all hernias were more common in females. Laparotomy for bowel surgery and 29(42.6%) and cesarean section/gynecologic surgeries, 27(29.7%) were the most common surgeries resulting IH. Of IH 57.4 %( n=39) had emergency surgery & 33.8% (n=23) had a low midline incision. Recurrent hernias accounted for 28.5 %( n=37) of the cases repaired with mesh.  Postoperative complication was seen in 14 patients (10.8%) surgical site infection being the main form followed by seroma formation (n=3) & recurrence (n=3). There was an increased rate of complications in females (p=0.043) & in patients with co-morbidity (p=0.041). No death.

Conclusion- Our study found that meshes are being used increasingly for incisional & recurrent inguinal hernias. Outcomes of our patients are comparable to published literatures.

Key words-Inguinal hernia; incisional hernia; Mesh repair

Abstract

Back ground: Congenital heart defect (CHD) is structural heart defect present at birth and it accounts for nearly one-third of all major congenital anomalies. Worldwide, CHD constitutes one of the major causes of infant mortality, particularly in developing countries.

Methods and Materials: Hospital based cross-sectional study was carried out, involving children with congenital anomalies, in four referral hospitals. The data were collected using a structured questionnaire and the diagnosis of CHD of children was recorded from the children’s medical records and sample size was 271.

Result:  The prevalence of CHD among children diagnosed with congenital anomalies was 35.8%. The most common CHD was VSD (Ventricular Septal Defect) 30 (30.9%), followed by ASD (Atrial Septal Defect) 23(23.7%). Previous history of abortion AOR (Adjusted odd ratio=1.96; CI= (0.277-0.935); p=0.03) and past history of drug intake during pregnancy (AOR=   2.149; CI= (0.252-0.861); p= 0.015) were significantly associated with CHD.

Conclusion: The present study has shown that the burden of CHDs among congenital anomalies was high. Mothers who had previous history of abortion and drug intake during pregnancy were significantly associated with the occurrence of CHD. This study has given insight into the magnitude of the problem and provided baseline data for future detailed studies, as there was very little data available in the past. Information from this study would be used in developing strategies for improved management and rehabilitation of patients with CHD. Further detailed studies that would influence decision making should be conducted.

Key words: congenital heart defects, prevalence, associated factors

ABSTRACT

Background: CPD (Cephalopelvic Disproportion) is defined as a mismatch between the maternal birth canal (the pelvis), and the fetal head. In developing countries, a significant number of maternal deaths are attributable to the complications of obstructed labor typically CPD.

Objective of the study: To assess Validity of Maternal Anatomical Anthropometric Measurements to Predict CPD.

Methods: Hospital based prospective cohort study was carried out in three hospitals. The sample size was 384. The data collected included socio-demographic characteristics such as age, residence, level of education and occupation of mothers. Data for gestational age, socio demographic and mode of delivery were collected from ante natal care follow up charts.

Results: Among 384 nulliparous mothers 337 of them were delivered through spontaneous vaginal delivery and 47 mothers gave birth by cesarean section (CS) due to confirmed CPD. Statistically significant decrease (p=0.013) in the mean fetal weight was observed in children who were delivered through spontaneous vaginal delivery (SVD). Significant differences were noted for height, foot length, Michaelis horizontal and head circumference of mothers with and without CPD. When foot length is combined with other anthropometric measurements such as height, Michaelis horizontal and maternal head circumference its sensitivity increased to 59.6%, 33.3% and 30.4% respectively

Conclusions: In the present study, the variable that predicted Cephalopelvic Disproportion the most was maternal height. In addition, foot length, head circumference and Michaelis horizontal diameter were also found to be predictors of CPD.

Key words: Cephalopelvic disproportion, Spontaneous vaginal delivery, anthropometric                                       measurements.

Background: Ethiopia with largest burden of rheumatic heart disease is still struggling to have a regular heart surgery programs. Since the commencement of open-heart surgery at Cardiac Center of Ethiopia by the local team 20 valve surgeries with different complexities have been performed. The aim of this pilot study is to assess the performance and outcome of local cardiac surgical team with valve surgeries.

Method: A retrospective study of patients who underwent valve surgeries at Cardiac Center of Ethiopia by the local team in the duration of nine months from may 2017 up to march 2018 time period were analyzed. This study assesses the outcome of the local team and demonstrates the general characteristics of the patients.

Result: A total of 20 valve surgeries were performed in this nine months duration. Patient’s age groups from 9 years to 75 years have the surgery with mean age of 26.4 years. Three fourth of the patients got mechanical valve replacement and 10% had tissue valve replacement. Three patients underwent mitral valve repair and 3 patients also had double valve replacement [DVR]. Two patients underwent MVR plus left maze procedure. There was one mortality attributed to the loss of one patient who underwent MVR.