Ethiopian Medical Journal最新文献

Objectives: To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM.

Methods: A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C.

Results: Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women.

Conclusions: The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities.

Introduction: There are good pointers from literature to the detrimental impacts of psychoactive substance use in HIV/AIDS patients. This study aimed at investigating the prevalence, types and demographic correlates of psychoactive substance use among people living with HIV/AIDS.

Methods: The study participants consisted of 295 adults with HIV/AIDS and were interviewed with a designed questionnaire that consisted of two parts. The first part contained questions to elicit socio-demographic and treatment related information of the participants, while the second part focused on psychoactive substance use.

Results: The mean (SD) age of participants was 37.6 (±8.6) years, and majority (61.0%) of them were made up of females. Most of the subjects were married, 181 (61.4%) and employed 174 (59.0%). Of the total participants, 64 (21.7%) reported use of a form of psychoactive substance, among which the largest proportion (19.3%) reported use of alcohol, 1.4% use cannabis while 1% admitted to use of nicotine. Following regression analyses, being male (Odds Ratio =2.38; 95% Confidence Interval: 95% CI = 1.26 - 4.49; p=0.008) and increasing educational attainment (Odds Ratio = 1.62; 95% CI: 1.07 - 2.45; p=0.02) correlated positively with psychoactive substance use, while being single (Odds Ratio = 0.59; 95% CI: 0.35 - 0.99; p=0.047) correlated negatively.

Conclusion: Proactive and targeted intervention strategies against psychoactive substance use among people living with HIV/AIDS using what is known about vulnerability are implied. Further research on the complex relationship between HIV/AIDS and psychoactive substance use is indicated.

We describe a 63 year old Romanian female patient admitted to our institution with complaints of typical anginaand a diagnosis of non ST-elevation myocardial infarction. Coronary arteriography unveiled anomalous origin ofa left circumflex coronary artery from the right coronary sinus of Valsalva near the right coronary ostium and ahyperdominant left anterior descending coronary artery giving off a posterior descending coronary artery withsmall distal-posterolateral left ventricular branch. The co-existence of a left circumflex coronary artery originatingectopically from the right sinus of Valsalva together with a posterior descending coronary artery originatingfrom the distal end of the anterior descending artery is important to keep in mind especially by those doing coronaryangiography in the cardiac catheterization laboratory.

Onchocerciasis is a severe parasitic infection which causes disabling skin and subcutaneous tissue changes. The disease is endemic in many African countries including Ethiopia. In 2013, Ethiopia launched Onchocerciasis elimination program with the goal of attaining interruption of onchocerciasis transmission nationwide by 2020. The country has successfully scaled up interventions and achieved 100% geographic coverage in all known endemic districts. The main strategy for interrupting the disease is mass drug administration (MDA) delivered two times per year. The treatment coverage for the last five years has been maintained at more than 80%. Despite many years of ivermectin MDA the transmission of onchocerciasis in many districts remained unabated. To achieve the 2020 goal, sustained high geographic and therapeutic coverage is required which is validated by coverage surveys. The programme should aim to improve the knowledge and attitude of the community towards the programme in order to improve drug compliance. The partnership between the relevant stakeholders should be strengthened to facilitate open discussions regarding the programme implementation and any challenges that may arise in the control and elimination of the disease. It is also important to consider intensified vector control.

Introduction: Institutional delivery is very low in Ethiopia, particularly in Oromia where less than one-third of antenatal care attendees utilize the services. This study assessed the magnitude of institutional delivery and associated factors in South West Showa Zone of Oromia.

Methods: A cross-sectional community based study was conducted in 2010. A stratified cluster sampling technique used to select study districts, villages and households. Four hundred thirty childbearing women with at least one birth in the past 5 years preceding the survey were interviewed. Qualitative study method was employed to supplement the quantitative data. Data analyses were done using SPSS v15. Frequency tables and percentages were used to describe study population. Association of independent variables with outcome variable was measured using odds ratio with 95% confidence interval. Multivariate logistic regression analysis was run to control for confounding variables.

Results: Eighty percent (344) respondents were from rural. Mean age of the women was 28.8 (±6.6). Most (70.5%) respondents and 39% of their husbands were uneducated. A quarter of them delivered at health institutions over five years preceding the survey. In a regression model with maternal age, residence, maternal and paternal education, all were significantly associated with use of institutional delivery services. Obstetric factors have also showed a statistically significant association. The qualitative findings revealed that trust in traditional birth attendants and health workers’ negative attitude were among the reasons for not delivering at health institutions.

Conclusion: Institutional delivery service utilization in the zone is affected by maternal and paternal education, ANC attendance and duration of labor. Traditional beliefs and health workers’ negative attitude were among the identified barriers. Multiple interventions involving community, service providers and health system are recommended.

Schistosomiasis and soil-transmitted helminthes are among seventeen WHO prioritized neglected tropical diseases that infect humans. These parasitic infections can be treated using single-dose and safe drugs. Ethiopia successfully mapped the distribution of these infections nationwide. According to the mapping there are an estimated 37.3 million people living in schistosomiasis endemic areas, and 79 million in schistosomiasis and soil-transmitted helminthes endemic areas. The Federal Ministry of Health successfully scaled up Schistosomiasis and schistosomiasis and soil-transmitted helminthes intervention in endemic areas and treated over 19 million individuals in 2015. The Ministry of Health has made a huge effort to establish neglected tropical diseases, including schistosomiasis and soil-transmitted helminthes program in the health system which helped to map majority of the woredas and initiate nationwide intervention. The National control programme is designed to achieve elimination for those diseases as a major public health problem by 2020 and aim to attain transmission break by 2025. The programme focuses on reaching those school-aged children who are not attending school, integration between neglected tropical diseases programme, and further collaboration with the WASH actors.

Introduction: Myoma is the most common pelvic tumor and an enormous healthcare concern in women. Complications occur in approximately 10-40% of pregnancies with myomatous uterus. This study is conducted to determine the prevalence and obstetric outcome of grossly visible and/or palpable myoma among women who gave birth by caesarean section.

Methods: A cross sectional study conducted in three teaching hospitals in Addis Ababa, Ethiopia. Data was collected using a pre-tested questioner.

Results: A total of 404 cases were included in the study. The prevalence of myoma was 15.3% (62/404). Only 9.7% (6/62) of the myoma cases were diagnosed preoperatively with ultrasound. The number of myoma per case ranged from 1-to-14 with mean number of 3 ±2.7. The mean diameter of largest single myoma per case was 5.2cm ± 3.4. The commonest location of myoma was subserous being the location in 58.1% (36/62). There was significant association between presence of myoma and age of the woman (P<0.05). The adjusted prevalence of myoma increases as women’s age increases, and gestational age and birth weight decreases. In addition, the prevalence of myoma was about two times higher in low (≤6) first and fifth minute APGAR score groups with adjusted prevalences of 22.2% (Vs 14.1% in ≥7 group) and 31.8% (Vs 14.4% in ≥7 group) respectively.

Conclusions: The prevalence of myoma during pregnancy in this study is higher than prior reports from similar setups. But, no statistically significant association was observed between the presence of myoma and maternal out come.

Background: Traumatic brain injury is the leading cause of death and disability in people younger than 40 years of age worldwide.

Objective: The study primarily aims at assessing the short-term outcome of patients operated for traumatic intracranial hemorrhage.

Patients and methods: This is a hospital based cross sectional study on patients with traumatic brain injury at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, between February 2013 and February 2014. Standardized and structured questionnaire was used to collect sociodemographic data. All patients with traumatic brain injury operated following intracranial hemorrhage were included. Glasgow Coma Scale was used to determine the outcome. Difference in proportions was examined using Chi-square test.

Results: The study reviewed 91 patients with traumatic brain injury. Their age ranged from 13 to 60 years with a mean (SD) of 32.3 (±12.1). Eighty-seven (95.6%) of the cases were males and 4(4.4%) females and 34(37.4%) of them cases had mild and 30(33%) had severe traumatic brain injury. Acute Epidural Hematoma was seen in 79(86.8%), Acute Subdural hematoma had the highest proportion, 4/11(36.4%), of deaths and it was also significantly associated with unfavorable Glasgow Outcoma Scale at 3 months (p=0.03). Overall, the proportion patients who died was 18.7% with older patients (>50 years) had a significantly higher proportion of death (p=0.01). Most of the patients had favorable Glasgow Outcoma Scale ,unfavorable was seen in 22/30 (73.3%) and 17/30 (56.7%) of patients with severe traumatic brain injury at 3 and 6 months, respectively.

Conclusion: In conclusion, male predominance was substantially high. Acute Subdural hematoma and old patients had high death rates and unfavorable outcome. Overall the death rate was not different from global figures.

Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia and is caused by Wuchereria bancrofti. Mapping for LF has shown that 70 woredas (districts) are endemic and 5.9 million people are estimated to be at risk. The national government's LF elimination programme commenced in 2009 in 5 districts integrated with the onchocerciasis programme. The programme developed gradually and has shown significant progress over the past 6 years, reaching 100% geographical coverage for mass drug administration (MDA) by 2016. To comply with the global LF elimination goals an integrated morbidity management and disability prevention (MMDP) guideline and a burden assessment programme has also been developed; MMDP protocols and a hydrocoele surgical handbook produced for country-wide use. In Ethiopia, almost all LF endemic districts are co-endemic with malaria and vector control aspects of the activities are conducted in the context of malaria programme as the vectors for both diseases are mosquitoes. In order to monitor the elimination, 11 sentinel and spot-check sites have been established and baseline information has been collected. Although significant achievements have been achieved in the scale up of the LF elimination programme, there is still a need to strengthen operational research to generate programme-relevant evidence, to increase access to morbidity management services, and to improve monitoring and evaluation of the LF programme. However, the current status of implementation of the LF national programme indicates that Ethiopia is poised to achieve the 2020 goal of elimination of LF. Nevertheless, to achieve this goal, high and sustained treatment coverage and strong monitoring and evaluation of the programme are essential.