Ethiopian Journal of Health Sciences最新文献

Background: Necrotizing soft tissue infection (NSTI) is one of the deadliest diseases among surgical infections. Prompt timely diagnosis and urgent surgical intervention with supportive care are cornerstones of patient management. This study aimed to assess patient outcomes and associated factors of adult patients diagnosed and surgically treated for NSTIs at Saint Paul's Hospital Millennium Medical College (SPHMMC), Ethiopia from January 2015 to December 2019.

Method: An institution-based cross-sectional study was conducted by reviewing medical records of patients treated for NSTIs at SPHMMC in the 5 years study period. A five-section survey instrument was developed, and the collected responses were cleaned and entered into Epi data (v3.1) and exported to SPSS (v.26). Statistical analysis of associated factors was done with binary logit regression model.

Result: Medical records of 110(84%) patients were retrieved and nine out of ten subjects were male with a median age of 42 years (IQR- 34-62yrs) The leading clinical presentations were painful swelling 96(87.3%), fever 79(71.8%) and foul-smelling discharge 62(56.4%). Five out of ten participants have known comorbidity and 9 out of 10 patients have specified predisposing events before their infection. The majority (86.3%) underwent surgical debridement and amputation was done for eighteen patients. The average length of hospital stay was 27 days (2 to 112 days range) with mortality rate of 20%. advanced age, shock at presentation, post-operative anemia, and infection involving the torso were significantly associated with poor patient outcomes.

Conclusion: Surgical management of NSTIs has favorable result and patient presentation and anatomical location of the lesion determine patient outcome.

Prolonged hospital stays in Nigerian teaching hospitals pose a significant challenge to patient care and hospital management, exacerbated by socio-economic and systemic factors. This case study report looked at the multifaceted role of medical social workers in addressing these challenges, focusing on their efforts in providing psychosocial support, coordinating care, and advocating for patients within a strained healthcare system. This case-study highlights the impact of resource constraints and inadequate hospital practices on patient outcomes, emphasizing the psychological toll on patients and their families. It underscores the critical role of medical social workers as they navigate complex healthcare landscapes to mitigate the adverse effects of extended hospitalizations. This calls for a comprehensive approach to address these systemic issues, including policy reforms, increased healthcare funding, and strategic improvements in hospital administration. Hence the urgency of systemic change to ensure a more resilient and compassionate healthcare environment for all Nigerians.

Background: Osteoporosis is a bone disease caused by decrease in bone mineral density (BMD). Quantitative computed tomography (QCT) has proven to be an effective tool to measure the BMD of the lumbar spine. Therefore, the objective of the study is to investigate the impact of intravenous contrast media (CM) on BMD of lumbar spine measured by QCT.

Methods: This is a prospective study and included a total of 141 patients (females: 71, males: 70) referred for contrast enhanced computed tomography (CECT) abdomen. First, the plain scan of abdomen was done. Contrast media was injected intravenously followed by acquisition of arterial and portovenous phase (PV) of abdomen. Plain, arterial and PV phases axial CT images were loaded on Philips BMD analysis application. A circular region of interest (ROI) measuring 30-40 mm² was placed at all five lumbar vertebrae (L1-L5) and value of BMD was obtained in mg/cm³.

Results: Paired t-test was used to compare BMD in plain, arterial and PV phase. There was significant difference (p <0.05) in BMD (L1-L5) between plain (110.86±36.61 mg/cm³), arterial (117.04±37.95 mg/cm³) and PV phase (127.52±40.9 mg/cm³). The study also noted significant difference between males and females in BMD of lumbar spine (L1-L5) for plain and CECT abdomen (p <0.05).

Conclusion: The BMD was highest for PV phase of the CECT abdomen. Therefore, the study concludes that BMD values are highly influenced by intravenous contrast media injections.

Background: Due to resource constraints, advanced spinal stabilization methods such as pedicle screws are unavailable at our center. Adeolu's technique, which employs low-cost and readily available vertical struts and spinal process wires, has been used as an adjunct in treating various spinal conditions to achieve rigid spinal constructs. This study evaluates the long-term clinical outcomes of this technique.

Methods: Nineteen patients treated with Adeolu's technique were prospectively followed to assess clinical outcomes. Primary outcomes included symptom reduction, absence of adverse events or need for re-intervention, and radiological evidence of stabilization and unrestricted mobilization. Secondary outcomes included back pain intensity, implant-related complications (rotation, migration, back-out, fracture), wound infection, worsening neurological status, and need for implant removal Data were analyzed using SPSS with simple descriptive statistics.

Results: The average follow-up period was 4.1 years (Range: 0.1 - 9.0 years). Patients' ages ranged from 20 to 81 years (Mean: 48.5). Indications for surgery included lumbar spondylosis (7, 36.8%), spinal trauma with unstable fractures (4, 21.1%), spinal tumors (4, 21.1%), and Pott's disease (4, 21.1%). All patients achieved satisfactory primary outcomes. Implant rotation was observed in 4 patients (21.1%), and implant migration in 1 patient (5.3%), requiring removal. Superficial surgical site infection occurred in 2 patients (10.5%). No implant fractures, deep infections, or worsening neurological status were noted.

Conclusion: Adeolu's technique is effective for a range of spinal pathologies, with favorable long-term clinical outcomes.

Background: Diagnostic autopsy has been in use for long to determine the cause of death. Since recently however 'Minimally Invasive Tissue Sampling' (MITS) is introduced to determine definitive cause of neonatal death. This study describes locally established facilitators to introduce MITS procedures to determine cause of neonatal death in Ethiopia.

Methods: Exploratory study was conducted in Butajira community where twenty-two key informants representing community opinion leaders' health care workers, five in depth interviews with parents who recently lost neonates and eight FGDs with community members were completed to generate evidences in line with the research question. Interviews and discussions were audio recorded, transcribed verbatim and analysed facilitated by open-code software. Thematic analysis was applied to identify and interpret patterns of the evidences.

Results: In Butajira, ANC and delivery in health facilities was found to have improved over the years. Yet, child death remains an outstanding problem. While different factors were identified to cause the death of a child, relatively few participants choose to accept newborn death as a natural occurrence or will of the creator. Majority of the study participants expressed interest to know definitive cause of death using MITS. Yet, awareness about MITS and how it works was unanimously desired. It was found that husbands and wives are key to authorize MITS procedure while community opinion leaders including religious leaders were identified as key to influence parental decisions for the procedure.

Conclusion: Building awareness of the community members and engagement of opinion leaders is critical to introduce MITS.

Background: Fatigue is a pervasive and debilitating symptom among hemodialysis patients, severely impacting their quality of life and ability to participate in social activities. Dialysis nurses are pivotal in alleviating these effects through physical exercise. This study aims to evaluate the effectiveness of an integrated dialysis nursing intervention in reducing fatigue among hemodialysis patients.

Methods: A quasi-experimental time series design was employed, involving 295 hemodialysis patients (148 in the experimental group and 147 in the control group) selected through consecutive sampling from two dialysis units in Chennai. Baseline fatigue was assessed in both groups. The experimental group received the integrated dialysis nursing intervention, including 15-minute sessions of aerobic exercises three times a week for eight weeks. The control group continued with routine care. Fatigue levels were reassessed at the end of the fourth and eighth weeks. Data were analyzed using SPSS version 20.

Results: The study revealed a significant reduction in fatigue scores in the experimental group compared to the control group, with p < 0.001 in post-test I and II. The experimental group showed greater improvement than the control group, with p < 0.05.

Conclusions: The integrated dialysis nursing intervention significantly reduced fatigue in hemodialysis patients. Incorporating this approach into routine intradialytic care can enhance fatigue management and improve patients' quality of life.

Background: Urology is one of the most rapidly evolving and technologically advanced surgical specialties. However, training programs in Sub-Saharan Africa (SSA) face unique challenges. This study aimed to assess the current status of urology training in SSA and identify areas for improvement, providing crucial insights into the strengths and limitations of these programs.

Methods: A 24-discrete items online survey was developed with "Google Forms" in English and French. The questionnaire was composed of two parts. The first part assessed general information about the urology training, and the second part evaluated the consultant's or department head's ability to perform and teach endourology procedures.

Result: A total of 25 responses were received from 18 countries. The oldest training center is the University of Cape Town, South Africa; the program started in 1950. The number of consultants in the department ranges from 1 to 12, with an average of 4.79. Twenty of the training sites have a compulsory general surgery clinical attachment in their program. Fourteen of the training sites stated that research is mandatory in their curriculum. Fourteen of the centers reported providing laparoscopic urology surgery. Cystoscopy is the most mastered procedure and percutaneous nephrolithotomy (PCNL) is the most difficult procedure to gain any experience with by residents.

Conclusion: Urology training in sub-Saharan Africa started late but is increasing in number through time. Urology training in Africa faces multiple challenges, including inadequate number of experts, limited availability of advanced equipment and simulation-based training sites. Training institutions should be encouraged to facilitate research and basic urological skills training.

Background: Access to safe drinking water remains a critical challenge in Sub-Saharan Africa, driven by a complex mix of environmental, political, social, economic, and infrastructural factors. This scoping review aims to map the literature on water access in Sub-Saharan Africa over the past decade.

Methods: We conducted a comprehensive search of academic databases and grey literature from January 2013 to the present. We included peer-reviewed quantitative, qualitative, and mixed-methods research, as well as reviews and reports focusing on factors influencing water access and related interventions in Sub-Saharan Africa. Data were extracted on study characteristics, key determinants, proposed solutions, and outcomes.

Results: A total of 137 studies were included. Commonly reported determinants included droughts, climate change, conflict, governance, gender, wealth, education, poverty, and inadequate infrastructure. Identified potential interventions included infrastructure development, water quality monitoring, climate adaptation, governance reforms, decentralized management, targeted subsidies, and integrated water resources management. However, most studies described barriers rather than evaluating solutions.

Conclusions: Persistent inequities in water access are driven by interconnected factors such as poverty, governance, gender, and infrastructure. Implementing integrated solutions is crucial, with a shift from problem identification to evaluating contextualized interventions across sectors. Dedicated implementation research is needed to translate knowledge into action, advancing water security and achieving Sustainable Development Goal 6 in the region.

Background: The basilar artery (BA) is a crucial vessel in the posterior cerebral circulation, supplying blood to the occipital lobes, cerebellum, and brainstem. Variations in BA diameter can be indicative of pathological conditions and may serve as a predictive marker for cerebrovascular events. Despite the importance of these measurements, data on the normal BA diameter in the Black African population is limited. This study aims to establish baseline values for BA diameter in healthy adults in Enugu, southeast Nigeria, and to examine any potential gender differences.

Methods: A cross-sectional study was conducted on 298 subjects (150 males, 148 females) at the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu State. Participants, referred for brain CT, had normal radiologist reports. Contrast-enhanced brain CT scans were performed using a 64-slice Brilliance Philips scanner. BA diameter was measured on axial images at the midpons level.

Results: The participants had a mean age of 49.4 years (±14 years). The BA diameter ranged from 3.1mm to 5.5mm, with a mean of 4.2mm (±0.5mm). Males had a significantly larger BA diameter compared to females (p<0.05). Diameter increased with age in both genders.

Conclusions: This study provides reference values for BA diameter in a Nigerian population, highlighting a gender difference and age-related increase in diameter. These findings contribute to the understanding of BA geometry in Black Africans and can assist in diagnosing and managing cerebrovascular conditions.