Ethiopian Journal of Health Sciences最新文献

Background: Maternal vaccination is a key strategy to meet Sustainable Development Goal 3, aiming to eliminate preventable deaths among newborns and children under five by 2030. This study explored obstetricians' knowledge and practices regarding maternal vaccination globally.

Methods: A cross-sectional survey targeting obstetricians was conducted by the World Association of Trainees in Obstetrics and Gynaecology (WATOG,) from June 25 to July 18, 2023. A structured 25-item questionnaire, distributed electronically, gathered data on sociodemographics and vaccination knowledge and practices. Data analysis was performed using IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, version 24.

Results: Ninety-two obstetricians participated. Only 16.3% exhibited good knowledge of safe vaccines in pregnancy. Fear of teratogenicity was the primary reason (58.7%) for vaccine hesitancy among pregnant women. Approximately 47.8% of participants indicated that only tetanus toxoid was routinely available in their hospitals, with 48.9% reporting that women had to pay for vaccines. Nonetheless, 62% stated their countries had national vaccination guidelines for pregnant women.

Conclusion: The study identifies significant gaps in obstetricians' knowledge of vaccine safety, alongside barriers related to availability and cost, impacting maternal vaccination uptake.

Background: Computed Tomography (CT) of the abdomen is one of the most frequently performed scans in adults for various abdominal pathologies. Its popularity stems from the immediate image reconstruction following acquisition. However, CT scans are known for their high radiation doses compared to other diagnostic X-ray procedures. This study aimed to analyze the effective dose in patients with varying body habitus during multidetector CT of the abdomen using automatic exposure control.

Methods: This prospective study was conducted in the Department of Radiodiagnosis and Imaging from February 2017 to March 2018. Patients aged 18 and older, regardless of gender, undergoing routine Contrast-Enhanced CT (CECT) of the abdomen were included. Participants were categorized into three groups based on Body Mass Index (BMI): normal weight, overweight, and obese.

Results: A total of 168 patients were enrolled, with a mean age of 49.8 ± 15.6 years, predominantly male (66.1%). Obese individuals exhibited significantly higher effective dose values (16.57 ± 2.27 mSv) compared to normal weight (9.45 ± 0.92 mSv) and overweight individuals (11.88 ± 0.77 mSv) (p < 0.01). Similarly, obese patients had significantly higher values for Computed Tomography Dose Index Volume (CTDIvol) (18.32 ± 2.54 mGy) and Dose Length Product (DLP) (1104.86 ± 151.84 mGycm) compared to normal weight (CTDIvol: 11.38 ± 1.24 mGy; DLP: 630.55 ± 61.57 mGycm) and overweight individuals (CTDIvol: 13.56 ±1.15 mGy; DLP: 792.37 ± 51.56 mGy*cm) (p < 0.05).

Conclusion: The effective dose received by obese patients during abdominal CT exams with Automatic Exposure Control (AEC) is nearly double that of normal-weight patients.

Background: Chronic Liver Disease (CLD) is a long-term condition marked by a gradual decline in liver function. Patients with CLD often experience multimorbidity and polypharmacy, which can adversely affect their health outcomes. The objective of the current study is to identify and resolve the drug-related problems associated with chronic liver disease.

Methods: This prospective observational study involved 150 patients with CLD over a six-month period. Eligible participants included individuals over 18 years old, diagnosed with CLD based on the Child-Pugh score, and currently receiving treatment. Drug-related problems (DRPs) were identified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. Data analysis was conducted using Chi-square and Fisher's exact tests with SPSS software version 29.

Results: A total of 212 DRPs were identified and resolved. The most frequent type of DRP was related to treatment efficacy, with 96 instances (45.29%). Within this category, the subcategory 'effect of drug treatment not optimal' was the most common, accounting for 45 patients (21.23%). Drug interactions were identified as the leading cause of DRPs, comprising 65 cases (30.66%). Most issues were addressed at the prescriber level, with 48.11% of interventions accepted by physicians.

Conclusion: This study provides valuable insights into identifying and managing DRPs that can negatively impact treatment outcomes in CLD patients. The findings can assist healthcare professionals in prioritizing strategies to enhance clinical results.

Background: Sickle cell disease (SCD) is a chronic genetic disorder that has significant psychosocial consequences for both patients and their families. This study aimed to investigate family functioning and the psychosocial burden experienced by caregivers of children with SCD.

Methods: This descriptive, cross-sectional study involved 170 caregivers of children with SCD, selected through systematic random sampling. Data were collected using both structured and semi-structured questionnaires. Family functioning was assessed using the Family APGAR (Adaptation, Partnership, Growth, Affectation, Resolve) while the psychosocial burden was evaluated using the Sickle Cell Disease Burden Instrument (SCDBI). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.

Results: The mean age of the participants was 34.7 years, and 83% were female. The majority of caregivers reported a high level of family functioning. However, significant psychosocial burden was observed in areas such as finances, disruption of routine family activities, and the caregivers' coping abilities. The impact on family interactions was minimal.

Conclusion: Most caregivers in this study demonstrated good family functioning. Although caring for a child with sickle cell disease imposed a significant psychosocial burden, the negative impact on family interactions was minimal.

Background: The health system needs competent managers to ensure and improve the health of people and manage resources, if managers are chosen correctly. The Managers' Competency Assessment Center is a popular and effective method for selecting, promoting, and developing management competencies. The present study aimed to explain the challenges of implementing an Assessment center in the health sector.

Methods: The present study was conducted with a qualitative and phenomenological approach in 2023 at Tabriz University of Medical Sciences. Interview data were collected through semi-structured interviews with 33 key informants including official assessors of the center, assessed managers by Assessment Centers, senior managers, and executive officers of the center for assessment of the competence of managers. then analyzed by the content analysis method through the software MAXQDA-18.

Results: The results of the present study were categorized into two main themes and nine sub-themes, which are internal challenges, including challenges related to assessed managers, assessors, competency assessment tools, assessment process, and Challenges of training courses for the development of managers and the external challenges including extra_ organizational, organizational, cultural, and political challenges.

Conclusions: The establishment of Assessment Centers within the health system is relatively recent. However, their implementation faces both external and internal challenges. To address this, policymakers should systematically analyze these challenges, prioritize them based on significance and feasibility, and then collaborate with other national centers and draw from international experiences.

Background: Retinoblastoma is the most prevalent intraocular retinal malignancy in children worldwide. Accurate staging is critical for treatment planning and relies heavily on radiologic imaging and clinical findings. This study aims to evaluate imaging patterns and staging of retinoblastoma in children at Tikur Anbessa Specialized Hospital (TASH).

Materials and methods: This cross-sectional study analyzed retrospective data from TASH between September 2018 and September 2021. It focused on patients diagnosed with retinoblastoma who underwent Computed Tomography (CT) scans or Magnetic Resonant Imaging (MRI) and had pathology results available. Two radiologists, each with over 10 years of experience, independently reviewed the scans. Supplementary data were gathered from the pediatric oncology unit registry using structured questionnaires. The International Retinoblastoma Staging System (IRSS) was used to stage extraocular disease based on cross-sectional imaging and the International Intraocular Retinoblastoma Classification (IIRC) for intraocular disease classification.

Results: Eighty-three patients were included, with 42 (50.6%) males and 41 (49.4%) females. The mean age at presentation was 3.4 ± 2 years. The most common clinical symptoms were proptosis (42 patients, 50.6%) and leukocoria (37 patients, 44.6%). Clinical staging revealed 63 (75.9%) patients in Group E, 19 (22.9%) in Group D, and 1 (1.2%) in Group C according to IIRC. Stage IV disease was predominant, with 33 (39.2%) in Stage IVA and 18 (21.4%) in Stage IVB according to IRSS.

Conclusion: Most patients presented with advanced retinoblastoma, particularly Stage IV. This underscores the need for community awareness of early signs and symptoms of retinoblastoma, promoting timely medical consultation.

Background: Cervical cancer remains a significant challenge in developing countries, with many patients diagnosed at advanced stages. The clinical staging of cervical cancer is guided by the International Federation of Obstetrics and Gynecology (FIGO) guidelines, while computed tomography (CT) and magnetic resonance imaging (MRI) offer valuable supplemental information. This study aimed to evaluate the initial clinical and imaging stages of cervical cancer and to assess the agreement between these staging methods.

Methods: A cross-sectional study was conducted involving 115 newly diagnosed cervical cancer patients at Tikur-Anbessa Specialized Hospital from September 1, 2022, to February 30, 2023. Clinical staging was performed for all patients, with CT staging for 107 and MRI staging for 34. Data were extracted from the hospital's central databases and analyzed using SPSS version 27. Descriptive and reliability analyses were conducted, with statistical significance set at a p-value of <0.05 and a 95% confidence interval.

Results: At diagnosis, 61 patients (53%) presented with advanced clinical stages (III-IV). CT imaging indicated advanced stages in 85 patients (73.9%), while MRI was performed on 34 patients. Agreement between clinical and CT-based staging was poor (weighted Cohen's kappa = 0.171, p = 0.016), while agreement between clinical and MRI-based staging was moderate (weighted Cohen's kappa = 0.418, p = 0.007).

Conclusion: Newly diagnosed cervical cancer patients exhibit a high prevalence of advanced-stage disease. There is poor agreement between clinical and CT-based cervical cancer staging, contrasted with moderate agreement between clinical and MRI-based staging.

Background: Traditionally, pediatric pneumonia is diagnosed through clinical examination and chest radiography (CXR), with computed tomography (CT) reserved for complications. Lung ultrasound (LUS) has gained popularity due to its portability and absence of ionizing radiation. This study evaluates LUS's accuracy compared to CXR in diagnosing pneumonia in children.

Methods: We conducted a cross-sectional study from April to September 2023 involving 108 children aged 14 or younger admitted with pneumonia. Each child underwent LUS using a 5-zone scanning protocol, followed by CXR, with the latter interpreted independently by two consultant radiologists. Agreement between LUS and CXR for diagnosing consolidation and interstitial pneumonia patterns was assessed using Cohen's Kappa (k) with SPSS version 26.0.

Results: Pneumonia was radiographically confirmed in 79 children (73.1%). LUS detected consolidation in 41.7% of cases, compared to 43.5% for CXR, demonstrating a sensitivity of 97.8%, specificity of 95.2%, positive predictive value (PPV) of 93.6%, and negative predictive value (NPV) of 98.4%. LUS showed higher accuracy for interstitial lung patterns (sensitivity 93.6%, specificity 97.4%). The agreement between LUS and CXR was excellent, with Cohen's Kappa values of 0.908 for consolidation and 0.863 for interstitial pneumonia. LUS also identified more pleural effusions (11.1%) compared to CXR (6.5%).

Conclusion: LUS demonstrates comparable diagnostic accuracy to CXR for pneumonia, exhibiting high sensitivity and specificity for pneumonia-related features. It outperforms CXR in detecting small-volume consolidations and effusions, supporting its routine use in clinical settings.

Background: Prostate cancer is a leading cause of cancer-related mortality among men, second only to lung cancer. Prostate magnetic resonance imaging (MRI) utilizing the Prostate Imaging and Reporting Data System (PI-RADS) v2.1 scoring system effectively stratifies patients by risk and correlates significantly with histopathological outcomes. This study aimed to assess the positive predictive value (PPV) of high-grade PI-RADS v2.1 MRI findings and their correlation with histopathological results from biopsies in patients visiting the interventional radiology unit at St. Paul's Hospital Millennium Medical College (SPHMMC).

Methods: A facility-based cross-sectional study was conducted involving patients referred to the SPHMMC interventional radiology unit with high-grade PI-RADS v2.1 MRI findings who underwent TRUS-guided prostate biopsy between January 2023 and April 2024.

Results: Among 105 patients, the PPV was 94.5% for a PI-RADS v2.1 score of 5 and 51.5% for a score of 4. These findings underscore the predictive power of high-grade PI-RADS scores, particularly for score 5 lesions, aiding clinicians in decision-making for further investigations and treatment. Significant correlations were observed between MRI characteristics-such as ill-defined margins, larger size, and extraprostatic extension- and high-grade PI-RADS scores in the peripheral zone (p<0.01).

Conclusion: High-grade PI-RADS v2.1 scores exhibit strong positive predictive value for detecting prostate cancer, emphasizing the essential role of multiparametric MRI in diagnosis. Integrating multiparametric MRI findings with clinical and laboratory data can further enhance patient care and outcomes.