Falciparum malaria with haemorrhagic stroke in a 26-year male patient: report of a rare case.

BACKGROUND: Malaria continues to cause unacceptably high levels of disease and death despite increased global efforts and is still significant public health problem. African countries are disproportionately affected by malaria. The objective of this study was to describe a rare case of haemorrhagic stroke as a possible complication of malaria in a 26-year-old male patient. CASE PRESENTATION: A 26-year-old male from southwest Ethiopia presented with complaint of loss of consciousness (LOC) of 12 h duration. He had fever, headache, vomiting, chills, rigors and shivering three days prior to the loss of consciousness. On physical examination, pulse rate 116 beats/min, blood pressure of 120/90 mmHg, respiratory rate was 24 breaths/min, a temperature of 38.9◦C and oxygen saturation of 94%. Nervous system examination; stuporous with Glasgow Coma Scale (GCS) 10/15(M5, E3, V2). Blood film and RDT confirmed a Plasmodium falciparum infection and a non-contrast CT scan found a right cerebral parenchymal haemorrhage. DISCUSSION AND CONCLUSION: The presented case described a very rare case of a 26-year-old male patient who was diagnosed with left side hemiparesis secondary to a haemorrhagic stroke, associated with P. falciparum malaria. This report highlights the fact that malaria with stroke should be considered a differential diagnosis in a patient presenting with body weakness in a malaria endemic area and in individuals who had travel history to malaria endemic areas.

High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis.

BACKGROUND: Substance use is a major public health concern in global settings, and is very common during adolescence period leading to physical and/or mental health complications. This study assessed the prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia, 2012. METHODS: A school based cross-sectional study was conducted from April 7 to April 15, 2012 amongst 684 9th to 12th grade high school students in the town of Woreta. Participants were selected by stratified sampling, and data were collected using an anonymous questionnaire adapted from the 2008 Community That Care Youth Survey. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with substance use. RESULTS: A total of 651 students participated in the study with a response rate of 95.2%. The current prevalence of substance use among Woreta high school students was 47.9% and life-time prevalence was 65.4%. The current and lifetime prevalence of alcohol use was 40.9% and 59% respectively. Siblings' use of substances (AOR [95% CI]: 2.72 [1.79, 4.14]), family history of alcohol and substance use (AOR [95% CI] 2.24 [1.39-3.59]) and friends' use of substances (AOR [95% CI] 2.14 [1.44-3.18]) were factors positively associated with substance use. On the other hand, religiosity and social skill were found to be 54% (AOR [95% CI] 0.46, [0.31-0.68]) and 39% (AOR [95% CI] 0.6 [0.40-0.91]) negatively associated with substance use. CONCLUSIONS: The prevalence of substance use amongst adolescents was high for the three substances namely alcohol, cigarette and khat with alcohol being the most common. Community norms favorable to substance use, family history of alcohol and substance use, siblings' substance use, poor academic performance, low perceived risk of substances and friends' use of substances had positive association with adolescent substance use while religiosity and social skills were found to have negative association with adolescent substance use. Initiate public awareness campaigns to inform adolescents and adults, particularly parents, of the risk of substance use. Developing culture friendly, gender based adolescent and family based programs and initiating public awareness are recommended to decrease substance use by adolescents.

Adherence to highly active antiretroviral therapy and associated factors among children at the University of Gondar Hospital and Gondar Poly Clinic, Northwest Ethiopia: a cross-sectional institutional based study.

BACKGROUND: The efficacy of antiretroviral therapy (ART) in suppressing viral replication and delaying the progress of the acquired immunodeficiency syndrome (AIDS) is related to optimal adherence. Adherence is a challenge in all HIV infected people on ART. It is especially a concern in children because of factors relating to children such as age, disclosure status of HIV sero status, and understanding of the medication. This study assessed the level of adherence to highly active antiretroviral therapy and its associated factors among children in Gondar University Hospital and Gondar Poly Clinic, Northwest Ethiopia. METHODS: Institutionally based cross-sectional study design was conducted from January-to March 2012. Simple random sampling technique was used to select study participants and a total of 342 study subjects were included in the study. Bivariate and multivariate logistic regressions were performed to identify associated factors with adherence to highly active antiretroviral therapy. Odds ratios with 95% confidence interval were computed to determine the level of significance. RESULTS: The overall ART adherence among children was found to be 90.4%. Age of the child [AOR = 0.37 (95% CI: 0.31, 0.46)], disclosure of the child's HIV status to the child [AOR = 0.27 (95% CI: 0.24, 0.32)], and knowledge of caregivers about ART medication [AOR = 4.7 (95% CI (3.7, 5.6)], were independently associated with adherence. CONCLUSION: Adherence rate to ART was found to be high. Disclosure of the child's HIV sero status to the child, the age of the child and the knowledge of the caregivers towards ART were factors associated with adherence.

Intent to stay in the nursing profession and associated factors among nurses working in Amhara Regional State Referral Hospitals, Ethiopia.

BACKGROUND: Nurses are essential to the health care delivery system especially to meet the health related millennium development goals. However, despite the significant shortage of nurses in Ethiopia, research in the country regarding nurses' intent to stay in their profession is lacking. This study assessed intent to stay in the nursing profession and associated factors among nurses working in referral hospitals, Amhara Regional State, Ethiopia. METHODS: Institution-based cross-sectional study was conducted among 389 nurses from April 8 to May 5, 2013. Stratified random sampling technique was used to select the study participants from five referral hospitals. Data were collected using pretested and structured self-administered questionnaires. Descriptive statistics were conducted to summarize the sample characteristics. Backward stepwise logistic regression model was fitted and adjusted odds ratio with 95% confidence interval was calculated to identify associated factors. RESULTS: The proportion of nurses who reported intent to stay in the nursing profession was 39.8%. Age 40 to 49 (AOR [95% CI] 4.5 [1.6-12.8]), being married (AOR [95% CI] 2.0 [1.0-3.8]), having a bachelor degree in nursing (AOR [95% CI] 2.2 [1.2-4.1]), satisfaction with: autonomy and professional opportunities (AOR [95% CI] 2.6 [1.2-5.9]), scheduling (AOR [95% CI] 3.4 [1.6-7.5]), and pay and benefits (AOR [95% CI] 8.8 [4.5-17.1]); high continuance commitment (AOR [95% CI] 2.4 [1.3-4.8]) and high normative commitment (AOR [95% CI] 3.7 [1.9-7.2]) were the significant predictors of intent to stay in the nursing profession. CONCLUSIONS: Intent to stay in the nursing profession was low among nurses working in Amhara Regional State referral hospitals. Interventions aimed at increasing the professional autonomy of nurses and revising the current salary and other duty payments are vital.

Predictors of delayed initiation of breast milk and exclusive breastfeeding in Ethiopia: A multi-level mixed-effect analysis.

BACKGROUND: Despite the well-established benefits of early initiation of breastfeeding and exclusive breastfeeding for the first six months to promote optimal neonatal and child health, evidence indicates that in Ethiopia, a significant number of newborns initiate breastfeeding late, do not adhere to exclusive breastfeeding (EBF) for the recommended duration, and instead are fed with bottles. OBJECTIVE: To determine the proportion of delayed initiation of breast milk, exclusive breastfeeding, and its individual and community-level predictors among mothers in Ethiopia. METHODS: A secondary data analysis was done using the 2019 Ethiopian Mini Demographic Health Survey data. We examined a weighted sample of 2,012 children born within the past 24 months and 623 children aged 0-5 months at the time of the survey. The data analysis was done using STATA version 15. To understand the variation in delayed initiation and exclusive breastfeeding, statistical measures such as the Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated. We employed a multilevel mixed-effects logistic regression model to identify predictors for each outcome variable. Statistical significance was determined with a p-value < 0.05. RESULTS: The proportion of delayed initiation of breast milk and exclusive breastfeeding were 24.56 and 84.5%, respectively. Women aged 34-49 years old (AOR = 0.33: 95% CI; 0.15-0.72), having a television in the house (AOR = 0.74: 95%CI; 0.33-0.97), delivered by cesarean section (AOR = 3.83: 95% CI; 1.57-9.32), and resided in the Afar regional state (AOR = 1.43: 95%CI; 1.03-12.7) were significantly associated with delayed initiation of breast milk. On the other hand, attended primary education (AOR = 0.67: 95%CI; 0.35-0.99), secondary education (AOR = 0.34: 95%CI; 0.19-0.53), women whose household headed by male (AOR = 0.68; 95% CI; 0.34-0.97), and rural residents (AOR = 1.98: 95%CI; 1.09-3.43) were significantly associated with exclusive breastfeeding practice. CONCLUSION: Health promotion efforts that encourage timely initation of breast milk and promote EBF, focused on young mothers, those who gave birth through cesarean section, and those residing in urban and the Afar regional state. Furthermore, government health policymakers and relevant stakeholders should consider these identified predictors when revising existing strategies or formulating new policies.

A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report.

BACKGROUND: Abdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel's lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient. CASE PRESENTATION: A 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain. CONCLUSION: Abdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management.

Metachronous volvulus of the descending colon after resection of the sigmoid volvulus; a case report.

INTRODUCTION AND IMPORTANCE: Volvulus of the large bowel is a pathological condition characterized by the twisting of the colon around itself, resulting in obstruction and potentially severe complications such as bowel ischemia and necrosis. The objective of this case report is to highlight the importance of considering volvulus as a differential diagnosis in patients with a history of colonic surgeries, particularly when presenting with symptoms indicative of bowel obstruction. CASE PRESENTATION: The case was a 55 years old male patient who underwent Hartman procedure three years back for an indication of gangrenous sigmoid volvulus. Three months later the colostomy was reversed and descending colo-rectal end-to-end anastomosis was performed. He currently presented to the emergency department with a one day history of abdominal distension which was progressive and associated with colicky persistent abdominal pain. Exploratory laparotomy was done which showed the descending colon was massively dilated and twisted 360 degree in the counterclockwise direction. The patient was discharged from the ward after one week stay. CLINICAL DISCUSSION: Despite of the fact that volvulus is the third most common cause of bowel obstruction, consecutive bowel obstruction secondary to volvulus at a separate time and site is an extremely rare phenomenon. CONCLUSION: A metachronous colonic volvulus is an extremely rare clinical entity. In a patient who presents with bowel obstruction with a history of prior sigmoid colectomy. it is important to consider metachronous volvulus as differential diagnosis specially in patients with significant risk factors or residing in a geographic area known with high rates of volvulus.

Mesenteroaxial gastric volvulus in a 12 Year female child: A rare case report.

INTRODUCTION AND IMPORTANCE: Gastric volvulus is an abnormal rotation of all or part of the stomach around one of its axes. It is a rare clinical entity and a potentially life-threatening condition. Mesenteroaxial volvulus is a less commonly encountered variant of gastric volvulus. The objective of this study was to describe a rare case of Mesenteroaxial volvulus in a 12-year-old female child. CASE PRESENTATION: A 12-year-old female child presented with a complaint of severe abdominal pain of two days duration associated with abdominal distention, failure to pass faeces and flatus, difficulty of breathing, and bloating. The vital sign was blood pressure of 90/60 mmHg, pulse rate of 130 beats per minute, respiratory rate of 29 breaths per minute, and temperature 37.8 degree Celsius. On abdominal examination, there was distension, hyperactive bowel sound, tenderness, and splenomegaly. Exploratory laparotomy was done and the intraoperative finding was gastric volvulus with Mesentroaxial type which was slightly ischemic with poor ligamentous attachment. Decompression with a Nasogastric tube (NGT) and gastropexy was done. The child was discharged on the 6th postoperative day. CLINICAL DISCUSSION: Gastric volvulus is an abnormal rotation of the stomach on horizontal or vertical axes causing various degrees of obstruction. Mesenteroaxial volvulus is most commonly seen in young children and is associated with ligamentous laxity. CONCLUSION: Gastric volvulus causes grave complications and death if not recognized early or surgical intervention is taken timely. Though it is a rare clinical entity, the primary physician should be aware of the clinical presentation.

Ascariasis causing small bowel obstruction in an adult female: A case report.

INTRODUCTION AND IMPORTANCE: Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Intestinal obstruction from ascariasis can result in a rare but severe and often fatal surgical emergency of intestinal perforation and peritonitis in endemic areas. There have been reports of ascariasis causing Small Bowel Obstruction (SBO) in children in endemic areas but this phenomenon has not been studied in adults. The objective of this study was to describe the case of ascariasis causing SBO in a 25-year-old female. CASE PRESENTATION: A 25-year-old female from southwest Ethiopia presented with a complaint of intermittent crampy abdominal pain of 02 days duration associated with vomiting of ingested matter of 02 to 03 episodes, progressive abdominal distension and failure to pass feces and flatus. On examination, she was acutely sick looking. She has mild abdominal distention and a hyperactive bowel sound. Subsequently, she was resuscitated, broad spectrum antibiotic started, consent taken & operated. Patient discharged on the 7th postoperative day. CLINICAL DISCUSSION: There have been reports of Ascariasis causing SBO in endemic areas of the tropics and sub-tropics. SBO secondary to the ascaris ball in an adult is very rare and is relevant to present as it adds key clinical lessons in the consideration as a differential diagnosis, investigation clues and patient management. CONCLUSION: In a patient presented with symptoms and signs suggestive of bowel obstruction, Ascariasis should be considered as a differential diagnosis for those from endemic areas. The treating physician should have a high index of suspicion.

Incarcerated Richter's congenital umbilical hernia in a young male: A case report.

INTRODUCTION AND IMPORTANCE: Richter's hernia is a protrusion of a portion of the circumference of anti-mesenteric side of intestine through the fascial defect. It is a rare type of hernia and typically occurs in elderly patients. Richter's hernia could result in grave complications. The objective of the study was to describe a rare case of incarcerated Richter's congenital umbilical hernia in a 20-year-old male patient. CASE PRESENTATION: A 20-year-old male presented with a complaint of intermittent crampy peri-umbilical pain of three days duration associated with non-reducible umbilical bulge and vomiting. On examination, there was 4 cm by 4 cm oval, firm, tender, non-reducible mass over the umbilical area without cough impulse. He was kept nothing per os, broad spectrum antibiotic started, consent taken & operated. A loop of the ilium which was mildly ischemic found in the hernia sac. Sac and entrapped intestine were thoroughly cleaned with warm saline and reduction and herniorrhaphy done. The client discharged on the 2nd postoperative day. CLINICAL DISCUSSION: There have been very few reports of Richter's congenital umbilical hernia. Richter's hernia progresses more rapidly to gangrene than other strangulated hernias however patients often have no intestinal obstruction. Raised suspicion therefore is important to take timely surgical intervention before the disease advance and complications occurred. CONCLUSION: Richter's hernia has subclinical symptoms and late presentation which could result in grave complications and increased mortality. The early decision for surgery has paramount importance in reducing complication and associated mortality.

Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis.

BACKGROUND: Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately. OBJECTIVE: To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia. METHOD: The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05. RESULTS: The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits. CONCLUSION: A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia.

BACKGROUND: Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%-75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. RESULTS: A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7-19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1-6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07-0.92) were the factors associated with depression among diabetic patients. CONCLUSION: The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended.