Stoma-related complications and quality-of-life assessment: A cross-sectional study with patients from Ethiopia and Sweden.

BACKGROUND: The situation for patients with ostomy can be challenging, probably more in a resource-constrained environment. Our objective was to evaluate quality of life (QoL) (using EQ5D-5L) and stoma-specific QoL (using Stoma QoL) in a high- and low-income setting. METHODS: In this cross-sectional study from the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, and South General Hospital (SGH), Stockholm, patients with a permanent or temporary ostomy at TASH (EthioPerm), (EthioTemp), and patients with ostomy at SGH (SweSto) were included in October 2022-January 2023. RESULTS: Patients N = 66 were included in groups: EthioPerm N = 28, EthioTemp N = 17, and SweSto N = 21. In EthioTemp, 88% used homemade stoma bags. Although morbidity related to the nipple itself was similar in the groups, the overall score from Stoma QoL was significantly lower in EthioPerm, 48/100 than in SweSto, 74/100. Scores were significantly lower for pouch-related problems and social interactions in Ethiopian patients. In EthioPerm, 71% of the patients worried that they were a burden to the people close to them compared to 14% in SweSto (p < 0.001). Leakage was over four times more common in EthioPerm than in SweSto. Mean overall EQ5D-5L score was 18 percentage points lower than the national mean score in EthioPerm and 2 percentage points lower in SweSto. CONCLUSION: QoL was more affected in the Ethiopian study participants than in the Swedish, even when commercial stoma bags were available. The largest problems were leakage, embarrassment with social interactions, and pouch-related problems. TRIAL REGISTRATION: NCT05970458 Clinicaltrials.gov, https://clinicaltrials.gov/study/NCT05970458?locStr=Ethiopia&country=Ethiopia&distance=50&cond=Stoma%20Ileostomy&rank=1.

Retroperitoneal necrotizing soft tissue infections: A case report and literature review.

Necrotizing soft tissue infections of the retroperitoneal is a rare disease identity. Here we present a 50-year-old male patient who underwent surgical exploration for retroperitoneal necrotizing soft tissue infection. Postoperatively, he was put on broad-spectrum antibiotics. He passed on after the first exploration and debridement.

Treatment Outcome of Severe Malaria and Associated Factors among Adults Admitted in Arba Minch General Hospital, Southern Nation Nationality and People's Region, Ethiopia.

INTRODUCTION: Malaria is a protozoan disease transmitted by the bite of infected female Anopheles mosquitoes. Progression to severe and fatal disease is largely but not entirely confined to Plasmodium falciparum infections. Malaria is a major public health problem in Ethiopia despite relatively low malaria prevalence compared to most other malaria-endemic countries in Africa. In Ethiopia, a nationwide report during 2015 showed that the total number of deaths associated with malaria was 1561. METHODS: A retrospective cross-sectional study was conducted in Arba Minch General Hospital on February 2019. Data were collected from a patient record who was admitted with severe malaria in the past four years from Sept. 2015 to Aug. 2018. RESULTS: This study included a total of 387 patients with severe malaria. The mortality rate associated with severe malaria in the year between 2015 and 2018 at Arba Minch General Hospital was 5.7%. Comorbidity, impaired consciousness, and acidosis were significantly associated with mortality, at significant level of P < 0.05. CONCLUSIONS: Comorbidity, impaired consciousness, and acidosis were found to be poor prognostic indicators for patients with severe malaria.

Knowledge of obstetric danger signs and associated factors: a study among mothers in Shashamane town, Oromia region, Ethiopia.

BACKGROUND: Child birth which is a special moment for parents, families and communities is also a time of intense vulnerability. In many developing countries including Ethiopia, maternal morbidity and mortality still pose a substantial burden. Raising awareness of women about the danger signs of pregnancy and childbirth is the first essential step in appropriate and timely obstetric care. OBJECTIVE: To assess the knowledge of obstetric danger signs among mothers and associated factors in Shashamane town, oromia region, Ethiopia. METHODS: A community based cross sectional study design was employed. All kebeles were included in study; the number of households was determined using proportionate-to-population size then systematic random sampling technique to select 422 women who gave birth in Shashamane town between April and May 2018. A structured questionnaire was used to collect data. Data was checked and entered into Epi data version 3.1 then exported to Statistical Package for Social Science version 23 for analysis. Univariate, bivariate and multivariable analysis with 95% CI was carried out. Women who spontaneously mentioned at least two danger signs of pregnancy from eight items were considered to have good knowledge of the obstetric danger signs. RESULT: A total of 422 mothers were involved in the study. The mean age of the respondent was 25 with a standard deviation of 4.3 year. 59.5% of the respondents were found to have poor knowledge of obstetric danger signs. Majority of respondents mentioned vaginal bleeding (64.7%) as a danger sign of pregnancy. According to the result of the multivariable analysis, antenatal care was significantly associated with the knowledge of obstetric danger sign. Respondents who attended antenatal care were 1.26 times more likely to have good knowledge of obstetric danger signs than those who had no antenatal care [AOR = 1.26, 95%CI (1.08-1.85)]. Respondents who gave birth at health center were 3.57 time more likely to have good knowledge of obstetric danger signs than those who gave birth at home [AOR = 3.57, 95%CI (1.23-10.39)]. CONCLUSION: According to this study, the knowledge of obstetric danger signs was poor. Some of the factors associated with this knowledge were antenatal care attendance and place of delivery; therefore, it is recommended that mothers should have at least four antenatal visits; this may create good relationship with the providers and enhance their knowledge. In addition to this providing compassionate and respectful maternity care in health facility is also crucial steps to attract more women to health facilities, and to reduce home deliveries.

Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study.

OBJECTIVES: This study was designed to assess the role of chest radiography for the diagnosis of pneumonia and assess the association of clinical characteristics with radiologic findings and predictors of hospitalization among children with severe community acquired pneumonia. METHODS: A prospective study was conducted on 122 children between ages of 3 month and 14 years admitted to pediatric emergency unit with diagnosis of severe pneumonia from September 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). Level of agreement between radiologists was assessed using Cohen's kappa coefficient. Clinical and laboratory parameters which could explain the variability in the duration of hospital stay were assessed using a linear regression mode. Independent predictors were assessed using multiple linear regression. RESULTS: The median age of the cohort was 10.0 months (interquartile range (IQR): 6.75-24.0); 76 (62.3%) were male. Nearly half, 63 (51.6%) did not have radiologic evidence of pneumonia. There was low level of agreement between R1 and R2 in reporting consolidation (kappa=0.435, p-value≤0.001), haziness (kappa=0.375, p-value≤0.001), and infiltration (kappa=0.267, p-value=0.008). Children with higher recorded temperature were more likely to have radiologic abnormalities suggesting pneumonia (p-value=0.033). The median duration of hospitalization was 3 days (IQR: 1-4 days); 118 (96.7%) were discharged with improvement. Height-for-age z-score (Coef.=0.203, R2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. CONCLUSION: Radiologic evidence of pneumonia was absent in half of the children with severe pneumonia. There was low agreement between senior radiologists in reporting chest radiographic findings, potentially necessitating harmonization activities to uniformly implement the WHO guidelines in reading chest radiographs.

Pediatric Residents' and Medical Interns' Awareness about Pediatric Ionizing Radiation Dose from Computed Tomography and Its Associated Risks in Tertiary Hospital in Ethiopia.

BACKGROUND: The international literature on physicians' knowledge regarding radiation dosages and risks due to computed tomography showed a widespread underestimation of diagnostic radiation doses. Hence, the objective of this work is to assess the awareness of pediatric residents and medical interns about pediatric CT dose and possible risks. METHODS: A cross-sectional study was conducted on May/2016 among year I to year III pediatric residents and 2015/2016 year medical interns attaching Pediatrics Department during the study period in Tikur Anbessa Specialized Referral and Teaching Hospital. Data was collected by distributing standardized structured questionnaires. Finally, after the data was checked for clarity and completeness, it was analyzed by using SPSS software. RESULT: While the majority (76.3%) of the residents and interns knew that children were more sensitive to radiation than adults, 93.7% did not know that there is currently no annual dose limit set for medical exposure of patients. The majority of the respondents (81.3%) know the risk of cancer from CT scan, but most (60%) of the respondents did not know that many imaging facilities still use adult doses for pediatric patients. Furthermore, 18.8% thought that magnetic resonance imaging involves ionizing radiation, and 8.9% of the physicians associated ultrasound examinations with ionizing radiation. CONCLUSION: Within resident group, since the level of clinical experience did not affect the outcome, we recommend that formal education and training on awareness of radiation with special concern on pediatric population is mandatory especially for pediatric residents and pediatricians who are major caretakers of children.

Laparascopic cholecstectomy at Myungsung Christian Medical Center, Ethiopia: a five-years experience.

BACKGROUND: Laparoscopic cholecystectomy is a recent entry in the treatment of gall bladder disease in Ethiopia mainly in private hospitals of the capital city, Addis Ababa, and is slowly gaining acceptance. Like all new techniques, it has generated considerable controversy and debate on its merits over the traditional open operation. OBJECTIVE: The aim of this study was to review our experience of laparoscopic cholecystectomy at Myungsung Christian Medical in, Ethiopia MATERIAL AND METHODS: A hospital based retrospective cross sectional analysis was conducted in Myungsung Christian Medical Center, Addis Ababa, Ethiopia. Patients' medical records and operation theater registers of 681 patients for whom laparoscopic cholecystectomy were done for symptomatic and complicated cholelithiasis, between January 2005 and December 2009 were analyzed using computer based statistical software SPSS version 11.0. Difference in proportions were examined using Chi-square test with its conventional criterion for statistical significance (p < 0.05). RESULTS: The female to male ratio was 6.6:1 with mean age of 44.4 [Standard Deviation, 0.53] years. Of the six hundred eighty-one patients admitted and planned for laparoscopic cholecystectomy, 661 (97.1%) patients completed the procedure successfully (p < 0.0001) and the procedure was converted to open surgery in 20 (2.9%) for various reasons. Mean duration of operation and hospital stay were 58.9 +/- 18.2 [SD] minutes and 36.9 +/- 10.9 [SD] hours respectively. Postoperative mortality and complication rate were 0.15% and 2.94% respectively. CONCLUSION: LC is safe and effective procedure even in difficult cholelithasis (p < 0.0001), in addition the merit of laparoscopic cholecstectomy include fast recovery, minimal tissue trauma, less postoperative hospital stay (p < 0.0001). Hence, LC could be practiced by general surgeons working in third world countries.