Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa.

BACKGROUND: The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS: Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS: We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION: Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.

Abdominal wall congenital infantile fibrosarcoma: A rare case report and literature review.

Congenital infantile fibrosarcoma is a rare malignant soft tissue tumor, accounting for less than 1%-2% of childhood cancers. Although it can arise from any body part, an abdominal wall origin is exceptionally rare. This case report presents a case of congenital infantile fibrosarcoma originating from the abdominal wall. To the best of our knowledge, this is only the second reported case of abdominal wall congenital infantile fibrosarcoma. Unlike adult fibrosarcoma, infantile fibrosarcoma has a good prognosis with less metastasis. Early diagnosis and management are critical for improving outcomes in such rare cases.

Fecal Carriage of Extended-Spectrum ß-Lactamase and Carbapenemase-Producing Enterobacteriaceae Among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia: A Comparative Cross-Sectional Study.

Purpose: Extended-spectrum ß-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) are among the major threats to global health because of their encoded protection against key antibiotics. Methods: A comparative cross-sectional study was conducted among oncology and non-oncology patient groups (1:1; n = 214) on a consecutive sampling approach. Stool or rectal swab was collected from June 2021 to November 2021 and screened for ESBL-PE and CPE using ChromID-ESBL media. Confirmation for the enzymes was made by using combination disc and modified carbapenem inactivation methods, respectively. Disk diffusion method was used to determine antimicrobial susceptibility testing following the recommendations of CLSI 2022. SPSS software version 23 was used for data analysis. Results: Fecal carriage prevalence of ESBL-PE was found in 90 (84.1%) of oncology participants and in 77 (71.9%) of non-oncology patients (p = 0.032). Escherichia coli was the most common ESBL-PE isolate in 82 (62.5%) and 68 (88.3%) of oncology and non-oncology patients, followed by Klebsiella oxytoca [15 (11.5%) versus 6 (7.8%)], respectively. Out of the total ESBL-PE isolates from both oncology and non-oncology patient groups, the maximum level of resistance was observed against ciprofloxacin 177 (86.3%), trimethoprim-sulfamethoxazole 103 (80.3%), tetracycline 97 (75.8%), whereas enhanced susceptibility was appreciated to tigecycline 200 (97.6%), meropenem 162 (79.0%), and ertapenem 145 (70.7%) with no significant difference between oncology and non-oncology group. Carbapenemase-producing isolates from oncology patients were 12 (11.2%), whereas it was 4 (3.7%) (p = 0.611) from non-oncology group. Bacterial isolates from oncology in this study showed a trend of multiple drug resistance of 113 (88.3%). Conclusion: The results revealed alarmingly high carriage rates of ESBL and CPE among all study participants. Moreover, the isolates showed increased resistance rates to alternative drugs and had multiple antibiotic-resistant patterns. Hence, it is important to emphasize strict adherence to antimicrobial stewardship program as well as infection prevention and control practices.

Attitude, Perceived Barriers, and Challenges Toward Implementing Resource-Appropriate Guidelines for Hematologic Malignancies: Physicians' Survey in Ethiopia.

PURPOSE: Cancer care in low-income countries poses formidable challenges. Care may be facilitated by resource-adapted guidelines, such as the National Comprehensive Cancer Network (NCCN) harmonized guidelines for sub-Saharan Africa (NCCN-HG). Understanding physicians' attitudes and knowledge toward guidelines, as well as patient- and resource-related barriers, is essential for promoting their effective implementation. METHODS: We conducted an online survey among oncologists, hematologists, internists, residents/fellows, and generalists treating hematologic malignancies in Ethiopia. We assessed attitudes toward the use of guidelines, institutional capacity, and barriers/determinants to effective care. RESULTS: Among the 47 physicians completing the survey (representing 64% of Ethiopian professionals treating hematologic malignancies), the majority (85%) reported using guidelines; however, only 22.7% (n = 10) used the NCCN-HG. While overall attitudes toward guidelines were favorable, 57.8% of physicians familiar with the NCCN-HG were either undecided or believed that it lowers the standard of care. Perceived lack of institutional regulation was negatively associated with guideline use (B = -3.23; P = .004). Lack of diagnostic facilities including immunohistochemistry and flow cytometry, supportive care, and poor utilization of guidelines were reported to be determinants of poor patient outcome. Regarding patient factors, 57.4% respondents identified treatment abandonment as an important contributor to poor outcome. Availability of chemotherapy/radiotherapy (89.4%), financial status (85.1%), distance from the hospital (74.5%), and harvest season (65%) had major influences on treatment decisions. Over 80% reported that targeted therapies were unavailable or rarely available. CONCLUSION: Awareness and usage of the NCCN-HG are limited among Ethiopian physicians. Lack of facilities, therapies, and regulation, in addition to patient-related factors, was identified as barriers to guideline adherence and determinants of poor outcome.

Hyperbilirubinemia and Associated Factors Among Neonates Admitted to the Neonatal Care Unit in Jimma Medical Center.

Background: Neonatal hyperbilirubinemia is a widespread and significant clinical problem among neonates worldwide. Globally, every year about 1.1 million babies develop it and the vast majority reside in South Asia and sub-Saharan Africa. Studies on the magnitude and factors associated with neonatal hyperbilirubinemia are limited in Ethiopia. So this study was aimed at assessing the prevalence and associated factors of neonatal hyperbilirubinemia among hospitalized neonates in the neonatal intensive care unit of Jimma Medical Center (JMC), Jimma, South West Ethiopia. Design: Hospital-based cross-sectional study was conducted at JMC from July 24 to October 19, 2020. Methods: A total of 222 neonates with their mothers were included and conveniently selected. Data was collected by interviewing mothers through structured questionnaires and reviewing neonates' medical records using a checklist. Multivariable binary logistic regression analyses were employed to identify factors associated with neonatal hyperbilirubinemia. Results: from a total of neo-maternal pairs included in the studies; the proportion of Neonatal hyperbilirubinemia was found to be 94 (42.3%). Neo-maternal ABO incompatibility 33 (35.1%), prematurity 41 (43.6%), sepsis 35 (37.2%), Neonatal birth asphyxia 20 (21.2%), and Rh isoimmunization 10 (10.6%) was significantly associated with neonatal hyperbilirubinemia. Conclusion: The prevalence of neonatal hyperbilirubinemia in the study setting was high. Antenatal care (including both mother and fetus detail examination and follow-ups) as well as cautions during labor need to focus on since Neonatal hyperbilirubinemia-associated factors were maternal and neonatal. Hence, further assessment, early intervention, and timely treatment are important to mitigate the burdens in neonates due to hyperbilirubinemia.

Incidence and geographic distribution of retinoblastoma in Ethiopia.

INTRODUCTION: Retinoblastoma is the most frequent intraocular malignancy of the eye in children, occurring in early childhood. Based on global estimates, Ethiopia is expected to observe over 200 new retinoblastoma cases per year, however without a cancer registry, this number is difficult to confirm. Therefore, the goal of the study was to determine the incidence and geographic distribution of retinoblastoma in Ethiopia. METHODS: A retrospective medical chart review of clinically diagnosed new retinoblastoma patients between January 1, 2017 - December 31, 2020, in four public Ethiopian tertiary hospitals was performed. The incidence of retinoblastoma was calculated by a birth-cohort analysis. RESULTS: There were 221 retinoblastoma patients observed in the study period. The incidence of retinoblastoma was found to be 1 in 52,156 live births. Incidence varied among different regions of Ethiopia. CONCLUSION: The incidence of retinoblastoma observed in this study is likely an underestimate. It is possible that patients were undercounted because they were seen outside of the 4 main retinoblastoma treatment facilities included in this facility, or they experienced barriers to accessing care. Our study suggests a need for a nationwide retinoblastoma registry and more retinoblastoma treatment centers in the country.

Adverse drug events and contributing factors among pediatric cancer patients at Jimma University medical center, Southwest Ethiopia.

BACKGROUND: The characteristics and incidence of adverse drug events (ADEs) among pediatric cancer patients in developing countries have not been well characterized. ADEs & medication errors associated with cancer chemotherapy in children need to be analyzed on their incidence and severity. The purpose of this study was hence, to assess the incidence of adverse drug events and contributing factors among pediatric cancer patients at Jimma university medical center, Jimma, Ethiopia. METHOD: A prospective observational method was used to study adverse drug events in pediatrics admitted to the pediatric oncology unit of Jimma University medical center between October and December 2020. The ADEs were identified using multifaceted approaches involving daily chart review, interviews of Parents/caregivers (and/or children themselves), attendance at ward rounds, and voluntary staff reports. Both univariate and multivariate logistic regression were used to assess the predictors of the identified ADEs. Those factors that showed association at p-value < 0.25 in the univariate analysis were added to the backward multivariate logistic regression model and the significant association was checked at p-value < 0.05. RESULT: A total of 73 (46 male and 27 female) patients were included in the study. A total of 466 ADEs were identified with an incidence of 638.36 ADEs per 100 patients, 38.35 ADEs per 100 patient days, and 2.34 ADEs per chemotherapy cycle. The most common ADEs were hematologic toxicities (anemia 55(11.8%), neutropenia 52(11.16%) & thrombocytopenia 31(6.65%)), and gastrointestinal effects (nausea 46(9.87%), vomiting 46(9.87%), anorexia 41(8.8%). Out of 466 ADEs, 150 (32.19%) were classified as common terminology criteria for adverse events (CTCAE) as Grade 1, 199 (42.70%) as Grade 2, 64(13.73%) as Grade 3, 48(10.30%) as grade 4 and 5(1.07%) as Grade 5. Severe acute malnutrition (SAM) is the most common comorbidity present, 20(27.40%) followed by pneumonia, 4(5.50%). Presence of comorbidity (AOR 12.700, CI 1.978-81.549), cancer type (AOR 13.332, CI 3.288-54.059), use of 4 or more chemotherapy drugs (AOR 6.179, CI 1.894-20.165) and length of hospital stay more than 8 days (AOR 5.367, CI 1.167-24.684) were associated with the risk of developing grades 3 and 4 ADEs. CONCLUSION: Adverse drug events were common in the pediatric oncology ward of JUMC. In particular, children with multiple chemotherapy drugs and those with the comorbid condition were at greater risk for adverse drug events.

Patient Satisfaction with Antiretroviral Therapy Service and Associated Factors at Jimma Town Public Health Facilities, Southwest, Ethiopia.

BACKGROUND: HIV/AIDS is the greatest and most urgent public health problem that the world is facing today. Antiretroviral therapy (ART) is the treatment option for people infected by the HIV virus and helps them to lead longer and healthier lives and improve their quality of life. This study aimed to measure level of satisfaction and associated factors among patients receiving ART services in ART Clinics at Jimma Town Public Health Facilities, Southwest, Ethiopia. METHODS: Facility-based, cross-sectional study was employed from March to April, 2018 among 383 clients attending ART in three public health facilities of Jimma town. Data was collected using exit interviewer administrated pre-test structured, coded and entered using Epi-data version 3.5.1 and then exported and analyzed using SPSS version 20 software. Variables having p < 0.25 at bivariate analysis were fitted to multivariate analysis. OR, P-value and 95% CI were computed to show the association of variables (p < 0.05). RESULTS: A total of 383 clients involved in the study. The majority of the study participants, 253 (66.1%), were females and 163 (42.6%) were in 28-37 age category. The overall satisfaction rate for ART service provision was 89.6%. Patients were satisfied with the availability of ARV drugs, measures taken by health care providers to keep confidentiality and location of the clinic in the facility, 97.9%, 93.2% and 96.3%, respectively. The findings of this study revealed statistically significant associations between the patients' satisfaction and duration of stay on ART and waiting time to get service (p<0.05). Those patients who stayed 36-60 months on ART treatment were 82.5% less likely to be satisfied than those who stayed less than 12 months on ART treatment (AOR=0.175, 95% CI: 0.04-0.771). CONCLUSION: Overall, most respondents were satisfied with ART services provision. Factors like duration of stay on ART and waiting time to get service should be taken into consideration to improve the patient's satisfaction.

Risk perceptions and attitudinal responses to COVID-19 pandemic: an online survey in Ethiopia.

BACKGROUND: Effective risk communication is one of the critical strategies in the response to COVID-19. This study examined risk perceptions and attitudinal responses to COVID-19 among the educated section of the society in Ethiopia. METHODS: An internet-based survey was conducted from April 22 to May 04, 2020, in Ethiopia. A questionnaire addressing the perception of health threat-combination of perceived vulnerability (PV) and perceived seriousness (PS), and perceived efficacy-combinations of perceived response efficacy (PRE), perceived self-efficacy (PSE), and perceived collective efficacy (PCE). The data were analyzed using SPSS 21.0. Descriptive statistics were computed after the standardization of the scores. The scores for overall efficacy and threat were split by median value and response classifications were generated through threat by efficacy interactions. For statistical significance, 95% CI and p-value < 0.05 were used. RESULTS: A total of 929 respondents submitted their responses. Eight hundred and twenty-eight (89.1%) of the respondents were male and 753 (81.1%) were Christian. The perceived threat to COVID-19 was generally low (median = 58.3). The median score for overall efficacy, PRE, and PSE were 79.8, 87.5, and 80.0, respectively. However, the median value (66.7) for PCE was relatively low. Perceived threat significantly varied by age, education, occupation, and place of residence (p < 0.05). Perceived efficacy significantly differed by gender, residence, and use of some sources of information (p < 0.05). In terms of response to COVID-19, 290 (31.2%), 239 (25.7%), 175 (18.8%) and 225 (24.2%) of the respondents were in the responsive, pro-active, avoidant, and indifferent attitudinal categories, respectively. The avoidant and indifferent groups constituted a fear control response (mal-adaptive motivation towards COVID-19 protective behavior) whereas responsive and pro-active categories formed a danger control response (self-protective motivation). These responses varied significantly by residence, region, religion, and sources of information (p < 0.05). CONCLUSIONS: Understanding people's perceived health threat and efficacy is a critical step toward creating risk communication campaigns. Hence, this study provided an insight that has the potential to inform the COVID-19 risk communication campaigns targeting the educated section of the society, by ensuring a balanced combination of threat appeals and efficacy messages for improved self-protective responses.

Intention to voluntary blood donation among private higher education students, Jimma town, Oromia, Ethiopia: Application of the theory of planned behaviour.

BACKGROUND: Blood is an important and crucial component in the management of patients presenting with severe accident injuries, surgical conditions, malignancies, pregnancy-related complications, and other medical conditions. OBJECTIVES: To assess intention to voluntary blood donation among private higher education students in Jimma Town, South West Ethiopia, 2019. METHODS: Institution-based cross-sectional study with quantitative methods was conducted in private higher education students in Jimma town. A multistage sampling technique was used to recruit study participants. First, a simple random sampling technique was used to select departments in each private higher education institution. Seven departments were included in the study and after proportionally allocated in each department, a total of 595 were participated in the study, producing a response rate of 98%. The data was collected using self-administered structured questioners with 3 trained data collectors. Multivariable linear regression analysis was done to assess association between the independent variables and dependent variable. RESULTS: The mean score for intention of the respondents to donate blood voluntarily was 15.41 out of 25 with standard deviation of 4.42.The TPB variables explained 61.3% of the variance of intention to donate blood. Direct perceived behavioral control (ß = 0.745, P < 0.001), direct attitude (B = 0.295, P<0.001) and direct subjective norm (ß = 0.131, P< 0.001) were significant predictors of the intention. CONCLUSION: Respondents' intentions are mainly determined by perceived barriers and, subjective norms, the attitude of respondents towards voluntary blood donation.

Psychological distress during the COVID-19 pandemic in Ethiopia: an online cross-sectional study to identify the need for equal attention of intervention.

BACKGROUND: The COVID-19 pandemic led individuals to suffer from different levels of mental health problems such as psychological distress, anxiety, depression, denial, panic, and fear. This study aimed at determining the prevalence of psychological distress and associated factors among the Ethiopian population during the COVID-19 pandemic. METHODS: A cross-sectional study was performed through an online survey using different online platforms. The questionnaire was created through Google Form and the survey link was administered by e-mail, LinkedIn, Telegram, and Facebook. Educated Ethiopian population who have access to the internet were invited to participate through an online survey and addressed to 929 respondents. The study participants completed the survey anonymously without any personal identifier. The psychological distress was assessed using the Kessler 10-item tool to measure psychological distress. Data were analyzed using SPSS and logistic regression to examine mutually adjusted associations, expressed as adjusted odds ratios. A generalized additive model was also employed to identify additional predictors using R. RESULTS: The prevalence of high psychological distress among the study population was 236 (25.5%). Of all respondents, 421 (45.1%) had low psychological distress, 274 (29.4%) had moderate psychological distress, 164 (17.6%) had high psychological distress, and 72 (7.3%) had very high psychological distress. Psychological distress increased with being at young and middle-aged adults, getting information from social media, and not correctly practicing infection prevention and control measures to prevent COVID-19 infection. Respondents with high perceived severity had increased psychological distress. On the contrary, those with the highest score of perceived response efficacy had low distress. CONCLUSION: Prevalence of psychological distress was substantial. The need for intervention of psychological distress inline with the prevention of COVID-19 is critically essential. The intervention target groups are those whose information sources are from social media, young and middle-aged adults, and those who do not correctly practice infection prevention and control measures against COVID-19 infection.

Myths, beliefs, and perceptions about COVID-19 in Ethiopia: A need to address information gaps and enable combating efforts.

BACKGROUND: The endeavor to tackle the spread of COVID-19 effectively remains futile without the right grasp of perceptions and beliefs presiding in the community. Therefore, this study aimed to assess myths, beliefs, perceptions, and information gaps about COVID-19 in Ethiopia. METHODS: An internet-based survey was conducted in Ethiopia from April 22 to May 04, 2020. The survey link was promoted through emails, social media, and the Jimma University website. Perceptions about COVID-19 have considered the World Health Organization (WHO) resources and local beliefs. The data were analyzed using Statistical Package for Social Science (SPSS) software version 20.0. Classifications and lists of factors for each thematic perception of facilitators, inhibitors, and information needs were generated. Explanatory factor analysis (EFA) was executed to assist categorizations. Standardized mean scores of the categories were compared using analysis of variance (ANOVA) and t-tests. A significant difference was claimed at p-value <0.05. RESULTS: A total of 929 responses were gathered during the study period. The EFA generated two main categories of perceived facilitators of COVID-19 spread: behavioral non-adherence (55.9%) and lack of enablers (86.5%). Behavioral non-adherence was illustrated by fear of stigma (62.9%), not seeking care (59.3%), and hugging and shaking (44.8%). Perceived lack of enablers of precautionary measures includes staying home impossible due to economic challenges (92.4%), overcrowding (87.6%), and inaccessible face masks (81.6%) and hand sanitizers (79.1%). Perceived inhibitors were categorized into three factors: two misperceived, myths (31.6%) and false assurances (32.9%), and one correctly identified; engagement in standard precautions (17.1%). Myths about protection from the virus involve perceived religiosity and effectiveness of selected food items, hot weather, traditional medicine, and alcohol drinking, ranging from 15.1% to 54.7%. False assurances include people's perception that they were living far away from areas where COVID-19 was rampant (36.9%), and no locally reported cases were present (29.5%). There were tremendous information needs reported about COVID-19 concerning protection methods (62.6%), illness behavior and treatment (59.5%), and quality information, including responses to key unanswered questions such as the origin of the virus (2.4%). Health workers were perceived as the most at-risk group (83.3%). The children, adolescents, youths were marked at low to moderate (45.1%-62.2%) risk of COVID-19. Regional, township, and access to communication showed significant variations in myths, false assurances, and information needs (p <0.05). CONCLUSIONS: Considering young population as being at low risk of COVID-19 would be challenging to the control efforts, and needs special attention. Risk communication and community engagement efforts should consider regional and township variations of myths and false assurances. It should also need to satisfy information needs, design local initiatives that enhance community ownership of the control of the virus, and thereby support engagement in standard precautionary measures. All forms of media should be properly used and regulated to disseminate credible information while filtering out myths and falsehoods.

Abundance, Diversity, and Distribution of Primates at Welel Mountain, Kellem Wollega Zone, Oromia Region, Ethiopia.

Primates are the mammals of the order Primate that is characterized by advanced development of binocular vision and enlargement of the cerebral hemispheres. The aim of this study was to investigate the abundance, diversity, and distribution of primates on Welel Mountain. From August 2017 to February 2018, we collected data from different parts of Welel Mountain during wet and dry seasons of the year and analyzed them using SPSS version 20. We identified four primate species: Chlorocebus aethiops, Cercopithecus mitis, Papio anubis, and Colobus guereza. We conducted t-test analysis for abundance and distribution of primates in wet and dry season of the year, and the P value obtained was 0.20. The mean percentages of primates in forest, woodland, and shrubs were 43.16%, 32.26%, and 24.58%, respectively. Shannon-Wiener diversity index (H') value was higher in wet season than in dry season. The current study showed that the species are distributed more evenly in wet season than in dry season, and the number of young individuals is more than that of adults. This indicates that currently the status of primates population on Welel Mountain is good. Therefore, to keep the status of primates in the study area effective, wildlife management and conservation policy should be formulated.