Predictors of complications and mortality among patients undergoing pacemaker implantation in resource-limited settings: a 10-year retrospective follow-up study.

INTRODUCTION: Pacemakers (PMs) are used to treat patients with severe bradycardia symptoms. They do, however, pose several complications. Even with these risks, there are only a few studies assessing PM implantation outcomes in resource-limited settings like Ethiopia and other sub-Saharan countries in general. Therefore, this study aims to assess the mid-term outcome of PM implantation in patients who have undergone PM implantation in the Cardiac Center of Ethiopia by identifying the rate and predictors of complications and death. METHODOLOGY: This retrospective study was conducted at the Cardiac Center of Ethiopia from October 2023 to January 2024 on patients who had PM implantation from September 2012 to August 2023 to assess the midterm outcome of the patients. Complication rate and all-cause mortality rate were the outcomes of our study. Multivariable logistic regression was used to identify factors associated with complications and death. To analyze survival times, a Kaplan-Meier analysis was performed. RESULTS: This retrospective follow-up study included 182 patients who underwent PM implantation between September 2012 and August 2023 and were at least 18 years old. The patients' median follow-up duration was 72 months (Interquartile range (IQR): 36-96 months). At the end of the study, 26.4% of patients experienced complications. The three most frequent complications were lead dislodgement, which affected 6.6% of patients, PM-induced tachycardia, which affected 5.5% of patients, and early battery depletion, which affected 5.5% of patients. Older age (Adjusted Odds Ratio (AOR) 1.1, 95% CI 1.04-1.1, p value < 0.001), being female (AOR 4.5, 95%CI 2-9.9, p value < 0.001), having dual chamber PM (AOR 2.95, 95%CI 1.14-7.6, p value = 0.006) were predictors of complications. Thirty-one (17%) patients died during the follow-up period. The survival rates of our patients at 3, 5, and 10 years were 94.4%, 92.1%, and 65.5% respectively with a median survival time of 11 years. Patients with a higher Charlson comorbidity index before PM implantation (AOR 1.2, 95% CI 1.1-1.8, p = 0.04), presence of complications (AOR 3.5, 95% CI 1.2-10.6, p < 0.03), and New York Heart Association (NYHA) class III or IV (AOR 3.3, 95% CI 1.05-10.1, p = 0.04) were associated with mortality. CONCLUSION: Many complications were experienced by patients who had PMs implanted, and several factors affected their prognosis. Thus, it is essential to identify predictors of both complications and mortality to prioritize and address the manageable factors associated with both mortality and complications.

Regulatory problems and associated factors among infants in Arba Minch health and demographic surveillance system sites, southern Ethiopia.

INTRODUCTION: Infant regulatory problems are a common source of concern for parents, and they increase the risk of impaired infant-caregiver bonding. Despite their impact, they are often overlooked in Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of infant regulatory problems in Arba Minch Health and Demographic Surveillance System sites in southern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 451 mother-infant pairs from February 15 to March 15, 2022. Regulatory problems were assessed using diagnostic interviews for regulatory problems. The data was collected using an open data kit Android application and analyzed with Stata version 17.0. Bivariable and multivariable logistic regression analyses were computed to identify factors associated with each infant regulatory problem. Statistical significance was declared at a p-value < 0.05. RESULTS: In this study, four hundred forty-nine mother-infant pairs were involved, with a response rate of 99.5%. The prevalence of excessive crying, feeding problems, and sleeping difficulties was 14.03% [95% CI: 10.95, 17.59], 20.04% [95% CI: 16.44, 24.05], and 13.59% [95% CI: 10.55, 17.11], respectively. Attending primary education (AOR: 2.54, 95% CI: 1.22, 5.32), high perceived social support (AOR: 0.32, 95% CI: 0.12, 0.89), feeding problems (AOR: 5.0, 95% CI: 2.65, 9.45), and depression, anxiety, and stress (DAS) symptoms (AOR: 2.67, 95% CI: 1.19, 5.98) were associated with excessive crying. In addition, a family size of above five (AOR: 1.82, 95% CI: 1.03, 3.22), excessive crying (AOR: 3.76, 95% CI: 1.85, 7.65), sleeping problems (AOR: 2.29, 95% CI: 1.13, 4.65), comorbid DAS symptoms (AOR: 3.42, 95% CI: 1.64, 7.11), alcohol abuse (AOR: 1.89, 95% CI: 1.04, 3.42), and late initiation of complementary feeding (AOR: 2.67, 95% CI: 1.22, 5.88) were associated with feeding problems. Furthermore, attending primary education (AOR: 2.35, 95% CI: 1.16, 4.77), feeding problems (AOR: 3.47, 95% CI: 1.86, 6.48), and comorbid DAS symptoms (AOR: 3.23, 95% CI: 1.53, 6.84) were associated with sleeping problems. CONCLUSIONS: Approximately one-third of infants encountered at least one regulatory problem. Level of education, perceived social support, feeding problems, and DAS symptoms were associated with excessive crying. Large family sizes, excessive crying, sleeping problems, comorbid DAS symptoms, alcohol abuse and, late initiation of complementary feeding increase the likelihood of feeding problems. Moreover, attending primary education, feeding problems, and comorbid DAS symptoms increase the odds of sleeping problems. Continuous guidance and support on infant soothing techniques, cognitive and behavioral therapy, and counselling on appropriate coping strategies for postpartum women are imperative to reduce the burden of infant regulatory problems.

Neonatal jaundice and associated factors in public hospitals of southern Ethiopia: A multi-center cross-sectional study.

Background: Neonatal jaundice is one of the most prevalent problems, affecting over a million newborns globally every year. It increases the likelihood of hospitalization, lifetime disability, and death, particularly in low and middle-income countries. Despite its impact and diverse risk factors, neonatal jaundice remains underappreciated in developing nations such as Ethiopia. As a result, this study aimed to determine the magnitude and associated factors of jaundice in newborns admitted to public hospitals in south Ethiopia. Methods: A facility-based cross-sectional study was conducted among 417 newborns from October 1, 2020, to April 30, 2021. The data was collected using pretested interviewer-administered questionnaire and checklist. Jaundice and its severity were assessed using the physician's diagnosis and the Kramer scale. Open data kit tools and Stata version 16.0 were used for data collection and analysis, respectively. Bivariable and multivariable analyses were used to identify factors associated with neonatal jaundice. An odds ratio with a 95 % confidence interval was used to assess the direction and strength of the association. Results: Out of the newborns, 24.46 % [95 % CI: 20.42-28.88] encountered neonatal jaundice. Being male [AOR: 1.81, 95 % CI: 1.06, 3.12], birth injuries [AOR: 3.01, 95 % CI: 1.27, 7.12], perinatal asphyxia [AOR: 2.10, 95 % CI: 1.18, 3.76], hyaline membrane disease [AOR: 2.16, 95 % CI: 1.16, 4.00], sepsis [AOR: 3.30, (95 % CI: 1.67, 6.54], the combined effect of low birth weight and prematurity [AOR: 1.88, 95 % CI: 1.06, 3.35], and maternal alcohol abuse during pregnancy [AOR: 2.46, 95 % CI: 1.02, 5.94] were significantly associated with neonatal jaundice. Conclusion: The burden of neonatal jaundice was high in the hospitals studied. Early detection and treatment of neonatal problems, counseling pregnant women to avoid consuming any level of alcohol, strict monitoring of labor and delivery, improving antenatal care utilization, and pre-discharge universal bilirubin screening of newborns are essential to reduce the incidence and complications of jaundice. The findings of this study will be used as input to initiate interventions and conduct further studies.

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study.

Background: A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods: The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications. Results: The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion: Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.

Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia.

Background: Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective: To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods: An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results: The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion: One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.

Rare Combination of Right Aortic Arch, Aberrant Left Subclavian Artery and Absent Left Pulmonary Artery in a Boy with Tetralogy of Fallot.

Introduction: Right aortic arch is associated with an aberrant subclavian artery and absence of left pulmonary artery in patients with Tetralogy of Fallot. However, the occurrence of a combination of the right aortic arch, an aberrant left subclavian artery, and an absent left pulmonary artery in a single patient is rare. Therefore, the purpose of this case report was to discuss the rare association between a right aortic arch, the absence of a left pulmonary artery, and an aberrant left subclavian artery in an 8-year-old Ethiopian boy with Tetralogy of Fallot. Case Presentation: An 8-year-old male child who presented with easy fatigability, dizziness, and intermittent difficulty in swallowing solid food over the past two years. He had grade clubbing, cyanosis of the lips, and an ejection systolic murmur at the left lower sternal border. Tetralogy of Fallot with absent left pulmonary and right aortic lesions was diagnosed using echocardiography. CT tomography revealed a detailed vascular anatomy and confirmed the diagnosis of an aberrant left subclavian artery. Conclusion: In the evaluation of patients with Tetralogy of Fallot, it is important to pay close attention to vascular abnormalities such as right aortic arch, aberrant left subclavian artery, and absent left pulmonary artery for not missing them.

Diaper dermatitis and associated factors among 1-24 months children visiting public health facilities of Arba Minch town, Gamo zone, southern Ethiopia.

Background: Diaper dermatitis is one of infants and toddlers' most common skin diseases; it accounts for 10-20 % of all skin diseases and 25 % of pediatric dermatology visits. Diaper dermatitis also increases parents' mental health problems and compromises the quality of life. Despite its ill outcome, diaper dermatitis's burden and risk factors are poorly studied in Ethiopia. Therefore, this study aimed to assess the magnitude of diaper dermatitis and associated factors among 1-24 months children visiting public health facilities in Arba Minch town, southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 671 mother-child pairs from May 15 to June 15, 2022. A structured and pretested interviewer-administered questionnaire and observational checklist were used to collect the information. The data was collected using an open data kit tools and analyzed using Stata version 17.0. Bivariable and multivariable analyses were carried out to identify factors associated with diaper dermatitis. P-value <0.05 was considered to declare statistical significance. Results: In this study, 664 mother-child pairs, yielded a response rate of 98.96 %, were involved. Overall, 35.69 % [95 % CI: 32.04, 39.47] of children encountered diaper dermatitis. Being government-employed (AOR: 2.49, 95 % CI: 1.42, 4.35), primiparity (AOR: 1.52, 95 % CI: 1.03, 2.23), unplanned pregnancy (AOR: 1.93, 95 % CI: 1.22, 3.04), having poor knowledge about diaper dermatitis (AOR: 1.74, 95 % CI: 1.19, 2.56), using both disposable and non-disposable diapers alternatively (AOR: 3.35, 95 % CI: 1.55, 7.22), and applying ointments on diaper area (AOR: 1.93, 95 % CI: 1.26, 2.97) all increase the likelihood of diaper dermatitis. Conclusion: Diaper dermatitis was high in the study hospitals; over one-third experienced it. Maternal occupation, parity, pregnancy status, maternal knowledge of diaper dermatitis, diaper type, and ointment application were significantly associated with diaper dermatitis. Improving maternal/guardian knowledge about diapering and diaper dermatitis is critical to reducing the burden and severity of the problem.

Health Related Quality of Life and Associated Factors Among Adult Patients with Rheumatic Heart Disease Patients in Ethiopia.

Background: Quality of life (QOL) is defined as "individuals" perceptions of their position in life. Rheumatic heart disease (RHD) is a consequence of severe, single, or recurrent bouts of acute rheumatic fever. To improve overall patient outcomes, there is currently a greater emphasis on assessing the QOL of these patients. The purpose of this study is to assess the QOL of adult RHD patients who had followed up at St Peter and Tikur Anbessa Hospital, Ethiopia. Methods: An institutional-based cross-sectional study done at St Peter and Tikur Anbessa Hospital, Ethiopia from March 1-June 30/2021 in adult RHD patients. The sample size was 297. Socio-demographic and clinical data were collected using a structured questionnaire. The Amharic version of Short form-36 (SF-36) was used to assess the QOL. A logistic regression model was used to identify associated factors. Results: The study included 297 patients. The majority are female (71%), and half of them are aged between 18-30 years of age. Of the patiends, 81.1% had no comorbidity, and 15.8% had interventions. RHD affects all domains and summary scores of short form 36 QOL parameters compared to normative values. Age, marital status, place of residence, presence of comorbidity, number of medications, and whether an intervention was done are associated with the QOL of these patients. Conclusion: RHD patients had poor QOL assessed by SF-36. It affects all domains and summary score of short form 36 QOL parameters. Old age, divorce, living in rural areas, associated comorbid conditions, and no intervention done are associated with poor QOL. Identification and treating comorbid conditions and intervention may improve QOL.

Assessment of Treatment Outcome and Its Associated Factors among Adult Epileptic Patients in Public Hospitals in the Southern Ethiopia: A Multi-center Cross-sectional Study.

Background: Epilepsy accounts for 0.5 % of the world's disease burden. Around 80 % of these are living in low and middle-income countries. In Ethiopia, the prevalence is 0.6 to 5 per 1000 population. There is a little study in our study area on the treatment and predictors of response of adult epilepsy. The purpose of this study was to determine the treatment outcome and its associated factors among adult epileptic patients in public hospitals in southern Ethiopia. Methods: Multi-centered, Hospital-based cross-sectional study was conducted from October 2021 - august 2022. Data were collected by face-to-face interviews and record review. Data was analysed using SPSS. The bivariate and multivariable logistic regression analyses have been performed between the dependent and the independent variables. Result: Of the total 422 participants, 55.9 % were males and 62.6% were below 30 years of age. The most common type of seizure was a generalized tonic-clonic seizure. Most (87.9 %) were treated by immunotherapy. Phenobarbitone is most common medication (77.5). One-quarter reported adverse effects of medication. The majority (78%) had good control (seizure free for at least one year) and 22% had poor control. Poor medication adherence (AOR=4.03) and shorter duration of seizure before treatment (AOR=4.233) were associated with poor control. Conclusion: A significant number of patients had poor control of seizures. Early identification of issues on medication adherence and early initiation of treatment will improve treatment outcome.

The Gasul Phenomenon Still Alive in the Developing World: A Case Report.

Background: In child, ventricular septal defect is the most prevalent congenital cardiac disease. Some ventricular septal defects have the potential for spontaneous closure. In poor nations closure based on indications may not be feasible. The patient's natural course may therefore be observed. The Gasul phenomenon, a right ventricular outflow obstruction, is one of the complications. Case Presentation: A 7-year-old child who had recurrent pneumonia, poor weight gain, and excessive sweating eventually had these symptoms go away. A large peri membranous ventricular septal defect and a small patent ductus arteriosus was detected on echocardiography during infancy. Later, the patient acquired a muscular ridge across the right ventricular outflow tract. Muscular ridge excision and closure of patent ductus arteriosus and ventricular septal defect were done. Patient was discharged in stable condition. Conclusion: Right ventricular outflow tract blockage can be avoided by performing early surgical closure of a ventricular septal defect.

Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen.

Introduction: Wandering spleen is a rare condition characterised by laxity or lack of splenic ligaments as a result of acquired or congenital causes. There is a possibility of misdiagnosis due to its vague symptoms. In order to make a proper diagnosis, imaging techniques including abdominal ultrasonography and CT scanning are essential. Surgery is the main option of management. If the spleen is viable and there is no thrombosis in the splenic veins, splenopexy is the preferred surgical procedure. Alternatively, splenectomy plus prophylactic antibiotic and vaccination usage may be employed if spleen has infarction. Case Presentation: A 12-year-old male child who had previously experienced constipation, mucoid diarrhoea, and abdominal distention arrived with crampy abdominal pain that had lasted for four days. The patient was tachycardic with abdominal tenderness. Whirlpool sign and lack of a spleen in its normal position were visualized on an abdominal ultrasound. The spleen was located intraoperatively in the lower abdomen, adhered to the ileum and appendix. It was 720° twisted and had necrotic areas. The patient underwent an appendectomy with splenectomy with a smooth post-operative course; combination meningococcal and pneumococcal vaccines were administered; and antibiotic prophylaxis was started for the patient. Conclusion: High clinical suspicion and the use of imaging modalities like ultrasound and CT scan are extremely crucial to diagnose wandering spleen and perform splenic salvage surgery because its clinical diagnosis is challenging.