Epidemiology and clinical characteristics of breast cancer in Ethiopia: a systematic review.

BACKGROUND: According to GLOBOCAN 2020 Breast cancer is the most common cancer among women and the prevalence is increasing worldwide and in Ethiopia. This review assessed studies conducted in Ethiopia on the clinical features and epidemiology of breast cancer. METHODS: Data base search conducted PubMed, Google Scholar African Journals Online (AJOL), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Hinari without time restrictions. The search keywords included; prevalence and pattern, clinical presentation, histological and molecular subtypes, and management. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to identify, search, extract articles, and report this systematic review. The protocol was registered in PROSPERO, ID: CRD42023403320. RESULTS: Twenty studies were included in the review with 33,369 participants and 3 were community-based and 17 were hospital-based. In all except two reviewed studies, breast cancer is the most common cancer among women of Ethiopia. The most frequent presenting symptom was a breast lump/mass and commonly affected side was right breast. Most patients presented at a late stage and they were premenopausal age group. The commonest histology type is ductal carcinoma, that the most prevalent receptor was estrogen receptor positive, and the most common molecular subtype was Luminal A in pathology samples. Surgery is main stay of treatment and the most common surgical technique practiced in Ethiopia is modified radical mastectomy. CONCLUSION: Breast cancer incidence is rising, and it accounts for the major cancer burden in the country. There is a need for additional awareness-raising and health education because delayed presentation are critical problems throughout Ethiopia. For planning and monitoring cancer patterns, comprehensive demographic and clinical data from a population or facility-based registry are needed in the regions. The available treatment options are still limited in Ethiopia it needs infrastructural development.

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis).

BACKGROUND: Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. METHODS: We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. RESULTS: We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. CONCLUSION: To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.

Impact of COVID-19 and mitigation plans on essential health services: institutional experience of a hospital in Ethiopia.

BACKGROUND: Health systems around the world are being challenged by an on-going COVID-19 pandemic. The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself, especially in resource-poor countries such as Ethiopia. This study aimed to explore the impact of the pandemic on these services and measures taken to combat the effect. METHODS: The study was conducted at St. Paul's hospital millennium medical college (SPHMMC) from December 15, 2020 to January 15, 2021 using a comparative cross-sectional study design. We collected data on the number of clients getting different essential health care services from May to October 2019 (Pre COVID) and the same period in 2020 (during a COVID-19 pandemic) from the patient registry book. The analysis was done with SPSS version 24 software. RESULT: Overall, the essential services of SPHMMC were affected by the COVID-19 pandemic. The most affected service is inpatient admission, which showed a 73.3% (2044 to 682) reduction from the pre-COVID period and the least affected is maternal service, which only decreased by 13% (3671 to 3177). During the 6 months after the COVID-19 pandemic, there was a progressive increment in the number of clients getting essential health services. CONCLUSION AND RECOMMENDATION: The establishment of a triple setup for fighting against COVID-19, which encompasses non-COVID services, an isolation center and a COVID-19 treatment center, played a vital role in preserving essential health services.

Improving Completeness of Surgical Inpatient Medical Records in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

INTRODUCTION: One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients' medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention. METHODS: surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards. RESULT: A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p < 0.05). CONCLUSION AND RECOMMENDATION: Study has shown that small and persistent quality improvement interventions that focus on continuous evaluation, leadership engagement, and innovative strategies bring significant improvement in record completeness.

Review of Breast Abscess Cases at a Tertiary Hospital in Addis Ababa, Ethiopia.

Background: Breast abscess is a prevalent cause of morbidity in women occurring in 0.4% to 11% of patients after mastitis. The majority are benign, but worrisome etiologies such as inflammatory cancer and concomitant immune-compromising diseases should be addressed when a non-lactating patient presents with a breast abscess. The problem is high among women in developing countries (1). The purpose of this study is to assess the magnitude, clinical presentation, and treatment of breast abscess patients at a tertiary hospital. Methodology: A descriptive cross-sectional study was conducted on all patients treated for breast abscesses from September 2015 to August 2020. A retrospective review of the clinical records was performed to collect data on sociodemographic, clinical, and management data using a data extraction form. The collected data were then cleaned and entered into SPSS for analysis. Results: Two hundred and nine patients were included in this study over 5 years and lactational breast abscess (LBA) is more prevalent,182 (87.1%) than non-lactational breast abscess (NLBA), 27 (12.9%). Bilateral breast abscesses occurred in 16 (7.7%) patients. Patients presented at a median duration of 11 days and had been breastfeeding for 2 or more months. A spontaneously ruptured abscess was detected in, 30 (14.4%) of the patients. Comorbidities identified include diabetes mellitus (DM) in, 24 (11.5%), Hypertension in, 7 (3.3%), HIV in, 5 (2.4%) of patients. All women were treated with Incision and Drainage and had a median volume of 60 mL of pus drained. Following surgery, all patients were given ceftriaxone in the immediate post-operative days and either cloxacillin,167 (80.3%), or Augmentin,41 (19.7%) antibiotics p on discharge. Follow-up data were available for 201 (96.1%) patients and the recurrence rate was 5.8%. Conclusions and Recommendations: Lactational breast abscesses are more common than non-lactational breast abscesses, particularly in primiparas. DM is the most common comorbidity in non-lactational breast abscesses and health-seeking behavior should be improved given the delayed presentation.

Reduction of In-Hospital Preoperative Waiting Time of Elective Surgeries in the Amidst of COVID-19 Pandemic: Experience from Ethiopia.

Background: The higher demand for surgical services during the advancement of the COVID-19 pandemic has resulted from the need for a pre-admission negative result, the need for extra resources, and a shortage of skilled expertise. This quality improvement project aimed to reduce the in-hospital preoperative waiting time of elective cases to less than 24 hours. Methods: The study was conducted in a tertiary care center. Following the collection of baseline data, we formed a multidisciplinary team to analyze the root causes and intervention ideas of delay using fishbone and driver diagrams, respectively. We prioritize key drivers and implemented several low-cost interventions using Plan-Do-Study-Act (PDSA) model. We monitored the average in-hospital preoperative waiting time of patients. Results: Overall, in-hospital preoperative waiting time for elective cases has been reduced from a baseline of 4.89 days to 1.32 days on average by the end of 10 months of initiating the project. Similarly, monthly elective case cancellation rate due to COVID-19-related reason has been reduced from baseline 62.5% of the total cancellation to 0%. Due to this, the average monthly inpatient bed utilization has increased from 2.21 patients per month during pre-COVID-19 period to 5.9 patients per month in each bed of the surgical ward by the end of the project. Conclusion: The implementation of a quality improvement project can optimize operation theatre efficiency, inpatient bed utilization, and reduce the surgical backlog. Meticulous and rigorous effort has to be laid down to do root cause analysis, generate feasible change ideas, and continuous follow-up, and testing of multiple PDSA cycles is required to impact an improvement and sustain it in the long run. The emergence of COVID-19 pandemic could be used as an opportunity to reduce the length of stay in the hospital.

Prevalence of H. Pylori in Perforated Peptic Ulcer Disease at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: Helicobacter Pylori is the most common cause of peptic ulcer disease with disputable association with perorated Peptic Ulcer disease (PPD). This study aims to determine magnitude of Helicobacter Pylori in PPD and the outcomes of treatment, at Saint Paul Hospital Millennium Medical College (SPHMMC). METHOD: Between January 9, 2013 and February 7, 2018, all patients operated for PPD were recruited retrospectively. Data was extracted from patient's medical records using pretested questionnaire. Data analysis was done by SPSS version 20. RESULT: During the 5 years, 46 patients fulfilling inclusion criteria were included in the study. H. Pylori test was positive for stool antigen in 10 (21.7%) and serology eleven (23.9 %) of patients. Overall, nineteen (41.3%) of patients had positive result regardless of the type of test used. Out of 46 patients, twenty-six (56.5%) patients were given eradication therapy and thirty-four (73.9%) patients were given PPI alone or as a part of eradication therapy. During their hospital stay, five (10.9%) patients developed deep and superficial surgical site infection and two (4.3%) of patients have died. CONCLUSION: The prevalence of H. Pylori among PPD patients in this study is lower compared to most studies. Further prospective studies should be conducted in the future to understand association with H. Pylori and provide recommendations on eradication treatment.

Use of Failure Mode and Effect Analysis to Reduce Admission of Asymptomatic COVID-19 Patients to the Adult Emergency Department: An Institutional Experience.

BACKGROUND: Failure mode and effect analysis is an important tool to identify failures in a system with its possible cause, effect, and set actions to be implemented proactively before the occurrence of problems. This study tries to identify common failure modes with its possible causes and effect to the health service and to plot actions to be implemented to reduce COVID-19 transmission to clients, staff, and subsequent service compromise from asymptomatic COVID-19 patients visiting the adult emergency department of SPHMMC (non-COVID-19 setup). METHOD AND STUDY DESIGN: A multidisciplinary team, representing different divisions of the adult emergency department at St. Paul's Hospital Millennium Medical College (SPHMMC), was chosen. This team was trained on failure mode and effect analysis and basics of COVID-19, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure, and plan changes in practice. RESULTS: A total of 22 failure modes and 89 associated causes and effects were identified. Many of these failure modes (12 out of 22) were found in all steps of patient flow and were associated with either due to lack of or failure to apply standard and transmission-based precautions. This suggests the presence of common targets for improvement, particularly in enhancing the safety of staff and clients. As a result of this FMEA, 23 general improvement actions were proposed. CONCLUSION: FMEA can be used as a useful tool for anticipating potential failures in the process and proposing improvement actions that could help in reducing secondary transmissions during the pandemic.

Quality of Life in Patients Living with Stoma.

BACKGROUND: Background and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study aims to assess stoma related quality of life. METHODS: A cross-sectional study was done at St. Paul's Hospital millennium Medical College from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on sociodemographic variables, type, and indications of the stoma. Data was collected using structured questionnaire adopted from the City of Hope and Beckman Research Institute after modifications to make it in line with the Ethiopian context. RESULTS: The mean score for the overall quality of life for stomata was 7.42 ± 0.53. Around 70% of patients have adjusted their dietary style due to stoma. More than half of them reported feelings of depression following stoma surgery. Only 34% of patients resumed sexual activity and only 11% were satisfied with it. None of them were enrolled in stoma association or support group. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall quality of life and its subscales (P < 0.05). CONCLUSIONS: This study demonstrated that living with stoma has a greater impact on the overall aspect of quality of life.

Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area. OBJECTIVES: The aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. METHODS: A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014-September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. The collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data. RESULTS: A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD = 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6-10 postoperative days. The majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation. CONCLUSION: The current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate.

Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia.

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking. METHODS: A facility based cross sectional study was conducted at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants' opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants' opinion about the morbidity and mortality conferences. RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations. CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia.

BACKGROUND: Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years. METHODS: A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016-Dec 30, 2018. RESULT: There were 10,259 admissions over three years and out of which there were 350 deaths between 2016-2018 making a crude mortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively. CONCLUSION: The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period.

A Giant Egg-like symptomatic Loose Body in the Peritoneal Cavity: A Case Report.

BACKGROUND: Peritoneal loose bodies are rare lesions that are usually found as an incidental finding during abdominal surgery. Large loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. Peritoneal loose bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity. CASE PRESENTATION: We report here the first case, in the local Ethiopian context, of a giant "egg-like" loose peritoneal body measuring 7 × 6 cm found in a 50-year-old man who presented with a cramping abdominal pain and features of abdominal obstruction. The current hypothesis as regards these bodies and the diagnostic challenges is discussed. CONCLUSION: Small peritoneal loose bodies are common but giant and symptomatic ones', like the one discussed here, are very rare and a diagnostic challenge. And, in the context of intestinal obstruction, a high index of suspicion is needed in order to diagnose them.