Implementation status of the nationally harmonized competency-based, integrated, modular medical curriculum in Ethiopia: opportunities and challenges.

BACKGROUND: Well-designed curriculums are crucial for quality education. This study aimed to assess the implementation status of a harmonized competency-based medical curriculum (CBMC) in Ethiopia, as well as identify the associated challenges and benefits. METHODS: A mixed-method approach was used. Data collection took place from September 1, 2023, to October 15, 2023. Eleven medical schools were randomly selected from a list of 28 public medical schools in Ethiopia. Participants were purposively chosen from selected medical schools using a controlled sampling method. A total of 121 participants took part in the survey. Interviews and focus group discussions were conducted with key informants to complement the quantitative findings. Descriptive statistics, such as frequencies and percentages, were used to summarize the quantitative survey responses. Thematic content analysis was used to analyze the qualitative data. RESULTS: The implementation of a CBMC in Ethiopian public universities faces various challenges and provides opportunities. Around 22% of respondents mentioned that the whole group session (WGS) had never been implemented in their school. Regarding community-based learning (CBL), 64.6% of respondents noted that it was intermittently implemented in their institution. Only 32% of respondents considered students' clinical exposure during preclerkship years to be reasonable. Interestingly, approximately 73% of respondents stated that problem-based learning (PBL) activities were regularly conducted in their school. Around 68% of respondents believed that competency-based assessment methods were moderately utilized. While many participants perceive the curriculum as having positive content alignment and structure with intended learning outcomes, challenges related to practical sessions, resource limitations, and uneven access to training opportunities persist. Resource constraints are a prominent challenge. The opportunities identified include early clinical exposure and enhanced communication skills. CONCLUSIONS: This survey highlights the need for ongoing curriculum evaluation and fine-tuning to ensure its success.

Magnitude and factors associated with musculoskeletal disorder among patients with diabetes attending chronic care at Arba Minch General Hospital, Arba Minch, southern Ethiopia, 2021: a cross-sectional study.

OBJECTIVE: This study aimed to assess the prevalence and determinants of musculoskeletal disorders (MSDs) among patients with diabetes in southern Ethiopia. DESIGN: Facility-based cross-sectional study. SETTING: Data collected from 1 March 2021 to 30 August 2021 at Arba Minch General Hospital. PARTICIPANTS: Three hundred and sixty-five patients with diabetes attending care at Arba Minch General Hospital. MAIN OUTCOME MEASURES: The magnitude and determinants of the MSDs. RESULTS: The prevalence of MSDs among patients with diabetes was 23.29% (95% CI 19.00 to 27.76). The likelihood of developing MSDs was 6.8 times higher among women than men (AOR=6.787, 95% CI 2.08 to 22.19). Rural participants were about 2.4 times (AOR=2.38, 95% CI 1.06 to 5.33) more likely to develop MSDs as compared with urban participants. Participants aged >50 years were 5.9 times more likely to develop MSDs as compared with those aged ≤50 years (AOR=5.864, 95% CI 2.663 to 12.914). The odds of developing MSDs was 6.2 times (AOR=6.247, 95% CI 1.158 to 33.702) and 5.5 times (AOR=5.451 95% CI 1.174 to 25.312) higher among participants who attended primary and secondary education as compared with those who attended college and above, respectively. Participants with cardiovascular disease were 3.9 times more likely to develop MSDs as compared with their counterparts (AOR=3.854, 95% CI 1.843 to 8.063). CONCLUSIONS: This study showed that age, sex, educational status, place of residence and cardiovascular disease were found to be determinants of MSDs. Thus, clinical and public health interventions working on diabetes mellitus should consider these determinants.

Evaluation of Dermatoglyphic Features of Type 2 Diabetic Patients as Compared to Non-Diabetics Attending Hospitals in Southern Ethiopia.

Background: Diabetes mellitus (DM) is a complex metabolic disorder characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 DM has a strong hereditary background. A study of the dermatoglyphic features can help in the early identification of people with a genetic predisposition to develop type 2 DM. Purpose of the Study: The study was aimed to compare the finger and palmar dermatoglyphics features in type 2 diabetic and non-diabetic patients and to evaluate the association with other variables. Patients and Materials: Institution-based cross-sectional study was conducted in one referral hospital and three primary hospitals located in Gedeo Zone. Three hundred ninety study participants (130 type 2 diabetics and 260 non-diabetics) from adult OPD and diabetic clinics were included in the study. The association among different dermatoglyphics variables was analyzed using the chi-square test. An independent t-test was conducted to analyze the mean difference and to test the significance of numerical variables. A statistically significant association was declared at P-value <0.05. Results: In the present study, a total of 3900 digits (1300 from type 2 diabetic and 2600 non-diabetic) were analyzed for distribution of digital dermatoglyphic patterns. Loop pattern is found to be the commonest in both study groups with a prevalence of 65.8% and 60.7% among type 2 diabetics and non-diabetics, respectively. Both the right-left axial tri-radius angle was significantly higher in type 2 diabetes mellitus patients compared to non-diabetic study participants. Total finger ridge counts and absolute finger ridge counts showed no significant difference in both groups. Conclusion: The study revealed Loop pattern was more frequent in type 2 DM compared to non-diabetic study participants. Whorl type was more common than arch type in non-diabetic patients compared to type 2 DM groups. The result also showed tri-radius angle is significantly wider in diabetic groups in both hands.

Prevalence and Associated Factors of Carpal Tunnel Syndrome Among Diabetic Patients in Arba Minch General Hospital, South West Ethiopia, 2021.

Purpose of the Study: This study aimed to assess the prevalence of carpal tunnel syndrome and associated factors among diabetic patients in Arba Minch General Hospital, Southwest Ethiopia. Carpal tunnel syndrome (CTS) is the second most common cause of absence from work which causes functional loss of the hands and leads to disability. However, it is understudied among diabetic patients in Ethiopia. Patients and Materials: An institution-based cross-sectional study was conducted from May 1 to October 1, 2021. Systematic random sampling method was used to select 353 study participants. CTS-6 Evaluation tool was applied to assess carpal tunnel syndrome. The data was coded and entered into Epi-Data version 3.1 statistical packages and exported to SPSS version 25 for analysis. Binary logistic regression model was applied to assess the association between outcome variable and independent variables. Odds ratio (OR) with 95% CI and p-values <0.05 were used to identify significantly associated factors with an outcome variable. Results: The study was conducted among 353 diabetic patients. The cumulative prevalence of carpal tunnel syndrome among diabetes was 3.1%. CTS was statistically significantly associated with high body mass index; AOR=0.34 (0.12, 0.97, 95% CI) (p=0.04. Majority of participants 322 (91.2%) had type 2 DM. Mean fasting blood sugar level ± standard error of study participants was 157.52 ± 1.91 mg/dl. Conclusion: The prevalence of carpal tunnel syndrome was relatively low. High body mass index (BMI) was significantly but negatively associated with carpal tunnel syndrome compared to diabetic patients with normal BMI. Diabetic patients with normal BMI should be screened for CTS for early management of the disease and prevention of further complications. Further investigations are recommended.

Patterns of superficial veins in the cubital fossa and its clinical implications among southern Ethiopian population.

Cubital fossa is the site where the venous accesses are frequently made. Superficial veins at this site display variations in their pattern among different populations. Knowledge of different venous pattern in the cubital fossa is important for diagnostic, surgical and therapeutic procedures. The purpose of this study was to report variations of the cubital superficial vein patterns in the southern Ethiopian subjects. An institution based cross-sectional study design was employed among 401 randomly selected patients presented at the triage room of Arba Minch General Hospital from January 15 to February 15, 2021. A questionnaire was used to collect socio-demographic data and images of the common and variant superficial venous patterns were recorded. Descriptive statistical analysis was performed. P<0.05 was considered as statistical significance. In the present study, a total of 802 cubital fossae from 401 study participants were examined. Five patterns of superficial veins were identified. Type 2 was the most common pattern and observed in 55.0% of cubital fossae (42.1% right and 67.8% left cubital fossae). The least common, type 5 variant was detected in 2.6% cubital fossae (2.7% right and 2.5% left). Statistically significant association based on sex and laterality was noted. The current study concluded that type 2 and type 3 patterns were more frequent superficial venous patterns in the cubital fossa and more common in males than female. Awareness of these uncommon cubital venous patterns and their incidence is very useful for those performing venipuncture or venisection especially under emergency conditions.

Ultrasonographic Determination of Portal Vein Diameter Among Adults with and without Chronic Liver Disease at Selected Referral Hospitals in Southern Ethiopia.

BACKGROUND: Measuring portal vein diameter (PVD) is a feasible method of detecting portal vein hypertension, which is a primary and fatal complication of chronic liver disease (CLD) and is usually diagnosed very late. However, there is a paucity of morphometric information on portal vein diameter in the Ethiopian population. Hence, it is important to determine the portal vein diameter among adults with and without chronic liver disease. PURPOSE: The study aimed to identify how PVD is affected by age, sex, and anthropometric measurements in patients with and without CLD. METHODS: A cross-sectional study was conducted among 220 participants (110 CLD patients and 110 controls) who have visited the radiology unit at selected Hospitals. Patients with CLD were selected consecutively as they present while controls were selected by a systematic sampling technique. A structured questionnaire was used to collect the data. Correlation and independent t-test were used to assess the relations. A statistically significant association was declared at P-value <0.05. RESULTS: Mean portal vein diameter for CLD patients was 17.03±1.97 mm with a range of 12.8-20.8mm and 10.79±1.27mm with a range of 7.70-13.25mm for the control group. Age, weight, and body mass index had a positive correlation with portal vein diameter in both groups. The mean portal vein diameter increased by 21.34% during deep inspiration in the control group. CONCLUSION: The mean portal vein diameter among patients with CLD was higher than that of the control group. A significant gender-based difference was recorded in the portal vein diameter of the control group only. Ultrasonography is a non-invasive, readily available diagnostic tool for portal vein pathology. RECOMMENDATION: It is recommended for clinicians to take into consideration age, sex and anthropometric measurements while measuring PVD.

Placental and Umbilical Cord Indices and Their Association with Fetal Distress in Hadiya Zone Public Hospitals, Southern Ethiopia: A Cross-Sectional Study.

BACKGROUND: The placenta and umbilical cord have been considered as significant contributors to the perinatal outcome and have contributed to some degree to neonatal mortality. The placenta has a very crucial role in normal fetal development. After about four weeks of gestation, the only link of the fetus to the placenta is the umbilical cord. Very little is known about placental and umbilical indices in Ethiopia. This study was aimed to determine placental and umbilical cord indices and their association with fetal distress in Hadiya zone public hospitals, southern Ethiopia. METHODS: This study included 249 placentae with the attached umbilical cord from normal singleton live birth with known gestational age. Bivariable and multivariable logistic regression was used, and variables with p < 0.25 in the bivariable analysis were entered into a multivariable logistic regression to identify the independent factors for the outcome variable. Odds ratios with 95% confidence were computed, and statistical significance was declared at p-value <0.05. RESULTS: Three-fourth (75.9%) of diameter of studied placenta was in normal range and 18.1%, 6.0% below and above normal range, respectively. About one-third (32.9%) of umbilical cords were short, 61.8% normal, and 5.2% long. Newborns with thin placenta [AOR = 3.43; 95% CI: 1.25, 9.40], short cord length [AOR = 3.43; 95% CI: 1.66, 7.09] and long cord length [AOR = 7.55; 95% CI: 2.07, 27.53] were significantly associated with fetal distress. CONCLUSION: In this study, deviation of umbilical cord length from the normal range and placental thickness were significantly associated with fetal distress. In addition, fetal distress was also associated with gestation age and sex of the newborn.

Magnitude, pattern and management outcome of intestinal obstruction among non-traumatic acute abdomen surgical admissions in Arba Minch General Hospital, Southern Ethiopia.

BACKGROUND: Intestinal obstruction is defined as a blockage or partial blockage of the passage of the intestinal contents. It is a potentially risky surgical emergency associated with high morbidity and mortality. Its pattern differs from country to country and even from place to place within a country. Therefore, this study aimed to find out the magnitude, pattern and management outcome of intestinal obstruction in Arba Minch General Hospital. METHODS: A retrospective cross-sectional study was conducted in Arba Minch General hospital from January 09, 2015, to November 09, 2018. The data collection period was from December 15, 2018, to February 09, 2019. A simple random technique was applied to select 801 study participants. Then, the required data entered into Epi Info version 7.2.1.0 and exported to the statistical package for the social sciences software package version 20 for analysis. The binary logistic regression analysis has been done to determine crude statistical associations between independent variables and dependent variables. Linearity, Multivariate normality and multicollinearity were checked between independent and dependent variables by using scatter plot and Q-Q plot respectively. Variables with a p-value of less than 0.25 in the binary logistic regression analysis were entered into multivariable logistic regression. Statistical significance factors were identified based on a p-value of < 0.05 and with a 95% confidence interval. RESULT: This study revealed that the overall magnitude of intestinal obstruction was 40.60% with 95% CI (34.95-45.95). The magnitude of unfavorable management outcomes and deaths during the study period were 22.3% with 95% CI (18.00-27.00) and 7.1% with 95% CI (4.00-10.00) respectively. Persistent tachycardia 10.3 (3.28-32.42), Dehydration 13.7 (3.34-56.56), elevated serum creatinine 10.2 (1.89-54.94), gangrenous small bowel volvulus 2.7 (1.27-5.84), ischemic bowel 3.4 (1.17-9.81) and perforated bowl 7.68 (2.96-19.93) were significantly associated with the management outcome of intestinal obstruction. CONCLUSION AND RECOMMENDATION: Intestinal obstruction was the most common among all acute abdomen cases and its management outcome highly associated with dehydration. Adequate early preoperative resuscitation and proper post-operative care with appropriate surgical techniques and wound care with sterile techniques would help to reduce further mortality. This could be achieved by increasing public awareness of health-seeking behavior. Moreover, health facilities capable of handling patients with small bowel obstruction should be available within the reach of the community.