Assessment of adverse events among healthcare workers following the Janssen COVID-19 vaccine in Tigray, Ethiopia.

Apart from the inequality in vaccination, war zones and areas where communication is disrupted are affected by myths and misconceptions about COVID-19 vaccines, heightening vaccine hesitancy. Local data on adverse events of the vaccines and their mildness can increase confidence and acceptance of the vaccines in the respective population. In areas of conflict and communication blackouts, the perception of the vaccines by health workers is of paramount importance as public health recommendations may not reach the public. Therefore, the scientific evaluation of adverse events following COVID-19 vaccination in such areas is invaluable. This cross-sectional, facility-based study was conducted using a structured, interviewer-administered questionnaire to assess the adverse events experienced by healthcare workers who received the Janssen COVID-19 vaccine. The sample was divided proportionally to the number of vaccinated healthcare workers for the different healthcare professions, and participants were then randomly selected from each profession. Prior to data collection, a pilot test was conducted with 5% of the sample size outside the selected hospital. The study was conducted using a structured questionnaire completed by an interviewer to assess adverse events in 442 healthcare workers who had received the Janssen COVID-19 vaccine between July 11 and 25, 2022. The study period was from August 15 to September 15, 2022. A significant number of healthcare workers [366 (83.3%); 95% CI 79.5%, 86.5%] experienced at least one adverse event. Nearly 90% of participants reported that the adverse events were mild to moderate. Pain at the injection site [307 (69.5%); 95% CI 65.0%, 73.6%] and headache [247 (55.9%); 95% CI 51.2%, 60.4%] were the most common local and systemic adverse events, respectively. Two HCWs experienced anaphylactic reaction. Younger age was significantly associated with the occurrence of adverse events. We deciphered that the adverse events reported by the study participants were not different from the typically occurring vaccine-related adverse reactions, and therefore concluded that post-vaccination reactions in healthcare workers were minor. Although vaccination in Tigray is currently stalled due to the siege, responsible stakeholders should develop a mechanism to track population-wide adverse events once the vaccines start to rollout.

Maternal mortality during war time in Tigray, Ethiopia: A community-based study.

OBJECTIVE: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. DESIGN: Community-based cross-sectional study. SETTING: Tigray region of Northern Ethiopia, between November 2020 and May 2022. POPULATION: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. METHODS: The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. MAIN OUTCOME MEASURES: Maternal mortality ratio level and cause-specific mortality. RESULTS: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. CONCLUSIONS: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.

Thyrotoxicosis and dilated cardiomyopathy in developing countries.

BACKGROUND: Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia. METHODS: An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at p < 0.05. RESULTS: Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89-38.16, p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04-7.15, p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning ß-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery. CONCLUSIONS: In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.