Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting.

BACKGROUND: Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. METHODS: A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. RESULT: Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p < 0.005) for the intervention and control groups respectively. Overall, the mean informed consent comprehension scores for the intervention and control groups were 73.1 % and 45.2 %, respectively, with a mean difference in comprehension score of 27.9 % (95 % CI 24.0 % - 33.4 %; p < 0.001,). Mean scores for quality of informed consent for the intervention and control groups were 89.1 % and 78.5 %, respectively, with a mean difference of 10.5 % (95 % CI 6.8 -14.2 %; p < 0.001). CONCLUSION: Levels of informed consent comprehension, quality of the consent process, study recruitment and retention rates were significantly improved in the intervention group. We recommend REA as a potential modality to improve informed consent comprehension and quality of informed consent process in low resource settings.

Review paper on research ethics in Ethiopia: experiences and lessons learnt from Addis Ababa University College of Health Sciences 2007-2012.

Health research in Ethiopia is increasing both in volume and type, accompanied with expansion of higher education and research since the past few years. This calls for a proportional competence in the governance of medical research ethics in Ethiopia in the respective research and higher learning institutes. The paper highlights the evolution and progress ofthe ethics review at Addis Ababa University - College of Health Sciences (AAU-CHS) in the given context of health research review system in Ethiopia. Reflections are made on the key lessons to be drawnfrom the formative experiences of the Institutional Review Board (IRB) and their implications to the Ethiopian health research review system. This article is a review paper based on review of published and un published documents on research ethics in Ethiopia and the AAU-CHS (2007-2012). Thematic summaries of review findings are presented in thematic areas - formation of ethics review and key factors in the evolution of ethics review and implications. The IRB at AAU-CHS has been pivotal in providing review and follow-up for important clinical studies in Ethiopia. It has been one of the first IRBs to get WHO/SIDCER recognition from Africa and Ethiopia. Important factors in the successes of the IRB among others included leadership commitment, its placement in institutional structure, and continued capacity building. Financial challenges and sustainability issues need to be addressed for the sustained gains registered so far. Similar factors are considered important for the new and younger IRBs within the emergent Universities and research centers in the country.

Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system.

One of the challenges in the process of ethical medical research in developing countries, including Ethiopia, is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate, relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community, with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system.

Analysis of medical malpractice clams and measures proposed by the Health Professionals Ethics Federal Committee of Ethiopia: review of the three years proceedings.

BACKGROUND: Mediccil malpractice is professional negligence by a healthcare provider in which the treatment provided falls below the starndard and causes injury or death to the patient. OBJECTIVE: To describe the adverse medical events, claims and decisions taken by the Ethiopian Health Professionals Ethics Committee at the Federal level. METHODS: A three-year report of the Ethics Committee and relevant documents of proclamations and regulations were reviewed. RESULTS: Between January 2011 and December 2013, the committee reviewed 60 complaints against health professionals. About one third of the complaints were filed by the patients and/or their families, about 32% by the police or court and the rest were filed by Addis Ababa health bureau, health professionals and other unrelateed observers. Thirty-nine complaints were related to death of the patient and 15 complaints were about disability. Twenty-five of the claims were against Obstetric and Gynecology specialists and 9 were against general surgeons. The committee verified that 14 of the 60 claims hadethical breach and/or negligence (incompetence). The committee took reasonable time to review complaints and respond the concerned authorities. CONCLUSION: The study showed that of the total claims lower than a quarter (23.3%) were proven beyond the benefit ofdoubt. More than 3/4 (76.7) of the complaints were wrong. Hospitals should lead in preventing patient injury. Creation of more awareness among Obstetrics and Gynecology specialists, General and Orthopaedic Surgeons about medical errors is needed and special training should be given.to those joining these specialities.

Research ethics review practices: experiences of the Armauer Hansen Research Institute/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center Ethics Review Committee, Ethiopia.

The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs.

A mixed-methods study on perceptions towards use of Rapid Ethical Assessment to improve informed consent processes for health research in a low-income setting.

BACKGROUND: Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia. METHODS: Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews among health researchers and regulators including ethics committee members in Ethiopian health research institutions and universities. RESULTS: In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity (48.1%), inadequate information (34%), language barriers (28.2%), cultural differences (27.4%), undue expectations (26.6%) and power imbalances (20.7%). About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test (pilot) phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed. CONCLUSION: The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended.

Spectrum of cardiovascular diseases among Ethiopian patients at Tikur Anbessa Specialized University Teaching Hospital, Addis Ababa.

BACKGROUND: Cardiovascular disorders vary throughout the world in type and distribution especially between the developed and the developing countries. Data on spectrum of cardiovascular diseases in Ethiopia is scarce. OBJECTIVE: To assess the spectrum of cardiovascular disorders at Tikur Anbessa Specialized Tertiary Referral Hospital. METHODS: A record review of patient registers from January 2001 to December 2012 was done for 3282 Ethiopian patients with confirmed cardiovascular disorders at adult Cardiology clinic and Neurology clinic of Tikur Anbessa Specialized hospital. Spectrum of valvular heart disease, heart failure, hypertension, ischemic heart disease, congenital heart disease, arrhythmias, cardiomyopathies, cerebrovascular diseases, and peripheral vascular diseases, defined by Physician International Classification of Diseases, Version 9, codes, were directly standardized to the population. Descriptive statitistics was applied to present results. RESULTS: The study population contained more women (n = 1937 [59.0%]) than men. The mean age of the patients was 31.6 +/- 16.6 years. Women were younger than men (mean 29.6 [SD 15.1] years vs 34.52 [18.3] years). Valvular Heart Disease was the most common primary diagnosis in 2036 (62.0%) with significantly higher proportion in the 3rd decade of life. About 300 (9.1%) of the patients were diagnosed with heart failure. Other major diagnoses included hypertension 482 (14.7%), cerebrovascular diseases or stroke 377 (11.5%), congenital heart disease 279 (8.5%) and ischemic heart disease 224 (7.4%). Fifty seven (26.5%) patients with ischemic heart disease had diabetes mellitus. CONCLUSION: While valvular heart disease is the commonest cardiovascular disorder in Ethiopian patients at the largest public hospital of the country, ischemic heart disease has dramatically increased over the years. It is high-time that effective population-based, health promotive strategies for primary prevention as well as secondary measures for the established cardiovascular disorders and risk factors are in place.

Magnitude, clinical and sociodemographic correlate of depression in diabetic patients, Addis Ababa, Ethiopia.

BACKGROUND: Depression is a major factor in causing hospital admissions and deaths in persons with diabetes mellitus. So far there is no study available on depression among Ethiopian diabetic patients. OBJECTIVE: This study aimed to determine the magnitude of clinical depression in diabetic patients and its association with the various clinical and sociodemographic factors related to diabetes mellitus. METHODS: 313 diabetic patients were selected from diabetic clinics of Black Lion & St. Paul hospitals, using systematic randomized sampling technique and assessed for over a period of three months, October - December 2009. Presence and severity of depression was evaluated using clinical interviews and a structured questionnaire, the Hamilton Depression Rating Scale. RESULTS: Of the total 313 patients, females account for 58.8% (n = 184), patients having type I diabetes 37.2% (n = 116) and type 2 diabetes 62.8% (n = 197). The average duration of illness with diabetes among male patients is found to be 8.2 +/- 6 years and 10.3 +/- 8 years for female patients. The mean duration of diabetes is 9.4 +/- 7.2 years. The magnitude of depression was 61% (n = 188) with mild, moderate, severe depression occurring in 40.9%, 14.7% and 4.5% of patients respectively. In this study depression diagnosed in 52.6% (n = 61) of type 1 DM and 64.8% (n = 127) of type 2 DM, 63% (n = 116) of females and 55.8% (n = 72) males. Occurrence of depression was more in patients with diabetic complications 68.2% (n = 107) and among patients in 36-54 years age group 66.7% (n = 80) compared to the rest age groups. The diagnosis of depression was also more prevalent in those with educational status below secondary level 63.9% (n = 152), (X2 = 5.868, P = 0.0075), among those with duration of DM greater than 5 yrs, 64.2% (n = 140) (X2 = 58.52, p < 0.023). CONCLUSION: Depression is an important psychiatric co morbidity in diabetic patients. The magnitude of depression in our study is significantly higher than reports from other countries. Raising awareness about co morbid emotional disorders in such chronic illnesses and availing effective treatment for depression with the basic diabetic care at these clinics may improve glycemia and diabetic related complications.

Prevalence of highly active antiretroviral therapy associated metabolic abnormalities and lipodystrophy in HIV infected patients.

BACKGROUND: Highly active antiretroviral therapy (HAART) improves the longevity of HIV patients. However, the side effect of the drugs leads to development of chronic metabolic and cardiovascular complications. OBJECTIVE: The aim of the study was to determine the prevalence and risk factors of the metabolic abnormalities and lipodystrophy among adult Ethiopian HIV infected patients on ART for one year and above. METHODS: A cross-sectional study was conducted among HIV infected patients on HAART for one year or more, attending the ART clinics of Tikur Anbessa Specialized hospital in Addis Ababa. A total of consecutive 356 HIV infected patients volunteered to participate in the study from July 2007 to January 2008. Data was collected using clinical interview technique on structured questionnaires and physical examination of the patient, 319 had biochemical tests performed. RESULTS: Three hundred fifty six HIV patients; 261 (73.1%) females and 95 (26%) males were studied. Two hundred nine (59.7%) patients were on Stavudine based and 135 (41.3%) were on Zidovudine based ART therapy. The overall prevalence of lipodystrophy was 68.3% (243), prevalence of hyperlipademia among 319 HIV patient was 56.9% Among these, the prevalence of hypercholesterolemia was 38.2%, high LDL cholesterol was 54.2% hypertryglyceredimeia was 15.2% Fasting hyperglycemia was 17.8% (IFG in 10.9% and overt diabetes in 6.9%). History of smoking was significantly associated with lipoatrophy and lipohypertrophy. ART regimen d4T was significantly associated with lipoatrophy. Duration of ART treatment > or = 1 yr was significantly associated with both lipoatrophy, lipohypertrophy and hypertriglyceredemia. CONCLUSIONS AND RECOMMENDATIONS: Lipodystrophies occurred in majority of patients on ART treatment for longer than one year, hyperlipaedemia and hyperglycaemia were also seen commonly in Ethiopian HIV patients on HAART. We recommend careful monitoring of metabolic abnormalities, examination of the patient for early detection of the side effect, change of the offending agents management of metabolic abnormalities.

Asymptomatic bacteriuria and symptomatic urinary tract infections (UTI) in patients with diabetes mellitus in Tikur Anbessa Specialized University Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The risk of urinary tract infection in diabetic patients is higher and the etiology and the antibiotic resistance of uropathogens have been changing over the past years. OBJECTIVE: The aim of this study was to determine the prevalence of symptomatic and asymptomatic bacteriuria and assess the antimicrobial susceptibility pattern of the isolates in diabetic patients. METHODS: A prospective study was conducted during June to August 2009 on diabetic in and out-patients in Tikur Anbessa University Hospital. A total of 413 consented adult patients were enrolled in the study. Two consecutive clean-catch midstream urine samples from diabetic subjects were collected for culture. Disc diffusion method was used to assess the antimicrobial susceptibility patterns of the isolates. RESULTS: Of the 413 diabetic patients participated in the study, 181 (43.8%) were males and 232 (56.2%) were females. Of these, 107 (25.9%) were type 1 and 306 (74.1%) were type 2 diabetes mellitus. Nine (13.6%) of the symptomatic diabetic patients had bacteriuria compared with 36 (10.4%) of asymptomatic diabetes patients had bacteriuria. The overall prevalence of urinary tract infection in the diabetic patients was 45 (10.9%). The predominant isolates were Escherichia coli and Klebsiella pneumoniae isolated in 6% and 28% followed by 2% and 6% in symptomatic and asymptomatic diabetic patients, respectively. Over 85% of Escherichia coli isolates were sensitive to ciprofloxacin, amoxicillin-clavulanic acid, ceftazidime, nitrofuranton, ceftiraxone, norfloxacin and geamicin. Klebsiella pneumoniae were 100% sensitive to ciprofloxacin, ceftazidime, ceftriaxone. The rate of resistance to two or more antimicrobials was 33 (71.7%). CONCLUSION: The prevalence of urinary tract infection in this study was higher in women than in men. Escherichia coli was frequently isolated in both symptomatic and asymptomatic patients. Over 60% of the isolates were resistant to ampicillin, trimethoprim-sulphamethoxazole and tetracycline. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of the development of renal complications.

Pattern, clinical presentations and management of thyroid diseases in national endocrine referral clinics, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Thyroid diseases are common endocrine abnormalities affecting the cellular metabolism of the body. There are limited recent studies addressing the different aspects of thyroid diseases in Ethiopia. OBJECTIVES: To assess the pattern, clinical presentations, management and associated illnesses of thyroid diseases in endocrine referral clinics of Tikur Anbessa Specialized Tertiary Hospital (TASH). METHODS: A cross-sectional study was conducted on consecutive thyroid patient attending endocrine referral clinics of TASH from Nov 2009 to March 2010. Patients with thyroid diseases, 14 years of age and above, thyroid patients with other endocrine diseases were included in the study. Data were collected by trained nurses and physicians using pre-constructed questionnaires. Review of charts for patients, presenting manifestations, date of diagnosis, laboratory investigation results, treatment and other pertinent information was conducted. RESULTS: Among 376 patients with thyroid diseases, females were 337 (90%) and males were 39 (10.4%). The mean (SD) age of female participants was 43.1 +/- 15.2 males was 37.3 +/- 17.3. Age 40 and above accounted for 59%. The prevalence of Hyperthyroidism and hypothyroidism in 376 patients were 233 (61.7%) and 129 (34.3%) respectively. Toxic Multinodular Goiter occurred in 135 (35.9%), Toxic nodules in 32 (8.5%) and of Graves' disease in 65 (17.3%), Seven patients progressed from Graves' disease to Hashimoto's thyroiditis. Subclinical hypothyroidism occurred in 5(1.32%), and secondary hypothyroidism in 4 patients. Palpitation (96%), goiter (99%) and hot intolerance (81.9%) were the commonest presentations of thyrotoxicosis, whereas hypothyroidism patients presented mostly with cold intolerance (50.4%) and goiter (38%). Autoimmune polyglandular syndrome occurred in 16 (4.3%) patients. 26 (7.0%) had history of pregnancy, 82 (22.2%) had family history of thyroid diseases and seven patients had history of alcohol intake. Thyrotoxicosis was treated with Propylthiouracil (96.8%) with or with out beta blockers, thyroidectomy was done in 16 (6.8%), few received radioiodine therapy. Hypothyroidism patients were treated with thyroxin. CONCLUSION: Thyroid diseases were more common in females and more prevalent in age group of 40-49. Toxic Multinodular Goiter, Graves' disease and Toxic Nodular Goiter were causes of thyrotoxicosis. The most common presenting feature of thyrotoxicosis was palpitation, and hypothyroidism was cold intolerance. A few Graves' disease cases were progressed to hypothyroidism. Autoimmune Polyglandular Syndrome was an important associated disease. There was limited access for radioiodine treatment. RECOMMENDATION: To conduct further studies in different aspects of thyroid disease, strengthening access for radioiodine therapy and introduce anti thyroid antibody tests.

Adverse drug reactions associated with antiretroviral treatment among adult Ethiopian patients in a tertiary hospital.

BACKGROUND: Adverse drug reactions (ADRs) are frequently encountered among patients taking Antiretroviral Treatment (ART). The aim of this study was to describe the type and frequency of ADRs among adult Ethiopians on ART. OBJECTIVE: to describe the type and frequency of short term adverse drug reactions among adult Ethiopian patients on ART at Tikur Anbessa teaching Hospital in Addis Ababa, Ethiopia. METHODS: From October 2008 to December 2009, 228 HIV positive patients were enrolled to a tertiary teaching hospital in Addis Ababa. Patients were closely monitored for ADRs for a median observation period of 18 weeks (79 total person-years of observation). Time-dependent occurrence of clinical adverse effects and abnormal laboratory values as defined by the AIDS Clinical Trial Group were analyzed (41). RESULTS: A total of 392 ARV drug related ADRs occurred Mild GI disturbances (36.8%) and headache (35.9%) were the most frequently reported symptoms. Thirty (7.7%) of the ADRs were severe requiring change or interruption of therapy (19 hematological and 11 hepatotoxic). Severe hematological complications were anemia (4.8%), neutropenia (2.6%) and thrombocytopenia (0.9%). Anemia occurred earl), in the first 4 weeks of ART treatment. Hepatic toxicity was also seen early but continued throughout the observation period, decreasing over time. Other ADRs encountered were grade I/II toxicities of rash, peripheral neuropathy, and metabolic disturbances. CONCLUSION AND RECOMMENDATIONS: ADRs occurred frequently in patients receiving ART. Grade III/IV toxicity that required withholding or change of treatment occurred in nearly 10% of the patients. Regular clinical, and laboratory monitoring appropriate to centers with limited resources need to be devised to monitor toxicity of ART Patient education on the easily recognizable ADRs could also reduce severe drug toxicities.

Prevalence, Clinical Manifestations, and Treatment Pattern of Patients with Rheumatoid Arthritis Attending the Rheumatology Clinic at Tikur Anbessa Specialized Hospital, Ethiopia: A Cross-Sectional Study.

Background: Rheumatoid arthritis (RA) is an a chronic inflammatory disease characterized by symmetric polyarticular inflammation that can lead to progressive joint damage. It is said to be rare among black Africans, even though there have been limited reports from some African countries and no study has been done on RA in Ethiopia. This study determined the prevalence, clinical features, and treatment of rheumatoid arthritis in Tikur Anbessa Specialized Hospital (TASH). Methods: A cross-sectional study design was conducted on diagnosed patients with RA attending the rheumatology clinic at TASH from November 2018 to February 2019. Data was collected through patient interviews and chart reviews. The dataset was subjected to descriptive statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25. Results: A total of 1116 patients attended a rheumatologic clinic with rheumatologic complaints. The prevalence of rheumatoid arthritis was 18.5% (206/1116). Females were mostly affected (F:M 4.6:1). One hundred nineteen (57.8%) were between 35 and 64 years of age. The seropositivity for rheumatoid factor was 47.1%. Almost all patients had morning stiffness (89.8%) and joint pain (97.1%), with the majority (74.8%) having both small and large joint involvement. Nearly half of the patients, 99 (48.1%), had a joint deformity. Comorbid conditions seen in this study were hypertension (17%), overweight in 43 (20.9%), and obesity in 8 (3.9%). Methotrexate was the most prescribed agent (82.5%), both as monotherapy and along with other medications, but 139 (67.5%) of them were on prednisolone, which 2/3 (122) of patients took for 6 months in duration. Conclusion: RA accounted for nearly one-fifth of the patients coming to the rheumatology clinics, with females affected more, which is similar to reports from some African countries. Disease-modifying anti-rheumatic drugs are the most prescribed agents, but most patients are on a prolonged dose of prednisolone.

Brown tumor an uncommon and late manifestation of hyperparathyroidism: a case series done at Tikur Anbessa Specialized Hospital, Addis Ababa.

Brown tumor of hyperparathyroidism is a non-neoplastic osteoclastic process which results in cystic lesions that are often expansile. It occurs rarely and is often a late manifestation of primary hyperparathyroidism (PHPT). Multiple bone involvement is extremely rare. Because of its resemblance with benign tumors if it occurs as a solitary bone lesion and of metastatic bone lesion when it is multiple, differentiation is often difficult without biochemical analysis. Here we presented eight patients who visited Tikur Anbessa Specialized Hospital for the last 15 years with primary skeletal complaints. Out of these six were females and except one patient all had multiple brown tumors. Based on radiographic features only it is often difficult to diagnose the condition and biochemical tests and anterior neck sonography is usually crucial to reach at a definitive diagnosis. Although the occurrence of more than one separate bone lesion in the skeleton usually suggests metastasis, our cases shows that brown tumors should also be included in the differential diagnosis of such lesions, particularly in patients with hyperparathyroidism.

Trend of diabetic admissions in Tikur Anbessa and St. Paul's University Teaching Hospitals from January 2005-December 2009, Addis Ababa, Ethiopia.

BACKGROUND: The prevalence of diabetes has been shown to increase especially in developing countries, over the last decades. OBJECTIVES: We investigated the trend of diabetic admissions, indications, chronic complications, comorbidities and outcomes in Ethiopian diabetic patients. METHODS: A retrospective study was conducted in all diabetic admissions at the Department of Internal Medicine of Tikur Anbessa and St. Paul's Specialized University teaching hospitals from January 2005-December 2009. Data were collected from medical records, diabetic clinic registries, admissions, discharges and death certificates using structured questionnaires. RESULTS: Total of 724 admissions, 51.7% males and 48.3%females were analyzed Among them 375 (51.8%) patients were Type-1 diabetes, 345 (47.6%) were Type 2 diabetes and the rest three were associated with Hyperthyroidism, and one with Cushing's syndrome. The median and mean age was 27.5 years, 30.1 +/- 12.6 years and 56.00 years, 55.1 +/- 14.5 yrs (p < 0.001) for Types 1 and 2 Diabetes respectively. The median and mean duration of diabetes for Type 1 before admission was 6.00, 8.7 +/- 7.6 and for Type 2 was 10.00, 11.3 +/- 7.5.years (p < 0.001). The admission rate increased serially from 51 (7.1%) patients in year 2005 to 86 (12.0%) in 2006, 144 (20.0%) in 2007, 193 (26.8%) in 2008 and 245 (34.1%) in 2009. There was no statistical significance difference between the types of diabetes (P = 0. 73, X2 = 2.0). Eleven percent and 3.6% were admitted twice and three times respectively. Commonest cause for admission was Diabetic Ketoacidosis (DKA) (71.1%), followed by who had infections (36.3%). Among those with infection, pneumonia occurred in 67 (9.9%), UTI occurred in 55 (8.1%), diabetic foot ulcer in 70 (9.7%), tuberculosis in 42 (5.5%) other infections in 10 (1.4%) of patients. Cardiovascular diseases (CVD) occurred in 126 (18.4%) and Hypertension was found in 250 (34%), hypoglycemia in 1.2% diabetic patients. Diabetic nephropathy, retinopathy, and neuropathy accounted 32% 15.5% and 12.4% respectively. Of total deaths (10.6%), CVD accounted for 28% infections for 14.8% and DKA for 5.8% In each year of the studied period, DKA persisted to be the leading cause for admission followed by infections. CONCLUSION: This study showed the serial increment of diabetic admissions over the study period Commonest causes for admission were DKA followed by infection and cardiovascular diseases. Mainly Cardiovascular diseases were the leading causes of death in hospitalized diabetic patients. So we recommend the. health policy makers to be alarmed of the growing magnitude of Diabetes Mellitus and strengthen methods of prevention and control of Diabetes Mellitus and associated cardiovascular diseases.

The prevalence, clinical features and management of periphral neuropathy among diabetic patients in Tikur Anbessa and St. Paul's Specialized University Hospitals, Addis Ababa, Ethiopia.

BACKGROUND: Neuropathy is one of the common chronic complications of diabetes. There are many forms of diabetic neuropathy, one of which is distal symmetric polyneuropathy (DSP). There are only few data on diabetic neuropathy in Ethiopia. OBJECTIVE: The objectives of this study were to determine the prevalence of peripheral neuropathy, describe the clinical features, identify risk factors and treatment of neuropathy among diabetic patients. METHODS: A cross-sectional study was conducted at Tikur-Anbessa (TASH) and St. Paul's Specialized (SPH) University Hospitals in Addis Ababa. A total of 384 diabetic patients were selected using systematic random sampling method taking every third patients from clinics attendees from December 2009 to February 2010. Data were collected using structured questionnaires containing sociodemographic data, risk factors and UK neuropathy screening test score, Neurological examination for pain, Achilles tendon reflex, Vibration, and temperature. RESULTS: A total of 176 males and 208 females were included, 27% were type 1 and 73% were type 2 diabetic patients. The overall prevalence of distal symmetrical polyneuropathy (DSP) was 48.2% (53.6% in type 2 and 33.3% in type 1 diabetic patients). DSP was present in 37% of patient with duration of diabetes < 5yrs and 53% of those with diabetic duration > 10yrs. Autonomic neuropathy was identified in 30% of patients. Out of 185 patients with peripheral Neuropathy 136 (77%) had moderate and severe symptom scores; while 101 (58%) had moderate and severe sign scores. Type of Diabetes, duration of diabetes, systolic hypertension, and age were significantly associated with DSP (p < 0.05). Amitriptylline in 14 (28.6%), Carbamazepine in 4 (8.2%), and other NSAIDs 7 (12.2%) were used for treatment of painful neuropathy. CONCLUSIONS: Distal symmetrical polyneuropathy is common. The commonest presenting features are pain and loss of sensation. Duration of diabetes 10yrs, type 2 D, old age and hypertension were the major risk factors for DSP. Treatment of painful diabetic neuropathy was not optimal. RECOMMENDATIONSs: We recommend strengthening of routine screening for neuropathy, to emphasis on foot ulcer risk reduction, management of co-morbidities like hypertension and dyslipidemia, to optimize treatment of painful neuropathy.

Barriers in adult vitamin D service provision by health care workers: a qualitative study in three ecologies of Ethiopia.

BACKGROUND: Adult vitamin D deficiency, which is a public health problem in low-income countries, is correlated with increased mortality. Although health care workers (HCWs) in Ethiopia are educated on important minerals their counseling on the uses of vitamin D and its possible sources was not witnessed since their knowledge and practice is low. The main aim of this study is to explore barriers to good knowledge, positive attitude, and practice of health care providers on adult vitamin D. METHODS: An exploratory qualitative study is done in three ecologies covering highland, midland, and lowland. The size of 27 participants was fixed by saturation of ideas. In-depth interviews were conducted among leaders and HCWs of different professional groups in health centers and hospitals. Moderators were Ph.D. holders. An interview guide was developed after reviewing research that was translated into the local language. Interviews were audio-taped, transcribed and, translated. Open Code software was used to code and categorize the data. Themes were developed using thematic analysis which is presented using themes and sub-themes. RESULT: The main barriers are related to health systems, HCWs' understandings, and the educational system. Lack of attention by the health systems' leadership, missing adult vitamin D as a priority in health programs, lack of capacity building scheme and the absence of adult vitamin D management and treatment guidelines are barriers related to the health system. On the other hand, health care professionals believed that the prevalence of adult vitamin D deficiency is insignificant and vitamin D deficiency is only an issue related to children. Besides, the absence of studies,the focus of the medical curriculum on child vitamin D and the inadequacy of laboratory investigation are barriers related to the education system and research. CONCLUSION: Adult vitamin D deficiency is a neglected public health problem with many barriers related to diagnosis and treatment. Barriers are related to the professionals themselves, their leadership, health facilities, and the education system. The government should give attention to adult vitamin D management and treatment, continuous on the job training, development of guidelines, purchase of laboratory equipment, the inclusion of adult vitamin D in pre-service and, in-service training curriculums.

A case report of steroid cell tumour of the ovary--not otherwise specified variant with hyperandrogenism, hypercortisolism, hyperprolactinemia and hyperestrogenemia.

Here, we report a case of Steroid cell tumour of ovary--Not otherwise specified variant, who presented with evidences of hyperandrogenism, hypercortisolismn and hyperprolactinemia and hyperestrogenemnia. All hormone abnormalities were resolved after Right Salpingo-Oopherectomy.

Knowledge, attitude and practice of health care workers on measuring adult vitamin D level, diagnosis of deficiency, and management of consequent health conditions in three ecologies of Ethiopia: a cross-sectional study.

BACKGROUND: Vitamin D is essential for health and its shortage exacerbates overall mortality. Health care workers (HCWs) need to educate on its uses and sources although studies indicate their low level of practice. The main aim of this study is therefore to assess the knowledge, attitude and practice of measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs in Ethiopia. METHODS: This study was conducted in three ecologies covering lowland, midland and highland districts. A total of 405 health care workers with different levels were interviewed. Tablets were used for data collection to archiving in a cloud server. Data were exported to Stata version 14 software for cleaning and analysis. Rates were computed and the Chi-square test was used to compare differences between the two groups. Binary logistic regression was used to measure the strength, direction and significance of the association between different covariates and the practice of HCWs. RESULT: The level of knowledge, positive attitude and good practice in measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs was 210 (51.8%), 261(63.5%) and 195(47.4%) respectively. The odds of good practice in the provision of adult vitamin D service were AOR = 6.87: 95% CI (3.57, 13.21) and AOR = 2.20: 95% CI (1.23, 3.92) times higher among HCWs in Addis Ababa and highlands compared with those working in lowlands. Good practice among clinicians was AOR = 4.26: 95% CI (1.48, 12.25) times higher compared with those working in leadership positions. The likelihood was AOR = 1.96: 95% CI (1.19, 3.23) times higher among those with good knowledge compared with those with poor knowledge. Besides, good practice in adult vitamin D service provision was AOR = 2.30: 95% CI (1.40, 3.78) times higher among those with positive attitude compared with those who had negative attitude. CONCLUSIONS: A little over half of HCWs have good knowledge and close to two-thirds of them have positive attitude while less than half of them have good practice on adult vitamin D deficiency. Besides, HCWs' residential ecology, clinical position, knowledge and attitude is associated with good practice on adult vitamin D. It is essential to provide rigorous and continuous training for HCWs focusing on their deployment ecology.

A case report of chronic tetanus.

Here, we report a case of tetanus who presented with five months of symptoms and signs suggesting the presence of unusual presentation of tetanus so called chronic tetanus. The available literature on this a typical presentation and difficulty in the diagnosis is briefly discussed.