TRENDS IN CARDIOVASCULAR DISEASE OVER TIME: A 30-YEAR RETROSPECTIVE ANALYSIS OF MEDICAL-ICU ADMISSIONS IN ADDIS ABABA, ETHIOPIA.

BACKGROUND: Increased urbanization with change in lifestyle in many developing countries exposed them to the challenge of double disease burden, battling with the existing communicable infectious diseases as well as the emerging epidemic of NCDs. OBJECTIVE: To describe trends of medical intensive care unit admission over thirty years in Ethiopia. METHODS: MICU registries at Tikur Anbessa Specialized Hospital over a thirty year period were examined for discharge diagnosis. Data included for analysis were selected at ten-year interval of equivalent six- months' period from December to May of 1981/82, 1991/92, 2001/02 and 2011/12. Variables included were age, gender, residence, discharge diagnosis, duration of stay in hospital, discharge status, admission date, and admission source. Obtained data were cleaned, coded, recoded and edited. The analysis was done using SPSS 15.0 statistical soft ware. RESULTS: A total of 500 cases are included for analysis. Among these 284 (57%) were male. The mean age was 40.2 ± 18 years rangingfrom 13 to 87 years. The aggregate cardiovascular disease, other non communicable disease and infectious disease as a cause of admission in the past thirty years were 213 (42.6), 141 (22.8), 105 (20.0) respectively. Unlike the other disease category cardiovascular disease increased steeply over the past thirty years. Overall case fatality rate at MICU was 31.6% ranging from 24.8% of other-NCD to 46.7% of infectious diseases. CONCLUSION: Cardiovascular disease has steeply increased till it became predominant in the last decade at MICU of TASH.

Characteristics and management of patients with acute coronary syndrome at Tikur Anbessa Specialized Hospital, Addis Ababab, Ethiopia.

BACKGROUND: Evidence based clinical guidelines have provided clinicians with an increasing tool for management of hospitalized patients. However, large differences in the management of patients with acute coronary syndrome observed across the globe. OBJECTIVE: To determine spectrum of severity, practice patterns and half-year outcomes of patients hospitalized with acute coronary syndrome in Ethiopia. METHODS: All charts from patients admitted to the intensive care unit of Tikur Anbessa Specialized Hospital over a six months period in 2011/12 were examined for discharge diagnosis of acute coronary syndrome. Complete data for these patients was collected for analysis. A total of 21 cases with complete data were included for analysis. RESULTS: Among a total of 21 patients, 16 (65.2%) were males. The mean age was 57.1 +/- 13.7 ranging from 33 to 80 years. All those patients had cardiac biomarkers and electrocardiography (ECG), 14 (66.7%) had echocardiography and only 2 (9.6%) patients had coronary angiography. Based on diagnostic result 13 (62%) patients had ST-elevation myocardial infarction (STEMI), 6 (28.6%) had non-ST elevation myocardial elevation (NSTEM) 1 and 2 (9.5%) had unstable angina. All were given anti-platelets and statin but none of them got thrombolytics. Three (14.4%) patients died after two weeks of hospitalization. CONCLUSION: Unavailability of reperfusion therapy with high rate of mortality and less diagnosis of non ST-elevation acute coronary syndrome were seen. Implementation of evidence-based medications and interventions, including reperfusion therapy is needed.

Prevalence and determinants of hypertension in rural and urban areas of southern Ethiopia.

BACKGROUND: Hypertension is an important public health challenge in both economically developed and developing countries. OBJECTIVE: To asses the magnitude of hypertension in rural and urban southern Ethiopia. PATIENTS AND METHODS: A cross sectional survey was conducted on 979 study participants in Sidama Zone, South Ethiopia from November 1-30, 2008. Data were collected using a structured questionnaire and standardized procedures recommended by the WHO MONICA project for the measurement of the anthopometric variables. Analysis was done using SPSS 15.0 version. RESULTS: Out of 979 participating subjects. 485 were from urban and 494 were from rural. The prevalence of hypertension was 9.9% with 10.1% in urban and 9.7% in rural areas ranging from 4.2% in those below 30 years to 29.4% in those above 60 years. Bivariate analysis showed hypertension was highly occurred more in those above 30 years old, in those with the family history of hypertension, and a BMI > or =25 kg/m2. Hypertension also correlated with, less physical activity, extended family size, personal and family history of diabetes mellitus, measured dysglycemia, excess meat consumption and drinking alcohol. Multivariate analysis showed similar correlation of increased possibility of hypertension with being over 30 years, having a family history of hypertension, a BMI > or =25 kg/m2. and excess meat consumption. Tea drinking was found as a protective factor for hypertension on bivariate and multivariate analysis. CONCLUSIONS: Hypertension has equal public health importance in urban and rural settings of southern Ethiopia. Hypertension is common among those age over 30years. overweight, consume excess meat and have family history of hypertension. Drinking tea may have a protective effect for hypertension.

Factors affecting adherence of antiretroviral treatment among AIDS patients in an Ethiopian tertiary university teaching hospital.

BACKGROUND: Higher level of antiretroviral adherence is associated with improved virological, immunological and clinical outcomes. Despite the availability of few studies in sub Saharan Africa the factors for poor adherence are diverse. OBJECTIVE: To determine adherence factors for antiretroviral treatment in Hawassa University teaching hospital in southern Ethiopia. PATIENTS AND METHODS: A cross sectional study was undertaken on total of 510 AIDS patients seen over one month period Data were collected using a structured questionnaire and analysis was done using SPSS 15.0. RESULTS: Out of interviewed patients 88.2% of them had > or = 95% and 97.1% of them had > or =80% antiretroviral adherence rate by self report over one month period. The major reasons for missing drugs in 79.8% were forgetting to take drug, gastrointestinal symptoms, give priority for praying, being hopeless and inadequate adherence counseling Significant predictors of poor adherence were lower level of knowledge about adherence, absence of job and 'Sidamnigna' as primary language. It is also observed that trend of adherence decreased as level of education decrease. CONCLUSIONS: Adherence rate found in this study is higher than many developed and developing countries and equivalent to other studies done in Ethiopia. Those who speak local language, jobless and having low education level may require intensive counseling to optimize their adherence.

Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening.

BACKGROUND: Auscultation-based surveys in Ethiopia conducted in the late 1990's reported a rural prevalence of 4.6/1000 and an urban prevalence of 6.4/1000 of rheumatic heart disease (RHD). With echo-based screening, we aimed to estimate the national prevalence of RHD in school children by taking school-based samples from six regions across the country using the 2012 World Heart Federation echocardiographic criteria. PATIENTS AND METHODS: We conducted a cross-sectional echocardiographic screening of RHD in school children aged 6-18years from 28 randomly selected primary and secondary schools found in six different geographic regions of Ethiopia. We used the standardized WHF echocardiographic criteria. RESULTS: A total of 3238 children (48.5% females) were screened. The mean age was 13.2±3.2years. Of these, 44 patients (1.4%) met the WHF criteria for definite RHD, while 15 (0.5%) met the criteria for borderline disease, yielding a prevalence of 19 [13.9-23.4, 95% CI] cases per 1000 school children between the ages of 6-18years. The majority of those who tested positive were girls (26/44). The prevalence was lowest in children aged 6-9years and otherwise uniformly distributed across ages 10-18years. Definite RHD involved the mitral valve in 42 subjects, 39 of whom had mitral regurgitation and 3 with mitral stenosis. The aortic valve was affected in 6 children. The ratio of definite to borderline cases was 2.9. CONCLUSION: This study demonstrated a consistent pattern of high prevalence of asymptomatic RHD with definite disease predominating over borderline involvement across six regions of Ethiopia.