Proportion Of vitiligo and associated factors among patients visiting dermatology opd in tibebe ghion specialized hospital and addisalem primary hospital, bahirdar city, Ethiopia,2023.

OBJECTIVE: This study aimed to determine the prevalence of vitiligo and associated factors among patients visiting the dermatologic outpatient departments at Tibebe Ghion Specialized Hospital and Addisalem Primary Hospitals, Bahir Dar, Ethiopia, from September 15 to November 15, 2023. RESULTS: Among the 460 patients studied, 243 (52.8%) were female, with the majority (28.9%) aged between 25 and 34 years. The overall prevalence of vitiligo was found to be 7.4% (34 patients). Significant predictors of vitiligo included rural residence (AOR: 3.18; 95% CI: 1.10-9.18), family history of vitiligo (AOR: 2.20; 95% CI: 2.16-4.76), and aggravating factors such as trauma (AOR: 1.08; 95% CI: 1.01-2.08). The highest prevalence was observed in the 14-24 age group. These findings suggest the importance of awareness campaigns focusing on the causes, symptoms, and treatments of vitiligo, particularly among young adults in rural areas.

[Securing the management of medicines at risk in a geriatric hospital: A comprehensive approach]. / La prise en charge des médicaments à risque dans un hôpital gériatrique.

High-risk drugs, which are potentially a source of serious adverse reactions, are a major concern in healthcare establishments, particularly for geriatric patients, who often have multiple medications and co-morbid conditions. With a view to continuously improving the quality and safety of care, we have embarked on a proactive approach aimed at identifying, securing and improving the management of medicines at risk in geriatric wards.

Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia.

BACKGROUND: Distal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate. METHODS: This prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer's scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations. RESULTS: In our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer's scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union. CONCLUSION: Closed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early.

Coronavirus disease-19 vaccine uptake, willingness for vaccination, and associated Factors among chronic follow patients attending in the two comprehensive specialized hospitals of Bahir Dar, Ethiopia.

BACKGROUND: Even though the disease has spread throughout the world, with millions killed, global COVID-19 vaccination coverage remains low, particularly in developing countries. However, epidemiological data is lacking in the area. Hence, this study aimed to assess COVID-19 uptake, willingness for vaccination, and associated factors. METHOD: A hospital-based cross-sectional study was conducted from May 1 to June 30, 2022, among patients attending chronic follow-up clinics in the two comprehensive specialized hospitals in Bahir Dar. The total sample size was 423. Participants were selected by a systematic random sampling technique. Data was gathered using a pre-tested questionnaire and analyzed using SPSS version 23. A descriptive analysis was performed. A binary logistic regression analysis was done to assess the association between variables. Variables with a p-value < 0.05 in the multi-variable logistic regression with a 95% confidence interval were considered statistically significant. RESULTS: The analysis included 400 out of 423 participants, representing a 95% response rate. The COVID-19 vaccination uptake was 46.8%, while the acceptance was 60.5%. About 56% and 68% of the respondents had good knowledge and a favorable attitude, respectively. Elderly people were 2.7 times more likely to be vaccinated. Similarly, urban residents were 3.94 times more vaccinated. The probability of being vaccinated among respondents with good knowledge and favorable attitudes was 70% and 79%, respectively. The willingness for vaccination increased among those individuals with favorable attitudes (AOR: 1.82). Urban people were less likely to accept vaccination (AOR: 0.46). Some participants misunderstood that vaccination may aggravate their disease condition. CONCLUSION: The overall COVID-19 vaccine uptake and acceptance for vaccination were low compared to what was estimated by the WHO. Age, residence, knowledge, and attitude were associated with COVID-19 vaccine uptake and acceptance of vaccination. Besides, there was a high level of rumor about the status of the vaccine and risk factors. Hence, special emphasis is warranted to deliver centrally trusted information. Moreover, further nationwide studies are warranted in the future.

Prevalence and antimicrobial susceptibility pattern of Klebsiella pneumoniae isolated from various clinical specimens at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: K. pneumoniae become multidrug-resistant (MDR) and commonly poses a serious health threat to patients due to limited therapeutic options. As a result, determining the prevalence and antimicrobial susceptibility patterns of K. pneumoniae isolates from clinical specimens is substantial to patient diagnosis and treatment. METHODS AND MATERIALS: A retrospective cross-sectional study was conducted from July 2021 to July 2022 at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Sociodemographic and laboratory data were collected from registered books using a data collection sheet. All types of samples were collected and processed using standard procedures. Identification of K. pneumoniae was done using Gram stain, colony characterization on culture media, anda series of biochemical tests. Antimicrobial susceptibility testing was done by the Kirby Bauer disc diffusion technique. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. RESULTS: Among 2600 clinical specimens, 735 (28.3%) were positive for bacteria, and K. pneumoniae isolates accounted for 147 (20%). Most of them were isolated from neonates and mainly obtained from blood specimens (81.6%). These isolates were 100% resistant to Nalidixic acid, Cefotaxime, and Cefazolin. About 84% and 83.3% of the isolates were also resistant to Ceftriaxone and Tetracycline, respectively. However, they are sensitive to Nitrofurantoin (86.6%), Imipenem (85.7%), Meropenem (79%), and Amikacin (78.3%). The overall proportion of MDR K. pneumoniae isolates accounted for 57.1%. CONCLUSION: The magnitude of MDR K. pneumoniae was very alarming. Therefore, strengthening antimicrobial stewardship programs and antimicrobial surveillance practices is strongly recommended in the study area.

Predictors for the incidence of pneumonia among HIV-infected children on antiretroviral therapy in Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia: a multicenter retrospective follow-up study.

BACKGROUND: Human Immune deficiency Virus (HIV) infected children are at higher risk of developing pneumonia. Particularly, in the early phase of HIV infection, the risk of acquiring pneumonia is high, and it remains a major public health problem even after the test and treatment strategy. There is no clear evidence of the overall incidence of pneumonia among HIV-infected children in Amhara region. Aimed to assess the incidence of pneumonia and its predictors among HIV-infected children receiving Antiretroviral therapy in Amhara Region Comprehensive Specialized Hospitals, 2022. METHODS: A multicenter retrospective follow-up study was conducted from June 10, 2014, to February 28, 2022, among 430 HIV-positive children receiving antiretroviral therapy. A simple random sampling technique was used. The data was taken from the national antiretroviral intake and follow-up forms. The data were collected via the KoBo toolbox and analyzed using Stata version 17. The Kaplan-Meier curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of pneumonia and a P-value < 0.05 was considered significant in to multivariable analysis. RESULTS: A total of 407 children with a record completeness rate of 94.7% were analyzed in the study. The incidence rate of pneumonia was 4.55 (95% CI; 3.5, 5.92) per 100 person-years observation. The mean survival time was 77.67 months and the total times at risk during follow-up period were yielding 1229.33 person-year observations. Having CD4 cell count below threshold [AHR; 2.71 (95% CI: 1.37, 5.35)], WHO stage III and IV [AHR: 2.17 (95% CI: 1.15, 4.08)], ever had fair and poor treatment adherence [AHR: 2.66 (95% CI: 1.45, 4.89)], and not initiated antiretroviral therapy within seven days [AHR: 2.35 (95% CI: 1.15, 4.78)] were the positive predictors for incidence of Pneumonia. CONCLUSIONS: In this study, the incidence of pneumonia was lower than the previous studies. CD4 cells below the threshold, ever had fair and poor adherence to antiretroviral therapy, WHO stage III and IV, and not initiated antiretroviral therapy within seven days were significant predictors. Therefore,, it is crucial to detect baseline assessment and give attention to those identified predictors promptly, and timely initiation of antiretroviral therapy need special attention.

Length of hospital stay and associated factors among adult surgical patients admitted to surgical wards in Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia.

INTRODUCTION: Hospitals across the country are facing increases in hospital length of stay ranging from 2% to 14%. This results in patients who stay in hospital for long periods of time being three times more likely to die in hospital. Therefore, identifying factors that contribute to longer hospital stays enhances the ability to improve services and quality of patient care. However, there is limited documented evidence on factors associated with longer hospital stays among surgical inpatients in Ethiopia and the study area. OBJECTIVE: This study aimed to assess the length of hospital stay and associated factors among adult surgical patients admitted to surgical wards in Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia, 2023. METHODS: An institutional-based cross-sectional study was conducted among 452 adult surgical patients from April 17 to May 22, 2023. Data were collected based on a pretested, structured, interviewer-administered questionnaire, medical record review, and direct measurement of BMI. Study participants were selected using a systematic random sampling technique. The collected data were cleaned, entered into EpiData version 4.6.0 and exported to STATA version 14 for analysis. Binary logistic regression analysis was used. Variables with a p value <0.05 in the multivariable logistic regression analysis were considered statistically significant. RESULTS: In the current study, the prevalence of prolonged hospital stay was 26.5% (95% CI: 22.7, 30.8). Patients referred from another public health facility (AOR = 2.65; 95% CI: 1.14, 6.14), hospital-acquired pneumonia (AOR = 3.64; 95% CI: 1.43, 9.23), duration of surgery ≥110 minutes (AOR = 2.54; 95% CI: 1.25, 5.16), being underweight (AOR = 5.21; 95%CI: 2.63, 10.33) and preoperative anemia (AOR = 3.22; 95% CI: 1.77, 5.86) were factors associated with prolonged hospital stays. CONCLUSION: This study found a significant proportion of prolonged hospital stays among patients admitted to surgical wards. Patients referred from another public health facility, preoperative anemia, underweight, duration of surgery ≥110 minutes, and hospital-acquired pneumonia were factors associated with prolonged hospital stay. Early screening and treatment of anemia and malnutrition before surgery can shorten the length of stay.

Incidence of mortality and its predictors among preterm neonates in nigist eleni mohammed memmorial comprehensive specialized hospital, Hossana, Ethiopia: a prospective follow-up study.

BACKGROUND: Preterm birth is the leading cause of neonatal mortality accounting for 35% of all neonatal deaths worldwide, and the second most frequent cause of death for under five children. Despite different efforts, preterm neonatal mortality is still persistently high in Ethiopia. Little is known about death and its predictors among preterm neonates in the study area. OBJECTIVE: This study is aimed at estimating the incidence of mortality and its predictors among preterm neonates admitted to the NICU of NEMMCSH. METHODS AND MATERIALS: A hospital-based prospective follow-up study was conducted from January to November 2022. A total of 197 preterm neonates were selected consecutively and followed. The Kaplan-Meier survival and failure curves were used to describe the proportion of deaths over time and to compare groups. The independent effects of covariates on the hazard of death were analyzed using a multivariable Cox proportional hazard model. RESULTS: Preterm neonates were followed for 1840 person-days. The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 (95% CI: 19.65, 34.61) per 1000 person days. Preterm neonates of mothers with eclamsia (AHR = 3.03), preterm neonates who have not received KMC (AHR = 2.26), and preterm neonates who have not exclusively breastfed (AHR = 4.4) had higher hazards of death as compared to their counterparts. CONCLUSION AND RECOMMENDATION: The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 per 1000 person days. Eclamsia, KMC, and exclusive breastfeeding were significant predictors of death among preterm neonates. The role of KMC in reducing mortality rates and improving outcomes has to be emphasized for mothers and families. Caregivers have to ensure that mothers and families receive adequate support and resources to facilitate KMC, including access to lactation support, counseling, and assistance with practical aspects of caregiving. Counseling and practical support to enhance exclusive breastfeeding initiation and continuation have to be strengthened. Special attention has to be given to the preterm neonates of mothers with eclampsia.

Burden and bacterial etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

BACKGROUND: Meningitis poses a significant challenge to public health in low-income nations, such as Ethiopia, with a particular impact on newborns. The magnitude and etiologies of meningitis vary based on geographic location and age of patients. There is limited data regarding the magnitude and etiology of meningitis from Sidama Regional State, Ethiopia. This study aimed to determine the magnitude and bacterial profile of meningitis among newborns aged less than 90 days at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS: A retrospective cross-sectional study was conducted among newborns under 90 days who were suspected of meningitis at HUCSH from January 2019 to July 2023, and for whom Cerebrospinal fluid (CSF) culture was performed. At HUCSH, bacteria are isolated and identified using standard microbiological techniques. Socio-demographic characteristics and culture results were extracted from the laboratory register. Data were entered into Excel and exported it to SPSS version 20 for analysis. RESULTS: Overall 1061 newborns suspected of meningitis were included in the study. Among the participants, 767 individuals (72.3%) fell within the age range of 8 to 90 days. Of the total participants, 437 (41.2%) were females. The magnitude of culture-confirmed meningitis was 90(8.5%) 95% CI: 6.8%-10.1%. The magnitude of culture-confirmed meningitis among newborns aged 0-7 days and 8-90 days were 1.6% and 6.9% respectively. The proportion of bacteria among newborns aged 0-7 days and 8-90 days were 18.9% and 81.1% respectively. Coagulase-negative Staphylococci (CONS) were the most common bacteria (n = 26; 28.9%) recovered followed by Acinetobacter species (n = 12, 13.3%), Escherichia coli (n = 9; 10%), and Klebsiella pneumoniae (n = 7; 7.8%). K. pneumoniae was the predominant bacteria among newborns within the age group of 0 to 7 days while Acinetobacter species was the most common among newborns within the 8 to 90 days age group. The prevalence of culture-confirmed neonatal meningitis was found to be greater in male newborns (x2 = 1.74, p = 0.18), newborns aged between 8 to 90 days (x2 = 0.07, p = 3.4), and newborns admitted in 2022 (x2 = 2.4, p = 0.66). CONCLUSIONS: In this study, the overall magnitude of culture-confirmed meningitis was relatively high. Culture-confirmed meningitis was high in newborns within the age range of 8 to 90 days. The most common bacteria were CONS in both age groups followed by Acinetobacter species, E. coli, and K. pneumoniae.

Evaluation of the implementation fidelity of comprehensive emergency obstetric and newborn care at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a mixed-method evaluation.

BACKGROUND: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia. METHOD: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria. RESULTS: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services. CONCLUSIONS: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines.

Survival and predictors of mortality among colorectal cancer patients on follow-up in Hawassa University Comprehensive Specialized Hospital, Sidama region, Southern Ethiopia, 2022. A 5-year retrospective cohort study.

BACKGROUND: The incidence and mortality of colorectal cancer were still rising rapidly in many low-income and middle-income countries, which was linked to ongoing societal and economic status. Colorectal cancer is the leading cancer in Ethiopia with relatively lower survival. However, colorectal cancer patients' survival time and predictors have not been well studied in Southern Ethiopia. OBJECTIVE: This study aimed to assess five-year survival and predictors of mortality among colorectal cancer patients at Hawassa Comprehensive Specialized Hospital, Ethiopia. METHOD: Facility-based retrospective cohort study was conducted among 323 patients who visited Hawassa Comprehensive Specialized Hospital from May 1st, 2017 to April 30th, 2022. The Kaplan-Meier survival curve with the Log-rank test was used to estimate the survival time. Bivariable and multivariable Cox proportional hazards regression models were used to determine the net effect of each independent variable on time to death after diagnosis. RESULT: Over the 5-year observation period, the overall mortality rate was 38.5%, with an incidence density of 31 fatalities per 100 person-years observation. Survival at 1, 2, 3, 4, and 5 years was 78%, 53, 32.4%, 23.3%, and 18.7% respectively. The multivariable analysis showed that metastatic disease (AHR = 4.2, CI: 1.5-11.5), baseline carcinoembryonic antigen level ≥5ng/ml (AHR: 2.4, CI: 1.2-5.8), living in rural areas (AHR = 2.2, CI:1.03-4.8) and mucinous carcinoma (AHR = 0.33, CI: 0.13-0.87) were independent predictors of colorectal cancer mortality. CONCLUSION: Overall survival of colorectal cancer patients in the study was low compared to similar studies in developing and developed worlds. A significantly low survival rate was observed for patients with advanced stage, elevated carcinoembryonic antigen levels, and rural residents indicating the key role of early detection and timely initiation of treatment to improve survival and quality of life of patients with colorectal cancer.

Prevalence and associated factors of lipodystrophy in type 1 diabetic children and adolescents at Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia.

INTRODUCTION: Lipodystrophy can cause poor glycemic control in addition to cosmetic problems in children and adolescents with type 1 diabetes mellitus. However, data on its prevalence and associated factors is scarce among children and adolescents who live in developing countries like Ethiopia. OBJECTIVE: To determine the prevalence and identify associated factors of lipodystrophy in children and adolescents with type 1 diabetes mellitus who visited the endocrinology clinic of Ayder Comprehensive Specialized Hospital between May 1 and July 31, 2020. METHOD: This was an institution-based cross-sectional study conducted on 57 children and 65 adolescents with type 1 diabetes mellitus who had been taking insulin injections for a year or more. The dependent variable was lipodystrophy. A pretested, structured questionnaire was used to collect data related to lipodystrophy and other characteristics. The principal investigator oversaw the data collection, which was done by pediatric and child health specialty residents with training. Data was subjected to descriptive statistics, and predictors of lipodystrophy were identified by fitting a multivariable logistic regression model. Statistical significance was declared at p < 0.05. RESULTS: More than half (53.3%) of patients were in the age range of 13 to 17. The male-to-female ratio was almost 1:1. Educational status for 63.1% of patients was primary school. Four-fifths of patients were residing in urban areas. Of the 122 participants, 60 (49.2%) had lipodystrophy (48.3% lipohypertrophy and 0.8% lipoatrophy), with grade II lipohypertrophy being the most common type at 81.7%. The thigh was the most common site of lipodystrophy. In multivariable regression analysis, the long duration of insulin injection (AOR = 3.6, 95% CI, 1.5 to 9.0, p = 0.005) and inappropriate rotation of the injection site (AOR = 9.0, 95% CI, 2.2 to 37.0, p = 0.002) were significantly associated with lipodystrophy. HbA1c testing was conducted for 70 patients, and poor glycemic control (HbA1c ≥ 7%) was found in 43 (61.4%) of them. Patients with lipodystrophy were more likely to have poor glycemic control (75%) than those without lipodystrophy (47.1%) (p = 0.016). CONCLUSION: The prevalence of lipodystrophy was comparable with other studies. Long duration of insulin injection and improper rotation of the injection site are associated with an increased risk of lipodystrophy. Patients with lipodystrophy were more likely to have poor glycemic control, defined by higher HgA1c, than those without lipodystrophy. Proper education of patients and their parents must include correct injection techniques, rotating injection sites, and changing injection sites intermittently to lessen the risk of developing lipodystrophy.

Visual outcome of penetrating ocular trauma among patients visiting University of Gondar comprehensive specialized hospital.

Ocular trauma, a preventable public health issue, is one of the common causes of ophthalmic morbidity and monocular blindness worldwide. It can occur in almost any setting and at any age in either sex but largely affects males. The mechanism and type of injury, the extent of damage, and the time-lapse between the occurrence of injury and eye care are among the factors that determine the visual outcome of ocular injuries. This study is designed to assess the clinical profile and visual outcome of patients presenting with penetrating ocular injury. A prospective hospital-based study was conducted among penetrating ocular trauma patients who visited UOG tertiary eye care and training center during the study period. All patients with penetrating ocular trauma who fulfilled the inclusion criteria were included in the study. Data on demography, initial and final visual acuity, type of injury, as well as management, were included in a structured questionnaire. The collected data were processed and analysed using Statistical Packages for the Social Sciences (SPSS) version 25.0. The study included 91 cases of penetrating ocular injuries. The majority of the patients 81.2% were males. The male-to-female ratio was 4.3:1. The left eye was involved in 52.7% of the patients. The median age was 20 years, with an IQR of 10-35. The majority (31.9%) of the cases were in the age range of 5-10 years. nearly half of the study participants (45.1%) sustained the injury at home. The commonest source of injury was wooden sticks 49.5%. Six patients were lost to follow-up at three-month visits. Traumatic cataracts (p = 0.001), and poor initial visual acuity were poor prognostic factors. Still ocular injury is a common cause of monocular blindness. We recommend that more has to be done on the primary prevention and control measures.

Surgical management of pancreatic cancer in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a 5 years retrospective descriptive study.

INTRODUCTION: The incidence of Pancreatic cancer is different in different parts of the world. It is a cancer with the worst prognosis of all malignancies. Pancreatic cancer is predominantly a disease of an older population. There are different environmental (modifiable) and non-modifiable risk factors associated with the development of pancreatic cancer. At present, surgical resection is the only potential cure for pancreatic cancer. However, as only 10-20% of the patients have resectable disease at the time of diagnosis. The morbidities associated with surgeries for pancreatic cancers remain high though the post-operative mortality has shown significant reduction in the past few decades. So far, no study has been conducted to investigate pancreatic cancer in Ethiopia. OBJECTIVES: To assess the clinico-pathologic profile, associated factors, surgical management and short-term outcome of patients with pancreatic cancer in Tikur Anbessa Specialized hospital. METHODS: A 5 years retrospective hospital-based cross-sectional study was conducted on 52 patients operated with the diagnosis of pancreatic cancer with either curative or palliative intents. The study period was from April 2016 to July 2021. The data collected includes demographic profile, associated risk factors and comorbidities, clinical presentations, biochemical parameters, pathologic features of the tumors as well as type of treatment offered and short term treatment outcome. The data was analyzed using SPSS version 25. RESULT: The mean and median age of patients was 54.1 and 54.5% respectively. Males constitute about 52% the patients. 21% of the patients have potential risk factors; whereas only 10 (19.2%) of the patients had medical comorbidities. Median duration of symptoms at diagnosis was 12 weeks. Abdominal pain (88.5%) was the most common presenting symptom followed by anorexia (80.8%) and significant weight loss (78.8%), while 71.2% of the patients have jaundice. On clinical evaluation, 69.2% were jaundiced, while 34.6% had a palpable gallbladder. More than two third of patients presented with advanced disease. 76.9% of the tumors are located in the head of pancreas. More than three quarters (77%) of the surgeries performed were palliative. Postoperative morbidity and mortality were 19.2% and 3.8% respectively. CONCLUSION: Age at first diagnosis of pancreatic cancer is relatively earlier in our setup. Most patients present with advanced condition, only amenable for palliative measures. The post-operative morbidity and mortality are more or less comparable with similar studies. The need for adjuvant therapy in pancreatic cancer should be emphasized.

Time to first optimal glycemic control and its predictors among adult type 2 diabetes patients in Amhara Regional State comprehensive specialized hospitals, Northwest Ethiopia.

BACKGROUND: Inadequate glycemic management in type 2 diabetes Mellitus patients is a serious public health issue and a key risk factor for progression as well as diabetes-related complications. The main therapeutic goal of preventing organ damage and other problems caused by diabetes is glycemic control. Knowing when to modify glycemic control in type 2 diabetes Mellitus is crucial for avoiding complications and early drug intensifications. METHODS: An institutional based retrospective follow-up study was undertaken among 514 eligible adult diabetes patients in Amhara region Comprehensive Specialized Hospitals, Northwest Ethiopia, from January 2017 to January 2022. Simple random sampling technique was used to select study participants. The Kaplan Meier curve was used to assess the survival status of categorical variables, and the log-rank test was used to compare them. The cox proportional hazard model was fitted to identify the predictors of time to first optimal glycemic control. Variables with a p-value < 0.05 were considered to be statistically significance at 95% confidence interval. RESULTS: A total of 514 patient records (227 males and 287 females) were reviewed in this study. The median time to first optimal glycemic control among the study population was 8.4 months IQR (7.6-9.7). The predictors that affect the time to first optimal glycemic control were age group ((AHR = 0.63, 95% CI = 0.463, 0.859 for 50-59 years), (AHR = 0.638, 95% CI = 0.471, 0.865 for 60-69 years), and (AHR = 0.480, 95% CI = 0.298, 0.774 for > = 70 years)), diabetes neuropathy (AHR = 0.629, 95% CI = 0.441,0.900), hypertension (AHR = 0.667, 95% CI = 0.524, 0.848), dyslipidemia (AHR = 0.561, 95% CI = 0.410, 0.768), and cardiovascular disease (AHR = 0.681, 95% CI = 0.494, 0.938). CONCLUSION: The median time to initial optimal glycemic control in type 2 diabetes Mellitus patients in this study was short. Age between 50 and 59 years and 60-69, diabetes neuropathy, hypertension, dyslipidemia, and cardiovascular disease were predictor's of time to first glycemic control. Therefore, health care providers should pay extra attention for patients who are aged and who have complications or co-morbidities.

Poor visual outcome and associated factors among patients underwent cataract surgery at Debre Markos and Felege Hiwot comprehensive specialized hospitals, Northwest Ethiopia, 2023.

OBJECTIVE: This study aimed to determine the proportion of poor visual outcome and associated factors among adult patients who underwent cataract surgery at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals in northwestern Ethiopia in 2023. METHODS: A hospital based cross-sectional study was conducted on 418 adult patients who had undergone cataract surgery from June 07 to August 07, 2023. Patients were recruited using systematic random sampling with an interval of 2. A pre-tested semi-structured questionnaire, medical record review, and ophthalmologic examination were used to collect data. The collected data was entered into Epi-info version 7 and exported to SPSS version 25 software for analysis. Binary logistic regression was used to determine the factors associated with poor visual outcomes of cataract surgery. Variables with a p-value of less than 0.05 in the multivariable binary logistic regression were considered statistically significant. RESULTS: A total of 408 study participants with a median age of 65 years and a response rate of 97.6% took part. The proportion of poor visual outcomes of cataract surgery from 4 weeks to one year was 25.7% (95%CI: 21.6%, 30.3%). Factors responsible for poor visual outcomes of cataract surgery were intraocular lens implantation without a posterior chamber (AOR = 2.91, 95%CI:1.46,5.80), per-existing central corneal opacity (AOR = 3.83, 95%CI:1.52,9.69), pseudoexfoliation (AOR = 3.91,95%CI:1.39,11.88), age-related macular degeneration(AOR = 3.75, 95%CI:1.22, 11.88), glaucoma (AOR = 3.11, 95%CI:1.06,9.17) and striate keratopathy(AOR = 3.4, 95%CI: 1.11, 10.88). CONCLUSION: In this study, the proportion of poor visual outcomes of cataract surgery is higher than the World Health Organization recommendation. The study found that implantation of an intraocular lens without a posterior chamber, pre-existing central corneal opacity, pre-existing age-related macular degeneration, pre-existing glaucoma, pseudoexfoliation, and striate keratopathy were significantly associated with poor visual outcomes of cataract surgery. We recommend that ophthalmologists and cataract surgeons prioritize the reduction of surgical complications and pre-existing ocular co-morbidities to enhance post-operative visual acuity. Improving pre-operative assessment and refining surgical techniques like phacoemulsification will aid in achieving this goal.

Self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Self-efficacy is the ability to execute, and it is a critical predictor of health-related outcomes among people living with human immunodeficiency virus (PLHIV). Self-efficacy directly determines treatment outcome. However, there is no evidence on the self-efficacy of PLHIV for self-management in Ethiopia. Currently, HIV is considered a manageable chronic disease. However, the burden remains high despite all the taken measures. OBJECTIVES: This study aimed to assess the self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), northwest Ethiopia, 2022. METHODS: A cross-sectional study was conducted on PLHIV selected by a systematic random sampling technique using an interviewer-administered questionnaire at the UOGCSH from August 10 to September 30, 2022. The data was entered and analyzed using the Statically Package for Social Science version 25.0. Categorical variables were summarized as frequency (percentage) of the total. Both descriptive and inferential statistics, such as the Kruskal-Wallis H test and Mann-Whitney U test were performed to detect difference. P-value < 0.05 was considered to indicate statistically significance. RESULTS: Overall, 405 PLHIV participated in the study, giving a 96% response rate. The overall median (Interquartile range) self-efficacy score of PLHIV for self-management was 22 (4) and 67.4% of the PLHIV self-efficacy score was above the median. A statistically significant difference was detected between the social support groups (χ2 (2) = 37.17, p < 0.0001), education background (U = 10,347, Z = 2.279, P = 0.023, r = 0.113), living conditions (U = 12,338, Z = 2.457, P = 0.014, r = 0.122) and medication adherence (U = 9516.5, Z = 3.699, P < 0.0001, r = 0.184). CONCLUSION: Most participants' self-efficacy score was above the median. Statistically significant differences in self-efficacy were observed based on individual, environmental, and clinical factors. We suggest training and workshops for healthcare workers and the hospital and adherence support groups should work to improve the self-efficacy of PLHIV.

Determinants of virological failure among HIV clients on second-line antiretroviral treatment at Felege-hiwot and University of Gondar comprehensive specialized hospitals in the Amhara Region, Northwest Ethiopia: A case-control study.

BACKGROUND: Second-line HIV treatment failure has become increasing worldwide, mainly in sub-Sahara Africa including Ethiopia. Even though the problem becomes increasing, inadequate information was available about its magnitude and associated factors in the current study area. OBJECTIVE: To assess the factors of second-line Anti-Retroviral Treatment virological failure among second-line ART users. METHOD AND MATERIALS: Institutional-based unmatched case-control study design was conducted from September to December 2021 at Felege Hiowt and University of Gondar Comprehensive Specialized Hospitals; Amhara region, Northwest Ethiopia. A total of 216 patients (60 cases and 156 controls) were recruited by a simple random sampling technique with a 1:3 cases-to-controls ratio. Patients who had two viral load results >1000 copies/ml within a 3-month interval after taking ART drugs for at least 6 months were cases and those who had ≤1,000 copies/ mL were controls. The sample size was calculated by using Epi-Info version 7.2.4. Structured questionnaires were used to gather the required information. SPSS version 26 was used to summarize the findings. In bivariate logistic regression model, Variables with two-tailed P-value ≤ 0.25 at 95% confidence interval were transferred into multivariate binary logistic regression model and P value at ≤ 0.05 was set as statistically significant. RESULTS: Out of 216 patients recruited, 212 have participated with a response rate of 98.2%. From these participants, 117(55.2%) were males and 187(88.2%) were urban dwellers. Among the total respondents, 208(98.1%) had age > 24 years, 200(94.3) were at HIV clinical stage I, 72(34%) had poor ART adherence and 112(52.8) did not disclose their HIV status. Likewise, most of the patients 147(69.37) didn't use condoms. The associated factors were not disclosing HIV status (AOR = 3.4, 95% CI: 1.52-7.79), medium adherence (AOR = 3.7, 95% CI = 1.3-10.7), poor adherence level (AOR = 5.27, 95% CI: 2.2-12.5), not using condoms (AOR = 4.47, 95% CI: 1.63-12.2) and Viral load (>150 copies/ml) when switched to second-line ART (AOR = 3.56, 95% CI: 1.5-8). CONCLUSION AND RECOMMENDATIONS: Non-disclosure, poor or medium adherence, not using condoms and high Viral load (>150 copes/ml) when switched to second-line ART were the main factors for second-line Anti-Retroviral Treatment virological failure. Disclosure about HIV status, using condoms and improving treatment adherence level are crucial to reduce second-line virological failure.

Prevalence of pressure ulcers and associated factors among adult patients admitted at Comprehensive Specialized Hospital, Northwest Ethiopia, 2023.

Pressure ulcers are a serious concern in patients with prolonged bedtime and present with common complications following surgery. It is one of the key performance indicators of the quality of nursing care provided to patients. Several studies have reported the prevalence of pressure ulcers in Ethiopia, but the current study area has not yet been fully addressed. Hence, the study aims to assess pressure ulcers and their associated factors among adult patients admitted to the surgical ward. An institution-based, cross-sectional study was conducted from April 15 to May 15, 2023. A systematic random sampling technique was used to select 480 patients. A standardized, pre-tested, and structured questionnaire was used. The results were presented descriptively using tables and figures. A binary logistic regression was used to assess associated factors. From a total of 480, all patients have participated with a 100% response rate. The prevalence rate of pressure ulcers was 10.2%. Being smoker [95% CI AOR 7.46 (2.64, 21.06)], bedridden [95% CI AOR 3.92 (1.28, 11.66)], having a length of hospital stay of greater than 20 days [95% CI AOR 3.01 (1.13, 8.02)], experiencing pain [95% CI AOR 3.20 (1.06, 7.51)], or having friction and shear [95% CI AOR 5.71 (1.91, 17.08)], were significantly associated with pressure ulcers. This study showed that a considerable proportion of patients had pressure ulcers. Smoking, having pain, being bedridden, being exposed to friction and shear problems, and length of hospital stay were significantly associated with pressure ulcers. Healthcare providers should educate patients about smoking risks, pain management, mattress installation, and linen care.

Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023.

Acute kidney injury (AKI) is characterized by a sudden decline in the kidneys' abilities to remove waste products and maintain water and electrolyte homeostasis. This study aims to determine the incidence and predictors of acute kidney injury among neonates with perinatal asphyxia admitted at the neonatal intensive care unit of West Amhara Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Multicentred institution-based retrospective follow-up study was conducted from October 1, 2021, to September 30, 2023, among 421 perinatal asphyxia neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.0. and analyzed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of Acute kidney injury. Statistical significance was declared at a p ≤ 0.05. The overall incidence of AKI was 54 (95% CI 47.07-62.51) per 100 neonate days. C/S delivery (AHR = 0.64; (95% CI 0.43-0.94), prolonged labor (AHR = 1.43; 95% CI 1.03-1.99) low-birth weight times (AHR = 1.49; (95% CI 1.01-2.20), stage three HIE(AHR: 1.68; (95% CI (1.02-2.77), No ANC follow up (AHR = 1.43; 95% CI 1.9 (1.07-3.43) and Hyperkalemia (AHR = 1.56; 95% CI 1.56 (1.05-2.29); 95% CI) were significant predictors. The incidence rate of acute kidney injury was higher than in other studies conducted on other groups of neonates. Cesarean section delivery, prolonged low birthweight, no Anc follow-up, stage 3 HIE, and neonatal hyperkalemia were predictors of acute kidney injury. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention to these predictors.