Predictors of infective endocarditis associated in-hospital mortality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Microbiological,clinical features, and management profiles.

BACKGROUND: Infective endocarditis (IE) is a continuously evolving disease with a high mortality rate despite different advances in treatment. In Ethiopia, there is a paucity of data regarding IE. Therefore, this study is aimed at assessing IE-related in-hospital mortality and characterization of IE patients based on their microbiological, clinical features, and management profiles in the Ayder Comprehensive Specified Hospital (ACSH). METHODS: We conducted a hospital-based prospective follow-up study with all consecutive sampling techniques for suspected infective endocarditis patients admitted to ACSH from January 2020 to February 2022. Echocardiography was performed, and three sets of blood samples for blood culture were taken as per the standard protocol. We also performed isolation of microbial etiologies and antimicrobial susceptibility tests. The data was analyzed using STATA version 16. Stepwise logistic regression was run to identify predictors of in-hospital mortality. Effects were measured through the odds ratio at the 5% level of significance. RESULTS: Seventy-four cases of suspected infective endocarditis were investigated; of these, 54 episodes fulfilled modified Duke's criteria. Rheumatic heart disease (RHD) (85.2%) was the most common underlying heart disease. Murmur (94.4%), fever (68.5%), and pallor (57.4%) were the most common clinical findings. Vegetation was present in 96.3% of episodes. Blood culture was positive only in 7 (13%) episodes. Complications occurred in 41 (75.9%) cases, with congestive heart failure being the most common. All patients were managed medically, with no surgical intervention. The in-hospital mortality was 14 (25.9%). IE-related in-hospital mortality was significantly associated with surgery recommendation and myalgia clinical symptoms. CONCLUSION: IE occurred relatively in a younger population, with RHD as the most common underlying heart disease. There was a high rate of culture-negative endocarditis, and the majority of patients were treated empirically. Mortality was high. The establishment of cardiac surgery and strengthening microbiology services should be given top priority.

Patterns of Medical Admissions and Predictors of Mortality in Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Prospective Observational Study.

Background: Previous works show that noncommunicable diseases (NCDs) are on the rise in developing nations, including Ethiopia, in the background of preexisting communicable diseases (CDs). Data on hospital admission in sub-Saharan Africa are scarce, particularly prospectively collected, and hence this study was done to close the gap in acquiring accurate diagnosis usually faced with retrospective data. We aimed to describe medical admission patterns, their outcomes and determinants at Ayder Comprehensive Specialized Hospital (ACSH) in Tigray, Ethiopia. Methods: Data were collected prospectively from November 1, 2017 to October 31, 2018 for all medical admissions. Sociodemographic profiles, final diagnosis, outcome of hospitalization, and complications were recorded using a data-abstraction checklist. Data were analyzed using SPSS 26. Results: There were 2084 medical admissions over 1 year. Median age was 45 years (IQR 31). A majority (1107, 53.1%) were male. The age-group 25-34 years had the most admissions (19.0%). NCDs constituted 68.2% of admissions. According to the International Classification of Diseases, patients were admitted most frequently due to disease of the circulatory system (36.7%) followed by infectious or parasitic diseases (24.1%). Of NCDs, cardiovascular diseases contributed to 53.9%, followed by cancers (8.6%). Of CDs, HIV/AIDS contributed to 31.3%, followed by tuberculosis (22.8%). A total of 1375 (66%) were discharged improved, while 311 (14.9%) died. On multivariate analysis, the in-hospital mortality was significantly higher (18.7%) for CDs than NCDs (13.2%, AOR 1.8, 95% CI 1.4-2.3; P<0.001). Bed occupancy of ACSH medical wards and ICU was 54%. Conclusion: NCDs were leading causes of medical admissions in ACSH. The presence of CDs and the development of complications were associated with higher risk of death. Attention should be given by policy-makers to curb the higher morbidity from NCDs and mortality from CDs.

Innovative approach for potential scale-up to jump-start simplified management of sick young infants with possible serious bacterial infection when a referral is not feasible: Findings from implementation research.

BACKGROUND: Neonatal bacterial infections are a common cause of death, which can be managed well with inpatient treatment. Unfortunately, many families in low resource settings do not accept referral to a hospital. The World Health Organization (WHO) developed a guideline for management of young infants up to 2 months of age with possible serious bacterial infection (PSBI) when referral is not feasible. Government of Ethiopia with WHO evaluated the feasibility of implementing this guideline to increase coverage of treatment. OBJECTIVE: The objective of this study was to implement a simplified antibiotic regimen (2 days gentamicin injection and 7 days oral amoxicillin) for management of sick young infants with PSBI in a programme setting when referral was not feasible to identify at least 80% of PSBI cases, achieve an overall adequate treatment coverage of at least 80% and document the challenges and opportunities for implementation at the community level in two districts in Tigray, Ethiopia. METHODS: Using implementation research, we applied the PSBI guideline in a programme setting from January 2016 to August 2017 in Raya Alamata and Raya Azebo Woredas (districts) in Southern Tigray, Ethiopia with a population of 260884. Policy dialogue was held with decision-makers, programme implementers and stakeholders at federal, regional and district levels, and a Technical Support Unit (TSU) was established. Health Extension Workers (HEWs) working at the health posts and supervisors working at the health centres were trained in WHO guideline to manage sick young infants when referral was not feasible. Communities were sensitized towards appropriate home care. RESULTS: We identified 854 young infants with any sign of PSBI in the study population of 7857 live births. The expected live births during the study period were 9821. Assuming 10% of neonates will have any sign of PSBI within the first 2 months of life (n = 982), the coverage of appropriate treatment of PSBI cases in our study area was 87% (854/982). Of the 854 sick young infants, 333 (39%) were taken directly to a hospital and 521 (61%) were identified by HEW at health posts. Of the 521 young infants, 27 (5.2%) had signs of critical illness, 181 (34.7%) had signs of clinical severe infection, whereas 313 (60.1%) young infants 7-59 days of age had only fast breathing pneumonia. All young infants with critical illness accepted referral to a hospital, while 117/181 (64.6%) infants with clinical severe infection accepted referral. Families of 64 (35.3%) infants with clinical severe infection refused referral and were treated at the health post with injectable gentamicin for 2 days plus oral amoxicillin for 7 days. All 64 completed recommended gentamicin doses and 63/64 (98%) completed recommended amoxicillin doses. Of 313 young infants, 7-59 days with pneumonia who were treated by the HEWs without referral with oral amoxicillin for 7 days, 310 (99%) received all 14 doses. No deaths were reported among those treated on an outpatient basis at health posts. But 35/477 (7%) deaths occurred among young infants treated at hospital. CONCLUSIONS: When referral is not feasible, young infants with PSBI can be managed appropriately at health posts by HEWs in the existing health system in Ethiopia with high coverage, low treatment failure and a low case fatality rate. Moreover, fast breathing pneumonia in infants 7-59 days of age can be successfully treated at the health post without referral. Relatively higher mortality in sick young infants at the referral level health facilities warrants further investigation.

Corrigendum to "Nutritional Status and Educational Performance of School-Aged Children in Lalibela Town Primary Schools, Northern Ethiopia".

[This corrects the article DOI: 10.1155/2020/5956732.].

Effectiveness of Anthropometric Measurements for Identifying Diabetes and Prediabetes among Civil Servants in a Regional City of Northern Ethiopia: A Cross-Sectional Study.

METHODS: The study involved a cross-sectional survey carried out from October 2015 to February 2016 among 1504 subjects aged from 18 to 75 years of age. Receiver operating characteristic (ROC) was used to select the most effective anthropometric cut-off point among waist circumference, waist-to-hip ratio, waist-to-height ratio, and BMI for identifying prediabetic and diabetes. Statistical significance was declared at p value of ≤0.05. RESULTS: Waist circumference was found better for identifying diabetes (AUC = 0.69) and prediabetes (AUC = 0.63) in women, respectively. Waist-to-hip ratio was better identifying diabetes (AUC = 0.67) while waist circumference-to-height ratio was better identifying prediabetes (AUC = 0.63) in men compared to body mass index. The optimal cut-off point with maximum sensitivity and specificity of waist circumference for identifying diabetes and prediabetes was 83.5 cm and 82.9 cm in women, respectively. The optimal ut-off point with maximum sensitivity and specificity of waist-to-hip ratio for identifying diabetes and prediabetes was 0.97 and 0.82 in men, respectively. CONCLUSION: Waist circumference and waist-to-hip ratio exhibited better discriminate performance than BMI for identifying prediabetes and diabetes in women and men, respectively.

Nutritional Status and Educational Performance of School-Aged Children in Lalibela Town Primary Schools, Northern Ethiopia.

BACKGROUND: Every student has the potential to do well in school. Failing to provide good nutrition puts them at risk for missing out on meeting that potential and leads to long-term irreversible damage to cognitive development. However, taking action today to provide healthier choices in schools can help set students up for a successful future full of possibilities. So, this study is aimed at assessing the effect of nutritional status on academic performance of school-aged children. METHODS: A school-based cross-sectional study was conducted from Feb 05- March 30, 2017 in Lalibela town. A total of 505 primary school students were included in the study. The child anthropometric measures were calculated using AnthroPlus software version 1.0.4 WHO 2007 standards. Bivariable and multivariable ordinal logistic regression were fitted. The proportional odds ratio (POR) with a 95% CI and P value < 0.05 were considered statistically significant. RESULTS: The overall prevalence of stunting, underweight, and thinness was 29.5%, 35.7%, and 29.5%, respectively. In this study, 14.7% of the study participants had low academic achievement in the semester. The multivariable analysis showed that rural residence (POR = 0.39; 95% CI: (0.21, 0.75)), not studying regularly (POR = 0.49; 95% CI: (0.29, 0.82)), severe underweight (POR = 0.25; 95% CI: (0.09, 0.71)), and severe stunting (POR = 0.03; 95% CI: (0.01, 0.37)) were associated with decreased odds of high average semester score achievement of school-aged children. Additionally, higher maternal educational status (POR = 2.12; 95% CI: (1.10, 4.07)) and family income from 550 to 2999 ETB (POR = 1.71; 95% CI: (1.04, 2.81)) were associated with increased odds of high semester average score achievement. CONCLUSION: Nearly one-third of school-aged children in Lalibela town were stunted, thin, and underweight. Rural place of residence, not studying regularly study, underweight, and stunting were associated with decreased academic achievement. While, family monthly income from 550 to 2999 ETB and higher maternal education status were associated with increased academic achievement.

Tuberculosis treatment outcome: The case of women in Ethiopia and China, ten-years retrospective cohort study.

BACKGROUND: Every year tuberculosis kills above half million women all over the world. Nonetheless, the factor affecting TB treatment outcome of women was less frequently studied and compared among countries. Hence, this study was aimed to measure and compare outcome of treatment and the death size of these two countries. METHOD: Socio demographic and clinical data of women treated for all form of tuberculosis in the past ten years 2007-2016 were collected from total of eight hospitals and six treatment centers of Tigray and Zigong respectively. Then, we measured the magnitude of TB, level of treatment success and identify factors associated with the unsuccessful TB outcome. RESULT: In the past ten years, a total of 5603(41.5%) and 4527 (24.5%) tuberculosis cases were observed in Tigray and Zigong respectively. Of those with treatment outcome record a total of 2602(92%) in Tigray and 3916(96.7%) in Zigong were successfully treated. Total of 170 (6%) cases in Tigray and 36(0.8%) cases in Zigong were dead. In Tigray, retreatment cases (aOR, 0.29; 95% CI: 0.16-0.53) and MDR-TB cases (aOR, 0.31; 95% CI: 0.003, 0.27) were less likely to show treatment success. However,, HIV co-infected TB cases (aOR, 3.58; 95% CI: 2.47, 5.18) were more likely to show treatment success compared with unknown HIV status. In Zigong, women with MDR TB (aOR, 0.90; 95%CI: 0.24, 0.34) were less likely to show treatment success and women in the age category of 15-49 (aOR, 1.55; 95% CI: 1.08, 2.206) were more likely to show treatment success. CONCLUSION: Big number of tuberculosis cases and death were observed in Tigray comparing with Zigong. Hence, a relevant measure should be considered to improve treatment outcome of women in Tigray regional state.

Factors associated with institutional delivery practice among women in pastoral community of Dubti district, Afar region, Northeast Ethiopia: a community-based cross-sectional study.

BACKGROUND: Eighty-five percent of the global burden of maternal mortality was covered by Sub-Saharan Africa. Ethiopia is a major contributor to the death of mothers with a maternal mortality ratio of 676 per 100,000 live births. Only 10% of deliveries in Ethiopia were at health facility with the least (6.4%) in the Afar region. However, there is limited evidence about factors of institutional delivery in the study area. Thus, this study aimed to assess the magnitude and associated factors of institutional delivery practice among women in the pastoral community of Dubti district, Northeast Ethiopia. METHODS: A community based cross-sectional study was conducted from April to May 2016, in the pastoral community of Dubti district. A total of 381 women were selected using systematic sampling technique and interviewed using a standardized structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to declare the factors associated with institutional delivery. RESULTS: This study revealed that 35.2% (95% CI: 30.5-40.1) of women were delivered at the health facility. Women who had travelled less than an hour to reach the nearest health facilities (AOR: 4.90, 95% CI: 2.62-9.18), attending antenatal care (AOR: 2.50, 95% CI:1.48-4.23), previous history of stillbirth (AOR: 4.34, 95% CI: 1.78-10.58), good knowledge (AOR: 2.09, 95% CI:1.23-3.56), and husband involved in decision making on delivery place (AOR: 4.42, 95% CI: 1.98-9.90) were the factors associated with institutional delivery practice. CONCLUSIONS: The overall institutional delivery practices in the study area was low as compared to the national level. This low practice of institutional delivery was contributed by residing far from the facility, does not received antenatal care, and having low awareness about ANC follow up and institutional delivery services. Therefore, strengthening the accessibility of health facility to nearby mothers resided, antenatal care services, and awareness creation provision at the community level for pregnant women in the pastoral community can improve institutional delivery practice.

Determinants of postnatal care utilization in Tigray, Northern Ethiopia: A community based cross-sectional study.

INTRODUCTION: Globally, 289,000 women die from complications related to pregnancy, childbirth, or the postnatal period every year. Two-thirds of all maternal deaths occur during the first six weeks following birth and more than two thirds of newborn deaths occur during the first week of life, These statistics underscore the importance of postnatal care, an often neglected service according to the World Health Organization (WHO). The purpose of this study was to assess the factors associated with postnatal service utilization in the Tigray region of Ethiopia. METHODS: The study was a community-based, cross-sectional study. A multi-stage sampling method was used to select study districts randomly from the entire region. A total of 1,690 participants were selected using systematic random sampling. Participants were 18-49 years old, had given birth within the last six months, and were residents of the district for at least six months. Using SPSS version 20 means, frequencies, and percentages were calculated for the sub-group of participants who did attend postnatal care. Barriers to non-attendance of postatal care were analyzed using descriptive statistics. Bivariate analysis was undertaken to assess the association between demographic, obstetric, and knowledge regarding PNC and attendance at antenatal care. Variables with a P value, <0.05 were included in the multivariate logistic regression analysis to identify the determinant factors of postnatal care utilization. RESULT: Of the women surveyed, 132 (8%) obtained postnatal care. Women who did not receive postnatal care reported lack of awareness of the services (n = 1110, 73.3%). Most mothers who received postnatal care reported that they were aware of the service prior to the birth of their child (n = 101, 76.5%). Women were more likely to receive postnatal services if they lived in an urban area (odds ratio 1.96, 95% confidence interval 1.07, 3.59), had greater than a secondary education (OR 3.60, 95% CI 1.32,9.83), delivered by cesarean section (OR 2.88 95% CI 1.32,6.29), had four or more antenatal visits (OR 4.84, 95% CI 1.57,14.9), or had a planned pregnancy (OR 6.47, 95% CI 2.04,20.5). CONCLUSION: Postnatal care service utilization is very low in Tigray region. Interventions targeted at increasing women's awareness of the importance of postnatal services and improving accessibility, particularly in rural areas, is needed.

Magnitude and risk factors for hypertension among public servants in Tigray, Ethiopia: A cross-sectional study.

BACKGROUND: Hypertension is a globally recognized threat to social and economic development with premature morbidity and mortality. In middle and low-income countries hypertension appears to be increasing. However, sufficient data on this silent-killer is not available in Ethiopia. Therefore, this study examined the magnitude and risk factors for hypertension among public servants in Tigray, Ethiopia. METHODS: We used a cross-sectional survey from May-June 2016 among 1525 public servants in Tigray region. Field workers collected data using a pre-tested, standardized questionnaire. A multivariate logistic regression analysis conducted to identify risk factors for hypertension. Statistical significance was declared using a p-value<0.05 and 95% of confidence interval (CI) for an adjusted odds ratio (AOR). RESULTS: The overall prevalence of hypertension was 16% (95% CI: 13.10-21.9) and the proportion of awareness (96.7%), treatment (31.3%) and control of hypertension (40.1%) among employees. Being male [AOR = 2.06, 95%CI:1.49, 2.84], ages groups of 30-49 years [AOR = 2.21, 95%CI:1.25, 3.89] and >50years [AOR = 3.61, 95% CI:1.93, 6.69], Body Mass Index(BMI); underweight [AOR = 0.40, 95% CI; 0.20, 0.78], overweight [AOR = 1.70, 95%CI; 1.22, 2.33] and obesity [AOR = 3.20, 95% CI; 1.78, 5.78] were determinants for hypertension. CONCLUSION: The prevalence of hypertension is relatively high in Mekelle city compared with previous reports. This study revealed that male sex, age-group, and BMI were evidenced as risk factors for hypertension. Policy makers need to consider sector wise integrating prevention and control of hypertension. Skilled based information, education and communication strategies should be designed and implemented to avoid unhealthy lifestyles, investing in workforces to eliminate the modifiable risk factors for non-communicable diseases and promote healthy practices.

Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia.

BACKGROUND: Globally, anemia is a public health problem affecting the life of more than two billion people. Pregnant women are at high risk of iron deficiency anemia due to increased nutrient requirement during pregnancy. Iron-folic acid supplementation is the main strategy for prevention and control of iron deficiency anemia and its effectiveness depends on adherence to Iron-Folic Acid tablets. In the refugee camps of Ethiopia, despite the efforts made to reduce iron deficiency anemia during pregnancy, information about adherence to iron-folic acid supplementation and its associated factors are lacking. The objective of this study was to assess magnitude and factors associated with adherence to iron-folic acid supplementation, among pregnant women, in Shire refugee camps. METHODS: Institution based cross-sectional study with mixed design (quantitative and qualitative) was carried out among pregnant women in Shire refugee camps from September to November 2015. For quantitative data, a sample of 320 pregnant women was systematically selected and data were collected via interview administered structured questionnaire. Quantitative data were coded and entered into Epi-info version 3.5.1 and exported into a statistical package for social sciences (SPSS) Version 19.0 software for analysis. Bivariable and multivariable logistic regressions were employed to identify the predictors at p-value < 0.2 and 0.05 respectively. For the qualitative part, six focus group discussions and three key informant interviews were conducted on purposely-selected individuals. Open-Code version 3.6.2.0 was used for analysis. Identified themes were arranged into coherent groupings and triangulated with quantitative findings. RESULTS: The adherence rate was found to be 64.7% [95% CI (59.7%, 70.0%)]. Women who were having lower knowledge about anemia [AOR; 0.23 95% CI (0.14, 0.38)] and not receiving information about importance of iron-folic acid supplementation [AOR; 0.43 95% CI (0.25, 0.74)] were negatively associated with adherence to iron and folic acid., Having four or more antenatal care visits [AOR; 2.83 95% CI (1.46, 5.48)] were positively significantly associated with adherence to iron-folic acid supplementation. CONCLUSIONS: Adherence rate of iron-folic acid supplementation during pregnancy in the study area is relatively low. Proper counseling and health promotion about Iron-Folic Acid tablet intake, promoting the benefits of early and frequent ANC visit, health promotion on anemia prevention and health benefits of the importance of iron-folic acid supplements are recommended to increase adherence with iron-folic acid supplementation.

Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: a case-control study.

BACKGROUND: Every year, an estimated 19-20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. METHODS: Unmatched case-control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions ("repeat abortion") were taken as cases and those who had a total of one abortion were taken as controls ("single abortion"). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. RESULTS: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1-3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. CONCLUSION: This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

A community-based study of menstrual beliefs in Tigray, Ethiopia.

OBJECTIVE: To investigate knowledge and beliefs about menstruation in the Tigray Region of Ethiopia. METHODS: Between May 5 and May 25, 2015, a cross-sectional survey using semi-structured questionnaires was undertaken in 10 subdistricts (5 urban, 5 rural) in the Tigray Region of northern Ethiopia by trained data collectors (native speakers of the local languages). Individuals in randomly selected households who were aged 10years or older and who were willing to participate were asked various questions regarding the nature and management of menstruation. Interviews were recorded, and handwritten field notes were taken during the interview process. Data were compiled, transcribed, translated into English, categorized, and analyzed thematically. RESULTS: Overall, 428 household members (349 female, 79 male) were interviewed. Reproductive anatomy and biology of menstrual regulation were poorly understood by the respondents. The belief that menstruating girls should not attend school was voiced by 17 (21.5%) male and 37 (10.6%) female respondents. Satisfactory management of menstrual hygiene was acknowledged to be a problem, and many respondents complained about the high cost of commercially produced, disposable menstrual pads. CONCLUSION: Improved education on menstruation and better access to low-cost, reusable menstrual hygiene supplies would be worthwhile in the Tigray Region of Ethiopia.

Costs of osteoporosis related fractures in hospital admitted patients, Tigrai, Northern Ethiopia: a retrospective study.

BACKGROUND: Osteoporotic fractures are among the non-communicable diseases imposing a growing morbidity and economic burden upon developing countries which have limited resources. Despite several studies from other countries, in Ethiopia sufficient information regarding the cost of illness related to osteoporotic fractures is not available. OBJECTIVE: The aim of the study was to estimate the direct and indirect costs attributable to osteoporotic fractures from a patient perspective. METHODS: A retrospective review of 1,169 medical records of cases of osteoporosis related fracture that had been diagnosed and treated over a two year period were selected systematically and included in the analysis. Cost of illness was estimated after developing a checklist to extract the direct patient side medical costs from individual based data and indirect costs were estimated using a human capital approach. RESULT: Analysis of the patient side direct medical costs of osteoporotic fracture according to the site of the fracture resulted in hip fractures identified as the most expensive fractures accounting for about 25% of the total (Median cost, was ETB 237.50 (US$14.09), and Mean = ETB 367.80 (US$ 21.83 per individual patient), while wrist fractures were the least expensive accounting for 6.2% (Median ETB 59.00 (US$3.50) and Mean ETB 59.40 (US$ 3.53 per individual patient). The average length of hospitalization was 22 days. The maximum number of days of hospitalization took place in cases with proximal femoral fracture and fractures of the hip and vertebrae, with a median of 25 days. For every single day increment in inpatient hospital stay there was an equivalent increment of ETB 23.27 (US$1.38). The hospital bed occupancy rate for the two years due to osteoporotic fractures was 6.8%. The total direct medical and indirect cost attributable to osteoporotic fractures during the two year period was ETB 1,314,979.00 (US$78,045.08). Of this total, direct medical cost and indirect costs incurred by the patients accounted for 49.2% and 50.9%, respectively. CONCLUSION: The total patient side cost attributable to osteoporotic fractures incurred over a two year time period was over ETB 1.3 million ($US 78,000). Over 50% of the cost was related to absenteeism from work due to hospitalization. From the patients' perspective the costs pose substantial burden on patients and their families. Hence, interventions to prevent osteoporosis should be implemented.

Magnitude and pattern of osteoporotic fractures among adults in Tigiray, Ethiopia; a retrospective hospital based study.

INTRODUCTION: Osteoporotic fractures are devastating public health problems due to significant morbidity, mortality, and the socioeconomic burden. h2 Ethiopia, the weight of such fractures is often underestimated due to lack of epidemiological data. OBJECTIVE: To assess the magnitude and pattern of osteoporotic fractures among adults admitted to zonal hospitals in Tigrai, North Ethiopia. METHODS: Two years retrospective hospital based medical-record review was employed. All fractures that occurred from September, 01, 2009 to August, 31, 2011 where the source population and osteoporosis related fracture cases were extracted. A total of 1173 charts was retrieved for further characterization of the cases with osteoporotic fractures. The sample size was proportionally distributed to the six hospitals, the cards were selected using a systematic random sampling technique and descriptive analysis was done using SPSS version 19.0. RESULT: A total of 24.672 (15.402 males and 9,270 females) fractures of all types were extracted from medical records of the six zonal hospitals in the region (September 2009-August 2011), among which 2,294 (1,465 males and 829 females) were cases with osteoporotic fractures. The overall prevalence of osteoporotic fractures was 9.3 % and the sex specific prevalence rate was 9.5 and 8.9% for males and females respectively. Characterization in terms of the fracture site, cause, residence, age, and gender was done for 1173 patient charts with osteoporotic fracture. Eight hundred twenty nine (70.9%) of the cases were males. The mean age was 50 (+/- 12) with median age of 45 years. The highest proportion 441 (37.7%) of osteoporotic fractures were of the proximal femur; with higher proportion among males than females. The majority of the fractures, 688 (58.9%) were observed between the age group 40-49. CONCLUSION: Osteoporotic fractures are not infrequent in Tigrai, Ethiopia. Clinicians and other health care providers should be more aware of osteoporosis as the predominant underlying cause of fragility fractures in the region.