High Magnitude Advanced Colorectal Cancer at Diagnosis in Ethiopian Patients: Imaging Pattern and Associated Factors.

Background: Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of the study was to determine the staging and imaging pattern of CRC at diagnosis. Methods: This is a descriptive cross-sectional study including all consecutive cases of CRC found in the departments of radiology and oncology during the study period from March 2016 - February 2017. Results: A total of 132 CRC cases were studied with M: F = 2.4:1, mean age of 46yrs and 67.4%

The journey of Radiology in Ethiopia.

The practice of radiology began after the invention of X-rays in 1895 which then spread to different parts of the world. There is no documentation on how and when the x-ray was introduced to the Ethiopian medical practice. However, radiology as a profession was in place for the last four decades. Similar with the experience in other countries, the history of progress in the field of radiology in the Ethiopian setup is related directly to technological advances that occurred during the past few decades. Radiography was the main modality used in the first two decades. In the early years of the initiation of radiology training, only radiographs and ultrasounds were available for training and service. In the subsequent years, modern cross-sectional imaging equipment was introduced. This was mainly accomplished with the involvement of the private institutions which played a significant role. So far, there are more than 300 practicing radiologists as diagnosticians. Recently, also radiologic interventions were also introduced with the commencement of subspecialty training.

Patterns of Hepatocellular Carcinoma on Computed Tomography at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

BACKGROUND: Hepatocellular cancer is the commonest liver cancer which contributes to a high incidence of morbidity and mortality in both developed and developing countries. Despite the anticipated high burden of the disease in the country, there is paucity of data on the associated risk factors and its pattern on imaging. The aim of this study was to assess Computed Tomography patterns and the risk factors of hepatocellular carcinoma. METHODS: A cross-sectional, prospective study on patients with a diagnosis of HCC on Computed Tomography examination, at Tikur Anbessa Specialized Hospital from July, 2016 to July, 2017. All patients who had characteristic Computed Tomography features and those who were diagnosed by Fine needle aspiration cytology (FNAC)/biopsy and had Computed Tomography examination were included in the study. Risk factors identified were reviewed from patients' medical records. RESULT: A total of 70(n=70) patients were included in the study. The mean age was 50 ± 16 years. Fifty-seven (81.4%) of the participants were males, and 13(18.6%) were females. Forty-five (64.3%) of them came from urban areas and 25(35.7%) of them were from rural areas. The lesions were focal in 52(74.3%) and infiltrative in 18(25.7%) of the cases. Vascular invasion and distant metastases were seen in 49(70%) and 17(24.3%) respectively. Twenty-nine (41%) had negative hepatitis markers, and 13(19%) were not investigated for hepatitis infection. CONCLUSION: The majority of the patients presented with advanced disease such as vascular invasion and metastases. The major risk factors such as hepatitis infection were negative in significant number of patients. The risk factors in our setting should be studied further. Moreover, high-risk group selection and screening is essential to diagnose HCC early.

The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia.

BACKGROUND: The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes. METHODS: A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis. RESULTS: Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda. CONCLUSIONS: The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia.

EVALUATING THE VALIDITY AND RELIABILITY OF CHEST RADIOGRAPHY IN THE DIAGNOSIS OF TUBERCULOSIS AMONG SMEAR NEGATIVE PULMONARY TUBERCULOSIS PATIENTS.

BACKGROUND: Tuberculosis (TB) is a mycobacterial infection mainly affecting the lungs. Early and correct diagnosis of sputum smear negative patients by chest radiography (CXR) is challenging since it depends on reader's ability to detect abnormal findings and to interpret it correctly. OBJECTIVES: To evaluate the validity and reliability of CXR the diagnosis of TB among smear negative pulmonary tuberculosis (PTB). METHODS: An institutional based cross-sectional study was conducted at seven selected health facilities from October 2011 to September 2012 on 159 adults aged 18 years and above who were newly diagnosed smear negative for PTB patients diagnosed using Chest X-ray (CXR). Morning sputum was collected and cultured from each patient using Lowenstein Jensen media. All the CXRs were revised by senior radiologists in conjunction with the principal investigator. A structured questionnaire was used to collect socio-demographic, clinical and radiological data. Sensitivity and specificity measures of the CXR findings were calculated in comparison to the gold standard sputum culture results. RESULTS: The mean (SD) age of patients involved in the study was 37.1 (16.7), ranging from 18 to 87 years. Of the total 159 smear negative PTB patients, the most common CXR finding was consolidation (40.3%) followed by cavitations (23.9%) and nodular lesions (17.0%). Sputum culture results showed that, 47 (29.6%) were culture positive, 103 (64.7%) were culture negative and 9 (5.6%) were contaminated. About 14% (22/159) of the study subjects were HIV positive. The sensitivity and specificity of CXR findings were 77.1% (37/48) and 36.9% (41/111), respectively. The positive and negative predictive values were 34.6% (3 7/107) and 78.8% (41/52), respectively. CONCLUSION: CXR can be used as supportive investigative modality to diagnose smear negative Pulmonary TB in conditions where TB culture is no more feasible.

Status of radiological services in Addis Ababa public hospitals.

BACKGROUND: The availability and quality of radiological service in the developing countries are generally poor. Ethiopia is one of the countries where overall health service has been compromised by inadequate & poorly maintained infrastructure and scarcity of health professionals. Radiological service is a resource intensive unit in a hospital and most developing countries radiological service is expected to be poor or may not be available at all. However, there is no study conducted to assess the radiological service in Ethiopia. OBJECTIVE: The aim of the study is to assess the status of radiological service in all public hospitals in Addis Ababa, capital of Ethiopia, and to render insight to the overall national service status. METHODS: A cross sectional survey was conducted from Aug 2008 to Oct 2009 G C in all twelve public hospitals in Addis Ababa, including specialized and military hospitals. Self administered pre-tested questioners were used to collect data from key informants, chief radiographers and radiologist. In addition, departmental daily work record book was used to extract the type of radiological examination performed Data analysis was done manually. RESULT: All hospitals in the study provide a basic level of radiological services. Plain x-ray and ultrasound is the type of service (100%) available, whereas services like mammography (9%), CT scan (18%) and MRI (0%) were found to be the least available. There are a total of 78 radiographers and 20 radiologists in Addis Ababa public hospitals with no radiologist in three. The average number of examinations performed in a year amounts to 113,204 and US and routine x-ray examinations account for nearly 98% of the service offered The study showed 25% of the radiological equipments are non-functional and no appropriately trained dark room technicians & no maintenance staffpresent in all hospitals CONCLUSION AND RECOMMENDATION: This study verifies the poor radiological infrastructure, poor level of support and the basic nature of the radiological service in the capital. We believe this finding can be used as an indirect indicator of the possible worse scenario in the regional and peripheral hospitals. Therefore a nation- wide survey & plannedgovernment intervention is recommended to improve the radiological service.

Clinical characterization of sarcoidosis in Ethiopia.

BACKGROUND: Sarcoidosis is a granulomatous multisystem disease. Its manifestations overlaps with more prevalent diseases like tuberculosis, hence, it is usually overlooked. OBJECTIVE: The objective of the study was to characterize the clinical, biochemical and radiologic pattern of patients with sarcoidosis in Ethiopia. METHODOLOGY: A hospital based descriptive case series study on 34 sarcoidosis patients was done from 2003-2008. The diagnosis was based on a combination of clinical, histological and radiological evidences after ruling out other possibilities. RESULTS: The majority, 82%, presented with respiratory symptoms. The common symptoms were cough 28 (82.4%), shortness of breathing 24 (70.6%) and wheezing 15 (47.1%). Next to the respiratory system, the skin 6 (17.6%), the extra thoracic lymph nodes 4 (11.7%) and small bones 3 (8.8%) of the patients were involved. Most of the patients were mistakenly diagnosed and received treatment for other diseases importantly tuberculosis. CONCLUSION: Manifestations of Sarcoidosis mimic more prevalent diseases like tuberculosis and should be considered as a differential diagnosis. This will help in avoiding unnecessary and potentially harmful empirical treatments.

Sonographic measurement of normal prostate volume and pattern of change with age among male adult Ethiopia patients at Black Lion Specialized Hospital.

BACKGROUND: The prostate, the major accessory sex organ in male, its functions are under the control of local and systemic hormones. It causes major source of trouble as the age gets over 40 years. OBJECTIVE: The aim of the study is to determine the normal volume and rate of growth of the prostate gland in Ethiopian adults and compare with other studies. PATIENTS AND METHODS: Transabdominal sonographic measurement of normal volume and patterns of change in prostate volume was performed in 384 of Ethiopian males above 40 years. The patients came for abdominal or pelvic ultrasound study to Black lion specialized hospital from October 1, 2009 to March 30, 2010. All examinations were done by senior radiology residents using standard examination technique. Data were collected on a prepared format. RESULTS: Our patient's age ranged from 40 to 90 years with an average age of 56.5 years. The prostate volume ranged from 7. 1cc to 169cc with mean and median volume of 42cc and 35cc respectively. Peak volume was seen in the seventh decade of life. The volume of the prostate progressively increases with age, however, the rate of growth was found to be decreasing with increasing age. There was a significant statistical association between lower urinary tract symptoms (LUTS) with prostate volume and age (p value < 0.05). CONCLUSION: The findings of prostate volume of our patients are comparable with other studies and it increases as the age advances while the rate is decreasing. LUTS was found to correlate with volume and age in our patients.