Outcomes and predictors of complications of thyroidectomy in a scarce resource setting: Retrospective cross-sectional study.

BACKGROUND: Outcomes and predictors of complications of thyroidectomy are diverse and have been extensively studied, but data from our country and other African countries with high disease burdens are limited. OBJECTIVE: To evaluate the outcomes and predictors of complications of thyroidectomy among operated patients. METHOD: Single institution retrospective cross-sectional study was conducted by reviewing charts from 365 patients who had undergone thyroidectomy on an elective basis between March 2018-February 2022. All patients who were admitted and underwent thyroidectomy were included in this study. Bivariate and multivariate logistic regressions were used to identify risk factors. P-value <0.05 was considered statistically significant. RESULT: Overall, post-thyroidectomy complications occurred in 17 % of the cases. The two most common complications were hypocalcemia and voice change; the latter being due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve with an incidence of 4.9 % and 2.5 % respectively. Thyroidectomy performed by surgical residents and having total thyroidectomy were significantly associated with overall complications of thyroidectomy. Total thyroidectomy was found to be a risk factor for postoperative hypocalcemia (AOR = 12.24 (95%CI: 4.53, 19.65); P = 0.02). Younger age of the patient (AOR =0.3(95%CI, 0.12,0.51)) and prolonged duration of presentation (AOR = 2.53(95%CI, 1.17,7.76)) were detected predictors of voice change due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve. CONCLUSION: The rate of thyroidectomy complications is relatively similar to other studies. In this study demographic and clinical factors associated with increased risk of complications after thyroid surgery were identified. This information will be useful for educating patients about the risks of thyroid surgery.

Immediate health and economic impact of the Tigray war on internally displaced persons and hosting households.

Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors.

Rape survivors' experience in Tigray: a qualitative study.

INTRODUCTION: As consequences of war, women and girls are the most likely segment of society to be impacted by violence. War also affects the critical facilities and makes the situation worse as victims cannot get the vital basic services. According to media and unpublished reports, Tigrayan women have been victimized by gang rape and sexual violence. Furthermore, there is substantive evidence of intentional destruction and vandalization of health facilities due to the one-year-old-armed conflict. This study aimed to explore experiences of rape survivors in areas hit by armed conflict in the Tigray region of Ethiopia. METHODS: In this qualitative study, a phenomenological study design was employed among Tigrayan sexual assault survivors in a war-ravaged of Tigray. Survivors were selected purposively and included in the study for an in-depth interview. An interview guide was used to collect the data. Audio records from the in-depth interviews in Tigrigna were transcribed verbatim and then translated into English for analysis. Atlas-ti 7 software was used to code the interview transcripts of the qualitative data, and categorizations and thematizing of the codes were done. Direct quotes were used to describe categories or themes. RESULTS: Ten women who were survivors of sexual violence and rape related to the war in Tigray participated in the interview. The age of the women ranged between 16 and 30 years with a mean age of 21.7. Among the participants, five were teenagers, six were single and/or economically dependent on their family or husband, and two did not attend any school and were not able to read and write. This study has generated five major thematic areas: (1) infliction of long-lasting trauma on children (2) effects of the rape (3) means of escaping from rape and killings (4) home remedies as means of life saving in war affected areas, and (5) beyond rape. CONCLUSIONS: Rape in war-stricken Tigray has been widespread which includes teenagers and it caused immense psychological and physical damage to the survivors and their families. Damage of critical facilities such as the absence of safe houses for survivors and health services was an added complexity to the victims of rape. Hence, a coordinated effort by the government of Tigray and international partners is required to heal, support and rehabilitate the victims and rebuild the damaged health institutions and reequip the health facilities.

A facility-based study of lipids, glucose levels and their correlates among pregnant women in public hospitals of northern Ethiopia.

BACKGROUND: Lipids and glucose concentrations in the blood rise during pregnancy period. Poor control of these analytes results in cardio metabolic dysfunction. Despite this, there are no documented studies which investigate lipids and glucose among pregnant women in Tigrai, northern Ethiopia. OBJECTIVE: The objective of this study was to assess lipid and glucose levels and identify their correlates among pregnant women in Tigrai, northern Ethiopia. METHOD: We conducted a facility-based cross sectional study comprising of systematically selected 200 pregnant women from July to October 2021. Those who were severely ill were excluded from the study. We used a structured questionnaire to collect socio-demographic and clinical characteristics of pregnant women. Lipids such as triglycerides, low density lipoprotein, cholesterol and blood glucose were also measured using Cobas C311 chemistry machine from plasma samples. The data were analyzed using SPSS version 25. Logistic regression was performed and statistical significance was declared at p-value < 0.05. RESULT: Proportion of pregnant women with cholesterol, triglyceride, low density lipoprotein and blood glucose levels above the upper limit of the normal range used for clinical decision were 26.5%, 43%, 44.5% and 21%, respectively. Pregnant women's income > = 10,000 ETB (AOR = 3.35; 95%CI: 1.46-7.66), age (AOR = 3.16; 95%CI: 1.03-9.68), gestational age 29-37 weeks (AOR = 8.02; 95%CI: 2.69-23.90) and having systolic blood pressure greater than 120 mmHg (AOR = 3.99; 95%CI: 1.64-9.75) demonstrated statistically significant association with raised levels of lipids. CONCLUSION AND RECOMMENDATION: Proportion of pregnant women with out of normal range values of lipids, particularly triglycerides and low density lipoprotein, is high. Gestational age is a strong predictor of increase in blood levels for both lipids. Provision of life style related health education and dietary intake to pregnant mothers matters. Moreover, monitoring lipid profile and glucose level during antenatal care period is essential.

A Community-Based Study of Level and Determinants of Substance Use: Findings from Children Experiencing Homelessness in Major Cities of Northern Ethiopia.

Background: Homelessness among children is a significant problem in most nations of the world. Children who experienced homelessness are most often unable to get secured and adequate housing. Such problems expose them to a range of destructive practices such as substance use. This study, therefore, was designed to evaluate the level and determinants of substance use by children who experienced homelessness in major cities of Northern Ethiopia. Methods: This cross-sectional study was undertaken from October 1, 2019 to February 30, 2020. We conducted street-based outreach searching to get a representative sample of the city's children who experienced homelessness and a total of 422 were recruited. The collected data were analyzed using SPSS version 20. Regression analysis was done to identify factors associated with substance use and statistical significance was declared at p < 0.05 and 95% confidence interval. Results: More than 80% of the children who experienced homelessness use alcohol, cigarette or chat. Marriage status of parents before the child experiences homelessness being divorce (AOR = 8.53, 95% CI: 1.87-38.89), occupational status of mother being a daily laborer (AOR = 2.78, 95% CI: 0.83, 9.31), child relationship status with parents before child experiences homelessness (AOR = 0.08, 95% CI: 0.02-0.30) and parents' residential status before child experiences homelessness being rural (AOR = 5.63, 95% CI: 1.77-17.89) are the independent variables that established statistically significant association with the outcome variable, substance use. Conclusion and Recommendation: The majority of the children who experienced homelessness are exposed to substance use, particularly alcohol and cigarette. Efforts are needed by concerned bodies of the region to work on factors that predispose to homelessness and strategically safeguard the health and wellbeing of the children.

Prevalence of Orthohantavirus-Reactive Antibodies in Humans and Peri-Domestic Rodents in Northern Ethiopia.

In 2012, Tigray orthohantavirus was discovered in Ethiopia, but its seasonal infection in small mammals, and whether it poses a risk to humans was unknown. The occurrence of small mammals, rodents and shrews, in human inhabitations in northern Ethiopia is affected by season and presence of stone bunds. We sampled small mammals in two seasons from low- and high-density stone bund fields adjacent to houses and community-protected semi-natural habitats in Atsbi and Hagere Selam, where Tigray orthohantavirus was first discovered. We collected blood samples from both small mammals and residents using filter paper. The presence of orthohantavirus-reactive antibodies in blood was then analyzed using immunofluorescence assay (human samples) and enzyme linked immunosorbent assays (small mammal samples) with Puumala orthohantavirus as antigen. Viral RNA was detected by RT-PCR using small mammal blood samples. Total orthohantavirus prevalence (antibodies or virus RNA) in the small mammals was 3.37%. The positive animals were three Stenocephalemys albipes rats (prevalence in this species = 13.04%). The low prevalence made it impossible to determine whether season and stone bunds were associated with orthohantavirus prevalence in the small mammals. In humans, we report the first detection of orthohantavirus-reactive IgG antibodies in Ethiopia (seroprevalence = 5.26%). S. albipes lives in close proximity to humans, likely increasing the risk of zoonotic transmission.

Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia.

INTRODUCTION: Birth asphyxia is defined by the World Health Organization as not initiating and maintaining default breathing at birth. Approximately 24% of neonatal deaths occurred annually worldwide due to birth asphyxia. About 3% of the 120 million neonates born each year acquire asphyxia in third world countries. Long-term survivors may experience cerebral palsy, delay in growth, vision, hearing and intellectual deficiency, epilepsy, difficulties with communication and behavior. Thus, this study aims to determine the risk factors of birth asphyxia among neonates who were delivered at public hospitals of Tigray, Ethiopia. MATERIALS AND METHODS: Hospital-based unmatched case-control study design was implemented on 390 samples from January to February 2018. Data were collected by interviews using a structured questionnaire and checklist. The collected data were coded and entered using EpiData version 3.1 statistical software and transported to statistical package for social science (SPSS) version 20 software for analysis. Cross-tabulation and odds ratio with 95% confidence interval were computed. Bivariate logistic regression and multivariable logistic regression were done. Multicollinearity was checked. Goodness of fit was checked by the Hosmer-Lemeshow test. RESULTS: A total of 260 controls and 130 cases were enrolled in the study. Multivariable logistic regression showed that Primi-parity [AOR 5.5 (CI: 2.5, 12.3)], pre-eclamcia/pregnancy-induced hypertension [AOR12.4 (CI: 4.17, 37.15)], post-term pregnancy [AOR 2.73 (CI: 1.00, 7.55)] meconium-stained liquor [AOR 29.2 (CI: 12.0, 71.1)], cord entangled [AOR 5.67 (CI: 1.66,19.3)] and non-vertex presentation [AOR 5.49 (CI: 2.20,13.7)] were found to be risk factors for perinatal birth asphyxia. CONCLUSION AND RECOMMENDATIONS: Intrapartum factors and neonatal factors in the index pregnancy have an association with perinatal birth asphyxia. The research finding suggests effective antenatal care follow-up and follow-up of labor progress using partograph after labor initiation.

Coverage, social mobilization and challenges of mass Zithromax administration campaign in South and South East zones of Tigray, Northern Ethiopia: A cross sectional study.

BACKGROUND: The antibiotic treatment of people with trachoma helps to prevent transmission the disease in a community. Currently, Zithromax is the drug recommended for mass drug administration (MDA). MDA should be carried out annually for three to five years in trachoma endemic areas. Coverage survey is essential to track progress towards program goals and to identify communities with poor coverage in order to permit timely and appropriate actions. We assessed mass Zithromax administration coverage, social mobilization and campaign challenges in south and southeast zones of Tigray, Ethiopia. METHOD: We conducted a survey in community in Southern and South East zones of Tigray region from August 15 to August 31, 2016. The survey included nine Woredas. It was supported by qualitative methods. A total of 3741 individuals were enrolled from 933 households using multistage sampling. We used structured questionnaire. In-depth interview and focus group discussion were also applied. Descriptive statistics was performed using SPSS version 20.We thematically analyzed the qualitative data using Atlas 7. RESULT: The overall coverage of Zithromax MDA was 93.3%. It ranges from 90.0% in Seharti Samre to 97.9% in Endamokoni. The coverage was 93.4% for males and 93.1% for females. A higher proportion (98.3%) of children aged 5 to 15 years and 409 (87.8%) under five children took Zithromax. The coverage was 94% in rural and 91.2% in urban. Women development army (43.3%) and health extension workers (32.5%) were the main source of information. Frequent occurrence of drug side effects, rumors, lack of community and leaders' engagement in the campaign, fasting, shortage of human power and short term unavailability of supplies were barriers during the campaign. CONCLUSION: The Zithromax MDA coverage in the study zones was higher than the minimum WHO set criteria of 80%. There was a wide difference in coverage among Woredas and Kebeles. The MDA coverage was lower in urban than rural. Misconceptions and poor mobilization were common challenges. Thus, proper planning, community mobilization and uniform training will need to be done ahead of the campaign in the future.

A facility-based study of factors associated with perinatal mortality in Tigray, northern Ethiopia.

OBJECTIVE: To identify perinatal mortality risk factors in the Southern Zone of Tigray, northern Ethiopia. METHODS: The present unmatched case-control study included data from 20 health facilities; stillbirths and neonatal deaths were included as a case group and patients with neonates who survived until discharge or day 7 postpartum were included as a control group. Perinatal mortality risk factors were investigated using bivariate and multivariate logistic regression analyses. RESULTS: There were 126 and 252 patients included in the case and control groups, respectively. Prematurity (adjusted odds ratio [AOR] 12.2; 95% confidence interval [CI] 3.46-43.17; P<0.001), delivery weight below 2500 g (AOR 11.5, 95% CI 3.16-42.36; P<0.001), and fewer prenatal visits (AOR 5.4; 95% CI 0.80-36.63; P=0.028) were determinants of perinatal mortality. Partograph use (AOR 0.2; 95% CI 0.08-0.48; P<0.001) and seeking labor care at the start of labor (AOR 0.1; 95% CI 0.01-0.96; P=0.010) were protective. Short childbirth interval (<2 years) (AOR 2.2; 95% CI 1.03-5.09; P=0.013), distance to facility (AOR 3.7; 95% CI 1.56-9.02; P=0.007), and lack of iron supplementation (AOR 3.3; 95% CI 1.16-9.76; P=0.021) were also predictors of perinatal mortality. CONCLUSION: Perinatal mortality was linked to prematurity and low delivery weight. Interventions including partograph and auscultation, as well as subsidizing transport and iron supplementation, could help in this region.

Determinants of severe anemia among laboring mothers in Mekelle city public hospitals, Tigray region, Ethiopia.

INTRODUCTION: Anemia is a global public health problem that has affected a significant number of pregnant mothers worldwide. The World Health Organization has estimated the prevalence of anemia in pregnant women at 18% and 56% in developed and developing countries, respectively. This study aimed to identify factors associated with severe anemia among laboring women in Mekelle city public hospitals, Tigray, Ethiopia. METHODS: This unmatched case-control study involved 264 (88 = cases and 176 = controls) pregnant women who were recruited when they came for delivery service in Mekelle city public hospitals. The data was collected from July to August, 2016. In this study, a systematic sampling technique was used inselecting controls, but the cases were enrolled until the required sample size was reached. Bivariate and multivariate analyses were conducted to find predictors of severe anemia. Statistically significant predictors of severe anemia were identified at P-value <0.05 and 95% confidence interval. RESULTS: A total of 264 pregnant women who came for delivery services were enrolled in this study. The major predicting variables for the occurrence of severe anemia among laboring women were residency (AOR = 3.28, 95% CI: 1.26-8.48), number of pregnancies (AOR = 2.46, 95% CI: 1.14-5.29), iron folate supplementation (AOR = 3.29, 95% CI: 1.27-8.49), dietary diversification score (AOR = 3.23, 95% CI: 1.19-8.71) and duration of menstrual cycle (AOR = 2.37, 95% CI: 1.10-5.10). The variable 'blood loss during pregnancy' (AOR = 6.63 95% CI: 2.96-14.86) was identified as a strong predictor of the outcome variable, severe anemia. CONCLUSION: This study identified determinants of severe anemia among laboring women in Mekelle city public hospitals, Northern Ethiopia. To reduce anemia, strengthening health education provision related to the importance of birth spacing and consuming diversified and iron-enriched food should be considered. Moreover, screening of pregnant women for state of anemia during their visits to health facilities, as well as de-worming for intestinal parasites infection are needed.