Hospital-acquired infections among obstetric and gynaecological patients at Tikur Anbessa Hospital, Addis Ababa.

Seven hundred patients admitted to the wards of the Department of Obstetrics/Gynaecology of Tikur Anbessa Hospital, Addis Ababa, between January and July 1984 were studied for the incidence of nosocomial infections. The overall hospital infection rate was 17.0%, with wound infection at 47% followed by urinary-tract infection at 15%. Over 80% of the bacterial isolates were Gram-negative bacteria, the majority of which were multiply resistant to the commonly used antibacterial drugs. Some hospital risk factors have been identified. The findings are discussed in the light of reports on nosocomial infections from hospitals of developed countries.

Illegal abortions in Addis Ababa, Ethiopia.

OBJECTIVES: To identify the primary abortionist while the patient is in the hospital; to determine the type of materials used to terminate the pregnancy; to determine the number of attempts made to terminate the index pregnancy and; to characterise women with induced abortions at five hospitals in the City of Addis Ababa. DESIGN: Cross-sectional hospital-based descriptive multi-centre (WHO) study. SETTING: Addis Ababa University, Faculty of Medicine. SUBJECTS: All cases of abortions admitted to the study hospitals at five hospitals with obstetric and gynaecologic services. MAIN OUTCOME MEASURES: Identification of the primary abortionist, the places where abortion is carried out, the number of attempts made to terminate the index pregnancy and the materials used to terminate the pregnancy and reasons for terminating the pregnancy. RESULTS: A total of 2275 cases of abortion had been identified and managed in the five study hospitals. The study demonstrated that 984 (43.3%) were spontaneous abortions. Of the 1290 illicit or unsafe abortions admitted by the patients (certainly induced) in 455 (35.3%) of the abortions were performed by the health assistants, 366 (28.3%) self-induced, and 306 (23.7%) by cleaners working in the operation theatres. In 744 (60%) of the abortion procedures were carried out at the abortionists home while 452 (35%) at the patients' home. The remaining 94 (5%) of the abortions were done safely in the hospital or doctor's office by professionals. The most commonly used methods for inducing the abortions were; in 417 (32.3%) high doses of ampicillin per OS, and in 414 (32.1%) by inserting plastic tubes (intravenous giving set) per vagina. CONCLUSION: The issue of abortion clearly presents an enormous complex moral and ethical dilemma. The study results are very clear. Where abortion is illegal or where the services are not readily available and/or personnel are not well trained, unsafe abortion carries a high risk of complications, permanent damage resulting in infertility and even death. The question is not really whether or not abortion should be legal or illegal but whether or not it should be prevented through modern family planning methods, safe or unsafe abortions. In all societies no matter what the legal moral or cultural status of abortion are, there will be some women who will desperately seek to terminate an unwanted or unplanned pregnancy. Unsafe abortion is a major medical and public health problem in Ethiopia. The magnitude of the problem in terms of numbers affected, and severe adverse consequences can no longer be ignored.

Ectopic pregnancy at Tikur Anbessa Hospital, Addis Ababa, Ethiopia, 1981-1987: a review of 176 cases.

Between September 1981 and August 1987, 242 cases of suspected ectopic pregnancy were admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, of which 231 were confirmed at laparotomy. Over the same period of time 28,600 deliveries were conducted in the same hospital, giving a ratio of eight ectopic pregnancies to 1,000 deliveries. Review of the 176 cases records which could be retrieved revealed that 57.9% were in the age group of 20-29 years and 27% were nulliparous. The history revealed lower abdominal pain in 98.8%, amenorrhoea in 82.9% and vaginal bleeding in 73%. On clinical examination, 92% had lower abdominal tenderness, 80.6% cervical excitation tenderness, 26.7% a mass in the adnexa and 31.2% a haemoglobin level of 7 gm percent or less. In 51.7% of the cases the ectopic was on the right and in 44.4% on the left. In 37.5% of the cases more than 1,000 millilitres of blood was contained in the peritoneal cavity. Only two were cases of unruptured ectopic pregnancy. There were 5 (2.8%) cornual and 2 (1.1%) ovarian pregnancies. Culdocentesis was the most reliable diagnostic test. In the 176 cases, repeat ectopic occurred in 7.3%. In a situation like ours, where adequate diagnostic facilities are not available, ectopic pregnancy should always be suspected in women with lower abdominal pain and amenorrhoea, or lower abdominal pain and irregular vaginal bleeding.

A six-year review of maternal mortality in a teaching hospital in Addis Ababa.

PIP: The case notes of all patients who died over the January 1980 to December 1985 period in Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, as a result of conditions associated with pregnancy, labor, and puerperium were reviewed in an effort to identify the most common causes of maternal death. Postpartum autopsy seldom was possible; consequently, the cause of death was based on clinical findings only. 216 deaths occurred over the 6-year period; there were 22,404 live births in the same period, giving a maternal mortality rate (MMR) of 9.6/1000. This rate included deaths from complications following abortions. 197 of the deaths occurred in women who were not booked into Tikur Anbessa Hospital. In terms of direct causes of death, abortion, puerperal sepsis, and ruptured uterus together accounted for 75.9% of deaths. Of indirect causes, infectious hepatitis, relapsing fever, and malaria accounted for 56.8% of deaths. Of deaths due to abortion, 21/48 occurred in nulliparas, and 25 were below age 19. Of the deaths caused by ruptured uterus, 20/29 occurred in multipara, and all of those women were from rural areas. The majority of deaths from hepatitis occurred in the 30-34 years age group. In Ethiopia, the maternal mortality rate is high because of both poor or inadequate antenatal and postnatal care as well as because of poor transportation and communication systems.^ieng

Seasonal variation in the parasite burden and body condition of working donkeys in East Shewa and West Shewa regions of Ethiopia.

A survey of donkeys arriving at markets in three localities in East and West Shewa regions of central Ethiopia was carried out during 2002. Total faecal worm egg counts and body condition scores were measured for a total of 963 donkeys over a 12-month period. Total faecal worm egg counts did not differ significantly between localities but there was significant (p < 0.001) seasonal variation within localities. Levels of helminth infection closely followed rainfall patterns, being lowest (956 eggs per gram of faeces, e.p.g.) at the end of the long dry season (February) and highest (2022 e.p.g.) in the middle of the long wet season (August). Body condition score was associated closely with level of helminth infection (Goodman-Kruskal measure of association 0.60-0.80). Seasonal variation in body condition score reflected the temporal changes in worm burden and the availability of forage. It is suggested that a body condition score of 3 or less could be used as a simple means of identifying donkeys that require therapeutic treatment with anthelmintic. It is further proposed that economically viable strategic control of helminths in donkeys could be achieved by administering a single annual dose of avermectin-based anthelmintic at the start of the long rainy season (May-June). This may allow donkeys to recover body condition when available forage is most abundant and nutritious. It is also recommended that protein-rich feed supplementation be provided during the later part of the dry season (November-January). This may help maintain body condition when forage is scarce and the helminth challenge is at its lowest.

The effect of providing feed supplementation and anthelmintic to donkeys during late pregnancy and lactation on live weight and survival of dams and their foals in central Ethiopia.

Anthelmintic treatment (A), feed supplementation (F), anthelmintic and feed supplementation (A+F) or traditional management (Control) was given to 166 pregnant female donkeys in three localities (Holetta, Debre Zeit and Adami Tulu) in Ethiopia during an on-farm study. Treatments started during the last trimester of pregnancy and continued until 6 months after parturition when the foals were weaned. The same treatments were administered to foals once they reached 1 month of age. Live weights of adults and foals were measured throughout the study along with work output of adult donkeys and survival to weaning of the foals. Faecal worm egg counts (FEC) and blood packed cell volumes (PCV) were recorded monthly. When applied alone, anthelmintic treatment (A) or feed supplementation (F) had no significant effect on live weight gain or foal survival. However, when combined, anthelmintic and feed supplementation (A+F) significantly (p<0.05) improved both live weight gain in adults and foals and foal survival. Workout was not affected by any of the treatments. Treatments A and A+F resulted in a highly significant (p<0.001) reduction in FEC in all three localities during the course of study and for at least 6 months after the last dose of anthelmintic in one of the study areas (Holetta). None of the treatments had any significant effect on PCV. Donkey owners in Ethiopia should be encouraged to adopt both anthelmintic treatment and feed supplementation if they expect tangible benefits in animal performance.