The efficacy of norfloxacin in the treatment of urinary tract infections in Tikure Anbessa Hospital, Addis Ababa, Ethiopia.

The efficacy of norfloxacin 400 mg every 12 hours for 7 days was prospectively and openly studied among patients with urinary tract infection. Enrolled were 30 patients based on inclusion and exclusion criteria. 23 patients completed the study and were evaluated for efficacy and tolerability with urinary infections defined as a bacterial count of at least 10(5) bacterial per ml of urine. Follow-up urine cultures at 14-21 days and 4-6 weeks post-treatment were done. 21 of 23 were cured and this was a cure rate of 91%. There were no clinical adverse effects which necessitated cessation of treatment. In vitro test studies were carried out to compare the activity of norfloxacin with commonly used antimicrobials as well as to observe its activity against other organisms which are not normally urinary pathogens. In this aspect of the study, norfloxacin was found to be superior to eleven other antimicrobials with which it was compared. This study showed that drug is very active against urinary and enteric pathogens.     

Oesophageal carcinoma in Tikur Anbessa Hospital, Addis Ababa

A five year review of oesophageal carcinoma in Tikur Anbessa Hospital (TAH), Department of Surgery, Faculty of Medicine is presented. One hundred and forty two patients representing 32.5% of all gastrointestinal and 13.8% of all malignant tumours were seen in the Department during the study period. The age range was 22 to 88 years with a mean of 54 years. There were 54 females and 88 males. Dysphagia, weight loss and anaemia were the significant features in the majority and 40% of patients presented between four and seven months. Squamous cell cancer accounted for 93% of all histologic types. The middle third was the commonest site of tumour formation (49%) while the lower third accounted for 44%. An operability rate of 56% is recorded but only 24% were suitable for oesophagectomy. The post operative mortality was 28%. The commonest causes of death were sepsis secondary to anastomotic leak and pneumonia. Follow up was possible only for three months for eleven patients and seven months for seven patients. The rest could not be traced. It is difficult not to implicate the commonly used dietary ingredients in the causation of this tumour.     

Comparison of oral cholecystography (OCG) with real time ultrasonography in the diagnosis of cholelithiasis at the Tikur Anbessa Hospital, Addis Ababa, Ethiopia

A prospective study of the accuracy of real time ultrasonography in the detection of gallstones was undertaken in 180 patients from February 1987 to February 1988. The ultrasound findings were compared with single dose oral cholecystography (OCG), and with the surgical findings where surgery was undertaken. Ultrasonography gave more accurate results than OCG, with an overall accuracy in the surgically proven patients of 97.1%, no false positive findings and a 2.9% false negative rate. OCG gave an accuracy of 80% with no false positive findings and a 20% false negative rate. Ultrasound was particularly valuable where there was non visualisation of the gall bladder at OCG, giving an overall accuracy of 93.3% in such patients. Ultrasonography is a non invasive, simple, safe and economic diagnostic test of high accuracy in the diagnosis of cholelithiasis and of particular benefit in those patients unsuited for OCG.     

Pre-eclampsia/eclampsia at Yekatit 12 Hospital, Addis Ababa, Ethiopia (1987-1989).

In Ethiopia, pre-eclampsia/eclampsia was reported to be uncommon. A clinical analysis of 327 (4.8%) pre-eclamptic and 21 (0.3%) eclamptic patients in 6766 deliveries at Yekatit 12 Hospital, Addis Ababa was made. Out of 327 pre-eclamptics, there were 52 (15.9%) cases of mild, 142 (43.4%) cases of moderate and 133 (40.7%) cases of severe pre-eclampsia. Among patients with pre-eclampsia/eclampsia, 78.2% had no antenatal care and only 39.3% of women from the total number of deliveries were unbooked. There were significantly high frequency of low birth-weight babies of patients with severe pre-eclampsia (mean +/- SD) 2154 +/- 506gms compared to the mean birth-weight of babies from the total number of deliveries 3112 +/- 461gms). In both pre-eclamptic and eclamptic patients, the perinatal mortality rate was 165 per 100 deliveries. This was a significantly higher rate than the total rate (28 per 1000 deliveries). These data suggest that this condition is more common in Ethiopian patients than presently appreciated and antenatal care among other factors remains to be one of the cornerstones in the prevention and control of pre-eclampsia/eclampsia.     

The pattern of tuberculosis in Addis Ababa, Ethiopia

Two hundred and forty available charts of medical patients treated for tuberculosis at Tikur Anbessa Hospital in Addis Ababa, Ethiopia over 2 years (9/83-9/85 were studied. TB was diagnosed in 11.2% of medical admissions. The average age of TB patients was 30.5; 58% were males; 53% were classed as poor. TB patients were poorer than other medical patients and averaged 38.9 days in hospital, non-TB patients averaged 31.9 days. Pulmonary disease was most common (47% of total), followed by spondylitis (12.1%), peritonitis (11.5%), and disseminated disease (11.1%). There were no cases of renal or cutaneous disease. 6% of admissions were diabetic, 16.4% had defaulted from previous TB treatment. Only 45% of patients had the diagnosis proven by histology or bacteriology. Pleural biopsy, lymph node biopsy, peritoneal biopsy, and sputum AFB stain were the most useful procedures in proving the diagnosis. A variety of drugs were given, 53% received INH-EMB-SM, 26% INH-SM-Thiacetazone; 32% received no form of vitamin supplements. The overall death rate was 8%, including 9% of pulmonary cases and 22% of patients with disseminated disease. Comparison is made with Ethiopian and other African data. It is suggested that patients receive definitive diagnostic tests earlier, along with earlier therapy and more consistent use of pyridoxine.     

Tetanus in Ethiopia: analysis of 55 cases from Addis Ababa

Fifty five cases of tetanus in patients over age 11 years from 6 Addis Ababa hospitals over several years are analyzed. No patient had been immunized. Mean age was 30, male:female 39:16, 34 patients were admitted from April through August (P less than .05). Most common causes of wounds were metal objects, thorns, and nails. There was no history of trauma in 8 patients. Mean incubation period was 11.9 days (range 1-90 days), mean invasion period was 38 hours (range less than 1 day-9 days). All cases were generalized tetanus, clinically diagnosed. Laboratory data was not helpful in management. Patients were treated with tetanus antitoxin, antibiotics, and sedatives. 15 patients (27%) died, there was no correlation between treatment and outcome. Deaths correlated with short incubation and invasion periods, and presence of abdominal rigidity, tachycardia, sweating, and fluctuating blood pressure. Only 3 patients received tetanus toxoid prior to discharge. Comparison is made with African and western studies. Tetanus remains a significant problem in Ethiopia, and vaccination is highly recommended.     

Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital.

Introduction: Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. Aims and objectives: This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth's classification and comparison made with earlier similar study. Results: Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth's classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V. Discussion: The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths. Conclusion: Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND).