The pattern of cardiac diseases at the cardiac clinic of jimma university specialised hospital, South west ethiopia

Background

Rheumatic heart disease is the commonest cardiac disease in most sub-Saharan African countries, followed by hypertensive heart disease which is rising along with the other non-communicable diseases. However the pattern in our setting is not known. This study aimed to determine the pattern of cardiac diseases among adult patients on follow-up at the cardiac follow-up clinic of Jimma University Specialized Hospital.

Methods

A cross-sectional study was conducted on cardiac patients who are newly enrolled to the cardiac follow up clinic of Jimma university specialized hospital during a five year period from 2003 to 2008. Out of the total 837 cases that were newly enrolled to the clinic in the five year period, 781 patients who had complete record about etiologic diagnosis were included in the study. The data were collected using structured record review checklist. The collected data were then analyzed using SPSS for windows version 12.0.

Results

Rheumatic heart disease was the diagnosis in 256 (32.8%) of the cardiac cases on follow-up followed by hypertensive heart disease and cardiomyopathy accounting for 189 (24.2%) and 158 (20.2%) of cases, respectively. Among Rheumatic heart disease patients; male to female ratio was 0.86:1 and the mean age was 31.4 years. One hundred ninety three (75.4%) of the cases with rheumatic heart disease had echocardiographic report that showed valve(s) involvements of pure MS in 99 (51.3%) and combined MS, MR in 49 (25.4%). Overall, hypertension contributed for a total of 241 (30.9%) of cardiac patients that included 189 (24.2%) hypertensive heart disease and 52 (6.7%) as one major risk factor for ischemic heart disease.

Conclusion

Rheumatic, hypertensive and cardiomyopathic heart diseases accounted for more than three-quarters of cardiac diseases in the study population. This study highlighted the need for further study to determine the burden at community setting.     

Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest ethiopia

Background

Urinary tract infection (UTI) is one of the most common bacterial infections encountered by clinicians in developing countries. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for urinary tract infections and their resistance patterns may help the clinician to choose the correct empirical treatment. Therefore, the aim of this study was to determine the type and antibiotic resistance pattern of the urinary pathogens isolated from patients attending Jimma University Specialized Hospital from April to June 2010.

Methods

A hospital based cross sectional stud was conducted and urine samples were collected using the mid-stream “clean catch” method from 228 clinically-suspected cases of urinary tract infections and tested bacteriologically using standard procedures. Antimicrobial susceptibility test was performed for the isolated pathogens using Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute guidelines.

Results

Significant bacteria were detected from 9.2% of the total patients. The most common pathogens isolated were Escherichia coli (33.3%), Klebsiella pneumoniae (19%) and S. saprophyticus (14.3%). E. coli and Klebsiella pneumoniae showed the highest percentage of resistance to ampicillin and amoxacillin (100%) however, all isolates of E. coli and K. pneumoniae were susceptible to ciprofloxacin. S. saprophyticus and S. aureus were resistant to ampicillin (100%) and amoxicillin (66.7%). For all UTI isolates, least resistance was observed against drugs such as ceftriaxone, gentamycin and chloramphenicol.

Conclusion

This study finding showed that E. coli isolates were the predominant pathogens and the presence of bacterial isolates with very high resistance to the commonly prescribed drugs that in turn leaves the clinicians with very few alternative options of drugs for the treatment of UTIs. As drug resistance among bacterial pathogens is an evolving process, routine surveillance and monitoring studies should be conducted to provide physicians knowledge on the updated and most effective empirical treatment of UTIs.     

Bacteraemia among severely malnourished children in jimma university hospital, ethiopia

Background

Sever acute malnutrition severely suppresses every component of the immune system leading to increased susceptibility and severity to infection. However, symptoms and signs of infections are often unapparent making prompt clinical diagnosis and early treatment very difficult. The aim of the study was to determine the magnitude of bacteraemia and antimicrobial sensitivity among severely malnourished children.

Methods

Severely malnourished children admitted in Jimma University Specialized Hospital were enrolled between October, 2009 to May, 2010. Blood samples were collected, processed and bacterial isolates were identified using standard bacteriological procedures. Then, antibiotic susceptibility pattern of the isolates was determined by using Kirby-Bauer technique.

Results

Bacteraemia was seen in 35 (20.6%) of the 170 study subjects. There were a total of 35 bacterial isolates, Gram positive bacteria constitute 24(68.6%) of the isolates, where Staphylococcus aureus was the leading Gram positive isolate while Klebsiella species were the dominant Gram negative isolates. Twelve (7.1%) children died and 4 (33.3%) of them had bacteraemia. While susceptibility was more than 80% to Gentamicin, Ciprofloxacin and Ceftriaxone, increased level of resistance was documented to commonly used antibiotics, such as Amoxycillin, Co-trimoxazole and Chloramphenicol.

Conclusion

High prevalence of bacteraemia with predominating Gram positive isolates and increased level of resistance to commonly used antibiotics was shown among severely malnourished children in Jimma. Further studies are required to revise the current guideline for antibiotic choice.     

Incidence, causes and outcome of obstructed labor in jimma university specialized hospital

Background

Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital.

Methods

Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0.

Results

The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score.

Conclusion

The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications.     

Knowledge, attitude and practice of emergency contraception among graduating female students of jimma university, southwest ethiopia

Background

Emergency contraception refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods including emergency contraceptives. The objective of this study was to assess the knowledge, attitude and practice of emergency contraception among graduating female students of Jimma University main campus.

Methods

A cross-sectional study was conducted in Jimma University main campus in 2009. The calculated sample size was allocated to each faculty proportions to size of female students. Then within the faculty the sample unit was selected by using simple random sampling technique. Data was collected using self administered questionnaire and analyzed using SPSS for widow version 16.0.

Results

A total of 389 (96.5%) volunteered graduating female students participated in the study. One hundred sixty three (41.9%) were ever heard of Emergency Contraceptive, only 11(6.8%) used the method. The common sources of information were friends 60 (36.5%), radio 37 (22.8%) and television 20 (12.3%). One hundred sixteen (71.2%) agreed to use Emergency Contraceptive when they practice unintended sexual intercourse.

Conclusion

Awareness and use of emergency contraception among graduating female students of Jimma University was low. There is a need to educate adolescents about emergency contraceptives, with emphasis on available methods and correct timing of use.     

Patterns of diabetic complications at jimma university specialized hospital, southwest ethiopia

Background

Diabetes Mellitus is common metabolic disease worldwide. Its complications in the Ethiopian care setup has not been well documented. The objective of this study was to assess the pattern and distribution of diabetic complications among patients having follow-up at Jimma University specialized Hospital diabetic clinic.

Methods

A cross sectional study based on record review of 305 patients, selected using systematic sampling with replacement was carried out in October 2008. The data were analyzed using SPSS for Windows version 13.0.

Results

Larger proportion, 189 (62.0%), of patients had type II diabetes and 163 (53.4%) of them were diabetic for less than 5 years. Seventy three of the 76 (96.1%) patients with type II diabetes mellitus had hypertension. Acute complications were observed in 93 (30.5%) of the patients of which Diabetic Ketoacidosis was documented in 66(71.0%).Forty eight (45.7%) of patients had proteinuria, 90 (29.5%) had peripheral neuropathy, 13(6.8%) had impotence. Diabetic foot ulcer, skin and/or subcutaneous tissue infection, dental problems and tuberculosis were documented in 14(4.5%), 31(10.0%), 31(10.0%), and 17(5.6%) patients, respectively. Any of the chronic complications were not different by sex of the patient but age had statistically significant association with hypertension, visual disturbance and neuropathy (p< 0.05). Type of diabetes had statistically significant association with all the tested complications except infection (P<0.05) where most of the complications occurred in type II diabetics. Statistically significant association was observed between the duration of the diabetes and impotence and visual disturbances (p < 0.05).

Conclusion

The majority of patients were type II diabetics. Acute complications were observed more commonly among type I diabetics and DKA was the commonest acute complication. The frequency of chronic complications was high. Increased occurrence of retinopathy, peripheral neuropathy, hypertension and nephropathy was observed with longer duration of illness. Impotence and diabetic nephropathy were more common in type II diabetics. The study showed that age, sex, type of diabetes mellitus and duration of diabetes were significantly associated with the development of diabetic complications.     

Reasons and outcomes of admissions to the medical wards of jimma university specialized hospital, southwest ethiopia

Background

Non-communicable diseases are the main reasons for admission to the medical wards in high-income countries. While in low and middle income countries communicable diseases are the main reasons for admission to the medical wards. However, in some low and middle income countries the reasons for admission are changing from communicable diseases to non-communicable diseases. But, data on reasons for admission to the medical wards of low income countries is scarce. Therefore, this study takes one year data from a low income country referral hospital aiming at describing the recent reasons and outcomes of medical admissions to see whether there is a change in reasons for admission and the outcome.

Methods

A retrospective study examined patient case notes and ward registration books of medical admissions at Jimma University Specialized Hospital from January 1, 2008 to December 31, 2008. Socio-demographic variables, reasons and outcomes of admission were some of the variables recorded during the data collection. The International Statistical Classification of Disease was used for sorting and categorizing the diagnosis. The data was then analyzed using SPSS windows version 13.0.

Result

A total of 610 patient case notes were reviewed. The mean age of the patients was 36 years (SD ± 15.75). The highest number of admissions 218 (35.7%) was among the age groups 21 to 30 years. Communicable diseases; namely severe community acquired pneumonia 139(22.8%), all infectious and parasitic diseases category 100 (16.4%), and pyogenic as well as chronic meningitis 80(13.1%) were the most common reasons for admission. The death rate among patients admitted to the medical wards was 12.6%.

Conclusions

Communicable diseases were still the common reasons for medical admissions at Jimma University Specialized Hospital. The outcome of medical admissions has not changed over sixteen years.     

Patients' preoperative expectation and outcome of cataract surgery at jimma university specialized hospital -department of ophthalmology

Background

Patient''s satisfaction for a given treatment is an important clinical outcome because a satisfied patient is more likely to comply with treatments, attend follow-ups and advocate the service to others. Therefore, knowing patients'' expectations before a planned procedure or treatment and the actual level of satisfaction and fulfillment of their initial expectations thereafter is much helpful. As far as the knowledge and experience of the researchers is concerned, there has not been any study conducted in Ethiopia to find out about patients'' preoperative expectations and postoperative level of satisfaction for actual outcomes. This study was therefore, conducted to describe and find out the relationship between preoperative expectations of cataract patients and the actual postoperative experience and their satisfaction level following the surgery at ophthalmology department in Jimma University Specialized Hospital.

Methods

A prospective cohort study of patients undergoing first eye cataract surgery was conducted from July 10 to Oct., 10, 2007 in the Ophthalmology department of Jimma University Specialized Hospital. Detailed interviews that included general and vision specific health status measures and patients'' preoperative expectations for cataract surgery outcomes were performed followed by visual acuity testing. Postoperatively, visual acuity testing was taken again and patients'' level of satisfaction with attained postoperative vision was assessed. Data were collected and filled in a separate questionnaire form for each patient, and entered into a computer and analyzed using SPSS for Windows version 12.0.

Results

Of the 200 patients operated for cataract, 179 (89.5%) were followed for the whole five weeks. The average expected preoperative Visual Function-15 score was 96.3, compared to an achieved (postoperative) Visual Function-15 score of just 96.2. However, the most unrealistic expectations observed were reading small prints and doing fine handiwork. The final pinhole visual acuity postoperatively was ≤ 6/18 in 126 (70.4%) patients. Of the 78 (39%) patients who were bilaterally blind preoperatively, 5 (2.5%) patients remained blind postoperatively.

Conclusions

Significant improvements were obtained in clinical, functional, and perceived vision by cataract surgery involving extracapsular cataract extraction with posterior chamber intraocular lens implantations. Expectations regarding visual functioning after cataract surgery were very high, and in most cases and in most cases they were fulfilled.     

Indoor air bacterial load and antibiotic susceptibility pattern of isolates in operating rooms and surgical wards at jimma university specialized hospital, southwest ethiopia

Background

Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms'' and surgical wards'' indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms'' and surgical wards'' indoor air of Jimma University Specialized Hospital.

Methods

A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher.

Results

The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5–8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250–450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S. aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively.

Conclusion

Higher degree of aerobic bacterial load was measured from operating rooms'' and surgical wards'' indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.     

Hypertensive disorders of pregnancy in jimma university specialized hospital

Background

Hypertensive disorders represent the most common medical complications of pregnancy with a reported incidence between 5 and 10%. The disorders are major causes of maternal and perinatal morbidities and mortalities. This study was conducted to determine the pattern and outcomes of pregnancies complicated by hypertensive disorders.

Methods

Hospital based cross-sectional study was conducted on all mothers who gave birth in the labor ward of Jimma University Specialized Hospital from April 1, 2009 to March 31, 2010. Data was collected by interviewing the mothers and review of their medical records using structured questionnaire and checklist, respectively. Data analysis was performed using SPSS for windows version 16.0.

Result

Majority (52.5%) of the mothers were in the age group of 25 - 34 years. The overall prevalence of hypertensive disorders of pregnancy was 8.5%. Severe preeclampsia accounted for 51.9% of the cases followed by eclampsia (23.4%). Residential area of the mothers (urban/rural) was found to have statistically significant association with severity of the disorder. Most (66.5% and 74.7%) of the mothers were nulliparous and had antenatal care follow-up during the index pregnancy, respectively. Antenatal care follow-up and parity had no statistically significant association with severity of the disease. The case fatality rate of hypertensive disorders of pregnancy was 1.3% with perinatal mortality of 317.1/1000 births.

Conclusion

Pregnancies complicated by hypertensive disorders have poor maternal and perinatal outcomes and rural women were more affected. Quality antenatal care services with good obstetric and neonatal care at delivery are essential for early recognition and management of hypertensive disorders of pregnancy.     

Child spacing and fertility planning behavior among women in mana district, jimma zone, South west ethiopia

Background

Short birth intervals and unintended pregnancies pose serious health risks to mothers and their infants by causing unnecessary high risk of pregnancy related complications and self induced abortions. The objective of the study was to assess the child spacing and fertility planning behavior of women in Mana district, Jimma zone.

Methods

A cross-sectional survey was conducted from July 18 – August 17, 2008 on 645 women who had a live birth in the three years prior to the survey. A simple random sampling technique was used to identify eligible women. A pre-tested structured questionnaire was used for data collection. Data were analyzed using SPSS for windows version 15. Frequency distributions, cross-tabulation, and logistic regression analysis were performed.

Results

Analysis of birth intervals for women with non first births showed that 27% of births occurred within less than 24 months after a previous birth, showing that a considerable proportion of births were not adequately spaced to promote maternal and child health. About 39% of women reported that their recent pregnancy was unintended. Women with unintended pregnancy are more likely to be illiterate (OR=1.85,95%CI,1.23–2.79), have four or more living children(OR=2.77,95% CI,1.77–4.33), had a previous birth interval of less than 24 months(OR=1.78,95% CI(1.19–2.69), have never used contraception (OR=4.53, 95% CI, 3.05–6.75) and did not desire any more children (OR=1.84, 95% CI, 1.23–2.76).

Conclusion

The study showed that an inadequate child spacing and high level of unintended pregnancy among considerable proportion of the study population. Unintended pregnancy and short birth intervals can pose serious health risks to mothers and their infants by causing unnecessary high risk of pregnancy related complications. Thus, improving access to safe and voluntary family planning counseling and services is essential to reduce the high level of unintended pregnancy and short birth intervals.     

Human intestinal schistosomiasis in communities living near three rivers of jimma town, South Western ethiopia

Background

Schistosoma mansoni is one of the parasites with high public and medical importance in Ethiopia. However, information is scarce about S. mansoni epidemiology in people living with higher risk of infection in Jimma town. This study was designed to determine point prevalence, intensity and risk factors of S. mansoni infection among residents nearby three rivers of Jimma town and assess the rate of Biomphalaria species shading cercariae from January to April, 2007.

Methods

A cross-sectional study was conducted in communities residing nearby three rivers of Jimma town. Structured questionnaires were used to collect data on socio- demographic and behavioral risk factors. After physical examination, stool samples were collected from 517 study participants and processed with Kato-Katz technique for microscopic examination and quantification of egg load. Snails were collected for identification of Biomphalaria species and then checked for cercarial shading.

Results

The prevalence of S. mansoni was 26.3 % with intensity ranging 24 to 936 eggs per gram of stool. Participants in the age group 10–19 years, OR = 2.19 (95% CI; 1.10 – 4.34), and those living near the Awetu River, OR = 2.67 (95% CI; 1.06 – 6.75), had higher risk of S. mansoni infection. Moreover, water contact while crossing a river, OR = 3.77 (95% CI; 1.79 – 7.95), and swimming, OR = 2.59 (95% CI; 1.37 – 4.91, was significantly associated with infection. Biomphalaria snails collected from Chore and Awetu Rivers shaded higher rate of cercariae compared with Kito River.

Conclusion

A moderate prevalence of S. mansoni infection was shown in the study population. Infection rate among the residents correlated with rate of cercarial shading Biomphalaria snails. Treatment of targeted groups, appropriate health education and environmental measures (e.g. snail control) are needed to improve the situation.     

专科医院医务人员职业暴露调查分析与对策

目的 了解专科医院医务人员的职业损伤情况,探讨职业暴露的危险因素,制定有效防范措施.方法 2008-2010年发生职业暴露医务人员填写针刺伤与锐器损伤报告表或血液、体液暴露接触报告表,并建立暴露后跟踪记录.结果 2008-2010年全院共发生职业暴露73人;暴露源主要为乙型肝炎、梅毒、HIV;锐器损伤58人,占79.45％;血液、体液暴露接触15人,占20.55％.结论 加强健康教育,提高医务人员的自我防护意识和应急处理能力,是减少职业暴露的关键.     

2006—2010年江苏省城市和农村地区儿童伤害监测结果分析

目的了解2006—2010年江苏省城市和农村地区儿童伤害发生情况,为制定干预措施提供依据。方法收集2006—2010年江苏省南京市浦口区和张家港市监测点伤害监测哨点医院儿童伤害病例资料,用SPSS16.0软件进行统计分析。结果儿童伤害病例32 853例,男性儿童伤害病例多于女性,城市与农村男女性别比分别为2.07∶1和1.83∶1;伤害发生前2位原因均为跌倒/坠落伤和交通伤害,城市为47.9%、17.5%,农村为33.1%、20.1%;发生地点以家中最多,城市和农村分别为26.2%和43.8%;城市和农村意外事故分别占93.3%和95.9%;伤害性质前2位为挫伤/擦伤以及锐器伤/咬伤/开放伤;伤害严重程度轻伤约占80%;仅有1%左右为重度伤害。城乡儿童病例在一般信息、伤害事件情况和临床信息方面差异均有统计学意义(P<0.05)。结论江苏省城市和农村监测点儿童伤害事件分布特征不同,在进行干预活动时,要根据具体情况选择优先干预的方向。     

新疆乌鲁木齐市伤害典型案例流行病学分析

目的了解乌鲁木齐市伤害典型案例的流行特征,以寻求有效的干预措施,控制与降低伤害典型案例的发生。方法选取乌鲁木齐市3家伤害监测哨点医院,采用统一制定的伤害监测登记表,对2012—2013年前来就诊的首诊伤害典型案例进行登记。对其发生的原因、地点、结局、患者性别和年龄等进行回顾性分析。结果累计收集伤害典型案例120起共518例,其中男性占55.2%,女性占44.8%,差异有统计学意义（χ2=13.491,P﹤0.01）。伤害发生原因构成比最高的前2位是车祸（50.8%）和中毒（29.5%）。伤害发生地点主要在公路/街道（54.1%）和家中（15.1%）。伤害结局构成比最高的前2位主要为治疗后回家（65.1%）、观察/住院/转院（33.8%）,死亡构成占1.2%。结论伤害是乌鲁木齐市一个严重的公共卫生问题,尤其是伤害典型案例。因此加强安全教育,采取有效措施,加强多部门合作,开展科研和干预十分必要。