Childhood meningitis in a tertiary hospital in Addis Ababa: clinical and epidemiological features

Hospital based prospective study of 136 children aged 3 months to 12 years admitted as cases of meningitis between June 1996 and May 1997 was undertaken to assess the epidemiological features, evaluate the outcome and measure the duration of clinical improvement after initiation of treatment. Infants accounted for 79 (58%) of cases and 23 (68%) of deaths. Next to fever and vomiting, neurologic signs were the commonest presentation. H. influenzae, S. pneumoniae and N. meningitidis accounted for 90% of culture isolates. Delayed presentation, partial treatment, altered sensorium at admission and pneumococcal meningitis were risk factors for mortality. The morbidity and mortality rates were 25% of total cases each. The mean duration of fever was 3.7 (+/- 2.27) days after treatment. The morbidity and mortality rates are still high in this hospital.     

Destructive vaginal deliveries at a teaching hospital in Addis Ababa, Ethiopia

OBJECTIVES: To assess the incidence, indications and complications of destructive vaginal deliveries. DESIGN: Retrospective study on the incidence, methods used, and outcomes of destructive vaginal deliveries (DVDs) performed by residents in obstetrics-gynecology from 1997 to 2002. SETTING: Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia. RESULT: Overall, there were 7.8 DVDs per 1000 deliveries, with an increasing trend during the five years of the study. Craniotomy was the most common (94%) DVD-procedure mainly used for cephalopelvic disproportion (CPD), accounting for 89% of the craniotomies. The proportion of craniotomy to all the DVDs used was significantly more (p-value < 0.05) among non-Addis Ababa residents (98.6%) than among Addis Ababa residents (87.2%). Among the 54 women with known last menstrual date, gestational ages ranged from 31 to 45 weeks with 7.4% 13% and 79.6% of them being post-term, preterm and term, respectively. Labor lasted from 8 to 96 hours. While 104 (88.8%) women had labor-duration of more than 24 hours, 65 (56%) women had duration of more than 12 hours. Fistula was significantly higher (p-value < 0.05) among women with labor of more than 24 hours (15.4%) than those with shorter durations (0%). Similarly, significantly higher difference (p-value < 0.05) was found in infection among labors of more than 24 hours (47.7%) than shorter duration (11.8%). Minor genital traumas were significantly more frequent (p-value < 0.05) among first-time mothers (50.6%) than multiparous (25.8%). CONCLUSION: The low use of episiotomy (7.8 %) might have contributed to the high rate of minor genital traumas. Compared to birth weight of singleton live births in Ethiopian described by various hospital based studies (Tikur Anbessa (3126 g), Jimma (3183 g) and Sidamo hospital (3243 g)), the average birth weight of the fetuses in the craniotomy group (2957 g) found in this study ivas smaller. This may indicate that, in Ethiopia, the role of small pelvic size in CPD is more important than fetal weight. To alleviate the painful and difficult travel of laboring mothers to major hospitals, training of general practitioners in destructive vaginal delivery, pre- and post procedure care need to be strengthened     

Severe rickets in a children's hospital in Addis Ababa

A retrospective, case-controlled study of rachitic patients admitted to Ethio-Swedish Children's Hospital (ESCH), Addis Ababa, Ethiopia, over a ten-year period (1979-1988) is presented. Clinical records of 131 patients with clinical and radiological evidence of rickets and an equal number of randomly selected, age and sex matched controls with no rickets were analysed. Rickets was found to be more common in males (2:1) and at 6 to 18 months of age (79%). Associated findings were infectious diseases (90%), protein-energy malnutrition (75%), anaemia (39%), and congestive heart failure (16). Mortality was much higher in rachitic patients. The admission rates show a progressive increase over the study period. The need for early diagnosis and treatment, continued nutrition and health education, and further study to elucidate the relation between protein-energy malnutrition (PEM) and rickets is suggested.     

Abdominal tuberculosis in a children's hospital in Addis Ababa

A review of the clinical records of all patients with the diagnosis of abdominal tuberculosis, admitted to the Ethio-Swedish Children's Hospital (ESCH), Addis Ababa, Ethiopia, over a ten year period was made. There were 57 patients that fulfilled the inclusion criteria, accounting for 0.22% of all admissions. Both sexes were nearly equally affected. In more than a quarter of the patients (30%), the diagnosis of tuberculosis was not considered at admission. Fever, weight loss, night sweating and abdominal pain were common presenting symptoms. The role of positive Mantoux and elevated erythrocyte sedimentation rate (ESR) as an aid to diagnosis were limited. The number of admitted patients with abdominal tuberculosis at ESCH is much lower than what has been reported from other African countries. The findings of the present study clearly indicate the need for a high index of clinical suspicion. Laparoscopic and peritoneal biopsy should be included in the diagnostic work up of patients suspected of having abdominal tuberculosis.     

Post term pregnancy at teaching hospitals in Addis Ababa, Ethiopia

OBJECTIVE: To Determine pregnancy outcome between term and post term deliveries and to assess the proportion of post maturity syndrome among neonates in the two groups. DESIGN: Cross-sectional comparative study of pregnancy outcome among term and post term mothers. SETTING: Two teaching hospitals in Addis Ababa, Ethiopia. SUBJECTS: 376 post-term mothers compared to 376 term mothers. MAIN OUTCOME MEASURES: Fetal distress, caesarean section rates, neonatal intensive care unit admission, perinatal mortality, congenital anomalies, low birth weight, Apgar scores, macrosomia and third stage complications. RESULTS: The proportion of mothers delivering post term at the study sites was 8.8%, which agrees with most series in which diagnosis of post term was based on LNMP. There were 99 (26.3%) fetal distress in the post term group compared to 50 (11.2%) among term deliveries (P<0.001). The caesarean rate for the post term mothers was 89 (23.7%) compared to term mothers of 47(12.5%) (P<0.001). Neonatal intensive care unit admission rate for post term mothers was 25(6.7%) compared with 1(2.9%) term mothers (P<0.05). No significant differences in the rates of perinatal mortality, congenital anomalies, low birth weight, macrosomia, CPD or third stage complications were observed between the two groups, though most were relatively frequent in post terms. CONCLUSION: Due to lack of antenatal care and late referral, the diagnosis of post terms is based on LNMP alone in most cases. Fetal distress, perinatal asphyxia and consequent caesarean delivery rate is much higher than other series. Health education on early initiation of antenatal care as well as timely referral from peripheral units is urgently needed. Based on the findings of our study we recommend that in all pregnant women (individualization is possible) with 42 completed weeks of gestation, the pregnancy should be terminated be it through vaginal or abdominal route for a better fetal outcome.     

Elective hysterectomy at Tikur Anbessa Teaching Hospital,Addis Ababa

A retrospective analysis of 969 elective hysterectomies performed at Tikur Anbessa teaching hospital from February 1992-October 2000 is presented. The objectives of the study were to outline the major indications, the frequencies of intraoperative and postoperative complications and the variations of these frequencies in the various types of hysterectomy, thereby providing data on this important gynaecologic operation in an Ethiopian hospital set-up. Elective hysterectomies accounted for 79.3% of all hysterectomies performed at the unit. There was a preference for the abdominal approach to hysterectomy (77.3%) with vaginal hysterectomy being done in only 22.7%. The three major indications for hysterectomy were leiomyoma 396/969 (41.1%), uterovaginal prolapse 221/969 (23%) and ovarian tumours 188/969 (19.5%). 567/969 (58.5%) of the patients had an underlying medical condition; anaemia being the commonest, accounting for 325/969 (33.5%). In 294/969 (30.2%) of the operations, intraoperative adhesions requiring adhesiolysis were encountered. A high proportion of intraoperative complications 167/969 (17.2%), and postoperative complications, 316/969 (32.6%), were found. Intraoperative haemorrhage rate 135/969 (14%) is significantly higher than reports from other series of hysterectomy. Postoperative febrile morbidity, 260/969 (27%), is also significantly higher than rates reported from other series. Unexplained fever was however lower, being responsible for only 20% of the febrile morbidity. There was a significantly increased risk of urinary tract infection in vaginal hysterectomies and unexplained fever in abdominal hysterectomy (P < 0.05). There is a need to use the vaginal approach to hysterectomy whenever feasible and introduce infection prevention protocols to reduce the high incidence of infection at the unit. Analytic studies to assess risk factors for haemorrhage and infection are required in order to devise preventive strategies.     

Assessment of quality of post abortion care in government hospitals in Addis Ababa, Ethiopia

BACKGROUND: Unsafe abortion is the leading cause of maternal death in Ethiopia. It is also known to cause several acute and long-term complications leading to disabilities. In countries like Ethiopia where there is no access to safe abortion, improvement of the available postabortion care services is an important strategy. OBJECTIVES: The aim of the study is to assess the quality of health services with respect to postabortion care in hospitals in Addis Ababa, Ethiopia. METHODS: A cross sectional survey on quality of postabortion care was conducted among 422 postabortion patients attending four hospitals in Addis Ababa. Additionally, 42 service providers involved in providing postabortion care services were interviewed. Direct service delivery observation and inventory of equipment and supplies were also conducted. The data were analyzed using Statistical Package for Social Sciences. RESULTS: Interaction between service providers and patients was found to be satisfactory whereas information provision on important aspects of care such as danger signs and follow-up needs were very limited. Only about 20% and 3% received family planning counseling and contraceptive methods respectively. Other reproductive health related issues such as STIs and HIV/AIDS were rarely raised by the service providers during caring for the patients. Overall 92.3% of the patients responded that they were satisfied with the services they have received. CONCLUSION: The study has shown several missed opportunities and indicated important areas for future service delivery improvement.