Genetic characterization and progression of B3 measles genotype in Ethiopia: a study of five measles outbreak cases

BACKGROUND: One of the countries where measles remains endemic is Ethiopia. Previously, sequence data from Measles Viruses (MV) circulating in Ethiopia were obtained from clinical specimens. Now the Ethiopian Health and Nutrition Research Institute (ENHRI) has implemented cell culture techniques to isolate measles virus and molecular epidemiologic studies can be generated more easily. OBJECTIVE: To characterize the strains of Measles Virus circulating in Ethiopia during measles outbreaks in 2006 using viral isolates, and compare the results to previously identified Ethiopian strains. METHODS: A case study and convenience sampling method were conducted on five measles outbreak cases tb identify the circulating measles virus genotype in Addis Ababa and Amhara regions of Ethiopia in 2006. RESULTS: Three isolates were obtained from five specimens collected in two regions (1 from Amhara: Bahir Dar, and 2 from Addis Ababa: Addis Ketema and Kolefe Keranio subcities) in Ethiopia during 2006. The viral isolates were analyzed using standard genotyping protocols and were classified as genotype B3, identical to the strain circulating widely in West Africa and imported into Europe (Britain, Netherlands, Germany) and America (Mexico, USA, Canada). CONCLUSION: The conserved sequences among three isolates, covering a 3-month period, suggest that this B3 strain was circulating in Addis Ababa, Bahir Dar and possibly elsewhere in Ethiopia. To interrupt the transmission and circulation of MV, Ethiopia needs a strong national program of epidemiological surveillance, with characterization of circulating MV performed in a timely manner.     

Perception of dental fluorosis among adolescents living in urban areas of Ethiopia

The objective of the study was to assess the perception of dental fluorosis among adolescents residing in two urban areas in Ethiopia: Addis Ababa (low-fluoride drinking water) and Nazreth (high-fluoride drinking water). Students aged 12-15 years, enrolled in two junior secondary schools in Addis Ababa (n = 161) and two similar schools in Nazreth (n = 177) responded to evaluative statements concerning the appearance of anterior maxillary teeth. Color photographs depicting dental fluorosis (TF score 2, 3, 5 and 7) in maxillary front teeth were used as reference during structured interviews. A majority of the students from Addis Ababa and Nazreth were dissatisfied with the appearance of teeth having TF scores 2 and above. More than 66% of the students from both areas confirmed a need for dental consultation concerning fluorotic teeth with TF > or = [corrected] 2. As compared to their counterparts in Nazreth, children in Addis Ababa felt more embarrassed with TF score 2 and 3 (p < 0.01). TF scores 5 and 7 were found unacceptable both in Addis Ababa and in Nazreth. Students in Addis Ababa, more frequently than their counterparts in Nazreth, believed (erroneously) that dental fluorosis were related to neglect on the part of the child. The present findings confirm that fluorotic teeth constitute a social problem among junior secondary school children residing in low-fluoride as well as in high-fluoride urban areas in Ethiopia and, thereby, corroborate the public concern for safe drinking water.     

Incidence and some perinatal problems of multiple pregnancies in a central referral hospital, Addis Ababa

This survey covers 41,645 deliveries registered in St. Paul's Hospital, Addis Ababa (one of the 6 central referral hospitals of Ethiopia), from 1971 to 1985, with multiple deliveries comprising 2.5% of all the cases. The results obtained from analysis of these data revealed that twins occurred in the ratio of 1:41 deliveries, and triplets in 1:41(2) deliveries, this is in conformity with Hellin's statement, made in 1895. The occurrence of multiple delivery in multigravidae is shown as 1.62 times greater than that in primigravidae. There was a male predominance (52.1%) among twins. Discordant twins and triplets were observed in 31.5% and 50% respectively. In 55.9% of twin deliveries, both twins had a birthweight of less than 2500g. Head presentation of both twins occurred in 40% of the multiple births. Operative delivery was undertaken in 12.4% of all the cases.     

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

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.     

Description of patients admitted to a burn unit of Yekatit 12 Hosptial, Addis Ababa, Ethiopia

OBJECTIVES: The over all aim of the study is to describe the characteristics of patients with burn injuries admitted Yekatit 12 Hospital, Addis Ababa, Ethiopia. METHODS: The design of the study is a cross-sectional type. The data was collected prospectively. All the 121 burn patients admitted to Yekatit Hospital, from July 2001 to September 2002 were included in this study. RESULTS: In the study, the median age was 22 years (range 2 months to 70 years). Among them 64.5% were female and 35.5% were male. Scald was a common cause of burns for young children and flame was a common cause for adults. The frequent mechanism of burn injury for adults was exploding kerosene stove. The average mean total body surface area (TBSA) burnt was 17.1 %. The over all median hospital stay was 44 days. Most of the adults (74.7%) had delayed split thickness grafting. The mortality was 11.6%. This study showed that burn is an important health problem in the country, and it is also burden on the existing poor health care system in our setup. CONCLUSION: Even though this study may not show the true picture of burn patients seen in the country, it can represent the clinical picture of patients seen in most hospitals. To have a clear picture of burns in the population a community based epidemiological study should be done.     

Serological survey of human immunodeficiency virus infection in Ethiopia

A serological survey was conducted on 1754 people in various parts of Ethiopia from 1982-1987, with no HIV positive findings until 1984. The problem of Aids reached epidemic proportion in North America and Central Africa in the early 1980s. The reasons for delayed appearance and the source of HIV infection in Ethiopia are not clear. There were 4 groups of subjects tested. The 1st from 1982-83 consisted of 500 patients: 100 each from Asmara, Harar, Addis Ababa, Yirga Alem, and Nekemte; the 2nd in 1983 consisted of 459 volunteer blood donors in Addis Ababa; the 3rd in 1984 consisted of 167 patients with Bell's palsy, and 100 others; the 4th from 1985-87 consisted of 528 patients of the liver clinic of Tikur Anbessa Hospital. The 1st 2 HIV positive sera appeared in group 3 during 1984, and since then 13 patients examined for liver and gastrointestinal conditions were found to be positive. It may be speculated that the new and delayed introduction of HIV infection into Ethiopia is part of the transcontinental spread, caused by migration of refugees, frequent visits to existing harbors by sailors, and the influx of many international organizations to Addis Ababa where prostitution is common. Considering the high prevalence of HIV infection among prostitutes, promiscuity might be the major mode of transmission in this population. The multiple use of inadequately sterilized hypodermics and blood transfusions without screening also contribute to the spread of HIV infection.     

Cerebrovascular accidents in Ethiopia

The causes, risk factors and outcome of cerebrovascular accidents (CVA) in 150 patients admitted to Tikur Anbessa Hospital, Addis Ababa, Ethiopia, between 1983 and 1985 were studied. Cerebral thrombosis was the commonest cause of CVA (50.6%), followed by cerebral haemorrhage (24%) and cerebral embolism (15%). The single most important risk factor for CVA was hypertension. Mortality was highest with cerebral haemorrhage (89.4%) and lowest with cerebral embolism (13%). An important measure which could reduce the incidence of CVA is the vigorous and sustained control of hypertension.     

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     

Characteristics and outcomes of stroke at Tikur Anbessa Teaching Hospital, Ethiopia

Hospital studies have shown that stroke is an important cause of hospital morbidity and mortality in Ethiopia. The aim of this study is to determine the pattern, risk factors and determinants of mortality in patients with clinical diagnosis of stroke. It is a cross sectional study of all patients admitted with a clinical diagnosis of stroke between September 2000 and August 2001 to the Addis Ababa University Teaching Hospital. A total of 128 patients with mean age of 53.2 and M: F ratios of 1.5:1 were admitted The hospital burden of stroke appears to have increased significantly over the past three decades. Hemorrhagic stroke was the most common cause of stroke accounting for 57% of all patients and 59.2% among those who had CT scan. The number of patients with stroke increased linearly until age group 55-64, with peak incidence in the age group 55-64 years accounting for a third of all admissions. Hypertension was the most frequent risk factor identified followed by cardiac disease, 65.6% and 22.7% respectively. The majority of hypertensive patients were either on no form of treatment (28.9%) or erratic and irregular treatments (38.3%). Valvular heart disease (VHD) accounted for 40% of all heart diseases, and almost half of these also had atrial fibrillation of which none were on treatment. The overall mortality was 44.5%. Altered mental state and non focal neurologic deficits were the only independent predictors of mortality, odds ratio (95% CI), 5.7 (2.8-11.6) P = 0.001 and 5.5 (1.6-19.2) P=0.008 respectively. Treatment of hypertension and educating health-care professionals and the public on strategies of primary and secondary prevention remains the most important tool to prevent stroke in Ethiopia. Intensive care and inpatient facilities at referral hospitals have to be improved to curb the high mortality.     

Factors determining acceptance of voluntary HIV counseling and testing among pregnant women attending antenatal clinic at army hospitals in Addis Ababa

BACKGROUND: Mother-to-child transmission (MTCT) is by far the largest spurce of HIV infection in children below the age of 15 years. For many years little was known about preventing transmission of HIV infection from mother to child. Recently however, many interventions are available to reduce mother to child transmission, such as anti retroviral drug and avoidance of breastfeeding. For women to take advantage of measures to reduce transmission, they need to know their HIV status. OBJECTIVE: The objective of the study was to identify factors determining acceptance of voluntary HIV testing among pregnant women at army hospitals in Addis Ababa. METHODS: A case control study was conducted in 88 acceptors and 176 non-acceptors of VCT using structured pre tested questionnaire from December 2004 to January 2005, at army hospitals in Addis Ababa. RESULTS: Among socio-demographic factors the odds of VCT acceptance was higher among better educated, married, with higher income women and among women whose husbands live at the same house. Women who had better knowledge of VCT and MTCT and women with frequent ANC visit had significantly higher VCT acceptance than their counterparts. Adjusted for socio-demographic and some reproductive characteristics VCT acceptance was significantly associated with knowledge about MTCT (OR = 7.34, 95% CI = 3.44, 15.67), previous VCT experience (OR = 2.51, 95% CI = 1.03, 6.17) and husbands residence (at the same house) (OR= 4.97, 95% CI = 2.15, 11.46). CONCLUSION: Education of the mother, knowledge of MTCT and VCT and partner participation were important factors of VCT acceptance. The study gives useful information to health care providers to introduce measures that could improve the utilization of antenatal HIV testing.     

Detection of intestinal microsporidiosis in diarrhoeal patients infected with the human immunideficiency virus (HIV-1) using PCR and Uvitex-2B stain

A total of 105 single fresh stool samples were collected from diarrhoeal patients with (80 HIV-positive and 25 HIV-negative) from the Army and the Police hospitals, Addis Ababa. The stool samples were processed by water-ether sedimentation method; they were stained with Uvitex-2B technique for microscopic detection of intestinal microsporidium. A portion of all samples were preserved in 200microl PBS containing 2% PVPP ((Polyvinylpolypyrolidone) for confirmation with PCR. 18/105(17.2%) of the cases were positive for intestinal microsporidial infection by at least one method. 8/105 (7.6%) positive both by microscopy and PCR and 10/105 (9.5%) were positive only by PCR. All microsporidia positive cases were also HIV positive. Based on PCR analysis, 15 Enterocytozoon bieneusi and 3 Encephalitozoon intestinalis were identified. This study has shown that intestinal microsporidiosis is a common cause of chronic diarrhoea in advanced AIDS patients and this is mainly attributed to Enterocytozoon bieneusi. To the best of our knowledge, this is the first report of intestinal microsporidiosis in Ethiopia. It has an important implication for the understanding of the aetiology of diarrhoea in HIV/AIDS patients in the country.     

Experience of surgical therapy in 72 patients with thoracic hydatidosis over a 10-year period

OBJECTIVE: This review aims to evaluate retrospectively 72 patients diagnosed to have thoracic hydatid disease and treated surgically in Tikur Anbessa Hospital between December 1993 and November 2003. DESIGN: Retrospective Analysis hospital records. SETTINGS: Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. PATIENTS AND METHODS: Medical records and Operation theater registers of seventy-two Patients operated on for Thoracic hydatidosis were evaluated retrospectively. Chest Roentgenogram was the main diagnostic tool used Main surgical techniques employed were evacuation in 44 (52.4%) cysts, cystotomy in 30 (35.7%) cysts, and enucleation in 10 (12%) cysts. Additional palliative procedures (such as pericystectomy and Capitonnage) and radical procedures (such as resection of the lung) were also employed. RESULTS: forty of the patients were male and thirty-two female with a mean age of 31.4 years. The most Common presenting symptoms were cough in 60 (83.3%) patients, expectoration in 47 (65.3%) patients and chest pain in 38 (52.8%) patients. Chest radiography revealed a round opacity or shadow in 58 (80.6%) patients. All patients were treated surgically. The mean hospital stay was 38.3 days. Major postoperative Complications occurred in 12 (16.9%) patients; pneumonia, pleural effusion and prolonged air leak were the complications in order of their frequency. There was one postoperative death and one recurrence at 6-months follow-up period. CONCLUSION: Surgical excision of pulmonary hydatidosis with maximum preservation of lung parenchyma is possible in the majority of patients and should remain the mainstay of surgical treatment.     

Pattern of admissions to the medical intensive care unit of Addis Ababa University Teaching Hospital

A case-series study of all admissions using patient registers was carried out to analyse patterns of medical admissions into the Medical Intensive Care Unit (MICU) of the Addis Ababa University Teaching Hospital, and evaluate for any changes in that pattern over a study period. All patients admitted to the MICU of a 500-bed Teaching Hospital in Addis Ababa between 1985-2000 were the study subjects. Demographic variables, specific categories of diagnoses and their outcomes were recorded A total of 3548 patients (male to female ratio of 1.4:1, mean age 37.10 +/- 17.29) were admitted from September 1985 to August 2000. Acute infectious and cardiovascular diseases accounted for half of the entire critical care admissions with infectious diseases accounting for 30%. Among specific diagnoses, diabetic ketoacidosis was the leading cause of admission followed by acute myocardial infarction and severe and complicated malaria, each accounting for 10.7, 9.8 and 9.3% of all admissions respectively. Trends of admissions over the sixteen-year period showed steady increase in relative frequency of acute complications of non-communicable diseases consisting of diabetes, acute myocardial infarction and stroke while infectious diseases showed interspersed peaks of admissions coinciding with epidemics. The overall mortality of the MICU was 32%, with proportionally more female deaths, 34.8 versus 29% (P = 0.0002). Severe and complicated malaria was the leading cause of death (10.3%) followed by tetanus (6.4%) and acute myocardial infarction (6.3%). The increase in relative and absolute frequency of acute complications of non-communicable diseases most probably heralds an emerging epidemic of non-communicable diseases related to life style changes in the urban well to do in addition to existing problems of infectious diseases of poverty.     

Quality of family planning service in Dembia district, north west Ethiopia

OBJECTIVE: Ethiopia is one of the countries with high population and population growth rate. Providing quality family planning service is the major strategy to control the population growth. Since there were no studies conducted in Northwest Ethiopia regarding quality of family planning services, this study was conducted with the objective of assessing the quality of family planning services in Dembia district, Northwest Ethiopia. MATERIALS AND METHODS: A cross sectional community and health institution based study was conducted in April 2004. One hundred sixty five women were included in the household survey. For the assessment of availability of different family planning methods, technical competence of service providers, and appropriate constellation of services, the District Health (Office, one health center, three health stations, and 8 Community Based Reproductive Health Agents were selected. RESULTS: The maximum number of available methods in the sites was 3. All the 165 clients were informed how and when the method should be used but the information provided regarding the side effects of the methods was insufficient. In all the service delivery points there were 9 (40.9%) service providers who got additional training on family planning. Except one health officer, there was no one who can insert IUCD. All the five health professionals in the health center and 2 (28.6%) health professionals in the three health stations can inject depo provera. One hundred and six (64.2%), and 50 (30.3%) of the clients rated the providers relation with the clients as very good and good, respectively. All the clients had follow up appointments. One hundred forty two (86.1%) of the current users have used the method for one year and over. The working days for all government health institutions in the district are from Monday to Friday, 8 hours a day. CONCLUSION: Adequate choice of contraceptives were not available and the information provided to the clients was insufficient. Based on the findings it is recommended to increase the number of methods; provide sufficient information to clients; increase community based reproductive health service sites; and give additional training for the providers so that they can give quality family planning service in their area.     

Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia

Our knowledge of chronic suppurative otitis media is scanty in Ethiopia. This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa. Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire. A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media. Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years. Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%). Otalgia was reported in only 18%. Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically. Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents. Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus. A total of 106 bacterial isolates were cultured from ear discharges of 80 patients. Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics. All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive. Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment. Awareness about the health implications of the disease seemed to be lacking in among the caretakers. Selective use of antibiotics and continuous aural cleansing need to be promoted. More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia.     

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.     

Survey of burn admissions to the Ethio-Swedish Children's Hospital

A retrospective analysis of burn accidents seen in Ethio-Swedish Children's Hospital, Addis Ababa, Ethiopia over 10 years from January 1978 to December 1987 is presented. A total of 347 cases were seen, accounting for 1.73% of all hospital admissions during the period studied. One hundred eighty-six (53.9%) were males. Scald was the commonest cause, 212 patients (61.1%). Second degree burns involving the extremities were the most frequent. Forty (11.5%) of the patients died. Increased mortality was seen in males with deep third degree burns, shock, a low total protein (less than 6 g%), extensive burns, and burns involving sites other than the extremities. Preventive measures such as educational programmes in schools and on the mass media, together with implementation of legislation to minimize the hazard, are recommended.