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.     

Magnitude of episiotomy in a teaching hospital in Addis Ababa, Ethiopia

OBJECTIVE: To assess the rate of Episiotomy in vaginal birth in Tikur Anbessa teaching Hospital and the associated factors that influences the use of episiotomy in the unit. METHODS: A cross-sectional study was conducted in the delivery unit of the Tikur Anbessa Hospital from May to September 2000. Data on mothers who delivered in the study period was collected using structured questionnaire. Variables on use of episiotomy, parity, fetal presentation, duration of labor, mode of delivery, Apgar scores at first and fifth minutes, indications for episiotomy and the practice of analgesia & anesthesia in the management of Episiotomy were collected Medical charts and the labor ward logbook were reviewed for collecting the data. RESULTS: A total of 917 deliveries were attended during the study period among which 672 mothers (83.1%) delivered vaginally. Among the vaginal deliveries, 270 (40.2%) mothers had episiotomy. Of these 203 (75.2%) mothers were primigravidae. Nulliparity (77.7% vs 21.3%), the duration of the second stage of labor more 90 minutes (76% vs. 13.8%) and instrumental delivery (86.2% vs. 13.8%) has been shown to be significantly associated to having episiotomy, while the birth weight and Apgar scores didn't show significant differences. Local anesthesia was used only in 71 (28.1%) cases among the 253 on whom information regarding the use of local anesthesia was retrieved. CONCLUSION: The rate of episiotomy is significantly higher than the recommended practice for many centers. Measures should be taken to lower the rate of episiotomy rate that include preparation of guidelines and protocols according to the standard and training and nurses, midwives and doctors on the selective use of episiotomy. The current practice of perineal repair without analgesia/anesthesia should be revised and making labor and delivery less painful needs to be advocated.     

Magnitude and pattern of injuries in north Gondar administrative zone, northwest Ethiopia

A prospective study was carried out between April and July 2000 in North Gondar administrative zone, Northwest Ethiopia, to assess the magnitude, pattern, outcome and burden of injuries. All trauma victims presenting to twenty health institutions were included. Of 37026 patients registered, 1982 (5.4%) presented with injury as main complaint. Trauma constituted about 46% of surgical patients, which shows a significant burden to the institutions. Seventy three percent of the injured patients were males. The leading cause of injury was assault (48.5%) followed by fall down injury (18.6%) and road traffic injuries (14.7%). Of the vehicle related injuries, 59.6% were caused by commercial vehicles. Admission was required in 15.2% of the injured patients. An average of 4.2 hours was required for initial outpatient management. The average hospital stay for the admitted patients was twelve and half days. In this and other parts of Ethiopia, injury prevention efforts should focus on assault, falls and transport safety with special attention to commercial vehicles. A community-based study is also recommended to explore the burden of trauma on the general community.     

Magnitude, type and outcomes of physical violence against married women in Butajira, southern Ethiopia

The seriousness in magnitude of physical violence globally, and lack of information on the dimensions and context of the problem in Ethiopia is very visible. A cross-sectional survey was conducted in Meskanena Mareko Woreda, Southern Ethiopia, from November 1 to 30, 1995 to assess the magnitude, type and outcomes of physical violence against married women. A total of 673 married women were included in the study. The study found out the overall prevalence of physical violence against married women to be 45% and 10% in their lifetime and last three months, respectively. Two hundred and twenty nine (76%) and 39 (60%) of the lifetime and three month's physically abused women respectively, were slapped with fist. Four (1%) of the lifetime physically abused women have been abused using a knife or a gun. Among the 303 physically abused women, 161 (53%) reported minor and serious somatic injuries in their lifetime. One hundred and nine (46%) of them had acquired minor lacerations or scars; 22 (7%) had reported to have fracture or dislocation; and 5 (2%) had lost their vision. It is concluded that physical violence among married women is quite high and a serious problem. We recommended that policy makers need to urgently explore for appropriate strategies to curtail the problem of physical violence against married women.     

Beliefs and traditional treatment of malaria in Kishe settlement area,southwest Ethiopia

Kishe settlement area southwest Ethiopia, is endemic for malaria, and malaria-related morbidity and mortality are important public health problems. Malaria beliefs and practices are often related to culture, and can influence the effectiveness of control strategies. This study assessed attitude and practices relative to causation, treatment, prevention and control of malaria, and documented traditional malaria treatment practices and remedies, in order to provide baseline data for control program planning and further investigation. A cross-sectional study was conducted in December 1997 by interviewing 254 randomly selected study subjects 85 indigenous and 169 settlers. Eighty three percent of 254 respondents attributed the cause of malaria infection to dirt and rubbish. Ranking of vector control measures was poor, with 77% prioritizing cleaning dirt and rubbish, while only 36% mentioned drainage of swampy areas. Ninety eight percent accepted Dichlorodiphenyltrichlroethane (DDT) house spraying. The prevalence of clinical malaria attacks was 77% and communities had good knowledge about malaria morbidity and mortality. Forty three percent had used traditional medicine for malaria, for reasons including greater accessibility (82%), low cost (48%), lack of awareness about modern medicine (25%) and belief that traditional medicine is better (7%). Most are well informed about malaria morbidity and mortality, understood about the use of DDT spraying and have good treatment seeking behavior but practice of prevention and concept about causation prevention, and control of malaria is poor. It is wise to put emphasis on health education particularly on preventive aspects. Malaria control technicians and environmental health technicians, who closely interact with the community could be used for this purpose. The common traditional treatments for malaria could be further investigated for their effects on malaria parasites and/or symptomatic relief of clinical illness.     

Prevalence of urban malaria and assocated factors in Gondar Town, Northwest Ethiopia

BACKGROUND: Malaria has become one of the major health problems currently facing the urban communities. The rapid increase in urbanization, rural-urban migration and climatic changes are among the main factors contributing for the rise of malaria in urban areas. To our knowledge, there has been no malaria prevalence study so far conducted in Gondar Town. OBJECTIVE: The aim of this study was to determine the prevalence of malaria infection and its associated risk factors in Gondar Town. METHODS: A community-based survey was conducted in three randomly selected malarious Kebeles of Gondar Town during November-December 2004. Blood films were collected from a finger-prick of 734 members of the selected households for microscopic examination of malaria parasites. RESULTS: Among 734 examined blood films, 39 (5.3%) were positive for malaria infection, of which 29 (74.4%) were due to Plasmodium falciparum and 10 (25.6%) due to P. vivax. Seven (18%) malaria infections were reported from children under the age of five years, indicating the endemicity of malaria to the study area. Age-specific rates show that higher malaria prevalence rate was found among under-five children (7.2%) and 15-19 year-old age group (7.3%). Proximity to mosquito breeding sites was found to be the main risk factor for malaria infection (OR = 2.4, 95% CI. 1.2-5.1). CONCLUSIONS: The prevalence of malaria in Gondar Town was found to be high. The prevalence was strongly associated with proximity of residence to potential mosquito breeding sites. The occurrence of the disease among under-five children would indicate that malaria is indigenous to the area. Use of personal protection methods such as insecticide treated mosquito nets should be scaled up, and malaria control interventions should target residents who are at a closer proximity to mosquito breeding sites.     

Evaluation of antiretroviral treatment in two private medical centers in Addis, Ethiopia

Ethiopia is one of the countries affected severely by the HIV/AIDS epidemic in sub-Saharan Africa. The disease is gradually fatal without antiretroviral therapy (ARV). The experience with antiretroviral therapy is limited in this country. This study is the first of its kind that has evaluated the status and implication of the clinical use of ARV drugs in Ethiopia. The guidelines for the initiation of treatment, the strengths and weaknesses of such treatment and the implications of similar intervention in a wider scale were assessed. Clinical records of 33 patients under follow-up and treatment with ARV in Hayat Hospital and Bethezatha Medical Center were identified. Data were collected from the medical records using a tool designed for the purpose. All 33 patients were receiving ARV for a mean duration of about 4 months. Twenty- three (69.7%) were males and 10 (30.3%) were females and the mean age was 38 years. Fifteen (45.5%) were married, fourteen (40.7%) were single, one (3%) divorced and there was no record for three (9.1%). Fifteen (45.5%) were businessmen, seven (21.2%) were private employees, four (12.1%) civil servants and in the remaining seven (21.2%) their occupation was not recorded. The decision to initiate ARV therapy was entirely based on the presence of symptomatic HIV disease. CD4+ lymphocyte count was done in 24 (72.7%) and basic hematological tests were done for all. However, biochemical investigations were incomplete in all of them. Triple therapy was started for all patients and the cost of the drugs was covered by their family in eleven (33.3%), by the patients in twenty-two (66.7%). Side effects of the drugs were noted in ten (30.3%) that resulted in change of the regimen in two and drug interruption in one. Response to treatment was entirely based on clinical parameters only. Twenty-three patients (69.7%) were noted to improve while nine (27.3%) remained the same and death occurred in one (3%). Standard triple therapy was used in all patients in this study and symptomatic HIV disease was the reason for the initiation of treatment. The improvement observed was not substantiated by immunological or virological parameters. Thus, the impacts of ARVs cannot be measured and the response documented in this study can be due to the effective treatment of opportunistic infections. Hence a standard protocol should be developed based on the minimum set-up required for the initiation of ARV therapy.     

The outcome of severe malnutrition in northwest Ethiopia: retrospective analysis of admissions

OBJECTIVE: To assess the clinical profile and treatment outcome of children with severe malnutrition. PATIENTS AND METHODS: A retrospective study of 335 children with severe malnutrition was conducted in Gondar University hospital over a period of four years; September 1997 - August 2000. RESULTS: There were 175 (52.2%) males and 160 (47.8%) females with severe malnutrition. Children below the age of 24 months constituted for 60.3% of all the admissions. Marasmus was the most common type of malnutrition, present in 174 (52.0%) of the patients. Kwashiorkor and marasmic kwashiorkor were seen in 78 (23.3%) and 83 (24.7%) of the patients respectively. The overall case fatality rate was 61 (18.4%) while 30 (9.1%) abandoned treatment. Two hundred forty (72.5%) of the patients were discharged improved. The case fatality rates for the different types of malnutrition were 28.4% for marasmic kwashiorkor, 16.9% for kwashiorkor and 14.5% for marasmus. A statistically significant risk of death was observed in those with history of bottle feeding (OR 4.5, P-value < 0.01), diarrhea with severe dehydration (OR 3.05, P-value < 0.01), altered level of consciousness (OR 7.08, P-value < 0.001), total serum protein of 5 g/dl and less (OR 3.45, P-value < 0.05) and patients having marasmic kwashiorkor (OR 2.55, P-value < 0.01). CONCLUSION: This study shows a high mortality rate of severe malnutrition despite hospitalization. The findings confirm the need for intensive management of severe malnutrition.     

Hospital admissions for malaria in Basel, Switzerland: an epidemiological review of 150 cases

The increase in international travel and immigration from tropical countries has led to a growing number of imported malaria cases in industrialized countries. We analyzed the charts of every patient hospitalized for malaria from 1970-1992 in Basel, Switzerland. A period lasting from 1970-1986 was compared to 1987-1992. There were 150 malaria-episodes recorded. Over time, the number of immigrants increased from 12 to 27% (p <.05). More patients were admitted with Plasmodium falciparum-infection (49 vs. 75%, p <.005). The number of untypable malaria decreased from 30 to 9% (p <.005). In the more recent period, more diagnosis were done within a week (66 vs. 50%, p <.05). Twenty-three (15%) patients were admitted to the ICU, four (2. 6%) patients died of cerebral malaria. Twenty-seven (18%) patients developed malaria while taking correct prophylaxis. Despite some progress, malaria is still causing considerable morbidity and mortality. Non adherence to chemoprophylaxis was a major risk factor for acquiring malaria in hospitalized patients.     

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.     

Community perceptions and practices about urban malaria prevention and control in Gondar Town, northwest Ethiopia

BACKGROUND: Malaria is becoming a major health problem in urban areas. Community perceptions, knowledge and practices have a major role in the implementation of effective malaria control interventions. Yet little is known about the perceptions and practices of urban community about urban malaria prevention and control. OBJECTIVE: The aim of this study was to assess the knowledge, attitudes and practices of an urban community about malaria prevention and control. METHODS: A community-based cross-sectional study was carried out in three randomly selected malarious Kebeles of Gondar Town during November-December 2004. Knowledge, attitudes and practices were assessed for 489 household members > or =18 years old. RESULTS: Almost all respondents knew about malaria and recognized it as one of the major health problems of the community. About 58% knew that malaria could be transmitted from one person to another, and most (97.2%) associated malaria with the bite of mosquito. The most frequently reported symptoms of malaria included fever (96.3%), chills and shivering (96.3%), headache (96.1%), loss of appetite (92.2%) and joini pain (90.2%). Knowledge about the names of the currently used antimalarials, sulfadoxine-pyrimethamine (90.4%) and chloroquine (81.6%), was high. About 39% of the total 163 surveyed households possessed at least one mosquito net; of these, 55 (83.7%) possessed one, 7 (11%) had two and 2 (2.3%) possessed three. Most respondents practiced draining stagnant water (46.3%) and clearing vegetation (43.3%) for malaria prevention. CONCLUSIONS: Although considerable gaps were observed between knowledge and practices of malaria prevention and control methods, community knowledge, attitudes and practices on the cause, treatment and prevention of the disease were encouraging. Since malaria is identified as a major health problem, the use of personal protection methods such as insecticide treated mosquito nets should be encouraged through increasing access to it.     

On-site provision of substance abuse treatment services at community health centers

We examined on-site and off-site referral-based provision of substance abuse (SA) treatment services among a sample of community health centers (CHCs). Analyses used survey data collected from CHCs in three states merged with administrative claims to both characterize CHC care delivery models and examine the association between models and care quality. Care quality was based on the Washington Circle measures of initiation and engagement. Approximately half the sample provided at least some SA treatment services on site. The provision of intensive outpatient treatment services on site was associated with significantly higher engagement rates. It was also associated with higher (but not significantly) initiation rates. At the same time, on-site provision of screening and counseling services was negatively associated with both initiation and engagement rates. Given limited resources, investing in more intensive services on site may yield better outcomes for CHC patients than lower level services, but further study is recommended.     

Change in epidemiology of malaria infections in a rural area in Ethiopia

We describe a change in epidemiology of 3,615 cases of malaria in a rural area in Ethiopia (from September 11, 1998, through September 10, 2003). The Plasmodium falciparum infection increased from 40.9% in the first year to 73.4% in the last year, and the Plasmodium vivax infection decreased from 54.7% to 22.4% (p < .001).