Cost of hospitalization of diabetic patients admitted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

OBJECTIVE: In Ethiopia the problems passed by diabetes is increasing for the last two to three decades. This indicates that diabetes is becoming a major economic factor in drug use and bed occupancy. So far there has been no study conducted to evaluate the cost of care among Ethiopian diabetic patients. This study aimed at assessing the cost of hospitalization of diabetic patients. METHODS: A case control study was conducted on consecutive 146 diabetic patients and 142 non diabetic controls admitted to the medical wards of Tikur Anbessa Specialized Hospital. Every first non-diabetic patient who was admitted to the same ward on the same day or in the subsequent days was taken as a control group. RESULTS: The average total cost of hospitalization of cases was significantly higher than the controls with mean cost of 1109.7 +/- 1026.4 for cases and 872.9 +/- 828.3 Birr for controls respectively, (p < 0.03). A large proportion (57%) of the total cost was utilized for treatment of acute and chronic complications of diabetes. The average treatment and laboratory cost were significantly higher among cases compared to controls (p = 0.013 and p = < 0.001 respectively). However, when adjusted by age, sex, address and history of hypertension and renal diseases, the average cost of laboratory investigation remained significantly higher for cases. CONCLUSION: The current study demonstrated that the direct cost of hospitalization of diabetic patient is significantly higher than non diabetics. The study showed that substantial proportion of the total cost of admission is utilized for treating acute and long term complications. This study warrants further research, attention of the health policy makers and health providers for future planning of prevention, diagnosis and treatment of diabetes.     

Cryptococcosis in patients from Tikur Anbessa Hospital, Addis Ababa, Ethiopia

A study was done to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Tikur Anbessa Hospital. Cryptococcus neoformans is an important opportunistic fungal pathogen in immunocompromised patients. The study was done over a period of 18 months, from October 1998 to April 2000. During this period, a total of 1088 cerebrospinal fluid (CSF) specimens were sent to the bacteriology laboratory in Tikur Anbessa Hospital, out of which 275 were subjected for India ink examination. Out of these 19 (7%) were India ink positive. Additionally one lymph node aspirate was also India ink positive. All these specimens were culture positive for Cryptococcus neoformans. The medical records of these patients were retrospectively reviewed and all presenting clinical symptoms were recorded. In this group of patients with meningitis the most common presenting were fever and headache. In addition, at the time of admission, 75% of the patients had other opportunistic infections, such as oral candidiasis, herpes zoster and Pneumocystis carini pneumonia. The mortality rate was high even in patients with appropriate therapy. All the isolates were identified as C. neoformans var. neoformans. The variety gatti was not isolated in this study.     

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.     

Child abuse in urban setting: a one-year analysis of hospital information on abused children at Yekatit 12 hospital, Addis Ababa

BACKGROUND: In recent years, there has been growing concern over the rapidly mounting situation of child abuse in Ethiopia. This tragic situation is generally thought to be rare in Sub-Saharan Africa. The government of Ethiopian has ratified and endorsed the Convention of Right of Children in spite of which the situation is considerable. It is important to consider the subject as a momentous issue and review the situation in the capital. OBJECTIVE: To know the extent, magnitude, seriousness and the existing trend of child abuse in the capital city of Ethiopia. METHODS: This study is a prospective cross-sectional analysis undertaken in pediatrics department of Yekatit 12 hospital. Two hundred and fifty six allegedly abused children were seen from July 2001 to June 2002 of which 214 were enrolled in this study that fulfilled the criteria of inclusion RESULTS: Among two hundred and fourteen children less than the age of 15 years 93% were female. Most common mode of abuse was sexual with vaginal penetration N=160 (75%). Forty one percent of abused children had laboratory investigations of which 9% were pathological results. The highest percent of victims reside in Woreda 11. The monthly distribution of abused children shows increasing trend. Only 18% had Psychological follow-up visit. Thirty percent of perpetrators were close neighbors followed by teachers. The age between 35 to 45 years were found to be the commonest age of perpetrators (29%). Among the offenders' occupation disclosed N= 17, 6 (35%) were priests. CONCLUSIONS: This study has tried to prove that child abuse is increasing in magnitude and seriousness & the growing trend of threat is to cross the threshold of public health alarm. Female children are at higher risk and need special protection. The low number of follow-up visits and few laboratory results show that there is lack of awareness on the future prospective of the child and/or lack of financial resources. It is necessary to improve and curb this catastrophic situation through comprehensive measures.     

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     

Trauma registry in Tikur Anbessa Hospital, Addis Ababa, Ethiopia

A simplified trauma registry was tested in Tikur anbessa hospital, with the aim of obtaining preliminary data on the patterns and magnitude of injuries and establishing the basis towards surveillance system. All injured patients presented to the surgical and pediatric emergency department between January 1, 1999 and June 31, 1999 were included. Interns completed the registry forms, which include demographic, injury event specific, severity and outcome data. The severity was assessed by new scoring system, Kampla Trauma Score (KTS). Among the 3822 injured patients 2869(75%) were males and 953(25%) were females and 80% were below the age of 40 years. 77% of the injuries were unintentional and motor vehicle injuries accounted for 41% of all causes among which 93% of them were pedestrians. Accidental fall and interpersonal assault accounted for 21% and 20% respectively. Admitted cases were 11.6%, while 20 (.5%) died at the outpatient department with the overall mortality of 1.47%. Though burn and gunshot accounted only for 6%, the case fatality rate was highest (4%) accounting for 20% of all deaths. The magnitude of fatal injuries is underestimated and the pattern of injuries may only reflect the situation in the big cities. Motor vehicle injuries, especially pedestrian injuries are serious problem in Addis as seen in patients in Tikur Anbessa hospital and require further situational studies and urgent intervention. Establishing hospital based simplified injury surveillance system is possible in Ethiopia and it is essential to asses the magnitude of the problem and identify priority area for injury prevention and control.     

Antiretroviral treatment adherence and its correlates in Addis Ababa, Ethiopia

OBJECTIVE: To assess the degree of adherence with highly active antiretroviral therapy (HAART), and its correlates among adults with HIV/AIDS in Addis Ababa. PATIENTS AND METHODS: Cross-sectional survey of consecutive patients attending three ART centers in Addis Ababa complemented by semi-structured audiotaped in-depth interviews with 10 purposively sampled patients on HAART Treatment adherence was defined as self-report of taking > or =95% of therapy correctly in a specified time period, depression measured using Beck's depression inventory, clinical data recorded by reviewing patients' charts, and knowledge about HAART assessed by questions in Yes/No format. RESULTS: 431 patients on HAART responded 81.2% of patients were > or =95% adherent by self report in the week before the assessment. The major reasons for non-adherence were: being too busy or simply forgot (33.9%) and being away from home (27.5%). Correlates of adherence included having regular follow-up, not being depressed having no side effects, a regimen that fitted the daily routine and satisfaction with the relationship with doctors. CONCLUSIONS: Self-reported adherence in our study was higher than that seen in developed countries. Recommendations to improve adherence include: provision of regular follow-up for patients, management of depression, forewarning of side effects of HAART, and creating medication schedules appropriate to patients' daily routines.     

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.     

Sero-prevalence of brucellosis in occupationally exposed people in Addis Ababa, Ethiopia

OBJECTIVE: Brucellosis is a Zoonosis, recognized worldwide as a serious public health hazard and economically significant disease. The etiologic agent of this disease is a bacterial species of the genus Brucella that causes undulant fever, sterility and other systemic illnesses in human. Thus, the aim of this study was to undertake seroepidemiological study of brucellosis on occupationally exposed persons in Addis Ababa abattoirs enterprise and different dairy farms. METHODS: Three hundred thirty six human individuals were screened using Rose Bengal Plate Test (RBPT) and the sera were further subjected to 2- Mercapto Ethanol Test (2-MET). Simultaneously, survey was conducted in farms and slaughterhouse to investigate epidemiological factors. RESULTS: An overall seroprevalence rate of 4.8% (16/336) was determined by taking RBPT+/2MET+ as confirmatory test (P < 0.05). Some of the risk factors contributing to the occurrence of the disease include occupation, gender, and unsafe handling of infected materials. Raw milk and meat consumption, lack of awareness and use of detergents were also found as important factors. CONCLUSION: The seroprevalence of brucellosis is expected to be more in other areas of the Region, where there is high human-animal contact and high number of cattle population with a respective traditional system of animal rearing.     

The pattern of glaucoma in Menelik II Hospital Addis Ababa, Ethiopia

OBJECTIVES: To describe the demographic and clinical profiles glaucoma and evaluate the magnitude of blindness among patients with glaucoma. PATIENTS AND METHODS: Cases with glaucoma that were seen at Menelik II hospital Addis Ababa between May 10, 1994 and May 9, 1997 were reviewed Data on relevant demographic and clinical variables were collected and analysed. RESULTS: A total of 1,586 glaucoma patients were seen at the glaucoma clinic during the study period. The male to female ratio was 2:1. The mean age is 51.9 (SD 17.9) years. Those patients above the age of 40 years represented 78% of the total glaucoma population. The prevalence of glaucoma was highest (27.1%) in the age group of 51-60 years. It was bilateral in 806 (51%) of the patients. Primary Open Angle Glaucoma (POAG) was the most frequent type documented in 631 (40%) of the patients, followed by Secondary Glaucomas in 605 (38%), Primary Angle Closure Glaucoma (PACG) in 285 (18%), Normal Tension Glaucoma (NTG) in 36 (2%), and Congenital Glaucoma in 33 (2%). Six hundred fifty six patients (41%) were blind either in one or both eyes. PACG was found to be potentially a blinding type of glaucoma, in which 53% of the patients suffered from blindness. In the other types, poor public awareness and lack of treatment services were the most important factors that largely precopitated the occurrence of blindness. CONCLUSION: We recommend that, in addition to improving the diagnostic and therapeutic facilities, intensive work be done to increase public awareness on the nature of the disease, to expand the infrastructure and to develop and rationally deploy the required human resources.