Home Versus Clinic Blood Pressure Measurements

To evaluate the cost effectiveness of home versus clinic blood pressure 11 patients with mild untreated hypertension were instructed in self-measurement of blood pressure with mercury manometers. The lower total cost of using home readings as well as problems of bias and blinding are discussed. Home blood pressure is a promising technique for clinical and epidemiologic research.     

Case of multiple furuncular myiasis in Northeast Ethiopia

Human myiasis is a neglected disease caused by parasitic infestation of the skin, cavities, and other body parts by larvae (maggots) of a wide variety of dipteran flies. Here, we present a case of multiple furuncular myiasis caused by Cordylobia anthropophaga in a 61‐year‐old woman from Northeast Ethiopia.     

Increased resistance of Streptococcus pneumoniae isolates to antimicrobial drugs, at a referral hospital in north-west Ethiopia

Beta lactam antibiotics were very effective against Streptococcus pneumoniae. However, resistance to this class of antibiotics has become an increasing problem. Reports of penicillin resistant and multidrug resistant strains are being made in many parts of the world. We examined the drug sensitivity pattern of S. pneumoniae isolates in a retrospective analysis of laboratory records of S. pneumoniae isolates between March 2001 and April 2005 at Gondar University Hospital, Ethiopia. A significant proportion of the isolates were found to be resistant to one or more of the commonly used antibiotics. Furthermore, the isolates appear to be acquiring an increasing resistance to crystalline penicillin, cotrimoxazole and ampicillin. This situation needs immediate attention.     

Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia

Objective To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART) in Jimma, Ethiopia. Methods Unmatched case control study: cases were individuals who had missed two or more clinical appointments (i.e. had not been seen for the last 2 months) between January 2005 and February 2007; controls were individuals who had been on ART at least for 1 year and were rated as excellent adherers by the providers. Data were collected from patient records, and by telephone call and home visit to identify the reason for defaulting. Results Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were loss of hope in medication, lack of food, mental illness, holy water, no money for transport, and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases. Taking hard drugs (cocaine, cannabis and IV drugs), excessive alcohol consumption, being bedridden, living outside Jimma town and having an HIV negative or unknown HIV status partner were associated with defaulting ART. Conclusion A significant proportion of patients defaulted from ART treatment. ART clinics should ensure that patients’ addresses are correct and complete. Programmatic and counseling efforts to decrease ART defaulting should address illicit drug and excessive alcohol use, decentralise ART services, institute home‐based treatment options for seriously ill and bedridden patients, and address patients concerns.     

Assessing the Performance of CareStart Malaria Pf/Pv Combo Test Against Thick Blood Film in the Diagnosis of Malaria in Northwest Ethiopia

Bivalent rapid diagnostic tests are promising diagnostic tools for Plasmodium falciparum and P. vivax. Their diagnostic performance was evaluated against thick blood smear to assist national malaria control programs. A cross-sectional study was conducted to evaluate the performance of CareStart against thick blood smears among 398 acute febrile patients visiting the Felegeselam Health Center in December of 2011. Thick blood smears were examined under 100× objectives to diagnose Plasmodium species. Similarly, CareStart Malaria Pf/Pv Combo Test was performed as per the manufacturer''s instruction. The ability of CareStart Malaria Pf/Pv Combo Test to diagnose Plasmodium malaria was very good, with 99.8% (95% confidence interval = 97.7–100%) sensitivity and 97.7% (95% confidence interval = 94.6–99.1%) specificity. The sensitivity and specificity of the CareStart Test is comparable with the thick blood smear in diagnosing malaria. Hence, it is preferable to use the CareStart Malaria Pf/Pv Combo Test instead of microscopy in areas where microscopic diagnosis is limited.     

Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases

To describe and compare the diagnosis, demographics and management of systemic lupus erythematosus (SLE) related versus idiopathic acute transverse myelitis during the initial presentation of the disease. We undertook a chart review of the hospital records of patients admitted to our hospital from 1994 until 2007 and had the diagnosis of SLE related and idiopathic acute transverse myelitis. Demographics, laboratory and imaging studies, diagnosis and treatment were recorded in both groups and analyzed in a case control fashion. We identified 15 patients with SLE-related acute transverse myelitis (SLE-ATM) and 39 idiopathic (I-ATM) cases between 1994 and 2007. Patients with SLE were more likely to be African American, have CNS demyelinating lesions on MRI, a high IgG% on their CSF analysis and a higher sedimentation rate on presentation. Treatment with high-dose steroids was instituted in both groups of patients, though SLE patients had a longer hospital stay by an average of 5 days. SLE-ATM patients were more likely to be African American as compared to I-ATM patients, have CNS demyelinating lesions on MRI, a high IgG% on CSF analysis and a higher sedimentation rate on presentation. The hospital stay for SLE patients was 5 days longer than the idiopathic patients. This study underlines the importance of early diagnosis of patients who develop ATM related to SLE.     

Negotiating the social and medical dangers of abortion in Addis Ababa: An exploration of young,unmarried women's abortion-seeking journeys

Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.