1
|
Gashaw M, Ali S, Berhane M, Tesfaw G, Eshetu B, Workneh N, Seeholzer T, Froeschl G, Kroidl A, Wieser A, Gudina EK. Neonatal Sepsis Due to Multidrug-resistant Bacteria at a Tertiary Teaching Hospital in Ethiopia. Pediatr Infect Dis J 2024:00006454-990000000-00840. [PMID: 38656939 DOI: 10.1097/inf.0000000000004364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia. METHODS An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH). RESULTS A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens. CONCLUSIONS The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.
Collapse
Affiliation(s)
- Mulatu Gashaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Solomon Ali
- Department of Medical Microbiology, Parasitology, and Immunology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Netsanet Workneh
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Thomas Seeholzer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Arne Kroidl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Andreas Wieser
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
- Max von Pettenkofer-Institute (Medical Microbiology), LMU, Munich, Germany
| | | |
Collapse
|
2
|
Thompson DS, McKenzie K, Opondo C, Boyne MS, Lelijveld N, Wells JC, Cole TJ, Anujuo K, Abera M, Berhane M, Koulman A, Wootton SA, Kerac M, Badaloo A. Faster rehabilitation weight gain during childhood is associated with risk of non-communicable disease in adult survivors of severe acute malnutrition. PLOS Glob Public Health 2023; 3:e0002698. [PMID: 38127945 PMCID: PMC10734994 DOI: 10.1371/journal.pgph.0002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
Nutritional rehabilitation during severe acute malnutrition (SAM) aims to quickly restore body size and minimize poor short-term outcomes. We hypothesized that faster weight gain during treatment is associated with greater cardiometabolic risk in adult life. Anthropometry, body composition (DEXA), blood pressure, blood glucose, insulin and lipids were measured in a cohort of adults who were hospitalized as children for SAM between 1963 and 1993. Weight and height measured during hospitalization and at one year post-recovery were abstracted from hospital records. Childhood weight gain during nutritional rehabilitation and weight and height gain one year post-recovery were analysed as continuous variables, quintiles and latent classes in age, sex and minimum weight-for-age z-scores-adjusted regression models against adult measurements. Data for 278 adult SAM survivors who had childhood admission records were analysed. Of these adults, 85 also had data collected 1 year post-hospitalisation. Sixty percent of participants were male, mean (SD) age was 28.2 (7.7) years, mean (SD) BMI was 23.6 (5.2) kg/m2. Mean admission age for SAM was 10.9 months (range 0.3-36.3 months), 77% were wasted (weight-for-height z-scores<-2). Mean rehabilitation weight gain (SD) was 10.1 (3.8) g/kg/day and 61.6 (25.3) g/day. Rehabilitation weight gain > 12.9 g/kg/day was associated with higher adult BMI (difference = 0.5 kg/m2, 95% CI: 0.1-0.9, p = 0.02), waist circumference (difference = 1.4 cm, 95% CI: 0.4-2.4, p = 0.005), fat mass (difference = 1.1 kg, 95% CI: 0.2-2, p = 0.02), fat mass index (difference = 0.32kg/m2, 95% CI: -0.0001-0.6, p = 0.05), and android fat mass (difference = 0.09 kg, 95% CI: 0.01-0.2, p = 0.03). Post-recovery weight gain (g/kg/month) was associated with lean mass (difference = 1.3 kg, 95% CI: 0.3-2.4, p = 0.015) and inversely associated with android-gynoid fat ratio (difference = -0.03, 95% CI: -0.07to-0.001 p = 0.045). Rehabilitation weight gain exceeding 13g/kg/day was associated with adult adiposity in young, normal-weight adult SAM survivors. This challenges existing guidelines for treating malnutrition and warrants further studies aiming at optimising these targets.
Collapse
Affiliation(s)
- Debbie S. Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kimberley McKenzie
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael S. Boyne
- Department of Medicine, The University of the West Indies, Kingston, Jamaica
| | - Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jonathan C. Wells
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tim J. Cole
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kenneth Anujuo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mubarek Abera
- Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen A. Wootton
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Asha Badaloo
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | |
Collapse
|
3
|
Zinab B, Ali R, Megersa BS, Belachew T, Kedir E, Girma T, Abdisa A, Berhane M, Admasu B, Friis H, Abera M, Olsen MF, Andersen GS, Wells JCK, Filteau S, Wibaek R, Nitsch D, Yilma D. Association of linear growth velocities between 0 and 6 years with kidney function and size at 10 years: A birth cohort study in Ethiopia. Am J Clin Nutr 2023; 118:1145-1152. [PMID: 37758061 DOI: 10.1016/j.ajcnut.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Risk of noncommunicable diseases accrues from fetal life, with early childhood growth having an important role in adult disease risk. There is a need to understand how early-life growth relates to kidney function and size. OBJECTIVES This study aimed to assess the association of linear growth velocities among children between 0 and 6 y with kidney function and size among children aged 10 y. METHODS The Ethiopian Anthropometric and Body Composition birth cohort recruited infants born at term to mothers living in Jimma with a birth weight of ≥1500 g and without congenital malformations. Participants were followed up with 13 measurements between birth and 6 y of age. The latest follow-up was at ages 7-12 y with measurement of serum cystatin C as a marker of kidney function and ultrasound assessment of kidney dimensions. Kidney volume was computed using an ellipsoid formula. Linear-spline multilevel modeling was used to compute linear growth velocities between 0 and 6 y. Multiple linear regression modeling was used to examine the associations of linear growth velocities in selected age periods with cystatin C and kidney size. RESULTS Data were captured from 355 children, at a mean age of 10 (range 7-12) y. The linear growth velocity was high between 0 and 3 mo and then decreased with age. There was no evidence of an association of growth velocity ≤24 mo with cystatin C at 10 y. Between 24 and 48 and 48 and 76 mo, serum cystatin C was higher by 2.3% [95% confidence interval (CI): 0.6, 4.2] and 2.1% (95% CI: 0.3, 4.0) for 1 SD higher linear growth velocity, respectively. We found a positive association between linear growth velocities at all intervals between 0 and 6 y and kidney volume. CONCLUSIONS Greater linear growth between 0 and 6 y of development was positively associated with kidney size, and greater growth velocity after 2 y was associated with higher serum cystatin C concentrations.
Collapse
Affiliation(s)
- Beakal Zinab
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Bikila S Megersa
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Melkamu Berhane
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bitiya Admasu
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Jonathan C K Wells
- Childhood Nutrition Research Center, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Yilma
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
4
|
McGrath M, Woldie M, Berhane M, Abera M, Hailu E, Rana R, Lanyero B, Grijalva-Eternod C, Abdissa A, Girma T, Kerac M, Smythe T. Mapping the range of policies relevant to care of small and nutritionally at-risk infants under 6 months and their mothers in Ethiopia: a scoping review protocol. BMJ Open 2023; 13:e069359. [PMID: 37730409 PMCID: PMC10510927 DOI: 10.1136/bmjopen-2022-069359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Evidence gaps limit management of small and/or nutritionally at-risk infants under 6 months and their mothers, who are at higher risk of death, illness, malnutrition and poor growth and development. These infants may be low birth weight, wasted, stunted and/or underweight. An integrated care model to guide their management (MAMI Care Pathway) is being tested in a randomised controlled trial in Ethiopia. Evaluating the extent to which an innovation is consistent with national policies and priorities will aid evidence uptake and plan for scale. METHODS AND ANALYSIS This review will evaluate the extent to which the MAMI Care Pathway is consistent with national policies that relate to the care of at-risk infants under 6 months and their mothers in Ethiopia. The objectives are to describe the range and characteristics, concepts, strategic interventions, coherence and alignment of existing policies and identify opportunities and gaps. It will be conducted in accordance with the JBI methodology for scoping reviews (PRISMA-ScR). Eligible documents include infant and maternal health, nutrition, child development, food and social welfare-related policies publicly available in English and Amharic. The protocol was registered on the Open Science Framework Registry on 20 June 2022 (https://osf.io/m4jt6).Grey literature will be identified through government and agency websites, national and subnational contacts and Google Scholar, and published policies through electronic database searches (MEDLINE, EMBASE and Global and Health Information). The searches will take place between October 2023 and March 2024. A standardised data extraction tool will be used. Descriptive analysis of data will be undertaken. Data will be mapped visually and tabulated. Results will be described in narrative form. National stakeholder discussions will inform conclusions and recommendations. ETHICS AND DISSEMINATION Ethical approval is not required as data consist solely of publicly available material. Findings will be used to evidence national and international policy and practice.
Collapse
Affiliation(s)
- Marie McGrath
- Emergency Nutrition Network, Kidlington, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Maternal and Child Health and Nutrition Directorate, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mubarek Abera
- Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Ritu Rana
- Department of Public Health Programmes, Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Betty Lanyero
- Emergency Preparedness and Response Unit, World Health Organization Country Office for Ethiopia, Addis Ababa, Ethiopia
| | - Carlos Grijalva-Eternod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Marko Kerac
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracey Smythe
- Faculty of Epidemiology and Population Health, International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
5
|
Megersa BS, Zinab B, Ali R, Kedir E, Girma T, Berhane M, Admassu B, Friis H, Abera M, Olsen MF, Filteau S, Nitsch D, Yilma D, Wells JC, Andersen GS, Wibaek R. Associations of weight and body composition at birth with body composition and cardiometabolic markers in children aged 10 y: the Ethiopian infant anthropometry and body composition birth cohort study. Am J Clin Nutr 2023; 118:412-421. [PMID: 37328067 DOI: 10.1016/j.ajcnut.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Although birth weight (BW) has been associated with later cardiovascular disease and type 2 diabetes, the role of birth fat mass (BFM) and birth fat-free mass (BFFM) on cardiometabolic health is unclear. OBJECTIVES To examine associations of BW, BFM, and BFFM with later anthropometry, body composition, abdominal fat, and cardiometabolic markers. METHODS Birth cohort data on standardized exposure variables (BW, BFM, and BFFM) and follow-up information at age 10 y on anthropometry, body composition, abdominal fat, and cardiometabolic markers were included. A linear regression analysis was used to assess associations of exposures with outcome variables, adjusting for maternal and child characteristics at birth and current body size in separate models. RESULTS Among 353 children, mean (SD) age was 9.8 (1.0) y, and 51.5% were boys. In the fully adjusted model, 1-SD higher BW and BFFM were associated with 0.81 cm (95% CI: 0.21, 1.41 cm) and 1.25 cm (95% CI: 0.64, 1.85 cm) greater height at 10 y, respectively. The 1-SD higher BW and BFM were associated with 0.32 kg/m2 (95% CI: 0.14, 0.51 kg/m2) and 0.42 kg/m2 (95% CI: 0.25, 0.59 kg/m2) greater fat mass index at 10 y, respectively. In addition, 1-SD higher BW and BFFM were associated with 0.22 kg/m2 (95% CI: 0.09, 0.34 kg/m2) greater FFM index, whereas a 1-SD greater BFM was associated with a 0.05 cm greater subcutaneous adipose tissue (95% CI: 0.01, 0.11 cm). Furthermore, 1-SD higher BW and BFFM were associated with 10.3% (95% CI: 1.4%, 20.0%) and 8.3% (95% CI: -0.5%, 17.9%) greater insulin, respectively. Similarly, 1-SD higher BW and BFFM were associated with 10.0% (95% CI: 0.9%, 20.0%) and 8.5% (95% CI: -0.6%, 18.5%) greater homeostasis model assessment of insulin resistance, respectively. CONCLUSIONS BW and BFFM rather than BFM are predictors of height and FFM index at 10 y. Children with higher BW and BFFM showed higher insulin concentrations and homeostasis model assessment of insulin resistance at 10 y of age. This trial was registered at ISRCTN as ISRCTN46718296.
Collapse
Affiliation(s)
- Bikila S Megersa
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Beakal Zinab
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Rahma Ali
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Yilma
- Department of Internal Medicine; Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jonathan Ck Wells
- Childhood Nutrition Research Center, Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Rasmus Wibaek
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
6
|
Lelijveld N, Cox S, Anujuo K, Amoah AS, Opondo C, Cole TJ, Wells JCK, Thompson D, McKenzie K, Abera M, Berhane M, Kerac M. Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi 'ChroSAM' cohort. Public Health Nutr 2023; 26:1658-1670. [PMID: 36876519 PMCID: PMC10466107 DOI: 10.1017/s1368980023000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 01/05/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition and describe associations with survival and non-communicable disease (NCD) risk 7 years post-treatment. DESIGN Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score and height-for-age z-score (HAZ). Three categorisation methods included no categorisation, quintiles and latent class analysis (LCA). Associations with mortality risk and seven NCD indicators were analysed. SETTING Secondary data from Blantyre, Malawi between 2006 and 2014. PARTICIPANTS A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score < 70 % median and/or MUAC (mid-upper arm circumference) < 110 mm and/or bilateral oedema) at ages 5-168 months. RESULTS Faster weight gain during treatment (g/d) and after treatment (g/kg/day) was associated with lower risk of death (adjusted OR 0·99, 95 % CI 0·99, 1·00; and adjusted OR 0·91, 95 % CI 0·87, 0·94, respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0·02, 95 % CI 0·00, 0·03) and larger HAZ (6·62, 95 % CI 1·31, 11·9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0·02, 95 % CI 0·01, 0·03), an indicator of later-life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/d during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder. CONCLUSIONS A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.
Collapse
Affiliation(s)
- Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Emergency Nutrition Network (ENN), Oxford, UK
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Sioned Cox
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
| | - Kenneth Anujuo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
| | - Abena S Amoah
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim J Cole
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan CK Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Debbie Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kimberley McKenzie
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | |
Collapse
|
7
|
Abera M, Workicho A, Berhane M, Hiko D, Ali R, Zinab B, Haileamlak A, Fall C. A systematic review and meta-analysis of adolescent nutrition in Ethiopia: Transforming adolescent lives through nutrition (TALENT) initiative. PLoS One 2023; 18:e0280784. [PMID: 37022989 PMCID: PMC10079135 DOI: 10.1371/journal.pone.0280784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/07/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Ethiopia has undergone rapid economic growth over the last two decades that could influence the diets and nutrition of young people. This work systematically reviewed primary studies on adolescent nutrition from Ethiopia, to inform future interventions to guide policies and programs for this age group. METHOD A systematic search of electronic databases for published studies on the prevalence of and interventions for adolescent malnutrition in Ethiopia in the English language since the year 2000 was performed using a three-step search strategy. The results were checked for quality using the Joanna Bridge Institute (JBI) checklist, and synthesized and presented as a narrative description. RESULTS Seventy six articles and two national surveys were reviewed. These documented nutritional status in terms of anthropometry, micronutrient status, dietary diversity, food-insecurity, and eating habits. In the meta-analysis the pooled prevalence of stunting, thinness and overweight/obesity was 22.4% (95% CI: 18.9, 25.9), 17.7% (95% CI: 14.6, 20.8) and 10.6% (7.9, 13.3), respectively. The prevalence of undernutrition ranged from 4% to 54% for stunting and from 5% to 29% for thinness. Overweight/obesity ranged from 1% to 17%. Prevalence of stunting and thinness were higher in boys and rural adolescents, whereas overweight/obesity was higher in girls and urban adolescents. The prevalence of anemia ranged from 9% to 33%. Approximately 40%-52% of adolescents have iodine deficiency and associated risk of goiter. Frequent micronutrient deficiencies are vitamin D (42%), zinc (38%), folate (15%), and vitamin A (6.3%). CONCLUSIONS The adolescent population in Ethiopia is facing multiple micronutrient deficiencies and a double-burden of malnutrition, although undernutrition is predominant. The magnitude of nutritional problems varies by gender and setting. Context-relevant interventions are required to effectively improve the nutrition and health of adolescents in Ethiopia.
Collapse
Affiliation(s)
- Mubarek Abera
- Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Hiko
- Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Rahma Ali
- Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Beakal Zinab
- Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abraham Haileamlak
- Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Caroline Fall
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
8
|
Soboka M, Gudina EK, Gashaw M, Amare H, Berhane M, Desalegn H, Tewolde D, Jebena MG, Ali S, Wieser A, Froeschl G, Tesfaye M. Depression among people with dyspepsia and H. pylori infection: A community based cross-sectional study in Ethiopia. PLoS One 2022; 17:e0275424. [PMID: 36201454 PMCID: PMC9536533 DOI: 10.1371/journal.pone.0275424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression is the most common mental health problem, and frequently associated with physical illnesses. A link between depression, dyspepsia and Helicobacter pylori (H. pylori) infection has previously been reported. However, there is limited data regarding the association between these conditions from sub-Saharan Africa where they are highly prevalent. OBJECTIVE This study aimed at elucidating the potential associations between depression, dyspepsia and H. pylori infection in Ethiopia. METHODS We conducted a community based cross-sectional study involving urban and rural residents aged 13 years or older in Jimma Zone, southwest Ethiopia. A total of 871 participants were evaluated using a structured case reporting format for symptoms of dyspepsia and the patient health questionnaire (PHQ-9) for depression. Additionally, participants were assessed for H. pylori infection using stool antigen and serology tests. A multivariate logistic regression was used to identify the association between depression, dyspepsia and H. pylori infection after controlling for potential confounders. RESULTS The prevalence of PHQ-9 scores indicative of probable case of depression among all participants was 10.9%. The prevalence of probable case of depression among patients who had at least one symptom of dyspepsia was 13.3% (X2 = 15.1 = p-value<0.001), while it was 11.9% (X2 = 1.23, p-value = 0.26) among patients who had H. pylori infection. Out of patients who took medications for their heartburn in the past 30 days, 14.9% (X2 = 3.6, p-value = 0.06) had probable case of depression. Dyspepsia symptoms such as epigastric discomfort (aOR = 2.59, 95%CI = 1.14, 5.87), postprandial fullness (aOR = 1.70, 95%CI = 1.48, 5.51), nausea (aOR = 1.71, 95%CI = 1.04, 2.82) excessive belching (aOR = 0.53, 95%CI = 0.31, 0.92) were associated with probable case of depression. However, being H. pylori test positive, gender, and age were not associated with probable case of depression. CONCLUSIONS There was an increased prevalence of probable case of depression among patients who had dyspepsia symptoms and H. pylori infection. Longitudinal studies are needed to examine possible further determinants of association between symptoms of dyspepsia and probable case of depression.
Collapse
Affiliation(s)
- Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
- * E-mail:
| | | | - Mulatu Gashaw
- School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Hiwot Amare
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Hailemichale Desalegn
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dagimawi Tewolde
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Mulusew Gerbababa Jebena
- Faculty of Public Health, Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Solomon Ali
- Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
9
|
Jibat N, Rana R, Negesse A, Abera M, Abdissa A, Girma T, Haile A, Barthorp H, McGrath M, Grijalva-Eternod CS, Kerac M, Berhane M. Carers’ and health workers’ perspectives on malnutrition in infants aged under six months in rural Ethiopia: A qualitative study. PLoS One 2022; 17:e0271733. [PMID: 35862411 PMCID: PMC9302717 DOI: 10.1371/journal.pone.0271733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
Supporting small and nutritionally at-risk (potentially malnourished) infants under six months is a global health priority, albeit with a weak evidence-base. To inform policy and research in this area, we aimed to assess the perceptions and understanding of infant malnutrition and its management among carers, communities, and healthcare workers in rural Ethiopia.
Methods
We conducted in-depth and key-informant interviews, from May-August 2020 in Jimma Zone and Deder District, Ethiopia. We used purposive sampling to recruit the participants. Interviews were transcribed into Amharic or Afaan Oromo and then translated into English. Atlas ti-7 was used to support data analysis. Findings were narrated based on the different themes arising from the interviews.
Results
Carers/community members and healthcare workers reported on five different themes: 1) Perceptions about health and well-being: an ‘ideal infant’ slept well, fed well, was active and looked ‘fat’; 2)Perceptions of feeding: overall knowledge of key recommendations like exclusive breastfeeding was good but practices were suboptimal, notably a cultural practice to give water to young infants; 3)Awareness about malnutrition: a key limitation was knowledge of exactly how to identify small and nutritionally at-risk infants; 4) Reasons for malnutrition: levels of understanding varied and included feeding problems and caregiver’s work pressures resulting in the premature introduction of complementary feeds; 5) Perceptions about identification & treatment: carers prefer treatment close to home but were concerned about the quality of community-based services.
Conclusion
To succeed, research projects that investigate programes that manage small and nutritionally at-risk infants under six months should understand and be responsive to the culture and context in which they operate. They should build on community strengths and tackle misunderstandings and barriers. Interventions beyond just focusing on knowledge and attitude of the carers and health workers are necessary to tackle the challenges around infants under 6 months of age at risk of malnutrition. Moreover, stakeholders beyond the health sector should also be involved in order to support the infants under 6 months and their mothers as some of the key reasons behind the at-risk infants are just beyond the capacity of the health sector or health system. Our list of themes could be used to inform infant nutrition work not just in Ethiopia but also in many others.
Collapse
Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Ritu Rana
- GOAL Global, Dublin, Ireland
- Indian Institute of Public Health, Gandhinagar, India
| | - Ayenew Negesse
- Department of Human Nutrition, Debre Markos University, Debre Markos, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Laboratory and Microbiology, Jimma University, Jimma, Ethiopia
- Armaeur Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Carlos S. Grijalva-Eternod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
10
|
Dubale M, Tadesse M, Berhane M, Mekonnen M, Abebe G. Stool-based Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children at a teaching and referral hospital in Southwest Ethiopia. PLoS One 2022; 17:e0267661. [PMID: 35511771 PMCID: PMC9070927 DOI: 10.1371/journal.pone.0267661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diagnosis of tuberculosis (TB) in children is challenging mainly due to the difficulty of obtaining respiratory specimen and lack of sensitive diagnostic tests. The objective of this study was to evaluate the diagnostic performance of Xpert MTB/RIF (Xpert here after) for the diagnosis of pulmonary TB (PTB) from stool specimen in children. METHODS A cross-sectional study was conducted among consecutively recruited children (less than 15 years old) with presumptive PTB at Jimma Medical Center, Ethiopia. One pulmonary specimen (expectorated sputum or gastric aspirate) was collected from each participant and tested for TB by Xpert and Lowenstein-Jensen (LJ) culture. In addition, one stool specimen per child was collected and tested by Xpert after a single step, centrifuge-free stool processing method adapted from KNCV TB Foundation. Diagnostic performance of Xpert was calculated with reference to LJ culture and to a composite reference standards (CRS) comprising of confirmed TB (positive by Xpert and/or culture) and unconfirmed TB (clinical diagnosis with improvement after anti-TB treatment). RESULTS A total of 178 children were enrolled; 152 of whom had complete microbiological results. Overall, TB was diagnosed in 13.2% (20/152) of the children with presumptive TB. Of these, only ten had microbiologically confirmed TB (positive Xpert and/or culture) and the remaining ten were clinically diagnosed with positive response to anti-TB treatment and were classified as unconfirmed TB. Stool Xpert had sensitivity of 100% (95%CI: 66.4-100) and specificity of 99.3% (95%CI: 96.2-100) compared to culture; however, the sensitivity was decreased to 50% (95%CI: 27.2-72.8) when compared to CRS. The Xpert on gastric aspirate had sensitivity of 77.8% (95%CI: 40-97.2) compared to culture and 40% (95%CI: 19.1-64) compared to CRS. CONCLUSIONS The sensitivity of Xpert for stool sample is comparable to that for gastric aspirate. Stool sample is a potential alternative to pulmonary specimen in the diagnosis of pulmonary TB in children using Xpert.
Collapse
Affiliation(s)
- Mitiku Dubale
- Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
- Department of Biology, Faculty of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia
- School of Medical Laboratory Sciences, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mulualem Tadesse
- Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
- School of Medical Laboratory Sciences, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatric and Child Health, Faculty Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mekidim Mekonnen
- School of Medical Laboratory Sciences, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| | - Gemeda Abebe
- Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
- School of Medical Laboratory Sciences, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
11
|
Alemu H, Alemu S, Berhane M. Omental Cyst Presenting as an Acute Abdomen in a Pediatric Patient: A Case Report. Int Med Case Rep J 2022; 15:43-46. [PMID: 35140530 PMCID: PMC8818982 DOI: 10.2147/imcrj.s351406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Omental cysts are the rarest forms of intra-abdominal cystic lesions. They are usually asymptomatic but can also present as acute abdomen. The presentation is confusing in some cases, which may result in mismanagement, added costs, and trouble for the patient. A pre-operative diagnosis is challenging, especially in resource-limited settings, and requires a high level of suspicion and a cautious approach during emergency exploratory laparotomy to avoid complications. Case Details This is a 4 year old male child who presented with high grade fever, vomiting, and abdominal pain of 2 days duration. He was tachypneic, tachycardic, and had diffuse abdominal tenderness. Emergency laparotomy revealed a large cyst with hemorrhagic content. Complete removal of the cyst was done, and the patient was discharged after improvement on the third post-operative day. Conclusion Omental cysts are rare in children and have varieties of presentations. Even though preoperative diagnosis is challenging, esspecially in resource-limited settings, clinicians should consider omental cysts in a child presenting with an acute abdomen. It is important for surgeons to consider omental cysts when carrying out emergency laparotomy for an unidentified abdominal condition.
Collapse
Affiliation(s)
- Hailu Alemu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Correspondence: Hailu Alemu, Email
| | - Seifu Alemu
- Department of Surgery, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
12
|
Birhanu K, Tesfaye W, Berhane M. Congenital Anomalies in Neonates Admitted to a Tertiary Hospital in Southwest Ethiopia: A Cross Sectional Study. Ethiop J Health Sci 2021; 31:1155-1162. [PMID: 35392332 PMCID: PMC8968368 DOI: 10.4314/ejhs.v31i6.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Congenital anomalies affect 2-3% of all live births. Anomalies of the central nervous system account for the highest incidence followed by that of the cardiovascular and renal systems. There is scarcity of data in developing countries like Ethiopia. The aim of the study was determining the magnitude and type of congenital anomalies and associated factors in neonates admitted to the neonatology ward of Jimma Medical Center, Southwest Ethiopia. Methods Institution based cross sectional study was done from March 1 to July 30, 2020. A total of 422 mother-infant pairs were enrolled into the study. Structured questionnaires were used to capture the socio-demographic, obstetric and medical characteristics of the mothers, demographic characteristics of the infants and type of congenital anomalies. Univariate and multivariate logistic regression analyses were done and results are presented as narratives and using figures and tables. Results Closer to one in five neonates admitted to the neonatology ward (78, 18.5%, 95%CI 14.7-22.3) had congenital anomalies; the majority (59, 13.98%) having only one type of anomaly. Anomalies of the nervous system (29, 6.87%) and gastrointestinal system (24, 5.68%) accounted for the majority of the cases. Inadequate antenatal care follow-up (p=0.018, AOR=1.9, 95%CI1.115, 3.257) and lack of folate supplementation during pregnancy (p=0.027, AOR=2.35, 95%CI 1.101, 5.015) were associated with congenital anomalies in the neonates. Conclusion Congenital anomalies account for significant number of admissions. Significant association was seen between neonatal congenital anomalies and poor antenatal attendance and lack of folic acid supplementation during pregnancy.
Collapse
Affiliation(s)
- Kassahun Birhanu
- Department of pediatrics and child health, Jimma University, Jimma, Ethiopia
| | - Workneh Tesfaye
- Department of pediatrics and child health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of pediatrics and child health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
13
|
Berhane M, Gidi NW, Eshetu B, Gashaw M, Tesfaw G, Wieser A, Bårnes GK, Froeschl G, Ali S, Gudina EK. Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2021; 31:485-494. [PMID: 34483605 PMCID: PMC8365478 DOI: 10.4314/ejhs.v31i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia. Methods A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization's case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected. Results Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria. Conclusion Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.
Collapse
Affiliation(s)
| | | | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University
| | - Mulatu Gashaw
- Department of Medical Laboratory Sciences, Jimma University
| | - Getnet Tesfaw
- Department of Medical Laboratory Sciences, Jimma University
| | - Andreas Wieser
- Max von Pettenkofer-Institute, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - Guro K Bårnes
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Innlandet Hospital Trust, Division Gjøvik-Lillehammer, Gjøvik, Norway
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Solomon Ali
- Department of Microbiology, St. Paul Hospital Millennium Medical College
| | | |
Collapse
|
14
|
Tilahun T, Babu H, Berhane M. Leech in the Rectum Causing Lower GI Bleeding in a Four Years Old Child: A Case Report. Ethiop J Health Sci 2021; 30:1055-1057. [PMID: 33883854 PMCID: PMC8047237 DOI: 10.4314/ejhs.v30i6.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Leeches belong to a group of annelids of the class Hirudinea which are blood feeding ecto-parasites of humans, wild animals and domesticated animals. A leech can suck out as much blood as ten times its own weight. Leech can occur at different sites in humans commonly in the eyes, nasopharynx, larynx, urethra, and vagina and rarely in the rectum. Case Details This is a four years old male child who presented with painless, bright red rectal bleeding for two weeks. Heamatocrit was 9.2%. Leech was removed from the rectum by letting the child sit on a bucket of water. The patient was transfused, followed for 24 hours and discharged with iron sulphate syrup. Conclusion Leech infestation should be considered in the differential diagnosis of a child presenting with hematochezia.
Collapse
Affiliation(s)
- Tsion Tilahun
- Department of Pediatrics and Child Health, Jimma University
| | - Hawi Babu
- Department of Pediatrics and Child Health, Jimma University
| | | |
Collapse
|
15
|
Sime H, Berhane M, Tilahun T, Kedir T, Dereje D, Beshir M, Tadesse I. Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia. Ethiop J Health Sci 2021; 31:311-320. [PMID: 34158783 PMCID: PMC8188083 DOI: 10.4314/ejhs.v31i2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Abnormal blood glucose level is one of the most frequently encountered problems in children with severe illnesses. However, its magnitude and outcome have rarely been determined in Ethiopia. We aimed to determine the magnitude, associated factors and outcome of dysglycemia in critically ill children admitted to Jimma Medical Center. Methods Prospective longitudinal study was conducted on children aged 28 days to 14 years admitted with critical illnesses at the different units of the Department of Pediatrics and Child Health of Jimma Medical Center, Southwest Ethiopia, from June to August 2019. Data were collected by trained medical personnel using structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) windows version 20.0. Dysglycemia was considered whenever the child had a random blood sugar >150mg/dl or <45mg/dl. Result Dysglycemia was seen at admission in 139/481, 28.9% children; 24 (5.0%) had hypoglycemia whereas 115 (23.9%) had hyperglycemia. The factors associated with dysglycemia at admission were severe acute malnutrition (p=002, AOR=3.09, CI=1.18,7.77), impaired mental status (p=0.003, AOR=4.63, CI=1.68, 12.71), place of residence (p=0.01, AOR=1.85, CI=1.15-2.96) and presence of diarrhea on date of admission. Among the children who had dysglycemia at admission, 16/139, 11.5% died. Conclusion Dysglycemia is a common problem in critically ill children in the setting. Blood glucose level should be determined for all critically ill children, and routine empirical administration of dextrose should be minimized since most of the children with dysglycemia had hyperglycemia than hypoglycemia.
Collapse
Affiliation(s)
- Habtamu Sime
- Department of Pediatrics and Child Health, Jimma University
| | | | - Tsion Tilahun
- Department of Pediatrics and Child Health, Jimma University
| | - Temam Kedir
- Department of Pediatrics and Child Health, Jimma University
| | | | - Muktar Beshir
- Department of Epidemiology, Jimma University.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, SA, Australia.,School of Clinical and Health Sciences, University of South Australia, SA, Australia
| | | |
Collapse
|
16
|
Berhane M, Girma T, Tesfaye W, Jibat N, Abera M, Abrahim S, Aboubaker S, Nisar YB, Ahmad Qazi S, Bahl R, Abdissa A. Implementation research on management of sick young infants with possible serious bacterial infection when referral is not possible in Jimma Zone, Ethiopia: Challenges and solutions. PLoS One 2021; 16:e0255210. [PMID: 34370744 PMCID: PMC8351942 DOI: 10.1371/journal.pone.0255210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Of 2.5 million newborn deaths each year, serious neonatal infections are a leading cause of neonatal death for which inpatient treatment is recommended. However, manysick newborns in sub-Saharan Africa and south Asia do not have access to inpatientcare. A World Health Organization (WHO) guideline recommends simplified antibiotic treatment atan outpatient level for young infants up to two months of age with possible serious bacterial infection (PSBI), when referral is not feasible.We implemented this guidelinein Ethiopia to increase coverage of treatment and to learn about potential facilitating factors and barriers for implementation. Methods We conducted implementation research in two districts (Tiro Afata and Gera) in Jimma Zone, Ethiopia, to learn about the feasibility of implementing the WHO PSBI guideline within a programme setting using the existing health care structure. We conducted orientation meetings and policy dialogue with key stakeholders and trained health extension workers and health centre staff to identify and manage sick young infants with PSBI signs at a primary health care unit. We established a Technical Support Unit (TSU) to facilitate programme learning, built health workers’ capacity and provided support for quality control, monitoring and data collection.We sensitized the community to appropriate care-seeking and supported the health care system in implementation. The research team collected data using structured case recording forms. Results From September 2016 to August 2017, 6185 live births and 601 sick young infants 0–59 days of age with signs of PSBI were identified. Assuming that 25% of births were missed (total births 7731) and 10% of births had an episode of PSBI in the first two months of life, the coverage of appropriate treatment for PSBI was 77.7% (601/773). Of 601 infants with PSBI, fast breathing only (pneumonia) was recorded in 432 (71.9%) infants 7–59 days of age; signs of clinical severe infection (CSI) in 155 (25.8%) and critical illnessin 14 (2.3%). Of the 432 pneumonia cases who received oral amoxicillin treatment without referral, 419 (97.0%) were successfully treated without any deaths. Of 169 sick young infants with either CSI or critical illness, only 110 were referred to a hospital; 83 did not accept referral advice and received outpatient injectable gentamicin plus oral amoxicillin treatment either at a health post or health centre. Additionally, 59 infants who should have been referred, but were not received injectable gentamicin plus oral amoxicillin outpatient treatment. Of infants with CSI, 129 (82.2%) were successfully treated as outpatients, while two died (1.3%). Of 14 infants with critical illness, the caregivers of five accepted referral to a hospital, and nine were treated with simplified antibiotics on an outpatient basis. Two of 14 (14.3%) infants with critical illness died within 14 days of initial presentation. Conclusion In settings where referral to a hospital is not feasible, young infants with PSBI can be treated on an outpatient basis at either a health post or health centre, which can contribute to saving many lives. Scaling-up will require health system strengthening including community mobilization. Registration Trial is registered on Australian New Zealand Clinical Trials registry (ANZCTR) ACTRN12617001373369.
Collapse
Affiliation(s)
- Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Workneh Tesfaye
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Nega Jibat
- College of Social Sciences and Humanities, Jimma University, Jimma, Ethiopia
| | - Mulumebet Abera
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | | | - Samira Aboubaker
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization (Retired) Currently WHO consultants, Geneva, Switzerland
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization (Retired) Currently WHO consultants, Geneva, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Alemseged Abdissa
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
17
|
Zewdu M, Kadir E, Berhane M, Alemayehu T. Variation of Ultrasonic Renal Volume between Hypertensive and Non-Hypertensive Individuals in Relation to Body Size Parameters. Ethiop J Health Sci 2021; 31:857-866. [PMID: 34703186 PMCID: PMC8512955 DOI: 10.4314/ejhs.v31i4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Estimation of renal size is vital for the diagnosis of abnormal structural change on the kidneys due to the adverse effects of chronic diseases like hypertension. This study evaluated renal volume by ultrasound in relation to body size parameters, notably body mass index (BMI) and body surface area(BSA) in hypertensive and non-hypertensive individuals. METHODS A hospital-based comparative cross-sectional study was conducted from February to September 2018 at the Radiology department of the Jimma University Medical Center (JUMC). The study included consecutively selected samples of 85 ambulatory hypertensive patients and 60non-hypertensive controls recruited consecutively on voluntary basis. After receiving verbal consent, each subject underwent abdominal ultrasound examination and length, width and thickness of both kidneys were measured and used for estimation of renal volume. The statistical evaluation included independent samples t-tests for mean differences with regard to ultrasonic renal measurements between hypertensive and non-hypertensive groups. RESULTS A total of 145 adults aged 16 - 80 years (mean ±SD=44 ±17) participated in the study. In the hypertensive group, mean renal volume of 97.7cm3 for the right kidney and104.4cm3 for the left kidney whereas in the control group, it was 101.1cm3 for the right and 111.8 cm3 for the left kidney. The mean right renal volume to BSA ratio was 58.2cm3/m2 in hypertensive group, while it was 62.6cm3/m2 among the control group (p=0.076). The mean left renal volume to BSA of the patients was 62.2cm3/m2 and significantly (p=0.012) lower than that of the non-hypertensive group, which was 69.3 cm3/m2. CONCLUSION Slightly smaller bilateral renal volume among hypertensive patients as compared the controls was obtained.
Collapse
Affiliation(s)
- Mesfin Zewdu
- Medical Physicist, Jimma University Radiology Department
| | - Elias Kadir
- Jimma University
- Medical Physicist, Jimma University Radiology Department
- Pediatrician, Jimma University Pediatrics & Child health Department
- Assistant Professor, Human Anatomy, Jimma University, Department of Biomedical Sciences
| | - Melkamu Berhane
- Pediatrician, Jimma University Pediatrics & Child health Department
| | - Tilehun Alemayehu
- Assistant Professor, Human Anatomy, Jimma University, Department of Biomedical Sciences
| |
Collapse
|
18
|
Yitbarek K, Hurlburt S, Hagen TP, Berhane M, Abraham G, Adamu A, Tsega G, Woldie M. Inequitable Utilization of Neonatal Health Services in Southwest Ethiopia: The Effects of Socioeconomic Disparities. Inquiry 2021; 58:469580211018290. [PMID: 34027707 PMCID: PMC8142524 DOI: 10.1177/00469580211018290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Low levels of neonatal health services utilization and high neonatal deaths are often concentrated among socially and economically disadvantaged groups, especially in low-income countries. Therefore the aim of this study was to assess inequity in the use of neonatal health services in Southwest Ethiopia. A community-based cross-sectional study was conducted in 8 districts located in Jimma Zone, Southwest Ethiopia from 19 March to 28 April 2018. A total of 835 mothers were included in the study with systematic random sampling. Principal component analysis was conducted to develop wealth quintiles of the households. Equity in neonatal health services was measured using rate-ratio, concentration curve, concentration index, and analyzed by binary logistic regression. Neonates from richer families were 1.25 times more likely to use neonatal health services than the poorer households with a concentration index value of 0.07. Neonates from highly educated mothers have better used the services and the corresponding concentration index value of 0.03. Neonatal service utilization was 1.32 times higher in the highest wealth quintile in rural settings. Similarly, services delivered at health posts and hospitals were used 2.4 and 2 times more by the wealthy, whereas services given at health centers are more utilized by the poorest. Outputs of binary logistic regression analysis indicated that neonates from middle quintile wealth households were found to be better neonatal health service users [AOR_1.72, 95% CI: 1.04, 2.82]. Neonate born from a secondary school attended mother [AOR_3.56, 95% CI: 1.90, 6.69] were more likely to use neonatal health services. Neonatal health service utilization in Southwest Ethiopia is more common among neonates from richer households and more educated mothers. There is a big difference among the wealthy and poorer in a rural setting and among those who used health posts. Working on the social-determinants of health will facilitate eliminating inequity.
Collapse
Affiliation(s)
| | - Sarah Hurlburt
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Gelila Abraham
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | | | | | - Mirkuzie Woldie
- Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
19
|
Zewdu M, Kadir E, Tesfaye M, Berhane M. ESTABLISHING LOCAL DIAGNOSTIC REFERENCE LEVELS FOR ROUTINE COMPUTED TOMOGRAPHY EXAMINATIONS IN JIMMA UNIVERSITY MEDICAL CENTER SOUTH WEST ETHIOPIA. Radiat Prot Dosimetry 2021; 193:200-206. [PMID: 33866377 DOI: 10.1093/rpd/ncab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
The main purpose of this study was to determine local diagnostic reference level (LDRL) for Routine Computed Tomography (CT) examination in, Jimma University Medical Center (JUMC) South West Ethiopia. Retrospective study was conducted to determine LDRL for routine CT examination in JUMC. We have considered CTDIvol and DLP as dosimetric quantity based on the recommended guidelines to determine LDRLs by different international legal Authorities. The 75th percentile values of the calculated CTDIvol and DLP were proposed as LDRL. LDRL was obtained as CTDIvol, 42.97mGy, 7.76mGy, 14.32mGy, and 10.86mGy for routine brain CT, routine chest CT, routine thoraco-lumbar CT and routine abdomen CT examination respectively. Similarly the determined LDRL from DLP was 1364.15mGycm, 368.96mGycm, 853.18mGycm, and 1568.96mGycm for brain, chest, thoraco-lumbar and abdomen examination respectively. The LDRL obtained for DLP was higher compared with international DRLs; it can be reduced by coordinating effort between radiologists, technologists and medical physicist.
Collapse
Affiliation(s)
- Mesfin Zewdu
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Elias Kadir
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Million Tesfaye
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Melkamu Berhane
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| |
Collapse
|
20
|
Melaku T, Gashaw M, Chelkeba L, Berhane M, Bekele S, Lemi G, Wakjira T, Tesfaw G, Mekonnen Z, Ali S, Kroidl A, Wieser A, Froeschl G, Gudina EK. Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics). Infect Drug Resist 2021; 14:1649-1658. [PMID: 33953576 PMCID: PMC8092616 DOI: 10.2147/idr.s293080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/30/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia. Methods A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization "AWaRe" classification scheme as "Access", "Watch" and "Reserve" group antibiotics and measured their consumption intensity. Results A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the "Watch" group had 2.10 DDD/100 outpatients per day. Conclusion There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the "Watch" group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.
Collapse
Affiliation(s)
| | - Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Sisay Bekele
- Department of Ophthalmology, Jimma University, Jimma, Ethiopia
| | - Gemechu Lemi
- Department of Surgery, Jimma University, Jimma, Ethiopia
| | - Tekle Wakjira
- Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Solomon Ali
- Department of Microbiology, Immunology and Parasitology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | | |
Collapse
|
21
|
Tilahun T, Diriba G, Berhane M. Bilateral Adrenal Hemorrhage in a 6-Day-Old Neonate Presenting with Hematuria of 2 Days Duration: Case Report. Int Med Case Rep J 2021; 14:183-185. [PMID: 33790660 PMCID: PMC8007555 DOI: 10.2147/imcrj.s294475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background The adrenal gland of newborns is susceptible to hemorrhage because of its relative larger size and high vascularity. Adrenal hemorrhage is bilateral in 10% of the cases. Neonates with adrenal hemorrhage present with anemia, jaundice, abdominal mass, and, rarely, adrenal insufficiency. Case Detail A 6-day-old macrosomic neonate presented with hematuria of 2 days duration. Delivery was difficult. Abdominal ultrasound demonstrated bilateral suprarenal echo complex mass (right 4.3 cm by 2.2 cm and left 4 cm by 2 cm) and abdominal CT scan showed bilateral hypo-dense non-enhancing fluid-attenuated suprarenal gland masses (right 4.3 cm by 2.5 cm and left- 3.9 cm by 2.4 cm). Conclusion Adrenal hemorrhage should be considered and looked for in at-risk newborns like those with macrosomia, overwhelming sepsis, and perinatal asphyxia as well as those with bleeding diathesis. Although rare, hematuria is one of the clinical features of adrenal hemorrhage in neonates. Asymptomatic neonates with adrenal hemorrhage may not need any intervention except close follow up.
Collapse
Affiliation(s)
- Tsion Tilahun
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Gezahegn Diriba
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
22
|
Grey K, Gonzales GB, Abera M, Lelijveld N, Thompson D, Berhane M, Abdissa A, Girma T, Kerac M. Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review. BMJ Glob Health 2021; 6:e003161. [PMID: 33692144 PMCID: PMC7949429 DOI: 10.1136/bmjgh-2020-003161] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Child malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs. METHODS Our peer-reviewed search strategy focused on 'severe childhood malnutrition', 'LMICs', 'famine', and 'cardiometabolic NCDs' to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist. RESULTS We identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome. CONCLUSION Severe malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors' long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.
Collapse
Affiliation(s)
- Kelsey Grey
- Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerard Bryan Gonzales
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | | | - Debbie Thompson
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | | | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Marko Kerac
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
23
|
Yitbarek K, Abraham G, Berhane M, Hurlburt S, Mann C, Adamu A, Tsega G, Woldie M. Significant inefficiency in running community health systems: The case of health posts in Southwest Ethiopia. PLoS One 2021; 16:e0246559. [PMID: 33606733 PMCID: PMC7895414 DOI: 10.1371/journal.pone.0246559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although much has been documented about the performance of the health extension program, there is a lack of information on how efficiently the program is running. Furthermore, the rising cost of health services and the absence of competition among publicly owned health facilities demands strong follow up of efficiency. Therefore, this study aimed to assess the technical efficiency of the health posts and determinants in Southwestern Ethiopia. Methods and materials We used data for one Ethiopian fiscal year (from July 2016 to June 2017) to estimate the technical efficiency of health posts. A total of 66 health posts were included in the analysis. We employed a two-stage data envelopment analysis to estimate technical efficiency. At the first stage, technical efficiency scores were calculated using data envelopment analysis program version 2.1. Predictors of technical efficiency were then identified at the second stage using Tobit regression, with STATA version 14. Results The findings revealed that 21.2% were technically efficient with a mean technical efficiency score of 0.6 (± 0.3), indicating that health posts could increase their service volume by 36% with no change made to the inputs they received. On the other hand, health posts had an average scale efficiency score of 0.8 (± 0.2) implying that the facilities have the potential to increase service volume by 16% with the existing resources. The regression model has indicated average waiting time for service has negatively affected technical efficiency. Conclusion More than three-quarters of health posts were found inefficient. The technical efficiency score of more than one-third of the health posts is even less than 50%. Community mobilization to enhance the uptake of health services at the health posts coupled with a possible reallocation of resources in less efficient health posts is a possible approach to improve the efficiency of the program.
Collapse
Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ayinengida Adamu
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| |
Collapse
|
24
|
Mekasha A, Tazu Z, Muhe L, Abayneh M, Gebreyesus G, Girma A, Berhane M, McClure EM, Goldenberg RL, Nigussie AK. Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study. Glob Pediatr Health 2020; 7:2333794X20970005. [PMID: 33283024 PMCID: PMC7689001 DOI: 10.1177/2333794x20970005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/05/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aim. To determine the risk factors for death among preterm
neonates. Methods and materials. The data set used was derived
from a prospective, multi-center, observational clinical study conducted in 5
tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were
infants admitted into neonatal intensive care unit. Results.
Risk factors were determined using statistical model developed for this study.
The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to
36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The
significant risk factors for preterm death were low gestational age, low birth
weight, being female, feeding problem, no antenatal care visits and vaginal
delivery among mothers with higher educational level.
Conclusions. The study identified several risk factors for
death among preterm neonates. Most of the risk factors are preventable. Thus, it
is important to address neonatal and maternal factors identified in this study
through appropriate ANC and optimum infant medical care and feeding practices to
decrease the high rate of preterm death.
Collapse
Affiliation(s)
- Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Tazu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | | |
Collapse
|
25
|
Eshetu B, Gashaw M, Solomon S, Berhane M, Molla K, Abebe T, Gizaw S, Abdissa A, Abayneh M, Goldenberg RL, Tigabu Z, Mekasha A, Worku B, McClure EM, Nigusse AK, Muhe LM. Bacterial Isolates and Resistance Patterns in Preterm Infants with Sepsis in Selected Hospitals in Ethiopia: A Longitudinal Observational Study. Glob Pediatr Health 2020; 7:2333794X20953318. [PMID: 33062808 PMCID: PMC7536471 DOI: 10.1177/2333794x20953318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Neonatal sepsis is the third leading cause of neonatal mortality, behind prematurity and intrapartum-related complications. The main objectives of this study are to assess the proportion of sepsis in preterm newborns and identify the etiologic agents and their antibiotic sensitivity patterns. Methods: A longitudinal observational study was done from July 2016 to May 2018. Whenever clinical diagnosis of sepsis was made, blood cultures and antibiotic susceptibility tests were done. Result: We did 690 blood cultures, 255 (36.9%) showing bacterial growth. The most commonly isolated bacteria were Klebsiella species 78 (36.6%), Coagulase negative Staphylococcus 42 (19.7%) and Staphylococcus aureus 39 (18.3%). Gram-positive bacteria showed high resistance to penicillin (98.9%) and ceftriaxone (91.3%) whereas Gram-negative bacteria were highly resistant to gentamicin (83.2%) and ceftriaxone (83.2%). Conclusion: Resistance to the more commonly used antibiotics such as ampicillin and gentamycin was very high, necessitating reconsideration of the empiric use of these antibiotics.
Collapse
Affiliation(s)
- Beza Eshetu
- Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Mulatu Gashaw
- Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Semaria Solomon
- St Paul Millennium Medical College Hospital, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | | | - Tamrat Abebe
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Solomon Gizaw
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Alemseged Abdissa
- Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Mahlet Abayneh
- St Paul Millennium Medical College Hospital, Addis Ababa, Ethiopia
| | | | | | - Amha Mekasha
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | - Lulu M Muhe
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| |
Collapse
|
26
|
Berhane M, Workineh N, Girma T, Lim R, Lee KJ, Nguyen CD, Neal E, Russell FM. Prevalence of Low Birth Weight and Prematurity and Associated Factors in Neonates in Ethiopia: Results from a Hospital-based Observational Study. Ethiop J Health Sci 2020; 29:677-688. [PMID: 31741638 PMCID: PMC6842723 DOI: 10.4314/ejhs.v29i6.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Low birth weight and prematurity are associated with increased morbidity, mortality and multiple short and long-term complications, exerting impacts on the individual, the families, the community and the health care system. Fetal, maternal and environmental factors have been associated with low birth weight and prematurity, based primarily on researches from high-income countries. It is unknown whether these risk factors are the same in low and middle income countries. The aims of this study are to determine the prevalence of low birth weight and prematurity and associated factors in Jimma University Specialized Hospital, Ethiopia. Methods This observational study was conducted at Jimma University Specialized Hospital, Ethiopia, from December 2014 to September 2016. Multivariable logistic regression was used to determine the associated factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results The prevalence of low birth weight and prematurity were 14.6% and 10.2%, respectively. The mean birth weight was 2,975g (standard deviation 494). Prematurity (OR 23.54, 95%CI 15.35-36.08, p<0.001) and unmarried marital status (OR 5.73, 95%CI 1.61-20.40, p=0.007) were positively associated with low birth weight. Female sex (OR 1.69, 95%CI 1.18-2.42, p=0.004) and unmarried marital status (OR 4.07, 95%CI 1.17-14.14, p=0.027) were positively associated with prematurity. Conclusion The prevalence of lower birth weight and prematurity in this study is lower than other studies reported from similar facilities. Prematurity and unmarried marital status are associated with LBW whereas female sex and unmarried marital status are associated with prematurity in this population.
Collapse
Affiliation(s)
| | | | - Tsinuel Girma
- Jimma University, Department of Pediatrics and Child Health
| | - Ruth Lim
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Cattram D Nguyen
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Eleanor Neal
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Fiona M Russell
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
27
|
Gidi NW, Berhane M, Girma T, Abdissa A, Lim R, Lee K, Nguyen C, Russell F. Anthropometric measures that identify premature and low birth weight newborns in Ethiopia: a cross-sectional study with community follow-up. Arch Dis Child 2020; 105:326-331. [PMID: 31676553 PMCID: PMC7146923 DOI: 10.1136/archdischild-2019-317490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/29/2019] [Accepted: 10/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate foot length (FL), chest circumference (CHC) and mid-upper arm circumference (MUAC) as predictors of low birth weight (LBW) or prematurity, and to describe the agreement between the gestational age (GA) assessments ascertained by the New Ballard Score (NBS) and the Eregie model. METHODS A hospital-based cross-sectional study with community follow-up in a subset was conducted in Jimma University Medical Center, Ethiopia. GA (NBS and Eregie model), weight, FL, CHC and MUAC were measured at birth. Anthropometrics were repeated at 5 days of age. RESULTS The optimal cut-offs indicative of LBW were ≤7.7 cm for FL; ≤31.2 cm for CHC and ≤9.8 cm for MUAC. CHC, MUAC and FL identified LBW with sensitivities (95% CI) of 91.6 (86.9 to 95), 83.7 (77.8 to 88.5) and 84.2 (78.4 to 88.9), and specificities (95% CI) of 85.4 (83.3 to 87.4), 90.2 (88.4 to 91.9) and 73.9 (71.3 to 76.4), respectively. CHC, MUAC and FL identified prematurity with sensitivities of 83.8 (76.7 to 89.4), 83.1 (75.9 to 88.9) and 81.7 (74.3 to 87.7), and specificities of 81.1 (78.9 to 83.3), 63.4 (60.7 to 66.1) and 77.0 (74.6 to 79.3), respectively. The cut-offs identified have comparable diagnostic ability for LBW and prematurity when measurements are repeated on day 5 of age. The GA assessment by the NBS and the Eregie model gave similar results, with the mean difference of 1.2 weeks. CONCLUSION CHC, MUAC and FL taken on day 1 and 5 after birth could be used as diagnostic tools for LBW or prematurity. The Eregie model for GA estimation gives similar results to the NBS.
Collapse
Affiliation(s)
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Ruth Lim
- Murdoch Children's Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Katherine Lee
- Murdoch Children's Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cattram Nguyen
- Murdoch Children's Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Russell
- Murdoch Children's Research Institute, The Royal Children’s Hospital, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Abstract
Background Lumbo-costo-vertebral syndrome is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. Case We present a case of Lumbo-costo-vertebral syndrome in a 6-month old female infant who had a progressive swelling over the right lumbar area since birth. Clinical examination revealed a reducible swelling on the right flank with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the right lumbar region. Chest X-ray revealed scoliosis and hemivertebrae with absent lower ribs on the right side. Computer tomography scan showed hernia sac containing the bowel and the right lobe of the liver with cross fused kidney. Conclusion Lumbo-costo-vertebraly syndrome is a rare condtion which could be associated with different organ malformations. Simple closure or meshplasty could be done depending on the size of the defect.
Collapse
Affiliation(s)
- Beza Eshetu
- Department of Pediatrics and Child Health Jimma University, Jimma, Ethiopia
| | - Teferi Mekonnen
- Department of Pediatrics and Child Health Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health Jimma University, Jimma, Ethiopia
| |
Collapse
|
29
|
Yitbarek K, Abraham G, Adamu A, Tsega G, Berhane M, Hurlburt S, Mann C, Woldie M. Technical efficiency of neonatal health services in primary health care facilities of Southwest Ethiopia: a two-stage data envelopment analysis. Health Econ Rev 2019; 9:27. [PMID: 31656977 PMCID: PMC6815357 DOI: 10.1186/s13561-019-0245-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Disparity in resource allocation is an issue among various health delivery units in Ethiopia. To sufficiently address this problem decision-makers require evidence on efficient allocation of resources. Therefore, the purpose of this study was to assess the technical efficiency of primary health care units providing neonatal health services in Southwest Ethiopia. METHODS Two-stage data envelopment analysis was conducted based on one-year (2016/17) data from 68 health posts and 23 health centers in Southwest Ethiopia. Primary data were collected from each of the facility, respective district health offices and finance and economic cooperation offices. Technical efficiency scores were calculated using data envelopment analysis software version 2.1. Tobit regression was then applied to identify determinants of technical efficiency. STATA version 14 was used in the regression model and for descriptive statistics. RESULTS By utilizing the best combination of inputs, eight health posts (11.76%) and eight health centers (34.78%) were found to be technically efficient in delivering neonatal health services. Compared with others included in the analysis, inefficient health delivery units were using more human and non-salary recurrent resources. The regression model indicated that there was a positive association between efficiency and the health center head's years of experience and the facility's catchment population. Waiting time at the health posts was found to negatively affect efficiency. CONCLUSIONS Most of health posts and the majority of health centers were found to be technically inefficient in delivering neonatal health services. This indicates issues with the performance of these facilities with regards to the utilization of inputs to produce the current outputs. The existing resources could be used to serve additional neonates in the facilities.
Collapse
Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayinengida Adamu
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and child health, Institute of health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| |
Collapse
|
30
|
Berhane M, Abera G, Alemu S, Eshetu B. Aphalia: An Extremely Rare Congenital Genitourinary Malformation-A Case Report. Ethiop J Health Sci 2019; 29:409-412. [PMID: 31447510 PMCID: PMC6689716 DOI: 10.4314/ejhs.v29i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Congenital aphalia is an extremely rare, urogenital malformation of the external genitalia characterized by congenitally absent penis in a karotypically XY child. It occurs 1 in 30 million live births. So far, only less than 100 cases have been reported. Case Details A 3-hour old newborn was diagnosed with aphalia after being referred from health center for respiratory distress and congenital malformation of the external genitalia. He had deranged renal function tests, hypoplastic kidneys, small patent foramen ovale and ventricular septal defect. Management of the acute conditions and parental counseling were done, but he passed away on the 8th day of life, due to the underlying diseases. Conclusion A patient with aphalia needs thorough evaluation for possible associated malformations. Management is multistaged and multidisciplinary. Parental counselling should be started as early as possible, and their decision should be respected.
Collapse
Affiliation(s)
| | | | | | - Beza Eshetu
- Department of Pediatric and Child Health, Jimma University
| |
Collapse
|
31
|
Eshetu B, Gashaw M, Berhane M, Abdissa A, McClure EM, Goldenberg RL, Muhe LM. Intravenous fluid contaminated with Klebsiella oxytoca as a source of sepsis in a preterm newborn: Case report. Am J Infect Control 2019; 47:840-842. [PMID: 30723029 DOI: 10.1016/j.ajic.2018.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
Advances in neonatal care have led to the increasing survival of smaller and sicker infants, but nosocomial infections continue to be a serious problem, associated with increased mortality rates, immediate and long-term morbidity, prolonged hospital stay, and increased cost of care. We report a case of hospital-acquired sepsis in a preterm baby secondary to Klebsiella oxytoca, resulting from contaminated intravenous fluid.
Collapse
Affiliation(s)
- Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.
| | - Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Research Triangle Park, NC
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Lulu M Muhe
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Maternal, Newborn, Child Health and Childhood HIV, TB and Malaria, Geneva, Switzerland
| |
Collapse
|
32
|
Dadi LS, Berhane M, Ahmed Y, Gudina EK, Berhanu T, Kim KH, Getnet M, Abera M. Maternal and newborn health services utilization in Jimma Zone, Southwest Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth 2019; 19:178. [PMID: 31113407 PMCID: PMC6530050 DOI: 10.1186/s12884-019-2335-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/07/2019] [Indexed: 01/07/2023] Open
Abstract
Background Majority of causes of maternal and newborn mortalities are preventable. However, poor access to and low utilization of health services remain major barriers to optimum health of the mothers and newborns. The objectives of this study were to assess maternal and newborn health services utilization and factors affecting mothers’ health service utilization. Methods A community based cross-sectional survey was carried out on randomly selected mothers who gave birth within a year preceding the survey. The survey was supplemented with key informant interviews of experts/health professionals. Multivariable logistic model was used to identify factors associated with service utilization. Adjusted odds ratios (AORs) were used to assess the strength of the associations at p-value ≤0.05. The qualitative data were summarized thematically. Results A total of 789 (99.1% response rate) mothers participated in the study. The proportion of the mothers who got at least one antennal care (ANC) visit, institutional delivery and postnatal care (PNC) were 93.3, 77.4 and 92.0%, respectively. Three-forth (74.2%) of the mothers started ANC lately and only 47.5% of them completed ANC4+ visits. Medium (4–6) family size (AOR: 2.3; 95% CI: 1.1, 4.9), decision on ANC visits with husband (AOR: 30.9; 95% CI: 8.3, 115.4) or husband only (AOR: 15.3; 95%CI: 3.8, 62.3) and listening to radio (AOR: 2.5; 95%CI: 1.1, 5.6) were associated with ANC attendance. Mothers whose husbands read/write (AOR: 1.6; 95% CI: 1.1, 2.), attended formal education (AOR: 2.8; 95% CI: 1.1, 6.8), have positive attitudes (AOR: 10.2; 95% CI: 25.9), living in small (AOR: 3.0; 95% CI: 1.2, 7.6) and medium size family (AOR: 2.3; 95% CI: 1.2, 4.1) were more likely to give birth in-health facilities. The proportion of PNC checkups among mothers who delivered in health facilities and at home were 92.0 and 32.5%, respectively. The key informants mentioned that home delivery, delayed arrival of the mothers, unsafe delivery settings, shortage of skilled personnel and supplies were major obstacles to maternal health services utilization. Conclusions Health information communication targeting husbands may improve maternal and newborn health services utilization. In service training of personnel and equipping health facilities with essential supplies can improve the provider side barriers. Electronic supplementary material The online version of this article (10.1186/s12884-019-2335-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University Medical Center, Jimma, Ethiopia
| | - Yusuf Ahmed
- Department of Obstetrics and Gynecology, Jimma University Medical Center, Jimma, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Medical Center, Jimma, Ethiopia
| | | | | | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Muluemabet Abera
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
33
|
Berhane M, Yimam H, Jibat N, Zewdu M. Parents' Knowledge of Danger Signs and Health Seeking Behavior in Newborn and Young Infant Illness in Tiro Afeta District, Southwest Ethiopia: A Community-based Study. Ethiop J Health Sci 2019; 28:473-482. [PMID: 30607060 PMCID: PMC6308740 DOI: 10.4314/ejhs.v28i4.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Neonatal mortality rates in Ethiopia are among the highest in the world. Reducing neonatal and young infant mortality highly relies on early recognition of symptoms and appropriate care-seeking behavior of parents/care givers. The main aim of this study was to assess the knowledge of danger signs and health seeking behavior of parents/care givers in newborn and young infant illness in Southwest Ethiopia. Methods A community-based cross-sectional study was conducted using cluster sampling technique to get 422 samples of parents/care givers who had infants of less than 6 month old. Data was collected through face-to-face interviews using structured questionnaire. Logistic regression was used to identify factors affecting care seeking behavior and knowledge of parents/care givers on newborn and young infant illness. Result Care seeking behavior for newborn and young infant illness was high (83%), the major factor associated with care seeking behavior being place of delivery. Only less than half of the respondents had adequate knowledge of symptoms of illness of newborns and young infants. The major factors associated with knowledge of parents/care givers were maternal education and paternal education. Conclusions To improve the knowledge of parents/care givers about newborn and young infant illness, counseling about the major symptoms of newborn and young infant illness should be intensified.
Collapse
Affiliation(s)
- Melkamu Berhane
- Department of Pediatric and Child Health, Jimma University, Ethiopia
| | - Hadiya Yimam
- Department of Pediatric and Child Health, Jimma University, Ethiopia
| | - Nega Jibat
- Department of Sociology, Jimma University, Ethiopia
| | - Mesfin Zewdu
- Departent of Radiology, Jimma University, Ethiopia
| |
Collapse
|
34
|
Bårnes GK, Gudina EK, Berhane M, Abdissa A, Tesfaw G, Abebe G, Feruglio SL, Caugant DA, Jørgensen HJ. New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription. BMC Infect Dis 2018; 18:684. [PMID: 30572843 PMCID: PMC6302510 DOI: 10.1186/s12879-018-3589-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited. Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis. METHODS A prospective study was conducted over three months in a teaching hospital in Ethiopia with limited laboratory resources. Cerebrospinal fluid (CSF) samples from patients with suspected meningitis were analysed using a multiplex PCR-based system (FilmArray, BioFire), in addition to basic routine testing with microscopy and culture. Clinical data, as well as information on treatment and outcome were collected. RESULTS Two hundred and eighteen patients were included; 117 (54%) neonates (0-29 days), 63 (29%) paediatrics (1 month-15 years) and 38 (17%) adults (≥16 years). Of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in paediatrics and 18% in adults. Virus was detected in 57% of the PCR positive samples, bacteria in 33% and fungi in 10%. All CSF samples that were PCR positive for a bacterial agent had a white cell count ≥75 cells/mm3 and/or turbid appearance. The majority (90%) of patients received more than one antibiotic for treatment of the meningitis episode. There was no difference in the mean number of different antibiotics received or in the cumulative number of days with antibiotic treatment between patients with a microorganism detected in CSF and those without. CONCLUSIONS A rapid molecular diagnostic system was successfully implemented in an Ethiopian setting without previous experience of molecular diagnostics. Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia, and viral agents were the most commonly detected microorganisms in CSF. This study illustrates the potential of rapid diagnostic tests for reducing antibiotic usage in suspected meningitis cases. However, the cost of consumables for the molecular diagnostic system used in this study limits its use in low-income countries.
Collapse
Affiliation(s)
- Guro K Bårnes
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Getnet Tesfaw
- Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gemeda Abebe
- Institute of Health, Jimma University, Jimma, Ethiopia.,Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
| | - Siri Laura Feruglio
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Hannah Joan Jørgensen
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Veterinary Institute, Oslo, Norway
| |
Collapse
|
35
|
Gorems K, Beyene G, Berhane M, Mekonnen Z. Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia. BMC Ear Nose Throat Disord 2018; 18:17. [PMID: 30524201 PMCID: PMC6278048 DOI: 10.1186/s12901-018-0065-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Abstract
Background Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope. Methods A prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant. Results Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age (p = 0.031), rural residence (p = 0.005), previous history of health care visit and treatment (p = 0.000), upper respiratory tract infection (p = 0.018) and presence of cigarette smoker in the house (p = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials. Conclusions Majority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment.
Collapse
Affiliation(s)
- Kasahun Gorems
- 1School of Medical Laboratory Sciences, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Getenet Beyene
- 1School of Medical Laboratory Sciences, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Melkamu Berhane
- 2Department of Pediatrics and Child Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- 1School of Medical Laboratory Sciences, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| |
Collapse
|
36
|
Gashaw M, Berhane M, Bekele S, Kibru G, Teshager L, Yilma Y, Ahmed Y, Fentahun N, Assefa H, Wieser A, Gudina EK, Ali S. Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study. Antimicrob Resist Infect Control 2018; 7:138. [PMID: 30479751 PMCID: PMC6245755 DOI: 10.1186/s13756-018-0431-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background The rates of resistant microorganisms which complicate the management of healthcare associated infections (HAIs) are increasing worldwide and getting more serious in developing countries. The objective of this study was to describe microbiological features and resistance profiles of bacterial pathogens of HAIs in Jimma University Medical Center (JUMC) in Ethiopia. Methods Institution based cross sectional study was carried out on hospitalized patients from May to September, 2016 in JUMC. Different clinical specimens were collected from patients who were suspected to hospital acquired infections. The specimens were processed to identify bacterial etiologies following standard microbiological methods. Antibacterial susceptibility was determined in vitro by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results Overall, 126 bacterial etiologies were isolated from 118 patients who had HAIs. Of these, 100 (79.4%) were gram negative and the remaining were gram positive. The most common isolates were Escherichia coli 31(24.6%), Klebsiella species 30(23.8%) and Staphylococcus aureus 26 (20.6%). Of 126 bacterial isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR, resistant to at least one agent in three or more antimicrobial categories), extensively drug resistant (XDR, resistant to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories), pan-drug resistant (PDR, resistant to all antibiotic classes) respectively. More than half of isolated gram-negative rods (51%) were positive for extended spectrum beta-lactamase (ESBL) and/or AmpC; and 25% of gram negative isolates were also resistant to carbapenem antibiotics. Conclusions The pattern of drug resistant bacteria in patients with healthcare associated infection at JUMC is alarming. This calls for coordinated efforts from all stakeholders to prevent HAIs and drug resistance in the study setting.
Collapse
Affiliation(s)
- Mulatu Gashaw
- 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia.,11Institute of Health, Jimma University, P.O. Box 1368, Jimma, Ethiopia
| | - Melkamu Berhane
- 2Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Sisay Bekele
- 3Department of Ophthalmology, Jimma University, Jimma, Ethiopia
| | - Gebre Kibru
- 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Lule Teshager
- 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Yonas Yilma
- 4Department of Surgery, Jimma University, Jimma, Ethiopia
| | - Yesuf Ahmed
- 5Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
| | - Netsanet Fentahun
- 6Department of Health Education and Behavioral Health, Jimma University, Jimma, Ethiopia
| | - Henok Assefa
- 7Department of Epidemiology and Statistics, Jimma University, Jimma, Ethiopia
| | - Andreas Wieser
- 8Head of the parasitology laboratory and deputy head of the molecular diagnostics laboratory at the Max von Pettenkofer-Institute, Ludwigs-Maximilians-University (LMU), München, Germany
| | | | - Solomon Ali
- 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia.,WHO-TDR clinical research former fellow at AERAS Africa and Rockville, Rockville, MD USA
| |
Collapse
|
37
|
Zewdu M, Kadir E, Berhane M. Assessment of Pediatrics Radiation Dose from Routine X-Ray Examination at Jimma University Hospital, Southwest Ethiopia. Ethiop J Health Sci 2017; 27:481-490. [PMID: 29217953 PMCID: PMC5615009 DOI: 10.4314/ejhs.v27i5.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Given the fact that children are more sensitive to ionizing radiation than adults, with an increased risk of developing radiation-induced cancer, special care should be taken when they undergo X-ray examinations. The main aim of the current study was to determine Entrance Surface Dose (ESD) to pediatric patients arising from routine x-ray examination in the Radiology Department of Jimma University Specialized Hospital (JUSH). METHODS Descriptive cross-sectional study was conducted on pediatric patients less than 15 years of age who visited to seek x-ray examinations in JUSH. In this study, chest (AP), skull (AP), Abdomen (AP) and Pelvic (AP) x-ray examinations were analyzed. Radiographic exposure factors were recorded in each examination. ESD was calculated using exposure parameters. The calculated ESD values were weighed against the Diagnostic Reference Level (DRL) recommended doses and similar published studies. Comparison was made among different age groups through mean comparison. RESULT The obtained ESD values were mostly higher than the values in internationally published studies and DRL for all age groups. For chest AP, the mean ESD values were 1.82mGy which is higher than similar studies in Nigeria (0.642Mgy), Brazil (o.o62mGy) and NRPB (0.050mGy) for ages of 0-1 years. CONCLUSION The higher pediatric patient dose obtained in this study is a further indicator that doses delivered to pediatric patients are not according to ALARA principle, and there is a need to optimize service and patients' radiation exposure in JUSH in particular and in Ethiopia in general.
Collapse
Affiliation(s)
- Mesfin Zewdu
- Department of Radiology Jimma Univerity, Ethiopia
| | - Elias Kadir
- Department of Radiology Jimma Univerity, Ethiopia
| | - Melkamu Berhane
- Department of Pediatric and Child Health, Jimma University, Ethiopia
| |
Collapse
|
38
|
Zewdu M, Kadir E, Berhane M. Analysis and Economic Implication of X-Ray Film Reject in Diagnostic Radiology Department of Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci 2017; 27:421-426. [PMID: 29217944 PMCID: PMC5615031 DOI: 10.4314/ejhs.v27i4.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients usually undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to poor image quality. This subjects the patients to excess radiation exposure and extra cost.It is therefore investigating the magnitude and causes of reject is mandatory. This study aimed to assess the reject rate of X-ray films and its economic implication in order to obtain information for further recommendations on image quality, cost and radiation exposure. METHOD A cross-sectional study approaches was employed. Reject rate was measured for two x-rays in the department across all plain x-ray films examinations using a structured format on which relevant data for reject were recorded by investigators. The results were then collected and entered into a database for analysis. RESULT Reject rate and cause of reject were measured across all plane x-ray examinations for the hospital. From a total of 6563 exposed films, 16.85% were rejected. This leads to economic waste of 24,721.99 ETB, or 17.8% of a total cost in 4month period and increase in radiation dose to both patients and staff. CONCLUSION The findings from this study show that both the overall reject rate and individual reject rate were higher than the accepted range which could be due to machine fault, operator's technical limitations, or absence of quality control program in the department. We recommend that regular quality assurance and quality control procedure which are well documented should be established in the department.
Collapse
Affiliation(s)
- Mesfin Zewdu
- Department of Radiology, Jimma University, Ethiopia
| | - Elias Kadir
- Department of Radiology, Jimma University, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Ethiopia
| |
Collapse
|
39
|
Gebrelul S, Marshall R, Ghebreiyessus Y, Adams C, Berhane M, Runles E. 100 The effects of mixed and sequential grazing on growth performances and parasitic resistances of kids. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|