Association of Delay in Breast Cancer Diagnosis With Survival in Addis Ababa, Ethiopia: A Prospective Cohort Study

PURPOSE

There are limited data on the association between delay in breast cancer diagnosis after breast symptom recognition and survival, particularly in sub-Saharan Africa. The recently launched Global Breast Cancer Initiative by WHO includes measuring delay as the core indicator for quality of breast cancer care. Herein, we examined the association between delay in breast cancer diagnosis with overall survival among women in Addis Ababa, Ethiopia.

MATERIALS AND METHODS

A total of 439 women diagnosed with breast cancer from January 1, 2017, to June 30, 2018, in Addis Ababa were followed for survival to the end of 2019. Survival rates were estimated using the Kaplan-Meier method. The association between delay in diagnosis (>3 months after symptom recognition) and overall survival was computed using the multivariable Cox regression model after adjusting for demographic and clinical factors.

RESULTS

Nearly 70% (303/439) of women with breast cancer were delayed in diagnosis of their cancer. During a median follow-up period of 25.1 months, 2-year overall survival rate was 73.5% (95% CI, 68.0 to 78.2) in women with diagnosis delay compared with 79.1% (95% CI, 71.2 to 85.1) in those women without diagnosis delay. In the multivariable Cox regression model, the risk of death was 73% higher (hazard ratio, 1.73; 95% CI, 1.09 to 2.74) in women with diagnosis delay compared with those without diagnosis delay.

CONCLUSION

Delay in diagnostic confirmation of breast cancer after recognition of breast symptoms was negatively associated with overall survival in Addis Ababa, Ethiopia, underscoring the need to increase awareness about the importance of prompt presentation for clinical evaluation and referral for diagnostic confirmation to mitigate the undue high burden of the disease.

Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022

BACKGROUND

There are foods considered as taboo across different communities in the world and in Ethiopia in particular. Although food taboos exist across all ages or physiologic states, they are predominant among pregnant women and children. Identifying such foods among pregnant women is crucial in providing focused interventions and prevents their negative consequences. Therefore, the aim of this review was to review the available evidence on food taboos and their perceived reasons among pregnant women in Ethiopia to provide comprehensive and precise evidence for decision making.

METHODS

Electronic search of the literature was made from Pub-Med, Google Scholar, Google Scopus, and Medline databases using search terms set based on the PICO/PS (Population, Intervention/exposure, Comparison, and Outcome) and PS (Population and Situation) search table. The search was made from December 05, 2020 - December, 29, 2021, and updated on January, 2022. All quantitative and qualitative studies published in English were included in the review. The systematic review protocol was registered at INPLASY (Registration number: INPLASY202310078). The outcome of interest was food taboo for pregnant women and its perceived reasons. The results of the review was narrated.

RESULTS

After identifying eighty two articles, thirteen were found eligible for the review. Vegetables, fruits, and fatty foods like meat, and dairy products were considered as taboo for pregnant women in different parts of Ethiopia. The reasons stated for the food taboo vary from fear of having a big baby, obstructed labour, and abortion to evil eye and physical and aesthetic deformities in the newborn.

CONCLUSIONS

Though not uniform across the country, there are foods considered as taboo for pregnant women in Ethiopia due to several perceived reasons, misconceptions, and societal influences. This could increase the risk of malnutrition and could have short and long term consequences on both the mother and her growing foetus. Therefore, context specific nutritional counseling with emphasis during ante-natal care and post-natal service is important.

Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia

There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR = 60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.

Delayed initiation of adjuvant chemotherapy among women with breast cancer in Addis Ababa, Ethiopia

PURPOSE

Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia.

METHODS

A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017-2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC > 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC > 90 days was associated with sociodemographic or clinical factors.

RESULTS

The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4-36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ < 61) was 3.98 (95% CI 1.67-9.46) higher than in those women with highest quartile family income group (US$ > 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients.

CONCLUSIONS

A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.

Prevalence and Risk Factors of Human Leishmaniasis in Ethiopia: A Systematic Review and Meta-Analysis

Introduction

Tropical diseases are public health problems affecting hundreds of millions of people globally. However, the development of adequate, affordable, and accessible treatments is mostly neglected, resulting in significant morbidity and mortality that could otherwise be averted. Leishmaniasis is one of the neglected tropical diseases caused by the obligate intracellular protozoan Leishmania parasite and transmitted by the bite of infected phlebotomine sandflies. No systematic review and meta-analysis has been done to identify the prevalence and risk factors of leishmaniasis to the authors’ knowledge. Therefore, the objective was to determine the prevalence and risk factors of human leishmaniasis in Ethiopia.

Methods

Eleven studies conducted in all regions of Ethiopia, which were fully accessible, written in any language, and original articles done on prevalence and risk factors of leishmaniasis, were included. STATA™ version 11.1 was used for statistical analysis. Chi-square, I², and p values were assessed to check heterogeneity. A random effects model with heterogeneity taken from an inverse-variance model was employed to estimate the pooled effect. Subgroup meta-analysis was computed to reduce random variations among each article’s point prevalence, and Egger and funnel plots were used to check for publication bias.

Results

The highest proportion of human leishmaniasis was reported from a study done in Amhara region (39.1%), and the lowest was reported from a survey done in Tigray (2.3%). The overall pooled prevalence of leishmaniasis was 9.13% (95% CI 5–13.27). Subgroup analysis by region revealed moderate heterogeneity (I² = 51.8%) in studies conducted in the Southern Nations Nationalities and Peoples Region (SNNPR). The presence of hyraxes and being male were associated with an increased risk of human leishmaniasis.

Conclusion

The prevalence of leishmaniasis in Ethiopia remains high (9.13%), with significant risk factors being male and the presence of hyraxes within a 300-m radius of the sleeping area.

Knowledge, Attitudes, and Practices Towards COVID-19 Pandemic Among Quarantined Adults in Tigrai Region, Ethiopia

Background

With the onset of any novel condition, it is the “first” case identified that brings attention and sets into motion the machinery to respond – so it began with a first novel pneumonia case of unknown origin in Wuhan, China. Currently, the World Health Organization has declared SARS-CoV-2 (more commonly known as COVID-19) a public health emergency of international concern. It is projected that the path of COVID-19 could kill 50–80 million people and impacts the world’s economy in its devastating global sweep. The surge is increasing on global and national levels, causing rapid loss of life, joblessness, deterioration of the healthcare systems, and both national and global economies. In Ethiopia, the first COVID-19 case was reported in March. Since then, the government has been taking different measures to prevent its spread. Locking down all schools, declared social distancing and hand hygiene, and restricting large gatherings were some of the Ethiopian government’s actions.

Objective

To determine knowledge, attitudes, and practices towards COVID-19 pandemic among quarantined adults in Tigrai region, Ethiopia.

Methods

A total of 331 participants selected using a systematic random sampling method were included in the study. We used an interviewer-administered questionnaire. After describing the variables using frequencies, means, and standard deviations, multivariable logistic regression determined factors associated with knowledge and chi-squared tests for attitudes and practices towards COVID-19.

Results

The study participants were primarily males (70%) and mean age 30.5 (SD=11) years. The mean knowledge score was 8.73 (SD=2.64), with less than half 42.9% (95% CI: 37.5–48%) of the study participants were knowledgeable. Regarding the attitude questions, three-fourths of the participants believed that Ethiopia will control and win the battle against the COVID-19 pandemic. Nearly one-third of the participants replied that the Ethiopian government is handling this pandemic health crisis well. About half of the study participants reported that they had gone to crowded places in recent days, did not wear face mask when leaving home, and practiced preventive measures given by local health authorities. Knowledge score was statistically significantly associated with gender, age, and educational status of the study participants, whereas attitude and practices were significantly associated with educational status and knowledge of participants.

Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study

OBJECTIVE

To describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia.

DESIGN

A population-based cross-sectional study.

SETTING

Seven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia.

PARTICIPANTS

All histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents.

OUTCOME MEASURES

The proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model.

RESULTS

The mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51).

CONCLUSIONS

Our findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.

Factors associated with late-stage diagnosis of breast cancer among women in Addis Ababa, Ethiopia

PURPOSE

Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia.

METHODS

Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis.

RESULTS

The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors' grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31; p = 0.001), had patient delay of >  3 months (aPR = 1.16; p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24; p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77; p = 0.021).

CONCLUSIONS

Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.

Assessment of the Appropriateness of Ceftazidime Use in a Tertiary Teaching Hospital, Northern Ethiopia

Background

Ceftazidime is nowadays one of the most commonly used antibiotics due to its high antibacterial potency, wide spectrum of activity, and low potential for toxicity. However, the global trend shows huge misuse of ceftazidime.

Objective

This study was conducted to assess the appropriateness of ceftazidime use and to identify areas of intervention to prevent inappropriate use in different wards of Ayder Compressive Specialized Hospital, a tertiary teaching Hospital, Mekelle-Ethiopia.

Methods

A facility-based prospective cross-sectional study design was steered on 327 patients who received ceftazidime during their hospitalization in the selected wards from February 1 to April 30, 2019.

Results

In the assessment of the appropriateness of ceftazidime use, 2,084 (70.8%) were appropriate. Appropriateness of indication was 295 (90.2%), the effectiveness of ceftazidime use was 221 (67.6%), correct dose of ceftazidime use was 264 (80.4%), and the correct frequency of ceftazidime use was 230 (70.3%). Its use was empiric in 275 participants (84.1%) and specific in 52 (15.9%) participants. The most common indication for ceftazidime use was uncomplicated pneumonia, at 112 (34.3%). One hundred and seventy-one (52.3%) participants had intervention to prevent inappropriate use of ceftazidime. Changing the drug combination (96, 29.4%), increasing the dose (13, 4%), decreasing the dose (21, 6.4%), holding the (21, 6.4%), and discontinuation of ceftazidime (20, 6.1%) were among the interventions.

Conclusion

This study revealed that more than one-fourth of the ceftazidime use was inappropriate. This may lead to the emergence of resistant pathogens which in turn lead to treatment failure and increased the cost of therapy. Therefore, adherence to current evidence-based guidelines and initiating antimicrobial stewardship are recommended.

Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case-Control Study

BACKGROUND

Diabetic foot ulcer is among the commonest complications of diabetic mellitus attributed to a number of morbidity and mortality cases in diabetic patients. Nowadays, the incidence of diabetic foot ulcer is increasing due to the increased prevalence of diabetes. However, the risk factors of the problem are less studied in Ethiopia. Hence, this study was conducted to assess the determinants of diabetic foot ulcer among adult patients with diabetes attending a diabetic clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019.

PATIENTS AND METHODS

An institution-based unmatched case-control study was conducted on 161 patients with diabetes (53 patients with diabetes with foot ulcer and 108 patients with diabetes without foot ulcer). Cases were selected from patients with diabetes with foot ulcer by consecutive sampling technique and controls from patients with diabetes without diabetic foot ulcer by systematic random sampling technique. A binary logistic regression model was used to assess the association between the dependent and independent variables. All variables with a P-value<0.25 were included in the multivariable analysis. Statistical significance was declared at P-value<0.05 with 95% confidence interval.

RESULTS

In this study, 28 (52.8%) cases and 55 (50.9%) controls were male. Taking insulin alone (AOR=2.75, 95% CI=1.04-7.23), having peripheral neuropathy (AOR=7.56, 95% CI=2.82-20.24), not inspecting feet daily (AOR=5.61, 95% CI=2.24-14.05), and using moisturizing cream between toes (AOR=3.35, 95% CI=1.35-8.32) were positively associated with diabetic foot ulcer, whereas employed (AOR=0.35, 95% CI=0.14-0.87) and combined treatment (insulin and oral hypoglycemic agents) (AOR=0.11, 95% CI=0.02-0.57) were negatively associated with diabetic foot ulcer.

CONCLUSION

Diabetic foot ulcer was significantly associated with occupation, kind of treatment of diabetes mellitus taking, peripheral neuropathy, inspecting feet daily, and putting moisturizing cream between toes. It will be helpful if diabetic patients inspect their feet on a daily basis and do not put moisturizing cream between their toes.

Prevalence and associated factors of adolescent undernutrition in Ethiopia: a systematic review and meta-analysis

BACKGROUND

In Ethiopia, there are different pocket studies that assessed adolescent undernutrition which came up with inconsistent and inconclusive findings. Therefore, estimating the pooled prevalence and associated factors of the adolescent undernutrition using meta-analysis is crucial in Ethiopia.

METHODS

A systematic review of eligible articles was conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature was made in Pub Med, Scopus, Google, Google Scholar, Cochrane Library and CINAHL. The quality of the articles included in the review was assessed using the Newcastle-Ottawa Scale (NOS) for non-randomized studies in meta-analyses. The pooled prevalence and odds ratio of the associated factors with their 95% confidence interval was computed using STATA version 14 software.

RESULTS

Twenty-two studies were included in the meta-analysis with a total of 17,854 adolescents. Using the random-effects model analysis, the pooled prevalence of stunting and underweight was 20.7% (95% CI: 16.08, 25.33) and 27.5% (95% CI: 17.9, 57.14), respectively. Rural residence, having family size≥5, households with an unprotected water source for drinking and food-insecure household were significant associated factors for adolescent stunting. Early adolescent age (10-14 years), family size≥5, food-insecure household, lack of latrine, WHO diet diversity score < 4, mother educational status (with no formal education) were significant associated factors for adolescent underweight.

CONCLUSION

Adolescent undernutrition remains one of the most important public health problems in Ethiopia. Almost a quarter of Ethiopian adolescents were affected by stunting and underweight. Large family size, rural residence and unprotected source of drinking water were the associated factors for adolescent stunting. Similarly, large family size, early age of adolescent, lack of latrine, low dietary diversity score, mother illiteracy, and food insecure household were the associated factors for adolescent underweight. It would be good to give high emphasis on adolescent undernutrition and it is important to address the above mentioned associated factors during adolescent nutritional interventions in Ethiopia.

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.

DESIGN

This is a cross-sectional study.

SETTINGS AND PARTICIPANTS

All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.

MAIN OUTCOMES AND MEASURES

Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.

RESULTS

Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.

CONCLUSIONS

Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.

Quality of basic emergency obstetric and newborn care (BEmONC) services from patients' perspective in Adigrat town, Eastern zone of Tigray, Ethiopia. 2017: a cross sectional study

Background

Most of the maternal and newborn deaths occur at birth or within 24 h of birth. Provision of quality Basic Emergency Obstetric and Neonatal Care (BEmONC) is very crucial and the current recommended intervention to prevent maternal and newborn morbidity and mortality.

Methods

An institution based cross-sectional study was conducted among mothers receiving at least one of the signal functions of BEmONC services. A total of 398 women were included in the study. The study participants were selected using a systematic random sampling method. Data was collected using structured interviewer-administered Tigrigna version questionnaire. Data were analyzed using SPSS version 20. Multi-variable logistic regression was used to control the effect of confounders.

Results

The perceived quality of BEmONC was 66.7%, which is poor. Clients scored lower quality rates on aspects such as the availability of necessary equipment, lack of clean and functional shower and toilet and administration of anti-pain during delivery and manual vacuum aspiration (MVA). Quality of BEmONC was lower among rural residents (AOR = 0.273, 95% CI: (0.151–0.830). Whereas, Presence of companion (AOR = 2.259; 95% CI: (3.563–13.452) were found with a higher score of quality of BEmONC compared to their counterparts.

Conclusion

The overall perception of quality of BEmONC services received was poor. Residence, ANC follow-up, and presence of companion during labor or delivery were found to have a significant association with the perceived quality of BEmONC services.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2307-6) contains supplementary material, which is available to authorized users.

Breast and cervical cancer patients' experience in Addis Ababa city, Ethiopia: a follow-up study protocol

INTRODUCTION

Cancer is an emerging public health problem in Ethiopia, with breast and cervical cancers accounting for over half of all newly diagnosed cancers in women. The majority of women with breast and cervical cancer are diagnosed at late stage of the disease and most patients do not receive care consistent with global standards. However, little is known about the health-seeking behaviours, barriers to early detection and treatment, patient-reported outcomes, financial burden and survival of women with breast and cervical cancer in the country. Therefore, this study aims to document the experience of women with breast and cervical cancer from recognition of symptoms to diagnosis, treatment and survivorship/mortality in Addis Ababa city, Ethiopia.

METHODS AND ANALYSIS

A prospective follow-up study using mixed methods (both quantitative and qualitative) will be employed. All women newly diagnosed with breast and cervical cancer from 1 January, 2017 to 30 June 2018 in Addis Ababa will be included in the study. Interviewer-administered questionnaires will be used to collect information about medical consultations after recognition of symptoms, health-seeking behaviours, treatment received, barriers to early detection and treatment, and survivorship care. In-depth interview will be conducted on purposefully selected women with breast and cervical cancer. The primary outcomes of the study are time intervals (patient and diagnostic waiting times), stage at diagnosis and survival. Multivariable analysis will be employed to determine the contributions of independent variables on the outcomes of interest. HRs with 95% CIs will be calculated for time-to-event outcomes. Qualitative data will be analysed using thematic analysis.

ETHICS AND DISSEMINATION

This protocol is ethically approved by Institutional Review Board of Addis Ababa University. Verbal informed consent will be obtained from study participants. Results will be disseminated in international peer-reviewed journals and presented in relevant conferences.

Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia

OBJECTIVE

Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients' interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0.

RESULTS

Participants' mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required.

Application of the rapid ethical assessment approach to enhance the ethical conduct of longitudinal population based female cancer research in an urban setting in Ethiopia

Background

Rapid Ethical Assessment (REA) is an approach used to design context tailored consent process for voluntary participation of participants in research including human subjects. There is, however, limited evidence on the design of ethical assessment in studies targeting cancer patients in Ethiopia. REA was conducted to explore factors that influence the informed consent process among female cancer patients recruited for longitudinal research from Addis Ababa Population-based Cancer Registry.

Methods

Qualitative study employing rapid ethnographic approach was conducted from May–July, 2017, at the Tikur Anbessa Specialized Referral Hospital. In-depth and key informants’ interviews were conducted among purposively selected 16 participants. Regular de-briefings among the study team helped to identify emerging themes and ensure saturation. Interviews and debriefings were tape recorded in Amharic, and transcribed and translated to English. Coding of the transcripts was facilitated by use of NVivo software. Thematic analysis was employed to respond to the initial questions and interpret findings.

Results

Perceived barriers to voluntary study participation included lack of reporting back study results of previous studies, the decision making status of women, hopelessness or fatigue in the patients, shyness of the women, data collectors approach to the patient, and patient’s time constraints. Most of the patients preferred oral over written consent and face-to-face interview over telephone interview. Provision of detail information about the study, using short and understandable tool, competent, compassionate and respectful enumerators of the same gender were suggested to assure participation. Due to the perceived severity, the use of the term “cancer” was associated with fear and anxiety. Alternatively, uses of phrases like “breast or cervical illness/disease” were suggested during patient interviews.

Conclusions

Voluntary participation is not straight forward but affected by different factors. Using competent, compassionate and respectful enumerators, short and precise questioning tools to limit the time of the interview could improve voluntary participation. Moreover, careful consideration of the patients and families concept of the disease such as wording and information has to be taken into account. This assessment helped in improving the consent process of the ongoing project on breast and cervical cancer patients.

Contraceptive use among lactating women in Ganta-Afeshum District, Eastern Tigray, Northern Ethiopia, 2015: a cross sectional study

Background

Women who are not exclusively breastfeeding are at risk of pregnancy after four to six weeks of childbirth. Postpartum contraceptive use is crucial to prevent unintended pregnancy, and to have spaced births. The study was conducted to determine the magnitude of modern contraceptive utilization and factors associated with it among lactating women in Ganta-Afeshum district.

Methods

A community based cross sectional study was conducted among lactating women with children in the age group of six to twelve months. A total of 605 women were included in the study. The study participants were selected using cluster sampling method. Data were collected using structured interviewer administered Tigrigna version questionnaire. Data were analyzed using SPSS version 21. Multivariable logistic regression was used to control the effect of confounders.

Results

The magnitude of institutional delivery was 96.5%. The mode of delivery of the participants was spontaneous, instrumental and caesarean section, 95.5%, 2.0%, and 2.5%, respectively. The magnitude of modern contraceptive (MC) utilization was 68.1% (95% CI: 64.4–71.8). The contraceptive method mix was dominated by Depo-Provera (58.8%) followed by implants (31.8%). Almost all the study participants had at least one antenatal care (ANC) visit (99.7%) during the pregnancy of their index child. Participants who had radio and those who delivered their recent child by assisted delivery had higher odds of modern contraceptive use.

Conclusions

The magnitude of contraceptive utilization among lactating mothers in the study area was higher than the national survey reports. However, significant numbers of women are not using contraceptives in their postpartum period, making them at risk of pregnancy. Mode of delivery of the women and having radio at home were significantly associated with the women’s contraceptive utilization. Family planning information dissemination using radio in rural settings should be encouraged to increase the uptake of contraceptives in the lactating women.

Attitude, reporting behavour and management practice of occupational needle stick and sharps injuries among hospital healthcare workers in Bale zone, Southeast Ethiopia: a cross-sectional study

Background

Although the prevalence of blood borne pathogens in many developing countries is high, documentation of infections due to occupational exposure is limited. Seventy percent of the world’s HIV infected population lives in Sub-Saharan Africa, but only 4 % of cases are reported from this region. Under reporting of needle stick and/or sharps injuries in healthcare facilities was common.

Methods

An institutional based cross-sectional study was conducted in December 2014 among healthcare workers in four hospitals of Bale zone, Southeast Ethiopia. A total of 362 healthcare workers were selected randomly from each of the working departments. Data were collected using self-administered questionnaire and were entered using Epi-Info version 3.5 and analysed using SPSS version 20.0. Multivariable logistic regression analysis was used to identify independent effect of each variable on the reporting behaviour of needle stick and/or sharp injury.

Results

Nearly six out of ten injuries (58.7 %) were not reported to the concerned body. The main reasons for not reporting the injuries were time constraint (35.1 %), sharps which caused injury were not used on any patient (27.0 %), the source patients did not have disease of concern (20.3 %), and lack of knowledge that it should be reported (14.9 %). Half of healthcare workers (HCWs) those who experienced injury had sought medical care next to self based action. Respondents with monthly salary of 450 to 1000 Ethiopian Birr (1 US Dollar = 22.00 Ethiopian Birr) were about six times more likely to report occupational needle stick and/or sharps injury (NSSI) than HCWs with salary of 2001 to 8379 birr (AOR = 5.73). However, HCWs who had no knowledge about probability of infection transmission through NSSI and not taking any self based measures after occurrence of injury were 45 % (AOR = 0.55) and 93 % (AOR = 0.07) less likely to report occupational injury than their counterparts, respectively.

Conclusions

Occupational needle stick and/or sharps injuries are common among HCWs at the study area. Even though majority of respondents were concerned about the risk of NSSI exposure, most respondents did not report it to the concerned body. Therefore, provision of on job training on the risk of occupational NSSI exposure may strengthen HCWs to practice timely reporting and its management in case of occupational injury exposure.

A national survey of parent perspectives on use of patient portals for their children's health care

OBJECTIVES

To assess parents' current utilization and future willingness to use patient portals to interact with their child's health care provider.

METHODS

A cross-sectional survey of a nationally representative sample of US parents was conducted using an established online panel. Bivariate analyses assessed associations between current utilization and future willingness to use patient portals, parental concerns, and demographic variables.

RESULTS

Among the 1,420 parent respondents, 40% did not know whether their child's health practice offers the option of setting up a patient portal for their child. Of the 21% of parents who reported being offered the option of setting up a patient portal for their child, 59% had done so. Among parents who had the option but chose not to set up a patient portal for their child, lack of time and low perceived need were the main reasons cited. Current use and likelihood of future use was highest for viewing lab results and immunization records. The most common concern about patient portals was the security of the child portal system.

CONCLUSIONS

Current use of patient portals by parents is low. Only about half of parents currently using or likely to use a portal perceive value in using portals for certain tasks, which suggests that providers will need to continue traditional communication mechanisms to reach their entire patient population.

Knowledge and perception on long acting and permanent contraceptive methods in adigrat town, tigray, northern ethiopia: a qualitative study

Background. Long acting and permanent contraceptive methods have the potential to reduce unintended pregnancies but the contraceptive choice and utilization in Ethiopia are highly dominated by short term contraceptives. Objective. To assess the knowledge and perception on long acting and permanent contraceptives of married women and men in Northern Ethiopia. Method. A qualitative method was conducted in Adigrat on January, 2012. Four focus group discussions with married women and men and six in-depth interviews with family planning providers were conducted. Content analysis was used to synthesize the data. Result. Participants' knowledge on long acting and permanent contraceptives is limited to recognizing the name of the methods. Most of the participants are not able to identify permanent methods as a method of contraception. They lack basic information on how these methods work and how they can use it. Women had fears and rumors about each of these methods. They prefer methods which do not require any procedure. Family planning providers stated as they have weakness on counseling of all contraceptive choices. Conclusion. There are personal barriers and knowledge gaps on these contraceptive methods. Improving the counseling service program can help women to increase knowledge and avoid misconceptions of each contraceptive choice.

Intention to use long acting and permanent contraceptive methods and factors affecting it among married women in Adigrat town, Tigray, Northern Ethiopia

Background

Despite the increase in contraceptive use worldwide over the last decade, there is still discrepancy in the need to limit birth and utilization of modern contraceptives specifically long acting and permanent contraceptive methods in sub-Saharan Africa including Ethiopia. Intention to use long acting and permanent methods of contraception is an important indicator of the potential demand for family planning services.

Objective

To assess intention to use long acting and permanent contraceptive methods (LAPMs) and identifying associated factors among currently married women in Adigrat town.

Methods

A community based cross sectional study design complemented with a qualitative method was conducted in three selected Kebeles of Adigrat town. A total of 594 study subjects were interviewed. Systematic random sampling method was used to select study subjects. Quantitative data were analyzed using SPSS version 16. Open code software version 3.6.2.0 was used to facilitate coding of the qualitative data. Factors associated with intention were identified using logistic regression model and content analysis was done on the qualitative data.

Results

Intention to use LAPMs was 48.4%. Intention to use LAPMs was higher among women who knew at least one of LAPMs (AOR = 4.7, 95% CI = 1.58, 14.01) and women who do not want to have birth within the next 2 years (AOR = 1.9, 95% CI = 1.22, 3.13). Intention to use LAMPs was less among women who perceive poor support from their husbands (AOR = 0.2, 95% CI = 0.09, 0.45) and those who perceive LAPMs are harmful for the womb (AOR = 0.24, 95% CI = 0.14, 0.41). Similarly, participants in the focus group discussion have expressed their concern on the return of fertility after using implants or IUCD as well as insertion and removal procedures.

Conclusions

The magnitude of intention to use LAPMs in the study area was low. The main limiting factors were fear of side effect, infertility after LAPMs use, knowledge on LAPMs and perception on partner’s support of LAPMs use. To further promote the use of LAPMs addressing associated misconceptions through effective communication strategies and involving spouses in family planning programs is essential.

Getting heavier, younger: trajectories of obesity over the life course

Context

Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes.

Objective

Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race.

Design, Setting, and Participants

We conducted an age, period, and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (1971-2006).

Main Outcome Measures

Obesity was defined as a body mass index ≥ 95th percentile for individuals aged 2-16 years or ≥ 30 kg/m2 among individuals older than 16 years. Age was represented by the age of the individual at each NHANES survey, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period.

Results

Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, whereas the 1966-75 and 1976-85 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20-29 years of age, this level was only reached by 30-39 years for the 1946-55 and 1956-65 birth cohorts, by 40-49 years for the 1936-45 birth cohort, and by 50-59 years of age for the 1926-35 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts.

Conclusions

The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

Polio outbreak response in Ethiopia

BACKGROUND

Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission.

OBJECTIVES

This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission.

DESIGN

A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment.

SUBJECTS

All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation.

RESULTS

Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case.

CONCLUSION

Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a one-year period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security.

Factors predisposing to low birth weight in Jimma Hospital south western Ethiopia

BACKGROUND

Low birth weight continues to remain a major public health problem in Ethiopia in contrast to what is observed in many developing countries.

OBJECTIVES

To assess some of the predisposing factors to low birth weight among deliveries in Jimma hospital.

DESIGN

Cross-sectional case referent study.

SETTING

Maternal and child health clinic and maternity ward of Jimma University Hospital, Ethiopia.

SUBJECTS

One hundred and forty seven mothers who gave birth to low birth weight (LBW) babies between June 1999 and July 2000 were identified.

MAIN OUTCOME MEASURES

Normal and low birth weight.

RESULTS

The incidence of LBW was found to be 11.02%. Mothers younger than 20 years and > or =35 years, short stature (< or =150 cm), late first antenatal visit and complications during pregnancy were significantly associated with LBW (p<0.001). However, parity showed a negative association with LBW.

CONCLUSION

Attention to nutritional education, early antenatal care interventions and strengthening of maternal and child health assists in combating LBW in the area.

Effectiveness of abdominal compression during helical renal CT

RATIONALE AND OBJECTIVES

The authors performed this study to assess the effect of abdominal compression on opacification and distention of the proximal renal collecting system during helical computed tomography (CT).

MATERIALS AND METHODS

Abdominal compression was applied during helical CT in 31 patients who were scanned 150 and 300 seconds after initiating a dynamic bolus injection of contrast material. Two reviewers assessed renal collecting system opacification and measured the maximal short-axis diameter of the collecting system at three locations: the upper pole, the lower pole, and the proximal ureter. A similar evaluation was performed in a control group of 29 patients who underwent CT without compression at 300 seconds after initiating the injection of contrast material.

RESULTS

Both reviewers noted collecting system opacification at all locations in 52 of 56 noncompressed collecting systems scanned at 300 seconds, 57 of 59 compressed collecting systems scanned at 300 seconds, but only 26 of 59 compressed collecting systems scanned at 150 seconds. Measured collecting system distention was statistically significantly greater at 300 seconds in patents who received compression than in patients who did not (P = .0013). For patients who received compression, measured collecting system distention was statistically significantly greater on scans obtained at 300 seconds than on scans obtained at 150 seconds (P = .0001).

CONCLUSION

Abdominal compression during renal helical CT produces a detectable increase in renal collecting system distention. In patients who receive compression, scanning at 300 seconds rather than at 150 seconds results in greater collecting system distention and more consistent opacification.

Multi--detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma

PURPOSE

To determine the optimal phase for enhancement of the normal pancreas and peripancreatic vasculature and the maximal tumor-to-pancreatic parenchymal enhancement difference by using multiphase, contrast material-enhanced, multi-detector row helical computed tomography (CT).

MATERIALS AND METHODS

Forty-nine patients with a normal-appearing pancreas but suspected of having pancreatic abnormality and 28 patients with proved pancreatic adenocarcinoma underwent multiphase, contrast-enhanced, multi-detector row CT during the arterial phase (AP), pancreatic parenchymal phase (PPP), and portal venous phase (PVP). Attenuation values of the normal pancreas, pancreatic adenocarcinoma, celiac and superior mesenteric arteries, and superior mesenteric and portal veins were measured during all three imaging phases. Quantitative analysis of these measurements and subjective qualitative analysis of tumor conspicuity were performed.

RESULTS

Maximal enhancement of the normal pancreatic parenchyma occurred during the PPP. Maximal tumor-to-parenchyma attenuation differences during the PPP and PVP were equivalent but greater than that during the AP. Subjective analysis revealed that tumor conspicuity during the PPP and PVP was equivalent but superior to that during the AP. Maximal arterial enhancement was seen during the PPP, and maximal venous enhancement was seen during the PVP.

CONCLUSION

A combination of PPP and PVP imaging is sufficient for detection of pancreatic adenocarcinoma, because it provides maximal pancreatic parenchymal and peripancreatic vascular enhancement. AP imaging can be reserved for patients in whom CT angiography is required.

Evaluation of competence in the interpretation of chest radiographs

RATIONALE AND OBJECTIVES

The purpose of this study was to determine relative rates of missed diagnoses for radiologists as a measure of competence in interpreting chest radiographs.

MATERIALS AND METHODS

Cases involving differing interpretations of chest radiographs were collected from January 1994 through December 1999 by faculty (chest and nonchest radiology specialists) in an academic radiology department. A quarterly peer-review process designated cases months after the fact, and anonymously, as no miss or as class I (nondiagnosable), class II (very difficult diagnosis), class III (should be diagnosed most of time), or class IV (should almost always be diagnosed) missed diagnoses. The rates and classes of missed diagnoses were compared among chest faculty and for the nonchest radiology specialists as a group.

RESULTS

Chest radiologists read 184,977 studies, and nonchest radiologists read 300,684 studies. Of these, 243 missed diagnoses were classified (classes I and II, 184 cases; class III, 50; and class IV, nine). No difference was detected in the rate of class III and IV misses among chest faculty, but nonchest faculty had significantly more class III (P = .022) and class IV misses (P = .016).

CONCLUSION

Random sampling of differing interpretations can yield a relative rate of missed diagnoses for radiologists. No difference was detected in clinically important misses (ie, classes III and IV) among chest radiologists, but a statistically significantly higher rate of seemingly obvious misdiagnoses was found for nonchest specialty radiologists. Potential biases may have influenced this analysis, including disease prevalence, sampling, clinical factors, observer variability, and truth-in-diagnosis.

Sydenham's chorea: risk factors and the role of prophylactic benzathine penicillin G in preventing recurrence

To determine the effect of prophylactic long-acting penicillin G in preventing recurrence of Sydenham's chorea and to discover the risk factors associated with occurrence of symptoms, 18 children with symptoms over a 5-year period were prospectively identified. Of these, ten were boys and eight were girls. The majority occurred between the ages of 8 and 10 years [mean (SD) 9.10 (2.62) years]. Sydenham's chorea was generalized in 14 children and one-sided in four. There was no difference in the incidence of right- and left-sided hemichorea. Among the risk factors examined, only a history of chorea in relatives had a significant association with the occurrence of Sydenham's chorea (OR = 6.39; 95% CI 1.30-31.3). A comparison of recurrence between those given prophylactic long-acting penicillin G and those who had none showed a statistically significant difference in the recurrence experience between the two groups (p < 0.02).

Discontinuing anti-epileptic medication(s) in epileptic children: 18 versus 24 months

For a period of slightly over 4 years, 80 children who had been seizure-free for at least 18 months while on anti-convulsant medication were prospectively collected. These 80 children were randomly assigned to either the 18-months seizure-free group (n = 41) or to the group where anti-convulsant medications were continued for another 6 months before they were gradually tapered off and stopped, i.e. the 24-months seizure-free group (n = 39). Twelve (29%) of the 41 children who had been seizure-free for 18 months and 14 (36%) of the 39 children who had been seizure-free for 24 months had seizure recurrence during the follow-up period. Log-rank test of the recurrence experience of the two groups of patients showed no statistically significant difference between the groups (p > 0.50). Similarly, when both groups were combined and other risk variables likely to influence the rate of seizure recurrence were tested, only EEG abnormality at discontinuation of anti-convulsant medication had a significant association with the risk of seizure recurrence (p < 0.001).

Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors

To identify the risk factors associated with subgaleal haemorrhage and to assess the long-term neurological and developmental morbidity in survivors, data were prospectively collected over 5 years on 69 newborns with subgaleal haemorrhage from a cohort of 23,353 live and term deliveries, giving an incidence of subgaleal haemorrhage of 3.0 per 1000 live and term births. Multivariate analysis of risk factors associated with subgaleal haemorrhage on univariate analysis showed that prolonged second stage of labour (OR = 9.02; 95% CI 6.15-17.51), fetal distress (OR = 5.05; 95% CI 2.67-11.12), vacuum delivery (OR = 7.17; 95% CI 5.43-10.25), forceps delivery (OR = 2.66; 95% CI 1.78-5.18), and birthweight (OR = 2.20; 95% CI 1.54-6.56) significantly influenced the occurrence of subgaleal haemorrhage. When the effects of prolonged second stage of labour, fetal distress, birthweight and gestational age were controlled for, the odds of harbouring subgaleal bleed following vacuum delivery were, respectively, OR = 7.80 (95% CI 5.45-11.61), OR = 6.15 (95% CI 3.71-10.84), OR = 5.01 (95% CI 2.78-9.63) and OR = 7.65 (95% CI 4.73-16.65). Among the 69 newborns with subgaleal haemorrhage, ten (14%) died and twelve (20%) of the 59 survivors were lost to follow-up. Of the remaining 47 survivors, three (6%) died during follow-up of diseases unrelated to the bleed, leaving 44 survivors, none of whom had either neurological deficit or developmental delay. The study concludes that subgaleal haemorrhage in neonates is the result of birth trauma associated with difficult instrumental delivery. Newborns with subgaleal haemorrhage who survive the acute episode of the bleed show no evidence of subsequent long-term neurological deficit or developmental delay.

Neonatal meningitis in Addis Ababa: a 10-year review

In a hospital population-based retrospective study of neonatal meningitis, 55 cases were identified over a period of 10 years. The prevalences of meningitis for preterm and term newborns were 3.66 and 0.97 per 1000, respectively (22/6465 vs 33/36638; p < 0.01). The overall prevalence was 1.37 per 1000 live births. Twenty-two (40%) babies with meningitis died, more preterm than term (13/22 vs 9/33; p < 0.05). Known maternal risk factors for neonatal meningitis were observed in 15 (27%) babies. The risk factors were more common in preterm than in term newborns (10/22 vs 5/33; p < 0.05). The common causative organisms were Klebsiella pneumoniae, Escherichia coli and Enterobacter spp. which together accounted for 67% of all CSF isolates. These organisms were evenly distributed between early- and late-onset meningitis, and among term and preterm newborns. Seven of 33 (21%) of the surviving newborns developed neurological complications. The short-term sequelae were hydrocephalus, spastic paresis and seizures.

Predictors of mortality in childhood neurotuberculosis: a retrospective study of 84 cases

In our institute neurotuberculosis now forms (0.6%) of an average of 2000 total admission per year. Our mortality rate was 38%. Young age patients who present themselves late and delay in the initiation of anti-tuberculous therapy correlated significantly with poor outcome.

Migrane in childhood and adolescence in Ethiopia

Thirty children and adolescents with migrane were reviewed. The male to female ratio was 1.7:1.0. Migrane was more common in males below the age of 10 years and in the females above the age of 12 years. Classical migrane occurred in equal numbers in both males and females. Common migrane was more common in males. The other forms of migrane were pretty rare. There was a high incidence of migrane in parents of patients with classical and complicated migrane.

Subacute sclerosing panencephalitis (SSPE) in an adolescent Ethiopian girl

Some 50 years have elapsed since Dawson first described a 16-year-old girl with an inclusion encephalitis. Since then, numerous publications on subacute sclerosing panencephalitis (SSPE) have appeared in the world literature. However, most of these reports are from the developed world. There have been few reports from Africa. One of them was from Kenya, where a retrospective analysis of EEGs of patients with epilepsy over a 5-year period identified 53 probable cases of subacute sclerosing panencephalitis (1). The other one was from South Africa where an incidence of 1.2 per million per year was reported on the basis of 15 cases collected from two hospitals in the Cape Province (2). No case, as yet, has been reported from Ethiopia. This paper reports SSPE presenting in an adolescent Ethiopian girl who had measles at the age of 18 months.