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MAGNITUDE AND ASSOCIATED FACTORS OF COMMON CHILDHOOD ILLNESS AMONG UNDER FIVE CHILDREN IN ENDAMOHONI DISTRICT, TIGRAY, ETHIOPIA. COMMUNITY BASED CROSS - SECTIONAL STUDY 2023/24.
(Mekelle University, 2024-05-28) HINTSA GEBREMEDHIN
Background: Common childhood illness includes acute respiratory infections, diarrheal diseases, and febrile illnesses. Thus illnesses remain a significant cause of morbidity and mortality among children under five children in developing country. Thus identification of associated factors of childhood illness would help to guide strategic planning and prioritize interventions. Objectives: To assess the magnitude and associated factors of common childhood illness among under five children in Endamohoni district, Tigray, Ethiopia. 2024. Methods: A community based cross sectional study design was employed. The study population were all children aged below 59 months and residents in the randomly selected Kebeles of Endamohoni District. A total of 552 study participants were selected using systematic random sampling technique and the sample size was determined using single and double proportion formula. Interviewer administered structured questionnaire was used to collect data. The data was entered in to Epi-data 4.4.2.1 and exported to SPSS version 25 for analysis. Binary Logistic regression analysis was used to assess the influence of independent variables to the outcome variable. Variables with p-value of ≤ 0.25 in the bivariate analysis were transferred to multivariable analysis. In the multivariable analysis, variables with P-value of P < 0.05 were considered statistically significant. Hosmer and Lemeshow was used to indicate goodness of fit. Result: One hundred eighty seven 33.9% (95% CI:30.0%-38.4%) under five children had common childhood illness. according to specific symptoms presence of cough ,diarrhea and fever were 15.2 % ( 95% CI:12.1%-18.3%) ,13 % ( 95% CI:10.1%-15.8%) and 12.3 % ( 95% CI:9.6%-15.4%). the factors affecting common childhood illness were place of residence (AOR= 2.3 (95% CI: (1.15, 4.59)), mother met minimum meal frequency while she was pregnant or lactating (AOR= 1.6 (95% CI: (1.05, 2.54)) and hand washing at critical times by family members (AOR= 4.00 (95% CI: (2.19, 7.56)). Conclusion and recommendation:. The findings of this study shows a concerning prevalence of common childhood illness ,affecting 33.9% of children in the surveyed population. in our community.by fostering better dietary practices and hygiene education ,we can create a healthier future for our children.
MAGNITUDE AND DETERMINANTS OF LOW BIRTH WEIGHT AMONG NEWBORN BABIES IN PUBLIC HOSPITALS OF MEKELLE CITY, TIGRAY REGION, ETHIOPIA, 2024
(Mekelle University, 2024-06-28) DESTA FITSUM
Background: Low birth weight is a serious global public health issue which is associated with increased risks of neonatal morbidity, mortality, and later health complications. Low birth weight is present in over 20 million neonates annually, and the vast majority live in low and middle-income countries, particularly in Sub-Saharan Africa. In Ethiopia, the prevalence of Low birth weight is strongly heterogeneous by place, and the prevalence has been between 7.8% and 40%. It has remained a challenge despite global efforts through comprehensive maternal and newborn care. This study addresses the persistent challenge of low birth weight in Ethiopia by identifying context specific risk factors, offering critical evidence to guide targeted interventions and reduce neonatal morbidity and mortality in high burden, resource limited settings. Objective: The objective of this study was to assess the magnitude and determinant factors of low birth weight among newborn babies in public hospitals in Mekelle City, Tigray, Ethiopia, in 2024. Methods: An institutional-based cross-sectional study was conducted. A total sample size of 383 was determined by using Epi Info version 7.2. Participants were selected using systematic random sampling. Data were collected using a semi-structured interviewer-administered questionnaire, that was pre-tested on 5% of the total sample outside the study area to ensure clarity, consistency. The collected data were entered into Epi Info version 7.2, then exported to SPSS version 27 for analysis. Both bivariate and multivariable logistic regression analyses were conducted and variables with a p-value less than 0.2 in the bivariate analysis were entered into the multivariable model. Adjusted odds ratios with 95% confidence intervals were calculated to assess the strength of associations, and statistical significance was determined at a p-value less than 0.05. Ethical clearance was obtained from the Institutional Review Board (IRB) of Mekelle University, and informed consent was secured from all participants. Result: The prevalence of low birth weight is 13.1%. Rural residence (AOR=4.17, 95% CI: 1.19, 14.52), short birth intervals (AOR=5.3, 95% CI: 1.73, 16.17), ANC attendance <4 visits (AOR=5.28, 95% CI: 1.68, 16.53), maternal anemia (AOR=9.31, 95% CI: 2.59, 33.42) and preterm birth (AOR=4.39, 95% CI: 1.38,13.97) significantly associated with LBW. Conclusion and recommendation: Maternal age, rural residence, short birth interval, inadequate ANC follow-up and maternal anemia were significantly associated with low birth weight. Efforts should be made to identify women with high odds of low birth weight.
OUTCOMES OF EMERGENCY ADMISSIONS AND ASSOCIATED FACTORS AMONG CHILDREN ADMITTED TO THE PEDIATRIC EMERGENCY UNIT OF PUBLIC HOSPITALS IN MEKELLE, ETHIOPIA, 2024.
(Mekelle University, 2024-07-28) GIRMAY HALEFOM
Background: Globally, approximately 5.2 million children under five die each year, with a significant proportion of these deaths occurring in hospitals following emergency admissions, underscoring persistent inequities despite declining mortality rates. In Ethiopia, the under-5 mortality rate stands at 55 per 1,000 live births, with emergency admissions accounting for 39% of pediatric hospitalizations. Despite global efforts, gaps remain in understanding the outcomes and factors influencing pediatric emergency admissions, particularly in low-resource settings. This study aims to assess the outcomes and associated factors of emergency admissions among children in selected public hospitals. Objective: The aim of the study was to assess the outcomes of emergency admissions and associated factors among children admitted to the pediatric emergency unit of public hospitals In Mekelle, Ethiopia, 2024. Methods: A health facility-based retrospective cross-sectional study was conducted in randomly selected three public hospitals located in Mekelle, Ethiopia. The total sample size was 294, which was proportionally allocated across the hospitals based on their estimated monthly case admissions. Medical records from each hospital were selected using a simple random sampling method. A pretest was carried out on 5% of the sample size at Kuiha General Hospital. In the bivariate analysis, variables with a p-value < 0.2 were considered candidates for multivariable logistic regression analysis, with statistical significance set at a p-value of < 0.05. Result: Out of 294 children admitted to the pediatric emergency department, 45.2% showed clinical improvement, 25.9% required ICU transfer, 18.7% were moved to general wards, and 6.8% died. Multivariable logistic regression revealed that previous hospital visit (AOR = 3.7, 95% CI: 1.17, 11.64), previous admission (AOR = 6.37, 95% CI: 2.09, 19.45), children with comorbidities (AOR = 6.71, 95% CI: 2.32, 19.37) and malnourished children (AOR = 4.8, 95% CI: 1.23, 18.8) had significantly higher odds of death. Conclusion and recommendation: The mortality rate is high with previous hospital visit, previous admission, the presence of comorbidities and being malnourished were found to be strong predictors of poor outcomes, underscoring the need for early identification and targeted care for high-risk pediatric patients. Health facilities should enhance follow-up for previously hospitalized children and implement routine comorbidity screening.
CLINICAL PROFILE, TREATMENT AND OUT COME PATTERN OF INFLAMATORY BOWEL DISEASE OF PATIENTS VISITING GASTRONTESTINAL CLINIC OF AYDER COMPREHENSIVE SPECIALLIZED HOSPITAL AND HIWOT SPECIALITY CLINIC FROM 2019 -2024.
(Mekelle University, 2024-09-01) Beriha Belay
BACKGROUND: inflammatory bowel disease (IBD) denotes a group of disorders Crohn’s disease (cd), ulcerative colitis (uc), and other forms known as indeterminate colitis (ic). These are characterized by chronic intestinal inflammation. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. Though there were sufficient data gathered worldwide on IBD and a few more in the continent of Africa, to date there is scarcity reports from Ethiopia at a nationwide or hospital levels about the clinical profile and treatment pattern of IBD. OBJECTIVE: The purpose of this study is to describe the socio-demographic features, clinical characteristics and treatment pattern of inflammatory bowel disease in patients seen in GI clinic at ASCH and Hiwot specialty clinic 2019_2024, Mekelle, Tigray, Ethiopia. METHODS: A five-year retrospective cross sectional descriptive study was conducted to describe the socio-demographic features, clinical characteristics and treatment pattern of IBD in patients attending the GI clinic, at ASCH and Hiwot specialty clinic. RESULT; A total of 114 patients with IBD, 54 from ACSH and 70 from the private clinic were included in this study. Ulcerative colitis patients 74(64.9) were slightly higher than CD patients 40(35.1%). The mean age of patients was 39.48 ± 16.37(range 18-85) and the mean age at diagnosis was 35.8± 16.7(range 14-80) and there was no significant difference between the two groups. Majority, 43(58.1%) of UC and 26(65.0%) of CD patients were on the 18-40 age category and there was no significant difference between UC and CD, (P=0.795) CONCLUSION; Ulcerative colitis was more common than CD with a ratio of 1.85:1, and the mean age at diagnosis was in the mid-thirties for both groups. Both of these disease entities were slightly common in males, M:F ratio 1.19:1. Most of patients, (53.8%) with IBD presented within 6-12 months after symptom onset, yet medically responsive. Left-side colitis in UC and ileacolon involvement in CD are the predominant disease phenotypes. The major hindering factor in caring for these patients remains the availability of major drugs, biologics among others.
Availability, price, and affordability of anti-cancer medicines in children in Mekelle, Tigray, Ethiopia
(Mekelle University, 2024-09-01) Teklebirhan Hailu
Background: Childhood cancer is a significant public health concern, particularly in low and middle-income countries (LMICs). Access to effective anti-cancer medicines is crucial for improving survival rates and quality of life. There is a lack of data on the availability and pricing of anti-cancer medicines for children in LMICs, including Ethiopia. This study aims to evaluate the availability, price, and affordability of anti-cancer medications for children in Mekelle, Tigray, Ethiopia. Methods: The study was cross-sectional using a modified form of the World Health Organization and Health Action international methodology of measuring medicine price, availability, and affordability of childhood anti-cancer drugs in purposeful Ayder Comprehensive Specialized Hospital, purposefully selected 7 private pharmacies, and a RedCross pharmacy found in Mekelle, Tigray, Ethiopia, from April to September 2024. The study includes 24 cytotoxic medications listed in the WHO essential medication list for children and was collected in the form of lowest-priced generics and originator brands from the health sectors found in Mekelle. The data were entered and analyzed using WHO/HAI data entry in a in a Microsoft Excel (V 15.0)-customized program to enter and analyze the data collected and analysis form. Result: The overall availability of anti-cancer medication in all sectors was found to be low (38.45%). The availability of LPGs was 41.7% and 37.49% in the public and private sectors, respectively. Anti-cancer medications were totally unavailable at Red Cross Pharmacy. The median MPR of LPG for the public sector and private sector was 1.293 and 2.8925, respectively. The prices of cytotoxic medications available in the private sector were higher than in the public. All anti-cancer medicines for the treatment of the most common cancers in Mekelle were unaffordable. Conclusion: Medicines for cancer treatment are unavailable, and the few available medicines are unaffordable in Mekelle. Based on this, we recommend subsidies for essential childhood cancer medicines and importation of cancer medicines by the government. Improvement in price transparency, health insurance schemes for childhood cancers to be affordable
MAGNITUDE AND ASSOCIATED FACTORS OF POST TUBERCULOSIS COMPLICATIONS AMONG PATIENTS ATTENDING IN CHEST CLINIC AT AYDER COMPREHENSIVE SPECIALIZED HOSPITAL.
(Mekelle University, 2024-09-01) MERHAWI GEBRIHANS
Background: Pulmonary tuberculosis remains an important public health problem globally and one of most common infectious disease. A past history of pulmonary tuberculosis (TB) is a risk factor for longterm respiratory impairment. Post-TB lung dysfunction often goes unrecognized, despite its relatively high prevalence and its association with reduced quality of life. There is no data on the prevalence and associated factors of post tuberculosis complications in Ethiopia, particularly Tigray region. Objective: To determine the magnitude and associated factors of post tuberculosis complications among patients attending chest clinic at Ayder Comprehensive Specialized Hospital. Method: This was a retrospective, cross-sectional analysis of patients registered in a clinical database, charts and log book at the chest clinic of Ayder Comprehensive Specialized Hospital from September, 2022 –September, 2024 GC. The data was collected from the charts and smart care using prepared form. Analysis was made on SPSS 27 software. Descriptive statistics, frequency and proportions were utilized for Socio-demographic and clinical variables and bivariate and multivariate analyses were done to explore association between the dependent and independent variables. Results: a total of 367 TB treated patients were reviewed at the chest clinic of Ayder Comprehensive Specialized Hospital. Among these patients, 41.4 %( 152) had a diagnosis of post TB complications/ sequelae by imaging (chest CT and/ or chest x-ray), which was commented on by radiologist and pulmonologist. Statistical analysis indicated that older age(AOR: 4.401, 95% CI: 2.193-8.832, p =0.000), rural residency(AOR: 2.290, 95% CI: 1.424-3.681, P =0.001), smoking history(AOR=3.509, 95% CI: 1.810- 6.803, p-value=.000)and prolonged duration of TB illness (AOR:2.00,95% CI: 1.260-3.175, P= 0.003) were significantly associated with higher risk of post TB complications. Conclusion and recommendation: This study shows high-rate post TB complications/sequelae. Older age, rural residency, smoking and prolonged duration of tuberculosis illness significantly increase the riskx of developing these sequelae. These findings highlight the need for targeted follow up care and rehabilitation.
ENDOSCOPY AND THEIR PREDICATING VALUE OF UPPER GASTROINTESTINAL MALIGNANCY IN ACSH, NORTHERN ETHIOPIA.
(Mekelle University, 2024-09-01) DR. AMANUEL KIROS
Background: In a resource-limited setup like Ethiopia, Alarm symptoms are generally accepted as an indication for prompt endoscopy, and these are effective and inexpensive tools to optimize diagnostic yield and identify malignant lesions in patients with upper GI complaints. However, previous studies noted that the sensitivity of alarm features for predicting cases with upper GI malignancies is unsatisfactory (29). Some studies on other part of Ethiopia have yielded mixed results. So far, there has been no study done in Ayder that assessed to what extent the indications of upper GI endoscopy could help identify patients with significant UGI pathologies or malignancies. Methods: Facility based cross-sectional study was conducted in patients who underwent upper GI endoscopy at GI clinic in ACSH from Jan 2019 and Jun 2024 was included in the study. Descriptive statistics were used as appropriate.Data analysis was done using SPSS 27.0 statistical software. Bivariate and multivariate analysis was done to identify significant indications of upper GI malignancy, finally, statistical significance was declared at p-value <0.05. Results: A total of 1,484 patients underwent complete upper gastrointestinal tract endoscopic evaluation during the study period. The median age of the patients was 38 years. Males accounted for 70.4% of the patients. Dyspepsia (21.6%) was the most common indication for endoscopic evaluation. Esophagitis (15.2%) were the most common pathology. The prevalence of upper GI malignancy recorded in our endoscopy cases 11.2%, and of those, 71.1 % had confirmed cancer of the stomach, the esophagus and the duodenum. It was statistically significant giving our study subjects a 7.9% (p<0.001) prevalence of cancer. Gastric cancer was accounting 62.7%, esophageal cancer 27.1%, duodenal cancer 5.08 % and gastro esophageal junction cancer 5.08%. The majority 77.1% of them had one or more alarm symptoms. The sensitivity, specificity, PPV and NPV of having any alarm features for predicting malignancy were 77.1%, 62.1%, 16.4% and 96.6%, respectively. The individual alarm symptoms such as an unexplained loss of weight, persistent vomiting and dysphagia were statistically significant correlation with a UGI malignancy (P: - 0.001) .Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 39.5 years in this population. Conclusion: Dyspepsia was the most common indication for EGD followed by screening varices of CLD patients. Clinically significant endoscopic findings were common. Esophagitis, pan gastropathy and esophageal varices were the common endoscopic finding. Of those, malignancies gastric CA followed by esophageal CA were common. Alarm symptoms were highly prevalent which was significantly higher among patients in the abnormal endoscopic group, particularly in upper GI malignancy group than in theix normal endoscopic group. There were inconsistent in finding between endoscopy and biopsy result. Being age above 39.5 and female, and certain alarm features (persistent vomiting, dysphagia, and unexplained weight loss) were independent predictor of UGI malignancy.
A Study on Electroencephalography (EEG): Its Indications, Findings, and Predictors of Abnormal Results In Pediatrics Age group at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia
(Mekelle University, 2024-10-01) Freweini Gebremeskel (MD)
Background: Electroencephalography, often referred to as EEG, is a non-invasive electrophysiological imaging technique used to record the brain’s electrical activity. In Ethiopia, particularly Tigray, there is no study a specific study on EEG study among pediatric age group, its indications, and findings at Ayder Comprehensive Specialized Hospital (ACSH) in Mekelle, Northern Ethiopia. Objective: To study the indications for EEG, the prevalence of abnormal EEG results, and identify predictors of EEG abnormality in pediatrics age group at ACSH. Methods : A cross-sectional study was carried out on 439 pediatric patients who underwent EEG study at ACSH for a range of neurological disorders from October 2019 to September 2024. Data were collected using a checklist, with the data source being electronic EEG records. The ODK collect mobile application was used for simultaneous data collection and entry. After exporting data to SPSS 27, both descriptive and inferential statistics were applied. Binary logistic regression was fitted to identify predictors of EEG abnormality. A p-value less than 0.05 was used to declare statistical significance. Result: The mean age of the study participants is 7.9 years and about two-third (63.6%) were male. More than three-fourths (77.0%) were right-handed and the most common clinical diagnosis wa generalized epilepsy (62%) and 89% of the participants had seizure history. The most prevalent EEG finding was generalized epileptiform (43.1%). Overall, two-thirds (66.5%) of the EEG studies exhibited abnormality. The odds of abnormal EEG findings were almost five times higher in children not on remission (AOR=4.6, 95% CI: 1.9 to 11.2, p=0.001). The odds of abnormal EEG were seven times higher in children with history of seizure (AOR=7.0, 95% CI: 3.4 to 14.3, p<0.001). The odds of abnormal EEG findings were found to increase by 20% as duration of epilepsy rises by one year (AOR=1.2, 95% CI: 1.1 to 1.4, p=0.001). The odds of abnormal EEG results were 12.6 times higher among children who had no febrile seizures than their counterparts (AOR=12.6, 95% CI: 1.4 to 111.3, p=0.022). Conclusion and Recommendations: In the present study, the prevalence of abnormal EEG results was higher compared to other Ethiopian studies due to different reasons. Factors remarkably related to EEG abnormality are duration of seizure/epilepsy, febrile seizure, seizure history, and remission status. Therefore, more emphasis should be given to children with an ongoing seizure (not on remission) and long history of seizure. Further research on the relationship between EEG abnormality and febrile seizure should be conducted and supported by concerned bodies.
EVALUATING THE PROCESS OF ADULT ANTIRETROVIRAL THERAPY SERVICE DELIVERY IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL, MEKELLE, TIGRAY, ETHIOPIA
(Mekelle University, 2024-10-20) Hailay Teklu Kidanu
Background: Antiretroviral therapy (ART) is vital for the prevention of morbidity and mortality in HIV-positive patients. It also helps prevent new infections, improves quality of life and increases productivity. ART is initiated in all adults, pregnant and lactating women, and adolescents with HIV, regardless of World Health Organization clinical stage or CD4 T lymphocyte count. This evaluation aimed to evaluate the delivery of ART services at Ayder Comprehensive Specialized Hospital. Objective: To evaluate the process of adult ART service delivery in Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia, 2024. Method: A case study design with formative evaluation approach was used, employing both qualitative and quantitative methods. The evaluation focused on the availability of essential resources, healthcare providers compliance to standard guidelines, and service accommodation dimensions. Quantitative data were collected from August 18-September 16/2024 by reviewing a sample of 142 ART clients’ clinical records and documents using structured format and entered and analyzed using SPSS 27.0. Sample size for charts review was calculated using a single population proportion formula and corrected for finite population. Qualitative data were obtained using evaluator administered unstructured questionnaire, five key informants and ten clients were interviewed, and the data were analyzed thematically. Results: Among ART clients who used the ART service in ACSH, 95.6% were adults. The overall rate of ART service for adults was 80.5% and was judged to be “good”. Resource availability was 76.5%, healthcare provider compliance to standard guidelines to enable sound ART service was 81.9%, and service accommodation was 82.6%. The level of provider compliance in assessing patients for ARV drugs adherence was 99.3% and judged as “very good”. In addition, the result of viral load test below 1000 copies/ml was 90.8%, corresponding to suppressed or low viremia, and was rated as “Very Good”. The most recent CD4 cell count result above 350 cells/µLwas 64.8%, with a mean CD4 cell count of 496 cells/µL (SD 282.692). Provision of co-trimoxazole prophylaxis was 83.8%, which is “good”, and monitoring of clients' body weight was 99.3%, and this was judged as “very good” according to predetermined evaluation criteria. However, TPT provision was only 20.4%, which is “poor and in need of urgent improvement”. The overallXIII acceptance of the service by users was rated at 80%. Only 71.1% of ART patients adhered to prescribed follow-up plans. Conclusion and Recommendations: The majority of resources recommended in the national ART implementation guideline were available in the clinic. However, it became apparent that there are limitations to the sustainability of ART medications, laboratory tests, and nutritional supplements. In addition, interruptions in the function of the CD4 cell count, and lack of the essential OI preventive drugs were demonstrated. It was also found that there were insufficient rooms to provide follow-up service, raising concerns about user privacy. Both the technical compliance of the providers and the acceptance of the service by ART users were rated as "good.". The clinic's ART service is rated 80.5% in terms of overall operational quality. This condition requires special attention in order for the institution to offer consistent service provision to all clients. As a result, particular suggestions were given in view of the findings.
PREDICTORS OF TIME TO RECOVERY FROM MODERATE ACUTE MALNUTRITION AMONG 6-59 MONTHS OLD CHILDREN IN INTERNALLY DISPLACED PERSONS SITES, NORTHWEST TIGRAY, ETHIOPIA, 2024, A RETROSPECTIVE FOLLOW UP
(Mekelle University, 2024-10-20) EFREM SHUSHAY BERHE
Background: Moderate acute malnutrition is one of the acute malnutrition categories diagnosed with an anthropometric measurement of weight for height [-3, -2) Z-score standard deviation or/and mid upper arm circumference (12.5-11.5] cm and the child should be with-out nutritional edema. Despite the existence of targeted supplementary feeding programs, the prevalence of moderate acute malnutrition was seriously high (15.1%) and the studies conducted previously used an out dated criteria to assess their recovery status from moderate acute malnutrition. Objective: The aim of this study was to determine the recovery time and its predictors among 6- 59 Months old children with moderate acute malnutrition enrolled to targeted supplementary feeding program in internally displaced persons sites of Northwest Tigray, Ethiopia, 2024. Methods: An institutional based retrospective cohort study was conducted among 452 children with moderate acute malnutrition selected using lottery method of simple random sampling with proportional allocation of the study participants to the selected fourteen sites. Data was collected using kobo tool box and imported to Stata version 17. Variables with p-value <0.25 at the restricted mean survival time uni-variable analysis, with 95% confidence interval were considered as important variables. The recovery status of the children was measured using mid upper arm circumference with measurement of >= 12.5 cm for two consecutive visits. Result: About 244 (53.08%) were female and 265(58.6%) with an age category of 24-59 months old. The overall restricted mean survival time was 15.16 weeks and recovery rate 68.36% with a truncation time of 16 weeks. Admission mid upper arm circumference category with restricted mean survival time difference of 5.47 (95% CI 3.53:8.48), ready to use supplementary food sharing status 2.07 (95% CI 1.39:3.08), and follow up status 0.57 (95% CI 0.42:0.76) were Significant predictors of time to recovery from moderate acute under nutrition. Conclusion: The study found an overall restricted mean survival time of 15.16 weeks and a recovery rate was below the minimum acceptable international standard. Recommendation: Strategies that enhance early detection should be implemented to get the child with moderate acute malnutrition at early stage. Tracking lost to follow-ups are critical, alongside counseling caregivers to treat food as medicine.
PREDICTORS AND TIME TO PNEUMONIA DEVELOPMENT IN MECHANICALLY VENTILATED ADULT PATIENTS IN THE ICU AT AYDER COMPREHENSIVE SPECIALIZED HOSPITAL, MEKELLE, TIGRAY 2024
(Mekelle University, 2024-10-20) Masresha Gebru
Introduction: Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection in the intensive care unit (ICU). Researchers have conducted limited studies, and identifying the factors linked to the development of VAP is crucial for implementing preventive measures. Objective: To determine predictors and time to pneumonia development in mechanically ventilated adult patients in the intensive care unit at Ayder Comprehensive Specialized Hospital, Mekelle, Tigray 2024. Methods and Materials: A retrospective cohort study design was employed. All patients admitted to the adult intensive care unit and under mechanical ventilation from January 1, 2018, to December 31, 2020, were recruited consecutively. Data was collected using ODK and exported to STATA 17 for analysis. Log-rank test and multivariable lognormal regression were fitted to identify time to pneumonia development predictors. An adjusted hazard ratio with a 95% confidence interval was used to measure the association. The lognormal model best fits the data based on goodness-of-fit criteria, including the Akaike Information Criterion and Bayesian Information Criterion. The assumptions of survival times were checked using graphical methods. Models with and without interaction terms were compared, and the final model was selected based on the best fit to the data. Result: Data from 203 patient folders were analyzed, with a median follow-up of 6 days. The overall occurrence of pneumonia among adult patients in the ICU under mechanical ventilation was 61.08%, with an incidence rate of 15.3 cases per 813 person-days. The duration of mechanical ventilation for late pneumonia (AHR=1.32, 95% CI: 1.13, 1.55), cause of admission to intensive care unit due to respiratory disease (AHR=0.72, 95% CI: 0.53, 0.93), primary indication for intubation for patient with trauma (AHR=0.72, 95% CI: 0.53, 0.98), Sex of patient female patients (AHR=0.85, 95% CI 0.73, 0.98) were significantly associated with VAP in the adult ICU patients. Conclusions and Recommendation: The study highlights high pneumonia incidence in mechanically ventilated patients, emphasizing prioritizing resources allocation for those who are under mechanical ventilation to minimize the incidence of pneumonia.
ROUTINE HEALTH INFORMATION UTILIZATION AND ASSOCIATED FACTORS AMONG HEALTHCARE PROFESSIONALS IN MEKELLE AND ENDERTA, TIGRAY, ETHIOPIA, 2024: A MULTILEVEL ANALYSIS
(Mekelle University, 2024-10-20) Hailemariam Atsbeha
Background: A routine health information system comprises data collected at regular intervals. Utilization of timely, accurate, and relevant health information facilitates decision-making for effective interventions, services, and policies and it can prevent and reduce major healthcare problems in the healthcare system. Though health information is a building block for the health system, there is limited evidence about the culture of using routine health information for decision-making in Ethiopia, particularly in Tigray. Thus, this study aimed to assess the utilization of routine health information and its associated multilevel factors among healthcare professionals in Tigray, Mekelle zone, and Enderta District public health facilities and tried to make possible recommendations based on the findings. So, understanding the level of RHI utilization will be important for healthcare providers, policymakers, and program managers to improve the overall effectiveness and efficiency of the healthcare system in the region. Objective: -The general objective of the study was to assess routine health information utilization and associated factors for routine health information in Tigray region; Mekelle Zone and Enderta District public health facilities. Method: - A facility-based cross-sectional study was conducted from Feb 2024 to March 2024 in 23 public health facilities of Mekelle zone and Enderta District, Tigray Ethiopia. A simple random sampling method was used to recruit 422 participants. Data were entered and analyzed using STATA 17 software. Percentage and frequency were used to summarize categorical variables. Bivariate analysis and multivariable analysis were done to identify significant factors. Variable with a p-value <0.05 was used to identify variables significantly associated with the utilization of Routine Health Information. Results: The study found that 59.7% of the healthcare professionals had a good level of RHI utilization. The multilevel analysis revealed that data recording habit (AOR = 7.1, 95% CI: 3.1, 16), computer skills (AOR = 4.4, 95% CI: 2.2,9.1), data analysis skills (AOR = 10.1, 95% CI: 5.5, 20.), availability of standard guidelines (AOR = 7.1, 95% CI:2.4, 20), regular feedback (AOR =2.9, 95% CI: 1.04, 8.2) and the presence of a functional performance monitoring team (AOR = 7.8, 95% CI:2.6, 22), were significantly positively associated with routine health information utilization. Conclusion: - This study concluded that nearly 60% of the healthcare professionals in Mekelle zone and Enderta woreda public health facilities had good routine health information utilization. Basic computer skills, data analysis skills, data recording habit, availability of standard guidelines, regular feedback, and the presence of a functional performance monitoring team were factors significantly associated with routine health information utilization. This study recommends enhancing healthcare professionals’ computer skills, and data analysis skills, establishing a performance monitoring team, availing standard guidelines, and providing regular feedback.
Evaluation of Microcrystalline Cellulose isolated from Mango (mangofera indica) kernel as Directly Compressible Pharmaceutical Excipient
(Mekelle University, 2024-10-28) DERSO TEJU
Cellulose, obtained predominantly from wood and cotton, stands as the most abundant natural polymer on earth. The consumption of cellulose for various industrial application is continuously increasing worldwide. The extraction of cellulose from agricultural waste addresses critical issues by enhancing efficient resource utilization, minimizing waste, and reducing the environmental impacts associated with deforestation. Therefore, a sustainable enviroment may be established by using the abundant agricultural waste from plant fibers. Mango is one of the main fruit crops produced and exported in Ethiopia. Therefore, this work aimed to prepare and characterize mango kernel microcrystalline cellulose (MK-MCC) and assess it as directly compressible pharmaceutical excipient. Mango kernel cellulose was extracted using NaOH treatments, then cellulose was hydrolyzed by HCl to prepare mango kernel microcrystalline cellulose. The isolated MCC was characterized through scanning electron microscope, Fourier Transform infrared spectroscopy, Laser diffraction, thermogravimetric analysis and x-ray diffraction and compared with Avicel PH 101. The mechanical properties of both plain MK-MCC tablets and model drug (paracetamol) containing MK-MCC tablets were evaluated and compared with standard Avicel PH 101 tablets. Cellulose and MCC yield on the dry weight basis of mango kernel were found to be 36.5% ± 1.57 and 28.64% ±1.66 respectively. Crystallinity index (CrI) of Mango kernel cellulose was 76.5%. Scanning electron microscopy also showed MK-MCC had smooth surface morphology, irregular and rod-shaped fiber strands. The MK-MCC powders exhibited a bimodal, moderate particle size distribution. The physicochemical studies of MK-MCC revealed moisture content 3.47% w/w, ash value (0.07), pH (5.97), water soluble substances (0.14%) and ether soluble substances (0.03%) that were all within the allowable limit of USP 30/NF 25. MK-MCC preparations showed lower crushing and tensile strengths than Avicel PH-101. MK-MCC effectively incorporated 50% paracetamol in a tablet formulation suitable for direct compression. Based on the results of this study mango kernel could be a promising locally available potential source of cellulose and MCC for pharmaceutical applications.
Sero-prevalence and Predictors of Syphilis and HIV Co-infection among pregnant women attending ANC in Mekelle City of Conflict-Affected Tigray Region, Ethiopia: Evidence from Firth Penalized Regression
(Mekelle University, 2024-11-21) SENAIT HADDIS
Background: Sexually transmitted infections (STIs), particularly syphilis and HIV, significantly impact pregnant women in resource-limited countries, complicating treatment and increasing maternal and neonatal risks. In Mekelle City, Tigray, Ethiopia, barriers including limited antenatal care (ANC) access, physiological vulnerability, behavioral risks, socio-economic constraints, and conflict further exacerbate the burden of these infections, underscoring the critical need for accurate prevalence data and identification of predictive factors. Objective: This study aimed to determine the sero-prevalence of HIV/syphilis co-infection and identify associated predictors among pregnant women attending ANC in Mekelle City. Method: A facility-based cross-sectional study was conducted among pregnant women attending ANC services in selected health facilities across Mekelle City, Tigray, Ethiopia. A two-stage stratified sampling procedure was utilized to draw representative pregnant women under ANC from a health facility in each sub city. Data collection involved an interview-administered questionnaire and pregnant women’s registration books. Due to the relatively small sample size and rarity of co-infection events, Firth penalized logistic regression was employed for statistical analysis to mitigate bias and ensure model stability. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were computed to identify significant predictors. Result: Out of 438 pregnant women enrolled, the sero-prevalence of HIVsyphilis co-infection was 3.7% (95% CI: 1.87–5.43%). Significant predictors included sexual violence (frequency: 13.7%; AOR=2.2, 95% CI: 1.27–3.81, p=0.001), displacement (frequency: 41.1%; AOR=1.6, 95% CI: 1.10–2.32, p=0.043), frequent alcohol consumption (most frequent: 8.9%; AOR=2.1, 95% CI: 1.27–3.46, p=0.004), and limited ANC visits (frequency: 47.5%; AOR=1.8, 95% CI: 1.13–2.87, p=0.014). Conclusion & Recommendation: The high prevalence of HIV and syphilis co-infection rate underscores the need for targeted sexual violence prevention, improved ANC access, and integrated STI screening within ANC services in Mekelle City. Enhanced education on substance abuse and sexual health is essential.
QUALITY AND SPATIAL DISTRIBUTION OF IMMEDIATE POSTPARTUM CARE IN ETHIOPIA: A MULTILEVEL ANALYSIS USING PERFORMANCE MONITORING FOR ACTION ETHIOPIA 2023 DATA
(Mekelle University, 2024-11-28) HAFTAAB ASHEB
The immediate postpartum period is associated with a significantly increased risk of morbidity and mortality for both the mothers and newborns. Providing quality immediate postpartum care helps reduce negative outcomes. Most studies conducted in Ethiopia have identified factors associated with postnatal care utilization. However, no evidence links household and community data to service delivery points and their geographic distribution, which are necessary to assess the quality of immediate postpartum care. To assess the quality and spatial distribution of immediate postpartum care in Ethiopia, 2024. We used a cohort of household and facility data from the National Performance Monitoring for Action Ethiopia study, which was conducted in 2023 across four major regions (Amhara, Oromia, South Ethiopia, and Addis Ababa). A total of 1,351 postpartum women and their newborns were linked to the nearest 264 health facilities. A multilevel binary logistic regression analysis was employed to assess contextual factors. The adjusted odds ratio with a 95% confidence interval (CI) was used to measure the associations between variables, with statistical significance set at P<0.05. The SaTScan V.10.2.5 and ArcGIS V.10.8 geostatistical software were used to explore the spatial distribution and interpolation of the quality of immediate postpartum care. The quality of immediate postpartum care among women and their newborns was 29.8% (95% CI 27%- 32%), ranging from 14.1% in Southern Ethiopia to 40.9% in Addis Ababa. In the multivariable multilevel analysis, religion (AOR=0.51; 95% CI 0.31-0.83), antenatal care visits (AOR=1.78; 95% CI 1.08-2.95), cesarean delivery (AOR=0.45; 95% CI 0.27-0.76), being attended by a nurse/midwife (AOR=1.96; 95% CI 1.26-3.03), urban residence (AOR=1.85; 95% CI 1.05-3.25), birth at private hospitals/clinics (AOR=4.12; 95% CI 2.07-8.51), and higher community media exposure (AOR=2.99; 95% CI 1.76-5.06) were significant predictors of the quality of immediate postpartum care. The spatial distribution of the quality of care varied significantly across regions, with a global Moran’s I = 0.99, P=0.001. Significant hotspots of good-quality care were detected in Addis Ababa. The quality of immediate postpartum care was low in Ethiopia, with significant spatial variation across the country. Therefore, public health interventions should be designed for areas where the quality is low to reduce maternal and newborn mortality by increasing antenatal care visits, increasing community media exposure, and strengthening health systems in rural areas.
PREVALENCE AND ASSOCIATED FACTORS OF SEXUALLY TRANSMITTED INFECTIONS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN PUBLIC HOSPITALS, CENTRAL ZONE OFTIGRAY, ETHIOPIA, 2024/25
(Mekelle University, 2024-12-15) YOSEPH GIRMAY
Background – Sexually transmitted infections (STIs) during pregnancy are a significant public health concern, leading to severe maternal and neonatal complications such as preterm labor, stillbirth, low birth weight, and congenital infections. In developing countries, including post-conflict settings like Tigray, the burden of STIs is often heightened due to weakened health services, increased sexual violence, and limited access to affordable and reliable diagnostic tools. These challenges hinder timely diagnosis and treatment, exacerbating adverse pregnancy outcomes. Objective - To assess the prevalence and associated factors of sexually transmitted infections among pregnant women attending antenatal care in public hospitals located in the Central Zone of Tigray, Ethiopia, 2024/25. Method: - A facility based cross-sectional quantitative study was conducted among 312 pregnant women receiving antenatal care at selected public hospitals in the Central Zone of Tigray, A 1.5 design effect was applied to account for potential errors from the two stage sampling technique. Data were collected from November 15 to December 15, 2024, using pretested, structured face-to-face interviews. Data analysis was entered in to Epi Info version 7.2.2.2 and analyzed with SPSS version 25. Descriptive statistics summarized key variables, while bivariate and multivariable logistic regression analyses were used to calculate crude and adjusted odds ratios. Statistical significance was set at a 95% confidence interval with a p-value less than 0.05. Result: The Prevalence of STI and associated Syndromes were 21.8%, 95% CI: 16.9-26.6). Out of the 312 respondents; Sixty eight of them reported were they have at least one of the syndromes. Age AOR = 6.341, 95% CI:(2.439-16.488), History of Abortion AOR= 5.3%, 95%CI: (1.73-16.19), Having multiple sexual partners (AOR=4.6%, 95 % CI: 1.45 - 14.73), History of STI AOR 6.9%, 95% CI: (2.79 - 17.14), and drinking of alcohol AOR 4.1% 95% CI; 1.66-10.12); have a strong association to be diagnosed with STI syndromes. However, being married found to be a protective factor from contracting of STI than unmarried women. Conclusion; in this Study, STI found to be a major health problem among pregnant women since found one in five. Therefore, pregnant women with the determined factors have to receive an attention to halt the potential problem. Hence, raising community awareness through mass media and provision of STI preventive materials is crucial to mitigate the possible adverse pregnancy outcomes.
TIME TO END STAGE OF RENAL DISEASE ASSOCIATED WITH SERUM CREATININE AMONG ADULT CHRONIC KIDNEY PATIENTS IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL: JOINT AND COPULA MODELING
(Mekelle University, 2024-12-20) MENGSTU SURAFEL TEKULU
Background- Chronic kidney disease (CKD) is a global public health issue and around 13.4% of people had CKD. Out of these, 14.5 million people have end stage of renal disease (ESRD) and 7.083 million needed renal replacement therapy. Paired kidney shared the same gene and comes from the same person. In Ethiopia, the incidence of CKD is estimated to be 21.71%. The war between Ethiopia federal and Tigray government leads to 70–80% of health facility dysfunctional. Objective The main objective was to determine time to ESRD associated with longitudinal serum creatinine, joint time to right and left kidney failure among adult CKD patients, and determinant factors in Ayder Comprehensive Specialized Hospital from 2019 to 2024. Methods - A retrospective cohort study conducted among 408 adult CKD patients in Ayder Comprehensive Specialized Hospital from 2019 to 2024. CKD patients without ESRD at the start of follow-up included in the study and data collected from medical card. Pretest, supervision and training used to assess data completeness. Joint and Copula Cox-proportional hazard model (CoxPH) used. Archimedean Copula model fitted to predict joint time to fail both kidney and interpretation done using hazard ratio (HR) and 95% confidence interval (C.I). Result- In the joint Cox-PH model variables with HR and 95% C.I interpreted. A unit increased in hemoglobin level the hazard of ESRD decreased by 11 %, HR= 0.89(0.7865,0.9935). A unit increased in urea the hazard of ESRD increased by HR =1.01(1.0065,1.0135) times, as estimate glomerular filtration rate increased, hazard of ESRD decreased by 2%, HR= 0.98(0.9621,0.9978). As longitudinal serum creatinine increased, hazard of ESRD increased by HR= 4.31(3.5760,5.0641) and being hepatitis, hazard of ESRD increased by HR= 2.61(1.8936,3.3264) times. In the Copula model, 86% of time to ESRD due to dependency of right and left kidney. Conclusion and Recommendation - The variables hemoglobin level and glomerular filtration rate value had a negative association, whereas urea level, longitudinal serum creatinine value and hepatitis had a significant positive effect on time to ESRD at the 5% level of significance. These factors increase the incidence of ESRD among CKD. To decrease the progression, health professional should provide early screening of chronic disease and strictly follow for laboratorial abnormality, every patient should follow appropriately for medical service and life style modification to prevent for chronic disease.
RECENT HIV INFECTION AMONG NEWLY DIAGNOSED HIV POSITIVE CLIENTS AND ASSOCIATED FACTORS IN TIGRAY, NORTHER ETHIOPIA 2024: A CROSS-SECTIONAL STUDY
(Mekelle University, 2024-12-25) TSEGAZEAB ARAYA
By the end of 2023, there were a projected 39 million HIV-positive individuals worldwide, and 1.3 million new cases of HIV infection. An estimated 51% of new HIV infections occurred in Sub-Saharan Africa. In order to support evidence-based decision-making, HIV case-based surveillance gathers information on recently diagnosed HIV cases, recent HIV infections, and other sentinel events. In the Tigray region, there is little evidence of these. Recent HIV infections were infections that were acquired within the previous six to twelve months as detected by Asante’s recency HIV test kit. Identifying individuals with recent HIV infection from a long-term and assessing the risk-factors such as age, sex, residence, educational status, occupations, OIs, sexual practice, illicit drug utilization, and others particularly in those who have recently been infected, is a critical step to control the epidemic and to end HIV/AIDS as a public-health threat by 2030. The proportion of recent HIV infections was 22.9% (95%CI, 19.4, and 26.4). 24.3% of recent HIV infections occurred in the Mekelle Special Zone, while the clients with the largest percentage of recent infections in the Tigray region were female (367, 72%) and employed (23%). The factors associated with recent HIV infections were age 15–24 years (AOR = 2.60, 95% CI: 1.150, 5.742), employment (AOR = 2.78, 95% CI: 1.23, 6.304), female sex workers (AOR = 2.8, 95% CI: 1.119, 7.037), and those paid or received money or a gift for sex (AOR = 2.2, 95% CI: 1.368, 3.673).
Assessment of Blood Glucose Level and Lipid Profiles among Hormonal Contraceptive Users in Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia, 2024
(Mekelle University, 2024-12-25) Seare Teklay
Hormonal contraceptives have been observed to affect and induce changes in blood glucose level and lipid profiles. Studies have been shown that hormonal contraceptive is suggested to trigger changes in blood glucose level and lipid profiles.To assess blood glucose level and lipid profile among hormonal contraceptive users at Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia, 2023/2024. Comparative cross-sectional study design was carried out on 57 hormonal contraceptive users and 57 age-matched non-users, in Ayder Comprehensive Specialized Hospital from July 2023 to October 2024. Fasting blood samples for the estimation of TC, TG, HDL-c, LDL-c and FBS levels were collected. Data was entered using Epi-data software version 4.5 and analyzed using SPSS software version 25. Student's independent t-test was used to compare the results. A one-way ANOVA was used to identify the variation in the lipid profile and FBS between oral contraceptive pills, DMPAs and implant users. Simple linear regression was used to determine the changes in blood glucose and lipid profile in relation to the duration of hormonal contraceptive use. The mean serum levels of TC, TG, LDL-c, and FBS were significantly greater in hormonal contraceptive users than in non-users (P =0.005, P =0.000, P =0.003, and P =0.012, respectively), and the mean serum HDL-c level was significantly lower than that in controls (P =0.002). The mean serum levels of TG, LDL-c, and HDL-c were significantly different between DMPA, implant, and OCP users (P =0.000, P =0.031, and P =0.001, respectively). Compared with OCP and implant users, DMPA users had the highest mean serum levels of TC, TG, and LDL-c but had the lowest mean serum levels of HDL-c. As the duration of oral contraception and DMPA use increased the serum levels of TG and LDL-c increased (P = 0.017 and P = 0.014 respectively), whereas the serum level of HDL-c decreased (P = 0.01). The serum levels of LDL-c increased as the duration of implant use increased (p = 0.017). As the duration of DMPA use increases, the serum level of FBS moderately increases (p =0.000). Over all, hormonal contraceptive use results in changes in the mean serum lipid profile and FBS level. DMPA produces more change on mean serum lipid profiles and FBS than the other types are, and implants have a minimal effect on the level of all lipid profiles.
Quality Evaluation of Different Brands of Metformin Hydrochloride 500 Mg and 850 Mg Tablets Available in Mekelle City
(Mekelle University, 2024-12-28) Afewerki Tesfay
Introduction: Metformin is the most commonly prescribed drug. The accessibility of substandard and falsified metformin products in the market lead to treatment failure, increased mortality, and morbidity. Ethiopia has a low port control and a weak regulatory system. Additionally, in Tigray, several brands of metformin tablets have been released into the market for the past three years without proper regulatory systems. To address this concern, this study was conducted. Objective: This study aims to assess and compare the quality of different brands of metformin 500 mg and 850 mg tablets available in Mekelle City, Tigray, Ethiopia. Method: Quality parameter tests such as physical characteristics, friability, dissolution, disintegration, weight variation, assay, and hardness tests were conducted as per British Pharmacopeia (BP), World Health Organization (WHO), and non-official standards. Data were analyzed using Origin Pro 2024 and one-way analysis of variance (ANOVA). To compare the dissolution profile of the tested product against the innovator, similarity factor (f2), and difference factor (f1) was used. Result: Except for one brand, they all had online EFDA registration numbers. For metformin 500 mg brands: Weight variation ranges from -3.96 % to 2.22 %, assay value ranges from 95.2% to 102.1%, and dissolution value ranges from 90.4 % to 99.7 % at 45 minutes. For metformin 850 mg brands: Weight variation ranges from -2.1 % to 2.6 %, assay value ranges from 97.9% to 103.7%, and dissolution value ranges from 97.9 % to 101.6. % at 45 minutes. Conclusion: Except for the hardness test, all the tested brands of metformin hydrochloride 500 mg and 850 mg tablets met the official BP and WHO specifications. This study could help to patients, EFDA, independent research groups, and other concerned bodies to get updated information on the quality status of metformin 500 mg and 850 mg tablets.