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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.
ADHERENCE TO ART AND ASSOCIATED FACTORS AMONG HIV INFECTED CHILDREN ON FOLLOW-UP AT MEKELLE GENERAL HOSPITA
(Mekelle University, 2025-02-01) Selam Gebreslassie Weldetatyos
Introduction: Adherence to antiretroviral therapy (ART) is a significant factor for the success of HIV treatment. The challenges are particularly serious in Sub-Saharan countries as the high rates of HIV/AIDS lead to greater numbers of affected individuals. The magnitude of this challenge remained large in developing countries like Ethiopia. In Tigray, though high rates of patient’s poor adherence are expected which is resulted from the war and associated siege there is limited evidence on adherence to ART particularly among children. Objective: to assess the level of adherence to ART and the factors associated among HIV infected children in Mekelle General hospital. Method: Using hospital based cross-sectional study design a total of 136 children age under 18 who was on ART. Census method of data collection was used. Then, the collected data was analyzed using SPSS27. Dependent variable was dictomized, then a descriptive, bi-variate and multivariate logistic regression analysis was performed to see the frequency, measure the level of adherence and identify the determinate factor of good / poor adherence. The research was done on April 2024 by September 2024. Result and discussion: A total of 136 study participants were included. The level of ART adherence among children was 115 (84.6%). Majority of children are in the age of 10-18 years 98[72%] of all female are dominant number than male 80[58.8%] majority resides in Mekelle 122[87.9%]. No variable is found significant factor affecting adherence. Care givers of lower economic status [AOR=5.711(0.532-61.350)], self-care-giver type [AOR=3.332(0.356-31.227)], and those who were aware of their HIV serio status [AOR=1.202(0.433-3.334)] were more likely to adhere to ART treatment. On the other hand, the study showed the Sex of the child [AOR=0.922(0.360-2.361)], sex of the caregiver [AOR=0.493(0.181-1.341)] and caregivers with other occupation [AOR=0.450(0.050-4.036)], were less related to Adherence of ART medication. Caregiver’s forgetfulness (28.7%) and stigma of children (25%) were more likely the main reasons for missed doses. Conclusion and recommendation: The level of adherence to antiretroviral therapy was poor. This study indicated the level of adherence (84.6%) showed a difference with WHO requirements, 95%
Assessment and Comparison of Serum Electrolyte Level among Pulmonary Tuberculosis Patients with and without HIV Co-infection at Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia, 2023/2024
(Mekelle University, 2025-01-25) Tsegay G/her Birhane
According to a World Health Organization report from 2021, tuberculosis is a primary cause of morbidity and one of the top causes of mortality globally. It has been discovered that electrolyte and fluid imbalances, which are common in tuberculosis and HIV/AIDS, have a significant role in morbidity and mortality. The aim of this study was to assess and compare serum electrolyte level among pulmonary tuberculosis patients with or without HIV co-infection at Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia. A comparative cross-sectional study utilizing a convenience sampling technique was used to sample 50 pulmonary tuberculosis patients with or without HIV co-infection at Ayder Comprehensive Specialized Hospital in the period from October 2023 to December 2024. HIV-PTB co-infected patients and PTB without HIV co-infection who fulfilled the inclusion criteria were included in the study. Socio-demographic and clinical data were collected using an interviewer administered structured questionnaire and medical record review. K-Light electrolyte analyser automachine analyser was used to determine the serum electrolyte status of pulmonary tuberculosis patients with or without HIV co-infection directly by taking 3 milliliters of venous blood. After checking for completeness and cleaning, the data were entered into Epi-data version 4.5 and exported into the SPSS software version 25 package for analysis, and the different variables were analyzed. Linear Regression was used to assess the relationship of anti-TB and ART Rx duration with serum electrolyte level. This study found that serum sodium levels were significantly higher in pulmonary tuberculosis (PTB) patients compared to those co-infected with HIV (132.65±4.15 vs. 130.28±4.09 mEq/L; p = 0.047). Conversely, serum potassium levels were significantly elevated in HIV-PTB coinfected patients (5.05±0.75 vs. 3.83±0.59 mEq/L; p = 0.000), and serum chloride levels were higher in PTB patients without HIV co-infection (103.42±3.16 vs. 100.61±5.10 mEq/L; p = 0.023). The study highlights the significantly higher level of serum sodium in pulmonary tuberculosis (PTB) patients without HIV co-infection compared to those co-infected with HIV. This study also showed a significantly higher level of serum potassium in HIV-PTB co-infected patients and significantly higher chloride level in PTB patients without HIV co-infection.
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.
Assessment of Magnitude and Determinants of Prediabetes among Commercial Bank Workers in Shire Endaslasie Town, Tigray, North Ethiopia, 2023/2024
(Mekelle University, 2025-03-25) Kibrom Tamene Berhe
Globally, the prevalence of prediabetes across various occupational groups and its relationship with an occupational factor is a topic of recent interest. Physical inactivity, long working hours, and workload stress were mentioned to play a big role in the development of prediabetes. Thus, bank workers who are always subjected to physical inactivity, long working hours, and workload stress are at risk of developing prediabetes. The aim of this study was to assess magnitude and determinant of prediabets among Commercial Bank of Ethiopian workers at Shire Endaslasie Branch between November 2023 and April 2024. A cross-sectional study was conducted using a systematic random sampling technique. The study populations were all Commercial Bank of Ethiopia workers at Shire Endaslasie town who had worked at least one year and above as bank workers. The total sample size for the study was 111. The data were collected using a semi-structured questionnaire, physical examinations, and blood samples by using the WHO stepwise approach. Data were entered into SPSS version 20.0. The entered data were cleaned and analyzed. Frequency distributions, percentages, tables, and charts were used to show the results of univariate analysis. Cross-tabulation, chi-square tests, and 95% confidence intervals are used to present results of bivariate analysis. Multivariate logistic regression analyses were done to control for potential confounding variables. Out of 111 eligible subjects, 105 (93.3%) commercial bank of Ethiopia workers participated in this study. Of the total subjects tested for fasting blood glucose level, the prevalence of impaired glucose (IFG) was 21.4% and 3.6% were undiagnosed diabetes. The history of alcohol intake (P = 0.041, AOR 14.6 (1.11-191.1)), having a history of physical inactivity (P = 0.014, AOR = 60 (2.29-159.3)), hypertension (P = 0.013, AOR = 1.694 (1.116-2.572)), and body mass index (P = 0.013, AOR = 1.694 (1.116-2.572)) were found to have statistical significance association with the prevalence of impaired fasting glucose among the study participants. in this study nearly one in five commercial banks employees have prediabetes, in addition to this Unhealthy lifestyle such as heavy alcohol use , physical inactivity and related derangements like elevated BMI and hypertension had significant associations with prediabetes. Hence, education on lifestyle modification and provision of targeted care & support is imperative to reduce the risk.
Assessment of Schistosoma mansoni Infection and Associated Risk Factors Among Elementary School Children in Gembella and Feleg-Daero, Mekelle City, Ethiopia
(Mekelle University, 2025-04-25) Abeba Teklu
Schistosomiasis is a widespread parasitic infection transmitted through contact with contaminated water, posing a major global public health challenge, particularly in developing countries. It affects individuals of all ages, with children being among the most vulnerable. Identifying the prevalence, associated risk factors, and high-risk populations is crucial for designing and implementing effective prevention and control strategies. This study aimed to assess Schistosoma mansoni infection and the associated risk factors among elementary school children in Gembella and Feleg-Daero (Adis Alem) elementary schools, in Mekelle City, Ethiopia. A cross-sectional study was conducted from January to September 2024, employing a purposive sampling technique to select schoolchildren. A total of 308 stool samples collected from elementary school children aged 7 to 20 years were examined using the wet mount and Kato-Katz techniques. A pre-tested questionnaire was utilized to gather socio-demographic information and associated risk factors. The data was coded, entered, and analyzed using descriptive statistics, bivariate and multivariate logistic regression and the significance level was set at p < 0.05 with 95% confidence interval. The overall prevalence of Schistosoma mansoni infection was 51.0% (157/308), with a median infection intensity of 192 eggs per gram of stool (EPG) among infected individuals. Among the infected children, 26.1%, 49.7% and 24.2% had light, moderate and heavy infections respectively. Significant risk factors for Schistosoma mansoni infection included swimming (AOR: 4.89; 95% CI:1.35, 17.75, P<0.001), washing clothes in rivers or streams (AOR:3.72; 95% CI: 1.12,12.37, P<0.001), engaging in irrigation activities (AOR:1.03;95%CI: 0.28,3.77, P<0.022), and bathing in river (AOR: 2.19,95% CI, 0.17-28.76, P< 0.001) and water contacts with flowing river (AOR:1.41; 95%CI: 0.23, 8.50, P<0.001). Schistosoma mansoni infection among children in this study was alarmingly high, with nearly half of the infected cases classified as having moderate intensity. These findings underscore the urgent need for targeted interventions, including health education, improved access to safe water, and regular deworming programs, to effectively reduce the disease burden and its associated risks.
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
CHALLENGES AND BARRIERS OF GLYCEMIC CONTROL AMONG ADULTS WITH DIABETES IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL
(Mekelle University, 2025-04-25) Filmon Beyenne Demoz
Diabetes mellitus is a public health concern in developed and developing countries. Currently, attaining the intended glycemic control in adult patients with diabetes is challenging more in lower income countries. This study aimed to evaluate the challenges and barriers of controlling glycated hemoglobin among adult patients with diabetes in diabetes clinic, Ayder Comprehensive Specialized Hospital, Mekelle University. The study also aimed to evaluate associated factors of knowledge, medication adherence, and self-care practice of the same patients. A cross-sectional study was conducted in diabetes clinic, Ayder comprehensive specialized hospital Mekelle University from May to June 2024. Structured tools were used to collect data about socio-demographics, knowledge, medication adherence, and self-care practices. The data was analyzed using the software Statistical Package for Social Science (SPSS) version 27.0. Binary logistic regression was performed to determine associated factors with poor glycemic control and poor self-care practice whereas ordinal logistic regression was applied to determine factors associated with knowledge and medication adherence. Statistical consideration was given for bivariate binary logistic regression at p-value<0.25 and a p-value <0.05 was considered statistically significant for mult-variate and ordinal logistic regression. Out of 338 study participants nearly three-fourth (73.4%) had poor glycemic control. Secondary educational level (AOR = 5.1, P<0.02), diabetes duration [(AOR = 3.1, p<0.002), AOR = 3, p<0.01), AOR = 5.1, p<0.02)], moderate adherence (AOR = 0.28, p<0.001), high knowledge levels (AOR = 3.3, p<0.007), and good self-care practice (0.26, p< 0.001) were found associated with poor glycemic control. Single (AOR = 3.3, p<0.018) and married (AOR = 2.4, p<0.03) marital status, levels of knowledge [(low, AOR = 0.3, p<0.001), (average, AOR = 0.4, p<0.03)] and presence of comorbidities (AOR = 0.56, p<0.03) and high knowledge level (AOR = 2.1, p<0.01) were associated with counterparts of knowledge, adherence, and self-care practice. Glycemic status was observed uncontrolled in participants with secondary educational level, long diabetes duration, poor adherence and self-care practice. Thus, the study recommends patients to overcome the problems discussed through strictly following the advice offered by physicians and stick to their prescribed medication.
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.
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.
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.
EVALUATION OF ANTIDIARRHEAL ACTIVITY OF 80% METHANOLIC STEM BARK EXTRACT OF TERMINALIA BROWNII FRESEN (COMBRETACEAE)
(Mekelle University, 2025-04-25) Selamawit Tesfamariam
Terminalia brownii is a medicinal plant traditionally used in Africa to manage diarrhea. Despite its ethnomedicinal significance, the safety and efficacy of its extracts remain underexplored in preclinical studies. This study aimed to evaluate the antidiarrheal properties and acute toxicity of an 80% methanolic stem bark extract of Termination brownii to bridge this scientific gap. The antidiarrheal activity of the 80% methanolic extract of Terminalia brownii was assessed using three models: the castor oil-induced diarrheal model, charcoal meal test, and enteropooling test in mice. Negative controls were treated with distilled water (10 mL/kg, oral), Test groups received the extract orally at doses of 100, 200, and 400 mg/kg. while positive controls received loperamide hydrochloride (3 mg/kg, oral). The extract delayed the onset of diarrhea and reduced the number and weight of wet feces, as well as total fecal weight, in a dose-dependent manner in the castor oil-induced diarrhea model. The diarrheal inhibition percentages were 28%, 53.42%, and 74.12% at doses of 100 mg/kg, 200 mg/kg, and 400 mg/kg, respectively, demonstrating a substantial dose-dependent increase in efficacy.The extract at 200 and 400 mg/kg demonstrated peristaltic indices of 54.5% and 37.3%, respectively, alongside significant inhibition of charcoal transit (39.5% and 58.9%) in the charcoal meal test. In the enteropooling test, the 400 mg/kg dose significantly reduced intestinal content weight and volume to 0.29 g and 0.24 mL, respectively, comparable to the loperamide-treated group (0.28 g and 0.22 mL). The in vivo antidiarrheal index revealed diarrhea inhibition values of 20.87%, 56.06%, and 86.81% for the extract (100, 200, and 400 mg/kg, respectively) and 92.77% for loperamide (3 mg/kg). This study demonstrated that the 80% methanolic stem bark extract of Terminalia brownii has significant antidiarrheal effects, validating its traditional use. The mechanism of action and long-term toxicity remain uncharacterized. Future studies should isolate bioactive compounds, assess chronic toxicity, and conduct clinical trials to confirm human efficacy. They should also focus on elucidating the mechanism of action behind the antidiarrheal effect.
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.
Immunomodulatory Activity Evaluation of Polysaccharides from Maerua Subcordata (Gilg) Dewolf Tuber
(Mekelle University, 2025-05-25) Werkey Araya Tekleargis
A robust, well-functioning immune system is the cornerstone of good health. The rising prevalence of infectious diseases and immune-related disorders underscores the urgent need for effective therapeutic solutions. Plant derived immunomodulators offer promi sing alternatives, enhancing immune responses with less toxicity and fewer side effects as compared to synthetic drugs. This study investigated the chemical characterization and immu nomodulatory activity evaluation of polysaccharides extracted from the tuber of Maerua subcordata. Polysaccharides were extracted from the tuber of M. subcordata using hot water extraction, followed by the addition of ethanol and centrifugation. Carbon clearance and humoral antibody titer (HAT) tests were used to evaluate the in vivo immunomodulatory activity of both the crude drug and the polysaccharide fraction. The crude drug and the polysaccharide fraction were tested at 100, 200, and 400 mg/kg in Swiss Albino mice. The chemical nature of the polysaccharide fraction was characterized by ultraviolet-visible (UVVis) and Fourier-transform infrared (FT-IR) spectroscopy. The polysaccharide fraction at 400 mg/kg bw has the maximum effect (P<0.05) on the carbon clearance rate. It increased the elimination of carbon particles by 0.1272±0.03763. The crude drug and the polysaccharide fraction increased the level of HAT against sheep red blood cell (SRBC) in comparison to the vehicle control group. Particularly, the polysaccharide fract ion at 400 mg/kg significantly (P<0.05) increases the level of mean secondary HAT (160.00 ±32.00) against SRBC, which is slightly greater than levamisole-treated groups. The FTIR analysis of polysaccharides shows the existence of various functional groups, such as alkenes, alkanes, alcohol, ether, carboxylic acid, amine, and carbonyl groups in the polysaccharide fraction. The crude drug mainly, the polysaccharide fractions exhibited promising immunostimulant activity by enhancing carbon clearance rate and humoral antibody titer tests.
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.
Parasitic contamination of raw vegetables and associated risk factors at production sites, markets, and street food vendors in urban and peri-urban areas of Mekelle and South Eastern Zone of Tigray
(Mekelle University, 2025-03-25) Mulaw Weldeslassie
For a healthy diet, people have been encouraged to eat lots of raw (fresh) vegetables and these can serve as vehicles of transmitting enteric parasitic pathogens throughout the process of planting to consumption. The aim of the present study was to determine the prevalence of parasitic contamination of raw vegetables and associated risk factors at production sites, markets and street food vendors in urban and peri-urban areas of Mekelle and South Eastern Zone of Tigray. To determine the prevalence of parasitic contamination of raw vegetables and associated risk factors at production sites, markets and street food vendors in urban and periurban areas of Mekelle and South Eastern Zone of Tigray. The study was conducted from July/2024-October30/2024 at the urban and peri urban areas of Mekelle and adjacent villages of South Eastern Zone of Tigray. The samples were collected from three different sites. These sites are the farm (production sites), markets (including street vendors) where these vegetables are sold and street food vendors where these vegetables are sold as a food where they are co nsumed at that point. A total of 13 sites were visited to collect vegetables. The samples was transported to the laboratory for parasitological analysis. Besides, samples of sludge and refreshing water was collected and analyzed for the presence of parasites. Moreover, information on socio-demographic and other risk factors was collected from the owners/sellers and the immediate environment. Data was coded, cleaned before and entered using SPSS 27.0 version for statistical analysis. This study found a 62.6% prevalence of parasitic contamination in raw vegetables, with B. coli (35%) and S. stercoralis (25%) being the most common. Lettuce had the highest contamination rate (95.8%), followed by beetroot (76.6%) and cabbage (56.5%).and the study identified several factors contributing to contamination, including poor hygiene practices, unhygienic environments, and inadequate washing of vegetables The level of parasitic contamination of raw vegetables in Mekelle city and its suburb is of public health importance. Hence, the public health sector should create public awareness in order to reduce parasitic transmission via consumption of raw vegetables. The project was accomplished within a period of 4 months starting from July/2024 to October 2024
Parasitic contamination of raw vegetables and associated risk factors at production sites, markets, and street food vendors in urban and peri-urban areas of Mekelle and South Eastern Zone of Tigray
(Mekelle University, 2025-03-25) Mulaw Weldeslassie
For a healthy diet, people have been encouraged to eat lots of raw (fresh) vegetables and these can serve as vehicles of transmitting enteric parasitic pathogens throughout the process of planting to consumption. The aim of the present study was to determine the prevalence of parasitic contamination of raw vegetables and associated risk factors at production sites, markets and street food vendors in urban and peri-urban areas of Mekelle and South Eastern Zone of Tigray. To determine the prevalence of parasitic contamination of raw vegetables and associated risk factors at production sites, markets and street food vendors in urban and periurban areas of Mekelle and South Eastern Zone of Tigray. The study was conducted from July/2024-October30/2024 at the urban and peri urban areas of Mekelle and adjacent villages of South Eastern Zone of Tigray. The samples were collected from three different sites. These sites are the farm (production sites), markets (including street vendors) where these vegetables are sold and street food vendors where these vegetables are sold as a food where they are co nsumed at that point. A total of 13 sites were visited to collect vegetables. The samples was transported to the laboratory for parasitological analysis. Besides, samples of sludge and refreshing water was collected and analyzed for the presence of parasites. Moreover, information on socio-demographic and other risk factors was collected from the owners/sellers and the immediate environment. Data was coded, cleaned before and entered using SPSS 27.0 version for statistical analysis. This study found a 62.6% prevalence of parasitic contamination in raw vegetables, with B. coli (35%) and S. stercoralis (25%) being the most common. Lettuce had the highest contamination rate (95.8%), followed by beetroot (76.6%) and cabbage (56.5%).and the study identified several factors contributing to contamination, including poor hygiene practices, unhygienic environments, and inadequate washing of vegetables. The level of parasitic contamination of raw vegetables in Mekelle city and its suburb is of public health importance. Hence, the public health sector should create public awareness in order to reduce parasitic transmission via consumption of raw vegetables. The project was accomplished within a period of 4 months starting from July/2024 to October 2024
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.
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.
PREVALENCE AND FACTORS ASSOCIATED WITH SPONTANEOUS PRETERM BIRTH AMONG MOTHERS WHO DELIVERED IN PUBLIC GENERAL AND REFERRAL HOSPITALS OF TIGRAY REGION, NORTHERN ETHIOPIA, 2024
(Mekelle University, 2025-01-28) PAWLOS TEKIA
Preterm birth has been referring to as babies born alive before 37 weeks or before 259 days of gestation of pregnancy are completed. Preterm birth is the leading cause of infant morbidity and mortality throughout the world. the magnitude of PTB remains a major issue in most developing countries including Ethiopia. To assess the prevalence of spontaneous preterm birth and associated factors among women’s giving birth in Tigray region, North Ethiopia in 2024. A hospital-based cross-sectional study was undertaken from November to December 2024. A systematic sampling technique was used to select 325 mother. The data were collected using kobo toolbox by interviewing the mothers and reviewing their charts using a structured and pretested questionnaire. The outcome variable was spontaneous preterm birth. Data were export from Kobo Toolbox to Excel then to SSPS version 27. Then analyzed using SSPS version 27. Bivariate and multivariable logistic regression analyses were done to determine the risk factors associated with premature birth. Variables statistically significant in Bivariate analysis at p-value less than 0.25 were taken to the multivariable logistic regression. Multivariable logistic regression was done to identify the associated factors of spontaneous preterm birth at P-value < 0.05 were considered reliable for the analysis of this study. in this study, the prevalence of spontaneous preterm birth was 25.2 % (95% CI: 20.48, 29.92%). In multivariable logistic regression model; multiple gestation(AOR) =0.069: 95% CI 0.023–0.206), inadequate iron folate supplementation (AOR = 6.019% CI 1.568–23.105), PROM (AOR = 7.680: 95%CI 3.044–19.378), PIH (AOR = 3.554:95% CI 1.325–9.532), and UTI during pregnancy (AOR = 2.589: 95% CI 1.970–6.912) were significantly associated with preterm birth. The present study found that multiple gestation, inadequate iron folate supplementation, PROM, PIH and UTI during pregnancy were factors associated with preterm birth. Ensure that all pregnant women receive comprehensive ANC services with a focus on monitoring high risk pregnancy like multiple pregnancy, those with history of PROM, PIH, screening and treating infections such as UTI and providing adequate iron folate supplementation for at least three months during pregnancy is decisive.