Vol 55, No 3 (2017): July Issue

Background. Chronic hepatitis C virus (HCV) is a pandemic affecting more than 170 million people worldwide. It leads to cirrhosis, hepatocellular carcinoma, and extra hepatic complications like type 2 Diabetes Mellitus (DM) in up to 13-33%.

Objective. To assess the association of chronic HCV with DM among adult Ethiopians.

Patients and Methods.This case control study was conducted at Adera Medical and Gastroenterology center in Addis Ababa during September 1 through November 30,2015. One hundred forty one cases and 359 controls were included in the study after consent. Data regarding DM risk factors,CBC, liver chemistry, FBS, andsonographywere collected. HCV screening was done by rapid antibody test and confirmed by ELISA followed by PCR genotype and viral load testing fortreatment. The data were analyzed using SPSS version 20 software including Odds ratio and 95% confidence interval.

Results. Among the 141 cases with HCV infection, most (69.5 %) were from Addis Ababa, 54% were females with mean age of 50 years.. Genotypes 4 and 1 were predominant in 70% and 20%, respectively. Type 2 DM was diagnosed among 31% and 27% of the males and females with HCV infection, respectively in contrast to 4.2 % and 2.8% among matching controls.

Conclusion. HCV infection is significantlyassociated with development of type 2 Diabetes Mellitus, as opposed to controls, indicating the importance of screening for DM and vice versa.

Key words: HCV, Diabetes Mellitus, Ethiopia

Background: Gallstone disease constitutes a significant health problem in developed countries. While it was thought to be uncommon in Africa, it currently seems that the disease is more frequently seen than expected. The magnitude of gallstone disease is not well studied in Ethiopia. The purpose of this study is to determine the magnitude of the problem as seen in Ayder Referral Hospital in Mekelle.

Methods: A cross-sectional descriptive study was conducted during the period January 1, 2010 - December 31, 2013 at the Department of Surgery, Ayder Referral Hospital in Mekelle, Ethiopia. Data was obtained from chart records using a pretested structured questionnaire developed for the purposes of the study.

Results: A total of 225 patients were included in the study. The age group 30-49 years comprised one-half of the patients and over two-thirds (71.6%) of the patients were female. Abdominal pain was the predominant complaint, including right upper quadrant pain (74.7%), epigastric pain (20%), and left upper quadrant pain (4.9%). About one-third (34.7%) had radiation of the pain to the back and 15.6% to the shoulders. Fatty meal was identified as an exacerbating factor in 62.2% of the patients. One hundred and eighty-four patients were operated on; laparoscopy was done in 30.2%, and open cholecystectomy in 51.6%. Only two patients had a complicated immediate post-operative course.

Conclusion: This hospital based study result suggests that gallstone disease is not uncommon in the northern part of Ethiopia. The pattern and clinical profile of the disease is not different from what has been reported from other parts of Ethiopia and the rest of Africa. Well-designed epidemiological studies are required to determine the risk factors, the types of stones, the diagnostic value of radiological examination and the efficacy of laparoscopic management of gallstone disease.

Key words: Gallstone disease; Magnitude, Ethiopia

Background: Gastroschisis and omphalocele are abdominal wall defects that were first described as early as the 16th century. However, it was not until recently that these two conditions were categorized as separate entities. The aim of the study was to determine the occurrence and outcomes of major abdominal wall defects managed at a referral hospital.

Materials and Methods: A retrospective review of omphalocele and gastroschisis managed over 4 years at Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, from 1 September 2010 to 31 August 2014.

Results: A total of 39 neonates were seen, 24(61.5%) of whom were male (male: female ratio of 1.6:1). Among these, 23(59%) presented with isolated omphalocele, 9(23.1%) with isolated gastroschisis, 6(15.4%) with omphalocele and another anomaly and 1 had gastroschisis with another anomaly. A total of 13 deaths were recorded, with overall fatality rate of 33%. Neonates with omphalocele had significantly better prognosis (20% fatality rate) than neonates with gastroschisis (70% fatality rate). Preterm cases with abdominal wall defect had 50% fatality in contrast to term neonates for whom fatality rate was 31.3%. The observed fatality rate for low birth weight neonates with abdominal wall defect was 56.3% in contrast to 18.2% for normal birth weight neonates. Preterm birth (prematurity), low birth weight and time elapsed before arrival to the tertiary center were significantly associated with poor outcome. 

Conclusion: Overall, major abdominal wall defects have high fatality and gastroschisis has a significantly worse outcome than omphalocele.

Key word: Abdominal wall defects, gastroschisis, omphalocele, outcomes

Background: Head Injury is one of the most common reasons for patient  admission and death in a trauma setting. Trauma is one of the major burdens on our health system. Although there are some studies done on head injury patterns elsewhere in the country and in the world, there is no study done in Mekele. Anecdotal evidence shows that we are having a significant number of patients with head injury. Characterizing the pattern of head injury will help plan preventive measures. The objective of this study was to assess the burden of head injury admissions and operations in Ayder Referral Hospital.

Methods: Record review was conducted on charts of patients admitted to the surgical ward with a diagnosis of head injury. The study was conducted in Ayder Referral Hospital Department of Surgery and included charts of patients who were seen from January, 2011 to December, 2014 using a structured questionnaire. The collected data were analyzed using SPSS version 16.

Results: A total of 750 records were analyzed. The gender distribution is 598 males to 152 females, making the male to female ratio 4:1. The most commonly affected age group was from 6-25 years. A total of 422 (56.3 %) of the head injury patients came from the urban area. The causes of the head injury were fall down accident  in 41.9%, interpersonal violence in 24.8%, and road traffic accident (RTA) in 24.9 %. Of the 187 RTA cases 102 were pedestrians and 84 were vehicle occupants.

Conclusion: Head injury is causing significant morbidity and mortality. The young and male are commonly affected. Interpersonal violence is a neglected cause of head injury that needs to be addressed.

Key words: head injury, road traffic accident, violence

Background: Childhood is a period characterized by increased physical activity. This, coupled with wrong judgment of dangerous and risky situations, leads to increased chances of injury, if daily activities and play are not supervised by care givers.

Objective: This study sets out to evaluate the burden of childhood injury and spotlight the common conditions that predispose to it with view to proffering some solutions.

Methods and Materials: A retrospective analysis was carried out in all children with injury admitted from 1 September 2010 to 30 August 2015 in Mekelle Hospital.

Results:  In this series, there were 508 childhood injuries and the age distribution was 135(26.6%) between 0-4years, 196(38.6%) between 5-9 years and 177(34.8%) between 10-14 years. Most, 196 (38.6.0%) childhood injuries occurred in ages between 5- 9 years  followed by10-14 years of life accounting for 177(34.8%) of the cases. Boys 348(68.5%)were more predominantly affected than girls 160(31.5%). The causes of injury were fall down accident (30.1%), road traffic accident (24.8%), burn injuries(23.8%), puncture wounds (11.2%) and non-fatal interpersonal violence (8.7%). Fall down and road traffic accidents were the top causes of injury in ages between 5–9 and 10-14 years. Among the injury types, fractures accounted for 30.7%. The overall mortality rate was 4.9%, most of which was due to road traffic crashes and burn injuries.

Conclusion: In this study, the rate of pediatric injury appeared to be low in early childhood, while it showed a significant increase in school ages for all kinds of injury. The evidence indicated that most childhood injuries are preventable and that effective preventive measures can significantly reduce injury related childhood morbidity and mortality.

Key wards: Children, Injury type, Outcomes.

Background: Despite the global efforts to control malaria, it claimed 500,000 lives worldwide in 2015. This was partly accounted for by the increase in the drug resistance of the parasite brought about by the misuse of antimalarials by health professionals, especially in poorly equipped setups, where appropriate diagnostic tests are not widely utilized. Accordingly, there has been no study of Knowledge, Attitude and Practice (KAP) of health extension workers (HEW), which are the providers of primary health care, in prescribing antimalarials in Ethiopia and Beni-Shangul Gumuz Regional State (BGRS) in particular.

Objectives: The main objective was to assess the KAP of HEWs in prescribing antimalarials in Assosa Zone of BGRS.

Methods: Survey of KAP of 341 HEWs in Assosa zone of BGRS was conducted with a cross-sectional study design using structured and pre-tested self-administered questionnaires between July 1, 2016- July 30, 2016.

Results: The study showed that 314 (93.7%) of the respondents identified the correct antimalarial for Plasmodium falciparum and 281 (86.2%) for Plasmodium vivax. However, only 117 (41.7%) were giving age/weight appropriate chloroquine dose for pediatric age group and 223 (79.5%) for adults. Regarding the attitude of HEWs, the study also revealed that 88 (26.1%) of the respondents claimed they were highly likely to treat patients with antimalarials for fever without carrying out diagnostic tests, while 115 (34%) claimed they would never do so. Also, regarding the likelihood of treating patients with antimalarials in the presence of negative RDTs, 91 (27%) claimed they were highly likely to treat patients with drugs despite negative RDT test results while 122 (36.2%) claimed not to do so.

Conclusion and Recommendation: Though the implementation of the HEP and participation of HEWs in malaria prevention and control improved community accessibility to prevention and control methods in the region      markedly, this wider access needs to be balanced with appropriate use in order to minimize the problem of       resistance. Providing refresher courses, supportive supervision, and improving the referral linkage between the health posts and health centers is recommended.

Keywords: HEWs, KAP, Antimalarial resistance, Assosa, BGRS