Referral of Surgical Patients Abroad: A 5-years Review from a Tertiary Teaching Hospital in Addis Ababa Ethiopia

Background: The general objective of this review was to determine the reasons for referral abroad of surgical patients at Addis Ababa University Medical Faculty; Tikur Anbassa Hospital Methods: The referral slips of patients who were referred abroad from September 2005 - August 2009 by surgical Department were collected and reviewed. Results: The study reviewed a total of 331 patents in the 5 year period mentioned. An average of 66 patients was referred per year. There was an over all male preponderance 183(55.3); majority of patients were in the age group 26 - 50 years (173).Most were residents from the Capital; 232 (70). Neoplastic diseases both benign and malignant account for 155 cases. Primary brain tumors either malignant or benign account for 74 cases. 97 of the cases had at least one surgical intervention done prior to referral. The overall trend is showing some decrement. The main reason for referral was for better surgical intervention (249). Referral for MRI which accounted for 16 of the referrals in the first 2 years was virtually non existent in the next 3 years. Conclusion: Most cases were form the capital; Neurosurgical cases have been referred more than any other subspecialties; neoplastic changes constitute the main reason for referral; and the overall trend seems decreasing along the course

Radiological and clinical details of major adult limb fractures in a teaching hospital, AAU, Ethiopia

Background: This prospective study done at Addis Ababa University; Medical Faculty; Department of Radiology; Tikur Anbessa Hospital was aimed at determining the causes; magnitude; radiological and Clinical patterns of major limb fractures in adults in a half-year period from March to August 2007.In Addis Ababa University; fractures are managed both conservatively and operatively; but for lack of implants or expertise; patient which should have been treated surgically are managed conservatively and stay very long (average hospital stay of 11 days) in the Hospital. Such knowledge helps to plan on the management of the fractures and resource-recruitment. . Methods: This was a half-year cross-sectional higher institution based study of 422 adult patients with major fracture/s on the limbs. The study included all the major limb trauma patients who attended the 'surgical' and orthopedic Emergency department of T.A.U.H and had fracture at the same time. Data collection related to radiological variables was done by the research team to help reduce inter-observer measurement variability. ""Difficult"" patterns were discussed further. Results: During the study period there were a total of 422 orthopedic adult patients who sustained a major fracture of their limbs. Mean age was 35 years with a male to female ratio was 3:1. Pathological fractures were encountered only in two (0.5) patients. Nearly half (202; 48) of the traumatic fractures were due to road traffic accidents. The highest frequency of fracture occurred on the femur (68; 15); tibiofibular bones (63; 14) and the humerus (61; 13.5). A little less than half (44.1) half of the femur fractures were in the proximal one-third and about half of the tibiofibular fractures were in the distal third. Transverse fracture pattern was seen in about half of the fractures. Compound fracture occurred in 90 (21.3) of the cases. Thirty four (7.6) of the fractures involved the hand and only 13 (2.9) involved the foot bones. Conclusion: The very high proportion of closed long bone shaft fractures in a center with limited number of beds compels short Hospital stay using efficient operative fixations; including SIGN interlocking nails; plates and other implants.. Road traffic accidents (RTAs) were responsible for almost half of the fractures. Machine injuries and fall injuries were second and third respectively. As the proportions and patterns of the leading causes of adult traumatic fractures remained steadily high over the many years (other similar studies published by the author on this journal); due mutisectorial attention should be emphasized once again to dwindle their burden

Begging on the Streets of Addis Ababa: an Impact of Musculoskeletal Disability

Background: This was a 2-year interventional prospective study aimed at determining the frequency and pattern of musculoskeletal disability among beggars of the streets of Addis Ababa. It was part of a continuous multidisciplinary study that was trying to assess causes of street begging and looked for ways to stop it or at least bring it to 'tolerable' proportions. This part of the study mainly focused on treatable/correctable musculoskeletal disabilities leading to begging on streets in the city. It also assessed the degree; duration and reasons for street begging and determined whether correcting treatable musculoskeletal disabilities stopped beggars from begging or not. The study setting was in Addis Ababa city; in collaboration with C.A.R.D.O.S. Ethiopia. Methods: This was an interventional prospective follow-up study on beggars of the streets of Addis Ababa who claimed musculoskeletal disability as their main cause for begging. A location in a sub city was selected for a reason of hosting the largest number of beggars. In collaboration with the local administrator a clinic was opened amidst the busy street and volunteer street beggars with musculoskeletal disability were recruited for the study. Surgical procedures were performed in 61 'patients' and were followed for two years; from April 2007-April 2009. Some beggars refused a clearly beneficial surgery Results: Our survey revealed there are 1;237 street beggars including the outskirts of 'Entoto' mountain. Nearly two-third of the street beggars were males and age ranged from a week to 90. Of the 204 beggars with musculoskeletal disability; 118 were evaluated to clearly benefit from a successful surgical procedure. The commonest diagnosis was leprosy with its complications recorded in 47 of the 204; followed by bone and joint infections; 13.2( 27/204) and complex; unclear congenital anomalies ranked third. Neglected dislocations; mal-united of non-united fractures were observed in twenty (9.8) of the street beggars. Iatrogenic cause was discovered as a cause of disability in six beggars. Sixty one beggars were operated. The ages for operated cases ranged from 12 to 78 years. The duration of begging in beggars selected for surgery was from 4.5 to 56 years. Corrective amputation; Bone grafting and Sequestrectomy were the commonest procedures in respected order. One patient died due to concomitant cardiac illness. From the whole group 68 patients went back to begging while from the operated group only a single patient recently was found begging in one of the streets in Addis. Conclusion: Musculoskeletal disability may lead to begging. Well-funded; multi-sectoral long-term campaign on begging will possibly reduce it to a 'tolerable' level