Aspergilloma of the Lungs: Operative Experience from Tikur Anbessa Hospital; Ethiopia

Background: Pulmonary aspergilloma represents a potentially life-threatening disease caused by saprophytic growth of Aspergillus fumigates in pulmonary cavities. This is the first report of its operative treatment from Ethiopia.The aim of this study was to determine the clinical presentations; operative treatments and post operative outcome of patients with pulmonary aspergilloma. Methods: This was a retrospective review of patients' record with post operative diagnosis of pulmonary aspergilloma treated over a period of three years between April 2005-March 2008 at The Tikur Anbessa hospital which is a teaching and referral hospital in Addis Ababa. Results: Eleven patients were included; 81.8of whom were males. Cough and hemoptysis were the two most common presenting symptoms; occurring in 11(100) and 10(90.9). The chest x-ray features typical for aspergilloma was seen in only 4(36.4). The left lung was involved in 8(72.75) and the upper lobes were the most commonly affected lobes occurring in 10 (90.9). The most frequent clinical indication for surgery was severe hemoptysis in 8 (72.75). Left upper lobectomy was the most frequently performed surgery in 4(36.4) and left pneumonectomy in 3(27.3). Four significant complications occurred in the postoperative period and one patient died; making the postoperative mortality 9.1. Histopathologic confirmation of the fungal ball was possible in 10 patients and the most common underlying cavitary disease was tuberculosis in 9(90). Conclusion: Aspergilloma is not an uncommon disease in Ethiopia and the diagnosis should be considered in patients who present with hemoptysis or chronic non-resolving cough. Surgery for pulmonary aspergilloma accounted for 5.8of all thoracotomies done at the hospital and we have adopted the policy of early surgical treatment for all cases. In our series; the commonest lung pathology behind the aspergillus lesions was cavitary pulmonary tuberculosis; similar to many reports. Since the typical x/ray finding is not present in all patients; we believe that a supportive x/ray finding is sufficient enough an investigation to decide on early surgery in patients who present with suggestive symptoms

The association of TB with HIV Infection in Oromia Regional National State; Ethiopia in 2006/7

Background: Infection with Human Immunodeficiency Virus (HIV) is an established risk factor for tuberculosis infection. Population-based data on associations between HIV and tuberculosis (TB) can provide an epidemiological assessment of the impact of HIV infection on TB in environments where individual based data are difficult to collect. Method: We used an ecological study to assess the association between infection with HIV and tuberculosis in Oromia Region National State; Ethiopia in 2006/7. Result: The prevalence of HIV infection was significantly associated with the incidence of TB across the areas in Oromia region (r=0.69; p0.01). Similar associations were also seen for the prevalence of HIV infection with the incidence of smear positive tuberculosis; smear negative tuberculosis and extra-pulmonary tuberculosis. Conclusion: Ecological association between HIV and TB is strong in Oromia Regional state. Therefore; in areas where there are high TB case notification rates; it is important to consider the possibility that the prevalence of HIV may also be increasing; and take appropriate public health measures to assess and address these issues

The Association of TB with HIV Infection in Oromia Regional National State; Ethiopia in 2006/7

Infection with Human Immunodeficiency Virus (HIV) is an established risk factor for tuberculosis infection. Population-based data on associations between HIV and tuberculosis (TB) can provide an epidemiologicalassessment of the impact of HIV infection on TB in environments where individual based data are difficult to collect. Method: We used an ecological study to assess the association between infection with HIV and tuberculosis in Oromia Region National State; Ethiopia in 2006/7. Result: The prevalence of HIV infection was significantly associated with the incidence of TB across the areas in Oromia region (r=0.69; p0.01). Similar associations were also seen for the prevalence of HIV infection with the incidence of smear positive tuberculosis; smear negative tuberculosis and extra-pulmonary tuberculosis. Conclusion: Ecological association between HIV and TB is strong in Oromia Regional state. Therefore; in areas where there are high TB case notification rates; it is important to consider the possibility that the prevalence of HIV may also be increasing; and take appropriate public health measures to assess and address these issues

Levels of Outpatient Satisfaction at Selected Health Facilities in Six Regions of Ethiopia

Background: Satisfaction is one of the meaningful indicators of patient experience of health care services. Asking patients what they think about the care and treatment they have received is an important step towards improving the quality of care; and to ensuring that local health services are meeting patients' needs. Various studies have reported that satisfied patients are more likely to utilize health services; comply with medical treatment; and continue with the health care provider. Objective: to assess and estimate the perceived levels of satisfaction with health services rendered at government health facilities in selected regions of Ethiopia. Methods: A cross-sectional study that involved an exit interview was conducted in purposively selected government health centers and general hospitals in six regions of Ethiopia. Data were collected using structured questionnaire between June and September 2004. Variables used in the study were grouped and summarized into three components; namely providers' characteristics; services characteristics and cleanliness of the health facilities. Each variable was scored on a 5 point Likert-like scale; ranging from 1 (very dissatisfied) to 5 (very satisfied). The mean score 2.5 is considered as a cut-off point and scores equal and above 2.5 are taken as an indicator of users' perceived satisfaction. Both bivariate and multivariate methods of data analyses were used as deemed necessary. Results: All the three components of investigated variables have reliability coefficients ranging from 0.57 to 0.82. Results of bivariate analyses depicted that the percentage for high mean score satisfaction with health providers' characteristics ranged from 77.25to 93.23; with service characteristics 68.64to 86.48; and satisfaction with cleanliness ranged from 76.50to 90.57. Results of multivariate analysis showed that relatively more explanatory variables were found to be significant ininfluencing cleanliness (cleanliness of waiting place; examination room and medical equipment). Most of the explanatory variables in service characteristics were not statistically significant as compared to other components. Conclusion: The investigators believe that improved service delivery in health facilities could be achieved by to proper and sustainable implementation of the newly initiated civil service reform program in civil service institutionsin the country. Furthermore; periodic assessment of health services and further study; especially from the user's satisfaction perspective is recommended as a fundamental initiative in the improvement of the performance of health facilities