Assessment of Morphological and Morphometrical Variations of Sacral Hiatus in Dry Human Sacrum in Ethiopia.

BACKGROUND: The sacral hiatus is an opening present at the lower end of the sacral canal. The anatomy of the sacral hiatus and its variations are clinically important during administration of caudal epidural block (CEB) in obstetrics and gynecology, orthopedic, urology and general surgical practices. The success and reliability of CEB depends upon the sound knowledge of anatomical variations of the sacral hiatus. OBJECTIVE: The aim of this study was to assess the morphological and morphometric variation of the sacral hiatus in dry human sacrum. METHODS: An institution-based observational cross-sectional study design was conducted to assess morphological and morphometric variations of the sacral hiatus in 61 dry human sacrum specimens at the anatomy departments of Gondar, Addis Ababa, Hawassa and Jimma universities and Hayat and Korea Medical Colleges in Addis Ababa. Descriptive analysis was applied to analyze the data. RESULTS: The most commonly recorded shape of the sacral hiatus is inverted-V (41%) followed by inverted-U (37.7%). The least common was complete bifida (1.6%). The apex of the sacral hiatus is mostly seen at the level of the 4th sacral vertebra (60.7%), while the base is commonly located at the level of the 5th sacral vertebra (78.7%). The mean length of the sacral hiatus is 22.67 ± 11.84 mm. The mean transverse width and mean anteroposterior diameter of the sacral hiatus at the apex are 13.14 mm ± 2.85 mm and 5.57 mm ± 1.53 mm, respectively. CONCLUSION: The sacral hiatus has anatomical variations. These variations should be kept in mind during administration of caudal epidural anesthesia and analgesia.

Sexual and reproductive health of young people with disability in Ethiopia: a study on knowledge, attitude and practice: a cross-sectional study.

BACKGROUND: As is common in developing countries, in Ethiopia young people with disabilities (YPWD) are more likely than the general population to be illiterate, unemployed and impoverished. They often lack equal access to information and education for reasons ranging from barriers regarding physical access to services to varied special learning needs. Very little is known about knowledge, attitude and practice (KAP) of YPWD regarding sexual and reproductive health (SRH) related issues. We, therefore, aimed to assess the KAP of 426 YPWD in Addis Ababa, Ethiopia. METHODS: A cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire covering socio-demographic information, as well as information on KAP regarding SRH. RESULTS: Only 64.6% of YPWD were aware of SRH services. Radio and TV were mentioned as the main sources of information by 62.2% of the participants. 77.9% had never had a discussion about SRH topics with their parents. Even though 96.7% of the respondents had heard about HIV, 88% had poor knowledge about ways of preventing HIV. Perception of the risk of getting infected with HIV was found to be generally low in YPWD; only 21.6% believed that they were at risk of acquiring HIV. CONCLUSIONS: Our study, in general, demonstrated that there is a lack of comprehensive knowledge, appropriate practice and favorable attitude of YPWD regarding different SRH-related issues. Our findings thus clearly indicate the need for strategies and programs to raise SRH-related awareness and to help YPWD to develop the appropriate skills and attitudes needed for a healthy reproductive life.

Conjunctival impression cytology and detection of vitamin A deficiency in pregnant women, Gondar, Northwest Ethiopia.

BACKGROUNDS: Ethiopia has been classified by the WHO as a country where vitamin A deficiency is a public health problem. Vitamin A deficiency is labelled as a public health problem based on its extensively studied endemicity among children. Maternal vitamin A deficiency has received little attention. Thus the principal objective of this study is to assess the vitamin A status of pregnant Ethiopians based on Conjunctival Impression Cytology (CIC) and serum levels of vitamin A. METHODS: It is a descriptive study done among women attending ANC in the second and third trimesters of pregnancy at the ante-natal clinic of Gondar University Hospital. Women who appeared in July to October 2006 were recruited into the study based on inclusion criteria. Their socio-demographic and economic status, dietary, anthropometric and maternity data were collected with the help of structured questionnaire. Fasting blood samples were taken from the antecubital vein of each woman for determination of serum retinol. Furthermore, conjunctival cell samples were collected on Millipore Cellulose Acetate Filter to detect vitamin A deficiency related to Goblet cells and squamous metaplasia. RESULTS: A total of 303 pregnant mothers were included in this study. Twenty-six percent of the pregnant women had vitamin A deficiency or low serum retinol. Night blindness was found in 4.3% of the pregnant women. CIC results showed absence of goblet cells and/or mucin was seen more in those with low serum retinol but this was not statistically significant. CONCLUSION: Adequate nutrient supplementation to pregnant women is recommended based on the results. Further studies should be conducted to validate the importance of CIC.

Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia.

BACKGROUND: Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients. METHODS: A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures. RESULTS: Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was Entamoeba histolytica/dispar (7.3%) followed by Giardia lamblia (5.0%), Cryptosporidium parvum (1.8%) and Isospora belli (1.3%). The dominant helminthic parasite identified was Ascaris lumbricoides (5.5%) followed by Strongyloides stercoralis and Schistosoma mansoni (3.1% each), hookworm infection (1.8%), and Hymenolepis species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria Shigella and Salmonella species were isolated from 15.6% and 1.6%, respectively, of the patients. Escherichia coli O57:H7 was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the Shigella and Salmonella isolates were resistant to one or more commonly used antibiotics, respectively.Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (P < 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (P < 0.05). CONCLUSIONS: The high prevalence of intestinal parasites and Shigella species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia.

BACKGROUND: Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia. METHODS: In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography. RESULTS: After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 µmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 µmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 µmol/L, P < 0.004). VAD (serum retinol < 0.7 µmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002). CONCLUSION: The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.

Experiences with dissection courses in human anatomy: a comparison between Germany and Ethiopia.

Dissection courses in human anatomy are laborious, and new teaching tools have become available. Therefore, some universities intend to reduce the dissection course. Furthermore, little is known about dissection courses in African universities. The aim of this study is to compare the students' experiences with and evaluations of the dissection courses in two universities: Leipzig (Germany) and Gondar (Ethiopia). Since the Gondar Medical College was founded in cooperation with the Leipzig University in 1978, the anatomy courses in both universities follow roughly the same rules. A structured questionnaire was used to assess the dissection courses from the students' point of view. The sample of students consisted of 109 German and 124 Ethiopian first year undergraduate medical students. Most students in both countries (94% in Germany and 82% in Ethiopia) judge the dissection course to be highly relevant compared to other courses. Perceived health hazards associated with dissection of the cadaver show significant differences between Germany (14%) and Ethiopia (44%). Most students had normal feelings again at the end of the dissection course. Further similarities and differences between the courses in Germany and Ethiopia are described. Dissection courses are highly appreciated also in Africa. The high degree of affirmation of the dissection courses should be taken into consideration when discussing modifications of gross anatomy curriculum or changes in the teacher to student ratio.

Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five--year retrospective study.

BACKGROUND: In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia. METHODS: We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables. RESULTS: From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate. CONCLUSION: The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.

Effects of dental implant surfaces on the expression of bone sialoprotein in cells derived from human mandibular bone.

BACKGROUND: Protein adsorption is believed to be the first event that takes place after contact of natural tissue with an artificial surface. Bone sialoprotein (BSP) is one of the major noncollagenous proteins in the extracellular matrix of bone. The expression of BSP coincides with initial bone mineralization and is believed to be a center of crystallization for hydroxyapatite formation. MATERIAL/METHODS: We used a variety of four differently designed dental implant surfaces (SLA, CPT, ANOX, TICER) to investigate the effects on the development of adult human mandibular bone at days 5, 10, 15, 20, and 25 in vitro. The time course of the expression of BSP and labeling of fibroblasts was visualized immunohistochemically. The distribution patterns of cells were determined semiquantitatively on both the surface and the tissue-implant borderline. RESULTS: BSP immunoresponse increased from day 5 before decreasing after day 15 in vitro. The distribution of BSP-expressing cells changed during that time. Cell counts revealed that the time course of the settlement of cells depended on the design of the surface of the implant. The design of the border of the implant affected both the cell distribution patterns and the survivals of cells to a higher degree than did the design of the implant surface. CONCLUSIONS: Investigation of novel biomaterials for bone engineering represents an essential area for the design of tissue-engineering strategies. The hydroxyapatite-based implant material TICER could be a good scaffold to guide and promote the regeneration of bone tissue.