Perceptions of readiness for interprofessional learning among Ethiopian medical residents at Addis Ababa University: a mixed methods study.

BACKGROUND: Interprofessional learning is an important approach to preparing residents for collaborative practice. Limited knowledge and readiness of residents for interprofessional learning is considered one of the barriers and challenges for applying Interprofessional learning. We aimed to assess the perceptions of readiness of medical residents for interprofessional learning in Ethiopia. METHODS: We conducted a parallel mixed-methods study design to assess the perceptions of readiness for interprofessional learning among internal medicine and neurology residents of Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, from May 1 to June 30, 2021. One hundred one residents were included in the quantitative arm of the study, using the Readiness for Interprofessional Learning Scale (RIPLS) tool. All internal medicine and neurology residents who consented and were available during the study period were included. SPSS/PC version 25 software packages for statistical analysis (SPSS) was used for statistical analysis. Descriptive statistics were summarized as mean and standard deviation for continuous data as well as frequencies and percentages to describe categorical variables. Data were presented in tables. In addition, qualitative interviews were undertaken with six residents to further explore residents' knowledge and readiness for IPL. Data were analyzed using a six-step thematic analysis. RESULTS: Of the 101 residents surveyed, the majority of the study participants were male (74.3%). The total mean score of RIPLS was 96.7 ± 8.9. The teamwork and collaboration plus patient-centeredness sub-category of RIPLS got a higher score (total mean score: 59.3 ± 6.6 and 23.5 ± 2.5 respectively), whereas the professional identity sub-category got the lowest score (total mean score: 13.8 ± 4.7). Medical residents' perceptions of readiness for interprofessional learning did not appear to be significantly influenced by their gender, age, year of professional experience before the postgraduate study, and department. Additionally, the qualitative interviews also revealed that interprofessional learning is generally understood as a relevant platform of learning by neurology and internal medicine residents. CONCLUSIONS: We found high scores on RIPLS for internal medicine and neurology postgraduate residents, and interprofessional learning is generally accepted as an appropriate platform for learning by the participants, which both suggest readiness for interprofessional learning. This may facilitate the implementation of interprofessional learning in the postgraduate medical curriculum in our setting. We recommend medical education developers in Ethiopia consider incorporating interprofessional learning models into future curriculum design.

Idiopathic Harlequin Syndrome in a Patient from Ethiopia: A Case Report.

Background: Harlequin syndrome is a rare disorder caused by autonomic nervous system dysfunction. It manifests as asymmetric facial flashing and sweating with contralateral anhidrosis. It may be primary (idiopathic) with a benign course or can occur secondary to structural abnormalities or iatrogenic factors. To our knowledge, there has been no report of idiopathic Harlequin syndrome published from Ethiopia. We are reporting this case since it signifies the existence of idiopathic Harlequin syndrome in our setting and the need to properly diagnose this condition. Case Presentation: We are reporting a 29-year-old female from Addis Ababa, Ethiopia, who presented with a complaint of left hemifacial hyperhidrosis of 8 years which worsen after routine household activities and exercise. Physical examination revealed left hemifacial hyperhidrosis with right-side anhidrosis. She was diagnosed with idiopathic Harlequin syndrome after an appropriate investigation revealed a nonremarkable finding. Symptomatic treatment showed no significant improvement and the patient was also counseled on the disease entity. Conclusions: The patient described here signifies an idiopathic Harlequin syndrome in an Ethiopian woman. This case highlights the existence of idiopathic Harlequin syndrome within our setting and the need to properly diagnose this condition.

Epidemiological and clinical profile of amyotrophic lateral sclerosis in Ethiopia: a 5-year multicenter retrospective study.

Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that results in progressive weakness of skeletal muscles including respiratory muscles. Epidemiological and clinical aspects of ALS are derived from a few world regions with very little representation of low- and middle-income countries. We therefore set out to determine the epidemiological and clinical phenotype of individuals with ALS in Ethiopia. Methods: Multicenter retrospective analysis was conducted using clinical records from ALS patients seen in Ethiopia at Tikur Anbessa Specialized Hospital and Yehuleshet specialty clinic between January 2016 and August 2021. The data collected included clinical characteristics, disease-related symptoms, a revised ALS functional rating scale, and medications. Results: Patients in Ethiopia had a younger age of onset with a mean age of disease onset of 51.9 years. 2.9% of patients had juvenile ALS, and the male-to-female ratio was almost 2:1. 4.9% had a positive family history of the disease. 68% of patients had spinal region involvement at onset, while 32% had bulbar region involvement at onset. Riluzole was used by 31% of ALS patients. 20.6% of patients had some respiratory symptoms, but none received a standard respiratory function assessment. 33.3% of patients were wheelchair-bound. Conclusion: In this retrospective study spanning 5 years, we examined the clinical phenotype of ALS in Ethiopian patients. Our findings suggest that most patients had clinically definite ALS with spinal region involvement. Further research, including genetic and epigenetic information, is necessary to understand the early onset of the disease in Ethiopia.

Probable HTLV-I/II Tropical Spastic Paraparesis Patient from Ethiopia: A Case Report.

Background: Available data on the burden of Human T-cell lymphotropic virus type I/II infection for eastern Africa, limited to Ethiopia, Mozambique, and Rwanda, show prevalence lower than elsewhere in Africa (0% - 1.8%). Even if Tropical Spastic Paraparesis occurs in an endemic form in Ethiopia, its seroprevalence is low. Over a lifetime, it is estimated that 1-2% of Human T-cell lymphotropic virus type I/ II -infected individuals will develop progressive and disabling inflammatory clinical manifestations. We are reporting this case since it signifies the existence of seropositive Tropical Spastic Paraparesis in our setting and the need to properly diagnose this condition. Case Presentation: We are reporting a 45 years old female patient from Addis Ababa, Ethiopia, who presented with progressive weakness of the lower limbs and urinary urge incontinence of five years duration. Serology for Human T-cell lymphotropic virus type I/ II antibody was positive. She was diagnosed to have probable tropical spastic paraparesis after fulfilling World Health Organization diagnostic criteria for tropical spastic paraparesis with the level of ascertainment. Symptoms showed transient improvements after providing five days of Methylprednisolone followed by low doses of corticosteroids and Azathioprine. The patient is now significantly disabled and wheelchair-bound. Conclusions: The patient described here signifies a probable Human T-cell lymphotropic virus type I/ II - associated myelopathy/tropical spastic paraparesis in Ethiopian women. This case highlights the existence of Human T-cell lymphotropic virus type I/II - associated myelopathy/ tropical spastic paraparesis within our setting and the need to properly diagnose this condition.

Aquaporin-4-IgG Positive Neuromyelitis Optica Spectrum Disorder from Ethiopia: A Case Report.

BACKGROUND: Neuromyelitis Optica spectrum disorder is an inflammatory disorder affecting the central nervous system), most commonly attacking the spinal cord or optic nerves. Limited cases of neuromyelitis optica have been reported in east Africa. Based on my review, if published, this would be the second published case of Neuromyelitis Optica spectrum disorder and the first published case of seropositive Neuromyelitis Optica spectrum disorder reported from Ethiopia. It signifies the need to have a high index of suspicion to promptly identify and properly treat these patients. CASE PRESENTATION: I am reporting a 32 years old female patient from Addis Ababa, Ethiopia, who presented with recurrent lower limb weakness and impairment of right eye vision of two-year duration. She was diagnosed based on Neuromyelitis Optica spectrum disorder diagnostic criteria, by having transverse myelitis, optic neuritis, confirmed by MRI imaging and high level of aquaporin-4-antibodies. Symptoms improved after providing five days of Methylprednisolone followed by low doses of corticosteroids and Azathioprine. The patient is now fully functional except for the right eye vision impairment. CONCLUSION: The patient described here signifies a classic manifestation of Neuromylitis Optica disorder with aquaporin-4-IgG occurring in Ethiopian woman. This case highlights the existence of Devic's disease within our setting and the need to properly diagnose this condition even in a resource-limited setting to avert disability.

Prevalence of sleep disorders in Parkinson's disease patients in two neurology referral hospitals in Ethiopia.

BACKGROUND: Non motor symptoms (NMS) of Parkinson's disease (PD) are common and can be more disabling than motor symptoms. Sleep disorders can be seen in up to 98% of patients with Parkinson disease. Poor sleep quality has been associated with poverty and race, and yet there has been no prior report on sleep disorders in those with PD living in sub Saharan Africa. We wished to document the prevalence of sleep disorders in PD patients in Ethiopia. METHODS: We conducted a cross-sectional point prevalence study from July 1 to October 30, 2015 of all patients attending the neurology outpatient department in Tikur Anbessa and Zewuditu Memorial Hospitals, Addis Ababa, Ethiopia. Demographic data, clinical history and physical examination findings were collected from participants using a structured questionnaire. We used the Parkinson's disease sleep scale version two (PDSS-2) and Epworth Sleepiness Scale (ESS) to assess the sleep symptoms. RESULTS: Of the 155 patients surveyed, all patients reported some sleep problem. Over 43.9% of patients had a PDSS score > 18. The median score of ESS was 9 (IQR = 5-12), with 77/155 (49.7%) of the patients having possible or definite excessive daytime somnolence. A high EDSS score significantly associated with a Hoehn & Yahr score > 4 (p = 0.02). CONCLUSIONS: In Ethiopian PD patients, the prevalence of those with severe sleep disorders is the highest reported to date. The prevalence of possible/definite EDS is amongst the highest in the world. Further investigation into whether poverty or race explains this finding is needed.