Validation of a Vaginal Birth after Cesarean Delivery Prediction Model in Teaching Hospitals of Addis Ababa University: A Cross-Sectional Study.

BACKGROUND: External validation of a vaginal birth after cesarean delivery (VBAC) prediction model is important before implementation in other settings. The primary aim of this study is to validate the Grobman prenatal VBAC calculator in the Ethiopian setting. Secondarily, the study was aimed at developing and comparing a new VBAC model that includes both the prenatal and intrapartum variables. METHODS: A cross-sectional survey was conducted, complemented by a medical chart review of 268 women admitted at three teaching hospitals of Addis Ababa University and who underwent a trial of labor after one prior cesarean birth. Maternal age, prepregnancy BMI, prior vaginal delivery, prior VBAC, and prior cesarean delivery indication type were included in the Grobman model. Observed delivery outcomes were recorded and then compared with the outcomes predicted by the calculator. We assessed the predictive abilities of the Grobman model and the new model using a receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was conducted to identify variables associated with successful VBAC. RESULTS: Out of the 268 participants, 186 (69.4%) (95% CI 57.5-81.3) had successful VBAC. The area under the ROC curve (AUC) of the Grobman model was 0.75 (95% CI 0.69-0.81). Notably, the novel model including both the prenatal and intrapartum variables had a better predictive value than the original model, with an AUC of 0.87 (95% CI 0.81-0.93). Prior VBAC, prepregnancy BMI, fetal membrane status, and fetal station at admission were predictors of VBAC in the newly developed logistic regression model. CONCLUSIONS: The success rate of VBAC was similar to other sub-Saharan African countries. The Grobman model performed adequately in the study setting; however, the model including both the prenatal and intrapartum variables was more predictive. Thus, intrapartum predictors used in the new model should be considered during intrapartum counseling.

Assessment of cervical cancer services and cervical cancer related knowledge of health service providers in public health facilities in Addis Ababa, Ethiopia.

OBJECTIVE: To assess cervical cancer services and knowledge of health service providers in public health facilities. RESULT: Two of the three hospitals had cervical cancer screening services. One-third of the hospital had cervical cancer diagnosis service punch biopsy and cervical cancer treatment. Majority, 289 (93.5%) of study participants said cervical cancer was a preventable disease. Having multiple sexual partners 257 (83.2%) and post coital bleeding 251 (81.2%), were the most mentioned risk factor and clinical manifestation of cervical cancer respectively. Majority of the participants were aware of the correct time to start screening 291 (70.5%), and only 95 (25.9%) knew the screening intervals. Overall, 165 (53.4%) of health providers scored below the mean knowledge level score. Females had better knowledge about cervical cancer than males (X2 = 8.4, P = 0.003).

Health related quality of life of gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

BACKGROUND: Being diagnosed with gynaecologic malignancy certainly will have different sequelae which can hamper quality of life (QOL).This study aimed to assess health related quality of life (HRQOL) among gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia. METHODS: This study employed facility-based cross-sectional study design on 153 gynaecological cancer patients attending TASH using the Amharic version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). We used descriptive statistics, independent t test and one way analysis of variance (ANOVA) in statistical analysis. RESULTS: The mean Global Health Status (GHS) was 40.95(SD ± 24.35) and of the functional scores, social function was most affected (42.26, SD ± 32.08), whereas cognitive function is the least affected domain (mean = 88.21, SD ± 18.49). The highest score on the symptom scores was found to be financial difficulties (mean = 64.76, SD ± 32.43) followed by pain (mean = 55.12, SD ± 29.64) and fatigue (mean = 53.97, SD ± 28.54); the lowest score on the contrary was scored for diarrhea (mean = 1.19, SD ± 7.38). As stage increases there was a statistically significant reduction in GHS (p = 0.005) and in all functional score domains except the physical and emotional function. Advancement in stage of the disease has also affected significantly the symptom score domains except financial difficulties, nausea /vomiting and diarrhea. Patients who never went to school have scored a statistically significant lower score in GHS, physical function, role function and social function (p < 0.05). CONCLUSION: GHS, social function, financial difficulties, pain and fatigue were the most affected domains; however, cognitive function and diarrhea were less affected components of HRQOL of gynaecologic cancer patients. Place of residence, educational status, marital status, payment type, cancer type and stage of the disease were associated with different quality of life scores.

Reliability and Validity of Amharic Version of EORTC QLQ-C 30 Questionnaire among Gynecological Cancer Patients in Ethiopia.

BACKGROUND: Cancer is a growing public health problem worldwide. The focus of cancer treatment, in addition to curation, is improving the quality of life (QOL). This study aimed to assess the reliability and validity of Amharic version of European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) among gynecological cancer patients in Ethiopia. METHODS: A facility-based cross-sectional study was conducted using the Amharic version of EORTC QLQ-C30 on 153 gynecological cancer patients in Tikur Anbassa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Descriptive statistics, correlation analysis and multivariable linear regression were employed in statistical analysis. RESULTS: The Amharic version of EORTC QLQ-C30 had a Cronbach's α value of 0.81. The internal consistency for each domain of EORTC QLQ-C30 was also acceptable (Cronbach's α >0.7) except for cognitive function domain (Cronbach's α = 0.29). Stepwise multivariable linear regression analysis showed that emotional functioning (p<0.001), fatigue (p<0.001) and social functioning (p = 0.004) were the determinative scales of EORTC QLQ-C30 on global health status (GHS). The clinical validity test (Known group validity) showed that there were significant differences in score for twelve out of 15 domains, between surgery and radiation scheduled patients. All items of emotional function, role function, fatigue, and GHS meet the discriminate validity criterion. CONCLUSION: The Amharic version of EORTC QLQ-C30 found to be reliable and had an acceptable validity to assess the QOL for gynecological cancer patients. We recommend further work on the validity and responsiveness of the EORTC QLQ-C30 with stronger design.

A comparative study on first stage versus second stage caesarean section on maternal and perinatal outcome.

BACKGROUND: Caesarean delivery (C/D) can be done in the first or second stage of labor. One fourth of the primary C/D are reported to be performed in the second stage of the labor but are more complicated compared to the ones performed in the first stage. OBJECTIVE: To compare maternal and perinatal outcomes of caesarean delivery (C/D) performed in the second stage of labor compared with the first stage in the Ethiopian setting. METHODS: An institution based comparative cross-sectional study was conducted in three teaching hospitals in Addis Ababa, Ethiopia. A sample size calculation for double proportion was used, and, for every second stage C/D, the next three consecutive first stage C/D cases were taken as controls till the desired sample size was achieved. mean and standard deviation for continuous and proportion for categorical variables were used for descriptive statistics. T-test for difference in independent mean and chi square test to compare proportions was utilized. Odds ratio with 95% CI was used to measure the strength of association of selected variables. RESULT: A total of 3238 deliveries were attended in the three teaching hospitals during the study period making the (C/D rate of 30.1%. Three hundred eighty-eight emergency caesarean delivery cases were enrolled using the aforementioned technique with the proportion of 97 (10.9%) second stage and 291 (89.1%) first stage C/D. The most common indications in the first stage were non-reassuring fetal heart rate pattern (NRFHRP) accounting for 110 (37.8%) followed by arrest or protraction disorder of 68 (23.4%), whereas the commonest indication for the second stage C/D was cephalopelvic disproportion 46 (48.5%). Significant difference observed in the mean blood loss between the second stage and first stage C/D, 552 ml vs. 410 ml, (OR 30.13, 95% CI 16.25-55.85). Similarly, the women in the second stage C/D had longer mean hospital stay and mean longer operation time than first stage C/D, 5.34 vs. 6.96 days, (OR 1.72, 95% CI 1.05-2.85), and 31.12 min vs. 37.5, (OR 2.33, 95% CI 1.33-4.07), respectively. Five caesarean hysterectomies were done for postpartum haemorrhage and four cases of extension of incision site were encountered following second stage C/D compared to none in the first stage C/D. CONCLUSION: Though no maternal death or significant perinatal complications were encountered, women with second stage C/D had significant maternal morbidities than first stage cesarean delivery. Therefore, utmost effort should be made to avoid the procrastination of the decision for C/D to the second stage, but if such compelling situations are encountered, precautions, like involvement of the most senior person and vigilance to minimize the expected complications is warranted.

ADNEXAL TORSION A FIVE-YEARS RETROSPECTIVE REVIEW IN TWO HOSPITALS.

BACKGROUND: Adnexal torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Objective: To describe the clinical profile and therapeutic approaches of adnexal torsion in the Ethiopian setting. METHODS: A retrospective cross sectional descriptive chart review ofwomen with surgically proven adnexal torsion was conducted in two teaching hospitals from Jan 1 2007 - Dec 31, 2011. RESULTS: A total of 53 women with AT were analyzed. About 33(62%) of torsion occurred in the age group of 20 - 29 years. The most common symptoms were lower abdominal pain 52 (98.1 %) followed by nausea and vomiting 46 (86.8%), whereas, the common physical findings were lower abdominal tenderness 49(92.5%) and palpable pelvic mass 40 (76.9%). Adnexal torsion was considered in the diferential diagnosis upon initial evaluation only in 27 (51%) of the cases. Of the study subjects, only 7(13.2%) had surgery within 24 hours of arrival to the facility and the mean time from initial evaluation to surgery was 53.8±44.5 hours. Moderately positive correlation was observed between ultrasound and intra-operative adnexal size measurement (r = 0.716, p = 0.000). Using non-parametric independent sample test, none of the clinical profile categories studied show significant difference in mean time from initial evaluation to surgery. Despite the overwhelmingly benign pathology, most 46 (86.8%) ofpatients underwent adnexectomy_with only 3(5.7%) adnexal salvage rate. CONCLUSION: Delayed surgical intervention and low ovarian salvage rate inspite of predominantly benign pathology was observed. Therefore, high degree of suspicion, especially in patients with high risk factors, and timely intervention must be exercised in an effort to salvage the adnexae.

Fertility desires predictors among people living with HIV/AIDS at art care centers of two teaching hospitals in Addis Ababa.

BACKGROUND: Studies from different contexts worldwide in both developed and developing countries in the era of wide access to antiretroviral drugs indicate that many HIV positive individuals continue to exhibit high risk sexual behaviors, fertility intentions being one of the many characteristics. OBJECTIVE: Identify the level and determinants of fertility desire among people living with HIV/AIDS (PLWHAs) at antiretroviral treatment (ART) centers. METHODS: A cross-sectional study was conducted on randomly sampled, 396 PLWHAs. Odds ratio along with 95% confidence intervals were used to measure the association of the study variables with the outcome variable. RESULTS: The majority of respondents were females, 330 (83.3%), and 224 (56.6%) were in the age category of 25-35 years with the mean age of 33.5 +/- 6.61 years. From a total of 396 study subjects interviewed, 172 (43.3%) desired to have children in the future, out of which 123 (71.5%) stated positively that they intended to give birth in the near future, and of these 33 (26.8%) had taken action and are currently pregnant. CD4 count above 350/mm3, partner's desire to have a child, life time history of not having live births and number of alive children are the most important predictors of fertility desire reported in this survey. CONCLUSION: Fertility desire remains to be high. This will pose serious challenges in areas of high HIV prevalence, like Ethiopia, on the implementation of the PMTCT programs. The strong predictors of fertility desire found in our study on the other hand can be used by policy makers, planners, and health service providers in the planning and implementation of the PMTCT programs. We suggest a large scale studies to be undertaken in the future.

Foreign body in the vagina (FBV) in women of two different age groups.

We are presenting two case series of vaginal foreign body (VFB) in patients belonging to two different age groups. The literature review, summary of the two cases, and, the corresponding discussions will be presented.

Bilateral loss of inferior pubic rami: a case report.

We are reporting a rare case on a fourteen years old girl who presented with a vague abdominopelvic pain and frequent complaints of urinary symptom of hesitancy since her early childhood. The bilateral loss of the inferior pubic rami is a very rare clinical and congenital abnormality as evidenced by the world literature. This is the first ever reported case in an Ethiopian subject.