Predictors of time to full enteral feeding in low birth weight neonates admitted to neonatal intensive care unit: a prospective follow up study.

BACKGROUND: Survival of LBW infants has increased in recent years because of novel perinatal interventions, but the introduction and advancement of enteral feeds for low birth weight infants is challenging. In Ethiopia the proportion of low birth weight infants is thought to be 17.3%. The purpose of this study was to determine the time to full enteral feeding (FEF) and its predictors in LBW neonates admitted to neonatal intensive care unit in selected hospitals of Addis Ababa, Ethiopia. METHOD: An institutional based prospective follow up study was conducted from March 15 to June 15, 2022 among 282 LBW neonates admitted to six randomly selected hospitals. Both primary and secondary data was used by interviewing mothers and prospective medical chart review of neonates. The Cox regression model was used and variables having a p-value less than 0.05 with 95% CIs in a multivariable analysis were declared as statistically significant association with time to full enteral feeding. RESULT: Out of 282 neonates involved in this study, 211 (74.8%) of them reached at FEF. The overall median time to full enteral feeding was 5 days. Predictors significantly associated with time to full enteral feeding were educational level, birth weight, cesarean delivery, hospital acquired infection, being on antibiotics, age at initiation of trophic feeding, routine gastric residual evaluation and NICU location (hospital). CONCLUSIONS: This study demonstrated the difficulty of understanding which low birth weight neonate will attain FEF in a timely manner and factors that affect time to FEF. There is a delay in full enteral feeding achievement among low birth weight neonates and there is a great deal of heterogeneity of practice among health care providers regarding feeding of infants as it was evidenced by a variation in feeding practice among hospitals. Nutrition should be considered as part of the management in neonatal intensive care units since low birth weight neonates are developing edematous malnutrition while they are in the NICU. There should be standard feeding protocol to avoid heterogeneity of practice and additional study should be conducted for each categories of GA and BW with long follow up time.

Survival and predictors of mortality among acute leukemia patients on follow-up in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5-year retrospective cohort study.

BACKGROUND: Although Ethiopia has more than 78% of leukemia cases and a significant burden of the disease, the survival of leukemia patients in the country is poorly recognized. The purpose of this study was to assess the survival and predictors of acute leukemia patients. METHODS: A 5-year retrospective cohort study was conducted including all acute Leukemia patients who visited Tikur Anbessa Specialized Hospital between January 2015 and December 2019. Data were retrieved from patient's medical records between March and April 2020. Using SPSS version 25, the Kaplan-Meier curve and Cox regression models were employed to analyze the data. RESULTS: A total of 119 patients with acute leukemia were retrospectively evaluated for 60 months, having 196 person-years of risk. About 46 deaths (38.7%) were recorded over the follow-up period, giving a mortality incidence rate of 23.5 (95% CL:18-52) per 100 person-years. The median survival time was 35 months (95% CI, 28.3-41.7). At 60 months of follow-up, the predicted overall survival rate after diagnosis for acute leukemia was 21%. The adjusted hazard ratio for acute leukemia subtypes (aHR:4.9, 95% CI:2.3-10.4), history of relapse (aHR:3.9, 95% CI:1.0-7.9), participant age (aHR:1.25, 95% CI:1-1.75), hepatomegaly (aHR:2.7, 95% CI:1.36-5.36), and splenomegaly (aHR:2.29, 95% CI:1.2-4.4). CONCLUSION: The 5-year overall survival rate was found to be 21%. The finding was remarkably lower than other published reports. Survival among acute leukemia patients was significantly associated with older age, history of relapse, hepatomegaly, splenomegaly, as well as certain subtypes. Therefore, improving early detection and initiation of treatment for all acute leukemia patients is necessary in order to improve patient's survival status.

Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia. METHOD: A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25. RESULT: A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs. CONCLUSION: There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.

Mother-to-Child Transmission of HIV and Associated Factors Among Exposed Infants in Pastoralist Health Facilities, South Omo Zone, Ethiopia, 2020 - A Retrospective Cross-Sectional Study.

BACKGROUND: Although HIV/AIDS is affecting all age groups, it is a primary cause of illness and deaths among children globally. A significant bulk of HIV infections in children under the age of 15 were as a result of vertical transmission, where it accounts for 95% of childhood HIV infections in Ethiopia. OBJECTIVE: To assess the proportion of mother-to-child transmission (MTCT) of HIV and associated factors among exposed infants on follow-up in pastoralist health facilities, South Omo, Ethiopia. METHODOLOGY: A retrospective, cross-sectional study was employed among 228 HIV-exposed infants. Medical records of HIV-exposed infant-mother pairs in the study institutions were extracted. The confirmatory HIV serostatus of every infant was taken at the end of 24 months. Data were entered in Epi Data 4.2 version and exported to SPSS version 25 for final analysis. Multivariable logistic regression analysis was used to identify significant predictor variables at P-value < 0.05. RESULTS: A total of 228 records were included in the analysis. The rate of HIV transmission was 5.3% (95% CI: 2.6-8.3%). Not receiving antiretroviral prophylaxis at birth (AOR = 5.8, 95% CI: 1.02-33.53), absence of maternal antiretroviral prior to current pregnancy (AOR = 5.6, 95% CI: 1.14-28.1), and mother's advanced World Health Organization clinical stage of HIV (AOR: 10.5, 95% CI: 1.4-81) were associated with MTCT of HIV. CONCLUSION: This study identified a high proportion of MTCT among exposed infants in the study area. Not receiving antiretrovirals prior to pregnancy and advanced WHO clinical stage of HIV, and not getting antiretroviral prophylaxis at birth resulted in higher risk of MTCT of HIV. Hence, health workers and policy-makers should offer antiretroviral prophylaxis, put mothers on antiretroviral therapy and limit the stage of HIV at lower WHO clinical stages.

Genetic Diversity and Acquired Drug Resistance Mutations Detected by Deep Sequencing in Virologic Failures among Antiretroviral Treatment Experienced Human Immunodeficiency Virus-1 Patients in a Pastoralist Region of Ethiopia.

PURPOSE: This study was conducted to investigate the drug resistance mutations and genetic diversity of HIV-1 in ART experienced patients in South Omo, Ethiopia. PATIENTS AND METHODS: A cross-sectional study conducted on 253 adult patients attending ART clinics for ≥6 months in South Omo. Samples with VL ≥1000 copies/mL were considered as virological failures (VF) and their reverse transcriptase gene codons 90-234 were sequenced using Illumina MiSeq. MinVar was used for the identification of the subtypes and drug resistance mutations. Phylogenetic tree was constructed by neighbor-joining method using the maximum likelihood model. RESULTS: The median duration of ART was 51 months and 18.6% (47/253) of the patients exhibited VF. Of 47 viraemic patients, the genome of 41 were sequenced and subtype C was dominant (87.8%) followed by recombinant subtype BC (4.9%), M-09-CPX (4.9) and BF1 (2.4%). Of 41 genotyped subjects, 85.4% (35/41) had at least one ADR mutation. Eighty-one percent (33/41) of viraemic patients harbored NRTI resistance mutations, and 48.8% (20/41) were positive for NNRTI resistance mutations, with 43.9% dual resistance mutations. Among NRTI resistance mutations, M184V (73.2%), K219Q (63.4%) and T215 (56.1%) complex were the most mutated positions, while the most common NNRTI resistance mutations were K103N (24.4%), K101E, P225H and V108I 7.5% each. Active tuberculosis (aOR=13, 95% CI= 3.46-29.69), immunological failure (aOR=3.61, 95% CI=1.26-10.39), opportunistic infections (aOR=8.39, 95% CI= 1.75-40.19), and poor adherence were significantly associated with virological failure, while rural residence (aOR 2.37; 95% CI: 1.62-9.10, P= 0.05), immunological failures (aOR 2.37; 95% CI: 1.62-9.10, P= 0.05) and high viral load (aOR 16; 95% CI: 5.35 51.59, P <0.001) were predictors of ADR mutation among the ART experienced and viraemic study subjects. CONCLUSION: The study revealed considerable prevalence of VF and ADR mutation with the associated risk indicators. Regular virological monitoring and drug resistance genotyping methods should be implemented for better ART treatment outcomes of the nation.

Machine Learning Model Applied on Chest X-Ray Images Enables Automatic Detection of COVID-19 Cases with High Accuracy.

PURPOSE: This research was designed to investigate the application of artificial intelligence (AI) in the rapid and accurate diagnosis of coronavirus disease 2019 (COVID-19) using digital chest X-ray images, and to develop a robust computer-aided application for the automatic classification of COVID-19 pneumonia from other pneumonia and normal images. MATERIALS AND METHODS: A total of 1100 chest X-ray images were randomly selected from three different open sources, containing 300 X-ray images of confirmed COVID-19 patients, 400 images of other pneumonia patients, and 400 normal X-ray images. In this study, a classical machine learning approach was employed. The model was built using the support vector machine (SVM) classifier algorithm. The SVM was trained by 630 features obtained from the HOG descriptor, which was quantized into 30 orientation bins in the range between 0 and 360. The model was validated using a 10-fold cross-validation method. The performance of the model was evaluated using appropriate classification metrics, including sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, kappa, and accuracy. RESULTS: The multi-level classification model was able to distinguish COVID-19 patients with a sensitivity of 97.92% and specificity of 98.91%, for the internal testing or cross-validation. For the independent external testing, the model showed sensitivity of 95% and specificity of 98.13%, for distinguishing COVID-19 from other pneumonia and no-findings. The binary classification model was able to distinguish COVID-19 patients with a sensitivity of 99.58% and specificity of 99.69%, for the internal testing. For the independent external testing, the model showed a sensitivity of 98.33% and specificity of 100%, for distinguishing COVID-19 from normal images. CONCLUSION: The model can achieve the rapid and accurate identification of COVID-19 patients from chest X-rays with more than 97% accuracy. This high accuracy and very rapid computer-aided diagnostic approach would be very helpful to control the pandemic.

Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study.

BACKGROUND: Acquired immune deficiency syndrome is one of the most destructive epidemics the world has ever witnessed. An estimated 36.9 million people were living with HIV in 2017. HIV/AIDS is the major contributing factor for morbidity and mortality in low- and middle-income countries. Although different studies on survival and predictors of mortality among HIV/AIDS patients after initiation of antiretroviral therapy were conducted, there are inconsistencies in the findings of those studies. Furthermore, to the authors' knowledge, there was a dearth of studies conducted in this study area. PURPOSE: The purpose of this study was to assess the survival and predictors of mortality among adult patients starting highly active antiretroviral therapy at Debre Berhan Referral Hospital, North Showa, Amhara, Ethiopia. PATIENTS AND METHODS: An institution-based retrospective study was conducted among the medical records of 447 study subjects' selected using simple random sampling from January 1t, 2013 to December 30, 2018. The data was collected using a structured data abstraction checklist and analyzed using Kaplan-Meier statistics and Cox regression models. RESULTS: Among 447 adult patients, 54 patients (12.1%) had died, giving a crude death rate of 4.18 per 100 person years (95% CI=3.20-5.45). The overall estimated survival rate after initiation of antiretroviral therapy was 81.7% (95% CI=75.36-86.54%) at 72 months of follow-up. The independent predictors of mortality were clinical stage IV (HR=15.6, 95% CI=6.609-36.948), baseline opportunistic infections (HR=1.86, 95% CI=1.048-3.330), baseline Hgb<10 mg/dL (HR=4.655, 95% CI=2.253-9.619), baseline CD4<200 cells/µL (HR=4.71, 95% CI=2.275-9.751), the presence of comorbidity (HR=2.56 95% CI=1.391-4.740), being widowed (HR=3.475, 95% CI=1.412-8.550), and bedridden functional status (HR=3.069, 95% CI=1.111-8.480). CONCLUSION: Patients with opportunistic infections, advanced clinical stage disease, bedridden functional status, baseline Hgb<10 mg/dL, baseline CD4<200 cells/µL, and comorbidity should be given special care.

Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study.

OBJECTIVES: The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia. METHODS: A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models. RESULTS: Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97). CONCLUSIONS: Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

Predictors of skilled assistance seeking behavior to pregnancy complications among women at southwest Ethiopia: a cross-sectional community based study.

BACKGROUND: In Ethiopia, about 20,000 women die each year from complications of pregnancy and child birth with many more maternal morbidities occurring for each maternal deaths. This makes Ethiopia one of the highest countries for maternal deaths in the developing world. This study attempted to assess women's skilled assistance seeking behaviour for pregnancy complications among those who gave birth. METHOD: A cross-sectional community based study was conducted among women who gave birth within one year regardless of their delivery place. The study was carried out in fifteen randomly selected villages at Arba Minch Zuria district, south west Ethiopia. Data was collected house-to-house using a pretested Amharic questionnaire. During the survey, 798 women were interviewed. Logistic regression model was applied to control confounders. RESULTS: Out of the total sample, 344 (43.1 %) respondents reported at least any one of the pregnancy complications faced in the recent pregnancy. The most common complications reported were malaria (57 %), nausea/vomiting (47.1 %) and severe head ache (29.1 %). of those women who faced complications, around 254 (73.8 %) sought assistance from a skilled provider. Ninety (26.2 %) of the respondents sought assistance either from unskilled provider or home based self-care. Unable to understand the seriousness of the complications, thought as unnecessary, and family disapproval were the major reasons for not seeking care from skilled providers. Belonging to monthly household income $US25- 100 (AOR = 3.4, 95 % CI; 1.04, 11.4), getting antenatal care from a skilled provider (AOR = 10.6, 95 % CI; 3.3, 34.5), Women in the age 20-34 years old (AOR = 3.8; 95 % CI, 1.2, 12.3), Availability of transport access (AOR = 72.2; 95 % CI; 17.2, 303.5) were significantly associated with seeking assistance from a skilled provider. CONCLUSIONS: Nearly half (43.1 %) of the women had faced pregnancy complications to the recent birth of last one year. Majority (2/3(rd)) of the women who reported complications sought skilled assistance. Family, income, transport issue and antenatal care use were independent predictors for skilled assistance from skilled provider.

High load of multi-drug resistant nosocomial neonatal pathogens carried by cockroaches in a neonatal intensive care unit at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

BACKGROUND: Cockroaches have been described as potential vectors for various pathogens for decades; although studies from neonatal intensive care units are scarce. This study assessed the vector potential of cockroaches (identified as Blatella germanica) in a neonatal intensive care unit setup in Tikur Anbessa Hospital, Addis Ababa, Ethiopia. METHODS: A total of 400 Blatella germanica roaches were aseptically collected for five consecutive months. Standard laboratory procedures were used to process the samples. RESULTS: From the external and gut homogenates, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter spp. Enterobacter cloacae, Citrobacter diversus, Pseudomonas aeruginosa, Providencia rettgeri, Klebsiella ozaenae, Enterobacter aeruginosa, Salmonella C1, Non Group A streptococcus, Staphylococcus aureus, Escherichia coli, Acinetobacter spp. and Shigella flexneri were isolated. Multi-drug resistance was seen in all organisms. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens. CONCLUSION: Cockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection. A high level of drug resistance pattern of the isolated pathogens was demonstrated.