Toxic effects of 70% ethanol extract of Moringa stenopetala leaf (Baker f.) Cufod. (Moringaceae) on fetus and placenta of pregnant Wistar rats.

BACKGROUND: Moringa stenopetala leaves (Baker f.) Cufod. (Moringaceae) are used as a staple food and traditional medicine for treating various diseases like malaria, hypertension, stomach pain, diabetes, elevated cholesterol, and removing the retained placenta. Its prenatal toxicity study is minimal. Thus, this study aimed to assess the toxic effects of a 70% ethanol extract of Moringa stenopetala leaf on the fetuses and placentas of pregnant Wistar rats. METHOD: Fresh leaves of Moringa stenopetala were collected, dried at room temperature, ground to powder, and extracted using 70% ethanol. For this study, five groups of animals, each containing ten pregnant rats, were used. Groups I-III were experimental groups and treated with 250, 500, and 1000 mg/kg body weight of Moringa stenopetala leaf extract, respectively. Groups IV and V were pair-fed and ad libitum control groups. The extract was given during gestation days 6 to 12. The fetuses were recovered at day 20 of gestation and examined for the presence of developmental delays, gross external malformations, skeletal and visceral defects. Gross and histopathological changes in the placenta were also evaluated. RESULTS: Compared to the pair-fed control group, maternal daily food intake and weight gain were reduced in the 1000 mg/kg-treated group during the treatment and post-treatment periods. A significantly higher number of fetal resorptions was also seen in the 1000 mg/kg treatment group. The crown-rump length and fetal and placental weights were all significantly reduced in pregnant rats given 1000 mg/kg. However, there were no visible malformations in the visceral organs as well as external genitalia in all the treatment and control groups. About 40.7% of the fetuses in the 1000 mg/kg treated rats had no proximal hindlimb phalanges. In addition, light microscopic investigations of the placenta in the high-dose treated rats revealed structural changes in the decidual basalis, trophoblastic zone, and labyrinthine zones. CONCLUSION: In conclusion, consumption of M. stenopetala leaves at a higher dose may have toxic effects on the development of rat fetuses. At a higher dose, the plant extract increased the number of fetal resorptions, reduced the number of fetuses, decreased the fetal and placental weights, and alter the placental histopathology. Thus, it is recommended to limit the excess feeding of M. stenopetala leaves during gestation.

The Missing Quality of Tuberculosis Care and Treatment Delivered in Public-Health Facilities, Northeast Ethiopia: A Cross-Sectional Study.

Tuberculosis (TB) remains a major global public-health problem. TB prevention and control measures are compromised by poor quality of care delivered to TB patients in health facilities during diagnosis, treatment, and follow-up; thus, this study was intended to determine the quality of TB care and treatment delivered in public-health facilities in Northeast Ethiopia. A cross-sectional study was conducted in health facilities in South Wollo zone from January to April 2018. Data were collected from each study participant through face-to-face interviews. A TB registration logbook was reviewed for every registered TB patient and compiled using a structured questionnaire and standard checklists. The quality of care for each health facility was graded as very good, good, marginal, poor, and very poor if health facilities achieved [90−100%], [80−90%), [70−80%), [60−70%), and <60% of performance indicators, respectively, using the Donabedian structure, process, and outcome model of healthcare quality. All the health facilities had at least one functional microscope, and all the facilities had sufficient TB drugs almost all the time. All the facilities had reported to have sufficient laboratory reagents and slides for sputum smear microscopy. Of 1579 patients registered, 18.5% and 66.1% were cured and successfully completed the course of treatment, respectively. The overall quality of TB care and treatment was good (72.5%), and ranged from 70.9% to 74.8% among health facilities. Outcome (83.4%) and process (80%) qualities of care were very good but the structural quality of care was very poor. In conclusion, the overall quality of TB care and treatment analysed in this study was found to be good. There should be an integrated approach to improve the quality of TB care and treatment in health facilities in Ethiopia. Based on the findings, continuous supply of anti-TB drugs, laboratory equipment and reagents, availing current guidelines, providing up to-date training for healthcare workers, and proper documentation are important to improve the quality of care delivered to TB patients.

Clinical profiles, comorbidities, and treatment outcomes of stroke in the medical ward of Dessie comprehensive specialized hospital, Northeast Ethiopia; a retrospective study.

BACKGROUND: Undoubtedly, stroke is expanding as a global public health issue. Stroke-related deaths are attributable to modifiable risk factors. A demographic shift in Ethiopia increased the prevalence of stroke risk factors. Furthermore, there is limited relevant information available about stroke. Therefore, the current study sought to evaluate the clinical profiles, comorbidities, and treatment outcomes of stroke in the medical ward of Dessie comprehensive specialized hospital. METHODS: A retrospective cross-sectional study design was employed among stroke patients. The study included medical records with complete patient information and a stroke diagnosis that had been verified using imaging techniques. Using simple random sampling, 344 medical records were selected, 312 of which met the requirements for inclusion. The frequency and percentage of sociodemographic characteristics and other variables were described using descriptive statistics. RESULTS: The patients were 59.2 ± 14.6 years old on average. About 14.7% of the study participants were chat chewers. Of stroke victims, about 52.2% had sensory loss and limb weakness. Nearly 44.9% of the patients had hemiplegia or hemiparesis when they were first seen, and 25.3% were unconscious. Hypertension (63.1%), atrial fibrillation (15.1%), and structural heart diseases (12.5%) were the frequently seen co-morbidities in stroke patients. About 35.8% of the patients had fully recovered and were released go from the hospital without suffering any repercussions. However, hospital deaths from stroke accounted for 21.8% of cases. Stroke fatalities usually involved hypertension, atrial fibrillation, and structural heart disorders. CONCLUSION: Sensory deficits, limb weakness, and mentation loss were all common clinical presentations in stroke patients. In particular, hypertension, atrial fibrillation, and structural heart diseases were commonly seen as comorbidities in stroke patients. Stroke mortality was high in the hospital. Thus, establishing promotive, preventive, curative, and rehabilitative strategies is indispensable.

Sex Differences in Stroke Risk Factors, Clinical Profiles, and In-Hospital Outcomes Among Stroke Patients Admitted to the Medical Ward of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Background: A stroke is a vascular accident that affects both men and women. The threat of stroke and outcome status differ between the sexes. Such data are lacking in Ethiopia. Therefore, this study assessed sex differences in stroke risk factors, clinical profiles, and outcomes in the medical ward of Dessie comprehensive specialized hospital. Methods: A retrospective cross-sectional study was employed among stroke patients. Medical records with complete information and a confirmed diagnosis of stroke using imaging techniques were included in the study. Using simple random sampling, 344 medical records were selected, 312 of which fulfilled the inclusion criteria. Bivariate and multivariate logistic regression analyses and a chi-square test were employed. The frequency, percentage, and mean and standard deviation of the variables were described using descriptive statistics. Findings with a P-value <0.05 were considered statistically significant. Results: Most of the patients were above or equal to 45 years old in both sexes. A significantly higher number of male than female patients were aged less than 45 years (p-value-0.001). Younger age (AOR: 2.998, p = 0.000), cigarette smoking (AOR: 2.911, p = 0.009), and Khat chewing (AOR: 3.650, p = 0.001) were risk factors for stroke in males. A higher number of males presented with hemiplegia/hemiparesis 89 (28.5%), aphasia 45 (14.4%), and facial palsy 19 (6.1%). However, more females were unconscious (15.1%). Significant differences were not seen in the stroke outcomes. Furthermore, there were no apparent differences in risk factors for stroke-related mortality. Conclusion: Males developed stroke at a younger age. Women were older at the time of stroke onset and presented unconscious. More males experienced hemiplegia/hemiparesis, aphasia, and facial palsy. Smoking, drinking, and khat chewing were risk factors for stroke in men. There were no gender differences in the stroke death rate. Therefore, educating the public about stroke risk factors, lifestyle modification, and conducting prospective research is required.

Maternal vitamin D and growth of under-five children: a systematic review and meta-analysis of observational and interventional studies.

BACKGROUND: Even though previous systematic reviews have reported on the role of prenatal vitamin D on birth outcomes, its effect on child growth is poorly understood. OBJECTIVE: To synthesize a systematic summary of the literature on the effect of maternal vitamin D supplementation on the linear growth of under-five children. METHOD: This study includes studies (both observational and interventional with a control group) that evaluated the effects of prenatal vitamin D status on child linear growth. The mean child length/length for age with 95% confidence interval (CI) was pooled as the weighted mean difference using a random-effects model. A funnel plot was used to assess potential publication bias. RESULTS: A total of 45 studies and 66 reports covering a total population of 44,992 (19,683 intervention or high vitamin D group, and 25,309 control or low vitamin D group) were analyzed. Studies spanned from 1977 to 2022. The pooled weighted mean difference was 0.4 cm (95% CI: 0.15-0.65). A subgroup analysis, based on vitamin D supplementation frequency, showed that mothers who supplemented monthly or less frequently had a 0.7 cm (95% CI: 0.2-1.16 cm) longer child. Supplementation with a dose of >2000 international units increased child length at birth. The weighted mean difference was 0.35 cm (95% CI: 0.11-0.58). CONCLUSION: The evidence from this review shows that maternal supplementation of vitamin D is associated with increased birth length. This is apparent at higher doses, low frequency (monthly or less frequent), and during the second/third trimester. It appears that vitamin D supplementation during pregnancy is protective of future growth in under-five children. Clinical trials are needed to establish evidence of effectiveness for the frequency and dose of supplementation.

Prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia: A systematic review and meta-analysis.

Objective: The main aim of this systematic review and meta-analysis is to provide summarized evidence on the prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia. Method: Databases of MEDLINE/PubMed, Embase, Google Scholar, CINAHL, Cochrane library, and ScienceDirect were searched. In addition, gray literatures were searched manually from university repositories. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to select potential studies. Microsoft Excel 2013 sheet template was used to extract data. The quality of included studies was assessed by utilizing the Newcastle-Ottawa Scale. STATA software version 14.0 is used to compute the estimated pooled prevalence and associated factors of chronic kidney disease. Result: Twelve articles that fulfilled the inclusion criteria were included. The pooled estimate of chronic kidney disease among patients with chronic illnesses in Ethiopia is 21.71% (95% confidence interval: 17.67, 25.74). The highest prevalence of chronic kidney disease among patients with chronic illnesses is from Oromia (32.55% (confidence interval: 19.91, 45.19)). Glomerular filtration rate showed a comparable pooled prevalence from Cockroft-Gault and MDRD methods; 22.38% (confidence interval: 15.83, 28.92), 22.18 (confidence interval: 18.01, 26.34), respectively. Hypertensives become more likely to have chronic kidney disease compared with normotensive patients, (odds ratio = 3.01, 95% confidence interval: 1.33, 6.81). Conclusion: Prevalence of chronic kidney disease among chronic illness patients was significantly high. Hypertension is significantly associated with chronic kidney disease. Hence, we recommend that continuous screening of possible risk factors and proper follow-up and management strategies should be designed.

Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study.

BACKGROUND: Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. METHODS: A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. RESULTS: From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. CONCLUSIONS: Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.

Prevalence and outcomes of birth defects in newborns of South Wollo and Oromia zones of Amhara regional state: a retrospective study

Background: Congenital malformations (CMs) are structural and functional anomalies that have a significant but under-recognized cause of mortality and morbidity among infants and children under 5 years of age. CMs are not only life threatening, but also result in long-term disabilities that negatively affect individuals, families, health care systems and societies. Objectives: The purpose of this study was to describe the prevalence and outcomes of birth defects in newborns of South Wollo and Oromia zones of Amhara regional state. Methods: A retrospective cross-sectional study was done in three hospitals of South Wollo and Oromia zones, where 22,624 infants were born between January 2015 and December 2017. The presence and type of birth defects in the infants, as well as their outcomes, were identified by reviewing the medical records of their mothers. Medical records with incomplete information were excluded from the study. The data were collected using a pre-tested checklist for data collection. Results: A total of 22,624 infants were born during the study period. Three hundred and twenty-four (1.43%) newborns were delivered with birth defects. Anomalies of the central nervous system (CNS) were the most frequent type of birth defect (43.2%), followed by defects of the musculoskeletal system (19.7%), orofacial malformations (11.0%) and gastrointestinal system anomalies (6.1%). Most of the malformed infants were born from mothers with a history of alcohol intake (55.8%), lack of iron and folic acid supplementation (58.4%), family history of birth defects (58.7%) and history of diseases during pregnancy (53.5%). The outcomes of newborns with birth defects were significantly affected by the type of birth defect, gestational age, weight of the newborn and presence of twin pregnancy (p-value ≤0.05). Conclusions: The prevalence of CNS anomalies was the highest, followed by musculoskeletal system anomalies. The type of birth defect, gestational age, weight of newborn and twin pregnancy significantly affected outcomes of the newborns with congenital anomalies. Therefore, in order to reduce the prevalence of CMs, the identification and management of risk factors should be the focus of stakeholders