Caregiver satisfaction and its associated factors in pediatric wards of Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Measuring the caregivers' satisfaction is vital for the effectiveness of childcare. Children admitted to pediatric wards require special hospital situations, a bespoke approach from the medical team, and the participation of caregivers. It is important to give attention to the caregivers while planning for child services. The purpose of this study was to assess the caregiver's satisfaction with the services provided in pediatric wards of Jimma University Medical Center and identify its associated factors. METHODS: Facility-based cross-sectional study design was done at Jimma University Medical Center. Participants in the study were primary caregivers who spent two or more days in the pediatric ward with their admitted children. Data were collected from 400 selected caregivers. A consecutive sampling method was employed. Principal component analysis was done for all Likert scale instruments to extract factor (s) representing each of the scales and to have factor scores. Variables with the Likert scale were treated as continuous after principal component analysis was employed. Using these factor scores, a multiple linear regression analysis was carried out to identify factors associated with caregivers' satisfaction with service in pediatric wards. A significance level of less than 0.05 was used in the final model to determine statistical significance. RESULT: This study showed that caregivers' satisfaction with the services in the pediatric ward was 68%. Level of education (ß = -0.24, (95% CI; -.411, -.070)), availability of basic facilities (ß = 0.163, (95% CI; .063, .263)), patience to listen to patients' problem (ß = 0.431, (95% CI; .324, .537, staff communication with client (ß = 0.163, (95% CI; -4.839, -1.610)), availability of laboratory tests and its service (ß = -0.964, (95% CI; -1.435, -.493)), availability of drug, imaging and service at radiology (ß = 2.907, (95% CI; 1.470, 4.344)) and availability of pathology and its service (ß = 1.869, (95% CI; .993, 2.746)) were significant factors associated with caregivers satisfaction with health service in pediatrics ward. CONCLUSION: Caregivers were moderately satisfied. Education level, availability of basic facilities communication with client, and the availability of laboratory tests and drugs were factors that significantly associated with caregiver satisfaction. Hospital should avail laboratory tests and drugs in order to maintain high levels of caregiver satisfaction.

Unilateral Renal Artery Stenosis Associated with Severe Hypertension: Atypical Presentation of Tuberculosis.

BACKGROUND: Renal artery stenosis is a common cause of hypertension in children; however, infectious causes of renal artery stenosis are rare. Diagnosis of TB in children is challenging, causing delay in diagnosis. CASE PRESENTATION: We report a case of a 4-year-old girl who was presented with loss of consciousness and seizure of one day duration. The patient had severe acute malnutrition, symptom complex of TB and contact with adults having smear positive tuberculosis. Subsequently, her blood pressure was 200/140 mmhg. The patient was diagnosed with disseminated TB with left renal artery stenosis, severe hypertension, cardiomegaly, upper gastrointestinal bleeding, stroke and severe malnutrition. Diagnosis was confirmed with head CT scan, MRI and ultrasound of the kidneys. The patient was on antituberculosis drugs, prednisolone, nifedipine, furosemide, antiepileptic drugs and nutritional therapy. After treatment with antituberculosis drugs and other supportive care all the symptoms subsided, while the hypertension was not controlled, necessitating surgical intervention for the left renal stenosis. CONCLUSION: Atypical presentations of TB have to be considered especially when there is a strong contact history. Tuberculosis preventive therapy may have prevented all the complications, had it been given the moment the index cases were diagnosed.

Treatment and Clinical Outcomes of Osteoarticular Infections Among Pediatrics Admitted to Jimma University Medical Center, Ethiopia: A Prospective Observational Study.

BACKGROUND: Despite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections. METHODS: A pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and in-hospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value <0.05 was considered statistically significant. RESULTS: Among a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08-10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16-7.3)]. Rural residence [AOR=0.39, 95% CI (0.168-0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006-0.144)] were associated with good treatment outcomes. CONCLUSION: Almost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study.

BACKGROUND: Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. OBJECTIVE: This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. METHODS: A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle's classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. RESULTS: Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7-55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2-22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. CONCLUSION: The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.

Vitamin d status in children with acute lymphoblastic leukemia

Background: Skeletal morbidities are a common initial presentation and outcome in acute lymphoblastic leukemia(ALL). Vitamin D plays a vital role in the physiological regulation of calcium and phosphate transport and bone mineralization. Also high (25(OH)) level and high vitamin d intake at the time of diagnosis and initiation of anticancer treatment were associated with improved outcome. Methods: Twenty five ALL patients admitted to hematology and oncology unit, children hospital Zagazig University in one-year .vitamin D (25 (OH)) level was assessed in all patients at diagnosis. Patients were classified into deficient vitamin D (0-20)ng/ml , insufficient vitamin D (20-30)ng/ml and sufficient vitamin D (30-50)ng/ml. Statistical analysis was done to determine relation between different groups and ALL patients characteristics. Results: Vitamin D deficient in 24% of patients, vitamin D insufficient in 48% of patients, and vitamin D sufficient in 28% of patients. There was high statistical difference between different groups regarding bone pain and sex. Conclusions: A non-sufficient level in childhood all (deficiency and insufficiency) is common in childhood ALL and this is related to bone pain as initial clinical presentation. Vitamin D is related to presentation and prognosis of ALL in children

Outcomes of patients with cirrhosis and hepatorenal syndrome type 1 treated with liver transplantation.

Hepatorenal syndrome type 1 (HRS1) is acute renal failure in the setting of advanced cirrhosis, and it results from hemodynamic derangements, which should be fully reversible after liver transplantation. However, the rate of hepatorenal syndrome (HRS) reversal and factors predicting renal outcomes after transplantation have not been fully elucidated. The aim of this study was to assess outcomes of HRS1 patients after liver transplantation and factors predicting HRS reversal. A chart review of all liver transplant patients with HRS1 (according to International Ascites Club criteria) at Toronto General Hospital from 2001 to 2010 was conducted. Patient demographic data, pretransplant and posttransplant laboratory data, and the presence of and time to posttransplant HRS reversal (serum creatinine < 1.5 mg/dL) were extracted from the center's transplant electronic database. Patients were followed until death or the end of the 2011 calendar year. Sixty-two patients (mean age, 54.7 ± 1.2 years; mean Model for End-Stage Liver Disease score, 35 ± 1) with HRS1 (serum creatinine, 3.37 ± 0.13 mg/dL) at liver transplant were enrolled. Thirty-eight patients received midodrine, octreotide, and albumin without success and subsequently received renal dialysis. One further patient received dialysis without pharmacotherapy. After liver transplantation, HRS1 resolved in 47 of 62 patients (75.8%) at a mean time of 13 ± 2 days. Patients without HRS reversal had significantly higher pretransplant serum creatinine levels (3.81 ± 0.34 versus 3.23 ± 0.14 mg/dL, P = 0.06), a longer duration of HRS1 {25 days [95% confidence interval (CI), 16-42 days] versus 10 days (95% CI, 10-18 days), P = 0.02}, a longer duration of pretransplant dialysis [27 days (95% CI, 13-41 days) versus 10 days (95% CI, 6-14 days), P = 0.01], and increased posttransplant mortality (P = 0.0045) in comparison with those whose renal function recovered. The only predictor of HRS1 nonreversal was the duration of pretransplant dialysis with a 6% increased risk of nonreversal with each additional day of dialysis. In conclusion, our study suggests that patients with HRS1 should receive a timely liver transplant to improve their outcome.