Assessment of Serum Vitamin B12 and Folate Levels and Macrocytosis in Patients with Type 2 Diabetes Mellitus on Metformin Attending Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Metformin is the first-line drug in the treatment of type 2 diabetes mellitus. Monitoring vitamin B12 deficiency associated with long-term and high-dose therapy is not a common practice in many clinical settings in Ethiopia. OBJECTIVE: The study aimed to measure levels of serum vitamin B12 and folate and to assess the macrocytic status of type 2 diabetes mellitus patients on metformin. METHODS: A cross-sectional study was conducted on 80 type 2 diabetes mellitus patients who had been on metformin for 5 months or more at the diabetic clinic of Tikur Anbessa Specialized Teaching Hospital. Serum vitamin B12 and folate levels were quantified by chemiluminescent immunoassays. Mean corpuscular volume was determined by complete blood count. Differences in vitamin B12 and folate levels and mean corpuscular volume between different groups were assessed using Kruskal-Wallis H and Mann-Whitney U tests. RESULTS: Vitamin B12 and folate deficiency were documented in 5% and 23.8% of participants, respectively, and 6.2% of patients were macrocytic. Levels of vitamin B12 and folate in patients who had been on metformin >1,500 mg/day ≥4 years were significantly lower those who had been on metformin 1,000-1,500 mg/day and <1,000 mg/day <4 years, respectively. CONCLUSION: Low serum vitamin B12 and folate levels and macrocytosis were found to be associated with prolonged metformin treatment.

Evaluation of Visual Serum Indices Measurements and Potential False Result Risks in Routine Clinical Chemistry Tests in Addis Ababa, Ethiopia.

BACKGROUND: Serum indices (SI) including hemolyzed, lipemic, and icteric samples, affects the accuracy of test result. The aim of this study was to evaluate SI values done by visual inspections and potential false result risks by comparing with actual measurements done by Cobas 6000 Chemistry analyzer at Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia. METHODS: An observational, cross-sectional study was conducted from April to May 2017 on samples referred to Clinical Chemistry laboratory of EPHI, Ethiopia. These samples SI values, after visual inspection by three trained observers, was analyzed again on Roche Cobas 6000 analyzer (RCA). The generated data was analyzed by using weighted kappa methods on STAT statistical software version 20. RESULTS: From a total of 1509 samples, SI values identified by the RCA as hemolysis, icteric, and lipemic were 933 (62%), 74(5%) and 59(4%) respectively. The SI average weighted kappa between RCA and visual inspection were: 0.1870, 0.3421, and 0.1259 for hemolysis, icteric, and lipemic samples, respectively. Combined inter-observers variability among observers for hemolysis, Icterus, and lipemic samples were 0.4758, 0.3258, and 0.3628 respectively. The best agreement among observers was in the case of hemolysis (0 grades), while the lowest agreement was observed in the case of icterus (+3 grades). In addition, test parameters, such as CK-MB (22%), and LDH (20%) were falsely accepted, whereas Cl- and Na+ (up to 25%) were falsely rejected tests by observers. On the other hand, results rejected by Cobas SI assessments included CK-MB (22%), LDH (20%), and BIL-D (4%). CONCLUSION: Visual inspection of SI showed poorly agreement with automated system. Thus, there is genuine need for more training of Laboratory professionals on identification of SI, and as much as possible SI should be done by automated system to improve quality of test results.

The performance of BD FACSPresto™ for CD4 T-cell count, CD4% and hemoglobin concentration test in Ethiopia.

INTRODUCTION: In Ethiopia, CD4+ T-cell counting is still required for all patients at baseline before antiretroviral therapy (ART) and to determine eligibility and follow-up of opportunistic infection prophylaxis. However, access to CD4+ T cell count in rural health facilities remains a major challenge in Ethiopia like other resource-limited settings. METHODOLOGY: Both capillary and venous blood was drawn from each of 325 study participant recruited in Addis Ababa and surroundings. The CD4+ T-cell count, CD4%, and hemoglobin (Hgb) were tested at one of the four study health facilities using capillary blood and BD FACSPresto™ device. These tests were also done at the national HIV reference laboratory, using venous blood with BD FACSCalibur™, Sysmex XT-1800i™, and BD FACSPresto™. RESULTS: BD FACSPresto™ had an absolute mean bias of -13.3 cells/ul (-2.99%) and 28.3 cells/µl (6.4%) using venous and capillary blood, respectively, compared with BD FACSCalibur™. The absolute CD4 assay on the BD FACSPresto™ had a regression coefficient (R2) of 0.87 and 0.92 using capillary blood and venous blood samples, respectively, compared with BD FACSCalibur™. The percentage similarity of the BD FACSPresto™ using capillary and venous blood was 105.2% and 99.3%, respectively. The sensitivity of the FACSPresto™ using threshold of 500 cells/µl for ART eligibility using capillary and venous blood was 87.9 and 94.3%, while the specificity was 91.4 and 83.8%, respectively. Furthermore, the BD FACSPresto™ had an absolute mean bias of -0.2 dl/µl (0.0%) (95% LOA: -1.7, 1.3) and -0.59 dl/µl (0.1%) (95% LOA: -1.49, 0.31) for Hgb using capillary and venous blood compared with the Sysmex XT-1800i™, respectively. CONCLUSION: Our results showed acceptable agreement between the BD FACSPresto™ and BD FACSCalibur™ for CD4+ T-cell counting and CD4%; and between the BD FACSPresto™ and Sysmex XT-1800i™for measuring Hgb concentration.

Assessment of quality of care delivered for infectious pulmonary tuberculosis patients in jimma zone, South west ethiopia.

BACKGROUND: Providing quality of care for infectious pulmonary tuberculosis patients is crucial in prevention and control of the disease. However, little is known about the existing quality of care in such services. The objective of the study was to assess the quality of care delivered for infectious pulmonary tuberculosis patient in Jimma Zone, South West Ethiopia. METHODS: Facility based cross- sectional study was conducted from January- February 2008 in 10 public health facilities in Jimma Zone. Facility audit was carried out to assess structural quality. Twenty providers were interviewed and records of 299 smear positive patients registered for 1 year was reviewed. Data were entered and analyzed using SPSS 11.0 for windows statistical software and findings at 95% CI and p value of 0.05 were reported as statistically significant. RESULTS: The results of the study showed that all the three quality dimensions were graded as poor in all the study health facilities and overall 66.0% of TB patients receive poor quality care. Four variables were identified that significantly predicted treatment success, i.e. conformity to the recommended schedule of sputum smear microscopy, conformity to DOTS drug regimen during both intensive and continuation phase of therapy and quality of registration of patients' medical records. CONCLUSION: This study revealed that most of the problems could be managed at local level, while a few needs further discussion with other management bodies. Success of anti tuberculosis therapy could be ensured through strict adherence to all the elements of DOTS strategy, with special emphasis on the 4 variables that significantly predicted treatment success in the present study.

Health services utilization and associated factors in jimma zone, South west ethiopia.

BACKGROUND: In Ethiopia, utilization of health services remains low and unevenly distributed. To ensure appropriate health care use, we need to understand factors affecting health care use, and the reasons for low levels of utilization among our community. The objective of the study was to assess utilization of health services and associated factors in Jimma zone, south west Ethiopia. METHODS: A cross sectional data was collected from January 15 to February 08, 2007 in Jimma zone. First, four districts were selected by lottery method. Then 2 'kebeles' from each district were selected randomly and households were selected by systematic sampling. A total of 836 households were studied. The data were cleaned, coded and entered into computer and analyzed using SPSS for windows version 12.0. Bivariate analysis and logistic regression were conducted and a significance level of 5% was considered for interpretation. RESULTS: The health services utilization rate was found to be 45.6%. After controlling confounders using logistic regression; sex (OR=0.23), marital status (OR=8.1), household income (OR=0.70), socioeconomic status (OR=3.5), presence of disabling health problem (OR=3.3), presence of an illness episode (OR=28.3), perceived transport cost (OR=3.6), perceived treatment cost (OR=0.15) and distance to the nearest health center or hospital (OR=2.9) were found to be predictors of utilization of health care. CONCLUSION: It has been shown that utilization level was not satisfactory. Thus, we recommend that the level of health service utilization should be improved by improving predictors of health care use like physical accessibility.

Upper extremity deep vein thrombosis in a 25 year old apparently healthy man.

This case of upper extremity deep vein thrombosis is selected for case report as it is a rare form of deep vein thrombosis without a very well established treatment modality and prognosis. The objective of this study was to report the outcome of a 25 years old male patient with idiopathic upper extremity deep vein thrombosis treated conservatively with low molecular weight heparin (LMWH) and oral warfarin. The data sources used were patient interview, laboratory and radiology investigation results and patient charts. The patient had no apparent recurrence or complication for 3 years except the presence of occasional dull pain over the affected left upper extremity.