RESUMO
BACKGROUND: Adult vitamin D deficiency, which is a public health problem in low-income countries, is correlated with increased mortality. Although health care workers (HCWs) in Ethiopia are educated on important minerals their counseling on the uses of vitamin D and its possible sources was not witnessed since their knowledge and practice is low. The main aim of this study is to explore barriers to good knowledge, positive attitude, and practice of health care providers on adult vitamin D. METHODS: An exploratory qualitative study is done in three ecologies covering highland, midland, and lowland. The size of 27 participants was fixed by saturation of ideas. In-depth interviews were conducted among leaders and HCWs of different professional groups in health centers and hospitals. Moderators were Ph.D. holders. An interview guide was developed after reviewing research that was translated into the local language. Interviews were audio-taped, transcribed and, translated. Open Code software was used to code and categorize the data. Themes were developed using thematic analysis which is presented using themes and sub-themes. RESULT: The main barriers are related to health systems, HCWs' understandings, and the educational system. Lack of attention by the health systems' leadership, missing adult vitamin D as a priority in health programs, lack of capacity building scheme and the absence of adult vitamin D management and treatment guidelines are barriers related to the health system. On the other hand, health care professionals believed that the prevalence of adult vitamin D deficiency is insignificant and vitamin D deficiency is only an issue related to children. Besides, the absence of studies,the focus of the medical curriculum on child vitamin D and the inadequacy of laboratory investigation are barriers related to the education system and research. CONCLUSION: Adult vitamin D deficiency is a neglected public health problem with many barriers related to diagnosis and treatment. Barriers are related to the professionals themselves, their leadership, health facilities, and the education system. The government should give attention to adult vitamin D management and treatment, continuous on the job training, development of guidelines, purchase of laboratory equipment, the inclusion of adult vitamin D in pre-service and, in-service training curriculums.
RESUMO
BACKGROUND: Vitamin D is essential for health and its shortage exacerbates overall mortality. Health care workers (HCWs) need to educate on its uses and sources although studies indicate their low level of practice. The main aim of this study is therefore to assess the knowledge, attitude and practice of measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs in Ethiopia. METHODS: This study was conducted in three ecologies covering lowland, midland and highland districts. A total of 405 health care workers with different levels were interviewed. Tablets were used for data collection to archiving in a cloud server. Data were exported to Stata version 14 software for cleaning and analysis. Rates were computed and the Chi-square test was used to compare differences between the two groups. Binary logistic regression was used to measure the strength, direction and significance of the association between different covariates and the practice of HCWs. RESULT: The level of knowledge, positive attitude and good practice in measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs was 210 (51.8%), 261(63.5%) and 195(47.4%) respectively. The odds of good practice in the provision of adult vitamin D service were AOR = 6.87: 95% CI (3.57, 13.21) and AOR = 2.20: 95% CI (1.23, 3.92) times higher among HCWs in Addis Ababa and highlands compared with those working in lowlands. Good practice among clinicians was AOR = 4.26: 95% CI (1.48, 12.25) times higher compared with those working in leadership positions. The likelihood was AOR = 1.96: 95% CI (1.19, 3.23) times higher among those with good knowledge compared with those with poor knowledge. Besides, good practice in adult vitamin D service provision was AOR = 2.30: 95% CI (1.40, 3.78) times higher among those with positive attitude compared with those who had negative attitude. CONCLUSIONS: A little over half of HCWs have good knowledge and close to two-thirds of them have positive attitude while less than half of them have good practice on adult vitamin D deficiency. Besides, HCWs' residential ecology, clinical position, knowledge and attitude is associated with good practice on adult vitamin D. It is essential to provide rigorous and continuous training for HCWs focusing on their deployment ecology.
RESUMO
UNLABELLED: Adamantinoma of long bones is an extremely rare tumor with no report, to authors' knowledge from neither Ethiopia nor Africa. We are reporting a 25 year old female college student with one and half years history of right mid leg pain and swelling with radiologically and histologically proven adamantinoma of right tibia. At CURE Hospital, she had undergone complete excision of the tumor with histologically documented clean margins. The limb was salvaged by reconstructing with a fresh frozen tibial allograft obtained from the USA and an interlocking intramedullary nail (SIGN nail). Such insertion and incorporation of huge allograft using SIGN nail and saving a limb is the first surgery in Ethiopia. The gradual incorporation of the allograft at different months during follow-up is elucidated with clinical signs of healing. CONCLUSION: At times, limb salvage surgery and technology should be offered to selected patients with a chosen type of bone tumor.
