Surgical Management of Acute Abdomen in Adult Patients: Experience from a Private Hospital in Addis Ababa, Ethiopia.

Background: Acute abdomen is a major surgical problem in Ethiopia with surgery for acute abdominal conditions accounting for roughly one-third of total emergency operations in many centers. This study was conducted with the aim of studying the pattern and outcome of surgically managed acute abdominal cases in a private general hospital in Addis Ababa, Ethiopia. Methods: This was a retrospective cross-sectional study of acute abdominal cases in adult patients operated at Teklehaimanot General Hospital between January 1, 2018 and August 1, 2019. Results: A total of 267 patients' medical records were reviewed. The male to female ratio was 1.5:1 and majority of patients were between the age range of 20 to 40 years with mean age of 36±16 years. The average duration of symptoms before arrival was 71.1±84.4 hours (range 3 to 504 hours) and only 85 (31.8%) of patients reached to the Hospital within 24 hours or less of onset of symptoms. Acute appendicitis was the most common cause of acute abdomen; observed in 193 (72.3%) of the cases. Overall post-operative complication rate was 14.8% and post-operative mortality rate was 1.9%. It was found that delayed presentation (OR 2.01, 95% CI 1.64-7.84), old age (OR 1.51, 95% CI 1.89-3.59), and tachycardia at presentation (OR 2.85, 95% CI 1.03-6.82) were major predictors of morbidity and mortality in operated patients. Conclusion: In this study acute appendicitis accounted for the majority of cases operated for acute abdomen. Length of post-operative hospital stay, early post-operative complication rate, and overall mortality rate were found to be significantly lower in our series than other reports.

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening.

BACKGROUND: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. METHODS: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. RESULTS: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. CONCLUSION: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. AFRICAN RELEVANCE: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening.

Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital.

BACKGROUND: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. METHODS: A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. RESULTS: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate. CONCLUSIONS: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening

Pattern of Vascular Diseases at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Vascular diseases are evolving fast in sub-Saharan Africa, but its management is challenged by lack of expertise and infrastructure. In the light of the prevailing challenge, this study was done to see the pattern of vascular disease and its treatment in a tertiary referral hospital. METHODS: A prospective cross-sectional study was done over a period of one year (February 9, 2016 to February 8, 2017) at Tikur Anbessa specialized hospital (TASH) at Addis Ababa, Ethiopia. RESULTS: A total of 386 patients were seen at the surgical OPD. Of these, 78(20.2%) were admitted and operate on. The male to female ratio was 1.3:1. The mean age affected was 39 +/- 10 (Range 12-91 years). On the other hand, 132 (34.2%) patients came with PAD. Of them, 46(34.8%) presented with either frank Gangrene or pre-gangrene stage. The rest 86(65.1%) had claudication pain. The other diseases seen are Varicose Vein, 100(25.9%), Carotid body tumors, 60(15.4%), Aneurysmal diseases, 36(9.1%), Vascular malformations, 34(8.7%), and Vascular injuries, 22(5.6%). During the study period, 28(35.9%) PAD, 22(28.2%) trauma patients, 8(10.2%) Chemodectomas, 8(10.2%) aneurysms, 6(7.7%) hemangiomas, 4(5.1%) varicose vein and 2(2.6%) AV fistula patients were operated. CONCLUSION: The pattern of vascular disease in Ethiopia is becoming a challenge. The gap created due to limited vascular surgeons, poor infrastructure and absent supply chain system has significantly compromised the number and type of operated-on patients. These challenges result in preventable morbidity and mortality.

Pattern of vascular diseases at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND: Vascular diseases are evolving fast in sub-Saharan Africa, but its management is challenged by lack of expertise and infrastructure. In the light of the prevailing challenge, this study was done to see the pattern of vascular disease and its treatment in a tertiary referral hospital. METHODS: A prospective cross-sectional study was done over a period of one year (February 9, 2016 to February 8, 2017) at Tikur Anbessa specialized hospital (TASH) at Addis Ababa, Ethiopia. RESULTS: A total of 386 patients were seen at the surgical OPD. Of these, 78(20.2%) were admitted and operate on. The male to female ratio was 1.3:1. The mean age affected was 39 +/- 10 (Range 12-91 years). On the other hand, 132 (34.2%) patients came with PAD. Of them, 46(34.8%) presented with either frank Gangrene or pre-gangrene stage. The rest 86(65.1%) had claudication pain. The other diseases seen are Varicose Vein, 100(25.9%), Carotid body tumors, 60(15.4%), Aneurysmal diseases, 36(9.1%), Vascular malformations, 34(8.7%), and Vascular injuries, 22(5.6%). During the study period, 28(35.9%) PAD, 22(28.2%) trauma patients, 8(10.2%) Chemodectomas, 8(10.2%) aneurysms, 6(7.7%) hemangiomas, 4(5.1%) varicose vein and 2(2.6%) AV fistula patients were operated. CONCLUSION: The pattern of vascular disease in Ethiopia is becoming a challenge. The gap created due to limited vascular surgeons, poor infrastructure and absent supply chain system has significantly compromised the number and type of operated-on patients. These challenges result in preventable morbidity and mortality

Feasibility of telephone-administered interviews to evaluate long-term outcomes of trauma patients in urban Ethiopia.

BACKGROUND: Little is known about long-term functional outcomes of trauma patients in low-income and middle-income countries. In sub-Saharan Africa most studies of injury only collect data through emergency department disposition or hospital discharge, and methods of collecting long-term data are subject to significant bias. With the recent increase in access to mobile telephone technology, we hypothesized that structured, telephone-administered interviews now offer a feasible means to collect data about the long-term functional outcomes of trauma patients in urban Ethiopia. METHODS: We piloted a telephone-administered interview tool based on the Glasgow Outcome Scale-Extended. Using departmental logbooks, 400 consecutive patients presenting to two public referral hospitals were identified retrospectively. Demographics, injury data, and telephone numbers were collected from medical records. When a telephone number was available, patients or their surrogates were contacted and interviewed 6 months after their injuries. RESULTS: We were able to contact 47% of subjects or their surrogates, and 97% of those contacted were able and willing to complete an interview. At 6-month follow-up, 22% of subjects had significant persistent functional disability. Many injuries had an ongoing financial impact, with 17% of subjects losing or changing jobs, 18% earning less than they had before their injuries, and 16% requiring ongoing injury-related medical care. Lack of documented telephone numbers and difficulty contacting subjects at recorded telephone numbers were the major obstacles to data collection. Language barriers and respondents' refusal to participate in the study were not significant limitations. DISCUSSION: In urban Ethiopia, many trauma patients have persistent disability 6 months after their injuries. Telephone-administered interviews offer a promising method of collecting data about the long-term trauma outcomes, including functional status and the financial impact of injury. These data are invaluable for capacity building, quality improvement efforts, and advocacy for injury prevention and trauma care. LEVEL OF EVIDENCE: III, retrospective cohort study.

Emergency medicine and its development in Ethiopia with emphasis on the role of Addis Ababa University, School of Medicine, Emergency Medicine Department.

INTRODUCTION: Globally Emergency Medicine (EM) is young discipline and even in developed countries it is about five decades old. In Ethiopia formal pre-hospital care or hospital based Emergency department (ED) development is a recent phenomenon and this article describes development of Emergency Medicine care in Ethiopia before, around and after Ethiopia millennium. METHODOLOGY: Documents related to emergency medicine development and implementation from different government and nongovernmental data sources are used as a resource for this article. RESULTS: Emergency Medicine task force (EMTF) has been established in Addis Ababa University (AAU) school of Medicine (SOM) in June 2006 and the taskforce has closely worked with Federal Ministry of Health (FMOH) and Addis Ababa city council Health Bureau (AACCHB). In addition to the main actors many partners have contributed significantly to this initiative. Some of the developments were establishment of emergency departments in Tikur Anbessa Specialized Hospital (TASH) and the restructuring of EM service by FMOH. Emergency care has been considered as a crucial service in hospitals' service along with outpatient and inpatient services. Furthermore, Pre-hospital care initiatives have been commenced in Addis Ababa and expanded to the regions with a arrangement of one or two ambulances to small districts having 100,000 population. There have also been key achievement in human resource development, notably the establishment of EM residency and MSC in EM and critical care nursing. Prehospital care givers training programs in order to produce emergency medicine technicians (EMT) have been started in various regional health professionals training centers. Furthermore, EM module has been included in the current undergraduate medical education. The Ethiopian society of emergency professionals (ESEP) has been established with members from different categories of emergency medicine professionals. In all these developments the emergency medicine training center in the emergency department of AAU has played key role in the training of human resources in different categories. DISCUSSION AND CONCLUSION: The recent successes in EM development is due to concerted efforts of the FMOH, AAU SOM and AACCHB along with committed partners. Hence, it is concluded that consistent local efforts and relevant stakeholders support in EM has resulted in successful development of the field in the country.

Development and implementation of an emergency medicine graduate training program at Addis Ababa University School of Medicine: challenges and successes.

BACKGROUND: Ethiopians experience high rates of acute illness and injury that have been sub-optimally addressed by the existing health care system. High rates of patient morbidity and mortality prompted the Federal Ministry of Health (FMOH) and the Addis Ababa University School of Medicine (AAU-SM) to prioritize the establishment of emergency medicine (EM) as a medical specialty in Ethiopia to meet this acute health system need. OBJECTIVES: To review the EM residency training program developed and implemented at AAU-SM in partnership with the University of Wisconsin (UW), the University of Toronto (UT) and University of Cape Town (UCT) and to evaluate the progress and challenges to date. METHODS: An EM Task Force (EMTF) at AAU-SM developed a context-specific three-year graduate EM curriculum with UW input. This curriculum has been co-implemented by faculty teachers from AAU-SM, UT and UW. The curriculum together with all documents (written, audio, video) are reviewed and used as a resource for this article. RESULTS: Seventeen residents are currently in full-time training. Five residents research projects are finalized and 100% of residents passed their year-end exams. CONCLUSION: A novel graduate EM training program has been successfully developed and implemented at AAU-SM. Interim results suggest that this curriculum and tri-institutional collaboration has been successful in addressing the emergency health needs of Ethiopians and bolstering the expertise of Ethiopian physicians. This program, at the forefront of EM education in Africa, may serve as an effective model for future EM training development throughout Africa.

Review of morbidity and mortality among patients adimitted to the Surgical Intensive Care Unit at Tikur Anbessa Specialized Teaching Hospital, Ethiopia.

BACKGROUND: Caring for the critically ill is a challenge in developing country including Ethiopia, where heath needs often outstrip available resources. There is scarce data available on morbidity and mortality of surgical intensive care unit patients in Ethiopia. OBJECTIVE: To describe mortality, morbidity and outcomes of patients under the care of surgical intensive care unit team between September 2010 and August 2011. PATIENTS AND METHODS: This is a hospital based retrospective review of morbidity and mortality among surgical patients admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in the period between September 2010 and August 2011. RESULTS: The study reviewed 441 surgical intensive care unit admissions over one- year period Age ranged from 10 to 90 years mean 37.55 ± 16.56 years. Mortality was high in 21-30 years age group, 9.1%. The highest admission was from cardiothoracic surgery unit, 37.4%, the average length of hospital stay was 4.52 days (range 1 to 87 days). Significant number 52 (33.3%) of patients who died under surgical ICU care belongs to General surgery unit. Two Hundred eighty (63.5%) patients had an uneventful course, while 156 (35.4%) and 161 (36.5%) died and developed complications respectively. Age of the patient at the time of admission, mode of admission, and post admission complications were significantly and positively associated with mortality (p = 0.0001) while gender did not show any association with mortality at SICU (p = 0.528).CCONCLUSION:The highest admission was from department of cardiothoracic surgery, while mortality rate was high-st from general surgery side. There are significant and positive associations ofa ge, urgency ofa dmission, and complications with mortality while gender did not show any association.

Medical students' choice of specialty and factors determining their choice: a cross-sectional survey at the Addis Ababa University, School oF Medicine, Ethiopia.

BACKGROUND: A consideration of the future specialization interests of undergraduate medical students might help in understanding the needs of higher medical education and future manpower availability for healthcare in a country. OBJECTIVE: This study assessed the career of choice made by medical students of the Addis Ababa University in the year 2012. METHOD: A cross-sectional study was conducted among 161 medical students of the Addis Ababa University, School of Medicine, Ethiopia in April 2012 using a self-administered questionnaire. Data were analyzed using computer based statistical software IBM SPSS data editor version 20.0. In addition to descriptive statistics difference in proportions was compared using Chi-square test RESULTS: Of the 161 students, 101 (62.7%) were male. The mean age of respondents was 24.1 years (SD 2.02, ranging from 21 to 35). Majority, 138 (85.7) wanted to pursue their specialty training in the near future, their first career of choice being surgery for, 50 (31.1%), followed by internal medicine for, 44 (27.3%) and Obstetrics and Gynaecology for, 29 (18.0%]), However 18 (11.2%) did not specify their career of choice. The basic science fields such as anesthesiology, and oncology were the least favored choices by the students. The main reasons that influenced the students' decisions to opt for a particular specialty were inspiration during their clinical practicein 67 (41.6%). Financial reward (24.2%), dedication to the field (19.2%) possession of competency needed for the speciality (18.6%) and Influence of teacher (16.1%) were also factors that influenced future choice of speciality of the students. CONCLUSION: The majority of medical students preferred to pursue their specialty training. As the number and interest in certain specialties is huge, training centers must be ready to cater for the interests shown by the students. The lack of interest towards certain specialists such as basic sciences, anesthesiology, and oncology requires a special attention by policy makers.

Squamous cell carcinoma of the esophagus presenting with features of intracranial space occupying lesion.

We are reporting on a rare case of a male patient with squamous cell carcinoma (SCC) of the esophagus presented itself clinically as a pure intracranial space occupying lesion with symptoms of abnormal body movement, hemiplegia and failure to communicate.

The McGill Pain Questionnaire in Amharic: Zwai Health Center patients' reports on the experience of pain.

This paper presents for the first time an Amharic translation of the McGill Pain Questionnaire developed by Melzack and used in many countries around the world. It allows for a quantitative and qualitative assessment of the intensity, location, and nature of experienced pain, as well as conditions that relieve pain. Data collected from one hundred patients attending the Zwai Health Center indicated that 81% reported pain at the time, one-quarter of whom were in severe pain. The most commonly chosen descriptors were: burning, stabbing, sore, gnawing, aching, and cramping. Descriptors were often associated with certain diagnoses: burning with gastrointestinal problems, stabbing with respiratory diseases, and gnawing or aching with myalgia/neuralgia. Approximately 40% of those in pain had previously sought relief from a clinic or pharmacy and were attending the center because the pain persisted. Analgesics were more likely to be prescribed for those in mild pain, while other medication without analgesics were prescribed for those in severe pain. The McGill Pain Questionnaire--Amharic (MPQ-Am) could be a useful tool for future studies of illness-specific pain, and of the effectiveness of pharmaceutical and non-pharmaceutical strategies for pain management.