The Impact of COVID-19 on Care Seeking Behavior of Patients at Tertiary Care Follow-up Clinics: A Cross-Sectional Telephone Survey. Addis Ababa, Ethiopia.

BackgroundCOVID-19, the disease caused by the new coronavirus SARS-CoV-2 is among the most obscure global pandemics resulting in diverse health and economic disruptions. It adversely affects the routine health care delivery and health service uptake by patients. However, its impact on care-seeking behaviour is largely unknown in Ethiopia. ObjectiveThis study was to determine the impact of the pandemic on care-seeking behaviour of patients with chronic health condition at Tikur Anbessa Specialized hospital in Addis Ababa. MethodsA cross-sectional hospital-based survey conducted between May and July 2020 on patients whose appointment was between March to June 2020. Sample of 750 patients were approached using phone call and data collection was done using a pretested questionnaire. After cleaning, the data entered in to IBM SPSS software package for analysis. ResultsA total of 644 patients with a median age of 25 years, and M: F ratio of 1:1.01 was described with a response rate of 86%. A loss to follow up, missed medication and death occurred in 70%, 12%, and 1.3% of the patients respectively. In the multivariable logistic regression analysis, patients above 60 years old were more likely to miss follow-up (OR-23.28 (9.32-58.15), P<001). Patients who reported fear of COVID-19 at the hospital were 19 times more likely to miss follow-up (adjusted OR=19.32, 95% CI:10.73-34.79, P<0.001), while patients who reported transportation problems were 6.5 times more likely to miss follow-up (adjusted OR=6.11, 95% CI:3.06-12.17, P<0.001). ConclusionsCOVID-19 pandemic affected the care-seeking behaviour of patients with chronic medical condition adversely and the impact was more pronounced among patients with severe disease, fear of COVID19 and with transportation problems. Education on preventive measures of COVID-19, use of phone clinic and improving chronic illness services at the local health institutions may reduce loss to follow-up among these patients. What is already known?O_LIAs a result of COVID-19, an essential maternal, newborn and child health (MNCH) services in Addis Ababa city showed that first antenatal attendance and under-five pneumonia treatment decreased by 12 and 35%. C_LIO_LIA drop in client flow was ascribed to fear of acquiring COVID-19 at health facilities, limited access due to movement restrictions, and dedication of health facilities as COVID-19 treatment centers. C_LI What are the new findings?O_LIA cross-sectional hospital-based telephone survey indicated that a loss to follow up, missed medication and death occurred in 70%, 12%, and 1.3% of patients with chronic medical conditions respectively. C_LI What do the new findings imply?O_LIFear of COVID-19 and transportation problems are the most commonly stated reasons thus, the finding implies that since health care services to patients with chronic medical conditions is concentrated in specialized referral hospitals mostly aggregated in big cities, patients who travel long distance to get the service are at high risk of Loss to follow up. C_LIO_LIStrengthening the chronic care service at a local health institutions, and promoting COVD-19 preventive measures, may help decrease the LTFU and associated complications. C_LI

Cardiac Rhabdomyoma: A Surrogate Diagnosis of Tuberous Sclerosis Complex in a Newborn Baby: Case Report from Tikur Anbessa University Hospital.

BACKGROUND: Neonatal tuberous sclerosis complex is an autosomal dominant inherited disease characterized by high rate of neurological, cardiac and skin manifestations. CASE PRESENTATION: We reported a 4 days old female neonate with respiratory distress, tachypnea, tachycardia and hypomelanotic macular lesions. Her chest X-ray and echocardiographic studies revealed cardiomegaly and multiple echogenic masses in the left and right ventricles, suggestive of cardiac rhabdomyoma. Furthermore, non-contrast brain magnetic resonance imaging revealed sub-ependymal nodules and cortical tubers. Therefore, a clinical diagnosis of neonatal tuberous sclerosis complex with heart failure was made. Then, the patient was initiated on diuretic treatment with oxygen by nasal catheter with subsequent improvement. Seizure was not occurred yet in the last three and half years of follow-up. Currently, the patient is thriving well with no symptoms. CONCLUSION: Detection of prenatal or early neonatal age, cardiac rhabdomyoma is a useful clue to the diagnosis of tuberous sclerosis complex in neonates. Proper clinical evaluation of patients at the time of first contact prevents missing of findings such as skin macules and chest X-ray findings, which helped us to diagnose tuberous sclerosis complex in the present case.

Imperforate anus associated with anomalous pulmonary venous return in scimitar syndrome. Case report from a tertiary hospital in Ethiopia.

BACKGROUND: Scimitar syndrome is a rare form of partial anomalous pulmonary venous drainage associated with pulmonary hypertension and congestive heart failure that may lead to death in the newborn infant. Although it is described with anomalies of the lung, heart and their vascular structure, extremely rare association with imperforate anus had been reported. The third case of Scimitar syndrome and imperforate anus will be reported in this case report. CASE PRESENTATION: A 3 days old male neonate with imperforate anus presented with abdominal distention. Loop colostomy was done to relieve abdominal distension. The chest x-ray revealed a curved shadow on the right mid lung zone extending to the diaphragm abutting and indenting the inferior vena cava (scimitar sign). Abdominal ultrasound, transthoracic echocardiography and computerized tomographic angiography confirmed the presence of Scimitar vein and associated dextro-position of the heart, hypoplastic right lung, hypoplastic right pulmonary artery, secundum atrial septal defect with bidirectional shunt, patent ductus arteriosus, pulmonary hypertension, left superior vena cava, and systemic collateral arteries feeding the lower lobe of the right lung. The rare association of scimitar syndrome with imperforate anus is discussed. CONCLUSION: Scimitar syndrome associated with imperforate anus with and without VACTERL association has been reported previously only in four cases. The knowledge of association between imperforate anus and Scimitar syndrome helps for early detection and management of cases. It is recommended to have high index of suspicion in every newborn with imperforate anus to check for symptoms of dextro-position of the heart, right lung hypoplasia which may be indicate scimitar syndrome.

Mission-based cardiac surgery and catheter treatment of coarctation of aorta in the young and older children: a facility based review of cases in Addis Ababa.

INTRODUCTION: Coarctation of the aorta is a congenital narrowing of the descending aorta. Hemodynamic derangement will be corrected with reopening of the narrowing either by surgery or catheter ballooning. There are few reports of post-operative cases in developing countries. The goal of this review is to describe the follow-up profile of cases in a setting with limited resource. METHODS: Data from a retrospective facility-based chart review of cases within a single institution in Addis Ababa, were analyzed to quantify procedure, timing and post-operative blood pressure outcomes. RESULTS: Thirty-two locally, and seven abroad operated cases, for a total of thirty-nine post-operative cases were analyzed. Balloon angioplasty with or without stent insertion, resection with end-to-end anastomosis and patch arthroplasty accounted for twenty, fourteen, and five cases respectively. Rebound hypertension occurred more frequently in the surgical group compared to the catheter group (P value < 0.01). The mean systolic blood pressures between pre and post-intervention differed significantly (P value = 0.001). Post-operative hypertension was observed in one-third of cases. Diagnosis and intervention time were late in majority of cases. A high rate of loss to follow-up was also observed. CONCLUSION: Delayed diagnosis of cases coupled with a delay in intervention after diagnosis, is hypothesized to account at least in part for the findings. The challenges related to early diagnosis and intervention of case with congenital heart disease was discussed. Early diagnosis and referral of cases is recommended.

Intestinal Obstruction in Early Neonatal Period: A 3-Year Review Of Admitted Cases from a Tertiary Hospital in Ethiopia.

BACKGROUND: Failure to pass meconium by a full-term neonate within the first 24 hours should raise a suspicion of bowel obstruction. The objective of this study was to determine pattern of presentation, diagnosis and outcome of management of intestinal obstruction in the early neonatal period in the Neonatal Care Unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. METHODS: Retrospective chart review of admitted cases from January 2011 to December 2013 was done. Data were entered into SPSS software version 20. Descriptive analysis of data were done at first; then cross tabulation of variables with chi-square tests were done. RESULTS: Fifty-one (41 males and 10 females) cases of neonatal intestinal obstructions were described. ARM was the most common type of intestinal obstruction followed by intestinal atresia and Hirschsprung's disease.Delayed diagnosis of cases was observed in 72%. Associated congenital anomalies were documented in 13 % of the cases. Death occurred in 20% of the cases. One or another form of infection accounted for 90% of the deaths. Neonatal sepsis and being unfit for anesthesia were determinants of mortality with p-value <0.02 and < 0.0007 respectively. CONCLUSION: Anorectal malformation is the commonest cause of early neonatal obstruction followed by small intestinal atresia and Hirschsprung's disease. Low number of associated anomalies has been reported. High rate of death due to preventable causes such as sepsis is observed. Delayed diagnosis of cases were also prevalent.