Browsing by Author "Shimelis Damte"

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    Assessment of Platelet Increment and Refractoriness to Platelet Transfusion in Pediatric Cancer Patients, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia : A Prospective Cross-sectional Study
    (Addis Abeba University, 2021-11) Yilma Misrak; Shimelis Damte ; Hailu Daniel
    Background: Platelet transfusion is an essential supportive component of the treatment of oncology patients with survival benefit. Platelet transfusion refractoriness is an important challenge in pediatric cancer patients who require repeated transfusions. Objectives To assess platelet increment and refractoriness after platelet transfusion in pediatric cancer patients, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia Methods: In this study, 113 eligible patients were included and data was collected by oriented nurses and physicians using structured questionnaire. Data completeness assessment and coding was done and it was processed and analyzed by SPSS version 25 using frequency tables, Chi Square and Regression analysis tools. Result: In this study, 113 pediatric cancer patients were included. Most of the patients are in the age group of 5-10 years (46.9%) followed by under 5 years (43.4%). The majority are male sex accounting for 57.5 %. There is a significant association between platelet increment after transfusion with the type of cancer(p=0.001) and being on chemotherapy (p 0.018) on Chi square analysis. Regression analysis revealed negative correlation between age of patient and platelet increment(p=0.14). There is also significant association between splenomegaly and previous platelet transfusion with platelet increment (p=0.003 for both). The incidence of platelet transfusion refractoriness is 12.5%. Conclusion: Based on the findings of this study, increment of platelet in pediatric cancer patients in TASH is affected by age of patient, Type of cancer, Splenomegaly, Previous platelet transfusion history and Chemotherapy. Platelet transfusion refractoriness is seen in 12.5% of the patients. Recommendation We recommend a larger-scale study with better organized methodology to be conducted to draw more representative results.
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    Challenges of Clinical Learning Environment of Dental Students at Addis Ababa University, Ethiopia, 2018/19
    (Addis Ababa University, 2019-05) Assefa Lakew; Shimelis Damte; Lawrence; Rangel Cristian
    Background: Clinical learning is one of the main teaching methods in health professions, including dental education, and it has many strengths. It is focused on real problems in the context of professional practice. Learners/students are motivated because they are involved directly and participate actively, but clinical learning can be challenging, unpredictable, stressful, and constantly changing environment. Objective: To identify the challenges, of the clinical learning environment of dental students at Addis Ababa University Dental Department, Ethiopia. Material &Methods: An institution based qualitative study was conducted from Dec. 2018 to Jan. 2019. The sample was obtained by purposive sampling of 4th, 5thyear and final year dental students. Data were collected by focus group (FG). Three FG discussions were conducted. (Groups contained 4 students from each year) using a semi-structured questionnaire. One data collector was selected. The information was recorded separately and transcribed for thematic analysis. Ideas were grouped and analyzed depending on themes. Results: Six themes were derived from the data analysis, which represented the students’ clinical learning challenges. These six themes included shortage of resources and maintenance problem, non-approachable & uncooperative instructors, poor teacher student relationship, evaluation and feedback, and non-organized administrative system Conclusion: The results of this study clearly indicated presence of challenges and the most common challenges are shortages of resources (e g. dental materials and equipment’s), non-approachable and uncooperative clinical teachers and unsupportive clinical learning environment are the main challenges of clinical learning Keywords: Challenges, clinical learning environment, dental students.
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    Evaluation of the Clinical learning Environment of Tikur Anbessa Specialized Teaching Hospital of Addis Ababa University using the Post Graduate Hospital Health Education’s Environment Measure
    (Addis Ababa University, 2020-02) Shimelis Damte; Martimianakis Tina
    Background: The public health system in Ethiopia is the main deliverer of health services and the largest employer of physicians. The public universities are the only available training institutions for post graduate medical education and also have full authority over residents’ training. In their training years, residents have dual responsibility as students and responsible physicians. A conflict arises between these two roles as students and workers leading to dissatisfaction among the residents that could affect the quality of the services they deliver during the training or then after and the training outcomes; thus negatively affecting resident learning. Determining the work place conditions that can exacerbate tensions in navigating student and worker roles, can inform reform to improve the resident experience. Assessing the post graduate hospital education environment using the Post Graduate Hospital Education Environment survey tool identifies the weaknesses and strengths of the hospital education environment for rectifying the weaknesses and maintaining the strengths. Objective: To assess the post graduate clinical education/work environment of Tikur Anbessa Specialized Teaching Hospital of Addis Ababa university using the PHEEM survey tool as seen by residents from the 4 major clinical departments (Internal medicine, Pediatrics, Surgery, Obstetrics and Gynecology) in the three domains of the Post graduate Hospital Educational Environment Measures (PHEEM); perception of role Autonomy, perception of teaching and perception of social support. Methods: This is a cross sectional study that was conducted from April 1-30, 2016. In this study we used the English version of the PHEEM tool to assess the perception of residents on the health educations learning environment. Results: Out of 363 residents 218 residents (60.06%) completed the questionnaire. There were 152 males (71.7%), and 60 females (28.3%) . Their age ranges between 20-38 years with a mean age of 26.1. There were 89 residents in year one (42%), 64 residents in year 2 (30.2%), 38 year 3 (17.9%) and 20 were in year 4 (20%) one resident didn’t mention year of residency. Twenty-two items were rated as poor with a score of less than 2. The overall score on the three domains of PHEEM was 76.8/160. This indicates plenty of problems of the clinical learning environment. There is statistically significant difference among genders, year of residency and department of residency in the perception of the learning environment (p < 0.05, p =0.002, p < 0.001) respectively. Male residents and junior residents rated the environment as more positive than females and senior residents respectively. The load of work is heavy in the order Obstetrics and Gynecology, Pediatrics, Internal Medicine and Surgery. Conclusion and recommendations: For our training program to succeed the program should be designed according to the best standards to ensure satisfaction of residents as well as clients. Improving the quality of duty rooms, more supervision during working hours, reducing the work load, providing junior doctors’ handbook etc. will improve the learning environment and facilitate learning. After remedial measures are taken we recommend a regular assessment of the clinical learning environment to determine whether the measures taken are effective. Key words: hospital, PHEEM, post graduate, resident
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    Managment Outcome of Severe Acute Malnutrition from 6 Months to 5 Years of Age Children Admitted to Yekatit 12 Hospital
    (Addis Ababa University, 2014-08) Ahmed Muluken; Shimelis Damte
    Background: severe acute malnutrition is major health problem in sub Sahara Africa. WHO prepared a guideline to manage SAM and Ethiopia also prepared its own guideline by adapting WHO guideline to decrease mortality below five percent even in children with HIV/AIDS. Despite applying same guideline there were different case fatality rate reports. Studying adverse outcome of SAM and associations that may lead to improve the outcome is important. Objective: the main objective of this study was assess the outcome of children admitted with SAM to yekatit 12 hospital Method: retrospective descriptive study was conducted in children between 6 months and 5 years of age with severe acute malnutrition admitted to Yekatit 12 hospital from a period of September 2012- September2013. Data was collected from the patients’ chart by using structured questionnaire. Data processing and analysis: compiled and analysed using software Statistical package for social science (SPSS 20). The charts of 193 was retrieved and analysed. Both bivariate and multivariable analysis was performed to determine the outcome of the management of SAM. A p-value of less than 0.05 was taken as statistically significant. Result: The average age of the study participants was 19.6 months, the majority being in the age group between 6months and 2 years of age. Male children accounted for 52.3 % of the study participants. The treatment outcome revealed that 75% of the patients improved while 12.4% died and the remaining 12.4% defaulted. Conclusion: This study shows a high mortality rate of severe acute malnutrition despite treatment with the standard guideline. This findings show that the treatment s goal, which is to keep the mortality below 5 % is far from achievable. The finding of high death rate suggests an urgent need to revisit our practice in the management of severe acute malnutrition and warrants more prospective studies.
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    Outcome and Associated Factors of Mechanically Ventilated Neonates among Selected Hospitals in Addis Ababa, Ethiopia; Cross -Sectional Multi-Center Study
    (Addis Ababa University, 2024-03) Workneh Betelehem; Shimelis Damte; Tesfaye Melat
    Background: Neonatal mortality has a significant impact on global mortality, morbidity,economic cost, and hospitalization worldwide. Improving neonatal health through innovations inhealthcare, such as mechanical ventilation, is vital for improving the well-being and loweringmortality rates among newborns. The most common indication for MV in NICUs was respiratory distress syndrome. Objective: To assess the outcome and associated factors of mechanically ventilated neonates admitted in three NICUat selected hospitals in Addis Ababa, Ethiopia 2023 Methods: A cross-sectional study was conducted to examine the outcomes and contributing factors for mechanically ventilated neonates admitted to Girum Hospital, Addis Hiwot Hospital,and Myungsung Christian Medical Center (MCM). Three private hospitals were chosen througha simple random sampling method, where a total of 160 mechanically ventilated neonates wereidentified during the study period. A univariate and multivariate binary logistic regression analysis was performed to examine the factors associated mortality of mechanical ventilatedneonates. The results of logistic regression reported as adjusted odds rations (OR) with 95%confidence intervals and p-value < 0.05 are considered statistically significant Results: An analysis of 160 neonates requiring mechanical ventilation that 61.3% were male and63.7% displayed preterm gestational age. The primary reasons for mechanical ventilation (MV)in this study was respiratory distress syndrome (RDS) being the most prevalent at 51.9%,followed by meconium aspiration syndrome (MAS) at 12.5%, and neonatal sepsis at 11.9%. The overall mortality rate of mechanical ventilated neonates was 24.4%. Moving to associated factors requirement of resuscitation(AOR=9.9(1.7, 58.5),p=0.011),extremeprematurity(AOR=61.7(3.3,1150.1),p=0.0006),DIC(AOR=13.1(1.6,104.5),p=0.015),AKI(AOR=13.1(2.24,76.9),p=0.004),MOF(AOR=246.9(14.4,4242.8),p=0.0000)andpulmonaryhemorrhage(AOR=16.7(1.9,145.9), p=0.011)emergedasthemost statistically significant variablesdetermining mortality of neonates on mechanical ventilator Conclusion: The commonest indication for mechanical ventilation in was RDS. Prematurity and disease-related complications were among the preventable factors contributing to mortality.Although the mortality rate of mechanically ventilated neonates is lower compared to similarstudies in low and middle-income countries,.
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    Parental Knowledge, Attitude and Practice About their Children Attending Medical Care at TASH Regarding COVID-19 Infection, Addis Ababa, Ethiopia
    (Addis Abeba University, 2021-11) Damtie Bethelhem; Shimelis Damte
    Background: Covid-19 is one of the global public health crises. Resource limitedcountries like Ethiopia are at risk of being severely affected by the pandemic. Childrenof all ages can be affected by the virus and are one of the burdens of Covid-19pandemic. As children accounts for majority of the population in Ethiopia, earlydiagnosis and management of the disease is crucial to curb the spread of the disease.Parents have a significant role in children’s health. Hence the aim of this study is toassess parents’ knowledge, attitude and practice towards Covid-19 in children. Methodology: A cross-sectional study was conducted at TASH located in Addis Ababa,the capital city of Ethiopia from June to August 2021 G.C. Parents whose children wereadmitted at TASH and parents who came to pediatric regular OPD and referral clinicswere used as a study population. An interview based questionnaire was used to gatherinformation from study participants. Data was entered using SPSS version 25 to beanalyzed based on the objectives of the study. A descriptive analysis was performed.Inferential statistics were investigated using a chi-square test. P value less than 0.05 was considered as statistically significant. Result: A total of 385 parents who fulfilled the inclusion criteria were enrolled. The finding of this study reveal that majority of the participants (68.6%) have moderate knowledge whereas 17.7% of participants have poor knowledge. Regarding attitude and practice of parents, 68.3% of participants have good attitude and 51.7% of participants have moderate practice. There was a moderate positive correlation between knowledge score and attitude score (r=0.56, p<0.001), between knowledge score and practice score (r=0.44, p<0.001) and between attitude score and practice score (r=0.43,p<0.001). Conclusion: The finding of this study suggests that knowledge and practice of parentsof children attending medical care at TASH towards COVID-19 in children was moderate. Majority of the parents had good attitude. A considerable number of sociodemographic characteristics of participants affect the knowledge, attitude and practice of parents towards COVID-19 in children.
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    Pattern and Treatment Outcome of Children With Oncologic Emergencies Seen at First Visit to Pediatric Emergency Unit, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
    (Addis Ababa University, 2024-01) Leulseged Mathias; Shimelis Damte; Seid Abdulkadir; Hailu Abel
    Background:Pediatric oncologic emergencies can occur at any time during a child's course of care for cancer; it can be either the initial manifestation of cancer or occur as a consequence. Pediatric oncologic emergencies maylead to acute and potentially life-threatening complications unless timely diagnosed and treated. Pediatric oncologic emergencies can be metabolic emergencies, neurological emergencies, thoracic emergencies,gastrointestinal emergencies, urogenital emergencies, acute respiratory distress syndrome (ARDS), andfebrile neutropenia. To our knowledge, there is no study done in our country on the pattern and treatmentoutcome of oncologic emergencies in the pediatric emergency ward admission during the initial visit. Objective: To determine the pattern and treatment outcome of children with oncologic emergencies seenat the first visit to the Pediatric Emergency Unit, TASH from January 2022 to January 2024 Method:A hospital-based retrospective cross-sectional study was conducted in TASH with all selected 240patients who attended the pediatrics emergency unit from January 2022 to January 2024. Data wascollected by quota sampling method and analysis was done using SPSS version 25. Statistical significancewas considered at a level of significance of 5%, and with a 95% confidence interval (CI) using a Chi-square to present the estimates of the association. The results were presented using text, tables, and charts. Results:There were 6,307 pediatric emergency admissions during the study period, and oncologic emergenciescontributed to 3.8% of pediatric emergency unit admissions. A total of 240 pediatric patients wereincluded in the study. Most of the patients; 80.8% were between the age of 1-9 years and 61.7% weremale with a male-to-female ratio of 1.6:1. The major presenting symptoms were abdominal swelling(20.8%) followed by easy fatigability (17.5%), and neck swelling (13.3%). The most common oncologic emergencies in pediatric emergency visits were tumor lysis syndrome (42.5%), hyperleukocytosis(28.3%), and increased intracranial pressure (14.1%). About 44% of patients stayed at the ER for morethan 1 week’; 80% of the patients were admitted to the inpatient oncology ward, and 6.3% were linked tothe outpatient oncology center. The most common childhood cancers were Acute LymphoblasticLeukemia (40%), Brain tumors (15%), and non-Hodgkin’s Lymphoma (12%). About 95% of the studypatients survived, and 5% of the patients did not survive the oncologic emergency during their stay at thepediatric emergency unit. The duration of illness, vital sign status at admission, oxygen saturation, type ofprimary cancer, serum uric acid level, and electrolytes (potassium, phosphorous, Calcium) weresignificantly associated with the survival of patients with oncologic emergencies. Conclusion: Our finding revealed that Tumor Lysis Syndrome was the most common oncologic emergency in children with cancer. The mortality rate in children with oncologic emergencies at the pediatric emergency unit was low in our setup.
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    Pattern and Treatment outcome of Children With oncologic Emergencies Seen at First Visit to Pediatric emergency unit, Tikur Anbessa specialized Hospital,Addis Ababa, Ethiopia
    (Addis Ababa University, 2024-01-15) Leulseged Mathias; Shimelis Damte
    Pediatric oncologic emergencies can occur at any time during a child's course of care for cancer; it can be either the initial manifestation of cancer or occur as a consequence. Pediatric oncologic emergencies may lead to acute and potentially life-threatening complications unless timely diagnosed and treated. Pediatric oncologic emergencies can be metabolic emergencies, neurological emergencies, thoracic emergencies, gastrointestinal emergencies, urogenital emergencies, acute respiratory distress syndrome (ARDS), and febrile neutropenia. To our knowledge, there is no study done in our country on the pattern and treatment outcome of oncologic emergencies in the pediatric emergency ward admission during the initial visit. Objective: To determine the pattern and treatment outcome of children with oncologic emergencies seen at the first visit to the Pediatric Emergency Unit, TASH from January 2022 to January 2024 Method: A hospital-based retrospective cross-sectional study was conducted in TASH with all selected 240 patients who attended the pediatrics emergency unit from January 2022 to January 2024. Data was collected by quota sampling method and analysis was done using SPSS version 25. Statistical significance was considered at a level of significance of 5%, and with a 95% confidence interval (CI) using a Chi square to present the estimates of the association. The results were presented using text, tables, and charts. Results: There were 6,307 pediatric emergency admissions during the study period, and oncologic emergencies contributed to 3.8% of pediatric emergency unit admissions. A total of 240 pediatric patients were included in the study. Most of the patients; 80.8% were between the age of 1-9 years and 61.7% were male with a male-to-female ratio of 1.6:1. The major presenting symptoms were abdominal swelling (20.8%) followed by easy fatigability (17.5%), and neck swelling (13.3%). The most common oncologic emergencies in pediatric emergency visits were tumor lysis syndrome (42.5%), hyperleukocytosis (28.3%), and increased intracranial pressure (14.1%). About 44% of patients stayed at the ER for more than 1 week’; 80% of the patients were admitted to the inpatient oncology ward, and 6.3% were linked to the outpatient oncology center. The most common childhood cancers were Acute Lymphoblastic Leukemia (40%), Brain tumors (15%), and non-Hodgkin’s Lymphoma (12%). About 95% of the study patients survived, and 5% of the patients did not survive the oncologic emergency during their stay at the pediatric emergency unit. The duration of illness, vital sign status at admission, oxygen saturation, type of primary cancer, serum uric acid level, and electrolytes (potassium, phosphorous, Calcium) were significantly associated with the survival of patients with oncologic emergencies. Conclusion: Our finding revealed that Tumor Lysis Syndrome was the most common oncologic emergency in children with cancer. The mortality rate in children with oncologic emergencies at the pediatric emergency unit was low in our setup. Keywords: Cancer, pattern, Tikur Anbessa Specialized Hospital, Oncologic emergency, survival
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    Prevalence of Asymptomatic Microscopic Hematuria in 7-12 Years School Age Children of Medhanealem Primary School in Addis Ababa
    (2014-10) Yeshidinber Abate; Shimelis Damte
    Background:Hematuria is one of the most important signs of renal or bladder disease in children and itcan represent a process that is simple and benign or complex and life threatening.Asymptomatic microscopic hematuria is common in unselected populations of children, witha prevalence that ranges from 0.4% to 4.1% depending on the criteria used to definehematuria.Urine analysis, a simple and inexpensive test, is the cornerstone in the evaluation of thekidney function. Proteinuria or hematuria may be the only early signs of renal diseaseincluding membranous nephropathy, membranoproliferative glomerulonephritis, postinfectious glomerulonephritis, IgA nephropathy and others. The basic dipstick method is themost rapid screening procedure that could be helpful in the early detection of renal or urinarytract diseases among apparently healthy or asymptomatic subjects in the hope of preventingand retarding progression to chronic renal failure. Many countries have used this screeningprogram to prevent and follow children with asymptomatic children. However the prevalenceof asymptomatic hematuria is unknown in Ethiopia and there is no recommendation onroutine screening urinalysis in Ethiopian school children. Objective:To determine the prevalence of asymptomatic hematuria in school age children inAddis Ababa Methods:A cross sectional survey using urinalysis was done over a period of 8 weeks in 382 apparentlyhealthy school age children (7-12 years) at MAPS in Addis Ababa. The children who testedpositive in the first screening were re-tested after 2 weeks. Results:In the first screening 32 children (8.4 %) tested positive for hematuria. Of these children, 16(4.2 %) cases tested positive in a second screening. The prevalence was both age and sexdependent. Co-existing proteinuria and leucocytes were common findings (19.6 % and 8.4 %respectively) where as pyuria, glycosuria and nitrite were seen in < 1% of children. Glomerulonephritis was the most commonly detected disorder (43.75%). 75 students (19.6%)were positive for protein,7 students(1.8%) were positive for both blood and protein, 1student(0.3%) was positive for glucose,1 student (0.3%) was positive for nitrite ,32 students(8.4%) were positive for leukocyte- esterase.88Subsequently, 10 children from the secondary screening group were lost to follow up andonly 6 students were referred to TAH pediatric renal clinic. Conclusions:This study helped to assess the prevalence of urinary abnormalities in school-aged childrenfor the first time in Ethiopia. Urine abnormalities are common finding among apparentlyhealthy school aged children with hematuria and proteinuria being the most prevailingabnormalities. Our study demonstrated that hematuria is higher in Ethiopian children thanother African children and worldwide. Coexisting urinary abnormalities especiallyLeukocyturia and proteinuria (most are trace) are common while nitrituria and glucosuria areuncommon.
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    Quality of Pediatric Prescription Writing at the Department of Pediatrics and Child Health Outpatient and Emergency Unit, Tikur Anbessa Specialized Hospital
    (Addis Ababa University, 2014-10) W/Gebriel Fitsum; Shimelis Damte
    Introduction: Drugs are important components of health care and play crucial role in saving life. Drug prescription is the product of most medical consultations. Despite the importance of good quality prescriptions erroneous prescribing habits are not uncommon worldwide. Illegible or incorrect prescription can result in loss of the patient, physician and pharmacist time and may cause therapeutic error or drug toxicity. Hence the objective of this study was to assess the nature of prescription deficiencies (omission and error) in production of prescription with regard to Patient identification, drug information, prescriber’s identification. Methods: This was a prospective, cross- sectional hospital based study. All prescriptions issued to non admitted patients below 14 yrs of age visiting pediatric regular OPD, emergency and follow up clinics were collected from pediatric emergency and special clinic every day and assessed for their quality based on the nationally adopted format approved by Food Medicine and Healthcare Administration and Control Authority . Data was collected from May 1 to 31/2014 until the desired sample size is reached. Data was analyzed by SPSS for windows version 20. Results: Total number of prescription studied was 246. With regard to patient identification, 78% of prescriptions were lack patient age, 80.5% sex and 86.2% patient weight. 50.8% of the prescriptions were without drug formulation and 19.9% drug generic name. 30% of the prescriptions were issued with erroneous dose. Prescribers name was not documented in 45.5% of the prescriptions and date of prescriptions issued was not written in 65% of the prescriptions. Based on the predefined …. Conclusion and recommendation: From this study production of prescription quality is unsatisfactory as most of the prescriptions lack the essential elements. Patients are not well identified drug information is incomplete and prescribes identification is lacking in most of the prescriptions studied. And most of the prescriptions with poor quality are from clinics attended by senior residents. As a specialized teaching hospital the department should device corrective measure to enhance prescription quality, the hospital has to have prescription error reporting system and this calls for medication error study to evaluate the impact of prescription quality in the patient care. Key words: Prescription, Quality; Handwriting, physicians