Internal Medicine

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Community Participation and the Effect of Participatory Research in South-Western Ethiopia
(Addis Ababa University, 1995-05) Kebede, Adugna; Stansfield, Sally (PhD)
A descriptive study was conducted from October 1994 to March 1995 to document the patterns and determinants o f community p a rticipation (CP) in 25 peasant associ at ion s in Seka Chekorsa Wo r e da. An experimen tal componen t o f the study tested the e ffect o f participatory r e search (PR ) on t he measurement and promot ion o f CPo The study address the barri ers to fuller communities participation in health development activities despite the high demand from the health sector. Ov e r half (52 . 5%) o f communi t y members rep o r ted partic ipatio n i n h ealth activ i t i e s wi t hin the preceding month . Most common forms of participation reported were contribution of labor (31.2%) or materials (11 . 9%) and attending meetings regarding health development (29 . 9%). Communities were most likely to identify more passive forms of CP, including s ervice utilization (60 . 9%), attending meetings (44.8%), and contri bution o f materi a l o r l abo r (33 . 9%) Few (11.2%) indi c a ted that CP implied involvement in dec ision making and planning. Key barriers to promotion of CP in health inc luded poor c ommuni t y aware ness of roles and responsibilities, lack of technical and f inancial res ources , and lack o f strategies and orga nizational structures to promote CPo PR was ef f ective in increas~ng community awareness of CP, and in increas i ng r ates of part i c ipa t ion , including through attending mee t ~ngs and through decision making the development and planning . S:rengthening CP through of clear strateg~es and policies and decentral ization of financial and technicial resources togethe r with utilization of existing mutual self help soc ieties such a s funeral soc ieties (Edi r ) were recomended in order to improve health development programs .
The Magnitude and Factors Associated with Pressure Ulcer Among Patients Admitted to Adult Medical and Surgical ICU, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: 6-Month Retrospective Study
(Addis Abeba University, 2018-07) Almaw, Aklog; Dr.Kebede, Dawit ( MD, Internist, Consultant Pulmonary and Critical Care Physician)2
Title: The Magnitude and Factors Associated with Pressure Ulcer Among Patients Admitted to Adult Medical and Surgical ICU, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: 6-Month Retrospective Study, from January 1,2018 to July 1, 2018. Background: Pressure ulcer represents a widespread, painful, and expensive health care problem directly associated with increased morbidity, mortality, and length of hospital stay. Knowledge of the magnitude and factors associated with to the development of pressure ulcer allows identification of patients at risk for ulcer development such that preventive measures may then be targeted to those specific patients. There were no previous local studies assessing the magnitude and factors associated with pressure ulcer among ICU admitted patients and this study aimed to fill this gap. Objective: To assess the magnitude and factors associated with pressure ulcer among patients admitted to adult medical and surgical ICU unit of Tikur Anbessa specialized hospital (TASH). Methods and materials: A 6-month facility based retrospective cross-sectional study was conducted to determine the magnitude and factors associated with pressure ulcer among patients admitted to adult medical and surgical ICU unit of Tikur Anbessa Specialized hospital (TASH). The study was done in a sample of 237 patients which were admitted to the ICU of TASH, from January 1,2018 to July 1, 2018. Data were collected using structured checklists from chart reviews. The collected data was cleaned and analyzed using SPSS version 26. Bivariate and Multivariate logistic regression models were used to identify the degree of the association. The degree of association between dependent and independent variables was interpreted by using crude odds ratio with 95% confidence intervals and P-value <0.05 was considered statistically significant. Results: From a sample of 237, a total of 58 (24.5%) participants had pressure ulcer. The magnitude of pressure ulcer among MICU admitted study participants was 36.6% whereas among SICU admitted participants was 11.4%. The length of ICU stay was found to be strongly associated with the development of pressure ulcer. Those who stayed in the ICU for more than 14 days were 8.9 times at increased risk of developing pressure ulcer compared to those who stayed for less than 14 days (AOR=8.995, P value=<0.0001, 95% CI 3.634 to 22.264). Conclusion: A quarter of adult patients admitted to the ICU had pressure ulcer and prolonged hospital stay was found to be associated with the development of the ulcer.
Clinical profile and treatment outcome of Acute leukemia patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2019-11) Gemechu, Lalise; Dr.Tadesse, Fissehatsion(Consultant Internist and Hematologist); Dr.Asres, Getahun (Consultant Internist and MPH specialist)
Background The incidence of acute leukemia is increasing worldwide. In Ethiopia, in terms of incidence among all cancer cases, it ranks fourth and fifth in men and women respectively. Despite acute leukemia being this prevalent nationally and even a more concerning issue in Tikur Anbessa Specialized Hospital(TASH) the largest hemato-oncology center in the country, there have been only few studies done on this area so far. This study is important to have a contemporary data on the clinical presentation and outcome of acute leukemia patients and helps to put a light on gaps of acute leukemia care in for further detailed studies. Objective The Main objective of this study is to define clinical profile and treatment outcome of all patients above the age of 12 years and admitted with the diagnosis of acute leukemia at TASH from January 1, 2015 to December 31, 2017. Methods The study design is a retrospective cross sectional study which was conducted at TASH from June, 2018 to October, 2019. Structured questionnaire was use to collect data from medical record chart of patients diagnosed with Acute leukemia TASH from January 1, 2015 to December 31, 2017. Descriptive analysis and frequencies were done using the software IBM SPSS statistics data editor version 25 .0. Result There were a total of 235 patients above the age of 12 and diagnosed with acute leukemia and admitted to TASH from January 1, 2015 to December 31, 2017. Out of these patients, 59.1% had AML, 40% had ALL and 1 patient had a Bi-lineage leukemia and 1 other had unclassified leukemia. Males were dominant with M: F ratio of 1.58. Majority of patients were young in the age category between 12-30 years. The commonest FAB subtype of AML and ALL were M4 and L2 subtypes respectively. The commonest presenting symptom was symptoms of anemia (94%) and the commonest sign was pallor (89.4%). The commonest laboratory finding was anemia (96.2%) followed by thrombocytopenia (94.9%). Majority (64.6%) of patients had leukocytosis. About 53.6% of patients were started on chemotherapy. Among these, 79.3% took intensive induction regimens while 12.7% patients took palliative treatment only. The commonest induction protocol used for ALL was CALGB, for Non M3 AML was 7+3 and ATRA+ Chemotherapy for patients with AML M3. Patients with AML had CR rates of 63.3% whereas ALL patients had CR rates of 92.9%. Default rates was 10.9% and induction death rate was 28.2% which w has high. The most common cause of death was neutropenic sepsis followed by intracranial hemorrhage. The rate of lost from follow up was very high with only 6 patients currently alive and on follow up. Conclusion The clinical presentation of patients with acute leukemia generally similar with most findings in the literature. However, acute leukemia occurred at a very young age compared with other studies. There is a very high early and induction mortality but comparable CR rates to most centers.
Clinical characteristics and outcomes of patients with dialysis requiring AKI at the Tikur Anbessa specialized hospital.
(Addis Abeba University, 2019-11) Getachew, Nebiyu; Dr.Melike, Addissu(Consultat internist and Nephrologist)
Background: Acute kidney injury (AKI) in developing countries is the disease of the young and children while developed countries elderly patients with co morbid conditions predominate. The management of patients with acute kidney injury (AKI) is supportive, with renal replacement therapy (RRT) indicated in patients with severe kidney injury. Even though, government run dialysis service is given in few centers in Ethiopia, data on epidemiological and clinical characteristics of dialysis requiring AKI patients and its outcome is sparse. Objectives: The objective of this study is to describe socio-demographic, clinical characteristics of patients with dialysis requiring AKI and their renal and hospital outcome at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: The study is an institution based retrospective chart review of patients with AKI who were hospitalized and had hemodialysis inTikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from July 14, 2016 to September 2019. Data on socio-demographic characteristics, clinical profiles, and dialysis and hospital outcomes were collected using a structured questionnaire. Data entry and analysis was done on (SPSS) version 20. Frequency tables and odds ratio was used to explain and analyze the results. Factors found to be significantly associated with mortality on bivariate analysis (P-value< 0.05) were analyzed with a multivariate model using logistic regression to determine the predictors of in-hospital mortality. P values less than 0.05 were considered statistically significant. Result A total 275 patients underwent hemodialyis during the period, of which 130 patients, 71 females (54.6%) and 59 males(45.6%), with a median age of 34 were included in the study. The most common causes of AKI were sepsis (33.8%), glomerulonephritis(31.5%) and pregnancy related causes (16.2%). A quarter of the patients (25.4%) did require ICU admission. The in hospital mortality was 26.2%. Sepsis, co morbid heart failure and age above 50 year were associated with increased mortality. In 12(9.2%) patients’ glomerulonephritis as a cause of AKI increased the risk of dialysis requirement beyond 4 weeks. Conclusion In this setting the majority of patients with dialysis requiring AKI are young. We have observed a shift in the etiology of dialysis requiring AKI in the last two decades; from Malaria and septic abortion predominated to sepsis and glomerulonephritis.
Assessment of utilization, practice, indication and complications of blood and blood component therapy at internal medicine wards Tikur Anbessa Specialized Hospital.
(Addis Abeba University, 2019-11) Gebregiorgis, Mahlet; Dr.Gebremedhin, Amha(Consultat internist and heamatologist)
Background: Despite the increased use of blood and blood component transfusion there seems to be an obvious lack in the knowledge and practice of the process. There is also a lack of institution wide guideline on the practice and adequate training given to physicians. This is a special concern because even though blood and blood component transfusion is a life saving process it carries its own risks. Objective: To evaluate the utilization, practice, indications, complications of blood and blood component therapy in medical patients admitted to Tikur Anbessa hospital. Methodology: Institutional based prospective quantitative descriptive study will be conducted to assess utilization, indications, complications of blood and blood component transfusion. Data will be collected using pre prepared check list and will be analyzed using Statistical Package for Social Sciences, version 20. Results: During the study period there were a total of 329 units of blood and blood component issued to the medical wards with 148 episodes of transfusion. Male patients accounted for % of patients and females accounted for -%. The most common age group transfused was (n = %). The most common indication for transfusion is (n = %). He most common primary diagnosis is ( n %). The most commonly used blood component is (n = %). Vital sign was recorded only in (n = 8, 5.4%) prior to transfusion, (n = 5, 3.4%)during transfusion and (n = 10, 6.8%) post transfusion. Conclusion: This study provides information about the trend of utilization, indication and practice of blood and blood component therapy in medical wards of black lion hospital. The data obtained will help to guide improve transfusion practice, and planning for future needs in blood and component therapy in the future.
Patterns of Hodgkin’s lymphoma: epidemiology, clinical presentation, histologic subtypes, prognostic factors, and treatment outcome in TASH from December 2010 to december2015.
(Addis Abeba University, 2019-11) Abate, Hiluf; Dr.Kebede, Seifu (MD, Assistant professor in medicine ,internist and Consultant in Hematologist)
Background: Hodgkin lymphoma (HL) exhibits considerable clinico pathological variations in different parts of the world. This study was prompted by the limited availability of HL data in developing countries (particularly long-term outcomes). Methodology: This is hospital based retrospective study of 96 patients diagnosed and treated with HL at TASH, from December 2010 to December 2015, at department of internal medicine, hematology unit. Patient records and phone interviewing was used to collect data. Results: The study included 96 patients with a median age of 24 years (range14–60 years); 58% of patients were between ages 14-25. 71 % were male, male to female ratio of 2.4. The most common primary presentation was peripheral lymphadenopathy (93%), the neck lymph nodes were primary complaints in 75% of patients. B symptoms occurred in 63% .71% had an advanced stage, 25% had bulky disease. Mixed Cellularity was the most common histological subtype (52%). Initial therapy outcomes were complete response, progressive disease, partial response, and in 84%, 8%, and 7% of patients, respectively. The mean follow up patients from patient records was 12 months, from phone interviews 36 months. The 5 year overall survival (OS) 81%., and progression free survival (PFS) was and 70%.Multivariate analysis showed that treatment discontinuation was independently associated with death. Conclusion: Hodgkin’s Lymphoma follows epidemiological and clinical features of developing countries at our center. The 5-year overall and progression-free survivals were below international rates. Treatment adherence significantly contributes to overall survival.
Knowledge, attitude and practice of health care workers towards personal protective equipment in the era of Covid-19
(Addis Abeba University, 2020-01) Chala, Kalkidan; Dr.Kebede, Dawit( Consultant Internist and PCCM specialist ); Dr .Melke, Addisu( Consultant Internist and Nephrologist )
Background; in this era of COVID-19 epidemic health care workers are at increased risk of contracting the disease. The WHO estimates that around 20% of HCW have already acquired the infection in the world worst affected areas. It is a paramount important to prevent spread of infection among the HCWs as they can be a source of community transmission. There are some evidences showing there is a gap in knowledge, attitude and practice of personal protective equipment use among the health care workers. Objective: To assess knowledge, attitude and practice of PPE among HCWs that are currently working in Tikur Anbessa Specialized hospital and Eka Kotebe general hospital, Addis Ababa, Ethiopia. Methodology: This cross-sectional, descriptive study was conducted on HCWs of TASH and EKGH in the month of October 2020. Participants were selected using convenient sampling method and 45 itemed, web-based, self-administered questionnaires were used for data collection via internet access. Data analysis was done using SPSS version 26. Socio-demographic and important information assessing KAP were collected. Result: A total of 277 HCWs responded to the questionnaire from both centers. The mean age was 30.77±5.78 years. Among them majority was male (n=158, 57%) and majority were from TASH 261 (94.2%). Medical doctors constituted 73.2% (n=203) followed by nurses (n=70, 25.3%). On average, 38.6% had 8hours of work per day. Among the responders, 18.8% (n=51) uses informal ways to gather information and 19.1% (n=53) of HCWs tested positive for COVID-19. Knowledge, attitude and practices regarding PPE use among these HCWs were 73.9%, 40.3% and 57.7% respectively. Conclusion and Recommendation: This survey shows that there is poor attitude and practice of PPE especially N95 use among HCWs. Institution based training and inclusive updates needs to be implemented.
Clinical, laboratory, treatment profiles and outcome of neutropenic fever among high-risk hematologic patients in Tikur Anbessa Specialized Hospital 2019, Ethiopia.
(Addis Abeba University, 2020-01) Ferdu, Eskedar; Dr.Amogne, Wondwossen (Consultant Internist and Infectious diseases specialist)
Background Patients with hematologic malignancy are at a higher risk to develop neutropenic fever. The febrile neutropenia episodes are associated with increase in morbidity and mortality of these patients. Outcome of each of the episodes of febrile neutropenia is associated with the clinical, laboratory, microbiological, imaging for source of infection and antimicrobial and chemotherapy regimen the patients is taking. Objectives The purpose of this study was to assess the correlation of the clinical, laboratory and treatment profiles of the patients with neutropenic fever and hematologic malignancy with all-cause mortality in 30 days of diagnosis of the neutropenic fever episode at Tikur Anbessa Specialized Hospital. Methods A single center, cross sectional retrospective study was conducted in hematology and medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia for the year 2019. The clinical profiles with history and presumed site of infection, treatment plans and outcome in 30 days of diagnosis of the NF episode were retrieved from medical charts. Chest imaging results during the diagnosis of the febrile neutropenia episode were taken from the Med Web intranet database of the institution. The microbiology data for the specimens collected for culture was retrieved form the log book at the microbiology department of the Hospital. The data was subjected to bivariate and multivariate analysis using SPSS Ver 26. Results A sample of 132 patients with hematologic malignancy and neutropenic fever episode in the year 2019 were assessed. The study revealed that among patients with febrile neutropenia male to female ratio was 13:10. The patients had ALL (43.2%) and AML (40.9%) as the common underlying diseases. Frequent site of primary infection was chest focus (33%). More than half of the patients were on combination therapy with Cefepime and Vancomycin (40.9%). The odds of dying in 30 days of diagnosis was 5.4 times higher in patients with Medical ICU admission [AOR= 5.4; 95% CI: 1.22 - 23.92] and 3.8 higher in those with past history of febrile neutropenia [AOR= 3.8; 1.44 - 10.16]. Conclusion The history of prior treatment for febrile neutropenia and medical ICU admission during the course of treatment of febrile neutropenia of patients with hematologic malignancy predicted all-cause in hospital mortality in 30 days.
Sociodemographic features, Clinical characteristics and Treatment patterns of inflammatory bowel disease in patients seen at Tikur Anbessa Specialized Hospital (TASH) during the period between January - August 2020, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-01) Fekede, Neway; Dr.Berhanu, Yohannes (Assistant Professor, Department of internal medicine, Gastroenterologist and Hepatologist, college of health sciences, AAU)
Background: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD). To date there are no reports from Ethiopia at a nationwide or hospital levels about the epidemiology and clinical characteristics of IBD. Objective: To describe the sociodemographic features, clinical characteristics and treatment patterns of IBD in our patients. Methods and Materials: A descriptive study consisted of 102 patients who attended the GI referral clinic in TASH from January - August 2020. Data was gathered through review of medical records and patient interview; and a standardized questionnaire was applied. The collected data was analyzed using SPSS v. 26. Results: A total of 102 IBD patients (29 UC, 73 CD and a ratio of 2.5:1) with female predominance, 57% (n = 58) was identified. The M-to-F ratio was 1:1.2 for CD and 1:1.6 for UC. The mean age at diagnosis was 26.4 years for CD and 33 years for UC. Only 5.9% of patients had a family history of IBD; and no association of smoking with IBD was found. EIMs were reported in 16.6%. In patients with CD, the ileo-colon type was the most common disease phenotype (38%), and the inflammatory type was the most common disease behavior (49.3%); 18.6% ended up in bowel resection. In patients with UC, left-sided colitis was the predominant disease extent (69.0%). Majority of the patients were on steroids and immunomodulators. Conclusions: There was a predominance of females in both IBD subtypes. CD was more common than UC, in comparison to what is mentioned in most literatures and the mean age at diagnosis was in the mid-twenties for the former and early thirties for the later. None of the IBD patients were treated with biologic therapy.
Retrospective analysis of etiology, clinical profile and management outcome of upper gastrointestinal bleeding in patients seen at Tikur Anbessa specialized hospital between December 2018 to December 2019.
(Addis Abeba University, 2020-01) Abeje, Bereket; Dr. Merdassa, Guda (MD, Internist,Consultant Gastroenterologist and Hepatologist)
Background: Upper gastrointestinal bleeding (UGIB) is one of the most of common medical emergencies patients visit to Emergency department having significant morbidity and mortality. The causes and outcomes of UGIB differ geographically depending on demographic differences and socioeconomic status of local population. Objectives: To assess the etiology, clinical profile and management outcome of patients admitted with UGIB at TASH. Methods and Materials: A Single centered retrospective study was conducted to determine the etiology, clinical profile and management outcomes of patients seen with UGIB at TASH over a period of one year (from December 2018 to December 2019). Data was collected analyzed using the latest SPSS version 26. Associations was done by chi-square test for categorical tests and considered to be statistically significant when the P value is below 0.05. Result: A total of 101 patients were enrolled in this study, 52.4% of patients were from outpatient and the rest were admitted patients. Majority of Patients (47.5%) were from Addis Ababa. Most patients had age less than 40 and the male to female ratio was 2.6:1.The most common clinical presentation was hematemesis seen in 42(41.6%) of patients. Risk factors identified were history of alcohol intake in 60 (59.4%), prior liver disease in 24 (23.4%), Smoking history in 10 (9.9%) patients respectively. The most common comorbidities were HTN and DM each accounts for 10% of patients. The most endoscopic finding was Esophageal varices seen in 34(33.7%) of patients followed by DU which is seen in 20 (19.8%) of patients.70 were managed only medically while 31 patients managed endoscopically. Timing of endoscopy was assessed for admitted patients and 30 (62.5%) of patients got endoscopy done after 24 hours. The most common endoscopic procedure was EVL which is done for 26 (25.7%) of patients. Patients who stayed in the wards for less than 7 days had 91% less risk of developing in hospital complications. Conclusion: In this study, most of patient has age less than 40 years, males are predominant and esophageal varices are the most common etiology identified.
Clinical characteristics, diagnosis and treatment response of adult prolactinoma patients on follow up at endocrine clinic of TikurAnbessa Specialized Hospital during the period from June 2015 to June2020, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-06) Beyene, Eyerusalem; Dr.Ahmed, Abdurezak(Consultant internist and Endocrinologist, department of internal medicine, college of health sciences, Addis Ababa University)
BACKGROUND-Prolactinomas are the most common type of pituitary adenomas in both sexes with different age distribution.They are benign neoplasms accounting for approximately 40% of all pituitary tumors. They are classified into two main groups based on the size of pituitary tumour at presentation: microprolactinoma (tumour diameter <1 cm) and macroprolactinoma (tumour diameter >1 cm). The clinical presentation of prolactinoma includes manifestations relating to hyperprolactinaemia and features relating to tumor bulk. OBJECTIVE- The objective of this study is to assess the clinical profile, diagnosis and treatment response of patients with prolactinoma on follow up at endocrine clinic ofTikurAnbessa specialized Hospital(TASH). METHOD; Ahospital based retrospective cross sectional study was conducted on adult patients with conﬁrmed prolactinoma attending Endocrine clinicof TASH from June, 2015 to June 2020. All patients with prolactinoma on follow up at endocrine clinic of TASHon the stated period were included. Data collection was conducted by the principal investigatorfrom the charts and electronic medical records of patients using a structured questionnaire. Data was cleared and entered to IBM SPSS version 26. Result was processed and analyzed using SPSS version 26.Descriptive statistics were used as a statistical data analysis method and presented as frequencies and percentages with their corresponding confidence intervals. Logistic regression analysis was used to assess the association between initial tumor size and prolactin level and a P value of <0.05 was considered significant. Result:Among the 217 patients with pituitary adenoma, prevalence of prolactinomawas 91(41.9%). 76.8% patients with prolactinoma were females. The mean age was 30.78 years (SD±7.97). Headache was the major presenting symptom (68.1%) followed by visual disturbance (49.3%).Most patients (79.7%) had macroadenoma. PRL level was <250ng/ml in 54.71% females and >500ng/ml in 56.25% males. 67out of the 69 patients were treated (medical and/or surgical). 59(85.5%)patients had clinical response and 10 (14.5%) had no clinical response.On multivariate logistic regression the prolactin level has strong association with the initial tumor size with p value <0.003, AOR of 19.51, 95% CI (2.689, 141.6). Treatment was discontinued in 16 out of the 65 patients and disease remission and financial limitation were the major reasons. Conclusion: Prolactinomas are the most common secretory pituitary tumors accounting for 41.9%. The initial tumor size has association with the presenting symptom and initial prolactin level. Our Patients with prolactinoma has good clinical response to medical therapy Recommendation- Laboratory investigations of hormonal analysis, MRI and drugs (dopamine agonists) should be available in the hospital.
Utilization and Barriers to Secondary prophylaxis for Rheumatic Heart disease at Tikur Anbessa Specialized Hospital adults outpatient clinic, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-12) Zewde, Lemma; Mekonnen, Desalew (MD, Internist and consultant Cardiologist, Addis Ababa University, Ethiopia)
Background: Rheumatic heart disease (RHD) is one of the major causes of cardiovascular disease in developing countries, affecting most of the young population. Secondary prophylaxis in the form of benzathine penicillin is effective for preventing recurrent acute rheumatic fever (ARF) and the progression of RHD. However, the low adherence rate reduced the effectiveness. Therefore, a systematic generalizable tool is necessary to tackle the barriers. Objective: The purpose of the study was to assess adherence and barriers to use secondary prophylaxis for RHD, at Tikur Anbessa specialized hospital (TASH). Methods: Cross-sectional study was conducted from June 5, 2020, to September 4, 2020, at Tikur Anbessa Specialized Hospital, Ethiopia. A structured questioner was used for the data collection on awareness, adherence, and barriers for benzathine penicillin prophylaxis in adults with RHD. Data were analyzed using SPSS version 26. Results: A total of 385 patients participated in this study, 305(79.6%) patients were aware, sore throat associated with heart disease, and about 288 (75.6%) patients; know that benzathine penicillin prevents tonsillitis. The adherence rate was 77.9% for benzathine penicillin prophylaxis (BPG) while the left 85 patients (22.1%) were non-adhered to the prophylaxis. The main barriers for none adherence in this study were the nonavailability of medication, forgetting, and health professionals refuse to inject benzathine penicillin. Increased age was found to have a significant association with adherence to BPG. For each one-year increase in the age of patients with RHD, the percent odds of adherence decreases by 3% (P value 0.006) Conclusion: Adherence level was low, which is below WHO recommendation. This study insight important major barriers that affect secondary prophylaxis for RHD that can be used to develop an intervention to improve adherence.
Prevalence of Anemia and associated factors in Heart failure with reduced ejection fraction patients attending Tikur Anbessa specialized Hospital Cardiac Clinic from June 1- October 30
(Addis Abeba University, 2020-12) Likinaw, Bekalu; Dr.Abebe, Sintayehu(Assistant Professor, Internist and Consultant Cardiologist Department of Internal Medicine, College of Health Science, Addis Ababa University)
Background: Anemia is one of the common comorbidities in heart failure patients with reduced ejection fraction and its presence is associated with decreased functional capacity, poor quality of life, an increase in the rate of hospital admission, and increased mortality. Previous studies have estimated the prevalence of anemia in heart failure patients to be 10-50%. Older age, renal dysfunction, female sex, and advanced NYHA functional class are reported to be independently associated with anemia. Anemia is a prevalent problem in the Ethiopian setting affecting 23% of reproductive-age women, and 18% of adult men. But data is lacking about its prevalence and factors associated with it in heart failure patients with reduced ejection fraction in our set up. Objective: To assess the prevalence of anemia and associated factors in heart failure patients with reduced ejection fraction on follow-up in the cardiac clinic of TASH with a clinical diagnosis of HFrEF from June 1 –October 30. Method- A hospital-based prospective cross-sectional study was conducted by interviewing HFrEF patients who came to the cardiac clinic during the study period and reviewing their i-care records. CBC and renal function tests were done for these patients and the results were collected. History of diabetes, etiology of HF, use of ACEI/ARB and admission in the past 6 month was assessed from the patient’s i-care records and patient interviewing. Quality of life assessment was done using Amharic version of KCCQ-12 questioner. EF was taken from previous echo reports documented on icare records. Patient’s demographic data, laboratory parameters and KCCQ-12 score were collected using a structured checklist. The data collected was cleared, entered and analyzed using SPSS software version 20. The research was conducted with an estimated total budget of 27,148.00 birr. Result- Among 138 HFrEF patients 27(19.8%) patients had anemia. Anemic patients had a lower quality of life as indicated by lower KCCQ-12 score (34 vs 43) (p=0.004), a higher rate of admission history within 6 months prior to presentation. (44% vs 12.6%) (p=0.041) and lower mean eCrCl(75 vs 87ml/min)(P=0.046). On binomial logistic regression, male sex is also found to be an independent predictor of anemia in this study(p=0.002) but no strong association was found with the age of patients, the presence of diabetes, etiology of HF, and the use of ACEI/ARBs. Anemic patients also tend to have more NHYA class III HF than Class II HF.
A cross sectional study on assessment of risk factors and utilization of GDMT on dilated cardiomyopathy patients having follow up at cardiac clinic, TASH presented to internal medicine department, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia from Sep, 2019 - Aug, 2020.
(Addis Abeba University, 2020-12) Mulugeta, Marshet; A, Mebratu (MD, Assistant Professor of cardiology TASH, Department of internal medicine)
Background: Dilated Cardiomyopathy which is the commonest of the cardiomyopathies is an important cause of cardiac-related morbidity and mortality globally. Despite the significant health impact associated with this disease, reliable data regarding the assessment of risk factors and therapy of these patients is lacking. Objective: This study aimed to identify the possible risk factors associated with dilated cardiomyopathy and assess the optimization of GDMT in this patient population. Methods: Hospital based crossectional study was conducted at TASH. The study included 107 patients who had follow up at TASH from Sep 2019 – Aug 2020. A semi structured selfadministered questionnaire and data from EMR was collected and used for analysis. The results were interpreted using descriptive statistics. Results: Of the total of 107 patients 12.1% patients reported family history of cardiac illness, 30.8 % had a significant alcohol and/or chat intake, 16% had peripartal diagnosis, 6.5 % were HIV infected patients, 1.8 % had history of thyrotoxicosis and 6.5% had antracycline chemotherapy treatment. Regarding therapy; 89.7% of our patients were on beta blocker while 91.4 % of patients were on ACEI/ARB/ARNI and 58.9 were taking MRA. The majority of patients were on suboptimal doses of all groups of medication. Conclusion: In the majority of our patients risk factors underlying the disease could be identified upon detailed inquiry. While most of our patients are on appropriate GDMT, the dose of the medications taken was far lower than that of the target dose as stated by the guidelines.
Pattern and Clinical Profile of Thyroid Disorders among Patients Attending Endocrine Clinic of Tikur Anbessa Specialized Hospital
(Addis Abeba University, 2020-12) Mohammed, Abdulhafiz; Dr.Tarekegn, Getahun (MD, Internist, Endocrinology Consultant); Dr.Feleke, Yeweyenhareg (MD, CSIM, MPhil)
Introduction Thyroid diseases are common endocrine disorders with a number of potentially serious complications. There are inadequate recent studies addressing the clinical picture of thyroid diseases in Ethiopia. Objectives The aim of this study was to assess the pattern and clinical presentations thyroid disorders. Methods A cross-sectional study was conducted on successive thyroid disease patients visiting Endocrinology Referral Clinic of TASH from Feb 2020 to June 2020 were included in this study. A retrospective medical chart review was carried out. Certain socio-demographic parameters and clinical characteristics of patients were assessed. Descriptive analysis was used for statistical analysis. The data was processed, summarized and presented in the form of narratives & tables. Results A total of 271 patients, 86.3% female and 13.7% male, with an age range of 14 to 81 years were included. And 60.5% of the patients were 40 to 81 years. Among all, 56.8% had overt hyperthyroidism and 39.5% had hypothyroidism while subclinical hypothyroidism and subclinical hyperthyroidism were documented in 2.6% & 1.1% of the patients. TMNG was responsible for 55.8% of hyperthyroidism cases as primary hypothyroidism accounted for 53.3% of the hypothyroidism cases. Palpitation (54.7%), goitre (26.4%), heat intolerance (25.9%) & hyperhidrosis (10.7%) were the commonest presentations of thyrotoxicosis, whereas hypothyroidism patients presented mostly with fatigue (49.1%), menstrual disturbance (25%), cold intolerance (20.5%) & weight gain (14.3%). Conclusion Thyroid diseases were more common in females and more prevalent in old age. More than half of the thyroid disorders were caused by TMNG and primary hypothyroidism. The most common presenting feature of thyrotoxicosis was palpitation, and of hypothyroidism, fatigue. Therefore, it is better to reinforce multidisciplinary approach, and introduce radioactive iodine uptake study and radioactive iodine therapy.
Coronary angiography findings and outcomes of percutaneous coronary interventions in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2020-12) Semere, Akberet; Alemayehu, Bekele (MD, Internist,Interventional Cardiologist)
Background: Some hospital based studies showed that CAD is a major cause of mortality and morbidity and the incidence of CAD is increasing in middle and low income countries like Ethiopia even though there is no country wide study done. Objective: The purpose of this study is to describe the coronary angiography findings and outcomes of PCI in TASH. Methodology: A retrospective cross sectional study was conducted on coronary angiography findings and outcomes of PCI at TASH using structured questionnaire from January 1/ 2017 to December 1 / 2020. Datas were analyzed and interpreted using SPSS version 26 software. Result: Coronary angiography was done for 149 patients, of which, 124 (83.2%) patients were males and 25 (16.8%) patients were females with the age range of 24 to 88 years. The median age was 52 years with mean ages of 53.2+ 12.46, the most frequent age stratum being 45 to 55 years. ACS was the clinical diagnosis in 68 (45.6 %) of patients, of which 51 patients (34.2% of the total) had STEMI. With catheterization, 108 (72.5%) patients had evidence of CAD, of which, 41 (37.9%) patients had multivessel disease. PCI was done for 60 (40.2%) patients and TIMI III was achieved. The in hospital mortality was 0.67%. In a bivariate analysis, Diabetes was associated with multi-vessel disease (P=0.016), (COR 3.04 ) 95% CI(1.23-7.51). Conclusion: CAD in Ethiopia occurs early in lfe mainly involving LAD and is associated with adverse consequences. PCI has been shown to have low complications and low in hospital mortality making it a safe procedure.
Risk stratification of Acute Heart Failureamong adult patients admitted to Black Lion Specialized Hospital.
(Addis Abeba University, 2020-12) Teshome, Gemechis; Dr.Mekonin, Desalew (Cardiologist and associate professor of internal medicine at AddisAbaba University)
INTRODUCTION Heart failure (HF) is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood. It is one of the major public health problems worldwide.It is one of major public health problem worldwide. Acute Heart failure is broadly defined as a rapid onset of new or worsening signs and symptoms of HF. Most of registries done in the developed world showed it is more common in elderly male, 66-75% of the patients has history of HF. In Sub Saharan African countries, Unlike developed nations; the most prevailing causes of HF in Africans remains largely non-ischemic, patients tend to be younger and most likely to present with severe symptoms. In Ethiopia, there are few hospital-based studies done. One retrospective chart review done at the University of Gonder showed of 311 patients; HFpEF is more common (52.73%) and tends to be women (76.22%). They predominantly had etiologies of valvular and hypertensive heart diseases.Another prospective study done at TASH showed; among 128 patients, 75 (58.6%)female, CRVHD was the most common (52.3%).A recent prospective study done at showed: median age of 34 years. The leading precipitating factor and underlying disease at the time of admission were pneumonia (47.5%) and chronic rheumatic heart disease (48.5%), respectively. In hospital, mortality was found to be 17.2%. In this retrospective chart review 259 patients charts was revied of which 33 patients were died and 226 were discharged improved. Mean age was 39 years and CRVHD was the commonest cause of AHF. With regards to comorbidity Hypertension and DM was associated with it in 25.5% and 19.7% of the cases. AF and CAP was the commonest identified precipitating factors. Low Hgb, lowsodium ,low potassium and increased creatine were predictors of mortality.
Assessment of Knowledge on Hepatitis B infection, Hepatitis B Vaccine and Vaccination Status among Health Care Workers in TASH from March 10-Sept 10 ,2020 G.C
(Addis Abeba University, 2020-12) Girum, Alebachew; Birhanu, Yohannes (MD, Internist, consultant Gastroenterologist and Hepatologist)
Background: Hepatitis B infection is usually higher among health workers than the general population, particularly in the sub-Saharan region. WHO recommends vaccination for all health care workers (HCWs) against the highly infectious, blood borne virus: HBV. However, previous studies reported that knowledge of HCWs toward the hepatitis B infection, Hepatitis B vaccine and their vaccination coverage was low and vary among HCWs in different settings. Objective: This study was aimed to assess knowledge about HBV infection, HBV vaccine and status of HBV vaccination among healthcare workers in TASH, Addis Ababa, Ethiopia from March 10 to September 10, 2020. Methods and materials: Hospital based cross-sectional study was conducted on 358 HCWs who were selected randomly. Stratified random sampling method was used to collect the data using self-administered questionnaire. Then, the data was entered into Epi-data 4.2 version and was exported to Statistical Package for Social Science (SPSS) version 26 for analysis. All covariates that showed p value < 0.25 in binary logistic analysis were further analyzed by multiple logistic regressions to detect true predictors. Result: Among the health care workers, who participated in this study, 180 (51.4%) of them had adequate knowledge on the HBV infection. Medical doctors were the most knowledgeable among the HCWs, with interns [AOR=11.3(95% CI=4.5-28.6)], consultant physicians [AOR=7(95% CI=3.1-15.9)] & resident physicians [AOR=3.5(95% CI=1.9-6.9)] being significant predictors of good knowledge. Vaccination coverage was 60% which was predicted by a shorter work experience [AOR=4.7(95%=1.4-5.8)]. Conclusion: This study reveals that general knowledge level of HCWs about HBV is inadequate and vaccine coverage is suboptimal. Thus, concerned stakeholders should devote more efforts to improve the HCWs awareness about the virus and role of its vaccine and also more work to avail vaccine.
Clinical characteristics and Endoscopic outcomes of patients who underwent UGIE for an indication of dyspepsia at Tikur Anbesa Hospital Gastroenterology referral clinic from December 1, 2015- December 30 2019.
(Addis Abeba University, 2020-12) Kefyalew, Endashaw; Dr. Sultan, Amir(MD, internist, Consultant Gastroenterologist)
Background: Dyspepsia is a frequent syndrome in our country, where there is limited endoscopy service and high prevalence of Helicobacter pylori (H. pylori) infection with some having an organic cause while others have functional dyspepsia. Endoscopy is the most accurate method of diagnosis of most endoscopically positive conditions associated with dyspepsia, including gastric cancer, peptic ulcer disease, esophagitis and gastro- duodenitis. Helicobacter pylori infection is associated with various upper gastrointestinal pathologies. Objective: The purpose of this study is to Clinical characteristics and Endoscopic outcomes of patients who underwent UGIE for an indication of dyspepsia at Tikur Anbesa Hospital Gastroenterology referral clinic. Methods: A Hospital based- Retrospective cross-sectional study was conducted using pretested, structured questionnaires to determine clinical characteristics of patients between 17-76 years’ old who underwent endoscopic procedure at Tikur Anbesa Hospital Gastrointestinal referral clinic. The study is conducted from April 2020-september 2020 G.C. A sample of 270 patients were included in the study. Based on the structured questionnaire, presenting symptom, alarm symptom, H.pylori test result and endoscopic finding and risk factors are assessed by the investigator. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Result: Two hundred seventy patients were included and analyzed in the study. The mean age was 38 years and Men comprised 58.5% of the study. 37 % of the patients reported alarm symptoms. The prevalence of H. pylori infection was 37.8 %. Endoscopic finding constitutes Normal, 29%, Ulcer disease, 16% (duodenal in 13% and gastric ulcer in 3%), Gastropathy/Gastritis 33 %, 13% had GERD and esophageal erosion and gastric mass account for 2.2 %. Ulcer diseases were found to have statistically significant association with H. pylori infection OR, (0.38 95% CI, (0.143-0.552) and alarm symptom (iron deficiency anemia and persistent vomiting), p <0.05. Conclusion: The endoscopic diagnosis in our setting showed predominance of abnormal findings and of this ulcer disease is the major endoscopic outcome with strong associations with Helicobacter pylori infection and GERD diagnosis was also shown to be frequent endoscopic diagnosis among our dyspeptic patient. Whereas cancer was an uncommon finding, despite the high prevalence of H. pylori.
Assessment of self-reported insulin injection techniques among patients with Diabetes Mellitus on follow-up at adult Endocrine clinic at Tikur Anbessa Specialized Hospital: Hospital-based cross-sectional study September 1 - October 31, 2020 G.C.
(Addis Abeba University, 2020-12) Efrem, Paulos; Dr.Tarekegn, Getahun(MD, Internist,Endocrinologist)
Background Assessment of injection device use and injection technique, are key components of a comprehensive diabetes medical evaluation and treatment plan. Proper insulin injection technique may lead to more effective use of this therapy and, as such, holds the potential for improved clinica l outcomes. The lack of a clear number of patients with diabetes mellitus requiring insulin therapy, and few studies focused on either assessing injection techniques or associated complicat ions separately have indicated suboptimal knowledge and skill with higher than the worldwide average on the presence of complications. Objective Major insulin injection parameters were assessed among patients with diabetes mellitus on followup at the adult diabetes referral clinic in TASH, Addis Ababa from September 1 to October 31, 2020. Methods A cross-sectional survey was conducted from September 1 to October 31, 2020, at the diabetes clinic in Tikur Anbessa Specialized Hospital. Data were collected by using a structured, interviewer-administered questionnaire. Then, entered and analyzed using SPSS version 20. To identify factors associated with injection techniques, bivariable and multivariable binary logist ic regression analyses were done. Statistical significance was considered at a level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association Results A total of 293 participants were included in this study. The most common type of diabetes reported was Type 2 diabetes mellitus. From the recommended injection sites, 256 (87.4%) inject at more than 1 site with the thigh (249/85%) being the most often used site. The median total daily insulin dose was 54IU. Insulin syringe reuse was practiced by practically all (98%) of the participants. Injection site rotation is practiced by 272 (92.8%) of the participants. The presence of anyswellings or lumps over the injection sites was reported by 113 (38.6%) of the participants with the thigh being the most common site. Disposal of used syringes capped into the trash is the practice of 176 (60.1%) of the study participants. From the multivariate analysis, sex (AOR=2.33, 95% CI:1.13-4.83), total daily dose of insulin (AOR=0.99, 95% CI:0.98-0.99), last time injection instructions were reviewed (AOR=0.35, 95% CI:0.13-0.97) and hyperglycemia events (AOR=0.56, 95% CI:0.31-0.99) showed significant association with the presence of lipohypertrophy. Conclusion: This study revealed that there are alarmingly high rates of injection-related complications. The diabetes education given pertaining to injection parameters and evaluation of injection sites are neglected which will fuel the occurrence of complications. It highlights the need for the provision of patient-centered instruction and education about insulin injection techniques.

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