Emergency Medicine

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Air way and breathing management knowledge and practice of nurses working in emergency department of selected governmental hospitals under health bureau of Addis Ababa, Ethiopia, 2021.
(Addis Abeba University, 2021-06) Nigatu, Mulachew; Dr. Debebe, Finot (EMCCP, ICS, Lecturer); Tuli, Wagari(EMCCN, MSc, Lecturer)
Background: Management of airway and breathing is one of the most important initial interventions to save the lives of patients and is a cornerstone of excellent emergency care. The first few minutes after an emergency condition are vital to providing these lifesaving interventions. Objective: This study aimed to assess the knowledge, and practice of nurses regarding airway and breathing management who were working in selected hospitals under Addis Ababa health bureau, Addis Ababa, Ethiopia from March to April 30, 2021. Methods: The study used an institutional-based cross-sectional descriptive study with a complete enumeration of all respondents by using the census method during the study period from March to April 30, 2021. A self-administered and structured questionnaire was used for collecting data from the respondents. Data quality was controlled by pre-testing the tools and providing training to the data collectors. The SPSS version 26 software was used for analyzing the data. Mean, frequency, binary, and multiple logistic regression analyses were used. Only Pvalue less than 0.05 was considered statistically significant. Result: About 102 respondents were included in this study with a response rate of 98%. Among those, 54(52.9%) were females. Findings from this study showed that 71.57% and 64.71% of the respondents had good knowledge and practice respectively. Being trained in training related to airway and breathing management before was statistically associated with knowledge and practice on both binary and multiple logistic regression at p<0.05. Conclusion and recommendation: This study showed relatively good knowledge and practice of nurses on airway and breathing management. Even though the finding is good, a significant number of participants had poor knowledge and practice. Therefore, it is very crucial to provide training since it was significantly associated with good practice and knowledge.
Analysis of the cause, classification and associated injuries of pelvic fracture in patients presenting to Tikur Anbessa specialized hospital emergency department, Addis Ababa, Ethiopia
(Addis Ababa Universty, 2018-07) Worku, Kindalem; Engida, Hywet (MD, Assistant professor of Emergency medicine)
Back ground; The trauma, a world public health problem, has been a major cause of morbidity and mortality, as it affects more than 50 million people today, an aggravated circumstance in urban centers, mainly due to the growing number of vehicles and the aggressiveness in traffic Which cause accidents with high energy and leading to an increase in the number of deaths and injuries. Among the orthopedic traumas, pelvic injuries are considered the third cause of death due to auto accidents; represent 20% to 25% of fractures in poly traumatized patients. However the pattern of pelvic fracture is not known in our setting. Objectives; The purpose of this study was to analyze the cause, classification and associated injuries in pelvic fracture in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia during the time of september1, 2016 – September 1, 2017. Methodology: A Retrospectivedescriptive study was conducted on 60 patients who were admitted to adult emergency medicine department of Tikur Anbessa specialized hospital, Addis Ababa university, Addis Ababa, Ethiopia with a diagnosis of pelvic fracture during the study period. The data were collected using structured pretested data collection tools and analyzed using SPSS for windows version 21.0. Results: From total of sixty patients enrolled in study thirty five patients were males (58.33%) and twenty five patients were females (41.67%).Age ranges from 13-75 years with a mean of 31.3 years (SD ± 14.8) and mode and median of 22 and 25.5years respectively. There were 2 deaths in this study 2/60(3.3%) both of them were in the ICU. Conclusion: In the data presented in this study 39/60 (65%) of hospitalized pelvic fractures were caused by transport accidents, and the mean length of stay is 11.3,7 and 13 days in Tile A, Tile B and Tile C respectively.
Analysis of the cause, classification and associated injuries of pelvic fracture in patients pressing to Tikur Anbessa specialized hospital emergency department, Addis Abeba, Ethiopia.
(Addis Abeba University, 2018-07) Worku, Kindalem; Engida, Hywet(MD, Assistant professor of Emergency medicine Head Department of Emergency medicine and critical care, AAU.); Zewdu, Tigist(MD, Assistant professor of Emergency medicine and critical care,AAU )
Back ground; The trauma, a world public health problem, has been a major cause of morbidity and mortality, as it affects more than 50 million people today, an aggravated circumstance in urban centers, mainly due to the growing number of vehicles and the aggressiveness in traffic Which cause accidents with high energy and leading to an increase in the number of deaths and injuries. Among the orthopedic traumas, pelvic injuries are considered the third cause of death due to auto accidents; represent 20% to 25% of fractures in poly traumatized patients. However the pattern of pelvic fracture is not known in our setting. Objectives; The purpose of this study was to analyze the cause, classification and associated injuries in pelvic fracture in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia during the time of september1, 2016 – September 1, 2017. Methodology: A Retrospectivedescriptive study was conducted on 60 patients who were admitted to adult emergency medicine department of Tikur Anbessa specialized hospital, Addis Ababa university, Addis Ababa, Ethiopia with a diagnosis of pelvic fracture during the study period. The data were collected using structured pretested data collection tools and analyzed using SPSS for windows version 21.0. Results: From total of sixty patients enrolled in study thirty five patients were males (58.33%) and twenty five patients were females (41.67%).Age ranges from 13-75 years with a mean of 31.3 years (SD ± 14.8) and mode and median of 22 and 25.5years respectively. There were 2 deaths in this study 2/60(3.3%) both of them were in the ICU. Conclusion: In the data presented in this study 39/60 (65%) of hospitalized pelvic fractures were caused by transport accidents, and the mean length of stay is 11.3,7 and 13 days in Tile A, Tile B and Tile C respectively.
Assesment of Knowledge and Practice of Adult Intensive Care Unit Nureses and Their Barriers on Pressure Ulcer Prevention and Management in Selected Public Hospitals
(Addis Ababa University, 2017-01) Gashaw, Linda; Debebe, Finote (Associate professor)
Background: Pressure ulcer is localized tissue necrosis that commonly develops on a bony prominence areas when soft tissue compressed for prolonged period of time. Critically ill patients are considered to be at greatest risk for pressure ulcer development. So that, nurses are the first line health professionals to provide adequate care. Objectives: To assess knowledge and practice of Adult Intensive care Unit nurses and their barriers towards pressure ulcer prevention and management in selected public Hospital, Addis Ababa, Ethiopia 2017. Methods: A descriptive cross-sectional survey was carried out among (N=128) Adult Intensive care Unit nurses in six selected public Hospitals. Simple random Sampling techniques was used to select sample hospitals in order to find research participants. In addition standardized questionnaire was used to collect data. Result: The study findings showed that the level of nurses’ knowledge regarding pressure ulcer prevention and management was good (Mean=18.52, SD+2.686), while the level of nurses’ practice was poor (Mean=12.39, SD+4.70924).Shortage of pressure relieving devices, inadequate training and education and presence of other priorities other than pressure ulcers were majorly cited barriers to carry out PrU care efficiently. The nurses’ knowledge has association (AOR= 2.499, p value = 0.028) with training but not with their practice and barriers. In addition nurses’ practice has significant association with barriers. Conclusions: In general, the study results indicates that nurses have good knowledge of PrU prevention and management but accounts poor practice. As a result the study recommends for the provision of in service training and fulfillment of proper equipments for AICU nurses and unit. The study finding implies the need for further researches and it will be used as point of reference. Keywords: Pressure ulcer, Knowledge, Practice, Barriers
Assesment of Knowledge, Attitude and Practice of First Aid Associated with Fighting Accidents Among Community Police Officers in Addis Abeba City, Ethiopia
(Addis Ababa University, 2017-06) Tafere, Tiruneh; Azazh, Aklilu (Associate Professor)
Introduction: In Ethiopia at the national level Pre-hospital comprehensive emergency medical system is practically non-existent, With regards to making Addis Ababa a model city in emergency medical service system, memorandum of understanding has been signed between important stake holders, One of very important member of the task force is Addis Ababa police commission which could have a different strategy in violence and injury prevention. Law enforcement officers are frequently the first responders to incidents that involve serious personal injury to situations that require balancing both tactical and medical issues. With a minimum of knowledge and training, officers can take essential first steps that often make the difference in a victim’s ability to survive. Objective: To assess the Knowledge, Attitude and Practice to wards first aid related to fighting accidents among community police officers in Addis Ababa city, Ethiopia, April, 2017. Methodology: A cross-sectional quantitative study was done among community police officers working in Addis Ababa city, Ethiopia from December 2016 to June 2017, using a cluster sampling method 128 community police officers of the city was participated for answering questioners. Data was analysed using spss version 21.0 and lastly presented using tables and graphs. Result: Participants were 110 (85.9%) male and 18(14.1%) female with an average age of 28 ±7.42 (SD) with a range from 20 to 49 years. Fifty and one (39.8%) were trained previously on first aid from different institution. Twenty nine (22.65%) respondents pointed all possible sign of airway problems related to accidents and One hundred and eighteen (92.2%) had impression and will to give first aid immediately for fighting victims but some of them are uncertain. Most participant’s first action during first aid was only transfer to near hospital. Conclusion and recommendation: This study identified what is known, believed and done of first aid by study population related to fighting accident, and showed that there was gap on knowledge of assessment and management of air way problems and this far speculate lack of experience of identifying airway problem. On the other hand respondents have a positive believe and will related to application of first aid at scene. Adjacently this study makes recommendation towards referred would be providing continues comprehensive training for ever-changing first aid activities. This will be done further in collaboration with governmental and non- governmental embodies.
Assesment of Patterns and Outcomes of Chest Injury Among Adult Patients Received Trauma Care at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethhiopia
(Addis Ababa University, 2017-06) W/Giorgis, Ermiyas; Zewdu, Tigist (Assistant professor)
Introduction: Globally, injury continues to be an important cause of morbidity and mortality both in the developed and developing countries. It is the major public health problem in every country across the world and causing approximately 5.8 million deaths per year. The Chest trauma is a disease that has worsened long with growing urbanization and industrialization; due to worldwide increases in violence, constructions and vehicle number. Objective: The objective of this study was to assess the patterns and outcomes of chest injuries among adult patients admitted with chest trauma in Tikur Anbessa specialized teaching hospital (TASTH) over one year period between January 1, 2016 to December 31, 2016. Methods and Materials: Hospital based retrospective descriptive cross- sectional study designs were used to assess magnitude and outcomes of chest injury among patients admitted to TASTH. The collected data were to Epi data software version 3.3.1. Then, the entered data was exported to SPSS, version 21 for analyses. Descriptive statistics was used to present the results. Logistic regression was used to determine association between dependent and independent variables. Association between variables was taken as statistically significant for all variables resulted in p- value of <0.05 on multiple logistic regression. RESULTS: A total of 192 chest injury patients were treated at TASTH. Fifty three of them were died during treatment. Age [AOR 8.9(95% CI, 1.51-53.24)], time of presentation to hospital after injury [AOR 4.6(95% CI, 1.19-18.00)], Length of stay in hospital [AOR 0.12(95% CI, 0.02- 0.58)], presence of extra-thoracic associated body region injury [AOR 25(95% CI, 4.18-150.02)] and development of complications [AOR 23(95% CI, 10-550)] were determinant of mortality in the present study. Conclusions and recommendations: Chest trauma predominantly affects the male and economically productive age group with high morbidity and mortality in this environment. Road traffic accident was the leading cause of chest trauma in this study outcome. The study calls for early recognition and management of complications, awareness creations to society on their health seeking behavior, adequate provision of ambulance service and road traffic accidents prevention to reduce the morbidity and mortality resulting from chest injuries. Key Words: Injuries, Chest injuries, Tikur Anbessa Specialized Teaching Hospital, Ethiopia
Assesment of Prevalence and Pattern of Medication Prescription for Bronchial Asthma, at Adult Emergency Department of Tikur Anbesa Specialsed Hospital
(Addis Ababa University, 2015-07) Mulat, Tadele; Girma, Biruk (Assistance professor)
Background; Bronchial asthma is a chronic inflammatory disorder of the airways. Asthma imposes a large burden on the individual and on health care systems.(1) Currently, asthma prevalence is approximately 10%-13%globaly.(1) WHO estimates globally,300 million are suffering with bronchial asthma with approximately 25,000 asthma related annual death.(6) in Africa estimated that a prevalence of 11.7% for asthma.(2) Objective; The main objective of this study was assessing the prevalence of bronchial asthma and pattern of medication prescription for bronchial asthma on adult patients visiting adult emergency department of TIKUR ANBESA SPECIALISED HOSPITAL from November 1-2012 to November 1-2014 according to national asthma prevention and education programme (NAEPP) and global initiative for asthma management(GINA). Method; this study was descriptive, crossectional, retrospective study. It was conducted in January to February 2015 in adult emergency department of Tikur Anbessa specialized hospital. The necessary data was collected from record of the patient who visited from November 1-2012 to November 1-2014. RESULT, 78(52.7%) were males giving a male to female ratio of 1.11 to 1. the prevalence of bronchial asthma was 1.04% with severity of 65(43.9%) moderate, 62(41.9%) were mild, and 21(14.2%) severe. 136(91.9%) had wheezing, 131(88.5%) dyspnea, 125(84.5%) cough, Conclusion, There was low prevalence of bronchial asthma in the emergency department with no difference in sex. Wheezing and Cough were the predominant symptoms and signs seen. Treating and managing patients with accordance to GINA is low. Patients who took low dose SABA were 78(52.7%), medium dose 64(43.2%), high dose 5(3.4%), systemic CS 97(65.5%), oxygen 122 (84.4%), adjective therapy 34(23.0%). Recommendation, Health authorities of the country should ensure the availability of nationally appropriate asthma management guidelines.
Assessement of Emergency Care Capacity of Dilla Univerisity Referal Teaching Zonal Hospital Emergency Department, Dilla University Referral Teaching Hospital, Snnpr,Ethiopia,2017
(Addis Ababa University, 2017-06) Feleke, Asresu; Azazh, Aklilu (Associate Professor)
Background; Ethiopian Federal ministry of health has published hospital transformation guidelines which contains lists of essential emergency equipment, supplies, drugs and Human resources (Clinical & non-clinical) necessary to provide service in emergency care area. Also Good opportunity made from FMOH to improve access to health service provision by expanding or constructing new facilities buildings to deliver quality care for communities. Additionally FMOH examining challenges and providing chance to local level to address the gap in the whole parts of Ethiopia. Objective; The objective of the study was to assess Emergency care capacity of Dilla University Referral teaching hospital, Gedeo zone ,SNNPR, Ethiopia. Methods: Descriptive Institution based cross-sectional study design was conducted from January 09 to June 07, 2017. This study was conducted at DURTH using Emergency and Trauma Services Resources Assessment Tool for Ethiopia. This assessment tool was modified from the general (ESRAT) to (ETSRAT-Ethiopia) by Emergency and critical care directorate in FMOH. Data was entered in excel, results of the study was organized and presented using tables, and; the following statistical analysis was considered .Such as Frequency, percentage. Results : The study demonstrated that emergency care capacity findings were ; nearly 67?% of emergency care personnel, and 70% of emergency medicine were available in the hospital, but only 43% emergency drugs were available in emergency care area. 36% over all emergency equipment indicator, 21% of emergency care supply, 75% of emergency care area laboratory indicator & 88% of system (routine) indicator were available in emergency unit of DURTH. Conclusion & Recommendation; The findings reveal extreme deficiency of essential emergency equipment, supplies & drugs. Additionally there were shortage of emergency care health personnel & lack of job specific training. Therefore Dilla Hospital stakeholders should take measure to fill the above listed gaps. In Addition, FMOH & appropriate stakeholders should assist to fulfill the gap
Assessement of Knowledge and Practice of Obstetric Care Providers Toward Active Management of Third Stage of Labor at Public Health Centers in the Towns of Finfine Area Special Zone of Oromia Regional State, Ethiopia
(Addis Ababa University, 2017-06) Nigussie, Dejene; Debebe, Finot (Assistant professor)
Introduction: Postpartum hemorrhage is the most common leading cause of maternal mortality worldwide a nd m ost of the de ath i s i n de veloping c ountries i ncluding E thiopia. G lobally, i t i s responsible for more than 25% of all maternal death and this proportion is higher in sub-Saharan Africa. P ostpartum he morrhage c an b e m inimized a nd pr evented b y a pplication of a pr otocol known as active management of third stage of labor. Proportion of deliveries assisted by a skilled birth at tendant and antenatal c are co verage h ave b een u sed as a k ey proxy i ndicator f or monitoring global p rogress to wards d ecreasing m aternal mo rtality. However, t hese t wo indicators may not reflect the content or quality of the care provider. Objective; The o bjective o f t his s tudy i s t o as sess K nowledge an d p ractice o f o bstetric ca re providers t oward active m anagement of t hird s tage of l abour (AMTSL) at h ealth c enters o f Finfine area special zone of Oromia regional state, Ethiopia from April to May 2017 Methods and materials; Institutional ba sed d escriptive c ross s ectional s tudy de sign w as implemented. Whole health cen ters i n s elected t owns w ere i ncluded to th e s tudy w ith 118 obstetric care providers from all health centers. Interviewer-administered structure questionnaire and observation by using observational check list was employed. Data was entered using Epidata V.3.1 and exported to SPSS version 21.0 f or statistical analyses. Descriptive statistical analysis was u sed to p resent d ata w hile lo gistic r egression w ere us ed t o de termine a ssociation of independent variables with practice of obstetrics care providers. Results: Adequate know ledge on A MTSL was a chieved b y 40.7% of ob stetrics care providers while good practice on AMTSL was achieved by 18.6% of them. Sex, pre or in service training, access to reading materials and knowledge levels of obstetrics care providers were among factors that affects their practice on AMTSL. Conclusions and recommendations: The overall know ledge and pr actice of obs tetric c are providers on A MTSL in the present study were not satisfactory. In views of the findings of this study, it imp lies th at th e p ractice o f o bstetric c are p roviders w as mu ch lo wer th an th eir knowledge of AMTSL. The investigator calls for immediate interventions. Key Word; Knowledge, p ractice, A ctive m anagement o f t hird s tage of l abour, pos tpartum hemorrhage,Ethiopia
Assessement of Knowledge, Attitude and Practices of First Aid Service Provision Associated with Road Trafic Accidents Among Taxi Drivers in Addis Ababa, Ethiopia
(Addis Ababa University, 2015-06) Getahun, Neway; Bacha, Tigist (Assistant professor)
BACKGROUND In Ethiopia traumatic injuries are one cause of morbidity and mortality. The largest proportion of serious injuries in Ethiopia comes from road traffic accidents; they have become one of the major national health burdens. According to our observation in Ethiopia most of the trauma victim of motor traffic accident is being handled by taxi driver, however limited first aid knowledge of first aid care have been observed from the taxi driver. Objective: To assess Knowledge, attitude, and practices of first aid service provision associated with road traffic accident among taxi drivers in Addis Ababa, Ethiopia. Methods: - cross-sectional study was carried out among Taxi drivers in Addis Ababa Ethiopia. A Multistage sampling technique was used on 400 taxi drivers The questionnaires were first prepared in English then it was translated to Amharic. To check the validity of the questionnaires, a pilot test was conducted. Data was collected by distributing questionnaires to taxi driver. SPSS version 20 was used for data entry and analysis. RESULT:-All participants were males. 345(86.3%345) were not trained first aid before. 50 %( n=200) u n d er s t ood t h a t, first a i d d u r i n g RTA given by taxi drivers. Participants were asked to prioritize first aid concepts but only 126(31.5%) taxi drivers were correctly reply and seeing that breathing maintenance as first aider. 95.5% (n=382)had interest to train first aid. 22.3% (n=89) were responded as application of alcohol is important to stop severe on-going bleeding. Only 39.5 %( n=158) participants a t t e n d e d to RTA victim. CONCLUSION:-Taxi drivers who participated in this study had considerable knowledge, attitude and skill gaps. This had serious implication in increasing preventable mortalities and disabilities caused by road traffic accidents so that first aid training and preparing guidelines that will assist the taxi drivers to perform his immediate lifesaving activities thoroughly and effectively is mandatory
Assessement of Prevalence and Out Come of Snake Bite Among Patients Attending at Abdurafie Town A Govrnmental Health Center and Msf (NGO‘S) North West;Gondar, Ethiopia,2014 Gc
(Addis Ababa University, 2015-06) Zewdu, Yemataw; Azazh, Aklilu (Associate Professor)
Background:-Snake bite is found in worldwide that environmental and occupational hazard causes a potential life threatening medical emergency and, it needs high priority assessment and treatment. It is agreater burden in low and middle income country. Globally snakebites (envenoming‘s) is a substantial cause of mortality and morbidity across all age groups. The incidence has been estimated as 500,000 and mortality reaches up to 125,000. The largest numbers of fatal snakebites occur in South Asia and Africa. In South Asia, there are 30,000– 50,000 deaths each year and in India With approximately 10,000 deaths occurring snake bite per year(1). Objective:-To assess the prevalence and the outcomes of snakebite patients attending at Abdurafie town a governmental Health center and MSF Holland, From January 2011- December2014 GC. North West; Gondar,Ethiopia. Methods and materials:- Institutional based retrospective; descriptive, cross-sectional study design will be conducted at Abdurafie town Health facilities North West, Gondar, Ethiopia; from January 2011 to December 2014 . All Snake bite patients who fulfill inclusion criteria that complete medical record registrations and visited during the study period. Data were collected by using prepared observational checklist through reviewing of patient chart. The collected data were encoded to Microsoft Excel and analyzed( SPSS) version 20.0.Frequency were generated and used binary logistic regression and chi squaretest the association between categorical variables. RESULT:-Predominantly males 408/358 (87.7%) were as 12.3% females affected .Majority of the victims attacks at the age groups of 21-30 (48.8%); 94.6% Urban areas peoples who had predominantly affected. 283 (64.9%) and 74 (18.1 %) were bitten outdoors and bitten indoors respectively.The lower limb frequently bite 57.8%) followed by the upper limb 31.1%.Among those poisonous snake bite 86.0% were 69.9 % received polyvalent Anti snake venom (ASV).The incidence of snake bite patients and 17.6% were referred to higher hospital. high; majority 74.0% patients improved and discharged, The mortality rate of snake bite patients were very high 4.9%.However three case(0.3%) corrective finger amputations were done. Conclusion:-A high prevalence of snake bites with high morbidity and mortality especially among the very active fertile youth segment in Abdurafie town a governmental health center and MSF NGO‘S, North West; Gondar,Ethiopia. Key words:- prevalence ,Snake bite, anti snake venom, envenomation, squeals, Abdurafi Town
Assessing triage implementation and factors affecting it among patients visited Tikur Anbessa Specialized Hospital Adult Emergency Department, Addis Ababa, Ethiopia
(Addis Abeba University, 2019-06) Desu, Birhanu; Dr..Beyene, Temesgen; Melaku, Birhanu
Introduction: - Triage is sorting of patients according to their clinical need and the availability of resource. It is important for resource limited setting in which the volume of patients visiting to hospital is unpredicted. Even though the triage tool is important to sort the right patient to the right place at the right time, some patients seen not triaged and evaluated properly as observed and evidenced from many literature. So, this study identifies whether the tool is properly filled, the parameters correctly measured and recorded, patients are well categorized and evaluated at given time frame and the factors affecting its implementation. Objectives: - To assess triage implementation and factors affecting it among patients visited Tikur Anbessa Specialized Hospital Adult Emergency Department, Jan.2016 to Jan.2018. Addis Ababa, Ethiopia. Methodology: - Institutional based cross sectional study was conducted at Tikur Anbessa Specialized Hospital Adult Emergency Department by selecting the patients chart using simple random sampling and reviewing it which was visited and triaged in the past two years. Descriptive statistics was used to compute individual variables, regression for associated variable and Odds ratio at 95% CI to show strength of association. Result: - From the total eligible sample 43.7% were incorrectly triaged. Among them 25.22% (n=29) were over triaged while 74.78% (n=86) were under triage. Correct TEWS score calculation for triage (AOR=3.019, 95% CI {1.139, 8.005, P=0.026), adult age group (AOR=3.018, 95% CI {1.357, 6.712}, P=0.007) and use of clinical discriminator (AOR=8.582, 95% CI {1.873, 17.389} P= 0.000) were the factors significantly associated with triage of patients. The use of clinical discriminator increase over triage proportion by 3.4 fold (AOR=2.400, 95% CI {2.095, 5.515}, P=0.000). Conclusion and recommendation: - Close to half of the patients are not triaged in proper way in adult emergency. Thus, those patients are not getting adequate and efficient care since they are not allocated in their respective area. Periodic monitoring and evaluation, training and awareness creation and allocation of materials is needed to solve the problem.
Assessment Magnitude And Associated Factors OfPediatrics Seizures, At Pediatrics Emergency Unit, Tikur Anbessa Specialized Hospital, Addis Ababa,Ethiopia, 2020
(Addis Abeba University, 2020-01) Habtamu, Asaminew; Dr. Argaw, Rahel(Md, Pediatric Pulmonology And Critical Care).; Tuli, Wagari(Aauchs, Msc, Emccn, Lecturer).; Dr.moges, Ayalew(Md,Pediatric Neurology)
background: - seizure is a transient occurrence of signs and symptoms resulting from abnormal excessive neuronal activity in the brain. It is an important cause for hospital admissions in children from developing countries. it accounts for about 1% of all emergency department visits, and about 2% of visits to children's hospital emergency department visits. It is a major factor for neurological and cognitive impairment in children living in sub-saharan africa. Limited studies have been conducted in ethiopia relating to the prevalence and associative factors of seizures in children. Objective: - This study aims to assess the magnitude of seizure and its’ associated factors among 1 month -12 years of age children admitted in tikur anbessa specialized hospital(tash), at the pediatric emergency unit from december 2016- december 2019. Result: - Medical records review was done for 256 children with a 96% response rate. The prevalence of seizure was 4.52 %( 45/1000 people) . 155( 60.5%) were males and with a male to female ratio of (1.5:1). the mean age of patients was 3.7 years (with standard devation 2.8). The mean age for onset of a seizure in males and females was 1.3(sd 1.1-1.5 at 95% ci) and 2.0(sd1.6-2.5 at 95% ci) respectively. on logistic regression, fever (or 1.85,p=0.01), newborn distress (or 2.31,p=0.01), hypoxia brain injury (or 2.43,p=0.00), and home delivery (or 2.8,0.04) were found to be significant predictors seizure.head trauma was 1.3 times more likely to had an earlier onset of the pediatric seizure, (aor: 1.3,p=0.00) , birth asphyxia, (aor: 2.3,p=0.00) hypoxic brain ischemia, (aor, 2.2,p=0.02)developmental delay, (aor, 2.5,p=0.01),fever, (aor, 1.2,p=0.01),male (aor, 2.7,p=0.01) were significantly associated with pediatric seizure early onset at p<0.05 with 95% ci. Conclusion:-:-this study has identified a considerable burden of seizure in younger children in this hospital. fever, perinatal insults and place of delivery were significantly associated with pediatric seizure .underlying the need to advocate the need of proper management of pregnancy and delivery Recommendation; -Health professional at different levels and institution should work to reduce the occurrence of childbirth asphyxia that commonly show most associations with pediatric seizure. health facilities better to give health education and health promotion to improve, the awareness on the risk factors of a seizure.
Assessment of Prevalence, Risk Factors, and Outcomes of Acute Kidney Injury Patients admitted to adult Intensive care unit at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2019
(Addis Abeba University, 2019-12) Getahun, Edmialem; Abebe, Asmamaw (Msc in Emccn, Lecturer); Zewdu, Tigist ( MD, Assistant professor of EMCC)
Introduction: Acute kidney injury is a syndrome characterized by the rapid loss of the kidney's excretory function and is typically diagnosed by -the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. In critically ill patients Acute Kidney Injury (AKI)occurs frequently and it allied with great rates of morbidity and mortality. Objective: This study aims to assess the prevalence, risk factors and outcome of acute kidney injury in patients admitted in the intensive care unit of Saint Paul's Hospital Millennium Medical College from January 2017 to December 2019. Methods: The study design was a facility-based retrospective; the cross-sectional study was conducted. Medical records of 108 were revised. Data collection checklist was developed and the data were extracted from the patients' medical records. Data entry and analysis were conduct by using the Epi-Data-4.2 and Statistical Package for the Social Sciences (SPSS) software version 25.0 respectively. The logistic regression model was used for analysis. Result: AKI in critically ill patients covered 16.1% with a mean age of 34 ± 15 age distribution and female predominance (66.7%). Being female and Anemia were the leading risk factors to develop AKI, 72 (66.7%)and 56 (51.9%) respectively. Sepsis was more likely associated to kill the patients with AKI. Most 81 (75%) AKI critically ill patients were initiated renal replacement therapy. Stage three AKI were account for 66(61.1%). Length of hospital stay ranged from 1 day to 52 days with a mean stay of 10.7 days. Critically ill patients with AKI (48.1%) had died in the study period. Conclusion: AKI is the most common cause for critically ill patient's morbidity I too observed the higher prevalence of AKI in critically ill patients with younger age groups and female predominance. The mortality rate of AKI in critically ill patients was near to half of all respondents during the study period.
Assessment of adult ICU nurses‟ knowledge, practice and associated factors regarding weaning of patient from mechanical ventilation in selected governmental hospitals of Addis Ababa Ethiopia.
(Addis Abeba University, 2020-06) Becheni, Seble; Dr. Debebe, Finot(MD, Ass’t prof); Tuli, wagari (M.Sc., Lecturer)
Weaning from mechanical ventilation defined as the process of brusquely or slowly discontinues ventilator support after a patient is able to sustain spontaneous breathing. The success of weaning depends on the resolution of the conditions that have caused the patient to be mechanically ventilated, daily ventilator performance assessment for weaning the patient, the patient readiness and effective application of weaning protocol and the weaning process. Objective: - The aim of this study was to assess knowledge, practice and associated factor regarding weaning patients from mechanical ventilation among nurses working in adult ICU of selected governmental hospitals Addis Ababa, Ethiopia, 2020 GC. Methodology: -Descriptive cross-sectional study design was conducted to determine adult ICU nurses' knowledge, practice and associated factors on weaning patient from mechanical ventilation in selected government hospitals. A total of 156 nurses were recruited by convenience sampling method. The data were collected by using semi structured self-administered questionnaires. SPSS version 25 was used for data entry and analyses. Descriptive statistics, bivariate and multivariate logistic regression were used to analyze the data. Result: - The finding revealed that, 89 (51.9%) of respondent had poor knowledge and 88 (56.41%) of them had poor practice toward weaning patient from mechanical ventilation. On bivariate logistic regression P<0.05, factors that had significant association on knowledge was an ICU work experience and training on weaning guideline. Also ICU work experience, educational status and availability of weaning protocol had a significant association with P <0.05 on the practice of ICU nurses. Conclusion and recommendation: The participants of this study had poor knowledge and practice. Work experience, weaning protocol training and availability of protocol had statistically significant with practice of ICU nurses. Therefore, to improve the levels of knowledge and practice, the investigator recommends continues on job training, preparation of protocols and supportive supervision is important.
Assessment of Availability of Treatment Resource in Emergency Department for the Management of Acute Toxic Exposures and Poisoning Detection in Selected Governmental hospitals, Addis Ababa, Ethiopia
(Addis Ababa University, 2017-06) Girma, Tesfaye; Tadele, Achamyelesh (PhD)
Background: Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. Objective: Assessment of availability of treatment resource in emergency department for the management of acute toxic exposures and poisoning detection in selected governmental hospitals, Addis Ababa, Ethiopia. Methodology: Hospital based descriptive cross sectional study was applied to assess availability of treatment resource for the management of acute toxic exposures and poisoning in selected governmental hospitals from December 2016 to June 2017. Data were collected using semi-structured questionnaire and the data obtained was analysed using SPSS and the result was presented using tables Chart and graph. Result: Over the study period, 920 poisoning cases were listed in the selected hospital registries. Among them, Organo phosphate poisoning was the most top leading cause of acute poison (18.8%, 173/920), Followed by Bleach (Sodium hypochlorite) poison (18.6%, 172/920). In all the hospitals all form of Charcoal and Sodium Sulphate were not available. Four of the five hospitals have had Orogastric tube and magnesium Sulphate. Only Nasogastric tube out of the ten decontamination resource had available in all hospitals. None of the studied hospitals have the stock of all either WHO or Ethiopian essential drug list recommended antidotes and none had fomepizole, pralidoxime, charcoal, sorbitol, ipecac, polyethylene glycol, deferoxamine dimercaprol, glucagon, and Protamine sulphate. In surveyed hospitals peritoneal dialysis was not available. Conclusion: For the majority of the surveyed hospitals the resources which are essential for treatment and management of poisoned patient are not sufficient. Furthermore, the available resources and the pattern of causes of poisoning show discrepancy. Recommendation: Based on the pattern of causes of poisoning it is better if the selected anti- dotes, stabilization, decontamination and elimination resource are available. Keywords Decontamination _ Elimination enhancement _ Stabilization resources _Availability_ Hospital _ Ethiopia _Poisoning.
Assessment of basic pre hospital ambulance care for patients transported from scene to emergency department hospitals/health centers of Addis Ababa, Ethiopia
(Addis Ababa Universty, 2018-06) Abdulkadir, Medina; Abebe, Yonass (BSC, MSC IN EMCC)
Back ground: Emergency medical services (EMS) system are a community’s gateway to acute and emergency medical care for members of the public facing time sensitive condition, critical illness and injury. Objective: This study is aimed to assess basic pre hospital ambulance care for patients transported from scene to emergency department hospitals/health centres of Addis Ababa, Ethiopia, 2018. Methods: An ambulance based cross sectional study was conducted prospectively for patients transported with emergency ambulance service from scene to emergency department from March 15-April 15, 2018 with observational check list for one month duration. The data was entered to epi data version 3.1 and analysed using SPSS version 20 software. Frequency, percentage, mean, median and standard deviation were used to describe the data using tables and figures. Result: one hundred twenty patients transported with ambulance from scene were included. From total assessed level of consciousness (n=118), 28(23.3%) patients were lost their consciousness out of them oral airway were applied only for 3(10.7%) patients. Circulation was assessed for 74(61.7%) patients among them 8 had cardiac arrest CPR were done for 6(75%) of them but no adrenaline drug. From (N=120), 44(36.7%) patients had bleeding but only for 23(52.2%) of them was tried to stop bleeding and out of 41(34.2%) trauma patients 5(12.1%) patients were applied c collar but majority 36(87.9) patients weren’t. In this study more than half of 64(53.3%) patients hadn’t documented their findings .Over all 69(57.7%) patients did not receive at least one of the necessary basic prehospital medical cares. Conclusion and recommendation: lifesaving procedures like manual airway opening, cardiopulmonary resuscitation, vital sign measurements, emergency drug administration, and stop bleeding as well as spinal immobilization were not performed adequately. Emergency professional inside ambulance, emergency physician consultation during transportation and performing administrative inspections may improve prehospital care.
Assessment of clinical presentation and outcomes sepsis among children admitted in pediatrics emergency department of Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia, 2019.
(Addis Abeba University, 2019-06) Alebel, Amsalu; Dr. Bacha, Tigist (MD, MPH, ASSOCIATE PROFFESORE); Wubetie, Andualem (MSC ECCN)
Introduction: Sepsis is life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of mortality among children worldwide. It is also the second leading cause of death for 1-14 years of age and fourth leading cause of death for under 1 year of age. Appropriate and timely recognition of sepsis is a prerequisite for starting goaldirected therapy bundles. Even though sepsis is common, few researches are done in the area of study and the country. Objectives: The study was conducted to assess the clinical presentations and outcomes of sepsis among children admitted in pediatric emergency department of Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. Methodology: Institutional based retrospective chart review method had been conducted by using standard checklist questionnaire for sepsis patients admitted in pediatric emergency unit of Tikur Anbesa specialized hospital from January 1, 2017 to January 1, 2019. Data has been checked, analyzed, and interpreted by using SPSS Software. The result was presented by tables, bar charts and pie charts. Result: A total of 305 sepsis patients were studied. Of this 3.9% and 2.9% were diagnosed as a complication of sepsis which were sever sepsis and septic shock during admission. The most common site of infection was chest focus accounted for (71%) of patients. The median value of SIRS criteria was (IQR=2) and most patients (79.3%) were alert. From the total studied sepsis patients, 13.4% have co morbidities. Majority of patients (81%) were started antibiotics more than 1 hour after triage. About 55.1% of studied patients were discharge and 8.2% were death. Of this, 3.6 %( n=11) of the death were within 48 hours. Conclusion and recommendation: sepsis is significant concerning condition among children due to its cause of mortality in the world. Majority patients had breathing problem; cardiac concomitant diseases and majority were treated after one hour triage time in this study. As a result every health providers should be awared for clinical presentations and treatments of sepsis.
Assessment of clinical profile and magnitude of early mortality in the adult emergency department of TASH, Addis Ababa city, Ethiopia.
(Addis Abeba University, 2020-06) Daniel, Hanna; Sr.Tadele, Achamyelesh ( MSC in EMCCN); Dr.Teklu, Sisay(Gynecologists physician)
Background: The classification of ED mortality is important because it identifies a group of patients who can benefit from the treatment that are provided at the department. Early mortality is defined as death within 72 hrs.‟ of ED presentation (7) and 'very early' ED mortality is defined as death within 24 hours (8). This 'very early' mortality group represents the most urgently ill patients likely to benefit from ED care interventions to prevent mortality. Objective: The purpose of this is study to assess clinical profile and magnitude of early emergency department mortality among patients presented to the adult emergency department of Tikur Anbesa Specialized Hospital from March 1,2018-March 1, 2020, Addis Ababa, Ethiopia. Methodology: A cross-sectional study design was used to assess clinical profile and Magnitude of early mortality in the adult emergency department, Tikur Anbesa Specialized Hospital; Addis Ababa, Ethiopia, From March 1, 2018 to March 1, 2020. The data were collected by review of patients‟ medical record cards. Data was entered by Epi data 4.2.1 and analyzed by SPSS Version 23. Binary and multiple logistic regression analysis were used for the association. Statically significance was P-value<0.05 at CI 95%. Result: Of analyzed 506 charts, overall early ED mortality rate was 1.68 %, with male to female ratio 1.1:1. From multiple logistic regression results, it was found that, patients who were triaged as Green were 4.2 times more likely to die after 24 hrs of admission.‟ than patients who triaged as red. (AOR= .235 95% CI .101, .546). Patients who presented with chief compliant of >1 week duration were 2.1 times more likely to die after 24 hrs of admission.‟ than who came with chief complaints of 4-24 hrs.‟ duration (AOR = .471, 95% CI: (.256, .866.). From co morbid diseases HIV patients were 2.7 times more likely to die after 24 hrs.‟ than Asthmatic patients.‟ (AOR = 2.720, 95% CI: (1.013, 7.300). Conclusion and recommendations: even though important steps were done to boost the emergency care there are still gaps. It has been found triage acuity; comorbid disease and duration of symptoms of patients were associated with Early ED mortality. Therefore it is essential to improve the quality of care of ED, to reduce the magnitude of preventable ED mortalities.
Assessment of clinical profile and outcome of patients with acute coronary syndrome in Tikur Anbessa and AaBET Hospitals ,Addis Abeba, Ethiopia.
(Addis Abeba University, 2018-07) Mebrahtom, Girmawi; Dr.Debebe, Finot; Dr.Zewde, Tigist
Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the world. Although no countrywide study has been done on cardiovascular disease (CVD) in Ethiopia some hospital based studies have shown the incidence of CVD is progressively increasing. Methodology: A retrospective cross sectional study was conducted on the clinical profile of patients with Acute Coronary Syndrome (ACS) In Tikur Anbessa and AaBET hospitals using a structured questionnaire from January 2016 to February 2018. The data were entered, analyzed and interpreted using SPSS version 20 software. Result: Of 142 patients with ACS, 62 (48.6%) were diagnosed as STEMI. The mean age was 57.5±12.09 years. The average time from onset of ACS symptoms to presentation in the emergency department was 2.4 days (61.96 hours) ±48.85. In about 101 (71.1%) patients, hypertension was identified as a risk factor for development of ACS. Nearly fifteen percent (14.8 %) of ACS patients in Tikur Anbessa and AaBET hospitals were either Killip class III or IV. The in-hospital mortality was 9.8%. Predictors of inhospital mortality in Tikur Anbessa and AaBET hospitals included female sex (P=0.016), time from symptom onset to presentation (P=0.04), being Killip class III and IV (P=0.001), and STEMI diagnosis (P=0.018). Conclusion: Patients with ACS have delayed presentation to the hospital from onset of symptoms. Patients had similar risk profiles with the developed world, but have higher mortality. Being female, delayed presentation, having STEMI, and higher Killip class was found to be independent predictors of in hospital mortality in Tikur Anbessa and AaBET Hospitals.

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