Neurology
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Item The Cost of Acute Stroke Care and Associated Factors in Tertiary Hospitals Addis Ababa,Ethiopia.(Addis Abeba University, 2021-06) Ali, Kemal; Dr.Mamushet, Yared(MD, Internist,consultant Neurologist); Dr.Alemayehu, Biniyam (MD, consultant Neurologist); Dr.Diltata, Girma (MD, consultant Neurologist); Tassew, Berhan(MPH in Health system and Health economics)Aim: Stroke is the commonest neurologic ward admission diagnosis in Ethiopia. It creates significant economic burden on the health care system. The acute stroke care cost is a major component of the annual cost for stroke. In this study, we aimed to determine the total acute stroke care cost per patient admitted to a tertiary level government hospital in Addis Ababa, Ethiopia. And to identify components and predictors of the costs in order to better estimate the overall cost of stroke. Materials and methods: This prospective study was done in Tikur Anbesa specialized hospital and Yekatit-12 hospital medical college on ward admitted patients between December 2020 and October 2021. All ward and ICU admitted stroke patients during the study period were enrolled. Direct and indirect costs from first stroke attack up to discharge were obtained. We used multiple linear regression analysis to determine factors associated with hospital cost. Results: A total of 118 stroke patients admitted to the study hospitals were enrolled and final analysis was performed on 99 patients. The mean acute stroke care cost per patient at the study hospitals was 14616.5 birr (228.3USD), direct and indirect costs 10209.55 birr (214.4 USD) and 4514. 6 birrs (94.8 USD) respectively. The average length of stay was 9.38 days. Multiple linear regression analysis of the natural log of the total acute stroke care cost showed variation in costs were largely attributable to: the length of hospital stays, ICU admission and rural residence. Conclusions: Acute stroke care cost in Addis Ababa, government tertiary hospitals are lower than previous African studies. Direct medical cost contributes the majority of acute stroke care cost. Length of hospital stay and ICU admission were the cost driving factors.Item Stigma among stroke survivors in Ethiopia: Experience from a tertiary hospital Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia.(Addis Abeba University, 2021-11) Tsegaye, Keberte; Mamushet, Yared (MD, Internist, Headache Subspecialist Assistant Professor of Neurology); Alemayehu, Biniyam (MD, Assistant Professor of Neurology); Diltata, Girma (MD, Assistant Professor of Neurology)Background: Stigma among neurologic disease is a widely recognized global health issue. The negative impact it has on different neurologic diseases has been described. Although stroke survivors have different degree of stigma which may contributes to negative outcomes, there is shortage of study on stigma among stroke survivors and its predictors, especially in low and middle income countries. Study title: Stigma among stroke survivors: Experience from a tertiary hospital in Addis Ababa, Ethiopia Objective: To assess the prevalence of stigma and its associated factors among stroke survivors having a follow up at the Neurologic Out-patient Clinic in Tikur Anbessa Specialized Hospital. Methods: Institution based quantitative cross sectional study was conducted among 123 stroke patients having a follow up at Tikur Anbessa Specialized Hospital Neurology Out-patient Clinics. Data were collected by interviewer administered questionnaire. Stigma was measured using Stigma scale for chronic illness (SSCI-8) tool and included self, family, and community perceived stigma. Depression was assessed using Patient Health related Questionnaire (PHQ9), and functional status using modified Rankin Scale. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS V25) software package. Binary logistic regression and multinomial logistic regression was used. Adjusted odds ratios with 95% confidence interval were used to identify associated factors with perceived stigma. Results: Overall, the prevalence of perceived stigma was 55%. For the perceived family and community, it was 17.9%, and 13.8% respectively. Functional disability [moderate to severe disability (AOR=6.88, CI: 2.257, 22.46) P=.001.], Depression (AOR=19, CI: 2.24, 161.34)P=.007 and residual weakness (AOR=9.71, CI: 0.94, 94.95) P=.051were factors associated with perceived stigma in stroke patients. Conclusion and recommendation: Around half of stroke survivors who participated in this study described some form of perceived stigma. The personal perceived stigma was higher when compared to family or community perceived stigma. Factors associated with perceived stigma were Depression, residual weakness post stroke, and moderate to severe disability functional status. The rehabilitation services for patients with stroke should be strengthened. These should include physical, emotional, and social aspect of disabilities. In addition, establishing patient support groups for stroke survivors, and educating the community about stroke may be important to address stigma.Item Assessment of Knowledge and Practice and Impact of Intervention about Early Diagnosis and Management of Increased Intracranial Pressure among Residents and Nurses Working at TASH: A cross-sectional Study, September-october, 2021.(Addis Abeba University, 2021-11) Workneh, Firaoly; Dr.Amare, Amanuel(MD,Internist, Consultant Neurologist); Dr.Wahlster, Sarah(MD,Consultant Neurologist, Neurological care specialist); Dr.Awraris, Meron(MD,Consultant Neurologist); Dr. Debebe, Yohhanes(MD,Consultant Neurologist)BACKGROUND Increased intracranial pressure is a commonly encountered and possibly fatal complication of neurologic, neurosurgical, and systemic diseases. Diagnosis is made based on clinical findings and neuroimaging and supplemented by invasive and noninvasive intracranial pressure monitoring methods. Depending on the underlying condition, management consists of medical and surgical treatments. Early diagnosis and prompt management is critical to diminish mortality and disability OBJECTIVE To assess knowledge and practices around early diagnosis and management of increased intracranial pressure among residents and nurses working at Tikur anbessa specialized hospital. To assess the impact of training on increased intracranial pressure diagnosis and management among residents and nurses working at Tikur anbessa specialized hospital. METHOD We conducted a cross-sectional analysis of data collected from September 1, 2021, to October 31, 2021, from 183 residents working in neurology, internal medicine, emergency, and critical care medicine, neurosurgery department, and nurses from the emergency department, neurology ward, neurosurgical ward, and adult intensive care unit. They were required to fill out a self-administered questionnaire in English designed to assess sociodemographic characteristics, knowledge, and practice on diagnosis and management of increased intracranial pressure. After completion of the questionnaire, they were shown a video of 18 minutes that was prepared by the investigator on increased intracranial pressure diagnosis and management. Adequate time was given for the participants to see and analyze the intervention material. Then after participants were asked to do the same questions again. Data were entered into Statistical package for social sciences version 26 for analysis. Categorical variables were summarized by frequency and percentages. Continuous variables were summarized by mean ± SD. Associations were done by one-way analysis of variants and paired-t-test. RESULT The total correct answer score of residents pretraining range from 55.75% - 90.4%. post training, the scores raised to 81.5% - 98.78% which was statically significant(p=<0.05). Post-intervention shows the level of knowledge risen in terms of the 20 questions out of 21.(p<0.05). only 5 out of the 20 questions answered with 85%of the participating residents correctly. But the post-training result shows nineteen questions were answered with more than 85%. For the nurses intervention has shown to increase the level of Knowledge score of 10 out of 12 questions and 7/10 of practice scores. CONCLUSION There is substantial knowledge and practice gap among the health care professionals and as the intervention resulted in significant increment of scores, continuous trainings and guidelines are important in advancing the level of understanding, practice and improving patient outcomes.Item One Stone, Two Birds: The Role of Families in Stroke Patients’ Care: A qualitative study among Stroke Survivors at Tikur Anbessa Specialized Hospital(Addis Abeba University, 2021-11) Adane, Emnet; Dr.Zenebe, Guta(MD, Consultant Neurologist); Dr.Demissie, Hanna (MD, Consultant Neurologist and Department Head); Dr.Gugssa, Seid (MD, Consultant Neurologist); Dr.Nuri, Hussien(Consultant Neurologist); Tamire, Mulugeta(MPH, PhD Student )Background: Stroke is the second leading cause of death and third leading cause of disability worldwide. After three months of sustaining stroke, 26% of stroke survivors require long-term care for long-term disabilities which includes mostly hemiparesis, speech problem, swallowing problem, sphincter dysfunction, dementia and depression for which there will be dependence for performing activities of daily living. So far, the role of families in stroke care is not studied in the context of Ethiopia but it is obvious that they have to adapt themselves to take care of their patient with what they know and think is caring. Objective: This study aims at explaining the role of families in stroke patients’ care among stroke survivors at Tikur Anbessa Specialized Hospital. Methods: A qualitative study was conducted using qualitative content analysis approach. We used a purposive sampling finding the maximum variation in participants by age, gender, residence, educational level, relationship to the patient, occupation, duration of stroke and monthly income. An in-depth interview using a semi-structured questionnaire was conducted to collect data by voice recording and the recording was transcribed verbatim then translated in to English language. Analysis was performed using an opencode software version 4.03. Result: A total of 26 participants were included in the in-depth interview and saturation was achieved. There were 20 female and 6 male participants. Majority of the females were daughters (8 participants) of the patients. The caregivers’ role included fulfilling patient’s self-care with hygiene, physical support in ADL, psychological and financial support. The challenges experienced by the caregivers’ were problems with their physical well-being, psychological disturbances and disruption of their social interaction. There are challenges due to financial crisis, inefficient health care facilities like pharmacies, laboratory services and unavailable rehabilitation centers. On top of these there was a challenge from knowledge gap from lack of proper health education provision. The study also found out the common support systems of the care givers which include families, friends, health professionals and others. There was a better recovery in patients with provision of rehabilitation and optimistic life styles like healthy diet, treatment adherence, continuation of follow up visits and provision of a health insurance free card for government services. Conclusion: family caregivers have a notable role in the care of post-stroke patients’ and there are undeniable challenges that are experienced by the caregivers which should also be taken in to consideration in planning a patient’s post-stroke care.Item Assessment of Knowledge, Attitude and Practice in Identification of Early Neurologic Deterioration in Stroke Patients among Health Professionals in Addis Ababa, Ethiopia.(Addis Abeba University, 2021-11) Asfaw, Nardos; Dr.Zenebe, Guta (MD, Internist and Neurologist, Assoc. Prof); Dr. Ali, Seid (MD, Internist and Neurologist, Assoc. Prof); Dr.Demissie, Hanna (MD, Consultant Neurologist, Ass. Prof); Dr.Nuri, Hussien (MD, Consultant Neurologist, Asst, Prof)ABSTRACT Background: - Worldwide, Stroke is the second most common cause of mortality and disability. In Ethiopia stroke is the 5 th cause of death accounting 7% from the top 10causes of death. Post stroke neurological deterioration is a significant clinical condition that affects up to a third of patients. Early neurological deterioration in stroke patients is a common event and is associated with poor outcomes. Therefore, attempts to prevent and treat early neurological deterioration should be made promptly and aggressively. Although studies have found that being aware of common causes of neurological deterioration can help for optimal care and preventive measures, so far there is no publication as to the knowledge and practice in identification of early neurological deterioration and associated factors in stroke patients among health professionals done in Ethiopia. Objective: To assess the knowledge, attitude, and practice towards identification of early neurologic deterioration in stroke patients among health care professionals in Addis Ababa Ethiopia. Methods: -We conducted a Facility based cross sectional analysis of data collected from June 2021 to September 2021 from 214 health professionals who are mostly involved in the care of stroke patients. Participants filled out pretested self-administered questionnaire. It includes demographic information, three sections to assess knowledge, practice and attitude towards early neurologic deterioration in stroke patient. Data was entered in to SPSS version 25. Categorical variables were summarized by frequency and percentages. Associations were done by binary and multivariable logistic regression to see the association between Knowledge-attitude, KnowledgePractice and Practice-attitude. Results:-A total of 209study participants responded to the study questions among a total of 214 participants making the response rate of 97.6%. Most of the respondents were male 114(54.5%).The mean age of the study participant is 29+/- 3.9. Nurses account for largest number of respondents 101(48.3%) followed by internal medicine residents 46(22%).Majority of respondents 111(53.1%) were from TASH, 41(19.6%) from Zewditu memorial hospital, The mean knowledge score of general practitioners and residents was 9.3 and the majority of internal medicine and Neurology residents scored above 9.3.Higher numbers of respondents 71.8% have positive attitude towards the causes of early neurologic deterioration in stroke patients could be prevented. Individuals who have training on acute care for stroke patients had 2.8 times (AOR = 2.8, CI = 1.4, 6.8) and neurological residents had 6.6 times (AOR = 6.6, CI = 1.2, 7.4 ) more likely to have stroke knowledge. Regarding stroke knowledge level, knowledgeable subjects had 2.7 times (AOR = 2.7, CI = 1.3, 3.5) more likely to have positive attitude towards stroke related early neurological deterioration as compared to those who were not knowledgeable. Health professionals below age 24 year were 0.58 times (AOR = 0.58, CI = 0.16, 2.1) less likely to practice preventive measures of early neurologic deterioration than those within the age range between 3444. Conclusion:-This study leads to the belief that there is a crucial need to rationalize and update knowledge regarding the predictors of early neurologic deterioration and preventive measures. It is important to have and use hospital based protocols to achieve optimum patient outcome and high quality of interdisciplinary care. Assessment to knowledge gap, current practice and attitude helps to fill the gaps as well as for provision of comprehensive, interactive and holistic approach to acute care of stroke and rehabilitation.Item Prevalence of Erectile Dysfunction and Associated Factors in Patients with Diabetes Mellitus having Follow up at Tikur Anbesa Specialized Hospital Endocrine Clinic ,Addis Ababa University, Addis Ababa, Ethiopia.(Addis Abeba University, 2021-11) Yayeh, Desalegn; Dr. Tafesse, Abenet (MSC., MD, Internist, And AssociateProfessor of Neurology); Dr.Tarekegn, Getahun (MD, Internist And AssistantT Professor of Endocrinology); Dr. Tsehayneh, Fikru (MD, Assistant Professor of Neurology); Dr.Assefa, Hanna (MD, Assistant Professor of Neurology); Dr.Hagos, Teklil (MD, Assistant Professor of Neurology)Background: Erectile dysfunction one of the earliest among the chronic complications of diabetes mellitus is increasing. The worldwide prevalence varies from 35-90%. In Ethiopia there were few studies done on prevalence of erectile dysfunction in men with diabetes and the result varies from 48.7% to 85.5%. In Tikur Anbesa Specialized Hospital Endocrine Clinic there was only one study which was done in 1998 which showed 48.7% of men with diabetes were affected by erectile dysfunction. Since the last 24 years a lot has been changed in terms of socioeconomic status, life expectancy and prevalence of chronic illnesses including the proportion of type of diabetes, prevalence of other associated risk factors like smoking and ways of living. Hence, our study was conducted to seal this opening and assessed the up-to-date prevalence and related factors of erectile dysfunction. Objectives: The goal of our study was to determine the prevalence of erectile dysfunction and associated factors among diabetic men attending Tikur Anbesa Specialized Hospital, Endocrine clinic in the study period. Methods: An institution based cross-sectional quantitative study of data collected from June 2021 to August 2021 from 269 men with diabetes mellitus who had a regular follow up at endocrine clinic, Tikur Anbessa Specialized Hospital. Face to face interview method was employed using a preset questionnaire for data collection & by reviewing their electronic medical records. The questionnaire included demographic information, lifestyle habits, medical conditions, the IIEF-5 Questionnaire and acceptance and treatment seeking rate for ED. Data was entered in to SPSS version 25. Median, mode & mean ±SD, minimum & maximum were used to summarize continuous variables. Categorical variables were summarized by frequency and percentages. Associations were done by chi-square test for categorical variables and by using ONE WAY ANOVA for continuous outcome variables. Strength of the association was determined by binary & multinominal logistic regression using odds ratio with 95% confidence interval and P values less than 0.05 was taken as statistically significant. Result: In this study the mean age of respondents was 54.45 ± 13.19. Majority (78.8%) were married & nearly half of them (43.5%) had attended college education or above. The mean duration of diabetes was 12.89 ± 8.98 years. Among a total of 269 respondents 243(90.3%) had varying degree of erectile dysfunction. Of those with ED 11.1% had mild, 44.9% mild to moderate, 23.5% moderate & 20.6% severe form of ED. Statistically significant association was seen in longer duration of diabetes, diabetes related microvascular complications, being on insulin therapy, having comorbid illnesses & drugs other than for diabetes. Majority of the study participants had never discussed about ED with their treating physicians (82.2%). Conclusion: The prevalence of erectile dysfunction has almost doubled from the previously reported in 1998. This study revealed duration of diabetes, microvascular complications, insulin therapy with or without oral agents, comorbid conditions &drugs other than for diabetes were associated with ED having statistical significance. ED should be given attention & healthcare providers should be proactive in assessing the problem.Item Prevalence and Associated Risk Factors of Falls among Parkinson Disease Patients in two Tertiary Hospitals, Addis Ababa, Ethiopia.(Addis Abeba University, 2021) Gizachew, Yirgalem; Dr. Tafesse, Abenet (MSC. MD, Consultant Internist& Neurologist, Associate Professor of Neurology); Dr. Tsehayneh, Fikru (MD, Assistant Professor of Neurology); Dr.Assefa, Hanna(MD, Assistant Professor of Neurology); Dr.Hagos, Teklil (MD, Assistant Professor of Neurology)ABSTRACT Introduction:Falls are a significant cause of disability, lost independence andreduced quality of life in people with Parkinson’s disease. Prospective studiesshow that between 45% and 68% of people with PD will fall each year, with alarge proportion (50–86%) falling recurrently. Objectives:To assess the prevalence of falls, their associated risk factorsamong Parkinson’s disease patients having follow up at TikurAnbesaSpecialized Hospital and Zewditu Memorial Hospital Neurology outpatienclinics, Addis Ababa, Ethiopia. Methods:Institution based cross sectional study was conducted amongParkinson’s disease patients on follow up at TikurAnbesa Specialized Hospitaland Zewditu Memorial Hospital Neurology outpatient clinics. Data wascollected by interviewer administered questionnaire and analyzed using SPSSV27 software package. Results: Data from 127 participants were collected and analyzed.The mean age of the recruited participants was 64 ± 12 years, and the males account for 70%. The mean duration of disease was 5.6 ± 4.6 years. 48 (37.8%) respondents had history of fallswith 13 (27%) having singlefall and 35 (63 %) with recurrent falls.Median occurrence of fall was6 months after PD diagnosis.Duration of illness and severity of disease as quantified by Hoehn and Yahr stage independently predicts risk of fall. Conclusion:In this study the prevalence of fall among Parkinson disease patients is 37.8% which is consistent with previous studies. Among all sociodemographic and clinical factors, duration of illness and Severity of Parkinson disease were independent predictors of falls.Item A two-yearretrospective review on theclinical and electrophysiologic profiles of Guillain-Barre Syndrome at two centers in Addis Ababa,Ethiopia(Addis Abeba University, 2020-12) Mulugeta, Abel; Prof.Mengistu, Getahun(Internist, Neurologist &Headache specialist); Dr.Melka, Dereje(MD, Consultant Neurologist); Dr.Zenebe, Yared(MD, consultant Neurologist); Dr.Nuri, Hussien(MD, consultant Neurologist); Dr.Alemayehu, Samson (MD, consultant Neurologist)Background: The clinical manifestations and electrophysiologic patterns of Guillain-Barre Syndrome(GBS)have been established with several studies previously.Nerve conduction study has been known to be one of the diagnostic tool complementing the clinical presentation of GBS patients. The aim of this study was to assess the clinical characteristicsand electrophysiologic pattern of GBSpatients at two facilities in Addis Ababa,Ethiopia. Methods:A retrospective cross-sectional study was conducted from October 1-30, 2020 upto by reviewing the medical record of GBS patientswho visited the neurology clinics at two facilities in Addis Ababa between from September 01, 2017 and September 30, 2019. Demographic, clinical, biochemical and electrophysiologic data were collected and analyzed. Results:A total of 59 GBS patients’ medical records were reviewed.Majority 46(72.8%)of the patients were male.The dominant age category was from 21-35 years of age having 26(44.1%)share.The mean age of the participants was 32.96 (15.04)years .Preceding illnesses were documented in 21patients wherediarrheal illness was reported by the majority (38%)followed by upper respiratory tract infections. Quadriparesis was the most frequent presenting symptom with 38(64.4%) patients. .Following the Nerve conduction test the two most common GBS variants identified were Acute Motor Axonal Neuropathy variant(AMAN)and AcuteInflammatory Demyelinating Polyneuropathy variants of GBS. Conclusion: The majority of GBS patientsincluded in our study were young adults who presented with quadriparesis, with the most common variant of GBS being AMAN variant.Item Health-Related Quality of life in Patients with non-traumatic myelopathy at two neurology referral clinics in Addis Ababa : Facility-based cross-sectional study(Addis Abeba University, 2020-11) Mesfin, Meron; Mamushet, Yared( MD, MSC); Belachew, Ayele (MD,MPH ); Alemayehu, Biniyam( MD)Background: Non-traumatic spinal cord injury is to a range of conditions caused by infection,autoimmune, vascular, neoplastic, metastatic, and compressive lesions. The health care option to patients with spinal cord injury, usually supportive and rehabilitative, assumes to have a longterm benefit, hence requires continuous monitoring of Quality of life as an outcome measure,with the overall goal of optimizing patient functioning and well-being. There is little information available on the quality of life in patients with non-traumatic spinal cord injury in Ethiopia. This study identifies the health-related quality of life in patients with non-traumatic myelopathy at two neurology referral clinics Of Tikur Anbessa Specialized Hospital and & Zewditu Memorial Hospital. Methods: Institution-based cross-sectional study was conducted among a sample of 50 patients with non-traumatic spinal cord injury, using short-form -36 questionnaires to determine the Health-related Quality of life. The data was collected through face-to-face and through phoneinterviews from Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital from March 2019-October 2020. Results- The mean age of the patients was 42.5±14.33. 23(46%) of them were males and 27(54%) were females with a male to female ratio of 1:1.1. 45(90%) patients were paraparetic and 18(36%) were bowel and bladder incontinent. The most common cause of non-traumatic myelopathy was compressive myelopathy (42%), followed by Transverse myelitis (34%). HIV myelopathy was seen in 4(8%) patients. The mean HRQOL was 37.08±25.41. 29(58%) patients with non-traumatic spinal cord injury fall in the lower range of HRQOL (0-33) while 12(24%) and 9(18%) in the moderate range (34-66), and higher range (67-100) respectively. The role of physical and role emotional domains were significantly affected. The body pain domain was least affected. Patients who walk supported were found to have significantly lower HRQOL compared to those unsupported patients (OR= 0.009, 95%CI: 0.001-0.097, P-Value= 0.01). Patients with sphincter dysfunction have lower HRQOL compared to those patients with no sphincter dysfunction (OR =1.600, 95%CI: 1.223- 2.093). Unemployment was found to have a significant association with low HRQOL (OR=0.014, 95% CI 0.004-0.0092, P-value =0.0021). Conclusion -Patients with non-traumatic myelopathy have a low health-related quality of life. Walking with support, unemployed, and patients with sphincter dysfunction have low HRQOL. The role physical and role of the emotional domain were significantly affected so that physiological and emotional support should be part of the rehabilitation therapy. Government and non-government organization should involve NTSCI patients by forming platforms to suit employment of this group of patients.Item Patterns of treatment outcome of epilepsy and associated factors among patients on followup at adult neurology clinic at Tikur Anbessa Specialized Teaching Hospital: Hospital based cross sectional study October 1-30, 2020G.C(Addis Abeba University, 2020-12) Dagnachew, Hilina; Amare, Amanuel(MD, Internisit, Associate professor of neurology); Gelan, Yohannes Debebe(MD, Assistant professor of neurology); Gebrewold, Meron Awrarisold (MD, Assistant professor of neurology)Background: Pattern of treatment outcome can be categorized based on the effect of an intervention on seizure control in relation to occurrence of adverse effects. A minimum of 12 months of seizure freedom from all types of seizure is required to label a treatment outcome as seizure freedom. Predictors of seizure treatment outcome can be utilized to direct resources towards strategies that lead to good seizure outcome. Despite the availability of interventions which can control the seizure frequency to an extent of 70% a large number of epileptic patients continue to have a seizure. Objective: Patterns of treatment outcome of epilepsy and associated factors among patients on follow-up at adult neurology clinic at Tikur Anbessa Specialized Teaching Hospital: Hospitalbased cross-sectional study October 1-30, 2020G.C Methods: A hospital-based cross-sectional descriptive study is conducted among epileptic patients who have a follow-up at the Neurology department referral clinic, Tikur Anbessa Specialized Hospital, Addis Ababa from Oct 1-30. A convenient sampling method was used. A questionnaire including, sociodemographic status, is used to assess patterns of treatment outcome with associated factors. The data were entered, processed, and analyzed using SPSS 26 window version. Result: A total of 245 participants were included in the study. More than half 145(59.2%) of patients with epilepsy were in the age range of 15-30. Among participants male gender account for 113(54.3%) and female gender for 112(45.7%). The age of onset of a seizure was below 15 for 115(46.9%) of patients. Generalized onset seizures 154(62.9%) was the commonest type of seizure diagnosed. Comorbidity is seen in 110(44.9%). Monotherapy 68(27.8%) was commonly used for treatment of seizure. The 166(67.8%) of patients had developed antiepilepatic related adverse event. Antiepileptic dugs non adherence seen in 68(27.8%)of patients. In 41(16.7%) of patients there is no seizure attack after initiation of antiepileptic medications. Seizure freedom was seen in 99(40.4%) of patients. Sex (adjusted odds ratio (AOR)= 3.316, CI=1.044-10.534;p-value=0.042) was predictor of poor seizure control. Conclusion: In this study, it was found that more than two-thirds of the participants continue to have seizure activity despite being placed on antiepileptic medications. Still, a large proportion of patients are not adherent to the medication prescribed. The older generation of antiepileptic medications utilized and more than half of patients reporting adverse events. Male sex is found to have a three times higher risk of developing poor seizure control. A further multicenter study of different subgroups of treatment is recommended and effect of sex on seizure can be studied further.Item Knowledge, Attitude and Practiceof Residentson Brain Death in Tikur Anbesa Specialized Hospital: a Cross Sectional Study(Addis Abeba University, 2020-12) Beyazn, Guadie; Mengistu, Getahun (MD, Internist, Neurologist, HeadacheSpecialist); Dr. Melka, Dereje (MD, Neurologist); Dr.Zenebe, Yared (MD,Neurologist)Background and Aims: Brain death is defined as irreversible and complete cessation of all brain function including that of the brainstem. The aim of this study was to assess the level of knowledge, attitude and practice of brain-death declaration among residents in Tikur Anbessa specialized hospital in the year 2020. Methods: This was a hospital based cross-sectional study in which residents from various field of specialty were included using convenient sampling method. Pretested questionnaire consisting of questions related to knowledge, attitude and performance of brain-death declaration were distributed among residents as per the inclusion criteria to fill. Statistical tools used were mean and standard deviation, and Chi-square test. Results: A total 123 residents responded to the questionnaire. About 81{68%} correctly defined it as complete cessation of brain activity including brainstem reflexes. Sixty-five {54.6%} of the residents do not agree on brain death to serve to declare legal death .Only 11.7% of the study participants have ever attempted brain death test. Conclusion: The majority of the residents know about the definition of brain death but most of them have difficulties in identifying the basic physiologic limits which are pre conditions to diagnose brain death. More than half of them don not accept brain death as a legal determinant of death .Practice of brain death testing was poorItem Depression in Epilepsy and its Effect on Seizure Control among Patients in Neurology Referral Clinic at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia(Addis Abeba University, 2020-12) Abdulhakim, Elham; Tafesse, Abenet (M.Sc., M.D, Associate Professor of Neurology); Tsehaynesh, Fikru(M.D. Assistant Professor of Neurology); Assefa, Hanna(M.D. Assistant Professor of Neurology)Background: Depression is the most frequent comorbid psychiatric disorder in epilepsy. The prevalence is 6-30% in developed countries and reaches approximately 50% in developing countries, including Ethiopia. There is a bidirectional relationship between depression and epilepsy. The seizures themselves or the anticonvulsant drugs can provoke depression in patients with epilepsy. Anti-depression medications can also lower the seizure threshold and provoke seizure. Objective: The study was conducted to assess socio-demographic characteristics and prevalence of depression in epilepsy and its impact on seizure control among epilepsy patients on follow up at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital neurology referral clinic. Method: A multi-institutional prospective cross-sectional study design was conducted from June 20, 2020 to October 30, 2020 at Tikur Anbessa Specialized Hospital and Zewditu Memorial hospital epilepsy follow up clinic. A stratified sampling method was used to collect data using a semi-structured questionnaire. The study participants were epilepsy patients who are on anti-epileptic drug treatment during the study period.The questionnaire comprises of basic demographic data, clinical variable and PHQ-9. Data analysis was conducted using SPSS version 25, descriptive statistics were used to describe the characteristics of the study participants. The results were summarized and described using tables. A logistic regression analysis was used to assess the association between seizure control and depression and P value of <0.05 was considered significant. Result: Of the 247 study participants, 128(51.8%) were females. The mean age was 30.7 ± 12.47 years. Co-morbid illness was present in 85(34.4%) with neurological diseases being the commonest. 137 (55.5%) of the respondents were seizure free in previous one year. The prevalence of depression in this study population was 38.1%. Presence of depression and the use of polytherapy was associated with poor seizure control. Conclusion: The prevalence of depression in epilepsy is high. The presence of depression and polytherapy use were significantly associated with poor seizure control. Recommendations: Epilepsy patients should be evaluated for presence of depression using screening tools as it helps in better management of seizure control.Item Patterns and presentation of surgically treated patients with spine trauma in two teaching hospitals, Addis Ababa, Ethiopia(Addis Ababa University, 2015-11) Adefris, Esayas; Biluts, Hagos (MD, PGD, FRC)Introduction: Acute injuries of the spine and spinal cord are among the most causes of severe disability and death after trauma. Objectives: To determine demographics of surgically treated spine trauma in two spine trauma centers in Addis Ababa, Ethiopia and determine association of neurologic deficit with the type of fracture. Patients and methods: Hospital based retrospective study undertaken at TASH & MCM in Addis Ababa on patients operated for spine traumas from January 1, 2011 to December 31, 2014. One hundred eighty patient records were investigated from both hospitals. Results: There were 180 patients with male preponderance (77.8%) and a mean age of 32.5 years. The most common cause of spine injury was road traffic injury (52.8%). Thoracolumbar (36.1%) and cervical (33.3%) spine injuries were the commonest levels to be affected. The majority of patients (55.4%) sustained a type A fracture, 23.2% a type B fracture, and 21.5% patients experienced a type C fracture. Three patients (1.7%) had odontoid and hangman fractures. Thoracolumbar spine injury accounted for the highest number of cases with complete neurologic deficit (43.4%). One hundred forty one (78.3%) patients had neurologic deficits. Pedicle screw and rods fixation (66.7%) & anterior cervical discectomy/corpectomy and fusion with plating (28.9%) were the two common procedures done. There greater likelihood for rotational type (Type C) fracture to cause neurologic deficit (92.3%) than either compression (Type A) (30.8) or distraction (Type B) (76.9%) fractures. This association was statistically significant (P = 0.023, Chi2 = 17.7). Conclusions: This study demonstrates basic epidemiologic distribution of spine injury patients who are surgically managed at the two major neurotrauma centers. Young men were the most common victims of spine injury. As RTA is the major and avoidable cause. We were able to confirm that type of fracture according to AO classification predicts the likelihood of neurologic deficit.Item Knowledge, attitude and practice of new stroke patients and their caregivers towards stroke: a hospital based interview(Addis Ababa University, 2017-11) Diltata, Girma; Ali, Seid (MD, Assistant Professor of Neurology)Background: Nearly three out of four deaths due to stroke in the world occur in low income and middle income countries – the majority are sub-Saharan African (SSA) countries. A rapidly rising stroke incidence in SSA created a large burden on the resource limited public health care. Stroke is one of the leading causes of adult onset disability in this region. Despite these impacts, very low level of awareness about stroke by the public is reported from a few studies done in SSA. In Ethiopia, there is no single study done that assesses knowledge, attitude and practice (KAP) of individuals towards stroke. Studying KAP of the victims towards stroke is essential step to improve public awareness and health care delivery system through community health education. Objective: This study was conducted to assess the baseline KAP of new stroke patients and their attending caregivers towards stroke. Methods & analyses: A facility – based, quantitative, cross – sectional, descriptive study was conducted. All new stroke patients and their attending caregivers were sampled from three teaching hospitals over a period of seven months. Standardized pretested mixed open ended and closed ended questionnaire was used to collect data from eligible 39 patients with new stroke and 214 caregivers of 77 new stroke patients. The questionnaire was administered face to face with in the first few hours or days after each new stroke patient’s admission to medical emergency unit or general medical ward of respective hospitals. A written informed consent was obtained from each study participants before the interview. The response rate among the selected participants was more than nighty percent (90.5%). Every study participant was given a short health education about stroke at the end of the interview. Protocol approvals were obtained from the Ethical Review Committee of the Department of Neurology. Data was entered and analysed using SPSS/PC version 20.0 software packages. Results & conclusions: Among 253 respondents 36% identified brain as the primary organ affected by stroke. Only about 11% knew three or more stroke warning signs/symptoms. The most frequently identified stroke symptom was sudden onset unilateral extremity weakness ( ). Approximately one in five (21%) participants was able to mention three or more risk factors of stroke but 40% respondent were unable to mention a single biologically plausible risk factor. 16% of respondents believe that stroke is associated with spiritual possession. Those who prefer to call ambulance or a health professional for immediate help were 111(~44%). A large proportion (41%) of individuals mentioned one or more culturally plausible but potentially dangerous practices that they would provide for unconscious stroke victims. Frequently mentioned wrong practices include giving sips of water or soft drinks, putting some food in the victims mouth, and sprinkling holly water on the patients face as first aid measures. Higher levelItem Prevalence and risk factors of low back pain in nurses working at Tikur Anbessa specialized hospital and Zewditu memorial hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2017-11) Assefa, Hanna (MD); Taffesse, Abenet (MD, Asst Prof of Neurology)BACK GROUND Studies showed slightly higher lifetime prevalence of lower back pain (LBP) among nurses and it is also a common cause of morbidity in the general as well as the working population. But, it is under studied in nurses working in Ethiopia. Objective The main objective of this study was to assess the prevalence of low back pain and associated risk factors among nurses working at Tikur Anbessa specialized and Zewditu Memorial hospitals. Methods and materials A cross-sectional study including all randomly selected nurses currently working in the above two hospitals was conducted using a structured self-administered questionnaire. Results Three hundred sixteen nurses (123 [38.9%] males and 193 [61.1%] females) participated in the study. The 12 month prevalence of LBP was 147 (46.5%). The prevalence was slightly higher in female nurses (50.3%). LBP was significantly associated with working hours, bad body posturing, having direct patient contact and previous history of trauma. 74 (50.3%) and 13 (8.8%) nurses reported mild and severe LBP, respectively. Chronic LBP accounted for 83.7% cases. Only 63 (42.9%) of nurses with LBP sought treatment. 49 (27.1%) nurses had been off-duty in one time or the other in the past one year and the total work days lost were 427 days. Conclusion Though it is not associated with a significant loss of work days, LBP is prevalent among nurses. Different occupational and non-occupational factors increased the risk. This can decrease the day to day effectiveness and job satisfaction of nurses and affect quality of their lives as well as patient care.