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Item Comprehensive Assessment of the Electronic Medical Record System at Tikur Anbessa Specialized Hospital(Addis Ababa University, 2022-12) Yaregal, Abiot; Mekonnen, DesalewBackground: Related to its bundles of advantages there is a worldwide trend toward paperless medical recording to avert the drawbacks of the paper based system. However, there is limitation in the adoption, expansion and modernization of Electronic Medical record (EMR) system in Ethiopia. There is also scarcity of data assessing the utilization of EMR in Ethiopia. Objective: The objective of this study and Quality Improvement (QI) project is to assess the quality of the EMR system used in TASH, to assess Knowledge, Attitude & Practice (KAP) of health professionals toward EMR and determinant factors for EMR improvement. Methods: A quantitative hospital based cross sectional descriptive study was conducted to assess KAP of health professionals while quality of EMR software was assessed using a checklist. Descriptive statistical methods were applied to analyze the KAP data. Results: Study participants were all degree and above, mainly males (63.6 %), physicians (76.54 %) and from department of internal medicine (67.7%). Most own personal computer (98.8%) and had adequate EMR knowledge (74.7%) and preferred using EMR than paper based record system (87.7%). Seventy (43.2%) had EMR experience at other government hospital. Fifty percent of the participants claimed TASH EMR did not contain all necessary functions and majority (70.4% for Doctor iCare) agreed on the need to improve TASH EMR system though EMR satisfaction was generally good (87.1% for Doctor iCare). Orientation by colleagues and work exposure were the main sources of EMR knowledge; only 10% participants got training. Majority agreed on hospital leaders (76.5%) and financial constraints (72.3%) as primary barriers for EMR expansion and improvement. Conclusion: Knowledge, attitude and practice of the end users are better. The interest to use EMR as compared to paper based recording is rewarding. EMR can be better implemented at TASH with better engagement of the hospital leaders and financial support.Item 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 .Item Radiological Manifestations in Symptomatic Patients with Positive (RT-PCR) covid19 Admitted at Tikur Anbessa Specialized Hospital AddisAbaba Ethiopia(Addis Ababa University, 2022-02) Mwapule, LuthGregory; Dr.Haile, Tewodros(PCCM Specialist); Dr.Ahmed, Abdurezak (Cardiothoracic Imaging Specialist)Introduction: In severe form patients with positive (RT-PCR) covid19 candevelop pneumonia or ARDS. It is reported that 30-50%of covid19 hospitalizedpatients can develop pneumonia. CXR/CT scan helps to identify covid19pneumonia by recognizing radiological manifestations of covid19 out of otherCXR/CT scan manifestations. Delay in diagnosis and subsequent treatment,developsserious acute respiratory failure, multiple endorgan failure, or death.Wedescribedsociodemographic, comorbidities and radiological manifestations insymptomatic patients with positive (RT-PCR)covid19 admitted at TASH.Methodology:A descriptive hospital based retrospective study was conductedamongsymptomaticpositive(RT-PCR)covid19 patients admitted in the covid19ICU and isolation covid19 wardfrom November 2020 to October2021. All adultpatients with CXR/CT scan recorded inmed-web (Tele-medicine internet softwareversion 7.0.11) computerized hospital medical system were included.Arrangements was made for abnormal CXR/CT scan to be reviewed jointly with aThoracic Radiologist. All information was recorded usingcase report formandanalysis was done using SPSS version 23.0Results:243patientswere recruited in this study, out of them 51.4%were female.Median age was 46years, IQR (30 - 60). The prevalence of radiologicalmanifestations was 65.8%, out of them 51.9%were male.Predominant CXR findings were bilateral 48.6%, multiple 47.3%, interstitial42.0%, patchy opacities 40.3%, peripherally 21.0%, lower 55.1% and middle46.1% lung zones. Most lesions had increased densities 44.9% followed by GGOdensities 17.7%. Common CT scan findings were bilateral 70.6%, multiple lobes70.6% and GGO23.5%.Majority of patients withold age (p-value=0.000*), CVD(p-value=0.016*),DM(p-value=0.013*), chronic lung disease (p-value=0.018*),PTB(p-value=0.038*),respiratory symptoms (p-value=0.000*), cough (p-value=0.000*), dyspnea(p-value=0.000*) chest pain (p-value=0.008*) and lower SPO2 (p-value=0.000*)when CXR/CT scan was taken had radiological manifestations.Majority cancerpatients didn’t have radiological manifestations (p-value=0.000*)Conclusion and Recommendation: Radiological manifestations in symptomaticpatients with positive (RT-PCR) covid19 admitted in isolation and covid19 ICU atTASHare common.Early recognition of radiological manifestations and propermanagement of comorbiditieswill improve care in covid19 patients.Patientswithcomorbidities, symptoms and radiological manifestationsshould be screened for covid19 (RT-PCR).COVID-19 Patients with cancer may not showradiologic abnormalities.Item Patterns of Anticoaulation and Outcome in COVID -19 Patients Admitted to TASH Isolation center, Addis Ababa Ethiopia, Retrospective Study (June 2020-June 2021)(Addis Ababa University, 2021-12) Nurlegn, Serkalem; Yusuf, Hanan(MD, Assistant Professor and Consultant in pulmonology and intensive care, consultant internist)Background Earlier reports of high prevalence of thrombosis and related mortality has led to use of anticoagulants being part of the main treatment with varying results. Despite current large scale data showing credible benefits there are no studies done to determine the pattern of anticoagulation use and outcome in COVID patients in Ethiopia. OBJECTIVE To assess patterns of anticoagulation and outcome, of COVID-19 patients admitted to TASH isolation ward June2020- June 2021. METHODOLOGY Facility based retrospective cross-sectional study using secondary data analysis, was conducted. Records were retrieved using TASH, isolation log book. 126 patients were included. Data was analyzed using descriptive and binary logistic regression analysis Result Of the total 126 cases, Anticoagulation was used in 94 pts 74.6%. Therapeutic dose anticoagulation was used in 13(13.8%) pts of which 8 had severe disease. Prophylactic dose 79(84%), intermediate dose in two pts. UFH was used in 78(82.9%), LMWH 13(13.8%), DOAC 2(2.2%). only 58.8% of the patients received the full dose of prescribed anticoagulation. Pulmonary Thrombo-Embolism occurred in 9 pts of which 8 had severe disease and nearly half were on anticoagulation. Venous thrombosis occurred in 7 pts among those 5 had severe disease. Three out of the seven pts were on anticoagulation. In Hospital mortality was (n=14, 11.8%). Conclusion In conclusion, majority of patients received anticoagulation with UFH in prophylactic dosage. Anticoagulation use was not associated with diseases severity, in hospital mortality or 3 months outcome. Complications of anticoagulation were rare and minor. Complications were not associated with poor outcome.Item Prevalence of Neurocognitive Impairment and Associated Factors among Type-2 Diabetic Patients on Follow Up at Diabetic Clinic, Tikur anbessa Specialized Hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2021-12) Gedefa, Bikila; Tarekegn, Getahun (MD, Consultant Internist and Endocrinologist)Background:-Neurocognitive disorders in patients with type 2 Diabetes Mellitus has spectrum manifestation which might range from subtle executive dysfunction to memory loss and overt dementia. Diabetes patients are at higher risk of all types of cognitive impairment, mainly because some diabetes complications results in cognitive impairments and they are also being considered as disease of the same spectrum. Even though it is estimated that more than 50 million peoples live with dementia worldwide, there is no enough data from low and middle income countries, including Ethiopia, where the number is projected to increase to 152 million by 2050. Hence this study will focus on assessing the overall prevalence, potential determinant and contributing factors among patients with type 2 DM over a period of two months at Black Lion Specialized Hospital, Ethiopia. Objective: - To assess the neurocognitive impairment and associated factors among diabetic patients on follow up at diabetic clinic, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from July 1- August 30, 2021 Methods A hospital based Cross-sectional study was conducted on total of 338 type 2 diabetic patients on follow-up at BLH. The sociodemographic, anthropometric and clinical data was collected by trained final year medical students. Both face to face interview and medical record reviews were used for data collection. A validated Mini Mental Status Examination tool was used to assess cognitive impairment. Data was entered to epi-data cleared and analyzed by SPSS version 26.0. Finally, Descriptive analysis was carried out and presence of statistical association between neuro-cognitive impairment and associated factors was assessed using logistic regression and associations with p-value of < 0.05 will be considered to be statistically significant. Results The overall prevalence of neurocognitive impairment among type 2 diabetic patients on follow up at black lion specialized hospital was 38.75%. From Socio-demographic factors low educational level [AOR=3.65(1.855-7.188)] was associated with increased odds of encountering cognitive impairments. While some clinical characteristics like being on oral hypoglycemic agents [AOR=0.786 (0.370-1.669)] or oral hypoglycemic agents combined with insulin [AOR=1.87(1.054-4.264) were associated with decreased likelihood of cognitive impairments. Total duration of DM [(AOR=1.95(0.987-3.877)] and overall glycemic control [AOR= 2.21(1.238-3.947)] had significant association with NCI. additionally coexisting hypertension [AOR= 0.53(0.314-0.918)] and presence of diabetic eye disease [AOR=1.84(1.056-3.229)] were also associated with increased odds of encountering impairment. Conclusion: - The finding indicated high prevalence of neurocognitive impairment among respondents who had low level of education, prolonged duration of DM, poorly controlled DM, diabetic eye disease and coexisting hypertension.Item Patterns of Diabetic Retinopathy Predicting Diabetic Kidney Disease Severity ,at Tikur Anbessa Specialized Hospital (TASH),College of Health Sciences, Addis Ababa University.(Addis Abeba University, 2021-12) Mengesha, Wodajo; Dr.Kebede, Tedla(MD, Associate Professor); Dr.Zemenfes, Abel(MD, Associate Professor)Background: Diabetic retinopathy and diabetic kidney disease are microvascular complications of diabetes mellitus. Patients with diabetic retinopathy are prone to develop diabetic kidney disease. However, there is limited evidence on the relationship between diabetic retinopathy stages and diabetic kidney disease severity. Objective: To identify the relationship between patterns of diabetic retinopathy and diabetic kidney disease Methods: A hospital based cross-sectional study was conducted at diabetes clinic of TASH, Ethiopia from June 2021 to July 2021. Structured questionnaire, patients’ charts and/or electronic medical records were used to collect data among 101 diabetic patients with diabetic retinopathy aged 18 years and above. Data were cleaned, coded and entered into IBM SPSS version 26 software for analysis. Descriptive and logistic regression analyses were used and P-value < 0.05 was used as statistically significant. Results: The mean (±SD) age of the participants was 52.9 (±11.8) years. Majority (94.1%) of our diabetic retinopathy patients had nonproliferative retinopathy and 70.3% of diabetic retinopathy patients had concomitant diabetic kidney disease. In multivariable logistic regression analyses, diabetic retinopathy severity (severe nonproliferative diabetic retinopathy to proliferative diabetic retinopathy vs. mild to moderate nonproliferative diabetic retinopathy) [AOR= 3.97; 95% CI: 1.01 - 15.62], T2DM [AOR= 3.74; 95% CI: 1.29 - 10.75], presence of CVD [AOR= 3.18; 95% CI: 1.05- 9.59] were the independent predictors of diabetic kidney disease. Conclusions: In this study, diabetic retinopathy severity was strongly associated with diabetic kidney disease. Therefore, evaluation of diabetic retinopathy severity at the time of retinal screening is recommended. Budget grant: Addis Ababa University (AAU), College of Health Sciences, School of MedicineItem Sociodemographic Features, Risk Factors, Clinical Characteristics and Treatment Outcomes of Patients with Chronic Portal Vein Thrombosis Seen at TASH and Adera Medical Center during the Period between August 2019 and August 2021, Addis Ababa, Ethiopia(Addis Abeba University, 2021-08) Yizelkal, Selamawit; Prof.Bane, Abate(MD,Consultant Internist and Gastroenterologist/hepatologist)Background:Portal vein thrombosis is the most common cause of extra-hepatic portal vein obstruction. Its prevalence is variable based on studied population, but is higher in developing countries than developed countries. PVT is mainly associated with cirrhosis and depends on the severity of the disease. Objectives: This study was conducted to assess the socio-demographic features, risk factors, clinical characteristics and treatment outcomes of patients with chronic portal vein thrombosis seen at Tikur Anbessa specialized hospital (TASH) and Adera medical center during the period between August 2019 and August 2021, Addis Ababa, Ethiopia. The study also tried to assess the difference of presentation and outcome of patients between cirrhotic andnoncirrhoticPortal vein thrombosis (PVT). Methods and materials: The study will be conducted as a cross sectional cohort descriptive study in two centers to describe the socio-demographic features risk factors, clinical characteristics and treatment outcome of PVT in patients following at Gastrointestinal (GI) outpatient clinic, or admitted at the emergency department (ED), intensive care unit (ICU) or medical wards in TASH and Adera medical center, Addis Ababa University. Datawas gathered through review of medical records and a questionnaire regarding their demographic characteristics, and clinical information including etiology, results of laboratory and imaging tests.The data was checked for clarity and completeness. Computerized data analysis was conducted by using SPSS (statistical package for the social sciences) version 26 software. Results:The mean age at diagnosis was 34.64 (± 11.86) years. Majority of patients in the study were male (52 (69.3%) Vs 23(30.7%)). Majority of patients (63.9%) had chronic presentation than acute presentation, which was seen in 36.1%. Majority of patients had normal liver enzymes and coagulation profile. The most common risk factors identified in this study were cirrhosis (28%), MPD (17.3%) and intra-abdominal infections (12%). The most common compilations identified were esophageal varices, portal hypertensive gastropathy, ascites and gastric varices. Endoscopic variceal band ligation was done, nonselective beta blocker, anticoagulation was given for 29, 38& 24 patients, respectively. Mortality among the 75 patients were 2.7%, 12 patients were lost to follow up and 61 patients continued follow up. Mortality was mainly as a result of the underling cirrhosis. Conclusion: Most Portal vein thrombosis patients in this study had chronic presentations of symptoms. Mortality of patients with cirrhosis is higher than those without cirrhosis.Item The Incidence, Risk Factors and Prognosis of Acute Kidney Injury in Severe and Critically Ill Patients with COVID-19 in ICU of Eka Kotebe Hospital, Addis Ababa Ethiopia: A Retrospective Chart Reviews.(Addis Abeba University, 2021-12) Gudeta, Nigusu; Dr.Kebede, Dawit; Dr.Melkie, AddisuAbstract Background-The incidence, clinical characteristics and outcomes of acute kidney injury (AKI) in patients with COVID-19 admitted to intensive care unit and its association with mortality and disease severity. Objective-To determine the incidence, risk factors, clinical characteristics and outcomes of AKI in a cohort of patients with COVID-19 admitted to Eka Kotebe Intensive Care Unit (ICU), and its association with in-hospital mortality(survival), dialysis requirement, increased need of mechanical ventilation, disease severity and renal status at discharge. Methods- It’s a single centered cohort study from a registry of patients with COVID-19. A total of 174 patients were admitted to medical ICU with confirmed COVID-19 between from 1st October 2020 to 31 may 2021. We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the need for mechanical ventilation, and in-hospital mortality. Measurements-Stage of AKI, LOS, mechanical ventilation, discharge, and in-hospital mortality. Results-Of the total 174 patients registered to the log book during the study time, and only 156 patients were found to be eligible for study and from this 95(60.9%) developed AKI, 36 (37.9%) presented with AKI, and 59 (62.1%) developed AKI in-hospital. High charlson comorbidity index, low lymphocyte count, low serum albumin level, higher white blood cell counts and Serum alkaline phosphatase measurement, vasopressor need for life support, and mechanical ventilation were found to be associated significantly with increased risk for AKI. Limitations-a cohort study with small sample size limits precision of estimates. Lack of nonhospitalized and stable admitted patients with confirmed COVID-19 as controls limits causal inferences. Conclusions-Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk.Item Worsening Renal Function in Patients Admitted With Acute Decompensated Heart Failure: Incidence and Risk Factors Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021: A Prospective Study(Addis Abeba University, 2021-10) Yalew, Eyerusalem; Tadesse, Yewondwossen (internist, consultant Nephrologist); Dr.Melkie, Addisu(internist, consultant Nephrologist)Background: acute kidney injury and worsening of renal function is common in patients with acute decompensated heart failure, and development of this entity affects patient’s morbidity and mortality. Objectives: The main objective of this study was to assess the prevalence, and associated factors for development of WRF in admitted ADHF patients. Methods: This was a prospective, hospital-based study of cardiac patients admitted to TASH between June, 2021 and October, 2021. A structured questionnaire was used to collect parameters on sociodemographic characteristics, comorbidities and clinical profile of patients. Trained physician data clerks collected the data from the chart, interview and electronic medical records. Data was entered into SPSS version 26 for analysis. Bivariate and multivariate binary logistic regression analyses was done to identify factors associated with AKI and WRF, Statistical significance was considered at the level of significance of 0.05%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association. Result: A total of 104 patients were included in the study. 64(61.5%) were male and 40(38.5) were female. The prevalence of AKI was 21.2% and the prevalence of WRF was 37.5%. The odds of developing AKI in smokers was 3.7 times higher [AOR= 3.7; 95% CI: (0.86, 13.18)]. Conclusion: This study demonstrated that WRF is frequent finding complicating management of ADHF patients.Item Assessment of Knowledge, Attitude and Practice of Diabetic Foot Care among Diabetic Patients in Tikur Anbessa Specialized Hospital, Ethiopia(Addis Abeba University, 2021-12) Fekadu, Elfign; Reja, Ahmed (MD, Endocrinologist)Background- The prevalence of diabetes continues to be a growing problem throughout the world and contributes significantly to the health care burden. One of the major complications that diabetes carries is foot ulcer. Diabetic foot ulcer (DFU) is one of the most feared complications and a common reason for the hospitalization of diabetic patients. The ultimate endpoint of diabetic foot disease could be amputation, which is associated with significant morbidity and mortality. It also has significant social, psychological, and financial consequences. Objective- This study is designed to address the status of knowledge, attitude and practice of diabetic foot care and barriers to foot care practice among diabetic patients on follow up at Endocrine clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methodology- This is a descriptive cross-sectional study which was done on diabetic patients on follow up at Endocrine clinic in Tikur Anbessa specialized hospital. The study included 378 diabetic patients using a convenient sampling technique. All patients whose records met the inclusion criteria were reviewed. SPSS version 25 was used for data analyses. Knowledge, attitude, and practice of foot care were assessed using descriptive statistics and bivariable and multivariable logistic regression. Results- A total of 378 study diabetic patients were included in this study where the mean age of the participants was 54 years. There was comparable sex distribution. The mean knowledge score using questionnaires adapted from recommendations by American College of Foot and Ankle surgeons was 12.1 1.94 of which 47.6% and 52.4% had good and poor knowledge of diabetes foot care respectively. The mean attitude score using questionnaires adapted from a previous Saudi study was 3.85 0.90 of which 73.5% had good attitude and the remaining 26.5% had poor attitude towards foot care. The practice score using questionnaires that were adapted from the Nottingham Assessment of Functional Foot Care (NAFFC) was considered good if the participants scored above mean. Based on that, 54.5% of the participants had good practice while 45.5% of the participants were considered to have poor practice. With regards to barriers of foot care nearly one third didn’t know what to do, 27.5% didn’t think it was important, and 6.9% of the participants mentioned poor communication between patients and HCP. Conclusion and recommendation- Knowledge and practice of foot care among diabetes patients in our study participants weren’t satisfactory. The result of this study displays the gaps in their knowledge and practice and puts an emphasis on the need for patient education. Most patients are reported to have good attitude which can signify that patients are willing to learn and practice if they get access to proper diabetes education. In conclusion, it is important to focus on the role of health education to minimize diabetic foot complications.Item Peripheral Oxygen Saturation Measured using Pulse Oximeter among Healthy Adults at Moderate to High Altitude City of Addis Ababa, Ethiopia.(Addis Abeba University, 2021-12) Berhanu, Bethelhem; Amogne, Wondwossen(MD, PhD, Associate Professor of Medicine and Infectious Diseases specialist ); Haile, Tewodros(MD, Associate Professor of Medicine and pulmonary and critical care specialist )Background: At high altitude, human body undergoes some changes as part of acclimatization and adaptation for exposure to inadequacy of oxygen due to reduction on barometric pressure of oxygen. Inadequacy of oxygen might lead to hypoxemia. The other well-known component of high altitude physiological adaptation is change in hemoglobin concentration. It is very important to know the changes in peripheral oxygen and hemoglobin (hgb) values of healthy adults living in moderately to high altitude areas such as Addis Ababa so that it helps to determine target values during disease states. However, such data are lacking for residents of Addis Ababa. Objective: The study was conducted to assess the profile of distribution of peripheral oxygen saturation measured with pulse oximeter among healthy adult population in the moderate to high altitude city of Addis Ababa. We also determined the hemoglobin concentration level of the participants to see if there is hematologic effect of altitude elevation on the permanent residents of Addis Ababa. In addition, other predictors of oxygen saturation in residents of Addis Ababa were assessed. Methods: A cross-sectional study was conducted between the dates of July 30, 2021 and November 30, 2021 on permanent and active apparently healthy residents of Addis Ababa. Data was collected via structured questionnaire as well as direct measurement of weight, height, RR, PR, BP, Hgb level and spo2 with appropriate gadgets. The collected data was checked for completeness and consistency and was entered to Excel. SPSS version 26.0 was used for analysis. Mean, median, standard deviation and variance were calculated. The Chisquare test was used to identify determinant variables. A significant level of p < 0.05 was taken to conclude that the variable has a statistically significant impact on the value of oxygen saturation. Result A total of 296 participants were enrolled among which 108 (36.5%) of the participants were male while 188 (63.5%) of the participants were female. The median age of the participants was 27 years, IQR (23,33). Larger proportion of study participants fall under healthy BMI category,63.2% of the study population. The mean SpO2 (±SD) of the study population was 95.6 %(±1.61) with mean SpO2 value of male participants being 95.61% (±1.54) and 95.63 (±1.64) for female participants. Over two-third of the participants, 68.5% of male participants and 69.1% of female participants had saturation value of ≥ 95%. The mean Hgb (±SD) was found to be 15.59 (±1.58) g/dl , 16.53 (±1.46) g/dl for males and 15.05 (±1.3) g/dl for females. There was no significant association between category of spo2 versus sex (p=.910), BMI(p=.580), female hgb category (p=.610) and male hemoglobin category (p=.861) individually. Fisher’s exact test done between age categories and spO2 categories, showed statistically significant association between the two variables (two-tailed p = .000) with lesser participants achieving spo2 of 95% and above as their age increases. Conclusion Majority of the sample population had spo2 with in the normal range proposed by WHO. In addition, the hgb profile also shows the majority of the participants had hgb value within the suggested normal cut offs. Thus, we share the previous thought of conclusion made on Ethiopians having yet undetermined adaptation mechanism for exposure to high altitude as there is no phenotypic effect on their spo2 or Hgb. Consequently, we can follow the already put forward cut off value for normal Spo2 as well as hypoxia when making medical decisions in treating our patients.Item Prevalence and Predictors of Diabetic Kidney Disease among Diabetes Patients in Diabetic Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross Sectional Study(Addis Abeba University, 2021-12) Berhanu, Amanuel; Zemenfes, Abel(MD, Consultant Internist and Nephrologist, Assistant Professor of Medicine)Background: Diabetes is the leading cause of CKD and ESRD in the worldwide. Diabetic kidney disease, one of which is Diabetic Nephropathy, is one of the common and significant complications in Diabetes Patients next only to cardiovascular complications. Many factors are thought to be associated with the development of DKD including older age, longer duration of DM, Poor Glycemic Control, Obesity. Dyslipidemia and HTN among others. Objective: The objective of this study is to assess the prevalence and predictors of Diabetic Kidney Disease in patients with Diabetes Mellitus in Tikur Anbessa Specialized Hospital. Methods: This cross-sectional study was done on 308 randomly selected Diabetic patients on follow up at Diabetic Clinic at Tikur Anbessa Specialized Hospital from July to November 2021. Structured questionnaire was employed to collect data on the sociodemographic, clinical and laboratory data of the study subjects. Trained physician data clerks collected data from the chart, interview and electronic medical records. Data was entered into EpiInfo 3.1 and was exported to SPSS version 25 for analysis. Descriptive analysis was done for all the cases. Ethical clearance was sought from the Institutional Review Board of the department of Internal Medicine, College of Health Sciences, Addis Ababa University. Results: One hundred nighty seven (64%) of the study participants are female. The mean age is 51.6 (95% CI= 41.0-62.0) years. Most (91.6%) of the study participants are from Addis and most of the patients have Type 2 DM (80.8%) and the remaining have Type 1 DM. Most of the patients have duration of Diabetes greater than 05 years (78.8%) and only 16 patients (5.1%) have duration of diabetes less than 01 year. Most (55%) of the study participants have a BMI in the overweight or obese category with mean BMI of 25.9 (95% CI, 22.7-28.9). Most of the patients have hypertension (57.5%) as a comorbidity. The prevalence of dyslipidemia in the study population is 77.6%. Our study found the prevalence of DKD in DM patients following at Diabetes Clinic of TASH to be 23.05%. Hypertension is the only significantly associated risk factor in this study. Conclusion: The results of our study show a high prevalence of DKD in Diabetes patients in Diabetes clinic of TASH. Our study also confirmed the high prevalence of other CVS risk factors including Hypertension, Overweight/Obesity and Dyslipidemia. Hypertension is associated with significantly higher risk of developing DKD in patients with DM.Item Knowledge, Attitude and Practice of Residents towards Patient Handover during Transitions of Care of Admitted Patients in Tikur Anbessa Specialized Hospital(Addis Abeba University, 2021-12) Lemma, Eyosias; Worku, Aschalew(MD,Consultant Internist, Pulmonary and Critical Care Medicine)Abstract Background: A patient handover refers to the transfer of care from one care provider to the next and involves three aspects: a transfer of information, responsibility and authority. Researchers and hospitals have been implementing different standardized models of handing over patients and giving trainings to their staff on how to use this models. Objective: To assess the knowledge, attitude and practice of residents currently doing their residency at TASH towards the effectiveness of currently implemented handing over system of admitted patients and use of standardized methods. Methods: A cross sectional survey was conducted which includes current residents at AAU, School of Health Science, using a structured questionnaire. Residents with previous attachment to the places where in-patient service is provided in TASH during the years 2018-2021 were included. The study was conducted from August 2021 – November 2021 G.C. They were provided with consent form to participate in the study and were asked to fill a structured questionnaire online. The data collection instruments was be coded and data was checked and entered using the software Microsoft Excel 2013. It was cleaned and edited accordingly and was exported to SPSS version 26.0 statistical package for analysis and checked for missing values before analysis. The Descriptive analysis was used frequency analysis. Result: This study showed that residents are knowledgeable (n=245, 90.8%) about the consequences of poor handover on patient outcome, however, they lack knowledge (n=245, 3.1%) when it comes to standardized methods of handing over patients. Their attitude towards the current method they are using to handover patients is not good as well (n=245, 72.7%). Rather they showed good attitude (n=245, 87.6%) towards change to a standardized and proper way of handover. They also feel positive about possible training of all residents on this standardized methods. When it comes to practice, this study showed a significant amount of residents reported as having poor practice (n=245, 42.5%). Recommendations and Conclusion: This survey has shown that poor handovers of patients during end of care are common in TASH and at times lead to bad patient outcome. It is therefore important to train and develop a system where standardized handovers are undertaken. Further studies can be done to compare if this new methods decrease the rate of patient harm as a result of poor handover.Item Assessment of Dyslipidemia and its Associated Risk Factors among Adult Type-2 Diabetic Patients on Follow up at Tikur Anbessa Specialized Hospital: A Hospital based Cross Sectional Study(Addis Abeba University, 2021-12) Addis, Wondwosen; Aberra, Theodros(MD,Endocrinologist &assistant professor)Background: Dyslipidemia is one of the major modifiable risk factors for cardiovascular diseases (CVD) in a type-2 diabetic (T2DM) patient. Dyslipidemia in T2DM patients is attributed to increased free fatty acid flux secondary to insulin resistance. Globally burden of dyslipidemia in diabetic patients is continuously increasing. Intensive management of dyslipidemia and its associated factors is required to prevent cardiovascular disease. Objective: The study was designed to assess the prevalence and associated factors of dyslipidemia among adult patients with type 2 diabetes at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Method: An institution-based- cross-sectional study was conducted from July 10 to November 10, 2021. A convenience sampling technique was used to recruit 208 T2DM patients. Data on socio-demographic characteristics, behavioral, and clinical factors were collected using a structured questionnaire through face to face interview. Anthropometry and blood pressure were measured. Laboratory data were retrieved from patients chart. Data was entered and analyzed using SPSS version 25. To identify determinant factors of dyslipidemia, bivariate and multivariate binary logistic regression analyses were done. Statistical significance was considered at the 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: The overall prevalence of dyslipidemia among study participants was 78.4%. Hypertriglyceridemia was found in 42.8%, hypercholesterolemia in 25.1%, high low-density lipoprotein in 30.3%, and low high-density lipoprotein in 36.5% study participants. Longer duration of diabetes &physical inactivity were significantly associated with dyslipidemia. Patients who have more than 10 years duration of diabetes had five times (95% CI, 1.24-20.149) more risk of dyslipidemia as compared with less than 5 years duration. Type2 DM patients who don’t perform moderate physical activity had nearly three times (95% CI, 1.077-7.767) increased risk of dyslipidemia as compared with those who perform 5-7 days moderate physical activity in a week. Conclusion: A high prevalence of dyslipidemia was found among T2DM patients in the study area. Physical inactivity and longer duration of diabetes were significantly associated with dyslipidemia among T2DM patients. Clinicians need to screen, treat, and educate diabetic patients about dyslipidemia and its associated risk factors.Item Breaking Bad News Knowledge and Attitude of Junior Physician Practicing at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.(Addis Abeba University, 2021-12) Mitiku, Tilahun; Dr.Merkebu, Ermias(Pulmonologist and Critical care specialist)Introduction: Breaking bad news to patients or discussing a serious case with a patient is part of the daily activity of many healthcare professionals and it is an inevitable clinical duty. In a Medical setting bad news is any information likely to alter drastically a patient's view of his or her future perspectives and vision of life. Effective communication skills of delivering bad news are very important to develop good patient-physician relationships. Objective; To assess the Knowledge, and Attitude of TASH Junior physicians about breaking bad news. Methods: An institutional-based cross-sectional study at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia from August to October 2021, and comprised 286 postgraduate residents of different specialties making a 98% response rate. Their knowledge and attitude were assessed by using a specifically-designed questionnaire based on SPIKES protocol. It is a six-step protocol of Setting, Perception, Invitation, Knowledge, Empathy, and Summarizing model. Data were collected through self-administered questionnaires and online surveys. The collected data were entered into Microsoft excel, then it was exported to SPSS of version 26.0 for analysis. Bivariate and multivariate analysis using logistic regression models was used to determine the association between different predictor variables with the dependent variable Results: Among 286 respondents, 201 (70.3%) were males and 85(29.7) were females and the mean age of the participants was 29.69 years (SD±2.205) years).98.3% of participants have been involved in breaking bad news, (37.1%) admitted bad experience in breaking bad news and 87.6% did not have any specific teaching or training on BBN. The mean and median score of the participants' knowledge about breaking bad news in this study was 5.94 (SD ± 1.100) and 6 respectively. Among participants, 70.3% had good knowledge, followed by a poor knowledge (16.4%) and a Moderate level of knowledge (13.3%). From self-reported breaking bad news skills majority of participants (57.7%) of participants were only fairly satisfied with their BBN skills. Conclusion Most of the participating physicians didn’t receive any training on BBN, a substantial number of residents didn't follow BBN protocol. Even though a majority of participants had good knowledge they had little satisfaction regarding their BBN skills Recommendation Education and training for trainees during their residency programs to improve their BBN skills should be considered and adoption of BBN protocolItem Evaluation of Leucocyte Esterase Reagent Strip Test for Rapid Diagnosis of Spontaneous Bacterial Peritonitis in Adult Cirrhotic Patients: A Hospital Based Cross Sectional Study, Addis Ababa, Ethiopia, 2021.(Addis Abeba University, 2021-12) Ahmed, Sebrina; Erkie, Mengistu (MD, Internist, Gastroenterology and hepatology); Birhanu, Yohannes (MD, Internist, Gastroenterology and hepatology)Introduction: Chronic liver disease is characterized by fibrosis and architectural distortion of the liver. Spontaneous Bacterial Peritonitis is the most common and fatal complication of liver cirrhosis. The standard diagnostic modality of SBP is costly, laborious, and most of all time consuming for resource limited set up. Hence, it is crucial to find an alternative easy, inexpensive and rapid diagnostic modality. Objective: To evaluate the use of leucocyte esterase reagent strip test in diagnosis of SBP among cirrhotic patients in two public and one private hospital in Addis Ababa, Ethiopia, 2021. Methodology: A facility based cross sectional study was conducted from August 15 to September 30, 2021 among adult cirrhotic patients at public and private health centre, Addis Ababa, Ethiopia. Data was collected through self-administered questionnaire and medical records. All patients had undergone paracentesis, and the ascetic fluid was processed for PMN, LERS and culture. The collected data was entered to SPSS version 26.0. Descriptive statistics was presented using tables and figures. Sensitivity, Specificity, PPV and NPP of LERS was calculated and association was assessed using Binary Logistic Regression where P-value and 95% CI for odds ratio are used for testing significance and interpretation of results. Result: Out of 94 study participants, 74 were males and the mean age was 47 9.4. The commonest cause of cirrhosis was HBV (36.2%) followed by ALD (26.6%) and HCV (21.3%). More than half (51) of the patients had CTP B, and 42 CTP C. Electrolyte disturbance, HE, and HRS were identified at a rate of 71.4%, 64.8% and 53.8% respectively. Of the 16 patients who died 11 were secondary to sepsis. SBP was diagnosed in 56 patients by ascetic fluid PMN count as compared to 51 detected by LERS test and 2 by ascetic fluid culture. At a cut off of 2 + , sensitivity, specificity, PPV, and NPV were 81.8%, 94.6%, 94.7%, and 81.4%. In comparison, at cut off level of 3 + ; sensitivity, specificity, PPV and NPV were 60%, 97.2, 92.3%, and 81.4% respectively. The overall accuracy of the test was 88.3% and the LDOR was 70. Conclusion: Our study demonstrated that LERS test is a simple, inexpensive, accessible, and sensitive alternative rapid screening tool for diagnose of SBP. Budget: Overall, a total of 80,500 Ethiopian Birr was utilized to accomplish the thesis work.Item Utilization of Post Exposure Prophylaxis among HIV Exposed Health Care Workers and Nonoccupational Exposure at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2017- 2021 G.C(Addis Abeba University, 2021-12) Teshome, Rediet; Amogne, Wondowssen(MD, PhD,Associate professor of Internal medicine)Background: -HIV is a major global public health issue, having claimed 38 million lives so far.Ethiopia is one of the most seriously affected countries in sub-Saharan Africa, with many people living with HIV/AIDS. HIV infection in health care facilities has become a significant health problem, especially in resource-poor settings.Health care workers are at risk of many diseases in health setups. There is a small but definite occupational risk of HIV transmission to health care workers. PEP is recommended to prevent the transmission of pathogens after potential exposure and further development of infection.If started soon after exposure, PEP can reduce the risk of HIV infection by over 80%.Although studies have found that awareness of PEP, no publication assesses utilization practice and subsequent follow-up in our institution. Objective: -To evaluate post-exposure prophylaxis (PEP) utilization among HIV-exposed health care workers and nonoccupational exposures at Tikur Anbessa Specialized Hospital (TASH)Antiretroviral Treatment (ART) clinic from January 1, 2017- July 30, 2021. Methods: -We conducted a retrospective cross-sectional study by reviewing the PEP registry book from January 1, 2017- to July 30, 2021, and follow-up data is collected by interviewing the exposed case. Data were entered using SPSS version 26, and descriptive analysis was done. Result: -A total of 353 cases of occupational and nonoccupational exposure were reported to the ARTclinic; PEP was prescribed for 352 subjects with an average of 77 subjects/year. The mean age of the study participant was 27.3 ±7., the majority (57.2%) was male, Most (86.7%) of the exposure was occupational, 27% of occupational exposure was reported by residents, followed by nurses 26.1%. Of the occupational exposure, 30.4% were from different wards, followed by emergency, OPD (17.1%), andoperatingtheater (7. 2%). Of nonoccupational exposure, 48.9% of cases were due to sexual assault. Most (42.7%) of the exposure risk type was EC2 code type followed by EC3 code type (37.6%). The source patient HIV status was unknown in 65.9% for nonoccupational and 30% for occupational exposure. Two drugs (TDF/3TC) regimen was prescribed for 87.8% of cases. Over 90% of the exposures were reported within 24hrs of the incident, and 45.2% of the exposed cases had an adverse reaction. No seroconversions were reported. Conclusion In TASH,the ART clinic risk assessment, PEP initiation followed the national occupational and nonoccupational exposures guideline. The type of regimen selected was a case-by-case analysis, and there was more PEP request among the occupational exposure during the months between July to December. Recommendation We recommend providers should follow the exposed individuals within 48 hours, and ongoing followup, either by telephone call or, if possible, in person, to assess PEP tolerability and adherence.Item Assessment of Knowledge and Practice of ICU Care Bundles in Infection Control among Physicians and Nurses Working in Three Governmental Hospitals (Tikur Anbesa Specialized Hospital (TASH),Yekatit 12 and st. Peter Specialized Hospital) Adult ICU,Ethiopia, 2021(Addis Abeba University, 2021-12) Teshome, Mulugeta; Dr.Haile, Tewodros(Consultant internist and PCCM)Background: Intensive care is a continuum of care from various source of admissions where patients‘ requiring a frequent evaluation and support to assure safe and effective outcomes. Mortality in intensive care unit (ICU) is a global burden which results in a huge loss of productivity and financial costs. In Africa, the ICU mortality rate is high compared to developed continents. ‗‗Evidence-Based Bundle‘‘ of care which involves 3–5 structured interventions help to reduce and prevent hospital acquired infections (HAI‘s). OBJECTIVE: To assess the knowledge and practice of ICU care bundles among physicians and nurses working in three government hospitals Adult ICU, Addis Ababa, Ethiopia 2021. METHODS: A cross-sectional descriptive study was conducted using a structured questionnaire and observational check list. Proportional sampling technique was used. Collected data was cleaned, coded and entered in to excel and SPSS version 26was used for analysis and descriptive methods such as frequencies, or proportions. A score of ≥ 60% is considered as knowledgeable or good practice. X 2 tests were used to look for association with P <0.05. RESULT: A total of 101 health professionals participated with the response rate of 96.2%. Of this 53 (52.5%) were nurses and 48 (47.3%) were physicians, majority 55 (54.5%) were from TASH, 64.4% of them were males and the mean age of respondents was 29.4 (SD ± 3.32) years. Regarding knowledge of ICU care bundles, 53 (52.5%), 69 (68.3%) and 79 (78.2%) were knowledgeable regarding VAP, sepsis and urinary catheter care bundle respectively. But 50 (49.5%), 64 (63.4%) and 68 (67.3%) were observed to have good practice of elements of VAP, sepsis and urinary catheter care bundles in their daily activity respectively. This study also showed that there is significant association between knowledge and practices (p < 0.001). DISCUSSION AND CONCLUSION: Even through nurses' and physicians‘ overall knowledge regarding ICU care bundles was good, the practice was inadequate and the health care workers do not implement the latest evidenced based bundle practices. So the overall knowledge and practice of ICU care bundles used for prevention of ICU infection was suboptimal.Item Management Profile of Rheumatoid Arthritis Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Two- year, Retrospective Chart Review(Addis Abeba University, 2021-12) Belay, Mastewal; Demelash, Birhanu (MD, Assistant Professor of Medicine)Background: Rheumatoid arthritis (RA), a chronic systemic inflammatory disease, predominantly affects the joints, leading to functional disability and premature mortality. Standards of care have been established for its treatment. Its management include early aggressive, and persistent use of disease-modifying antirheumatic drugs (DMARDs) to prevent joint damage in people with active inflammation. However, published evidence and guidance for its clinical management are lacking in resource limited countries such as Ethiopia. This research assesses whether care for RA is consistent with current treatment guidelines. Objective: To assess the management profile of RA patients who attended rheumatology outpatient care center of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia from January 1 st , 2018 to December 31 st , 2019. Methodology: A facility-based, cross-sectional study was conducted at rheumatology outpatient care center of TASH, Addis Ababa, Ethiopia. Data was collected using a structured checklist, and then entered and analyzed using SPSS version 26. Descriptive analysis employed to identify the management gaps. Tables and figures were used to present the results. Results: The study evaluated medical records of 314 RA patients. Their age ranged from 18 to 74 years with a median of 39.5 years and IQR of 30 to 51. Females dominated with a female: male ratio of 5.4:1. RF was positive in 62.1% and anti-CCP was positive in 73.1% of the tested patients. Methotrexate was included in the regimen of most (93.6%) of the patients and chloroquine in 67.2% of them. Overall, 48.7% were on combination therapy. And 85.4% were subjected to steroids for more than six months. Baseline investigations were suboptimal. Objective measures of clinical remission were used in only 17.5% of the total. Successful clinical remission was achieved in 75.8% of patients. Non-pharmacological treatments such as physical therapy and psychological counseling were only delivered to 6.4% and 1% of patients, respectively. Conclusion: Management gap of RA patients is a common observation in the study setting. The most frequently observed management pitfalls are suboptimal use of DMARDs, use of steroids for extended duration, and underuse of non- pharmacological therapy such as physical therapy and psychological support.Item Assessment of Knowledge and Practice towards Household Transmission Prevention among People with Chronic Hepatitis B Attending Liver Clinic at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia.(Addis Abeba University, 2021-12) Liban, Dida; Dr.Belachew, Hiwot(MD, Consultant Gastroenterologist and Hepatologist, Assistant Professor at Department of internal medicine)Background: Hepatitis B infection is a major global public health problem. Better disease related knowledge among Hepatitis B patients is important for prevention of transmission and facilitate screening of their sexual partners and household contacts. Objective: To assess the level of knowledge and practice of household transmission prevention among people with chronic hepatitis B attending liver clinic at Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A cross-sectional study among 229 hepatitis B patients visiting liver clinic for follow up service was undertaken in 2021. Data were collected using a structured interviewer guided questionnaires and analyzed using descriptive and inferential statistical methods in SPSS 26. Results: Mean age of respondents was 40 years, 68% were male, Mean total knowledge score was 11.1(79 out of 100) with 65% of respondents scoring ≥75 (defined as a high knowledge). In adjusted linear regression, age <40 years, presence of additional infected household members and disease duration >3 years were associated with higher knowledge score (R 2 = 0.106, F=8.936, P<0.001).Mean total practice score was 4.7 with only 38.6% of paticipants scoring ≥6 (defined as good prevention practice). In Adjusted logistic regression, factors associated with poor practice were; low level of education (OR: 5.218; 95%CI: 1.34-20.23; p=0.017), being on anti HBV treatment (OR: 3.582; 95%CI: 1.04-12.33; p=0.043) and duration of follow up at TASH <2 years (OR: 2.93; 95%CI: 1.14-7.55; p=0.025). Conclusion: Poor implementation of recommended prevention practices and misunderstandings about transmission were identified among chronic hepatitis B patients.