Pediatrics and Child Health
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Item Prevalence and Outcome of Health- Care Associated Infection in Neonates Admitted to Neonatal Intensive Care Unit Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia.(Addis Ababa University, 2023-11) Sany,Elham; Abebe,Workeabeba(Prof.)Background: Health care–associated infections are infections acquired in the hospital while receiving treatment for other conditions. Healthcare-associated infection (HAI) is a serious problem in neonates who are admitted to the neonatal intensive care unit (NICU) because of impaired host-defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of their skin, use of invasive procedures and devices, and frequent exposure to broad spectrum antibiotic agents. Due to variations in definitions and reporting, the exact global burden of HAI cannot be accurately estimated. There exists wide variation in the bacteriological profile and antibiogram of microorganisms in different NICUs which changes consistently with time. Objective: To assess the prevalence and outcome of HAI in neonates. Study Setting: The study will be conducted in NICU of Tikur Anbessa Specialized Hospital, Addis Ababa from December 2023 to January 2023. Method: A hospital based retrospective cross-sectional study will be conducted on prevalence and outcome of HAI in neonates. A data collection sheet will be designed to include baseline and progress data for each admitted neonate who develops HAI. Data collection protocol will be prepared, and data collectors will be trained as per the protocol. After data cleaning and entry, analysis will be done using the Statistical Package for Social Sciences (SPSS). Descriptive and analytical statistics will be used as applicable. Statistically significant association will be taken for p values of <0.05. Work Plan and Budget: This study will be conducted from December 2023 to January 2024. This period will be utilized to finalize the research proposal, collect, and analyze the data. A total of 40,000 birr will be used to cover the costs for data collection and suppliesItem Prevalence of Breakthrough Urinary Tract Infection among Patient on Prophylactic Antibiotics for Recurrent UTI on Follow up atTikur Anbessa Specialized Hospital, Addis Ababa, Ethiopa.(Addis Ababa University, 2023-06) Merga,Gelassa; Getachew,Semhal(Dr.); Abebe,Bezaye(Dr.)Background: Urinary tract infections (UTIs) are the most common infectious diseases diagnosed around the globe, particularly in developing countries. It is one of the most common microbial diseases encountered in medical practice. Risk factor for Recurrent UTI can be Anatomic factors, toileting habits, constipation, and other factors may contribute to an elevated risk of reinfection. Vesicoureteral reflux (VUR), urinary obstruction, or bladder and bowel dysfunction (BBD) are some of anatomical factor that predispose to recurrent UTI. Objectives: To assess the prevalence of breakthrough urinary tract infection among patient on prophylactic antibiotics for recurrent UTI on follow up at Tikur Anbessa specialized hospital Methods: This study was conducted using a hospital-based Cross-sectional study design from August 2023 to January 2024 at Tikur Anbessa specialized Hospital Renal, Neurology and Pediatric surgical follow-up unit. The sample size required was 277. Data was entered into Statistical Package for Social Sciences version 25 (SPSS) for subsequent descriptive and analytical statistics where applicable. Statistically, a significant association was taken for a p- value of <0.05. Result: The overall prevalence of BUTI was 27%. The average age was 1-4 years of age and 74.2% were males. 35.3% of the male participant were uncircumcised. The most common indication for prophylactic antibiotic was CAKUT. 69.2% of the children were on prophylactic antibiotic for more than 12 months. 91.2% of the children in the study used trimethoprim- sulfamethoxazole as prophylactic. The most common etiology identified was E.coli (42%). Males that were uncircumcised, neurogenic bladder and urine WBC more than 5 were associated with increased risk for recurrent UTI. 37% of the organism that grew were resistant to more than 3 classes of antibiotics. 70% of the organisms that grew were resistant to trimethoprim- sulfamethoxazole. Conclusion: our finding revealed that there is significant burden of breakthrough UTI and uncircumcised male children, neurogenic bladder are higher risk for breakthrough UTI and there is high resistance pattern for the most commonly used antibiotic in our setup which is Trimethoprim-SulfamethoxazoleItem Assessment of Behavioral Abnormalities among children with congenital heart disease aged 4-14 years attending follow-up at Pediatric cardiac Clinic in Tikur Anbessa Specialized Hospital and cardiac center between October 2023-March 2024, Addis Ababa, Ethiopia(Addis Ababa University, 2024) Yak,Acheng; Ahmed, Hayat(Ass.Prof.)Background:Congenital heart disease (CHD)is a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. Congenital heart disease is one of the most frequently diagnosed congenital disorders affecting approximately 0.8% of live births worldwide.(Liu et al., 2019) Children with CHD are experiencing challenges throughout their development. They can be affected by several circumstances that may contribute to serious behavioral problems, which interfere with their normal development, socialization, or future life (Dahlawi et al., 2020). Objectives:The purpose of this study is to assess behavioral abnormalities among children with congenital heart disease aged 4-14 years on follow up at the Pediatric cardiac Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, from October 2023 to March 2024. Methods:A hospital based cross sectional study design was conducted among children with congenital heart disease aged 4-14 years attending cardiac clinic at TASH and their primary caretakers. A total of 231 selected patient were studied, pre- test questionnaire was used to assess socio-demographic characteristics, and Strengths and Difficulties Questionnaire (SDQ), was used to assess the behavioral problems, data were collected through ODK and analyzed using SPSS version 27 software package. Mean, median, mode and standard deviation were used to describe Continuous data; and frequency and percentage were used to describe categorical data. To identify factors associated with behavioral abnormalities Bivariable and Multivariable binary logistic regression analyses were done. Statistical significance was considered at level of significance of 5% (p-value 0.05). Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association. Result: the over all prevalence of behavioral abnormalities was 61% with a 95% CL. The prevalence of emotional symptoms was 17.7%, conduct problems 9.5%, hyperactivity 2.6% and peer problems was 38.5%. first birth order (AOR = 1.4, 95% CL, (1.15,8.72) , family size (1-4) ( AOR = 10.8 , 95% CL , ( 4.94 , 23.68) , cyanotic CHD ( AOR = 1.8 , 95% CL , ( 1.37, 2.88), present of pulmonary hypertension (AOR = 1.5 , 95% CL, ( 1.17 , 2.81) and if the child has a history of hospitalization or history of heart failure(AOR = 8.4 ,95% CL , (3.82 , 18.74) were more likely to have any form of behavioral disorder than their counterparts. Conclusion: the magnitude of behavioral abnormalities among children with congenital heart disease is significant. children with cyanotic CHD, present of pulmonary hypertension and previous history of hospitalization or history of heart failure are more likely to suffer from a behavioral and mental abnormality. we recommend children with congenital heart disease especially cyanotic CHD should be provided with better counseling services.Item What is normal infant body temperature during the era of digital thermometer? :An institution based cross-sectional observational study.(Addis Ababa University, 2024-01) Tarekegn, Almaz; Mekasha,Amha (MD, MSc, Prof.)Item Risk Factors Associated with Outcome of Peritoneal Dialysis and Hemodialaysis Done for Patient with Acute Kidney Injury in Tikur Anbessa Hospital Pediatrics Intensive Care Unit From January 2018 To Dec 2023.(Addis Ababa University, 2024-04) Tafere,Anteneh; Tefera,Muluwork(Ass.Prof.)Back ground: Acute kidney injury is an abrupt loss of kidney function that results in a decline in glomerular filtration rate, retention of urea and other nitrogenous waste products, and deregulation of extracellular volume and electrolytes The AKI is a serious condition, with a multi factorial etiology In numerous cases, and with variable mortality, reaching further than 60% in patient who took dialysis. Morbidity and mortality is especially high in sub-Saharan Africa where access to dialysis is veritably limited. Identifying modifiable risk factor associated with outcome of dialysis may improve the outcome Objective: - To identify the risk factors associated with the outcomes of HD and PD among patient with acute kidney injury at Tikure Anbessa hospital pediatric intensive care unit from Jan 2018 to Dec 2023 Method:-a retrospective cohort study will be conducted on risk factors associated with outcomes of hemodyalisis and peritoneal dialysis done for patient with AKI in TASH PICU from Jan 2018 to Dec 2023 with structured questionnaire to collect the data from the patients’ card. Data checked, gutted and Inputted into SPSS interpretation 27.0 software version for analysis. P values of (P <0.005) will be considered statistically significant. Paired t test was used to compare blood biochemistry before initiation and at the end of dialysis and Multinomial logistic regression was used to determine the relation between the different independent variables to final outcome. Results:-there were 30 children in this study Most of patient were male in 56.7% .Most of the cases who undertake peritoneal dialysis were less than 5 years (59.1%) whereas greater than 10 years for those who took hemodyalisis .The majority were from outside of Addis Ababa which is 24 (80%) . The highest cause of AKI was RPGN in 20 (66.6%) from this PSGN was the cause in 50% but the remaining cause of RPGN was not identified, followed by ATN and lupus nephritis each in (10%) HUS in (6.5%), malignancy and ATIN each in (3.3%).there is a statistically significant mean difference on serum BUN, creatinine and potassium before initiation and after the last dialysis with P value of (P< 0.001). In hospital mortality rate was in 40% and low urine output was significantly associated with mortality with P value of (P< 0.037). In these study most of peritoneal dialysis was done with locally prepared solution with Ringer lactate and Dextrose and Hemodyalisis was done on adult side. Complication encountered in 17 (56.7%) of patients from this 13 (60%) associated with peritoneal dialysis and 4 (50%) associated with hemodyalisis Most common complication associated with peritoneal dialysis were catheter leakage 6 (26%) then followed by catheter blockage 5 (21.7%) and peritonitis in 5 (21.7% ), omental herniation 2(8.6%), hyperglycemia 2 (8.6%) presence of complication was not associated with mortality with P value of 0.9 Conclusion:-our finding revealed that majority of pediatrics AKI patients had successful restoration of kidney function after dialysis which was comparable to other study. Low urine output at the end of dialysis was the independent predictor for death, which was supported by other study. In poor resource setting like in our country improvised peritoneal dialysis was safe and effective method to manage pediatrics AKI. It is recommended to have more trained medical staff in pediatrics Nephrology and extending PD service to other parts of the country. It is recommended to conduct well-structured prospective study including the other referral hospital in the country with adequate sample size to better assess the outcome of dialysisItem Assessment Of School Performance And Associated Factors Of Children With Congenital Heart Disease Attending Tikur Anbessa Specialized Hospital Pediatrics Cardiac Clinic Addis Ababa, Ethiopia 2024.(Addis Ababa University, 2024-03) Tedila,Asamirew; Mintesinot, Helen(Dr.)Background: The condition is known as a congenital heart defect (CHD) occurs when heart or the blood arteries surrounding it don't grow normally before birth. Biological and environmental risk factors contribute to the neurodevelopmental morbidity risk in children with congenital heart disease. The risk can be higher in setting like ours where timely surgical correction palliation and Periodic developmental surveillance, screening, evaluation and interventions guidelines lacks. In our setup the magnitude of the impact that heart disease has on school performance has never been estimated Objective: To determine school performance of children with congenital heart disease who are on follow up at TASH paediatrics cardiac clinic. Method: The study was a hospital based cross-sectional study conducted between September 2023 to January 2024 .For those willing participants structured questionnaire was administered to collect data. There were three sections to the questionnaire. The first section included basic demographic data. Inquiries to evaluate the child's medical status were included in the second section. Seven questions made up the third section, which evaluated the child's academic performance. After being examined and cleaned, the data was encoded into SPSS version 27.0 for analysis. Finally, the study result will be disseminated to each concerned body. Result: 140 children with CHD was participated .There were 65(46.4%)) males and 75 (63.6%) were females .the commonest non -cyanotic CHD was VSD and cyanotic lesion was TOF. Surgical correction were done for 33(23.6%). The rate drop out school withdrawal of children with congenital heart disease was 15.7 % (22 of 140) and 12.1% (17 /140) of students respectively. 48 (34.3%) of the subjects had a record of greater than 10 days of school absentee, The mean of the average score and SD of the participant in the past academic year was 74.65 ± 13.25 with 95% CI [72.34-76.96]. multiple ordinal logistic analyses showed that malnutrition and low maternal educational level were negatively associated school performance while few absent days and symptomatic treatment are positively related .But type of sex, CHD ,surgical correction, socio-economic level of the family show no relation with school performance Conclusion: The rate of drop out of school among children with CHD at TASH can be higher than the healthy children. The average of score of children with CHD is above satisfactory. Higher absent days as a result heart disease related symptoms malnutrition and low maternal education negatively affect the school performance of children with CHD.Item Assessment of Knowledge on Cardiopulmonary Resuscitation Among Pediatric Nurses in Tikur Anbessa Specialized Hospital(Addis Ababa University, 2024-02) Mohamed,Bahja Abdirahman; Tefera,Muluwork(Ass.Prof.)Background: -. The nurses, who are the first witnesses to the cardiac arrest patients, must implement cardiopulmonary resuscitation (CPR) to them at once, and the immediate implementation of CPR by the first witness is very important in enhancing the survival rate by raising the circulation recovery rate. Out of the factors that influence the nurse in providing CPR, knowledge and self-efficacy are factors that need to be noticed. Knowledge of CPR related to the standard of care and the effectiveness of CPR performance. Objective: - assess knowledge of cardiopulmonary resuscitation among pediatric nurses in Tikur Anbessa Specialized Hospital Methods: - all nurses working in pediatric department were included in the study. From these 20 were not included in the study due to annual, maternity leave and refusal. The total numbers of participants were 94 making the response rate of 81%. Data was collected by total enumerating (censes) method and the collected data entered in epi data version 4.2 and analyzed by SPSS version 25. After cleaning the data were analyzed by SPSS and the result were explained through graphs, tables and charts. To determine the associated variable 95% CI used and those having a p-value <0.05 stated as statistically significant. Result : - the knowledge levels shows that only 38 (45.5%) of those who scored good levels of knowledge and skill levels were calculated and shows that only 31 (33%) of those who scored on skill items good levels of skill. Year of the study participants and level of education were a statistically significant for level of knowledge on BLS using chi square test at p-value <0.05 and Year of the service of the study participants, sex and level of education were a statistically significant for level of skill on BLS using chi square test at p-value <0.05.Item Outcome and associated factors of mechanically ventilated Neonates among selected hospitals in Addis Ababa, Ethiopia; Cross -sectional Multi-center study(Addis Ababa University, 2024-03) Workneh,Betelehem; Shimelis,Damte(Prof.); Tesfaye, Melat(Ass.Prof.)Background: Neonatal mortality has a significant impact on global mortality, morbidity, economic cost, and hospitalization worldwide. Improving neonatal health through innovations in healthcare, such as mechanical ventilation, is vital for improving the well-being and lowering mortality rates among newborns. The most common indication for MV in NICUs was respiratory distress syndrome. Objective: To assess the outcome and associated factors of mechanically ventilated neonates admitted in three NICUat selected hospitals in Addis Ababa, Ethiopia 2023 Methods: A cross-sectional study was conducted to examine the outcomes and contributing factors for mechanically ventilated neonates admitted to Girum Hospital, Addis Hiwot Hospital, and Myungsung Christian Medical Center (MCM). Three private hospitals were chosen through a simple random sampling method, where a total of 160 mechanically ventilated neonates were identified during the study period. A univariate and multivariate binary logistic regression analysis was performed to examine the factors associated mortality of mechanical ventilated neonates. The results of logistic regression reported as adjusted odds rations (OR) with 95% confidence intervals and p-value < 0.05 are considered statistically significant Results: An analysis of 160 neonates requiring mechanical ventilation that 61.3% were male and 63.7% displayed preterm gestational age. The primary reasons for mechanical ventilation (MV) in this study was respiratory distress syndrome (RDS) being the most prevalent at 51.9%, followed by meconium aspiration syndrome (MAS) at 12.5%, and neonatal sepsis at 11.9%. The overall mortality rate of mechanical ventilated neonates was 24.4%. Moving to associated factors requirement of resuscitation(AOR=9.9(1.7, 58.5),p=0.011),extreme prematurity (AOR=61.7(3.3,1150.1),p=0.0006),DIC(AOR=13.1(1.6, 104.5), p=0.015),AKI (AOR=13.1(2.24, 76.9), p=0.004), MOF (AOR=246.9(14.4, 4242.8), p=0.0000) and pulmonary hemorrhage (AOR=16.7(1.9,145.9), p=0.011) emerged as the most statistically significant variables determining mortality of neonates on mechanical ventilator Conclusion: The commonest indication for mechanical ventilation in was RDS. Prematurity and disease-related complications were among the preventable factors contributing to mortality. Although the mortality rate of mechanically ventilated neonates is lower compared to similar studies in low and middle-income countries,.Item Clinico-pathologic profile and treatment outcome of children with nasopharyngeal cancer seen at pediatric hemato-oncology unit of TASH, Ethiopia(Addis Ababa University, 2024-04) Barkiligne,Bezawit Melaku; Hailu,Daniel(Dr.)Background: As an unusual disease in children, nasopharyngeal cancer has variable incidence among nations around the world. There are insufficient studies from non-endemic areas like ours and similar LMICs. It is usually diagnosed late in the more advanced stages of the disease. Histologic presentation and treatment outcome is especially different among children and yet therapeutic approaches have been extrapolated from guidelines made for adults. Objective: To assess the sociodemographic, clinico-pathologic profile and treatment outcome of children with nasopharyngeal cancer seen at pediatric hemato-oncology unit of TASH Methods: This is a cross-sectional descriptive review of pediatric patients who were treated for nasopharyngeal carcinoma at Tikur Anbessa Specialized Hospital. The hospital’s database and patients’ chart review was done to collect data on the diagnosis and management of NPC during the study period. All eligible pediatric patients who were on follow-up beginning from January 2018 to January 2024 were assessed for their clinico-pathologic profile and treatment outcome. A questionnaire was used to collect the clinical data including sociodemographics, clinical, radiologic and pathologic reports along with the treatment oucome. The data was entered into SPSS for analysis. The relationship between the independent and dependent variables was explained through chi-sqaure analysis. The overall and event-free survival of the patients was estimated using Kaplan-meier analysis. Result: Out of the 31 patients in the study, 61.3% were male with a M:F ratio of 1.6:1. Their ages ranged from 6-18 years with the median age of presentation being 14 years. The majority of cases came from Oromia region accounting for 38.7% of case. The major presenting symptom was neck mass (90.3%) followed by nasal congestion and epistaxis. The duration of illness upon presentation ranged from 8 weeks to 2 years with a median of 21 weeks. 64.5% of the patients presented with T4 stage disease. Undifferentiated histology predominated accounting for 77% cases. All patients were started with chemotherapy but only 58.1% could gain access to radiotherapy. There was significantly low overall and event-free survival at 3 years with 42% and 20% respectively. Conclusion: Nasopharyngeal cancer commonly presents in pre-adolescent and adolescent age groups with a unilateral or bilateral neck swelling. Most presentations are loco-regionally advanced and undifferentiated in histology. Treatment is via concurrent chemoradiotherapy with survival significantly lower than the developed world’s counterparts.Item Barrier’s and Enablers for the Implementation of Standardized Blood culture Specimen Collection in Hospitalized Children, TikurAnbessa Specialized Hospital, Addis Ababa, Ethiopia:Prospective Cross Sectional Study.(Addis Ababa University, 2024-03) Assefa,Elias; Abebe, Workeabeba(Prof.)Background: Clinical culture specimen collection plays a vital role in diagnosing and managing infectious disease in hospitalized children. Obtaining accurate and reliable culture specimens is crucial for guiding appropriate antimicrobial therapy and preventing the spread of infections. However, there is often a lack of standardization in clinical culture specimen collection practices, leading to potential barriers and challenges in obtaining high quality samples. Objectives: To identify the practice standardizing blood culture specimen collection and associated factors in hospitalized children at TikurAnbessa Specialized Hospital, Addis Ababa Ethiopia. Methods: This study was conducted using a hospital- based prospective cross-sectional study design from July 2023 – October 2023 GC. Descriptive statistics was presented with frequency tables and charts. Binary logistic regression model was used to assess the association between the independent variable and treatment outcomes. All statistical tests were significant at P-value less than 0.05. Result: In this study a total of 400 nurses were participated. More than half of them 233 (58.3%) were in the age group of 30-39 years with the minimum age of 26 and the highest age 44 years. The mean age of the study participants was 31.64 years with a standard deviation of 4.09. Only 104 (26%) with (95%CI, 21.8-30.3) blood collection specimen technique among the study participants was according to the standard. Those who had good understanding about the enablers and scored above the mean (AOR=1.68, 95%CI, 1.01-2.81) and those who had good understanding about the barriers and scored above the mean (AOR=95% CI, 1.75(1.04-2.95) were significantly associated with standardizing blood culture specimen collection practice. Conclusion and recommendation: According to the findings, several enablers and barriers negatively influenced blood collection practice according to the standard. To achieve successful increased awareness and efforts by the individual professional are necessary. However, facilities must facilitate for its achievement by providing adequate resources, clear task statements and follow up.Item Pediatric Resident Knowledge of Transfusion Medicine in Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, 2024(Addis Ababa University, 2024-03) Tadesse,Elias; Gidey,Abdulkadir(MD, Ass.Prof.)Background: One of the most often performed hospital treatments worldwide is blood transfusion. Approximately 5% of pediatric patients require transfusions at least once while they are hospitalized. Clinician’s knowledge about blood products and their preparation, storage, demands, doses and administration, may have profound impact on patient care and transfusion outcomes. Despite the frequent use of transfusion therapy in almost every medical field and potential risk, there is very little educational time in medical school and residency spent on transfusion medicine topics. Objective: - This study amid to assess Pediatric Resident Knowledge of Transfusion Medicine in Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, 2024. Methods: Hospital based cross-sectional study was conducted among 107 conveniently selected residents at study Hospitals from 16/10/2015 -16/01/2016 E.C. Knowledge of residents were assessed by a structured questionnaire adapted from different literature. Then the data was analyzed using SPSS version 25 software package. Descriptive summary statistics, One-Way analysis of variance (ANOVA) was performed to determine if there were any statistically significant differences between the mean scores for different subgroups and fisher exact test was computed, to check if there was statistically significant association between the knowledge level and explanatory variable. Statistical significance was considered at level of significance of 5% (p value <0.05). finally, the results were presented using text, table, and charts. Result: 107 pediatric residents in TASH participated in this study. Majority of the residents (80.4%) had good knowledge on diagnosing/treating acute hemolytic transfusion reactions. The average score was 34.7% with no statistically significant difference in year of residency. Conclusion: this study examined, using a validated, pediatric-focused assessment tool, transfusion medicine knowledge in a large sample of pediatric residents of TASH. The results demonstrated that many pediatric residents do not have adequate transfusion medicine education and knowledge.Item Quality of life and associated factors among caregivers of children with Down syndrome aged 6-month to 18 years and associated factors in Tikur Anbessa Specialized Hospital, Ethiopia(Addis Ababa University, 2024-03) G/meskel,Martha; Abebe,Workeabeba(Prof.)Down syndrome (DS), also known as trisomy 21, is the most common chromosomal disease in humans and is caused by an extra copy of chromosome 21. Given that children with DS frequently have significant morbidities, this can place an immense burden on their caregivers and negatively affect their quality of life (QoL). Even though there are a sizable number of children with DS in our setup, there are no studies that specifically address the burden that having a child with DS puts on these caregivers. Objectives: aim to assess the Quality of caregivers and associated factor among caregivers of children with DS. Method: A cross-sectional study design was used to assess different variables of QoL among caregivers of children with DS at TASH. Data was collected using the WHOQoL-BREF tool through a modified face-to-face interview, and chart reviews for a calculated sample size of 292. Mean and SD were used to present continuous variables. Frequency and percentage are used to present categorical variables. The analysis will be done using SPSS Version 28, ANOVA, independent sample t-test, and Kruskal-Wallis test were used to compare continuous variables among different groups. Multiple linear regression analysis was used to determine factors independently associated with different domains. Result Among the 285 included caregivers, the mean age was 37.8±7.99. Over half of caregivers were between 30-39 years old 155, (54.4%). The WHOQoL-BREF score findings in this study revealed that the mean scores for physical health and psychological domain were 53.43 and 58.05, respectively, which are relatively higher compared to the lower mean scores for Social relationship and Environmental domains which are 45.71 ±22.44 and 43.39 respectively. Caregiver education status, sex, household income and perceived severity of child illness showed significant association with the four domain of quality of life (P-value <0.05). Conclusion and recommendation:-This study revealed that caregivers of children with Down syndrome have a significantly compromised quality of life in all the 4 domains of QoL, particularly in social relations and environmental health domains. Poor economic condition, sex of caregiver, lower education level and perceived severity of their children’s illness are significant determinants of their QoL. This is indicative of the need for a coordinated care plan for children with down syndrome and their caregivers and we suggest further qualitative and case controlled studies to better define the kind of intervention these study group urgently requires.Item Time to Diagnosis and Factors Associated with Delayed Diagnosis in Children with Solid Cancer at a Tertiary Referral Hospital in Ethiopia: A Prospective Study(Addis Ababa University, 2024-09) Arega,Gashaw; Mohamedsaid,Abdulkadir( Ass.Prof.); Korones,David(MD)Background: Only one-third of children with cancer can survive in developing countries in Africa. Timely diagnosis, early treatment initiation, and access to cancer treatment are integral components of pediatric oncology to improve the outcomes of children with cancer. Objectives: The primary aim of this study was to assess the time to diagnosis (TD), and patterns of delay among newly diagnosed pediatric solid cancer patients and to investigate associated factors affecting time to diagnosis and treatment in a tertiary referral hospital in Ethiopia, Materials and Methods: This prospective study was conducted in the Pediatric Hematology and Oncology (PHO) unit, Department of Pediatrics and Child Health, Tikur Anbessa Specialized Hospital, Addis Ababa University from May 2023 to May 2024. All newly diagnosed solid cancers under the age of 15 were included in the study. The pretreatment diagnostic time intervals were classified into Time to Presentation (TP), Time to Referral (TR), Time to Registration (Tr), Time to Definitive Diagnosis (TDD), and Time to Diagnosis (TD) from the onset of symptoms and signs to the confirmed diagnosis at the oncology treatment center. The parental delay, referral delay, physician delay, health care system delay, treatment delay, and total delay, and the factors associated were also investigated. Results: A total of 250 children with solid cancers (excluding hematolymphoid cancers) were prospectively studied with a male-to-female ratio of 1.3:1, and 49.2% of children were between 1-5 years old. Central nervous tumors, renal tumors, retinoblastoma, and soft tissue sarcoma were the most common solid cancers accounting for 24%, 17.2%, 16.8%, and 15.2% respectively. The median times for TP, TR, Tr, TDD, and TD were 30, 30, 2, 5, and 99 days respectively. The median physician, healthcare system, treatment, and total time delay were 40, 5, 46, and 112 days respectively. The shortest total delay was seen in patients with germ cell tumors, neuroblastoma, and Wilms tumor, and the longest total delay was in patients with retinoblastoma, and endocrine tumors. About 63.6% of children with cancer had a referral delay to the oncology center of more than two weeks, and the factors associated were misdiagnosis of cancer and patient management for non-oncologic diseases. The longer time of diagnosis (TD) was correlated with parental education status (p=0.007), types of solid cancers (p=0.005), and sites of the tumor (p=0.003). Conclusions: Educating the caregivers, training about the symptoms and signs of childhood cancer presentations to the primary care physicians, and designing policies and strategies for early diagnosis, referral and treatment of childhood cancer are crucial for better outcomes.Item Identifying Factors Resulting in Delayed Diagnosis and Treatment of Pediatrics Retinoblastoma ,Addis Ababa, Ethiopia:Multicenter Cross-Sectional Study.(Addis Ababa University, 2024-09) Fikad,Getasew; Hailu,Daniel(Dr.); Bekele,Wondwosen(Dr.)Background: Retinoblastoma is the most common pediatric intraocular tumor, it is rare compared to other pediatric cancers, accounting for approximately 3 to 4% of all childhood malignancies. More than 60% of cases in low-income countries are advanced retinoblastoma, and mortality is significant due to delayed presentation, diagnosis, and treatment, with more than 50% of patients dying. This study determined the sociodemographic profile, clinical profile, diagnosis and treatment modalities, and factors affecting early diagnosis and treatment of pediatric retinoblastoma who were treated in TASH, St. Paulos, and Menelik specialized hospitals in Ethiopia from April 1, 2023, to June 30, 2024. Objective: The primary aim of this study was to identify factors resulting in delayed diagnosis and treatment of RB at Tikur Anbessa, St, Paulos, and Menelik specialized hospital, Addis Ababa, Ethiopia Method: A prospective multicenter study of all pediatric patients diagnosed with retinoblastoma at, Tikur Anibessa, St, Paulos, and Menelik the II specialized hospital, Ethiopia. All 111 newly diagnosed pediatric retinoblastoma cases were included in the analysis to establish the extent of presentation, diagnosis, treatment, delay, and associated reasons. Data was collected prospectively for those who fulfilled the inclusion criteria by using a semi-structured checklist questionnaire prepared from previous literature with amendments. The data was coded, cleaned, and entered into the SPSS version 26 software program, and analysis was done. The data was categorized and summarized with descriptive statistics, and univariate and multivariate binary logistic regression analysis examined the factors associated with the treatment delay of retinoblastoma. Logistic regression results revealed that adjusted odds ratios (OR) with 95% confidence intervals and p-value < 0.05 are statistically significant. Result: The analysis of 111 newly diagnosed pediatric retinoblastoma cases was conducted. Males accounted for 51.4% of diagnoses. The median age is 40 months for unilateral and 22 months for bilateral retinoblastoma. More than 59.5% of patients have a delayed time to treatment initiation. The median time before starting treatment was 6.2 months. The most prevalent reasons for delayed treatment were the guardian's lack of knowledge of the disease, delayed referral, and being so far from the treatment center. Moving on to associated factors for delayed presentation, diagnosis, and treatment of retinoblastoma, far residency from treatment (AOR=1.5, p=0.035), lack of caregiver awareness (AOR=3.64, p=0.044), and delayed referral (AOR =2.95, p=0.035) emerged as the most statistically significant variables determining total treatment delay. Conclusion: Results from our study show that more than half of the pediatric RB patients experienced a total delay of more than 6 months. Lack of RB awareness among guardians, referral delays, and travel challenges, were significant barriers to receiving timely care. As a result, there is an urgent need for high-level actions and an evidence-based approach to addressing determining factorsItem Structural and functional echocardiographic abnormalities in children pre- and post-kidney transplant in Cape Town, South Africa(Addis Ababa University, 2024) Tadesse,Handsome; Swanson,Lenise(MBChB); McCulloch,Mignon (MBChB,PhD); Nourse,Peter(MBChB,Phd); Coetzee,Ashton (MBChB); Morrow,Brenda M(PhD); Reddy,Deveshni(MBChB)Introduction: Cardiovascular manifestations of chronic kidney disease (CKD) include structural changes such as left ventricular hypertrophy (LVH) related to hypertension and fluid overload, vascular wall thickening, and calcification. There are also functional abnormalities such as systolic and diastolic dysfunction including - reduced ejection fraction (EF) and fractional shortening (FS), diastolic dysfunction, arrhythmias, and increased stiffness of vessels. The risk of these abnormalities worsens with a decreasing glomerular filtration rate (GFR). The best treatment for patients with kidney failure is kidney transplantation. Candidates are usually screened for cardiac abnormalities, and it is not uncommon to find echocardiographic abnormalities. It is important to study how patients with cardiac abnormalities on echocardiography (echo) do during and after kidney transplantation to optimize pre-transplant treatment, peri-transplant care, and short and long-term post-transplant care. Objectives: The objective of this study is to identify patients with KF who had structural and functional cardiac abnormalities on echo before kidney transplant and to determine whether these abnormalities improved or worsened post-transplant. Method: Single-center retrospective review of children with cardiac abnormalities on echo who had kidney transplants from 1st January 2018 to 31st Dec 2023 at Red Cross War Memorial Children’s Hospital (RCWMCH). Result: Thirty-two patients out of forty-three (74%) had echocardiographic screening within one year before kidney transplant. Out of these 15/32 (46.9%) had abnormal structural or functional echocardiographic findings before transplant. Of the abnormal echocardiography, left ventricular systolic and diastolic constitute 6/32 (19%) while 3/15(9%) had left ventricular hypertrophy. During the study period, a total of 5 patients died after transplant (11.6%). There was no significant difference in independent variables between survivors and those who died (P value>0.05). There was no significant difference between ejection fraction (p = 0.5) or shortening fraction (p = 0.4) pre- to post-transplant, in those who had paired samples (n=6) [using Wilcoxon signed rank test]. Similarly, there was no association between pre-transplant ejection fraction or fractional shortening and immediate graft functioning or graft rejection (p > 0.1). Conclusion: Our study showed that close to half of patients who had echocardiographic screening had abnormality. Left ventricular systolic and diastolic dysfunction were the more common compared to left ventricular hypertrophy.There was no significant difference between ejection fraction and fractional shortening on echocardiographic evaluation pre and post-transplant among 6 patients who had paired pre and post-transplant echocardiographic study.Item Pattern and Factors associated with Congenital Anomalies among NICU admitted Neonates in TASH: Case-Control study(Addis Ababa University, 2024-03) Asfaw,Hewan; Tesfaye,Edomgenet ( MD,Ass.Prof.)Background: Congenital anomalies have imposed a sizable burden on global mortality, disability and medical cost worldwide. Several studies have investigated the risk factors attributed to lethal congenital anomalies Objective: To assess pattern and associated factors of congenital anomalies, in neonatal intensive care unit, Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia 2023 Methodology: The case-control study was employed to investigate factors associated with congenital anomalies at Tikur Anbesa Specialized hospital. Cases included all newborns with congenital anomalies admitted to the ICU, while controls were randomly selected unmatched newborns without congenital anomalies. The normal distribution of continuous variables was assessed using Shapiro-Wilk test. The mean and standard deviation calculated for normality distributed data while median and interquartile range calculated for skewed data. A univariate and multivariate binary logistic regression analysis was performed to examine the factors associated Congenital anomalies. The results of logistic regression reported as adjusted odds rations (OR) with 95% confidence intervals and p-value < 0.05 are considered statistically significant. Results: An analysis involving 131 cases and 128 controls revealed that the median age of mothers stood at 28(±IQR= 6) years. Respiratory anomalies were identified as the most common, accounting for 21.4 % of the cases, followed by multiple congenital anomalies at 20.6 %, and gastrointestinal anomalies at 19.8 % of cases. After adjusting for all variables in the multivariate analysis, folic acid supplementation was found to have a significant impact on preventing congenital anomalies (AOR=0.58, 95% CI 0.3, 0.99, p=0.032). Further analysis of the data revealed that maternal age over 35 years (AOR=2.3, 95% CI 0.8, 6.5, p=0.12), maternal smoking (AOR=6.7, 95% CI 0.8, 58.1, p=0.08), a history of previous congenital anomalies (AOR=2.1, 95% CI 0.4, 11.8, p=0.4), exposure to environmental toxins (AOR=0.2, 95% CI 0.3, 3.8, p=0.78), maternal alcohol consumption (AOR=2.4, 95% CI 0.6, 9.6, p=0.21), and maternal chronic medical conditions (AOR=1.8, 95% CI 0.7, 4.4, p=0.23) were non-statistical positive association with congenital anomalies. Conclusion: Numerous factors have been linked to the occurrence of congenital anomalies. The pattern of these anomalies differed from those found in other local studies and global evidence, despite similar contributing and aggravating factors.Item Early treatment-related mortality and morbidity of children with non-Hodgkin lymphoma treated at Tikur Anbessa specialized hospital with modified ALCL protocol:Prospective Cohort Study.(Addis Ababa University, 2024-09) Nigusie,Mulualeme; Adam,Haileyesus (Dr.); Weitzman,Sheila(Prof.)Background: - Childhood non-Hodgkin lymphoma is a varied collection of malignant neoplasms that includes all lymphomas that are not categorized as Hodgkin lymphoma. It is the third most prevalent malignancy after leukemia and brain tumors. Over the last twenty years, significant improvements in chemotherapy combination, intensification, and supportive care have led to significant survival in high- income countries. However, in low- and middle-income countries, underlying malnutrition, delayed and advanced presentation, inadequate supportive care, and infection will all lead to poor overall outcomes and treatment-related early or late mortality; this study aimed to Assess, early induction phase treatment- related mortality and associated factors of children with non-Hodgkin’s Lymphoma treated at TASH treated with modified ALCL protocol. Methods: - A hospital-based Prospective cohort study design was conducted on a total of 50 children with confirmed non-Hodgkin’s lymphoma treated at Tikur Anbesa specialized hospital from March 2023 to June 2024. data were collected using a structured questionnaire and entered into Epi Data 3.1 then exported to SPSS for analysis. The categorical variables in the study were presented using frequency, and percentage, and compared between groups using the chi-square test. Multivariate logistic regression analysis, cox proportional hazard ratio, and Kaplan Meier analysis were performed to analyze the survival and factors associated with early treatment-related mortality. Results: the mean age at diagnosis was 5 years; abdominal swelling and constitutional symptoms like fever and weight loss were the common presenting complaints. Burkitt lymphoma accounts for 40% of the diagnosis and the majority of the patients present with advanced stage of the disease with elevated LDH (86%), and stage III/IV disease (92%). The majority of the patients had one or more oncologic emergencies at presentation the commonest being TLS (56%) and infection (32%). Infectious complications, hematologic toxicity, mucositis, and typhlitis were the commonly encountered chemotherapy-related toxicities and 24% of patients died during the induction phase. Conclusion: The induction phase of treatment resulted in a significantly high death rate (24%) for children and adolescents with NHL who were treated by the locally modified ALCL protocol.Item Magnitude, Risk Factors, and Outcome of Neonates Who Develop Sclerema Neonatorum at Tikur Anbessa Specialized Hospital and Gandhi Memorial Hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2024-04) Musa,Ibrahim; Deksiso,Handsome(Dr.)Background: The classic description of sclerema neonatorum (SN) is credited to Underwood, who described it in 1784 and appropriately termed it "skin bound disease." In 1817, Alibert introduced the term sclerema, derived from the Greek word skleros, meaning hard. Sclerema neonatorum is a disorder of the subcutaneous fat in debilitated neonates and is considered best as a sign of a poten- tially fatal underlying disease process and not a specific disease entity. Sclerema neonatorum is an uncommon severe panniculitis that manifests as a diffuse skin harden- ing in critically ill, premature, and low-birth weight infants. SN is a disease of the subcutaneous ad- ipose tissue. It is characterized by hardening of the skin that gets bound down to the underlying muscle and bone, hindering respiration and feeding and is associated with congenital anomalies, cyanosis, respiratory illnesses and sepsis. Objectives: To determine the magnitude, risk factors and outcome of neonates who develop sclerema neonatorum at TASH and GMH, Addis Ababa, Ethiopia in the year 2023/24 Methods: An institutional based, observational and cross-sectional study with prospective data col- lection. The study period was from 1st May 2023 to 31st January, 2024 at the NICU of TASH and GMH. Using single population proportion formula with a 95% level of confidence and 5% preci- sion the sample size required is 422 but due to the condition being rare convenience sampling method is used and all neonates who develop the condition during the study period were includ- ed. Data was entered into Statistical Package for Social Sciences version 26 (SPSS) for subsequent descriptive statistics where applicable. RESULT: A survey of 52 neonates who developed sclerema neonatorum, admitted to NICU of TASH and GMH was done, the majority 41(78.8%) of the neonates end up in death. nearly half of the neonates 29(55.8%) were 1500-2499 gm at birth. About one-third of neonates (34.6%) were born at gestational age of 34 – 36+6 weeks, and a quarter (26.9%) born at 32 – 33+6 weeks CONCLUSION: nearly three-fourth of neonates who developed sclerema neonatorum died from the condition. Since sclerema neonatorum is a devastating condition prompt diagnosis and quick intervention is of paramount importance.Item Prvalence and Associated Factors of Visual Impairment among Preschool Children in Selected Kindergarten Schools in Addis Ababa, Ethiopia: Cross-Sectional Study.(Addis Ababa University, 2024-03) Asmelash,Kirubel; Gebre,Hanna(Ass. Prof.); W.Gebreal,Girum(Ass. Prof.)Background: A child's vision provides valuable information about the surrounding world. The eye problem in Ethiopia is among the major public health challenges. The prevalence of low vision and blindness in Ethiopia is 3.7% and 1.6% respectively. The America Academy of Pediatrics in its Recommendations for Preventive Pediatrics Health Care recommends for Ophthalmological evaluation to be started from the age of 3 years up to 6 years. With much visual impairment being due to either preventable or treatable causes, early detection or correction of visual problems at an early age is important. Objectives: To determine the prevalence and the associated factors of visual impairment among preschool-age children in selected Kindergarten schools in Addis Ababa, Ethiopia from September 29, 2023- October 29, 2023. Methods: Cross-Sectional Study was conducted at selected preschools located in Addis Ababa. The total sample size was estimated to be 238. A multistage sampling technique was used to select study participants. Data was collected by trained data collectors using a structured questionnaire and physical examination. Data collected was checked for completeness, cleaned and entered into SPSS version 25 for analysis. Descriptive Statistics was computed in frequency tables. Correlation analysis and Binary Logistic regression was done to assess factors affecting visual impairment. P value < 0.05 is taken as statistically significant. Result: Among the 229 pre-school children who participated in this study 12 of them had visual impairment making the prevalence of visual impairment in the selected kindergartens to be 5.28%. Maternal alcohol use during pregnancy (AOR=8.529, 95% CI (1.51-48.02)) and abnormal pen light evaluation (AOR=18.932, 95% CI (3.85-92.89)) were found to be significantly associated with visual impairment. Conclusion: This study has shown that visual impairment is prevalent in pre-school children. It has shown that screening at this age as per the recommendations of the AAP can be beneficial with many of the visual impairments being due to either preventable or treatable causes,Item Prevalence of early onset neonatal sepsis in term prolonged rupture of membrane, associated factors and management practice in Tikur Anbessa Specialized and Ghandi Memorial Hospitals, Addis Ababa, Ethiopia:Institution Based Prospective Cross-Sectioal Study.(Addis Ababa University, 2024-02) Sechiw,Mandefro; Demtse,Asrat(Dr.)Background: Generally newborn babies are at higher risk of infection because of their weak immune systems related to their age. According to the World Health Organization, approximately four million neonates die annually with a global neonatal mortality rate of 23/1,000 live births . About a million of these deaths are attributable to neonatal infection. Prolonged rupture of membrane is one of the risk factors for EONS and it is more common in term pregnancy. However there was no study in Ethiopia about its association of EONS in term neonates. Objective: The overall aim of this study was to determine the prevalence of EONS in term prolonged rupture of membrane and associated factors at TASH and Gandhi memorial hospital Methods: Institutional based prospective cross sectional study was conducted among 319 selected newborns who were evaluated at TASH and Gandhi memorial hospital from August 1st 2023 to January 30th 2024 .Data was collected from patient history, physical examination, laboratory results and from chart review through a structured questionnaire. Data was compiled and analyzed using software Statistical package for social science (SPSS) version 26. Descriptive statistics were performed using frequency, mean and standard deviation. Bivariable and multivariable binary logistic regression were done to identify risk factors of EONS .Adjusted odds ratio with 95% confidence interval at a p-value<0.05 was declared as statistically significant. Result: About 278/ 319 (87%) of the mother were between the age of 20 to 35 years. Around 2/3 (76%) of mothers gave birth vaginally and in about 67 (21%) of cases C/S was done. Labor was spontaneous in about 88%. Most mothers 292(91.5%) delivered at hospital. Duration of labor was less than 20 hours in about 89% of cases. Most of the mothers (93%) took antibiotics for more than 04 hours before delivery. More than ½(58.6%) of newborns were male and 97% had normal birth weight. The prevalence of EONS was 32/319(10%). Tachypnea was the most common (87.5%) sign of sepsis. Around 2/3 (78%) of cases developed clinical manifestation with in the first 24 hours of life. Maternal fever (p value < 0.05 AOR, 73). Newborns with duration of ROM <24 hours was 87 %( 0.13(0.02, 0.80) less septic as compared to duration of ROM more than 72 hours. Conclusion: Maternal fever, prolonged duration of rupture of membrane and no maternal antibiotics administration was associated with early onset sepsis.so proper advice about rupture of membrane during ANC follow up and early prophylactic antibiotics admirations recommended.