Pediatrics and Child Health

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Traige At the Pediatric Emergency Unit: Association Between Triage Level and Clinical Outcome
(Addis Ababa University, 2022) Mijwok Bachay; Muluwork Tefera
Background: Triage is a preliminary process of assessing Emergency to rapidly prioritize patients based on the level of their urgency and required treatment. A big challenge in pediatric triage is that children have a variety of presentations, and a critically ill child may appear stable and suddenly deteriorate. The Emergency Triage Assessment and Treatment (ETAT) protocol is widely adopted in low- and middle-income countries (LMIC) to reduce under five mortality and ensure the appropriate prioritization of care. However, few studies have examined whether triage level predicts clinical outcomes nationwide, and even less at Tikur Anbesa Specialized Hospital (TASH), the largest referral hospital in the country. This study seeks to address this gap. Objective: This research aims to study relationship between triage levels at the initial health care contact with clinical outcomes in TASH pediatric emergency. Method: In this retrospective cross sectional study of children age above 7 days to 14 years, data was gathered from eligible medical records using structured questionnaire and then coded and entered using Epi Data version 4. 6. The SPSS version 25 was used for both descriptive statistics analysis and multi-variable logistic regression analysis. Statistical significance was defined as a p-value less than 0.05, a 95% confidence interval. Results: A total of 405 patients who were triaged between November 2025 and January 2026 were studied. Over 91% of patients fell into the Red or Orange categories, Cases triaged as Orange, accounted for 293 patients (72.3%), Red were 77 patients (19.0%) and Green comprised the smallest group, with 35 patients (8.6%). Among Red (emergency) patients, 32 (41.6%) were discharged home, 38 (49.4%) were admitted to the ward, 1 (1.3%) required ICU admission, and 6 (7.8%) died. In contrast, Orange (priority) patients were predominantly discharged (183, 62.5%) patients were admitted to the ward (103, 35.2%), with only 3 patients (1.0%) requiring ICU care and 4 patients (1.4%) died. Green (non-urgent) patients 28/35 were discharged, with a smaller proportion admitted to the ward (7, 20.0%) and no ICU admissions or deaths. Conclusion: ETAT triage system strongly predicts outcome. While it is a reliable and clinically valuable tool in this context, optimal outcomes depend on both accurate triage and timely, system-supported clinical response.
Outcomes of Children with Acute Kidney Injury Admitted with Critical Illness to a Tertiary Hospital, in a sub-Saharan African country
(Addis Ababa University, 2025) Gustave Karemera; Damte Shimelis
Background: Pediatric acute kidney injury (AKI) is increasingly recognized as a major cause of morbidity and mortality among hospitalized children, especially in low- and middle-income countries. Limited diagnostic capacity and delayed recognition often contribute to poor outcomes. Despite growing attention to AKI in adults, data in the pediatric population remain sparse in sub-Saharan Africa. This study aimed to determine treatment outcomes, describe the clinical patterns of pediatric AKI, and identify determinants using the Phoenix criteria. Methods: A hospital-based cross-sectional study was conducted among 360 pediatric patients admitted to the tertiary pediatric intensive care units. Demographic, clinical, and laboratory data were collected using a structured checklist. AKI was diagnosed and staged using the Phoenix (KDIGO-based) criteria, which incorporate changes in serum creatinine and urine output. Data were analyzed using SPSS version 26. Descriptive statistics were presented as frequencies and percentages, and associations between AKI and potential determinants were assessed through bivariate and multivariable logistic regression. A p-value <0.05 was considered statistically significant. Results: The overall prevalence of AKI was 28%, with stage 1, stage 2, and stage 3 comprising 7.5%, 11.1%, and 9.4% of cases, respectively. AKI was most common among children aged 1–5 years and slightly more prevalent in males. Sepsis was the most significant determinant, associated with a more than twofold increased risk of AKI (AOR = 1.26, p < 0.001). Additional factors associated with AKI included hypotension, shock, use of nephrotoxic medications, and underlying malignancy. Among children with AKI, 63.5% presented with oliguria or anuria. The mortality rate among AKI patients was 45.4%, compared to 9.5% in non-AKI patients. Only 1.9% of those who met dialysis criteria received renal replacement therapy, reflecting limited access to specialized care. At discharge, 18.6% of AKI patients had fully recovered kidney function, whereas 32.1% showed residual renal impairment. Conclusion: Pediatric AKI is common in hospitalized children and is strongly associated with sepsis, hemodynamic instability, and exposure to nephrotoxins. The high mortality and low renal recovery rates highlight the urgent need for early recognition, improved fluid and sepsis management, and expanded access to renal replacement therapies. Strengthening hospital-based AKI surveillance and nephrology consultation systems could reduce preventable AKI-related deaths in children.
Treatment outcomes and Relapse determinants in Pediatric Acute Lymphoblastic Leukemia Patients Treated at Tikur Anbesa Specialized Hospital: A Retrospective cohort Study
(Addis Ababa University, 2025) Abdi Mulatu; Abdulkadir Mohamadsaid
Background: Acute lymphoblastic leukemia accounts for approximately 75% of childhood leukemias worldwide. The overall survival exceeds 90% in high-income countries. The Outcome in low- and middle-income countries remains suboptimal, including Ethiopia (10–40%). Relapse is reported in 25–35% of LMIC cases and is a major contributor to mortality. Predictors of relapse in this setting remain insufficiently characterized. Methods: A retrospective cohort study included children younger than 18 years with newly diagnosed ALL treated at Tikur Anbessa Specialized Hospital between 2020 and 2025. Overall and relapse-free survival were demonstrated with Kaplan–Meier survival analysis, predictors for death and relapse were evaluated with R using bivariate and multivariate Cox proportional hazards models at p < 0.05. Results: A total of 251 children were included (male: female (1.5:1); median age 6.2 years; median follow-up 20.1 months). At diagnosis, 52.2% were standard-risk and 47.8% high-risk; nearly half were undernourished. Immunophenotyping and cytogenetic testing were infrequently performed. Infections accounted for 42 % of deaths, mainly during induction. Treatment abandonment occurred in 11.2%. OS was 74.9% at 1 year and 54.5% at 4 years. Relapse occurred in 14.4%, predominantly in the bone marrow (36.8%), with RFS of 70.5% at 1 year and 45.9% at 4 years. Relapse had a dismal outcome with an OS of 32.9 at 3 years. Infants had higher mortality (AHR 4.58 vs >10 years; AHR = 11.1 vs 1–10 years), and treatment abandonment increased mortality 2.41-fold. High WBC strongly predicted relapse: >100,000/μL (AHR = 7.47) and 50,000–100,000/μL (AHR = 3.52) compared with WBC <20,000/μL. Conclusion: Survival and relapse outcomes in pediatric ALL patients in Ethiopia remain suboptimal, with infant age, elevated WBC, infection, and treatment abandonment driving mortality and relapse. Strengthening supportive care, early diagnosis, and diagnostic capacity is crucial for improving outcomes.
Magnitude , Associated Factors, and Outcome of Neonatal Hyperglycemia among Neonates Admitted To NICU At TASH : Cross Sectional Study
(Addis Ababa University, 2025-04-15) Ayalew, Tsion; Mekasha, Amha (Prof.)
Hyperglycemia in neonates is a common metabolic disorder among preterm and critically ill newborns, occurring in one-third of preterm and small-for-gestational-age (SGA) infants. Hyperglycemia is most common in extremely preterm infants during the first week of life, with prevalence rates between 20-88%; in very low birth weight (VLBW) infants, prevalence is 40-80%. Multiple clinical determinants contribute to increased risk, particularly preterm delivery, low birth weight, disease progression, bloodstream infections, hypoxic events, depressed APGAR results, surgical stress, and metabolic stressors. Acute consequences of neonatal hyperglycemia encompass fluid depletion, electrolyte imbalances, cerebral hemorrhage, and elevated mortality risk. Potential long-term sequelae involve neurodevelopmental impairments and vision-threatening retinopathy. Method:
Prevalence of Iron Deficiency and Iron Supplementation Practices Among Uncorrected Cyanotic Congenital Heart Disease Patients and its associated factors at the Pediatrics Cardiac Clinic of Tikur Anbessa Specialized Hospital; Hospital based Cross-Sectional Study
(Addis Ababa University, 2025-06-19) Manie, Yibeltal; Ahmed, Hayat (Ass. Prof); Hailu, Daniel (Ass. Prof)
Congenital heart disease (CHD) refers to a significant structural defect in the heart or major blood vessels within the chest that affects how the heart functions. According to EUROCAT registries, CHD affected approximately 8 out of every 1,000 births in Europe between 2000 and 2005, with cyanotic congenital heart disease (CCHD) making up 25% of cases. CCHD is characterized by the right-to-left shunting of desaturated blood, leading to decreased oxygen saturation in the systemic circulation. A common but often overlooked complication in children with CCHD is iron deficiency (ID), which can go undetected due to misleading high hemoglobin levels that mask the condition.
Prevalence, Risk Factors and outcome of Neonatal Acute Bilirubin Encephalopathy among Neonates Admitted to Neonatal Intensive Care unit in Tash and Gmh, Addis Ababa, Case Control Study, 2024/25 G.C.
(Addis Ababa University, 2025-04-05) Mente, Yoseph; Moges, Tamirat (PhD)
Acute bilirubin encephalopathy (ABE) is a clinical syndrome associated with bilirubin toxicity in the CNS, resulting in chronic and permanent sequelae. Despite ABE complications contribute to a substantial burden of neonatal deaths and several neurodevelopmental disorders in the country, there is limited study showing the prevalence and factors associated to ABE. Even the available limited studies were only showing the prevalence of jaundice rather than ABE
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 supplies
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-Sulfamethoxazole
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.
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.)
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 dialysis
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.
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.
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,.
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.
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.
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.
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.
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.
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 factors

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