Ethiopian Journal of Health Sciences

Yibeltal Siraneh — 2025-04-03

TABLE OF CONTENTS

Concern for the Health of Ethiopia's Elderly Population: A Call for a Comprehensive Geriatric Medicine Strategy

Woldesenbet Waganew Dode — 2025-04-03

Editorial message

Low Dose Contrast Enhanced CT Thorax Protocol: Comparison of Low Kilovoltage, Low Contrast Volume Using Iterative Reconstruction Technique with Standard Protocol

Cauvery Sirdeshpande — 2025-04-03

BACKGROUND: Computed enhanced computed tomography (CECT) of the thorax is an effective imaging technique for diagnosing lung diseases. However, the increased use of CECT thorax scans has raised concerns regarding cancer risk and contrast-induced nephropathy (CIN). The iterative reconstruction (IR) method, specifically iDose4, enhances image quality (IQ) and reduces artifacts at low doses (LD). This study aimed to evaluate the image quality (IQ) and radiation dose (RD) of low-dose, low-volume (LD-LV) CECT thorax with iDose4, compared to standard dose (SD) CECT thorax (iDose4).

METHODS: Group A consisted of 40 patients who underwent SD CECT thorax (120 kVp, 60 ml), while Group B included 40 patients who underwent LD-LV CECT thorax (80 kVp, 40 ml). All CECT thorax scans were performed using a 128-slice Incisive CT (Philips Healthcare Systems). A qualitative analysis of thoracic structures in both the lung and mediastinal windows was performed. Quantitative parameters, including Hounsfield units (HU) for the pulmonary artery (CTPA) and infraspinatus muscle (CTISM), noise (SD), and contrast-to-noise ratio (CNR), were also assessed. The Mann-Whitney U test and independent t-test were used to compare IQ and radiation dose between the two groups.

RESULTS: Qualitative analysis of thoracic structures in the lung and mediastinal windows revealed no significant difference (p > 0.001) between the two groups. Quantitative parameters, such as CTPA, CTISM, and CNR, showed statistically significant differences (p < 0.001), with higher values observed in the LD-LV group compared to the SD group. The effective dose (ED) was reduced by 65.2% in the LD-LV group.

CONCLUSION: Our LD-LV CECT thorax protocol using iDose4 demonstrated a significant reduction in effective dose and iodine contrast volume, while maintaining image quality and enhancing diagnostic confidence.

Impact of the COVID-19-Related Lockdown on Psychoactive Substance Consumption and Mental Health in Morocco

Salma AIT BOUIGHOULIDNE — 2025-04-03

BACKGROUND: The COVID-19 pandemic and its lockdown measures disrupted daily life globally, potentially impacting substance use and mental health. However, the effects in Morocco, shaped by cultural and social factors, remain underexplored. This study aimed to assess the impact of the COVID-19 lockdown on psychoactive substance use and mental health in Morocco, while identifying key socio-demographic determinants of these changes.

METHODS: A cross-sectional online survey was conducted in April 2020, with 1,001 participants who had used at least one psychoactive substance in the past year. Data on substance use changes, socio-demographic characteristics, and emotional states were collected. Chi-square and McNemar's tests were used for statistical analysis.

RESULTS: The results indicated a significant reduction in the consumption of tobacco, alcohol, cannabis, and other substances during the lockdown (p < 0.001). The main reasons for this decrease were health concerns (37.6%) and limited consumption opportunities (25.9%). Younger individuals (18–30 years), students, and those with lower incomes were more likely to reduce their use (p < 0.05). Furthermore, 71.3% of participants reported worsened emotional states, with worry (66.6%) and loneliness (52%) being the most common.

CONCLUSION: The COVID-19 lockdown led to a significant reduction in substance use in Morocco, mainly due to restricted access and lifestyle changes. However, it was also associated with worsened mental health, highlighting the need for culturally appropriate mental health support and harm-reduction strategies during crises.

Outcome of Renal Tissue Biopsy in Children and Adolescents Presenting with Features of Nephropathy at a Tertiary Hospital in Nigeria

Adedoyin Olanrewaju Timothy — 2025-04-03

BACKGROUND: Oedematous renal lesions are significant chronic kidney diseases in childhood, with causes that may vary, especially in light of emerging illnesses like coronavirus, environmental pollution, and climate change. This study aimed to determine the histopathologic characteristics of oedematous renal lesions in children seen at a tertiary health facility in north-central Nigeria between January 2010 and December 2023.

METHODS: This was a prospective study conducted on all children aged 2-18 years who presented with features of oedematous renal lesions between January 2010 and December 2023 at a health facility in north-central Nigeria. All eligible patients underwent renal biopsy.

RESULTS: A total of 66 children with oedematous renal lesions were biopsied, comprising 35 males and 31 females, with a male-to-female ratio of 1.2:1. The age range of the subjects was 2-18 years, with a mean ± standard deviation (SD) of 7.8 ± 3.8 years. Of the 66 patients who consented to the biopsy, the histological findings were as follows: Minimal Change Nephropathy (MCNS)(n= 35 ,53.0%), membranoproliferative glomerulonephritis (MPGN) (n=5, 7.6%), post-infectious glomerulonephritis (PSAGN) (n=3, 4.5%), and focal segmental glomerulosclerosis (FSGS)(n= 2, 3.0%).

CONCLUSION: This study shows that the predominant histopathologic characteristic of childhood oedematous renal lesions was MCNS in the cohort of children studied.

Challenges and Outcomes of Retinoblastoma Treatment in Ethiopia: A Case of Jimma University Medical Center, Southwest Ethiopia

Kumale Tolesa Daba — 2025-04-03

BACKGROUND: Retinoblastoma, the most common intraocular malignancy in children, presents significant challenges globally, especially in low-resource settings like Ethiopia. This study aimed to assess the challenges and outcomes of retinoblastoma treatment at Jimma University Medical Center from October 2015 to September 2022.

MEHODS: A retrospective study was conducted to evaluate the treatment outcomes of retinoblastoma patients. Statistical analysis was performed using SPSS Version 26, with variables summarized as frequencies, percentages, means, or medians.

RESULTS: A total of 43 children were treated from October 2015 to September 2022. The most common symptom recognized by caregivers was leucocoria (67.4%). Proptosis was the most frequent presenting symptom (53.5%), and delayed healthcare seeking was common. Diagnostic tools primarily included B-scan ultrasound (65.1%). Most children presented with advanced disease stages (Group D or E), requiring aggressive treatments such as intravenous chemotherapy (74.4%) and enucleation (23.8%). However, treatment adherence was poor, with high abandonment rates (55.8%) and incomplete chemotherapy cycles (81.3%). Metastasis occurred in 40% of patients, highlighting the aggressive nature of the disease. The mortality rate was 20.9%, mainly due to disease progression exacerbated by treatment interruptions. Challenges in follow-up and communication with remote patients further complicated outcomes assessment.

CONCLUSION: The treatment outcomes for retinoblastoma were suboptimal, affected by delayed presentation and inadequate adherence to treatment. This emphasizes the critical need for improved early detection programs, enhanced treatment adherence strategies, and strengthened healthcare infrastructure to mitigate the impact of retinoblastoma and improve treatment outcome in resource-limited settings like Ethiopia.

Evaluating the Efficacy of 0.5% Sodium Hypochlorite Disinfection for Microbial Control in Korle Bu Teaching Hospital's Burns and Plastics Unit

Collins Amponsah — 2025-04-03

BACKGROUND: The rise in nosocomial infections, also known as healthcare-associated infections (HAIs), has led to widespread illness and fatalities, affecting both patients and healthcare workers. This surge is a result of inadequate disinfection practices. We aimed to evaluate the efficacy of a 5% disinfectant on microbial contamination in the Burns Unit of Korle-Bu Teaching Hospital (KBTH).

METHODS: Swab samples were collected from surfaces such as working benches, door handles, sinks, taps, and trolleys in the Burns Unit of KBTH before and after routine disinfection. The samples were cultured on Blood agar and MacConkey agar. Standard bacteriological techniques, including Gram staining and biochemical tests, were used to identify the isolated bacteria. The isolates were then tested against prepared dilutions of the bleach disinfectant used in the Burns Unit. Additionally, the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of sodium hypochlorite against the isolates were determined.

RESULTS: Statistical analysis revealed no significant difference in microbial load before and after routine disinfection for most sampled surfaces (p > 0.05), except for air-exposed plates. The isolated organisms included Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus spp., Pseudomonas spp., Klebsiella pneumoniae, and Citrobacter freundii. While the working solution showed no inhibition zones, laboratory testing confirmed that a properly prepared 0.5% sodium hypochlorite solution was effective against all isolates.

CONCLUSION: This study found that the bioburden remained high after routine disinfection. A 0.5% sodium hypochlorite solution (1:10 dilution of the 5% stock) was effective in eliminating all isolates.

Factors Associated with Utilization of Modern Contraceptives among Female Undergraduates of Addis Ababa University Ethiopia

Eskinder Kebede — 2025-04-03

BACKGROUND: The prevalence of unintended pregnancy is very high in Addis Ababa. The lack of knowledge about modern contraception methods and poor utilization are the main contributing factors to the increasing prevalence of unintended pregnancies. In this study, we aimed to determine the level of and assess factors affecting the utilization of modern contraceptive methods.

Methods: An institution-based cross-sectional study was conducted at Addis Ababa University in 2022. A multi-stage sampling technique was used to select the students. Data were collected through a self-administered questionnaire and analyzed using descriptive statistics. Chi-square tests and logistic regression analysis were used to identify predictors of the outcome variable.
RESULTS: A total of 691 students were included in the study, with a mean age of 20.8 ± 1.3 years. More than half of the participants (56%) had ever taken sexual education lessons, and 114 (16.5%) were currently sexually active. The ever use of modern contraceptives was 19.4%, and the current use of modern contraceptives was 19.0%. Factors strongly associated with the utilization of modern contraceptives include participants' age (AOR: 0.176, 95% CI: 1.150, 4.117), field of study (medical school) (AOR: 3.501, 95% CI: 1.475, 8.309), being in the first and second year of study (AOR: 0.270, 95% CI: 0.133, 0.548), and having taken sexual education lessons (AOR: 3.413, 95% CI: 1.771, 6.579).
CONCLUSION: Modern contraceptive use is low (19.4%). This study found that age, field of study, year of study, taking sexual education lessons, and ever use of emergency contraception are strongly associated with the utilization of modern contraception among female undergraduate students. School health education should be emphasized.

Assessing the Perceived Attitude of Nurses towards Childbirth: Experiences of Rural Childbearing Women in Kwara State, Nigeria

Odebode Adeola Aminat — 2025-04-03

BACKGROUND: Childbirth is a crucial event in a woman's life, and healthcare practitioners are expected to approach the process with the appropriate demeanor. This study aimed to investigate the perceived attitude of nurses towards the child delivery process by childbearing women in Kwara State, Nigeria. Additionally, the study examined the influence of moderating variables such as age, educational attainment, and parity on the respondents' views.

METHODS: A descriptive survey with a mixed-methods approach was used. A total of 384 childbearing women were selected using simple random and purposive sampling techniques. The participants completed a researcher-designed questionnaire titled the “Perceived Attitude of Nurses Toward Child Delivery Process Questionnaire (PANCDPQ),” with the psychometric properties thoroughly verified. Ten willing participants were also interviewed using an Interview Guide. The data were analyzed using percentages, mean, standard deviation, and Analysis of Variance (ANOVA) at a 0.05 level of significance. Thematic analysis was applied to analyze the qualitative data.

RESULTS: The results indicated that childbearing women in rural areas of Kwara State, Nigeria, perceived nurses as unfriendly towards expectant mothers. They reported that nurses did not provide vital information, failed to give full attention to women in labor, and demonstrated a lack of competence during delivery. The interviews further revealed that nurses spoke recklessly to women in labor and shouted at them.

CONCLUSION: It was concluded that the perceived attitude of nurses towards the child delivery process by childbearing women in rural areas was inappropriate. It is recommended that nurses be trained on the perceptions of childbearing women regarding their attitudes towards childbirth. Health counsellors should collaborate with nurses to foster the development of appropriate attitudes towards mothers during childbirth, thereby improving service quality.

Magnitude, Pattern, and Associated Factors of Thyroid Dysfunction in Diabetic Patients at Debre Markos Referral Hospital in North- West Ethiopia: A Cross-Sectional Hospital-based Study

Melkamu Tilahun — 2025-04-03

BACKGROUND: Diabetes mellitus and thyroid disease are the two most prevalent endocrine disorders recognized in clinical practice in the twenty-first century. Diabetic patients with undiagnosed thyroid disorders are twice as likely to suffer from diabetic complications. The relationship between thyroid dysfunction and its risk factors in diabetic patients in Ethiopia is still being explored. We aimed to assess the magnitude, patterns, and associated factors of thyroid dysfunction in diabetic patients at Debre Markos Referral Hospital.

METHODS: The study involved 426 participants, selected using a systematic sampling procedure. Pregnant women, individuals with neck radiation exposure, and those who had undergone thyroid surgery were excluded. Measurements including weight, height, blood pressure (BP), fasting blood glucose (FBG), triiodothyronine (T3),thyroxine(T4), thyroid stimulating hormone(TSH), total cholesterol, and triglyceride levels were taken. Data were entered into EpiData 3.1 and exported to SPSS for analysis. Variables with a p-value of <0.25 in bivariable logistic regression were included in multivariate logistic regression. Variables with a p-value <0.05 in multivariate logistic regression were considered statistically significant.

RESULTS: Thyroid dysfunction was found in 102 (23.94%) of the respondents, with 29 (6.8%) diagnosed with hyperthyroidism and 73 (17.1%) with hypothyroidism. The majority of those with thyroid dysfunction (11.50%) had clinical hypothyroidism. Glycemic control, illness duration, blood cholesterol, and low-density lipoprotein (LDL) were significantly associated with thyroid dysfunction.

CONCLUSION: Thyroid problems were present in 25% of diabetic patients. Thyroid dysfunction was associated with poor glycemic control, long-term illness, high blood cholesterol, and low-density lipoprotein levels.

Adhesion Study of Pseudomonas aeruginosa on Different Urinary Catheter Materials

Yogesh B. Bele — 2025-04-03

BACKGROUND: Foley catheters, composed of various materials, can affect bacterial contamination, adhesion, and subsequent biofilm formation. Biofilm formation by Pseudomonas aeruginosa is a major virulence factor. As catheterization duration increases, so does the risk of contamination and biofilm adhesion. The aim of this study was to investigate bacterial adherence to different Foley urinary catheter materials.

METHODS: A total of 300 used urinary catheters were analyzed for bacterial contamination. The bacteria isolated from these catheters were studied for biofilm formation using the tissue culture plate method. Sections of new Foley catheters made of latex, polyvinyl chloride (PVC), and silicone were exposed to a high biofilm-forming strain of P. aeruginosa to determine which material was more susceptible to bacterial attachment and biofilm formation. The surface morphology of the catheter materials was analyzed using scanning electron microscopy (SEM).

RESULTS: Of the 300 urinary catheters, 270 were contaminated with various uropathogens. A latex Foley catheter became contaminated with P. aeruginosa at 72 hours, while PVC and silicone catheters were infected at 120 hours. SEM analysis revealed biofilm formation on the catheter surfaces.

CONCLUSIONS: Among the contaminated catheters, 49% contained P. aeruginosa, forming a consistent biofilm. Latex catheters were more susceptible to early infection compared to PVC and silicone.

The Burden of Out-of-Pocket Expenditure for Emergency Health Care Service in St. Paul Hospital Millennium Medical College, Addis Ababa Ethiopia

Woldesenbet Waganew — 2025-04-03

BACKGROUND: High burden of out-of-pocket health care expenditure is a known factor that affects universal access health care, in general and acute care more specifically. The aim of this study was to assess the burden of out-of-pocket payment in acutely ill patients in emergency department.

METHODS: A cross-sectional study was conducted by reviewing patient record visited St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia in study period. Data were analysed using SPSS Version 25. Descriptive statistics was used to summarize the finding.

RESULTS: A total of 22,982 clients were seen, with 388 eligible charts examined. Participants ranged in age from 15 to 100 years, with a mean age of 49.84 ± 18.21 years. The male-to-female ratio among participants was 1.3:1. Most participants were from Addis Ababa (52.8%), followed by Oromia (31.4%). Among the specified payment methods, out-of-pocket payments were the most prevalent at 35.8%, followed by community-based health insurance at 15.5% and government fee waivers at 13.7%.

CONCLUSION: Out-of-pocket payments were the predominant method of payment, followed by Community-Based Health Insurance (CBHI) and government waivers. Out-of-pocket spending consistently exceeded other payment methods across all age groups, both genders, various geographic regions, referral sources, and among individuals with comorbid conditions.