Ethiopian Journal of Health Sciences

Yibeltal Siraneh — Thu, 06 Feb 2025 00:00:00 +0000

TABLE OF CONTENTS

Increase in Cardiovascular Disease Mortality in Low- and Middle- Income Countries: A Time for Action

Thu, 06 Feb 2025 00:00:00 +0000

Editorial

Incidence of Neonatal Mortality and the Factors Influencing Neonate Mortality in Neonatal Intensive Care Unit in Northern Ethiopia: A Prospective Cohort Study

Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Neonatal mortality remains high globally, with an estimated 2.4 million neonatal deaths in 2020. In Ethiopia, neonatal mortality is particularly concerning. Despite some research, data on neonatal mortality incidence and influencing factors are limited. This study aimed to assess the incidence of neonatal mortality and identify factors affecting neonatal mortality in intensive care units.

METHODS: A prospective follow up cohort study was conducted in public hospitals in northern Ethiopia from October 2021 to May 2022, involving 334 neonates admitted to the intensive care unit. Systematic random sampling was employed to select participants, and data were collected through structured interviews and chart reviews. Data were analyzed using STATA 14, with a Cox model to calculate hazard ratios (AHR) and 95% confidence intervals (CI), considering statistical significance at P<0.05.

RESULTS: The neonatal mortality incidence rate was 23.21 per 1000 person-days (95% CI: 17.15, 31.41). Significant predictors of neonatal mortality included: no antenatal care (ANC) utilization (AHR: 3.69; 95% CI: 1.62, 8.42), a 5-minute APGAR score <7 (AHR: 0.38; 95% CI: 0.19, 0.77), prematurity (AHR: 0.34; 95% CI: 0.13, 0.90), and perinatal asphyxia (PNA) (AHR: 0.17; 95% CI: 0.04, 0.66).

CONCLUSION: The neonatal mortality rate was high. ANC utilization, 5-minute APGAR score <7, prematurity, and PNA were significant predictors. Healthcare professionals should prioritize these factors to improve neonatal survival in intensive care units.

Maternal Financial Autonomy as Predictor of Children’s Meal Frequency: Evidence from Jimma Zone, Oromia, Ethiopia

Jemal Abafita — Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Optimal meal frequency is a key factor in determining nutritional outcomes for infants and young children (6 to 24 months). While previous studies have emphasized household socio-demographics and healthcare utilization as major influences on child feeding practices, fewer have focused on intrinsic maternal factors such as financial autonomy. This study explored the relationship between maternal financial autonomy and child meal frequency.

METHODS: A cross-sectional, community-based study was conducted in Jimma Zone, Southwest Ethiopia. A multi-stage stratified sample of 572 participants was selected from three Woredas (Mana, Gomma, and Limukossa), stratified by semi-urban and rural areas. Data were collected through face-to-face interviews with women caregivers using a structured questionnaire. Maternal financial autonomy was assessed across four domains adapted from the Demographic and Health Survey (DHS) tool, while children's meal frequency was evaluated based on WHO Infant and Young Children Feeding (IYCF) recommendations. Multivariable logistic regression was used for analysis.

RESULTS: Among the mothers, 61.3% had the freedom to visit marketplaces, and 80.1% had the autonomy to purchase food. However, only 43.6% had autonomy over major household purchases, and 45.3% were able to work outside the home. Overall, 51.6% of the 548 mothers interviewed scored below half in the four autonomy domains. Over half (52.9%) of the children had suboptimal meal frequency. After adjusting for factors such as setting, family size, household head's sex, child sex and age, marital status, land ownership, wealth index, dependency ratio, and maternal education, maternal financial autonomy was strongly associated with improved child meal frequency (OR 5.90, 95% CI: 3.97 to 8.78).

CONCLUSION: Maternal financial autonomy was strongly linked to child meal frequency in the study area. Interventions should focus on enhancing women's control over resources in addition to addressing health and food security issues.

Assessment of Renal Function in Patients with Chronic Kidney Disease with and without Hypothyroidism

Pujitha Mallina, Vinay Rajan, Eswar Kumar, Gullipalli Prasad — Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Hypothyroidism is a common endocrine disorder with a bi-directional relationship to Chronic Kidney Disease (CKD), presenting a notable complication in CKD patients. This study aimed to explore the impact of hypothyroidism on kidney function in CKD patients.

MATERIALS AND METHODS: This study included 150 participants, with 110 CKD patients without hypothyroidism and 40 CKD patients with hypothyroidism. The participants were further categorized into stages 3, 4, and 5 based on their estimated Glomerular Filtration Rate (eGFR). They were followed for three consecutive months at intervals of 28 ± 3 days, 57 ± 3 days, and 86 ± 3 days. Clinical and demographic data, including age, gender, serum creatinine, serum urea, Blood Urea Nitrogen (BUN), eGFR, and serum sodium, potassium, and chloride levels, were assessed over time. Data analysis was performed using GraphPad Prism, with a significance level set at 0.05%.

RESULTS: In CKD patients with hypothyroidism, serum creatinine (P = 0.0002), serum urea (P = 0.0046), and BUN (P = 0.0042) levels were significantly higher, while eGFR (P < 0.0001) was lower compared to CKD patients without hypothyroidism. Potassium levels were significantly elevated in CKD patients with hypothyroidism (P = 0.0001), whereas no significant difference was observed in serum sodium (P = 0.0802) or chloride (P = 0.2089) levels.

CONCLUSION: This study concludes that CKD patients with hypothyroidism experience a more significant decline in kidney function compared to CKD patients without hypothyroidism.

A Comparison of Three Techniques in Neonatal Circumcision: Artery Forceps, Bone-cutter, and Gomco Clamp Methods

Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Neonatal circumcision is the oldest and most common surgical procedure The safety, ease, and outcomes of various methods of surgical procedures for neonatal circumcision have become increasingly the focus in the reviews of this procedure. This study aimed to identify the easy, safe and acceptable method for neonatal circumcision.

METHODS: This prospective study involved 357 male neonates, divided into three groups based on the methods used for neonatal circumcision: artery-forceps, bone-cutter, and Gomco methods. Clamps were uniformly applied for 7 minutes (420 seconds). The study assessed procedure time, primary and reactionary bleeding, and outcomes using the adapted Paediatric Penile Perception (PPP) score. Data were analyzed using SPSS version 23, with a p-value set at <0.05.

RESULTS: Each group consisted of 119 neonates. The bone-cutter method was the fastest (590.2 ± 60.14 seconds), while the Gomco method was the slowest (624.2 ± 55.16 seconds, p<0.001). Primary bleeding occurred most frequently with the artery-forceps method (37 out of 119), and least with the bone-cutter (p<0.001). Only the artery-forceps group had reactionary bleeding (p=0.018). The bone-cutter and Gomco methods had the highest PPP mean scores: 11.91 ± 0.390 and 11.87 ± 0.566, respectively (p<0.001).

CONCLUSION: The bone-cutter method is the fastest, safest, and produces the best cosmetic outcomes of the three methods studied.

Patterns of Trauma Presentation in Ilorin, Nigeria: A 15-Year Review

Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Injuries make up a significant portion of the emergency surgical patient load in most hospitals, representing a major public health threat. The burden of injury as a public health issue is especially pronounced in low- and middle-income countries, where injuries are responsible for up to 90% of mortality. Identifying common mechanisms of trauma and patterns of presentation can aid in identifying at-risk populations and in the development of targeted preventive protocols.

METHODS: From February 2000 to January 2015, a prospective observational study was conducted to examine the patterns of presentation and epidemiology of patients presenting to the surgical emergency department of a University Teaching Hospital. All patients who presented during these 15 years were enrolled in the study.

RESULTS: A total of 27,588 patients were admitted through the surgical emergency department during the study period. Of these, 18,374 patients (66.6%) presented with trauma, while the remaining 33.4% sought care for other surgical emergencies. Trauma patients were generally younger, with an average age of 30.27 years, compared to an average age of 41.33 years for those presenting with other surgical emergencies. Road traffic crashes accounted for the majority of injuries (65.3%), followed by falls (8.9%) and assaults (6.9%). The majority of patients (69.2%) were transported to the hospital by friends and relatives.

CONCLUSION: Injuries represent a substantial portion of the emergency surgical care demands in this setting. Road traffic injuries continue to be the predominant cause of trauma, with young adult males being the most frequent victims.

Connecting Emotional Intelligence with Academic Performance and Family Dynamics among Fresh Undergraduates in a Health Sciences University: Preliminary Findings

Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Emotional intelligence (EI) is vital in various life domains, particularly for new undergraduates in health sciences. The study assessed the prevalence and associated factors of above-average EI among fresh undergraduates in a health sciences university.

METHODS: A cross-sectional descriptive study was conducted at UNIMED Ondo, assessing socio-demographic characteristics, family dynamics, psychiatric morbidity, and EI through questionnaires. Data were analyzed with SPSS 21 from November 2023 to January 2024.

RESULTS: The prevalence of above-average EI was 92.9%. Respondents with married parents had significantly higher odds of above-average EI compared to those with non-married parents (odds ratio: 13.466, p < 0.001). Respondents who self-identified as academically "good" had 0.059 times lower odds of above-average EI compared to those who identified as "very good" academically (p < 0.001). The odds of above-average EI increased by one for each scale increase in monthly allowance (p = 0.034). Conversely, the odds decreased by 0.889 for each scale increase in Post United Matriculation Examination score (p < 0.001). The odds of above-average EI also decreased by 0.481 for each scale increase in the number of children the mother had (OR = 0.481, p < 0.001).

CONCLUSIONS: Fresh health sciences undergraduates demonstrated high EI, which positively impacted academic performance . Strengthening family systems is critical for enhancing EI.

Consequences of Population Ageing on Health Systems: A Conceptual Framework for Policy and Practice

Alireza Hajizadeh, Reza Hafezi, Fatemeh Torabi, Ali Akbari Sari, Maryam Tajvar — Thu, 06 Feb 2025 00:00:00 +0000

BACKGROUND: Population aging significantly affects the social, economic, and political landscapes of countries, including their health systems. This study aimed to develop a conceptual framework that illustrates the consequences of population aging on the functions and goals of health systems.

METHODS: This multi-method study consisted of four stages. First, the WHO-2000 framework for health systems was selected after a comprehensive review and consensus. Second, a systematic review identified the impacts of population aging. Third, an initial conceptual framework was designed. Finally, the framework was validated, completed, and finalized through semi-structured interviews.

RESULTS: The study identified 120 concepts related to the consequences of population aging, which were categorized within the functions and goals of the WHO framework. Key consequences for "stewardship" included adapting to demographic changes, modifying system design, and enhancing performance assessment. "Creating resources" faces increased demand, particularly for trained healthcare workers and geriatric care teams. "Financing" requires sustainable resources and strategic purchasing to address the higher healthcare costs associated with an aging population. "Service delivery" needs to focus on meeting the complex needs of older adults. The goals of health systems are also impacted, with implications for improving health outcomes, financial fairness, and responsiveness to non-medical expectations, including a client-oriented approach and respect for vulnerable older adults.

CONCLUSION: Adopting strategies and policies based on these identified consequences, coupled with effective implementation, will help policymakers manage the impacts of population aging within health systems.

Recto Sigmoid Sub-Mucosal Bleeding Due to Warfarin over Anticoagulation Presenting as Intestinal Obstruction

Fithanegest Teferra Gebretekle, Minyahil Zeleke Tesfaye, Tibebu Tesfaye — Thu, 06 Feb 2025 00:00:00 +0000

Patients on anticoagulation therapy, particularly those on warfarin, are at risk of gastrointestinal bleeding, gum bleeding, hematuria, and ecchymosis. However, it is rare for such patients to present with intramural or submucosal bleeding leading to intestinal obstructive symptoms. Sub-mucosal intestinal bleeding due to prolonged anticoagulant use is uncommon. Literature suggests that the duodenum and small intestine are common locations for anticoagulant-induced hematomas, occurring in approximately 1 case per 2,500 anticoagulated patients per year. However, intramural colonic hematomas are rarely reported. Spontaneous anticoagulant induced hematomas may develop as early as 10 days after starting therapy. We report the case of a 63-year-old female who presented with recto-sigmoid sub-mucosal bleeding causing obstructive symptoms. The patient was managed surgically with laparotomy, resulting in significant improvement, and was scheduled for follow-up to evaluate the feasibility of reintroducing anticoagulation therapy.

Alport Syndrome May contribute to Grand Multiparity in a Typical Low Income Setting

Victoria I Ogala-Akogwu, Peter K Uduagbamen, Emmauuel A Anteyi, Habib AGaladanci — Thu, 06 Feb 2025 00:00:00 +0000

Alport syndrome (AS) is a rare, inherited disorder affecting the basement membranes of the glomerulus, cochlea, and lens. It presents with visual and hearing deficits, as well as kidney disease, which can progress to end-stage renal failure and death. A 26-year-old male presented with a three-week history of body swelling, foamy urine, worsening hematuria, and hearing and visual impairments of 17- and 10-years’ duration, respectively. Three of his siblings (two males and one female) had similar symptoms. Molecular genetic screening, involving children from the two wives, identified a pathogenic mutation in the COL4A5 gene, confirming X-linked AS in the patient and his three maternal siblings. The patient underwent maintenance hemodialysis (HD), followed by two failed living-related kidney transplants, and died in his sleep a year after the second transplant, hours after a routine dialysis session.

Multiple deaths from AS within a family can contribute to grand multiparity, particularly in low-income settings.